Aug 2026· Psychoneuroendocrinology· Vol 193, pp.
107997
· 0 citations· 41 references
Medicine
TL;DR
Night eating symptoms are elevated in active CD but appear more closely linked to psychological distress and sleep disruption than to concurrent cortisol levels, which suggests sleep problems may occur without a shift in circadian preference.
Abstract
Objective
Cushing's disease (CD) is characterized by chronic exposure to excess cortisol and disruption of circadian cortisol rhythms. Given cortisol's role in affective regulation and circadian synchronization, eating disturbances-particularly those linked to mood and sleep-may represent an underexplored aspect of CD. We investigated night eating symptoms and chronotype in CD and examined their clinical, psychological, sleep-related, and endocrine correlates.
Methods
Ninety-eight participants were included (22 active CD, 33 remission, 43 healthy controls). Night eating symptoms were assessed using the Night Eating Questionnaire (NEQ) and chronotype with the Morningness-Eveningness Questionnaire. Psychological distress and sleep were measured using Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, and Insomnia Severity Index. Endocrine measures included 24-hour urinary free cortisol, late-night salivary cortisol, and 1-mg dexamethasone suppression test. Hierarchical regression models identified independent predictors of NEQ scores.
Results
Patients with active CD exhibited greater night eating severity than controls (p = .005), with 16.4% meeting criteria for night eating syndrome. Chronotype did not differ across groups (p = .917). Night eating severity was not associated with cortisol biomarkers. The active disease-night eating association diminished after adjusting for psychological distress. Psychological distress and sleep disturbance independently predicted night eating, accounting for ∼59% of variance.
Conclusion
Night eating symptoms are elevated in active CD but appear more closely linked to psychological distress and sleep disruption than to concurrent cortisol levels. Similar chronotype across groups suggests sleep problems may occur without a shift in circadian preference. Screening for night eating may inform multidisciplinary care in CD.
Systematic assessment of mood and circadian rhythms may offer a more comprehensive framework for identifying clinically relevant chronobiological disruption in patients with multiple sclerosis.
G. Cinesi, S. Sperandei, Ludovica Quattrucci et al.· Chronobiology International· 0 citations
Aim: It is known that phasic social and behavioral changes occur during the
menstrual cycle. As a stress marker, cortisol rises in the morning (cortisol
awakening response, CAR) and decreases around midnight. Therefore, the
present study aimed to establish a link between perceived symptom severity
and diurnal cortisol levels during the menstrual cycles of cyclic women.
Materials and Methods: Healthy, cycling women (18–31 years old, n=15) had
salivary cortisol tested at 12:00 pm, 05:00 pm, and 10:00 pm (for diurnal
rhythm) after waking (0, 15, 30, and 60 min, CAR). The same subjects were
tested during menses, luteal, and premenstrual periods of a single menstrual
cycle. Participants recorded perceived problem severity during the test. The
STAI-T and Karolinska Sleep Scale measured trait anxiety and sleep quality.
CAR and diurnal cortisol area under curve (AUC) were calculated.
Results: The phases did not differ in cortisol concentration or CAR AUC
(p>0.05). CAR was significantly higher than diurnal cortisol throughout all
phases (p<0.05). Additionally, Diurnal AUCg of cortisol was higher during
menses than luteal and premenstrual phases (p<0.05). The diurnal AUC and the
CAR-AUC showed a strong positive correlation across all phases (rho=0.210;
p=0.002). Problem scores and diurnal AUCg correlated negatively (rho=-
0.648; p=0.01). STAI-T points were negatively correlated with menses and
premenstrual diurnal AUCg (rho=-0.638; p=0.014, -0.744; p=0.002).
Conclusion: In conclusion, the findings suggest that the pattern of cortisol
secretion during the hours of the day is higher in the menses than in luteal and
premenstrual phases. Potential changes in cortisol secretion patterns can
trigger cycle-specific behavioral issues.
Keywords: Cortisol awakening response, diurnal cortisol, Hypothalamuspituitary-
adrenal (HPA) axis, menstrual cycle, premenstrual symptoms, state
trait anxiety inventory score.
Tuba Ozgocer, Cihat Uçar, S. Yıldız· Dynamic Medical Theories· 0 citations
Background: Medical students are vulnerable to sleep disturbance and nocturnal eating behaviors that may jointly increase psychiatric and metabolic morbidity. Comprehensive sleep-eating evaluations in Turkish medical students remain limited. To determine the prevalence of poor sleep quality and night eating syndrome (NES) risk and to examine their cross-sectional associations with insomnia, anxiety, emotional eating, restless legs symptoms, chronotype, and lifestyle factors. Methods: This cross-sectional study, conducted from March to December 2023, included 265 medical students who completed validated instruments assessing sleep quality (Pittsburgh Sleep Quality Index [PSQI]), night eating syndrome (NES) risk (a score of ≥25 indicating high risk), insomnia severity, daytime sleepiness (Epworth Sleepiness Scale [ESS]), anxiety, emotional eating, Restless Legs Syndrome (RLS) symptoms, and chronotype. Group comparisons, Spearman’s correlation analyses, and multiple linear regression were conducted. Results: Poor sleep quality (PSQI > 5) affected 50.2% of participants, and high NES risk affected 14.7%. PSQI correlated with NEQ (r = 0.301; p < 0.001), insomnia severity (r = 0.538), anxiety, and emotional eating. Mean NEQ was higher in the poor-sleep group (18.67 ± 8.00 vs. 15.38 ± 6.36; p < 0.001; Cohen’s d = 0.455). Females had higher PSQI and ESS scores, anxiety, and emotional eating scores; high NES risk was numerically more frequent in males (18.6% vs. 11.8%; p = 0.175). RLS symptoms (score > 0) were present in 34.7% (mild 22.6%; moderate 7.9%; severe 4.2%). In the primary multivariable model (PSQI and sex), PSQI was the strongest independent correlate of NEQ (standardized β = 0.325; p < 0.001); sensitivity analyses showed stable PSQI estimates after additional covariate adjustment, whereas sex coefficients were non-significant and unstable across models. A secondary model excluding PSQI identified alcohol use as a significant lifestyle correlate (standardized β = 0.167; p = 0.014). R2 = 0.148 for the full covariate model and R2 = 0.108 for the primary model. Conclusions: Sleep disturbance and NES risk are prevalent and cross-sectionally associated in Turkish medical students. Poor sleep quality was the strongest independent correlate of night eating scores. Integrated campus screening targeting sleep, eating behavior, anxiety, and comorbid sleep symptoms may facilitate prevention and referral.
V. Tekin, Sümeyra Delibaş, Eyüp Sina Keten et al.· Healthcare· 0 citations
Anxiety, depression and daytime symptoms (sleepiness, tiredness) are overrepresented in people with snoring and insomnia, but the associations are not completely understood. We aimed to investigate relationships between insomnia and snoring with future psychological distress and daytime symptoms. Longitudinal data in 5193 women (age 43.2 ± 15.3 years; BMI 24.0 ± 4.06 kg/m2), from the population-based study 'Sleep and Health in women', was used and included data on sleep, daytime symptoms, somatic health and psychological distress. Subgroups according to presence of snoring and insomnia at baseline and outcome variables (anxiety, depression, daytime sleepiness, daytime tiredness) were created. Adjusted logistic regression was performed. At baseline 5% of the women were snorers, 22% had insomnia and 2% indicated both. Of the women, 9.2% developed anxiety, 4.6% depression, 7.9% sleepiness and 8.7% tiredness. Anxiety was more likely at follow-up among women reporting baseline insomnia (OR 2.03, 95% CI 1.55-2.65) or snoring (1.83; 1.14-2.94). Depression was more frequent in the subgroup with insomnia alone (2.39; 1.74-3.28), but not isolated snoring or both. Insomnia but not snoring alone increased the risk of sleepiness (2.40; 1.84-3.13) and tiredness (3.07; 2.39-3.94) and individuals reporting both insomnia and snoring had the highest risk for both sleepiness (3.34; 1.74-6.40) and tiredness (4.26; 2.28-7.96). Insomnia appears as the strongest risk factor for future psychological distress in women. The combination of insomnia and snoring may have an additive effect on the development of both psychological distress and daytime symptoms and clinically assessing both snoring and insomnia may be of importance for targeting future negative outcomes.
Galileo Frustaci, Eva Lindberg, J. Theorell-Haglöw· Journal of Sleep Research· 0 citations
Sleep disturbances are frequent in childhood and have been associated with emotional vulnerability and modifiable lifestyle behaviours. The relative and combined contributions of child anxiety, parental anxiety, and unstructured daily routines to paediatric sleep disturbances remain incompletely characterized. We conducted a cross-sectional study of 306 otherwise healthy children aged 3–14 years. Parents completed validated questionnaires assessing sleep disturbances, child anxiety, parental anxiety, and daily lifestyle habits, including evening screen exposure. Multivariable linear regression, mediation, and cluster analyses were performed to identify correlates of sleep disturbances and distinct profiles. Clinically significant sleep disturbances were identified in 39.2% of participants. Higher child trait anxiety was consistently associated with greater sleep disturbance severity (all P < .001). Evening screen exposure was independently associated with higher sleep disturbance scores (P < .05). Parental trait anxiety not directly associated with sleep disturbances both directly and indirectly through child trait anxiety, which mediated approximately 30% of the association (P < .001). Cluster analysis identified three distinct profiles, including two groups with comparable sleep disturbance severity but contrasting characteristics: one marked by high emotional vulnerability and one by predominant lifestyle dysregulation. Conclusion: Sleep disturbances are strongly associated with trait anxiety and independently related to evening screen exposure, while parental anxiety appears to exert its effect both directly and, in part, indirectly through child anxiety. Similar sleep complaints may reflect different underlying emotional and lifestyle mechanisms. A multidimensional assessment integrating anxiety screening and evaluation of evening habits may improve early identification of at-risk children and support targeted preventive strategies within routine paediatric care. What is Known: • Paediatric sleep disturbances are common and linked to psychological, family and lifestyle risk factors. • Most studies examine these factors in isolation rather than within an integrated framework. What is New: • Child trait anxiety was the strongest correlate of sleep disturbances and partially mediated the effect of parental anxiety; evening screen exposure and later bedtime contributed independently. • Children with similar sleep disturbance severity showed distinct emotional or lifestyle profiles, supporting multidimensional assessment.
A. Suppiej, Elia Sigolotto, C. Malaventura· European Journal of Pediatri...· 0 citations
Insomnia disorder (ID) is a common sleep–wake disorder characterized by persistent difficulty initiating or maintaining sleep, early-morning awakening, or non-restorative sleep, accompanied by daytime functional impairment. ID has traditionally been explained by the hyperarousal model, which emphasizes cognitive, emotional, cortical, neuroendocrine, and autonomic overactivation. However, this model alone does not fully account for the chronic persistence, relapse tendency, and multisystem associations of ID. Emerging evidence suggests that circadian rhythm disruption, impaired melatonin signaling, hypothalamic–pituitary–adrenal (HPA) axis activation, autonomic imbalance, and low-grade inflammation may also contribute to the development and maintenance of ID. Available evidence indicates that sleep disturbance is more consistently associated with selected inflammatory markers, particularly C-reactive protein (CRP) and interleukin-6 (IL-6), whereas findings for tumor necrosis factor-alpha (TNF-α) remain less consistent. The circadian system regulates sleep, endocrine function, metabolism, and immune-inflammatory activity through the suprachiasmatic nucleus, melatonin and cortisol rhythms, peripheral clock genes, and rhythmic immune-cell responses. Disruption of this temporal network may alter melatonin secretion, inflammatory rhythmicity, and stress-related neuroendocrine responses, thereby contributing to the persistence of insomnia symptoms. Compared with previous reviews that have separately discussed hyperarousal, circadian rhythm disruption, melatonin signaling, or sleep-related inflammation, this review integrates these processes into a circadian–immune perspective for understanding ID. We summarize alterations in sleep–wake rhythms, melatonin signaling, HPA-axis activity, autonomic regulation, and immune-inflammatory responses in ID, and discuss potential intervention strategies, including light management, melatonin and melatonin receptor agonists, cognitive behavioral therapy for insomnia (CBT-I), physical activity, time-restricted eating, and stress management. This review aims to provide a mechanistic basis for understanding the chronicity and heterogeneity of ID and for developing individualized intervention strategies.
Yini Huang, Xiuying Wang, Xiang-Jiao Chen et al.· Frontiers in Neuroscience· 0 citations
