Behavioral and Policy Sciences, Division of Social and Economic Wellbeing, RAND Corporation, Pittsburgh, Pennsylvania.
Behavioral and Policy Sciences, Division of Social and Economic Wellbeing, RAND Corporation, Santa Monica, California.
JAMA Netw Open. 2024 Jun 3;7(6):e2414735. doi: 10.1001/jamanetworkopen.2024.14735.
Adolescent sleep problems are prevalent, particularly among racial and ethnic minority groups, and can increase morbidity. Despite the numerous strengths of their racial and ethnic group, urban American Indian and Alaska Native adolescents face significant health disparities but are rarely included in health research. Understanding how sleep problems are associated with health outcomes among American Indian and Alaska Native adolescents may elucidate novel targets for interventions to promote health equity.
To assess whether baseline sleep problems are associated with changes in behavioral and cardiometabolic health outcomes among urban American Indian and Alaska Native adolescents 2 years later.
DESIGN, SETTING, AND PARTICIPANTS: American Indian and Alaska Native adolescents were recruited via flyers and community events for an observational cohort study in California. Baseline assessments were conducted among 142 adolescents from March 1, 2018, to March 31, 2020, and follow-ups were conducted among 114 adolescents from December 1, 2020, to June 30, 2022.
Baseline actigraphy-assessed sleep duration and efficiency and self-reported sleep disturbances and social jet lag (absolute value of the difference in sleep midpoint on weekends vs weekdays; indicator of circadian misalignment).
Main outcome measures included self-reported depression (measured using the Patient Health Questionnaire), anxiety (measured using the Generalized Anxiety Disorder 7-item scale), past year alcohol and cannabis use, body mass index, systolic blood pressure (SBP) and diastolic blood pressure (DBP), waist circumference, and glycosylated hemoglobin (HbA1c). Analyses examined whether baseline sleep was associated with health outcomes at follow-up, controlling for age, sex, and baseline outcome measures.
The baseline sample included 142 urban American Indian and Alaska Native adolescents (mean [SD] age, 14.0 [1.4] years; 84 girls [59%]), 80% of whom (n = 114; mean [SD] age, 14.1 [1.3] years; 71 girls [62%]) completed follow-ups. Linear or logistic regressions showed significant negative associations between shorter sleep duration and depression (β = -1.21 [95% CI, -2.19 to -0.24]), anxiety (β = -0.89 [95% CI, -1.76 to -0.03]), DBP (β = -2.03 [95% CI, -3.79 to -0.28]), and HbA1c level (β = -0.15 [95% CI, -0.26 to -0.04]) and likelihood of alcohol (odds ratio [OR], 0.57 [95% CI, 0.36-0.91]) and cannabis use (full week: OR, 0.59 [95% CI, 0.35-0.99]) at follow-up. Greater social jet lag was associated with significantly higher SBP (β = 0.06 [95% CI, 0.01-0.11]) at follow-up.
This cohort study found significant associations between poor sleep and adverse changes in health outcomes. Findings highlight the importance of developing culturally responsive interventions that target sleep as a key modifiable risk factor to improve the health of American Indian and Alaska Native adolescents.
青少年睡眠问题普遍存在，尤其是在少数族裔群体中，并且会增加发病率。尽管美国城市印第安人和阿拉斯加原住民在种族和民族方面有许多优势，但他们面临着严重的健康差距，但他们很少被纳入健康研究。了解睡眠问题与美国印第安人和阿拉斯加原住民青少年的健康结果之间的关系，可能会为促进健康公平的干预措施提供新的目标。
评估城市印第安人和阿拉斯加原住民青少年的基线睡眠问题是否与 2 年后的行为和心血管代谢健康结果的变化有关。
设计、地点和参与者：印第安人和阿拉斯加原住民青少年通过传单和社区活动招募参加加利福尼亚州的观察性队列研究。基线评估于 2018 年 3 月 1 日至 2020 年 3 月 31 日进行，142 名青少年参加，随访于 2020 年 12 月 1 日至 2022 年 6 月 30 日进行，其中 114 名青少年完成。
使用活动记录仪评估的基线睡眠时间和效率，以及自我报告的睡眠障碍和社交时差（周末和工作日睡眠中点之间绝对值的差异；昼夜节律失调的指标）。
主要结局指标包括自我报告的抑郁（使用患者健康问卷测量）、焦虑（使用一般焦虑障碍 7 项量表测量）、过去一年的酒精和大麻使用、体重指数、收缩压（SBP）和舒张压（DBP）、腰围和糖化血红蛋白（HbA1c）。分析检查了基线睡眠与随访时健康结果之间的关系，控制了年龄、性别和基线结局测量值。
基线样本包括 142 名城市印第安人和阿拉斯加原住民青少年（平均[SD]年龄，14.0[1.4]岁；84 名女孩[59%]），其中 114 名（平均[SD]年龄，14.1[1.3]岁；71 名女孩[62%]）完成了随访。线性或逻辑回归显示，睡眠时间较短与抑郁（β=-1.21[95%CI，-2.19 至 -0.24]）、焦虑（β=-0.89[95%CI，-1.76 至 -0.03]）、DBP（β=-2.03[95%CI，-3.79 至 -0.28]）和 HbA1c 水平（β=-0.15[95%CI，-0.26 至 -0.04]）呈显著负相关，与饮酒（优势比[OR]，0.57[95%CI，0.36-0.91]）和大麻使用（全周：OR，0.59[95%CI，0.35-0.99]）的可能性呈显著负相关。更大的社交时差与 SBP 显著升高有关（β=0.06[95%CI，0.01-0.11]）。
本队列研究发现，睡眠质量差与健康结果的不良变化之间存在显著关联。研究结果强调了制定以文化为响应的干预措施的重要性，这些干预措施以睡眠为关键的可改变风险因素，以改善印第安人和阿拉斯加原住民青少年的健康。
