Review 1: "The Relationship Between Mental Health, Sleep Quality, and the Immunogenicity of COVID-19 Vaccinations"

Pei Xue

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

by Isabell Wagenhäuser, Julia Reusch, Alexander Gabel, Juliane Mees, Helmut Nyawale, Anna Frey, Thiên-Trí Lâm, Alexandra Schubert-Unkmeir, Lars Dölken, Oliver Kurzai, Stefan Frantz, Nils Petri, Manuel Krone, and Lukas B. Krone

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Published on Mar 01, 2023
www.medrxiv.org

Description

Abstract Sleep modulates the immune response and sleep loss can reduce the immunogenicity of certain vaccinations. Vice versa immune responses impact sleep. We aimed to investigate the influence of mental health and sleep quality on the immunogenicity of COVID-19 vaccinations and, conversely, of COVID-19 vaccinations on sleep quality.The prospective CoVacSer study monitored mental health, sleep quality, and Anti-SARS-CoV-2-Spike IgG titres in a cohort of 1,082 healthcare workers from the 29th of September 2021 to the 19th of December 2022. Questionnaires and blood samples were collected before, 14 days, and three months after the third COVID-19 vaccination. In 154 participants the assessments were also conducted before and 14 days after the fourth COVID-19 vaccination.Healthcare workers with psychiatric disorders had slightly lower Anti-SARS-CoV-2-Spike IgG levels before the third COVID-19 vaccination. However, this effect was mediated by higher median age and body mass index in this subgroup. Antibody titres following the third and fourth COVID-19 vaccination (‘booster vaccinations’) were not significantly different between subgroups with and without psychiatric disorders. Sleep quality did not affect the humoral immunogenicity of the COVID-19 vaccinations. Moreover, the COVID-19 vaccinations did not impact self-reported sleep quality.Our data suggests that in a working population neither mental health nor sleep quality relevantly impact the immunogenicity of COVID-19 vaccinations and that COVID-19 vaccinations are not a precipitating factor for insomnia. The findings from this large-scale real-life cohort study will inform clinical practice regarding the recommendation of COVID-19 booster vaccination for individuals with mental health and sleep problems.

RR:C19 Evidence Scale rating by reviewer:

Potentially informative. The main claims made are not strongly justified by the methods and data, but may yield some insight. The results and conclusions of the study may resemble those from the hypothetical ideal study, but there is substantial room for doubt. Decision-makers should consider this evidence only with a thorough understanding of its weaknesses, alongside other evidence and theory. Decision-makers should not consider this actionable, unless the weaknesses are clearly understood and there is other theory and evidence to further support it.

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Review:

The present study aims to explore the association between mental health, sleep quality, and immunogenicity of COVID-19 vaccinations. While the study addresses potentially intriguing topics, there are several significant concerns that need to be addressed:

1. The author uses the terms "psychiatric disorder" and "mental health" without defining them clearly. It is unclear whether the subjects meet the diagnostic criteria for a psychiatric disorder. If so, the specific diagnosis (e.g., anxiety, depression) and the criteria used to define it (e.g., illness course) should be clearly stated.

2. Sleep quality is a crucial factor in this study. However, it is unclear how self-reported sleep quality represents objective sleep parameters such as sleep efficiency.

3. The study should account for key covariates such as baseline diseases, the severity of the infection, physical activity, and so on, as they may confound the relationship between mental health, sleep quality, and immunogenicity of COVID-19 vaccinations.

4. The authors' conclusion that "COVID-19 vaccinations are not a precipitating factor for insomnia" is not adequately supported. It is unclear how insomnia was measured, and the study design may not have been suitable for establishing a causal relationship.

5. The possibility of acute reinfection is a crucial factor that the authors should consider. Addressing these concerns will significantly strengthen the study and provide more meaningful insights into the relationship between mental health, sleep quality, and the immunogenicity of COVID-19 vaccinations.

Since our solicitation of reviews, this preprint has been published in Journal of Sleep Research and the link to the published manuscript can be found here.