Numerous studies have shown that the incidence of hypertension, obesity, type 2 diabetes, stroke, and heart attack is highest in the African American community. Several studies have revealed findings that might in part explain this difference. However, the most interesting and logical explanation seems to revolve around sleep. In fact, in this month’s journal Sleep Medicine Reviews an extensive analysis of this very important topic was published. In the following, I will utilize several points made in this review, as well as other studies that have been published recently.
We know that African American women have the highest incidence of hypertension in America. We also know that blood pressure drops 10 to 20% when we sleep. This is referred to as nocturnal dipping and has a lot to do with keeping our blood pressures normal. However, in several studies a significant proportion of African American women, as much as one third, fail to show this dip while sleeping.
Other studies have shown that African American men and women are more likely than their Caucasian counterparts to develop hypertension and obesity when they sleep less than seven hours. This is important because several recent studies have shown that on average African Americans sleep less than Caucasians or Hispanics. This disparity is even more prevalent in the group that sleeps less than six hours.
In the case of sleep apnea, a major cause of diabetes, hypertension, and stroke, there are also racial differences. Although the incidence of sleep apnea appears to be similar, the severity of the disease as judged by the number of events per hour is worse on average in African American males than their Caucasian or Hispanic counterparts.
As a result, what can we to learn from these studies? I believe that health care providers, researchers, and the general public need to be aware of the effects of sleep on health. Nowhere does this seem to be more important than in the African American population. We as physicians need to be more vigilant about enquiring about the sleep habits of our patients. Questionnaires about sleep should become a routine part of primary care. I think this would go a long way to improving the health of our patients. This would seem to especially apply to our African American community.
