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Original Research

Sleep restriction increases white blood cells, mainly neutrophil count, in young healthy men: A pilot study

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Pages 1467-1470 | Published online: 05 Dec 2008

Abstract

Objectives:

This study examines the effects of sleep restricted to four hours for three consecutive nights on blood parameters, known to be associated with cardiovascular risk, in young healthy men.

Material and methods:

Eight young healthy men (age 24.5 ± 3.3 years) were studied in the sleep restricted group. Nine young healthy men (age 24 ± 2 years) were included in the control group and spent the days and nights in the sleep lab, while sleeping eight hours/night. One baseline night was followed by three nights of sleep restriction to four hours and by one recovery night of eight hours. Blood samplings were performed after the baseline night and after the third night of sleep restriction or without restriction for the control group.

Results:

A significant increase in white blood cells (WBC) (5.79 ± 1.05 vs. 6.89 ± 1.31 103 cell/μl, p = 0.03), and neutrophils (3.17 ± 0.69 vs 4.24 ± 0.97 103 cell/μl, p = 0.01) was observed after the third night of sleep restriction. Other blood parameters were not affected. No significant variation was observed in the control group.

Conclusion:

Sleep restriction affected WBC count, mainly neutrophils, considered as risk factor for cardiovascular disease. Stress induced by the short term sleep restriction could be involved in this observation.

Introduction

Accumulating evidence indicates that atherosclerosis is an inflammatory process involving a network of vascular cells, leukocytes, proinflammatory cytokines, chemoattractant cytokines (chemokines), and growth factors (CitationLind 2003).

In our society, many people choose to prioritise social life, leisure, professional activities to the detriment of sleep and voluntary reduce their sleep duration. Several reports indicate that a shortened sleep may be associated with an increased risk of morbidity, mortality (CitationHeslop et al 2002) and hypertension (CitationGangwisch et al 2006). The mechanisms underlying these associations are not yet elucidated. A study performed in healthy adult subjects showed an increase in high-sensitivity C-reactive-protein (hs-CRP), a stable marker of inflammation, during acute total and short term partial sleep deprivation (CitationMeier-Ewert et al 2004). Recently, we observed that in postmenopausal women, treated with hormonal replacement therapy, a sleep restriction to four hours of sleep for three consecutive nights increased white blood cells (WBC), monocytes, neutrophils, total cholesterol and low density lipoprotein – cholesterol (LDL-C) (CitationKerkhofs et al 2007).

Over the last several decades, an inversing number of prospective studies conducted in coronary heart disease (CHD) free populations have shown a clear and positive correlation between the leukocyte count and risk of CHD (CitationZalokar et al 1981; CitationGrimm et al 1985; CitationPhillips et al 1992; CitationKannel et al 1992; CitationGillum et al 1993). The correlation appears to persist even after adjustment for other risk factors (CitationFolsom et al 1997; CitationLee et al 2001; CitationBrown et al 2001). Other studies reported also correlations between other leukocytes subtypes such as monocyte count (CitationOlivares et al 1993; CitationSweetnam et al 1997) and neutrophil count (Horne et al 2005).

We hypothesized that sleep restriction could activate inflammatory processes and secondarily affect blood variables known to be associated with cardiovascular events and that a similar process could occur in young men. The current study examined the effect of sleep restriction to four hours for three consecutive nights on blood variables (inflammatory markers and lipid profile) known to be associated with an increased cardiovascular risk.

Material and methods

Eight young healthy nonsmoker men (age 24.5 ± 3.3 years) free of neurological, psychiatric, cardiac and endocrine disease participated in the partial sleep deprivation experiment and nine nonsmoker young healthy men aged 22–29 years (age 24 ± 2 years) were included in the control group. They had no sleep complaints and were not snoring. The presence of a sleep disorder was excluded on the basis of an interview and one night of polysomnography before inclusion in the study. All volunteers were not drinking alcohol on a regular basis and were drug-free. Their consumption of xanthine beverages had to be less than five units/day.

The protocol was approved by the Ethics Committee at the Vésale Hospital. The volunteers gave written informed consent and received a financial compensation for their participation in the study.

After two weeks of a regular sleep–wake schedule of eight hours of sleep per night documented by actigraphic recordings and sleep diaries, the volunteers were admitted to the Sleep Laboratory of the Vésale Hospital, for five days and nights. The first night was a baseline night during which the subjects were allowed to sleep from 11 pm to 7 am. The following three nights were the restriction nights during which sleep was allowed only between 1 am and 5 am. The last night was a recovery night of 8 hours (from 11 pm to 7 am). The control group slept three consecutive nights of 8 hours (from 11 pm to 7 am). Both groups were studied in similar conditions.

During the study, the subjects were under close supervision of the staff and performed several neurobehavioral tests. Continuous EEG recordings were performed with an ambulatory device (Medatec Pamela®) during the day (except between 9 am and 1 pm to allow the subjects to have a shower and to perform cognitive tests) and night, in order to control the vigilance state of the subjects and to avoid sleep episodes outside the permitted hours. Sleep EEG recordings were scored according to standard criteria (CitationIber et al 2007). The subjects received standard hospital meals of a maximum of 2500 calories/day with a comparable proportion of nutrients (protein, fat, carbohydrate) across days and sessions. Controlled drinks and snacks were available during the restriction nights. Alcohol and xanthine derivatives (coffee, tea, chocolate, colas) were prohibited during the study.

The effectiveness of the sleep restriction procedure was confirmed by the continuous EEG recordings.

Blood samples were obtained from an antecubital vein at 7 am after the baseline night and after the third night of sleep with or without restriction. Serum samples were collected in vacuum tubes without anticoagulant. Plasma samples were harvested in citrated vacuum tubes. Whole blood was collected on EDTA-treated tubes. Lipids (total cholesterol, HDL-c, triglycerides) were measured by standardized laboratory techniques on a SYNCHRON LX® automate (Beckman Coulter), LDL cholesterol was calculated as LDL-C = total cholesterol – HDL cholesterol – triglycerides/5 (in mg/dl). Hs-CRP, ApoA and ApoB were evaluated on an Immage® device (Beckman). Fibrinogen was determined by the Clauss method on a STA® automate (Stago). Leucocytes and subsets were determined on a CELL-DYN4000® hemocytometer (Abbott).

Wilcoxon paired tests were used to compare baseline values to the values obtained after the third night of sleep restriction.

Results and discussion

represents the values of the different blood parameters obtained after the baseline night and after the third night of sleep restriction.

Table 1 Inflammatory markers and lipid profiles (mean ± SD) at baseline and after the third night of sleep restriction

A significant increase in WBC and neutrophils was observed after the third night of sleep restriction. The other blood parameters were not affected. represents blood parameters in the control group. No modifications were observed.

Table 2 Inflammatory markers and lipid profiles (mean ± SD) at baseline and after the third night of sleep without restriction. Control group

Polysomnography recordings indicated a significant raise in the percentage of slow wave sleep during the third night of sleep restriction as compared to the baseline night in the sleep restricted group (p = 0.008) while no significant variation was found in the control group.

Our data indicate that a decrease in sleep duration to four hours for three consecutive nights significantly affected WBC counts and mainly neutrophil counts in young healthy men. In contrast to our previous work in postmenopausal women, we did not find any significant modifications in monocyte counts or the lipid profile (total cholesterol, LDL). This difference could be attributed to the age and gender.

In addition, contrary to the study of CitationMeier-Ewert and colleagues (2004), we did not observe any change in hs-CRP levels. This could be attributed to the shorter duration of sleep restriction in our study (three nights vs 10).

Interestingly, CitationGomez-Merino and colleagues (2005) reported that, in young men, three weeks of physical conditioning followed by five days of combat course, sleep deprivation and physiological stress increased leukocyte and neutrophil counts while total lymphocytes were unchanged. CitationDinges and colleagues (1994) also observed that 64 hours of sleep deprivation increased neutrophil and monocyte counts. Another work showed that after one partial night of sleep deprivation, norepinephrine and epinephrine blood concentration were raised (CitationIrwin et al 1999). Interestingly, shifts in leukocyte have already been shown in healthy subjects after administration of epinephrine and hydrocortisone (CitationBrohee et al 1990). Considering our data and all these findings, we surmise that the stress induced by the sleep restriction could be involved in the observed modifications.

Leukocytes may influence the development of coronary heart disease through their ability to cause proteolytic and oxidative damage to coronary arteries. Indeed, stimulated neutrophils are known to: 1, secrete proteolytic proteases that promote the detachment of endothelial cells from vessel walls and the adherence of paltelets to subendothelial collagen and fibronectin (CitationHarlan et al 1981); 2, release large amounts of the chemotactic agent leukotriene B4 in patients with stable angina (CitationMehta et al 1989); 3, secrete large amounts of inflammatory mediators (CitationWeissman et al 1980); 4, release superoxide anions in hyperlipidemic patients CitationLudwig et al 1982).

Furthermore, CitationElkind and colleagues (2005) reported that the leukocyte count was associated with a reduced endothelial reactivity, furnishing a possible link with a higher cardiovascular risk.

Conclusion

Sleep restriction to four hours of sleep during three consecutive nights induced an increase in WBC counts, mainly neutrophils in young healthy subjects. The stress induced by the sleep restriction could be one mechanism involved. Further studies are needed to confirm these findings and to explore the supposed mechanisms.

Disclosure

Sources of Funding are European Union Grant MCRTN-CT-2004-512362 and Scientific Research Fund of the ISPPC-CHU de Charleroi.

References

  • BrohéeDVanhaeverbeekMKennesB1990Leukocyte and lymphocyte subsets after a short pharmacological stress by intravenous epinephrine and hydrocortisone in healthy humansIntern J Neurosci535362
  • BrownDWGilesWHCroftJB2001White blood cell count: an independent predictor of coronary heart disease mortality among a national cohortJ Clin Epidemiol543162211223329
  • DaneshJCollinsRApplebyP1998C-reactive protein, albumin or leukocyte count with coronary heart disease: meta-analyses of prospective studiesJAMA2791477829600484
  • DingesDFDouglasSZauggL1994Leukocytosis and natural killer cell function parallel neurobehavioral fatigue induced by 64 hours of sleep deprivationJ Clin Invest93193097910171
  • ElkindMSVSciaccaRRBoden-AlbalaB2005Leukocytes count is associated with reduced endothelial reactivityAtherosclerosis1813293816039287
  • FolsomARWuKKRosamondWD1997Prospective study of hemostatic factors and incidence of coronary heart disease: Atherosclerosis Risk In Communities (ARIC) studyCirculation96110279286936
  • GangwischJEHeymsfieldSBBoden-AlbalaB2006Short sleep duration as a risk factor for hypertension: analyses of the first National Health and Nutrition Examination SurveyHypertension47833916585410
  • GillumRFIngramDDMakucDM1993White blood cell count, coronary heart disease and death: the NHANES I epidemiologic follow-up studyAm Heart J125855638438715
  • Gomez-MerinoDDrogouCChennaouiM2005Effects of combinated stress during intense training on cellular immunity, hormones and respiratory infectionsNeuroimmunomodulation121647215905625
  • GrimmRHJrNeatonJDLudwigW1985Prognostic importance of the white blood cell count for coronary, cancer, and all cause mortalityJAMA254193274046122
  • HarlanJMKillenPDHarkerLA1981NEutrophil-mediated endothelial injury in vitro mechanisms of cell detachmentJ Clin Invest6813944037033282
  • HeslopPDavey SmithGMetcalfeC2002Sleep duration and mortality: the effects of short or long sleep duration on cardiovascular and all-cause mortality in working men and womenSleep Med33051414592192
  • IberCAncoli-IsraelSChessonAL2007The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology, and Technical SpecificationsWestchester, IllAmerican Academy of Sleep Medicine
  • IrwinMThompsonJMillerC1999Effects of sleep deprivation on catecholamine and interleukin-2 levels in humans: clinical implicationsJ Clin Endocrinol Metab8419798510372697
  • KannelWBAndersonKWilsonPW1992White blood cell count and cardiovascular disease: insight from the Framingham StudyJAMA267125361538564
  • KerkhofsMZouaoui BoudjeltiaKStenuitP2007Sleep restriction increases blood neutrophils, total cholesterol and Low Density Lipoprotein Cholesterol in postmenopausal women: a preliminary studyMaturitas56212516950577
  • LeeCDFolsomARNietoFJ2001White blood cell count and incidence of coronary heart disease and ischemic stroke and mortality from cardiovascular disease in African-american and white men and women: atherosclerosis risk in communities studyAm J Epidemiol1547586411590089
  • LindL2003Circulating markers of inflammation and atherosclerosisAtherosclerosis1692031412921971
  • LudwigPWHunnighakeDBHoidalJR1982Increased leucocyte oxidative metabolism in hyperlipoproteinaemiaLancet2348506124758
  • MehtaJDinermanJMehtaP1989Neutrophil function in ischemic heart diseaseCirculation79549562537159
  • Meier-EwertHKRidkerPRifaiN2004Effects of sleep loss on C-reactive protein, an inflammatory marker of cardiovascular riskJ Am Coll Cardiol436788314975482
  • OlivaresRDucimetierePClaudeJR1993Monocyte count: a risk factor for coronary heart disease?Am J Epidemiol13749538434572
  • PhillipsANNeatonJDCookDG1992Leukocyte count and risk of major coronary heart disease eventsAm J Epidemiol13659701415132
  • SweetmanPMThomasHFYarnellJW1997Total and differential leukocyte counts as predictors of ischemic heart disease: the Caerphilly and speedwell studiesAm J Epidemiol145416219048515
  • WeissmanGSmolenJEKorchakHM1980Release of inflammatory mediators from stimulated neutrophilsN Engl J Med30327346246431
  • ZalokarJBRichardJLClaudeJR1981Leulocyte count, smoking, and myocardial infarctionN Engl J Med30446587453772