Sleep duration and cardiometabolic outcomes in American Indians/Alaska Natives and other race/ethnicities
While there is evidence in previous epidemiological studies that sleep duration is an important contributor to morbidity and mortality, variability by race/ethnicity in the association between sleep duration and adverse health outcomes has not been extensively studied in the literature. In particular, prior studies have essentially ignored sleep duration and its association with cardiometabolic diseases within the American Indian and Alaska Native (AI/AN) population, a group that exhibits an alarmingly high rate of diabetes and relevant cardiometabolic conditions. In this dissertation, I investigated the relationship between sleep duration and cardiometabolic outcomes using two cohorts of AI/ANs: 1) a unique longitudinal lifestyle intervention project; 2) a large cross-sectional survey. The main findings of this dissertation include: 1) suboptimal sleep duration is prevalent in the AI/AN population, as with other minority populations; 2) among AI/ANs with prediabetes undergoing lifestyle intervention, those with adequate sleep benefit more from the intervention than those with short sleep duration; 3) the association between suboptimal sleep and diabetes is stronger in AI/ANs than other race/ethnic groups; and 4) adherence to a set of healthy lifestyle factors confers significant reduction in risk of diabetes and CVD in AI/ANs. This work represents an important step forward in systematically characterizing sleep duration and its cardiometabolic consequences in the AI/AN population and may have a significant impact for future public health interventions in this severely underserved population.