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Gabaldón-Estevan D, Carmona-Talavera D, Catalán-Gregori B, Mañas-García E, Martin-Carbonell V, Monfort L, Martinez-Besteiro E, González-Carrasco M, Hernández-Jiménez MJ, Täht K, Talavera M, Ancheta-Arrabal A, Sáez G, Estany N, Pin-Arboledas G, Reis C. Kairos study protocol: a multidisciplinary approach to the study of school timing and its effects on health, well-being and students' performance. Front Public Health 2024; 12:1336028. [PMID: 38525330 PMCID: PMC10957785 DOI: 10.3389/fpubh.2024.1336028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
Recent evidence from chronobiology, chssronomedicine and chronopsychology shows that the organisation of social time (e.g., school schedules) generally does not respect biological time. This raises concerns about the impact of the constant mismatch between students' social and internal body clocks on their health, well-being and academic performance. The present paper describes a protocol used to investigate the problem of (de) synchronisation of biological times (chronotypes) in childhood and youth in relation to school times. It studies the effects of student chronotype vs. school schedule matches/mismatches on health behaviours (e.g., how many hours students sleep, when they sleep, eat, do physical activity, spend time outdoors in daylight) and learning (verbal expression, spatial structuring, operations) and whether alert-fatigue levels mediate this effect alignments/misalignments on learning (verbal expression, spatial structuring, operations) and their mediation by alert-fatigue levels. The novelty of our protocol lies in its multidisciplinary and mixed methodology approach to a relevant and complex issue. It draws on up-to-date knowledge from the areas of biology, medicine, psychology, pedagogy and sociology. The methods employed include a varied repertoire of techniques from hormonal analysis (cortisol and melatonin), continuous activity and light monitoring, self-registration of food intake, sleep timings, exercise and exposure to screens, alongside with systematic application of cognitive performance tests (e.g., memory, reasoning, calculation, attention) and self-reported well-being. This comprehensive and interdisciplinary protocol should support evidence-based education policy measures related to school time organisation. Appropriate and healthier school timetables will contribute to social change, healthier students and with more efficient learning. The results of studies using a similar methodology in other countries would ensure replication and comparability of results and contribute to knowledge to support policy making.
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Affiliation(s)
| | | | | | - Elena Mañas-García
- Department of Sociology and Social Anthropology, University of Valencia, Valencia, Spain
| | | | - Lucía Monfort
- Department of Pediatrics, Clinical University Hospital, Valencia, Spain
| | - Elvira Martinez-Besteiro
- Department of Personality, Assessment and Psychological Treatments, University of Valencia, Valencia, Spain
| | | | | | - Kadri Täht
- Institute of International Social Studies, School of Governance, Law and Society, Tallinn University, Tallinn, Estonia
| | - Marta Talavera
- Department of Experimental and Social Sciences Teaching, University of Valencia, Valencia, Spain
| | - Ana Ancheta-Arrabal
- Department of Comparative Education and History of Education, University of Valencia, Valencia, Spain
| | - Guillermo Sáez
- Service of Clinical Analysis, University Hospital Dr. Peset, Valencia, Spain
- Department of Biochemistry and Molecular Biology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Nuria Estany
- Service of Clinical Analysis, University Hospital Dr. Peset, Valencia, Spain
| | - Gonzalo Pin-Arboledas
- Grupo de Sueño y Cronobiologia de la Asociación Española de Pediatría, Valencia, Spain
| | - Catia Reis
- CRC-W - Faculdade de Ciências Humanas, Universidade Católica Portuguesa, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, IMM, Lisboa, Lisbon, Portugal
- ISAMB - Faculdade de Medicina Universidade de Lisboa, Lisbon, Portugal
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2
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Specht A, Kolosov G, Cederberg KLJ, Bueno F, Arrona-Palacios A, Pardilla-Delgado E, Ruiz-Herrera N, Zitting KM, Kramer A, Zeitzer JM, Czeisler CA, Duffy JF, Mignot E. Circadian protein expression patterns in healthy young adults. Sleep Health 2024; 10:S41-S51. [PMID: 38087675 PMCID: PMC11031319 DOI: 10.1016/j.sleh.2023.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 04/20/2024]
Abstract
OBJECTIVES To explore how the blood plasma proteome fluctuates across the 24-hour day and identify a subset of proteins that show endogenous circadian rhythmicity. METHODS Plasma samples from 17 healthy adults were collected hourly under controlled conditions designed to unmask endogenous circadian rhythmicity; in a subset of 8 participants, we also collected samples across a day on a typical sleep-wake schedule. A total of 6916 proteins were analyzed from each sample using the SomaScan aptamer-based multiplexed platform. We used differential rhythmicity analysis based on a cosinor model with mixed effects to identify a subset of proteins that showed circadian rhythmicity in their abundance. RESULTS One thousand and sixty-three (15%) proteins exhibited significant daily rhythmicity. Of those, 431 (6.2%) proteins displayed consistent endogenous circadian rhythms on both a sleep-wake schedule and under controlled conditions: it included both known and novel proteins. When models were fitted with two harmonics, an additional 259 (3.7%) proteins exhibited significant endogenous circadian rhythmicity, indicating that some rhythmic proteins cannot be solely captured by a simple sinusoidal model. Overall, we found that the largest number of proteins had their peak levels in the late afternoon/evening, with another smaller group peaking in the early morning. CONCLUSIONS This study reveals that hundreds of plasma proteins exhibit endogenous circadian rhythmicity in humans. Future analyses will likely reveal novel physiological pathways regulated by circadian clocks and pave the way for improved diagnosis and treatment for patients with circadian disorders and other pathologies. It will also advance efforts to include knowledge about time-of-day, thereby incorporating circadian medicine into personalized medicine.
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Affiliation(s)
- Adrien Specht
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - German Kolosov
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Katie L J Cederberg
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Flavia Bueno
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Arturo Arrona-Palacios
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital and Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Enmanuelle Pardilla-Delgado
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital and Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Noelia Ruiz-Herrera
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital and Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Kirsi-Marja Zitting
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital and Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Achim Kramer
- Division of Chronobiology, Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital and Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeanne F Duffy
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital and Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA.
| | - Emmanuel Mignot
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA.
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3
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Dermanowski MM, Wichniak A, Hejduk A, Kuczyńska J, Dominiak M, Mierzejewski P. Behavioural Parameters of Circadian Rhythm Are Not Correlated with Dim Light Melatonin Onset: An Observational Study on Healthy Volunteers. J Clin Med 2023; 12:7757. [PMID: 38137826 PMCID: PMC10743549 DOI: 10.3390/jcm12247757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
Dim light melatonin onset (DLMO) is considered the most reliable marker of the circadian rhythm phase in humans. DLMO may moderately correlate with sleep onset and sleep offset time. There are no sufficient data about the correlations between DLMO and clinical scales assessing sleep quality and daytime symptoms of poor night sleep. The aim of the study was to determine the association between DLMO and basic sleep parameters from actigraphy and sleep diaries, as well as the association between DLMO and the following insomnia clinical scales: the Athens Insomnia Scale (AIS), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and chronotype questionnaires: Morningness-Eveningness Questionnaire (MEQ) and Composite Scale of Morningness (CSM). Participants of the study were healthy volunteers. Sleep parameters were measured by sleep diaries and actigraphy, and the following clinical scales: the AIS, ISI, and ESS, and chronotype questionnaires: MEQ and CSM. DLMO was calculated based on plasma melatonin concentration. The blood samples were collected hourly at five time points between 20:00 and 00:00 during the session in dim red light (<50 lux). Melatonin concertation was determined by LC-MS/MS. Twenty-one volunteers participated in the study. DLMO was calculated in 12 participants. There was a significant correlation between DLMO and ISI (r = 0.60, p = 0.038) and ESS (r = 0.61, p = 0.034). The correlation coefficient between the DLMO and the AIS was also high, however insignificant (r = 0.57, p = 0.054). There were no significant correlations between DLMO and chronotype scales MEQ and CSM. DLMO did not correlate with sleep onset and sleep offset; however, DLMO correlated with the Sleep Fragmentation Index (SFI) (r = 0.67, p = 0.017). DLMO is associated with poorer sleep maintenance, a stronger feeling of insomnia, and sleepiness during the day. Simultaneously, chronotype pattern and circadian rhythm parameters do not correlate with DLMO. Biological circadian rhythm does not reflect the real-life sleep-wake rhythm, indicating that the lifestyle is more often disconnected from the biological clock.
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Affiliation(s)
- Michał Mateusz Dermanowski
- Department of Pharmacology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957 Warsaw, Poland; (M.M.D.); (J.K.); (M.D.)
| | - Adam Wichniak
- Third Department of Psychiatry, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957 Warsaw, Poland;
| | - Arkadiusz Hejduk
- Department of Research and Development, LEK-AM Pharmaceutical Company Ltd., Ostrzykowizna 14A, 05-170 Zakroczym, Poland;
| | - Julita Kuczyńska
- Department of Pharmacology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957 Warsaw, Poland; (M.M.D.); (J.K.); (M.D.)
| | - Monika Dominiak
- Department of Pharmacology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957 Warsaw, Poland; (M.M.D.); (J.K.); (M.D.)
| | - Paweł Mierzejewski
- Department of Pharmacology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957 Warsaw, Poland; (M.M.D.); (J.K.); (M.D.)
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Witt RM, Byars KC, Decker K, Dye TJ, Riley JM, Simmons D, Smith DF. Current Considerations in the Diagnosis and Treatment of Circadian Rhythm Sleep-Wake Disorders in Children. Semin Pediatr Neurol 2023; 48:101091. [PMID: 38065634 PMCID: PMC10710539 DOI: 10.1016/j.spen.2023.101091] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 09/29/2023] [Indexed: 12/18/2023]
Abstract
Circadian Rhythm Sleep-Wake Disorders (CRSWDs) are important sleep disorders whose unifying feature is a mismatch between the preferred or required times for sleep and wakefulness and the endogenous circadian drives for these. Their etiology, presentation, and treatment can be different in pediatric patients as compared to adults. Evaluation of these disorders must be performed while viewed through the lens of a patient's comorbid conditions. Newer methods of assessment promise to provide greater diagnostic clarity and critical insights into how circadian physiology affects overall health and disease states. Effective clinical management of CRSWDs is multimodal, requiring an integrated approach across disciplines. Therapeutic success depends upon appropriately timed nonpharmacologic and pharmacologic interventions. A better understanding of the genetic predispositions for and causes of CRSWDs has led to novel clinical opportunities for diagnosis and improved therapeutics.
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Affiliation(s)
- Rochelle M Witt
- Division of Child Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Center for Circadian Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Kelly C Byars
- Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Center for Circadian Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Kristina Decker
- Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Center for Circadian Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Thomas J Dye
- Division of Child Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Center for Circadian Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jessica M Riley
- Center for Circadian Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Danielle Simmons
- Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Center for Circadian Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - David F Smith
- Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Center for Circadian Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Otolaryngology- Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.
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5
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Wu A. Updates and confounding factors in delayed sleep-wake phase disorder. Sleep Biol Rhythms 2023; 21:279-287. [PMID: 37363638 PMCID: PMC9979143 DOI: 10.1007/s41105-023-00454-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 02/09/2023] [Indexed: 03/06/2023]
Abstract
Delayed sleep-wake phase disorder (DSWPD) is a circadian rhythm sleep disorder characterised by a delay in the main sleep period, with patients experiencing difficulty getting to sleep and waking up at socially appropriate times. This often causes insomnia and compromised sleep, results in impairment to daytime function and is associated with a range of comorbidities. Besides interventions aimed at ameliorating symptoms, there is good evidence supporting successful phase advancement with bright light therapy or melatonin administration. However, no treatment to date addresses the tendency to phase delay, which is a common factor amongst the various contributing causes of DSWPD. Circadian phase markers such as core body temperature and circulating melatonin typically correlate well with sleep timing in healthy patients, but numerous variations exist in DSWPD patients that can make these unpredictable for use in diagnostics. There is also increasing evidence that, on top of problems with the circadian cycle, sleep homeostatic processes actually differ in DSWPD patients compared to controls. This naturally has ramifications for management but also for the current approach to the pathogenesis itself in which DSWPD is considered a purely circadian disorder. This review collates what is known on the causes and treatments of DSWPD, addresses the pitfalls in diagnosis and discusses the implications of current data on modified sleep homeostasis, making clinical recommendations and directing future research.
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Affiliation(s)
- Alexandra Wu
- Division of Biosciences, University College London, Gower Street, London, WC1E 6BT UK
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6
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Kunorozva L, Rae DE, Roden LC. Dim light melatonin onset following simulated eastward travel is earlier in young males genotyped as PER35/5 than PER34/4. Chronobiol Int 2022; 39:1611-1623. [PMID: 36324294 DOI: 10.1080/07420528.2022.2139184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Inter-individual variability exists in recovery from jetlag following travel across time zones. Part of this variation may be due to genetic differences at the variable number tandem repeat (VNTR) polymorphism of the PERIOD3 (PER3) gene as this polymorphism has been associated with chronotype and sleep, as well as sensitivity to blue light on melatonin suppression. To test this hypothesis we conducted a laboratory-based study to compare re-entrainment in males genotyped as PER34/4 (n = 8) and PER35/5 (n = 8) following simulated eastward travel across six time zones. The recovery strategy included morning blue-enriched light exposure and appropriately-timed meals during the first 24 h after simulated travel. Dim light melatonin onset (DLMO), sleep characteristics, perceived sleepiness levels (Stanford Sleepiness Scale), and resting metabolic parameters were measured during constant routine periods before and after simulated travel. While DLMO time was similar between the two groups prior to simulated eastward travel (p = .223), it was earlier in the PER35/5 group (17h23 (17h15; 17h37)) than the PER34/4 group (18h05 (17h53; 18h12)) afterwards (p = .046). During resynchronisation, perceived sleepiness and metabolic parameters were similar to pre-travel in both groups but sleep was more disturbed in the PER35/5 group (total sleep time: p = .008, sleep efficiency: p = .008, wake after sleep onset: p = .023). The PER3 VNTR genotype may influence the efficacy of re-entrainment following trans-meridian travel when blue-enriched light exposure is incorporated into the recovery strategy on the first day following travel.
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Affiliation(s)
- Lovemore Kunorozva
- Department of Molecular and Cell Biology, University of Cape Town, Private Bag Rondebosch, Cape Town, South Africa.,Division of Sleep Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Dale E Rae
- Health through Physical Activity, Lifestyle and Sport Research Centre & Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Laura C Roden
- Department of Molecular and Cell Biology, University of Cape Town, Private Bag Rondebosch, Cape Town, South Africa.,Health through Physical Activity, Lifestyle and Sport Research Centre & Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Centre for Sport, Exercise and Life Sciences/School of Life Sciences, Coventry University, Coventry, UK
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7
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Menczel Schrire Z, Gordon CJ, Palmer JR, Murray J, Hickie I, Rogers NL, Lewis SJG, Terpening Z, Pye JE, Naismith SL, Hoyos CM. Actigraphic and melatonin alignment in older adults with varying dementia risk. Chronobiol Int 2022; 40:91-102. [PMID: 36408793 DOI: 10.1080/07420528.2022.2144744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Circadian rhythms alter with ageing and may be aetiologically linked to neurodegeneration. This study explored the association between clinical markers and 1) dim light melatonin onset (DLMO) time and 2) phase angle derived from sleep midpoint, in older adults with varying dementia risks. Participants completed 14 days of actigraphy followed by in-lab measurement of salivary melatonin, from which DLMO time and phase angle were computed. Eighty participants (age = 65.5, SD = 9.6), 44 males (55%), MMSE (28.6, SD = 1.5) were included in the analysis. Sex (t = 2.15, p = .04), sleep onset (r = 0.49, p < .001) and midpoint (r = 0.44, p < .001) also correlated with DLMO time. Multiple linear regression showed chronotype, average actigraphy-derived light exposure during the DLMO window (window 2 h prior to DLMO to 2 h post), early biological day (6-10 h post DLMO time) and late biological day (10-14 h post DLMO time) were predictive of DLMO time (adjusted R2 = 0.75). Sleep offset, depression severity, average light exposure during the early biological night and early and late biological day were shown to be predictive variables in the estimation of phase angle (adjusted R2 = 0.78). The current study highlights the potential use of clinical variables, such as actigraphy-derived light, as circadian markers in ageing which could be easily implemented into existing clinical practice and could yield potential targets focusing on chronotherapeutic interventions.
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Affiliation(s)
- Zoe Menczel Schrire
- School of Psychology, Faculty of Science, Healthy Brain Ageing Program, the University of Sydney, Sydney, Australia
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, the University of Sydney, Sydney, Australia
- Brain & Mind Centre, the University of Sydney, Sydney, Australia
| | - Christopher J Gordon
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, the University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, the University of Sydney, Sydney, Australia
| | - Jake R Palmer
- School of Psychology, Faculty of Science, Healthy Brain Ageing Program, the University of Sydney, Sydney, Australia
- Brain & Mind Centre, the University of Sydney, Sydney, Australia
- Department of Psychology, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Jade Murray
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria, Australia
| | - Ian Hickie
- School of Psychology, Faculty of Science, Healthy Brain Ageing Program, the University of Sydney, Sydney, Australia
- Brain & Mind Centre, the University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, the University of Sydney, Sydney, Australia
| | - Naomi L. Rogers
- Brain & Mind Centre, the University of Sydney, Sydney, Australia
| | - Simon JG Lewis
- Brain & Mind Centre, the University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, the University of Sydney, Sydney, Australia
| | - Zoe Terpening
- School of Psychology, Faculty of Science, Healthy Brain Ageing Program, the University of Sydney, Sydney, Australia
| | - Jonathon E Pye
- Faculty of Medicine and Health, the University of Sydney, Sydney, Australia
| | - Sharon L Naismith
- School of Psychology, Faculty of Science, Healthy Brain Ageing Program, the University of Sydney, Sydney, Australia
- Brain & Mind Centre, the University of Sydney, Sydney, Australia
| | - Camilla M Hoyos
- School of Psychology, Faculty of Science, Healthy Brain Ageing Program, the University of Sydney, Sydney, Australia
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, the University of Sydney, Sydney, Australia
- Brain & Mind Centre, the University of Sydney, Sydney, Australia
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Liset R, Grønli J, Henriksen RE, Henriksen TEG, Nilsen RM, Pallesen S. A randomized controlled trial on the effect of blue-blocking glasses compared to partial blue-blockers on melatonin profile among nulliparous women in third trimester of the pregnancy. Neurobiol Sleep Circadian Rhythms 2022; 12:100074. [PMID: 35024497 PMCID: PMC8728098 DOI: 10.1016/j.nbscr.2021.100074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE In pregnancy melatonin regulates circadian rhythms, induce sleep, and has a neuroprotective positive effect on fetal development. Artificial blue light in the evening delays and suppresses melatonin production. Thus, we investigated the effect of blocking blue light on the melatonin profile. METHODS A randomized controlled trial (n=30 blue-blocking glasses vs. n=30 control glasses with partial blue-blocking effect) including healthy nulliparous pregnant women in the beginning of the third trimester. Salivary melatonin and subjective sleep were measured before and after two weeks of intervention/control condition. Saliva was sampled at 30-min intervals from 3 h before normal bedtime. Melatonin onset was set at 4.0 pg/ml. RESULTS Due to missing data melatonin onset was estimated for 47 participants. At posttreatment, melatonin onset advanced by 28 min in the blue-blocking group compared with the control condition (p=.019). Melatonin levels were significantly higher, favoring the blue-blocking glass condition, at clock time 20:00, 21:00 and 22:00 h, and for sample number 3 and 4. The phase angle (time interval) between melatonin onset and sleep bedtime and sleep onset time increased within the blue blocking group (+45 min and +41 min, respectively), but did not reach statistical significance compared to control condition (+13 min and +26 min, respectively). CONCLUSION Blocking blue light in the evening had a positive effect on the circadian system with an earlier onset and rise of melatonin levels in healthy nulliparous pregnant women. This demonstrated the effectiveness and feasibility of a simple non-pharmacological chronobiological intervention during pregnancy.
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Affiliation(s)
- Randi Liset
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Janne Grønli
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Roger Ekeberg Henriksen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Roy Miodini Nilsen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Ståle Pallesen
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
- Optentia, The Vaal Triangle Campus of the North-West University, Vanderbijlpark, South Africa
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9
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Pundir M, Papagerakis S, De Rosa MC, Chronis N, Kurabayashi K, Abdulmawjood S, Prince MEP, Lobanova L, Chen X, Papagerakis P. Emerging biotechnologies for evaluating disruption of stress, sleep, and circadian rhythm mechanism using aptamer-based detection of salivary biomarkers. Biotechnol Adv 2022; 59:107961. [DOI: 10.1016/j.biotechadv.2022.107961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/30/2022] [Accepted: 04/09/2022] [Indexed: 12/26/2022]
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10
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Dermanowski MM, Hejduk A, Kuczyńska J, Wichniak A, Urbańska A, Mierzejewski P. Assessment of dim light melatonin onset based on plasma and saliva samples. Chronobiol Int 2022; 39:626-635. [PMID: 35168448 DOI: 10.1080/07420528.2021.2016796] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Melatonin (MELA) is a nocturnal hormone involved in the regulation of the circadian rhythm. MELA can be detected in plasma and saliva, and its salivary concentration strongly correlates with its plasma concentration. Dim light melatonin onset (DLMO) is considered to be the most accurate objective marker for assessing the circadian phase. The purpose of the study was to establish a method for the determination of MELA in plasma and saliva based on the liquid chromatography with tandem mass spectrometry (LC-MS/MS) and compare DLMO using both plasma and saliva matrices. The validation of the LC-MS/MS methods was performed in accordance with the European Medicines Agency (EMA) guideline. The study was conducted on a group of 21 volunteers, male and females, aged 26-54 years. Plasma and saliva were collected at five time points: between 20:00 and 00:00 hours. The MELA concentration was determined by the LC-MS/MS. The DLMO was considered as the point in time when MELA concentration exceeds 20 pg/mL in plasma and 7 pg/mL in saliva. The correlation coefficient between the plasma and salivary MELA concentration was r = 0.764 (p < .001). The ratio of the plasma/saliva MELA concentrations was 2.87. The mean time of the DLMO in the plasma was 21:30 ± 0:45 hours, and in the saliva was as follows: 21:34 ± 1:00 hours. The correlation between the DLMO, calculated based on the plasma and saliva MELA profiles, was r = 0.679 (p < .05). The determination of salivary MELA concentration using LC-MS/MS allows for the determination of the DLMO. Our method may be applied in clinical practice for the diagnosis and monitoring of circadian rhythm disorders.Abbreviations: CE: Collision Energy; CID: Collision-Induced Dissociation; DL: Desolvation Module; DLMO: Dim Light Melatonin Onset; EFSA: European Food Safety Authority; EMA: European Medicines Agency; ESI: electrospray ionization; HB: heat block; HPLC: high performance liquid chromatography; IS: internal standard; K3EDTA: ethylenediaminetetraacetic acid tripotassium salt; LC-MS/MS: liquid chromatography with tandem mass spectrometry; LLE: liquid-liquid extraction; LLOQ: lower limit of quantification; MELA: melatonin; MELA-D4: melatonin-d4; MRM: multiple reaction monitoring; Q1: quadrupole 1; Q3: quadrupole 3; RE: relative error; RIA: radioimmunoassay; RSD: relative standard deviation; SD: standard deviation; ULOQ: upper limit of quantification.
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Affiliation(s)
| | - Arkadiusz Hejduk
- Chair and Department of Pharmaceutical Technology, Faculty of Pharmacy, Poznan University of Medical Sciences, Poznan, Poland.,Research and Development Department, LEK-AM Pharmaceutical Company Ltd, Zakroczym, Poland
| | - Julita Kuczyńska
- Department of Pharmacology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Adam Wichniak
- Third Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Agnieszka Urbańska
- Research and Development Department, LEK-AM Pharmaceutical Company Ltd, Zakroczym, Poland
| | - Paweł Mierzejewski
- Department of Pharmacology, Institute of Psychiatry and Neurology, Warsaw, Poland
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11
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Abstract
Melatonin is a hormonal product of the pineal gland, a fact that is often forgotten. Instead it is promoted as a dietary supplement that will overcome insomnia, as an antioxidant and as a prescription only drug in most countries outside the United States of America and Canada. The aim of this review is to step back and highlight what we know about melatonin following its discovery 60 years ago. What is the role of endogenous melatonin; what does melatonin do to sleep, body temperature, circadian rhythms, the cardiovascular system, reproductive system, endocrine system and metabolism when administered to healthy subjects? When used as a drug/dietary supplement, what safety studies have been conducted? Can we really say melatonin is safe when it has not been systematically studied and many studies show interactions with a wide range of physiological processes? Finally the results of studies investigating the efficacy of melatonin as a drug to alleviate insomnia are critically evaluated. In summary, melatonin is an endogenous pineal gland hormone with specific physiological functions in animals and humans, with its primary role in humans to maintain synchrony of sleep with the day/night cycle. When administered as a drug it affects a wide range of physiological systems and has clinically important drug interactions. With respect to efficacy for treating sleep disorders, melatonin can advance the time of sleep onset but the effect is modest and variable. In children with neurodevelopmental disabilities melatonin appears to have the greatest impact on sleep onset but little effect on sleep efficiency.
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Affiliation(s)
- David J Kennaway
- Robinson Research Institute and Adelaide School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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12
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Spitschan M, Garbazza C, Kohl S, Cajochen C. Sleep and circadian phenotype in people without cone-mediated vision: a case series of five CNGB3 and two CNGA3 patients. Brain Commun 2021; 3:fcab159. [PMID: 34447932 PMCID: PMC8385249 DOI: 10.1093/braincomms/fcab159] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 01/28/2023] Open
Abstract
Light exposure entrains the circadian clock through the intrinsically photosensitive retinal ganglion cells, which sense light in addition to the cone and rod photoreceptors. In congenital achromatopsia (prevalence 1:30-50 000), the cone system is non-functional, resulting in severe light avoidance and photophobia at daytime light levels. How this condition affects circadian and neuroendocrine responses to light is not known. In this case series of genetically confirmed congenital achromatopsia patients (n = 7; age 30-72 years; 6 women, 1 male), we examined survey-assessed sleep/circadian phenotype, self-reported visual function, sensitivity to light and use of spectral filters that modify chronic light exposure. In all but one patient, we measured rest-activity cycles using actigraphy over 3 weeks and measured the melatonin phase angle of entrainment using the dim-light melatonin onset. Owing to their light sensitivity, congenital achromatopsia patients used filters to reduce retinal illumination. Thus, congenital achromatopsia patients experienced severely attenuated light exposure. In aggregate, we found a tendency to a late chronotype. We found regular rest-activity patterns in all patients and normal phase angles of entrainment in participants with a measurable dim-light melatonin onset. Our results reveal that a functional cone system and exposure to daytime light intensities are not necessary for regular behavioural and hormonal entrainment, even when survey-assessed sleep and circadian phenotype indicated a tendency for a late chronotype and sleep problems in our congenital achromatopsia cohort.
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Affiliation(s)
- Manuel Spitschan
- Department of Experimental Psychology, University of Oxford, Oxford, OX2 6GG, UK
- Centre for Chronobiology, Psychiatry Hospital of the University of Basel (UPK), CH-4002 Basel, Switzerland
- Transfaculty Research Platform Molecular and Cognitive Neurosciences (MCN), University of Basel, CH-4055 Basel, Switzerland
| | - Corrado Garbazza
- Centre for Chronobiology, Psychiatry Hospital of the University of Basel (UPK), CH-4002 Basel, Switzerland
- Transfaculty Research Platform Molecular and Cognitive Neurosciences (MCN), University of Basel, CH-4055 Basel, Switzerland
| | - Susanne Kohl
- Institute for Ophthalmic Research, Centre for Ophthalmology, University of Tübingen, D-72076 Tübingen, Germany
| | - Christian Cajochen
- Centre for Chronobiology, Psychiatry Hospital of the University of Basel (UPK), CH-4002 Basel, Switzerland
- Transfaculty Research Platform Molecular and Cognitive Neurosciences (MCN), University of Basel, CH-4055 Basel, Switzerland
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13
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Sunde E, Pedersen T, Mrdalj J, Thun E, Grønli J, Harris A, Bjorvatn B, Waage S, Skene DJ, Pallesen S. Alerting and Circadian Effects of Short-Wavelength vs. Long-Wavelength Narrow-Bandwidth Light during a Simulated Night Shift. Clocks Sleep 2020; 2:502-522. [PMID: 33255613 PMCID: PMC7712639 DOI: 10.3390/clockssleep2040037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/12/2020] [Accepted: 11/23/2020] [Indexed: 11/18/2022] Open
Abstract
Light can be used to facilitate alertness, task performance and circadian adaptation during night work. Novel strategies for illumination of workplaces, using ceiling mounted LED-luminaires, allow the use of a range of different light conditions, altering intensity and spectral composition. This study (ClinicalTrials.gov Identifier NCT03203538) investigated the effects of short-wavelength narrow-bandwidth light (λmax = 455 nm) compared to long-wavelength narrow-bandwidth light (λmax = 625 nm), with similar photon density (~2.8 × 1014 photons/cm2/s) across light conditions, during a simulated night shift (23:00–06:45 h) when conducting cognitive performance tasks. Light conditions were administered by ceiling mounted LED-luminaires. Using a within-subjects repeated measurements study design, a total of 34 healthy young adults (27 females and 7 males; mean age = 21.6 years, SD = 2.0 years) participated. The results revealed significantly reduced sleepiness and improved task performance during the night shift with short-wavelength light compared to long-wavelength light. There was also a larger shift of the melatonin rhythm (phase delay) after working a night shift in short-wavelength light compared to long-wavelength light. Participants’ visual comfort was rated as better in the short-wavelength light than the long-wavelength light. Ceiling mounted LED-luminaires may be feasible to use in real workplaces, as these have the potential to provide light conditions that are favorable for alertness and performance among night workers.
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Affiliation(s)
- Erlend Sunde
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, 5020 Bergen, Norway; (A.H.); (S.P.)
- Correspondence: ; Tel.: +47-93638159
| | - Torhild Pedersen
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, 5020 Bergen, Norway; (T.P.); (J.M.); (J.G.)
| | - Jelena Mrdalj
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, 5020 Bergen, Norway; (T.P.); (J.M.); (J.G.)
| | - Eirunn Thun
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, 5020 Bergen, Norway;
| | - Janne Grønli
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, 5020 Bergen, Norway; (T.P.); (J.M.); (J.G.)
| | - Anette Harris
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, 5020 Bergen, Norway; (A.H.); (S.P.)
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, 5020 Bergen, Norway; (B.B.); (S.W.)
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, 5021 Bergen, Norway
| | - Siri Waage
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, 5020 Bergen, Norway; (B.B.); (S.W.)
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, 5021 Bergen, Norway
| | - Debra J. Skene
- Chronobiology, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK;
| | - Ståle Pallesen
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, 5020 Bergen, Norway; (A.H.); (S.P.)
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, 5021 Bergen, Norway
- Optentia Research Focus Area, North-West University, Vanderbijlpark 1900, South Africa
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14
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Sunde E, Pedersen T, Mrdalj J, Thun E, Grønli J, Harris A, Bjorvatn B, Waage S, Skene DJ, Pallesen S. Blue-Enriched White Light Improves Performance but Not Subjective Alertness and Circadian Adaptation During Three Consecutive Simulated Night Shifts. Front Psychol 2020; 11:2172. [PMID: 33013558 PMCID: PMC7462016 DOI: 10.3389/fpsyg.2020.02172] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 08/03/2020] [Indexed: 01/28/2023] Open
Abstract
Use of blue-enriched light has received increasing interest regarding its activating and performance sustaining effects. However, studies assessing effects of such light during night work are few, and novel strategies for lighting using light emitting diode (LED) technology need to be researched. In a counterbalanced crossover design, we investigated the effects of a standard polychromatic blue-enriched white light (7000 K; ∼200 lx) compared to a warm white light (2500 K), of similar photon density (∼1.6 × 1014 photons/cm2/s), during three consecutive simulated night shifts. A total of 30 healthy participants [10 males, mean age 23.3 (SD = 2.9) years] were included in the study. Dependent variables comprised subjective alertness using the Karolinska Sleepiness Scale, a psychomotor vigilance task (PVT) and a digit symbol substitution test (DSST), all administered at five time points throughout each night shift. We also assessed dim-light melatonin onset (DLMO) before and after the night shifts, as well as participants' opinion of the light conditions. Subjective alertness and performance on the PVT and DSST deteriorated during the night shifts, but 7000 K light was more beneficial for performance, mainly in terms of fewer errors on the PVT, at the end of the first- and second- night shift, compared to 2500 K light. Blue-enriched light only had a minor impact on PVT response times (RTs), as only the fastest 10% of the RTs were significantly improved in 7000 K compared to 2500 K light. In both 7000 and 2500 K light, the DLMO was delayed in those participants with valid assessment of this parameter [n = 20 (69.0%) in 7000 K light, n = 22 (78.6%) in 2500 K light], with a mean of 2:34 (SE = 0:14) and 2:12 (SE = 0:14) hours, respectively, which was not significantly different between the light conditions. Both light conditions were positively rated, although participants found 7000 K to be more suitable for work yet evaluated 2500 K light as more pleasant. The data indicate minor, but beneficial, effects of 7000 K light compared to 2500 K light on performance during night work. Circadian adaptation did not differ significantly between light conditions, though caution should be taken when interpreting these findings due to missing data. Field studies are needed to investigate similar light interventions in real-life settings, to develop recommendations regarding illumination for night workers. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03203538.
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Affiliation(s)
- Erlend Sunde
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Torhild Pedersen
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Jelena Mrdalj
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Eirunn Thun
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Janne Grønli
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Anette Harris
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Siri Waage
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Debra J Skene
- Chronobiology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Ståle Pallesen
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
- Optentia, North-West University Vaal Triangle Campus, Vanderbijlpark, South Africa
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15
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Kennaway DJ. Measuring melatonin by immunoassay. J Pineal Res 2020; 69:e12657. [PMID: 32281677 DOI: 10.1111/jpi.12657] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/29/2020] [Accepted: 03/31/2020] [Indexed: 12/11/2022]
Abstract
The pineal gland hormone melatonin continues to be of considerable interest to biomedical researchers. Of particular interest is the pattern of secretion of melatonin in relation to sleep timing as well as its potential role in certain diseases. Measuring melatonin in biological fluids such as blood and saliva presents particular methodological challenges since the production and secretion of the hormone are known to be extremely low during the light phase in almost all situations. Active secretion only occurs around the time of lights out in a wide range of species. The challenge then is to develop practical high-throughput assays that are sufficiently sensitive and accurate enough to detect levels of melatonin less than 1 pg/mL in biological fluids. Mass spectrometry assays have been developed that achieve the required sensitivity, but are really not practical or even widely available to most researchers. Melatonin radioimmunoassays and ELISA have been developed and are commercially available. But the quality of the results that are being published is very variable, partly not only because of poor experimental designs, but also because of poor assays. In this review, I discuss issues around the design of studies involving melatonin measurement. I then provide a critical assessment of 21 immunoassay kits marketed by 11 different companies with respect to validation, specificity and sensitivity. Technical managers of the companies were contacted in an attempt to obtain information not available online or in kit inserts. A search of the literature was also conducted to uncover papers that have reported the use of these assays, and where possible, both daytime and night-time plasma or saliva melatonin concentrations were extracted and tabulated. The results of the evaluations are disturbing, with many kits lacking any validation studies or using inadequate validation methods. Few assays have been properly assessed for specificity, while others report cross-reaction profiles that can be expected to result in over estimation of the melatonin levels. Some assays are not fit for purpose because they are not sensitive enough to determine plasma or saliva DLMO of 10 and 3 pg/mL, respectively. Finally, some assays produce unrealistically high daytime melatonin levels in humans and laboratory animals in the order of hundreds of pg/mL. In summary, this review provides a comprehensive and unique assessment of the current commercial melatonin immunoassays and their use in publications. It provides researchers new to the field with the information they need to design valid melatonin studies from both the perspective of experimental/clinical trial design and the best assay methodologies. It will also hopefully help journal editors and reviewers who may not be fully aware of the pitfalls of melatonin measurement make better informed decisions on publication acceptability.
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Affiliation(s)
- David J Kennaway
- Robinson Research Institute and Adelaide School of Medicine, University of Adelaide, Adelaide, SA, Australia
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16
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Stone JE, Postnova S, Sletten TL, Rajaratnam SM, Phillips AJ. Computational approaches for individual circadian phase prediction in field settings. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.coisb.2020.07.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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17
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Abstract
The temporal organization of molecular and physiological processes is driven by environmental and behavioral cycles as well as by self-sustained molecular circadian oscillators. Quantification of phase, amplitude, period, and disruption of circadian oscillators is essential for understanding their contribution to sleep-wake disorders, social jet lag, interindividual differences in entrainment, and the development of chrono-therapeutics. Traditionally, assessment of the human circadian system, and the output of the SCN in particular, has required collection of long time series of univariate markers such as melatonin or core body temperature. Data were collected in specialized laboratory protocols designed to control for environmental and behavioral influences on rhythmicity. These protocols are time-consuming, expensive, and not practical for assessing circadian status in patients or in participants in epidemiologic studies. Novel approaches for assessment of circadian parameters of the SCN or peripheral oscillators have been developed. They are based on machine learning or mathematical model-informed analyses of features extracted from 1 or a few samples of high-dimensional data, such as transcriptomes, metabolomes, long-term simultaneous recording of activity, light exposure, skin temperature, and heart rate or in vitro approaches. Here, we review whether these approaches successfully quantify parameters of central and peripheral circadian oscillators as indexed by gold standard markers. Although several approaches perform well under entrained conditions when sleep occurs at night, the methods either perform worse in other conditions such as shift work or they have not been assessed under any conditions other than entrainment and thus we do not yet know how robust they are. Novel approaches for the assessment of circadian parameters hold promise for circadian medicine, chrono-therapeutics, and chrono-epidemiology. There remains a need to validate these approaches against gold standard markers, in individuals of all sexes and ages, in patient populations, and, in particular, under conditions in which behavioral cycles are displaced.
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Affiliation(s)
- Derk-Jan Dijk
- Surrey Sleep Research Centre, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.,UK Dementia Research Institute, University of Surrey
| | - Jeanne F Duffy
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
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18
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Esposito D, Belli A, Ferri R, Bruni O. Sleeping without Prescription: Management of Sleep Disorders in Children with Autism with Non-Pharmacological Interventions and Over-the-Counter Treatments. Brain Sci 2020; 10:brainsci10070441. [PMID: 32664572 PMCID: PMC7407189 DOI: 10.3390/brainsci10070441] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 12/18/2022] Open
Abstract
Autism Spectrum Disorders (ASD) are lifelong neurodevelopmental conditions characterized by abnormal social interaction, communication, and behavior. Sleep disturbances represent a common comorbidity in children and adolescents with ASD, with prevalence ranging from 50 to 80%. It has been proved that sleep disruption worsens the symptoms of autism and results in challenging behaviors. Improving sleep should therefore be a primary therapeutic goal. Treatment options range from lifestyle modifications to pharmacological therapy. Several reviews have been written on pharmacological treatments, but very few on the beneficial effects of non-pharmacological interventions, over-the-counter drugs, and nutritional supplements. This study consists of a narrative review of the literature, presenting the available evidence on the following treatments: sleep education, behavioral interventions, complementary and alternative medicine (special mattresses and blankets, massage, aromatherapy, yoga, physical activity), and commonly used over-the-counter medications and supplements (antihistamines, melatonin, tryptophan, carnosine, iron, vitamins, and herbal remedies). For some treatments—such as melatonin and behavioral interventions—effectiveness in ASD is well established in the literature, while other interventions appear of benefit in clinical practice, even if specific studies in children and adolescents with ASD are lacking. Conversely, other treatments only seem to show anecdotal evidence supporting their use.
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Affiliation(s)
- Dario Esposito
- Child Neurology and Psychiatry Unit, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (D.E.); (A.B.)
| | - Arianna Belli
- Child Neurology and Psychiatry Unit, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (D.E.); (A.B.)
| | - Raffaele Ferri
- Sleep Research Centre, Oasi Research Institute–IRCCS, 94018 Troina, Italy;
| | - Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University of Rome, 00185 Rome, Italy
- Correspondence:
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19
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Sleep duration and timing in obsessive-compulsive disorder (OCD): evidence for circadian phase delay. Sleep Med 2020; 72:111-117. [PMID: 32575000 DOI: 10.1016/j.sleep.2020.03.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/04/2020] [Accepted: 03/17/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To investigate potential delays in endogenous melatonin in individuals with obsessive-compulsive disorder (OCD). METHODS First, data are presented for 15 individuals with OCD and matched healthy controls. Next, nine additional participants with OCD who did not have matched controls were added, resulting in a sample of 24 individuals with OCD. All participants were assessed for sleep and circadian rhythm disturbance. Dim light melatonin onset (DLMO) was derived from salivary melatonin and was used in conjunction with sleep diaries, interview measures, and questionnaires. A subset of the OCD group (n = 16) also used actigraphy. RESULTS In sum, 42% percent (10/24) of the patients with OCD met the criteria for delayed sleep-wake phase disorder (DSWPD) in comparison to 0% in the control sample. DLMO was significantly later in individuals with OCD compared to controls. DLMO and bedtime were not significantly associated with the severity of obsessive-compulsive symptoms or negative affect. CONCLUSIONS Replication of the findings presented herein, particularly the DLMO results, is warranted. Further, there are now three studies showing that nearly ½ of individuals with OCD meet criteria for a DSWPD. Future studies can explore the mechanisms underlying these connections and the implications of this comorbidity. These findings may increase our understanding of OCD and inform future interventions.
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20
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Sunde E, Mrdalj J, Pedersen T, Thun E, Bjorvatn B, Grønli J, Harris A, Waage S, Pallesen S. Role of nocturnal light intensity on adaptation to three consecutive night shifts: a counterbalanced crossover study. Occup Environ Med 2020; 77:249-255. [PMID: 32019847 DOI: 10.1136/oemed-2019-106049] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 12/27/2019] [Accepted: 01/12/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate how a standard ceiling mounted light-emitting diode (LED)-based bright light intervention affected alertness and neurobehavioural performance during three consecutive simulated night shifts, and timing of circadian rhythm after the shifts. METHODS Twenty seven participants (20 females, 21.4±2.1 years; mean±SD) worked three consecutive night shifts (23:00-07:00) under a full-spectrum (4000 K) bright light (900 lx) and a standard light (90 lx) condition in a counterbalanced crossover design (separated by 4 weeks). Subjective alertness (Karolinska Sleepiness Scale) and neurobehavioural performance (Psychomotor Vigilance Task and Digit Symbol Substitution Test) were assessed five times during each shift. Salivary dim-light melatonin onset (DLMO) was assessed before and after the shifts. The simulated night shifts were conducted in a laboratory while the participants slept at home. RESULTS Subjective alertness and neurobehavioural performance deteriorated during the night shifts in both light conditions. However, bright light significantly reduced alertness and performance decrements as compared with standard light. For a subset of the participants, DLMO was delayed by a mean of 3:17±0:23 (mean±SEM) hours after three night shifts in bright light and by 2:06±0:15 hours in standard light, indicating that bright light causes larger phase delay. CONCLUSION Bright light improved performance and alertness during simulated night shifts and improved adaptation to night work. Bright light administered by ceiling mounted LED luminaires has the potential to improve adaptation to night work and reduce the risk of accidents and injuries among night workers. TRIAL REGISTRATION NUMBER NCT03203538.
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Affiliation(s)
- Erlend Sunde
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Jelena Mrdalj
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Torhild Pedersen
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Eirunn Thun
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Janne Grønli
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Anette Harris
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Siri Waage
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Ståle Pallesen
- Department of Psychosocial Science, University of Bergen, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
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21
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Gaspar LS, Álvaro AR, Carmo‐Silva S, Mendes AF, Relógio A, Cavadas C. The importance of determining circadian parameters in pharmacological studies. Br J Pharmacol 2019; 176:2827-2847. [PMID: 31099023 PMCID: PMC6637036 DOI: 10.1111/bph.14712] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/26/2019] [Accepted: 04/01/2019] [Indexed: 12/25/2022] Open
Abstract
In mammals, most molecular and cellular processes show circadian changes, leading to daily variations in physiology and ultimately in behaviour. Such daily variations induce a temporal coordination of processes that is essential to ensure homeostasis and health. Thus, it is of no surprise that pharmacokinetics (PK) and pharmacodynamics (PD) of many drugs are also subject to circadian variations, profoundly affecting their efficacy and tolerability. Understanding how circadian rhythms influence drug PK, PD, and toxicity might significantly improve treatment efficacy and decrease related side effects. Therefore, it is essential to take circadian variations into account and to determine circadian parameters in pharmacological studies, especially when drugs have a short half-life or target rhythmic processes. This review provides an overview of the current knowledge on circadian rhythms and their relevance to the field of pharmacology. Methodologies to evaluate circadian rhythms in vitro, in rodent models and in humans, from experimental to computational approaches, are described and discussed. Lastly, we aim at alerting the scientific, medical, and regulatory communities to the relevance of the physiological time, as a key parameter to be considered when designing pharmacological studies. This will eventually lead to more successful preclinical and clinical trials and pave the way to a more personalized treatment to the benefit of the patients.
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Affiliation(s)
- Laetitia S. Gaspar
- CNC—Center for Neuroscience and Cell BiologyUniversity of CoimbraCoimbraPortugal
- Center for Innovation in Biomedicine and Biotechnology (CIBB)University of CoimbraCoimbraPortugal
- Institute for Interdisciplinary Research (IIIUC)University of CoimbraCoimbraPortugal
| | - Ana Rita Álvaro
- CNC—Center for Neuroscience and Cell BiologyUniversity of CoimbraCoimbraPortugal
- Center for Innovation in Biomedicine and Biotechnology (CIBB)University of CoimbraCoimbraPortugal
| | - Sara Carmo‐Silva
- CNC—Center for Neuroscience and Cell BiologyUniversity of CoimbraCoimbraPortugal
- Center for Innovation in Biomedicine and Biotechnology (CIBB)University of CoimbraCoimbraPortugal
| | - Alexandrina Ferreira Mendes
- CNC—Center for Neuroscience and Cell BiologyUniversity of CoimbraCoimbraPortugal
- Center for Innovation in Biomedicine and Biotechnology (CIBB)University of CoimbraCoimbraPortugal
- Faculty of PharmacyUniversity of CoimbraCoimbraPortugal
| | - Angela Relógio
- Institute for Theoretical BiologyCharité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt—Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
- Medical Department of Hematology, Oncology, and Tumor Immunology, Molecular Cancer Research CenterCharité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt—Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
| | - Cláudia Cavadas
- CNC—Center for Neuroscience and Cell BiologyUniversity of CoimbraCoimbraPortugal
- Center for Innovation in Biomedicine and Biotechnology (CIBB)University of CoimbraCoimbraPortugal
- Faculty of PharmacyUniversity of CoimbraCoimbraPortugal
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Paul MA, Love RJ, Jetly R, Richardson JD, Lanius RA, Miller JC, MacDonald M, Rhind SG. Blunted Nocturnal Salivary Melatonin Secretion Profiles in Military-Related Posttraumatic Stress Disorder. Front Psychiatry 2019; 10:882. [PMID: 31866882 PMCID: PMC6910089 DOI: 10.3389/fpsyt.2019.00882] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/08/2019] [Indexed: 12/16/2022] Open
Abstract
Background: Sleep disturbances are a hallmark of posttraumatic stress disorder (PTSD), yet few studies have evaluated the role of dysregulated endogenous melatonin secretion in this condition. Methods: This study compared the sleep quality and nocturnal salivary melatonin profiles of Canadian Armed Forces (CAF) personnel diagnosed with PTSD, using the Clinician Administered PTSD Scale (CAPS score ≥50), with two healthy CAF control groups; comprising, a "light control" (LC) group with standardized evening light exposure and "normal control" (NC) group without light restriction. Participants were monitored for 1-week using wrist actigraphy to assess sleep quality, and 24-h salivary melatonin levels were measured (every 2h) by immunoassay on the penultimate day in a dim-light (< 5 lux) laboratory environment. Results: A repeated measures design showed that mean nocturnal melatonin concentrations for LC were higher than both NC (p = .03) and PTSD (p = .003) with no difference between PTSD and NC. Relative to PTSD, NC had significantly higher melatonin levels over a 4-h period (01 to 05 h), whereas the LC group had higher melatonin levels over an 8-h period (23 to 07 h). Actigraphic sleep quality parameters were not different between healthy controls and PTSD patients, likely due to the use of prescription sleep medications in the PTSD group. Conclusions: These results indicate that PTSD is associated with blunted nocturnal melatonin secretion, which is consistent with previous findings showing lower melatonin after exposure to trauma and suggestive of severe chronodisruption. Future studies targeting the melatonergic system for therapeutic intervention may be beneficial for treatment-resistant PTSD.
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Affiliation(s)
- Michel A Paul
- Defence Research & Development Canada, Toronto Research Centre, Operational Health and Performance Section, Toronto, ON, Canada
| | - Ryan J Love
- Defence Research & Development Canada, Toronto Research Centre, Operational Health and Performance Section, Toronto, ON, Canada
| | - Rakesh Jetly
- Directorate of Mental Health, Canadian Forces Health Services, Ottawa, ON, Canada
| | - J Donald Richardson
- Department of Psychiatry, Western University, London, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Operational Stress Injury Clinic, Parkwood Institute, London, ON, Canada.,MacDonald Franklin Operational Stress Injury Research Centre, Lawson Research Institute, London, ON, Canada
| | - Ruth A Lanius
- Department of Psychiatry, Western University, London, ON, Canada.,Department of Neuroscience, Western University, London, ON, Canada
| | - James C Miller
- Department of Life Sciences, Texas A&M University Corpus Christi, Corpus Christi, TX, United States
| | - Michael MacDonald
- Directorate of Mental Health, Canadian Forces Health Services, Ottawa, ON, Canada
| | - Shawn G Rhind
- Defence Research & Development Canada, Toronto Research Centre, Operational Health and Performance Section, Toronto, ON, Canada
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23
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Reis C, Paiva T. Delayed sleep-wake phase disorder in a clinical population: gender and sub-population diferences. ACTA ACUST UNITED AC 2019; 12:203-213. [PMID: 31890097 PMCID: PMC6932846 DOI: 10.5935/1984-0063.20190086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective/Background Delayed sleep-wake phase disorder (DSWPD) is defined by a delay in the major sleep episode relative to desired or required sleep and wake times. The objectives of this study were to evaluate DSWPD in our population and to compare it with similar clinical data, to analyse gender differences, and to identify possible subpopulations based on circadian timing and alignment. Patients/Methods 162 consecutive DSWPD patients from a sleep clinic with a median age of 35.5 (24.0) years, 85 (52.5%) males were studied. Patient data were obtained from a clinical interview composed of socio-demographic, life events, daily habits, consumptions, and comorbidities data; and from diaries, actimetry, melatonin and PSG T1. The Dim Light Melatonin Onset (DLMO) was used to define circadian alignment or misalignment. Results In our DSWPD cohort, there were gender differences for different age groups (p=0.028). Men were more likely to be single and women more likely to be married (p=0.034). In students, school failure was higher for women (p<0.001); for workers, absenteeism was higher in women (p=0.001). In the circadian aligned (compared to misaligned group), DLMO was later (p<0.001), sleep onset time (p=0.046) was later, total sleep time (p=0.035), and number of sleep cycles (p=0.018) were lower, as measured using PSG T1. Conclusions In this clinical population, DSWPD is more prevalent in young men and in middle age women, although with no overall significant differences between genders. There are two different phenotypes of DSWPD: circadian misaligned and circadian aligned. Depression is prevalent in both groups. Better definition, classification and diagnostic criteria for DSWPD are still needed, and targeted therapeutical intervention should be evaluated.
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Affiliation(s)
- Cátia Reis
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa - Lisboa- Portugal.,CENC - Sleep Medicine Center - Lisboa - Portugal
| | - Teresa Paiva
- CENC - Sleep Medicine Center - Lisboa - Portugal
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Solheim B, Olsen A, Kallestad H, Langsrud K, Bjorvatn B, Gradisar M, Sand T. Cognitive performance in DSWPD patients upon awakening from habitual sleep compared with forced conventional sleep. J Sleep Res 2018; 28:e12730. [PMID: 30105851 DOI: 10.1111/jsr.12730] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/25/2018] [Accepted: 06/11/2018] [Indexed: 11/29/2022]
Abstract
Difficult early morning awakening is one of the defining symptoms of delayed sleep-wake phase disorder. It is accompanied by low cognitive arousal and drowsiness resulting in difficulty concentrating and focusing attention upon awakening. We designed the current study to quantitate cognitive performance (i.e. omissions, commissions, reaction time [average and variability]) and cognitive domains (i.e. focused attention, sustained attention, impulsivity and vigilance) with Conners' Continuous Performance Test II during both habitual and conventional (00:00-07:00 hr) sleep-wake schedule in young adult patients with delayed sleep-wake phase disorder (n = 20, mean age = 24.8 years, SD = 3.0) and controls (n = 16, mean age = 24.4 years, SD = 3.4). Conners' Continuous Performance Test II was administered after awakening and in the afternoon during both habitual and conventional conditions. In-laboratory polysomnography was performed for 2 nights. We assessed sleep, tiredness, chronotype and depression using questionnaires. Saliva was sampled for dim light melatonin onset measurements. Repeated-measures ANOVAs were applied for the Conners' Continuous Performance Test II measures with group (patient/control), time (afternoon/morning) and condition (habitual/conventional schedule) as fixed factors. Patients with delayed sleep-wake phase disorder had reduced reaction times, especially in the morning, greater response speed variability, and made more omission and commission errors compared with controls. Patients with delayed sleep-wake phase disorder also had reduced focused attention, especially upon forced early awakening. The short total sleep time of patients with delayed sleep-wake phase disorder could not statistically explain this outcome. In conclusion, we observed a state-dependent reduced ability to focus attention upon early morning awakening in patients with delayed sleep-wake phase disorder. Patients also had more omissions, longer reaction time and increased RT variability after habitual sleep, suggesting a possible small cognitive trait dysfunction in delayed sleep-wake phase disorder.
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Affiliation(s)
- Brandy Solheim
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Alexander Olsen
- Department of Psychology, Faculty of Social Sciences and Technology Management, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Håvard Kallestad
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Division of Mental Health Care, St Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway
| | - Knut Langsrud
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Division of Mental Health Care, St Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Michael Gradisar
- School of Psychology, Flinders University of South Australia, Adelaide, SA, Australia
| | - Trond Sand
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway
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25
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Solheim B, Langsrud K, Kallestad H, Engstrøm M, Bjorvatn B, Sand T. Sleep structure and awakening threshold in delayed sleep-wake phase disorder patients compared to healthy sleepers. Sleep Med 2018; 46:61-68. [PMID: 29773213 DOI: 10.1016/j.sleep.2018.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 02/07/2018] [Accepted: 03/01/2018] [Indexed: 10/17/2022]
Abstract
STUDY OBJECTIVES Difficult early morning awakening is a primary symptom of delayed sleep-wake phase disorder (DSWPD), however, it remains poorly investigated. Our main objective was to quantify the awakening threshold in DSWPD-patients and healthy controls as well as investigate a possible relationship with sleep stages. A secondary objective was to compare habitual sleep measured by polysomnography and actigraphy between patients and controls. METHODS Twenty DSWPD patients and 16 controls had two polysomnographic recordings at a sleep laboratory. Participants followed their habitual sleep-wake schedule on the first night and a forced sleep-wake schedule (00:00-07:00 h) on the second night. We used a custom-made alarm clock was for the forced-night awakening, starting at 72 dB sound intensity which increased up to 104 dB. RESULTS Mean awakening threshold in dB was higher in patients compared to controls; 75.5 vs. 72.6, p = 0.01, and the difference could not be explained statistically by sleep-time. Patients who were in REM sleep upon attempted awakening had a higher awakening threshold compared to patients who were in NREM sleep; 80.0 vs 74.7, F = 6.4, p = 0.02. Patients had increased sleep onset latency both at home with actigraphy and by PSG during the first laboratory night (20.6 vs 12.1 min, p = 0.004), however no further differences between the groups were observed regarding sleep structure. CONCLUSIONS A high early-morning forced awakening threshold in DSWPD was related to REM sleep. Sleep onset problems, even with habitual bedtimes, may also be an integral feature of DSWPD.
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Affiliation(s)
- Brandy Solheim
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, N-7491, Trondheim, Norway.
| | - Knut Langsrud
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway; Division of Mental Health Care, St. Olavs Hospital HF, Trondheim University Hospital, Norway
| | - Håvard Kallestad
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway; Division of Mental Health Care, St. Olavs Hospital HF, Trondheim University Hospital, Norway
| | - Morten Engstrøm
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, N-7491, Trondheim, Norway; Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital HF, Trondheim University Hospital, Norway
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Trond Sand
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, N-7491, Trondheim, Norway; Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital HF, Trondheim University Hospital, Norway
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26
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Sleep-wake profiles and circadian rhythms of core temperature and melatonin in young people with affective disorders. J Psychiatr Res 2017; 94:131-138. [PMID: 28711776 DOI: 10.1016/j.jpsychires.2017.07.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 07/05/2017] [Accepted: 07/07/2017] [Indexed: 02/07/2023]
Abstract
While disturbances of the sleep-wake cycle are common in people with affective disorders, the characteristics of these disturbances differ greatly between individuals. This heterogeneity is likely to reflect multiple underlying pathophysiologies, with different perturbations in circadian systems contributing to the variation in sleep-wake cycle disturbances. Such disturbances may be particularly relevant in adolescents and young adults with affective disorders as circadian rhythms undergo considerable change during this key developmental period. This study aimed to identify profiles of sleep-wake disturbance in young people with affective disorders and investigate associations with biological circadian rhythms. Fifty young people with affective disorders and 19 control participants (aged 16-31 years) underwent actigraphy monitoring for approximately two weeks to derive sleep-wake cycle parameters, and completed an in-laboratory assessment including evening dim-light saliva collection for melatonin assay and overnight continuous core body temperature measurement. Cluster analysis based on sleep-wake cycle parameters identified three distinct patient groups, characterised by 'delayed sleep-wake', 'disrupted sleep', and 'long sleep' respectively. The 'delayed sleep-wake' group had both delayed melatonin onset and core temperature nadir; whereas the other two cluster groups did not differ from controls on these circadian markers. The three groups did not differ on clinical characteristics. These results provide evidence that only some types of sleep-wake disturbance in young people with affective disorders are associated with fundamental circadian perturbations. Consequently, interventions targeting endogenous circadian rhythms to promote a phase shift may be particularly relevant in youth with affective disorders presenting with delayed sleep-wake cycles.
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Keijzer H, Spruyt K, Smits MG, de Geest A, Curfs LMG. Can dim light melatonin onset be predicted by the timing of sleep in patients with possible circadian sleep-wake rhythm disorders? BIOL RHYTHM RES 2017. [DOI: 10.1080/09291016.2017.1287817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Henry Keijzer
- Department of Clinical Chemistry and Hematology, Rijnstate Hospital, Arnhem, The Netherlands
- Governor Kremers Centre, University Maastricht, The Netherlands
| | - Karen Spruyt
- Governor Kremers Centre, University Maastricht, The Netherlands
- Department of Developmental and Behavioral Pediatrics, Shanghai Children’s Medical Centre affiliated with Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Marcel G. Smits
- Governor Kremers Centre, University Maastricht, The Netherlands
- Centre for Sleep-wake Disturbances and Chronobiology, Ede, The Netherlands
| | - Antoon de Geest
- Department of Clinical Chemistry and Hematology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Leopold M. G. Curfs
- Governor Kremers Centre, University Maastricht, The Netherlands
- Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
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28
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Keijzer H, Snitselaar MA, Smits MG, Spruyt K, Zee PC, Ehrhart F, Curfs LM. Precision medicine in circadian rhythm sleep-wake disorders: current state and future perspectives. Per Med 2017; 14:171-182. [PMID: 29754559 DOI: 10.2217/pme-2016-0079] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In circadian rhythm sleep-wake disorders precision medicine is less developed than in other medical disciplines mainly because homeostatic sleep and circadian timing have a very complex phenotype with multiple genetic regulation mechanisms. However, biomarkers, phenotyping and psychosocial characteristics are increasingly used. Devices for polysomnography, actigraphy and sleep-tracking applications in mobile phones and other consumer devices with eHealth technologies are increasingly used. Also sleep-related questionnaires and the assessment of co-morbidities influencing sleep in circadian rhythm sleep-wake disorders are major contributors to precision sleep medicine. To further strengthen the (pharmaco-)genetic and biomarker pillar, technology needs to be evolved further. Routinely measuring treatment results using patient-reported outcome measures and clinical neurophysiological instruments will boost precision sleep medicine.
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Affiliation(s)
- Henry Keijzer
- Governor Kremers Centre, University Maastricht, Maastricht, The Netherlands.,Department of Clinical Chemistry & Hematology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Mark A Snitselaar
- Centre for Sleep-Wake Disturbances & Chronobiology, Gelderse Vallei Hospital, Ede, The Netherlands.,Pro Persona Mental Health Care, Ede, The Netherlands
| | - Marcel G Smits
- Governor Kremers Centre, University Maastricht, Maastricht, The Netherlands.,Centre for Sleep-Wake Disturbances & Chronobiology, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Karen Spruyt
- Rett Expertise Centre, University Maastricht, Maastricht, The Netherlands.,Faculty of Psychology & Educational Sciences, Vrije Universiteit Brussel, Belgium.,Department of Developmental & Behavioral Pediatrics, Shanghai Children's Medical Centre affiliated with Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Phyllis C Zee
- Center for Circadian & Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Friederike Ehrhart
- Governor Kremers Centre, University Maastricht, Maastricht, The Netherlands.,Rett Expertise Centre, University Maastricht, Maastricht, The Netherlands.,Department of Bioinformatics, Maastricht University, Maastricht, The Netherlands
| | - Leopold Mg Curfs
- Governor Kremers Centre, University Maastricht, Maastricht, The Netherlands.,Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
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Larcher S, Gauchez AS, Lablanche S, Pépin JL, Benhamou PY, Borel AL. Impact of sleep behavior on glycemic control in type 1 diabetes: the role of social jetlag. Eur J Endocrinol 2016; 175:411-9. [PMID: 27530460 DOI: 10.1530/eje-16-0188] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 08/16/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Sleep behavior is changing toward shorter sleep duration and a later chronotype. It results in a sleep debt that is acquitted on work-free days, inducing a small but recurrent sleep misalignment each week, referred to as "social jetlag". These sleep habits could affect health through misalignment with circadian rhythms. OBJECTIVES The primary objective is to address the impact of sleep behavior on glycemic control, assessed by HbA1c, in patients with type 1 diabetes, independently of other lifestyle or sleep-related factors. The secondary objective is to address whether circadian phase affects glycemic control. DESIGN In total, 80 adult patients with type 1 diabetes (46% female) were included in a clinical cohort study. METHODS Sleep behavior was addressed objectively by a 7-day actimetry, lifestyle by questionnaires, sleep breathing disorders by nocturnal oximetry and circadian phase by dim light melatonin onset (DLMO). RESULTS Univariate analyses showed that chronotype (r = 0.23, P = 0.042) and social jetlag (r = 0.30, P = 0.008) were significantly associated with HbA1c. In multivariable analysis, social jetlag was the only sleep habit independently associated with HbA1c (β = 0.012 (0.006; 0.017), P < 0.001). HbA1c was lower in patients with a social jetlag below versus above the median (7.7% (7.1-8.7) and 8.7% (7.6-9.8), P = 0.011). DLMO was not associated with HbA1c. However, the later the DLMO, the worse the sleep efficiency (r = -0.41, P < 0.001) and fragmentation index (r = 0.35, P = 0.005). CONCLUSIONS Social jetlag, a small but recurrent circadian misalignment, is associated with worse glycemic control in type 1 diabetes, whereas circadian phase is not. Further intervention studies should address the potential improvement of glycemic control by correcting social jetlag.
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Affiliation(s)
- Sandra Larcher
- Grenoble Alpes University HospitalPole DIGIDUNE, Department of Endocrinology, Grenoble, France
| | - Anne-Sophie Gauchez
- Grenoble Alpes University HospitalPole biology, "Institut de Biologie et de Pathologie", Grenoble, France UMR-S INSERM 1039
| | - Sandrine Lablanche
- Grenoble Alpes University HospitalPole DIGIDUNE, Department of Endocrinology, Grenoble, France "Laboratoire de bioénergétique fondamentale et appliquée"INSERM U1055
| | - Jean-Louis Pépin
- Hypoxia Pathophysiology LaboratoryINSERM U1042, Grenoble Alpes University, Grenoble, France Grenoble Alpes University HospitalPole Thorax et Vaisseaux, Physiology, Sleep and Exercise Clinic, Grenoble, France
| | - Pierre-Yves Benhamou
- Grenoble Alpes University HospitalPole DIGIDUNE, Department of Endocrinology, Grenoble, France
| | - Anne-Laure Borel
- Grenoble Alpes University HospitalPole DIGIDUNE, Department of Endocrinology, Grenoble, France Hypoxia Pathophysiology LaboratoryINSERM U1042, Grenoble Alpes University, Grenoble, France
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30
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Salivary melatonin and cortisol and occupational injuries among Italian hospital workers. Neurol Sci 2016; 37:1613-20. [DOI: 10.1007/s10072-016-2630-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/06/2016] [Indexed: 10/21/2022]
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Lovato N, Micic G, Gradisar M, Ferguson SA, Burgess HJ, Kennaway DJ, Lack L. Can the circadian phase be estimated from self-reported sleep timing in patients with Delayed Sleep Wake Phase Disorder to guide timing of chronobiologic treatment? Chronobiol Int 2016; 33:1376-1390. [PMID: 27611743 DOI: 10.1080/07420528.2016.1220386] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The efficacy of bright light and/or melatonin treatment for Delayed Sleep Wake Phase Disorder (DSWPD) is contingent upon an accurate clinical assessment of the circadian phase. However, the process of determining this circadian phase can be costly and is not yet readily available in the clinical setting. The present study investigated whether more cost-effective and convenient estimates of the circadian phase, such as self-reported sleep timing, can be used to predict the circadian phase and guide the timing of light and/or melatonin treatment (i.e. dim-light melatonin onset, core body temperature minimum and melatonin secretion mid-point) in a sample of individuals with DSWPD. METHOD Twenty-four individuals (male = 17; mean age = 21.96, SD = 5.11) with DSWPD were selected on the basis of ICSD-3 criteria from a community-based sample. The first 24-hours of a longer 80-hour constant laboratory ultradian routine were used to determine core body temperature minimum (cBTmin), dim-light melatonin onset (DLMO) and the midpoint of the melatonin secretion period (DLMmid = [DLM°ff-DLMO]/2). Prior to the laboratory session subjective sleep timing was assessed using a 7-day sleep/wake diary, the Pittsburgh Sleep Quality Index (PSQI), and the Delayed Sleep Phase Disorder Sleep Timing Questionnaire (DSPD-STQ). RESULTS Significant moderate to strong positive correlations were observed between self-reported sleep timing variables and DLMO, cBTmin and DLMmid. Regression equations revealed that the circadian phase (DLMO, cBTmin and DLMmid) was estimated within ±1.5 hours of the measured circadian phase most accurately by the combination of sleep timing measures (88% of the sample) followed by sleep diary reported midsleep (83% of the sample) and sleep onset time (79% of the sample). DISCUSSION These findings suggest that self-reported sleep timing may be useful clinically to predict a therapeutically relevant circadian phase in DSWPD.
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Affiliation(s)
- Nicole Lovato
- a Adelaide Institute for Sleep Health: A Flinders Centre for Research Excellence , Flinders University of South Australia , Adelaide , South Australia
| | - Gorica Micic
- b Flinders University of South Australia , Adelaide , South Australia
| | - Michael Gradisar
- b Flinders University of South Australia , Adelaide , South Australia
| | - Sally A Ferguson
- c Appleton Institute , Central Queensland University , Adelaide , South Australia
| | - Helen J Burgess
- d Biological Rhythms Research Laboratory Rush University Medical Center , Chicago , IL , USA
| | - David J Kennaway
- e Robinson Research Institute, School of Medicine, Discipline of Obstetrics and Gynaecology , University of Adelaide , Adelaide , South Australia
| | - Leon Lack
- a Adelaide Institute for Sleep Health: A Flinders Centre for Research Excellence , Flinders University of South Australia , Adelaide , South Australia.,b Flinders University of South Australia , Adelaide , South Australia
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Goril S, Zalai D, Scott L, Shapiro CM. Sleep and melatonin secretion abnormalities in children and adolescents with fetal alcohol spectrum disorders. Sleep Med 2016; 23:59-64. [PMID: 27692277 DOI: 10.1016/j.sleep.2016.06.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 05/02/2016] [Accepted: 06/04/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Caregivers describe significant sleep disturbances in the vast majority of children and adolescents, which is diagnosed as fetal alcohol spectrum disorders (FASD), but objective data on sleep disorders in this population are almost completely lacking. Animal models suggest that intrauterine alcohol exposure may disrupt sleep wake patterns, cause sleep fragmentation, and specifically affect the suprachiasmatic nucleus, thus disrupting melatonin secretion. The objective of this pioneering study was to evaluate sleep and melatonin abnormalities in children with FASD using objective, gold-standard measures. METHODS Children and adolescents (N = 36, 6-18 years) with FASD participated in clinical assessments by sleep specialists, overnight polysomnography (PSG), and a dim light melatonin onset (DLMO) test in a pediatric sleep laboratory. PSG was analyzed according to standardized scoring guidelines and sleep architecture was compared with normative data. DLMOs were determined and melatonin secretion curves were evaluated qualitatively to classify melatonin profiles. Sleep disorders were evaluated according to international diagnostic criteria. RESULTS There was a high prevalence (58%) of sleep disorders. The most common sleep problems were parasomnias (27.9%) and insomnia (16.8%). The sleep studies showed lower than normal sleep efficiency and high rates of sleep fragmentation. Most participants (79%) had an abnormal melatonin profile. CONCLUSIONS This study led to the recognition that both sleep and melatonin secretion abnormalities are present in children with FASD. Therefore, to be effective in managing the sleep problems in children with FASD, one needs to consider both the sleep per se and a possible malfunction of the circadian regulation.
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Affiliation(s)
- Shery Goril
- Youthdale Child and Adolescent Sleep Centre, Toronto, Ontario, Canada; Collaborative Program in Neurosciences, University of Toronto, Toronto, Ontario, Canada
| | - Dora Zalai
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada.
| | | | - Colin M Shapiro
- Youthdale Child and Adolescent Sleep Centre, Toronto, Ontario, Canada; Department of Psychiatry and Ophthalmology, University Health Network, Toronto, Ontario, Canada
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Burkhalter H, De Geest S, Wirz-Justice A, Cajochen C. Melatonin rhythms in renal transplant recipients with sleep-wake disturbances. Chronobiol Int 2016; 33:810-20. [PMID: 27101434 DOI: 10.3109/07420528.2016.1169192] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We assessed salivary melatonin levels in renal transplant (RTx) recipients who participated in a randomised, multicentre wait-list controlled trial on the effect of bright light therapy on their sleep and circadian rhythms. A large proportion of RTx recipients in our cohort had unexpectedly low melatonin values, which precluded calculation of the dim-light melatonin onset (DLMO) as a circadian marker. Thus, the aim of this post hoc analysis was to describe the melatonin profile of home-dwelling RTx recipients diagnosed with sleep-wake disturbances (SWDs). The participants were characterised by means of sleep questionnaires, validated psychometric instruments [Pittsburgh sleep quality Index (PSQI), Epworth sleepiness scale (ESS), Morningness-Eveningness Questionnaire (MEQ) and Depression, Anxiety and Stress Scale (DASS)] in addition to melatonin assay in saliva. Data were analysed with descriptive statistics and group comparisons made with appropriate post hoc tests. RTx recipients [n = 29 (aged 54.83 ± 13.73, transplanted 10.62 ± 6.84 years ago)] were retrospectively grouped into two groups: RTx recipients whose dim light melatonin onset (DLMO) could be calculated (n = 11) and those whose DLMO could not be calculated (n = 18). RTx recipients having a measurable DLMO had a number of differences from those without DLMO: they were younger [46.4 ± 14.9 compared to 60.0 ± 10.3 (p = .007)], had higher haemoglobin values [135.36 ± 12.01 versus 122.82 ± 11.56 (p = .01)], less anxiety [4 (0;8) versus 12 (6.5;14) (p = .021)] and a better overall sense of coherence [SOC Score: 71.09 ± 12.78 versus 56.28 ± 15.48 (p = 0.013)]. These results suggest that RTx recipients whose DLMO could be calculated have less health impairments, underlying the relevance of a stable circadian system.
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Affiliation(s)
- Hanna Burkhalter
- a Centre for Sleep Medicine , Hirslanden Group , Zürich , Switzerland.,b Institute of Nursing Science, University of Basel , Basel , Switzerland
| | - Sabina De Geest
- b Institute of Nursing Science, University of Basel , Basel , Switzerland.,c Academic Center for Nursing and Midwifery , KU Leuven , Belgium
| | - Anna Wirz-Justice
- d Centre for Chronobiology , Psychiatric Hospital of the University of Basel , Basel , Switzerland
| | - Christian Cajochen
- d Centre for Chronobiology , Psychiatric Hospital of the University of Basel , Basel , Switzerland
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Burgess HJ, Park M, Wyatt JK, Fogg LF. Home dim light melatonin onsets with measures of compliance in delayed sleep phase disorder. J Sleep Res 2016; 25:314-7. [PMID: 26847016 DOI: 10.1111/jsr.12384] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 12/07/2015] [Indexed: 11/27/2022]
Abstract
The dim light melatonin onset (DLMO) assists with the diagnosis and treatment of circadian rhythm sleep disorders. Home DLMOs are attractive for cost savings and convenience, but can be confounded by home lighting and sample timing errors. We developed a home saliva collection kit with objective measures of light exposure and sample timing. We report on our first test of the kit in a clinical population. Thirty-two participants with delayed sleep phase disorder (DSPD; 17 women, aged 18-52 years) participated in two back-to-back home and laboratory phase assessments. Most participants (66%) received at least one 30-s epoch of light >50 lux during the home phase assessments, but for only 1.5% of the time. Most participants (56%) collected every saliva sample within 5 min of the scheduled time. Eighty-three per cent of home DLMOs were not affected by light or sampling errors. The home DLMOs occurred, on average, 10.2 min before the laboratory DLMOs, and were correlated highly with the laboratory DLMOs (r = 0.93, P < 0.001). These results indicate that home saliva sampling with objective measures of light exposure and sample timing, can assist in identifying accurate home DLMOs.
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Affiliation(s)
- Helen J Burgess
- Biological Rhythms Research Laboratory, Rush University Medical Center, Chicago, IL, USA
| | - Margaret Park
- Sleep Disorders Service and Research Center, Rush University Medical Center, Chicago, IL, USA
| | - James K Wyatt
- Sleep Disorders Service and Research Center, Rush University Medical Center, Chicago, IL, USA
| | - Louis F Fogg
- College of Nursing, Rush University Medical Center, Chicago, IL, USA
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Estimating the dim light melatonin onset of adolescents within a 6-h sampling window: the impact of sampling rate and threshold method. Sleep Med 2015; 20:59-66. [PMID: 27318227 DOI: 10.1016/j.sleep.2015.11.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/12/2015] [Accepted: 11/28/2015] [Indexed: 02/04/2023]
Abstract
OBJECTIVE/BACKGROUND Circadian rhythm sleep-wake disorders (CRSWDs) often manifest during the adolescent years. Measurement of circadian phase such as the dim light melatonin onset (DLMO) improves diagnosis and treatment of these disorders, but financial and time costs limit the use of DLMO phase assessments in clinic. The current analysis aims to inform a cost-effective and efficient protocol to measure the DLMO in older adolescents by reducing the number of samples and total sampling duration. PATIENTS/METHODS A total of 66 healthy adolescents (26 males) aged 14.8-17.8 years participated in a study; they were required to sleep on a fixed baseline schedule for a week before which they visited the laboratory for saliva collection in dim light (<20 lux). Two partial 6-h salivary melatonin profiles were derived for each participant. Both profiles began 5 h before bedtime and ended 1 h after bedtime, but one profile was derived from samples taken every 30 min (13 samples) and the other from samples taken every 60 min (seven samples). Three standard thresholds (first three melatonin values mean + 2 SDs, 3 pg/mL, and 4 pg/mL) were used to compute the DLMO. An agreement between DLMOs derived from 30-min and 60-min sampling rates was determined using Bland-Altman analysis; agreement between the sampling rate DLMOs was defined as ± 1 h. RESULTS AND CONCLUSIONS Within a 6-h sampling window, 60-min sampling provided DLMO estimates within ± 1 h of DLMO from 30-min sampling, but only when an absolute threshold (3 or 4 pg/mL) was used to compute the DLMO. Future analyses should be extended to include adolescents with CRSWDs.
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Slawik H, Stoffel M, Riedl L, Veselý Z, Behr M, Lehmberg J, Pohl C, Meyer B, Wiegand M, Krieg SM. Prospective Study on Salivary Evening Melatonin and Sleep before and after Pinealectomy in Humans. J Biol Rhythms 2015; 31:82-93. [PMID: 26647380 DOI: 10.1177/0748730415616678] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Melatonin is secreted systemically from the pineal gland maximally at night but is also produced locally in many tissues. Its chronobiological function is mainly exerted by pineal melatonin. It is a feedback regulator of the main circadian pacemaker in the hypothalamic suprachiasmatic nuclei and of many peripheral oscillators. Although exogenous melatonin is approved for circadian rhythm sleep disorders and old-age insomnia, research on endogenous melatonin in humans is hindered by the great interindividual variability of its amount and circadian rhythm. Single case studies on pinealectomized patients report on disrupted but also hypersomnic sleep. This is the first systematic prospective report on sleep with respect to pinealectomy due to pinealocytoma World Health Organization grade I without chemo- or radiotherapy. Before and after pinealectomy, 8 patients completed questionnaires on sleep quality and circadian rhythm (Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Morningness-Eveningness Questionnaire), 2 nights of polysomnography, salivary evening melatonin profiles, and qualitative assessment of 2 weeks of actigraphy and sleep logs. Six patients were assessed retrospectively up to 4 years after pinealectomy. Before pinealectomy, all but 1 patient showed an evening melatonin rise typical for indifferent chronotypes. After pinealectomy, evening saliva melatonin was markedly diminished, mostly below the detection limit of the assay (0.09 pg/mL). No systematic change in subjective sleep quality or standard measures of polysomnography was found. Mean pre- and postoperative sleep efficiency was 94% and 95%, and mean sleep-onset latency was 21 and 17 min, respectively. Sleep-wake rhythm during normal daily life did not change. Retrospective patients had a reduced sleep efficiency (90%) and more stage changes, although this was not significantly different from prospective patients. In conclusion, melatonin does seem to have a modulatory, not a regulatory, effect on standard measures of sleep. Study output is limited by small sample size and because only evening melatonin profiles were assessed.
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Affiliation(s)
- Helen Slawik
- Center of Sleep Medicine, Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, TU München, Germany Universitäre Psychiatrische Kliniken, Basel, Switzerland
| | - Michael Stoffel
- Department of Neurosurgery, Klinikum rechts der Isar, TU München, Germany Helios Klinikum, Krefeld, Germany
| | - Lina Riedl
- Center of Sleep Medicine, Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, TU München, Germany
| | - Zdenko Veselý
- Center of Sleep Medicine, Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, TU München, Germany Deceased
| | - Michael Behr
- Department of Neurosurgery, Klinikum rechts der Isar, TU München, Germany
| | - Jens Lehmberg
- Department of Neurosurgery, Klinikum rechts der Isar, TU München, Germany
| | - Corina Pohl
- Center of Sleep Medicine, Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, TU München, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, TU München, Germany
| | - Michael Wiegand
- Center of Sleep Medicine, Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, TU München, Germany
| | - Sandro M Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, TU München, Germany
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Burgess HJ, Wyatt JK, Park M, Fogg LF. Home Circadian Phase Assessments with Measures of Compliance Yield Accurate Dim Light Melatonin Onsets. Sleep 2015; 38:889-97. [PMID: 25409110 PMCID: PMC4434555 DOI: 10.5665/sleep.4734] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 10/24/2014] [Indexed: 01/17/2023] Open
Abstract
STUDY OBJECTIVES There is a need for the accurate assessment of circadian phase outside of the clinic/laboratory, particularly with the gold standard dim light melatonin onset (DLMO). We tested a novel kit designed to assist in saliva sampling at home for later determination of the DLMO. The home kit includes objective measures of compliance to the requirements for dim light and half-hourly saliva sampling. DESIGN Participants were randomized to one of two 10-day protocols. Each protocol consisted of two back-to-back home and laboratory phase assessments in counterbalanced order, separated by a 5-day break. SETTING Laboratory or participants' homes. PARTICIPANTS Thirty-five healthy adults, age 21-62 y. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Most participants received at least one 30-sec epoch of light > 50 lux during the home phase assessments (average light intensity 4.5 lux), but on average for < 9 min of the required 8.5 h. Most participants collected every saliva sample within 5 min of the scheduled time. Ninety-two percent of home DLMOs were not affected by light > 50 lux or sampling errors. There was no significant difference between the home and laboratory DLMOs (P > 0.05); on average the home DLMOs occurred 9.6 min before the laboratory DLMOs. The home DLMOs were highly correlated with the laboratory DLMOs (r = 0.91, P < 0.001). CONCLUSIONS Participants were reasonably compliant to the home phase assessment procedures. The good agreement between the home and laboratory dim light melatonin onsets (DLMOs) demonstrates that including objective measures of light exposure and sample timing during home saliva sampling can lead to accurate home DLMOs. CLINICAL TRIAL REGISTRATION Circadian Phase Assessments at Home, http://clinicaltrials.gov/show/NCT01487252, NCT01487252.
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Affiliation(s)
- Helen J. Burgess
- Biological Rhythms Research Laboratory, Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - James K. Wyatt
- Sleep Disorders Service and Research Center, Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Margaret Park
- Sleep Disorders Service and Research Center, Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Louis F. Fogg
- College of Nursing, Rush University Medical Center, Chicago, IL
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38
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Rahman SA. Are We Ready to Assess Circadian Phase at Home? Sleep 2015; 38:849-50. [PMID: 26039960 DOI: 10.5665/sleep.4722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 04/24/2015] [Indexed: 11/03/2022] Open
Affiliation(s)
- Shadab A Rahman
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA and Division of Sleep Medicine, Harvard Medical School, Boston, MA
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39
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Bruni O, Alonso-Alconada D, Besag F, Biran V, Braam W, Cortese S, Moavero R, Parisi P, Smits M, Van der Heijden K, Curatolo P. Current role of melatonin in pediatric neurology: clinical recommendations. Eur J Paediatr Neurol 2015; 19:122-33. [PMID: 25553845 DOI: 10.1016/j.ejpn.2014.12.007] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 12/09/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND/PURPOSE Melatonin, an indoleamine secreted by the pineal gland, plays a key role in regulating circadian rhythm. It has chronobiotic, antioxidant, anti-inflammatory and free radical scavenging properties. METHODS A conference in Rome in 2014 aimed to establish consensus on the roles of melatonin in children and on treatment guidelines. RESULTS AND CONCLUSION The best evidence for efficacy is in sleep onset insomnia and delayed sleep phase syndrome. It is most effective when administered 3-5 h before physiological dim light melatonin onset. There is no evidence that extended-release melatonin confers advantage over immediate release. Many children with developmental disorders, such as autism spectrum disorder, attention-deficit/hyperactivity disorder and intellectual disability have sleep disturbance and can benefit from melatonin treatment. Melatonin decreases sleep onset latency and increases total sleep time but does not decrease night awakenings. Decreased CYP 1A2 activity, genetically determined or from concomitant medication, can slow metabolism, with loss of variation in melatonin level and loss of effect. Decreasing the dose can remedy this. Animal work and limited human data suggest that melatonin does not exacerbate seizures and might decrease them. Melatonin has been used successfully in treating headache. Animal work has confirmed a neuroprotective effect of melatonin, suggesting a role in minimising neuronal damage from birth asphyxia; results from human studies are awaited. Melatonin can also be of value in the performance of sleep EEGs and as sedation for brainstem auditory evoked potential assessments. No serious adverse effects of melatonin in humans have been identified.
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Affiliation(s)
- Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, Rome, Italy
| | - Daniel Alonso-Alconada
- Institute for Women's Health, University College London, London, UK; Department of Cell Biology and Histology, University of the Basque Country, Spain
| | - Frank Besag
- South Essex Partnership University NHS Foundation Trust, Bedfordshire, & Institute of Psychiatry, London, UK
| | - Valerie Biran
- Neonatal Intensive Care Unit, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, Univ Paris Diderot, 75019 Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, INSERM, U1141, 75019 Paris, France
| | - Wiebe Braam
- 's Heeren Loo, Department Advisium, Wekerom, The Netherlands; Governor Kremers Centre, University Maastricht, The Netherlands
| | - Samuele Cortese
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; School of Medicine, and the Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, Institute of Mental Health, University of Nottingham, UK; New York University Child Study Center, NY, USA
| | - Romina Moavero
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University of Rome, Italy; Neurology Unit, Neuroscience Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Pasquale Parisi
- Child Neurology-Chair of Pediatrics, c/o Sant'Andrea Hospital, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University, Rome, Italy
| | - Marcel Smits
- Governor Kremers Centre, University Maastricht, The Netherlands; Department of Sleep-wake Disorders and Chronobiology, Hospital Gelderse Vallei Ede, The Netherlands
| | - Kristiaan Van der Heijden
- Leiden Institute for Brain and Cognition & Institute of Education and Child Studies, Leiden University, The Netherlands
| | - Paolo Curatolo
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University of Rome, Italy.
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40
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Gradisar M, Smits MG, Bjorvatn B. Assessment and Treatment of Delayed Sleep Phase Disorder in Adolescents. Sleep Med Clin 2014. [DOI: 10.1016/j.jsmc.2014.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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41
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Rovers J, Smits M, Duffy JF. Headache and Sleep: Also Assess Circadian Rhythm Sleep Disorders. Headache 2014; 54:175-7. [DOI: 10.1111/head.12217] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jörgen Rovers
- Headache Clinic; Gelderse Vallei Hospital; Ede The Netherlands
| | - Marcel Smits
- Headache Clinic; Gelderse Vallei Hospital; Ede The Netherlands
- Centre for Sleep-Wake Disturbances and Chronobiology; Gelderse Vallei Hospital; Ede The Netherlands
| | - Jeanne F. Duffy
- Division of Sleep Medicine; Brigham & Women's Hospital and Harvard Medical School; Boston Massachusetts USA
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42
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Keijzer H, Smits MG, Duffy JF, Curfs LMG. Why the dim light melatonin onset (DLMO) should be measured before treatment of patients with circadian rhythm sleep disorders. Sleep Med Rev 2013; 18:333-9. [PMID: 24388969 DOI: 10.1016/j.smrv.2013.12.001] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 12/02/2013] [Accepted: 12/02/2013] [Indexed: 11/16/2022]
Abstract
Treatment of circadian rhythm sleep disorders (CRSD) may include light therapy, chronotherapy and melatonin. Exogenous melatonin is increasingly being used in patients with insomnia or CRSD. Although pharmacopoeias and the European food safety authority (EFSA) recommend administering melatonin 1-2 h before desired bedtime, several studies have shown that melatonin is not always effective if administered according to that recommendation. Crucial for optimal treatment of CRSD, melatonin and other treatments should be administered at a time related to individual circadian timing (typically assessed using the dim light melatonin onset (DLMO)). If not administered according to the individual patient's circadian timing, melatonin and other treatments may not only be ineffective, they may even result in contrary effects. Endogenous melatonin levels can be measured reliably in saliva collected at the patient's home. A clinically reliably DLMO can be calculated using a fixed threshold. Diary and polysomnographic sleep-onset time do not reliably predict DLMO or circadian timing in patients with CRSD. Knowing the patient's individual circadian timing by assessing DLMO can improve diagnosis and treatment of CRSD with melatonin as well as other therapies such as light or chronotherapy, and optimizing treatment timing will shorten the time required to achieve results.
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Affiliation(s)
- Henry Keijzer
- Department of Clinical Chemistry and Hematology, Rijnstate Hospital, Arnhem, The Netherlands; Governor Kremers Centre, University Maastricht, The Netherlands.
| | - Marcel G Smits
- Governor Kremers Centre, University Maastricht, The Netherlands; Centre for Sleep-Wake Disturbances and Chronobiology, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Jeanne F Duffy
- Division of Sleep Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Leopold M G Curfs
- Governor Kremers Centre, University Maastricht, The Netherlands; Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
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43
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Saxvig IW, Wilhelmsen-Langeland A, Pallesen S, Vedaa O, Nordhus IH, Bjorvatn B. A randomized controlled trial with bright light and melatonin for delayed sleep phase disorder: effects on subjective and objective sleep. Chronobiol Int 2013; 31:72-86. [PMID: 24144243 DOI: 10.3109/07420528.2013.823200] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Delayed sleep phase disorder (DSPD) is assumed to be common amongst adolescents, with potentially severe consequences in terms of school attendance and daytime functioning. The most common treatment approaches for DSPD are based on the administration of bright light and/or exogenous melatonin with or without adjunct behavioural instructions. Much is generally known about the chronobiological effects of light and melatonin. However, placebo-controlled treatment studies for DSPD are scarce, in particular in adolescents and young adults, and no standardized guidelines exist regarding treatment. The aim of the present study was, therefore, to investigate the short- and long-term effects on sleep of a DSPD treatment protocol involving administration of timed bright light and melatonin alongside gradual advancement of rise time in adolescents and young adults with DSPD in a randomized controlled trial and an open label follow-up study. A total of 40 adolescents and young adults (age range 16-25 years) diagnosed with DSPD were recruited to participate in the study. The participants were randomized to receive treatment for two weeks in one of four treatment conditions: dim light and placebo capsules, bright light and placebo capsules, dim light and melatonin capsules or bright light and melatonin capsules. In a follow-up study, participants were re-randomized to either receive treatment with the combination of bright light and melatonin or no treatment in an open label trial for approximately three months. Light and capsules were administered alongside gradual advancement of rise times. The main end points were sleep as assessed by sleep diaries and actigraphy recordings and circadian phase as assessed by salivary dim light melatonin onset (DLMO). During the two-week intervention, the timing of sleep and DLMO was advanced in all treatment conditions as seen by about 1 h advance of bed time, 2 h advance of rise time and 2 h advance of DLMO in all four groups. Sleep duration was reduced with approximately 1 h. At three-month follow-up, only the treatment group had maintained an advanced sleep phase. Sleep duration had returned to baseline levels in both groups. In conclusion, gradual advancement of rise time produced a phase advance during the two-week intervention, irrespective of treatment condition. Termination of treatment caused relapse into delayed sleep times, whereas long-term treatment with bright light and melatonin (three months) allowed maintenance of the advanced sleep phase.
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Affiliation(s)
- Ingvild West Saxvig
- Department of Global Public Health and Primary Care, University of Bergen , Bergen , Norway
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44
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Saxvig IW, Wilhelmsen-Langeland A, Pallesen S, Vedaa Ø, Nordhus IH, Sørensen E, Bjorvatn B. Objective measures of sleep and dim light melatonin onset in adolescents and young adults with delayed sleep phase disorder compared to healthy controls. J Sleep Res 2013; 22:365-72. [DOI: 10.1111/jsr.12030] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Accepted: 12/09/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Ingvild W. Saxvig
- Department of Public Health and Primary Health Care; University of Bergen; Bergen Norway
- Norwegian Competence Center for Sleep Disorders; Haukeland University Hospital; Bergen Norway
| | | | - Ståle Pallesen
- Norwegian Competence Center for Sleep Disorders; Haukeland University Hospital; Bergen Norway
- Department of Psychosocial Science; University of Bergen; Bergen Norway
| | - Øystein Vedaa
- Department of Psychosocial Science; University of Bergen; Bergen Norway
| | - Inger H. Nordhus
- Norwegian Competence Center for Sleep Disorders; Haukeland University Hospital; Bergen Norway
- Department of Clinical Psychology; University of Bergen; Bergen Norway
| | - Eli Sørensen
- Norwegian Competence Center for Sleep Disorders; Haukeland University Hospital; Bergen Norway
- Department of Child and Adolescent Psychiatry; Haukeland University Hospital; Bergen Norway
| | - Bjørn Bjorvatn
- Department of Public Health and Primary Health Care; University of Bergen; Bergen Norway
- Norwegian Competence Center for Sleep Disorders; Haukeland University Hospital; Bergen Norway
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45
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Verheggen RJHM, Jones H, Nyakayiru J, Thompson A, Groothuis JT, Atkinson G, Hopman MTE, Thijssen DHJ. Complete absence of evening melatonin increase in tetraplegics. FASEB J 2012; 26:3059-64. [PMID: 22474242 DOI: 10.1096/fj.12-205401] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Individuals with a spinal cord injury (SCI), especially with tetraplegia, experience poor sleep quality, and this may be related to impaired control of circadian rhythmicity. Here, we examined the evening onset of melatonin secretion, an important hormone for the initiation of sleep, in people with a complete cervical (tetraplegia) and thoracic (paraplegia) SCI, and age- and sex-matched able-bodied control participants. Multiple samples of salivary melatonin were obtained during the evening hours and analyzed by ELISA methods in 10 control partcipants, 9 individuals with paraplegia, and 6 individuals with tetraplegia. Sleep quality was assessed using questionnaires. Interactive effects of group and time were found for melatonin levels (P=0.022). In the control and paraplegia groups, the mean melatonin level increased significantly from 2.59 ± 1.04 and 4.28 ± 3.28 pg/ml at 7 PM to 10.62 ± 4.59 and 13.10 ± 7.39 pg/ml at 11 PM, respectively (P<0.001). In the tetraplegia group, melatonin level was 5.25 ± 3.72 at 7 PM but only 2.41 ± 1.25 pg/ml at 11 PM (P>0.05). Decreased sleep quality was more prevalent in individuals with tetraplegia (83%) and paraplegia (75%) compared with controls (20%; P=0.02). Unlike in the control and paraplegia groups, the evening increase in melatonin concentration was completely absent in the tetraplegia group. This provides biological insight into sleep regulation in humans and provides better understanding of the poor sleep quality in people with tetraplegia.
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Affiliation(s)
- Rebecca J H M Verheggen
- Department of Physiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Pullman RE, Roepke SE, Duffy JF. Laboratory validation of an in-home method for assessing circadian phase using dim light melatonin onset (DLMO). Sleep Med 2012; 13:703-6. [PMID: 22445311 DOI: 10.1016/j.sleep.2011.11.008] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 11/07/2011] [Accepted: 11/09/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine whether an accurate circadian phase assessment could be obtained from saliva samples collected by patients in their home. METHODS Twenty-four individuals with a complaint of sleep initiation or sleep maintenance difficulty were studied for two evenings. Each participant received instructions for collecting eight hourly saliva samples in dim light at home. On the following evening they spent 9h in a laboratory room with controlled dim (<20 lux) light where hourly saliva samples were collected. Circadian phase of dim light melatonin onset (DLMO) was determined using both an absolute threshold (3 pg ml(-1)) and a relative threshold (two standard deviations above the mean of three baseline values). RESULTS Neither threshold method worked well for one participant who was a "low-secretor". In four cases the participants' in-lab melatonin levels rose much earlier or were much higher than their at-home levels, and one participant appeared to take the at home samples out of order. Overall, the at-home and in-lab DLMO values were significantly correlated using both methods, and differed on average by 37 (± 19)min using the absolute threshold and by 54 (± 36)min using the relative threshold. CONCLUSIONS The at-home assessment procedure was able to determine an accurate DLMO using an absolute threshold in 62.5% of the participants. Thus, an at-home procedure for assessing circadian phase could be practical for evaluating patients for circadian rhythm sleep disorders.
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Affiliation(s)
- Rebecca E Pullman
- Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
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Lemoine P, Zisapel N. Prolonged-release formulation of melatonin (Circadin) for the treatment of insomnia. Expert Opin Pharmacother 2012; 13:895-905. [DOI: 10.1517/14656566.2012.667076] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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