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 https://doi.org/10.47488/dhrp.v2iS4.75 

 

 

 
DHR Proceedings ǀ http://dhrproceedings.org 1 2022, Vol. 2 No. S4 1-6 

 

COMMENTARY 

Sociology of Sleep Health in the Rio Grande 

Valley 
 

Jiya Devnani1, Deepak Srivastava2, and Sohail Rao3,4 

1The Village High School, Houston, Texas (Grade 12) 

ORCID ID: 0000-0003-0468-7826  
2Deepak Srivastava MD, FAASM, FACP, FCCP, RPSGT. Professor of Medicine, Sleep Medicine, and Critical Care, UC Davis,  

ORCID ID: 0000-0002-7708-4885 
3Sohail Rao, MD, MA, DPhil. Executive Vice President for Research and Leadership Development, DHR Health System and 

  Founding President & CEO, DHR Health Institute for Research & Development 

ORCID ID: 0000-0001-5027-9992 

 
4Corresponding Author: Sohail Rao, MD, MA, DPhil. DHR Health Institute for Research & Development, 5323 S McColl Road,        

Edinburg, TX 78539. E-mail: s.rao@dhr-rgv-com 

 

Received 10/10/2022 

Accepted for publication: 10/11/2022 

Published: 10/11/2022

Abstract 

It is estimated that 50 – 70 million Americans have sleep disorders and 1 in 3 (33%) of adults do not regularly 

get the recommended amount of uninterrupted sleep. Several factors contribute to this burgeoning healthcare crisis 

which has far-reaching consequences at the individual and societal levels. Residents in the Rio Grande Valley have 

been identified as the third most vulnerable population for the prevalence of cardiovascular disease in the country, 

with obesity being a major identifiable contributory factor. Factors that further augment this encumbrance include 

undiagnosed comorbid sleep disorders. Identifying unique socio-cultural challenges in this growing, vibrant 

population is vital to improve public health outcomes. Lack of accessible medical resources, high level of uninsured, 

poverty, and inadequate sleep health education makes this population extremely vulnerable to the sleep debt crisis 

with its intended negative outcomes.  

Keywords: Sleep disorders, sleep apnea, Hispanic, racial disparities 

Introduction 

Sleep is a natural, reversible condition of rest, 

and inactivity for the body and mind. Sleep is when 

our bodies mend, regenerate, and revitalize. A third of 

our lifetimes is spent in this universally inescapable 

physiological state, driven by neurochemical 

phenomena which is significantly influenced by 

environmental, social, and personal cues. Sleep health 

is a burgeoning yet neglected health concern; various 

biological and social variables intertwine to contribute 

to this burden, which has far-reaching implications at 

the individual, social, and societal levels. The 

importance of sleep deprivation impacting cerebral, 

cardiovascular, metabolic health, and immunity is well 

documented in the medical literature. Obstructive 

sleep apnea is linked to hypertension, heart disease, 

stroke, atherosclerosis, and poor glycemic control (1). 

Additionally, sleep interruptions interfere with deep 

restorative slow-wave sleep, which impacts mental 

health, memory concentration, and productivity. The 

amount of sleep one needs changes with age with 

infants requiring more sleep as compared to the adults 

https://orcid.org/0000-0003-0468-7826
https://orcid.org/0000-0002-7708-4885
https://orcid.org/0000-0001-5027-9992
mailto:s.rao@dhr-rgv-com


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(2, 3). As per the recommendations of the American 

Academy of Sleep Medicine, infants require 12-16 

hours of sleep per day whereas adults aged 18-60 years 

require over seven hours of sleep per day (Table 1). 

Sleep has a bidirectional link between social 

and environmental influences dictated by 

interpersonal factors. Recognizing the constraints 

impacting sleep from an economic and sociocultural 

landscape is vital. The study of upstream social-

environmental forces that weave a complex 

framework is critical in identifying key influencers 

that play a role in healthcare delivery. The Rio Grande 

Valley (RGV) in South Texas is among the fastest 

growing region in the nation with an estimated 

population of >1.4 million people. Over 90% of the 

people living in RGV are of Hispanic ethnicity; 30-

40% are uninsured; and >30% live below the poverty 

line in medically underserved regions.  This unique 

socio-economic and demographic pattern makes it a 

very vulnerable at-risk population thus requiring 

strategies with visionary public policy to improve 

health outcomes. 

The Burden of Chronic Disease and Poor 

Sleep Health in The Rio Grande Valley 

Aptly summarizing the urgency of the health 

crisis, Evelia Castillo, the coordinator of the “Working 

on Wellness Program,” declared that, "The Valley is 

ground zero for Texas." (4). Obesity is significantly 

more prevalent among Hispanics, who constitute 

>90% of the population. In the lower RGV, almost 

40% population is classified as clinically obese which 

is greater than the state or national levels. Equally 

disconcerting is the high percentage of people in the 

Valley suffering from chronic diseases such as 

diabetes, liver disorders, cancer, cardiovascular 

diseases, etc.  

Sleep disorders have been linked to an 

increased risk of heart failure, glucose intolerance, and 

cognitive impairment. Sleep is a natural, reversible 

condition of rest, and inactivity for the body and mind. 

Sleep is when our bodies mend, regenerate, and 

revitalize. A third of our lifetimes are spent in this 

universally inescapable physiological state, driven by 

neurochemical phenomena yet significantly 

influenced by environmental, social, and personal 

cues. Sleep health is a burgeoning yet neglected health 

concern; various biological and social variables 

intertwine to contribute to this burden, which has far-

reaching implications at the individual, social, and 

societal levels. Sleep has a bidirectional link between 

social and environmental influences dictated by 

interpersonal factors therefore recognizing the 

constraints impacting sleep from an economic and 

sociocultural landscape is vital. The study of upstream 

social-environmental forces that weave a complex 

framework is critical in identifying key influencers 

that play a role in healthcare delivery. 

Methods 

A literature review spanning 2000-2021 

utilizing databases that covered social sciences 

(ASSIA) and clinical medicine (PubMed, Medline) 

were explored for articles addressing sleep disorders 

and their adverse health outcomes, disparities, and 

limitations in access to healthcare with focus on 

demographically and geographically relevant data. 

Articles were identified that addressed the influence of 

factors such as race, language, economic challenges, 

and sociocultural and environmental conditions. 

Results and Discussion 

Effects of Sleep Deprivation 

It is predicted that 50–70 million Americans 

suffer from chronic sleep and wakefulness disorders, 

which impede everyday functioning and negatively 

affect health and longevity. There are over 90 separate 

sleep disorders, the International Classification of 

Sleep Disorders has grouped them into six major 

categories based on clinical symptoms of sleep-related 

breathing disorders; excessive daytime drowsiness; 

trouble starting or sustaining sleep; and abnormal 

behaviors occurring prior to or during sleep (5). The 

cumulative long-term impacts of sleep deprivation and 

sleep disorders have been linked to various negative 

health outcomes, including an increased risk of 

hypertension, diabetes, obesity, depression, heart 

attack, and stroke. 

Demographics of Rio Grande Valley 

RGV comprises four counties: Cameron, 

Hidalgo, Starr, and Willacy. Residents of the RGV 

have been recognized as the third most vulnerable in 

the country to cardiovascular disease, with obesity 

being a critical risk factor. Of the estimated 1.4 million 

people in the RGV approximately 86% of the 

population is below the age of 65 years. It is estimated 

that by 2045, the population in RGV will double to 

approximately 2.4 – 2.8 million people (6). 

Limited access to and motivation for 

education is reflected in one-third of over 25-years’ 

old not having achieved a ninth-grade education as 



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opposed to the national average of 5 percent. In 

addition, half and two-thirds of adults have high 

school diplomas, and area unemployment rates are 

high, with 30%–40% living below the federal poverty 

level. In practically every area of educational 

attainment, cities in RGV ranked “least educated” (7). 

Limited health insurance, lack of public 

transportation, and lack of easily accessible healthy 

meals are all contributory factors to poor health 

outcomes (8). 

The Burden of Chronic Disease in RGV 

Aptly summarizing the urgency of the health 

crisis, Evelia Castillo, the coordinator of the ‘Working 

on Wellness Program’ declared "The Valley is ground 

zero for Texas." Obesity is significantly more 

prevalent among Hispanics who constitute >90% of 

the population in RGV. In the lower RGV, almost 40% 

population are classified as clinically obese a number 

far greater than the state or national levels. Estimated 

prevalence of diabetes is 11.6% of adults in South 

Texas higher than the rest of Texas [9.3%] (9). South 

Texas Hispanics have a higher rate of mortality than 

Hispanics in the remainder of Texas. Hispanics in 

South Texas experienced a slightly higher rate of 

mortality from heart disease than non-Hispanics. 

Hispanic male mortality from strokes is greater than 

females in South Texas. Sleep disorders have been 

linked to an increased risk of heart failure, glucose 

intolerance, and cognitive impairment 

Barriers to Sleep Health 

"Where we sleep, when we sleep, and with 

whom we sleep are all important markers or indicators 

of social status, privilege, and prevailing power 

relations." said William Rodrigues Cintron (10). 

Obesity, diabetes, residing in the inner city, and 

alcohol use are all risk factors in Hispanics. 

Acculturation to the American way of life may result 

in worse sleep patterns, including short sleep duration 

and poor sleep hygiene. 

Is Race a Risk factor? 

By 2060, Hispanics/Latinos are expected to 

constitute 28% of the US population (Figure 1). 

Hispanics are more likely to be uninsured as compared 

to whites (11). Two current NIH-sponsored sleep 

studies on Hispanics in the United States promise to 

significantly contribute to the literature on various 

sleep disorders such as obstructive sleep apnea, 

insufficient sleep syndrome, and restless legs 

syndrome. Sleep Apnea Global Interdisciplinary 

Consortium has given insight into the Hispanic 

population's different phenotypic subgroups and 

gender variations (12). Many individuals meeting 

clinical obstructive sleep apnea criteria could go 

undiagnosed and subsequently not receive appropriate 

treatment due to minimum symptoms and presenting 

complaints. 

Disparities and Limitations in access to care: 

Language Barriers 

Health knowledge deficits may negatively 

affect outcomes. Spanish is the first language for 79% 

of the RGV population, and 19% of the population 

speak English. The inclusion of Spanish-speaking 

healthcare providers can improve health literacy. 

Developing trust among new immigrants is vital in 

developing continuity of care. High social and health 

risk factors affect children living in low-income areas. 

These families should be targeted with early-age and 

culturally appropriate health programs (13). 

Sociocultural and environmental factors 

Socioeconomically disadvantaged 

individuals are more likely to sleep in less-than-

optimal environments (e.g., too hot, or too cold, noisy, 

or crowded). Social determinants at individual, 

societal and social levels impact the framework that 

influences sleep health. Limited access to healthcare 

and comprehensive behavioral medicine services and 

ethno-racial disparities also impacts outcomes (14). 

Hispanics were less likely to report insufficient sleep 

than whites; they also have culturally specific sleep 

patterns, including siestas.  

Disparities in Treatment Adherence and 

Outcomes 

Continuous positive airway pressure (CPAP) 

adherence rates in Hispanic populations are lower than 

White populations. At a societal level, limited access 

to sleep medicine specialists, inequitable distribution 

healthcare resources, limited support from durable 

medical equipment providers for troubleshooting and 

support after CPAP initiation as well as language 

barriers have been identified as contributory factors. 

At an individual level, there exists mistrust among 

minorities in the medical system which has been 

linked to lower medication adherence. Unstable 

housing conditions, frequent changes in sleeping 

location can predict lower CPAP use (15). 

 



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Clinical Implications and The Path Forward 

Proposed Public Policy Reforms 

Several grass root movements have been 

initiated to improve collaborative research and 

enhance population health outcomes. The Working on 

Wellness Program, a Texas A&M University's 

Healthy South Texas initiative, is focused on 

improving preventive community and clinical health 

care. The Valley Interprofessional Dedicated Access 

and Service (VIDAS) program supports the 

development and implementation of primary care 

services for residents in the Colonias. The unique role 

of “promotoras,” who live and work in the 

communities serving as community advocates and 

liaisons, educators, mentors, outreach workers, role 

models, and interpreters is extremely valuable. This 

emphasis on building relationships within the 

community is also known as personalismo. 

Expanding the mission of the “UniMovil” 

Mobile Health Clinic to screen for sleep apnea is 

recommended. UniMovil is a revolutionary concept of 

a mobile clinic focusing on seven clinical outcomes all 

of which have impact of sleep health. It includes focus 

on obesity, diabetes, hypertension, 

hypertriglyceridemia, low high-density lipoprotein 

cholesterol (HDL-C) levels, and depression utilizing 

the Duke Health Profile. 

Organizations like LUPE and the Texas 

A&M AgriLife Extension Service run similar nutrition 

education programs tackling the obesity epidemic. The 

National Healthy Sleep Awareness Project launched 

the pledge to Dejar de Roncar (Stop the Snore) to raise 

awareness among Hispanics about adverse health 

outcomes associated with sleep-breathing disorders. 

Building on the existing social network and 

disseminating sleep health information, integrating 

screening for sleep disorders into primary care 

frameworks, and embracing telemedicine to widen the 

footprint are vital strategies. A multidisciplinary 

approach is required to increase targeted healthcare 

access in a cost-effective, sustainable model with 

limited resources in a challenging sociocultural 

landscape. 

Summary 

Strategies with visionary public policy are 

vital to improving health outcome measures. Several 

grass root movements have been initiated to strengthen 

collaborative research and enhance population health 

outcomes. Generating social awareness, addressing 

public safety, and implementing change can improve 

sleep health and associated comorbidities in 

predominantly Hispanic population in the RGV. 

Funding 

The project was funded by a Seed Grant from the DHR 

Health Institute for Research & Development. 

Conflict of Interest 

The authors have reported no conflict of interest 

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Table 1. Recommended Hours of Sleep for Various Age Groups 

AGE AGE GROUP RECOMMENDED HOURS OF SLEEP 

4-12 months Infant 12-16 hours per 24 hours 

1-2 years Toddler 11-14 hours per 24 hours 

3-5 years Pre-School 10-13 years per 24 hours 

6-12 years School Age 9-12 hours per 24 hours 

13-18 years Teen 13-18 ours per 24 hours 

>18 years Adults >7hours per night 

 

 

 

 

 

Figure 1.  Projected Hispanic Population Growth (in percentage) by Year 2060 in the United States* 

*Adapted from United States Census Bureau. (https://www.census.gov/library/visualizations/2018/comm/hispanic-

projected-pop.html) 

 

19
20

21
22

23

25
26

27
28

0

5

10

15

20

25

30

2020 2025 2030 2035 2040 2045 2050 2055 2060

https://www.census.gov/library/visualizations/2018/comm/hispanic-projected-pop.html
https://www.census.gov/library/visualizations/2018/comm/hispanic-projected-pop.html

