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

城市儿童睡眠、哮喘和睡眠环境的差异

• 批准号: 10614425
• 负责人: Mary A Carskadon
• 金额: $ 68.02万
• 依托单位: RHODE ISLAND HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-24 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10614425
• 关键词: 9 year old; Affect; African American; Age; Allergens; Area; Arousal; Asthma; Beds; Behavioral; Belief; Biological; Caregivers; Child; Childhood; Clinical; Crowding; Disparity; Enrollment; Ethnic Origin; Ethnic Population; Exposure to; Family; Fright; Future; Health; Home; Immunologic Markers; Intervention; Interview; Irritants; Latino; Length; Light; Link; Location; Maintenance; Measurement; Measures; Melatonin; Methods; Monitor; Morbidity - disease rate; Neighborhoods; Outcome; Outcome Assessment; Patient Self-Report; Pharmaceutical Preparations; Phase; Polysomnography; Protocols documentation; Qualitative Methods; Reporting; Research; Resources; Risk; Role; Saliva; Sampling; School-Age Population; Sleep; Sleep disturbances; Spirometry; Stress; Symptoms; Time; Walking; Work; actigraphy; circadian; circadian biology; cytokine; elementary school; ethnic difference; ethnic minority; experience; health disparity; high risk population; improvement on sleep; minority children; peer; poor sleep; primary caregiver; pulmonary function; sleep behavior; sleep health; sleep pattern; sleep position; sleep quality; stressor; urban children; urban poverty; urban setting

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.

项目概要/摘要 儿童在哮喘和睡眠方面的健康差异仍然存在；哮喘和睡眠不良的结果是 多见于少数民族和城市儿童。已知的城市贫困压力源且控制不力 哮喘会对城市哮喘儿童的睡眠健康产生不利影响。我们与城市儿童的合作 持续性哮喘表明，拉丁裔和非裔美国人 (AA) 儿童暴露于社会背景环境中 （例如，邻里压力、过敏原/刺激物）和文化（例如，文化压力）挑战的风险 哮喘管理并增加哮喘发病率。此外，我们最近完成的研究表明实时 城市儿童哮喘、睡眠质量和白天功能之间的联系。每日睡眠环境的作用 特定种族的城市儿童的睡眠习惯和睡眠行为尚不清楚。我们的工作有 重点关注造成哮喘健康差异的因素，通过体动记录仪评估该群体的睡眠质量 自我报告睡眠行为测量。儿童睡眠环境中的文化、睡眠和哮喘特定因素 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 尚未对这些群体的昼夜节律措施进行评估。针对睡眠设置和睡眠行为 结合对城市哮喘儿童潜在昼夜节律的生物测量，有可能 确定改善睡眠和哮喘结果的干预措施的机制。 我们建议利用多种方法、深入的方法来表征睡眠模式和睡眠 城市儿童的环境与可能因儿童种族而异的生物措施相结合 群体背景并可能导致哮喘结果。我们将招收240名城市儿童（7-9岁， 患有持续性哮喘的拉丁裔、AA 和非拉丁裔白人背景）及其主要照顾者。每个 儿童/看护者将参加为期 16 天的方案，其中包括评估儿童的睡眠环境、睡眠情况 状态（体动记录仪；动态多导睡眠图，PSG；唾液检测弱光褪黑激素发作，DLMO），以及 哮喘状态（通过家庭肺量计测定肺功能、免疫生物标志物评估、症状/控制报告）。 我们将通过我们的环境演练评估来深入检查睡眠环境 护理人员/儿童访谈、自我报告评估以及监测期间客观的光测量。 该研究的首要目的是检查睡眠模式的种族差异，重点关注此类差异 结果如时间（例如，每晚就寝时间的变化）、连续性（例如，夜间觉醒）和 通过体动记录仪测量 16 天的长度（睡眠持续时间）以及昼夜节律阶段 (DLMO) 和 睡眠时间与昼夜节律相一致。第二个目标涉及审查共同群体中的种族差异 睡眠状态和哮喘状态的发生。第三个目标将识别与睡眠相关的因素（例如睡眠干扰因素）， 哮喘（例如，救援药物的可用性/位置）和文化相关（例如，睡眠信念）风险和 儿童睡眠环境的资源因素可调节睡眠与哮喘结果之间的关联。