Reviewer’s report
Title: 
Short sleep duration and interest in sleep improvement in a multi-ethnic
cohort of diverse women participating in a community-based wellness
intervention:  An unmet need for improvement
Version: 
0 
Date: 
28 Dec 2022
Reviewer's report:
Short sleep duration (defined at <7hrs) has significant implications for women's
cardio-metabolic health and is rarely addressed in research. In a secondary
analysis, authors describe baseline data from a survey in preparation for a
Community Based Participatory Research (CBPR) project involving a culturally
tailored wellness program on physical activity and diet. A third topic to be
selected from among other choices included sleep (or smoking, mental health,
etc.). The manuscript reads like participants were asked about interest in
intervention to improve sleep, but the discussion is clear in many places that
"interest" was based on selecting sleep as a priority topic from among many
other options. 
The survey sample is impressive and includes 486 women of color representing
5 communities in Salt Lake City Utah, USA. While 41% had short sleep, only
10.7% (or Figure 1: 11.8%) were "interested" in a sleep improvement
intervention. However, the way the study was designed, this percentage was
dependent on other topics with lower priority. 
It is interesting that the researchers opted to include both immigrants and
refugees, yet refugees often experience posttraumatic stress disorder (PTSD) that
adversely affects sleep. It is not clear how long participants have been living in
the USA, but that would be a covariate in addition to shiftwork even though
there was a low rate of full-time employment. 
The sample inclusion/exclusion criteria could be better described in the methods
section and are not particularly rigorous, as would be expected in a CBPR
design, but for this secondary analysis it would be prudent to control for
potential covariates before concluding that one of the five groups is worse or
better than another. Covariates to consider include age, reproductive stage
(pregnancy or breastfeeding, menopausal status), bed partner, and nightshift
worker. 
The depression measure is validated, but the stress measure (0-10 scale) is not.
Participants were only asked typical hours sleep (not differentiating weekdays
from weekends) yet many aspects of sleep could be improved rather than
focusing on sleep extension. A secondary analysis has its own limitations, which
should be discussed briefly, but without measures of stress, ethnic
discrimination, PTSD, or other measures of sleep health besides duration, there is
little new knowledge about women of color and their sleep.
Table 1 has confusing percentages for the 2 groups. For example sleep apnea is
9% of the total, but the other two columns are percentages of the group. 
Tables 2 and 4 are very difficult to read as formatted. The figure of sleep
duration by cultural group is interesting, but there was no control for covariates
(shiftworker, refugee status, nativity, reproductive stage, age, etc.). 
References are clear and current. Reference #37 (Mindell et al) is about young
children's sleep and it is not clear why it is relevant to this topic (page 15, line
343) focused on women 18+ years of age. 
Comments about the abstract: please mention in the methods that it is a
secondary analysis and CBPR was the design; and while the abstract states
women "reported" short sleep duration, they only reported hours of sleep - the
researchers decided what was considered "short" sleep. 
The methods needs to be detailed so that the study can be replicated; it is not
sufficient to say anthropometrics were measured using "best practices" (page 6);
there are more details later in the methods and perhaps this could be re-
organized.
The strengths and limitations of this study are discussed. The sample size was
sufficient for analyses, but differences by shiftwork, weekdays and weekends,
poverty, etc. are not discussed. Cases of sleep apnea were included and there was
no exclusion based on BMI. Stress measured as a single item rather than a
validated questionnaire should distinguish stress of immigration as a refugee
from stress of other adverse events such as discrimination or poverty.
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
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No
Is the presentation of the work clear?
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Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
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