Racial Disparities in Sleep, Circadian Rhythm, and Glucoregulation Among Individuals Post-Coronary Artery Bypass Surgery

冠状动脉搭桥手术后个体在睡眠、昼夜节律和血糖调节方面的种族差异

• 批准号: 10750187
• 负责人: Pamela Bolton
• 金额: $ 4.77万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10750187
• 关键词: Adult; Antibiotics; Area; Behavior Therapy; Behavioral; Black American; Black race; Blood Glucose; Cardiac Surgery procedures; Cardiovascular Diseases; Cardiovascular system; Caring; Cessation of life; Characteristics; Circadian Dysregulation; Circadian Rhythms; Cities; Clinical; Communities; Complex; Convalescence; Coronary Artery Bypass; Coronary artery; Critical Illness; Death Rate; Diabetes Mellitus; Disparity; Environment; Foundations; Future; Guidelines; Hospitals; Hyperglycemia; Hypoglycemia; Impairment; Individual; Infusion procedures; Inpatients; Insulin; Insulin Resistance; Intensive Care Units; Intervention Studies; Length of Stay; Link; Longitudinal Studies; Measures; Morbidity - disease rate; National Institute of Nursing Research; Not Hispanic or Latino; Ohio; Operative Surgical Procedures; Outcome; Patients; Pattern; Persons; Physiology; Population; Population Heterogeneity; Postoperative Period; Process; Research; Research Activity; Risk; Role; Sleep; Sleep disturbances; Strategic Planning; Stress; Training; Universities; University Hospitals; actigraphy; caucasian American; circadian; deprivation; health disparity; high risk; immune function; improved; insulin sensitivity; lens; mortality; mortality disparity; negative affect; novel; outcome disparities; racial disparity; racial diversity; racial minority; racial population; repaired; response; social health determinants; socioeconomics; urban area

PROJECT SUMMARY/ABSTRACT It is well established that there are racial disparities in mortality rates and postoperative outcomes following coronary artery bypass graft with or without valvular replacement / repair (CABG/VR) surgery, particularly in Non-Hispanic Black Americans compared to Non-Hispanic White Americans. Hospital quality and a lack of guideline-concordant care (e.g., insulin infusions, timely antibiotics) are significant contributors; however, a large fraction of this racial disparity remains unexplained. Sleep, circadian rhythm disruption, and impaired glucoregulation may play a role in post-CABG/VR health disparities in Non-Hispanic Black Americans. These disruptions may result in prolonged length of stay, postoperative convalescence, impaired immune function, and cardiovascular morbidity and mortality. Therefore, the purpose of this descriptive study is to examine sleep and circadian rhythm characteristics and the relationships between sleep, circadian rhythm, and glucoregulation among adults in the intensive care unit postoperative CABG/VR surgery. In Aim 1, we will determine between- and within-person associations of sleep, circadian rhythm and glucoregulation associations among 30 adults post-coronary artery bypass graft with or without valvular surgery (50% non-Hispanic Black and 50% non- Hispanic White). Sleep and circadian characteristics will be described through the timing of behavioral (actigraphy) measures. In Aim 2, we will compare sleep, circadian rhythm characteristics, and glucoregulation between 15 individuals identifying as Non-Hispanic Black to 15 individuals identifying as Non-Hispanic White post-coronary artery bypass graft with or without valvular surgery. Our central hypothesis is that higher sleep and circadian disruption are associated with poorer glucoregulation and that there are sleep, circadian, and glucoregulation racial disparities among individuals post-CABG/VR. The proposed F31 study and training plan will provide a strong foundation in sleep and circadian rhythm health disparities. Promoting sleep and circadian rhythm stability post-surgery through behavioral modifications may improve glucoregulation by reducing insulin resistance, improving insulin sensitivity, and other short- and long-term postoperative outcomes in a population where such clinical gains may otherwise be difficult to achieve. This study will provide information on a novel potential contributor to racial disparities in coronary artery post-operative outcomes in the ICU where it is critical to optimize glucoregulation. Additionally, these results will provide preliminary evidence to inform future longitudinal and intervention studies to improve glucoregulation and postoperative outcomes in this understudied population.

项目摘要/摘要 众所周知，死亡率和术后结果存在种族差异 冠状动脉搭桥移植物，有或没有瓣膜置换 /维修（CABG / VR）手术，尤其是在 与非西班牙裔白人美国人相比，非西班牙裔黑人美国人。医院质量和缺乏 准则符合护理（例如胰岛素输注，及时的抗生素）是重要的贡献者；但是，一个大 这种种族差异的一部分仍无法解释。睡眠，昼夜节律破坏和受损 葡萄糖调节可能在非西班牙裔黑人美国人的CABG/VR健康差异中发挥作用。这些 干扰可能会导致住院时间延长，术后康复，免疫功能受损和 心血管发病率和死亡率。因此，这项描述性研究的目的是检查睡眠和 昼夜节律特征以及睡眠，昼夜节律和葡萄糖调节之间的关系 在重症监护病房的成年人中，术后CABG/VR手术。在AIM 1中，我们将确定 30名成年人之间的睡眠，昼夜节律和葡萄糖调节的关联 冠状动脉后旁通移植物进行或不进行瓣膜手术（50％非西班牙裔黑人和50％非 - 西班牙裔白色）。睡眠和昼夜节律特征将通过行为的时间来描述 （艺术学）措施。在AIM 2中，我们将比较睡眠，昼夜节律特征和葡萄糖调节 在15个人中识别为非西班牙裔黑人至15个人，识别为非西班牙裔白人 冠状动脉旁路移植物进行或不进行瓣膜手术。我们的中心假设是睡眠更高 和昼夜节律的干扰与较差的葡萄糖调节有关，并且有睡眠，昼夜节律和 CABG/VR的个体之间的种族差异。拟议的F31研究和培训计划 将在睡眠和昼夜节律健康差异方面奠定坚实的基础。促进睡眠和昼夜节律 通过行为修改手术后的节奏稳定性可以通过减少胰岛素来改善葡萄糖调节 抗药性，提高胰岛素敏感性以及其他短期和长期术后结果 否则可能难以实现这种临床收益。这项研究将提供有关小说的信息 ICU中冠状动脉术后冠状动脉术后种族差异的潜在贡献者，这是至关重要的 优化葡萄糖调节。此外，这些结果将提供初步证据，以告知未来 纵向和干预研究，以改善该研究的葡萄糖调节和术后结局 人口。