CoChat
Sign Up
Cited by 884Sleep and related disordersStress Responses and CortisolSleep and Wakefulness Research

The DOI matches its Crossref record; 45 of the 48 references it cites were found in a registry or an index.

Chronic Insomnia Is Associated with Nyctohemeral Activation of the Hypothalamic-Pituitary-Adrenal Axis: Clinical Implications

Vgontzas, Alexandros N., Bixler, Edward O., Lin, Hung-Mo, Prolo, Paolo, Mastorakos, George, Vela-Bueno, Antonio, Kales, Anthony, Chrousos, George P.·2001·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/jcem.86.8.7778
Open this paper in CoChat — free account

Abstract

Although insomnia is, by far, the most commonly encountered sleep disorder in medical practice, our knowledge in regard to its neurobiology and medical significance is limited. Activation of the hypothalamic-pituitary-adrenal axis leads to arousal and sleeplessness in animals and humans; however, there is a paucity of data regarding the activity of the hypothalamic-pituitary-adrenal axis in insomniacs. We hypothesized that chronic insomnia is associated with increased plasma levels of ACTH and cortisol. Eleven young insomniacs (6 men and 5 women) and 13 healthy controls (9 men and 4 women) without sleep disturbances, matched for age and body mass index, were monitored in the sleep laboratory for 4 consecutive nights, whereas serial 24-h plasma measures of ACTH and cortisol were obtained during the fourth day. Insomniacs, compared with controls, slept poorly (significantly higher sleep latency and wake during baseline nights). The 24-h ACTH and cortisol secretions were significantly higher in insomniacs, compared with normal controls (4.2 +/- 0.3 vs. 3.3 +/- 0.3 pM, P = 0.04; and 218.0 +/- 11.0 vs. 190.4 +/- 8.3 nM, P = 0.07). Within the 24-h period, the greatest elevations were observed in the evening and first half of the night. Also, insomniacs with a high degree of objective sleep disturbance (% sleep time < 70), compared with those with a low degree of sleep disturbance, secreted a higher amount of cortisol. Pulsatile analysis revealed a significantly higher number of peaks per 24 h in insomniacs than in controls (P < 0.05), whereas cosinor analysis showed no differences in the temporal pattern of ACTH or cortisol secretion between insomniacs and controls. We conclude that insomnia is associated with an overall increase of ACTH and cortisol secretion, which, however, retains a normal circadian pattern. These findings are consistent with a disorder of central nervous system hyperarousal rather than one of sleep loss, which is usually associated with no change or decrease in cortisol secretion or a circadian disturbance. Chronic activation of the hypothalamic-pituitary-adrenal axis in insomnia suggests that insomniacs are at risk not only for mental disorders, i.e. chronic anxiety and depression, but also for significant medical morbidity associated with such activation. The therapeutic goal in insomnia should be to decrease the overall level of physiologic and emotional arousal, and not just to improve the nighttime sleep.

Overview

Integrity signals

Registry

Crossref · 10.1210/jcem.86.8.7778

Cites

45 of 45 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Verification

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Citations

Cites

Flagged first, then by citations

3 of the 48 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. Chrousos, 1993, Side effects of glucocorticoid treatment., JAMA, 269, 2110, 10.1001/jama.1993.03500160080036 · DOI
  2. Genazzani, 1991, 124, 295

Cited by

Sorted by citations

See all 884

Related

See all

Metadata

Authors
Vgontzas, A. N., Bixler, E. O., Lin, H.-M., Prolo, P., Mastorakos, G., Vela-Bueno, A., Kales, A., & Chrousos, G. P.
Affiliations
  • Pennsylvania State University (US)
  • University of California, Los Angeles (US)
  • National and Kapodistrian University of Athens (GR)
  • Department of Psychiatry (A.V.-B.), Autonomous University, Madrid, Spain 28003
  • National Institutes of Health (US)
Corresponding author
Vgontzas, Alexandros N.
ORCID
Venue
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Published
2001-08-01
Volume
86
Issue
8
Pages
3787-3794
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
DOI
10.1210/jcem.86.8.7778
OpenAlex
W1999790218
Cited by
884
References
48
Citations by year
2026: 43 · 2025: 38 · 2024: 35 · 2023: 37 · 2022: 53 · 2021: 38 · 2020: 37 · 2019: 38 · 2018: 36 · 2017: 40 · 2016: 44 · 2015: 43 · 2014: 36 · 2013: 49 · 2012: 31
FWCI
26.48
Type
journal article
Language
en
Open access
closed
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
  • PubMed (publishedVersion)
Funders
NIH Clinical Center
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
Keywords
chronic insomnia, hypothalamic-pituitary-adrenal axis, ACTH, cortisol, circadian rhythm, hyperarousal, sleep disorders, sleep latency, anxiety, depression, neuroendocrine activation, neurodegeneration, neuroinflammation
MeSH terms
Adrenocorticotropic Hormone, Adult, Circadian Rhythm, Female, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Sleep Initiation and Maintenance Disorders, Male, Pituitary-Adrenal System, Reference Values, Sleep Stages, Sleep, REM, Body Mass Index, Area Under Curve, Sleep Disorders, Circadian Rhythm

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review