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Abstract
Aspects of sleep change across the menstrual cycle in some women. Poorer sleep quality in the premenstrual phase and menstruation is common in women with premenstrual symptoms or painful menstrual cramps. Although objective sleep continuity remains unchanged across the regular, asymptomatic menstrual cycle, activity in the sleep electroencephalogram varies, with a prominent increase in sleep spindle activity in the postovulatory luteal phase, when progesterone is present, relative to the follicular phase. Menstrual cycle phase, reproductive stage, and menstrual-related disorders should be considered when assessing women's sleep complaints.
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Affiliation(s)
- Elisabet Alzueta
- Human Sleep Research Program, SRI International, Menlo Park, CA, USA
| | - Fiona C Baker
- Human Sleep Research Program, SRI International, Menlo Park, CA, USA; Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa.
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2
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Baker FC, Lee KA. Menstrual Cycle Effects on Sleep. Sleep Med Clin 2022; 17:283-294. [DOI: 10.1016/j.jsmc.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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3
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Yin W, Zhang J, Guo Y, Wu Z, Diao C, Sun J. Melatonin for premenstrual syndrome: A potential remedy but not ready. Front Endocrinol (Lausanne) 2022; 13:1084249. [PMID: 36699021 PMCID: PMC9868742 DOI: 10.3389/fendo.2022.1084249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 12/12/2022] [Indexed: 01/11/2023] Open
Abstract
Premenstrual syndrome (PMS), a recurrent and moderate disorder that occurs during the luteal phase of the menstrual cycle and quickly resolves after menstruation, is characterized by somatic and emotional discomfort that can be severe enough to impair daily activities. Current therapeutic drugs for PMS such as selective serotonin reuptake inhibitors are not very satisfying. As a critical pineal hormone, melatonin has increasingly been suggested to modulate PMS symptoms. In this review, we update the latest progress on PMS-induced sleep disturbance, mood changes, and cognitive impairment and provide possible pathways by which melatonin attenuates these symptoms. Moreover, we focus on the role of melatonin in PMS molecular mechanisms. Herein, we show that melatonin can regulate ovarian estrogen and progesterone, of which cyclic fluctuations contribute to PMS pathogenesis. Melatonin also modulates gamma-aminobutyric acid and the brain-derived neurotrophic factor system in PMS. Interpreting the role of melatonin in PMS is not only informative to clarify PMS etiology but also instructive to melatonin and its receptor agonist application to promote female health. As a safe interaction, melatonin treatment can be effective in alleviating symptoms of PMS. However, symptoms such as sleep disturbance, depressive mood, cognitive impairment are not specific and can be easily misdiagnosed. Connections between melatonin receptor, ovarian steroid dysfunction, and PMS are not consistent among past studies. Before final conclusions are drawn, more well-organized and rigorous studies are recommended.
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Affiliation(s)
- Wei Yin
- Shandong Key Laboratory of Mental Disorders, Department of Anatomy and Neurobiology, Shandong University, Jinan, Shandong, China
| | - Jie Zhang
- Department of Neurosurgery, Laizhou City People’s Hospital, Laizhou, Shandong, China
| | - Yao Guo
- Department of Psychiatry, Shandong Provincial Mental Health Center, Jinan, Shandong, China
| | - Zhibing Wu
- Department of Anatomy, Changzhi Medical College, Changzhi, Shanxi, China
| | - Can Diao
- School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Jinhao Sun
- Shandong Key Laboratory of Mental Disorders, Department of Anatomy and Neurobiology, Shandong University, Jinan, Shandong, China
- *Correspondence: Jinhao Sun,
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4
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Abstract
Declining female fertility has become a global health concern. It results partially from an abnormal circadian clock caused by unhealthy diet and sleep habits in modern life. The circadian clock system is a hierarchical network consisting of central and peripheral clocks. It not only controls the sleep-wake and feeding-fasting cycles but also coordinates and maintains the required reproductive activities in the body. Physiologically, the reproductive processes are governed by the hypothalamic-pituitary-gonadal (HPG) axis in a time-dependent manner. The HPG axis releases hormones, generates female characteristics, and achieves fertility. Conversely, an abnormal daily rhythm caused by aberrant clock genes or abnormal environmental stimuli contributes to disorders of the female reproductive system, such as polycystic ovarian syndrome and premature ovarian insufficiency. Therefore, breaking the "time code" of the female reproductive system is crucial. In this paper, we review the interplay between circadian clocks and the female reproductive system and present its regulatory principles, moving from normal physiology regulation to disease etiology.
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Affiliation(s)
- Shuyi Shao
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, China
- The Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, 200011, China
| | - Huanqiang Zhao
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, China
- The Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, 200011, China
| | - Zhiying Lu
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, China
- The Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, 200011, China
| | - Xiaohong Lei
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, China
- The Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, 200011, China
| | - Ying Zhang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, China
- The Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, 200011, China
- Correspondence: Dr. Ying Zhang, Obstetrics and Gynecology Hospital of Fudan University, Fangxie Road 419, Huangpu District, Shanghai, 200011, China.
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Moderie C, Boudreau P, Shechter A, Lesperance P, Boivin DB. Effects Of Exogenous Melatonin On Sleep And Circadian Rhythms In Women With Premenstrual Dysphoric Disorder. Sleep 2021; 44:6317701. [PMID: 34240212 DOI: 10.1093/sleep/zsab171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 07/01/2021] [Indexed: 12/18/2022] Open
Abstract
We previously found normal polysomnographic (PSG) sleep efficiency, increased slow wave sleep (SWS) and a blunted melatonin secretion in women with premenstrual dysphoric disorder (PMDD) compared to controls. Here, we investigated the effects of exogenous melatonin in five patients previously studied. They took 2 mg of slow-release melatonin 1 hour before bedtime during their luteal phase (LP) for three menstrual cycles. At baseline, patients spent every third night throughout one menstrual cycle sleeping in the laboratory. Measures included morning urinary 6-sulfatoxymelatonin (aMt6), PSG sleep, nocturnal core body temperature (CBT), visual analogue scale for mood (VAS-Mood), Prospective Record of the Impact and Severity of Menstrual Symptoms (PRISM), and ovarian hormones. Participants also underwent two 24-hour intensive physiological monitoring (during the follicular phase and LP) in time-isolation/constant conditions to determine 24-hour plasma melatonin and CBT rhythms. The same measures were repeated during their third menstrual cycle of melatonin administration. In the intervention condition compared to baseline, we found increased urinary aMt6 (p<0.001), reduced objective SOL (p=0.01), reduced SWS (p<0.001) and increased Stage 2 sleep (p<0.001). Increased urinary aMt6 was associated with reduced SWS (r=-0.51, p<0.001). Circadian parameters derived from 24-hour plasma melatonin and CBT did not differ between conditions, except for an increased melatonin mesor in the intervention condition (p=0.01). Ovarian hormones were comparable between the conditions (p≥0.28). Symptoms improved in the intervention condition, as measured by the VAS-Mood (p=0.02) and the PRISM (p<0.001). These findings support a role for disturbed melatonergic system in PMDD that can be partially corrected by exogenous melatonin.
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Affiliation(s)
- Christophe Moderie
- Centre For Study And Treatment Of Circadian Rhythms, Douglas Mental Health University Institute, Mcgill University, Montreal, Quebec, Canada.,Department Of Psychiatry, Mcgill University, Montreal, Quebec, Canada
| | - Philippe Boudreau
- Centre For Study And Treatment Of Circadian Rhythms, Douglas Mental Health University Institute, Mcgill University, Montreal, Quebec, Canada
| | - Ari Shechter
- Department Of Medicine, Columbia University, New York,NY, USA
| | - Paul Lesperance
- CHUM, Department Of Psychiatry, Université De Montréal, Quebec, Canada
| | - Diane B Boivin
- Centre For Study And Treatment Of Circadian Rhythms, Douglas Mental Health University Institute, Mcgill University, Montreal, Quebec, Canada.,Department Of Psychiatry, Mcgill University, Montreal, Quebec, Canada
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6
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Amiel Castro RT, Ehlert U, Fischer S. Variation in genes and hormones of the hypothalamic-pituitary-ovarian axis in female mood disorders - A systematic review and meta-analysis. Front Neuroendocrinol 2021; 62:100929. [PMID: 34171352 DOI: 10.1016/j.yfrne.2021.100929] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/02/2021] [Accepted: 06/20/2021] [Indexed: 11/28/2022]
Abstract
Women's increased risk for depression during reproductive transitions suggests an involvement of the hypothalamic-pituitary-ovarian (HPO) axis. This is the first systematic review and meta-analysis of HPO functioning in female mood disorders. Inclusionary criteria were: i) women suffering from premenstrual dysphoric disorder (PMDD) or a depressive disorder, ii) assessment of HPO-axis related biomarkers, iii) a case-control design. Sixty-three studies (N = 5,129) were included. There was evidence for PMDD to be paralleled by lower luteal oestradiol levels. Women with depression unrelated to reproductive transition showed lower testosterone levels than healthy controls and there was some evidence for lower dehydroepiandrosterone sulfate levels. There were no differences in HPO-related parameters between women with pregnancy, postpartum, and perimenopausal depression and controls. Women with PMDD and depression unrelated to reproductive transitions exhibit specific changes in the HPO-axis, which potentially contribute to their symptoms. Further research into reproductive mood disorders characterised by extreme endocrine changes is warranted.
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Affiliation(s)
- Rita T Amiel Castro
- University of Zurich, Institute of Psychology, Clinical Psychology and Psychotherapy, Binzmühlestrasse 14/26, 8050-Zurich, Switzerland.
| | - Ulrike Ehlert
- University of Zurich, Institute of Psychology, Clinical Psychology and Psychotherapy, Binzmühlestrasse 14/26, 8050-Zurich, Switzerland
| | - Susanne Fischer
- University of Zurich, Institute of Psychology, Clinical Psychology and Psychotherapy, Binzmühlestrasse 14/26, 8050-Zurich, Switzerland
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7
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Affiliation(s)
- Bei Bei
- Melbourne School of Psychological Sciences, University of Melbourne,
- Centre for Women's Mental Health, Royal Women's Hospital,
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University,
| | - Soledad Coo
- Melbourne School of Psychological Sciences, University of Melbourne,
| | - Fiona C Baker
- Center for Health Sciences, SRI International,
- Brain Function Research Group, School of Physiology, University of the Witwatersrand,
| | - John Trinder
- Melbourne School of Psychological Sciences, University of Melbourne,
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8
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Meers JM, Nowakowski S. Sleep, premenstrual mood disorder, and women’s health. Curr Opin Psychol 2020; 34:43-9. [DOI: 10.1016/j.copsyc.2019.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/05/2019] [Accepted: 09/05/2019] [Indexed: 01/20/2023]
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9
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Baglioni C, Bostanova Z, Bacaro V, Benz F, Hertenstein E, Spiegelhalder K, Rücker G, Frase L, Riemann D, Feige B. A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials Evaluating the Evidence Base of Melatonin, Light Exposure, Exercise, and Complementary and Alternative Medicine for Patients with Insomnia Disorder. J Clin Med 2020; 9:E1949. [PMID: 32580450 PMCID: PMC7356922 DOI: 10.3390/jcm9061949] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 12/15/2022] Open
Abstract
Insomnia is a prevalent disorder and it leads to relevant impairment in health-related quality of life. Recent clinical guidelines pointed out that Cognitive-Behavior Therapy for Insomnia (CBT-I) should be considered as first-line intervention. Nevertheless, many other interventions are commonly used by patients or have been proposed as effective for insomnia. These include melatonin, light exposure, exercise, and complementary and alternative medicine. Evaluation of comparable effectiveness of these interventions with first-line intervention for insomnia is however still lacking. We conducted a systematic review and network meta-analysis on the effects of these interventions. PubMed, PsycInfo, PsycArticles, MEDLINE, and CINAHL were systematically searched and 40 studies were included in the systematic review, while 36 were entered into the meta-analysis. Eight network meta-analyses were conducted. Findings support effectiveness of melatonin in improving sleep-onset difficulties and of meditative movement therapies for self-report sleep efficiency and severity of the insomnia disorder. Some support was observed for exercise, hypnotherapy, and transcranial magnetic resonance, but the number of studies for these interventions is still too small. None of the considered interventions received superior evidence to CBT-I, which should be more widely disseminated in primary care.
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Affiliation(s)
- Chiara Baglioni
- Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany; (Z.B.); (F.B.); (K.S.); (L.F.); (D.R.); (B.F.)
- Department of Human Sciences, Guglielmo Marconi University, 00193 Rome, Italy;
| | - Zarina Bostanova
- Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany; (Z.B.); (F.B.); (K.S.); (L.F.); (D.R.); (B.F.)
| | - Valeria Bacaro
- Department of Human Sciences, Guglielmo Marconi University, 00193 Rome, Italy;
| | - Fee Benz
- Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany; (Z.B.); (F.B.); (K.S.); (L.F.); (D.R.); (B.F.)
| | - Elisabeth Hertenstein
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3012 Bern, Switzerland;
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany; (Z.B.); (F.B.); (K.S.); (L.F.); (D.R.); (B.F.)
| | - Gerta Rücker
- Institute of Medical Biometry and Statistics, Medical Center, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany;
| | - Lukas Frase
- Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany; (Z.B.); (F.B.); (K.S.); (L.F.); (D.R.); (B.F.)
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany; (Z.B.); (F.B.); (K.S.); (L.F.); (D.R.); (B.F.)
| | - Bernd Feige
- Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany; (Z.B.); (F.B.); (K.S.); (L.F.); (D.R.); (B.F.)
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10
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Abstract
There has been increased interest in the measurement of melatonin in plasma and saliva recently either as a marker of circadian phase or to understand the physiological role of melatonin. For both situations, there is a need for a specific assay for melatonin that is sensitive enough to detect low concentrations (<2 pg/mL). Since the mid-1970s, there have been many assays developed to measure melatonin in blood and saliva. Radioimmunoassays and ELISA have predominated because of their relative simplicity and high throughput. In this review, I show that the early radioimmunoassays while providing valuable information about nocturnal melatonin levels in humans, generally produced inaccurate basal (daytime) levels. Mass spectrometry assays, however, have provided us with the target values that immunoassays need to achieve, that is, daytime plasma melatonin levels <1 pg/mL. There are now many contemporary commercial assays available utilising both RIA and ELISA technologies, but not all achieve the standards set by the mass spectrometry assays. The performance of these assays is reviewed. I conclude with recommendations on issues researchers need to consider when conducting melatonin studies, including the importance of time of day of collection, validation of assays, the potential causes of poor assay specificity at low levels, the advantages/disadvantages of using saliva vs plasma and extraction assays vs direct assays, kit manufacturers responsibilities and the reporting requirements when publishing melatonin studies.
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Affiliation(s)
- David J Kennaway
- Robinson Research Institute and Adelaide School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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Draper CF, Duisters K, Weger B, Chakrabarti A, Harms AC, Brennan L, Hankemeier T, Goulet L, Konz T, Martin FP, Moco S, van der Greef J. Menstrual cycle rhythmicity: metabolic patterns in healthy women. Sci Rep 2018; 8:14568. [PMID: 30275458 DOI: 10.1038/s41598-018-32647-0] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 09/12/2018] [Indexed: 12/20/2022] Open
Abstract
The menstrual cycle is an essential life rhythm governed by interacting levels of progesterone, estradiol, follicular stimulating, and luteinizing hormones. To study metabolic changes, biofluids were collected at four timepoints in the menstrual cycle from 34 healthy, premenopausal women. Serum hormones, urinary luteinizing hormone and self-reported menstrual cycle timing were used for a 5-phase cycle classification. Plasma and urine were analyzed using LC-MS and GC-MS for metabolomics and lipidomics; serum for clinical chemistries; and plasma for B vitamins using HPLC-FLD. Of 397 metabolites and micronutrients tested, 208 were significantly (p < 0.05) changed and 71 reached the FDR 0.20 threshold showing rhythmicity in neurotransmitter precursors, glutathione metabolism, the urea cycle, 4-pyridoxic acid, and 25-OH vitamin D. In total, 39 amino acids and derivatives and 18 lipid species decreased (FDR < 0.20) in the luteal phase, possibly indicative of an anabolic state during the progesterone peak and recovery during menstruation and the follicular phase. The reduced metabolite levels observed may represent a time of vulnerability to hormone related health issues such as PMS and PMDD, in the setting of a healthy, rhythmic state. These results provide a foundation for further research on cyclic differences in nutrient-related metabolites and may form the basis of novel nutrition strategies for women.
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13
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Tada Y, Yoshizaki T, Tomata Y, Yokoyama Y, Sunami A, Hida A, Kawano Y. The Impact of Menstrual Cycle Phases on Cardiac Autonomic Nervous System Activity: An Observational Study Considering Lifestyle (Diet, Physical Activity, and Sleep) among Female College Students. J Nutr Sci Vitaminol (Tokyo) 2018; 63:249-255. [PMID: 28978872 DOI: 10.3177/jnsv.63.249] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Studies examining the impact of menstrual cycle phases on the cardiac autonomic nervous system have produced inconsistent results. This study aimed to investigate this relationship, controlling for the confounding effects of diet, physical activity, and sleep, which can be affected by the menstrual cycle. Fifteen female college students with regular menses were enrolled. Data regarding 24-h heart rate variability (HRV), dietary intake, eating behavior, menstrual distress, and sleep and activity parameters were obtained during the follicular and luteal phases. Power spectral analysis of HRV was used to calculate low-frequency (0.04-0.15 Hz, LF), high-frequency (>0.15 Hz, HF), and total spectral power (TP). Cardiac sympathetic and parasympathetic nervous system activity indicators were evaluated as LF/HF and HF/TP, respectively. Intake of protein and fat, as well as total sleep time and number of awakenings, were higher in the luteal phase than in the follicular phase (p<0.05). Tendencies for increased mean activity counts, emotional eating scores, and behavioral change scores in the Menstrual Distress Questionnaire were observed in the luteal phase (p<0.10). Although LF/HF was higher in the luteal phase (p=0.036), the relationship was weakened after controlling for diet, physical activity, and sleep (p=0.113). Our findings suggest that altering sympathetic nervous system activity during the menstrual cycle was not independent from major lifestyle factors (diet, physical activity, and sleep). Menstrual cycle phase and changes of these parameters should be considered when assessing the cardiac autonomic function among menstruating woman.
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Affiliation(s)
- Yuki Tada
- Department of Nutritional Science, Faculty of Applied Bioscience, Tokyo University of Agriculture
| | | | - Yasutake Tomata
- Division of Epidemiology, Tohoku University School of Public Health, Graduate School of Medicine
| | - Yuri Yokoyama
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology
| | - Ayaka Sunami
- Graduate School of Agriculture, Tokyo University of Agriculture
| | - Azumi Hida
- Department of Nutritional Science, Faculty of Applied Bioscience, Tokyo University of Agriculture
| | - Yukari Kawano
- Department of Nutritional Science, Faculty of Applied Bioscience, Tokyo University of Agriculture
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Cuesta M, Boudreau P, Cermakian N, Boivin DB. Rapid resetting of human peripheral clocks by phototherapy during simulated night shift work. Sci Rep 2017; 7:16310. [PMID: 29176713 DOI: 10.1038/s41598-017-16429-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/08/2017] [Indexed: 11/22/2022] Open
Abstract
A majority of night shift workers have their circadian rhythms misaligned to their atypical schedule. While bright light exposure at night is known to reset the human central circadian clock, the behavior of peripheral clocks under conditions of shift work is more elusive. The aim of the present study was to quantify the resetting effects of bright light exposure on both central (plasma cortisol and melatonin) and peripheral clocks markers (clock gene expression in peripheral blood mononuclear cells, PBMCs) in subjects living at night. Eighteen healthy subjects were enrolled to either a control (dim light) or a bright light group. Blood was sampled at baseline and on the 4th day of simulated night shift. In response to a night-oriented schedule, the phase of PER1 and BMAL1 rhythms in PBMCs was delayed by ~2.5–3 h (P < 0.05), while no shift was observed for the other clock genes and the central markers. Three cycles of 8-h bright light induced significant phase delays (P < 0.05) of ~7–9 h for central and peripheral markers, except BMAL1 (advanced by +5h29; P < 0.05). Here, we demonstrate in humans a lack of peripheral clock adaptation under a night-oriented schedule and a rapid resetting effect of nocturnal bright light exposure on peripheral clocks.
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Verkaik S, Kamperman AM, van Westrhenen R, Schulte PF. The treatment of premenstrual syndrome with preparations of Vitex agnus castus: a systematic review and meta-analysis. Am J Obstet Gynecol 2017; 217:150-166. [PMID: 28237870 DOI: 10.1016/j.ajog.2017.02.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/05/2017] [Accepted: 02/15/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Premenstrual syndrome is characterized by the cyclic occurrence of physical, behavioral and psychological symptoms during the luteal phase of the menstrual cycle disappearing within a few days of the onset of menstruation. Generally symptoms are mild, but 5-8% of women suffer from severe PMS. Apart from conventional drugs, like serotonin reuptake inhibitors and oral contraceptives, complementary and alternative medicines such as Vitex agnus castus are used by many women experiencing PMS. OBJECTIVE Our objective was to determine the efficacy, tolerability, and acceptability of Vitex agnus castus preparations for treatment of premenstrual syndrome. STUDY DESIGN All journals in the Ovid software from inception through January 2016 were searched, including the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and PsycINFO. Gray literature was searched by Google Scholar and manufacturers of Vitex agnus castus preparations were contacted for information about unpublished trials. We included randomized controlled trials with Vitex agnus castus in women with premenstrual syndrome and/or premenstrual dysphoric disorder with a minimal duration of 2 menstrual cycles. The eligibility of the manuscripts was assessed by 2 reviewers independently. The data abstracted included characteristics of the study design, characteristics of the patient population, intervention details, type of comparator, method of diagnosis, and outcome measures. We adhered to the PRISMA guidelines. RESULTS We found 17 randomized controlled trials of Vitex agnus castus in the treatment of premenstrual syndrome. Fourteen of these could be included in the quantitative analysis. Thirteen of 14 studies with placebo, dietary supplements, or herbal preparations as controls reported positive effects of Vitex agnus castus on total premenstrual syndrome symptoms. Unfortunately most of the trials are associated with a high risk of bias. The pooled effect of Vitex agnus castus in placebo-controlled trials was large (Hedges g, -1.21; 95% confidence interval, -1.53 to -0.88), but heterogeneity was extremely high (I2, 91%). We were unable to single out factors that could explain this heterogeneity satisfactorily. The funnel plot and Egger tests suggest the presence of publication bias. CONCLUSION Although meta-analysis shows a large pooled effect of Vitex agnus castus in placebo-controlled trials, the high risk of bias, high heterogeneity, and risk of publication bias of the included studies preclude a definitive conclusion. The pooled treatment effects should be viewed as merely explorative and, at best, overestimating the real treatment effect of Vitex agnus castus for premenstrual syndrome symptoms. There is a clear need for high-quality trials of appropriate size examining the effect of standardized extracts of Vitex agnus castus in comparison to placebo, selective serotonin reuptake inhibitors, and oral contraceptives to establish relative efficacy.
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Abstract
Body temperature is known to vary with circadian phase and to be influenced by factors that can mask its circadian expression. We wanted to test whether skin temperature rhythms were sensitive to an abrupt shift of the sleep schedule and to the resetting effects of light. Nineteen healthy subjects spent 6 days in time isolation and underwent a simulated night-shift procedure. They were assigned to either a control group ( n = 10) or bright light group ( n = 9) and measurements were taken under a baseline day-oriented schedule and during the 4th cycle of a night-oriented schedule. In the bright light group, participants were exposed to a 3-cycle 8-h exposure of ~6,500 lux at night, while the control group remained in dim light conditions (~3 lux). Skin temperature was recorded in 10 and 4 participants from the control and bright light groups, respectively. We found significant circadian rhythms of plasma melatonin, core body temperature (CBT), and skin temperature at baseline for both groups ( p < 0.001 for all). Rhythms of melatonin, CBT, and skin temperature following night shifts were significantly phase delayed by about 7 to 9 h ( p < 0.05) in response to bright light at night, whereas there was no shift in the control group. In addition, we found that at bedtime melatonin does not consistently increase before the increase in distal skin temperature and subsequent decrease in CBT, in contrast to what has been previously reported. The present study shows that, in constant posture conditions, skin temperature rhythms have an evoked component sensitive to abrupt changes in the timing of sleep. They also comprise an endogenous component that is sensitive to the resetting effects of bright light exposure. These results have applications for the determination of circadian phase, as skin temperature is less intrusive than rectal temperature recordings.
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Affiliation(s)
- Marc Cuesta
- Centre for Study and Treatment of Circadian Rhythms, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Québec, Canada.,Laboratory of Molecular Chronobiology, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Québec, Canada
| | - Philippe Boudreau
- Centre for Study and Treatment of Circadian Rhythms, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Québec, Canada
| | - Nicolas Cermakian
- Laboratory of Molecular Chronobiology, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Québec, Canada
| | - Diane B Boivin
- Centre for Study and Treatment of Circadian Rhythms, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Québec, Canada
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Cuesta M, Boudreau P, Dubeau-Laramée G, Cermakian N, Boivin DB. Simulated Night Shift Disrupts Circadian Rhythms of Immune Functions in Humans. J Immunol 2016; 196:2466-75. [PMID: 26873990 DOI: 10.4049/jimmunol.1502422] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 01/04/2016] [Indexed: 12/19/2022]
Abstract
Recent research unveiled a circadian regulation of the immune system in rodents, yet little is known about rhythms of immune functions in humans and how they are affected by circadian disruption. In this study, we assessed rhythms of cytokine secretion by immune cells and tested their response to simulated night shifts. PBMCs were collected from nine participants kept in constant posture over 24 h under a day-oriented schedule (baseline) and after 3 d under a night-oriented schedule. Monocytes and T lymphocytes were stimulated with LPS and PHA, respectively. At baseline, a bimodal rhythmic secretion was detected for IL-1β, IL-6, and TNF-α: a night peak was primarily due to a higher responsiveness of monocytes, and a day peak was partly due to a higher proportion of monocytes. A rhythmic release was also observed for IL-2 and IFN-γ, with a nighttime peak due to a higher cell count and responsiveness of T lymphocytes. Following night shifts, with the exception of IL-2, cytokine secretion was still rhythmic but with peak levels phase advanced by 4.5-6 h, whereas the rhythm in monocyte and T lymphocyte numbers was not shifted. This suggests distinct mechanisms of regulation between responsiveness to stimuli and cell numbers of the human immune system. Under a night-oriented schedule, only cytokine release was partly shifted in response to the change in the sleep-wake cycle. This led to a desynchronization of rhythmic immune parameters, which might contribute to the increased risk for infection, autoimmune diseases, cardiovascular and metabolic disorders, and cancer reported in shift workers.
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Affiliation(s)
- Marc Cuesta
- Centre for Study and Treatment of Circadian Rhythms, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec H4H 1R3, Canada; and Laboratory of Molecular Chronobiology, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec H4H 1R3, Canada
| | - Philippe Boudreau
- Centre for Study and Treatment of Circadian Rhythms, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec H4H 1R3, Canada; and
| | - Geneviève Dubeau-Laramée
- Laboratory of Molecular Chronobiology, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec H4H 1R3, Canada
| | - Nicolas Cermakian
- Laboratory of Molecular Chronobiology, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec H4H 1R3, Canada
| | - Diane B Boivin
- Centre for Study and Treatment of Circadian Rhythms, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec H4H 1R3, Canada; and
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Rajkumar RP, Sarkar S. Seasonality of Admissions for Mania: Results From a General Hospital Psychiatric Unit in Pondicherry, India. Prim Care Companion CNS Disord 2015; 17:15m01780. [PMID: 26644962 DOI: 10.4088/pcc.15m01780] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 03/02/2015] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Bipolar disorder is affected by variables that modulate circadian rhythm, including seasonal variations. There is evidence of a seasonal pattern of admissions of mania in various geographical settings, though its timing varies by region and climate. Variables such as age and gender have been shown to affect seasonality in some studies. METHODOLOGY Data on monthly admission patterns for mania at a general hospital psychiatry unit in Pondicherry, India, were collected for 4 years (2010-2013) and analyzed for seasonality and seasonal peaks. The effects of age and gender were analyzed separately. RESULTS There was overall evidence of a seasonal pattern of admissions for mania (P < .01, Friedman test for seasonality), with a peak beginning during the rainy season and ending before summer (P < .0.1, Ratchet circular scan test). Male sex (P < .005, Ratchet circular scan test) and age > 25 years (P < .005, Ratchet circular scan test) were specifically associated with this seasonal peak. DISCUSSION The effect of seasons on mania is complex and is modulated by a variety of variables. Our study is consistent with earlier research findings: a greater degree of seasonality for mania in men. It is possible that climatic and individual variables interact to determine seasonal patterns in bipolar disorder in a given setting.
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Affiliation(s)
- Ravi Philip Rajkumar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Siddharth Sarkar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
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Cuesta M, Cermakian N, Boivin DB. Glucocorticoids entrain molecular clock components in human peripheral cells. FASEB J 2015; 29:1360-70. [PMID: 25500935 DOI: 10.1096/fj.14-265686] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 11/17/2014] [Indexed: 12/16/2023]
Abstract
In humans, shift work induces a desynchronization between the circadian system and the outside world, which contributes to shift work-associated medical disorders. Using a simulated night shift experiment, we previously showed that 3 d of bright light at night fully synchronize the central clock to the inverted sleep schedule, whereas the peripheral clocks located in peripheral blood mononuclear cells (PBMCs) took longer to reset. This underlines the need for testing the effects of synchronizers on both the central and peripheral clocks. Glucocorticoids display circadian rhythms controlled by the central clock and are thought to act as synchronizers of rodent peripheral clocks. In the present study, we tested whether the human central and peripheral clocks were sensitive to exogenous glucocorticoids (Cortef) administered in the late afternoon. We showed that 20 mg Cortef taken orally acutely increased PER1 expression in PBMC peripheral clocks. After 6 d of Cortef administration, the phases of central markers were not affected, whereas those of PER2-3 and BMAL1 expression in PBMCs were shifted by ∼ 9.5-11.5 h. These results demonstrate, for the first time, that human peripheral clocks are entrained by glucocorticoids. Importantly, they suggest innovative interventions for shift workers and jet-lag travelers, combining synchronizing agents for the central and peripheral clocks.
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Affiliation(s)
- Marc Cuesta
- *Centre for Study and Treatment of Circadian Rhythms, Laboratory of Molecular Chronobiology, and Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Nicolas Cermakian
- *Centre for Study and Treatment of Circadian Rhythms, Laboratory of Molecular Chronobiology, and Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Diane B Boivin
- *Centre for Study and Treatment of Circadian Rhythms, Laboratory of Molecular Chronobiology, and Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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Toffol E, Kalleinen N, Haukka J, Vakkuri O, Partonen T, Polo-Kantola P. The effect of hormone therapy on serum melatonin concentrations in premenopausal and postmenopausal women: a randomized, double-blind, placebo-controlled study. Maturitas 2014; 77:361-9. [PMID: 24602553 DOI: 10.1016/j.maturitas.2014.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/17/2014] [Accepted: 01/27/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Melatonin levels decrease physiologically with age, and possibly with the transition to menopause. The plausible influence of hormone therapy (HT) on melatonin is poorly understood. The aim of this randomized, placebo-controlled, double-blind trial was to investigate the effect of HT administration on serum melatonin concentrations in late premenopausal and postmenopausal women. STUDY DESIGN Analyses were carried out among 17 late premenopausal and 18 postmenopausal healthy women who participated in a prospective HT study in Finland. Serum melatonin was sampled at 20-min (21:00-24:00 h; 06:00-09:00 h) and 1-h (24:00-06:00 h) intervals at baseline and after 6 months with HT or placebo. MAIN OUTCOME MEASURES Melatonin levels and secretion profile after 6 months of HT compared to placebo. RESULTS Mean melatonin levels, mean melatonin exposure level (area under curve, AUC) and mean duration of melatonin secretion did not differ after 6 months with HT vs. placebo, irrespectively of the reproductive state. However, in postmenopausal women the melatonin peak time (acrophase) was delayed by 2.4h (2 h 21 min) on average after 6 months with HT vs. placebo (p<0.05). No interaction between time and group was detected when melatonin level was modelled before or after treatment. CONCLUSIONS Administration of HT to postmenopausal women alters melatonin peak time, but not melatonin levels. Further research on larger clinical samples is needed to better understand the effects of HT on melatonin profile.
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Affiliation(s)
- Elena Toffol
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare (THL), Mannerheimintie 170, Helsinki, Finland.
| | - Nea Kalleinen
- Sleep Research Unit, Department of Physiology, University of Turku, Lemminkäisenkatu 14-18A, 5th Floor, Turku, Finland; Heart Center, Turku University Hospital and University of Turku, PL 52, Turku, Finland
| | - Jari Haukka
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare (THL), Mannerheimintie 170, Helsinki, Finland; Department of Public Health, Hjelt Institute, University of Helsinki, Mannerheimintie 172, Helsinki, Finland
| | - Olli Vakkuri
- Department of Physiology, University of Oulu, Aapistie 7, Oulu, Finland
| | - Timo Partonen
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare (THL), Mannerheimintie 170, Helsinki, Finland
| | - Päivi Polo-Kantola
- Sleep Research Unit, Department of Physiology, University of Turku, Lemminkäisenkatu 14-18A, 5th Floor, Turku, Finland; Department of Obstetrics and Gynaecology, Turku University Central Hospital and University of Turku, PL 52, Turku, Finland
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