Addressing Sleep Duration, Regularity, and Efficiency: A Multidimensional Sleep Health Intervention for Reducing Ethnic Disparities in Cardiometabolic Health
Public Health Relevance
Sleep health disparities contribute to the disproportionate burden of poor cardiometabolic health in Latinx, and its downstream effects on risk for multiple chronic diseases. The DREAM randomized controlled trial will evaluate the effect of a community health worker-delivered multidimensional sleep health intervention on multiple domains of cardiometabolic health in middle-aged to older Latinx men and women. Culturally adapted sleep health interventions may elucidate scalable and sustainable contextual behavioral approaches to improve cardiometabolic health and extend health.
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
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
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.
3) 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. 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 health.