Determinants and Cardiovascular Consequences of Disparities in Sleep and Circadian Rhythms between Black and White Adults

超过四分之一的成年人经历睡眠和昼夜节律紊乱，其特征在于： 睡眠时间不足、睡眠质量差、存在睡眠障碍和非最佳睡眠时间。 非白人种族群体，西班牙裔/拉丁裔和社会经济资源较少的成年人有更高的 睡眠和昼夜节律紊乱的负担比他们的同行。这些先前研究的局限性包括 横断面研究设计，自我报告的睡眠，以及对睡眠和昼夜节律的不完整评估。 我们研究的目的是确定一组可改变的因素，解释睡眠中的种族差异， 黑人和白色中年人之间的昼夜节律紊乱。我们还将测试这些 睡眠和昼夜节律的差异是血压控制差异的原因。我们的总体假设是 黑人参与者有更大的负担，不良健康行为，肥胖，心理和社会 压力源，以及邻里和家庭层面的环境侮辱，这些都有助于增加睡眠 和昼夜节律紊乱。为了达成我们的目标，我们将进行一次辅助行动 在即将到来的35年随访中，对2，500名53-65岁的成年人（45%黑人和60%女性）进行了研究 年轻人冠状动脉风险发展（CARDIA）研究。所有参与者将 进行腕关节活动记录7天，使用家庭内测定的阻塞性睡眠呼吸暂停严重程度（OSA） 筛查设备，并通过问卷调查睡眠行为、睡眠障碍诊断和睡眠质量。中 来自芝加哥和伯明翰现场中心的1,000名参与者的子集，我们将评估社区 和使用二次源的组合的家庭环境（例如，交通数据）、问卷调查和 记录设备，以捕捉家庭噪音，光线和温度。我们将联合收割机 具有丰富信息的数据，将在核心心脏检查中确定， 以标准化方式收集8次既往检查。我们研究的具体目的如下： 1)确定35年来行为、心理社会和临床特征对种族差异的贡献。 中年人睡眠和昼夜节律紊乱的差异; 2）确定与 睡眠持续时间的7天平均值和个体内变异性（每日变化）的种族差异， 质量; 3）量化睡眠和昼夜节律紊乱对血液中种族差异的贡献 估计60%的高血压患者的血压水平。我们还将探讨 性别作为一个生物学变量修改了所有目标之间的假设关联。我们提出的研究是一个 及时承认睡眠对心血管健康种族差异的重要性。我们 预计我们的研究结果将对广泛的利益相关者产生持续的影响，包括临床医生， 研究人员、政策制定者和中年人正在寻找干预目标，以减少种族歧视。 睡眠和昼夜节律的差异将促进心血管健康的公平性。

Over one quarter of the adult population experiences sleep and circadian disturbances, characterized by inadequate sleep duration, poor sleep quality, the presence of sleep disorders and non-optimal timing of sleep. Non-white racial groups, Hispanic/Latinos and adults with fewer socioeconomic resources have a higher burden of sleep and circadian disturbances than their counterparts. Limitations of these prior studies include cross-sectional study designs, self-reported sleep, and incomplete assessment of sleep and circadian rhythms. The objective of our study is to identify a set of modifiable factors that explain racial disparities in sleep and circadian disturbances between black and white middle-aged adults. We will additionally test whether these sleep and circadian disparities account for disparities in blood pressure control. Our overall hypothesis is that black participants have a greater burden of adverse health behaviors, adiposity, psychological and social stressors, and environmental insults at the neighborhood and household level that contribute to more sleep and circadian disturbances as compared with whites. To accomplish our goal, we will conduct an ancillary study in 2,500 adults (45% black and 60% women) aged 53-65 years old at the upcoming 35-year follow-up examination of the Coronary Artery Risk Development in Young Adults (CARDIA) study. All participants will undergo wrist actigraphy for 7 days, obstructive sleep apnea severity (OSA) determined using an in-home screening device, and sleep behaviors, diagnoses of sleep disorders and sleep quality via questionnaire. In a subset of 1,000 participants from the Chicago and Birmingham field centers, we will assess the neighborhood and household environment using a combination of secondary sources (e.g., traffic data), questionnaires and recording devices to capture household noise, light and temperature. We will combine these newly collected data with the wealth of information that will be determined in the core CARDIA examination and that has been collected in a standardized manner across 8 prior examinations. The Specific Aims of our study are as follows: 1) Determine the contribution of behavioral, psychosocial, and clinical characteristics over 35 years on racial disparities in sleep and circadian disturbances in middle-age; 2) Identify environmental factors associated with racial disparities in 7-day average and intra-individual variability (day-to-day changes) in sleep duration and quality; and, 3) Quantify the contribution of sleep and circadian disturbances on racial disparities in blood pressure levels in the estimated 60% of participants with hypertension. We will additionally explore whether sex as a biological variable modifies the hypothesized associations across all Aims. Our proposed study is a timely acknowledgement of the significance of sleep to racial disparities in cardiovascular health. We anticipate that our findings will have a sustained impact on a broad set of stakeholders, including clinicians, researchers, policymakers and middle-aged adults who are looking for intervention targets to reduce racial disparities in sleep and circadian rhythms that will promote cardiovascular health equity.