Stress, sleep, and autonomic function in healthy adolescent girls and boys: Findings from the NCANDA study

Sleep Health. 2021 Feb;7(1):72-78. doi: 10.1016/j.sleh.2020.06.004. Epub 2020 Jul 27.


Objectives: Starting in adolescence, female sex is a strong risk factor for the development of insomnia. Reasons for this are unclear but could involve altered stress reactivity and/or autonomic nervous system (ANS) dysregulation, which are strongly associated with the pathophysiology of insomnia. We investigated sex differences in the effect of stress on sleep and ANS activity in adolescents, using the first night in the laboratory as an experimental sleep-related stressor.

Design: Repeated measures (first night vs. a subsequent night) with age (older/younger) and sex (males/females) as between factors.

Setting: Recordings were performed at the human sleep laboratory at SRI International.

Participants: One hundred six healthy adolescents (Age, mean ± SD: 15.2 ± 2.0 years; 57 boys).

Measures: Polysomnographic sleep, nocturnal heart rate (HR), and frequency-domain spectral ANS HR variability (HRV) indices.

Results: Boys and girls showed a first-night effect, characterized by lower sleep efficiency, lower %N1 and %N2 sleep, more wake after sleep onset and %N3 sleep, altered sleep microstructure (increased high-frequency sigma and Beta1 electroencephalographic activity), and reduced vagal activity (P < .05) on the first laboratory night compared to a subsequent night. The first night ANS stress effect (increases in HR and suppression in vagal HRV during rapid eye movement sleep) was greater in girls than boys (P < .05).

Conclusions: Sleep and ANS activity were altered during the first laboratory night in adolescents, with girls exhibiting greater ANS alterations than boys. Findings suggest that girls may be more vulnerable than boys to sleep-specific stressors, which could contribute to their increased risk for developing stress-related sleep disturbances.

Keywords: Autonomic nervous system; Heart rate variability; Insomnia; Sex differences; Sleep; Stress.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Female
  • Heart Rate / physiology
  • Humans
  • Male
  • Polysomnography
  • Sleep Initiation and Maintenance Disorders*
  • Sleep Stages / physiology
  • Sleep* / physiology