Abstract
Repeated stress is associated with an increased risk of developing psychiatric illnesses such as Post-Traumatic Stress Disorder and Major Depressive Disorder, which are more common in women, yet the neurobiology behind this sex difference is unknown. Habituation to repeated stress is impaired in these stress-related disorders, and recent preclinical studies have shown that female rats do not habituate as fully as male rats to repeated stress, which can lead to impairments in cognition and sleep. However, more research should be done to examine potential sex differences after repeated stress in other relevant measures, such as body temperature and neural activity. In this study, we analyzed core body temperature and EEG power spectra in adult (~75d) Sprague Dawley male and female rats during restraint, as well as during sleep transitions following restraint stress. 2-way (Sex x Time) repeated measure ANOVAs were used to analyze core body temperature and spectral data. We found that core body temperature of male rats habituated to repeated restraint stress more fully than female rats. Additionally, we found that females had a higher average beta band power than males on both days of restraint, indicating higher levels of arousal. Lastly, we observed that females had lower delta band power than males during sleep transitions on day 1 of restraint, however, females demonstrated higher delta band power than males by day 5 of restraint. This data suggests that it may take females longer to initiate sleep recovery compared with males. These findings indicate that there are measurable, lasting differences in the physiological and neural processes of males and females both during and after repeated stress. Understanding the way that the stress response is physiologically and neurobiologically regulated in both sexes can provide insight into individualized treatment and management of stress-related disorders.
Keywords: stress, sex differences, brain activity, neural spectra, sleep, body temperature, restraint
Introduction
Repeated stress is associated with an increased likelihood of developing psychiatric illnesses such as Post-Traumatic Stress Disorder (PTSD), Major Depressive Disorder and Panic Disorder [1,2]. These disorders are more prevalent in women, but the neurobiology behind this sex difference is unknown [3-9]. Habituation to repeated stress is disrupted in many stress-related illnesses, such as PTSD and Panic Disorder [10]. Importantly, previous literature has indicated that female rats exhibit impaired habituation to repeated restraint compared to male rats [11]. However, these studies have been limited to measures of the HPA response, orexins, cognition, and sleep [11-13]. More research should be done to examine potential sex differences in the response to repeated stress in other relevant measures, such as body temperature and neural activity. Understanding the way that the stress response is physiologically and neurobiologically regulated in both sexes can provide insight into individualized treatment and management of stress-related health concerns.
A key physiological response to stress in both rodents and humans is an increase in body temperature[14-20]. However, many of these studies only examine the effect of acute stress and do not include females. Of the few studies that do include females, the overwhelming consensus is that acute stress produces a sharper increase in core body temperature in females compared with males [18,21,22]. But, it is important investigate potential sex differences in body temperature after repeated stress, as this may be a simple physiological measure to gauge habituation to stress and subsequent phenotypes relevant to mental health.
In addition to hyperthermia, another key change in response to stress is altered arousal [23-26]. In general, stress and its associated hormones promote wake and reduce sleep (including Slow Wave Sleep (SWS) and Rapid Eye Movement Sleep (REMS)), but many factors play a role in determining how sleep measures are altered after stress [27-33]. Studies in both rodents and humans have reported sex differences in sleep after stress, with females showing more prominent arousal and poorer quality sleep [12,34-36]. However, these studies have not included a more detailed view of neural activity during wake and sleep states after stress.
Importantly, Electroencephalography (EEG) power spectrum measures can inform how stress changes brain activity during wake and sleep states [37]. Specifically, the power spectral density (PSD), which is also known as the power spectrum, describes the distribution of signal power over frequency [38]. There are four main frequency band ranges that are used in most rodent and human analysis: delta (.5-4 Hz), theta (4-8 Hz), alpha (8-14 Hz), and beta (15-30 Hz). By examining power value of different frequency ranges, or the band power, one can see which frequency bands dominate certain affective states and vigilance states before, during, and after stress in both sexes.
In general, high arousal states are defined by fast, desynchronized EEG activity and deep sleep states display more synchronized slow waves [39]. Specifically, wake includes high proportions of alpha (8-14 Hz) and beta (15-30 Hz) frequencies, REM sleep includes predominantly theta rhythms (4-8 Hz), and SWS includes the highest percentage of delta rhythms (.5-4 Hz) [37,40,41]. Importantly, stress affects the spectral density within EEG measures. This can be observed both during stress and in subsequent sleep.
Current research in both humans and rodents suggests that EEG power spectral density changes during the experience of stress. In short, studies have found an increase in beta band power and a decrease in alpha band power during psychologically stressful scenarios [16,42-44]. The beta frequency band is associated with an increase in mental workload and concentration under psychological stress [45]. In contrast, the alpha frequency band is more indicative of a relaxed state with lower mental vigilance [46-48]. However, it is unknown whether males and females differ in their neural power spectral density during repeated stress.
Stress can also impact spectral density in subsequent sleep. We are interested in power spectral density changes within SWS and REMS, as well as during sleep state transitions. Previous research has indicated that the continuity of REM is disrupted after repeated stress [49,50]. Examinations of power spectral changes during SWS and REM sleep transitions may provide important insight as to how stress affects brain activity during sleep cycles. Unfortunately, the vast majority of studies that describe the impact of stress on delta, beta, and alpha PSD during subsequent sleep only include male subjects, and therefore, do not consider sex differences in neural spectra in sleep following repeated stress [51-57].
In sum, the current literature has robustly investigated sex differences in the stress response, and separately, the effect of stress on thermoregulation and sleep architecture. However, less is known about sex differences in the effect of repeated stress on physiological and neurobiological measures, such as core body temperature and neural power spectra during different vigilance states. To fill this gap in the literature, we examined core body temperature and neural power spectra in male and female rats before, during, and after 5 consecutive days of 30-minute restraint stress. Ultimately, we hope to shed light on sex differences in the physiological and neurobiological responses to repeated stress, so that we may inform individualized treatments for phenotypes relevant to stress-related disorders.
Methods
Animals
Seven male (~75 d, 325-350 g) and seven female (~75 d, 200-225 g) Sprague Dawley rats were included in the study. Based on previous publications analyzing EEG/EMG data in rodents, this n per group is sufficient to gain enough statistical power [12,58,59]. Rats were singly housed in conventional cages under a 12-hour light-dark cycle (lights on at 7 am and off at 7 pm) and were given food and water ad libitum. Rats acclimated to their housing for at least 5 days before the experiment began. All procedures were approved by the Institutional Animal Care and Use Committee of The Children’s Hospital of Philadelphia Research Institute.
Instrumentation surgery, telemetric recordings, and restraint stress paradigm
Animals were implanted with telemetric transmitters (Physiotel HD-S02; Data Science International, St. Paul, MN, USA). In a sterile surgery, isofluorane (2-3%) was used to induce and maintain anesthesia. A midline incision was made in the abdominal cavity and the telemeter was sutured to the peritoneal wall. Telemeter implants had sensors that measured the core body temperature and motor activity of the animal, along with two bipotential amplifiers. To secure the cortical EEG, two screws were implanted into the skull and were connected to an amplifier. The postural muscle EMG activity was recorded through two insulated stainless steel wire electrodes that were attached bilaterally to the dorsal neck muscles. To conclude, the scalp and peritoneal cavity were sutured and the analgesic meloxicam (2 mg/kg, sc) was administered. Animals were given at least one week to recover from surgery before recordings began.
The telemeter recorded continuous core body temperature, EEG, and EMG signals for 9 days total (for experimental paradigm, see Figure 1A). The first two days of the experiment were used to record baseline activity. Animals were then exposed to 5 consecutive days of 30-min restraint stress, as previously described [11]. Briefly, animals were restrained in Broome-style plexiglas tubes differently sized for male and female rats. Each restraint session occurred within 2 hours after lights-on to control for circadian fluctuation of stress hormones [12]. The recovery period was designated as the time after the end of the repeated restraint stress paradigm, and recovery data was collected for 2 full days. Core body temperature was averaged into 5-minute bins before further analysis. Sleep scoring and analysis are detailed below.
Figure 1.
Experimental paradigm and representative sleep traces. A. A visual depicting the experimental paradigm. Briefly, rodents were implanted with a telemeter one week prior to experimentation. Continuous recordings for core body temperature, EEG, and EMG were collected for 2 baseline days, 5 consecutive days of 30-minute restraint stress, and 2 days of recovery. The light period is represented by open white boxes and the dark period is represented by dark boxes. B. Representative EEG, EMG, and locomotor activity traces for 10 second epochs of Wake (denoted as W), SWS (denoted as S), and REM sleep (denoted as P, for paradoxical sleep).
Sleep Scoring and Analysis
Sleep stage
Sleep-wake states were scored in ten-second epochs with the Rodent Sleep Score Module 2 using Neuroscore Software (Data Science International, St. Paul, MN, USA). Neuroscore uses EEG signals along with EMG signals and activity data to assign a vigilance state (for representative EEG, EMG, and locomotor traces for each vigilance state, see Figure 1B). Briefly, the Rodent Sleep Score Module 2 assesses each individual second of the recording and determines the probability of vigilance state (wake, slow-wave sleep, or paradoxical sleep, also known as REMS) based upon the delta power, theta power, EMG power, stage transition probabilities, contribution factors, and epochs with activity greater than 0. For more information about activity parameters, see https://support.datasci.com/hc/en-us/articles/115005030328-Understanding-the-Ponemah-Activity-Derived-Parameter. If the amplitude of the EEG or EMG exceeds the artifact threshold or has a signal dropout, the 1-second epoch is labeled by the program as an artifact (Data Sciences International, 2012, 302). Two research assistants blind to group conditions visually cross-checked the accuracy of the recognition of sleep-wake stages by Neuroscore.
Power spectral density
Power spectral density was analyzed using the Periodogram Power Bands function in Neuroscore. Specifically, we used predefined frequency ranges of delta (0.5-4 Hz), theta (4-8 Hz), alpha (8-14 Hz), and beta (15-30) to calculate the signal content in the frequency domain for each epoch in our frequency bands of interest. This displays the integral between the lower and the upper bounds for a specific frequency range of the power spectrum. We calculated the “Relative Power Band” value, which normalizes the output by “representing the power band as a ratio between the desired power band and the total power in the signal.” This computation was executed using a Fast Fourier Transform with a default value of 8 and a Hamming window [60].
Sleep Bouts
A sleep bout is an occurrence of a sleep stage before transitioning to the next differentially scored sleep stage. A bout may occur over consecutive scored epochs. Sleep bouts were calculated for the 6 hours immediately after restraint on Day 1 and 5. Neuroscore categorized the sleep stage every 2 seconds and then determined the sleep bout length in seconds for each sleep stage [60]. This information was later used to identify SWS to REM sleep transitions involving sleep bouts with a length of 10 seconds or more.
Neural power spectra during restraint
To examine neural activity during restraint stress, the % PSD for alpha, beta, delta, and theta frequency bands were analyzed in 10s epochs during the last fifteen minutes of restraint on Day 1 and Day 5 for both sexes. We chose to analyze neural spectra data during the last 15 minutes of restraint because we observed the largest sex difference in core body temperature during these time points by Day 5 of restraint.
Power spectra during sleep transitions
To examine neural activity during sleep state transitions after stress, we had to utilize several measures, including sleep stages, sleep bout duration, and relative spectral band powers <alpha, beta, delta, and theta> on day 1 and day 5 of restraint. Spectral data were selected at the first occurrence of a SWS to REM transition after the end of restraint, where each SWS and REM bout was ≥ 10 s. The minimum of 10s for each sleep stage bout was used to ensure that we were analyzing true SWS and REM states, which is common practice in previously published work [61,62].
Statistical Analysis
All data are presented as mean ± standard error of the mean. GraphPad Prism Software (v9.3.1) was employed for statistical analysis and graphical representation. Outliers were identified as 2 standard deviations above or below the mean. A Shapiro-Wilk Normality test was run on all data prior to further statistical analysis; all data passed the normality test. 2-way repeated measure ANOVAs were then used to analyze both core body temperature and spectral data. For core body temperature, the 2-way ANOVA variables were Stress Day x Time. For neural spectra data, each frequency band was analyzed separately, and the 2-way ANOVA variables were Sex x Time. A Mixed-Effects model was used if there were missing data points. Sidak’s multiple comparisons test with a pooled variance was utilized to further examine differences in stress day, sex, or time. Descriptive statistical analyses were used to examine the average % PSD of the sexes on each stress day. The level of significance for all analyses was set at p<0.05.
Results
Core body temperature of male rats habituates to repeated restraint more fully than female rats
To determine if there were sex differences in the physiological response to repeated stress, we examined the core body temperature of males and females before, during, and after 30-min restraint stress on day 1 and day 5. A 2-way ANOVA in males revealed a significant main effect of time and an interaction between time and stress day on core body temperature (Time, F (24, 72) = 22.2, p<0.0001; Time x Stress Day, F (24, 71) = 5.5, p<0.0001; Figure 2A, B). A 2-way ANOVA in females revealed a significant main effect of Time on core body temperature (Time, F (24, 96) = 14.5, p<0.001; Figure 2C, D). Post-hoc tests indicated that males had a significantly lower body temperature at several time points (during the last fifteen minutes of restraint and first 5 minutes of recovery) on day 5 compared to day 1, whereas females showed no statistically significant differences in body temperature during the restraint period. Thus, restraint stress induces an increase in body temperature in both sexes, but the core body temperature of male rats habituates to repeated restraint stress more fully than female rats by day 5 of restraint.
Figure 2.
Core body temperature in male and female rats on Day 1 and Day 5 of restraint, displayed in both heat map and line graph format. A. Heat map of core body temperature in male rats on Day 1 and Day 5 of restraint. B. Line graph illustrating core body temperature in male rats on Day 1 and Day 5 of restraint (with the 30-min restraint noted as the yellow rectangle). There was a main effect of Stress Day on the core body temperature of males between Days 1 and 5. Post hoc testing revealed that core body temperature during restraint was significantly lower on day 5 compared to day 1 of restraint in males. C. Heat map of core body temperature in female rats on Day 1 and Day 5 of restraint. D. Line graph illustrating core body temperature in female rats on Day 1 and Day 5 of restraint (with the 30-min restraint noted as the yellow rectangle). There was no main effect of Stress on core body temperatures in females. This suggests males habituated more fully to restraint stress by Day 5 than females.** indicates p<0.01
Repeated restraint stress alters the power spectral density of alpha and beta frequency bands differentially in male and female rats
In order to examine whether repeated restraint altered brain activity during stress differentially in males and females, we calculated the percent power spectral density of each frequency band during the last 15 minutes of the restraint stress period. We also calculated percent power spectral density at the equivalent circadian time during baseline recordings, but found no statistically significant differences between the sexes (data not shown). We then examined differences in power spectra between males and females on stress day 1 and then on stress day 5 (Time x Sex). Below, we report the findings for the beta and alpha bands only, as the literature has indicated changes in those frequencies in other models of stress [42,63].
To examine the contribution of the beta frequency to the overall neural signal during stress, we conducted a 2-way ANOVA on restraint stress day 1 and 5 during the last 15 minutes of restraint. On day 1, there was a significant effect of time (but not sex) on the % PSD for the beta frequency (Time, F (7, 88) =2.09, p<.05; Figure 3A). On day 5, there was no main effect of sex or time on % PSD of beta (Figure 3C). However, when we examined the average beta band power during that time frame, we found that females had a higher average beta band power than males on both days of restraint, but this was more obvious on day 1 (Figure 3B, 3D: Day 1, Males = 11.7±0.2 vs. Females = 14.6±0.2; Day 5, Males = 15.1±0.2 vs. Females = 16.7±0.2).
Figure 3.
Percent Power Spectral Density (PSD) for the Beta frequency during the last 15 minutes of restraint on Day 1 and Day 5 in male and female rats, displayed in both heat map and bar graph format. A. Heat map of % Power Spectral Density for the beta frequency in males and females during the last 15 minutes of restraint on Day 1. There was a significant effect of time (but not sex) on the % PSD of beta in males and females on Day 1. B. Bar graph quantifying % Power Spectral Density for the beta frequency from Panel A. C. Heat map of % Power Spectral Density for the beta frequency in males and females during the last 15 minutes of restraint on Day 5. There was no main effect of sex or time on % PSD of beta in males and females on Day 5 of restraint. D. Bar graph quantifying % Power Spectral Density for the beta frequency from Panel C.
To examine how the alpha frequency changes during stress in males and females, we performed a 2-way ANOVA on day 1 and 5 of stress. There were no main effects of sex or time on day 1 of restraint on % PSD for the alpha frequency (Figure 4A, B). Moreover, there were no main effects of sex or time on day 5 of restraint on % PSD of alpha (Figure 4C), though descriptive statistics revealed that females reported a higher average % alpha PSD than males (Figure 4D, Males = 11.4±0.1 vs Females = 13.7±0.1).
Figure 4.
Percent Power Spectral Density (PSD) for the Alpha frequency during the last 15 minutes of restraint on Day 1 and Day 5 in male and female rats, displayed in both heat map and bar graph format. A. Heatmap of the % Power Spectral Density for the alpha frequency on Day 1 in males and females. There were no significant main effects of time or sex on the % Power Spectral Density of alpha. B. Bar graph quantifying % Power Spectral Density for the alpha frequency from Panel A. C. Heatmap of the % Power Spectral Density for the alpha frequency on Day 5 in males and females. There were no significant main effects of time or sex on the % PSD of alpha. D. Bar graph quantifying % Power Spectral Density for the alpha frequency from Panel C.
Repeated restraint stress induces sex differences in the power spectral density of the delta, beta, and alpha frequency bands during a SWS to REM transition
In order to examine if restraint stress altered brain activity during subsequent sleep, we calculated the % PSD of each frequency band for the first SWS to REM sleep transition following restraint on day 1 and day 5. Examinations of power spectral changes during SWS and REM sleep transitions may provide important insight as to how stress affects brain activity during sleep cycles. We also calculated percent power spectral density at the equivalent circadian time during baseline recordings, but found no statistically significant differences between the sexes (data not shown). We then used 2-way ANOVAs to examine differences in power spectra between males and females on restraint day 1 as well as on restraint day 5 (Time x Sex). We found interesting sex differences for the delta, beta, and alpha frequencies, as we will discuss in order in more detail below.
There was a significant main effect of sex and an interaction between time and sex on the % PSD of delta on day 1 (Sex, F (1, 8) =5.79, p<.05; Time X Sex, F (39, 274) =1.46, p<.05; Figure 5A, B). Specifically, males had a higher average % PSD of delta than females (Males = 31.2±1.5 vs. Females = 23.4±1.0). There was also a significant main effect of sex on the % PSD of delta on day 5 of restraint (Sex, F (1, 7) =5.88, p<.05; Figure 5C, D). Surprisingly, we found that females had a higher % PSD of delta on day 5 than males (Males = 22.5±0.9 vs. Females = 26.1±1.3). In sum, females had a lower % PSD of delta on day 1 of restraint compared with males, but a higher % PSD of delta on day 5 of restraint compared with males. This may suggest that females take longer to initiate sleep recovery after repeated stress compared with males.
Figure 5.
Percent Power Spectral Density (PSD) for the Delta frequency during a SWS to REMS transition on Day 1 and Day 5 in male and female rats, displayed in both heat map and bar graph format. A. Heat map of % Power Spectral Density for the delta frequency in males and females during a SWS to REMS transition on restraint Day 1. There was a significant main effect of sex on the % PSD of delta. B. Bar graph quantifying % Power Spectral Density for the delta frequency from Panel A. Females had a significantly lower % PSD of delta than males on day 1 of restraint. C. Heat map of % Power Spectral Density for the delta frequency in males and females during a SWS to REMS transition on restraint Day 5. There was a significant main effect of sex on the % PSD of delta. D. Bar graph quantifying % Power Spectral Density for the delta frequency from Panel C. Females had a significantly higher % PSD of delta than males. This suggests that repeated restraint stress differentially affects the % PSD of delta in males and females; it may take females longer to initiate sleep recovery compared with males. * indicates p<.05.
There was a significant interaction between time and sex on the % PSD of beta (Time x Sex, F (39, 273) = 1.67, p=.01; Figure 6A, B). Surprisingly, we found that males had a significantly higher average % PSD of beta on day 1 of restraint compared with females (Males = 21.3±1.2 vs. Females = 9.5±0.4). There were no significant differences in the % PSD of beta between males and females by stress day 5 (Figure 6C, D). Thus, males had a higher % PSD for beta than females during the SWS to REMS transition on day 1 of restraint, but this was transient, as there were no sex differences by day 5 of restraint.
Figure 6.
Percent Power Spectral Density (PSD) for the Beta frequency during a SWS to REMS transition on Day 1 and Day 5 in male and female rats, displayed in both heat map and bar graph format. A. Heat map of % Power Spectral Density for the beta frequency in males and females during a SWS to REMS transition on Day 1 of restraint. There was a significant interaction of time and sex on the % PSD of beta. B. Bar graph quantifying % Power Spectral Density for the beta frequency from Panel A. Males demonstrate a higher % PSD of beta on day 1 than females. C. Heat map of % Power Spectral Density for the beta frequency in males and females during a SWS to REMS transition on restraint Day 5. There was no main effect of time or sex on % PSD of beta in male and female rats on Day 5 of restraint. D. Bar graph quantifying % Power Spectral Density for the beta frequency from Panel C. Thus, males had a higher % PSD for Beta than females during the SWS to REMS transition on day 1 of restraint, but this was transient, as there were no sex differences by day 5 of restraint.** indicates p<0.01
Lastly, there were no significant main effects of time or sex on the % PSD of alpha on restraint day 1 (Figure 7A, B). However, on day 5, there was a significant main effect of sex on the % PSD of alpha (Sex, F (1, 10) =16.47, p<.01; Figure 7C, D). Descriptive statistics indicated a higher average % PSD of alpha in males throughout the transition period (Males = 18.8±0.7 vs. Females = 15.0±0.5). These analyses suggest that by day 5, repeated restraint stress may differentially affect the % PSD of alpha in males compared with females; this sex difference is not apparent until repeated stress exposure.
Figure 7.
Percent Power Spectral Density (PSD) for the alpha frequency during a SWS to REMS transition on Day 1 and Day 5 in male and female rats, displayed in both heat map and bar graph format. A. Heat map of the % Power Spectral Density for the alpha frequency in males and females during a SWS to REMS transition on restraint Day 1.There were no significant main effects of time or sex on restraint Day 1. B. Bar graph quantifying % Power Spectral Density for the alpha frequency from Panel A. C. Heat map of the % Power Spectral Density for the alpha frequency in males and females during a SWS to REMS transition on restraint Day 5. There was a significant main effect of sex on the % PSD of alpha. D. Bar graph quantifying % Power Spectral Density for the alpha frequency from Panel. Females appear to have a lower % PSD of alpha on day 5 than males. These analyses suggest that by day 5, repeated restraint stress may differentially affect the % PSD of alpha in males compared with females; this sex difference is not apparent until repeated stress exposure.** indicates p<0.01
Representative hypnograms of male and female rats on day 1 and 5 of restraint (Figure 8) reveal the development of sex-specific sleep profiles after repeated stress. In short, after restraint on day 1, more initial SWS recovery is apparent in the male rat compared with the female rat. In contrast, after restraint on day 5, there is more prominent SWS recovery in the female rat compared with the male rat. This supports the idea that female rats may take longer to initiate sleep recovery compared with male rats after stress.
Figure 8.
Representative hypnograms of male and female rats on day 1 and 5 of restraint. Each hypnogram shows 120 minutes of sleep (SWS and REMS) and wake behavior before, during, and after 30 min of restraint. Restraint duration is denoted with a red bar above each hypnogram. A. Hypnogram of male rat on day 1 of restraint. B. Hypnogram of female rat on day 1 of restraint. C. Hypnogram of male rat on day 5 of restraint. D. Hypnogram of female rat on day 5 of restraint. After restraint on day 1, more initial SWS recovery is apparent in the male rat compared with the female rat. In contrast, after restraint on day 5, there is more prominent SWS recovery in the female rat compared with the male rat.
Discussion
Acute activation of the stress response is evolutionarily adaptive; however, chronic stress is associated with a variety of adverse health consequences [64]. Two key physiological variables affected by stress are thermoregulation and sleep; previous research has indicated that chronic stress may impact these variables differently in men and women [22,36]. The current literature has robustly investigated sex differences in the stress response and, separately, the effect of stress on thermoregulation and sleep architecture. However, less is known about the sex differences in the effect of stress on core body temperature and sleep. Moreover, the few studies focusing on the sex differences in stress-induced sleep changes do not examine changes to neural power spectra during sleep state transitions. To fill the gap in this knowledge, we examined core body temperature as well neural power spectra in male and female rats before, during, and after 5 consecutive days of 30-minute restraint stress.
Stress effects on core body temperature during restraint stress
We found that restraint stress reliably increased core body temperature in both sexes, and males showed a larger decrease in stress-induced core body temperature by day 5 of repeated restraint compared to females. An increase in thermogenesis has been well documented as an adaptive physiological response to stress and this is, in part, due to activation of the sympathetic nervous system in response to psychological arousal [17,22]. Thus, our findings may suggest a sex difference in the habituation of sympathetic reactivity to restraint stress. In addition, previous studies have revealed sex differences in behavioral and hormonal habituation to restraint stress [11,12]. Specifically, females demonstrate more struggle behavior and HPA activity compared to males by day 5 of restraint [11,12]. Importantly, HPA hormones such as glucocorticoids are associated with increased thermoregulatory responses [18]. In sum, our data aligns with previous findings of sexual dimorphisms in the physiological stress response [65].
Stress effects on the % PSD of beta and alpha
We were interested in determining whether the physiological differences observed in males and females in response to restraint stress (e.g., core body temperature changes) extended to sex differences in neural activity. Thus, we examined the % PSD of the different frequency bands during the end of the restraint stress period. We focused our analyses on the beta and alpha frequencies, as the literature indicated changes in those frequencies in other models of stress [42,63].
We observed that the average percent power spectral density for the beta frequency was higher in females on both day 1 and day 5 compared to males. The beta frequency band has previously been associated with an increase in mental workload and concentration under psychological stress [45]. Additionally, restraint stress has been proven to induce psychological stress in rodents [66]. Taken together with females exhibiting a prolonged time to habituate to the physiological responses from restraint stress, these findings may support the examination of beta band power as an indicator of prolonged psychological stress.
We also observed that the average alpha band power was higher in females on day 5 compared to males. This was unexpected, as alpha power spectral density has previously been established to occur during relaxed states, and multiple measures have shown that females take longer to habituate to repeated restraint stress compared to males [11,48]. However, this finding could potentially be explained by more struggle behavior in the restrainer on day 5 of restraint in females compared with males, as shown in previous research with this paradigm [11]. Specifically, one study found that physical effort resulted in an increase in the power of alpha and beta [67]. If females still had not habituated to the stress and were struggling more during the restraint period on day 5 than males, it is possible this could explain both the elevated alpha and beta frequencies. Thus, we examined locomotor activity counts in both sexes during the last 15 minutes of restraint on day 5. Though female rats had a higher number of counts/minute than male rats (27.7±6.2 vs 15.5±5.6 counts per min, respectively), the variability was quite high and there was no statistical difference between the sexes.
Alternatively, the increased alpha band power in females relative to males may be due to increased mental fatigue [68]. Importantly, females in a restraint stress paradigm exhibit shorter sleep times and more disrupted sleep than males [12]. Previous studies have observed that individuals with burn-out syndrome (which is correlated with poor sleep quality and mental fatigue), exhibit significantly higher alpha activity [69,70]. Thus, it is possible that disrupted sleep in females during repeated restraint is similar to the phenotype observed in burn-out syndrome, subsequently increasing mental fatigue and alpha power relative to males. Indeed, a representative hypnogram of a female rat on day 5 of restraint shows that SWS recovery after restraint is fragmented by many wake episodes. In sum, our findings may suggest that restraint stress leads to greater psychological stress in females on both day 1 and day 5.
Stress effects on the % PSD of delta, beta, and alpha during a SWS to REM transition
In order to examine if restraint stress resulted in changes in brain activity during subsequent sleep, we analyzed the power spectral density of each frequency band for the first SWS to REM sleep transition following the restraint stress period on restraint day 1 and day 5. We chose to examine this as previous research has suggested sex differences in the effects of stress on sleep architecture, and there is a lack of literature examining changes in the power spectra of different frequency bands during sleep transitions following stress [12,71].
We found that males have significantly higher delta band power on day 1 of restraint than females, and this difference is especially prominent during SWS. This may be indicative of males having a faster “sleep rebound” to stress than females, where increased delta power during SWS is able to dissipate the sleep debt built up during stress [51]. However, we found that on day 5, females exhibited a higher relative delta band power than males. One possible explanation for this data is that females took longer to initiate sleep recovery compared with males. Alternatively, elevated delta during REM has been associated with nightmares [54], and previous studies have indicated that females demonstrate higher nightmare-like activity after repeated restraint compared with males [12]. Therefore, it is possible the continued stress contributes to a PTSD like phenotype by day 5 but not by day 1 in females. Regardless, the data suggests that the sexes differ in the neural process of the dissipation of sleep debt associated with psychological stress.
We next found that females had lower % PSD of beta than males on day 1 and by day 5, there were no significant sex differences. This was surprising, as we had hypothesized that females would show elevated beta frequency, indicating hyperarousal and a shift away from restorative sleep [55]. Moreover, increases in beta band power have been found in individuals with primary insomnia during SWS, and insomnia is more common in women [72]. However, previous research in sleep transitions has found a rise in beta frequency through the last minute of SWS that is maintained through the first 15 minutes of REM sleep [73]. Thus, it is possible our data reflects that stress causes an initial inconsistency in this typical sleep state transition trend in females, which is resolved by day 5.
Lastly, we found that males have higher average alpha band power than females during the first sleep transition after restraint on day 5. A previous study examining the EEG activity of veterans with and without PTSD observed a decreased alpha power in those with PTSD [57]. Thus, it is possible alpha power after prolonged stress could be a marker relevant to stress resiliency [57]. In our paradigm, this may suggest that females are less resilient to the neurobiological changes of repeated restraint stress, reflected by a lower alpha power compared to males which develops only after repeated stress.
Limitations and future directions
Previous studies have indicated that HPA hormones such as corticosterone and ACTH can be reliable markers of habituation during repeated restraint stress [11,74]. Since stress hormone increases are associated with a rise in core body temperature, simultaneously collecting HPA hormones and core body temperature readings may allow us to further elucidate the association between the HPA axis and thermoregulation and determine whether there are sex differences in the timing of these changes [74].
Previous research indicates that sex differences in stress-induced changes in REM sleep are influenced by gonadal hormones [75]. Moreover, human studies have observed that changes in sleep power spectra and sleep architecture occur in association with hormonal fluctuations during the menstrual cycle [76]. Since gonadal hormones may modulate the effects of stress on sleep, there is room for further research examining the effects of stress on power spectra within females in different phases of the estrous cycle [77]. Though we collected estrous data with vaginal lavage in this study, we only recorded our findings on restraint days (5 days total), which is not enough data to reliably track female rats (2 weeks is standard) [78]. Based on our dataset, it appears that our sample of female rats was quite variable on where they were in their estrous cycle on days 1 and 5 of restraint (some females were in diestrus, proestrus, and estrus), which may have contributed to variability in the female data.
Conclusions
Our data reveal that stress-induced increases in core body temperature habituate more fully in males by day 5 of repeated restraint compared to females. Additionally, our data suggest that females show more high frequency activity (e.g., beta and alpha waves) than males during repeated restraint. Lastly, our data indicate that males and females differ in their neural response during the first SWS to REM sleep transition following stress, with females showing a delay in delta sleep recovery. These findings indicate that there are measurable, lasting differences in the physiological and neural processes of males and females both during and after repeated stress. Understanding the way that the stress response is physiologically and neurobiologically regulated in both sexes can provide insight into individualized treatments for stress-related disorders.
Acknowledgements
The authors would like to acknowledge Sandy Luz for her help with data collection and Jay Arner for his insight on the spectral data.
Funding
This research was supported by an R21 grant from the National Institute of Mental Health awarded to S. Bhatnagar (R21MH131944) and Bryn Mawr College Faculty Grants awarded to L.A. Grafe.
Footnotes
Ethics approval and consent to participate
All procedures were approved by the Institutional Animal Care and Use Committee of The Children’s Hospital of Philadelphia Research Institute.
Consent for publication
All authors consent to the publication of this manuscript.
Availability of data and materials
Data can be made available upon request.
Competing Interests
The authors have no competing interested related to the work described in this manuscript.
References
- 1.Marin M-F, Lord C, Andrews J, Juster R-P, Sindi S, Arsenault-Lapierre G, et al. Chronic stress, cognitive functioning and mental health. Neurobiology of Learning and Memory. 2011;96:583–95. [DOI] [PubMed] [Google Scholar]
- 2.Abdallah CG, Averill LA, Akiki TJ, Raza M, Averill CL, Gomaa H, et al. The Neurobiology and Pharmacotherapy of Posttraumatic Stress Disorder. Annual Review of Pharmacology and Toxicology. 2019;59:171–89. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Nestler EJ, Barrot M, DiLeone RJ, Eisch AJ, Gold SJ, Monteggia LM. Neurobiology of depression. Neuron. 2002;34:13–25. [DOI] [PubMed] [Google Scholar]
- 4.Sheikh JI, Leskin GA, Klein DF. Gender differences in panic disorder: findings from the National Comorbidity Survey. The American journal of psychiatry. 2002;159:55–8. [DOI] [PubMed] [Google Scholar]
- 5.Keane TM, Marshall AD, Taft CT. Posttraumatic stress disorder: etiology, epidemiology, and treatment outcome. Annual review of clinical psychology. 2006;2:161–97. [DOI] [PubMed] [Google Scholar]
- 6.Bangasser DA, Valentino RJ. Sex Differences in Stress-Related Psychiatric Disorders: Neurobiological Perspectives. Front Neuroendocrinol. 2014;35:303–19. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Suh S, Cho N, Zhang J. Sex Differences in Insomnia: from Epidemiology and Etiology to Intervention. Curr Psychiatry Rep. 2018;20:69. [DOI] [PubMed] [Google Scholar]
- 8.Swaab DF, Bao A-M. Sex differences in stress-related disorders: Major depressive disorder, bipolar disorder, and posttraumatic stress disorder. Handb Clin Neurol. 2020;175:335–58. [DOI] [PubMed] [Google Scholar]
- 9.Wang R, Kogler L, Derntl B. Sex differences in cortisol levels in depression: a systematic review and meta-analysis. Front Neuroendocrinol. 2024;101118. [DOI] [PubMed] [Google Scholar]
- 10.Johnson PL, Molosh A, Fitz SD, Truitt WA, Shekhar A. Orexin, stress, and anxiety/panic states. Progress in brain research. 2012;198:133–61. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Grafe LA, Cornfeld A, Luz S, Valentino R, Bhatnagar S. Orexins Mediate Sex Differences in the Stress Response and in Cognitive Flexibility. Biological Psychiatry. 2017;81:683–92. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Gargiulo AT, Jasodanand V, Luz S, O’Mara L, Kubin L, Ross RJ, et al. Sex differences in stress-induced sleep deficits. Stress. 2021;24:541–50. [DOI] [PubMed] [Google Scholar]
- 13.Medina-Saldivar C, Cruz-Visalaya S, Zevallos-Arias A, Pardo GVE, Pacheco-Otálora LF. Differential effect of chronic mild stress on anxiety and depressive-like behaviors in three strains of male and female laboratory mice. Behav Brain Res. 2024;460:114829. [DOI] [PubMed] [Google Scholar]
- 14.Meerlo P, Sgoifo A, De Boer SF, Koolhaas JM. Long-lasting consequences of a social conflict in rats: behavior during the interaction predicts subsequent changes in daily rhythms of heart rate, temperature, and activity. Behav Neurosci. 1999;113:1283–90. [DOI] [PubMed] [Google Scholar]
- 15.Keeney AJ, Hogg S, Marsden CA. Alterations in core body temperature, locomotor activity, and corticosterone following acute and repeated social defeat of male NMRI mice. Physiol Behav. 2001;74:177–84. [DOI] [PubMed] [Google Scholar]
- 16.Hayashida S, Oka T, Mera T, Tsuji S. Repeated social defeat stress induces chronic hyperthermia in rats. Physiology & Behavior. 2010;101:124–31. [DOI] [PubMed] [Google Scholar]
- 17.Oka T. Psychogenic fever: how psychological stress affects body temperature in the clinical population. Temperature (Austin). 2015;2:368–78. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Vinkers CH, Penning R, Hellhammer J, Verster JC, Klaessens JHGM, Olivier B, et al. The effect of stress on core and peripheral body temperature in humans. Stress. 2013;16:520–30. [DOI] [PubMed] [Google Scholar]
- 19.Marazziti D, Di Muro A, Castrogiovanni P. Psychological stress and body temperature changes in humans. Physiology & Behavior. 1992;52:393–5. [DOI] [PubMed] [Google Scholar]
- 20.Oka T, Oka K. Age and gender differences of psychogenic fever: a review of the Japanese literature. BioPsychoSocial Med. 2007;1:1–5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Thompson R (Trey) L, Lewis SL, Murphy MR, Hale JM, Blackwell PH, Acton GJ, et al. Are there Sex Differences in Emotional and Biological Responses in Spousal Caregivers of Patients with Alzheimer’s Disease? Biological Research For Nursing. 2004;5:319–30. [DOI] [PubMed] [Google Scholar]
- 22.McGivern RF, Zuloaga DG, Handa RJ. Sex differences in stress-induced hyperthermia in rats: Restraint versus confinement. Physiology & Behavior. 2009;98:416–20. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Winsky-Sommerer R, Boutrel B, de Lecea L. Stress and arousal: the corticotrophin-releasing factor/hypocretin circuitry. Molecular neurobiology. 2005;32:285–94. [DOI] [PubMed] [Google Scholar]
- 24.Sanford LD, Suchecki D, Meerlo P. Stress, Arousal, and Sleep. Current topics in behavioral neurosciences [Internet]. 2014. [cited 2017 Aug 3]. p. 379–410. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24852799 [DOI] [PubMed] [Google Scholar]
- 25.Bangasser DA, Eck SR, Telenson AM, Salvatore M. Sex differences in stress regulation of arousal and cognition. Physiology & Behavior. 2018;187:42–50. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Bangasser DA, Eck SR, Ordoñes Sanchez E. Sex differences in stress reactivity in arousal and attention systems. Neuropsychopharmacology. 2019;44:129–39. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Vazquez-Palacios G, Velazquez-Moctezuma J. Effect of electric foot shocks, immobilization, and corticosterone administration on the sleep-wake pattern in the rat. Physiol Behav. 2000;71:23–8. [DOI] [PubMed] [Google Scholar]
- 28.Vázquez-Palacios G, Retana-Márquez S, Bonilla-Jaime H, Velázquez-Moctezuma J. Further definition of the effect of corticosterone on the sleep–wake pattern in the male rat. Pharmacology Biochemistry and Behavior. 2001;70:305–10. [DOI] [PubMed] [Google Scholar]
- 29.Wang Z, Yu B, Zhang X, Sheng Z, Li S, Huang Y, et al. Correlations between depression behaviors and sleep parameters after repeated corticosterone injections in rats. Acta Pharmacol Sin. 2014;35:879–88. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Tsutsui R, Shinomiya K, Sendo T, Kitamura Y, Kamei C. Effects of the 5-HT(1A) Receptor Agonist Tandospirone on ACTH-Induced Sleep Disturbance in Rats. Biol Pharm Bull. 2015;38:884–8. [DOI] [PubMed] [Google Scholar]
- 31.Lo Martire V, Caruso D, Palagini L, Zoccoli G, Bastianini S. Stress & sleep: A relationship lasting a lifetime. Neuroscience & Biobehavioral Reviews. 2020;117:65–77. [DOI] [PubMed] [Google Scholar]
- 32.Xu Y-X, Liu G-Y, Ji Z-Z, Li Y-Y, Wang Y-L, Wu X-Y, et al. Restraint stress induced anxiety and sleep in mice. Front Psychiatry. 2023;14:1090420. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Wright CJ, Milosavljevic S, Pocivavsek A. The stress of losing sleep: Sex-specific neurobiological outcomes. Neurobiol Stress. 2023;24:100543. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 34.Krishnan V, Collop NA. Gender differences in sleep disorders. Current opinion in pulmonary medicine. 2006;12:383–9. [DOI] [PubMed] [Google Scholar]
- 35.Page GG, Opp MR, Kozachik SL. Sex differences in sleep, anhedonia, and HPA axis activity in a rat model of chronic social defeat. Neurobiol Stress. 2016;3:105–13. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 36.Gargiulo AT, Peterson LM, Grafe LA. Stress, coping, resilience, and sleep during the COVID-19 pandemic: A representative survey study of US adults. Brain Behav. 2021;e2384. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 37.Vyazovskiy VV, Delogu A. NREM and REM Sleep: Complementary Roles in Recovery after Wakefulness. Neuroscientist. 2014;20:203–19. [DOI] [PubMed] [Google Scholar]
- 38.Dressler O, Schneider G, Stockmanns G, Kochs EF. Awareness and the EEG power spectrum: analysis of frequencies. British Journal of Anaesthesia. 2004;93:806–9. [DOI] [PubMed] [Google Scholar]
- 39.Brown RE, Basheer R, McKenna JT, Strecker RE, McCarley RW. Control of sleep and wakefulness. Physiological reviews. 2012;92:1087–187. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 40.Oken BS, Salinsky MC, Elsas SM. Vigilance, alertness, or sustained attention: physiological basis and measurement. Clin Neurophysiol. 2006;117:1885–901. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 41.Liu D, Dan Y. A Motor Theory of Sleep-Wake Control: Arousal-Action Circuit. Annual Review of Neuroscience. 2019;42:27–46. [DOI] [PubMed] [Google Scholar]
- 42.Hinrichs H, Machleidt W. Basic emotions reflected in EEG-coherences. International Journal of Psychophysiology. 1992;13:225–32. [DOI] [PubMed] [Google Scholar]
- 43.Awang SA, Pandiyan PM, Yaacob S, Ali YM, Ramidi F, Mat F. Spectral Density Analysis: Theta Wave as Mental Stress Indicator. In: Kim T, Adeli H, Ramos C, Kang B-H, editors. Signal Processing, Image Processing and Pattern Recognition. Berlin, Heidelberg: Springer; 2011. p. 103–12. [Google Scholar]
- 44.Rajendran VG, Jayalalitha S, Adalarasu K. EEG Based Evaluation of Examination Stress and Test Anxiety Among College Students. IRBM [Internet]. 2021. [cited 2022 Mar 14]; Available from: https://www.sciencedirect.com/science/article/pii/S1959031821000798 [Google Scholar]
- 45.Palacios-García I, Silva J, Villena-González M, Campos-Arteaga G, Artigas-Vergara C, Luarte N, et al. Increase in Beta Power Reflects Attentional Top-Down Modulation After Psychosocial Stress Induction. Front Hum Neurosci. 2021;15:630813. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 46.MacLean MH, Arnell KM, Cote KA. Resting EEG in alpha and beta bands predicts individual differences in attentional blink magnitude. Brain Cogn. 2012;78:218–29. [DOI] [PubMed] [Google Scholar]
- 47.Kamzanova AT, Kustubayeva AM, Matthews G. Use of EEG workload indices for diagnostic monitoring of vigilance decrement. Hum Factors. 2014;56:1136–49. [DOI] [PubMed] [Google Scholar]
- 48.Fernandez Rojas R, Debie E, Fidock J, Barlow M, Kasmarik K, Anavatti S, et al. Electroencephalographic Workload Indicators During Teleoperation of an Unmanned Aerial Vehicle Shepherding a Swarm of Unmanned Ground Vehicles in Contested Environments. Front Neurosci. 2020;14:40. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 49.Grafe LA, O’Mara L, Branch A, Dobkin J, Luz S, Vigderman A, et al. Passive Coping Strategies During Repeated Social Defeat Are Associated With Long-Lasting Changes in Sleep in Rats. Front Syst Neurosci [Internet]. 2020. [cited 2021 May 14];14. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7043017/ [DOI] [PMC free article] [PubMed] [Google Scholar]
- 50.Grafe L, Miller KE, Ross RJ, Bhatnagar S. The importance of REM sleep fragmentation in the effects of stress on sleep: Perspectives from preclinical studies. Neurobiology of Stress. 2024;28:100588. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 51.Meerlo P, de Bruin EA, Strijkstra AM, Daan S. A social conflict increases EEG slow-wave activity during subsequent sleep. Physiology & behavior. 2001;73:331–5. [DOI] [PubMed] [Google Scholar]
- 52.Wang C, Ramakrishnan S, Laxminarayan S, Dovzhenok A, Cashmere JD, Germain A, et al. An attempt to identify reproducible high-density EEG markers of PTSD during sleep. Sleep. 2020;43:zsz207. [DOI] [PubMed] [Google Scholar]
- 53.Xi K, Huang X, Liu T, Liu Y, Mao H, Wang M, et al. Translational relevance of behavioral, neural, and electroencephalographic profiles in a mouse model of post-traumatic stress disorder. Neurobiology of Stress. 2021;15:100391. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 54.de Boer M, Nijdam MJ, Jongedijk RA, Bangel KA, Olff M, Hofman WF, et al. The spectral fingerprint of sleep problems in post-traumatic stress disorder. Sleep. 2019;43:zsz269. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 55.Perlis ML, Merica H, Smith MT, Giles DE. Beta EEG activity and insomnia. Sleep Med Rev. 2001;5:363–74. [DOI] [PubMed] [Google Scholar]
- 56.Zhao W, Van Someren EJW, Li C, Chen X, Gui W, Tian Y, et al. EEG spectral analysis in insomnia disorder: A systematic review and meta-analysis. Sleep Medicine Reviews. 2021;59:101457. [DOI] [PubMed] [Google Scholar]
- 57.Jokić-begić N, Begić D. Quantitative electroencephalogram (qEEG) in combat veterans with post-traumatic stress disorder (PTSD). Nordic Journal of Psychiatry. 2003;57:351–5. [DOI] [PubMed] [Google Scholar]
- 58.Boyle CE, Parkar A, Barror A, Kubin L. Noradrenergic terminal density varies among different groups of hypoglossal premotor neurons. J Chem Neuroanat. 2019;100:101651. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 59.Herr KB, Stettner GM, Kubin L. Reduced c-Fos expression in medullary catecholaminergic neurons in rats 20 h after exposure to chronic intermittent hypoxia. Am J Physiol Regul Integr Comp Physiol. 2013;304:R514–22. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 60.Neuroscore User Manual. NeuroScore v3.4.0 User Manual [Internet]. Data Sciences International. 2021. [cited 2022 Jul 30]. Available from: https://support.datasci.com/hc/en-us/articles/4402145447059-NeuroScore-v3-4-0-User-Manual [Google Scholar]
- 61.Vanini G, Baghdoyan HA. Extrasynaptic GABAA Receptors in Rat Pontine Reticular Formation Increase Wakefulness. Sleep. 2013;36:337–43. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 62.Rempe MJ, Clegern WC, Wisor JP. An automated sleep-state classification algorithm for quantifying sleep timing and sleep-dependent dynamics of electroencephalographic and cerebral metabolic parameters. Nat Sci Sleep. 2015;7:85–99. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 63.Jacinto L, Reis J, Dias N, Cerqueira J, Correia J, Sousa N. Stress affects theta activity in limbic networks and impairs novelty-induced exploration and familiarization. Frontiers in Behavioral Neuroscience [Internet]. 2013. [cited 2022 Apr 22];7. Available from: https://www.frontiersin.org/article/10.3389/fnbeh.2013.00127 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 64.Goel N, Workman JL, Lee TT, Innala L, Viau V. Sex Differences in the HPA Axis. Comprehensive Physiology. 2014;4:1121–55. [DOI] [PubMed] [Google Scholar]
- 65.Bangasser DA, Wiersielis KR. Sex differences in stress responses: a critical role for corticotropin-releasing factor. Hormones (Athens). 2018;17:5–13. [DOI] [PubMed] [Google Scholar]
- 66.Buynitsky T, Mostofsky DI. Restraint stress in biobehavioral research: Recent developments. Neurosci Biobehav Rev. 2009;33:1089–98. [DOI] [PubMed] [Google Scholar]
- 67.Smit AS, Eling PATM, Hopman MT, Coenen AML. Mental and physical effort affect vigilance differently. International Journal of Psychophysiology. 2005;57:211–7. [DOI] [PubMed] [Google Scholar]
- 68.Borghini G, Vecchiato G, Toppi J, Astolfi L, Maglione A, Isabella R, et al. Assessment of mental fatigue during car driving by using high resolution EEG activity and neurophysiologic indices. Annu Int Conf IEEE Eng Med Biol Soc. 2012;2012:6442–5. [DOI] [PubMed] [Google Scholar]
- 69.Rothe N, Steffen J, Penz M, Kirschbaum C, Walther A. Examination of peripheral basal and reactive cortisol levels in major depressive disorder and the burnout syndrome: A systematic review. Neuroscience & Biobehavioral Reviews. 2020;114:232–70. [DOI] [PubMed] [Google Scholar]
- 70.Tement S, Pahor A, Jaušovec N. EEG alpha frequency correlates of burnout and depression: The role of gender. Biological Psychology. 2016;114:1–12. [DOI] [PubMed] [Google Scholar]
- 71.Cano G, Mochizuki T, Saper CB. Neural Circuitry of Stress-Induced Insomnia in Rats. Journal of Neuroscience. 2008;28:10167–84. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 72.Spiegelhalder K, Regen W, Feige B, Holz J, Piosczyk H, Baglioni C, et al. Increased EEG sigma and beta power during NREM sleep in primary insomnia. Biol Psychol. 2012;91:329–33. [DOI] [PubMed] [Google Scholar]
- 73.Ferri R, Cosentino FII, Elia M, Musumeci SA, Marinig R, Bergonzi P. Relationship between Delta, Sigma, Beta, and Gamma EEG bands at REM sleep onset and REM sleep end. Clinical Neurophysiology. 2001;112:2046–52. [DOI] [PubMed] [Google Scholar]
- 74.Bhatnagar S, Lee TM, Vining C. Prenatal stress differentially affects habituation of corticosterone responses to repeated stress in adult male and female rats. Hormones and behavior. 2005;47:430–8. [DOI] [PubMed] [Google Scholar]
- 75.Morrison SF, Nakamura K. Central Mechanisms for Thermoregulation. Annual Review of Physiology. 2019;81:285–308. [DOI] [PubMed] [Google Scholar]
- 76.Paul KN, Losee-Olson S, Pinckney L, Turek FW. The ability of stress to alter sleep in mice is sensitive to reproductive hormones. Brain research. 2009;1305:74–85. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 77.Corsi-Cabrera M, Sánchez AI, del-Río-Portilla Y, Villanueva Y, Pérez-Garci E. Effect of 38 h of total sleep deprivation on the waking EEG in women: sex differences. International journal of psychophysiology : official journal of the International Organization of Psychophysiology. 2003;50:213–24. [DOI] [PubMed] [Google Scholar]
- 78.Dib R, Gervais NJ, Mongrain V. A review of the current state of knowledge on sex differences in sleep and circadian phenotypes in rodents. Neurobiol Sleep Circadian Rhythms. 2021;11:100068. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 79.Becker JB, Arnold AP, Berkley KJ, Blaustein JD, Eckel LA, Hampson E, et al. Strategies and methods for research on sex differences in brain and behavior. Endocrinology. 2005;146:1650–73. [DOI] [PubMed] [Google Scholar]








