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Cox RC, Blumenstein AB, Burke TM, Depner CM, Guerin MK, Hay-Arthur E, Higgins J, Knauer OA, Lanza SM, Markwald RR, Melanson EL, McHill AW, Morton SJ, Ritchie HK, Smith MR, Smits AN, Sprecher KE, Stothard ER, Withrow D, Wright KP. Distribution of dim light melatonin offset (DLMOff) and phase relationship to waketime in healthy adults and associations with chronotype. Sleep Health 2024; 10:S76-S83. [PMID: 37777359 DOI: 10.1016/j.sleh.2023.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVES Dim light melatonin onset, or the rise in melatonin levels representing the beginning of the biological night, is the gold standard indicator of circadian phase. Considerably less is known about dim light melatonin offset, or the decrease in melatonin to low daytime levels representing the end of the biological night. In the context of insufficient sleep, morning circadian misalignment, or energy intake after waketime but before dim light melatonin offset, is linked to impaired insulin sensitivity, suggesting the need to characterize dim light melatonin offset and identify risk for morning circadian misalignment. METHODS We examined the distributions of dim light melatonin offset clock hour and the phase relationship between dim light melatonin offset and waketime, and associations between dim light melatonin offset, phase relationship, and chronotype in healthy adults (N = 62) who completed baseline protocols measuring components of the circadian melatonin rhythm and chronotype. RESULTS 74.4% demonstrated dim light melatonin offset after waketime, indicating most healthy adults wake up before the end of biological night. Later chronotype (morningness-eveningness, mid-sleep on free days corrected, and average mid-sleep) was associated with later dim light melatonin offset clock hour. Later chronotype was also associated with a larger, positive phase relationship between dim light melatonin offset and waketime, except for morningness-eveningness. CONCLUSIONS These findings suggest morning circadian misalignment risk among healthy adults, which would not be detected if only dim light melatonin onset were assessed. Chronotype measured by sleep timing may better predict this risk in healthy adults keeping a consistent sleep schedule than morningness-eveningness preferences. Additional research is needed to develop circadian biomarkers to predict dim light melatonin offset and evaluate appropriate dim light melatonin offset timing to promote health.
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Affiliation(s)
- Rebecca C Cox
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Alivia B Blumenstein
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Tina M Burke
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA; Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Christopher M Depner
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA; Department of Health and Kinesiology, University of Utah, Salt Lake City, Utah, USA
| | - Molly K Guerin
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Emily Hay-Arthur
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Janine Higgins
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Oliver A Knauer
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Shannon M Lanza
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Rachel R Markwald
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA; Naval Health Research Center, San Diego, California, USA
| | - Edward L Melanson
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Andrew W McHill
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA; Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, Oregon, USA
| | - Sarah J Morton
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Hannah K Ritchie
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Mark R Smith
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Alexandra N Smits
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Kate E Sprecher
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Ellen R Stothard
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA; Colorado Sleep Institute, Boulder, Colorado, USA
| | - Dana Withrow
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Kenneth P Wright
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA; Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
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Futenma K, Takaesu Y, Komada Y, Shimura A, Okajima I, Matsui K, Tanioka K, Inoue Y. Delayed sleep-wake phase disorder and its related sleep behaviors in the young generation. Front Psychiatry 2023; 14:1174719. [PMID: 37275982 PMCID: PMC10235460 DOI: 10.3389/fpsyt.2023.1174719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/08/2023] [Indexed: 06/07/2023] Open
Abstract
Delayed sleep-wake phase disorder (DSWPD) is a sleep disorder in which the habitual sleep-wake timing is delayed, resulting in difficulty in falling asleep and waking up at the desired time. Patients with DSWPD frequently experience fatigue, impaired concentration, sleep deprivation during weekdays, and problems of absenteeism, which may be further complicated by depressive symptoms. DSWPD is typically prevalent during adolescence and young adulthood. Although there are no studies comparing internationally, the prevalence of DSWPD is estimated to be approximately 3% with little racial differences between Caucasians and Asians. The presence of this disorder is associated with various physiological, genetic and psychological as well as behavioral factors. Furthermore, social factors are also involved in the mechanism of DSWPD. Recently, delayed sleep phase and prolonged sleep duration in the young generation have been reported during the period of COVID-19 pandemic-related behavioral restrictions. This phenomenon raises a concern about the risk of a mismatch between their sleep-wake phase and social life that may lead to the development of DSWPD after the removal of these restrictions. Although the typical feature of DSWPD is a delay in circadian rhythms, individuals with DSWPD without having misalignment of objectively measured circadian rhythm markers account for approximately 40% of the cases, wherein the psychological and behavioral characteristics of young people, such as truancy and academic or social troubles, are largely involved in the mechanism of this disorder. Recent studies have shown that DSWPD is frequently comorbid with psychiatric disorders, particularly mood and neurodevelopmental disorders, both of which have a bidirectional association with the pathophysiology of DSWPD. Additionally, patients with DSWPD have a strong tendency toward neuroticism and anxiety, which may result in the aggravation of insomnia symptoms. Therefore, future studies should address the effectiveness of cognitive-behavioral approaches in addition to chronobiological approaches in the treatment of DSWPD.
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Affiliation(s)
- Kunihiro Futenma
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
| | - Yoko Komada
- Institute for Liberal Arts, Tokyo Institute of Technology, Tokyo, Japan
| | - Akiyoshi Shimura
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
- Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
| | - Isa Okajima
- Department of Psychological Counseling, Faculty of Humanities, Tokyo Kasei University, Tokyo, Japan
| | - Kentaro Matsui
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
- Department of Clinical Laboratory, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kosuke Tanioka
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
| | - Yuichi Inoue
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
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3
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Lang C, Richardson C, Micic G, Gradisar M. Understanding Sleep-Wake Behavior in Late Chronotype Adolescents: The Role of Circadian Phase, Sleep Timing, and Sleep Propensity. Front Psychiatry 2022; 13:785079. [PMID: 35360141 PMCID: PMC8963423 DOI: 10.3389/fpsyt.2022.785079] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Adolescents with a late chronotype are at greater risk for mood disorders, risk-taking behaviors, school absenteeism, and lower academic achievement. As there are multiple causes for late chronotype, the field lacks studies on the relationship between mood, circadian phase, and phase angle of entrainment in late chronotype adolescents. Three objectives guide this explorative study: (1) to describe sleep, circadian phase, and phase angle of entrainment in late chronotype adolescents, (2) to explore how different levels of lateness are associated with sleep quality, sleep propensity, and mood, and (3) to investigate the influence of circadian phase on bedtime choice and sleep duration. METHODS Baseline data from 19 male adolescents (M = 16.4 ± 1.0 yrs), who were part of a larger intervention trial, were analyzed. Chronotype was measured with the Munich Chronotype Questionnaire, circadian timing via dim light melatonin onset (DLMO), and sleep habits with a 7-day sleep log. Further questionnaires assessed daytime sleepiness, sleep quality, and mood. Evening sleepiness and sustained attention were used as a proxy for evening sleep propensity. RESULTS On school nights, sleep duration averaged 7.78 h (±1.65), and 9.00 h (±1.42) on weekend nights. Mean DLMO was observed at 23.13 h (± 1.65), with a weekend phase angle of entrainment of 2.48 h. Regression fittings revealed a tendency for shorter phase angles with delayed DLMOs. Further analysis with chronotype subgroups revealed that this was only true for light and moderate late types, whereas extreme late types showed wide phase angles. Even though daytime sleepiness and sleep duration did not differ between subgroups, mood and sleep quality declined as lateness increased. Extreme late chronotypes experienced higher evening sleepiness, while slight late chronotypes showed higher evening attention. Chronotype but not DLMO predicted bedtime on school- and particularly weekend-nights. CONCLUSIONS Our findings suggest that with increasing lateness, the likelihood of experiencing poor sleep quality and mood disorders increases. As DLMO did not predict bedtime, our data indicate that the factors contributing to a late chronotype are versatile and complex, particularly for extreme late types. Further studies involving a larger and gender-balanced sample are needed to confirm findings.
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Affiliation(s)
- Christin Lang
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland.,College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Cele Richardson
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia.,Centre for Sleep Science, School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Gorica Micic
- Adelaide Institute for Sleep Health, Flinders Health & Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Michael Gradisar
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
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Otsuki R, Matsui K, Yoshiike T, Nagao K, Utsumi T, Tsuru A, Ayabe N, Hazumi M, Fukumizu M, Kuriyama K. Decrease in Social Zeitgebers Is Associated With Worsened Delayed Sleep-Wake Phase Disorder: Findings During the Pandemic in Japan. Front Psychiatry 2022; 13:898600. [PMID: 35757225 PMCID: PMC9222896 DOI: 10.3389/fpsyt.2022.898600] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Delay in sleep-wake rhythms was observed in the general population during the coronavirus disease 2019 (COVID-19) pandemic. Patients with delayed sleep-wake phase disorder (DSWPD) may have also experienced exacerbation of symptoms, but no studies have investigated this topic. In this study, we aimed to retrospectively examine the changes in symptoms of outpatients with DSWPD both before and during the pandemic and to identify the factors associated with the exacerbation of sleep-wake rhythms. METHODS We included outpatients with DSWPD aged 16 years or older who visited the outpatient clinic due to sleep disorders between January and September 2020. Decreased social zeitgebers was defined as a reduction of 50% or more in the frequency of commuting to school or work during the COVID-19 pandemic. The severity of DSWPD was assessed using the clinical global impressions - severity of illness (CGI-S) at two points: before and during the pandemic. We defined the worsened, unchanged, and improved groups as those whose CGI-S scores worsened by at least one point, remained unchanged, and improved by at least one point, respectively. Multivariate logistic regression analysis was performed to determine the factors associated with worsened DSWPD symptoms. RESULTS Sixty patients with DSWPD were eligible for this study. Even before the pandemic, patients who were unemployed or did not attend school tended to show more severe DSWPD symptoms. During the pandemic, 27 patients belonged to the worsened group; 28 patients, unchanged group; and 5 patients, improved group. Decreased social zeitgebers (odds ratio [OR] = 6.668, 95% confidence interval [CI]: 1.653-26.891, p < 0.05) and comorbid mood disorders (OR = 8.876, 95% CI: 1.714-45.974, p < 0.05) showed independent significant associations with the worsening of DSWPD symptoms. CONCLUSIONS During the pandemic, the symptoms of DSWPD tended to worsen. The obtained findings emphasize the importance of social zeitgebers, suggesting the need for external motivation in DSWPD treatment.
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Affiliation(s)
- Rei Otsuki
- Department of Laboratory Medicine, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology & Psychiatry, Tokyo, Japan.,Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Kentaro Matsui
- Department of Laboratory Medicine, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology & Psychiatry, Tokyo, Japan
| | - Takuya Yoshiike
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology & Psychiatry, Tokyo, Japan
| | - Kentaro Nagao
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology & Psychiatry, Tokyo, Japan.,Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tomohiro Utsumi
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology & Psychiatry, Tokyo, Japan.,Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Ayumi Tsuru
- Department of Laboratory Medicine, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology & Psychiatry, Tokyo, Japan
| | - Naoko Ayabe
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology & Psychiatry, Tokyo, Japan.,Department of Regional Studies and Humanities, Faculty of Education and Human Studies, Akita University, Akita, Japan
| | - Megumi Hazumi
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology & Psychiatry, Tokyo, Japan.,Department of Public Mental Health, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Michio Fukumizu
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology & Psychiatry, Tokyo, Japan.,Segawa Memorial Neurological Clinic for Children, Tokyo, Japan
| | - Kenichi Kuriyama
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology & Psychiatry, Tokyo, Japan
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Frangopoulos F, Nicolaou I, Zannetos S, Economou NT, Adamide T, Georgiou A, Nikolaidis PT, Rosemann T, Knechtle B, Trakada G. Setting Objective Clinical Assessment Tools for Circadian Rhythm Sleep-Wake Disorders - A Community-Based Cross-Sectional Epidemiological Study. Nat Sci Sleep 2021; 13:791-802. [PMID: 34163273 PMCID: PMC8215907 DOI: 10.2147/nss.s308917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/22/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Circadian rhythm sleep-wake disorder (CRSWD) is an often-misdiagnosed group of sleep disturbances with limited data concerning diagnostic and therapeutic algorithms in the general population. Therefore, reported prevalence varies in the literature due to different case definitions, methodological, and environmental factors. OBJECTIVES The purpose of our cross-sectional study was to estimate the prevalence of CRSWD in the general population of Cyprus and to suggest clinical parameters for the assessment of atypical sleep schedules. The estimation was carried out by introducing normal preset sleep time limits, according to the imposed local environment and by administering well-established questionnaires for symptoms and consequence dysfunction, as objective evaluation tools. METHODS In a nationwide epidemiological survey, 4118 Cypriot adult participants, selected and stratified to represent the general population, were interviewed on sleep habits and complaints by computer-assisted telephone interviewing (CATI). In the second stage, 250 adults were randomly selected from the initial representative sample, for a CRSWD assessment. According to the proposed diagnostic criteria, patients were interviewed about sleepiness and/or insomnia, and daytime dysfunction (fatigue, anxiety, and depression). They were also assessed by a weekly sleep diary for sleep schedules. Finally, all participants underwent a Type III Sleep Study, to rule out obstructive sleep apnea. RESULTS From 195 enrolled participants (response rate 78%), 25 individuals (12.8%) met the criteria for CRSWD. The two most prevalent disorders were delayed sleep-wake phase disorder (DSWPD) (10pts, 5.1%) and shift work sleep disorder (SWD) (13, 6.7%). Less prevalent disorders included irregular sleep-wake rhythm disorder (ISWRD) (1, 0.5%) and advanced sleep-wake phase disorder (ASWPD) (1, 0.5%). CONCLUSIONS According to our data, CRSWDs are common in the general population of Cyprus, especially DSWPD and SWD. Affected individuals usually suffer from sleep deprivation and complain about insomnia, sleepiness and depression.
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Affiliation(s)
| | - Ivi Nicolaou
- Respiratory Department, Nicosia General Hospital, Nicosia, Cyprus
| | - Savvas Zannetos
- Health Economics and Statistics, Neapolis University, Paphos, Cyprus
| | - Nicholas-Tiberio Economou
- Division of Pulmonology, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra Hospital, Athens, Greece
| | - Tonia Adamide
- Respiratory Department, Nicosia General Hospital, Nicosia, Cyprus
| | - Andreas Georgiou
- Respiratory Department, Nicosia General Hospital, Nicosia, Cyprus
| | | | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Georgia Trakada
- Division of Pulmonology, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra Hospital, Athens, Greece
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Combs D, Hsu CH, Bailey O, Patel SI, Mashaqi S, Estep L, Provencio-Dean N, Lopez S, Parthasarathy S. Differences in sleep timing and related effects between African Americans and non-Hispanic Whites. J Clin Sleep Med 2021; 17:897-908. [PMID: 33382030 PMCID: PMC8320474 DOI: 10.5664/jcsm.9060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 12/25/2022]
Abstract
STUDY OBJECTIVES Prior studies have shown a morning chronotype for African Americans compared with non-Hispanic Whites, yet self-reported sleep timing is delayed in African Americans compared with Whites. METHODS We analyzed data from the Multi-Ethnicity Study of Atherosclerosis, a multisite community-based cohort. Self-reported and actigraphic sleep timing, chronotype measured by the modified Horne-Östberg Morningness-Eveningness Questionnaire, and risk of depression measured by the Center for Epidemiologic Studies Depression scale were examined using nonparametric approaches and linear or logistic regression while comparing between African Americans and Whites and evaluating the effects of delayed sleep phase. RESULTS In 1,401 participants, there was no difference in chronotype between African Americans and Whites. African Americans were 80% more likely to report a delayed sleep phase (defined as bedtime after midnight) on weekdays and 50% more likely on weekends than were Whites. Actigraphic data showed similar results. Actigraphic midsleep time was delayed 38 minutes on weekdays and 24 minutes on weekends in African Americans compared with Whites. Stratified analysis by chronotype showed that African Americans with a morning or intermediate chronotype had a significantly delayed sleep phase compared with Whites, but there was no difference between African Americans and Whites with an evening chronotype. Delayed sleep phase was associated with depression, but this relationship was only significant in White participants. CONCLUSIONS African Americans had a delayed sleep phase compared with Whites that was more pronounced in individuals with a morning or intermediate chronotype. Consequences of delayed sleep phase may vary by race and ethnicity.
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Affiliation(s)
- Daniel Combs
- UAHS Center for Sleep and Circadian Sciences, University of Arizona, Tucson, Arizona
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Arizona, Tucson, Arizona
- Department of Pediatrics, University of Arizona, Tucson, Arizona
| | - Chiu-Hsieh Hsu
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, Tucson, Arizona
| | - Omavi Bailey
- UAHS Center for Sleep and Circadian Sciences, University of Arizona, Tucson, Arizona
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Arizona, Tucson, Arizona
| | - Salma I. Patel
- UAHS Center for Sleep and Circadian Sciences, University of Arizona, Tucson, Arizona
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Arizona, Tucson, Arizona
| | - Saif Mashaqi
- UAHS Center for Sleep and Circadian Sciences, University of Arizona, Tucson, Arizona
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Arizona, Tucson, Arizona
| | - Lauren Estep
- UAHS Center for Sleep and Circadian Sciences, University of Arizona, Tucson, Arizona
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Arizona, Tucson, Arizona
| | - Natalie Provencio-Dean
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Arizona, Tucson, Arizona
| | - Silvia Lopez
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Arizona, Tucson, Arizona
| | - Sairam Parthasarathy
- UAHS Center for Sleep and Circadian Sciences, University of Arizona, Tucson, Arizona
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Arizona, Tucson, Arizona
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Micic G, Lovato N, Ferguson SA, Burgess HJ, Lack L. Circadian tau differences and rhythm associations in delayed sleep-wake phase disorder and sighted non-24-hour sleep-wake rhythm disorder. Sleep 2021; 44:5867108. [PMID: 32619243 DOI: 10.1093/sleep/zsaa132] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 06/19/2020] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES We investigated biological and behavioral rhythm period lengths (i.e. taus) of delayed sleep-wake phase disorder (DSWPD) and non-24-hour sleep-wake rhythm disorder (N24SWD). Based on circadian phase timing (temperature and dim light melatonin onset), DSWPD participants were dichotomized into a circadian-delayed and a circadian non-delayed group to investigate etiological differences. METHODS Participants with DSWPD (n = 26, 17 m, age: 21.85 ± 4.97 years), full-sighted N24SWD (n = 4, 3 m, age: 25.75 ± 4.99 years) and 18 controls (10 m, age: 23.72 ± 5.10 years) participated in an 80-h modified constant routine. An ultradian protocol of 1-h "days" in dim light, controlled conditions alternated 20-min sleep/dark periods with 40-min enforced wakefulness/light. Subjective sleepiness ratings were recorded prior to every sleep/dark opportunity and median reaction time (vigilance) was measured hourly. Obtained sleep (sleep propensity) was derived from 20-min sleep/dark opportunities to quantify hourly objective sleepiness. Hourly core body temperature was recorded, and salivary melatonin assayed to measure endogenous circadian rhythms. Rhythm data were curved using the two-component cosine model. RESULTS Patients with DSWPD and N24SWD had significantly longer melatonin and temperature taus compared to controls. Circadian non-delayed DSWPD had normally timed temperature and melatonin rhythms but were typically sleeping at relatively late circadian phases compared to those with circadian-delayed DSWPD. CONCLUSIONS People with DSWPD and N24SWD exhibit significantly longer biological circadian rhythm period lengths compared to controls. Approximately half of those diagnosed with DSWPD do not have abnormally delayed circadian rhythm timings suggesting abnormal phase relationship between biological rhythms and behavioral sleep period or potentially conditioned sleep-onset insomnia.
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Affiliation(s)
- Gorica Micic
- Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia
| | - Nicole Lovato
- Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia
| | - Sally A Ferguson
- Appleton Institute, Central Queensland University, Adelaide, South Australia
| | - Helen J Burgess
- Sleep and Circadian Research Laboratory, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan
| | - Leon Lack
- Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia.,College of Education, Psychology and Social Work, Flinders University, Bedford Park, South Australia
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8
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Izuhara M, Kawano K, Otsuki K, Hashioka S, Inagaki M. Prompt improvement of difficulty with sleep initiation and waking up in the morning and daytime somnolence by combination therapy of suvorexant and ramelteon in delayed sleep-wake phase disorder: a case series of three patients. Sleep Med 2021; 80:100-104. [PMID: 33588260 DOI: 10.1016/j.sleep.2021.01.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/06/2021] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
Patients with delayed sleep-wake phase disorder (DSWPD) suffer from difficulties in sleep initiation at night, difficulties in waking up at the socially required time, and daytime somnolence. About half of the patients resist conventional light therapy and melatonin therapy. Therapy using hypnotics is not recommended due to its adverse effects. Recently, suvorexant, an orexin receptor antagonist, has become available for clinical use. The drug is relatively safer than traditional hypnotics such as benzodiazepines. We report three DSWPD patients who were successfully treated by the combination therapy of suvorexant and ramelteon. The first case was a 19-year-old woman who was experiencing difficulties in sleep initiation, difficulty in waking up in the morning, and daytime somnolence. She showed a prompt response to the combination therapy of suvorexant and ramelteon. Her sleep phase advanced, and her daytime somnolence reduced. The second and third cases were 21-year-old and 17-year-old men, respectively, who also showed significant sleep phase advances. Although case 2 was resistant to ramelteon treatment, his sleep phase advanced after suvorexant started. His difficulty in falling asleep and his habit of daytime napping disappeared after the combination therapy of suvorexant and ramelteon was started. Case 3 also showed a prompt response. His difficulties in falling asleep and waking up in the morning were ameliorated immediately after suvorexant with ramelteon was started. No obvious side effects were observed. Therapy using the combination therapy of suvorexant and ramelteon might be a reasonable option for DSWPD patients.
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Affiliation(s)
- Muneto Izuhara
- Department of Psychiatry, Faculty of Medicine, Shimane University, Shimane, Japan
| | - Kiminori Kawano
- Department of Psychiatry, Faculty of Medicine, Shimane University, Shimane, Japan
| | - Koji Otsuki
- Department of Psychiatry, Faculty of Medicine, Shimane University, Shimane, Japan
| | - Sadayuki Hashioka
- Department of Psychiatry, Faculty of Medicine, Shimane University, Shimane, Japan
| | - Masatoshi Inagaki
- Department of Psychiatry, Faculty of Medicine, Shimane University, Shimane, Japan.
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Reis C, Madeira SG, Lopes LV, Paiva T, Roenneberg T. Validation of the Portuguese Variant of the Munich Chronotype Questionnaire (MCTQ PT). Front Physiol 2020; 11:795. [PMID: 32760292 PMCID: PMC7372122 DOI: 10.3389/fphys.2020.00795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/15/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction Differences in the manner circadian clocks entrain to the 24-h day are expressions of different chronotypes that can range from extreme early to extreme late, from proverbial larks to owls. The Morningness Eveningness Questionnaire (MEQ) was one of the first to assess daily preference based on subjective self-assessment – a psychological construct. The later developed Munich Chronotype Questionnaire (MCTQ) uses instead the actual sleep timing to assess chronotype. It calculates the mid-sleep point, halfway between onset and offset on work-free days (MSF), which is then corrected for potential oversleep on free days compensating for sleep debt accumulated over the workweek (MSFsc). MSFsc is expressed in local time and is thought to be a proxy for “phase of entrainment” of the circadian clock. The MCTQ-derived chronotype is therefore a biological construct. In the present report, we validate the Portuguese variant (MCTQPT) of the MCTQ. Portugal is of particular interest, since it is thought to consist of especially late chronotypes. Methods We have used three methods to assess the timing of daily behavior, namely, the chronotype (MCTQ), the daily preference (rMEQ), and a simple self-assessment (time-of-day type). A total of 80 healthy adults living in Portugal, with age and sex distributed according to the Portuguese population, were recruited. We analyzed 4 weeks of continuous records of actimetry data to validate the MCTQPT and used the rMEQ to compare between a biological chronotype (sleep timing) and a psychological chronotype (daily preference). MCTQ variables were analyzed by descriptive statistics; correspondence between measurements was done by Spearman correlations or cross-tabulation; in a subset of 41 individuals, test–retest reliability was assessed. Results MCTQ-derived variables (MSF, MSW, MSFsc) correlated highly with their counterparts calculated from actimetry (MSW: rho = 0.697; MSF: rho = 0.747; MSFsc: rho = 0.646; all p < 0.001). The MCTQ assessment of the chronotype showed good test–retest reliability (rho = 0.905; p < 0.001). The rMEQ score correlates with MSFsc (rho = −0.695; p < 0.001), and the agreement for the self-assessment with the MSFsc was fair (kw = 0.386; p < 0.001). Conclusion The Portuguese variant of the MCTQ revealed to be a reliable questionnaire to assess the chronotype for the Portuguese adult population, as previously reported for other countries.
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Affiliation(s)
- Cátia Reis
- Centro de Medicina de Sono (CENC), Lisbon, Portugal.,Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Sara Gamboa Madeira
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Unidade de Saúde Familiar Mactamã, Administração Regional de Saúde de Lisboa e Vale do Tejo (ARSLVT), Lisbon, Portugal
| | - Luísa V Lopes
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Teresa Paiva
- Centro de Medicina de Sono (CENC), Lisbon, Portugal.,Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Comprehensive Health Research Center (CHRC), Nova Medical School, Faculdade de Ciências Médicas, Lisbon, Portugal
| | - Till Roenneberg
- Institute for Medical Psychology, Medical Faculty, Ludwig-Maximilians University (LMU), Munich, Germany
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