Phenotypes of Sleep Health among Black and Hispanic Women of Childbearing Age

U.S. women of childbearing age (WOCBA: 18-49 years) have the highest death rates from pregnancy and cardiometabolic abnormalities, more chronic conditions, and more unmet mental health care needs than other women. Black and Hispanic women are at elevated risk for adverse pregnancy outcomes, hypertension, and diabetes. Sleep health is an important determinant, and Black and Hispanic WOCBA report short, irregular, and fragmented sleep, as well as poor sleep quality. Although behavioral sleep interventions may improve sleep and sleep-related outcomes, they are hindered by a lack of comprehensive understanding of the multidimensional aspects of sleep health and the interactive influences of multilevel personal, behavioral, cognitive, social, and environmental factors. The purpose of this mixed methods study is to obtain an in-depth understanding of multi-dimensional aspects or phenotypes of sleep health; the contributions of personal, behavioral, cognitive, social, and environmental factors to sleep health; and whether sleep-related behaviors and cognitions moderate the influence of social and environmental influences on sleep health among 300 Black and Hispanic WOCBA. The scientific premise is that cognition and behaviors serve as risk or protective factors for sleep health, influenced by social and environmental factors. We will address the following specific aims: (SA1) Characterize sleep health phenotypes based on sleep continuity, duration, timing, satisfaction, alertness, and sleep disorders indices; (SA2) Determine (a) the effects of social and environmental factors on sleep health phenotypes; (b) associations between sleep behaviors and cognitions and sleep health phenotypes; and (c) the extent to which sleep behaviors and cognitions moderate the effects of social and environmental factors on sleep health phenotypes. We will use moderator analyses to identify protective (positive), harmful (negative), or absent interaction effects between social and environmental influences, cognitive and behavioral factors, and sleep health, while considering potential covariates. (e.g., age and health); (SA3) Use sequential explanatory mixed methods and semi-structured qualitative interviews to integrate quantitative findings from aims 1 and 2 to gain a comprehensive understanding of sleep health. We will compare themes across sleep phenotypes to evaluate concordance, complementarity, or divergence, and use the merged information to identify potential targets for behavioral sleep intervention. This application responds to recommendations outlined in the National Sleep and Circadian Biology Research Plan. Mixed methods will ensure a comprehensive perspective, including the voices of women and their communities, and support recommendations for future multi-level sleep health interventions targeted at identified risk and protective factors among Black and Hispanic women.