Association of Sleep Health, Acculturation, and Acculturative Stress in South Asians Living in the U.S.

Background: Poor sleep is associated with increased risk of cardiometabolic diseases and other chronic illnesses. Various racial/ethnic minority populations in the U.S. have shown suboptimal sleep. Acculturation and acculturative stress have been negatively associated with minority immigrants’ health, but their role in sleep health remains unclear for many racial/ethnic groups, including South Asians. The fastest growing population in the U.S., South Asians have a greater burden of cardiometabolic diseases. Acculturation is a known contributor to the increased cardiometabolic disease risk, however the sleep health status of South Asian Americans and the role of acculturation in their sleep remains unclear. Objectives: This study aimed to (a) synthesize knowledge on influences of acculturation and acculturative stress on immigrants’ sleep health in the U.S. and (b) identify sleep health characteristics and risk for sleep disorders in South Asians, and to examine the relationship of sleep health with acculturation and acculturative stress. Methods: A scoping review was first conducted using Arksey and O’Malley’s framework, and results from 16 research articles were synthesized. Subsequently, a descriptive correlational study was conducted using a convenience sample of 150 South Asian Indian or Nepali adults. Data were collected by online survey or telephone interview and were analyzed using multiple regression. Results: The scoping review indicated that immigrants have sub-optimal sleep health, and that acculturation and acculturative stress may be influencing factors. The primary research study showed that approximately 41% did not meet the recommended 7 to 9 hours of sleep per night. Overall, 42% of participants reported poor sleep quality, and up to 17% were at risk of sleep disorders. Individuals with high acculturation tended to have shorter sleep duration. Poor sleep hygiene and depressed mood were negatively associated with sleep quality, insomnia, daytime sleepiness, and obstructive sleep apnea risk. Conclusions: Greater acculturation showed significant association with shorter sleep duration. Also, high acculturative stress may increase obstructive sleep apnea risk, however use of better sleep measures are recommended to improve accuracy of sleep apnea risk. Poor sleep hygiene and depressed mood play key roles in the sleep health of this South Asian Indians and Nepalese sample. Researchers should examine the role of sleep variability in acculturation and should involve underrepresented immigrants, including other South Asian groups, to better understand the sleep-acculturation relationship. Mental health and health behavior assessments should be emphasized in treating patients with sleep problems.