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

PSYCHONEUROENDOCRINOLOGY

卷:79

Article

Ryan, Richella^1,2  Clow, Angela³  Spathis, Anna^1,2  Smyth, Nina³  Barclay, Stephen²  Fallon, Marie⁴  Booth, Sara¹ 

[1] Cambridge Univ Hosp NHS Fdn Trust, Addenbrookes Hosp, Palliat Care Dept, Hills Rd, Cambridge CB2 0QQ, England

[2] Univ Cambridge, Dept Publ Hlth & Primary Care, Primary Care Unit, Inst Publ Hlth, Univ Forvie Site,Robinson Way, Cambridge CB2 0SR, England

[3] Univ Westminster, Dept Psychol, Psychophysiol & Stress Grp, 115 New Cavendish St, London W1W 6UW, England

[4] Univ Edinburgh, Edinburgh Canc Res Ctr IGMM, Crewe Rd South, Edinburgh EH4 2XR, Midlothian, Scotland

关键词: Cortisol;    Hypothalamic-pituitary-adrenal axis;    Breathlessness;    Palliative care;    Dyspnoea;    Saliva;   

DOI  :  10.1016/j.psyneuen.2017.01.025

来源: Elsevier

【 摘 要 】

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. (C) 2017 Elsevier Ltd. All rights reserved.

【 授权许可】

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