Department of Psychology, ACSENT Laboratory.
Centre for Higher Education Development, Department of Medicine, University of Cape Town, Cape Town, South Africa.
Eur J Endocrinol. 2018 Oct 16;179(5):319-330. doi: 10.1530/EJE-18-0439.
Cortisol plays a key role in initiating and maintaining different sleep stages. Patients with Addison's disease (AD) frequently report disrupted sleep, and their hydrocortisone medication regimes do not restore the natural diurnal rhythm of cortisol. However, few studies have investigated relations between sleep quality, especially as measured by polysomnographic equipment, and night-time cortisol concentrations in patients with AD.
We used sleep-adapted EEG to monitor a full night of sleep in 7 patients with AD and 7 healthy controls. We sampled salivary cortisol before bedtime, at midnight, upon awakening, and at 30-minutes post-waking.
Controls had lower cortisol concentrations than patients before bedtime and at midnight. During the second half of the night, patient cortisol concentrations declined steeply, while control concentrations increased steadily. Whereas most controls experienced a positive cortisol awakening response, all patients experienced a decrease in cortisol concentrations from waking to 30-minutes post-waking (P = .003). Patients experienced significantly lower proportions of slow-wave sleep (SWS; P = .001), which was associated with elevated night-time cortisol concentrations.
Overall, these results suggest that patients with AD demonstrate different patterns of night-time cortisol concentrations to healthy controls, and that relatively elevated concentrations are associated with a reduction of SWS. These hormonal and sleep architectural aberrations may disrupt the routine sleep-dependent processes of memory consolidation, and hence may explain, at least partially, the memory impairments often experienced by patients with AD.
皮质醇在启动和维持不同睡眠阶段方面起着关键作用。患有艾迪生病（Addison's disease，AD）的患者经常报告睡眠中断，其氢化可的松治疗方案并不能恢复皮质醇的自然昼夜节律。然而，很少有研究调查 AD 患者的睡眠质量（尤其是通过多导睡眠图设备测量的睡眠质量）与夜间皮质醇浓度之间的关系。
我们使用睡眠适应的 EEG 监测 7 名 AD 患者和 7 名健康对照者的一整个晚上的睡眠。我们在睡前、午夜、醒来时和醒来后 30 分钟时采集唾液皮质醇样本。
与患者相比，对照组在睡前和午夜时皮质醇浓度较低。在夜间的后半段，患者的皮质醇浓度急剧下降，而对照组的皮质醇浓度则稳步上升。虽然大多数对照组经历了皮质醇觉醒反应，但所有患者从醒来到醒来后 30 分钟时皮质醇浓度都下降（P =.003）。患者经历的慢波睡眠（slow-wave sleep，SWS）比例明显较低（P =.001），这与夜间皮质醇浓度升高有关。
总的来说，这些结果表明，AD 患者的夜间皮质醇浓度与健康对照组表现出不同的模式，而相对较高的浓度与 SWS 减少有关。这些激素和睡眠结构的异常可能会破坏睡眠依赖性记忆巩固的常规过程，因此至少可以部分解释 AD 患者经常经历的记忆障碍。
