Research Protocol
 

By Dr. Simon B Thompson , Mr. Phil Bishop
Corresponding Author Dr. Simon B Thompson
Psychology Research Centre, Bournemouth University, - United Kingdom BH12 5BB
Submitting Author Dr. Simon B Thompson
Other Authors Mr. Phil Bishop
Psychology Research Centre, Bournemouth University, - United Kingdom BH12 5BB

NEUROLOGY

Chasmology; Clinical practice; Cortisol; Electro-myography; Multiple Sclerosis; Neural pathway; Saliva; Stroke; Trial; Yawning

Thompson SB, Bishop P. Trial to Investigate the Maintenance Effects of Yawning on Salivary Cortisol levels: Thompson Cortisol Hypothesis. A Protocol. WebmedCentral NEUROLOGY 2012;3(7):WMC003553
doi: 10.9754/journal.wmc.2012.003553

This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
No
Submitted on: 04 Jul 2012 06:15:44 PM GMT
Published on: 05 Jul 2012 09:16:22 PM GMT

Abstract


Introduction. Yawning consistently poses a conundrum to the medical profession and neuroscientists. Despite neurological evidence such as parakinesia brachialis oscitans in stroke patients and thermo-irregulation in multiple sclerosis patients, there is considerable debate over the reasons for yawning with the mechanisms and hormonal pathways still not fully understood. A study protocol is presented that attempts to discover the extent to which cortisol may be implicated during yawning and additionally, whether or not many neurological disorders may be linked via observed changes in cortisol levels during yawning. Evidence will be gathered to test the Thompson Cortisol Hypothesis that proposes the elevation of cortisol levels during yawning just as they are known to rise during stress and fatigue. Method & Analysis. 100 male and female volunteers aged between 18-65 years will be exposed to conditions that provoke a yawning response in a randomised controlled trial. Saliva samples will be collected at start and again after yawning response together with electro-myographical data of the jaw muscles to determine rest and yawning phases of neural activity. Yawning susceptibility scale, Hospital Anxiety and Depression Scale, General Health Questionnaire, demographic and health details are also to be collected from each participant. A comprehensive data set should allow comparison between yawners and non-yawners as well as between rest and yawning phases. Electro-myographical data collected from the yawning phase is novel and it is hoped this will provide new information about neuro-muscular activity related to cortisol levels. Exclusion criteria will include chronic fatigue, diabetes, fibromyalgia, heart condition, high blood pressure, hormone replacement therapy, multiples sclerosis, stroke. Between- and within-subjects data comparisons will be made.  We hope to devise a diagnostic tool based on changes in cortisol levels that may assist in the early diagnosis of neurological disorders based on these data collected. A further longitudinal study is then planned to test neurological patients. Ethics. Bournemouth University Research & Ethics approval has been granted: BU-PS5/10/11-PS1/3/12. Professional code of conduct, confidentiality, and safety issues have been addressed and approved in the Ethics submission. Trials ID: ISRCTN61942768. http://www.controlled-trials.com/isrctn/

 

Introduction


Yawning consistently poses a conundrum to neurologists and neuroscientists (1). Increasingly, evidence is found to link neurological disorders through the commonality of yawning episodes and contagious yawning. Despite discrete incidences (such as parakinesia brachialis oscitans) in brain stem ischaemic stroke patients, there is considerable debate over the reasons for yawning with the mechanism of yawning still not fully understood (2). A study protocol is presented that attempts to discover the extent to which cortisol may be implicated during yawning and additionally, whether or not many neurological disorders may be linked via observed changes in cortisol levels during yawning. Evidence will be gathered to test the Thompson Cortisol Hypothesis (3, 4); this proposes that cortisol levels may be elevated during yawning and contagious yawning, just as cortisol levels are known to be raised in instances of stress and fatigue (5). Yawning also occurs during thermo-irregulation in patients with multiple sclerosis. It is hoped that an understanding of yawning and its role in neurological disorders may be achieved by exploring cortisol levels in these different disorders.

Method & Analysis


100 male and female volunteers aged between 18-65 years will be recruited from students atBournemouthUniversityusing the computerised recruitment system (SONA), and Facebook. All participants will be properly consented according to code of conduct and research guidelines, and exposed, under randomised controlled trials guidelines, to three conditions intended to provoke a yawning response – photos of people yawning; boring text about yawning; short video of person yawning. Comparisons will be made with people exposed to the same conditions but who do not yawn. Saliva samples will be collected at start and again after yawning response together with electro-myographical data of the jaw muscles to determine rest and yawning phases of neural activity. If there is no yawning response then a second saliva sample will be taken at the end of the experimental paradigm. A yawning susceptibility scale (questionnaire designed for this study), Hospital Anxiety and Depression Scale (6, 7), General Health Questionnaire GHQ28 (8 - 12), and demographic and health details are also to be collected from each participant. Exclusion criteria will include chronic fatigue, diabetes, fibromyalgia, heart condition, high blood pressure, hormone replacement therapy, multiples sclerosis, stroke. Saliva sample is collected at start and again after yawning response (if produced). Electro-myographical data of the jaw muscles will be collected via surface-placed electrodes to determine rest and yawning phases. Between- and within-subjects comparisons will be made using Analysis of Variance and Spearman’s Rank Correlation Coefficient (Statistical Package for the Social Sciences computerised program). This will enable a comparison to be made, of measures including electro-myographical data and cortisol levels, between those participants that yawn and non-yawners as well as between rest status and yawning episodes.

Discussion


It is hoped that an understanding of yawning and its role in many neurological disorders may be achieved by exploring cortisol levels in these different disorders. The potential development of a diagnostic test for the early identification of neurological sequelae is intended; and at least, a better understanding of the neural pathways and hormonal activity during yawning. We hope to devise a diagnostic tool based on changes in cortisol levels that may assist in the early diagnosis of neurological disorders based on these data collected. A further longitudinal study is then planned to test neurological patients.

Ethics


Bournemouth University Research & Ethics approval has been granted: BU-PS5/10/11; PS1/3/12. Professional code of conduct, confidentiality, and safety issues have been addressed and approved in the Ethics submission. Data collected by verbal and written consent will be anonymised, coded, securely stored and destroyed after completion of the study analysis. Protective measures will be put in place for collection and analysis of saliva samples and the right of participants to withdraw from the study, will be made clear to all participants. Trials ID: ISRCTN61942768.

References


1. Thompson SBN: The dawn of the yawn: is yawning a warning? Linking neurological disorders. Med Hyp 2010, 75:630-633.
2. Thompson SBN: Is yawning a warning, neurologically? Neurology 2011, 2(2):1-7. doi:WMC001610.
3. Thompson SBN: Born to yawn? Cortisol linked to yawning: a new hypothesis. Med Hyp 2011, 77:861-862.
4. Thompson SBN, Zisa L: Yawning: Thompson Cortisol Hypothesis discussed. Physiology 2011, 2(8):1-19. doi:WMC002136.
5. Thompson SBN, Zisa L: Ill-health, stress, cortisol levels and yawning. In Psychology of trauma: clinical reviews, case histories, research. Edited by Thompson SBN. Portsmouth: Blackwell-Harvard-Academic; 2012:125-132.
6. Snaith RP, Zigmond AS: Hospital Anxiety and Depression Scale. Acta Psych Scand 1994, 67:361-370.
7. Abiodun OA: A validity study of the Hospital Anxiety and Depression Scale in general hospital units and a community sample in Nigeria. Br J Psychiatry 1994, 165:169-172.
8. Goldberg D: Manual of the General Health Questionnaire. Edition 3. Windsor: NFER; 1978.
9. Banks MH: Validation of the General Health Questionnaire in a young community sample. Psych Med 1983, 13:349-353.
10. Lobo A, Pérez-Echeverría MJ, Artal J: Validation of the scaled version of the General Health Questionnaire (GHQ28) in a Spanish population. Psych Med 1986, 16:135-140.
11. Goldberg D: Use of the General Health Questionnaire in clinical work. Br Med J 1986, 293:1188-1189.
12. Bridges KW, Goldberg D: The validation of the GHQ28 and the use of the MMSE in neurological in-patients. Br J Psychiatry 1986, 148:548-553.

Source(s) of Funding


This research received funding of £4000 from the host institution,Bournemouth University,United Kingdom, to support the purchase of essential equipment and materials. In addition, £4344 was received from Santander plc for travel expenses incurred to assist Author 1 to gain essential information for the selection and analysis of salivary cortisol kits.

Competing Interests


No competing interests. 

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Reviews
6 reviews posted so far

Review on paper
Posted by Dr. Yaroslav Winter on 07 Jul 2012 10:40:36 AM GMT

Trial to Investigate....Review
Posted by Mr. Brian Thompson on 06 Jul 2012 06:03:34 PM GMT

Trial to investigate
Posted by Ms. Natalie Jones on 05 Jul 2012 09:35:30 PM GMT

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