Association of sleep duration and quality with immunological response after vaccination against severe acute respiratory syndrome coronavirus‐2 infection

Abstract

Summary Growing evidence suggests that sleep could affect the immunological response after vaccination. The aim of this prospective study was to investigate possible associations between regular sleep disruption and immunity response after vaccination against coronavirus disease 2019 (COVID‐19). In total, 592 healthcare workers, with no previous history of COVID‐19, from eight major Greek hospitals were enrolled in this study. All subjects underwent two Pfizer–BioNTech messenger ribonucleic acid (mRNA) COVID‐19 vaccine BNT162b2 inoculations with an interval of 21 days between the doses. Furthermore, a questionnaire was completed 2 days after each vaccination and clinical characteristics, demographics, sleep duration, and habits were recorded. Blood samples were collected and anti‐spike immunoglobulin G antibodies were measured at 20 ± 1 days after the first dose and 21 ± 2 days after the second dose. A total of 544 subjects (30% males), with median (interquartile range [IQR]) age of 46 (38–54) years and body mass index of 24·84 (22.6–28.51) kg/m 2 were eligible for the study. The median (IQR) habitual duration of sleep was 6 (6–7) h/night. In all, 283 participants (52%) had a short daytime nap. In 214 (39.3%) participants the Pittsburgh Sleep Quality Index score was >5, with a higher percentage in women (74·3%, p < 0.05). Antibody levels were associated with age ( r = −0.178, p < 0.001), poor sleep quality ( r = −0.094, p < 0.05), insomnia ( r = −0.098, p < 0.05), and nap frequency per week ( r = −0.098, p < 0.05), but after adjusting for confounders, only insomnia, gender, and age were independent determinants of antibody levels. It is important to emphasise that insomnia is associated with lower antibody levels against COVID‐19 after vaccination.

The relationship between mental health, sleep quality, and the immunogenicity of COVID-19 vaccinations

“…This large and representative example of HCWs represents a rather young and overall healthy population with only around 20% of participants reporting dissatisfaction with their sleep, while in the adult population dissatisfactory sleep is generally more common with more than 40% reporting some insomnia symptoms before the COVID-19 pandemic and more than 50% of the population during the pandemic in 2020 (Morin et al, 2021). The insomnia prevalence of 36% and the short sleep duration of only six hours in the first study investigating the association of sleep variables and the immunogenicity of COVID-19 vaccines might explain why the authors found a significant impact of the AIS and PSQI scores on antibody levels at some time points after adjustment for potential confounders (Athanasiou et al, 2023). It must be considered that both clinical scores include an item on sleep duration (Buysse et al, 1989).…”

“…Expert advice had been given that shift workers should avoid vaccinations on shift days and hospital inpatients should consider rescheduling their vaccinations due to the sleep disruptions associated with hospitalization (Zhu et al, 2021). However, the first and only previous study investigating the effects of sleep on antibody levels following COVID-19 vaccinations found no correlation between the duration of sleep two days prior and one day after the vaccination with antibody levels (Athanasiou et al, 2023). In light of this and our data, and because COVID-19 vaccinations represent an essential disease prevention measure (Benenson et al, 2021), COVID-19 vaccines should be applied in a timely manner.…”

“…However, data on the relationship between sleep and immunogenicity of COVID-19 vaccinations is still sparse. To our knowledge, currently the first has recently been conducted in a small cohort of Greek healthcare workers (HCWs) (Athanasiou et al, 2023). Surprisingly, night shifts two days before or one day after COVID-19 vaccination did not affect antibody levels.…”

“…Surprisingly, night shifts two days before or one day after COVID-19 vaccination did not affect antibody levels. However, the Athens Insomnia Scale (AIS) (Soldatos et al, 2000) and the PSQI predicted antibody levels after the first and second vaccination (Athanasiou et al, 2023), yet to a smaller degree than other established factors such as age and smoking. Considering that the study participants were assessed during the peak of the COVID-19 pandemic and severely sleep deprived with an average sleep duration of only six hours per night, it remains unclear if the effects were mediated by sleep duration, sleep quality or other factors such as mental health.…”

Considerations and clinical management of infections in sarcoidosis

“…While sarcoidosis may not, overall, increase the risk of adverse outcomes from respiratory infections, the burden of super-imposed infectious events may be higher for patients with sarcoidosis who often have reduced physiologic reserve and/or quality of life impairments. The results of recent research highlight the importance of sleep quantity in contributing to vaccine efficacy for the COVID-19 vaccine, with the evolving understanding that sleep acts as a ‘natural adjuvant’ to enhance short-term immune responses and long-term immune memory [45–48,49 ▪▪ ,50]. As patients with sarcoidosis have increased risk of impaired sleep [51,52] counselling patients on sleep practices during the pre and post vaccination weeks may be especially beneficial.…”