Cited by 856Stress Responses and CortisolAdrenal Hormones and DisordersCircadian rhythm and melatonin

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The Awakening Cortisol Response: Methodological Issues and Significance

Clow, A., Thorn, L., Evans, P., Hucklebridge, F.·2004·Stress

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Abstract

The awakening cortisol response (ACR) is a discrete and distinctive part of the cortisol circadian cycle. In healthy adults salivary free cortisol concentrations increase by between 50 and 160% in the first 30 min immediately post-awakening (approximate average increase of 9 nmol/l, range 4-15 nmol/l, estimated to be equivalent to about three secretory episodes). However there are no agreed norms for the absolute concentrations of free cortisol in saliva either immediately post-awakening (range of 4.7-18.5 nmol/l) or 30 min post-awakening (range of 8.6-21.9 nmol/l). This review explores reasons for these discrepancies in normative data including confounding factors such as gender, age, awakening time, light and participant adherence. Although the physiological role of the ACR has not been clearly defined evidence is discussed that suggests it is under a distinct regulatory influence, different from the rest of the diurnal cortisol secretory cycle. Despite the difficulties associated with its measurement a range of studies have demonstrated an association between the ACR and psychosocial variables, stress and health. However it remains unclear whether positive affect and good health are consistently associated with larger or smaller awakening responses. It is early days in the search for the role and significance of the ACR. Its putative role in the regulation of physiological function across the day (e.g. the immune system) and its sensitivity to psychosocial variables make it a prime candidate as an intermediary linking mind and health.

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Authors: Clow, A., Thorn, L., Evans, P., & Hucklebridge, F.
Affiliations: University of Westminster (GB)
Venue: Stress
Publisher: Informa UK Limited
Published: 2004-03
Volume: 7
Issue: 1
Pages: 29-37
ISSN: 1025-3890 (ISSN-L)
1607-8888
DOI: 10.1080/10253890410001667205
OpenAlex: W1973501977
Cited by: 856
References: 55
Citations by year: 2026: 10 · 2025: 19 · 2024: 14 · 2023: 21 · 2022: 32 · 2021: 34 · 2020: 43 · 2019: 47 · 2018: 31 · 2017: 47 · 2016: 54 · 2015: 51 · 2014: 55 · 2013: 47 · 2012: 47
FWCI: 2.37
Type: journal article
Language: en
Open access: closed
Locations: Stress (publishedVersion)
PubMed (publishedVersion)
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: cortisol awakening response, diurnal cortisol rhythm, cortisol secretion, reference values, gender differences, age effects, light exposure, participant adherence, positive affect, immune regulation, mind-body problem
MeSH terms: Adrenal Cortex, Arousal, Circadian Rhythm, Humans, Hydrocortisone

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The Awakening Cortisol Response: Methodological Issues and Significance

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