Effort-reward-imbalance and overcommitment are associated with hypothalamus-pituitary-adrenal (HPA) axis responses to acute psychosocial stress in healthy working schoolteachers

In this study, we examined HPA axis responses to acute psychosocial stress in relation to effort-reward-imbalance (ERI) and overcommitment (OC) to test whether chronic stress at work is accompanied by altered HPA axis stress responses in teachers. According to Siegrist's work stress model, ERI reflects stress due to a lack of reciprocity between personal costs and gains at work, whereas OC is conceptualized as a personality trait mainly characterized by the inability to withdraw from work obligations. Fifty-three medication-free, non-smoking, healthy teachers (33 women, 20 men, 29–63 years, mean age 49.9 ± 8.58 years) were confronted with the Trier Social Stress Test (TSST), a widely used standardized stress protocol to induce acute psychosocial stress in the laboratory. ACTH (five samples), total plasma (six samples) and free salivary cortisol (eight samples) were repeatedly measured before and after challenge. In the total group, ERI and OC were only marginally associated with HPA axis responses to acute stress. However, in the subgroup of responders (N = 30) high levels of OC were significantly associated with lower ACTH (p = 0.03) as well as plasma (p = 0.02) and salivary cortisol (p < 0.001) responses and results remained significant controlling for depressive symptoms. When additionally controlling for acute perceived stressfulness of the TSST, significant associations between OC and HPA axis responses emerged in responders as well as the total study sample. In respect to ERI, higher stress levels were solely related to significantly stronger plasma cortisol increases after TSST exposure, but this effect became non-significant controlling for depressive symptomatology. In sum, our findings support the notion of HPA axis hyporeactivity in highly overcommitted schoolteachers.     

In healthy young and elderly adults, hypothalamic-pituitary-adrenocortical axis reactivity (HPA AR) varies with increasing pharmacological challenge and with age, but not with gender

Background

Hypothalamic-pituitary-adrenocortical axis reactivity (HPA AR) is the key indicator of the psychophysiological response to stress. The HPA AR may vary with age and gender. To investigate these factors concurrently, the aims of the present study were to observe HPA AR (plasma ACTH and plasma cortisol) in response to a pharmacological challenge (dexamethasone/corticotropin releasing hormone test: DEX/CRH-test) and as a function of age and gender.

Method

19 young (10 females and 9 males; mean age = 24.05 years) and 23 elderly (11 females and 12 males; mean age = 71.61 years) healthy volunteers took part in the study. To assess HPA AR, participants underwent the combined DEX/CRH test applied with the following DEX doses: 0.75, 1.5, and 3.0 mg, respectively.

Results

A dose-dependent response was observed in young adult participants, but not in elderly participants. With increasing DEX doses, ACTH and cortisol values decreased in young adult participants, while the decrease was blunted among elderly compared to young adult participants. No differences were observed for gender.

Conclusions

Results point to diminished HPA axis sensitivity as an effect of normal aging, irrespective of gender. Therefore, altered HPA regulation in old age should be taken into account for developing new therapeutic approaches acting on the HPA axis and its receptor mechanisms.     

Elevated cortisol in healthy female adolescent offspring of mothers with posttraumatic stress disorder

Offspring with maternal PTSD are at increased risk of developing PTSD themselves. Alterations in the hypothalamic-pituitary-adrenal (HPA) axis may play a role and have been noted in offspring, although evidence is mostly from adult offspring with PTSD symptoms themselves. The present study of adolescent girls (N = 472) and their mothers (n = 18 with lifetime PTSD versus n = 454 with no PTSD) sought to determine whether healthy, non-affected offspring of mothers with PTSD would exhibit altered HPA axis function. Saliva samples were collected from the adolescent girls at waking, 30 min after waking, and 8 pm on 3 consecutive days. Offspring whose mothers were diagnosed with PTSD demonstrated higher cortisol awakening response (CAR; Cohen’s d = 0.58) and greater total cortisol output (Cohen’s d = 0.62). In this preliminary study, higher cortisol levels during adolescence among offspring of mothers with PTSD may index a vulnerability in these at-risk youth.     

Burnout in direct care staff in intellectual disability services: a factor analytic study of the Maslach Burnout Inventory

Background There is gathering research interest in the well‐being of staff working in services for people with intellectual disability (ID), including the assessment of burnout and its correlates. However, no previous studies have considered the applicability of the main three dimensions of burnout to staff in ID services. Methods Data were analysed from two samples of staff (total n = 184) who participated in research studies that included completion of the Maslach Burnout Inventory (MBI). Results Nineteen of the MBI items loaded clearly onto factors closely resembling the three original subscales: emotional exhaustion, depersonalization and personal accomplishment. Internal consistency for the three MBI subscales was fair to good (range 0.68–0.87). Conclusions The original three MBI dimensions were found to be highly relevant to the present sample of staff. The analyses support the construct validity and reliability of the MBI for staff in ID services.     

Burnout and victimisation: impact of inmates' aggression towards prison guards

Introduction

Prison is typically considered as a dangerous setting partly because of promiscuity and violence, which leads to a whole series of suffering and frustration among prisoners. Due to their occupation, prison guards must ensure the safety of the inmates, their colleagues, as well as any other persons working in prison and in the prison setting. Thus, correctional guards are the “Bumper excitement” of prison violence and suffer from stressful and traumatic events. Indeed, inmates’ sufferings and frustration are firstly expressed towards them because they share daily relationships with inmates. In addition, correctional guards are faced with the high inmate suicide risk. One potential consequence of these chronic stressful situations is burnout. Burnout is described as a three-dimensional syndrome composed of emotional exhaustion, depersonalization and sense of lack of personal accomplishment. Burnout is a severe psychological suffering, which can lead to depression. It has been initially identified among persons who are working with patients. Nevertheless, research shows that burnout is not a psychopathology of work but of the relationship with others. In other terms, burnout seems to arise when people share stressful, chronic and violent relationships with someone else. Burnout doesn’t appear per se in any international classification of mental disorders: clinicians often use the diagnosis of adjustment disorder.

Purpose

Our aim is to assess the impact of victimization on burnout among guards in French prisons. Prison guards were chosen for two major reasons. First, the custodial role of correctional officers is typically described as a stressful occupation, sensitive to burnout. Second, prison is generally considered “dangerous”. Indeed, victimizations and aggressions frequently occur. Consequently, we hypothesize that burnout levels will be high for prison guards. We also hypothesize that the intensity of the victimizations (verbal, physical or armed aggression) will heighten burnout levels.

Material and methods

Two hundred and thirty-five prison guards were involved. Among these 235 correctional guards, there were 46 women and 188 men, ranging from 22 to 56 years old. Victimizations were very common: more than 87 % had experienced an aggression, whether verbally, physically or armed. They were asked to fill out the French form of the Maslach burnout Inventory (MBI). The MBI is a 22-item self-report measurement that assesses the three dimensions of burnout: emotional exhaustion, depersonalization and personal accomplishment. Items are rated on a 7-point scale ranging from 0 (“never”) to 6 (“every day”). We have statistically created a new global level of burnout with the three dimensions. It is called “burnout level”. We have assessed two sets of independent variables (VI): demographic VI (age, sex, tenure, level of studies) and correctional VI (penal status of prison, victimizations). Regarding our dependent variables, we have four levels which are (1) global burnout (GB), (2) emotional exhaustion (EE), (3) depersonalization (D), and (4) personal accomplishment (PA). For the purpose of our study, we carried out variance analyses (Anova) in order to compare the averages of our groups of subjects. Further to Anova, we chose the Bonferroni/Dunn post hoc test.

Results

The results indicate that demographic variables such as age, sex or level of studies have no significant effect on GB, EE, D and PA levels. Tenure has a significant effect on GB and D levels. Concerning correctional variables, results show that the penal status of prison has a significant effect on GB and EE. Prison guards working with inmates incarcerated for more than 5 years report higher GB and EE than their counterparts working with inmates not already convicted. Victimizations have a significant effect on GB, EE, D and PA levels. Prison guards with physical or armed aggressions report higher global GB, EE, D and PA levels than prison guards without aggressions. Furthermore, prison guards with physical or armed aggressions report higher global GB and D levels than prison guards with verbal aggressions. Two major points are highlighted by our study. First, characteristics of prison and inmates are related to burnout among prison guards. Second, victimizations lead to burnout.     

The role of BDNF and HPA axis in the neurobiology of burnout syndrome

Chronic stress is known to affect the HPA axis. The few clinical studies which have been conducted on HPA-axis function in burnout have produced inconsistent results. The etiological relationship between sBDNF and burnout has not yet been studied. The aim of the current study was to investigate the role of BDNF and HPA axis in the neurobiology of burnout. In the current study 37 clinically diagnosed burnout participants were compared with 35 healthy controls in terms of BDNF, HPA axis, burnout symptoms, depression, anxiety and psychosomatic complaints. Basal serum cortisol, sBDNF and cortisol level after 1 mg DST was sampled. We found no significant differences in terms of HPA-axis function (for basal serum cortisol, p=0.592; for cortisol level after 1 mg DST, p=0.921), but we did find lowered sBDNF levels in burnout group (88.66+/-18.15 pg/ml) as compared to healthy controls (102.18+/-20.92 pg/ml) and the difference was statistically significant (p=0.005). Logistic Regression Analysis revealed that emotional exhaustion (p=0.05), depersonalization (p=0.005) and depression (p=0.025) were significantly associated with burnout. sBDNF levels correlated negatively with emotional exhaustion (r=-,268, p=0.026), depersonalization (r=-,333, p=0.005) and correlated positively with competence (r=0.293, p=0.015) sub-scales of burnout inventory. However, there were no significant relationships between cortisol levels and sBDNF levels (r=0.80, p=0.51), depression, anxiety, psychosomatic complaints and burnout inventory. Our results suggest that low BDNF might contribute to the neurobiology of burnout syndrome and it seems to be associated with burnout symptoms including altered mood and cognitive functions.     

Burnout syndrome and associated factors among university teaching staff in Cameroon: Effect of the practice of sport and physical activities and leisures

ObjectivesThis study aimed to evaluate the epidemiology of burnout syndrome among university teaching staff in Cameroon; and to establish if the practice of physical activities and leisures could have preventive effect.MethodsA cross-sectional study using a self-administered questionnaire on socio-demographic characteristics, socio-professional conditions, Maslach Burnout Inventory-Educator Survey (MBI-ES) to evaluate burnout syndrome, and Ricci-Gagnon metrics to assess level of physical activities practice among grades of teaching staff, in the various faculties of the University of Douala, Cameroon.ResultsThree hundreds and three teaching staff members aged 43 ± 7 years were included (69% males). The prevalence of burnout syndrome was 68%, distributed within the three dimensions as follows: emotional exhaustion (15.2%), depersonalization (32.1%) and loss of personal accomplishment (22.1%), with 57% low level, 38% moderate and 6% severe. Burnout affected respectively 55.4% lecturers, 38.3% senior lecturers and 6.3% professors. Burnout was significantly associated with poor working conditions (P = 0.0001), unsatisfactory salary (P = 0.0001), part time teaching in private university institutions (P = 0.027), sensation of strenuous job (P = 0.002), conflict with colleagues (P = 0.028), sedentariness (P = 0.007). Sport and physical activities showed significant protective effect against burnout (P = 0.004), the same with leisures (P = 0.016).ConclusionThe prevalence burnout syndrome is high among university teaching staff in Cameroon. The practice of sport and physical activities and leisures has a protective effect against burnout syndrome.     

The Bright Side of Grit in Burnout-Prevention: Exploring Grit in the Context of Demands-Resources Model among Chinese High School Students

This study contributes to understanding students’ emotional responses to academic stressors by integrating grit into the well-established Job Demands-Resources Model and by examining the relationship between academic demands, grit (consistency of interests, perseverance of effort), burnout, engagement, academic achievement, depression, and life satisfaction in Chinese students. We conducted a self-report study with N?=?1527 Chinese high school students (M_age?=?16.38 years, SD?=?1.04). The results of structural equation modeling showed that after controlling for gender, socio-economic status, and school types, demands positively related to burnout and negatively related to engagement. Both facets of grit negatively related to exhaustion, whereas only perseverance of effort positively related to engagement. Burnout positively related to depression and negatively related to life satisfaction, whereas engagement positively related to life satisfaction. However, neither burnout nor engagement was related to academic achievement. Our findings indicate that grit may be protective against school burnout.

     

Gonadotropin inhibitory hormone and RF9 stimulate hypothalamic-pituitary-adrenal axis in adult male rhesus monkeys

Stress activates gonadotropin inhibitory hormone (GnIH), hypothalamic-pituitary-adrenal axis (HPA-axis) and represses hypothalamic-pituitary-gonadal axis (HPG-axis) but RF9 administration relieves stress-induced repression of the HPG-axis. Importantly, it was not known whether GnIH signaling and RF9 synthetic peptide modulate the HPA axis. To assess this, mammalian orthologs of GnIH (RFRP-1 and RFRP-3) and RF9 were administered to intact adult male rhesus monkeys. RFRP-1 (125 μg/animal), RFRP-3 (250 μg/animal) and RF9 (0.1 mg/kg BW) were intravenously (iv) injected into normal fed (n = 4) monkeys. Additionally, a single bolus iv injection of RF9 (0.1 mg/kg BW) was also administered to 48 h fasted monkeys (n = 4) to check the effects of RF9 signaling on an activated HPA-axis. Serial blood samples were collected, centrifuged and the obtained plasma was used for the analysis of cortisol by specific enzyme immunoassay. RFRP-1 treatment significantly increased cortisol levels while RFRP-3 increased the plasma cortisol, but the effect was non-significant. RF9 treatment significantly increased cortisol levels in normal fed animals. In contrast, RF9 injection did not significantly alter circulating cortisol in fasted monkeys. In conclusion, our results suggest stimulatory action of RFRPs and RF9 on the HPA axis in the adult male monkeys. However, the mechanism and site of action of RFRP-1 and RF9 along the HPA-axis is still unknown. Therefore, further studies are needed to decipher the mechanism and site of action of RFRPs and RF9 on the HPA axis in primates.     

A survey of burnout among Australian mental health occupational therapists and social workers

Abstract. Background: This study investigated the extent to which occupational therapists and social workers employed in Australian mental health settings are affected by burnout. Method: Questionnaires were sent to occupational therapists and social workers who had indicated that they were interested in participating in the study. An overall response rate of 76.6% (n = 304) was achieved. The outcome measure was the Maslach Burnout Inventory (comprising emotional exhaustion, depersonalisation and personal accomplishment scales). Results: There were no significant differences, with respect to any of the three burnout scales, between occupational therapists and social workers. Both groups experienced high emotional exhaustion, moderate depersonalisation, and high personal accomplishment. Levels of burnout were not significantly different between inpatient and community staff. Conclusions: These results suggested that, while occupational therapists and social workers reported emotional exhaustion, there was less evidence of depersonalisation and they reported very high personal accomplishment in their work. Results are congruent with those of previous studies and it is argued that the focus of future research should be on identifying characteristics of mental health work that contribute to emotional exhaustion.     

Correlation of salivary cortisol level with obstructive sleep apnea syndrome in pediatric subjects

Objective

Obstructive sleep apnea syndrome (OSAS) is associated with stress system activation involving the hypothalamic–pituitary–adrenocortical (HPA) axis. The relationships among salivary cortisol, a measure of the HPA axis, and objective parameters of polysomnography (PSG) and subjective sleep symptoms were examined.

Methods

Our prospective study enrolled 80 children who had a physical examination, underwent overnight PSG, and completed the Korean version of the modified pediatric Epworth sleepiness scale (KMPESS) and OSA-18 (KOSA-18) questionnaires. Saliva was collected at night before PSG and in the early morning after PSG.

Results

Subjects (N = 80) were divided into control (n = 32, apnea–hypopnea index [AHI] < 1) and OSAS (n = 48, AHI ? 1) groups; the OSAS group was subdivided into mild (1 ? AHI < 5) and moderate to severe (AHI ? 5) groups. Although salivary cortisol before PSG (n-sCor) did not show a significant change with OSAS severity, salivary cortisol after PSG (m-sCor) significantly decreased with OSAS severity. This decrease resulted in a salivary cortisol ratio (r-sCor) that was significantly different between the control group and the two OSAS subgroups. The m-sCor and sub-sCor of the total group as well as the m-sCor, sub-sCor, and r-sCor of the OSAS group were negatively related to the oxygen desaturation index (ODI). The m-sCor and r-sCor in the OSAS group also were related to subjective sleep symptoms (quality of life [QOL] by KOSA-18).

Conclusions

Among the four salivary cortisol parameters, r-sCor was negatively associated with OSAS severity, ODI, and QOL (KOSA-18), which may indicate a chronically stressed HPA axis. These results demonstrate that salivary cortisol may be a useful biomarker of OSAS.     

Parental support buffers the association of depressive symptoms with cortisol and C-reactive protein during adolescence

Social experiences can affect the relationship between depression and physical health. The current study examined how social support from parents and friends may moderate the association of depressive symptoms with hypothalamic-pituitary-adrenal (HPA) axis activity and C-reactive protein among adolescents (N = 316, M_age = 16.40, SD = .74; 57% female) from diverse ethnic backgrounds (23.1% Asian, 29.1% European, 41.8% Latino, and 6.0% other backgrounds). Results indicated that parent support, but not friend support, moderated the link between depressive symptoms and both total daily cortisol output (a measure HPA activity) and C-reactive protein (a marker of inflammation). These patterns did not differ by ethnicity. Overall, the study highlights the continued, and perhaps accumulated, importance of parents during adolescence despite increasing needs for autonomy from and exploration outside of the family unit.     

Burnout chez les résidents en médecine tunisiens : à propos de 149 cas

Background

Burnout is a professional psychological chronic stress-induced syndrome defined by three dimensions: emotional exhaustion, depersonalization, and low personal accomplishment. This syndrome concerns all professions but especially healthcare staff. Numerous studies have attempted to document the impact of work activities on the doctor's mental health. According to the literature, junior doctors are more vulnerable to develop this syndrome.

Abnormal externally guided movement preparation in recent-onset schizophrenia is associated with impaired selective attention to external input

Chronic stress can result in frequent or persistent challenges of the hypothalamic-pituitary-adrenal (HPA) axis resulting in abnormal cortisol patterns and increased risk for cardiovascular disease (CVD). Police work is an environment replete with stress. The present article describes associations between cortisol, a biomarker of stress, and brachial artery flow mediated dilation (FMD) in police officers. A random sample stratified on gender (n = 100, 33% women) was generated from officers in a mid-sized urban department. Four salivary cortisol parameters were derived: after awakening, following a standardized high protein meal challenge, during the entire day, and after a dexamethasone suppression test. Continuous scan B-Mode ultrasound was used to measure percent change in brachial artery FMD following occlusion and release. Elevated cortisol secretion after awakening was significantly associated with impaired FMD in women, reflected by an inverse trend. Adjustment for age, smoking, and alcohol consumption did not appreciably alter this trend. A similar result was not evident among male officers. Responses of other cortisol challenges to the HPA axis were not associated with FMD. In conclusion, increased cortisol secretion after awakening was independently associated with impaired FMD in female police officers only, indicating a possible link between HPA axis stress response and subclinical CVD. However, because associations were not found with other cortisol parameters and were not evident in male officers, replication of these findings with a prospective study design may be warranted.     

Biomarkers in burnout: a systematic review

Background

Burnout is a stress state characterized by symptoms of mental exhaustion and physical fatigue, detachment from work, and feelings of diminished competence. Several biomarkers have been tested for association with burnout, but the results are conflicting.

Aim

The objective of this review was to identify potential biomarkers for burnout.

Methods

We carried out a systematic review of studies comparing biomarkers in individuals with burnout and healthy controls, or individuals with low scores and those with high scores on burnout questionnaires. Literature searches in MEDLINE and EMBASE were performed. We describe biomarkers on which at least three studies were available. Where appropriate, a meta-analysis was carried out.

Results

We identified 31 studies on 38 biomarkers involved in the hypothalamus–pituitary–adrenal axis, autonomic nervous system, immune system, metabolic processes, antioxidant defense, hormones, and sleep. At least 3 studies were available for cortisol in saliva and blood, blood pressure, heart rate, cholesterol, dehydroepiandrosterone sulfate, (numbers or activity of) natural killer cells, C-reactive protein, and prolactin. The comparability of studies was limited, due to differences in the methods used to characterize patients and controls, to assess biomarkers, and to control for confounders. Furthermore, burnout was operationalized in different ways. Meta-analyses showed no differences for cortisol awakening response and cortisol awakening response after administration of dexamethasone, cortisol in blood, and blood pressure.

Conclusions

No potential biomarkers for burnout were found, largely due to the incomparability of studies. We emphasize the need for a dimensional and longitudinal approach in future research to account for the heterogeneity of burnout.     

Elevated Macrophage Migration Inhibitory Factor (MIF) is associated with depressive symptoms,blunted cortisol reactivity to acute stress,and lowered morning cortisol

Macrophage Migration Inhibitory Factor (MIF) is a proinflammatory cytokine produced by leukocytes and the secretory cells of the HPA axis. Remarkably, glucocorticoids (GC) induce leukocyte MIF secretion, while MIF renders leukocytes insensitive to the anti-inflammatory effects of glucocorticoids. In light of reported associations between dysphoric states, increased inflammatory activity, and reduced GC sensitivity, the current study investigated the association between MIF, loneliness and depressive symptoms. The study further investigated the relation between plasma MIF and markers of HPA function, i.e., diurnal cortisol and the cortisol response to acute stress.Healthy university undergraduates (N = 126; 64 women) were invited to participate if their scores on the Beck Depression Inventory or UCLA loneliness scale were in the upper or lower quintile of their peer group. Plasma MIF and salivary cortisol were measured in response to a public speaking task. Ambulatory diurnal cortisol was assessed for 5 consecutive days.MIF levels were 40% higher in the high-depressive symptoms group compared to the low depressive symptoms group. Elevated MIF was also associated with a smaller cortisol response to acute stress and lower diurnal morning cortisol values. The observed association between HPA function and MIF remained robust after adjustment for depressive symptoms, and demographic, anthropomorphic, and behavioural factors. High levels of depressive symptoms were likewise associated with lower morning cortisol, but this association became non-significant after adjustment for MIF.MIF may be an important neuro-immune mediator linking depressive symptoms with inflammation and HPA dysregulation.     

Associations between satisfaction with life,burnout-related emotional and physical exhaustion,and sleep complaints

Abstract

Objectives. Burnout is a state of work-related emotional and physical exhaustion. Burnout is related to sleep complaints. By contrast, people with optimistic attitude seem to be less vulnerable to stress and burnout. Therefore, the present study aimed at investigating the relation between burnout, depressive symptoms, satisfaction with life, and sleep complaints. Methods. A total of 2231 participants (age [years]: M=40.8; 1183 females and 1048 males) took part in the study. Participants completed a series of questionnaires such as the Tedium Measure, the Insomnia Severity Index, and the Satisfaction with Life-questionnaire. For statistical analyses, a Structural Equation Model (SEM) was applied. Results. Pessimism, emotional and physical exhaustion, depressive symptoms, and low satisfaction with life were interrelated. Emotional and physical exhaustion was related to sleep complaints, whereas sleep complaints were not related to depressive symptoms and pessimism. Satisfaction with life was related to low sleep complaints, though mediated via low emotional and physical exhaustion, and low pessimism. Conclusions. Results suggest that among burnout symptoms emotional and physical exhaustion, but not depressive symptoms, are related to sleep complaints. Satisfaction with life, via low emotional and physical exhaustion, and low pessimism, further contributes to favourable sleep.     

Changes in salivary cortisol levels in pediatric patients with obstructive sleep apnea syndrome after adenotonsillectomy

ObjectiveObstructive sleep apnea syndrome (OSAS) activates the stress response system, including the hypothalamic–pituitary–adrenocortical (HPA) axis. The salivary cortisol, as an index of free circulating cortisol levels, may be used as a measure of HPA axis activity. We examined the change in the salivary cortisol level in pediatric OSAS patients before and after adenotonsillectomy (AT).MethodsForty-eight subjects from 80 subjects suspicious of having OSAS were diagnosed with OSAS by overnight PSG, 34 of 48 OSAS patients undergoing AT, and 13 of 34 OSAS patients were finally enrolled prospectively for this study. Before and three months after the AT, the saliva was collected at night before PSG (n-sCor) and in the early morning after PSG (m-sCor) for the measurements of the salivary cortisol level.ResultsChildren in the study population (n = 13) were divided into mild (1⩽ AHI <5, n = 5), moderate (5⩽ AHI <10, n = 3), and severe (AHI ⩾10, n = 5) OSAS groups. The mean preoperative AHI in the children was 14.7, and the mean postoperative AHI was 0.33. The percentage of children with AHI <1 after AT was 92.3%. Postoperative m-sCor, the difference of cortisol level (sub-sCor: m-sCor minus n-sCor), and the ratio of cortisol level (r-sCor: m-sCor/n-sCor) showed significant difference postoperatively.ConclusionsAT was associated with improvements in PSG and subjective symptoms in pediatric OSAS patients. In addition, these improvements were significantly related to normalization of salivary cortisol level after AT. Although further study on salivary cortisol levels needs to be done, the measurement of salivary cortisol level before and after AT may predict the outcome of AT as a treatment of OSAS.     

Cortisol,inflammatory biomarkers and neurotrophins in children and adolescents with attention deficit hyperactivity disorder (ADHD) in Taiwan

BackgroundHypothalamus-Pituitary-Adrenal (HPA) axis dysregulation, inflammation and imbalance of neurotrophins have been suggested in attention deficit hyperactivity disorder (ADHD), but the results have not been conclusive. The aim of this study is to investigate the levels of salivary cortisol across 4-time points during the day, and of morning plasma inflammatory biomarkers and neurotrophins, in youth with ADHD and in typically developing youth (TD), with stratification by age, ADHD subtypes and oppositional defiant disorder (ODD) comorbidity in Taiwan.MethodsWe conducted a case-control study measuring saliva cortisol levels at 4 different time points during the day (at awakening, noon, 1800 h and bedtime) and morning plasma levels of inflammatory and neurotrophins biomarkers in youth with ADHD (n = 98, age 6–18 years old with mean age 9.32 ± 3.05 years) and TD (n = 21, age 6–18 years old with mean age 9.19 ± 2.96 years) in Taiwan.ResultsOur study showed that youth with ADHD had lower levels of bedtime salivary cortisol (effects size (ES) = −0.04, p = .023), with children with the combined form of the disorder (with inattention, hyperactivity and impulsivity all present) having the lowest awakening salivary cortisol levels. ADHD youth also had higher levels of plasma high-sensitivity C-reactive protein (hs-CRP) and interleukin (IL)-6 (ES = 0.85–1.20, p < .0001), and lower plasma tumor necrosis factor-alpha (ES = −0.69, p = .009) and brain-derived neurotrophic factors (BDNF) (ES = −1.13, p < .0001). Both ADHD groups regardless of ODD comorbidity had higher levels of IL-6 (p < .0001) and lower levels BDNF (p < .0001).ConclusionThe lower bedtime salivary cortisol levels and higher levels of inflammatory biomarkers in youth with ADHD further support the role of abnormal HPA axis and inflammation in ADHD. Moreover, the lower levels of BDNF in ADHD also indicate that BDNF may be a potential biomarker in this disorder that is part of a broader biological dysfunction.     

The Renin-Angiotensin-Aldosterone system in patients with depression compared to controls – a sleep endocrine study

Background  

Hypercortisolism as a sign of hypothamamus-pituitary-adrenocortical (HPA) axis overactivity and sleep EEG changes are frequently observed in depression. Closely related to the HPA axis is the renin-angiotensin-aldosterone system (RAAS) as 1. adrenocorticotropic hormone (ACTH) is a common stimulus for cortisol and aldosterone, 2. cortisol release is suppressed by mineralocorticoid receptor (MR) agonists 3. angiotensin II (ATII) releases CRH and vasopressin from the hypothalamus. Furthermore renin and aldosterone secretion are synchronized to the rapid eyed movement (REM)-nonREM cycle.