Sleep and Cardiometabolic Health Disparities at the US/Mexico Border: The Nogales Cardiometabolic Health and Sleep (NoCHeS) Study

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ABSTRACT Short sleep duration, insomnia disorder, and sleep apnea are all highly prevalent in the US population and are associated with significant morbidity, including poor mental health, impaired neurocognitive function, metabolic dysregulation, and cardiovascular disease. In the context of the high prevalence of pernicious sleep disturbances, there is evidence that sleep disparities exist in the population, such that racial/ethnic minorities – including Mexican-Americans – are at increased risk of sleep disturbances. This is alarming, since this group is also at increased risk for many of the adverse cardiometabolic and functional outcomes linked to sleep disturbances. These associations may be influenced by economic hardship, psychosocial stress, unhealthy behaviors (diet, exercise, alcohol, and smoking), and acculturation – the degree to which an individual adopts (in this case) traditional Mexican versus American culture. The first goal of this project is to examine sleep duration, insomnia symptoms, and sleep apnea severity among Mexican-Americans and examine the role of these social-behavioral factors in this relationship. Second, this study aims to examine the role of sleep and cardiometabolic disease risk in this population and explore the role of acculturation, psychosocial stress, economic hardship, and/or unhealthy behaviors in these associations. To accomplish this, this project will partner with the Mariposa Community Health Center, the federally qualified clinic in the Nogales, AZ area. Nogales is a small city on the US/Mexico border that is an ideal location for studying non-urban Mexican- Americans, as it is made up of 83% Hispanics/Latinos, 33% immigrants, and 77% who primarily speak Spanish at home. This community-engaged project will partner with Mariposa and their Platicamos Salud program that uses experienced Community Health Workers (promotoras de salud) to collect data and perform home visits. The study will recruit N=900 Mexican-Americans and N=200 Non-Hispanic Whites to complete a battery of assessments from a clinic visit (questionnaires, interviews, exam for anthropometry and arterial stiffness, and collection of biomarkers), a 1-night home sleep apnea assessment, a 24-hour ambulatory blood pressure recording, and a 2-week home monitoring period with sleep diary and actigraphy. This will result in a rich dataset that can help to identify and reduce sleep disparities in the population and point to potential intervention approaches to reducing cardiometabolic disease disparities. The analytic plan will take advantage of a machine-learning analytic approach, which will be used to evaluate the complex relationships among all of these variables. This project will address many relevant issues in sleep medicine, health disparities research, and border health. The partnership with Mariposa will enhance recruitment, promote research integrity (or ensure appropriateness of research methods), and facilitate dissemination of the study results into the community through education programs associated with Platicamos Salud and other community outreach efforts.