The Role of Sleep Quality, Trait Anxiety and Hypothalamic-Pituitary-Adrenal Axis Measures in Cognitive Abilities of Healthy Individuals

Abstract

Sleep plays a crucial role in cognitive processes. Sleep and wake memory consolidation seem to be regulated by glucocorticoids, pointing out the potential role of the hypothalamic-pituitary-adrenal (HPA) axis in the relationship between sleep quality and cognitive abilities. Trait anxiety is another factor that is likely to moderate the relationship between sleep and cognition, because poorer sleep quality and subtle HPA axis abnormalities have been reported in people with high trait anxiety. The current study aimed to explore whether HPA axis activity or trait anxiety moderate the relationship between sleep quality and cognitive abilities in healthy individuals. We studied 203 healthy individuals. We measured verbal and visual memory, working memory, processing speed, attention and executive function. Sleep quality was assessed with the Pittsburgh Sleep Quality Index. Trait anxiety was assessed with the State-Trait Anxiety Inventory. HPA axis measures included the cortisol awakening response (CAR), diurnal cortisol slope and cortisol levels during the day. Multiple linear regression analyses explored the relationship between sleep quality and cognition and tested potential moderating effects by HPA axis measures and trait anxiety. Poor sleep quality was associated with poorer performance in memory, processing speed and executive function tasks. In people with poorer sleep quality, a blunted CAR was associated with poorer verbal and visual memory and executive functions, and higher cortisol levels during the day were associated with poorer processing speed. Trait anxiety was a moderator of visual memory and executive functioning. These results suggest that subtle abnormalities in the HPA axis and higher trait anxiety contribute to the relationship between lower sleep quality and poorer cognitive functioning in healthy individuals.

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“…This hypothesis is further supported by recent studies showing that trait anxiety was associated with depression and poor sleep quality. [ 32 33 ]…”

Sleepy and Anxious: Sleep and State/Trait Anxiety and Anxiety Disorders in Adolescents and Young Adults: A Literature Review

“…Labad et al looked at the relationship between sleep quality, cognitive functioning, and trait anxiety. They focused on adults who had no history of mental illness but scored low on the General Health Questionnaire-28 (GHQ-28), a self-report questionnaire that assesses symptoms of anxiety, depression, and insomnia [6]. Using a Neuropsychological Assessment Battery (NAB), they found that poor sleep quality was associated with poorer performance in verbal and visual memory, processing speed, and executive functioning [6].…”

“…They focused on adults who had no history of mental illness but scored low on the General Health Questionnaire-28 (GHQ-28), a self-report questionnaire that assesses symptoms of anxiety, depression, and insomnia [6]. Using a Neuropsychological Assessment Battery (NAB), they found that poor sleep quality was associated with poorer performance in verbal and visual memory, processing speed, and executive functioning [6]. They also performed a saliva cortisol test to determine whether the Hypothalamic-Pituitary-Adrenal (HPA) axis activity had an effect on sleep quality and found that abnormalities in the HPA axis may cause an increase in cortisol that contribute to poorer processing speed [6].…”

“…[5]. These new pathways improve memory, problem-solving skills, and emotional and behavioural regulation [6]. The development of these critical cognitive functions is especially crucial for adolescents and young adults, whose brains are still in the process of maturation [7].…”