Human growth hormone release: relation to slow-wave sleep and sleep-walking cycles

Synchronization of proximal intratubular pressure oscillations: evidence for interaction between nephrons

Previous studies in rat kidneys have demonstrated that oscillations in the proximal intratubular pressure are a prominent feature of the tubulo-glomerular feedback mechanism (TGF) operating during free flow conditions. The purpose of the present study was to investigate whether a subpopulation of synchronized, interacting nephrons could be detected. In group A nephrons, i.e., nephrons with a high probability of having their afferent arterioles arising from the same interlobular artery, 29 out of 33 pairs of nephrons were found to show synchronized pressure oscillations. In group B nephrons, not expected to have this common origin of their afferent arterioles, only 1 out of 23 pairs was found to be synchronized. The standard deviation of the frequency differences was 0.063 cycles per minute in group A nephron pairs and 0.202 cycles per minute in group B pairs (p less than 0.05), showing the greater homogeneity in frequency in group A. Furthermore, nephrons having synchronized pressure oscillations were found to interact with each other. Thus, perturbation of the proximal tubular pressure oscillations in one nephron by loop microperfusion affected the amplitude of the pressure oscillations in the non-perfused nephron; and reactivation of pressure oscillations in one nephron was followed by reactivation of oscillations in the non-perfused nephron. Thus, the present results show that there exists a well defined subpopulation of nephrons, in which the TGF-mediated proximal pressure oscillations are synchronized. This synchronization is a result of interaction between the different nephrons.(ABSTRACT TRUNCATED AT 250 WORDS)

Nocturnal pulsatile growth hormone releasing hormone treatment in growth hormone deficiency

We have treated five GH-deficient prepubertal children (4 M, 1 F) with GH releasing hormone 1-40 (GHRH1-40) in two dosage regimens over 9 months. Profiles of serum GH concentrations were obtained over 24 hours before treatment and nocturnal profiles were obtained serially throughout the study. GHRH was administered subcutaneously at night for four pulses using 1 microgram/kg/pulse in the first 3 months and 2 micrograms/kg/pulse for a further 6 months. All subjects demonstrated pituitary responsiveness to i.v. GHRH before treatment and at 3 and 6 months. GH secretion was induced in a pulsatile fashion in response to subcutaneous GHRH in three children from the first night of treatment. A self priming effect to successive GHRH pulses was evident and the response augmented with time and with the higher dose regimen. The growth velocity of these three children increased from a mean of 3.7 cm/year (range 3.7-3.8) before treatment to 5.5 cm/year (range 4.1-7.2) over the first 3 months and to 7.2 cm/year (range 4.8-9.2) over the following 6 months. In one subject entrainment of GH secretion to GHRH did not occur until the higher dose regimen and this was associated with a modest increase in growth velocity. One subject did not respond to treatment. Pulsatile administration of GHRH1-40 is effective in inducing GH secretion and promoting growth acceleration in some children with idiopathic GH deficiency. The optimal dose and mode of administration of GHRH have yet to be established.

Sleep deprivation alters the cell population kinetics in the jejunum of the male Syrian hamster (Mesocricetus auratus)

The proliferative and functional units of the jejunum were studied every 3 hr during 24 hr in groups of control and sleep-deprived hamsters. Peaks in kinetic parameters were evident during the sleep period in control hamsters; in the absence of sleep, peak values were significantly reduced. Sleep deprivation was associated with reduction of G2 to M flux and reduction of the circadian rhythm in mitotic index from 74% to 25%. The reduction in the number of cells passing through M was reflected by a drop in labelling index 9 hr later. These findings are consistent with the theory that sleep promotes restorative processes.

Sleep apnea disorders. Introduction to sleep and sleep disorders

This overview of normal and disordered sleep introduces techniques for recording and classifying sleep stages, physiological and temporal characteristics of sleep, age-related changes in sleep, consequences of sleep deprivation, theories on the function of sleep, and neurophysiological and biochemical mechanisms regulating sleep. Various categories of sleep disorders are briefly surveyed, with special emphasis on differential diagnosis of sleep apnea syndromes and other disorders characterized by symptoms of excessive daytime somnolence.

Hypothalamic control of GH secretion: pathophysiology and clinical implications

GH is secreted episodically. Its pattern is regulated by the interplay of a releasing and a release-inhibiting hormone of hypothalamic origin. Modulation occurs by metabolic factors (glucose, free fatty acids, ketone bodies, amino acids). Altered GH secretion has been observed in states of metabolic derangement such as diabetes mellitus, malnutrition and obesity. Further modulation occurs by extrahypothalamic CNS structures. In man--but not in animals, including subhuman primates--sleep has an important effect on GH secretion. A defective GH secretory pattern has been found to occur in several states of sleep disturbance, such as sleep deprivation, narcolepsy, severe psychosocial derangement, the apallic syndrome. Other CNS influences on GH secretion are related to stress, emotional changes and psychiatric disturbances. The exact mechanisms by which most of these influences are relayed to the GH secretory apparatus of the hypothalamus remain yet to be investigated.

Alteration in the nocturnal pulsatile release of GH during the induction of puberty using low dose pulsatile LHRH: a case report

A 16.4 year old girl with idiopathic hypogonadotrophic hypogonadism had successful induction of puberty by administration of low dose LHRH by pulsatile subcutaneous infusion at night. Peak serum GH was increased with therapy but more importantly, pulsatile secretion of GH which was minimal before treatment, was restored after one week of LHRH treatment.

Are poor sleepers changed into good sleepers by hypnotic drugs?

Sleep can be measured by subjective ratings, electrophysiological recordings and by the physiological and biochemical changes occurring with sleep. Using these methods, we can select those who rate their sleep as unsatisfactory and those who feel fully satisfied by their sleep. Electrophysiological recordings of sleep show that there are relatively small differences between these good and poor sleepers: poor sleepers sleep less than good sleepers, but not as little as they think. However, the complaints of poor sleepers that they feel unrestored by their sleep should not be dismissed, for investigations employing the tools of physiology and biochemistry have revealed differences between good and poor sleepers that suggest that the sleep of poor sleepers may indeed be less restorative. The actions of hypnotic drugs on sleep can be similarly investigated. Preliminary findings suggest that hypnotic drugs may reverse some of the detrimental metabolic concomitants of poor sleep.

Sleep related growth hormone and prolactin secretion in children during constant rate enteral nutrition

The aim of this study was to investigate the nocturnal secretion of growth hormone and prolactin in a particular model where nutrients are delivered continuously. Six children with severe intestinal diseases undergoing total constant rate enteral nutrition for 1.5 to 8 months have been studied; all children had a normal nutritional status at the time of the recording. Sleep patterns were studied by the usual polygraphic methods from 10 p.m. to 8 a.m. Blood samples were taken every 20 min through an indwelling catheter for growth hormone and prolactin plasma level determination. Several growth hormone peaks were observed with a peak always secreted in connection with stage III-IV of the first cycle. This early peak was significantly higher than the following ones. Nocturnal patterns of prolactin secretion showed individual differences characterized by a series of episodic releases which consisted of a few long rises (4 patients) and several small fluctuations; no correlation was found with the sleep patterns; no increase in the level throughout the night was observed. Loss of the rhythmicity of alimentation does not alter the secretion of growth hormone during sleep.

Slow-wave sleep: a recovery period after exercise

Sleep recordings were carried out on athletes on four successive nights after completing a 92-kilometer road race. Significant increases in total sleep time and slow-wave sleep were found after this metabolic stress. The results show a definite exercise effect on sleep and support sleep-restoration hypotheses.

Cardiac denervation and other multisystem manifestations caused by isolated autonomic neuropathy in a young diabetic patient

A young, diabetic woman suffering from fainting spells, vomiting, and diarrhea is described. Extensive investigations showed total cardiac denervation, orthostatic hypotension, and disturbances in the the pupillary and sudomotor functions, as well as impairment of glucagon secretion during hypoglycemia. These disturbances were found to be caused by autonomic neuropathy. No signs of peripheral neuropathy could be detected. To the best of our knowledge this is the second case of total cardiac denervation due to diabetic neuropathy described in the literature.

Intravenous infusions of nutrients and sleep in the rat: an ischymetric sleep regulation hypothesis

Unrestrained food-deprived rats received their daily caloric needs through continuous or discontinuous intravenous infusions of specific nutritive substances over a period of 3 consecutive days each, and the effect on sleep monitored by electroencephalogram was examined. Continuous glucose or lipid infusions did not affect the daily sleep quotas. Amino-acid infusion brought about a significant increase in paradoxical sleep (PS), whereas slow-wave sleep (SWS) remained unchanged. Rats that received the highly nutritive composite solution showed significant increase in both SWS and PS. The same increase in SWS and PS was observed when exogenous insulin was coinfused with continuous infusion of glucose or when glucose infusions were discontinuous. These findings suggest that sleep might be related to both the nature and the degree of utilization of the circulating metabolites. A model for the action on sleep of nutrients at the systemic level was proposed; only when substances are metabolized is there a direct effect on sleep mechanisms.

Circadian sleep and feeding patterns in the rat: possible dependence on lipogenesis and lipolysis

Sleep and feeding patterns were continuously recorded in rats under intravenous saline (control) and alternating insulin-epinephrine (experimental) infusions. The infusion of insulin (lipogenetic hormone) during the normally light period (0800-1600) replaced by epinephrine (lipolytic hormone) during the normally lipogenetic dark period (1600-0800) resulted in a complete inversion of the normal circadian distribution of sleep and feeding patterns and also of their correlation. Insulin infusion resulted in low blood glucose and glycerol levels whereas epinephrine increased these physiological parameters. Different control conditions showed that the fluctuations of sleep and feeding were dependent on the rate of utilization of the circulating metabolites at the cellular level. These results together with previous data suggest that the relation between sleep and feeding and their concomitant circadian fluctuation are possibly modulated by a common factor, namely the metabolic rate that is influenced by the lipogenesis/lipolysis rate.

Effects of restricted sleep with different exercise loads upon subsequent sleep

Seven male cats were adapted to different schedules of restricted sleep. The cat was permitted to go to sleep either 2, 4 or 8 hours per day with the balance to 24-h periode spent in wakefulness enforced by means of a treadmill. Two experiments were run and the same cats served in both runs. The experiments and schedules were separated by at least two weeks during which time cats were maintained under ordinary laboratory conditions. Our experiment used treadmill speed of 2.6 m/min which was easily tolerated and effective in eliminating sleep. Another experiment used treadmill speed of 4.6 m/min which produced more physical exercise. As available sleep time become progressively shorter, REM sleep increased while SWS decreased. If restriction in sleep time was associated with more physical exercise then the composition of the subsequent sleep was different : SWS increased while REM sleep decreased. The functional significance of these opposite effects are presumably different. The immediate SWS response to the prior muscular exercise is suggestive of its recovery function.

[Circadian rhythms in the endocrine system (author's transl)]

In four sections, the contribution reviews data on 24-hour variations of cortisol, growth hormone, prolactine, testosterone, LH and FSH in the human plasma. 1) Experiments on isolated subjects show that the 24-h variation of cortisol is based on an endogenous circadian rhythm which can be independent from the rhythm of sleep and wakefulness. 2) The various pattern each of which has been described in good correspondence by several groups of authors, suggest a series of hormones with a strong circadian component (e.g. cortisol) to those with a weaker (testosterone) or even without a circadian component (FSH). 3) The sleep-wake-cycle influences the phase of hormone rhythms by various degrees; therefore, a uniform reference to sleep time seems preferable to a reference to local time in order to compare several rhythms. 4) The rhythms of cortisol and growth hormone as described in man agree satisfactorily with those in other vertebrate species.

Serum growth hormone levels in schizophrenic patients during sleep

Ten schizophrenic and five epileptic patients under antipsychotic drug treatment were studied to evaluate sleep-related GH secretion. Four of the schizophrenic patients had a high secretion peak of GH (range 15.2 to 38.0 ng/ml), four had a moderate peak (range 5.8--8.3 ng/ml), while two had no increase in GH secretion during sleep (range 0.5--1.0 ng/mg). Four of the five epileptic patients had a moderately increased secretion (range 5.8--9.2 ng/ml) and one had no increase in GH secretion during sleep. Thus, the GH secretory pattern varied with the patient as in known to be also with healthy individuals. However, no clear disturbances were noted in sleep-related GH secretion in schizophrenic patients receiving antipsychotic drug treatment, when compared e.g. to non-schizophrenic, epileptic patients under a same kind of drug treatment.

Paradoxical sleep deprivation: effects on brain energy metabolism

A study was made of brain nucleotides and glycolytic intermediates in paradoxical sleep (PS)-deprived and recovery-sleeping rats. It was observed that PS deprivation of 24 h produced a fall in glucose, glucose 6-phosphate and pyruvate in cerebral frontal lobes. After three hours of recovery sleep all values returned toward their predeprivational levels. In cerebellar hemispheres ATP was increased, while glucose 6-phosphate and pyruvate were decreased. After three hours of recovery sleep, glucose 6-phosphate was increased and pyruvate decreased, indicating restoration of glycogen and creatine phosphate respectively.

Temperature and endocrine activity during sleep in man. Activation of cortisol and thyroid-stimulating hormone, inhibition of human growth hormone secretion by raised or decreased ambient and body temperatures

1. Polygraphic night sleep recordings in eight healthy male volunteers with simultaneous measurement of rectal temperature, plasma growth hormone (HGH), cortisol, and TSH concentrations were performed during normal, raised, and lowered ambient and body temperature. 2. There was a statistically significant increase in plasma cortisol and TSH levels during cold nights with a smaller rise during high temperatures. 3. Growth hormone levels, measured as the mean highest plasma concentration in the first two NREM-REM sleep cycles, were slightly lower during hot and cold nights than corresponding baseline values. It is suggested that there may be an inverse relation between ACTH and HGH secretion by the anterior pituitary gland. 4. During the nights of high ambient temperature, decreased total duration of sleep and particularly low values of paradoxical sleep were observed. Night sleep in low ambient temperature with a significant decrease of body temperature is not different from baseline conditions. 5. The results suggest that a pronounced increase in stress hormone secretion may occur without changes in polygraphic EEG criteria.

Stress, cardiac activity and sleep

An overview is presented of the relationship between cardiovascular activity and sleep, emphasizing the interrelations between stage of sleep and cardiovascular dysfunction. Possible implications of the data are discussed, especially in relation to stress-related factors and possible treatment regimens.

Time of day effects with standardized exercise upon subsequent sleep

The effect standardized exercise had upon sleep was studied with eight subjects. A pilot study assessed individual work capacity by the sub-maximal estimation of VO2 max. In the main study each subject performed the exercise, once a.m. and once p. m., on different days. Sleep was scored into stages and an additional sub-division of stage 2 containing 10-20% by time of delta. Comparison with baseline showed no significant whole night changes with any criteria following either a.m. or p. m. exercise. After p.m. exercise there was a significant increase in stage 3 for the first half of the night. It was concluded that ensuing wakefulness following early daytime exercise is sufficient for recovery, but late daytime exercise may result in an intrusion of recovery into initial sleep. Sleep is not seen to be necessary for recovery from muscular fatigue.

Effects of growth hormone on brain biogenic amine levels

The effects of IP administered bovine growth hormone (GH) on regional brain serotonin, 5-hydroxyindoleacetic acid (5-HIAA) and norepinephrine levels in rats were examined. GH decreased the levels of both monoamines and 5-HIAA in the diencephalon and brainstem while not affecting telencephalic concentrations. In hypophysectomized rats, however GH produced significant elevations of monoamine and 5-HIAA levels in all brain regions. In normal rats the decreases in norepinephrine content produced by GH were correlated with a reduction in the stimulatory action of d-amphetamine on general activity levels. These results demonstrate that GH can affect brain biogenic amines and that these effects have behavioral consequences.

Isocaloric diet changes and electroencephalographic sleep

Electroencephalographic (E.E.G.) sleep changes were studied in eight young healthy male subjects who were given a normal balanced diet or a high-carbohydrate/low-fat or low-carbohydrate/high-fat isocaloric diet, according to an experimental design. Significantly less slow-wave sleep (S.W.S.) was found after consuming a high-carbohydrate/low-fat diet than after consuming a normal balanced diet or a low-carbohydrate/high-fat diet. The latter two diets did not differ in terms of the amounts of S.W.S. Both high-carbohydrate/low-fat and low-carbohydrate/high-fat isocaloric diets, especially the former, were associated with significantly more rapid-eye-movement (R.E.M.) sleep than was the normal balanced diet. These findings emphasise the importance of daily diet for the following night's sleep.

Human puberty. Simultaneous augmented secretion of luteinizing hormone and testosterone during sleep

Plasma luteinizing hormone (LH) and testosterone (T) were measured by radioimmunoassay in nine pubertal boys and three sexually mature young men at 20-min intervals for 24 h. Plasma LH and T were also measured in one boy during a delayed sleep onset study. Polygraphic monitoring was carried out to identify precisely sleep onset. Wakefulness, and specific sleep stages. In all nine pubertal boys the plasma T concentration fluctuated and was significantly higher during normal nocturnal sleep as compared to daytime waking. This increased T secretion during sleep was temporally linked to the characteristic pubertal sleep augmentation of LH secretion. To define further the relationship of this increased T secretion to sleep, plasma LH and T were also measured in three of the pubertal boys after acute (1-day) reversal of the sleep-wake cycle. One of these boys was also studied after 3 days of sleep-wake cycle reversal. The results of these studies showed that plasma T was now augmented during the reversed daytime sleep period; the mean T concentrations during this period were significantly higher (P < 0.001) than during nocturnal waking in all four studies. Measurement of plasma LH and T in the three sexually mature young men showed episodic secretion of LH and T during both waking and sleep periods; there was no consistent significant augmentation of LH or T secretion during sleep. This study demonstrates that (a) in normal pubertal boys and sexually mature young men plasma T fluctuates episodically; (b) there is marked augmentation of T secretion during sleep in pubertal boys, which is dependent on increased LH secretion; (c) this pubertal LH-T secretory "program" is dependent on sleep, since it shifts with delayed sleep onset and reversal of the sleep-wake cycle; and (d) this demonstrable tropic effect of LH on T is evident only during puberty, since sexually mature young men fail to show any consistent relationship between LH and T secretion either awake or asleep.

Hypothalamic-pituitary function in diverse hyperprolactinemic states

Prolactin secretion in normal adults is characterized by periods of episodic secretion which increase in magnitude during sleep. In this study, we report the 24-h mean prolactin concentrations, prolactin secretory patterns, and associated pituitary hormone function in nine patients (seven women and two men) with hyperprolactinemia of diverse etiologies. Four of the women and one of the men had clinically demonstrable pituitary tumors, one boy had a hypothalamic tumor, and the three other women had "functional" hyperprolactinemia. The 24-h mean prolactin concentrations derived from averaging the 20-min interval samples for 24 h ranged from 28.6 to 1,220 ng/ml. The plasma prolactin patterns in these patients showed persistence of episodic secretion in all and loss of the normal sleep-wake difference in plasma prolactin in seven of nine. Three of the patients with galactorrhea and comparable 24-h mean prolactin concentrations (58.3, 59.7, and 64.3 ng/ml) showed similar prolactin secretory patterns despite different etiologic mechanisms. Evaluation of the secretory patterns of luteinizing hormone (LH) in these patients showed loss of normal pulsatile LH release and a low 24-h mean LH concentration in the patient with the pituitary tumor, while the two patients without clinically demonstrable pituitary tumors ("post-pill" galactorrhea and "idiopathic" galactorrhea) showed normal LH secretory patterns and 24-h mean LH concentrations. The 24-h mean cortisol concentrations and secretory patterns were normal in five of the seven patients who had these parameters measured. The patient with the hypothalamic tumor had a low 24-h mean cortisol concentration and production rate and absent response to metyrapone. The patient with "idiopathic" galactorrhea had an elevated 24-h mean cortisol concentration but normal cortisol production rate and urinary 17-hydroxycorticoid excretion. Growth hormone secretion was abnormal in four of the patients (one with the hypothalamic tumor and three with pituitary tumors). Thyrotropin-releasing hormone (TRH) administration in four patients resulted in normal TSH release in two patients (one of whom developed galactorrhea after the test), an absent response in the patient with the hypothalamic tumor, and a blunted response in one of the women with a pituitary tumor. The two men had low 24-h mean plasma testosterone concentrations (69 and 30 ng/100 ml) and symptoms of impotence and loss of libido. Five of the women (four with pituitary tumors and one with Chiari-Frommel syndrome) had either low 24-h mean LH concentrations, abnormal LH secretory patterns, or both. These data indicate that patients with hyperprolactinemia encompassing a varied etiological range frequently show loss of the normal sleep-associated increase in prolactin secretion as well as abnormalities in the regulation of the other hypothalamic pituitary-regulated hormones. The finding that the abnormalities in LH, growth hormone, thyrotropin, and cortisol (adrenocorticotrophic) secretion were almost uniformly confined to the patients with the clinically demonstrable hypothalamic or pituitary tumors suggests that the size of the lesion is the critical factor.