Race, Ethnicity, and Sleep in US Children.

Abstract

Importance: Although racial and ethnic disparities are well documented in children's mean levels of sleep, particularly duration, evidence is mixed for sleep variability, an important sleep dimension of growing interest. Most research has also focused on comparisons of Black and White children, with limited attention to sleep variability disparities among other racially and ethnically minoritized groups such as Asian, Latinx, and multiracial children.

Objective: To investigate racial and ethnic disparities in children's mean levels of sleep and variability of sleep across multiple dimensions and diverse racial and ethnic groups using actigraphy data.

Design, setting, and participants: This cross-sectional study used data from the Adolescent Brain Cognitive Development (ABCD) study, a national cohort study, from 21 study sites across the US. ABCD participants were recruited at baseline (2016-2018) using a multistage, stratified, probability sampling method. The current study used a subsample with reliable actigraphy data collected at 2-year follow-up (2018-2020). Data analysis occurred from July 2023 to October 2024.

Exposures: Parent-reported race and ethnicity at baseline. Sociodemographic, health, and contextual covariates of sleep were also included.

Main outcomes and measures: Actigraphy-assessed mean levels of sleep and sleep variability across multiple dimensions (duration, bedtime, risetime, efficiency, and latency) over 3 weeks.

Results: The analytic sample included 3868 children (mean [SD] age, 11.50 [0.67] years; 1913 female [49.5%]), of whom 104 (2.7%) were Asian, 347 (9.0%) were Black or African American, 801 (20.7%) were Latinx, 356 (9.2%) were multiracial, and 2260 (58.4%) were White. Asian, Black, Latinx, and multiracial children exhibited shorter sleep duration and later bedtime than White children. Importantly, compared with White children, bedtime variability was greater among Asian (β = 0.04; 95% CI, 0.01 to 0.07; P = .02), Black (β = 0.11 95% CI, 0.08 to 0.15; P < .001), Latinx (β = 0.08; 95% CI, 0.05 to 0.12; P < .001), and multiracial children (β = 0.08; 95% CI, 0.05 to 0.11; P < .001). Similarly, risetime variability was greater among Asian (β = 0.04; 95% CI, 0.01 to 0.07; P = .01), Black (β = 0.08; 95% CI, 0.04 to 0.12; P < .001), and Latinx (β = 0.06; 95% CI, 0.02 to 0.10; P < .01) children in comparison with White children. Black children exhibited the most profound disparities across mean levels (duration and bedtime) and variability of sleep (duration, bedtime, risetime, and efficiency) than other groups. Asian and multiracial children also exhibited some disparities sleep duration, efficiency, and efficiency variability, when compared with Latinx children.

Conclusions and relevance: In this cross-sectional study of children's sleep disparities, racially and ethnically minoritized children exhibited disparities in mean levels and variability of sleep compared with their White peers. These findings suggest that policies and practices should target multiple sleep dimensions among diverse racial and ethnic groups to promote equitable pediatric sleep health.