Sleep Health in the Rural South and Its Relationships with Cardiometabolic Health Disparities

项目总结/摘要 美国南部的农村社区遭受着不成比例的发病率和死亡率负担， 心血管代谢疾病，传统的风险因素只能解释适度比例的过度负担 疾病。越来越多的证据表明睡眠健康不良是心血管疾病的一个重要危险因素。 疾病虽然这是最好的睡眠呼吸暂停和失眠，有相当多的证据表明， 睡眠健康的多个方面，包括睡眠时间、效率、时间和规律性，也会影响 心脏代谢疾病风险。此外，南方农村社区可能会经历高比率的 睡眠健康受损，反映出高水平的心理社会和环境压力，如经济压力， 压力、社会孤立、环境污染和不良的建筑环境以及高吸烟率 和肥胖。然而，目前缺乏系统开发的农村人口睡眠数据。 NHLBI认识到对这一高风险农村人群的心脏代谢风险研究的缺乏， 最近，我在阿巴拉契亚和密西西比三角洲的农村地区发起了一项新的纵向流行病学研究（农村研究 研究），以确定造成这一高负担的复杂的个人、社会和环境因素。 疾病拟议的农村睡眠研究将补充农村研究， 在基线队列评估时， 约4000名25-64岁的成年人，利用移动的健康技术（a）测量睡眠呼吸暂停 （B）在多个连续的夜晚测量睡眠持续时间、定时、规律性和碎片化; （c）管理标准化问卷，以评估失眠、时间类型、睡眠质量和 与睡眠有关的损害。这些数据将使我们能够利用计划中的广泛评估， 心血管代谢危险因素、亚临床疾病、心理社会和环境应激源（以及恢复力 这些因素），以实现以下具体目标： 目标1a。一个农村队列中睡眠健康指标的人群分布 呼吸暂停、失眠、睡眠时型和睡眠持续时间、效率、时间和规律性。 目标1b。确定农村社区睡眠健康的社会心理，行为和环境相关因素。 目标2.评估睡眠健康与心血管代谢危险因素和亚临床心血管疾病的关系 疾病独立于其他已确定的心血管和代谢风险因素。 预计结果将告知卫生保健提供者，公共卫生官员和公众， 这些农村社区睡眠健康受损的患病率、风险因素和后果， 预防、识别和管理睡眠障碍和改善睡眠的关键基础， 心脏代谢健康

PROJECT SUMMARY/ABSTRACT Rural communities in the southern U.S. suffer a disproportionate burden of morbidity and mortality from cardiometabolic disease, with traditional risk factors explaining only a modest proportion of the excess burden of disease. Growing evidence implicates poor sleep health as an important risk factor for cardiometabolic disease. While this is most well established for sleep apnea and insomnia, there is considerable evidence that multiple dimensions of sleep health, including sleep duration, efficiency, timing, and regularity, also affect cardiometabolic disease risk. Moreover, rural Southern communities are likely to experience high rates of impaired sleep health, reflecting high levels of psychosocial and environmental stressors, such as financial stress, social isolation, environmental pollution, and poor built environment in addition to high rates of smoking and obesity. However, there is currently a lack of systematically developed sleep data in rural populations. Recognizing the paucity of research on cardiometabolic risk in this high-risk rural population, the NHLBI recently initiated a new longitudinal epidemiology study in rural Appalachia and Mississippi Delta (the RURAL Study) to identify the complex individual, social and environmental factors contributing to this high burden of disease. The proposed RURAL Sleep Study will complement the RURAL Study by incorporating minimally burdensome measures of multiple dimensions of sleep health at the time of baseline cohort assessment in approximately 4000 adults age 25-64 years, utilizing mobile health technologies to (a) measure sleep apnea over 4 consecutive nights; (b) measure sleep duration, timing, regularity and fragmentation over multiple weeks; and (c) administer standardized questionnaires to assess insomnia, chronotype, sleep quality and sleep-related impairment. These data will allow us to leverage the planned extensive assessments of cardiometabolic risk factors, subclinical disease, and psychosocial and environmental stressors (and resilience factors) to address the following specific aims: Aim 1a. Quantify population distributions of sleep health measures in a rural cohort along dimensions of sleep apnea, insomnia, chronotype, and sleep duration, efficiency, timing, and regularity. Aim 1b. Identify psychosocial, behavioral, and environmental correlates of sleep health in rural communities. Aim 2. Assess the association of sleep health with cardiometabolic risk factors and subclinical cardiovascular disease independent of other established cardiovascular and metabolic risk factors. The results are expected to inform health care providers, public health officials, and the general public of the prevalence, risk factors, and consequences of impaired sleep health in these rural communities, providing a critical basis for prevention, recognition, and management of sleep disorders and improvement of sleep and cardiometabolic health.