Maurer Natalie, Perkinson-Gloor Nadine, Stalder Tobias, Hagmann-von Arx Priska, Brand Serge, Holsboer-Trachsler Edith, Wellmann Sven, Grob Alexander, Weber Peter, Lemola Sakari
University of Basel, Department of Psychology, Basel, Switzerland.
Technische Universität Dresden, Department of Psychology, Dresden, Germany.
Psychoneuroendocrinology. 2016 Oct;72:166-74. doi: 10.1016/j.psyneuen.2016.07.003. Epub 2016 Jul 6.
Very preterm birth involves increased stress for the child, which may lead to programming of the hypothalamic-pituitary-adrenal (HPA) axis activity and poor sleep in later life. Moreover, there is evidence for a relationship between HPA axis activity and sleep. However, research with objective sleep measures in very preterm children during school-age is rare. Eighty-five healthy children born very preterm (<32nd gestational week) and 91 full-term children aged 7-12 years were recruited for the present study. To assess HPA axis activity, salivary cortisol was measured at awakening, 10, 20, and 30min later. In addition, hair cortisol and cortisone concentrations were quantified using liquid chromatography tandem mass spectrometry to assess cumulative endocrine activity over the preceding months. One night of in-home polysomnographic sleep assessment was conducted to assess sleep duration, sleep continuity, and sleep architecture. Children born very preterm showed significantly lower levels of cortisol at awakening and lower overall post-awakening cortisol secretion, lower cortisone in hair, and earlier sleep onset than full-term children. Across the whole sample, overall post-awakening cortisol secretion was positively related to sleep onset time and negatively to sleep duration. The association between prematurity status and post-awakening cortisol secretion was partially mediated by earlier sleep onset time. In conclusion, this study provides evidence for a possible down-regulation of the HPA axis activity and slightly earlier sleep phase in very preterm children during school age.
极早产会给儿童带来更大的压力，这可能导致下丘脑-垂体-肾上腺（HPA）轴活动编程，并在日后生活中出现睡眠不佳的情况。此外，有证据表明HPA轴活动与睡眠之间存在关联。然而，针对学龄期极早产儿童进行客观睡眠测量的研究却很少见。本研究招募了85名极早产（<孕32周）的健康儿童和91名7至12岁的足月儿。为评估HPA轴活动，在觉醒时、觉醒后10、20和30分钟测量唾液皮质醇。此外，使用液相色谱串联质谱法定量测定头发中的皮质醇和可的松浓度，以评估前几个月的累积内分泌活动。进行了一晚的家庭多导睡眠图睡眠评估，以评估睡眠时间、睡眠连续性和睡眠结构。极早产儿童在觉醒时的皮质醇水平显著低于足月儿，觉醒后总体皮质醇分泌较低，头发中的可的松含量较低，入睡时间也比足月儿早。在整个样本中，觉醒后总体皮质醇分泌与入睡时间呈正相关，与睡眠时间呈负相关。早产状态与觉醒后皮质醇分泌之间的关联部分由较早的入睡时间介导。总之，本研究为学龄期极早产儿童HPA轴活动可能下调以及睡眠阶段略早提供了证据。
