Pressure Pain Sensitivity and Chronotype: A Population-based Study of Middle-aged Finns

Evening chronotype individuals experience pain more often than morning chronotypes, but relationships with pain sensitivity have rarely been studied. We examined whether chronotype is associated with pressure pain sensitivity, with special reference to mental health disorders, insomnia, and chronic musculoskeletal (MSK) pain as potential moderating factors. The study sample consisted of members of the Northern Finland Birth Cohort 1966 aged 46. Pressure pain threshold and tolerance were measured via the standardized protocol, categorized as lowest quartile versus others. Chronotype (morning [M; the reference], intermediate [I], and evening [E]) was defined using the Short Morningness-Eveningness questionnaire. Sex-stratified binary logistic regression models were separately adjusted for education, body mass index, long-term diseases (fully adjusted model), and for mental health disorders, insomnia, and chronic MSK pain (a residual confounding analysis). Interaction terms (Chronotype × Mental health/insomnia/chronic MSK pain) were tested. The study had 2,132 males and 2,830 females. The E-type males had 1.5-fold odds of having a low pain threshold (fully adjusted odds ratio [OR] 1.45, 95% confidence interval 1.05-2.00) and pressure pain tolerance (fully adjusted OR 1.47, 1.07-2.02), in comparison to M-types. Having a mental health disorder intensified the association with low pain threshold fourfold (4.06, 1.56-10.6). Being an E-type female was also associated with a low pain threshold, but the association was statistically nonsignificant (fully adjusted OR 1.18, .90-1.53). No statistically significant interactions were found among females. These results emphasize the role of chronotype in pain sensitivity and add an understanding of pain experience in light of innate circadian types. PERSPECTIVE: Male evening chronotypes are more sensitive to pain than morning chronotypes. Diagnosed mental health disorders in particular indicate a low pain threshold for evening chronotype males.

Impact of sleep chronotype on in-laboratory polysomnography parameters

Morningness-eveningness preference, also known as chronotype, is the tendency for a person to sleep during certain hours of the day and is broadly categorised into morning and evening types. In-laboratory polysomnography (iPSG) is the gold-standard to assess sleep, however, an individual's chronotype is not accounted for in current protocols, which may confound collected sleep data. The objective of our study was to assess if chronotype had an association with sleep physiology. Patients who completed the diagnostic iPSG and the Morningness-Eveningness Questionnaire (MEQ), which categorises patients into morning type, neither or evening type, were assessed. Multivariable linear regression models were used to assess if chronotype was associated with sleep quality, duration, and physiology during iPSG. The study sample included 2612 patients (mean age of 53.6 years, 48% male) recruited during 2010-2015. Morning type, compared with neither type, was significantly associated with an increase in total sleep time and rapid eye movement (REM) sleep, and a decrease in sleep onset latency and the arousal index. Evening type, compared with neither type, was significantly associated with a decrease in total sleep time, sleep efficiency, and REM sleep, and an increase in sleep onset latency and wake after sleep onset. Additionally, iPSG lights out time was significantly different between the different chronotypes. Overall, a morningness chronotype was associated with favourable sleep quality and duration while an eveningness chronotype was associated with reduced sleep quality. Our study quantifies the association of chronotype with iPSG metrics and suggests that laboratory protocols should consider chronotype in their evaluations.

Association of chronotype, social jetlag, sleep duration and depressive symptoms in Chinese college students

OBJECTIVES

To describe the prevalence of depressive symptoms among Chinese college students and examine the relationship between sleep and circadian rhythm disruption (SCRD) indicators (chronotype, social jetlag, sleep duration) and depressive symptoms.

METHODS

From April to May 2019, the College Student Behavior and Health Cohort Study was conducted among Chinese college students from 2 universities in Anhui and Jiangxi provinces. The current study used data from the third follow-up study. Questionnaire content includes socio-demographic and lifestyle information. Social jetlag and sleep duration were calculated by answering the question about sleep time. Chronotype was assessed by the Morning and Evening Questionnaire (MEQ-5). Depressive symptoms were evaluated by the Patient Health Questionnaire 9 (PHQ-9). A Chi-square test was used to examine the proportion depressive symptoms. Multinomial logistic regression model were used to explore the associations of circadian rhythm indicators with depressive symptoms.

RESULTS

The prevalence of mild depression, moderate and above depression was 18.8 % and 6.9 %. Evening types (E-types) and short sleep duration were significantly associated with depression. Stratified analysis indicated that E-types and social jetlag≥2 h were associated with mild depression (OR = 5.67, 95 % CI: 1.83-17.51), as well as stratified analysis indicated that E-types and sleep duration<8 h were associated with mild depression (OR = 5.10, 95 % CI: 1.88-13.87).

CONCLUSIONS

The findings suggest that depressive symptoms are more severe when multiple SCRD indicators are out of whack. The intervention programs of depressive symptoms should consider the context of the multidimensional aspects of Chinese college student sleep.

Eveningness is associated with persistent multisite musculoskeletal pain: a 15-year follow-up study of Northern Finns

Chronotype, a phenotype representing a person's 24-hour circadian rhythm, has been increasingly acknowledged as playing a role in musculoskeletal (MSK) pain. Most prior research on chronotype and MSK pain have been based on cross-sectional data, and no study has explored multisite MSK pain (two or more pain locations) as the outcome. We drew the study sample from the 31- and 46-year data collections (baseline and follow-up, respectively) of the Northern Finland Birth Cohort 1966 and collected self-reported data on chronotype at follow-up (morning [M]-type, intermediate [I]-type, and evening [E]-type) and longitudinal multisite MSK pain trajectories (n=3,294). Multinomial logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CIs) in multisite MSK pain trajectories between the chronotypes. We conducted additional sensitivity analyses that 1) accounted for several confounders, and 2) examined the potential moderating role of sex, mental distress, and sleep disturbance status in the chronotype-multisite MSK pain associations. The E-types had two-and-a-half-times higher odds of multisite MSK pain at baseline and follow-up (OR 2.47, 95% CI 1.84-3.32) than the M-types. Having severe mental distress or poor sleep at baseline and follow-up, or sex did not change the strength of this association. Our examination of this longitudinal birth cohort study suggested that evening types, in comparison to morning types, are more likely to experience multisite MSK pain between ages 31 and 46 years. Chronotype should be recognized as a predictor of multisite pain and thus taken into account in the evaluation of a patient's risk for multisite pain. Perspective: This longitudinal study shows that evening types, compared to morning types, have higher odds of experiencing multisite MSK pain between ages 31 and 46 years. Chronotype should be considered while evaluating MSK patient's risk for persistent multisite pain symptoms.

Eveningness intensifies the association between musculoskeletal pain and health-related quality of life: a Northern Finland Birth Cohort Study 1966

ABSTRACT

People with an evening (E)-type preference (ie, chronotype) experience musculoskeletal (MSK) pain and reduced health-related quality of life (HRQoL) more often than morning (M) types. Musculoskeletal pain is a well-established contributor to reduced HRQoL. This study aimed to evaluate whether eveningness amplifies the association between MSK pain and HRQoL in contrast to morningness. Questionnaire data on MSK pain dimensions (intensity, disability at work, number of pain sites [NPSs], and frequency), chronotype, covariates (sex, sufficiency of sleep duration, mental distress, and presence of coexisting diseases), and HRQoL (measured by 15D) were collected among 46-year-old individuals belonging to the Northern Finland Birth Cohort 1966 (N = 4257). Individuals without any MSK pain were excluded. General linear models were conducted to estimate the associations between chronotypes, MSK pain dimensions, and HRQoL. The interaction terms (chronotype × pain dimension) were tested in the models. There were 13% E-types and 43% M-types in the study sample. Each pain dimension and chronotype were related to HRQoL. In the sex-adjusted chronotype-specific models, the reduction in HRQoL in relation to pain appeared to be stronger among E-types than among M-types in respect to all pain dimensions. After adjustments, this was particularly seen in terms of NPS and pain frequency. Our findings suggest that eveningness intensifies the association between MSK pain and HRQoL, and, thus, they are indicative of E-types being more sensitive than M-types to the consequences of MSK pain. As such, MSK pain treatment and rehabilitation actions to improve HRQoL should be especially targeted at E-types.

Translation and validation of the SCRAM questionnaire in a German adolescent inpatient sample

Sleep, depressive symptoms and circadian preference are highly interconnected processes. Evidence suggests that, especially in adolescence, all processes should be considered in the assessment and treatment of patients with clinically relevant psychopathology. The SCRAM (Sleep, Circadian Rhythms, and Mood) questionnaire was developed and validated in a student sample as a promising tool to conjointly measure and separate sleep, circadian preference and depression symptomatology. The present study aims to validate a German version of the SCRAM questionnaire in an adolescent psychiatric inpatient sample. A two-step analytic strategy consisting of an exploratory factor analysis EFA followed by confirmatory factor analyses (CFA) was conducted. The EFA was run in the first half of the sample (n = 422, M = 14.92, SD = 1.67). To validate the factor structure of the EFA and the original study, two CFA`s were performed in the second half of the adolescent sample (n = 438, M = 15.07, SD = 1.68). The EFA analysis revealed a 4-factor model with 12 items. Two Sleep items and one Morningness item had cross-factor loadings. The fit indices in the CFA were good using the factor model of the original study, whereas the 4-factor model of the EFA did not converge. The German SCRAM factor model seems structurally sound in an adolescent inpatient sample, but questions remain regarding the role of diagnosis, gender, external correlates, and examining the change scores of the SCRAM scores with treatment. Before this application, further research is needed to replicate the factor structure, investigate test-retest reliability, predictive and discriminant validity and test in more generalizable samples.

Diurnal preference and depressive symptomatology: a meta-analysis

Eveningness, a preference for later sleep and rise times, has been associated with a number of negative outcomes in terms of both physical and mental health. A large body of evidence links eveningness to Major Depressive Disorder (MDD). However, to date, evidence quantifying this association is limited. The current meta-analysis included 43 effect sizes from a total 27,996 participants. Using a random-effects model it was demonstrated that eveningness is associated with a small effect size (Fisher's Z = - 2.4, 95% CI [- 0.27. - 0.21], p < 0.001). Substantial heterogeneity between studies was observed, with meta-regression analyses demonstrating a significant effect of mean age on the association between diurnal preference and depression. There was also evidence of potential publication bias as assessed by visual inspection of funnel plots and Egger's test. The association between diurnal preference and depression is small in magnitude and heterogenous. A better understanding of the mechanistic underpinnings linking diurnal preference to depression and suitably powered prospective studies that allow causal inference are required.

Genetic variants for morningness in relation to habitual sleep-wake behavior and diurnal preference in a population-based sample of 17,243 adults

OBJECTIVE

Associations of eveningness with health hazards benefit from analyzing to what extent the polygenic score for morningness correlates with the assessments of the behavioral trait of morningness-eveningness and chronotype.

METHODS

With a population-based sample of 17,243 Finnish adults, aged 25-74 years, this study examines the associations of four feasible assessment methods of chronotype, a) biological the genetic liability based on the polygenic score for morningness (PGS_morn), b) the widely-used single item for self-assessed morningness/eveningness (MEQ_i19) of the original Morningness-Eveningness Questionnaire (MEQ), c) the behavioral trait of morningness-eveningness as assessed with the score on the shortened version (sMEQ) of the original MEQ, and d) the phase of entrainment as assessed with the habitual midpoint of sleep based on the self-reported sleep-wake schedule during weekend (Sleep_mid-wknd) as well as the sleep debt corrected midpoint of sleep (Sleep_mid-corr).

RESULTS

All self-report measures correlated with each other, but very weakly with the PGS_morn, which explained 1-2% of the variation in diurnal preference or habitual sleep-wake schedule. The influence of age was greater on Sleep_mid-wknd and Sleep_mid-corr than on the sMEQ or MEQ_i19, indicating that the diurnal preference might be a more stable indicator for morningness-eveningness than the sleep-wake schedule. Analyses of the discrepancies between sMEQ and MEQ_i19 indicated that eveningness can be over-estimated when relying on only the single-item self-assessment.

CONCLUSIONS

The current polygenic score for morningness explains only a small proportion of the variation in diurnal preference or habitual sleep-wake schedule. The molecular genetic basis for morningness-eveningness needs further elucidation.

The search for causality of personality-chronotype associations: insights from a one-year longitudinal study of adolescents

Associations between certain personality traits and individual differences in diurnal preferences, referred to as morningness-eveningness, are well established from cross-sectional studies. However, it is unclear whether personality affects diurnal preference, diurnal preference affects personality, or some third factor influences both. The current study assessed the Big Five personality traits and morningness-eveningness in a one-year, two-wave longitudinal design, in a sample of 169 Polish high school students (59% females), aged 16-17 years (M = 16.80, SD = 0.39) during the first wave of measurement. During the second wave the participants were respectively 1 year older. Cross lagged panel analyses were run to determine wave 1 predictors of wave 2 variables. Cross-sectional analyses replicated the association between morningness and conscientiousness that has been reliably found in previous studies, but the cross-lagged paths between these variables were nonsignificant. These two traits appear to be intrinsically linked to one another by adolescence, possibly as a consequence of genetic influences that shape temperament earlier in childhood. In contrast, emotional stability and morningness were not significantly correlated in wave 1 cross-sectional data, but a significant relationship was found in the cross-lagged panel analysis. Wave 1 emotional stability predicted wave 2 morningness, although wave 1 morningness did not predict personality. We tentatively suggest that there may be a causal effect of personality on diurnal preference, associated with avoidance strategies for coping with academic stress as the high school years approach their end. More neurotic individuals may cope with their aversion to classes by distracting themselves with evening pursuits, such as use of the internet. Further work might examine in more depth how contextual stressors interact with personality to affect daily activities at different times of the day.

Asking the Clock: How to Use Information from Questionnaires for Circadian Phenotyping

With the emergence of big data science, the question how we can easily collect meaningful information about circadian clock phenotypes in large human cohorts imposes itself. Here, we describe potentials and limitations of using questionnaires, specifically the Munich ChronoType Questionnaire (MCTQ), to characterize such circadian phenotypes. We also discuss scenarios when alternative methods might be more appropriate.

Chronotype, Sleep, and Depressive Symptoms Among Chinese College Students: A Cross-Sectional Study

Objective: To describe the prevalence of chronotype and depressive symptoms among Chinese college students and to examine the association between chronotype and depressive symptoms.

Methods: From April to May 2019, a cross-sectional survey was conducted among 1,179 Chinese college students from 2 universities in Anhui and Jiangxi provinces. A total of 1,135 valid questionnaires were collected, the valid response rate was 98.6%. The questionnaire investigated age, gender, major, height, weight, only child status, living place, self-reported family economy, and self-reported study burden. The chronotype was assessed by the Morning and Evening Questionnaire (MEQ). Depressive symptoms and sleep quality were evaluated by the Patient Health Questionnaire 9 (PHQ-9) and the Pittsburgh Sleep Quality Index (PSQI), respectively. A Chi-square test was used to examine the proportion of depressive symptoms among Chinese college students with different demographic characteristics. The generalized linear model was used to analyze the relationships between chronotype and depressive symptoms.

Results: The proportion of morning types (M-types), neutral types (N-types), and evening types (E-types) of college students were 18.4, 71.1, and 10.5%, respectively. The proportion of mild depression, moderate depression, and moderate to severe depression of participants were 32.4, 6.0, and 4.2%, respectively. Compared to the M-types, after controlled for age, gender, major, sleep quality, self-reported study burden, father's education level, and self-reported family economy, depressive symptoms were positively correlated with E-types (OR = 2.36, 95% CI: 1.49–3.73).

Conclusions: There was a significant association between chronotype and depressive symptoms among Chinese college students. Further longitudinal studies were needed to clarify the causal relationship between chronotype and depressive symptoms.

Measuring circadian function in bipolar disorders: Empirical and conceptual review of physiological, actigraphic, and self-report approaches

BACKGROUND

Interest in biological clock pathways in bipolar disorders (BD) continues to grow, but there has yet to be an audit of circadian measurement tools for use in BD research and practice.

PROCEDURE

The International Society for Bipolar Disorders Chronobiology Task Force conducted a critical integrative review of circadian methods that have real-world applicability. Consensus discussion led to the selection of three domains to review-melatonin assessment, actigraphy, and self-report.

RESULTS

Measurement approaches used to quantify circadian function in BD are described in sufficient detail for researchers and clinicians to make pragmatic decisions about their use. A novel integration of the measurement literature is offered in the form of a provisional taxonomy distinguishing between circadian measures (the instruments and methods used to quantify circadian function, such as dim light melatonin onset) and circadian constructs (the biobehavioral processes to be measured, such as circadian phase).

CONCLUSIONS

Circadian variables are an important target of measurement in clinical practice and biomarker research. To improve reproducibility and clinical application of circadian constructs, an informed systematic approach to measurement is required. We trust that this review will decrease ambiguity in the literature and support theory-based consideration of measurement options.

A psychometric investigation of the sleep, circadian rhythms, and mood (SCRAM) questionnaire

The sleep, circadian rhythms, and mood (SCRAM) questionnaire (Byrne, Bullock et al., 2017) was designed to concurrently measure individual differences in three clinically important functions: diurnal preference, sleep quality, and mood. The 15-item questionnaire consists of three 5-item scales named Morningness, Good Sleep, and Depressed Mood. The overarching aim of the current project was to investigate the validity and reliability of the questionnaire. Here, we report on associations investigated in three data sets. Study 1 (N = 70, 80% females) was used to examine the test-retest reliability of the questionnaire, finding strong test-retest reliability of the three scales over a 2-week period (r's ranging from 0.73 to 0.86). Study 2 (N = 183, 80% females) enabled us to examine the construct validity of the SCRAM scales against well-validated self-report measures of diurnal preference, sleep quality, and depression. Strong correlations were found between each SCRAM scale and their respective measure in bivariate analyses, and associations were robust after the inclusion of the remaining two SCRAM scales as predictors in regression analyses. Data from Study 3 (N = 42, 100% males) were used to measure the extent to which SCRAM scores correlated with objective measures of sleep-wake behavior using actigraphy. Morningness was found to be related to earlier sleep onset and offset times, and Good Sleep was related to higher sleep efficiency but to no other measures of sleep quality; Depressed Mood was not related to actigraphy measures. The findings provide provisional support for construct validity and reliability of the SCRAM questionnaire as a measure of diurnal preference, sleep quality, and depressed mood. Future research into the psychometrics of SCRAM should test the questionnaire's discriminant and predictive validity in clinical samples.

Development of a Measure of Sleep, Circadian Rhythms, and Mood: The SCRAM Questionnaire

Sleep quality, circadian phase, and mood are highly interdependent processes. Remarkably, there is currently no self-report questionnaire that measures all three of these clinically significant functions: The aim of this project was to address this deficit. In Study 1, 720 participants completed a set of potential items was generated from existing questionnaires in each of the three domains and refined to follow a single presentation format. Study 2 used an independent sample (N = 498) to interrogate the latent structure. Exploratory factor analysis was used to identify a parsimonious, three-factor latent structure. Following item reduction, the optimal representation of sleep quality, circadian phase, and mood was captured by a questionnaire with three 5-item scales: Depressed Mood, Morningness, and Good Sleep. Confirmatory factor analysis found the three-scale structure provided adequate fit. In both samples, Morningness and Good Sleep were positively associated, and each was negatively associated with the Depressed Mood scale. Further research is now required to quantify the convergent and discriminant validity of its three face-valid and structurally replicated scales. The new sleep, circadian rhythms, and mood (SCRAM) questionnaire is the first instrument to conjointly measure sleep quality, circadian phase, and mood processes, and has significant potential as a clinical tool.

Sleep problems in university students - an intervention

INTRODUCTION

Up to 60% of all college students suffer from a poor sleep quality, and 7.7% meet all criteria of an insomnia disorder. Sleep problems have a great impact on the students' daily life, for example, the grade point average. Due to irregular daytime routines, chronotype changes, side jobs and exam periods, they need specialized treatments for improving sleep. "Studieren wie im Schlaf" (SWIS; (studying in your sleep)) is a multicomponent sleep training that combines Cognitive Behavioral Therapy for Insomnia and Hypnotherapy for Insomnia to improve students' sleep, insomnia symptoms and nightmares. The aim of the present study is to evaluate the acceptance, feasibility and the first effects of SWIS.

METHODS

Twenty-seven students (mean =24.24, standard deviation =3.57) participated in a study of pre-post design. The acceptance and feasibility were measured with questionnaires. In addition, the Pittsburgh Sleep Quality Index (PSQI), sleep logs and actigraphy were implemented. Further variables encompassed daytime sleepiness, sleep-related personality traits and cognitions about sleep.

RESULTS

Seventy-four percent of the participants reported symptoms of an insomnia disorder, and 51.9% fulfilled all criteria of an insomnia disorder according to the Diagnostic and Statistical Manual of Mental Disorders (fifth edition). Correspondingly, the students suffered from clinically relevant sleep problems according to the PSQI. The SWIS sleep training is a well-accepted and feasible program. Significant improvements were observed in the subjective sleep quality and sleep-related personality traits, as well as clinical improvements in objective sleep measures.

DISCUSSION

Findings showed that SWIS is a feasible program for the treatment of sleep problems in college and university students due to its various effects on sleep and cognitive outcomes. Further evaluation of follow-up measurements and additional variables, that is, cognitive performance and mental health, is needed.

Coordination difficulty and internalizing symptoms in adults: A twin/sibling study

Increased anxiety and depression symptoms have been reported in individuals with neurodevelopmental disorders, and have been found to be associated with motor coordination difficulties, but little is known about the etiology of these associations. This study aimed to assess genetic, shared (making twins/siblings alike) and non-shared (individual-specific) environmental influences on the association between poor coordination and symptoms of anxiety and depressed mood using a sample of adult twin and sibling pairs. Participants were asked about their coordination skill and anxiety and depression symptoms. About half of the variance in coordination difficulty was explained by familial (combined genetic and shared environmental) influences, with the remaining variance explained by non-shared environmental influences. Phenotypic associations between coordination and anxiety (r=.46) and depression symptoms (r=.44) were largely underpinned by shared familial liability for the three traits. Non-shared environment accounted for about a third of the phenotypic association. Results suggest that both familial and non-shared environmental influences play a role in the etiology of coordination difficulty and its association with internalizing symptoms. The current study highlights that both biological and environmental pathways shared between these symptoms should be examined in future research to inform prevention and treatment approaches in clinical settings.