Mohammadi Hiwa, Rezaei Mohammad, Amiri Seyed Mojtaba, Rahimi Zohreh, Mansouri Kamran, Khazaie Habibolah
Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Department of Neurology, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Basic Clin Neurosci. 2018 Nov-Dec;9(6):397-407. doi: 10.32598/bcn.9.6.397. Epub 2018 Nov 1.
There are controversial reports about association between sleep and Hypothalamic-Pituitary-Adrenal (HPA) activity. Studies have reported the influence of insomnia on HPA hormones. However, they usually ignored the heterogeneity of insomnia symptoms, so subtypes of the disorder have not been considered in the reports. The present study aimed to investigate the final and intermediate products of HPA system among a group of psychophysiological and paradoxical insomniac patients in comparison to a group of normal sleepers.
We investigated the awakening serum level of Adrenocorticotropic Hormone (ACTH) and cortisol after one night Polysomnography (PSG) in 17 subjects with psychophysiological insomnia, 19 subjects with paradoxical insomnia and 17 subjects with normal sleep profile. Groups were matched for age and Body Mass Index (BMI). Serum levels of ACTH and cortisol were measured by Enzyme-Linked Immunosorbent Assay (ELISA) method.
Although, a tendency toward elevation of both ACTH and cortisol was observed among patients with paradoxical insomnia compared to both control and psychophysiological insomnia, the differences were not significant comparing three groups. According to regression analysis, higher Non-Rapid Eye Movement sleep (NREM) arousal and Pulse Transit Time (PTT) significantly predicted higher level of ACTH.
These findings could suggest the personality traits hypothesis for paradoxical insomnia. Both cortical and subcortical arousal could lead to more HPA activity and higher ACTH level. Further studies are recommended to confirm the hypothesis.
关于睡眠与下丘脑 - 垂体 - 肾上腺（HPA）活动之间的关联，存在有争议的报道。已有研究报告了失眠对HPA激素的影响。然而，这些研究通常忽略了失眠症状的异质性，因此在报告中未考虑该疾病的亚型。本研究旨在调查一组心理生理性失眠患者和矛盾性失眠患者中HPA系统的终末产物和中间产物，并与一组正常睡眠者进行比较。
我们在17名心理生理性失眠患者、19名矛盾性失眠患者和17名睡眠状况正常的受试者中，通过一夜的多导睡眠图（PSG）检查后，调查其促肾上腺皮质激素（ACTH）和皮质醇的觉醒血清水平。各组在年龄和体重指数（BMI）方面进行了匹配。采用酶联免疫吸附测定（ELISA）法测量ACTH和皮质醇的血清水平。
虽然与对照组和心理生理性失眠患者相比，矛盾性失眠患者中ACTH和皮质醇均有升高的趋势，但三组之间的差异并不显著。根据回归分析，较高的非快速眼动睡眠（NREM）觉醒和脉搏传输时间（PTT）显著预测了较高水平的ACTH。
这些发现可能提示矛盾性失眠的人格特质假说。皮层和皮层下觉醒均可能导致更多的HPA活动和更高的ACTH水平。建议进一步研究以证实该假说。
