Northumbria Sleep Research, Northumbria University, Newcastle upon Tyne, UK.
Institut de Neurosciences Cognitives et Intégratives d'Aquitaine-UMR 5287 CNRS, Team Neuroimaging and Human Cognition, Université de Bordeaux, Bordeaux, France.
J Sleep Res. 2023 Aug;32(4):e13842. doi: 10.1111/jsr.13842. Epub 2023 Feb 7.
Stress and sleep are very closely linked, and stressful life events can trigger acute insomnia. The ongoing COVID-19 pandemic is highly likely to represent one such stressful life event. Indeed, a wide range of cross-sectional studies demonstrate that the pandemic is associated with poor sleep and sleep disturbances. Given the high economic and health burden of insomnia disorder, strategies that can prevent and treat acute insomnia, and also prevent the transition from acute insomnia to insomnia disorder, are necessary. This narrative review outlines why the COVID-19 pandemic is a stressful life event, and why activation of the hypothalamic-pituitary-adrenal axis, as a biological marker of psychological stress, is likely to result in acute insomnia. Further, this review outlines how sleep disturbances might arise as a result of the COVID-19 pandemic, and why simultaneous hypothalamic-pituitary-adrenal axis measurement can inform the pathogenesis of acute insomnia. In particular, we focus on the cortisol awakening response as a marker of hypothalamic-pituitary-adrenal axis function, as cortisol is the end-product of the hypothalamic-pituitary-adrenal axis. From a research perspective, future opportunities include identifying individuals, or particular occupational or societal groups (e.g. frontline health staff), who are at high risk of developing acute insomnia, and intervening. From an acute insomnia treatment perspective, priorities include testing large-scale online behavioural interventions; examining if reducing the impact of stress is effective and, finally, assessing whether "sleep vaccination" can maintain good sleep health by preventing the occurrence of acute insomnia, by preventing the transition from acute insomnia to insomnia disorder.
压力和睡眠密切相关，压力大的生活事件会引发急性失眠。持续的 COVID-19 大流行极有可能是这样一种压力大的生活事件。事实上，大量的横断面研究表明，大流行与睡眠不佳和睡眠障碍有关。鉴于失眠症的高经济和健康负担，需要采取预防和治疗急性失眠症的策略，同时也需要预防从急性失眠症到失眠症的转变。这篇叙述性综述概述了为什么 COVID-19 大流行是一种压力大的生活事件，以及为什么下丘脑-垂体-肾上腺轴的激活作为心理压力的生物学标志物，可能导致急性失眠症。此外，本综述还概述了 COVID-19 大流行如何导致睡眠障碍，并解释了为什么同时测量下丘脑-垂体-肾上腺轴可以阐明急性失眠症的发病机制。特别是，我们重点关注皮质醇觉醒反应作为下丘脑-垂体-肾上腺轴功能的标志物，因为皮质醇是下丘脑-垂体-肾上腺轴的终产物。从研究的角度来看，未来的机会包括确定处于急性失眠高风险的个体或特定职业或社会群体（例如一线医护人员），并进行干预。从急性失眠症治疗的角度来看，优先事项包括测试大规模的在线行为干预措施；研究减轻压力的影响是否有效，最后，评估“睡眠疫苗接种”是否可以通过预防急性失眠症的发生，预防从急性失眠症到失眠症的转变，从而保持良好的睡眠健康。
