Overnight Th1 immune activation predicts the cortisol awakening response

The cortisol awakening response (CAR) marks the transition from rest to wake phase by a sharp increase in cortisol levels upon awakening in the morning. This increase may assist in cognitive and behavioral awakening, but its function is not fully understood yet. In this pilot study we aimed to provide first data on the influence of immune system activity on the CAR. Thereby, a within-subject analysis approach was applied to avoid confounding by between-subject bias and improve inference of the results. Three healthy subjects collected their overnight urine for analysis of neopterin (Th1 immune activation marker) and sampled saliva at 0, 30, and 45 minutes after awakening in the morning for cortisol determination and CAR estimation. Additionally, subjects wore an EEG-headband overnight for objective determination of the awakening timepoint. Random-effects models were computed to estimate the effect of overnight neopterin on the CAR. There was a significant positive effect of overnight neopterin levels on the CAR, indicating that overnight Th1 immune activation may predict the dynamic increase of cortisol in the morning, with higher immune levels leading to a stronger CAR. These results provide first evidence for the immunological awakening hypothesis and a potential role of the CAR in the maintenance of circadian immune rhythms, but given the small number of participants, findings should be interpreted as exploratory.