The duration of the cortisol awakening pulse exceeds sixty minutes in a meaningful pattern

HPA axis activity across the menstrual cycle - a systematic review and meta-analysis of longitudinal studies

Differential HPA axis function has been proposed to underlie sex-differences in mental disorders; however, the impact of fluctuating sex hormones across the menstrual cycle on HPA axis activity is still unclear. This meta-analysis investigated basal cortisol concentrations as a marker for HPA axis activity across the menstrual cycle. Through a systematic literature search of five databases, 121 longitudinal studies were included, summarizing data of 2641 healthy, cycling participants between the ages of 18 and 45. The meta-analysis showed higher cortisol concentrations in the follicular vs. luteal phase (d_SMC = 0.12, p =.004, [0.04 - 0.20]). Comparisons between more precise cycle phases were mostly insignificant, aside from higher concentrations in the menstrual vs. premenstrual phase (d_SMC = 0.17, [0.02 - 0.33], p =.03). In all included studies, nine samples used established cortisol parameters to indicate HPA axis function, specifically diurnal profiles (k = 4) and the cortisol awakening response (CAR) (k = 5). Therefore, the meta-analysis highlights the need for more rigorous investigation of HPA axis activity and menstrual cycle phase.

Aldosterone secretion during the day: Salivary aldosterone awakening response and daytime levels

BACKGROUND

The mineralocorticoid hormone aldosterone is a key regulator of the sodium-potassium balance and blood pressure. In excess, aldosterone relates to hypertension and cardiovascular disease (CVD). Here, we systematically investigated aldosterone secretion during the day in terms of salivary aldosterone awakening response (AldAR) and salivary aldosterone daytime levels (AldDay) under controlled conditions in participants' natural environment including assessment of potential confounding variables.

METHODS

In 40 healthy young men, saliva samples for AldAR were collected immediately after awakening and 15, 30, 45, and 60 min thereafter. AldDay levels were measured in 1 h intervals from 9:00-22:00 h. Analyses were complemented by salivary cortisol assessment. Fluid and food intake was standardized and as potential confounders, we assessed awakening time and sleep duration, age, BMI and MAP, as well as chronic stress.

RESULTS

Awakening was followed by significant increases in salivary aldosterone (p = .004, f= 0.31), returning to baseline levels > 60 min later. Longer sleep duration was associated with lower AldAR (p < .001, f= 0.36). Over the course of the day we observed a continuous decrease of AldDay (p < .001, f= 0.45). Longer sleep duration (p = .097, f= .21), later time of awakening (p < .001, f= .29), and higher chronic stress (p = .041, f= .23) were associated with AldDay characteristics. Circadian aldosterone secretion was positively associated with most cortisol measures.

CONCLUSIONS

We observed an awakening response in salivary aldosterone and could confirm a decrease in aldosterone levels during the day, comparable to cortisol. Significant confounders were sleep-related variables and chronic stress. Clinical implications of circadian aldosterone secretion with respect to CVD risk remain to be elucidated.

Sleep quality and neurohormonal and psychophysiological accompanying factors in adolescents with depressive disorders: study protocol

BACKGROUND

Depressive disorders are common mental health problems during adolescence. Many adolescents with depression describe difficulties with sleeping. Findings of previous studies regarding changes in objective sleep quality in adolescents with depressive disorders are heterogeneous.

AIMS

This study aims to investigate differences in objective and subjective sleep quality between adolescents with depressive disorders and healthy peers, and to evaluate if potential changes in sleep occur concurrently with changes in the release of cortisol and alpha-amylase after awakening.

METHOD

This non-interventional parallel study examines correlations between depressive disorders, sleep quality and release of stress hormones. Sleep quality in the past 2 weeks, severity of depressive symptoms, psychiatric comorbidities and stress response of 30 adolescents with depressive disorders and 30 healthy controls (N = 60) are assessed via questionnaires. In participants' home environments, the objective sleep quality of seven consecutive nights is measured by sleep accelerometry. After awakening, participants answer sleep questionnaires to examine the subjective sleep quality of those nights. Furthermore, salivary cortisol and alpha-amylase are measured three times after awakening (+0 min, +30 min and +45 min after awakening).

CONCLUSIONS

Sleep is an important factor for prognosis and well-being in adolescents with depression. The results of this study can be highly valuable to integrate a more detailed examination of sleep quality and sleeping impairments in the treatment of adolescent depressive disorders.

Effects of psychological, sensory, and metabolic energy prime manipulation on the acute endocrine stress response in fasted women

The stress response supports survival through energy mobilization. Paradoxically, a low blood glucose level dampens the endocrine stress response, and sugar consumption prior to stress restores it. Thus, energy availability may play a causal role in the endocrine stress response. Yet, it has never been tested whether sweet taste or expectations towards a drink content modulate the stress response. We investigated the potential role of sweetness, energy load and expectations towards energy load of a drink consumed prior to stress in restoring stress reactivity after fasting. N = 152 women (meanage=21.53, sdage=2.61) participated in the Trier Social Stress Test for groups in the morning after an overnight fast. Prior to stress induction, participants consumed a drink containing saccharose (sugar, n = 51), an equally sweet drink containing non-caloric sweetener (sweetener, n = 46), or water (n = 56). Additionally, participants in the sugar and sweetener group (n = 97) were informed whether or not their drink contained any calories (energy prime), which was deceptive in 50% of the cases. Eight salivary cortisol (-30, -20, -10, 0, +12, +25, +35, +45 min) and three blood glucose samples (-30, 0, +25 min) were assessed throughout the experiment. The effects of the experimental manipulations on cortisol trajectories were tested using multilevel mixed models. We found that compared with water, sugar and sweetener both significantly increased cortisol stress reactivity and with comparable intensity. However, our sensitivity analysis revealed a significant effect of sugar on cortisol trajectories compared to water and to sweetener. Drink-induced changes in blood glucose concentration were not associated with increases in cortisol. The energy prime did not affect the stress response. Overall, we could replicate the boosting effect of sugar consumption in a female sample after 8 h of fasting. The specific contribution of sweet taste and metabolic hormones to this boosting effect should be tested more rigorously in sex-balanced designs in the future.

Non-communicable diseases among women survivors of intimate partner violence: Critical review from a chronic stress framework

A neurobiological framework of chronic stress proposes that the stress-response system can be functionally altered by the repeated presentation of highly stressful situations over time. These functional alterations mainly affect brain processing and include the dysregulation of the hypothalamic-pituitary-adrenal axis and associated processes. In the present critical review, we translate these results to inform the clinical presentation of women survivors of intimate partner violence (IPV). We approach IPV as a scenario of chronic stress where women are repetitively exposed to threat and coping behaviours that progressively shape their neurobiological response to stress. The changes at the central and peripheral levels in turn correlate with the phenotypes of non-communicable diseases. The reviewed studies clarify the extent of the impact of IPV on women's health in large (N > 10,000) population-based designs, and provide observations on experimental neuroendocrine, immune, neurocognitive and neuroimaging research linking alterations of the stress-response system and disease. This evidence supports the prevention of violence against women as a fundamental action to reduce the prevalence of non-communicable diseases.

Association between hair cortisol and diurnal basal cortisol levels: A 30-day validation study

This study aimed to validate the association between hair cortisol and 30-day integrated salivary cortisol levels. Additionally, the intra-individual stability of the hair cortisol and the association between hair cortisol and salivary cortisol in several time domains were systematically explored. Twenty-four adults (15 men and 9 women, mean age: 22.7 ± 2.8 years) were asked to collect three saliva samples per day for 30 days, immediately after awakening (time 1), 30 min after awakening (time 2), and at bedtime (time 3). The hair sample was taken from the posterior vertex as close as possible to the scalp at the end of the 30-day study period. The area under the curve based on times 1 and 3 showed that cortisol levels in the 1 cm hair segment closest to the scalp were moderately correlated with the 30-day salivary cortisol levels (r = 0.41, p = 0.047). However, this correlation was not observed for the cortisol awakening response, diurnal slope, or other metrics in different time domains. The mean salivary cortisol at time 3 was significantly correlated with hair cortisol (r = 0.42, p = 0.041). Intra-individual stability of the hair cortisol was maintained for at least 4 months. Hair cortisol may reflect basal cortisol levels more substantially over longer periods (longer than 1 month and for at least 4 month), thus reflecting longitudinal cortisol production, rather than the day-to-day temporal cortisol response. Salivary cortisol is an ideal metric for short-term or day-to-day stress response. Researchers should select suitable metrics, such as hair cortisol for basal level (or trait) or salivary cortisol for response (or state), depending on the study objective.