Accepted for/Published in: JMIR Formative Research
Date Submitted: May 20, 2020
Date Accepted: Jul 26, 2020
Ethnicity Differences in Sleep Changes Among Pre-hypertensive Adults Using a Smartphone Meditation Application: A Dose-Response Trial
ABSTRACT
Background:
African Americans (AAs) experience greater sleep quality problems than Non-Hispanic Whites (NHWs). Meditation has shown promise in improving sleep though dose levels needed to achieve such benefits have not been studied. No trials have utilized smartphone application (app) delivery and monitoring of adherence to meditation protocols.
Objective:
This 6-month feasibility trial investigated effects of a breathing awareness meditation, Tension Tamer (TT), on secondary outcomes of sleep quality using self-report and actigraphy derived measures.
Methods:
Sixty-four prehypertensive adults (SBP <139 mmHg; 31 AAs, 33 NHWs) were randomized into 3 different TT dose conditions (5 ,10 or 15 minutes twice daily). Sleep quality was assessed at baseline, 1, 3, and 6 months using the Pittsburgh Sleep Quality Index (PSQI) and one-week bouts of continuous wrist actigraphy monitoring.
Results:
At baseline, PSQI and actigraphy data indicated AAs experienced shorter sleep duration, greater sleep disturbance, poorer efficiency and worse quality of sleep (P-range <.03 to <.001). Longitudinal GLM modeling revealed a dose effect modulated by ethnicity (P<.01). Multi-method assessment showed a consistent pattern of NHWs exhibiting the most favorable responses to the 5-minute dose. They reported greater improvements in sleep efficiency and quality dimensions, as well as PSQI global value compared to 10- and 15-minute doses (P-value range: .04 to <.001). Actigraphy findings revealed a consistent but generally not statistically significant pattern in the 5-minute group showing lower fragmentation, longer sleep duration and higher efficiency compared to the other two dose conditions. Among AAs, actigraphy indicated exhibited lower sleep fragmentation in the 5-minute group compared to 10 and 15-minute doses (Ps=.03, <.001 respectively). The 10-minute group showed longer sleep duration than the 5- and 15-minute groups (Ps =.02, <.001, respectively). The 5-minute group also exhibited significantly longer average sleep compared to the 15-minute group (p=.03).
Conclusions:
These findings indicate need for further study of potential modulating influence of ethnicity upon impact of breathing awareness meditation upon sleep indices, and user-centered exploration to ascertain the potential merits of refining the TT app with attention to cultural tailoring among AAs and NHWs with pre-existing sleep complaints. Clinical Trial: NCT03168789
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