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Hulsegge G, Coenen P, Gascon GM, Pahwa M, Greiner B, Bohane C, Wong IS, Liira J, Riera R, Pachito DV. Adapting shift work schedules for sleep quality, sleep duration, and sleepiness in shift workers. Cochrane Database Syst Rev 2023; 9:CD010639. [PMID: 37694838 PMCID: PMC10494487 DOI: 10.1002/14651858.cd010639.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND Shift work is associated with insufficient sleep, which can compromise worker alertness with ultimate effects on occupational health and safety. Adapting shift work schedules may reduce adverse occupational outcomes. OBJECTIVES To assess the effects of shift schedule adaptation on sleep quality, sleep duration, and sleepiness among shift workers. SEARCH METHODS We searched CENTRAL, PubMed, Embase, and eight other databases on 13 December 2020, and again on 20 April 2022, applying no language restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) and non-RCTs, including controlled before-after (CBA) trials, interrupted time series, and cross-over trials. Eligible trials evaluated any of the following shift schedule components. • Permanency of shifts • Regularity of shift changes • Direction of shift rotation • Speed of rotation • Shift duration • Timing of start of shifts • Distribution of shift schedule • Time off between shifts • Split shifts • Protected sleep • Worker participation We included studies that assessed sleep quality off-shift, sleep duration off-shift, or sleepiness during shifts. DATA COLLECTION AND ANALYSIS Two review authors independently screened the titles and abstracts of the records recovered by the search, read through the full-text articles of potentially eligible studies, and extracted data. We assessed the risk of bias of included studies using the Cochrane risk of bias tool, with specific additional domains for non-randomised and cluster-randomised studies. For all stages, we resolved any disagreements by consulting a third review author. We presented the results by study design and combined clinically homogeneous studies in meta-analyses using random-effects models. We assessed the certainty of the evidence with GRADE. MAIN RESULTS We included 11 studies with a total of 2125 participants. One study was conducted in a laboratory setting and was not considered for drawing conclusions on intervention effects. The included studies investigated different and often multiple changes to shift schedule, and were heterogeneous with respect to outcome measurement. Forward versus backward rotation Three CBA trials (561 participants) investigated the effects of forward rotation versus backward rotation. Only one CBA trial provided sufficient data for the quantitative analysis; it provided very low-certainty evidence that forward rotation compared with backward rotation did not affect sleep quality measured with the Basic Nordic Sleep Questionnaire (BNSQ; mean difference (MD) -0.20 points, 95% confidence interval (CI) -2.28 to 1.89; 62 participants) or sleep duration off-shift (MD -0.21 hours, 95% CI -3.29 to 2.88; 62 participants). However, there was also very low-certainty evidence that forward rotation reduced sleepiness during shifts measured with the BNSQ (MD -1.24 points, 95% CI -2.24 to -0.24; 62 participants). Faster versus slower rotation Two CBA trials and one non-randomised cross-over trial (341 participants) evaluated faster versus slower shift rotation. We were able to meta-analyse data from two studies. There was low-certainty evidence of no difference in sleep quality off-shift (standardised mean difference (SMD) -0.01, 95% CI -0.26 to 0.23) and very low-certainty evidence that faster shift rotation reduced sleep duration off-shift (SMD -0.26, 95% CI -0.51 to -0.01; 2 studies, 282 participants). The SMD for sleep duration translated to an MD of 0.38 hours' less sleep per day (95% CI -0.74 to -0.01). One study provided very low-certainty evidence that faster rotations decreased sleepiness during shifts measured with the BNSQ (MD -1.24 points, 95% CI -2.24 to -0.24; 62 participants). Limited shift duration (16 hours) versus unlimited shift duration Two RCTs (760 participants) evaluated 80-hour workweeks with maximum daily shift duration of 16 hours versus workweeks without any daily shift duration limits. There was low-certainty evidence that the 16-hour limit increased sleep duration off-shift (SMD 0.50, 95% CI 0.21 to 0.78; which translated to an MD of 0.73 hours' more sleep per day, 95% CI 0.30 to 1.13; 2 RCTs, 760 participants) and moderate-certainty evidence that the 16-hour limit reduced sleepiness during shifts, measured with the Karolinska Sleepiness Scale (SMD -0.29, 95% CI -0.44 to -0.14; which translated to an MD of 0.37 fewer points, 95% CI -0.55 to -0.17; 2 RCTs, 716 participants). Shorter versus longer shifts One RCT, one CBA trial, and one non-randomised cross-over trial (692 participants) evaluated shorter shift duration (eight to 10 hours) versus longer shift duration (two to three hours longer). There was very low-certainty evidence of no difference in sleep quality (SMD -0.23, 95% CI -0.61 to 0.15; which translated to an MD of 0.13 points lower on a scale of 1 to 5; 2 studies, 111 participants) or sleep duration off-shift (SMD 0.18, 95% CI -0.17 to 0.54; which translated to an MD of 0.26 hours' less sleep per day; 2 studies, 121 participants). The RCT and the non-randomised cross-over study found that shorter shifts reduced sleepiness during shifts, while the CBA study found no effect on sleepiness. More compressed versus more spread out shift schedules One RCT and one CBA trial (346 participants) evaluated more compressed versus more spread out shift schedules. The CBA trial provided very low-certainty evidence of no difference between the groups in sleep quality off-shift (MD 0.31 points, 95% CI -0.53 to 1.15) and sleep duration off-shift (MD 0.52 hours, 95% CI -0.52 to 1.56). AUTHORS' CONCLUSIONS Forward and faster rotation may reduce sleepiness during shifts, and may make no difference to sleep quality, but the evidence is very uncertain. Very low-certainty evidence indicated that sleep duration off-shift decreases with faster rotation. Low-certainty evidence indicated that on-duty workweeks with shift duration limited to 16 hours increases sleep duration, with moderate-certainty evidence for minimal reductions in sleepiness. Changes in shift duration and compression of workweeks had no effect on sleep or sleepiness, but the evidence was of very low-certainty. No evidence is available for other shift schedule changes. There is a need for more high-quality studies (preferably RCTs) for all shift schedule interventions to draw conclusions on the effects of shift schedule adaptations on sleep and sleepiness in shift workers.
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Affiliation(s)
- Gerben Hulsegge
- The Netherlands Organization for Applied Scientific Research, TNO, Leiden, Netherlands
| | - Pieter Coenen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Gregg M Gascon
- OhioHealth, Columbus, Ohio, USA
- Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Manisha Pahwa
- Occupational Cancer Research Centre, Ontario Health, Toronto, Canada
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Birgit Greiner
- School of Public Health, University College Cork, Cork, Ireland
| | | | - Imelda S Wong
- Division of Science Integration, National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Juha Liira
- Department of Occupational Health, University of Turku, Turku, Finland
| | - Rachel Riera
- Cochrane Brazil Rio de Janeiro, Cochrane, Petrópolis, Brazil
- Center of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, Brazil
- Núcleo de Ensino e Pesquisa em Saúde Baseada em Evidência, Avaliação Tecnológica e Ensino em Saúde (NEP-Sbeats), Universidade Federal de São Paulo, São Paulo, Brazil
| | - Daniela V Pachito
- Prossono Centro de Diagnóstico e Medicina do Sono, Ribeirão Preto, São Paulo, Brazil
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Abstract
Data-centric models of COVID-19 have been attempted, but have certain limitations. In this work, we propose an agent-based model of the epidemic in a confined space of agents representing humans. An extension to the SEIR model allows us to consider the difference between the appearance (black-box view) of the spread of disease and the real situation (glass-box view). Our model allows for simulations of lockdowns, social distancing, personal hygiene, quarantine, and hospitalization, with further considerations of different parameters, such as the extent to which hygiene and social distancing are observed in a population. Our results provide qualitative indications of the effects of various policies and parameters, for instance, that lockdowns by themselves are extremely unlikely to bring an end to an epidemic and may indeed make things worse, that social distancing is more important than personal hygiene, and that the growth of infection is significantly reduced for moderately high levels of social distancing and hygiene, even in the absence of herd immunity.
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Lin YH, Wong BY, Lin SH, Chiu YC, Pan YC, Lee YH. Development of a mobile application (App) to delineate "digital chronotype" and the effects of delayed chronotype by bedtime smartphone use. J Psychiatr Res 2019; 110:9-15. [PMID: 30611008 DOI: 10.1016/j.jpsychires.2018.12.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 12/05/2018] [Accepted: 12/07/2018] [Indexed: 11/19/2022]
Abstract
The widespread use and deep reach of smartphones motivate the use of mobile applications to continuously monitor the relationship between circadian system, individual sleep patterns, and environmental effects. We selected 61 adults with 14-day data from the "Know Addiction" database. We developed an algorithm to identify the "sleep time" based on the smartphone behaviors. The total daily smartphone use duration and smartphone use duration prior to sleep onset were identified respectively. We applied mediation analysis to investigate the effects of total daily smartphone use on sleep through pre-sleep use (PS). The results showed participants' averaged pre-sleep episodes within 1 h prior to sleep are 2.58. The duration of three pre-sleep uses (PS1∼3) maybe a more representative index for smartphone use before sleep. Both total daily duration and the duration of the last three uses prior to sleep of smartphone use significantly delayed sleep onset, midpoint of sleep and reduced total sleep time. One hour of increased smartphone use daily, delays the circadian rhythm by 3.5 min, and reduced 5.5 min of total sleep time (TST). One hour of increased pre-sleep smartphone use delayed circadian rhythm by 1.7 min, and reduced 39 s of TST. The mediation effects of PS1∼3 significantly impacted on these three sleep indicators. PS1∼3 accounted for 14.3% of total daily duration, but the proportion mediated of delayed circadian rhythm was 44.0%. We presented "digital chronotype" with an automatic system that can collect high temporal resolution data from naturalistic settings with high ecological validity. Smartphone screen time, mainly mediated by pre-sleep use, delayed the circadian rhythm and reduced the total sleep time.
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Affiliation(s)
- Yu-Hsuan Lin
- Institute of Population Health Sciences, National Health Research Institute, Miaoli, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan; Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan.
| | - Bo-Yu Wong
- Institute of Population Health Sciences, National Health Research Institute, Miaoli, Taiwan.
| | - Sheng-Hsuan Lin
- Institute of Statistics, National Chiao Tung University, Hsin-Chu, Taiwan.
| | - Yu-Chuan Chiu
- Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan.
| | - Yuan-Chien Pan
- Institute of Population Health Sciences, National Health Research Institute, Miaoli, Taiwan; Department of Psychology, National Taiwan University, Taipei, Taiwan.
| | - Yang-Han Lee
- Department and Graduate School of Electrical Engineering, Tamkang University, New Taipei City, Taiwan.
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4
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Erren TC, Groß JV, Lewis P. Computing sleep deficiency. J Sleep Res 2017; 27:e12630. [PMID: 29159867 DOI: 10.1111/jsr.12630] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 09/25/2017] [Indexed: 12/30/2022]
Abstract
Sleep deficiency is a major public health concern. Since epidemiological studies play an important role in public health evaluations, this theoretical paper pursues answers to the question: 'How can we compute sleep deficiency as informative measures of exposures or doses in observational research?' Starting from the social jetlag concept and based on the chronodisruption rationale, we illustrate and discuss five approaches (one established and four untested, each with unique strengths and limitations) to quantify sleep deficiency by focusing on the timing and duration of sleep. Hitherto, social jetlag and chronodisruption rationale were neither explicitly proposed nor developed as assessments of sleep deficiency but, as we suggest, could potentially be utilized to this end. This first foray into computing sleep deficiency in epidemiological studies makes clear that laboratory, field and epidemiological collaboration is pre-requisite to elucidating potential (co-)causal roles of sleep deficiency in disease endpoints.
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Affiliation(s)
- Thomas C Erren
- Institute and Policlinic for Occupational Medicine, Environmental Medicine and Prevention Research, University Hospital of Cologne, Cologne, Germany
| | - J Valerie Groß
- Institute and Policlinic for Occupational Medicine, Environmental Medicine and Prevention Research, University Hospital of Cologne, Cologne, Germany
| | - Philip Lewis
- Institute and Policlinic for Occupational Medicine, Environmental Medicine and Prevention Research, University Hospital of Cologne, Cologne, Germany
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Dube N, Khan K, Loehr S, Chu Y, Veugelers P. The use of entertainment and communication technologies before sleep could affect sleep and weight status: a population-based study among children. Int J Behav Nutr Phys Act 2017; 14:97. [PMID: 28724380 PMCID: PMC5517950 DOI: 10.1186/s12966-017-0547-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 07/03/2017] [Indexed: 12/24/2022] Open
Abstract
Background Short sleep duration and poor sleep quality have been demonstrated to be associated with childhood obesity. It has been suggested that electronic entertainment and communication devices (EECDs) including TVs, computers, tablets, video games and cell phones interfere with sleep in children and youth. The aim of this study was to assess the impact that the use of EECDs in the hour before bedtime has on sleep and weight status to inform sleep promotion interventions and programs to prevent childhood obesity. Methods A provincially representative sample of 2334 grade 5 children and their parents in Alberta, Canada was surveyed. Parents reported their child’s bedtime and wake-up time along with how often their child snored, felt sleepy during the day, woke-up at night and woke-up in the morning feeling unrefreshed. Sleep duration, sleep quality and sleep efficiency were derived from these indicators. Parents also reported on the presence of EECDs in their child’s bedroom, while children reported use of EECDs during the day and frequency of using each of these devices during the hour before sleep. The height and weight of children were measured. Multivariable mixed effect linear and logistic regression models were used to determine how sleep duration, sleep quality, sleep efficiency and weight status are influenced by (i) access to EECDs in children’s bedrooms, (ii) use of EECDs during the hour before sleep, and (iii) calming activities specifically reading during the hour before sleep. Results Sleep duration was shorter by −10.8 min (cell phone), −10.2 min (computer) and −7.8 min (TV) for those with bedroom access to and used these EECDs during the hour before sleep compared to no access and no use. Good sleep quality was hindered by bedroom access to and use of all EECDs investigated during the hour before sleep, particularly among users of cell phones (OR = 0.64, 95% CI: 0.58–0.71) and computers (OR = 0.72, 95% CI: 0.65–0.80). Very good sleep efficiency was decreased by access to and frequent use of a TV (54%), cell phone (52%), tablet (51%) and video games (51%). Odds of obesity were doubled by bedroom access to and use of a TV and computer during the hour before sleep. Children who rarely read a printed book in the bedroom during the hour before sleep had a shorter sleep duration and poorer sleep quality and sleep efficiency compared to their peers. Having access to an EECD in the bedroom was associated with increased obesity despite frequently reading during the hour before sleep. Conclusions Our findings suggest that sleep duration, sleep quality, sleep efficiency and weight status are better among children who do not have EECDs in the bedroom and frequently read a book during the hour before sleep as opposed to those who use EECDs during this hour. Education of limits against EECD use by parents may improve sleep outcomes. These findings will inform health promotion messages and may give rise to national recommendations regarding EECD use. Trial registration ClinicalTrials.gov NCT01914185. Registered 31 July 2013 Retrospectively registered.
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Affiliation(s)
- Nomathemba Dube
- Department of Public Health Sciences, Population Health Intervention Research Unit, School of Public Health, University of Alberta, 3-50 University Terrace, 8303 112 Street, Edmonton, AB, T6G 2T4, Canada
| | - Kaviul Khan
- Department of Public Health Sciences, Population Health Intervention Research Unit, School of Public Health, University of Alberta, 3-50 University Terrace, 8303 112 Street, Edmonton, AB, T6G 2T4, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Sarah Loehr
- Department of Public Health Sciences, Population Health Intervention Research Unit, School of Public Health, University of Alberta, 3-50 University Terrace, 8303 112 Street, Edmonton, AB, T6G 2T4, Canada
| | - Yen Chu
- Department of Public Health Sciences, Population Health Intervention Research Unit, School of Public Health, University of Alberta, 3-50 University Terrace, 8303 112 Street, Edmonton, AB, T6G 2T4, Canada.,Centre for Clinical Epidemiology and Evaluation, University of British Columbia, Vancouver, BC, Canada
| | - Paul Veugelers
- Department of Public Health Sciences, Population Health Intervention Research Unit, School of Public Health, University of Alberta, 3-50 University Terrace, 8303 112 Street, Edmonton, AB, T6G 2T4, Canada.
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6
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Benabu JC, Stoll F, Gonzalez M, Mathelin C. [Night work, shift work: Breast cancer risk factor?]. ACTA ACUST UNITED AC 2015; 43:791-9. [PMID: 26597486 DOI: 10.1016/j.gyobfe.2015.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 10/08/2015] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The aim of this review was to determine the link between night/shift work and breast cancer. METHODS The analysed articles were taken from the PUBMED database between 1996 and 2015. The keywords used were "breast cancer risk", "night work" and "shift work". In total, 25 articles were selected. RESULTS Night/shift workers are more at risk to develop a breast cancer (relative risk (RR) between 1.09; 95% CI: 1.02-1.20 and 1.48; 95% CI: 1.36-1.61 in the meta-analyses). However, this risk is not found by some cohort and case-control studies. The circadian rhythm disruption, responsible of disorderliness of melatonin secretion, could be one of the mechanisms involved in the increase of that risk. Hormonal status of night/shift workers, their geographic origin, their lifestyle and their vitamin D deficiency appear as other mechanisms potentially responsible for increased risk of cancer in this professional population. Moreover, a dose-effect connection may exist, with an increase of the risk with the number of years of night/shift work. CONCLUSION Night/shift work is associated with a moderate increased risk of breast cancer, especially among women who worked over 20 years. Recommendations concerning the breast monitoring in this population could be diffused. The benefit of melatonin supplementation remains to be assessed.
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Affiliation(s)
- J-C Benabu
- Pôle de gynécologie-obstétrique, CHRU de Strasbourg, avenue Molière, 67200 Strasbourg cedex, France.
| | - F Stoll
- Pôle de gynécologie-obstétrique, CHRU de Strasbourg, avenue Molière, 67200 Strasbourg cedex, France
| | - M Gonzalez
- Service de pathologie professionnelle et médecine du travail, CHRU de Strasbourg, 67092 Strasbourg cedex, France
| | - C Mathelin
- Unité de sénologie, CHRU de Strasbourg, avenue Molière, 67200 Strasbourg cedex, France
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Chang AM, Aeschbach D, Duffy JF, Czeisler CA. Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness. Proc Natl Acad Sci U S A 2015; 112:1232-7. [PMID: 25535358 PMCID: PMC4313820 DOI: 10.1073/pnas.1418490112] [Citation(s) in RCA: 650] [Impact Index Per Article: 72.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
In the past 50 y, there has been a decline in average sleep duration and quality, with adverse consequences on general health. A representative survey of 1,508 American adults recently revealed that 90% of Americans used some type of electronics at least a few nights per week within 1 h before bedtime. Mounting evidence from countries around the world shows the negative impact of such technology use on sleep. This negative impact on sleep may be due to the short-wavelength-enriched light emitted by these electronic devices, given that artificial-light exposure has been shown experimentally to produce alerting effects, suppress melatonin, and phase-shift the biological clock. A few reports have shown that these devices suppress melatonin levels, but little is known about the effects on circadian phase or the following sleep episode, exposing a substantial gap in our knowledge of how this increasingly popular technology affects sleep. Here we compare the biological effects of reading an electronic book on a light-emitting device (LE-eBook) with reading a printed book in the hours before bedtime. Participants reading an LE-eBook took longer to fall asleep and had reduced evening sleepiness, reduced melatonin secretion, later timing of their circadian clock, and reduced next-morning alertness than when reading a printed book. These results demonstrate that evening exposure to an LE-eBook phase-delays the circadian clock, acutely suppresses melatonin, and has important implications for understanding the impact of such technologies on sleep, performance, health, and safety.
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Affiliation(s)
- Anne-Marie Chang
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA 02115; Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115; and
| | - Daniel Aeschbach
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA 02115; Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115; and Institute of Aerospace Medicine, German Aerospace Center, 51147 Cologne, Germany
| | - Jeanne F Duffy
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA 02115; Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115; and
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA 02115; Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115; and
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Aberrant methylation of miR-34b is associated with long-term shiftwork: a potential mechanism for increased breast cancer susceptibility. Cancer Causes Control 2014; 26:171-178. [PMID: 25398683 DOI: 10.1007/s10552-014-0494-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 11/05/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Although the evidence linking exposure to light at night (LAN) and breast cancer risk continues to accumulate, the molecular mechanisms driving this association remain to be fully elucidated. We have previously suggested that long-term exposure to LAN through shiftwork may result in dysregulated patterns of methylation genome-wide. In this study, we investigate the link between miR-34b, a miRNA suggested to be an important tumor suppressor, and shiftwork-related breast cancer. METHODS Methylation states in the miR-34b promoter region were previously compared between 10 female long-term shiftworkers and 10 folate intake- and age-matched female dayworkers participating in the Danish "Diet, Cancer and Health" prospective cohort study. In order to further explore the functional role of miR-34b in breast tumorigenesis, a genome-wide expression microarray was carried out in miR-34b-overexpressed MCF-7 breast cancer cells and the identified transcripts were further analyzed for network and functional interrelatedness using Ingenuity Pathway Analysis software. RESULTS We observed a 49.1 % increase in miR-34b promoter methylation among shiftworkers at a CpG site in this region (p = 0.016). Transfection of the miR-34b mimic in an MCF-7 breast cancer cell line induced differential expression of 230 transcripts that are involved in the interferon-mediated antiviral response as well as apoptotic and antiproliferative gene networks. CONCLUSIONS Together, our results suggest that long-term shiftwork may increase the risk of breast cancer via methylation-based suppression of miR-34b and a consequent reduction in immunomediated anti-tumor capacity and support our previous findings that LAN may induce epigenetic alteration of cancer-relevant microRNAs.
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Nogueira LM, Sampson JN, Chu LW, Yu K, Andriole G, Church T, Stanczyk FZ, Koshiol J, Hsing AW. Individual variations in serum melatonin levels through time: implications for epidemiologic studies. PLoS One 2013; 8:e83208. [PMID: 24376664 PMCID: PMC3871612 DOI: 10.1371/journal.pone.0083208] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 11/11/2013] [Indexed: 12/14/2022] Open
Abstract
Melatonin, a marker for the circadian rhythm with serum levels peaking between 2AM and 5AM, is hypothesized to possess anti-cancer properties, making it a mechanistic candidate for the probable carcinogenic effect of circadian rhythm disruption. In order to weigh epidemiologic evidence on the association of melatonin with cancer, we must first understand the laboratory and biological sources of variability in melatonin levels measured in samples. Participants for this methodological study were men enrolled in the Prostate Lung Colorectal and Ovarian Cancer Screening Trial (PLCO). We measured serum melatonin levels over a five year period in 97 individuals to test if melatonin levels are steady over time. The Pearson correlation coefficient between two measures separated by 1 year was 0.87, while the correlation between two measures separated by 5 years was to 0.70. In an additional cross-sectional study of 292 individuals, we used Analysis of Variance to identify differences in melatonin levels between different lifestyle and environmental characteristics. Serum melatonin levels were slightly higher in samples collected from 130 individuals during the winter, (6.36±0.59 pg/ml) than in samples collected from 119 individuals during the summer (4.83±0.62 pg/ml). Serum melatonin levels were lowest in current smokers (3.02±1.25 pg/ml, p = 0.007) compared to never (6.66±0.66 pg/ml) and former (5.59±0.50 pg/ml) smokers whereas BMI did not significantly affect serum melatonin levels in this study. In conclusion, the high 5 year correlation of melatonin levels implies that single measurements may be used to detect population level associations between melatonin and risk of cancer. Furthermore, our results reiterate the need to record season of sample collection, and individual characteristics in order to maximize study power and prevent confounding.
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Affiliation(s)
- Leticia M. Nogueira
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America
- * E-mail:
| | - Joshua N. Sampson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Lisa W. Chu
- Cancer Prevention Institute of California, Fremont, California, United States of America
| | - Kai Yu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Gerald Andriole
- Division of Urological Surgery, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Timothy Church
- Department of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota, United States of America
| | - Frank Z. Stanczyk
- Department of Obstetrics, Gynecology, and Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Jill Koshiol
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Ann W. Hsing
- Cancer Prevention Institute of California, Fremont, California, United States of America
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Fritschi L, Erren TC, Glass DC, Girschik J, Thomson AK, Saunders C, Boyle T, El-Zaemey S, Rogers P, Peters S, Slevin T, D'Orsogna A, de Vocht F, Vermeulen R, Heyworth JS. The association between different night shiftwork factors and breast cancer: a case-control study. Br J Cancer 2013; 109:2472-80. [PMID: 24022188 PMCID: PMC3817316 DOI: 10.1038/bjc.2013.544] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 07/31/2013] [Accepted: 08/14/2013] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Research on the possible association between shiftwork and breast cancer is complicated because there are many different shiftwork factors, which might be involved including: light at night, phase shift, sleep disruption and changes in lifestyle factors while on shiftwork (diet, physical activity, alcohol intake and low sun exposure). METHODS We conducted a population-based case-control study in Western Australia from 2009 to 2011 with 1205 incident breast cancer cases and 1789 frequency age-matched controls. A self-administered questionnaire was used to collect demographic, reproductive, and lifestyle factors and lifetime occupational history and a telephone interview was used to obtain further details about the shiftwork factors listed above. RESULTS A small increase in risk was suggested for those ever doing the graveyard shift (work between midnight and 0500 hours) and breast cancer (odds ratio (OR)=1.16, 95% confidence interval (CI)=0.97-1.39). For phase shift, we found a 22% increase in breast cancer risk (OR=1.22, 95% CI=1.01-1.47) with a statistically significant dose-response relationship (P=0.04). For the other shiftwork factors, risks were marginally elevated and not statistically significant. CONCLUSION We found some evidence that some of the factors involved in shiftwork may be associated with breast cancer but the ORs were low and there were inconsistencies in duration and dose-response relationships.
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Affiliation(s)
- L Fritschi
- Western Australian Institute for Medical Research, The University of Western Australia, Nedlands, Western Australia, Australia
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Erren TC, Herbst C, Koch MS, Fritschi L, Foster RG, Driscoll TR, Costa G, Sallinen M, Liira J. Adaptation of shift work schedules for preventing and treating sleepiness and sleep disturbances caused by shift work. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010639] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Thomas C Erren
- University Hospital of Cologne, University of Cologne; Institute and Policlinic for Occupational Medicine, Environmental Medicine and Prevention Research; Kerpener Str. 62 Cologne Germany 50937
| | - Christine Herbst
- University Hospital of Cologne, University of Cologne; Institute and Policlinic for Occupational Medicine, Environmental Medicine and Prevention Research; Kerpener Str. 62 Cologne Germany 50937
| | - Melissa S Koch
- University Hospital of Cologne, University of Cologne; Institute and Policlinic for Occupational Medicine, Environmental Medicine and Prevention Research; Kerpener Str. 62 Cologne Germany 50937
| | - Lin Fritschi
- University of Western Australia; Western Australian Institute for Medical Research; 35 Stirling Highway Crawley West Australia Australia
| | - Russell G Foster
- University of Oxford; Nuffield Department of Clinical Neurosciences; Circadian and Visual Neuroscience; Level 6, West Wing, The John Radcliffe Hospital Headley Way Oxford UK OX3 9DU
| | - Tim R Driscoll
- The University of Sydney; School of Public Health; Edward Ford Building (A27) Sydney New South Wales Australia 2006
| | - Giovanni Costa
- University of Milan; Department of Occupational Health; Via S. Barnaba 8 Milan Italy 20122
| | - Mikael Sallinen
- Finnish Institute of Occupational Health; Centre of Expertise for Human Factors at Work, Team of Working Hours and Cognitive Ergonomics; Topeliuksenkatu 41 a A Helsinki Finland FI-00250
| | - Juha Liira
- Finnish Institute of Occupational Health; Research and Development in Occupational Health Services; Topeliuksenkatu 41 a A Helsinki Finland FI-00250
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Herbst C, Erren TC, Sallinen M, Fritschi L, Costa G, Driscoll TR, Foster RG, Koch MS, Liira J. Person-directed non-pharmacological interventions for preventing and treating sleepiness and sleep disturbances caused by shift work. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Trabajo en turnos, privación de sueño y sus consecuencias clínicas y médicolegales. REVISTA MÉDICA CLÍNICA LAS CONDES 2013. [DOI: 10.1016/s0716-8640(13)70180-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Erren TC, Reiter RJ. Revisiting chronodisruption: when the physiological nexus between internal and external times splits in humans. Naturwissenschaften 2013; 100:291-8. [PMID: 23494200 DOI: 10.1007/s00114-013-1026-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 02/14/2013] [Accepted: 02/20/2013] [Indexed: 12/11/2022]
Abstract
In this Concepts & Synthesis paper, we expand the definition of chronodisruption in humans by proposing that it can be operationalized as the split nexus of internal and external times. With this premise, we suggest how chronotype may be used as a temporal marker (chronomarker) of exposure to chronodisruption in studies of cancer, and beyond, offer cancer risk predictions for observational research on the basis of a chronotype-related hypothesis and corollary, and point to first empirical data in humans. In an a priori way, we examine possible outcomes and perspectives for preventive measures following from our rationale and the suggested chronobiology-driven studies and close with overall advances of chronodisruption research.
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Affiliation(s)
- Thomas C Erren
- Institute and Policlinic for Occupational Medicine, Environmental Medicine, and Prevention Research, University of Cologne, Lindenthal, Cologne, Germany.
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Erren TC. Light exposure and melatonin among rotating shift nurses--letter. Cancer Epidemiol Biomarkers Prev 2012; 21:387. [PMID: 22313941 DOI: 10.1158/1055-9965.epi-11-1043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Erren TC. IARC's plea for traditional 'expert' working groups--a recipe for problems? Int J Epidemiol 2011; 40:1727-8; author reply 1728-31. [PMID: 22158674 DOI: 10.1093/ije/dyr155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Erren TC, Gross JV, Meyer-Rochow VB. Light, clocks, mood, and cancer: consolidation and novel tests of latitude and instability hypotheses. Chronobiol Int 2011; 28:471-3; author reply p 473. [PMID: 21721862 DOI: 10.3109/07420528.2011.577542] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Erren TC, Morfeld P. Attributing the burden of cancer at work: three areas of concern when examining the example of shift-work. EPIDEMIOLOGIC PERSPECTIVES & INNOVATIONS : EP+I 2011; 8:4. [PMID: 21962031 PMCID: PMC3198874 DOI: 10.1186/1742-5573-8-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 09/30/2011] [Indexed: 11/30/2022]
Abstract
This commentary intends to instigate discussions about epidemiologic estimates and their interpretation of attributable fractions (AFs) and the burden of disease (BOD) of cancers due to factors at workplaces. By examining recent work that aims to estimate the number of cancers attributable to shift-work in Britain, we suggest that (i) causal, (ii) practical and (iii) methodological areas of concern may deter us from attributable caseload estimations of cancers at this point in time. Regarding (i), such calculations may have to be avoided as long as we lack established causality between shift-work and the development of internal cancers. Regarding (ii), such calculations may have to be avoided as long as we can neither abandon shift-work nor identify personnel that may be unaffected by shift-work factors. Regarding (iii), there are at least four methodological pitfalls which are likely to make AF calculations uninterpretable at this stage. The four pitfalls are: (1) The use of Levin's 1953 formula in case of adjusted relative risks; (2) The use of broad definitions of exposure in calculations of AFs; (3) The non-additivity of AFs across different levels of exposure and covariables; (4) The fact that excess mortality counts are misleading due to the fact that a human being dies exactly once - a death may occur earlier or later, but a death cannot occur more than once nor can it be avoided altogether for any given individual. Overall, causal, practical and methodological areas of concern should be diligently considered when performing and interpreting AF or BOD computations which - at least at the present time - may not be defensible.
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Affiliation(s)
- Thomas C Erren
- Institute and Policlinic for Occupational Medicine, Environmental Medicine and Prevention Research, University of Cologne, Germany.
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Abstract
Circadian rhythms play an important role in the function of the body. Among others, the activity of the immune system is subject to daily variability which explains the different intensity of rheumatic symptoms during the day (e.g. morning stiffness). Circadian rhythms are subject to continuous adaptation via external time signals (zeitgebers), such as light-dark periods, time of food intake, as well as daily activity and resting periods. Following an acute phase shift of these external zeitgebers, e.g. via transmeridian travel (east-west or west-east), the body has to adjust all circadian systems to these new circumstances during an adjustment response, which lasts for several days. The classical symptoms of jet lag, such as tiredness during the day, mood swings and cognitive malfunction occur during this adjustment period. The impact of acute phase shifts as a result of transmeridian travel in subjects with rheumatic disorders, as well as strategies to prevent jet lag will be discussed in the following article.
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Affiliation(s)
- G Pongratz
- Labor für experimentelle Rheumatologie und Neuroendokrinoimmunologie, Klinik und Poliklinik für Innere Medizin I, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93042, Regensburg, Deutschland.
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Mezuk B, Abdou CM, Lee H, Jackson JS. Four of the Authors Reply. Am J Epidemiol 2011. [DOI: 10.1093/aje/kwr109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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van Mark A, Vitzthum K, Höndorf F, Kloss L, Quarcoo D, Groneberg DA. [Shift- and Nightwork - a scientometric analysis]. Wien Med Wochenschr 2011; 161:209-16. [PMID: 21442214 DOI: 10.1007/s10354-011-0890-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 01/05/2011] [Indexed: 11/30/2022]
Abstract
Economic restructuring processes in Germany require changes within all social and health care systems regarding night shiftwork. The aim of this paper was to analyse research results referring to shift- and nightwork using scientometric methods. A total of 3092 items could be detected. A constant increase in the number of publications per year since 1977, especially since 1990' was obvious. One third of the research results, a total of 884 articles could be assigned to the USA. Great Britain could be identified with 365 articles and France with 244 published articles. Sleep, Ergonomics and Chronobiology International are the most prolific journals. The Swedish scientist Torbjörn Akerstedt is to this date the most acclaimed researcher referring to his issue. He has written 105 articles about shift- and nightwork. He is not only a most efficient author, but also has the highest h-index [30]. Self-citations and multiple co-authorships distort parameters like impact factor and h-index enormously and should be regarded from a critical point of view.
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Affiliation(s)
- Anke van Mark
- Institut für Arbeitsmedizin, Universität Schleswig Holstein, Campus Lübeck, Lübeck, Germany
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