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The Social
Epidemiology of Sleep
The Social
Epidemiology of Sleep
Edited by
Dustin T. Duncan
Ichiro Kawachi
and
Susan Redline
1
1
Oxford University Press is a department of the University of Oxford. It furthers
the University’s objective of excellence in research, scholarship, and education
by publishing worldwide. Oxford is a registered trade mark of Oxford University
Press in the UK and certain other countries.
This material is not intended to be, and should not be considered, a substitute for medical or other
professional advice. Treatment for the conditions described in this material is highly dependent on
the individual circumstances. And, while this material is designed to offer accurate information with
respect to the subject matter covered and to be current as of the time it was written, research and
knowledge about medical and health issues is constantly evolving and dose schedules for medications
are being revised continually, with new side effects recognized and accounted for regularly. Readers
must therefore always check the product information and clinical procedures with the most up-to-
date published product information and data sheets provided by the manufacturers and the most
recent codes of conduct and safety regulation. The publisher and the authors make no representations
or warranties to readers, express or implied, as to the accuracy or completeness of this material.
Without limiting the foregoing, the publisher and the authors make no representations or warranties
as to the accuracy or efficacy of the drug dosages mentioned in the material. The authors and the
publisher do not accept, and expressly disclaim, any responsibility for any liability, loss or risk that
may be claimed or incurred as a consequence of the use and/or application of any of the contents of
this material.
1 3 5 7 9 8 6 4 2
Paperback printed by Marquis, Canada
Hardback printed by Bridgeport National Bindery, Inc., United States of America
Contents
Part II: Sleep Health Over the Life Course and Among Special Populations
3. Sleep in Pregnancy 49
Louise M. O’Brien and Galit L. Dunietz
Glossary 431
Index 435
About the Editors
Ichiro Kawachi, MBChB, PhD, is the John L. Loeb and Frances Lehman Loeb
Professor of Social Epidemiology at the Harvard T. H. Chan School of Public Health,
where he has taught since 1992. Dr. Kawachi received both his medical degree and his
PhD (in epidemiology) from the University of Otago, New Zealand. Dr. Kawachi is the
coeditor (with Lisa Berkman) of the first textbook on social epidemiology, titled Social
Epidemiology (Oxford University Press, 2000; new and revised edition published in
2014 with Lisa Berkman and Maria Glymour). His other books include Neighborhoods
vii
viii About the Editors
and Health with Lisa Berkman (Oxford University Press, 2003; new and revised edition
published in 2018 with Dustin Duncan); Globalization and Health with Sara Wamala
(Oxford University Press, 2006); Social Capital and Health with S. V. Subramanian
and Daniel Kim (Springer, 2008); the Oxford Handbook of Public Health Practice with
Charles Guest, Walter Ricciardi, and Iain Laing (Oxford University Press, 2013); Global
Perspectives on Social Capital and Health with Soshi Takao and S. V. Subramanian
(Springer, 2013); and Behavioral Economics and Public Health with Christina Roberto
(Oxford University Press, 2015). His current NIH-funded R01 project is focused on
the longitudinal impacts of community social cohesion/social capital on functional
recovery after the March 11, 2011, Great Eastern Japan earthquake and tsunami. In
2013, he launched a massive, open online course (MOOC) through HarvardX called
“Health and Society” (PHx 201), which is a version of a class he has taught for 20 years
at Harvard. In 2013–2014, 35,000 participants from throughout the world enrolled in
the MOOC course. Dr. Kawachi is the coeditor in chief (with S.V. Subramanian) of
the international journal Social Science & Medicine. He is an elected member of the
Institute of Medicine of the U.S. National Academy of Sciences.
Susan Redline, MD, MPH, is the Peter C. Farrell Professor of Sleep Medicine at
Harvard Medical School. She directs programs in Sleep and Cardiovascular Medicine
and Sleep Medicine Epidemiology at Brigham and Women’s Hospital and Beth Israel
Deaconess Medical Center. Dr. Redline’s research includes epidemiological studies and
clinical trials designed to (a) elucidate the etiologies of sleep disorders, including the
role of genetic and early life developmental factors, and (b) understand the cardiovas-
cular and other health outcomes of sleep disorders and the role of sleep interventions in
improving health. She has led sleep assessments made in numerous community-based
cohort studies and clinical trials, as well as national initiatives aimed at identifying the
genetic and environmental contributors to sleep disorders. She has published over 450
peer-reviewed articles and has served the sleep research community in a number of
capacities, including as a member of the board of directors for the American Academy
of Sleep Medicine and the Sleep Research Society, the NIH’s Sleep Disorders Research
Advisory Board, and the Institute of Medicine’s Committee on Sleep Medicine and
Research; she is also deputy editor for the journal Sleep and for Annals of the American
Thoracic Society. She received her BS and MD degrees from Boston University and an
MPH degree from the Harvard T. H. Chan School of Public Health and completed
internal medicine and pulmonary and critical care medicine training at Case Western
Reserve University and a research fellowship in respiratory epidemiology at Harvard
Medical School.
Contributors
ix
x Contributors
An Introduction to
Sleep Epidemiology
1
Sleep Epidemiology
A Social Perspective
Dustin T. Duncan, ScD, Ichiro Kawachi, MBChB, PhD, and
Susan Redline, MD, MPH
When we sleep, where we sleep, and with whom we sleep are all important markers or
indicators of social status, privilege, and prevailing power relations.
Simon J. Williams, 2005
University of Warwick
3
4 An Introduction to Sleep Epidemiology
and family economic pressures by increasing the numbers of work hours and duration
of work shifts. In contrast, “exempt” workers have work hour flexibility and can have
economic value not directly related to hours worked but level of complexity, creativity,
or innovation of their work contributions. Differences in economic resources provide
higher income individuals the resources to assist with home and family obligations,
while lower income working individuals need to find time to address a myriad child
and elder care and household obligations in a finite number of nonoccupational work
hours. These days, the ability to get a decent night’s sleep has become a symbol of
power, prestige, and status.
What are the consequences of poor sleep for population health? Answering this
question using an epidemiological framework has been limited by the relative dearth
of sleep data included in community studies and the late emergence of sleep epidemi-
ology as a discipline, as discussed in Chapter 2. When we sift through the surveys of
early cohort studies (like the Framingham Heart Study, established in 1948), we can
see that the other health behaviors are all represented on early questionnaires (i.e.,
smoking, drinking, exercise, diet) but not sleep, which was not included in surveys
until the 1980s. In 1977, the National Health Interview Survey included a single
question on sleep duration, and, in 1982–1984, the National Health and Nutrition
Examination Survey included seven items on sleep quality, sleeping medications, and
sleep duration. The Nurses Health Study (NHS) began in 1976 but did not include
questions regarding sleep until 1986. No objective measurements of sleep were in-
cluded in any NHS examination, although a pilot study of sleep apnea screening is
planned for 2020. Objective measurements of sleep were not included in large cohort
studies until the launch of the Wisconsin Sleep Cohort in 1993 and the Sleep Heart
Health Study in 1994.
As epidemiologists started to ask about sleep, it became quickly apparent that poor
sleep health contributes to a broad range of health outcomes across populations, in-
cluding premature death, chronic disease, and mental health conditions—not to men-
tion accidents/injuries, (un)happiness, marital discord, learning impairment, and
cognitive decline (see Chapter 2). Despite the strong evidence linking poor sleep to
the population’s leading causes of death and disability, poor sleep is not identified as a
risk factor in the World Health Association’s Global Burden of Disease. The U.S. gov-
ernment has an Office on Smoking and Health at the Centers for Disease Control and
Prevention and a National Institute of Alcohol Abuse and Alcoholism; the Surgeon
General has issued Reports on Physical Activity and Health across the Atlantic; and the
UK government recently even appointed a Minister of Loneliness—but sleep has yet
to reach a comparable level of policy attention. However, early success in recognizing
sleep as a public health concern is reflected in the recent inclusion of sleep health as
an objective in the United States’ Healthy People 2020 goals. For the first time, the
U.S. Department of Health and Human Services specifically prioritized the goal to
“Increase public knowledge of how adequate sleep and treatment of sleep disorders
improve health, productivity, wellness, quality of life, and safety on roads and in the
workplace.” Moreover, internationally, the highly influential Wellcome Trust convened
5 Sleep Epidemiology: A Social Perspective