Saridjan Nathalie S, Kocevska Desana, Luijk Maartje P C M, Jaddoe Vincent W V, Verhulst Frank C, Tiemeier Henning
From the The Generation R Study Group (Saridjan, Kocevska, Luijk, Jaddoe), Erasmus MC-University Medical Center; Department of Child and Adolescent Psychiatry (Saridjan, Kocevska, Verhulst, Tiemeier), Erasmus MC-Sophia Children's Hospital; School of Pedagogical and Educational Sciences (Luijk), Erasmus University Rotterdam; Department of Epidemiology (Jaddoe, Tiemeier), Erasmus Medical Center; and Department of Pediatrics (Jaddoe), Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
Psychosom Med. 2017 Jun;79(5):557-564. doi: 10.1097/PSY.0000000000000440.
Cortisol, the end product of the hypothalamic-pituitary-adrenal axis, plays an important role in modulating sleep. Yet, studies investigating the association between diurnal cortisol rhythm and sleep patterns in young children are scarce. We tested the hypothesis that the diurnal cortisol rhythm is associated with shorter sleep duration and more sleep problems across early childhood.
This study was embedded in Generation R, a population-based cohort from fetal life onward. Parents collected saliva samples from their infant at five moments during day 1. In 322 infants aged 12 to 20 months, we determined the diurnal cortisol rhythm by calculating the area under the curve (AUC), the cortisol awakening response (CAR), and the diurnal slope. Sleep duration and sleep behavior were repeatedly assessed across ages of 14 months to 5 years. Generalized estimating equation models were used to assess related cortisol measures to sleep duration and sleep behavior.
The diurnal cortisol slope and the CAR, but not the AUC, were associated with sleep duration across childhood. Children with flatter slopes and children with a more positive CAR were more likely to have shorter nighttime sleep duration (β per nmol/L/h slope = -0.12, 95% confidence interval = -0.19 to -0.05, p = .001; β per nmol/L CAR = -0.01, 95% confidence interval = -0.02 to 0.00, p = .04). Cortisol measures did not predict sleep problems.
The present study suggests that a flatter diurnal cortisol slope and a more marked morning rise, which can indicate stress (or hypothalamic-pituitary-adrenal dysregulation), have a long-term association with sleep regulation.
皮质醇是下丘脑-垂体-肾上腺轴的终产物，在调节睡眠方面发挥重要作用。然而，关于幼儿日间皮质醇节律与睡眠模式之间关联的研究较少。我们检验了这样一个假设：在整个幼儿期，日间皮质醇节律与较短的睡眠时间及更多的睡眠问题相关。
本研究纳入了“R世代”队列，这是一个从胎儿期开始的基于人群的队列研究。父母在第1天的五个时间点采集婴儿的唾液样本。在322名12至20个月大的婴儿中，我们通过计算曲线下面积（AUC）、皮质醇觉醒反应（CAR）和日间斜率来确定日间皮质醇节律。在14个月至5岁的不同年龄段反复评估睡眠时间和睡眠行为。使用广义估计方程模型来评估与睡眠时间和睡眠行为相关的皮质醇指标。
日间皮质醇斜率和CAR与整个儿童期的睡眠时间相关，但AUC与睡眠时间无关。斜率较平缓的儿童和CAR较正向的儿童夜间睡眠时间更短的可能性更大（每nmol/L/h斜率的β=-0.12，95%置信区间=-0.19至-0.05，p=0.001；每nmol/L CAR的β=-0.01，95%置信区间=-0.02至0.00，p=0.04）。皮质醇指标不能预测睡眠问题。
本研究表明，较平缓的日间皮质醇斜率和更显著的早晨升高，这可能表明存在压力（或下丘脑-垂体-肾上腺调节失调），与睡眠调节存在长期关联。
