Okun Michele L, Segerstrom Suzanne, Jackman Susan, Ross Kharah, Schetter Christine Dunkel, Coussons-Read Mary
University of Colorado, Colorado Springs, USA.
Oregon State University, USA.
Psychoneuroendocrinology. 2025 Feb;172:107248. doi: 10.1016/j.psyneuen.2024.107248. Epub 2024 Nov 23.
Pregnancy is often typified with a decrease in sleep quality, which for many women, progressively worsens across gestation and into the postpartum. A mechanism linking poor sleep with certain adverse pregnancy outcomes is dysregulation of the HPA axis resulting in atypically elevated cortisol production. While total cortisol output normally increases across pregnancy, the cortisol awakening response (CAR), a response to waking up, is influenced by factors such as stress and mood. It attenuates as pregnancy progresses, with normalization in the first weeks after delivery. The goals of the present study were to (1) assess the temporal relationship between sleep quality and cortisol indices across the perinatal period; (2) evaluate whether sleep quality was associated with postpartum mood; and (3) assess whether cortisol mediated these associations.
Data were collected as part of the Healthy Babies Before Birth (HB3) study. Sleep quality, depressive and anxiety symptoms, and cortisol from four time-points (8-16 weeks gestation, 30-36 weeks gestation, 6 months postpartum, and 1-year postpartum) were assessed. Participants (N = 223) who had sleep quality (PSQI) and cortisol data from at least 1 of 4 time-points were included in analyses. Three salivary cortisol indices were calculated: cortisol awakening response (CAR), diurnal slope, and area under the curve (AUC). Multi-level models were run to predict cortisol parameters based on deviations and typical maternal sleep quality at each wave as well as mood outcomes.
Multilevel (time, wave, and person) modeling indicated that sleep quality was not associated with any of the cortisol indices, and none significantly varied across time. However, when PSQI scores were higher than the woman's own mean sleep quality, the CAR slope was steeper (+1 point in PSQI, γ=0.18), and when PSQI scores were lower than mean, the CAR slope was flatter (-1 point, γ=0.11). Poorer sleep quality was associated with greater depression severity (γ = 0.367) and anxiety symptoms (γ = 0.120). Cortisol did not mediate the relationship between sleep quality and depression symptoms.
Increases in PSQI scores, but not higher mean PSQI scores, were associated with a larger CAR. There was no association between sleep quality and the diurnal slope or AUC. These data suggest that variability in sleep quality is significantly associated with the amount of cortisol secreted upon awakening.
怀孕通常表现为睡眠质量下降，对许多女性而言，这种情况在整个孕期及产后会逐渐恶化。睡眠不佳与某些不良妊娠结局之间的一种机制是下丘脑-垂体-肾上腺（HPA）轴失调，导致皮质醇分泌异常升高。虽然孕期皮质醇的总分泌量通常会增加，但皮质醇觉醒反应（CAR），即对醒来的反应，会受到压力和情绪等因素的影响。随着孕期进展，它会减弱，在产后头几周恢复正常。本研究的目的是：（1）评估围产期睡眠质量与皮质醇指标之间的时间关系；（2）评估睡眠质量是否与产后情绪有关；（3）评估皮质醇是否介导了这些关联。
作为“出生前健康婴儿”（HB3）研究的一部分收集数据。评估了四个时间点（妊娠8 - 16周、妊娠30 - 36周、产后6个月和产后1年）的睡眠质量、抑郁和焦虑症状以及皮质醇水平。分析纳入了至少有4个时间点中1个时间点的睡眠质量（匹兹堡睡眠质量指数，PSQI）和皮质醇数据的参与者（N = 223）。计算了三个唾液皮质醇指标：皮质醇觉醒反应（CAR）、昼夜斜率和曲线下面积（AUC）。运行多水平模型以根据每一波的偏差和典型的母亲睡眠质量以及情绪结果来预测皮质醇参数。
多水平（时间、波次和个体）建模表明，睡眠质量与任何皮质醇指标均无关联，且这些指标在不同时间均无显著变化。然而，当PSQI得分高于女性自身的平均睡眠质量时，CAR斜率更陡（PSQI增加1分，γ = 0.18），当PSQI得分低于平均水平时，CAR斜率更平缓（降低1分，γ = 0.11）。较差的睡眠质量与更严重的抑郁（γ = 0.367）和焦虑症状（γ = 0.120）相关。皮质醇并未介导睡眠质量与抑郁症状之间的关系。
PSQI得分的增加而非更高的平均PSQI得分与更大的CAR相关。睡眠质量与昼夜斜率或AUC之间无关联。这些数据表明，睡眠质量的变异性与醒来时分泌的皮质醇量显著相关。
