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）和癌症是拉丁美洲死亡的主要原因，它们有许多共同的风险因素， 包括心脏代谢风险因素。拉丁裔的肥胖和2型糖尿病患病率最高 糖尿病（T2D），并且在纽约市，是高血压（HTN）负担最高的城市之一。改善多个 心脏代谢健康（CMH）领域，通过情境行为干预， 减轻多种疾病负担的效果。尽管有强有力的证据支持 睡眠是CMH主要因素，包括我们团队的工作，大多数生活方式干预都有针对性的饮食 或体力活动而不是睡觉。睡眠可以通过干预来改善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、差 高质量的睡眠是普遍存在的，影响了超过50%的美国成年人，在种族方面的负担不成比例地高。 和少数民族，睡眠健康差异已被证明占种族和少数民族的很大一部分。 CMH中的种族差异。我们将开展社区参与和持份者参与研究， 完善和文化适应多维睡眠健康（MDSH）干预拉丁美洲成年人（目标1）。使用 采用平行双组随机对照试验（RCT）设计，评价MDSH的疗效 干预改善血压（BP），血糖控制指标和人体测量标志物， 肥胖症（目标2）。我们将招募300名中年至老年的拉丁裔男性和女性，这些男性和女性有多种慢性 疾病，通过纽约长老会医院癌症筛查中心确定，并随机 接受标准Life's Simple 7心血管健康教育材料的对照组， 一个干预部门，除了Life's Simple 7材料外，还接受基于以下内容的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）。我们将进一步利用该RCT， 探索睡眠对与CVD和癌症相关的全身炎症标志物的影响 风险最后，利用实施研究综合框架并与 社区中心实现科学核心，我们将使用混合方法来理解实现 决定因素、过程和结果，确保这项工作的成功完成和未来的扩展 (Aim 3）。社区卫生工作者，与纽约拉丁社区的工作经验，将提供 干预，我们将组建一个社区和利益相关者合作小组， 社区连接，将积极参与各方面的目标。调查结果将告知 制定和实施可扩展和可持续的个性化人口健康方法， 解决睡眠健康差异，以提高干预措施的有效性，实施和覆盖范围 旨在减少多种慢性疾病和延长健康寿命。

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.