Chronotype and postmenopausal breast cancer risk among women in the California Teachers Study

ABSTRACT

Chronotype is the behavioral manifestation of an individual’s underlying circadian rhythm, generally characterized by one’s propensity to sleep at a particular time during the 24 hour cycle. Evening chronotypes (“night owls”) generally suffer from worse physical and mental health compared to morning chronotypes (“morning larks”) – for reasons that have yet to be explained. One hypothesis is that evening chronotypes may be more susceptible to circadian disruption, a condition where the coordinated timing of biologic processes breaks down. The role of chronotype as an independent or modifying risk factor for cancer has not been widely explored. The objective of the current study was to evaluate the risk of breast cancer associated with chronotype in a case-control study nested within the California Teachers Study (CTS) cohort. The study population consisted of 39686 post-menopausal CTS participants who provided information on chronotype by completing a questionnaire in 2012–2013. 2719 cases of primary invasive breast cancer diagnosed from 1995/1996 through completion of the chronotype questionnaire were identified by linkage of the CTS to the California Cancer Registry. 36967 CTS participants who had remained cancer-free during this same time period served as controls. Chronotype was ascertained by responses to an abbreviated version of the Horne-Ostberg Morningness-Eveningness Questionnaire (MEQ) and was characterized into five categories: definite morning, more morning than evening, neither morning or evening, more evening than morning, definite evening. Multivariable unconditional logistic regression analyses were performed to estimate the odds ratios (ORs) and 95% confidence intervals (95% CIs) for each of the chronotypes, adjusted for established breast cancer risk factors. Compared to definite morning types, definite evening types had an increased risk of breast cancer with elevated ORs that were statistically significant in both the crude (OR = 1.24, 95% CI: 1.10–1.40) and fully-adjusted models (OR = 1.20, 95% CI: 1.06–1.35). The risk estimates in the fully-adjusted model for all other chronotypes did not significantly differ from one. These results suggest that evening chronotype may be an independent risk factor for breast cancer among a population of women who are not known to have engaged in any substantial night shift work. Further research in other populations of non-shift workers is warranted.     

Chronotype and Breast Cancer Risk in a Cohort of US Nurses

The aim of this study was to examine the relation between chronotype and breast cancer risk. We analyzed the association between chronotype (definite morning type, probable morning type, probable evening type, definite evening type, or neither morning nor evening type) and breast cancer risk among 72 517 women in the Nurses’ Health Study II (NHS II). Chronotype was self-reported in 2009, and 1834 breast cancer cases were confirmed among participants between 1989 and 2007; a 2-yr lag period was imposed to account for possible circadian disruptions related to breast cancer diagnosis. Age- and multivariable-adjusted logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Participants who self-reported as neither morning nor evening type had a 27% increased risk of breast cancer (multivariable-adjusted OR?=?1.27, 95% CI?=?1.04–1.56), compared with definite morning types. None of the other chronotypes were significantly associated with breast cancer risk (multivariable-adjusted OR?=?0.99, 95% CI?=?0.87–1.12 for probable morning versus definite morning types; OR?=?0.96, 95% CI?=?0.84–1.09 for probable evening versus definite morning types; and OR?=?1.15, 95% CI?=?0.98–1.34 for definite evening versus definite morning types). Overall, chronotype was not associated with breast cancer risk in our study. A modestly increased risk among neither morning nor evening types may indicate circadian disruption as a potentially underlying mechanism; however, more studies are needed to confirm our results.     

Individual differences in chronotypes associated with academic performance among Chilean University students

A chronotype is an individual trait that determines circadian rhythm (dark/light cycle) characteristics, associated with bedtime, waking, and other daily activities. A chronotype is classified as morning, intermediate, and evening. The objective is to associate chronotypes with academic performance in university students. A cross-sectional study was performed to evaluate the chronotype of university students (n = 703) by Horne-Ostberg questionnaire and associated with academic performance. The group with higher GPAs had higher chronotype scores (p = 0.002). Morning and intermediate chronotypes exhibited better academic performance; however, more studies are necessary to determine the underlying causes, which could influence cognitive aspects.     

Evening chronotype is associated with poor cardiovascular health and adverse health behaviors in a diverse population of women

ABSTRACT

Chronotype reflects time of day preferences for performing daily activities. Previous research within Asian and European cohorts indicates evening chronotype is associated with elevated cardiometabolic risk. However, evidence is limited from population-based US cohorts, particularly among women in whom evening chronotype prevalence may become higher after middle-age, coinciding with life stages associated with higher cardiovascular disease (CVD) risk. This cross-sectional study evaluated associations of chronotype with overall cardiovascular health (CVH), health behaviors, and cardiometabolic risk factors among 506 women (mean age = 37 ± 16y, 62% racial/ethnic minority) in the American Heart Association (AHA)’s Go Red for Women Strategically-Focused Research Network cohort at Columbia University (New York City, NY, USA). Chronotype was assessed using the validated Morningness-Eveningness Questionnaire (MEQ) and categorized as “evening”, “intermediate”, and “morning” chronotypes. Health behaviors (diet, physical activity, and sleep) were assessed using validated questionnaires. Anthropometrics, clinical blood pressure, and blood biomarkers were assessed at the clinic visit. CVH was evaluated using the AHA Life’s Simple 7 (LS7) metrics; LS7 scores of 0–8 and 9–14 were considered indicative of poor and moderate-to-high CVH, respectively. Linear and logistic regression models adjusted for age, race/ethnicity, education, health insurance, and menopausal status were used to examine associations of MEQ scores and chronotype categories with overall CVH, clinical cardiometabolic risk factors, and health behaviors. Overall, 13% of women identified as evening chronotypes, while 55% and 32% reported being intermediate and morning types. In linear models, higher MEQ scores were associated with higher AHA LS7 scores (β(SE) = 0.02(0.01); p = .014), indicative of more favorable CVH, and with health behaviors not included in the LS7. Higher MEQ scores were also associated with lower Pittsburgh Sleep Quality Index, i.e. better sleep quality, (β(SE) = ?0.07(0.02), p < .0001), lower insomnia severity (β(SE) = ?0.14(0.01), p < .0001), shorter time to fall asleep (β(SE) = ?0.28(0.14), p = .044), and less sedentary time (β(SE) = ?0.11(0.03), p = .001). In logistic regression models, evening chronotype, compared to intermediate/morning type, was associated with higher odds of having poor CVH (OR(95%CI):2.41(1.20–4.85)), not meeting AHA diet (OR(95%CI):2.89(1.59–5.23)) and physical activity guidelines (OR(95%CI):1.78(1.03–3.07)), and having short sleep (OR(95%CI):2.15(1.24–3.73)) or insomnia (OR(95%CI):2.69(1.53–4.75)). The evening type compared to morning type was also associated with being a current smoker (OR(95%CI):2.14(1.02–4.52)) and having poor sleep quality (OR(95%CI:2.35(1.27–4.37)) and long sleep onset latency (OR(95%CI:1.89(1.00–3.56)). In our cohort of women, evening chronotype was related to poor CVH, likely driven by its influence on health behaviors. These findings, although warranting confirmation prospectively in other populations, suggest chronotype is an important factor to consider and possibly target when designing lifestyle interventions for CVD prevention.     

The epidemiology of morningness/eveningness: influence of age, gender, ethnicity, and socioeconomic factors in adults (30-49 years)

The Horne and Ostberg Morningness/Eveningness Questionnaire (MEQ) is widely used to differentiate between morning and evening types, but there is very little epidemiological evidence about the distribution of MEQ chronotypes in the general population. The purpose of the present study was to simultaneously investigate the influence of demographic, socioeconomic, and work factors on the distribution of morningness/eveningness. A New Zealand version of the MEQ was mailed to 5000 New Zealand adults, ages 30 to 49 years, who were randomly selected from the electoral rolls (55.7% response rate). A total of 2526 questionnaires were included in the analyses. According to the Horne and Ostberg classification, 49.8% of the total population was classified as morning type compared to 5.6% having an evening-type preference. However, using new cutoffs for middle-aged working adults described by Taillard et al. (2004), 24.7% of the population was morning type and 26.4% was evening type. After controlling for ethnicity, gender, and socioeconomic deprivation, participants ages 30 to 34 years were more likely to be definitely evening type (odds ratio [OR] = 1.59, p < 0.05) and less likely to be morning type (moderately morning type, OR = 0.59, p < 0.01, or definitely morning type, OR = 0.59, p < 0.05) compared to those ages 45 to 49 years. Work schedules were also important predictors of chronotype, with night workers more likely to be definitely evening type (OR = 1.49, p = 0.05) and the unemployed less likely to be moderately morning type (OR = 0.64, p < 0.05) compared to other workers. Evening types were 2.5 times more likely to report that their general health was only poor or fair compared to morning types (p < 0.01). This study confirms that the original criteria of Horne and Ostberg (1976) are not useful for classifying chronotypes in a middle-aged population. The authors conclude that morningness/eveningness preference is largely independent of ethnicity, gender, and socioeconomic position, indicating that it is a stable characteristic that may be better explained by endogenous factors.     

Chronotype,class times,and academic achievement of university students

Numerous studies over the years have documented an effect of human chronotypes on physiological and psychological processes. Studies evaluating the impact of an individual’s chronotype on his/her academic achievement have indicated that morning chronotypes have an academic advantage over evening chronotypes. However, these studies did not account for the time of day in which the participants were being evaluated. The goal of the present study was to examine whether morning chronotypes do have an academic advantage over evening chronotypes when the time of day of classes and exams is taken into consideration. We obtained morningness–eveningness scores and course grades from 207 university students who took classes (and exams) at different times of the day. We confirmed that morning chronotypes attain better grades than evening chronotypes, although the association is weak (r² = 0.02). The difference persisted even after the time of day of classes and exams was taken into consideration. This is probably due to the fact that evening chronotypes are generally more sleep deprived than morning chronotypes as a result of the early schedule of most schools, which can impair their performance both early and late in the day.     

Evening preference is related to the incidence of depressive states independent of sleep-wake conditions

Although evening preference has recently been identified as a risk factor for depression, it has not been substantiated whether evening preference is a direct risk factor for depressive states, or if it is associated secondarily through other factors, such as delayed sleep timing and shortened sleep duration. The objective of this study is to investigate associations in Japanese adult subjects between evening preference and incidence of depressive states, adjusting for various sleep parameters related to depressive states. The Morningness-Eveningness Questionnaire (MEQ), the Pittsburgh Sleep Quality Index (PSQI), and the Center for Epidemiologic Studies Depression Scale (CES-D) were administered to 1170 individuals (493 males/677 females; mean and range 38.5 and 20-59 yrs) to assess their diurnal preferences, sleeping states, and presence of depression symptoms. Subjects were classified into five chronotypes based on MEQ scores. Evening preference was associated with delayed sleep timing, shortened sleep duration, deteriorated subjective sleep quality, and worsened daytime sleepiness. Logistic regression analysis demonstrated that the extreme evening type (odds ratio [OR]?=?1.926, p?=?.018) was associated with increased incidence of depressive states and that the extreme morning type (OR?=?0.342, p?=?.038) was associated with the decreased incidence of depressive states, independent of sleep parameters, such as nocturnal awakening (OR?=?1.844, p?相似文献   

The association between chronotype and perceived academic stress to depression in medical students

Depression is a multifactorial illness that is highly prevalent among medical students (MS). Chronotypes, which reflect circadian preference in humans, as well as academic stress have been associated with depression in different populations. However, it is not known how chronotype and stress might alone or in combination, associate with depression in MS. Thus, we aimed to evaluate the association between stress, chronotype and depression in MS. In a cross-sectional study, we evaluated a total of 1068 medical students from a public Medical School in Mexico City. The Patient Health Questionnaire-9 (PHQ-9) was used to evaluate depressive symptom severity and the presence of a current depressive episode with a cutoff score of 10 or higher. The Morning-Evening Questionnaire (MEQ) was used to establish chronotype and the Academic Stress Inventory was used to measure perceived academic stress (PAS). We observed that depressive symptom severity was higher in non-morning chronotypes and moderate/severe PAS groups. A factorial ANOVA showed an association between PAS groups and depressive symptom severity. Linear regression showed an association between depressive symptom severity and variables such as PAS scores (p = 0.001), family history of depression (p = 0.001), gender (p = 0.001) and academic year (p = 0.029). Logistic regression analysis showed that evening chronotype (OR: 2.3, 95% CI: 1.2–4.3, p = 0.01) and severe PAS (OR: 4.4, 95% CI: 2.8–7.0, p = 0.0001) were associated with depression. Further, MS with the combination of severe PAS and morning (OR: 5.9, 95% CI: 1.6–22.2, p = 0.01), intermediate (OR: 7.5, 95% CI: 2.3–24.4, p = 0.001) or evening (OR: 10.6, 95% CI: 2.8–40.0, p = 0.001) chronotypes showed a greater association with depression than any PAS or chronotype group alone. Being female, perceiving restricted or limited economic resources, having severe scores of academic stress, and evening chronotype were associated with an increased probability to suffer a current depressive episode. Collectively, these results show that chronotype and PAS are factors associated with depression in MS, and when combined promote this association. Our results might aid in early identification of MS susceptible to depression. Future research could focus on the implementation of simple, low cost preventive strategies, such as chronotype-oriented academic schedules.     

Evidence for a relationship between chronotype and reproductive function in women

There is evidence for the reciprocal interaction between circadian oscillation and reproduction, and disruption of circadian rhythms has been associated with impaired menstrual functions and reduced fertility in women. However, only little information is available on the relationship between reproduction and chronotype. The aim of the present study is to better assess this relationship. The participants (aged 25 to 74?yrs) were selected randomly from the Finnish Population Information System. The data from 2672 female participants of the National FINRISK Survey 2007 were analyzed to test the associations between chronotype (morning, intermediate, or evening) and reproductive features. Of the participants, 139 (5.6%) were evening, 1217 (48.7%) intermediate, and 1145 (45.8%) morning chronotypes. Among the participants aged 25 to 54?yrs, the duration of menstrual cycle was longer among evening chronotypes (28.8?±?4.4?d) than among morning (27.7?±?2.6?d; p?<?0.01) and intermediate (27.8?±?3.3?d; p?=?0.05) chronotypes. Significant correlations were found between the higher morningness-eveningness scores (the more of morning chronotype) and the shorter durations of menstrual bleeding, both in the whole sample (p?<?0.001) and after limiting the analyses to women younger than 55?yrs (p?<?0.05). In multivariable analyses on the whole sample, as compared with morning chronotypes, intermediate chronotypes had a significantly longer duration of menstrual bleeding (B?=?0.160, 95% confidence interval [CI]?=?0.044 to 0.276; p?<?0.01) as well as a higher odds for difficulties in getting pregnant (odds ratio [OR]?=?1.464, 95% CI?=?1.118 to 1.917; p?<?0.01). Our findings suggest that chronotype is related to the reproductive function in women.     

Validity of the Morningness‐Eveningness Scale for Children among Spanish Adolescents

Adolescents tend to be much later chronotypes than other age groups. This circadian phase delay is attributed as much to biological as psychosocial factors. Because the consequences of this change on performance and health have been documented, questionnaires to identify morning and evening‐type adolescents are necessary. The aim of the present study was to validate a Spanish version of the Morningness‐Eveningness Scale for Children (MESC) by means of several relevant psychological variables as external criteria. A sample of 623 urban high school students completed the MESC and self‐reported measures of sleep behaviors, subjective alertness, physical performance, and mood. On the whole, results indicate a good validity of MESC. Significant differences in the self‐reported ratings between morning and evening types were obtained by time‐of‐day. These results provide preliminary support for the Spanish version of MESC.     

Clinical correlates of chronotypes in young persons with mental disorders

While important changes in circadian rhythms take place during adolescence and young adulthood, it is unclear how circadian profiles during this period relate to emerging mental disorders. This study aimed to: (i) characterise morningness–eveningness preference in young people with primary anxiety, depression, bipolar or psychotic disorders as compared to healthy controls, and (ii) to investigate associations between morningness–eveningness preference and the severity of psychiatric symptoms. Four hundred and ninety-six males and females aged between 12 and 30 years were divided into five groups according to primary diagnosis. The Hamilton Depression Rating Scale and the Brief Psychiatric Rating Scale were administered by a research psychologist and participants completed the Kessler Psychological Distress Scale and the Horne–Östberg Morningness–Eveningness Questionnaire (ME). ME scores were significantly lower (i.e. higher levels of “eveningness”) in all patient diagnosis subgroups compared to the control group. The psychosis group had higher ME scores than the depression and anxiety groups. Compared to the control group, the anxiety, depression and bipolar subgroups had a significantly higher proportion of “moderate evening” types, with a similar trend for the psychosis group. The proportion of “extreme evening” types was significantly higher in the anxiety and depression subgroups than in the control group. Lower ME scores correlated with worse psychological distress in males from the bipolar group. Lower ME scores correlated with higher depression severity in females with depression and in males with bipolar disorder. These results suggest that young persons with various mental disorders, especially those with affective disorders, present with a stronger “eveningness” preference and higher rates of evening chronotypes than healthy controls from the same age group. Later chronotypes were generally associated with worse psychological distress and symptoms severity. These associations were modulated by sex and primary diagnosis.     

The association between sleep chronotype and obesity among black and white participants of the Bogalusa Heart Study

ABSTRACT

Research indicates that sleep duration and quality are inter-related factors that contribute to obesity, but few studies have focused on sleep chronotype, representing an individual’s circadian proclivity, nor assessed these factors in racially diverse middle-aged samples. We examined the associations between chronotype and obesity among black and white men and women participating in the Bogalusa Heart Study (BHS).

Body mass index (BMI) and sleep data were available for 1,197 middle-aged men and women (mean age 48.2 ± 5.3 years) who participated in the BHS 2013–2016. Based on the reduced Morningness-Eveningness Questionnaire’s cutoff values for chronotypes, we combined ‘definitely morning’ and ‘moderately morning’ types into ‘morning’ type, ‘definitely evening’ and ‘moderately evening’ types into ‘evening’ type and kept those who were “neither” type in a separate group. We used ‘morning’ type as the referent group. Obesity was defined as a BMI ≥ 30. Multivariable logistic regression models were used to examine associations adjusting for sex, age, education, smoking, alcohol use and drug use, depression, shift work, physical activity and sleep duration.

Evening chronotype, reported by 11.1% of participants, was associated with obesity after multi-variable adjustment, including shift work, physical activity and sleep duration (OR 1.67, 95% CI: 1.08–2.56). However, once stratified by race (black/white), this association was found only among white participants (OR = 1.91, 95% CI = 1.12–3.25) after full adjustment.

In our biracial, community-based population, evening chronotype was independently associated with obesity, specifically among white participants. Further research is needed to identify behavioral, endocrine, nutritional and genetic pathways which underlie these associations.     

Daily Changes in the Competence for Photo- and Gravitropic Response by Potato Plantlets

Competence for phototropic (PT) and gravitropic (GT) bending by potato plantlets grown in vitro manifests regular daily changes indicating possible involvement of circadian regulation. Unilateral stimulation of plantlets with blue light at dawn resulted in moderate PT response regarding both attained curvature and long lag phase. The PT response was the strongest between 8:00 and 12:00 h. Throughout the afternoon and in the evening, bending rate and maximal PT curvature declined significantly until 23:00 h. The GT response was fastest and strongest for plantlets stimulated early in the morning and late in the evening. During the rest of the day, GT competence did not change much apart from a minimum at 15:00. In conditions comprising either prolonged day or prolonged night, plantlets appeared to maintain rhythmicity of competence for PT and GT at least in the short-term. Introduction of a dark period prior to the tropic stimulation at 11:00 h when both PT and GT responses were strong resulted in the opposite effect: PT was depressed, and GT was enhanced. There was a time threshold of 60 min for the duration of the dark period so the plants can sense interruption in the daylight. Levels of relative expression of a PHOT2 gene indicate rhythmic daily changes. The PHOT2 gene was present at high levels during morning hours and late in the evening. As the mid-day and the afternoon hours approached, PHOT2 expression decreased and reached a daily minimum at 17:00 h. We believe that our data offer strong support for the conclusion that there is an involvement of circadian rhythms in control of both PT and GT.     

The influences of sleep duration,chronotype, and nightwork on the ovarian cycle

ABSTRACT

Despite research indicating that sleep disorders influence reproductive health, the effects of sleep on reproductive hormone concentrations are poorly characterized. We prospectively followed 259 regularly menstruating women across one to two menstrual cycles (the BioCycle Study, 2005–2007), measuring fasting serum hormone concentrations up to eight times per cycle. Women provided information about daily sleep in diaries and chronotype and night/shift work on a baseline questionnaire. We evaluated percent differences in mean hormone concentrations, the magnitude of shifts in the timing and amplitude of hormone peaks, and the risk for sporadic anovulation associated with self-reported sleep patterns and night/shift work. We estimated chronotype scores – categorizing women below and above the interquartile range (IQR) as “morning” and “evening” chronotypes, respectively. For every hour increase in daily sleep duration, mean estradiol concentrations increased by 3.9% (95% confidence interval [CI] 2.0, 5.9%) and luteal phase progesterone by 9.4% (CI 4.0, 15.2%). Receiving less than 7 hours of sleep per day was associated with slightly earlier rises in peak levels for several hormones. Women reporting night/shift work (n = 77) had lower testosterone relative to women employed without night/shift work (percent difference: ?9.9%, CI ?18.4, ?0.4%). Women with morning chronotypes (n = 47) had earlier rises in estradiol during their cycles and potentially an earlier rise in luteinizing hormone. Compared to those who had intermediate chronotypes, women with evening chronotypes (n = 42) had a later luteinizing hormone peak of borderline statistical significance. A reduced risk for sporadic anovulation was suggested, but imprecise, for increasing hours of daily sleep leading up to ovulation (risk ratio 0.79, CI 0.59, 1.06), while an imprecise increased risk was observed for women with morning chronotypes (risk ratio 2.50, CI 0.93, 6.77). Sleep-related hormonal changes may not greatly alter ovarian function in healthy women, but have the potential to influence gynecologic health.     

EVENING PREFERENCE IS RELATED TO THE INCIDENCE OF DEPRESSIVE STATES INDEPENDENT OF SLEEP-WAKE CONDITIONS

Although evening preference has recently been identified as a risk factor for depression, it has not been substantiated whether evening preference is a direct risk factor for depressive states, or if it is associated secondarily through other factors, such as delayed sleep timing and shortened sleep duration. The objective of this study is to investigate associations in Japanese adult subjects between evening preference and incidence of depressive states, adjusting for various sleep parameters related to depressive states. The Morningness-Eveningness Questionnaire (MEQ), the Pittsburgh Sleep Quality Index (PSQI), and the Center for Epidemiologic Studies Depression Scale (CES-D) were administered to 1170 individuals (493 males/677 females; mean and range 38.5 and 20–59 yrs) to assess their diurnal preferences, sleeping states, and presence of depression symptoms. Subjects were classified into five chronotypes based on MEQ scores. Evening preference was associated with delayed sleep timing, shortened sleep duration, deteriorated subjective sleep quality, and worsened daytime sleepiness. Logistic regression analysis demonstrated that the extreme evening type (odds ratio [OR]?=?1.926, p?=?.018) was associated with increased incidence of depressive states and that the extreme morning type (OR?=?0.342, p?=?.038) was associated with the decreased incidence of depressive states, independent of sleep parameters, such as nocturnal awakening (OR?=?1.844, p?<?.001), subjective sleep quality (OR?=?2.471, p?<?.001), and daytime sleepiness (OR?=?1.895, p?=?.001). However, no significant associations were observed between the incidence of depressive states and sleep duration, sleep timing, and sleep debt (levels of insufficient sleep). Although the findings of this study do not demonstrate a causative relationship between evening preference and depression, they do suggest the presence of functional associations between mood adjustment and biological clock systems that regulate diurnal preference. They also suggest that evening preference might increase susceptibility to the induction of mood disorders. (Author correspondence: mishima@ncnp.go.jp)     

Wise “birds” follow their clock: The role of emotional intelligence and morningness–eveningness in diurnal regulation of mood

Emotional intelligence (EI) and morningness–eveningness (M-E) preference have been shown to influence mood states. The present article investigates the way in which these two constructs may interact, influencing morning and evening mood levels. A sample of 172 participants completed a multidimensional mood scale measuring energetic arousal (EA), tense arousal (TA), and hedonic tone at 7:00 and at 22:00. As expected, morning and evening types experienced higher EA at their preferred time of day; effects of M-E on other mood dimensions were weaker. EI was found to correlate with lower TA, but the association was stronger at 22:00, perhaps reflecting the role of EI in managing the social events characteristic for the evening hours. An interactive effect of EI and M-E was found for both diurnal changes and morning levels of EA. Namely, in individuals higher in EI, there appeared a more marked synchrony effect between chronotype and EA, which was absent in those low in EI; individuals higher in EI showed more pronounced diurnal changes in EA characteristic for their chronotype (i.e., higher EA at morning hours in morning chronotypes; higher EA at evening hours in evening chronotypes), while in participants low in EI, diurnal changes in EA were smaller. Moreover, the characteristic positive association between morningness and EA during morning hours was apparent only in those high in EI. These findings suggest that individual differences in circadian variation in mood reflect several factors, including an endogenous rhythm in energy, the distribution of social activities throughout the day, and the person’s awareness of their own energy level.     

Impairment of sleep quality and quality of life in bimodal chronotype individuals

There is still insufficient data about the characteristics and clinical significance of the bimodal chronotype. We evaluated more than 1000 students with Morningness-Eveningness Questionnaire, Munich Chronotype Questionnaire (MCTQ), Pittsburgh Sleep Quality Index and 36-item Short Form Health Survey. Twelve percent of the sample was bimodal and they showed similar results to intermediate chronotype in MCTQ-chronotype and social jetlag, both different from morning and evening chronotypes. However, their quality of life and sleep quality were similar to evening types, both different from morning and intermediate types. We discuss if being bimodal would be a maladaptive aspect of circadian preference     

Associations between chronotype,morbidity and mortality in the UK Biobank cohort

Later chronotype (i.e. evening preference) and later timing of sleep have been associated with greater morbidity, including higher rates of metabolic dysfunction and cardiovascular disease (CVD). However, no one has examined whether chronotype is associated with mortality risk to date. Our objective was to test the hypothesis that being an evening type is associated with increased mortality in a large cohort study, the UK Biobank. Our analysis included 433 268 adults aged 38–73 at the time of enrolment and an average 6.5-year follow-up. The primary exposure was chronotype, as assessed through a single self-reported question-defining participants as definite morning types, moderate morning types, moderate evening types or definite evening types. The primary outcomes were all-cause mortality and mortality due to CVD. Prevalent disease was also compared among the chronotype groups. Analyses were adjusted for age, sex, ethnicity, smoking, body mass index, sleep duration, socioeconomic status and comorbidities. Greater eveningness, particularly being a definite evening type, was significantly associated with a higher prevalence of all comorbidities. Comparing definite evening type to definite morning type, the associations were strongest for psychological disorders (OR 1.94, 95% CI 1.86–2.02, p = < 0.001), followed by diabetes (OR 1.30, 95% CI 1.24–1.36, p = < 0.001), neurological disorders (OR 1.25, 95% CI 1.20–1.30, p = < 0.001), gastrointestinal/abdominal disorders (OR 1.23, 95% CI 1.19–1.27, p = < 0.001) and respiratory disorders (OR 1.22, 95% CI 1.18–1.26, p = < 0.001). The total number of deaths was 10 534, out of which 2127 were due to CVD. Greater eveningness, based on chronotype as an ordinal variable, was associated with a small increased risk of all-cause mortality (HR 1.02, 95% CI 1.004–1.05, p = 0.017) and CVD mortality (HR 1.04, 95% CI 1.00–1.09, p = 0.06). Compared to definite morning types, definite evening types had significantly increased risk of all-cause mortality (HR 1.10, 95% CI 1.02–1.18, p = 0.012). This first report of increased mortality in evening types is consistent with previous reports of increased levels of cardiometabolic risk factors in this group. Mortality risk in evening types may be due to behavioural, psychological and physiological risk factors, many of which may be attributable to chronic misalignment between internal physiological timing and externally imposed timing of work and social activities. These findings suggest the need for researching possible interventions aimed at either modifying circadian rhythms in individuals or at allowing evening types greater working hour flexibility.