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.

The impact of daylight-saving time (DST) on patients with delayed sleep-wake phase disorder (DSWPD).

Due to time zones, sun time and local time rarely match. The difference between local and sun time, which we designate by Solar Jet Lag (SoJL), depends on location within a time zone and can range from zero to several hours. Daylight saving time (DST) simply adds 1 h to SoJL, independently of the location. We hypothesised that the impact of DST is particularly problematic in patients with delayed sleep-wake phase disorder (DSWPD), worsening their sleep debt. DSWPD is characterised by a chronic misalignment between the internal and social timing, reflected by an inability to fall asleep and wake-up at conventional or socially acceptable times. We analysed the clinical records of 162 DSWPD patients from a sleep medicine centre in Lisbon, Portugal (GMTzone), and separated them into two groups: the ones diagnosed across DST or across Standard Time (ST). We included 82 patients (54.9% male; age: median [Q1 , Q3 ] 34.5 [25.0, 45.3]; range 16-92; 54 in DST and 28 in ST) who had Dim Light Melatonin Onset (DLMO) measured as a marker for the circadian phase and sleep timing (onset, SO, mid-point, MS and end, SE) self-reported separately for work- and work-free days. Differences between ST and DST were compared using Mann-Whitney or Student's t-tests. On a weekly average, patients in DST slept less (difference between medians of 37 min. p < .01), mainly due to sleep on workdays (SDw, p < .01), which also correlated with SoJL (rsp = .38, p < .01). While the time from DLMO to SO was similar in those in ST or those in DST, the time from DLMO to SE was significantly shorter for those in DST. The average duration between DLMO and sleep end was close to 10.5 h in ST, the biological night length described in the literature. Our results favour perennial ST and suggest assigning time-zones close to sun time to prevent social jetlag and sleep deprivation.

The circadian system, sleep, and the health/disease balance: a conceptual review.

The field of "circadian medicine" is a recent addition to chronobiology and sleep research efforts. It represents a logical step arising from the increasing insights into the circadian system and its interactions with life in urbanised societies; applying these insights to the health/disease balance at home and in the medical practice (outpatient) and clinic (inpatient). Despite its fast expansion and proliferating research efforts, circadian medicine lacks a formal framework to categorise the many observations describing interactions among the circadian system, sleep, and the health/disease balance. A good framework allows us to categorise observations and then assign them to one or more components with hypothesised interactions. Such assignments can lead to experiments that document causal (rather than correlational) relationships and move from describing observations to discovering mechanisms. This review details such a proposed formal framework for circadian medicine and will hopefully trigger discussion among our colleagues, so that the framework can be improved and expanded. As the basis of the framework for circadian medicine, we define "circadian health" and how it links to general health. We then define interactions among the circadian system, sleep, and the health/disease balance and put the framework into the context of the literature with examples from six domains of health/disease balance: fertility, cancer, immune system, mental health, cardiovascular, and metabolism.

Outdoor daylight exposure and longer sleep promote wellbeing under COVID-19 mandated restrictions.

Light is an important regulator of daily human physiology in providing time-of-day information for the circadian clock to stay synchronised with the 24-hr day. The coronavirus disease 2019 (COVID-19) pandemic led to social restrictions in many countries to prevent virus spreading, restrictions that dramatically altered daily routines and limited outdoor daylight exposure. We previously reported that sleep duration increased, social jetlag decreased, and mid-sleep times delayed during social restrictions (Global Chrono Corona Survey, N = 7,517). In the present study, we investigated in the same dataset changes in wellbeing and their link to outdoor daylight exposure, and sleep-wake behaviour. In social restrictions, median values of sleep quality, quality of life, physical activity and productivity deteriorated, while screen time increased, and outdoor daylight exposure was reduced by ~58%. Yet, many survey participants also reported no changes or even improvements. Larger reductions in outdoor daylight exposure were linked to deteriorations in wellbeing and delayed mid-sleep times. Notably, sleep duration was not associated with outdoor daylight exposure loss. Longer sleep and decreased alarm-clock use dose-dependently correlated with changes in sleep quality and quality of life. Regression analysis for each wellbeing aspect showed that a model with six predictors including both levels and their deltas of outdoor daylight exposure, sleep duration and mid-sleep timing explained 5%-10% of the variance in changes of wellbeing scores (except for productivity). As exposure to daylight may extenuate the negative effects of social restriction and prevent sleep disruption, public strategies during pandemics should actively foster spending more daytime outdoors.

Social jetlag, a novel predictor for high cardiovascular risk in blue-collar workers following permanent atypical work schedules.

Cardiovascular diseases cause >4 million deaths each year in Europe alone. Preventive approaches that do not only consider individual risk factors but their interaction, such as the Systematic COronary Risk Evaluation (SCORE), are recommended by European guidelines. Increased cardiovascular risk is associated with shift-work, surely interacting with the concurrent conditions: disruption of sleep, unhealthy behaviours, and circadian misalignment. Social jetlag (SJL) has been proposed as a way to quantify circadian misalignment. We therefore investigated the association between SJL and cardiovascular health in a cross-sectional observational study involving blue-collar workers, who either worked permanent morning, evening, or night shifts. Sociodemographic, health and productivity data were collected through questionnaires. Blood pressure and cholesterol were measured and the cardiovascular risk was estimated according to the relative risk SCORE chart. Bivariate analysis was performed according to the cardiovascular risk and the relationship between SJL and high cardiovascular risk was analysed through logistic regression. Cumulative models were performed, adjusted for various confounding factors. After 49 exclusions, the final sample comprised 301 workers (56% males; aged <40 years, 73%). Mean standard deviation (SD) SJL was 1:57 (1:38) hr (59.4% ≤2 hr). Cardiovascular risk was high in 20% of the sample. Multivariate analysis revealed SJL to be an independent risk factor for high cardiovascular risk. Each additional hour of SJL increased this risk by >30% (odds ratio 1.31, 95% confidence interval 1.02-1.68). This is the first study indicating that SJL potentially increases cardiovascular risk, and suggests that sleep and individual circadian qualities are critical in preventing negative health impacts of shift-work.

Validation of the Munich Actimetry Sleep Detection Algorithm for estimating sleep-wake patterns from activity recordings.

Periods of sleep and wakefulness can be estimated from wrist-locomotor activity recordings via algorithms that identify periods of relative activity and inactivity. Here, we evaluated the performance of our Munich Actimetry Sleep Detection Algorithm. The Munich Actimetry Sleep Detection Algorithm uses a moving 24-h threshold and correlation procedure estimating relatively consolidated periods of sleep and wake. The Munich Actimetry Sleep Detection Algorithm was validated against sleep logs and polysomnography. Sleep-log validation was performed on two field samples collected over 54 and 34 days (median) in 34 adolescents and 28 young adults. Polysomnographic validation was performed on a clinical sample of 23 individuals undergoing one night of polysomnography. Epoch-by-epoch analyses were conducted and comparisons of sleep measures carried out via Bland-Altman plots and correlations. Compared with sleep logs, the Munich Actimetry Sleep Detection Algorithm classified sleep with a median sensitivity of 80% (interquartile range [IQR] = 75%-86%) and specificity of 91% (87%-92%). Mean onset and offset times were highly correlated (r = .86-.91). Compared with polysomnography, the Munich Actimetry Sleep Detection Algorithm reached a median sensitivity of 92% (85%-100%) but low specificity of 33% (10%-98%), owing to the low frequency of wake episodes in the night-time polysomnographic recordings. The Munich Actimetry Sleep Detection Algorithm overestimated sleep onset (~21 min) and underestimated wake after sleep onset (~26 min), while not performing systematically differently from polysomnography in other sleep parameters. These results demonstrate the validity of the Munich Actimetry Sleep Detection Algorithm in faithfully estimating sleep-wake patterns in field studies. With its good performance across daytime and night-time, it enables analyses of sleep-wake patterns in long recordings performed to assess circadian and sleep regularity and is therefore an excellent objective alternative to sleep logs in field settings.

Shift work, sleep disturbances and social jetlag in healthcare workers.

The aim of this study was to compare chronotype- and age-dependent sleep disturbances and social jetlag between rotating shift workers and non-shift workers, and between different types of shifts. In the Klokwerk+ cohort study, we included 120 rotating shift workers and 74 non-shift workers who were recruited from six Dutch hospitals. Participants wore Actigraph GT3X accelerometers for 24 hr for 7 days. From the Actigraph data, we predicted the sleep duration and social jetlag (measure of circadian misalignment). Mixed models and generalized estimation equations were used to compare the sleep parameters between shift and non-shift workers. Within shift workers, sleep on different shifts was compared with sleep on work-free days. Differences by chronotype and age were investigated using interaction terms. On workdays, shift workers had 3.5 times (95% confidence interval: 2.2-5.4) more often a short (< 7 hr per day) and 4.1 times (95% confidence interval: 2.5-6.8) more often a long (≥ 9 hr per day) sleep duration compared with non-shift workers. This increased odds ratio was present in morning chronotypes, but not in evening chronotypes (interaction p-value < .05). Older shift workers (≥ 50 years) had 7.3 times (95% confidence interval: 2.5-21.8) more often shorter sleep duration between night shifts compared with work-free days, while this was not the case in younger shift workers (< 50 years). Social jetlag due to night shifts increased with increasing age (interaction p-value < .05), but did not differ by chronotype (interaction p-value ≥ .05). In conclusion, shift workers, in particular older workers and morning chronotypes, experienced more sleep disturbances than non-shift workers. Future research should elucidate whether these sleep disturbances contribute to shift work-related health problems.

Genome-Wide Association Analyses in 128,266 Individuals Identifies New Morningness and Sleep Duration Loci.

Disrupted circadian rhythms and reduced sleep duration are associated with several human diseases, particularly obesity and type 2 diabetes, but until recently, little was known about the genetic factors influencing these heritable traits. We performed genome-wide association studies of self-reported chronotype (morning/evening person) and self-reported sleep duration in 128,266 white British individuals from the UK Biobank study. Sixteen variants were associated with chronotype (P<5x10-8), including variants near the known circadian rhythm genes RGS16 (1.21 odds of morningness, 95% CI [1.15, 1.27], P = 3x10-12) and PER2 (1.09 odds of morningness, 95% CI [1.06, 1.12], P = 4x10-10). The PER2 signal has previously been associated with iris function. We sought replication using self-reported data from 89,283 23andMe participants; thirteen of the chronotype signals remained associated at P<5x10-8 on meta-analysis and eleven of these reached P<0.05 in the same direction in the 23andMe study. We also replicated 9 additional variants identified when the 23andMe study was used as a discovery GWAS of chronotype (all P<0.05 and meta-analysis P<5x10-8). For sleep duration, we replicated one known signal in PAX8 (2.6 minutes per allele, 95% CI [1.9, 3.2], P = 5.7x10-16) and identified and replicated two novel associations at VRK2 (2.0 minutes per allele, 95% CI [1.3, 2.7], P = 1.2x10-9; and 1.6 minutes per allele, 95% CI [1.1, 2.2], P = 7.6x10-9). Although we found genetic correlation between chronotype and BMI (rG = 0.056, P = 0.05); undersleeping and BMI (rG = 0.147, P = 1x10-5) and oversleeping and BMI (rG = 0.097, P = 0.04), Mendelian Randomisation analyses, with limited power, provided no consistent evidence of causal associations between BMI or type 2 diabetes and chronotype or sleep duration. Our study brings the total number of loci associated with chronotype to 22 and with sleep duration to three, and provides new insights into the biology of sleep and circadian rhythms in humans.

Sleep and glycemic control in adolescents with type 1 diabetes.

BACKGROUND: Increasing evidence link sleep curtailment and circadian misalignment with adverse metabolic outcome. Adolescents might be most affected, given their late sleep timing and early school and work start times. OBJECTIVE: Our aim was to examine the impact of poor sleeping habits on glycemic control in adolescents with type 1 diabetes. SUBJECTS AND METHODS: This was a non-interventional multicenter study across Germany recruiting pubertally mature adolescents with type 1 diabetes. Medical records were used to collect information on diabetes duration, treatment, and complications. Participants self-reported sleep quality, timing, chronotype, and social jetlag-a measure of circadian misalignment. Hemoglobin A1c (HbA1c) was determined at the time of questionnaire response. We used multivariable linear regression models to examine associations between sleep and glycemic control. RESULTS: A total of 191 patients aged 16.5 years (mean HbA1c 8.0% [64 mmol/mol]) were included in this study. In multivariable adjusted analyses, sleep quality was significantly associated with HbA1c (mean difference; ß = -0.07, P = .05). Stratified analysis indicated that this association might be stronger in boys and also in children with migration background. In contrast, neither sleep duration, sleep debt, chronotype, nor social jetlag was associated with HbA1c . Secondary analyses showed that social jetlag was significantly associated with levels of insulin requirements (mean difference; ß = 0.035, P = .03). CONCLUSIONS: Our study suggests that poor sleep quality is associated with increased HbA1c in adolescents with type 1 diabetes and that higher levels of circadian misalignment are associated with increased insulin requirements. If replicated, our results indicate a clinical relevance of sleep habits in adolescents with type 1 diabetes.

Not later, but longer: sleep, chronotype and light exposure in adolescents with remitted depression compared to healthy controls.

The relationship between sleep and adolescent depression is much discussed, but still not fully understood. One important sleep variable is self-selected sleep timing, which is also referred to as chronotype. Chronotype is mostly regulated by the circadian clock that synchronises the internal time of the body with the external light dark cycle. A late chronotype as well as a misalignment between internal time and external time such as social jetlag has been shown to be associated with depressive symptoms in adults. In this study, we investigated whether adolescents with remitted depression differ from healthy controls in terms of chronotype, social jetlag and other sleep-related variables. For this purpose, we assessed chronotype and social jetlag with the Munich ChronoType Questionnaire (MCTQ), subjective sleep quality with the Pittsburgh Sleep Quality Index (PSQI) and used continuous wrist-actimetry over 31 consecutive days to determine objective sleep timing. Given the potentially mediating effect of light on chronotype and depressive symptoms, we measured light exposure with a light sensor on the actimeter. In our sample, adolescents with remitted depression showed similar chronotypes and similar amounts of social jetlag compared to controls. However, patients with remitted depression slept significantly longer on work-free days and reported a worse subjective sleep quality than controls. Additionally, light exposure in remitted patients was significantly higher, but this finding was mediated by living in a rural environment. These findings indicate that chronotype might be modified during remission, which should be further investigated in longitudinal studies.

Sleep and need for recovery in shift workers: do chronotype and age matter?

This study examined associations of chronotype and age with shift-specific assessments of main sleep duration, sleep quality and need for recovery in a cross-sectional study among N = 261 industrial shift workers (96.6% male). Logistic regression analyses were used, adjusted for gender, lifestyle, health, nap behaviour, season of assessment and shift schedule. Shift workers with latest versus earliest chronotype reported a shorter sleep duration (OR 11.68, 95% CI 3.31-41.17) and more awakenings complaints (OR 4.84, 95% CI 4.45-11.92) during morning shift periods. No associations were found between chronotype, sleep and need for recovery during evening and night shift periods. For age, no associations were found with any of the shift-specific outcome measures. The results stress the importance of including the concept of chronotype in shift work research and scheduling beyond the concept of age. Longitudinal research using shift-specific assessments of sleep and need for recovery are needed to confirm these results. PRACTITIONER SUMMARY: Chronotype seems to better explain individual differences in sleep than age. In view of ageing societies, it might therefore be worthwhile to further examine the application of chronotype for individualised shift work schedules to facilitate healthy and sustainable employment.

[Chronotype and depression in adolescents ­ a review]. / Chronotyp und Depression bei Jugendlichen ­ ein Review.

Many patients with depressive disorders experience symptoms in relation to sleep behavior and daily rhythmicity. However, the multifaceted associations between sleep, depression and circadian rhythms are not fully understood. During the past years, the concept of chronotypehas become increasingly popular in research. The Munich Chronotype Questionnaire (MCTQ) derives chronotype from sleep timing on work-free days and therefore represents a biological measure for the circadian clock, whereas the Morningness-Eveningness-Questionnaire(MEQ) assesses chronotype as a subjective preference for different activities at specific times of day. Chronotype changes with age, with adolescents and young adults being especially late types. We conducted a systematic literature research and identified studies that explore the association between chronotype (MEQ, MCTQ) and depressive symptoms or depressive disorders. Most of the studies showed an association between a late chronotype and depressive symptomatology. However, it is still unclear what is cause and effect. We propose a bidirectional relationship: On the one hand, due to reduced social and physical activity, depressed patients get less daylight which causes their chronotype to delay. On the other hand, a discrepancy between internal time (directed by the circadian clock) and external time (such as early school- or works tarting times) can cause problems

Sleep patterns in Metropolitan and Regional areas in Japan: Before and during COVID-19 social restrictions.

Sleep timing is an important output of the circadian system. The COVID-19-mandated social restrictions significantly altered commuting time and sleep duration regionally in Japan. This study aimed to elucidate sleep patterns, especially chronotype and social jetlag (SJL), due to changes in social time pressure through the social restrictions between the Metropolitan and Regional areas in Japan. As part of the Global Chrono Corona Survey 2020 (GCCS), the data were collected during social restrictions (SR), but pre-COVID-19 behaviours were also queried retrospectively. We analyzed a cohort of 729 respondents representing both the Metropolitan and the Regional areas separately for workdays and work-free days. While the areas showed no difference in SJL before SR, the differential decrease was larger in the Metropolitan area during SR, resulting in a significant difference in SJL between the areas. The outdoor light exposure before SR was 30 min longer in the Metropolitan areas than in the Regional; during SR both areas showed similarly low (below 1 h) outdoor light exposures. The variables associated with decreased SJL were the Metropolitan areas, work-from-home, a no-usage alarm clock on workdays, and chronotypes (mid-sleep time on free days corrected for sleep deficit accumulated over the workweek, MSFsc) during SR. The results suggest that relaxed social schedules, as reflected in the increased frequency of work-from-home and reduced alarm clock use, and moving towards earlier MSFsc during SR were linked to decreased SJL and were more prominent in the Metropolitan areas. This study provides insights into sleep patterns and the social time pressure markers, by comparison between residential groups in Japan.

Severe atopic dermatitis, sleep disturbance, and low light exposure.

STUDY OBJECTIVES: Atopic dermatitis (AD) is a chronic inflammatory skin disorder in children. AD worsens at night, particularly in severe disease. Low light exposure contributes to inflammation, poor sleep, and misalignment between circadian (24-hour) rhythms (biological clocks) and social clocks (weekday vs. weekend sleep timing), but has not been evaluated in AD. Our objective was to perform a cross-sectional study to determine whether there is an association between AD severity, recorded light exposure (RLE), and sleep measures in participants with AD and healthy controls. METHODS: Secondary data analysis from two prospective observational studies of 74 participants ages 5-17 years old with severe AD compared to others (healthy controls and mild/moderate AD). Participants wore actigraphy watches for at least 1 weekday and one weekend. Rest/activity and RLE (lux) were obtained from the watches and were analyzed to estimate duration and quality of sleep/light exposure. RESULTS: Participants (n = 74) were on average 10.9 ±â€…3.6 years old, with 45% female, 17% no AD, 27% mild, 32% moderate, and 24% severe AD. On weekends, severe AD participants versus others fell asleep at a similar time (23:52 ±â€…1:08 vs. 23:40 ±â€…1:29 mean clock-time hours ±â€…SD; p = 0.23), had similar sleep-onset latency (8.2 ±â€…8.7 vs. 12.7 ±â€…16.9 minutes; p = 0.28), but woke later (09:12 ±â€…1:04 vs. 08:13 ±â€…1:14 minutes; p < 0.01) resulting in a later sleep-midpoint (04:32 ±â€…0:53 vs. 03:49 ±â€…1:08 minutes; p = 0.02). Severe AD participants had lower levels of daytime RLE than others (mean-over-all-days: 1948.4 ±â€…2130.0 vs. 10341.3 ±â€…13453.8 lux; p = 0.01) and throughout seasons, weekdays, or weekend, yet had similar nighttime RLE. CONCLUSION: Severe AD is characterized by low RLE and sleep disturbance. Low RLE could potentially induce circadian misalignment, contributing to inflammation and worse disease in severe AD. Low RLE can also reflect altered lifestyle and behavior due to atopic disease impacts. Prospective studies are needed to test causality and the potential of bright light as an adjuvant therapy for severe AD.

Classifying fMRI-derived resting-state connectivity patterns according to their daily rhythmicity.

The vast majority of biological functions express rhythmic fluctuations across the 24-hour day. We investigated the degree of daily modulation across fMRI (functional Magnetic Resonance Imaging) derived resting-state data in 15 subjects by evaluating the time courses of 20 connectivity patterns over 8h (4 sessions). For each subject, we determined the chronotype, which describes the relationship between the individual circadian rhythm and the local time. We could therefore analyze the daily time course of the connectivity patterns controlling for internal time. Furthermore, as the participants' scan times were staggered as a function of their chronotype, we prevented sleep deprivation and kept time awake constant across subjects. Individual functional connectivity within each connectivity pattern was defined at each session as connectivity strength measured by a mean z-value and, in addition, as the spatial extent expressed by the number of activated voxels. Highly rhythmic connectivity patterns included two sub-systems of the Default-Mode Network (DMN) and a network extending over sensori-motor regions. The network characterized as the most stable across the day is mainly associated with processing of executive control. We conclude that the degree of daily modulation largely varies across fMRI derived resting-state connectivity patterns, ranging from highly rhythmic to stable. This finding should be considered when interpreting results from fMRI studies.

Light and the human circadian clock.

The circadian clock can only reliably fulfil its function if it is stably entrained. Most clocks use the light-dark cycle as environmental signal (zeitgeber) for this active synchronisation. How we think about clock function and entrainment has been strongly influenced by the early concepts of the field's pioneers, and the astonishing finding that circadian rhythms continue a self-sustained oscillation in constant conditions has become central to our understanding of entrainment.Here, we argue that we have to rethink these initial circadian dogmas to fully understand the circadian programme and how it entrains. Light is also the prominent zeitgeber for the human clock, as has been shown experimentally in the laboratory and in large-scale epidemiological studies in real life, and we hypothesise that social zeitgebers act through light entrainment via behavioural feedback loops (zeitnehmer). We show that human entrainment can be investigated in detail outside of the laboratory, by using the many 'experimental' conditions provided by the real world, such as daylight savings time, the 'forced synchrony' imposed by the introduction of time zones, or the fact that humans increasingly create their own light environment. The conditions of human entrainment have changed drastically over the past 100 years and have led to an increasing discrepancy between biological and social time (social jetlag). The increasing evidence that social jetlag has detrimental consequences for health suggests that shift-work is only an extreme form of circadian misalignment, and that the majority of the population in the industrialised world suffers from a similarly 'forced synchrony'.

A circadian clock in Saccharomyces cerevisiae.

Circadian timing is a fundamental biological process, underlying cellular physiology in animals, plants, fungi, and cyanobacteria. Circadian clocks organize gene expression, metabolism, and behavior such that they occur at specific times of day. The biological clocks that orchestrate these daily changes confer a survival advantage and dominate daily behavior, for example, waking us in the morning and helping us to sleep at night. The molecular mechanism of circadian clocks has been sketched out in genetic model systems from prokaryotes to humans, revealing a combination of transcriptional and posttranscriptional pathways, but the clock mechanism is far from solved. Although Saccharomyces cerevisiae is among the most powerful genetic experimental systems and, as such, could greatly contribute to our understanding of cellular timing, it still remains absent from the repertoire of circadian model organisms. Here, we use continuous cultures of yeast, establishing conditions that reveal characteristic clock properties similar to those described in other species. Our results show that metabolism in yeast shows systematic circadian entrainment, responding to cycle length and zeitgeber (stimulus) strength, and a (heavily damped) free running rhythm. Furthermore, the clock is obvious in a standard, haploid, auxotrophic strain, opening the door for rapid progress into cellular clock mechanisms.

Chronotype, Social Jetlag, and Nicotine Use.

Late chronotype, which often leads to higher social jetlag (SJL), is strongly associated with the prevalence of smoking. Any circadian disruption, strain, or misalignment, results in people not being able to live according to their biological time as is described by SJL, which we will therefore use as umbrella term. We hypothesized two scenarios potentially explaining the association between smoking and SJL: (A) If smoking delays the clock, circadian phase should advance upon quitting. (B) If people smoke more to compensate the consequences of SJL, circadian phase should not change upon quitting. To distinguish between these two hypotheses, we accompanied participants of a smoking cessation program (not involving nicotine replacement products) across the cessation intervention (3 weeks prior and 6 weeks after) by monitoring their circadian behavior, sleep quality, and daytime sleepiness via questionnaires and actimetry. Our results show no effects of cessation on SJL, chronotype, sleep quality, or daytime sleepiness, thereby favoring scenario (B). Thus, smoking may be a consequence of rather than a cause for SJL. Daytime sleepiness was a significant predictor for the outcome in our model but did not improve with cessation.

Light at night in older age is associated with obesity, diabetes, and hypertension.

Light at night (LAN) has been associated with negative health consequences and metabolic risk factors. Little is known about the prevalence of LAN in older adults in the United States and its association with CVD risk factors. We tested the hypothesis that LAN in older age is associated with higher prevalence of individual CVD risk factors. Five hundred and fifty-two community-dwelling adults aged 63-84 years underwent an examination of CVD risk factor profiles and 7-day actigraphy recording for activity and light measures. Associations between actigraphy-measured LAN, defined as no light vs. light within the 5-hour nadir (L5), and CVD risk factors, including obesity, diabetes, hypertension, and hypercholesterolemia, were examined, after adjusting for age, sex, race, season of recording, and sleep variables. LAN exposure was associated with a higher prevalence of obesity (multivariable-adjusted odds ratio [OR] 1.82 [95% CI 1.26-2.65]), diabetes (OR 2.00 [1.19-3.43]), and hypertension (OR 1.74 [1.21-2.52]) but not with hypercholesterolemia. LAN was also associated with (1) later timing of lowest light exposure (L5-light) and lowest activity (L5-activity), (2) lower inter-daily stability and amplitude of light exposure and activity, and (3) higher wake after sleep onset. Habitual LAN in older age is associated with concurrent obesity, diabetes, and hypertension. Further research is needed to understand long-term effects of LAN on cardiometabolic risks.