Heart Rate Variability was not Associated with Subsequent Night Sleep Parameters and Cortisol Awakening Response

Öz

Background: Changes in sleep duration and sleep disturbance have been reported to affect hypothalamic-pituitary-adrenal axis (HPA) and the autonomic nervous system (ANS) activities. However, the effect of ANS activity on sleep parameters and HPA activity in the subsequent night and morning is not known. The aim of the current study, was, therefore, to assess the effects of heart rate varibility (HRV) on subsequent night sleep parameters and cortisol awakening response (CAR).
Materials and Methods: Electrocardiographic recordings were carried out for 5 min for determination of HRV in healty medical students (n=48). They were allowed to sleep in their normal routines in following night. Sleep diaries were filled for sleep parameters (Karolinska Sleep Diary and Questionnaire). Salivary samples were taken at 0, 15, 30- and 60-min post-awakening for measurement of CAR. Cortisol concentrations were measured in the salivary samples by enzyme immunoassay. Correlations were carried out by Spearman Rho. p <0.05 values were considered significant.
Results: The majority of the participants (80%) had time-domain variables within the normal range and they did not have sleep disturbances. Time- and frequency-domain parameters of HRV during the morning did not correlate with sleep parameters (time, duration, disturbed sleep, awakening problems) or CAR (mean, area under the curve) in the next day (p>0.05).
Conclusion: The results of the current study suggest that, under the conditions which do not have profound effects on ANS activity, neither sleep parameters nor the next morning cortisol responses are affected by HRV. Additionally, a quality night sleep might counterbalance both the possible effects of previous days autonomic pressures and the next morning’s cortisol responses.

Kalp Hızı Değişkenliği, Müteakip Gece Uyku Parametreleri ve Kortizol Uyanma Yanıtı ile İlişkili Değildi

Öz

Amaç: Uyku bozukluğu ve uyku düzeninin değişmesi hipotalamus-hipofiz-adrenal aksı (HPA) ve otonom sinir sistemini (OSS) etkilediği bildirilmiştir. Ancak gün içerisindeki otonom sinir sistemi aktivitesinin gece uykusuna ve bir sonraki gün HPA aksına etkisi bilinmemektedir. Bu nedenle, mevcut çalışmanın amacı, OSS aktivitesinin belirteci olan kalp hızı değişkenliğinin (KHD), gece uyku parametreleri ve bir sonraki gün HPA aksının belirteci olan kortizol uyanma yanıtına (KUY) olan etkisini incelemekti.
Materyal ve Metod: Bu çalışmada 48 sağlıklı Tıp Fakültesi öğrencilerinden KHD belirlemek için 5 dakikalık elektrokardiyografi (EKG) kaydı alındı. Takip eden gece normal uyku düzenlerinde uyumaları sağlandı. Uyku verilerini elde etmek için uyku ölçekleri dolduruldu (Karolinska uyku günlüğü ve ölçeği). KUY ölçümü için sabah uyandıktan 0, 15, 30 ve 60 dakika sonra tükürük örnekleri toplandı. Tükürük örneklerinde kortizol konsantrasyonu enzim immunoassay yöntemiyle belirlendi. Korelasyonlar Spearman Rho ile bakıldı. P < 0.05 değerleri anlamlı kabul.edildi.
Bulgular: Katılımcıların çoğunda (%80) zaman bağımlı değişimlerin normal sınırlar içerisindeydi ve bu kişiler uyku bozukluğu yaşamamışlardı. Gün içerisinde elde edilen KHD’nin zaman ve frekans bağımlı parametrelerinin, takip eden gün içerisindeki uyku parametreleri (uyanma ve uyku süresi, uyku bozukluğu, uyanma problemleri) ve KUY (ortalama, eğri altında kalan alan) ile bir korelasyon bulunmadı (p>0.05).
Sonuç: Bu çalışmanın sonuçları gösteriyor ki; OSS aktivitesi üzerinde derin etkileri olmayan koşullar altında ne uyku parametrelerinin ne de ertesi sabah kortizol yanıtlarının KHD'den etkilenmediğini göstermektedir. Buna ek olarak, kaliteli bir gece uykusu hem önceki günlerin otonom baskılarının olası etkilerini hem de ertesi sabahın kortizol tepkilerini dengeleyebilir.

Anahtar Kelimeler

• Uyku
• Kortizol
• Kalp hızı değişkenliği (KHD)

Kaynakça

1. Referans1. Hillman DR, Lack LC. Public health implications of sleep loss: The community burden. Medical Journal of Australia. 2013, 199: 7-10.
2. Referans2. Bonnet MH, Arand DL. We are chronically sleep deprived. Sleep. 1995 Dec;18(10):908–11.
3. Referans3. Benbir G, Demir AU, Aksu M, Ardic S, Firat H, Itil O, ve ark. Prevalence of insomnia and its clinical correlates in a general population in Turkey. Psychiatry and Clinical Neurosciences. 2015 Sep;69(9):543-52.
4. Referans4. Van Cauter E, Spiegel K, Tasali E, Leproult R. Metabolic consequences of sleep and sleep loss. Sleep Medicine. 2008;9 Suppl 1(01):S23–S28.
5. Referans5. Uçar C, Özgöçer T, Yildiz S. Late-night exercise affects the autonomic nervous system activity but not the hypothalamo-pituitary-adrenal axis in the next morning. The Journal of Sports Medicine and Physical Fitness. 2018;58(1-2):57–65.
6. Referans6. Ozgocer T, Ucar C, Yildiz S. Cortisol awakening response is blunted and pain perception is increased during menses in cyclic women. Psychoneuroendocrinology. 2017;77:158–164.
7. Referans7. Pruessner JC, Kirschbaum C, Meinlschmid G, Hellhammer DH. Two formulas for computation of the area under the curve represent measures of total hormone concentration versus time-dependent change. Psychoneuroendocrinology. 2003;28(7):916–931.
8. Referans8. Marques AH, Silverman MN, Sternberg EM. Evaluation of stress systems by applying noninvasive methodologies: measurements of neuroimmune biomarkers in the sweat, heart rate variability and salivary cortisol. Neuroimmunomodulation. 2010;17(3):205-8.

9. Referans9. Shaffer F, McCraty R, Zerr CL. A healthy heart is not a metronome: an integrative review of the heart's anatomy and heart rate variability. Frontiers in Psychology. 2014;5:1040.
10. Referans10. Tobaldini E, Nobili L, Strada S, Casali KR, Braghiroli A, Montano N. Heart rate variability in normal and pathological sleep. Frontiers in Psychology. 2013;4:294.
11. Referans11. Meerlo P, Koehl M, van der Borght K, Turek FW. Sleep restriction alters the hypothalamic-pituitary-adrenal response to stress. Journal of Neuroendocrinology. 2002;14(5):397–402.
12. Referans12. Kinlein SA, Karatsoreos IN. The hypothalamic-pituitary-adrenal axis as a substrate for stress resilience: Interactions with the circadian clock. Front Neuroendocrinology. 2020;56:100819.
13. Referans13. Akerstedt T. Psychosocial stress and impaired sleep. Scandinavian Journal of Work, Environment & Health. 2006;32(6):493–501.
14. Referans14. Wust S, Wolf J, Hellhammer DH, Federenko I, Schommer N, Kirschbaum C. The cortisol awakening response-normal values and confounds. Noise Health. 2000, 2: 79-88.
15. Referans15. Kumari M, Badrick E, Ferrie J, Perski A, Marmot M, Chandola T. Self-reported sleep duration and sleep disturbance are independently associated with cortisol secretion in the Whitehall II study. The Journal of Clinical Endocrinology&Metabolism. 2009, 94: 4801-9.
16. Referans16. Hansen AM, Thomsen JF, Kaergaard A, Kolstad HA, Kaerlev L, Mors O, et al. Salivary cortisol and sleep problems among civil servants. Psychoneuroendocrinology. 2012, 37: 1086-95.
17. Referans17. Stalder T, Evans P, Hucklebridge F, Clow A. Associations between psychosocial state variables and the cortisol awakening response in a single case study. Psychoneuroendocrinology. 2010, 35: 209-14.
18. Referans18. Tsai HJ, Kuo TB, Lee GS, Yang CC. Efficacy of paced breathing for insomnia: enhances vagal activity and improves sleep quality. Psychophysiology. 2015;52(3):388–396.
19. Referans19. Ozgocer T, Yildiz S, Uçar C. Development and validation of an enzyme-linked immunosorbent assay for detection of cortisol in human saliva. Journal of Immunoassay and Immunochemistry. 2017;38(2):147–164.
20. Referans20. Michels N, Sioen I, Clays E, De Buyzere M, Ahrens W, Huybrechts I, et al. Children's heart rate variability as stress indicator: Association with reported stress and cortisol. Biological Psychology. 2013, 94: 433-40.
21. Referans21. Bonnet MH, Arand DL. Sleepiness as measured by modified multiple sleep latency testing varies as a function of preceding activity. Sleep. 1998, 21(5): 477-83.
22. Referans22. Dettoni JL, Consolim-Colombo FM, Drager LF, Rubira MC, Souza SB, Irigoyen MC, et al. Cardiovascular effects of partial sleep deprivation in healthy volunteers. Journal of Applied Physiology. 2012, 113(2): 232-6.
23. Referans23. Kleiger RE. Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. American Journal of Cardiology. 1987, 59: 256–62.
24. Referans24. Dettenborn L, Rosenloecher F, Kirschbaum C. No effects of repeated forced wakings during three consecutive nights on morning cortisol awakening responses (CAR): A preliminary study. Psychoneuroendocrinology. 2007, 32: 915-21.
25. Referans25. Crasset V, Mezzetti S, Antoine M, Linkowski P, Degaute JP, Van de Borne P. Effects of aging and cardiac denervation on heart rate variability during sleep. Circulation. 2001, 103: 84-8.
26. Referans26. Izawa S, Sugaya N, Yamamoto R, Ogawa N, Nomura S. The cortisol awakening response and autonomic nervous system activity during nocturnal and early morning periods. Neuro Endocrinology Letters. 2010, 31(5): 685-9.
27. Referans27. Lemola S, Perkinson-Gloor N, Hagmann-von Arx P, Brand S, Holsboer-Trachsler E, Grob A, et al. Morning cortisol secretion in school-age children is related to the sleep pattern of the preceding night. Psychoneuroendocrinology. 2015, 52: 297- 301.
28. Referans28. Wolfram M, Bellingrath S, Kudielka BM. The cortisol awakening response (CAR) across the female menstrual cycle. Psychoneuroendocrinology. 2011, 36(6): 905-12.
29. Referans29. Gomez-Santos C, Saura CB, Lucas JA, Castell P, Madrid JA, Garaulet M. Menopause status is associated with circadian- and sleep-related alterations. Menopause. 2016, 23(6): 682-90.