in medical care along various lines, including race, ethnicity, gender identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can manifest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assumptions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact health outcomes. Addressing implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve
education and awareness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures prioritizing equitable treatment for all patients can play a pivotal role in reducing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treatment regardless of their background or characteristics.
INTRODUCTION
To promote optimal health and well-being, it is recommended that adults aged 18 to 60 get at least 7 hours of sleep each night (Centers for Disease Control and Prevention [CDC]). Sleeping less than the recommended 7 hours per night is associated with increased risk for obesity, diabetes, high blood pressure, coronary heart disease, stroke, frequent mental distress, and all- cause mortality (Liu et al., 2016). The Centers for Disease Control and Prevention has even gone so far as to call insufficient sleep “a public health concern” (CDC, 2009). Data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) survey found that among adult respondents, 35.2% reported fewer than 7 hours of sleep during a typical 24-hour period (CDC, 2017b). Results for adults in 12 states who responded to the BRFSS 2009 survey indicated that 48.0% reported snoring, 37.9% reported unintentionally falling asleep during the day at least once in the preceding month, and 4.7% reporting nodding off or falling asleep while driving in the preceding month (CDC, 2011). The results of this survey are shown in Figure 1. Figure 1: Age-Adjusted Percentage of Certain Sleep-Related Behaviors
Note . From “Unhealthy Sleep-Related Behaviors – 12 States, 2009,” by the Centers for Disease Control and Prevention, 2011, p. 238, retrieved from http://www.cdc.gov/mmwr/PDF/wk/mm6008.pdf. The lack of adequate sleep is such a public health concern that Healthy People 2020 has added a new topic pertaining to Sleep Health. Its goal is to “increase public knowledge of how adequate sleep and treatment of sleep disorders improve health, productivity, wellness, quality of life, and safety on roads and in the workplace” (HealthyPeople.gov, 2018b). The four objectives of this new topic are detailed in Table 1. Table 1: Healthy People 2020’s Sleep Health Objectives Sleep Health Objective Details SH-1 Increase the proportion of persons with symptoms of obstructive sleep apnea who seek medical evaluation. SH-2 Reduce the rate of vehicular crashes per 100 million miles traveled that are due to drowsy driving.
SH-3
Increase the proportion of students in grades 9 through 12 who get sufficient sleep. Increase the proportion of adults who get sufficient sleep.
SH-4
Note . From “Sleep Health: Objectives,” by HealthyPeople.gov, 2018b, retrieved from https://www.healthypeople.gov/2020/topics- objectives/topic/sleep-health/objectives. A study by the Rand Corporation on the economic costs of insufficient sleep reported the following key findings: (a) The United States sustains up to $411 billion per year in economic losses because of insufficient sleep; (b) the United States loses the equivalent of 1.23 million working days every year due to insufficient sleep; and (c) sleep deprivation is linked to a higher mortality risk. People who sleep on average fewer than 6 hours per night have a 10% higher mortality risk than people who sleep between 7 and 9 hours, and people who sleep 6 to 7 hours per night have a 4% higher mortality risk than those who sleep 7 to 9 hours per night (Hafner, Stepanek, Taylor, Troxel, & Van Stolk, 2017).
DEFINITION OF OBSTRUCTIVE SLEEP APNEA
Obstructive sleep apnea (OSA) is sleep-disordered breathing (SDB) in which a person frequently stops breathing while sleeping. This situation is usually caused by a recurring, repetitive collapse or blockage of the upper airway, typically as a result of the size or position of the tongue or soft palate or inadequate motor tone of the airway dilator muscles (Bonsignore, et al., 2019). This anatomical or functional
narrowing of the upper airway during sleep results in reduced oxygen delivery to the body. Consequently, carbon dioxide (CO2) builds up in the bloodstream. Carbon dioxide receptors in the bloodstream signal the brain to wake the person so that he or she can breathe and get oxygen (Marieb and Hoehn, 2018). The person with apnea is usually not aware of the occurrence of these events.
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