AMERICAN INDIAN CHronic disEase RIsk and Sleep Health (AI-CHERISH)

摘要：比较研究和单种族研究都表明，睡眠障碍至少与 在美国印第安人和阿拉斯加原住民（AI/AN）中普遍存在，因为他们在所有种族人口中。睡眠 众所周知，这些问题是所有人群中慢性病和早期死亡的重要因素， 有效治疗睡眠障碍可改善对各种健康状况的管理。我们建议 进行一项创新的混合方法研究-美国印第安人慢性疾病风险和睡眠健康（AI- CHERISH）-评估CVD与代谢风险和睡眠健康之间的关系， 文化在首两个项目年度，我们将举办5个焦点小组（共15个小组，每组12名参与者） 和2轮半结构化访谈，5个关键的线人（共30次访谈）。由此产生的定性 数据将为睡眠健康的患者报告结果测量（PROM）的开发提供信息，以增强 制定措施，考虑到土著社区特有的因素，并以文化为基础， 改善睡眠的补充指南。在这项工作的定量部分，我们将实施 迄今为止最大的睡眠健康流行病学研究，使用AI/AN样本评估 睡眠不足及其与特定CVD风险因素的相关性。流行病学研究的参与者 他们之前参加了Strong Heart Family Study（SHFS）。在流行病学研究中，我们将招募 来自每个地理区域的250名年龄在30-50岁之间的AI参与者（N=750），并从每个区域收集睡眠数据。 受试者在9个月内的2次研究访视期间，其中一次访视在最长和 最短日照（5月至7月和11月至1月）。每次数据收集访视前7天， 参与者将佩戴腕关节活动记录仪来测量睡眠和清醒时的活动，并将记录日记， 记录清醒活动以及睡眠持续时间、巩固和时间。当他们归还活动记录仪时， 他们将完成4个有效的自我报告工具：匹兹堡睡眠质量指数，埃普沃思嗜睡 量表、睡眠卫生指数、失眠严重程度指数和STOP-Bang问卷。他们还将 提供关于社会人口统计学和CVD风险因素（血脂，血红蛋白A1 C，血压， BMI）已知受睡眠影响。我们的具体目标是：1）制定一个文化上适当的PROM， 通过使用焦点小组，基于影响每个研究地点睡眠的当地环境的睡眠健康。2)重点 访谈知情人，评估现有的指导方针，并阐明补充性的文化指导方针 改善每个研究地点的睡眠健康，以增强人工智能社区的现有指导方针。3)估计 通过分析3个研究中心的750名AI成年人样本中睡眠不足的患病率和性质， 来自活动记录仪的数据和来自睡眠/觉醒日记和标准化睡眠仪器的主观数据 在9个月期间的2个时间点。4)评估睡眠健康状况不佳的横截面关联， 通过我们的客观和主观睡眠测量，以及CVD和代谢风险因素来定义。

ABSTRACT: Both comparative and single-race studies suggest that sleep disorders are at least as prevalent among American Indians and Alaska Natives (AI/ANs) as they are in the all-races population. Sleep problems are known to be important contributors to chronic disease and early mortality in all populations, while effective treatment of sleep disorders improves the management of diverse health conditions. We propose to conduct an innovative mixed-methods study – American Indian CHronic disEase RIsk and Sleep Health (AI- CHERISH) – to assess the relationship between CVD and metabolic risk and sleep health in the context of Native culture. During the first 2 project years, we will conduct 5 focus groups (15 groups total; 12 participants each) and 2 rounds of semi-structured interviews with 5 key informants (30 interviews total). The resulting qualitative data will inform the development of a patient-reported outcome measure (PROM) of sleep health, to augment established measures accounting for factors specific to Native communities, and culturally-grounded, complementary guidelines for improving sleep. In the quantitative portion of this work, we will implement the largest epidemiologic study of sleep health to date with an AI/AN sample to assess the population prevalence of sleep deficiencies and their association with specific CVD risk factors. Participants in the epidemiologic study were previously enrolled in the Strong Heart Family Study (SHFS). For the epidemiologic study, we will recruit 250 AI participants aged 30–50 years from each geographic region (N=750) and collect sleep data from each participant during 2 study visits in a single 9-month period, with a visit during the months with the longest and shortest daylight exposure (May–July and November–January). For 7 days before each data collection visit, participants will wear wrist actigraphs to measure sleeping and waking activities, and will keep a diary to document waking activities as well as sleep duration, consolidation, and timing. When they return the actigraphs, they will complete 4 validated self-report instruments: the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, the Sleep Hygiene Index, the Insomnia Severity Index, and the STOP-Bang questionnaire. They will also provide data on sociodemographics and on CVD risk factors (blood lipids, hemoglobin A1C, blood pressure, BMI) known to be influenced by sleep. Our Specific Aims are to: 1) Develop a culturally appropriate PROM of sleep health based on the local context affecting sleep at each study site by using focus groups. 2) In key informant interviews, evaluate existing guidelines and elucidate complementary culturally-grounded guidelines for improving sleep health at each study site to augment existing guidelines for AI communities. 3) Estimate the prevalence and nature of sleep deficiencies in a sample of 750 AI adults at 3 study sites by analyzing objective data from actigraphy and subjective data from sleep/wake diaries and standardized sleep instruments collected at 2 time points during a 9-month period. 4) Assess the cross-sectional associations of poor sleep health, as defined by our objective and subjective sleep measures, with CVD and metabolic risk factors.