Center for Health Sciences, SRI International, Menlo Park, CA, USA.
Center for Health Sciences, SRI International, Menlo Park, CA, USA; Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa.
Int J Psychophysiol. 2023 May;187:43-53. doi: 10.1016/j.ijpsycho.2023.02.006. Epub 2023 Feb 22.
Abnormal stress responses have been linked to the etiology of insomnia. We investigated the relationship between insomnia, stress, hypothalamic-pituitary-adrenal (HPA) axis activity, and autonomic nervous system (ANS) function in adolescence.
Forty-seven post-pubertal adolescents (16-20 years old, 28 female) with (N = 16; insomnia group) and without (N = 31; control group) DSM-5 insomnia symptoms were assessed for stress levels and stress reactivity and underwent a standardized stress protocol (Trier Social Stress Test (TSST)), after an overnight laboratory stay. Cortisol was measured upon awakening and 30-minutes later to calculate the cortisol awakening response (CAR). During the TSST, perceived stress, salivary cortisol (HPA activity), heart rate (HR) and blood pressure (BP) measures were collected.
Participants in the insomnia group reported more stress from school performance and work overload, with insomnia girls experiencing more stress from peer pressure and future uncertainty than control girls (p < 0.05). No group differences were detected in the CAR and pre-TSST stress levels. All participants showed significant increases in perceived stress (19 %), HR (33 %), systolic (13 %), and diastolic (15 %) BP in response to the TSST (p < 0.05). Overall HR stress response did not differ between groups, but was lower in boys with insomnia than in girls with insomnia (p < 0.05). Cortisol stress responses were inconclusive, possibly due to a masking effect of CAR, as the task was performed shortly after awakening and larger CARs were associated with blunted cortisol stress responses.
Results mostly show no group difference in physiological stress responses, although some interaction effects suggest a potential sex by insomnia interaction. Larger samples are needed to understand the physiological disturbances of insomnia in adolescence.
异常的应激反应与失眠的病因有关。我们研究了青少年时期失眠、压力、下丘脑-垂体-肾上腺（HPA）轴活动和自主神经系统（ANS）功能之间的关系。
47 名青春期后青少年（16-20 岁，28 名女性），有（N=16；失眠组）和没有（N=31；对照组）DSM-5 失眠症状，评估压力水平和应激反应，并进行标准化应激方案（Trier 社会应激测试（TSST）），在一夜的实验室住宿后。在觉醒和 30 分钟后测量皮质醇以计算皮质醇觉醒反应（CAR）。在 TSST 期间，收集感知压力、唾液皮质醇（HPA 活性）、心率（HR）和血压（BP）测量值。
失眠组的参与者报告说，来自学业成绩和工作超负荷的压力更大，失眠女孩比对照组女孩报告说，来自同伴压力和未来不确定性的压力更大（p<0.05）。在 CAR 和 TSST 前的应激水平方面，两组之间没有差异。所有参与者在 TSST 后感知压力（19%）、HR（33%）、收缩压（13%）和舒张压（15%）显著增加（p<0.05）。整体 HR 应激反应在两组之间没有差异，但失眠男孩的 HR 应激反应低于失眠女孩（p<0.05）。皮质醇应激反应不确定，可能是由于 CAR 的掩蔽效应，因为该任务是在觉醒后不久进行的，并且更大的 CAR 与皮质醇应激反应迟钝有关。
结果显示，除了一些交互作用表明潜在的失眠性别交互作用外，大多数情况下两组之间的生理应激反应没有差异。需要更大的样本量来了解青少年失眠的生理紊乱。
