35218 Sleep disturbance in adults with prurigo nodularis is associated with increased circulating C-reactive protein levels and adverse cardiovascular outcomes

Abstract

Prurigo nodularis (PN) is an inflammatory skin disease associated with a significant reduction in quality of life. The association between PN and sleep comorbidities remains understudied. To evaluate this association, we used TriNetX, a healthcare network of approximately 73 million medical records. A total of 73,181 patients were identified as having ≥2 instances of ICD-10 code L28.1 for PN, and were age, race, and sex-matched to nonpruritic controls. P values were adjusted for multiple hypotheses using the Benjamini-Hochberg method. Relative to controls, PN patients had an increased risk of developing general sleep disorders [relative risk (RR) 1.47, 95% confidence interval (95% CI) 1.42-1.52], obstructive sleep apnea [RR 1.61, 95% CI 1.54-1.69], insomnia [RR 1.37, 95% CI 1.29-1.45], hypersomnia [RR 1.47, 95% CI 1.32-1.64], sleep-related movement disorders [RR 1.36, 95% CI 1.17-1.58], restless legs syndrome [RR 1.45, 95% CI 1.28-1.65], and unspecified sleep disorders [RR 1.20, 95% CI 1.06-1.35]. PN patients had higher mean C-reactive protein (CRP) than controls (12.7 mg/L vs. 7.6 mg/L, P < .0001), and PN patients with sleep disorders had higher CRP than PN patients without sleep disorders (16.2 mg/L vs. 10.6 mg/L, P < .0001). PN patients with sleep disorders were more likely to experience myocardial infarction [RR 1.60, 95% CI 1.38-1.85], cerebral infarction [RR 1.77, 95% CI 1.52-2.07], and peripheral vascular disease [RR 1.82, 95% CI 1.66-2.00] than PN patients without sleep disorders. PN is associated with an increased risk of developing sleep disorders, which may contribute to the systemic inflammatory impact of PN and increase the risk of cardiovascular outcomes.