A Life Course Approach to Racial/Ethnic and Sex/Gender Disparities in Sleep Duration and Implications on Cardiometabolic Risk in Adulthood Open Access

Saelee, Ryan (Fall 2021)

Permanent URL: https://etd.library.emory.edu/concern/etds/b2773w89g?locale=en


Cardiometabolic diseases remain the leading causes of morbidity and mortality in the U.S. with sleep as a significant risk factor. Race and sex disparities in sleep duration have been documented, with limited studies examining these disparities across developmental periods. Additionally, few studies have explored the impact of sleep duration across the life span on adult cardiometabolic risk factors (CRFs). Furthermore, racial disparities in adolescent sleep are well established but contributors of these disparities are largely unknown. This dissertation sought to address these gaps using data from the National Longitudinal Study of Adolescent to Adult Health.

Aim 1 examined whether neighborhood (socioeconomic disadvantage, social cohesion, and safety) and household (socioeconomic status (HSES) and single parent household) environments mediated racial differences in adolescent sleep duration. Results suggested, although HSES partially explained racial disparities, higher HSES was positively associated with short sleep duration. Future work should explore mechanisms linking varying levels of HSES to short sleep duration within each racial/ethnic group and identify buffers to reduce the detrimental impacts of HSES on sleep.

Aim 2 investigated racial/ethnic and sex/gender differences in sleep duration trajectories from adolescence to adulthood. Three trajectory types by race and sex were found: 1) Consistent Increasing Short Sleepers (i.e., increasing probability of short sleep into adulthood); 2) Late Onset Short Sleepers (i.e., no probability of short sleep in adolescence, but in adulthood); and 3) Early Onset Short Sleepers (i.e., declining probability of short sleep from adolescence into adulthood). The prevalence of Consistent Increasing Short Sleepers was highest among African American males, Late Onset Short Sleepers was highest among White females, and Early Onset Short Sleepers was the greatest among Latinx males. 

Aim 3 assessed racial/ethnic and sex/gender differences in the association between sleep duration trajectories and adult CRFs.  Females, regardless of race, and White males with a Consistent Increasing Short Sleeper trajectory generally had a lower prevalence of CRFs than Early or Late Onset Short Sleepers. There was a higher prevalence of dyslipidemia for African American males and elevated C-reactive protein for Latinx males among Early and Late Onset Short Sleepers.

Altogether, findings highlight the need for a life course approach and intervention during adolescence to improve adult cardiometabolic health.

Table of Contents


Chapter 1: Introduction....1

Background and Literature Review....1

Cardiometabolic Disease Burden and Health Risk Behaviors.... 1

Mechanisms Linking Sleep Duration to Cardiometabolic Health.... 1

Racial/ethnic and Sex Disparities in Sleep Duration among Adolescents and Adults.... 2

Sleep Duration across the Life Course.... 4

Neighborhood and Household Environment as Contributors to Racial Disparities in Adolescents....6

Study Aims.... 8

Study Population....9

Contributions to the Literature/Public Health Importance....10


Chapter 2: Neighborhood and Household Environment as Contributors to Racial Disparities in Sleep Duration among U.S. Adolescents....12




Results.... 20

Discussion.... 23


Chapter 3: Race and Sex Differences in Sleep Duration Trajectories from

Adolescence to Adulthood in a National U.S. Sample....34

Abstract... 34

Introduction.... 35

Methods.... 39

Results.... 43

Discussion.... 46


Chapter 4: Race and Sex Differences in the Association between Sleep Duration Trajectories from Adolescence to Adulthood and Adult Cardiometabolic Risk....60


Introduction.... 61

Methods.... 63

Results.... 68

Discussion.... 71


Chapter 5: Conclusions and Future Research.... 81

Conclusion/Public Health Impact... 81

Future research.... 83


References.... 90

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