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Journal of Cellular Immunology

ISSN: 2689-2812

Research Article Open Access
Volume 3 | Issue 3 | DOI: https://doi.org/10.33696/immunology.3.098

Sleep Disturbances are a Significant Predictor of Chikungunya Arthritis Flare Severity

Sarah R. Tritsch1, Richard Amdur4, Liliana Encinales2, Andres Cadena3, Paige Fierbaugh4, Geraldine Avendaño3, Carlos Andres Herrera Gomez4, Karol Suchowiecki4, Evelyn Mendoza-Torres5, Wendy Rosales5, Dennys Jimenez3, Carlos Alberto Perez Hernandez3, Alfonso Sucerquia Hernandez3, Paula Bruges Silvera3, Yerlenis Galvis Crespo3, Alberto David Cabana Jimenez3, Jennifer Carolina Martinez Zapata3, Christopher N. Mores1, Gary S. Firestein6, Gary Simon4, Aileen Y. Chang4,*
  • 1Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
  • 2Allied Research Society, LLC, Barranquilla, Colombia
  • 3Clinica de La Costa Ltda., Barranquilla, Colombia
  • 4School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
  • 5Faculty of Health Sciences, Universidad Libre, Barranquilla, Colombia
  • 6University of California, San Diego, USA
+ Affiliations - Affiliations

Corresponding Author

Dr. A.Y. Chang, chang@gwu.edu

Received Date: April 10, 2021

Accepted Date: June 08, 2021

Citation:

Tritsch SR, Amdur R, Encinales L, Cadena A, Fierbaugh P, Avendaño G, et al. Sleep Disturbances are a Significant Predictor of Chikungunya Arthritis Flare Severity. J Cell Immunol. 2021; 3(3): 191-197.


Copyright: © 2021 Tritsch SR, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Objective: The primary objective of this research was to explore the link between sleep and flare pain associated with chikungunya virus (CHIKV) infection. The secondary objective was to investigate if cytokines and T regulatory (Treg) cells have an influence on this relationship.

Methods: A cross-sectional study was performed using data collected in Barranquilla, Colombia, which enrolled patients with and without chronic arthritis with a history of chikungunya infection. Flare severity was measured by a version of the Outcome Measures in Rheumatoid Arthritis Clinical Trials (OMERACT) flare questionnaire adapted for CHIKV arthritis, including metrics for pain, difficulty with physical activity, fatigue, stiffness and difficulty maintaining social activities due to arthritis that contribute to flare severity. In addition, four sleep disturbance items, five inflammatory cytokine levels, four anti-inflammatory cytokine levels, and six Treg levels were measured. Then, multivariable linear regression models were used to test the direct and indirect effects of flarepain on sleep disturbance, and to determine whether this relationship was mediated by cytokines or Tregs. Finally, the SAS CALIS procedure was used to test path models showing possible causal effects with mediators and confounds.

Results: The analysis showed that sleep disturbance is positively correlated with CHIKV arthritis flare pain, and that it is a significant predictor of flare severity after adjusting for demographic variables, cytokine, and T cell levels. Further, neither T cells nor cytokines mediate the pain/sleep relationship in CHIKV arthritis.

Conclusion: There is a strong association between sleep disturbance and arthritis flare pain and severity; however, this relationship is not mediated by cytokines or T cells. Since this study is unable to determine causation, further research is needed to determine the mechanism underlying the relationship between sleep disturbances and CHIKV arthritis flares.

Keywords

Chikungunya, Arthritis, Pain, Inflammation, Sleep, Cytokines, T regulatory cells

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