CORTISOL AS A MEDIATOR OF METABOLIC DISTURBANCES AND SLEEP QUALITY IN HEALTHY ADULTS – A REVIEW OF CURRENT EVIDENCE

Dominika Gosztyła; Magdalena Rumin; Weronika Bukwald; Natalia Muzyka; Kacper Kość; Gabriela Panek; Amanda Abramowicz; Jakub Giersz; Adam Prusek; Remigiusz Piliński

doi:10.31435/ijitss.2(50).2026.5381

Authors

Dominika Gosztyła Private Medical Practice in Bydgoszcz / 10th Military Clinical Hospital with Polyclinic in Bydgoszcz, Poland https://orcid.org/0009-0007-9156-3499
Magdalena Rumin Military Institute of Aviation Medicine in Warsaw, Poland https://orcid.org/0009-0009-4281-8971
Weronika Bukwald Military Institute of Medicine - National Research Institute in Warsaw, Poland https://orcid.org/0009-0001-5651-4815
Natalia Muzyka Military Institute of Medicine in Warsaw, Poland https://orcid.org/0009-0000-3164-216X
Kacper Kość Kazimierz Pułaski University of Technology and Humanities in Radom, Poland https://orcid.org/0009-0000-5344-8667
Gabriela Panek Military Institute of Aviation Medicine in Warsaw, Poland https://orcid.org/0009-0004-3588-5336
Amanda Abramowicz Military Institute of Aviation Medicine in Warsaw, Poland https://orcid.org/0009-0004-6674-0594
Jakub Giersz 4th Military Clinical Hospital with Polyclinic in Wrocław, Poland https://orcid.org/0009-0002-6374-1730
Adam Prusek 5th Military Clinical Hospital with Polyclinic in Kraków, Poland https://orcid.org/0009-0004-3343-2835
Remigiusz Piliński Military Institute of Aviation Medicine in Warsaw, Poland https://orcid.org/0009-0003-5543-7058

DOI:

https://doi.org/10.31435/ijitss.2(50).2026.5381

Keywords:

Cortisol; Sleep Quality; Stress; Metabolism; Healthy Adults; Nocturnal Hypercortisolemia

Abstract

Background: Contemporary lifestyles, characterized by chronic stress and disruptions of circadian rhythms, significantly affect the functioning of the hypothalamic–pituitary–adrenal (HPA) axis. Cortisol, the primary effector hormone of this axis, exhibits a well-defined circadian pattern that is closely linked to the sleep–wake cycle. Under physiological conditions, cortisol levels decline during the evening hours; however, a range of behavioral and environmental factors may contribute to nocturnal hypercortisolemia. The impact of elevated nighttime cortisol on both subjective and objective sleep quality, as well as on metabolic health in otherwise healthy adult individuals, remains an area of active and ongoing investigation

Objective: The aim of this literature review is to analyze the relationship between cortisol concentrations and sleep quality and architecture in healthy adult individuals, as well as to evaluate the health consequences associated with increased nocturnal activity of the hypothalamic–pituitary–adrenal (HPA) axis.

Methods: The literature review was conducted using the PubMed database and applied strict inclusion criteria: studies involving human participants, adult populations (≥19 years), individuals considered to be in good general health, and the absence of pharmacological interventions known to affect sleep architecture. A total of ten selected publications—including experimental studies, cohort studies, and systematic reviews—were analyzed. These studies directly examined the association between cortisol biomarkers (plasma, salivary, and hair cortisol) and sleep parameters assessed using polysomnography, actigraphy, and the Pittsburgh Sleep Quality Index (PSQI).

Results: The analysis of the literature indicates the presence of a “sleep quality paradox,” whereby factors such as late meal timing and everyday psychosocial stress increase nocturnal cortisol levels, which correlates with a subjective perception of non-restorative sleep, as assessed by the Pittsburgh Sleep Quality Index (PSQI), despite the absence of marked alterations in objective sleep architecture measured by polysomnography. Elevated evening and nighttime cortisol levels were shown to promote sleep fragmentation and to induce insulin resistance as well as a pro-inflammatory immune response, including increased interleukin-6 (IL-6) levels. A bidirectional relationship was also identified, whereby sleep deprivation enhances hypothalamic–pituitary–adrenal (HPA) axis reactivity on the following day, thereby creating a self-perpetuating vicious cycle.

Conclusions: A normal circadian cortisol profile is essential for the metabolic and immunological functions of sleep. Nocturnal hypercortisolemia in healthy adults, even if it does not markedly reduce total sleep duration, leads to significant impairments in glucose metabolism and an increase in inflammatory responses, which over the long term may elevate the risk of obesity and metabolic diseases.

References

Bush, A. M., Arslancan, S., Taylor, K. S., & Barbey, A. K. (2016). Relationship between sleep efficiency and the cortisol awakening response in healthy adults. Psychoneuroendocrinology, 63, 1–7. https://doi.org/10.1016/j.psyneuen.2015.09.008

Dahlgren, A., Kecklund, G., Theorell, T., & Akerstedt, T. (2017). Stress and sleep variation in daily life as predictors of cortisol. Psychoneuroendocrinology, 77, 120–126. https://doi.org/10.1016/j.psyneuen.2017.01.004

Elder, G. J., Wetherell, M. A., Barclay, N. L., & Ellis, J. G. (2016). The relationship between evening cortisol levels and sleep quality in primary insomnia and good sleepers. Journal of Sleep Research, 25(4), 459–467. https://doi.org/10.1111/jsr.12392

Gu, C., Brereton, N., Schweitzer, A., Cotter, M., Duan, D., Børsheim, E., Wolfe, R. R., Pham, L. V., Polotsky, V. Y., & Jun, J. C. (2020). Metabolic effects of late dinner in healthy volunteers—A randomized crossover clinical trial. The Journal of Clinical Endocrinology & Metabolism, 105(8), 2789–2802. https://doi.org/10.1210/clinem/dgaa354

Hirotsu, C., Tufik, S., & Andersen, M. L. (2015). Interactions between sleep, stress and metabolism: From physiological to pathological conditions. Sleep Science, 8(3), 143–152. https://doi.org/10.1016/j.slsci.2015.09.002

Kim, T. W., Choi, J. H., Jeong, J. H., & Park, K. S. (2022). Effects of sleep duration on cortisol and glucose metabolism in healthy adults. Frontiers in Endocrinology, 13, Article 915442. https://doi.org/10.3389/fendo.2022.915442

Lopresti, A. L. (2017). The role of inflammation in depression and fatigue: Exploring the link between the HPA axis and immunity. Neuroscience & Biobehavioral Reviews, 80, 22–35. https://doi.org/10.1016/j.neubiorev.2017.05.006

Michaud, D. S., & Guay, M. (2020). Elevated hair cortisol concentrations are associated with poor sleep quality evaluated using the Pittsburgh Sleep Quality Index but not with actigraphy. Stress, 23(6), 668–676. https://doi.org/10.1080/10253890.2020.1764923

Vargas, I., Vgontzas, A. N., Abelson, J. L., Faghih, R. T., Morales-Muñoz, I., & Drake, C. L. (2020). Evening cortisol levels and the risk of developing insomnia: A prospective study. Journal of Sleep Research, 29(5), Article e12975. https://doi.org/10.1111/jsr.12975

Zhao, Z., Zhao, X., Liu, P., & Li, Z. (2019). Relationship between sleep quality and cortisol level in Chinese health examination population. Medicine, 98(31), Article e16645. https://doi.org/10.1097/MD.0000000000016645