CONTEXT: The association between insomnia disorder and the hypothalamic-pituitary-adrenal (HPA) axis needs to be explored in both adults and adolescents. OBJECTIVES: Our objective was to investigate the associations of the HPA axis (via serial salivary cortisol) with insomnia disorder and subjective and objective sleep quality in a community-based study. DESIGN AND SETTING: This was a community-based case-control family study. PARTICIPANTS: Participants included 205 adolescents (14.2 ± 2.8 years old, 51.7% females, and 57 with insomnia) and 244 adults (46.4 ± 4.1 years old, 52.8% females, and 69 with insomnia). MAIN OUTCOME MEASURES: Outcome measures included a diagnostic interview for assessment of insomnia disorder, 3-day actigraphy and sleep diary, and serial salivary cortisol measurement. RESULTS: Adults with insomnia had a significantly greater cortisol awakening response (CAR) reference to increase (CARi) but a comparable CAR reference to ground and a comparable cortisol level during afternoon and evening when compared with noninsomniac adults. The association between insomnia disorder and larger CARi was also found in adolescents at late/post puberty but not in pre/early pubertal adolescents. There was an interaction effect between sex and insomnia disorder on CARi level with adult females having larger CARi than adult males. Among subjects with insomnia disorder, those with lower subjective sleep efficiency had higher cortisol levels in the late evening (10:00 pm) in both adults and adolescents. CONCLUSIONS: Our study suggests that a series of insomniac indices at both syndromal and symptomatic levels including clinical diagnosis and poor sleep quality are associated with dysfunction of the HPA axis. The association between insomnia and increased CARi emerges at late puberty, and the sex difference in this association occurs in adulthood but not in adolescence.
CONTEXT: The association between insomnia disorder and the hypothalamic-pituitary-adrenal (HPA) axis needs to be explored in both adults and adolescents. OBJECTIVES: Our objective was to investigate the associations of the HPA axis (via serial salivary cortisol) with insomnia disorder and subjective and objective sleep quality in a community-based study. DESIGN AND SETTING: This was a community-based case-control family study. PARTICIPANTS: Participants included 205 adolescents (14.2 ± 2.8 years old, 51.7% females, and 57 with insomnia) and 244 adults (46.4 ± 4.1 years old, 52.8% females, and 69 with insomnia). MAIN OUTCOME MEASURES: Outcome measures included a diagnostic interview for assessment of insomnia disorder, 3-day actigraphy and sleep diary, and serial salivary cortisol measurement. RESULTS: Adults with insomnia had a significantly greater cortisol awakening response (CAR) reference to increase (CARi) but a comparable CAR reference to ground and a comparable cortisol level during afternoon and evening when compared with noninsomniac adults. The association between insomnia disorder and larger CARi was also found in adolescents at late/post puberty but not in pre/early pubertal adolescents. There was an interaction effect between sex and insomnia disorder on CARi level with adult females having larger CARi than adult males. Among subjects with insomnia disorder, those with lower subjective sleep efficiency had higher cortisol levels in the late evening (10:00 pm) in both adults and adolescents. CONCLUSIONS: Our study suggests that a series of insomniac indices at both syndromal and symptomatic levels including clinical diagnosis and poor sleep quality are associated with dysfunction of the HPA axis. The association between insomnia and increased CARi emerges at late puberty, and the sex difference in this association occurs in adulthood but not in adolescence.
Authors: Julio Fernandez-Mendoza; Joshua H Baker; Alexandros N Vgontzas; Jordan Gaines; Duanping Liao; Edward O Bixler Journal: Brain Behav Immun Date: 2016-12-30 Impact factor: 7.217
Authors: Jihui Zhang; Ngan Yin Chan; Siu Ping Lam; Shirley Xin Li; Yaping Liu; Joey W Y Chan; Alice Pik Shan Kong; Ronald C W Ma; Kate C C Chan; Albert Martin Li; Yun-Kwok Wing Journal: Sleep Date: 2016-08-01 Impact factor: 5.849
Authors: Sandhya Kajeepeta; Sixto E Sanchez; Bizu Gelaye; Chunfang Qiu; Yasmin V Barrios; Daniel A Enquobahrie; Michelle A Williams Journal: BMC Pregnancy Childbirth Date: 2014-09-27 Impact factor: 3.007
Authors: Jihui Zhang; Siu-Ping Lam; Alice P S Kong; Ronald C W Ma; Shirley Xin Li; Joey W Y Chan; Mandy W M Yu; Junying Zhou; Michael H M Chan; Chung-Shun Ho; Albert M Li; Xiangdong Tang; Yun-Kwok Wing Journal: Sci Rep Date: 2016-03-01 Impact factor: 4.379