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While biomarkers such as cortisol have been extensively studied, integrated analyses of neuroendocrine-immune-circadian interactions remain limited. In this cross-sectional study with two complementary components, psychometric assessments of 637 undergraduates revealed that 90.4% experienced moderate-to-high perceived stress. These stress levels correlated with fatigue (r\u2009=\u20090.41,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.01) and poor sleep quality (r\u2009=\u20090.35,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.01). A second component involved laboratory-based diurnal biomarker profiling of 33 high-stress and low-stress participants, revealing stress-dependent physiological patterns. Specifically, high stress was associated with sympathetic activation (\u03b1-amylase\u2191), HPA axis dysregulation (altered diurnal cortisol patterns), circadian disruption (melatonin\u2191), and mucosal immune activation (IgA\u2009\u2191\u2009, lysozyme\u2191). The coupling of \u03b1-amylase and lysozyme suggested neuro-immune coordination (r\u2009=\u20090.52,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). These findings indicate that salivary biomarker profiles are associated with perceived stress. Sleep quality and fatigue warrant further investigation as potential intervention targets in future longitudinal studies.\n                  <\/jats:p>","DOI":"10.1371\/journal.pmen.0000717","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T17:27:42Z","timestamp":1789493262000},"page":"e0000717","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmen.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["The hidden burden of college life: Stress, sleep, and salivary biomarkers in students\u2014A cross-sectional study"],"prefix":"10.1371","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-3125-7054","authenticated-orcid":true,"given":"Hongyu","family":"Xu","sequence":"first","affiliation":[{"name":"College of Science and Technology, Wenzhou-Kean University","place":["Wenzhou, Zhejiang, China"]},{"name":"Dorothy and George Hennings College of Science, Mathematics and Technology, Kean University","place":["Union, New Jersey, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiqiang","family":"Yan","sequence":"additional","affiliation":[{"name":"Xijing Hospital, Fourth Military Medical University","place":["Xi'an, Shaanxi, China"],"department":["Department of Neurosurgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9808-4902","authenticated-orcid":true,"given":"Xinyi","family":"Kong","sequence":"additional","affiliation":[{"name":"College of Science and Technology, Wenzhou-Kean University","place":["Wenzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuang","family":"Wu","sequence":"additional","affiliation":[{"name":"College of Science and Technology, Wenzhou-Kean University","place":["Wenzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Shi","sequence":"additional","affiliation":[{"name":"The Key Laboratory of Aerospace Medicine, Ministry of Education, Fourth Military Medical University","place":["Xi'an, Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6370-1414","authenticated-orcid":true,"given":"Qiong","family":"Ye","sequence":"additional","affiliation":[{"name":"College of Science and Technology, Wenzhou-Kean University","place":["Wenzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zijin","family":"Li","sequence":"additional","affiliation":[{"name":"College of Science and Technology, Wenzhou-Kean University","place":["Wenzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia","family":"Lu","sequence":"additional","affiliation":[{"name":"College of Science and Technology, Wenzhou-Kean University","place":["Wenzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Fang","sequence":"additional","affiliation":[{"name":"Second Affiliated Hospital of Anhui Medical University","place":["Hefei, Anhui, China"],"department":["Department of Neurosurgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kexin","family":"Chen","sequence":"additional","affiliation":[{"name":"College of Science and Technology, Wenzhou-Kean University","place":["Wenzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiajun","family":"Bao","sequence":"additional","affiliation":[{"name":"College of Science and Technology, Wenzhou-Kean University","place":["Wenzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiyao","family":"Huang","sequence":"additional","affiliation":[{"name":"College of Science and Technology, Wenzhou-Kean University","place":["Wenzhou, Zhejiang, 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hemodialysis patients: a cross-sectional study","volume":"24","author":"M Zhou","year":"2023","journal-title":"BMC Nephrol"},{"issue":"9","key":"pmen.0000717.ref032","doi-asserted-by":"crossref","first-page":"1963","DOI":"10.1017\/S0033291711000092","article-title":"Asymmetry of salivary cortisol and \u03b1-amylase responses to psychosocial stress in anorexia nervosa but not in bulimia nervosa","volume":"41","author":"P Monteleone","year":"2011","journal-title":"Psychol Med"},{"key":"pmen.0000717.ref033","doi-asserted-by":"crossref","first-page":"3639441","DOI":"10.1155\/2021\/3639441","article-title":"Salivary biomarkers (opiorphin, cortisol, amylase, and IgA) related to age, sex, and stress perception in a prospective cohort of healthy schoolchildren","volume":"2021","author":"A Krahel","year":"2021","journal-title":"Mediators Inflamm"},{"issue":"7","key":"pmen.0000717.ref034","doi-asserted-by":"crossref","first-page":"1571","DOI":"10.3390\/s19071571","article-title":"Hand-held 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global measure of perceived stress","volume":"24","author":"S Cohen","year":"1983","journal-title":"J Health Soc Behav"},{"key":"pmen.0000717.ref038","first-page":"760","article-title":"Epidemiological study on psychological stress among urban residents during social transition","volume":"24","author":"T Yang","year":"2003","journal-title":"Chinese Journal of Epidemiology"},{"issue":"7","key":"pmen.0000717.ref039","doi-asserted-by":"crossref","first-page":"4386","DOI":"10.3390\/curroncol29070350","article-title":"Health-Related Quality of Life following Total Thyroidectomy and Lobectomy for Differentiated Thyroid Carcinoma: A Systematic Review","volume":"29","author":"V Landry","year":"2022","journal-title":"Curr Oncol"},{"key":"pmen.0000717.ref040","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.socscimed.2014.09.050","article-title":"A blunted diurnal cortisol response in the lower educated does not explain educational differences in coronary heart disease: findings 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Wu","year":"2012","journal-title":"Clin J Oncol Nurs"},{"issue":"3","key":"pmen.0000717.ref049","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1016\/j.biopsycho.2006.05.003","article-title":"Psychosocial factors at home and at work and levels of salivary cortisol","volume":"73","author":"NH Eller","year":"2006","journal-title":"Biol Psychol"},{"issue":"12","key":"pmen.0000717.ref050","doi-asserted-by":"crossref","DOI":"10.1111\/psyp.13937","article-title":"Effects of a mindfulness-based intervention on mindfulness, stress, salivary alpha-amylase and cortisol in everyday life","volume":"58","author":"C Aguilar-Raab","year":"2021","journal-title":"Psychophysiology"},{"key":"pmen.0000717.ref051","doi-asserted-by":"crossref","first-page":"119692","DOI":"10.1016\/j.envpol.2022.119692","article-title":"Fine particulate matter, airway inflammation, stress response, non-specific immune function and buccal microbial diversity in young adults","volume":"308","author":"Z Lin","year":"2022","journal-title":"Environ Pollut"},{"key":"pmen.0000717.ref052","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.bbi.2019.09.018","article-title":"Free light chains as an emerging biomarker in saliva: Biological variability and comparisons with salivary IgA and steroid hormones","volume":"83","author":"A Rapson","year":"2020","journal-title":"Brain Behav Immun"},{"issue":"3","key":"pmen.0000717.ref053","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1111\/j.1365-2796.2010.02292.x","article-title":"LDL-associated apolipoprotein J and lysozyme are associated with atherogenic properties of LDL found in type 2 diabetes and the metabolic syndrome","volume":"269","author":"C Pettersson","year":"2011","journal-title":"J Intern Med"},{"issue":"6","key":"pmen.0000717.ref054","doi-asserted-by":"crossref","first-page":"3184","DOI":"10.3390\/ijerph18063184","article-title":"Salivary Biomarkers and Work-Related Stress in Night Shift 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Kim","year":"2017","journal-title":"Oncol Lett"},{"key":"pmen.0000717.ref083","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.bbi.2022.04.010","article-title":"Secretory immunoglobulin A (s-IgA) reactivity to acute psychosocial stress in children and adolescents: The influence of pubertal development and history of maltreatment","volume":"103","author":"L Marques-Feixa","year":"2022","journal-title":"Brain Behav Immun"},{"key":"pmen.0000717.ref084","doi-asserted-by":"crossref","first-page":"655896","DOI":"10.3389\/fcimb.2021.655896","article-title":"IgA Antibodies and IgA Deficiency in SARS-CoV-2 Infection","volume":"11","author":"I Quinti","year":"2021","journal-title":"Front Cell Infect Microbiol"},{"issue":"2","key":"pmen.0000717.ref085","first-page":"16","article-title":"Neuroprotective effects of melatonin administration against chronic immobilization stress in rats","volume":"9","author":"AM Gomaa","year":"2017","journal-title":"Int J Physiol Pathophysiol 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