@article{3087894,
    title = "Insomnia symptoms, objective sleep duration and hypothalamic-pituitary-adrenal activity in children",
    author = "Fernandez-Mendoza, J. and Vgontzas, A.N. and Calhoun, S.L. and Vgontzas, A. and Tsaoussoglou, M. and Gaines, J. and Liao, D. and Chrousos, G.P. and Bixler, E.O.",
    journal = "European Journal of Clinical Investigation",
    year = "2008",
    volume = "44",
    number = "5",
    pages = "493-500",
    publisher = "Wiley-Blackwell Publishing Ltd",
    issn = "0014-2972, 1365-2362",
    doi = "10.1111/eci.12263",
    keywords = "hydrocortisone;  hydrocortisone, anxiety;  apnea hypopnea index;  article;  body mass;  child;  childhood disease;  cohort analysis;  depression;  disease association;  female;  human;  hypothalamus hypophysis adrenal system;  insomnia;  major clinical study;  male;  morbidity;  named inventories, questionnaires and rating scales;  Pediatric Behavior Scale;  polysomnography;  priority journal;  saliva analysis;  sleep time;  waist circumference;  chemistry;  hypophysis adrenal system;  hypothalamus hypophysis system;  insomnia;  metabolism;  pathophysiology;  physiology;  preschool child;  saliva, Child;  Child, Preschool;  Cohort Studies;  Female;  Humans;  Hydrocortisone;  Hypothalamo-Hypophyseal System;  Male;  Pituitary-Adrenal System;  Polysomnography;  Saliva;  Sleep Initiation and Maintenance Disorders",
    abstract = "Background: Insomnia symptoms are the most common parent-reported sleep complaints in children; however, little is known about the pathophysiology of childhood insomnia symptoms, including their association with hypothalamic-pituitary-adrenal (HPA) axis activation. The objective of this study is to examine the association between parent-reported insomnia symptoms, objective short sleep duration and cortisol levels in a population-based sample of school-aged children. Design: A sample of 327 children from the Penn State Child Cohort (5-12 years old) underwent 9-h overnight polysomnography and provided evening and morning saliva samples to assay for cortisol. Objective short sleep duration was defined based on the median total sleep time (i.e., < 7·7 h). Parent-reported insomnia symptoms of difficulty initiating and/or maintaining sleep were ascertained with the Pediatric Behavior Scale. Results: Children with parent-reported insomnia symptoms and objective short sleep duration showed significantly increased evening (0·33 ± 0·03 μg/dL) and morning (1·38 ± 0·08 μg/dL) cortisol levels. In contrast, children with parent-reported insomnia symptoms and 'normal' sleep duration showed similar evening and morning cortisol levels (0·23 ± 0·03 μg/dL and 1·13 ± 0·08 μg/dL) compared with controls with 'normal' (0·28 ± 0·02 μg/dL and 1·10 ± 0·04 μg/dL) or short (0·28 ± 0·02 μg/dL and 1·13 ± 0·04 μg/dL) sleep duration. Conclusions: Our findings suggest that insomnia symptoms with short sleep duration in children may be related to 24-h basal or responsive physiological hyperarousal. Future studies should explore the association of insomnia symptoms with short sleep duration with physical and mental health morbidity. © 2014 Stichting European Society for Clinical Investigation Journal Foundation."
}