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

摘要： 心血管疾病(CVD)和癌症是拉美裔人死亡的主要原因，它们都有许多危险因素， 包括心脏代谢风险因素。拉美裔人的肥胖率和2型肥胖率最高 糖尿病(T2D)，在纽约市，高血压(HTN)负担最高之一。提高倍数 通过情境行为干预的心脏代谢健康(CMH)领域可能具有深远的影响 减轻多发病负担的效果。尽管有强有力的证据支持 睡眠作为CMH的主要贡献者，包括我们团队的工作，大多数生活方式干预都针对饮食 或者是身体活动而不是睡眠。睡眠是可以干预的，并可以通过以下方式改善CMH 与其他生活方式因素互补或协同的生物途径。不足、不规范和较差 高质量的睡眠普遍存在，影响了50%的美国成年人，他们的种族负担不成比例地高 和少数民族，以及睡眠健康差距已被证明在很大一部分种族和 CMH中的种族差异。我们将开展社区参与和利益相关者参与性研究，以 为拉美裔成年人改进和文化适应多维睡眠健康(MDSH)干预措施(目标1)。vbl.使用 一项平行的双臂随机对照试验(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指标的干预 肥胖(目标2)。我们将招募300名中年至年长的拉丁裔男性和女性，他们是多发性慢性病的高危人群 通过纽约长老会医院癌症筛查中心识别的疾病，并随机分配到 要么是接受标准人寿简单7号心血管健康教育材料的对照手臂，要么是 一种干预手臂，除了Life的简单7种材料外，还可以接受基于以下条件的MDSH干预 循证睡眠卫生教育和既定的行为改变技术(个性化睡眠 健康反馈、目标设定、自我监控、激励增强)。我们将进一步利用这一RCT来 探讨睡眠对与心血管疾病和癌症相关的全身炎症标志物的影响 风险。最后，使用执行研究综合框架，并与 社区中心实施科学核心，我们将用混合的方法来理解实施 决定因素、过程和结果，确保这项工作的成功完成和未来扩展 (目标3)。社区卫生工作者，与纽约市拉美裔社区合作的经验，将提供 干预，我们将组建一个社区和利益相关者协作小组，并得到 社区连接体，将积极参与AIMS的方方面面。调查结果将告知 开发和实施可扩展和可持续的个人化人口健康方法 解决睡眠健康差距，以提高干预措施的有效性、实施性和覆盖面 旨在减少多种慢性病，延长健康寿命。

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.