Social, environmental and economic determinants of sleep disturbances in Latin America: A systematic review and a meta-analysis of public health literature

BackgroundMental health recovery is associated with healthy sleep, and disturbances of both, areas represent an increasing public health issue worldwide, particularly in Latin America. Among multiple determinants affecting sleep health, individuals socioeconomic status (SES) is the most ignored and underestimated through literature. No systematic review on the relation between SES and sleep health has been previously conducted in Latin America. MethodsPRISMA guidelines were used. ResultsTwenty cross-sectional studies were selected. 80,0% (n=16) were performed in Brazil, 10,0% (n=2) in Peru, 5,0% (n=1) in Chile, and 5,0% (n=1) were multicentric (11 countries). The combined total number of participants were N=128455, being 3,7% (n= 4693) children, 16,0% (n= 20586) adolescents and 80,3% (n=103176) adults. Higher SES was associated with lower sleep duration. Lower SES was associated with a decrease in sleep quality. Excessive Daytime Sleepiness (EDS) was significantly more prevalent in individuals with lower family income and less education. Sleep bruxism was associated with higher education and lower SES was associated with more sleep bruxism. A meta-analysis of random effects model showed that pooled prevalence of sleep disturbances was 27.32 % (95 % CI 21.71-33.75) with high heterogeneity (I2 = 100 %). Pooled prevalence decreased with high education (OR 0.83; 95%CI [0.75-0.91]; I2= 79%), while it increased by low income (OR 1.26; 95%CI [1.12-1.42]; I2= 59%), unemployment (OR 2.84; 95%CI [2.14-3.76]; I2= 0%) or being housewife (OR 1.72; 95%CI [1.19-2.48]; I2=55.4%). DiscussionGradient of health disparity existing for some diseases like cardiovascular illness, seems the same for sleep disturbances regardless of world region. Therefore, sleep disturbances management should be address in a multidimensional approach with a significant investment of government in targeted public health program, to reduce sleep disparities and support research before the situation become uncontrollable.