Association Between Sleep Reactivity, Pre-Sleep Arousal State, and Neuroendocrine Hormones in Patients with Chronic Insomnia Disorder
Open accessAbstract
Purpose: The purpose of this study was to look into the relationship between pre-sleep arousal state, sleep reactivity, and serum levels of neuroendocrine hormones (cortisol, copeptin, and corticotropin-releasing hormone) in patients with chronic insomnia disorders (CID), and whether the effects of sleep reactivity and pre-sleep arousal on insomnia are related to the levels of these neuroendocrine hormones. Patients and Methods: This study included 61 CID patients and 27 healthy controls (HC) whose base data were matched to those of the CID patients. The Pittsburgh Sleep Quality Index(PSQI), Pre-Sleep Arousal Scale (PSAS), and the Ford Insomnia Response to Stress Test (FIRST) were used to evaluate the participants' sleep, stress, and neuropsychological function. We measured the participants' serum concentration levels of cortisol, copeptin, and corticotropin-releasing hormone (CRH), using quantitative sandwich enzyme-linked immunosorbent assays. Results: The CID group had significantly greater serum levels of copeptin, CRH, and cortisol, as well as higher FIRST and PSAS scores than the HC group. The partial correlation analysis revealed a substantial and positive association among cortisol, CRH, copeptin PSQI, PSAS, and FIRST after adjusting for sex, age, depression, and cognition. Principal component analysis showed that PSQI, FIRST, and PSAS, as well as cortisol, CRH, and copeptin, were all loaded on factor 1. Conclusion: Patients with CID showed increased sleep reactivity and pre-sleep arousal, which correlated with serum levels of cortisol, copeptin, and CRH. Changes in neuroendocrine hormone levels may influence how pre-sleep arousal and sleep reactivity affect the development of insomnia.
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Somatic hyperarousal is characterized by excessive physical tension and heightened autonomic activation, leading to increased heart rate, muscle contraction, and elevated cortisol release.
“Somatic hyperarousal is characterized by excessive physical tension and heightened autonomic activation, leading to symptoms such as increased heart rate, muscle contraction, and elevated cortisol release, a hormone associated with stress [19].”
From Pre-Sleep Anxiety: Mechanisms and Therapeutic Approaches in Clinical Practice. (2026) · cites this paper as [19]
The Introduction describes pre-sleep arousal as including somatic activation, and the Discussion reports increased heart rates and cortisol levels in patients with chronic insomnia. Our copy does not characterize somatic hyperarousal by physical tension or muscle contraction, or establish that somatic hyperarousal causes the listed changes. The indexed passages provide section labels but no page numbers. (LLM, conf=0.85)
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- Authors
- Yu, K., Xia, L., Chen, H.-H., Zou, T.-T., Zhang, Y., Zhang, P., Yang, Y., Wei, R.-M., Su, Z.-F., & Chen, G.-H.
- Affiliations
- Chaohu Hospital of Anhui Medical University (CN)
- Corresponding author
- Chen, Gui-Hai
- Venue
- Nature and Science of Sleep
- Publisher
- Informa UK Limited
- Published
- 2024-12
- Volume
- Volume 16
- Pages
- 1907-1919
- ISSN
- 1179-1608 (ISSN-L)
- PMC
- PMC11627101
- OpenAlex
- W4405083640
- Cited by
- 7
- References
- 58
- Citations by year
- 2026: 6 · 2025: 1
- FWCI
- 2.86
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Nature and Science of Sleep (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
- Funders
- National Natural Science Foundation of China (81671316)
- 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, sleep reactivity, pre-sleep arousal, neuroendocrine hormones, cortisol, copeptin, corticotropin-releasing factor, stress response
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