Association between light at night, melatonin secretion, sleep deprivation, and the internal clock: Health impacts and mechanisms of circadian disruption

Determinants of variations in sleep patterns across Brazil: Exploring geographic influences

Objective

To examine the influence of latitude, longitude, sunrise, and daylight, in conjunction with individual and behavioral factors, on sleep duration, wake time, and bedtime in a country with the world's broadest latitude range, yet characterized by homogeneity in language, cultural traits, and consistent time zones.

Methods

Participants (n = 1440; 18-65y) were part of a virtual population-based survey (2021-22). Sleep patterns were spatially represented through maps using Multilevel B-spline Interpolation. Relationships between and within biological/personal/socio-economic, behavioral and environment characteristics, and sleep outcomes were examined by Lasso regression. Restricted cubic splines were employed to examine the shape of the association of latitude and sunrise with sleep variables and of screen time before bed with bedtime.

Results

Latitude emerged as the primary geographic factor influencing variations in sleep duration and wake time, shortening and advancing, respectively, as latitude increased (towards equatorial line). Younger individuals, those living without partners, with depression, engaging in more frequent evening alcohol consumption, and with poorer diet quality, tended to wake up later. All the variables influenced bedtime, with daylight emerging as the environmental factor exerting the strongest association. While the variability in bedtime showed a non-linear association with latitude and sunrise, it displayed a dose-response relationship with screen time before bed.

Conclusions

Given that adults living in the same country, potentially with a similar timetable, could be having shorter sleep durations according to their latitude position, further studies are required to contemplate advocating for policies that implement schedules based on the sun position rather than the national time zone.

Exposure to artificial lighting at night: from an ecological challenge to a risk factor for glucose dysmetabolism and gestational diabetes? Narrative review

INTRODUCTION

Artificial lighting at night (ALAN) leads to pervasive light pollution, affecting ecosystems and human health globally. Satellite assessments reveal widespread nocturnal illumination worldwide and research indicates adverse health effects. Environmental light pollution disrupts natural cycles, affecting the behavior and reproduction of various organisms.

AIM/METHOD

In this narrative review we aimed to present research on the effects of ALAN on glucose metabolism and diabetes and hone on its recently reported association with gestational diabetes (GDM).

RESULTS

Conflicting data exist on the effects of melatonin's administration vis-à-vis glycemia, with some studies suggesting beneficial outcomes for patients with type 2 diabetes mellitus and insomnia. Ambient light influences plasma glucose, with bright light increasing both fasting and postprandial glucose levels. Perinatal light exposure is linked to later-life health risks and prenatal exposure to ALAN is linked to fetal macrosomia. Analyzing European ALAN data in conjunction with epidemiological records for GDM reveals a notable probable association. Additionally, recent research from China (one case-control and two cohort studies) has shown that exposure to ALAN during pregnancy significantly increases the risk of GDM.

DISCUSSION/CONCLUSION

Despite progress, interdisciplinary research is needed to understand the impact of light pollution on health, especially regarding disrupted light-dark cycles and physiological functions relevant to conditions like GDM. At present, the simplest advice for all people and particularly for women who anticipate pregnancy, or for pregnant women, is to ensure a totally dark environment during sleep time.

Tracking Daily Variations in Rest-Wake to Guide Personalized Timing of Temozolomide for High-Grade Glioma Patients

High-grade gliomas, like glioblastoma multiforme (GBM), are the most common malignant brain tumors in adults and are treated with the chemotherapy drug temozolomide (TMZ). In humans, a retrospective analysis of patients' overall survival suggests that morning dosing may confer a benefit over evening dosing. Circadian variation in O6-methylguanine-DNA methyltransferase (MGMT) gene expression and promoter methylation has been implicated in increased tumor cell sensitivity to TMZ in the morning. Although patient compliance with timed oral administration of TMZ was high in a prospective trial, it is not known whether differences in daily sleep patterns of patients impact the biological time of drug administration or overall survival. Using wrist actigraphy collected from 10 high-grade glioma patients, we quantified the moment of oral TMZ delivery in terms of wall clock time and internal biological time during the months after surgical tumor resection. We found that variation of daily rhythms within and between individuals caused dosing times to vary more in their internal biological time than wall clock time so that, for example, some doses taken by patients assigned for the evening (2000 h) were closer to the patient's internal biological morning. We conclude that wrist actigraphy provides a reliable and non-invasive estimate of personal circadian time that could improve efficacy and precision of TMZ delivery. These findings may inform personalized circadian medicine and optimized times for TMZ delivery in the clinic.

The Relationship Between Sleep Quality and the Risk of Medication Errors in Nurses Working in Surgical Wards: A Multicenter Study

AIM

Determination of the relationship between sleep quality and the risk of medication errors in nurses working in surgical services.

METHODS

This multicenter, descriptive and correlational study was conducted with 192 nurses working in surgical wards of all training and research hospitals in Ankara, the capital of Türkiye, between January and December 2023. Data were collected using the "Nurse Information Form," "Pittsburgh Sleep Quality Index," "Epworth Sleepiness Scale," and "Medication Administration Error Scale." The suitability of numerical variables for normal distribution was examined graphically and with the Shapiro-Wilk test. Additionally, Mann-Whitney test, Kruskal-Wallis, Bonferroni, and Spearman's Rank Correlation Coefficient tests were used in the analyses. The STROBE checklist was followed in writing the study.

RESULTS

The median age of nurses was 27.0 (IQR = 8.0) years, and 38.5% were in the 21-25 age group. Among the nurses, 81.3% stated that they had sleep problems due to working hours, and 44.3% stated that they made medication errors due to insomnia. The nurses' Pittsburgh Sleep Quality Index total score median was 12.00 (IQR = 9.00), Epworth Sleepiness Scale score was 11.00 (IQR = 8.75), and Medication Administration Error Scale score was 85.00 (IQR = 25.75). No statistically significant relationship was found between nurses' Epworth Sleepiness Scale and Medication Administration Error Scale scores (rs = 0.042; p = 0.565). A statistically significant low-level relationship was found between the nurses' Epworth Sleepiness Scale score and the total Pittsburgh Sleep Quality Index score (rs = 0.387; p < 0.001). Statistically significant weak and very weak relationships were found between Medication Administration Error Scale and subjective sleep quality, sleeping pill use, and daytime dysfunction (p < 0.05).

CONCLUSION

The study found that nurses had poor sleep quality and daytime sleepiness. It was determined that nurses with sleep problems were at a higher risk of making medication errors.

PUBLIC CONTRIBUTION

Based on these results, it is recommended that nurses' working hours be planned to support their sleep patterns, and nurses be provided with adequate rest time during shift work hours. Additionally, nurses should be educated about sleep hygiene and the effects of sleep disorders, and more research should be conducted to understand the causes of medication errors and develop preventive strategies.

RELEVANCE TO CLINICAL PRACTICE

The basic principle of healthcare is to "do no harm." Among healthcare professionals, nurses have great responsibility in preventing medical errors. However, the excessive workload, high number of patients under their care, and working in a day-night shift system lead to fatigue and sleep deprivation. Sleep problems increases their tendency to make mistakes. This study aims to contribute evidence to the literature on the impact of sleep problems on medication errors.

Timing of physical activity, genetic predisposition, and incident depression: An accelerometer-based prospective cohort study

BACKGROUND

There is a lack of prospective cohort studies exploring the associations between the timing of physical activity and incident depression. This study aimed to explore the associations and to investigate whether genetic predisposition of depression may modify the associations.

METHODS

The study using data from UK Biobank, included 76,218 participants. The data of total physical activity (TPA) and moderate-to-vigorous physical activity (MVPA) were collected by accelerometer measurements over 7 consecutive days. Cox proportional hazard models were performed to calculate the hazard ratio (HR) and 95 % confidence interval (CI).

RESULTS

In total, compared to the midday-afternoon group, participants in the early morning group of TPA had a lower risk of depression (HR: 0.76, 95 % CI: 0.65-0.89). Compared to the inactive group, a lower risk of incident depression was found among the participants with MVPA in the morning (HR: 0.80, 95 % CI: 0.67-0.96) and middy-afternoon (HR: 0.82, 95 % CI: 0.70-0.96). The joint effect analysis of the timing of TPA and genetic predisposition for incident depression showed that compared to the participants with a high genetic predisposition and in the middy-afternoon group of TPA, early morning group had a reduced risk of depression regardless of genetic predisposition. However, in subgroup analyses for genetic predisposition, only participants with a high genetic predisposition to depression benefited from TPA in the early morning.

CONCLUSIONS

TPA in the early morning and MVPA in the morning and middy-afternoon were significantly associated with a lower depression risk, especially for participants with a higher genetic predisposition of depression.

Synergistic impact of air pollution and artificial light at night on memory disorders: a nationwide cohort analysis

BACKGROUND

Air pollutants and outdoor artificial light at night (ALAN) are known health risks, with established effects on respiratory and cardiovascular health. However, their impact on cognitive function, particularly neurodegenerative diseases like Alzheimer's, remains poorly understood.

METHODS

Using data from the China Health and Retirement Longitudinal Study (CHARLS) and the China Family Panel Studies (CFPS), including 44,689 participants, memory impairment (Memrye) was defined by self-reported memory-related diseases. Cox regression models were applied to assess the relationship between pollutants, ALAN exposure, and Memrye. Interaction analyses evaluated the combined effects using relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (S). Biomarker analyses and stepwise causal mediation examined the underlying mechanisms.

RESULTS

Air pollutants and ALAN were significantly associated with Memrye (p < 0.05), with hazard ratios (HR) ranging from 1.010 to 1.343. Synergistic effects were observed, such as for PM2.5 and ALAN, with RERI, AP, and S values of 0.65 (0.33, 0.97), 0.30 (0.26, 0.34), and 1.43 (1.21, 1.65), respectively. Biomarker analyses showed significant correlations between pollutants, glucose, cholesterol, and uric acid, while ALAN was negatively associated with glucose and uric acid. Mediation analyses indicated that PM2.5, NO2, and ALAN indirectly affected Memrye through biomarkers, accounting for 1.07-8.28% of the total effects.

CONCLUSION

Air pollution and ALAN exposure are linked to memory impairment, with combined effects potentially amplifying risk. Biomarkers play a key role in mediating these effects, suggesting a need for targeted public health measures to mitigate these environmental health risks.

Molecular Links Between Circadian Rhythm Disruption, Melatonin, and Neurodegenerative Diseases: An Updated Review

Circadian rhythms are molecular oscillations governed by transcriptional-translational feedback loops (TTFLs) operating in nearly all cell types and are fundamental to physiological homeostasis. Key circadian regulators, such as circadian locomotor output cycles kaput (CLOCK), brain and muscle ARNT-like 1 (BMAL1), period (PER), and cryptochrome (CRY) gene families, regulate intracellular metabolism, oxidative balance, mitochondrial function, and synaptic plasticity. Circadian disruption is known as a central contributor to the molecular pathophysiology of neurodegenerative disorders. Disease-specific disruptions in clock gene expression and melatoninergic signaling are known as potential early-stage molecular biomarkers. Melatonin, a neurohormone secreted by the pineal gland, modulates clock gene expression, mitochondrial stability, and inflammatory responses. It also regulates epigenetic and metabolic processes through nuclear receptors and metabolic regulators involved in circadian and cellular stress pathways, thereby exerting neuroprotective effects and maintaining neuronal integrity. This review provides recent findings from the past five years, highlighting how circadian dysregulation mediates key molecular and cellular disturbances and the translational potential of circadian-based therapies in neurodegenerative diseases.

Circadian immunometabolism: A future insight for targeted therapy in cancer

Circadian rhythms send messages to regulate the sleep-wake cycle in living beings, which, regulate various biological activities. It is well known that altered sleep-wake cycles affect host metabolism and significantly deregulate the host immunity. The dysregulation of circadian-related genes is critical for various malignancies. One of the hallmarks of cancer is altered metabolism, the effects of which spill into surrounding microenvironments. Here, we review the emerging literature linking the circadian immunometabolic axis to cancer. Small metabolites are the products of various metabolic pathways, that are usually perturbed in cancer. Genes that regulate circadian rhythms also regulate host metabolism and control metabolite content in the tumor microenvironment. Immune cell infiltration into the tumor site is critical to perform anticancer functions, and altered metabolite content affects their trafficking to the tumor site. A compromised immune response in the tumor microenvironment aids cancer cell proliferation and immune evasion, resulting in metastases. The role of circadian rhythms in these processes is largely overlooked and demands renewed attention in the search for targets against cancer growth and spread. The precision medicine approach requires targeting the circadian immune metabolism in cancer.

Supporting the management of long-term health risk from night work

Societal demands mean that many companies operate throughout the day to provide services. The impact of night work on long-term health is not clear, but there is sufficient evidence for closer monitoring of this as a concern and industry is not sure what more they need to do about this potential problem. There are many health conditions and potential interventions to reduce risks from night working, but there is no clarity on how to design and implement intervention programmes for long-term health issues. This paper reports on a rapid review of 24 articles to examine how interventions can minimise long-term health risk from night work. The analysis has identified eight types of intervention that have been used in relation to seven types of long-term health conditions but has highlighted weaknesses in evaluation, in relation to the current knowledge of the implementation and effectiveness of the interventions for long-term health. Commentary is provided on how researchers and industry practitioners need to think about risk in different ways, improve implementation of interventions through a systemic approach to work design and organisation, and employ more participatory approaches to embed cultural change in organisations.

Association of physical activity, sedentary behaviour, sleep and myopia in children and adolescents: a systematic review and dose-response meta-analysis

PURPOSE

This study aimed to systematically evaluate the dose-response relationships between physical activity (PA), sedentary behavior(SB) (including near work [NW] and screen time [ST]), sleep duration (SD), and myopia risk among children and adolescents.

DESIGN

Systematic review and dose-response meta-analysis.

METHODS

We systematically searched PubMed, EMBASE, Cochrane Library, and Web of Science up to November 19, 2024. Methodological quality was assessed using Joanna Briggs Institute (JBI) and ROBINS-I tools. Random-effects meta-analyses were used to estimate categorical and continuous dose-response relationships. Subgroup analyses and sensitivity analyses were performed to explore heterogeneity sources and test robustness.

RESULTS

A total of 45 observational studies (766,848 participants aged 5-19 years) were included. Categorical analyses showed that, compared with the lowest exposure categories, higher PA levels (highest: OR = 0.77, 95% CI: 0.63-0.96; intermediate: OR = 0.76, 95% CI: 0.63-0.93) and longer SD (highest: OR = 0.67, 95% CI: 0.48-0.92; intermediate: OR = 0.82, 95% CI: 0.73-0.92) significantly reduced myopia risk. Conversely, higher levels of NW (highest: OR = 1.71, 95% CI: 1.28-2.27; intermediate: OR = 1.34, 95% CI: 1.19-1.50) and ST (highest: OR = 1.59, 95% CI: 1.14-2.22; intermediate: OR = 1.29, 95% CI: 1.12-1.49) were associated with significantly increased risk. In the continuous dose-response meta-analysis, a linear association was observed between PA, ST, and myopia. Each additional hour of PA per day reduced the risk of myopia by 12%, while each additional hour of ST increased the risk by 31%. Nonlinear associations were found between NW, SD, and myopia. Among children and adolescents, 1.5 and 2.5 h/day of NW increased the risk of myopia by 25% and 29%, respectively. Although longer SD was associated with a reduced risk of myopia, this effect did not reach statistical significance at any exposure level.Subgroup analyses revealed that protective effects of PA were more evident in low- and middle-income countries, smaller sample sizes, and cross-sectional studies, while increased risks related to ST and NW were stronger in low-income settings. No subgroup significantly modified the association between SD and myopia risk.

CONCLUSION

Increasing PA, while limiting ST and NW, effectively reduces the risk of myopia among children and adolescents. The association between sleep duration and myopia remains inconclusive, warranting further investigation.

BMAL1 rescued the hippocampus-dependent recognition memory induced by sleep deprivation

Sleep plays an important role in the process of memory. This study investigated the role of the circadian clock gene, BMAL1 of the master circadian clock in mediating the impairment of hippocampus-dependent recognition memory caused by sleep deprivation. After 4 weeks of sleep deprivation, the novel object recognitiontask was used to evaluate the recognition memory of mice, the expression levels of circadian clock genes, and Nrf2 and PKA/CREB/BDNF signal pathways were detected by Western blot, Realtime-qPCR, and immunofluorescence. The mice in the SD group exhibited a significant decrease in the duration of exploration of novel objects. The protein expression levels of PER1, PER2, CLOCK, and BMAL1, and PKA/CREB/BDNF pathway in the hippocampus of the SD group were significantly reduced, and the Nrf2-mediated anti-oxidative capacity was also compromised in the SD group. Moreover, these aberrations could be mitigated through compensation with BMAL1 in the SCN of the hypothalamus. Sleep deprivation resulted in a reduction in the expression of the core clock gene BMAL1 in the hippocampus, leading to an imbalance in the antioxidant system and damaging down-regulating the PKA/CREB/BDNF signal pathway that related to the proteins associated with recognition memory in the hippocampal synapse plasticity and oxidative stress, which could be reversed by overexpression compensation of BMAL1 in the SCN that might rely on the multi-synaptic neural projections to the hippocampus.

The mediating role of the TyG index in the relationship between circadian syndrome and cancer among middle-aged and elderly Chinese

BACKGROUND

Circadian Syndrome (CircS) is a significant marker of metabolic imbalance and has been linked to various chronic diseases. However, its relationship with cancer risk remains underexplored. This research aims to explore the relationship between CircS and cancer, while also assessing the possible mediating role of the triglyceride glucose (TyG) index.

METHODS

Baseline data from the 2011 China Health and Retirement Longitudinal Study (CHARLS) and follow-up data from 2015 were analyzed, including participants' sociodemographic characteristics, health behaviors, and metabolic indicators. Linear regression, mediation analysis, and logistic regression were employed to explore relationships between CircS, cancer risk, and the TyG index, with a dose-response analysis conducted on TyG index and cancer risk.

RESULTS

Among 7,864 middle-aged and elderly participants, CircS was significantly and positively associated with cancer risk (r = 0.17, P < 0.001). The TyG index showed a significant correlation with both CircS (r = 0.52, P < 0.001) and cancer (r = 0.15, P < 0.001). Mediation modeling indicated that the TyG index partially mediated the association between CircS and cancer, accounting for 23% of this relationship. Additionally, a significant nonlinear dose-response relationship was observed between the TyG index and cancer risk (Pnonlinear = 0.0024).

CONCLUSION

Circadian syndrome is associated with increased cancer risk, with the TyG index partially mediating this relationship.

Association between outdoor artificial light at night and metabolic diseases in middle-aged to older adults-the CHARLS survey

Introduction

Artificial light at night (LAN) is associated with metabolic diseases, but its precise relationship is still not fully understood. This study explores the association between LAN and metabolic diseases.

Methods

A cross-sectional study involving 11,729 participants conducted in 2015 was selected from the China Health and Retirement Longitudinal Study. Diabetes, metabolic syndrome (MetS), overweight, obesity, dyslipidemia, and hyperuricemia (HUA) were defined according to established guidelines. Using satellite data, we estimated LAN exposure for 2015 and matched each participant's address with the corresponding annual mean LAN value. Multivariate logistic regression models were used to assess the relationship between LAN and metabolic diseases. To investigate possible non-linear associations and visualize the dose-response relationship between LAN and metabolic diseases, we used the restricted cubic splines (RCS) regression model.

Results

We found that higher levels of LAN significantly correlate with metabolic diseases. In the final adjusted model, participants in the highest LAN quartile group (Q4) showed the highest risk for metabolic diseases: diabetes [odds ratio (OR): 1.03, 95% confidence interval (CI): 1.01, 1.05], MetS (OR: 1.04, 95% CI: 1.02, 1.06), overweight (OR: 1.08, 95% CI: 1.06, 1.11), obesity (OR: 1.03, 95% CI: 1.01, 1.05), and dyslipidemia (OR: 1.03, 95% CI: 1.01, 1.05). In the RCS regression model, there was a non-linear association between LAN and risk of MetS, overweight, obesity, dyslipidemia, and HUA (for non-linear: p < 0.05).

Conclusion

LAN is associated with an increased risk of metabolic diseases. This highlights the urgent need to address LAN pollution in public health strategies; reducing LAN exposure may help mitigate the risk of metabolic diseases.

Linking Circadian Rhythms to Gut-Brain Axis Lipid Metabolism Associated With Endoplasmic Reticulum Stress in Alzheimer's Disease

BACKGROUND

Alzheimer's disease (AD) is characterized by a decline in cognitive, learning, and memory abilities. Neuroinflammation is associated with the spread of tau tangles in the neocortex of AD, leading to cognitive impairment. Therefore, clarifying the pathogenesis of Neuroinflammation and finding effective treatments are the crucial issues for the clinical management of AD.

METHOD

We systematically review the latest research on the pathogenesis and therapeutic strategies of AD in PubMed, Web of Science, and Elsevier SD.

RESULT

In this review, the mechanism of the effect of gut-brain axis lipid metabolism mediated by circadian rhythm on AD was discussed, and we also analysed the effects of inflammation and endoplasmic reticulum stress (ERS) induced by lipid abnormalities on intestinal mucosal barrier and neurodegeneration; furthermore, the importance of lipid homeostasis (phospholipids, fatty acids, sterol) in maintaining the functions of endoplasmic reticulum was emphasized. Meanwhile, as lipid composition affects protein conformation, the membrane phospholipids surrounding sarcoplasmic reticulum Ca2+-ATPase (SERCA) that influence SERCA to release Ca2+ mediating inflammation were also reviewed.

CONCLUSION

We interpreted the mechanism of action between lipid microdomains and ER membrane proteins, reviewed the role of the new pathway of circadian rhythm, lipid metabolism, intestinal mucosa, and brain signaling in the pathogenesis of AD, and proposed strategies to prevent AD by changing the dietary lipid measures.

Sleep interventions in elite sport - a systematic review

Background

Elite athletes encounter various situations and conditions that may disrupt their sleep, a crucial factor for optimal performance and well-being.

Objectives

The aim of this study was to synthesise existing research on the effect of sleep interventions on sleep quantity and quality in elite sports and to provide evidence-based guidance for athletes, coaches, and other stakeholders in elite sports who seek to enhance sleep quantity and quality.

Methods

This review followed the PRISMA guidelines, whereas the search was executed in September 2023 utilising the electronic databases SCOPUS, PubMed and Web of Science. Studies were included if they met the inclusion criteria.

Results

A total of 1014 studies were retrieved from the databases, and data extraction was performed on 32 studies. The included studies evaluated sleep hygiene education/strategies, acute cold exposure, light therapies, supplementation, neurostimulation/neurofeedback, and other (mindfulness and massage therapy) strategies. Sleep hygiene education was the most effective intervention to improve sleep quantity. Supplementation and light therapy interventions showed improved sleep quality and quantity. Additionally, cold water immersion and mindfulness showed improved sleep quality, but further studies are required for confirmation.

Conclusion

Future research should use reliable and valid methods to improve the quality of evidence and ensure conclusive findings.

Bright night sleeping environment induces diabetes and impaired glucose tolerance in non-human primates

Background

According to the IDF Diabetes Atlas regularly published by International Diabetes Federation, the prevalence of diabetes and impaired glucose tolerance (IGT), diabetes-related mortality and health expenditure are becoming serious eventually at the global, regional and national level. While the data alarm people, the exact cause remains unknown. It is widely accepted that glucose metabolism can be impaired by circadian rhythms disruption and sleep disturbances, both closely linked to exposure to light at night. However, there is little direct experiment on primates to study the precise extent of how serious bright sleeping environment at night impairs glucose metabolism, what the relationship is between nocturnal brightness and the development of diabetes and IGT, any difference between male and female, and whether aging and weight are involved. This study aims to address these questions in monkeys.

Methods

In a reduced daytime bright condition resembling human living rooms, 197 Cynomolgus (130 male, 67 female) were exposed to three distinct light intensities (13, 35, 75Lux) at night for consecutive ten months. Animals were retrospectively divided into four groups according to glucose metabolic status by the end of the experimental session, spontaneous diabetes mellitus (SDM, N=11), light-induced diabetes (LID, N=83), impaired fasting glucose tolerance (IFG, N=36), and normal glucose tolerance (NGT, N=67). Data pertaining to the glucose metabolism such as concentrations of fasting glucose, glycosylated hemoglobin, plasma insulin and C-peptide were collected monthly and analyzed.

Results

1) Bright night exasperated glucose metabolism in individuals with pre-existing diabetes, led to premature death; 2) Stronger white light intensity-dependently induced diabetes and IFG in previous healthy monkeys: the brighter the light, the quicker the metabolism disturbance and IFG developed, and also the higher morbidity of LID and IFG; 3) Exposure to nocturnal light had a synergistic impairing effect on glucose metabolism with aging and weight. 4) Female were more susceptible to night brightness.

Conclusions

Light in sleeping environment exacerbates glucose metabolism in individuals with pre-existing diabetes, leads to IFG and diabetes in healthy primates. Moreover, the harmful effects of bright night on glucose metabolism are synergistic with aging and weight.

Network analysis of the hair-based nine hormones from four neuroendocrine systems

INTRODUCTION

The stress response maintains the homeostasis of the body's internal environment and normal physiological activities, involving several neuroendocrine systems, such as the HPA axis, the HPG axis, the endocannabinoid system, and the melatonin system. However, studies on the intricate interactions among the four neuroendocrine systems are lacking, and it is not clear how these interactions are affected by demographic variables. The aim of this study was to investigate the network characteristics of hormonal networks comprising nine hormones from four neuroendocrine systems and how they were affected by demographic variables.

METHODS

252 healthy current students were recruited from Southeast University, China. The concentrations of nine hormones in their hair were measured by LC/MS methods, and hormonal network was constructed. Network analysis was used to characterize the interrelationships between hormones or neuroendocrine systems, central hormones, bridge hormones, hormonal network characteristics, and their changes in response to demographic variables.

RESULTS

Complex interactions between the HPA axis, the HPG axis, the ECS and the melatonin system formed a sparse and stable network, with cortisol and cortisone being the central hormones and melatonin as the bridge hormone. Demographic variables did not affect the overall characteristics of the network or the central hormone, but a number of specific connections in the network changed and the bridge hormones became cortisone and progesterone.

CONCLUSION

The interactions between the four stress-related neuroendocrine systems were relatively stable and were centered and initiated by the HPA axis. Demographic variables did not affect the overall structure of the network, but influenced local features of the network, such as edge weights and bridge centrality.

Bibliometric analysis of global research status and trends of circadian rhythms in cancer from 2004 to 2024

Research linking circadian dysregulation to cancer development has received increasing attention recently. However, a comprehensive understanding of research hotspots and trends in this area remains limited. International studies on the circadian rhythms in cancer were retrieved and downloaded from the Web of Science database. Bibliometric analysis and visualization were performed using VOSviewer, CiteSpace, and HistCite. Three thousand three hundred and eighteen English articles from 2004 to 2024 were screened and evaluated. The increase in publications and citations reflected the rapid expansion of the field. Scholars and institutions in the United States have relatively high academic productivity and impact. Chronobiology International is the most popular journal. Key clustering analysis identified six themes: biochemistry and molecular biology, physiology and immunomodulation, night shift work and health effects, physiological and mental health, tumor therapy research, and oxidative stress and cancer-related mechanisms. Keyword burst analysis identified the regulation of circadian rhythms on cells and tumor microenvironment as the research frontiers. The role of circadian rhythms in tumor immunotherapy was a current research hotspot identified by reference co-citation clustering analysis. This study reveals the current status of research on the circadian rhythms in cancer and predicts future trends. These findings provide new ideas for developing novel cancer prevention and treatment strategies.

Genetic and epigenetic alterations in night shift nurses with breast cancer: a narrative review

This narrative review explores the link between breast cancer and night shift work in nurses, focusing on genetic and epigenetic factors. Breast cancer disproportionately affects women globally, and night shift work is increasingly recognized as a potential risk factor. Nurses who work consecutive overnight shifts face elevated risks due to disruptions in their circadian rhythms. Studies suggest that working six or more successive night shifts, particularly over five years or more, may increase breast cancer risk. This review hypothesizes that disruptions in the sleep-wake cycle, such as changes in melatonin production and telomere length, could contribute to breast cancer susceptibility. Currently, there is limited genetic evidence to support this hypothesis. However, it is plausible that genetic and epigenetic alterations, including changes in genes like ER and HER2, may heighten the risk for night shift nurses. These alterations may involve variations in telomere length, DNA methylation, and disruptions in critical breast cancer-related genes. We highlight various genetic and epigenetic changes that may influence this increased susceptibility. Further research is needed to explore the underlying mechanisms and contributing factors in this association.

Associations of lamplight exposure during sleep and sleep duration with attention-deficit/hyperactivity disorder among preschool children in China

INTRODUCTION

This study aimed to examine the associations of exposure to light while sleeping at night and different sleep durations with attention-deficit/hyperactivity disorder (ADHD) among preschool children in China.

METHODS

A cross-sectional study including 4197 preschool children (2190 boys and 2007 girls) was conducted in 2021. Lamplight exposure during sleep and sleep duration were collected via a validated questionnaire. ADHD was assessed using the Conners Parental Symptom Questionnaire (PSQ). Associations of exposure to light while sleeping and sleep duration with ADHD were examined by multivariable logistic regression models.

RESULTS

The overall prevalence of ADHD was 3.7%. Compared to the children who slept with the lamplight off at night, those who slept with the lamplight on ≥3 nights/week were more likely to have ADHD after multivariable adjustment (OR=3.37; 95% CI: 1.95, 5.82; P-trend <0.001). The risk associations of lamplight exposure during sleep with ADHD were similar in subgroups stratified by sex, picky eating, gestational hyperglycemia, and gestational anemia. Moreover, compared to the children with sleep duration of 10-12 hours/day, adjusted OR for ADHD was 1.64 (95% CI: 1.14, 2.35) for those with sleep duration <10 hours/day and 2.69 (95% CI: 1.12, 6.44) for those who slept>12 hours/day.

DISCUSSION

Lamplight exposure during sleep at night was positively associated with ADHD among preschool children. Also, both sleep duration of <10 hours/day and >12 hours/day increased the likelihood of ADHD. Our novel findings suggest the importance of sleeping habit on the prevention of ADHD. Prospective and interventional studies are warranted to elucidate the observed associations.

Chronic artificial light exposure in daytime and reversed light: Dark cycle inhibit anti-apoptotic cytokines and defect Bcl-2 in peripheral lymphoid tissues during acute systemic inflammatory response to lipopolysaccharide

AIMS

The disturbed light: dark (LD) cycle has been associated with critical complications, including obesity, diabetes and cancer. In the present study, we investigated the chronic effects of artificial light at daytime (AL) and light at night (RAL) after intraperitoneal (i.p.) injection of saline and 0.5 mg/kg lipopolysaccharide (LPS) in male Wistar rats.

METHODS

Liver and kidney parameters, fasting blood glucose (FBG), melatonin level, immunohistochemical examinations of B-cell lymphoma-2 (Bcl-2) in spleen and mesenteric lymph and serum antiapoptotic cytokines [interleukin (IL-) 2, 7 and 1].

KEY FINDINGS

After 16 weeks of a daily disturbed LD cycle, RAL increased body weight, upgraded FBG and altered liver and kidney functions with surprisingly increased daytime plasma melatonin. AL + LPS and RAL + LPS rats suffered significantly higher oxidative-nitrosative stress compared to NL + LPS. Oxidative-nitrosative stress was associated with multi-organ inflammation in hepatic, renal, pancreatic, splenic and mesenteric lymph node tissues due to LPS-induced endotoxemia. Anti-apoptotic Bcl-2 activity in peripheral lymphoid organs (spleen and mesenteric lymph node) was lowered due to AL and RAL regimens. At the same pattern, lowering of antiapoptotic serum levels of IL-2, IL-7 and IL-15 indicate alteration of cell cycle and the shifted ability of cells to undergo apoptosis due to abnormal light pollution.

SIGNIFICANCE

Here, the increased lymphocyte apoptosis in lymphoid tissues due to disturbed LD cycle defects the host defense, dysregulates the inflammatory immune response and dysregulates the immune tolerance during acute systemic inflammation due to LPS.

Effects of light on biological functions and human sleep

The nonvisual effects of light in humans are mainly conveyed by a subset of retinal ganglion cells that contain the pigment melanopsin which renders them intrinsically photosensitive (= intrinsically photosensitive retinal ganglion cells, ipRGCs). They have direct connections to the main circadian clock in the suprachiasmatic nuclei (SCN) of the hypothalamus and modulate a variety of physiological processes, pineal melatonin secretion, autonomic functions, cognitive processes such as attention, and behavior, including sleep and wakefulness. This is because efferent projections from the SCN reach other hypothalamic nuclei, the pineal gland, thalamus, basal forebrain, and the brainstem. The ipRGCs also directly impact the prefrontal cortex and the perihabenular nucleus (mood). In particular, light suppresses the secretion of melatonin in a dose-dependent manner, mainly depending on irradiance and spectral composition of light. There is evidence that exposure to light-emitting devices from luminaires and screens before bedtime can impact on sleep onset latency, sleep duration, and sleep quality. Likewise, light exposure during daytime modulates sleep architecture, duration, and sleep quality during the subsequent night. Therefore, the integration of acute, circadian, and long-term effects of light together influence sleep-wake quality and behavior in healthy individuals, as well as in patients with psychiatric or medical disorders.

American Academy of Nursing Policy Recommendations to Reduce and Prevent Negative Health Outcomes and Health Care Costs Among Night Shift Nurses: An AAN Consensus Paper

A growing body of evidence demonstrates occupational night shift hazards. Decades of research point to health risks for nurses contributing to chronic diseases, including diabetes, cardiovascular disease, cognitive/mental health, and cancers-all associated with earlier mortality. Patient safety, recruitment and retention of quality nursing workforce, and related costs are important concerns associated with night shift work. Post COVID-19, nurses have advocated and lobbied for many changes in their work environments, yet little emphasis has been placed on addressing night shift health and patient safety hazards, and concomitant personal, insurer, organizational, and federal costs. Nurses are also recipients of health care, and their work-related risks must be prioritized. Innovative solutions targeting individuals, work environments, novel schedules, virtual nursing, and artificial intelligence have been examined and must continue to be studied and implemented. Policy and legislation must be among the strategies for nurses, no different than other night shift workers (e.g., flight crews).

Evaluating circadian light hygiene: Methodology and health implications

Background — A growing body of research demonstrates that a substantial daily range of light exposure, characterized by ample daylight followed by darkness during sleep, is essential for human well-being. This encompasses crucial aspects like sleep quality, mood regulation, and cardiovascular and metabolic health. Objective — This study characterizes Circadian Light Hygiene (CLH) as an essential factor in maintaining health, well-being, and longevity in modern society. CLH involves adjusting the 24-hour light exposure dynamic range to support the natural sleep-wake cycle and circadian rhythms. Three major challenges to CLH negatively impacting human health are: 1) light pollution (light at night, or LAN), characterized by excessive evening and nighttime artificial light; 2) insufficient natural daylight; and 3) irregular light exposure patterns. These interacting challenges necessitate a systematic approach to measurement and analysis. Material and Methods — A systematic review of peer-reviewed literature published through October 30, 2024, examined the methodologies and health effects of circadian and seasonal aspects of light exposure. Conclusion — This review elucidates fundamental principles of circadian light hygiene, synthesizing existing literature and our research to assess the benefits of adequate daylight, the risks of light at night, and adverse outcomes stemming from diminished light exposure range, mistimed light exposure, and irregular patterns. Novel indices for quantifying and optimizing circadian light hygiene are introduced.

Association between night shift work and the risk of type 2 diabetes mellitus: a cohort-based meta-analysis

BACKGROUND

The impact of night shift work on the incidence of type 2 diabetes mellitus (T2DM) is not well understood. This meta-analysis assesses the association between night shift work and the risk of developing T2DM and explores this relationship across various subgroups.

METHODS

We systematically searched PubMed, Web of Science, EBSCO, and the Cochrane Library from their inception until February 2024. We employed hazard ratios (HR) and 95% confidence intervals (95%CI) to quantify the association between night shift work and T2DM risk.

RESULTS

Our analysis synthesized data from 9 articles encompassing 10 cohort studies. Overall, night shift workers exhibited a 30% increased incidence of T2DM compared to their daytime counterparts (HR = 1.30, 95% CI: [1.18, 1.43], P < 0.001). Among females, night shift workers had a higher incidence of T2DM (HR = 1.28, 95% CI: [1.16, 1.41]); however, in males, the association was not statistically significant (95% CI: [0.89, 2.63]). For individuals with a body mass index (BMI) > 30 kg/m2, night shift work was associated with an increased T2DM risk (HR = 1.14, P = 0.007), whereas there was no significant association for those with a BMI ≤ 30 kg/m2 (P = 0.255). Further, the risk of T2DM increased with longer durations of night shift work; workers with more than 10 years of night shift work faced a higher T2DM risk than those with 10 years or fewer (HR for > 10 years = 1.17, 95% CI: [1.10, 1.24]; HR for ≤ 10 years = 1.06, 95% CI: [1.03, 1.10]).

CONCLUSION

Findings suggest potential link between night shift work and T2DM risk. Longer durations of night shift work may increase the risk of T2DM. There may be gender differences (greater harm in women, but the male sample size is small) and obesity differences.

Nocturnal Light Pollution Synergistically Impairs Glucose Metabolism With Age and Weight in Monkeys

Over the past decades, the global prevalence of Type 2 diabetes mellitus (T2D) and impaired glucose tolerance (IGT) has been increasing at an epidemic rate, yet the exact cause remains unknown. It is widely accepted that glucose metabolism can be impaired by circadian rhythms and sleep disturbances. Concurrently, exposures to light at night have been closely linked to circadian and sleep disturbances. However, there is no direct experiment on primates to demonstrate the precise extent of how serious light pollution impairs glucose metabolism, whether people will eventually become accustomed to this environment, and whether the pollution has synergistic impairing effects with aging and weight on glucose metabolism. To quantitatively address these questions, 137 cynomolgus were exposed to three distinct nocturnal light intensities for consecutive 10 months. Monthly glucose metabolism assessments were conducted. Data pertaining to the mortality rate of preexisting diabetes, incidence of light-induced diabetes and IGT, and alterations in insulin secretion were collected and analyzed. The results show that nocturnal light (1) caused premature deaths in individuals with preexisting diabetes; (2) intensity-dependently induced diabetes and IGT in previous healthy monkeys; (3) intensity-dependently reduced melatonin secretion; (4) had a synergistic impairing effect on glucose metabolism with aging and weight; and (5) although monkeys would eventually adapt to the environment, the disrupted glucose metabolism would not fully recover in most individuals. In conclusion, nocturnal light is associated with the global high prevalence of T2D and IGT. The harmful effects of light pollution on glucose metabolism are synergistic with age and weight.

Outdoor light at night is a modifiable environmental factor for metabolic syndrome: The 33 Communities Chinese Health Study (33CCHS)

Metabolic syndrome (MetS) is a significant public health problem and presents an escalating clinical challenge globally. To combat this problem effectively, urgent measures including identify some modifiable environmental factors are necessary. Outdoor artificial light at night (LAN) exposure garnered much attention due to its impact on circadian rhythms and metabolic process. However, epidemiological evidence on the association between outdoor LAN exposure and MetS remains limited. To determine the relationship between outdoor LAN exposure and MetS, 15,477 adults participated the 33 Communities Chinese Health Study (33CCHS) in 2009 were evaluated. Annual levels of outdoor LAN exposure at participants' residential addresses were assessed using satellite data from the Defense Meteorological Satellite Program (DMSP) Operational Linescan System (OLS). Generalized linear mixed effect models were utilized to assess the association of LAN exposure with MetS and its components, including elevated waist circumference (WC), triglycerides (TG), blood pressure (BP), fasting blood glucose (FBG), and reduced high-density lipoprotein cholesterol (HDL-C). Effect modification by various social demographic and behavior factors was also examined. Overall, 4701 (30.37 %) participants were defined as MetS. The LAN exposure ranged from 6.03 to 175.00 nW/cm2/sr. The adjusted odds ratio (OR) of MetS each quartile increment of LAN exposure were 1.43 (95 % CI: 1.21-1.69), 1.44 (95 % CI: 1.19-1.74) and 1.52 (95 % CI: 1.11-2.08), respectively from Q2-Q4. Similar adverse associations were also found for the components of MetS, especially for elevated BP, TG and FBG. Interaction analyses indicated that the above associations were stronger in participants without habitual exercise compared with those with habitual exercise (e.g. OR were 1.52 [95 % CI: 1.28-1.82] vs. 1.27 [95 % CI, 1.04-1.55], P-interaction = 0.042 for MetS). These findings suggest that long-term exposure to LAN can have a significant deleterious effect on MetS, potentially making LAN an important modifiable environmental factor to target in future preventive strategies.

Exploring the relationships between chronotypes, attachment styles, and mental health in flight attendants

Circadian rhythm-related individual differences such as chronotypes (morningness/eveningness) are associated with mental health though not elucidated in circadian-disrupted populations such as flight attendants. International flight attendants (n = 288) aged 21 to 55 (70.8% female, 76.4% white) completed an online survey assessing chronotypes, attachment, depression, and anxiety to investigate the associations between these variables. Results showed a prevalence of intermediate (41.6%) and evening types (40.6%). Evening chronotype was associated with and significantly predicted depression but not anxiety. Individuals who scored higher in attachment anxiety or avoidance had higher levels of depression and anxiety. Exploratory mediation showed that attachment avoidance partially mediated the relationship between anxiety and depression. Overall, chronotypes and attachment are implied as transdiagnostic factors for mental health outcomes and highlighted using a Chrono-Attachment Health Model. Further research is needed to confirm these findings among flight attendants and shift workers.

Short-term exposure to indoor artificial light at night during sleep impairs cardiac autonomic function of young healthy adults in China

The artificial light at night (ALAN) exposure has emerged as a significant environmental and public health concern globally. However, there is far less evidence on the health effects of indoor ALAN than on outdoor ALAN. Moreover, evidence on cardiovascular effects of indoor ALAN is more limited. To evaluate the association between short-term exposure to ALAN during sleep with heart rate variability (HRV) in young healthy adults, as well as the mediating role of blood oxygen saturation (SpO2), and to further explore the intervention effects of shading habits, this prospective repeated measurement study was conducted among 81 adults with 150 nights (1324h) of HRV monitoring. HRV and SpO2 were monitored during sleep, concurrently with the measurement of indoor and outdoor ALAN. Shading habits were defined as whether to wear blindfolds or draw bed curtains during sleep, and were collected by questionnaires. Linear mixed-effect model was conducted to assess the association between ALAN exposure and HRV indices. The role of SpO2 in the association was analyzed using mediation analyses. We found that indoor ALAN exposure reduced parasympathetic activity and imbalanced cardiac autonomic function. We also found that the use of outdoor ALAN may underestimate or misestimate the potential health effects of ALAN. A significant mediation effects were observed on standard deviation of normal-to-normal intervals (SDNN; p-value for ACME = 0.014) and the ratio of low frequency power to high frequency power (LF/HF; p-value for ACME = 0.026) through minimum SpO2 after indoor ALAN exposure. The association between indoor ALAN and HRV was more pronounced among participants without shading habits during sleep. This study provides general population-based evidence that short-term exposure to indoor ALAN was significantly associated with impaired HRV, and SpO2 partially mediated the association. Improve shading habits during sleep may mitigate the adverse effects of indoor ALAN.

Enhancing Deep Sleep Induction Through a Wireless In-Ear EEG Device Delivering Binaural Beats and ASMR: A Proof-of-Concept Study

This study presents the development of a wireless in-ear EEG device designed to monitor brain activity during sleep and deliver auditory stimuli aimed at enhancing deep sleep. The device records EEG signals and plays a combined auditory stimulus consisting of autonomous sensory meridian response (ASMR) and 3 Hz binaural beats at a 60:30 dB ratio, intended to promote delta wave activity and non-rapid eye movement (NREM) stage 3 sleep. Fifteen participants completed this study, which included two consecutive nights: a baseline night and a testing night. Participants were divided into an experimental group, which received the combined ASMR and binaural beat stimulus, and a control group, which received only ASMR. The combined stimulus was delivered upon entering NREM stage 2 and replaced by ASMR when NREM stage 3 was reached. Results showed that the experimental group experienced an increase in NREM 3 sleep, a decrease in NREM 2 sleep, and a slight increase in NREM 3 latency compared to the baseline night. Although the findings are promising, further testing with a larger sample size is required to confirm the device's potential to enhance sleep quality and promote delta activity in the brain.

Effects of exposure to outdoor light at night on blood lipids in China: a nationwide cross-sectional study

Previous studies have reported that a potential association between exposure to outdoor light at night (LAN) and diseases. However, there is no evidence regarding the impacts of outdoor LAN exposure on lipid metabolism in humans. This study aims to evaluate the associations between outdoor LAN exposure and the prevalence of dyslipidemia, using a nationwide sample of 10,894 adults aged ≥ 45 years from 150 investigated sites across China in 2011-2012. Outdoor LAN exposure was assessed by using satellite imaging data. The prevalence ratio (PR) was calculated. The present study found that a per-quintile LAN exposure was positively associated with the prevalence of high LDL-cholesterol (PR = 1.10, 95% CI = 1.04-1.16), high triglyceride (PR = 1.07, 95% CI = 1.03-1.12), low HDL-cholesterol (PR = 1.11, 95% CI = 1.08-1.16), and dyslipidemia (PR = 1.06, 95% CI = 1.03-1.09). The fifth quintile of LAN exposure was associated with a significantly increased prevalence of dyslipidemia (PR = 1.20, 95% CI = 1.07-1.35) compared with the first quintile of exposure. Long-term exposure to outdoor LAN was positively associated with dyslipidemia prevalence. Public policies aimed at reducing light pollution at night, guided by the spatial distribution patterns, could lessen the adverse effects.

Chronobiological disruptions: unravelling the interplay of shift work, circadian rhythms, and vascular health in the context of stroke risk

Shift work, particularly night shifts, disrupts circadian rhythms and increases stroke risk. This manuscript explores the mechanisms connecting shift work with stroke, focusing on circadian rhythms, hypertension, and diabetes. The circadian system, controlled by different mechanisms including central and peripheral clock genes, suprachiasmatic nuclei (SCN), and pineal gland (through melatonin production), regulates body functions and responds to environmental signals. Disruptions in this system affect endothelial cells, leading to blood pressure issues. Type 2 diabetes mellitus (T2DM) is significantly associated with night shifts, with circadian disturbances affecting glucose metabolism, insulin sensitivity, and hormone regulation. The manuscript examines the relationship between melatonin, insulin, and glucose balance, highlighting pathways that link T2DM to stroke risk. Additionally, dyslipidemia, particularly reduced HDL-c levels, results from shift work and contributes to stroke development. High lipid levels cause oxidative stress, inflammation, and endothelial dysfunction, increasing cerebrovascular risks. The manuscript details the effects of dyslipidemia on brain functions, including disruptions in blood flow, blood-brain barrier integrity, and neural cell death. This comprehensive analysis emphasizes the complex interplay of circadian disruption, hypertension, diabetes, and dyslipidemia in increasing stroke risk among shift workers. Understanding these mechanisms is essential for developing targeted interventions to reduce stroke susceptibility and improve cerebrovascular health in this vulnerable population.

Effect of daily light exposure on sleep in polar regions: A meta-analysis

Although studies have shown that light affects sleep in polar populations, the sample size of most studies is small. This meta-analysis provides the first systematic review of the effects of summer glare, spring and fall moderate daylight, and artificial lighting on general sleep problems (sleep duration, efficiency, and delay). This analysis included 18 studies involving 986 participants. We calculated the random effect size via an evidence-based meta-analysis that analysed the effect of bright/auxiliary light on sleep and the effect of three different types of light on sleep compared with conventional light. There was no significant correlation between specific light types and sleep duration. Intense summer light has a negative effect on sleep time and efficiency. Moderate, natural light in spring and autumn effectively delayed sleep but could not improve sleep efficiency. For artificial fill light, neither blue light nor enhanced white light has been found to have a significant effect. In summary, summer light has a detrimental effect on sleep in polar populations, and moderate natural light may be superior to conventional light. However, specific strategies to improve sleep and artificial lighting in polar populations must be explored further.

Interactive correlations between artificial light at night, health risk behaviors, and cardiovascular health among patients with diabetes: A cross-sectional study

BACKGROUND

Artificial light at night (ALAN) is a common phenomenon and contributes to the severe light pollution suffered by more than 80% of the world's population. This study aimed to evaluate the relationship between outdoor ALAN exposure and cardiovascular health (CVH) in patients with diabetes and the influence of various modifiable factors.

METHODS

A survey method based on the China Diabetes and Risk Factor Monitoring System was adopted. Study data were extracted for 1765 individuals with diabetes in Anhui Province. Outdoor ALAN exposure (nW/cm2/sr) within 1000 m of each participant's residential address was obtained from satellite imagery data, with a resolution of ~1000 m. Health risk behaviors (HRBs) were measured via a standardized questionnaire. A linear regression model was employed to estimate the relationship between outdoor ALAN, HRBs, and CVH.

RESULTS

Participants' mean age was 59.10 ± 10.0 years. An association was observed between ALAN and CVH in patients with diabetes (β = 0.205) and exercise (β = -1.557), moderated by HRBs, or metabolic metrics. There was an association between ALAN, ALAN, vegetable intake, and CVH.

CONCLUSIONS

Exploring the relationship between ALAN exposure and cardiovascular and metabolic health provides policy data for improving light pollution strategies and reducing the risk of cardiovascular and metabolic disease in patients with diabetes.

Dim light at night unmasks sex-specific differences in circadian and autonomic regulation of cardiovascular physiology

Shift work and artificial light at night disrupt the entrainment of endogenous circadian rhythms in physiology and behavior to the day-night cycle. We hypothesized that exposure to dim light at night (dLAN) disrupts feeding rhythms, leading to sex-specific changes in autonomic signaling and day-night heart rate and blood pressure rhythms. Compared to mice housed in 12-hour light/12-hour dark cycles, mice exposed to dLAN showed reduced amplitudes in day-night feeding, heart rate, and blood pressure rhythms. In female mice, dLAN reduced the amplitude of day-night cardiovascular rhythms by decreasing the relative sympathetic regulation at night, while in male mice, it did so by increasing the relative sympathetic regulation during the daytime. Time-restricted feeding to the dim light cycle reversed these autonomic changes in both sexes. We conclude that dLAN induces sex-specific changes in autonomic regulation of heart rate and blood pressure, and time-restricted feeding may represent a chronotherapeutic strategy to mitigate the cardiovascular impact of light at night.

Association of outdoor artificial light at night with myopia among Chinese adolescents: a representative cross-sectional study

Background

The association between the rapid increase in myopia among adolescents and the amount of outdoor artificial light at night (ALAN) remains unclear. The aim of this study was to investigate the association between outdoor ALAN and myopia in adolescents.

Methods

Stratified cluster random sampling was used to obtain a sample of 33,160 students (age range: 9-18 years; mean: 13.51 years) with complete data from 120 primary and secondary schools across the Ningxia region in China in 2021. Myopia was defined as a spherical equivalent (SE) ≤-0.5 diopters (D) in at least one eye, determined by automated refractometers without cycloplegia. Outdoor ALAN data were obtained from satellite data and the two-year average outdoor ALAN exposure for each participant was determined by matching it to their school address (home addresses were not available). The association between ALAN and myopia was assessed using multiple logistic regression models and restricted cubic spline (RCS) regression. Stratified analyses were performed by age, sex, residence, school level, and outdoor exercise time.

Results

The myopia group had higher outdoor ALAN levels than the non-myopia group [median (interquartile spacing): 14.44 (3.88-26.56) vs. 6.95 (1.21-21.74) nanoWatts/cm2/sr]. After adjusting for covariates identified through stepwise regression, it was observed that the prevalence of myopia increased by 4% for every 10-unit change [95% confidence interval (CI): 1.02-1.07]. Compared to the first quantile (Q1) of outdoor ALAN exposure, the odds ratio (OR) of myopia was 1.20 (95% CI: 1.08-1.34) in the fourth quantile. RCS further showed a positive nonlinear relationship between outdoor ALAN exposure and myopia (p for nonlinear <0.001). Stronger effects were not found in subgroup analyses.

Conclusion

Outdoor ALAN exposure is positively and nonlinearly associated with the prevalence of myopia in adolescents. Controlling outdoor light pollution may constitute a potential strategy to reduce the incidence of myopia in adolescents.

Association between outdoor light at night exposure and executive function in Chinese children

BACKGROUND

Recent evidences highlight the potential impact of outdoor Light at Night (LAN) on executive function. However, few studies have investigated the association between outdoor LAN exposure and executive function.

METHODS

We employed data from 48,502 Chinese children aged 5-12 years in a cross-sectional study conducted in Guangdong province during 2020-2021, to examine the association between outdoor LAN and executive function assessed using the validated parent-completed Behavior Rating Inventory of Executive Function. We assessed children's outdoor LAN exposure using the night-time satellite images based on the residential addresses. We used generalized linear mixed models to estimate the association between outdoor LAN exposure and executive function scores and executive dysfunction.

RESULTS

After adjusting for potential covariates, higher quintiles of outdoor LAN exposure were associated with poorer executive function. Compared to the lowest quintile (Q1), all higher quintiles of exposure showed a significant increased global executive composite (GEC) score with β (95% confidence intervals, CI) of 0.58 (0.28, 0.88) in Q2, 0.59 (0.28, 0.9) in Q3, 0.85 (0.54, 1.16) in Q4, and 0.76 (0.43, 1.09) in Q5. Higher quintiles of exposure were also associated with higher risks for GEC dysfunction with odd ratios (ORs) (95% CI) of 1.34 (1.18, 1.52) in Q2, 1.40 (1.24, 1.59) in Q3, 1.40 (1.23, 1.59) in Q4, and 1.39 (1.22, 1.58) in Q5. And stronger associations were observed in children aged 10-12 years.

CONCLUSIONS

Our study suggested that high outdoor LAN exposure was associated with poor executive function in children. These findings suggested that future studies should determine whether interventions to reduce outdoor LAN exposure can have a positive effect on executive function.

Impact of sleep disturbance in shift workers on hippocampal volume and psychomotor speed

STUDY OBJECTIVES

Shift work interferes with circadian rhythms, affecting sleep quality and cognitive function. Poor sleep quality in shift worker (SW)s can impair psychomotor performance due to fatigue and sleepiness, increasing the risk of errors, accidents, and reduced productivity. Given the potential for atrophic changes in the hippocampus due to sleep disturbances, our study investigates how poor sleep quality correlates with hippocampal structural alterations and impacts psychomotor performance among SWs.

METHODS

We recruited 100 SWs, classifying them based on sleep quality into two groups: good sleep-SW group (n = 59) and poor sleep-SW group (n = 41). Sleep quality was assessed using both 7-day actigraphy for sleep efficiency and the Pittsburgh Sleep Quality Index. A control group of 106 non-SWs without sleep problems (non-SW group) was also included for comparison. The outcome measures were psychomotor speed and hippocampal volumes, both total and by subfield.

RESULTS

The poor sleep-SW group showed significantly smaller hippocampal volumes than both the good sleep-SW group (p < .001) and the non-SW group (p = .003). Longer shift work years correlated with greater reductions in hippocampal volume in this group (r = -0.42, p = .009), unlike in the good sleep-SW group (r = 0.08, p = .541). Furthermore, they demonstrated declines in psychomotor speed relative to the non-SW group (p = .006), which correlated with smaller hippocampal volumes (r = 0.37, p = .020).

CONCLUSIONS

SWs with poor sleep quality exhibit significant hippocampal volume reductions and psychomotor speed decline, underscoring the importance of early intervention and support for sleep issues in this population.

Artificial Light at Night and Type 2 Diabetes Mellitus

The widespread and pervasive use of artificial light at night (ALAN) in our modern 24-hour society has emerged as a substantial disruptor of natural circadian rhythms, potentially leading to a rise in unhealthy lifestyle-related behaviors (e.g., poor sleep; shift work). This phenomenon has been associated with an increased risk of type 2 diabetes mellitus (T2DM), which is a pressing global public health concern. However, to date, reviews summarizing associations between ALAN and T2DM have primarily focused on the limited characteristics of exposure (e.g., intensity) to ALAN. This literature review extends beyond prior reviews by consolidating recent studies from 2000 to 2024 regarding associations between both indoor and outdoor ALAN exposure and the incidence or prevalence of T2DM. We also described potential biological mechanisms through which ALAN modulates glucose metabolism. Furthermore, we outlined knowledge gaps and investigated how various ALAN characteristics beyond only light intensity (including light type, timing, duration, wavelength, and individual sensitivity) influence T2DM risk. Recognizing the detrimental impact of ALAN on sleep health and the behavioral correlates of physical activity and dietary patterns, we additionally summarized studies investigating the potential mediating role of each component in the relationship between ALAN and glucose metabolism. Lastly, we proposed implications of chronotherapies and chrononutrition for diabetes management in the context of ALAN exposure.

Redox and metabolic reprogramming in breast cancer and cancer-associated adipose tissue

Redox and metabolic processes are tightly coupled in both physiological and pathological conditions. In cancer, their integration occurs at multiple levels and is characterized by synchronized reprogramming both in the tumor tissue and its specific but heterogeneous microenvironment. In breast cancer, the principal microenvironment is the cancer-associated adipose tissue (CAAT). Understanding how the redox-metabolic reprogramming becomes coordinated in human breast cancer is imperative both for cancer prevention and for the establishment of new therapeutic approaches. This review aims to provide an overview of the current knowledge of the redox profiles and regulation of intermediary metabolism in breast cancer while considering the tumor and CAAT of breast cancer as a unique Warburg's pseudo-organ. As cancer is now recognized as a systemic metabolic disease, we have paid particular attention to the cell-specific redox-metabolic reprogramming and the roles of estrogen receptors and circadian rhythms, as well as their crosstalk in the development, growth, progression, and prognosis of breast cancer.

Smartphone addiction habit is positively associated with coronary artery disease and its severity in Chinese adults: a case-control study

Background

Coronary artery disease (CAD) has a high incidence and poor prognosis worldwide. It has been confirmed that smartphone addiction (SA) habit can increase the incidence of hypertension and obesity in adolescents. However, the association of SA with CAD and its severity in Chinese adults remains largely unknown.

Methods

A total of 700 Chinese adults (aged 18-70 years) including 350 CAD patients and 350 control subjects were enrolled. The Smartphone Addiction Scale Short Version (SAS-SV) was used to measure SA habit, and the Pittsburgh sleep quality index (PSQI) was used to assess sleep quality. Multiple logistic regression was employed to analyze the relationship between SA habit and CAD.

Results

After adjusting for age, smoking, hypertension, type 2 diabetes mellitus, and other risk factors, there was a significant association between SA habit and CAD in adults (p < 0.001). Subgroup analysis showed that there were statistical differences in the correlation between SA habit and CAD in the hypertension, ≤55 years age old, and female subgroups. Moreover, we performed a subgroup analysis based on the number of coronary artery lesions. The result showed that the rate of SA habit in the three-vessel disease group was the highest (p < 0.001). We applied Gensini score to evaluate the severity of coronary artery lesions (median Gensini score, 34) and divided all CAD patients into high Gensini score group (>34) and low Gensini score group (≤34), respectively. Compared with low Gensini score group, patients in high Gensini score group were more likely to have SA habit (p = 0.049).

Conclusions

There is a positive association of SA habit with CAD and its severity in Chinese adults.

Insights into the Effect of Light Pollution on Mental Health: Focus on Affective Disorders-A Narrative Review

The presence of artificial light at night has emerged as an anthropogenic stressor in recent years. Various sources of light pollution have been shown to affect circadian physiology with serious consequences for metabolic pathways, possibly disrupting pineal melatonin production with multiple adverse health effects. The suppression of melatonin at night may also affect human mental health and contribute to the development or exacerbation of psychiatric disorders in vulnerable individuals. Due to the high burden of circadian disruption in affective disorders, it has been hypothesized that light pollution impacts mental health, mainly affecting mood regulation. Hence, the aim of this review was to critically summarize the evidence on the effects of light pollution on mood symptoms, with a particular focus on the role of circadian rhythms in mediating this relationship. We conducted a narrative review of the literature in the PubMed, Scopus, and Web of Science datasets. After the screening process, eighteen papers were eligible for inclusion. The results clearly indicate a link between light pollution and the development of affective symptoms, with a central role of sleep disturbances in the emergence of mood alterations. Risk perception also represents a crucial topic, possibly modulating the development of affective symptoms in response to light pollution. The results of this review should encourage a multidisciplinary approach to the design of healthier environments, including lighting conditions among the key determinants of human mental health.

Dynamic endocannabinoid-mediated neuromodulation of retinal circadian circuitry

Circadian rhythms are biological rhythms that originate from the "master circadian clock," called the suprachiasmatic nucleus (SCN). SCN orchestrates the circadian rhythms using light as a chief zeitgeber, enabling humans to synchronize their daily physio-behavioral activities with the Earth's light-dark cycle. However, chronic/ irregular photic disturbances from the retina via the retinohypothalamic tract (RHT) can disrupt the amplitude and the expression of clock genes, such as the period circadian clock 2, causing circadian rhythm disruption (CRd) and associated neuropathologies. The present review discusses neuromodulation across the RHT originating from retinal photic inputs and modulation offered by endocannabinoids as a function of mitigation of the CRd and associated neuro-dysfunction. Literature indicates that cannabinoid agonists alleviate the SCN's ability to get entrained to light by modulating the activity of its chief neurotransmitter, i.e., γ-aminobutyric acid, thus preventing light-induced disruption of activity rhythms in laboratory animals. In the retina, endocannabinoid signaling modulates the overall gain of the retinal ganglion cells by regulating the membrane currents (Ca2+, K+, and Cl- channels) and glutamatergic neurotransmission of photoreceptors and bipolar cells. Additionally, endocannabinoids signalling also regulate the high-voltage-activated Ca2+ channels to mitigate the retinal ganglion cells and intrinsically photosensitive retinal ganglion cells-mediated glutamate release in the SCN, thus regulating the RHT-mediated light stimulation of SCN neurons to prevent excitotoxicity. As per the literature, cannabinoid receptors 1 and 2 are becoming newer targets in drug discovery paradigms, and the involvement of endocannabinoids in light-induced CRd through the RHT may possibly mitigate severe neuropathologies.

Effect of Ambient Lighting on Intraocular Pressure Rhythms in Rats

Purpose

The purpose of this study was to determine the effects of ambient lighting on intraocular pressure (IOP) rhythmicity and variability.

Methods

IOP was continuously recorded by wireless telemetry from rats under light/dark (LD), dark/light (DL), asymmetric (6L18D and 18D6L), constant dark (DD), and constant light (LL) cycles. In some DD experiments, 1-hour light pulses were presented at varying times. IOP rhythmicity and variability were respectively quantified via cosinor analysis and peak detection algorithms that identified transient and sustained fluctuations.

Results

Rat IOP peaked at night and troughed during the day with LD amplitude of 8.7 ± 3.4 mm Hg. Rhythmicity persisted in DD and LL with a free-running period of 24.1 ± 0.3 and 25.2 ± 0.4 hours, respectively. Peak-to-trough amplitude was approximately 60% smaller in LL, often disappeared after 1 to 2 weeks as daytime IOP drifted 2.6 ± 1.5 mm Hg higher, and returned to approximately 60% larger in LD. Rhythmicity was similarly impacted but resynchronized to DL over 4 to 6 days. Rhythmicity was unaltered by short photoperiods (6L18D), but the nocturnal IOP elevation was markedly shortened by long photoperiods (18L6D) and temporarily lowered to daytime levels by light pulses during the subjective night. Transient and sustained event rate, amplitude, interval, and energy content were nearly identical in LD, DD, and LL.

Conclusions

Aqueous humor dynamics of rat eyes are intrinsically configured to set IOP at daytime levels. Circadian clock input modulates these dynamics to elevate IOP at night. Light at night blocks this input, sending IOP back to daytime levels. Effects of abnormal lighting on IOP rhythmicity may contribute to pressure-related ocular neuropathies.

Changes of adolescent sleep patterns during the COVID-19 pandemic

OBJECTIVE

The COVID-19 pandemic has raised numerous concerns regarding its effects on individuals' health and lifestyle. We aim to analyze potential changes in adolescent sleep patterns from before and during the pandemic and identify specific predictors of changes.

METHODS

A subgroup of adolescents from a population-based birth cohort from Pelotas, Brazil, was assessed pre-pandemic (T1, November-2019 to March-2020) and peri-pandemic (T2, August-2021 to December-2021) in in-person interviews (n = 1,949). Sleep parameters, including sleep duration and latency time on workdays and free days, as well as social jetlag (SJL), were assessed using the Munich ChronoType Questionnaire (MCTQ). Socio-demographic, pre-pandemic, and pandemic-related predictors were analyzed. Changes in sleep parameters from T1 to T2 were estimated by multivariate latent change score modeling.

RESULTS

The latent change factor shows a significant mean increase in workday sleep duration (M = 0.334, p < 0.001), workday sleep latency (M = 0.029, p = 0.002), and free day sleep latency (M = 0.021, p = 0.034), and a decreased in SJL (M = -0.758, p < 0.001) during the pandemic. Female adolescents presented higher increases in workday sleep duration. Adolescents who adopted a stricter social distancing level during the pandemic presented greater increases in workday sleep duration and smaller reductions in SJL. Self-evaluated insomnia during the pandemic predicted lower increases in workday and free day sleep duration and higher increases in workday and free day sleep latency.

CONCLUSION

The COVID-19 outbreak brought certain advantages regarding increased sleep duration and reduced SJL. However, the observed increase in sleep latency and the influence of self-reported insomnia could be related to psychological distress inherent to the pandemic.

Outdoor Artificial Light at Night and Reproductive Endocrine and Glucose Homeostasis and Polycystic Ovary Syndrome in Women of Reproductive Age

BACKGROUND

Artificial light at night, a well-recognized circadian clock disrupter, causes disturbances in endocrine homeostasis. However, the association of artificial light at night with polycystic ovary syndrome (PCOS) is still unknown. This study examines the effects of outdoor artificial light at night on sex hormones, glucose homeostasis markers, and PCOS prevalence in Anhui Province, China.

METHODS

We recruited 20,633 women of reproductive age from Anhui Medical University Reproductive Medicine Center. PCOS was diagnosed according to Rotterdam criteria. We estimated long-term (previous year) and short-term (previous month) artificial light at night values for residential addresses using 500 m resolution satellite imagery. We fitted multivariable models, using both linear and logistic regression, to estimate the association of artificial light at night with sex hormones, glucose homeostasis markers, and PCOS prevalence.

RESULTS

Both long-term and short-term exposure to outdoor artificial light at night were negatively associated with follicle-stimulating hormone and luteinizing hormone levels, while positively associated with testosterone, fasting insulin, homeostasis model assessment-insulin resistance, and homeostasis model assessment-insulin resistance-β levels. The second-highest quintile of artificial light at night was associated with increased PCOS prevalence (odds ratio [OR long-term ] = 1.4; 95% confidence interval [CI] = 1.2, 1.6 and OR short-term = 1.3; 95% CI = 1.1, 1.5) compared with the lowest quintile. In addition, prevalence of PCOS was linearly associated with long-term exposure to artificial light at night, but nonlinearly associated with short-term exposure. This association was more evident in younger, obese or overweight, moderately educated, rural women, and for the summer and fall seasons.

CONCLUSION

Outdoor artificial light at night may be a novel risk factor for PCOS.

Dysrhythmic saliva microbiota in mobile phone addicts with sleep disorders and restored by acupuncture

Background

Mobile phone addiction (MPA) greatly affects the biological clock and sleep quality and is emerging as a behavioral disorder. The saliva microbiota has been linked to circadian rhythms, and our previous research revealed dysrhythmic saliva metabolites in MPA subjects with sleep disorders (MPASD). In addition, acupuncture had positive effects. However, the dysbiotic saliva microbiota in MPASD patients and the restorative effects of acupuncture are unclear.

Objectives

To probe the circadian dysrhythmic characteristics of the saliva microbiota and acupunctural restoration in MPASD patients.

Methods

MPASD patients and healthy volunteers were recruited by the Mobile Phone Addiction Tendency Scale (MPATS) and the Pittsburgh Sleep Quality Index (PSQI). Saliva samples were collected every 4 h for 72 h. After saliva sampling, six MPDSD subjects (group M) were acupuncturally treated (group T), and subsequent saliva sampling was conducted posttreatment. Finally, all the samples were subjected to 16S rRNA gene sequencing and bioinformatic analysis.

Results

Significantly increased MPATS and PSQI scores were observed in MPDSD patients (p< 0.01), but these scores decreased (p<0.001) after acupuncture intervention. Compared with those in healthy controls, the diversity and structure of the saliva microbiota in MPASD patients were markedly disrupted. Six genera with circadian rhythms were detected in all groups, including Sulfurovum, Peptostreptococcus, Porphyromonas and Prevotella. There were five genera with circadian rhythmicity in healthy people, of which the rhythmicities of the genera Rothia and Lautropia disappeared in MPASD patients but effectively resumed after acupuncture intervention.

Conclusions

This work revealed dysrhythmic salivary microbes in MPASD patients, and acupuncture, as a potential intervention, could be effective in mitigating this ever-rising behavioral epidemic.

Multimorbidity and its Associated Factors in Korean Shift Workers: Population-Based Cross-Sectional Study

BACKGROUND

Multimorbidity is a crucial factor that influences premature death rates, poor health, depression, quality of life, and use of health care. Approximately one-fifth of the global workforce is involved in shift work, which is associated with increased risk for several chronic diseases and multimorbidity. About 12% to 14% of wage workers in Korea are shift workers. However, the prevalence of multimorbidity and its associated factors in Korean shift workers are rarely reported.

OBJECTIVE

This study aimed to assess multimorbidity prevalence, examine the factors associated with multimorbidity, and identify multimorbidity patterns among shift workers in Korea.

METHODS

This study is a population-based cross-sectional study using Korea National Health and Nutrition Examination Survey data from 2016 to 2020. The study included 1704 (weighted n=2,697,228) Korean shift workers aged 19 years and older. Multimorbidity was defined as participants having 2 or more chronic diseases. Demographic and job-related variables, including regular work status, average working hours per week, and shift work type, as well as health behaviors, including BMI, smoking status, alcohol use, physical activity, and sleep duration, were included in the analysis. A survey-corrected logistic regression analysis was performed to identify factors influencing multimorbidity among the workers, and multimorbidity patterns were identified with a network analysis.

RESULTS

The overall prevalence of multimorbidity was 13.7% (302/1704). Logistic regression indicated that age, income, regular work, and obesity were significant factors influencing multimorbidity. Network analysis results revealed that chronic diseases clustered into three groups: (1) cardiometabolic multimorbidity (hypertension, dyslipidemia, diabetes, coronary heart disease, and stroke), (2) musculoskeletal multimorbidity (arthritis and osteoporosis), and (3) unclassified diseases (depression, chronic liver disease, thyroid disease, asthma, cancer, and chronic kidney disease).

CONCLUSIONS

The findings revealed that several socioeconomic and behavioral factors were associated with multimorbidity among shift workers, indicating the need for policy development related to work schedule modification. Further organization-level screening and intervention programs are needed to prevent and manage multimorbidity among shift workers. We also recommend longitudinal studies to confirm the effects of job-related factors and health behaviors on multimorbidity among shift workers in the future.

The effects of melatonin and magnesium in a novel supplement delivery system on sleep scores, body composition and metabolism in otherwise healthy individuals with sleep disturbances

The purpose of this study was to investigate the effects of a novel dietary supplement, including melatonin and magnesium, delivered via coffee pods on sleep quality, resting metabolic rate (RMR), and body composition in individuals with poor sleep quality disturbances. Using a double-blinded, randomized, crossover trial, we recruited 35 participants to a 4-week intervention with both supplements (1.9 mg melatonin + 200 mg elemental magnesium before sleep) and placebo conditions, considering a 7d washout period between treatments. The Pittsburgh Sleep Quality Index (PSQI) questionnaire was applied, RMR (kcal) was measured using indirect calorimetry (canopy ventilated open-circuit system) and body composition was assessed using dual-energy X-ray absorptiometry. Decreases in PSQI and anger - hostility scores, as well as in energy intake and fat mass, were observed (p < 0.05) for both conditions, from baseline to the end of each 4-week intervention. Differences between conditions were also observed for these parameters along with energy spent in activity, number of sedentary breaks, sleep efficiency, latency time, time in bed, total sleep time, awakening time, and movement index (p < 0.05) favouring the supplement condition. However, the final PSQI questionnaire scores still indicated poor sleep quality on average (PSQI > 5), in both conditions, with no changes regarding RMR. A melatonin-magnesium supplement, in a coffee pod format, showed improvements in sleep quality in otherwise healthy individuals with sleep disturbances, however PSQI questionnaire scores still indicated poor quality on average (PSQI > 5).

Urinary Incontinence in the Third Trimester of Pregnancy of Type 1 Diabetic Women

BACKGROUND

Type 1 diabetes increases the prevalence of urinary incontinence and may be responsible for additional changes to those existing in a regular gestational period. This study aimed to describe the presence and symptoms of urinary incontinence in pregnant women with type 1 diabetes.

METHODS

In this Cross-sectional case control study, forty pregnant women in third gestational trimester were allocated in two equal groups - control group (CG) and type 1 diabetic group (1DMG). The patients answered the International Consultation on Incontinence Questionnaire Short Form and, to characterize the sample, they answered the Pregnancy Physical Activity Questionnaire, gynecological history and, after delivery, the newborn weight was registered. The groups were compared using the Student's T Test for parametric variables and the U-Mann Whitney Test for non-parametric variables, both at 5% probability.

RESULTS

The International Consultation on Incontinence Questionnaire Short Form score (p = 0.026) is higher in 1DMG (3.95 ± 4.70) compared to CG (1.05 ± 2.23). No correlations were found between time of diagnosis, HbA1c and newborn weight in relation to ICIQ-SF and other variables in CG and 1DMG with ICIQ-SF (p < 0.05).

CONCLUSION

Type 1 diabetes mellitus, in the third trimester of gestation, seem to be associated with increase in the ICIQ-SF score.