Melanopic illuminance defines the magnitude of human circadian light responses under a wide range of conditions

Designing Light for Night Shift Workers: Application of Nonvisual Lighting Design Principles in an Industrial Production Line

Chronodisruption deteriorates the health and wellbeing of shift workers. Artificial light at night and the lack of light during the day are major contributors to chronodisruption and need to be optimized in shift work scenarios. Here, we present one solution for a lighting and automation system in an industrial production workplace. The setting is a rapidly rotating shift work environment with morning, evening, and night shifts. We describe a procedure to specify the new lighting through a software-agnostic nonvisual lighting simulation for artificial and daylighting scenarios. Through this process, a new luminaire is created, called Drosa, that allows for a large melanopic stimulus range between 412 and 73 lx melanopic equivalent daylight (D65) illuminance vertically at eye level, while maintaining a neutral white illuminance at task level between 1250 and 900 lx, respectively. This is possible through a combination of glare-free spotlights with adjustable areal wing lights. An individually programmed automation system controls the light dosage and timing during the day and night. The work is relevant for other shift work scenarios, where the presented example and the discussed rationale behind the automation might provide insights. The work is further relevant for other lighting scenarios beyond industrial shift work, as the nonvisual lighting simulation process can be adapted to any context.

Assessment of the Light Exposures of Shift-working Nurses in London and Dortmund in Relation to Recommendations for Sleep and Circadian Health

Shift work causes disruption to circadian physiological processes in the human body, and desynchronization from the natural day-and-night rhythm. Circadian disruption is thought to explain the associations between shift work and various long-term diseases; light is an unrivalled synchronizer (or Zeitgeber) of circadian processes and inappropriate light exposure plausibly plays a critical role in the development of health impairments. As published measurement data on the actual light environments encountered by shift workers are sparse, nurses working in two hospitals in London (UK) and Dortmund (Germany) wore light-logging dosimetry devices to measure personal light exposures continuously over a week in three different seasons. The study identifies and quantifies several of the characteristics of light exposure related to different working patterns in winter, spring, and summer, and quantifies interindividual variations. These data enable informed design of light exposure interventions or changes to shifts to reduce unwanted effects of disruptive light exposure profiles.

Effects of general versus subarachnoid anaesthesia on circadian melatonin rhythm and postoperative delirium in elderly patients undergoing hip fracture surgery: A prospective cohort clinical trial

BACKGROUND

Circadian rhythm disturbance is common postoperatively in older patients with hip fractures, which may contribute to the development of postoperative delirium (POD). As a reliable biomarker of endogenous circadian rhythms, melatonin regulates the sleep-wake cycle and environmental adaptation, and its secretory rhythm may be modified by anaesthesia and surgery. This study compared the impact of subarachnoid anaesthesia (SA) and general anaesthesia (GA), on the peak of melatonin secretion (primary outcome), the circadian rhythm of melatonin, cortisol and sleep, and the POD incidence (secondary outcome).

METHODS

In this prospective cohort observational study, hip fracture surgery patients were enrolled and assigned to receive either SA or GA. Postoperative plasma melatonin and cortisol levels were dynamically measured every six hours on seven time-points, and the circadian rhythm parameters including mesor, amplitude, and acrophase were calculated. Subjective and objective sleep assessments were performed by sleep diaries and sleep trackers, respectively. The Confusion Assessment Method was used twice daily by a specific geriatrician to screen for POD occurrence.

FINDINGS

In a cohort of 138 patients who underwent hip fracture surgery, the circadian rhythm disruption of the patients in the GA group (n=69) was greater than the SA group (n=69). Compared with SA, GA provided the lower peak concentration, mesor, and amplitude of melatonin secretion on postoperative day 1 (p < 0.05). Patients in the GA group experienced higher awakenings, more sleep deprivation, and poor sleep quality on surgery day (p < 0.05). A proportion of 12 patients in the SA group (17.4%) and 24 patients in the GA group (34.8%) experienced POD (p = 0.020).

INTERPRETATION

These results suggest that SA may be superior to GA in elderly patients undergoing hip fracture surgery as SA is associated with less impairment of the melatonin rhythm and sleep patterns, and fewer POD occurrences.

FUNDING

The study was supported by the National Natural Science Foundation of China (81971012, 81873726, 81901095, 81701052, and 81801070), Key Clinical Projects of Peking University Third Hospital (BYSYZD2019027), and Peking University "Clinical Medicine plus X" Youth Project (PKU2020LCXQ016).

Sleep in Normal Aging, Homeostatic and Circadian Regulation and Vulnerability to Sleep Deprivation

In the context of geriatric research, a growing body of evidence links normal age-related changes in sleep with many adverse health outcomes, especially a decline in cognition in older adults. The most important sleep alterations that continue to worsen after 60 years involve sleep timing, (especially early wake time, phase advance), sleep maintenance (continuity of sleep interrupted by numerous awakenings) and reduced amount of sigma activity (during non-rapid eye movement (NREM) sleep) associated with modifications of sleep spindle characteristics (density, amplitude, frequency) and spindle-Slow Wave coupling. After 60 years, there is a very clear gender-dependent deterioration in sleep. Even if there are degradations of sleep after 60 years, daytime wake level and especially daytime sleepiness is not modified with age. On the other hand, under sleep deprivation condition, older adults show smaller cognitive impairments than younger adults, suggesting an age-related lower vulnerability to extended wakefulness. These sleep and cognitive age-related modifications would be due to a reduced homeostatic drive and consequently a reduced sleep need, an attenuation of circadian drive (reduction of sleep forbidden zone in late afternoon and wake forbidden zone in early morning), a modification of the interaction of the circadian and homeostatic processes and/or an alteration of subcortical structures involved in generation of circadian and homeostatic drive, or connections to the cerebral cortex with age. The modifications and interactions of these two processes with age are still uncertain, and still require further investigation. The understanding of the respective contribution of circadian and homeostatic processes in the regulation of neurobehavioral function with aging present a challenge for improving health, management of cognitive decline and potential early chronobiological or sleep-wake interventions.

Measurement of Circadian Effectiveness in Lighting for Office Applications

As one factor among others, circadian effectiveness depends on the spatial light distribution of the prevalent lighting conditions. In a typical office context focusing on computer work, the light that is experienced by the office workers is usually composed of a direct component emitted by the room luminaires and the computer monitors as well as by an indirect component reflected from the walls, surfaces, and ceiling. Due to this multi-directional light pattern, spatially resolved light measurements are required for an adequate prediction of non-visual light-induced effects. In this work, we therefore propose a novel methodological framework for spatially resolved light measurements that allows for an estimate of the circadian effectiveness of a lighting situation for variable field of view (FOV) definitions. Results of exemplary in-field office light measurements are reported and compared to those obtained from standard spectral radiometry to validate the accuracy of the proposed approach. The corresponding relative error is found to be of the order of 3–6%, which denotes an acceptable range for most practical applications. In addition, the impact of different FOVs as well as non-zero measurement angles will be investigated.

Time-Varying Light Exposure in Chronobiology and Sleep Research Experiments

Light exposure profoundly affects human physiology and behavior through circadian and neuroendocrine photoreception primarily through the melanopsin-containing intrinsically photosensitive retinal ganglion cells. Recent research has explored the possibility of using temporally patterned stimuli to manipulate circadian and neuroendocrine responses to light. This mini-review, geared to chronobiologists, sleep researchers, and scientists in adjacent disciplines, has two objectives: (1) introduce basic concepts in time-varying stimuli and (2) provide a checklist-based set of recommendations for documenting time-varying light exposures based on current best practices and standards.

Correlated color temperature and light intensity: Complementary features in non-visual light field

An appropriate exposure to the light-dark cycle, with high irradiances during the day and darkness during the night is essential to keep our physiology on time. However, considering the increasing exposure to artificial light at night and its potential harmful effects on health (i.e. chronodisruption and associated health conditions), it is essential to understand the non-visual effects of light in humans. Melatonin suppression is considered the gold standard for nocturnal light effects, and the activation of intrinsically photosensitive retinal ganglion cells (ipRGCs) through the assessment of pupillary light reflex (PLR) has been recently gaining attention. Also, some theoretical models for melatonin suppression and retinal photoreceptors activation have been proposed. Our aim in this study was to determine the influence of correlated color temperature (CCT) on melatonin suppression and PLR, considering two commercial light sources, as well as to explore the possible correlation between both processes. Also, the contribution of irradiance (associated to CCT) was explored through mathematical modelling on a wider range of light sources. For that, melatonin suppression and PLR were experimentally assessed on 16 healthy and young volunteers under two light conditions (warmer, CCT 3000 K; and cooler, CCT 5700 K, at ~5·1018 photons/cm2/sec). Our experimental results yielded greater post-stimulus constriction under the cooler (5700 K, 13.3 ± 1.9%) than under the warmer light (3000 K, 8.7 ± 1.2%) (p < 0.01), although no significant differences were found between both conditions in terms of melatonin suppression. Interestingly, we failed to demonstrate correlation between PLR and melatonin suppression. Although methodological limitations cannot be discarded, this could be due to the existence of different subpopulations of Type 1 ipRGCs differentially contributing to PLR and melatonin suppression, which opens the way for further research on ipRGCs projection in humans. The application of theoretical modelling suggested that CCT should not be considered separately from irradiance when designing nocturnal/diurnal illumination systems. Further experimental studies on wider ranges of CCTs and light intensities are needed to confirm these conclusions.

Reply to Bracke et al. Comment on "Prayag et al. Light Modulation of Human Clocks, Wake, and Sleep. Clocks&Sleep 2019, 1, 193-208"

We thank Bracke and colleagues [...].

The interindividual variability of sleep timing and circadian phase in humans is influenced by daytime and evening light conditions

Human cognitive functioning shows circadian variations throughout the day. However, individuals largely differ in their timing during the day of when they are more capable of performing specific tasks and when they prefer to sleep. These interindividual differences in preferred temporal organization of sleep and daytime activities define the chronotype. Since a late chronotype is associated with adverse mental and physical consequences, it is of vital importance to study how lighting environments affect chronotype. Here, we use a mathematical model of the human circadian pacemaker to understand how light in the built environment changes the chronotype distribution in the population. In line with experimental findings, we show that when individuals spend their days in relatively dim light conditions, this not only results in a later phase of their biological clock but also increases interindividual differences in circadian phase angle of entrainment and preferred sleep timing. Increasing daytime illuminance results in a more narrow distribution of sleep timing and circadian phase, and this effect is more pronounced for longer photoperiods. The model results demonstrate that modern lifestyle changes the chronotype distribution towards more eveningness and more extreme differences in eveningness. Such model-based predictions can be used to design guidelines for workplace lighting that help limiting circadian phase differences, and craft new lighting strategies that support human performance, health and wellbeing.

Biologically Relevant Lighting: An Industry Perspective

Innovations in LED lighting technology have led to tremendous adoption rates and vastly improved the metrics by which they are traditionally evaluated-including color quality, longevity, and energy efficiency to name a few. Additionally, scientific insight has broadened with respect to the biological impact of light, specifically our circadian rhythm. Indoor electric lighting, despite its many attributes, fails to specifically address the biological responses to light. Traditional electric lighting environments are biologically too dim during the day, too bright at night, and with many people spending much of their lives in these environments, it can lead to circadian dysfunction. The lighting industry's biological solution has been to create bluer days and yellower nights, but the technology created to do so caters primarily to the cones. A better call to action is to provide biologically brighter days and biologically darker nights within the built environment. However, current lighting design practices have specified the comfort and utility of electric light. Brighter intensity during the day can often be uncomfortable or glary, and reduced light intensity at night may compromise visual comfort and safety, both of which will affect user compliance. No single lighting solution will effectively create biologically brighter days and biologically darker nights, but rather a variety of parameters need to be considered. This paper discusses the contributions of spectral power distribution, hue or color temperature, spatial distribution, as well as architectural geometry and surface reflectivity, to achieve biologically relevant lighting.

luox: novel validated open-access and open-source web platform for calculating and sharing physiologically relevant quantities for light and lighting

Light exposure has a profound impact on human physiology and behaviour. For example, light exposure at the wrong time can disrupt our circadian rhythms and acutely suppress the production of melatonin. In turn, appropriately timed light exposure can support circadian photoentrainment. Beginning with the discovery that melatonin production is acutely suppressed by bright light more than 40 years ago, understanding which aspects of light drive the 'non-visual' responses to light remains a highly active research area, with an important translational dimension and implications for "human-centric" or physiologically inspired architectural lighting design. In 2018, the International Commission on Illumination (CIE) standardised the spectral sensitivities for predicting the non-visual effects of a given spectrum of light with respect to the activation of the five photoreceptor classes in the human retina: the L, M and S cones, the rods, and the melanopsin-containing intrinsically photosensitive retinal ganglion cells (ipRGCs). Here, we described a novel, lean, user-friendly, open-access and open-source platform for calculating quantities related to light. The platform, called luox, enables researchers and research users in chronobiology, sleep research and adjacent field to turn spectral measurements into reportable quantities. The luox code base, released under the GPL-3.0 License, is modular and therefore extendable to other spectrum-derived quantities. luox has been endorsed by the CIE following black-box validation.

Should We Re-think Regulations and Standards for Lighting at Workplaces? A Practice Review on Existing Lighting Recommendations

Nowadays lighting projects often include temporal variations of the light, both spectrally and in terms of intensity to consider non-visual effects of light on people. However, as of today there are no specific regulations. Compliance with common lighting standards that address visual aspects of light, often means that only little non-visually effective light reaches the eye. In this practice review we confront existing regulations and standards on visual lighting aspects with new recommendations on non-visual aspects and highlight conflicts among them. We conclude with lighting recommendations that address both aspects.

Modulations in irradiance directed at melanopsin, but not cone photoreceptors, reliably alter electrophysiological activity in the suprachiasmatic nucleus and circadian behaviour in mice

Intrinsically photosensitive retinal ganglion cells convey intrinsic, melanopsin-based, photoreceptive signals alongside those produced by rods and cones to the suprachiasmatic nucleus (SCN) circadian clock. To date, experimental data suggest that melanopsin plays a more significant role in measuring ambient light intensity than cone photoreception. Such studies have overwhelmingly used diffuse light stimuli, whereas light intensity in the world around us varies across space and time. Here, we investigated the extent to which melanopsin or cone signals support circadian irradiance measurements in the presence of naturalistic spatiotemporal variations in light intensity. To address this, we first presented high- and low-contrast movies to anaesthetised mice whilst recording extracellular electrophysiological activity from the SCN. Using a mouse line with altered cone sensitivity (Opn1mw^R mice) and multispectral light sources we then selectively varied irradiance of the movies for specific photoreceptor classes. We found that steps in melanopic irradiance largely account for the light induced-changes in SCN activity over a range of starting light intensities and in the presence of spatiotemporal modulation. By contrast, cone-directed changes in irradiance only influenced SCN activity when spatiotemporal contrast was low. Consistent with these findings, under housing conditions where we could independently adjust irradiance for melanopsin versus cones, the period lengthening effects of constant light on circadian rhythms in behaviour were reliably determined by melanopic irradiance, regardless of irradiance for cones. These data add to the growing evidence that modulating effective irradiance for melanopsin is an effective strategy for controlling the circadian impact of light.

luox: novel open-access and open-source web platform for calculating and sharing physiologically relevant quantities for light and lighting

Light exposure has a profound impact on human physiology and behaviour. For example, light exposure at the wrong time can disrupt our circadian rhythms and acutely suppress the production of melatonin. In turn, appropriately timed light exposure can support circadian photoentrainment. Beginning with the discovery that melatonin production is acutely suppressed by bright light more than 40 years ago, understanding which aspects of light drive the 'non-visual' responses to light remains a highly active research area, with an important translational dimension and implications for "human-centric" or physiologically inspired architectural lighting design. In 2018, the International Commission on Illumination (CIE) standardised the spectral sensitivities for predicting the non-visual effects of a given spectrum of light with respect to the activation of the five photoreceptor classes in the human retina: the L, M and S cones, the rods, and the melanopsin-containing intrinsically photosensitive retinal ganglion cells (ipRGCs). Here, we described a novel, lean, user-friendly, open-access and open-source platform for calculating quantities related to light. The platform, called luox, enables researchers and research users in chronobiology, sleep research and adjacent field to turn spectral measurements into reportable quantities. The luox code base, released under the GPL-3.0 License, is modular and therefore extendable to other spectrum-derived quantities.

Crystalline lens transmittance spectra and pupil sizes as factors affecting light-induced melatonin suppression in children and adults

PURPOSE

To investigate the contributions of ocular crystalline lens transmittance spectra and pupil size on age-related differences in the magnitude of light-induced melatonin suppression at night. The first aim was to demonstrate that spectral lens transmittance in children can be measured in vivo with a Purkinje image-based system. The second aim was to test the hypothesis that the magnitude of melatonin suppression in children is enhanced by larger pupils and higher lens transmittance of short wavelengths.

METHODS

Fourteen healthy children and 14 healthy adults participated in this study. The experiment was conducted for two nights in our laboratory. On the first night, the participants spent time under dim light conditions (<10 lux) until one hour after their habitual bedtime (BT+1.0). On the second night, the participants spent time under dim light conditions until 30 min before their habitual bedtime (BT-0.5). They were then exposed to LED light for 90 min up to BT+1.0. Individual pupil sizes were measured between BT and BT+1.0 for both conditions. Lens transmittance spectra were measured in vivo using the Purkinje image-based system during the daytime. Non-visual photoreception was calculated from lens transmittance and pupil size. This was taken as an index of the influence of age-related ocular changes on the non-visual photopigment melanopsin.

RESULTS

Measured lens transmittance in children was found to be higher than for adults, especially in the short wavelength region (p < 0.001). Pupil size in children was significantly larger than that of adults under both dim (p = 0.003) and light (p < 0.001) conditions. Children's non-visual photoreception was 1.48 times greater than that of adults, which was very similar to the finding that melatonin suppression was 1.52 times greater in children (n = 9) than adults (n = 9).

CONCLUSIONS

Our Purkinje image-based system can measure children's lens transmittance spectra in vivo. Lens transmittance and pupil size may contribute to differences in melatonin suppression between primary school children and middle-aged adults.

Intrinsically Photosensitive Retinal Ganglion Cells of the Human Retina

Light profoundly affects our mental and physical health. In particular, light, when not delivered at the appropriate time, may have detrimental effects. In mammals, light is perceived not only by rods and cones but also by a subset of retinal ganglion cells that express the photopigment melanopsin that renders them intrinsically photosensitive (ipRGCs). ipRGCs participate in contrast detection and play critical roles in non-image-forming vision, a set of light responses that include circadian entrainment, pupillary light reflex (PLR), and the modulation of sleep/alertness, and mood. ipRGCs are also found in the human retina, and their response to light has been characterized indirectly through the suppression of nocturnal melatonin and PLR. However, until recently, human ipRGCs had rarely been investigated directly. This gap is progressively being filled as, over the last years, an increasing number of studies provided descriptions of their morphology, responses to light, and gene expression. Here, I review the progress in our knowledge of human ipRGCs, in particular, the different morphological and functional subtypes described so far and how they match the murine subtypes. I also highlight questions that remain to be addressed. Investigating ipRGCs is critical as these few cells play a major role in our well-being. Additionally, as ipRGCs display increased vulnerability or resilience to certain disorders compared to conventional RGCs, a deeper knowledge of their function could help identify therapeutic approaches or develop diagnostic tools. Overall, a better understanding of how light is perceived by the human eye will help deliver precise light usage recommendations and implement light-based therapeutic interventions to improve cognitive performance, mood, and life quality.

Abrupt light transitions in illuminance and correlated colour temperature result in different temporal dynamics and interindividual variability for sensation, comfort and alertness

Detailed insights in both visual effects of light and effects beyond vision due to manipulations in illuminance and correlated color temperature (CCT) are needed to optimize study protocols as well as to design light scenarios for practical applications. This study investigated temporal dynamics and interindividual variability in subjective evaluations of sensation, comfort and mood as well as subjective and objective measures of alertness, arousal and thermoregulation following abrupt transitions in illuminance and CCT in a mild cold environment. The results revealed that effects could be uniquely attributed to changes in illuminance or CCT. No interaction effects of illuminance and CCT were found for any of these markers. Responses to the abrupt transitions in illuminance and CCT always occurred immediately and exclusively amongst the subjective measures. Most of these responses diminished over time within the 45-minute light manipulation. In this period, no responses were found for objective measures of vigilance, arousal or thermoregulation. Significant interindividual variability occurred only in the visual comfort evaluation in response to changes in the intensity of the light. The results indicate that the design of dynamic light scenarios aimed to enhance human alertness and vitality requires tailoring to the individual to create visually comfortable environments.

The Lighting Environment, Its Metrology, and Non-visual Responses

International standard CIE S 026:2018 provides lighting professionals and field researchers in chronobiology with a method to characterize light exposures with respect to non-visual photoreception and responses. This standard defines five spectral sensitivity functions that describe optical radiation for its ability to stimulate each of the five α-opic retinal photoreceptor classes that contribute to the non-visual effects of light in humans via intrinsically-photosensitive retinal ganglion cells (ipRGCs). The CIE also recently published an open-access α-opic toolbox that calculates all the quantities and ratios of the α-opic metrology in the photometric, radiometric and photon systems, based on either a measured (user-defined) spectrum or selected illuminants (A, D65, E, FL11, LED-B3) built into the toolbox. For a wide variety of ecologically-valid conditions, the melanopsin-based photoreception of ipRGCs has been shown to account for the spectral sensitivity of non-visual responses, from shifting the timing of nocturnal sleep and melatonin secretion to regulating steady-state pupil diameter. Recent findings continue to confirm that the photopigment melanopsin also plays a role in visual responses, and that melanopsin-based photoreception may have a significant influence on brightness perception and aspects of spatial vision. Although knowledge concerning the extent to which rods and cones interact with ipRGCs in driving non-visual effects is still growing, a CIE position statement recently used melanopic equivalent daylight (D65) illuminance in preliminary guidance on applying "proper light at the proper time" to manipulate non-visual responses. Further guidance on this approach is awaited from the participants of the 2nd International Workshop on Circadian and Neurophysiological Photometry (in Manchester, August 2019). The new α-opic metrology of CIE S 026 enables traceable measurements and a formal, quantitative specification of personal light exposures, photic interventions and lighting designs. Here, we apply this metrology to everyday light sources including a natural daylight time series, a range of LED lighting products and, using the toobox, to a smartphone display screen. This collection of examples suggests ways in which variations in the melanopic content of light over the day can be adopted in strategies that use light to support human health and well-being.

Daytime Exposure to Short Wavelength-Enriched Light Improves Cognitive Performance in Sleep-Restricted College-Aged Adults

We tested the effect of daytime indoor light exposure with varying melanopic strength on cognitive performance in college-aged students who maintained an enforced nightly sleep opportunity of 7 h (i.e., nightly sleep duration no longer than 7 h) for 1 week immediately preceding the day of light exposure. Participants (n = 39; mean age ± SD = 24.5 ± 3.2 years; 21 F) were randomized to an 8 h daytime exposure to one of four white light conditions of equal photopic illuminance (~50 lux at eye level in the vertical plane) but different melanopic illuminance [24–45 melanopic-EDI lux (melEDI)] generated by varying correlated color temperatures [3000K (low-melEDI) or 5000K (high-melEDI)] and spectra [conventional or daylight-like]. Accuracy on a 2-min addition task was 5% better in the daylight-like high-melEDI condition (highest melEDI) compared to the conventional low-melEDI condition (lowest melEDI; p < 0.01). Performance speed on the motor sequence learning task was 3.2 times faster (p < 0.05) during the daylight-like high-melEDI condition compared to the conventional low-melEDI. Subjective sleepiness was 1.5 times lower in the conventional high-melEDI condition compared to the conventional low-melEDI condition, but levels were similar between conventional low- and daylight-like high-melEDI conditions. These results demonstrate that exposure to high-melanopic (short wavelength-enriched) white light improves processing speed, working memory, and procedural learning on a motor sequence task in modestly sleep restricted young adults, and have important implications for optimizing lighting conditions in schools, colleges, and other built environments.

Modeling Circadian Phototransduction: Quantitative Predictions of Psychophysical Data

A revised computational model of circadian phototransduction is presented. The first step was to characterize the spectral sensitivity of the retinal circuit using suppression of the synthesis of melatonin by the pineal gland at night as the outcome measure. From the spectral sensitivity, circadian light was defined. Circadian light, thereby rectifies any spectral power distribution into a single, instantaneous photometric quantity. The second step was to characterize the circuit’s response characteristic to different amounts of circadian light from threshold to saturation. By doing so a more complete instantaneous photometric quantity representing the circadian stimulus was defined in terms of both the spectral sensitivity and the response magnitude characteristic of the circadian phototransduction circuit. To validate the model of the circadian phototransduction circuit, it was necessary to augment the model to account for different durations of the circadian stimulus and distribution of the circadian stimulus across the retina. Two simple modifications to the model accounted for the duration and distribution of continuous light exposure during the early biological night. A companion paper (https://www.frontiersin.org/articles/10.3389/fnins.2020.615305/full) provides a neurophysiological foundation for the model parameters.

Naturalistic Intensities of Light at Night: A Review of the Potent Effects of Very Dim Light on Circadian Responses and Considerations for Translational Research

In this review, we discuss the remarkable potency and potential applications of a form of light that is often overlooked in a circadian context: naturalistic levels of dim light at night (nLAN), equivalent to intensities produced by the moon and stars. It is often assumed that such low levels of light do not produce circadian responses typically associated with brighter light levels. A solid understanding of the impacts of very low light levels is complicated further by the broad use of the somewhat ambiguous term “dim light,” which has been used to describe light levels ranging seven orders of magnitude. Here, we lay out the argument that nLAN exerts potent circadian effects on numerous mammalian species, and that given conservation of anatomy and function, the efficacy of light in this range in humans warrants further investigation. We also provide recommendations for the field of chronobiological research, including minimum requirements for the measurement and reporting of light, standardization of terminology (specifically as it pertains to “dim” light), and ideas for reconsidering old data and designing new studies.

Human-Centric Lighting: Foundational Considerations and a Five-Step Design Process

At its best, human-centric lighting considers the visual and non-visual effects of light in support of positive human outcomes. At its worst, it is a marketing phrase used to healthwash lighting products or lighting design solutions. There is no doubt that environmental lighting contributes to human health, but how might one practice human-centric lighting given both the credible potential and the implausible hype? Marketing literature is filled with promises. Technical lighting societies have summarized the science but have not yet offered design guidance. Meanwhile, designers are in the middle, attempting to distinguish credible knowledge from that which is dubious to make design decisions that affect people directly. This article is intended to: (1) empower the reader with fundamental understandings of ways in which light affects health; (2) provide a process for human-centric lighting design that can dovetail with the decision-making process that is already a part of a designer's workflow.

Melanopic Limits of Metamer Spectral Optimisation in Multi-Channel Smart Lighting Systems

Modern indoor lighting faces the challenge of finding an appropriate balance between energy consumption, legal requirements, visual performance, and the circadian effectiveness of a spectrum. Multi-channel LED luminaires have the option of keeping image-forming metrics steady while varying the melanopic radiance through metamer spectra for non-visual purposes. Here, we propose the theoretical concept of an automated smart lighting system that is designed to satisfy the user’s visual preference through neural networks while triggering the non-visual pathway via metamers. To quantify the melanopic limits of metamers at a steady chromaticity point, we have used 561 chromaticity coordinates along the Planckian locus (2700 K to 7443 K, ±Duv 0 to 0.048) as optimisation targets and generated the spectra by using a 6-channel, 8-channel, and 11-channel LED combination at three different luminance levels. We have found that in a best-case scenario, the melanopic radiance can be varied up to 65% while keeping the chromaticity coordinates constant (Δu′v′≤7.05×10−5) by using metamer spectra. The highest melanopic metamer contrast can be reached near the Planckian locus between 3292 and 4717 K within a Duv range of −0.009 to 0.006. Additionally, we publish over 1.2 million optimised spectra generated by multichannel LED luminaires as an open-source dataset along with this work.

A Blue-Enriched, Increased Intensity Light Intervention to Improve Alertness and Performance in Rotating Night Shift Workers in an Operational Setting

PURPOSE

This study examined the efficacy of a lighting intervention that increased both light intensity and short-wavelength (blue) light content to improve alertness, performance and mood in night shift workers in a chemical plant.

PATIENTS AND METHODS

During rostered night shifts, 28 workers (46.0±10.8 years; 27 male) were exposed to two light conditions each for two consecutive nights (~19:00-07:00 h) in a counterbalanced repeated measures design: traditional-spectrum lighting set at pre-study levels (43 lux, 4000 K) versus higher intensity, blue-enriched lighting (106 lux, 17,000 K), equating to a 4.5-fold increase in melanopic illuminance (24 to 108 melanopic illuminance). Participants completed the Karolinska Sleepiness Scale, subjective mood ratings, and the Psychomotor Vigilance Task (PVT) every 2-4 hours during the night shift.

RESULTS

A significant main effect of time indicated KSS, PVT mean reaction time, number of PVT lapses (reaction times > 500 ms) and subjective tension, misery and depression worsened over the course of the night shift (p<0.05). Percentage changes in KSS (p<0.05, partial η²=0.14) and PVT mean reaction time (p<0.05, partial η²=0.19) and lapses (p<0.05, partial η²=0.17) in the middle and end of night shift, expressed relative to start of shift, were significantly improved during the lighting intervention compared to the traditional lighting condition. Self-reported mood did not significantly differ between conditions (p>0.05).

CONCLUSION

Our findings, showing improvements in alertness and performance with exposure to blue-enriched, increased intensity light, provide support for light to be used as a countermeasure for impaired alertness in night shift work settings.

Chrono-nutrition: From molecular and neuronal mechanisms to human epidemiology and timed feeding patterns

The circadian timing system governs daily biological rhythms, synchronising physiology and behaviour to the temporal world. External time cues, including the light-dark cycle and timing of food intake, provide daily signals for entrainment of the central, master circadian clock in the hypothalamic suprachiasmatic nuclei (SCN), and of metabolic rhythms in peripheral tissues, respectively. Chrono-nutrition is an emerging field building on the relationship between temporal eating patterns, circadian rhythms, and metabolic health. Evidence from both animal and human research demonstrates adverse metabolic consequences of circadian disruption. Conversely, a growing body of evidence indicates that aligning food intake to periods of the day when circadian rhythms in metabolic processes are optimised for nutrition may be effective for improving metabolic health. Circadian rhythms in glucose and lipid homeostasis, insulin responsiveness and sensitivity, energy expenditure, and postprandial metabolism, may favour eating patterns characterised by earlier temporal distribution of energy. This review details the molecular basis for metabolic clocks, the regulation of feeding behaviour, and the evidence for meal timing as an entraining signal for the circadian system in animal models. The epidemiology of temporal eating patterns in humans is examined, together with evidence from human intervention studies investigating the metabolic effects of morning compared to evening energy intake, and emerging chrono-nutrition interventions such as time-restricted feeding. Chrono-nutrition may have therapeutic application for individuals with and at-risk of metabolic disease and convey health benefits within the general population.

Light Pollution and Cancer

For many individuals in industrialized nations, the widespread adoption of electric lighting has dramatically affected the circadian organization of physiology and behavior. Although initially assumed to be innocuous, exposure to artificial light at night (ALAN) is associated with several disorders, including increased incidence of cancer, metabolic disorders, and mood disorders. Within this review, we present a brief overview of the molecular circadian clock system and the importance of maintaining fidelity to bright days and dark nights. We describe the interrelation between core clock genes and the cell cycle, as well as the contribution of clock genes to oncogenesis. Next, we review the clinical implications of disrupted circadian rhythms on cancer, followed by a section on the foundational science literature on the effects of light at night and cancer. Finally, we provide some strategies for mitigation of disrupted circadian rhythms to improve health.

The Effect of Blue-Enriched Lighting on Medical Error Rate in a University Hospital ICU

BACKGROUND

Fatigue-related errors that occur during patient care impose a tremendous socioeconomic impact on the health care system. Blue-enriched light has been shown to promote alertness and attention. The present study tested whether blue-enriched light can help to reduce medical errors in a university hospital adult ICU.

METHODS

In this interventional study, a blue-enriched white light emitting diode was used to enhance traditional fluorescent light at the nurse workstation and common areas in the ICU. Medical errors were identified retrospectively using an established two-step surveillance process. Suspected incidents of potential errors detected on nurse chart review were subsequently reviewed by two physicians blinded to lighting conditions, who made final classifications. Error rates were compared between the preintervention fluorescent and postintervention blue-enriched lighting conditions using Poisson regression.

RESULTS

The study included a total of 1,073 ICU admissions, 522 under traditional and 551 under interventional lighting (age range 17-97 years, mean age ± standard deviation 58.5 ± 15.8). No difference was found in overall medical error rate (harmful and non-harmful) pre- vs. postintervention, 45.5 vs. 42.7 per 1,000 patient-days (rate ratio: 0.94, 95% confidence interval = 0.71-1.23, p = 0.64).

CONCLUSION

Interventional lighting did not have an effect on overall medical error rate. The study was likely underpowered to detect the 25% error reduction predicted. Future studies are required that are powered to assess more modest effects for lighting to reduce the risk of fatigue-related medical errors and errors of differing severity.

Evening home lighting adversely impacts the circadian system and sleep

The regular rise and fall of the sun resulted in the development of 24-h rhythms in virtually all organisms. In an evolutionary heartbeat, humans have taken control of their light environment with electric light. Humans are highly sensitive to light, yet most people now use light until bedtime. We evaluated the impact of modern home lighting environments in relation to sleep and individual-level light sensitivity using a new wearable spectrophotometer. We found that nearly half of homes had bright enough light to suppress melatonin by 50%, but with a wide range of individual responses (0–87% suppression for the average home). Greater evening light relative to an individual’s average was associated with increased wakefulness after bedtime. Homes with energy-efficient lights had nearly double the melanopic illuminance of homes with incandescent lighting. These findings demonstrate that home lighting significantly affects sleep and the circadian system, but the impact of lighting for a specific individual in their home is highly unpredictable.

The Role of Light Sensitivity and Intrinsic Circadian Period in Predicting Individual Circadian Timing

There is large interindividual variability in circadian timing, which is underestimated by mathematical models of the circadian clock. Interindividual differences in timing have traditionally been modeled by changing the intrinsic circadian period, but recent findings reveal an additional potential source of variability: large interindividual differences in light sensitivity. Using an established model of the human circadian clock with real-world light recordings, we investigated whether changes in light sensitivity parameters or intrinsic circadian period could capture variability in circadian timing between and within individuals. Healthy participants (n = 12, aged 18-26 years) underwent continuous light monitoring for 3 weeks (Actiwatch Spectrum). Salivary dim-light melatonin onset (DLMO) was measured each week. Using the recorded light patterns, a sensitivity analysis for predicted DLMO times was performed, varying 3 model parameters within physiological ranges: (1) a parameter determining the steepness of the dose-response curve to light (p), (2) a parameter determining the shape of the phase-response curve to light (K), and (3) the intrinsic circadian period (tau). These parameters were then fitted to obtain optimal predictions of the three DLMO times for each individual. The sensitivity analysis showed that the range of variation in the average predicted DLMO times across participants was 0.65 h for p, 4.28 h for K, and 3.26 h for tau. The default model predicted the DLMO times with a mean absolute error of 1.02 h, whereas fitting all 3 parameters reduced the mean absolute error to 0.28 h. Fitting the parameters independently, we found mean absolute errors of 0.83 h for p, 0.53 h for K, and 0.42 h for tau. Fitting p and K together reduced the mean absolute error to 0.44 h. Light sensitivity parameters captured similar variability in phase compared with intrinsic circadian period, indicating they are viable targets for individualizing circadian phase predictions. Future prospective work is needed that uses measures of light sensitivity to validate this approach.

Influence of common lighting conditions and time-of-day on the effort-related cardiac response

Melanopic stimuli trigger diverse non-image-forming effects. However, evidence of a melanopic contribution to acute effects on alertness and performance is inconclusive, especially under common lighting situations. Effects on cognitive performance are likely mediated by effort-related physiological changes. We assessed the acute effects of lighting in three scenarios, at two times of day, on effort-related changes to cardiac contraction as indexed by the cardiac pre-ejection period (PEP). In a within-subject design, twenty-seven participants performed a cognitive task thrice during a morning and a late-afternoon session. We set the lighting at 500 lux in all three lighting scenarios, measured horizontally at the desk level, but with 54 lux, 128 lux, or 241 lux melanopic equivalent daylight illuminance at the eye level. Impedance cardiography and electrocardiography measurements were used to calculate PEP, for the baseline and task period. A shorter PEP during the task represents a sympathetic heart activation and therefore increased effort. Data were analysed with linear mixed-effect models. PEP changes depended on both the light scene and time of day (p = 0.01 and p = 0.002, respectively). The highest change (sympathetic activation) occurred for the medium one of the three stimuli (128 lux) during the late-afternoon session. However, effect sizes for the singular effects were small, and only for the combined effect of light and time of day middle-sized. Performance scores or self-reported scores on alertness and task demand did not change with the light scene. In conclusion, participants reached the same performance most efficiently at both the highest and lowest melanopic setting, and during the morning session. The resulting U-shaped relation between melanopic stimulus intensity and PEP is likely not dependent solely on intrinsic ipRGC stimuli, and might be moderated by extrinsic cone input. Since lighting situations were modelled according to current integrative lighting strategies and real-life indoor light intensities, the result has implications for artificial lighting in a work environment.

Phenotypic plasticity of circadian entrainment under a range of light conditions

The response to a zeitgeber, particularly the light/dark cycle, may vary phenotypically. Phenotypic plasticity can be defined as the ability of one genome to express different phenotypes in response to environmental variation. In this opinion paper, we present some evidence that one of the most prominent effects of the introduction of electric light to the everyday life of humans is a significant increase in phenotypic plasticity and differences in interindividual phases of entrainment. We propose that the healthy limits of phenotypic plasticity have been surpassed in contemporary society.

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Electric light increased phenotypic plasticity in humans and differences in interindividual phases of entrainment.

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Healthy limits of phenotypic plasticity have been surpassed in contemporary society.

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The correlation between biological time (DLMO) and behavioral time (MSFsc) is reduced in the population without access to electrical light.

Can Special Light Glasses Reduce Sleepiness and Improve Sleep of Nightshift Workers? A Placebo-Controlled Explorative Field Study

Nightshift workers go against the natural sleep-wake rhythm. Light can shift the circadian clock but can also induce acute alertness. This placebo-controlled exploratory field study examined the effectiveness of light glasses to improve alertness while reducing the sleep complaints of hospital nurses working nightshifts. In a crossover within-subjects design, 23 nurses participated, using treatment glasses and placebo glasses. Sleepiness and sleep parameters were measured. A linear mixed model analysis on sleepiness revealed no significant main effect of the light intervention. An interaction effect was found indicating that under the placebo condition, sleepiness was significantly higher on the first nightshift than on the last night, while under the treatment condition, sleepiness remained stable across nightshift sessions. Sleepiness during the commute home also showed a significant interaction effect, demonstrating that after the first nightshift, driver sleepiness was higher for placebo than for treatment. Subjective sleep quality showed a negative main effect of treatment vs. placebo, particularly after the first nightshift. In retrospect, both types of light glasses were self-rated as effective. The use of light glasses during the nightshift may help to reduce driver sleepiness during the commute home, which is relevant, as all participants drove home by car or (motor) bike.