Growth hormone secretion in night workers

The reference curves of percentile for the length and head circumference of infants aged 0-1 year in Hainan Province, China

We first established percentile reference curves for infant length and head circumference in Hainan Province based on gender and age in months and compared them with the 2022 national standards and World Health Organization (WHO) standards. This cross-sectional survey involved 2736 infants (1471 boys and 1265 girls) in 18 cities and counties in Hainan Province. Standardized instruments were used to measure head circumference and length. Reference values for Hainan infants' length and head circumference were determined using the LMS method. Curves were generated using the LMS Chart Maker software. According to the newly established reference curves, the length and head circumference of Hainan infants exhibited a consistent trend of steady growth. However, the average head circumference was below the 2022 national reference values and WHO standards. The mean length was lower than the new national reference values but roughly consistent with the WHO standards. Differences exist in infant length and head circumference in Hainan compared to national and global averages. To enhance infant length and head circumference growth, the health department should encourage exclusive breastfeeding for the first 6 months, ensure infants' sleep needs at night, and promote the regularity of vitamin D supplementation during the perinatal period.

Pitfalls in the lab assessment of hypopituitarism

The diagnostic approach to hypopituitarism involves many disciplines. Clinical symptoms rarely are specific. Imaging techniques are helpful but cannot prove the specific functional defects. Therefore, the definitive diagnosis of pituitary insufficiency is largely based on laboratory tests. However, also laboratory methods come with inherent limitations, and it is essential for the clinician to know and recognize typical pitfalls. Most factors potentially impairing the quality of hormone measurements are introduced in the preanalytical phase, i.e. before the hormones are measured by the laboratory. For example, the timing of blood drawing with respect to circadian rhythm, stress, and medication can have an influence on hormone concentrations. During the actual analysis of the hormones, cross-reactions with molecules present in the sample presenting the same or similar epitopes than the intended analyte may affect immunoassays. Interference can also come from heterophilic or human anti-animal antibodies. Unexpected problems can also be due to popular nutritional supplements which interfere with the measurement procedures. An important example in this respect is the interference from biotin. It became only clinically visible when the use of this vitamin became popular among patients. The extreme serum concentrations reached when patients take it as a supplement can lead to incorrect measurements in immunoassays employing the biotin-streptavidin system. To some extent, hormone analyses using liquid chromatography mass spectrometry (LCMS) can overcome problems, although availability and cost-effectiveness of this method still imposes restrictions. In the post-analytical phase, appropriateness of reference intervals and cut-offs with respect to the specific analytical method used is of outmost importance. Furthermore, for interpretation, additional biological and pharmacological factors like BMI, age and concomitant diseases must be considered to avoid misinterpretation of the measured concentrations. It is important for the clinician and the laboratory to recognize when one or more laboratory values do not match the clinical picture. In an interdisciplinary approach, the search for the underlying cause should be initiated.

Narrative review: The role of circadian rhythm on sports performance, hormonal regulation, immune system function, and injury prevention in athletes

Objectives

This study was a narrative review of the importance of circadian rhythm (CR), describes the underlying mechanisms of CR in sports performance, emphasizes the reciprocal link between CR, endocrine homeostasis and sex differences, and the unique role of the circadian clock in immune system function and coordination.

Method

As a narrative review study, a comprehensive search was conducted in PubMed, Scopus, and Web of Science (core collection) databases using the keywords "circadian rhythm", "sports performance", "hormonal regulation", "immune system", and "injury prevention". Inclusion criteria were studies published in English and peer-reviewed journals until July 2023. Studies that examined the role of CR in sports performance, hormonal status, immune system function, and injury prevention in athletes were selected for review.

Results

CR is followed by almost all physiological and biochemical activities in the human body. In humans, the superchiasmatic nucleus controls many daily biorhythms under solar time, including the sleep-wake cycle. A body of literature indicates that the peak performance of essential indicators of sports performance is primarily in the afternoon hours, and the evening of actions occurs roughly at the peak of core body temperature. Recent studies have demonstrated that the time of day that exercise is performed affects the achievement of good physical performance. This review also shows various biomarkers of cellular damage in weariness and the underlying mechanisms of diurnal fluctuations. According to the clock, CR can be synchronized with photonic and non-photonic stimuli (i.e., temperature, physical activity, and food intake), and feeding patterns and diet changes can affect CR and redox markers. It also emphasizes the reciprocal links between CR and endocrine homeostasis, the specific role of the circadian clock in coordinating immune system function, and the relationship between circadian clocks and sex differences.

Conclusion

The interaction between insufficient sleep and time of day on performance has been established in this study because it is crucial to balance training, recovery, and sleep duration to attain optimal sports performance.

The relationship between shift work pattern and thyroid stimulating hormone in female workers

Background

Shift work is known to cause changes in the circadian rhythm of the human body and adversely affect not only physical health but also mental health. Some studies have demonstrated the correlation between shift work and thyroid stimulating hormone (TSH), a hormone that changes according to the diurnal rhythm, but few studies have reported the different TSH levels according to the shift work type. This study aimed to investigate changes in TSH according to the shift work type.

Methods

This study included 1,318 female workers who had a medical checkup at a university hospital in Changwon from 2015 to 2019. Shift work types were classified as non-shift work, regular 2 shifts, and irregular three shifts, and a TSH ≥ 4.2 mIU/L was defined as abnormal. A general linear model (GLM) was used to compare the TSH levels and the risk of subclinical hypothyroidism in each year, and a binary logistic analysis was performed using a generalized estimation equation (GEE) to compare the risk of subclinical hypothyroidism over the 5-year period.

Results

Of the 1,318 participants included in this study, 363, 711, and 244 were non-shift, two-shift, and irregular three-shift workers, respectively. In the GEE analysis, after adjusting for age, body mass index, smoking, and alcohol consumption, the odds ratios (ORs) were 1.81 (95% confidence interval [CI]: 1.15-2.86; p = 0.011) in 2 shifts and 2.02 (95% CI: 1.23-3.32; p = 0.006) in irregular three shifts, compared to non-shift.

Conclusions

Our results showed that shift work had a higher risk of subclinical hypothyroidism than non-shift work and that there was a significant difference in the risk of subclinical hypothyroidism according to the shift work type. These findings suggest that the shift work type can be considered in future thyroid function tests and evaluations.

Obstructive Sleep Apnea, Circadian Clock Disruption, and Metabolic Consequences

Obstructive sleep apnea (OSA) is a chronic disorder characterized by recurrent episodes of apnea and hypopnea during sleep. It is associated with various cardiovascular and metabolic complications, including type 2 diabetes mellitus (T2DM) and obesity. Many pathways can be responsible for T2DM development in OSA patients, e.g., those related to HIF-1 and SIRT1 expression. Moreover, epigenetic mechanisms, such as miRNA181a or miRNA199, are postulated to play a pivotal role in this link. It has been proven that OSA increases the occurrence of circadian clock disruption, which is also a risk factor for metabolic disease development. Circadian clock disruption impairs the metabolism of glucose, lipids, and the secretion of bile acids. Therefore, OSA-induced circadian clock disruption may be a potential, complex, underlying pathway involved in developing and exacerbating metabolic diseases among OSA patients. The current paper summarizes the available information pertaining to the relationship between OSA and circadian clock disruption in the context of potential mechanisms leading to metabolic disorders.

Morphological and Functional Changes of Pituitary GH and PRL Cells Following Prolonged Exposure of Female Rats to Constant Light

Light regulates numerous physiological functions including secretion of different hormones. Our aim was to determine morphological and functional changes of the pituitary growth hormone (GH) and prolactin (PRL) producing cells in female rats exposed to constant light regime from the peripubertal to adult period of life. Starting from the thirtieth postnatal day, female Wistar rats were exposed to constant light (600 lx) for the following 95 days. Controls were maintained under the regular laboratory lighting conditions. The GH and PRL cells were immunohistochemically visualized. Changes in cell volumes and volume densities were evaluated by stereology. Concentrations of PRL and GH in circulation were also determined. We detected significant decrease of the GH cell volume and volume density, followed by reduced the GH blood concentration in comparison to the controls. In contrast, PRL cells were larger in size and their volume density was significantly increased when compared to the controls. Accordingly, PRL concentration was elevated. It can be concluded that exposure of female rats to constant light regime, from peripubertal to adult period of life, causes inhibition of the pituitary GH and stimulation of PRL cells.

Circadian Rhythms and the Gastrointestinal Tract: Relationship to Metabolism and Gut Hormones

Circadian rhythms are 24-hour biological rhythms within organisms that have developed over evolutionary time due to predefined environmental changes, mainly the light-dark cycle. Interestingly, metabolic tissues, which are largely responsible for establishing diurnal metabolic homeostasis, have been found to express cell-autonomous clocks that are entrained by food intake. Disruption of the circadian system, as seen in individuals who conduct shift work, confers significant risk for the development of metabolic diseases such as type 2 diabetes and obesity. The gastrointestinal (GI) tract is the first point of contact for ingested nutrients and is thus an essential organ system for metabolic control. This review will focus on the circadian function of the GI tract with a particular emphasis on its role in metabolism through regulation of gut hormone release. First, the circadian molecular clock as well as the organization of the mammalian circadian system is introduced. Next, a brief overview of the structure of the gut as well as the circadian regulation of key functions important in establishing metabolic homeostasis is discussed. Particularly, the focus of the review is centered around secretion of gut hormones; however, other functions of the gut such as barrier integrity and intestinal immunity, as well as digestion and absorption, all of which have relevance to metabolic control will be considered. Finally, we provide insight into the effects of circadian disruption on GI function and discuss chronotherapeutic intervention strategies for mitigating associated metabolic dysfunction.

Yin and Yang: Why did evolution implement and preserve the circadian rhythmicity?

Yin and Yang concept emphasizes the reciprocal and interrelated nature; neither is sufficient, both are needed to sustain the overall balance of the living system. Changing the balance, by implementing deficiency or excess of one of them, upsets the equilibrium (homeostasis) of the whole system.

PURPOSE

In this opinion article intermittent exposure is presented as the stimulus for development and evolutionary conservation of circadian rhythm, an endogenous, entrainable oscillation of approximately 24 h, to counteract/balance the cells' natural tendency to attenuate their response during long-term exposure to different endogenous substances.

RESULTS

The concept of Yin and Yang duality is an allegory on which the avoidance of attenuation of the cells' responses hypothesis is presented as an explanation for the circadian rhythmicity, which is integrated in all human cells, with the exception of stem and cancer cells.

CONCLUSIONS

We hypothesize, that circadian rhythmicity has evolved, during evolution, into a mechanism that prevents disruption of the organism's negative-feedback-loop homeostasis.

Analysis of Prevalence, Magnitude and Timing of the Dawn Phenomenon in Adults and Adolescents With Type 1 Diabetes: Descriptive Analysis of 2 Insulin Pump Trials

OBJECTIVES

To better understand the dawn phenomenon in type 1 diabetes, we sought to determine its prevalence, timing and magnitude in studies specifically designed to assess basal insulin requirements in patients using insulin pumps.

METHODS

Thirty-three participants from 2 sensor-augmented insulin pump studies were analyzed. Twenty participants were obtained from a methodologically ideal semiautomated basal analysis trial in which basal rates were determined from repeated fasting tests (the derivation set) and 13 from an artificial pancreas trial in which duration of fasting was variable (the "confirmation" set). Prevalence was determined for the total cohort and for individual trials using the standard definition of an increase in insulin exceeding 20% and lasting ≥90 minutes. Among cases, time of onset and percent change in the magnitude of basal delivery were determined.

RESULTS

Seventeen participants (52%) experienced the dawn phenomenon (11 of 20 [55%] in the derivation set and 6 of 13 [46%] in the confirmation set). Time of onset was 3 AM (interquartile range [IQR], 3 to 4:15 AM) in the derivation set and 3 AM (IQR, 3 to 4 AM) in the confirmation set. The magnitude of the dawn phenomenon was a 58.1% (IQR, 28.8% to 110.6%) increase in insulin requirements in the derivation set and 65.5% (IQR, 45.6% to 87.4%) in the confirmation set.

CONCLUSIONS

The dawn phenomenon occurs in approximately half of patients with type 1 diabetes; when present, it has predictable timing of onset (generally 3 AM) and a substantial, but highly variable, magnitude. These findings imply that optimization of glycemic control requires clinical emphasis on fasted overnight basal insulin assessment.

The Mouse Microbiome Is Required for Sex-Specific Diurnal Rhythms of Gene Expression and Metabolism

The circadian clock and associated feeding rhythms have a profound impact on metabolism and the gut microbiome. To what extent microbiota reciprocally affect daily rhythms of physiology in the host remains elusive. Here, we analyzed transcriptome and metabolome profiles of male and female germ-free mice. While mRNA expression of circadian clock genes revealed subtle changes in liver, intestine, and white adipose tissue, germ-free mice showed considerably altered expression of genes associated with rhythmic physiology. Strikingly, the absence of the microbiome attenuated liver sexual dimorphism and sex-specific rhythmicity. The resulting feminization of male and masculinization of female germ-free animals is likely caused by altered sexual development and growth hormone secretion, associated with differential activation of xenobiotic receptors. This defines a novel mechanism by which the microbiome regulates host metabolism.

Mutual influence of sleep and circadian clocks on physiology and cognition

The 24-h sleep-wake cycle is one of the most prominent outputs of the circadian clock system. At the same time, changes in sleep-wake behavior feedback on behavioral and physiological circadian rhythms, thus altering the coordination of the body's clock network. Sleep and circadian rhythm disruption have similar physiological endpoints including metabolic, cognitive, and immunologic impairments. This raises the question to which extent these phenomena are causally linked. In this review, we summarize different physiologic outcomes of sleep deprivation and mistimed sleep and discuss the experimental evidence for a mediating role of the circadian clock machinery in this context.

Relationship between thyroid stimulating hormone and night shift work

BACKGROUND

Night shift work has well-known adverse effects on health. However, few studies have investigated the relationship between thyroid diseases and night shift work. This study aimed to examine night shift workers and their changes in thyroid stimulating hormones (TSH) levels over time.

METHODS

Medical check-up data (2011-2015) were obtained from 967 female workers at a university hospital in Incheon, Korea. Data regarding TSH levels were extracted from the records, and 2015 was used as a reference point to determine night shift work status. The relationships between TSH levels and night shift work in each year were analyzed using the general linear model (GLM). The generalized estimating equation (GEE) was used to evaluate the repeated measurements over the 5-year period.

RESULTS

The GEE analysis revealed that from 2011 to 2015, night shift workers had TSH levels that were 0.303 mIU/L higher than the levels of non-night shift workers (95 % CI: 0.087-0.519 mIU/L, p = 0.006) after adjusting for age and department. When we used TSH levels of 4.5 ≥ mIU/L to identify subclinical hypothyroidism, night shift workers exhibited a 1.399 fold higher risk of subclinical hypothyroidism (95 % CI: 1.050-1.863, p = 0.022), compared to their non-night shift counterparts.

CONCLUSIONS

This result of this study suggests that night shift workers may have an increased risk of thyroid diseases, compared to non-night shift workers.

Evidence for a Circadian Effect on the Reduction of Human Growth Hormone Gene Expression in Response to Excess Caloric Intake

Rhythmicity of biological functions is fundamental for optimal adaptations to environmental cues. Growth hormone (GH) is a major metabolic homeostatic factor that is secreted with a circadian pattern, but whether it is synthesized rhythmically is unknown. We used transgenic mice containing the human (h) GH gene (hGH1) locus to investigate the rhythmicity of hGH synthesis and secretion and to show that RNA and secreted protein levels oscillate over a 24-h cycle. Analysis of hGH1 promoter sequences revealed an enhancer motif (E-box) element that binds the circadian transcriptional machinery (Bmal1 and Clock). Furthermore, Bmal1/Clock were able to transactivate the hGH1 promoter, and mutation of this E-box element adversely affected basal activity after gene transfer. The ability of Bmal1 to bind the hGH1 promoter region containing the E-box element was confirmed in the hGH1 transgenic mouse pituitary in situ Occupancy was reduced in mice fed a high fat diet during the light (inactive) stage of the daily cycle in mice and corresponded to a decrease in hGH1 RNA levels. The decreases in occupancy and RNA levels were not seen, however, during the dark (active) stage. A chromatin loop required for efficient postnatal hGH1 expression was negatively affected by the high fat diet in the light but not dark stage similar to the pattern observed with Bmal1 association with the promoter region. This is the first evidence that hGH synthesis follows a diurnal rhythm and of dynamic associations of the circadian machinery with a component of a chromosomal structure of the hGH1 locus that is essential for efficient expression.

Neuroendocrine Regulation of Growth Hormone Secretion

This article reviews the main findings that emerged in the intervening years since the previous volume on hormonal control of growth in the section on the endocrine system of the Handbook of Physiology concerning the intra- and extrahypothalamic neuronal networks connecting growth hormone releasing hormone (GHRH) and somatostatin hypophysiotropic neurons and the integration between regulators of food intake/metabolism and GH release. Among these findings, the discovery of ghrelin still raises many unanswered questions. One important event was the application of deconvolution analysis to the pulsatile patterns of GH secretion in different mammalian species, including Man, according to gender, hormonal environment and ageing. Concerning this last phenomenon, a great body of evidence now supports the role of an attenuation of the GHRH/GH/Insulin-like growth factor-1 (IGF-1) axis in the control of mammalian aging.

A pilot study to determine the short-term effects of milk with differing glycaemic properties on sleep among toddlers: a randomised controlled trial

Background

Sleep is important for children as it directly impacts their mental and physical development. Sleep is not only influenced by the timing but also the macronutrient (carbohydrate and protein) content of meals. Glycaemic index (GI) and glycaemic load (GL) describe the quality of carbohydrates in a food and the burden of these foods on the body’s blood glucose response. Diets with a high GI/GL may increase the risk of developing obesity and type 2 diabetes mellitus in adulthood. The present study is piloted to evaluate the short-term impact of milk products with differing glycaemic properties on the sleep patterns of toddlers.

Methods

Toddlers were recruited from various day care centres. Informed consent was obtained from both the mothers and the centres. A double-blind randomised controlled trial with a between-subjects design was adopted. The toddlers were randomised to either one of two types of milk with a differing GI (“Low” = 23 and “High = 65”) for a period of 3.5 days. There were no other dietary restrictions imposed except that the enrolled child did not consume any other milk during the study period. The sleep patterns were recorded using a Phillips Actiwatch-2, which was worn on the wrist for 24 h over 4 days. The parameters used to measure the sleep pattern were sleep-onset latency (SOL), total sleep time (TST), wake after sleep onset (WASO) and sleep efficiency (SE).

Results

A total of 56 toddlers completed the study. The toddlers had a mean age of 19.9 ± 4.3 months. There were no significant differences (p > 0.05) between the two GI groups for SOL, TST, WASO and SE at the end of the feeding period.

Conclusions

Sleep patterns of toddlers on low-GI milk did not differ from those with high-GI milk consumed over a short period. Future studies should consider the glycaemic effects of other foods, along with milk with differing GI, consumed for a longer feeding duration.

Trial registration

ClinicalTrial.gov NCT01589003.

The impact of sleep and circadian disturbance on hormones and metabolism

The levels of several hormones fluctuate according to the light and dark cycle and are also affected by sleep, feeding, and general behavior. The regulation and metabolism of several hormones are influenced by interactions between the effects of sleep and the intrinsic circadian system; growth hormone, melatonin, cortisol, leptin, and ghrelin levels are highly correlated with sleep and circadian rhythmicity. There are also endogenous circadian mechanisms that serve to regulate glucose metabolism and similar rhythms pertaining to lipid metabolism, regulated through the actions of various clock genes. Sleep disturbance, which negatively impacts hormonal rhythms and metabolism, is also associated with obesity, insulin insensitivity, diabetes, hormonal imbalance, and appetite dysregulation. Circadian disruption, typically induced by shift work, may negatively impact health due to impaired glucose and lipid homeostasis, reversed melatonin and cortisol rhythms, and loss of clock gene rhythmicity.

Exercise-Induced growth hormone during acute sleep deprivation

The effect of acute (24‐h) sleep deprivation on exercise‐induced growth hormone (GH) and insulin‐like growth factor‐1 (IGF‐1) was examined. Ten men (20.6 ± 1.4 years) completed two randomized 24‐h sessions including a brief, high‐intensity exercise bout following either a night of sleep (SLEEP) or (24‐h) sleep deprivation (SLD). Anaerobic performance (mean power [MP], peak power [PP], minimum power [MinP], time to peak power [TTPP], fatigue index, [FI]) and total work per sprint [TWPS]) was determined from four maximal 30‐sec Wingate sprints on a cycle ergometer. Self‐reported sleep 7 days prior to each session was similar between SLEEP and SLD sessions (7.92 ± 0.33 vs. 7.98 ± 0.39 h, P =0.656, respectively) and during the actual SLEEP session in the lab, the total amount of sleep was similar to the 7 days leading up to the lab session (7.72 ± 0.14 h vs. 7.92 ± 0.33 h, respectively) (P =0.166). No differences existed in MP, PP, MinP, TTPP, FI, TWPS, resting GH concentrations, time to reach exercise‐induced peak GH concentration (TTP), or free IGF‐1 between sessions. GH area under the curve (AUC) (825.0 ± 199.8 vs. 2212.9 ± 441.9 μg/L*min, P <0.01), exercise‐induced peak GH concentration (17.8 ± 3.7 vs. 39.6 ± 7.1 μg/L, P <0.01) and ΔGH (peak GH – resting GH) (17.2 ± 3.7 vs. 38.2 ± 7.3 μg/L, P <0.01) were significantly lower during the SLEEP versus SLD session. Our results indicate that the exercise‐induced GH response was significantly augmented in sleep‐deprived individuals.

Human growth hormone release is heavily influenced by sleep and exercise. Our study shows that sleep deprivation dramatically augments the exercise‐induced human growth hormone response.

Validation of a questionnaire to screen for shift work disorder

STUDY OBJECTIVE

At least 15% of the full-time work force is shift workers. Working during the overnight hours, early morning start times, and variable or rotating schedules present a challenge to the circadian system, and these shifts are associated with adverse health and safety consequences. Shift work disorder (SWD), a primary (circadian rhythm) sleep disorder indicated by excessive daytime sleepiness and/or insomnia associated with a shiftwork schedule, is under-recognized by primary care physicians. We sought to develop and validate a questionnaire to screen for high risk of SWD in a shift working population.

DESIGN

Shift workers completed a 26-item questionnaire and were evaluated by a sleep specialist (physician) who diagnosed them as either positive or negative for SWD. The physician assessment of SWD was guided by a flow chart that operationalized the ICSD-2 criteria for SWD.

SETTING

18 sleep clinics in the USA.

PATIENTS OR PARTICIPANTS

311 shift workers.

INTERVENTIONS

Not applicable.

MEASUREMENTS AND RESULTS

Responses to the items in the questionnaire were entered into a series of discrimination function analyses to determine the diagnostic value of the items and the fewest number of questions with the best predictive value. The function was then cross-validated. A final 4-item questionnaire has 89% positive predictive value and 62% negative predictive value (sensitivity = 0.74; specificity = 0.82).

CONCLUSIONS

This Shiftwork Disorder Screening Questionnaire may be appropriate for use in primary care settings to aid in the diagnosis of SWD.

Photic resetting in night-shift work: impact on nurses' sleep

The objective of this study was to quantify daytime sleep in night-shift workers with and without an intervention designed to recover the normal relationship between the endogenous circadian pacemaker and the sleep/wake cycle. Workers of the treatment group received intermittent exposure to full-spectrum bright light during night shifts and wore dark goggles during the morning commute home. All workers maintained stable 8-h daytime sleep/darkness schedules. The authors found that workers of the treatment group had daytime sleep episodes that lasted 7.1 ± .1 h (mean ± SEM) versus 6.6 ± .2 h for workers in the control group (p = .04). The increase in total sleep time co-occurred with a larger proportion of the melatonin secretory episode during daytime sleep in workers of the treatment group. The results of this study showed reestablishment of a phase angle that is comparable to that observed on a day-oriented schedule favors longer daytime sleep episodes in night-shift workers. (Author correspondence: diane.boivin@douglas.mcgill.ca ).

Circadian system, sleep and endocrinology

Levels of numerous hormones vary across the day and night. Such fluctuations are not only attributable to changes in sleep/wakefulness and other behaviors but also to a circadian timing system governed by the suprachiasmatic nucleus of the hypothalamus. Sleep has a strong effect on levels of some hormones such as growth hormone but little effect on others which are more strongly regulated by the circadian timing system (e.g., melatonin). Whereas the exact mechanisms through which sleep affects circulating hormonal levels are poorly understood, more is known about how the circadian timing system influences the secretion of hormones. The suprachiasmatic nucleus exerts its influence on hormones via neuronal and humoral signals but it is now also apparent that peripheral tissues contain circadian clock proteins, similar to those in the suprachiasmatic nucleus, that are also involved in hormone regulation. Under normal circumstances, behaviors and the circadian timing system are synchronized with an optimal phase relationship and consequently hormonal systems are exquisitely regulated. However, many individuals (e.g., shift-workers) frequently and/or chronically undergo circadian misalignment by desynchronizing their sleep/wake and fasting/feeding cycle from the circadian timing system. Recent experiments indicate that circadian misalignment has an adverse effect on metabolic and hormonal factors such as circulating glucose and insulin. Further research is needed to determine the underlying mechanisms that cause the negative effects induced by circadian misalignment. Such research could aid the development of novel countermeasures for circadian misalignment.

Physiological restitution after night-call duty in anaesthesiologists: impact on metabolic factors

BACKGROUND

Several studies have shown impaired mental well-being and performance in physicians work on call, but knowledge of the physiological effects is scarce. The aims of the present study were to investigate if there was a metabolic stress response in the restitutional phase after night-call duty, indicating potential negative health effects, and determine whether there were differences between physician specialities.

METHODS

Anaesthesiologists (n = 19) were compared with paediatricians/ear, nose and throat (ENT) surgeons (n = 18). On an ordinary workday, 1 and 3 days after work on night call, blood samples were taken for analysis of glucose, thyroid-stimulating hormone (TSH), free thyroxine, testosterone, insulin growth factor-1 (IGF-1), high- and low-density lipoprotein cholesterol (HDL and LDL), triglycerids (TG) and insulin. Saliva cortisol was sampled on an ordinary working day, a day including 16-h night call, the third day following, and for anaesthesiologists also on a day off work.

RESULTS

TSH differed significantly between days in both groups, with a 26% lower level 1 day after on-call duty (P < 0.001). A 48% cortisol rise in the morning preceding night duty was found for paediatricians/ENT surgeons (P < 0.01).

CONCLUSION

The significant dip in TSH level 24 h after night-call duty indicates a metabolic effect of working on night call and should be studied further. However, the levels were within the normal range and the overall results do not imply any serious metabolic changes and only minor differences were seen between specialist groups.

Light treatment and circadian adaptation to shift work

Work at unconventional hours can have both long and short term consequences. Shift workers are often required to perform their duties at times that are not favoured by the body's endogenous clock, or circadian pacemaker. A typical night shift worker, for example, may report reductions in alertness and performance during shifts, or significant difficulty attaining sleep of recuperative value in the day, all the while being more likely to develop health complications. The study of circadian physiology has significantly contributed to our current ability to aid the shift worker deal with atypical schedules. We discuss the usefulness of light treatment as a countermeasure for maladaptation to atypical work schedules.

Hormonal changes in satisfied and dissatisfied shift workers across a shift cycle

Although the literature claims that shift work is harmful, it overlooks the fact that that many shift workers are satisfied and stay healthy. There is little knowledge of the biological mechanisms mediating the differences in susceptibility. The present study compared satisfied and dissatisfied shift workers with respect to major anabolic and catabolic hormones. Forty-two male shift workers, with an extremely rapidly rotating shift schedule, were divided into two groups according to their ratings of satisfaction with their work hours. Morning blood samples were taken during the first and last morning shift in the shift cycle. Serum was analyzed with respect to testosterone, cortisol, and prolactin. Dissatisfied shift workers had lower morning testosterone than satisfied ones, but they did not significantly differ with respect to cortisol or prolactin. Low testosterone levels were, in addition, associated with a greater sleep need, disturbed sleep/wakefulness, and an increased need for recovery after the work period, the latter being the best predictor of testosterone levels. The only change across the shift cycle concerned a significant decrease of morning cortisol at the end of the shift cycle. High morning cortisol was related to having a morning personality and fewer sleep problems before the morning shift. Dissatisfaction with the shift system seems related to lower testosterone levels, which in turn are related to disturbed sleep/wakefulness and increased need for sleep and recovery. Furthermore, morning cortisol was reduced across a shift cycle. It is suggested that reduced testosterone levels may be part of a mechanism of shift work maladjustment.

Adaptation of the 24-h growth hormone profile to a state of sleep debt

In normal men, the majority of GH secretion occurs in a single large postsleep onset pulse that is suppressed during total sleep deprivation. We examined the impact of semichronic partial sleep loss, a highly prevalent condition, on the 24-h growth hormone profile. Eleven young men were studied after six nights of restricted bedtimes (0100-0500) and after 7 nights of extended bedtimes (2100-0900). Slow-wave sleep (SWS) was estimated as the duration of stages III and IV. Slow-wave activity (SWA) was calculated as electroencephalogram power density in the 0.5- to 3-Hz frequency range. During the state of sleep debt, the GH secretory pattern was biphasic, with both a presleep onset "circadian" pulse and a postsleep onset pulse. Postsleep onset GH secretion was negatively related to presleep onset secretion and tended to be positively correlated with the amount of concomitant SWA. When sleep was restricted, both SWS and SWA were increased during early sleep. Unexpectedly, the increase in SWA affected the second, rather than the first, SWA cycle, suggesting that presleep onset GH secretion may have limited SWA in the first cycle, possibly via an inhibition of central GH-releasing hormone activity. Thus neither the GH profile nor the distribution of SWA conformed with predictions from acute sleep deprivation studies, indicating that adaptation mechanisms are operative during chronic partial sleep loss.

Twenty-four-hour rhythms of plasma glucose and insulin secretion rate in regular night workers

To determine whether the ultradian and circadian rhythms of glucose and insulin secretion rate (ISR) are adapted to their permanent nocturnal schedule, eight night workers were studied during their usual 24-h cycle with continuous enteral nutrition and a 10-min blood sampling procedure and were compared with 8 day-active subjects studied once with nocturnal sleep and once with an acute 8-h-shifted sleep. The mean 24-h glucose and ISR levels were similar in the three experiments. The duration and the number of the ultradian oscillations were influenced neither by the time of day nor by the sleep condition or its shift, but their mean amplitude increased during sleep whenever it occurred. In day-active subjects, glucose and ISR levels were high during nighttime sleep and then decreased to a minimum in the afternoon. After the acute sleep shift, the glucose and ISR rhythms were split in a biphasic pattern with a slight increase during the night of deprivation and another during daytime sleep. In night workers, the glucose and ISR peak levels exhibited an 8-h shift in accordance with the sleep shift, but the onset of the glucose rise underwent a shift of only 6 h and the sleep-related amplification of the glucose and ISR oscillations did not occur simultaneously. These results demonstrate that despite a predominant influence of sleep, the 24-h glucose and ISR rhythms are only partially adapted in permanent night workers.

Disturbances in hormonal profiles of night workers during their usual sleep and work times

In a previous study, the authors reported that the 24-h rhythms of pituitary and adrenal hormones--that is, thyrotropin (TSH), prolactin (PRL), growth hormone, and cortisol--adapted only partially in a group of permanent night workers. However, the real impact of circadian rhythm alterations on the health and well-being of subjects is still unclear. In this study, the authors focus on an ergonomic field and address questions of adaptation of these hormones during the usual day sleep time (0700-1500 h) and during the usual night work time (2200-0600 h) in permanent night workers. Eleven night workers, working a night schedule for at least 2 years, submitted to a high-frequency blood sampling procedure (10 min) and to electroencephalographic recordings during sleep. The endocrine profiles of night workers were compared to those of day-active subjects studied during their usual sleep-wake schedule. During usual day sleep, despite an adapted sleep structure, cortisol levels among night workers were abnormally enhanced, whereas the TSH decreased in comparison to the plateau observed among day-active subjects. During usual work time, some hormonal disturbances persisted, in particular concerning cortisol and PRL (two hormones known to reflect the level of activation). Among night workers, the work time was associated with the quiescent period of cortisol secretion normally occurring during the first hours of sleep, and with a transient PRL increase. These results revealed altered hormonal profiles during the sleep time of night workers that do not result in an altered sleep pattern. The nocturnal work time, which requires a high level physical and mental performance, is associated with some endocrine alterations reflecting an eventual phase of hypovigilance.