Sensitivity of the human circadian pacemaker to nocturnal light: melatonin phase resetting and suppression

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.

Healthy Behaviors through Behavioral Design-Obesity Prevention

Evidence for behavior modification for improved health outcomes was evaluated for nutrition, physical activity (PA), and indoor environmental quality (IEQ). The databases searched included LISTA, PubMed, and Web of Science, with articles rated using an a priori baseline score of 70/100 to establish inclusion. The initial search produced 52,847 articles, 63 of which were included in the qualitative synthesis. Thirteen articles met inclusion for nutrition: cafeteria interventions, single interventions, and vending interventions. Seventeen articles on physical activity were included: stair use, walking, and adjustable desks. For IEQ, 33 articles met inclusion: circadian disruption, view and natural light, and artificial light. A narrative synthesis was used to find meaningful connections across interventions with evidence contributing to health improvements. Commonalities throughout the nutrition studies included choice architecture, increasing the availability of healthy food items, and point-of-purchase food labeling. Interventions that promoted PA included stair use, sit/stand furniture, workplace exercise facilities and walking. Exposure to natural light and views of natural elements were found to increase PA and improve sleep quality. Overexposure to artificial light may cause circadian disruption, suppressing melatonin and increasing risks of cancers. Overall, design that encourages healthy behaviors may lower risks associated with chronic disease.

Adaptive light: a lighting control method aligned with dark adaptation of human vision

Light exposure before sleep causes a reduction in the quality and duration of sleep. In order to reduce these detrimental effects of light exposure, it is important to dim the light. However, dimming the light often causes inconvenience and can lower the quality of life (QOL). We therefore aimed to develop a lighting control method for use before going to bed, in which the illuminance of lights can be ramped down with less of a subjective feeling of changes in illuminance. We performed seven experiments in a double-blind, randomized crossover design. In each experiment, we compared two lighting conditions. We examined constant illuminance, linear dimming, and three monophasic and three biphasic exponential dimming, to explore the fast and slow increases in visibility that reflect the dark adaptation of cone and rod photoreceptors in the retina, respectively. Finally, we developed a biphasic exponential dimming method termed Adaptive Light 1.0. Adaptive Light 1.0 significantly prevented the misidentification seen in constant light and effectively suppressed perceptions of the illuminance change. This novel lighting method will help to develop new intelligent lighting instruments that reduce the negative effect of light on sleep and also lower energy consumption.

Effects of light transitions on measures of alertness, arousal and comfort

Knowledge on the onset, persistence, and symmetry of effects of lighting transitions on humans is relevant when designing dynamic lighting scenarios and, additionally, can shed light on the dominance of underlying mechanisms. We examined temporal trajectories in measures of alertness, arousal and comfort after abrupt lighting transitions that were created using two strongly contrasting light conditions (warm, dim lighting vs. cool, bright lighting). In this controlled within-subjects experiment, thirtyeight healthy subjects participated in four separate sessions of 90 min. Subjective experiences (alertness, comfort and mood) and objective measures of vigilance (PVT performance), arousal (HR, HRV, SCL), and thermoregulation (skin temperature and DPG) were studied. The comparison of the temporal trajectories following the transition in light for the different variables indicates a complex interplay of underlying physiological and psychological processes driving these effects.

[The effects of quarantine for SARS-CoV-2 on sleep: An online survey]

Objectif

Déterminer l’évolution du sommeil chez les Français pendant le confinement motivé par la pandémie du SARS-CoV-2 et définir les facteurs comportementaux associés à un sommeil détérioré.

Méthodologie

Une enquête en ligne via les réseaux sociaux pendant la période de confinement. Les questions ont ciblé les conditions de confinement, les comportements relatifs au sommeil et les éléments de l’environnement potentiellement perturbateurs du sommeil (exposition à la lumière et activités sportives).

Résultats

Au total, 1777 participants ont été inclus dont 77 % femmes, 72 % âgés de 25–54 ans. Les conditions de confinement les plus fréquentes étaient en couple avec enfants (36 %) et en maison avec jardin (51 %). Quarante-sept pour cent rapportent une diminution de la qualité du sommeil en confinement. Les facteurs associés à une détérioration du sommeil retenus par l’analyse multivariée sont une diminution de la durée du sommeil (OR 15,52 — p < 0,001), un coucher plus tardif (OR 1,72 — p < 0,001), un lever plus matinal (2,18 — p = 0,01), des horaires plus irréguliers (OR 2,29 — p < 0,001), une diminution de l’exposition à la lumière du jour (OR 1,46 — p = 0,01) et une augmentation de l’utilisation des écrans le soir (OR 1,33 — p = 0,04).

Conclusion

La mauvaise qualité subjective du sommeil en confinement est associée à une modification des comportements relatifs au sommeil et de l’exposition à la lumière (moins de lumière du jour et plus d’écran le soir). Pour optimiser le sommeil en confinement, des horaires adaptés et réguliers, une exposition de plus d’une heure/jour à la lumière du jour et l’éviction des écrans le soir sont à conseiller.

Light Exposure during Days with Night, Outdoor, and Indoor Work

OBJECTIVE

To assess light exposure during days with indoor, outdoor, and night work and days off work.

METHODS

Light intensity was continuously recorded for 7 days across the year among indoor (n = 170), outdoor (n = 151), and night workers (n = 188) in Denmark (55-56°N) equipped with a personal light recorder. White light intensity, duration above 80, 1000, and 2500 lux, and proportion of red, green, and blue light was depicted by time of the day and season for work days and days off work.

RESULTS

Indoor workers' average light exposure only intermittently exceeded 1000 lux during daytime working hours in summer and never in winter. During daytime working hours, most outdoor workers exceeded 2500 lux in summer and 1000 lux in winter. Night workers spent on average 10-50 min >80 lux when working night shifts. During days off work, indoor and night workers were exposed to higher light intensities than during work days and few differences were seen between indoor, outdoor, and night workers. The spectral composition of light was similar for indoor, outdoor, and night workers during days at and off work.

CONCLUSION

The night workers of this study were during night hours on average exposed for a limited time to light intensities expected to suppress melatonin. The indoor workers were exposed to light levels during daylight hours that may reduce general well-being and mood, especially in winter. Outdoor workers were during summer daylight hours exposed to light levels comparable to those used for the treatment of depression.

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.

Accuracy of the GENEActiv Device for Measuring Light Exposure in Sleep and Circadian Research

Light is a variable of key interest in circadian rhythms research, commonly measured using wrist-worn sensors. The GENEActiv Original is a cost-effective and practical option for assessing light in ambulatory settings. With increasing research on health and well-being incorporating sleep and circadian factors, the validity of wearable devices for assessing light environments needs to be evaluated. In this study, we tested the accuracy of the GENEActiv Original devices (n = 10) for recording light under a range of ecologically relevant lighting conditions, including LED, fluorescent, infrared, and outdoor lighting. The GENEActiv output had a strong linear relationship with photopic illuminance. However, the devices consistently under-reported photopic illuminance, especially below 100 lux. Accuracy below 100 lux depended on the light source, with lower accuracy and higher variability under fluorescent lighting. The device’s accuracy was also tested using light sources of varying spectral composition, which indicated that the device tends to under-report photopic illuminance for green light sources and over-report for red light sources. Furthermore, measures of photopic illuminance were impacted by infrared light exposure. We conclude that the GENEActiv Original is suitable for mapping light patterns within an individual context, and can reasonably differentiate indoor vs. outdoor lighting, though the accuracy is variable at low light conditions. Given the human circadian system’s high sensitivity to light levels below 100 lux, if using the GENEActiv Original, we recommend also collecting light source data to better understand the impact on the circadian system, especially where participants spend prolonged periods in dim lighting.

Melatonin-Measurement Methods and the Factors Modifying the Results. A Systematic Review of the Literature

Melatonin plays an important role in regulating the sleep-wake cycle and adaptation to environmental changes. Concentration measurements in bioliquids such as serum/plasma, saliva and urine are widely used to assess peripheral rhythm. The aim of the study was to compare methods and conditions of determinations carried out with the identification of factors potentially affecting the measurements obtained. We have identified a group of modifiable and unmodifiable factors that facilitate data interpretation. Knowledge of modifiers allows you to carefully plan the test protocol and then compare the results. There is no one universal sampling standard, because the choice of method and biofluid depends on the purpose of the study and the research group.

Sleep problems and suicide risk in youth: A systematic review, developmental framework, and implications for hospital treatment

OBJECTIVE

Sleep problems are transdiagnostic symptoms that confer significant risk for suicidal thoughts and behaviors (STBs) in adults. However, less is known about the sleep-STB association in adolescence-a developmental period when rates of STBs increase drastically, and sleep problems may be particularly pernicious. This article provides a systematic review of research on the sleep-STB association in youth, an overview of changes in sleep regulation during adolescence that may make sleep problems particularly detrimental for youth, and a discussion of the clinical implications of the sleep-STB association for hospitalized youth.

METHOD

The systematic review included all longitudinal studies in which sleep problems were examined as prospective predictors of STBs in adolescents (aged 10-24 years). The search was conducted on December 1, 2017 using PsychINFO, PubMed, and Web of Science databases.

RESULTS

Ten studies qualified for inclusion in this review. Of these, seven studies found at least one type of sleep problem significantly predicted a STB outcome.

CONCLUSIONS

Although findings are mixed, growing research suggests that sleep problems may be a unique risk factor for STBs in youth. Sleep problems may be particularly important intervention target because they are easily assessed across healthcare settings and are amenable to treatment.

Association of Sunlight Exposure with Sleep Hours in Iranian Children and Adolescents: The CASPIAN-V Study

We aimed to assess the association of sunlight exposure with sleep duration and sleep onset time in children. Data were obtained from the fifth survey of a national school-based surveillance program in Iran. Sunlight exposure time, sleep duration, sleep onset time, physical activity time, mental health status and frequency of consuming coffee and tea were recorded. Overall, 14 274 students aged 7-18 years were recruited. Sleep duration was associated positively with sex, age, body mass index and physical activity, as well as with sunlight exposure and negatively with the consumption of coffee and tea. Higher physical activity, exposure to sunlight and mental status score in children exposed to sunlight via their face, hands, arms and feet, reduced the likelihood of sleep onset time after midnight (odds ratio (OR) = 0.909, 0.741 and 0.554 respectively). Daily exposure to sunlight may increase sleep duration and advance the sleep onset time in children and adolescents.

An Extensive Collection of Evaluation Indicators to Assess Occupants’ Health and Comfort in Indoor Environment

Today, the effects of the indoor environment on occupants’ health and comfort represent a very important topic and requires a holistic approach in which the four main environmental factors (thermal comfort, air quality, acoustics, and lighting) should be simultaneously assessed. The present paper shows the results of a literature survey that aimed to collect the indicators for the evaluation of occupants’ health and comfort in indoor environmental quality evaluations. A broad number of papers that propose the indicators of a specific environmental factor is available in the scientific literature, but a review that collects the indicators of all four factors is lacking. In this review paper, the difference between indicators for the evaluation of risk for human health and for comfort evaluation is clarified. For each environmental factor, the risk for human health indicators are proposed with the relative threshold values, and the human comfort indicators are grouped into categories according to the number of parameters included, or the specific field of application for which they are proposed. Furthermore, the differences between human health and comfort indicators are highlighted.

Effects of Evening Exposure to Light from Organic Light-Emitting Diodes on Melatonin and Sleep

BACKGROUND AND PURPOSE

Organic light-emitting diodes (OLEDs) emit less blue light than traditional light-emitting diodes (LEDs), but the effects of OLED light exposure (LE) on melatonin and sleep have not been evaluated.

METHODS

Twenty-four healthy subjects (age 26.9±5.7 years; including 18 females) with the intermediate chronotype were exposed to three different light conditions [4,000 K 150 lux OLED LE, 4,000 K 150 lux LED LE, and dim light (DL) at <10 lux] for 6.5 h from 17:30 to 24:00, in a random order and with a 1-week interval. Participants entered the unit for the experiment at 16:00, and their daylight was measured by actigraphy from 8:00 to 16:00 during each session. Saliva samples for melatonin were taken every hour from 18:00 to 24:00. Sleep was monitored by polysomnography, and vigilance was evaluated by psychomotor vigilance test upon awakening.

RESULTS

Melatonin onset occurred at 21:11±01:24, 21:20±01:19, and 21:36±01:16 in the DL, OLED, and LED conditions, respectively. Melatonin onset was significantly delayed under LED LE compared to DL (p=0.007) but did not differ under OLED LE (p=0.245). Melatonin suppression, sleep parameters, and vigilance were similar among the three light conditions. The accumulated amount of daytime light in each session was negatively correlated with the melatonin onset time under the DL (rho=-0.634, p=0.002) and OLED (rho=-0.447, p=0.029) conditions, not under the LED condition (p=0.129).

CONCLUSIONS

Melatonin onset under OLED LE was not significantly delayed compared to DL. Exposure to sufficient daylight may advance melatonin onset even when a subject is exposed to OLED LE in the evening.

Regulation of Circadian Genes by the MAPK Pathway: Implications for Rapid Antidepressant Action

Accumulating evidence suggests that the circadian rhythm plays a critical role in mood regulation, and circadian disturbances are often found in patients with major depressive disorder (MDD). The mitogen-activated protein kinase (MAPK)/extracellular signal-regulated kinase (ERK) pathway is involved in mediating entrainment of the circadian system. Furthermore, the MAPK/ERK signaling pathway has been shown to be involved in the pathogenesis of MDD and the rapid onset of action of antidepressant therapies, both pharmaceutical and non-pharmaceutical. This review provides an overview of the involvement of the MAPK/ERK pathway in modulating the circadian system in the rapid action of antidepressant therapies. This pathway holds much promise for the development of novel, rapid-onset-of-action therapeutics for MDD.

Resetting the Aging Clock: Implications for Managing Age-Related Diseases

Worldwide, individuals are living longer due to medical and scientific advances, increased availability of medical care and changes in public health policies. Consequently, increasing attention has been focused on managing chronic conditions and age-related diseases to ensure healthy aging. The endogenous circadian system regulates molecular, physiological and behavioral rhythms orchestrating functional coordination and processes across tissues and organs. Circadian disruption or desynchronization of circadian oscillators increases disease risk and appears to accelerate aging. Reciprocally, aging weakens circadian function aggravating age-related diseases and pathologies. In this review, we summarize the molecular composition and structural organization of the circadian system in mammals and humans, and evaluate the technological and societal factors contributing to the increasing incidence of circadian disorders. Furthermore, we discuss the adverse effects of circadian dysfunction on aging and longevity and the bidirectional interactions through which aging affects circadian function using examples from mammalian research models and humans. Additionally, we review promising methods for managing healthy aging through behavioral and pharmacological reinforcement of the circadian system. Understanding age-related changes in the circadian clock and minimizing circadian dysfunction may be crucial components to promote healthy aging.

A data-driven phase and isostable reduced modeling framework for oscillatory dynamical systems

Phase-amplitude reduction is of growing interest as a strategy for the reduction and analysis of oscillatory dynamical systems. Augmentation of the widely studied phase reduction with amplitude coordinates can be used to characterize transient behavior in directions transverse to a limit cycle to give a richer description of the dynamical behavior. Various definitions for amplitude coordinates have been suggested, but none are particularly well suited for implementation in experimental systems where output recordings are readily available but the underlying equations are typically unknown. In this work, a reduction framework is developed for inferring a phase-amplitude reduced model using only the observed model output from an arbitrarily high-dimensional system. This framework employs a proper orthogonal reduction strategy to identify important features of the transient decay of solutions to the limit cycle. These features are explicitly related to previously developed phase and isostable coordinates and used to define so-called data-driven phase and isostable coordinates that are valid in the entire basin of attraction of a limit cycle. The utility of this reduction strategy is illustrated in examples related to neural physiology and is used to implement an optimal control strategy that would otherwise be computationally intractable. The proposed data-driven phase and isostable coordinate system and associated reduced modeling framework represent a useful tool for the study of nonlinear dynamical systems in situations where the underlying dynamical equations are unknown and in particularly high-dimensional or complicated numerical systems for which standard phase-amplitude reduction techniques are not computationally feasible.

Artificial Light at Night (ALAN): A Potential Anthropogenic Component for the COVID-19 and HCoVs Outbreak

The origin of the coronavirus disease 2019 (COVID-19) pandemic is zoonotic. The circadian day-night is the rhythmic clue to organisms for their synchronized body functions. The "development for mankind" escalated the use of artificial light at night (ALAN). In this article, we tried to focus on the possible influence of this anthropogenic factor in human coronavirus (HCoV) outbreak. The relationship between the occurrences of coronavirus and the ascending curve of the night-light has also been delivered. The ALAN influences the physiology and behavior of bat, a known nocturnal natural reservoir of many Coronaviridae. The "threatened" and "endangered" status of the majority of bat species is mainly because of the destruction of their proper habit and habitat predominantly through artificial illumination. The stress exerted by ALAN leads to the impaired body functions, especially endocrine, immune, genomic integration, and overall rhythm features of different physiological variables and behaviors in nocturnal animals. Night-light disturbs "virus-host" synchronization and may lead to mutation in the genomic part of the virus and excessive virus shedding. We also proposed some future strategies to mitigate the repercussions of ALAN and for the protection of the living system in the earth as well.

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.

Evidence That Homeostatic Sleep Regulation Depends on Ambient Lighting Conditions during Wakefulness

We examined whether ambient lighting conditions during extended wakefulness modulate the homeostatic response to sleep loss as indexed by. slow wave sleep (SWS) and electroencephalographic (EEG) slow-wave activity (SWA) in healthy young and older volunteers. Thirty-eight young and older participants underwent 40 hours of extended wakefulness [i.e., sleep deprivation (SD)] once under dim light (DL: 8 lux, 2800 K), and once under either white light (WL: 250 lux, 2800 K) or blue-enriched white light (BL: 250 lux, 9000 K) exposure. Subjective sleepiness was assessed hourly and polysomnography was quantified during the baseline night prior to the 40-h SD and during the subsequent recovery night. Both the young and older participants responded with a higher homeostatic sleep response to 40-h SD after WL and BL than after DL. This was indexed by a significantly faster intra-night accumulation of SWS and a significantly higher response in relative EEG SWA during the recovery night after WL and BL than after DL for both age groups. No significant differences were observed between the WL and BL condition for these two particular SWS and SWA measures. Subjective sleepiness ratings during the 40-h SD were significantly reduced under both WL and BL compared to DL, but were not significantly associated with markers of sleep homeostasis in both age groups. Our data indicate that not only the duration of prior wakefulness, but also the experienced illuminance during wakefulness affects homeostatic sleep regulation in humans. Thus, working extended hours under low illuminance may negatively impact subsequent sleep intensity in humans.

Indoor light pollution and progression of carotid atherosclerosis: A longitudinal study of the HEIJO-KYO cohort

Exposure to light at inappropriate times in relation to the solar cycle can disturb circadian endocrine and metabolic rhythms. Previous studies have suggested an association between light exposure at night (LAN) and obesity, an important risk factor of atherosclerosis, although it remains unclear whether LAN associates with progression of atherosclerosis. To evaluate the longitudinal association between bedroom LAN intensity and progression of carotid atherosclerosis, light intensity in the bedroom at baseline and carotid artery intima-media thickness (IMT) at baseline and follow-up were measured in 989 elderly participants (945 at baseline and 780 at a median follow-up time of 34 months). The mean age of the participants was 71.4 ± 6.9 years. The average mean and maximal carotid IMT at baseline were 0.88 ± 0.15 and 1.10 ± 0.32 mm, respectively. The median intensity of bedroom LAN was 0.68 lx (IQR, 0.07-3.29). In multivariable analysis adjusted for potential confounders, the highest LAN group exhibited a significant increase in mean carotid IMT (adjusted β, 0.028; 95% CI, 0.005-0.052; P = 0.019) compared with the lowest LAN quartile group. A similar relationship was found between LAN and maximal carotid IMT (adjusted β, 0.083; 95% CI, 0.037-0.129; P < 0.001). In conclusion, we found a clear and significant association between bedroom LAN intensity and progression of subclinical carotid atherosclerosis, which was independent of known risk factors for atherosclerosis, including age, obesity, smoking, economic status, hypertension, and diabetes. Indoor light pollution may be a potential risk factor for atherosclerosis in the general population.

The chronotherapeutic treatment of bipolar disorders: A systematic review and practice recommendations from the ISBD task force on chronotherapy and chronobiology

AIMS

To systematically review the literature on the efficacy and tolerability of the major chronotherapeutic treatments of bipolar disorders (BD)-bright light therapy (LT), dark therapy (DT), treatments utilizing sleep deprivation (SD), melatonergic agonists (MA), interpersonal social rhythm therapy (IPSRT), and cognitive behavioral therapy adapted for BD (CBTI-BP)-and propose treatment recommendations based on a synthesis of the evidence.

METHODS

PRISMA-based systematic review of the literature.

RESULTS

The acute antidepressant (AD) efficacy of LT was supported by several open-label studies, three randomized controlled trials (RCTs), and one pseudorandomized controlled trial. SD showed rapid, acute AD response rates of 43.9%, 59.3%, and 59.4% in eight case series, 11 uncontrolled, studies, and one RCT, respectively. Adjunctive DT obtained significant, rapid anti-manic results in one RCT and one controlled study. The seven studies on MA yielded very limited data on acute antidepressant activity, conflicting evidence of both antimanic and maintenance efficacy, and support from two case series of improved sleep in both acute and euthymic states. IPSRT monotherapy for bipolar II depression had acute response rates of 41%, 67%, and 67.4% in two open studies and one RCT, respectively; as adjunctive therapy for bipolar depression in one RCT, and efficacy in reducing relapse in two RCTs. Among euthymic BD subjects with insomnia, a single RCT found CBTI-BP effective in delaying manic relapse and improving sleep. Chronotherapies were generally safe and well-tolerated.

CONCLUSIONS

The outcome literature on the adjunctive use of chronotherapeutic treatments for BP is variable, with evidence bases that differ in size, study quality, level of evidence, and non-standardized treatment protocols. Evidence-informed practice recommendations are offered.

Estimating Representative Group Intrinsic Circadian Period from Illuminance-Response Curve Data

The human circadian pacemaker entrains to the 24-h day, but interindividual differences in properties of the pacemaker, such as intrinsic period, affect chronotype and mediate responses to challenges to the circadian system, such as shift work and jet lag, and the efficacy of therapeutic interventions such as light therapy. Robust characterization of circadian properties requires desynchronization of the circadian system from the rest-activity cycle, and these forced desynchrony protocols are very time and resource intensive. However, circadian protocols designed to derive the relationship between light intensity and phase shift, which is inherently affected by intrinsic period, may be applied more broadly. To exploit this relationship, we applied a mathematical model of the human circadian pacemaker with a Markov-Chain Monte Carlo parameter estimation algorithm to estimate the representative group intrinsic period for a group of participants using their collective illuminance-response curve data. We first validated this methodology using simulated illuminance-response curve data in which the intrinsic period was known. Over a physiological range of intrinsic periods, this method accurately estimated the representative intrinsic period of the group. We also applied the method to previously published experimental data describing the illuminance-response curve for a group of healthy adult participants. We estimated the study participants' representative group intrinsic period to be 24.26 and 24.27 h using uniform and normal priors, respectively, consistent with estimates of the average intrinsic period of healthy adults determined using forced desynchrony protocols. Our results establish an approach to estimate a population's representative intrinsic period from illuminance-response curve data, thereby facilitating the characterization of intrinsic period across a broader range of participant populations than could be studied using forced desynchrony protocols. Future applications of this approach may improve the understanding of demographic differences in the intrinsic circadian period.

Light Pollution, Circadian Photoreception, and Melatonin in Vertebrates

Artificial light at night (ALAN) is increasing exponentially worldwide, accelerated by the transition to new efficient lighting technologies. However, ALAN and resulting light pollution can cause unintended physiological consequences. In vertebrates, production of melatonin—the “hormone of darkness” and a key player in circadian regulation—can be suppressed by ALAN. In this paper, we provide an overview of research on melatonin and ALAN in vertebrates. We discuss how ALAN disrupts natural photic environments, its effect on melatonin and circadian rhythms, and different photoreceptor systems across vertebrate taxa. We then present the results of a systematic review in which we identified studies on melatonin under typical light-polluted conditions in fishes, amphibians, reptiles, birds, and mammals, including humans. Melatonin is suppressed by extremely low light intensities in many vertebrates, ranging from 0.01–0.03 lx for fishes and rodents to 6 lx for sensitive humans. Even lower, wavelength-dependent intensities are implied by some studies and require rigorous testing in ecological contexts. In many studies, melatonin suppression occurs at the minimum light levels tested, and, in better-studied groups, melatonin suppression is reported to occur at lower light levels. We identify major research gaps and conclude that, for most groups, crucial information is lacking. No studies were identified for amphibians and reptiles and long-term impacts of low-level ALAN exposure are unknown. Given the high sensitivity of vertebrate melatonin production to ALAN and the paucity of available information, it is crucial to research impacts of ALAN further in order to inform effective mitigation strategies for human health and the wellbeing and fitness of vertebrates in natural ecosystems.

Human perception of light chromaticity: short-wavelength effects in spectra with low circadian stimulation, and broader implications for general LED sources

Although light sources are designed assuming the same color sensitivity for all viewers, inter-user variability can in fact cause significant discrepancies in individual perception. Here, perception variability related to short-wavelength effects is investigated. An experimental study is reported on LED sources with reduced blue content, which cause reduced circadian stimulation. Perceived chromaticity is strongly dependent on the viewer's age and spectral shape, in excellent agreement with a model based on modern colorimetry. Broader implications for LED sources in lighting and displays are discussed, and significant effects are found. These results confirm the inadequacy of conventional colorimetry and support the use of modern color science in the design and engineering of lighting products.

Macroscopic Models for Human Circadian Rhythms

Mathematical models have a long and influential history in the study of human circadian rhythms. Accurate predictive models for the human circadian light response have been used to study the impact of a host of light exposures on the circadian system. However, generally, these models do not account for the physiological basis of these rhythms. We illustrate a new paradigm for deriving models of the human circadian light response. Beginning from a high-dimensional model of the circadian neural network, we systematically derive low-dimensional models using an approach motivated by experimental measurements of circadian neurons. This systematic reduction allows for the variables and parameters of the derived model to be interpreted in a physiological context. We fit and validate the resulting models to a library of experimental measurements. Finally, we compare model predictions for experimental measurements of light levels and discuss the differences between our model’s predictions and previous models. Our modeling paradigm allows for the integration of experimental measurements across the single-cell, tissue, and behavioral scales, thereby enabling the development of accurate low-dimensional models for human circadian rhythms.

An Exploration of the Temporal Dynamics of Circadian Resetting Responses to Short- and Long-Duration Light Exposures: Cross-Species Consistencies and Differences

Light is the most effective environmental stimulus for shifting the mammalian circadian pacemaker. Numerous studies have been conducted across multiple species to delineate wavelength, intensity, duration, and timing contributions to the response of the circadian pacemaker to light. Recent studies have revealed a surprising sensitivity of the human circadian pacemaker to short pulses of light. Such responses have challenged photon counting-based theories of the temporal dynamics of the mammalian circadian system to both short- and long-duration light stimuli. Here, we collate published light exposure data from multiple species, including gerbil, hamster, mouse, and human, to investigate these temporal dynamics and explore how the circadian system integrates light information at both short- and long-duration time scales to produce phase shifts. Based on our investigation of these data sets, we propose 3 new interpretations: (1) intensity and duration are independent factors of total phase shift magnitude, (2) the possibility of a linear/log temporal function of light duration that is universal for all intensities for durations less than approximately 12 min, and (3) a potential universal minimum light duration of ~0.7 sec that describes a "dead zone" of light stimulus. We show that these properties appear to be consistent across mammalian species. These interpretations, if confirmed by further experiments, have important practical implications in terms of understanding the underlying physiology and for the design of lighting regimens to reset the mammalian circadian pacemaker.

Home versus laboratory assessments of melatonin production and melatonin onset in young adults complaining of a delayed sleep schedule

Recent evidence points toward an association between higher non-visual sensitivity to light and a later circadian phase in young adults complaining of a delayed sleep schedule. Light exposure in the evening may therefore induce a larger suppression of melatonin production in these individuals, which might: (a) bias home estimates of melatonin onset; and (b) decrease sleep propensity at bedtime. In this study, we compared home and laboratory melatonin onsets and production in sleep-delayed and control participants, using saliva samples collected in the 3 hr preceding habitual bedtime. The mean light intensity measured during saliva sampling at home was ~10 lux in both groups. Melatonin suppression at home was significant, averaging 31% and 24% in sleep-delayed and control individuals, respectively. Group difference in melatonin suppression was not significant. Estimates of melatonin onset were on average 27 min later at home than in laboratory conditions, with no group difference. Looking specifically at sleep-delayed participants, there was no correlation between non-visual sensitivity to light and home-laboratory differences in melatonin onsets. However, higher light sensitivity was associated with greater melatonin suppression in the hour before habitual bedtime. Greater melatonin suppression before bedtime was also associated with a later circadian phase. These results indicate that the validity of home estimates of melatonin onset is similar in sleep-delayed and in control individuals. Results also suggest that increased non-visual sensitivity to light could impact melatonin secretion in sleep-delayed individuals and contribute to a late bedtime by delaying circadian phase and decreasing sleep propensity.

Predictability of individual circadian phase during daily routine for medical applications of circadian clocks

BACKGROUNDCircadian timing of treatments can largely improve tolerability and efficacy in patients. Thus, drug metabolism and cell cycle are controlled by molecular clocks in each cell and coordinated by the core body temperature 24-hour rhythm, which is generated by the hypothalamic pacemaker. Individual circadian phase is currently estimated with questionnaire-based chronotype, center-of-rest time, dim light melatonin onset (DLMO), or timing of core body temperature (CBT) maximum (acrophase) or minimum (bathyphase).METHODSWe aimed at circadian phase determination and readout during daily routines in volunteers stratified by sex and age. We measured (a) chronotype, (b) every minute (q1min) CBT using 2 electronic pills swallowed 24 hours apart, (c) DLMO through hourly salivary samples from 1800 hours to bedtime, and (d) q1min accelerations and surface temperature at anterior chest level for 7 days, using a teletransmitting sensor. Circadian phases were computed using cosinor and hidden Markov modeling. Multivariate regression identified the combination of biomarkers that best predicted core temperature circadian bathyphase.RESULTSAmong the 33 participants, individual circadian phases were spread over 5 hours, 10 minutes (DLMO); 7 hours (CBT bathyphase); and 9 hours, 10 minutes (surface temperature acrophase). CBT bathyphase was accurately predicted, i.e., with an error less than 1 hour for 78.8% of the subjects, using a new digital health algorithm (INTime), combining time-invariant sex and chronotype score with computed center-of-rest time and surface temperature bathyphase (adjusted R2 = 0.637).CONCLUSIONINTime provided a continuous and reliable circadian phase estimate in real time. This model helps integrate circadian clocks into precision medicine and will enable treatment timing personalization following further validation.FUNDINGMedical Research Council, United Kingdom; AP-HP Foundation; and INSERM.

Decreased sensitivity of the circadian system to light in current, but not remitted depression

BACKGROUND

Misalignment of circadian timing in patients with depression has commonly been reported, but the underlying mechanisms are not known. Individual differences in the sensitivity of the circadian system to light affect how the biological clock synchronizes with the external environment and can lead to misalignment of rhythms. We investigated the sensitivity of the circadian system to light in unmedicated (for >3 months) women with a current or previous diagnosis of major depression, and healthy controls.

METHODS

Baseline melatonin levels in dim light (<1 lux) were assessed, followed by melatonin levels in normal indoor lighting of 100 lux in order to determine melatonin suppression.

RESULTS

Patients currently experiencing a depressive episode showed significantly lower levels of melatonin suppression to light compared to remitted patients and controls, with large effect sizes. Remitted patients and controls showed similar suppression.

LIMITATIONS

The relatively small sample, and lack of long-term, within subject assessments, make it difficult to determine the potential causal role of reduced light sensitivity in the development of circadian disruption.

CONCLUSIONS

We conclude that hyposensitivity of the circadian system to light may contribute to circadian misalignment in patients with depression. Interventions that increase sensitivity to light or provide stronger light cues may assist in normalizing circadian clock function.

Sleep Timing in Late Autumn and Late Spring Associates With Light Exposure Rather Than Sun Time in College Students

Timing of the human sleep-wake cycle is determined by social constraints, biological processes (sleep homeostasis and circadian rhythmicity) and environmental factors, particularly natural and electrical light exposure. To what extent seasonal changes in the light-dark cycle affect sleep timing and how this varies between weekdays and weekends has not been firmly established. We examined sleep and activity patterns during weekdays and weekends in late autumn (standard time, ST) and late spring (daylight saving time, DST), and expressed their timing in relation to three environmental reference points: clock-time, solar noon (SN) which occurs one clock hour later during DST than ST, and the midpoint of accumulated light exposure (50% LE). Observed sleep timing data were compared to simulated data from a mathematical model for the effects of light on the circadian and homeostatic regulation of sleep. A total of 715 days of sleep timing and light exposure were recorded in 19 undergraduates in a repeated-measures observational study. During each three-week assessment, light and activity were monitored, and self-reported bed and wake times were collected. Light exposure was higher in spring than in autumn. 50% LE did not vary across season, but occurred later on weekends compared to weekdays. Relative to clock-time, bedtime, wake-time, mid-sleep, and midpoint of activity were later on weekends but did not differ across seasons. Relative to SN, sleep and activity measures were earlier in spring than in autumn. Relative to 50% LE, only wake-time and mid-sleep were later on weekends, with no seasonal differences. Individual differences in mid-sleep did not correlate with SN but correlated with 50% LE. Individuals with different habitual bedtimes responded similarly to seasonal changes. Model simulations showed that light exposure patterns are sufficient to explain sleep timing in spring but less so in autumn. The findings indicate that during autumn and spring, the timing of sleep associates with actual light exposure rather than sun time as indexed by SN.

Effects of light on human circadian rhythms, sleep and mood

Humans live in a 24-hour environment, in which light and darkness follow a diurnal pattern. Our circadian pacemaker, the suprachiasmatic nuclei (SCN) in the hypothalamus, is entrained to the 24-hour solar day via a pathway from the retina and synchronises our internal biological rhythms. Rhythmic variations in ambient illumination impact behaviours such as rest during sleep and activity during wakefulness as well as their underlying biological processes. Rather recently, the availability of artificial light has substantially changed the light environment, especially during evening and night hours. This may increase the risk of developing circadian rhythm sleep-wake disorders (CRSWD), which are often caused by a misalignment of endogenous circadian rhythms and external light-dark cycles. While the exact relationship between the availability of artificial light and CRSWD remains to be established, nocturnal light has been shown to alter circadian rhythms and sleep in humans. On the other hand, light can also be used as an effective and noninvasive therapeutic option with little to no side effects, to improve sleep,mood and general well-being. This article reviews our current state of knowledge regarding the effects of light on circadian rhythms, sleep, and mood.

What is the 'spectral diet' of humans?

Our visual perception of the world — seeing form and colour or navigating the environment — depends on the interaction of light and matter in the environment. Light also has a more fundamental role in regulating rhythms in physiology and behaviour, as well as in the acute secretion of hormones such as melatonin and changes in alertness, where light exposure at short-time, medium-time and long-time scales has different effects on these visual and non-visual functions. Yet patterns of light exposure in the real world are inherently messy: we move in and out of buildings and are therefore exposed to mixtures of artificial and natural light, and the physical makeup of our environment can also drastically alter the spectral composition and spatial distribution of the emitted light. In spatial vision, the examination of natural image statistics has proven to be an important driver in research. Here, we expand this concept to the spectral domain and develop the concept of the ‘spectral diet’ of humans.

Chronotype-Dependent Changes in Sleep Habits Associated with Dim Light Melatonin Onset in the Antarctic Summer

Dim light melatonin onset (DLMO) is the most reliable measure of human central circadian timing. Its modulation by light exposure and chronotype has been scarcely approached. We evaluated the impact of light changes on the interaction between melatonin, sleep, and chronotype in university students (n = 12) between the Antarctic summer (10 days) and the autumn equinox in Montevideo, Uruguay (10 days). Circadian preferences were tested by validated questionnaires. A Morningness–Eveningness Questionnaire average value (47 ± 8.01) was used to separate late and early participants. Daylight exposure (measured by actimetry) was significantly higher in Antarctica versus Montevideo in both sensitive time windows (the morning phase-advancing and the evening phase-delaying). Melatonin was measured in hourly saliva samples (18–24 h) collected in dim light conditions (<30 lx) during the last night of each study period. Early and late participants were exposed to similar amounts of light in both sites and time windows, but only early participants were significantly more exposed during the late evening in Antarctica. Late participants advanced their DLMO with no changes in sleep onset time in Antarctica, while early participants delayed their DLMO and sleep onset time. This different susceptibility to respond to light may be explained by a subtle difference in evening light exposure between chronotypes.

Reduced melatonin synthesis in pregnant night workers: Metabolic implications for offspring

Several novel animal studies have shown that intrauterine metabolic programming can be modified in the event of reduced melatonin synthesis during pregnancy, leading to glucose intolerance and insulin resistance in the offspring. It is therefore postulated that female night workers when pregnant may expose the offspring to unwanted health threats. This may be explained by the fact that melatonin is essential for regulating energy metabolism and can influence reproductive activity. Moreover, the circadian misalignment caused by shift work affects fertility and the fetus, increasing the risk of miscarriage, premature birth and low birth weight, phenomena observed in night workers. Thus, we hypothesize that light-induced melatonin suppression as a result of night work may alter intrauterine metabolic programming in pregnant women, potentially leading to metabolic disorders in their offspring.

Morning Circadian Misalignment Is Associated With Insulin Resistance in Girls With Obesity and Polycystic Ovarian Syndrome

CONTEXT

To our knowledge, circadian rhythms have not been examined in girls with polycystic ovarian syndrome (PCOS), despite the typical delayed circadian timing of adolescence, which is an emerging link between circadian health and insulin sensitivity (SI), and decreased SI in PCOS.

OBJECTIVE

To examine differences in the circadian melatonin rhythm between obese adolescent girls with PCOS and control subjects, and evaluate relationships between circadian variables and SI.

DESIGN

Cross-sectional study.

PARTICIPANTS

Obese adolescent girls with PCOS (n = 59) or without PCOS (n = 33).

OUTCOME MEASURES

Estimated sleep duration and timing from home actigraphy monitoring, in-laboratory hourly sampled dim-light, salivary-melatonin and fasting hormone analysis.

RESULTS

All participants obtained insufficient sleep. Girls with PCOS had later clock-hour of melatonin offset, later melatonin offset relative to sleep timing, and longer duration of melatonin secretion than control subjects. A later melatonin offset after wake time (i.e., morning wakefulness occurring during the biological night) was associated with higher serum free testosterone levels and worse SI regardless of group. Analyses remained significant after controlling for daytime sleepiness and sleep-disordered breathing.

CONCLUSION

Circadian misalignment in girls with PCOS is characterized by later melatonin offset relative to clock time and sleep timing. Morning circadian misalignment was associated with metabolic dysregulation in girls with PCOS and obesity. Clinical care of girls with PCOS and obesity would benefit from assessment of sleep and circadian health. Additional research is needed to understand mechanisms underlying the relationship between morning circadian misalignment and SI in this population.

Application of a Limit-Cycle Oscillator Model for Prediction of Circadian Phase in Rotating Night Shift Workers

Practical alternatives to gold-standard measures of circadian timing in shift workers are needed. We assessed the feasibility of applying a limit-cycle oscillator model of the human circadian pacemaker to estimate circadian phase in 25 nursing and medical staff in a field setting during a transition from day/evening shifts (diurnal schedule) to 3-5 consecutive night shifts (night schedule). Ambulatory measurements of light and activity recorded with wrist actigraphs were used as inputs into the model. Model estimations were compared to urinary 6-sulphatoxymelatonin (aMT6s) acrophase measured on the diurnal schedule and last consecutive night shift. The model predicted aMT6s acrophase with an absolute mean error of 0.69 h on the diurnal schedule (SD = 0.94 h, 80% within ±1 hour), and 0.95 h on the night schedule (SD = 1.24 h, 68% within ±1 hour). The aMT6s phase shift from diurnal to night schedule was predicted to within ±1 hour in 56% of individuals. Our findings indicate the model can be generalized to a shift work setting, although prediction of inter-individual variability in circadian phase shift during night shifts was limited. This study provides the basis for further adaptation and validation of models for predicting circadian phase in rotating shift workers.

Shedding Light on the Association between Night Work and Breast Cancer

Shift work that involves circadian disruption has been classified as probably carcinogenic to humans by the International Agency for Research on Cancer, although more recent epidemiological evidence is not consistent. Several mechanisms have been postulated to explain an association between night work and female breast cancer, but the most likely is suppression of the hormone melatonin by light exposure at night. Three articles recently published in this journal describe aspects of exposure to light during night work. These articles and other evidence suggest that nighttime light levels may not always be sufficient to affect melatonin production, which could in part explain the inconsistencies in the epidemiological data. There is need to improve the specificity and reliability of exposure assessments in future epidemiological studies of night shift workers.

A placebo-controlled pilot study of a wearable morning bright light treatment for probable PTSD

BACKGROUND

Evidence-based treatments for post-traumatic stress disorder (PTSD) have poor uptake and remission rates, suggesting that alternative treatments are needed. Morning bright light may be an effective treatment for PTSD given its established effects on mood and sleep, however, there are no published trials.

METHODS

We conducted a placebo-controlled pilot trial of a wearable light device, the Re-timer®, for individuals with probable PTSD. Individuals were randomly assigned to the active Re-timer® (n = 9) or a placebo Re-timer® dimmed with neutral density filters (n = 6). Participants self-administered the treatment at home 1 hr each morning over 4 weeks. PTSD and depression symptoms were assessed at pre- and post-treatment.

RESULTS

The Re-timer® was well tolerated and the perceived benefit was high, though treatment adherence was only moderate. Those in the active group were more likely to achieve a minimal clinically important change in PTSD and depression symptoms and had larger symptom reductions than those in the placebo group CONCLUSIONS: A wearable morning light treatment was acceptable and feasible for patients with probable PTSD. This study provides initial proof-of-concept that light treatment can improve PTSD. A larger trial is warranted to establish treatment efficacy. NCT#: 03513848.

Circadian Responses to Fragmented Light: Research Synopsis in Humans

Light is the chief signal used by the human circadian pacemaker to maintain precise biological timekeeping. Though it has been historically assumed that light resets the pacemaker's rhythm in a dose-dependent fashion, a number of studies report enhanced circadian photosensitivity to the initial moments of light exposure, such that there are quickly diminishing returns on phase-shifting the longer the light is shown. In the current review, we summarize findings from a family of experiments conducted over two decades in the research wing of the Brigham and Women's Hospital that examined the human pacemaker's responses to standardized changes in light patterns generated from an overhead fluorescent ballast. Across several hundred days of laboratory recording, the research group observed phase-shifts in the body temperature and melatonin rhythms that scaled with illuminance. However, as suspected, phase resetting was optimized when exposure occurred as a series of minute-long episodes separated by periods of intervening darkness. These observations set the stage for a more recent program of study at Stanford University that evaluated whether the human pacemaker was capable of integrating fragmented bursts of light in much the same way it perceived steady luminance. The results here suggest that ultra-short durations of light-lasting just 1-2 seconds in total-can elicit pacemaker responses rivaling those created by continuous hour-long stimulation if those few seconds of light are evenly distributed across the hour as discreet 2-millisecond pulses. We conclude our review with a brief discussion of these findings and their potential application in future phototherapy techniques.

High sensitivity and interindividual variability in the response of the human circadian system to evening light

Electric lighting has fundamentally altered how the human circadian clock synchronizes to the day/night cycle. Exposure to light after dusk is pervasive in the modern world. We examined group-level sensitivity of the circadian system to evening light and the degree to which sensitivity varies between individuals. We found that, on average, humans are highly sensitive to evening light. Specifically, 50% suppression of melatonin occurred at <30 lux, which is comparable to or lower than typical indoor lighting used at night, as well as light produced by electronic devices. Significantly, there was a >50-fold difference in sensitivity to evening light across individuals. Interindividual differences in light sensitivity may explain differential vulnerability to circadian disruption and subsequent impact on human health.

Before the invention of electric lighting, humans were primarily exposed to intense (>300 lux) or dim (<30 lux) environmental light—stimuli at extreme ends of the circadian system’s dose–response curve to light. Today, humans spend hours per day exposed to intermediate light intensities (30–300 lux), particularly in the evening. Interindividual differences in sensitivity to evening light in this intensity range could therefore represent a source of vulnerability to circadian disruption by modern lighting. We characterized individual-level dose–response curves to light-induced melatonin suppression using a within-subjects protocol. Fifty-five participants (aged 18–30) were exposed to a dim control (<1 lux) and a range of experimental light levels (10–2,000 lux for 5 h) in the evening. Melatonin suppression was determined for each light level, and the effective dose for 50% suppression (ED₅₀) was computed at individual and group levels. The group-level fitted ED₅₀ was 24.60 lux, indicating that the circadian system is highly sensitive to evening light at typical indoor levels. Light intensities of 10, 30, and 50 lux resulted in later apparent melatonin onsets by 22, 77, and 109 min, respectively. Individual-level ED₅₀ values ranged by over an order of magnitude (6 lux in the most sensitive individual, 350 lux in the least sensitive individual), with a 26% coefficient of variation. These findings demonstrate that the same evening-light environment is registered by the circadian system very differently between individuals. This interindividual variability may be an important factor for determining the circadian clock’s role in human health and disease.

Use of "Lights" for Bipolar Depression

PURPOSE

In this review, we will review the background and diagnosis of bipolar disorder (BD); describe the efficacy data and potential circadian and neural mechanisms underlying the effects of bright light for bipolar depression; and discuss the implementation of light therapy in clinical practice.

RECENT FINDINGS

To date, morning bright light is the most widely tested form of light therapy for all mood disorders. Clinical trial reports suggest that midday or morning bright light treatment and novel chronotherapeutic interventions are effective for bipolar depression. Mechanisms of response may relate to effects on the circadian system and other changes in neural functioning. Using bright light to manage depressive symptoms in BD is reasonable but also requires concurrent antimanic treatment and careful clinical monitoring for response, safety, and mood polarity switch.

Association between shift work and hyperhomocysteinemia in male workers

Background

Shift work is associated with a higher risk of cardiovascular diseases. Here, we sought to assess the relationship between shift work and plasma homocysteine levels. Determining the correlations between shift work and homocysteine levels may provide a better understanding of the mechanisms underlying cardiovascular diseases.

Methods

This study was performed using data from routine health examinations of steel workers in 2017. In total, 431 male workers (70 daytime workers and 361 shift workers) employed on a rolling departure schedule were recruited. Plasma homocysteine levels > 15 μmol/L were considered elevated. The χ², analysis of variance, and multiple logistic regression analyses were used to examine the association between shift work and plasma homocysteine levels.

Results

In comparison to daytime workers, the odds ratio (OR) of hyperhomocysteinemia in individuals with < 10 years of shift work was 1.14 (95% confidence interval [CI]: 0.64–2.03), compared to 2.01 (95% CI: 1.14–3.54) for workers with ≥ 10 years of experience. After adjusting for confounding variables, the adjusted OR for shift workers with < 10 years of experience was 0.95 (95% CI: 0.50–1.80), compared to 2.00 (95% CI: 1.07–3.74) for workers with ≥ 10 years of experience.

Conclusions

The risk of hyperhomocysteinemia was significantly higher in shift workers compared to those working normal daytime hours, particularly among long-term shift workers.