Project 1: Addressing Sleep Duration, Regularity, and Efficiency: A Multidimensional Sleep Health Intervention for Reducing Ethnic Disparities in Cardiometabolic Health (The DREAM Study)

项目 1：解决睡眠持续时间、规律性和效率问题：减少心脏代谢健康种族差异的多维睡眠健康干预措施（DREAM 研究）

• 批准号: 10437180
• 负责人: Nour Makarem
• 金额: $ 69.7万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-24 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10437180
• 关键词: Address; Adult; Affect; Behavior Therapy; Behavioral; Biological; Biological Markers; Blood Pressure; Cancer Hospital; Cardiovascular Diseases; Caribbean region; Cause of Death; Characteristics; Chronic Disease; Communities; Community Health Aides; Consolidated Framework for Implementation Research; Development; Diet; Dimensions; Disease Outcome; Education; Educational Materials; Effectiveness; Enrollment; Ensure; Evaluation; Feedback; Future; Generations; Goals; Health; High Prevalence; High Risk Woman; Hypertension; Individual; Intervention; Language; Latinx; Life; Malignant Neoplasms; Measures; Methods; Modeling; Monitor; Morbidity - disease rate; Motivation; New York; New York City; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Obesity; Outcome; Pathway interactions; Physical activity; Presbyterian Church; Process; Public Health; Randomized; Randomized Controlled Trials; Research; Risk; Risk Factors; Role; Screening for cancer; Sleep; Techniques; Testing; Time; Washington; Woman; Work; actigraphy; aged; alertness; arm; base; behavior change; cancer prevention; cancer risk; cardiometabolic risk; cardiometabolism; cardiovascular disorder prevention; cardiovascular disorder risk; cardiovascular health; community center; community engagement; ethnic disparity; ethnic minority population; evidence base; experience; glycemic control; health disparity; health equity; health training; healthspan; implementation determinants; implementation intervention; implementation science; improved; inflammatory marker; intervention effect; lifestyle factors; lifestyle intervention; men; middle age; minority health; mortality; multiple chronic conditions; novel; poor sleep; population health; primary outcome; racial and ethnic; racial and ethnic disparities; racial minority; satisfaction; scale up; secondary outcome; sleep health; sleep quality; systematic review; systemic inflammatory response; treatment arm; trial design

ABSTRACT: Cardiovascular disease (CVD) and cancer, the leading causes of mortality in Latinx, share many risk factors, including cardiometabolic risk factors. Latinx have some of the highest prevalence rates for obesity and type 2 diabetes (T2D), and in New York City, one of the highest hypertension (HTN) burdens. Improving multiple domains of cardiometabolic health (CMH) through contextual behavioral interventions can have far-reaching effects for reducing the burden of multiple morbidities. Despite a strong evidence base supporting the role of sleep as a major contributor to CMH, including work by our team, most lifestyle interventions have targeted diet or physical activity and not sleep. Sleep is amenable to intervention, and can improve CMH through complementary or synergistic biologic pathways with other lifestyle factors. Insufficient, irregular, and poor quality sleep is widely prevalent, affecting >50% of US adults with a disproportionately higher burden in racial and ethnic minorities, and sleep health disparities have been shown to account for a large portion of racial and ethnic disparities in CMH. We will conduct community engagement and stakeholder participatory research to refine and culturally adapt a multidimensional sleep health (MDSH) intervention for Latinx adults (Aim 1). Using a parallel two-arm randomized controlled trial (RCT) design, we will evaluate the effect of the MDSH intervention on improving blood pressure (BP), glycemic control indicators, and anthropometric markers of adiposity (Aim 2). We will enroll 300 midlife to older Latinx men and women at high risk for multiple chronic diseases, identified through the New York-Presbyterian Hospital cancer screening centers, and randomize to either a control arm that receives standard Life's Simple 7 cardiovascular health educational materials or an intervention arm that, in addition to Life's Simple 7 materials, receives a MDSH intervention based on evidence-based sleep hygiene education and established behavior change techniques (personalized sleep health feedback, goal setting, self-monitoring, motivational enhancement). We will further leverage this RCT to explore the effect of sleep on markers of systemic inflammation that are related to both CVD and cancer risk. Finally, using the Consolidated Framework for Implementation Research and working closely with the COMMUNITY Center Implementation Science Core, we will use mixed methods to understand implementation determinants, processes, and outcomes, ensuring the successful completion and future expansion of this work (Aim 3). Community health workers, with experience working with the NYC Latinx communities, will deliver the intervention, and we will assemble a community and stakeholder collaborative panel, with support from the COMMUNITY CONNECTOME, that will actively participate in all aspects of the aims. Findings will inform the development and implementation of scalable and sustainable personalized population health approaches for addressing sleep health disparities to improve the effectiveness, implementation, and reach of interventions aimed at reducing multiple chronic diseases and extending healthspan.

抽象的： 心血管疾病（CVD）和癌症是拉丁裔死亡率的主要原因，共享许多危险因素， 包括心脏代谢风险因素。 Latinx的肥胖症和2型的患病率最高 糖尿病（T2D），在纽约市，是高血压（HTN）负担最高的人之一。改进倍数 通过上下文行为干预措施的心脏代谢健康（CMH）领域可能具有深远的影响 减轻多种病因负担的影响。尽管有强有力的证据基础支持 作为CMH的主要贡献者睡眠，包括我们团队的工作，大多数生活方式干预措施都针对饮食 或体育锻炼，不睡觉。睡眠适合干预，可以通过 与其他生活方式因素的互补或协同生物学途径。不足，不规则且贫穷 优质的睡眠普遍普遍，影响了50％的美国成年人，种族负担不高。 少数民族和睡眠健康差异已被证明是种族的很大一部分和 CMH中的种族差异。我们将进行社区参与和利益相关者的参与研究 精炼和文化适应拉丁人的多维睡眠健康（MDSH）干预措施（AIM 1）。使用 平行的两臂随机对照试验（RCT）设计，我们将评估MDSH的效果 改善血压（BP），血糖控制指标和人体测量标记的干预措施 肥胖（目标2）。我们将向年龄较大的拉丁裔男性和女性注册300个中年，多个慢性 疾病，通过纽约总理医院癌症筛查中心确定，然后随机分配 接收标准生活的简单7心血管健康教育材料的控制臂，或者 除了人生的简单7材料外，干预臂还接受了基于MDSH的干预措施 基于证据的睡眠卫生教育和建立行为改变技术（个性化睡眠 健康反馈，目标设定，自我监控，动机增强）。我们将进一步利用此RCT 探索睡眠对与CVD和癌症有关的全身炎症标记的影响 风险。最后，使用合并框架进行实施研究，并与 社区中心实施科学核心，我们将使用混合方法来了解实施 决定因素，过程和结果，确保成功完成和将来的这项工作的扩展 （目标3）。社区卫生工作者，具有与纽约市拉丁裔社区合作的经验，将提供 干预，我们将在社区和利益相关者的合作小组中组装，并在 社区Connectome，将积极参与目标的各个方面。调查结果将告知 开发和实施可扩展和可持续的个性化人口健康方法 解决睡眠健康差异，以提高干预措施的有效性，实施和达到 旨在减少多种慢性疾病并扩大健康状况。