Sleep Problems in Chronic Inflammatory Diseases: Prevalence, Treatment, and New Perspectives: A Narrative Review

Abstract

Epidemiological studies have shown that individuals with sleep problems are at a greater risk of developing immune and chronic inflammatory diseases. As sleep disorders and low sleep quality in the general population are frequent ailments, it seems important to recognize them as serious public health problems. The exact relation between immunity and sleep remains elusive; however, it might be suspected that it is shaped by others stress and alterations of the circadian rhythm (commonly caused by for example shift work). As studies show, drugs used in the therapy of chronic inflammatory diseases, such as steroids or monoclonal antibodies, also influence sleep in more complex ways than those resulting from attenuation of the disease symptoms. Interestingly, the relation between sleep and immunity appears to be bidirectional; that is, sleep may influence the course of immune diseases, such as inflammatory bowel disease. Thus, proper diagnosis and treatment of sleep disorders are vital to the patient’s immune status and, in effect, health. This review examines the epidemiology of sleep disorders and immune diseases, the associations between them, and their current treatment and novel perspectives in therapy.

Potential Role of Sleep Deficiency in Inducing Immune Dysfunction

“…Other sleep problems are even more common; Bamer et al have surmised that even one out of every two MS patients could suffer from sleep problems [ 62 ]. Disease symptoms themselves might preclude afflicted individuals from having normal sleep; e.g., in male MS and female RA patients, the main determinant of sleep quality was pain [ 63 ]. Moreover, in this group, symptoms such as spasms and crawling feeling in the legs might be difficult to differentiate from restless leg syndrome, another sleep disorder frequently met in this population [ 63 ].…”

The Role of Inflammation, Hypoxia, and Opioid Receptor Expression in Pain Modulation in Patients Suffering from Obstructive Sleep Apnea

“…The link between OSA and systemic inflammation has been a topic of interest and has been widely described in recent years [ 64 , 65 , 66 ]. It is commonly described that OSA is linked with increased expression of inflammatory mediators and elevation of many pro-inflammatory cytokines (PIC) [ 64 ]. ( Figure 2 ) The most documented are IL-6 and TNFα [ 67 , 68 ].…”

Immune-Mediated Diseases from the Point of View of Psychoneuroimmunoendocrinology

“…Psychosocial interventions can also favourably modulate the immune system function and reduce inflammatory markers [ 124 , 125 ], showing the potential role of these approaches in the management of IMIDs. Finally, sleep-based interventions, especially cognitive–behavioral therapy for insomnia (CBTi) has been widely explored in patients with IMIDs with concomitant sleep disturbances [ 126 ]. This strategy includes relaxation, sleep restriction, stimulus control, and cognitive techniques [ 127 ].…”

“…This strategy includes relaxation, sleep restriction, stimulus control, and cognitive techniques [ 127 ]. Other approaches are melatonin or hypnotic drugs such as benzodiazepines or antidepressants for patients with depression, although they are less effective and may show some adverse effects for these patients [ 126 ]. It would be interesting to conduct studies in this field in an effort to improve the prognosis and quality of life of patients with IMIDs.…”