Socio-ecological factors linked to co-occurring early childhood sleep health disparities and developmental outcomes

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PROJECT SUMMARY/ABSTRACT There is an urgent need to address pediatric sleep health disparities in early childhood, as sleep deficiencies disproportionately affect racially/ethnically minoritized children and negatively impact crucial neurobehavioral and social-emotional development. Two common early childhood sleep deficiencies linked to adverse outcomes are (1) sleep disordered breathing (SDB), which ranges from snoring to severe obstructive sleep apnea (OSA), and (2) insufficient sleep, or sleeping less than age-based 24-hour sleep guidelines. Compared to non-Latinx White (hereafter ‘White’) youth, non-Latinx Black/African American (‘Black’) youth are 4-6 times more likely to experience SDB and are also more likely to experience short sleep duration. SDB and insufficient sleep also often co-occur in young children. The mechanisms of racial disparities in co-occurring SDB and insufficient sleep and their developmental impacts are poorly understood, which impedes effective intervention. The long-term goal of this research is to develop multi-level interventions that leverage modifiable socio-ecological factors to reduce the incidence and developmental consequences of common, co-occurring racial sleep health disparities in preschoolers. To achieve this goal, there is a critical need to identify the factors that contribute to or buffer against these disparities and their developmental impacts. Although socioeconomic disparities in SDB and insufficient sleep are well documented, family factors including caregiver stress, health literacy, and work schedules are rarely considered. Few studies have examined other modifiable family factors, such as bedtime routines, bedtime electronics, and parenting practices, which may contribute to or buffer against disparities in these sleep deficiencies and related outcomes. Furthermore, ongoing personally mediated and structural racism faced by Black families, teachers’ racial bias, childcare quality, and neighborhood characteristics are likely, but understudied, contributors to these disparities. To address these gaps and inform effective interventions, the objectives of this work are to (1) examine racial disparities in the neurobehavioral and social-emotional impacts of early childhood SDB and/or insufficient sleep and (2) identify proximal and distal socio-ecological factors linked to these racial disparities in sleep-related outcomes. Black and White 3-5-year-olds will be recruited with (A) SDB only, (B) insufficient sleep only, (C) SDB and insufficient sleep, and (D) matched healthy controls to examine the following aims, using a multi-method, multi-informant approach with caregiver and teacher reporters, observational tasks, and qualitative methods. Aim 1 will compare neurobehavioral (executive functioning, attention, vigilance) and social-emotional functioning (social skills, emotion regulation) in groups A, B, C, and D. Aim 2 will identify modifiable family factors that contribute to sleep-related racial disparities in the developmental outcomes of Black and White children in groups A, B, C, and D. Aim 3 will identify proximal and distal childcare and neighborhood factors that contribute to sleep- related racial disparities in the developmental outcomes of Black and White children in groups A, B, C, and D.