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Biller AM, Fatima N, Hamberger C, Hainke L, Plankl V, Nadeem A, Kramer A, Hecht M, Spitschan M. The Ecology of Human Sleep (EcoSleep) Cohort Study: Protocol for a longitudinal repeated measurement burst design study to assess the relationship between sleep determinants and outcomes under real-world conditions across time of year. J Sleep Res 2024:e14225. [PMID: 39039613 DOI: 10.1111/jsr.14225] [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: 02/26/2024] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 07/24/2024]
Abstract
The interplay of daily life factors, including mood, physical activity, or light exposure, influences sleep architecture and quality. Laboratory-based studies often isolate these determinants to establish causality, thereby sacrificing ecological validity. Furthermore, little is known about time-of-year changes in sleep and circadian-related variables at high resolution, including the magnitude of individual change across time of year under real-world conditions. The Ecology of Human Sleep (EcoSleep) cohort study will investigate the combined impact of sleep determinants on individuals' daily sleep episodes to elucidate which waking events modify sleep patterns. A second goal is to describe high-resolution individual sleep and circadian-related changes across the year to understand intra- and inter-individual variability. This study is a prospective cohort study with a measurement-burst design. Healthy adults aged 18-35 years (N = 12) will be enrolled for 12 months. Participants will continuously wear actimeters and pendant-attached light loggers. A subgroup will also measure interstitial fluid glucose levels (six paticipants). Every 4 weeks, all participants will undergo three consecutive measurement days of four ecological momentary assessments each day ('bursts') to sample sleep determinants during wake. Participants will also continuously wear temperature loggers (iButtons) during the bursts. Body weight will be captured before and after the bursts in the laboratory. The bursts will be separated by two at-home electroencephalogram recordings each night. Circadian phase and amplitude will be estimated during the bursts from hair follicles, and habitual melatonin onset will be derived through saliva sampling. Environmental parameters (bedroom temperature, humidity, and air pressure) will be recorded continuously.
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Affiliation(s)
- Anna M Biller
- Department Health and Sport Sciences, Chronobiology and Health, Technical University of Munich, TUM School of Medicine and Health, Munich, Germany
- Max Planck Institute for Biological Cybernetics, Research Group Translational Sensory and Circadian Neuroscience, Tübingen, Germany
| | - Nayab Fatima
- Department Health and Sport Sciences, Chronobiology and Health, Technical University of Munich, TUM School of Medicine and Health, Munich, Germany
| | - Chrysanth Hamberger
- Department Health and Sport Sciences, Chronobiology and Health, Technical University of Munich, TUM School of Medicine and Health, Munich, Germany
| | - Laura Hainke
- Department Health and Sport Sciences, Chronobiology and Health, Technical University of Munich, TUM School of Medicine and Health, Munich, Germany
- Department of Psychiatry and Psychotherapy, Technical University of Munich, TUM School of Medicine and Health, Munich, Germany
- Department of Psychology, Ludwig Maximilian University, Munich, Germany
| | - Verena Plankl
- Department Health and Sport Sciences, Chronobiology and Health, Technical University of Munich, TUM School of Medicine and Health, Munich, Germany
| | - Amna Nadeem
- Department Health and Sport Sciences, Chronobiology and Health, Technical University of Munich, TUM School of Medicine and Health, Munich, Germany
| | - Achim Kramer
- Laboratory of Chronobiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Hecht
- Department of Psychology, Helmut Schmidt University, Hamburg, Germany
| | - Manuel Spitschan
- Department Health and Sport Sciences, Chronobiology and Health, Technical University of Munich, TUM School of Medicine and Health, Munich, Germany
- Max Planck Institute for Biological Cybernetics, Research Group Translational Sensory and Circadian Neuroscience, Tübingen, Germany
- TUM Institute for Advanced Study (TUM-IAS), Technical University of Munich, Garching, Germany
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Xu M, Papatsimpa C, Schlangen L, Linnartz JP. Improving adjustment to daylight saving time transitions with light. Sci Rep 2024; 14:15001. [PMID: 38951618 PMCID: PMC11217455 DOI: 10.1038/s41598-024-65705-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/24/2024] [Indexed: 07/03/2024] Open
Abstract
Daylight saving time (DST) is currently utilized in many countries with the rationale that it enhances the alignment between daylight hours and activity peaks in the population. The act of transitioning into and out of DST introduces disruptions to the circadian rhythm, thereby impacting sleep and overall health. Despite the substantial number of individuals affected, the consequences of this circadian disruption have often been overlooked. Here, we employ a mathematical model of the human circadian pacemaker to elucidate how the biological clock interacts with daytime and evening exposures to both natural and electrical light. This interaction plays a crucial role in determining the adaptation to the 1 hour time zone shift imposed by the transition to or from DST. In global discussions about DST, there is a prevailing assumption that individuals easily adjust to DST transitions despite a few studies indicating that the human circadian system requires several days to fully adjust to a DST transition. Our study highlights that evening light exposure changes can be the main driving force for re-entrainment, with chronobiological models predicting that people with longer intrinsic period (i.e. later chronotype) entrain more slowly to transitions to or from DST as compared to people with a shorter intrinsic period (earlier chronotype). Moreover, the model forecasts large inter-individual differences in the adaptation speed, in particular during the spring transition. The predictions derived from our model offer circadian biology-based recommendations for light exposure strategies that facilitate a more rapid adaptation to DST-related transitions or travel across a single time zone. As such, our study contributes valuable insights to the ongoing discourse on DST and its implications for human circadian rhythms.
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Affiliation(s)
- Mengzhu Xu
- Lighting and IoT lab, department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | - Luc Schlangen
- Human-Technology Interaction Group, department of Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Jean-Paul Linnartz
- Lighting and IoT lab, department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
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Zhang Y, Folarin AA, Sun S, Cummins N, Ranjan Y, Rashid Z, Stewart C, Conde P, Sankesara H, Laiou P, Matcham F, White KM, Oetzmann C, Lamers F, Siddi S, Simblett S, Vairavan S, Myin-Germeys I, Mohr DC, Wykes T, Haro JM, Annas P, Penninx BW, Narayan VA, Hotopf M, Dobson RJ. Longitudinal Assessment of Seasonal Impacts and Depression Associations on Circadian Rhythm Using Multimodal Wearable Sensing: Retrospective Analysis. J Med Internet Res 2024; 26:e55302. [PMID: 38941600 PMCID: PMC11245656 DOI: 10.2196/55302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/22/2024] [Accepted: 03/29/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Previous mobile health (mHealth) studies have revealed significant links between depression and circadian rhythm features measured via wearables. However, the comprehensive impact of seasonal variations was not fully considered in these studies, potentially biasing interpretations in real-world settings. OBJECTIVE This study aims to explore the associations between depression severity and wearable-measured circadian rhythms while accounting for seasonal impacts. METHODS Data were sourced from a large longitudinal mHealth study, wherein participants' depression severity was assessed biweekly using the 8-item Patient Health Questionnaire (PHQ-8), and participants' behaviors, including sleep, step count, and heart rate (HR), were tracked via Fitbit devices for up to 2 years. We extracted 12 circadian rhythm features from the 14-day Fitbit data preceding each PHQ-8 assessment, including cosinor variables, such as HR peak timing (HR acrophase), and nonparametric features, such as the onset of the most active continuous 10-hour period (M10 onset). To investigate the association between depression severity and circadian rhythms while also assessing the seasonal impacts, we used three nested linear mixed-effects models for each circadian rhythm feature: (1) incorporating the PHQ-8 score as an independent variable, (2) adding seasonality, and (3) adding an interaction term between season and the PHQ-8 score. RESULTS Analyzing 10,018 PHQ-8 records alongside Fitbit data from 543 participants (n=414, 76.2% female; median age 48, IQR 32-58 years), we found that after adjusting for seasonal effects, higher PHQ-8 scores were associated with reduced daily steps (β=-93.61, P<.001), increased sleep variability (β=0.96, P<.001), and delayed circadian rhythms (ie, sleep onset: β=0.55, P=.001; sleep offset: β=1.12, P<.001; M10 onset: β=0.73, P=.003; HR acrophase: β=0.71, P=.001). Notably, the negative association with daily steps was more pronounced in spring (β of PHQ-8 × spring = -31.51, P=.002) and summer (β of PHQ-8 × summer = -42.61, P<.001) compared with winter. Additionally, the significant correlation with delayed M10 onset was observed solely in summer (β of PHQ-8 × summer = 1.06, P=.008). Moreover, compared with winter, participants experienced a shorter sleep duration by 16.6 minutes, an increase in daily steps by 394.5, a delay in M10 onset by 20.5 minutes, and a delay in HR peak time by 67.9 minutes during summer. CONCLUSIONS Our findings highlight significant seasonal influences on human circadian rhythms and their associations with depression, underscoring the importance of considering seasonal variations in mHealth research for real-world applications. This study also indicates the potential of wearable-measured circadian rhythms as digital biomarkers for depression.
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Affiliation(s)
- Yuezhou Zhang
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Amos A Folarin
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, United Kingdom
- NIHR Biomedical Research Centre at University College London Hospitals, NHS Foundation Trust, London, United Kingdom
- Health Data Research UK London, University College London, London, United Kingdom
| | - Shaoxiong Sun
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Department of Computer Science, University of Sheffield, Sheffield, United Kingdom
| | - Nicholas Cummins
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Yatharth Ranjan
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Zulqarnain Rashid
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Callum Stewart
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Pauline Conde
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Heet Sankesara
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Petroula Laiou
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Faith Matcham
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- School of Psychology, University of Sussex, Falmer, United Kingdom
| | - Katie M White
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Carolin Oetzmann
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Femke Lamers
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
- Mental Health Program, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Sara Siddi
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
- Teaching Research and Innovation Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Barcelona, Spain
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Sara Simblett
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | - Inez Myin-Germeys
- Department of Neurosciences, Center for Contextual Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Josep Maria Haro
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
- Teaching Research and Innovation Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Barcelona, Spain
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | | | - Brenda Wjh Penninx
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
- Mental Health Program, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Vaibhav A Narayan
- Janssen Research and Development LLC, Titusville, NJ, United States
- Davos Alzheimer's Collaborative, Geneva, Switzerland
| | - Matthew Hotopf
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Richard Jb Dobson
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, United Kingdom
- NIHR Biomedical Research Centre at University College London Hospitals, NHS Foundation Trust, London, United Kingdom
- Health Data Research UK London, University College London, London, United Kingdom
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Ferguson T, Curtis R, Fraysse F, Olds T, Dumuid D, Brown W, Esterman A, Maher C. The Annual Rhythms in Sleep, Sedentary Behavior, and Physical Activity of Australian Adults: A Prospective Cohort Study. Ann Behav Med 2024; 58:286-295. [PMID: 38394346 DOI: 10.1093/abm/kaae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Sleep, sedentary behavior, and physical activity have fundamental impacts on health and well-being. Little is known about how these behaviors vary across the year. PURPOSE To investigate how movement-related behaviors change across days of the week and seasons, and describe movement patterns across a full year and around specific temporal events. METHODS This cohort study included 368 adults (mean age = 40.2 years [SD = 5.9]) who wore Fitbit activity trackers for 12 months to collect minute-by-minute data on sleep, sedentary behavior, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA). Data were analyzed descriptively, as well as through multilevel mixed-effects linear regression to explore associations with specific temporal cycles (day-of-the-week, season) and events. RESULTS Movement patterns varied significantly by day-of-the-week and season, as well as during annual events like Christmas-New Year and daylight saving time (DST) transitions. For example, sleep was longer on weekends (+32 min/day), during autumn and winter relative to summer (+4 and +11 min/day), and over Christmas-New Year (+24 min/day). Sedentary behavior was longer on weekdays, during winter, after Christmas-New Year, and after DST ended (+45, +7, +12, and +8 min/day, respectively). LPA was shorter in autumn, winter, and during and after Christmas-New Year (-6, -15, -17, and -31 min/day, respectively). Finally, there was less MVPA on weekdays and during winter (-5 min/day and -2 min/day, respectively). CONCLUSIONS Across the year, there were notable variations in movement behaviors. Identifying high-risk periods for unfavorable behavior changes may inform time-targeted interventions and health messaging.
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Affiliation(s)
- Ty Ferguson
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, City East Campus, Frome Road, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Rachel Curtis
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, City East Campus, Frome Road, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - François Fraysse
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, City East Campus, Frome Road, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Timothy Olds
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, City East Campus, Frome Road, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Dorothea Dumuid
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, City East Campus, Frome Road, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Wendy Brown
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland 4072, Australia
| | - Adrian Esterman
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, City East Campus, Frome Road, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Carol Maher
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, City East Campus, Frome Road, GPO Box 2471, Adelaide, SA, 5001, Australia
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Koçali K. The Effects of Daylight Saving Time (DST) Transition Cancelation on Work Accidents of Turkey. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2023; 29:1542-1551. [PMID: 37272121 DOI: 10.1080/10803548.2023.2221590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Objectives. Turkey canceled the daylight saving time (DST) transition and started permanent clock application. Considering the effect of this new regulation on working hours, this study examines whether there is a relationship with the increase in the number of work accidents in shifts. Methods. Data on work accidents were obtained from the Republic of Turkey Social Security Institution (SSI), filed between 2011 and 2020. We estimate accident rates using Poisson regression and log-linear models as a function of a variety of date-based factors. Results. The results show that DST transition is effective (ineffective in terms of gender) on changes in the number of work accidents. With statistical analyses, the hourly distribution of work accidents was determined, indicating at which hour the most work accidents occurred, using the work accident frequency rate. The number of prevented work accidents was calculated as 286,793 for Turkey. Conclusion. The findings from these studies suggest that cancellation of the DST transition does not have a negative effect on the incidence of work accidents in Turkey; on the contrary, this practice also serves the purpose of preventing work accidents.
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Affiliation(s)
- Kaan Koçali
- Istanbul Gelisim Vocational School, Istanbul Gelisim University, Turkey
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Pelayo RA, Xu S, Walter JR. Embryo transfers performed during daylight savings time led to reduced live birth rates in older patients. J Assist Reprod Genet 2023; 40:2639-2647. [PMID: 37667016 PMCID: PMC10643731 DOI: 10.1007/s10815-023-02920-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023] Open
Abstract
PURPOSE To study the impact of undergoing an embryo transfer during the week of daylight savings time transition on live birth rates. METHODS We performed a retrospective observational cohort study of patients undergoing embryo transfer at an academic infertility practice during the week of spring or fall daylight savings time transition (cases), or the 2 weeks preceding and following the daylight savings transition (controls) between 2015 and 2021. The primary exposure was completion of an embryo transfer during the week of daylight savings time transition. The primary outcome was a comparison of live birth rate per embryo transfer among individuals undergoing an embryo transfer during the week of daylight savings time (DST) transition and those who did not. RESULTS A total of 309 embryo transfers occurred during the week of daylight savings transition and 1242 embryo transfers occurred in the control group outside of the daylight savings transition week. The live birth rate after embryo transfer during DST transition weeks was 39.2% (121/309) compared to 40.8% (507/1242) (p = 0.59). When restricting the analysis to individuals (age > 37 years), the live birth rate after embryo transfer during DST transition week was 23.5% (24/102) compared to 34.8% (149/429) (p = 0.03). This difference persisted in the mixed-effects regression model demonstrating that after adjusting for relevant covariates, embryo transfer during DST transition weeks resulted in a 45% decrease in the odds of achieving a live birth. CONCLUSION Daylight savings time transition may be associated with less favorable outcomes after embryo transfer among an older infertile patient population. Future work is needed to prospectively examine the influence of circadian rhythm disruption on reproductive outcomes.
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Affiliation(s)
- Ramon A Pelayo
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Jessica R Walter
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 259 E Erie St Suite 2400, Chicago, IL, 60611, USA.
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Kaziród-Wolski K, Piotrowska A, Sielski J, Zając P, Malinowski KP, Zabojszcz M, Pytlak K, Wolska M, Kołodziej A, Mamas MA, Mizera P, Siudak Z. The Effect of Daylight-Saving Time on Percutaneous Coronary Intervention Outcomes in Acute Coronary Syndrome Patients-Data from the Polish National Registry of Percutaneous Coronary Interventions (ORPKI) in the Years 2014-2022. J Cardiovasc Dev Dis 2023; 10:375. [PMID: 37754804 PMCID: PMC10532136 DOI: 10.3390/jcdd10090375] [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: 07/06/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023] Open
Abstract
INTRODUCTION Many factors related to the switch to summer/winter time interfere with biological rhythms. OBJECTIVES This study aimed to analyze the impact of time change on clinical outcomes of patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI). PATIENTS AND METHODS Electronic data of 874,031 patients with ACS who underwent invasive procedures were collected from the Polish National Register of Interventional Cardiology Procedures (ORPKI) between 2014 and 2021. We determined the number of patients undergoing PCI and periprocedural mortality during the day of spring or autumn time change and within the first 3 and 7 days after the time change. RESULTS We demonstrated the impact of time changes on the periprocedural mortality of ACS patients within 1 day and the period of 3 and 7 days from the time change. We observed that the occurrence of all ACS and NSTEMI on the first day was lower for both time changes and higher in the case of UA and spring time change. The autumn time change significantly reduced the occurrence of all types of ACS. A significant decrease in the number of invasive procedures was found after autumn transition in the period from the first day to 7 days for ACS, NSTEMI, and UA. CONCLUSIONS The occurrence of ACS and the number of invasive procedures were lower for both changes over time. Autumn time change is associated with increased periprocedural mortality in ACS and a less frequent occurrence of UA and NSTEMI within 7 days.
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Affiliation(s)
- Karol Kaziród-Wolski
- Collegium Medicum, Jan Kochanowski University in Kielce, 25-317 Kielce, Poland; (K.K.-W.); (A.P.); (J.S.); (M.Z.); (K.P.); (A.K.); (P.M.)
- Intensive Cardiac Care Unit, Świętokrzyskie Cardiology Center, 25-736 Kielce, Poland
| | - Aleksandra Piotrowska
- Collegium Medicum, Jan Kochanowski University in Kielce, 25-317 Kielce, Poland; (K.K.-W.); (A.P.); (J.S.); (M.Z.); (K.P.); (A.K.); (P.M.)
| | - Janusz Sielski
- Collegium Medicum, Jan Kochanowski University in Kielce, 25-317 Kielce, Poland; (K.K.-W.); (A.P.); (J.S.); (M.Z.); (K.P.); (A.K.); (P.M.)
- Intensive Cardiac Care Unit, Świętokrzyskie Cardiology Center, 25-736 Kielce, Poland
| | - Patrycja Zając
- The Rheumatology Department, The Province Hospital in Końskie, 26-200 Końskie, Poland;
| | - Krzysztof P. Malinowski
- Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, 30-688 Kraków, Poland;
| | - Michał Zabojszcz
- Collegium Medicum, Jan Kochanowski University in Kielce, 25-317 Kielce, Poland; (K.K.-W.); (A.P.); (J.S.); (M.Z.); (K.P.); (A.K.); (P.M.)
| | - Kamil Pytlak
- Collegium Medicum, Jan Kochanowski University in Kielce, 25-317 Kielce, Poland; (K.K.-W.); (A.P.); (J.S.); (M.Z.); (K.P.); (A.K.); (P.M.)
| | - Magdalena Wolska
- Outpatient Treatment Facility “CenterMed”, 25-314 Kielce, Poland;
| | - Agnieszka Kołodziej
- Collegium Medicum, Jan Kochanowski University in Kielce, 25-317 Kielce, Poland; (K.K.-W.); (A.P.); (J.S.); (M.Z.); (K.P.); (A.K.); (P.M.)
| | - Mamas A. Mamas
- Keele Cardiac Research Group, Keele University, Keele ST5 5BG, UK;
| | - Paulina Mizera
- Collegium Medicum, Jan Kochanowski University in Kielce, 25-317 Kielce, Poland; (K.K.-W.); (A.P.); (J.S.); (M.Z.); (K.P.); (A.K.); (P.M.)
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University in Kielce, 25-317 Kielce, Poland; (K.K.-W.); (A.P.); (J.S.); (M.Z.); (K.P.); (A.K.); (P.M.)
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Lévy L, Robine JM, Rey G, Méndez Turrubiates RF, Quijal-Zamorano M, Achebak H, Ballester J, Rodó X, Herrmann FR. Daylight saving time affects European mortality patterns. Nat Commun 2022; 13:6906. [PMID: 36372798 PMCID: PMC9659560 DOI: 10.1038/s41467-022-34704-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 11/03/2022] [Indexed: 11/15/2022] Open
Abstract
Daylight saving time (DST) consists in a one-hour advancement of legal time in spring offset by a backward transition of the same magnitude in fall. It creates a minimal circadian misalignment that could disrupt sleep and homoeostasis in susceptible individuals and lead to an increased incidence of pathologies and accidents during the weeks immediately following both transitions. How this shift affects mortality dynamics on a large population scale remains, however, unknown. This study examines the impact of DST on all-cause mortality in 16 European countries for the period 1998-2012. It shows that mortality decreases in spring and increases in fall during the first two weeks following each DST transition. Moreover, the alignment of time data around DST transition dates revealed a septadian mortality pattern (lowest on Sundays, highest on Mondays) that persists all-year round, irrespective of seasonal variations, in men and women aged above 40.
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Affiliation(s)
- Laurent Lévy
- Medical School of the University of Geneva, Geneva, Switzerland
| | - Jean-Marie Robine
- Institut National de la Santé et de la Recherche Médicale (INSERM), Montpellier, France
- École Pratique des Hautes Études, Paris, France
| | | | | | | | | | | | - Xavier Rodó
- ISGlobal, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Catalonia, Spain
| | - François R Herrmann
- Medical School of the University of Geneva, Geneva, Switzerland.
- Division of Geriatrics, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Thônex, Switzerland.
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Phase Response Curve to Light under Ambulatory Conditions: A Pilot Study for Potential Application to Daylight Saving Time Transitions. BIOLOGY 2022; 11:biology11111584. [PMID: 36358285 PMCID: PMC9687529 DOI: 10.3390/biology11111584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/17/2022] [Accepted: 10/25/2022] [Indexed: 01/25/2023]
Abstract
Several studies have investigated the relationship between daylight saving time (DST) and sleep alterations, psychiatric disorders, cardiovascular events and traffic accidents. However, very few have monitored participants while maintaining their usual lifestyle before and after DST. Considering that DST transitions modify human behavior and, therefore, people's light exposure patterns, the aim of this study was to investigate the potential effects of DST on circadian variables, considering sleep and, for the first time, the human phase response curve to light. To accomplish this, eight healthy adults (33 ± 11 years old, mean ± SD) were recruited to monitor multivariable circadian markers and light exposure by means of a wearable ambulatory monitoring device: Kronowise®. The following night phase markers were calculated: midpoints of the five consecutive hours of maximum wrist temperature (TM5) and the five consecutive hours of minimum time in movement (TL5), sleep onset and offset, as well as sleep duration and light intensity. TM5 for wrist temperature was set as circadian time 0 h, and the balance between advances and delays considering the phase response curve to light was calculated individually before and after both DST transitions. To assess internal desynchronization, the possible shift in TM5 for wrist temperature and TL5 for time in movement were compared. Our results indicate that the transition to DST seems to force the circadian system to produce a phase advance to adapt to the new time. However, the synchronizing signals provided by natural and personal light exposure are not in line with such an advance, which results in internal desynchronization and the need for longer synchronization times. On the contrary, the transition back to ST, which implies a phase delay, is characterized by a faster adaptation and maintenance of internal synchronization, despite the fact that exposure to natural light would favor a phase advance. Considering the pilot nature of this study, further research is needed with higher sample sizes.
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10
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Osborne-Christenson EJ. Saving light, losing lives: How daylight saving time impacts deaths from suicide and substance abuse. HEALTH ECONOMICS 2022; 31 Suppl 2:40-68. [PMID: 36000150 DOI: 10.1002/hec.4581] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 06/20/2022] [Accepted: 07/13/2022] [Indexed: 06/15/2023]
Abstract
This paper estimates the impact of Daylight Saving Time (DST) on deaths from suicide and substance abuse in the United States. Using Multiple Cause-of-Death Mortality Data from the National Vital Statistics System of the National Center for Health Statistics from 1979 to 1988, the effect is identified in two ways: a regression discontinuity design that exploits discrete time changes in the Spring and Fall; and a fixed effects model that uses a policy change and a switching mechanism that introduces random variation to DST's start and end dates. This is one of the first attempts to estimate the impact of DST on deaths due to suicide and substance abuse and the first to use either identification strategy. The results from both methods suggest that the sleep disruptions during the Spring transition cause the suicide rate to rise by 6.25 percent and the death rate from suicide and substance abuse combined to increase by 6.59 percent directly after the time change. There is no evidence for any change in these outcomes during the Fall transition. The contrasting results from Spring to Fall suggest the entire effect can be attributed to disruptions in sleep patterns rather than changes in ambient light exposure.
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11
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Ben Simon E, Vallat R, Rossi A, Walker MP. Sleep loss leads to the withdrawal of human helping across individuals, groups, and large-scale societies. PLoS Biol 2022; 20:e3001733. [PMID: 35998121 PMCID: PMC9398015 DOI: 10.1371/journal.pbio.3001733] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/29/2022] [Indexed: 11/19/2022] Open
Abstract
Humans help each other. This fundamental feature of homo sapiens has been one of the most powerful forces sculpting the advent of modern civilizations. But what determines whether humans choose to help one another? Across 3 replicating studies, here, we demonstrate that sleep loss represents one previously unrecognized factor dictating whether humans choose to help each other, observed at 3 different scales (within individuals, across individuals, and across societies). First, at an individual level, 1 night of sleep loss triggers the withdrawal of help from one individual to another. Moreover, fMRI findings revealed that the withdrawal of human helping is associated with deactivation of key nodes within the social cognition brain network that facilitates prosociality. Second, at a group level, ecological night-to-night reductions in sleep across several nights predict corresponding next-day reductions in the choice to help others during day-to-day interactions. Third, at a large-scale national level, we demonstrate that 1 h of lost sleep opportunity, inflicted by the transition to Daylight Saving Time, reduces real-world altruistic helping through the act of donation giving, established through the analysis of over 3 million charitable donations. Therefore, inadequate sleep represents a significant influential force determining whether humans choose to help one another, observable across micro- and macroscopic levels of civilized interaction. The implications of this effect may be non-trivial when considering the essentiality of human helping in the maintenance of cooperative, civil society, combined with the reported decline in sufficient sleep in many first-world nations.
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Affiliation(s)
- Eti Ben Simon
- Center for Human Sleep Science, Department of Psychology, University of California, Berkeley, California, United States of America
| | - Raphael Vallat
- Center for Human Sleep Science, Department of Psychology, University of California, Berkeley, California, United States of America
| | - Aubrey Rossi
- Center for Human Sleep Science, Department of Psychology, University of California, Berkeley, California, United States of America
| | - Matthew P. Walker
- Center for Human Sleep Science, Department of Psychology, University of California, Berkeley, California, United States of America
- Helen Wills Neuroscience Institute, University of California, Berkeley, California, United States of America
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12
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Kahn M, Gradisar M. Sleeping through COVID-19: a longitudinal comparison of 2019 and 2020 infant auto-videosomnography metrics. J Child Psychol Psychiatry 2022; 63:693-700. [PMID: 34409612 DOI: 10.1111/jcpp.13509] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND With the outbreak of the COVID-19 pandemic, pediatric experts called attention to the potential adverse effects of living restrictions (e.g., lockdown) on child well-being, but at the same time- acknowledged their possible benefits. To date, only few data-driven reports have been published on child sleep during COVID-19, and all have been based on parent- or self-reports. This study used auto-videosomnography to capture the effects of COVID-19 stay-at-home orders imposed in the USA on objectively measured infant sleep. METHODS Auto-videosomnography metrics of infants assessed nightly between January and May 2020 were compared with metrics of an equivalent infant cohort, assessed in the corresponding 2019 period. A total of 610 infants (50.7% girls) aged 6-18 months (M = 11.8, SD = 3.6) were included, with 71,472 analyzed nights. Multilevel models were applied to assess differences between 2019 and 2020 infant sleep pre- and during-lockdown. RESULTS Whereas infant cohorts were equivalent in demographic and January-March/April sleep characteristics, during the 2020 lockdown infants had longer nighttime sleep durations (Mdifference = 11.0 min, p = .01), later morning rise times (Mdifference = 9.5 min, p = .008), and later out-of-crib times (Mdifference = 12.3 min, p < .0001), compared to the equivalent 2019 period. In addition, weekday-weekend differences in sleep onset and midpoint times were diminished during 2020 home-confinement compared to the equivalent 2019 period (2019: Mdifference = 5.5 min, p < .0001; Mdifference = 4.5 min, p < .0001; 2020: Mdifference = 2.3 min, p = .01; Mdifference = 3.1 min, p < .0001, respectively). CONCLUSIONS Notwithstanding the negative implications of COVID-19 living restrictions in other domains, our findings indicate that there might be a silver lining-in promoting longer and more consistent infant sleep. These benefits should be considered in determining policy for the current and future pandemics.
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Affiliation(s)
- Michal Kahn
- Flinders University, Bedford Park, South Australia, Australia
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13
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Teke C, Kurtoğlu Çelik G, Yıldırım Ç, Şener A, Tanrıverdi F, Kahraman FA, Gökhan Ş. Assessment of the number of admissions for road traffic collisions and severity of injury in daylight saving time and permanent daylight saving time periods. Int J Clin Pract 2021; 75:e14798. [PMID: 34482615 DOI: 10.1111/ijcp.14798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/18/2021] [Accepted: 09/02/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIM Permanent daylight saving time has been implemented in Turkey since 2016. The present study determines the characteristics of road traffic collisions in the short-term, trauma severity, and whether permanent daylight saving time has an impact on these parameters. MATERIALS AND METHODS Drivers admitted because of road traffic collisions to a tertiary care university hospital emergency service two weeks before and after the transition to wintertime in 2014 and 2015 and summertime in 2015 and 2016 as well as those admitted two weeks before and after the same period with permanent daylight saving time in 2016 and 2017 wintertime and 2017 and 2018 summertime were included in the study. Trauma severity was measured using the Injury Severity Score. RESULTS The study analysed the data of 710 patients. There was no statistically significant difference was found between admissions in the summertime and permanent daylight saving time periods in terms of gender, time of admission, week of admission, Injury Severity Score and outcome (P > .05 for all values). CONCLUSIONS In this study, we examined the short-term effects of daylight saving time on road traffic collisions, and demonstrated that it had no impact on the number or time of admission, trauma severity and patient outcomes. More comprehensive studies covering longer periods can be performed across the country.
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Affiliation(s)
- Cahit Teke
- Department of Emergency Medicine, Birecik State Hospital, Şanlıurfa, Turkey
| | - Gülhan Kurtoğlu Çelik
- Department of Emergency Medicine, School of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
- Department of Emergency Medicine, Ankara City Hospital, Ankara, Turkey
| | - Çağdaş Yıldırım
- Department of Emergency Medicine, School of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
- Department of Emergency Medicine, Ankara City Hospital, Ankara, Turkey
| | - Alp Şener
- Department of Emergency Medicine, School of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
- Department of Emergency Medicine, Ankara City Hospital, Ankara, Turkey
| | - Fatih Tanrıverdi
- Department of Emergency Medicine, School of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
- Department of Emergency Medicine, Ankara City Hospital, Ankara, Turkey
| | - Fatih Ahmet Kahraman
- Department of Emergency Medicine, School of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
- Department of Emergency Medicine, Ankara City Hospital, Ankara, Turkey
| | - Şervan Gökhan
- Department of Emergency Medicine, School of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
- Department of Emergency Medicine, Ankara City Hospital, Ankara, Turkey
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14
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O'Connor PJ, Kancheva M. Marathon run performance on daylight savings time transition days: results from a natural experiment. Chronobiol Int 2021; 39:151-157. [PMID: 34530660 DOI: 10.1080/07420528.2021.1974471] [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: 10/20/2022]
Abstract
Advancing clock times by 1 h in the spring to daylight savings time and setting clock times back 1 h in the autumn to standard time disrupts circadian timing, sleep and skilled motor behavior such as driving an automobile. It is unknown if endurance performance is impacted by daylight savings transition (DST). The natural experiment described here examined whether exposure to a DST in the 10 h prior to the start of a marathon race was associated with a different mean completion time compared to participants who ran the same course but were unexposed to a recent DST. The primary outcome was the average running time of finishers of United States marathons that were completed on either spring-DST or autumn-DST days in the years 2000-2018. Comparisons were made to results from the same marathon held in a different year that was not run on a DST day. Data were obtained from the public data base marathonguide.com/results. Analysis of the primary outcome used paired samples t-tests weighted by sample size. Spring and autumn data were analyzed separately. Eighteen spring and 29 autumn marathons met the inclusion criteria. Compared to control marathons, the weighted spring-DST performance was worse by 12.3 min (4.1%; P < .001) and equal to a moderate standardized effect size of 0.57 while autumn-DST was trivially worse by 1.4 min (0.5%), which was equivalent to an effect size of 0.13. Ambient temperatures for the DST and control races did not differ for either the spring (10.6 vs. 8.9℃; P = .212) or autumn marathons (7.6 vs. 9.3℃; P = .131). Within the limitations of a natural experiment research design, it is concluded that the findings support worse running performance in marathon races held in the spring on the day of transition to daylight savings time when there is a forced circadian change and sleep loss.
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Affiliation(s)
| | - Mihaela Kancheva
- Department of Medicine, University of Central Florida, Orlando, Florida, USA
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15
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Abeyrathna WANU, Langen TA. Effect of Daylight Saving Time clock shifts on white-tailed deer-vehicle collision rates. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2021; 292:112774. [PMID: 34015612 DOI: 10.1016/j.jenvman.2021.112774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 03/23/2021] [Accepted: 05/11/2021] [Indexed: 06/12/2023]
Abstract
To devise effective measures for reducing hazardous wildlife-vehicle collisions, it is necessary to know when during the year accidents occur most frequently, and what factors cause the seasonal patterns. Daylight Saving Time (DST) 1-h clock-shifts around the spring and fall equinoxes at temperate zone latitudes are associated with increased vehicle accidents, attributed to driver error caused by disrupted sleep patterns and changes in visibility during peak driving times. Collision with deer is a significant cause of motor vehicle accidents in North America; in New York State alone, 65,000 vehicle accidents annually are caused by collision with white-tailed deer (Odocoileus virginianus). We asked whether white-tailed deer-vehicle collisions (DVC) increased in frequency after DST clock shifts in New York State, by analyzing 35,167 New York State DVC reports from 2005 to 2007. For the spring, when the clock is shifted an hour forward relative to sunrise (i.e. later sunrise and sunset), there was either no change or possibly a small decrease in workweek evening DVC after the clock shift. For fall, when the clock is shifted an hour back relative to sunrise (i.e. earlier sunrise and sunset), the DVC rate was far higher than spring. The DVC rate was higher after the clock shift than before, caused in part by an ongoing seasonal trend for increasing DVC associated with deer behavior around the time of rut, peaking about two weeks after the clock shift. However, there was also a reduction in workweek morning DVC after clock-shift, but an even greater increase in DVC in the evening. DVC rates are highest around dusk and during the fall, and the fall DST clock-shift caused more workweek commuter traffic to coincide with the annual hourly period of peak risk of DVC. We conclude that in New York State, DST clock-shift results in an increase in the number of DVC, and therefore injuries and property damage associated with such accidents. The justification for DST clock-shifts is controversial; when evaluating the benefits and costs, one should include the consequences for risk of wildlife-vehicle collisions, especially in regions where ungulate-vehicle accidents are frequent, and clock-shifts coincide with the rut or other periods of peak accident risk.
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Affiliation(s)
- W A N U Abeyrathna
- Department of Biology, Clarkson University, Potsdam, 13699, New York, USA; Department of Biology, Clarkson University, Potsdam, 13699, New York, USA.
| | - Tom A Langen
- Department of Biology, Clarkson University, Potsdam, 13699, New York, USA; Department of Biology, Clarkson University, Potsdam, 13699, New York, USA.
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16
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Abstract
The original rationale for the adoption of daylight saving time (DST) was to conserve energy; however, the effects of DST on energy consumption are questionable or negligible. Conversely, there is substantial evidence that DST transitions have the cumulative effect on sleep deprivation with its adverse health effects. In light of current evidence, the European Commission in 2018 decided that biannual clock change in Europe would be abolished. Current indirect evidence supports the adoption of perennial standard time, which aligns best with the human circadian system and has the potential to produce benefits for public health and safety.
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17
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Salfi F, Amicucci G, Corigliano D, D'Atri A, Viselli L, Tempesta D, Ferrara M. Changes of evening exposure to electronic devices during the COVID-19 lockdown affect the time course of sleep disturbances. Sleep 2021; 44:6270772. [PMID: 34037792 PMCID: PMC8194574 DOI: 10.1093/sleep/zsab080] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/11/2021] [Indexed: 12/23/2022] Open
Abstract
STUDY OBJECTIVES During the coronavirus disease 2019 (COVID-19) lockdown, there was a worldwide increase in electronic devices' daily usage. Prolonged exposure to backlit screens before sleep influences the circadian system leading to negative consequences on sleep health. We investigated the relationship between changes in evening screen exposure and the time course of sleep disturbances during the home confinement period due to COVID-19. METHODS 2,123 Italians (mean age ± standard deviation, 33.1 ± 11.6) were tested longitudinally during the third and the seventh week of lockdown. The web-based survey evaluated sleep quality and insomnia symptoms through the Pittsburgh Sleep Quality Index and the Insomnia Severity Index. The second assessment survey inquired about intervening changes in backlit screen exposure in the two hours before falling asleep. RESULTS Participants who increased electronic device usage showed decreased sleep quality, exacerbated insomnia symptoms, reduced sleep duration, prolonged sleep onset latency, and delayed bedtime and rising time. In this subgroup, the prevalence of poor sleepers and individuals reporting moderate/severe insomnia symptoms increased. Conversely, respondents reporting decreased screen exposure exhibited improved sleep quality and insomnia symptoms. In this subgroup, the prevalence of poor sleepers and moderate/severe insomniacs decreased. Respondents preserving screen time habits did not show variations of the sleep parameters. CONCLUSIONS Our investigation demonstrated a strong relationship between modifications of evening electronic device usage and time course of sleep disturbances during the lockdown period. Monitoring the potential impact of excessive evening exposure to backlit screens on sleep health is recommendable during the current period of restraining measures due to COVID-19.
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Affiliation(s)
- Federico Salfi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giulia Amicucci
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.,Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Domenico Corigliano
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Aurora D'Atri
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Lorenzo Viselli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Daniela Tempesta
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Michele Ferrara
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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18
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Bjorvatn B, Pallesen S, Saxvig IW, Waage S. Daylight Saving Time preferences in Norway: Do individual chronotype and home address' latitude and longitude matter? Chronobiol Int 2021; 38:1449-1459. [PMID: 34034618 DOI: 10.1080/07420528.2021.1931278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Daylight Saving Time is highly debated and associated with several health risks. Health experts recommend terminating adjusting the clock time, and to keep permanent standard (winter) time year around. The aims of the study were to investigate preferences for keeping or terminating this biannual adjustment of clock times and for permanent standard or summer time, in the general Norwegian population. Furthermore, we aimed to investigate whether such preferences depended on individual chronotype and home address' latitude/longitude. The online survey included 47,194 participants. Chronotype was measured with the Composite Scale of Morningness (morning types, intermediate types, evening types). Results showed that 78.2% preferred to terminate adjusting the clock time. Summer time year around was preferred by 61.5% whereas 29.1% preferred standard time year around, and 9.4% did not have any preference. Preferences for terminating adjustment of clock times and summer time year around were found in all chronotypes and regardless of living south (latitude 58-59°N), north (latitude 69-71°N), west (longitude 5-6°E) or east (longitude 19-31°E). However, a relatively larger proportion of evening chronotypes preferred to terminate adjusting the clock time compared to morning chronotypes, and relatively more people living north or east preferred termination than people living south or west, respectively. Permanent standard time was more strongly preferred by extreme morning types in comparison with the other chronotypes. In conclusion, nearly four out of five participants reported to prefer to terminate adjusting the clock time, in line with recommendations. However, in contrast to advice from health experts, permanent summer time was preferred by twice as many as permanent standard time. Both chronotype and home address' latitude and longitude mattered in regard to such preferences, but only to a small degree.
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Affiliation(s)
- 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
| | - Ståle Pallesen
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.,Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Ingvild W Saxvig
- 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
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19
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Mattingly SM, Grover T, Martinez GJ, Aledavood T, Robles-Granda P, Nies K, Striegel A, Mark G. The effects of seasons and weather on sleep patterns measured through longitudinal multimodal sensing. NPJ Digit Med 2021; 4:76. [PMID: 33911176 PMCID: PMC8080821 DOI: 10.1038/s41746-021-00435-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 02/25/2021] [Indexed: 11/16/2022] Open
Abstract
Previous studies of seasonal effects on sleep have yielded unclear results, likely due to methodological differences and limitations in data size and/or quality. We measured the sleep habits of 216 individuals across the U.S. over four seasons for slightly over a year using objective, continuous, and unobtrusive measures of sleep and local weather. In addition, we controlled for demographics and trait-like constructs previously identified to correlate with sleep behavior. We investigated seasonal and weather effects of sleep duration, bedtime, and wake time. We found several small but statistically significant effects of seasonal and weather effects on sleep patterns. We observe the strongest seasonal effects for wake time and sleep duration, especially during the spring season: wake times are earlier, and sleep duration decreases (compared to the reference season winter). Sleep duration also modestly decreases when day lengths get longer (between the winter and summer solstice). Bedtimes and wake times tend to be slightly later as outdoor temperature increases.
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Affiliation(s)
- Stephen M Mattingly
- Department of Computer Science & Engineering, University of Notre Dame, Notre Dame, IN, USA.
| | - Ted Grover
- Department of Informatics, University of California, Irvine, CA, USA
| | - Gonzalo J Martinez
- Department of Computer Science & Engineering, University of Notre Dame, Notre Dame, IN, USA
| | | | - Pablo Robles-Granda
- Department of Computer Science & Engineering, University of Notre Dame, Notre Dame, IN, USA
| | - Kari Nies
- Department of Informatics, University of California, Irvine, CA, USA
| | - Aaron Striegel
- Department of Computer Science & Engineering, University of Notre Dame, Notre Dame, IN, USA
| | - Gloria Mark
- Department of Informatics, University of California, Irvine, CA, USA
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20
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Derks L, Houterman S, Geuzebroek GSC, van der Harst P, Smits PC. Daylight saving time does not seem to be associated with number of percutaneous coronary interventions for acute myocardial infarction in the Netherlands. Neth Heart J 2021; 29:427-432. [PMID: 33765223 PMCID: PMC8397810 DOI: 10.1007/s12471-021-01566-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background In multiple studies, the potential relationship between daylight saving time (DST) and the occurrence of acute myocardial infarction (MI) has been investigated, with mixed results. Using the Dutch Percutaneous Coronary Intervention (PCI) registry facilitated by the Netherlands Heart Registration, we investigated whether the transitions to and from DST interact with the incidence rate of PCI for acute MI. Methods We assessed changes in hospital admissions for patients with ST-elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) undergoing PCI between 1 January 2015 and 31 December 2018. We compared the incidence rate of PCI procedures during the first 3 or 7 days after the transition with that during a control period (2 weeks before transition plus second week after transition). Incidence rate ratio (IRR) was calculated using Poisson regression. Potential gender differences were also investigated. Results A total of 80,970 PCI procedures for STEMI or NSTEMI were performed. No difference in incidence rate a week after the transition to DST in spring was observed for STEMI (IRR 0.95, 95% confidence interval (CI) 0.87–1.03) or NSTEMI (IRR 1.04, 95% CI 0.96–1.12). After the transition from DST in autumn, the IRR was also comparable with the control period (STEMI: 1.03, 95% CI 0.95–1.12, and NSTEMI: 0.98, 95% CI 0.91–1.06). Observing the first 3 days after each transition yielded similar results. Gender-specific results were comparable. Conclusion Based on data from a large, nationwide registry, there was no correlation between the transition to or from DST and a change in the incidence rate of PCI for acute MI.
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Affiliation(s)
- L Derks
- Netherlands Heart Registration, Utrecht, The Netherlands.
| | - S Houterman
- Netherlands Heart Registration, Utrecht, The Netherlands
| | - G S C Geuzebroek
- Department of Cardiothoracic Surgery, Radboudumc, Nijmegen, The Netherlands
| | - P van der Harst
- Department of Cardiology, Division of Heart & Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - P C Smits
- Netherlands Heart Registration, Utrecht, The Netherlands.,Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands
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21
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Kolla BP, Coombes BJ, Morgenthaler TI, Mansukhani MP. Increased Patient Safety-Related Incidents Following the Transition into Daylight Savings Time. J Gen Intern Med 2021; 36:51-54. [PMID: 32789617 PMCID: PMC7859153 DOI: 10.1007/s11606-020-06090-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 07/29/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND "Spring forward," the start of daylight savings time (DST), reduces sleep opportunity by an hour. Insufficient sleep in healthcare workers resulting from the spring forward time change could potentially result in an increase in medical errors. OBJECTIVE We examined the change in reported patient safety-related incidents (SRIs), in the week following the transition into and out of DST over a period of 8 years. DESIGN Observational study SETTING: A US-based large healthcare organization with sites across multiple states MEASUREMENTS: Voluntarily reported SRIs that occurred 7 days prior to and following the spring and fall time changes for years 2010-2017 were ascertained. SRIs likely resulting from human error were identified separately. The changes in the number of SRIs (either all SRIs or SRIs restricted to those likely resulting from human error) from the week before and after the time change (either spring or fall) were modeled using a negative binomial mixed model with a random effect to correct for non-independent observations in consecutive weeks. RESULTS Over the 8-year period, we observed 4.2% (95% CI: - 1.1 to 9.7%; p = 0.12) and 8.8% (95% CI: - 2.5 to 21.5%; p = 0.13) increases in overall SRIs in the 7 days following DST when compared with 7 days prior for spring and fall, respectively. By restricting to SRIs likely resulting from human errors, we observed 18.7% (95% CI: 5.6 to 33.6%; p = 0.004) and 4.9% (95% CI: - 1.3 to 11.5%; p = 0.12) increases for spring and fall, respectively. CONCLUSION Policy makers and healthcare organizations should evaluate delayed start of shifts or other contingency measures to mitigate the increased risk of SRIs during transition to DST in spring.
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Affiliation(s)
- Bhanu Prakash Kolla
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA. .,Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA.
| | | | - Timothy I Morgenthaler
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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22
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Kountouris Y. Human activity, daylight saving time and wildfire occurrence. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 727:138044. [PMID: 32315901 DOI: 10.1016/j.scitotenv.2020.138044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/12/2020] [Accepted: 03/17/2020] [Indexed: 06/11/2023]
Abstract
Wildfires shape landscapes and ecosystems, affecting health and infrastructure. Understanding the complex interactions between social organization, human activity and the natural environment that drive wildfire occurrence is becoming increasingly important as changing global environmental conditions combined with the expanding human-wildland interface, are expected to increase wildfire frequency and severity. This paper examines the anthropogenic drivers of wildfire, and the relationship between the organization of human activity in time and wildfire occurrence focusing on the effects of transitions into and out of Daylight Saving Time (DST). DST transitions shift activity in relation to natural wildfire risk within a solar day, induce changes in the time allocated to wildfire-causing activities and disrupt sleep patterns. The paper estimates short and medium run effects of DST-induced changes in the temporal organization of human activity through a Regression Discontinuity Design with time as the running variable and Fixed Effects models, using data from over 1.88 million non-prescribed ignitions recorded in the contiguous US over 23 years. Estimates suggest that DST has a quantitatively and statistically significant immediate and medium-run effect on wildfire occurrence. Wildfire occurrence jumps by around 30% in the immediate aftermath of transitions into DST, adding about 98 human-caused wildfires across the contiguous US per year, while the transition's effect is detectable for 3 weeks. Transitions induce within-day temporal displacement of wildfires in a pattern compatible with the shifting of human activity mechanism, while the result cannot be attributed exclusively on disruptions in sleep patterns. Naturally arising lightning-strike wildfires do not respond to changes in civil time, while the results are robust to changes in assumptions. Results suggest that wildfire policy should account for the temporal organization of human activity.
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Affiliation(s)
- Yiannis Kountouris
- Centre for Environmental Policy, Imperial College London, Weeks Building, 16-18 Prince's Gardens, London SW7 1NE, United Kingdom of Great Britain and Northern Ireland.
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23
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Roenneberg T, Wirz-Justice A, Skene DJ, Ancoli-Israel S, Wright KP, Dijk DJ, Zee P, Gorman MR, Winnebeck EC, Klerman EB. Why Should We Abolish Daylight Saving Time? J Biol Rhythms 2020; 34:227-230. [PMID: 31170882 DOI: 10.1177/0748730419854197] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Local and national governments around the world are currently considering the elimination of the annual switch to and from Daylight Saving Time (DST). As an international organization of scientists dedicated to studying circadian and other biological rhythms, the Society for Research on Biological Rhythms (SRBR) engaged experts in the field to write a Position Paper on the consequences of choosing to live on DST or Standard Time (ST). The authors take the position that, based on comparisons of large populations living in DST or ST or on western versus eastern edges of time zones, the advantages of permanent ST outweigh switching to DST annually or permanently. Four peer reviewers provided expert critiques of the initial submission, and the SRBR Executive Board approved the revised manuscript as a Position Paper to help educate the public in their evaluation of current legislative actions to end DST.
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Affiliation(s)
- Till Roenneberg
- Institute for Medical Psychology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Anna Wirz-Justice
- Centre for Chronobiology, Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Debra J Skene
- Chronobiology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Sonia Ancoli-Israel
- Department of Psychiatry and Center for Circadian Biology, University of California, San Diego, La Jolla, California, USA
| | - Kenneth P Wright
- Department of Integrative Physiology, University of Colorado at Boulder, Boulder, Colorado, USA
| | - Derk-Jan Dijk
- Surrey Sleep Research Centre, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Phyllis Zee
- Department of Neurology, Northwestern University, Chicago, Illinois, USA
| | - Michael R Gorman
- Department of Psychology and the Center for Circadian Biology, University of California, San Diego, La Jolla, California, USA
| | - Eva C Winnebeck
- Institute for Medical Psychology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Elizabeth B Klerman
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA
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24
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Daylight saving time and the incidence of thrombolysis to treat acute ischemic stroke. Rev Neurol (Paris) 2020; 176:361-365. [DOI: 10.1016/j.neurol.2019.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/25/2019] [Accepted: 08/27/2019] [Indexed: 11/18/2022]
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25
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Response to Martín-Olalla. Curr Biol 2020; 30:R300-R301. [PMID: 32259499 DOI: 10.1016/j.cub.2020.03.009] [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
Vetter et al. respond to Martín-Olalla's comment about their study linking motor vehicle fatalities to the transition to Daylight Saving Time.
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26
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Fritz J, VoPham T, Wright KP, Vetter C. A Chronobiological Evaluation of the Acute Effects of Daylight Saving Time on Traffic Accident Risk. Curr Biol 2020; 30:729-735.e2. [PMID: 32008905 DOI: 10.1016/j.cub.2019.12.045] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/31/2019] [Accepted: 12/12/2019] [Indexed: 12/26/2022]
Abstract
There is evidence that the spring Daylight Saving Time (DST) transition acutely increases motor vehicle accident (MVA) risk ("DST effect"), which has been partly attributed to sleep deprivation and circadian misalignment [1-6]. Because spring DST also shifts clock time 1 h later, mornings are darker and evenings brighter, changing illumination conditions for peak traffic density. This daytime-dependent illumination change ("time of day effect") is hypothesized to result in DST-associated afternoon and evening accident risk reductions [2, 5, 7]. Furthermore, sunrise and local photoperiod timing depend on position in time zone. The sun rises at an earlier clock time in the eastern regions of a given time zone than in the western regions, which is thought to induce higher levels of circadian misalignment in the west than in the east ("time zone effect") [8, 9]. This study evaluated the acute consequences of the DST transition on MVAs in a chronobiological context, quantifying DST, time of day, and time zone effects. We used large US registry data, including 732,835 fatal MVAs recorded across all states (1996-2017), and observed that spring DST significantly increased fatal MVA risk by 6%, which was more pronounced in the morning and in locations further west within a time zone. DST-associated MVA risk increased even in the afternoon hours, despite longer daylight hours. The MVA risk increase waned in the week subsequent to DST, and there were no effects of the fall-back transition to Standard Time (ST) on MVA risk, further supporting the hypothesis that DST-transition-associated, preventable circadian misalignment and sleep deprivation might underlie MVA risk increases.
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Affiliation(s)
- Josef Fritz
- Circadian and Sleep Epidemiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA
| | - Trang VoPham
- Epidemiology Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Kenneth P Wright
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA
| | - Céline Vetter
- Circadian and Sleep Epidemiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA.
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27
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Chudow JJ, Dreyfus I, Zaremski L, Mazori AY, Fisher JD, Di Biase L, Romero J, Ferrick KJ, Krumerman A. Changes in atrial fibrillation admissions following daylight saving time transitions. Sleep Med 2020; 69:155-158. [PMID: 32088351 DOI: 10.1016/j.sleep.2020.01.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 01/13/2020] [Accepted: 01/15/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Daylight saving time (DST) imposes a twice-yearly hour shift. The transitions to and from DST are associated with decreases in sleep quality and environmental hazards. Detrimental health effects include increased incidence of acute myocardial infarction (MI) following the springtime transition and increased ischemic stroke following both DST transitions. Conditions effecting sleep are known to provoke atrial fibrillation (AF), however the effect of DST transitions on AF are unknown. METHODS Admitted patients aged 18-100 with primary ICD9 code of AF between 2009 and 2016 were included. The number of admissions was compiled and means were compared for the Monday to Thursday period and the entire seven day interval following each DST transition and the entire year for the entire cohort and separated by gender. Significance was determined with Wilcoxon nonparametric tests. RESULTS Admission data for 6089 patients were included, with mean age of 68 years and 53% female. A significant increase was found in mean AF admissions over the Monday to Thursday period (3.09 vs 2.47 admissions/day [adm/d], P = 0.017) and entire week (2.48 vs 2.09 adm/d, P = 0.025) following the DST spring transition compared to the yearly mean. When separated by gender, women exhibited an increase in AF admissions following the DST spring transition (1.78 vs 1.28 adm/d for Monday to Thursday period, P = 0.036 and 1.38 vs 1.11 adm/d for entire week, P = 0.050) while a non-significant increase was seen in men. No significant differences were found following the autumn transition for the entire cohort or when separated by gender. CONCLUSION An increase in AF hospital admissions was found following the DST springtime transition. When separated by gender, this finding persisted only among women. This finding adds to evidence of negative health effects associated with DST transitions and factors that contribute to AF episodes.
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Affiliation(s)
- Jay J Chudow
- Department of Medicine, Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Isaac Dreyfus
- Department of Medicine, Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Lynn Zaremski
- Department of Medicine, Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alon Y Mazori
- Department of Medicine, Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - John D Fisher
- Department of Medicine, Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Luigi Di Biase
- Department of Medicine, Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jorge Romero
- Department of Medicine, Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kevin J Ferrick
- Department of Medicine, Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andrew Krumerman
- Department of Medicine, Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
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28
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Manfredini R, Fabbian F, De Giorgi A, Cappadona R, Capodaglio G, Fedeli U. Daylight saving time transitions and circulatory deaths: data from the Veneto region of Italy. Intern Emerg Med 2019; 14:1185-1187. [PMID: 30968264 DOI: 10.1007/s11739-019-02085-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/03/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Roberto Manfredini
- Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, Via L. Ariosto 35, 44121, Ferrara, Italy.
| | - Fabio Fabbian
- Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, Via L. Ariosto 35, 44121, Ferrara, Italy
| | - Alfredo De Giorgi
- Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, Via L. Ariosto 35, 44121, Ferrara, Italy
| | - Rosaria Cappadona
- Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, Via L. Ariosto 35, 44121, Ferrara, Italy
| | | | - Ugo Fedeli
- Epidemiological Department, Veneto region, Padua, Italy
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29
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Harding C, Pompei F, Bordonaro SF, McGillicuddy DC, Burmistrov D, Sanchez LD. The daily, weekly, and seasonal cycles of body temperature analyzed at large scale. Chronobiol Int 2019; 36:1646-1657. [PMID: 31530024 DOI: 10.1080/07420528.2019.1663863] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We performed large-scale analyses of circadian and infradian cycles of human body temperature, focusing on changes over the day, week, and year. Temperatures (n= 93,225) were collected using temporal artery thermometers from a Boston emergency department during 2009-2012 and were statistically analyzed using regression with cyclic splines. The overall mean body temperature was 36.7°C (98.1°F), with a 95% confidence interval of 36.7-36.7°C (98.1-98.1°F) and a standard deviation of 0.6°C (1.1°F). Over the day, mean body temperature followed a steady cycle, reaching its minimum at 6:00-8:00 and its maximum at 18:00-20:00. Across days of the week, this diurnal cycle was essentially unchanged, even though activities and sleeping hours change substantially during the weekly cycles of human behavior. Over the year, body temperatures were slightly colder in winter than summer (~0.2°C difference), consistent with most prior studies. We propose these seasonal differences might be due to ambient effects on body temperature that are not eliminated because they fall within the tolerance range of the thermoregulatory system. Over the year, bathyphase (daily time of minimum temperature) appeared to parallel sunrise times, as expected from sunrise's zeitgeber role in circadian rhythms. However, orthophase (daily time of maximum temperature) and sunset times followed opposite seasonal patterns, with orthophase preceding nightfall in summer and following nightfall in winter. Throughout the year, bathyphase and orthophase remained separated by approximately 12 h, suggesting this interval might be conserved. Finally, although 37.0°C (98.6°F) is widely recognized as the mean or normal human body temperature, analysis showed mean temperature was <37.0°C during all times of day, days of the week, and seasons of the year, supporting prior arguments that the 37.0°C standard has no scientific basis. Overall, this large study showed robust and consistent behavior of the human circadian cycle at the population level, providing a strong example of circadian homeostasis.
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Affiliation(s)
- Charles Harding
- Statistical Analyst and Data Scientist, Seattle, Washington, USA
| | | | - Samantha F Bordonaro
- Professional Emergency Services, Gates Vascular Institute, Buffalo, NewYork, USA
| | - Daniel C McGillicuddy
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Michigan, USA
| | | | - Leon D Sanchez
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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30
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Zalta AK, Bravo K, Valdespino-Hayden Z, Pollack MH, Burgess HJ. A placebo-controlled pilot study of a wearable morning bright light treatment for probable PTSD. Depress Anxiety 2019; 36:617-624. [PMID: 30995350 PMCID: PMC6721597 DOI: 10.1002/da.22897] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/15/2019] [Accepted: 03/22/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Evidence-based treatments for post-traumatic stress disorder (PTSD) have poor uptake and remission rates, suggesting that alternative treatments are needed. Morning bright light may be an effective treatment for PTSD given its established effects on mood and sleep, however, there are no published trials. METHODS We conducted a placebo-controlled pilot trial of a wearable light device, the Re-timer®, for individuals with probable PTSD. Individuals were randomly assigned to the active Re-timer® (n = 9) or a placebo Re-timer® dimmed with neutral density filters (n = 6). Participants self-administered the treatment at home 1 hr each morning over 4 weeks. PTSD and depression symptoms were assessed at pre- and post-treatment. RESULTS The Re-timer® was well tolerated and the perceived benefit was high, though treatment adherence was only moderate. Those in the active group were more likely to achieve a minimal clinically important change in PTSD and depression symptoms and had larger symptom reductions than those in the placebo group CONCLUSIONS: A wearable morning light treatment was acceptable and feasible for patients with probable PTSD. This study provides initial proof-of-concept that light treatment can improve PTSD. A larger trial is warranted to establish treatment efficacy. NCT#: 03513848.
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Affiliation(s)
- Alyson K. Zalta
- Department of Psychological Science, University of California, Irvine, Irvine, CA,Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Karyna Bravo
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Zerbrina Valdespino-Hayden
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL,Department of Psychology, Montclair State University, Montclair, NJ
| | - Mark H. Pollack
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Helen J. Burgess
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL,Department of Psychiatry, University of Michigan, Ann Arbor, MI
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31
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Watson NF. Time to Show Leadership on the Daylight Saving Time Debate. J Clin Sleep Med 2019; 15:815-817. [PMID: 31138392 DOI: 10.5664/jcsm.7822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 04/15/2019] [Indexed: 11/13/2022]
Affiliation(s)
- Nathaniel F Watson
- Department of Neurology, University of Washington Medical School, Seattle, Washington; UW Medicine Sleep Center, Seattle, Washington
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32
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Schneider LD, Moss RE, Goldenholz DM. Daylight saving time transitions are not associated with increased seizure incidence. Epilepsia 2019; 60:764-773. [PMID: 30889273 PMCID: PMC6447440 DOI: 10.1111/epi.14696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/27/2019] [Accepted: 02/27/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Given the known association of daylight saving time (DST) transitions with increased risk of accidents, heart attack, and stroke, we aimed to determine whether seizures, which are reportedly influenced by sleep and circadian disruption, also increased in frequency following the transition into DST. METHODS Using Seizure Tracker's self-reported data from 12 401 individuals from 2008-2016, 932 717 seizures were assessed for changes in incidence in relation to DST transitions. Two methods of standardization-z scores and unit-scaled rate ratios (RRs)-were used to compare seizure propensities following DST transitions to other time periods. RESULTS As a percentile relative to all other weeks in a given year, absolute seizure counts in the week of DST fell below the median (DST seizure percentiles mean ± SD: 19.68 ± 16.25, P = 0.01), which was concordant with weekday-specific comparisons. Comparatively, RRs for whole-week (1.06, 95% confidence interval [CI] 1.02-1.10, P = 0.0054) and weekday-to-weekday (RR range 1.04-1.16, all P < 0.001) comparisons suggested a slightly higher incidence of seizures in the DST week compared to all other weeks of the year. However, examining the similar risk of the week preceding and following the DST-transition week revealed no significant weekday-to-weekday differences in seizure incidence, although there was an unexpected, modestly decreased seizure propensity in the DST week relative to the whole week prior (RR 0.94, 95% CI 0.91-0.96, P < 0.001). SIGNIFICANCE Despite expectations that circadian and sleep disruption related to DST transitions would increase the incidence of seizures, we found little substantive evidence for such an association in this large, longitudinal cohort. Although large-scale observational/epidemiologic cohorts can be effective at answering such questions, additional covariates (eg, sleep duration, seizure type, and so on) that may underpin the association were not able available, so the association has not definitively been ruled out.
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Affiliation(s)
- Logan D Schneider
- Stanford Center for Sleep Sciences and Medicine, Stanford University, Palo Alto, California
| | | | - Daniel M Goldenholz
- Division of Epilepsy, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts
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33
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Daylight Saving Time and Acute Myocardial Infarction: A Meta-Analysis. J Clin Med 2019; 8:jcm8030404. [PMID: 30909587 PMCID: PMC6463000 DOI: 10.3390/jcm8030404] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/12/2019] [Accepted: 03/20/2019] [Indexed: 12/21/2022] Open
Abstract
Background: The available evidence on the effects of daylight saving time (DST) transitions on major cardiovascular diseases is limited and conflicting. We carried out the first meta-analysis aimed at evaluating the risk of acute myocardial infarction (AMI) following DST transitions. Methods: We searched cohort or case-control studies evaluating the incidence of AMI, among adults (≥18 y), during the weeks following spring and/or autumn DST shifts, versus control periods. The search was made in MedLine and Scopus, up to 31 December 2018, with no language restriction. A summary odds ratio of AMI was computed after: (1) spring, (2) autumn or (3) both transitions considered together. Meta-analyses were also stratified by gender and age. Data were combined using a generic inverse-variance approach. Results: Seven studies (>115,000 subjects) were included in the analyses. A significantly higher risk of AMI (Odds Ratio: 1.03; 95% CI: 1.01–1.06) was observed during the two weeks following spring or autumn DST transitions. However, although AMI risk increased significantly after the spring shift (OR: 1.05; 1.02–1.07), the incidence of AMI during the week after winter DST transition was comparable with control periods (OR 1.01; 0.98–1.04). No substantial differences were observed when the analyses were stratified by age or gender. Conclusion: The risk of AMI increases modestly but significantly after DST transitions, supporting the proposal of DST shifts discontinuation. Additional studies that fully adjust for potential confounders are required to confirm the present findings.
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34
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Meira E Cruz M, Miyazawa M, Manfredini R, Cardinali D, Madrid JA, Reiter R, Araujo JF, Agostinho R, Acuña-Castroviejo D. Impact of Daylight Saving Time on circadian timing system: An expert statement. Eur J Intern Med 2019; 60:1-3. [PMID: 30617016 DOI: 10.1016/j.ejim.2019.01.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/02/2019] [Accepted: 01/03/2019] [Indexed: 02/07/2023]
Affiliation(s)
- M Meira E Cruz
- Sleep Unit, Cardiovascular Center, University of Lisbon, Faculty of Medicine, Lisbon, Portugal.
| | - M Miyazawa
- Department of Immunology, Faculty of Medicine and Anti-Aging Center, Kindai University, Osaka, Japan
| | - R Manfredini
- Department of Medical Sciences, Faculty of Medicine, Surgery and Prevention, University of Ferrara, Ferrara, Italy
| | - D Cardinali
- BIOMED-UCA-CONICET, Department of Teaching and Research, Faculty of Medical Sciences, Pontificia Catholic University of Argentina, Buenos Aires, Argentina
| | - J A Madrid
- Department of Physiology, Faculty of Biology, University of Murcia, Spain
| | - R Reiter
- Department of Cell Systems and Anatomy, UT Health, United States
| | - J F Araujo
- Laboratory of Neurobiology and Biological Rhythmicity, Department of Physiology and Biophysics, Federal University of Rio Grande do Norte, Natal, Brazil
| | - R Agostinho
- Institute of Astrophysic and Space Sciences, Department of Physics, Faculty of Sciences, University of Lisbon, Lisbon, Portugal
| | - D Acuña-Castroviejo
- Department of Physiology, Faculty of Medicine, Center of Biomedical Research, Parque Tecnologico de Ciencias de la Salud, University of Granada, Granada, Spain
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35
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Manfredini R, Fabbian F, Cappadona R, Modesti PA. Daylight saving time, circadian rhythms, and cardiovascular health. Intern Emerg Med 2018; 13:641-646. [PMID: 29971599 PMCID: PMC6469828 DOI: 10.1007/s11739-018-1900-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 06/17/2018] [Indexed: 02/07/2023]
Abstract
Very recently, the European Parliament, called to decide on possible abolition of the Daylight Saving Time (DST), approved a resolution calling the scientific community to conduct a more in-depth evaluation. The question is based on disruption of body's circadian rhythms. We review here the relationship between DST and cardiovascular health. The available evidence suggests the existence of an association between DST and a modest increase of occurrence of acute myocardial infarction, especially in the first week after the spring shift. Possible mechanisms include sleep deprivation, circadian misalignment and environmental conditions. The role of gender and individual preference in circadian rhythms (chronotype) will need further assessment.
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Affiliation(s)
- Roberto Manfredini
- Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/B, 44121 Ferrara, Italy
| | - Fabio Fabbian
- Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/B, 44121 Ferrara, Italy
| | - Rosaria Cappadona
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy
| | - Pietro Amedeo Modesti
- Department of Clinical and Experimental Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
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Cognitions about time affect perception, behavior, and physiology - A review on effects of external clock-speed manipulations. Conscious Cogn 2018; 63:99-109. [PMID: 29966862 DOI: 10.1016/j.concog.2018.06.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/11/2018] [Accepted: 06/20/2018] [Indexed: 01/30/2023]
Abstract
Our understanding of (altered) time perception may benefit from investigating its potential effects upon other psychological and physiological parameters. To date, however, only a few rather isolated studies have experimentally manipulated the subjective passage of time or the amount of apparently elapsed duration in order to investigate such effects. Based on our review of these studies, first, altered time perception can be induced effectively by means of rigged (accelerated or decelerated) external clocks, second, these clock-speed manipulations remain unnoticed by most participants, and third, several psychological, cognitive, behavioral, and physiological variables can be affected, e.g., fatigue, hunger, pain perception. However, the existing studies on time-perception manipulation do not systematically relate to each other and the underlying mechanisms of the observed effects are poorly understood. Based on cognitive appraisal theories and the given empirical results, we propose a cognitive framework for interpreting and explaining the effects of manipulations of time perception.
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Robb D, Barnes T. Accident rates and the impact of daylight saving time transitions. ACCIDENT; ANALYSIS AND PREVENTION 2018; 111:193-201. [PMID: 29223028 DOI: 10.1016/j.aap.2017.11.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 09/22/2017] [Accepted: 11/22/2017] [Indexed: 06/07/2023]
Abstract
One-third of nations have adopted some form of Daylight Saving Time (DST). Associated costs and benefits include impacts on accident rates. Using data from 12.6 million accident claims in New Zealand during 2005-2016, we model accident rates as a function of various date-based predictors including days before/after the start and end of DST, holidays, day of week, and month of year. This is the first study to consider multiple accident categories (Road, Work, Falls and Home & Community), and the first in the southern hemisphere. The start of DST is associated with significantly higher rates of road accidents (first day +16% and second day +12%). Evidence that accident rates for Falls and Home & Community decline (increase) prior to the start (end) of DST suggest potential behavioural adaption from anticipating the change. While Work accidents show limited impact from DST changes, they exhibit a significant decline over the course of the week (Friday 13% lower than Monday), whereas Road accidents exhibit a significant increase (Friday 19% higher than Monday). Our results have implications for both DST implementation and policy.
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Affiliation(s)
- David Robb
- Graduate School of Management, The University of Auckland Business School, Private Bag 92019, Auckland, 1142, New Zealand.
| | - Thomas Barnes
- Apt 317 Railway Station Apartments, Te Taou Crescent, Auckland, 1010, New Zealand
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Ellis DA, Luther K, Jenkins R. Missed medical appointments during shifts to and from daylight saving time. Chronobiol Int 2017; 35:584-588. [PMID: 29283286 DOI: 10.1080/07420528.2017.1417313] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Transitions into and out of Daylight Saving Time (DST) can provide insights into how a minor change to a regular sleep-wake cycle can inadvertently affect health. We examined the relationship between DST and missed medical appointments. Using a large dataset, the proportion of missed appointments were examined prior and post spring and autumn clock changes. As predicted, the number of missed medical appointments significantly increased following the spring (forward) clock change and the week of the clock change. This trend was reversed following the transition out of DST. The implications of scheduling appointments around DST to increase attendance are discussed.
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Affiliation(s)
- David A Ellis
- a Department of Psychology , Lancaster University , Lancaster , UK
| | - Kirk Luther
- a Department of Psychology , Lancaster University , Lancaster , UK
| | - Rob Jenkins
- b Department of Psychology , University of York , York , UK
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Uttley J, Fotios S. The effect of ambient light condition on road traffic collisions involving pedestrians on pedestrian crossings. ACCIDENT; ANALYSIS AND PREVENTION 2017; 108:189-200. [PMID: 28910684 DOI: 10.1016/j.aap.2017.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 08/22/2017] [Accepted: 09/04/2017] [Indexed: 06/07/2023]
Abstract
Previous research suggests darkness increases the risk of a collision involving a pedestrian and the severity of any injury suffered. Pedestrian crossings are intended to make it safer to cross the road, but it is not clear whether they are effective at doing this after-dark, compared with during daylight. Biannual clock changes resulting from transitions to and from daylight saving time were used to compare RTCs in the UK during daylight and darkness but at the same time of day, thus controlling for potential influences on RTC numbers not related to the ambient light condition. Odds ratios and regression discontinuity analysis suggested there was a significantly greater risk of a pedestrian RTC at a crossing after-dark than during daylight. Results also suggested the risk of an RTC after-dark was greater at a pedestrian crossing than at a location at least 50m away from a crossing. Whilst these results show the increased danger to pedestrians using a designated crossing after-dark, this increased risk is not due to a lack of lighting at these locations as 98% of RTCs at pedestrian crossings after-dark were lit by road lighting. This raises questions about the adequacy and effectiveness of the lighting used at pedestrian crossings.
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Affiliation(s)
- Jim Uttley
- School of Architecture, University of Sheffield, Western Bank, Sheffield S10 2TN, United Kingdom.
| | - Steve Fotios
- School of Architecture, University of Sheffield, Western Bank, Sheffield S10 2TN, United Kingdom
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Ellis WA, FitzGibbon SI, Barth BJ, Niehaus AC, David GK, Taylor BD, Matsushige H, Melzer A, Bercovitch FB, Carrick F, Jones DN, Dexter C, Gillett A, Predavec M, Lunney D, Wilson RS. Daylight saving time can decrease the frequency of wildlife-vehicle collisions. Biol Lett 2017; 12:rsbl.2016.0632. [PMID: 27881767 DOI: 10.1098/rsbl.2016.0632] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 10/31/2016] [Indexed: 11/12/2022] Open
Abstract
Daylight saving time (DST) could reduce collisions with wildlife by changing the timing of commuter traffic relative to the behaviour of nocturnal animals. To test this idea, we tracked wild koalas (Phascolarctos cinereus) in southeast Queensland, where koalas have declined by 80% in the last 20 years, and compared their movements with traffic patterns along roads where they are often killed. Using a simple model, we found that DST could decrease collisions with koalas by 8% on weekdays and 11% at weekends, simply by shifting the timing of traffic relative to darkness. Wildlife conservation and road safety should become part of the debate on DST.
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Affiliation(s)
- William A Ellis
- School of Agriculture and Food Science, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Sean I FitzGibbon
- School of Agriculture and Food Science, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Benjamin J Barth
- School of Agriculture and Food Science, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Amanda C Niehaus
- School of Biological Sciences, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Gwendolyn K David
- School of Biological Sciences, The University of Queensland, Brisbane, Queensland 4072, Australia
| | | | - Helena Matsushige
- School of Agriculture and Food Science, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Alistair Melzer
- Koala Research Centre of Central Queensland, School of Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland 4702, Australia
| | - Fred B Bercovitch
- Primate Research Institute and Wildlife Research Center, Kyoto University, 41-2 Kanrin, Inuyama 484-8506, Japan
| | - Frank Carrick
- Centre for Mined Land Rehabilitation, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Darryl N Jones
- Environmental Futures Research Institute, Griffith University, Queensland 4111, Australia
| | - Cathryn Dexter
- Environmental Futures Research Institute, Griffith University, Queensland 4111, Australia
| | - Amber Gillett
- Australia Zoo Wildlife Hospital, Beerwah, Queensland 4519, Australia
| | - Martin Predavec
- Science Division, Office of Environment and Heritage NSW, P.O. Box 1967, Hurstville, New South Wales 2220, Australia
| | - Dan Lunney
- Science Division, Office of Environment and Heritage NSW, P.O. Box 1967, Hurstville, New South Wales 2220, Australia
| | - Robbie S Wilson
- School of Biological Sciences, The University of Queensland, Brisbane, Queensland 4072, Australia
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Alencar JCND, Leocadio-Miguel MA, Duarte LL, Louzada F, Fontenele Araujo J, Pedrazzoli M. Self-reported discomfort associated with Daylight Saving Time in Brazilian tropical and subtropical zones. Ann Hum Biol 2017; 44:628-635. [PMID: 28715917 DOI: 10.1080/03014460.2017.1355982] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Daylight Saving Time (DST) annually moves clocks 1 hour forward, when daytime is longer than night. Previous studies from medium and high latitude locations have pointed to a disruptive effect of DST on human circadian rhythms. Since Brazil is an equatorial country implementing DST, a different relationship between photic and social synchronisers may interfere with DST effects. AIM To explore the prevalence and duration of self-reported discomfort related to DST among Brazilian residents (latitude 12-33° S, longditude 39-57° W). It was hypothesised that an elevated prevalence of self-reported discomfort would be found in Brazil, due to the pronounced uncoupling between social and geophysical synchronisers. SUBJECTS AND METHODS In total, 12 467 volunteers completed a web-based, Brazilian version of Horne-Östberg Morningness-Eveningness Questionnaire, provided demographic information, and answered questions related to DST complaints (discomfort, duration of discomfort). RESULTS Of the total sample, 45.43% reported no discomfort related to DST, with meaningful proportions for all chronotypes. However, eveningness was most associated with discomfort. About one fourth of the total sample reported discomfort over the whole DST period. Gender interaction is largely supported by these results. CONCLUSIONS DST at low latitude locations may be disruptive for circadian rhythms, since seasonality of sunrise near the equator is negligible or very mild.
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Affiliation(s)
| | - Mario André Leocadio-Miguel
- b Departamento de Fisiologia , Universidade Federal do Rio Grande do Norte , Natal , Brazil.,c Programa de Pós-graduação em Psicobiologia, Universidade Federal do Rio Grande do Norte , Natal , Brazil
| | - Leandro Lourenção Duarte
- d Centro de Ciência da Saúde, Universidade Federal do Reconcavo da Bahia , Santo Antônio de Jesus , Brazil
| | - Fernando Louzada
- e Departamento de Fisiologia , Universidade Federal do Parana , Curitiba , Brazil
| | - John Fontenele Araujo
- b Departamento de Fisiologia , Universidade Federal do Rio Grande do Norte , Natal , Brazil.,c Programa de Pós-graduação em Psicobiologia, Universidade Federal do Rio Grande do Norte , Natal , Brazil
| | - Mario Pedrazzoli
- f Escola de Artes, Ciências e Humanidades, Universidade de Sao Paulo , Sao Paulo , Brazil
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Abstract
BACKGROUND Bills have been put forward in the UK and Republic of Ireland proposing a move to Central European Time (CET). Proponents argue that such a change will have benefits for road safety, with daylight being shifted from the morning, when collision risk is lower, to the evening, when risk is higher. Studies examining the impact of daylight saving time (DST) on road traffic collision risk can help inform the debate on the potential road safety benefits of a move to CET. The objective of this systematic review was to examine the impact of DST on collision risk. METHODS Major electronic databases were searched, with no restrictions as to date of publication (the last search was performed in January 2017). Access to unpublished reports was requested through an international expert group. Studies that provided a quantitative analysis of the effect of DST on road safety-related outcomes were included. The primary outcomes of interest were road traffic collisions, injuries and fatalities. FINDINGS Twenty-four studies met the inclusion criteria. Seventeen examined the short-term impact of transitions around DST and 12 examined long-term effects. Findings from the short-term studies were inconsistent. The long-term findings suggested a positive effect of DST. However, this cannot be attributed solely to DST, as a range of road collision risk factors vary over time. INTERPRETATION The evidence from this review cannot support or refute the assertion that a permanent shift in light from morning to evening will have a road safety benefit.
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Affiliation(s)
- Rachel N Carey
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Kiran M Sarma
- School of Psychology, National University of Ireland Galway, Galway, Republic of Ireland
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Roveda E, Vitale JA, Bruno E, Montaruli A, Pasanisi P, Villarini A, Gargano G, Galasso L, Berrino F, Caumo A, Carandente F. Protective Effect of Aerobic Physical Activity on Sleep Behavior in Breast Cancer Survivors. Integr Cancer Ther 2017; 16:21-31. [PMID: 27252076 PMCID: PMC5736068 DOI: 10.1177/1534735416651719] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 05/02/2016] [Accepted: 05/03/2016] [Indexed: 12/16/2022] Open
Abstract
HYPOTHESES Sleep disorders are associated with an increased risk of cancer, including breast cancer (BC). Physical activity (PA) can produce beneficial effects on sleep. STUDY DESIGN We designed a randomized controlled trial to test the effect of 3 months of physical activity on sleep and circadian rhythm activity level evaluated by actigraphy. METHODS 40 BC women, aged 35-70 years, were randomized into an intervention (IG) and a control group (CG). IG performed a 3 month of aerobic exercise. At baseline and after 3 months, the following parameters were evaluated both for IG and CG: anthropometric and body composition measurements, energy expenditure and motion level; sleep parameters (Actual Sleep Time-AST, Actual Wake Time-AWT, Sleep Efficiency-SE, Sleep Latency-SL, Mean Activity Score-MAS, Movement and Fragmentation Index-MFI and Immobility Time-IT) and activity level circadian rhythm using the Actigraph Actiwatch. RESULTS The CG showed a deterioration of sleep, whereas the IG showed a stable pattern. In the CG the SE, AST and IT decreased and the AWT, SL, MAS and MFI increased. In the IG, the SE, IT, AWT, SL, and MAS showed no changes and AST and MFI showed a less pronounced change in the IG than in the CG. The rhythmometric analysis revealed a significant circadian rhythm in two groups. After 3 months of PA, IG showed reduced fat mass %, while CG had improved weight and BMI. CONCLUSION Physical activity may be beneficial against sleep disruption. Indeed, PA prevented sleep worsening in IG. PA can represent an integrative intervention therapy able to modify sleep behaviour.
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Affiliation(s)
- Eliana Roveda
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Jacopo A. Vitale
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Eleonora Bruno
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Angela Montaruli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | - Anna Villarini
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Letizia Galasso
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Franco Berrino
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Andrea Caumo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- IRCCS Policlinico San Donato Milanese, Milan, Italy
| | - Franca Carandente
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Sipilä JOT, Ruuskanen JO, Rautava P, Kytö V. Changes in ischemic stroke occurrence following daylight saving time transitions. Sleep Med 2016; 27-28:20-24. [PMID: 27938913 DOI: 10.1016/j.sleep.2016.10.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/29/2016] [Accepted: 10/19/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Circadian rhythm disruption has been associated with increased risk of ischemic stroke (IS). Daylight saving time (DST) transitions disrupt circadian rhythms and shifts the pattern of diurnal variation in stroke onset, but effects on the incidence of IS are unknown. METHODS Effects of 2004-2013 DST transitions on IS hospitalizations and in-hospital mortality were studied nationwide in Finland. Hospitalizations during the week following DST transition (study group, n = 3033) were compared to expected hospitalizations (control group, n = 11,801), calculated as the mean occurrence during two weeks prior to and two weeks after the index week. RESULTS Hospitalizations for IS increased during the first two days (Relative Risk 1.08; CI 1.01-1.15, P = 0.020) after transition, but difference was diluted when observing the whole week (RR 1.03; 0.99-1.06; P = 0.069). Weekday-specific increase was observed on the second day (Monday; RR 1.09; CI 1.00-1.90; P = 0.023) and fifth day (Thursday; RR 1.11; CI 1.01-1.21; P = 0.016) after transition. Women were more susceptible than men to temporal changes during the week after DST transitions. Advanced age (>65 years) (RR 1.20; CI 1.04-1.38; P = 0.020) was associated with increased risk during the first two days, and malignancy (RR 1.25; CI 1.00-1.56; P = 0.047) during the week after DST transition. CONCLUSIONS DST transitions appear to be associated with an increase in IS hospitalizations during the first two days after transitions but not during the entire following week. Susceptibility to effects of DST transitions on occurrence of ischemic stroke may be modulated by gender, age and malignant comorbidities.
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Affiliation(s)
- Jussi O T Sipilä
- Department of Neurology, North Karelia Central Hospital, Joensuu, Finland; Neurology, University of Turku, Turku, Finland; Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
| | - Jori O Ruuskanen
- Neurology, University of Turku, Turku, Finland; Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland.
| | - Päivi Rautava
- Clinical Research Center, Turku University Hospital, Turku, Finland; Department of Public Health, University of Turku, Turku, Finland
| | - Ville Kytö
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Heart Center, Turku University Hospital, Turku, Finland
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Valax MF, Rattat AC, Baracat B, Cegarra J. Effect of Daylight Saving Time on Punctuality for Medical Appointments. APPLIED COGNITIVE PSYCHOLOGY 2016. [DOI: 10.1002/acp.3278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Marie-Françoise Valax
- Laboratoire Sciences de la Cognition, Technologie, Ergonomie (SCoTE) EA 7420; Université de Toulouse, INU Champollion; ALBI France
| | - Anne-Claire Rattat
- Laboratoire Sciences de la Cognition, Technologie, Ergonomie (SCoTE) EA 7420; Université de Toulouse, INU Champollion; ALBI France
| | - Bruno Baracat
- Laboratoire Sciences de la Cognition, Technologie, Ergonomie (SCoTE) EA 7420; Université de Toulouse, INU Champollion; ALBI France
| | - Julien Cegarra
- Laboratoire Sciences de la Cognition, Technologie, Ergonomie (SCoTE) EA 7420; Université de Toulouse, INU Champollion; ALBI France
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László KD, Cnattingius S, Janszky I. Transition into and out of daylight saving time and spontaneous delivery: a population-based study. BMJ Open 2016; 6:e010925. [PMID: 27630067 PMCID: PMC5030578 DOI: 10.1136/bmjopen-2015-010925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To investigate whether the circadian rhythm disruption following the transition into and out of daylight saving time (DST) is associated with an increased risk of spontaneous delivery. DESIGN We compared the number of spontaneous deliveries in the Swedish Medical Birth Register during the week after the change to and the week after the change from DST (exposure periods) with the average number of spontaneous deliveries in the control period, defined as the week before and the week after each exposure period. SETTING Sweden, 1993-2006. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcomes were the weekly and the daily number of spontaneous deliveries in the exposure and the control periods. In secondary analyses we also compared the mean length of pregnancy of the women with spontaneous deliveries in the exposure and control periods. RESULTS The number of deliveries during the week after the transition into or out of DST was similar to that in the comparison period (18 519 observed vs 18 434 expected in case of the spring shift and 19 073 observed vs 19 122 expected in case of the autumn shift); the corresponding incidence ratio and 95% CIs were 1.005 (0.990 to 1.019) and 0.997 (0.983 to 1.012), respectively. There were no differences in the length of gestation of the deliveries in the exposure and the control periods. CONCLUSIONS Our results do not support the hypothesis that a minor circadian rhythm disruption is associated with an increased short-term risk of spontaneous delivery.
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Affiliation(s)
- Krisztina D László
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Sven Cnattingius
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - Imre Janszky
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Medina D, Ebben M, Milrad S, Atkinson B, Krieger AC. Adverse Effects of Daylight Saving Time on Adolescents' Sleep and Vigilance. J Clin Sleep Med 2015; 11:879-84. [PMID: 25979095 DOI: 10.5664/jcsm.4938] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 03/23/2015] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Daylight saving time (DST) has been established with the intent to reduce energy expenditure, however unintentional effects on sleep and vigilance have not been consistently measured. The objective of this study was to test the hypothesis that DST adversely affects high school students' sleep and vigilance on the school days following its implementation. METHODS A natural experiment design was used to assess baseline and post-DST differences in objective and subjective measures of sleep and vigilance by actigraphy, sleep diary, sleepiness scale, and psychomotor vigilance testing (PVT). Students were tested during school days immediately preceding and following DST. RESULTS A total of 40 high school students were enrolled in this study; 35 completed the protocol. Sleep duration declined by an average of 32 minutes on the weeknights post-DST, reflecting a cumulative sleep loss of 2 h 42 min as compared to the baseline week (p = 0.001). This finding was confirmed by sleep diary analyses, reflecting an average sleep loss of 27 min/night (p = 0.004) post-DST. Vigilance significantly deteriorated, with a decline in PVT performance post-DST, resulting in longer reaction times (p < 0.001) and increased lapses (p < 0.001). Increased daytime sleepiness was also demonstrated (p < 0.001). CONCLUSION The early March DST onset adversely affected sleep and vigilance in high school students resulting in increased daytime sleepiness. Larger scale evaluations of sleep impairments related to DST are needed to further quantify this problem in the population. If confirmed, measures to attenuate sleep loss post-DST should be implemented.
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Affiliation(s)
- Diana Medina
- Weill Cornell Medical College Center of Sleep Medicine, Cornell University, New York, NY
| | - Matthew Ebben
- Weill Cornell Medical College Center of Sleep Medicine, Cornell University, New York, NY
| | - Sara Milrad
- Weill Cornell Medical College Center of Sleep Medicine, Cornell University, New York, NY
| | | | - Ana C Krieger
- Weill Cornell Medical College Center of Sleep Medicine, Cornell University, New York, NY
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Kirchberger I, Wolf K, Heier M, Kuch B, von Scheidt W, Peters A, Meisinger C. Are daylight saving time transitions associated with changes in myocardial infarction incidence? Results from the German MONICA/KORA Myocardial Infarction Registry. BMC Public Health 2015; 15:778. [PMID: 26271748 PMCID: PMC4535383 DOI: 10.1186/s12889-015-2124-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 08/05/2015] [Indexed: 11/23/2022] Open
Abstract
Background Some studies suggest that transitions to and from daylight saving time (DST) have an influence on acute myocardial infarction (AMI) incidence. However, the available publications have a number of limitations e.g. regarding sample size, exclusion of fatal AMI cases, precise assessment of AMI onset, and consideration of possible confounders, and they were conducted in countries with different geographical location. The objective of this study was to examine the association of DST transitions with AMI incidence recorded in the population-based German MONICA/KORA Myocardial Infarction Registry. Methods The study sample consisted of 25,499 coronary deaths and non-fatal AMI cases aged 25–74 years. We used Poisson regression with indicator variables for the 3 days or the week after the spring and the autumn transition and adjusted for potential confounders to model the association between DST transitions and AMI incidence. In addition, we built an excess model by calculating observed over expected events per day. Results Overall, no significant changes of AMI risk during the first 3 days or 1 week after the transition to and from DST were found. However, subgroup analyses on the spring transition revealed significantly increased risks for men in the first 3 days after transition (RR 1.155, 95 % CI 1.000–1.334) and for persons who took angiotensine converting enzyme (ACE) inhibitors prior to the AMI (3 days: RR 1.489, 95 % CI 1.151–1.927; 1 week: RR 1.297, 95 % CI 1.063–1.582). After the clock shift in autumn, patients with a prior infarction had an increased risk to have a re-infarction (3 days: RR 1.319, 95 % CI 1.029–1.691; 1 week: RR 1.270, 95 % CI 1.048–1.539). Conclusions Specific subgroups such as men and persons with a history of AMI or prior treatment with ACE inhibitors, may have a higher risk for AMI during DST. Further studies which include data on chronotype and sleep duration are needed in order to confirm these results.
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Affiliation(s)
- Inge Kirchberger
- Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Stenglinstr. 2, D-86156, Augsburg, Germany. .,Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.
| | - Kathrin Wolf
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.
| | - Margit Heier
- Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Stenglinstr. 2, D-86156, Augsburg, Germany. .,Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.
| | - Bernhard Kuch
- Hospital of Nördlingen, Department of Internal Medicine/Cardiology, Stoffelsberg 4, 86720, Nördlingen, Germany. .,Central Hospital of Augsburg, Department of Internal Medicine I - Cardiology, Stenglinstr. 2, D-86156, Augsburg, Germany.
| | - Wolfgang von Scheidt
- Central Hospital of Augsburg, Department of Internal Medicine I - Cardiology, Stenglinstr. 2, D-86156, Augsburg, Germany.
| | - Annette Peters
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.
| | - Christa Meisinger
- Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Stenglinstr. 2, D-86156, Augsburg, Germany. .,Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.
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Bano M, Chiaromanni F, Corrias M, Turco M, De Rui M, Amodio P, Merkel C, Gatta A, Mazzotta G, Costa R, Montagnese S. The influence of environmental factors on sleep quality in hospitalized medical patients. Front Neurol 2014; 5:267. [PMID: 25566173 PMCID: PMC4263101 DOI: 10.3389/fneur.2014.00267] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 11/27/2014] [Indexed: 11/29/2022] Open
Abstract
Introduction: Sleep–wake disturbances are common in hospitalized patients but few studies have assessed them systematically. The aim of the present study was to assess sleep quality in a group of medical inpatients, in relation to environmental factors, and the switch to daylight-saving time. Methods: Between March and April 2013, 118 consecutive inpatients were screened and 99 (76 ± 11 years; hospitalization: 8 ± 7 days) enrolled. They slept in double or quadruple rooms, facing South/South-East, and were qualified as sleeping near/far from the window. They underwent daily sleep assessment by standard questionnaires/diaries. Illuminance was measured by a luxmeter at each patient’s eye-level, four times per day. Noise was measured at the same times by a phonometer. Information was recorded on room lighting, position of the rolling shutters and number/type of extra people in the room. Results: Compliance with sleep-wake assessment was poor, with a range of completion of 2–59%, depending on the questionnaires. Reported sleep quality was sufficient and sleep timing dictated by hospital routine; 33% of the patients reported one/more sleepless nights. Illuminance was generally low, and rolling shutters half-way down for most of the 24 h. Patients who slept near the window were exposed to more light in the morning (i.e., 222 ± 72 vs. 174 ± 85 lux, p < 0.05 before the switch; 198 ± 72 vs. 141 ± 137 lux, p < 0.01 after the switch) and tended to sleep better (7.3 ± 1.8 vs. 5.8 ± 2.4 on a 1–10 scale, before the switch, p < 0.05; 7.7 ± 2.3 vs. 6.6 ± 1.8, n.s. after the switch). Noise levels were higher than recommended for care units but substantially comparable across times/room types. No significant differences were observed in sleep parameters before/after the switch. Conclusion: Medical wards appear to be noisy environments, in which limited attention is paid to light/dark hygiene. An association was observed between sleep quality and bed position/light exposure, which is worthy of further study.
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Affiliation(s)
- Milena Bano
- Department of Medicine, University of Padova , Padova , Italy
| | | | - Michela Corrias
- Department of Medicine, University of Padova , Padova , Italy
| | - Matteo Turco
- Department of Medicine, University of Padova , Padova , Italy
| | - Michele De Rui
- Department of Medicine, University of Padova , Padova , Italy
| | - Piero Amodio
- Department of Medicine, University of Padova , Padova , Italy
| | - Carlo Merkel
- Department of Medicine, University of Padova , Padova , Italy
| | - Angelo Gatta
- Department of Medicine, University of Padova , Padova , Italy
| | | | - Rodolfo Costa
- Department of Biology, University of Padova , Padova , Italy
| | - Sara Montagnese
- Department of Medicine, University of Padova , Padova , Italy
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Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a common diagnosis in clinical practice. Excessive daytime sleepiness may be a warning for possible OSA. OBJECTIVES To assess the prevalence of excessive daytime sleepiness as measured by the Epworth Sleepiness Scale (ESS) in a rural community population; potential risk factors for OSA were also assessed. METHODS In 2010, a baseline respiratory health questionnaire within the Saskatchewan Rural Health Study was mailed to 11,982 households in Saskatchewan. A total of 7597 adults within the 4624 (42%) respondent households completed the ESS questionnaire. Participants were categorized according to normal or high (>10) ESS scores. Data obtained included respiratory symptoms, doctor-diagnosed sleep apnea, snoring, hypertension, smoking and demographics. Body mass index was calculated. Multivariable logistic regression analysis examined associations between high ESS scores and possible risk factors. Generalized estimating equations accounted for the two-tiered sampling procedure of the study design. RESULTS The mean age of respondents was 55.0 years and 49.2% were male. The prevalence of ESS>10 and 'doctor diagnosed' OSA were 15.9% and 6.0%, respectively. Approximately 23% of respondents reported loud snoring and 30% had a body mass index >30 kg⁄m2. Of those with 'doctor-diagnosed' OSA, 37.7% reported ESS>10 (P<0.0001) and 47.7% reported loud snoring (P<0.0001). Risk of having an ESS>10 score increased with age, male sex, obesity, lower socioeconomic status, marriage, loud snoring and doctor-diagnosed sinus trouble. CONCLUSIONS High levels of excessive daytime sleepiness in this particular rural population are common and men >55 years of age are at highest risk. Examination of reasons for residual sleepiness and snoring in persons with and without sleep apnea is warranted.
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