Sleep and Cardiometabolic Health in United States Hispanic/Latino Late Adolescents/Young Adults

项目摘要/摘要 心脏代谢性(CM)疾病伴随心血管(CV)风险增加。治疗和 生活方式干预可以针对和减少一个或多个CM风险因素，从而预防或延迟不利的CM 结果和降低心血管疾病死亡率。然而，在过去的十年里，心血管疾病死亡率的下降已经趋于平缓。 可能是由于高血压、肥胖症、糖尿病和其他新出现的CM风险因素的日益流行 (包括尤其是睡眠障碍)。因此，至关重要的是：1)勾画出 多模式相互关联的CM风险因素，以及2)制定新的CM风险亚组分类标准 发现，使新的有针对性的多模式干预能够降低高危亚组的CM风险并改善 厘米健康。然而，现有关于CM风险亚组发现的研究存在三个关键的知识缺口。 差距一：以前的研究侧重于中老年人口，对以下方面的研究有限 年轻人群中早发性心肌梗塞的危险因素。GAP II：与传统的CM危险因素不同，睡眠不足 和精神压力是新出现的CM危险因素。然而，人们对它们的了解很少，特别是在美国。 拉美裔/拉丁裔。GAP III：最新的西班牙裔社区健康研究(HCHS)调查了 拉美裔/拉丁裔中CM疾病的患病率和危险因素，并提供了前所未有的机会 在西班牙裔/拉丁裔青少年/年轻人中确定CM疾病的高危亚群，但 缺乏结构化的多维分析方法，能够直接分析和分类 多模式相互关联的CM风险因素。这一丰富而全面的数据集没有得到充分利用。 1)提出了一种新的稀疏多振型结构方程模型 (多结构方程)对多模式混合型风险因素进行聚类；2)应用所开发的算法对多模式混合型风险因素进行识别 根据跨多个亚组的特定亚组特征，确定高风险和低风险CM疾病亚组的特征 睡眠障碍、精神和文化适应压力、代谢失调、肥胖、缺乏体力活动以及 HCHS数据集中的晚年青少年/青壮年营养不良。具体目标是： 目的1：建立一种新的稀疏多扫描电子显微镜用于CM风险亚群的识别和表征。 模式混合型风险因素。 目标2：将稀疏多结构方程应用于HCHS数据集：(1)识别、表征和验证CM风险 来自多模式CM风险因素的子组；(2)总结可重现的CM风险子组 西班牙裔/拉丁裔晚年青少年/年轻人。 影响：这项研究将有助于为综合多式联运提供循证指导和干预措施 针对早发风险亚组的成本效益和早期干预措施 西班牙裔/拉丁裔晚年/青壮年，最终改善从青少年到成年人的健康过渡 护理和减少美国拉美裔/拉丁裔人口中的CM健康差距和医疗费用。

Project Summary/Abstract Cardiometabolic (CM) disease is accompanied by increased cardiovascular (CV) risk. Therapeutic and lifestyle interventions can target and reduce one or more CM risk factors, and thus prevent or delay adverse CM outcomes and reduce CV mortality. However, the decline in CV mortality has flattened over the past decade, likely due to the growing prevalence of hypertension, obesity, diabetes, and other emerging CM risk factors (including and especially sleep disorders). Therefore, it is critical to: 1) delineate the substantial heterogeneity in multi-modal interconnected CM risk factors, and 2) develop new classification criteria for CM risk subgroup discovery, enabling novel targeted multi-modal intervention to reduce CM risk in high-risk subgroups and improve CM health. However, existing research on CM risk subgroup discovery has three critical knowledge gaps. GAP I: Prior research has focused on the middle-aged and older adult population, with limited research on early-onset CM risk factors in the younger population. GAP II: Unlike traditional CM risk factors, sleep deprivation and mental stress are emerging CM risk factors. However, they are very poorly understood, particularly in U.S. Hispanics/Latinos. GAP III: The newly available Hispanic Community Health Study (HCHS) investigates the prevalence of CM diseases and risk factors among Hispanics/Latinos and offers unprecedented opportunity to identify subgroups at high-risk for CM diseases among Hispanic/Latino late adolescents/young adults, but there is a lack of structured multi-dimensional analytical approaches with direct capacity to analyze and cluster the multi-modal interconnected CM risk factors. This rich and comprehensive dataset is under-utilized. We propose a secondary analysis to: 1) develop a novel sparse multi-modal Structural Equation Model (multi-SEM) to cluster multi-modal mixed-typed risk factors; 2) apply the developed algorithm to identify and characterize high-risk vs low-risk CM disease subgroups based upon subgroup-specific profiles across multi- modal sleep disruption, mental and acculturation stress, metabolic dysregulation, obesity, physical inactivity, and poor nutrition among late adolescents/young adults from the HCHS dataset. Specific Aims are: Aim 1: Develop a novel sparse multi-SEM for CM risk subgroup identification and characterization from multi- modal mixed-typed risk factors. Aim 2: Apply the sparse multi-SEM to the HCHS dataset to: (1) identify, characterize, and validate CM risk subgroups from multi-modal CM risk factors; (2) summarize reproducible CM risk subgroups among the Hispanic/Latino late adolescents/young adults. Impact: This study will help provide evidence-based guidelines and interventions for integrated multi-modal cost-effective and early interventions targeting subgroups with early-onset risk for adverse CM outcomes among Hispanic/Latino late adolescents/young adults, eventually improving the transition from adolescent to adult health care and reducing CM health disparities and health care costs in the U.S. Hispanic/Latino population.