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.