Article

Sleep as a Mediator of the Stress-Immune Relationship

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Abstract

To evaluate the role of sleep in the relationship of intrusive thoughts/avoidance behaviors to natural killer cell (NKC) number and function. Twenty-nine individuals seeking treatment for bereavement-related depression were studied in the sleep laboratory. Background and clinical variables, including the Impact of Event Scale (IES) and the Hamilton Rating Scale for Depression (HRSD), were administered during the week preceding a 3-night sleep study. Blood samples were collected upon awakening after the second or third night of sleep. Greater frequency of intrusive thoughts and avoidance behaviors was associated with more time spent awake during the first non-rapid eye movement period (NREM-1) and lower NKC number (p values < .01). Greater time spent awake during NREM-1 was associated with lower NKC numbers (p < .05). Regression analyses revealed that the significant relationship between symptoms of intrusion/avoidance and NKC number was no longer significant when time spent awake during NREM-1 was entered into the regression equation. Time spent awake during NREM-1 accounted for 12% of the variance in NKC number (p < .05), whereas intrusion/avoidance accounted for 7% of the variance in NKC number (NS). These results suggest that EEG-assessed sleep may be a significant correlate of the stress-immune relationship.

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... In addition, one study rated good quality found that a higher level of depressed mood was associated with a lower percentage of CD16 NK cells compared with bereaved men with a lower level of depressed mood (23). Likewise, another study found that higher levels of bereavement-related intrusive thoughts and avoidance were associated with lower NK cell levels but were not associated with NK cell activity (30). Thus, the cumulative findings on the association between NK cell enumeration and activity and psychological responses to bereavement in healthy adults suggest that grief and depression after bereavement may influence immune function above and beyond the bereavement event. ...
... Of note, most studies examining psychological responses to bereavement (e.g., grief severity), which included three rated good quality, reported associations between the level of bereavement response and immune function (16,17,19,20,(23)(24)(25)(27)(28)(29)(30)34,38). Overall, six studies, including one rated good quality, reported an association between higher levels of depression and worse immune function in bereaved adults (16,17,23,25,27,30); two studies, including two rated good quality, did not find this association in gay and bisexual men with and without HIV (26,28). ...
... Of note, most studies examining psychological responses to bereavement (e.g., grief severity), which included three rated good quality, reported associations between the level of bereavement response and immune function (16,17,19,20,(23)(24)(25)(27)(28)(29)(30)34,38). Overall, six studies, including one rated good quality, reported an association between higher levels of depression and worse immune function in bereaved adults (16,17,23,25,27,30); two studies, including two rated good quality, did not find this association in gay and bisexual men with and without HIV (26,28). One study examining two samples-younger and older bereaved adults-did not find an association between psychosocial variables and neutrophil function (39). ...
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Objective: Bereavement is associated with increased risk for morbidity and all-cause mortality across epidemiological, meta-analytic, and case-control studies. The body of research examining the association between bereavement and immune function, beginning in 1977, has yet to be reviewed. The current systematic review clarifies these findings, identifies limitations of the diverse literature, and suggests a model and directions for future research. Methods: The PRISMA guidelines for systematic reviews were used to synthesize 41 years of research. Compared with a meta-analysis, a systematic review is appropriate given the heterogeneous nature of the studies. We used the National Heart, Lung, and Blood Institute Study Quality Assessment Tool to assess the quality of select studies. Results: Thirty-three publications met inclusion criteria. Most studies support the association between bereavement and maladaptive changes in immune parameters in adults, with mixed findings on bereavement-related changes in cellular immunity. A handful of recent, good-quality studies show bereaved people demonstrate higher levels of systemic inflammation, maladaptive immune cell gene expression, and lower antibody response to vaccination compared with nonbereaved controls. Individual differences in psychological response to bereavement (e.g., depression, grief) seem to influence the association between bereavement and immune function. Conclusions: Research examining the association between bereavement and biomarkers of immune function is heterogeneous in methods and quality. Despite these limitations, there is evidence supporting maladaptive changes in immune function after bereavement. The research area would benefit from longitudinal research with larger sample sizes, advanced immunological methods, and incorporating measures of psychological responses to bereavement. The field is poised to refine and scale up its investigation of this common and important phenomenon.
... Several previous studies have shown lowered immune functioning in individuals who reported poor sleep, sleep deprivation, or insomnia (Burgos et al., 2005;Cover & Irwin, 1994;Hall et al., 1998;Irwin, 2002;Irwin, Clark, Kennedy, Christian Gillin, & Ziegler, 2003;Irwin et al., 1996;Miller et al., 2004;Prather et al., 2012). Studies to date, however, have fallen into one of two categories: (a) the measurement of immune cell numbers or cytokines (e.g., Cover & Irwin, 1994;Hall et al., 1998;Savard et al., 2003) in persons with insomnia, or (b) examination of vaccine responses (e.g., Miller et al., 2004;Prather et al., 2012) in relation to poor sleep or reduced sleep duration (Frey, Fleshner, & Wright, 2007;Lange et al., 2003;Spiegel et al., 2002). ...
... Several previous studies have shown lowered immune functioning in individuals who reported poor sleep, sleep deprivation, or insomnia (Burgos et al., 2005;Cover & Irwin, 1994;Hall et al., 1998;Irwin, 2002;Irwin, Clark, Kennedy, Christian Gillin, & Ziegler, 2003;Irwin et al., 1996;Miller et al., 2004;Prather et al., 2012). Studies to date, however, have fallen into one of two categories: (a) the measurement of immune cell numbers or cytokines (e.g., Cover & Irwin, 1994;Hall et al., 1998;Savard et al., 2003) in persons with insomnia, or (b) examination of vaccine responses (e.g., Miller et al., 2004;Prather et al., 2012) in relation to poor sleep or reduced sleep duration (Frey, Fleshner, & Wright, 2007;Lange et al., 2003;Spiegel et al., 2002). ...
... Studies have shown that insomnia is related to suppression of natural killer (NK) cell activity (Cover & Irwin, 1994;Hall et al., 1998), lymphocyte counts (Savard, Laroche, Simard, Ivers, & Morin, 2003), as well as chronic increases in certain proinflammatory cytokines (e.g., IL-6; Burgos et al., 2005;Vgontzas et al., 2002). However, it is unclear how these cross-sectional insomnia-immune relationships will translate to vaccination response (e.g., influenza vaccine). ...
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Healthy young adult college students (N = 133) with Insomnia (n = 65) or No Insomnia (n = 68) were compared on influenza serum antibody levels pre- and four weeks postvaccination. Volunteers underwent structured clinical interviews for sleep disorders to ensure insomnia diagnoses, as well as psychiatric interviews, physical examinations, and drug testing to ensure comorbid health problems were not potential confounds. There were significant time (both groups had increases in antibody levels pre- to postvaccination) and group (Insomnia group had lower HI antibody levels overall) main effects, but the time x group interaction was nonsignificant. Exploratory analyses did find significant PSQI x Time (p < .001) and Insomnia Status x Time (p = .002) interaction effects. Results indicate insomnia may be a risk factor for lowered immunity to the influenza virus.
... Factors associated with sleep disturbances in cancer patients include psychiatric disorders; the distress associated with cancer diagnosis and progression; the effects of cancer treatments, including surgery, hormonal therapy, and chemotherapy; and cancer symptoms such as discomfort and pain (Savard & Morin, 2001). The potential consequences of disturbed sleep for cancer patients arise from the prominent role sleep has in mediating psychological and physical health (Hall et al., 1998;Savard & Morin, 2001). Persistent sleep disturbances may increase a cancer patient's risk for mood disorders, including depression, fatigue, altered metabolic and endocrine function, and compromised immune functioning (Hall, et al., 1998;Savard & Morin, 2001; Spiegel, Leproult, & Van Cauter, 1999). ...
... The potential consequences of disturbed sleep for cancer patients arise from the prominent role sleep has in mediating psychological and physical health (Hall et al., 1998;Savard & Morin, 2001). Persistent sleep disturbances may increase a cancer patient's risk for mood disorders, including depression, fatigue, altered metabolic and endocrine function, and compromised immune functioning (Hall, et al., 1998;Savard & Morin, 2001; Spiegel, Leproult, & Van Cauter, 1999). Potential changes in metabolic, endocrine, and immune function may have important health consequences for patients with an immunogenic cancer such as RCC, particularly those undergoing vaccine therapy. ...
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Forty-two patients with metastatic renal cell carcinoma who were participating in a Phase II clinical trial were randomly assigned to an expressive writing (EW) or neutral writing (NW) group. Patients in the EW group wrote about their cancer, and patients in the NW group wrote about health behaviors. No statistically significant group differences were found in symptoms of distress, perceived stress, or mood disturbance, except for the Vigor subscale of the Profile of Mood States. However, patients in the EW group reported significantly less sleep disturbance, better sleep quality and sleep duration, and less daytime dysfunction compared with patients in the NW group. The results suggest that EW may have sleep-related health benefits in terminally ill cancer patients.
... Buysse et al. (17) have suggested that complaints about sleep quality have become common and that a considerable proportion of adults experience sleep quality disturbances, such as difficulty initiating asleep. Difficulty initiating sleep is suggested as a mechanism to link the consequences of stress with immune suppression that in turn leads to chronic inflammation and progression to chronic disease states (18). Because sleep is recognized as an important determinant of health and well-being, sleep hygiene recommendations were developed by several health organizations (19)(20)(21). ...
... Several groups have linked food insecurity to both acute and chronic stress (8,47,48). Researchers have reported an association between depression, stress, and sleep (16,18,49). Although we included mental health status in our analyses, it is possible that mental health problems in marginally FS, low FS, and very low FS adults could still potentially result in poor sleep outcomes. ...
Article
Although food insecure (FI) adults are at risk of chronic conditions, little research attention is given to their health behaviors, such as sleep. We examined the associations between adult food security status and sleep duration, sleep latency, and sleep complaints reported to a health care professional. Our population-based sample included 5637 men and 5264 women (≥22 y) who participated in the NHANES 2005-2010. Food security status was assessed with USDA's 10-item adult Food Security Survey Module. Self-reported information about sleep duration, sleep latency, and sleep complaints to a health care professional were used as sleep outcomes. Multiple linear, stratified by sex, and logistic regression models were used to estimate the association between food security status and the 3 sleep outcomes. Very low food secure (FS) women reported significantly shorter sleep duration than fully FS women (difference: -30 ± 5.2 min; P < 0.01); however, no relation to sleep duration was observed among men. Among men, participants who were marginally FS (4 ± 1.1 min), low FS (4 ± 1.7 min), and very low FS (5 ± 1.8 min) reported significantly longer sleep latency than fully FS men (P < 0.05), but no association with sleep latency was observed among women. The divergent patterns in sleep duration and latency were likely because of our reference groups reporting undesirable sleep outcomes; fully FS men reported inadequate sleep and fully FS women reported long sleep latency. Among both men and women, marginally FS (OR: 1.64; 95% CI: 1.24, 2.16), low FS (OR: 1.63; 95% CI: 1.16, 2.30), and very low FS (OR: 1.99; 95% CI: 1.36, 2.92) participants were more likely to report sleep complaints than their fully FS counterparts (P < 0.05). Poor sleep quantity and quality may predispose FI adults to adverse health outcomes. © 2015 American Society for Nutrition.
... This trend is consistent with previous studies conducted by Dyrbye et al. (2006) and Wadikar et al. (2017), further reinforcing the notion of gender-specific stress responses in academic settings. While Sulaiman et al. (2009) reported lower stress levels among male students compared to females, a body of literature including studies by Hall et al. (1998), Adlaf et al. (2001), Hudd et al. (2000), Kelly et al. (2006), and Kudielka and Kirschbaum (2005) consistently support the notion that female students tend to report greater levels of stress overall. These significant psychological differences between men and women may primarily arise from women's greater inclination to express their concerns and emotions openly. ...
Article
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Recent research indicates an escalating prevalence of stress among students during exam time. Our study aims to explore the correlation between stress induced by exams, its impact on immunity, and the varying effects of stress levels on students' health outcomes. A random online questionnaire survey involving 252 students across three educational levels, school, undergraduate, and postgraduate, have been conducted in this study. This study assessed stress levels, related symptoms experienced during exams, and stress-related health outcomes. The data were analyzed using Venn diagrams and statistically interpreted with Pearson correlation analysis and one-tailed ANOVA. The results revealed that across all three educational levels, females experience higher stress levels than males during exam periods. Additionally, females facing similar stress levels were found to be more susceptible to health issues than their male counterparts. Increased stress levels were correlated with higher incidences of weakness and digestive problems. These findings are consistent with previous research indicating that females are significantly more affected by stress than males and that stress is associated with adverse health outcomes. Our study underscores the need for further investigation into stress and immune response dynamics. Future research could explore blood biomarkers to understand these relationships better.
... Symptoms of depression, poor sleep quality, and systemic inflammation markers (like IL-6) are often associated with this (96). Researchers have found that an increase in wake time during the first non-rapid eye movement (NREM) sleep cycle is negatively correlated with the count of natural killer (NK) cells (97). Compared to patients with sleep disorders, those with good sleep have significantly higher levels of CD3+, CD4+, and CD8+ cells in the body (98). ...
Article
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Sleep disorders often accompany neurological injuries, significantly impacting patient recovery and quality of life.The efficacy and adherence of traditional treatment methods have certain limitations. Exercise has been found to be a highly beneficial treatment method, capable of preventing and alleviating neurological injuries and sleep disorders. This article reviews relevant research findings from both domestic and international sources over the past few decades, systematically summarizing and analyzing the application of exercise therapy in sleep disorders,strategy of exercise intervention program and the potential molecular mechanisms by which exercise therapy improves sleep disorders. Shortcomings in current research and suggestions are presented, providing a reference for future in-depth studies on exercise interventions for sleep disorders.
... fewer NK cells) and adverse health outcomes (e.g. diabetes) [63][64][65] . Furthermore, a prospective study found that stress reactivity to short sleep predicts increases in chronic health conditions 8 years later [66] . ...
Article
Study objectives: To naturalistically measure sleep disturbances following stress exposure (i.e., sleep reactivity) and stress responses following sleep disturbances (i.e., stress reactivity) at the daily level and prospectively examine these reactivity measures as individual risk factors for insomnia. Methods: The study assessed 392 nurses' sleep and stress for 14 days using daily diaries and actigraphy. Self-reported insomnia symptoms were assessed at the end of the 14 days, as well as 6 and 11 months later. Results: In multilevel modeling, while negative fixed effects indicated that shorter total sleep time (TST) and lower sleep efficiency led to greater stress and vice versa, significant random effects indicated individual variability in sleep reactivity and stress reactivity. In latent score change modeling, greater sleep reactivity (lower diary-determined sleep efficiency following greater stress) and greater stress reactivity (greater stress following shorter diary-determined TST) at baseline were associated with greater insomnia symptoms at 11 months (b = 10.34, p = .026; b = 7.83, p = .03). Sleep reactivity and stress reactivity also interacted to predict insomnia symptoms, such that sleep reactivity was significantly associated with insomnia symptoms for those with high (+1SD) stress reactivity (b = 17.23, p = .001), but not for those with low (-1SD) stress reactivity (b = 5.16, p = .315). Conclusions: Baseline stress reactivity and sleep reactivity independently as well as jointly predict greater insomnia symptoms 11 months later. The findings delineate processes underlying the stress-diathesis model of insomnia and highlight the utility of longitudinal and naturalistic measures of sleep and stress reactivity.
... Because of the no-visitor and social distancing policies, residents have not been able to spend time with their families and friends in the same facilities (Barnett & Grabowski, 2020), which put them at the high risk of loneliness (Simard & Volicer, 2020). Such feeling of loneliness may further lead to many deleterious consequences, such as high blood pressure, depression, suicidal thoughts, and anxiety (Gerst-Emerson & Jayawardhana, 2015;Simard & Volicer, 2020), which are all detrimental to the functioning of the immune system (Hall et al., 1998;Reiche, Nunes, & Morimoto, 2004). Therefore, preventing loneliness is at least as important as providing them sufficient help for personal hygiene. ...
Article
In this commentary, we overview the existing research on psychological consequences caused by COVID-19 for both residents and staff in the nursing homes. We identify loneliness and emotional anxiety as main psychological consequences for nursing home residents, whereas uncertainty, hopelessness, work overload, and role conflicts are the most salient psychological challenges for the staff in the nursing homes during the pandemic. We then summarize the existing strategies and interventions responsive to the above challenges. We suggest that this overview may help nursing home managers understand what are the key psychological challenges and how to deal with them during a crisis period. Finally, we also encourage future research to pay more attention to exploring interventions specifically designed for vulnerable older people, understanding the role of the nursing home leader team in managing emotional and ethical challenges in organizations, and developing community-wide collaboration with multiple external stakeholders.
... Sleep quality is usually defined as how well a person is sleeping and is assessed by the frequency and severity of sleep onset issues, sleep duration, sleep disturbances, the use of sleeping medications, and daytime drowsiness [18][19][20][21][22][23]. Sleep quality is complicated to measure, but one of the most common scales used to measure sleep quality is the Pittsburgh Sleep Quality Index (PSQI). ...
Article
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Background: Sleep is critical to a person’s overall physical and mental health. The current study investigated the relationship between mindfulness and sleep quality, to determine if this relationship is influenced by emotion regulation and perceived stress. Method: Three hundred sixty-seven undergraduate students responded to five self-report measures, (1) The Cognitive and Affective Mindfulness Scale (CAMS-R), (2) The Impact of Event Scale (IES-R), (3) The Five Facet Mindfulness Questionnaire (FFMQ), (4) The Emotion Regulation Questionnaire (ERQ), and (5) The Pittsburgh Sleep Quality Index (PSQI). Results: Results revealed (1) sleep quality was predicted by the presence of hyperarousal, acting with awareness, and the CAMS-R, (2) the Impact of Event Scale was moderately positively correlated with a person’s global score on the Pittsburgh Sleep Quality Index, and (3) the relationship between mindfulness and sleep quality was mediated by hyperarousal. Conclusions: Together, our findings suggest that higher levels of intrusive thoughts, avoidance, and hyperarousal are correlated with lower overall sleep quality, and the use of mindfulness techniques such as acting with awareness and being non-reacting to negative thoughts or hyperarousal may help predict an individual’s sleep quality.
... Studies using a control/reference group and/or longitudinal design (category 1-3) provided most of our information on bereavement-related sleep problems and sleep disorders, 2 Twelve of the studies in the 4th category are not discussed in further detail in the next section, since they do not directly address any of our specific research questions. They have been retained in Table 1, since they explicitly highlight sleep problems in bereavement (meeting the review's inclusion criteria); these results (i.e., on dream recall [30,41], the relationships between sleep and chronic pain [14], depression [67,88]; PTSD [35]; quality of life [25]; immune system/physiological markers [44,83]; medication use for sleep problems [38], and sleep disruptions before/after/on anniversary of bereavement [54,94]) merit further investigation. ...
Article
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Severe, persistent and disabling grief occurs among a sizable minority experiencing bereavement, with diagnostic manuals newly including complicated grief (CG) disorders. Sleep disturbances/disorders have been established as worsening affective and stress-related conditions. However, the role of sleep difficulties in bereavement and CG has not received similar scientific attention. We therefore conducted a systematic review with narrative syntheses on this topic to clarify the role of sleep in bereavement (PROSPERO: CRD42018093145). We searched PubMed, Web of Science and PsychInfo for peer-reviewed English-language articles including (at least one) bereaved sample and sleep disturbance measure. We identified 85 articles on 12.294 participants. We answered seven pre-defined research questions demonstrating: high prevalence of sleep disturbances in bereavement; positive associations of grief intensity with sleep difficulties; preliminary indications of risk factors of post-loss sleep disturbance; higher prevalence of sleep disturbances in CG, enhanced by psychiatric comorbidity (i.e., depression); and initial evidence of causal relationships between (complicated) grief and sleep. Grief therapy partly improves sleep difficulties, yet no intervention studies have specifically targeted sleep problems in bereaved persons. Causal relationships between sleep and grief require further examination in intensive longitudinal investigations, including randomized trials, thereby clarifying whether treating sleep problems enhances CG treatment effects.
... Poor sleep is also a recognized physiological and psychological stressor, and like stress, can dysregulate normal immune processes, subsequently increasing the risk for adverse health outcomes, such as cardiovascular disease and depression [13,14]. Comparable to stress, poor sleep can manifest differently among people [15,16] leading to varying associations with health. For example, some individuals selfreport difficulty in initiating sleep, whereas others will selfreport poor sleep quality [17][18][19]. ...
Article
Background It is unclear whether subjective or objective measures of sleep during pregnancy are more pertinent to pregnancy outcomes. Moreover, it is unclear as to whether subjective indices (i.e., those likely influenced by psychological thoughts and emotions) are more likely than objective measures to modify inflammatory cytokines.Method Subjective and objective measures of sleep were collected from 166 pregnant women. Sleep data, both aggregate and variability measures, from diary and actigraphy, were ascertained for three 2-week periods during early gestation (10–20 weeks). A fasting morning blood sample was assayed for the cytokines (IL-6, IFN-γ, and TNF-α). Sleep, stress, and depression questionnaires were also collected. Repeated measures ANOVAs, regression models, and independent t tests were used to analyze the data.ResultsDiary-assessed total sleep time (p < .05) and actigraphy-assessed sleep latency (p = .05) were negatively associated with gestational age. Variability in actigraphy-assessed sleep latency (p < .01) was negatively associated with infant weight. None of the cytokines was associated with any of the outcomes. t tests revealed that those with a complication were older (p < .05) and had higher pre-pregnancy BMI (p < .05), higher self-reported stress (p < .05), and lower IFN-γ (p < .05).Conclusion Findings suggest that longer and more variable sleep latency, as well as shorter sleep duration, is associated with shorter gestational age or a lower birth weight infant. Overall, the findings suggest that among a low-risk, healthy sample of pregnant women, sleep disturbance does not pose a substantial risk for adverse delivery outcomes.
... Nonetheless, little is known concerning the influences of the longitudinal effects of sleep disruptions among trauma survivors. The limited findings have shown sleep disruptions to be associated with immune functions, such as natural killer cell (NKC) function (Hall et al., 1998) as well as physical complaints, such as headaches, upset stomach, and back pain (Clum, Nishith, & Resick, 2001), independent of other symptoms of PTSD. Therefore, the main goal of our study was to explore the longitudinal influences of sleep disruptions on premature aging among trauma survivors. ...
Article
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Objectives: Sleep is necessary for brain function as well as physical and cognitive processes. Sleep disruptions, common with aging, intensify among trauma survivors. Moreover, former prisoners-of-war (ex-POWs) often experience premature aging. This study investigates the longitudinal effects of sleep disruptions for ex-POWs in relation to cognitive performance and telomere length as well as between cognition and telomeres. Method: This study included Israeli veterans from the 1973 Yom Kippur War who participated in four assessments (1991, 2003, 2008, 2015): (1) ex-POWs (n=99), and (2) veterans who not were captured (controls) (n=101). Among both groups, sleep disruptions were assessed using a self-report item in all four assessments. Cognitive performance was assessed using the Montreal Cognitive Assessment (MOCA) and telomere length was assessed via total white blood cells (leukocytes) from whole blood samples using Southern blot, both were measured only among ex-POWs in 2015. We conducted descriptive statistics, repeated measures, correlations, and path analyses. Results: Sleep disruptions were related to lower cognitive performance but not to shorter telomeres. Moreover, cognitive performance and telomere length were found to be related when sleep disruptions were taken into consideration. Conclusion: Interpersonal trauma was shown to be a unique experience resulting in sleep disruptions over time, leading to cognitive impairment. These findings highlight the importance of viewing trauma survivors at high-risk for sleep disruptions. Therefore, it is imperative to inquire about sleep and diagnose cognitive disorders to help identify and treat premature aging.
... The link between sleep disturbances and immune measures has been also investigated in depression (124,227,393,532), schizophrenia (176), alcohol dependence (462), hemodialysis (107,458), organ transplantation (193), pregnancy (55,409), cervical cancer risk (491), and diabetes (548), with most studies reporting a significant association between some aspects of sleep disturbances and immune measures. ...
Article
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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.
... (29,30) Future studies could also benefit from a greater emphasis on behavior as a potential mechanism. This strategy has proven useful in studies of clinically depressed patients, in which decreased physical activity and psychomotor retardation (33), increased body mass (32), disturbed sleep (33), have been shown to explain some of the immune dysregulation evident in this population. There is already preliminary evidence, for instance, that sleep loss might be responsible for some of the immune system changes that accompany stressors ( 34) Stress, the Immune System, and Disease The most pressing question that future research needs to address is the extent to which stressor induced changes in the immune system have meaningful implications for disease susceptibility in otherwise healthy humans. ...
Article
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Cardiovascular and immune system pathophysiological changes and diseases may be attributed to stress. Sometimes stress may be beneficial when it is not 'overwhelming' as it ,may improve performance in certain cases. Modern medicine is focusing on the close relationship between stress and cardiovascular and immune system morbidity and mortality. New therapeutic strategies have to be set in place.Brief naturalistic stressors (such as exams) were associated with potentially adaptive upregulation of some parameters of natural immunity and downregulation of some functions of specific immunity; tended to suppress cellular immunity while preserved humoral immunity On the other hand chronic stressors were associated with suppression of both cellular and humoral immunity. In some cases, physical vulnerability as a function of age or disease also increased vulnerability to immune change during stressors.In mammals, physiological responses such as "fight or flight." to chronic stressors , include changes that increase the delivery of oxygen and glucose to the heart and the large skeletal muscles. The changes in Immune responses to stressful situations may be part of these adaptive responses..Pychological challenges are capable of modifying various features of the immune response.
... Although such dysfunctions have been thought of primarily as immunosuppressive, recent data have suggested immunoregulatory dysfunctions may play a more central role in stress-induced immune alterations [14]. Sleep alterations are suggested to modulate the stress-health relationship [15,16]. Poor sleep, in turn, is associated with subsequent decrements in mental health including symptom reporting, incident cases of mood and anxiety disorders, and immune function [17][18][19][20]. ...
... The perpetuating factors relate to the maintenance of sleep disturbance over time, such as maladjusted sleep behaviors, erroneous beliefs, and attitudes about sleep. 23 Individuals with sleep disturbance may be at risk of depression, 15,24 anxiety, 21 immune deficiency, 25 cardiovascular disease, 26 and a poor quality of life. 27 Although several studies have investigated the sleep quality of FCs 10,18 and the risk factors for sleep disturbance, 11,15 few studies have followed up FCs until the patients' death to explore the changes in sleep quality throughout the patients' dying process, and no study has comprehensively included the predisposing, precipitating, and perpetuating factors in investigating factors affecting the sleep quality of FCs. ...
Article
Background: Sleep disturbance commonly has a negative impact on the well-being of family caregivers (FCs) of terminally ill patients with cancer. The effect of sleep disturbance on FCs has not been explored through long-term follow-up studies in Taiwan. Objective: The purposes of this study were to (1) identify the trajectory of sleep quality of FCs of terminally ill patients with cancer in Taiwan and (2) examine the determinants of sleep disturbance through a longitudinal follow-up until patient death. Methods: A prospective, longitudinal study was conducted among 95 FCs of terminally ill patients with cancer. The FCs' sleep quality was measured subjectively by using the Pittsburgh Sleep Quality Index and objectively by wearing a wrist actigraphy for 48 hours each month during the 6-month follow-up assessments. The trajectory and determinants of sleep quality were identified using a generalized estimation equation approach. Results: The FCs' sleep quality significantly decreased as the patient's death approached. Family caregivers who were women or older, had a relative with a longer survival period after diagnosis, reported higher levels of depression and fatigue, and provided lower levels of assistance to their relatives experienced more sleep disturbance. Conclusion: The sleep quality of Taiwanese FCs significantly deteriorated as the death of the terminally ill patients with cancer approached. Early detection of the FCs' sleep disturbance, increasing their self-awareness of sleep problems, and providing nonpharmacological interventions and psychosocial support may be helpful for FCs to improve their quantity and quality of sleep.
... Im Einklang damit bestätigten Brand et al. (2010) in einer Studie mit Universitätsstudierenden, dass die Effekte einer hohen Stresswahrnehmung auf die Schlafqualität indirekt über vermehrte depressive Symptome undin besonders hohem Masse über dysfunktionale schlafbezogene Kognitionen vermittelt wurden. Ferner ist unzureichender Schlaf mit einer herabgesetzten Immunfunktion assoziiert, was unter Stress die Anfälligkeit für Krankheiten weiter erhöht (Hall et al. 1998;Irwin 2002). ...
Chapter
Das Leben ist ein ständiger Anpassungsprozess. Misslingt diese Anpassung, entsteht Unzufriedenheit. Ebenso steigt das Risiko für zahlreiche chronisch-degenerative Erkrankungen. Das vorliegende Kapitel hat zum Ziel, einen repräsentativen Überblick über den Stand der Forschung zum Thema Stress und gesundheitliche Beeinträchtigungen zu liefern. Ausgehend von der Frage, ob ein Zusammenhang zwischen der Stressbelastung und dem Mortalitätsrisiko besteht, werden nacheinander verschiedene Krankheiten und Beschwerden (kardiovaskuläre Erkrankungen, metabolisches Syndrom, Übergewicht/Adipositas, Krebs, Infektionserkrankungen, HIV/AIDS, chronisch-entzündliche Darmerkrankungen, Asthma bronchiale, kognitive Leistungsfähigkeit, Migräne/Kopfschmerzen, Sexualfunktion, psychische Störungen) in den Blick genommen. Damit soll Forschenden die Vielfalt der Zugänge aufgezeigt werden, aus denen heraus man sich dem Thema Stress und Gesundheitsbeeinträchtigungen annähern kann.
... Im Einklang damit bestätigten Brand et al. (2010) in einer Studie mit Universitätsstudierenden, dass die Effekte einer hohen Stresswahrnehmung auf die Schlafqualität indirekt über vermehrte depressive Symptome undin besonders hohem Masse über dysfunktionale schlafbezogene Kognitionen vermittelt wurden. Ferner ist unzureichender Schlaf mit einer herabgesetzten Immunfunktion assoziiert, was unter Stress die Anfälligkeit für Krankheiten weiter erhöht (Hall et al. 1998;Irwin 2002). ...
Chapter
Das Leben ist ein ständiger Anpassungsprozess. Misslingt diese Anpassung, entsteht Unzufriedenheit. Ebenso steigt das Risiko für zahlreiche chronisch-degenerative Erkrankungen. Das vorliegende Kapitel hat zum Ziel, einen repräsentativen Überblick über den Stand der Forschung zum Thema Stress und gesundheitliche Beeinträchtigungen zu liefern. Ausgehend von der Frage, ob ein Zusammenhang zwischen der Stressbelastung und dem Mortalitätsrisiko besteht, werden nacheinander verschiedene Krankheiten und Beschwerden (kardiovaskuläre Erkrankungen, metabolisches Syndrom, Übergewicht/Adipositas, Krebs, Infektionserkrankungen, HIV/AIDS, chronisch-entzündliche Darmerkrankungen, Asthma bronchiale, kognitive Leistungsfähigkeit, Migräne/Kopfschmerzen, Sexualfunktion, psychische Störungen) in den Blick genommen. Damit soll Forschenden die Vielfalt der Zugänge aufgezeigt werden, aus denen heraus man sich dem Thema Stress und Gesundheitsbeeinträchtigungen annähern kann.
... A majority of people spend half of their waking hours at work (Bureau of Labor Statistics, 2016); those who are dissatisfied for half of their waking hours experience increased anxiety and depression. Although we only find a modest effect of lowest job satisfaction trajectory membership on physical health, these mental health manifestations may likely serve as a precursor to future physical health problems whereby eventually increased anxiety and depression lead to cardiovascular or other physical health problems (Cuijpers and Smit, 2002;Hall et al., 1998;Lane et al., 2000). Therefore, job satisfaction's influence on physical health most likely operates through its deleterious effect on mental health and may manifest in old age rather than age 40s examined in this study. ...
... Taking longer to fall asleep and sleeping less efficiently may also reflect cognitive and affective factors that render adolescents more susceptible to the effects of family demands. Cognitive and affective factors, including intrusive thoughts, negative affect, worry, and perception of threat, lead to a state of prolonged arousal or vigilance, delaying sleep onset (Dahl and Lewin, 2002;Hall et al., 1998;Kalmbach et al., 2014;Tang and Harvey, 2004;Wicklow and Espie, 2000;Wuyts et al., 2012;Zoccola et al., 2009) and decreasing sleep efficiency (Åkerstedt et al., 2007;Soderstrom et al., 2004). Taking longer to fall asleep and sleeping less efficiency, then, may indicate a decreased ability to regulate physiological, cognitive, and/or affective arousal (Dahl, 1996;Silk et al., 2007), which in turn, can disrupt physiological systems, including the HPA axis (Buchanan et al., 1999;Juster et al., 2012;Zoccola and Dickerson, 2012). ...
Article
The present study examined the moderating role of sleep in the association between family demands and conflict and hypothalamic-pituitary-adrenal (HPA) axis functioning in a sample of ethnically diverse adolescents (n = 316). Adolescents completed daily diary reports of family demands and conflict for 15 days, and wore actigraph watches during the first 8 nights to assess sleep. Participants also provided five saliva samples for 3 consecutive days to assess diurnal cortisol rhythms. Regression analyses indicated that sleep latency and efficiency moderated the link between family demands and the cortisol awakening response. Specifically, family demands were related to a smaller cortisol awakening response only among adolescents with longer sleep latency and lower sleep efficiency. These results suggest that certain aspects of HPA axis functioning may be sensitive to family demands primarily in the context of longer sleep latency and lower sleep efficiency.
Article
Objective An emerging literature suggests that sleep may play an important role in moderating the association between discrimination and mental health problems among adolescents. However, few if any studies have considered this topic among adults. Addressing this knowledge gap, the current study examined multiple sleep parameters as moderating variables in the association between discrimination and mental health problems among adults. Methods Participants were 874 adults residing in small towns and semi-rural contexts within the Southeastern region of the United States ( M age = 41 years, SD = 7; 57% female; 31% Black, 69% White; 52% income-to-needs <2). Sleep duration and night-to-night variability in duration were assessed using wrist actigraphy. Established self-report measures were used to assess global sleep problems, experiences of discrimination, and mental health problems (anxiety, depression, and externalizing symptoms). Results Experiences of discrimination were associated with more depression, anxiety, and externalizing problems. Two out of three sleep parameters were found to moderate the effects of discrimination on mental health. The association between discrimination and externalizing problems (but not anxiety or depression) was attenuated among those with less night-to-night variability in sleep duration. The associations between discrimination and anxiety and externalizing problems (but not depression) were attenuated among those with fewer global sleep problems. Less variability in sleep duration and fewer global sleep problems were also directly associated with lower levels of depression, anxiety, and externalizing problems. Conclusions Greater consistency in sleep duration from night-to-night, and fewer overall sleep problems appear to mitigate risk of mental health problems among adults, particularly in contexts where discrimination is prevalent.
Chapter
The topic of stress regulation and sports can be viewed from two differing perspectives. From the point of view of sports as a health-promoting activity, the focus is on sports as a means to stress regulation. The central question is the degree to which sports, exercise, and physical activity can help us to cope with daily challenges, so that the negative health effects of these stressors can be avoided or reduced. From the point of view of performance sports, on the other hand, the central focus is stress regulation during sporting activity. In other words, how can athletes cope with high levels of training and psychological pressure, without suffering a drop in physical performance or psychological complaints? From this perspective, important factors are those which allow high-performance and elite athletes to perform at the highest level under pressure. The first section of this chapter presents the theoretical foundations of stress regulation and sports; in the second section, the two perspectives presented here will be discussed in detail.
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The purpose of this 2006 book is to present non-invasive methods of measuring the biological responses to psychosocial stress in humans, in non-laboratory (field) settings. Following the pathways of Seyle's General Adaptation Syndrome, the text first describes how to assess the psychosocial stressors of everyday life and then outlines how to measure the psychological, behavioral, neurohumeral, physiological and immunological responses to them. The book concludes with practical information on assessing special populations, analyzing the often-complicated data that are collected in field stress studies and the ethical treatment of human subjects in stress studies. It is intended to be a practical guide for developing and conducting psychophysiological stress research in human biology. This book will assist students and professionals in designing field studies of stress.
Chapter
The purpose of this 2006 book is to present non-invasive methods of measuring the biological responses to psychosocial stress in humans, in non-laboratory (field) settings. Following the pathways of Seyle's General Adaptation Syndrome, the text first describes how to assess the psychosocial stressors of everyday life and then outlines how to measure the psychological, behavioral, neurohumeral, physiological and immunological responses to them. The book concludes with practical information on assessing special populations, analyzing the often-complicated data that are collected in field stress studies and the ethical treatment of human subjects in stress studies. It is intended to be a practical guide for developing and conducting psychophysiological stress research in human biology. This book will assist students and professionals in designing field studies of stress.
Chapter
The purpose of this 2006 book is to present non-invasive methods of measuring the biological responses to psychosocial stress in humans, in non-laboratory (field) settings. Following the pathways of Seyle's General Adaptation Syndrome, the text first describes how to assess the psychosocial stressors of everyday life and then outlines how to measure the psychological, behavioral, neurohumeral, physiological and immunological responses to them. The book concludes with practical information on assessing special populations, analyzing the often-complicated data that are collected in field stress studies and the ethical treatment of human subjects in stress studies. It is intended to be a practical guide for developing and conducting psychophysiological stress research in human biology. This book will assist students and professionals in designing field studies of stress.
Chapter
The purpose of this 2006 book is to present non-invasive methods of measuring the biological responses to psychosocial stress in humans, in non-laboratory (field) settings. Following the pathways of Seyle's General Adaptation Syndrome, the text first describes how to assess the psychosocial stressors of everyday life and then outlines how to measure the psychological, behavioral, neurohumeral, physiological and immunological responses to them. The book concludes with practical information on assessing special populations, analyzing the often-complicated data that are collected in field stress studies and the ethical treatment of human subjects in stress studies. It is intended to be a practical guide for developing and conducting psychophysiological stress research in human biology. This book will assist students and professionals in designing field studies of stress.
Chapter
The purpose of this 2006 book is to present non-invasive methods of measuring the biological responses to psychosocial stress in humans, in non-laboratory (field) settings. Following the pathways of Seyle's General Adaptation Syndrome, the text first describes how to assess the psychosocial stressors of everyday life and then outlines how to measure the psychological, behavioral, neurohumeral, physiological and immunological responses to them. The book concludes with practical information on assessing special populations, analyzing the often-complicated data that are collected in field stress studies and the ethical treatment of human subjects in stress studies. It is intended to be a practical guide for developing and conducting psychophysiological stress research in human biology. This book will assist students and professionals in designing field studies of stress.
Chapter
The purpose of this 2006 book is to present non-invasive methods of measuring the biological responses to psychosocial stress in humans, in non-laboratory (field) settings. Following the pathways of Seyle's General Adaptation Syndrome, the text first describes how to assess the psychosocial stressors of everyday life and then outlines how to measure the psychological, behavioral, neurohumeral, physiological and immunological responses to them. The book concludes with practical information on assessing special populations, analyzing the often-complicated data that are collected in field stress studies and the ethical treatment of human subjects in stress studies. It is intended to be a practical guide for developing and conducting psychophysiological stress research in human biology. This book will assist students and professionals in designing field studies of stress.
Chapter
The purpose of this 2006 book is to present non-invasive methods of measuring the biological responses to psychosocial stress in humans, in non-laboratory (field) settings. Following the pathways of Seyle's General Adaptation Syndrome, the text first describes how to assess the psychosocial stressors of everyday life and then outlines how to measure the psychological, behavioral, neurohumeral, physiological and immunological responses to them. The book concludes with practical information on assessing special populations, analyzing the often-complicated data that are collected in field stress studies and the ethical treatment of human subjects in stress studies. It is intended to be a practical guide for developing and conducting psychophysiological stress research in human biology. This book will assist students and professionals in designing field studies of stress.
Chapter
The purpose of this 2006 book is to present non-invasive methods of measuring the biological responses to psychosocial stress in humans, in non-laboratory (field) settings. Following the pathways of Seyle's General Adaptation Syndrome, the text first describes how to assess the psychosocial stressors of everyday life and then outlines how to measure the psychological, behavioral, neurohumeral, physiological and immunological responses to them. The book concludes with practical information on assessing special populations, analyzing the often-complicated data that are collected in field stress studies and the ethical treatment of human subjects in stress studies. It is intended to be a practical guide for developing and conducting psychophysiological stress research in human biology. This book will assist students and professionals in designing field studies of stress.
Chapter
The purpose of this 2006 book is to present non-invasive methods of measuring the biological responses to psychosocial stress in humans, in non-laboratory (field) settings. Following the pathways of Seyle's General Adaptation Syndrome, the text first describes how to assess the psychosocial stressors of everyday life and then outlines how to measure the psychological, behavioral, neurohumeral, physiological and immunological responses to them. The book concludes with practical information on assessing special populations, analyzing the often-complicated data that are collected in field stress studies and the ethical treatment of human subjects in stress studies. It is intended to be a practical guide for developing and conducting psychophysiological stress research in human biology. This book will assist students and professionals in designing field studies of stress.
Chapter
The purpose of this 2006 book is to present non-invasive methods of measuring the biological responses to psychosocial stress in humans, in non-laboratory (field) settings. Following the pathways of Seyle's General Adaptation Syndrome, the text first describes how to assess the psychosocial stressors of everyday life and then outlines how to measure the psychological, behavioral, neurohumeral, physiological and immunological responses to them. The book concludes with practical information on assessing special populations, analyzing the often-complicated data that are collected in field stress studies and the ethical treatment of human subjects in stress studies. It is intended to be a practical guide for developing and conducting psychophysiological stress research in human biology. This book will assist students and professionals in designing field studies of stress.
Chapter
The purpose of this 2006 book is to present non-invasive methods of measuring the biological responses to psychosocial stress in humans, in non-laboratory (field) settings. Following the pathways of Seyle's General Adaptation Syndrome, the text first describes how to assess the psychosocial stressors of everyday life and then outlines how to measure the psychological, behavioral, neurohumeral, physiological and immunological responses to them. The book concludes with practical information on assessing special populations, analyzing the often-complicated data that are collected in field stress studies and the ethical treatment of human subjects in stress studies. It is intended to be a practical guide for developing and conducting psychophysiological stress research in human biology. This book will assist students and professionals in designing field studies of stress.
Chapter
For the physical therapist interested in treating insomnia, this chapter presents some ways to improve sleep quality, insomnia severity and some related symptoms such as depression and anxiety. Cognitive behavioral therapy for insomnia has been considered the first-line treatment and physical exercise is one of the most promising alternative treatment, along with mindfulness. There are also other resources showing positive results on insomnia (acupuncture, massage and light therapy) with good evidence of trials but still lack a consensus and guidelines directing its use.
Article
Objectives This study provides the first investigation into the correspondence between self-reported and actigraph-measured nighttime sleep duration in adolescents that disambiguates between- vs. within-person associations. Moderators were evaluated to determine if between- and within-person correspondence vary by participant characteristics. Methods One hundred fifty adolescents (14–21 years) reported sleep time for 1 week, while wearing an actigraph, and reported on moderators, including demographics (i.e., sex, age, ethnicity, and socioeconomic status), depressive symptoms, and perceived stress. Mixed effects models evaluated within- and between-person associations between self-reported and actigraph-measured sleep, and examined whether these associations differed by possible moderators. Results Results indicated significant between- (b = 0.77, SE = 0.08, P < .001) and within-person (b = 0.51, SE = 0.04, P < .001) associations between self-reported and actigraph-measured sleep duration, with no significant moderation effects. Conclusions Our results support the use of either self-reports or actigraphs to examine within-person nighttime sleep duration in adolescent community samples.
Article
Use of implantable cardioverter defibrillators has become standard therapy for patients at high risk for life-threatening ventricular arrhythmias. Although acceptance of the device is generally high among patients and their families, quality of life and psychosocial issues associated with use of the defibrillators deserve greater attention to improve outcomes. Psychosocial issues, their ramifications, and theory-and evidence-based approaches to improving outcomes are described.
Chapter
Das Thema Stressregulation und Sport kann aus zwei unterschiedlichen Perspektiven betrachtet werden. Aus Sicht des Gesundheitssports geht es primär um Stressregulation durch Sport. Es stellt sich die Frage, inwieweit sich durch körperliche und sportliche Aktivität die Belastungen des Alltags besser bewältigen lassen, so dass Gesundheitsbeeinträchtigungen vermieden oder reduziert werden können. Aus Sicht des Leistungssports geht es um Stressregulation im Sport. Mit anderen Worten: Wie können Athleten und Athletinnen mit hohen Trainingsbelastungen und psychischem Druck umgehen, ohne dass dabei die Leistungsfähigkeit beeinträchtigt wird oder psychische Beschwerden entstehen? Hier geht es also um Faktoren, die dazu beitragen, dass Personen im Leistungs- und Spitzensport auch unter Druck ihre besten Leistungen abrufen können. Nachdem im ersten Teil dieses Kapitels die theoretischen Grundlagen erarbeitet werden, wird im zweiten Teil auf diese beiden Perspektiven eingegangen.
Article
Objectives: Caregivers’ perceived stress and reactions to patients’ memory and behavior problems have been commonly regarded as outcomes in caregiving research; however, these variables may also serve as predictors of caregivers’ depressive symptoms. The current study investigated the relationship between perceived stress and reactions to patients’ problems and depression among the family caregivers of persons with Alzheimer’s disease. Additionally, we examined caregiving self-efficacy and sleep quality as possible mediators in the relationship between perceived stress and reactions to patients’ memory and problem behaviors and depression. Methods: This study is a cross-sectional study. The study sample consisted of 72 family members caring for a loved one with Alzheimer’s disease who completed a set of questionnaires that included the Perceived Stress Scale, the Chinese Pittsburg Sleep Quality Index, the Revised Scale for Caregiving Self-efficacy, and the Revised Memory and Behavior Checklist (RMBPC). Results: The results indicated that both higher perceived stress and RMBPC reaction scores were directly and indirectly associated with higher depressive symptoms. A specific domain of caregivers’ self-efficacy and sleep quality mediated the indirect path. Conclusion: These findings suggest that caregiving self-efficacy and sleep quality may function as mechanisms through which perceived stress and reactions influence depressive symptoms and that this mechanism may be domain specific.
Book
During the last few decades, sleep medicine and science, and many of their diverse aspects, have emerged as areas of intense medical and scientific interest. Of these, sleep and neuroimmunology, which cut across many behavioral states, are highly interlinked, inherently fascinating and touching upon many facets of human health and well-being. Elucidating the roles of immune substances and cells in central nervous system functions, especially their involvement in the regulation of sleep and wakefulness, may help unravel pathophysiologic mechanisms of sleep disorders and improve their management. Neuroimmunology of Sleep provides an introduction to the interphase between sleep and neuroimmunology. Written both from basic and clinical perspectives, the volume contains useful information to many biomedical professionals and students of human biology. This informative and forward-looking volume will be valuable to sleep researchers, neuroimmunologists, psychiatrists, psychologists, neurologists, and all physicians or health-care professionals who evaluate and treat patients with sleep problems. In addition, this volume will be helpful to medical students and clinicians of various disciplines who want to get an overall grasp of the neuroimmunology of sleep field. S.R. Pandi-perumal, MSc., Comprehensive Center for Sleep Medicine, Department of Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai School of Medicine, New York, NY 10029, U.S.A. D.P. Cardinali, MD., PhD., Department of Physiology, Faculty of Medicine, University of Buenos Aires, Paraguay 2155, 1121, Buenos Aires, Argentina. G.P. Chrousos, MD, FAAP, MACP, MACE, First Department of Pediatrics, Athens University Medical School, Aghia Sophia Children's Hospital, 115 27 Athens, Greece and Reproductive Biology and Medicine Branch, National Institute of Child and Human Development (NICHD), Bethesda, MD, USA. © 2007 Springer Science+Business Media, LLC. All rights reserved.
Article
Introduction Depression has a huge impact on individuals and society, with a lifetime prevalence of over 15%. By 2020, depression will be the second leading illness in the world, as projected by the World Health Organization (WHO). In addition to the emotional consequences of depression, the disorder is increasingly implicated in a wide range of medical conditions. Moreover, a growing body of evidence indicates that depression, including even minor depression, has notable immunological consequences. It is important therefore to consider possible immune mechanisms in the detrimental effects of depression on health, particularly in vulnerable individuals such as elderly people and patients with chronic disease. This chapter provides a review of the research being conducted on the relationship between depression and immunity, beginning with an overview of the clinical importance of depressive disorders for mortality risk. The various immune alterations that occur during depression are examined, with discussion of the role of autonomic, neuroendocrine and behavioural (e.g., sleep) mechanisms. The chapter concludes with consideration of the clinical implications of immune changes in depression for several medical disorders. Clinical characteristics of depression Definition of depression Depression can be defined as a condition that primarily entails a disturbance of mood; this affective disturbance is often characterised by a mood that is sad, hopeless, discouraged or simply depressed [1].
Article
This chapter reviews literature pertaining to clinical sleep disorders and nonclinical aspects of sleep patterns among children and adolescents in relation to socioeconomic status (SES) and race/ethnicity. Sleep duration, quality, and/or scheduling are compared in individuals of various SES and ethnic/racial backgrounds. First, initial epidemiologic studies assessing sleep parameters among members of these groups are reviewed. Following this initial summary, more recent studies are summarized, and these investigations are separated into those conducted with participants in three age groups: young children (ages two through eight years), preadolescents (ages eight to thirteen years), and adolescents. Then, the literature comparing individuals of various SES levels and racial/ethnic backgrounds on symptoms and diagnoses of sleep disordered breathing (SDB) are considered. SDB is discussed because of the significant daytime consequences associated with this illness and because of recent studies showing disparities in SDB associated with SES and race/ethnicity. Finally, conclusions, limitations, and future directions will be highlighted.
Article
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In recent psychology literature very few plausible conceptions of the relations between personality and health outcomes have been proposed. It goes about four dominant theory models trying to explain the processes and mechanisms lying in the core of that complex relation. The models are based on the assumptions about the existence of physiological mechanisms (stress) in the background of relations between personality and health outcomes; about the existence of close links between personality and physical health derived from equivalent constitution predisposition; about the influence of the personality on health in which the risky/useful behaviour occurs as a mediator, respectively the active choice of the milieu or health risky situations; and about the existence of a connection between the personality and the so-called patient's behaviour as one of the health outcomes. Although the researchers obviously agree that there is not only one connection between the personality and an increased risk of falling sick, the multi dimensionality and multi directivity of such relations seems rather to be a rule, whereas the majority of researches in this field still try to check if a certain feature of personality is connected to a certain illness, a part of the illness development process or certain risky factors of that illness. That is to say that the existing draft researches are not set in the way they can detect a multiple connection or causality between tested variables, which results in the absence of an integral picture of the relations between personality and health outcomes. That is why the primary suggestion of this paper would be to direct the researchers to test the proposed models, as well as to try to integrate them into one broader model which needs to be tested. A better understanding of how and why the personality influences the health and the illness, namely who gets sick and why, would make it possible to develop more efficient illness prevention programmes and health promotion.
Chapter
Until recently, behavioral medicine research, including its conceptual models, measures, and clinical applications, has focused almost exclusively on psychological, social, behavioral, and environmental factors that occur or are measured during waking. Yet, humans spend 1/3 to 1/4 of their lives asleep, and there is strong evidence that sleep is essential to health and functioning. The premise of this chapter is that behavioral medicine models that incorporate sleep, whether as a major variable of interest, a confounder, an effect modifier or therapeutic target, offer a more complete understanding of the processes through which psychological, social, behavioral, and environmental factors affect and are affected by health and functioning. The goal of this chapter is to identify the dimensions of sleep that may be most relevant to behavioral medicine, describe how each may be assessed, and briefly summarize relevant evidence linking sleep to health and functioning. The chapter concludes by identifying important future directions related to the role of sleep in behavioral medicine research and its clinical applications.
Article
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The basic purpose of the current study was to explore the occupational health stress reasons, consequences, and job outcomes in the service sector as well as to suggest stress management techniques to overcome stress. This research used a mixed qualitative research methodology, which included a collective case study method as well as a narrative inquiry method. Respondents (both males and females) were selected from two of the most important service sectors -- the banking industry where working hours are long, and the education sector where working hours are comparatively short. A total of eight case studies were taken through focus group discussions in which respondents were requested to write a one-page report about their work experiences, problems faced at their workplace, whether they were facing any stressful challenge and threat, and how their health was affecting them due to stressful situations at the workplace. The data was reported from the words of respondents as it was written on their response forms. From the list of responses, the following themes emerged and were derived in Figure 1: stressors (reasons), consequences (change in physical, psychological, and behavioral response), and outcomes (job outcomes). Stress management techniques were suggested from an organizational and individual point of view.
Article
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It is not known whether psychological stress suppresses host resistance to infection. To investigate this issue, we prospectively studied the relation between psychological stress and the frequency of documented clinical colds among subjects intentionally exposed to respiratory viruses. After completing questionnaires assessing degrees of psychological stress, 394 healthy subjects were given nasal drops containing one of five respiratory viruses (rhinovirus type 2, 9, or 14, respiratory syncytial virus, or coronavirus type 229E), and an additional 26 were given saline nasal drops. The subjects were then quarantined and monitored for the development of evidence of infection and symptoms. Clinical colds were defined as clinical symptoms in the presence of an infection verified by the isolation of virus or by an increase in the virus-specific antibody titer. The rates of both respiratory infection (P less than 0.005) and clinical colds (P less than 0.02) increased in a dose-response manner with increases in the degree of psychological stress. Infection rates ranged from approximately 74 percent to approximately 90 percent, according to levels of psychological stress, and the incidence of clinical colds ranged from approximately 27 percent to 47 percent. These effects were not altered when we controlled for age, sex, education, allergic status, weight, the season, the number of subjects housed together, the infectious status of subjects sharing the same housing, and virus-specific antibody status at base line (before challenge). Moreover, the associations observed were similar for all five challenge viruses. Several potential stress-illness mediators, including smoking, alcohol consumption, exercise, diet, quality of sleep, white-cell counts, and total immunoglobulin levels, did not explain the association between stress and illness. Similarly, controls for personality variables (self-esteem, personal control, and introversion-extraversion) failed to alter our findings. Psychological stress was associated in a dose-response manner with an increased risk of acute infectious respiratory illness, and this risk was attributable to increased rates of infection rather than to an increased frequency of symptoms after infection.
Article
Full-text available
The relationship between chronic stress and symptoms of posttraumatic stress syndrome was examined in people living within 5 miles (8 km) of the Three Mile Island (TMI) nuclear power station. Residents of Frederick, Maryland, a town at least 80 miles (129 km) from TMI, were used as a control population. Chronic stress levels were evaluated using self-report, behavioral, and biochemical measures. Symptoms of posttraumatic stress were also measured. TMI-area residents experienced more symptoms of chronic stress as well as more symptoms of posttraumatic stress than the control group. Residents at TMI were particularly bothered by intrusive thoughts about the damaged reactor. There was a strong relationship between self-report, behavioral, and psychological measures of chronic stress and characteristics central to posttraumatic stress as defined by the third edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1980). Data provided evidence of substantive links between chronic stress and development of mild symptoms of posttraumatic stress disorder.
Article
Full-text available
In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators.
Article
Dynamic changes in sleep in response to infectious challenge are a facet of the acute phase response. Changes in sleep induced by infection seem to be of recuperative value to the host. Furthermore, loss of sleep is associated with changes in immune function. Specific components of microbes such as muramyl peptides or endotoxin from bacteria or double-stranded RNA from virus induce sleep responses. These microbial-induced responses are mediated via enhanced cytokine and hormone production. Interleukin-1, tumor necrosis factor and interferon-αare somnogenic. Interleukin-1-enhanced sleep involves growth hormone-releasing hormone. Microbial-cytokine-altered sleep results from an amplification of physiological sleep mechanisms.
Article
Current evidence indicates that natural killer (NK) cells, which are large granular lymphocytes that mediate non-major histocompatibility complex (MHC)-restricted cytotoxicity and antibody-dependent cytotoxicity and that are involved in multiple regulatory, developmental, and immunologic processes, are important in health. Immunodeficiency states presenting with low NK activity are often associated with malignancies, chronic viral infections, or autoimmune diseases. Monitoring of NK function appears to be indicated as an aid to diagnosis, prognosis, and follow-up after therapy. Reliable performance of NK assays in a clinical laboratory requires that uniform criteria be established and followed for the acceptability of results. Statistical analysis of daily variability can be of great assistance in identifying and tracking sources of error, but routine statistical adjustments are not generally advisable. The quality control program described here provides a degree of assurance that this cytotoxicity assay can be dependable whether performed at one time point or serially. The successful implementation of this program requires laboratory resouces, biostatistical support, and interpretative skills, all of which are available in a modern clinical laboratory.
Article
Clinical, field, and experimental studies of response to potentially stressful life events give concordant findings: there is a general human tendency to undergo episodes of intrusive thinking and periods of avoidance. A scale of current subjective distress, related to a specific event, was based on a list of items composed of commonly reported experiences of intrusion and avoidance. Responses of 66 persons admitted to an outpatient clinic for the treatment of stress response syndromes indicated that the scale had a useful degree of significance and homogeneity. Empirical clusters supported the concept of subscores for intrusions and avoidance responses.
Article
Insomnia is associated with a reduction of natural killer (NK) activity in depression independent of the severity of other depressive symptoms. This study extends these findings by exploring the relationship between objective electroencephalographic (EEG) assessment of sleep and values of NK activity in depressed patients (n = 23) and in control subjects (n = 17). The sleep EEG parameters total sleep time, sleep efficiency, and duration of nonREM sleep were each positively correlated with NK activity in the depressed patients and in the control subjects, demonstrating similar relationships between the amount of sleep and NK activity in the separate groups. These observations support the hypothesis that sleep measures are associated with NK cytotoxicity, independent of the effects of severity of depressive symptoms or the presence of a mood disorder.
Article
Despite the prevalence of sleep complaints among psychiatric patients, few questionnaires have been specifically designed to measure sleep quality in clinical populations. The Pittsburgh Sleep Quality Index (PSQI) is a self-rated questionnaire which assesses sleep quality and disturbances over a 1-month time interval. Nineteen individual items generate seven "component" scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The sum of scores for these seven components yields one global score. Clinical and clinimetric properties of the PSQI were assessed over an 18-month period with "good" sleepers (healthy subjects, n = 52) and "poor" sleepers (depressed patients, n = 54; sleep-disorder patients, n = 62). Acceptable measures of internal homogeneity, consistency (test-retest reliability), and validity were obtained. A global PSQI score greater than 5 yielded a diagnostic sensitivity of 89.6% and specificity of 86.5% (kappa = 0.75, p less than 0.001) in distinguishing good and poor sleepers. The clinimetric and clinical properties of the PSQI suggest its utility both in psychiatric clinical practice and research activities.
Article
The present experiments were designed to compare the influences of delayed sleep onset and temporary slow wave sleep (SWS) deprivation on nocturnal GH and cortisol release in humans. Polysomnographic recordings and blood samples were obtained from 10 male subjects each participating on three experimental nights. On all nights the subjects went to bed at 2300 h and were wakened at 0700 h. On the baseline night, the lights were turned off at 2300 h, enabling the subject to fall asleep. To delay sleep onset, on the second night, the subjects were kept awake until 0200 h. On the third night, the subjects were deprived of SWS between 2300 h and 0200 h. SWS deprivation was accomplished by sounding a tone as soon as it appeared the subject was going into stage 3 sleep. The order of experimental conditions was randomized. On the baseline nights, the occurrence of SWS was closely associated with the occurrence of GH secretory bursts, and plasma cortisol concentrations were low at that time. Delaying sleep onset after 0200 h substantially delayed the GH secretory bursts, which again coincided with the initial periods of SWS. Deprivation of SWS between 2300 h and 0200 h did not significantly reduce the time spent in SWS, because it recovered after the deprivation was discontinued. On these nights, the GH secretory peaks were not significantly changed in amplitude. However, they were dissociated from SWS, because they occurred mostly subsequent to sleep onset rather than during the main epochs of SWS occurring after 0200 h. Nocturnal cortisol release was distinctly delayed with delayed sleep onset, whereas temporary SWS suppression had no significant effect. Thus, the timing of both nocturnal GH and cortisol secretion seems more dependent on sleep onset than on SWS.
Article
Serial sampling of peripheral blood from six healthy adult male volunteers was performed during daytime waking and nighttime sleeping. In addition, sleep physiology was assessed in all subjects (Ss) and sleep stages scored blind by standard criteria. Samples of plasma were analyzed for cortisol (Co) levels, functional interleukin-1 (IL-1), and interleukin-2 (IL-2) activity. Peripheral blood monocytes (PBM) were assayed to evaluate natural killer (NK) activity and mitogen responsiveness. Dramatic increase in IL-1 activity along with changes in other immune functions occurred during sleep and were related to onset of slow wave sleep.
Article
There is evidence that psychological stress adversely affects the immune system. We have investigated the effects of such stress, caused by caring for a relative with Alzheimer's disease, on wound healing. We studied 13 women caring for demented relatives (mean age 62.3 [SE 2.3] years) and 13 controls matched for age (60.4 [2.8] years) and family income. All subjects underwent a 3.5 mm punch biopsy wound. Healing was assessed by photography of the wound and the response to hydrogen peroxide (healing was defined as no foaming). Wound healing took significantly longer in caregivers than in controls (48.7 [2.9] vs 39.3 [3.0] days, p < 0.05). Peripheral-blood leucocytes from caregivers produced significantly less interleukin-1 beta mRNA in response to lipopolysaccharide stimulation than did controls' cells. Stress-related defects in wound repair could have important clinical implications, for instance for recovery from surgery.
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We report on the implementation of digital processing in a large clinical and research sleep laboratory. The system includes the digital collection, display, analysis, and repository of physiological signals collected during sleep. After describing the original analog system, the computer equipment and software necessary for the digital implementation are presented and we explain our algorithms for rapid eye movement (REM) and delta-wave detection. Finally, we describe an experiment validating the digital system of display and analyses. The digital processing of sleep signals saves computer operator, polysomnographic technologist, and computer time. It also saves resources such as polysomnographic paper and FM tape. The digital signals lend themselves to a large array of analysis techniques and result in improved signal quality. Automated REM and delta-wave detection via digital processing correlate highly with visual counts of rapid eye movements and delta waves.
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Natural killer cells were first identified by their cytotoxic activity against tumor cells, suggesting a role in immunological surveillance against neoplasia. However, there is now increasing evidence that natural killer cells are important mediators of innate resistance against a variety of pathogenic micro-organisms. Recently, several important advances have been made in our understanding of how these cells are activated during infection, the contribution of cytokines derived from natural killer cells to host resistance and their influence on the development of antigen-specific T-cell responses.
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Amidst confusion about the nature and usefulness of the stress construct and distinctions between acute and chronic stress, research has begun to identify mechanisms by which stress affects health and by which stress can persist beyond the physical presence of the stressor. In addition, research has begun to identify reasons for selective vulnerability to chronic stress. One of the possible reasons for chronic stress following traumatic events is the disorganizing effect of loss of control and violation of expectations for regulating aspects of one's life normally under control. Data from a longitudinal study of chronic stress at Three Mile Island in the wake of the nuclear accident there suggest that loss of control and frequent experience of intrusive memories about the accident and its aftermath were related to persistent stress responding several years after the accident. The relationships between stress responding and conditioning and consolidation of stressful memories are considered as a basis for persistent intrusive memories and chronic stress.
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Excerpt Glucocorticoids are of great clinical importance in the treatment of autoimmune diseases. However, their immunosuppressive action is associated with many potentially serious side effects, such as hypertension, hyperglycemia, osteoporosis, weight gain and predisposition to infections. So far, it has been impossible to separate the immunomodulatory action of glucocorticoid analogs from their untoward effects, reflecting the fact that most, if not all, cortisol effects are mediated through a single nuclear receptor molecule. Hence, the better understanding of the molecular basis of steroids on the inflammatory response are pivotal for the potential development of more selective immunosuppressive agents. Although glucocorticoids induce the apoptosis of lymphocytes and alter leukocyte migration and redistribution, a major component of their action is the inhibition of cytokine gene expression, resulting in a decreased release of interleukins (IL), interferons (IFN) and tumor necrosis factor (TNF), such as IL-2, IL-6, IFN-γ and TNF-α, While the simplest mechanism of negative
Article
The purpose of this study is to examine the circadian pattern of specific immunologic measures and to compare observed circadian rhythms of these measures with the well-established circadian rhythms of hypothalamic-pituitary-adrenal axis hormones and sympathetic neurotransmitters. Blood samples were collected every 2 hours for a total of 24 hours from nine healthy volunteers. The blood samples were assayed for hormones and immune measures, including adrenocorticotropic hormone (ACTH), cortisol, norepinephrine, and epinephrine. The immune measures included percentage and absolute number of neutrophils, lymphocytes, the lymphocyte subsets CD3+ (T cells), CD4+ (T helper/inducer), CD8+ (T suppressor/cytotoxic), CD56+ (natural killer [NK] cells) and NK cell activity (NKCA). The following immune measures exhibited a significant circadian rhythm: the percentages of neutrophils, CD4+ cells, and CD56+ cells; the absolute numbers of total lymphocytes, CD3+ cells, CD4+ cells, and CD8+ cells; and NKCA. Cross-correlations between the circadian rhythms of selected hormones and immune measures indicated a strong inverse association between the circadian rhythms of cortisol and the different T cell subsets on the one hand, and a strong direct association between the rhythms of cortisol and the percentage of CD56+ and NKCA on the other. Cross-correlations involving the circadian rhythms of norepinephrine and the same immune measures were in general much weaker and statistically nonsignificant. In healthy individuals, both enumerative and functional immune measures exhibit circadian rhythms that seem to be associated most closely with the circadian rhythm of cortisol.
Article
To examine the impact of and relationship between exposure to Hurricane Andrew, a severe stressor, posttraumatic stress symptoms and immune measures. Blood draws and questionnaires were taken from community volunteer subjects living in the damaged neighborhoods between 1 and 4 months after the Hurricane. The sample exhibited high levels of posttraumatic stress symptoms by questionnaire (33% overall; 76% with at least one symptom cluster), and 44% scored in the high impact range on the Impact of Events (IES) scale. A substantial proportion of variance in posttraumatic stress symptoms could be accounted for by four hurricane experience variables (damage, loss, life threat, and injury), with perceived loss being the highest correlate. Of the five immune measures studied Natural Killer Cell Cytotoxicity (NKCC) was the only measure that was meaningfully related (negatively) to both damage and psychological variables (loss, intrusive thoughts, and posttraumatic stress disorder (PTSD). White blood cell counts (WBCs) were significantly positively related with the degree of loss and PTSD experienced. Both NKCC (lower) and WBC were significantly related to retrospective self-reported increase of somatic symptoms after the hurricane. Overall, the community sample was significantly lower in NKCC, CD4 and CD8 number, and higher in NK cell number compared to laboratory controls. Finally, evidence was found for new onset of sleep problems as a mediator of the posttraumatic symptom-NKCC relationship. Several immune measures differed from controls after Hurricane Andrew. Negative (intrusive) thoughts and PTSD were related to lower NKCC. Loss was a key correlate of both posttraumatic symptoms and immune (NKCC, WBC) measures.
Article
Losing close attachments through death in late life is common and can lead to depression. Previous work has shown the clinical benefits of treating these depressions. This article describes the 2-year course of 53 elderly subjects with bereavement-related depression after responding to various treatments. Forty-six patients experienced a full response to acute treatment, but 36% experienced relapse or recurrence. This finding suggests that the treatment response in depressed bereaved older patients is more brittle than expected.
  • Hall
  • Pasternak