Researching Equitable Sleep Time (REST) in Appalachia

Insufficient sleep (habitual sleep duration of ≤6 hours), is a costly, prevalent, public health problem associated with numerous negative health outcomes. Prior research suggests that insufficient sleep is more prevalent among health disparity populations (e.g., racial minorities, adults of low socioeconomic status), but our understanding of the mechanisms and consequences of sleep disparities in rural populations is limited. The present study “Researching Equitable Sleep Time in Kentucky Communities (REST-KY),” focuses on Appalachian adults, an NIH-designated health disparity population, whose serious health inequities include multiple health morbidities and premature mortality. Six of the counties with the highest concentration of insufficient sleep in the nation are in Central Appalachian Kentucky (KY), where 25-58% of adults report insufficient sleep 15+ nights/month. These counties are severely economically distressed, yet, nearby counties with comparable economic distress, rurality, and demographic homogeneity are not “hotspots” of insufficient sleep. Use of a mixed methods, longitudinal design will allow us to evaluate mechanisms contributing to both sleep deficiencies and health in this rural community. Knowledge gaps include 1) Sparse insights into specific individual-, social-, and societal-level factors contributing to sleep deficiencies in Appalachian adults.; 2) It is not known if regional sleep and health disparities share the same underlying mechanisms; and 3) Critical points of variance between “hotspot” and non-“hotspot” counties have not been examined. We will recruit a cohort of 400 adults from 6 insufficient sleep “hotspot” counties (n=200) in Appalachian KY, and 6 similarly rural and economically distressed non-“hotspot” counties. Recruitment will be stratified across “hotspot” and non-“hotspot” counties by key demographic factors linked to sleep deficiencies (e.g., age, sex, race/ethnicity) to promote county cluster-level comparisons. Specific Aims. 1. Use mixed methods to compare how individual, social, and societal factors linked to sleep deficiencies differ between insufficient sleep “hotspot” and non-“hotspot” counties. 2. Evaluate mechanisms driving sleep deficiencies and health outcomes over time. Bi-directional models of sleep and health outcomes will be examined. 3. Quantify day-to-day sleep reactivity (i.e., the degree to which daytime distress impacts sleep) and test if individual differences in sleep reactivity predict worsened health outcomes over time. Differences by sex and county cluster (“hotspot” vs. non-“hotspot”) will also be examined in Aims 2-3. Our multiple, sophisticated objective and subjective data collection methods, made possible by our interdisciplinary team’s varied expertise, will advance scientific knowledge about biological, behavioral, emotional, and social contributions to sleep health. This holistic approach explicitly acknowledges the inseparable overlap between health function, and sleep. Our findings will offer unprecedented insight into the bi- directional relationships between sleep and health in an understudied rural health disparity population. Results will inform strategies to reduce sleep disparities, thus having strong potential for public health impact.