title: Anticipation of public speaking and sleep and the hypothalamic-pituitary-adrenal axis in women with irritable bowel syndrome.
abstract: BACKGROUND
  Evidence suggests that subgroups of patients with irritable bowel syndrome (IBS) are hyper-responsive to a variety of laboratory stress conditions.
  
  
  METHODS
  This study compared sleep quality and night time plasma adrenocorticotropic hormone (ACTH) and serum cortisol levels in response to anticipation of public speaking between 43 women with IBS and 24 healthy control women. In addition, comparisons were made between subgroups within the IBS sample based on predominant stool patterns, 22 IBS-constipation and 21 IBS-diarrhea. Subjects slept three nights in a sleep laboratory, and on the third night serial blood samples were drawn every 20 min from 08:00 PM until awakening. As the subjects had different sleep onsets, each subject's results were synchronized to the first onset of stage 2 sleep.
  
  
  RESULTS
  Compared the healthy control group, women with IBS had significantly worse sleep efficiency, and higher cortisol but not ACTH levels over the night. However, there were no IBS bowel pattern subgroup differences. Among IBS subjects, cortisol levels early in the night were higher than found in our previous study with a similar protocol but without the threat of public speaking. These results suggest that a social stressor, such as public speaking prior to bedtime, increases cortisol but not ACTH levels suggesting HPA dysregulation in women with IBS.
  
  
  CONCLUSIONS
  This response to a social stressor contributes to our understanding of the relationship of stress to symptom expression in IBS.
authors.affiliation: Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA 98195-7266, USA. heit@uw.edu
authors.forename: M M
authors.initials: MM
authors.lastname: Heitkemper
authors.forename: K C
authors.initials: KC
authors.lastname: Cain
authors.forename: W
authors.initials: W
authors.lastname: Deechakawan
authors.forename: A
authors.initials: A
authors.lastname: Poppe
authors.forename: S-E
authors.initials: SE
authors.lastname: Jun
authors.forename: R L
authors.initials: RL
authors.lastname: Burr
authors.forename: M E
authors.initials: ME
authors.lastname: Jarrett
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood; D059031:Anticipation, Psychological / Q000502:physiology; D001007:Anxiety / Q000503:physiopathology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D043183:Irritable Bowel Syndrome / Q000097:blood / Q000503:physiopathology*; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D012890:Sleep / Q000502:physiology*; D013060:Speech / Q000502:physiology*; D013315:Stress, Psychological / Q000097:blood / Q000503:physiopathology
chemical_list: D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone