The DOI matches its Crossref record; 21 of the 22 references it cites were found in a registry or an index.
Elevation of Plasma Cytokines in Disorders of Excessive Daytime Sleepiness: Role of Sleep Disturbance and Obesity
Abstract
Excessive daytime sleepiness (EDS) and fatigue are frequent symptoms in the general population and the chief complaint of the majority of patients at Sleep Disorders Centers. There is evidence that the inflammatory cytokines tumor necrosis factor-alpha (TNF alpha), interleukin-1beta (IL-1beta), and IL-6 are involved in physiological sleep regulation and that their administration to humans is associated with sleepiness and fatigue. To explore whether plasma levels of TNF alpha, IL-1beta, and IL-6 are elevated in patients with EDS, we measured morning plasma levels of TNF alpha, IL-1beta, and IL-6 in 12 sleep apneics, 11 narcoleptics, 8 idiopathic hypersomniacs, and 10 normal controls. TNF alpha was significantly elevated in sleep apneics and narcoleptics compared to that in normal controls (P < 0.001 and P = 0.001, respectively). Plasma IL-1beta concentrations were not different between sleep disorder patients and controls, whereas IL-6 was markedly and significantly elevated in sleep apneics compared to that in normal controls (P = 0.028). The primary factor influencing TNF alpha values was the degree of nocturnal sleep disturbance, whereas the primary determinant for IL-6 levels was the body mass index. Our findings suggest that TNF alpha and IL-6 might play a significant role in mediating sleepiness and fatigue in disorders of EDS in humans.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“Other researchers have shown that higher levels of IL-6 levels are associated with greater body fat and a higher BMI (34).”
From Chronic stress and age-related increases in the proinflammatory cytokine IL-6. (2003) · cites this paper as [34]
In the citing paper
“Other researchers have demonstrated that higher plasma IL-6 levels are associated with adverse health habits: values are higher in smokers than nonsmokers, in individuals who report less physical activity, in those whose sleep is impaired, and in those with a higher BMI, all behaviors that are adversely affected by stress (14, 34, 37, 50-52).”
From Chronic stress and age-related increases in the proinflammatory cytokine IL-6. (2003) · cites this paper as [34]
Citations
Cites
Rechtschaffen, A. (1968) · Medical Entomology and Zoology · Cited by 11,772
Adipose Expression of Tumor Necrosis Factor-α: Direct Role in Obesity-Linked Insulin Resistance
Hotamisligil, G. S., Shargill, N. S., & Spiegelman, B. M. (1993) · Science · doi:10.1126/science.7678183 · Cited by 7,518
Reaven, G. M., Lithell, H., & Landsberg, L. (1996) · New England Journal of Medicine · doi:10.1056/nejm199602083340607 · Cited by 1,435
Daynes, R. A., Araneo, B. A., Ershler, W. B., Maloney, C., Li, G. Z., & Ryu, S. Y. (1993) · The Journal of Immunology · doi:10.4049/jimmunol.150.12.5219 · Cited by 1,264
Prevalence of sleep disorders in the Los Angeles metropolitan area
Bixler, E. O., Kales, A., Soldatos, C. R., Kales, J. D., & Healey, S. (1979) · American Journal of Psychiatry · doi:10.1176/ajp.136.10.1257 · Cited by 889
Self-citationRecombinant interleukin-6 activates the hypothalamic-pituitary-adrenal axis in humans.
Mastorakos, G., Chrousos, G. P., & Weber, J. S. (1993) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.77.6.8263159 · Cited by 591
Self-citationSleep Apnea and Sleep Disruption in Obese Patients
Vgontzas, A. N. (1994) · Archives of Internal Medicine · doi:10.1001/archinte.1994.00420150073007 · Cited by 470
Self-citationFletcher, E. C., MILLER, J. F., Schaaf, J. W., & Fletcher, J. G. (1987) · SLEEP · doi:10.1093/sleep/10.1.35 · Cited by 313
The relationship of interleukin-1 and immune functions to sleep in humans.
Moldofsky, H., Lue, F. A., Eisen, J. S., Keystone, E., & Gorczynski, R. M. (1986) · Psychosomatic Medicine · doi:10.1097/00006842-198605000-00001 · Cited by 229
Papanicolaou, D. A., Petrides, J. S., Tsigos, C., Bina, S., Kalogeras, K. T., Wilder, R. L., Gold, P. W., Deuster, P. A., & Chrousos, G. P. (1996) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.1996.271.3.e601 · Cited by 226
Self-citation
Cited by
Sorted by citations
Items 901–974 of 974
Obesity alters the immune response to influenza virus infection: a mechanism for immune modulation
Smith, A. G. (2019) · Carolina Digital Repository (University of North Carolina at Chapel Hill) · doi:10.17615/8g6s-9d79
Psychoneuroimmunology and Chronic Pain
Giron, S. E. (2015) · doi:10.22371/07.2015.016
Obstructive Sleep Apnea and Behavioural Obesity Management in Adult Patients
Cayanan, E. A. (2015) · The Sydney eScholarship Repository (The University of Sydney)
Interleukin-6, Obstructive Sleep Apnea, and Obesity
Carpagnano, G. E., & Barnes, P. J. (2003) · CHEST Journal · doi:10.1016/s0012-3692(16)48720-9
Mechanizmy i Patofizjologia Obturacyjnego Bezdechu Podczas Snu
Zielinski, J. (2007) · Advances in respiratory medicine · doi:10.5603/arm.27935
Narcolepsia: Diagnóstico Diferencial nas Síncopes Não Explicadas Artigo de Revisão
Infante, E., de Carvalho, J., Palmegiani, E., Barbosa, P., Pereira, V. C., Ruiz, L. F., Batista, A. L., & Greco, O. T. (2009)
Sleep and its disorders: basic science
Opp, M. R., & Imeri, L. (2010) · Cambridge University Press eBooks · doi:10.1017/cbo9780511780868.020
Th17 Cell Related Cytokine Profiles in Narcolepsy and Other Types of Excessive Daytime Sleepiness
Debebe, D. G., Sadeghniat-Haghighi, K., Shakiba, Y., Rahimi‐Golkhandan, A., & Izad, M. H. (2016) · DOAJ (DOAJ: Directory of Open Access Journals)
The effects of sleep restriction on neurobiological parameters
Pejović-Nikolić, S. (2014) · Engrami · doi:10.5937/engrami1402009p
Lee, E. K., & Hawa, R. (2016) · Springer eBooks · doi:10.1007/978-3-319-42536-8_12
Genetics of Cardiovascular of Obstructive Sleep Apnea Syndrome
Ryan, S. J., Kent, B. D., & McNicholas, W. T. (2011)
Chapter 8 CYTOKINES AND SLEEP REGULATION
Krueger, J. M., & Churchill, L. (2003)
Neuroinflammation and psychosis; antipsychotic medication.
Bloomfield, P. S. (2015) · Spiral (Imperial College London) · doi:10.25560/39588
Perioperative Management of Obstructive Sleep Apnea After Bariatric Surgery
Gomes, R. M. (2017) · Springer eBooks · doi:10.1007/978-981-10-2705-5_21
Excessive Daytime Sleepiness in Children and Adolescents across the Weight Spectrum
Kamer, L. (2011) · TSpace (University of Toronto)
Review Article: Diabetes mellitus and obstructive sleep apnoea: implications for clinicians
Raju, Y. S. N., Swaroopa, D., Yadati, R., & Alekhya, A. (2016)
Al-Khatib, K. (2017) · DalSpace (Dalhousie University)
Aspectos genéticos y trastornos del sueño en el ser humano y en los animales de experimentación
Maret, S., Dauvilliers, Y. A., & Tafti, M. (2011) · Elsevier eBooks · doi:10.1016/b978-84-8086-733-7.00022-x
A Potential Role for Ghrelin in Partial Sleep Deprivation Mediated Immunomodulation
Youssef, M., Hanna, M. O. F., & Rashed, L. (2008) · Bulletin of Egyptian Society for Physiological Sciences · doi:10.21608/besps.2008.37019
Addressing Comorbidities in Difficult Asthma
Kwah, J. H., Peters, A. T., & Khatri, S. B. (2019) · Respiratory medicine · doi:10.1007/978-3-030-20812-7_4
Obesity, Sleep and Sleep-disordered Breathing
Palm, A. (2018) · KTH Publication Database DiVA (KTH Royal Institute of Technology)
Shresth, S. K., Shrestha, S., Sharma, L., Shrivastava, T., Mahaseth, R., & Neopane, A. (2019) · Journal of Advances in Internal Medicine · doi:10.3126/jaim.v8i1.27999
Obstructive sleep apnea in adults : evolution, and related inflammation in early stages of disease
Sahlman, J. (2011) · UEF eRepo (University of Eastern Finland)
Schinner, S. (2010) · Univ. Duesseldorf: Duesseldorfer Dokumenten- und Publikationsserver
Towards an Embodied Account of Sleep Loss
Krause, A. J. (2021) · eScholarship (California Digital Library)
Snoring and Sleep Apnea in Women Risk Factors, Signs and Consequences
Svensson, M. (2008) · KTH Publication Database DiVA (KTH Royal Institute of Technology)
HANFORD SITE LOW EXPOSURE PIPELINE REPAIR USING A NON-METALLIC COMPOSITE SYSTEM
Huth, R. J. (2009) · University of North Texas Digital Library (University of North Texas)
Neuroimmunology of Pregnancy-Related Sleep Disturbances
Okun, M. L., & Coussons‐Read, M. E. (2007) · Springer eBooks · doi:10.1007/978-0-387-69146-6_12
Neuroimmune Activation in Sleep Apnea
Mills, P. J., Ziegler, M. G., & Dimsdale, J. E. (2007) · Springer eBooks · doi:10.1007/978-0-387-69146-6_15
Mims, K. N. (2022) · Elsevier eBooks · doi:10.1016/b978-0-12-822963-7.00265-6
Biomarkers and obstructive sleep apnea
Arnardóttir, E. S., Sunwoo, B. Y., & Pack, A. I. (2011) · Informa Healthcare eBooks · doi:10.3109/9781420020885.010
Wang, Y., Liu, X., Xiang, Y., Chen, B., Chen, Y., & Zhou, C. (2022) · Research Square · doi:10.21203/rs.3.rs-1385685/v1
Musa, E., Bohra, M. H., & Shapiro, C. M. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-822963-7.00133-x
Cytokines and Sleep Regulation
Fang, J., & Krueger, J. M. (1998) · CRC Press eBooks · doi:10.1201/9780849331510.ch35
Causes of extreme fatigue in underperforming athletes - a synthesis of recent hypotheses and reviews
Robson-Ansley, P., & SMITH, L. L. (2009) · South African Journal of Sports Medicine · doi:10.17159/2413-3108/2006/v18i4a232
Research Status on Biomarkers of Obstructive Sleep Apnea Syndrome
马, 静. (2022) · Advances in Clinical Medicine · doi:10.12677/acm.2022.1281016
Pharmacotherapeutic trials for sleep-disordered breathing
Hedner, J. A., Grote, L., & Zou, D. (2011) · Informa Healthcare eBooks · doi:10.3109/9781420020885.026
El síndrome de apneas obstructivas del sueño en la obesidad: un conspirador en la sombra
Salvador, J., Iriarte, J., Silva, C., Ambrosi, J. G., Caballero, A., & Frühbeck, G. (2017) · Revista de medicina de la Universidad de Navarra · doi:10.15581/021.7458
Bienia, G., ŚWIĘTOCHOWSKI, J., ŻOŁNIEREK, M., SIEKIERKO, N., Lubczyńska, Z., Lewandowski, M. M., KOTUSIEWICZ, W., POPRAVKO, Y., & Kostrzewa, A. (2023) · Journal of Education Health and Sport · doi:10.12775/jehs.2023.28.01.007
Five-year Transitions of Symptom Subtypes in Untreated Obstructive Sleep ApneaPreprint
Morris, J. L., Scott, P. W., Magalang, U. J., Keenan, B. T., Patel, S. R., Pack, A. I., & Mazzotti, D. R. (2023) · medRxiv · doi:10.1101/2023.05.18.23290191
The family business: turning sleep into dreams
Kales, A., Kales, J. D., & Kales, H. C. (2023) · SLEEP Advances · doi:10.1093/sleepadvances/zpad036
Self-citationChianeh, Y. R., Mehrabani, A. M., Kharazi, A. A., Ghaffari, M., & Asgari, F. (2024) · Journal of Advances in Medical and Pharmaceutical Sciences · doi:10.9734/jamps/2024/v26i6692
Inflammatory Biomarker Levels and Vaccine Response
Alkire, C. (2022) · University of North Texas Digital Library (University of North Texas) · doi:10.12794/metadc1944287
Exploring the Impact of Obstructive Sleep Apnea on Cirrhosis
Dossaji, Z., Amin, R. N., & Manne, V. (2025) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0000000000002142
Unraveling the relationship between disordered sleep and systemic sclerosis outcomes
So-gnern, A., Mahakkanukrauh, A., Suwannaroj, S., Pongkulkiat, P., Onchan, T., & Foocharoen, C. (2025) · Current Opinion in Rheumatology · doi:10.1097/bor.0000000000001113
Jakubowski, K. (2015) · D-Scholarship@Pitt (University of Pittsburgh)
Sleep and Fatigue during Chronic Viral Infection.
Olivadoti, M. D. (2007) · Deep Blue (University of Michigan)
Pereira, R. R., Sampaio, M. R., & Pessoa, B. P. (2025) · Ciência & Saúde Coletiva · doi:10.1590/1413-81232025308.19642023en
Goble, T., Kundu, T., Meyer, L. S., Klinaki, D., Hawkins, T. A., & Rihel, J. (2025) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.64898/2025.12.25.696495
Prediabetes, Diabetes and Peripheral Arterial Disease
Schernthaner, G.-H., & Höbaus, C. (2026) · Springer eBooks · doi:10.1007/978-3-031-82232-2_40
Influence de polymorphismes génétiques sur le sommeil et l'efficacité de la caféine
Erblang, M. (2020) · theses.fr (ABES) · doi:10.70675/10d39c5czed91z47dez802cz926b956f3874
Lee, C., Thompson, H. J., McCurry, S. M., Kwon, S., Park, S., Phianhasin, L., Huynh, C., Bammler, T. K., Becker, K. J., Bleil, M. E., et al. (2026) · Biological Research For Nursing · doi:10.1177/10998004261444672
Thiru, S. S., Rossettie, S. S., Rani, R., Lucas, S., Onor, G., Hankins, M., Aksu, N. E., Marchi, L. D., & Chang, E. S. (2026) · European Journal of Orthopaedic Surgery & Traumatology · doi:10.1007/s00590-026-04781-3
Stewart, A. R., Bustillos, A., Beauregard, L. L., Link, C. D., Niemeyer, C. S., & Rowe, R. K. (2026) · Journal of Neuroinflammation · doi:10.1186/s12974-026-03944-7 · Cited by 1
Su, C., Zhu, G., Kang, Z., Li, Y., & Lin, Y. (2026) · Journal of Physiology and Biochemistry · doi:10.1007/s13105-026-01209-8
The Intertwined Epidemics of Obesity and Obstructive Sleep Apnea: A Comprehensive Analysis
PATIL, S. (2026) · Obesity Reviews · doi:10.1111/obr.70235
Xu, J., Tian, Y., Luo, W., Zhai, Z., Wang, X., Wang, T., Xu, Q., 胡兴越, & Zhang, L. (2026) · Frontiers in Medicine · doi:10.3389/fmed.2026.1948049
Rubina, S. S., & Макарова, И. И. (2026) · S S Korsakov Journal of Neurology and Psychiatry · doi:10.17116/jnevro2026126091132
Sleepiness is associated with antibody response to influenza vaccination
Kennedy, R. (2025) · ImmPort · doi:10.21430/m3u2f0hwal
Bikman, B. T. (2005) · ScholarsArchive (Brigham Young University)
Valentine, R. J., McAuley, E., Evans, E. M., Woods, J. A., & Dantzer, R. (2011) · Illinois Digital Environment for Access to Learning and Scholarship (University of Illinois at Urbana-Champaign)
Malnutrition and fatigue in coccidioidomycosis: Measurement and mechanisms
Bowers, J. M. (2002) · UA Campus Repository (The University of Arizona)
Riedl, S. (2009) · University of Regensburg Publication Server (University of Regensburg) · doi:10.5283/epub.12369
Inflammatory cytokines alter normal lipid mobilization in adipocytes.
Card, N. (2013) · UNM’s Digital Repository (University of New Mexico)
Rogers, N. H., Obin, M. S., & Greenherg, A. S. (2007) · Humana Press eBooks · doi:10.1007/978-1-59745-400-1_4
Neuroendocrine and Neuroimmune Correlates of Narcolepsy
Okun, M. L., & Coussons‐Read, M. E. (2006) · Springer eBooks · doi:10.1007/0-387-23692-9_27
Brewerton (2000) · doi:10.1002/1098-108x(200011)28:3
Metadata
- Authors
- Vgontzas, A. N., Papanicolaou, D. A., Bixler, E. O., Kales, A., Tyson, K., & Chrousos, G. P.
- Affiliations
- Pennsylvania State University (US)
- National Institutes of Health (US)
- Corresponding author
- Vgontzas, Alexandros N.
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 1997-05
- Volume
- 82
- Issue
- 5
- Pages
- 1313-1316
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W1975319022
- Cited by
- 974
- References
- 22
- Citations by year
- 2026: 10 · 2025: 23 · 2024: 24 · 2023: 24 · 2022: 32 · 2021: 33 · 2020: 25 · 2019: 24 · 2018: 23 · 2017: 23 · 2016: 29 · 2015: 40 · 2014: 42 · 2013: 38 · 2012: 46
- FWCI
- 11.57
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
- Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Keywords
- excessive daytime sleepiness, plasma cytokines, TNF-α, IL-1β, interleukin-6, sleep apnea, narcolepsy, idiopathic hypersomnia, sleep disorders, obesity, body mass index, fatigue, inflammation
- MeSH terms
- Adult, Female, Humans, Disorders of Excessive Somnolence, Interleukin-1, Male, Narcolepsy, Obesity, Sleep Apnea Syndromes, Sleep Wake Disorders, Tumor Necrosis Factor-alpha, Interleukin-6, Body Mass Index, Cytokines
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review