Morning Salivary Cortisol Levels Research Articles

Sleep bruxism and perceived stress: assessment using salivary cortisol levels, a biomarker of stress

Sleep bruxism (SB) corresponds to physiologically based manducatory muscle reactions, with no identifiable neuropathic cause, in relation to anxiety disorders, respiratory disorders or behavioral "tocs". The aim of this study was to assess the relationship between SB and perceived stress by measuring salivary cortisol levels. The study included 61 consenting adult participants: 31 for the study group (bruxers) and 30 for the control group (no bruxers). The diagnosis of BS was made using a standard bruxism assessment questionnaire defined by the American Academy of Sleep Medicine (AASM). The preliminary diagnosis was confirmed by clinical assessment according to AASM criteria. The BRUXi index, a tool proposed by Orthlieb, was used to determine the intensity of bruxism. Perceived stress was measured using the Perceived Stress Scale questionnaire. Unstimulated whole saliva was collected and morning salivary cortisol levels were determined by ELISA. Non-parametric statistical methods were used to analyze the data. The bruxers (study group) had significantly high levels of mean salivary cortisol (12.3±4.2 ng/mL or 34.5±14.6 nmol/L) than the non-bruxers (control group) (5.3±1.2 ng/mL or 14.5±4.6 nmol/L) (p<0.001). The elevated salivary cortisol level was positively associated with perceived stress and SB (p<0.0001) in the study group. These results suggest that bruxing activity is associated with higher levels of perceived psychological stress and salivary cortisol. Despite the absence of polysomnographic recording for the diagnosis of SB, a positive correlation between SB and salivary cortisol levels was observed in bruxers.

Mekanik ventilasyon modlarının prematüre bebeklerin tükürük kortizol düzeylerine etkisi

Purpose: The aim of this study was to examine the relationship between mechanical ventilation modes and stress levels by measuring salivary cortisol levels in preterm infants.
 Materials and Methods: The study group comprised 65 preterm infants on respiratory support and 43 control preterm infants. The Neonatal Infant Pain Scale (NIPS) was used to evaluate pain. To determine the stress level, salivary cortisol levels were studied in saliva samples taken in the morning and evening on the 4th postnatal day.
 Results: In the study group, morning and evening cortisol levels of the infants were measured 8.33±5.7 ng/ml and 8.05±5.6 ng/ml, respectively. In the control group, morning and evening cortisol values of the infants were measured 1.50±0.7 ng/ml and 1.48±0.7 ng/ml, respectively. The morning and evening salivary cortisol levels of the infants in the study group were significantly higher than those of the infants in the control group. In the invasive mechanical ventilation group infants, morning and evening cortisol levels of the infants were measured 12.46±5,3 ng/ml and 12.0±5,2 ng/ml, respectively. In the non-invasive mechanical ventilation group, morning and evening cortisol values were measured 4.57±2.7 ng/ml and 4.41±2.7 ng/ml, respectively. Both morning and evening salivary cortisol levels of infants on invasive mechanical ventilation were higher than those of infants on non-invasive mechanical ventilation. 
 Conclusion: Increased salivary cortisol levels in invasive modes indicate that intubation causes pain and stress in newborns.

Effects of Auricular Acupressure Therapy on Psychological Factors, Sleep Quality, and Salivary Cortisol Levels in South Korean Older Adults in the Community: A Single-blind, Randomized Controlled Trial

Purpose: This study aimed to investigate the effects of auricular acupressure (AA) therapy on psychological factors, sleep quality, and salivary cortisol levels in community-dwelling older adults. Methods: This was a single-blind, randomized, placebo-controlled comparative pretest-posttest study that applied AA for three weeks. The experimental group received AA on the shenmen, sympathetic, subcortical, and adrenal areas, while the control group received acupuncture in four areas along the helix. Nineteen participants were assigned to the experimental group and 21 to the control group. All participants were community-dwelling seniors aged 65 years or older who had an Insomnia Severity Index score of 8 or higher and experienced psychological stress. Depression, anxiety, and stress were measured using the Korean version of the Depression Anxiety Stress Scale for psychological factors, and the Korean version of the Pittsburgh Sleep Quality Index and morning salivary cortisol levels were measured to evaluate sleep quality. Results: Statistically significant differences were observed between the groups for depression (t=5.56, <i>p</i><.001), anxiety (t=3.53, <i>p</i>=.001), and stress (t=3.55, <i>p</i>=.001). The PSQI (t=4.72, <i>p</i><.001) and salivary cortisol levels (z=-4.21, <i>p</i><.001) showed statistically significant differences between the groups. Conclusion: AA demonstrated its effectiveness as an intervention for addressing complex symptoms in community-dwelling older adults. It was found to alleviate depression, anxiety, and stress, enhance sleep quality, and reduce salivary cortisol levels.

Salivary cortisol awakening levels are reduced in human subjects with intermittent explosive disorder compared with controls

BackgroundThe role of the hypothalamic-pituitary-adrenal (HPA) axis in human aggressive behavior is poorly characterized, though some studies report that, unlike depression, circulating or salivary levels of cortisol are low compared with controls. MethodsIn this study, we collected three salivary cortisol levels (two in the morning and one in the evening) on three separate days in 78 adult study participants with (n = 28) and without (n = 52) prominent histories of impulsive aggressive behavior. Plasma C-Reactive Protein (CRP) and Interleukin-6 (IL-6) were also collected in most study participants. Aggressive study participants meet DSM-5 criteria for Intermittent Explosive Disorder (IED) while non-aggressive participants either had a history of a psychiatric disorder or no such history (Controls). ResultsMorning, but not evening, salivary cortisol levels were significantly lower in IED (p < 0.05), compared with control, study participants. In addition, salivary cortisol levels correlated with measures of trait anger (partial r = −0.26, p < 0.05) and aggression (partial r = −0.25, p < 0.05) but not with measures of impulsivity, psychopathy, depression, history of childhood maltreatment, or other tested variables that often differ in individuals with IED. Finally, plasma CRP levels correlated inversely with morning salivary cortisol levels (partial r = −0.28, p < 0.05); plasma IL-6 levels showed a similar, though not statistically significant (rp = −0.20, p = 0.12) relationship with morning salivary cortisol levels. ConclusionThe cortisol awakening response appears to be lower in individuals with IED compared with controls. In all study participants, morning salivary cortisol levels correlated inversely with trait anger, trait aggression, and plasma CRP, a marker of systemic inflammation. This suggests the present of a complex interaction between chronic-low level inflammation, the HPA axis, and IED that warrants further investigation.

Potential role of salivary cortisol levels to reflect stress response in children undergoing congenital heart surgery.

This study aimed to provide baseline information on the potential role of salivary cortisol in reflecting the stress response in children undergoing congenital heart surgery. Children underwent congenital cardiac surgery, aged between one and seventeen years were included. Saliva samples were collected pre- and postoperatively by the health caregiver immediately after the children woke up (07:00-09:00 am) and at 06:00 pm in the evening. Salivary cortisol levels were compared with the reference index values from a large database. Median baseline preoperative morning salivary cortisol levels were significantly lower than the reference values in both < 5-year-old females (p = 0.01) and males (p = 0.04) and in males between 11 and 20 years of age (p = 0.01). Median baseline preoperative evening salivary cortisol levels were significantly higher than the reference value in < 5-year-old females (p = 0.01) and between 5 and 10 years of age (p = 0.04) and in between 11- and20-year-old males (p = 0.01). Median postoperative morning salivary cortisol levels were significantly lower than the reference value in both < 5-year-old females (p = 0.01) and males (p = 0.04) and females between 5 and 10 year of age (p = 0.04). Median postoperative evening salivary cortisol levels were significantly higher than the reference value in < 5-year-old females (p = 0.01) and between 5- and 10-year-old females (p = 0.04). Diurnal variability of salivary cortisol levels in children undergoing congenital heart surgery may be different from normal reference values both in preoperative and postoperative periods that can be a predictive indicator of anxiety on pre- and postoperative period for children that undergoing cardiac surgery.

Evaluating the Interrelationship Between Salivary Cortisol and Glycemia in Type 2 Diabetics

Introduction: Diabetes mellitus is a multifactorial metabolic condition marked by high blood sugar levels as well as problems with carbohydrate, lipid, and protein metabolism. Impaired insulin secretion and hepatic gluconeogenesis cause high blood sugar levels. Cortisol in the saliva is the unbound, free hormone, with absolute quantities between 30% and 50% fewer than in blood. The aim of the study was to evaluate the levels of salivary cortisol in normal healthy controls and type 2 diabetics. The objective was to evaluate the morning and evening levels of salivary cortisol in normal and type 2 diabetics by enzyme-linked immunosorbent assay (ELISA). Materials and Methods: 20 patients in the age group of 30 to 60 years with type 2 diabetes with HbA1c <6.5% were included in Group I. Twenty participants in the age group of 30 to 60 years were included in Group II. Salivary samples were collected and centrifuged at –4°C at 3500 rpm and ELISA was performed. Data were analyzed using Statistical Package for the Social Sciences version software version 16. Paired sample t test was used. Results: The mean morning salivary cortisol level of diabetic patients (Group I) was 1.62 mmol/dL and the evening was 1.34 mmol/dL. The difference was statistically significant (P = 0.00001). The mean salivary cortisol level of healthy subjects in the morning was 0.47 mmol/dL and evening was 0.29 mmol/dL, which is statistically significant (P = 0.00001). Conclusion: From this study, we can conclude that the salivary cortisol level is increased in patients with type 2 diabetes when compared to healthy individuals. There are no obvious changes in morning and evening salivary cortisol levels of diabetes patients.

Benefits of a Mindfulness-Based Intervention upon School Entry: A Pilot Study.

Background: mindfulness meditation is effective at fostering the executive functioning of children, i.e., the skills that play important roles in academic performance and social–emotional wellbeing. One possible mechanism for such an effect might be that meditation practices can decrease stress, especially if someone is at a risk for elevated cortisol levels, for instance, due to a stressful life event, such as starting school. Participants and methods: the present pilot study tested the effects of a six-session mindfulness intervention applied right after school entry compared to a passive control group. In total 61 first graders participated (Mage = 84.95 months, SD = 5.21) in this study from four classes of a primary school in Budapest. Repeated-measures ANOVA were performed to explore the effects on executive functioning skills and cortisol levels. Results: no effect was found on morning salivary cortisol levels, but the working memory capacities of girls significantly improved as a result of the intervention. Conclusions: a relatively short, story-based mindfulness intervention can improve the working memory capacities of first-graders; thus, it could potentially contribute to the academic performance and adaptation of children in schools.

Morning and evening salivary cortisol levels in patients with chronic widespread pain and those at high risk.

Hypothalamic-Pituitary-Adrenal (HPA) axis dysregulation has been implicated in chronic widespread pain (CWP); the hallmark of fibromyalgia (FM). This is the first study to compare HPA axis changes in individuals with CWP and those at high risk of symptom development. We sought to determine differences in morning and evening salivary cortisol levels in FM (n=19), those at-risk (n=20) and pain-free controls (n=17). Risk factors included non-CWP pain, somatic symptoms, illness behaviour and sleep disturbance. We conducted the study in the absence of centrally acting medication, to address limitations of previous research. Repeated measures ANOVA revealed significant main effects of group (p=0.003), and time of day (p=0.002), with no significant interaction. Cortisol levels were higher in FM (p=0.027) and at-risk (p=0.003) groups, compared to controls, but there was no significant difference between FM and at-risk groups. The main effect of group remained significant with sleep problems (p=0.021) and life events (p=0.007), but was not significant with anxiety (p=0.076) or depression (p=0.098) scores as covariates. With sleep problems as a covariate, cortisol levels remained significantly higher only in the at-risk group (p=0.017). This study indicates elevated salivary cortisol in FM and those at high risk, and identifies anxiety, depression and sleep problems as potential contributing factors. The results shed light on the dynamic relationship between stress, mood and sleep disorders and the brain's resilience to pain. This study examines neurobiological changes in chronic widespread pain and high risk individuals. One strength of the study is the absence of centrally acting medication. We found high salivary cortisol common to Fibromyalgia and those at risk and identified contributing factors. Our results offer insight into the early mechanistic changes underlying Fibromyalgia development and open up possibilities for early diagnosis and prevention.

To evaluate the serum cortisol, salivary cortisol, and serum interleukin-1 B level in patients of chronic periodontitis with smoking and stress and without smoking and stress.

The role of cognitive, social and biological factors in the etiology of chronic periodontitis has been reported.The aim of this study was to evaluate the salivary cortisol level and interleukin-1 B level in patients of Chronic periodontitis in smokers and stress and nonsmokers without stress.The design of study randomized, prospective, double-blinded, and prospective study.The total sample size was comprised of 600 subjects between the ages of 20 and 50 years. The sample size was divided into 300 males and 300 females. Out of 600 subjects, 200 subjects comprised of subjects with chronic periodontitis with positive depression level with a history of smoking (Group I), 200 subjects comprised of subjects with chronic periodontitis without depression and without smoking (Group II), and 200 subjects who were taken as the control group comprised of healthy subjects without chronic periodontitis, without depression level, and no smoking history (Group III). Salivary cortisol levels were determined by enzyme-linked immunosorbent assay (ELISA).The result showed that there was a positive correlation between morning and evening salivary cortisol level in all the groups with correlation coefficient. There was significant higher value of salivary cortisol in Group I patients when compared with Group II and Group III. However, when the comparison of salivary cortisol levels was done between the Group II and Control group, the result showed nonsignificant P value.It is suggested that stress is positively correlated with the salivary cortisol levels in smokers and nonsmokers.

Effects of Lactococcus lactis subsp. cremoris YRC3780 daily intake on the HPA axis response to acute psychological stress in healthy Japanese men

BackgroundLactococcus lactis subsp. cremoris (YRC3780), which is isolated from kefir, has been associated with anti-allergic effects in humans. However, it remains unknown whether daily intake of YRC3780 attenuates the response to psychological stress in humans in parallel with changes to the gut microbiome. We examined the fundamental role of YRC3780 in the gut microbiome, stress response, sleep, and mental health in humans.MethodsEffects of daily intake of YRC3780 on the hypothalamic-pituitary-adrenal (HPA) axis response to acute psychological stress were investigated in a double-blind, placebo-controlled clinical trial involving 27 healthy young men (mean age and body mass index: 23.5 years and 21.5 kg/m2) who were randomly assigned to placebo (n = 13) or YRC3780 (n = 14) groups. The HPA axis response to acute psychological stress, the diurnal rhythm of HPA axis activity, and gut microbiome were assessed and compared between the two groups.ResultsThe results showed that daily intake of YRC3780 significantly lowered morning salivary cortisol levels compared with placebo. In addition, salivary cortisol levels following a social stress test significantly decreased +40 min after beginning the TSST in the YRC3780-treated group compared to placebo. There were no significant differences between the two groups in terms of actigraphy-based sleep quality, but the subjective sleep quality and mental health were significantly improved in the YRC3780-treated group compared to placebo.ConclusionsOur study suggests that daily intake of YRC3780 improves the HPA axis response to acute psychological stress, which might be associated with a decrease in morning cortisol levels.

Loss of nocturnal dipping pattern of skin sympathetic nerve activity during and following an extended-duration work shift in residents in training

BackgroundExtended-duration work shifts (EDWSs) might affect the health of physician residents, causing autonomic alteration. Skin sympathetic nerve activity (SKNA) recorded by noninvasive neuro-electrocardiography (neuECG) is used to estimate cardiac sympathetic tone. In this study, we aim to evaluate the impact of EDWSs on nocturnal SKNA assessed in resident doctors. MethodsTwenty-four residents working EDWSs and 12 PhD students not working nightshift schedules were prospectively recruited. The neuECG was performed between 12 am and 6 am for 5 consecutive nights. SKNA was filtered from neuECG recorded signals. The questionnaires regarding work stress and sleep quality, blood pressure, and salivary alpha-amylase and cortisol levels were administered. ResultsThe hours of weekly working and sleep opportunities were similar between residents and students, while residents reported more work stress and worse sleep quality. In residents, SKNA at 6 am (SKNA6am) was significantly higher than SKNA2am during the precall night, revealing a dipping pattern. However, the SKNA dipping disappeared during the on-call night and prominently flattened during the first postcall night, the full recovery of which was delayed until the second postcall nights. The morning blood pressure and salivary alpha-amylase and cortisol levels were similar between the precall and postcall days. In contrast, SKNA in students exhibited a constant dipping profile for all recorded nights. ConclusionsIn healthy young adults, SKNA presents a dip night. The SKNA dip is impaired by working a nightshift, with a delayed recovery. The neuECG might serve as a useful tool to detect subclinical autonomic disturbances in shiftworkers.

Long-term cortisol levels in hair of children and adolescents with Prader-Willi Syndrome

ContextPrader-Willi syndrome (PWS) is characterized by hypothalamic dysfunction. In children with PWS, stress-induced central adrenal insufficiency (CAI) has been described, however, daily life cortisol production may be normal. Hair cortisol concentration (HCC) is a marker of long-term systemic cortisol production. Cortisol awakening response (CAR) is the increase in cortisol level after awakening. A negative CAR might suggest hypothalamic-pituitary-adrenal (HPA)-axis reactivity problems. Little is known about HCC and CAR in children with PWS. ObjectiveTo investigate long-term cortisol levels in hair and CAR in children with PWS. DesignCross-sectional study. Patients41 children with PWS. SettingDutch PWS Reference Center. Main outcome measuresHCC and salivary cortisol measured by LCMS. ResultsMedian (IQR) HCC was 1.90 (1.02–3.30) pg/mg at a median (IQR) age of 14.5 (8.20–19.0) years, with median HCC in age-matched references being 2.63 pg/mg. Five patients (13.2%) had HCC < 2.5th percentile for age and these patients had a repeatedly negative CAR. Median HCC was significantly lower in patients with negative CAR than in patients with normal CAR (1.00 (0.22–1.59) vs. 2.25 (1.47–3.26) pg/mg, p = 0.007). One patient had both HCC < 2.5th percentile and repeatedly low morning salivary cortisol levels and negative CAR, and was diagnosed with adrenal insufficiency by overnight metyrapone test. ConclusionsHCC were normal in the majority of children with PWS. Our data suggest that children with HCC < 2.5th percentile and (repeatedly) negative CAR might possibly have adrenal insufficiency or delayed HPA-axis responsiveness.

Associations between baseline cortisol and trajectory of symptom improvement in depressed adolescents receiving psychological therapy

BackgroundCortisol hypersecretion in depressed adolescents and adults is associated with more persistent illness and may signal a lower response to psychological therapies. A meta-analysis of small and heterogenous studies demonstrated that higher pre-treatment basal cortisol levels were associated with poorer response specifically to psychological therapy for depression. The objective of this study was to investigate the relationship between both morning and evening salivary cortisol levels and response to psychological therapy in depressed adolescents participating in one large randomised controlled trial. MethodsWe tested the association between morning and evening salivary cortisol levels at baseline and improvement in depressive symptoms in response to psychological therapies in depressed adolescents at 6 time points: baseline, 6, 12, 36, 52- and 86-weeks post-randomisation, using the self-reported Mood and Feelings Questionnaire (MFQ). ResultsHigh evening cortisol was associated with a slower initial decline in depressive symptoms (cortisol x quadratic time p = .022); however it was not associated with total change in depressive symtoms over the whole course of the study. Morning cortisol was not associated with change in depressive symptoms. These effects were not significantly different across the three psychological therapies. LimitationsResults may not generalize to adolescents receiving other treatments (medication) or no treatment, and may not generalize to adults. Only a minority of eligible participants collected valid cortisol samples. ConclusionsHigher pretreatment evening cortisol may impair a depressed adolescent's ability to use psychological therapy.

Cortisol circadian rhythm and jet-lag syndrome: evaluation of salivary cortisol rhythm in a group of eastward travelers

PurposeThe activity of the hypothalamus–pituitary–adrenal axis plays a crucial role as an endogenous stress-reactive system. Lifestyle and work often interfere with the endogenous circadian rhythms and can modify the physiological patterns of stress-hormones secretion, including cortisol. We evaluated the cortisol circadian rhythm in the “jet-lag syndrome” that is the most known condition associated with the desynchronization of the circadian rhythm.MethodsTo assess the modifications of cortisol secretion after a long-haul flight, we compared baseline and post-travel salivary cortisol rhythm in a group of 28 healthy eastward travelers (from the U.S.A. or Canada to Italy). The salivary samples were collected about 1 week before the departure at 11 p.m. on day 0 and at 8 a.m., 12 a.m. (midday) and 11 p.m. on day 1 (R0). The same samples were obtained after the landing, the day they flew back home (R1).ResultsStatistical analysis showed a significant difference between R0 and R1 for each sample considered (p < 0.005). In particular, the post-travel salivary cortisol levels detected at 11 p.m. both on day 0 and on day 1, were significantly higher than at baseline. Post-travel morning salivary cortisol levels were lower compared with basal rhythm and increased during the morning, reaching the acrophase at 12 a.m.ConclusionsIn eastward travelers, crossing more than five time zones, the cortisol circadian rhythm after the return to the East “remained behind,” being synchronized with the West time. This impaired cortisol secretion can contribute to the pathogenesis of the jet-lag syndrome.

Determination of reference values for salivary cortisol in healthy infants aged 0-12 months.

Salivary cortisol is a useful tool as a biomarker of stress in pediatrics because it allows for non-invasive sampling. There is little information about its use in children, and no reference values for healthy infants have been reported in Argentina. Reference values should be established at each site as the basis for subsequent tests in infants, for whom salivary cortisol appears to be the most relevant objective tool to assess stress at present. To determine reference values for salivary cortisol in healthy infants aged 0-12 months. Descriptive, cross-sectional study that assessed morning salivary cortisol levels in healthy male and female infants aged 0-12 months that attended Hospital Pirovano for a health checkup between March 2017 and March 2018. Fasting saliva samples were collected between 8 and 9 a.m. and were processed using electrochemiluminescence. Results were reported as mean and standard deviation. A total of 140 infants were included, and 96 samples were collected. Mean morning salivary cortisol levels were 5.46 nmol/L (95 % confidence interval: 4.66-6.38), standard deviation: 2.15. No correlation to age was observed, so it was not necessary to divide the reference range into age groups. No significant differences were observed in terms of sex, gestational age, birth weight, type of delivery or type of feeding. The reference range of morning salivary cortisol levels in healthy infants aged 0-12 months was reported.

Virus, allergic sensitisation and cortisol in infant bronchiolitis and risk of early asthma.

BackgroundAcute bronchiolitis during infancy and human rhinovirus (HRV) lower respiratory tract infections increases the risk of asthma in atopic children. We aimed to explore whether specific viruses, allergic sensitisation or cortisol levels during acute bronchiolitis in infancy increase the risk of early asthma, using recurrent wheeze as a proxy.MethodsIn 294 children with a mean (range) age of 4.2 (0–12) months enrolled during hospitalisation for acute infant bronchiolitis, we analysed virus in nasopharyngeal aspirates, serum specific immunoglobulin E against food and inhalant allergens, and salivary morning cortisol. These factors were assessed by regression analyses, adjusted for age, sex and parental atopy, for risk of recurrent wheeze, defined as a minimum of three parentally reported episodes of wheeze at the 2-year follow-up investigation.ResultsAt 2 years, children with, compared to without, recurrent wheeze had similar rates of respiratory syncytial virus (RSV) (82.9% versus 81.8%) and HRV (34.9% versus 35.0%) at the acute bronchiolitis, respectively. During infancy, 6.9% of children with and 9.2% of children without recurrent wheeze at 2 years were sensitised to at least one allergen (p=0.5). Neither recurrent wheeze nor incidence rate ratios for the number of wheeze episodes at 2 years were significantly associated with specific viruses, high viral load of RSV or HRV, allergic sensitisation, or morning salivary cortisol level during acute bronchiolitis in infancy.ConclusionIn children hospitalised with acute infant bronchiolitis, specific viruses, viral load, allergic sensitisation and salivary morning cortisol did not increase the risk of early asthma by 2 years of age.

Salivary cortisol could be a promising tool in the diagnosis of temporomandibular disorders associated with psychological factors

Background: Biopsychosocial models emphasize the multifactorial nature of temporomandibular disorders (TMDs). The role of cognitive, social, and biological factors in the etiology of TMDs has been reported. Aim: To test the salivary cortisol levels in young adults with the temporomandibular joint disorder and having positive depression level and with TMD but with negative depression level and compared with the control group. The correlation between cortisol levels and depression levels according to axis-II of Research Diagnostic Criteria (RDC) was assessed. Settings and Design: The study was a randomized, prospective, and double-blinded study. Materials and Method: The total sample comprised 60 subjects. The study comprised 20 subjects with TMD and depression, 20 subjects with TMDs and without depression, and 20 subjects were taken as the control group. To measure these variables, research diagnostic criteria (RDC/TMJ) were used for the study. Salivary cortisol levels were determined by Enzyme-linked immunosorbent assay (ELISA). Statistical Analysis: A paired t-test, ANOVA, and linear multi regression tests applied to compare the TMD groups with the control group. Results: The results showed that there was a positive correlation between morning and evening salivary cortisol levels in all the groups and the correlation coefficient was 0.729. There was a significantly higher value of salivary cortisol in TMD patients with depression than TMD patients without depression and the control group. Conclusion: Salivary cortisol could be a promising tool in identifying underlying psychological factors that could be associated with TMD.

Increased cortisol levels are associated with low treatment retention in crack cocaine users

BackgroundDysregulation of the hypothalamic–pituitaryadrenal (HPA) axis has been associated with craving and early relapse among individuals with substance use disorders. However, no association has been postulated regarding treatment retention and prognosis in crack cocaine users. ObjectiveOur aim was to investigate the association between morning salivary cortisol levels and treatment retention in crack cocaine users. Methods44 male crack cocaine users were recruited from a detoxification unit. Saliva collection was performed in the morning of the second treatment day. Substance use profile was assessed using the Addiction Severity Index. ResultsThe median length of stay in inpatient treatment was 7 days (IQR 3–16). Treatment retention was associated with cortisol levels (r = −0.324; p = 0.032), especially in the group with positive family history. Moreover, treatment retention was correlated with age (r = 0.333, p = 0.027), and number of days of tobacco use (r = 0.332, p = 0.028) and crack use (r = 0.327, p = 0.031). A Cox regression model was performed and showed that inpatients with above normal cortisol levels (≥0.69 µg/dL) presented a worse prognostic related to treatment retention (HR = 2.39, CI95% 1.1–5.1, p = 0.024). ConclusionSeveral factors could contribute to increased cortisol levels in these patients, e.g. craving, dysregulation of the HPA axis, chronic drug use, stress due to confinement, and substance abstinence. Nevertheless, our findings could guide further studies about new biomarkers in crack cocaine use disorder, since HPA axis dysregulation at the time of treatment admittance may be a prognostic marker for treatment retention.

Oral Microbiota Development in Early Childhood

Early life determinants of the oral microbiota have not been thoroughly elucidated. We studied the association of birth and early childhood characteristics with oral microbiota composition using 16 S ribosomal RNA (rRNA) gene sequencing in a population-based Swedish cohort of 59 children sampled at 6, 12 and 24 months of age. Repeated-measurement regression models adjusted for potential confounders confirmed and expanded previous knowledge about the profound shift of oral microbiota composition in early life. These alterations included increased alpha diversity, decreased beta diversity and alteration of bacterial composition with changes in relative abundance of 14 of the 20 most common operational taxonomic units (OTUs). We also found that birth characteristics, breastfeeding and antibiotic use were associated with overall phyla distribution and/or with the relative abundance of specific OTUs. Further, we detected a novel link between morning salivary cortisol level, a physiological marker of neuroendocrine activity and stress, and overall phyla distribution as well as with decreased abundance of the most common OTU mapped to the Streptococcaceae family. In conclusion, a major part of the maturation of the oral microbiome occurs during the first two years of life, and this development may be influenced by early life circumstances.

Salivary cortisol levels as a biomarker for severity of withdrawal in opioid-exposed newborns.

Scoring tools used to quantify withdrawal in infants with neonatal abstinence syndrome (NAS) are often confounded by subjective measurements. This study assessed salivary cortisol as an objective biomarker of withdrawal severity in opioid-exposed newborns. A prospective study was conducted in 25 full-term opioid-exposed newborns monitored for NAS. Morning and evening salivary cortisol levels were collected starting within 48 h post birth until initiation of pharmacologic treatment for withdrawal (Pre-Treatment) or when the infant was discharged without pharmacotherapy (No Treatment). Cortisol levels in the Pre-Treatment group (n = 11) were significantly higher within the first week of life (median 1.74 µg/dl) than in the No Treatment group (n = 11; median 0.72 µg/dl; P = 0.003); three infants had inadequate saliva volume for cortisol assay. Cortisol significantly decreased after 72 h post birth among infants discharged without pharmacotherapy (≤72 h median 1.25 µg/dl; ≥72 h median 0.58 µg/dl; P = 0.022), whereas cortisol remained elevated for infants subsequently treated for severity of withdrawal. No cortisol circadian rhythm was observed for either group. Salivary cortisol in opioid-exposed newborns may provide an index of stress and help identify infants who will have more severe clinical presentation of NAS. Such a biomarker would allow risk stratification for early treatment and discharge decisions.