Researching Equitable Sleep Time (REST) in Appalachia

睡眠不足(习惯性睡眠持续时间为≤6小时)，是一个代价高昂、普遍存在的公共卫生问题 带来了许多负面的健康后果。先前的研究表明，睡眠不足更为普遍 在健康差距人群中(例如，少数族裔、社会经济地位较低的成年人)，但我们的 对农村人口睡眠差距的机制和后果的了解有限。这个 目前的研究“研究肯塔基州社区的公平睡眠时间(REST-KY)”，重点是 阿巴拉契亚成年人，美国国立卫生研究院指定的健康差距人口，他们严重的健康不平等包括 多种健康疾病和过早死亡。其中六个县是二氧化碳浓度最高的县 在肯塔基州的阿巴拉契亚中部，25%-58%的成年人表示睡眠不足 睡眠不足15晚/月以上。这些县经济严重不景气，但附近的县 在类似的经济困境下，乡村和人口同质性并不是不足的“热点” 睡吧。使用混合的方法，纵向设计将允许我们评估对两者都有贡献的机制 睡眠不足与这个农村社区的健康。知识差距包括1)对具体问题缺乏深入的洞察力 个人、社会和社会层面的因素导致阿巴拉契亚成年人睡眠不足；2)不是 了解地区睡眠和健康差异是否具有相同的潜在机制；以及3)临界点 “热点”县和非“热点”县之间的差异尚未得到检验。我们将招募一个400人的队伍 来自肯塔基州阿巴拉契亚6个睡眠不足热点县(n=200)的成年人，以及6个类似的农村和 经济困难的非热点县。招聘将按“热点”和非“热点”分层 通过与睡眠不足有关的关键人口统计因素(例如，年龄、性别、种族/民族)来促进县 群集级比较。明确的目标。1.使用混合方法比较个人、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”县有所不同。2. 随着时间的推移，评估导致睡眠不足和健康结果的机制。双向睡眠模式 并将检查健康结果。3.量化每天的睡眠反应性(即白天的睡眠反应性 痛苦影响睡眠)，并测试睡眠反应性的个体差异是否预示着更糟糕的健康结果 随着时间的推移。在目标2-3中，还将研究按性别和县级群(“热点”与非“热点”)的差异。 我们多种复杂的客观和主观数据收集方法，由我们的 跨学科团队的各种专业知识，将促进生物学、行为学、 情绪和社交对睡眠健康的贡献。这种整体性的方法明确承认 健康功能和睡眠之间密不可分的重叠。我们的发现将为我们提供前所未有的洞察力。 未被充分研究的农村健康差距人群中睡眠与健康之间的方向性关系。结果 将为减少睡眠差距的战略提供参考，从而对公共卫生产生巨大的影响。

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.