Zhang Xiang-Xia, Sun Shi-Yu, Ma Zi-Jie, Li Zong-Yin, Zhou Yu-Shun, Yang Ye, Rao Ji-Xian, Zhang Ping, Kong Xiao-Yi, Li Xue-Yan, Ge Yi-Jun, Chen Gui-Hai
Department of Neurology (Sleep Disorder), The Affiliated Chaohu Hospital of Anhui Medical University, Hefei, (Chaohu), 238000, Anhui Province, China.
Department of Neurology, The First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan, 232007, Anhui, China.
Sleep Med. 2024 May;117:177-183. doi: 10.1016/j.sleep.2024.03.017. Epub 2024 Mar 21.
To explore the relationship between nocturnal levels of stress-related hormones and different sleep-wake states in chronic insomnia disorder (CID) patients.
Thirty-three CID patients and 34 good sleepers were enrolled and completed assessment of sleep log, Pittsburgh Sleep Quality Index and Insomnia Severity Index. During a-overnight polysomnography monitoring, the patients' vein bleeds were continually collected at different time points (pre-sleep, deep-sleep, 5-min or 30-min waking, and morning waking-up). The control subjects' bleeds were collected only at 22:00 and morning waking-up. The serum hormones were detected using enzyme-linked immunosorbent assay.
Compared with at pre-sleep, the level of cortisol was significantly higher at morning waking-up respectively in two-group subjects (Ps < 0.001), with insignificant inter-group differences in cortisol, corticotropin releasing hormone and copeptin at the two time-points. In the patients, the nocturnal secretion curves of three hormones were similar, with the highest concentration at morning waking-up, followed by 30-min waking, 5-min waking, pre-sleep, and deep-sleep. The patients' cortisol (Z = 79.192, P < 0.001) and copeptin (Z = 12.333, P = 0.015) levels were statistically different at different time-points, with higher cortisol at morning waking-up relative to deep-sleep, pre-sleep and 5-min waking (Ps < 0.05), and at 30-min waking relative to deep-sleep and pre-sleep (Ps < 0.05), and higher copeptin at morning waking-up relative to deep-sleep (P < 0.05).
In CID, the nocturnal wakes were instantaneously accompanied by high level, and deep sleep was accompanied by the lowest levels, of stress-related hormones, especially in cortisol, supporting the insomniac hypothesis of increased nocturnal pulse-release of cortisol.
探讨慢性失眠障碍（CID）患者夜间应激相关激素水平与不同睡眠-觉醒状态之间的关系。
招募33例CID患者和34例睡眠良好者，完成睡眠日志、匹兹堡睡眠质量指数和失眠严重程度指数评估。在整夜多导睡眠图监测期间，于不同时间点（睡前、深睡眠、5分钟或30分钟觉醒以及晨起）持续采集患者静脉血。仅在22:00和晨起时采集对照受试者的血样。采用酶联免疫吸附测定法检测血清激素。
与睡前相比，两组受试者晨起时皮质醇水平均显著升高（P<0.001），两个时间点的皮质醇、促肾上腺皮质激素释放激素和 copeptin 组间差异无统计学意义。在患者中，三种激素的夜间分泌曲线相似，晨起时浓度最高，其次是30分钟觉醒、5分钟觉醒、睡前和深睡眠。患者在不同时间点的皮质醇（Z = 79.192，P<0.001）和 copeptin（Z = 12.333，P = 0.015）水平存在统计学差异，晨起时皮质醇相对于深睡眠、睡前和5分钟觉醒时更高（P<0.05），30分钟觉醒时相对于深睡眠和睡前更高（P<0.05），晨起时 copeptin 相对于深睡眠更高（P<0.05）。
在CID中，夜间觉醒即刻伴随着应激相关激素的高水平，而深睡眠伴随着最低水平，尤其是皮质醇，支持了夜间皮质醇脉冲释放增加的失眠假说。
