Longitudinal relationships among sleep health, systemic inflammation, and disease activity in psoriatic arthritis

Brigham And Women'S Hospital, Boston MA

Investigators

Abstract

Project Summary/Abstract Research: Psoriatic Arthritis (PsA) is a chronic inflammatory disease that often leads to disability and reduced health-related quality of life. Even with recommended therapy, less than 40% of patients achieve treatment targets such as minimal disease activity (MDA). We previously showed that 73% of patients with PsA experience poor sleep quality compared to 27% of “healthy controls”, and that poor sleep quality is associated with markers of disease activity such as swollen joint counts and pain. Furthermore, our qualitative research suggests a bidirectional relationship between PsA disease activity and sleep quality. Our proposed 12-month longitudinal prospective study will document both objective (i.e., actigraphy) and subjective (i.e., sleep diaries and questionnaires) measures of sleep, novel serum inflammatory markers, and achievement of MDA to test the overarching hypothesis that sleep quality and disease activity are bidirectionally associated, and that these associations are mediated by systemic inflammation. Specifically, we will determine whether (1). poor sleep quality (exposure) reduces the probability of achieving sustained MDA (outcome), (2). moderate-to-high disease activity (exposure) reduces the probability of achieving sustained good sleep quality (outcome), and (3) that systemic inflammation is a mediator in the causal pathway of these associations. The overarching goals of this proposal are to a) better understand the relationship between sleep and PsA disease activity to support the development and testing of interventions to improve sleep health and short and long-term outcomes in PsA and b) provide a training vehicle for Dr. Perez Chada to become an independent investigator. Candidate: Dr. Perez Chada is a dermatologist with current expertise in psoriatic disease and outcome measures research. Environment: Dr. Klerman, the candidate’s primary mentor, and her co-mentors (Dr. Alexis Ogdie, Dr. Monika Haack, and Dr. Joseph Merola) have directly supervised the training of numerous successful junior faculty members. Harvard Medical School and its hospitals and its Division of Sleep Medicine (DSM) offer a rich training environment including resources and expertise. These are available in the NIH-supported DSM Research Training Program in Sleep, Circadian and Respiratory Neurobiology; the Harvard School of Public Health; and Harvard Catalyst. Combined with the expertise available in her mentors’ lab, these opportunities will be important training for Dr. Perez Chada’s career. Career Development: Dr. Perez Chada’s long-term career goal is to become an R01-funded independent, patient-oriented physician-scientist. Dr. Perez Chada’s training will focus on sleep physiology and analysis, advanced biostatical and epidemiological techniques, mechanisms of inflammation, and rheumatology. Completion of the proposed research and career development plan will give the candidate the knowledge and skills to be uniquely positioned to lead research in sleep health and its relationship(s) with skin and musculoskeletal chronic inflammatory disease.