The influence of sleep on human hypothalamic-pituitary-adrenal (HPA) axis reactivity: A systematic review

Sleep Med Rev. 2018 Jun;39:187-194. doi: 10.1016/j.smrv.2017.10.002. Epub 2017 Oct 18.


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.

Keywords: Cortisol; Hypothalamic pituitary adrenal axis; Sleep; Stress.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Humans
  • Hydrocortisone
  • Hypothalamo-Hypophyseal System / physiopathology*
  • Pituitary-Adrenal System / physiopathology*
  • Sleep / physiology*
  • Stress, Psychological / physiopathology*


  • Hydrocortisone