Researching Equitable Sleep Time (REST) in Appalachia

睡眠不足（习惯性睡眠持续时间≤6小时）是一个昂贵的，普遍的，公共卫生问题相关 带来了许多负面的健康后果先前的研究表明，睡眠不足更普遍， 在健康差异人群中（例如，少数族裔、社会经济地位较低的成年人），但我们的 对农村人口睡眠差异的机制和后果的理解有限。的 目前的研究“研究公平睡眠时间在肯塔基州社区（REST-KY）”，重点是 阿巴拉契亚成年人，NIH指定的健康差距人群，其严重的健康不平等包括 多种疾病和过早死亡。六个最集中的县 全国睡眠不足的地区是中阿巴拉契亚肯塔基州，那里25-58%的成年人报告说， 睡眠不足超过15晚/月。这些县经济严重困难，然而，附近的县 与可比的经济困境，农村，和人口同质性不是“热点”的不足 睡吧使用混合方法，纵向设计将使我们能够评估有助于两者的机制 睡眠不足和健康问题。知识差距包括：（1）对具体问题缺乏了解， 导致阿巴拉契亚成年人睡眠不足的个人、社会和社会水平的因素。2)不 已知区域睡眠和健康差异是否具有相同的潜在机制;以及3） “热点”和非“热点”县之间的差异尚未得到检验。我们会招募400人 来自肯塔基州阿巴拉契亚6个睡眠不足“热点”县的成年人（n=200），以及6个类似的农村和 经济困难的非“热点”县。招聘将在“热点”和非“热点”之间分层 与睡眠不足有关的关键人口因素（例如，年龄、性别、种族/民族）， 集群级比较。具体目标。1.使用混合方法来比较个人，社会和社会 与睡眠不足有关的因素在睡眠不足的“热点”和非“热点”县之间是不同的。2. 评估随着时间的推移导致睡眠不足和健康结果的机制。睡眠的双向模型 和健康结果进行检查。3.量化日常睡眠反应（即，在白天 抑郁影响睡眠），并测试睡眠反应的个体差异是否预示着健康状况恶化 随着时间还将在目标2-3中审查按性别和国家分组（“热点”与非“热点”）分列的差异。 我们的多种复杂的客观和主观数据收集方法， 跨学科团队的各种专业知识，将推进有关生物，行为， 情绪和社会对睡眠健康的贡献。这种整体方法明确承认， 保健功能与睡眠密不可分。我们的研究结果将提供前所未有的深入了解双- 在一个未充分研究的农村健康差异人群中，睡眠与健康之间的方向性关系。结果 将为减少睡眠差异的战略提供信息，从而对公共卫生产生巨大影响。

Insufficient sleep (habitual sleep duration of ≤6 hours), is a costly, prevalent, public health problem associated with numerous negative health outcomes. Prior research suggests that insufficient sleep is more prevalent among health disparity populations (e.g., racial minorities, adults of low socioeconomic status), but our understanding of the mechanisms and consequences of sleep disparities in rural populations is limited. The present study “Researching Equitable Sleep Time in Kentucky Communities (REST-KY),” focuses on Appalachian adults, an NIH-designated health disparity population, whose serious health inequities include multiple health morbidities and premature mortality. Six of the counties with the highest concentration of insufficient sleep in the nation are in Central Appalachian Kentucky (KY), where 25-58% of adults report insufficient sleep 15+ nights/month. These counties are severely economically distressed, yet, nearby counties with comparable economic distress, rurality, and demographic homogeneity are not “hotspots” of insufficient sleep. Use of a mixed methods, longitudinal design will allow us to evaluate mechanisms contributing to both sleep deficiencies and health in this rural community. Knowledge gaps include 1) Sparse insights into specific individual-, social-, and societal-level factors contributing to sleep deficiencies in Appalachian adults.; 2) It is not known if regional sleep and health disparities share the same underlying mechanisms; and 3) Critical points of variance between “hotspot” and non-“hotspot” counties have not been examined. We will recruit a cohort of 400 adults from 6 insufficient sleep “hotspot” counties (n=200) in Appalachian KY, and 6 similarly rural and economically distressed non-“hotspot” counties. Recruitment will be stratified across “hotspot” and non-“hotspot” counties by key demographic factors linked to sleep deficiencies (e.g., age, sex, race/ethnicity) to promote county cluster-level comparisons. Specific Aims. 1. Use mixed methods to compare how individual, social, and societal factors linked to sleep deficiencies differ between insufficient sleep “hotspot” and non-“hotspot” counties. 2. Evaluate mechanisms driving sleep deficiencies and health outcomes over time. Bi-directional models of sleep and health outcomes will be examined. 3. Quantify day-to-day sleep reactivity (i.e., the degree to which daytime distress impacts sleep) and test if individual differences in sleep reactivity predict worsened health outcomes over time. Differences by sex and county cluster (“hotspot” vs. non-“hotspot”) will also be examined in Aims 2-3. Our multiple, sophisticated objective and subjective data collection methods, made possible by our interdisciplinary team’s varied expertise, will advance scientific knowledge about biological, behavioral, emotional, and social contributions to sleep health. This holistic approach explicitly acknowledges the inseparable overlap between health function, and sleep. Our findings will offer unprecedented insight into the bi- directional relationships between sleep and health in an understudied rural health disparity population. Results will inform strategies to reduce sleep disparities, thus having strong potential for public health impact.