Microbial Products and Cytokines in Sleep and Fever Regulation

Crit Rev Immunol. 2017;37(2-6):291-315. doi: 10.1615/CritRevImmunol.v37.i2-6.70.


Excessive sleepiness and fever are constitutional symptoms associated with systemic infection. Although fevers have been investigated for many years, sleep responses to infectious challenge have only recently been investigated. Inoculation of animals with bacterial, viral, protozoan and fungal organisms result in complex sleep responses dependent upon the microbial agent and route of administration. The general pattern is characterized by an initial robust increase in non-rapid eye movement sleep (NREMS) followed by a period of NREMS inhibition. REMS is inhibited after infectious challenge. The sleep responses are accompanied by fever but the two responses are, in part, independent from each other. Sleep responses, like fevers, may be beneficial to host defense although this area is relatively uninvestigated. Microbial products likely responsible for sleep and fever responses include bacterial muramyl peptides and endotoxin, and viral double stranded RNA. These microbial products induce sleep and fever responses in animal models. The exact mechanism of how these structurally diverse microbial products elicit sleep and fever remain unknown; however these substances share the ability to induce cytokine production. Cytokines such as interleukin-1 (IL-1), tumor necrosis factor, acidic fibroblast growth factor (FGF), and interferon-α (IFN-α) are somnogenic whether given directly into brain or intravenously. Other cytokines lack somnogenic activity, e.g., IL-2, IL-6, IFNβ and basic FGF. The somnogenic actions of cytokines probably involve growth hormone-releasing hormone (GHRH) and nitric oxide. Anti-GHRH or inhibition of NO production inhibits normal sleep and inhibits IL-1-induced sleep. In conclusion, cytokines are likely key mediators of fever and sleep responses to infection. The microbial-cytokine altered sleep likely results from an amplification of physiological sleep mechanisms which include cytokines, several neuropeptides and neurotransmitters such as nitric oxide.

Publication types

  • Review

MeSH terms

  • Acetylmuramyl-Alanyl-Isoglutamine / immunology
  • Acetylmuramyl-Alanyl-Isoglutamine / metabolism
  • Animals
  • Brain / immunology
  • Brain / metabolism
  • Cytokines / immunology
  • Cytokines / metabolism
  • Endotoxins / immunology
  • Endotoxins / metabolism
  • Fever / immunology*
  • Fever / microbiology
  • Fever / parasitology
  • Fever / virology
  • Growth Hormone-Releasing Hormone / immunology
  • Growth Hormone-Releasing Hormone / metabolism
  • Host Microbial Interactions / immunology*
  • Host-Parasite Interactions / immunology*
  • Humans
  • Infections / immunology*
  • Infections / microbiology
  • Infections / parasitology
  • Infections / virology
  • Nitric Oxide / immunology
  • Nitric Oxide / metabolism
  • Sleep / immunology
  • Sleepiness*


  • Cytokines
  • Endotoxins
  • Nitric Oxide
  • Acetylmuramyl-Alanyl-Isoglutamine
  • Growth Hormone-Releasing Hormone