The longitudinal association of sleep and 24-hour activity rhythms with cortisol response to a very low dose of dexamethasone

Maud de Feijter; Jitske Tiemensma; Mohammad A. Ikram; Bruno H. Stricker; Annemarie I. Luik

doi:10.1016/j.sleh.2022.03.002

The longitudinal association of sleep and 24-hour activity rhythms with cortisol response to a very low dose of dexamethasone

Maud de Feijter, Jitske Tiemensma, Mohammad A. Ikram, Bruno H. Stricker, Annemarie I. Luik^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Objectives: Poor sleep is common in the general population, with hyperarousal and stress often suggested as causal factors. Conversely, sleep might also affect the stress response, in which the hypothalamic-pituitary-adrenal (HPA) axis plays a key role. We assessed the longitudinal association of sleep and 24-hour activity rhythms with functioning of the negative feedback loop of the HPA axis, as indicated by the cortisol response to a very low dose of dexamethasone. Design: Longitudinal cohort. Setting: Population-based. Participants: This study included 410 participants (mean age: 56.1 ± 5.5 years, 59% women) from the Rotterdam Study. For 217 participants, the cortisol response to dexamethasone was assessed again after a median follow-up of 5.7 years (IQR = 5.5-5.8). Measurements: Between 2004 and 2007, sleep and 24-hour activity rhythms were estimated with actigraphy (mean duration: 146 ± 19.6 hours) and sleep quality with the Pittsburgh Sleep Quality Index. To assess the negative feedback loop of the HPA axis we measured cortisol before and after the intake of a very low-dose of dexamethasone (0.25 mg). Results: Unstable (B = 1.64, 95% CI = 0.78; 2.50) and fragmented (B = -1.31, 95% CI = -2.17; -0.45) 24-hour activity rhythms, and a poor self-rated sleep quality (B = -0.02, 95% CI = -0.04; 0.00) were associated with an enhanced cortisol response to dexamethasone over time, also in those without clinically relevant depressive symptoms and those not using psychoactive medication. Conclusions: This study demonstrates a longitudinal association of disturbed 24-hour activity rhythms and poor self-rated sleep quality with an enhanced cortisol response to dexamethasone, in other words stronger suppression of cortisol. Statement of significance: This study shows that disturbed 24-hour activity rhythms and a poor self-rated sleep quality are associated with functioning of the negative feedback loop over a period of years.

Original language	English
Pages (from-to)	398-405
Number of pages	8
Journal	Sleep Health
Volume	8
Issue number	4
DOIs	https://doi.org/10.1016/j.sleh.2022.03.002
Publication status	Published - Aug 2022

Bibliographical note

Funding Information:
The Rotterdam Study is funded by Erasmus Medical Center and Erasmus University, Rotterdam, the Netherlands Organization for the Health Research and Development (ZonMw) , the Research Institute for Diseases in the Elderly (RIDE) , the Ministry of Education, Culture and Science, the Ministry of Health, Welfare and Sports , the European Commission (DG XII) , and the Municipality of Rotterdam . This research project was made possible by an award from the Sleep Research Society Foundation awarded to AI Luik .

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© 2022 The Authors

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title = "The longitudinal association of sleep and 24-hour activity rhythms with cortisol response to a very low dose of dexamethasone",

abstract = "Objectives: Poor sleep is common in the general population, with hyperarousal and stress often suggested as causal factors. Conversely, sleep might also affect the stress response, in which the hypothalamic-pituitary-adrenal (HPA) axis plays a key role. We assessed the longitudinal association of sleep and 24-hour activity rhythms with functioning of the negative feedback loop of the HPA axis, as indicated by the cortisol response to a very low dose of dexamethasone. Design: Longitudinal cohort. Setting: Population-based. Participants: This study included 410 participants (mean age: 56.1 ± 5.5 years, 59% women) from the Rotterdam Study. For 217 participants, the cortisol response to dexamethasone was assessed again after a median follow-up of 5.7 years (IQR = 5.5-5.8). Measurements: Between 2004 and 2007, sleep and 24-hour activity rhythms were estimated with actigraphy (mean duration: 146 ± 19.6 hours) and sleep quality with the Pittsburgh Sleep Quality Index. To assess the negative feedback loop of the HPA axis we measured cortisol before and after the intake of a very low-dose of dexamethasone (0.25 mg). Results: Unstable (B = 1.64, 95% CI = 0.78; 2.50) and fragmented (B = -1.31, 95% CI = -2.17; -0.45) 24-hour activity rhythms, and a poor self-rated sleep quality (B = -0.02, 95% CI = -0.04; 0.00) were associated with an enhanced cortisol response to dexamethasone over time, also in those without clinically relevant depressive symptoms and those not using psychoactive medication. Conclusions: This study demonstrates a longitudinal association of disturbed 24-hour activity rhythms and poor self-rated sleep quality with an enhanced cortisol response to dexamethasone, in other words stronger suppression of cortisol. Statement of significance: This study shows that disturbed 24-hour activity rhythms and a poor self-rated sleep quality are associated with functioning of the negative feedback loop over a period of years.",

author = "{de Feijter}, Maud and Jitske Tiemensma and Ikram, {Mohammad A.} and Stricker, {Bruno H.} and Luik, {Annemarie I.}",

note = "Funding Information: The Rotterdam Study is funded by Erasmus Medical Center and Erasmus University, Rotterdam, the Netherlands Organization for the Health Research and Development (ZonMw) , the Research Institute for Diseases in the Elderly (RIDE) , the Ministry of Education, Culture and Science, the Ministry of Health, Welfare and Sports , the European Commission (DG XII) , and the Municipality of Rotterdam . This research project was made possible by an award from the Sleep Research Society Foundation awarded to AI Luik . Publisher Copyright: {\textcopyright} 2022 The Authors",

year = "2022",

month = aug,

doi = "10.1016/j.sleh.2022.03.002",

language = "English",

volume = "8",

pages = "398--405",

journal = "Sleep Health",

issn = "2352-7218",

publisher = "Elsevier Inc.",

number = "4",

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T1 - The longitudinal association of sleep and 24-hour activity rhythms with cortisol response to a very low dose of dexamethasone

AU - de Feijter, Maud

AU - Tiemensma, Jitske

AU - Ikram, Mohammad A.

AU - Stricker, Bruno H.

AU - Luik, Annemarie I.

N1 - Funding Information: The Rotterdam Study is funded by Erasmus Medical Center and Erasmus University, Rotterdam, the Netherlands Organization for the Health Research and Development (ZonMw) , the Research Institute for Diseases in the Elderly (RIDE) , the Ministry of Education, Culture and Science, the Ministry of Health, Welfare and Sports , the European Commission (DG XII) , and the Municipality of Rotterdam . This research project was made possible by an award from the Sleep Research Society Foundation awarded to AI Luik . Publisher Copyright: © 2022 The Authors

PY - 2022/8

Y1 - 2022/8

N2 - Objectives: Poor sleep is common in the general population, with hyperarousal and stress often suggested as causal factors. Conversely, sleep might also affect the stress response, in which the hypothalamic-pituitary-adrenal (HPA) axis plays a key role. We assessed the longitudinal association of sleep and 24-hour activity rhythms with functioning of the negative feedback loop of the HPA axis, as indicated by the cortisol response to a very low dose of dexamethasone. Design: Longitudinal cohort. Setting: Population-based. Participants: This study included 410 participants (mean age: 56.1 ± 5.5 years, 59% women) from the Rotterdam Study. For 217 participants, the cortisol response to dexamethasone was assessed again after a median follow-up of 5.7 years (IQR = 5.5-5.8). Measurements: Between 2004 and 2007, sleep and 24-hour activity rhythms were estimated with actigraphy (mean duration: 146 ± 19.6 hours) and sleep quality with the Pittsburgh Sleep Quality Index. To assess the negative feedback loop of the HPA axis we measured cortisol before and after the intake of a very low-dose of dexamethasone (0.25 mg). Results: Unstable (B = 1.64, 95% CI = 0.78; 2.50) and fragmented (B = -1.31, 95% CI = -2.17; -0.45) 24-hour activity rhythms, and a poor self-rated sleep quality (B = -0.02, 95% CI = -0.04; 0.00) were associated with an enhanced cortisol response to dexamethasone over time, also in those without clinically relevant depressive symptoms and those not using psychoactive medication. Conclusions: This study demonstrates a longitudinal association of disturbed 24-hour activity rhythms and poor self-rated sleep quality with an enhanced cortisol response to dexamethasone, in other words stronger suppression of cortisol. Statement of significance: This study shows that disturbed 24-hour activity rhythms and a poor self-rated sleep quality are associated with functioning of the negative feedback loop over a period of years.

AB - Objectives: Poor sleep is common in the general population, with hyperarousal and stress often suggested as causal factors. Conversely, sleep might also affect the stress response, in which the hypothalamic-pituitary-adrenal (HPA) axis plays a key role. We assessed the longitudinal association of sleep and 24-hour activity rhythms with functioning of the negative feedback loop of the HPA axis, as indicated by the cortisol response to a very low dose of dexamethasone. Design: Longitudinal cohort. Setting: Population-based. Participants: This study included 410 participants (mean age: 56.1 ± 5.5 years, 59% women) from the Rotterdam Study. For 217 participants, the cortisol response to dexamethasone was assessed again after a median follow-up of 5.7 years (IQR = 5.5-5.8). Measurements: Between 2004 and 2007, sleep and 24-hour activity rhythms were estimated with actigraphy (mean duration: 146 ± 19.6 hours) and sleep quality with the Pittsburgh Sleep Quality Index. To assess the negative feedback loop of the HPA axis we measured cortisol before and after the intake of a very low-dose of dexamethasone (0.25 mg). Results: Unstable (B = 1.64, 95% CI = 0.78; 2.50) and fragmented (B = -1.31, 95% CI = -2.17; -0.45) 24-hour activity rhythms, and a poor self-rated sleep quality (B = -0.02, 95% CI = -0.04; 0.00) were associated with an enhanced cortisol response to dexamethasone over time, also in those without clinically relevant depressive symptoms and those not using psychoactive medication. Conclusions: This study demonstrates a longitudinal association of disturbed 24-hour activity rhythms and poor self-rated sleep quality with an enhanced cortisol response to dexamethasone, in other words stronger suppression of cortisol. Statement of significance: This study shows that disturbed 24-hour activity rhythms and a poor self-rated sleep quality are associated with functioning of the negative feedback loop over a period of years.

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The longitudinal association of sleep and 24-hour activity rhythms with cortisol response to a very low dose of dexamethasone

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