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

项目摘要/摘要 众所周知，以下患者的死亡率和术后结果存在种族差异。 冠状动脉旁路移植加或不加瓣膜置换/修复(CABG/VR)手术，尤其是在 非西班牙裔美国黑人与非西班牙裔美国白人的对比。医院质量和缺乏 符合指南的护理(例如，胰岛素注射、及时的抗生素)是重要的贡献因素；然而，很大一部分 这种种族差异的一小部分仍然无法解释。睡眠、昼夜节律紊乱和受损 糖调节可能在非西班牙裔美国黑人CABG/VR术后的健康差异中发挥作用。这些 中断可能会导致住院时间延长、术后康复、免疫功能受损以及 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、昼夜节律和糖调节之间的关系 在重症监护病房的成年人中，术后行CABG/VR手术。在目标1中，我们将确定- 以及30名成年人的睡眠、昼夜节律和糖调节关联的人内关联 接受或不接受瓣膜手术的冠状动脉搭桥术(50%非西班牙裔黑人和50%非西班牙裔黑人 西班牙裔白人)。睡眠和昼夜节律特征将通过行为的时序来描述 (动作)测量。在目标2中，我们将比较睡眠、昼夜节律特征和血糖调节 15个非西班牙裔黑人到15个非西班牙裔白人之间 冠状动脉搭桥术加或不加瓣膜手术。我们的中心假设是较高的睡眠 而昼夜节律紊乱与较差的糖调节有关，而且有睡眠、昼夜节律和 CABG/VR术后个体间的血糖调节种族差异。拟议的F31学习和培训计划 将为睡眠和昼夜节律健康差异提供坚实的基础。促进睡眠和生理节律 术后通过行为矫正的节律稳定性可能通过降低胰岛素来改善血糖调节 人群中的抵抗、改善胰岛素敏感性和其他短期和长期术后结果 否则，这样的临床收益可能很难实现。这项研究将提供关于一部小说的信息 ICU患者冠状动脉手术后预后存在种族差异的潜在因素 来优化血糖调节。此外，这些结果将提供初步的证据，以告知未来 这项未被研究的改善血糖调节和术后结果的纵向和干预性研究 人口。

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.