Disparities in Sleep, Asthma, and the Sleep Context in Urban Children

项目摘要/摘要 儿童在哮喘和睡眠方面的健康差距依然存在；哮喘和睡眠质量差 在少数民族和城市儿童中普遍存在。已知的城市贫困和控制不善的压力源 哮喘会对城市哮喘儿童的睡眠健康造成不利影响。我们为城市儿童所做的工作 持续性哮喘表明，拉丁裔和非裔美国人(AA)儿童暴露在社会背景下 (例如，邻里压力、过敏原/刺激物)和文化(例如，文化适应压力)风险挑战 哮喘管理和增加哮喘发病率。此外，我们最近完成的研究表明，实时 城市儿童哮喘、睡眠质量和日间功能之间的联系。睡眠环境的作用，每天 城市特定民族儿童的睡眠习惯和睡眠行为尚不清楚。我们的工作已经完成 重点关注哮喘健康差异的贡献者，通过动作图和睡眠质量评估这一组的睡眠质量 自我报告睡眠行为测量。儿童睡眠环境中的文化、睡眠和哮喘特有因素 会影响儿童维持健康的睡眠行为，进而影响哮喘的发病率。睡眠时间和 这些组的昼夜节律测量还没有被评估。针对睡眠设置和睡眠行为 随着对城市哮喘儿童潜在昼夜节律的生物学测量，有可能 确定为改善睡眠和哮喘结果的干预提供信息的机制。 我们建议利用一种多方法、深入的方法来表征睡眠模式和睡眠 城市儿童的环境与生物措施相结合，这些措施可能因儿童的种族而有所不同 群体背景，并可能对哮喘的结果作出贡献。我们将招收240名城市儿童(7-9岁，从 拉丁裔、AA和非拉丁裔白人背景)患有持续性哮喘及其主要照顾者。每个人 儿童/照顾者将参与一个为期16天的方案，其中包括评估儿童的睡眠环境、睡眠 状态(通过活动描记；动态多导睡眠图，PSG；唾液褪黑素发作，DLMO)；以及 哮喘状态(家庭肺功能、免疫生物标记物评估、症状/控制报告)。 我们将通过深入的环境走查评估来检查睡眠环境 照顾者/儿童面谈、自我报告评估，以及监测期间对光线的客观测量。 这项研究的第一个目的是检查睡眠模式的种族差异，重点是 结果如时间(例如，上床睡觉时间的夜间变化)、连续性(例如，夜间唤醒)以及 使用活动记录仪测量16天的睡眠长度(睡眠持续时间)，以及昼夜节律(DLMO)和 睡眠时序与昼夜节律相一致。第二个目标涉及到检查联合--的种族差异。 睡眠状态和哮喘状态的发生。第三个目标将确定与睡眠相关的(例如，睡眠干扰物)， 哮喘(例如，抢救药物的可获得性/位置)，以及与文化相关的(例如，睡眠信念)风险和 儿童睡眠环境的资源因素，在睡眠和哮喘结果之间有适度的联系。

Project Summary / Abstract Pediatric health disparities in the areas of asthma and sleep persist; asthma and poor sleep outcomes are prevalent among ethnic minority and urban children. Known stressors of urban poverty and poorly controlled asthma can adversely impact the sleep health of urban children with asthma. Our work with urban children with persistent asthma has shown that Latino and African American (AA) children are exposed to sociocontextual (e.g., neighborhood stress, allergens/irritants) and cultural (e.g., acculturative stress) risks that challenge asthma management and increase asthma morbidity. Further, our recently completed study indicates real-time links among asthma, sleep quality, and daytime functioning in urban children. The roles of sleep context, daily sleep routines, and sleep behaviors of urban children of specific ethnic groups are unknown. Our work has focused on contributors to asthma health disparities, assessing sleep quality in this group with actigraphy and self-report sleep behavior measures. Cultural, sleep, and asthma-specific factors in children's sleep contexts can affect children's maintenance of healthy sleep behaviors, and in turn, asthma morbidity. Sleep timing and circadian measures have not been assessed in these groups. Targeting the sleep setting and sleep behaviors along with biological measures of underlying circadian timing in urban children with asthma has the potential to identify mechanisms to inform interventions to improve sleep and asthma outcomes. We propose to utilize a multi-method, in-depth approach to characterize the sleep patterns and sleep settings of urban children in combination with biological measures that may differ based on children's ethnic group background and may contribute to asthma outcomes. We will enroll 240 urban children (ages 7-9, from Latino, AA, and Non-Latino White backgrounds) with persistent asthma and their primary caregivers. Each child/caregiver will participate in a 16- day protocol involving an assessment of the child's sleep context, sleep status (by actigraphy; ambulatory polysomnography, PSG; saliva for dim light melatonin onset, DLMO), and asthma status (lung function by home spirometry, immune biomarker assessment, report of symptoms/control). The sleep context will be examined through our environmental walk-through assessment, in-depth caregiver/child interviews, and self-report assessments, and objective measurement of light during monitoring. The first aim of the study is to examine ethnic differences in sleep patterns, with a focus on such outcomes as timing (e.g., night-to-night variability in time to bed), continuity (e.g., nighttime arousals), and length (sleep duration) measured across 16 days with actigraphy, as well as circadian phase (DLMO) and alignment of sleep timing to circadian phase. The second aim involves examining ethnic differences in the co- occurrence of sleep status and asthma status. The third aim will identify sleep-related (e.g., sleep disruptors), asthma (e.g., availability/location of rescue medication), and cultural-related (e.g., sleep beliefs) risk and resource factors of children's sleep context that moderate associations between sleep and asthma outcomes.