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Cited by 35Sleep and Wakefulness ResearchAdrenal Hormones and DisordersStress Responses and Cortisol

The DOI matches its Crossref record; 291 of the 292 references it cites were found in a registry or an index.

Sleep, Cognition and Cortisol in Addison’s Disease: A Mechanistic Relationship

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Henry, Michelle, Thomas, Kevin Garth Flusk, Ross, Ian Louis·2021·Frontiers in Endocrinology
DOI 10.3389/fendo.2021.694046PMC PMC8429905
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Abstract

Sleep is a critical biological process, essential for cognitive well-being. Neuroscientific literature suggests there are mechanistic relations between sleep disruption and memory deficits, and that varying concentrations of cortisol may play an important role in mediating those relations. Patients with Addison's disease (AD) experience consistent and predictable periods of sub- and supra-physiological cortisol concentrations due to lifelong glucocorticoid replacement therapy, and they frequently report disrupted sleep and impaired memory. These disruptions and impairments may be related to the failure of replacement regimens to restore a normal circadian rhythm of cortisol secretion. Available data provides support for existing theoretical frameworks which postulate that in AD and other neuroendocrine, neurological, or psychiatric disorders, disrupted sleep is an important biological mechanism that underlies, at least partially, the memory impairments that patients frequently report experiencing. Given the literature linking sleep disruption and cognitive impairment in AD, future initiatives should aim to improve patients' cognitive performance (and, indeed, their overall quality of life) by prioritizing and optimizing sleep. This review summarizes the literature on sleep and cognition in AD, and the role that cortisol concentrations play in the relationship between the two.

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Crossref · 10.3389/fendo.2021.694046

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291 of 291 references verified0 citation errors · 0 not checkable

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Figures

Figure 1 The hormonal control of sleep. Red arrows: negative feedback on the indicated brain structure.
Figure 1 The hormonal control of sleep. Red arrows: negative feedback on the indicated brain structure.CC BY · PubMed Central
Figure 2 The hippocampal-to-neocortical dialogue. (A) During NREM sleep, memories temporarily stored in the hippocampus are transferred to the long-term store in the neocortex. (B) The dialogue involves the interaction between the slow oscillations, sleep spindles and hippocampal ripples to create spindle-ripple events (magnified circle). From Born et al. (75). System consolidation of memory during sleep. Psychological Research, 76, 192-203.
Figure 2 The hippocampal-to-neocortical dialogue. (A) During NREM sleep, memories temporarily stored in the hippocampus are transferred to the long-term store in the neocortex. (B) The dialogue involves the interaction between the slow oscillations, sleep spindles and hippocampal ripples to create spindle-ripple events (magnified circle). From Born et al. (75). System consolidation of memory during sleep. Psychological Research, 76, 192-203.CC BY · PubMed Central
Figure 3 Simulated cortisol profile for a patient [broken line] following thrice-daily hydrocortisone administration [10mg at 06:00, 5mg at 12:00 and 2.5mg at 18:00, shown as solid arrows]. The normal circadian rhythm of cortisol [solid line]. From Mah et al. (211). Weight‐related dosing, timing and monitoring hydrocortisone replacement therapy in patients with adrenal insufficiency. Clinical Endocrinology, 61(3), 367-375.
Figure 3 Simulated cortisol profile for a patient [broken line] following thrice-daily hydrocortisone administration [10mg at 06:00, 5mg at 12:00 and 2.5mg at 18:00, shown as solid arrows]. The normal circadian rhythm of cortisol [solid line]. From Mah et al. (211). Weight‐related dosing, timing and monitoring hydrocortisone replacement therapy in patients with adrenal insufficiency. Clinical Endocrinology, 61(3), 367-375.CC BY · PubMed Central
Figure 4 Concentration-time profiles for modified-release hydrocortisone (MR-HC) 5mg, 10mg, 15mg and 30mg compared with immediate-release hydrocortisone (IRHC). Graph showing delayed and sustained release characteristic of MR-HC (to convert values from mcg/dl to nmol/l x 27.59). From Debono et al. (230). Modified-release hydrocortisone to provide circadian cortisol profiles. The Journal of Clinical Endocrinology & Metabolism, 94(5), 1548-1554.
Figure 4 Concentration-time profiles for modified-release hydrocortisone (MR-HC) 5mg, 10mg, 15mg and 30mg compared with immediate-release hydrocortisone (IRHC). Graph showing delayed and sustained release characteristic of MR-HC (to convert values from mcg/dl to nmol/l x 27.59). From Debono et al. (230). Modified-release hydrocortisone to provide circadian cortisol profiles. The Journal of Clinical Endocrinology & Metabolism, 94(5), 1548-1554.CC BY · PubMed Central

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Research works printed but not linked: 2

  1. Chorous, 2016, HPA Axis and Sleep.
  2. Steiger, 2002, Sleep and the Hypothalamo-Pituitary-Adrenocortical System, Sleep Med Rev, 6, 10.1053/smrv.2001.0159 · DOI

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Metadata

Authors
Henry, M., Thomas, K. G. F., & Ross, I. L.
Affiliations
University of Cape Town (ZA)
Corresponding author
Henry, Michelle
ORCID
Venue
Frontiers in Endocrinology
Publisher
Frontiers Media SA
Published
2021-08-27
Volume
12
Pages
694046-694046
ISSN
1664-2392 (ISSN-L)
DOI
10.3389/fendo.2021.694046
PMC
PMC8429905
OpenAlex
W3198496472
Cited by
34
References
292
Citations by year
2026: 6 · 2025: 8 · 2024: 9 · 2023: 7 · 2022: 4
FWCI
0.74
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Endocrinology (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
  • Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
Keywords
Addison's disease, sleep disruption, cognitive impairment, memory impairment, cortisol, glucocorticoid replacement therapy, circadian rhythm, quality of life
MeSH terms
Addison Disease, Cognition, Humans, Hydrocortisone, Memory Disorders, Quality of Life, Risk Factors, Sleep, Signal Transduction

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