Cited by 542Stress Responses and CortisolAdrenal Hormones and DisordersCircadian rhythm and melatonin

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Several daily measurements are necessary to reliably assess the cortisol rise after awakening: State-and trait components

Hellhammer, J., Fries, E., Schweisthal, O.W., Schlotz, W., Stone, A.A., Hagemann, D.·2007·Psychoneuroendocrinology

DOI 10.1016/j.psyneuen.2006.10.005

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Abstract

The cortisol rise after awakening (CAR) is a frequently applied measure of pituitary-adrenal activity. This measure seems to reflect the acrophase of the diurnal cycle and can easily be assessed in saliva samples, collected by the proband or patient under real life conditions. Since different state and trait factors affect the CAR, we here address the questions (a) to which extent state and trait factors affect the CAR, and (b) how often cortisol measures after awakening have to be taken to obtain reliable results. In this study, we assessed the CAR on 6 consecutive days. After applying structural equation models and correlation analyses, we conclude that (a) the CAR of a single day is determined to a great extent by situational factors and only for a small proportion by trait factors and (b) from two (AUC(t)) to six (AUC(i)) days are necessary to achieve reliable trait measures, since state factors bias data from a single day.

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“As is true for other diurnal cortisol parameters (Segerstrom et al., 2014), the amount of variance in the CAR that generalizes beyond the day on which it was collected is small (36-60% for AUC [baseline, 30, 45, and 60 minutes]; 15-37% for increase; Hellhammer et al., 2007.)”
Background
What constitutes too long of a delay? Determining the cortisol awakening response (CAR) using self-report and PSG-assessed wake time
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Authors: Hellhammer, J., Fries, E., Schweisthal, O. W., Schlotz, W., Stone, A. A., & Hagemann, D.
Affiliations: Universität Trier (DE)
Stony Brook University (US)
ORCID: Schlotz, W.
Stone, A.A.
Hagemann, D.
Venue: Psychoneuroendocrinology
Publisher: Elsevier BV
Published: 2007-01
Volume: 32
Issue: 1
Pages: 80-86
ISSN: 0306-4530 (ISSN-L)
DOI: 10.1016/j.psyneuen.2006.10.005
OpenAlex: W2109539558
Cited by: 540
References: 34
Citations by year: 2026: 13 · 2025: 13 · 2024: 13 · 2023: 11 · 2022: 17 · 2021: 20 · 2020: 22 · 2019: 34 · 2018: 31 · 2017: 36 · 2016: 39 · 2015: 40 · 2014: 34 · 2013: 46 · 2012: 36
FWCI: 8.09
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Psychoneuroendocrinology (publishedVersion)
PubMed (publishedVersion)
ePrints Soton (University of Southampton) (submittedVersion)
MPG.PuRe (Max Planck Society) (submittedVersion)
Funders: Deutsche Forschungsgemeinschaft
Topics: Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
Keywords: diurnal cortisol rhythm, state factors, measurement reliability, salivary cortisol, acrophase, circadian rhythm
MeSH terms: Adult, Aged, Aged, 80 and over, Arousal, Circadian Rhythm, Female, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Male, Middle Aged, Models, Psychological, Monitoring, Physiologic, Pituitary-Adrenal System, Saliva, Wakefulness

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Several daily measurements are necessary to reliably assess the cortisol rise after awakening: State-and trait components

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