Influenza and insomnia are significant public health problems. The 2009 H1N1 pandemic had greater clinical impact on children and young adults;prompting the CDC to issue an H1N1 Infections Alert for Institutions of Higher Education. Although the influenza vaccine is recommended for everyone, the vaccination is ineffective in a modest percent of cases. One possibility is that concomitant health problems (e.g., insomnia) serve as stressors which can reduce the effectiveness of the influenza vaccination via suppressed antibody responses to the viral strains. Insomnia plays an integral role in host defense and development of inflammatory diseases, and is regulated by and may be altered by a number of immune messengers (e.g., cytokines). These insomnia- immune relationships need translation to the more clinically relevant area of vaccination response. Considering the prevalence of insomnia (46%-69% of primary care patients;10-15% of college students), it is critical to determine if insomnia is a risk factor for reduced response to the influenza and other vaccinations, while controlling for confounding medical conditions and medications. Major theories suggest that once insomnia becomes chronic, it becomes a major stressor, and is no longer a result of stress. If this is true, then it would follow that insomnia would result in reduced effectiveness of the influenza vaccination via suppressed antibody responses to the viral strains. The proposed R15 (AREA) pilot study moves beyond the paradigm of measuring isolated immune factors to a more integrated, systemic view of immune function, and is the first exploration of in vivo immune response in a healthy young adult insomnia population. The primary aim of the proposed study is to determine if insomnia is a risk factor for lower influenza vaccine antibody response. To test this aim, a repeated-measures between subjects design will be used to assess groups differences (people with insomnia vs. people without insomnia) pre-vaccination and 4 weeks post-vaccination on measures of antibody titers for the specific influenza strains (including H1N1) used in the yearly vaccine. Insomnia diagnoses will be determined with clinical interview. Antibody amounts, antibody sub-class and quality will be measured utilizing hemagglutination inhibition (HI), serum anti-influenza IgG and IgG1, and a virus neutralization assay. Recruitment will occur over 2 years/influenza seasons (32 subjects per group each year), with a final sample size of N=128. It is likely that each yearly vaccine will be comprised of different viral strains (determined yearly by the World Health Organization). The current design will allow assessment of antibody response to the influenza vaccine as a whole (i.e., including all possible virus strains over 2 years) using MANOVA, as well as each individual virus strain per year using follow-up ANOVA. All immune assays (HI, ELISA, viral neutralization) will be performed at the Iowa State University Health and Human Performance research laboratory. Additional analyses will examine a meditational role between insomnia and stress, as well as determining if other measures of sleep disturbance are better predictors of antibody response.

Public Health Relevance

Influenza and other communicable diseases pose a significant health risk to the American public. Vaccines are available for many of these diseases, but they are not always effective. Insomnia is a highly prevalent disease that may suppress immune functioning and reduce the effectiveness of these vaccines. If evidence supports this, then treating insomnia may become an important public health initiative to help improve the prevention of communicable diseases.

National Institute of Health (NIH)
National Institute of Allergy and Infectious Diseases (NIAID)
Academic Research Enhancement Awards (AREA) (R15)
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Biobehavioral Mechanisms of Emotion, Stress and Health Study Section (MESH)
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Kim, Sonnie
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University of North Texas
Schools of Arts and Sciences
United States
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Taylor, Daniel J; Kelly, Kimberly; Kohut, Marian L et al. (2017) Is Insomnia a Risk Factor for Decreased Influenza Vaccine Response? Behav Sleep Med 15:270-287