Cytokine polymorphisms are associated with poor sleep maintenance in adults living with human immunodeficiency virus/acquired immunodeficiency syndrome.

STUDY OBJECTIVES: Cytokine activity and polymorphisms have been associated with sleep outcomes in prior animal and human research. The purpose of this study was to determine whether circulating plasma cytokines and cytokine polymorphisms are associated with the poor sleep maintenance commonly experienced by adults living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). DESIGN: Cross-sectional descriptive study. SETTING: HIV clinics and community sites in the San Francisco Bay area. PARTICIPANTS: A convenience sample of 289 adults (193 men, 73 women, and 23 transgender) living with HIV/AIDS. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: A wrist actigraph was worn for 72 h to estimate the percentage of wake after sleep onset (WASO%) and total sleep time (TST), plasma cytokines were analyzed, and genotyping was conducted for 15 candidate genes involved in cytokine signaling: interferon-gamma (IFNG), IFNG receptor 1 (IFNGR1), interleukins (IL1B, IL1R2, IL1R2, IL2, IL4, IL6, IL8, IL10, IL13, IL17A), nuclear factor of kappa light polypeptide gene enhancer in B cells (NFKB1 and NFKB2), and tumor necrosis factor-alpha (TNFA). Controlling for demographic variables such as race and sex, and clinical variables such as CD4+ count and medications, higher WASO% was associated with single nucleotide polymorphisms (SNPs) of IL1R2 rs11674595 and TNFA rs1041981 and less WASO% was associated with IL2 rs2069776. IL1R2 rs11674595 and TNFA rs1041981 were also associated with short sleep duration. CONCLUSIONS: This study strengthens the evidence for an association between inflammation and sleep maintenance problems. In this chronic illness population, cytokine polymorphisms associated with wake after sleep onset provide direction for intervention research aimed at comparing anti-inflammatory mechanisms with hypnotic agents for improving sleep maintenance and total sleep time.

Polymorphisms of interleukin-1 Beta and interleukin-17Alpha genes are associated with restless legs syndrome.

OBJECTIVE: Dopamine, iron, and inflammatory pathways are considered important to the development of restless legs syndrome (RLS). Recent genetic studies support involvement of dopamine and iron; however, cytokine gene variation in the inflammatory component remains unexplored. A recent study reported a high prevalence of RLS among HIV-infected adults. We estimate occurrence of RLS in an ethnically diverse sample of HIV-infected adults and examine differences in demographic factors, clinical characteristics, and biomarkers relating to dopamine, iron, and inflammation between adults with and without RLS symptoms. DESIGN: A prospective longitudinal study aimed at identifying biomarkers of RLS symptom experience among HIV-infected adults. METHOD: 316 HIV-positive adults were evaluated using International RLS Study Group criteria. Genes were chosen for hypothesized relationships to dopamine (NOS1, NOS2), iron (HFE) or inflammation-mediated by cytokine genes (interferon [IFN], interleukin [IL], nuclear factor kappa-B [NFKB], and tumor necrosis factor alpha [TNFA]). RESULTS: Similar to general population estimates, 11% of the sample met all four RLS diagnostic criteria. Controlling for race, gender, and hemoglobin, carrying two copies of the minor allele for IL1B rs1143643, rs1143634, or rs1143633 or carrying the minor allele for IL17A rs8193036 was associated with increased likelihood of meeting RLS diagnostic criteria. CONCLUSION: This study provides preliminary evidence of a genetic association between IL1B and IL17A genes and RLS.

Heredity of restless legs syndrome in a pregnant population.

OBJECTIVE: To synthesize published research on genetic and heredity findings related to restless legs syndrome (RLS) in a pregnant population. DATA SOURCES: PubMed, CINAHL, and PsycINFO databases and reference lists from published articles. STUDY SELECTION: Literature searches were conducted for primary research studies published in English on the genetic and heredity findings of RLS in pregnant populations. DATA EXTRACTION: Study characteristics and findings related to genetic and heredity aspects of RLS in a pregnant population. DATA SYNTHESIS: Five data-based articles met the criteria for study inclusion. Study findings comprised Level-2 and Level-3 evidence. Four of the five studies were larger population studies and contained a subset of pregnant participants. Parity and family history were important predictors of RLS proband status. Probands reported symptoms were often initiated during or after pregnancy. CONCLUSIONS: Symptoms of RLS for female probands are often initiated during pregnancy or after childbirth. A history of RLS in a previous pregnancy and family history of RLS were strong predictors of RLS in the current pregnancy. Future research on genetic associations of RLS in pregnancy is warranted.

Stressors, resources, and stress responses in pregnant African American women: a mixed-methods pilot study.

This research aimed to develop an initial understanding of the stressors, stress responses, and personal resources that impact African American women during pregnancy, potentially leading to preterm birth. Guided by the ecological model, a prospective, mixed-methods, complementarity design was used with 11 pregnant women and 8 of their significant others. Our integrated analysis of quantitative and qualitative data revealed 2 types of stress responses: high stress responses (7 women) and low stress responses (4 women). Patterns of stress responses were seen in psychological stress and cervical remodeling (attenuation or cervical length). All women in the high stress responses group had high depression and/or low psychological well-being and abnormal cervical remodeling at one or both data collection times. All but 1 woman had at least 3 sources of stress (racial, neighborhood, financial, or network). In contrast, 3 of the 4 women in the low stress responses group had only 2 sources of stress (racial, neighborhood, financial, or network) and 1 had none; these women also reported higher perceived support. The findings demonstrate the importance of periodically assessing stress in African American women during pregnancy, particularly related to their support network as well as the positive supports they receive.

Skipping meals and less walking among African Americans diagnosed with preterm labor.

PURPOSE: The aim was to compare meal frequency, macronutrient intake, and physical activity between African Americans with preterm labor and those without preterm labor. DESIGN: A descriptive comparative study was used with 80 pregnant African Americans. METHODS: Three 24-hour diet recalls, the Block 2005 food frequency questionnaire, International Physical Activity Questionnaire, and Perceived Stress Scale were collected at 24 to 34 weeks of gestation. FINDINGS: The odds of skipping meals for women in the preterm labor group was 3.57 times the odds of skipped meals for women in the term labor group (95% confidence interval [CI] 1.28-10.16, p=.006). The association was increased to 6.86 (95% CI 2.13-22.12, p<.001) after adjustment for age, prepregnancy body mass index, education, and income. Walking was significantly less in terms of total amount of walking in the preterm labor group (p=.03). CONCLUSIONS: Results have implications for prenatal counseling regarding the importance of frequent meal and snack consumption throughout the day. Further research is necessary to establish the mechanisms by which energy consumption contributes to risk for preterm labor. CLINICAL RELEVANCE: Pregnancy is a time when health professionals monitor women regularly and presents a unique opportunity for practitioners to communicate the importance of frequent meals and snacks throughout pregnancy, as well as the health benefits of walking as a form of physical activity.

Psychological and physiological stress: impact on preterm birth.

Stress increases corticotropin-releasing hormone and may ultimately result in increased uterine contractility. Stress also increases cytokine production, which independently may lead to preterm birth or increase susceptibility to infection, thereby increasing the risk of preterm birth. Finally, stress may change health behaviors that lead to preterm birth. Research findings on the relationship between stress and preterm birth have been contradictory. In this article, the authors propose a model of the relationship between stress and preterm birth, evaluate the research on stress and pregnancy outcomes, and discuss the implications for nursing practice and research.