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Schlaf und Schläfrigkeit im Rahmen von Infektionen und im Rahmen experimenteller Immunmodulation beim Menschen

Sleep and sleepiness in the course of infections and of experimental immunomodulation in humans

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Zusammenfassung

Infektionen, Entzündungen und Autoimmunprozesse sind von erheblichen Störungen des Wohlbefindens, der beruflichen und sozialen Leistungsfähigkeit, der kognitiven Funktionen und des Verhaltens begleitet. Insbesondere das Schlaf-Wach-Verhalten reagiert auf immunologische Prozesse sehr sensitiv. In der vorliegenden Übersichtsarbeit wird der gegenwärtige Stand des Wissens zum Einfluss einerseits von Infektionen und andererseits experimenteller Immunmodulation auf Schlaf und Schläfrigkeit beim Menschen dargestellt. Das Wissen über den Schlaf im Rahmen von Infektionen ist spärlich und zum Teil widersprüchlich. In den meisten der experimentellen Studien wurde der Einfluss bakteriellen Endotoxins untersucht, das eine Vielzahl pathophysiologischer Aspekte akuter Infektionen imitiert, einschließlich der Freisetzung inflammatorischer Zytokine. Diese Studien zeigen, dass das menschliche Schlaf-Wach-Verhalten auf eine Aktivierung der primären Wirtsantwort sehr sensibel reagiert. Geringe Mengen Endotoxin, die weder die Körpertemperatur noch neuroendokrine Systeme beeinflussen, aber in diskreter Weise die Freisetzung inflammatorischer Zytokine stimulieren, führen zu einer Zunahme der nonREM-Schlafmenge und Intensität. Größere Mengen Endotoxin hingegen, die prominente febrile Reaktionen induzieren und eine ausgeprägte neuroendokrine Aktivierung, gehen mit einer erheblichen Störung des Nachtschlafes einher. Nach dem gegenwärtigen Wissensstand ist Tumor Nekrose Faktor-α (TNF-α) wahrscheinlich der zentrale Mediator dieser Effekte, wobei es aber wahrscheinlich ist, dass die erhebliche Schlafstörung, die während fieberhafter Wirtsantworten auftritt, auch durch die endokrine Aktivierung mit bedingt ist. Diese experimentelle Datenlage macht es verständlich, warum Infektionen beim Menschen sowohl mit einer Zunahme der Schlafmenge, als auch mit erheblichen Schlafstörungen einher gehen können; denn je nach dem Ausmaß der Wirtsantwort und dem Stadium der Infektion dürfte die Menge an zirkulierenden inflammatorischen Zytokinen und die endokrine Aktivierung sehr unterschiedlich sein. Aus weiteren Humanstudien gibt es erste Hinweise darauf, dass inflammatorische Zytokine wie TNF-α nicht nur die Veränderung des Schlaf-Wach-Verhaltens im Rahmen von Infektionen vermitteln, sondern dass diese Zytokine zudem eine Rolle in der physiologischen Schlafregulation spielen, und dass sie möglicherweise die hypnotische Wirkung bereits etablierter und zugelassener Medikamente mediieren.

Summary

Infection, inflammation and autoimmune processes are accompanied by disturbances of well-being, psychosocial functioning, cognitive performance, and behavior. Here we review those studies that have investigated the effects of infectious diseases or experimental immunomodulation on sleep and sleepiness in humans. Naturalistic studies in infected humans are scantly and have yielded conflicting results. In most of the experimental studies bacterial endotoxin was injected intravenously to model various aspects of infection including the release of inflammatory cytokines. These studies show that human sleep-wake behavior is very sensitive to host defense activation. Small amounts of endotoxin that neither affect body temperature nor neuroendocrine systems, but slightly stimulate the secretion of inflammatory cytokines, promote non-rapid-eye-movement (nonREM) sleep amount and intensity. Febrile host responses, in contrast, go along with prominent sleep disturbances. According to the present knowledge tumor necrosis factor-α (TNF-α) is most probably a key mediator of these effects, although it is likely that disturbed sleep during febrile host responses involves endocrine systems as well. Hence, enhanced and disturbed sleep during infections disease might be caused by different degrees of host defense activation. Moreover, there is preliminary evidence from human studies suggesting that inflammatory cytokines such as TNF-α not only mediate altered sleep-wake behavior during infections, but in addition are involved in physiological sleep regulation and in hypnotic effects of established sedating drugs.

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Authors and Affiliations

  1. The Stanley Division of Developmental Neurovirology, Johns Hopkins University, Baltimore, MD, USA

    Dunja Hinze-Selch

  2. Department of Neurology, Beth Israel Deacones Medical Center & Harvard Medical School, Boston, MA, USA

    Janet Mullington

  3. Max-Planck-Institut für Psychiatrie, Kraepelinstr. 10, D-80804, München, Deutschland

    Thomas Pollmächer, Andreas Schuld, Thomas Kraus & Monika Haack

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  1. Thomas Pollmächer
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Unterstützt durch die Volkswagenstiftung, Hannover, (I/7 1979)

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Pollmächer, T., Schuld, A., Kraus, T. et al. Schlaf und Schläfrigkeit im Rahmen von Infektionen und im Rahmen experimenteller Immunmodulation beim Menschen. Somnologie 4, 68–78 (2000). https://doi.org/10.1046/j.1439-054x.2000.12700.x

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