Circadian Health and Light: A Report on the National Heart, Lung, and Blood Institute's Workshop

Mediation and Dose-Response Relationship Among Physical Activity, Daylight Exposure, and Rest-Activity Circadian Rhythm in Patients With Esophageal and Gastric Cancer

BACKGROUND

Physical activity and daylight exposure predict rest-activity circadian rhythm (RACR) in patients with cancer. However, whether daylight exposure mediates the relationship between physical activity and RACR and the optimal amounts of physical activity and daylight that benefit RACR remain unclear.

OBJECTIVES

This study investigated the mediating role of daylight exposure and determined the dose-response relationship among daylight exposure, physical activity, and RACR in patients with cancer.

METHODS

This cross-sectional exploratory study recruited 319 patients with esophageal and gastric cancer from 2 surgery outpatient departments in Taiwan. Daylight exposure (>500 lux), physical activity (up activity mean), and RACR (midline estimating statistic of rhythm) were measured through actigraphy. Regression was performed, and the receiver operating characteristic curve was plotted.

RESULTS

Daylight exposure (>500 lux) partially mediated the relationship between physical activity (up activity mean) and RACR (midline estimating statistic of rhythm). The optimal cutoffs for discriminating between satisfactory and poor RACR were 187.43 counts/min for physical activity (sensitivity, 90.3%; specificity, 84.4%) and 35.71 min/d for daylight exposure (sensitivity, 55.9%; specificity, 78.2%).

CONCLUSIONS

Participants who engaged in physical activity were more likely to receive daylight exposure and experience improved RACR. The optimal level of daylight exposure and frequency of physical activity that can improve RACR in patients with esophageal and gastric cancer are 36 min/d and 187 counts/min, respectively.

IMPLICATIONS FOR PRACTICE

Healthcare professionals should encourage patients to engage in exercise or physical activity during the daytime to improve their circadian rhythm.

Characteristics of objectively-measured naturalistic light exposure patterns in U.S. adults: A cross-sectional analysis of two cohorts

Light is an environmental feature important for human physiology. Investigation of how light affects population health requires exposure assessment and personal biomonitoring efforts. Here, we derived measures of amount, duration, regularity, and timing from objective personal light (lux) measurement in >4000 participants across two United States (US)-based cohort studies, the Multi-Ethnic Study of Atherosclerosis (MESA) and the Hispanic Community Health Study / Study of Latinos (HCHS/SOL), encompassing eight geographic regions. Objective light and actigraphy data were collected over a week using wrist-worn devices (Actiwatch Spectrum). Cohort-stratified light exposure metrics were analyzed in relation to sex, season, time-of-day, location, and demographic and sleep health characteristics using Spearman correlation and linear and logistic regressions (separately by cohort) adjusted for age, sex (where applicable), and exam site. Light exposure showed sex-specific patterns and had seasonal, diurnal, geographic, and demographic and sleep health-related correlates. Results between independent cohorts were strongly consistent, supporting the utility and feasibility of light biomonitoring. These findings provide a fundamental first characterization of light exposure patterns in a large US sample and will inform future work to incorporate light as a biologically relevant exposure in environmental public health and key component of the human exposome.

Light Exposure Differs by Gender in the US: Women Have Less Bright Light Exposure than Men

Light is a salient environmental exposure, serving as the primary entraining cue for the circadian system and having other, non-circadian, effects on health. Gender differences in light exposure patterns could contribute to gender differences in health outcomes and would have important implications for sleep and circadian research. Gender differences in real-world light exposure (measured over a week with wrist-worn ActiGraph GT3X+ devices) were investigated in cross- sectional data from the 2011-2014 National Health and Nutrition Examination Survey (NHANES). Measures of time above light threshold (TALT), individual photoperiod (IP), first and last timing of light (FTL and LTL, respectively), and mean light timing revised (MLiTR) at different light intensity thresholds were derived. Gender differences in light exposure were tested using two-sample t-tests, Watson's two-sample test of homogeneity, and linear regression models. Exploratory analyses to investigate work and physical activity-related factors in relation to bright light exposure were also conducted. A total of 11,318 NHANES participants (age range: 3-80+, 52.2% women) with 6 days of valid actigraphy and light data were included in the analysis. The findings suggest that for every 60 minutes of bright light (≥1,000 lux) that men receive, women receive 39.6 minutes. Men spend approximately 52% more time in bright light than women and this gender difference begins in childhood. The IP of bright light exposure is also longer for men, with earlier first and later last timing of bright light exposure compared to women. These gender differences were robust across ages and between race and ethnicity groups. While further research is needed, these gender differences in light exposure may be due to gender differences in indoor vs. outdoor activities. Future studies of gender differences in response to light exposure should consider light exposure history in study design and analysis. The results of this study may inform future health disparities research and support the importance of the study of light as an important environmental exposure and component of the human exposome.

County-level artificial light at night (ALAN) in the contiguous US (2012-2019): spatial variations, temporal trends, and environmental justice analyses

Artificial light at night (ALAN) is a growing environmental hazard with economic, ecological, and public health implications. Previous studies suggested a higher burden of light pollution and related adverse effects in disadvantaged communities. It is critical to characterize the geographic distribution and temporal trend of ALAN and identify associated demographic and socioeconomic factors at the population level to lay the foundation for environmental and public health monitoring and policy-making. We used satellite data from the Black Marble suite to characterize ALAN in all counties in contiguous US and reported considerable variations in ALAN spatiotemporal patterns between 2012 and 2019. As expected, ALAN levels were generally higher in metropolitan and coastal areas; however, several rural counties in Texas experienced remarkable increase in ALAN since 2012, while population-level ALAN burden also increased substantially in many metropolitan areas. Importantly, we found that during this period, although the overall ALAN levels in the USA declined modestly, the temporal trend of ALAN varied across areas with different racial/ethnic compositions: counties with a higher percentage of racial/ethnic minority groups, particularly Hispanic populations, exhibited significantly less decline. As a result, the differences in ALAN levels, as measured by the Black Marble product, across racial/ethnic groups became larger between 2012 and 2019. In conclusion, our study documented variations in ALAN spatiotemporal patterns across America and identified multiple population correlates of ALAN patterns that warrant further investigations. Future studies should identify underlying factors (e.g., economic development and decline, urban planning, and transition to newer lighting technologies such as light emitting diodes) that may have contributed to ALAN disparities in the USA.

Associations of 24-Hour Light Exposure and Activity Patterns and Risk of Cognitive Impairment and Decline in Older Men: The MrOS Sleep Study

BACKGROUND

Older men with the worse alignment of activity and light may have lower levels of cognition and increased rates of cognitive decline.

METHODS

This cohort consisted of 1 036 older men (81.1 ± 4.6 years) from the MrOS Sleep Study (2009-2012). Light and activity levels were gathered by wrist actigraphy. Phasor analysis was used to quantify the alignment of light-dark and rest-activity patterns (magnitude) and their temporal relationship (angle). Global cognitive function (Modified Mini-Mental State examination [3MS]) and executive function (Trails B test) were measured, then repeated 4.2 ± 0.8 years later. Linear regression models examined the associations of phasor magnitude and angle with cognition and cognitive decline. Models were adjusted for age, clinic, race, education, and season.

RESULTS

Smaller phasor magnitude (worse aligned light and activity patterns) was associated with lower initial level and increased decline in executive function. Compared to those with higher phasor magnitude, those with lower magnitude took an average of 11.1 seconds longer to complete the Trails B test (quartile 1 vs quartile 4, p = .02). After follow-up, Trails B completion time increased an average of 5.5 seconds per standard deviation decrease in phasor magnitude (95% confidence interval [CI] 0.7-10.4, p = .03). There were no associations with phasor angle, and none with magnitude and global cognition (3MS).

CONCLUSION

Among older men, worse alignment of light and activity patterns was associated with worse initial performance and increased decline in executive function, but not related to global cognition. Interventions that improve the alignment of light and activity may slow cognitive decline in older adults.

Outdoor light at night and risk of liver cancer in the NIH-AARP diet and health study

PURPOSE

Accumulating evidence suggests that light at night (LAN) disrupts circadian rhythms and may increase risk of liver cancer. However, there is no population-based study that examined LAN and liver cancer risk. Therefore, we aimed to investigate the association between outdoor LAN and liver cancer risk in a prospective cohort.

METHODS

Residential outdoor LAN level was measured from satellite imagery in the NIH-AARP Diet and Health Study, a prospective cohort of 451,945 men and women, 50-71 years old. Relative risks (RR) and 95% confidence intervals (CIs) were estimated using Cox proportional hazard models that adjusted for known risk factors for liver cancer and neighborhood characteristics.

RESULTS

During an average 12.2 years of follow-up, 897 liver cancers, 603 of which were hepatocellular carcinomas (HCC), were diagnosed. Residential outdoor LAN was not associated with risk of liver cancer (RR_{Q5 vs Q1} = 0.96, 95% CI: 0.77-1.20, p trend = 0.771) or HCC (RR_{Q5 vs Q1} = 0.82, 95% CI: 0.62-1.07, p trend = 0.425).

CONCLUSION

No association between outdoor LAN and risk of liver cancer or HCC may in part be due to limitations in LAN assessment. More studies on the relationship between light intensity, duration, timing, and wavelength and liver cancer are warranted.

Light exposure during sleep impairs cardiometabolic function

SignificanceAmbient nighttime light exposure is implicated as a risk factor for adverse health outcomes, including cardiometabolic disease. However, the effects of nighttime light exposure during sleep on cardiometabolic outcomes and the related mechanisms are unclear. This laboratory study shows that, in healthy adults, one night of moderate (100 lx) light exposure during sleep increases nighttime heart rate, decreases heart rate variability (higher sympathovagal balance), and increases next-morning insulin resistance when compared to sleep in a dimly lit (<3 lx) environment. Moreover, a positive relationship between higher sympathovagal balance and insulin levels suggests that sympathetic activation may play a role in the observed light-induced changes in insulin sensitivity.

Recommendations for daytime, evening, and nighttime indoor light exposure to best support physiology, sleep, and wakefulness in healthy adults

Ocular light exposure has important influences on human health and well-being through modulation of circadian rhythms and sleep, as well as neuroendocrine and cognitive functions. Prevailing patterns of light exposure do not optimally engage these actions for many individuals, but advances in our understanding of the underpinning mechanisms and emerging lighting technologies now present opportunities to adjust lighting to promote optimal physical and mental health and performance. A newly developed, international standard provides a SI-compliant way of quantifying the influence of light on the intrinsically photosensitive, melanopsin-expressing, retinal neurons that mediate these effects. The present report provides recommendations for lighting, based on an expert scientific consensus and expressed in an easily measured quantity (melanopic equivalent daylight illuminance (melaponic EDI)) defined within this standard. The recommendations are supported by detailed analysis of the sensitivity of human circadian, neuroendocrine, and alerting responses to ocular light and provide a straightforward framework to inform lighting design and practice.

S-cone contribution to the acute melatonin suppression response in humans

Light influences diverse aspects of human physiology and behaviour including neuroendocrine function, the circadian system and sleep. A role for melanopsin-expressing intrinsically photosensitive retinal ganglion cells (ipRGCs) in driving such effects is well established. However, rod and/or cone signals routed through ipRGCs could also influence "non-visual" spectral sensitivity. In humans, this has been most extensively studied for acute, light-dependent, suppression of nocturnal melatonin production. Of the published action spectra for melatonin suppression, one demonstrates a spectral sensitivity consistent with that expected for melanopsin while our own (using briefer 30 minute light exposures) displays very high sensitivity to short wavelength light, suggesting a contribution of S-cones. To clarify that possibility, six healthy young male participants were each exposed to 30 minutes of five irradiances of 415 nm monochromatic light (1-40 µW/cm² ) across different nights. These data were then combined with the original action spectrum. The aggregated data are incompatible with the involvement of any single-opsin and multi-opsin models based on the original action spectrum (including Circadian Stimulus) fail to predict the responses to 415 nm stimuli. Instead, the extended action spectrum can be most simply approximated by an ~2:1 combination of melanopsin and S-cone signals. Such a model also better describes the magnitude of melatonin suppression observed in other studies using an equivalent 30 minute mono- or polychromatic light paradigm but not those using longer (90 minute) light exposures. In sum, these data provide evidence for an initial S-cone contribution to melatonin suppression that rapidly decays under extended light exposure.

The interindividual variability of sleep timing and circadian phase in humans is influenced by daytime and evening light conditions

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.

Bright daytime light enhances circadian amplitude in a diurnal mammal

Mammalian circadian rhythms are orchestrated by a master pacemaker in the hypothalamic suprachiasmatic nuclei (SCN), which receives information about the 24 h light-dark cycle from the retina. The accepted function of this light signal is to reset circadian phase in order to ensure appropriate synchronization with the celestial day. Here, we ask whether light also impacts another key property of the circadian oscillation, its amplitude. To this end, we measured circadian rhythms in behavioral activity, body temperature, and SCN electrophysiological activity in the diurnal murid rodent Rhabdomys pumilio following stable entrainment to 12:12 light-dark cycles at four different daytime intensities (ranging from 18 to 1,900 lx melanopic equivalent daylight illuminance). R. pumilio showed strongly diurnal activity and body temperature rhythms in all conditions, but measures of rhythm robustness were positively correlated with daytime irradiance under both entrainment and subsequent free run. Whole-cell and extracellular recordings of electrophysiological activity in ex vivo SCN revealed substantial differences in electrophysiological activity between dim and bright light conditions. At lower daytime irradiance, daytime peaks in SCN spontaneous firing rate and membrane depolarization were substantially depressed, leading to an overall marked reduction in the amplitude of circadian rhythms in spontaneous activity. Our data reveal a previously unappreciated impact of daytime light intensity on SCN physiology and the amplitude of circadian rhythms and highlight the potential importance of daytime light exposure for circadian health.

The Urban Observatory: A Multi-Modal Imaging Platform for the Study of Dynamics in Complex Urban Systems

We describe an “Urban Observatory” facility designed for the study of complex urban systems via persistent, synoptic, and granular imaging of dynamical processes in cities. An initial deployment of the facility has been demonstrated in New York City and consists of a suite of imaging systems—both broadband and hyperspectral—sensitive to wavelengths from the visible (∼400 nm) to the infrared (∼13 micron) operating at cadences of ∼0.01–30 Hz (characteristically ∼0.1 Hz). Much like an astronomical survey, the facility generates a large imaging catalog from which we have extracted observables (e.g., time-dependent brightnesses, spectra, temperatures, chemical species, etc.), collecting them in a parallel source catalog. We have demonstrated that, in addition to the urban science of cities as systems, these data are applicable to a myriad of domain-specific scientific inquiries related to urban functioning including energy consumption and end use, environmental impacts of cities, and patterns of life and public health. We show that an Urban Observatory facility of this type has the potential to improve both a city’s operations and the quality of life of its inhabitants.

Changing color and intensity of LED lighting across the day impacts on circadian melatonin rhythms and sleep in healthy men

We examined whether dynamically changing light across a scheduled 16-h waking day influences sleepiness, cognitive performance, visual comfort, melatonin secretion, and sleep under controlled laboratory conditions in healthy men. Fourteen participants underwent a 49-h laboratory protocol in a repeated-measures study design. They spent the first 5 hours in the evening under standard lighting, followed by an 8-h nocturnal sleep episode at habitual bedtimes. Thereafter, volunteers either woke up to static light or to a dynamic light that changed spectrum and intensity across the scheduled 16-h waking day. Following an 8-h nocturnal sleep episode, the volunteers spent another 11 hours either under static or dynamic light. Static light attenuated the evening rise in melatonin levels more compared to dynamic light as indexed by a significant reduction in the melatonin AUC prior to bedtime during static light only. Participants felt less vigilant in the evening during dynamic light. After dynamic light, sleep latency was significantly shorter in both the baseline and treatment night while sleep structure, sleep quality, cognitive performance, and visual comfort did not significantly differ. The study shows that dynamic changes in spectrum and intensity of light promote melatonin secretion and sleep initiation in healthy men.

A Quantitative General Population Job Exposure Matrix for Occupational Daytime Light Exposure

High daytime light levels may reduce the risk of affective disorders. Outdoor workers are during daytime exposed to much higher light intensities than indoor workers. A way to study daytime light exposure and disease on a large scale is by use of a general population job exposure matrix (JEM) combined with national employment and health data. The objective of this study was to develop a JEM applicable for epidemiological studies of exposure response between daytime light exposure, affective disorders, and other health effects by combining expert scores and light measurements. We measured light intensity during daytime work hours 06:00–17:59 for 1–7 days with Philips Actiwatch Spectrum® light recorders (Actiwatch) among 695 workers representing 71 different jobs. Jobs were coded into DISCO-88, the Danish version of the International Standard Classification of Occupations 1988. Daytime light measurements were collected all year round in Denmark (55–56°N). Arithmetic mean white light intensity (lux) was calculated for each hour of observation (n = 15,272), natural log-transformed, and used as the dependent variable in mixed effects linear regression models. Three experts rated probability and duration of outdoor work for all 372 jobs within DISCO-88. Their ratings were used to construct an expert score that was included together with month of the year and hour of the day as fixed effects in the model. Job, industry nested within job, and worker were included as random effects. The model estimated daytime light intensity levels specific for hour of the day and month of the year for all jobs with a DISCO-88 code in Denmark. The fixed effects explained 37% of the total variance: 83% of the between-jobs variance, 57% of the between industries nested in jobs variance, 43% of the between-workers variance, and 15% of the within-worker variance. Modeled daytime light intensity showed a monotonic increase with increasing expert score and a 30-fold ratio between the highest and lowest exposed jobs. Building construction laborers were based on the JEM estimates among the highest and medical equipment operators among the lowest exposed. This is the first quantitative JEM of daytime light exposure and will be used in epidemiological studies of affective disorders and other health effects potentially associated with light exposure.

[Treating circadian sleep-wake disorders by light]

Phototherapy is one treatment of circadian sleep-wake disorders, which is based on consensual and numerous scientific and clinical evidences. Phototherapy efficiency depends on several light characteristics based on intensity, length of exposure, time of exposure and wavelength. Phototherapy is potentially indicated in the following circadian disorders: advanced sleep-wake phase disorder (ASWPD), delayed sleep-wake phase disorder (DSWPD), non-24-hour sleep-wake rhythm disorder (N24SWD), jet-lag and night-shift work sleep-wake disorders (NSSWD). Phototherapy, acting via the retina, may be avoided in patients with retina disorders, an ophthalmologist should be consulted.