title: Daily salivary cortisol patterns in midlife women with hot flashes.
abstract: OBJECTIVE
  Diurnal salivary cortisol patterns in healthy adults are well established but have not been studied in midlife women with hot flashes. We hypothesized that frequent hot flashes are associated with aberrant cortisol patterns similar to sleep-deficient individuals.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  A total of 306 women, ages 40-62, randomized to a behavioural intervention for hot flashes.
  
  
  METHODS
  Baseline comparisons of cortisol geometric means (nmol/l) from four daily time points averaged over two consecutive days plus other calculated cortisol measures were made between groups defined by baseline: (i) mean daily hot flash frequency tertile (≤5·5, N = 103; >5·5-8·8, N = 103; >8·8, N = 100) and (ii) selected characteristics. Repeated-measures linear regression models of log-transformed cortisol evaluated group differences, adjusting for covariates.
  
  
  RESULTS
  Women were 67% White and 24% African American, with 7·6 (SD 3·9) hot flashes per day. Salivary cortisol geometric means (nmol/l) among all women were as follows: 75·0 (SD 44·8) total, 8·6 (SD 5·6) wake, 10·0 (SD 7·5) wake +30 min, 3·7 (SD 3·3) early afternoon and 1·6 (SD 1·8) bedtime. Wake + 30-minute values showed an 18% median rise from wake values (interquartile range -24 to 96%), and means varied by hot flash frequency tertile, from lowest to highest: 11·4(SD 7·3), 10·3 (SD 6·5) and 8·6 (SD 7·8), respectively, P = 0·003. Beside the early afternoon value (P = 0·02), cortisol values did not vary by hot flash frequency.
  
  
  CONCLUSIONS
  Taken together, these findings suggest that high frequency of moderate-to-severe hot flashes may be associated with subtle abnormalities in cortisol concentrations - a pattern consistent with chronic sleep disturbance.
authors.affiliation: Departments of Obstetrics and Gynecology and Epidemiology, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: S D
authors.initials: SD
authors.lastname: Reed
authors.affiliation: Group Health Research Institute, Seattle, WA, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Newton
authors.affiliation: Data Coordinating Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Larson
authors.affiliation: School of Nursing, University of Washington, Seattle, WA, USA.
authors.forename: C
authors.initials: C
authors.lastname: Booth-LaForce
authors.affiliation: School of Nursing, University of Washington, Seattle, WA, USA.
authors.forename: N F
authors.initials: NF
authors.lastname: Woods
authors.affiliation: School of Nursing, University of Washington, Seattle, WA, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Landis
authors.affiliation: Laboratory Testing Services University of Washington Seattle WA.
authors.forename: E
authors.initials: E
authors.lastname: Tolentino
authors.affiliation: School of Nursing, Indiana University, Indianapolis, IN, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Carpenter
authors.affiliation: Departments of Obstetrics and Gynecology and Psychiatry, Perelman School of Medicine, Philadelphia, PA, USA.
authors.forename: E W
authors.initials: EW
authors.lastname: Freeman
authors.affiliation: Department of Psychiatry, Brigham and Women's Hospital and Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
authors.forename: H
authors.initials: H
authors.lastname: Joffe
authors.affiliation: Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: B D
authors.initials: BD
authors.lastname: Anawalt
authors.affiliation: Data Coordinating Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Guthrie
mesh_terms: D000328:Adult; D002940:Circadian Rhythm; D003430:Cross-Sectional Studies; D015444:Exercise / Q000502:physiology*; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use*; D005260:Female; D019584:Hot Flashes / Q000378:metabolism / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis*; D016014:Linear Models; D016015:Logistic Models; D008593:Menopause / Q000502:physiology; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D012463:Saliva / Q000737:chemistry*
chemical_list: D015525:Fatty Acids, Omega-3; D006854:Hydrocortisone