Links Between Stress, Sleep, and Inflammation: Are there Sex Differences?
- 109 Downloads
Purpose of Review
Inflammation has emerged as an important biological process in the development of many age-related diseases that occur at different frequencies in men and women. The aim of this review was to examine the current evidence linking stress and sleep with inflammation with a focus on sex differences.
Psychosocial stress that occurs either acutely or chronically is associated with elevated levels of systemic inflammation. While not as robust, insufficient sleep, particularly sleep disturbances, appears to be associated with higher levels of inflammatory activity as well. In several contexts, associations of stress and insufficient sleep with inflammation appear stronger in women than in men. However, this should be interpreted with caution as few studies test for sex differences.
Stress and poor sleep often predict elevations in systemic inflammation. While there is some evidence that these associations are stronger in women, findings are largely mixed and more systematic investigations of sex differences in future studies are warranted.
KeywordsStress Sleep Sex Inflammation Immune system
This work was supported by the NIH funding R24AG048024 (ADC, AAP), K01AG057859 (ADC), and R01HL142051 (AAP) and a predoctoral training fellowship T32MH020006 for MRD.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 10.Deak T, Quinn M, Cidlowski JA, Victoria NC, Murphy AZ, Sheridan JF. Neuroimmune mechanisms of stress: sex differences, developmental plasticity, and implications for pharmacotherapy of stress-related disease. Stress. 2015;18(4):367–80. https://doi.org/10.3109/10253890.2015.1053451.CrossRefPubMedPubMedCentralGoogle Scholar
- 11.• Epel ES, Crosswell AD, Mayer SE, Prather AA, Slavich GM, Puterman E, et al. More than a feeling: a unified view of stress measurement for population science. Front Neuroendocrinol. 2018;49:146–69. https://doi.org/10.1016/j.yfrne.2018.03.001 This review provides a contemporary theoretical perspective on stress and stress measurement. CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Cohen S, Murphy MLM, Prather AA. Ten surprising facts about stressful life events and disease risk. Annu Rev Psychol. 2018;70:577–97. https://doi.org/10.1146/annurev-psych-010418-102857.CrossRefPubMedGoogle Scholar
- 14.• Baumeister D, Akhtar R, Ciufolini S, Pariante CM, Mondelli V. Childhood trauma and adulthood inflammation: a meta-analysis of peripheral C-reactive protein, interleukin-6 and tumour necrosis factor-alpha. Mol Psychiatry. 2016;21(5):642–9. https://doi.org/10.1038/mp.2015.67 This paper provides a meta-analytic review of the data linking early life trauma and inflammation. CrossRefPubMedGoogle Scholar
- 16.• Marsland AL, Walsh C, Lockwood K, John-Henderson NA. The effects of acute psychological stress on circulating and stimulated inflammatory markers: a systematic review and meta-analysis. Brain Behav Immun. 2017;64:208–19. https://doi.org/10.1016/j.bbi.2017.01.011 This paper provides a meta-analytic review of the human literature on acute stress and markers of inflammation. CrossRefPubMedPubMedCentralGoogle Scholar
- 18.• Lockwood KG, Marsland AL, Cohen S, Gianaros PJ. Sex differences in the association between stressor-evoked interleukin-6 reactivity and C-reactive protein. Brain Behav Immun. 2016;58:173–80. https://doi.org/10.1016/j.bbi.2016.07.001 This study demonstrates sex differences in levels of IL-6 in response to acute laboratory stress. CrossRefPubMedPubMedCentralGoogle Scholar
- 23.• Irwin MR, Olmstead R, Carroll JE. Sleep disturbance, sleep duration, and inflammation: a systematic review and meta-analysis of cohort studies and experimental sleep deprivation. Biol Psychiatry. 2015. https://doi.org/10.1016/j.biopsych.2015.05.014 This paper provides a meta-analytic review of the literature linking sleep and inflammation.
- 24.Nowakowski S, Matthews KA, von Kanel R, Hall MH, Thurston RC. Sleep characteristics and inflammatory biomarkers among midlife women. Sleep. 2018;41(5). https://doi.org/10.1093/sleep/zsy049.
- 27.• Gordon AM, Mendes WB, Prather AA. The social side of sleep: elucidating the links between sleep and social processes. Curr Dir Psychol Sci. 2017;26(5):470–5. https://doi.org/10.1177/0963721417712269 This review discusses the bidirectional links between sleep and social processes including social stress. CrossRefPubMedPubMedCentralGoogle Scholar
- 32.Bixler EO, Papaliaga MN, Vgontzas AN, Lin HM, Pejovic S, Karataraki M, et al. Women sleep objectively better than men and the sleep of young women is more resilient to external stressors: effects of age and menopause. J Sleep Res. 2009;18(2):221–8. https://doi.org/10.1111/j.1365-2869.2008.00713.x.CrossRefPubMedPubMedCentralGoogle Scholar
- 35.Krishnan V, Collop NA. Gender differences in sleep disorders. Curr Opin Pulm Med. 2006;12(6):383–9. https://doi.org/10.1097/01.mcp.0000245705.69440.6a.CrossRefPubMedGoogle Scholar
- 36.Mong JA, Cusmano DM. Sex differences in sleep: impact of biological sex and sex steroids. Philosophical transactions of the Royal Society of London Series B, Biological sciences. 2016;371(1688):20150110. https://doi.org/10.1098/rstb.2015.0110.
- 38.Bakour C, Schwartz S, O'Rourke K, Wang W, Sappenfield W, Couluris M et al. Sleep duration trajectories and systemic inflammation in young adults: results from the National Longitudinal Study of Adolescent to Adult Health (Add Health). Sleep. 2017;40(11). doi: https://doi.org/10.1093/sleep/zsx156.
- 39.Kim TH, Carroll JE, An SK, Seeman TE, Namkoong K, Lee E. Associations between actigraphy-assessed sleep, inflammatory markers, and insulin resistance in the Midlife Development in the United States (MIDUS) study. Sleep Med. 2016;27–28:72–9. https://doi.org/10.1016/j.sleep.2016.07.023.CrossRefPubMedPubMedCentralGoogle Scholar
- 40.• Prather AA, Epel ES, Cohen BE, Neylan TC, Whooley MA. Gender differences in the prospective associations of self-reported sleep quality with biomarkers of systemic inflammation and coagulation: findings from the Heart and Soul Study. J Psychiatr Res. 2013;47(9):1228–35. https://doi.org/10.1016/j.jpsychires.2013.05.004 This study shows that poor sleep quality prospectively predicts levels of inflammation in women but not in men. CrossRefPubMedGoogle Scholar
- 47.Institue of Medicine. Sex Differences and Implications for Translational Neuroscience Research: Workshop Summary. Washington, DC: National Academies Press; 2011.Google Scholar