Sleep disorders are a significant contributor to racial health gaps and if we could treat them then there would be reduction in health disparities.
What they found was a community unfamiliar with sleep health and hesitant to undergo lab tests. One of their studies tracked 421 black patients who were referred to get tested for sleep apnea. Just 38 percent showed up to get a diagnosis (even though all were called by the doctor to remind them of their appointments). Of those 38 percent, nearly all received a positive diagnosis. Many of those referred for sleep tests were obese, hypertensive, and had high cholesterol. Missing out on sleep treatments meant they were missing out on an opportunity to manage those conditions as well.
Jean-Louis joined NYU in 2013. In his current study—which is being funded by the NIH at a cost of $423,750—he and his colleagues are trying to figure out whether simple interventions could better diagnose and treat minorities for sleep apnea. (For the first year, the study was only for blacks; now it has been opened up to all minorities.) Hence the team’s visit to places like Christ Church International. “Girardin’s studies are pioneering,” says Twery of the NIH, “in the sense he is doing community-based research to understand the cultural basis of the problem and how to improve the health of these communities.”
Jean-Louis says he has preliminary data that shows this approach is working. People who receive culturally tailored sleep education are, he says, four times more likely to make an appointment for a follow-up exam. “And once they are in, they will actually stay in,” he says.
For privacy reasons, the NYU team wouldn’t put me in touch with any participants in the study. But the lead peer health educator introduced me to her sister, Kimberly Turner, a 55-year-old African-American resident of Canarsie, Brooklyn, who had been diagnosed with sleep apnea. Before she was diagnosed, she told me, she felt like she was in the Twilight Zone. Time seemed to disappear. A coworker sitting next to her would suddenly vanish. She’d stop at a red light and then, an instant later, car horns would be blaring at her. She would wonder: “Did that really happen?” She hadn’t realized she was falling asleep during the day. “You start to question everything,” she says.
Turner was tired all the time. She woke up with terrible headaches. All the clues pointing toward apnea were there, but she didn’t realize something might be wrong with her breathing during sleep until her husband told her. “He just literally said that I stopped breathing, and I was like, ‘You’re kidding me, I don’t stop breathing.’ I had never really heard of it at that point.”
SLEEP APNEA IS the most extreme manifestation of the sleeping problems that disproportionately affect black Americans. But focusing on community-based health education—as Jean-Louis is doing—may help not just with sleep apnea but with other sleeping problems, too. And if his interventions work, they could be scaled up.
Ultimately, sleep may offer researchers a way to attack seemingly even more intractable health problems—including those that disproportionately affect black Americans. “Not only might sleep be a potential causal factor in health disparities making things worse, it might be a potential place to help the situation,” Grandner says. “If you take someone who is not getting enough sleep, and you increase their sleep, can that prevent some of these things”—obesity, diabetes, heart disease—“over time? That’s still an open question.”
Tomfohr also sees some cause for optimism. “I don’t think this is totally fatalistic,” she says. “My hope is that this is addressable from multiple levels—that we can identify people who are at risk for sleeping poorly, and then we can do good interventions to help them sleep better, so this isn’t a sentence towards getting cardiovascular disease, or getting sick, or getting diabetes. I have a hopeful feeling about this.”
https://archive.is/dqBLG