Elsevier

Psychoneuroendocrinology

Volume 57, July 2015, Pages 51-60
Psychoneuroendocrinology

Poor sleep as a pathophysiological pathway underlying the association between stressful experiences and the diurnal cortisol profile among children and adolescents

https://doi.org/10.1016/j.psyneuen.2015.03.006Get rights and content

Highlights

  • Poor sleep is a plausible pathophysiological pathway by which stressful experiences “get under the skin” to disrupt the diurnal cortisol profile in youth.

  • The association between stressful experiences and the diurnal cortisol profile in youth was driven by the quality, not the quantity of sleep.

  • The overall diurnal cortisol profile, rather than the cortisol awakening response or single sample cortisol measures, was affected by stressful experiences through sleep.

Summary

Recent evidence suggests that poor sleep is a potential pathway underlying the association between stressful experiences and the diurnal cortisol profile. However, existing findings are largely limited to adults. The present study examines whether poor sleep (duration, quality) mediates the relation between stressful experiences and the diurnal cortisol profile in children and adolescents. Children and adolescents (N = 220, Mage = 12.62) provided six saliva samples over two days to derive cortisol indices (bedtime, AUCAG, AUCTG, slopeMAX). Perceived stress, stressful life events, self-reported sleep duration, and sleep quality were measured. Using bootstrapping analyses, sleep quality mediated the relation between perceived stress and AUCTG (R2 = 0.10, F(7, 212) = 3.55, p = .001; 95% BCI[0.09, 1.15]), as well as the relation between stressful life events and AUCTG (R2 = 0.11, F(7, 212) = 3.69, p = .001; 95% BCI[0.40, 3.82]). These mediation models remained significant after adjusting for sleep duration, suggesting that poor sleep quality underlies the association between stressful experiences and the diurnal cortisol profile in children and adolescents. Longitudinal data combined with objectively-measured sleep is essential to further disentangle the complex association between sleep and stress.

Section snippets

Participants

Youth aged 8–18 were recruited as part of the Healthy Heart Project at Concordia University, Montreal, Quebec. Participants were recruited using bookmarks distributed in primary and secondary schools approved by the English Montreal School Board and flyers posted in the local neighbourhood. Youth with serious psychopathology (e.g., psychosis, severe depression) or medication use known to interfere with cardiovascular or endocrine functioning were not eligible to participate. Participants (N = 

Descriptive statistics

On average, youth endorsed one in five stressors on the SLES (13.7 out of 76 events; 19.79%), with an average total stress intensity rating of 24.31 for the endorsed stressors. Consistent with previous adult studies, youth reported moderate levels of perceived stress (Cohen et al., 1983). Mean sleep disturbance scores were consistent with previous research (Owens et al., 2000). Youth reported good sleep quality and moderate daytime sleepiness. Youth reported 9.12 h of sleep during school nights,

Discussion

There is emerging evidence to support the contribution of poor sleep as a pathophysiological pathway underlying the adverse effect of stressful experiences on the diurnal cortisol profile. Previous cross-sectional and experimental findings demonstrate the adverse effects of stressful experiences on sleep, which subsequently disrupts the diurnal cortisol profile. Accordingly, it was hypothesized that the association between stressful experiences and diurnal cortisol would be mediated by sleep.

Conclusions

Taken together, the present study suggests that poor sleep is one potential pathophysiological pathway underlying the association between stressful experiences and diurnal cortisol in youth. Further, the association between stressful experiences and the diurnal cortisol profile in youth were linked to the quality, not the quantity of sleep. These findings provide empirical support for a plausible neuroendocrinological relation between stress experiences, sleep, and diurnal cortisol among

Role of the funding source

This work was made possible through funding support from the Canadian Institutes of Health Research Operating Grants (J.J. McGrath MOP89886 and OCO79897), New Investigator Award (J.J. McGrath MSH95353), and Fonds de recherche Québec santé bourse de formation maîtrise (J. Ly).

Conflict of interest statement

None declared.

Acknowledgments

We thank the participants and their families of the Healthy Heart Project and the research assistants and project coordinators of the Pediatric Public Health Psychology Laboratory. Special thanks to Natasha Hunt, Sabrina Giovanniello, and Neressa Noel for their continued dedication.

References (58)

  • A. Oskis et al.

    Diurnal patterns of salivary cortisol across the adolescent period in healthy females

    Psychoneuroendocrinology

    (2009)
  • A.K. Pesonen et al.

    The associations between adolescent sleep, diurnal cortisol patterns and cortisol reactivity to dexamethasone suppression test

    Psychoneuroendocrinology

    (2014)
  • A.-K. Pesonen et al.

    Sex-specific associations between sleep problems and hypothalamic–pituitary–adrenocortical axis activity in children

    Psychoneuroendocrinology

    (2012)
  • S. Rotenberg et al.

    Sampling compliance for cortisol upon awakening in children and adolescents

    Psychoology

    (2014)
  • S. Rotenberg et al.

    Stability of the diurnal cortisol profile in children and adolescents

    Psychoneuroendocrinology

    (2012)
  • K. Spiegel et al.

    Early report Impact of sleep debt on metabolic and endocrine function

    Lancet

    (1999)
  • K.A. Stamatakis et al.

    Short sleep duration across income, education, and race/ethnic groups: population prevalence and growing disparities during 34 years of follow-up

    Ann. Epidemiol.

    (2007)
  • I. Vargas et al.

    Dissecting the impact of sleep and stress on the cortisol awakening response in young adults

    Psychoneuroendocrinology

    (2014)
  • D.E. Williamson et al.

    The stressful life events schedule for children and adolescents: development and validation

    Psychiatry Res.

    (2003)
  • D.E. Williamson et al.

    Stressful life events and EEG sleep in depressed and normal control adolescents

    Soc. Biol. Psychiatry

    (1995)
  • J.M. Wolf et al.

    Chronic stress, salivary cortisol, and alpha-amylase in children with asthma and healthy children

    Biol. Psychol.

    (2008)
  • K.H. Zeiders et al.

    Reciprocal relations between objectively measured sleep patterns and diurnal cortisol rhythms in late adolescence

    J. Adolesc. Health

    (2011)
  • M. Balbo et al.

    Impact of sleep and its disturbances on hypothalamo–pituitary–adrenal axis activity

    Int. J. Endocrinol.

    (2010)
  • J. Born et al.

    Hypothalamus–pituitary–adrenal activity during human sleep: a coordinating role for the limbic hippocampal system

    Exp. Clin. Endocrinol. Diabetes

    (1998)
  • T.M. Buckley et al.

    On the interactions of the hypothalamic–pituitary–adrenal (HPA) axis and sleep: normal HPA axis activity and circadian rhythm, exemplary sleep disorders

    J. Clin. Endocrinol. Metab.

    (2005)
  • S. Cohen et al.

    Strategies for measuring stress in studies of psychiatric and physical disorders

  • S. Cohen et al.

    A global measure of perceived stress

    J. Health Social Behav.

    (1983)
  • I.M. Colrain et al.

    Changes in sleep as a function of adolescent development

    Neuropsychology review

    (2011)
  • S.S. Dickerson et al.

    Acute stressors and cortisol responses: a theoretical integration and synthesis of laboratory research

    Psychol. Bull.

    (2004)
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