A wide range of serious health problems disproportionately afflict individuals from economically disadvantaged backgrounds. These conditions, which reduce quality of life and shorten lifespan, include heart disease, stroke, diabetes, asthma, and cancer. Other health problems commonly associated with poverty are obesity, pregnancy complications, increased infant mortality, HIV/AIDS and dental disease. The U.S. Department of Health and Human Service's "Healthy People 2020," which sets 10-year national objectives for improving the health of the nation, has prioritized the need to close the gap in these "health disparities." There are numerous potential targets for improving the health of low-income people, such as improving nutrition and access to health care. In addition, accumulating research points to a need to improve sleep as means for improving alertness and daily functioning, as well as for reducing the risk of developing chronic diseases such as diabetes and heart disease.
Sleep disorders and sleep deficiency (akin to a vitamin deficiency, reflecting a lack of an essential ingredient for healthy functioning) afflict a high proportion of both children and adults. Notably, individuals from disadvantaged neighborhoods and racial/ethnic minorities are at increased risk for poor sleep and for sleep disorders due to a variety of environmental exposures, occupational and psychosocial conditions, and possibly genetic factors. As will be discussed next week by Drs. Buxton and Okechukwu, persons of color and from poor neighborhoods are significantly more likely to be sleep-deprived and to have poor sleep quality, which often leads to elevations in blood pressure, abnormalities in blood sugar, weight gain and obesity, and other health problems.
The sleep disorder sleep apnea is also especially common in minority groups and individuals from disadvantaged neighborhoods. This disorder occurs when the throat closes during sleep, resulting in snoring (vibration of the tissues of the throat as the air passages narrow and increase) and periods when breathing briefly but repeatedly stops ("apnea"=no breathing). These interruptions in breathing, which may occur hundreds of times during the night in individuals with sleep apnea, can lead to marked decreases in the body's oxygen levels, frequent awakenings, release of stress hormones, and marked spikes in blood pressure. These stresses, however, are not confined to the night, but also often lead to persistent physiological abnormalities that affect the cardiovascular and endocrine systems. In fact, sleep apnea results in a marked increase in risk for developing high blood pressure, heart failure, stroke, diabetes, abnormal heart rhythms (atrial fibrillation), and early death. Sleep apnea is also is associated with pregnancy complications. In children, sleep apnea is associated with elevations in blood pressure, a predisposition to diabetes, and behavioral problems such as attention-deficient hyperactivity disorder.
Why are minority and low-income people at increased risk for sleep apnea? The answer is not completely clear, but it appears that some of the risk is associated with elevated exposure to poor air quality due to environmental tobacco smoke and air pollution-factors that may cause chronic inflammation of the tissues near the throat. The increased risk is partly associated with higher frequencies of overweight, which itself may be a result of sleep deprivation, a cause of overeating. Sleep apnea tends to run in families, and it appears that genetic factors may also contribute to disease risk.
Despite the relatively high prevalence of sleep apnea in low-income populations, it is often under-recognized and inadequately treated in these groups. Recognition may be hampered when individuals do not receive regular medical care, when health care providers only focus on their patient's known medical problems and do not ask about sleep problems, when patients themselves do not recognize the potential dangers of their poor sleep and snoring and do not discuss these issues with their doctors.
Treatment of sleep apnea also is often inadequate in individuals with more limited resources. The "gold standard" treatment of sleep apnea involves using a device on a nightly basis that keeps the throat from collapsing (a CPAP machine). This treatment is highly effective, but often requires initial support from an experienced team of sleep specialists to make sure the device is properly fit for the patient, who may need to be supported while adjusting to this new treatment. This requires a solid partnership between the patient and medical team, which sadly, is less common for many low-income patients. Research indeed shows that use of prescribed CPAP is often suboptimal in minority and low-income patients. Thus, it is likely that large numbers of patients with sleep apnea are left undiagnosed and/or untreated for a treatable condition that can have profound health effects.
Recognizing the importance of this emerging public health issue, this past June, Harvard University and its partner institutions sponsored a symposium "Sleep Health Disparities: Opportunities to Improve the Health of the Community" to bring together experts in health disparities research, sleep medicine, population health, community outreach, and environmental science to foster new dialogue, consider emerging questions, and identify important next steps to move forward the field of sleep health disparities. Presenters and participants explored the mediating role of sleep disorders in health disparities, potential mechanisms linking sleep disorders to chronic health conditions, and barriers to clinical recognition and treatment of sleep deficiency and sleep disorders in disadvantaged populations. Participants endorsed a need to better identify the determinants of poor sleep in low-income populations, including focusing on risk factors operating in households and the work place and behaviors that influence parents and their children. The consensus: a clear need to improve recognition of sleep apnea by primary care providers and to understand how to best support treatment in minority and low-income populations.
This post is part of the HuffPost Shadow Conventions 2012, a series spotlighting three issues that are not being discussed at the national GOP and Democratic conventions: The Drug War, Poverty in America, and Money in Politics.
HuffPost Live will be taking a comprehensive look at the persistence of poverty in America August 29th and September 5th from 12-4 pm ET and 6-10 pm ET. Click here to check it out -- and join the conversation.
Susan Blumenthal, M.D.: The Weight of the Nation
I have asthma from second hand smoke, but not sleep apnea. Both my husbands smoked. I never had asthma in childhood or early adulthood.
My boyfriend does not smoke. I finally realized what I needed to avoid.
http://www.livingfithealthyandhappy.com/2012/06/pollution-makes-asthma-worse-for-obese-adults.html
Although it is unlikely that people living on fixed incomes will have the funds to purchase air filters, they can take other steps, notably to avoid cigarette smoke.
Obesity and overweight also disproportionately affect lower income people, and obesity is a risk factor for sleep apnea. In that case, people tend to buy foods that are high in calories but low in nutrients. Even in this case, if government agencies and community leaders work with the public i.e. teaching them how to buy the healthiest foods with their limited finances, it would make a difference.
Sleep disorders affect higher cognitive function, people are more likely to make mistakes when they lack sleep. A study on the link between lack of sleep and poor academic performance underscore this fact.
http://www.livingfithealthyandhappy.com/2011/09/good-sleep-hygiene-can-improve-your-academic-performance-research-study-finds.html
The poor are at a severe disadvantage because they lack the resources of the middle and upper classes. Nonetheless, people have a responsibility to take care of themselves. They must learn the facts about these disorders and take proactive steps to protect their health.
-healthy_blogging
http://www.livingfithealthyandhappy.com/2011/06/how-to-use-social-media-tools-on-this-website.html
- healthy_blogging
I was diagnosed with acute sleep apnea and got a CPAP machine and I instantly noticed the difference. Now I sleep through the entire night without waking up when before I would wake up several times during the night. My blood pressure dropped immediately. Now when I wake up I yawn and stretch. Before I had to drag myself out of bed.
In terms of the economic aspect of it, without health insurance, the poor nor the middle class can afford the treatment, diagnosis or maintenance. My insurance company was billed $3500 for a two night study and a machine. Who can afford that out of pocket?
No wonder you have a sleep disorder.
I don't know much about sleep apnea (you are right), however I do know about being poor and having nutritional food available. Healthy food is available and affordable -- we just need to learn to choose it, serve it, . . . love it. We need to learn to be informed and choosy consumers. What we can't afford is POOR HEALTH -- That is expensive! We need to understand that our health is in our choices. We all choose what comes into our homes, what is served on our tables, what foods color our plates . . . what NUTRITION goes into our mouths . . . our bodies. All of us, minorities or not, cannot keep playing the VICTIM card -- we choose our food . . . by choosing our food we are choosing and impacting our health (MOST -- not all -- health issues . . . maybe not sleep apnea . . . are based on nutrition). Bottom line: Food is related to health. Healthy food is affordable . . . it is more affordable than MEDICAL BILLS. Everyone should learn that . . . take it to heart . . . take it home . . . and EAT FROM THE RAINBOW and HEAL-THY SELF.
You must not food shop at all cause if you did you'd know the skyrocketing prices of food and that "healthy" food is generally way more expensive than junk food.
Well, not to worry, soon there will be a lot of company in the same situation unless we stop spending so much money.
The 2 men I know that have been diagnosed with sleep apnea and given this mask to wear at night, are retired, very wealthy, have multiple homes, private insurance and never hunger for a meal.Not part of the study and both sleep in separate rooms from their wives, and don't even use the mask as it's too confining.
"How socioeconomics impacts treatment and proper diagnosis"...Go fiqure.
There doesn't appear to be a solution these studies can put fourth to actually help. If the link exists.
There are those too, that have had severe trauma, and cannot work because of the damages, but went to great lengths to repair the physical, psychological, then had to file for disability because of the inability to work due to medical maladies gone catastrophic, but learn to live within their means.
It frightens me the people who live in the streets and have lost everything, that couldn't get help quickly enough to even give them the hope of having a roof over their head or a proper meal. I have met some who are quite helpless and some who cannot be helped. It does not appear that any of those I've met have a problem with sleep apnea
One researcher described OSA as a condition inconsistent with human evolution. It is obviously not a natural condition occurring over the eons of human existence. Why? The daytime fatigue and other maladies associated with OSA would have long ago put sufferers at such a disadvantage that those inclined toward it would have died out. And if loud human snoring were epidemic in paleolithic times and during the vast bulk of human evolution, every prowling leopard and lion in East Africa would have long since zeroed in on every loudly snoring human at night and eaten him or her.
I know many patients for whom CPAP's have been prescribed, and only a tiny minority use them regularly and long enough for benefit. Yet OSA sufferers face a vicious cycle, where OSA makes them more obese and obesity makes OSA worse. CPAP is an adequate stopgap if tolerated, but a lean and fit body mass is the best answer.
Besides, I have less migraines now. That alone is worth using anything that helps!