ABSTRACT
BACKGROUND AND AIMS: Chronic low back pain (chronic LBP) is the number one cause for years lived with disability among 301 diseases and injuries analyzed by The Global Burden of Disease study 2013. Insomnia is highly prevalent among people with chronic LBP. To explain the sleep-pain relationship, theoretical models propose that insomnia symptoms may be associated with increased basal inflammation, operationalized as c-reactive protein (CRP) and lead to further pain and disrupted sleep. We aimed to determine the associations between insomnia, chronic LBP, and inflammation (operationalized as CRP), whilst controlling for age, body mass index, smoking, physical activity, depression, anxiety and osteoarthritis. METHODS: A cross-sectional analysis of the third Nord-Trøndelag Health Study (2006-2008), a rural population survey of 50,666 participants in Norway aged 20-96 years. Insomnia (dichotomous) was defined according to the Diagnostic and Statistical Manual of Mental Disorders 5th Edition, and chronic LBP (dichotomous) as low back pain or stiffness lasting at least 3 months. Data for CRP were obtained from non-fasting serum samples and assessed via latex immunoassay methodology. We excluded participants with the following self-reported chronic somatic diseases: chronic heart failure, chronic obstructive pulmonary disease, rheumatoid arthritis, fibromyalgia or ankylosing spondylosis. Possible associations between presence of insomnia and presence of chronic LBP (dependent), and the level of CRP and presence of chronic LBP (dependent), were assessed using logistic regression models. The possible association between insomnia and CRP (dependent) was assessed using linear regression. Multivariable analyses were conducted adjusting for confounders stated in our aim that achieved p ≤ 0.2 in univariate regressions. We performed stratified analyses for participants with "Normal" (<3 mg/L) "Elevated" (3-10 mg/L) and "Very High" (>10 mg/L) levels of CRP. RESULTS: In our total included sample (n = 30,669, median age 52.6, 54% female), 6.1% had insomnia (n = 1,871), 21.4% had chronic LBP (n = 6,559), and 2.4% had both (n = 719). Twenty four thousand two hundred eighty-eight (79%) participants had "Normal" CRP, 5,275 (17%) had "Elevated" CRP, and 1,136 (4%) had "Very High" CRP. For participants with "Normal" levels of CRP, insomnia was associated with higher levels of CRP (adjusted B = 0.04, 95%CI [0.00-0.08], p = 0.046), but not for people with "Elevated" or "Very High" levels of CRP. There was an association between CRP and presence of chronic LBP in the total sample (adjusted OR = 1.01, [1.00-1.01], p = 0.013) and for people with "Normal" CRP (1.05, [1.00-1.10, p = 0.034]. Insomnia was associated with the presence of chronic LBP in the total sample (adjusted OR = 1.99, 95%CI [1.79-2.21], <0.001) and for people with "Normal", "Elevated" and "Very High". CONCLUSIONS: Individuals with insomnia have twice the odds of reporting chronic LBP. Insomnia, CRP and chronic LBP appear to be linked but the role of CRP appears to be limited. Longitudinal studies may help further explore the causal inference between insomnia chronic LBP, and inflammation. IMPLICATIONS: Given the strong relationship between insomnia and chronic LBP, screening and management of comorbid insomnia and chronic LBP should be considered in clinical practice. Further longitudinal studies are required to explore whether the presence of insomnia and increased inflammation affects the development of chronic LBP.
ABSTRACT
PURPOSE: Patients with pulmonary fibrosis often exhibit reduced lung function and diminished health-related quality of life. Studies have shown that paraquat-induced, extrapulmonary, acute lung injury affects the metabolic profile of glycogen content in different tissues. The purpose of the present study was to investigate whether the process of pulmonary fibrosis induced by continuous exposure to the toxic herbicide paraquat or by a local insult from bleomycin affects the glycogen content in tissues. METHODS: In the paraquat experiment, Wistar rats (n = 5 per group) received either saline (controls) or an intraperitoneal injection of a paraquat solution (7.0 mg/kg; experimental group) once a week for 4 weeks. In the bleomycin experiment, Balb/c mice (n = 5 per group) received either saline (controls) or 6.25 U/kg of bleomycin through intratracheal instillation in single dose (experimental group). Glycogen content in different tissues (mg/g tissue) was measured using the anthrone reagent. The lungs submitted to histopathological and quantitative analyses of fibrosis. RESULTS: Paraquat-induced fibrosis led to lower glycogen content in the gastrocnemius muscle (2.7 ± 0.1 vs. 3.4 ± 0.1; 79 %) compared with the controls, whereas no changes in glycogen content were found in the diaphragm or heart. Bleomycin-induced fibrosis led to lower glycogen content in the diaphragm (0.43 ± 0.02 vs. 0.79 ± 0.09, 54 %), gastrocnemius muscle (0.62 ± 0.11 vs. 1.18 ± 0.06, 52 %), and heart (0.68 ± 0.11 vs. 1.39 ± 0.1, 49 %) compared with the controls (p < 0.05). Moreover, the area of fibrous connective tissue (µm(2)) in the lungs was significantly increased in paraquat-induced fibrosis (3,463 ± 377 vs. 565 ± 89) and bleomycin-induced fibrosis (3,707 ± 433.9 vs. 179 ± 51.28) compared with the controls. CONCLUSIONS: The findings suggest that the effects of fibrogenesis in the lungs are not limited to local alterations but also lead to a reduction in glycogen content in the heart and other muscles. This reduction could partially explain the impaired muscle performance found in patients with pulmonary fibrosis.
