title: Association of Sleep Duration and Quality With Alterations in the Hypothalamic-Pituitary Adrenocortical Axis: The Multi-Ethnic Study of Atherosclerosis (MESA).
abstract: BACKGROUND
  Short sleep duration and poor sleep quality are associated with cardiovascular outcomes. One mechanism proposed to explain this association is altered diurnal cortisol secretion.
  
  
  OBJECTIVE
  The objective of the study was to examine the associations of sleep duration and sleep quality with diurnal salivary cortisol levels.
  
  
  METHODS
  This was a cross-sectional analysis using data from examination 5 (2010-2012) of the Multi-Ethnic Study of Atherosclerosis. Actigraphy-based measures of sleep duration and efficiency were collected over 7 days, and salivary cortisol samples were collected over 2 days from participants aged 54-93 years (n = 600 with analyzable data).
  
  
  RESULTS
  Shorter average sleep duration (<6 h/night) was associated with less pronounced late decline in cortisol [2.2% difference in slope; 95% confidence interval (CI) 0.8-3.7; P ≤ .01] and less pronounced wake-to-bed slope (2.2% difference; 95% CI 1.0-3.4; P ≤ .001) compared with longer sleep duration (≥6 h/night). Lower sleep efficiency (<85%) was associated with less pronounced early decline in cortisol (29.0% difference in slope; 95% CI 4.1-59.7; P < .05) compared with higher sleep efficiency (≥85%). Subjects reporting insomnia had a flatter cortisol awakening response (-16.1% difference in slope; 95% CI -34.6 to -0.1; P < .05) compared with those not reporting insomnia.
  
  
  CONCLUSIONS
  Shorter sleep duration, lower sleep efficiency, and insomnia are associated with alterations in diurnal cortisol levels consistent with changes in hypothalamic-pituitary-adrenal regulation.
authors.affiliation: Department of Medicine (C.C.-D., S. S.), Columbia University College of Physicians and Surgeons, New York, New York 10032; Department of Epidemiology (C.C.-D., S. S.), Mailman School of Public Health, Columbia University, New York, New York 10032; Department of Epidemiology and Biostatistics (A.V.D.R.), Drexel University School of Public Health, Philadelphia, Pennsylvania 19104; Departments of Medicine (S.R.), Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115; Department of Medicine/Geriatrics (T.S.), University of California, Los Angeles, Los Angeles, California 90095; and Department of Biostatistics (S. E. S.), University of Washington, Seattle, Washington 98115.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Castro-Diehl
authors.affiliation: Department of Medicine (C.C.-D., S. S.), Columbia University College of Physicians and Surgeons, New York, New York 10032; Department of Epidemiology (C.C.-D., S. S.), Mailman School of Public Health, Columbia University, New York, New York 10032; Department of Epidemiology and Biostatistics (A.V.D.R.), Drexel University School of Public Health, Philadelphia, Pennsylvania 19104; Departments of Medicine (S.R.), Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115; Department of Medicine/Geriatrics (T.S.), University of California, Los Angeles, Los Angeles, California 90095; and Department of Biostatistics (S. E. S.), University of Washington, Seattle, Washington 98115.
authors.forename: Ana V
authors.initials: AV
authors.lastname: Diez Roux
authors.affiliation: Department of Medicine (C.C.-D., S. S.), Columbia University College of Physicians and Surgeons, New York, New York 10032; Department of Epidemiology (C.C.-D., S. S.), Mailman School of Public Health, Columbia University, New York, New York 10032; Department of Epidemiology and Biostatistics (A.V.D.R.), Drexel University School of Public Health, Philadelphia, Pennsylvania 19104; Departments of Medicine (S.R.), Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115; Department of Medicine/Geriatrics (T.S.), University of California, Los Angeles, Los Angeles, California 90095; and Department of Biostatistics (S. E. S.), University of Washington, Seattle, Washington 98115.
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
authors.affiliation: Department of Medicine (C.C.-D., S. S.), Columbia University College of Physicians and Surgeons, New York, New York 10032; Department of Epidemiology (C.C.-D., S. S.), Mailman School of Public Health, Columbia University, New York, New York 10032; Department of Epidemiology and Biostatistics (A.V.D.R.), Drexel University School of Public Health, Philadelphia, Pennsylvania 19104; Departments of Medicine (S.R.), Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115; Department of Medicine/Geriatrics (T.S.), University of California, Los Angeles, Los Angeles, California 90095; and Department of Biostatistics (S. E. S.), University of Washington, Seattle, Washington 98115.
authors.forename: Teresa
authors.initials: T
authors.lastname: Seeman
authors.affiliation: Department of Medicine (C.C.-D., S. S.), Columbia University College of Physicians and Surgeons, New York, New York 10032; Department of Epidemiology (C.C.-D., S. S.), Mailman School of Public Health, Columbia University, New York, New York 10032; Department of Epidemiology and Biostatistics (A.V.D.R.), Drexel University School of Public Health, Philadelphia, Pennsylvania 19104; Departments of Medicine (S.R.), Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115; Department of Medicine/Geriatrics (T.S.), University of California, Los Angeles, Los Angeles, California 90095; and Department of Biostatistics (S. E. S.), University of Washington, Seattle, Washington 98115.
authors.forename: Sandi E
authors.initials: SE
authors.lastname: Shrager
authors.affiliation: Department of Medicine (C.C.-D., S. S.), Columbia University College of Physicians and Surgeons, New York, New York 10032; Department of Epidemiology (C.C.-D., S. S.), Mailman School of Public Health, Columbia University, New York, New York 10032; Department of Epidemiology and Biostatistics (A.V.D.R.), Drexel University School of Public Health, Philadelphia, Pennsylvania 19104; Departments of Medicine (S.R.), Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115; Department of Medicine/Geriatrics (T.S.), University of California, Los Angeles, Los Angeles, California 90095; and Department of Biostatistics (S. E. S.), University of Washington, Seattle, Washington 98115.
authors.forename: Steven
authors.initials: S
authors.lastname: Shea
mesh_terms: D056044:Actigraphy; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000208:ethnology / Q000378:metabolism / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000378:metabolism* / Q000503:physiopathology; D012463:Saliva / Q000378:metabolism; D012890:Sleep / Q000502:physiology*; D012893:Sleep Wake Disorders / Q000453:epidemiology / Q000378:metabolism* / Q000503:physiopathology; D014851:Wakefulness / Q000502:physiology
chemical_list: D006854:Hydrocortisone