Salience versus magnitude in the measurement of the cortisol awakening response

Evans, P., Smyth, N., Thorn, L., Hucklebridge, F. and Clow, A. 2019. Salience versus magnitude in the measurement of the cortisol awakening response. Psychoneuroendocrinology. 103, pp. 249-258. https://doi.org/10.1016/j.psyneuen.2019.01.023

TitleSalience versus magnitude in the measurement of the cortisol awakening response
TypeJournal article
AuthorsEvans, P.
Smyth, N.
Thorn, L.
Hucklebridge, F.
Clow, A.
Abstract

Pulsatile ultradian secretion of cortisol, rarely studied in salivary data, has functional importance in hypothalamic pituitary adrenal (HPA) axis regulation. The first daily ultradian episode, the cortisol awakening response (CAR), was examined in healthy adults, in 5-min secretion rates of salivary cortisol from electronically monitored awakening time to 1.25 h. Aggregated rates revealed a cubic trend, with wave-length of almost exactly 1 h, as predicted from known ultradian periodicity. Peak secretion rate occurred 20-min post-awakening. Peak (20-min) to trough (59-min) amplitude (PTA) expressed a salient signal shape. Rates rose steeply to and from peak, and major secretion was packaged into a few 5-min intervals, inconsistent with normal or uniform distribution of 5-min rates, but consistent with known pulsatile cortisol delivery. Null hypotheses asserting normal or uniform distributions were rejected. Maximal rates overwhelmingly occurred before and minimal rates after 30-mins, with degree of extremity at each polarity significantly positively correlated.

To demonstrate utility and reliability of PTA estimation in a clinically relevant domain, re- analyses of a previously published study were conducted. Data from only three saliva samples were used, given importance of cost considerations for many CAR researchers. Difference between mean rates before and after 30-min yielded a simple salience index, highly correlated with PTA derived from full 5-min interval data. CAR salience performed significantly better than traditional AUCi magnitude in discriminating control cases (higher inferred amplitude) and cases with Seasonal Affective Disorder (lower inferred amplitude). Evidence suggested that low AUCi may be more sensitive in identifying within-subject changes (e.g. more depressed mood in winter among SAD cases) and low CAR salience better at revealing enduring between-subjects associations (e.g. underlying disorder vulnerability). Since both PTA salience and AUCi magnitude can be analysed and compared using exactly the same data from the same commonly used saliva sampling points, further research is warranted into the importance of individual differences in patterns of cortisol delivery, not just how much is delivered.

JournalPsychoneuroendocrinology
Journal citation103, pp. 249-258
ISSN0306-4530
Year2019
PublisherElsevier
Accepted author manuscript
Digital Object Identifier (DOI)https://doi.org/10.1016/j.psyneuen.2019.01.023
Publication dates
Published in printMay 2019
Published online31 Jan 2019
LicenseCC BY-NC-ND 4.0

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Use of a single case study design to examine state variation in the cortisol awakening response: relationship with time of awakening
Stalder, T., Hucklebridge, F., Evans, P. and Clow, A. 2009. Use of a single case study design to examine state variation in the cortisol awakening response: relationship with time of awakening. Psychoneuroendocrinology. 34 (4), pp. 607-614. https://doi.org/10.1016/j.psyneuen.2008.10.023

The cortisol awakening response, seasonality, stress and arousal: a study of trait and state influences
Thorn, L., Hucklebridge, F., Evans, P. and Clow, A. 2009. The cortisol awakening response, seasonality, stress and arousal: a study of trait and state influences. Psychoneuroendocrinology. 34 (3), pp. 299-306. https://doi.org/10.1016/j.psyneuen.2008.11.005

Diurnal patterns of salivary cortisol across the adolescent period in healthy females
Oskis, A., Loveday, C., Hucklebridge, F., Thorn, L. and Clow, A. 2009. Diurnal patterns of salivary cortisol across the adolescent period in healthy females. Psychoneuroendocrinology. 34 (3), pp. 307-316. https://doi.org/10.1016/j.psyneuen.2008.09.009

Practice Nurses' views of their role in the management of Chronic Fatigue Syndrome/Myalagic Encephalitis: a qualitative study
Chew-Graham, C., Dixon, R., Shaw, J.W., Smyth, N., Lovell, K. and Peters, S. 2009. Practice Nurses' views of their role in the management of Chronic Fatigue Syndrome/Myalagic Encephalitis: a qualitative study. BMC Nursing. 8 (2). https://doi.org/10.1186/1472-6955-8-2

Caregiving is associated with low secretion rates of immunoglobulin A in saliva
Gallagher, S., Phillips, A.C., Evans, P., Der, G., Hunt, K. and Carroll, D. 2008. Caregiving is associated with low secretion rates of immunoglobulin A in saliva. Brain, Behavior, and Immunity. 22 (4), pp. 565-572. https://doi.org/10.1016/j.bbi.2007.11.007

Cortisol secretory activity in older people in relation to positive and negative well-being
Evans, P., Forte, D., Jacobs, C., Fredhoi, C., Aitchison, E., Hucklebridge, F. and Clow, A. 2007. Cortisol secretory activity in older people in relation to positive and negative well-being. Psychoneuroendocrinology. 32 (8-10), pp. 922-930. https://doi.org/10.1016/j.psyneuen.2007.06.017

Suspected non-adherence and weekend versus week day differences in the awakening cortisol response
Thorn, L., Hucklebridge, F., Evans, P. and Clow, A. 2006. Suspected non-adherence and weekend versus week day differences in the awakening cortisol response. Psychoneuroendocrinology. 31 (8), pp. 1009-1018. https://doi.org/10.1016/j.psyneuen.2006.05.012

'I think that it's a pain in the ass that I have to stand outside in the cold and have a cigarette': representations of smoking and experiences of disapproval in UK and Greek smokers
Louka, P., Maguire, M., Evans, P. and Worrell, M. 2006. 'I think that it's a pain in the ass that I have to stand outside in the cold and have a cigarette': representations of smoking and experiences of disapproval in UK and Greek smokers. Journal of Health Psychology. 11 (3), pp. 441-451. https://doi.org/10.1177/1359105306063317

Post-awakening cortisol secretion during basic military training
Clow, A., Edwards, S., Owen, G., Evans, G., Evans, P., Hucklebridge, F. and Casey, A. 2006. Post-awakening cortisol secretion during basic military training. International Journal of Psychophysiology. 60 (1), pp. 88-94. https://doi.org/10.1016/j.ijpsycho.2005.05.007

Stressful life events are associated with low secretion rates of immunoglobulin A in saliva in the middle aged and elderly
Phillips, A.C., Carroll, D., Evans, P., Bosch, J.A., Clow, A., Hucklebridge, F. and Der, G. 2006. Stressful life events are associated with low secretion rates of immunoglobulin A in saliva in the middle aged and elderly. Brain, Behavior, and Immunity. 20 (2), pp. 191-197. https://doi.org/10.1016/j.bbi.2005.06.006

Salivary cortisol, stress and arousal following five weeks training in kinesthetic meditation to undergraduate students
Bullen, V., Fredhoi, C., Bloom, W., Povey, J., Hucklebridge, F., Evans, P. and Clow, A. 2006. Salivary cortisol, stress and arousal following five weeks training in kinesthetic meditation to undergraduate students. Journal of Holistic Healthcare. 3 (3), pp. 34-38.

Reduction in cortisol after smoking cessation among users of nicotine patches
Ussher, M., West, R., Evans, P., Steptoe, A., McEwen, A., Clow, A. and Hucklebridge, F. 2006. Reduction in cortisol after smoking cessation among users of nicotine patches. Psychosomatic Medicine. 68 (2), pp. 299-306. https://doi.org/10.1097/01.psy.0000204926.27215.a1

Optimism, positive affectivity, and salivary cortisol
Lai, J.C.L., Evans, P., Ng, S.H., Chong, A.M.L., Siu, O.T., Chan, C.L.W., Ho, S.M.Y., Ho, R.T.H., Chan, P. and Chan, C.C. 2005. Optimism, positive affectivity, and salivary cortisol. British Journal of Health Psychology. 10 (4), pp. 467-484. https://doi.org/10.1348/135910705X26083

The diurnal patterns of the adrenal steroids cortisol and dehydroepiandrosterone (DHEA) in relation to awakening
Hucklebridge, F., Hussain, T., Evans, P. and Clow, A. 2005. The diurnal patterns of the adrenal steroids cortisol and dehydroepiandrosterone (DHEA) in relation to awakening. Psychoneuroendocrinology. 30 (1), pp. 51-57. https://doi.org/10.1016/j.psyneuen.2004.04.007

Acute reduction in secretory immunoglobulin A following smoking cessation
Ussher, M., West, R., Evans, P., Steptoe, A., McEwen, A., Clow, A. and Hucklebridge, F. 2004. Acute reduction in secretory immunoglobulin A following smoking cessation. Psychoneuroendocrinology. 29 (10), pp. 1335-1340. https://doi.org/10.1016/j.psyneuen.2004.04.004

The effect of dawn simulation on the cortisol response to awakening in healthy participants
Thorn, L., Hucklebridge, F., Esgate, A., Evans, P. and Clow, A. 2004. The effect of dawn simulation on the cortisol response to awakening in healthy participants. Psychoneuroendocrinology. 29 (7), pp. 925-930. https://doi.org/10.1016/j.psyneuen.2003.08.005

The awakening cortisol response: methodological issues and significance
Clow, A., Thorn, L., Evans, P. and Hucklebridge, F. 2004. The awakening cortisol response: methodological issues and significance. Stress. 7 (1), pp. 29-37. https://doi.org/10.1080/10253890410001667205

Components of the diurnal cortisol cycle in relation to upper respiratory symptoms and perceived stress
Edwards, S., Hucklebridge, F., Clow, A. and Evans, P. 2003. Components of the diurnal cortisol cycle in relation to upper respiratory symptoms and perceived stress. Psychosomatic Medicine. 65 (2), pp. 320-327. https://doi.org/10.1097/01.PSY.0000033123.70631.8E

An investigation into asymmetrical cortical regulation of salivary S-IgA in conscious man using transcranial magnetic stimulation
Clow, A., Lambert, S., Evans, P., Hucklebridge, F. and Higuchi, K. 2003. An investigation into asymmetrical cortical regulation of salivary S-IgA in conscious man using transcranial magnetic stimulation. International Journal of Psychophysiology. 47 (1), pp. 57-64. https://doi.org/10.1016/S0167-8760(02)00093-4

The awakening cortisol response: no evidence for an influence of body posture
Hucklebridge, F., Mellins, J., Evans, P. and Clow, A. 2002. The awakening cortisol response: no evidence for an influence of body posture. Life Sciences. 71 (6), pp. 639-646. https://doi.org/10.1016/S0024-3205(02)01726-5

Ultrasound measures of bone and the diurnal free cortisol cycle: a positive association with the awakening cortisol response in healthy premenopausal women
Brooke-Wavell, K., Clow, A., Ghazi-Noori, S., Evans, P. and Hucklebridge, F. 2002. Ultrasound measures of bone and the diurnal free cortisol cycle: a positive association with the awakening cortisol response in healthy premenopausal women. Calcified Tissue International. 70 (6), pp. 463-468. https://doi.org/10.1007/s00223-001-2085-8

Low frequency noise enhances cortisol among noise sensitive subjects during work performance
Persson Waye, K., Bengtsson, J., Rylander, R., Hucklebridge, F., Evans, P. and Clow, A. 2002. Low frequency noise enhances cortisol among noise sensitive subjects during work performance. Life Sciences. 70 (7), pp. 745-758. https://doi.org/10.1016/S0024-3205(01)01450-3

Association between time of awakening and diurnal cortisol secretory activity
Edwards, S., Evans, P., Hucklebridge, F. and Clow, A. 2001. Association between time of awakening and diurnal cortisol secretory activity. Psychoneuroendocrinology. 26 (6), pp. 613-622. https://doi.org/10.1016/S0306-4530(01)00015-4

Exploration of the awakening cortisol response in relation to diurnal cortisol secretory activity
Edwards, S., Clow, A., Evans, P. and Hucklebridge, F. 2001. Exploration of the awakening cortisol response in relation to diurnal cortisol secretory activity. Life Sciences. 68 (18), pp. 2093-2103. https://doi.org/10.1016/S0024-3205(01)00996-1

Modulation of secretory immunoglobulin A in saliva; response to manipulation of mood
Hucklebridge, F., Lambert, S., Clow, A., Warburton, D.M., Evans, P. and Sherwood, N. 2000. Modulation of secretory immunoglobulin A in saliva; response to manipulation of mood. Biological Psychology. 53 (1), pp. 25-35. https://doi.org/10.1016/S0301-0511(00)00040-5

The cortisol response to normal and nocturnal awakening
Hucklebridge, F., Clow, A., Rahman, H. and Evans, P. 2000. The cortisol response to normal and nocturnal awakening. Journal of Psychophysiology. 14 (1), pp. 24-28. https://doi.org/10.1027//0269-8803.14.1.24

Mind, immunity and health: the science of psychoneuroimmunology
Evans, P., Hucklebridge, F. and Clow, A. 2000. Mind, immunity and health: the science of psychoneuroimmunology. London Free Association.

Endogenous monoamine oxidase inhibitory activity and HPA activation in the pig
Clow, A., Vellucci, S.V., Parrott, R.F., Hucklebridge, F., Sen, S. and Evans, P. 1999. Endogenous monoamine oxidase inhibitory activity and HPA activation in the pig. Life Sciences. 66 (1), pp. 35-41. https://doi.org/10.1016/S0024-3205(99)00559-7

The awakening cortisol response and blood glucose levels
Hucklebridge, F., Clow, A., Abeyguneratne, T., Huezo-Diaz, P. and Evans, P. 1999. The awakening cortisol response and blood glucose levels. Life Sciences. 64 (11), pp. 931-937. https://doi.org/10.1016/S0024-3205(99)00019-3

The relationship between salivary secretory immunoglobulin A and cortisol: neuroendocrine response to awakening and the diurnal cycle
Hucklebridge, F., Clow, A. and Evans, P. 1998. The relationship between salivary secretory immunoglobulin A and cortisol: neuroendocrine response to awakening and the diurnal cycle. International Journal of Psychophysiology. 31 (1), pp. 69-76. https://doi.org/10.1016/S0167-8760(98)00042-7

Mind-body influences on immunity: lateralised control, stress, individual differences, and prophylaxis
Gruzelier, J., Clow, A., Evans, P., Lazar, I. and Walker, L. 1998. Mind-body influences on immunity: lateralised control, stress, individual differences, and prophylaxis. Annals of the New York Academy of Sciences. 851, pp. 487-494. https://doi.org/10.1111/j.1749-6632.1998.tb09027.x

The relationship between circadian patterns of salivary cortisol and endogenous inhibitor of monoamine oxidase A
Hucklebridge, F., Sen, S., Evans, P. and Clow, A. 1998. The relationship between circadian patterns of salivary cortisol and endogenous inhibitor of monoamine oxidase A. Life Sciences. 62 (25), pp. 2321-2328. https://doi.org/10.1016/S0024-3205(98)00213-6

Secretory immunoglobulin A and cardiovascular responses to mental arithmetic and cold pressor
Willemsen, G., Ring, C., Evans, P. and Clow, A. 1998. Secretory immunoglobulin A and cardiovascular responses to mental arithmetic and cold pressor. Psychophysiology. 35 (3), pp. 252-259. https://doi.org/10.1111/1469-8986.3530252

Regional and molecular separation of the four bioactivities of ‘tribulin’
Hucklebridge, F., Doyle, A., Pang, F.Y., Adlard, M., Evans, P. and Clow, A. 1998. Regional and molecular separation of the four bioactivities of ‘tribulin’. Neuroscience Letters. 240 (1), pp. 29-32. https://doi.org/10.1016/S0304-3940(97)00916-6

The role and regulation of monoamines in stress
Clow, A., Hucklebridge, F. and Evans, P. 1998. The role and regulation of monoamines in stress. in: Levi, A., Grauer, E., Ben-Nathan, D. and de Kloet, E.R. (ed.) New frontiers in stress research: modulation of brain function Amsterdam Harwood Academic. pp. 21-31

The cortisol response to psychological challenge is preceded by a rise in endogenous inhibitor of monoamine oxidase.
Clow, A., Patel, S., Najafi, M., Evans, P. and Hucklebridge, F. 1997. The cortisol response to psychological challenge is preceded by a rise in endogenous inhibitor of monoamine oxidase. Life Sciences. 61 (5), pp. 567-575. https://doi.org/10.1016/S0024-3205(97)00416-5

Endogenous monoamine oxidase A inhibitory activity (tribulin), measured in saliva, is related to cardiovascular reactivity in normal individuals
Clow, A., Doyle, A., Hucklebridge, F., Carroll, D., Ring, C., Shrimpton, J., Willemsen, G. and Evans, P. 1997. Endogenous monoamine oxidase A inhibitory activity (tribulin), measured in saliva, is related to cardiovascular reactivity in normal individuals. Journal of Neural Transmission (supplement). 52, pp. 77-83.

Modulation of secretory immunoglobulin A in saliva in relation to an acute episode of stress and arousal
Bristow, M., Hucklebridge, F., Clow, A. and Evans, P. 1997. Modulation of secretory immunoglobulin A in saliva in relation to an acute episode of stress and arousal. Journal of Psychophysiology. 11 (3), pp. 248-255.

Positive but not negative life events predict vulnerability to upper respiratory illness
Evans, P., Doyle, A., Hucklebridge, F. and Clow, A. 1996. Positive but not negative life events predict vulnerability to upper respiratory illness. British Journal of Health Psychology. 1 (4), pp. 339-348. https://doi.org/10.1111/j.2044-8287.1996.tb00514.x

Salivary monoamine oxidase A and B inhibitory activities correlate with stress
Doyle, A., Hucklebridge, F., Evans, P. and Clow, A. 1996. Salivary monoamine oxidase A and B inhibitory activities correlate with stress. Life Sciences. 59 (16), pp. 1357-1362. https://doi.org/10.1016/0024-3205(96)00461-4

Urinary output of endogenous monoamine oxidase inhibitory activity is related to everyday stress
Doyle, A., Hucklebridge, F., Evans, P. and Clow, A. 1996. Urinary output of endogenous monoamine oxidase inhibitory activity is related to everyday stress. Life Sciences. 58 (20), pp. 1723-1730. https://doi.org/10.1016/0024-3205(96)00153-1

Tribulin and stress in normal individuals
Doyle, A., Pang, F.Y., Hucklebridge, F., Evans, P. and Clow, A. 1996. Tribulin and stress in normal individuals. in: McCarty, R., Aguilera, G., Sabban, E. and Kvetnansky, R. (ed.) Stress: molecular genetic and neurobiological advances Amsterdam Harwood Academic.

Urinary cortisol and endogenous monoamine oxidase inhibitor(s), but not isatin, are raised in anticipation of stress and/or arousal in normal individuals
Doyle, A., Pang, F.Y., Bristow, M., Hucklebridge, F., Evans, P. and Clow, A. 1996. Urinary cortisol and endogenous monoamine oxidase inhibitor(s), but not isatin, are raised in anticipation of stress and/or arousal in normal individuals. Stress Medicine. 12 (1), pp. 43-49. https://doi.org/10.1002/(SICI)1099-1700(199601)12:1<43::AID-SMI677>3.0.CO;2-4

Secretory immunoglobulin A as convenient biomarker in health survey work
Evans, P., Hucklebridge, F., Clow, A. and Doyle, A. 1995. Secretory immunoglobulin A as convenient biomarker in health survey work. in: Rodriguez-Martin, J. (ed.) Health psychology and quality of life research: Proceedings of the 8th Annual Conference of the European Health Psychology Society Alicante University of Alicante.

Stress, arousal, Cortisol and secretory immunoglobulin A in students undergoing assessment
Evans, P., Bristow, M., Hucklebridge, F., Clow, A. and Pang, F.Y. 1994. Stress, arousal, Cortisol and secretory immunoglobulin A in students undergoing assessment. British Journal of Clinical Psychology. 33 (4), pp. 575-576. https://doi.org/10.1111/j.2044-8260.1994.tb01154.x

Dysphoria and immune status in postpartum women
Hucklebridge, F., Smith, M.D., Clow, A., Evans, P., Glover, V., Taylor, A., Adams, D. and Lydyard, P.M. 1994. Dysphoria and immune status in postpartum women. Biological Psychology. 37 (3), pp. 199-206. https://doi.org/10.1016/0301-0511(94)90002-7

The relationship between secretory immunity, mood and life-events
Evans, P., Bristow, M., Hucklebridge, F., Clow, A. and Walters, N. 1993. The relationship between secretory immunity, mood and life-events. British Journal of Clinical Psychology. 32 (2), pp. 227-236. https://doi.org/10.1111/j.2044-8260.1993.tb01050.x

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