title: [Immune outcomes of sleep disorders: the hypothalamic-pituitary-adrenal axis as a modulatory factor].
abstract: OBJECTIVE
  To review the literature on the interaction between sleep and the immune system.
  
  
  METHODS
  A search on Web of Science and Pubmed database including the keywords sleep, sleep deprivation, stress, hypothalamic-pituitary-adrenal axis, immune system, and autoimmune diseases.
  
  
  RESULTS
  On Web of Science, 588 publications were retrieved; 61 references, more significant and closer to our objective, were used, including original articles and review papers.
  
  
  CONCLUSIONS
  Sleep deprivation and immune system exert a bidirectional influence on each other. Since sleep deprivation is considered a stressor, inasmuch as it induces elevation of cortisol or corticosterone levels in humans and rodents, respectively, and given the well-known immunosuppressive effect of glucocorticoids, we propose that increased activation of the hypothalamic-pituitary-adrenal axis is a major mediator of the immune alterations observed in patients with insomnia or in sleep deprived subjects.
authors.affiliation: Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Beatriz Duarte
authors.initials: BD
authors.lastname: Palma
authors.forename: Paula Ayako
authors.initials: PA
authors.lastname: Tiba
authors.forename: Ricardo Borges
authors.initials: RB
authors.lastname: Machado
authors.forename: Sergio
authors.initials: S
authors.lastname: Tufik
authors.forename: Deborah
authors.initials: D
authors.lastname: Suchecki
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D000818:Animals; D002940:Circadian Rhythm / Q000502:physiology; D005938:Glucocorticoids / Q000378:metabolism; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D007030:Hypothalamo-Hypophyseal System / Q000502:physiology*; D007107:Immune System / Q000502:physiology*; D010913:Pituitary-Adrenal System / Q000502:physiology*; D012890:Sleep / Q000276:immunology / Q000502:physiology*; D012892:Sleep Deprivation / Q000276:immunology / Q000503:physiopathology*; D020178:Sleep Disorders, Circadian Rhythm / Q000503:physiopathology; D012895:Sleep, REM; D013312:Stress, Physiological / Q000503:physiopathology*
chemical_list: D005938:Glucocorticoids; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone