Review Article|Articles in Press

A systematic review of acculturation and sleep health among adult immigrants in the United States

Published:February 25, 2023DOI:


      The United States (US) has more immigrants than any other country in the world, with an estimated 44 million non-US-born individuals residing in the country as of 2018. Previous studies have linked US acculturation to both positive and negative health outcomes, including sleep. However, the relationship between US acculturation and sleep health is not well understood. This systematic review aims to identify and synthesize scientific studies on acculturation and sleep health among adult immigrants in the US. A systematic search of the literature was performed in PubMed, Ovid MEDLINE, and Web of Science in 2021 and 2022 with no date limiters. Quantitative studies published anytime in a peer-reviewed journal in English among an adult immigrant population with an explicit measure of acculturation and a sleep health dimension, sleep disorder, or daytime sleepiness measure were considered for inclusion. The initial literature search yielded 804 articles for review; after removing duplicates, applying inclusion and exclusion criteria, and searching reference lists, 38 total articles were included. We found consistent evidence that acculturative stress was associated with worse sleep quality/continuity, daytime sleepiness, and sleep disorders. However, we discovered limited consensus on the association of acculturation scales and acculturation proxy measures with sleep. Our review demonstrated that compared to US-born adult populations, there is a high prevalence of adverse sleep health among immigrant populations, and acculturation likely plays an important role in shaping this disparity, particularly through acculturative stress.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Sleep Health: Journal of the National Sleep Foundation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Buysse DJ.
        Sleep health: can we define it? Does it matter?.
        Sleep. 2014; 37: 9-17
        • Buxton OM
        • Marcelli E.
        Short and long sleep are positively associated with obesity, diabetes, hypertension, and cardiovascular disease among adults in the United States.
        Soc Sci Med. 2010; 71: 1027-1036
        • Jackson CL
        • Redline S
        • Emmons KM.
        Sleep as a potential fundamental contributor to cardiovascular health disparities.
        Annu Rev Public Health. 2015; 36: 417-440
        • Johnson DA
        • Jackson CL
        • Williams NJ
        • Alcántara C.
        Are sleep patterns influenced by race/ethnicity – a marker of relative advantage or disadvantage? Evidence to date.
        Nat Sci Sleep. 2019; 11: 79-95
        • Kingsbury JH
        • Buxton OM
        • Emmons KM.
        Sleep and its relationship to racial and ethnic disparities in cardiovascular disease.
        Curr Cardiovasc Risk Rep. 2013; 7: 387-394
        • Grandner MA
        • Williams NJ
        • Knutson KL
        • Roberts D
        • Jean-Louis G
        Sleep disparity, race/ethnicity, and socioeconomic position.
        Sleep Med. 2016; 18: 7-18
        • Billings ME
        • Cohen RT
        • Baldwin CM
        • et al.
        Disparities in sleep health and potential intervention models.
        Chest. 2021; 159: 1232-1240
        • Budiman A
        • Tamir C
        Inquiries D 20036USA202 419 4300 | M 857 8562 | F 419 4372 | M. Immigrants in America: Current Data and Demographics.
        Pew Research Center, 2020 (Published August 20. Available at:) (Accessed January 17, 2021)
        • Jackson CL
        • Hu FB
        • Redline S
        • Williams DR
        • Mattei J
        • Kawachi I.
        Racial/ethnic disparities in short sleep duration by occupation: the contribution of immigrant status.
        Soc Sci Med. 2014; 118 (1982): 71-79
        • Reid KJ
        • Weng J
        • Ramos AR
        • et al.
        Impact of shift work schedules on actigraphy-based measures of sleep in Hispanic workers: results from the Hispanic Community Health Study/Study of Latinos ancillary Sueño study.
        Sleep. 2018; 41: zsy131
        • Johnson DA
        • Billings ME
        • Hale L.
        Environmental determinants of insufficient sleep and sleep disorders: implications for population health.
        Curr Epidemiol Rep. 2018; 5: 61-69
        • Murillo R
        • Ayalew L.
        • Hernandez DC
        The association between neighborhood social cohesion and sleep duration in Latinos.
        Ethn Health. 2021; 26: 1000-1011
        • Giannotti F
        • Cortesi F.
        Family and cultural influences on sleep development.
        Child Adolesc Psychiatr Clin N Am. 2009; 18: 849-861
        • Alcántara C
        • Patel SR
        • Carnethon M
        • et al.
        Stress and sleep: results from the Hispanic community health study/study of Latinos sociocultural ancillary study.
        SSM - Popul Health. 2017; 3: 713-721
        • Shen Y
        • Gellis LA.
        Insomnia severity and its correlates among English as a second language (ESL) college students.
        J Am Coll Health J ACH. 2021; (Published online August 27): 1-8
      1. Grandner Michael A, PME Ruiter, R Pinyo, J Nicholas, P Alec, Patel Nirav P. Sleep symptoms, race/ethnicity, and socioeconomic position. J Clin Sleep Med. 09(09):897-905. doi:10.5664/jcsm.2990

        • Green T
        • Shipman J
        • Valrie C
        • et al.
        Discrimination and health among first-generation Hispanic/Latinx immigrants: the roles of sleep and fatigue.
        J Racial Ethn Health Disparities. 2022; 9 (Published online October 4): 2105-2116
        • Seicean S
        • Neuhauser D
        • Strohl K
        • Redline S.
        An exploration of differences in sleep characteristics between Mexico-born US immigrants and other Americans to address the Hispanic paradox.
        Sleep. 2011; 34: 1021-1031
        • Kachikis AB
        • Breitkopf CR.
        Predictors of sleep characteristics among women in southeast Texas.
        Womens Health Issues. 2012; 22: e99-e109
        • García C
        • Sheehan CM
        • Flores-Gonzalez N
        • Ailshire JA.
        Sleep patterns among US Latinos by nativity and country of origin: results from the National Health Interview Survey.
        Ethn Dis. 2020; 30: 119-128
        • Jean-Louis G
        • Magai CM
        • Cohen CI
        • et al.
        Ethnic differences in self-reported sleep problems in older adults.
        Sleep. 2001; 24: 926-933
        • Cunningham TJ
        • Wheaton AG
        • Ford ES
        • Croft JB.
        Racial/ethnic disparities in self-reported short sleep duration among US-born and foreign-born adults.
        Ethn Health. 2016; 21: 628-638
        • Abraído-Lanza AF
        • Armbrister AN
        • Flórez KR
        • Aguirre AN.
        Toward a theory-driven model of acculturation in public health research.
        Am J Public Health. 2006; 96: 1342-1346
        • Williams NJ
        • Grandne MA
        • Snipes A
        • et al.
        Racial/ethnic disparities in sleep health and health care: importance of the sociocultural context.
        Sleep Health. 2015; 1: 28-35
        • Young E
        • Xiong S
        • Finn L
        • Young T.
        Unique sleep disorders profile of a population-based sample of 747 Hmong immigrants in Wisconsin.
        Soc Sci Med. 2013; 79 (1982): 57-65
        • Fox M
        • Thayer Z
        • Wadhwa PD.
        Acculturation and health: the moderating role of socio-cultural context.
        Am Anthropol. 2017; 119: 405-421
        • Grandner MA
        • Khader WS
        • Warlick CD
        • Fernandez F.
        Acculturation and sleep: implications for sleep and health disparities.
        Sleep. 2019; 42
        • Hale L
        • Rivero-Fuentes E.
        Negative acculturation in sleep duration among Mexican immigrants and Mexican Americans.
        J Immigr Minor Health. 2011; 13: 402-407
        • Loredo JS
        • Soler X
        • Bardwell W
        • Ancoli-Israel S
        • Dimsdale JE
        • Palinkas LA.
        Sleep health in U.S. Hispanic population.
        Sleep. 2010; 33: 962-967
        • Roberts RE
        • Lee ES
        • Hernandez M
        • Solari AC.
        Symptoms of insomnia among adolescents in the Lower Rio Grande Valley of Texas.
        Sleep. 2004; 27: 751-760
        • Duncan DT
        • Kawachi I
        • Redline S
        The Social Epidemiology of Sleep.
        1st ed. Oxford University Press, Oxford, England2019
        • Stein MD
        • Friedmann PD.
        Disturbed sleep and its relationship to alcohol use.
        Subst Abuse. 2005; 26: 1-13
        • Chapagai S
        • Martyn-Nemeth P.
        Sleep health, acculturation, and acculturative stress in immigrants in the United States: a scoping review.
        J Transcult Nurs. 2022; 33 (Published online January 25): 398-415
        • Moher D
        • Liberati A
        • Tetzlaff J
        • Altman DG.
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        PLoS Med. 2009; 6e1000097
      2. Henriquez-Castillo M. Acculturation Patterns in Childhood/Adolescence, Cultural Stress in Young Adulthood, and Exploring the Moderating Role of Skin Tone Among Puerto Rican Youth in Two Contexts. New York, NY, USA: City University of New York (CUNY):148.

      3. Veritas Health Innovation. Covidence Systematic Review Software. Available at: Accessed February 8th, 2021

      4. NHLBI. Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Study Quality Assessment Tools. Available at: Accessed February 21, 2022.

        • Zeiders KH
        • Updegraff KA
        • Kuo SIC
        • Umaña-Taylor AJ
        • McHale SM.
        Perceived discrimination and Mexican-origin young adults’ sleep duration and variability: the moderating role of cultural orientations.
        J Youth Adolesc. 2017; 46: 1851-1861
        • D'Anna-Hernandez KL
        • Garcia E
        • Coussons-Read M
        • Laudenslager ML
        • Ross RG
        Sleep moderates and mediates the relationship between acculturation and depressive symptoms in pregnant Mexican-American women.
        Matern Child Health J. 2016; 20: 422-433
        • Alcántara C
        • Gallo LC
        • Wen J
        • et al.
        Employment status and the association of sociocultural stress with sleep in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).
        Sleep. 2019; 42
        • Cantero PJ
        • Richardson JL
        • Baezconde-Garbanati L
        • Marks G.
        The association between acculturation and health practices among middle-aged and elderly Latinas.
        Ethn Dis. 1999; 9: 166-180
        • Ghani SB
        • Delgadillo ME
        • Granados K
        • et al.
        Acculturation associated with sleep duration, sleep quality, and sleep disorders at the US-Mexico border.
        Int J Environ Res Public Health. 2020; 17
        • Martinez-Miller EE
        • Prather AA
        • Robinson WR
        • et al.
        US acculturation and poor sleep among an intergenerational cohort of adult Latinos in Sacramento, California.
        Sleep. 2018; 42
        • Green R
        • Santoro NF
        • McGinn AP
        • et al.
        The relationship between psychosocial status, acculturation and country of origin in mid-life Hispanic women: data from the Study of Women's Health Across the Nation (SWAN).
        Climacteric J Int Menopause Soc. 2010; 13: 534-543
        • Song Y
        • Martin JL
        • Lee D
        • et al.
        Associations of self-reported sleep quality with demographic and other characteristics in older Korean immigrants.
        J Immigr Minor Health. 2022; 24: 403-411
        • Hale L
        • Troxel WM
        • Kravitz HM
        • Hall MH
        • Matthews KA.
        Acculturation and sleep among a multiethnic sample of women: the Study of Women's Health Across the Nation (SWAN).
        Sleep. 2014; 37: 309-317
        • Barajas-Gonzalez RG
        • Huang KY
        • Hoque S
        • Karim F
        • Shakir A
        • Stressors CS.
        Legal vulnerability and Bangladeshi parent and child well-being in New York City.
        J Health Care Poor Underserved. 2021; 32: 799-818
        • González KA
        • Tarraf W
        • Wallace DM
        • et al.
        Phenotypes of obstructive sleep apnea in the Hispanic Community Health Study/Study of Latinos.
        Sleep. 2021; 44: zsab181
        • Sawanyawisuth K
        • Palinkas LA
        • Ancoli-Israel S
        • Dimsdale JE
        • Loredo JS.
        Ethnic differences in the prevalence and predictors of restless legs syndrome between Hispanics of Mexican descent and non-Hispanic Whites in San Diego county: a population-based study.
        J Clin Sleep Med JCSM. 2013; 9: 47-53
        • Im EO
        • Ko Y
        • Chee E
        • Chee W.
        Immigration transition and sleep-related symptoms experienced during menopausal transition.
        Women Health. 2017; 57: 69-87
        • Park C
        • Spruill TM
        • Butler MJ
        • et al.
        Gender differences in acculturative stress and habitual sleep duration in Korean American immigrants.
        J Immigr Minor Health. 2020; 22: 736-745
        • Lee S
        • Ryu S
        • Lee GE
        • Kawachi I
        • Morey BN
        • Slopen N.
        The association of acculturative stress with self-reported sleep disturbance and sleep duration among Asian Americans.
        Sleep. 2021; 45 (Published online December 18)
        • Ehlers CL
        • Gilder DA
        • Criado JR
        • Caetano R.
        Sleep quality and alcohol-use disorders in a select population of young-adult Mexican Americans.
        J Stud Alcohol Drugs. 2010; 71: 879-884
        • Suh M
        • Barksdale DJ
        • Logan J.
        Relationships among acculturative stress, sleep, and nondipping blood pressure in Korean American women.
        Clin Nurs Res. 2013; 22: 112-129
        • Whinnery J
        • Jackson N
        • Rattanaumpawan P
        • Grandner MA.
        Short and long sleep duration associated with race/ethnicity, sociodemographics, and socioeconomic position.
        Sleep. 2014; 37: 601-611
        • Chakraborty BM
        • Mueller WH
        • Reeves R
        • et al.
        Migration history, health behaviors, and cardiovascular disease risk factors in overweight Mexican-American women.
        Ethn Dis. 2003; 13: 94-108
        • Gaston SA
        • Nguyen-Rodriguez S
        • Aiello AE
        • et al.
        Hispanic/Latino heritage group disparities in sleep and the sleep-cardiovascular health relationship by housing tenure status in the United States.
        Sleep Health. 2020; 6: 451-462
        • Patel SR
        • Sotres-Alvarez D
        • Castaneda SF
        • et al.
        Social and health correlates of sleep duration in a US Hispanic population: results from the Hispanic Community Health Study/Study of Latinos.
        Sleep. 2015; 38: 1515-1522
        • Ryu S
        • Slopen N
        • Ogbenna BT
        • Lee S.
        Acculturation and sleep outcomes in Asian Americans and Pacific Islanders: results from the national epidemiologic survey on alcohol and related conditions-III.
        Sleep Health. 2021; 7: 683-690
        • Heilemann MV
        • Choudhury SM
        • Kury FS
        • Lee KA.
        Factors associated with sleep disturbance in women of Mexican descent.
        J Adv Nurs. 2012; 68: 2256-2266
        • Seicean S
        • Seicean A.
        Insomnia in adult Latino immigrants in the United States.
        Hisp Health Care Int. 2010; 8: 227-234
        • Manber R
        • Steidtmann D
        • Chambers AS
        • Ganger W
        • Horwitz S
        • Connelly CD.
        Factors associated with clinically significant insomnia among pregnant low-income Latinas.
        J Womens Health. 2013; 22 (2002): 694-701
        • Gonzalez BD
        • Lu Q.
        Sleep disturbance among Chinese breast cancer survivors living in the USA.
        Support Care Cancer. 2018; 26: 1695-1698
        • Johnson DA
        • Knutson K
        • Colangelo LA
        • et al.
        Associations of chronic burden, sleep characteristics, and metabolic syndrome in the coronary artery risk development in young adults study.
        Psychosom Med. 2022; 84: 711-718
        • Easterlin RA
        • Marcelli E
        The Cross-over in the Life Cycle Happiness of American Women and Men.
        in: Hinte H Zimmermann KF Happiness, Growth, and the Life Cycle. Oxford University Press, Oxford, England2010: 175-178 (IZA Prize in Labor Economics Series)
        • Thomson MD
        • Hoffman-Goetz L.
        Defining and measuring acculturation: a systematic review of public health studies with Hispanic populations in the United States.
        Soc Sci Med. 2009; 69: 983-991
        • Cuellar I
        • Harris LC
        • Jasso R.
        An acculturation scale for Mexican American normal and clinical populations.
        Hisp J Behav Sci. 1980; 2: 199-217
        • Marin G
        • Sabogal F
        • Marin BV
        • Otero-Sabogal R
        • Perez-Stable EJ.
        Development of a short acculturation scale for Hispanics.
        Hisp J Behav Sci. 1987; 9: 183-205
        • Marin G
        • Gamba RJ.
        A new measurement of acculturation for Hispanics: The Bidimensional Acculturation Scale for Hispanics (BAS).
        Hisp J Behav Sci. 1996; 18: 297-316
        • Cuellar I
        • Arnold B
        • Maldonado R.
        Acculturation rating scale for Mexican Americans-II: a revision of the original ARSMA scale.
        Hisp J Behav Sci. 1995; 17: 275-304
        • Cervantes RC
        • Fisher DG
        • Padilla AM
        • Napper LE.
        The Hispanic stress inventory version 2: improving the assessment of acculturation stress.
        Psychol Assess. 2016; 28: 509-522
        • Williams DR
        • Yu Y
        • Jackson JS.
        Racial differences in physical and mental health.
        J Health Psychol. 1997; 2: 335-351
        • Cappuccio FP
        • Cooper D
        • D'Elia L
        • Strazzullo P
        • Miller MA
        Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies.
        Eur Heart J. 2011; 32: 1484-1492
        • van der Zee K
        • Benet-Martínez V
        • van Oudenhoven JP.
        Personality and acculturation.
        (eds.)in: Sam DL Berry JW The Cambridge Handbook of Acculturation Psychology. 2nd ed. Cambridge University Press, Cambridge, England2016: 50-70 (Cambridge Handbooks in Psychology)
        • Mead MP
        • Persich MR
        • Duggan KA
        • Veronda A
        • Irish LA.
        Big 5 personality traits and intraindividual variability in sleep duration, continuity, and timing.
        Sleep Health J Natl Sleep Found. 2021; 7: 238-245
        • Viruell-Fuentes EA
        • Miranda PY
        • Abdulrahim S.
        More than culture: structural racism, intersectionality theory, and immigrant health.
        Soc Sci Med. 2012; 75: 2099-2106
        • Karan M
        • Park H
        Sleep quality and cultural orientation among Chinese and Korean undergraduates in the United States.
        J Am Coll Health. 2022; 70: 660-664
        • Nuyen BA
        • Fox RS
        • Malcarne VL
        • Wachsman SI
        • Sadler GR.
        Excessive daytime sleepiness as an indicator of depression in Hispanic Americans.
        Hisp Health Care Int. 2016; 14: 116-123
        • Jackson CL
        • Kawachi I
        • Redline S
        • Juon HS
        • Hu FB.
        Asian-White disparities in short sleep duration by industry of employment and occupation in the US: a cross-sectional study.
        BMC Public Health. 2014; 14: 552