[Immune outcomes of sleep disorders: the hypothalamic-pituitary-adrenal axis as a modulatory factor]

Braz J Psychiatry. 2007 May;29 Suppl 1:S33-8. doi: 10.1590/s1516-44462007000500007.
[Article in Portuguese]


Objective: To review the literature on the interaction between sleep and the immune system.

Method: A search on Web of Science and Pubmed database including the keywords sleep, sleep deprivation, stress, hypothalamic-pituitary-adrenal axis, immune system, and autoimmune diseases.

Results: On Web of Science, 588 publications were retrieved; 61 references, more significant and closer to our objective, were used, including original articles and review papers.

Conclusion: Sleep deprivation and immune system exert a bidirectional influence on each other. Since sleep deprivation is considered a stressor, inasmuch as it induces elevation of cortisol or corticosterone levels in humans and rodents, respectively, and given the well-known immunosuppressive effect of glucocorticoids, we propose that increased activation of the hypothalamic-pituitary-adrenal axis is a major mediator of the immune alterations observed in patients with insomnia or in sleep deprived subjects.

Publication types

  • English Abstract
  • Review

MeSH terms

  • Adrenocorticotropic Hormone / metabolism
  • Animals
  • Circadian Rhythm / physiology
  • Glucocorticoids / metabolism
  • Humans
  • Hydrocortisone / metabolism
  • Hypothalamo-Hypophyseal System / physiology*
  • Immune System / physiology*
  • Pituitary-Adrenal System / physiology*
  • Sleep / immunology
  • Sleep / physiology*
  • Sleep Deprivation / immunology
  • Sleep Deprivation / physiopathology*
  • Sleep Disorders, Circadian Rhythm / physiopathology
  • Sleep, REM
  • Stress, Physiological / physiopathology*


  • Glucocorticoids
  • Adrenocorticotropic Hormone
  • Hydrocortisone