Determinants of Health Inequalities in Iran and Saudi Arabia: A Systematic Review of the Sleep Literature

Sleep health inequalities represent an increasing public health concern. Among multiple determinants affecting sleep health, there is people's socioeconomic status (SES), and no systematic review on the relationship between SES and sleep health has been previously conducted in Iran and Saudi Arabia. Following the Prisma protocol, ten articles were selected. Findings revealed that the combined number of participants was N = 37,455 participants, including 73.23% of children and adolescents (n = 27,670) and 26.77% of adults (n = 10,026). The smallest sample was N = 715 and the larger was N = 13,486. In all these studies, sleep variables were assessed using self-reported questionnaires. The studies conducted in Iran assessed the risk of obstructive sleep apnea (OSA), while those in Saudi Arabia were interested in sleep duration, nap time, bedtime, rise time and insomnia. The studies performed on adult populations in Iran and Saudi Arabia concluded that there is no significant association between SES determinants and sleep components in adult populations. One study in Iran found a significant association between parent's low SES and children and adolescent insomnia; and one study in Saudi Arabia found a significant association between the father's education and the longer sleep duration of their children. More longitudinal studies are necessary to establish a causal relationship between public health policies and sleep health inequalities. An extension of the investigation to more sleep disturbances is required to cover the entirety of sleep health inequalities in Iran and Saudi Arabia.