Pahwa, Punam2023-09-2520232023-082023-09-25August 202https://hdl.handle.net/10388/15062Background:  Limited research has examined the relationship between impaired sleep, social determinants of health, and the interconnected four domains of health (physical, mental, emotional, and spiritual) based on the Indigenous Medicine Wheel.  Purpose: This study aimed to find the association between impaired sleep and the four domains of health and the role of chronic conditions as mediators between impaired sleep and the four domains of health among First Nations people. Methodology: Baseline data (n=588) from First Nation Sleep Health Project (FNSHP), collected from participants in two Cree First Nation communities in Saskatchewan, was used for this thesis. The outcome variables of interest were four domains of health: physical, mental, spiritual, and emotional. Each outcome variable was dichotomous: good or better vs poor or fair. Primary predictors of interest were: Insomnia Severity Index (ISI) & Pittsburgh Sleep Quality Index (PSQI). Multivariable logistic regression analysis was conducted to determine the strength of potential risk factors, confounders, and interactive effects. The strength of associations between significant predictors was presented as odds ratio (OR) with a 95% confidence interval (CI). By generalized structure equation modeling, we assessed the mediational effect of chronic diseases (multimorbidity) after adjusting the confounders.  Result: Most of the participants had good or better physical (69.09%), mental (77.07%), emotional (71.48%), and spiritual (78.03%) health. Impaired sleep was significantly associated with poor or fair health in all four domains After adjusting for potential risk factors, we found that probability of poor or fair health in all four domains was higher among people that had severe to moderate insomnia based on ISI [OR=3.06 (1.76-5.30), 2.77 (1.54-4.99), 3.19 (1.85-5.52), & 1.57 (0.88-2.80)] and had poor quality of sleep based on PSQI [OR (95% CI)1.44 (0.88-2.35), 3.24 (1.82-5.76), 2.79 (1.70-4.58) & 2.09 (1.24-3.54)]. Additionally, the total effect of ISI on physical, mental, emotional & spiritual health was significantly mediated by multimorbidity by 51.34%, 61.72%, 44.81% & 57.27%, respectively. This indicates ISI is not only responsible for developing poor or fair health in each domain of health, but the impact of ISI on multimorbidity is also responsible for increasing odds in four domains of health. Conclusions: The impact of impaired sleep on four domains of health and the mediation effect of chronic disease on this path are unique findings. These associations indicates early diagnosis and treatment of both impaired sleep and multimorbidity might improve overall health.application/pdfenInsomniaInsomnia Severity Index (ISI)Pittsburg Sleep Quality Index (PSQI)MultimorbidityMedicine WheelSelf-Reported HealthFirst Nations.Thesis2023-09-25