Elsevier

Sleep Medicine Reviews

Volume 16, Issue 2, April 2012, Pages 137-149
Sleep Medicine Reviews

Clinical Review
Immune, inflammatory and cardiovascular consequences of sleep restriction and recovery

https://doi.org/10.1016/j.smrv.2011.05.001Get rights and content

Summary

In addition to its effects on cognitive function, compelling evidence links sleep loss to alterations in the neuroendocrine, immune and inflammatory systems with potential negative public-health ramifications. The evidence to suggest that shorter sleep is associated with detrimental health outcomes comes from both epidemiological and experimental sleep deprivation studies. This review will focus on the post-sleep deprivation and recovery changes in immune and inflammatory functions in well-controlled sleep restriction laboratory studies. The data obtained indicate non-specific activation of leukocyte populations and a state of low-level systemic inflammation after sleep loss. Furthermore, one night of recovery sleep does not allow full recovery of a number of these systemic immune and inflammatory markers. We will speculate on the mechanism(s) that link(s) sleep loss to these responses and to the progression of cardiovascular disease. The immune and inflammatory responses to chronic sleep restriction suggest that chronic exposure to reduced sleep (<6 h/day) and insufficient time for recovery sleep could have gradual deleterious effects, over years, on cardiovascular pathogenesis with a heightened risk in women and in night and shift workers. Finally, we will examine countermeasures, e.g., napping or sleep extension, which could improve the recovery processes, in terms of alertness and immune and inflammatory parameters, after sleep restriction.

Introduction

There is a clear trend emerging of reduced sleep duration at night leading to a growing sleep debt in the general population in western countries. The proportion of adults who sleep less than 6 h per night in the US is now greater than at any other time on record this past decade. The 2009 National Sleep Foundation survey reported that the percentage of the population sleeping less than 6 h per night on weekdays has almost doubled over the last ten years, increasing from 12% in 1998 to 20% in 2009.1

Increasing numbers of people are becoming chronically sleep deprived because of greater work pressure in urban economies, e.g., extended working hours outside the regular 0800–1700 h working day, shift work, or increased accessibility to media of all sorts.

What are the consequences of sleep loss and lack of time for recovery sleep? It was commonly thought that the most important effect of night time sleep loss was daytime sleepiness resulting in cognitive impairment.2 However, in addition to cognitive dysfunction, compelling evidence links sleep loss to alterations in the metabolic, endocrine, immune and inflammatory systems with potential clinical relevance and public-health ramifications.

The evidence to suggest that shorter sleep is associated with detrimental health outcomes comes from epidemiological studies and well-controlled sleep deprivation (SD) laboratory studies. Experimental laboratory studies have primarily investigated neurobehavioral performance, metabolism, neuroendocrine stress, immune and inflammatory systems. The data obtained suggest that SD triggers impairment and dysregulation of all these physiological functions.2, 3, 4, 5, 6 Some effects are modest and some will argue that adaptive physiological processes and/or sleep recovery could be sufficient to counterbalance these changes. However, chronic exposure to sleep restriction (SR) could have gradual and cumulative deleterious health effects over years as indicated by epidemiological results.

The main domains addressed by epidemiological studies related to sleep are mental health, mortality risk, obesity and cardiovascular disease. Epidemiological surveys highlight that night and shift workers (NSWs), a population that is chronically sleep restricted in addition to sleeping and eating at abnormal circadian times, are at an increased risk of diabetes, obesity and cardiovascular pathologies.*7, 8 Short duration sleep has, by itself, also been found to be associated with a higher risk of obesity, diabetes and hypertension.9, 10 Epidemiological surveys relating subjective self-reported sleep duration to health implicate poor sleep as a predictor of cardiovascular risk, and meta-analyses have reported that shorter sleep duration, an emerging condition in the western population, is associated with a higher incidence of cardiovascular events.1, 11, 12

However, the underlying mechanism(s) that link(s) sleep loss to the progression of cardiovascular diseases is poorly understood. In this review, we will focus on post-SD changes in immune and inflammatory functions – possibly mediated via the neuroendocrine system – in well-controlled SR laboratory studies and the links of these changes to cardiovascular pathogenesis. Finally, we will examine countermeasures that may improve the recovery processes of immune and inflammatory parameters after SD.

Section snippets

Slow-wave-sleep – growth hormone – stress axis interactions

The elevated SWS pressure and extended epochs of SWS within the first hours of the night coincide with peak secretion of growth hormone (GH) and minimum cortisol release.41 This nearly complete suppression of cortisol release

Insufficient recovery sleep

Sleep deprivation and restriction studies have assessed alertness and performance after recovery sleep but immune cells and inflammatory markers have been investigated to a lesser extent. The data obtained on performance indicated that one or even two nights of an 8 h recovery night of sleep is not sufficient to normalize neurobehavioral deficits after SD.105, 106, 107 The same profiles were also found for immune and inflammatory parameters. The increased levels of the inflammatory marker CRP

Acknowledgments

We would like to thank Pr Damien Léger for his comments on the manuscript and Karen Pickett for English-language editing. Sources of Funding: European Union Grant MCRTN-CT-2004-512362 and Scientific Research Fund of the ISPPC-CHU de Charleroi.

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