Racial/ethnic disparities in infant sleep in the COVID-19 Mother Baby Outcomes (COMBO) study

Maristella Lucchini, Monica R. Ordway, Margaret H. Kyle, Nicolò Pini, Jennifer R. Barbosa, Ayesha Sania, Lauren C. Shuffrey, Morgan R. Firestein, Cristina R. Fernández, William P. Fifer, Carmela Alcántara, Catherine Monk, Dani Dumitriu

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Objective: Investigate racial and ethnic differences in infant sleep and examine associations with insurance status and parent-infant bedtime behavioral factors (PIBBF). Methods: Participants are part of the COVID-19 Mother Baby Outcomes (COMBO) Initiative, Columbia University. Data on infant sleep (night, day and overall sleep duration, night awakenings, latency, infant's sleep as a problem) were collected at 4 months postpartum. Regressions estimated associations between race/ethnicity, insurance status, PIBBF and infants’ sleep. Results: A total of 296 infants were eligible (34.4% non-Hispanic White [NHW], 10.1% Black/African American [B/AA], 55.4% Hispanic). B/AA and Hispanic mothers were more likely to have Medicaid, bed/room-share, and report later infant bedtime compared to NHW mothers. Infants of B/AA mothers had longer sleep latency compared to NHW. Infants of Hispanic mothers slept less at night (∼70 ± 12 minutes) and more during the day (∼41 ± 12 minutes) and Hispanic mothers were less likely to consider infants’ sleep as a problem compared to NHW (odds ratio 0.4; 95% confidence interval: 0.2-0.7). After adjustment for insurance status and PIBBF, differences by race/ethnicity for night and day sleep duration and perception of infant's sleep as a problem persisted (∼32 ± 14 minutes, 35 ± 15 minutes, and odds ratio 0.4; 95% confidence interval: 0.2-0.8 respectively). Later bedtime was associated with less sleep at night (∼21 ± 4 minutes) and overall (∼17 ± 5 minutes), and longer latency. Infants who did not fall asleep independently had longer sleep latency, and co-sleeping infants had more night awakenings. Conclusions: Results show racial/ethnic differences in sleep in 4-month-old infants across sleep domains. The findings of our study suggest that PIBBF have an essential role in healthy infant sleep, but they may not be equitably experienced across racial/ethnic groups.

Original languageEnglish
Pages (from-to)429-439
Number of pages11
JournalSleep Health
Issue number5
StatePublished - Oct 2022
Externally publishedYes


  • Bedtime behavioral factors
  • Disparities
  • Ethnicity
  • Infancy
  • Race
  • Sleep


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