{"id":829,"date":"2015-09-11T15:03:56","date_gmt":"2015-09-11T15:03:56","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=829"},"modified":"2017-08-21T11:34:17","modified_gmt":"2017-08-21T11:34:17","slug":"primary-care-corner-with-geoffrey-modest-md-sleep-deprivation-and-colds","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2015\/09\/11\/primary-care-corner-with-geoffrey-modest-md-sleep-deprivation-and-colds\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: Sleep Deprivation and Colds"},"content":{"rendered":"<p><strong>By Dr. Geoffrey Modest<\/strong><\/p>\n<p>There have been several articles finding an association between short sleep duration and various infectious diseases. The current study was a better-documented\u00a0clinical trial supporting this (see\u00a0SLEEP 2015;38(9):1353\u20131359). Details:<\/p>\n<ul>\n<li>164 healthy adults (94 men and 70 women, mean age 30) volunteered for the study<\/li>\n<li>These volunteers were monitored for 7 consecutive days for their sleep duration and continuity, both by subjective questionnaires and by wrist actigraphy (which correlates well with polysomnography, the gold standard)<\/li>\n<li>Then they were given nasal drops containing rhinovirus 39\u00a0and subsequently\u00a0monitored for 5 days in a quarantined hotel. A &#8220;clinical cold&#8221; was defined if they were both infected and met the illness criteria (objective measures of mucous production and nasal congestion)<\/li>\n<\/ul>\n<p>Results:<\/p>\n<ul>\n<li>124 of 164 participants (75.6%) were infected with rhinovirus\u00a0(antibody measurements before and 28d after viral exposure, and daily nas<br \/>\nal\u00a0rhinovirus cultures)<\/li>\n<li>48 (29.3% of them) developed a clinical cold<\/li>\n<li>Objective sleep duration (by actigraphy) was associated with an increased likelihood of developing a clinical cold,\u00a0with odds ratios of developing a cold,\u00a0as compared to those sleeping\u00a0&gt;7hrs per night:\n<ul>\n<li>&lt;5 hrs\/night had OR=4.50 (1.08-18.69)<\/li>\n<li>&lt;5-6 hrs\/night had OR=4.24\u00a0(1.08-16.71)<\/li>\n<li>6-7 hrs\/night had a nonsignificant\u00a0 OR=1.66\u00a0(0.40-6.95)<\/li>\n<\/ul>\n<\/li>\n<li>These results were independent of prechallenge antibody levels, demographics (e.g. SES, education), season of the year, BMI, various psychological variables (e.g. perceived stress), and health practices (e.g. smoking, physical activity, alcohol)<\/li>\n<li>Sleep continuity was not associated with developing a cold<\/li>\n<li>Sleep duration was not related to getting the infection, just in getting sick<\/li>\n<\/ul>\n<p><a href=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/files\/2015\/09\/sleep.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-830\" src=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/files\/2015\/09\/sleep.png\" alt=\"sleep\" width=\"414\" height=\"221\" \/><\/a><\/p>\n<p>I bring up this study for a few reasons:<\/p>\n<ul>\n<li>This study fits in with the very large literature on stress and diseaseover the past many decades,\u00a0showing that both acute and chronic stressors, both physical and mental,\u00a0can create huge changes in both hormones (essentially all hormones\u00a0are affected), and\u00a0in immunologic function (esp\u00a0T cell and natural killer NK cell function),\u00a0perhaps largely through the effects of the\u00a0cortisol increases from the stressors. Of note, at least in several\u00a0studies which directly looked at this: the issue is not so much\u00a0the intensity of the stressor, but\u00a0how the stressor is perceived by the\u00a0person;\u00a0and\u00a0the physiologic\u00a0effect of the stressor (including cortisol levels) is moderated by\u00a0the degree of social support that the person has (not surprising that there are mediators to the effect of stress on individuals, since\u00a0people exposed to the same physical or mental stressor often have different physiological reactions to it).<\/li>\n<li>It brings up the limitations of the &#8220;germ theory&#8221;. Perhaps the main conclusion (to me)\u00a0of this study is that infectious diseases (at least the vast majority of them) reflect a complex interplay between the characteristics of the bug and the host response to that bug. It is not just the presence of an external stimulus, but its interaction with the human organism. \u00a0Not everyone exposed to an organism gets infected (in this study 75.6% actually got infected, though this was not related to decreased sleep) and not everyone who gets infected develops disease (in this study 29.3% got a cold, which was related). In addition, not assessed in\u00a0this study, there is great variability in the disease severity in those who get the disease, perhaps related to the individual&#8217;s immunologic\u00a0response\u00a0that\u00a0is partly determined by the social\u00a0environment. One summary article noted that even relatively acute sleep deprivation (less than one week)\u00a0is associated with increases in cortisol, decreases in TSH, increases in prolactin,\u00a0increases in growth hormone, and\u00a0 increases in ghrelin\/decreases in leptin,\u00a0which might cause the munchies found with sleep deprivation\u00a0(see\u00a0<a href=\"http:\/\/www.medscape.org\/viewarticle\/502825\">http:\/\/www.medscape.org\/viewarticle\/502825<\/a>, as well as the\u00a0whole issue of the journal Brain, Behavior, and Immunity, volume 18, 2004 devoted to the hormonal\/immunological effects of sleep deprivation\u200b). Other studies have found sleep deprivation related to\u00a0increases in inflammatory markers (e.g. C-reactive protein), down regulation of T cell production of interleukin-2, overall decreased proliferative capacity of T cells in vitro, and decreases in NK cells. Of interest,\u00a0there seems to be a bidirectional association between sleep deficiency\u00a0and inflammation, with studies finding that cognitive behavioral therapy for older adults with insomnia leads\u00a0to decreased levels of systemic inflammation (Sleep. 2014; 37: 1543-52).<\/li>\n<li>And, as the graph below showed, overall we are getting less sleep over the past 50 years.<\/li>\n<li>The presumed association between disease and social conditions, by the way, has been articulated for a long time. For example,\u00a0Virchow in 1879 wrote: &#8220;Don&#8217;t crowd diseases (epidemics) point everywhere to deficiencies of society?&#8221;\u200b<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Primary Care Corner with Geoffrey Modest MD: Sleep Deprivation and Colds [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2015\/09\/11\/primary-care-corner-with-geoffrey-modest-md-sleep-deprivation-and-colds\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":148,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[14283],"tags":[],"class_list":["post-829","post","type-post","status-publish","format-standard","hentry","category-archive"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/829","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/users\/148"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/comments?post=829"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/829\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/media?parent=829"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/categories?post=829"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/tags?post=829"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}