Sleep disparities' role in adolescent fatigue and functioning: A mixed-methods study

摘要：疲劳是青少年常见的主诉症状，并与多种不良反应有关。 健康、行为和功能结果。疲劳患病率存在差异，频率更高 见于少数族裔、经济困难人群。睡眠数量和质量的差距也在缩小 在种族和经济方面，人们观察到经济上处于不利地位的人睡眠更差， 有色人种。由于疲劳与睡眠不足有很强的联系，我们对疲劳的理解将 受益于更多地认识到它与睡眠差距的关系，特别是在早期青少年中， 当睡眠持续时间和时间上出现显著的种族差异时。中国的众多社会环境因素 个人、家庭和邻里层面可能是形成差异的风险和弹性因素 睡眠和疲劳。然而，这些因素的相对贡献尚不清楚。此外，该协会 睡眠不足和疲劳之间的关系被另一个常见的青少年抱怨所掩盖：白天困倦。 疲劳与嗜睡的关系及其对青少年健康的不同影响 目前还不清楚它的功能。我们的研究目的是找出种族和性别差异的关键机制 睡眠中的经济差异及其与疲劳、日间嗜睡和功能障碍的关系 青春期早期。我们假设，家庭组织的差异、社会经济劣势和 歧视经历是非裔美国人和白人睡眠差距的关键驱动因素 青少年。在社区顾问委员会的指导下，使用一种新的智能手机/传感器技术 在我们对青少年睡眠的初步研究中，我们提议在非洲人中进行一项基于家庭的研究 俄亥俄州克利夫兰的美国和白人青少年(A)确定导致青少年睡眠的因素 (B)确定睡眠差异对疲劳、日间困倦和功能的影响；以及 (B)将困倦与疲劳的影响分开。使用350个样本的混合方法设计 青少年和照顾者根据种族和社会经济地位进行平衡，我们将进行线性混合 建模以评估关键的基线(时不变)和夜间(时变)度量之间的关联 在两周的时间里，睡眠质量和数量、疲劳、困倦和功能的机制。 定性研究部分将侧重于家庭/邻里因素和歧视如何形成 睡眠，青少年对困倦和疲劳的体验，以及解决问题的自我管理策略 睡眠和疲劳。这项研究是创新的：它同时研究了多种潜在的机制 消除青少年睡眠差距，并使用新技术更好地衡量青少年睡眠的背景。 预期结果将是显著的：找出睡眠差异的驱动因素对于改善睡眠、减少 疲劳和嗜睡，并改善青少年的健康、功能和生活质量。此外，解开纠缠 白天嗜睡所致的疲劳是必要的，因为它们的临床意义和治疗方法不同。

Abstract: Fatigue is a frequently reported complaint of adolescents and is linked to a wide range of adverse health, behavioral, and functional outcomes. Disparities in fatigue prevalence exist, with greater frequency seen in minority, economically disadvantaged populations. Disparities in sleep quantity and quality also fall along ethnic and economic lines, with poorer sleep observed among the economically disadvantaged and persons of color. Because of fatigue’s strong link with inadequate sleep, our understanding of fatigue will benefit from greater awareness of its relationship with sleep disparities, especially among early adolescents, when notable racial differences in sleep duration and timing emerge. Numerous social-environmental factors in individual, household, and neighborhood levels may serve as risk and resilience factors shaping disparities in sleep and fatigue. Yet, the relative contributions of these factors are yet unclear. Moreover, the association between inadequate sleep and fatigue is obscured by another common teen complaint: daytime sleepiness. The relationship between fatigue and sleepiness, and their differential effects on adolescent health and functioning are yet unclear. Our study purpose is to identify key mechanisms underlying racial and economic disparities in sleep and their association with fatigue, daytime sleepiness, and functioning in early adolescents. We posit that differences in household organization, socioeconomic disadvantage, and experiences of discrimination are key drivers of sleep disparity between African American and White adolescents. Guided by a community advisory board, and using a novel smart phone/sensor technology developed in our pilot research on adolescent sleep, we propose a home-based study among African American and White adolescents in Cleveland, OH to (a) identify factors responsible for adolescent sleep disparities; (b) determine the effects of sleep disparities on fatigue, daytime sleepiness, and functioning; and (b) disentangle effects of sleepiness from fatigue. Using a mixed-methods design and sample of 350 adolescents and caregivers balanced by race and socio-economic status, we will conduct linear mixed modeling to assess associations between baseline (time-invariant) and nightly (time-varying) measures of key mechanisms with that of sleep quality and quantity, fatigue, sleepiness, and functioning over a 2-week period. A qualitative study component will focus on how household/neighborhood factors and discrimination shape sleep, the teen experience of sleepiness vs. fatigue, and self-management strategies to address problematic sleep and fatigue. The study is innovative: it simultaneously investigates multiple potential mechanisms driving adolescent sleep disparities and uses novel technology to better measure the context of teen sleep. Expected results will be significant: identifying drivers of sleep disparities is vital to improve sleep, reduce fatigue and sleepiness, and improve adolescent health, functioning, and quality of life. Moreover, disentangling fatigue from daytime sleepiness is needed because their clinical implications and treatment differ.