Sleep and cytokine-immune functions in medical, psychiatric and primary sleep disorders

The role of disturbed sleep physiology and altered cytokine and immune functions are reviewed in infections and chronic debilitating systemic diseases where fatigue, and increased desire to sleep, dysphoria and impairment in cognition are common symptoms. Activation of cytokines, sleepiness and malaise occur during the acute phase response to bacterial or viral disease. Sleep and cytokine-immune functions are disturbed in chronic protozoal and viral disease e.g., trypanosomiasis, human immune deficiency viral disease. Sleep-related physiological disturbances may play a role in post-febrile illness, end-stage renal disease and cancer. Various sleep disturbances accompany the fatigue and malaise in such chronic autoimmune diseases as rheumatoid arthritis, systemic lupus erythematosis and multiple sclerosis. HLA DR2 and DBQ1*0602 may have implications for changes in sleep and increased IL-6 and TNF-alpha in the blood of patients with narcolepsy. The elevation of these cytokines in sleep apnea may be the result of disturbances in sleep or may be an aspect of the disorder. The cytokine-immune changes that occur in major mental illness such as depression or schizophrenia appear to be the result of the disturbances in sleep. (C) 1999 Harcourt Publishers Ltd.