Michael A. Grandner, Ph.D. - US grants

DESCRIPTION (provided by applicant): There is growing evidence from epidemiological and experimental studies that individuals who Apart from these larger literatures, there are a few studies that have investigated the short sleeper phenomenon directly and more intensively, but these do not address health-related outcomes. Research: The study proposed within this K-Award is intended to be a first step in a larger program of research that will serve to bridge between the epidemiologic and experimental domains. This will ultimately allow for (1) Identification of individuals that are at risk for the ill effects of short sleep, (2) Development f behavioral interventions aimed at ameliorating adverse cardiometabolic effects of insufficient sleep, and (3) Detection of individuals that are true short sleepers and the qualities that make them resistant to the ill effects of short sleep. The proposed study utilizes a large-scale survey (n=1200) to recruit 60 subjects (40 short and 20 normal duration sleepers) to be assessed in two phases.report short sleep are at risk for a number of negative cardiovascular and metabolic health outcomes. These studies, in evaluated samples sleeper short The limitations. have seminal, and groundbreaking while epidemiological sleeper short aggregate and assessments item) (single nonstandard use often studies samples that are likely very heterogeneous. The experimental studies, while highly controlled and populated by homogenous sleep partial to similar more is that state a produce that manipulations engage samples, deprivation than naturally-occurring short sleep. Phase 1, a 2-week home-based study, will be used to prospectively corroborate subjects' survey responses regarding sleep duration, to screen for sleep-disordered breathing, and to gather blood pressure data. Phase-2, a 3-night, in-lab study, will be used to gather standardized measures of sleep continuity and sleep architecture (via polysomnography), sleepiness (via a Multiple Sleep Latency Test), psychomotor performance (via the Psychomotor Vigilance Task), aortic glucose homeostasis (via an Oral Glucose Tolerance Test) and biomarkers including atherogenic lipoproteins (i.e., HDL and LDL), IL-6, CRP, leptin and ghrelin. The lab-based data will be used to (1) Determine whether short and normal duration sleepers differ on objective measures of sleep, sleepiness/performance, and cardiometabolic function, and (2) Explore (in a preliminary way) whether subgroups within the short sleeper cohort account for the association between sleep duration and health. pulse wave velocity (via arterial tonometry), Training: This component of the K23 is comprised of the didactic and mentored experiences required to enable the applicant to develop the proposed program of research. The training plan builds upon the applicant's background in Health Psychology and provides him the necessary training in cardiovascular and metabolic physiology to address if and how the behavioral phenotype of short sleep is associated with negative health outcomes. The pedagogic approach includes routine one-on-one mentorship, course work, lab-based practica, and completion of a Masters degree program in Translational Research.

DESCRIPTION (provided by applicant): Sleep duration represents a biological imperative that is influenced by an interaction of social, behavioral and environmental factors. Behavioral factors include habitual sleep timing as well as other socially-influenced behaviors that engage physiological processes promoting or impairing sleep. Factors in the social environment include the home, work and other social influences on an individual's sleep schedule that may or may not be line with normal biological imperatives, as well as aspects of the physical environment that may interfere with sleep. Very little research has explored the impact of health behaviors (diet, physical activity, and substance use), social factors (family status, social functioning, isolation, and stress), or the physical environment (neighborhood and sleeping environment) as pathways to reduced sleep time. In addition, studies that have examined these factors typically explored sleep using broad survey items, rather than validated methods. Accordingly, a 2-Phase protocol will be deployed to address these issues. Phase 1 involves an online survey of n=1000 adults, using validated measures to assess sleep in the context of general health (obesity, functioning and mood), healthy behaviors (diet, physical activity, and substance use) and social factors (work and home social and social demands, functioning, isolation). These individual-level data will be merged with data neighborhood-level obtained through existing geospatial databases. This will allow for evaluation of whether individual-level sleep variables are associated with area-level measures (derived using respondents' address) of neighborhood variables, including population density, socioeconomic status, social isolation, traffic, noise, an crime/violence, and whether external sources of information predict sleep duration over and above individual-level measures. Phase 2 will consist of an intensive, prospective analysis of a subgroup of n=90 from the survey sample (n=30 each of <5, 5-6, and 7-8 hours of habitual sleep). This assessment will include objective measures of sleep (wrist actigraphy), health status (e.g., body mass index, blood-based measures), physical activity (hip actigraphy), and the sleeping environment (sensors for light, temperature, and noise). Daily diaries will assess sleep, diet, physical activity, substance use, social interactions, and the sleeping environment. The overall goal of this study is to assess the relative contributions of behavior, social, and factors on sleep of environmental habitual duration, employing multimodal assessments all domains, and leveraging novel approaches, such as geospatial analyses. As insufficient sleep duration is an important public health problem, the eventual goal of developing interventions to address this problem cannot be reached until we better understand (1) which factors need to be part of an intervention, (2) where interventions should be targeted, and (3) what types of assessments capture the relevant social and environmental features. The present exploratory/developmental research study will address these important issues and initiate a program of research developing and implementing successful interventions for insufficient sleep in the general population. PUBLIC HEALTH RELEVANCE: Adequate Sleep has been included as a national health priority in Healthy People 2020, and Sleep Deprivation and Sleep Disorders were identified by the Institute of Medicine as a major unmet public health problem. Short sleep is an important issue that needs to be addressed: it is prevalent (up to 120 million Americans sleep 6 hours or less); it is costly (an individual with insufficient sleep costs his/her employer approximately $2700 per year); it is debilitating (insufficient sleep is associated with cardiovascular, metaboli, cognitive, and other adverse health outcomes); and it is likely addressable through behavioral interventions. However, before behavioral interventions can be implemented, basic knowledge about behavioral, social, and environmental determinants of sleep duration needs to be understood. The results of this study will have important implications for public health.

ABSTRACT Short sleep duration, insomnia disorder, and sleep apnea are all highly prevalent in the US population and are associated with significant morbidity, including poor mental health, impaired neurocognitive function, metabolic dysregulation, and cardiovascular disease. In the context of the high prevalence of pernicious sleep disturbances, there is evidence that sleep disparities exist in the population, such that racial/ethnic minorities ? including Mexican-Americans ? are at increased risk of sleep disturbances. This is alarming, since this group is also at increased risk for many of the adverse cardiometabolic and functional outcomes linked to sleep disturbances. These associations may be influenced by economic hardship, psychosocial stress, unhealthy behaviors (diet, exercise, alcohol, and smoking), and acculturation ? the degree to which an individual adopts (in this case) traditional Mexican versus American culture. The first goal of this project is to examine sleep duration, insomnia symptoms, and sleep apnea severity among Mexican-Americans and examine the role of these social-behavioral factors in this relationship. Second, this study aims to examine the role of sleep and cardiometabolic disease risk in this population and explore the role of acculturation, psychosocial stress, economic hardship, and/or unhealthy behaviors in these associations. To accomplish this, this project will partner with the Mariposa Community Health Center, the federally qualified clinic in the Nogales, AZ area. Nogales is a small city on the US/Mexico border that is an ideal location for studying non-urban Mexican- Americans, as it is made up of 83% Hispanics/Latinos, 33% immigrants, and 77% who primarily speak Spanish at home. This community-engaged project will partner with Mariposa and their Platicamos Salud program that uses experienced Community Health Workers (promotoras de salud) to collect data and perform home visits. The study will recruit N=900 Mexican-Americans and N=200 Non-Hispanic Whites to complete a battery of assessments from a clinic visit (questionnaires, interviews, exam for anthropometry and arterial stiffness, and collection of biomarkers), a 1-night home sleep apnea assessment, a 24-hour ambulatory blood pressure recording, and a 2-week home monitoring period with sleep diary and actigraphy. This will result in a rich dataset that can help to identify and reduce sleep disparities in the population and point to potential intervention approaches to reducing cardiometabolic disease disparities. The analytic plan will take advantage of a machine-learning analytic approach, which will be used to evaluate the complex relationships among all of these variables. This project will address many relevant issues in sleep medicine, health disparities research, and border health. The partnership with Mariposa will enhance recruitment, promote research integrity (or ensure appropriateness of research methods), and facilitate dissemination of the study results into the community through education programs associated with Platicamos Salud and other community outreach efforts.

Project Summary Cardiovascular disease (CVD) is a major cause of morbidity and mortality in adults living with HIV (ALHIV), and cigarette smoking is the single most important modifiable CVD risk factor in this population. Success rates for existing smoking cessation interventions are relatively low. Poor sleep is more prevalent among smokers, more prevalent among ALHIV, can be caused by smoking cessation attempts, predicts relapse to former smoking patterns, and represents a parallel pathway to morbidity including increased cardiovascular disease (CVD) among ALHIV. Thus, unhealthy sleep may make smoking cessation more difficult and increase cardiovascular risk and other poor health conditions in ALHIV. Yet, poor sleep is amenable to nonpharmacologic interventions, and a pilot study from our group revealed that a sleep health intervention increased smoking cessation rates when added to routine smoking cessation treatment. The mechanisms by which improvements in sleep health enhance tobacco cessation are unknown, but improved cognitive and affective functioning are two candidates. To evaluate the efficacy of our sleep training approach to improve sleep health and increase smoking cessation rates in ALHIV, the proposed study will supplement an empirically-supported smoking cessation program (6- session, 15-week counseling program with varenicline) with a Sleep Training Approach to Reducing Smoking (STARS) intervention developed for smokers. This intervention uniquely addresses (1) existing sleep difficulties, if any, prior to quitting that may be associated with HIV status or nicotine use; (2) inoculation against future sleep difficulties brought on by quitting and/or varenicline; (3) acute intervention on sleep efficiency and duration as the participant progresses through the program; and (4) development of healthy sleep habits to carry forward beyond the intervention. This approach is based on the gold-standard approach to treating insomnia (Cognitive Behavioral Therapy for Insomnia) but includes a number of novel elements tailored to this population. STARS will be compared to a General Health (GH) educational control. The study will recruit N=200 ALHIV smokers who are interested in quitting. They will be randomized to smoking cessation with either STARS (N=100) or GH (N=100). The study will measure the efficacy of STARS versus GH to improve objectively measured healthy sleep metrics, assess its impact on smoking cessation as well as other metrics of CVD risk, and determine whether cognitive and affective variables mediate the association between sleep health and smoking cessation. Results of these studies will provide practical information as well as mechanistic insight into how sleep health can be leveraged to optimize smoking cessation treatment in ALHIV.