Influence of Circadian Disruption Associated With Artificial Light at Night on Micturition Patterns in Shift Workers

Nocturia and frailty in older adults: a scoping review

BACKGROUND

More than one in two older people wake up several times a night to urinate. Far from being a minor inconvenience, nocturia is associated with poor health outcomes. Given the importance of sleep as a foundation for resilience and healthy ageing, nocturia may promote the development of frailty, which is inextricably linked to physical decline, disability, and mortality. The aim of this scoping review was to collate published evidence on the relationship between nocturia and frailty, using the methodological framework of Arksey and O'Malley, together with the Joanna Briggs Institute methodology as guidance (OSF registration: osf.io/d5ct7).

METHODS

Relevant publications were retrieved via PubMed, Embase, the Cochrane Library and Google Scholar. The Rayyan tool was used to facilitate the screening process. Data were extracted by two independent reviewers. 250 publications were initially identified, of which 87 met the eligibility criteria.

RESULTS

Most of the evidence came from cross-sectional studies, most of which had been published within the last 5 years. The researchers were diverse, with 27% having a geriatric background. Only few publications established a clear association between nocturia and frailty. Other topics included: the association between nocturia and poor sleep quality and duration; the association between sleep and frailty; the association between frailty, multimorbidity, and age-related changes in the lower urinary tract.

CONCLUSION

The findings emphasize the increasing interest and interdisciplinary nature of research into the relationship between frailty, nocturia, lower urinary tract symptoms, and sleep disturbances. Further research is required to enhance understanding, establish causality, and identify potential therapeutic approaches.

Circadian light/dark cycle reversal exacerbates the progression of chronic kidney disease in mice

Circadian disruption such as shift work, jet lag, has gradually become a global health issue and is closely associated with various metabolic disorders. The influence and mechanism of circadian disruption on renal injury in chronic kidney disease (CKD) remains inadequately understood. Here, we evaluated the impact of environmental light disruption on the progression of chronic renal injury in CKD mice. By using two abnormal light exposure models to induce circadian disruption, we found that circadian disruption induced by weekly light/dark cycle reversal (LDDL) significantly exacerbated renal dysfunction, accelerated renal injury, and promoted renal fibrosis in mice with 5/6 nephrectomy and unilateral ureteral obstruction (UUO). Mechanistically, RNA-seq analysis revealed significant immune and metabolic disorder in the LDDL-conditioned CKD kidneys. Consistently, renal content of ATP was decreased and ROS production was increased in the kidney tissues of the LDDL-challenged CKD mice. Untargeted metabolomics revealed a significant buildup of lipids in the kidney affected by LDDL. Notably, the level of β-NMN, a crucial intermediate in the NAD+ pathway, was found to be particularly reduced. Moreover, we demonstrated that both β-NMN and melatonin administration could significantly rescue the light-disruption associated kidney dysfunction. In conclusion, environmental circadian disruption may exacerbate chronic kidney injury by facilitating inflammatory responses and disturbing metabolic homeostasis. β-NMN and melatonin treatments may hold potential as promising approaches for preventing and treating light-disruption associated CKD.

Disrupted Circadian Control of Hormonal Rhythms and Anticipatory Thirst by Dim Light at Night

AIMS

Our study addresses underlying mechanisms of disruption of the circadian timing system by low-intensity artificial light at night (ALAN), which is a growing global problem, associated with serious health consequences.

METHODS

Rats were exposed to low-intensity (∼2 lx) ALAN for 2 weeks. Using in situ hybridization, we assessed 24-h profiles of clock and clock-controlled genes in the suprachiasmatic nuclei (SCN) and other hypothalamic regions, which receive input from the master clock. Moreover, we measured the daily rhythms of hormones within the main neuroendocrine axes as well as the detailed daily pattern of feeding and drinking behavior in metabolic cages.

RESULTS

ALAN strongly suppressed the molecular clockwork in the SCN, as indicated by the suppressed rhythmicity in the clock (Per1, Per2, and Nr1d1) and clock output (arginine vasopressin) genes. ALAN disturbed rhythmic Per1 expression in the paraventricular and dorsomedial hypothalamic nuclei, which convey the circadian signals from the master clock to endocrine and behavioral rhythms. Disruption of hormonal output pathways was manifested by the suppressed and phase-advanced corticosterone rhythm and lost daily variations in plasma melatonin, testosterone, and vasopressin. Importantly, ALAN altered the daily profile in food and water intake and eliminated the clock-controlled surge of drinking 2 h prior to the onset of the rest period, indicating disturbed circadian control of anticipatory thirst and fluid balance during sleep.

CONCLUSION

Our findings highlight compromised time-keeping function of the central clock and multiple circadian outputs, through which ALAN disturbs the temporal organization of physiology and behavior.

Dysfunction of the circadian clock in the kidney tubule leads to enhanced kidney gluconeogenesis and exacerbated hyperglycemia in diabetes

The circadian clock is a ubiquitous molecular time-keeping mechanism which synchronizes cellular, tissue, and systemic biological functions with 24-hour environmental cycles. Local circadian clocks drive cell type- and tissue-specific rhythms and their dysregulation has been implicated in pathogenesis and/or progression of a broad spectrum of diseases. However, the pathophysiological role of intrinsic circadian clocks in the kidney of diabetics remains unknown. To address this question, we induced type I diabetes with streptozotocin in mice devoid of the circadian transcriptional regulator BMAL1 in podocytes (cKOp mice) or in the kidney tubule (cKOt mice). There was no association between dysfunction of the circadian clock and the development of diabetic nephropathy in cKOp and cKOt mice with diabetes. However, cKOt mice with diabetes exhibited exacerbated hyperglycemia, increased fractional excretion of glucose in the urine, enhanced polyuria, and a more pronounced kidney hypertrophy compared to streptozotocin-treated control mice. mRNA and protein expression analyses revealed substantial enhancement of the gluconeogenic pathway in kidneys of cKOt mice with diabetes as compared to diabetic control mice. Transcriptomic analysis along with functional analysis of cKOt mice with diabetes identified changes in multiple mechanisms directly or indirectly affecting the gluconeogenic pathway. Thus, we demonstrate that dysfunction of the intrinsic kidney tubule circadian clock can aggravate diabetic hyperglycemia via enhancement of gluconeogenesis in the kidney proximal tubule and further highlight the importance of circadian behavior in patients with diabetes.

A Study of Workspace Design Characteristics Exemplified by Nurses' Satisfaction Within Three Intensive Care Units in a University Hospital

BACKGROUND

The critical conditions of intensive care patients require providing them with a higher acuity of care. Thus, it is essential to focus on critical care nurses and improve their work environment in a way that maximizes productivity, collaboration, satisfaction, and leads to improved patient care.

PURPOSE

This study aims to explore the role the workplace layout design play in determining nurses' satisfaction in three intensive care units (ICUs) at a university hospital.

METHOD

A prospective, cross-sectional, single-center, survey-based design was employed in this study. Data were obtained, via a standardized questionnaire, from 36 morning shift nurses. The nurses' self-reported satisfaction scores in three different ICUs with differing overall layouts, nursing station locations, and workplace design were statistically compared.

RESULTS

The study found that ICU 1 (private rooms, single corridor, central nursing station, close to supported services) had higher nursing satisfaction levels than ICUs 2 and 3 (open wards with separate service zones), F _(2,34) = 5.054, p = .012. However, overall satisfaction was higher with the ICU 2 primary workspace design, possibly due to the perceived acoustic privacy in this configuration, F _(2,34)= 4.492, p = .019. The ability of the ICU layout design to enhance teamwork and minimize traffic in patients care areas was found to be an important predictor of nurses' satisfaction. The primary workspace design capacity to minimize congestion and the presence of large numbers of providers in a confined workplace might account for variation in nurses' satisfaction.

CONCLUSION

Physical environment variables in the ICU design may contribute to staff workplace satisfaction scores and may help in guiding informed choices regarding the future ICU design.

Rotating Night Shift Work, Exposure to Light at Night, and Glomerular Filtration Rate: Baseline Results from a Chinese Occupational Cohort

The misalignment between the circadian clock and behavioral cycles has been implicated in pathogenesis of many diseases. The main purpose of this study is to examine the association between rotating night shift work, exposure to light at night, and glomerular filtration rate among steelworkers in north China. A total of 6869 steelworkers, aged 22 to 60 years, were included in this study. Multivariable logistic regression was used to examine the association between night shift work, the brightness of bedroom ambient light at night (LAN), and estimated glomerular filtration rate (eGFR), with adjustment for potential confounders. Mediation analysis was performed to examine the mediation effect of potential mediators on the association of duration of night shifts and eGFR. Long duration of night shift work (≥29 years) had elevated odds of decreased eGFR (≤89 mL/min/1.73 m²) (odds ratio (OR), 1.37, 95% confidence interval (CI) 1.09–1.73) compared with day work after adjustment for potential confounders. The association between duration of night shifts and eGFR (continuous) was partially modified by diastolic blood pressure (average causal mediation effect (ACME), –0.077, 95% CI –0.134 to −0.030, p < 0.001). No significant associations were observed among the different brightness of bedroom ambient light levels: middle level (OR, 0.90, 95% CI 0.77–1.05), lightest level (OR, 0.94, 95% CI 0.75–1.18), and decreased eGFR compared with the darkest level. Long-term night-shift work, rather than the brightness of bedroom ambient LAN, is associated with early stage of renal dysfunction in steelworkers, and blood pressure may mediate the relationship between night shift work and decreased eGFR.

Defining nocturnal polyuria in women

AIMS

Nocturnal polyuria (NP) is defined by the International Continence Society (ICS) as "excessive production of urine during the main sleep period" and is one of the main causes of nocturia. The ICS recognized that "excessive" is not clearly defined and that this needs to be highlighted in both clinical and research settings. The aim of this study was to identify different definitions of NP and apply them to a population of women attending the Urogynaecology clinic.

METHODS

This was a retrospective study of complete bladder diaries collected from women attending a tertiary Urogynaecology Unit. Six different definitions were identified and were divided into "absolute," "relative," and "functional definitions." Prevalence data were calculated and values generated for sensitivity, specificity, positive and negative predictive values when related to women voiding ≥ 2 times per night.

RESULTS

Complete bladder diaries were obtained from 1398 women, over 6 years, with a mean age of 57 years. Prevalence varied across the definitions from 21.5% (absolute definition) to 77% (relative definition). Sensitivity ranged from 43% (absolute) to 87% (relative). The definitions that showed the highest combined sensitivity and specificity were the functional definitions.

CONCLUSION

From this study it is clear that more work needs to be done to arrive at a consensus for defining NP to enable accurate diagnosis and development of treatment pathways. We propose that a relative definition may provide a more clinically relevant method of defining NP.