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Zhang T, Cheng P, Ma X, Yu X. Influence of circadian rhythm and sleep schedules on depressive symptoms among adolescents in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024:1-9. [PMID: 38753525 DOI: 10.1080/09603123.2024.2352076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/30/2024] [Indexed: 05/18/2024]
Abstract
Circadian rhythm (24-hour period of physiological and behavioral changes) is the basis of the overall health, including mood and health. This study aimed to explore the influence of circadian rhythm and sleep schedules on depressive symptoms in Chinese adolescents. In this cross-sectional study, 841 middle school students were recruited and divided into two groups (depressive group, DG, n = 210, and control group, n = 631) depending on the total score of The Center for Epidemiological Studies Depression Scale for Children (CES-DC). The circadian rhythm and sleep quality among adolescents were evaluated by using the Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN) and Self-rating scale of Sleep (SRSS) scales. Furthermore, correlation analysis and logistic regression analysis were used to determine the effects of demographic factors, sleeping arrangement, sleep quality, and circadian rhythm on depressive symptoms. The DG group's CES-DC, BRIAN and SRSS scores were significantly higher than the control group's. Higher scores of BRIAN and SRSS were risk factors for depressive symptoms in Chinese adolescents. Attending a day school and waking up later on weekends may be weak protective factors. Our results suggest that circadian rhythm disturbance, sleep quality, and sleeping arrangement have a significant influence on depressive symptoms among adolescents in China.
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Affiliation(s)
- Ting Zhang
- School of Medicine, Tongji University, Shanghai, China
- Department of General Psychiatry, The Affiliated Mental Health Center of Jiangnan University, Wuxi, Jiangsu, China
| | - Peipei Cheng
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiquan Ma
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaodan Yu
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- MOE-Shanghai Key Lab of Children's Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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2
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Ventresca C, Mohamed W, Russel WA, Ay A, Ingram KK. Machine learning analyses reveal circadian clock features predictive of anxiety among UK biobank participants. Sci Rep 2023; 13:22304. [PMID: 38102312 PMCID: PMC10724169 DOI: 10.1038/s41598-023-49644-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 12/11/2023] [Indexed: 12/17/2023] Open
Abstract
Mood disorders, including depression and anxiety, affect almost one-fifth of the world's adult population and are becoming increasingly prevalent. Mutations in circadian clock genes have previously been associated with mood disorders both directly and indirectly through alterations in circadian phase, suggesting that the circadian clock influences multiple molecular pathways involved in mood. By targeting previously identified single nucleotide polymorphisms (SNPs) that have been implicated in anxiety and depressive disorders, we use a combination of statistical and machine learning techniques to investigate associations with the generalized anxiety disorder assessment (GAD-7) scores in a UK Biobank sample of 90,882 individuals. As in previous studies, we observed that females exhibited higher GAD-7 scores than males regardless of genotype. Interestingly, we found no significant effects on anxiety from individual circadian gene variants; only circadian genotypes with multiple SNP variants showed significant associations with anxiety. For both sexes, severe anxiety is associated with a 120-fold increase in odds for individuals with CRY2_AG(rs1083852)/ZBTB20_TT(rs1394593) genotypes and is associated with a near 40-fold reduction in odds for individuals with PER3-A_CG(rs228697)/ZBTB20_TT(rs1394593) genotypes. We also report several sex-specific associations with anxiety. In females, the CRY2/ZBTB20 genotype combination showed a > 200-fold increase in odds of anxiety and PER3/ZBTB20 and CRY1 /PER3-A genotype combinations also appeared as female risk factors. In males, CRY1/PER3-A and PER3-B/ZBTB20 genotype combinations were associated with anxiety risk. Mediation analysis revealed direct associations of CRY2/ZBTB20 variant genotypes with moderate anxiety in females and CRY1/PER3-A variant genotypes with severe anxiety in males. The association of CRY1/PER3-A variant genotypes with severe anxiety in females was partially mediated by extreme evening chronotype. Our results reinforce existing findings that females exhibit stronger anxiety outcomes than males, and provide evidence for circadian gene associations with anxiety, particularly in females. Our analyses only identified significant associations using two-gene combinations, underscoring the importance of combined gene effects on anxiety risk. We describe novel, robust associations between gene combinations involving the ZBTB20 SNP (rs1394593) and risk of anxiety symptoms in a large population sample. Our findings also support previous findings that the ZBTB20 SNP is an important factor in mood disorders, including seasonal affective disorder. Our results suggest that reduced expression of this gene significantly modulates the risk of anxiety symptoms through direct influences on mood-related pathways. Together, these observations provide novel links between the circadian clockwork and anxiety symptoms and identify potential molecular pathways through which clock genes may influence anxiety risk.
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Affiliation(s)
- Cole Ventresca
- Department of Mathematics, Colgate University, Hamilton, NY, USA
- Department of Computer Science, Colgate University, Hamilton, NY, USA
| | - Wael Mohamed
- Department of Computer Science, Colgate University, Hamilton, NY, USA
- Department of Psychological and Brain Sciences, Colgate University, Hamilton, NY, USA
| | | | - Ahmet Ay
- Department of Mathematics, Colgate University, Hamilton, NY, USA
- Department of Biology, Colgate University, Hamilton, NY, USA
| | - Krista K Ingram
- Department of Biology, Colgate University, Hamilton, NY, USA.
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Asarnow LD, Soehner A, Dolsen E, Dong L, Harvey AG. Report from a randomized control trial: improved alignment between circadian biology and sleep-wake behavior as a mechanism of depression symptom improvement in evening-type adolescents with depressive symptoms. J Child Psychol Psychiatry 2023; 64:1652-1664. [PMID: 37589403 PMCID: PMC10840628 DOI: 10.1111/jcpp.13880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2023] [Indexed: 08/18/2023]
Abstract
STUDY OBJECTIVES An evening circadian preference is common among adolescents. It is characterized by a behavioral predilection for later sleep and wake timing and is associated with higher rates of Major Depressive Disorder (MDD). The present study aims to (a) test the effectiveness of a cognitive behavioral sleep intervention (Transdiagnostic Sleep and Circadian Intervention; TranS-C) in a sample of adolescents with an evening circadian preference and clinically significant depressive symptoms and (b) evaluate improved alignment between circadian biology and sleep-wake behavior as a potential mechanism in the relationship between sleep and depression symptom improvement. METHODS Adolescents with an evening circadian preference and clinically significant depressive symptoms were randomized to receive TranS-C (n = 24) or a psychoeducation condition (PE; n = 18). Alignment between circadian biology and sleep-wake behavior was measured using objective biological measurement. Measures of sleep and circadian rhythm were taken at pre- and posttreatment, and depression symptoms were measured at pre- and posttreatment and 6- and 12-month follow-up. RESULTS Mixed effects modeling revealed that compared with an active control condition, TranS-C resulted in a significant reduction in MDD severity at 12-month follow-up. A MacArthur mediation analysis conducted to explore alignment between circadian biology and sleep-wake behavior as a mediator of depression severity reduction through 12-month follow-up revealed a significant interaction between change in alignment between circadian biology and sleep-wake behavior and treatment arm, indicating that improved alignment between circadian biology and sleep-wake behavior at posttreatment was associated with improvements in depression outcomes at 12-month follow-up under the treatment condition. CONCLUSIONS These results provide novel evidence for improved alignment between circadian biology and sleep-wake behavior as a specific mechanism of depression improvement, provide key clues into the complex relationship between sleep and depression, and have significant clinical implications for adolescents with depression.
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Affiliation(s)
- Lauren D. Asarnow
- University of California, San Francisco, Department of Psychiatry and Behavioral Science
| | - Adriane Soehner
- University of Pittsburgh, Department of Psychiatry and Behavioral Science
| | - Emily Dolsen
- University of California, San Francisco, Department of Psychiatry and Behavioral Science
- Department of Veterans Affairs, San Francisco, Department of Psychiatry
- Mental Illness Research Education and Clinical Centers, San Francisco VA Healthcare System
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Smieszek SP, Kaden AR, Johnson CE, Brzezynski JL, Xiao C, Polymeropoulos CM, Birznieks G, Emsellem HA, Polymeropoulos MH. Case report: A patient with Delayed Sleep-Wake Phase Disorder and Optic Nerve Hypoplasia treated with tasimelteon: a case study. Front Neurosci 2023; 17:1287514. [PMID: 38033548 PMCID: PMC10682171 DOI: 10.3389/fnins.2023.1287514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/11/2023] [Indexed: 12/02/2023] Open
Abstract
We present a case of an adult female diagnosed with Delayed Sleep-Wake Phase Disorder (DSWPD) and Optic Nerve Hypoplasia (ONH), with a confirmed delayed Dim Light Melatonin Onset (DLMO), who reports the inability to fall asleep at their desired bedtime and obtain adequate sleep nightly, despite the ability to have a full night's sleep when not required to be up at a specific time for societal requirements. The participant was enrolled in an 11-month Open-Label Extension (OLE) following the randomized portion of a clinical study and was successfully treated with tasimelteon. DSWPD symptoms were resolved, and their previously delayed sleep-wake cycle was advanced. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT04652882, identifier NCT04652882.
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Affiliation(s)
| | | | | | | | - Changfu Xiao
- Vanda Pharmaceuticals Inc., Washington, DC, United States
| | | | | | - Helene A. Emsellem
- The Center for Sleep & Wake Disorders, Chevy Chase, MD, United States
- Department of Neurology, George Washington University, Washington, DC, United States
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Lyu X, Dunietz GL, O'Brien LM, Chervin RD, Koumpias A, Shedden K. Disparities in sleep-wake patterns by labor force status: Population-based findings. Chronobiol Int 2023; 40:1111-1122. [PMID: 37691398 DOI: 10.1080/07420528.2023.2253904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 06/01/2023] [Accepted: 08/25/2023] [Indexed: 09/12/2023]
Abstract
Sleep disturbances have been associated with unemployment, but variation in sleep-wake patterns by labor force status has rarely been examined. With a population-based sample, we investigated differences in sleep-wake patterns by labor force status (employed, unemployed, and not-in-the-labor-force) and potential disparities by sociodemographic variables. The analysis included 130,602 adults aged 25-60 y, who participated in the American Time Use Survey between 2003 and 2019. Individual sleep-wake pattern was extracted from time use logs in a strict 24-h period (04:00 h-03:59 h). Functional nonparametric regression models based on dimensionality reduction and neighborhood matching were applied to model the relationship between sleep-wake patterns and labor force status. Specifically, we predicted changes in intra-person sleep-wake patterns under hypothetical changes of labor force status from employed to unemployed or not-in-the-labor-force. We then studied moderations of this association by gender, race/ethnicity and educational attainment. In comparison to the employed state, unemployed and not-in-the-labor-force states were predicted to have later wake-times, later bedtimes, and higher tendency for taking midday naps. Changes in labor force status led to more apparent shifts in wake-times than in bedtimes. Additionally, sleep schedules of Hispanics and those with higher education level were more vulnerable to the change of labor force status from employed to unemployed.
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Affiliation(s)
- Xiru Lyu
- Department of Statistics, University of Michigan, Ann Arbor, Michigan, USA
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Galit Levi Dunietz
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Louise M O'Brien
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ronald D Chervin
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Antonios Koumpias
- Department of Social Sciences, University of Michigan, Dearborn, Michigan, USA
| | - Kerby Shedden
- Department of Statistics, University of Michigan, Ann Arbor, Michigan, USA
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Bormes G, Love J, Akeju O, Cherry J, Kunorozva L, Qadri S, Rahman SA, Westover B, Winkelman J, Lane JM. Self-Directed Home-Based Dim-Light Melatonin Onset Collection: The Circadia Pilot Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.26.23290467. [PMID: 37398260 PMCID: PMC10312844 DOI: 10.1101/2023.05.26.23290467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Study Objectives To test the feasibility of a novel at-home salivary Dim Light Melatonin Onset (DLMO) assessment protocol to measure the endogenous circadian phase of 10 individuals ( 1 Advanced Sleep-Wake Phase Disorder patient (ASWPD), 4 Delayed Sleep-Wake Phase Disorder patients (DSWPD), and 5 controls). Methods The study involved 10 participants (sex at birth: females = 9; male= 1), who ranged between 27 to 63 years old, with an average age of 38 years old. Our study population consisted of 7 individuals who identified as white and 3 who identified as Asian. Our participants were diverse in gender identity (woman = 7, male = 1, transgender = 1, nonbinary = 1, none = 1).The study tracked the sleep and activity patterns of 10 individuals over a 5-6 week period using self-reported online sleep diaries and objective actigraphy data. Participants completed two self-directed DLMO assessments, approximately one week apart, adhering to objective compliance measures. Participants completed the study entirely remotely: they completed all sleep diaries and other evaluations online and were mailed a kit with all materials needed to perform the actigraphy and at-home sample collections. Results Salivary DLMO times were calculated for 8/10 participants using the Hockeystick method. DLMO times were on average 3 hours and 18 minutes earlier than self-reported sleep onset times (DSPD: 12:04 AM, controls: 9:55 PM.) Among the 6 participants for whom we calculated two separate DLMO times, DLMOs 1 and 2 were 96% correlated (p<0.0005.). Conclusions Our results indicate that self-directed, at-home DLMO assessments are feasible and accurate. The current protocol may serve as a framework to reliably assess circadian phase in both clinical and general populations.
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Affiliation(s)
- Gregory Bormes
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA USA
| | - Jessica Love
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA USA
| | - Oluwaseun Akeju
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA USA
| | - Jakob Cherry
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA USA
| | - Lovemore Kunorozva
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Salim Qadri
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA USA
| | - Shadab A Rahman
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA USA
| | - Brandon Westover
- Department of Neurology and Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | - John Winkelman
- Harvard Medical School, Boston, MA USA
- Department of Neurology and Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | - Jacqueline M Lane
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA USA
- Medical and Population Genetics, Broad Institute, Cambridge, MA USA
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Futenma K, Takaesu Y, Komada Y, Shimura A, Okajima I, Matsui K, Tanioka K, Inoue Y. Delayed sleep-wake phase disorder and its related sleep behaviors in the young generation. Front Psychiatry 2023; 14:1174719. [PMID: 37275982 PMCID: PMC10235460 DOI: 10.3389/fpsyt.2023.1174719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/08/2023] [Indexed: 06/07/2023] Open
Abstract
Delayed sleep-wake phase disorder (DSWPD) is a sleep disorder in which the habitual sleep-wake timing is delayed, resulting in difficulty in falling asleep and waking up at the desired time. Patients with DSWPD frequently experience fatigue, impaired concentration, sleep deprivation during weekdays, and problems of absenteeism, which may be further complicated by depressive symptoms. DSWPD is typically prevalent during adolescence and young adulthood. Although there are no studies comparing internationally, the prevalence of DSWPD is estimated to be approximately 3% with little racial differences between Caucasians and Asians. The presence of this disorder is associated with various physiological, genetic and psychological as well as behavioral factors. Furthermore, social factors are also involved in the mechanism of DSWPD. Recently, delayed sleep phase and prolonged sleep duration in the young generation have been reported during the period of COVID-19 pandemic-related behavioral restrictions. This phenomenon raises a concern about the risk of a mismatch between their sleep-wake phase and social life that may lead to the development of DSWPD after the removal of these restrictions. Although the typical feature of DSWPD is a delay in circadian rhythms, individuals with DSWPD without having misalignment of objectively measured circadian rhythm markers account for approximately 40% of the cases, wherein the psychological and behavioral characteristics of young people, such as truancy and academic or social troubles, are largely involved in the mechanism of this disorder. Recent studies have shown that DSWPD is frequently comorbid with psychiatric disorders, particularly mood and neurodevelopmental disorders, both of which have a bidirectional association with the pathophysiology of DSWPD. Additionally, patients with DSWPD have a strong tendency toward neuroticism and anxiety, which may result in the aggravation of insomnia symptoms. Therefore, future studies should address the effectiveness of cognitive-behavioral approaches in addition to chronobiological approaches in the treatment of DSWPD.
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Affiliation(s)
- Kunihiro Futenma
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
| | - Yoko Komada
- Institute for Liberal Arts, Tokyo Institute of Technology, Tokyo, Japan
| | - Akiyoshi Shimura
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
- Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
| | - Isa Okajima
- Department of Psychological Counseling, Faculty of Humanities, Tokyo Kasei University, Tokyo, Japan
| | - Kentaro Matsui
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
- Department of Clinical Laboratory, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kosuke Tanioka
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
| | - Yuichi Inoue
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
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Gong L, He K, Cheng F, Deng Z, Cheng K, Zhang X, Zhou W, Ou J, Wang J, Zhang B, Ding X, Xu R, Xi C. The role of ascending arousal network in patients with chronic insomnia disorder. Hum Brain Mapp 2022; 44:484-495. [PMID: 36111884 PMCID: PMC9842899 DOI: 10.1002/hbm.26072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/02/2022] [Accepted: 08/16/2022] [Indexed: 01/25/2023] Open
Abstract
The ascending arousal system plays a crucial role in individuals' consciousness. Recently, advanced functional magnetic resonance imaging (fMRI) has made it possible to investigate the ascending arousal network (AAN) in vivo. However, the role of AAN in the neuropathology of human insomnia remains unclear. Our study aimed to explore alterations in AAN and its connections with cortical networks in chronic insomnia disorder (CID). Resting-state fMRI data were acquired from 60 patients with CID and 60 good sleeper controls (GSCs). Changes in the brain's functional connectivity (FC) between the AAN and eight cortical networks were detected in patients with CID and GSCs. Multivariate pattern analysis (MVPA) was employed to differentiate CID patients from GSCs and predict clinical symptoms in patients with CID. Finally, these MVPA findings were further verified using an external data set (32 patients with CID and 33 GSCs). Compared to GSCs, patients with CID exhibited increased FC within the AAN, as well as increased FC between the AAN and default mode, cerebellar, sensorimotor, and dorsal attention networks. These AAN-related FC patterns and the MVPA classification model could be used to differentiate CID patients from GSCs with 88% accuracy in the first cohort and 77% accuracy in the validation cohort. Moreover, the MVPA prediction models could separately predict insomnia (data set 1, R2 = .34; data set 2, R2 = .15) and anxiety symptoms (data set 1, R2 = .35; data set 2, R2 = .34) in the two independent cohorts of patients. Our findings indicated that AAN contributed to the neurobiological mechanism of insomnia and highlighted that fMRI-based markers and machine learning techniques might facilitate the evaluation of insomnia and its comorbid mental symptoms.
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Affiliation(s)
- Liang Gong
- Department of NeurologyChengdu Second People's HospitalChengduSichuanChina
| | - Kewu He
- Department of RadiologyThe Third Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Fang Cheng
- Department of NeurologyThe Third Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Zhenping Deng
- Department of RadiologyChengdu Second People's HospitalChengduSichuanChina
| | - Kang Cheng
- Department of RadiologyChengdu Second People's HospitalChengduSichuanChina
| | - Xi'e Zhang
- Department of RadiologyChengdu Second People's HospitalChengduSichuanChina
| | - Wenjun Zhou
- Southwest Petroleum UniversityChengduSichuanChina
| | - Jing Ou
- Southwest Petroleum UniversityChengduSichuanChina
| | - Jian Wang
- Department of NeurologyChengdu Second People's HospitalChengduSichuanChina
| | - Bei Zhang
- Department of NeurologyChengdu Second People's HospitalChengduSichuanChina
| | - Xin Ding
- Department of NeurologyChengdu Second People's HospitalChengduSichuanChina
| | - Ronghua Xu
- Department of NeurologyChengdu Second People's HospitalChengduSichuanChina
| | - Chunhua Xi
- Department of NeurologyThe Third Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
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Kuula L, Lipsanen J, Partonen T, Kauramäki J, Halonen R, Pesonen AK. Endogenous circadian temperature rhythms relate to adolescents’ daytime physical activity. Front Physiol 2022; 13:947184. [PMID: 36160868 PMCID: PMC9490324 DOI: 10.3389/fphys.2022.947184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Abstract
Circadian rhythms relate to multiple aspects of health and wellbeing, including physical activity patterns. Susceptible circadian regulation predisposes to circadian misalignment, poor sleep, sleep deprivation, increased sleepiness, and thereby sedentary behavior. Adolescents’ circadian regulation is particularly vulnerable, and may lead to sedentary behavior. To investigate which factors associate strongest between physical activity (PA) and circadian behavior, we conducted multimodal circadian rhythm analyses. We investigate how individual characteristics of habitual circadian patterns associate with objectively measured PA. We studied 312 adolescents [70% females) (56% with delayed sleep phase (DSP)], mean age 16.9 years. Circadian period length, temperature mesor (estimated 24 h midline) and amplitude (difference between mesor and peak) were measured using distally attached thermologgers (ibutton 1922L, 3-day-measurement). We additionally utilized algorithm-formed clusters of circadian rhythmicity. Sleep duration, timing, DSP, and PA were measured using actigraphs (GeneActiv Original, 10-day-measurement). We found that continuous circadian period length was not associated with PA, but lower mesor and higher amplitude were consistently associated with higher levels of PA as indicated by mean Metabolic Equivalent (METmean) and moderate-to-vigorous PA (MVPA), even when controlling for sleep duration. Separate circadian clusters formed by an algorithm also reflected distinct patterns of PA accordingly. Late sleepers and those with DSP were less likely to engage in MVPA compared to non-DSP and had more sedentary behavior. Adolescents who engage in higher levels or high-intensity PA have better circadian regulation, as measured by different objective methods including distal temperature measurements as well as actigraphy-measured sleep-wake behavior.
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Affiliation(s)
- Liisa Kuula
- SleepWell Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- *Correspondence: Liisa Kuula,
| | - Jari Lipsanen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Timo Partonen
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jaakko Kauramäki
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Cognitive Brain Research Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Risto Halonen
- SleepWell Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Anu-Katriina Pesonen
- SleepWell Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Mousavi ZA, Lai J, Simon K, Rivera AP, Yunusova A, Hu S, Labbaf S, Jafarlou S, Dutt ND, Jain RC, Rahmani AM, Borelli JL. Sleep Patterns and Affect Dynamics Among College Students During the COVID-19 Pandemic: Intensive Longitudinal Study. JMIR Form Res 2022; 6:e33964. [PMID: 35816447 PMCID: PMC9359303 DOI: 10.2196/33964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 05/24/2022] [Accepted: 06/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Sleep disturbance is a transdiagnostic risk factor that is so prevalent among young adults that it is considered a public health epidemic, which has been exacerbated by the COVID-19 pandemic. Sleep may contribute to mental health via affect dynamics. Prior literature on the contribution of sleep to affect is largely based on correlational studies or experiments that do not generalize to the daily lives of young adults. Furthermore, the literature examining the associations between sleep variability and affect dynamics remains scant.
Objective
In an ecologically valid context, using an intensive longitudinal design, we aimed to assess the daily and long-term associations between sleep patterns and affect dynamics among young adults during the COVID-19 pandemic.
Methods
College student participants (N=20; female: 13/20, 65%) wore an Oura ring (Ōura Health Ltd) continuously for 3 months to measure sleep patterns, such as average and variability in total sleep time (TST), wake after sleep onset (WASO), sleep efficiency, and sleep onset latency (SOL), resulting in 1173 unique observations. We administered a daily ecological momentary assessment by using a mobile health app to evaluate positive affect (PA), negative affect (NA), and COVID-19 worry once per day.
Results
Participants with a higher sleep onset latency (b=−1.09, SE 0.36; P=.006) and TST (b=−0.15, SE 0.05; P=.008) on the prior day had lower PA on the next day. Further, higher average TST across the 3-month period predicted lower average PA (b=−0.36, SE 0.12; P=.009). TST variability predicted higher affect variability across all affect domains. Specifically, higher variability in TST was associated higher PA variability (b=0.09, SE 0.03; P=.007), higher negative affect variability (b=0.12, SE 0.05; P=.03), and higher COVID-19 worry variability (b=0.16, SE 0.07; P=.04).
Conclusions
Fluctuating sleep patterns are associated with affect dynamics at the daily and long-term scales. Low PA and affect variability may be potential pathways through which sleep has implications for mental health.
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Affiliation(s)
- Zahra Avah Mousavi
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - Jocelyn Lai
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - Katharine Simon
- Department of Cognitive Sciences, University of California, Irvine, Irvine, CA, United States
| | - Alexander P Rivera
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - Asal Yunusova
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - Sirui Hu
- Department of Economics, University of California, Irvine, Irvine, CA, United States
| | - Sina Labbaf
- Department of Computer Science, University of California, Irvine, Irvine, CA, United States
| | - Salar Jafarlou
- Department of Computer Science, University of California, Irvine, Irvine, CA, United States
| | - Nikil D Dutt
- Department of Cognitive Sciences, University of California, Irvine, Irvine, CA, United States
- Department of Computer Science, University of California, Irvine, Irvine, CA, United States
| | - Ramesh C Jain
- Department of Computer Science, University of California, Irvine, Irvine, CA, United States
| | - Amir M Rahmani
- Department of Computer Science, University of California, Irvine, Irvine, CA, United States
- School of Nursing, University of California, Irvine, Irvine, CA, United States
| | - Jessica L Borelli
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
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11
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Takaesu Y, Kanda Y, Nagahama Y, Shiroma A, Ishii M, Hashimoto T, Watanabe K. Delayed sleep-wake rhythm is associated with cognitive dysfunction, social dysfunction, and deteriorated quality of life in patients with major depressive disorder. Front Psychiatry 2022; 13:1022144. [PMID: 36419978 PMCID: PMC9677332 DOI: 10.3389/fpsyt.2022.1022144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The delayed sleep-wake phase is commonly observed in major depressive disorder (MDD) and thought to be associated with functional impairments. This study aimed to evaluate the relationship between the delayed sleep-wake phase, cognitive dysfunction, social dysfunction, and quality of life in patients with MDD. METHODS This cross-sectional design included 33 outpatients with MDD. Objective sleep-wake rhythm was assessed by actigraphy. Functional impairments were evaluated by the Japanese version of the Brief Assessment of Cognition in Schizophrenia (BACS-J), World Health Organization Disability Assessment Schedule (WHO-DAS), and Euro QOL 5 dimensions (EQ5D). RESULTS Actigraphic assessment of the delayed sleep-wake phase (midpoint of sleep) was significantly correlated with the composite score of the BACS-J (r = -0.489, p = 0.010), WHO-DAS score (r = 0.466, p = 0.014), and EQ5D score (r = 0.472, p = 0.013). No significant correlation was found between the other actigraphic sleep parameters (sleep latency, total sleep time, and sleep efficiency) and functional impairments. CONCLUSION Our study's results suggested that the delayed sleep-wake phase is associated with cognitive dysfunction, social dysfunction, and deteriorated quality of life in patients with MDD. Clinicians should pay attention to the sleep-wake rhythm in patients with MDD in clinical settings.
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Affiliation(s)
- Yoshikazu Takaesu
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan.,Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Yuta Kanda
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Yu Nagahama
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Ayano Shiroma
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Miho Ishii
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Tasuku Hashimoto
- Department of Psychiatry, School of Medicine, International University of Health and Welfare, Narita, Japan.,Department of Psychiatry, Sodegaura Satsukidai Hospital, Sodegaura, Japan.,Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
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12
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Tomishima S, Komada Y, Tanioka K, Okajima I, Inoue Y. Prevalence and Factors Associated With the Risk of Delayed Sleep-Wake Phase Disorder in Japanese Youth. Front Psychiatry 2022; 13:878042. [PMID: 35633786 PMCID: PMC9135999 DOI: 10.3389/fpsyt.2022.878042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Delayed sleep-wake phase disorder (DSWPD) is more prevalent among the younger generation. However, the prevalence of this disorder in Asia, particularly Japan, has not yet been elucidated. Furthermore, the impact of DSWPD morbidity on daytime functioning and factors associated with the presence of the disorder remain unclear. METHODS A web-based survey was conducted among youth aged 15-30 years. In total, 7,810 individuals completed the questionnaire. The questionnaire included items on sociodemographic variables as well as the Japanese version of the Biological Rhythms Interview of Assessment in Neuropsychiatry self-report (J-BRIAN-SR), which assesses the risk of DSWPD, sleep behaviors and possibly related lifestyle variables, productivity loss [WHO Health and Work Performance Questionnaire (HPQ)], and health-related quality of life (HRQOL). The risk of DSWPD was indicated by a J-BRIAN-SR score greater than or equal to 40 points and days of absence ≥4 days per month. After comparing these variables for participants at risk of DSWPD and those who were not, the factors associated with the risk of DSWPD were examined using logistic regression analysis, with sociodemographic and lifestyle variables as independent variables. RESULTS The overall prevalence of participants at risk DSWPDs was 4.3%. Compared with participants without DSWPD, those at risk of DSWPD presented significantly worse HPQ and HRQOL scores. The risk of DSWPD was positively associated with the presence of currently treated diseases, length of nighttime liquid crystal display (LCD) viewing, and being a high school/university students. It was negatively associated with habitual exercise. CONCLUSION The risk of DSWPD seemed to be consistent with reports from Western countries, and individuals possibly affected by the disorder were thought to have deteriorated daytime functioning. In addition, lifestyle specific to youth, such as long-term LCD viewing at night and relatively loose social constraints, could be associated with the presence of DSWPD in this generation.
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Affiliation(s)
| | - Yoko Komada
- Department of Somnology, Tokyo Medical University, Tokyo, Japan.,Faculty of Liberal Arts, Meiji Pharmaceutical University, Tokyo, Japan
| | - Kosuke Tanioka
- Department of Somnology, Tokyo Medical University, Tokyo, Japan.,Japan Somnology Center, Institute of Neuropsychiatry, Tokyo, Japan
| | - Isa Okajima
- Department of Somnology, Tokyo Medical University, Tokyo, Japan.,Department of Psychological Counseling, Faculty of Humanities, Tokyo Kasei University, Tokyo, Japan
| | - Yuichi Inoue
- Department of Somnology, Tokyo Medical University, Tokyo, Japan.,Japan Somnology Center, Institute of Neuropsychiatry, Tokyo, Japan
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13
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Circadian Rhythm Sleep-Wake Disorders. Respir Med 2022. [DOI: 10.1007/978-3-030-93739-3_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Otsuki R, Matsui K, Yoshiike T, Nagao K, Utsumi T, Tsuru A, Ayabe N, Hazumi M, Fukumizu M, Kuriyama K. Decrease in Social Zeitgebers Is Associated With Worsened Delayed Sleep-Wake Phase Disorder: Findings During the Pandemic in Japan. Front Psychiatry 2022; 13:898600. [PMID: 35757225 PMCID: PMC9222896 DOI: 10.3389/fpsyt.2022.898600] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Delay in sleep-wake rhythms was observed in the general population during the coronavirus disease 2019 (COVID-19) pandemic. Patients with delayed sleep-wake phase disorder (DSWPD) may have also experienced exacerbation of symptoms, but no studies have investigated this topic. In this study, we aimed to retrospectively examine the changes in symptoms of outpatients with DSWPD both before and during the pandemic and to identify the factors associated with the exacerbation of sleep-wake rhythms. METHODS We included outpatients with DSWPD aged 16 years or older who visited the outpatient clinic due to sleep disorders between January and September 2020. Decreased social zeitgebers was defined as a reduction of 50% or more in the frequency of commuting to school or work during the COVID-19 pandemic. The severity of DSWPD was assessed using the clinical global impressions - severity of illness (CGI-S) at two points: before and during the pandemic. We defined the worsened, unchanged, and improved groups as those whose CGI-S scores worsened by at least one point, remained unchanged, and improved by at least one point, respectively. Multivariate logistic regression analysis was performed to determine the factors associated with worsened DSWPD symptoms. RESULTS Sixty patients with DSWPD were eligible for this study. Even before the pandemic, patients who were unemployed or did not attend school tended to show more severe DSWPD symptoms. During the pandemic, 27 patients belonged to the worsened group; 28 patients, unchanged group; and 5 patients, improved group. Decreased social zeitgebers (odds ratio [OR] = 6.668, 95% confidence interval [CI]: 1.653-26.891, p < 0.05) and comorbid mood disorders (OR = 8.876, 95% CI: 1.714-45.974, p < 0.05) showed independent significant associations with the worsening of DSWPD symptoms. CONCLUSIONS During the pandemic, the symptoms of DSWPD tended to worsen. The obtained findings emphasize the importance of social zeitgebers, suggesting the need for external motivation in DSWPD treatment.
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Affiliation(s)
- Rei Otsuki
- Department of Laboratory Medicine, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology & Psychiatry, Tokyo, Japan.,Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Kentaro Matsui
- Department of Laboratory Medicine, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology & Psychiatry, Tokyo, Japan
| | - Takuya Yoshiike
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology & Psychiatry, Tokyo, Japan
| | - Kentaro Nagao
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology & Psychiatry, Tokyo, Japan.,Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tomohiro Utsumi
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology & Psychiatry, Tokyo, Japan.,Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Ayumi Tsuru
- Department of Laboratory Medicine, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology & Psychiatry, Tokyo, Japan
| | - Naoko Ayabe
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology & Psychiatry, Tokyo, Japan.,Department of Regional Studies and Humanities, Faculty of Education and Human Studies, Akita University, Akita, Japan
| | - Megumi Hazumi
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology & Psychiatry, Tokyo, Japan.,Department of Public Mental Health, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Michio Fukumizu
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology & Psychiatry, Tokyo, Japan.,Segawa Memorial Neurological Clinic for Children, Tokyo, Japan
| | - Kenichi Kuriyama
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology & Psychiatry, Tokyo, Japan
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15
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Abstract
Circadian disruption is pervasive and can occur at multiple organizational levels, contributing to poor health outcomes at individual and population levels. Evidence points to a bidirectional relationship, in that circadian disruption increases disease severity and many diseases can disrupt circadian rhythms. Importantly, circadian disruption can increase the risk for the expression and development of neurologic, psychiatric, cardiometabolic, and immune disorders. Thus, harnessing the rich findings from preclinical and translational research in circadian biology to enhance health via circadian-based approaches represents a unique opportunity for personalized/precision medicine and overall societal well-being. In this Review, we discuss the implications of circadian disruption for human health using a bench-to-bedside approach. Evidence from preclinical and translational science is applied to a clinical and population-based approach. Given the broad implications of circadian regulation for human health, this Review focuses its discussion on selected examples in neurologic, psychiatric, metabolic, cardiovascular, allergic, and immunologic disorders that highlight the interrelatedness between circadian disruption and human disease and the potential of circadian-based interventions, such as bright light therapy and exogenous melatonin, as well as chronotherapy to improve and/or modify disease outcomes.
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Affiliation(s)
- Anna B Fishbein
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, Ann & Robert H. Lurie Children's Hospital, and
| | - Kristen L Knutson
- Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Phyllis C Zee
- Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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16
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Circadian Rhythm Dysregulation and Restoration: The Role of Melatonin. Nutrients 2021; 13:nu13103480. [PMID: 34684482 PMCID: PMC8538349 DOI: 10.3390/nu13103480] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/17/2022] Open
Abstract
Sleep is an essential component of overall human health but is so tightly regulated that when disrupted can cause or worsen certain ailments. An important part of this process is the presence of the well-known hormone, melatonin. This compound assists in the governing of sleep and circadian rhythms. Previous studies have postulated that dysregulation of melatonin rhythms is the driving force behind sleep and circadian disorders. A computer-aided search spanning the years of 2015–2020 using the search terms melatonin, circadian rhythm, disorder yielded 52 full text articles that were analyzed. We explored the mechanisms behind melatonin dysregulation and how it affects various disorders. Additionally, we examined associated therapeutic treatments including bright light therapy (BLT) and exogenous forms of melatonin. We found that over the past 5 years, melatonin has not been widely investigated in clinical studies thus there remains large gaps in its potential utilization as a therapy.
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17
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Soreca I. The role of circadian rhythms in Obstructive Sleep Apnea symptoms and novel targets for treatment. Chronobiol Int 2021; 38:1274-1282. [PMID: 34027758 DOI: 10.1080/07420528.2021.1929281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/09/2021] [Accepted: 05/09/2021] [Indexed: 10/21/2022]
Abstract
Obstructive Sleep Apnea (OSA) is a common disorder that is associated with disability, premature mortality and lost quality of life. Excessive daytime sleepiness and depressive symptoms confer a great portion of the disability and lost quality of life associated with the disorder. While showing robust rates of response and symptoms resolutions, current treatments aimed at correcting the respiratory disturbances are not universally successful and a non-negligible proportion of patients who are correctly using available therapies do not experience symptomatic relief, suggesting that mechanisms beyond the respiratory disturbances may be involved in the pathogenesis of symptoms. A growing body of literature concerning animal and human models suggests that the sleep and respiratory disturbances commonly seen in OSA, namely sleep fragmentation, partial sleep deprivation, intermittent hypoxia, can promote shifts in circadian rhythms ultimately leading to misalignment between sleep-wake rhythms and the internal clock, as well as desynchrony amongst peripheral clocks and peripheral and central clock. This manuscript reviews the current evidence in support of a circadian disturbance underlying OSA symptomatology and proposes new applications for existing chronotherapeutic interventions with the potential for improving symptoms and quality of life for those patients that do not find symptomatic relief with currently available treatments.
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Affiliation(s)
- Isabella Soreca
- Department of Sleep Medicine, Mental Illness Research, Clinical, Education Centers of Excellence (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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18
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Papatsimpa C, Schlangen LJM, Smolders KCHJ, Linnartz JPMG, de Kort YAW. The interindividual variability of sleep timing and circadian phase in humans is influenced by daytime and evening light conditions. Sci Rep 2021; 11:13709. [PMID: 34211005 PMCID: PMC8249410 DOI: 10.1038/s41598-021-92863-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/17/2021] [Indexed: 02/06/2023] Open
Abstract
Human cognitive functioning shows circadian variations throughout the day. However, individuals largely differ in their timing during the day of when they are more capable of performing specific tasks and when they prefer to sleep. These interindividual differences in preferred temporal organization of sleep and daytime activities define the chronotype. Since a late chronotype is associated with adverse mental and physical consequences, it is of vital importance to study how lighting environments affect chronotype. Here, we use a mathematical model of the human circadian pacemaker to understand how light in the built environment changes the chronotype distribution in the population. In line with experimental findings, we show that when individuals spend their days in relatively dim light conditions, this not only results in a later phase of their biological clock but also increases interindividual differences in circadian phase angle of entrainment and preferred sleep timing. Increasing daytime illuminance results in a more narrow distribution of sleep timing and circadian phase, and this effect is more pronounced for longer photoperiods. The model results demonstrate that modern lifestyle changes the chronotype distribution towards more eveningness and more extreme differences in eveningness. Such model-based predictions can be used to design guidelines for workplace lighting that help limiting circadian phase differences, and craft new lighting strategies that support human performance, health and wellbeing.
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Affiliation(s)
- C. Papatsimpa
- grid.6852.90000 0004 0398 8763Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - L. J. M. Schlangen
- grid.6852.90000 0004 0398 8763Department of Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - K. C. H. J. Smolders
- grid.6852.90000 0004 0398 8763Department of Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - J.-P. M. G. Linnartz
- grid.6852.90000 0004 0398 8763Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands ,grid.510043.3Signify, Eindhoven, The Netherlands
| | - Y. A. W. de Kort
- grid.6852.90000 0004 0398 8763Department of Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, Eindhoven, The Netherlands
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19
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Watson LA, McGlashan EM, Hosken IT, Anderson C, Phillips AJK, Cain SW. Sleep and circadian instability in delayed sleep-wake phase disorder. J Clin Sleep Med 2021; 16:1431-1436. [PMID: 32347206 DOI: 10.5664/jcsm.8516] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES In patients with delayed sleep-wake phase disorder (DSWPD), the circadian clock may be more easily affected by light at night. This creates a potential vulnerability, whereby individuals with irregular schedules may have less stable circadian rhythms. We investigated the stability of circadian timing and regularity of sleep in patients with DSWPD and healthy controls. METHODS Participants completed 2 dim-light melatonin onset (DLMO) assessments approximately 2 weeks apart while keeping their habitual sleep/wake schedule. After the second DLMO assessment, light sensitivity was assessed using the phase-resetting response to a 6.5-hour 150-lux stimulus. The change in DLMO timing (DLMO instability) was assessed and related to light sensitivity and the sleep regularity index. RESULTS Relative to healthy controls, patients with DSWPD had later sleep rhythm timing relative to clock time, earlier sleep rhythm timing relative to DLMO, lower sleep regularity index, and greater DLMO instability. Greater DLMO instability was associated with increased light sensitivity across all participants, but not within groups. CONCLUSIONS We find that circadian timing is less stable and sleep is less regular in patients with DSWPD, which could contribute to etiology of the disorder. Measures of light sensitivity may be informative in generating DSWPD treatment plans.
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Affiliation(s)
- Lauren A Watson
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; *Contributed equally
| | - Elise M McGlashan
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; *Contributed equally
| | - Ihaia T Hosken
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; *Contributed equally
| | - Clare Anderson
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; *Contributed equally
| | - Andrew J K Phillips
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; *Contributed equally
| | - Sean W Cain
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; *Contributed equally
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20
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Murray JM, Magee M, Sletten TL, Gordon C, Lovato N, Ambani K, Bartlett DJ, Kennaway DJ, Lack LC, Grunstein RR, Lockley SW, Rajaratnam SMW, Phillips AJK. Light-based methods for predicting circadian phase in delayed sleep-wake phase disorder. Sci Rep 2021; 11:10878. [PMID: 34035333 PMCID: PMC8149449 DOI: 10.1038/s41598-021-89924-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/13/2021] [Indexed: 02/04/2023] Open
Abstract
Methods for predicting circadian phase have been developed for healthy individuals. It is unknown whether these methods generalize to clinical populations, such as delayed sleep-wake phase disorder (DSWPD), where circadian timing is associated with functional outcomes. This study evaluated two methods for predicting dim light melatonin onset (DLMO) in 154 DSWPD patients using ~ 7 days of sleep-wake and light data: a dynamic model and a statistical model. The dynamic model has been validated in healthy individuals under both laboratory and field conditions. The statistical model was developed for this dataset and used a multiple linear regression of light exposure during phase delay/advance portions of the phase response curve, as well as sleep timing and demographic variables. Both models performed comparably well in predicting DLMO. The dynamic model predicted DLMO with root mean square error of 68 min, with predictions accurate to within ± 1 h in 58% of participants and ± 2 h in 95%. The statistical model predicted DLMO with root mean square error of 57 min, with predictions accurate to within ± 1 h in 75% of participants and ± 2 h in 96%. We conclude that circadian phase prediction from light data is a viable technique for improving screening, diagnosis, and treatment of DSWPD.
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Affiliation(s)
- Jade M. Murray
- grid.1002.30000 0004 1936 7857Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton, VIC 3800 Australia ,Cooperative Research Centre for Alertness, Safety and Productivity, Clayton, VIC Australia ,NHMRC Centre for Sleep and Circadian Neurobiology, Sydney, NSW Australia
| | - Michelle Magee
- grid.1002.30000 0004 1936 7857Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton, VIC 3800 Australia ,Cooperative Research Centre for Alertness, Safety and Productivity, Clayton, VIC Australia ,NHMRC Centre for Sleep and Circadian Neurobiology, Sydney, NSW Australia ,grid.1008.90000 0001 2179 088XCentre for Neuroscience of Speech, Department of Audiology and Speech Pathology, University of Melbourne, Melbourne, VIC Australia
| | - Tracey L. Sletten
- grid.1002.30000 0004 1936 7857Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton, VIC 3800 Australia ,Cooperative Research Centre for Alertness, Safety and Productivity, Clayton, VIC Australia ,NHMRC Centre for Sleep and Circadian Neurobiology, Sydney, NSW Australia
| | - Christopher Gordon
- Cooperative Research Centre for Alertness, Safety and Productivity, Clayton, VIC Australia ,NHMRC Centre for Sleep and Circadian Neurobiology, Sydney, NSW Australia ,grid.417229.b0000 0000 8945 8472Woolcock Institute of Medical Research and Sydney Local Health District, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XUniversity of Sydney Susan Wakil School of Nursing, Camperdown, NSW Australia
| | - Nicole Lovato
- Cooperative Research Centre for Alertness, Safety and Productivity, Clayton, VIC Australia ,grid.1014.40000 0004 0367 2697Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA Australia
| | - Krutika Ambani
- grid.1002.30000 0004 1936 7857Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton, VIC 3800 Australia
| | - Delwyn J. Bartlett
- Cooperative Research Centre for Alertness, Safety and Productivity, Clayton, VIC Australia ,NHMRC Centre for Sleep and Circadian Neurobiology, Sydney, NSW Australia ,grid.417229.b0000 0000 8945 8472Woolcock Institute of Medical Research and Sydney Local Health District, Sydney, NSW Australia
| | - David J. Kennaway
- grid.1010.00000 0004 1936 7304Robinson Research Institute and School of Medicine, University of Adelaide, Adelaide, SA Australia
| | - Leon C. Lack
- Cooperative Research Centre for Alertness, Safety and Productivity, Clayton, VIC Australia ,grid.1014.40000 0004 0367 2697Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA Australia
| | - Ronald R. Grunstein
- Cooperative Research Centre for Alertness, Safety and Productivity, Clayton, VIC Australia ,NHMRC Centre for Sleep and Circadian Neurobiology, Sydney, NSW Australia ,grid.417229.b0000 0000 8945 8472Woolcock Institute of Medical Research and Sydney Local Health District, Sydney, NSW Australia
| | - Steven W. Lockley
- grid.1002.30000 0004 1936 7857Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton, VIC 3800 Australia ,Cooperative Research Centre for Alertness, Safety and Productivity, Clayton, VIC Australia ,NHMRC Centre for Sleep and Circadian Neurobiology, Sydney, NSW Australia ,grid.62560.370000 0004 0378 8294Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XDivision of Sleep Medicine, Harvard Medical School, Boston, MA USA
| | - Shantha M. W. Rajaratnam
- grid.1002.30000 0004 1936 7857Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton, VIC 3800 Australia ,Cooperative Research Centre for Alertness, Safety and Productivity, Clayton, VIC Australia ,NHMRC Centre for Sleep and Circadian Neurobiology, Sydney, NSW Australia ,grid.62560.370000 0004 0378 8294Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XDivision of Sleep Medicine, Harvard Medical School, Boston, MA USA
| | - Andrew J. K. Phillips
- grid.1002.30000 0004 1936 7857Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton, VIC 3800 Australia ,Cooperative Research Centre for Alertness, Safety and Productivity, Clayton, VIC Australia
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21
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Duffy JF, Abbott SM, Burgess HJ, Crowley SJ, Emens JS, Epstein LJ, Gamble KL, Hasler BP, Kristo DA, Malkani RG, Rahman SA, Thomas SJ, Wyatt JK, Zee PC, Klerman EB. Workshop report. Circadian rhythm sleep-wake disorders: gaps and opportunities. Sleep 2021; 44:zsaa281. [PMID: 33582815 PMCID: PMC8120340 DOI: 10.1093/sleep/zsaa281] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/02/2020] [Indexed: 01/09/2023] Open
Abstract
This White Paper presents the results from a workshop cosponsored by the Sleep Research Society (SRS) and the Society for Research on Biological Rhythms (SRBR) whose goals were to bring together sleep clinicians and sleep and circadian rhythm researchers to identify existing gaps in diagnosis and treatment and areas of high-priority research in circadian rhythm sleep-wake disorders (CRSWD). CRSWD are a distinct class of sleep disorders caused by alterations of the circadian time-keeping system, its entrainment mechanisms, or a misalignment of the endogenous circadian rhythm and the external environment. In these disorders, the timing of the primary sleep episode is either earlier or later than desired, irregular from day-to-day, and/or sleep occurs at the wrong circadian time. While there are incomplete and insufficient prevalence data, CRSWD likely affect at least 800,000 and perhaps as many as 3 million individuals in the United States, and if Shift Work Disorder and Jet Lag are included, then many millions more are impacted. The SRS Advocacy Taskforce has identified CRSWD as a class of sleep disorders for which additional high-quality research could have a significant impact to improve patient care. Participants were selected for their expertise and were assigned to one of three working groups: Phase Disorders, Entrainment Disorders, and Other. Each working group presented a summary of the current state of the science for their specific CRSWD area, followed by discussion from all participants. The outcome of those presentations and discussions are presented here.
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Affiliation(s)
- Jeanne F Duffy
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Sabra M Abbott
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Helen J Burgess
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - Stephanie J Crowley
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Jonathan S Emens
- Department of Psychiatry, Oregon Health & Science University, Portland, OR
| | - Lawrence J Epstein
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Karen L Gamble
- Department of Psychiatry University of Alabama at Birmingham, Birmingham, AL
| | - Brant P Hasler
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - David A Kristo
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Roneil G Malkani
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Shadab A Rahman
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - S Justin Thomas
- Department of Psychiatry University of Alabama at Birmingham, Birmingham, AL
| | - James K Wyatt
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Phyllis C Zee
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Elizabeth B Klerman
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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22
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Tonon AC, Pilz LK, Markus RP, Hidalgo MP, Elisabetsky E. Melatonin and Depression: A Translational Perspective From Animal Models to Clinical Studies. Front Psychiatry 2021; 12:638981. [PMID: 33897495 PMCID: PMC8060443 DOI: 10.3389/fpsyt.2021.638981] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/15/2021] [Indexed: 12/13/2022] Open
Abstract
Daily rhythm of melatonin synchronizes the body to the light/dark environmental cycle. Several hypotheses have been raised to understand the intersections between melatonin and depression, in which changes in rest-activity and sleep patterns are prominent. This review describes key experimental and clinical evidence that link melatonin with the etiopathology and symptomatology of depressive states, its role in the follow up of therapeutic response to antidepressants, as well as the clinical evidence of melatonin as MDD treatment. Melatonin, as an internal temporal cue contributing to circadian organization and best studied in the context of circadian misalignment, is also implicated in neuroplasticity. The monoaminergic systems that underly MDD and melatonin production overlap. In addition, the urinary metabolite 6-sulfatoxymelatonin (aMT6) has been proposed as biomarker for antidepressant responders, by revealing whether the blockage of noradrenaline uptake has taken place within 24 h from the first antidepressant dose. Even though animal models show benefits from melatonin supplementation on depressive-like behavior, clinical evidence is inconsistent vis-à-vis prophylactic or therapeutic benefits of melatonin or melatonin agonists in depression. We argue that the study of melatonin in MDD or other psychiatric disorders must take into account the specificities of melatonin as an integrating molecule, inextricably linked to entrainment, metabolism, immunity, neurotransmission, and cell homeostasis.
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Affiliation(s)
- André C. Tonon
- Laboratório de Cronobiologia e Sono, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Graduate Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Luísa K. Pilz
- Laboratório de Cronobiologia e Sono, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Graduate Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Regina P. Markus
- Laboratório de Cronofarmacologia, Departamento de Fisiologia, Instituto de Biociência, Universidade de São Paulo, São Paulo, Brazil
| | - Maria Paz Hidalgo
- Laboratório de Cronobiologia e Sono, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Graduate Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Elaine Elisabetsky
- Programa de Pós-Graduação em Ciências Biológicas-Bioquímica, Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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23
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Yan T, Qiu Y, Yu X, Yang L. Glymphatic Dysfunction: A Bridge Between Sleep Disturbance and Mood Disorders. Front Psychiatry 2021; 12:658340. [PMID: 34025481 PMCID: PMC8138157 DOI: 10.3389/fpsyt.2021.658340] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/12/2021] [Indexed: 12/14/2022] Open
Abstract
Mounting evidence demonstrates a close relationship between sleep disturbance and mood disorders, including major depression disorder (MDD) and bipolar disorder (BD). According to the classical two-process model of sleep regulation, circadian rhythms driven by the light-dark cycle, and sleep homeostasis modulated by the sleep-wake cycle are disrupted in mood disorders. However, the exact mechanism of interaction between sleep and mood disorders remains unclear. Recent discovery of the glymphatic system and its dynamic fluctuation with sleep provide a plausible explanation. The diurnal variation of the glymphatic circulation is dependent on the astrocytic activity and polarization of water channel protein aquaporin-4 (AQP4). Both animal and human studies have reported suppressed glymphatic transport, abnormal astrocytes, and depolarized AQP4 in mood disorders. In this study, the "glymphatic dysfunction" hypothesis which suggests that the dysfunctional glymphatic pathway serves as a bridge between sleep disturbance and mood disorders is proposed.
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Affiliation(s)
- Tao Yan
- Department of Psychiatry, Changxing People's Hospital, Huzhou, China
| | - Yuefeng Qiu
- Department of Psychiatry, Zhejiang Hospital, Hangzhou, China
| | - Xinfeng Yu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Linglin Yang
- Department of Psychiatry, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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24
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Circadian misalignment increases mood vulnerability in simulated shift work. Sci Rep 2020; 10:18614. [PMID: 33122670 PMCID: PMC7596056 DOI: 10.1038/s41598-020-75245-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 10/08/2020] [Indexed: 01/05/2023] Open
Abstract
Night shift work can associate with an increased risk for depression. As night workers experience a 'misalignment' between their circadian system and daily sleep-wake behaviors, with negative health consequences, we investigated whether exposure to circadian misalignment underpins mood vulnerability in simulated shift work. We performed randomized within-subject crossover laboratory studies in non-shift workers and shift workers. Simulated night shifts were used to induce a misalignment between the endogenous circadian pacemaker and sleep/wake cycles (circadian misalignment), while environmental conditions and food intake were controlled. Circadian misalignment adversely impacted emotional state, such that mood and well-being levels were significantly decreased throughout 4 days of continuous exposure to circadian misalignment in non-shift workers, as compared to when they were under circadian alignment (interaction of "circadian alignment condition" vs. "day", mood: p < 0.001; well-being: p < 0.001; adjusted p-values). Similarly, in shift workers, mood and well-being levels were significantly reduced throughout days of misalignment, as compared to circadian alignment (interaction of "circadian alignment condition" vs. "day", mood: p = 0.002; well-being: p = 0.002; adjusted p-values). Our findings indicate that circadian misalignment is an important biological component for mood vulnerability, and that individuals who engage in shift work are susceptible to its deleterious mood effects.
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25
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van Andel E, Bijlenga D, Vogel SWN, Beekman ATF, Kooij JJS. Effects of chronotherapy on circadian rhythm and ADHD symptoms in adults with attention-deficit/hyperactivity disorder and delayed sleep phase syndrome: a randomized clinical trial. Chronobiol Int 2020; 38:260-269. [PMID: 33121289 DOI: 10.1080/07420528.2020.1835943] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The majority of adults with Attention-Deficit/Hyperactivity Disorder (ADHD) have a delayed circadian rhythm that is a characteristic of Delayed Sleep Phase Syndrome (DSPS). Treatment of DSPS may improve both the circadian rhythm and ADHD symptoms. In this three-armed randomized clinical trial, 51 adults (18-55 y) with ADHD and DSPS received sleep education and 3 weeks of (1) 0.5 mg/d placebo, (2) 0.5 mg/d melatonin, or (3) 0.5 mg/d melatonin plus 30 minutes of 10,000 lux bright light therapy (BLT) between 07:00 and 08:00 h. Placebo/melatonin conditions were double-blind. Treatment took place in the participants' naturalistic home settings. Dim-light melatonin onset (DLMO) was measured in saliva as marker of internal circadian rhythm. Melatonin or placebo administration followed individual schedules, starting 3 hours before the individual DLMO and weekly advancing by 1 h. DLMO and ADHD Rating Scale score were assessed at baseline, directly after 3-week treatment, and two weeks after the end of treatment. Results show that at baseline 77% had a DLMO after 21:00 h with an average DLMO at 23:43 h ± 1h46. Directly after treatment, melatonin had advanced DLMO by 1h28 (p = .001), and melatonin plus BLT by 1h58 (p < .001). Placebo did not affect DLMO. ADHD symptoms reduced by 14% (p = .038) directly after melatonin treatment. Placebo and melatonin plus BLT did not impact ADHD symptoms. Two weeks after end of treatment, ADHD symptoms and DLMO had returned to baseline levels. It can be concluded that low doses of melatonin advanced the circadian rhythm and reduced self-reported ADHD symptoms. Given the large number of adult ADHD patients with concurrent DSPS, treating delayed sleep with melatonin is an important component of effective ADHD treatment.
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Affiliation(s)
- Emma van Andel
- PsyQ, Expertise Center Adult ADHD , The Hague, The Netherlands
| | - Denise Bijlenga
- PsyQ, Expertise Center Adult ADHD , The Hague, The Netherlands
| | - Suzan W N Vogel
- PsyQ, Expertise Center Adult ADHD , The Hague, The Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center , Amsterdam, The Netherlands
| | - J J Sandra Kooij
- PsyQ, Expertise Center Adult ADHD , The Hague, The Netherlands.,Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center , Amsterdam, The Netherlands
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26
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Linnaranta O, Bourguignon C, Crescenzi O, Sibthorpe D, Buyukkurt A, Steiger H, Storch KF. Late and Instable Sleep Phasing is Associated With Irregular Eating Patterns in Eating Disorders. Ann Behav Med 2020; 54:680-690. [PMID: 32211873 PMCID: PMC7459186 DOI: 10.1093/abm/kaaa012] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Sleep problems are common in eating disorders (EDs). PURPOSE We evaluated whether sleep-phasing regularity associates with the regularity of daily eating events. METHODS ED patients (n = 29) completed hourly charts of mood and eating occasions for 2 weeks. Locomotor activity was recorded continuously by wrist actigraphy for a minimum of 10 days, and sleep was calculated based on periods of inactivity. We computed the center of daily inactivity (CenDI) as a measure of sleep phasing and consolidation of the daily inactivity (ConDI) as a measure of daily sleep rhythm strength. We assessed interday irregularities in the temporal structure of food intake using the standard deviation (SD) of frequency (IFRQ), timing (ITIM), and interval (IINT) of food intake. A self-evaluation of other characteristics included mood, anxiety, and early trauma. RESULTS A later phasing of sleep associated with a lower frequency of eating (eating frequency with the CenDI rho = -0.49, p = .007). The phasing and rhythmic strength of sleep correlated with the degree of eating irregularity (CenDI with ITIM rho = 0.48, p = .008 and with IINT rho = 0.56, p = .002; SD of CenDI with ITIM rho = 0.47, p = .010, and SD of ConDI with IINT rho = 0.37, p = .048). Childhood Trauma Questionnaire showed associations with variation of sleep onset (rho = -0.51, p = .005) and with IFRQ (rho = 0.43, p = .023). CONCLUSIONS Late and variable phasing of sleep associated robustly with irregular pattern of eating. Larger data sets are warranted to enable the analysis of diagnostic subgroups, current medication, and current symptomatology and to confirm the likely bidirectional association between eating pattern stability and the timing of sleep.
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Affiliation(s)
- Outi Linnaranta
- Department of Psychiatry, Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Clément Bourguignon
- Department of Psychiatry, Douglas Mental Health University Institute, Montreal, QC, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
| | - Olivia Crescenzi
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | | | - Asli Buyukkurt
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Howard Steiger
- Department of Psychiatry, Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Eating Disorders Continuum, Douglas University Institute, Montreal, QC, Canada
| | - Kai-Florian Storch
- Department of Psychiatry, Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
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27
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Zafar M, Musa Omer EO, Hassan ME, Ansari K. Association of sleep disorder with academic performance among medical students in Sudan. RUSSIAN OPEN MEDICAL JOURNAL 2020. [DOI: 10.15275/rusomj.2020.0208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background — Sleep disorder is a common problem amongst medical students. The objective of this study is to determine the association of sleep disorder with academic performances among medical students in Sudan. Methods — A cross-sectional study was conducted in which 199 medical students were selected through simple random sampling techniques. Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale were used to assess the sleep pattern and daytime sleepiness respectively. Logistic regression analysis was used to determine the association of sleep disorder with academic performance. Results — Majority of the students (82.5%) suffered poor sleep quality and 56.5% were suffered from severe day time sleepiness. All the characteristics of sleep quality were associated with poor academic performance but only sleep duration, use of sleep medication, global PSQI score and day time sleepiness were a statistically significant association with poor academic performance. Conclusion — A high prevalence of sleep disorder and its associated with poor academic performance was found in medical students. There is a need for a formulation of policies to address the factors which affect sleep of students.
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28
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Simon SL, Behn CD, Laikin A, Kaar JL, Rahat H, Cree-Green M, Wright KP, Nadeau KJ. Sleep & Circadian Health are Associated with Mood & Behavior in Adolescents with Overweight/Obesity. Behav Sleep Med 2020; 18:550-559. [PMID: 31218887 PMCID: PMC6923622 DOI: 10.1080/15402002.2019.1629444] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE/BACKGROUND Rates of overweight/obesity and insufficient/delayed sleep are high among adolescents and are also unique risk factors for mood/behavior difficulties. This study aimed to evaluate relationships between sleep/circadian health and mood/behavior in a cohort of adolescents with overweight/obesity. PARTICIPANTS Twenty-two adolescents (16.4 ± 1.1 years) with overweight/obesity attending high school completed in the study. METHODS Participants completed one week of home sleep monitoring (actigraphy), questionnaires assessing chronotype (diurnal preference; Morningness/Eveningness Scale for Children) and mood/behavior (Strengths & Difficulties Questionnaire), and had in-laboratory salivary melatonin sampling on a Thursday or Friday during the academic year. RESULTS Linear regressions revealed later weekday bedtime and shorter weekday time in bed and sleep duration were associated with worse mood/behavior scores. Shorter duration of melatonin secretion and greater "eveningness" were also associated with worse mood/behavior scores. CONCLUSIONS Short and late sleep, shorter melatonin secretion, and eveningness chronotype are associated with worse mood/behavior symptoms in a cohort of adolescents with overweight/obesity. Clinicians should assess for both sleep and mood/behavior symptoms and further research is needed to evaluate the impact of improved sleep on mood/behavior in adolescents with overweight/obesity.
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Affiliation(s)
- Stacey L. Simon
- Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children’s Hospital Colorado, Aurora, CO
| | - Cecilia Diniz Behn
- Department of Applied Mathematics & Statistics, Colorado School of Mines, Golden, CO
| | - Andrea Laikin
- Pediatric Mental Health Institute, Children’s Hospital Colorado, Aurora, CO
| | - Jill L. Kaar
- Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children’s Hospital Colorado, Aurora, CO
| | - Haseeb Rahat
- Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children’s Hospital Colorado, Aurora, CO
| | - Melanie Cree-Green
- Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children’s Hospital Colorado, Aurora, CO
| | - Kenneth P. Wright
- Sleep & Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO,Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kristen J. Nadeau
- Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children’s Hospital Colorado, Aurora, CO
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29
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Abstract
Circadian rhythms are observed in most physiologic functions across a variety of species and are controlled by a master pacemaker in the brain called the suprachiasmatic nucleus. The complex nature of the circadian system and the impact of circadian disruption on sleep, health, and well-being support the need to assess internal circadian timing in the clinical setting. The ability to assess circadian rhythms and the degree of circadian disruption can help in categorizing subtypes or even new circadian rhythm disorders and aid in the clinical management of the these disorders.
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Affiliation(s)
- Kathryn J Reid
- Department of Neurology, Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, 710 North Lakeshore Drive, Abbott Hall Room 522, Chicago, IL 60611, USA.
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30
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Bailey O, Combs D, Sans-Fuentes M, Havens CM, Grandner MA, Poongkunran C, Patel S, Berryhill S, Provencio N, Quan SF, Parthasarathy S. Delayed Sleep Time in African Americans and Depression in a Community-Based Population. J Clin Sleep Med 2019; 15:857-864. [PMID: 31138383 DOI: 10.5664/jcsm.7836] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 02/08/2019] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVES Studies have shown racial differences in circadian rhythm in African Americans when compared to non-Hispanic whites, and an association between circadian dyssynchrony and depression. We hypothesized that the prevalence of delayed sleep time is greater in African Americans when compared to whites and that delayed sleep time is associated with depression. METHODS We analyzed data from the Sleep Heart Health Study (SHHS), a large community-based sample. Delayed sleep time was defined as self-reported weeknight bedtime after midnight. Depression was defined based on participant's response to the question, "In the past 4 weeks have you felt downhearted and blue?" or reported antidepressant use. We performed multivariate linear and logistic regression, adjusting for age, sex, race, body mass index, smoking, apnea-hypopnea index, alcohol use, and caffeine consumption. RESULTS Adjusted weekday bedtime was 15 ± 7 minutes later in African Americans compared to whites (P < .001). Similarly, weekend bedtime was 18 ± 7 minutes later in African Americans compared to whites (P = .025). The prevalence of delayed sleep time was greater in African Americans (33.3%) compared to whites (18.7%; P < .001). After adjusting for confounders, when compared to whites, a greater proportion of African Americans had delayed sleep time (adjusted odds ratio [aOR] 2.03; 95% confidence interval [95% CI] 1.5, 2.4; P < .0001). Depression was independently associated with delayed sleep time after adjustment (aOR 1.4; 95% CI 1.1, 1.7; P = .007). CONCLUSIONS African Americans are more likely to have a delayed sleep time compared to whites, and delayed sleep time was independently associated with depression.
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Affiliation(s)
- Omavi Bailey
- UAHS Center for Sleep and Circadian Sciences, University of Arizona, Tucson, Arizona.,Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Arizona, Tucson, Arizona
| | - Daniel Combs
- UAHS Center for Sleep and Circadian Sciences, University of Arizona, Tucson, Arizona.,Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Arizona, Tucson, Arizona.,Department of Pediatrics, University of Arizona, Tucson, Arizona
| | - Maria Sans-Fuentes
- UAHS Center for Sleep and Circadian Sciences, University of Arizona, Tucson, Arizona
| | - Cody M Havens
- UAHS Center for Sleep and Circadian Sciences, University of Arizona, Tucson, Arizona.,Department of Integrative Life Sciences, Virginia Commonwealth University, Richmond, Virginia.,Virginia Institute of Psychiatric, Behavioral, and Statistical Genetics, Virginia Commonwealth University, Richmond, Virginia
| | - Michael A Grandner
- UAHS Center for Sleep and Circadian Sciences, University of Arizona, Tucson, Arizona.,Department of Psychiatry, University of Arizona, Tucson
| | - Chithra Poongkunran
- UAHS Center for Sleep and Circadian Sciences, University of Arizona, Tucson, Arizona.,Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Arizona, Tucson, Arizona
| | - Sarah Patel
- UAHS Center for Sleep and Circadian Sciences, University of Arizona, Tucson, Arizona.,Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Arizona, Tucson, Arizona
| | - Sarah Berryhill
- UAHS Center for Sleep and Circadian Sciences, University of Arizona, Tucson, Arizona
| | - Natalie Provencio
- UAHS Center for Sleep and Circadian Sciences, University of Arizona, Tucson, Arizona
| | - Stuart F Quan
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Asthma and Airways Disorders Research Center, University of Arizona, Tucson, Arizona
| | - Sairam Parthasarathy
- UAHS Center for Sleep and Circadian Sciences, University of Arizona, Tucson, Arizona.,Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Arizona, Tucson, Arizona.,Asthma and Airways Disorders Research Center, University of Arizona, Tucson, Arizona
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31
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Asarnow LD, Bei B, Krystal A, Buysse DJ, Thase ME, Edinger JD, Manber R. Circadian Preference as a Moderator of Depression Outcome Following Cognitive Behavioral Therapy for Insomnia Plus Antidepressant Medications: A Report From the TRIAD Study. J Clin Sleep Med 2019; 15:573-580. [PMID: 30952216 DOI: 10.5664/jcsm.7716] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 01/07/2019] [Indexed: 01/24/2023]
Abstract
STUDY OBJECTIVES We previously presented results from a randomized controlled trial that examined the effects of antidepressant medication plus cognitive behavioral therapy for insomnia (CBT-I) among patients with major depressive disorder (MDD) and insomnia. The current secondary analysis aims to examine whether circadian preference moderated the reduction in depression and insomnia symptom severity during this trial. METHODS A total of 139 adult participants with MDD and insomnia disorder were treated with antidepressant medication and randomized to receive 7 sessions of CBT-I or a control therapy (CTRL). Circadian preference (eveningness) was measured using the Composite Scale of Morningness (CSM). Depression symptom severity was assessed using the Hamilton Depression Rating Scale (HDRS); insomnia symptom severity was assessed using the Insomnia Severity Inventory (ISI). The moderating role of circadian preference on changes in HRSD and ISI was assessed via latent growth models within the framework of structural equation modeling. RESULTS Greater evening preference was associated with smaller reduction in HDRS (P = .03) from baseline to week 6 across treatment groups. The interaction between CSM and treatment group was also significant (P = .02), indicating that participants with greater evening preference in the CTRL group had significantly smaller HDRS reduction than those with greater evening preference in the CBT-I group. Circadian preference did not share significant associations with ISI (all P > .30). CONCLUSIONS Individuals with MDD and insomnia who have an evening preference are at increased risk for poor response to pharmacological depression treatment augmented with either CBT-I or CTRL behavioral insomnia treatment. However, evening types have better depression outcomes when treated with CBT-I than with CTRL for insomnia.
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Affiliation(s)
- Lauren D Asarnow
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California
| | - Bei Bei
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Andrew Krystal
- School of Medicine, University of California, San Francisco, California
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh, Pennsylvania
| | - Michael E Thase
- Department of Psychiatry, University of Pittsburgh, Pennsylvania
| | - Jack D Edinger
- Department of Medicine, National Jewish Health, Denver, Colorado.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Rachel Manber
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California
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32
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Ganesan S, Magee M, Stone JE, Mulhall MD, Collins A, Howard ME, Lockley SW, Rajaratnam SMW, Sletten TL. The Impact of Shift Work on Sleep, Alertness and Performance in Healthcare Workers. Sci Rep 2019; 9:4635. [PMID: 30874565 PMCID: PMC6420632 DOI: 10.1038/s41598-019-40914-x] [Citation(s) in RCA: 141] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 02/19/2019] [Indexed: 01/19/2023] Open
Abstract
Shift work is associated with impaired alertness and performance due to sleep loss and circadian misalignment. This study examined sleep between shift types (day, evening, night), and alertness and performance during day and night shifts in 52 intensive care workers. Sleep and wake duration between shifts were evaluated using wrist actigraphs and diaries. Subjective sleepiness (Karolinska Sleepiness Scale, KSS) and Psychomotor Vigilance Test (PVT) performance were examined during day shift, and on the first and subsequent night shifts (3rd, 4th or 5th). Circadian phase was assessed using urinary 6-sulphatoxymelatonin rhythms. Sleep was most restricted between consecutive night shifts (5.74 ± 1.30 h), consecutive day shifts (5.83 ± 0.92 h) and between evening and day shifts (5.20 ± 0.90 h). KSS and PVT mean reaction times were higher at the end of the first and subsequent night shift compared to day shift, with KSS highest at the end of the first night. On nights, working during the circadian acrophase of the urinary melatonin rhythm led to poorer outcomes on the KSS and PVT. In rotating shift workers, early day shifts can be associated with similar sleep restriction to night shifts, particularly when scheduled immediately following an evening shift. Alertness and performance remain most impaired during night shifts given the lack of circadian adaptation to night work. Although healthcare workers perceive themselves to be less alert on the first night shift compared to subsequent night shifts, objective performance is equally impaired on subsequent nights.
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Affiliation(s)
- Saranea Ganesan
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Victoria, Australia.,Monash Institute of Cognitive and Clinical Neurosciences and School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Michelle Magee
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Victoria, Australia.,Monash Institute of Cognitive and Clinical Neurosciences and School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Julia E Stone
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Victoria, Australia.,Monash Institute of Cognitive and Clinical Neurosciences and School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Megan D Mulhall
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Victoria, Australia.,Monash Institute of Cognitive and Clinical Neurosciences and School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Allison Collins
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Mark E Howard
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Victoria, Australia.,Monash Institute of Cognitive and Clinical Neurosciences and School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Steven W Lockley
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Victoria, Australia.,Monash Institute of Cognitive and Clinical Neurosciences and School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Shantha M W Rajaratnam
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Victoria, Australia.,Monash Institute of Cognitive and Clinical Neurosciences and School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Tracey L Sletten
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Victoria, Australia. .,Monash Institute of Cognitive and Clinical Neurosciences and School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.
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Lang Y, Zhang J, Yuan Z. Construction and dissection of the ceRNA‑ceRNA network reveals critical modules in depression. Mol Med Rep 2019; 19:3411-3420. [PMID: 30864711 PMCID: PMC6471059 DOI: 10.3892/mmr.2019.10009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 11/09/2018] [Indexed: 12/12/2022] Open
Abstract
The prevalence of mental health disorders such as depression is high. Depression is a multifactorial disorder and its underlying mechanisms remain unclear. Competing endogenous RNA (ceRNA) regulation has been reported to serve important roles in human disease. In the present study, ceRNA networks for depression and the corresponding normal physiological states were constructed. Further analysis of the ceRNA networks revealed that ceRNA regulation may be important for depression. Hub ceRNAs including high mobility group nucleosomal binding domain 3, peroxisome proliferator-activated receptor-γ coactivator 1β and leukemia inhibitory factor receptor-α were associated with depression. A common core ceRNA network was identified by comparison analysis. Functional analysis suggested that these ceRNAs may be implicated in depression. Differential expression analysis revealed that ceRNAs in the obtained ceRNA interaction networks were significantly enriched with significantly differentially expressed genes. A total of 8 key functional modules for depression were identified, and small target molecules were screened. ceRNA protocadherin-α subfamily C2 in module 1 and ceRNA Cyclin-dependent kinase 6 in module 3 were reported to be implicated in the occurrence and development of depressive disorders. Thus, the present analysis may provide insight into the pathogenesis of depression and improve its treatment.
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Affiliation(s)
- Yan Lang
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
| | - Jingchao Zhang
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
| | - Zheng Yuan
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
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Corona CC, Zhang M, Wadhawan A, Daue ML, Groer MW, Dagdag A, Lowry CA, Hoisington AJ, Ryan KA, Stiller JW, Fuchs D, Mitchell BD, Postolache TT. Toxoplasma gondii IgG associations with sleep-wake problems, sleep duration and timing. Pteridines 2019; 30:1-9. [PMID: 30918422 PMCID: PMC6433149 DOI: 10.1515/pteridines-2019-0001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Evidence links Toxoplasmagondii (T. gondii), a neurotropic parasite, with schizophrenia, mood disorders and suicidal behavior, all of which are associated and exacerbated by disrupted sleep. Moreover, low-grade immune activation and dopaminergic overstimulation, which are consequences of T. gondii infection, could alter sleep patterns and duration. Methods: Sleep data on 833 Amish participants [mean age (SD) = 44.28 (16.99) years; 59.06% women] were obtained via self-reported questionnaires that assessed sleep problems, duration and timing. T. gondii IgG was measured with ELISA. Data were analyzed using multivariable logistic regressions and linear mixed models, with adjustment for age, sex and family structure. Results: T. gondii seropositives reported less sleep problems (p < 0.005) and less daytime problems due to poor sleep (p < 0.005). Higher T. gondii titers were associated with longer sleep duration (p < 0.05), earlier bedtime (p< 0.005) earlier mid-sleep time (p < 0.05). Conclusions: It seems unlikely that sleep mediates the previously reported associations between T. gondii and mental illness. Future longitudinal studies with objective measures are necessary to replicate our findings.
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Affiliation(s)
- Celine C Corona
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Man Zhang
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimers, MD 21201, USA
| | - Abhishek Wadhawan
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA, Saint Elizabeths Hospital, Psychiatry Residency Program, Washington, DC 20032, USA
| | - Melanie L Daue
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimers, MD 21201, USA, Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA, Geriatrics Research and Education Clinical Center, Veteran Affairs Medical Center, Baltimore, MD 21201, USA
| | - Maureen W Groer
- College of Nursing, University of South Florida College of Nursing, Tampa, FL 33612, USA
| | - Aline Dagdag
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA, Psychiatry Adult Inpatient & Behavioral Health, University of Maryland Medical Center, Baltimore, MD 21201, USA
| | - Christopher A Lowry
- Department of Integrative Physiology and Center for Neuroscience, University of Colorado Boulder, Boulder, CO 80309, USA; Department of Physical Medicine and Rehabilitation and Center for Neuroscience, University of Colorado Anschutz Medical Campus, Aurora, CO80045, USA, Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Military and Veteran. Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO80 045, USA
| | - Andrew J Hoisington
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Military and Veteran. Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO80 045, USA, Department of Systems Engineering and Management, Air Force Institute of Technology, Wright-Patterson AFB, OH 45433, USA
| | - Kathleen A Ryan
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimers, Md 21201, USA, Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - John W Stiller
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA, Saint Elizabeths Hospital, Department of Neurology, Washington DC 20032, USA; Maryland State Athletic Commission, Baltimore, MD 21202, USA
| | - Dietmar Fuchs
- Division of Biological Chemistry, Biocenter, Innsbruck Medical University, Innsbruck, Austria
| | - Braxton D Mitchell
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimers, MD 21201, USA, Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA, Geriatrics Research and Education Clinical Center, Veteran Affairs Medical Center, Baltimore, MD 21201, USA
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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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Reis C, Paiva T. Delayed sleep-wake phase disorder in a clinical population: gender and sub-population diferences. ACTA ACUST UNITED AC 2019; 12:203-213. [PMID: 31890097 PMCID: PMC6932846 DOI: 10.5935/1984-0063.20190086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective/Background Delayed sleep-wake phase disorder (DSWPD) is defined by a delay in the major sleep episode relative to desired or required sleep and wake times. The objectives of this study were to evaluate DSWPD in our population and to compare it with similar clinical data, to analyse gender differences, and to identify possible subpopulations based on circadian timing and alignment. Patients/Methods 162 consecutive DSWPD patients from a sleep clinic with a median age of 35.5 (24.0) years, 85 (52.5%) males were studied. Patient data were obtained from a clinical interview composed of socio-demographic, life events, daily habits, consumptions, and comorbidities data; and from diaries, actimetry, melatonin and PSG T1. The Dim Light Melatonin Onset (DLMO) was used to define circadian alignment or misalignment. Results In our DSWPD cohort, there were gender differences for different age groups (p=0.028). Men were more likely to be single and women more likely to be married (p=0.034). In students, school failure was higher for women (p<0.001); for workers, absenteeism was higher in women (p=0.001). In the circadian aligned (compared to misaligned group), DLMO was later (p<0.001), sleep onset time (p=0.046) was later, total sleep time (p=0.035), and number of sleep cycles (p=0.018) were lower, as measured using PSG T1. Conclusions In this clinical population, DSWPD is more prevalent in young men and in middle age women, although with no overall significant differences between genders. There are two different phenotypes of DSWPD: circadian misaligned and circadian aligned. Depression is prevalent in both groups. Better definition, classification and diagnostic criteria for DSWPD are still needed, and targeted therapeutical intervention should be evaluated.
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Affiliation(s)
- Cátia Reis
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa - Lisboa- Portugal.,CENC - Sleep Medicine Center - Lisboa - Portugal
| | - Teresa Paiva
- CENC - Sleep Medicine Center - Lisboa - Portugal
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37
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Abstract
Last year melatonin was 60 years old, or at least its discovery was 60 years ago. The molecule itself may well be almost as old as life itself. So it is time to take yet another perspective on our understanding of its functions, effects and clinical uses. This is not a formal review-there is already a multitude of systematic reviews, narrative reviews, meta-analyses and even reviews of reviews. In view of the extraordinary variety of effects attributed to melatonin in the last 25 years, it is more of an attempt to sort out some areas where a consensus opinion exists, and where placebo controlled, randomized, clinical trials have confirmed early observations on therapeutic uses. The current upsurge of concern about the multiple health problems associated with disturbed circadian rhythms has generated interest in related therapeutic interventions, of which melatonin is one. The present text will consider the physiological role of endogenous melatonin, and the mostly pharmacological effects of exogenous treatment, on the assumption that normal circulating concentrations represent endogenous pineal production. It will concentrate mainly on the most researched, and accepted area of therapeutic use and potential use of melatonin-its undoubted ability to realign circadian rhythms and sleep-since this is the author's bias. It will touch briefly upon some other systems with prominent rhythmic attributes including certain cancers, the cardiovascular system, the entero-insular axis and metabolism together with the use of melatonin to assess circadian status. Many of the ills of the developed world relate to deranged rhythms-and everything is rhythmic unless proved otherwise.
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38
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McGlashan EM, Poudel GR, Vidafar P, Drummond SPA, Cain SW. Imaging Individual Differences in the Response of the Human Suprachiasmatic Area to Light. Front Neurol 2018; 9:1022. [PMID: 30555405 PMCID: PMC6281828 DOI: 10.3389/fneur.2018.01022] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 11/13/2018] [Indexed: 01/10/2023] Open
Abstract
Circadian disruption is associated with poor health outcomes, including sleep and mood disorders. The suprachiasmatic nucleus (SCN) of the anterior hypothalamus acts as the master biological clock in mammals, regulating circadian rhythms throughout the body. The clock is synchronized to the day/night cycle via retinal light exposure. The BOLD-fMRI response of the human suprachiasmatic area to light has been shown to be greater in the night than in the day, consistent with the known sensitivity of the clock to light at night. Whether the BOLD-fMRI response of the human suprachiasmatic area to light is related to a functional outcome has not been demonstrated. In a pilot study (n = 10), we investigated suprachiasmatic area activation in response to light in a 30 s block-paradigm of lights on (100 lux) and lights off (< 1 lux) using the BOLD-fMRI response, compared to each participant's melatonin suppression response to moderate indoor light (100 lux). We found a significant correlation between activation in the suprachiasmatic area in response to light in the scanner and melatonin suppression, with increased melatonin suppression being associated with increased suprachiasmatic area activation in response to the same light level. These preliminary findings are a first step toward using imaging techniques to measure individual differences in circadian light sensitivity, a measure that may have clinical relevance in understanding vulnerability in disorders that are influenced by circadian disruption.
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Affiliation(s)
- Elise M McGlashan
- Monash Institute of Cognitive and Clinical Neurosciences and School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Govinda R Poudel
- Monash Institute of Cognitive and Clinical Neurosciences and School of Psychological Sciences, Monash University, Melbourne, VIC, Australia.,Sydney Imaging, The University of Sydney, Camperdown, NSW, Australia.,Mary Mackillop Institute of Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Parisa Vidafar
- Monash Institute of Cognitive and Clinical Neurosciences and School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Sean P A Drummond
- Monash Institute of Cognitive and Clinical Neurosciences and School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Sean W Cain
- Monash Institute of Cognitive and Clinical Neurosciences and School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
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Watson LA, Phillips AJK, Hosken IT, McGlashan EM, Anderson C, Lack LC, Lockley SW, Rajaratnam SMW, Cain SW. Increased sensitivity of the circadian system to light in delayed sleep-wake phase disorder. J Physiol 2018; 596:6249-6261. [PMID: 30281150 DOI: 10.1113/jp275917] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 09/21/2018] [Indexed: 01/08/2023] Open
Abstract
KEY POINTS This is the first study to demonstrate an altered circadian phase shifting response in a circadian rhythm sleep disorder. Patients with delayed sleep-wake phase disorder (DSWPD) demonstrate greater sensitivity of the circadian system to the phase-delaying effects of light. Increased circadian sensitivity to light is associated with later circadian timing within both control and DSWPD groups. DSWPD patients had a greater sustained pupil response after light exposure. Treatments for DSWPD should consider sensitivity of the circadian system to light as a potential underlying vulnerability, making patients susceptible to relapse. ABSTRACT Patients with delayed sleep-wake phase disorder (DSWPD) exhibit delayed sleep-wake behaviour relative to desired bedtime, often leading to chronic sleep restriction and daytime dysfunction. The majority of DSWPD patients also display delayed circadian timing in the melatonin rhythm. Hypersensitivity of the circadian system to phase-delaying light is a plausible physiological basis for DSWPD vulnerability. We compared the phase shifting response to a 6.5 h light exposure (∼150 lux) between male patients with diagnosed DSWPD (n = 10; aged 20.8 ± 2.3 years) and male healthy controls (n = 11; aged 22.4 ± 3.3 years). Salivary dim light melatonin onset (DLMO) was measured under controlled conditions in dim light (<3 lux) before and after light exposure. Correcting for the circadian time of the light exposure, DSWPD patients exhibited 31.5% greater phase delay shifts than healthy controls. In both groups, a later initial melatonin phase was associated with a greater magnitude phase shift, indicating that increased circadian sensitivity to light may be a factor that contributes to delayed phase, even in non-clinical groups. DSWPD patients also had reduced pupil size following the light exposure, and showed a trend towards increased melatonin suppression during light exposure. These findings indicate that, for patients with DSWPD, assessment of light sensitivity may be an important factor that can inform behavioural therapy, including minimization of exposure to phase-delaying night-time light.
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Affiliation(s)
- Lauren A Watson
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Andrew J K Phillips
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Ihaia T Hosken
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Elise M McGlashan
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Clare Anderson
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Leon C Lack
- Adelaide Institute for Sleep Health, School of Medicine, Flinders University, Adelaide, South Australia
| | - Steven W Lockley
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Shantha M W Rajaratnam
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Sean W Cain
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
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40
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Liou TG. The Clinical Biology of Cystic Fibrosis Transmembrane Regulator Protein: Its Role and Function in Extrapulmonary Disease. Chest 2018; 155:605-616. [PMID: 30359614 DOI: 10.1016/j.chest.2018.10.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 10/08/2018] [Accepted: 10/10/2018] [Indexed: 02/07/2023] Open
Abstract
Normal cystic fibrosis (CF) transmembrane regulator (CFTR) protein has multiple functions in health and disease. Many mutations in the CFTR gene produce abnormal or absent protein. CFTR protein dysfunction underlies the classic CF phenotype of progressive pulmonary and GI pathology but may underlie diseases not usually associated with CF. This review highlights selected extrapulmonary disease that may be associated with abnormal CFTR. Increasing survival in CF is associated with increasing incidence of diseases associated with aging. CFTR dysfunction in older individuals may have novel effects on glucose metabolism, control of insulin release, regulation of circadian rhythm, and cancer cell pathophysiology. In individuals who have cancers with acquired CFTR suppression, their tumors may more likely exhibit rapid expansion, epithelial-to-mesenchymal transformation, abnormally reduced apoptosis, and increased metastatic potential. The new modulators of CFTR protein synthesis could facilitate the additional exploration needed to better understand the unfolding clinical biology of CFTR in human disease, even as they revolutionize treatment of patients with CF.
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Affiliation(s)
- Theodore G Liou
- Center for Quantitative Biology, The Adult Cystic Fibrosis Center and the Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT.
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Circadian rhythms and psychiatric profiles in young adults with unipolar depressive disorders. Transl Psychiatry 2018; 8:213. [PMID: 30301878 PMCID: PMC6177460 DOI: 10.1038/s41398-018-0255-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 08/05/2018] [Accepted: 08/09/2018] [Indexed: 12/11/2022] Open
Abstract
Abnormalities in circadian rhythms have been reported in people with mood disorders, but these abnormalities are marked by considerable inter-individual variability. This study aimed to identify pathophysiological subgroups on the basis of circadian markers and evaluate how these subgroups relate to psychiatric profiles. Thirty-five young adults (18-31 years old) receiving clinical care for unipolar depressive disorders and 15 healthy controls took part to this study. The Hamilton Rating Scale for Depression and the Young Mania rating scale were used to evaluate the severity of mood symptoms in participants with depressive disorders. All participant underwent ambulatory sleep monitoring with actigraphy for about 12 days before attending a laboratory-based chronobiological assessment which included repeated salivary samples to determine dim light melatonin onset (DLMO) and continuous core body temperature (CBT) monitoring using an ingestible temperature sensor. Cluster analyses were conducted across all participants to identify subgroups with consistent circadian timing profiles based on DLMO and the nocturnal minima of CBT. Two clusters were identified: 'delayed' and 'conventional timing' circadian phase. Descriptive analyses showed that the delayed cluster was characterised by abnormal time relationships between circadian phase markers and the sleep-wake cycle. Importantly, individuals from the delayed cluster had worse depression severity (t(28) = -2.7, p = 0.011) and hypomanic symptoms (Z = -2.2, p = 0.041) than their peers with conventional circadian timing. These findings suggest that delayed and disorganised circadian rhythms may be linked to worse psychiatric profiles in young people with depressive disorders.
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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] [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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43
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Salazar ER, Richter HG, Spichiger C, Mendez N, Halabi D, Vergara K, Alonso IP, Corvalán FA, Azpeleta C, Seron-Ferre M, Torres-Farfan C. Gestational chronodisruption leads to persistent changes in the rat fetal and adult adrenal clock and function. J Physiol 2018; 596:5839-5857. [PMID: 30118176 DOI: 10.1113/jp276083] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 08/06/2018] [Indexed: 12/14/2022] Open
Abstract
KEY POINTS Light at night is essential to a 24/7 society, but it has negative consequences on health. Basically, light at night induces an alteration of our biological clocks, known as chronodisruption, with effects even when this occurs during pregnancy. Here we explored the developmental impact of gestational chronodisruption (chronic photoperiod shift, CPS) on adult and fetal adrenal biorhythms and function. We found that gestational chronodisruption altered fetal and adult adrenal function, at the molecular, morphological and physiological levels. The differences between control and CPS offspring suggest desynchronization of the adrenal circadian clock and steroidogenic pathway, leading to abnormal stress responses and metabolic adaptation, potentially increasing the risk of developing chronic diseases. ABSTRACT Light at night is essential to a 24/7 society, but it has negative consequences on health. Basically, light at night induces an alteration of our biological clocks, known as chronodisruption, with effects even when this occurs during pregnancy. Indeed, an abnormal photoperiod during gestation alters fetal development, inducing long-term effects on the offspring. Accordingly, we carried out a longitudinal study in rats, exploring the impact of gestational chronodisruption on the adrenal biorhythms and function of the offspring. Adult rats (90 days old) gestated under chronic photoperiod shift (CPS) decrease the time spent in the open arm zone of an elevated plus maze to 62% and increase the rearing time to 170%. CPS adults maintained individual daily changes in corticosterone, but their acrophases were distributed from 12.00 h to 06.00 h. CPS offspring maintained clock gene expression and oscillation, nevertheless no daily rhythm was observed in genes involved in the regulation and synthesis of steroids. Consistent with adult adrenal gland being programmed during fetal life, blunted daily rhythms of corticosterone, core clock gene machinery, and steroidogenic genes were observed in CPS fetal adrenal glands. Comparisons of the global transcriptome of CPS versus control fetal adrenal gland revealed that 1078 genes were differentially expressed (641 down-regulated and 437 up-regulated). In silico analysis revealed significant changes in Lipid Metabolism, Small Molecule Biochemistry, Cellular Development and the Inflammatory Response pathway (z score: 48-20). Altogether, the present results demonstrate that gestational chronodisruption changed fetal and adult adrenal function. This could translate to long-term abnormal stress responses and metabolic adaptation, increasing the risk of developing chronic diseases.
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Affiliation(s)
- E R Salazar
- Laboratorio de Cronobiología del Desarrollo, Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - H G Richter
- Laboratorio de Cronobiología del Desarrollo, Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - C Spichiger
- Laboratorio de Cronobiología del Desarrollo, Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - N Mendez
- Laboratorio de Cronobiología del Desarrollo, Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - D Halabi
- Laboratorio de Cronobiología del Desarrollo, Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - K Vergara
- Laboratorio de Cronobiología del Desarrollo, Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - I P Alonso
- Laboratorio de Cronobiología del Desarrollo, Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - F A Corvalán
- Laboratorio de Cronobiología del Desarrollo, Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - C Azpeleta
- Department of Basic Biomedical Sciences, Faculty of Biomedical Sciences and Health, European University of Madrid, Villaviciosa de Odón, Spain
| | - M Seron-Ferre
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - C Torres-Farfan
- Laboratorio de Cronobiología del Desarrollo, Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile.,Centro Interdisciplinario de Estudios del Sistema Nervioso (CISNe), Universidad Austral de Chile, Valdivia, Chile
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Abstract
PURPOSE OF REVIEW Evening chronotype is increasingly recognized as a correlate of, and perhaps a contributor to, mental illness. The current review evaluates recent evidence for the association between chronotype and mental illness and putative mechanisms underlying the association, while highlighting methodological advances and areas of research that are relatively under-examined in the literature. RECENT FINDINGS While evening chronotype is most consistently associated with severity of mood disorder symptoms, emerging evidence implicates evening chronotype as a transdiagnostic correlate of substance use severity, anxiety symptoms, attentional difficulties, and maladaptive behaviors such as aggression. Longitudinal studies point to the possibility that evening chronotype precedes problematic substance use, depression, and anxiety. Neural processes related to reward and affective regulation may underlie associations between evening chronotype and illness. The literature on chronotype and mental illness has evolved to (1) include associations with a broader range of psychiatric symptom profiles; (2) explore underlying mechanisms; and (3) expand on earlier research using objective measures and more sophisticated study designs. In addition to further mechanistic research, additional work is needed to examine the stability and key subcomponents of the chronotype construct, as well as more attention to pediatric and special populations. This research is needed to clarify the chronotype-mental health relationship, and to identify how, when, and what aspects of chronotype can be targeted via therapeutic interventions.
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Sletten TL, Magee M, Murray JM, Gordon CJ, Lovato N, Kennaway DJ, Gwini SM, Bartlett DJ, Lockley SW, Lack LC, Grunstein RR, Rajaratnam SMW. Efficacy of melatonin with behavioural sleep-wake scheduling for delayed sleep-wake phase disorder: A double-blind, randomised clinical trial. PLoS Med 2018; 15:e1002587. [PMID: 29912983 PMCID: PMC6005466 DOI: 10.1371/journal.pmed.1002587] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 05/15/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Delayed Sleep-Wake Phase Disorder (DSWPD) is characterised by sleep initiation insomnia when attempting sleep at conventional times and difficulty waking at the required time for daytime commitments. Although there are published therapeutic guidelines for the administration of melatonin for DSWPD, to our knowledge, randomised controlled trials are lacking. This trial tested the efficacy of 0.5 mg melatonin, combined with behavioural sleep-wake scheduling, for improving sleep initiation in clinically diagnosed DSWPD patients with a delayed endogenous melatonin rhythm relative to patient-desired (or -required) bedtime (DBT). METHODS This randomised, placebo-controlled, double-blind clinical trial was conducted in an Australian outpatient DSWPD population. Following 1-wk baseline, clinically diagnosed DSWPD patients with delayed melatonin rhythm relative to DBT (salivary dim light melatonin onset [DLMO] after or within 30 min before DBT) were randomised to 4-wk treatment with 0.5 mg fast-release melatonin or placebo 1 h before DBT for at least 5 consecutive nights per week. All patients received behavioural sleep-wake scheduling, consisting of bedtime scheduled at DBT. The primary outcome was actigraphic sleep onset time. Secondary outcomes were sleep efficiency in the first third of time in bed (SE T1) on treatment nights, subjective sleep-related daytime impairment (Patient Reported Outcomes Measurement Information System [PROMIS]), PROMIS sleep disturbance, measures of daytime sleepiness, clinician-rated change in illness severity, and DLMO time. FINDINGS Between September 13, 2012 and September 1, 2014, 307 participants were registered; 116 were randomised to treatment (intention-to-treat n = 116; n = 62 males; mean age, 29.0 y). Relative to baseline and compared to placebo, sleep onset occurred 34 min earlier (95% confidence interval [CI] -60 to -8) in the melatonin group. SE T1 increased; PROMIS sleep-related impairment, PROMIS sleep disturbance, insomnia severity, and functional disability decreased; and a greater proportion of patients showed more than minimal clinician-rated improvement following melatonin treatment (52.8%) compared to placebo (24.0%) (P < 0.05). The groups did not differ in the number of nights treatment was taken per protocol. Post-treatment DLMO assessed in a subset of patients (n = 43) was not significantly different between groups. Adverse events included light-headedness, daytime sleepiness, and decreased libido, although rates were similar between treatment groups. The clinical benefits or safety of melatonin with long-term treatment were not assessed, and it remains unknown whether the same treatment regime would benefit patients experiencing DSWPD sleep symptomology without a delay in the endogenous melatonin rhythm. CONCLUSIONS In this study, melatonin treatment 1 h prior to DBT combined with behavioural sleep-wake scheduling was efficacious for improving objective and subjective measures of sleep disturbances and sleep-related impairments in DSWPD patients with delayed circadian phase relative to DBT. Improvements were achieved largely through the sleep-promoting effects of melatonin, combined with behavioural sleep-wake scheduling. TRIAL REGISTRATION This trial was registered with the Australian New Zealand Clinical Trials Registry, ACTRN12612000425897.
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Affiliation(s)
- Tracey L. Sletten
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Victoria, Australia
- Cooperative Research Centre for Alertness, Safety and Productivity, Victoria, Australia
| | - Michelle Magee
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Victoria, Australia
- Cooperative Research Centre for Alertness, Safety and Productivity, Victoria, Australia
| | - Jade M. Murray
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Victoria, Australia
- Cooperative Research Centre for Alertness, Safety and Productivity, Victoria, Australia
| | - Christopher J. Gordon
- Cooperative Research Centre for Alertness, Safety and Productivity, Victoria, Australia
- CIRUS, Woolcock Institute of Medical Research, University of Sydney, New South Wales, Australia
- Sydney Nursing School, University of Sydney, New South Wales, Australia
| | - Nicole Lovato
- Cooperative Research Centre for Alertness, Safety and Productivity, Victoria, Australia
- School of Psychology, Faculty of Social and Behavioural Sciences, Flinders University, South Australia, Australia
| | - David J. Kennaway
- Robinson Research Institute, School of Medicine, Discipline of Obstetrics and Gynaecology, University of Adelaide, Adelaide, South Australia, Australia
| | - Stella M. Gwini
- Department of Epidemiology and Preventative Medicine, Monash University, Victoria, Australia
- University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Delwyn J. Bartlett
- CIRUS, Woolcock Institute of Medical Research, University of Sydney, New South Wales, Australia
| | - Steven W. Lockley
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Victoria, Australia
- Cooperative Research Centre for Alertness, Safety and Productivity, Victoria, Australia
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Division of Sleep Medicine, Harvard Medical School, Massachusetts, United States of America
| | - Leon C. Lack
- School of Psychology, Faculty of Social and Behavioural Sciences, Flinders University, South Australia, Australia
| | - Ronald R. Grunstein
- Cooperative Research Centre for Alertness, Safety and Productivity, Victoria, Australia
- CIRUS, Woolcock Institute of Medical Research, University of Sydney, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, New South Wales, Australia
| | - Shantha M. W. Rajaratnam
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Victoria, Australia
- Cooperative Research Centre for Alertness, Safety and Productivity, Victoria, Australia
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Division of Sleep Medicine, Harvard Medical School, Massachusetts, United States of America
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Hasler BP. Invited Commentary: "Bedroom Light Exposure at Night and the Incidence of Depressive Symptoms: A Longitudinal Study of the HEIJO-KYO Cohort". Am J Epidemiol 2018; 187:435-438. [PMID: 28992102 PMCID: PMC5860044 DOI: 10.1093/aje/kwx288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 06/16/2017] [Indexed: 12/18/2022] Open
Abstract
In modern society, we are increasingly disconnected from natural light/dark cycles and beset by round-the-clock exposure to artificial light. Light has powerful effects on physical and mental health, in part via the circadian system, and thus the timing of light exposure dictates whether it is helpful or harmful. In their compelling paper, Obayashi et al. (Am J Epidemiol. 2018;187(3):427-434.) offer evidence that light at night can prospectively predict an elevated incidence of depressive symptoms in older adults. Strengths of the study include the longitudinal design and direct, objective assessment of light levels, as well as accounting for multiple plausible confounders during analyses. Follow-up studies should address the study's limitations, including reliance on a global self-report of sleep quality and a 2-night assessment of light exposure that may not reliably represent typical light exposure. In addition, experimental studies including physiological circadian measures will be necessary to determine whether the light effects on depression are mediated through the circadian system or are so-called "direct" effects of light. In any case, these exciting findings could inform novel approaches to preventing depressive disorders in older adults.
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Affiliation(s)
- Brant P Hasler
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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47
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Simor P, Harsányi A, Csigó K, Miklós G, Lázár AS, Demeter G. Eveningness is associated with poor sleep quality and negative affect in obsessive-compulsive disorder. J Behav Addict 2018; 7:10-20. [PMID: 29415552 PMCID: PMC6035014 DOI: 10.1556/2006.7.2018.07] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 01/18/2018] [Accepted: 01/21/2018] [Indexed: 11/19/2022] Open
Abstract
Background Obsessive-compulsive disorder (OCD) is characterized by intrusive thoughts and repetitive behaviors that severely encumber daily functioning. OCD patients seem to exhibit sleep disturbances, especially delayed bedtimes that reflect disrupted circadian rhythmicity. Morningness-eveningness is a fundamental factor reflecting individual variations in diurnal preferences related to sleep and waking activities. Eveningness reflecting a delayed sleep-wake timing has repeatedly been associated with sleep problems and negative affect (NA). Therefore, the aim of this study was to examine the associations between morningness-eveningness, sleep complaints, and symptom severity in OCD patients and compared with a mixed psychiatric control group. Materials and methods The data of 49 OCD and 49 mixed psychiatric inpatients (with unipolar depression and anxiety disorders) were analyzed. Patients completed questionnaires regarding morningness-eveningness, sleep quality, nightmare frequency, depression, anxiety, and affective states. Obsessive and compulsive symptom severity was also assessed within the OCD group by clinician-rated scales. Results Eveningness preference was associated with impaired sleep quality and higher NA in OCD patients. In addition, impaired sleep quality showed a moderate correlation with anxiety and strong correlations with depressive symptoms and NA. Interestingly, in the mixed psychiatric group, eveningness was not linked to NA, and sleep quality also showed weaker associations with depressive symptoms and NA. Within the OCD group, eveningness preference was predictive of poorer sleep quality regardless the influence of depressive symptoms. Conclusion Our findings suggest that eveningness and sleep complaints are predictive of affective dysfunctions, and should be carefully considered in the evaluation and treatment of OCD patients.
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Affiliation(s)
- Péter Simor
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
- Nyírő Gyula Hospital, National Institute of Psychiatry and Addictions, Budapest, Hungary
| | - András Harsányi
- Nyírő Gyula Hospital, National Institute of Psychiatry and Addictions, Budapest, Hungary
| | - Kata Csigó
- Nyírő Gyula Hospital, National Institute of Psychiatry and Addictions, Budapest, Hungary
| | | | - Alpár Sándor Lázár
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Gyula Demeter
- Department of Cognitive Sciences, Budapest University of Technology and Economics, Budapest, Hungary
- Rehabilitation Department of Brain Injuries, National Institute of Medical Rehabilitation, Budapest, Hungary
- Learning and Memory Disorders Research Group, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary
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48
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Advances of Melatonin-Based Therapies in the Treatment of Disturbed Sleep and Mood. Handb Exp Pharmacol 2018; 253:305-319. [PMID: 31123831 DOI: 10.1007/164_2018_139] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Melatonin and melatonin agonists offer novel treatments for sleep and mood disorders, particularly where circadian misalignment is also present. The therapies offer both phase-shifting and sleep-promoting effects and have shown potential to treat advanced and delayed sleep-wake phase disorder, non-24-h sleep-wake cycle, jetlag, shift work disorder, insomnia, seasonal affective disorder and major depressive disorder.
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49
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Abstract
Delayed sleep-wake phase disorder (DSWPD) is the most commonly encountered of the circadian rhythm sleep-wake disorders (CRSDs), and is often confused with sleep initiation insomnia. It typically emerges in teenage years and persists into adulthood. In essence, people with the disorder have an abnormally delayed major sleep episode relative to the dark phase of the solar cycle, and hence great difficulty initiating sleep at an appropriately early time, and, as a knock-on effect, waking at a desirable time in the morning, leading to chronic, and often quite severe sleep restriction trying to conform to a 9 to 5 schedule. As a result, sleep on free days is often extended in compensation. When released from such schedule constraints, sleep duration and quality is normal; it is just delayed. This review highlights elements of our current understanding of the epidemiology, associations and pathophysiology of the disorder, before discussing how some of our knowledge of sleep and circadian physiology can be applied to guide treatment of it.
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Affiliation(s)
- Alexander D Nesbitt
- Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Neurology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,SleepCity, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Circadian Rhythm Disturbances in Mood Disorders: Insights into the Role of the Suprachiasmatic Nucleus. Neural Plast 2017; 2017:1504507. [PMID: 29230328 PMCID: PMC5694588 DOI: 10.1155/2017/1504507] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 09/05/2017] [Accepted: 10/03/2017] [Indexed: 12/28/2022] Open
Abstract
Circadian rhythm disturbances are a common symptom among individuals with mood disorders. The suprachiasmatic nucleus (SCN), in the ventral part of the anterior hypothalamus, orchestrates physiological and behavioral circadian rhythms. The SCN consists of self-sustaining oscillators and receives photic and nonphotic cues, which entrain the SCN to the external environment. In turn, through synaptic and hormonal mechanisms, the SCN can drive and synchronize circadian rhythms in extra-SCN brain regions and peripheral tissues. Thus, genetic or environmental perturbations of SCN rhythms could disrupt brain regions more closely related to mood regulation and cause mood disturbances. Here, we review clinical and preclinical studies that provide evidence both for and against a causal role for the SCN in mood disorders.
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