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We agree with the findings from previous studies that the development of AMS is associated with a lower sleeping oxygen saturation. ""5077" "Hypothesizing that stress dysregulation may worsen cocaine dependence, we investigated the effect of diurnal cortisol secretion profile, suppression of cortisol secretion, and total cortisol secretion on retention, abstinence-based voucher earnings, days of cravings, and mood status of participants at the end of a 2-week medication-free lead-in prior to randomization BMS-777607 cell line in a clinical trial of mirtazapine (60?mg vs. placebo) for depressed cocaine-dependent patients. We measured saliva cortisol levels at 9?AM, 2?PM, and 5?PM on the first two consecutive days of a 2-week medication-free lead-in period. Results from saliva samples were used to estimate the total daily level of cortisol, the diurnal profile of secretion (typical vs. atypical), and response to dexamethasone suppression (.1?mg). Seventy-seven patients collected saliva samples at baseline, and 65 (85%) were suitable for profile analysis. Patients with typical profiles (52%) collected significantly more abstinence-based voucher earnings during the lead-in (U?=?299.50, p?=?.025). Diurnal secretion profile did not significantly affect mood status, days of craving, or retention. There were no significant effects of suppression of cortisol secretion or of total cortisol levels on any outcome measures. In a subgroup of cocaine-dependent patients, deviation of cortisol secretion away from the RVX-208 homeostatic diurnal pattern was associated with reduced success at achieving early abstinence, an important determinant of treatment success. (Am J Addict 2014;23:1�C6) The relapsing nature of cocaine addiction may relate to the stress response of individuals with cocaine dependence. Cocaine-dependent patients expressing high stress sensitivity are more likely to relapse in human laboratory studies.[1-4] Stress is involved in cocaine addiction because cocaine acts as a stressor,[5, 6] and its effect on the stress response may play a role in the transition from intermittent selleckchem use of cocaine to addiction.[7] When a stressor like cocaine becomes chronic, normal regulation of stress is lost. Indications of stress dysregulation include hyper- or hypo-secretion of cortisol, altered diurnal secretion profile, and alteration in the regulation of cortisol secretion. These types of dysregulations are found, together or separately, in a host of medical, psychiatric, and addictive conditions. In depression, increased diurnal cortisol secretion, a flattened diurnal secretion profile, and unresponsiveness of cortisol secretion to the corticosteroid analog dexamethasone is reported.[8] In cocaine dependence, similar dysregulations are reported also.[9] These signs of stress dysregulation are associated with greater physical and psychiatric morbidity, and diminished treatment effects.