DORMIR: Determinants, Outcomes, Responses and Markers of Insufficient sleep in Rural-Urban settings

项目摘要 美国农村和城市各种原因和心血管疾病死亡率和发病率之间日益扩大的差距是最大的- 时间到了。拉美裔美国人是美国最大的少数民族群体，受城乡差异的影响似乎最大 心血管疾病结局的差异，因为他们不成比例地承受着心血管疾病风险(超重/肥胖， 高血压、血脂异常、糖尿病)和心血管疾病死亡率(20%，拉丁裔/AS的第二大死因) 相对于其他种族/民族群体。不同于其他群体，农村和城市地区的个人 不同的心血管疾病风险，农村和城市拉丁裔/AS具有类似的高心血管风险比率。虽然，健康饮食/ 营养、戒烟和有规律的体力活动与心血管疾病风险有关，但它们并不是很重要。 有效地减轻种族/族裔群体，特别是拉美裔/AS群体的心血管疾病负担。几项研究 表明睡眠不足(7小时/天)解释了拉丁裔/AS中相当大的心血管疾病负担。 初步证据表明，睡眠不足可能会导致观察到的心血管疾病负担 拉丁裔/AS，因为与非西班牙裔相比，拉丁裔/AS经历睡眠不足的几率更大 白色的。证据还表明，睡眠不足与潜在威胁生命的心血管疾病有关， 是一个关键的可改变的风险因素，有很大潜力缩小健康差距。然而，目前还不清楚是什么 导致城乡睡眠不足(IS)差距和IS相关心血管疾病负担的因素 拉丁裔/AS。为了解决这些差距，我们将在农村和城市社区招募525名拉丁裔/AS参加 使用新型mHealth设备进行的家庭研究。多学科团队将：1)确定行为， 与睡眠不足和IS相关的心血管疾病相关的遗传、心理社会和环境因素 2)评估睡眠不足对心血管疾病风险标记物(肥胖、血压、血脂和 空腹血糖/糖化血红蛋白)和炎症危险标志物(IL-6、IL-10和肿瘤坏死因子-α)。这项研究将 提供多层次证据支持以下人群中睡眠不足发生率较高的流行病学发现 拉丁裔/AS，这可能解释了他们心血管疾病风险的不成比例负担。它还将评估是否以及为什么 拉丁裔/AS的IS存在城乡差异，以及这可能如何导致IS相关的心血管疾病结果。 这些数据将提供：1)干预措施的基础，以减轻睡眠不足的不良影响 心血管疾病健康结果，2)有证据表明睡眠不足和心血管疾病负担的潜在因素 拉丁裔/就像在农村和城市环境中一样，以及3)对行为、遗传、环境和 农村和城市拉丁裔/AS睡眠不足的心理社会决定因素和相关的心血管疾病危险因素。 研究结果可能导致可行的临床、生活方式和政策干预，以改善拉美裔人的健康。

Project Summary The widening gap in all-cause and CVD-mortality and morbidity rates in rural and urban America is at an all- time high. Latino/as, the largest minority ethnic group in the U.S., appear to be most affected by rural-urban divide in CVD outcomes, as they are disproportionately burdened by CVD risk (overweight/obesity, hypertension, dyslipidemia, diabetes) and CVD mortality (20%, 2nd leading cause of death among Latino/as) relative to other racial/ethnic groups. Unlike other groups where individuals in rural and urban areas have differing CVD risk, rural and urban Latino/as have similarly high rates of CVD risk. Although, healthy diets/ nutrition, smoking cessation, and regular physical activity are linked to CVD risk, they have not been very effective in reducing the CVD burden among racial/ethnic groups, specifically among Latino/as. Several studies indicate that insufficient sleep (<7hrs./day) explains a significant amount of the CVD burden among Latino/as. Preliminary evidence indicates that insufficient sleep may contribute to the observed CVD burden among Latino/as, as Latino/as have greater odds of experiencing insufficient sleep compared with non-Hispanic whites. Evidence also shows that insufficient sleep, which is associated with potentially life-threatening CVD, is a key modifiable risk factor with great potential to reduce health disparities. However, it is unclear what factors contribute to insufficient sleep (IS) disparities and IS-related CVD burden among rural and urban Latino/as. To address these gaps, we will enroll 525 Latino/as in rural and urban communities to participate in home-based studies using novel mHealth devices. The multidisciplinary team will: 1) identify behavioral, genetic, psychosocial, and environmental factors that are associated with insufficient sleep and IS-related CVD and 2) assess effects of insufficient sleep on CVD risk markers (obesity, blood pressure, lipid profile, and fasting plasma glucose/ HbA1C) and inflammatory risk markers (IL-6, IL-10, and TNF-α). This study will provide multi-level evidence supporting epidemiological findings of greater rates of insufficient sleep among Latino/as, which may explain their disproportionate burden of CVD risk. It will also assess whether and why rural and urban differences in IS exist among Latino/as and how that may lead to IS-related CVD outcomes. These data will provide: 1) the foundation for interventions to mitigate adverse effects of insufficient sleep on CVD health outcomes, 2) evidence to delineate factors underlying insufficient sleep and CVD burden among Latino/as in rural and urban settings, and 3) a possible explanation of behavioral, genetic, environmental and psychosocial determinants of insufficient sleep and related CVD risk factors in rural and urban Latino/as. Findings can lead to actionable clinical, lifestyle, and policy interventions to improve Latino health.