Table 2.

Methodology and results of studies examining racial/ethnic sleep disparities in US children and adolescents 6–19 years

First author, year	Sleep variables	Covariates	Results
Study samples include children 6–13 y only
Combs, 201622	Duration (parent-reported)	None	Weekdays, Hispanic children slept a median 0.5 h less than White children at phase 1 (median 9.5 h vs 10 h; P < .0001), and weekends, 0.3 h less (9.4 h vs 9.7 h; P = .003), but this disparity disappeared at phase 2 (P = .13). Hispanic children had later bedtimes than White children at phase 1 (9:00 pm vs 8:30 pm; P < .0001) and phase 2 (9:40 pm vs 9:27 pm; P = .013). The authors explain the lack of disparity at phase 2 by speculating that White children slept less at phase 2; that is, Hispanic children did not increase their sleep to meet Whites, but rather White children decreased their sleep to the level of Hispanic children. No significant differences in weekday wake time at phase 1 (P = .16) or phase 2 (P = .847).
	Bedtime (parent-reported)
	Wake time (parent-reported)
Goodwin, 200748	Duration (PSG; 1-d diary: parent; parent-reported)	None	No disparities in PSG-measured duration. Parents of Hispanic children reported their child sleeping 21 min less than White children nightly (566 vs 587 min; P < .001) and also that they took more naps (36% Hispanics vs 19% of White parents reported their child napping; P = .014). No disparities in PSG-measured or parent-reported sleep onset latency.
	Sleep onset latency (PSG; 1-d diary: parent; parent-reported)
Spilsbury, 200449	Duration (1-wk diary: child)	Age, sex, preterm status, chronic health problems, vacation status, caregiver's education	Minority boys (10–11 y) had the shortest mean sleep duration (9.12 h) for all days, whereas the rest of the sample slept 19 to 43 min longer. Minority boys (10–11 y) also had the shortest weekend sleep duration (9.25 h). Minority children were 4.8 times more likely to have a bedtime of 11 pm or later than White children (95% CI: 2.9–8.0). Minority boys and girls (10–11 y) had the latest bedtimes (10:33 pm and 10:37 pm, respectively). Minority boys and girls (10–11 y) had the greatest variability in night-tonight sleep duration for all days (CV: 11.3% and 10.8%, respectively), and minority boys (10–11 y) (CV: 10.7%) and minority girls (8 y) had the greatest variability in weekend sleep duration (CV: 11.3%).
	Bedtime (1-wk diary: child)
	Wake time (1-wk diary: child)
	Variability in duration (1-wk diary: child)
			At 10–11 years old, minority boys (9.28 h) reported less sleep than nonminority girls (9.55 h, P = .02), non-minority boys (9.52 h, P = .005), and minority girls (9.53 h, P = .01). No significant disparities for 8- to-9-y-olds and 9- to 10-y-olds.
Study samples include both children (6–13 y) and adolescents (14–19 y)
Adam, 200744	Duration (2-d [1 weekday and 1 weekend day] diary: child)	35 variables (demographic, school schedule, activity, and family functioning variables)	Children:
	Bedtime (2-d [1 weekday and 1 weekend day] diary: child)		Weekdays, Asian children slept 0.68 h less than White children (P < .01). Weekends, Hispanic children slept 0.39 h less than White children (P < .05).
	Wake time (2-d [1 weekday and 1 weekend day] diary: child)		Weekdays, Asian children had later bedtimes than White children by 0.57 h (P < .05).
			Weekdays, Hispanic children woke up 0.16 h later than White children (P < .10). Weekends, Black children woke up 0.33 h later (P < .01), Hispanic children woke up 0.25 h earlier (P < .10), and Asian children woke up 0.65 h later than White children (P < .05).
			Adolescents:
			Weekdays, Black adolescents slept 0.42 h less than Whites (P < .01).Weekends, Black adolescents slept 0.47 h less (P < .05), and Hispanic adolescents slept 0.49 h less than Whites (P < .10).
			Weekdays, Black adolescents had later bedtimes than Whites by 0.28 h (P < .01). No significant difference for weekend bed times.
			No other older adolescent group showed significant differences for either weekday or weekend bed time.
			No disparities in wake time between White and either Black, Hispanic, or Asian adolescents.
Bates, 201645	Duration (actigraphy)	None	At baseline, Latina girls slept longer than Black girls (564 vs 518 min; P = .006) and had earlier sleep onset times (11:38 pm vs 12:29 am; P = .016). After completing a program that promoted physical activity, Latina and Black girls had comparable sleep duration and onset times. At both time points, there were no significant differences in wake time.
	Bedtime (actigraphy)
	Wake time (actigraphy)
Hawkins, 201637	Inadequate sleep (parent-reported)	Age, sex, employment, family structure, highest education in household, health care coverage, household poverty, community/neighborhood safety	Children:
			Ages 6–9 y, White (29.8%), Hispanic (26.0%), Black (29.4%), and other (26.4%) parents reported insufficiency. In adjusted regressions, Hispanics and other adolescents had lower odds of parent reported inadequate sleep (OR: 0.8 for both; 95% CI: 0.7–0.9 for both).
			Ages 10–13 y, White (37.5%), Hispanic (30.9%), Black (33.3%), and other (32.1%) parents reported insufficiency. In adjusted regressions, Hispanic, Black, and other adolescents had lower odds of parent reported inadequacy (OR: 0.8, 0.8, 0.7; 95% CI: 0.7–0.9 and 0.7–0.9 and −0.6 to 0.9, respectively).
			Adolescents:
			Ages 14–17 y, White (49.1%), Hispanic (35.7%), Black (39.3%), and other (45.9%) parents reported insufficiency. In adjusted regressions, Hispanic and Black adolescents had lower odds of parent reported inadequate sleep (OR: 0.7 and 0.8; 95% CI: 0.6–0.8 and 0.7–0.9, respectively).
Organek, 201536	Duration (self-reported)	None	Hispanic male children (7.95 h) slept less than Asian (8.51 h) and White male children (8.44 h) (P < .001). No disparities between Black males (8.05 h) and males of other races/ethnicities. Black females (7.80 h) slept less than White females (8.30 h; P < .05). No disparities between Asian females (8.15 h) or Hispanic females (8.16 h) and females of other races/ethnicities.
Roberts, 200050	Sleep disturbance: insomnia (self-reported)	Age, sex, SES	Chinese American children had approximately half (OR: 0.54) the insomnia risk of Whites almost every day (P = .02), and Mexican Americans had approximately 25% (OR: 1.28) increased risk for reporting insomnia often or every day (P = .03).
	Sleep disturbance: hypersomnia (self-reported)		Black adolescents had 2.09 the odds compared with Whites of reporting hypersomnia almost every day (P = .000) and 1.87 the odds of reporting hypersomnia often or almost every day (P = .000). Mexican Americans adolescents had 1.89 the odds of reporting hypersomnia almost every day (P = .001) and 1.63 the odds for reporting hypersomnia often or almost every day (P = .000). Central Americans had 1.85 the odds for reporting hypersomnia almost every day (P = .03) and 1.67 the odds for reporting hypersomnia often or almost every day (P = .009). Pakistani Americans and Vietnamese Americans reported increased odds of hypersomnia of often or almost every day (1.60 and 1.62, P = .04 and .006, respectively).
Roberts, 200652	Insomnia symptoms (self-reported)	Age, sex, caregiver education, family income, ethnic identity, ethnic stress	Whites reported the highest prevalence of difficulty initiating sleep (8.3%, P < .05); Blacks reported the highest prevalence of night time awakenings with difficulty falling asleep again (4.3%, P < .05) and easily falling asleep again (6.7%, P < .05). No other insomnia symptoms were significant for any other group.
			For fully adjusted models, Whites had greater difficulty initiating sleep than Mexican Americans (OR: 1.65) and Blacks (OR: 2.07). Blacks had greater difficulty maintaining sleep and falling asleep again after awakenings than Mexican Americans (OR: 2.02). Whites had less difficulty maintaining sleep but falling asleep again compared with Blacks (OR: 0.66). No other ethnic comparison significant for fully adjusted models.
Roblyer, 201546	Duration (self-reported)	Sex, age, grade in school, income, depressive symptoms, parental involvement, parent-child conflict, parent control	Latino children reported longer sleep duration (9.04 h vs 6.83 h; P ≤ .001) and fewer difficulties maintaining sleep than non-Latinos (P ≤ .010). In regression models, Latinos had longer sleep duration (β = 0.35, P ≤ .001) and less difficulty maintaining sleep (β = −0.33, P ≤ .010) than non-Latinos.
	Difficulty maintaining sleep (self-reported)
Singh, 20132	Sleep problems: inadequate sleep (parent-reported)	21 variables (SES, demographic factors, social, physical, and built environments, and behavioral factors)	Blacks (15.31%) had the highest prevalence of b5 d/wk of adequate sleep (Hawaiian/Pacific Islander: 13.90%; Whites: 13.80%; American Indian: 13.12%; mixed: 12.70%; other: 12.32%; Asian: 12.04%; Hispanic: 10.82%; P = .40).
			Whites (39.40%) had the highest prevalence of b7 d/wk of adequate sleep (mixed: 38.66%; Hawaiian/Pacific Islander: 36.17%; Black: 32.75%; American Indian: 32.09%; other: 29.01%; Hispanic: 28.54%; Asian: 26.96%; P < .001).
			For fully adjusted logistic models, there were no significant differences among races/ethnicities for b5 d/wk of adequate sleep.
			For b7 d/wk of adequate sleep, Whites (OR: 1.29), mixed (OR: 1.38), and other (OR: 0.59) significantly differed from Hispanics (reference group).
Smaldone, 200753	Inadequate sleep (parent-reported)	18 covariates representing demographics, child health, school and activities, family life	White children more frequently had inadequate sleep (defined as not sleeping enough on at least 1 night/wk) than Blacks, Hispanics, and “other”/multiple race/ethnicity children (ages 6–11 y: P < .01; ages 12–17 y: P < .001). Adjusting for covariates, Black children ages 6–11 y showed no significant differences from White adolescents; other than this exception, all groups (Black, Hispanic, other/mixed race/ethnicity) showed significantly lower odds of inadequate sleep compared with Whites in all age groups (6–11 y and 12–17 y). Black children aged 12–17 showed lower odds (OR = 0.73) than Whites for obtaining inadequate sleep.
Williams, 201347	Duration (2-d [1 weekday and 1 weekend day] diary: parent)	Age	White children generally slept longer than black children (10- to 15-min difference depending on age group) and shorter than Hispanic children (19-min difference for ages 9 and older). Authors concluded no clinically significant disparities in duration.
Study samples include adolescents 14–19 y only
Basch, 201438	Duration (self-reported)	None	Every wave from 2007 to 2013, Black females were more likely to sleep 5 or fewer hours on school nights than White females, and this same pattern followed for Black vs White males.
Eaton, 201039	Duration/insufficient sleep (self-reported)	Sex, grade level	Black adolescents (20.6%) reported having borderline (8 h) sleep significantly less than White (24.4%) and Hispanic (23.8%) adolescents (P < .05 for both). Black adolescents (71.2%) reported having insufficient sleep (≤7 h) significantly more than Hispanic (65.5%) adolescents (P < .05). Hispanic adolescents (10.6%) reported optimal sleep (≥9 h) significantly more than White (6.5%) adolescents (P < .05).
Keyes, 20151	Duration (self-reported)	None	Nearly all times periods (1991–2012), Black, Hispanic, Asian, and “other” race/ethnicity adolescents were less likely to have 7 or more average hours of sleep than White adolescents. At all time periods (1991–2012), Black and Hispanic adolescents were the most likely to report regular adequate sleep of any race/ethnicity.
	Inadequate sleep (self-reported)
Knutson, 200954	Time in bed (2-d [1 school day and 1 nonschool day] diary: adolescent)	Age, day of week, year, sex, income, various activities	Bedtimes for Black adolescents were approximately 25 min later thanWhite adolescents (P = .007).Wake times were 45 min later for Asian adolescents thanWhite adolescents (P = .04). No other disparities betweenWhites (reference group) and the rest of the sample.
	Bedtime (2-d [1 school day and 1 nonschool day] diary: adolescent)
	Wake time (2-d [1 school day and 1 nonschool day] diary: adolescent)
Maslowsky, 201440	Duration (self-reported)	None	Black adolescents had a higher prevalence of reporting b6 h of sleep (8.60%) thanWhite (3.98%), Hispanic (4.55%), and other (6.04%) adolescents, and higher percentages of reporting N10 h of sleep (3.53%) thanWhite (2.58%), Hispanic (2.13%), and other (2.12) adolescents. These differences were all significant (P < .001) except for a null difference between Hispanic and other. Black adolescents reported a mean sleep duration of 7.54 h, whereas whites reported 7.78, Hispanics reported 7.72, and other adolescents reported 7.55 h. These differences were all significant (P < .001), except for a null difference between Blacks and other.
	Bedtime (self-reported)
	Wake time (self-reported)
Maslowsky, 201440	Duration (self-reported)	None	Black adolescents had a higher prevalence of reporting b6 h of sleep (8.60%) thanWhite (3.98%), Hispanic (4.55%), and other (6.04%) adolescents, and higher percentages of reporting N10 h of sleep (3.53%) thanWhite (2.58%), Hispanic (2.13%), and other (2.12) adolescents. These differences were all significant (P < .001) except for a null difference between Hispanic and other.
	Bedtime (self-reported)		Black adolescents reported a mean sleep duration of 7.54 h, whereas whites reported 7.78, Hispanics reported 7.72, and other adolescents reported 7.55 h. These differences were all significant (P < .001), except for a null difference between Blacks and other.
	Wake time (self-reported)
Matthews, 201441	Duration (actigraphy; 1-wk diary: adolescent)	Smoking, BMI, age, physical activity	Actigraphy
	Sleep onset delay (self-reported)		Duration was shorter for Black adolescents than whites by 0.27 standard deviation overall (P < .001), 0.22 standard deviation on weekdays (P < .001), 0.13 standard deviation on weekends (P = .05) (Black males 6.2 h, Black females 6.3 h; White males 6.4 h, White females 6.9 h) and 0.27 standard deviation greater fragmentation (P < .001).
	Daytime sleepiness (self-reported)		Diary
	Fragmentation (actigraphy)		Diary-measured duration was also shorter for Black adolescents than Whites by 0.16 standard deviation overall (P = .01) and 0.13 standard deviation less on weekdays (P = .05) (Black males 7.4 h, Black females 7.2 h; White males 7.5 h, White females 7.7 h). No significant differences for weekend duration (P = .33) and total quality (P = .15)
	Quality (self-reported)		Questionnaire
			No disparities in sleep onset delay (P = .55) or daytime sleepiness (P = .66).
Moore, 201142	Duration (actigraphy)	Age, asthma, ADHD, preterm birth, BMI, vacation status	Minority adolescents slept less than nonminority adolescents by an average of approximately 20 min nightly (464 vs 484 min; P < .05). Minority adolescents had greater night-to-night variability in duration (CV: 17.9% vs 14.6%; P < .05) than nonminority adolescents.
	Variability in duration and wake time (actigraphy)
Rao 200955	Efficiency (PSG)	SES	Adjusting for SES, Black adolescents had the lowest sleep efficiency out of any racial/ethnic subgroup (P ≤ .05).
Roberts, 200451	Duration (self-reported)	Sex, age, standard of living, generational status, depressive symptoms, substance use	Unadjusted models showed a significant difference in odds of insomnia for Mexican American (Mexico born) (OR: 0.68, P < .05) and no significant differences for any other group compared with Whites. Adjusted odds ratios revealed that ethnicity (US Mexican American, Mexico Mexican American, and Mexican nationals vs Whites) showed no significant differences. χ2 tests revealed no differences between ethnicities (European American, US-born Mexican American, foreign-born Mexican American, or Mexican nationals) in hours slept on weekday, weekend, waking feeling rested in the past 4 wk, difficulty initiating sleep, and early morning awakenings. Significant differences were found in presence of insomnia (P = .0001), overall quality of sleep (P = .0012), and difficulty maintaining sleep (P = .0140).
	Insomnia symptoms (self-reported)
Wong, 201343	Duration (actigraphy)	Age, sex, obesity, SES (free and reduced-price lunch)	Adjusting for SES, Hispanic children had longer sleep duration than Blacks by 0.2 h (P < .001).

PSG, polysomnography; CV, coefficient of variation; self-reported and parent-reported: response to questionnaire;CV, coefficient of variation.