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

翻译后摘要：疲劳是一个经常报告的投诉的青少年，并与广泛的不良反应。 健康、行为和功能结果。疲劳患病率存在差异， 在少数民族中，经济上处于不利地位的人群中。睡眠数量和质量的差异也会下降 沿着种族和经济线，在经济弱势群体中观察到睡眠较差， 有色人种。由于疲劳与睡眠不足密切相关，我们对疲劳的理解将 受益于更好地认识到它与睡眠差异的关系，特别是在青少年早期， 在睡眠时间和时间上的种族差异。许多社会环境因素， 个人、家庭和邻里水平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，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：白天嗜睡。 疲劳和嗜睡之间的关系，以及它们对青少年健康和 功能尚不清楚。我们的研究目的是确定种族和性别差异背后的关键机制， 睡眠的经济差异及其与疲劳、白天嗜睡和 早期青少年。我们认为，家庭组织、社会经济劣势和 歧视经历是非洲裔美国人和白色人之间睡眠差异的主要驱动因素 青少年。由社区咨询委员会指导，并使用新颖的智能手机/传感器技术 在我们对青少年睡眠的试点研究中，我们提出了一项以家庭为基础的研究， 俄亥俄州克利夫兰市的美国和白色青少年，（a）确定青少年睡眠的因素 （B）确定睡眠差异对疲劳、白天嗜睡和功能的影响;以及 (b)把困倦和疲劳区分开来。采用混合方法设计，样本350例 青少年和照顾者的种族和社会经济地位的平衡，我们将进行线性混合 建模以评估基线（时不变）和夜间（时变）关键指标之间的关联 两周内的睡眠质量和数量、疲劳、嗜睡和功能机制。 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，青少年的嗜睡与疲劳的经历，以及解决问题的自我管理策略 睡眠和疲劳。该研究具有创新性：它同时研究了多种潜在机制 推动青少年睡眠差异，并使用新技术来更好地衡量青少年睡眠的背景。 预期的结果将是显著的：识别睡眠差异的驱动因素对于改善睡眠，减少睡眠， 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 由于白天嗜睡引起的疲劳的临床意义和治疗方法不同，因此需要对它们进行检查。

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.