0964 Anxiety and Poor Sleep Quality are associated with Cortisol in University Students during the COVID-19 pandemic

Abstract

Abstract Introduction Students experience a disproportionate amount of stress. The COVID-19 pandemic exacerbated and introduced stressors rarely encountered by students, including quarantining, and switching to remote learning. Psychological stress, mood, and sleep issues are known to have a negative effect on a variety of physiological biomarkers of stress, especially cortisol and a less studied marker, dehydration, (e.g., urine specific gravity levels (USG)). Methods This cross-sectional study examined associations between psychological and physiological markers of stress in university students during the latter part of the COVID-19 pandemic. Students completed online questionnaires on stress, depression, anxiety (DASS-21), and sleep quality (PSQI), followed by home collection of saliva (8 samples for 2 days) and urine (first catch). Three cortisol indices were evaluated: CAR, diurnal slope, and AUCg. Urine specific gravity was assessed as a marker of dehydration. Bivariate correlations assessed associations and independent t-tests were used to compare the 25th and 75th percentiles on cortisol indices and dehydration levels. Results A total of 43 female students (22.7 ± 6.9 years old) completed the study. Levels of depression (70.7%), anxiety (75.8%), stress (90.2%) fell in the normal range. Sleep quality was poor (9.4 ± 2.8), but TST = 7.74 ± 1.2 hours and SE = 88.1 ± 1.0%. About 20% had symptoms of insomnia. There was a significant difference in AUCg between the 25th and 75th percentile of anxiety (t = -1.90, p = .037; 154.26 ± 17.0 vs 228.12 ± 35.0, ug/dL) indicating those with highest levels of anxiety had higher overall diurnal cortisol than those with lowest levels. Sleep quality was also significantly associated with AUCg. Those with poor sleep (PSQI > 5) had higher cortisol levels than those with good sleep (t = -2.17, p = .019; 236.4 ± 21.2 vs 120.1 ± 10.6 ug/dL). There were no significant associations between the psychological measures and USG levels. Conclusion Findings suggest that while stress, depression, and anxiety levels may have leveled off 1 ½ years into the pandemic, those with residual high anxiety and poor sleep quality may continue to be at risk for poor health due to high levels of cortisol. Support (if any)