Association between light exposure at night and nighttime blood pressure in the elderly independent of nocturnal urinary melatonin excretion

Exposure to light at night (LAN) and risk of overweight/obesity, hypertension, and diabetes: a systematic review and meta-analysis

Current studies have presented conflicting findings regarding the associations between light at night (LAN) exposure and the risk of overweight/obesity, hypertension, and diabetes. Our study systematically summarized the evidence of the association between LAN exposure and the risk of overweight/obesity, hypertension, and diabetes. We searched five databases (PubMed, Web of Science, Embase, Scopus, and Cochrane) for observational studies published up to 1 August 2023. The pooled odds ratio (ORs) and 95% confidence intervals (CIs) were estimated by random-effects models for the association. Eighteen studies were included in the meta-analysis. Compared with the group with the lowest level of LAN, the group with the highest level of LAN is associated with an increased risk of overweight/obesity (pooled OR = 1.19, 95%CI: 1.13-1.26), hypertension (pooled OR: 1.86, 95% CI:1.28-2.72), and diabetes (pooled OR = 1.21, 95%CI: 1.07-1.31). Our meta-analysis demonstrated LAN exposure is associated with increased risk of overweight/obesity, hypertension, and diabetes.

Noise and light exposure and cardiovascular outcomes: A review of evidence, potential mechanisms and implications

Cardiovascular diseases (CVD) are the leading cause of global non-communicable disease-related deaths. In recent years there has been increasing discussion about the influence of environmental risk factors, including noise and light, on the occurrence and course of these conditions. Recent studies highlight the impact of road traffic noise on an elevated risk of stroke and increased mortality in the course of coronary artery disease (CAD). In the case of threats arising from light pollution, there are more limited published studies; however, these show an increased hospitalization risk associated with CAD. Existing analyses cannot dismiss these environmental factors, highlighting the need for further research. Future studies should investigate not only road traffic noise but also consider railway and aircraft noise. Additionally, research on light pollution should include younger individuals too. In the future, incorporating individual assessments of noise and light pollution exposure, along with the identification of particularly vulnerable groups, could contribute to refining methods of individual risk stratification and implementing new preventive strategies.

Artificial light at night affects the daily profile of pulse pressure and protein expression in the thoracic aorta of rats

Artificial light at night (ALAN) disrupts 24-h variability of blood pressure, but the molecular mechanisms underlying these effects are unknown. Therefore, we analysed the daily variability of pulse pressure, the maximum value of acceleration rate of aortic pressure (dP/dt(max)) measured by telemetry and protein expression in the thoracic aorta of normotensive male rats exposed to ALAN (1-2 lx) for 3 weeks. Daily, 24-h variability of pulse pressure and dP/dt(max) was observed during a regular light/dark regimen with higher values during the dark compared to the light phase of the day. ALAN suppressed 24-h variability and enhanced ultradian (<12-h) periods of pulse pressure and dP/dt(max) in duration-dependent manners. From beat-to-beat blood pressure variability, ALAN decreased low-frequency bands (a sympathetic marker) and had minimal effects on high-frequency bands. At the molecular level, ALAN decreased angiotensin II receptor type 1 expression and reduced 24-h variability. ALAN caused the appearance of 12-h oscillations in transforming growth factor β1 and fibulin 4. Expression of sarco/endoplasmic reticulum Ca2+-ATPase type 2 was increased in the middle of the light and dark phase of the day, and ALAN did not affect its daily and 12-h variability. In conclusion, ALAN suppressed 24-h variability of pulse pressure and dP/dt(max), decreased the power of low-frequency bands and differentially affected the expression of specific proteins in the rat thoracic aorta. Suppressed 24-h oscillations by ALAN underline the pulsatility of individual endocrine axes with different periods, disrupting the cardiovascular control of central blood pressure.

Environmental Impacts on Cardiovascular Health and Biology: An Overview

Environmental stressors associated with human activities (eg, air and noise pollution, light disturbance at night) and climate change (eg, heat, wildfires, extreme weather events) are increasingly recognized as contributing to cardiovascular morbidity and mortality. These harmful exposures have been shown to elicit changes in stress responses, circadian rhythms, immune cell activation, and oxidative stress, as well as traditional cardiovascular risk factors (eg, hypertension, diabetes, obesity) that promote cardiovascular diseases. In this overview, we summarize evidence from human and animal studies of the impacts of environmental exposures and climate change on cardiovascular health. In addition, we discuss strategies to reduce the impact of environmental risk factors on current and future cardiovascular disease burden, including urban planning, personal monitoring, and mitigation measures.

Neighborhood Light at Night and Noise Levels, and Long-Term Sleep Trajectories in the Southern Community Cohort Study

While light at night (LAN) and noise levels have been linked to suboptimal sleep outcomes, little is known about the link between these factors and long-term suboptimal sleep trajectories. The current study examined the association of neighborhood LAN and nighttime noise with long-term sleep trajectories in a cohort of Black individuals and White individuals predominantly from low-income communities. We used data from the Southern Community Cohort Study (N = 28,759 Black individuals and 16,276 White individuals). Sleep duration was self-reported at baseline and after an average of five years of follow-up, based on which we constructed nine sleep trajectories: normal-normal (optimal, reference), short-short, long-long, short-long, long-short, normal-short, normal-long, short-normal, and long-normal. LAN and nighttime noise were derived from satellite imagery and model-based estimates, respectively. Multinomial logistic regression was used to determine the relationship between LAN and noise exposures and sleep trajectories. Higher exposures to LAN and nighttime noise were associated with multiple suboptimal long-term sleep trajectories. In the total sample, higher LAN was associated with higher odds of long-long (OR Q5 vs. Q1 = 1.23 (CI = 1.02, 1.48)) and long-short (OR = 1.35 (CI = 1.06, 1.72)) trajectories, while higher nighttime noise was associated with short-short (1.19 (1.07, 1.31)), long-short (1.31 (1.05, 1.64)), and normal-song (1.16 (1.01, 1.34)) trajectories. Black and White individual-specific results showed qualitatively similar patterns between Black individuals and White individuals, although we also observed suggestive evidence for Black-White individual differences. In conclusion, elevated LAN and nighttime noise levels were associated with various suboptimal long-term sleep trajectories. However, it is noteworthy that the light and noise measures in our study may not accurately reflect individual-level exposures, and residual confounding from other factors is a concern. Future studies should use more accurate exposure measurements, collect information on and control for a wider range of factors, and examine whether reductions in neighborhood light and noise levels may contribute to improved long-term sleep health.

Artificial light at night suppresses the day-night cardiovascular variability: evidence from humans and rats

Artificial light at night (ALAN) affects most of the population. Through the retinohypothalamic tract, ALAN modulates the activity of the central circadian oscillator and, consequently, various physiological systems, including the cardiovascular one. We summarised the current knowledge about the effects of ALAN on the cardiovascular system in diurnal and nocturnal animals. Based on published data, ALAN reduces the day-night variability of the blood pressure and heart rate in diurnal and nocturnal animals by increasing the nocturnal values of cardiovascular variables in diurnal animals and decreasing them in nocturnal animals. The effects of ALAN on the cardiovascular system are mainly transmitted through the autonomic nervous system. ALAN is also considered a stress-inducing factor, as glucocorticoid and glucose level changes indicate. Moreover, in nocturnal rats, ALAN increases the pressure response to load. In addition, ALAN induces molecular changes in the heart and blood vessels. Changes in the cardiovascular system significantly depend on the duration of ALAN exposure. To some extent, alterations in physical activity can explain the changes observed in the cardiovascular system after ALAN exposure. Although ALAN acts differently on nocturnal and diurnal animals, we can conclude that both exhibit a weakened circadian coordination among physiological systems, which increases the risk of future cardiovascular complications and reduces the ability to anticipate stress.

Exposome in ischaemic heart disease: beyond traditional risk factors

Ischaemic heart disease represents the leading cause of morbidity and mortality, typically induced by the detrimental effects of risk factors on the cardiovascular system. Although preventive interventions tackling conventional risk factors have helped to reduce the incidence of ischaemic heart disease, it remains a major cause of death worldwide. Thus, attention is now shifting to non-traditional risk factors in the built, natural, and social environments that collectively contribute substantially to the disease burden and perpetuate residual risk. Of importance, these complex factors interact non-linearly and in unpredictable ways to often enhance the detrimental effects attributable to a single or collection of these factors. For this reason, a new paradigm called the 'exposome' has recently been introduced by epidemiologists in order to define the totality of exposure to these new risk factors. The purpose of this review is to outline how these emerging risk factors may interact and contribute to the occurrence of ischaemic heart disease, with a particular attention on the impact of long-term exposure to different environmental pollutants, socioeconomic and psychological factors, along with infectious diseases such as influenza and COVID-19. Moreover, potential mitigation strategies for both individuals and communities will be discussed.

Association between outdoor light at night and hypertension and high-normal blood pressure: A nationwide cross-sectional study among Chinese adults

The authors aimed to investigate the association between outdoor light at night (LAN) intensity and blood pressure. The study included 13 507 participants aged 45 and above from the 2011-2012 China Health and Retirement Longitudinal Study baseline survey. Blood pressure measurements were obtained by averaging the last two readings recorded (three measurements with an interval of 45-60 s between each measurement) during the survey. Outdoor LAN intensity was assessed using Defense Meteorological Satellite Program data. The study categorized participants based on quartiles of outdoor LAN intensity and employed statistical methods like linear regression, restricted cubic splines, and logistic models to analyze the connections. After adjusting for potential confounding factors, higher levels of outdoor LAN intensity were associated with increase in systolic blood pressure (0.592 mmHg/interquartile range [IQR], 95% confidence interval [CI]: 0.027,1.157), diastolic blood pressure (0.853 mmHg/IQR, 95% CI: 0.525,1.180) and mean arterial pressure (0.766 mmHg/IQR, 95% CI: 0.385,1.147). Interestingly, the relationship between LAN intensity and odds of hypertension followed a non-linear pattern, resembling a reverse "L" shape on cubic splines. Participants with the highest quartile of outdoor LAN intensity had 1.31-fold increased odds of hypertension (95% CI: 1.08-1.58) compared to the lowest quartile. Additionally, there was an observable trend of rising odds for high-normal blood pressure with higher levels of LAN intensity in the crude model, but no statistically significant differences were observed after adjusting for confounding factors. In conclusion, this study underscores a significant connection between outdoor LAN intensity and the prevalence of hypertension.

Nighttime Outdoor Artificial Light and Risk of Age-Related Macular Degeneration

Importance

Light pollution's impact on human health is increasingly recognized, but its link to exudative age-related macular degeneration (EAMD) remains unclear.

Objective

To investigate the association between exposure to outdoor artificial light at night (OALAN) and the risk of incident EAMD.

Design, Setting, and Participants

In this nationwide population-based case-control study, all individuals 50 years or older with newly diagnosed EAMD between January 1, 2010, and December 31, 2011, were identified with reference to the Korean National Health Insurance Service registration program database for rare and intractable diseases. Birth year- and sex-matched controls (with no EAMD diagnosis until 2020) were selected at a 1:30 ratio. Data were acquired from May 1 to December 31, 2021, and analyzed from June 1 to November 30, 2022.

Exposures

Mean levels of OALAN at participants' residential addresses during 2008 and 2009 were estimated using time-varying satellite data for a composite view of persistent nighttime illumination at an approximate scale of 1 km2.

Main Outcomes and Measures

The hazard ratios (HRs) and 95% CIs of the association between residential OALAN and risk of incident EAMD were determined based on maximum likelihood estimation after adjusting for sociodemographic characteristics, comorbidities, and area-level risk factors (ie, nighttime traffic noise and particulate matter of aerodynamic diameter ≤10 μm in each participant's administrative district of residence).

Results

A total of 126 418 participants were included in the analysis (mean [SD] age, 66.0 [7.9] years; 78 244 men [61.9%]). Of these, 4078 were patients with newly diagnosed EAMD and 122 340 were EAMD-free matched controls. In fully adjusted models, an IQR (55.8 nW/cm2/sr) increase in OALAN level was associated with an HR of 1.67 (95% CI, 1.56-1.78) for incident EAMD. The exposure-response curve demonstrated a nonlinear, concave upward slope becoming more pronounced at higher levels of light exposure (ie, at approximately 110 nW/cm2/sr). In a subgroup analysis, an IQR increase in OALAN was associated with increased risk of incident EAMD in urban areas (HR, 1.46 [95% CI, 1.33-1.61]) but not in rural areas (HR, 1.01 [95% CI, 0.84-1.22]).

Conclusions and Relevance

In this nationwide population-based case-control study, higher levels of residential OALAN were associated with an increased risk of incident EAMD. Future studies with more detailed information on exposure, individual adaptive behaviors, and potential mediators are warranted.

Circadian Disruption and the Molecular Clock in Atherosclerosis and Hypertension

Circadian rhythms are crucial for maintaining vascular function and disruption of these rhythms are associated with negative health outcomes including cardiovascular disease and hypertension. Circadian rhythms are regulated by the central clock within the suprachiasmatic nucleus of the hypothalamus and peripheral clocks located in nearly every cell type in the body, including cells within the heart and vasculature. In this review, we summarize the most recent preclinical and clinical research linking circadian disruption, with a focus on molecular circadian clock mechanisms, in atherosclerosis and hypertension. Furthermore, we provide insight into potential future chronotherapeutics for hypertension and vascular disease. A better understanding of the influence of daily rhythms in behaviour, such as sleep/wake cycles, feeding, and physical activity, as well as the endogenous circadian system on cardiovascular risk will help pave the way for targeted approaches in atherosclerosis and hypertension treatment/prevention.

The Environmental Pollution and Cardiovascular Risk: The Role of Health Surveillance and Legislative Interventions in Cardiovascular Prevention

Environmental pollution in considered an established determinant of non-communicable illness, including cardiovascular diseases (CVDs). Air pollution is the result of a complex combination of chemical, physical, and biological agents, and represents one of the main causes of mortality and morbidity in the world population. It is responsible for 7.6% of global mortality. In this regard, it has been documented that it increases the risk of CVDs and major adverse cardiovascular and cerebrovascular events. In northern regions of China, long-term exposures to the particulate matter < 2.5 µm (PM2.5) increase in the risk of ischemic heart disease by almost two-folds. Similarly, the additional risk for stroke, increases by almost 10% for long-term exposure to PM2.5. The detrimental effects of air pollution on cardiovascular system are particularly manifest in vulnerable subjects, such as the elderly, patients with heart disease, and obese individuals. Therefore, nowadays, cardiovascular prevention strategies, in addition to controlling traditional risk factors, should also include measures to improve the environment. This goal can be achieved by the implementation of the health surveillance in occupational medicine and by the extensive application of the national and international legislative measures. In fact, the health surveillance represents a crucial preventive measure for workers exposed to health risks (chemical, physical agents, etc.) that may lead to occupational diseases after long-term exposure. On the other hand, since environmental pollution does not recognize well-defined boundaries, only the implementation of regulations among large territorial areas can be useful to improve the quality of environment.

Association of exposure to artificial light at night during adolescence with blood pressure in early adulthood

Artificial light at night (ALAN) is related to various diseases, such as cancer, obesity, and coronary heart disease. However, its impact on blood pressure in adolescents is not well understood. To investigate this, we conducted a cross-sectional study with a nationwide sample of college students in China, who were freshmen from four disperse universities during Sep. and Oct. 2018. Mean levels of ALAN at participants' residential addresses during 2013-2018 were estimated using time-varying satellite data. The association of the 6-y average of ALAN with blood pressure was estimated by using generalized linear mixed models. A total of 17 046 participants (18.2 ± 0.7 y of age, 46.79% female) from 2,412 counties and cities were included in the final analysis. After a full adjustment for potential confounders, ALAN was positively associated with systolic blood pressure (β = 0.20, p = 0.032) and pulse pressure (β = 0.28, p  = 0.001), but there was no association between ALAN and diastolic blood pressure (β = -0.08, p = 0.213). In the sensitivity analysis, the results consistent with the main analysis were observed. The blood pressure of males and those with a BMI ≤24 kg/m2 were more susceptible to ALAN exposure. Our findings highlight the importance of ALAN management for blood pressure control, particularly among male and normal-weight individuals.

Environmental exposures and blood pressure in adolescents and adults in the T1D exchange clinic registry

AIMS

To examine the associations between environmental determinants of health and blood pressure and whether age, sex, or race moderated the associations among 18,754 adolescents and adults from the type 1 diabetes (T1D) Exchange Clinic Registry.

METHODS

We used multivariable linear regression. Environmental determinants included exposure to ambient fine particulate matter (PM2.5, obtained from an integrated model), nitrogen dioxide (NO2), noise and light pollution, and the normalized difference vegetation index (NDVI, a marker of green space) at the ZIP code level of residence.

RESULTS

Higher exposure to PM2.5 and NO2, and lower NDVI, was associated with higher systolic and diastolic blood pressure, and higher light pollution exposure were similarly associated with higher diastolic blood pressure. These associations between environmental exposures and blood pressure remained significant after accounting for other covariates (age, sex, race/ethnicity, BMI, and T1D duration). With aging, the negative association between NDVI and blood pressure weakened.

CONCLUSIONS

These findings emphasize the significance of minimizing exposure to environmental pollutants, including PM2.5 and NO2, as well as ensuring access to areas with higher NDVI, to promote cardiovascular health in individuals with T1D.

Association of outdoor artificial light at night with metabolic syndrome and the modifying effect of tree and grass cover

BACKGROUND

Epidemiological studies show that outdoor artificial light at night (ALAN) is linked to metabolic hazards, but its association with metabolic syndrome (MetS) remains unclear. We aimed to investigate the association of outdoor ALAN with MetS in middle-aged and elderly Chinese.

METHODS

From 2017-2020, we conducted a cross-sectional study in a total of 109,452 participants living in ten cities of eastern China. MetS was defined by fasting blood glucose (FG), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), blood pressure (BP), and waist circumference (WC). In 2021, we followed up 4395 participants without MetS at the baseline. Each participant's five-year average exposure to outdoor ALAN, as well as their exposure to green space type, were measured through matching to their address. Generalized linear models were used to assess the associations of outdoor ALAN with MetS. Stratified analyses were performed by sex, age, region, physical activity, and exposure to green space.

RESULTS

In the cross-sectional study, compared to the first quantile (Q1) of outdoor ALAN exposure, the odds ratios (ORs) of MetS were 1.156 [95 % confidence interval (CI): 1.111-1.203] and 1.073 (95 %CI: 1.021-1.128) respectively in the third and fourth quantiles (Q3, Q4) of outdoor ALAN exposure. The follow-up study found that, compared to the first quantile (Q1) of outdoor ALAN exposure, the OR of MetS in Q4 of ALAN exposure was 1.204 (95 %CI: 1.019-1.422). Adverse associations of ALAN with MetS components, including high FG, high TG, and obesity, were also found. Greater associations of ALAN with MetS were found in males, the elderly, urban residents, those with low frequency of physical activity, and those living in areas with low levels of grass cover and tree cover.

CONCLUSIONS

Outdoor ALAN exposure is associated with an increased MetS risk, especially in males, the elderly, urban residents, those lacking physical activity, and those living in lower levels of grass cover and tree cover.

Exposure to outdoor artificial light at night increases risk and burden of metabolic disease in Ningxia, China

Nearly a quarter of the world's land has already been polluted by artificial light. And numerous human and animal studies have corroborated that light at night can disrupt metabolism. Therefore, we aimed to estimate the association between outdoor artificial light at night (ALAN) and the presence of metabolic disease. Daily hospital admission cases from Ningxia, China, between 2014 and 2020 were included. Cumulative associations between outdoor ALAN and metabolic disease were estimated using logistic regression and distributed lagged non-linear models (DLNM) with lags of 0-30 days and stratified analysis by age groups and gender. The results suggest that 26.80% of metabolic disease cases in Ningxia can be attributed to outdoor ALAN and that men, especially in men aged 46-59 years, are more susceptible to lighting. Policymakers need to develop measures and facilities in corresponding areas, such as universal access to indoor blackout curtains. In particular, men should be urged to minimize going outside at night and to develop protective measures specifically for men.

Outdoor light at night, genetic predisposition and type 2 diabetes mellitus: A prospective cohort study

BACKGROUND

According to animal and human epidemiologic studies, exposure to outdoor light at night (LAN) may cause circadian disruption, which may disturb sleep quality and lead to incident type 2 diabetes mellitus (T2DM).

METHODS

We followed 283,374 persons from 2006 through 2020. Outdoor LAN exposure was estimated using satellite data for individual address with 500 m² scale buffer during follow-up. Incidence of T2DM was confirmed by hospital inpatient records. We identified potential confounders by a directed acyclic graph, including demographic, genetic, individual and regional level socioeconomic status, and environmental risk factors, and calculated hazard ratios (HRs) and 95% confidence intervals (CIs) through time-varying Cox proportional hazard model. Furthermore, we examined the association of outdoor LAN with a defined health sleep scores and moderation of genetic predisposition and shift work on the relationship of outdoor LAN and incident T2DM.

RESULTS

We identified 7,775 incident T2DM cases over 3,027,505 person-years. Higher outdoor LAN exposures were significantly associated with higher risk of T2DM. The estimated HR for incident T2DM with an interquartile range (IQR: 11.22 nW/cm²/sr) increase in outdoor LAN was 1.05 (95%CI: 1.01, 1.09) in the fully adjusted model. Participants who lived in the highest quarter of outdoor LAN area were more likely to develop T2DM (HR: 1.14,95%CI: 1.02, 1.27). Besides, those who were exposed to higher levels of outdoor LAN had poorer sleep quality. No moderation role of PRS on outdoor LAN-induced T2DM observed both on the multiplicated and additive scale. The hazards of outdoor LAN were observed in those who never owned a night shift work.

CONCLUSION

Although further work is required to clarify potential mechanisms, our findings indicate that exposure to residential outdoor LAN may contribute to T2DM risk and low sleep quality.

Outdoor light at night in relation to glucose homoeostasis and diabetes in Chinese adults: a national and cross-sectional study of 98,658 participants from 162 study sites

AIMS/HYPOTHESIS

Exposure to artificial light at night (LAN) disrupts the circadian timing system and might be a risk factor for diabetes. Our aim was to estimate the associations of chronic exposure to outdoor LAN with glucose homoeostasis markers and diabetes prevalence based on a national and cross-sectional survey of the general population in China.

METHODS

The China Noncommunicable Disease Surveillance Study was a nationally representative study of 98,658 participants aged ≥18 years who had been living in their current residence for at least 6 months recruited from 162 study sites across mainland China in 2010. Diabetes was defined according to ADA criteria. Outdoor LAN exposure in 2010 was estimated from satellite data and the participants attending each study site were assigned the same mean radiance of the outdoor LAN at the study site. The linear regression incorporating a restricted cubic spline function was used to explore the relationships between LAN exposure and markers of glucose homoeostasis. Cox regression with a constant for the time variable assigned to all individuals and with robust variance estimates was used to assess the associations between the levels of outdoor LAN exposure and the presence of diabetes by calculating the prevalence ratios (PRs) with adjustment for age, sex, education, smoking status, drinking status, physical activity, family history of diabetes, household income, urban/rural areas, taking antihypertensive medications, taking lipid-lowering medications, and BMI.

RESULTS

The mean age of the study population was 42.7 years and 53,515 (weighted proportion 49.2%) participants were women. Outdoor LAN exposure levels were positively associated with HbA_1c, fasting and 2 h glucose concentrations and HOMA-IR and negatively associated with HOMA-B. Diabetes prevalence was significantly associated with per-quintile LAN exposure (PR 1.07 [95% CI 1.02, 1.12]). The highest quintile of LAN exposure (median 69.1 nW cm^-2 sr^-1) was significantly associated with an increased prevalence of diabetes (PR 1.28 [95% CI 1.03, 1.60]) compared with the lowest quintile of exposure (median 1.0 nW cm^-2 sr^-1).

CONCLUSIONS/INTERPRETATION

There were significant associations between chronic exposure to higher intensity of outdoor LAN with increased risk of impaired glucose homoeostasis and diabetes prevalence. Our findings contribute to the growing evidence that LAN is detrimental to health and point to outdoor LAN as a potential novel risk factor for diabetes.

Physical activity alleviates negative effects of bedroom light pollution on blood pressure and hypertension in Chinese young adults

Excessive exposure to light at night (LAN) has become a serious public health concern. However, little is known about the impact of indoor LAN exposure on blood pressure, particularly among young adults. We aimed to investigate the effects of bedroom individual-level LAN exposure in real-world environment on blood pressure and hypertension among vulnerable young adults, and to evaluate the possible buffering effect of physical activity. In this cross-sectional study, a total of 400 healthy young adults aged 16-22 years were included. Bedroom LAN exposure was recorded at 1-min intervals for two consecutive nights using a TES-1339 R illuminance meter. Blood pressure was measured three times (8-11 a.m. in the physical examination day) in the seated position using an Omron HEM-7121 digital sphygmomanometer. A wrist-worn triaxial accelerometer (ActiGraph GT3X-BT) was used to assess physical activity for seven consecutive days. Each 1 lx increase of bedroom LAN intensity was associated with 0.55 mmHg-increase in SBP (95% CI: 0.15, 0.95), 0.30 mmHg-increase in DBP (95% CI: 0.06, 0.54), and 0.38 mmHg-increase in MAP (95% CI: 0.12, 0.65). Higher levels of LAN exposure were associated with increased risk of hypertension (LAN ≥ 3lx vs. LAN < 3lx: OR = 3.30, 95%CI = 1.19-9.19; LAN ≥ 5lx vs. LAN < 5lx: OR = 3.87, 95%CI = 1.37-10.98). However, these detrimental effects of bedroom LAN exposure on blood pressure and hypertension were not observed among young adults with high MVPA (≥2 h/day) level. MVPA can alleviate negative effects of bedroom LAN exposure on blood pressure and hypertension. Maintaining bedroom settings darkness at night may be an important strategy for reducing the risk of hypertension. Furthermore, for individuals living with high levels of indoor LAN exposure, regular physical activity may be a good option for preventing cardiovascular disease and hypertension.

Association of perceptions of artificial light-at-night, light-emitting device usage and environmental noise appraisal with psychological distress, sleep quality and chronotype: A cross sectional study

Exposure to artificial light-at-night (ALAN) is increasing globally, and there are concerns around how ALAN may impact sleep, psychological and physical health. However, there is a lack of evidence in the literature on how individuals perceive ALAN relative to their sleeping environment and habits, and how such perceptions correspond to objectively assessed night-time illuminance at the level of the residence. This cross-sectional study examined how such perceptions associate with sleep quality, sleep timing, psychological distress and cognitive failures. Further we examined the association between illuminance levels calculated as the biologically-relevant melatonin-suppression index (MSI) and the self-report of perception of ALAN. Five hundred and fifty two adult participants completed a survey addressing perception of ALAN in sleep environment along with the Pittsburgh Sleep Quality Index, Munich Chronotype Questionnaire, Cognitive Failure Questionnaire and the General Health Questionnaire. We report that perception of external ALAN in the sleeping environment was associated with poorer sleep quality, more cognitive failures and greater psychological distress, when controlling for age, sex, house location and MSI. No associations were found between the perception of external ALAN and MSI scores, and MSI scores were not associated with scores on any of the self-report measures. Internal lighting passing into the sleeping environment was associated with poorer sleep quality but not with psychological wellbeing. Habitual use of light-emitting devices was associated with poorer psychological wellbeing but not with sleep quality and sleep timing. Perception of environmental noise annoyance at night was associated with higher psychological distress and poorer quality sleep, and the perception of noise annoyance was associated with perception of ALAN. These results may suggest heightened attentional bias towards ALAN associated with poor sleep quality and higher levels of psychological distress, and highlight the need for more granular approaches in the study of ALAN and sleep and psychological health in terms of levels individual ALAN exposure, and an interpretation that seeks to integrate biological and psychological perspectives.

Association between bedroom light exposure at night and allostatic load among Chinese young adults

Light at night (LAN) has received increasing attention for its potential health hazards to human and animals. However, to our knowledge, no study has explored the specific effects of bedroom nighttime light exposure on allostatic load (AL). To investigate the association between bedroom individual-level LAN exposure and AL among young adults, an integrative index manifests multiple system dysregulation. Using data from a cohort of 484 Chinese young adults aged 16-22 years. Bedroom light was objectively recorded at 1-min intervals for two nights using a portable illuminance meter. Fasting blood samples were collected at one-year follow-up for the detection of AL parameters. AL score was derived as sum of the top quartile of twelve physiological biomarkers in four systems: metabolic system (BMI, WC, TC, HDL, LDL, TG, HbA1c, INS, GLU); cardiovascular system (SBP, DBP); immune and inflammatory systems (hs-CRP), with HDL was lowest quartile. Univariate and multivariate linear regression models were used to evaluate the association between LAN intensity with AL score and separate AL parameters. The average age of subjects was 18.7 years, 64.3% were female. The mean AL score of LAN group (average LAN intensity ≥ 3lx) was significantly higher than Dim group (3.6 ± 2.6 vs. 2.7 ± 2.1; P = 0.007). For each 1 lx increase of LAN intensity was associated with 0.15-unit increase in AL score (95% CI: 0.06, 0.24; P = 0.001). Moreover, LAN group was associated with increased 1.01-unit in AL score (95% CI: 0.36-1.66; P = 0.003) compared to Dim group. Significant associations between bedroom LAN exposure with allostatic load and separate AL biomarkers were observed in our study. Keeping bedroom darkness at night may be a practicable option to reduce the wear of multiple body systems and improve human cardiometabolic health from early in life.

Exposure to dim light at night alters daily rhythms of glucose and lipid metabolism in rats

Nocturnal light pollution has been rapidly increasing during the last decades and even though dim artificial light at night (ALAN) has been associated with metabolic diseases, its mechanism is still far from clear. Therefore, the aim of our study was to thoroughly analyze the effects of ALAN on energy metabolism, metabolites, metabolic hormones, and gene expression. Male Wistar rats were kept in either the standard light:dark (12:12) cycle or exposed to ALAN (∼2 lx) during the whole 12-h dark phase for 2 weeks. Energy metabolism was measured in metabolic cages. In addition, we measured plasma and hepatic metabolites, clock and metabolic gene expression in the liver and epididymal adipose tissue, and plasma hormone levels. In ALAN rats, we observed an unexpected transitory daytime peak of locomotor activity and a suppression of the peak in locomotor activity at the beginning of the dark period. These changes were mirrored in the respiratory exchange ratio. Plasma metabolites became arrhythmic, and plasma and hepatic cholesterol levels were increased. Lost rhythmicity of metabolites was associated with disrupted behavioral rhythms and expression of metabolic genes. In the liver, the rhythms of metabolic sensors were either phase-advanced (Ppara, Pgc1a, Nampt) or arrhythmic (Sirt1, Lxra) after ALAN. The rhythmic pattern of Ppara and Sirt1 was abolished in the adipose tissue. In the liver, the amplitude of the daily rhythm in glycogen content was attenuated, the Glut2 rhythm was phase-advanced and Foxo1 lost its daily rhythmicity. Moreover, hepatic Foxo1 and Gck were up-regulated after ALAN. Interestingly, several parameters of lipid metabolism gained rhythmicity (adiponectin, Hmgcs2, Lpl, Srebf1c) in the liver, whereas Noct became arrhythmic in the adipose tissue. Peripheral clock genes maintained their robust oscillations with small shifts in their acrophases. Our data show that even a low level of ALAN can induce changes in the daily pattern of behavior and energy metabolism, and disturb daily rhythms of genes encoding key metabolic sensors and components of metabolic pathways in the liver and adipose tissue. Disturbed metabolic rhythms by ALAN could represent a serious risk factor for the development and progression of metabolic diseases.

Environmental light exposure and mealtime regularity: Implications for human health

Light exposure and mealtime act as cues to the human circadian rhythm, which subsequently regulates various physiological functions in the body. However, modernization alters lifestyles, with changes to social and work-related activities independent of the natural light-dark cycle. This review summarizes the role of light exposure and regular mealtime on bodily processes and, ultimately, metabolic health. Various aspects of light are reviewed, including the type of light (natural/artificial), intensity (lux), spectral composition, time of exposure (night/day), and exposure duration. Further, the possible relationship between light exposure and mealtime irregularity is discussed as a function affecting metabolic health. In essence, research evidence suggests that mealtime regularity and light exposure habits based on the natural occurring light-dark cycle are essential for metabolic health in relation to an aligned circadian rhythm.

Role of circadian rhythm and impact of circadian rhythm disturbance on the metabolism and disease

ABSTRACT

Molecular circadian clocks exist in almost all cells of the organism and operate for approximately 24 h, maintain the normal physiological and behavioral body processes and regulate metabolism of many cells related to a variety of disease states. Circadian rhythms regulate metabolism, mainly including neurotransmitters, hormones, amino acids and lipids. Circadian misalignment is related to metabolic syndromes, such as obesity, diabetes and hypertension, which have reached an alarming level in modern society. We reviewed the mechanism of the circadian clock and the interaction between circadian rhythm and metabolism, as well as circadian rhythm disturbance on the metabolism of hypertension, obesity and diabetes. Finally, we discuss how to use the circadian rhythm to prevent diseases. Thus, this review is a micro to macro discussion from the perspective of circadian rhythm and aims to provide basic ideas for circadian rhythm research and disease therapies.

Environmental risk factors and cardiovascular diseases: a comprehensive review

Noncommunicable diseases (NCDs) are fatal for more than 38 million people each year and are thus the main contributors to the global burden of disease accounting for 70% of mortality. The majority of these deaths are caused by cardiovascular disease. The risk of NCDs is strongly associated with exposure to environmental stressors such as pollutants in the air, noise exposure, artificial light at night and climate change, including heat extremes, desert storms and wildfires. In addition to the traditional risk factors for cardiovascular disease such as diabetes, arterial hypertension, smoking, hypercholesterolemia and genetic predisposition, there is a growing body of evidence showing that physicochemical factors in the environment contribute significantly to the high NCD numbers. Furthermore, urbanization is associated with accumulation and intensification of these stressors. This comprehensive expert review will summarize the epidemiology and pathophysiology of environmental stressors with a focus on cardiovascular NCDs. We will also discuss solutions and mitigation measures to lower the impact of environmental risk factors with focus on cardiovascular disease.

Heart healthy cities: genetics loads the gun but the environment pulls the trigger

The world's population is estimated to reach 10 billion by 2050 and 75% of this population will live in cities. Two-third of the European population already live in urban areas and this proportion continues to grow. Between 60% and 80% of the global energy use is consumed by urban areas, with 70% of the greenhouse gas emissions produced within urban areas. The World Health Organization states that city planning is now recognized as a critical part of a comprehensive solution to tackle adverse health outcomes. In the present review, we address non-communicable diseases with a focus on cardiovascular disease and the urbanization process in relation to environmental risk exposures including noise, air pollution, temperature, and outdoor light. The present review reports why heat islands develop in urban areas, and how greening of cities can improve public health, and address climate concerns, sustainability, and liveability. In addition, we discuss urban planning, transport interventions, and novel technologies to assess external environmental exposures, e.g. using digital technologies, to promote heart healthy cities in the future. Lastly, we highlight new paradigms of integrative thinking such as the exposome and planetary health, challenging the one-exposure-one-health-outcome association and expand our understanding of the totality of human environmental exposures.

Prenatal hypoxia increases blood pressure in male rat offspring and affects their response to artificial light at night

Prenatal hypoxia (PH) has negative consequences on the cardiovascular system in adulthood and can affect the responses to additional insults later in life. We explored the effects of PH imposed during embryonic day 20 (10.5% O2 for 12 h) on circadian rhythms of systolic blood pressure (BP) and heart rate (HR) in mature male rat offspring measured by telemetry. We evaluated: (1) stability of BP and HR changes after PH; (2) circadian variability of BP and HR after 2 and 5 weeks of exposure to artificial light at night (ALAN; 1-2 lx); and (3) response of BP and HR to norepinephrine. PH increased BP in the dark (134 ± 2 mmHg vs. control 127 ± 2 mmHg; p = 0.05) and marginally in the light (125 ± 1 mmHg vs. control 120 ± 2 mmHg) phase of the day but not HR. The effect of PH was highly repeatable between 21- and 27-week-old PH male offspring. Two weeks of ALAN decreased the circadian variability of HR (p < 0.05) and BP more in control than PH rats. After 5 weeks of ALAN, the circadian variability of HR and BP were damped compared to LD and did not differ between control and PH rats (p < 0.05). Responses of BP and HR to norepinephrine did not differ between control and PH rats. Hypoxia at the end of the embryonic period increases BP and affects the functioning of the cardiovascular system in mature male offspring. ALAN in adulthood decreased the circadian variability of cardiovascular parameters, more in control than PH rats.

Effects of dim artificial light at night on locomotor activity, cardiovascular physiology, and circadian clock genes in a diurnal songbird

Artificial light is transforming the nighttime environment and quickly becoming one of the most pervasive pollutants on earth. Across taxa, light entrains endogenous circadian clocks that function to synchronize behavioral and physiological rhythms with natural photoperiod. Artificial light at night (ALAN) disrupts these photoperiodic cues and has consequences for humans and wildlife including sleep disruption, physiological stress and increased risk of cardiovascular disease. However, the mechanisms underlying organismal responses to dim ALAN, resembling light pollution, remain elusive. Light pollution exists in the environment at lower levels (<5 lux) than tested in many laboratory studies that link ALAN to circadian rhythm disruption. Few studies have linked dim ALAN to both the upstream regulators of circadian rhythms and downstream behavioral and physiological consequences. We exposed zebra finches (Taeniopygia gutatta) to dim ALAN (1.5 lux) and measured circadian expression of five pacemaker genes in central and peripheral tissues, plasma melatonin, locomotor activity, and biomarkers of cardiovascular health. ALAN caused an increase in nighttime activity and, for males, cardiac hypertrophy. Moreover, downstream effects were detectable after just short duration exposure (10 days) and at dim levels that mimic the intensity of environmental light pollution. However, ALAN did not affect circulating melatonin nor oscillations of circadian gene expression in the central clock (brain) or liver. These findings suggest that dim ALAN can alter behavior and physiology without strong shifts in the rhythmic expression of molecular circadian pacemakers. Approaches that focus on ecologically-relevant ALAN and link complex biological pathways are necessary to understand the mechanisms underlying vertebrate responses to light pollution.

Effects of Experimental Sleep Restriction on Ambulatory and Sleep Blood Pressure in Healthy Young Adults: A Randomized Crossover Study

[Figure: see text].

The diversity of photosensitivity and its implications for light pollution

Artificial light at night (ALAN) is a pervasive anthropogenic pollutant, emanating from urban and suburban developments and reaching nearly all ecosystems from dense forests to coastlines. One proposed strategy for attenuating the consequences of ALAN is to modify its spectral composition to forms that are less disruptive for photosensory systems. However, ALAN is a complicated pollutant to manage due to the extensive variation in photosensory mechanisms and the diverse ways these mechanisms manifest in biological and ecological contexts. Here, we highlight the diversity in photosensitivity across taxa and the implications of this diversity in predicting biological responses to different forms of night lighting. We curated this paper to be broadly accessible and inform current decisions about the spectrum of electric lights used outdoors. We advocate that efforts to mitigate light pollution should consider the unique ways species perceive ALAN, as well as how diverse responses to ALAN scale up to produce diverse ecological outcomes.

Sleep and Cardiovascular Risk

Sleep is essential for healthy being and healthy functioning of human body as a whole, as well as each organ and system. Sleep disorders, such as sleep-disordered breathing, insomnia, sleep fragmentation, and sleep deprivation are associated with the deterioration in human body functioning and increased cardiovascular risks. However, owing to the complex regulation and heterogeneous state sleep per se can be associated with cardiovascular dysfunction in susceptible subjects. The understanding of sleep as a multidimensional concept is important for better prevention and treatment of cardiovascular diseases.

Artificial light at night suppresses the expression of sarco/endoplasmic reticulum Ca2+ -ATPase in the left ventricle of the heart in normotensive and hypertensive rats

NEW FINDINGS

What is the central question of this study? Artificial light at night decreases blood pressure and heart rate in rats. Are these changes in heart rate accompanied by changes in protein expression in the heart's left ventricle? What is the main finding and its importance? Five weeks of artificial light at night affected protein expression in the heart's left ventricle in normotensive and hypertensive rats. Artificial light at night decreased expression of the sarco/endoplasmic reticulum Ca²⁺ -ATPase, angiotensin II receptor type 1 and endothelin-1.

ABSTRACT

Artificial light at night (ALAN) affects the circadian rhythm of the heart rate in normotensive Wistar rats (WT) and spontaneously hypertensive rats (SHR) through the autonomic nervous system, which regulates the heart's activity through calcium handling, an important regulator in heart contractility. We analysed the expression of the sarco/endoplasmic reticulum Ca²⁺ -ATPase (SERCA2) and other selected regulatory proteins involved in the regulation of heart contractility, angiotensin II receptor type 1 (AT₁ R), endothelin-1 (ET-1) and tyrosine hydroxylase (TH), in the left ventricle of the heart in WT and SHR after 2 and 5 weeks of ALAN with intensity 1-2 lx. Expression of SERCA2 was decreased in WT (control: 0.53 ± 0.07; ALAN: 0.46 ± 0.10) and SHR (control: 0.72 ± 0.18; ALAN: 0.56 ± 0.21) after 5 weeks of ALAN (P = 0.067). Expression of AT₁ R was significantly decreased in WT (control: 0.51 ± 0.27; ALAN: 0.34 ± 0.20) and SHR (control: 0.38 ± 0.07; ALAN: 0.23 ± 0.09) after 2 weeks of ALAN (P = 0.028) and in SHR after 5 weeks of ALAN. Expression of ET-1 was decreased in WT (control: 0.51 ± 0.27; ALAN: 0.28 ± 0.12) and SHR (control: 0.54 ± 0.10; ALAN: 0.35 ± 0.23) after 5 weeks of ALAN (P = 0.015). ALAN did not affect the expression of TH in WT or SHR. In conclusion, ALAN suppressed the expression of SERCA2, AT₁ R and ET-1, which are important for the regulation of heart contractility, in a strain-dependent pattern in both WT and SHR.

Outdoor light at night and risk of coronary heart disease among older adults: a prospective cohort study

AIMS

We estimated the association between outdoor light at night at the residence and risk of coronary heart disease (CHD) within a prospective cohort of older adults in Hong Kong.

METHODS AND RESULTS

Over a median of 11 years of follow-up, we identified 3772 incident CHD hospitalizations and 1695 CHD deaths. Annual levels of outdoor light at night at participants' residential addresses were estimated using time-varying satellite data for a composite of persistent night-time illumination at ∼1 km2 scale. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of the association between outdoor light at night at the residence and risk of CHD. The association between light at night and incident CHD hospitalization and mortality exhibited a monotonic exposure-response function. An interquartile range (IQR) (60.0 nW/cm2/sr) increase in outdoor light at night was associated with an HR of 1.11 (95% CI: 1.03, 1.18) for CHD hospitalizations and 1.10 (95% CI: 1.00, 1.22) for CHD deaths after adjusting for both individual and area-level risk factors. The association did not vary across strata of hypothesized risk factors.

CONCLUSION

Among older adults, outdoor light at night at the residence was associated with a higher risk of CHD hospitalizations and deaths. We caution against causal interpretation of these novel findings. Future studies with more detailed information on exposure, individual adaptive behaviours, and potential mediators are warranted to further examine the relationship between light at night and CHD risk.

Chronic Exposure to Continuous Brightness or Darkness Modulates Immune Responses and Ameliorates the Antioxidant Enzyme System in Male Rats

Circadian rhythms are considered vital regulators of immune functions. This study aims to elucidate the effects of chronic circadian disruption on immune functions, clock genes expression, and antioxidant enzymes levels in lymphoid tissues. Adult male Sprague-Dawley rats were subjected to a normal light/dark cycle or either continuous light (LL) or continuous dark (DD) for 8 weeks. The results demonstrated (1) significant decreases in the circulating levels of interleukin 1β, interleukin 6 and tumor necrosis factor alpha (TNF-α) and significant increases in the levels of interleukin 10, interleukin 12, C-reactive protein (CRP) and corticosterone in both LL and DD groups; (2) upregulation in mRNA expression of core clock genes Cry1, Cry2, Per1, Per2, and Per3 in the spleen of the DD group and downregulation in Cry1 and Cry2 genes in the LL group; (3) elevation of total antioxidant capacity (TAC), superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), nitric oxide (NO) and the lipid peroxidation marker malondialdehyde (MDA) in the spleen, lymph node and bone marrow of both the LL and DD groups and decreases in the levels of the same markers in the thymus of the LL group; (4) decreased numbers of CD4⁺ and CD8⁺ cells in lymphoid tissues of both the LL and the DD groups; (5) reduced platelets count and suppressed immunoglobulin (IgM, IgE) in the LL and DD groups with marked erythropenia and leukocytosis in the DD group. Taken together, circadian misalignment leads to hematological disruptions, dysregulation of clock genes, and inflammatory mediators, which further enhances the antioxidant enzyme system that is crucial for an organism's adaptation to stresses.

Dim Light at Night Impairs Daily Variation of Circulating Immune Cells and Renal Immune Homeostasis

Dim light at night (dLAN) has become a pervasive part of the modern world, and growing evidence shows its association with increased health risks. Though this link is attributed to a disturbed circadian clock, the underlying mechanisms that can explain how circadian disruption from dLAN causes negative health effects remain unclear. Here, we exposed rats to a light–dark cycle (12:12 h) with low-intensity light at night (~2 lx) for 2 and 5 weeks and explored the steady-state pattern of circulating immune cells and renal immune-related markers, which are well controlled by the circadian clock. After 5 weeks, dLAN impaired the daily variation in several types of white blood cells, especially monocytes and T cells. Two-week dLAN caused a reduction in blood monocytes and altered gene expression of macrophage marker Cd68 and monocyte-attracting chemokine Ccl2 in the kidney. Interestingly, dLAN decreased renal 3-nitrotyrosine levels and resulted in up-regulation of the main endogenous antioxidant pathways, indicating a disturbance in the renal redox balance and an activation of compensatory mechanisms. These effects paralleled the altered renal expression of the molecular clock components and increased plasma corticosterone levels. Together, our results show that chronic exposure to dLAN weakened the circadian control of daily variation of circulating immune cells and disturbed renal immune and redox homeostasis. Consequences of this dLAN-disturbed immune balance on the ability of the immune system to cope with other challenges should by clarified in further studies.

Lighting in the Home and Health: A Systematic Review

Poor housing is an important determinant of poor health. One key aspect of housing quality is lighting. Light is important for visual performance and safety, and also plays a vital role in regulating human physiological functions. This review aims to synthesise existing evidence on the relationship between lighting in the home and health and recommends areas for future research. Three databases were searched for relevant literature using pre-defined inclusion criteria. Study quality was assessed using the Newcastle Ottawa Scale. Extracted data were qualitatively synthesised according to type of lighting (natural light, artificial light and light at night) and stratified by broad health domains (physical, mental and sleep health). Of the 4043 records retrieved, 28 studies met the inclusion criteria. There was considerable heterogeneity in light exposure metrics used and specific health outcome assessed by the studies. Lighting in the home can negatively affect health but the current evidence base is limited to a small number of studies in different domains of light and health. Further research surrounding specific health outcomes is required to better inform housing quality assessments and lighting practises in the home.

Is night-time light intensity associated with cardiovascular disease risk factors among adults in early-stage urbanisation in South India? A cross-sectional study of the Andhra Pradesh Children and Parents Study

OBJECTIVES

To explore associations of night-time light intensity (NTLI), a novel proxy for continuous urbanisation levels, with mean systolic blood pressure (SBP), body mass index (BMI), fasting serum low-density lipoprotein (LDL) and fasting plasma glucose (FPG), among adults in early-stage urbanisation in Telangana, South India.

DESIGN

Cross-sectional analysis of the third wave of the Andhra Pradesh Children and Parents Study cohort.

SETTING

28 villages representing a continuum of urbanisation levels, ranging from rural settlement to medium-sized town in Telangana, South India.

PARTICIPANTS

Data were available from 6944 participants, 6236 of whom were eligible after excluding pregnant women, participants younger than 18 years of age and participants missing data for age. Participants were excluded if they did not provide fasting blood samples, had implausible or missing outcome values, were medicated for hypertension or diabetes or had triglyceride levels invalidating derived LDL. The analysis included 5924 participants for BMI, 5752 participants for SBP, 5287 participants for LDL and 5328 participants for FPG.

RESULTS

Increasing NTLI was positively associated with mean BMI, SBP and LDL but not FPG. Adjusted mean differences across the range of village-level NTLI were 1.0 kg/m2 (95% CI 0.01 to 1.9) for BMI; 4.2 mm Hg (95% CI 1.0 to 7.4) for SBP; 0.3 mmol/L (95% CI -0.01 to 0.7) for LDL; and -0.01 mmol/L (95% CI -0.4 to 0.4) for FPG. Associations of NTLI with BMI and SBP were stronger in older age groups.

CONCLUSION

The association of NTLI with cardiovascular disease (CVD) risk factors identify NTLI as a potentially important tool for exploring urbanisation-related health. Consistent associations of moderate increases in urbanisation levels with important CVD risk factors warrant prevention strategies to curb expected large public health impacts from continued and rapid urbanisation in India.

Dim Light at Night Disturbs Molecular Pathways of Lipid Metabolism

Dim light at night (dLAN) is associated with metabolic risk but the specific effects on lipid metabolism have only been evaluated to a limited extent. Therefore, to explore whether dLAN can compromise lipid metabolic homeostasis in healthy individuals, we exposed Wistar rats to dLAN (~2 lx) for 2 and 5 weeks and analyzed the main lipogenic pathways in the liver and epididymal fat pad, including the control mechanisms at the hormonal and molecular level. We found that dLAN promoted hepatic triacylglycerol accumulation, upregulated hepatic genes involved in de novo synthesis of fatty acids, and elevated glucose and fatty acid uptake. These observations were paralleled with suppressed fatty acid synthesis in the adipose tissue and altered plasma adipokine levels, indicating disturbed adipocyte metabolic function with a potential negative impact on liver metabolism. Moreover, dLAN-exposed rats displayed an elevated expression of two peroxisome proliferator-activated receptor family members (Pparα and Pparγ) in the liver and adipose tissue, suggesting the deregulation of important metabolic transcription factors. Together, our results demonstrate that an impaired balance of lipid biosynthetic pathways caused by dLAN can increase lipid storage in the liver, thereby accounting for a potential linking mechanism between dLAN and metabolic diseases.

Daily and Seasonal Variation in Light Exposure among the Old Order Amish

Exposure to artificial bright light in the late evening and early night, common in modern society, triggers phase delay of circadian rhythms, contributing to delayed sleep phase syndrome and seasonal affective disorder. Studying a unique population like the Old Order Amish (OOA), whose lifestyles resemble pre-industrial societies, may increase understanding of light’s relationship with health. Thirty-three participants (aged 25–74, mean age 53.5; without physical or psychiatric illnesses) from an OOA community in Lancaster, PA, were assessed with wrist-worn actimeters/light loggers for at least 2 consecutive days during winter/spring (15 January–16 April) and spring/summer (14 May–10 September). Daily activity, sleep–wake cycles, and their relationship with light exposure were analyzed. Overall activity levels and light exposure increased with longer photoperiod length. While seasonal variations in the amount and spectral content of light exposure were equivalent to those reported previously for non-Amish groups, the OOA experienced a substantially (~10-fold) higher amplitude of diurnal variation in light exposure (darker nights and brighter days) throughout the year than reported for the general population. This pattern may be contributing to lower rates of SAD, short sleep, delayed sleep phase, eveningness, and metabolic dysregulation, previously reported among the OOA population.

Response to commentary: does before bedtime body warming by bathing or other means attenuate sleep-time arterial blood pressure?

The commentary by Dr. Smolensky provides an insightful assessment of our study from the circadian point of view. In the present letter, we have responded to the commentary by Dr. Smolensky et al., suggesting interpretation of our analytic results and providing additional statistical data regarding the timing of antihypertensive drug use. In addition, we have discussed the terms "nighttime" and "sleep-time" period used in previous researches in relation to ambulatory blood pressure.

Indoor light pollution and progression of carotid atherosclerosis: A longitudinal study of the HEIJO-KYO cohort

Exposure to light at inappropriate times in relation to the solar cycle can disturb circadian endocrine and metabolic rhythms. Previous studies have suggested an association between light exposure at night (LAN) and obesity, an important risk factor of atherosclerosis, although it remains unclear whether LAN associates with progression of atherosclerosis. To evaluate the longitudinal association between bedroom LAN intensity and progression of carotid atherosclerosis, light intensity in the bedroom at baseline and carotid artery intima-media thickness (IMT) at baseline and follow-up were measured in 989 elderly participants (945 at baseline and 780 at a median follow-up time of 34 months). The mean age of the participants was 71.4 ± 6.9 years. The average mean and maximal carotid IMT at baseline were 0.88 ± 0.15 and 1.10 ± 0.32 mm, respectively. The median intensity of bedroom LAN was 0.68 lx (IQR, 0.07-3.29). In multivariable analysis adjusted for potential confounders, the highest LAN group exhibited a significant increase in mean carotid IMT (adjusted β, 0.028; 95% CI, 0.005-0.052; P = 0.019) compared with the lowest LAN quartile group. A similar relationship was found between LAN and maximal carotid IMT (adjusted β, 0.083; 95% CI, 0.037-0.129; P < 0.001). In conclusion, we found a clear and significant association between bedroom LAN intensity and progression of subclinical carotid atherosclerosis, which was independent of known risk factors for atherosclerosis, including age, obesity, smoking, economic status, hypertension, and diabetes. Indoor light pollution may be a potential risk factor for atherosclerosis in the general population.

Linking Light Exposure and Subsequent Sleep: A Field Polysomnography Study in Humans

Study objectives

To determine the effect of light exposure on subsequent sleep characteristics under ambulatory field conditions.

Methods

Twenty healthy participants were fitted with ambulatory polysomnography (PSG) and wrist-actigraphs to assess light exposure, rest–activity, sleep quality, timing, and architecture. Laboratory salivary dim-light melatonin onset was analyzed to determine endogenous circadian phase.

Results

Later circadian clock phase was associated with lower intensity (R² = 0.34, χ²(1) = 7.19, p < .01), later light exposure (quadratic, controlling for daylength, R² = 0.47, χ²(3) = 32.38, p < .0001), and to later sleep timing (R² = 0.71, χ²(1) = 20.39, p < .0001). Those with later first exposure to more than 10 lux of light had more awakenings during subsequent sleep (controlled for daylength, R² = 0.36, χ²(2) = 8.66, p < .05). Those with later light exposure subsequently had a shorter latency to first rapid eye movement (REM) sleep episode (R² = 0.21, χ²(1) = 5.77, p < .05). Those with less light exposure subsequently had a higher percentage of REM sleep (R² = 0.43, χ²(2) = 13.90, p < .001) in a clock phase modulated manner. Slow-wave sleep accumulation was observed to be larger after preceding exposure to high maximal intensity and early first light exposure (p < .05).

Conclusions

The quality and architecture of sleep is associated with preceding light exposure. We propose that light exposure timing and intensity do not only modulate circadian-driven aspects of sleep but also homeostatic sleep pressure. These novel ambulatory PSG findings are the first to highlight the direct relationship between light and subsequent sleep, combining knowledge of homeostatic and circadian regulation of sleep by light. Upon confirmation by interventional studies, this hypothesis could change current understanding of sleep regulation and its relationship to prior light exposure.

Clinical trial details

This study was not a clinical trial. The study was ethically approved and nationally registered (NL48468.042.14).

Sleep duration and 24-hour ambulatory blood pressure in adults not on antihypertensive medications

Short sleep duration has been widely linked to increased cardiovascular morbidity and mortality. We performed a post hoc analysis of 24-hour ambulatory blood pressure monitoring (ABPM) in the Lifestyle Modification in Blood Pressure Lowering Study (LIMBS) and Penn Icelandic Sleep Apnea (PISA) Study. The 24-hour mean systolic blood pressure (BP) was 12.7 mm Hg higher in LIMBS (P < 0.001; n = 66) and 4.7 mm Hg higher in PISA (P = 0.005; n = 153) among participants with shorter sleep duration (less than 7 hours) compared to those with longer sleep duration (at least 7 hours). In multivariable adjusted models, shorter sleep duration was strongly associated with higher systolic BP on 24-hour ABPM, independent of nocturnal BP and in-office BP. There was no effect modification by obstructive sleep apnea. Adults with shorter sleep duration may benefit from screening with 24-hour ABPM to promote earlier detection of hypertension and potentially mitigate their increased risk for future cardiovascular disease.

Sleep Environment and Insomnia in Elderly Persons Living at Home

The aim of this study was to draw a portrait of the sleep environment of elderly persons living in private households and to determine its relationship with the presence of insomnia. A sample of 599 individuals aged 70 years and older responded to questions about the comfort of their pillow and mattress and the noise level and brightness of their bedroom at night and in the morning. They were also asked whether or not they shared their bed or bedroom with a sleep partner. The Insomnia Severity Index was used to assess insomnia severity. Over 40% of the study participants were using a pillow that was not very comfortable, and almost 30% said that their bedroom was not completely quiet. Binomial logistic regression results revealed that two variables were significantly associated with insomnia symptoms: a pillow rated as moderately comfortable to very uncomfortable and a bedroom that was not completely quiet. No other sleep environment characteristics considered in this study were associated with the risk of insomnia. These results indicate that a nonnegligible proportion of the elderly population endures a suboptimal sleep environment. Although it is difficult to predict the real impact of changes to the sleep environment, this study supports the proposal that simple, minor changes to the bedroom can promote sleep in the elderly.

Bedroom Light Exposure at Night and the Incidence of Depressive Symptoms: A Longitudinal Study of the HEIJO-KYO Cohort

Previous studies have indicated that minimal exposure to light at night (LAN) increases depression risk, even at 5 lux, in nocturnal and diurnal mammals. Although such low-level LAN may affect human circadian physiology, the association between exposure to LAN and depressive symptoms remains uncertain. In the present study, bedroom light intensity was measured objectively, and depressive symptoms were assessed, during 2010-2014 in Nara, Japan. Of 863 participants (mean age = 71.5 years) who did not have depressive symptoms at baseline, 73 participants reported development of depressive symptoms during follow-up (median, 24 months). Compared with the "dark" group (average of <5 lux; n = 710), the LAN group (average of ≥5 lux; n = 153) exhibited a significantly higher depression risk (hazard ratio = 1.89; 95% CI: 1.13, 3.14), according to a Cox proportional hazards model adjusting for age, sex, body mass index, and economic status. Further, the significance remained in a multivariable model adjusting for hypertension, diabetes, and sleep parameters (hazard ratio = 1.72; 95% CI: 1.03, 2.89). Sensitivity analyses using bedroom light data with a cutoff value of ≥10 lux suggested consistent results. In conclusion, these results indicated that exposure to LAN in home settings was independently associated with subsequent depression risk in an elderly general population.

Medical hypothesis: Light at night is a factor worth considering in critical care units

Exposure to light at night is not an innocuous consequence of modernization. There are compelling data linking long-term exposure to occupational and environmental light at night with serious health conditions, including heart disease, obesity, diabetes, and cancer. However, far less is known about the physiological and behavioral effects of acute exposure to light at night. Among healthy volunteers, acute night-time light exposure increases systolic blood pressure and inflammatory markers in the blood, and impairs glucose regulation. Whether critically ill patients in a hospital setting experience the same physiological shifts in response to evening light exposure is not known. This paper reviews the available data on light at night effects on health and wellbeing, and argues that the data are sufficiently compelling to warrant studies of how lighting in intensive care units may be influencing patient recovery.

The effect of dim light at night on cerebral hemodynamic oscillations during sleep: A near-infrared spectroscopy study

Recent studies have reported that dim light at night (dLAN) is associated with risks of cardiovascular complications, such as hypertension and carotid atherosclerosis; however, little is known about the underlying mechanism. Here, we evaluated the effect of dLAN on the cerebrovascular system by analyzing cerebral hemodynamic oscillations using near-infrared spectroscopy (NIRS). Fourteen healthy male subjects underwent polysomnography coupled with cerebral NIRS. The data collected during sleep with dim light (10 lux) were compared with those collected during sleep under the control dark conditions for the sleep structure, cerebral hemodynamic oscillations, heart rate variability (HRV), and their electroencephalographic (EEG) power spectrum. Power spectral analysis was applied to oxy-hemoglobin concentrations calculated from the NIRS signal. Spectral densities over endothelial very-low-frequency oscillations (VLFOs) (0.003-0.02 Hz), neurogenic VLFOs (0.02-0.04 Hz), myogenic low-frequency oscillations (LFOs) (0.04-0.15 Hz), and total LFOs (0.003-0.15 Hz) were obtained for each sleep stage. The polysomnographic data revealed an increase in the N2 stage under the dLAN conditions. The spectral analysis of cerebral hemodynamics showed that the total LFOs increased significantly during slow-wave sleep (SWS) and decreased during rapid eye movement (REM) sleep. Specifically, endothelial (median of normalized value, 0.46 vs. 0.72, p = 0.019) and neurogenic (median, 0.58 vs. 0.84, p = 0.019) VLFOs were enhanced during SWS, whereas endothelial VLFOs (median, 1.93 vs. 1.47, p = 0.030) were attenuated during REM sleep. HRV analysis exhibited altered spectral densities during SWS induced by dLAN, including an increase in very-low-frequency and decreases in low-frequency and high-frequency ranges. In the EEG power spectral analysis, no significant difference was detected between the control and dLAN conditions. In conclusion, dLAN can disturb cerebral hemodynamics via the endothelial and autonomic systems without cortical involvement, predominantly during SWS, which might represent an underlying mechanism of the increased cerebrovascular risk associated with light exposure during sleep.