Project 1: Addressing Sleep Duration, Regularity, and Efficiency: A Multidimensional Sleep Health Intervention for Reducing Ethnic Disparities in Cardiometabolic Health (The DREAM Study)

项目 1：解决睡眠持续时间、规律性和效率问题：减少心脏代谢健康种族差异的多维睡眠健康干预措施（DREAM 研究）

• 批准号: 10657751
• 负责人: Nour Makarem
• 金额: $ 65.85万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-24 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10657751
• 关键词: 2 arm randomized control trial; Address; Adult; Affect; Behavior Therapy; Behavioral; Biological; Biological Markers; Black Populations; Blood Pressure; Cancer Hospital; Cardiovascular Diseases; Caribbean region; Cause of Death; Characteristics; Chronic Disease; Communities; Community Health Aides; Consolidated Framework for Implementation Research; Development; Diet; Dimensions; Disease Outcome; Disparity; Education; Educational Materials; Effectiveness; Enrollment; Ensure; Equity; Ethnic Origin; Evaluation; Feedback; Future; Goals; Health; Height; High Prevalence; High Risk Woman; Hypertension; Individual; Intervention; Language; Latinx; Life; Malignant Neoplasms; Measures; Methods; Modeling; Monitor; Morbidity - disease rate; Motivation; National Institute on Minority Health and Health Disparities; New York; New York City; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Obesity; Outcome; Pathway interactions; Physical activity; Presbyterian Church; Process; Public Health; Randomized; Randomized, Controlled Trials; Reduce health disparities; Research; Risk; Risk Factors; Role; Screening for cancer; Sleep; Techniques; Testing; Time; Washington; Woman; Work; actigraphy; aged; alertness; arm; behavior change; cancer prevention; cancer risk; cardiometabolic risk; cardiometabolism; cardiovascular disorder prevention; cardiovascular disorder risk; cardiovascular health; community center; community engagement; ethnic disparity; ethnic minority; evidence base; experience; glycemic control; health disparity; health equity; health training; healthspan; implementation determinants; implementation intervention; implementation science; improved; inflammatory marker; intervention effect; lifestyle factors; lifestyle intervention; men; middle age; minority health; mortality; multiple chronic conditions; novel; poor sleep; population health; primary outcome; racial disparity; racial minority; satisfaction; scale up; secondary outcome; sleep health; sleep quality; systematic review; systemic inflammatory response; treatment arm; trial design

ABSTRACT: Cardiovascular disease (CVD) and cancer, the leading causes of mortality in Latinx, share many risk factors, including cardiometabolic risk factors. Latinx have some of the highest prevalence rates for obesity and type 2 diabetes (T2D), and in New York City, one of the highest hypertension (HTN) burdens. Improving multiple domains of cardiometabolic health (CMH) through contextual behavioral interventions can have far-reaching effects for reducing the burden of multiple morbidities. Despite a strong evidence base supporting the role of sleep as a major contributor to CMH, including work by our team, most lifestyle interventions have targeted diet or physical activity and not sleep. Sleep is amenable to intervention, and can improve CMH through complementary or synergistic biologic pathways with other lifestyle factors. Insufficient, irregular, and poor quality sleep is widely prevalent, affecting >50% of US adults with a disproportionately higher burden in racial and ethnic minorities, and sleep health disparities have been shown to account for a large portion of racial and ethnic disparities in CMH. We will conduct community engagement and stakeholder participatory research to refine and culturally adapt a multidimensional sleep health (MDSH) intervention for Latinx adults (Aim 1). Using a parallel two-arm randomized controlled trial (RCT) design, we will evaluate the effect of the MDSH intervention on improving blood pressure (BP), glycemic control indicators, and anthropometric markers of adiposity (Aim 2). We will enroll 300 midlife to older Latinx men and women at high risk for multiple chronic diseases, identified through the New York-Presbyterian Hospital cancer screening centers, and randomize to either a control arm that receives standard Life's Simple 7 cardiovascular health educational materials or an intervention arm that, in addition to Life's Simple 7 materials, receives a MDSH intervention based on evidence-based sleep hygiene education and established behavior change techniques (personalized sleep health feedback, goal setting, self-monitoring, motivational enhancement). We will further leverage this RCT to explore the effect of sleep on markers of systemic inflammation that are related to both CVD and cancer risk. Finally, using the Consolidated Framework for Implementation Research and working closely with the COMMUNITY Center Implementation Science Core, we will use mixed methods to understand implementation determinants, processes, and outcomes, ensuring the successful completion and future expansion of this work (Aim 3). Community health workers, with experience working with the NYC Latinx communities, will deliver the intervention, and we will assemble a community and stakeholder collaborative panel, with support from the COMMUNITY CONNECTOME, that will actively participate in all aspects of the aims. Findings will inform the development and implementation of scalable and sustainable personalized population health approaches for addressing sleep health disparities to improve the effectiveness, implementation, and reach of interventions aimed at reducing multiple chronic diseases and extending healthspan.

抽象的： 心血管疾病 (CVD) 和癌症是拉丁美洲人死亡的主要原因，它们具有许多共同的危险因素， 包括心脏代谢危险因素。拉丁裔的肥胖和 2 型肥胖患病率最高 糖尿病（T2D），也是纽约市高血压（HTN）负担最高的疾病之一。提高多项 通过背景行为干预来改善心脏代谢健康（CMH）领域可以产生深远的影响 减轻多种疾病负担的效果。尽管有强有力的证据基础支持 睡眠作为 CMH 的主要贡献者，包括我们团队的工作，大多数生活方式干预措施都针对饮食 或体力活动而不是睡眠。睡眠易于干预，并且可以通过以下方式改善 CMH： 与其他生活方式因素互补或协同的生物途径。不足、不规范、差 优质睡眠普遍存在，影响了超过 50% 的美国成年人，种族负担尤为严重 睡眠健康差异已被证明是种族和少数民族的很大一部分原因 CMH 中的种族差异。我们将开展社区参与和利益相关者参与式研究 针对拉丁裔成年人完善多维睡眠健康 (MDSH) 干预措施并在文化上进行调整（目标 1）。使用 平行双臂随机对照试验 (RCT) 设计，我们将评估 MDSH 的效果 改善血压（BP）、血糖控制指标和人体测量指标的干预措施 肥胖（目标 2）。我们将招募 300 名患有多种慢性病高风险的中年至老年拉丁裔男性和女性 通过纽约长老会医院癌症筛查中心确定的疾病，并随机分组 接收标准 Life's Simple 7 心血管健康教育材料的控制臂，或 一个干预组，除了 Life's Simple 7 材料外，还接受基于 MDSH 的干预 基于证据的睡眠卫生教育和既定的行为改变技术（个性化睡眠 健康反馈、目标设定、自我监控、激励增强）。我们将进一步利用该随机对照试验 探索睡眠对与 CVD 和癌症相关的全身炎症标志物的影响 风险。最后，利用实施研究综合框架并与 社区中心实施科学核心，我们将使用混合方法来理解实施 决定因素、过程和结果，确保这项工作的成功完成和未来的扩展 （目标 3）。具有与纽约拉丁裔社区合作经验的社区卫生工作者将提供 干预，我们将在以下方面的支持下组建一个社区和利益相关者协作小组 COMMUNITY CONNECTOME，即积极参与各个方面的目标。调查结果将告知 制定和实施可扩展且可持续的个性化人口健康方法 解决睡眠健康差异，以提高干预措施的有效性、实施和范围 旨在减少多种慢性疾病并延长健康寿命。