Prolonged experimental sleep disturbance affects the inflammatory resolution pathways in healthy humans

BACKGROUND

Sleep disturbances, as manifested in insomnia symptoms of difficulties falling asleep or frequent nighttime awakenings, are a strong risk factor for a diverse range of diseases involving immunopathology. Low-grade systemic inflammation has been frequently found associated with sleep disturbances and may mechanistically contribute to increased disease risk. Effects of sleep disturbances on inflammation have been observed to be long lasting and remain after recovery sleep has been obtained, suggesting that sleep disturbances may not only affect inflammatory mediators, but also the so-called specialized pro-resolving mediators (SPMs) that actively resolve inflammation. The goal of this investigation was to test for the first time whether the omega-3 fatty acid-derived D- (RvD) and E-series (RvE) resolvins are impacted by prolonged experimental sleep disturbance (ESD).

METHODS

Twenty-four healthy participants (12 F, age 20-42 years) underwent two 19-day in-hospital protocols (ESD/control), separated by > 2 months. The ESD protocol consisted of repeated nights of short and disrupted sleep with intermittent nights of undisturbed sleep, followed by three nights of recovery sleep at the end of the protocol. Under the control sleep condition, participants had an undisturbed sleep opportunity of 8 h/night throughout the protocol. The D- and E-series resolvins were measured in plasma using liquid chromatography-tandem mass spectrometry (LC-MS/MS).

RESULTS

The precursor of the D-series resolvins, 17-HDHA, was downregulated in the ESD compared to the control sleep condition (p <.001 for condition), and this effect remained after the third night of recovery sleep has been obtained. This effect was also observed for the resolvins RvD3, RvD4, and RvD5 (p <.001 for condition), while RvD1 was higher in the ESD compared to the control sleep condition (p <.01 for condition) and RvD2 showed a mixed effect of a decrease during disturbed sleep followed by an increase during recovery sleep in the ESD condition (p <.001 for condition*day interaction). The precursor of E-series resolvins, 18-HEPE, was downregulated in the ESD compared to the control sleep condition (p <.01 for condition) and remained low after recovery sleep has been obtained. This effect of downregulation was also observed for RvE2 (p <.01 for condition), while there was no effect for RvE1 (p >.05 for condition or condition*day interaction). Sex-differential effects were found for two of the D-series resolvins, i.e., RvD2 and RvD4.

CONCLUSION

This first investigation on the effects of experimental sleep disturbance on inflammatory resolution processes shows that SPMs, particularly resolvins of the D-series, are profoundly downregulated by sleep disturbances and remain downregulated after recovery sleep has been obtained, suggesting a longer lasting impact of sleep disturbances on these mediators. These findings also suggest that sleep disturbances contribute to the development and progression of a wide range of diseases characterized by immunopathology by interfering with processes that actively resolve inflammation. Pharmacological interventions aimed at promoting inflammatory resolution physiology may help to prevent future disease risk as a common consequence of sleep disturbances.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02484742.

Alterations of pain pathways by experimental sleep disturbances in humans: central pain-inhibitory, cyclooxygenase, and endocannabinoid pathways

STUDY OBJECTIVES

There is strong evidence that sleep disturbances are an independent risk factor for the development of chronic pain conditions. The mechanisms underlying this association, however, are still not well understood. We examined the effect of experimental sleep disturbances (ESDs) on three pathways involved in pain initiation/resolution: (1) the central pain-inhibitory pathway, (2) the cyclooxygenase (COX) pathway, and (3) the endocannabinoid (eCB) pathway.

METHODS

Twenty-four healthy participants (50% females) underwent two 19-day long in-laboratory protocols in randomized order: (1) an ESD protocol consisting of repeated nights of short and disrupted sleep with intermittent recovery sleep; and (2) a sleep control protocol consisting of nights with an 8-hour sleep opportunity. Pain inhibition (conditioned pain modulation, habituation to repeated pain), COX-2 expression at monocyte level (lipopolysaccharide [LPS]-stimulated and spontaneous), and eCBs (arachidonoylethanolamine, 2-arachidonoylglycerol, docosahexaenoylethanolamide [DHEA], eicosapentaenoylethanolamide, docosatetraenoylethanolamide) were measured every other day throughout the protocol.

RESULTS

The central pain-inhibitory pathway was compromised by sleep disturbances in females, but not in males (p < 0.05 condition × sex effect). The COX-2 pathway (LPS-stimulated) was activated by sleep disturbances (p < 0.05 condition effect), and this effect was exclusively driven by males (p < 0.05 condition × sex effect). With respect to the eCB pathway, DHEA was higher (p < 0.05 condition effect) in the sleep disturbance compared to the control condition, without sex-differential effects on any eCBs.

CONCLUSIONS

These findings suggest that central pain-inhibitory and COX mechanisms through which sleep disturbances may contribute to chronic pain risk are sex specific, implicating the need for sex-differential therapeutic targets to effectively reduce chronic pain associated with sleep disturbances in both sexes.

CLINICAL TRIALS REGISTRATION

NCT02484742: Pain Sensitization and Habituation in a Model of Experimentally-induced Insomnia Symptoms. https://clinicaltrials.gov/ct2/show/NCT02484742.

Differential effects of an experimental model of prolonged sleep disturbance on inflammation in healthy females and males

Sleep disturbances, including disrupted sleep and short sleep duration, are highly prevalent and are prospectively associated with an increased risk for various widespread diseases, including cardiometabolic, neurodegenerative, chronic pain, and autoimmune diseases. Systemic inflammation, which has been observed in populations experiencing sleep disturbances, may mechanistically link disturbed sleep with increased disease risks. To determine whether sleep disturbances are causally responsible for the inflammatory changes reported in population-based studies, we developed a 19-day in-hospital experimental model of prolonged sleep disturbance inducing disrupted and shortened sleep. The model included delayed sleep onset, frequent nighttime awakenings, and advanced sleep offset, interspersed with intermittent nights of undisturbed sleep. This pattern aimed at providing an ecologically highly valid experimental model of the typical sleep disturbances often reported in the general and patient populations. Unexpectedly, the experimental sleep disturbance model reduced several of the assessed proinflammatory markers, namely interleukin(IL)-6 production by monocytes and plasma levels of IL-6 and C-reactive protein (CRP), presumably due to intermittent increases in the counterinflammatory hormone cortisol. Striking sex differences were observed with females presenting a reduction in proinflammatory markers and males showing a predominantly proinflammatory response and reductions of cortisol levels. Our findings indicate that sleep disturbances causally dysregulate inflammatory pathways, with opposing effects in females and males. These results have the potential to advance our mechanistic understanding of the pronounced sexual dimorphism in the many diseases for which sleep disturbances are a risk factor.

0279 Fatigue and Pain Responses Across Repeated Exposure to Experimentally Induced Sleep Disturbance and Intermittent Recovery Sleep: Sex Differences

Introduction

Sleep disturbances are more common in women than in men, as are many chronic pain disorders characterized by inflammation and fatigue. This study investigated sex differences in fatigue and pain responses to sleep disruption and whether such responses recover with uninterrupted sleep.

Methods

24 healthy young individuals (12 women; ages 18–42 yrs) participated in a study consisting of two counterbalanced 19-day experimental in-hospital stays, separated by two months. Following 3 baseline nights, participants were exposed to 3 nights of sleep disruption (SD) involving delayed sleep onset, hourly awakenings, and early-morning awakenings without return to sleep, followed by 1 night of recovery sleep. This 4-day cycle was repeated three times and finished with 3 additional nights of recovery sleep. Total sleep opportunity on SD nights was 4 hrs, and on recovery/sleep control (SC) nights was 8 hrs. Light exposure, ambient temperature, food and fluid intake, and physical activity were controlled. Self-reported fatigue and pain, pain sensitivity, and habituation were collected throughout. Data were analyzed with linear mixed models.

Results

For women but not men, fatigue in response to SD recovered incompletely starting after the 2nd sleep disruption-recovery cycle and remained elevated after the final 3 recovery nights in women (p&lt;.05). Additionally, women became more sensitive to pressure pain in response to SD (p&lt;.001) with incomplete return to baseline after the final 3 recovery nights. Whereas men habituated to cold pain across SC and even more so across SD (p=.045 Day, p=.021), women did not habituate.

Conclusion

These results indicate that incomplete recovery in both fatigue and pressure pain, alongside a lack of habituation to cold pain, in response to sleep disruption may explain the common co-occurrence of insomnia, fatigue, and pain observed as more prevalent in women.

Support

NIH/NINDS R01-NS091177; NIH/National Center for Research Resources UL1-RR02758 and M01-RR01032 to the Harvard Clinical and Translational Science Center.

0031 Photoperiodic Effects on Diurnal Rhythms in the Immune System, Rest-Activity Behavior, and Cortisol Revealed in a Diurnally Active Large Animal Model - The Domestic Pig

Introduction

Diurnal variations in immune cell number and function are regarded important for immune competence and are thought to be mediated by rest-activity rhythms and hormones. Moreover, the photoperiod is also known to modulate the immune system and considered to affect seasonal disease susceptibility. Whereas few studies investigated seasonal effects, the present study is the first investigating the specific effect of the photoperiod on diurnal rhythms in cell numbers of peripheral leukocyte types in any species.

Methods

Domestic pigs were held either under long day (LD, 16L:8D, lights-on 07:00-23:00, n=9) or short day conditions (SD, 8L:16D, lights-on 07:00-15:00, n=11) and fed concentrate at 07:30 + 14:00 (ad libitum hay/water). Blood samples were taken every 2 h over periods of 50 h via indwelling vein catheters. Rest-activity behavior of the pigs was analyzed using continuous camera recordings.

Results

Cosinor analyses (p&lt;.05) revealed photoperiodic differences in diurnal rhythms of cell numbers of various peripheral leukocyte subtypes, rest-activity behavior, and cortisol concentration. Cell numbers of total leukocytes, NK cells, T cells, and eosinophils in blood, rest-activity behavior, and cortisol concentration peaked earlier relative to lights-on under SD (p&lt;.05). Relative amplitudes in rest-activity behavior and cell counts of total leukocytes, NK cells, T cells, and monocytes were higher under SD (p&lt;.05). However, there was no photoperiodic effect on diurnal rhythms in neutrophil counts and mesor in any leukocyte type. Generalized linear mixed models revealed associations of leukocyte counts with rest-activity behavior and cortisol concentration in most cell types (p&lt;.05). Moreover, the found photoperiodic effects on diurnal rhythms in rest-activity behavior and cortisol concentration are in agreement with research in humans and primates.

Conclusion

The present study revealed photoperiodic effects on diurnal rhythms in the immune system, rest-activity behavior, and cortisol concentration in pigs and strengthens the importance of the domestic pig as suitable model for chronoimmunology.

Support

German Research Foundation DFG (grant provided to SS, grant number SCHM3162/1-1), Federal Ministry of Education and Research, Germany (grant number 01PL16003), Faculty of Agricultural Sciences, University of Hohenheim (scholarship provided to LE).

0275 Exposure to Experimentally Induced Sleep Disturbance Affects the Inflammatory Resolution Pathways in Healthy Humans

Introduction

Sleep disturbances are assumed to impair health through induction of low-grade systemic inflammation. Experimental studies have shown that such inflammatory upregulation does not normalize even after a couple of nights of recovery sleep. We hypothesized that sleep disturbances do not only affect inflammatory pathways, but also the recently detected inflammatory resolution pathways, which actively terminate inflammation. Mediators of inflammatory resolution mainly derive from omega-3 fatty acids converted to specialized pro-resolving mediators (SPMs), such as resolvins. We investigated SPMs in healthy humans exposed to a novel model of experimental insomnia.

Methods

Twenty-four individuals (age 18–42 years, 12 women) participated in a study consisting of two 19-day in-hospital protocols (insomnia/control). After three nights of baseline sleep (8h/night, 23:00-07:00), participants in the experimental insomnia condition were exposed to three cycles of three nights of disturbed sleep (delayed sleep-onset, hourly sleep disruption, advanced sleep-offset) followed by one night of 8h-recovery sleep. The protocol ended with three additional nights of recovery sleep. In the control condition, participants had an uninterrupted sleep opportunity (8h/night) across the 19-day protocol. Blood samples were taken at 11:00 at baseline, during experimental insomnia exposure, and after recovery sleep. Several SPMs were measured in plasma using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Data were analyzed using linear mixed models.

Results

Exposure to experimental insomnia affected several SPMs compared to control sleep, including a decrease of resolvin D4 and E2 concentrations, which was still evident after the third recovery night (p&lt;.05).

Conclusion

This is the first investigation on the effects of experimentally induced sleep disturbance on inflammatory resolution pathways. The results support that SPMs, particularly resolvin D4 and E2, are decreased by sleep disturbances, and do not normalize after a couple of nights of recovery sleep. Targeting these pathways by pharmacologically increasing SPMs may help to limit inflammatory consequences of sleep disturbances.

Support

NIH/NINDS R01-NS091177; NIH/National Center for Research Resources UL1-RR02758 and M01-RR01032 to the Harvard Clinical and Translational Science Center.

Photoperiodic Effects on Diurnal Rhythms in Cell Numbers of Peripheral Leukocytes in Domestic Pigs

The photoperiod is known to modulate immune cell number and function and is regarded essential for seasonal disease susceptibility. In addition, diurnal variations in the immune system are regarded important for immune competence. Whereas few studies investigated the influence of season, none investigated the specific effect of the photoperiod on these diurnal immune rhythms until now. Therefore, the present study compared diurnal rhythms in cell numbers of peripheral leukocyte types in domestic pigs held either under long day conditions (LD) or short day conditions (SD). Cosinor analyses of cell numbers of various peripheral leukocyte subtypes investigated over periods of 50 h revealed distinct photoperiodic differences in diurnal immune rhythms. Relative amplitudes of cell numbers of total leukocytes, NK cells, T cells, and monocytes in blood were higher under SD than LD. In addition, cell counts of total leukocytes, NK cells, T cells including various T cell subtypes, and eosinophils peaked earlier relative to the time of lights-on under SD than LD. In contrast, diurnal rhythms of neutrophil counts did not show photoperiodic differences. Mesor values did not differ in any leukocyte type. Generalized linear mixed model analyses revealed associations of leukocyte counts with plasma cortisol concentration and activity behavior in most investigated cell types. Moreover, the present study demonstrated photoperiodic effects on diurnal rhythms in plasma cortisol concentrations and activity behavior, which is in agreement with human and primate studies. The results of the present study imply stronger rhythmicity in leukocyte counts in general under SD. Common intrinsic mechanisms seem to regulate photoperiodic effects on diurnal rhythms in leukocyte counts, except for neutrophils, in domestic pigs. Our results reveal considerable insights into the regulation of immune rhythms in diurnally active species.

Data characterizing diurnal rhythms in the number of peripheral CD8α- and CD8α+ γδ T cells in domestic pigs

This data article is related to the original research article “Diurnal rhythms in peripheral blood immune cell numbers of domestic pigs” of Engert et al. [1] and describes diurnal rhythms in the number of CD8α⁻ and CD8α⁺ γδ T cells in peripheral blood of domestic pigs. Blood samples were taken from 18 animals over periods of up to 50 h and immune cell subtypes were determined by flow cytometry. Diurnal rhythmicity of cell numbers of γδ T cell subtypes was analyzed with cosinor analysis and different properties of rhythmicity (mesor, amplitude, and peak time) were calculated. In addition, associations between cell numbers of the investigated cell types in porcine blood with plasma cortisol concentration, hematocrit, and experimental conditions were identified with linear mixed model analysis.

Diurnal rhythms in peripheral blood immune cell numbers of domestic pigs

Diurnal rhythms within the immune system are considered important for immune competence. Until now, they were mostly studied in humans and rodents. However, as the domestic pig is regarded as suitable animal model and due to its importance in agriculture, this study aimed to characterize diurnal rhythmicity in porcine circulating leukocyte numbers. Eighteen pigs were studied over periods of up to 50 h. Cosinor analyses revealed diurnal rhythms in cell numbers of most investigated immune cell populations in blood. Whereas T cell, dendritic cell, and eosinophil counts peaked during nighttime, NK cell and neutrophil counts peaked during daytime. Relative amplitudes of cell numbers in blood differed in T helper cell subtypes with distinctive differentiation states. Mixed model analyses revealed that plasma cortisol concentration was negatively associated with cell numbers of most leukocyte types, except for NK cells and neutrophils. The observed rhythms mainly resemble those found in humans and rodents.

Glucocorticoid receptor number and affinity differ between peripheral blood mononuclear cells and granulocytes in domestic pigs

The aim of the present study was to characterize the number and affinity of glucocorticoid receptors (GR) in peripheral blood mononuclear cells (PBMC) and granulocytes of domestic pigs because glucocorticoid signaling is considered important for animal health and welfare. To investigate GR binding characteristics in intact porcine immune cells, blood samples of 6 castrated male pigs were collected via indwelling vein catheters. Porcine PBMC and granulocytes were isolated using two-layer density gradients, followed by radioligand binding assays to determine the number of GR sites per cell and the dissociation constant K_d as a measure for GR binding affinity. The present study revealed a greater number of GR sites per cell (P = 0.039) in PBMC (mean ± SEM: 1,953 ± 207 sites/cell) compared to granulocytes (1,561 ± 159 sites/cell) in domestic pigs. Furthermore, porcine PBMC had a higher GR binding affinity than porcine granulocytes (P = 0.003) as the dissociation constant K_d of PBMC (1.8 ± 0.2 nM) was lower than that of granulocytes (3.5 ± 0.4 nM). Our results point to differences in underlying mechanisms of glucocorticoid signaling in different porcine leukocyte populations.