Platelet count and sleep quality in immune thrombocytopenia: correlation with 5-hydroxytryptamine and therapeutic implications of platelet-5-HT-melatonin axis dysregulation
Abstract
Background Immune thrombocytopenia (ITP) disrupts platelet homeostasis via autoimmune mechanisms, yet its systemic effects beyond bleeding risk remain poorly characterized. Sleep disturbances are frequently reported in ITP patients, but the relationship between thrombocytopenia, serotonergic signaling, and sleep architecture remains undefined. This study investigates whether platelet dynamics modulate sleep quality through the “platelet-5-HT-melatonin axis” and explores therapeutic implications of this axis in ITP. Methods In a prospective longitudinal cohort of 87 ITP patients (baseline platelet count: 28.7 ± 15.2 × 109/L) and 71 healthy controls, sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI) at baseline and after 12 weeks of standard glucocorticoid therapy. Subgroup analysis stratified patients by platelet count (10). After treatment, patients achieving platelet normalization (>100 × 109/L) showed significant improvements in sleep latency (−23.5%, p = 0.008), duration (+18.2%, p = 0.02), and 5-HT levels (+42.7%, p < 0.001), alongside reduced fatigue scores. Mechanistically, thrombocytopenia impaired 5-HT uptake and reduced nocturnal melatonin secretion, while elevated hs-CRP and IL-6 indicated inflammation-driven hypothalamic-pituitary-adrenal axis dysregulation. Conclusion ITP-associated thrombocytopenia disrupts sleep architecture through serotonergic dysregulation and chronic inflammation. Standard glucocorticoid therapy not only restores…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 87 participants or records.
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