Poor sleep and altered hypothalamic-pituitary-adrenocortical and sympatho-adrenal-medullary system activity in children

J Clin Endocrinol Metab. 2010 May;95(5):2254-61. doi: 10.1210/jc.2009-0943. Epub 2010 Mar 1.


Context: Neuroendocrine alterations, with well-known links with health, may offer insight into why poor sleep is associated with poor health. Yet, studies testing associations between sleep and neuroendocrine activity in children are scarce.

Objective: The aim of this study was to determine whether actigraphy-based sleep pattern is associated with hypothalamic-pituitary-adrenocortical axis and sympatho-adrenal-medullary system activity in children.

Design and setting: We conducted a cross-sectional study in a birth cohort in Helsinki, Finland.

Participants: We studied 282 8-yr-old children.

Main outcome measures: We measured diurnal salivary cortisol and salivary cortisol and alpha-amylase (a sympatho-adrenal-medullary system marker) responses to the Trier Social Stress Test for Children (TSST-C).

Results: Children with short (<or=7.7 h) vs. average sleep duration (7.8-9.3 h) displayed higher cortisol awakening response and nadir (P < 0.042). Those with low (<or=77.4%) vs. average-high sleep efficiency (>77.4%) displayed higher diurnal cortisol levels across the entire day (P < 0.03), higher cortisol levels after the TSST-C stressor (P < 0.04), and higher overall alpha-amylase levels across the entire TSST-C protocol (P < 0.05). The effects were not confounded by factors that may alter sleep or hormonal patterns.

Conclusions: Poor sleep may signal altered neuroendocrine functioning in children. The findings may offer insight into the pathways linking poor sleep with poor health.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenal Cortex / physiopathology*
  • Child
  • Cross-Sectional Studies
  • Female
  • Humans
  • Hydrocortisone / analysis*
  • Male
  • Medulla Oblongata / physiopathology*
  • Pituitary-Adrenal System / physiopathology*
  • Saliva / chemistry
  • Sleep Wake Disorders / etiology*
  • Stress, Psychological / physiopathology
  • Sympathetic Nervous System / physiopathology*
  • Wakefulness


  • Hydrocortisone