Social Health and Sleep Quality Among Older Korean Americans In Senior Housing

Background and Purpose: Poor sleep is highly prevalent among older adults and is associated with adverse health outcomes such as cognitive decline, cardiovascular disease, and increased mortality. Growing attention has been paid to various social determinants of sleep health; however, social network and loneliness warrant further attention. Representing the structural and subjective dimensions of social relationships, respectively, social network and loneliness are not only interrelated, but they also undermine sleep health. Moving beyond these, we conceptualized loneliness as a mediator in the association between social networks and sleep health. It is anticipated that the negative effect of limited social networks on sleep health would be mediated through perceived loneliness. This indirect effect model was examined among older Korean Americans residing in low-income senior housing, a population characterized by disparities in social and sleep health, while incorporating multiple domains of sleep health (sleep efficiency, sleep quality, and daytime dysfunction).

Methods: Data were collected from 603 Korean American older adults residing in senior housing communities in Los Angeles, California (Mean age = 80.3, SD = 6.50; 70.5% female; 60.6% living alone). Three dimensions of sleep health (sleep efficiency, sleep quality, and daytime dysfunction) were measured with the Pittsburgh Sleep Quality Index, social network with the Lubben Social Network Scale (LSNS-6), and loneliness with the 3-item UCLA Loneliness Scale. Covariates included age, gender, living arrangement, education, financial status, years in the U.S., acculturation, chronic conditions, and functional disability. A series of multivariate models of sleep health were tested with the sequential entry of social network and loneliness, and mediation analyses were conducted using bootstrapping with 5,000 replications.

Results: Consistent with previous literature, social network, loneliness, and sleep health outcomes were closely associated. We also confirmed a significant direct effect of social network on each sleep health outcome. Furthermore, loneliness significantly mediated the associations across all sleep health outcomes, including sleep efficiency (B [SE] = −.01 [.01], 95% CI [−.02, −.00]), perceived sleep quality (B [SE] = −.03 [.01], 95% CI [−.05, −.02]), and daytime dysfunction (B [SE] = −.02 [.00], 95% CI [−.03, −.01]).

Conclusions and Implications: Loneliness mediated the association between social network and all three sleep dimensions, suggesting that deficits in social networks influence sleep primarily through increased feelings of loneliness. Targeting loneliness alongside social contact may therefore improve sleep outcomes. Senior housing, where residents share physical proximity, language, and cultural context, provides a natural setting for delivering targeted interventions. These characteristics can be leveraged to implement group-based social programs or peer support initiatives aimed at reducing loneliness and, in turn, improving sleep health in this population. The consistent mediation across all three dimensions underscores the value of multidimensional sleep assessment over reliance on a single composite score. Future longitudinal research is needed to establish the temporal ordering of these relationships and to determine whether loneliness-targeted interventions lead to meaningful improvements in sleep health.