Evaluation of chronotype and sleep quality in infertile population and comparison with fertile population: a cross-sectional study

PURPOSE

Infertility is a stressful condition for couples and can affect patients' circadian rhythm and sleep quality. The goal of this study is to assess differences in chronotype and sleep quality between infertile and fertile people.

METHODS

A cross-sectional study was conducted. The infertile patient population consisted study group. Primiparous patients without any known gynecological disease who presented for routine cervical cancer screening follow-up were included in the control group. The Turkish version of the Morningness-Eveningness Questionnaire (MEQ) and Pittsburg Sleep Quality Index (PSQI) scores were evaluated between groups.

RESULTS

A total of 227 patients were assessed. There were 110 patients in the study (infertile) group and 117 patients in the control (fertile) group. The evening chronotype proportion (23.6 vs. 0.9%, p < 0.001) was higher in the infertile group. The median of MEQ score was significantly higher in the fertile patients (50, IQR = 43 - 55 vs. 56, IQR = 51 - 59; p < 0.001), and the median of PSQI score was significantly higher in the infertile patients (5, IQR = 4 - 6, vs. 4, IQR = 3 - 5; p < 0.001).

CONCLUSIONS

In this study, we found significantly worse sleep quality, and more evening chronotype in the patients with infertility.

The association between chronotype, sleep quality and medication errors among critical care nurses

Medication administration errors could result in severe complications in critical care units. This study investigated an association between chronotype, sleep quality and medication errors among essential nurses of care in Qazvin teaching hospitals in Iran. In this multicenter, cross-sectional study, all registered nurses of critical care units of Qazvin teaching hospitals were recruited. Data were collected through anonymous questionnaires, including socio-demographic data, Morning-Evening Questionnaire (MEQ), Pittsburgh Sleep Quality Index (PSQI) and medication errors data. Data were analyzed with SPSS v.24 by using the Chi-square test, Mann-Whitney U test, and logistic regression analysis. P values less than 0.05 were considered significant. The mean age and work experience were 33.12 ± 6.74 and 9.11 ± 5.96, respectively. One hundred sixty-six nurses (96%) have been working in rotating shifts. Nurses with intermediate chronotypes were predominant (n = 122; 70.5%). The majority of nurses (68.2%) had poor sleep quality (n = 118). Logistic regression analysis showed eveningness chronotype was associated with 4.743 fold increased risk of medication error (P < 0.033). No association was found between medication error and sleep quality (p < 0.95). There was no significant relationship between chronotype and sleep quality (P < 0.257). Our study showed that nurses with eveningness chronotype make more medication errors; therefore, considering the individual circadian preference before deciding on their shift timing assignment will be an important issue in reducing nurses' medication errors and improving patient safety in critical care units.

The circadian preferences in the context of sociodemographic indicators and lifestyle

Circadian preferences are frequently used as a synonym for chronotype. Both terms are based on different principles and are measured by a variant questionnaire. We focused on circadian preferences, delimited as an individual preference for the timing of various activities, and their relationship to the selected sociodemographic factors. All participants (n = 2068) filled out online questionnaires including MEQ, MCTQ, and sociodemographic information (age, sex, place of residence, marital status, childcare, education, financial security, physical and mental health). Although the concept of chronotype and circadian preference differ, the mutual correlation was high. Our results of the observed variables are similar to other studies. We revealed evening preference is related to a higher probability of living in a big city, having a single life, a higher risk of smoking, worse health status, and worse financial security. We observed a higher social jet lag among them. Our research complies with previous studies, which found that in some areas, people with evening preferences evince worse results. Due to the evening preference, these people are at a disadvantage, and the society's setting for morning operations can lead to a deepening of these differences. We recommend further research, which would focus on the practical application of results to the everyday life of participants to create preventive programs aimed at reducing the negative impact of evening preferences on life.

Mindful Eating Questionnaire: Validation and Reliability in Romanian Adults

Mindful eating may play an important role in long-term weight maintenance. In interventions aiming at weight reduction, increasing the levels of mindful eating was associated with higher levels of success and lower levels of weight rebound in the long run. This study aimed to determine the validity and reliability of a mindful eating questionnaire for Romanian adults using Framson's Mindful Eating Questionnaire (MEQ). To calculate the internal (n = 495) and external (n = 45) reliability, a general population sample was taken. Construct validity was assessed using the "known groups" method: dietitians (n = 70), sports professionals (n = 52), and individuals with overweight and obesity (n = 200). Convergent validity tested the association between the MEQ score and demographic characteristics of the total sample (n = 617). The internal (0.72) and external (0.83) reliability were adequate. Dietitians and sports professionals had overall lower scores, meaning more mindful eating compared to the group of individuals with overweight and obesity. The lower mindful eating practice was associated with the presence of excess weight, suboptimal health status perception, higher levels of stress and younger age. The Romanian version of the MEQ is a reliable and valid tool for measuring mindfulness of eating in adults.

Investigation of psychometric properties of the Mindful Eating Questionnaire in Chinese adolescents and young adults using mixed methods

Overweight and obesity are major public health challenges in China, and increasingly among young people. Valid measures are needed to examine the relationship between eating styles and weight to advance understanding and intervention. Mindful approaches show promise in weight management. This study aimed to investigate the psychometric properties of a Chinese version of Mindful Eating Questionnaire (C-MEQ). Study 1 used a think aloud methodology to examine Chinese young adults' (n = 7) and adolescents' (n = 10) comprehension of C-MEQ items. Findings informed revision of problematic items before a full validation study (Study 2) of the revised C-MEQ (C-MEQ-R) in a sample of 430 Chinese young adults. In Study 1, both groups misinterpreted ten items as asking about noticing about whether behaviour ever occurred rather than noticing experience, indicating the lack of content validity of the C-MEQ. Ten items were rephrased to emphasise mindful (intentional) noticing in the moment. In Study 2, confirmatory factor analysis revealed an inadequate fit to the original MEQ structure. Exploratory Structural Equation Model of the C-MEQ-R revealed five distinct domains. The C-MEQ-R showed better psychometric properties than the C-MEQ, and significant associations with mindfulness, emotional eating, external eating and BMI in expected directions. However, psychometric limitations including low internal reliability, inadequate coherence of the subscales and limited construct validity were identified. These findings contribute to the progress in the measurement of mindful eating by highlighting the weaknesses of the MEQ. Further research is called to adopt and validate alternative mindful eating measurements to assess mindful eating in Chinese adolescents and young adults.

First report of Serotype-1 Marek's disease virus (MDV-1) with oncogenic form in backyard turkeys in Turkey: a molecular analysis study

Background

Marek’s disease (MD) is a lymphoproliferative disease caused by Gallid alphaherpesvirus 2 (GaHV-2, MDV-1), which primarily affects chickens. However, the virus is also able to induce tumors and polyneuritis in turkeys, albeit less frequently than in chickens.

Results

This is the first study in Turkey reporting the molecular characterization of a MDV-1 strain detected in a flock of backyard turkeys exhibiting visceral lymphoma. Here, MEQ, vIL-8, pp38 and 132-bp tandem repeat regions, which are frequently preferred in the pathotyping of MDV-1, were examined. It was determined that the MEQ gene of MDV-1/TR-21/turkey strain obtained in the present study encoded 339 amino acids (1020 nt) and had four proline-rich repeat regions (PPPP). Based on the nucleotide sequence of the MEQ gene of the MDV-1/TR-21/turkey strain, a phylogenetic tree was created using the MEGA-X software with the Maximum Likelihood Method (in 1000 replicates). Our strain was highly identical (> 99.8) to the Italian/Ck/625/16, Polish (Polen5) and some Turkish (Layer-GaHV-2-02-TR-2017, Tr/MDV-1/19) MDV-1 strains. Also, nt and aa sequences of the MEQ gene of our strain were 99.1 and 99.41% identical to another Turkish strain (MDV/Tur/2019) originated from chickens. Sequence analysis of pp38 and vIL-8 genes also supported the above finding. The identity ratios of nucleotide and amino acid sequences of vIL-8 and pp38 genes of MDV-1/TR-21/turkey strain were 99.64–100% and 99.79–100%, respectively, when compared with those of the Polish strain. According to 132-bp tandem repeat PCR results, the MDV-1/TR-21/turkey strain had five copies.

Conclusions

These results suggested that the MDV-1/TR-21/turkey strain obtained from backyard turkeys can be either very virulent or very virulent plus pathotype, though experimental inoculation is required for precise pathotyping.

Chronotype, sleep quality and academic performances among Mizo students

Sleep is an essential component of the daily cycle. Age and puberty-related declines in sleep duration, delays in chronotype, and an increase in social jet lag have been consistently reported. This study examined chronotype and gender-based differences in adolescents' sleep quality, depression level, and academic achievements. Eight hundred fifteen school students (372 male and 443 female) aged 14 to 20 years voluntarily participated in this study. Horne and Östberg Morningness-Eveningness Questionnaire (MEQ) was used to measure their chronotype. Sleep duration, sleep quality, and daytime sleepiness were assessed by the Pediatric Daytime Sleepiness Scale (PDSS) and Epworth Sleepiness Scale (ESS). Pittsburgh's Sleep Quality Index (PSQI) was used to evaluate sleep habits. Cleveland Adolescent Sleepiness Questionnaire (CASQ) was used to measure the sleep pattern of the students. Zung Self-Rating Depression Scale (SDS) was used to assess the level of depression for the students. Our results show neither type of students dominated the population studied but interestingly, in comparison to evening type, morning type individuals were higher among the population. Chronotype-based sleep quality and academic performances were observed, and higher depression levels, poor sleep quality, poor academic performances were observed in evening type compared to neither type and morning type. In contrast to males, females had a poor sleep pattern (CASQ) and a higher depression level (SDS). Altogether, our study shows the effect of chronotype and gender on sleep quality and depression levels among school students.

Concordance of Chronotype Categorisations Based on Dim Light Melatonin Onset, the Morningness-Eveningness Questionnaire, and the Munich Chronotype Questionnaire

Chronotype reflects circadian timing and can be determined from biological markers (e.g., dim light melatonin onset; DLMO), or questionnaires (e.g., Morningness-Eveningness Questionnaire; MEQ, or Munich Chronotype Questionnaire; MCTQ). The study’s aim was to quantify concordance between chronotype categorisations based on these measures. A total of 72 (36f) young, healthy adults completed the MEQ and MCTQ and provided saliva samples hourly in dim light during the evening in a laboratory. The corrected midpoint of sleep on free days (MSF_sc) was derived from MCTQ, and tertile splits were used to define early, intermediate and late DLMO-CT, MEQ-CT and MSF_sc-CT chronotype categories. DLMO correlated with MEQ score (r = −0.25, p = 0.035) and MSF_sc (r = 0.32, p = 0.015). For early, intermediate and late DLMO-CT categories, mean(SD) DLMO were 20:25(0:46), 21:33(0:10) and 23:03(0:53). For early, intermediate and late MEQ-CT categories, mean(SD) MEQ scores were 60.5(5.3), 51.4(2.9) and 40.8 (5.0). For early, intermediate and late MSF_sc-CT categories, mean(SD) MSF_sc were 03:23(0:34), 04:37(0:12) and 05:55(0:48). Low concordance of categorisations between DLMO-CT and MEQ-CT (37%), and between DLMO-CT and MSF_sc-CT (37%), suggests chronotype categorisations depend on the measure used. To enable valid comparisons with previous results and reduce the likelihood of misleading conclusions, researchers should select measures and statistical techniques appropriate to the construct of interest and research question.

Chronobiological traits predict the restrained, uncontrolled, and emotional eating behaviors of female university students

Although significant associations between diurnal preference and restrained eating behaviors were previously reported, such reports are scarce and, in some respects, inconclusive. In this cross-sectional survey of 567 female university students aged between 17 and 23 years, we tried to clarify and extend the previous findings on chronobiological correlates of these behaviors. We administered the three-Factor-Eating-Questionnaire Revised and three questionnaires designed to assess trait-, ability-, and state-like differences in the domain of chronobiology, the Morningness-Eveningness Questionnaire (MEQ), the Sleep-Wake Pattern Assessment Questionnaire, and the Munich ChronoType Questionnaire, respectively. Statistical analyses included factor, correlation, and regression analyses. We found that any of three aspects of unhealthy eating behaviors (i.e., lack of cognitive eating restraint, uncontrolled eating, and emotional eating) was linked to one or more dimensions of individual chronobiological differences. We explained the previously reported inconclusive results by the differential relationship of two subconstructs of diurnal preferences to eating behaviors. For instance, such relationship was found for two (morning and evening) subscales of the MEQ. Cognitive eating restraint and uncontrolled eating were related to the morning subscale, while emotional eating was related to the evening subscale. These associations were supported by the associations revealed for morning vs. evening components of earliness-lateness assessed with two other questionnaires, (e.g., morning lateness and sleep offset vs. evening lateness and sleep onset, respectively). We conclude that unhealthy eating behaviors seem to be linked to unhealthy sleep-wake habits and behaviors and to inabilities to wake or sleep on demand at certain times of the day.

Genetic variants for morningness in relation to habitual sleep-wake behavior and diurnal preference in a population-based sample of 17,243 adults

OBJECTIVE

Associations of eveningness with health hazards benefit from analyzing to what extent the polygenic score for morningness correlates with the assessments of the behavioral trait of morningness-eveningness and chronotype.

METHODS

With a population-based sample of 17,243 Finnish adults, aged 25-74 years, this study examines the associations of four feasible assessment methods of chronotype, a) biological the genetic liability based on the polygenic score for morningness (PGS_morn), b) the widely-used single item for self-assessed morningness/eveningness (MEQ_i19) of the original Morningness-Eveningness Questionnaire (MEQ), c) the behavioral trait of morningness-eveningness as assessed with the score on the shortened version (sMEQ) of the original MEQ, and d) the phase of entrainment as assessed with the habitual midpoint of sleep based on the self-reported sleep-wake schedule during weekend (Sleep_mid-wknd) as well as the sleep debt corrected midpoint of sleep (Sleep_mid-corr).

RESULTS

All self-report measures correlated with each other, but very weakly with the PGS_morn, which explained 1-2% of the variation in diurnal preference or habitual sleep-wake schedule. The influence of age was greater on Sleep_mid-wknd and Sleep_mid-corr than on the sMEQ or MEQ_i19, indicating that the diurnal preference might be a more stable indicator for morningness-eveningness than the sleep-wake schedule. Analyses of the discrepancies between sMEQ and MEQ_i19 indicated that eveningness can be over-estimated when relying on only the single-item self-assessment.

CONCLUSIONS

The current polygenic score for morningness explains only a small proportion of the variation in diurnal preference or habitual sleep-wake schedule. The molecular genetic basis for morningness-eveningness needs further elucidation.

Reliability and Validity of the Malay Mindful Eating Questionnaire (MEQ-M) among Overweight and Obese Adults

The Mindful Eating Questionnaire is a reliable tool for the assessment of mindful eating behavior among the general population. This study aimed to determine the reliability and validity of The Malay Mindful Eating Questionnaire (MEQ-M) in a sample of overweight and obese adults. This is a cross-sectional survey which involved 144 overweight and obese adults in a selected public university. After linguistic validation of the Malay version of the MEQ, exploratory factor analysis (EFA) with varimax rotation was performed on the scale constructs. The psychometric properties of the MEQ were assessed through Cronbach’s alpha and intraclass correlation coefficient (ICC) analysis. The EFA of the MEQ produced a seven-dimensional model (58.8% of overall variances). The concurrent validity analysis between total MEQ scores and total Mindfulness Attention Awareness Scale (MAAS) scores indicated a weak non-significant correlation (p = 0.679). The internal consistency reliability of the MEQ was reasonable (Cronbach’s α = 0.64). The agreement stability of the MEQ over eight weeks was poor (ICC = 0.10). In conclusion, the psychometric properties of the Malay-translated MEQ are acceptable through construct validity and internal consistency reliability tests. This instrument may be used for assessing mindful eating habits in the Malaysian population, especially among overweight and obese adults.

Chronotype-Dependent Changes in Sleep Habits Associated with Dim Light Melatonin Onset in the Antarctic Summer

Dim light melatonin onset (DLMO) is the most reliable measure of human central circadian timing. Its modulation by light exposure and chronotype has been scarcely approached. We evaluated the impact of light changes on the interaction between melatonin, sleep, and chronotype in university students (n = 12) between the Antarctic summer (10 days) and the autumn equinox in Montevideo, Uruguay (10 days). Circadian preferences were tested by validated questionnaires. A Morningness–Eveningness Questionnaire average value (47 ± 8.01) was used to separate late and early participants. Daylight exposure (measured by actimetry) was significantly higher in Antarctica versus Montevideo in both sensitive time windows (the morning phase-advancing and the evening phase-delaying). Melatonin was measured in hourly saliva samples (18–24 h) collected in dim light conditions (<30 lx) during the last night of each study period. Early and late participants were exposed to similar amounts of light in both sites and time windows, but only early participants were significantly more exposed during the late evening in Antarctica. Late participants advanced their DLMO with no changes in sleep onset time in Antarctica, while early participants delayed their DLMO and sleep onset time. This different susceptibility to respond to light may be explained by a subtle difference in evening light exposure between chronotypes.

Rapid antidepressant effects of the psychedelic ayahuasca in treatment-resistant depression: a randomized placebo-controlled trial

BACKGROUND

Recent open-label trials show that psychedelics, such as ayahuasca, hold promise as fast-onset antidepressants in treatment-resistant depression.

METHODS

To test the antidepressant effects of ayahuasca, we conducted a parallel-arm, double-blind randomized placebo-controlled trial in 29 patients with treatment-resistant depression. Patients received a single dose of either ayahuasca or placebo. We assessed changes in depression severity with the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Hamilton Depression Rating scale at baseline, and at 1 (D1), 2 (D2), and 7 (D7) days after dosing.

RESULTS

We observed significant antidepressant effects of ayahuasca when compared with placebo at all-time points. MADRS scores were significantly lower in the ayahuasca group compared with placebo at D1 and D2 (p = 0.04), and at D7 (p < 0.0001). Between-group effect sizes increased from D1 to D7 (D1: Cohen's d = 0.84; D2: Cohen's d = 0.84; D7: Cohen's d = 1.49). Response rates were high for both groups at D1 and D2, and significantly higher in the ayahuasca group at D7 (64% v. 27%; p = 0.04). Remission rate showed a trend toward significance at D7 (36% v. 7%, p = 0.054).

CONCLUSIONS

To our knowledge, this is the first controlled trial to test a psychedelic substance in treatment-resistant depression. Overall, this study brings new evidence supporting the safety and therapeutic value of ayahuasca, dosed within an appropriate setting, to help treat depression. This study is registered at http://clinicaltrials.gov (NCT02914769).

Chronotype and response to training during the polar night: a pilot study

BACKGROUND

An individual's chronotype influences his or her physiological rhythms. Some studies have looked at the effect of time of day on the responses to exercise, but studies on the effect of long-term training are lacking.

OBJECTIVE

To report the effects of an 8-week training period during the polar night in non-athletes of different chronotypes living at 70°N.

DESIGN

In all, 10 morning (M), 10 neither (N) and 10 evening (E) types were recruited, and their aerobic capacity (VO_2max), strength, flexibility and balance before and after the training period were tested.

RESULTS

3 E-types, 5 N-types and 6 M-types completed the protocol. An increase in VO_2max and strength was observed for the whole group. The best negative correlation (r=-0.5287) was found between the Morningness-Eveningness Questionnaire (MEQ) score and the increase in VO2max, and the best positive correlation (r=0.4395) was found between MEQ and the increase in strength. Changes in balance and flexibility did not show any clear trends.

CONCLUSION

In an environment with no outdoor daylight, it seems that the response to 8 weeks of aerobic training is larger in the E- than in the M-types, although the M-types showed a larger improvement in strength.

Polycyclic aromatic hydrocarbons bound to outdoor and indoor airborne particles (PM2.5) and their mutagenicity and carcinogenicity in Silesian kindergartens, Poland

Assessment of exposure to polycyclic aromatic hydrocarbons (PAHs) is important due to the widespread presence of PAHs in the environment and their toxicological relevance, especially to susceptible populations such as children and their health. The aim of this study is to compare indoor and outdoor concentrations of particulate matter with a diameter of 2.5 μm or less (PM2.5) and 15 individual PAHs, as well as contribution of the analyzed PAHs to mutagenic and carcinogenic activity. Samples were collected during spring season in two sites in southern Poland (Silesia) representing urban and rural areas. Indoor samples of PM2.5 were sampled in kindergartens. At the same time, in the vicinity of the kindergarten buildings, the collection of the outdoor PM2.5 samples was carried out. Mutagenic (MEQ) and carcinogenic (TEQ) equivalents related to BaP and the percentage share expressed as mutagenic (MP) and carcinogenic (CP) potential of each individual compound to the total mutagenic/carcinogenic potential of the PAH mixture were calculated. The obtained results show that high concentrations of PM2.5 (above 25 μg/m³) and 15 PM2.5-bound PAHs in outdoor and indoor air were similar in the two studied areas. In overall PAHs mutagenic and carcinogenic potential, the percentage share of benzo(a)pyrene (BaP) was dominant and varied from 49.0-54.5% to 62.5-70.0%, respectively. The carried out study indicates the necessity of reducing PAH emission from solid fuel combustion, which is reflected in PM2.5-bound PAHs concentrations and their diagnostic ratios. In the recent years, health effects on children resulting from their activity pattern and air quality in the public places have been a serious problem.

Associations of pineal volume, chronotype and symptom severity in adults with attention deficit hyperactivity disorder and healthy controls

The pineal gland, as part of the human epithalamus, is the main production site of peripheral melatonin, which promotes the modulation of sleep patterns, circadian rhythms and circadian preferences (morningness vs. eveningness). The present study analyses the pineal gland volume (PGV) and its association with circadian preferences and symptom severity in adult ADHD patients compared to healthy controls. PGV was determined manually using high-resolution 3T MRI (T1-magnetization prepared rapid gradient echo) in medication free adult ADHD patients (N=74) compared to healthy controls (N=86). Moreover, the Morningness-Eveningness Questionnaire (MEQ), the ADHD Diagnostic Checklist and the Wender-Utah Rating Scale were conducted. PGV differed between both groups (patients: 59.9±33.8mm(3); healthy controls: 71.4±27.2mm(3), P=0.04). In ADHD patients, more eveningness types were revealed (patients: 29%; healthy controls: 17%; P=0.05) and sum scores of the MEQ were lower (patients: 45.8±11.5; healthy controls 67.2±10.1; P<0.001). Multiple regression analyses indicated a positive correlation of PGV and MEQ scores in ADHD (β=0.856, P=0.003) but not in healthy controls (β=0.054, P=0.688). Patients' MEQ scores (β=-0.473, P=0.003) were negatively correlated to ADHD symptoms. The present results suggest a linkage between the PGV and circadian preference in adults with ADHD and an association of the circadian preference to symptom severity. This may facilitate the development of new chronobiological treatment approaches for the add-on treatment in ADHD.

Examination of the reliability and validity of the Mindful Eating Questionnaire in pregnant women

OBJECTIVE

Mindfulness is theorized to affect the eating behavior and weight of pregnant women, yet no measure has been validated during pregnancy.

METHODS

This study qualitatively and quantitatively evaluated the reliability and validity of the Mindful Eating Questionnaire (MEQ) in overweight and obese pregnant women. Participants completed focus groups and cognitive interviews. The MEQ was administered twice to measure test-retest reliability. The Eating Inventory (EI) and Mindful Attention Awareness Scale (MAAS) were administered to assess convergent validity, and the Neighborhood Environment Walkability Scale (NEWS) assessed discriminant validity.

RESULTS

Participants were 20 ± 8 weeks gestation (mean ± SD), 30 ± 2 years old, and 55% were obese. The MEQ total score had good test-retest reliability (r = .85). The total score internal consistency reliability was poor (Cronbach's α = .56). The external cues subscale (ECS) was not internally consistent (α = .31). Other subscales ranged from α = .59-.68. When the ECS was excluded, the MEQ total score internal consistency was acceptable (α = .62). Convergent validity was supported by the MEQ total score (with and without ECS) correlating significantly with the MAAS and the EI disinhibition and hunger subscales. Discriminant validity of the MEQ was supported by the MEQ and NEWS total scores and subscales not being significantly correlated. The quantitative results were supported by the qualitative context and content analysis.

CONCLUSION

With the exception of the ECS, the MEQ's reliability and validity was supported in pregnant women, and most of the subscales were more robust in pregnant women than in the original sample of healthy adults. The MEQ's use with overweight and obese pregnant women is supported.

Chronotypes in patients with nonseasonal depressive disorder: Distribution, stability and association with clinical variables

The individual's chronotype is regarded as rather stable trait with substantial heritability and normal distribution of the "morningness-eveningness" dimension in the general population. Eveningness has been related to the risk of developing affective, particularly depressive, disorders. However, age and other sociobiological factors may influence chronotypes. The present study investigated the distribution, stability, and clinical correlates of chronotype and morningness-eveningness in hospitalized patients with affective disorder. Chronotype was assessed with the morningness-eveningness questionnaire (MEQ) in 93 patients with nonseasonal depressive syndrome (85% major depression; 15% depressive adjustment disorder) after admission, and in 19 patients again before discharge. Distribution, stability and correlations of MEQ scores with clinical variables were calculated. Additionally, a literature analysis of chronotype distributions in samples of nondepressed persons and patients with nonseasonal depression was carried out. MEQ scores (mean 49 ± 11, range 23-75, higher scores indicate morningness) in 93 acutely depressed inpatients (age 41 ± 14 years, range 18-75 years; 63% women; hospitalization 48 ± 22 days; BDI-II 32 ± 11) were normally distributed (Shapiro-Wilk test; W = 0.993, p = 0.920) with 59.1% intermediate types, 19.4% evening types, and 21.5% morning types. MEQ change scores from admission to discharge were nonsignificant (-1.3 ± 5.0; paired t-test, t18 = -1.09; p = 0.29) despite significantly improved depression scores (-19.4 ± 7.6; paired t-test, t18 = 11.2, p < 0.001). Age (r = 0.24), and depression scores (r = -0.21) correlated significantly (p < 0.05) with MEQ scores; associations with sex and hospitalization duration were nonsignificant. The present study and literature findings revealed that the frequency of evening types is not clearly elevated in depression, but morning types are less frequent compared to healthy samples (p < 0.001). Morningness-eveningness scores were normally distributed and stable in depressive inpatients. In line with previous findings, but contrary to theoretical assumptions, evening types were not overrepresented in depressed patients. Additionally, relatively less morning types and more intermediate types were found in depressed patients. Future studies should focus on transitions from morning to intermediate types as a tentative risk or correlate of emerging depression.

Chronotype in patients with epilepsy: A controlled study in 60 subjects with late-onset focal epilepsy

Studies based on self-administered questionnaires indicate that most patients with epilepsy are morning-oriented. We aimed to investigate chronotype in patients with epilepsy with late-onset focal epilepsy by combining subjective data with dim light melatonin onset (DLMO) as an objective marker of the circadian phase. Sixty adult patients (mean age 46.5±13.8; 27 males) with late-onset focal epilepsy under pharmacological treatment were prospectively studied. Subjective chronotype was determined using the Morningness-Eveningness Questionnaire (MEQ) and circadian phase through analysis of salivary melatonin secretion, considering 3pg/ml as the dim light melatonin onset (DLMO) threshold. The mean MEQ score was significantly higher in the patients with epilepsy than in the controls, and significantly, more patients had a MEQ score indicative of the morning type (50.0% vs 30.0%, p=0.02). However, no significant differences were found in mean time of DLMO (21:38±01:21 vs 21:26±01:03; p=ns), and DLMO time was in the range indicative of an intermediate chronotype in both patients and controls. Sleep onset and sleep offset phase angles were significantly shorter in the patients. Patients whose global MEQ score identified them as morning types were significantly older than those with an intermediate or evening chronotype, and they had less social jet lag. No difference in epilepsy features and treatments was found between morning-oriented and nonmorning-oriented patients. Our analyses showed that the patients with epilepsy tended to be morning-oriented and to perceive themselves as morning types, even though this was not reflected in their DLMO values which did not differ significantly from those of controls and mostly fell within the intermediate chronotype range. Several factors may considerably influence subjective chronotype. We speculate that, in patients with epilepsy, the disease itself, prompting certain lifestyle choices, including a regular sleep schedule and early bedtime, may induce morning orientation and a morning-type self-perception.

Habitual sleep/wake patterns in the Old Order Amish: heritability and association with non-genetic factors

STUDY OBJECTIVES

We sought to evaluate the contribution of genetic and non-genetic factors on habitual sleep/wake patterns in a community-dwelling agrarian population using a physical activity monitoring device, the Actical.

DESIGN

Cross-sectional population-based study of healthy Old Order Amish enrolled in the Heredity and Phenotype Intervention (HAPI) Heart Study.

SETTING

Lancaster County, PA, USA.

PARTICIPANTS

723 healthy adults (54% men) with a mean age of 43.3 ± 13.8 years (range: 20-80). 96% of the subjects were connected into one 5-generation pedigree.

INTERVENTIONS

N/A.

MEASUREMENTS

Participants wore Actical accelerometers 24 hours/day for 7 days to determine physical activity level, as well as habitual wake time, bedtime, and sleep duration. Participants completed the Horne-Östberg Morningness-Eveningness Questionnaire (MEQ), a modified Epworth Sleepiness Scale (ESS), and a lifestyle questionnaire. A sub-study of 164 participants kept sleep diaries.

RESULTS

Habitual wake time and bedtime determined by Actical were highly correlated with results from sleep diaries (r = 0.82 for wake time and 0.72 for bedtime, both P < 0.0001). After adjustment for age, sex, occupation, and season, higher activity level was associated with earlier wake time but not with bedtime, and correspondingly with shorter sleep duration. After adjustment for the aforementioned factors and the effects of a shared household, habitual wake time, MEQ score, and ESS score showed significant heritability (wake time h(2) = 0.20, MEQ h(2) = 0.21, and ESS h(2) = 0.17).

CONCLUSIONS

Objectively measured wake time, self-reported morningness-eveningness preference, and daytime sleepiness appear heritable and wake time may be associated with physical activity level.