The effects of exposure to night shift work on liver function: A cross-sectional study with emphasis of alkaline phosphatase enzyme

ABSTRACT

Background: Previous studies have demonstrated that shift work can be significantly associated with adverse effects on liver function. However, the association between shift work and alkaline phosphatase (ALP) enzyme as a well-known biomarker of liver disease has been undefined. Methods: This cross-sectional study was conducted on a total number of 6,475 eligible oil refinery workers. According to shift work schedules, the participants divided to the following groups: 12-hr rotating night (n = 2,630) and 12-hr fixed day (n = 3845). The Spearman’s correlation and logistic regression were applied to assess the association between shift work and ALP. Results: We found significantly higher levels of ALP in 12-hr rotating night compared to 12-hr fixed-day shift work groups (196.2 ± 52.1 versus 191.5 ± 53.4). According to quartile (Q) logistic regression adjusted by significant variables between study group (age, body mass index, fasting blood sugar, and total cholesterol), the odds ratio and 95% confidence interval of high (Q2–<Q3 versus <Q1) and severe (≥Q3 versus <Q1) levels of ALP in 12-hr rotating night group in comparison to 12-hr fixed-day group were estimated as 1.26 (1.08–1.45) and 1.26 (1.09–1.45), respectively. Conclusions: This study indicated that 12-hr rotating night shift work may be associated with higher levels of ALP. More studies are needed to confirm our findings.     

Shift work and depressive symptoms: the mediating effect of vitamin D and sleep quality

Shift work is associated with vitamin D level, sleep quality, and depressive symptoms. Vitamin D and sleep quality are also associated with depressive symptoms. The purpose of this study was to compare vitamin D level, sleep quality, and depressive symptoms between shift workers and daytime workers and analyze the mediating effect of vitamin D and sleep quality between shift work and depressive symptoms. Among those who participated in the Kangbuk Samsung Health Study in 2012 and 2014, 82,078 cases of full-time workers were analyzed. We evaluated their shift work, vitamin D level, sleep quality, and depressive symptoms with blood samples and questionnaires. Chi-square tests, t-tests, and path statistical analysis were performed. More depressive symptoms, lower vitamin D levels, and poorer sleep quality were associated with shift work. According to a path analysis, shift work had both a direct effect and an indirect effect on depressive symptoms, each mediated by sleep quality and vitamin D level. When a multigroup analysis was conducted for each sex, paths containing sleep quality were more significant in female shift workers than male shift workers; paths involving vitamin D did not differ between sexes. To assess depression risk in shift workers, evaluating vitamin D level and sleep quality is essential. Also, sleep problems are more prevalent in female compared to male shift workers with respect depression prevalence.     

Shift work and inter-individual differences in sleep and sleepiness

Inter-individual differences in tolerance for shift work have been studied primarily in terms of external factors affecting alertness on the job or the ability to rest and sleep while at home. However, there is increasing evidence that neurobiological factors play a role as well, particularly the major processes involved in the regulation of sleep and wakefulness. These include a sleep homeostatic process seeking to balance wakefulness and sleep and a circadian process seeking to promote wakefulness during the day and sleep during the night. Shift work is associated with a temporal misalignment of these two endogenous processes. During nightwork, this misalignment makes it difficult to stay awake during the nightshift and sleep during the day. However, inter-individual variability in the processes involved in sleep/wake regulation is substantial. Recent studies have demonstrated the existence of inter-individual differences in vulnerability to cognitive deficits from sleep loss. Moreover, these inter-individual differences were shown to constitute a trait. Interestingly, self-evaluations of sleepiness did not correspond well with the trait inter-individual variability in objective levels of performance impairment during sleep deprivation. Perhaps because of this discrepancy, in operational settings, the inter-individual differences in vulnerability to sleep loss do not appear to be limited due to self-selection mechanisms. Indeed, even among a highly select group of active-duty jet fighter pilots flying a series of simulated night missions, systematic inter-individual differences in performance impairment from sleep loss were still observed. There are significant personal and economic consequences to human error and accidents caused by performance deficits due to sleep loss. It is important, therefore, to study the inter-individual differences in the regulation of sleep and wakefulness in the work environment so that cognitive impairment during shift work may be better anticipated and prevented.     

Impact of night-float rotation on sleep,mood, and alertness: the resident's perception

Night-float rotations were designed to alleviate the workload of residents on night call and thereby improve patient safety. However, the impact of the night float on residents is yet to be surveyed. We assessed the impact of the night-float rotation on pediatric residents using an anonymous questionnaire that covered topics, based on recall, about sleep, mood, alertness, adjustment, and others. The study was conducted in a major tertiary pediatric teaching hospital in the United States. Participants were pediatric residents who had completed one or two night-float rotations and were in active training at our teaching hospital at the time of the study. Fifty-two of 60 eligible residents (87%) responded. Sleep duration during the night-float rotation was shorter than during day-shift work in 24 residents (46%), longer in 20 (38%), and unchanged in eight (15%). A higher proportion of residents took longer to fall asleep, had more difficulty falling asleep, had more sleep interruptions, and felt less rested upon awakening. Twenty-four residents (46%) felt that their bodies never adjusted to the night shift. Also, 22 residents (43%) felt moody or depressed in contrast to seven (14%) who felt depressed during the daytime rotation (p=0.0001). Twenty-one residents (41%) felt they were slower in their thinking during the night float than daytime rotations. The results suggest that disturbances of sleep and mood and decreased alertness, typical of night shift, are present in the night-float rotation. Residency programs should monitor closely the impact of the night-float rotation on resident well being and patient safety. The impact of night-shift work should be considered in the design of night-float schedules, and teaching should be provided for residents to learn coping strategies for night-shift work.     

Shift work parameters and disruption of diurnal cortisol production in female hospital employees

Shift work is associated with an increased risk of cardiovascular diseases (CVD). Disruption of cortisol production is a potential underlying mechanism. This study explored the associations of diurnal quantity and pattern of cortisol production in relation to (1) current shift work status (exclusive day versus rotating days and nights), (2) years of past shift work and (3) parameters of rotating shift work (timing, length and intensity). Female hospital employees (160 day workers and 168 rotating shift workers) from southeastern Ontario, Canada, participated in a cross-sectional study. Participants completed a baseline questionnaire and measures of body height, weight, and waist circumference were taken. Midstream urine samples were collected over two separate 24-hour periods to measure creatinine-adjusted cortisol. Total diurnal cortisol production and pattern were described with two measures of the area under the curve. The effect of shift work on cortisol was modeled using multivariable linear regression analyses. Cortisol production in day workers and shift workers on their day shift were similar; however, shift workers on the night shift had flatter diurnal cortisol curves and produced less cortisol. This suggests that night work is associated with an acute attenuation of cortisol production.     

Occupational stress and work efficiency of nursing staff engaged in rotating shift work

Occupational stress and stress-related performance impairment is a common feature among hospital nurses engaged in rotating shift work, particularly night work. This cross-sectional survey determined workplace stress and cognitive efficiency of nursing staff engaged in rotating shift work. One hundred twenty-two full-time staff nurses in three different government hospitals in West Bengal, India, were the participants. Perceived exertion, alertness, sleep duration and various performance tests were performed. Sleep duration was least between repeated night shifts in comparison with the other shifts. Though alertness and performance of the staff nurses varied on different shifts, the late portion of the night shift as well as the early portion of the morning shift was most prone to impairment of work efficiency.     

Association of habitual dietary intake with morningness-eveningness and rotating shift work in Japanese female nurses

Rotating shift workers are associated with imbalanced dietary intakes. Rotating shift workers and dietary intakes in adults who do not engage in night work have also been shown to be associated with chronotype. However, no studies have examined associations between morningness-eveningness (i.e., the degree to which people prefer to be active in the morning or the evening), rotating shift work and dietary intakes. Therefore, our first purpose was to elucidate the association between morningness-eveningness and habitual food group intakes in rotating shift workers. The second purpose was to elucidate the association of morningness-eveningness and rotating shift work with food group intakes, considering habitual sleep durations. Japanese nurses (1095 day workers and 1464 rotating shift workers) were studied using a self-administered questionnaire. The questionnaire covered habitual dietary intakes, morningness-eveningness and demographic characteristics of the participants. A Japanese version of the Morningness-Eveningness Questionnaire (MEQ) was used to measure self-rated morningness-eveningness. Dietary intakes over the previous 1 month were evaluated using a semi-quantitative food frequency questionnaire. Intakes of pulses, green/yellow vegetables, white vegetables, fruits, algae, eggs, confectioneries/savory snacks and sugar-sweetened beverages were significantly (p < 0.05) associated with the MEQ score in rotating shift workers. Among these food groups, intakes of green/yellow vegetables, white vegetables, fruits and algae were significantly (p < 0.05) lower in rotating shift workers than in day workers, and intakes of confectioneries/savory snacks and sugar-sweetened beverages were significantly (p < 0.05) higher in rotating shift workers than in day workers. Intakes of these food groups were also significantly (p < 0.05) associated with the MEQ score in day workers. In addition, the MEQ score was significantly (p < 0.05) lower in rotating shift workers than in day workers, indicating greater eveningness among rotating shift workers. Multivariate linear regression revealed that the MEQ scores were significantly (p < 0.05) associated with intakes of these food groups, while rotating shift work was associated only with confectioneries/savory snacks. These results suggest that morningness-eveningness is associated with unbalanced dietary intakes in rotating shift workers as well as day workers, which may partially explain associations between rotating shift work and unfavorable dietary intakes. These findings have important implications for the development of novel strategies for preventing poor health caused by imbalanced dietary intakes in rotating shift workers.     

Differences in workday sleep fragmentation,rest-activity cycle,sleep quality,and activity level among nurses working different shifts

ABSTRACT

Schedule changes associated with rotating shifts can interfere with the circadian rhythms of nurses and thereby affect their sleep duration, sleep quality, work efficiency, and work performance. The objectives of this study was to investigate differences in workday sleep fragmentation, rest-activity cycle, sleep quality, and activity level among nurses working different shifts. After filling out a basic information questionnaire and completing the Pittsburgh Sleep Quality Index (PSQI) questionnaire, participants were asked to wear an actigraph and keep sleep records for seven consecutive days. Data pertaining to wake after sleep onset (WASO), 24-hour autocorrelation coefficient (r24), and daytime activity mean was collected in order to investigate workday sleep fragmentation, rest-activity cycle, and daytime activity level. We obtained complete questionnaires and data from 191 nurses. Day- and evening-shift nurses had more regular workday rest-activity cycles than did night-shift nurses (F = 51.26, p < .001). After controlling for r24 coefficients, we determined that nurses who experienced greater workday sleep fragmentation had higher PSQI scores (β = .18, p = .008). After controlling for WASO times, we determined that nurses who had more regular rest-activity cycles on workdays had lower PSQI scores (β = – .16, p = .036). After controlling for shift type and WASO times, we determined that nurses with higher PSQI scores displayed lower activity levels (β = – .21, p = .015) and those with higher r24 coefficients displayed higher activity levels (β = .18, p = .040) on workdays. We then examined the causal path relationships. Among the shifts, only the day-shift nurses had a higher r24 (β = ?.59, p < .001) than did the night-shift nurses; WASO exerted a significant impact on PSQI scores (β = .20, p = .002); r24 had a significant and negative influence on PSQI scores (β = ?.38, p < .001), and PSQI scores significantly and negatively influenced workday activity levels (β = ?.20, p = .006). This study determined that day- and evening-shift nurses enjoyed more regular and consistent rest-activity cycles than did night-shift nurses; nurses with greater workday sleep fragmentation and/or more irregular rest-activity cycles experienced poorer sleep quality; and nurses suffering from poorer sleep quality displayed lower daytime activity levels on workdays.     

宽恕与睡眠质量关系的研究进展

近年来,国内外对宽恕的研究逐渐增多,但宽恕与睡眠质量关系的研究较少,本文通过综述现有的一些研究资料,分析二者之间的关系。分析表明,人际侵犯事件是影响宽恕的外部因素,其严重程度直接影响受害者的宽恕水平及睡眠质量;宽恕能够降低受害者的生理唤醒、情绪唤醒、及认知唤醒,从而改善睡眠质量,但之间的相互作用及具体的内在影响机制并不明确。同时,影响宽恕水平的宜人性、外倾等人格特质也会影响睡眠质量。最后分析了目前研究中存在的缺陷,并对宽恕与睡眠质量关系的研究前景进行了展望。     

宽恕与睡眠质量关系的研究进展

近年来,国内外对宽恕的研究逐渐增多,但宽恕与睡眠质量关系的研究较少,本文通过综述现有的一些研究资料,分析二者之间的关系。分析表明,人际侵犯事件是影响宽恕的外部因素,其严重程度直接影响受害者的宽恕水平及睡眠质量;宽恕能够降低受害者的生理唤醒、情绪唤醒、及认知唤醒,从而改善睡眠质量,但之间的相互作用及具体的内在影响机制并不明确。同时,影响宽恕水平的宜人性、外倾等人格特质也会影响睡眠质量。最后分析了目前研究中存在的缺陷,并对宽恕与睡眠质量关系的研究前景进行了展望。     

Effects of shift work on attention deficit,hyperactivity, and impulsivity,and their relationship with chronotype

There is growing evidence that shift-work schedules cause severe disturbances to circadian rhythms and the sleep–wakefulness cycle, and that these changes in turn lead to cognitive and behavioral problems. The objective of this study is to explore the relationships between biological rhythm differences (chronotype) and impulsive behaviors and attention-deficit hyperactivity symptoms in shift workers. Seventy-nine nurses working in the daytime and 127 nurses working on night shifts were evaluated with the Barratt Impulsiveness Scale, Adult Attention Deficit Hyperactivity Disorder Self-Report Scale (ASRS), and Morningness–Eveningness questionnaire for identifying circadian preference. It was found that shift workers had more attention deficit (p < .05) and impulsivity (p < .01) when compared with daytime workers. Morning-type workers reported lower hyperactivity and ASRS total scores than evening- and intermediate-type workers. The mean impulsivity score of evening-type workers was higher than both the other groups (p < .05). It has been shown that attention deficit, hyperactivity, and impulsivity levels that appear as a result of working shifts might change in accordance with the individual’s chronotype. It might, therefore, be desirable to evaluate an individual’s chronotype to establish suitability for working shifts.     

Association of rest–activity and light exposure rhythms with sleep quality in insomnia patients

ABSTRACT

The relevance of altered rest-activity rhythm (RAR) and light exposure rhythm (LER) in insomnia patients under natural conditions remains unclear. The aim of this study was to compare the parametric and nonparametric circadian variables of RAR and those of LER under natural conditions between insomnia patients and normal controls (NC) in a community-dwelling setting. The relationship of the nonparametric variables with sleep quality was also explored in both groups. Participants above 18 years old were recruited from three Public Health Centers in a rural area of Korea. Actigraphy (Actiwatch 2; Philips Respironics, Murrysville PA, USA) recording was conducted for 7 days. Subjects were eligible for our study if they had an insomnia disorder (ID) for at least 1 month. Actigraphy data of 78 normal control (NC) subjects (Age, 55.95 ± 13.22 years) and 104 patients with insomnia disorder (ID) (Age, 62.14 ± 12.34 years) were included for the analysis. Acrophases and amplitudes of RAR and LER were estimated using cosinor analysis. Interdaily stability (IS), intradaily variability (IV), and relative amplitude (RA) of these rhythms were determined using nonparametric methods. Parametric cosinor and nonparametric variables of RAR and LER were compared between the NC and ID groups. Generalized linear models (GLMs) were applied to evaluate the main effects of group and each nonparametric variable as well as a group by each variable interaction on the sleep onset latency (SOL), sleep efficiency (SE), and wake after sleep onset (WASO) reflecting sleep quality. Among sleep parameters, the ID group showed significantly lower SE and greater WASO than the NC group. There were no significant differences in the acrophase and amplitude of RAR and LER between the two groups. There were no significant differences in IV, IS, and RA of RAR and LER between the two groups either. GLMs for RAR revealed a significant interaction between the group and IS on the SOL (β = ?46.39, p < 0.01), indicating a negative relationship of the IS with SOL in ID unlike its positive relationship in NC. There were no significant main effects of IV on the SOL, SE, and WASO, but significant main effects of RA on the SE and WASO (β = 63.65 and β = ?221.43, respectively, p < 0.01). GLMs for LER revealed no significant main effects of IS, IV or RA on the SOL, SE, and WASO, but significant interactions between group and RA on the SE and WASO (β = 56.17 and β = ?171.93, respectively, p < 0.05), indicating a stronger positive relationship of the RA with SE in ID compared to NC, and a negative relationship of the RA with WASO in ID, unlike its positive relationship in NC. Although our study did not reveal group differences in circadian variables of RAR and LER, it suggested that the regularity of RAR could be positively associated with sleep initiation, while the robustness of LER could be positively associated with sleep maintenance in insomnia patients.     

Association of sickness absence with poor sleep and depressive symptoms in shift workers

A cross-sectional study was conducted to evaluate the contribution of daily sleep habits and depressive symptoms to sickness absences of shift workers. A self-administered questionnaire that solicited answers about sleep, symptoms of depression, sickness absence, diseases/injuries, and lifestyle factors was submitted to a sample of 522 rotating shift workers between the ages of 18-59 (mean 27) yrs of an electric equipment manufacturing company. The seven features of sleep queried were daily hours of sleep, time to fall asleep, awakening during sleep, early morning awakening, sleep well at night, sufficiency of sleep, and excessive daytime sleepiness at work. The responses were assessed over the subject's previous 1-yr period. Each sleep feature, except daily sleeping hours, was dichotomized by the following responses: (1) taking more than 30min to fall asleep (difficulty initiating sleep; DIS), (2) awakening during sleep almost every day (difficulty maintaining sleep; DMS), (3) early morning awakening almost every day (EMA), (4) sleeping very poorly or not so well at night, (5) definite or somewhat insufficient nightly sleep, and (6) excessive daytime sleepiness at work almost every day (EDS). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. Sickness absence was calculated by asking subjects "How many days in total have you been absent from work due to sickness, including paid vacation, in the last 1-yr period?" The responses were divided into three groups that included no (0 days) sickness absences (reference group, n=235 subjects), 1 to 4 days (short-term, n=199 subjects), and 5 days or more (long-term, n = 88 subjects). Compared to the prevalence of sleep features of the reference group, workers with short-term absence showed a significantly higher prevalence of EMA with an odds ratio (OR) of 5.3, 95% confidence interval (CI) 1.3-22.0. Long-term absence was significantly associated with DMS (OR = 2.1, 95%CI 1.0-4.6), EMA (OR = 5.6, 95%CI 1.0-28.7), sleeping poorly at night (OR= 2.6, 95%CI 1.4-5.0), and high depressive symptoms (OR = 2.0, 95%CI 1.0-3.7) according to the CES-D score of >16, after adjusting for multiple confounding variables. These data point to an association between both the parameters of poor sleep and symptoms of deep depression when self-reported sickness absence is frequent. The association is particularly strong with long-term absence in male shift workers.     

Daily activities and sleep quality in college students

There is growing evidence that social rhythms (e.g., daily activities such as getting into or out of bed, eating, and adhering to a work schedule) have important implications for sleep. The present study used a prospective measure of daily activities to assess the relation between sleep and social rhythms. College students (n=243) 18 to 39 yrs of age, completed the Social Rhythm Metric (SRM) each day for 14 d and then completed the Pittsburgh Sleep Quality Index (PSQI). The sample was divided into groups of good or poor sleepers, according to a PSQI cut-off score of 5 points and was compared on the regularity, frequency, timing, and extent of social engagement during activities. There was a lower frequency and less regularity of social rhythms in poor sleepers relative to good sleepers. Good sleepers engaged more regularly in activities with active social engagement. Earlier rise time, first consumption of a beverage, going outdoors for the first time, and bedtime were associated with better sleep. Greater variability in rise time, consuming a morning beverage, returning home for the last time, and bedtime were associated with more disturbed sleep. The results are consistent with previous findings of reduced regularity in bedtime and rise time schedules in undergraduates, other age groups, and in clinical populations. Results augment the current thought that regulating behavioral zeitgebers may be important in influencing bed and rise times, and suggest that engaging in activities with other people may increase regularity.     

Job strain and vagal recovery during sleep in shift working health care professionals

Within sample female nurses/nurse assistants in three shift work, we explored the association of job strain with heart rate variability before and during sleep. The participants (n?=?95) were recruited from the Finnish Public Sector Study, from hospital wards that belonged either to the top (high job strain [HJS], n?=?42) or bottom quartiles on job strain (low job strain [LJS], n?=?53) as rated by Job Content Questionnaire responses. A further inclusion criterion was that participants' own job strain was at least as high (HJS group) or low (LJS group) as their ward's average estimation. Three-week field measurements included sleep diary and actigraphy to study the participants' sleep patterns and sleep–wake rhythm. A subset of three pre-selected, circadian rhythm and recovery controlled measurement days, one morning shift, one night shift and a day off, included 24-h heart rate variability (HRV) measurements. The bootstrapped HRV parameters (HR, HF, LF, LF-to-HF-ratio and RMSSD) 30?min before and during 30?min of sleep with lowest average heart rate showed no statistically significant job strain group differences. No association of exposure to stressful work environment and HRV before and during sleep was found.     

Association between shift work and risk of type 2 diabetes mellitus: a systematic review and dose-response meta-analysis of observational studies

ABSTRACT

To evaluate the association between shift work and risk of type 2 diabetes mellitus, we searched PubMed, EMBASE and Web of Science from their inception to June 8, 2019. Observational studies examining the relationship between shift work and type 2 diabetes were included. Subgroup analyses were conducted to explore whether specific characteristics would affect the relationship. A dose-response relationship was estimated by using generalized least squares trend regression. Finally, twelve cohort studies and nine cross-sectional studies were included (inter-rater agreement, k = 0.96). The result of meta-analysis indicated that shift work was associated with an increased risk of type 2 diabetes (relative risk = 1.10, 95% confidence interval = 1.05–1.14). Subgroup analyses demonstrated that female shift workers have increased risk of type 2 diabetes while male not observed, health care workers showed the highest risk compared with civil servants and manual workers, and night shift and rotating shift were associated with an increased risk of type 2 diabetes. Dose-response meta-analysis based on three cohorts among female workers indicated that there might be a positive association between duration of shift work and the risk of type 2 diabetes. In conclusion, shift work is positively associated with an increased risk of type 2 diabetes. Among female workers, with the years of exposure to shift work prolonged, the risk of type 2 diabetes might increase accordingly. In the future, more studies are needed to confirm the results of dose-response analysis.     

A Reliability and Validity Study of the Bergen Shift Work Sleep Questionnaire in Nurses Working Three-Shift Rotations

The “Bergen Shift Work Sleep Questionnaire” (BSWSQ) was developed to systematically assess discrete sleep problems related to different work shifts (day, evening, night shifts) and rest days. In this study, we assessed the psychometric properties of the BSWSQ using a sample of 760 nurses, all working in a three-shift rotation schedule: day, evening, and night shifts. BSWSQ measures insomnia symptoms using seven questions: >30-min sleep onset latency, >30-min wake after sleep onset, >30-min premature awakenings, nonrestorative sleep, being tired/sleepy at work, during free time on work days, and when not working/on vacation. Symptoms are assessed separately for each work shift and rest days, as “never,” “rarely,” “sometimes,” “often,” “always,” or “not applicable.” We investigated the BSWSQ model fit, reliability (test-retest of a subsample, n?=?234), and convergent and discriminant validity between the BSWSQ and Epworth Sleepiness Scale, Fatigue Questionnaire, and Hospital Anxiety Depression Scale. We also investigated differences in mean scores between the different insomnia symptoms with respect to different work shifts and rest days. BSWSQ demonstrated an adequate model fit using structural equation modeling: root mean square error of approximation?=?.071 (90% confidence interval [CI]?=?.066–.076), comparative fit index?=?.91, and chi-square/degrees of freedom?=?4.41. The BSWSQ demonstrated good reliability (test-retest coefficients p?<?.001). We found good convergent and discriminant validity between BSWSQ and the other scales (all coefficients p?<?.001). There were significant differences between the overall/composite scores of the various work shifts. Night shift showed the highest score compared to day and evening shifts as well as to rest days (all post hoc comparisons p?<?.001). Mean scores of different symptoms also varied significantly within the individual work shifts. We conclude that the BSWSQ meets the necessary psychometric standards, enabling systematic study of discrete insomnia symptoms in different work shifts. (Author correspondence: elisabeth.flo@psykp.uib.no)     

The effect of cataract surgery on salivary melatonin and sleep quality in aging people

Blue light plays an important role in circadian photoentrainment by stimulating the melanopsin-expressing photosensitive retinal ganglion cells. Age-related cataract causes progressive loss of blue light transmission, which may lead to changes in circadian rhythm and sleep quality. In theory, increased light transmission by cataract surgery may improve circadian misalignment and sleep quality, while the effect of cataract surgery on circadian rhythm is not well understood. In this study, we assessed 30 binocular age-related nuclear cataract patients (aged 72.5 ± 7.2, 16 female) who were eligible for cataract surgery. All the patients underwent phacoemulsification cataract extraction and neutral ultraviolet-only blocking intraocular lens (IOLs) implantation. Visual functions including best-corrected visual acuity (BCVA), color perception and dark adaptation were assessed. Salivary samples were collected at 1-hour interval from 19:00 to 23:00 48 hours before and after surgery. Salivary melatonin concentration was measured and dim light melatonin onset (DLMO) was calculated subsequently. Sleep quality and daytime alertness were assessed before and a month after surgery using Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). All the operated eyes demonstrated significant improvements in BCVA, color perception and dark adaptation after cataract surgery. Salivary melatonin concentration at 23:00 was significantly increased after surgery (P < 0.001). However, the average DLMO did not change significantly after surgery. In addition, PSQI and ESS scores were significantly decreased a month after surgery (P = 0.027, P < 0.001, respectively). In conclusion, cataract surgery promotes blue-light transmission; consequently, it may lead to the increase in nighttime melatonin concentration and improvement in sleep quality as well as daytime alertness.     

Rest-activity circadian rhythm and sleep quality in patients with binge eating disorder

Recent findings suggest that altered rest-activity circadian rhythms (RARs) are associated with a compromised health status. RARs abnormalities have been observed also in several pathological conditions, such as cardiovascular, neurological, and cancer diseases. Binge eating disorder (BED) is the most common eating disorder, with a prevalence of 3.5% in women and 2% in men. BED and its associate obesity and motor inactivity could induce RARs disruption and have negative consequences on health-related quality of life. However, the circadian RARs and sleep behavior in patients with BED has been so far assessed only by questionnaires. Therefore, the purpose of this study was to determine RARs and sleep parameters by actigraphy in patients with BED compared to a body mass index-matched control group (Ctrl). Sixteen participants (eight obese women with and eight obese women without BED diagnosis) were recruited to undergo 5-day monitoring period by actigraphy (MotionWatch 8®, CamNtech, Cambridge, UK) to evaluate RARs and sleep parameters. In order to determine the RARs, the actigraphic data were analyzed using the single cosinor method. The rhythmometric parameters of activity levels (MESOR, amplitude and acrophase) were then processed with the population mean cosinor.

The Actiwatch Sleep Analysis Software (Cambridge Neurotecnology, Cambridge, UK) evaluated the sleep patterns. In each participant, we considered seven sleep parameters (sleep onset: S-on; sleep offset: S-off; sleep duration: SD; sleep latency: SL; movement and fragmentation index: MFI; immobility time: IT; sleep efficiency: SE) calculated over a period of five nights.

The population mean cosinor applied to BED and Ctrl revealed the presence of a significant circadian rhythm in both groups (p < 0.001). The MESOR (170.0 vs 301.6 a.c., in BED and Ctrl, respectively; p < 0.01) and amplitude (157.66 vs 238.19 a.c., in BED and Ctrl, respectively p < 0.05) differed significantly between the two groups. Acrophase was not different between BED and Ctrl, as well as all sleep parameters. Both groups displayed a low level of sleep quality (SE 80.7% and 75.7% in BED and Ctrl, respectively). These data provided the first actigraphy-based evidence of RARs disruption and sleep behavior disorder in patients with BED. However, while sleep disorders could be reasonably ascribed to overweight/obesity and the related lower daily physical activity, RARs disruption in this pathology should be ascribed to factors other than reduced physical activity. The circadian timing approach can represent a novel potential tool in the treatment of patients with eating disorders. These data provide exploratory evidence of behavioral association in a small population of patients that, if confirmed in a wider number of subjects and across different populations, may lead to a revision and enhancement of interventions in BED patients.     

Correlation among clock gene expression rhythms,sleep quality,and meal conditions in delayed sleep-wake phase disorder and night eating syndrome

Clock genes that comprise the circadian clock system control various physiological functions. Delayed sleep-wake phase disorder (DSWPD) and night eating syndrome (NES) are characterized by delayed sleep and meal timing, respectively. We estimated that clock gene expression rhythms in DSWPD patients may be delayed in comparison with the healthy subjects due to delayed melatonin secretion rhythms, producing eveningness chronotype in these individuals. However, it was difficult to estimate which clock gene expression rhythms were delayed or not in NES patients, because previous studies revealed that melatonin secretion rhythm was a little delayed compared with healthy individuals and that chronotype of NES patients depended on the individuals. Therefore, we examined expression rhythms of clock genes such as Period3 (Per3), nuclear receptor subfamily 1, group D, member 1 (Nr1d1) and Nr1d2 in these patients. Further, we expected sleep and meal patterns in DSWPD and NES patients may be more diverse than patterns observed in healthy subjects, and thus analyzed relationships among clock gene expression rhythms, sleep quality, sleep midpoint time, and meal times. We enrolled healthy male participants along with DSWPD and NES male patients, and asked all participants to answer questionnaires and to keep diaries to record information on their sleep and meals. Further, we asked them to collect 5–10 beard follicle samples, 6 times every 4 h. We measured clock gene expression rhythms using total RNA extracted from beard follicle cells. Peak time of clock gene expression in the NES group showed more diversity than the other groups, and that in the DSWPD group was delayed compared with the control group. In addition, the peak time of clock gene expression was negatively correlated with sleep quality and positively correlated with meal time after a long fast. Amplitudes of clock gene expression, especially Per3, positively responded to better mental and physical conditions as well as with better sleep quality. Results of this study suggest that peak times of clock gene expression in NES patients depended on the individuals; some patients with NES showed similar clock gene expression rhythm to healthy subjects, and other patients with NES showed similar to DSWPD patients. Moreover, this study suggests that meal time after a long fast may influence more determination in clock gene expression rhythms than the time of breakfast. Therefore, this study also indicates that Per3 clock gene may be one of the parameters that will help us understand sleep and meal rhythm disturbances.