The Impact of Sleep Deficits in Incarceration Settings: A Systematic Review and Meta-Analysis

Abstract

Background: Inadequate sleep has been an ongoing and large-scale health concern that disproportionately affects incarcerated populations. Because correctional health is an understudied area of research, there is a lack of comprehensive evidence on the exposure-response relationships and long-term health outcomes of chronic insufficient sleep that is specific to this population. Research aim: This study aims to systematically synthesize the literature regarding sleep within the context of incarceration settings, and to quantitatively estimate the health impact of inadequate sleep on incarcerated populations. Methods: A systematic review was conducted using multiple databases including MEDLINE, Project Muse, and Criminal Justice Abstracts, and data analysis was used to determine the morbidity and mortality burden that is attributable to inadequate sleep. Results: A total of 15 peer-reviewed articles and 25 grey literature records were included for review. The most commonly reported factors associated with poor sleep include loud noise, bright lighting, inadequate bedding, and mental illness. Meta-analysis results found the incarcerated population’s pooled mean sleep duration to be 5.7 hours (95% CI 5.56 - 5.84). Attributable risk calculations found an estimated 539 excess deaths (515 male, 24 female), 711 excess cardiovascular disease incident cases (692 male, 19 female), and 31 excess stroke incident cases (25 male, 6 female) due to insufficient sleep. Conclusion: The average sleep duration of the U.S. incarcerated population is lower than that of the general population, and individuals in incarceration settings are at higher risk of poor health outcomes. The physical conditions and policies within prison and jail environments have considerable influence on sleep and restructuring these factors may be beneficial. Future research studies specifically focusing on risk factors and exploring potential solutions are necessary.