Sleep, Neuroendocrine Disorders, And the Bidirectional Relationship between the Hypothalamic-Pituitary-Adrenal Axis: A Mini-Review

Abstract

This review explores the intricate and bidirectional relationships between the hypothalamic-pituitary-adrenal (HPA) axis, sleep architecture and regulation, and the manifestation of various neuroendocrine disorders. The HPA axis, a critical component of the stress response system, exhibits diurnal rhythmicity and is profoundly influenced by sleep. Conversely, HPA axis activity significantly impacts sleep quality, duration, and consolidation. Disruptions in either the HPA axis or sleep can lead to or exacerbate a range of neuroendocrine disorders, including depression, anxiety disorders, Cushing's syndrome, Addison's disease, and sleep disorders themselves (e.g., insomnia, sleep apnea). This review examines the physiological mechanisms underlying these interactions, focusing on the roles of key hormones like cortisol, corticotropin-releasing hormone (CRH), and adrenocorticotropic hormone (ACTH). Furthermore, it discusses the clinical implications of these interrelationships, including diagnostic considerations and potential therapeutic strategies that target the HPA axis and sleep pathways to improve outcomes in individuals with neuroendocrine disorders. A thorough understanding of this complex interplay is crucial for developing effective interventions and personalized treatment approaches.