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

Mental health recovery is associated to a healthy sleep and disturbances of both, represents an increasing public health issue in the world in general and in Latin America in particular. Among multiple determinants affecting sleep health, individual 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. Following Prisma protocol, twenty articles were included in the final sample, all cross-sectional studies. Among these studies, 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. The most used determinants were income (monthly personal income, monthly family income, per capita income, annual household income), wealth/assets, number of residents in the household, employment status/occupation, accessed healthcare system and composite indices. The sleep outcomes analyzed were excessive daytime sleepiness (EDS), sleep duration, sleep quality/sleep disturbance, insomnia, obstructive sleep apnea (OSA)/sleep-disordered breathing (SDB) symptoms and bruxism. Higher SES was associated with lower sleep duration. Lower SES was associated with a decrease in sleep quality. 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. For the 20 articles included, 12 were rated as fair or poor in study quality. Therefore, a meta-analysis was performed to estimate the prevalence of sleep disturbances in Latin America and the main SES risk factors that could be associated with it. The pooled prevalence using a meta-analysis of the random effects model was 27.32 % (95 % CI 21.71 to 33.75), with high heterogeneity (I2 = 100 %). The meta-analysis showed that the prevalence of sleep disturbances decreased by high education (OR 0.83; 95%CI [0.75 to 0.91]; I2= 79%), while it increased by low income (OR 1.26; 95%CI [1.12 to 1.42]; I2= 59%), no working (OR 2.84; 95%CI [2.14 to 3.76]; I2= 0%) or being housewife (OR 1.72; 95%CI [1.19 to 2.48]; I2=55.4%). ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data used for this review are available publicly and already published.