Cited by 1,325Sleep and Wakefulness ResearchSleep and related disordersCircadian rhythm and melatonin

The DOI matches its Crossref record; 203 of the 203 references it cites were found in a registry or an index; none of the 130 sources its claims cite is checked for support yet.

Why Sleep Is Important for Health: A Psychoneuroimmunology Perspective

Open access
Irwin, Michael R.·2015·Annual Review of Psychology

Abstract

Sleep has a critical role in promoting health. Research over the past decade has documented that sleep disturbance has a powerful influence on the risk of infectious disease, the occurrence and progression of several major medical illnesses including cardiovascular disease and cancer, and the incidence of depression. Increasingly, the field has focused on identifying the biological mechanisms underlying these effects. This review highlights the impact of sleep on adaptive and innate immunity, with consideration of the dynamics of sleep disturbance, sleep restriction, and insomnia on (a) antiviral immune responses with consequences for vaccine responses and infectious disease risk and (b) proinflammatory immune responses with implications for cardiovascular disease, cancer, and depression. This review also discusses the neuroendocrine and autonomic neural underpinnings linking sleep disturbance and immunity and the reciprocal links between sleep and inflammatory biology. Finally, interventions are discussed as effective strategies to improve sleep, and potential opportunities are identified to promote sleep health for therapeutic control of chronic infectious, inflammatory, and neuropsychiatric diseases.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review argues that sleep disturbance impairs adaptive immunity and increases inflammation through HPA-axis and sympathetic pathways, linking sleep to infectious disease, cardiovascular disease, cancer, and depression. It synthesizes evidence that behavioral sleep treatments may reduce inflammatory markers, though mediation by inflammation remains unproven.

Key findings

  • Insomnia complaints occur in nearly 25% of the US population, nearly 10% meet diagnostic criteria for chronic insomnia, and insomnia persists for as long as three years in nearly 50% of patients.
  • Experimental sleep loss reduces T-cell IL-2 production, shifts Th1/Th2 balance toward Th2, reduces monocyte IL-12, and increases IL-10; partial sleep loss reduced influenza A vaccine response by over 50%, and shorter sleep duration (<6 h) was linked to decreased hepatitis B vaccine protection in 125 midlife adults.
  • Sleep loss and short sleep increase inflammatory markers including CRP, IL-6, TNF, IL-1β, and IL-17 via NF-κB and TLR-4 signaling; insomnia with short sleep duration (≤5 h) was associated with a fivefold greater risk of hypertension and a fourfold increased risk of incident hypertension, while persistent insomnia conferred a 14-fold greater risk of depression in the following year.
  • Behavioral treatments may reduce inflammation: cognitive behavioral therapy for insomnia was associated with 50% lower CRP one year after treatment among those with insomnia remission, and tai chi improved insomnia complaints, augmented herpes zoster vaccine responses, and reduced IL-6.

Methods

  • Narrative review of psychoneuroimmunology literature; no primary data collection. It synthesizes human and animal experimental sleep deprivation, naturalistic sleep disturbance, epidemiologic cohorts, vaccine response studies, and behavioral intervention trials.
  • Main analysis is a conceptual integration of sleep effects on adaptive and innate immunity, HPA-axis and sympathetic nervous system pathways, inflammatory signaling, and disease outcomes; no formal systematic search or meta-analysis is described.

Limitations

  • Stated: no prospective study has systematically evaluated whether elevated inflammation mediates associations between sleep disturbance and cardiovascular disease or cancer, and the prospective role of sleep disturbance in driving inflammation that mediates depression is not known.
  • Stated: epidemiologic findings on insomnia and CRP are mixed; no systematic studies have evaluated sedative hypnotics on markers of inflammation, and no randomized controlled trials have assessed whether inflammation is altered with pharmacotherapy of insomnia.
  • Evident: as a narrative review, it lacks systematic search, quality appraisal, and quantitative synthesis; heterogeneity in sleep measures, populations, and study designs limits causal inference.

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Integrity signals

Registry

Crossref · 10.1146/annurev-psych-010213-115205

Cites

203 of 203 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

96 Not checked yet · 22 Own interpretation · 1 No basis given

Verify all 130 references — free account

Show all 104 claims

  • It may state two separate claims as one. 15
  • Probably not a substantial claim. 1
15 of 15
  • The paper relies on this without support.

    Immunologic response to vaccination is a valid proxy for infectious disease risk.

    “Research on the effects of sleep loss on vaccine responses provides a translational perspective on the sleep-related changes in adaptive immunity by identifying clinically relevant endpoints related to infectious disease risk including immunologic response to vaccination.”
  • The paper relies on this without support.

    Findings from experimental sleep deprivation in healthy adults generalize to naturalistic sleep disturbance and clinical populations.

    “In humans, partial sleep deprivation mimics the ubiquitous sleep disturbance found in persons exposed to social adversity or who are aged and most vulnerable to infectious diseases.”
2 of 2

Claims other papers make about this one

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Self-check

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Each contradiction between two passages listed here was confirmed by an independent check.

2 of 2

Citations

Cites

Items 201–203 of 203

Research works printed but not linked: 11

  1. Afshar R, 2011, Iran J. Kidney Dis., 5, 119
  2. Brown R, 1989, Reg. Immunol., 2, 321
  3. 10.1073/pnas.0509281102 · DOI · Paper page
  4. Irwin M, 1999, J. Clin. Endocrinol. Metab., 84, 1979
  5. Irwin MR, 2008, Sleep, 31, 1001
  6. Miller MA, 2009, Sleep, 32, 857
  7. Prather AA, 2012, Sleep, 35, 1063
  8. Redwine L, 2000, J. Clin. Endocrinol. Metab., 85, 3597
  9. Renegar KB, 1998, Sleep, 21, 19
  10. Renegar KB, 1998, Sleep, 21, 241
  11. Spath-Schwalbe E, 1998, J. Clin. Endocrinol. Metab., 83, 1573

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Metadata

Authors
Irwin, M. R.
Affiliations
University of California, Los Angeles (US)
Corresponding author
Irwin, Michael R.
Venue
Annual Review of Psychology
Published
2015-01-03
Volume
66
Issue
1
Pages
143-172
ISSN
  • 0066-4308 (ISSN-L)
  • 1545-2085
OpenAlex
W2125158184
Cited by
1,325
References
202
Citations by year
2026: 165 · 2025: 172 · 2024: 156 · 2023: 153 · 2022: 137 · 2021: 125 · 2020: 155 · 2019: 76 · 2018: 61 · 2017: 54 · 2016: 42 · 2015: 26
FWCI
4.02
Type
journal article
Language
en
Open access
Locations
  • Annual Review of Psychology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • National Institute on Aging (R01AG026364, R01AG034588)
  • National Heart, Lung, and Blood Institute (R01HL079955, R01HL095799)
  • National Institute on Drug Abuse (R01DA032922)
  • National Cancer Institute (R01CA160245, R01CA119159)
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
Keywords
sleep, sleep disorders, insomnia, sleep restriction, psychoneuroimmunology, adaptive immunity, innate immunity, antiviral immunity, vaccine response, infectious disease risk, pro-inflammatory response, cardiovascular disease, cancer, depression, neuroendocrine regulation, autonomic nervous system, sleep interventions, sleep health
MeSH terms
Humans, Immune System, Inflammation, Psychoneuroimmunology, Sleep, Sleep Wake Disorders

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