COMMENTARY

Fractured Sleep Exacts a Heavy Toll

David A. Johnson, MD

Disclosures

February 19, 2014

In This Article

Profound Implications for Sleep Health

This has profound implications for the advancement of tumorigenesis, immunosuppressive cytokines, the development of apoptosis resistance, and the promotion of cellular adhesion for the cancer cells. This may also have implications for chemotherapy, as we look at these pathways and potentially find ways to target the TLR4 signalling pathway with chemotherapy. We do know from colon cancer that patients who have early relapse also have upregulation of TLR4, so there are implications for counseling patients about sleep.

Returning to the animal model, the researchers also looked at tumor-associated macrophages (TAMs) in these cancers, of which there are 2 types: M1 and M2.

M1 is a macrophage that protects and upregulates the immune system and protects it against cancer cells. M1 was more evident in the mice that had normal sleep, and it was markedly reduced in the sleep-deprived mice.

The opposite was true for M2, which is a deleterious cell that promotes angiogenesis and inhibits the immune system. As you might expect, in these sleep-deprived mice, M2 was increased, and decreased in the mice with normal sleep.

So let's put it all together. Sleep deprivation, or fragmentation, has profound implications for cancer biology. From a gastroenterology standpoint, it has profound implications, because it may be related to colon cancer and gastric cancer and is certainly in the pathway to chronic bowel disease and its progression to cancer genesis.

Where this plays out with respect to the activity of inflammatory bowel disease, I can't speak to at this point. However, the implications for cancer are fairly profound. We talked earlier about sleep and the implications for multiple disease states -- virtually all of the systems of the body are affected.

It's time that we start talking to our patients about this. Patients who are sick need to hear this more clearly, and for prevention, we can perhaps do more proactively to reduce the risk for cancer. Instead of looking at sleep and saying, "I only slept 3 hours last night," as a macho thing, it's time to say, "How dare you harm yourself. You can do better."

We need to open up our eyes to the value of closing them. Take the time to talk to your patients about what you do. We are probably the most sleep-deprived group of people that we know, but nonetheless, we need to do a better job in the education of our patients.

I'm Dr. David Johnson. Thanks for listening.

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