Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA 98195-7266, USA.
Neurogastroenterol Motil. 2012 Jul;24(7):626-31, e270-1. doi: 10.1111/j.1365-2982.2012.01915.x. Epub 2012 Apr 3.
Evidence suggests that subgroups of patients with irritable bowel syndrome (IBS) are hyper-responsive to a variety of laboratory stress conditions.
This study compared sleep quality and night time plasma adrenocorticotropic hormone (ACTH) and serum cortisol levels in response to anticipation of public speaking between 43 women with IBS and 24 healthy control women. In addition, comparisons were made between subgroups within the IBS sample based on predominant stool patterns, 22 IBS-constipation and 21 IBS-diarrhea. Subjects slept three nights in a sleep laboratory, and on the third night serial blood samples were drawn every 20 min from 08:00 PM until awakening. As the subjects had different sleep onsets, each subject's results were synchronized to the first onset of stage 2 sleep.
Compared the healthy control group, women with IBS had significantly worse sleep efficiency, and higher cortisol but not ACTH levels over the night. However, there were no IBS bowel pattern subgroup differences. Among IBS subjects, cortisol levels early in the night were higher than found in our previous study with a similar protocol but without the threat of public speaking. These results suggest that a social stressor, such as public speaking prior to bedtime, increases cortisol but not ACTH levels suggesting HPA dysregulation in women with IBS.
CONCLUSIONS & INFERENCES: This response to a social stressor contributes to our understanding of the relationship of stress to symptom expression in IBS.
有证据表明，肠易激综合征（IBS）患者存在亚组人群，他们对各种实验室应激条件反应过度。
本研究比较了 43 名 IBS 女性和 24 名健康对照组女性在预期公开演讲前后的睡眠质量以及夜间血浆促肾上腺皮质激素（ACTH）和血清皮质醇水平。此外，还根据主要排便模式，对 IBS 样本中的亚组进行了比较，其中包括 22 名 IBS-便秘和 21 名 IBS-腹泻患者。研究对象在睡眠实验室中连续睡三晚，在第三晚，从晚上 8 点开始每 20 分钟采集一次连续的血液样本，直到醒来。由于研究对象的入睡时间不同，每个研究对象的结果都与进入第二阶段睡眠的第一时间同步。
与健康对照组相比，IBS 女性的睡眠效率明显较差，夜间皮质醇水平较高，但 ACTH 水平没有差异。然而，IBS 排便模式亚组之间没有差异。在 IBS 患者中，夜间早期的皮质醇水平高于我们之前进行的一项具有相似方案但没有睡前公开演讲威胁的研究。这些结果表明，像睡前公开演讲这样的社会应激源会增加皮质醇但不会增加 ACTH 水平，提示 IBS 患者的 HPA 失调。
对这种社会应激源的反应有助于我们理解压力与 IBS 症状表达之间的关系。
