Acute alerting effects of light: A systematic literature review

Towards an evidence-based integrative lighting score: a proposed multi-level approach

Background: Human circadian clocks are synchronized daily with the external light-dark cycle and entrained to the 24-hour day. There is increasing evidence that a lack of synchronization and circadian entrainment can lead to adverse health effects. Beyond vision, light plays a critical role in modulating many so-called non-visual functions, including sleep-wake cycles, alertness, mood and endocrine functions. To assess (and potentially optimize) the impact of light on non-visual functions, it is necessary to know the exact 'dose' (i.e. spectral irradiance and exposure duration at eye level) of 24-hour light exposures, but also to include metadata about the lighting environment, individual needs and resources.

Problem statement: To address this problem, a new assessment tool is needed that uses existing metrics to provide metadata and information about light quality and quantity from all sources. In this commentary, we discuss the need to develop an evidence-based integrative lighting score that is tailored to specific audiences and lighting environments. We will summarize the most compelling evidence from the literature and outline a future plan for developing such a lighting score using internationally accepted metrics, stakeholder and user feedback.

Conclusion: We propose a weighting system that combines light qualities with physiological and behavioral effects, and the use of mathematical modelling for an output score. Such a scoring system will facilitate a holistic assessment of a lighting environment, integrating all available light sources.

Diurnal biological effects of correlated colour temperature and its exposure timing on alertness, cognition, and mood in an enclosed environment

Artificial lighting, which profits from the non-visual effects of light, is a potentially promising solution to support residents' psychophysiological health and performance at specific times of the day in enclosed environments. However, few studies have investigated the non-visual effects of daytime correlated colour temperature (CCT) and its exposure timing on human alertness, cognition, and mood. However, the neural mechanisms underlying these effects are largely unknown. The current study evaluated the effects of daytime CCT and its exposure timing on markers of subjective experience, cognitive performance, and cerebral activity in a simulated enclosed environment. Forty-two participants participated a single-blind laboratory study with a 4 within (CCT: 4000 K vs. 6500 K vs. 8500 K vs. 12,000 K) × 2 between (exposure timing: morning vs. afternoon) mixed design. The results showed time of the day dependent benefits of the daytime CCT on subjective experience, vigilant attention, response inhibition, working memory, emotional perception, and risk decisions. The results of the electroencephalogram (EEG) revealed that lower-frequency EEG bands, including theta, alpha, and alpha-theta, were quite sensitive to daytime CCT intervention, which provides a valuable reference for trying to establish the underlying mechanisms that support the performance-enhancement effects of exposure to CCT in the daytime. However, the results revealed no consistent intervention pattern across these measurements. Therefore, future studies should consider personalised optimisation of daytime CCT for different cognitive demands.

Acute effects of light during daytime on central aspects of attention and affect: A systematic review

Light regulates both image- and various non-image forming responses in humans, including acute effects on attention and affect. To advance the understanding of light's immediate effects, this systematic review describes the acute effects of monochromatic/narrow bandwidth and polychromatic white light during daytime on distinct aspects of attention (alertness, sustained attention, working memory, attentional control and flexibility), and measures of affect (self-report measures, performance-based tests, psychophysiological measures) in healthy, adult human subjects. Original, peer-reviewed (quasi-) experimental studies published between 2000 and May 2024 were included according to predefined inclusion and exclusion criteria. Study quality was assessed, and results were synthesized across aspects of attention and affect and grouped according to light interventions; monochromatic/narrowband-width or polychromatic white light (regular white, bright white, and white with high correlated color temperature (CCT)). Results from included studies (n = 62) showed that alertness and working memory were most affected by light. Electroencephalographic markers of alertness improved the most with exposure to narrow bandwidth long-wavelength light, regular white, and white light with high CCT. Self-reported alertness and measures of working memory improved the most with bright white light. Results from studies testing the acute effects on sustained attention and attentional control and flexibility were inconclusive. Performance-based and psychophysiological measures of affect were only influenced by narrow bandwidth long-wavelength light. Polychromatic white light exerted mixed effects on self-reported affect. Studies were strongly heterogeneous in terms of light stimuli characteristics and reporting of light stimuli and control of variables influencing light's acute effects.

Blue Light and Digital Screens Revisited: A New Look at Blue Light from the Vision Quality, Circadian Rhythm and Cognitive Functions Perspective

Research conducted over the years has established that artificial light at night (ALAN), particularly short wavelengths in the blue region (~400-500 nm), can disrupt the circadian rhythm, cause sleep disturbances, and lead to metabolic dysregulation. With the increasing number of people spending considerable amounts of time at home or work staring at digital screens such as smartphones, tablets, and laptops, the negative impacts of blue light are becoming more apparent. While blue wavelengths during the day can enhance attention and reaction times, they are disruptive at night and are associated with a wide range of health problems such as poor sleep quality, mental health problems, and increased risk of some cancers. The growing global concern over the detrimental effects of ALAN on human health is supported by epidemiological and experimental studies, which suggest that exposure to ALAN is associated with disorders like type 2 diabetes, obesity, and increased risk of breast and prostate cancer. Moreover, several studies have reported a connection between ALAN, night-shift work, reduced cognitive performance, and a higher likelihood of human errors. The purpose of this paper is to review the biological impacts of blue light exposure on human cognitive functions and vision quality. Additionally, studies indicating a potential link between exposure to blue light from digital screens and increased risk of breast cancer are also reviewed. However, more research is needed to fully comprehend the relationship between blue light exposure and adverse health effects, such as the risk of breast cancer.

Melanopsin-mediated amplification of cone signals in the human visual cortex

The ambient daylight variation is coded by melanopsin photoreceptors and their luxotonic activity increases towards midday when colour temperatures are cooler, and irradiances are higher. Although melanopsin and cone photoresponses can be mediated via separate pathways, the connectivity of melanopsin cells across all levels of the retina enables them to modify cone signals. The downstream effects of melanopsin-cone interactions on human vision are however, incompletely understood. Here, we determined how the change in daytime melanopsin activation affects the human cone pathway signals in the visual cortex. A 5-primary silent-substitution method was developed to evaluate the dependence of cone-mediated signals on melanopsin activation by spectrally tuning the lights and stabilizing the rhodopsin activation under a constant cone photometric luminance. The retinal (white noise electroretinogram) and cortical responses (visual evoked potential) were simultaneously recorded with the photoreceptor-directed lights in 10 observers. By increasing the melanopsin activation, a reverse response pattern was observed with cone signals being supressed in the retina by 27% (p = 0.03) and subsequently amplified by 16% (p = 0.01) as they reach the cortex. We infer that melanopsin activity can amplify cone signals at sites distal to retinal bipolar cells to cause a decrease in the psychophysical Weber fraction for cone vision.

ICNIRP Statement on Short Wavelength Light Exposure from Indoor Artificial Sources and Human Health

ABSTRACT

Concerns have been raised about the possibility of effects from exposure to short wavelength light (SWL), defined here as 380-550 nm, on human health. The spectral sensitivity of the human circadian timing system peaks at around 480 nm, much shorter than the peak sensitivity of daytime vision (i.e., 555 nm). Some experimental studies have demonstrated effects on the circadian timing system and on sleep from SWL exposure, especially when SWL exposure occurs in the evening or at night. The International Commission on Non-Ionizing Radiation Protection (ICNIRP) has identified a lack of consensus among public health officials regarding whether SWL from artificial sources disrupts circadian rhythm, and if so, whether SWL-disrupted circadian rhythm is associated with adverse health outcomes. Systematic reviews of studies designed to examine the effects of SWL on sleep and human health have shown conflicting results. There are many variables that can affect the outcome of these experimental studies. One of the main problems in earlier studies was the use of photometric quantities as a surrogate for SWL exposure. Additionally, the measurement of ambient light may not be an accurate measure of the amount of light impinging on the intrinsically photosensitive retinal ganglion cells, which are now known to play a major role in the human circadian timing system. Furthermore, epidemiological studies of long-term effects of chronic SWL exposure per se on human health are lacking. ICNIRP recommends that an analysis of data gaps be performed to delineate the types of studies needed, the parameters that should be addressed, and the methodology that should be applied in future studies so that a decision about the need for exposure guidelines can be made. In the meantime, ICNIRP supports some recommendations for how the quality of future studies might be improved.

Cerebral, systemic physiological and behavioral responses to colored light exposure during a cognitive task: A SPA-fNIRS study

Colored light has important implications for human health and well-being, as well as for the aesthetics and function of various environments. In addition to its effects on visual function, colored light has significant effects on cognitive performance, behavior and systemic physiology. The aim of the current study was to comprehensively investigate how colored light exposure (CLE) combined with a cognitive task (2-back) affects performance, cerebral hemodynamics, oxygenation, and systemic physiology as assessed by systemic physiology augmented functional near-infrared spectroscopy (SPA-fNIRS). 36 healthy subjects (22 female, 14 male, age 26.3 ± 5.7 years) were measured twice on two different days. They were exposed to the sequence of blue and red light or vice versa in a randomized crossover design. During the CLE, the subjects were asked to perform a 2-back task. The 2-back task performance was correlated with changes in the concentration of oxygenated hemoglobin in the prefrontal cortex (red: r = -0.37, p = 0.001; blue: r = -0.33, p = 0.004) and the high-frequency component of the heart rate variability (red: r = 0.35, p = 0.003; blue: r = 0.25, p = 0.04). These changes were independent of the CLE. Sequence-dependent effects were observed for fNIRS signals at the visual cortex (VC) and for electrodermal activity (EDA). While both colors caused relatively similar changes in the VC and EDA at the position of the first exposure, blue and red light caused greater changes in the VC and EDA, respectively, in the second exposure. There was no significant difference in the subjects' 2-back task performance between the CLE (p = 0.46). The results of this study provide new insights into how human physiology and behavior respond to colored light exposure. Our findings are important for understanding the impact of colored light in our daily lives and its potential applications in a variety of settings, including education, the workplace and healthcare.

The Efficacy of a Multimodal Bedroom-Based 'Smart' Alarm System on Mitigating the Effects of Sleep Inertia

Previous work has demonstrated the modest impact of environmental interventions that manipulate lighting, sound, or temperature on sleep inertia symptoms. The current study sought to expand on previous work and measure the impact of a multimodal intervention that collectively manipulated light, sound, and ambient temperature on sleep inertia. Participants slept in the lab for four nights and were awoken each morning by either a traditional alarm clock or the multimodal intervention. Feelings of sleep inertia were measured each morning through Psychomotor Vigilance Test (PVT) assessments and ratings of sleepiness and mood at five time-points. While there was little overall impact of the intervention, the participant's chronotype and the length of the lighting exposure on intervention mornings both influenced sleep inertia symptoms. Moderate evening types who received a shorter lighting exposure (≤15 min) demonstrated more lapses relative to the control condition, whereas intermediate types exhibited a better response speed and fewer lapses. Conversely, moderate evening types who experienced a longer light exposure (>15 min) during the intervention exhibited fewer false alarms over time. The results suggest that the length of the environmental intervention may play a role in mitigating feelings of sleep inertia, particularly for groups who might exhibit stronger feelings of sleep inertia, including evening types.

The cognitive impact of light: illuminating ipRGC circuit mechanisms

Ever-present in our environments, light entrains circadian rhythms over long timescales, influencing daily activity patterns, health and performance. Increasing evidence indicates that light also acts independently of the circadian system to directly impact physiology and behaviour, including cognition. Exposure to light stimulates brain areas involved in cognition and appears to improve a broad range of cognitive functions. However, the extent of these effects and their mechanisms are unknown. Intrinsically photosensitive retinal ganglion cells (ipRGCs) have emerged as the primary conduit through which light impacts non-image-forming behaviours and are a prime candidate for mediating the direct effects of light on cognition. Here, we review the current state of understanding of these effects in humans and mice, and the tools available to uncover circuit-level and photoreceptor-specific mechanisms. We also address current barriers to progress in this area. Current and future efforts to unravel the circuits through which light influences cognitive functions may inform the tailoring of lighting landscapes to optimize health and cognitive function.

Diurnal variation in variables related to cognitive performance: a systematic review

PURPOSE

The aim of this review was to assess current evidence regarding changes in cognitive function according to time-of-day (TOD) and assess the key components of research design related to manuscripts of chronobiological nature.

METHODS

An English-language literature search revealed 523 articles through primary database searches, and 1868 via organization searches/citation searching. The inclusion criteria were met by eleven articles which were included in the review. The inclusion criteria set were healthy adult males, a minimum of two timepoints including morning and evening, cognitive measures of performance, and peer-reviewed academic paper.

RESULTS

It was established that cognitive performance varies with TOD and the degree of difference is highly dependent on the type of cognitive task with differences ranging from 9.0 to 34.2% for reaction time, 7.3% for alertness, and 7.8 to 40.3% for attention. The type of cognitive function was a determining factor as to whether the performance was better in the morning, evening, or afternoon.

CONCLUSION

Although some studies did not establish TOD differences, reaction time and levels of accuracy were highest in the evening. This implies that cognitive processes are complex, and existing research is contradictory. Some studies or cognitive variables did not show any measurable TOD effects, which may be due to differences in methodology, subjects involved, testing protocols, and confounding factors. No studies met all requirements related to chronobiological research, highlighting the issues around methodology. Therefore, future research must use a rigorous, approach, minimizing confounding factors that are specific to examinations of TOD.

An at-home evaluation of a light intervention to mitigate sleep inertia symptoms

OBJECTIVES

Under laboratory settings, light exposure upon waking at night improves sleep inertia symptoms. We investigated whether a field-deployable light source would mitigate sleep inertia in a real-world setting.

METHODS

Thirty-six participants (18 female; 26.6 years ± 6.1) completed an at-home, within-subject, randomized crossover study. Participants were awoken 45 minutes after bedtime and wore light-emitting glasses with the light either on (light condition) or off (control). A visual 5-minute psychomotor vigilance task, Karolinska sleepiness scale, alertness and mood scales, and a 3-minute auditory/verbal descending subtraction task were performed at 2, 12, 22, and 32 minutes after awakening. Participants then went back to sleep and were awoken after 45 minutes for the opposite condition. A series of mixed-effect models were performed with fixed effects of test bout, condition, test bout × condition, a random effect of the participant, and relevant covariates.

RESULTS

Participants rated themselves as more alert (p = .01) and energetic (p = .001) in the light condition compared to the control condition. There was no effect of condition for descending subtraction task outcomes when including all participants, but there was a significant improvement in descending subtraction task total responses in the light condition in the subset of participants waking from N3 (p = .03). There was a significant effect of condition for psychomotor vigilance task outcomes, with faster responses (p < .001) and fewer lapses (p < .001) in the control condition.

CONCLUSIONS

Our findings suggest that light modestly improves self-rated alertness and energy after waking at home regardless of sleep stage, with lower aggression and improvements to working memory only after waking from N3. Contrary to laboratory studies, we did not observe improved performance on the psychomotor vigilance task. Future studies should include measures of visual acuity and comfort to assess the feasibility of interventions in real-world settings.

Integrative Lighting Aimed at Patients with Psychiatric and Neurological Disorders

The purpose of this paper is to investigate the impact of circadian lighting-induced melatonin suppression on patients with psychiatric and neurological disorders in hospital wards by using an ad-hoc metrology framework and the subsequent metrics formalized by the CIE in 2018. A measurement scheme was conducted in hospital ward rooms in the Department of Neurology, Zealand University Hospital, at Roskilde in Denmark, to evaluate the photometric and colorimetric characteristics of the lighting system, as well as its influence on the circadian rhythm of the occupants. The measurement scheme included point measurements and data logging, using a spectrophotometer mounted on a tripod with adjustable height to assess the newly installed circadian lighting system. The measured spectra were uploaded to the Luox platform to calculate illuminance, CCT, MEDI, etc., in accordance with the CIE S026 standard. Furthermore, the MLIT based on MEDI data logging results was calculated. In addition to CIE S026, we have investigated the usefulness of melatonin suppression models for the assessment of circadian performance regarding measured light. From the results, the lighting conditions in the patient room for both minimal and abundant daylight access were evaluated and compared; we found that access to daylight is essential for both illumination and circadian entrainment. It can be concluded that the measurement scheme, together with the use of the Luox platform and Canva template, is suitable for the accurate and satisfactory measurement of integrative lighting that aligns with CIE requirements and recommendations.

The impact of wavelength on acute non-visual responses to light: A systematic review and meta-analysis

Light is detected in the eye by three classes of photoreceptors (rods, cones, and intrinsically photosensitive retinal ganglion cells (ipRGCs)) that are each optimized for a specific function and express a particular light-detecting photopigment. The significant role of short-wavelength light and ipRGCs in improving alertness has been well-established; however, few reviews have been undertaken to assess the other wavelengths' effects regarding timing and intensity. This study aims to evaluate the impact of different narrowband light wavelengths on subjective and objective alertness among the 36 studies included in this systematic review, 17 of which were meta-analyzed. Short-wavelength light (∼460-480 nm) significantly improves subjective alertness, cognitive function, and neurological brain activities at night, even for a sustained period (∼6h) (for λmax: 470/475 nm, 0.4 < |Hedges's g| < 0.6, p < 0.05), but except early morning, it almost does not show this effect during the day when melatonin level is lowest. Long-wavelength light (∼600-640 nm) has little effect at night, but significantly increases several measures of alertness at lower irradiance during the daytime (∼1h), particularly when there is homeostatic sleep drive (for λmax: ∼630 nm, 0.5 < |Hedges's g| < 0.8, p < 0.05). The results further suggest that melanopic illuminance may not always be sufficient to measure the alerting effect of light.

Numerical correlation between non-visual metrics and brightness metrics-implications for the evaluation of indoor white lighting systems in the photopic range

From the beginning of the [Formula: see text] century until today, the demand for lighting systems includes not only visual parameters (brightness, contrast perception, color quality), but also non-visual parameters. It is necessary to define the new non-visual parameters for the realization of the new concept of Human Centric Lighting (HCL) or Integrative Lighting. As a contribution to this approach, many international research groups have tried to quantify the non-visual parameters such as Circadian Stimulus by Rea et. al. in USA ([Formula: see text], [Formula: see text]), Melanopic Equivalent Daylight ([Formula: see text]) illuminance, mEDI of the CIE S 026/E:2018 or the latest formula by Giménez et al., for the nocturnal melatonin suppression. Therefore, it is necessary to analyze the correlation between these non-visual metrics and brightness metrics such as the equivalent luminance of Fotios et al., or the latest brightness model of TU Darmstadt so that scientists, lighting engineers and lighting system users can correctly apply them in their work. In this context, this paper attempts to investigate and analyze these correlations between the three metric groups based on the database of 884 light sources of different light source technologies and daylight spectra. The obtained results show that the latest Circadian Stimulus model of Rea et. al. [Formula: see text] with the improvement of Circadian Light [Formula: see text] ([Formula: see text]) has solved the disadvantage of [Formula: see text], especially for the interrupted point between warm and cold white (about [Formula: see text]) or the junction between negative and positive signal of the opponent channel ([Formula: see text]). Moreover, these three metrics of the three research groups contain a high correlation coefficient, so that one metric can be transformed by linear functions to the other two parameters.

Impact of repeated morning bright white light exposures on attention in a simulated office environment

Attention is essential to the work. This study investigated the effects of two different light pulses on a simple attention task. In addition, the effects of subsequent exposure to constant but different illuminance levels on the continuation of the simple attention task and a subsequent complex attention task were examined. A total of 56 subjects were assigned in random order to two white light interventions that were repeated five times during the morning. Each light intervention consisted of a brief light pulse followed by constant light exposure and differed in temporal dimming dynamics and corneal illuminance. Subjective and psychometric parameters were recorded several times during light exposure. Heart rate variability (HRV) was derived from continuous electrocardiograms. Subjects showed improved reaction speed in the simple attention task, accompanied by higher HRV under a brighter light pulse without habituation by repetition. This difference in simple attention performance disappeared when light exposure remained the same after the light pulse. In addition, higher reaction speed and HRV were observed in the complex attention task under constant bright light exposure. Intermittent bright light seems promising to acutely improve attentional performance in office workplaces. Future research is needed to investigate daytime light effects on other work-related cognitive functions.

Determination and Measurement of Melanopic Equivalent Daylight (D65) Illuminance (mEDI) in the Context of Smart and Integrative Lighting

In the context of intelligent and integrative lighting, in addition to the need for color quality and brightness, the non-visual effect is essential. This refers to the retinal ganglion cells (ipRGCs) and their function, which were first proposed in 1927. The melanopsin action spectrum has been published in CIE S 026/E: 2018 with the corresponding melanopic equivalent daylight (D65) illuminance (mEDI), melanopic daylight (D65) efficacy ratio (mDER), and four other parameters. Due to the importance of mEDI and mDER, this work synthesizes a simple computational model of mDER as the main research objective, based on a database of 4214 practical spectral power distributions (SPDs) of daylight, conventional, LED, and mixed light sources. In addition to the high correlation coefficient R2 of 0.96795 and the 97% confidence offset of 0.0067802, the feasibility of the mDER model in intelligent and integrated lighting applications has been extensively tested and validated. The uncertainty between the mEDI calculated directly from the spectra and that obtained by processing the RGB sensor and applying the mDER model reached ± 3.3% after matrix transformation and illuminance processing combined with the successful mDER calculation model. This result opens the potential for low-cost RGB sensors for applications in intelligent and integrative lighting systems to optimize and compensate for the non-visual effective parameter mEDI using daylight and artificial light in indoor spaces. The goal of the research on RGB sensors and the corresponding processing method are also presented and their feasibility is methodically demonstrated. A comprehensive investigation with a huge amount of color sensor sensitivities is necessary in a future work of other research.

Utilizing EEG and fNIRS for the detection of sleep-deprivation-induced fatigue and its inhibition using colored light stimulation

Drowsy driving is a common, but underestimated phenomenon in terms of associated risks as it often results in crashes causing fatalities and serious injuries. It is a challenging task to alert or reduce the driver's drowsy state using non-invasive techniques. In this study, a drowsiness reduction strategy has been developed and analyzed using exposure to different light colors and recording the corresponding electrical and biological brain activities. 31 subjects were examined by dividing them into 2 classes, a control group, and a healthy group. Fourteen EEG and 42 fNIRS channels were used to gather neurological data from two brain regions (prefrontal and visual cortices). Experiments shining 3 different colored lights have been carried out on them at certain times when there is a high probability to get drowsy. The results of this study show that there is a significant increase in HbO of a sleep-deprived participant when he is exposed to blue light. Similarly, the beta band of EEG also showed an increased response. However, the study found that there is no considerable increase in HbO and beta band power in the case of red and green light exposures. In addition to that, values of other physiological signals acquired such as heart rate, eye blinking, and self-reported Karolinska Sleepiness Scale scores validated the findings predicted by the electrical and biological signals. The statistical significance of the signals achieved has been tested using repeated measures ANOVA and t-tests. Correlation scores were also calculated to find the association between the changes in the data signals with the corresponding changes in the alertness level.

Reconfigurations in brain networks upon awakening from slow wave sleep: Interventions and implications in neural communication

Sleep inertia is the brief period of impaired alertness and performance experienced immediately after waking. Little is known about the neural mechanisms underlying this phenomenon. A better understanding of the neural processes during sleep inertia may offer insight into the awakening process. We observed brain activity every 15 min for 1 hr following abrupt awakening from slow wave sleep during the biological night. Using 32-channel electroencephalography, a network science approach, and a within-subject design, we evaluated power, clustering coefficient, and path length across frequency bands under both a control and a polychromatic short-wavelength-enriched light intervention condition. We found that under control conditions, the awakening brain is typified by an immediate reduction in global theta, alpha, and beta power. Simultaneously, we observed a decrease in the clustering coefficient and an increase in path length within the delta band. Exposure to light immediately after awakening ameliorated changes in clustering. Our results suggest that long-range network communication within the brain is crucial to the awakening process and that the brain may prioritize these long-range connections during this transitional state. Our study highlights a novel neurophysiological signature of the awakening brain and provides a potential mechanism by which light improves performance after waking.

Verification, analytical validation and clinical validation (V3) of wearable dosimeters and light loggers

Background

Light exposure is an important driver and modulator of human physiology, behavior and overall health, including the biological clock, sleep-wake cycles, mood and alertness. Light can also be used as a directed intervention, e.g., in the form of light therapy in seasonal affective disorder (SAD), jetlag prevention and treatment, or to treat circadian disorders. Recently, a system of quantities and units related to the physiological effects of light was standardized by the International Commission on Illumination (CIE S 026/E:2018). At the same time, biometric monitoring technologies (BioMeTs) to capture personalized light exposure were developed. However, because there are currently no standard approaches to evaluate the digital dosimeters, the need to provide a firm framework for the characterization, calibration, and reporting for these digital sensors is urgent.

Objective

This article provides such a framework by applying the principles of verification, analytic validation and clinical validation (V3) as a state-of-the-art approach for tools and standards in digital medicine to light dosimetry.

Results

This article describes opportunities for the use of digital dosimeters for basic research, for monitoring light exposure, and for measuring adherence in both clinical and non-clinical populations to light-based interventions in clinical trials.

Reported sleep duration reveals segmentation of the adult life-course into three phases

Classically the human life-course is characterized by youth, middle age and old age. A wide range of biological, health and cognitive functions vary across this life-course. Here, using reported sleep duration from 730,187 participants across 63 countries, we find three distinct phases in the adult human life-course: early adulthood (19-33yrs), mid-adulthood (34-53yrs), and late adulthood (54+yrs). They appear stable across culture, gender, education and other demographics. During the third phase, where self-reported sleep duration increases with age, cognitive performance, as measured by spatial navigation, was found to have an inverted u-shape relationship with reported sleep duration: optimal performance peaks at 7 hours reported sleep. World-wide self-reported sleep duration patterns are geographically clustered, and are associated with economy, culture, and latitude.

Light Intervention Effects on Circadian Activity Rhythm Parameters and Nighttime Sleep in Dementia Assessed by Wrist Actigraphy: A Systematic Review and Meta-Analysis

BACKGROUND AND OBJECTIVES

Persons with dementia often show circadian rhythm disturbances and sleep problems. Timed light exposure seems to be a promising nonpharmacological treatment option. In this review, meta-analyses were run on light effects on circadian activity rhythm parameters in persons with dementia measured with wrist actimetry. Furthermore, we update a Cochrane review, published in 2014, on actigraphically measured light effects in nighttime sleep parameters in persons with dementia.

RESEARCH DESIGN AND METHODS

Four electronic databases were searched for randomized controlled trials. Effects in meta-analyses were summarized by using mean differences and 95% confidence intervals. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to assess the risk of bias and registered the review protocol (PROSPERO: CRD42020149001).

RESULTS

Thirteen trials met inclusion criteria, and either utilized light therapy devices, ambient room lighting systems, or dawn-dusk interventions. Eleven of these studies were subjected to meta-analyses. They did not reveal significant light effects on circadian activity parameters: amplitude (p = .62; n = 313), acrophase (p = .34; n = 313), intradaily variability (p = .51; n = 354), and interdaily stability (p = .38; n = 354). Furthermore, no light effects were found on sleep parameters: total sleep duration (p = .53; n = 594), sleep efficiency (p = .63; n = 333), wake after sleep onset (p = .95; n = 212), and sleep onset latency (p = .26; n = 156). Subgroup analyses, pooling data from 3 studies including persons with Alzheimer's dementia, also did not show light effects on circadian activity and sleep parameters. The overall risk of bias of included studies was high.

DISCUSSION AND IMPLICATIONS

There is insufficient evidence for actigraphically measured circadian light effects in persons with dementia. More high-quality research is needed to recommend the application of adjunctive light.

How people wake up is associated with previous night's sleep together with physical activity and food intake

How people wake up and regain alertness in the hours after sleep is related to how they are sleeping, eating, and exercising. Here, in a prospective longitudinal study of 833 twins and genetically unrelated adults, we demonstrate that how effectively an individual awakens in the hours following sleep is not associated with their genetics, but instead, four independent factors: sleep quantity/quality the night before, physical activity the day prior, a breakfast rich in carbohydrate, and a lower blood glucose response following breakfast. Furthermore, an individual's set-point of daily alertness is related to the quality of their sleep, their positive emotional state, and their age. Together, these findings reveal a set of non-genetic (i.e., not fixed) factors associated with daily alertness that are modifiable.

Melatonin suppression does not automatically alter sleepiness, vigilance, sensory processing, or sleep

Presleep exposure to short-wavelength light suppresses melatonin and decreases sleepiness with activating effects extending to sleep. This has mainly been attributed to melanopic effects, but mechanistic insights are missing. Thus, we investigated whether two light conditions only differing in the melanopic effects (123 vs. 59 lx melanopic EDI) differentially affect sleep besides melatonin. Additionally, we studied whether the light differentially modulates sensory processing during wakefulness and sleep. Twenty-nine healthy volunteers (18-30 years, 15 women) were exposed to two metameric light conditions (high- vs. low-melanopic, ≈60 photopic lx) for 1 h ending 50 min prior to habitual bed time. This was followed by an 8-h sleep opportunity with polysomnography. Objective sleep measurements were complemented by self-report. Salivary melatonin, subjective sleepiness, and behavioral vigilance were sampled at regular intervals. Sensory processing was evaluated during light exposure and sleep on the basis of neural responses related to violations of expectations in an oddball paradigm. We observed suppression of melatonin by ≈14% in the high- compared to the low-melanopic condition. However, conditions did not differentially affect sleep, sleep quality, sleepiness, or vigilance. A neural mismatch response was evident during all sleep stages, but not differentially modulated by light. Suppression of melatonin by light targeting the melanopic system does not automatically translate to acutely altered levels of vigilance or sleepiness or to changes in sleep, sleep quality, or basic sensory processing. Given contradicting earlier findings and the retinal anatomy, this may suggest that an interaction between melanopsin and cone-rod signals needs to be considered. Clinical Trial Registry: German Clinical Trials Register, DRKS00023602, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023602.

The human factors of mineworker fatigue: An overview on prevalence, mitigation, and what's next

BACKGROUND

Though mining remains a vital shiftwork industry for U.S. commerce, problems of continued prevalence of mineworker fatigue and its mitigation persist. Publications and reports on fatigue in mining appear to be rich and diverse, yet variable and remote, much like the industry itself.

METHODS

The authors engaged in a brief nonexhaustive overview of the literature on sleep and fatigue among mineworking populations.

RESULTS

This overview covers: potential sources of fatigue unique to mine work (e.g., monotonous and disengaging Work Tasks, underground environments and light exposure, remote work operations); evaluation of mitigation strategies for mineworker fatigue or working hours (e.g., shift-scheduling and training); and areas for future research and practice (e.g., fatigue risk management systems in mining, mineworker sleep and fatigue surveillance, lighting interventions, and automation).

CONCLUSIONS

Fatigue continues to be a critical challenge for the mining industry. While research on the problems and solutions of mineworker fatigue has been limited to date, the future of fatigue research in mining can expand these findings by exploring the origins, nature, and outcomes of fatigue using advancements in lighting, automation, and fatigue risk management.

Impact of Evening Light Exposures with Different Solid Angles on Circadian Melatonin Rhythms, Alertness, and Visual Comfort in an Automotive Setting

Future automotive interior lighting might have the potential to go beyond decorative purposes by influencing alertness, circadian physiology, and sleep. As the available space in the interior of an automobile for lighting applications is limited, understanding the impact of various luminous surface sizes on non-image-forming effects is fundamental in this field. In a laboratory study using a within-subject design, 18 participants were exposed to two bright light conditions with different solid angles and one dim light condition in a balanced, randomized order during the course of the evening. Our results demonstrate that both light conditions significantly increased subjective alertness and reduced salivary melatonin concentration but not cognitive performance compared to dim light. The solid angle of light exposure at constant corneal illuminance only affected visual comfort. While subjective alertness can be increased and melatonin can be attenuated with rather small luminaires, larger solid angles should be considered if visual comfort is a priority.

Brighter Time: A Smartphone App Recording Cognitive Task Performance and Illuminance in Everyday Life

Light is an influential regulator of behavioural and physiological state in mammals. Features of cognitive performance such as memory, vigilance and alertness can be altered by bright light exposure under laboratory and field conditions. However, the importance of light as a regulator of performance in everyday life is hard to assess and has so far remained largely unclear. We set out to address this uncertainty by developing a tool to capture measures of cognitive performance and light exposure, at scale, and during everyday life. To this end, we generated an app (Brighter Time) which incorporated a psychomotor vigilance (PVT), an N-back and a visual search task with questionnaire-based assessments of demographic characteristics, general health, chronotype and sleep. The app also measured illuminance during task completion using the smartphone's intrinsic light meter. We undertook a pilot feasibility study of Brighter Time based on 91-week-long acquisition phases within a convenience sample (recruited by local advertisements and word of mouth) running Brighter Time on their own smartphones over two study phases in winter and summer. Study compliance was suitable (median = 20/21 requested task completions per subject). Statistically significant associations were observed between subjective sleepiness and performance in all tasks. Significant daily variations in PVT and visual search performance were also observed. Higher illuminance was associated with reduced reaction time and lower inverse efficiency score in the visual search. Brighter Time thus represents a viable option for large-scale collection of cognitive task data in everyday life, and is able to reveal associations between task performance and sleepiness, time of day and current illuminance. Brighter Time's utility could be extended to exploring associations with longer-term patterns of light exposure and/or other light metrics by integrating with wearable light meters.

Rise and shine: The use of polychromatic short-wavelength-enriched light to mitigate sleep inertia at night following awakening from slow-wave sleep

Sleep inertia is the brief period of performance impairment and reduced alertness experienced after waking, especially from slow-wave sleep. We assessed the efficacy of polychromatic short-wavelength-enriched light to improve vigilant attention, alertness and mood immediately after waking from slow-wave sleep at night. Twelve participants (six female, 23.3 ± 4.2 years) maintained an actigraphy-confirmed sleep schedule of 8.5 hr for 5 nights, and 5 hr for 1 night prior to an overnight laboratory visit. In the laboratory, participants were awakened from slow-wave sleep, and immediately exposed to either dim, red ambient light (control) or polychromatic short-wavelength-enriched light (light) for 1 hr in a randomized crossover design. They completed a 5-min Psychomotor Vigilance Task, the Karolinska Sleepiness Scale, and Visual Analogue Scales of mood at 2, 17, 32 and 47 min after waking. Following this testing period, lights were turned off and participants returned to sleep. They were awakened from their subsequent slow-wave sleep period and received the opposite condition. Compared with the control condition, participants exposed to light had fewer Psychomotor Vigilance Task lapses (χ² [1] = 5.285, p = 0.022), reported feeling more alert (Karolinska Sleepiness Scale: F_1,77  = 4.955, p = 0.029; Visual Analogue Scale_alert : F_1,77  = 8.226, p = 0.005), and reported improved mood (Visual Analogue Scale_cheerful : F_1,77  = 8.615, p = 0.004). There was no significant difference in sleep-onset latency between conditions following the testing period (t₁₀  = 1.024, p = 0.330). Our results suggest that exposure to polychromatic short-wavelength-enriched light immediately after waking from slow-wave sleep at night may help improve vigilant attention, subjective alertness, and mood. Future studies should explore the potential mechanisms of this countermeasure and its efficacy in real-world environments.

Alerting effects of light in healthy individuals: a systematic review and meta-analysis

Light plays an essential role in psychobiological and psychophysiological processes, such as alertness. The alerting effect is influenced by light characteristics and the timing of interventions. This meta-analysis is the first to systematically review the effect of light intervention on alertness and to discuss the optimal protocol for light intervention. In this meta-analysis, registered at PROSPERO (Registration ID: CRD42020181485), we conducted a systematic search of the Web of Science, PubMed, and PsycINFO databases for studies published in English prior to August 2021. The outcomes included both subjective and objective alertness. Subgroup analyses considered a variety of factors, such as wavelength, correlated color temperature (CCT), light illuminance, and timing of interventions (daytime, night-time, or all day). Twenty-seven crossover studies and two parallel-group studies were included in this meta-analysis, with a total of 1210 healthy participants (636 (52%) male, mean age 25.62 years). The results revealed that light intervention had a positive effect on both subjective alertness (standardized mean difference (SMD) = –0.28, 95% confidence interval (CI): –0.49 to –0.06, P = 0.01) and objective alertness in healthy subjects (SMD = –0.34, 95% CI: –0.68 to –0.01, P = 0.04). The subgroup analysis revealed that cold light was better than warm light in improving subjective alertness (SMD = –0.37, 95% CI: –0.65 to –0.10, P = 0.007, I² = 26%) and objective alertness (SMD = –0.36, 95% CI: –0.66 to –0.07, P = 0.02, I² = 0). Both daytime (SMD = –0.22, 95% CI: –0.37 to –0.07, P = 0.005, I² = 74%) and night-time (SMD = –0.32, 95% CI: –0.61 to –0.02, P = 0.04, I² = 0) light exposure improved subjective alertness. The results of this meta-analysis and systematic review indicate that light exposure is associated with significant improvement in subjective and objective alertness. In addition, light exposure with a higher CCT was more effective in improving alertness than light exposure with a lower CCT. Our results also suggest that both daytime and night-time light exposure can improve subjective alertness.

A review of the current state of research on artificial blue light safety as it applies to digital devices

Light is necessary for human health and well-being. As we spend more time indoors, we are being increasingly exposed to artificial light. The development of artificial lighting has allowed us to control the brightness, colour, and timing of our light exposure. Yet, the widespread use of artificial light has raised concerns about the impact of altering our light environment on our health. The widespread adoption of personal digital devices over the past decade has exposed us to yet another source of artificial light. We spend a significant amount of time using digital devices with light-emitting screens, including smartphones and tablets, at close range. The light emitted from these devices, while appearing white, has an emission spectrum with a peak in the blue range. Blue light is often characterised as hazardous as its photon energy is higher than that of other wavelengths of visible light. Under certain conditions, visible blue light can cause harm to the retina and other ocular structures. Blue light can also influence the circadian rhythm and processes mediated by melanopsin-expressing intrinsically photosensitive retinal ganglion cells. While the blue component of sunlight is necessary for various physiological processes, whether the low-illuminance artificial blue light emitted from digital devices presents a risk to our health remains an ongoing area of debate. As technological advancements continue, it is relevant to understand how new devices may influence our well-being. This review examines the existing research on artificial blue light safety and the eye, visual performance, and circadian functions.

Effects of Lighting Interventions to Improve Sleepiness in Night-Shift Workers: A Systematic Review and Meta-Analysis

Shift work disrupts an otherwise normal circadian rhythm, which may result in sleepiness among night-shift workers. Artificial light has been shown to alter the light–dark cycle of shift workers and reset or phase shift the biological clock, improving nighttime alertness in workers. However, the effect of light therapy on improving sleepiness in nighttime workers has not been effectively confirmed in nursing clinical studies, and it is worth using relevant studies to provide the best evidence in any clinical setting. Systematic review and meta-analysis were used. The study was performed using PRISMA. Academic Search Complete, Embase, MEDLINE, the Cochrane Library, and CINAHL were searched, from the inception of each database to 27 December 2021. The Cochrane risk of bias tool was used to assess the methodological quality of each study. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were synthesized using a random-effects model to assess the efficacy of lighting intervention to improve sleepiness in night-shift workers. Sensitivity analysis followed by subgroup analysis was employed to examine heterogeneity. The meta-analysis was performed using Review Manager 5.4.1 software. A total of 14 studies from 7 countries were included. The overall result shows that lighting interventions significantly improved sleepiness. Further, the blue-enriched white light with a color temperature greater than 5000 Kelvin was effective in improving sleepiness of night-shift workers. This study unveils the emergent knowledge that light interventions with blue-enriched white were effective in improving sleepiness for night-shift workers, including nurses. This finding can be applied to ensure patient safety, reduce accidents, and improve work efficiency and job satisfaction. Nurses constitute the largest health professional workforce. We suggest that hospitals can insert blue-enriched white light equipment for night-shift healthcare providers. Several evidence-based suggestions are made for further consideration.

Sleep and work functioning in nurses undertaking inpatient shifts in a blue-depleted light environment

BACKGROUND

Blue-depleted light environments (BDLEs) may result in beneficial health outcomes for hospital inpatients in some cases. However, less is known about the effects on hospital staff working shifts. This study aimed to explore the effects of a BDLE compared with a standard hospital light environment (STLE) in a naturalistic setting on nurses' functioning during shifts and sleep patterns between shifts.

METHODS

Twenty-five nurses recruited from St. Olavs Hospital in Trondheim, Norway, completed 14 days of actigraphy recordings and self-reported assessments of sleep (e.g., total sleep time/sleep efficiency) and functioning while working shifts (e.g., mood, stress levels/caffeine use) in two different light environments. Additionally, participants were asked to complete several scales and questionnaires to assess the symptoms of medical conditions and mental health conditions and the side effects associated with each light environment.

RESULTS

A multilevel fixed-effects regression model showed a within-subject increase in subjective sleepiness (by 17%) during evening shifts in the BDLE compared with the STLE (p = .034; Cohen's d = 0.49) and an 0.2 increase in number of caffeinated beverages during nightshifts in the STLE compared with the BDLE (p = .027; Cohen's d = 0.37). There were no significant differences on any sleep measures (either based on sleep diary data or actigraphy recordings) nor on self-reported levels of stress or mood across the two conditions. Exploratory between-group analyses of questionnaire data showed that there were no significant differences except that nurses working in the BDLE reported perceiving the lighting as warmer (p = .009) and more relaxing (p = .023) than nurses working in the STLE.

CONCLUSIONS

Overall, there was little evidence that the change in the light environment had any negative impact on nurses' sleep and function, despite some indication of increased evening sleepiness in the BDLE. We recommend further investigations on this topic before BDLEs are implemented as standard solutions in healthcare institutions and propose specific suggestions for designing future large-scale trials and cohort studies.

TRIAL REGISTRATION

The study was registered before data collection was completed on the ISRCTN website ( ISRCTN21603406 ).

Daily variation in time-trial sporting performance: A systematic review

Few functional measures related to time-trial display diurnal variation. The diversity of tests/protocols used to assess time-trial performance on diurnal effects and the lack of a standardised approach hinder agreement in the literature. Therefore, the aims of the present study were to investigate and systematically review the evidence relating to time-of-day differences in time-trial measures and to examine the main aspects related to research design important for studies of a chronobiological nature. The entire content of Manipal Academy of Higher Education electronic library and Qatar National Library, and electronic databases: PubMed (MEDLINE), Scopus and Web of Science were searched. Research studies published in peer-reviewed journals and non-peer reviewed studies, conducted in male adult participants aged ≥18 y before November 2021 were screened/included. Studies assessing tests related to time-trials in any modality between a minimum of 2 time-points during the day (morning [06:30-10:30 h] vs evening [14:30-20:00 h]) were deemed eligible. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence to inform recommendations. The primary search revealed that a total of 10 from 40 articles were considered eligible and subsequently included. Six were conducted using cycling, two using running and two using swimming as the mode of exercise. Distances ranged from 1 to 16.1-km in distance or 15 to 20-min time in the cycling and running time-trials, and 50 to 200-m in the swimming time-trials. Only four studies found one or several of their performance variables to display daily variations, with significantly better values in the evening; while six studies found no time-of-day significance in any variables assessed. The magnitude of difference ranged from 2.9% to 7.1% for performance time to complete a cycling time-trial, while running and swimming did not find any differences for performance time. Power output during a 16.1-km time trial in cycling also found evening performance to be significantly better by 10%. The only other observed differences were stroke rate and stroke length during a swimming time-trial and stroke rate (cycles.min^-1) during a cycling time-trial. The magnitude of difference is dependent on exercise modality, individual chronotype, the training status of the individual and sample size differences. The lack of diurnal variation present in the majority of studies can in-part be explained with some of the methodological limitations and issues present related to quality and control. It is paramount that research assessing diurnal variation in performance uses appropriate session timings around the core body temperature minimum (~05:00 h; morning) and maximum (~17:00 h; evening). Although, differences in motivation/arousal, habitual training times, chronotypes and genotypes could provide an explanation as to why some studies/variables did not display time-of-day variation, more work is needed to provide an accurate conclusion. There is a clear demand for a rigorous, standardised approach to be adopted by future investigations which control factors that specifically relate to investigations of time-of-day, such as appropriate familiarisation, counterbalancing the order of administration of tests, providing sufficient recovery time between sessions and testing within a controlled environment.

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

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

The effect of evening light on circadian-related outcomes: A systematic review

Bright light exposure at night can help workers adapt to their shift schedules, but there has been relatively little research on evening light. We conducted a systematic review of studies that manipulated light exposure in the evening (broadly defined as 16:00-22:00) before real or simulated night shifts. Across the five eligible studies, evening light produced phase delays in melatonin, body temperature, and sleep propensity; it also improved sleep quality, sleep duration, memory, and work performance. There were mixed effects for mood, no changes in sleepiness, and no negative effects. The confidence in these results ranged from moderate for physiological markers of circadian phase delays to very low for mood. Future studies should compare the relative effectiveness and safety of evening versus night-time light exposure. Overall, the benefits of evening light for shift workers are tentative yet promising.

Satisfaction with activity-support and physical home-workspace characteristics in relation to mental health during the COVID-19 pandemic

Previous research indicates that employees' mental health might be influenced by their satisfaction with physical office characteristics, such as noise, daylight, and ventilation. However, similar research on mental health in relation to working from home (WFH) is limited. Therefore, this study aimed to identify the relationships between satisfaction with physical home workspace characteristics and support of work activities and mental health while WFH during the COVID-19 pandemic. Relationships were analysed using a path analysis approach, based on a sample of 1219 office workers, who had to work fully from home. The internal relationships between the ten considered mental health variables were also studied. Results showed that satisfaction with daylight, artificial light, greenery, and views outside were directly related to one of the mental health variables and indirectly to several others. Surprisingly, satisfaction with temperature, noise, ventilation, and air quality did not seem to play a role at the home workplace. In addition, unlike at the office, personal characteristics did not relate to workspace satisfaction nor perceived support of activities at home. Furthermore, all mental health variables were related to at least one other mental health variable. Workplace managers could use these insights to formulate recommendations for employees on how to design their home-workspace.

Bright light exposure during simulated night work improves cognitive flexibility

Night work leads to sleepiness and reduced vigilant attention during work hours, and bright light interventions may reduce such effects. It is also known that total sleep deprivation impairs cognitive flexibility as measured by reversal learning tasks. Whether night work impairs reversal learning task performance or if bright light can mitigate reversal learning deficits during night work is unclear. In this counterbalanced crossover study (ClinicaTrials.gov Identifier NCT03203538), young healthy individuals completed a reversal learning task twice during each of three consecutive simulated night shifts (23:00-07:00 h). The night shifts were performed in a laboratory under a full-spectrum (4000 K) bright light (~900 lx) and a standard light (~90 lx) condition. Reversal learning task performance was reduced towards the end of the night shifts (04:50 h), compared to the first part of the night shifts (00:20 h) in both light conditions. However, with bright light, the reversal learning task performance improved towards the end of the night shifts, compared to standard light. The study shows that bright light may mitigate performance deficits on a reversal learning task during night work and implies that bright light interventions during night work may be beneficial not only for vigilant attention but also for cognitive flexibility.

Recommendations for daytime, evening, and nighttime indoor light exposure to best support physiology, sleep, and wakefulness in healthy adults

Ocular light exposure has important influences on human health and well-being through modulation of circadian rhythms and sleep, as well as neuroendocrine and cognitive functions. Prevailing patterns of light exposure do not optimally engage these actions for many individuals, but advances in our understanding of the underpinning mechanisms and emerging lighting technologies now present opportunities to adjust lighting to promote optimal physical and mental health and performance. A newly developed, international standard provides a SI-compliant way of quantifying the influence of light on the intrinsically photosensitive, melanopsin-expressing, retinal neurons that mediate these effects. The present report provides recommendations for lighting, based on an expert scientific consensus and expressed in an easily measured quantity (melanopic equivalent daylight illuminance (melaponic EDI)) defined within this standard. The recommendations are supported by detailed analysis of the sensitivity of human circadian, neuroendocrine, and alerting responses to ocular light and provide a straightforward framework to inform lighting design and practice.

Predicting melatonin suppression by light in humans: Unifying photoreceptor-based equivalent daylight illuminances, spectral composition, timing and duration of light exposure

Light-induced melatonin suppression data from 29 peer-reviewed publications was analysed by means of a machine-learning approach to establish which light exposure characteristics (ie photopic illuminance, five α-opic equivalent daylight illuminances [EDIs], duration and timing of the light exposure, and the dichotomous variables pharmacological pupil dilation and narrowband light source) are the main determinants of melatonin suppression. Melatonin suppression in the data set was dominated by four light exposure characteristics: (1) melanopic EDI, (2) light exposure duration, (3) pupil dilation and (4) S-cone-opic EDI. A logistic model was used to evaluate the influence of each of these parameters on the melatonin suppression response. The final logistic model was only based on the first three parameters, since melanopic EDI was the best single (photoreceptor) predictor that was only outperformed by S-cone-opic EDI for (photopic) illuminances below 21 lux. This confirms and extends findings on the importance of the metric melanopic EDI for predicting biological effects of light in integrative (human-centric) lighting applications. The model provides initial and general guidance to lighting practitioners on how to combine spectrum, duration and amount of light exposure when controlling non-visual responses to light, especially melatonin suppression. The model is a starting tool for developing hypotheses on photoreceptors' contributions to light's non-visual responses and helps identifying areas where more data are needed, like on the S-cone contribution at low illuminances.

Influence of Wearing Blue Lenses on Melatonin Production and Performance in Volleyball Players

We analyzed the effects of wearing blue lenses on melatonin level, physical and cognitive performance. Fifteen youth volleyball players (15.0±1.5 yrs) attended the laboratory on 3 occasions (48-h interval): on the 1 ^st visit they were familiarized with the procedures of the study, and on 2 ^nd and 3 ^rd visits they were submitted to the testing protocol wearing transparent (control) or blue lens glasses in a counterbalanced crossover design. The protocol consisted of 10 min in “total darkness,” 30 min of light stimulation (wearing blue or transparent lenses), followed by an attentional test, and an agility T-test (without wearing the glasses). Samples of saliva (to determine melatonin concentration) were obtained pre- and post-exposure (30 min) to artificial light, wearing the lenses. Sleepiness, alertness, attention, mood, and perceived recovery status and performance variables (reaction time and T-test) were assessed after lens exposure. Melatonin levels did not differ within and between groups (blue lenses, pre: 0.79±0.73 and post: 1.19±1.374 pg/dl, p=0.252, effect size (ES)=0.38; control, pre: 0.97±1.00 and post: 0.67±0.71 pg/dl, p=0.305, ES=–0.35). Nonetheless, melatonin differences were significantly correlated with physical sedation for glasses with blue lenses (r=−0.526; p=0.04). No other variables differed (p>0.05) between protocols, including T-test performance (p=0.07; ES=0.41). Blue lenses do not influence melatonin levels, cognitive/physical performance, and mood status in amateur youth volleyball players.

Science Forum: Sex differences and sex bias in human circadian and sleep physiology research

Growing evidence shows that sex differences impact many facets of human biology. Here we review and discuss the impact of sex on human circadian and sleep physiology, and we uncover a data gap in the field investigating the non-visual effects of light in humans. A virtual workshop on the biomedical implications of sex differences in sleep and circadian physiology then led to the following imperatives for future research: (1) design research to be inclusive and accessible, (2) implement recruitment strategies that lead to a sex-balanced sample, (3) use data visualization to grasp the effect of sex, (4) implement statistical analyses that include sex as a factor and/or perform group analyses by sex, where possible, (5) make participant-level data open and available to facilitate future meta-analytic efforts.

Sleep improvements on days with later school starts persist after 1 year in a flexible start system

Early school times fundamentally clash with the late sleep of teenagers. This mismatch results in chronic sleep deprivation posing acute and long-term health risks and impairing students' learning. Despite immediate short-term benefits for sleep, the long-term effects of later starts remain unresolved. In a pre-post design over 1 year, we studied a unique flexible school start system, in which 10–12th grade students chose daily between an 8:00 or 8:50AM-start. Missed study time (8:00–8:50) was compensated for during gap periods or after classes. Based on 2 waves (6–9 weeks of sleep diary each), we found that students maintained their ~ 1-h-sleep gain on later days, longitudinally (n = 28) and cross-sectionally (n = 79). This gain was independent of chronotype and frequency of later starts but attenuated for boys after 1 year. Students showed persistently better sleep quality and reduced alarm-driven waking and reported psychological benefits (n = 93) like improved motivation, concentration, and study quality on later days. Nonetheless, students chose later starts only infrequently (median 2 days/week), precluding detectable sleep extensions in the flexible system overall. Reasons for not choosing late starts were the need to make up lost study time, preference for extra study time and transport issues. Whether flexible systems constitute an appealing alternative to fixed delays given possible circadian and psychological advantages warrants further investigation.

A randomized controlled trial on the effects of blue-blocking glasses compared to partial blue-blockers on sleep outcomes in the third trimester of pregnancy

OBJECTIVE

Sleep disturbances are common in pregnancy. Blocking blue light has been shown to improve sleep and may be a suitable intervention for sleep problems during pregnancy. The present study investigated the effects of blue light blocking in the evening and during nocturnal awakenings among pregnant women on primary sleep outcomes in terms of total sleep time, sleep efficiency and mid-point of sleep.

METHODS

In a double-blind randomized controlled trial, 60 healthy nulliparous pregnant women in the beginning of the third trimester were included. They were randomized, using a random number generator, either to a blue-blocking glass intervention (n = 30) or to a control glass condition constituting partial blue-blocking effect (n = 30). Baseline data were recorded for one week and outcomes were recorded in the last of two intervention/control weeks. Sleep was measured by actigraphy, sleep diaries, the Bergen Insomnia Scale, the Karolinska Sleepiness Scale and the Pre-Sleep Arousal Scale.

RESULTS

The results on the primary outcomes showed no significant mean difference between the groups at posttreatment, neither when assessed with sleep diary; total sleep time (difference = .78[min], 95%CI = -19.7, 21.3), midpoint of sleep (difference = -8.9[min], 95%CI = -23.7, 5.9), sleep efficiency (difference = -.06[%], 95%CI = -1.9, 1.8) and daytime functioning (difference = -.05[score points], 95%CI = -.33, .22), nor by actigraphy; total sleep time (difference = 13.0[min], 95%CI = -9.5, 35.5), midpoint of sleep (difference = 2.1[min], 95%CI = -11.6, 15.8) and sleep efficiency (difference = 1.7[%], 95%CI = -.4, 3.7). On the secondary outcomes, the Bergen Insomnia Scale, the Karolinska Sleepiness Scale and the Pre-Sleep Arousal Scale the blue-blocking glasses no statistically significant difference between the groups were found. Transient side-effects were reported in both groups (n = 3).

CONCLUSIONS

The use of blue-blocking glasses compared to partially blue-blocking glasses in a group of healthy pregnant participants did not show statistically significant effects on sleep outcomes. Research on the effects of blue-blocking glasses for pregnant women with sleep-problems or circadian disturbances is warranted.

TRIAL REGISTRATION

The trial is registered at ClinicalTrials.gov (NCT03114072).

Effects of Daytime Electric Light Exposure on Human Alertness and Higher Cognitive Functions: A Systematic Review

This paper reports the results of a systematic review conducted on articles examining the effects of daytime electric light exposure on alertness and higher cognitive functions. For this, we selected 59 quantitative research articles from 11 online databases. The review protocol was registered with PROSPERO (CRD42020157603). The results showed that both short-wavelength dominant light exposure and higher intensity white light exposure induced alertness. However, those influences depended on factors like the participants' homeostatic sleep drive and the time of day the participants received the light exposure. The relationship between light exposure and higher cognitive functions was not as straightforward as the alerting effect. The optimal light property for higher cognitive functions was reported dependent on other factors, such as task complexity and properties of control light. Among the studies with short-wavelength dominant light exposure, ten studies (morning: 3; afternoon: 7) reported beneficial effects on simple task performances (reaction time), and four studies (morning: 3; afternoon: 1) on complex task performances. Four studies with higher intensity white light exposure (morning: 3; afternoon: 1) reported beneficial effects on simple task performance and nine studies (morning: 5; afternoon: 4) on complex task performance. Short-wavelength dominant light exposure with higher light intensity induced a beneficial effect on alertness and simple task performances. However, those effects did not hold for complex task performances. The results indicate the need for further studies to understand the influence of short-wavelength dominant light exposure with higher illuminance on alertness and higher cognitive functions.

Temporal Dynamics of Subjective and Objective Alertness During Exposure to Bright Light in the Afternoon for 5 h

Light can induce an alertness response in humans. The effects of exposure to bright light vs. dim light on the levels of alertness during the day, especially in the afternoon, as reported in the literature, are inconsistent. This study employed a multiple measurement strategy to explore the temporal variations in the effects of exposure to bright light vs. regular office light (1,200 lx vs. 200 lx at eye level, 6,500 K) on the alertness of participants for 5 h in the afternoon. In this study, 20 healthy adults (11 female; mean age 23.25 ± 2.3 years) underwent the Karolinska sleepiness scale (KSS), the auditory psychomotor vigilance test (PVT), and the waking electroencephalogram (EEG) test for two levels of light intervention. The results yielded a relatively lower relative delta power and a relatively higher beta power for the 1,200 lx condition in comparison with the 200 lx condition. However, the light conditions elicited no statistically significant differences in the KSS scores and performance with respect to the PVT. The results suggested that exposure to bright light for 5 h in the afternoon could enhance physiological arousal while exerting insignificant effects on subjective feelings and performance abilities relating to the alertness of the participants.