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Davis H, Attwell D. Heart failure causes sleepless nights. Science 2023; 381:270-271. [PMID: 37471547 DOI: 10.1126/science.adj0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Cardiac dysfunction triggers immune-mediated loss of pineal gland melatonin release.
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Affiliation(s)
- Harvey Davis
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK
| | - David Attwell
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK
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2
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Ziegler KA, Ahles A, Dueck A, Esfandyari D, Pichler P, Weber K, Kotschi S, Bartelt A, Sinicina I, Graw M, Leonhardt H, Weckbach LT, Massberg S, Schifferer M, Simons M, Hoeher L, Luo J, Ertürk A, Schiattarella GG, Sassi Y, Misgeld T, Engelhardt S. Immune-mediated denervation of the pineal gland underlies sleep disturbance in cardiac disease. Science 2023; 381:285-290. [PMID: 37471539 DOI: 10.1126/science.abn6366] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 06/01/2023] [Indexed: 07/22/2023]
Abstract
Disruption of the physiologic sleep-wake cycle and low melatonin levels frequently accompany cardiac disease, yet the underlying mechanism has remained enigmatic. Immunostaining of sympathetic axons in optically cleared pineal glands from humans and mice with cardiac disease revealed their substantial denervation compared with controls. Spatial, single-cell, nuclear, and bulk RNA sequencing traced this defect back to the superior cervical ganglia (SCG), which responded to cardiac disease with accumulation of inflammatory macrophages, fibrosis, and the selective loss of pineal gland-innervating neurons. Depletion of macrophages in the SCG prevented disease-associated denervation of the pineal gland and restored physiological melatonin secretion. Our data identify the mechanism by which diurnal rhythmicity in cardiac disease is disturbed and suggest a target for therapeutic intervention.
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Affiliation(s)
- Karin A Ziegler
- Institute of Pharmacology and Toxicology, Technical University Munich (TUM), Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Andrea Ahles
- Institute of Pharmacology and Toxicology, Technical University Munich (TUM), Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Anne Dueck
- Institute of Pharmacology and Toxicology, Technical University Munich (TUM), Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Dena Esfandyari
- Institute of Pharmacology and Toxicology, Technical University Munich (TUM), Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Pauline Pichler
- Institute of Pharmacology and Toxicology, Technical University Munich (TUM), Munich, Germany
| | - Karolin Weber
- Institute of Pharmacology and Toxicology, Technical University Munich (TUM), Munich, Germany
| | - Stefan Kotschi
- Institute for Cardiovascular Prevention (IPEK), Faculty of Medicine, Ludwig-Maximilians-Universität (LMU) München, Munich, Germany
| | - Alexander Bartelt
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Institute for Cardiovascular Prevention (IPEK), Faculty of Medicine, Ludwig-Maximilians-Universität (LMU) München, Munich, Germany
- Institute for Diabetes and Cancer, Helmholtz Center Munich, Neuherberg, Germany
- Department of Molecular Metabolism & Sabri Ülker Center for Metabolic Research, Harvard. T.H. Chan School of Public Health, Boston, MA, USA
| | - Inga Sinicina
- Institute of Legal Medicine, Faculty of Medicine, Ludwig-Maximilians-Universität (LMU) München, Munich, Germany
| | - Matthias Graw
- Institute of Legal Medicine, Faculty of Medicine, Ludwig-Maximilians-Universität (LMU) München, Munich, Germany
| | - Heinrich Leonhardt
- Human Biology & Bioimaging, Faculty of Biology, Ludwig-Maximilians-Universität (LMU) München, Munich, Germany
| | - Ludwig T Weckbach
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- Institute of Cardiovascular Physiology and Pathophysiology, Biomedical Center, Ludwig-Maximilians-Universität (LMU), Planegg-Martinsried, Germany
| | - Steffen Massberg
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Martina Schifferer
- DZNE (German Center for Neurodegenerative Diseases), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Mikael Simons
- DZNE (German Center for Neurodegenerative Diseases), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- Institute of Neuronal Cell Biology, Technical University Munich (TUM), Munich, Germany
| | - Luciano Hoeher
- Institute for Tissue Engineering and Regenerative Medicine (iTERM), Helmholtz Center Munich, Neuherberg, Germany
| | - Jie Luo
- Institute for Tissue Engineering and Regenerative Medicine (iTERM), Helmholtz Center Munich, Neuherberg, Germany
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität (LMU) München, Munich, Germany
| | - Ali Ertürk
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- Institute for Tissue Engineering and Regenerative Medicine (iTERM), Helmholtz Center Munich, Neuherberg, Germany
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität (LMU) München, Munich, Germany
| | - Gabriele G Schiattarella
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Max Rubner Center for Cardiovascular Metabolic Renal Research (MRC), Deutsches Herzzentrum der Charité (DHZC), Charité-Universitätsmedizin Berlin, Berlin, Germany
- Translational Approaches in Heart Failure and Cardiometabolic Disease, Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Yassine Sassi
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, USA
- Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Thomas Misgeld
- DZNE (German Center for Neurodegenerative Diseases), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- Institute of Neuronal Cell Biology, Technical University Munich (TUM), Munich, Germany
| | - Stefan Engelhardt
- Institute of Pharmacology and Toxicology, Technical University Munich (TUM), Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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Abstract
Circadian rhythms, present in most phyla across life, are biological oscillations occurring on a daily cycle. Since the discovery of their molecular foundations in model organisms, many inputs that modify this tightly controlled system in humans have been identified. Polygenic variations and environmental factors influence each person's circadian rhythm, contributing to the trait known as chronotype, which manifests as the degree of morning or evening preference in an individual. Despite normal variation in chronotype, much of society operates on a "one size fits all" schedule that can be difficult to adjust to, especially for certain individuals whose endogenous circadian phase is extremely advanced or delayed. This is a public health concern, as phase misalignment in humans is associated with a number of adverse health outcomes. Additionally, modern technology (such as electric lights and computer, tablet, and phone screens that emit blue light) and lifestyles (such as shift or irregular work schedules) are disrupting circadian consistency in an increasing number of people. Though medical and lifestyle interventions can alleviate some of these issues, growing research on endogenous circadian variability and sensitivity suggests that broader social changes may be necessary to minimize the impact of circadian misalignment on health.
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Affiliation(s)
| | | | - Ying-Hui Fu
- Department of Neurology
- Institute for Human Genetics
- Weill Institute for Neurosciences, and
- Kavli Institute for Fundamental Neuroscience, UCSF, San Francisco, California, USA
| | - Louis J. Ptáček
- Department of Neurology
- Institute for Human Genetics
- Weill Institute for Neurosciences, and
- Kavli Institute for Fundamental Neuroscience, UCSF, San Francisco, California, USA
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Salfi F, Lauriola M, D'Atri A, Amicucci G, Viselli L, Tempesta D, Ferrara M. Demographic, psychological, chronobiological, and work-related predictors of sleep disturbances during the COVID-19 lockdown in Italy. Sci Rep 2021; 11:11416. [PMID: 34075173 PMCID: PMC8169862 DOI: 10.1038/s41598-021-90993-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/17/2021] [Indexed: 11/24/2022] Open
Abstract
The first COVID-19 contagion wave caused unprecedented restraining measures worldwide. In Italy, a period of generalized lockdown involving home confinement of the entire population was imposed for almost two months (9 March-3 May 2020). The present is the most extensive investigation aimed to unravel the demographic, psychological, chronobiological, and work-related predictors of sleep disturbances throughout the pandemic emergency. A total of 13,989 Italians completed a web-based survey during the confinement period (25 March-3 May). We collected demographic and lockdown-related work changes information, and we evaluated sleep quality, insomnia and depression symptoms, chronotype, perceived stress, and anxiety using validated questionnaires. The majority of the respondents reported a negative impact of confinement on their sleep and a delayed sleep phase. We highlighted an alarming prevalence of sleep disturbances during the lockdown. Main predictors of sleep disturbances identified by regression models were: female gender, advanced age, being a healthcare worker, living in southern Italy, confinement duration, and a higher level of depression, stress, and anxiety. The evening chronotype emerged as a vulnerability factor, while morning-type individuals showed a lower predisposition to sleep and psychological problems. Finally, working from home was associated with less severe sleep disturbances. Besides confirming the role of specific demographic and psychological factors in developing sleep disorders during the COVID-19 pandemic, we propose that circadian typologies could react differently to a particular period of reduced social jetlag. Moreover, our results suggest that working from home could play a protective role against the development of sleep disturbances during the current pandemic emergency.
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Affiliation(s)
- Federico Salfi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio (Coppito 2), 67100, Coppito, AQ, Italy
| | - Marco Lauriola
- Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy
| | - Aurora D'Atri
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio (Coppito 2), 67100, Coppito, AQ, Italy
| | - Giulia Amicucci
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio (Coppito 2), 67100, Coppito, AQ, Italy
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Lorenzo Viselli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio (Coppito 2), 67100, Coppito, AQ, Italy
| | - Daniela Tempesta
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio (Coppito 2), 67100, Coppito, AQ, Italy
| | - Michele Ferrara
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio (Coppito 2), 67100, Coppito, AQ, Italy.
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Abstract
PURPOSE OF REVIEW This article provides an overview of circadian physiology and discusses common presentations and treatment strategies for the circadian rhythm sleep-wake disorders. RECENT FINDINGS Circadian rhythms are present throughout the body, and appreciation for the role that circadian dysregulation plays in overall health is increasing, with mounting associations between circadian disruption and cardiometabolic disease risk. SUMMARY It is important to recognize the ubiquitous role that circadian rhythms play throughout the brain and body. An understanding of circadian neurophysiology will provide insight into the means by which patients with a variety of neuropathologies at the level of the retina, optic nerve, or hypothalamus may also be at risk for circadian dysfunction.
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da Silveira Cruz-Machado S, Guissoni Campos LM, Fadini CC, Anderson G, Markus RP, Pinato L. Disrupted nocturnal melatonin in autism: Association with tumor necrosis factor and sleep disturbances. J Pineal Res 2021; 70:e12715. [PMID: 33421193 DOI: 10.1111/jpi.12715] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/22/2020] [Accepted: 12/24/2020] [Indexed: 12/12/2022]
Abstract
Sleep disturbances, abnormal melatonin secretion, and increased inflammation are aspects of autism spectrum disorder (ASD) pathophysiology. The present study evaluated the daily urinary 6-sulfatoxymelatonin (aMT6s) excretion profile and the salivary levels of tumor necrosis factor (TNF) and interleukin-6 (IL-6) in 20 controls and 20 ASD participants, as well as correlating these measures with sleep disturbances. Although 60% of ASD participants showed a significant night-time rise in aMT6s excretion, this rise was significantly attenuated, compared to controls (P < .05). The remaining 40% of ASD individuals showed no significant increase in nocturnal aMT6s. ASD individuals showed higher nocturnal levels of saliva TNF, but not IL-6. Dysfunction in the initiation and maintenance of sleep, as indicated by the Sleep Disturbance Scale for Children, correlated with night-time aMT6s excretion (r = -.28, P < .05). Dysfunction in sleep breathing was inversely correlated with aMT6s (r = -.31, P < .05) and positively associated with TNF level (r = .42, P < .01). Overall such data indicate immune-pineal axis activation, with elevated TNF but not IL-6 levels associated with disrupted pineal melatonin release and sleep dysfunction in ASD. It is proposed that circadian dysregulation in ASD is intimately linked to heightened immune-inflammatory activity. Such two-way interactions of the immune-pineal axis may underpin many aspects of ASD pathophysiology, including sleep disturbances, as well as cognitive and behavioral alterations.
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Affiliation(s)
- Sanseray da Silveira Cruz-Machado
- Laboratory of Chronopharmacology, Department of Physiology, Institute of Biosciences, University of São Paulo (USP), São Paulo, Brazil
| | | | - Cintia Cristina Fadini
- Department of Speech, Language and Hearing Sciences, São Paulo State University (UNESP), Marilia, Brazil
| | | | - Regina P Markus
- Laboratory of Chronopharmacology, Department of Physiology, Institute of Biosciences, University of São Paulo (USP), São Paulo, Brazil
| | - Luciana Pinato
- Department of Speech, Language and Hearing Sciences, São Paulo State University (UNESP), Marilia, Brazil
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Mentink LJ, Thomas J, Melis RJF, Olde Rikkert MGM, Overeem S, Claassen JAHR. Home-EEG assessment of possible compensatory mechanisms for sleep disruption in highly irregular shift workers - The ANCHOR study. PLoS One 2020; 15:e0237622. [PMID: 33382689 PMCID: PMC7774973 DOI: 10.1371/journal.pone.0237622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/12/2020] [Indexed: 11/30/2022] Open
Abstract
Study objectives While poor sleep quality has been related to increased risk of Alzheimer’s disease, long-time shift workers (maritime pilots) did not manifest evidence of early Alzheimer’s disease in a recent study. We explored two hypotheses of possible compensatory mechanisms for sleep disruption: Increased efficiency in generating deep sleep during workweeks (model 1) and rebound sleep during rest weeks (model 2). Methods We used data from ten male maritime pilots (mean age: 51.6±2.4 years) with a history of approximately 18 years of irregular shift work. Subjective sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). A single lead EEG-device was used to investigate sleep in the home/work environment, quantifying total sleep time (TST), deep sleep time (DST), and deep sleep time percentage (DST%). Using multilevel models, we studied the sleep architecture of maritime pilots over time, at the transition of a workweek to a rest week. Results Maritime pilots reported worse sleep quality in workweeks compared to rest weeks (PSQI = 8.2±2.2 vs. 3.9±2.0; p<0.001). Model 1 showed a trend towards an increase in DST% of 0.6% per day during the workweek (p = 0.08). Model 2 did not display an increase in DST% in the rest week (p = 0.87). Conclusions Our findings indicated that increased efficiency in generating deep sleep during workweeks is a more likely compensatory mechanism for sleep disruption in the maritime pilot cohort than rebound sleep during rest weeks. Compensatory mechanisms for poor sleep quality might mitigate sleep disruption-related risk of developing Alzheimer’s disease. These results should be used as a starting point for future studies including larger, more diverse populations of shift workers.
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Affiliation(s)
- Lara J. Mentink
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Alzheimer Centre, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- * E-mail:
| | - Jana Thomas
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Alzheimer Centre, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - René J. F. Melis
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Alzheimer Centre, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcel G. M. Olde Rikkert
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Alzheimer Centre, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Sebastiaan Overeem
- Sleep Medicine Center Kempenhaeghe, Heeze, The Netherlands
- Biomedical Diagnostics Group, Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Jurgen A. H. R. Claassen
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Alzheimer Centre, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
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Onninen J, Hakola T, Puttonen S, Tolvanen A, Virkkala J, Sallinen M. Sleep and sleepiness in shift-working tram drivers. Appl Ergon 2020; 88:103153. [PMID: 32678773 DOI: 10.1016/j.apergo.2020.103153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 03/24/2020] [Accepted: 05/10/2020] [Indexed: 06/11/2023]
Abstract
Driver sleepiness contributes to traffic accidents. However, sleepiness in urban public transport remains an understudied subject. To fill this gap, we examined the sleepiness, sleep, and on-duty sleepiness countermeasures (SCMs) in 23 tram drivers working morning, day, and evening shifts for three weeks. Sleepiness was measured using Karolinska Sleepiness Scale (KSS). Nocturnal total sleep time (TST) was measured with wrist actigraphy. SCMs and naps were self-reported with a smartphone application. Caffeine and napping were considered effective SCMs. Severe sleepiness (KSS ≥ 7) was observed in 22% of shifts with no differences between shift types. Rest breaks were associated with slight reductions in sleepiness. TST between days off averaged 7 h but was 1 h 33 min and 38 min shorter prior to morning and day shifts, respectively. The use of effective SCMs showed little variance between shift types. These results highlight the need for fatigue management in non-night-working tram drivers.
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Affiliation(s)
- Jussi Onninen
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland; Finnish Institute of Occupational Health, Helsinki, Finland.
| | - Tarja Hakola
- Finnish Institute of Occupational Health, Helsinki, Finland
| | | | - Asko Tolvanen
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Jussi Virkkala
- Finnish Institute of Occupational Health, Helsinki, Finland; Department of Clinical Neurophysiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mikael Sallinen
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland; Finnish Institute of Occupational Health, Helsinki, Finland
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Rizza S, Longo S, Piciucchi G, Romanello D, Mavilio M, Montagna M, Coppeta L, Martelli E, Magrini A, Federici M. Carotid intimal medial thickness in rotating night shift is related to IL1β/IL6 axis. Nutr Metab Cardiovasc Dis 2020; 30:1826-1832. [PMID: 32665209 DOI: 10.1016/j.numecd.2020.05.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/24/2020] [Accepted: 05/27/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Sleep disturbances may promote glucose abnormalities and inflammatory burden among shift workers. Therefore, precocious subclinical atherosclerotic process might develop in healthy shift workers even without known metabolic and cardiovascular risk factors. METHODS AND RESULTS We measured anthropometric parameters, glucose, lipids, inflammation and common carotid Intimal Medial Thickness (cIMT) in rotating-night shift workers (r-NSW, n = 88, age = 40.3 ± 7.8 y) in comparison with former-night shift workers (f-NSW, n = 35, age = 44.2 ± 6.4 y) and with day-only workers (DW, n = 64, age = 44.1 ± 8.9 y). R-NSW and f-NSW showed significantly higher cIMT and high sensitivity C-Reactive Protein (hs-CRP) respect to DW (p = 0.043 and p = 0.025, respectively). IL-1β levels were higher in r-NSW than in DW and f-NSW (p = 0.043) and significantly correlated with IL6 (r = 0.365, p < 0.001). In addition, r-NSW and f-NSW had higher HbA1c levels in comparison with DW (p = 0.047). Carotid-IMT was significantly related to night shift work (p = 0.023), with age (p < 0.001), with HOMA IR (p = 0.009), with insulin (p = 0.006) with HbA1c (p = 0.002), with LDL cholesterol (p < 0.001), with diastolic BP (p < 0.001), with WBC (p = 0.002) and with IL6 (p = 0.004). After performing a multivariate analysis night shift work remained statistically related to cIMT (B = 2.633, 95%CI = 0.489-4.776, p = 0.016). CONCLUSIONS Our result described a possible link bridging night shift work, inflammation and carotid Intimal Medial Thickness. Future studies are warranted to understand if carotid atherosclerosis process should be mainly driven by the IL1β/IL6 citokine axis connected to sleep disturbances.
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Affiliation(s)
- Stefano Rizza
- Department of Systems Medicine, University of Rome Tor Vergata, Italy.
| | - Susanna Longo
- Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Giacomo Piciucchi
- Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Daniele Romanello
- Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Maria Mavilio
- Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Martina Montagna
- Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Luca Coppeta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Eugenio Martelli
- Division of Vascular Surgery, Department of Medical, Surgical, and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Andrea Magrini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Massimo Federici
- Department of Systems Medicine, University of Rome Tor Vergata, Italy
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Luca G, Van Den Broecke S. [Circadian rhythm sleep disorders: clinical picture, diagnosis and treatment]. Rev Med Suisse 2020; 16:1237-1242. [PMID: 32558452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Circadian rhythm sleep disorders (CRSD) represent sleep-wake disturbances due to a disruption of endogenous circadian system or to a desynchronization between internal sleep-wake rhythms and the external environment. They comprise seven diagnostic entities grouped in two main categories: endogenous and exogenous. The patients typically describe chronic excessive daytime sleepiness and/or insomnia symptoms, impacting their daytime functioning. The exact prevalence of CRSD is probably underestimated. The diagnosis is based on sleep diary coupled with actigraphy. Several therapeutic options are validated to allow the realignment between endogenous circadian rhythm and the external environment. The correct diagnostic of CRSD is important to improve the patient's quality of life and to propose them appropriate treatment.
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Affiliation(s)
- Gianina Luca
- Unité d'exploration du sommeil et de l'éveil, Service de pneumologie, Réseau hospitaliser neuchâtelois, 45, rue de la Maladière, 2000 Neuchâtel
| | - Sandra Van Den Broecke
- Unité d'exploration du sommeil et de l'éveil, Service de pneumologie, Réseau hospitaliser neuchâtelois, 45, rue de la Maladière, 2000 Neuchâtel
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Zeitzer JM, Joyce DS, McBean A, Quevedo YL, Hernandez B, Holty JE. Effect of Suvorexant vs Placebo on Total Daytime Sleep Hours in Shift Workers: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e206614. [PMID: 32484552 PMCID: PMC7267849 DOI: 10.1001/jamanetworkopen.2020.6614] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Many shift workers have difficulty sleeping during the daytime owing to an inappropriately timed circadian drive for wakefulness. OBJECTIVE To determine whether a dual hypocretin receptor antagonist would enable shift workers to have more daytime sleep. DESIGN, SETTING, AND PARTICIPANTS This double-blind, placebo-controlled randomized clinical trial included 2 weeks of baseline data and 3 weeks of intervention data, from March 2016 to December 2018. Individuals were recruited through poster advertisements in the broader San Francisco Bay area in California. From an initial voluntary recruitment cohort of 38 shift workers, 19 individuals with self-reported difficulty sleeping during the daytime following night work shift were included. Data were analyzed from Janaury to March 2019. INTERVENTIONS 1 week of 10 mg suvorexant or placebo, titrated upward to 20 mg suvorexant or placebo for 2 additional weeks. MAIN OUTCOMES AND MEASURES Objective (ie, actigraphy) and subjective (ie, sleep logs) measures of sleep. RESULTS Among 19 participants who completed the study (mean [SD] age, 37.7 [11.1] years; 13 [68%] men), 8 participants (42%) were assigned to the suvorexant group and 11 participants (58%) were assigned to the placebo group. Compared with individuals in the placebo group, individuals in the suvorexant group increased their objective total sleep time by a mean (SE) of 1.04 (0.53) hours (P = .05) at the end of 1 week of 10-mg doses and by 2.16 (0.75) hours (P = .004) by the end of the 2 weeks of 20-mg doses. Subjective sleep was similarly improved as, compared with the placebo group, individuals in the suvorexant group increased their subjective total sleep time by a mean (SE) of 2.08 (0.47) hours (P < .001) at the end of 1 week of 10-mg doses and by 2.97 (0.56) hours (P < .001) by the end of the 2 weeks of 20-mg doses. Physician ratings of daytime sleep aligned with these measures, as there was no change in the placebo group and a much improved change in the suvorexant group. No adverse events were reported in the suvorexant group. CONCLUSIONS AND RELEVANCE This pilot study found that the use of a dual hypocretin receptor antagonist in shift workers under real-world conditions resulted in more than 2 extra hours of daytime sleep per episode. Future research should confirm this pilot finding in a larger sample size and examine whether, over the long term, use of this medication has a concomitant improvement in medical and psychiatric health as well as workplace performance and safety. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02491788.
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Affiliation(s)
- Jamie M. Zeitzer
- Stanford Center for Sleep Sciences And Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
- Mental Illness Research, Education, and Clinical Center, VA Palo Alto Health Care System, Palo Alto, California
| | - Daniel S. Joyce
- Stanford Center for Sleep Sciences And Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Amanda McBean
- Stanford Center for Sleep Sciences And Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Yvonne L. Quevedo
- Mental Illness Research, Education, and Clinical Center, VA Palo Alto Health Care System, Palo Alto, California
| | - Beatriz Hernandez
- Mental Illness Research, Education, and Clinical Center, VA Palo Alto Health Care System, Palo Alto, California
| | - Jon-Erik Holty
- Pulmonary, Critical Care, and Sleep Medicine Section, VA Palo Alto Health Care System, Palo Alto, California
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, California
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Swanson CM, Kohrt WM, Wolfe P, Wright KP, Shea SA, Cain SW, Munch M, Vujović N, Czeisler CA, Orwoll ES, Buxton OM. Rapid suppression of bone formation marker in response to sleep restriction and circadian disruption in men. Osteoporos Int 2019; 30:2485-2493. [PMID: 31446439 PMCID: PMC6879850 DOI: 10.1007/s00198-019-05135-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 08/16/2019] [Indexed: 01/25/2023]
Abstract
UNLABELLED We describe the time course of bone formation marker (P1NP) decline in men exposed to ~ 3 weeks of sleep restriction with concurrent circadian disruption. P1NP declined within 10 days and remained lower with ongoing exposure. These data suggest even brief exposure to sleep and circadian disruptions may disrupt bone metabolism. INTRODUCTION A serum bone formation marker (procollagen type 1 N-terminal, P1NP) was lower after ~ 3 weeks of sleep restriction combined with circadian disruption. We now describe the time course of decline. METHODS The ~ 3-week protocol included two segments: "baseline," ≥ 10-h sleep opportunity/day × 5 days; "forced desynchrony" (FD), recurring 28 h day (circadian disruption) with sleep restriction (~ 5.6-h sleep per 24 h). Fasted plasma P1NP was measured throughout the protocol in nine men (20-59 years old). We tested the hypothesis that PINP would steadily decline across the FD intervention because the magnitude of sleep loss and circadian misalignment accrued as the protocol progressed. A piecewise linear regression model was used to estimate the slope (β) as ΔP1NP per 24 h with a change point mid-protocol to estimate the initial vs. prolonged effects of FD exposure. RESULTS Plasma P1NP levels declined significantly within the first 10 days of FD ([Formula: see text] = - 1.33 μg/L per 24 h, p < 0.0001) and remained lower than baseline with prolonged exposure out to 3 weeks ([Formula: see text] = - 0.18 μg/L per 24 h, p = 0.67). As previously reported, levels of a bone resorption marker (C-telopeptide (CTX)) were unchanged. CONCLUSION Sleep restriction with concurrent circadian disruption induced a relatively rapid decline in P1NP (despite no change in CTX) and levels remained lower with ongoing exposure. These data suggest (1) even brief sleep restriction and circadian disruption can adversely affect bone metabolism, and (2) there is no P1NP recovery with ongoing exposure that, taken together, could lead to lower bone density over time.
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Affiliation(s)
- C M Swanson
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado, 12801 E. 17th Ave. Mail Stop 8106, Aurora, CO, 80045, USA.
| | - W M Kohrt
- Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, and Eastern Colorado VA Geriatric, Research, Education, and Clinical Center, Aurora, CO, USA
| | - P Wolfe
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - K P Wright
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado, 12801 E. 17th Ave. Mail Stop 8106, Aurora, CO, 80045, USA
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - S A Shea
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA
- OHSU-PSU School of Public Health, Portland, OR, USA
| | - S W Cain
- Sleep Health Institute, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, VIC, 3800, Australia
| | - M Munch
- Institute of Physiology, Charité University Medicine Berlin, Berlin, Germany
- Sleep/Wake Research Centre, Massey University Wellington Campus, Wellington, New Zealand
| | - N Vujović
- Sleep Health Institute, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - C A Czeisler
- Sleep Health Institute, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - E S Orwoll
- Division of Endocrinology and Bone and Mineral Unit, Oregon Health & Science University, Portland, OR, USA
| | - O M Buxton
- Sleep Health Institute, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- Department of Biobehavioral Health, Pennsylvania State University, University Park, State College, PA, USA
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13
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Kaplan KA, Mashash M, Williams R, Batchelder H, Starr-Glass L, Zeitzer JM. Effect of Light Flashes vs Sham Therapy During Sleep With Adjunct Cognitive Behavioral Therapy on Sleep Quality Among Adolescents: A Randomized Clinical Trial. JAMA Netw Open 2019; 2:e1911944. [PMID: 31553469 PMCID: PMC6763980 DOI: 10.1001/jamanetworkopen.2019.11944] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Owing to biological, behavioral, and societal factors, sleep duration in teenagers is often severely truncated, leading to pervasive sleep deprivation. OBJECTIVE To determine whether a novel intervention, using both light exposure during sleep and cognitive behavioral therapy (CBT), would increase total sleep time in teenagers by enabling them to go to sleep earlier than usual. DESIGN, SETTING, AND PARTICIPANTS This double-blind, placebo-controlled, randomized clinical trial, conducted between November 1, 2013, and May 31, 2016, among 102 adolescents enrolled full-time in grades 9 to 12, who expressed difficulty going to bed earlier and waking up early enough, was composed of 2 phases. In phase 1, participants were assigned to receive either 3 weeks of light or sham therapy and were asked to try to go to sleep earlier. In phase 2, participants received 4 brief CBT sessions in addition to a modified light or sham therapy. All analyses were performed on an intent-to-treat basis. INTERVENTIONS Light therapy consisted of receiving a 3-millisecond light flash every 20 seconds during the final 3 hours of sleep (phase 1) or final 2 hours of sleep (phase 2). Sham therapy used an identical device, but delivered 1 minute of light pulses (appearing in 20-second intervals, for a total of 3 pulses) per hour during the final 3 hours of sleep (phase 1) or 2 hours of sleep (phase 2). Light therapy occurred every night during the 4-week intervention. Cognitive behavioral therapy consisted of four 50-minute in-person sessions once per week. MAIN OUTCOMES AND MEASURES Primary outcome measures included diary-based sleep times, momentary ratings of evening sleepiness, and subjective measures of sleepiness and sleep quality. RESULTS Among the 102 participants (54 female [52.9%]; mean [SD] age, 15.6 [1.1] years), 72 were enrolled in phase 1 and 30 were enrolled in phase 2. Mixed-effects models revealed that light therapy alone was inadequate in changing the timing of sleep. However, compared with sham therapy plus CBT alone, light therapy plus CBT significantly moved sleep onset a mean (SD) of 50.1 (27.5) minutes earlier and increased nightly total sleep time by a mean (SD) of 43.3 (35.0) minutes. Light therapy plus CBT also resulted in a 7-fold greater increase in bedtime compliance than that observed among participants receiving sham plus CBT (mean [SD], 2.21 [3.91] vs 0.29 [0.76]), as well as a mean 0.55-point increase in subjective evening sleepiness as compared with a mean 0.48-point decrease in participants receiving sham plus CBT as measured on a 7-point sleepiness scale. CONCLUSIONS AND RELEVANCE This study found that light exposure during sleep, in combination with a brief, motivation-focused CBT intervention, was able to consistently move bedtimes earlier and increase total sleep time in teenagers. This type of passive light intervention in teenagers may lead to novel therapeutic applications. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01406691.
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Affiliation(s)
- Katherine A. Kaplan
- Stanford Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Meital Mashash
- Stanford Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Rayma Williams
- Stanford Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | | | | | - Jamie M. Zeitzer
- Stanford Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
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Peter L, Reindl R, Zauter S, Hillemacher T, Richter K. Effectiveness of an Online CBT-I Intervention and a Face-to-Face Treatment for Shift Work Sleep Disorder: A Comparison of Sleep Diary Data. Int J Environ Res Public Health 2019; 16:ijerph16173081. [PMID: 31450619 PMCID: PMC6747089 DOI: 10.3390/ijerph16173081] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/15/2019] [Accepted: 08/18/2019] [Indexed: 12/28/2022]
Abstract
In western societies, about one in six employees works in shifts. Shiftwork is associated with a number of poor somatic and psychological health outcomes, especially sleep issues. Higher rates of absenteeism and accidents in the workplace are possible consequences. Still, prevention programs and treatment options that are specifically tailored to shift-workers’ needs are rare. We devised a 4-week online cognitive behavioral therapy for insomnia (CBT-I) intervention (n = 21) and compared sleep outcomes to a face-to-face outpatient treatment for shift-workers (n = 12) using a sleep diary and the Epworth Sleepiness Scale (ESS). In the online sample, measures also included the World Health Organization wellbeing questionnaire (WHO-5) and the Insomnia Severity Index (ISI). In the outpatient sample, the Beck Depression Inventory (BDI-II), the Montgomery–Åsberg Depression Rating Scale (MADRS), and the Pittsburgh Sleep Quality Index (PSQI) were administered. Results showed significant improvements in sleep efficiency by 7.2% in the online sample and 7.7% in the outpatient sample. However, no significant difference was found in the rate of improvement in sleep efficiency across four weeks of treatment between the samples. In the online sample, the wellbeing (WHO-5) and insomnia symptoms (ISI) scores were significantly improved following the CBT-I intervention (p < 0.004 and p < 0.002 respectively). In the outpatient sample, symptoms of depression (BDI-II and MADRS scores) and insomnia symptoms (PSQI scores) improved significantly following the CBT-I intervention. In summary, CBT-I significantly improved sleep efficiency in both the online and outpatient samples, in addition to wellbeing, symptoms of insomnia, and depression. The findings of this study demonstrate online CBT-I as a feasible approach for treating insomnia in shift-workers. Future randomized controlled trials are needed.
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Affiliation(s)
- Lukas Peter
- University Clinic for Psychiatry and Psychotherapy, Paracelsus Medical University, 90419 Nuremberg, Germany.
- Faculty for Social Sciences, University of Applied Sciences Georg Simon Ohm, 90402 Nuremberg, Germany.
| | - Richard Reindl
- Faculty for Social Sciences, University of Applied Sciences Georg Simon Ohm, 90402 Nuremberg, Germany
| | - Sigrid Zauter
- Faculty for Social Sciences, University of Applied Sciences Georg Simon Ohm, 90402 Nuremberg, Germany
| | - Thomas Hillemacher
- University Clinic for Psychiatry and Psychotherapy, Paracelsus Medical University, 90419 Nuremberg, Germany
| | - Kneginja Richter
- University Clinic for Psychiatry and Psychotherapy, Paracelsus Medical University, 90419 Nuremberg, Germany
- Faculty for Social Sciences, University of Applied Sciences Georg Simon Ohm, 90402 Nuremberg, Germany
- Faculty for Medical Sciences, University Goce Delcev, 2000 Stip, Republic of North Macedonia
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15
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Simon SL, McWhirter L, Diniz Behn C, Bubar KM, Kaar JL, Pyle L, Rahat H, Garcia-Reyes Y, Carreau AM, Wright KP, Nadeau KJ, Cree-Green M. Morning Circadian Misalignment Is Associated With Insulin Resistance in Girls With Obesity and Polycystic Ovarian Syndrome. J Clin Endocrinol Metab 2019; 104:3525-3534. [PMID: 30888398 PMCID: PMC6610211 DOI: 10.1210/jc.2018-02385] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 03/13/2019] [Indexed: 02/08/2023]
Abstract
CONTEXT To our knowledge, circadian rhythms have not been examined in girls with polycystic ovarian syndrome (PCOS), despite the typical delayed circadian timing of adolescence, which is an emerging link between circadian health and insulin sensitivity (SI), and decreased SI in PCOS. OBJECTIVE To examine differences in the circadian melatonin rhythm between obese adolescent girls with PCOS and control subjects, and evaluate relationships between circadian variables and SI. DESIGN Cross-sectional study. PARTICIPANTS Obese adolescent girls with PCOS (n = 59) or without PCOS (n = 33). OUTCOME MEASURES Estimated sleep duration and timing from home actigraphy monitoring, in-laboratory hourly sampled dim-light, salivary-melatonin and fasting hormone analysis. RESULTS All participants obtained insufficient sleep. Girls with PCOS had later clock-hour of melatonin offset, later melatonin offset relative to sleep timing, and longer duration of melatonin secretion than control subjects. A later melatonin offset after wake time (i.e., morning wakefulness occurring during the biological night) was associated with higher serum free testosterone levels and worse SI regardless of group. Analyses remained significant after controlling for daytime sleepiness and sleep-disordered breathing. CONCLUSION Circadian misalignment in girls with PCOS is characterized by later melatonin offset relative to clock time and sleep timing. Morning circadian misalignment was associated with metabolic dysregulation in girls with PCOS and obesity. Clinical care of girls with PCOS and obesity would benefit from assessment of sleep and circadian health. Additional research is needed to understand mechanisms underlying the relationship between morning circadian misalignment and SI in this population.
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Affiliation(s)
- Stacey L Simon
- Division of Pulmonary Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - Laura McWhirter
- Division of Pulmonary Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - Cecilia Diniz Behn
- Division of Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
- Department of Applied Mathematics and Statistics, Colorado School of Mines, Golden, Colorado
| | - Kate M Bubar
- Department of Applied Mathematics and Statistics, Colorado School of Mines, Golden, Colorado
| | - Jill L Kaar
- Division of Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - Laura Pyle
- Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - Haseeb Rahat
- Division of Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - Yesenia Garcia-Reyes
- Division of Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - Anne-Marie Carreau
- Division of Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - Kenneth P Wright
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kristen J Nadeau
- Division of Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
- Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Melanie Cree-Green
- Division of Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
- Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Abstract
The Metabolic Syndrome is a cluster of cardio-metabolic risk factors and comorbidities conveying high risk of both cardiovascular disease and type 2 diabetes. It is responsible for huge socio-economic costs with its resulting morbidity and mortality in most countries. The underlying aetiology of this clustering has been the subject of much debate. More recently, significant interest has focussed on the involvement of the circadian system, a major regulator of almost every aspect of human health and metabolism. The Circadian Syndrome has now been implicated in several chronic diseases including type 2 diabetes and cardiovascular disease. There is now increasing evidence connecting disturbances in circadian rhythm with not only the key components of the Metabolic Syndrome but also its main comorbidities including sleep disturbances, depression, steatohepatitis and cognitive dysfunction. Based on this, we now propose that circadian disruption may be an important underlying aetiological factor for the Metabolic Syndrome and we suggest that it be renamed the 'Circadian Syndrome'. With the increased recognition of the 'Circadian Syndrome', circadian medicine, through the timing of exercise, light exposure, food consumption, dispensing of medications and sleep, is likely to play a much greater role in the maintenance of both individual and population health in the future.
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Affiliation(s)
- P. Zimmet
- Department of DiabetesCentral Clinical SchoolMonash UniversityMelbourneVic.Australia
- Sagol Center for Epigenetics and MetabolismTel Aviv Medical CenterTel AvivIsrael
| | | | - N. Stern
- Sagol Center for Epigenetics and MetabolismTel Aviv Medical CenterTel AvivIsrael
| | - C. Bilu
- School of ZoologyTel Aviv UniversityTel AvivIsrael
| | - A. El‐Osta
- Department of DiabetesCentral Clinical SchoolMonash UniversityMelbourneVic.Australia
- Department of PathologyThe University of MelbourneParkvilleVic.Australia
- Hong Kong Institute of Diabetes and ObesityPrince of Wales HospitalThe Chinese University of Hong KongHong Kong SARChina
| | - H. Einat
- School of Behavioral SciencesTel Aviv‐Yaffo Academic CollegeTel AvivIsrael
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Gupta CC, Centofanti S, Dorrian J, Coates AM, Stepien JM, Kennaway D, Wittert G, Heilbronn L, Catcheside P, Noakes M, Coro D, Chandrakumar D, Banks S. Subjective Hunger, Gastric Upset, and Sleepiness in Response to Altered Meal Timing during Simulated Shiftwork. Nutrients 2019; 11:nu11061352. [PMID: 31208092 PMCID: PMC6628383 DOI: 10.3390/nu11061352] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/14/2019] [Accepted: 06/14/2019] [Indexed: 01/28/2023] Open
Abstract
Shiftworkers report eating during the night when the body is primed to sleep. This study investigated the impact of altering food timing on subjective responses. Healthy participants (n = 44, 26 male, age Mean ± SD = 25.0 ± 2.9 years, BMI = 23.82 ± 2.59kg/m2) participated in a 7-day simulated shiftwork protocol. Participants were randomly allocated to one of three eating conditions. At 00:30, participants consumed a meal comprising 30% of 24 h energy intake (Meal condition; n = 14, 8 males), a snack comprising 10% of 24 h energy intake (Snack condition; n = 14; 8 males) or did not eat during the night (No Eating condition; n = 16, 10 males). Total 24 h individual energy intake and macronutrient content was constant across conditions. During the night, participants reported hunger, gut reaction, and sleepiness levels at 21:00, 23:30, 2:30, and 5:00. Mixed model analyses revealed that the snack condition reported significantly more hunger than the meal group (p < 0.001) with the no eating at night group reporting the greatest hunger (p < 0.001). There was no difference in desire to eat between meal and snack groups. Participants reported less sleepiness after the snack compared to after the meal (p < 0.001) or when not eating during the night (p< 0.001). Gastric upset did not differ between conditions. A snack during the nightshift could alleviate hunger during the nightshift without causing fullness or increased sleepiness.
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Affiliation(s)
- Charlotte C Gupta
- Sleep and Chronobiology Laboratory, Behaviour-Brain-Body Research Centre, School of Psychology, Social Work and Social Policy, University of South Australia, 5072 Adelaide, Australia.
| | - Stephanie Centofanti
- Sleep and Chronobiology Laboratory, Behaviour-Brain-Body Research Centre, School of Psychology, Social Work and Social Policy, University of South Australia, 5072 Adelaide, Australia.
| | - Jillian Dorrian
- Sleep and Chronobiology Laboratory, Behaviour-Brain-Body Research Centre, School of Psychology, Social Work and Social Policy, University of South Australia, 5072 Adelaide, Australia.
| | - Alison M Coates
- Sleep and Chronobiology Laboratory, Behaviour-Brain-Body Research Centre, School of Psychology, Social Work and Social Policy, University of South Australia, 5072 Adelaide, Australia.
- Division of Health Sciences, University of South Australia, 5000 Adelaide, Australia.
| | - Jacqueline M Stepien
- Sleep and Chronobiology Laboratory, Behaviour-Brain-Body Research Centre, School of Psychology, Social Work and Social Policy, University of South Australia, 5072 Adelaide, Australia.
| | - David Kennaway
- Robinson Research Institute and Adelaide School of Medicine, University of Adelaide, 5000 Adelaide, Australia.
| | - Gary Wittert
- Discipline of Medicine, Adelaide Medical School, University of Adelaide, 5000Adelaide, Australia.
| | - Leonie Heilbronn
- Discipline of Medicine, Adelaide Medical School, University of Adelaide, 5000Adelaide, Australia.
- South Australia Medical Research Institute (SAHMRI), 5000 Adelaide, Australia.
| | - Peter Catcheside
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, 5042 Adelaide, Australia.
| | - Manny Noakes
- Commonwealth Scientific and Industrial Research Organisation - Food and Nutrition Flagship, 5000 Adelaide, Australia.
| | - Daniel Coro
- Sleep and Chronobiology Laboratory, Behaviour-Brain-Body Research Centre, School of Psychology, Social Work and Social Policy, University of South Australia, 5072 Adelaide, Australia.
| | - Dilushi Chandrakumar
- Cognitive Ageing Impairment Neurosciences Laboratory, Behaviour-Brain-Body Research Centre, School of Psychology, Social Work and Social Policy, University of South Australia, 5072 Adelaide, Australia.
| | - Siobhan Banks
- Sleep and Chronobiology Laboratory, Behaviour-Brain-Body Research Centre, School of Psychology, Social Work and Social Policy, University of South Australia, 5072 Adelaide, Australia.
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18
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Abstract
The measurement of daytime sleepiness is important in the evaluation of patients with excessive sleepiness. The multiple sleep latency test (MSLT) is an objective test that measures the tendency to fall asleep under controlled conditions. It is based on the notion that sleep latency reflects underlying physiological sleepiness. The MSLT consists of four to five naps given 2h apart during the day, following a standardized procedure. The mean sleep latency from all naps is used as the measure of sleepiness. The test has been shown to be valid and reliable and is part of the diagnostic criteria for narcolepsy and idiopathic hypersomnia. However, the MSLT is affected by numerous variables including insufficient sleep, drugs, activity, and arousal level. Adherence to the established protocol is necessary to limit the effect of these extraneous factors on the MSLT. While the test is a valuable and widely used diagnostic tool for narcolepsy and idiopathic hypersomnia, the use of MSLT in other sleep disorders is not well established.
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Affiliation(s)
- Donna L Arand
- Kettering Medical Center and Wright State University Boonshoft School of Medicine, Dayton, OH, United States.
| | - Michael H Bonnet
- Kettering Medical Center and Wright State University Boonshoft School of Medicine, Dayton, OH, United States
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19
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Abstract
Many processes in the human body - including brain function - are regulated over the 24-hour cycle, and there are strong associations between disrupted circadian rhythms (for example, sleep-wake cycles) and disorders of the CNS. Brain disorders such as autism, depression and Parkinson disease typically develop at certain stages of life, and circadian rhythms are important during each stage of life for the regulation of processes that may influence the development of these disorders. Here, we describe circadian disruptions observed in various brain disorders throughout the human lifespan and highlight emerging evidence suggesting these disruptions affect the brain. Currently, much of the evidence linking brain disorders and circadian dysfunction is correlational, and so whether and what kind of causal relationships might exist are unclear. We therefore identify remaining questions that may direct future research towards a better understanding of the links between circadian disruption and CNS disorders.
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Affiliation(s)
- Ryan W Logan
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - Colleen A McClung
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA.
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20
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Abstract
Women who do shift work are a sizable part of the workforce. Shift workers experience circadian misalignment due to shifted sleep periods, with potentially far-reaching health consequences, including elevated risk of sleep disturbances, metabolic disorders, and cancer. This review provides an overview of the circadian timing system and presents the sex differences that can be observed in the functioning of this system, which may account for the lower tolerance to shift work for women compared with men. Recent epidemiologic findings on female-specific health consequences of shift work are discussed.
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Affiliation(s)
- Laura Kervezee
- Department of Psychiatry, Centre for Study and Treatment of Circadian Rhythms, Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montreal, Quebec H4H 1R3, Canada
| | - Ari Shechter
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University, 622 West 168th Street, Room 9-300B, New York, NY 10032, USA
| | - Diane B Boivin
- Department of Psychiatry, Centre for Study and Treatment of Circadian Rhythms, Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montreal, Quebec H4H 1R3, Canada.
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McGlashan EM, Burns AC, Murray JM, Sletten TL, Magee M, Rajaratnam SMW, Cain SW. The pupillary light reflex distinguishes between circadian and non-circadian delayed sleep phase disorder (DSPD) phenotypes in young adults. PLoS One 2018; 13:e0204621. [PMID: 30261080 PMCID: PMC6160141 DOI: 10.1371/journal.pone.0204621] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/11/2018] [Indexed: 11/19/2022] Open
Abstract
This study investigated the utility of the pupillary light reflex as a method of differentiating DSPD patients with delayed melatonin timing relative to desired/required sleep time (circadian type) and those with non-delayed melatonin timing (non-circadian type). All participants were young adults, with a total of 14 circadian DSPD patients (M = 28.14, SD = 5.26), 12 non-circadian DSPD patients (M = 29.42, SD = 11.51) and 51 healthy controls (M = 21.47 SD = 3.16) completing the protocol. All participants were free of central nervous system acting medications and abstained from caffeine and alcohol on the day of the assessment. Two pupillary light reflex measurements were completed by each participant, one with a 1s dim (~10 lux) light exposure, and one with a 1s bright (~1500 lux) light exposure. Circadian DSPD patients showed a significantly faster pupillary light reflex than both non-circadian DSPD patients and healthy controls. Non-circadian patients and healthy controls did not differ significantly. Receiver operating characteristic curves were generated to determine the utility of mean and maximum constriction velocity in differentiating the two DSPD phenotypes, and these demonstrated high levels of sensitivity (69.23–-100%) and specificity (66.67–91.67%) at their optimal cut offs. The strongest predictor of DSPD phenotype was the mean constriction velocity to bright light (AUC = 0.87). These results support the potential for the pupillary light reflex to clinically differentiate between DSPD patients with normal vs. delayed circadian timing relative to desired bedtime, without the need for costly and time-consuming circadian assessments.
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Affiliation(s)
- Elise M. McGlashan
- Monash Institute of Cognitive and Clinical Neurosciences and School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Angus C. Burns
- Monash Institute of Cognitive and Clinical Neurosciences and School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Jade M. Murray
- Monash Institute of Cognitive and Clinical Neurosciences and School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Tracey L. Sletten
- Monash Institute of Cognitive and Clinical Neurosciences and School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Michelle Magee
- Monash Institute of Cognitive and Clinical Neurosciences and School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Shantha M. W. Rajaratnam
- Monash Institute of Cognitive and Clinical Neurosciences and School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Sean W. Cain
- Monash Institute of Cognitive and Clinical Neurosciences and School of Psychological Sciences, Monash University, Melbourne, Australia
- * E-mail:
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22
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Pickering L, Thorstensen EW, Riedel C, Jennum PJ. [Sleep and circadian rhythms]. Ugeskr Laeger 2018; 180:V05180319. [PMID: 30348254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The sleep-wake regulatory system and the circadian rhythm generating system are two brain networks integrated in the classical two-process model. These processes interact continuously, and to obtain an optimal sleep they must be correctly aligned. The suprachiasmatic nucleus located in the hypothalamus is crucial in the regulation of circadian rhythms, and the hypothalamus is a key component of the sleep-wake regulatory system in association with the thalamus, basal forebrain and brainstem. Alterations of these processes can result in a variety of sleep disturbances or sleep disorders.
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Abstract
PURPOSE OF REVIEW The endogenous circadian rhythms are one of the cardinal processes that control sleep. They are self-sustaining biological rhythms with a periodicity of approximately 24 hours that may be entrained by external zeitgebers (German for time givers), such as light, exercise, and meal times. This article discusses the physiology of the circadian rhythms, their relationship to neurologic disease, and the presentation and treatment of circadian rhythm sleep-wake disorders. RECENT FINDINGS Classic examples of circadian rhythms include cortisol and melatonin secretion, body temperature, and urine volume. More recently, the impact of circadian rhythm on several neurologic disorders has been investigated, such as the timing of occurrence of epileptic seizures as well as neurobehavioral functioning in dementia. Further updates include a more in-depth understanding of the symptoms, consequences, and treatment of circadian sleep-wake disorders, which may occur because of extrinsic misalignment with clock time or because of intrinsic dysfunction of the brain. An example of extrinsic misalignment occurs with jet lag during transmeridian travel or with intrinsic circadian rhythm sleep-wake disorders such as advanced or delayed sleep-wake phase disorders. In advanced sleep-wake phase disorder, which is most common in elderly individuals, sleep onset and morning arousal are undesirably early, leading to impaired evening function with excessive sleepiness and sleep-maintenance insomnia with early morning awakening. By contrast, delayed sleep-wake phase disorder is characterized by an inability to initiate sleep before the early morning hours, with subsequent delayed rise time, leading to clinical symptoms of severe sleep-onset insomnia coupled with excessive daytime sleepiness in the morning hours, as patients are unable to "sleep in" to attain sufficient sleep quantity. Irregular sleep-wake rhythm disorder is misentrainment with patches of brief sleep and wakefulness spread throughout the day, leading to unstable sleep and waking behavioral patterns and an entirely idiosyncratic sleep-wake schedule. SUMMARY Familiarity with these major circadian rhythm sleep-wake disorder phenotypes and their overlap with other neurologic disorders is essential for the neurologist so that clinicians may intervene and improve patient functioning and quality of life.
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Chabal S, Welles R, Haran FJ, Markwald R. Effects of sleep and fatigue on teams in a submarine environment. Undersea Hyperb Med 2018; 45:257-272. [PMID: 30028913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Successful submarine operations rely on the performance of tactical teams who must work under conditions of physiological and cognitive fatigue. Sleep loss and circadian disruption contribute to fatigue in this setting and, although the effects of this fatigue have been studied extensively in individuals, little is understood about how fatigue impacts team performance Рespecially in a submarine environment. The present review provides an overview of the fatigue on submarine teams and is divided into four main sections: 1) A discussion of factors that should be considered in team fatigue research. 2) An outline of how sleep and circadian rhythms of submariners are impacted by submarine-specific factors. 3) A discussion of the known effects of fatigue from sleep loss and circadian disruption on individual performance. 4) A consideration of how this fatigue impacts team performance. As the submarine force has recognized the need to protect submariner sleep and improve team dynamics, it is vital that future research accounts for the interplay between these two factors.
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Affiliation(s)
- Sarah Chabal
- Naval Submarine Medical Research Laboratory, Groton, Connecticut
| | - Rebecca Welles
- Naval Submarine Medical Research Laboratory, Groton, Connecticut
- Leidos, Inc., Reston, Virginia
| | - F Jay Haran
- Naval Submarine Medical Research Laboratory, Groton, Connecticut
| | - Rachel Markwald
- Naval Submarine Medical Research Laboratory, Groton, Connecticut
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25
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Royse KE, El-Serag HB, Chen L, White DL, Hale L, Sangi-Haghpeykar H, Jiao L. Sleep Duration and Risk of Liver Cancer in Postmenopausal Women: The Women's Health Initiative Study. J Womens Health (Larchmt) 2017; 26:1270-1277. [PMID: 28933583 PMCID: PMC6037184 DOI: 10.1089/jwh.2017.6412] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Sleep duration has been associated with nonalcoholic fatty liver disease, but its association with liver cancer remains unknown. MATERIAL AND METHODS In the prospective Women's Health Initiative Study, 139,368 postmenopausal women reported sleep habits at baseline (1993-1998). We ascertained 175 incident liver cancer cases during an average 13.8 years of follow-up through August 2014. We used multivariable Cox proportional hazard regression models to estimate a hazard ratio (HR) and its 95% confidence interval (95% CI) for risk of liver cancer in association with nocturnal sleep duration. RESULTS Compared to women reporting 6-8 hours of sleep, the HR for liver cancer was 1.94 (95% CI 1.07-3.53) for women reporting ≥9 hours of sleep. Among the obese women, the HR associated with ≥9 hours of sleep was 3.18 (95% CI 1.84-8.60). The HR was 0.93 (95% CI 0.34-2.53) among nonobese women (p value for interaction = 0.18). Short sleep duration (≤5 hours) was not associated with liver cancer risk. CONCLUSION Long sleep duration was associated with a moderate increase in liver cancer risk in obese postmenopausal women in the United States. Larger study is needed to confirm our observation on effect modification by adiposity status.
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Affiliation(s)
- Kathryn E. Royse
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Center for Innovations in Quality, Effectiveness and Safety (iQuEST), Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Hashem B. El-Serag
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Center for Innovations in Quality, Effectiveness and Safety (iQuEST), Michael E. DeBakey VA Medical Center, Houston, Texas
- Texas Medical Center Digestive Disease Center, Houston, Texas
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Liang Chen
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Center for Innovations in Quality, Effectiveness and Safety (iQuEST), Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Donna L. White
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Center for Innovations in Quality, Effectiveness and Safety (iQuEST), Michael E. DeBakey VA Medical Center, Houston, Texas
- Texas Medical Center Digestive Disease Center, Houston, Texas
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
- Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Lauren Hale
- Program in Public Health, School of Medicine, Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, New York
| | | | - Li Jiao
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Center for Innovations in Quality, Effectiveness and Safety (iQuEST), Michael E. DeBakey VA Medical Center, Houston, Texas
- Texas Medical Center Digestive Disease Center, Houston, Texas
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
- Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, Texas
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Morris DM, Pilcher JJ, Mulvihill JB, Vander Wood MA. Performance awareness: Predicting cognitive performance during simulated shiftwork using chronobiological measures. Appl Ergon 2017; 63:9-16. [PMID: 28502410 DOI: 10.1016/j.apergo.2017.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 03/16/2017] [Accepted: 03/16/2017] [Indexed: 06/07/2023]
Abstract
Physiological tracers of circadian rhythms and a performance awareness index were examined as predictors of cognitive performance during two sleep deprivation conditions common to occupational shiftwork. Study 1: Thirty-three sleep-deprived participants completed a simulated nightshift. Study 2: Thirty-two partially sleep-deprived participants completed a simulated dayshift. A standardized logic test was used to measure cognitive performance. Body temperature and heart rate were measured as chronobiological indices of endogenous circadian rhythms. Performance awareness was calculated as a correlation between actual and perceived performance. These studies demonstrated a parallelism between performance awareness and the circadian rhythm. Chronobiological changes were predictive of performance awareness during the simulated nightshift but not dayshift. Only oral temperature was a significant independent predictor. Oral temperature predicted an individual's awareness of their own performance better than their own subjective awareness. These findings suggest that using circadian rhythms in applied ergonomics may reduce occupational risk due to low performance awareness.
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Affiliation(s)
- Drew M Morris
- Department of Psychology, Clemson University, Clemson, SC, USA
| | - June J Pilcher
- Department of Psychology, Clemson University, Clemson, SC, USA.
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Burman D. Sleep Disorders: Circadian Rhythm Sleep-Wake Disorders. FP Essent 2017; 460:33-36. [PMID: 28845960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Shift work sleep disorder is a common problem in industrialized countries because of the need for occupations and services to continue to function 24 hours/day. Approximately 20% of employed adults in the United States are engaged in shift work. Shift work sleep disorder is diagnosed if there is a report of insomnia or excessive sleepiness for at least 3 months associated with a recurring work schedule that overlaps the usual time for sleep. Shift work is associated with an increased occurrence of metabolic disorders, such as insulin resistance, diabetes, dyslipidemia, and metabolic syndrome, and it has been implicated in weight gain and cognitive impairment. There is evidence of increased absenteeism in night workers compared with day workers. A planned sleep schedule, timed bright light exposure, timed melatonin administration, and stimulants or drugs promoting alertness can be used to manage shift work sleep disorder. Jet lag is characterized by a misalignment between internal circadian rhythms and local time caused by rapid travel across at least two time zones. Not all travelers experience jet lag; risk factors include age, number of time zones crossed, and circadian preference. Management includes timed melatonin along with optional timed and dosed bright light exposure.
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Affiliation(s)
- Deepa Burman
- Latterman Family Health Center, 2347 Fifth Ave, McKeesport, PA 15132
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28
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Li P, Morris CJ, Patxot M, Yugay T, Mistretta J, Purvis TE, Scheer FAJL, Hu K. Reduced Tolerance to Night Shift in Chronic Shift Workers: Insight From Fractal Regulation. Sleep 2017; 40:3836914. [PMID: 28838129 PMCID: PMC6317507 DOI: 10.1093/sleep/zsx092] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Study Objectives Healthy physiology is characterized by fractal regulation (FR) that generates similar structures in the fluctuations of physiological outputs at different time scales. Perturbed FR is associated with aging and age-related pathological conditions. Shift work, involving repeated and chronic exposure to misaligned environmental and behavioral cycles, disrupts circadian coordination. We tested whether night shifts perturb FR in motor activity and whether night shifts affect FR in chronic shift workers and non-shift workers differently. Methods We studied 13 chronic shift workers and 14 non-shift workers as controls using both field and in-laboratory experiments. In the in-laboratory study, simulated night shifts were used to induce a misalignment between the endogenous circadian pacemaker and the sleep-wake cycles (ie, circadian misalignment) while environmental conditions and food intake were controlled. Results In the field study, we found that FR was robust in controls but broke down in shift workers during night shifts, leading to more random activity fluctuations as observed in patients with dementia. The night shift effect was present even 2 days after ending night shifts. The in-laboratory study confirmed that night shifts perturbed FR in chronic shift workers and showed that FR in controls was more resilience to the circadian misalignment. Moreover, FR during real and simulated night shifts was more perturbed in those who started shift work at older ages. Conclusions Chronic shift work causes night shift intolerance, which is probably linked to the degraded plasticity of the circadian control system.
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Affiliation(s)
- Peng Li
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Christopher J Morris
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Melissa Patxot
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
| | - Tatiana Yugay
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
| | - Joseph Mistretta
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
| | - Taylor E Purvis
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
| | - Frank A J L Scheer
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Kun Hu
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
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Abstract
BACKGROUND Subjective reports of insomnia and hypersomnia are common in bipolar disorder (BD). It is unclear to what extent these relate to underlying circadian rhythm disturbance (CRD). In this study we aimed to objectively assess sleep and circadian rhythm in a cohort of patients with BD compared to matched controls. METHOD Forty-six patients with BD and 42 controls had comprehensive sleep/circadian rhythm assessment with respiratory sleep studies, prolonged accelerometry over 3 weeks, sleep questionnaires and diaries, melatonin levels, alongside mood, psychosocial functioning and quality of life (QoL) questionnaires. RESULTS Twenty-three (50%) patients with BD had abnormal sleep, of whom 12 (52%) had CRD and 29% had obstructive sleep apnoea. Patients with abnormal sleep had lower 24-h melatonin secretion compared to controls and patients with normal sleep. Abnormal sleep/CRD in BD was associated with impaired functioning and worse QoL. CONCLUSIONS BD is associated with high rates of abnormal sleep and CRD. The association between these disorders, mood and functioning, and the direction of causality, warrants further investigation.
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Affiliation(s)
- A J Bradley
- Institute of Neuroscience,Newcastle University,Wolfson Research Centre,Campus for Aging and Vitality,Newcastle Upon Tyne,UK
| | - R Webb-Mitchell
- Institute of Neuroscience,Newcastle University,Wolfson Research Centre,Campus for Aging and Vitality,Newcastle Upon Tyne,UK
| | - A Hazu
- Institute of Neuroscience,Newcastle University,Wolfson Research Centre,Campus for Aging and Vitality,Newcastle Upon Tyne,UK
| | - N Slater
- Institute of Neuroscience,Newcastle University,Wolfson Research Centre,Campus for Aging and Vitality,Newcastle Upon Tyne,UK
| | - B Middleton
- Surrey Sleep Research Centre and Centre for Chronobiology,Faculty of Health and Medical Sciences,University of Surrey,Guildford,UK
| | - P Gallagher
- Institute of Neuroscience,Newcastle University,Wolfson Research Centre,Campus for Aging and Vitality,Newcastle Upon Tyne,UK
| | - H McAllister-Williams
- Institute of Neuroscience,Newcastle University,Wolfson Research Centre,Campus for Aging and Vitality,Newcastle Upon Tyne,UK
| | - K N Anderson
- Regional Sleep Service, Freeman Hospital,High Heaton,Newcastle upon Tyne,UK
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Kyeong S, Choi SH, Eun Shin J, Lee WS, Yang KH, Chung TS, Kim JJ. Functional connectivity of the circadian clock and neural substrates of sleep-wake disturbance in delirium. Psychiatry Res Neuroimaging 2017; 264:10-12. [PMID: 28390292 DOI: 10.1016/j.pscychresns.2017.03.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 03/18/2017] [Accepted: 03/20/2017] [Indexed: 01/06/2023]
Abstract
A possible mechanism of disrupted circadian rhythms in delirium was identified using resting-state functional connectivity. Thirty-four delirious patients and 38 non-delirious controls were scanned for resting-state functional MRI. Seed-based connectivity of the suprachiasmatic nucleus was compared between the groups. In delirious patients functional connectivity from the circadian clock was increased to the dorsal anterior cingulate cortex and decreased to the posterior cingulate cortex, parahippocampal gyrus, cerebellum, and thalamus. A dysregulation of the default mode network and mental coordination processing areas by the circadian clock may be the underlying pathophysiology of sleep-wake cycle disturbance and symptom fluctuation in delirium.
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Affiliation(s)
- Sunghyon Kyeong
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soo-Hee Choi
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung Eun Shin
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woo Suk Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyu Hyun Yang
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Sub Chung
- Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Jin Kim
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Abstract
BACKGROUND Sailors in the U.S. Navy are habitual shiftworkers, often experiencing circadian misalignment due to their irregular work/rest schedules. This study assessed the effect of sunlight exposure, work hours, and caffeinated beverage consumption on the daily sleep duration of crewmembers of a U.S. Navy ship during a 2-wk underway period. METHODS Working in an artificially lit area with no access to sunlight during work hours, U.S. Navy crew members (N = 91) used daily logs to report their daily activity, caffeinated beverage consumption, and exposure to sunlight while off-duty; sleep was assessed by wrist-worn actigraphy. RESULTS Hours of sunlight exposure, work duration, and the amount of coffee/tea/soft drinks were statistically significant predictors of sleep duration. On average, crewmembers who reported more than one half-hour of sunlight each day slept on average ∼40 min (10%) less than their peers working the same shifts who received less than one half-hour of sunlight (on average 6.05 ± 0.90 h vs. 6.71 ± 0.91 h, respectively). DISCUSSION Exposure to sunlight, work hours, and consumption of caffeinated beverages are important factors when planning watchstanding schedules at sea. Even though further research is needed, our results suggest that even brief exposure to sunlight may contribute to circadian misalignment that negatively affects sleep in the operational environment. Educating crewmembers about sleep hygiene, especially the important roles played by sunlight and caffeine, could potentially improve the sleep and fatigue levels of this population of maritime shiftworkers.Shattuck NL, Matsangas P. Sunlight exposure, work hours, caffeine consumption, and sleep duration in the naval environment. Aerosp Med Hum Perform. 2017; 88(6):579-585.
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Hida A, Ohsawa Y, Kitamura S, Nakazaki K, Ayabe N, Motomura Y, Matsui K, Kobayashi M, Usui A, Inoue Y, Kusanagi H, Kamei Y, Mishima K. Evaluation of circadian phenotypes utilizing fibroblasts from patients with circadian rhythm sleep disorders. Transl Psychiatry 2017; 7:e1106. [PMID: 28440811 PMCID: PMC5416712 DOI: 10.1038/tp.2017.75] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 02/12/2017] [Accepted: 03/08/2017] [Indexed: 12/11/2022] Open
Abstract
We evaluated the circadian phenotypes of patients with delayed sleep-wake phase disorder (DSWPD) and non-24-hour sleep-wake rhythm disorder (N24SWD), two different circadian rhythm sleep disorders (CRSDs) by measuring clock gene expression rhythms in fibroblast cells derived from individual patients. Bmal1-luciferase (Bmal1-luc) expression rhythms were measured in the primary fibroblast cells derived from skin biopsy samples of patients with DSWPD and N24SWD, as well as control subjects. The period length of the Bmal1-luc rhythm (in vitro period) was distributed normally and was 22.80±0.47 (mean±s.d.) h in control-derived fibroblasts. The in vitro periods in DSWPD-derived fibroblasts and N24SWD-derived fibroblasts were 22.67±0.67 h and 23.18±0.70 h, respectively. The N24SWD group showed a significantly longer in vitro period than did the control or DSWPD group. Furthermore, in vitro period was associated with response to chronotherapy in the N24SWD group. Longer in vitro periods were observed in the non-responders (mean±s.d.: 23.59±0.89 h) compared with the responders (mean±s.d.: 22.97±0.47 h) in the N24SWD group. Our results indicate that prolonged circadian periods contribute to the onset and poor treatment outcome of N24SWD. In vitro rhythm assays could be useful for predicting circadian phenotypes and clinical prognosis in patients with CRSDs.
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Affiliation(s)
- A Hida
- Department of Psychophysiology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Y Ohsawa
- Department of Psychophysiology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - S Kitamura
- Department of Psychophysiology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - K Nakazaki
- Department of Psychophysiology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - N Ayabe
- Department of Psychophysiology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Y Motomura
- Department of Psychophysiology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - K Matsui
- Yoyogi Sleep Disorder Center, Tokyo, Japan
| | - M Kobayashi
- Yoyogi Sleep Disorder Center, Tokyo, Japan
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
| | - A Usui
- Yoyogi Sleep Disorder Center, Tokyo, Japan
| | - Y Inoue
- Yoyogi Sleep Disorder Center, Tokyo, Japan
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
| | - H Kusanagi
- Department of Neuropsychiatry, Bioregulatory Medicine, Akita University, Graduate School of Medicine, Akita, Japan
| | - Y Kamei
- Department of Laboratory Medicine, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - K Mishima
- Department of Psychophysiology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
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Lu K, Chen J, Wang L, Wang C, Ding R, Wu S, Hu D. Association of Sleep Duration, Sleep Quality and Shift-Work Schedule in Relation to Hypertension Prevalence in Chinese Adult Males: A Cross-Sectional Survey. Int J Environ Res Public Health 2017; 14:ijerph14020210. [PMID: 28230809 PMCID: PMC5334764 DOI: 10.3390/ijerph14020210] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 02/05/2017] [Accepted: 02/06/2017] [Indexed: 12/21/2022]
Abstract
Background: Previous studies indicated that measurement of sleep only by duration and quality may be biased. This study aimed to investigate the interactive association of self-reported sleep duration, quality and shift-work schedule with hypertension prevalence in Chinese adult males. Methods: A total of 4519 Chinese adult males (≥18 years) were enrolled into the cross-sectional survey. Sleep attributes were measured from the responses to the standard Pittsburgh Sleep Quality Index and relevant questions in a structured questionnaire survey. The association of sleep duration, quality and shift-work schedule with hypertension prevalence was analyzed using multivariate logistic regression, considering the interaction between them or not. Results: Taking the potential interaction of the three aspects of sleep into consideration, only short sleep duration combined with poor sleep quality was found to be related to hypertension prevalence in Chinese adult males (odds ratio (OR): 1.74, 95% confidence interval (CI): 1.31–2.31), which could be modified by occasional and frequent shift-work schedule (OR: 1.43, 95% CI: 1.05–1.95; OR: 1.97, 95% CI: 1.40–2.79). Conclusions: Short sleep duration was not associated with the prevalence of hypertension in Chinese adult males unless poor sleep quality exists, which could be further modified by shift-work schedule. Assessment of sleep by measuring sleep duration only was not sufficient when exploring the association of sleep with hypertension.
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Affiliation(s)
- Kai Lu
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400042, China.
| | - Jia Chen
- Department of Clinical Nutrition, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400042, China.
| | - Li Wang
- Department of Cardiology, Yong Chuan Hospital, Chongqing Medical University, Chongqing 400042, China.
| | - Changying Wang
- Department of Cardiology, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China.
| | - Rongjing Ding
- Heart Center, Peking University People's Hospital, Beijing 100044, China.
| | - Shouling Wu
- Kailuan General Hospital, Hebei United University, Tangshan 100816, China.
| | - Dayi Hu
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400042, China.
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Zhou X, Sargent C, Kosmadopoulos A, Darwent D, Dawson D, Roach GD. Do split sleep/wake schedules reduce or increase sleepiness for continuous operations? Accid Anal Prev 2017; 99:434-439. [PMID: 26549869 DOI: 10.1016/j.aap.2015.10.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 10/20/2015] [Accepted: 10/23/2015] [Indexed: 06/05/2023]
Abstract
This study compared the impact of split and consolidated sleep/wake schedules on subjective sleepiness during the biological day and biological night. This was achieved using a between-group design involving two forced desynchrony protocols: consolidated sleep/wake and split sleep/wake. Both protocols included 7×28-h days with 9.33h in bed and 18.67h of wake each day. While the consolidated sleep/wake protocol had 1×9.33-h sleep opportunity and 1×18.67-h wake period each day, the split sleep/wake protocol had 2×4.67-h sleep opportunities and 2×9.33-h wake periods each day. For both protocols, subjective sleepiness was measured using the Karolinska Sleepiness Scale every 2.5h during wake. A total of 29 healthy adult males participated, with 13 in the consolidated sleep/wake group (mean age=22.5 yrs) and 16 in the split sleep/wake group (mean age=22.6 yrs). On average, subjective sleepiness during wake periods of the split condition was significantly higher than that during the first half of wake periods of the consolidated condition, but was similar to the level during the second half. These findings were observed for wake periods that occurred during both the biological day and biological night. Previous data have shown that cognitive impairment at night is lower for split schedules than consolidated schedules, but the current data indicate that feelings of sleepiness are greater for split schedules than consolidated schedules for at least half of the time awake. Thus, it should be explained to people operating split sleep/wake schedules that although they may perform well, they are likely to feel sleepy.
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Affiliation(s)
- Xuan Zhou
- Central Queensland University, Appleton Institute for Behavioural Science, PO Box 42, Goodwood, SA 5034, Australia.
| | - Charli Sargent
- Central Queensland University, Appleton Institute for Behavioural Science, PO Box 42, Goodwood, SA 5034, Australia.
| | - Anastasi Kosmadopoulos
- Central Queensland University, Appleton Institute for Behavioural Science, PO Box 42, Goodwood, SA 5034, Australia.
| | - David Darwent
- Central Queensland University, Appleton Institute for Behavioural Science, PO Box 42, Goodwood, SA 5034, Australia.
| | - Drew Dawson
- Central Queensland University, Appleton Institute for Behavioural Science, PO Box 42, Goodwood, SA 5034, Australia.
| | - Gregory D Roach
- Central Queensland University, Appleton Institute for Behavioural Science, PO Box 42, Goodwood, SA 5034, Australia.
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Hilditch CJ, Dorrian J, Centofanti SA, Van Dongen HP, Banks S. Sleep inertia associated with a 10-min nap before the commute home following a night shift: A laboratory simulation study. Accid Anal Prev 2017; 99:411-415. [PMID: 26589387 DOI: 10.1016/j.aap.2015.11.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 10/14/2015] [Accepted: 11/06/2015] [Indexed: 06/05/2023]
Abstract
Night shift workers are at risk of road accidents due to sleepiness on the commute home. A brief nap at the end of the night shift, before the commute, may serve as a sleepiness countermeasure. However, there is potential for sleep inertia, i.e. transient impairment immediately after awakening from the nap. We investigated whether sleep inertia diminishes the effectiveness of napping as a sleepiness countermeasure before a simulated commute after a simulated night shift. N=21 healthy subjects (aged 21-35 y; 12 females) participated in a 3-day laboratory study. After a baseline night, subjects were kept awake for 27h for a simulated night shift. They were randomised to either receive a 10-min nap ending at 04:00 plus a 10-min pre-drive nap ending at 07:10 (10-NAP) or total sleep deprivation (NO-NAP). A 40-min York highway driving task was performed at 07:15 to simulate the commute. A 3-min psychomotor vigilance test (PVT-B) and the Samn-Perelli Fatigue Scale (SP-Fatigue) were administered at 06:30 (pre-nap), 07:12 (post-nap), and 07:55 (post-drive). In the 10-NAP condition, total pre-drive nap sleep time was 9.1±1.2min (mean±SD), with 1.3±1.9min spent in slow wave sleep, as determined polysomnographically. There was no difference between conditions in PVT-B performance at 06:30 (before the nap). In the 10-NAP condition, PVT-B performance was worse after the nap (07:12) compared to before the nap (06:30); no change across time was found in the NO-NAP condition. There was no significant difference between conditions in PVT-B performance after the drive. SP-Fatigue and driving performance did not differ significantly between conditions. In conclusion, the pre-drive nap showed objective, but not subjective, evidence of sleep inertia immediately after awakening. The 10-min nap did not affect driving performance during the simulated commute home, and was not effective as a sleepiness countermeasure.
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Affiliation(s)
- Cassie J Hilditch
- Centre for Sleep Research, University of South Australia, Adelaide, South Australia 5001, Australia.
| | - Jillian Dorrian
- Centre for Sleep Research, University of South Australia, Adelaide, South Australia 5001, Australia
| | - Stephanie A Centofanti
- Centre for Sleep Research, University of South Australia, Adelaide, South Australia 5001, Australia
| | - Hans P Van Dongen
- Sleep and Performance Research Center, Washington State University, Spokane, WA, USA
| | - Siobhan Banks
- Centre for Sleep Research, University of South Australia, Adelaide, South Australia 5001, Australia
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Roach GD, Zhou X, Darwent D, Kosmadopoulos A, Dawson D, Sargent C. Are two halves better than one whole? A comparison of the amount and quality of sleep obtained by healthy adult males living on split and consolidated sleep-wake schedules. Accid Anal Prev 2017; 99:428-433. [PMID: 26574119 DOI: 10.1016/j.aap.2015.10.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 10/06/2015] [Accepted: 10/13/2015] [Indexed: 06/05/2023]
Abstract
The aim of this study was to compare the quantity/quality of sleep obtained by people living on split and consolidated sleep-wake schedules. The study had a between-groups design, with 13 participants in a consolidated condition (all males, mean age of 22.5yr) and 16 participants in a split condition (all males, mean age of 22.6yr). Both conditions employed forced desynchrony protocols with the activity:rest ratio set at 2:1, but the consolidated condition had one sleep-wake cycle every 28h (9.33+18.67), while the split condition had one sleep-wake cycle every 14h (4.67+9.33). Sleep was assessed using polysomnography. Participants in the split and consolidated conditions obtained 4.0h of sleep per 14h and 7.6h of sleep per 28h, respectively. Some differences between the groups indicated that sleep quality was lower in the split condition than the consolidated condition: the split sleeps had longer sleep onset latency (9.7 vs. 4.3min), more arousals (7.4 vs. 5.7 per hour in bed), and a greater percentage of stage 1 sleep (4.1% vs. 3.1%), than the consolidated sleeps. Other differences between the groups indicated that sleep quality was higher in the split condition than the consolidated condition: the split sleeps had a lower percentage of wake after sleep onset sleep (11.7% vs. 17.6%), and a greater percentage of slow wave sleep (30.2% vs. 23.8%), than the consolidated sleeps. These results indicate that the split schedule was not particularly harmful, and may have actually been beneficial, to sleep. Split work-rest schedules can be socially disruptive, but their use may be warranted in work settings where shiftworkers are separated from their normal family/social lives (e.g., fly-in fly-out mining) or where the need for family/social time is secondary to the task (e.g., emergency response to natural disasters).
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Affiliation(s)
- Gregory D Roach
- Appleton Institute for Behavioural Science, Central Queensland University, PO Box 42, Goodwood, SA 5034, Australia.
| | - Xuan Zhou
- Appleton Institute for Behavioural Science, Central Queensland University, PO Box 42, Goodwood, SA 5034, Australia.
| | - David Darwent
- Appleton Institute for Behavioural Science, Central Queensland University, PO Box 42, Goodwood, SA 5034, Australia.
| | - Anastasi Kosmadopoulos
- Appleton Institute for Behavioural Science, Central Queensland University, PO Box 42, Goodwood, SA 5034, Australia.
| | - Drew Dawson
- Appleton Institute for Behavioural Science, Central Queensland University, PO Box 42, Goodwood, SA 5034, Australia.
| | - Charli Sargent
- Appleton Institute for Behavioural Science, Central Queensland University, PO Box 42, Goodwood, SA 5034, Australia.
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Kosmadopoulos A, Sargent C, Zhou X, Darwent D, Matthews RW, Dawson D, Roach GD. The efficacy of objective and subjective predictors of driving performance during sleep restriction and circadian misalignment. Accid Anal Prev 2017; 99:445-451. [PMID: 26534845 DOI: 10.1016/j.aap.2015.10.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 10/13/2015] [Accepted: 10/14/2015] [Indexed: 06/05/2023]
Abstract
Fatigue is a significant contributor to motor-vehicle accidents and fatalities. Shift workers are particularly susceptible to fatigue-related risks as they are often sleep-restricted and required to commute around the clock. Simple assays of performance could provide useful indications of risk in fatigue management, but their effectiveness may be influenced by changes in their sensitivity to sleep loss across the day. The aim of this study was to evaluate the sensitivity of several neurobehavioral and subjective tasks to sleep restriction (SR) at different circadian phases and their efficacy as predictors of performance during a simulated driving task. Thirty-two volunteers (M±SD; 22.8±2.9 years) were time-isolated for 13-days and participated in one of two 14-h forced desynchrony protocols with sleep opportunities equivalent to 8h/24h (control) or 4h/24h (SR). At regular intervals during wake periods, participants completed a simulated driving task, several neurobehavioral tasks, including the psychomotor vigilance task (PVT), and subjective ratings, including a self-assessment measure of ability to perform. Scores transformed into standardized units relative to baseline were folded into circadian phase bins based on core body temperature. Sleep dose and circadian phase effect sizes were derived via mixed models analyses. Predictors of driving were identified with regressions. Performance was most sensitive to sleep restriction around the circadian nadir. The effects of sleep restriction around the circadian nadir were larger for simulated driving and neurobehavioral tasks than for subjective ratings. Tasks did not significantly predict driving performance during the control condition or around the acrophase during the SR condition. The PVT and self-assessed ability were the best predictors of simulated driving across circadian phases during SR. These results show that simple performance measures and self-monitoring explain a large proportion of the variance in driving when fatigue-risk is high.
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Affiliation(s)
- Anastasi Kosmadopoulos
- Appleton Institute for Behavioural Science, Central Queensland University, PO Box 42, Goodwood, South Australia 5034, Australia; Bushfire Cooperative Research Centre, East Melbourne, Victoria, Australia.
| | - Charli Sargent
- Appleton Institute for Behavioural Science, Central Queensland University, PO Box 42, Goodwood, South Australia 5034, Australia.
| | - Xuan Zhou
- Appleton Institute for Behavioural Science, Central Queensland University, PO Box 42, Goodwood, South Australia 5034, Australia.
| | - David Darwent
- Appleton Institute for Behavioural Science, Central Queensland University, PO Box 42, Goodwood, South Australia 5034, Australia.
| | - Raymond W Matthews
- Appleton Institute for Behavioural Science, Central Queensland University, PO Box 42, Goodwood, South Australia 5034, Australia.
| | - Drew Dawson
- Appleton Institute for Behavioural Science, Central Queensland University, PO Box 42, Goodwood, South Australia 5034, Australia.
| | - Gregory D Roach
- Appleton Institute for Behavioural Science, Central Queensland University, PO Box 42, Goodwood, South Australia 5034, Australia.
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Harvey AG, Hein K, Dong L, Smith FL, Lisman M, Yu S, Rabe-Hesketh S, Buysse DJ. A transdiagnostic sleep and circadian treatment to improve severe mental illness outcomes in a community setting: study protocol for a randomized controlled trial. Trials 2016; 17:606. [PMID: 27998295 PMCID: PMC5175375 DOI: 10.1186/s13063-016-1690-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 11/10/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Severe mental illness (SMI) is common, chronic and difficult to treat. Sleep and circadian dysfunctions are prominent correlates of SMI, yet have been minimally studied in ways that reflect the complexity of the sleep problems experienced. Prior treatment studies have been disorder-focused-they have treated a specific sleep problem in a specific diagnostic group. However, real life sleep and circadianproblems are not so neatly categorized, particularly in SMI where features of insomnia overlap with hypersomnia, delayed sleep phase and irregular sleep-wake schedules. Accordingly, the aim of this studyprotocol is to test the hypothesis that a Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) will improve functional impairment, disorder-focused symptoms and sleep and circadian functioning. Participants across DSM diagnoses and across common sleep and circadian problems are eligible. The elements of TranS-C are efficacious across SMI in research settings with research-based providers. The next step is to test TranS-C in a community setting. Accordingly, this study is being conducted within Alameda County Behavioral Health Care Services (ACBHCS), the Community Mental Health Centre (CMHC) for Alameda County. METHODS/DESIGN 120 adults diagnosed with SMI and sleep and circadian dysfunction within ACBHCS will be randomly allocated to TranS-C (n = 60) or 6-months of Usual Care followed by Delayed Treatment with TranS-C (UC-DT; n = 60). TranS-C is modularized and delivered across eight to twelve 50-minute, weekly, individual sessions. All participants will be assessed before and immediately following treatment and again 6 months later. Primary analysis will examine whether TranS-C significantly improves functional impairment, disorder-specific symptoms and sleep and circadian functioning, relative to UC-DT. Exploratory analysis will examine whether improvements in sleep and circadian functioning predict reduction in functional impairment and disorder-specific symptoms, and whether the intervention effects are mediated by improved sleep and circadian functioning and moderated by previously reported risk factors (demographics, symptom severity, medications, psychiatric and medical comorbidity). DISCUSSION This trial tests an important and understudied mechanism-dysregulated sleep and circadian rhythms-in SMI, a novel transdiagnostic treatment approach, in a community setting so as to contribute to the goal of bridging the gap between research and practice. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02469233 . Registered on 9 June 2015.
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Affiliation(s)
- Allison G. Harvey
- Department of Psychology, University of California, 2205 Tolman Hall #1650, Berkeley, CA 94720-1650 USA
| | - Kerrie Hein
- Department of Psychology, University of California, 2205 Tolman Hall #1650, Berkeley, CA 94720-1650 USA
| | - Lu Dong
- Department of Psychology, University of California, 2205 Tolman Hall #1650, Berkeley, CA 94720-1650 USA
| | | | - Michael Lisman
- Alameda County Behavioral Health Care Services, Oakland, CA USA
| | - Stephanie Yu
- Department of Psychology, University of California, 2205 Tolman Hall #1650, Berkeley, CA 94720-1650 USA
| | - Sophia Rabe-Hesketh
- Department of Education, University of California, 2205 Tolman Hall #1650, Berkeley, CA 94720-1650 USA
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Fifel K. Alterations of the circadian system in Parkinson's disease patients. Mov Disord 2016; 32:682-692. [PMID: 27859638 DOI: 10.1002/mds.26865] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/28/2016] [Accepted: 10/05/2016] [Indexed: 01/21/2023] Open
Abstract
Alterations of circadian rhythms are among the most debilitating non-motor symptoms in Parkinson's Disease (PD). Although a growing awareness towards these symptoms has occurred during the last decade, their underlying neuropathophysiology remains poorly understood and consequently no effective therapeutic strategies are available to alleviate these problems. Recent studies have investigated multiple circadian rhythms at different stages of PD. The advances made have allowed an accurate evaluation of the affected underlying pathways and mechanisms. Here I dissect, over disease progression, the relative causal contribution to health impairments in PD patients of dysfunctions in the different components of the neural network governing circadian rhythms. A deeper understanding of these mechanisms will provide not only a greater understanding of disease neuropathology, but also hold the promise for effective therapies. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Karim Fifel
- Laboratory of Neurophysiology, Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands
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Abstract
Alterations in sleep and behavioral symptoms are consistently reported among nursing home residents with dementia. Disregulation in the hypothalamic-pituitary-adrenal axis (HPA), indexed by basal cortisol levels, offers one explanation. The purpose of this study is to examine the relationship between wake time and cortisol slope in residents with behavioral symptoms. The study included 27 residents aged 71 to 84 years with dementia and behavioral symptoms. Using a within-subject longitudinal design, the researchers documented wake time and collected saliva samples for 4 consecutive days upon waking and at 30 min, 6 hr, and 12 hr after waking. Within-person cortisol slopes were categorized into zero-positive and negative slopes. The zero—positives (35%) exhibited an earlier wake time than the negatives (65%). These preliminary results suggest both a relationship between wake time and HPA diurnal profile and an association between the sleep-wake cycle and cortisol secretion among nursing home residents with dementia.
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Affiliation(s)
- Diana Lynn Woods
- School of Nursing, University of California, Los Angeles, CA 90095-6919, USA.
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Takaesu Y, Inoue Y, Murakoshi A, Komada Y, Otsuka A, Futenma K, Inoue T. Prevalence of Circadian Rhythm Sleep-Wake Disorders and Associated Factors in Euthymic Patients with Bipolar Disorder. PLoS One 2016; 11:e0159578. [PMID: 27442503 PMCID: PMC4956158 DOI: 10.1371/journal.pone.0159578] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 07/04/2016] [Indexed: 11/26/2022] Open
Abstract
Recent studies have suggested that there are certain pathophysiological relationships between bipolar disorder (BD) and circadian rhythm dysfunction. However, apparently no studies have clarified the prevalence of circadian rhythm sleep-wake disorders (CRSWD) in patients with BD. This study was set out to investigate the prevalence of CRSWD and associated factors in patients with BD. One hundred four euthymic BD outpatients participated in this study. The subjects were asked to answer questionnaires including demographic variables, clinical course of BD, and family history of psychiatric disorders and suicide. Severity of BD was assessed by the Montgomery-Åsberg Depression Rating Scale and Young Mania Rating Scale. CRSWD was diagnosed by clinical interview, together with sleep logs, according to the International Classification of Sleep Disorders, third edition (ICSD-3). Thirty-five subjects (32.4%) met the criteria for CRSWD. The age at the time of investigation and that at the onset of BD were both lower in the CRSWD group than in the non-CRSWD group. The rates of family history of psychiatric disorders and suicide in the CRSWD group were higher than those in the non-CRSWD group. Multiple logistic regression analysis revealed that the presence of CRSWD was significantly associated with younger onset age of BD and family history of suicide. The prevalence of CRSWD could be quite high in BD patients. Younger onset age of BD and family history of suicide were associated with presence of CRSWD in BD patients.
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Affiliation(s)
- Yoshikazu Takaesu
- Department of Psychiatry, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160–0023, Japan
- * E-mail:
| | - Yuichi Inoue
- Department of Psychiatry, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160–0023, Japan
- Department of Somnology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160–0023, Japan
| | - Akiko Murakoshi
- Department of Psychiatry, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160–0023, Japan
| | - Yoko Komada
- Department of Somnology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160–0023, Japan
| | - Ayano Otsuka
- Department of Psychiatry, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160–0023, Japan
| | - Kunihiro Futenma
- Department of Psychiatry, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160–0023, Japan
| | - Takeshi Inoue
- Department of Psychiatry, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160–0023, Japan
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Fernandes-Junior SA, Ruiz FS, Antonietti LS, Tufik S, Túlio de Mello M. Sleep, Fatigue and Quality of Life: A Comparative Analysis among Night Shift Workers with and without Children. PLoS One 2016; 11:e0158580. [PMID: 27391478 PMCID: PMC4938497 DOI: 10.1371/journal.pone.0158580] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 06/17/2016] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION The reversal of the natural cycle of wakefulness and sleep may cause damage to the health of workers. However, there are few studies evaluating sleep, fatigue and quality of life of night shift workers considering the influence of small children on these variables. AIMS Evaluate the sleep time, fatigue and quality of life of night shift workers and verify the relationship between these variables with the presence or absence of children in different age groups. METHODS Were evaluated 78 mens shiftworkers, with or without children. Group 1, workers without children (G1-NC), group 2, workers with children pré-school age (G2-PS) and group 3, workers with children school age (G3-S). The sleep time (ST), sleep efficiency (SE), sleep latency (SL) and maximum time awake (MTA) were recorded by actigraphy. The risk of being fatigued at work was estimated by risk index for fatigue (RIF). RESULTS The G1-NC showed a longer ST on working days and when evaluated only the first nights shift, after day off (p<0,005). This sample, the age of the children did not influence the sleep time these workers. The MTA on day off was lower in the workers from G2-PS. The RIF was lower on G1-NC in the first nights shift compared to the other groups. CONCLUSION In this research, workers without children had higher sleep time during the working days. These workers also were less likely to feel fatigued during night work than workers with children, regardless of age these children.
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Affiliation(s)
| | | | | | - Sergio Tufik
- Department of Psychobiology, Federal University, São Paulo, Brazil
| | - Marco Túlio de Mello
- Department of Psychobiology, Federal University, São Paulo, Brazil
- Center for Multidisciplinary Studies in Sleepiness and Accidents (CEMSA), São Paulo, Brazil
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Micic G, Lovato N, Gradisar M, Burgess HJ, Ferguson SA, Lack L. Circadian Melatonin and Temperature Taus in Delayed Sleep-wake Phase Disorder and Non-24-hour Sleep-wake Rhythm Disorder Patients: An Ultradian Constant Routine Study. J Biol Rhythms 2016; 31:387-405. [PMID: 27312974 DOI: 10.1177/0748730416650069] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Our objectives were to investigate the period lengths (i.e., taus) of the endogenous core body temperature rhythm and melatonin rhythm in delayed sleep-wake phase disorder patients (DSWPD) and non-24-h sleep-wake rhythm disorder patients (N24SWD) compared with normally entrained individuals. Circadian rhythms were measured during an 80-h ultradian modified constant routine consisting of 80 ultrashort 1-h "days" in which participants had 20-min sleep opportunities alternating with 40 min of enforced wakefulness. We recruited a community-based sample of 26 DSWPD patients who met diagnostic criteria (17 males, 9 females; age, 21.85 ± 4.97 years) and 18 healthy controls (10 males, 8 females; age, 23.72 ± 5.10 years). Additionally, 4 full-sighted patients (3 males, 1 female; age, 25.75 ± 4.99 years) were diagnosed with N24SWD and included as a discrete study group. Ingestible core temperature capsules were used to record minute temperatures that were averaged to obtain 80 hourly data points. Salivary melatonin concentration was assessed every half-hour to determine time of dim light melatonin onset at the beginning and end of the 80-h protocol. DSWPD patients had significantly longer melatonin rhythm taus (24 h 34 min ± 17 min) than controls (24 h 22 min ± 15 min, p = 0.03, d = 0.70). These results were further supported by longer temperature rhythm taus in DSWPD patients (24 h 34 min ± 26 min) relative to controls (24 h 13 min ± 15 min, p = 0.01, d = 0.80). N24SWD patients had even longer melatonin (25 h ± 19 min) and temperature (24 h 52 min ± 17 min) taus than both DSWPD (p = 0.007, p = 0.06) and control participants (p < 0.001, p = 0.02, respectively). Between 12% and 19% of the variance in DSWPD patients' sleep timing could be explained by longer taus. This indicates that longer taus of circadian rhythms may contribute to the DSWPD patients' persistent tendency to delay, their frequent failure to respond to treatment, and their relapse following treatment. Additionally, other factors can contribute to misalignments in DSWPD and N24SWD disorders.
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Affiliation(s)
- Gorica Micic
- Flinders University of South Australia, Adelaide, SA, Australia
| | - Nicole Lovato
- Flinders University of South Australia, Adelaide, SA, Australia Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | | | | | - Sally A Ferguson
- Appleton Institute, Central Queensland University, Adelaide, SA, Australia
| | - Leon Lack
- Flinders University of South Australia, Adelaide, SA, Australia Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
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Wu LJ, Gander PH, van den Berg MJ, Signal TL. Estimating long-haul airline pilots' at-home baseline sleep duration. Sleep Health 2016; 2:143-145. [PMID: 28923257 DOI: 10.1016/j.sleh.2016.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 02/21/2016] [Accepted: 02/26/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Characterize the baseline sleep of long-haul airline pilots. METHODS Sleep of 332 pilots (median age = 51 years, range = 23-64 years) from 4 airlines was measured by actigraphy while at home and off-duty and by retrospective estimate of the total amount of nighttime sleep usually obtained at home. RESULTS Mean actigraphic sleep per 24 hours during baseline periods was 6.8 hours (SD = 1.0 hour), 52 minutes shorter than mean self-reported usual nighttime sleep (7.6 hours, SD = 1.1 hours). CONCLUSIONS Pilots' self-reported sleep duration was comparable to weekend sleep of men in general population samples, but their actigraphic baseline sleep was longer than objectively monitored sleep of other samples. Long-haul pilots routinely experience sleep restriction and circadian disruption across trips, both of which are implicated in increased health risks. We recommend that they be educated about the long-term importance for health of obtaining adequate sleep on off-duty days.
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Affiliation(s)
- Lora J Wu
- Sleep/Wake Research Centre, PO Box 756, Massey University, Wellington, 6140, New Zealand.
| | - Philippa H Gander
- Sleep/Wake Research Centre, PO Box 756, Massey University, Wellington, 6140, New Zealand
| | - Margo J van den Berg
- Sleep/Wake Research Centre, PO Box 756, Massey University, Wellington, 6140, New Zealand
| | - T Leigh Signal
- Sleep/Wake Research Centre, PO Box 756, Massey University, Wellington, 6140, New Zealand
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Landolt HP. [Self-rated Caffeine Sensitivity: Implications for Personalized Sleep Medicine?]. Praxis (Bern 1994) 2016; 105:563-568. [PMID: 27167478 DOI: 10.1024/1661-8157/a002352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The prevalence of the insomnia syndrome and the effects of caffeine on sleep are in part genetically determined. Pharmacogenetic studies in humans demonstrate that functional polymorphisms of the genes encoding adenosine A2A receptors and dopamine transporters contribute to individual differences in impaired sleep quality by caffeine. The A2A receptor and dopamine transporter are preferentially expressed in the striatum. Together, these observations suggest that the striatum plays an important role in sleep-wake regulation. Individual caffeine sensitivity and A2A receptor genotype should be taken into account in the development of possible novel adenosine-based pharmacotherapies of sleep-wake disorders and neurodegenerative disorders such as Parkinson's disease. This may permit the prediction of individual drug effects and improve the reliability of clinical trials.
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Affiliation(s)
- Hans Peter Landolt
- 1 Institut für Pharmakologie und Toxikologie, Universität Zürich
- 2 Klinischer Forschungsschwerpunkt Sleep & Health, Universität Zürich
- 3 Zürcher Zentrum für interdisziplinäre Schlafforschung (ZiS), Universität Zürich
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Shattuck NL, Matsangas P. Operational assessment of the 5-h on/10-h off watchstanding schedule on a US Navy ship: sleep patterns, mood and psychomotor vigilance performance of crewmembers in the nuclear reactor department. Ergonomics 2016; 59:657-664. [PMID: 26360772 DOI: 10.1080/00140139.2015.1073794] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We assessed sleep patterns, psychomotor vigilance performance, work demands and mood of 77 crewmembers of USS NIMITZ (CVN-68) on the rotating 5-h on/10-h off (5/10) watchstanding schedule. Within the 3-day cycle of the 5/10, sleep occurred at distinctly different times each day. On two of these days, sailors typically received only brief, 4-h sleep episodes followed by periods of sustained wakefulness (approximately 22 and 20 h). Crewmembers received approximately seven hours of sleep daily, but reported excessive fatigue and dissatisfaction with their schedule. Crewmembers' mood worsened significantly over the course of the underway phase. Psychomotor vigilance performance (reaction times, lapses) was significantly degraded compared to performance when working circadian-aligned schedules. Overall, standing watch on the 5/10 schedule, combined with other work duties, resulted in poor sleep hygiene. Crewmembers on the 5/10 experienced periodic bouts of sustained wakefulness and accrued a significant sleep debt due to extended workdays and circadian-misaligned sleep. Practitioner summary: We assessed crewmembers' sleep patterns, psychomotor vigilance performance and work demands when working a rotating 5-h on/10-h off (5/10) watchstanding schedule. The 5/10, combined with other work duties, resulted in poor sleep hygiene. Crewmembers experienced periodic bouts of sustained wakefulness and accrued a significant sleep debt due to extended workdays and circadian-misaligned sleep.
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Affiliation(s)
- Nita Lewis Shattuck
- a Operations Research Department , Naval Postgraduate School , Monterey , USA
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Short MA, Centofanti S, Hilditch C, Banks S, Lushington K, Dorrian J. The effect of split sleep schedules (6h-on/6h-off) on neurobehavioural performance, sleep and sleepiness. Appl Ergon 2016; 54:72-82. [PMID: 26851466 DOI: 10.1016/j.apergo.2015.12.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 10/20/2015] [Accepted: 12/09/2015] [Indexed: 06/05/2023]
Abstract
Shorter, more frequent rosters, such as 6h-on/6h-off split shifts, may offer promise to sleep, subjective sleepiness and performance by limiting shift length and by offering opportunities for all workers to obtain some sleep across the biological night. However, there exists a paucity of studies that have examined these shifts using objective measures of sleep and performance. The present study examined neurobehavioural performance, sleepiness and sleep during 6h-on/6h-off split sleep schedules. Sixteen healthy adults (6 males, 26.13 y ± 4.46) participated in a 9-day laboratory study that included two baseline nights (BL, 10h time in bed (TIB), 2200 h-0800 h), 4 days on one of two types of 6h-on/6h-off split sleep schedules with 5h TIB during each 'off' period (6h early: TIB 0300 h-0800 h and 1500 h-20000 h, or 6-h late: TIB 0900 h-1400 h and 2100 h-0200 h), and two recovery nights (10h TIB per night, 2200 h-0800 h). Participants received 10h TIB per 24h in total across both shift schedules. A neurobehavioural test bout was completed every 2 h during wake, which included the Psychomotor Vigilance Task (PVT) and the Karolinska Sleepiness Scale (KSS). Linear mixed effects models were used to assess the effect of day (BL, shift days 1-4), schedule (6h early, 6h late) and trial (numbers 1-6) on PVT lapses (operationalised as the number of reaction times >500 ms), PVT total lapse time, PVT fastest 10% of reaction times and KSS. Analyses were also conducted examining the effect of day and schedule on sleep variables. Overall, PVT lapses and total lapse time did not differ significantly between baseline and shift days, however, peak response speeds were significantly slower on the first shift day when compared to baseline, but only for those in the 6h-late condition. Circadian variations were apparent in performance outcomes, with individuals in the 6h-late condition demonstrated significantly more and longer lapses and slower peak reaction times at the end of their night shift (0730 h) than at any other time during their shifts. In the 6h-early condition, only response speed significantly differed across trials, with slower response speeds occurring at trial 1 (0930 h) than in trials 3 (1330 h) or 4 (2130 h). While subjective sleepiness was higher on shift days than at baseline, sleepiness did not accumulate across days. Total sleep was reduced across split sleep schedules compared to baseline. Overall, these results show that while there was not a cumulative cost to performance across days of splitting sleep, participants obtained less sleep and reported lowered alertness on shift days. Tests near the circadian nadir showed higher sleepiness and increased performance deficits. While this schedule did not produce cumulative impairment, the performance deficits witnessed during the biological night are still of operational concern for industry and workers alike.
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Affiliation(s)
- Michelle A Short
- Centre for Sleep Research, University of South Australia, Adelaide, Australia; Bushfire Cooperative Research Centre, East Melbourne, Australia; School of Psychology, Flinders University, Bedford Park, Australia.
| | | | - Cassie Hilditch
- Centre for Sleep Research, University of South Australia, Adelaide, Australia
| | - Siobhan Banks
- Centre for Sleep Research, University of South Australia, Adelaide, Australia
| | - Kurt Lushington
- Centre for Sleep Research, University of South Australia, Adelaide, Australia
| | - Jillian Dorrian
- Centre for Sleep Research, University of South Australia, Adelaide, Australia
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48
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Narciso FV, Barela JA, Aguiar SA, Carvalho ANS, Tufik S, de Mello MT. Effects of Shift Work on the Postural and Psychomotor Performance of Night Workers. PLoS One 2016; 11:e0151609. [PMID: 27115868 PMCID: PMC4845980 DOI: 10.1371/journal.pone.0151609] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 03/01/2016] [Indexed: 11/18/2022] Open
Abstract
The purpose of the study was to investigate the effects of shift work on the psychomotor and postural performance of night workers. The study included 20 polysomnography technicians working schedule of 12-h night shift by 36-h off. On the first day of protocol, the body mass and height were measured, and an actigraph was placed on the wrist of each participant. On the second day of protocol, sleepiness by Karolinska Sleepiness Scale, postural control by force platform (30 seconds) and psychomotor performance by Psychomotor Vigilance Task (10 minutes) were measured before and after 12-h night work. Results showed that after 12-h night work, sleepiness increased by 59% (p<0.001), postural control variables increased by 9% (p = 0.048), and 14% (p = 0.006). Mean reaction time, and the number of lapses of attention increased by 13% (p = 0.006) and 425% (p = 0.015), respectively, but the mean reciprocal reaction time decreased by 7%. In addition, there were correlations between sleepiness and postural control variables with opened eyes (r = 0.616, 95% confidence interval [CI] = 0.361-0.815; r = 0.538; 95% CI = 0.280-0.748) and closed eyes (r = 0.557; 95% CI = 0.304-0.764, r = 0497; 95% CI = 0.325-0.715) and a pronounced effect of sleepiness on postural sway (R2 = 0.393; 95% CI = 0.001-0.03). Therefore, 12-h night work system and sleepiness showed a negative impact in postural and psychomotor vigilance performance of night workers. As unexpected, the force platform was feasibility to detect sleepiness in this population, underscoring the possibility of using this method in the workplace to prevent occupational injuries and accidents.
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Affiliation(s)
| | | | | | | | - Sergio Tufik
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Marco Túlio de Mello
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- * E-mail:
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49
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Sargent C, Zhou X, Matthews RW, Darwent D, Roach GD. Daily Rhythms of Hunger and Satiety in Healthy Men during One Week of Sleep Restriction and Circadian Misalignment. Int J Environ Res Public Health 2016; 13:170. [PMID: 26840322 PMCID: PMC4772190 DOI: 10.3390/ijerph13020170] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 09/14/2015] [Accepted: 09/29/2015] [Indexed: 01/09/2023]
Abstract
The impact of sleep restriction on the endogenous circadian rhythms of hunger and satiety were examined in 28 healthy young men. Participants were scheduled to 2 × 24-h days of baseline followed by 8 × 28-h days of forced desynchrony during which sleep was either moderately restricted (equivalent to 6 h in bed/24 h; n = 14) or severely restricted (equivalent to 4 h in bed/24 h; n = 14). Self-reported hunger and satisfaction were assessed every 2.5 h during wake periods using visual analogue scales. Participants were served standardised meals and snacks at regular intervals and were not permitted to eat ad libitum. Core body temperature was continuously recorded with rectal thermistors to determine circadian phase. Both hunger and satiety exhibited a marked endogenous circadian rhythm. Hunger was highest, and satiety was lowest, in the biological evening (i.e., ~17:00–21:00 h) whereas hunger was lowest, and satiety was highest in the biological night (i.e., 01:00–05:00 h). The results are consistent with expectations based on previous reports and may explain in some part the decrease in appetite that is commonly reported by individuals who are required to work at night. Interestingly, the endogenous rhythms of hunger and satiety do not appear to be altered by severe—as compared to moderate—sleep restriction.
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Affiliation(s)
- Charli Sargent
- Appleton Institute for Behavioural Science, Central Queensland University, P.O. Box 42, Goodwood 5034, Australia.
| | - Xuan Zhou
- Appleton Institute for Behavioural Science, Central Queensland University, P.O. Box 42, Goodwood 5034, Australia.
| | - Raymond W Matthews
- Appleton Institute for Behavioural Science, Central Queensland University, P.O. Box 42, Goodwood 5034, Australia.
| | - David Darwent
- Appleton Institute for Behavioural Science, Central Queensland University, P.O. Box 42, Goodwood 5034, Australia.
| | - Gregory D Roach
- Appleton Institute for Behavioural Science, Central Queensland University, P.O. Box 42, Goodwood 5034, Australia.
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Lee ML, Howard ME, Horrey WJ, Liang Y, Anderson C, Shreeve MS, O'Brien CS, Czeisler CA. High risk of near-crash driving events following night-shift work. Proc Natl Acad Sci U S A 2016; 113:176-81. [PMID: 26699470 PMCID: PMC4711869 DOI: 10.1073/pnas.1510383112] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Night-shift workers are at high risk of drowsiness-related motor vehicle crashes as a result of circadian disruption and sleep restriction. However, the impact of actual night-shift work on measures of drowsiness and driving performance while operating a real motor vehicle remains unknown. Sixteen night-shift workers completed two 2-h daytime driving sessions on a closed driving track at the Liberty Mutual Research Institute for Safety: (i) a postsleep baseline driving session after an average of 7.6 ± 2.4 h sleep the previous night with no night-shift work, and (ii) a postnight-shift driving session following night-shift work. Physiological measures of drowsiness were collected, including infrared reflectance oculography, electroencephalography, and electrooculography. Driving performance measures included lane excursions, near-crash events, and drives terminated because of failure to maintain control of the vehicle. Eleven near-crashes occurred in 6 of 16 postnight-shift drives (37.5%), and 7 of 16 postnight-shift drives (43.8%) were terminated early for safety reasons, compared with zero near-crashes or early drive terminations during 16 postsleep drives (Fishers exact: P = 0.0088 and P = 0.0034, respectively). Participants had a significantly higher rate of lane excursions, average Johns Drowsiness Scale, blink duration, and number of slow eye movements during postnight-shift drives compared with postsleep drives (3.09/min vs. 1.49/min; 1.71 vs. 0.97; 125 ms vs. 100 ms; 35.8 vs. 19.1; respectively, P < 0.05 for all). Night-shift work increases driver drowsiness, degrading driving performance and increasing the risk of near-crash drive events. With more than 9.5 million Americans working overnight or rotating shifts and one-third of United States commutes exceeding 30 min, these results have implications for traffic and occupational safety.
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Affiliation(s)
- Michael L Lee
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA 02115; Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115
| | - Mark E Howard
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA 02115; Department of Respiratory & Sleep Medicine, Institute for Breathing & Sleep, Austin Health, Heidelberg, VIC 3084, Australia
| | - William J Horrey
- Center for Behavioral Sciences, Liberty Mutual Research Institute for Safety, Hopkinton, MA 01748
| | - Yulan Liang
- Center for Behavioral Sciences, Liberty Mutual Research Institute for Safety, Hopkinton, MA 01748
| | - Clare Anderson
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA 02115; Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115; Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3800, Australia
| | - Michael S Shreeve
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA 02115
| | - Conor S O'Brien
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA 02115
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA 02115; Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115;
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