Exploring Subjective Stress, Sleep and Diurnal Variation of Salivary Cortisol in Korean Female Adults

여대생의 스트레스, 수면, 타액 코티솔 일중변동 연구

  • Lee, Sunock (Department of Nursing, Korea National Open University) ;
  • Suh, Minhee (Department of Nursing, Inha University)
  • 이선옥 (한국방송통신대학교 간호학과) ;
  • 서민희 (인하대학교 간호학과)
  • Received : 2015.12.24
  • Accepted : 2016.02.04
  • Published : 2016.02.29


Purpose: The purpose of this exploratory study was to find a specific time of day with a stable cortisol level and to investigate the relationship between salivary cortisol and sleep. Methods: A total of 36 Korean female college students participated in the study. Salivary specimens were collected 6 times a day for 2 days in different stressful situations. Sleep characteristics were measured using an actigraph while salivary specimens were collected. Perceived stress was evaluated using the Global Assessment of Recent Stress. Results: Depending on whether there were morning peak and/or afternoon elevations in the cortisol levels, the type of diurnal cortisol pattern was classified into 4 types. None of the cortisol levels in different times of the day showed significant relationships to perceived stress levels. Cortisol levels in the morning, levels of peak cortisol and diurnal differences of cortisol were significantly correlated with sleep duration. The time with most stable cortisol level was 9-10 pm. Conclusion: It is recommended that measurements of salivary cortisol are taken from 9-10 pm since it showed a stable value regardless of diurnal cortisol rhythm and sleep. Sleep duration should be considered as an important confounding factor in measuring cortisol levels in the morning and the diurnal differences of cortisol.


Supported by : 한국방송통신대학교


  1. Hellhammer DH, Wust S, Kudielka BM. Salivary cortisol as a biomarker in stress research. Psychoneuroendocrinology. 2009;34(2):163-171.
  2. Powell DJ, Schlotz W. Daily life stress and the cortisol awakening response: Testing the anticipation hypothesis. PloS one. 2012;7(12):e52067. 10.1371/journal.pone.0052067
  3. Nader N, Chrousos GP, Kino T. Interactions of the circadian CLOCK system and the HPA axis. Trends in Endocrinology and Metabolism. 2010;21(5):277-286.
  4. Woods DL, Mentes JC. Spit: Saliva in nursing research, uses and methodological considerations in older adults. Biological Research for Nursing. 2011;13(3):320-327. 10.1177/1099800411404211
  5. Corbett BA, Mendoza S, Wegelin JA, Carmean V, Levine S. Variable cortisol circadian rhythms in children with autism and anticipatory stress. Journal of Psychiatry and Neuroscience. 2008;33(3):227-234.
  6. Chan S, Debono M. Replication of cortisol circadian rhythm: new advances in hydrocortisone replacement therapy. Therapeutic Advances in Endocrinology and Metabolism. 2010;1(3):129-138.
  7. Schulz P, Kirschbaum C, PruBne J, Hellhammer D. Increased free cortisol secretion after awakening in chronically stressed individuals due to work overload. Stress Medicine. 1998;14:91-97.<91::AID-SMI765>3.0.CO;2-S
  8. Hulme PA, French JA, Agrawal S. Changes in diurnal salivary cortisol levels in response to an acute stressor in healthy young adults. Journal of the American Psychiatric Nurses Association. 2011;17(5):339-349. 1078390311419352
  9. Murphy L, Denis R, Ward CP, Tartar JL. Academic stress differentially influences perceived stress, salivary cortisol, and immunoglobulin-A in undergraduate students. Stress. 2010;13(4):365-370.
  10. Kim IS, Kang SJ, Kim JO. Effects of the aroma inhalation method with a roll-on on life stress, salivary cortisol and fatigue in nursing student. Journal of the Korea Academia-inderstrial Cooperation Society. 2014;15(2):7214-7223.
  11. Lee SH. Effects of back massage with lavender essence oil on the stress response of the ICU nurses. Journal of Korean Academy of Nursing. 2001;31(5):770-780.
  12. Saban KL, Mathews HL, Bryant FB, O'Brien TE, Janusek LW. Depressive symptoms and diurnal salivary cortisol patterns among female caregivers of stroke survivors. Biological Research for Nursing. 2012;14(4):396-404. 10.1177/1099800412439458
  13. Lee JH, Kim CY. The Effects of Stress on Salivary Cortisol Level of Some of the Dental Hygienists. Journal of Dental Hygiene Science. 2012;21(1):65-70.
  14. Kim D, Chung Y-S, Park S. Relationship between the stress hormone, salivary cortisol level and stress score by self-report measurement. The Korean Journal of Health Psychology. 2004;9(3):633-645.
  15. Ho RT, Fong TC, Chan CK, Chan CL. The associations betweendiurnal cortisol patterns, self-perceived social support, and sleep behavior in Chinese breast cancer patients. Psychoneuroendocrinology. 2013;38(10):2337-2342.
  16. Woods DL, Yefimova M. Evening cortisol is associated with intra-individual instability in daytime napping in nursing home residents with dementia: an allostatic load perspective. Biological Research for Nursing. 2012;14(4):387-395.
  17. Koh KB, Park JK. Validity and reliability of the Korean version of the global assessment of recent stress scale. Korean Journal of Psychosomatic Medicine. 2000;8(2):201-211.
  18. Sadeh A. The role and validity of actigraphy in sleep medicine: an update. Sleep Medicine Reviews. 2011;15(4):259-267.
  19. Bakken LN, Lee KA, Kim HS, Finset A, Lerdal A. Sleep-wake patterns during the acute phase after first-ever stroke. Stroke Research and Treatment. 2011; 2011:936298.
  20. Barksdale DJ, Woods-Giscombe C, Logan JG. Stress, cortisol, and nighttime blood pressure dipping in nonhypertensive Black American women. Biological Research for Nursing. 2013;15(3):330-337.
  21. Nater UM, Maloney E, Boneva RS, Gurbaxani BM, Lin JM, Jones JF, et al. Attenuated morning salivary cortisol concentrations in a population-based study of persons with chronic fatigue syndrome and well controls. The Journal of Clinical Endocrinology and Metabolism. 2008;93(3):703-709.
  22. Knorr U, Vinberg M, Kessing LV, Wetterslev J. Salivary cortisol in depressed patients versus control persons: a systematic review and meta-analysis. Psychoneuroendocrinology. 2010;35(9):1275-1286.
  23. Abercrombie HC, Giese-Davis J, Sephton S, Epel ES, Turner-Cobb JM, Spiegel D. Flattened cortisol rhythms in metastatic breast cancer patients. Psychoneuroendocrinology. 2004;29(8):1082-1092.
  24. Sohn BM. Effects of workload and job stress on salivary cortisol level [dissertation]. Busan: Busan National University; 2004. pp. 1-46.
  25. Kim KS. Stress response: Physiological and behavioral aspects. Perspectives in Nursing Science. 2005;2(1):61-75.
  26. Kim IH. The effects of essential oil inhalation on the blood pressure, salivary cortisol, perceived stress in prehypertensive and hypertensive subjects [dissertation]. Daejon: Eulji University; 2012. pp. 1-100.
  27. Rystedt LW, Cropley M, Devereux JJ, Michalianou G. The relationship between long-term job strain and morning and evening saliva cortisol secretion among white-collar workers. Journal of Occupational Health Psychology. 2008;13(2):105-113.
  28. Dedert E, Lush E, Chagpar A, Dhabhar FS, Segerstrom SC, Spiegel D, et al. Stress, coping, and circadian disruption among women awaiting breast cancer surgery. Annals of Behavioral Medicine: a publication of the Society of Behavioral Medicine. 2012;44(1):10-20.
  29. Maslowsky J, Ozer EJ. Developmental trends in sleep duration in adolescence and young adulthood: Evidence from a national United States sample. The Journal of Adolescent Health : official publication of the Society for Adolescent Medicine. 2014;54(6):691-697.
  30. Van Laethem M, Beckers DG, Kompier MA, Kecklund G, van den Bossche SN, Geurts SA. Bidirectional relations between work-related stress, sleep quality and perseverative cognition. Journal of Psychosomatic Research. 2015;79(5):391-398.

Cited by

  1. Effects of Music Therapy on Subjective Stress Response, Salivary Cortisol, and Fatigue for Intensive Care Nurses vol.17, pp.2, 2017,