Non-visual effects of light on melatonin, alertness and cognitive performance: can blue-enriched light keep us alert?

Exposure to Short Wavelength-Enriched White Light and Exercise Improves Alertness and Performance in Operational NASA Flight Controllers Working Overnight Shifts

OBJECTIVE

We evaluated the efficacy of a combined short-wavelength-enriched white light and exercise fatigue countermeasure during breaks for flight controllers working overnight shifts.

METHODS

Twenty NASA flight controllers were studied for two blocks of nightshifts in ISS mission control, randomized to either the control or countermeasure condition. The countermeasure constituted passive exposure to blue-enriched polychromatic lighting for three 20-minute intervals, which included 10 minutes of exercise and occurred before and twice during their shifts. Alertness, performance, and mood were evaluated.

RESULTS

Flight controllers reported being significantly more alert (P < 0.0001) and happy (P = 0.003) and had faster reaction times (10% slowest responses; P < 0.05) during the countermeasure condition compared to control.

CONCLUSIONS

The combined light and exercise countermeasure improved alertness, performance, and mood in shift workers overnight. Further research is necessary to determine their relative contribution.

Long-Term Narrowband Lighting Influences Activity but Not Intrinsically Photosensitive Retinal Ganglion Cell-Driven Pupil Responses

Purpose: Light affects a variety of non-image forming processes, such as circadian rhythm entrainment and the pupillary light reflex, which are mediated by intrinsically photosensitive retinal ganglion cells (ipRGCs). The purpose of this study was to assess the effects of long- and short-wavelength ambient lighting on activity patterns and pupil responses in rhesus monkeys. Methods: Infant rhesus monkeys were reared under either broadband "white" light (n = 14), long-wavelength "red" light (n = 20; 630 nm), or short-wavelength "blue" light (n = 21; 465 nm) on a 12-h light/dark cycle starting at 24.1 ± 2.6 days of age. Activity was measured for the first 4 months of the experimental period using a Fitbit activity tracking device and quantified as average step counts during the daytime (lights-on) and nighttime (lights-off) periods. Pupil responses to 1 s red (651 nm) and blue (456 nm) stimuli were measured after approximately 8 months. Pupil metrics included maximum constriction and the 6 s post-illumination pupil response (PIPR). Results: Activity during the lights-on period increased with age during the first 10 weeks (p < 0.001 for all) and was not significantly different for monkeys reared in white, red, or blue light (p = 0.07). Activity during the 12-h lights-off period was significantly greater for monkeys reared in blue light compared to those in white light (p = 0.02), but not compared to those in red light (p = 0.08). However, blue light reared monkeys exhibited significantly lower activity compared to both white and red light reared monkeys during the first hour of the lights-off period (p = 0.01 for both) and greater activity during the final hour of the lights-off period (p < 0.001 for both). Maximum pupil constriction and the 6 s PIPR to 1 s red and blue stimuli were not significantly different between groups (p > 0.05 for all). Conclusion: Findings suggest that long-term exposure to 12-h narrowband blue light results in greater disruption in nighttime behavioral patterns compared to narrowband red light. Normal pupil responses measured later in the rearing period suggest that ipRGCs adapt after long-term exposure to narrowband lighting.

In search of blue-light effects on cognitive control

People are constantly exposed to blue light while engaging in work. It is thus crucial to understand if vast exposure to blue light influences cognitive control, which is essential for working efficiently. Previous studies proposed that the stimulation of intrinsically photosensitive retinal ganglion cells (ipRGCs), a newly discovered photoreceptor that is highly sensitive to blue light, could modulate non-image forming functions. Despite studies that showed blue light (or ipRGCs) enhances brain activations in regions related to cognitive control, how exposure to blue light changes our cognitive control behaviorally remains elusive. We examined whether blue light influences cognitive control through three behavioral tasks in three studies: the sustained attention to response task (SART), the task-switching paradigm, and the Stroop task. Classic effects of the SART, switch cost, and the Stroop effect were found, but no differences were observed in results of different background lights across the six experiments. Together, we conclude that these domains of cognitive control are not influenced by blue light and ipRGCs, and whether the enhancement of blue light on brain activities extends to the behavioral level should be carefully re-examined.

The effects of bright light treatment on affective symptoms in people with dementia: a 24-week cluster randomized controlled trial

BACKGROUND

The majority of people with dementia have behavioral and psychological symptoms of dementia (BPSD), including depression, anxiety and agitation. These may be elicited or aggravated by disrupted circadian rhythms. Bright light treatment (BLT) is a promising non-pharmacological approach to the management of BPSD, but previous research has yielded mixed results.

METHODS

Eight nursing home dementia units (1 unit = 1 cluster) with 78 patients were invited to participate in a cluster randomized controlled trial from September 2017 to April 2018 investigating the effects of BLT on sleep and circadian rhythms (primary outcome) and BPSD (secondary outcome). Ceiling mounted LED-panels were installed in the intervention group (four units), providing light at 1000 lx and 6000 K (vertically at 1.2 m) between 10 a.m. and 3 p.m., with lower values in the mornings and evenings. Standard indoor light was used in the control group (four units). BPSD were assessed with The Cornell Scale for Depression in Dementia (CSDD) and the Neuropsychiatric Inventory Nursing Home Version (NPI-NH). Data collection took place at baseline and after 8, 16 and 24 weeks. Multilevel regression models with and without false discovery rate correction were used for the analysis, with baseline values and dementia stage entered as covariates.

RESULTS

Sixty-nine patients were included in the study at baseline. Compared to the control group, the intervention group had a larger reduction on the composite scores of both the CSDD (95% CI = - 6.0 - - 0.3) and the NPI-NH (95% CI = - 2.2 - - 0.1), as well as on the NPI-NH Affect sub-syndrome, and the CSDD Mood related signs sub-scale at follow-up after 16 weeks. With FDR correction, the group difference was significant on the CSDD Mood related signs sub-scale (95% CI = - 2.7 - - 0.8) and the NPI-NH Affect sub-syndrome (95% CI = - 1.6 - - 0.2). No differences were found between conditions at weeks 8 or 24.

CONCLUSION

Compared to the control condition, affective symptoms were reduced after 16 weeks in the group receiving BLT, suggesting BLT may be beneficial for nursing home patients with dementia.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03357328 . Retrospectively registered on November 29, 2017.

Effect of lighting illuminance and colour temperature on mental workload in an office setting

The mental workload of subjects was tested under different lighting conditions, with colour temperatures ranging from 3000 to 6500 K and illuminance ranging from 300 to 1000 lx. We used both psychological and physiological responses for evaluation. The former was based on NASA Task Load Index (NASA-TLX, NASA), and the latter was based on the electroencephalogram (EEG) P3b analysis of event-related potentials using the “oddball” paradigm experimental task. The results show that as illuminance increases, and the response time becomes longer with a colour temperature of 3000 K (P < 0.01). However, when the colour temperature is set at 6500 K, the response time becomes shorter as the illuminance increases (P < 0.01). P3b amplitudes were significantly affected by colour temperature (P = 0.009) and illuminance (P = 0.038) levels. The highest amplitudes occurred at 3000 K and 750 lx, which is consistent with the trend shown by the subjective scale. The data analysis of error rates is not significant. These results suggest that an office environment with a colour temperature of 3000 K and illumination of 750 lx, which exerts the lowest mental workload, is the most suitable for working. However, the interaction between colour temperature and illuminance in affecting the mental workload of participants is not clear. This work provides more appropriate lighting choices with colour temperature and illuminance to reduce people’s mental workload in office settings.

Factors Associated With Response to Pilot Home-Based Light Therapy for Fatigue Following Traumatic Brain Injury and Stroke

Background: Fatigue and sleep disturbance are common and debilitating problems after brain injury. Light therapy shows promise as a potential treatment. We conducted a trial of in-home light therapy to alleviate fatigue and sleep disturbance. The aim of the current study was to identify factors moderating treatment response.

Methods: Participants were 24 individuals with traumatic brain injury (TBI) (n = 19) or stroke (n = 5) reporting clinically significant fatigue. Outcomes included fatigue on Brief Fatigue Inventory (primary outcome), sleep disturbance on Pittsburgh Sleep Quality Index, reaction time (RT) on Psychomotor Vigilance Task and time spent in productive activity. Interactions of demographic and clinical variables with these outcomes were examined in linear mixed-model analyses.

Results: Whilst there were no variables found to be significantly associated with change in our primary outcome of fatigue, some variables revealed medium or large effect sizes, including chronotype, eye color, injury severity as measured by PTA, and baseline depressive symptoms. Chronotype significantly moderated sleep quality, with evening chronotype being associated with greater improvement during treatment. Injury type significantly predicted mean RT, with stroke participants exhibiting greater post-treatment reduction than TBI. Age significantly predicted productive activity during Treatment, with younger participants showing stronger Treatment effect.

Conclusion: Light therapy may have a greater impact on sleep in younger individuals and those with an evening chronotype. Older individuals may need higher treatment dose to achieve benefit.

Clinical Trial Registration:www.anzctr.org.au, identifier: ACTRN12617000866303.

The diversity of photosensitivity and its implications for light pollution

Artificial light at night (ALAN) is a pervasive anthropogenic pollutant, emanating from urban and suburban developments and reaching nearly all ecosystems from dense forests to coastlines. One proposed strategy for attenuating the consequences of ALAN is to modify its spectral composition to forms that are less disruptive for photosensory systems. However, ALAN is a complicated pollutant to manage due to the extensive variation in photosensory mechanisms and the diverse ways these mechanisms manifest in biological and ecological contexts. Here, we highlight the diversity in photosensitivity across taxa and the implications of this diversity in predicting biological responses to different forms of night lighting. We curated this paper to be broadly accessible and inform current decisions about the spectrum of electric lights used outdoors. We advocate that efforts to mitigate light pollution should consider the unique ways species perceive ALAN, as well as how diverse responses to ALAN scale up to produce diverse ecological outcomes.

Home-based light therapy for fatigue following acquired brain injury: a pilot randomized controlled trial

BACKGROUND AND OBJECTIVES

Fatigue and sleep disturbance are debilitating problems following brain injury and there are no established treatments. Building on demonstrated efficacy of blue light delivered via a lightbox in reducing fatigue and daytime sleepiness after TBI, this study evaluated the efficacy of a novel in-home light intervention in alleviating fatigue, sleep disturbance, daytime sleepiness and depressive symptoms, and in improving psychomotor vigilance and participation in daily productive activity, following injury METHODS: The impact of exposure to a dynamic light intervention (Treatment) was compared to usual lighting (Control) in a randomized within-subject, crossover trial. Outcomes were fatigue (primary outcome), daytime sleepiness, sleep disturbance, insomnia symptoms, psychomotor vigilance, mood and activity levels. Participants (N = 24, M ± SD_age = 44.3 ± 11.4) had mild-severe TBI or stroke > 3 months previously, and self-reported fatigue (Fatigue Severity Scale ≥ 4). Following 2-week baseline, participants completed each condition for 2 months in counter-balanced order, with 1-month follow-up. Treatment comprised daytime blue-enriched white light (CCT > 5000 K) and blue-depleted light (< 3000 K) 3 h prior to sleep.

RESULTS

Random-effects mixed-model analysis showed no significantly greater change in fatigue on the Brief Fatigue Inventory during Treatment, but a medium effect size of improvement (p = .33, d = -0.42). There were significantly greater decreases in sleep disturbance (p = .004), insomnia symptoms (p = .036), reaction time (p = .004) and improvements in productive activity (p = .005) at end of Treatment relative to Control, with large effect sizes (d > 0.80). Changes in other outcomes were non-significant.

CONCLUSIONS

This pilot study provides preliminary support for in-home dynamic light therapy to address sleep-related symptoms in acquired brain injury.

TRIAL REGISTRATION

This trial was registered with the Australian and New Zealand Clinical Trials Registry on 13 June 2017, www.anzctr.org.au , ACTRN12617000866303.

The effects of dynamic daylight-like light on the rhythm, cognition, and mood of irregular shift workers in closed environment

Shift workers are mostly suffered from the disruption of circadian rhythm and health problems. In this study, we designed proper light environment to maintain stable circadian rhythm, cognitive performance, and mood status of shift workers. We used five-channel light-emitting diodes to build up the dynamic daylight-like light environment. The illuminance, correlated color temperature, and circadian action factor of light were tunable in the ranges of 226 to 678 lx, 2680 to 7314 K, and 0.32 to 0.96 throughout the day (5:30 to 19:40). During the nighttime, these parameters maintained about 200 lx, 2700 K, and 0.32, respectively. In this light environment, three subjects had engaged in shift work for 38 consecutive days. We measured plasma melatonin, activity counts, continuous performance tests, and visual analogue scale on mood to assess the rhythm, cognitive performance, and mood of subjects. After 38-day shift work, the subjects' peak melatonin concentration increased significantly. Their physiological and behavioral rhythms maintained stable. Their cognitive performance improved significantly after night work, compared with that before night work. Their mood status had no significant change during the 38-day shift work. These results indicated that the light environment was beneficial to maintain circadian rhythm, cognitive performance and mood status during long-term shift work in closed environment.

Sleep in Older Adults and Its Possible Relations With COVID-19

Since the beginning of the COVID-19 pandemic, older adults have been found to be a highly vulnerable group, with a higher prevalence of severe cases and negative outcomes. Research has focused on the reasons why older adults are at greater risk; Sleep-related factors have been suggested as one possible explanation for this. An individual's sleep pattern undergoes significant changes over the course of their life. In older adults a specific sleep profile can be observed, one characterized by advanced sleep timing, a morningness preference, longer sleep-onset latency, shorter overall sleep duration, increased sleep fragmentation, reduced slow-wave sleep and, increased wake time after sleep onset. Additionally, an increased prevalence of sleep disorders can be observed, such as obstructive sleep apnea and insomnia. Previous research has already linked sleep disorders (especially sleep apnea) with COVID-19, but few studies have focused specifically on the older population. We believe that the intrinsic sleep patterns of older adults, and the prevalence of sleep disorders in this population, may be important factors that could explain why they are at a greater risk of negative COVID-19 outcomes. In this review, we discuss the relationship between sleep and COVID-19 among older adults, focusing on three different aspects: (1) Sleep-related issues that might increase the likelihood of getting infected by SARS-COV-2; (2) Sleep disturbances that might increase the predisposition to worse COVID-19 prognosis and outcomes; and (3) COVID-19-related aspects affecting community-dwelling older adults, such as social isolation, quarantine, and home confinement, among others, that might impact sleep.

Is the use of high correlated color temperature light at night related to delay of sleep timing in university students? A cross-country study in Japan and China

Background

Blue-enriched white light at night has the potential to delay the circadian rhythm in daily life. This study was conducted to determine whether the use of high correlated color temperature (CCT) light at home at night is associated with delay of sleep timing in university students.

Methods

The survey was conducted in 2014–2015 in 447 university students in Japan and 327 students in China. Habitual sleep timing and type of CCT light at home were investigated by using a self-administered questionnaire. The Japanese students were significantly later than the Chinese students in bedtime, wake time, and midpoint of sleep. They were asked whether the lighting in the room where they spend most of their time at night was closer to warm color (low CCT) or daylight color (high CCT). The amount of light exposure level during daily life was measured for at least 1 week by the use of a light sensor in 60 students in each country.

Results

The percentages of participants who used high CCT lighting at night were 61.6% for Japanese students and 80.8% for Chinese students. Bedtime and sleep onset time on school days and free days were significantly later in the high CCT group than in the low CCT group in Japan. The midpoint of sleep in the high CCT group was significantly later than that in the low CCT group on free days but not on school days. On the other hand, none of the sleep measurements on school days and free days were significantly different between the high CCT and low CCT groups in China. Illuminance level of light exposure during the night was significantly higher in Japanese than in Chinese, but that in the morning was significantly higher in China than in Japan.

Conclusions

The use of high CCT light at night is associated with delay of sleep timing in Japanese university students but not in Chinese university students. The effects of light at night on sleep timing and circadian rhythm may be complicated by other lifestyle factors depending on the country.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40101-021-00257-x.

Does Bright Light Counteract the Post-lunch Dip in Subjective States and Cognitive Performance Among Undergraduate Students?

The post-lunch dip in alertness and performance was widely experienced during the early afternoon. Taking a short nap was documented as a practical strategy for habitual nappers to counteract the decline of alertness and performance. Yet, it remains unknown whether bright light exposure in the early afternoon working hours could alleviate the performance deficits caused by a post-lunch nap loss for habitual nappers. Seventeen undergraduate students who had a long-term habit of taking a post-lunch nap were assigned to three interventions: (1) a short nap + normal indoor light (100 lx, 4,000 K at eye level); (2) no nap + normal indoor light, and (3) no nap + blue-enriched bright light (1,000 lx, 6,500 K at eye level), in which subjective alertness (Karolinska Sleepiness Scale, KSS), mood (Positive and Negative Affect Schedule, PANAS), and task performance in sustained attention (psychomotor vigilance test, PVT), response inhibition (go/no-go task), and working memory (paced visual serial addition test, PVSAT) were measured. Results showed that a post-lunch nap deprivation significantly increased subjective sleepiness and negative mood and impaired performance in PVT and PVSAT, while exposure to bright blue-enriched white light vs. normal indoor light in the early afternoon significantly relieved such negative effects on mood, sleepiness, and performance in PVSAT; subjective positive mood and performance in PVT and go/no-go task remained unaffected with light intervention. These findings suggested that bright blue-enriched white light exposure could be a potential strategy for those who are suffering from drowsiness and low working memory following a habitual midday nap loss.

Positive effect of timed blue-enriched white light on sleep and cognition in patients with mild and moderate Alzheimer's disease

Conflicting results have been reported regarding the effectiveness of light treatment (LT) in patients with Alzheimer's disease (AD). We investigated the effectiveness of blue-enriched white LT on sleep, cognition, mood and behavior in patients with mild and moderate AD. The treatment group (n = 14) sat about 60 cm away from a small (136 × 73 × 16 mm) LED light box for 1 h each morning for 2 weeks. The control group (n = 11) wore dark, blue-attenuating sunglasses during the 1 h exposures. The morning light started 9-10 h after each individual's dim light melatonin onset (DLMO). Assessments were done at baseline (T0), immediate post-treatment (T1), and 4 weeks after the end of the 2 weeks of LT (T2). Sleep was measured by actigraphy. Blue-enriched LT had a significantly better effect on the Pittsburgh Sleep Quality Index at T2 compared to blue-attenuated LT, and a trend of better effectiveness on total sleep time at T2. There was a significant increase in Mini-Mental State Examination score at T2 after blue-enriched LT than that at T0. Our findings suggest that morning blue-enriched LT has a benefit in improving sleep and cognitive function in AD patients.

Increase in cortisol concentration due to standardized bright and blue light exposure on saliva cortisol in the morning following sleep laboratory

Research studies on LED light exposure and cortisol are inconsistent and not comparable due to different types of light, exposure times, and sample sizes. Therefore, one hour of standardized exposure LED light at different intensities and the spectral composition during the post-awakening phase at 7:30 were compared. A sample of 23 (Study 1) and 26 (Study 2) healthy males were randomly assigned to: 1) bright white light (414 lux) and 2) dim darkened light (<2 lux) as well as 3) red light (235 lux) and 4) blue light (201 lux) exposure conditions. Results from repeated measures ANOVA confirm that light exposure affects the cortisol concentration. Study 1 revealed an increase in the saliva cortisol concentration after bright light exposure compared to dim light. An increase in the cortisol concentration of blue light compared to red light (Study 2) and dim light was found. This study shows that bright light and blue light affect the cortisol response in contrast to dim light and red light conditions. The HPA axis showed a stimulatory effect by bright versus dim light and different wavelengths of light exposure.Lay summaryThe effects of LED light exposure on the stress hormone cortisol were investigated. The light exposure took place during the hours people would start working at the office. The results showed that after one hour of exposure to bright light or blue light the stress hormones increase in contrast to dim light and red light conditions. Thus, stress hormones can be altered by the types of light people are exposed to.

Individual differences in light sensitivity affect sleep and circadian rhythms

Artificial lighting is omnipresent in contemporary society with disruptive consequences for human sleep and circadian rhythms because of overexposure to light, particularly in the evening/night hours. Recent evidence shows large individual variations in circadian photosensitivity, such as melatonin suppression, due to artificial light exposure. Despite the emerging body of research indicating that the effects of light on sleep and circadian rhythms vary dramatically across individuals, recommendations for appropriate light exposure in real-life settings rarely consider such individual effects. This review addresses recently identified links among individual traits, for example, age, sex, chronotype, genetic haplotypes, and the effects of evening/night light on sleep and circadian hallmarks, based on human laboratory and field studies. Target biological mechanisms for individual differences in light sensitivity include differences occurring within the retina and downstream, such as the central circadian clock. This review also highlights that there are wide gaps of uncertainty, despite the growing awareness that individual differences shape the effects of evening/night light on sleep and circadian physiology. These include (1) why do certain individual traits differentially affect the influence of light on sleep and circadian rhythms; (2) what is the translational value of individual differences in light sensitivity in populations typically exposed to light at night, such as night shift workers; and (3) what is the magnitude of individual differences in light sensitivity in population-based studies? Collectively, the current findings provide strong support for considering individual differences when defining optimal lighting specifications, thus allowing for personalized lighting solutions that promote quality of life and health.

Changing color and intensity of LED lighting across the day impacts on circadian melatonin rhythms and sleep in healthy men

We examined whether dynamically changing light across a scheduled 16-h waking day influences sleepiness, cognitive performance, visual comfort, melatonin secretion, and sleep under controlled laboratory conditions in healthy men. Fourteen participants underwent a 49-h laboratory protocol in a repeated-measures study design. They spent the first 5 hours in the evening under standard lighting, followed by an 8-h nocturnal sleep episode at habitual bedtimes. Thereafter, volunteers either woke up to static light or to a dynamic light that changed spectrum and intensity across the scheduled 16-h waking day. Following an 8-h nocturnal sleep episode, the volunteers spent another 11 hours either under static or dynamic light. Static light attenuated the evening rise in melatonin levels more compared to dynamic light as indexed by a significant reduction in the melatonin AUC prior to bedtime during static light only. Participants felt less vigilant in the evening during dynamic light. After dynamic light, sleep latency was significantly shorter in both the baseline and treatment night while sleep structure, sleep quality, cognitive performance, and visual comfort did not significantly differ. The study shows that dynamic changes in spectrum and intensity of light promote melatonin secretion and sleep initiation in healthy men.

Exposure to Blue Wavelength Light Is Associated With Increases in Bidirectional Amygdala-DLPFC Connectivity at Rest

Blue wavelength light has been used successfully as a treatment method for certain mood disorders, but, the underlying mechanisms behind the mood enhancing effects of light remain poorly understood. We investigated the effects of a single dose of 30 min of blue wavelength light (n = 17) vs. amber wavelength light (n = 12) exposure in a sample of healthy adults on subsequent resting-state functional and directed connectivity, and associations with changes in state affect. Individuals who received blue vs. amber wavelength light showed greater positive connectivity between the right amygdala and a region within the left dorsolateral prefrontal cortex (DLPFC). In addition, using granger causality, the findings showed that individuals who received blue wavelength light displayed greater bidirectional information flow between these two regions relative to amber light. Furthermore, the strength of amygdala-DLPFC functional connectivity was associated with greater decreases in negative mood for the blue, but not the amber light condition. Blue light exposure may positively influence mood by modulating greater information flow between the amygdala and the DLPFC, which may result in greater engagement of cognitive control strategies that are needed to perceive and regulate arousal and mood.

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.

Classrooms' indoor environmental conditions affecting the academic achievement of students and teachers in higher education: A systematic literature review

This study reports the outcomes of a systematic literature review, which aims to determine the influence of four indoor environmental parameters - indoor air, thermal, acoustic, and lighting conditions -on the quality of teaching and learning and on students' academic achievement in schools for higher education, defined as education at a college or university. By applying the Cochrane Collaboration Method, relevant scientific evidence was identified by systematically searching in multiple databases. After the screening process, 21 publications of high relevance and quality were included. The collected evidence showed that the indoor environmental quality (IEQ) can contribute positively to the quality of learning and short-term academic performance of students. However, the influence of all parameters on the quality of teaching and the long-term academic performance could not be determined yet. Students perform at their best in different IEQ conditions, and these conditions are task-dependent, suggesting that classrooms which provide multiple IEQ classroom conditions facilitate different learning tasks optimally. In addition, the presented evidence illuminates how to examine the influence of the IEQ on users. Finally, this information supports decision-makers in facility management and building systems engineering to improve the IEQ, and by doing so, allow teachers and students to perform optimally.

Age-related neuroendocrine and alerting responses to light

Aging is associated with sleep and circadian alterations, which can negatively affect quality of life and longevity. Importantly, the age-related reduction in light sensitivity, particularly in the short-wavelength range, may underlie sleep and circadian alterations in older people. While evidence suggests that non-image-forming (NIF) light responses may diminish in older individuals, most laboratory studies have low sample sizes, use non-ecological light settings (e.g., monochromatic light), and typically focus on melatonin suppression by light. Here, we investigated whether NIF light effects on endogenous melatonin levels and sleep frontal slow-wave activity (primary outcomes), and subjective sleepiness and sustained attention (secondary outcomes) attenuate with aging. We conducted a stringently controlled within-subject study with 3 laboratory protocols separated by ~ 1 week in 31 young (18-30 years; 15 women) and 16 older individuals (55-80 years; eight women). Each protocol included 2 h of evening exposure to commercially available blue-enriched polychromatic light (6500 K) or non-blue-enriched light (3000 K or 2500 K) at low levels (~ 40 lx, habitual in evening indoor settings). Aging significantly affected the influence of light on endogenous melatonin levels, subjective sleepiness, sustained attention, and frontal slow-wave activity (interaction: P < 0.001, P = 0.004, P = 0.007, P = 0.001, respectively). In young individuals, light exposure at 6500 K significantly attenuated the increase in endogenous melatonin levels, improved subjective sleepiness and sustained attention performance, and decreased frontal slow-wave activity in the beginning of sleep. Conversely, older individuals did not exhibit signficant differential light sensitivity effects. Our findings provide evidence for an association of aging and reduced light sensitivity, with ramifications to sleep, cognition, and circadian health in older people.

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.

Blue-wavelength light therapy for post-traumatic brain injury sleepiness, sleep disturbance, depression, and fatigue: A systematic review and network meta-analysis

OBJECTIVE

This review aimed to determine the efficacy of blue-wavelength light therapy (BWLT) for post-traumatic brain injury (TBI) sleepiness, sleep disturbance, depression, and fatigue.

METHODS

Pubmed, Scopus, Web of Science, Cochrane Library, Academic Search Complete, and CINAHL. Included trials were randomized controlled trials (RCTs) of BWLT in adults with a history of TBI. Outcomes of interest included sleepiness, sleep disturbance, depression, or fatigue. Two reviewers independently screened the searched items, selected the trials, extracted the data, and rating the quality of trials. We aggregated the data using a random-effect, frequentist network meta-analysis (NMA).

RESULTS

We searched the databases on July 4, 2020. This review included four RCTs of 117 patients with a history of TBI who were randomized to received BWLT, amber light therapy (ALT), or no light therapy (NLT). Moderate-quality evidence revealed that: i) BWLT was significantly superior to NLT in reducing depression (SMD = 0.81, 95% CI = 0.20 to 1.43) ii) BWLT reduced fatigue at a significantly greater extent than NLT (SMD = 1.09, 95% CI = 0.41 to 1.76) and ALT (SMD = 1.00, 95% CI = 0.14 to 1.86). Low-quality evidence suggested that BWLT reduced depression at a greater extent than ALT (SMD = 0.57, 95% CI = 0.04 to 1.10). Low-quality evidence found that the dropout rates of those receiving BWLT and ALT were not significantly different (RR = 3.72, 95% CI = 0.65 to 21.34).

CONCLUSION

Moderate-quality evidence suggests that BWLT may be useful for post-TBI depression and fatigue.

The effects of short-term light exposure on subjective affect and comfort are dependent on the lighting time of day

Light, one of the key environmental components for both life and work, played significant role in subjective feelings (e.g. affect and comfort), but the exact effects and mechanisms were still to be determined. The present study screened thirty healthy adults (13 females, 22.45 ± 3.26 years) and examined subjective affect and comfort under short-term white lights with different combination of correlated color temperature (CCT) and illuminance at different times of day (e.g. morning, afternoon, and evening). Our results showed a significant interaction between illuminance level and time-of-day on subjective comfort. Participants felt more comfortable under 50 lx and 100 lx instead of 500 lx in the evening, and more comfortable under 500 lx in the morning and afternoon. In addition, a positive correlation between illuminance and comfort in the morning and a negative correlation between them in the evening were found. No significant effect of CCT on any subjective feeling was revealed. Our results necessitate the consideration of time-of-day in understanding lighting effects and application of healthy lighting in daily life.

Preliminary Results: The Impact of Smartphone Use and Short-Wavelength Light during the Evening on Circadian Rhythm, Sleep and Alertness

Smartphone usage strongly increased in the last decade, especially before bedtime. There is growing evidence that short-wavelength light affects hormonal secretion, thermoregulation, sleep and alertness. Whether blue light filters can attenuate these negative effects is still not clear. Therefore, here, we present preliminary data of 14 male participants (21.93 ± 2.17 years), who spent three nights in the sleep laboratory, reading 90 min either on a smartphone (1) with or (2) without a blue light filter, or (3) on printed material before bedtime. Subjective sleepiness was decreased during reading on a smartphone, but no effects were present on evening objective alertness in a GO/NOGO task. Cortisol was elevated in the morning after reading on the smartphone without a filter, which resulted in a reduced cortisol awakening response. Evening melatonin and nightly vasodilation (i.e., distal-proximal skin temperature gradient) were increased after reading on printed material. Early slow wave sleep/activity and objective alertness in the morning were only reduced after reading without a filter. These results indicate that short-wavelength light affects not only circadian rhythm and evening sleepiness but causes further effects on sleep physiology and alertness in the morning. Using a blue light filter in the evening partially reduces these negative effects.

Individual Differences in Hemodynamic Responses Measured on the Head Due to a Long-Term Stimulation Involving Colored Light Exposure and a Cognitive Task: A SPA-fNIRS Study

When brain activity is measured by neuroimaging, the canonical hemodynamic response (increase in oxygenated hemoglobin ([O2Hb]) and decrease in deoxygenated hemoglobin ([HHb]) is not always seen in every subject. The reason for this intersubject-variability of the responses is still not completely understood. This study is performed with 32 healthy subjects, using the systemic physiology augmented functional near-infrared spectroscopy (SPA-fNIRS) approach. We investigate the intersubject variability of hemodynamic and systemic physiological responses, due to a verbal fluency task (VFT) under colored light exposure (CLE; blue and red). Five and seven different hemodynamic response patterns were detected in the subgroup analysis of the blue and red light exposure, respectively. We also found that arterial oxygen saturation and mean arterial pressure were positively correlated with [O2Hb] at the prefrontal cortex during the CLE-VFT independent of the color of light and classification of the subjects. Our study finds that there is substantial intersubject-variability of cerebral hemodynamic responses, which is partially explained by subject-specific systemic physiological changes induced by the CLE-VFT. This means that both subgroup analyses and the additional assessment of systemic physiology are of crucial importance to achieve a comprehensive understanding of the effects of a CLE-VFT on human subjects.

Non-visual effects of indoor light environment on humans: A review✰

As a result of the desire to improve living standards, increasing attention is paid to creating a comfortable and healthy lighting environment that contributes to human health and well-being. It is crucial to understand the effects of environmental lighting regulation on humans' physical responses and mental activities. In this review, we focus on the scientific research on light-induced non-visual effects on humans, providing a systematic review of how the quantity of light, spectral changes, time of day, and duration have effects on the circadian rhythm, alertness, and mood based on eligible literature. The key findings are as follows: (1) The increase of illuminance and correlated colour temperature (CCT) at night were both positively associated with melatonin suppression, thus affecting the circadian rhythm. Meanwhile, a high CCT is conducive to the stimulation of positive mood. (2) Blue light and high CCT light at night induced delayed phase shift, and the objective alertness was reduced under the condition of lack of blue components. (3) High illuminance was positively correlated with subjective alertness during daytime, and increased the positive mood in the morning and decreased it in the afternoon. These findings serve as an important reference for stakeholders to optimise lighting in constructed environments to improve health and well-being considering the non-visual effects above and beyond visual performance.

Effects of Parental Education on Screen Time, Sleep Disturbances, and Psychosocial Adaptation Among Asian Preschoolers: A Randomized Controlled Study

PURPOSE

A recent increase in screen time during early childhood has adversely affected the sleep and psychosocial health of children; however, limited information is available regarding effective interventions to reduce the screen time among them. This study aimed to investigate the effect of a parental educational program on screen use, sleep quality, and psychosocial adaptation among preschoolers.

DESIGN AND METHODS

A clustered randomized controlled study with a parallel-group design was conducted. Preschoolers with a screen time of ≥2 h/day and their parents were recruited. In total, 14 kindergartens containing 129 parent-child dyads were randomly allocated to either the experimental group (receiving parental education, N = 63 dyads) or the control group (daily activities, N = 66 dyads). Data were collected before and after the intervention. A screen time questionnaire, the Children's Sleep Habits Questionnaire, and the Pediatric Symptom checklist-17 were provided to the participants. A linear mixed-model analysis was performed to examine the efficacy of the intervention.

RESULTS

After the intervention, the screen time of children in the experimental group was significantly reduced (effect size: 0.83, p < .001), and they presented improved sleep quality (effect size: 0.57, p = .01) and attention score (effect size: 0.77, p = .02) for psychosocial adaptation.

CONCLUSIONS

Parental education is an effective intervention for reducing screen time and improving sleep quality and attention among preschoolers.

PRACTICE IMPLICATIONS

Healthcare professionals should consider implementing parental educational programs to reduce screen time, and thus improve the sleep quality and psychosocial health of preschoolers.

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.

A Hybrid Effectiveness-Implementation Study of a Multi-Component Lighting Intervention for Hospital Shift Workers

Simple lighting solutions may mitigate the harmful effects of shiftwork. This hybrid effectiveness-implementation study evaluated a multi-component lighting intervention in hospital nurses that included 6500 K architectural lighting in the nurses' station plus optional behavioral components (a lightbox, blueblocker glasses, eyemasks) with instruction about appropriately timed usage. Selective improvements from baseline were observed in on-shift performance, sleep quality, and caffeine consumption in day workers (all p < 0.05); off-shift sleepiness scores improved for night workers (p < 0.05). Further, self-reported measures of quality of life improved for both groups (p < 0.05). Preliminary implementation data from interviews and questionnaires suggest perceived benefits and high acceptability of the intervention.

A Review of Silent Substitution Devices for Melanopsin Stimulation in Humans

One way to study the specific response of the non-visual melanopsin photoreceptors of the human eye is to silence the response of cones and rods. Melanopsin photoreceptors (ipRGC), highlighted in the early 2000s, are intimately linked to the circadian rhythm and therefore to our sleep and wakefulness. Rest and sleep regulation, health and cognitive functions are all linked to ipRGC and play an important role in work and human relationships. Thus, we believe that the study of ipRGC responses is important.We searched and reviewed scientific articles describing instrumentation dedicated to these studies. PubMed lists more than 90,000 articles created since the year 2000 that contain the word circadian but only 252 with silent substitution. In relation to melanopsin, we found 39 relevant articles from which only 11 give a device description for humans, which is incomplete in most cases. We did not find any consensus for light intensity description, melanopsin contrast, sequences of melanopsin light stimulation and optical setup to expose the retina to the light.

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.

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.

Red visual stimulation in the Ganzfeld leads to a relative overestimation of duration compared to green

A Ganzfeld is a homogenized visual and auditory perceptual field which can induce altered states of consciousness (ASC; Metzger, 1929; Schmidt & Prein, 2019). Using a balanced intrasubject design, we compared participants' experience during two differently colored (red, green) 25-min Ganzfeld sessions with brown noise as acoustic stimulation. Participants were exposed to the colored visual field through commercially available goggles and to brown noise over headphones. We selected 67 participants with some prior meditation experience to increase the probability that they would engage meaningfully with this specifically restricted stimulus situation. We tested the functional components of the standard cognitive model of time perception (Zakay & Block, 1997) in a path analysis for direct (red vs. green light) and indirect effects (arousal, attention) on subjective duration and perceived passage of time. Subjective arousal and valence states were measured using the Self-Assessment Manikin (SAM). The amount of attention directed to time and the perceived passage of time were rated with standard visual analog scales (VAS). Participants also estimated the duration of each Ganzfeld exposure. The session with the red visual field lasted significantly longer than did the green session (μ_red = 23.1 min; μ_green = 19.8 min). After the green session, participants rated their arousal level to have significantly decreased; after the red session, individuals on average felt emotionally less positive. Multiple path analyses revealed that the effect of color on estimated duration is completely mediated through higher arousal levels during the red Ganzfeld session. In turn, the higher arousal level generates a longer subjective estimate of duration. For induction of relaxation in studies probing altered states of consciousness employing the Ganzfeld technique, we recommend using the green light.

Effects of a blue-blocking screen filter on accommodative accuracy and visual discomfort

INTRODUCTION

The prescription of blue-blocking (B-B) filters for the management of visual symptoms and signs associated with the use of electronic devices is routinely performed by eye care specialists. However, the utility of B-B filters is a matter of debate and discussion by the scientific community due to the lack of evidence supporting their use. Here, we aimed to determine the effects of using B-B filters on the dynamics of the accommodative response and pupil size and perceived levels of visual discomfort, while performing a 30-min reading task at a close distance in subjects who routinely use electronic devices.

METHODS

Nineteen healthy young adults (22.0 ± 2.7 years) read two 30-min passages on a computer screen placed at 50 cm, either while using a commercially available B-B filter or without any filter on two different days. The magnitude and variability of both the accommodative response and pupil size were dynamically measured for 60 s using the WAM-5500 open field autorefractometer at 4-5, 9-10, 14-15, 19-20, 24-25, and 29-30 min into the trial. The perceived levels of visual discomfort were also obtained.

RESULTS

The lag and variability of accommodation were insensitive to the blue light level (p = 0.34 and 0.62, respectively). There was a time-on-task effect for the variability of accommodation, showing greater instability over time regardless of the blue light level. The use of the B-B filter was associated with improved reading speed (p = 0.02), with an increase of 16.5 words per minute. However, it was not associated with any significant change in pupil dynamics or the perceived levels of visual discomfort (p> 0.05 in both cases).

CONCLUSIONS

Our data showed that the use of a B-B filter had no effect on accommodative dynamics or visual symptomatology. Based on these findings, there is no support for the prescription of B-B filters to attenuate the visual symptoms and signs associated with the use of electronic devices in healthy young adults.

Modeling melanopsin-mediated effects of light on circadian phase, melatonin suppression, and subjective sleepiness

A physiologically based model of arousal dynamics is improved to incorporate the effects of the light spectrum on circadian phase resetting, melatonin suppression, and subjective sleepiness. To account for these nonvisual effects of light, melanopic irradiance replaces photopic illuminance that was used previously in the model. The dynamic circadian oscillator is revised according to the melanopic irradiance definition and tested against experimental circadian phase resetting dose-response and phase response data. Melatonin suppression function is recalibrated against melatonin dose-response data for monochromatic and polychromatic light sources. A new light-dependent term is introduced into the homeostatic weight component of subjective sleepiness to represent the direct alerting effect of light; the new term responds to light change in a time-dependent manner and is calibrated against experimental data. The model predictions are compared to a total of 14 experimental studies containing 26 data sets for 14 different spectral light profiles. The revised melanopic model shows on average 1.4 times lower prediction error for circadian phase resetting compared to the photopic-based model, 3.2 times lower error for melatonin suppression, and 2.1 times lower error for subjective sleepiness. Overall, incorporating melanopic irradiance allowed simulation of wavelength-dependent responses to light and could explain the majority of the observations. Moving forward, models of circadian phase resetting and the direct effects of light on alertness and sleep need to use nonvisual photoreception-based measures of light, for example, melanopic irradiance, instead of the traditionally used illuminance based on the visual system.

Blue-Enriched White Light Improves Performance but Not Subjective Alertness and Circadian Adaptation During Three Consecutive Simulated Night Shifts

Use of blue-enriched light has received increasing interest regarding its activating and performance sustaining effects. However, studies assessing effects of such light during night work are few, and novel strategies for lighting using light emitting diode (LED) technology need to be researched. In a counterbalanced crossover design, we investigated the effects of a standard polychromatic blue-enriched white light (7000 K; ∼200 lx) compared to a warm white light (2500 K), of similar photon density (∼1.6 × 1014 photons/cm2/s), during three consecutive simulated night shifts. A total of 30 healthy participants [10 males, mean age 23.3 (SD = 2.9) years] were included in the study. Dependent variables comprised subjective alertness using the Karolinska Sleepiness Scale, a psychomotor vigilance task (PVT) and a digit symbol substitution test (DSST), all administered at five time points throughout each night shift. We also assessed dim-light melatonin onset (DLMO) before and after the night shifts, as well as participants' opinion of the light conditions. Subjective alertness and performance on the PVT and DSST deteriorated during the night shifts, but 7000 K light was more beneficial for performance, mainly in terms of fewer errors on the PVT, at the end of the first- and second- night shift, compared to 2500 K light. Blue-enriched light only had a minor impact on PVT response times (RTs), as only the fastest 10% of the RTs were significantly improved in 7000 K compared to 2500 K light. In both 7000 and 2500 K light, the DLMO was delayed in those participants with valid assessment of this parameter [n = 20 (69.0%) in 7000 K light, n = 22 (78.6%) in 2500 K light], with a mean of 2:34 (SE = 0:14) and 2:12 (SE = 0:14) hours, respectively, which was not significantly different between the light conditions. Both light conditions were positively rated, although participants found 7000 K to be more suitable for work yet evaluated 2500 K light as more pleasant. The data indicate minor, but beneficial, effects of 7000 K light compared to 2500 K light on performance during night work. Circadian adaptation did not differ significantly between light conditions, though caution should be taken when interpreting these findings due to missing data. Field studies are needed to investigate similar light interventions in real-life settings, to develop recommendations regarding illumination for night workers. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03203538.

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

Ocular light drives a range of nonvisual responses in humans including suppression of melatonin secretion and circadian phase resetting. These responses are driven by intrinsically photosensitive retinal ganglion cells (ipRGCs) which combine intrinsic, melanopsin-based, phototransduction with extrinsic rod/cone-mediated signals. As a result of this arrangement, it has remained unclear how best to quantify light to predict its nonvisual effects. To address this, we analysed data from nineteen different laboratory studies that measured melatonin suppression, circadian phase resetting and/or alerting responses in humans to a wide array of stimulus types, intensities and durations with or without pupil dilation. Using newly established SI-compliant metrics to quantify ipRGC-influenced responses to light, we show that melanopic illuminance consistently provides the best available predictor for responses of the human circadian system. In almost all cases, melanopic illuminance is able to fully account for differences in sensitivity to stimuli of varying spectral composition, acting to drive responses that track variations in illumination characteristic of those encountered over civil twilight (~1-1000 lux melanopic equivalent daylight illuminance). Collectively, our data demonstrate widespread utility of melanopic illuminance as a metric for predicting the circadian impact of environmental illumination. These data therefore provide strong support for the use of melanopic illuminance as the basis for guidelines that seek to regulate light exposure to benefit human health and to inform future lighting design.

Circadian Photoentrainment in Mice and Humans

Light around twilight provides the primary entrainment signal for circadian rhythms. Here we review the mechanisms and responses of the mouse and human circadian systems to light. Both utilize a network of photosensitive retinal ganglion cells (pRGCs) expressing the photopigment melanopsin (OPN4). In both species action spectra and functional expression of OPN4 in vitro show that melanopsin has a λ_max close to 480 nm. Anatomical findings demonstrate that there are multiple pRGC sub-types, with some evidence in mice, but little in humans, regarding their roles in regulating physiology and behavior. Studies in mice, non-human primates and humans, show that rods and cones project to and can modulate the light responses of pRGCs. Such an integration of signals enables the rods to detect dim light, the cones to detect higher light intensities and the integration of intermittent light exposure, whilst melanopsin measures bright light over extended periods of time. Although photoreceptor mechanisms are similar, sensitivity thresholds differ markedly between mice and humans. Mice can entrain to light at approximately 1 lux for a few minutes, whilst humans require light at high irradiance (>100’s lux) and of a long duration (>30 min). The basis for this difference remains unclear. As our retinal light exposure is highly dynamic, and because photoreceptor interactions are complex and difficult to model, attempts to develop evidence-based lighting to enhance human circadian entrainment are very challenging. A way forward will be to define human circadian responses to artificial and natural light in the “real world” where light intensity, duration, spectral quality, time of day, light history and age can each be assessed.

Blue light emission spectra of popular mobile devices: The extent of user protection against melatonin suppression by built-in screen technology and light filtering software systems

Blue light, with wavelengths shorter than 440-450 nm, is the most energetic radiation of the visible spectrum for the human eye, and its possible multiple effects on the human nervous and other systems have become a line of research by many investigators. The use of mobile devices whose screens emit various amounts of blue light is common nowadays. This study evaluated the efficiency of the blue light screen and control software technologies of eight different mobile devices. Emitted screen spectra of the different mobile devices according to different conditions of blue light emission software control were obtained using a spectrograph, and the derived spectra were compared with the melatonin suppression action spectrum. The amount of blue light emission and predicted melatonin suppression varied according to the unique software control and screen technology of each device. AMOLED screen technology, compared with other screen technologies, achieved better control of blue light emission. The effect of blue light filters depends on the screen technology; however, the melatonin suppression index of mobile devices is not reduced sufficiently by the use of blue light-attenuating software.

Long-Term Reduction of Short-Wavelength Light Affects Sustained Attention and Visuospatial Working Memory With No Evidence for a Change in Circadian Rhythmicity

The short wavelength, i.e., blue light, is crucial for non-image forming effects such as entrainment of the circadian system in humans. Moreover, many studies showed that blue light enhances alertness and performance in cognitive tasks. However, most scientific reports in this topic are based on experiments using short exposure to blue or blue-enriched light, and only a few focused on the effects of its reduced transmittance, especially in longer periods. The latter could potentially give insight into understanding if age-related sleep problems and cognitive decline are related to less amount of blue light reaching the retina, as the eyes' lenses yellow with age. In this study, we investigated the effects of prolonged blocking of blue light on cognitive functioning, in particular-sustained attention and visuospatial working memory, as well as on sleep, and melatonin and cortisol levels. A group of young, healthy participants was randomly allocated to either blue light blocking or control group. Depending on the group, participants wore amber contact lenses, reducing the transmittance of blue light by ∼90% or regular contact lenses for a period of 4 weeks. No changes were observed for measurements related to sleep and sleep-wake rhythm. Dim light melatonin onset, evening levels of melatonin, and morning cortisol answer did not show any significant alterations during blue light (BL) blockade. The significant effects were revealed both for sustained attention and visuospatial memory, i.e., the longer blocking the blue light lasted, the greater decrease in performance observed. Additionally, the follow-up session conducted ∼1 week after taking off the blue-blocking lenses revealed that in case of sustained attention, this detrimental effect of blocking BL is fully reversible. Our findings provide evidence that prolonged reduction of BL exposure directly affects human cognitive functioning regardless of circadian rhythmicity.

Melatonin suppression during a simulated night shift in medium intensity light is increased by 10-minute breaks in dim light and decreased by 10-minute breaks in bright light

Exposure to light at night results in disruption of endogenous circadian rhythmicity and/or suppression of pineal melatonin, which can consequently lead to acute or chronic adverse health problems. In the present study, we investigated whether exposure to very dim light or very bright light for a short duration influences melatonin suppression, subjective sleepiness, and performance during exposure to constant moderately bright light. Twenty-four healthy male university students were divided into two experimental groups: Half of them (mean age: 20.0 ± 0.9 years) participated in an experiment for short-duration (10 min) light conditions of medium intensity light (430 lx, medium breaks) vs. very dim light (< 1 lx, dim breaks) and the other half (mean age: 21.3 ± 2.5 years) participated in an experiment for short-duration light conditions of medium intensity light (430 lx, medium breaks) vs. very bright light (4700 lx, bright breaks). Each simulated night shift consisting of 5 sets (each including 50-minute night work and 10-minute break) was performed from 01:00 to 06:00 h. The subjects were exposed to medium intensity light (550 lx) during the night work. Each 10-minute break was conducted every hour from 02:00 to 06:00 h. Salivary melatonin concentrations were measured, subjective sleepiness was assessed, the psychomotor vigilance task was performed at hourly intervals from 21:00 h until the end of the experiment. Compared to melatonin suppression between 04:00 and 06:00 h in the condition of medium breaks, the condition of dim breaks significantly promoted melatonin suppression and the condition of bright breaks significantly diminished melatonin suppression. However, there was no remarkable effect of either dim breaks or bright breaks on subjective sleepiness and performance of the psychomotor vigilance task. Our findings suggest that periodic exposure to light for short durations during exposure to a constant light environment affects the sensitivity of pineal melatonin to constant light depending on the difference between light intensities in the two light conditions (i.e., short light exposure vs. constant light exposure). Also, our findings indicate that exposure to light of various intensities at night could be a factor influencing the light-induced melatonin suppression in real night work settings.

Intraocular cataract lens replacement and light exposure potentially impact procedural learning in older adults

Procedural learning declines with age and appropriately timed light exposure can improve cognitive performance in older individuals. Because cataract reduces light transmission and is associated with cognitive decline in older adults, we explored whether lens replacement (intraocular blue-blocking [BB] or UV-only blocking) in older patients with cataracts enhances the beneficial effects of light on procedural learning. Healthy older participants (n = 16) and older patients with post-cataract surgery (n = 13 with BB or UV lens replacement) underwent a randomized within-subject crossover laboratory design with three protocols. In each protocol, 3.5 hr dim-dark adaptation was followed by 2 hr evening blue-enriched (6,500K) or non-blue-enriched light exposure (3,000K or 2,500K), 30 min dim post-light, ~8 hr sleep and 2 hr morning dim light. Procedural learning was assessed by the alternating serial reaction time task (ASRT), as part of a larger test battery. Here, ASRT performance was indexed by type of trial (random or sequence) and sequence-specific (high or low probability) measures. During evening light exposure, we observed a significant effect of the interaction of "group" versus "light condition" on the type of trial (p = .04; p = .16; unadjusted and adjusted p-values, respectively) and sequence-specific learning (p = .04; p = .16; unadjusted and adjusted p-values, respectively), whereby patients with UV lens replacement performed better than patients with BB lens or non-cataract controls, during blue-enriched light exposure. Lens replacement in patients with cataracts may potentially be associated with beneficial effects of blue light on procedural learning. Thus, optimizing spectral lens transmission in patients with cataracts may help improve specific aspects of cognitive function, such as procedural learning.

The Role of Daylight for Humans: Gaps in Current Knowledge

Daylight stems solely from direct, scattered and reflected sunlight, and undergoes dynamic changes in irradiance and spectral power composition due to latitude, time of day, time of year and the nature of the physical environment (reflections, buildings and vegetation). Humans and their ancestors evolved under these natural day/night cycles over millions of years. Electric light, a relatively recent invention, interacts and competes with the natural light-dark cycle to impact human biology. What are the consequences of living in industrialised urban areas with much less daylight and more use of electric light, throughout the day (and at night), on general health and quality of life? In this workshop report, we have classified key gaps of knowledge in daylight research into three main groups: (I) uncertainty as to daylight quantity and quality needed for "optimal" physiological and psychological functioning, (II) lack of consensus on practical measurement and assessment methods and tools for monitoring real (day) light exposure across multiple time scales, and (III) insufficient integration and exchange of daylight knowledge bases from different disciplines. Crucial short and long-term objectives to fill these gaps are proposed.

Crosstalk: The diversity of melanopsin ganglion cell types has begun to challenge the canonical divide between image-forming and non-image-forming vision

Melanopsin ganglion cells have defied convention since their discovery almost 20 years ago. In the years following, many types of these intrinsically photosensitive retinal ganglion cells (ipRGCs) have emerged. In the mouse retina, there are currently six known types (M1-M6) of melanopsin ganglion cells, each with unique morphology, mosaics, connections, physiology, projections, and functions. While melanopsin-expressing cells are usually associated with behaviors like circadian photoentrainment and the pupillary light reflex, the characterization of multiple types has demonstrated a reach that may extend far beyond non-image-forming vision. In fact, studies have shown that individual types of melanopsin ganglion cells have the potential to impact image-forming functions like contrast sensitivity and color opponency. Thus, the goal of this review is to summarize the morphological and functional aspects of the six known types of melanopsin ganglion cells in the mouse retina and to highlight their respective roles in non-image-forming and image-forming vision. Although many melanopsin ganglion cell types do project to image-forming brain targets, it is important to note that this is only the first step in determining their influence on image-forming vision. Even so, the visual system has canonically been divided into these two functional realms and melanopsin ganglion cells have begun to challenge the boundary between them, providing an overlap of visual information that is complementary rather than redundant. Further studies on these ganglion cell photoreceptors will no doubt continue to illustrate an ever-expanding role for melanopsin ganglion cells in image-forming vision.

Daytime Exposure to Blue-Enriched Light Counters the Effects of Sleep Restriction on Cortisol, Testosterone, Alpha-Amylase and Executive Processes

Sleep debt is becoming a better acknowledged cause of physiological stress and neurobehavioral deficits with major public-health concerns. We investigated whether exposure to blue light during daytime could be an efficient countermeasure to limit sleep restriction’s impact on relevant behavioral (stress, sleepiness, sustained attention, and memory performance) and physiological (saliva cortisol, testosterone, and alpha-amylase) markers. Our semi-ecological, crossover, randomized design included 17 young men that underwent two sleep-restricted nights (3 h each) followed or not by blue light exposure (30-min-long sessions at 100 lux repeated four times throughout the day). Behavioral and physiological measurements were performed in the lab but outside these periods the participants kept following their usual routine. After sleep restriction, morning cortisol and testosterone, and afternoon alpha-amylase levels decreased. In parallel, subjective ratings of stress and sleepiness increased while performance on the sustained attention and memory tasks deteriorated. In contrast, after periods of blue light exposure, all these parameters were largely restored to baseline levels, despite an identical sleep restriction procedure, although this restorative effect was reduced for the memory task. Our findings suggest that even short exposure to blue light could trigger persistent beneficial effects throughout the day and could be potentially efficient in real-life settings.

Characterizing the temporal Dynamics of Melatonin and Cortisol Changes in Response to Nocturnal Light Exposure

We studied the dynamics of melatonin suppression and changes in cortisol levels in humans in response to light exposure at night using high-frequency blood sampling. Twenty-one young healthy participants were randomized to receive either intermittent bright (~9,500 lux) light (IBL), continuous bright light (CBL) or continuous dim (~1 lux) light (VDL) for 6.5 h during the biological night (n = 7 per condition). Melatonin suppression occurred rapidly within the first 5 min and continued until the end of each IBL stimuli (t1/2 = ~13 min). Melatonin recovery occurred more slowly between IBL stimuli (half-maximal recovery rate of ~46 min). Mean melatonin suppression (~40%) and recovery (~50%) were similar across IBL stimuli. Suppression dynamics under CBL were also rapid (t1/2 = ~18 min), with no recovery until the light exposure ended. There was a significant linear increase of cortisol levels between the start and end of each IBL stimulus. Under CBL conditions cortisol showed trimodal changes with an initial linear activating phase, followed by an exponential inhibitory phase, and a final exponential recovery phase. These results show that light exposure at night affects circadian driven hormones differently and that outcomes are influenced by the duration and pattern of light exposure.

The importance of including position and viewing direction when measuring and assessing the lighting conditions of office workers

BACKGROUND

Light and alertness studies have applied different measurement methodologies to determine lighting conditions. However, it has been demonstrated that researchers rarely measure or describe the lighting conditions of their studies in sufficient detail to generalize conclusions or derive universal guidelines.

OBJECTIVE

Part I of this paper summarizes the current measurement methodologies used in light and alertness studies to potentially identify methodological issues. Part II determines the differences in lighting conditions for different viewing directions within an office environment.

METHODS

A literature review (part I) and both experimental studies and an observational study (part II) were undertaken in this study.

RESULTS

Part I demonstrates that most light and alertness studies include photometric quantities; however, it is recommended that one should measure radiometric quantities as well. Further, the light measurements should be performed at the individual level. Part II demonstrates large differences in lighting conditions between viewing directions. For example, when looking toward the window, vertical illuminances were at least 12 times higher when compared to looking in the opposite direction.

CONCLUSIONS

Our findings suggest that when analysing or designing an office environment, office workers' positions and viewing direction should be included in the determination of personal lighting conditions.