Hypothalamic–Pituitary–Gonadal Activity in Paradoxical and Psychophysiological Insomnia
DOI: 10.4103/jmss.JMSS_31_18
Abstract
Objective: Although insomnia is a sex-dimorphic disorder, there is limited knowledge about the association between sex hormones and insomnia. In the present study, we aimed to investigate the level of hypothalamus-pituitary-gonadal (HPG) axis activity in patients with insomnia by measuring serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), 17a-Hydroxyprogesterone, testosterone, progesterone, estradiol, dehydroepiandrosterone sulfate, and sex hormone-binding globulin. Materials and Methods: Numbers of 19 patients; including 13 females (68.4%) with paradox insomnia (32-53 years; 43.2 ± 6.4) and 17 patients; including 8 females (47.1%) with psychophysiological insomnia (14-62 years; 38.4 ± 16.3) were recruited. Seventeen aged-matched normal sleeper consisted of 13 males (26-59 years; 40.7 ± 10) were also recruited as control group. Insomnia was diagnosed by a sleep clinician according to the International Classification of Sleep Disorders-Second Edition criteria and an overnight polysomnography (PSG). A volume of 5 ml of venous blood samples were collected, prepared, and stored at 8 AM under standard condition. Serum levels hormones were measured using enzyme-linked immunosorbent assay kits. Data were analyzed by Chi-square and ANCOVA. Multiple linear regression analysis was used to evaluate the associations between PSG and biochemical parameters. Results: There were no significant differences in all biochemical analyses between two insomnia subgroups (paradoxical and psychophysiological insomnia) and normal sleepers. Testosterone was positively related to maximum pulse transit time (PTT). Moreover, both LH and FSH were positively associated with wake index and diastolic blood pressure. Conclusion: Although there were no significant differences in all HPG's hormones between groups, both LH and FSH were positively associated with wake index and diastolic blood pressure. Moreover, testosterone was positively related to PTT.
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Koren D, Levitt Katz LE, Brar PC, Gallagher PR, Berkowitz RI, Brooks LJ. Sleep architecture and glucose and insulin homeostasis in obese adolescents. Diabetes Care 2011;34:2442-7.
Mullington JM, Simpson NS, Meier-Ewert HK, Haack M. Sleep loss and inflammation. Best Pract Res Clin Endocrinol Metab 2010;24:775-84.
Ioja S, Weir ID, Rennert NJ. Relationship between sleep disorders and the risk for developing type 2 diabetes mellitus. Postgrad Med 2012;124:119-29.
Potter GD, Skene DJ, Arendt J, Cade JE, Grant PJ, Hardie LJ. Circadian rhythm and sleep disruption: Causes, metabolic consequences, and countermeasures. Endocr Rev 2016;37:584-608.
Ohayon MM, Reynolds CF 3rd. Epidemiological and clinical relevance of insomnia diagnosis algorithms according to the DSM-IV and the international classification of sleep disorders (ICSD). Sleep Med 2009;10:952-60.
American Psychiatric Publication. Diagnostic and Statistical Manual of Mental disoRders (DSM-5). USA: American Psychiatric Publication; 2013.
Mallampalli MP, Carter CL. Exploring sex and gender differences in sleep health: A Society for women's health research report. J Womens Health (Larchmt) 2014;23:553-62.
Calhoun SL, Fernandez-Mendoza J, Vgontzas AN, Liao D, Bixler EO. Prevalence of insomnia symptoms in a general population sample of young children and preadolescents: Gender effects. Sleep Med 2014;15:91-5.
Subramanian S, Guntupalli B, Murugan T, Bopparaju S, Chanamolu S, Casturi L, et al. Gender and ethnic differences in prevalence of self-reported insomnia among patients with obstructive sleep apnea. Sleep Breath 2011;15:711-5.
Ahmed AE, Al-Jahdali H, Fatani A, Al-Rouqi K, Al-Jahdali F, Al-Harbi A, et al. The effects of age and gender on the prevalence of insomnia in a sample of the Saudi population. Ethn Health 2017;22:285-94. Back to cited text no. 10
Pallesen S, Sivertsen B, Nordhus IH, Bjorvatn B. A 10-year trend of insomnia prevalence in the adult Norwegian population. Sleep Med 2014;15:173-9.
Melcangi RC, Panzica GC. Neuroactive steroids and the nervous system: Further observations on an incomplete tricky puzzle. J Neuroendocrinol 2013;25:957-63.
Brunton PJ. Programming the brain and behaviour by early-life stress: A focus on neuroactive steroids. J Neuroendocrinol 2015;27:468-80.
Mannella P, Simoncini T. Sex steroids and their receptors: Molecular actions on brain cells. Gynecol Endocrinol 2012;28 Suppl 1:2-4.
Nowakowski S, Meers J, Heimbach E. Sleep and women's health. Sleep Med Res 2013;4:1-22.
Hall MH, Kline CE, Nowakowski S. Insomnia and sleep apnea in midlife women: Prevalence and consequences to health and functioning. F1000Prime Rep 2015;7:63.
Joffe H, Massler A, Sharkey KM. Evaluation and management of sleep disturbance during the menopause transition. Semin Reprod Med 2010;28:404-21.
Sharkey KM, Crawford SL, Kim S, Joffe H. Objective sleep interruption and reproductive hormone dynamics in the menstrual cycle. Sleep Med 2014;15:688-93.
Wittert G. The relationship between sleep disorders and testosterone in men. Asian J Androl 2014;16:262-5.
Sowers MF, Zheng H, Kravitz HM, Matthews K, Bromberger JT, Gold EB, et al. Sex steroid hormone profiles are related to sleep measures from polysomnography and the pittsburgh sleep quality index. Sleep 2008;31:1339-49.
Meston N, Davies RJ, Mullins R, Jenkinson C, Wass JA, Stradling JR. Endocrine effects of nasal continuous positive airway pressure in male patients with obstructive sleep apnoea. J Intern Med 2003;254:447-54.
Schmid SM, Hallschmid M, Jauch-Chara K, Lehnert H, Schultes B. Sleep timing may modulate the effect of sleep loss on testosterone. Clin Endocrinol (Oxf) 2012;77:749-54.
Arnal PJ, Drogou C, Sauvet F, Regnauld J, Dispersyn G, Faraut B, et al. Effect of sleep extension on the subsequent testosterone, cortisol and prolactin responses to total sleep deprivation and recovery. J Neuroendocrinol 2016;28:12346.
Abraham PA, Kazman JB, Zeno SA, Poth M, Deuster PA. Age-related decline in salivary dehydroepiandrosterone sulfate and associated health risks among African Americans. Ethn Dis 2013;23:149-54.
Lord C, Sekerovic Z, Carrier J. Sleep regulation and sex hormones exposure in men and women across adulthood. Pathol Biol (Paris) 2014;62:302-10.
American Academy of Sleep Medicine. International Classification of Sleep Disorders. Diagnostic and Coding Manual. USA, Texas: American Academy of Sleep Medicine; 2005. p. 51-5.
Sadock B. Kaplan and Sadock's Comprehensive Textbook of Psychiatry. Baltimore: Lippincott Williams & Wilkins; 2000.
Sadock B. Kaplan and Sadock's Comprehensive Textbook of Psychiatry. Baltimore: Lippincott Williams & Wilkins; 2017.
Edinger JD, Bonnet MH, Bootzin RR, Doghramji K, Dorsey CM, Espie CA, et al. Derivation of research diagnostic criteria for insomnia: Report of an American Academy of Sleep Medicine Work Group. Sleep 2004;27:1567-96.
American Academy of Sleep Medicine. International Classification of Sleep Disorders (ICSD). 3rd ed. Darien, IL: American Academy of Sleep Medicine; 2014.
Vgontzas AN, Fernandez-Mendoza J, Liao D, Bixler EO. Insomnia with objective short sleep duration: The most biologically severe phenotype of the disorder. Sleep Med Rev 2013;17:241-54.
Hey S, Sghir H, editors. Psycho-Physiological Stress Monitoring using Mobile and Continous Pulse Transit Time Measurement. Proceeding of the International Conference on eHealth, Telemedicine, and Social Medicine eTELEMED; 2011.
Chehri A, Kiamanesh A, Ahadi H, Khazaie H. Psychometric properties of the Persian version of sleep hygiene index in the general population. Iran J Psychiatry Behav Sci 2016;10:e5268.
Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193-213.
American Academy of Sleep Medicine. Standards for Accreditation of Sleep Disorders Centers (SASDC). Westchester, IL: American Academy of Sleep Medicine; 2002.
Khazaie H, Rezaie L, Darvishi F, Najafi F, Avis K. Treatment of paradoxical insomnia with atypical antipsychotic drugs: A comparison of olanzapine and risperidone. Sleep Med 2013;14:e167-8.
Carskadon MA, Dement WC, Mitler MM, Roth T, Westbrook PR, Keenan S, et al. Guidelines for the multiple sleep latency test (MSLT): A standard measure of sleepiness. Sleep 1986;9:519-24.
Carra MC, Rompré PH, Kato T, Parrino L, Terzano MG, Lavigne GJ, et al. Sleep bruxism and sleep arousal: An experimental challenge to assess the role of cyclic alternating pattern. J Oral Rehabil 2011;38:635-42.
Cvetkovic D, Cosic I. Sleep Onset Process as an Altered State of Consciousness. States of Consciousness. Berlin, Heidelberg: Springer; 2011. p. 157-85.
Oudegeest-Sander MH, Eijsvogels TH, Verheggen RJ, Poelkens F, Hopman MT, Jones H, et al. Impact of physical fitness and daily energy expenditure on sleep efficiency in young and older humans. Gerontology 2013;59:8-16.
Utoyo DB, Jaya ES, Arjadi R, Hanum L, Astri K, Putri MD, et al. Preliminary study on the effectiveness of short group cognitive behavioral therapy (GCBT) on Indonesian older adults. PLoS One 2013;8:e57198.
Netzer N, Eliasson AH, Netzer C, Kristo DA. Overnight pulse oximetry for sleep-disordered breathing in adults: A review. Chest 2001;120:625-33.
Harvey AG, Stinson K, Whitaker KL, Moskovitz D, Virk H. The subjective meaning of sleep quality: A comparison of individuals with and without insomnia. Sleep 2008;31:383-93.
Clark VL, Kruse JA. Clinical methods: The history, physical, and laboratory examinations. JAMA 1990;264:2808-9.
Mong JA, Baker FC, Mahoney MM, Paul KN, Schwartz MD, Semba K, et al. Sleep, rhythms, and the endocrine brain: Influence of sex and gonadal hormones. J Neurosci 2011;31:16107-16.
Edinger JD, Krystal AD. Subtyping primary insomnia: Is sleep state misperception a distinct clinical entity? Sleep Med Rev 2003;7:203-14.
Ghadami MR, Khaledi-Paveh B, Nasouri M, Khazaie H. PTSD-related paradoxical insomnia: An actigraphic study among veterans with chronic PTSD. J Inj Violence Res 2015;7:54-8.
Auyeung TW, Kwok T, Leung J, Lee JS, Ohlsson C, Vandenput L, et al. Sleep duration and disturbances were associated with testosterone level, muscle mass, and muscle strength – A cross-sectional study in 1274 older men. J Am Med Dir Assoc 2015;16:630.e1-6.
Stefan H, Adnene G, Birte von H, Katrin W, Nils K, Simone L, et al. Continuous Noninvasive Pulse Transit Time Measurement for Psycho-physiological Stress Monitoring. Proceedings of the 2009 International Conference on eHealth, Telemedicine, and Social Medicine: IEEE Computer Society; 2009.
Zito JB, Hanna A, Kadoo N, Tomaszycki ML. Early life stress increases testosterone and corticosterone and alters stress physiology in zebra finches. Horm Behav 2017;95:57-64.
Wegner M, Koedijker JM, Budde H. The effect of acute exercise and psychosocial stress on fine motor skills and testosterone concentration in the saliva of high school students. PLoS One 2014;9:e92953.
Katz ES, Lutz J, Black C, Marcus CL. Pulse transit time as a measure of arousal and respiratory effort in children with sleep-disordered breathing. Pediatr Res 2003;53:580-8.
Szymusiak R, Steininger T, Alam N, McGinty D. Preoptic area sleep-regulating mechanisms. Arch Ital Biol 2001;139:77-92.
Shaw ND, Butler JP, McKinney SM, Nelson SA, Ellenbogen JM, Hall JE, et al. Insights into puberty: The relationship between sleep stages and pulsatile LH secretion. J Clin Endocrinol Metab 2012;97:E2055-62.
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