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.

Key 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 & inferences: This response to a social stressor contributes to our understanding of the relationship of stress to symptom expression in IBS.

Figure 1

Plasma adrenocorticotropic hormone (ACTH) levels prior to and during sleep in IBS (N=42) versus HC (N=24) subjects. Vertical intervals show geometric means and 95% confidence interval. Note that the values on the ordinate are shown in linear measurement units, but are plotted on an axis with logarithmic spacing. IBS = Irritable Bowel Syndrome; HC = Healthy Controls.

Figure 2

Serum cortisol levels prior to and during sleep in IBS (N=42) versus HC (N=24) subjects. Vertical intervals show geometric means and 95% confidence intervals. Note that the values on the ordinate are shown in linear measurement units, but are plotted on an axis with logarithmic spacing. IBS = Irritable Bowel Syndrome; HC = Healthy Controls; * = p-value < 0.05, ** = p-value < .01, from ANCOVA controlling for age, body mass index, and median bedtime over prior two weeks.

Figure 3

Serum cortisol levels prior to and during sleep comparing results from two studies, stratified into HC (N=31 Study A, N=24 Study B) and IBS (N=30 Study A, N=42 Study B). Vertical intervals show geometric means and 95% confidence intervals. Note that the values on the ordinate are shown in linear measurement units, but are plotted on an axis with logarithmic spacing. Study A = prior study, with no threat of public speaking; Study B = current study, with threat of public speaking but otherwise similar to study A; IBS = Irritable Bowel Syndrome; HC = Healthy Controls; * = p-value < 0.05, ** = p-value < .01, from ANCOVA controlling for age and body mass index.