Steiger Axel
a Max Planck Institute of Psychiatry, Department of Psychiatry, Kraepelinstrasse 10, 80804 Munich, Germany.
Expert Rev Endocrinol Metab. 2006 Sep;1(5):609-622. doi: 10.1586/17446651.1.5.609.
A bidirectional interaction exists between the electrophysiological and neuroendocrine components of sleep. The first is represented by the nonrapid eye movement sleep (NREMS) and rapid eye movement sleep (REMS) cycles, the latter by distinct patterns of the secretion of various hormones. Certain hormones (neuropeptides and steroids) play a specific role in sleep regulation. Changes in their activity contribute to the pathophysiology of sleep disorders. A reciprocal interaction of the peptides growth hormone-releasing hormone (GHRH) and corticotropin-releasing hormone (CRH) plays a key role in sleep regulation. GHRH promotes growth hormone secretion and, at least in males, NREMS, whereas CRH impairs NREMS, promotes REMS and stimulates the secretion of adrenocorticotropic hormone and cortisol. Changes in the CRH:GHRH ratio in favor of CRH contribute to impaired sleep, elevated cortisol secretion and blunted GH levels during depression and normal aging. However, in women, GHRH exerts CRH-like effects. Galanin, ghrelin and neuropeptide Y are other sleep-promoting peptides, whereas somatostatin impairs sleep. A decline of orexin activity causes narcolepsy. In addition to CRH overactivity, hypercortisolism appears to be involved in the pathophysiology of sleep- electroencephalogram (EEG) changes in depression. Various neuroactive steroids exert specific effects on sleep. The changes of sleep EEG in women after the menopause are related to the decline of estrogen and progesterone. Furthermore, sleep-EEG changes in dwarfism, acromegaly, Addison's disease, Cushing's disease, brain injury, sleep apnea syndrome, primary insomnia, prolactinoma and dementia appear to be related to changes in the activity of peptides and steroids.
睡眠的电生理和神经内分泌成分之间存在双向相互作用。前者以非快速眼动睡眠（NREMS）和快速眼动睡眠（REMS）周期为代表，后者以各种激素分泌的不同模式为代表。某些激素（神经肽和类固醇）在睡眠调节中起特定作用。它们活性的变化会导致睡眠障碍的病理生理学改变。肽类生长激素释放激素（GHRH）和促肾上腺皮质激素释放激素（CRH）的相互作用在睡眠调节中起关键作用。GHRH促进生长激素分泌，至少在男性中还促进NREMS，而CRH会损害NREMS、促进REMS并刺激促肾上腺皮质激素和皮质醇的分泌。CRH:GHRH比值向有利于CRH的方向变化会导致抑郁和正常衰老过程中睡眠受损、皮质醇分泌增加以及生长激素水平降低。然而，在女性中，GHRH发挥类似CRH的作用。甘丙肽、胃饥饿素和神经肽Y是其他促进睡眠的肽类，而生长抑素会损害睡眠。食欲素活性下降会导致发作性睡病。除了CRH活性过高外，高皮质醇血症似乎也参与了抑郁症患者睡眠脑电图（EEG）变化的病理生理学过程。各种神经活性类固醇对睡眠有特定影响。绝经后女性睡眠EEG的变化与雌激素和孕激素水平下降有关。此外，侏儒症、肢端肥大症、艾迪生病、库欣病、脑损伤、睡眠呼吸暂停综合征、原发性失眠、催乳素瘤和痴呆症患者的睡眠EEG变化似乎与肽类和类固醇活性的改变有关。
