1231 Implementation Determinants of Uptake of a Digital Therapeutic for Insomnia for Hispanics: A Qualitative Analysis of Key Stakeholder Perspectives

SLEEP · 2026-05-01

Abstract Introduction Cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for chronic insomnia, yet few receive this standard of care, and those from marginalized groups suffer a disproportionate impact. While digital CBT-I (dCBTi) shows promise in addressing access disparities, the specific barriers and facilitators for the successful implementation of digital therapeutics for those with limited English proficiency is unknown. Our aim was to identify the implementation determinants of dCBTi, overall, and for Hispanic adults. Methods We conducted 25 semi-structured virtual interviews with 5 Spanish-speaking Hispanic patients with chronic insomnia, 9 healthcare providers from a large urban hospital, and 11 content experts/leaders (local/national hospital administrators, community and business leaders, sleep advocates, health navigators, clinical psychologists, and representatives from digital therapeutics advocacy groups and government agencies). Interviews were audio-recorded and transcribed. Data were analyzed using thematic analysis and categorized using the Consolidated Framework for Implementation Research. Results Patients (Mage=49.8 [SD=12.3]) were middle-aged Hispanic women from Mexico, Cuba, or the Dominican Republic. Providers (Mage=50.6 [SD=9.2]), and content experts/leaders (Mage=47.7 [SD=4.8]) were majority women, non-Hispanic White, and >80% had worked with their organization for over 5 years. Over 90% of the themes identified pertained to perceived determinants of digital therapeutics uptake related to the innovation (source, evidence-base, relative advantage, adaptability, trialability, complexity, design), and individuals’ domain (concerns about the capability, opportunity, need or motivation of digital therapeutic recipients or deliverers), which were raised by all stakeholder groups. Content experts and leaders were the only stakeholder group to identify themes focused on outer setting determinants (local attitudes, policies and laws, financing, external pressure). Patients and providers indicated that the inclusion of third-party support (i.e., additional social and navigation support) will be an essential implementation process strategy to engage digital therapeutic recipients. Content experts/leaders and providers also emphasized inner setting determinants such as integrating the digital therapeutics within their existing work-infrastructure (i.e., electronic health record). Conclusion Our analysis of stakeholders’ perspectives suggests that increasing the uptake of dCBTi in underserved populations will require coordinated, multi-level implementation strategies that address multiple barriers at the policy, organizational, individual, and the digital therapeutic design level. Support (if any) HS242747

0954 Perceived Stress, Acculturation, and Sleep Among Immigrant and Non-Immigrant Mothers

SLEEP · 2026-05-01

Abstract Introduction Recent research highlights persistent sleep disparities by immigrant status, yet less is known about the upstream psychosocial determinants, particularly among new parents, needed to guide tailored support. This study examines generational differences in acculturation and perceived stress and how they relate to sleep among parents of infants. Methods 1,274 mothers of children 0–24 months (10.07±6.8) participated in this study. 957 were non-immigrant, 134 first-generation, and 183 second-generation. Participants completed the Perceived Stress Scale (PSS) and the Stephenson Multigroup Acculturation Scale (SMAS) consisting of two subscales: Ethnic Society Immersion (ESI), indicating engagement with one’s heritage culture, and Dominant Society Immersion (DSI), indicating engagement with mainstream U.S. cultural norms. Sleep outcomes included the overall Pittsburgh Sleep Quality Index (PSQI) score and seven individual components. Acculturation differences were assessed with independent samples t-tests. Generational status’ association with parental stress was tested with multiple linear regressions controlling for parent age, income, education, and employment. Associations between perceived stress and maternal sleep outcomes, as well as associations between acculturation and mothers' sleep, were examined using linear regression adjusting for child's age. Results Second-generation mothers had the highest perceived stress levels (M=16.98±6.68,p< 0.001). Higher perceived stress was associated with higher global PSQI scores (β=0.23,SE=0.01,p< 0.001), poorer sleep quality (β=0.04,SE=0.003,p< 0.001), longer sleep latency (β=0.04,SE=0.004,p< 0.001), shorter sleep duration (β=0.03, SE=0.004,p< 0.001), lower sleep efficiency (β =0.04,SE=0.005,p< 0.001), greater sleep disturbance (β=0.02,SE=0.002,p< 0.001), more frequent sleep medication use (β=0.02,SE=0.004,p< 0.001), and greater daytime dysfunction (β=0.06,SE=0.003,p< 0.001). Second-generation mothers reported significantly higher DSI (M=3.71±0.28,p< 0.001) than first-generation mothers (M=3.5±0.28, p< 0.001), but no differences in ESI. Higher ESI was associated with better sleep, including better overall sleep quality (β=–0.79,SE=0.39,p=0.04) and higher sleep efficiency (β=–0.17,SE=0.05,p=0.002). Similarly, higher DSI was associated with lower daytime dysfunction (β=–0.28,SE=0.12,p=0.023). Conclusion These findings highlight differences in acculturation and perceived stress across immigrant generational groups. We found that second generation immigrant mothers show greater dominant-society immersion and report higher perceived stress than first-generation and non-immigrant mothers. In turn, higher perceived stress and weaker ethnic-society immersion are associated with worse parental sleep, suggesting potential psychosocial pathways that link generational status to sleep health. Support (if any)

1230 Social Determinants of Acceptability of Digital Therapeutics for Insomnia Among Hispanic Adults: Patient and Provider Perspectives

SLEEP · 2026-05-01

Abstract Introduction Self-guided digital health treatments represent an innovative means of addressing the increasing prevalence of insomnia among Hispanics. This study assessed how social determinants of health influence patient and provider perceptions of the acceptability of a digital cognitive behavioral therapy for insomnia (dCBTi) intervention adapted for Spanish-speaking populations. Methods This was a secondary analysis of a hybrid type 1 effectiveness-implementation study on barriers and facilitators to dCBTi implementation. Individual semi-structured interviews were conducted with 5 Spanish-speaking Hispanic patients with chronic insomnia and 9 healthcare providers from a large urban hospital system. Qualitative data were analyzed using thematic analysis and categorized using the National Institute on Minority Health and Health Disparities (NIMHD) interpretive framework. Results Patients were 49.8 years of age (± 12.3 years) on average and 100% female. Providers were 50.6 years old (± 9.2 years) on average, 22% male, and 78% female. Across domains of influence in the NIMHD framework, 20 themes were identified, 80% of which fell within the sociocultural environment domain. Patients more often described sociocultural factors at the community and society levels, emphasizing the impacts of mental health stigma and the influence of gender-role expectations shaped by marianismo (traditional feminine gender roles) on sleep. Patients also highlighted neighborhood noise, the broader public health burden of insomnia in the Hispanic community, and the limited knowledge of available mental health treatments. Providers primarily identified social determinants at the individual level, noting the influence of immigration status, language, educational attainment, and digital literacy on perceived patient suitability for digital therapeutics. Providers also described individual-level factors like lack of smartphone access, limited time, and housing instability as barriers to patient acceptability. Conclusion Factors related to the sociocultural environment shaped patient and provider perceptions of the acceptability for dCBTi for Hispanic populations. Successful implementation of dCBTi in the Hispanic community requires a more nuanced approach that accounts for the multiple levels and domains of social determinants shaping acceptability, particularly in relation to the sociocultural environment. Support (if any) This research was supported by the Agency for Healthcare Research and Quality under Award Number R01 HS242747.

0617 Cultural and Gender Dynamics in Hispanic/Latinx Couples Managing OSA and PAP Therapy

SLEEP · 2026-05-01

Abstract Introduction Obstructive sleep apnea (OSA) and PAP therapy affect not only individuals but also the health, functioning, and sleep of romantic partners. These dynamics may be particularly salient in Hispanic/Latinx families, where core sociocultural values shape how couples perceive illness, engage in treatment, and support one another. Yet little work has examined how Hispanic/Latinx couples experience OSA and PAP use, including cultural and gender dynamics. This study explored how these experiences shape daily life, shared sleep, and relationships. Methods We conducted three Spanish-language virtual focus group discussions (FGDs) with Hispanic/Latinx adults with OSA (with and without PAP use) and their partners together. A semi-structured facilitator guide examined: (1) interdependence of sleep within couples managing OSA; (2) collaborative and gendered strategies used to address sleep-related challenges; and (3) perceived barriers and facilitators to PAP use in the context of cultural values. FGDs were audio-recorded, transcribed, and thematically analyzed. Results Participants (N = 18; 9 male, 9 female; 9 PAP users, 9 non-users; Mage = 54.3 years, SD = 11.3, range = 37–76) consistently described OSA as a shared problem that influenced safety, mood, sleep quality, and intimacy. Partners, most often women, reported sleep loss, hypervigilance, and anxiety related to their partner’s symptoms, as well as taking primary responsibility for reminders, equipment setup, and troubleshooting PAP. Over time, many partners described fatigue and frustration, while some men minimized symptoms or disengaged from care. Gendered expectations were a pervasive theme: women were described as “on top of everything,” carrying caregiving and household responsibilities. Cultural norms such as familismo and marianismo intensified these caregiving loads and shaped decisions about seeking and maintaining treatment. PAP use sometimes disrupted intimacy and self-image but also reduced conflict and improved rest when couples collaborated effectively. Conclusion Findings demonstrate that OSA management in Hispanic/Latinx families is a deeply interdependent, dyadic process shaped by sociocultural values and gendered caregiving roles. Culturally responsive, couples-based education and support may enhance PAP adherence while reducing the disproportionate burden placed on women partners, improving sleep health and well-being for both patients and their partners. Support (if any)

0314 Sleep and Self-Regulation Resources in Latine Adults: An Exploration of Effect Modification by Trauma

SLEEP · 2026-05-01

Abstract Introduction Self-regulation is an important basic and multidimensional behavioral mechanism that is influenced by sleep. In experimental studies, conditions of acute sleep deprivation have been shown to negatively impact multiple dimensions of self-regulation (e.g., cognitive regulation, behavioral regulation, and emotion regulation). How these processes work in an ecological and real-world setting, and with marginalized populations, remains unknown. Emerging evidence suggests that trauma exposure may contribute to poor sleep outcomes and disrupt one’s ability to self-regulate. Our aim was to examine the relationships between sleep and multiple dimensions of self-regulation (i.e., cognitive and behavioral self-regulation), and the extent to which these relationships were moderated by trauma in Latine adults. Methods We analyzed data from an intensive 40-day longitudinal study. Sleep duration and sleep efficiency were measured via wrist-actigraphy. Cognitive self-regulation was measured daily using an app-based Stroop Color-Word Interference test (Lumosity). Behavioral self-regulation was measured via self-report using a modified Brief Self-Control Scale, which assesses control over thoughts, emotions, impulses, and habits. Lifetime exposure to trauma was measured using the Life Events Checklist, and PTSD severity was measured using the Post-Traumatic Stress Disorder Checklist. We assessed the bi-directional association between sleep and self-regulation using lagged linear random-intercept models to estimate both within-person effects (person-centered) and between-person effects (person mean centered around overall mean) adjusting for covariates. For models with significant main effect, we further examined interactions between the primary predictor and trauma exposure or PTSD severity. Results Participants were 59 Latine adults free from sleep disorders (mean(SD): age 36.8(11.0), years of education 15.6(4.8); 69.5% women, 66.1% immigrant, and 37.3% Spanish-speaking). Higher than usual sleep efficiency predicted higher next day behavioral self-regulation score (B=0.004, 95% CI: 0, 0.009, p< 0.05). Greater than 6 hours of sleep the previous night was associated with higher next day behavioral self-regulation score (B=0.05, 95% CI: 0.001, 0.105, p< 0.05). There were no statistically significant interactions between trauma and efficiency or trauma and sleep duration. Conclusion We found a uni-directional relationship in which sleep duration and sleep efficiency were associated with next-day behavioral self-regulation. Our results highlight the importance of sleep health for effective behavioral self-regulation. Support (if any) HL125748

0599 Cultural Adaptation of a Dyadic Digital Health Treatment to Improve Positive Airway Pressure Adherence and Sleep Health Among Hispanic Couples

SLEEP · 2026-05-01

Abstract Introduction While the gold-standard treatment for OSA is positive airway pressure (PAP), most patients are non-adherent. Current PAP adherence treatments were designed with a focus on the individual and on non-Hispanic White populations, overlooking the role of the bedpartner in treatment, and salient sociocultural factors that may shape treatment adherence in marginalized groups. Our aim was to describe the rigorous cultural adaptation process we used to develop “Nuestro Sueño,” a culturally adapted, evidence-based, 3 session dyadic digital health treatment to improve PAP adherence and sleep health among Hispanic patients and their bedpartners. Methods We used an integrated four-stage model of cultural adaptation to guide our process. A bilingual (Spanish/English) community advisory board provided critical input. In stages 1-3, six focus groups with 15 couples, and 6 dyadic interviews were conducted to obtain feedback. In stage 4, a pilot study was conducted with 4 couples. To organize and report our findings, we used the cultural adaptation taxonomy of common elements. Results Participants were 54 adults (Mage=51.4 [SD=11.3], 52% female, 74% Spanish-language preference, 33% Mexican, 30% Peruvian, 17% US-born, 20% Other). Relationship duration was 22.3 years (SD=14.22). Average PAP use was 3.85 years (SD=3.4). Cultural adaptations to the original intervention were made in each of the taxonomy components (81 total). Deep-level adaptations (52% of the changes based on sociocultural values) included integration of cultural values of familismo and marianismo into treatment, inclusion of Spanish language proverbs, and language tailoring to address health literacy concerns. Surface-level adaptations (48% of the changes based on observable characteristics) included structural changes to the treatment such as use of ethnicity-matched community health workers as interventionists, Spanish-language translation, use of culturally and age-appropriate images, and integrating health information relevant to the target population. Conclusion We used a rigorous cultural adaptation process to develop an innovative, culturally acceptable dyadic digital health treatment that leverages the central role of family in health promotion. Future research should evaluate the effectiveness of Nuestro Sueño in improving PAP adherence and sleep health among Hispanic couples. Support (if any) R61AG084477

Insomnia-Related Metabolomic Profiles Reflect Antioxidant Deficits and Relate to Cognitive Decline Through a Metabolic Risk Score in HCHS/SOL

medRxiv · 2026-02-05

Abstract Background We aimed to identify metabolites and create risk scores for insomnia symptoms in U.S. Hispanic/Latino adults. Methods We analyzed data from 6,107 participants in the Hispanic Community Health Study/Study of Latinos, split into discovery (n=3,932) and replication datasets (n=2,175). Serum metabolites and the Women’s Health Initiative Insomnia Rating Scale (WHIIRS) were collected at baseline. We examined the relationships between 768 metabolites and insomnia symptoms and suspected insomnia (WHIIRS≥9) using the discovery dataset, followed by replication. Metabolite risk scores (MRSs) were generated with LASSO regression and evaluated for replication. We assessed the relationships of replicated metabolite measures and MRS with sleep, cognitive, and psychological traits (cross-phenotypes). Findings Nine metabolites were associated with insomnia symptoms in the discovery study, with two of these being replicated. Lower levels of hydrocinnamate and indolepropionate correlated with increased insomnia symptoms. We developed MRS for insomnia symptoms with replication. Various associations were observed between the two metabolites, 2 MRS, and cross-phenotypes. For instance, the WHIIRS MRS was associated with a higher risk of mild cognitive impairment (MCI) seven years later (OR:1.58, 95%CI:1.43-1.74 per 1 SD increase in MRS). Interpretation The metabolomic profile associated with insomnia symptoms encompasses diet and gut microbiome metabolites. This study identified specific metabolites linked to insomnia that are also related to comorbidities, such as a higher risk of developing MCI during follow-up, suggesting a shared mechanism. Funding Grants from various National Institutes of Health and the JLH Foundation supported the work. Research in context Evidence before this study Insomnia affects 30–36% of individuals, with clinical insomnia estimated at 6–10%, and it is more severe among Hispanics, who also face higher risks for cognitive decline and cardiovascular disease. While previous metabolomics studies have investigated sleep disorders, most have focused on sleep apnea or sleep duration, not insomnia. The few studies that focus on insomnia were limited by small sample sizes or co-occurring psychiatric conditions. Only two large-scale studies linked insomnia symptoms to specific metabolites, but neither examined these associations in Hispanics or their connection to cognitive decline—gaps this study aims to address using data from the HCHS/SOL cohort. Added value of this study We identified nine metabolites related to insomnia symptoms, with two—hydrocinnamate and indolepropionate—being replicated. We also created and validated metabolite risk scores (MRS), which predicted a higher likelihood of developing mild cognitive impairment (MCI) seven years later. These results provide new insights into the metabolic pathways connecting insomnia and cognitive decline in a high-risk Hispanic population. Implications of all the available evidence Our findings indicate that insomnia symptoms are linked to specific metabolic changes, some of which may also play a role in cognitive decline. Identifying metabolites related to diet and the gut microbiome points to biological pathways that could be modified through lifestyle or therapeutic interventions. The metabolite risk scores (MRS) developed in this study showed links with mild cognitive impairment (MCI) over time, suggesting their potential usefulness in understanding long-term health risks associated with sleep disturbances. These results encourage further research into the role of metabolomics in sleep and cognitive health, especially in high-risk populations like Hispanics.

0671 Obstructive Sleep Apnea and Hispanic Identity Among Immigrant Couples in Utah

SLEEP · 2026-05-01

Abstract Introduction Perspectives on obstructive sleep apnea (OSA) and its symptoms vary across communities, and understanding these differences can improve the cultural proficiency of research and care with Hispanic/Latine patients. In these communities, treatment seeking, adherence, and stigma are shaped by medical mistrust, cultural values, and community-level communication, yet few studies have examined how these factors shape understandings of OSA and decisions about care. This study examined Hispanic/Latine immigrant patients’ experiences with OSA, focusing on cultural mechanisms that frame motivation to address sleep problems within couples. Methods immigrant patients with OSA and their partners (N = 18; 9 men, 9 women; 9 patients with OSA, 9 partners; Mage = 54.3 years). A guide, developed from literature and refined with a Community Advisory Board, was used by bilingual community health workers to explore couples’ sleep practices, strategies for managing OSA, and barriers and facilitators to PAP use. FGDs were audio-recorded, transcribed, and analyzed in Spanish using Braun and Clarke’s thematic content analysis. Results Participants described boca a boca (word-of-mouth) as a key cultural mechanism through which communities disseminated information and circumvented traditional, yet mistrusted medical sources. Discussions of boca a boca were frequently paired with accounts of rushed appointments, dismissed concerns, and unclear explanations from healthcare providers. In the absence of such community-level communication, many participants were unsure whether OSA symptoms signaled a serious disease or something “normal,” which lowered their perceived need for evaluation and treatment. Motivation to seek diagnosis and use PAP typically arose when friends, family, or other community members shared personal experiences, highlighted risks, and framed OSA as worthy of concern. Participants described delaying or avoiding diagnosis and treatment, sometimes for more than a decade, when these messages were lacking. Conclusion Findings suggest that community-wide approaches to communication, alongside community health workers bridging clinical care and community networks, may prove crucial for reducing underdiagnosis of OSA in Hispanic/Latine communities. Culturally-grounded approaches to OSA screening and treatment may consider centering cultural mechanisms like boca a boca to improve engagement and advance sleep health equity. Support (if any)

0939 Immigrant Generation Status and its Associations with Objective Infant Sleep and Maternal Sleep Quality

SLEEP · 2026-05-01

Abstract Introduction Prior research has documented sleep health disparities across immigrant groups. However, less is known about how these differences occur in mother-infant dyads. This study examined whether immigrant generational status is associated with infants’ objectively measured sleep and mothers’ self-report sleep, providing an intergenerational view of sleep health within immigrant families. Methods Participants were 1,274 mothers of infants aged 0–24 (10.07±6.8) months residing in the US. First-generation mothers were not born in the US (n=134), second-generation were born in the US with at least one parent born outside the US (n=183). Non-immigrant mothers (n=957) were born in the US to US-born parents. 72% were White, 10% multiracial, 6% Asian, 7% Hispanic/Latino and 3% Black, and >55% earning ≥$150,000/year. Infant sleep was measured using Nanit autovideosomnography, including sleep duration, night wakings, and parent nighttime crib visits. Parental sleep was assessed using the PSQI. Generational differences in infant sleep were examined with linear regressions, while in parental sleep were examined using ANCOVAs. Child age was a covariate. Results Second-generation mothers reported poorer overall PSQI score compared to non-immigrant mothers (β=-1.124,SE=0.323,p=0.002), while first-generation mothers did not differ from either group. Second-generation mothers reported poorer subjective sleep quality (β=-0.190,SE=0.067,p=0.014) than non-immigrant mothers. First-generation mothers showed longer sleep latency than non-immigrant (β=0.293,SE=0.102,p=0.011) and second-generation mothers (β=-0.465,SE=0.129,p< 0.001). Both first (β=-0.326,SE=0.084,p< 0.001) and second-generation mothers (β=-0.229,SE=0.077,p=0.008) slept less than non-immigrant mothers. Infants of first-generation mothers slept 27 minutes less (p=0.007), woke 0.52 more times per night (p=0.034), and experienced 1.5 more parental nighttime visits (p< 0.001) than infants of non-immigrant mothers. Infants of second-generation mothers did not differ from non-immigrant families. Conclusion Immigrant mothers showed poorer sleep than non-immigrant mothers. Similarly, babies born to first-generation mothers had shorter and more fragmented sleep than those of non-immigrant mothers, while infants of second-generation mothers did not differ from non-immigrant infants. Given sleep’s critical role in lifelong health, the parallel sleep disadvantages in immigrant mothers and their children point to a potential intergenerational transmission of vulnerability within immigrant communities. Support (if any)

Protocol for Nuestro Sueño: A randomized trial of a couples-based intervention to improve PAP adherence and sleep health among Hispanic patients beginning positive airway pressure (PAP) and their partners

Sleep Medicine · 2026-05-15

Obstructive sleep apnea (OSA) is more common among Hispanic individuals and contributes to risk for cardiometabolic diseases, dementia and poor quality of life. Positive airway pressure (PAP) improves sleep and quality of life, and culturally adapted interventions are promising for increasing treatment engagement. The goal of this study is to test Nuestro Sueño, a culturally adapted couples-based intervention to promote positive airway pressure adherence and sleep health for Hispanic couples in which one partner is recently diagnosed with OSA. We are conducting a two-arm, parallel group, single blind, randomized controlled pilot/feasibility trial to compare our novel culturally adapted treatment to an information control (IC). Nuestro Sueño is a culturally adapted dyadic behavioral intervention based on a transdiagnostic model. The digital health program involves 3- weekly sessions delivered via telehealth with a community health worker. Content is focused on education about OSA and PAP, improving both partner’s sleep quality, increasing partner support and communication, and couple-level goal-setting around sleep and PAP use. The IC includes standardized patient educational materials. Both groups receive the usual follow-up care. Assessments will be completed pre-treatment, 1 and 3 months after starting PAP. Our main outcomes are feasibility and treatment satisfaction. Secondary outcomes include comparing Nuestro Sueño to IC for PAP adherence, sleep quality (self-report and objective) and cognitive measures of memory, processing speed and verbal fluency. Nuestro Sueño is a novel culturally adapted intervention focused on improving PAP adherence and sleep health among couples in which one partner is recently diagnosed with OSA. Results of this study will be used to inform the design of a subsequent fully adequately-powered clinical trial. If successful, this intervention could significantly advance current clinical practice in the treatment of OSA and sleep health more comprehensively as well as promote sleep health equity among Hispanic patients, who are more likely to face challenges to obtaining diagnosis and treatment for OSA. Clinicaltrials.gov, NCT06649929 • Sleep apnea risk is elevated among Hispanics. • Culturally tailored interventions can improve engagement with treatment. • Nuestro Sueno focuses on improving the couples’ sleep within their language and culture.