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Sleep Buffers the Effect of Discrimination on Cardiometabolic Allostatic Load in Native Americans: Results from the Oklahoma Study of Native American Pain Risk

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Abstract

Objectives

Compared to other racial/ethnic groups, Native Americans (NAs) are more likely to develop health conditions associated with allostatic load (stress-related wear-and-tear). Psychosocial factors (i.e., adverse life events, discrimination, psychological distress) often promote stress and may help explain greater allostatic load in NAs. Moreover, previous research suggests sleep may either mediate or moderate the effects of some psychosocial stressors, like discrimination, on allostatic load. The current study investigated the relationship between adverse life events, discrimination, psychological stress, sleep, and cardiometabolic load.

Methods

Using a sample of 302 healthy, chronic pain-free NAs and non-Hispanic White (NHW) participants, bootstrapped mediation analyses were conducted to determine whether the relationship between NA race/ethnicity and cardiometabolic allostatic load (composite score of body mass index, mean arterial pressure, and heart rate variability) was mediated by psychosocial stressors. Models also assessed whether sleep disturbance served as an additional mediator or a moderator to the effects.

Results

Consistent with prior research, we found that NAs experienced greater discrimination, adverse life events (potentially traumatic events), and cardiometabolic allostatic load than NHWs. Further, discrimination was associated with increased psychological stress for NAs, but this did not explain why NAs experience higher cardiometabolic allostatic load. A moderating effect of sleep on discrimination was found, such that discrimination partially contributed to the relationship between NA race/ethnicity and cardiometabolic allostatic load, but only for participants reporting greater sleep disturbance.

Implications These findings highlight that good sleep can buffer the effect of psychosocial stress on cardiometabolic allostatic load in Native Americans.

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Data and Materials Availability

Means, standard deviations, and intercorrelations necessary to replicate the analyses are provided in the manuscript. Deidentified raw data are available upon request.

Funding

This research was supported by the National Institute on Minority Health and Health Disparities of the National Institute of Health under award number R01MD007807. Edward Lannon was supported by a National Science Foundation Graduate Research Fellowship Program.

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J.O.S. served as one of the primary investigators, designed the study, and wrote most of the manuscript. P.A.K. helped write the manuscript. T.A.T., F.A.H., B.L.K., E.W.L., N.H., C.A.S., and E.N.R. collected data and provided revisions to the manuscript. J.L.R. served as the primary investigator, designed the study, analyzed the data, and helped write the manuscript. All authors read and approved the final manuscript.

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Correspondence to Joanna O. Shadlow.

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The study was approved by IRBs of The University of Tulsa, Cherokee Nation, and the Indian Health Service Oklahoma City Area Office.

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Shadlow, J.O., Kell, P.A., Toledo, T.A. et al. Sleep Buffers the Effect of Discrimination on Cardiometabolic Allostatic Load in Native Americans: Results from the Oklahoma Study of Native American Pain Risk. J. Racial and Ethnic Health Disparities 9, 1632–1647 (2022). https://doi.org/10.1007/s40615-021-01103-7

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