The Causal Associations of Altered Inflammatory Proteins with Sleep Duration, Insomnia and Daytime Sleepiness.

Abstract

Growing evidence linked inflammation with sleep. This study aimed to evaluate the associations and causal effects of sleep traits including insomnia, excessive daytime sleepiness (EDS) and sleep duration (short:<7h; normal:7-9h; long:≥9h), with levels of C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α) and interleukins. Standard procedures of quantitative analysis were applied to estimate the expression differences for each protein in compared groups. Then, a two-sample Mendelian randomization (MR) analysis was performed to explore their causal relationships with published GWAS summary statistics. The inverse-variance weighted (IVW) was used as the primary method, followed by several complementary approaches as sensitivity analyses. A total of 44 publications with 51879 participants were included in the quantitative analysis. Our results showed that the levels of CRP, IL-1β, IL-6 and TNF-α were higher from 0.36 to 0.58 (after standardization) in insomnia compared to controls, while there was no significant difference between participants with EDS and controls. Besides, there was a U/J-shaped expression of CRP and IL-6 with sleep durations. In MR analysis, the primary results demonstrated the causal effects of CRP on sleep duration (estimate:0.017; 95% CI, [0.003, 0.031]) and short sleep duration (estimate:-0.006; 95% CI, [-0.011, -0.001]). Also, IL-6 was found to be associated with long sleep duration (estimate:0.006; 95% CI, [0.000, 0.013]). These results were consistent in sensitivity analyses. There are high inflammatory profiles in insomnia and extremes of sleep duration. Meanwhile, elevated CRP and IL-6 have causal effects on longer sleep duration. Further studies can focus on related upstream and downstream mechanisms.