اثر عوامل استرس زای روانی-اجتماعی و وضعیت اجتماعی-اقتصادی در خواب در میان نوجوانان مبتلا به آسم The influence of psychosocial stressors and socioeconomic status on sleep among caregivers of teenagers with asthma, the Puff City study

Introduction The American Academy of Sleep Medicine recommends that adults sleep 7 to 8 hours for optimal health and performance1 ; however, only 65% of adults in the United States adhere to this recommendation, with an even lower prevalence of 54% among African Americans.2 Caregivers tend to have shorter sleep duration, poorer sleep quality, and a higher prevalence of sleep disturbances compared with noncaregivers.3–7 Short sleep duration and disturbed sleep are associated with mood, accidents, and negative health outcomes including obesity, hypertension, diabetes, cardiovascular disease, and all-cause mortality.8,9 It is important to identify the factors contributing to poor sleep among caregivers to improve their quality of life. Caring for a child with asthma or a chronic illness is associated with a higher exposure to psychosocial stressors (depression) and poor health,10,11 which is associated with poor sleep.12–14 To our knowledge, few studies have specifically focused on the sleep of caregivers of children with asthma.6,15,16 Caregivers of children with chronic illnesses such as asthma may have disturbed sleep due to nocturnal caregiving or stress due to the challenges of caregiving,6,15,16 which may be influenced by stressors that are due to socioeconomic status (SES).17,18 However, these factors are understudied. Another limitation of this literature is that the vast majority of the prior studies were conducted among non-Hispanic White populations.6,15 Associations may be different in African Americans given the high prevalence of poor sleep,19 the greater exposure to psychosocial stressors, and the likelihood of living in low-socioeconomic environments.12,19–23 Prior studies have shown that psychosocial stressors and neighborhood factors contribute to poor sleep, particularly among African Americans.12,22,24 For example, in a study of African American adults, participants with higher stress slept on average 33 minutes less than those reporting less stress.12 The prior study focused on general stressors, as opposed to understanding the influence of specific stressors such as anxiety, worry, or depressive symptoms. Additionally, asthma is a highly prevalent condition among African American children, with striking racial disparities in morbidity and mortality.25 As a result of the higher prevalence of asthma among African American children,26 psychosocial factors may be particularly pertinent to African American caregivers and may help to identify a population that may be at increased risk for poor sleep.