A Community-Based Study on the Association Between Insomnia and Hypothalamic-Pituitary-Adrenal Axis: Sex and Pubertal Influences (original) (raw)
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1Departments of Psychiatry (J.Z., S.-P.L., S.X.L., Y.-K.W.), Hong Kong SAR, China
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1Departments of Psychiatry (J.Z., S.-P.L., S.X.L., Y.-K.W.), Hong Kong SAR, China
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1Departments of Psychiatry (J.Z., S.-P.L., S.X.L., Y.-K.W.), Hong Kong SAR, China
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2Medicine and Therapeutics (R.C.W.M., A.P.S.K.), Hong Kong SAR, China
5 Li Ka Shing Institute of Health Sciences (R.C.W.M., A.P.S.K.), The Chinese University of Hong Kong, Hong Kong SAR, China
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2Medicine and Therapeutics (R.C.W.M., A.P.S.K.), Hong Kong SAR, China
5 Li Ka Shing Institute of Health Sciences (R.C.W.M., A.P.S.K.), The Chinese University of Hong Kong, Hong Kong SAR, China
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3Chemical Pathology (M.H.M.C., C.-S.H.), Hong Kong SAR, China
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3Chemical Pathology (M.H.M.C., C.-S.H.), Hong Kong SAR, China
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4Paediatrics (A.M.L.), Hong Kong SAR, China
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1Departments of Psychiatry (J.Z., S.-P.L., S.X.L., Y.-K.W.), Hong Kong SAR, China
*Address all correspondence and requests for reprints to: Dr Y. K. Wing, Professor, Director of Sleep Assessment Unit, Department of Psychiatry, Shatin Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR.
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Received:
09 October 2013
Accepted:
28 February 2014
Cite
Jihui Zhang, Siu-Ping Lam, Shirley Xin Li, Ronald C. W. Ma, Alice P. S. Kong, Michael H. M. Chan, Chung-Shun Ho, Albert M. Li, Yun-Kwok Wing, A Community-Based Study on the Association Between Insomnia and Hypothalamic-Pituitary-Adrenal Axis: Sex and Pubertal Influences, The Journal of Clinical Endocrinology & Metabolism, Volume 99, Issue 6, 1 June 2014, Pages 2277–2287, https://doi.org/10.1210/jc.2013-3728
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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.
Copyright © 2014 by the Endocrine Society
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