title: What constitutes too long of a delay? Determining the cortisol awakening response (CAR) using self-report and PSG-assessed wake time.
abstract: The cortisol awakening response (CAR) is a burst of cortisol in response to awakening from sleep that is superimposed on the circadian rhythm of cortisol. Determination of the CAR is contingent on the timing of sample collection: a delay between waking and collection of the first sample may affect the rise of the CAR, and could explain equivocal findings reported in the literature. We evaluated the impact of a delay between wake time and collection of waking cortisol samples on the CAR. Two methods were used to identify wake time: polysomnography (PSG) and self-report (S-R). Participants (total n=207, mean age 74.0+/-7.2 years) included bereaved older adults (n=35), caregivers (n=50), patients with insomnia and co-morbid medical disorders (n=68), and the healthy older adults (n=54). We used ANOVA to test if a delay >15 min affected the CAR. We also fitted cubic spline models to assess expected cortisol levels, the expected CAR, and the expected decrease in CAR. Wake times measured by PSG and S-R did not differ significantly. Large delays were observed (for both PSG and S-R) between wake time and collection of the waking cortisol sample (24.8+/-32.2 min for PSG and 28.3+/-49.2 min for S-R). Both statistical methods indicated that a delay >15 min between wake time and first cortisol sample collection significantly affected the CAR (p's<.005); later collection times were associated with smaller CAR values. Later collection times and reduced CAR values may affect the interpretation of clinical associations. Our data also show that S-R assessments of wake time perform equally well to PSG for evaluating adherence with CAR sampling procedures.
authors.affiliation: University of Pittsburgh School of Medicine, Department of Psychiatry, United States. okunml@upmc.edu
authors.forename: Michele L
authors.initials: ML
authors.lastname: Okun
authors.forename: Robert T
authors.initials: RT
authors.lastname: Krafty
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Buysse
authors.forename: Timothy H
authors.initials: TH
authors.lastname: Monk
authors.forename: Charles F
authors.initials: CF
authors.lastname: Reynolds
authors.forename: Amy
authors.initials: A
authors.lastname: Begley
authors.forename: Martica
authors.initials: M
authors.lastname: Hall
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001143:Arousal / Q000502:physiology*; D002940:Circadian Rhythm / Q000502:physiology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis* / Q000378:metabolism; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D017286:Polysomnography; D015203:Reproducibility of Results; D012463:Saliva / Q000737:chemistry / Q000378:metabolism; D012648:Self Care; D012890:Sleep / Q000502:physiology; D013048:Specimen Handling / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors
chemical_list: D006854:Hydrocortisone