Salivary diurnal cortisol profiles in patients suffering from chronic breathlessness receiving supportive and palliative care services: A cross-sectional study. (May 2017)

• Record Type: Journal Article
• Authors: Ryan, Richella; Clow, Angela; Spathis, Anna; Smyth, Nina; Barclay, Stephen; Fallon, Marie; Booth, Sara
• Is Part Of: Psychoneuroendocrinology. Volume 79(2017)
• Page Start: 134
• Page End: 145
• Publication Date: 2017-05
• Subjects: Cortisol -- Hypothalamic-pituitary-adrenal axis -- Breathlessness -- Palliative care -- Dyspnoea -- Saliva; Psychoneuroendocrinology -- Periodicals; Endocrinology -- Periodicals; Neurology -- Periodicals; Psychiatry -- Periodicals; Neuropsychoendocrinologie -- Périodiques; 616.8
• DOI: 10.1016/j.psyneuen.2017.01.025
• Languages: English
• ISSNs: 0306-4530

Abstract

Highlights: Flatter mean diurnal cortisol slope in patients compared to healthy controls. Differences in mean diurnal cortisol slope depending on severity of breathlessness. Positive correlation for diurnal cortisol slope and MRC dyspnoea grade in patients. Aberrant cortisol profile patterns in patients with moderate-to-severe breathlessness. Abstract: Chronic breathlessness is a common source of psychological and physical stress in patients with advanced or progressive disease, suggesting that hypothalamic-pituitary-adrenal (HPA) axis dysregulation may be prevalent. The aim of this study was to measure the salivary diurnal cortisol profile in patients receiving supportive and palliative care for a range of malignant and non-malignant conditions and to compare the profile of those experiencing moderate-to-severe disability due to breathlessness against that of patients with mild/no breathlessness and that of healthy controls. Saliva samples were collected over two consecutive weekdays at 3, 6, and 12 h after awakening in 49 patients with moderate-to-severe breathlessness [Medical Research Council (MRC) dyspnoea grade ≥3], 11 patients with mild/no breathlessness (MRC dyspnoea grade ≤2), and 50 healthy controls. Measures of breathlessness, stress, anxiety, depression, wellbeing and sleep were examined concomitantly. The diurnal cortisol slope (DCS) was calculated for each participant by regressing log-transformed cortisol values against collection time. Mean DCS was compared across groups using ANCOVA. Individual slopes were categorised into one of four categories: consistent declining, consistent flat, consistent ascending and inconsistent. Controlling for age, gender and socioeconomic status, the mean DCS was significantly flatter in patients with moderate-to-severe breathlessness compared to patients with mild/no breathlessness and healthy controls [F (2, 103) = 45.64, p < 0.001]. Furthermore, there was a higher prevalence of flat and ascending cortisol profiles in patients with moderate-to-severe breathlessness (23.4%) compared to healthy controls (0%). The only variable which correlated significantly with DCS was MRC dyspnoea grade (rs = 0.29, p < 0.05). These findings suggest that patients with moderate-to-severe breathlessness have evidence of HPA axis dysregulation and that this dysregulation may be related to the functional disability imposed by breathlessness.