Clinical Report: Sleep Health Disparities in Rural Appalachian Adults

Overview

This study found high prevalence rates of sleep deficiencies among rural Appalachian adults, with 64.9% experiencing insomnia, 51.3% at elevated risk for obstructive sleep apnea (OSA), and 44.8% reporting insufficient sleep duration. Significant associations were identified between sleep outcomes and sociodemographic, behavioral, and psychosocial factors, highlighting pronounced socioeconomic gradients and distinct risk profiles.

Background

Sleep deficiencies, including insufficient sleep duration, insomnia, and OSA, contribute substantially to public health burdens, especially in populations facing health inequities. Rural Appalachian communities are federally designated as health disparity populations with documented insufficient sleep hotspots, yet clinical sleep disorder prevalence and social determinants remain undercharacterized. This study aimed to investigate sociodemographic, health behavior, and psychosocial factors associated with insomnia, OSA risk, and insufficient sleep among adults in economically distressed Eastern Kentucky counties.

Data Highlights

Key Findings

• Insomnia prevalence showed a strong socioeconomic gradient, decreasing from 82.9% in participants earning <$20,000 annually to 44.4% in those earning >$100,000.
• Insomnia was significantly associated with female sex, non–full-time employment, living alone, cigarette use, poor diet quality, low social support, poor self-rated health, polypharmacy, trauma history, moderate to severe anxiety or depression, and high stress.
• Elevated OSA risk correlated with older age, male sex, cigarette use, higher body mass index, poor self-rated health, polypharmacy, and trauma history.
• Insufficient sleep duration was significantly linked to lower social support.
• Prevalence rates of insomnia (64.9%), OSA risk (51.3%), and insufficient sleep (44.8%) in this population exceed national averages, indicating a disproportionate burden.
• Distinct risk profiles across sleep conditions suggest the need for targeted, multifaceted interventions rather than uniform approaches.

Clinical Implications

Clinicians should recognize the high burden of sleep disorders in rural Appalachian adults and consider socioeconomic and psychosocial factors when assessing sleep health. Tailored interventions addressing specific risk profiles—including gender, employment status, living arrangements, and health behaviors—are essential to effectively reduce sleep health disparities in this underserved population.

Conclusion

This study highlights a substantially disproportionate burden of sleep deficiencies among rural Appalachian adults, shaped by complex social determinants. These findings support the development of culturally appropriate, equity-focused sleep health interventions tailored to this population's unique needs.

References

1. Researching Equitable Sleep Time in Kentucky Communities (REST-KY) Study 2023-2025
2. National Sleep Foundation 2023 -- Sleep Disorder Prevalence Estimates