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Cermakian N, Stegeman SK, Tekade K, Labrecque N. Circadian rhythms in adaptive immunity and vaccination. Semin Immunopathol 2021; 44:193-207. [PMID: 34825270 DOI: 10.1007/s00281-021-00903-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/29/2021] [Indexed: 11/25/2022]
Abstract
Adaptive immunity allows an organism to respond in a specific manner to pathogens and other non-self-agents. Also, cells of the adaptive immune system, such as T and B lymphocytes, can mediate a memory of an encounter with a pathogen, allowing a more efficient response to a future infection. As for other aspects of physiology and of the immune system, the adaptive immune system is regulated by circadian clocks. Consequently, the development, differentiation, and trafficking between tissues of adaptive immune cells have been shown to display daily rhythms. Also, the response of T cells to stimuli (e.g., antigen presentation to T cells by dendritic cells) varies according to a circadian rhythm, due to T cell-intrinsic mechanisms as well as cues from other tissues. The circadian control of adaptive immune response has implications for our understanding of the fight against pathogens as well as auto-immune diseases, but also for vaccination, a preventive measure based on the development of immune memory.
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Affiliation(s)
- Nicolas Cermakian
- Douglas Research Centre, McGill University, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada.
| | - Sophia K Stegeman
- Douglas Research Centre, McGill University, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada
| | - Kimaya Tekade
- Douglas Research Centre, McGill University, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada
| | - Nathalie Labrecque
- Hôpital Maisonneuve Rosemont Research Centre, Département de Médecine and Département de Microbiologie, infectiologie et immunologie, Université de Montréal, QC, H1T 2M4, Montreal, Canada
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Robinson CH, Albury C, McCartney D, Fletcher B, Roberts N, Jury I, Lee J. The relationship between duration and quality of sleep and upper respiratory tract infections: a systematic review. Fam Pract 2021; 38:802-810. [PMID: 33997896 PMCID: PMC8656143 DOI: 10.1093/fampra/cmab033] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Upper respiratory tract infections (URTIs) are common, mostly self-limiting, but result in inappropriate antibiotic prescriptions. Poor sleep is cited as a factor predisposing to URTIs, but the evidence is unclear. OBJECTIVE To systematically review whether sleep duration and quality influence the frequency and duration of URTIs. METHODS Three databases and bibliographies of included papers were searched for studies assessing associations between sleep duration or quality and URTIs. We performed dual title and abstract selection, discussed full-text exclusion decisions and completed 50% of data extraction in duplicate. The Newcastle-Ottawa Quality Assessment Scale assessed study quality and we estimated odds ratios (ORs) using random effects meta-analysis. RESULTS Searches identified 5146 papers. Eleven met inclusion criteria, with nine included in meta-analyses: four good, two fair and five poor for risk of bias. Compared to study defined 'normal' sleep duration, shorter sleep was associated with increased URTIs (OR: 1.30, 95% confidence interval [CI]: 1.19-1.42, I2: 11%, P < 0.001) and longer sleep was not significantly associated (OR: 1.11 95% CI: 0.99-1.23, I2: 0%, P = 0.070). Sensitivity analyses using a 7- to 9-hour baseline found that sleeping shorter than 7-9 hours was associated with increased URTIs (OR: 1.31, 95% CI: 1.22-1.41, I2: 0%, P < 0.001). Sleeping longer than 7-9 hours was non-significantly associated with increased URTIs (OR: 1.15, 95% CI: 1.00-1.33, I2: 0%, P = 0.050, respectively). We were unable to pool sleep quality studies. No studies reported on sleep duration and URTI severity or duration. CONCLUSIONS Reduced sleep, particularly shorter than 7-9 hours, is associated with increased URTIs. Strategies improving sleep should be explored to prevent URTIs.
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Affiliation(s)
| | - Charlotte Albury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - David McCartney
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Benjamin Fletcher
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Imogen Jury
- Department of Medical Sciences, University of Oxford, Oxford, UK
| | - Joseph Lee
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Mitsunaga T, Ohtaki Y, Seki Y, Yoshioka M, Mori H, Suzuka M, Mashiko S, Takeda S, Mashiko K. The evaluation of factors affecting antibody response after administration of the BNT162b2 vaccine: a prospective study in Japan. PeerJ 2021; 9:e12316. [PMID: 34721989 PMCID: PMC8520395 DOI: 10.7717/peerj.12316] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/25/2021] [Indexed: 12/18/2022] Open
Abstract
The aim of this study was to evaluate the antibody reaction after administration of the BNT162b2 vaccine, and to reveal the factors that affect antibody production. This prospective study was carried out in the Association of EISEIKAI Medical and Healthcare Corporation Minamitama Hospital, in Tokyo, Japan, from April 15, 2021 to June 09, 2021. All our hospital's workers who were administered the BNT162b2 vaccine as part of a routine program were included in this study. We calculated the anti-SARS-CoV-2 spike-specific antibody titter (1) before vaccination, (2) 7 to 20 days after the first vaccination, and (3) A total of 7 to 20 days after the second vaccination. The low-antibody titer group (LABG) was defined as the group having less than 25 percentiles of antibody titer. Univariate and Multivariate logistic regression analysis were performed to ascertain the effects of factors on the likelihood of LABG. A total of 374 participants were eventually included in our study, and they were divided into 94 LABG and 280 non-LABG. All samples showed significant antibody elevation in the second antibody test, with a mean value of 3,476 U/mL. When comparing the LABG and non-LABG groups, the median age, blood sugar, and HbA1c were significantly higher in the LABG group. The rates of participants with low BMI (<18.5) and high BMI (>30) were significantly higher in the LABG group. The proportion of chronic lung disease, hypertension, diabetes, dyslipidemia, autoimmune disease, and cancer were significantly higher in the LABG group. Although there was no significant difference confirmed with respect to the exercise hours per day, the proportion of participants that did not perform outdoor exercises was significantly higher in the LABG group. The time interval between the second vaccination and the second antibody test, and between the first and the second vaccination was significantly longer in the non-LABG group. In the multivariate logistic regression analysis, older than 60 years, the past history of hypertension, HbA1c higher than 6.5%, and lack of outdoor exercises were significant suppressors of antibody responses, whereas the length of days from the first to the second vaccination longer than 25 days promoted a significant antibody response. Again, our single-center study demonstrates that older than 60 years, hypertension, HbA1c higher than 6.5%, and lack of outdoor exercises were significant suppressors of antibody responses, whereas the length of days from the first to the second vaccination longer than 25 days promoted a significant antibody response. Evidence from multi-center studies is needed to develop further vaccination strategies.
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Affiliation(s)
- Toshiya Mitsunaga
- Department of Emergency Medicine, Association of EISEIKAI Medical and Healthcare Corporation Minamitama Hospital, Tokyo, Japan
- Department of Emergency Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Yuhei Ohtaki
- Department of Emergency Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Yutaka Seki
- Department of Emergency Medicine, Association of EISEIKAI Medical and Healthcare Corporation Minamitama Hospital, Tokyo, Japan
- Department of Cardiology, Association of EISEIKAI Medical and Healthcare Corporation Minamitama Hospital, Tokyo, Japan
- Department of Internal Medicine, Association of EISEIKAI Medical and Healthcare Corporation Minamitama Hospital, Tokyo, Japan
| | - Masakata Yoshioka
- Department of Internal Medicine, Association of EISEIKAI Medical and Healthcare Corporation Minamitama Hospital, Tokyo, Japan
| | - Hiroshi Mori
- Department of Medical Engineering, Association of EISEIKAI Medical and Healthcare Corporation Minamitama Hospital, Tokyo, Japan
| | - Midori Suzuka
- Department of Pharmacy, Association of EISEIKAI Medical and Healthcare Corporation Minamitama Hospital, Tokyo, Japan
| | - Syunsuke Mashiko
- Department of Emergency Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Satoshi Takeda
- Department of Emergency Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Kunihiro Mashiko
- Department of Emergency Medicine, Association of EISEIKAI Medical and Healthcare Corporation Minamitama Hospital, Tokyo, Japan
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Lammers-van der Holst HM, Lammers GJ, van der Horst GTJ, Chaves I, de Vries RD, GeurtsvanKessel CH, Koch B, van der Kuy HM. Understanding the association between sleep, shift work and COVID-19 vaccine immune response efficacy: Protocol of the S-CORE study. J Sleep Res 2021; 31:e13496. [PMID: 34617358 PMCID: PMC8646925 DOI: 10.1111/jsr.13496] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/07/2021] [Accepted: 09/13/2021] [Indexed: 11/30/2022]
Abstract
This protocol describes an innovative study to investigate the relationship between sleep, shift work and the immune response to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2; coronavirus disease 2019 [COVID-19]) vaccination. As the COVID-19 pandemic is a global crisis with devastating health, social and economic impacts, there is a pressing need for effective vaccination programmes. Previous influenza and hepatitis vaccination studies suggest that lack of sleep can negatively alter immune responsiveness, while circadian misalignment most likely may also play an important role in the immune response to vaccination. Our present study will be the first to address this question in actual shift workers and in relation to COVID-19 vaccination. We hypothesise that the occurrence of recent night shifts and diminished sleep will negatively alter the immune response to vaccination in shift workers compared to dayworkers. We aim to recruit 50 shift workers and 50 dayworkers. Participants will receive an mRNA-based vaccination, through the Dutch vaccination programme. To assess immune responsiveness, blood will be drawn at baseline (before first vaccination), 10 days after first vaccination, the day prior to the second vaccination; and 28 days, 6 and 12 months after the second vaccination. Actigraphy and daily sleep e-diaries will be implemented for 7 days around each vaccination to assess sleep. The Pittsburgh Sleep Quality Index will be used to monitor sleep in the long term. Optimising the efficacy of the COVID-19 vaccines is of outmost importance and results of this study could provide insights to develop sleep and circadian-based interventions to enhance vaccination immunity, and thereby improve global health.
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Affiliation(s)
| | - Gert Jan Lammers
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Sleep Wake Center SEIN, Stichting Epilepsie Instellingen Nederland, Heemstede, the Netherlands
| | | | - Inês Chaves
- Department Molecular Genetics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Rory D de Vries
- Department Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Birgit Koch
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Hugo M van der Kuy
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands
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Tune C, Hahn J, Autenrieth SE, Meinhardt M, Pagel R, Schampel A, Schierloh LK, Kalies K, Westermann J. Sleep restriction prior to antigen exposure does not alter the T cell receptor repertoire but impairs germinal center formation during a T cell-dependent B cell response in murine spleen. Brain Behav Immun Health 2021; 16:100312. [PMID: 34589803 PMCID: PMC8474616 DOI: 10.1016/j.bbih.2021.100312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 07/28/2021] [Indexed: 11/25/2022] Open
Abstract
It is well known that sleep promotes immune functions. In line with this, a variety of studies in animal models and humans have shown that sleep restriction following an antigen challenge dampens the immune response on several levels which leads to e.g. worsening of disease outcome and reduction of vaccination efficiency, respectively. However, the inverse scenario with sleep restriction preceding an antigen challenge is only investigated in a few animal models where it has been shown to reduce antigen uptake and presentation as well as pathogen clearance and survival rates. Here, we use injection of sheep red blood cells to investigate the yet unknown effect on a T cell-dependent B cell response in a well-established mouse model. We found that 6 h of sleep restriction prior to the antigen challenge does not impact the T cell reaction including the T cell receptor repertoire but dampens the development of germinal centers which correlates with reduced antigen-specific antibody titer indicating an impaired B cell response. These changes concerned a functionally more relevant level than those found in the same experimental model with the inverse scenario when sleep restriction followed the antigen challenge. Taken together, our findings showed that the outcome of the T cell-dependent B cell response is indeed impacted by sleep restriction prior to the antigen challenge which highlights the clinical significance of this scenario and the need for further investigations in humans, for example concerning the effect of sleep restriction preceding a vaccination.
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Key Words
- Antigen presentation
- BCZ, B cell zone
- CCL, C–C motif ligand
- CCR, C–C motif receptor
- CD, cluster of differentiation
- CIITA, class II major histocompatibility complex transactivator
- CXCL, C-X-C motif ligand
- FDR, false discovery rate
- GC, germinal center
- Germinal center
- IFN, interferon
- IL, interleukin
- IgG, Immunglobulin G
- MHC-II, major histocompatibility complex II
- Mouse
- RP, red pulp
- SD, standard deviation
- SLO, secondary lymphoid organ
- SRBC, sheep red blood cells
- Sheep red blood cells
- Sleep deprivation
- Spleen
- T cell-dependent B cell response
- TCR, T cell receptor
- TCR-R, T cell receptor repertoire
- TCZ, T cell zone
- Tfh, follicular T helper cells
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Affiliation(s)
- Cornelia Tune
- Institute of Anatomy, University of Luebeck, Germany
| | - Julia Hahn
- Department of Internal Medicine II, University of Tuebingen, Germany
| | | | | | - Rene Pagel
- Institute of Anatomy, University of Luebeck, Germany
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Metin Ökmen B, Ayar K, Altan L, Yeşilöz Ö. Central sensitisation in primary Sjögren Syndrome and its effect on sleep quality. Mod Rheumatol 2021; 32:908-914. [PMID: 34918134 DOI: 10.1093/mr/roab075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/05/2021] [Accepted: 08/26/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The aim of the present study is to evaluate the presence and frequency of central sensitisation (CS) in primary Sjögren Syndrome (pSS) and to determine the effect of CS on sleep quality. MATERIALS AND METHODS In this cross-sectional study, 50 patients diagnosed with pSS between the ages of 18 and 75 were included. The healthy control group was composed of 43 healthcare workers. Each participant underwent a physical examination, and demographic data and the medications they used were recorded. Central sensitisation inventory and Pittsburgh Sleep Quality Index questionnaires were filled in to garner data on CS and sleep quality, respectively, from all participants. RESULTS While central sensitisation inventory >40 was detected in 74% of pSS patients, it was 25.6% in healthy controls, and there is a statistically significant difference between the groups (p < .05). A correlation analysis of the central sensitisation inventory and Pittsburgh Sleep Quality Index values of all participants revealed a statistically significant correlation between all parameters other than the duration of sleep (p < .05). CONCLUSIONS CS was found to have a negative effect on sleep quality in patients with pSS. We suggest that the cause of widespread pain seen in patients with pSS as the possible development of CS should be considered.
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Affiliation(s)
- Burcu Metin Ökmen
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Koray Ayar
- Department of Rheumatology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Lale Altan
- Department of Physical Medicine and Rehabilitation, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Özgür Yeşilöz
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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Hajduczok AG, DiJoseph KM, Bent B, Thorp AK, Mullholand JB, MacKay SA, Barik S, Coleman JJ, Paules CI, Tinsley A. Physiologic Response to the Pfizer-BioNTech COVID-19 Vaccine Measured Using Wearable Devices: Prospective Observational Study. JMIR Form Res 2021; 5:e28568. [PMID: 34236995 PMCID: PMC8341091 DOI: 10.2196/28568] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 06/12/2021] [Accepted: 06/14/2021] [Indexed: 12/23/2022] Open
Abstract
Background The Pfizer-BioNTech COVID-19 vaccine uses a novel messenger RNA technology to elicit a protective immune response. Short-term physiologic responses to the vaccine have not been studied using wearable devices. Objective We aim to characterize physiologic changes in response to COVID-19 vaccination in a small cohort of participants using a wearable device (WHOOP Strap 3.0). This is a proof of concept for using consumer-grade wearable devices to monitor response to COVID-19 vaccines. Methods In this prospective observational study, physiologic data from 19 internal medicine residents at a single institution that received both doses of the Pfizer-BioNTech COVID-19 vaccine was collected using the WHOOP Strap 3.0. The primary outcomes were percent change from baseline in heart rate variability (HRV), resting heart rate (RHR), and respiratory rate (RR). Secondary outcomes were percent change from baseline in total, rapid eye movement, and deep sleep. Exploratory outcomes included local and systemic reactogenicity following each dose and prophylactic analgesic use. Results In 19 individuals (mean age 28.8, SD 2.2 years; n=10, 53% female), HRV was decreased on day 1 following administration of the first vaccine dose (mean –13.44%, SD 13.62%) and second vaccine dose (mean –9.25%, SD 22.6%). RHR and RR showed no change from baseline after either vaccine dose. Sleep duration was increased up to 4 days post vaccination, after an initial decrease on day 1. Increased sleep duration prior to vaccination was associated with a greater change in HRV. Local and systemic reactogenicity was more severe after dose two. Conclusions This is the first observational study of the physiologic response to any of the novel COVID-19 vaccines as measured using wearable devices. Using this relatively small healthy cohort, we provide evidence that HRV decreases in response to both vaccine doses, with no significant changes in RHR or RR. Sleep duration initially decreased following each dose with a subsequent increase thereafter. Future studies with a larger sample size and comparison to other inflammatory and immune biomarkers such as antibody response will be needed to determine the true utility of this type of continuous wearable monitoring in regards to vaccine responses. Our data raises the possibility that increased sleep prior to vaccination may impact physiologic responses and may be a modifiable way to increase vaccine response. These results may inform future studies using wearables for monitoring vaccine responses. Trial Registration ClinicalTrials.gov NCT04304703; https://www.clinicaltrials.gov/ct2/show/NCT04304703
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Affiliation(s)
- Alexander G Hajduczok
- Division of Internal Medicine, Department of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Kara M DiJoseph
- Division of Internal Medicine, Department of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Brinnae Bent
- Department of Biomedical Engineering, Duke University, Durham, NC, United States
| | - Audrey K Thorp
- Division of Internal Medicine, Department of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Jon B Mullholand
- Division of Internal Medicine, Department of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Stuart A MacKay
- Division of Internal Medicine, Department of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Sabrina Barik
- Division of Internal Medicine, Department of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Jamie J Coleman
- Department of Surgery, Denver Health Medical Center, Denver, CO, United States
| | - Catharine I Paules
- Division of Infectious Diseases, Department of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Andrew Tinsley
- Division of Gastroenterology, Department of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States
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Pires GN, Ishikura IA, Xavier SD, Petrella C, Piovezan RD, Xerfan EMS, Andersen ML, Tufik S. Sleep in Older Adults and Its Possible Relations With COVID-19. Front Aging Neurosci 2021; 13:647875. [PMID: 34177550 PMCID: PMC8226324 DOI: 10.3389/fnagi.2021.647875] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/15/2021] [Indexed: 01/08/2023] Open
Abstract
Since the beginning of the COVID-19 pandemic, older adults have been found to be a highly vulnerable group, with a higher prevalence of severe cases and negative outcomes. Research has focused on the reasons why older adults are at greater risk; Sleep-related factors have been suggested as one possible explanation for this. An individual's sleep pattern undergoes significant changes over the course of their life. In older adults a specific sleep profile can be observed, one characterized by advanced sleep timing, a morningness preference, longer sleep-onset latency, shorter overall sleep duration, increased sleep fragmentation, reduced slow-wave sleep and, increased wake time after sleep onset. Additionally, an increased prevalence of sleep disorders can be observed, such as obstructive sleep apnea and insomnia. Previous research has already linked sleep disorders (especially sleep apnea) with COVID-19, but few studies have focused specifically on the older population. We believe that the intrinsic sleep patterns of older adults, and the prevalence of sleep disorders in this population, may be important factors that could explain why they are at a greater risk of negative COVID-19 outcomes. In this review, we discuss the relationship between sleep and COVID-19 among older adults, focusing on three different aspects: (1) Sleep-related issues that might increase the likelihood of getting infected by SARS-COV-2; (2) Sleep disturbances that might increase the predisposition to worse COVID-19 prognosis and outcomes; and (3) COVID-19-related aspects affecting community-dwelling older adults, such as social isolation, quarantine, and home confinement, among others, that might impact sleep.
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Affiliation(s)
- Gabriel Natan Pires
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Sandra Doria Xavier
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
- Department of Otolaryngology, Santa Casa de São Paulo, São Paulo, Brazil
| | - Caetano Petrella
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Ellen Maria Sampaio Xerfan
- Programa de Pós-Graduação em Medicina Translacional, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Monica Levy Andersen
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
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Ben Salah A, DeAngelis BN, al'Absi M. Resilience and the Role of Depressed and Anxious Mood in the Relationship Between Perceived Social Isolation and Perceived Sleep Quality During the COVID-19 Pandemic. Int J Behav Med 2021; 28:277-285. [PMID: 33415694 PMCID: PMC7790523 DOI: 10.1007/s12529-020-09945-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of the study was to examine the mediating role of depressed and anxious mood in the relationship between perceived social isolation and perceived sleep quality during the COVID-19 pandemic. We also aimed to investigate the moderating role of psychological resilience in this mediation. METHODS A cross-sectional study of adults (18+ years old) was conducted using an online, multi-language, international survey between March 31 and May 15, 2020. Simple and moderated mediation analyses were performed using the PROCESS macro for SPSS, with perceived social isolation as an independent variable, change in perceived sleep quality (during vs. before the COVID-19 pandemic) as a dependent variable, depressed and anxious mood (Patient Health Questionnaire-4, PHQ-4) as a mediator, and resilience (Brief Resilience Scale, BRS) as a moderator. RESULTS A convenience sample of 3816 participants (2692 = female) from 94 countries (47.4% USA) met criteria for inclusion in the analyses. Results showed that depressed and anxious mood mediated the relationship between perceived social isolation and change in perceived sleep quality. This mediation was moderated by resilience; the indirect effect of perceived social isolation on change in perceived sleep quality through depressed and anxious mood decreased as the level of resilience increased (index of moderated mediation = 0.008, SE = 0.003, 95%CI [0.001; 0.014]). CONCLUSIONS The study findings indicate benefits of psychological resilience in buffering negative effects of perceived isolation, suggesting potential benefits of developing targeted strategies to enhance resilience during times of significant crises.
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Affiliation(s)
- Arwa Ben Salah
- Community Medicine Department, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Briana N DeAngelis
- Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minneapolis, 55812, USA
| | - Mustafa al'Absi
- Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minneapolis, 55812, USA.
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Mok EM, Greenough G, Pollack CC. Untreated obstructive sleep apnea is associated with increased hospitalization from influenza infection. J Clin Sleep Med 2021; 16:2003-2007. [PMID: 32780010 DOI: 10.5664/jcsm.8744] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
STUDY OBJECTIVES There is evidence that sleep deprivation or diseases such as obstructive sleep apnea (OSA) that lead to sleep disruption may adversely impact immune system functioning. We hypothesized that individuals who have OSA who did not use continuous positive airway pressure (CPAP) would have higher rates of hospitalization and complications from influenza infection than patients with OSA who were adherent to treatment. METHODS Medical records of patients at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire who had both OSA and a new, laboratory-confirmed influenza infection between 2016 and 2018 were reviewed for results of polysomnography, CPAP usage, influenza vaccination records, confirmation of influenza infection, and influenza-related hospitalizations and complications. RESULTS Compared to the patients who were adherent to CPAP, patients who were either conservatively treated without CPAP or who were nonadherent to CPAP therapy had higher odds of hospitalization from influenza infections (odds ratio = 4.7, 95% confidence interval 1.3 to 19.5, P = .01) but no higher odds of complications from influenza. The patients who had untreated sleep apnea had a higher percentage of influenza vaccination for their season of illness (75% of patients) compared to patients who were adherent to CPAP (56% of patients), although the difference in vaccination was not statistically significant. CONCLUSIONS Patients with OSA who did not use CPAP appear to have greater rates of hospitalization from acute influenza infection, despite having a higher trend of influenza vaccination compared to patients who were adherent to CPAP.
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Affiliation(s)
- Eva M Mok
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Glen Greenough
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Abstract
PURPOSE OF REVIEW This article outlines the neurocircuitry underlying sleep-wake and circadian physiology with a focus on the fundamental roles that sleep and circadian health play in optimal neurologic function. RECENT FINDINGS The foundation of sleep and wake promotion is laid primarily by the "fast-acting" neurotransmitters: γ-aminobutyric acid (GABA) for sleep and glutamate for wake. External to these primary systems are a host of modulatory systems that are characterized by two flip-flop switches of mutually inhibitory neurotransmitter systems that facilitate transitions between wake and sleep as well as non-rapid eye movement (non-REM) and REM sleep. Additional mechanisms are in place to help coordinate the sleep-wake states with environmental, metabolic, and behavioral demands. The complexity of the evolutionarily preserved sleep-wake and circadian systems, the proportion of the day dedicated to the natural sleeping period, as well as the neurocognitive dysfunction and neurodegeneration caused by deficient sleep highlight the importance of defining, assessing, and optimizing the sleep health of our patients and ourselves. SUMMARY Exciting discoveries continue to elucidate the underlying mechanisms of sleep and wake state coordination, reinforcing fundamental healthy practices and paving the way for new interventions that preserve and promote optimal neurologic health.
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Noack H, Doeller CF, Born J. Sleep strengthens integration of spatial memory systems. ACTA ACUST UNITED AC 2021; 28:162-170. [PMID: 33858969 PMCID: PMC8054676 DOI: 10.1101/lm.053249.120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/21/2021] [Indexed: 11/24/2022]
Abstract
Spatial memory comprises different representational systems that are sensitive to different environmental cues, like proximal landmarks or local boundaries. Here we examined how sleep affects the formation of a spatial representation integrating landmark-referenced and boundary-referenced representations. To this end, participants (n = 42) were familiarized with an environment featuring both a proximal landmark and a local boundary. After nocturnal periods of sleep or wakefulness and another night of sleep, integration of the two representational systems was tested by testing the participant's flexibility to switch from landmark-based to boundary-based navigation in the environment, and vice versa. Results indicate a distinctly increased flexibility in relying on either landmarks or boundaries for navigation, when familiarization to the environment was followed by sleep rather than by wakefulness. A second control study (n = 45) did not reveal effects of sleep (vs. wakefulness) on navigation in environments featuring only landmarks or only boundaries. Thus, rather than strengthening isolated representational systems per se, sleep presumably through forming an integrative representation, enhances flexible coordination of representational subsystems.
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Affiliation(s)
- Hannes Noack
- Institute for Medical Psychology and Behavioral Neurobiology, University Tübingen, 72076 Tübingen, Germany.,Department of Psychiatry and Psychotherapy, Medical School, University Tübingen, 72076 Tübingen, Germany
| | - Christian F Doeller
- Kavli Institute for Systems Neuroscience, Centre for Neural Computation, The Egil and Pauline Braathen and Fred Kavli Centre for Cortical Microcircuits, Norwegian University of Science and Technology and St. Olavs Hospital, Trondheim University Hospital, Trondheim NO-7491, Norway.,Department of Psychology, Max Planck Institute for Cognitive and Brain Sciences, 04103 Leipzig, Germany
| | - Jan Born
- Institute for Medical Psychology and Behavioral Neurobiology, University Tübingen, 72076 Tübingen, Germany
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63
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Abstract
BACKGROUND Growing evidence suggests that sleep plays an important role in immunological memory, including antibody responses to vaccination. However, much of the prior research has been carried out in the laboratory limiting the generalizability of the findings. Furthermore, no study has sought to identify sensitive periods prior to or after vaccination where sleep may have a stronger influence on antibody responses. METHODS Eighty-three healthy young adults completed 13 days of sleep diaries and received the trivalent influenza vaccine on day 3 of the study. Measures of self-reported sleep duration, sleep efficiency, and subjective sleep quality were assessed on each day. Antibody levels to the influenza viral strains were quantified at baseline and 1 and 4 months following influenza vaccination. RESULTS Shorter sleep duration, averaged over the collection period, was associated with fewer antibodies to the A/New Caledonia viral strain 1 and 4 months later, independent of baseline antibodies, age, sex, and cohort year. Analyses focused on nightly sleep on the days preceding and after the vaccination revealed that shorter sleep duration on the two nights before the vaccination predicted fewer antibodies 1 and 4 months later. Measures of self-reported sleep efficiency and subjective quality were unrelated to antibody responses to the influenza vaccination. CONCLUSION These findings provide further support for an association between sleep duration and antibody responses to the influenza vaccine and suggest that perhaps sleep on nights prior to vaccination are critical. If replicated, these findings may support sleep as a target for enhancing vaccination efficacy.
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Madison AA, Shrout MR, Renna ME, Kiecolt-Glaser JK. Psychological and Behavioral Predictors of Vaccine Efficacy: Considerations for COVID-19. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2021; 16:191-203. [PMID: 33501900 PMCID: PMC7841255 DOI: 10.1177/1745691621989243] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine candidates are being evaluated, with the goal of conferring immunity on the highest percentage of people who receive the vaccine as possible. It is noteworthy that vaccine efficacy depends not only on the vaccine but also on characteristics of the vaccinated. Over the past 30 years, a series of studies has documented the impact of psychological factors on the immune system's vaccine response. Robust evidence has demonstrated that stress, depression, loneliness, and poor health behaviors can impair the immune system's response to vaccines, and this effect may be greatest in vulnerable groups such as the elderly. Psychological factors are also implicated in the prevalence and severity of vaccine-related side effects. These findings have generalized across many vaccine types and therefore may be relevant to the SARS-CoV-2 vaccine. In this review, we discuss these psychological and behavioral risk factors for poor vaccine responses, their relevance to the COVID-19 pandemic, as well as targeted psychological and behavioral interventions to boost vaccine efficacy and reduce side effects. Recent data suggest these psychological and behavioral risk factors are highly prevalent during the COVID-19 pandemic, but intervention research suggests that psychological and behavioral interventions can increase vaccine efficacy.
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Affiliation(s)
- Annelise A. Madison
- The Institute for Behavioral Medicine Research, The Ohio State University College of Medicine
- Department of Psychology, The Ohio State University
| | - M. Rosie Shrout
- The Institute for Behavioral Medicine Research, The Ohio State University College of Medicine
| | - Megan E. Renna
- The Institute for Behavioral Medicine Research, The Ohio State University College of Medicine
- The Comprehensive Cancer Center, The Ohio State University College of Medicine
| | - Janice K. Kiecolt-Glaser
- The Institute for Behavioral Medicine Research, The Ohio State University College of Medicine
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine
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Abbas A, Al-Otaibi T, Gheith OA, Nagib AM, Farid MM, Walaa M. Sleep Quality Among Healthcare Workers During the COVID-19 Pandemic and Its Impact on Medical Errors: Kuwait Experience. Turk Thorac J 2021; 22:142-148. [PMID: 33871338 PMCID: PMC8051301 DOI: 10.5152/turkthoracj.2021.20245] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/21/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Millions of people suffer from sleep disturbances. In addition, the coronavirus disease 2019 (COVID-19) pandemic created several new challenges-particularly for frontline healthcare workers (HCWs). This study assessed the sleep quality (SQ) among HCWs. MATERIAL AND METHODS A cross-sectional study was conducted using an English-language online survey. The participants were invited via a web link sent using social network platforms. It included sociodemographic- and profession-related characteristics. COVID-19-associated risks were assessed (e.g., being on the front line, doing swabs, satisfaction about protective equipment, and management protocols). Assessment of SQ was done using the Pittsburgh Sleep Quality Index (PSQI) and various medical errors were recorded. RESULTS A total of 217 HCWs completed the survey with mean (±standard deviation) age of 35.8 (±7.3) years; 56.2% were male, 18.43% had comorbidities, and 61.75% experienced sleep difficulties before the COVID-19 crisis. This work reports a 78.8% prevalence of poor SQ, with the mean (standard deviation) global PSQI score of 9.36 (±4.4). HCWs with poor sleep experienced more positive comorbid profile (23.64% versus 6.52%, p=0.01). Working on the front lines of COVID-19 was associated with poor sleep (69.59% versus 47.83%, p=0.006). Among the participants, 77.42% performed medical errors, particularly not checking for drug allergies (17.97%), dispensing medication with incomplete instructions (20.74%), providing incorrect doses or overdosing (14.75%), incorrectly explaining the use of medication (9.22%), and prescribing a drug to the wrong patient (10.14%). CONCLUSION This nationwide survey reported high prevalence of poor SQ among HCWs during the COVID-19 pandemic. Being an HCW on the front lines of COVID-19 and doing swabs with a positive comorbidity was associated with poor sleep.
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Affiliation(s)
- Ahmad Abbas
- Department of Chest Diseases, Faculty of Medicine, Zagazig University, Zagazig, Egypt
- Department of Nephrology, Hamed Al-Essa Organ Transplant Center, Ibn Sina Hospital, Sabah area, Kuwait
| | - Torki Al-Otaibi
- Department of Nephrology, Hamed Al-Essa Organ Transplant Center, Ibn Sina Hospital, Sabah area, Kuwait
| | - Osama Ashry Gheith
- Department of Nephrology, Hamed Al-Essa Organ Transplant Center, Ibn Sina Hospital, Sabah area, Kuwait
- Department of Dialysis and Transplantation, Urology Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ayman Maher Nagib
- Department of Nephrology, Hamed Al-Essa Organ Transplant Center, Ibn Sina Hospital, Sabah area, Kuwait
- Department of Dialysis and Transplantation, Urology Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mahmoud M. Farid
- National Blood Transfusion Services, Egypt & Health Care Management Consultant, Technical Office, MOH, Kuwait
| | - Mohammad Walaa
- Department of Chest Diseases, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Abstract
Sleep is fundamental for everyday functioning, yet it is often negatively impacted in critically ill patients by the intensive care setting. With a focus on the neurological intensive care unit (NeuroICU), this narrative review summarizes methods of measuring sleep and addresses common causes of sleep disturbance in the hospital including environmental, pharmacological, and patient-related factors. The effects of sleep deprivation on the cardiovascular, pulmonary, immune, endocrine, and neuropsychological systems are discussed, with a focus on short-term deprivation in critically ill populations. Where evidence is lacking in the literature, long-term sleep deprivation studies and the effects of sleep deprivation in healthy individuals are also referenced. Lastly, strategies for the promotion of sleep in the NeuroICU are presented.
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Robbins R, Affouf M, Weaver MD, Czeisler MÉ, Barger LK, Quan SF, Czeisler CA. Estimated Sleep Duration Before and During the COVID-19 Pandemic in Major Metropolitan Areas on Different Continents: Observational Study of Smartphone App Data. J Med Internet Res 2021; 23:e20546. [PMID: 33493126 PMCID: PMC7857389 DOI: 10.2196/20546] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/04/2020] [Accepted: 01/19/2021] [Indexed: 01/04/2023] Open
Abstract
Background Amid the COVID-19 pandemic, public health policies to curb the spread of SARS-CoV-2 and its associated disease, COVID-19, have resulted in significant alterations to daily routines (eg, work-from-home policies) that may have enabled longer sleep duration among the general population. Objective We aimed to examine changes in estimated sleep duration in 5 major metropolitan areas before and after the start of the COVID-19 pandemic. Methods We conducted a prospective observational study using estimated sleep duration data obtained from a smartphone app. The data were obtained from regular users of the smartphone app before and after the World Health Organization declared COVID-19 a pandemic in March 2020. We compared within-subject estimated sleep duration before and during the COVID-19 pandemic using generalized linear mixed models. Results Among the 2,871,037 observations, 957,022 (33.3%) were from users in London; 549,151 (19.1%) were from users in Los Angeles; 846,527 (29.5%) were from users in New York City; 251,113 (8.7%) were from users in Seoul; and 267,224 (9.3%) were from users in Stockholm. The average age of the users in the sample was 35 years (SE 11 years). Prior to the COVID-19 pandemic, people residing in Seoul had the shortest estimated sleep duration (mean 6 hours 28 minutes, SE 11.6 minutes) and those residing in Stockholm had the longest estimated sleep duration (mean 7 hours 34 minutes, SE 9.9 minutes). The onset of the COVID-19 pandemic was associated with a 13.7 minute increase in estimated sleep duration when comparing March 2019 and March 2020 (95% CI 13.1-14.3, P<.001) and an increase of 22.3 minutes when comparing April 2019 and April 2020 (95% CI 21.5-23.1, P<.001). Conclusions The average estimated sleep duration increased sharply in the months after the onset of the COVID-19 pandemic. This finding suggests that the implementation of COVID-19 mitigation strategies has provided people worldwide with increased opportunities to sleep, which may enhance the response of the immune system to viral pathogens.
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Affiliation(s)
- Rebecca Robbins
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, United States.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
| | - Mahmoud Affouf
- Department of Mathematics, Kean University, Union, NJ, United States
| | - Matthew D Weaver
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, United States.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
| | - Mark É Czeisler
- School of Psychological Sciences, Turner Institute Brain and Mental Health, Monash University, Victoria, Australia.,Institute for Breathing and Sleep, Austin Health, Melbourne, Australia
| | - Laura K Barger
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, United States.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
| | - Stuart F Quan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, United States.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, United States.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
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Han M, Ye X, Rao S, Williams S, Thijssen S, Hymes J, Maddux FW, Kotanko P. Hepatitis B Vaccination Response in Hemodialysis Patients: The Impact of Dialysis Shift. Blood Purif 2021; 50:628-635. [PMID: 33508838 DOI: 10.1159/000513154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/17/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Hepatitis B (HB) vaccination in hemodialysis patients is important as they are at a higher risk of contracting HB. However, hemodialysis patients have a lower HB seroconversion rate than their healthy counterparts. As better sleep has been associated with better seroconversion in healthy populations and early hemodialysis start has been linked to significant sleep-wake disturbances in hemodialysis patients, we examined if hemodialysis treatment start time is associated with HB vaccination response. METHODS Demographics, standard-of-care clinical, laboratory, and treatment parameters, dialysis shift data, HB antigen status, HB vaccination status, and HB titers were collected from hemodialysis patients in Fresenius clinics from January 2010 to December 2015. Patients in our analysis received 90% of dialysis treatments either before or after 8:30 a.m., were negative for HB antigen, and received a complete series of HB vaccination (Engerix B® or Recombivax HB™). Univariate and multivariate regression models examined whether dialysis start time is a predictor of HB vaccination response. RESULTS Patients were 65 years old, 57% male, and had a HD vintage of 10 months. Patients whose dialysis treatments started before 8:30 a.m. were more likely to be younger, male, and have a greater dialysis vintage. Patients receiving Engerix B® and starting dialysis before 8:30 a.m. had a significantly higher seroconversion rate compared to patients who started dialysis after 8:30 a.m. Early dialysis start was a significant predictor of seroconversion in univariate and multivariate regression including male gender, but not in multivariate regression including age, neutrophil-to-lymphocyte ratio, and vintage. CONCLUSION While better sleep following vaccination is associated with seroconversion in the general population, this is not the case in hemodialysis patients after multivariate adjustment. In the context of end-stage kidney disease, early dialysis start is not a significant predictor of HB vaccination response. The association between objectively measured postvaccination sleep duration and seroconversion rate should be investigated.
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Affiliation(s)
- Maggie Han
- Renal Research Institute, New York, New York, USA,
| | - Xiaoling Ye
- Renal Research Institute, New York, New York, USA
| | - Sharon Rao
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | | | | | - Jeffrey Hymes
- Fresenius Medical Care North America, Waltham, Massachusetts, USA
| | - Franklin W Maddux
- Fresenius Medical Care Management AG, Bad Homburg, Bad Homburg, Germany
| | - Peter Kotanko
- Renal Research Institute, New York, New York, USA.,Icahn School of Medicine, New York, New York, USA
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Sengupta S, Ince L, Sartor F, Borrmann H, Zhuang X, Naik A, Curtis A, McKeating JA. Clocks, Viruses, and Immunity: Lessons for the COVID-19 Pandemic. J Biol Rhythms 2021; 36:23-34. [PMID: 33480287 PMCID: PMC7970201 DOI: 10.1177/0748730420987669] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Circadian rhythms are evolutionarily conserved anticipatory systems that
allow the host to prepare and respond to threats in its environment.
This article summarizes a European Biological Rhythms Society (EBRS)
workshop held in July 2020 to review current knowledge of the
interplay between the circadian clock and viral infections to inform
therapeutic strategies against SARS-CoV-2 and COVID-19. A large body
of work supports the role of the circadian clock in regulating various
aspects of viral replication, host responses, and associated
pathogenesis. We review the evidence describing the multifaceted role
of the circadian clock, spanning host susceptibility, antiviral
mechanisms, and host resilience. Finally, we define the most pressing
research questions and how our knowledge of chronobiology can inform
key translational research priorities.
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Affiliation(s)
- Shaon Sengupta
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Institute of Translational Medicine and Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Chronobiology and Sleep Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Louise Ince
- Departement de Pathologie et Immunologie, Geneva, Switzerland
| | - Francesca Sartor
- Institute of Medical Psychology, Medical Faculty, Ludwig Maximilian University of Munich, Munich, Germany
| | - Helene Borrmann
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Xiaodong Zhuang
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Amruta Naik
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Annie Curtis
- School of Pharmacy and Biomolecular Sciences, Tissue Engineering Research Group, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jane A McKeating
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Chinese Academy of Medical Sciences Oxford Institute, University of Oxford, Oxford, UK
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Dorsey A, de Lecea L, Jennings KJ. Neurobiological and Hormonal Mechanisms Regulating Women's Sleep. Front Neurosci 2021; 14:625397. [PMID: 33519372 PMCID: PMC7840832 DOI: 10.3389/fnins.2020.625397] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/22/2020] [Indexed: 01/22/2023] Open
Abstract
Sleep is crucial for optimal well-being, and sex differences in sleep quality have significant implications for women's health. We review the current literature on sex differences in sleep, such as differences in objective and subjective sleep measures and their relationship with aging. We then discuss the convincing evidence for the role of ovarian hormones in regulating female sleep, and survey how these hormones act on a multitude of brain regions and neurochemicals to impact sleep. Lastly, we identify several important areas in need of future research to narrow the knowledge gap and improve the health of women and other understudied populations.
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Affiliation(s)
| | | | - Kimberly J. Jennings
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, United States
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71
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Davis SM, Mekany M, Kim JJ, Han JJ. Patient Sleep Quality in Acute Inpatient Rehabilitation. PM R 2021; 13:1385-1391. [PMID: 33432699 DOI: 10.1002/pmrj.12550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/23/2020] [Accepted: 01/05/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Sleep is an important component of neurorehabilitation. This study evaluates sleep quality in the acute inpatient rehabilitation setting and is the first to compare sleep quality in acute rehabilitation versus the acute care hospital and home settings. OBJECTIVE To assess patient sleep quality in the acute inpatient rehabilitation setting. DESIGN Cross-sectional survey study. SETTING Acute inpatient rehabilitation unit. PATIENTS Seventy-three patients admitted to the acute rehabilitation unit participated in the study. INTERVENTIONS A validated sleep questionnaire was provided on admission regarding sleep at home and in the acute care hospital. The questionnaire was repeated on discharge from the acute rehabilitation unit regarding sleep during their rehabilitation admission. MAIN OUTCOME MEASURES Visual analog scale of sleep depth, falling asleep, number of awakenings, percentage of time awake, and quality of sleep were obtained through use of the Richards-Campbell Sleep Questionnaire. These values were averaged to obtain "overall sleep perception." An additional question on environmental noise was added. Scores ranged from 0 for "worst sleep possible" to 100 for "best sleep possible." RESULTS Patients reported significantly better sleep in all domains and overall in the acute rehabilitation unit compared to the acute care hospital, with the exception of percentage of time awake. Patients also reported significantly better sleep depth but worse noise in the acute rehabilitation unit when compared to home. Similarly, patients reported significantly better sleep in all domains and overall at home in comparison to the acute care hospital with the exception of percentage of time awake. CONCLUSIONS Patient in the acute rehabilitation unit experience sleep quality that matches their experience at home and exceeds that in the hospital.
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Affiliation(s)
- Shane M Davis
- University of California Irvine Medical Center, Orange, CA
| | - Majid Mekany
- University of California Irvine Medical Center, Orange, CA
| | - Jeff J Kim
- University of California Irvine Medical Center, Orange, CA
| | - Jay J Han
- University of California Irvine Medical Center, Orange, CA
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72
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Robertson BD, Collen JC. Sleep touches everything. J Clin Sleep Med 2020; 16:1997-1998. [DOI: 10.5664/jcsm.8936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Brian D. Robertson
- Sleep Disorders Center, Walter Reed National Military Medical Center, Bethesda, Maryland
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jacob C. Collen
- Sleep Disorders Center, Walter Reed National Military Medical Center, Bethesda, Maryland
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Walsh NP, Halson SL, Sargent C, Roach GD, Nédélec M, Gupta L, Leeder J, Fullagar HH, Coutts AJ, Edwards BJ, Pullinger SA, Robertson CM, Burniston JG, Lastella M, Le Meur Y, Hausswirth C, Bender AM, Grandner MA, Samuels CH. Sleep and the athlete: narrative review and 2021 expert consensus recommendations. Br J Sports Med 2020; 55:bjsports-2020-102025. [PMID: 33144349 DOI: 10.1136/bjsports-2020-102025] [Citation(s) in RCA: 193] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 12/22/2022]
Abstract
Elite athletes are particularly susceptible to sleep inadequacies, characterised by habitual short sleep (<7 hours/night) and poor sleep quality (eg, sleep fragmentation). Athletic performance is reduced by a night or more without sleep, but the influence on performance of partial sleep restriction over 1-3 nights, a more real-world scenario, remains unclear. Studies investigating sleep in athletes often suffer from inadequate experimental control, a lack of females and questions concerning the validity of the chosen sleep assessment tools. Research only scratches the surface on how sleep influences athlete health. Studies in the wider population show that habitually sleeping <7 hours/night increases susceptibility to respiratory infection. Fortunately, much is known about the salient risk factors for sleep inadequacy in athletes, enabling targeted interventions. For example, athlete sleep is influenced by sport-specific factors (relating to training, travel and competition) and non-sport factors (eg, female gender, stress and anxiety). This expert consensus culminates with a sleep toolbox for practitioners (eg, covering sleep education and screening) to mitigate these risk factors and optimise athlete sleep. A one-size-fits-all approach to athlete sleep recommendations (eg, 7-9 hours/night) is unlikely ideal for health and performance. We recommend an individualised approach that should consider the athlete's perceived sleep needs. Research is needed into the benefits of napping and sleep extension (eg, banking sleep).
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Affiliation(s)
- Neil P Walsh
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - Shona L Halson
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Queensland, Australia
| | - Charli Sargent
- Appleton Institute for Behavioural Science, Central Queensland University, Adelaide, Queensland, Australia
| | - Gregory D Roach
- Appleton Institute for Behavioural Science, Central Queensland University, Adelaide, Queensland, Australia
| | - Mathieu Nédélec
- Laboratory Sport, Expertise and Performance (EA 7370), French National Institute of Sport (INSEP), Paris, France
| | - Luke Gupta
- English Institute of Sport, Bisham Abbey National High Performance Centre, Marlow, UK
| | | | - Hugh H Fullagar
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Aaron J Coutts
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Ben J Edwards
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - Samuel A Pullinger
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
- Sports Science Department, Aspire Academy, Doha, Qatar
| | - Colin M Robertson
- School for Sport and Exercise Sciences, University of Bolton, Bolton, UK
| | - Jatin G Burniston
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - Michele Lastella
- Appleton Institute for Behavioural Science, Central Queensland University, Adelaide, Queensland, Australia
| | - Yann Le Meur
- Laboratory Sport, Expertise and Performance (EA 7370), French National Institute of Sport (INSEP), Paris, France
| | | | - Amy M Bender
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Michael A Grandner
- Sleep and Health Research Program, University of Arizona, Tucson, Arizona, USA
| | - Charles H Samuels
- Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Henderson D, Moore V, MacMorran K, Castellini J, Hay K, Keegan V, Reid D, Curtin D, Tay G. A Cohort Study of Sleep Quality in Adult Patients with Acute Pulmonary Exacerbations of Cystic Fibrosis. Intern Med J 2020; 52:63-68. [PMID: 33025684 DOI: 10.1111/imj.15082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The impact of an acute pulmonary exacerbation of CF on sleep quality has not been established. Patients have greater burden of symptoms, higher intensity of therapy, and are often admitted to hospital outside of their usual sleeping environment. METHODS This prospective, observational study determined the prevalence of impaired sleep quality and associated factors in adult patients admitted to a single CF unit with an acute pulmonary exacerbation of CF. Sleep quality was defined by the Pittsburgh Sleep Quality Index (PSQI), with >5 indicating poor sleep quality. Data was obtained through patient questionnaires, chart review, and examination. RESULTS Sixty-six percent of patients had impaired sleep quality. Patients with poor sleep had more sleep disruption due to pain (median response "mild sleep disruption" vs "no sleep disruption" p=0.003) and insomnia (mean insomnia severity index (ISI) 13 vs 5, p<0.001). In patients with symptoms of restless legs, poor sleepers had worse symptoms (mean IRLSS 15 vs 5, p=0.029). Univariate modelling showed relationships between PSQI and symptoms of depression and anxiety as well as with sleep disruption due to pain, general noise, and nursing observations. In a multivariable model, ISI was the only variable that remained significantly associated with PSQI. Mean PSQI score increased 0.58 units for each 1 unit increase in ISI (95% CI 0.42-0.73, p<0.001). CONCLUSIONS Poor sleep quality is common among patients admitted with an acute exacerbation of CF and is strongly associated with insomnia symptoms in this cohort. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Vanessa Moore
- Clinical Nurse Consultant, The Prince Charles Hospital
| | | | | | - Karen Hay
- Statistics Unit QIMR Berghofer Medical Research Institute
| | | | - David Reid
- Director of Adult Cystic Fibrosis Centre, The Prince Charles Hospital
| | - Deanne Curtin
- Director of Sleep Disorders Centre, The Prince Charles Hospital
| | - George Tay
- Sleep and Thoracic Physician, The Prince Charles Hospital
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Ruiz FS, Rosa DS, Zimberg IZ, Dos Santos Quaresma MV, Nunes JO, Apostolico JS, Weckx LY, Souza AR, Narciso FV, Fernandes-Junior SA, Gonçalves B, Folkard S, Bittencourt L, Tufik S, Tulio de Mello M. Night shift work and immune response to the meningococcal conjugate vaccine in healthy workers: a proof of concept study. Sleep Med 2020; 75:263-275. [PMID: 32866895 DOI: 10.1016/j.sleep.2020.05.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND It is well-established that sleep regulates immune functions. Immunological functions are dependent on circadian rhythms and regular sleep as both have an impact on the magnitude of immune responses following antigenic challenge (eg, in vaccination). Here we investigated whether nocturnal shift work can influence post-vaccination response. METHODS Thirty-four healthy workers (23 females) working either nocturnal or diurnal shifts (17 in each group) received the meningococcal C meningitis vaccine. Sleep was recorded polysomnographically (PSG) and with actigraphy. Humoral and cellular responses were assessed after vaccination. RESULTS Night workers showed decreased N3 stage and REM sleep duration, increased inflammatory mediators (TNF-α and IL-6 levels), and a weak specific humoral response to vaccination associated with reduced CD4 T lymphocytes, reduced plasmacytoid dendritic cells, reduced prolactin levels, increased TReg and increased IL-10 levels. In addition, the decrease in total sleep time and circadian rhythm alterations were associated with a reduced humoral response post-vaccination. CONCLUSIONS Our findings provide novel evidence concerning immune alterations of shift work on workers' health based on real-life circumstances. In association with circadian components, sufficient sleep time and rhythm synchronization were important for the development of the Ag-specific immune response, suggesting that the humoral response to vaccination may be impaired in individuals with chronic sleep restriction and circadian misalignment.
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Affiliation(s)
- Francieli S Ruiz
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil; Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK.
| | - Daniela S Rosa
- Departamento de Microbiologia, Imunologia e Parasitologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Ioná Z Zimberg
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Jethe Of Nunes
- Departamento de Microbiologia, Imunologia e Parasitologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Juliana S Apostolico
- Departamento de Microbiologia, Imunologia e Parasitologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Lily Y Weckx
- Departamento de Pediatria, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Alessandra R Souza
- Departamento de Pediatria, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Fernanda V Narciso
- Escola de Educação Física, Fisioterapia e Terapia Ocupacional (EEFFTO), Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Bruno Gonçalves
- Escola de Artes, Ciências e Humanidades, Universidade de São Paulo, Brazil
| | | | - Lia Bittencourt
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Marco Tulio de Mello
- Escola de Educação Física, Fisioterapia e Terapia Ocupacional (EEFFTO), Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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76
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Effects of sleep on the splenic milieu in mice and the T cell receptor repertoire recruited into a T cell dependent B cell response. Brain Behav Immun Health 2020; 5:100082. [PMID: 34589857 PMCID: PMC8474558 DOI: 10.1016/j.bbih.2020.100082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 02/06/2023] Open
Abstract
Sleep is known to improve immune function ranging from cell distribution in the naïve state to elevated antibody titers after an immune challenge. The underlying mechanisms still remain unclear, partially because most studies have focused on the analysis of blood only. Hence, we investigated the effects of sleep within the spleen in female C57BL/6J mice with normal sleep compared to short-term sleep-deprived animals both in the naïve state and after an antigen challenge. Lack of sleep decreased the expression of genes associated with immune cell recruitment into and antigen presentation within the spleen both in the naïve state and during a T cell dependent B cell response directed against sheep red blood cells (SRBC). However, neither T cell proliferation nor formation of SRBC-specific antibodies was affected. In addition, the T cell receptor repertoire recruited into the immune response within seven days was not influenced by sleep deprivation. Thus, sleep modulated the molecular milieu within the spleen whereas we could not detect corresponding changes in the primary immune response against SRBC. Further studies will show whether sleep influences the secondary immune response against SRBC or the development of the B cell receptor repertoire, and how this can be compared to other antigens. Sleep deprivation (SD) decreases expression of genes involved in T cell function. SD induces those changes in the milieu of both lymph nodes and spleen. SD dampens the expression of several genes in the spleen during an immune response. SD does not alter the T cell receptor repertoire recruited into the immune response.
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Key Words
- Antigen presentation
- BCZ, B cell zone
- CCL, C–C motif ligand
- CCR, C–C motif receptor
- CD, cluster of differentiation
- CIITA, class II major histocompatibility complex transactivator
- CXCL, C-X-C motif ligand
- FDR, false discovery rate
- GC, germinal center
- IFN, interferon
- IL, interleukin
- Lymphocyte migration
- MHC-II, major histocompatibility complex II
- SD, sleep deprivation
- SLO, secondary lymphoid organ
- SRBC, sheep red blood cells
- Sheep red blood cells
- Sleep deprivation
- T cell dependent B cell Response
- T cell receptor repertoire
- TCR, T cell receptor
- TCR-R, T cell receptor repertoire
- TCZ, T cell zone
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77
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Abdulah DM, Musa DH. Insomnia and stress of physicians during COVID-19 outbreak. Sleep Med X 2020; 2:100017. [PMID: 33860222 PMCID: PMC7237900 DOI: 10.1016/j.sleepx.2020.100017] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/01/2020] [Accepted: 05/06/2020] [Indexed: 12/13/2022] Open
Abstract
Background Healthcare workers are at high risk of developing sleep disorders during an outbreak. This study aimed to measure severity of sleep difficulty and its correlation with duration of deal with suspected/confirmed cases of novel coronavirus (COVID-19) in physicians. Methods In this cross-sectional study, 268 physicians from different medical settings were included during the COVID-19 outbreak. Results The mean age and experience of physicians were 35.06 (33-70 years) and 10.13 years. The median duration of dealing with suspected/confirmed cases of COVID-19 was 1.0 (0-30 days). The mean sleep score and stress of physicians were 8.43 of 24.0 and 4.20 of 10, respectively. More than two-thirds of the physicians were sleepless (68.3%) and majority had stress (93.7%). The study did not find a significant difference in sleep score of physicians with different specialties (P = 0.059). However, most physicians were sleepless; including anesthesia and intensive care (77.8%); general physicians (80.8%), and obstetrics and gynecology (80.0%). They were sleepless in morning (58.7%); evening (77.8%); night (100%); and multi-shift (70.9%). The physicians who dealt with suspected or confirmed cases of COVID-19 or with stress had more escalated sleep compared to those who did not deal with patients or without stress (9.39 vs. 7.17 and 8.78 vs. 2.69 P < 0.001). The sleep of physicians was escalated with increasing stress (r = 0.558; P < 0.001) and a number of days that physicians dealt with suspected/confirmed cases of COVID-19 (r = 0.210; P = 0.001), respectively. Conclusion The study confirmed that working with COVID-19 patients has a negative effect on the sleep of physicians.
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Affiliation(s)
| | - Dildar Haji Musa
- Department of Surgery, College of Medicine, University of Duhok, Iraq
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78
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Nieters A, Blagitko-Dorfs N, Peter HH, Weber S. Psychophysiological insomnia and respiratory tract infections: results of an infection-diary-based cohort study. Sleep 2020; 42:5491053. [PMID: 31099836 DOI: 10.1093/sleep/zsz098] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 03/21/2019] [Indexed: 01/24/2023] Open
Abstract
STUDY OBJECTIVES The immune theory of sleep suggests an important role of sleep for a functioning immune system. Insomnia has been associated with heightened risk for infections. The aim of the study was to test whether psychophysiological insomnia (PI) is associated with subsequent respiratory tract infections (RTIs) in the context of an infection-diary-based cohort study. METHODS We recruited 674 adults from a cross-sectional survey on airway infections into the airway infection susceptibility (AWIS) cohort and invited them to self-report in diaries incident RTIs experienced during 7097 months (mean of 11.9 months of completed infection diaries per individual). The Regensburg Insomnia Scale (RIS) was assessed at baseline to measure PI. As outcome, we considered an infection diary score summing up prospectively reported RTIs. RESULTS The RIS score correlated significantly with the infection diary score summarizing reported RTIs (correlation coefficient = 0.265, p < 0.001). Adjustments by putative confounders did only marginally affect this relationship. No significant differences in the relationship between RIS score and diary score were found for subgroups including those by gender, body mass index, perceived stress, and comorbidity. People affected by a combination of high PI and obesity were eight times more likely to belong to the group reporting the highest 10% of RTIs compared to the nonobese group with low RIS score (p < 0.001). A high RIS score in men was associated with a higher neutrophil-to-lymphocyte ratio, an indicator of inflammation. CONCLUSIONS Our data support the relevance of adequate sleep for an immune system ready to fight pathogens and prevent airway infections.
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Affiliation(s)
- Alexandra Nieters
- Institute for Immunodeficiency and Center for Chronic Immunodeficiency (CCI), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nadja Blagitko-Dorfs
- Institute for Immunodeficiency and Center for Chronic Immunodeficiency (CCI), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hans-Hartmut Peter
- Institute for Immunodeficiency and Center for Chronic Immunodeficiency (CCI), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Susanne Weber
- Institute for Immunodeficiency and Center for Chronic Immunodeficiency (CCI), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Institute of Medical Biometry and Statistics, University of Freiburg, Freiburg, Germany
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79
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The immune-sleep crosstalk in inflammatory bowel disease. Sleep Med 2020; 73:38-46. [PMID: 32769031 DOI: 10.1016/j.sleep.2020.04.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 02/07/2023]
Abstract
Sleep disorders are progressively common and sometimes are associated with aberrant regulation of the adaptive and innate immune responses. Sleep interruption can increase the inflammatory burden by enhancing the pro-inflammatory cytokines particularly in patients with chronic diseases such as inflammatory bowel disease (IBD). IBD is a chronic inflammatory disease characterized by immune dysregulation, dysbiosis of gut microbiome, and poor-quality life. Therefore, this review highlights the crosstalk between sleep and immune responses during the progression of IBD.
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80
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Shneider A, Kudriavtsev A, Vakhrusheva A. Can melatonin reduce the severity of COVID-19 pandemic? Int Rev Immunol 2020; 39:153-162. [PMID: 32347747 DOI: 10.1080/08830185.2020.1756284] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The current COVID-19 pandemic is one of the most devastating events in recent history. The virus causes relatively minor damage to young, healthy populations, imposing life-threatening danger to the elderly and people with diseases of chronic inflammation. Therefore, if we could reduce the risk for vulnerable populations, it would make the COVID-19 pandemic more similar to other typical outbreaks. Children don't suffer from COVID-19 as much as their grandparents and have a much higher melatonin level. Bats are nocturnal animals possessing high levels of melatonin, which may contribute to their high anti-viral resistance. Viruses induce an explosion of inflammatory cytokines and reactive oxygen species, and melatonin is the best natural antioxidant that is lost with age. The programmed cell death coronaviruses cause, which can result in significant lung damage, is also inhibited by melatonin. Coronavirus causes inflammation in the lungs which requires inflammasome activity. Melatonin blocks these inflammasomes. General immunity is impaired by anxiety and sleep deprivation. Melatonin improves sleep habits, reduces anxiety and stimulates immunity. Fibrosis may be the most dangerous complication after COVID-19. Melatonin is known to prevent fibrosis. Mechanical ventilation may be necessary but yet imposes risks due to oxidative stress, which can be reduced by melatonin. Thus, by using the safe over-the-counter drug melatonin, we may be immediately able to prevent the development of severe disease symptoms in coronavirus patients, reduce the severity of their symptoms, and/or reduce the immuno-pathology of coronavirus infection on patients' health after the active phase of the infection is over.
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Affiliation(s)
- Alex Shneider
- CureLab Oncology, Inc, Dedham, Massachusetts, USA.,Department of Molecular Biology, Ariel University, Ariel, Israel
| | - Aleksandr Kudriavtsev
- Biological Faculty, Lomonosov Moscow State University, Moscow, Russia.,Emanuel Institute of Biochemical Phisics, RAS, Moscow, Russia
| | - Anna Vakhrusheva
- Biological Faculty, Lomonosov Moscow State University, Moscow, Russia
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81
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Abstract
The discovery of reciprocal connections between the central nervous system, sleep and the immune system has shown that sleep enhances immune defences and that afferent signals from immune cells promote sleep. One mechanism by which sleep is proposed to provide a survival advantage is in terms of supporting a neurally integrated immune system that might anticipate injury and infectious threats. However, in modern times, chronic social threats can drive the development of sleep disturbances in humans, which can contribute to the dysregulation of inflammatory and antiviral responses. In this Review, I describe our current understanding of the relationship between sleep dynamics and host defence mechanisms, with a focus on cytokine responses, the neuroendocrine and autonomic pathways that connect sleep with the immune system and the role of inflammatory peptides in the homeostatic regulation of sleep. Furthermore, I discuss the therapeutic potential of harnessing these reciprocal mechanisms of sleep-immune regulation to mitigate the risk of inflammatory and infectious diseases.
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82
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Downton P, Early JO, Gibbs JE. Circadian rhythms in adaptive immunity. Immunology 2020; 161:268-277. [PMID: 31837013 DOI: 10.1111/imm.13167] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 10/31/2019] [Accepted: 12/05/2019] [Indexed: 12/11/2022] Open
Abstract
The circadian clock provides organisms with the ability to track time of day, allowing them to predict and respond to cyclical changes in the external environment. In mammals this clock consists of multiple auto-regulatory feedback loops generated by a network of circadian clock proteins. This network provides the fundamental basis for rhythms in behaviour and physiology. This clockwork machinery exists in most cells, including those of the immune system. In recent years evidence has emerged highlighting the important role of molecular clocks in dictating the response of immune pathways. While initial work highlighted the effect of the clock in the 'first line of defence', the innate immune system, it has become increasingly apparent that it also plays a role in the more tailored, later-stage adaptive immune response. This review provides an overview of the role of the circadian cycle in the adaptive immune response. We interrogate the depth of knowledge on cell intrinsic clocks within adaptive immune cells and how these cells may be temporally directed by extrinsic rhythmic signals. We discuss the role of the circadian clock in diseases associated with adaptive immunity such as multiple sclerosis, asthma and parasitic infection. We also discuss the current knowledge on timing of vaccination, and the implications this may have on how we can harness and modulate temporal gating of the adaptive immune response in a clinical setting.
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Affiliation(s)
- Polly Downton
- Centre for Biogical Timing, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - James O Early
- Centre for Biogical Timing, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Julie E Gibbs
- Centre for Biogical Timing, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
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Haspel JA, Anafi R, Brown MK, Cermakian N, Depner C, Desplats P, Gelman AE, Haack M, Jelic S, Kim BS, Laposky AD, Lee YC, Mongodin E, Prather AA, Prendergast BJ, Reardon C, Shaw AC, Sengupta S, Szentirmai É, Thakkar M, Walker WE, Solt LA. Perfect timing: circadian rhythms, sleep, and immunity - an NIH workshop summary. JCI Insight 2020; 5:131487. [PMID: 31941836 PMCID: PMC7030790 DOI: 10.1172/jci.insight.131487] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Recent discoveries demonstrate a critical role for circadian rhythms and sleep in immune system homeostasis. Both innate and adaptive immune responses - ranging from leukocyte mobilization, trafficking, and chemotaxis to cytokine release and T cell differentiation -are mediated in a time of day-dependent manner. The National Institutes of Health (NIH) recently sponsored an interdisciplinary workshop, "Sleep Insufficiency, Circadian Misalignment, and the Immune Response," to highlight new research linking sleep and circadian biology to immune function and to identify areas of high translational potential. This Review summarizes topics discussed and highlights immediate opportunities for delineating clinically relevant connections among biological rhythms, sleep, and immune regulation.
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Affiliation(s)
- Jeffrey A. Haspel
- Division of Pulmonary, Critical Care and Sleep Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Ron Anafi
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marishka K. Brown
- National Center on Sleep Disorders Research, Division of Lung Diseases, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland, USA
| | - Nicolas Cermakian
- Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Christopher Depner
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, Colorado, USA
| | - Paula Desplats
- Department of Neurosciences and
- Department of Pathology, UCSD, La Jolla, California, USA
| | - Andrew E. Gelman
- Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Monika Haack
- Human Sleep and Inflammatory Systems Laboratory, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Sanja Jelic
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University School of Medicine, New York, New York, USA
| | - Brian S. Kim
- Center for the Study of Itch
- Department of Medicine
- Department of Anesthesiology
- Department of Pathology, and
- Department of Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Aaron D. Laposky
- National Center on Sleep Disorders Research, Division of Lung Diseases, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland, USA
| | - Yvonne C. Lee
- Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Emmanuel Mongodin
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Aric A. Prather
- Department of Psychiatry, UCSF, San Francisco, California, USA
| | - Brian J. Prendergast
- Department of Psychology and Committee on Neurobiology, University of Chicago, Chicago, Illinois, USA
| | - Colin Reardon
- Department, of Anatomy, Physiology, and Cell Biology, UCD School of Veterinary Medicine, Davis, California, USA
| | - Albert C. Shaw
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Shaon Sengupta
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Éva Szentirmai
- Department of Biomedical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA
| | - Mahesh Thakkar
- Harry S. Truman Memorial Veterans Hospital, Columbia, Missouri, USA
- Department of Neurology, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Wendy E. Walker
- Center of Emphasis in Infectious Diseases, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Health Sciences Center, Texas Tech University, El Paso, Texas, USA
| | - Laura A. Solt
- Department of Immunology and Microbiology, Scripps Research Institute, Jupiter, Florida, USA
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84
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Pichard LE, Simonelli G, Schwartz L, Balkin TJ, Hursh S. Precision Medicine for Sleep Loss and Fatigue Management. Sleep Med Clin 2019; 14:399-406. [PMID: 31375208 DOI: 10.1016/j.jsmc.2019.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Sleep loss is a widespread phenomenon and a public health threat. Sleep disorders, medical conditions, lifestyles, and occupational factors all contribute to insufficient sleep. Regardless of the underlying cause, insufficient sleep has well-defined consequences and the severity of said consequences partially influenced by individual characteristics. It is here where precision medicine needs to understand and define sleep insufficiency in hopes for personalizing medical approach to improve patient outcomes. Following a discussion on causes and consequences of sleep loss, this article discusses tools for assessing sleep sufficiency, mitigating strategies to sleep loss, and sleep loss in the context of fatigue management.
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Affiliation(s)
- Luis E Pichard
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA.
| | - Guido Simonelli
- Behavioral Biology Branch, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Lindsay Schwartz
- Institutes for Behavior Resources, Inc, 2104 Maryland Avenue, Baltimore, MD 21218, USA
| | - Thomas J Balkin
- Behavioral Biology Branch, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Steven Hursh
- Institutes for Behavior Resources, Inc, 2104 Maryland Avenue, Baltimore, MD 21218, USA
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Chung SW, Hur J, Ha YJ, Kang EH, Hyon JY, Lee HJ, Song YW, Lee YJ. Impact of sleep quality on clinical features of primary Sjögren's syndrome. Korean J Intern Med 2019; 34:1154-1164. [PMID: 29458245 PMCID: PMC6718760 DOI: 10.3904/kjim.2017.158] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 11/10/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND/AIMS This study aimed to investigate the inf luence of poor sleep quality on clinical features of primary Sjögren's syndrome (pSS). METHODS Sleep quality was cross-sectionally assessed using the Pittsburgh Sleep Quality Index (PSQI), and demographic, clinical, and laboratory data were collected from 115 Korean patients with pSS. The patients completed questionnaires on the European League Against Rheumatism (EULAR) SS Patient Reported Index (ESSPRI), quality of life (EuroQOL five dimensions questionnaire [EQ-5D]), fatigue (fatigue severity score [FSS]), and depression (Beck Depression Inventory [BDI] II]). Symptoms and patient global assessment (PGA) were evaluated with a 100-mm visual analogue scale (VAS). The EULAR sicca score (ESS), ESSPRI, and EULAR SS Disease Activity Index (ESSDAI) were calculated at study enrollment. RESULTS Fifty-three patients (46.1%) had poor sleep quality and 32.4% of 71 patients without depression were poor sleepers. Poor sleepers had a significantly lower EQ-5D or ESSDAI and a significantly higher FSS, BDI-II, PGA, ESS, ESSPRI, or VAS scores for extra-glandular symptoms than good sleepers. Neutrophil and lymphocyte counts were significantly higher and immunoglobulin G levels tended to decrease in poor sleepers. Additionally, PSQI was negatively correlated with EQ-5D and ESSDAI and positively with ESS, FSS, BDI-II, PGA, VAS scores for their symptoms, and ESSPRI. Multivariate analysis revealed that poor sleep quality remained the independent determinants of the unsatisfactory symptom state (ESSPRI ≥ 5). CONCLUSION Our results showed that poor sleep quality could significantly affect the patient-oriented outcomes and physician-reported activity index of pSS patients through the various effects of sleep quality on the psychological or somatic symptoms and the immune system.
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Affiliation(s)
- Sang Wan Chung
- Department of Internal Medicine, Graduate School, Kyung Hee University, Seoul, Korea
| | - Jaehyung Hur
- Department of Internal Medicine, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - You-Jung Ha
- Department of Internal Medicine, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Ha Kang
- Department of Internal Medicine, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joon Young Hyon
- Department of Ophthalmology, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyo-Jung Lee
- Department of Periodontology, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yeong Wook Song
- Department of Internal Medicine, Medical Research Institute, Seoul National University College of Medicine, Seoul, Korea
- WCU Department of Molecular Medicine and Biopharmaceutical Sciences, Medical Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Yun Jong Lee
- Department of Internal Medicine, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Medical Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Correspondence to Yun Jong Lee, M.D. Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea Tel: +82-31-787-7049 Fax: +82-31-787-4051 E-mail:
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Febrile and sleep responses to an immune challenge are affected by trait aggressiveness in rats. Brain Behav Immun 2019; 80:300-307. [PMID: 30953773 DOI: 10.1016/j.bbi.2019.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 03/18/2019] [Accepted: 04/02/2019] [Indexed: 12/15/2022] Open
Abstract
Sleep is altered in response to an immune challenge: non-rapid eye movement (NREM) sleep is increased and fragmented, REM sleep is inhibited. Sleep and immune response are affected by stress: several stressors inhibit sleep and increase waking time; stress-induced cortisol secretion affects the immune response, with immunosuppressive effects. Different levels of trait aggressiveness are associated with specific patterns of neuroendocrine and autonomic stress responsiveness. Aim of this study was to test the hypothesis that trait aggressiveness, by affecting response to stressors, modifies sleep alterations induced by the activation of the immune response. To this aim, rats were selected on the basis of their latency time to attack a male intruder in the resident-intruder test. Animals were instrumented for chronic recordings of sleep-wake activity and injected, intraperitoneally, with an immune challenge (250 μg/kg lipopolysaccharide - LPS, a component of gram-negative bacterial cell wall). Here we report that high aggressive (HA) rats responded to an immune challenge with a 24-h long increase in cortical brain temperature. During the first 12 post-injection hours, HA rats also responded with a prolonged increase in NREM sleep amount, and a 5-h long and continuous inhibition of REM sleep. In HA rats, the LPS-induced increase in the amount of time spent in NREM sleep was due to an increase in the number of episodes of this sleep phase, without any change in the bout duration. The LPS-induced REM sleep inhibition observed in HA rats was due to a decrease in both the number and duration of REM sleep bouts. In HA rats, during REM sleep, LPS administration significantly reduced the power of the EEG theta band. In non-aggressive (NA) rats, in response to LPS administration, cortical brain temperature was increased only for two hours, NREM sleep was unaffected, and REM sleep inhibition was scattered along the first 8 post-injection hours. The LPS-induced changes in the number of NREM sleep bouts of NA rats were limited to few and scattered hours, with a change in bout duration only in a single hour. A combination of decreases, in few hours, in both REM sleep bouts and their duration contributed to the REM sleep inhibition observed in NA rats. In NA rats, the power of EEG theta band was not modified, during REM sleep, by LPS administration. Gross motor activity was inhibited in both HA and NA rats. Results of this study show that trait aggressiveness affects febrile and sleep responses to an immune challenge.
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Besedovsky L, Lange T, Haack M. The Sleep-Immune Crosstalk in Health and Disease. Physiol Rev 2019; 99:1325-1380. [PMID: 30920354 PMCID: PMC6689741 DOI: 10.1152/physrev.00010.2018] [Citation(s) in RCA: 655] [Impact Index Per Article: 131.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 02/08/2023] Open
Abstract
Sleep and immunity are bidirectionally linked. Immune system activation alters sleep, and sleep in turn affects the innate and adaptive arm of our body's defense system. Stimulation of the immune system by microbial challenges triggers an inflammatory response, which, depending on its magnitude and time course, can induce an increase in sleep duration and intensity, but also a disruption of sleep. Enhancement of sleep during an infection is assumed to feedback to the immune system to promote host defense. Indeed, sleep affects various immune parameters, is associated with a reduced infection risk, and can improve infection outcome and vaccination responses. The induction of a hormonal constellation that supports immune functions is one likely mechanism underlying the immune-supporting effects of sleep. In the absence of an infectious challenge, sleep appears to promote inflammatory homeostasis through effects on several inflammatory mediators, such as cytokines. This notion is supported by findings that prolonged sleep deficiency (e.g., short sleep duration, sleep disturbance) can lead to chronic, systemic low-grade inflammation and is associated with various diseases that have an inflammatory component, like diabetes, atherosclerosis, and neurodegeneration. Here, we review available data on this regulatory sleep-immune crosstalk, point out methodological challenges, and suggest questions open for future research.
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Affiliation(s)
- Luciana Besedovsky
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen , Tübingen , Germany ; Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School , Boston, Massachusetts ; and Department of Rheumatology and Clinical Immunology, University of Lübeck , Lübeck , Germany
| | - Tanja Lange
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen , Tübingen , Germany ; Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School , Boston, Massachusetts ; and Department of Rheumatology and Clinical Immunology, University of Lübeck , Lübeck , Germany
| | - Monika Haack
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen , Tübingen , Germany ; Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School , Boston, Massachusetts ; and Department of Rheumatology and Clinical Immunology, University of Lübeck , Lübeck , Germany
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88
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Sleep Matters: CD4 + T Cell Memory Formation and the Central Nervous System. Trends Immunol 2019; 40:674-686. [PMID: 31262652 DOI: 10.1016/j.it.2019.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 06/05/2019] [Accepted: 06/05/2019] [Indexed: 11/23/2022]
Abstract
The mechanisms of CD4+ T-cell memory formation in the immune system are debated. With the well-established concept of memory formation in the central nervous system (CNS), we propose that formation of CD4+ T-cell memory depends on the interaction of two different cell systems handling two types of stored information. First, information about antigen (event) and challenge (context) is taken up by antigen-presenting cells, as initial storage. Second, event and context information is transferred to CD4+ T cells. During activation, two categories of CD4+ T cell develop: effector CD4+ T cells, carrying event and context information, enabling them to efficiently focus their response to tissues under attack; and persisting CD4+ T cells, providing context-independent antigen-specific memories and long-term storage. This novel hypothesis is supported by the observation that mammalian sleep can improve both CNS and CD4+ T-cell memory.
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89
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Chiang JJ, Cole SW, Bower JE, Irwin MR, Taylor SE, Arevalo J, Fuligni AJ. Daily interpersonal stress, sleep duration, and gene regulation during late adolescence. Psychoneuroendocrinology 2019; 103:147-155. [PMID: 30690224 PMCID: PMC8447850 DOI: 10.1016/j.psyneuen.2018.11.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 10/11/2018] [Accepted: 11/19/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Psychological stress and poor sleep are associated with a wide range of negative health outcomes, which are thought to be mediated in part by alterations in immune processes. However, the molecular bases of links among stress, sleep, and immune processes are not completely understood, particularly during adolescence when sensitivity to stress and problems with sleep tend to increase. In the current study, we investigated whether various stressors (daily stress, major life events, perceived stress), sleep indices (duration, efficiency), and their interactions (e.g., moderating effects) are associated with expression of genes bearing response elements for transcription factors that regulate inflammatory and anti-viral processes. METHOD Eighty-seven late adolescents completed daily checklists of their social experiences across a 15-day period and reported on their major life events during the previous year. They also completed actigraphy-based assessments of sleep quality and duration during 8 consecutive nights. An average of 5.5 months later, participants reported on their global perceptions of stress during the previous month and provided blood samples for genome-wide expression profiling of mRNA from peripheral blood mononuclear cells (PBMCs). RESULTS Higher levels of daily interpersonal stress and shorter sleep duration were associated with upregulation of inflammation-related genes bearing response elements for proinflammatory transcription factor nuclear factor kappa B (NF-κB). Shorter sleep duration was also linked to downregulation of antiviral-related genes bearing response elements for interferon response factors (IRFs). Lastly, there was a significant interaction between daily stress and shorter sleep duration, such that the association between daily stress and inflammation-related gene expression was exacerbated in the context of shorter sleep duration. Results were independent of sex, ethnicity, parent education, body mass index, and smoking and alcohol history. CONCLUSION Everyday interpersonal stress and shortened sleep can be consequential for upstream NF-κB signaling pathways relevant to inflammatory processes during late adolescence. Notably, the occurrence of both may lead to even greater activation of NF-κB signaling.
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Affiliation(s)
- Jessica J. Chiang
- Institute for Policy Research, Northwestern University, United States,Corresponding author at: Foundations of Health Research Center, 1801 Maple Avenue, Suite 2450, Evanston, 60201, IL, United States. (J.J. Chiang)
| | - Steve W. Cole
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, United States,Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, United States
| | - Julienne E. Bower
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, United States,Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, United States,Department of Psychology, University of California, Los Angeles, United States
| | - Michael R. Irwin
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, United States,Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, United States,Department of Psychology, University of California, Los Angeles, United States
| | - Shelley E. Taylor
- Department of Psychology, University of California, Los Angeles, United States
| | - Jesusa Arevalo
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, United States,Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, United States
| | - Andrew J. Fuligni
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, United States,Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, United States,Department of Psychology, University of California, Los Angeles, United States
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90
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Sleep deprivation alters neutrophil functions and levels of Th1-related chemokines and CD4+ T cells in the blood. Sleep Breath 2019; 23:1331-1339. [DOI: 10.1007/s11325-019-01851-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 04/02/2019] [Accepted: 04/16/2019] [Indexed: 12/22/2022]
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91
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Ghanem E, Al Bitar S, Dib R, Kabrita CS. Sleep restriction alters the temporal expression of major histocompatibility complex class II molecules in murine lymphoid tissues. Behav Brain Res 2019; 362:152-159. [DOI: 10.1016/j.bbr.2019.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 01/10/2019] [Accepted: 01/10/2019] [Indexed: 01/27/2023]
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92
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Abstract
There is substantial variation between individuals in the immune response to vaccination. In this review, we provide an overview of the plethora of studies that have investigated factors that influence humoral and cellular vaccine responses in humans. These include intrinsic host factors (such as age, sex, genetics, and comorbidities), perinatal factors (such as gestational age, birth weight, feeding method, and maternal factors), and extrinsic factors (such as preexisting immunity, microbiota, infections, and antibiotics). Further, environmental factors (such as geographic location, season, family size, and toxins), behavioral factors (such as smoking, alcohol consumption, exercise, and sleep), and nutritional factors (such as body mass index, micronutrients, and enteropathy) also influence how individuals respond to vaccines. Moreover, vaccine factors (such as vaccine type, product, adjuvant, and dose) and administration factors (schedule, site, route, time of vaccination, and coadministered vaccines and other drugs) are also important. An understanding of all these factors and their impacts in the design of vaccine studies and decisions on vaccination schedules offers ways to improve vaccine immunogenicity and efficacy.
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93
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Dimitrov S, Lange T, Gouttefangeas C, Jensen ATR, Szczepanski M, Lehnnolz J, Soekadar S, Rammensee HG, Born J, Besedovsky L. Gα s-coupled receptor signaling and sleep regulate integrin activation of human antigen-specific T cells. J Exp Med 2019; 216:517-526. [PMID: 30755455 PMCID: PMC6400544 DOI: 10.1084/jem.20181169] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 12/03/2018] [Accepted: 01/11/2019] [Indexed: 12/26/2022] Open
Abstract
This study demonstrates a regulatory role of Gαs-coupled receptor agonists (catecholamines, prostaglandins, and adenosine) and sleep on integrin activation on T cells in humans. The findings point to a mechanism by which T cell responses are altered in several conditions characterized by aberrant levels of these substances. Efficient T cell responses require the firm adhesion of T cells to their targets, e.g., virus-infected cells, which depends on T cell receptor (TCR)–mediated activation of β2-integrins. Gαs-coupled receptor agonists are known to have immunosuppressive effects, but their impact on TCR-mediated integrin activation is unknown. Using multimers of peptide major histocompatibility complex molecules (pMHC) and of ICAM-1—the ligand of β2-integrins—we show that the Gαs-coupled receptor agonists isoproterenol, epinephrine, norepinephrine, prostaglandin (PG) E2, PGD2, and adenosine strongly inhibit integrin activation on human CMV- and EBV-specific CD8+ T cells in a dose-dependent manner. In contrast, sleep, a natural condition of low levels of Gαs-coupled receptor agonists, up-regulates integrin activation compared with nocturnal wakefulness, a mechanism possibly underlying some of the immune-supportive effects of sleep. The findings are also relevant for several pathologies associated with increased levels of Gαs-coupled receptor agonists (e.g., tumor growth, malaria, hypoxia, stress, and sleep disturbances).
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Affiliation(s)
- Stoyan Dimitrov
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany .,German Center for Diabetes Research (DZD), Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich, University of Tübingen, Tübingen, Germany
| | - Tanja Lange
- Clinic for Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Cécile Gouttefangeas
- Department of Immunology, Institute for Cell Biology, University of Tübingen, Tübingen, Germany
| | - Anja T R Jensen
- Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Szczepanski
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Jannik Lehnnolz
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Surjo Soekadar
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany.,Clinical Neurotechnology Laboratory, Department of Psychiatry and Psychotherapy, Neuroscience Research Center, Charité - University Medicine Berlin, Berlin, Germany
| | - Hans-Georg Rammensee
- Department of Immunology, Institute for Cell Biology, University of Tübingen, Tübingen, Germany.,Partner Site Tübingen, German Cancer Consortium, Tübingen, Germany
| | - Jan Born
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD), Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich, University of Tübingen, Tübingen, Germany
| | - Luciana Besedovsky
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
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94
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Carvalho MF, Gill D. Rotavirus vaccine efficacy: current status and areas for improvement. Hum Vaccin Immunother 2018; 15:1237-1250. [PMID: 30215578 PMCID: PMC6663136 DOI: 10.1080/21645515.2018.1520583] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/12/2018] [Accepted: 08/28/2018] [Indexed: 12/16/2022] Open
Abstract
The difference noted in Rotavirus vaccine efficiency between high and low income countries correlates with the lack of universal access to clean water and higher standards of hygiene. Overcoming these obstacles will require great investment and also time, therefore more effective vaccines should be developed to meet the needs of those who would benefit the most from them. Increasing our current knowledge of mucosal immunity, response to Rotavirus infection and its modulation by circadian rhythms could point at actionable pathways to improve vaccination efficacy, especially in the case of individuals affected by environmental enteropathy. Also, a better understanding and validation of Rotavirus entry factors as well as the systematic monitoring of dominant strains could assist in tailoring vaccines to individual's needs. Another aspect that could improve vaccine efficiency is targeting to M cells, for which new ligands could potentially be sought. Finally, alternative mucosal adjuvants and vaccine expression, storage and delivery systems could have a positive impact in the outcome of Rotavirus vaccination.
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Affiliation(s)
| | - Davinder Gill
- MSD Wellcome Trust Hilleman Laboratories Pvt. Ltd., New Delhi, India
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95
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Pigarev IN, Pigareva ML. Association of sleep impairments and gastrointestinal disorders in the context of the visceral theory of sleep. J Integr Neurosci 2018; 16:143-156. [PMID: 28891506 DOI: 10.3233/jin-170005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
It was noticed long ago that sleep disorders or interruptions to the normal sleep pattern were associated with various gastrointestinal disorders. We review the studies which established the causal link between these disorders and sleep impairment. However, the mechanism of interactions between the quality of sleep and gastrointestinal pathophysiology remained unclear. Recently, the visceral theory of sleep was formulated. This theory proposes that the same brain structures, and particularly the same cortical sensory areas, which in wakefulness are involved in processing of the exteroceptive information, switch during sleep to the processing of information coming from various visceral systems. We review the studies which demonstrated that neurons of the various cortical areas (occipital, parietal, frontal) during sleep began to fire in response to activation coming from the stomach and small intestine. These data demonstrate that, during sleep, the computational power of the central nervous system, including all cortical areas, is engaged in restoration of visceral systems. Thus, the general mechanism of the interaction between quality of sleep and health became clear.
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Affiliation(s)
- Ivan N Pigarev
- Institute for Information Transmission Problems (Kharkevich Institute), Russian Academy of Sciences, Bol'shoy Karetniy st. 19, Moscow, 127994, Russia. E-mail:
| | - Marina L Pigareva
- Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Butlerova st. 5-a, Moscow, 117485, Russia. E-mail:
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96
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Torres-Ruiz J, Sulli A, Cutolo M, Shoenfeld Y. Air Travel, Circadian Rhythms/Hormones, and Autoimmunity. Clin Rev Allergy Immunol 2018; 53:117-125. [PMID: 28244020 DOI: 10.1007/s12016-017-8599-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Biological rhythms are fundamental for homeostasis and have recently been involved in the regulatory processes of various organs and systems. Circadian cycle proteins and hormones have a direct effect on the inflammatory response and have shown pro- or anti-inflammatory effects in animal models of autoimmune diseases. The cells of the immune system have their own circadian rhythm, and the light-dark cycle directly influences the inflammatory response. On the other hand, patients with autoimmune diseases characteristically have sleep disorders and fatigue, and in certain disease, such as rheumatoid arthritis (RA), a frank periodicity in the signs and symptoms is recognized. The joint symptoms predominate in the morning, and apparently, subjects with RA have relative adrenal insufficiency, with a cortisol peak unable to control the late night load of pro-inflammatory cytokines. Transatlantic flights represent a challenge in the adjustment of biological rhythms, since they imply sleep deprivation, time zone changes, and potential difficulties for drug administration. In patients with autoimmune diseases, the use of DMARDs and prednisone at night is probably best suited to lessen morning symptoms. It is also essential to sleep during the trip to improve adaptation to the new time zone and to avoid, as far as possible, works involving flexible or nocturnal shifts. The study of proteins and hormones related to biological rhythms will demonstrate new pathophysiological pathways of autoimmune diseases, which will emphasize the use of general measures for sleep respect and methods for drug administration at key daily times to optimize their anti-inflammatory and immune modulatory effects.
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Affiliation(s)
- J Torres-Ruiz
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico city, Mexico
| | - A Sulli
- Research Laboratories and Academic Division of Clinical Rheumatology, Director Postgraduate School on Rheumatology-Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS San Martino AOU, Genoa, Italy
| | - M Cutolo
- Research Laboratories and Academic Division of Clinical Rheumatology, Director Postgraduate School on Rheumatology-Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS San Martino AOU, Genoa, Italy
| | - Y Shoenfeld
- The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, 5265601, Tel-Hashomer, Israel.
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97
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Sugiura A, Eto T, Kinoshita F, Takada H. [Effect of Reading a Book on a Tablet Computer on Cerebral Blood Flow in the Prefrontal Cortex]. Nihon Eiseigaku Zasshi 2018; 73:39-45. [PMID: 29386445 DOI: 10.1265/jjh.73.39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES By measuring cerebral blood flow in the prefrontal cortex, we aimed to determine how reading a book on a tablet computer affects sleep. METHODS Seven students (7 men age range, 21-32 years) participated in this study. In a controlled illuminance environment, the subjects read a novel in printed form or on a tablet computer from any distance. As the subjects were reading, the cerebral blood flow in their prefrontal cortex was measured by near-infrared spectroscopy. The study protocol was as follows. 1) Subjects mentally counted a sequence of numbers for 30 s as a pretest to standardized thinking and then 2) read the novel for 10 min, using the printed book or tablet computer. In step 2), the use of the book or tablet computer was in a random sequence. Subjects rested between the two tasks. RESULTS Significantly increased brain activity (increase in regional cerebral blood flow) was observed following reading a novel on a tablet computer compared with that after reading a printed book. Furthermore, the region around Broca's area was more active when reading on a tablet computer than when reading a printed book. CONCLUSIONS Considering the results of this study and previous studies on physiological characteristics during nonrapid eye movement sleep, we concluded that reading a book on a tablet computer before the onset of sleep leads to the potential inhibition of sound sleep through mechanisms other than the suppression of melatonin secretion.
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Affiliation(s)
- Akihiro Sugiura
- Department of Radiological Technology, Gifu University of Medical Science
| | - Takuya Eto
- Graduate School of Engineering, University of Fukui
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98
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Timing Matters: Circadian Rhythm in Sepsis, Obstructive Lung Disease, Obstructive Sleep Apnea, and Cancer. Ann Am Thorac Soc 2018; 13:1144-54. [PMID: 27104378 DOI: 10.1513/annalsats.201602-125fr] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Physiological and cellular functions operate in a 24-hour cyclical pattern orchestrated by an endogenous process known as the circadian rhythm. Circadian rhythms represent intrinsic oscillations of biological functions that allow for adaptation to cyclic environmental changes. Key clock genes that affect the persistence and periodicity of circadian rhythms include BMAL1/CLOCK, Period 1, Period 2, and Cryptochrome. Remarkable progress has been made in our understanding of circadian rhythms and their role in common medical conditions. A critical review of the literature supports the association between circadian misalignment and adverse health consequences in sepsis, obstructive lung disease, obstructive sleep apnea, and malignancy. Circadian misalignment plays an important role in these disease processes and can affect disease severity, treatment response, and survivorship. Normal inflammatory response to acute infections, airway resistance, upper airway collapsibility, and mitosis regulation follows a robust circadian pattern. Disruption of normal circadian rhythm at the molecular level affects severity of inflammation in sepsis, contributes to inflammatory responses in obstructive lung diseases, affects apnea length in obstructive sleep apnea, and increases risk for cancer. Chronotherapy is an underused practice of delivering therapy at optimal times to maximize efficacy and minimize toxicity. This approach has been shown to be advantageous in asthma and cancer management. In asthma, appropriate timing of medication administration improves treatment effectiveness. Properly timed chemotherapy may reduce treatment toxicities and maximize efficacy. Future research should focus on circadian rhythm disorders, role of circadian rhythm in other diseases, and modalities to restore and prevent circadian disruption.
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99
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Sutton CE, Finlay CM, Raverdeau M, Early JO, DeCourcey J, Zaslona Z, O'Neill LAJ, Mills KHG, Curtis AM. Loss of the molecular clock in myeloid cells exacerbates T cell-mediated CNS autoimmune disease. Nat Commun 2017; 8:1923. [PMID: 29234010 PMCID: PMC5727202 DOI: 10.1038/s41467-017-02111-0] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 11/07/2017] [Indexed: 12/26/2022] Open
Abstract
The transcription factor BMAL1 is a core component of the molecular clock, regulating biological pathways that drive 24 h (circadian) rhythms in behaviour and physiology. The molecular clock has a profound influence on innate immune function, and circadian disruption is linked with increased incidence of multiple sclerosis (MS). However, the mechanisms underlying this association are unknown. Here we show that BMAL1 and time-of-day regulate the accumulation and activation of various immune cells in a CNS autoimmune disease model, experimental autoimmune encephalomyelitis (EAE). In myeloid cells, BMAL1 maintains anti-inflammatory responses and reduces T cell polarization. Loss of myeloid BMAL1 or midday immunizations to induce EAE create an inflammatory environment in the CNS through expansion and infiltration of IL-1β-secreting CD11b+Ly6Chi monocytes, resulting in increased pathogenic IL-17+/IFN-γ+ T cells. These findings demonstrate the importance of the molecular clock in modulating innate and adaptive immune crosstalk under autoimmune conditions.
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Affiliation(s)
- Caroline E Sutton
- Immune Regulation Research Group, Trinity Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, D02 R590, Dublin, Ireland
| | - Conor M Finlay
- Immune Regulation Research Group, Trinity Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, D02 R590, Dublin, Ireland
| | - Mathilde Raverdeau
- Immune Regulation Research Group, Trinity Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, D02 R590, Dublin, Ireland
| | - James O Early
- Inflammatory Research Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, D02 R590, Dublin, Ireland
- Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland (RCSI), 123 St. Stephens Green, D02 YN77, Dublin, Ireland
| | - Joseph DeCourcey
- Immune Regulation Research Group, Trinity Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, D02 R590, Dublin, Ireland
| | - Zbigniew Zaslona
- Inflammatory Research Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, D02 R590, Dublin, Ireland
| | - Luke A J O'Neill
- Inflammatory Research Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, D02 R590, Dublin, Ireland
| | - Kingston H G Mills
- Immune Regulation Research Group, Trinity Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, D02 R590, Dublin, Ireland.
| | - Annie M Curtis
- Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland (RCSI), 123 St. Stephens Green, D02 YN77, Dublin, Ireland.
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100
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Watson NF, Buchwald D, Delrow JJ, Altemeier WA, Vitiello MV, Pack AI, Bamshad M, Noonan C, Gharib SA. Transcriptional Signatures of Sleep Duration Discordance in Monozygotic Twins. Sleep 2017; 40:2952682. [PMID: 28364472 DOI: 10.1093/sleep/zsw019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2017] [Indexed: 12/23/2022] Open
Abstract
Introduction Habitual short sleep duration is associated with adverse metabolic, cardiovascular, and inflammatory effects. Co-twin study methodologies account for familial (eg, genetics and shared environmental) confounding, allowing assessment of subtle environmental effects, such as the effect of habitual short sleep duration on gene expression. Therefore, we investigated gene expression in monozygotic twins discordant for actigraphically phenotyped habitual sleep duration. Methods Eleven healthy monozygotic twin pairs (82% female; mean age 42.7 years; SD = 18.1), selected based on subjective sleep duration discordance, were objectively phenotyped for habitual sleep duration with 2 weeks of wrist actigraphy. Peripheral blood leukocyte (PBL) RNA from fasting blood samples was obtained on the final day of actigraphic measurement and hybridized to Illumina humanHT-12 microarrays. Differential gene expression was determined between paired samples and mapped to functional categories using Gene Ontology. Finally, a more comprehensive gene set enrichment analysis was performed based on the entire PBL transcriptome. Results The mean 24-hour sleep duration of the total sample was 439.2 minutes (SD = 46.8 minutes; range 325.4-521.6 minutes). Mean within-pair sleep duration difference per 24 hours was 64.4 minutes (SD = 21.2; range 45.9-114.6 minutes). The twin cohort displayed distinctive pathway enrichment based on sleep duration differences. Habitual short sleep was associated with up-regulation of genes involved in transcription, ribosome, translation, and oxidative phosphorylation. Unexpectedly, genes down-regulated in short sleep twins were highly enriched in immuno-inflammatory pathways such as interleukin signaling and leukocyte activation, as well as developmental programs, coagulation cascade, and cell adhesion. Conclusions Objectively assessed habitual sleep duration in monozygotic twin pairs appears to be associated with distinct patterns of differential gene expression and pathway enrichment. By accounting for familial confounding and measuring real life sleep duration, our study shows the transcriptomic effects of habitual short sleep on dysregulated immune response and provides a potential link between sleep deprivation and adverse metabolic, cardiovascular, and inflammatory outcomes.
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Affiliation(s)
- N F Watson
- Department of Neurology, University of Washington, Seattle, WA.,UW Medicine Sleep Center, University of Washington, Seattle, WA.,Washington State Twin Registry, Seattle, WA.,Center for Research in the Management of Sleep Disorders, University of Washington, Seattle, WA
| | - D Buchwald
- Washington State Twin Registry, Seattle, WA.,Initiative for Research and Education to Advance Community Health, Elson S Floyd College of Medicine, Spokane, WA
| | - J J Delrow
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - W A Altemeier
- Department of Medicine, University of Washington, Seattle, WA
| | - M V Vitiello
- Center for Research in the Management of Sleep Disorders, University of Washington, Seattle, WA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - A I Pack
- Division of Sleep Medicine/Department of Medicine and Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - M Bamshad
- Department of Pediatrics, University of Washington, Seattle, WA
| | - C Noonan
- Initiative for Research and Education to Advance Community Health, Elson S Floyd College of Medicine, Spokane, WA
| | - S A Gharib
- UW Medicine Sleep Center, University of Washington, Seattle, WA.,Department of Medicine, University of Washington, Seattle, WA
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