Sleep and Cardiometabolic Health Disparities at the US/Mexico Border: The Nogales Cardiometabolic Health and Sleep (NoCHeS) Study

摘要 睡眠时间短、失眠症和睡眠呼吸暂停在美国人群中非常普遍， 与显著的发病率相关，包括精神健康状况不佳，神经认知功能受损，代谢 失调和心血管疾病。在恶性睡眠的高流行率的背景下 干扰，有证据表明，睡眠差距存在于人口，如种族/少数民族- 包括墨西哥裔美国人在内，睡眠障碍的风险增加。这是令人震惊的，因为这个群体是 也增加了许多与睡眠相关的不良心脏代谢和功能结果的风险 干扰.这些关联可能受到经济困难、心理压力、不健康 行为（饮食，锻炼，酒精和吸烟）和文化适应-个人接受的程度 (in传统的墨西哥文化与美国文化。这个项目的第一个目标是研究睡眠 持续时间，失眠症状和睡眠呼吸暂停的严重程度在墨西哥裔美国人，并检查的作用， 这些社会行为因素其次，这项研究旨在研究睡眠的作用， 心脏代谢疾病的风险，并探讨文化适应，心理社会压力， 经济困难和/或这些协会中的不健康行为。为了实现这一目标，该项目将 与马里波萨社区卫生中心合作，该中心是亚利桑那州诺加莱斯的联邦合格诊所。 诺加莱斯是美国/墨西哥边境的一个小城市，是研究非城市墨西哥人的理想地点。 美国人，因为它是由83%的西班牙裔/拉丁美洲人，33%的移民，77%的人主要讲西班牙语 在家里这个社区参与的项目将与马里波萨及其Platicamos Salud计划合作， 使用经验丰富的社区卫生工作者（promotoras de salud）收集数据并进行家访。 该研究将招募N=900名墨西哥裔美国人和N=200名非西班牙裔白人， 来自诊所访视的评估（问卷调查、访谈、人体测量学和动脉硬度检查，以及 生物标志物的收集），1晚的家庭睡眠呼吸暂停评估，24小时动态血压 记录，和2周的家庭监测期与睡眠日记和活动记录。这将产生丰富的数据集 这可以帮助识别和减少人口中的睡眠差异，并指出潜在的干预措施。 减少心脏代谢疾病差异的方法。分析计划将利用 机器学习分析方法，将用于评估所有 这些变量。该项目将解决睡眠医学，健康差异研究， 边境卫生。与马里波萨的伙伴关系将加强招聘，促进研究的完整性（或确保 研究方法的适当性），并促进向社区传播研究结果 通过与Platicamos Salud和其他社区外展工作相关的教育计划。

ABSTRACT Short sleep duration, insomnia disorder, and sleep apnea are all highly prevalent in the US population and are associated with significant morbidity, including poor mental health, impaired neurocognitive function, metabolic dysregulation, and cardiovascular disease. In the context of the high prevalence of pernicious sleep disturbances, there is evidence that sleep disparities exist in the population, such that racial/ethnic minorities – including Mexican-Americans – are at increased risk of sleep disturbances. This is alarming, since this group is also at increased risk for many of the adverse cardiometabolic and functional outcomes linked to sleep disturbances. These associations may be influenced by economic hardship, psychosocial stress, unhealthy behaviors (diet, exercise, alcohol, and smoking), and acculturation – the degree to which an individual adopts (in this case) traditional Mexican versus American culture. The first goal of this project is to examine sleep duration, insomnia symptoms, and sleep apnea severity among Mexican-Americans and examine the role of these social-behavioral factors in this relationship. Second, this study aims to examine the role of sleep and cardiometabolic disease risk in this population and explore the role of acculturation, psychosocial stress, economic hardship, and/or unhealthy behaviors in these associations. To accomplish this, this project will partner with the Mariposa Community Health Center, the federally qualified clinic in the Nogales, AZ area. Nogales is a small city on the US/Mexico border that is an ideal location for studying non-urban Mexican- Americans, as it is made up of 83% Hispanics/Latinos, 33% immigrants, and 77% who primarily speak Spanish at home. This community-engaged project will partner with Mariposa and their Platicamos Salud program that uses experienced Community Health Workers (promotoras de salud) to collect data and perform home visits. The study will recruit N=900 Mexican-Americans and N=200 Non-Hispanic Whites to complete a battery of assessments from a clinic visit (questionnaires, interviews, exam for anthropometry and arterial stiffness, and collection of biomarkers), a 1-night home sleep apnea assessment, a 24-hour ambulatory blood pressure recording, and a 2-week home monitoring period with sleep diary and actigraphy. This will result in a rich dataset that can help to identify and reduce sleep disparities in the population and point to potential intervention approaches to reducing cardiometabolic disease disparities. The analytic plan will take advantage of a machine-learning analytic approach, which will be used to evaluate the complex relationships among all of these variables. This project will address many relevant issues in sleep medicine, health disparities research, and border health. The partnership with Mariposa will enhance recruitment, promote research integrity (or ensure appropriateness of research methods), and facilitate dissemination of the study results into the community through education programs associated with Platicamos Salud and other community outreach efforts.