The central autonomic network (CAN) plays a critical role in the stress response, which is triggered by challenges on the homeostasis (physiological stressors) or unpleasant social or environmental situations. This review focuses on the role of areas of the CAN including the insular and anterior cingulate cortices, extended amygdala, hypothalamus, periaqueductal gray and locus coeruleus in the stress response. These areas are interconnected and affect sympathetic or parasympathetic output via their influence on premotor or preganglionic autonomic neurons in the lower brainstem and spinal cord. The insula integrates multiple inputs to create a sense of the physiological state of the body, whereas the anterior cingulate initiates predictive visceromotor commands. The amygdala and bed nucleus of the stria terminalis provide automatic emotional tagging and trigger automatic survival responses to threat via their outputs to the hypothalamus, periaqueductal gray, and lower brainstem. Several regions of the hypothalamus, including the paraventricular nucleus, dorsomedial nucleus and lateral hypothalamic area participate in different patterns of stress response according to the type of stimulus and projections to premotor and preganglionic autonomic neurons. The periaqueductal gray initiates different patterns of autonomic, pain modulatory, and motor responses, including the “fight or flight” or “playing dead” responses. The locus coeruleus promotes emotional learning in the amygdala associated with states of anxiety. Neurons of the C1 area of the rostral ventrolateral medulla elicit sympathoexcitatory responses to internal stressors such as hypoxia and inflammation. The ventromedial medulla, including the nucleus raphe pallidus, initiates sympathoexcitatory responses to social and other external stressors.

中枢自主神经网络 (CAN) 在压力反应中起着关键作用，压力反应是由体内平衡（生理压力源）的挑战或不愉快的社会或环境状况引发的。本综述重点关注 CAN 区域的作用，包括岛叶和前扣带回皮质、扩展的杏仁核、下丘脑、导水管周围灰质和蓝斑在应激反应中的作用。这些区域相互关联，并通过影响下脑干和脊髓中的运动前或节前自主神经元来影响交感神经或副交感神经输出。岛叶整合多个输入以产生身体生理状态的感觉，而前扣带回则启动预测性内脏运动命令。杏仁核和终纹的床核提供自动情绪标记，并通过它们对下丘脑、导水管周围灰质和下脑干的输出触发对威胁的自动生存反应。下丘脑的几个区域，包括室旁核、背内侧核和下丘脑外侧区，根据对运动前和节前自主神经元的刺激和投射类型，参与不同的应激反应模式。导水管周围灰质启动不同模式的自主神经、疼痛调节和运动反应，包括“战斗或逃跑”或“装死”反应。蓝斑基因座促进与焦虑状态相关的杏仁核中的情绪学习。延髓头侧腹外侧 C1 区域的神经元引起对内部压力源（如缺氧和炎症）的交感神经兴奋反应。腹内侧髓质，包括苍白中缝核，启动对社会和其他外部压力源的交感神经兴奋反应。