Acculturation and sleep outcomes in Asian Americans and Pacific Islanders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions-III

Abstract

Objectives: This study investigates an association between acculturation and sleep outcomes in Asian Americans and Pacific Islanders, an understudied population in sleep studies.

Design: Cross-sectional.

Participants: About 1401 adults who spoke an Asian or Pacific Islander language from the National Epidemiologic Survey on Alcohol and Related Conditions-III.

Measurements: Acculturation was assessed using the Bidimensional Acculturation Scale and participants were categorized into non-Asian (proficient only in English), Bicultural (proficient in English and an Asian language), and Asian (proficient only in an Asian language). Nativity and years lived in the United States (US-born, ≤5 years, 6-20 years, and ≥21 years) was used as a proxy of acculturation. Linear and logistic regression models were examined associations between acculturation and sleep duration and sleep difficulties.

Results: Those in the Bicultural group slept slightly longer by 0.19 hours per day than those in the non-Asian group, but this increase was driven by those sleeping >9 hours. Foreign-born Asians who lived in the United States for 6-20 years and ≥21 years slept less by 0.17 and by 0.28 hours relative to US-born Asians. Foreign-born Asians who lived in the United States ≤5 years were less likely to have sleep difficulties than US-born Asians (odds ratio: 0.49, 95% confidence interval: 0.26-0.92).

Conclusions: The Bicultural group has unusually long sleep hours, while the benefits of not having sleep difficulties among recent immigrants did not exist among immigrants who lived a longer time in the United States. Future studies should identify the mechanism underlying the observed associations.

Keywords: Acculturation; Asian Americans; sleep difficulty; sleep duration.