Association of Sleep Duration and Quality With Alterations in the Hypothalamic-Pituitary Adrenocortical Axis: The Multi-Ethnic Study of Atherosclerosis (MESA)

• Published in: The journal of clinical endocrinology and metabolism Vol. 100; no. 8; pp. 3149 - 3158
• Main Authors: Castro-Diehl, Cecilia, Diez Roux, Ana V, Redline, Susan, Seeman, Teresa, Shrager, Sandi E, Shea, Steven
• Format: Journal Article
• Language: English
• Published: United States Endocrine Society 01.08.2015; Copyright by The Endocrine Society
• Subjects: Actigraphy; Aged; Aged, 80 and over; Atherosclerosis - ethnology; Atherosclerosis - metabolism; Atherosclerosis - physiopathology; Cross-Sectional Studies; Ethnic Groups; Female; Humans; Hydrocortisone - metabolism; Hypothalamo-Hypophyseal System - metabolism; Hypothalamo-Hypophyseal System - physiopathology; Male; Middle Aged; Original; Pituitary-Adrenal System - metabolism; Pituitary-Adrenal System - physiopathology; Saliva - metabolism; Sleep - physiology; Sleep Wake Disorders - epidemiology; Sleep Wake Disorders - metabolism; Sleep Wake Disorders - physiopathology; Wakefulness - physiology
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2015-1198

Context: Short sleep duration and poor sleep quality are associated with cardiovascular outcomes. One mechanism proposed to explain this association is altered diurnal cortisol secretion. Objective: The objective of the study was to examine the associations of sleep duration and sleep quality with diurnal salivary cortisol levels. Design: This was a cross-sectional analysis using data from examination 5 (2010–2012) of the Multi-Ethnic Study of Atherosclerosis. Actigraphy-based measures of sleep duration and efficiency were collected over 7 days, and salivary cortisol samples were collected over 2 days from participants aged 54–93 years (n = 600 with analyzable data). Results: Shorter average sleep duration (<6 h/night) was associated with less pronounced late decline in cortisol [2.2% difference in slope; 95% confidence interval (CI) 0.8–3.7; P ≤ .01] and less pronounced wake-to-bed slope (2.2% difference; 95% CI 1.0–3.4; P ≤ .001) compared with longer sleep duration (≥6 h/night). Lower sleep efficiency (<85%) was associated with less pronounced early decline in cortisol (29.0% difference in slope; 95% CI 4.1–59.7; P < .05) compared with higher sleep efficiency (≥85%). Subjects reporting insomnia had a flatter cortisol awakening response (−16.1% difference in slope; 95% CI −34.6 to −0.1; P < .05) compared with those not reporting insomnia. Conclusions: Shorter sleep duration, lower sleep efficiency, and insomnia are associated with alterations in diurnal cortisol levels consistent with changes in hypothalamic-pituitary-adrenal regulation.