Effects of probiotics and paraprobiotics on subjective and objective sleep metrics: A systematic review and meta-analysis

Khalesi, S ORCiD: 0000-0002-8208-2518Inadequate sleep (i.e., duration and/or quality) is becoming increasingly recognized as a global public health issue. Interaction via the gut-brain axis suggests that modification of the gut microbial environment via supplementation with live microorganisms (probiotics) or nonviable microorganisms/microbial cell fractions (paraprobiotics) may improve sleep health. This systematic review and meta-analysis aimed to clarify the effect of consuming probiotics/paraprobiotics on subjective and objective sleep metrics. Online databases were searched from 1980 to October 2019 for studies involving adults who consumed probiotics or paraprobiotics in controlled trials, during which, changes in subjective and/or objective sleep parameters were examined. A total of 14 studies (20 trials) were included in meta-analysis. Random effects meta-analyses indicated that probiotics/paraprobiotics supplementation significantly reduced Pittsburgh Sleep Quality Index (PSQI) score (i.e., improved sleep quality) relative to baseline (−0.78-points, 95% confidence interval: 0.395–1.166; p < 0.001). No significant effect was found for changes on other subjective sleep scales, nor objective parameters of sleep (efficiency/latency) measured using polysomnography or actigraphy. Subgroup analysis for PSQI data suggested that the magnitude of the effect was greater (although not statistically) in healthy participants than those with a medical condition, when treatment contained a single (rather than multiple) strain of probiotic bacteria, and when the duration of treatment was ≥8 weeks. Probiotics/paraprobiotics supplementation may have some efficacy in improving perceived sleep health, measured using the PSQI. While current evidence does not support a benefit of consuming probiotics/paraprobiotics when measured by other subjective sleep scales, nor objective measures of sleep; more studies using well-controlled, within-subject experimental designs are needed. © 2020, The Author(s), under exclusive licence to Springer Nature Limited

Why does the microbiome affect behaviour?

Growing evidence indicates that the mammalian microbiome can affect behaviour, and several symbionts even produce neurotransmitters. One common explanation for these observations is that symbionts have evolved to manipulate host behaviour for their benefit. Here, we evaluate the manipulation hypothesis by applying evolutionary theory to recent work on the gut-brain axis. Although the theory predicts manipulation by symbionts under certain conditions, these appear rarely satisfied by the genetically diverse communities of the mammalian microbiome. Specifically, any symbiont investing its resources to manipulate host behaviour is expected to be outcompeted within the microbiome by strains that do not manipulate and redirect their resources into growth and survival. Moreover, current data provide no clear evidence for manipulation. Instead, we show how behavioural effects can readily arise as a by-product of natural selection on microorganisms to grow within the host and natural selection on hosts to depend upon their symbionts. We argue that understanding why the microbiome influences behaviour requires a focus on microbial ecology and local effects within the host