Systemic Inflammation in Association with Periodic Limb Movements of Sleep 公开
Trotti, Lynn Marie (2011)
Published
Abstract
Abstract
Systemic Inflammation in Association with Periodic Limb Movements
of Sleep
By Lynn Marie Trotti
Systemic inflammation is associated with cardiovascular disease.
While restless
legs syndrome (RLS) is also known to be associated with
cardiovascular disease, the
mechanism for this relationship is unknown. We evaluated the
association between
periodic limb movements (PLMs) and inflammatory markers as a
possible mediator
underlying this relationship.
A cross-sectional study of inflammation and PLMs was performed
using a
retrospective sample of 350 subjects evaluated for RLS/PLMs. PLMs
were measured by
actigraphy (n = 167) or polysomnography (n = 237). Subjects'
demographic and clinical
features were collected from existing databases. Banked plasma was
assayed for CRP by
nephelometry and for IL-6 and TNF-alpha by fluorokine multianalyte
profiling. CRP
was categorized as low-normal (<3 mg/L) or high (3-10 mg/L).
IL-6 and TNF-alpha
were divided into quartiles and lowest versus highest quartiles
compared.
In subjects with actigraphically-measured PLMs, mean PLM/hour
was
significantly higher in the high CRP group (40.2/hr vs 26.1/hr, p =
0.04), but did not
differ based on IL-6 or TNF-alpha quartile. No association was seen
between
polysomnographically-measured PLMs and the inflammatory markers. In
an unadjusted
logistic regression model using actigraphy subjects, the OR for
each PLM/hr was 1.015
(95% CI 1.003, 1.03). Adding age, gender, and race did not
substantially alter the
estimate of the effect of PLMs (OR = 1.016), but improved
predictive value (likelihood
ratio test 9.23, p = 0.03). Further adding clinical conditions
known to affect
inflammation or cardiovascular disease risk did not substantially
change the estimate for
PLMs (OR = 1.015) and did not improve the predictive value (LRT =
8.76, p = 0.27), but
resulted in the estimate of PLMs' effect becoming marginally
non-significant (95% CI
0.999, 1.03). Body mass index, sleep length, RLS severity, current
smoking, and ferritin
could not be fully evaluated due to missing data, but did not
appear to strongly confound
the PLM-CRP association.
PLMs are associated with increased CRP, with each single PLM per
hour
corresponding to a 1.5% increase in odds of elevated CRP. After
controlling for relevant
confounders, the relationship between PLMs and CRP remains
apparent. Further
investigation into the relationship between PLMs and inflammation
is warranted.
Systemic Inflammation in Association with Periodic Limb
Movements of Sleep
By
Lynn Marie Trotti
MD, Baylor College of Medicine, 2003
Advisors: Donald L. Bliwise, PhD
David B. Rye, MD, PhD
A thesis submitted to the Faculty of the
James T. Laney School of Graduate Studies of Emory University
in partial fulfillment of the requirements for the degree of
Master of Science
in Clinical Research
2011
Table of Contents
Table of Contents
1.
Introduction……………………………………………………………..1
2.
Background……………………………………………………………...3
3.
Methods…………………………………………………………………8
4.
Results………………………………………………………………….18
5.
Discussion………………………………………………………………22
6.
References…..…………………………………………………………..27
7.
Tables……………………………………………………………………31
About this Master's Thesis
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