How Acculturation Shapes Sleep in Thai Women in the United States During Menopausal Transition: A Mediation and Moderation Analysis

Abstract

Introduction:

This study examines acculturation’s impact on sleep quality, efficiency, and obstructive sleep apnea (OSA) risk among Thai women in the United States transitioning through menopause.

Methodology:

This cross-sectional descriptive study recruited 120 Thai women aged 40 to 65. Questionnaires assessed sleep quality (Pittsburgh Sleep Quality Index [PSQI]), OSA risk (Berlin), menopausal symptoms (Menopause Rating), acculturation (Suinn-Lew Asian Self-Identity Scale), and anxiety (Patient-Reported Outcome Measurement Information System). Data were analyzed using bivariate correlations, multivariable regression, and mediation/moderation analyses.

Results:

Mean age was 51.53 (SD = 7.73) years. Most were good sleepers (PSQI <5: 80.83%) and 14.17% at high risk of OSA. Acculturation was associated with better sleep quality (B = −1.086, p = .027) and higher sleep efficiency (B = 2.425, p = .021). Mediation analysis indicated that length of stay in the United States indirectly affected sleep quality (B = −0.022, p = .026) and efficiency (B = 0.051, p = .018) via acculturation.

Discussion:

Acculturation significantly affects sleep among Thai women; higher acculturation correlates with better sleep quality and efficiency. Acculturation did not affect OSA risk, suggesting context-specific influences that may benefit sleep through increased social integration. Future research should explore underlying mechanisms in immigrant populations.

Keywords

sleep health acculturation midlife women menopause Thai immigrants

Get full access to this article

View all access options for this article.

References

American Sleep Apnea Association. (2023, March 20). The state of sleep health in America 2023—Sleep Health. https://www.sleephealth.org/sleep-health/the-state-of-sleephealth-in-america/

Aqua

J. K.

White

Johnson

D. A.

(2023). A systematic review of acculturation and sleep health among adult immigrants in the United States. Sleep Health, 9(3), 288–305. https://doi.org/10.1016/j.sleh.2023.01.007

Baker

F. C.

Lampio

Saaresranta

Polo-Kantola

(2018). Sleep and sleep disorders in the menopausal transition. Sleep Medicine Clinics, 13(3), 443–456. https://doi.org/10.1016/j.jsmc.2018.04.011

Barot

(2021). Optimal sleep habits in middle-aged adults. In Stein

(Ed.), Reference module in neuroscience and biobehavioral psychology (pp. 116–122). Elsevier. https://doi.org/10.1016/B978-0-12-822963-7.00003-7

Buysse

D. J.

Reynolds

C. F.

Monk

T. H.

Berman

S. R.

Kupfer

D. J.

(1989). The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193–213. https://doi.org/10.1016/0165-1781(89)90047-4

Cadge

Sangdhanoo

(2005). Thai Buddhism in America: An historical and contemporary overview. Contemporary Buddhism, 6, 7–35. https://doi.org/10.1080/14639940500129421

Cappuccio

F. P.

Miller

M. A.

(2017). Sleep and cardio-metabolic disease. Current Cardiology Reports, 19(11), 110. https://doi.org/10.1007/s11886-017-0916-0

Carnethon

M. R.

De Chavez

P. J.

Zee

P. C.

Kim

K.-Y. A.

Liu

Goldberger

J. J.

Knutson

K. L.

(2016). Disparities in sleep characteristics by race/ethnicity in a population-based sample: Chicago Area Sleep Study. Sleep Medicine, 18, 50–55. https://doi.org/10.1016/j.sleep.2015.07.005

Chair

S. Y.

Wang

Cheng

H. Y.

S. W.-S.

X. M.

Wong

E. M.-L.

Sit

J. W.-H.

(2017). Relationship between sleep quality and cardiovascular disease risk in Chinese post-menopausal women. BMC Women’s Health, 17(1), 79. https://doi.org/10.1186/s12905-017-0436-5

10.

Chapagai

Martyn-Nemeth

(2022). Sleep health, acculturation, and acculturative stress in immigrants in the United States: A scoping review. Journal of Transcultural Nursing, 33(3), 398–415. https://doi.org/10.1177/10436596211072884

11.

Choi

J. W.

(2020). Association of sleep disturbance with risk of cardiovascular disease and all-cause mortality in patients with new-onset type 2 diabetes: Data from the Korean NHIS-HEALS. Cardiovascular Diabetology, 19, 61. https://doi.org/10.1186/s12933-020-01032-5

12.

Fetveit

Straand

Bjorvatn

Kristoffersen

E. S.

(2019). Self-reported sleeplessness in 12,655 persons living in the north of Norway: The Tromsø Study. Sleep Science (Sao Paulo, Brazil), 12(3), 147–155. https://doi.org/10.5935/1984-0063.20190070

13.

Freedman

D. A.

(2006). On the so-called “Huber Sandwich Estimator” and “Robust Standard Errors.” The American Statistician, 60(4), 299–302. https://doi.org/10.1198/000313006X152207

14.

Ghani

S. B.

Delgadillo

M. E.

Granados

Okuagu

A. C.

Alfonso-Miller

Buxton

O. M.

Patel

S. R.

Ruiz

Parthasarathy

Haynes

P. L.

Molina

Seixas

Williams

Jean-Louis

Grandner

M. A.

(2020). Acculturation associated with sleep duration, sleep quality, and sleep disorders at the US-Mexico border. International Journal of Environmental Research and Public Health, 17(19), 7138. https://doi.org/10.3390/ijerph17197138

15.

Hafner

Stepanek

Taylor

Troxel

W. M.

van Stolk

(2017). Why sleep matters—The economic costs of insufficient sleep. Rand Health Quarterly, 6(4), 11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5627640/

16.

Hale

Rivero-Fuentes

(2011). Negative acculturation in sleep duration among Mexican immigrants and Mexican Americans. Journal of Immigrant and Minority Health, 13(2), 402–407. https://doi.org/10.1007/s10903-009-9284-1

17.

Hale

Troxel

Kravitz

Hall

Matthews

(2014). Acculturation and sleep among a multiethnic sample of women: The Study of Women’s Health Across the Nation (SWAN). Sleep, 37, 309–317. https://doi.org/10.5665/sleep.3404

18.

Harlow

S. D.

Gass

Hall

J. E.

Lobo

Maki

Rebar

R. W.

Sherman

Sluss

P. M.

de Villiers

T. J.

(2012). Executive summary of the Stages of Reproductive Aging Workshop + 10: Addressing the unfinished agenda of staging reproductive aging. Menopause, 19(4), 387–395. https://doi.org/10.1097/gme.0b013e31824d8f40

19.

Hayes

A. F.

(2022). Introduction to mediation, moderation, and conditional process analysis, third edition: A regression-based approach. The Guilford Press.

20.

Heinze

Wallisch

Dunkler

(2018). Variable selection–a review and recommendations for the practicing statistician. Biometrical Journal, 60(3), 431–449.

21.

Hilbe

(2009). Data analysis using regression and multilevel/hierarchical models. Journal of Statistical Software, 30, 1–5.

22.

Hombrados-Mendieta

Millán-Franco

Gómez-Jacinto

Gonzalez-Castro

Martos-Méndez

M. J.

García-Cid

(2019). Positive influences of social support on sense of community, life satisfaction and the health of immigrants in Spain. Frontiers in Psychology, 10, 2555. https://doi.org/10.3389/fpsyg.2019.02555

23.

E.-O.

Lee

Chee

(2020). Immigration transition and cognitive symptoms during menopausal transition. Western Journal of Nursing Research, 42(4), 269–277. https://doi.org/10.1177/0193945919858366

24.

Ishikura

Lucena

Andersen

Tufik

Girao

Hachul

(2022). 0711 Do postmenopausal women with insomnia and obstructive sleep apnea have deterioration in sexual function. Sleep, 45, A312.

25.

James

Witten

Hastie

Tibshirani

(2013). An introduction to statistical learning (Vol. 103). Springer. https://doi.org/10.1007/978-1-4614-7138-7

26.

Jenatabadi

H. S.

(2015). An overview of path analysis: Mediation analysis concept in structural equation modeling.

27.

Jones

H. J.

Zak

Lee

K. A.

(2018). Sleep disturbances in midlife women at the cusp of the menopausal transition. Journal of Clinical Sleep Medicine, 14(7), 1127–1133. https://doi.org/10.5664/jcsm.7208

28.

Julia

(2022, September 7). Sleep statistics: Facts & latest data in America (2024 update). The Center for Advancing Health (CFAH). https://cfah.org/sleep-statistics/

29.

Kalleinen

Aittokallio

Lampio

Kaisti

Polo-Kantola

Polo

Heinonen

O. J.

Saaresranta

(2021). Sleep during menopausal transition: A 10-year follow-up. Sleep, 44(6), zsaa283. https://doi.org/10.1093/sleep/zsaa283

30.

Kandula

N. R.

Lauderdale

D. S.

(2005). Leisure time, non-leisure time, and occupational physical activity in Asian Americans. Annals of Epidemiology, 15(4), 257–265. https://doi.org/10.1016/j.annepidem.2004.06.006

31.

Lee

Ryu

Lee

G. E.

Kawachi

Morey

B. N.

Slopen

(2022). The association of acculturative stress with self-reported sleep disturbance and sleep duration among Asian Americans. Sleep, 45(4), zsab298. https://doi.org/10.1093/sleep/zsab298

32.

Leong

Chou

E. L.

(1998). Developing brief versions of the Suinn-Lew Asian self-identity acculturation (SLASIA) Scale for counseling research. Asian American and Pacific Islander Journal of Health, 6(1), 13–24.

33.

Liu

Cho

(2024). Heterogeneities in sleep duration and quality among US immigrants from different racial and ethnic backgrounds. Sleep Health, 10(4), 393–401.

34.

Long

J. S.

Long

J. S.

(1997). Regression models for categorical and limited dependent variables. Sage.

35.

Lueck

Wilson

(2010). Acculturative stress in Asian immigrants: The impact of social and linguistic factors. International Journal of Intercultural Relations, 34(1), 47–57. https://doi.org/10.1016/j.ijintrel.2009.10.004

36.

Martinez-Miller

E. E.

Prather

A. A.

Robinson

W. R.

Avery

C. L.

Yang

Y. C.

Haan

M. N.

Aiello

A. E.

(2019). US acculturation and poor sleep among an intergenerational cohort of adult Latinos in Sacramento, California. Sleep, 42(3), zsy246. https://doi.org/10.1093/sleep/zsy246

37.

Mirer

A. G.

Young

Palta

Benca

R. M.

Rasmuson

Peppard

P. E.

(2017). Sleep-disordered breathing and the menopausal transition among participants in the Sleep in Midlife Women Study. Menopause, 24(2), 157–162. https://doi.org/10.1097/GME.0000000000000744

38.

Nandagiri

Vannemreddy

Spector

(2023). Sleep disparities in Asian Americans: A comprehensive review. Journal of Clinical Sleep Medicine, 19(2), 393–402.

39.

National Institute on Aging. (2021). What is menopause? https://www.nia.nih.gov/health/menopause/what-menopause

40.

Neruntarat

Chantapant

(2011). Prevalence of sleep apnea in HRH Princess Maha Chakri Srinthorn Medical Center, Thailand. Sleep and Breathing = Schlaf & Atmung, 15(4), 641–648. https://doi.org/10.1007/s11325-010-0412-x

41.

Netzer

N. C.

Stoohs

R. A.

Netzer

C. M.

Clark

Strohl

K. P.

(1999). Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Annals of Internal Medicine, 131(7), 485–491. https://doi.org/10.7326/0003-4819-131-7-199910050-00002

42.

Newsome

Seixas

Iwelunmor

Zizi

Kothare

Jean-Louis

(2017). Place of birth and sleep duration: Analysis of the National Health Interview Survey (NHIS). International Journal of Environmental Research and Public Health, 14(7), 738. https://doi.org/10.3390/ijerph14070738

43.

Noonil

Hendricks

Aekwarangkoon

(2012). Lived experience of Thai women and their changing bodies in midlife. Nursing & Health Sciences, 14(3), 312–317.

44.

Odai

Terauchi

Umeki

Miyasaka

Somekawa

(2022). Sleep apnea in postmenopausal women is associated with joint pain severity and fatigability: A cross-sectional study. Menopause, 29(6), 680–686. https://doi.org/10.1097/GME.0000000000001974

45.

Ormiston

C. K.

Lopez

Ishino

F. A. M.

McNeel

T. S.

Williams

(2022). Acculturation and depression are associated with short and long sleep duration among Mexican Americans in NHANES 2005–2018. Preventive Medicine Reports, 29, 101918.

46.

Pien

G. W.

Sammel

M. D.

Freeman

E. W.

Lin

DeBlasis

T. L.

(2008). Predictors of sleep quality in women in the menopausal transition. Sleep, 31(7), 991–999.

47.

Potthoff

Heinemann

L. A.

Schneider

H. P.

Rosemeier

H. P.

Hauser

G. A.

(2000). The Menopause Rating Scale (MRS II): Methodological standardization in the German population. Zentralblatt Fur Gynakologie, 122(5), 280–286.

48.

Ravichandran

Gupta

Singh

Nag

Thomas

Panjiyar

B. K.

(2023). The interplay between sleep disorders and cardiovascular diseases: A systematic review. Cureus, 15(9), e45898. https://doi.org/10.7759/cureus.45898

49.

Richters

J. M. A.

(1997). Menopause in different cultures. Journal of Psychosomatic Obstetrics & Gynecology, 18(2), 73–80.

50.

Rothe

E. M.

Tzuang

Pumariega

A. J.

(2010). Acculturation, development, and adaptation. Child and Adolescent Psychiatric Clinics of North America, 19(4), 681–696. https://doi.org/10.1016/j.chc.2010.07.002

51.

Rothrock

N. E.

Amtmann

Cook

K. F.

(2020). Development and validation of an interpretive guide for PROMIS scores. Journal of Patient-Reported Outcomes, 4(1), 16. https://doi.org/10.1186/s41687-020-0181-7

52.

Ryu

Slopen

Ogbenna

B. T.

Lee

(2021). Acculturation and sleep outcomes in Asian Americans and Pacific Islanders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Sleep Health, 7(6), 683–690. https://doi.org/10.1016/j.sleh.2021.09.004

53.

Sarkkola

Rounge

T. B.

Simola-Ström

Von Kraemer

Roos

Weiderpass

(2016). Validity of home-measured height, weight and waist circumference among adolescents. The European Journal of Public Health, 26(6), 975–977.

54.

Seicean

Neuhauser

Strohl

Redline

(2011). An exploration of differences in sleep characteristics between Mexico-born US immigrants and other Americans to address the Hispanic paradox. Sleep, 34(8), 1021–1031. https://doi.org/10.5665/SLEEP.1154

55.

Sephton

S. E.

Kay

D. B.

(2024). How do psychosocial and cultural factors influence sleep and circadian health disparities? Research Directions: Sleep Psychology, 1, e1.

56.

StataCorp. (2017). Stata statistical software: Release 15 [Computer software]. https://www.stata.com/support/faqs/resources/citing-software-documentation-faqs/

57.

Suinn

R. M.

Ahuna

Khoo

(1992). The Suinn-Lew Asian Self-Identity Acculturation Scale: Concurrent and factorial validation. Educational and Psychological Measurement, 52(4), 1041–1046. https://doi.org/10.1177/0013164492052004028

58.

Tandon

V. R.

Sharma

Mahajan

Tandon

(2022). Menopause and sleep disorders. Journal of Mid-Life Health, 13(1), 26–33. https://doi.org/10.4103/jmh.jmh_18_22

59.

Thomas

A. J.

Mitchell

E. S.

Woods

N. F.

(2018). The challenges of midlife women: Themes from the Seattle midlife Women’s health study. Women Midlife Health, 4, 8. https://doi.org/10.1186/s40695-018-0039-9

60.

Tobin

(1958). Estimation of relationships for limited dependent variables. Econometrica, 26(1), 24–36. https://doi.org/10.2307/1907382

61.

Whinnery

Jackson

Rattanaumpawan

Grandner

M. A.

(2014). Short and long sleep duration associated with race/ethnicity, sociodemographics, and socioeconomic position. Sleep, 37(3), 601–611.

62.

Winzer

Gray

R. S.

(2019). The role of Buddhist practices in happiness and health in Thailand: A structural equation model. Journal of Happiness Studies, 20, 411–425.

63.

Woods

N. F.

Mitchell

E. S.

(2016). The Seattle Midlife Women’s Health Study: A longitudinal prospective study of women during the menopausal transition and early postmenopause. Women’s Midlife Health, 2(1), 6. https://doi.org/10.1186/s40695-016-0019-x

64.

Yazdi

Sadeghniiat-Haghighi

Ziaee

Elmizadeh

Ziaeeha

(2013). Influence of sleep disturbances on quality of life of Iranian menopausal women. Psychiatry Journal, 2013, 1–5. https://doi.org/10.1155/2013/907068

65.

Yin

Jin

Shan

Huang

Peng

Bao

Yang

Chen

Liu

(2017). Relationship of sleep duration with all-cause mortality and cardiovascular events: A systematic review and dose-response meta-analysis of prospective cohort studies. Journal of the American Heart Association, 6(9), e005947. https://doi.org/10.1161/JAHA.117.005947

66.

Zak

Zitser

Jones

H. J.

Gilliss

C. L.

Lee

K. A.

(2023). Sleep symptoms signaling the menopausal transition. Journal of Clinical Sleep Medicine, 19(8), 1513–1521.

67.

Zou

Waliwitiya

Luo

Sun

Shao

Zhang

Huang

(2021). Factors influencing healthy menopause among immigrant women: A scoping review. BMC Women’s Health, 21(1), 189.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.06 MB