Clinical significance of social jetlag in patients with excessive daytime sleepiness

ABSTRACT

Social jetlag has recently attracted attention as the circadian misalignment between biological and social clocks. We aimed to examine social jetlag and its effect on daytime sleepiness and daily functions in patients with narcolepsy, behaviorally induced insufficient sleep syndrome (BIISS) and delayed sleep-wake phase disorder (DSPD). The levels of social jetlag (SJL_mid) and sleep-corrected social jetlag (SJL_sc) were calculated for each patient, and the effect of these social jetlag-related parameters on daytime sleepiness and daily functions were examined. Objective sleepiness measured by the mean sleep latency in the multiple sleep latency test, subjective sleepiness assessed by the Epworth sleepiness scale (ESS), health-related quality of life (HRQoL) assessed by the SF-8 health survey, and incidences of mistakes in daily activities, traffic accidents and near-miss events related to daytime sleepiness were compared among the narcolepsy (n = 39), BIISS (n = 87) and DSPD (n = 28) groups. Both SJL_mid and SJL_sc showed a negative correlation with physical HRQoL in patients with narcolepsy and a positive correlation with the ESS score in patients with DSPD. In patients with BIISS, SJL_sc reflected sleep loss rather than circadian misalignment; moreover, SJL_sc was not associated with daytime sleepiness and daily functions. Social jetlag was not associated with incidences of mistakes in daily activities, traffic accidents and near-miss events.

The state of social jetlag and its association with daily functions differed among the narcolepsy, BIISS and DSPD groups. Social jetlag represented sleep debt in BIISS, circadian misalignment in narcolepsy and both in DSPD. Our results thus show that the clinical manifestations and significance of social jetlag differ depending on the underlying sleep disorders.     

Later chronotype is associated with higher hemoglobin A1c in prediabetes patients

The circadian system is known to play a role in glucose metabolism. Chronotype reflects the interindividual variability in the phase of entrainment. Those with later chronotype typically prefer later times in the day for different activities such as sleep or meals. Later chronotype has been shown to be associated with metabolic syndrome, increased diabetes risk and poorer glycemic control in type 2 diabetes patients. In addition, “social jetlag”, a form of circadian misalignment due to a mismatch between social rhythms and the circadian clock, has been shown to be associated with insulin resistance. Other sleep disturbances (insufficient sleep, poor sleep quality and sleep apnea) have also been shown to affect glucose metabolism. In this study, we explored whether there was a relationship between chronotype, social jetlag and hemoglobin A1c (HbA1c) levels in prediabetes patients, independent of other sleep disturbances. A cross-sectional study was conducted at the Department of Family Medicine, Ramathibodi Hospital, Bangkok, from October 2014 to March 2016 in 1014 non-shift working adults with prediabetes. Mid-sleep time on free day adjusted for sleep debt (MSFsc) was used as an indicator of chronotype. Social jetlag was calculated based on the absolute difference between mid-sleep time on weekdays and weekends. The most recent HbA1c values and lipid levels were retrieved from clinical laboratory databases. Univariate analyses revealed that later MSFsc (p = 0.028) but not social jetlag (p = 0.48) was significantly associated with higher HbA1c levels. Multivariate linear regression analysis was applied to determine whether an independent association between MSFsc and HbA1c level existed. After adjusting for age, sex, alcohol use, body mass index (BMI), social jetlag, sleep duration, sleep quality and sleep apnea risk, later MSFsc was significantly associated with higher HbA1c level (B = 0.019, 95% CI: 0.00001, 0.038, p = 0.049). The effect size of one hour later MSFsc on HbA1c (standardized coefficient = 0.065) was approximately 74% of that of the effect of one unit (kg/m²) increase in BMI (standardized coefficient = 0.087). In summary, later chronotype is associated with higher HbA1c levels in patients with prediabetes, independent of social jetlag and other sleep disturbances. Further research regarding the potential role of chronotype in diabetes prevention should be explored.     

Social jetlag affects subjective daytime sleepiness in school-aged children and adolescents: A study using the Japanese version of the Pediatric Daytime Sleepiness Scale (PDSS-J)

The aim of this study was to elucidate the level of daytime sleepiness in Japanese school-aged children and adolescents, and to examine associated factors including sleep loss and social jetlag using the Japanese version of the Pediatric Daytime Sleepiness Scale (PDSS-J). After the linguistic validation of the PDSS-J with a multi-step translation methodology, consisting of forward translation, back translation, expert review and cognitive debriefing interviews, we conducted a psychometric validation for 492 students aged 11–16 years (46.7% boys) of public elementary school, junior high school and high school, using the PDSS-J, the Karolinska Sleepiness Scale (KSS), and bedtimes and wake-up times on school days and free days. Internal consistency (Cronbach’s alpha) of the PDSS-J was 0.77, and the test–retest reliability demonstrated by the intraclass coefficient was 0.88. Multivariate logistic regression analysis revealed that both short sleep duration and social jetlag were identified as factors associated with daytime sleepiness, after adjustment for age and sex. PDSS-J scores were significantly higher in the group with large social jetlag with or without sufficient sleep duration than in the group with sufficient sleep duration and small social jetlag. The PDSS-J is an important tool for assessing daytime sleepiness, given its ease of administration and robust psychometric properties. The impact of not only sleep loss but also social jetlag on daytime sleepiness among school-aged children and adolescents must be fully taken into account.     

Association between morningness and resilience in Korean college students

Circadian typology and sleep quality may be essential factors associated with the promotion of resilience. However, previous studies investigating the association between circadian typology and resilience did not analyze the effects of sleep quality on resilience. Thus, the present study evaluated the association between circadian typology and resilience in Korean college students after controlling for sleep quality. Additionally, this study investigated several sleep-related variables, including sleep duration, social jetlag and sunlight exposure during the daytime, to examine the modifiable behavioral features of morningness and also investigated whether the findings regarding morningness-related modifiable habits were associated with resilience. This study included 1094 participants (947 males and 147 females) between 19 and 29 years of age (22.8 ± 1.9 years) who completed the 10-item Korean version of the Connor–Davidson Resilience Scale (CD-RISC-10), the Korean version of the Morningness–Eveningness Questionnaire (MEQ), the Pittsburgh Sleep Quality Index (PSQI), the Korean version of the Hospital Anxiety and Depression Scale (HADS) and a survey about social jetlag that determined misalignments between weekday and weekend times of awakening and activity duration under conditions of sunlight between 10:00 and 15:00. A multiple linear regression analysis revealed that sleep duration, mean daily sunlight exposure between 10:00 and 15:00 and age were positive predictors of morningness, whereas social jetlag was a negative predictor of morningness. Of these morningness-related modifiable behavioral features, mean daily sunlight exposure between 10:00 and 15:00 significantly predicted greater resilience. An additional multiple linear regression analysis revealed that morningness was a positive predictor of resilience after controlling for age, sex, depression, anxiety and sleep quality. These results support the idea that morningness and better sleep quality are associated with greater resilience. Morningness was also associated with longer sleep duration, longer sunlight exposure during the daytime and less social jetlag, whereas longer daily sunlight exposure between 10:00 and 15:00 was associated with greater resilience. Future longitudinal studies are needed to examine whether manipulations of morningness-related modifiable behavioral features can rearrange chronotype and promote resilience.     

Depression scores associate with chronotype and social jetlag in a rural population

In public health, mood disorders are among the most important mental impairments. Patients with depressive episodes exhibit daily mood variations, abnormal patterns in sleep-wake behavior, and in the daily rhythms of several endocrine-metabolic parameters. Although the relationship between the sleep/circadian processes and mood disorders is poorly understood, clock-related therapies, such as light therapy, sleep deprivation, and rigid sleep schedules, have been shown to be effective treatments. Several studies investigated the relationship between circadian phenotype (chronotype) and depression. These focused mainly on urban populations and assessed diurnal preferences (Morningness-Eveningness score) rather than the actual timing of sleep and activity. Here, we used the Beck Depression Inventory (BDI) in an essentially rural population (N?=?4051), and investigated its relation to circadian phenotype (chronotype and social jetlag), assessed with the Munich Chronotype Questionnaire (MCTQ). In our study design, we (i) normalized both chronotype and BDI scores for age and sex (MSF(sas) and BDI(as), respectively); (ii) calculated individual social jetlag (misalignment of the biological and social time); and (iii) investigated the relationship between circadian phenotypes and BDI scores in a population homogeneous in respect to culture, socioeconomic factors, and daily light exposure. A 15.65% (N?=?634) of the participants showed mild to severe depressive BDI scores. Late chronotypes had a higher BDI(as) than intermediate and early types, which was independent of whether or not the participants were smokers. Both chronotype and BDI(as) correlated positively with social jetlag. BDI(as) was significantly higher in subjects with >2?h of social jetlag than in the rest of the population?again independent of smoking status. We also compared chronotype and social jetlag distributions between BDI categories (no symptoms, minimal symptoms, and mild to severe symptoms of depression) separately for men and women and for four age groups; specifically in the age group 31?40 yrs, subjects with mild to severe BDI scores were significantly later chronotypes and suffered from higher social jetlag. Our results indicate that misalignment of circadian and social time may be a risk factor for developing depression, especially in 31- to 40-yr-olds. These relationships should be further investigated in longitudinal studies to reveal if reduction of social jetlag should be part of prevention strategies. (Author correspondence: karla.allebrandt@med.uni-muenchen.de ).     

Adaptation to night shifts and synchronisation processes of night workers

Human beings are accustomed to being active and awake during the day, and asleep and rest at night. Since we live in a society which is organised predominantly along daytime activity, therefore working in the night shift may deeply disrupt our social and family life. It is also a well-known fact that night shift causes fatigue and circadian disruption. The basic manifestation of fatigue and circadian rhythm has been linked to health and safety problems, involving decrements in psychophysical and physiological functions, plus subjective complaints. In this context quantitative relationships between shift work and circadian rhythm need to be assessed to explore suitable time schedule, and to minimise sleep depth and fatigue. There is also a great need to discuss circadian disruption, sleepiness and the increasing cost of work related illness among night workers. In this regard, some aspects of fatigue and circadian disruption caused from night shift work are revealed in this paper aiming to increase workers' health, safety and well being as well as productivity. Light/dark cycle and social stimuli issues acting on the circadian timing systems are also explored to solicit opinions and discussion on the controversy of night work. Suggestions are therefore likewise given to enhance workers' adaptation to night shift and synchronization process.     

Social jetlag and obesity

Obesity has reached crisis proportions in industrialized societies. Many factors converge to yield increased body mass index (BMI). Among these is sleep duration. The circadian clock controls sleep timing through the process of entrainment. Chronotype describes individual differences in sleep timing, and it is determined by genetic background, age, sex, and environment (e.g., light exposure). Social jetlag quantifies the discrepancy that often arises between circadian and social clocks, which results in chronic sleep loss. The circadian clock also regulates energy homeostasis, and its disruption-as with social jetlag-may contribute to weight-related pathologies. Here, we report the results from a large-scale epidemiological study, showing that, beyond sleep duration, social jetlag is associated with increased BMI. Our results demonstrate that living "against the clock" may be a factor contributing to the epidemic of obesity. This is of key importance in pending discussions on the implementation of Daylight Saving Time and on work or school times, which all contribute to the amount of social jetlag accrued by an individual. Our data suggest that improving the correspondence between biological and social clocks will contribute to the management of obesity.     

Depression Scores Associate With Chronotype and Social Jetlag in a Rural Population

In public health, mood disorders are among the most important mental impairments. Patients with depressive episodes exhibit daily mood variations, abnormal patterns in sleep-wake behavior, and in the daily rhythms of several endocrine-metabolic parameters. Although the relationship between the sleep/circadian processes and mood disorders is poorly understood, clock-related therapies, such as light therapy, sleep deprivation, and rigid sleep schedules, have been shown to be effective treatments. Several studies investigated the relationship between circadian phenotype (chronotype) and depression. These focused mainly on urban populations and assessed diurnal preferences (Morningness-Eveningness score) rather than the actual timing of sleep and activity. Here, we used the Beck Depression Inventory (BDI) in an essentially rural population (N?=?4051), and investigated its relation to circadian phenotype (chronotype and social jetlag), assessed with the Munich Chronotype Questionnaire (MCTQ). In our study design, we (i) normalized both chronotype and BDI scores for age and sex (MSF_sas and BDI_as, respectively); (ii) calculated individual social jetlag (misalignment of the biological and social time); and (iii) investigated the relationship between circadian phenotypes and BDI scores in a population homogeneous in respect to culture, socioeconomic factors, and daily light exposure. A 15.65% (N?=?634) of the participants showed mild to severe depressive BDI scores. Late chronotypes had a higher BDI_as than intermediate and early types, which was independent of whether or not the participants were smokers. Both chronotype and BDI_as correlated positively with social jetlag. BDI_as was significantly higher in subjects with >2?h of social jetlag than in the rest of the population—again independent of smoking status. We also compared chronotype and social jetlag distributions between BDI categories (no symptoms, minimal symptoms, and mild to severe symptoms of depression) separately for men and women and for four age groups; specifically in the age group 31–40 yrs, subjects with mild to severe BDI scores were significantly later chronotypes and suffered from higher social jetlag. Our results indicate that misalignment of circadian and social time may be a risk factor for developing depression, especially in 31- to 40-yr-olds. These relationships should be further investigated in longitudinal studies to reveal if reduction of social jetlag should be part of prevention strategies. (Author correspondence: karla.allebrandt@med.uni-muenchen.de)     

Validating and Extending the Three Process Model of Alertness in Airline Operations

Sleepiness and fatigue are important risk factors in the transport sector and bio-mathematical sleepiness, sleep and fatigue modeling is increasingly becoming a valuable tool for assessing safety of work schedules and rosters in Fatigue Risk Management Systems (FRMS). The present study sought to validate the inner workings of one such model, Three Process Model (TPM), on aircrews and extend the model with functions to model jetlag and to directly assess the risk of any sleepiness level in any shift schedule or roster with and without knowledge of sleep timings. We collected sleep and sleepiness data from 136 aircrews in a real life situation by means of an application running on a handheld touch screen computer device (iPhone, iPod or iPad) and used the TPM to predict sleepiness with varying level of complexity of model equations and data. The results based on multilevel linear and non-linear mixed effects models showed that the TPM predictions correlated with observed ratings of sleepiness, but explorative analyses suggest that the default model can be improved and reduced to include only two-processes (S+C), with adjusted phases of the circadian process based on a single question of circadian type. We also extended the model with a function to model jetlag acclimatization and with estimates of individual differences including reference limits accounting for 50%, 75% and 90% of the population as well as functions for predicting the probability of any level of sleepiness for ecological assessment of absolute and relative risk of sleepiness in shift systems for safety applications.     

Sleep quality and sleep duration,but not circadian parameters are associated with decreased insulin sensitivity in Type 1 diabetes

ABSTRACT

The objective of this cross-sectional analysis was to investigate in 109 adults with type 1 diabetes the relationship between sleep, circadian parameters and insulin sensitivity, as assessed by estimated glucose disposal rate (eGDR). In multiple regression analysis only poor sleep quality and sleep duration were negatively associated with eGDR (β = ?0.219 [95%CI:-1.977; ?0.445], p = .002 for poor sleep quality; β = ?0.183 [95%CI: ?0.645; ?0.111], p = .006 for sleep duration) independent of age, gender, smoking status and body mass index. In conclusion, poor sleep quality and longer sleep duration were significant predictors of decreased insulin sensitivity. Social jetlag, chronotype, and sleep debt had no effect on insulin sensitivity.     

Fibromyalgia syndrome and chronotype: late chronotypes are more affected

Sleep has strong links to the symptomology of fibromyalgia syndrome (FMS), a diffuse musculoskeletal pain disorder. Information about the involvement of the circadian clock is, however, sparse. In this study, 1548 individuals with FMS completed an online survey containing questions on demographics, stimulant consumption, sleep quality, well-being and subjective pain, chronotype (assessed by the Munich ChronoType Questionnaire, MCTQ), and FMS impact. Chronotype (expressed as the mid-sleep-point on free days, corrected for sleep deficit on workdays, MSF(sc)) significantly correlated with stress-ratings, so-called "memory failures in everyday life," fatigue, FMS impact, and depression but not with anxiety. When chronotypes were categorized into 3 groups (early, intermediate, late), significant group differences were found for sum scores of perceived stress, memory failures in everyday life, fatigue, FMS impact, and depression but not anxiety, with late chronotypes being more affected than early chronotypes. Sleepiness ratings were highest in early chronotypes. Challenges of sleep quality and subjective pain were significantly increased in both early and late chronotypes. The results show that according to their reports, late chronotypes are more affected by fibromyalgia.     

Interrelationships between distinct circadian manifestations of possible bruxism,perceived stress,chronotype and social jetlag in a population of undergraduate students

ABSTRACT

This study investigates the recently hypothesized association between distinct circadian manifestations of possible bruxism in subjects with different chronotype profiles, social jetlag and levels of perceived stress. A cross-sectional study was performed by surveying dental students’ of Lithuanian University of Health Sciences. A survey instrument was designed and pilot tested for reliability and validity prior to full-scale administration. The instrument consisted of four sections: socio-demographic questions, bruxism-related items, the Perceived Stress Scale and the Munich ChronoType Questionnaire. The study included 228 students (82.5% females; mean age 22.67 ± 2.27). Awake grinding was significantly associated with later chronotype values (p = 0,039). Despite the lack of significance, binary regression models demonstrated that students with later chronotypes report higher rates of possible bruxism, especially as far as awake grinding (p = .170; OR = 1.89) and sleep grinding (p = .140; OR = 1.60) are concerned. There were no significant associations between perceived stress, social jetlag and bruxism. The scores of perceived stress did not correlate with chronotype values, although a high positive correlation was found between chronotype and social jetlag (r = 0.516, p = .000). It can be concluded that later chronotypes increase the odds for self-reported bruxism, and are significantly associated with higher rates of awake grinding and social jetlag. No interrelationships were found between perceived stress, possible bruxism and social jetlag.     

Sleep duration and social jetlag are independently associated with anxious symptoms in adolescents

Although short total sleep time (TST) is associated with increased anxious symptoms in adolescents, it is unknown whether social jetlag, a misalignment between sleep timing on the weekend and school week, is independently associated with anxious symptoms. In the current study, sleep timing, anxious symptoms, and demographic information were assessed from 3097 adolescents (48% female, mean ± SD age 15.59 ± .77 years) from the age 15 wave of the Fragile Families and Child Wellbeing Study. Social jetlag was calculated as the absolute value of the midpoint of sleep on the weekend minus the midpoint of sleep during the school week. Anxious symptoms were measured through the 6-item anxiety subscale of the Brief Symptom Inventory 18. We assessed associations between sleep variables and anxious symptoms using multiple linear regression. Adjusted analyses controlled for sex, race/ethnicity, age in years, body mass index percentile, number of other children below the age of 18 in the household, and primary caregiver (PCG) married/cohabiting with youth’s biological parent, PCG employment status, PCG household income and PCG education level. In fully adjusted models (R² = .034), school night TST (b = ?.04, ?R² = .005, p < .001) was negatively associated with anxiety symptoms, while social jetlag (b = .04, ?R² = .009, p < .001) was positively and independently associated with anxiety symptoms. Findings indicate small associations of school night TST and social jetlag with anxious symptoms. Thus, maintenance of optimal emotional health in adolescents may require both sufficient sleep duration and regularity of sleep timing across the week.     

Sleep habits,circadian preferences and substance use in a Mexican population: the use of the Morningness-Eveningness-Stability-Scale improved (MESSi)

ABSTRACT

This study aimed to validate the Morningness-Eveningness-Stability-Scale improved (MESSi) in Mexico, analyzing the factor structure and sleep habits, combined with the proposal of cutoff values for the scales, and to assess the relationship with substance use. We applied the questionnaires through an online survey to a total sample of 510 Mexicans, aged 18–77 years (M = 27.79, SD = 10.24). The MESSi showed an acceptable fit and the Cronbach’s alpha coefficients were good to satisfactory in the Mexican sample in every subscale: Morning Affect (MA, α = 0.90), Eveningness (EV, α = 0.88), Distinctness (DI, α = 0.80). In order to obtain a better interpretation of the MESSi subscales, we decided to propose cutoff points corresponding to the 25th–75th percentile. The categories were depicted as strong trait presence, intermediate trait presence and weak trait presence. When applying the cutoff points for the MESSi sub-scales, with Morning Affect (MA), strong-types went to bed and woke up earlier and had more sleep than weak-types during weekdays and weekends and reported less social jetlag. For Eveningness (EV), strong-types went to bed and woke up later than weak-types on weekdays and weekends. Also, strong-types had a shorter time in bed during weekdays but not on weekends and reported more social jetlag. Lastly, with Distinctness (DI), the results reported that those with a strong-type showed greater amplitude on weekdays and weekends. Furthermore, the MESSi scale found that evening people consumed more alcohol and tobacco. Our study supported the validity and reliability of the MESSi in a Mexican population and the relationship between eveningness and substance consumption. Furthermore, the proposed cutoff scores for the MESSi sub-scales add a novel approach for the measurement and interpretation of the scale.     

Quantitative physiologically based modeling of subjective fatigue during sleep deprivation

A quantitative physiologically based model of the sleep-wake switch is used to predict variations in subjective fatigue-related measures during total sleep deprivation. The model includes the mutual inhibition of the sleep-active neurons in the hypothalamic ventrolateral preoptic area (VLPO) and the wake-active monoaminergic brainstem populations (MA), as well as circadian and homeostatic drives. We simulate sleep deprivation by introducing a drive to the MA, which we call wake effort, to maintain the system in a wakeful state. Physiologically this drive is proposed to be afferent from the cortex or the orexin group of the lateral hypothalamus. It is hypothesized that the need to exert this effort to maintain wakefulness at high homeostatic sleep pressure correlates with subjective fatigue levels. The model's output indeed exhibits good agreement with existing clinical time series of subjective fatigue-related measures, supporting this hypothesis. Subjective fatigue, adrenaline, and body temperature variations during two 72 h sleep deprivation protocols are reproduced by the model. By distinguishing a motivation-dependent orexinergic contribution to the wake-effort drive, the model can be extended to interpret variation in performance levels during sleep deprivation in a way that is qualitatively consistent with existing, clinically derived results. The example of sleep deprivation thus demonstrates the ability of physiologically based sleep modeling to predict psychological measures from the underlying physiological interactions that produce them.     

Impact of layover length on sleep, subjective fatigue levels, and sustained attention of long-haul airline pilots

Long-haul airline pilots often experience elevated levels of fatigue due to extended work hours and circadian misalignment of sleep and wake periods. During long-haul trips, pilots are typically given 1-3 d off between flights (i.e., layover) to recover from, and prepare for, duty. Anecdotally, some pilots prefer long layovers because it maximizes the time available for recovery and preparation, but others prefer short layovers because it minimizes both the length of the trip, and the degree to which the body clock changes from "home time" to the layover time zone. The aim of this study was to examine the impact of layover length on the sleep, subjective fatigue levels, and capacity to sustain attention of long-haul pilots. Participants were 19 male pilots (10 Captains, 9 First Officers) working for an international airline. Data were collected during an 11- or 12-d international trip. The trips involved (i) 4 d at home prior to the trip; (ii) an eastward flight of 13.5 h across seven time zones; (iii) a layover of either 39 h (i.e., short, n = 9) or 62 h (i.e., long, n = 10); (iv) a return westward flight of 14.3 h across seven time zones; and (v) 4 d off at home after the trip. Sleep was recorded using a self-report sleep diary and wrist activity monitor; subjective fatigue level was measured using the Samn-Perelli Fatigue Checklist; and sustained attention was assessed using the psychomotor vigilance task for a personal digital assistant (PalmPVT). Mixed-model regression analyses were used to determine the effects of layover length (short, long) on the amount of sleep that pilots obtained during the trip, and on the pilots' subjective fatigue levels and capacity to sustain attention. There was no main effect of layover length on ground-based sleep or in-flight sleep, but pilots who had a short layover at the midpoint of their trip had higher subjective fatigue levels and poorer sustained attention than pilots who had a long layover. The results of this study indicate that a short layover during a long-haul trip does not substantially disrupt pilots' sleep, but it may result in elevated levels of fatigue during and after the trip. If short layovers are used, pilots should have a minimum of 4 d off to recover prior to their next long-haul trip.     

Wrist temperature and cortisol awakening response in humans with social jetlag in the North

The discrepancy between biological and social rhythms known as social jetlag (SJL) is common in modern society and has a range of negative consequences for cognitive functioning, well-being and health. Social jetlag is typical for people with late chronotypes. As shown earlier, the prevalence of individuals with a late chronotype is higher among the residents of high latitudes. Therefore, a higher rate of detection of people with SJL should be expected in the North. In this study we assessed the detection rate of SJL among 62 young inhabitants of the European North of Russia (the Komi Republic), and the relationship between SJL, the circadian rhythm of the wrist temperature, and the cortisol awakening response (CAR). The detection rate of SJL was 65% among the people examined. A significant decrease in the amplitude (A) of circadian rhythm of wrist temperature: (β = ?0.34 (CI 95%: ?0.66 to ?0.33); F_1,60 = 10.4; p < 0.0001; η² = 0.31), an increased incidence of depression: No-SJL = 4.5%; SJL = 17.5% (H = 4.84; p < 0.05), and a tendency for an increase in CAR was also observed in the SJL group. There were sex differences in sensitivity to SJL. Females with SJL but not males had higher global seasonality scores (β = 0.51 (CI 95%: 0.21 to 0.81); F_1,33 = 10.9; p < 0.002; η² =0.24), shorter sleep duration (β = ?0.52 (CI 95%: ?0.82 to ?0.22); F_1,33 = 12.9; p < 0.001; η² = 0.28), worse sleep quality (β = 0.39 (CI 95%: 0.07 to 0.72); F_1,33 = 6.31; p < 0.017; η² = 0.16) and lower A of circadian rhythm of wrist temperature (β = ?0.18 (CI 95%: ?0.55 to 0.18); F_1,33 = 4.48; p < 0.043; η² = 0.13) compared with females without SJL. Thus, our data indicate that 40 of 62 participants of investigation had social jetlag. A decrease of the amplitude of the circadian rhythm of the wrist temperature appears to be an objective marker of SJL. Social jetlag had a strong negative impact on females but not on males.     

Associations of chronotype with social jetlag and behavioral problems in preschool children

The timing, duration, and intensity of sleep are determined by the interaction between a sleep-wake-dependent homeostatic process and a sleep-wake-independent, intrinsic, clock-like circadian process. Chronotype represents individual differences in diurnal preferences, which are not only genetically determined but also influenced by social and environmental factors. Thus, the discrepancy between biological and social clocks, so-called “social jetlag”, occurs. Chronotype, social jetlag, and the links between chronotype and behavioral problems are well documented in adults and adolescents. However, such studies on young children are limited. We conducted a survey of sleep and health for preschool children attending kindergarten or childcare centers in Wako, Okayama and Kurashiki cities, Japan, between May and July 2012. A total of 654 children aged 4–6 years (342 boys and 312 girls, with an average age of 4.7 years) were assessed using the Children’s ChronoType Questionnaire and the Strength and Difficulties Questionnaire. Morning (M)-type, neither (N)-type and evening (E)-type accounted for 36.2%, 54.0% and 9.8% of the participants, respectively. The weekday-to-weekend differences in midsleep time – originally proposed as the concept of social jetlag – were 11, 25 and 35?min for M-, N- and E-types, respectively. There was a negative correlation between chronotype and sleep period during weekdays (p?<?0.001) and a positive correlation on weekends (p?<?0.001). The weekday-to-weekend difference in sleep period was 0.5?h for E-types, whereas there was no difference for M-types. Binomial logistic regression analyses were used to examine the links between chronotype and behavioral problems, adjusted for participants’ sex, age, childcare programs and locations. Chronotype was significantly associated with hyperactivity/inattention: N-type (adjusted OR?=?1.74, 95% CI?=?1.03–2.95, p?<?0.05) and E-type (adjusted OR?=?2.47, 95% CI?=?1.18–5.20, p?<?0.05). E-type was significantly associated with conduct problems (adjusted OR?=?2.11, 95% CI?=?1.03–4.31, p?<?0.05) and peer problems (adjusted OR?=?2.75, 95% CI?=?1.18–6.44, p?<?0.05). The results suggest that E-type children are vulnerable to higher social jetlag and more behavioral problems. The immature adjustment function of their endogenous circadian pacemakers may not be able to correct a small but significant social jetlag to synchronize with their social clocks. Furthermore, guidance based on chronobiological evidence is required for parents, teachers and health professionals to help children achieve optimal sleep and reduce behavioral problems.     

Sleep quality,chronotype and social jetlag differentially associate with symptoms of attention deficit hyperactivity disorder in adults

Attention deficit hyperactivity disorder (ADHD) is a common neurobehavioural disorder which has been associated with sleep and circadian rhythm disturbances. Numerous studies have linked evening circadian typology with traits and behaviours associated with the disorder, although a precise reason for this relationship has not been clarified. The current study examines ADHD symptoms, impulsivity, cognitive failures, sleep quality and chronotype in a cohort of healthy young adults (N = 396). Results show significant, small magnitude associations between mid-point of sleep on free days, social jetlag (SJL) and ADHD symptoms and impulsivity, although not with cognitive failures. Similarly, sleep quality is also associated with ADHD symptoms and impulsivity. Group-wise approaches show that higher SJL is associated with significantly more ADHD symptoms and impulsivity, and later mid-sleep on free days is also associated with more ADHD symptoms. Stepwise multiple linear regression reveals that, when controlling for age and sex, SJL but not mid-sleep on free days is a significant predictor of ADHD symptoms and impulsivity. These results indicate that SJL may be an important factor to consider when exploring circadian rhythm associations with ADHD symptoms.     

A systematic review of circadian function,chronotype and chronotherapy in attention deficit hyperactivity disorder

Reports of sleep disturbances in attention deficit hyperactivity disorder (ADHD) are common in both children and adults; however, the aetiology of such disturbances is poorly understood. One potentially important mechanism which may be implicated in disrupted sleep in ADHD is the circadian clock, a known key regulator of the sleep/wake cycle. In this systematic review, we analyse the evidence for circadian rhythm changes associated with ADHD, as well as assessing evidence for therapeutic approaches involving the circadian clock in ADHD. We identify 62 relevant studies involving a total of 4462 ADHD patients. We find consistent evidence indicating that ADHD is associated with more eveningness/later chronotype and with phase delay of circadian phase markers such as dim light melatonin onset and delayed sleep onset. We find that there is evidence that melatonin treatment may be efficacious in addressing ADHD-related sleep problems, although there are few studies to date addressing other chronotherapeutic approaches in ADHD. There are only a small number of genetic association studies which report linkages between polymorphisms in circadian clock genes and ADHD symptoms. In conclusion, we find that there is consistent evidence for circadian rhythm disruption in ADHD and that such disruption may present a therapeutic target that future ADHD research might concentrate explicitly on.