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The influence of sleep on human hypothalamic-pituitary-adrenal (HPA) axis reactivity: a systematic review
Abstract
Inadequate sleep is highly prevalent and known to decline both physical- and mental health. Literature suggests that altered functioning of the hypothalamic-pituitary-adrenal (HPA) axis might underlie this association. This assumption is mainly based on changes in basal neuroendocrine activity and it is of equal importance to elucidate whether sleep may also influence HPA stress responsiveness. The present review provides a complete outline of recent human studies that have investigated how different aspects of sleep influence cortisol reactivity to laboratory stress. From the available data it can be concluded that both objective and subjective decrements in sleep quality potentiate the stress reactivity of the HPA axis. On the contrary, normal variations in sleep duration do not seem to influence cortisol stress responsiveness whereas excessive daytime sleepiness is associated with a blunting of the cortisol response. Given its well-established health consequences, sensitization of the HPA axis might well be a crucial component linking inadequate sleep to stress-related pathology.
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“Numerous studies have shown that sleep dysfunction is also often associated with mild increases in the activity of the major neuroendocrine stress systems, that is, the autonomic sympatho-adrenal system and the HPA axis.”
From Towards an Integrative Account of Potential Mechanisms Mediating the Path From Sleep Dysfunction to Hallucinations (2025) · cites this paper as [70]
In the citing paper
“Sensitization of the HPA axis might be a critical mechanism linking inadequate sleep to stress-related pathology, including impairments to mental health.”
From Towards an Integrative Account of Potential Mechanisms Mediating the Path From Sleep Dysfunction to Hallucinations (2025) · cites this paper as [70]
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Metadata
- Authors
- van Dalfsen, J. H., & Markus, C. R.
- Affiliations
- Maastricht University (NL)
- Venue
- Sleep Medicine Reviews
- Publisher
- Elsevier BV
- Published
- 2018-06
- Volume
- 39
- Pages
- 187-194
- ISSN
- 1087-0792 (ISSN-L)
- OpenAlex
- W2765534164
- Cited by
- 329
- References
- 74
- Citations by year
- 2026: 46 · 2025: 85 · 2024: 32 · 2023: 36 · 2022: 41 · 2021: 39 · 2020: 20 · 2019: 16 · 2018: 13
- FWCI
- 1.18
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Sleep Medicine Reviews (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion)
- Topics
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- sleep, hypothalamic-pituitary-adrenal axis, HPA axis reactivity, cortisol, stress reactivity, sleep quality, sleep duration, excessive daytime sleepiness, insufficient sleep, neuroendocrine function
- MeSH terms
- Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Pituitary-Adrenal System, Sleep, Stress, Psychological
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