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Sleep. 2019 Dec 21. pii: zsz310. doi: 10.1093/sleep/zsz310. [Epub ahead of print]

How stress affects sleep and mental health: Nocturnal heartrate increases during prolonged stress and interacts with childhood trauma exposure to predict anxiety.

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Division of Experimental Psychopathology and Psychotherapy, Department of Psychology, University of Zurich, Switzerland.
Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland.
Sleep & Health Zürich, University of Zurich, Zurich, Switzerland.
Zurich Center for Neuroeconomics, Department of Economics, University of Zurich, Switzerland.
Mobile Health Systems Lab, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.



Stress can adversely impact sleep health by eliciting arousal increase and a cascade of endocrine reactions that may impair sleep. To date, little is known regarding continuous effects of real-world stress on physiological sleep characteristics and potential effects on stress-related psychopathology. We examined effects of stress on heart-rate (HR) during sleep and total sleep time (TST) during prolonged real-world stress exposure in medical interns. Moreover, we investigated the influence of previous stress and childhood trauma exposure on HR during sleep, TST, and its interaction in predicting anxiety.


We examined a sample of 50 medical students prior to and during their first internship, a well described real-world stressor. Heartrate and total sleep time were continuously collected over 12 weeks non-invasively by a wrist-worn activity monitor. Prior to starting the internship, at baseline, participants reported on their sleep, anxiety and childhood trauma exposure. They also tracked stress exposure during internship and reported on their anxiety symptoms after 3 months after this professional stress.


Mean HR during sleep increased over time, while TST remained unchanged. This effect was more pronounced in interns exposed to childhood trauma exposure. In multilevel models, childhood trauma exposure also moderated the relation between individual HR increase and development of anxiety.


Prolonged stress may lead to increased HR during sleep, whereas individuals with childhood trauma exposure are more vulnerable. childhood trauma exposure also moderated the relation between individual HR increase and development of anxiety. These findings may inform prevention and intervention measures.


anxiety; childhood trauma; heart rate; medical students; sleep


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