Inadequate sleep associated with reduced vaccine-induced humoral immunity

In a recent study published in cell biology, Researchers are conducting a meta-analysis to assess the association between sleep duration and humoral response to vaccination.

study: Meta-analysis of association between insufficient sleep duration and antibody response to vaccinationImage credit: fizkes / Shutterstock.com

Background

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is causing unprecedented mortality and morbidity worldwide. Vaccines remain the most effective option for mitigating the 2019 coronavirus disease (COVID-19) pandemic. However, no simple behavioral interventions, such as increased sleep duration, that may promote vaccine-induced humoral responses have been identified.

The National Sleep Foundation recommends 7-9 hours of sleep for healthy adults and 7-8 hours for adults 65 and older every day. The immune protection provided by a vaccine depends on the extent of the vaccine-induced immune response. Antibody titers are important biomarkers of immune protection and can indicate immunity at an early stage.

Humoral responses vary by gender, age, body mass index (BMI), smoking habits, and comorbidities. The lowest levels of vaccine-induced humoral immunity have been reported among older, obese, and hypertensive male smokers.

In particular, one previous study reported that anti-influenza virus immunoglobulin (IgG) titers 10 days after influenza vaccination were more than 50% lower in sleep-deprived individuals.

About research

In the current study, researchers are investigating the impact of inadequate nighttime sleep for several days before and after vaccination on vaccine-induced humoral immunity.

Analyzes included data on the association between sleep duration and humoral responses to hepatitis and influenza vaccines. A total of 165 studies were retrieved from the PubMed database by July 19, 2022, including search terms such as “sleep” and “vaccine.” In addition, two records were retrieved from the list of references and one record was retrieved from another data source.

Only original peer-reviewed studies published in French or English that were conducted in adults aged 19 years or older and evaluated objective and/or subjective sleep duration were included in the analysis.

Of these, 149 were excluded. Taken together, the full text of 19 studies was reviewed, after which 12 records were excluded.

Reasons for exclusion included lack of assessment of nighttime sleep duration or humoral response to vaccine (5 studies), duplicate results in 2 studies, and 3 studies assessing sleep during the pre- and post-vaccination days. and including individuals with more than 7.5 hours. Night sleep in one study.

One study that measured antibody titers 1 week to 5 months after COVID-19 vaccination was also excluded. This was in contrast to other studies in which the post-vaccination evaluation period was fixed.

Data were obtained on first author’s name, study title, year of publication, sample size, sex and age of study participants, and study design. The researchers also reported on various techniques used to assess sleep duration. They included single survey items, validated questionnaires, sleep diaries, polysomnography, or actigraphy. Various approaches used to manipulate sleep duration, and post-vaccination vaccine-induced humoral responses were also recorded.

The quality of the evidence was assessed using the Downs and Black Quality Index scoring method. Effect size (ES) estimates were determined and ES estimates were considered to be between 0.5 and 0.8. In addition, we performed exploratory analyses, excluding individuals aged 65 years and older.

result

Three prospective cohort studies and four studies were considered in the meta-analysis. Pre- and post-immunization sleep deprivation, defined as less than 6 hours per night, reduced the humoral response to the vaccine. However, these findings were not statistically significant.

After excluding adults over 60 years of age out of 299, the association was significant with an ES of 0.6. The reduction in humoral responses was comparable to the reduction in vaccine-induced antibodies within 2 months of vaccination with the Pfizer-Biontech BNT162b2 COVID-19 vaccine.

This association appeared to be strong in men but not in women, with ES values ​​of 0.8 and 0.6, respectively. This difference is likely due to varying sex hormone levels due to menstrual cycle phase, hormonal contraceptive use, menopausal status, and use of hormone replacement therapy among postmenopausal women.

Objectively assessed short sleep was associated with significantly reduced antibody responses. The pooled ES estimates for studies (n=133) and prospective studies (n=171) were 0.9 and 0.7, respectively. The pooled ES estimates for males and females were 0.9 and 0.4, respectively.

These findings indicate that self-recorded sleep and objective sleep are moderately correlated, with subjective reports tending to overestimate actual sleep duration.

Conclusion

The current study showed that optimizing pre- and post-vaccination sleep duration may enhance vaccine-induced humoral immunity. It is a relatively simple, efficient, acceptable and feasible modification of behavior that can be used to optimize the humoral response to vaccination.

However, large-scale trials controlling known hormonal regulators of immune function may determine the optimal timing of sleep duration for maximal immune effects, elucidate the reasons for gender differences in the effects of sleep on immunity, and Required to determine the required sleep time. Protects humoral reactions.