The Effect of a Race-Based Stress Reduction Intervention on Sleep Quality,Melatonin Onset,and Inflammation in African American Women: Protocol for a Pilot Randomized Controlled Trial

Abstract

African American women carry a disproportionate burden of cardiometabolic disease (CMD) risk and experience higher rates of sleep disturbances compared to other racial and ethnic groups. Sleep and the sleep-regulating hormone melatonin play key roles in modulating inflammation, a biological pathway central to CMD. Chronic exposure to racism and discrimination may exacerbate stress, disrupt sleep and melatonin rhythms, and elevate inflammatory responses, further heightening CMD risk. The purpose of this pilot study is to evaluate the effects of a race-based stress reduction intervention–Resilience, Stress, and Ethnicity (RiSE)–on sleep quality and dim-light melatonin onset (DLMO) as primary outcomes, and to examine inflammation as a secondary outcome among older African American women with CMD risk. Leveraging an ongoing randomized controlled trial (RCT) (R01AG081251), this embedded pilot RCT will randomize 32 women to either the RiSE intervention or an attention control health education program, both delivered via eight weekly online sessions. Sleep quality will be assessed using validated questionnaires and wrist-worn ActiGraph devices for seven nights. DLMO will be determined from seven salivary samples collected around habitual bedtime, and salivary cytokines will be measured for inflammation. All measures will be obtained pre- and post-intervention. This pilot study is the first to examine an integrative, race-based stress reduction intervention targeting sleep and melatonin rhythms in this population. Findings will inform future mechanistic studies and the development of nurse-led strategies to mitigate the adverse physiological consequences of discrimination-related stress on sleep and cardiometabolic health among African American women.