Comparing cortisol levels of saliva samples
collected with the passive drool collection methodwith the Salivette® Cortisol
Anne Dubberke1, Christa Seipelt2, Juliane Hellhammer1
12

Daacro GmbH & Co. KG, Max-Planck-Straße 22, 54296 Trier, Germany
SARSTEDT AG & Co. KG, Sarstedtstrasse 1, 51588 Nümbrecht, Germany

Introduction
The use of saliva as a non-invasive and easy tocollect bioanalytic specimen is still increasing
in health care and scientific studies of stress andimmunity [1,2]. Saliva can be collected undermany circumstances from humans - including
infants and elderly - and even animals without themain difficulty of blood collection, which is theinvasiveness of the puncture resulting in increased
release of stress hormones [2]. Saliva is commonly
collected with two methods: through passive drool,
which is still considered as the gold standard, andwith a swab, similar as it is been used by dentists.
The Salivette® swab collection device provides ahygienic and easy to handle method to collectsaliva samples. It was the first device speciallydeveloped for easy saliva collection over 30 years
ago. The easy-to-follow instructions for use of theSalivette® lead to increased participant complianceresulting in better and stronger data sets. The
participant places the swab in the mouth where it
easily absorbs saliva. The saturated swab is thenplaced back into the Salivette® container, cappedand sent to the laboratory. The Salivette® Cortisol,
REF 51.1534.500 code blue with a synthetic swab,
is specially designed and evaluated for cortisol
determination. Due to its high clinical relevance,
cortisol is one of the most frequent analytes thatcan be determined from saliva.

Therefore, to estimate possible influences ofthe swab-based collection using the Salivette®
Cortisol, the present study was performed,
comparing cortisol levels in native saliva samples(collected through unstimulated passive drool =reference samples) with cortisol levels after
pipetting whole saliva of the same sample
onto the swab of the Salivette® Cortisol.

In autumn 2018, a bulletin was released stating thatthe use of SARSTEDT swabs may introduce bias
in salivary analyte results [3]. This is contradictory
to a recent publication saying that cortisol levels
in saliva were unaffected by using the Salivettes
system [4]. Based on this inconsistency, acomparative study was initiated and thenperformed by the Saliva Lab Trier.

1/8Comparing
cortisol levels of saliva samples collected with
Study
designWhite Paper

the passive drool collection method with the Salivette® Cortisol

The study population consisted of 32 participants (22 females, 10 males; demographic
characteristics can be found in Table 1). Volunteers were asked to collect 4 saliva samples at
Study designStudydesigndifferent timesof the day (at awakening, 30 and 45 minutes after awaking and at 8 pm) to cover
The study population consisted of 32 participants (22 females, 10 males; demographic
diverselevelsof cortisol
and touse
the Cortisol Awakening(CAR),Awakening
the pronounced
cortisol and Response
to use the Cortisol
The
study
populationconsistedparticipantscharacteristics
can befound in
Table of1).32Volunteers
were asked to collect 4 saliva samples at
Response(CAR),
the pronouncedin(22
females,
10 males;releasedemographic
increasein cortisol
withincharacteristics
the first 30 to 45 minutes
after
awakening[5], as aincrease
standardized
different times
of
the
day
(at
awakening,
30
and
45
minutesafter
awaking
and
at
8
pm)
to
cover
cortisol release within the first 30 to 45 minutes
can be found in Table 1). Volunteers were asked to
and well-researchedbiomarker.
awakening[5], theas a pronounced
standardized andcollect
4
salivasamplesatdifferent
times
of
the
diverse levels of cortisol and to use the Cortisol Awakening after
Response(CAR),
well-researched biomarker.

day (at awakening, 30 and 45 minutes after

increase inawaking
cortisoland
releasewithinthe first
to
45 minutes
standardized[cm]awakening
Weight [5],[kg]as aBMI
[kg/m2]Age30[years]
at 8 pm)
to coverdiverselevelsofHeightafter
Mean
45.3
173.0
73.5
24.4
and well-researched biomarker.
SD
17.4
11.3
17.3
4.8
2
Age [years] Height[cm] 137.0
Weight [kg] 27.0
BMI [kg/m ] 14.4
Minimum
9
Maximum
86173.0
190.073.5
115.024.4
37.1
Mean
45.3
N
32 11.3
32 17.3
32 4.832
SD
17.4
Minimum
9
137.0
27.0
14.4
Table
1.
Demographic
characteristics
of
the
study
population
Maximum
86
190.0
115.0
37.1
N
32
32
32
32
To preclude that cortisol levels were affected by eating or tooth brushing, participants refrain
Table
Demographic
characteristics
thewater)study
population
Table 1. Demographic
characteristicsof theofstudy
populationfrom 1.eating
anddrinking(except
for1 h prior to saliva collection; tooth brushing was

not allowed during the post-awakening period. Furthermore, participants were asked to rinse
To preclude that cortisol levels were affected by eating or tooth brushing, participants refrain
their mouth with water 10 minutes before each saliva collection (except for the first morningfrom eating
drinking(except
for werewater)
1 h priorcollection; until
tooth
was they
the refrigerator
thebrushingnext day, whenToandprecludethat cortisol
levelsaffectedby to saliva
sample).
Participants
collected
unstimulated
wholesalivainthepolypropylene
tubeof thehandedthe4samples
to
the
lab.
In
the
lab, samples
eating or tooth brushing, participants refrain fromnot allowed
during the post-awakening period. Furthermore, participants were asked to rinse
werevortexed
500 μlinofthesalivawas pipetted
eatingand®drinking(except
for water)
1 h tubeprior to(without
the swaband theinsert) andstoredthe andsamplesrefrigerator
until
Salivette®
their mouth
with
water
10
minutes
beforeeach
salivacollection(except
for
the
first
morning
Cortisol.
Afteronto the swab of the Salivettesaliva collection; tooth brushing was not allowed
the next
when theyperiod.
handedthe 4 samples to thelab.soaking, the whole Salivette® Cortisol,
5 minduringtheday,post-awakening
Furthermore,
sample). Participants
collected unstimulated
whole saliva inthe polypropylene tube of the
including the insert tube and the swab, and theparticipants were asked to rinse their mouth withthe samples
swab
andwerethe saliva
tube
insert)and500storedthesamplesthe refrigerator
until
Salivette® (without
In the10lab,
vortexed
andµl ofsalivawasinwere
pipettedswab
nativesamplefrozenonto
at -20the°Cusing aof thewater
minutes
beforeeachcollection

control system
until further
analysis.
(except
for®theythefirstmorning
Participants
the next day,when
handedthesample).
samplesto thethelab.
Salivette
Cortisol.
After
54 minsoaking,
wholetemperature
Salivette® Cortisol,includingthe insert
tube
The longest time period between freezing and daycollected unstimulated whole saliva in the
and
the
swab,
and
the
nativesamplewerefrozenatusing24a days;
temperature
controlsystem®
(without
theof -20°C
analysisdetails of
canbe foundin
tubevortexedof the Salivette
In the lab,polypropylene
samples wereand 500 µl of saliva waspipettedwas
onto the swab
theswab
the tube
insert)Theand stored
thetimesamplesin between
Tablefreezing
2.
until andfurtheranalysis.
longestperiodand day of analysis was 24 days;

Salivette® Cortisol. After 5 min soaking, the whole Salivette® Cortisol, including the insert tube
details can be found in Table 2.
and the swab, and the native sample were frozen at -20°C using a temperature control system

until furtherDays
analysis. The longest
andwas
24 time
20period
19between
14 freezing
12
10 day7of analysis
6
5 24 3days; 1
Sample2
details can befoundsetsin Table 2.

2

1

5

4

4

3

4

3

1

3

∑
32

Table
periodof thesamples
at -20 °C.
Table2.2.Storage
Storagethe14collected
at7 -20°C.
Days
24
20period
19of collected
12 samples
10
6
5
3
1
∑
Sample sets
2
2
1
5
4
4
3
4
3
1
3
32
On day of assay, samples were thawed and centrifuged at 1500 x g for 15 minutes to removeOn
day period
ofandassay,
were thawed
andAllcentrifuged
x g forwere
15 minutes
to removeandandTable 2. Storage
ofsamplesthecollected
samplesat-20°C.
mucinsotherparticulatematter.
samples atof1500
the study
assayedon the mucins
same dayother particulate matter. All samples of the study were assayed on the same day and all the samples of
all the samples of one participant (4 x native + 4 x swab samples) were analyzed on the same
participant(4 xwere
native+ 4 x swab
wereatanalyzed
plate to avoid
any bias due toOn day ofone
assay,
samplesthawedand samples)
centrifuged
1500 xongthe
forsame15 minutes
to removeplate to avoid
any bias due to inter-assay variation.
inter-assay
variation.

mucins and other particulate matter. All samples of the study were assayed on the same day andall the samples of one participant (4 x native + 4 x swab samples) were analyzed on the sameplate to avoid any bias due to inter-assay variation.
20201008_SAR01-2020_Final_Report

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Comparing cortisol levels of saliva samples collected withthe passive drool collection method with the Salivette® Cortisol

Salivary cortisol levels were determined at theSaliva Lab Trier using a high sensitivity salivary
cortisol competitive immunoassay kit
manufactured by Salimetrics LLC (Carlsbad,USA). The kit contains a 96-well microplate coatedwith monoclonal antibodies to cortisol. All samples
were analyzed in duplicate. The assay was carriedout according to the manufacturer’s instructions.
After assay completion, optical density was readon a BioTek ELx808 microplate reader at 450 nm(with correction at 490 nm). The calculations fordetermining the cortisol concentration on eachsample were carried out following the kit
manufacturer’s instructions and using the Gen
5 v.3.08 software which enabled, as required, a4-parameter non-linear regression standard curve
to be generated. Analyses were performed
according to the quality and safety guidelines ofthe laboratory. Assay quality was measured by
calculating the intra-assay coefficient of variation(CV). Samples that showed a CV higher than 10%
were reanalyzed unless the cortisol concentration
was very low in which case a higher CV % was
expected. Inter-assay variability was checked withthe low and high controls on each microplate. The
intra- and interassay coefficients of variation were2.35 % (2.31 % native; 2.38 swab) and 3.44 %,respectively.

White Paper

Salimetrics report the lower limit of sensitivity(analytical sensitivity) as the minimal
concentration of cortisol that can be distinguishedfrom 0 as 0.193 nmol/L. The functional sensitivity
was determined by assaying 60 samples at aconcentration level resulting in a CV ofapproximately 20%. The functional sensitivityof the salivary cortisol ELISA is 0.773 nmol/L.

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Comparing cortisol levels of saliva samples collected withthe passive drool collection method with the Salivette® Cortisol

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Results

Results

Salivary cortisol is expected to increase in response to the impulse of awakening, reaching its(not processed) and swab samples (saliva pipetted

Salivary cortisol is expected to increase in response

peaktowithin
30 tominutesreachingafter awakening
withintheSalivetteday, resulting
in showed
low®
Cortisol),
onto the swabof thethe impulseof 45
awakening,its peak and decreasing

the expected
patternno greatdifferences
withinvalues.
30 to 45
minutes
after
awakening
Results
eveningTheoverallmean
valuesandof the native (notprocessed)
andandswab
samples(saliva
betweenthetwocollection
methods(Table3,
decreasing within the day, resulting in low
evening®
Salivary
cortisol
is expected
to increase
response totheimpulse ofshowedawakening,its
Cortisol),
thereaching
expectedpattern and no great
pipettedonto
the swabof thein Salivette
Figure 1).
values. The overall mean values of the native
peak within 30 to 45 minutes after awakening and decreasing within the day, resulting in low
differences between the two collection methods (Table 3, Figure 1).
evening values. The overall mean values of the native (not processed) and swab samples (saliva
pipetted onto the swab of the Salivette® Cortisol), showed the expected pattern and no great

Awakening+30 mindifferences between the two collection
methods (Table 3, Figure1).
[nmol/L][nmol/L]

Mean Native
Awakening[nmol/L]SD
Mean Native
9.70
Mean Swab
SD
4.91
SD
Mean Swab
9.81
SD

5.00

9.70+30 min
4.91[nmol/L]
16.34
9.81
6.21
5.00 15.97

16.34+45 min[nmol/L]
6.21
16.20
15.97
7.57
6.30
15.58

6.30

7.27

+45 min[nmol/L]

8 pm [nmol/L]

16.20
7.57
2.03
15.58
1.16
2.427.27

2.03
1.16
2.42
1.13

8 pm [nmol/L]

1.13

Table
3. Measuresofofsalivary
salivary cortisol
cortisol ininnative
andswab
samples.
The cortisol
concentration
is given is
Table
3. Measuresnativeandswabsamples.
The cortisol
concentration
Table 3.
Measuresofsalivary
cortisolinnativeandswabsamples.
The
cortisolconcentrationisin in
nmol/L.
The Thecortisolvaluesvaluesof N = of
32 N
participants
were averaged
each time
point
given
nmol/L.
cortisol= 32 participants
wereforaveragedforeach time point
given in nmol/L. The cortisol values of N = 32 participants were averaged for each time point
25

25

20

Salivary Cortisol [nmol/L]

Salivary Cortisol [nmol/L]

20

15

15

10

5

10

0

5

Awakening+30 min+45 min

8 pm

Mean Native
Mean Swab0

Awakening+30
minand swab
+45
min
Figure 1.
Mean1.
salivarylevelsin native
and inswab
samplesFigureMeancortisol
salivary
cortisollevelsnativesamples

8 pm

Mean Native
Mean Swab(around 2 nmol/L; evening samples at 8 pm).

The swab samples measure a little lower insamples of median cortisol values (around
Therefore, the salivary cortisol levels separated
20201008_SAR01-2020_Final_Report
Pagepoint
5 / 11 and each participant is given
16 nmol/L; + 30 and + 45 minutes samples) andfor each time
Figure1.
Meansalivary
cortisollevelsinnativeandswabsamplesa bit higher in samples of very low cortisol levels
in Figure 2.
4/8

The swab samples measure a little lower in samples of median cortisol values (around 16 nmol/L;
Comparinglevelsof saliva
samplescollected+ 30
and + 45cortisol
minutessamples)anda bit higher
in withsamples of very low cortisol
levels(around 2
White
Paper
the passive drool collection method with the Salivette® Cortisol
nmol/L; evening samples at 8 pm). Therefore, the salivary cortisol levels separated for each time
point and each participant is given in Figure 2.
Awakening+30 minutes

30

50

40

Salivary cortisol [nmol/L]

Salivary cortisol [nmol/L]

25

20

15

10

30

20

10

5

0

0

0

5

10

15

20

25

30

0

5

10

15

20

ParticipantsParticipants

NativeSwabNative
Swab

25

30

8 pm

+45 minutes

6

50

5

Salivary cortisol [nmol/L]

Salivary cortisol [nmol/L]

40

30

20

10

4

3

2

1

0

0
0

5

10

15

20

25

30

0

5

10

15

20

ParticipantsParticipants

NativeSwabNative
Swab

25

30

Figure 2. Salivary cortisol levels in native and swab samples, separated for each time point
Figure2. Salivary cortisol levels in native and swab samples, separated for each time point

To evaluate a possible correlation between the both methods, a scatterplot was created (Figure
To evaluate a possible correlation between the both

The correlation coefficient is 0.991 (p<0.001),

3methods,
and 4).a scatterplot
The plot was
indicates
betweenand swabsampleswithcreatednearly(Figureperfect
3 and correlation
indicating
almostnative
no differences
betweenthe two4). Thea plotcorrelation
methods. indicating no differences
only
fewindicatesoutliers.nearly
Theperfectcorrelation
coefficient iscollection
0.991 (p<0.001),
between native and swab samples with only abetweenthe two collection methods.
few outliers.

5/8

20201008_SAR01-2020_Final_Report

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Comparing cortisol levels of saliva samples collected withthe passive drool collection method with the Salivette® Cortisol

White Paper

Figure 3. Scatterplot of native cortisol versus swab cortisol levels

Figure 3. Scatterplot of native cortisol versus swab cortisol levels (mean values of the two assay
FigureFigure3.
Scatterplot
3. Scatterplotof nativeofnativecortisol
cortisolversusversusswab
swab
cortisol
cortisollevelslevels(mean(meanvaluesvaluesof theof twothe two
assay
assay
(mean
valuesof the two
assay
duplicatemeasurements)
duplicate measurements)
Figure3. Scatterplotof native cortisol versus swab cortisol levels (mean values of the two assay
duplicate
duplicatemeasurements)
measurements)
duplicate measurements)

Figure 3. Scatterplot of native cortisol versus swab cortisol levels (mean values of the two assay
Figure3. Scatterplotof native cortisol versus swab cortisol levels (mean values of the two assay
duplicatemeasurements)
Figure 3. Scatterplotof native cortisol versus swab cortisol levels (mean values of the two assay
duplicatemeasurements)
Figure4.3.Scatterplot
withthe 95%
confidence
interval(gray levels
shading)
FigureScatterplotof withnativecortisolversus swab
cortisol(mean values of the two assay
duplicatemeasurements)
FigureFigure4. Scatterplot
4.
Scatterplot
withthe 95%the95%
confidence
confidence
intervalinterval
(gray
(gray
shading)
shading)
Figure3.
Scatterplot
ofnativecortisolversusswab
cortisollevels(mean values of the two assay
duplicatemeasurements)
Figure4.
Scatterplot
with95%
confidence
interval
shading)
Figure4.
Scatterplot
withthe the95%
confidence
interval(gray(grayshading)
Figure3.
Scatterplot
ofnativecortisolversusswab
cortisollevels(mean
values
of
the
two
assay
duplicatemeasurements)
FigureFigureFigureFigureFigureFigure
3.
3.
3.
3.
3.
3.
Scatterplot
Scatterplot
Scatterplot
Scatterplot
Scatterplot
Scatterplot
of
of
of
of
of
of
nativenativenativenativenativenativecortisol
cortisol
cortisol
cortisol
cortisolversusversusversusversusversusversus
swab
swab
swab
swab
swab
swab
cortisol
cortisol
cortisol
cortisol
cortisol
cortisollevelslevelslevelslevelslevelslevels
(mean
(mean
(mean
(mean
(mean
(mean
valuesvaluesvaluesvaluesvaluesvalues
of
of
of
of
of
of
the
the
the
the
the
the
two
two
two
two
two
two
assay
assay
assay
assay
assay
assay
The
R-squared
with 0.983
is incortisol
the
same
range
of thecorrelation
coefficient.
The
calculated
The
The
R-squared
R-squared
with
with
0.983
0.983
is
in
is
the
in
the
same
same
range
range
of
the
of
the
correlation
correlation
coefficient.
coefficient.
TheThe
calculated
calculated
duplicatemeasurements)
duplicate
duplicate
duplicate
duplicate
duplicate
duplicatemeasurements)
measurements)
measurements)
measurements)
measurements)
measurements)
standard
deviation withshows0.983
an expectedfrommean of 1.012(residual
standard
The R-squared
is in the deviation
same
range
of thethe thecorrelationThe
calculated
standard
deviation
deviationshowsaninexpectedandeviationthemeanof 1.012
ofcoefficient.
1.012(residual(residual
standard
standard
Thestandard
R-squared
withshows
0.983
istheexpectedsame deviation
range
of fromfrom
Themeanregression
model
therefore
hasa higherror).
The regression
model
therefore
has a deviationhigh goodnessoffit.meanA linearrelationshipbetweenstandard
deviationshows
anexpected
from
the
of
1.012
(residual
standard
error).
error).
TheTheregression
regression
model
model
therefore
therefore
has hasa higha highgoodnessgoodnessof fit.
of A
fit.linear
A linearrelationshiprelationshipbetweenbetweenthe correlation coefficient. The calculated standard

goodness of fit. A linear relationship between

thetwovariables
canexpected
be assumed.
error).
The
regression
model
therefore
ofvariables
fit. A linear
deviationshows
andeviation
fromhasthea high goodness
the twocanrelationshipbe assumed.between
thetwo
the twovariables
variables
can canbe assumed.
beassumed.
mean
1.012(residual
error).
theoftwo
variables
canstandard
be assumed.
20201008_SAR01-2020_Final_Report
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Difference Native minus Swab Cortisol

Difference Native minus Swab Cortisol

Comparing cortisol levels of saliva samples collected withthe passive drool collection method with the Salivette® Cortisol

White Paper+1.96 SD
2.2
Mean
0.1
-1.96 SD
-2.0

+1.96 SD
2.2
Mean
0.1
-1.96 SD
-2.0

Mean Native and Swab Cortisol
Mean Native and Swab Cortisol

Figure5. Bland-Altman
plot, the bluethe
lines
indicate
the average± 1.96 SD ± 1.96 SD
Figure5. Bland-Altman
blue
lines
indicate
thedifference
averagedifference
Figure 5. Bland-Altman
plot, the blue plot,lines indicate
theaveragedifference± 1.96 SD
The Bland-Altman
plot (Figure5) shows
the difference
the measured
The Bland-Altman
plot (Figure5) shows
the difference
betweenbetween
the measured
values ofvalues
both of both
The
Bland-Altman
plot(Figure
5)
shows
the
displaysahighdegree of agreement between themethods(Y-axis)andmeantheir valuemean(X-axis).
value (X-axis).
It displays
a highofdegreeof agreement
methods(Y-axis)and their
It displays
a high degree
agreement
between between

difference between the measured values of bothmethods (Y-axis) and their mean value (X-axis). It

two cortisol measuring methods, since almost allvalues lie within the standard deviation of ±1.96,

thecortisol
two cortisol
measuring
methods,
since almost
alllievaluesliethewithinthe standardofthe twomeasuring
methods,
since almost
all values
withinstandard
deviationdeviationof±1.96,±1.96,

140% 140%
119

119

0%Awakening+30 minutes+45 minutes
8 pm
Awakening+30 minutes+45 minutes

8 pm

120% 120%
101
100% 100%
80%

80%

60%

60%

40%

40%

20%
0%

101

98

98

96

96

20%

Figure 6. Meansalivary
cortisollevels cortisolof swab samples
forswabeach time
point relatively
the point
native relatively to the native samples
Figure
6. Meansalivarylevels ofsamplesfor each totime
Figure 6. Mean salivary cortisol levels of swab samples for each time point relatively to the native
samples (setto100%).
The
red
band
represents
theacceptable
range
(±20%
acceptance(set to 100 %). The red band represents the acceptable range (±20% acceptance criterion)
samples (set to 100%). The red band represents the acceptable range (±20% acceptancecriterion)
criterion)
20201008_SAR01-2020_Final_Report
Besides the correlation of the two different method,
20201008_SAR01-2020_Final_Report

also the specificity of the method is important andshould be considered. Figure 6 shows the valuesof the mean swab samples relatively to the mean
native samples (set to 100 %) for each time point.

Page 8 values/ 11
All four mean
are within the acceptance
Page 8 / 11
range of ±20 %, again showing that the mostvariation using the Salivettes® occur at low
cortisol values (around 2 nmol/L; evening
samples at 8 pm).

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Comparing cortisol levels of saliva samples collected withthe passive drool collection method with the Salivette® Cortisol

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Conclusions
The main advantage of measuring biomarkers
in saliva is the non-invasive and easy sample
collection procedure. It is important to use aswab method that does not change the biomarker
concentration and closely matches passive drool
results.

Cortisol very closely match passive drool levels.
Evaluating the minimal difference between bothmethods against the benefit of using the Salivette®
Cortisol, data sets surely benefit from a better
compliance of individuals using the Salivette®
Cortisol.

In the present study, the concentration ofcortisol in saliva samples collected with thepassive drool method was compared with thecortisol concentration of the same samples after
pipetting onto the swab of the Salivette® Cortisol.
No significant differences between the twocollection methods can be oberserved. A nearly
perfect correlation (r=0.911, p<0.001) with only
a few outliers indicates very low bias between
the two collection methods. It could bedemonstrated that sampling with the Salivette®
Cortisol is a good alternative to the passive
drool method ensuring the preservation ofsample integrity.

This study was performed in August 2020 byContract Research Organization DAACRO(Trier, Germany) and its Saliva Lab Trier. As
an ISO 9001:2015 certified unit with a special
focus on stress related research, daacro’s Saliva
Lab Trier commits itself to work with and provide
only collections devices and analytical methods
that are evaluated and scientifically established.
The lab functions as an excellence laboratory for
Salimetrics, USA and serves as a consultant for
academic and industrial research projects. Further,
the lab develops customer tailed saliva diagnostic
devices for individuals and health care providers.

Although discussed vividly in the literature, abias in salivary cortisol results using the Salivette®
Cortisol cannot be confirmed. The present study
indicates that the results from the Salivette®

Technical modifications reserved[1] Takagi K, Ishikura Y, Hiramatsu M, Nakamura K, Degawa M. Development of a saliva collection device
for use in the field. Clin Chim Acta, 425:181-185, 2013.
[2] Gröschl M. Saliva: a reliable sample matrix in bioanalytics. Bioanalysis, 9(8):655-668, 2017.
[3] http://staging.salimetrics.com/rigor-and-reproducibility-for-collecting-saliva-samples[4] Büttler RM, Bagci E, Brand HS, Heijer MD, Blankenstein MA, Heijboer AC. Testosterone, androstenedione, cortisoland cortisone levels in human unstimulated, stimulated and parotid saliva. Steroids, 138:26-34, 2018.
[5] Stalder T, Kirschbaum C, Kudielka BM, Adam EK, Pruessner JC, Wüst S, Dockray S, Smyth N, Evans P, Hellhammer
DH, Miller R, Wetherell MA, Lupien SJ, Clow A. Assessment of the Cortisol Awakening Response: Expert Consensus
Guidelines. Psychoneuroendocrinology, 63: 414-32, 2016.

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References

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