Sleep, Chronobiology and Neuroendocrinology Research Laboratory, Department of Medicine, The University of Chicago, Chicago, IL 60637, USA.
Int J Endocrinol. 2010;2010:759234. doi: 10.1155/2010/759234. Epub 2010 Jun 9.
The daily rhythm of cortisol secretion is relatively stable and primarily under the influence of the circadian clock. Nevertheless, several other factors affect hypothalamo-pituitary-adrenal (HPA) axis activity. Sleep has modest but clearly detectable modulatory effects on HPA axis activity. Sleep onset exerts an inhibitory effect on cortisol secretion while awakenings and sleep offset are accompanied by cortisol stimulation. During waking, an association between cortisol secretory bursts and indices of central arousal has also been detected. Abrupt shifts of the sleep period induce a profound disruption in the daily cortisol rhythm, while sleep deprivation and/or reduced sleep quality seem to result in a modest but functionally important activation of the axis. HPA hyperactivity is clearly associated with metabolic, cognitive and psychiatric disorders and could be involved in the well-documented associations between sleep disturbances and the risk of obesity, diabetes and cognitive dysfunction. Several clinical syndromes, such as insomnia, depression, Cushing's syndrome, sleep disordered breathing (SDB) display HPA hyperactivity, disturbed sleep, psychiatric and metabolic impairments. Further research to delineate the functional links between sleep and HPA axis activity is needed to fully understand the pathophysiology of these syndromes and to develop adequate strategies of prevention and treatment.
皮质醇分泌的日节律相对稳定，主要受昼夜节律的影响。然而，其他一些因素也会影响下丘脑-垂体-肾上腺（HPA）轴的活动。睡眠对 HPA 轴活动有适度但可明显检测到的调节作用。睡眠开始对皮质醇分泌有抑制作用，而觉醒和睡眠结束则伴随着皮质醇的刺激。在清醒状态下，还检测到皮质醇分泌爆发与中枢觉醒指标之间存在关联。睡眠周期的突然变化会导致皮质醇日节律的严重紊乱，而睡眠剥夺和/或睡眠质量下降似乎会导致轴突的适度但功能上重要的激活。HPA 过度活跃与代谢、认知和精神障碍明显相关，并且可能与睡眠障碍与肥胖、糖尿病和认知功能障碍风险之间的已充分记录的关联有关。一些临床综合征，如失眠、抑郁症、库欣综合征、睡眠呼吸障碍（SDB），表现出 HPA 过度活跃、睡眠紊乱、精神和代谢障碍。需要进一步研究以阐明睡眠和 HPA 轴活动之间的功能联系，以充分理解这些综合征的病理生理学，并制定适当的预防和治疗策略。
