Sleeping without borders: Gaps in contextualizing sleep duration guidelines for adults in low-income countries

Empirical data on adult sleep health are scarce in many low-income countries, despite the significant health risks associated with inadequate sleep. To help address this gap in low-income countries, the World Sleep Society's Global Sleep Health Taskforce recommends applying evidence from high-income settings - such as guidance from the American Academy of Sleep Medicine/Sleep Research Society AASM/SRS) and the National Sleep Foundation (NSF) to inform the development of sleep health policies and programs.

To evaluate the appropriateness of adapting existing consensus recommendations on healthy sleep duration for adults from the AASM/SRS and the NSF for use in low-income countries by applying World Health Organization (WHO) contextualization benchmarks.

We reviewed AASM/SRS and NSF methods papers and assessed four WHO benchmarks: (1) consideration of low-income country priorities in question formulation and literature search; (2) inclusion of evidence from low-income countries; (3) involvement of stakeholders from low-income countries in consensus preparation; and (4) representation of low-income countries or relevant expertise in expert panels. Empirical studies cited in both statements were classified by country income level using World Bank 2025-2026 classifications. Chi-square tests compared distributions across income groups.

Neither the AASM/SRS or NSF consensus process incorporated priorities, evidence, or representation from low-income countries. Of the empirical studies reviewed, 96% originated from high-income countries, 4% from upper-middle-income countries, and none from lower-middle-income countries (LMIC). No stakeholders or experts from low-income countries participated in guideline development. Both statements showed significant overrepresentation of high-income contexts (p < .001).

Current sleep duration recommendations lack contextualization for low-income settings and do not meet WHO standards in this regard. Future guideline development should broaden evidence sources, engage local stakeholders, and apply participatory frameworks to ensure cultural relevance, equity, and practical implementation.