HYPERSENSITIVITY OF MELATONIN SUPPRESSION IN RESPONSE TO LIGHT IN PATIENTS WITH DELAYED SLEEP PHASE SYNDROME*

Patients with delayed sleep phase syndrome (DSPS) experiencea chronic mismatch between the usual daily schedule required by the individual'senvironment and their circadian sleep-wake pattern, resulting in major academic,work, and social problems. Although functional abnormalities of the circadianpacemaker system have been reported in patients with DSPS, the etiology ofDSPS has not been fully elucidated. One hypothesis proposed to explain whypatients with DSPS fail to synchronize their 24h sleep-wake cycle to theirenvironment is that they might have reduced sensitivity to environmental timecues, most notably light-dark cycles. Therefore, we compared the sensitivityof melatonin suppression in response to light in patients with DSPS and normalcontrol subjects. Fifteen patients with DSPS and age- and sex-matched healthycontrols were studied. As the melatonin secretion rhythm in patients withDSPS was expected to be delayed compared to the controls, the time of peakmelatonin secretion was determined in each subject in the first session. Inthe second session, each subject was exposed to light with an intensity of1000 lux for 2h beginning 2h prior to his or her peak melatonin secretion.Melatonin was measured by radioimmunoassay in saliva sampled every 30 minutesduring the period of light exposure. Suppression of the melatonin concentrationin saliva was dependent on duration of light exposure. In addition, the suppressiveeffect of light on the melatonin concentration was significantly greater inpatients with DSPS than in control subjects. The results suggest hypersensitivityto nighttime light exposure in patients with this syndrome. Our findings thereforesuggest that evening light restriction is important for preventing patientswith DSPS from developing a sleep phase delay. (ChronobiologyInternational, 18(2), 263–271, 2001)     

Hypersensitivity of melatonin suppression in response to light in patients with delayed sleep phase syndrome

Patients with delayed sleep phase syndrome (DSPS) experience a chronic mismatch between the usual daily schedule required by the individual's environment and their circadian sleep-wake pattern, resulting in major academic, work, and social problems. Although functional abnormalities of the circadian pacemaker system have been reported in patients with DSPS, the etiology of DSPS has not been fully elucidated. One hypothesis proposed to explain why patients with DSPS fail to synchronize their 24h sleep-wake cycle to their environment is that they might have reduced sensitivity to environmental time cues, most notably light-dark cycles. Therefore, we compared the sensitivity of melatonin suppression in response to light in patients with DSPS and normal control subjects. Fifteen patients with DSPS and age- and sex-matched healthy controls were studied. As the melatonin secretion rhythm in patients with DSPS was expected to be delayed compared to the controls, the time of peak melatonin secretion was determined in each subject in the first session. In the second session, each subject was exposed to light with an intensity of 1000 lux for 2h beginning 2h prior to his or her peak melatonin secretion. Melatonin was measured by radioimmunoassay in saliva sampled every 30 minutes during the period of light exposure. Suppression of the melatonin concentration in saliva was dependent on duration of light exposure. In addition, the suppressive effect of light on the melatonin concentration was significantly greater in patients with DSPS than in control subjects. The results suggest hypersensitivity to nighttime light exposure in patients with this syndrome. Our findings therefore suggest that evening light restriction is important for preventing patients with DSPS from developing a sleep phase delay. (Chronobiology International, 18(2), 263-271, 2001)     

Actigraphic estimates of sleep and the sleep-wake rhythm,and 6-sulfatoxymelatonin levels in healthy Dutch children

ABSTRACT

Sleep and the sleep-wake rhythm are essential for children’s health and well-being, yet reference values are lacking. This study therefore aimed to assess actigraphic estimates of sleep and the 24-h sleep-wake rhythm, as well as 6-sulfatoxymelatonin (aMT6s) levels in healthy children of different age groups. Additionally, relationships between the outcomes and sex, highest parental educational level (as an indication of socioeconomic status (SES)), and body-mass-index (BMI) were explored. In this cross-sectional study, healthy Dutch children (2–18 years) wore an actigraph (GT3x) for 7 consecutive days, collected first-morning void urine and completed a sleep log and sociodemographic questionnaire. Actigraphically estimated sleep variables were sleep onset latency (SOL), sleep efficiency (SE), total sleep time (TST), and wake after sleep onset (WASO). Non-parametric sleep-wake rhythm variables were intradaily variability (IV); interdaily stability (IS); the activity counts and timing of the least active 5-h period (L5counts and midpoint) and of the most active 10-h period (M10 counts and midpoint); and the relative amplitude (RA), i.e. the ratio of the difference and the sum of M10 and L5 counts. Finally, creatinine-corrected aMT6s levels were obtained by isotope dilution mass spectrometry. Effects of age group (preschool 2–5 years/school-aged 6–12 years/teenager 13–18 years), sex, highest parental educational level and BMI (Z-scores) were explored. Ninety-four children participated, equally divided across age groups (53% boys). Teenagers slept less, but more efficiently, than younger children, while their 24 h sleep-wake rhythm was the least stable and most fragmented (likely due to fragmentation of daytime activity). Additionally, aMT6s levels significantly declined over the age groups. Children from highly educated parents had lower sleep efficiency, but a more stable sleep-wake rhythm. Finally, sex or increase in BMI was not associated with any of the outcomes in this study. In conclusion, this study provides reference values of healthy children across different age groups and different sociodemographic factors. In the future, this information may help to better interpret outcomes in clinical populations.     

Evolution of sleep and wakefulness organization in Macaca mulatta during Spacelab flight simulation

NASA and CNES agencies planned to perform neurophysiological studies aboard Spacelab using rhesus monkeys as human models. The present study was conducted to assess the influence of restraint and confinement conditions on the circadian sleep-wake rhythm before an actual flight. Three experimental 18-day flight simulations were performed on 6 adult Macaca mulatta, chair-restrained in a high-fidelity mock-up of the Spacelab compartment. Wakefulness, non-REM sleep and REM-sleep were determined by analysis of animal behavior from video recordings. As the experiment progressed significant changes were observed, characterized by a progressive increase of non-REM sleep of around one hour, mainly during the light period (7 am - 11 pm) at the expense of wakefulness. Duration and number of sleepiness episodes and phases of inactivity increased. A clear, new, pattern of sleep-wake cycles occurred, mainly in the last 3 days with a sharp rise in total non-REM sleep. The observed disturbances were determined to be a consequence of the confinement, the limited space and the reduced motor activity as well as of restraint. The evolution of sleep-wake cycles in 3 stages reflected the fact that the organism appeared to have adapted to the new situation. These results suggest that future studies of monkeys during orbital flight should take into account the effects of external factors such as the conditions of confinement and of restraint as well as the effects of microgravity.     

Sleep, performance, circadian rhythms, and light-dark cycles during two space shuttle flights

Sleep, circadian rhythm, and neurobehavioral performance measures were obtained in five astronauts before, during, and after 16-day or 10-day space missions. In space, scheduled rest-activity cycles were 20-35 min shorter than 24 h. Light-dark cycles were highly variable on the flight deck, and daytime illuminances in other compartments of the spacecraft were very low (5.0-79.4 lx). In space, the amplitude of the body temperature rhythm was reduced and the circadian rhythm of urinary cortisol appeared misaligned relative to the imposed non-24-h sleep-wake schedule. Neurobehavioral performance decrements were observed. Sleep duration, assessed by questionnaires and actigraphy, was only approximately 6.5 h/day. Subjective sleep quality diminished. Polysomnography revealed more wakefulness and less slow-wave sleep during the final third of sleep episodes. Administration of melatonin (0.3 mg) on alternate nights did not improve sleep. After return to earth, rapid eye movement (REM) sleep was markedly increased. Crewmembers on these flights experienced circadian rhythm disturbances, sleep loss, decrements in neurobehavioral performance, and postflight changes in REM sleep.     

A three-oscillator model of the human circadian system controlling the core temperature rhythm and the sleep-wake cycle

Even during “free-running” experiments, in which subjects lived in caves or cellars without any time cues, various circadian rhythms such as core body temperature and the sleep-wake cycle remained for a long time mutually synchronized in one group of subjects. In another group of subjects, or later in the same subjects, a number of unusually long sleep-wake cycles occurred while body temperature persisted in a near-24 hr rhythm. This has been termed “internal desynchronization” by Aschoff & Wever (1962) to emphasize the uncoupling of rhythms. Zulley (1980) and Czeisler et al. (1980) found that the duration of sleep depends regularly on the phase of the sleep onset in the body temperature rhythm, even in the apparently “random and irregular” sleep-wake pattern. The graph which plots, the sleep duration against the sleep onset phase is called sleep duration in this paper. We develop a quantitative, multi-oscillator model of human circadian system following Wever (1979) and Kronauer et al. (1982). Because the simplest model, which describes the state of each component oscillator by only one variable (ptlase) was adopted for each component oscillator, we can determine the intFraction between oscillators using sleep duration. It is found that a three-oscillator model can simulate several qualitative features of human circadian rhythms, such as an irregular free-running pattern and sleep duration. Moreover we find that the model reproduces the mysterious phenomenon of “forbidden wake up”, although we do not incorporate a priori any mechanism to explain it.     

Effects of alternating 45-min light-dark cycles on sleep in the rat

We studied the effect of alternating 45-min light-dark (L-D) cycles on sleep in rats. Introduction of short L-D cycles did not abolish the normal circadian rhythm of sleep-wake activity. The amount of non-REM sleep was however increased in the L and decreased in the D 45-min periods. REM was promoted in the D and inhibited in the L 45-min periods. The influence of L-D or D-L transitions depended on the sleep wake activity immediately before the transition.     

Circadian phase in adults of contrasting ages

There is evidence that aging may impair phase-shifting responses to light synchronizers, which could lead to disturbed or malsynchronized circadian rhythms. To explore this hypothesis, 62 elder participants (age, 58 to 84 years) and 25 young adults (age, 19 to 40 years) were studied, first with baseline 1-wk wrist actigraphy at home and then by 72 h in-laboratory study using an ultra-short sleep-wake cycle. Subjects were awake for 60 minutes in 50 lux followed by 30 minutes of darkness for sleep. Saliva samples were collected for melatonin, and urine samples were collected for aMT6s (a urinary metabolite of melatonin) and free cortisol every 90 minutes. Oral temperatures were also measured every 90 minutes. The timing of the circadian rhythms was not significantly more variable among the elders. The times of lights-out and wake-up at home and urinary free cortisol occurred earlier among elders, but the acrophases (cosinor analysis-derived peak time) of the circadian rhythm of salivary melatonin, urinary aMT6s, and oral temperature were not significantly phase-advanced among elders. The estimated duration of melatonin secretion was 9.9 h among elders and 8.4 h among young adults (p < 0.025), though the estimated half-life of blood melatonin was shorter among elders (p < 0.025), and young adults had higher saliva melatonin and urinary aMT6s levels. In summary, there was no evidence for circadian desynchronization associated with aging, but there was evidence of some rearrangement of the internal phase-angles among the studied circadian rhythms.     

Can dim light melatonin onset be predicted by the timing of sleep in patients with possible circadian sleep-wake rhythm disorders?

Dim Light Melatonin Onset (DLMO) is a reliable marker of the endogenous circadian rhythm. To determine if sleep timing can predict DLMO, we investigated the relationship between sleep timing and DLMO in patients in various circadian sleep-wake rhythm disorders (CSWRDs), ages and genders. We found that correlations were only moderate between DLMO and sleep-onset in the complete data-set, but they increased in patients with delayed sleep-wake phase disorder (DSWPD), DSWPD patients with a regular sleep pattern and patients with advanced sleep-wake phase disorder (ASWPD); the levels of correlation were r = 0.542, 0.657, 0.728 and 0.814, respectively. In DSWPD patients with a regular sleep pattern, mid-sleep strongly correlated (r = 0.839) with DLMO. Correlation in other CSRWDs was not significant. DLMO, sleep-onset and age were most discriminated factors between the various CSRWDs. Estimation of DLMO is only possible in patients with ASWPD and in DSWPD patients with a regular sleep pattern.     

月经周期对女性睡眠-觉醒和静息-活动的影响

目前有关月经周期对睡眠影响的研究结果并不一致,而对月经周期中昼夜睡眠-觉醒及静息-活动节律尚缺乏系统性的研究.本研究旨在观察正常育龄期女性月经周期中睡眠-觉醒及静息-活动昼夜节律的变化.我们采用静息-活动监测仪(actigraphy)和睡眠日志,调查了12个自然生活状态下健康育龄期妇女在月经周期不同阶段,即行经期、围排卵期、黄体早期及黄体晚期中睡眠与活动节律的变化.结果显示,睡眠-觉醒节律参数在四期之间无统计学显著差异;而静息-活动节律方面,所有受试女性静息-活动节律的平均日周期长度为(24.01±0.29)h,并且四期之间无显著性差异.行经期日间稳定系数(interdaily stability,IS)比黄体早期显著增加(P＜0.05).黄体早期日间活动开始时间明显较黄体晚期提前(P＜0.05);黄体早期的活动峰值时相比围排卵期显著提前(P＜0.05).月经周期可以影响静息-活动昼夜节律时相.而总体静息-活动数量与质量未发生显著变化;健康育龄期妇女在月经周期的各阶段中睡眠-觉醒节律亦无明显变异.     

The pattern of entrainment of the human sleep-wake rhythm by the natural photoperiod in the north

Recently, it was shown that the sleep-wake rhythm of the inhabitants of the temperate zone is entrained to sun time. In the North, significant seasonal changes in the photoperiod may interfere with entrainment of the circadian system to sunlight. This investigation assessed the influence of photoperiod characteristics on the sleep length and sleep-wake rhythm of residents of high latitude. The study was conducted in four towns and six villages located between 59.5?N and 67.6?N latitude between the months of October and May from 2009 through 2011 and included 2822 subjects aged 10 to 97 yrs, 1621 of whom were females and 1201 males. The chronotype and sleep length of the subjects were assessed using the Munich Chronotype Questionnaire. The instructions for the questionnaire stressed the need to specify the sleep-wake schedule during the week preceding the date of completing the questionnaire. The study found that the length of sleep and the chronotype of the inhabitants surveyed in Northern European Russia depend on age, sex, type of settlement, and place of residence. The time of sunrise was a stronger predictor of sleep length and chronotype than the time of sunset and day length. A later chronotype and shorter sleep length were found for the subjects during the equinox (sunrise at 06:00 h) than under long-photoperiod conditions (sunrise at 04:00-05:00 h). During short-photoperiod conditions (sunrise at 07:00-10:00 h), no significant changes in the self-reported sleep-wake rhythm were found. The time of sunrise had the strongest impact on the sleep-wake rhythm of 30- to 97-yr-old persons. Sunrise had a stronger influence on chronotype and sleep length in January to May, when the days become longer, than in October to December, when the days become shorter. Age- and season-associated changes were found in the entrainment of the sleep-wake rhythm by photoperiod in the North.     

RETINAL CIRCADIAN RHYTHMS IN HUMANS *

Circadian rhythms in the retina may reflect intrinsic rhythms in the eye. Previous reports on circadian variability in electrophysiological human retinal measures have been scanty, and the results have been somewhat inconsistent. We studied the circadian variation of the electrooculography (EOG), electroretinography (ERG), and visual threshold (VTH) in subjects undergoing a 36h testing period. We used an ultrashort sleep-wake cycle to balance effects of sleep and light-dark across circadian cycles. Twelve healthy volunteers (10 males, 2 females; mean age 26.3 years, standard deviation [SD] 8.0 years, range 19-40 years) participated in the study. The retinal functions and oral temperature were measured every 90 min. The EOG was measured in the light, whereas the ERG and the VTH were measured in the dark. Sleep was inferred from activity detected by an Actillume monitor. The EOG peak-to-peak responses followed a circadian rhythm, with the peak occurring late in the morning (acrophase 12:22). The ERG b-wave implicit time peaked in the early morning (acrophase 06:46). No statistically significant circadian rhythms could be demonstrated in the ERG a-wave implicit time or peak-to-peak amplitude. The VTH rhythm peaked in the early morning (acrophases 07:59 for blue and 07:32 for red stimuli). All retinal rhythms showed less-consistent acrophases than the temperature and sleep rhythms. This study demonstrated several different circadian rhythms in retinal electrophysiological and psychophysical measures of healthy subjects. As the retinal rhythms had much poorer signal-to-noise ratios than the temperature rhythm, these measures cannot be recommended as circadian markers. (Chronobiology International, 18(6), 957-971, 2001)     

Rhythms of ghrelin, leptin, and sleep in rats: effects of the normal diurnal cycle, restricted feeding, and sleep deprivation

To determine the relationships among plasma ghrelin and leptin concentrations and hypothalamic ghrelin contents, and sleep, cortical brain temperature (Tcrt), and feeding, we determined these parameters in rats in three experimental conditions: in free-feeding rats with normal diurnal rhythms, in rats with feeding restricted to the 12-h light period (RF), and in rats subjected to 5-h of sleep deprivation (SD) at the beginning of the light cycle. Plasma ghrelin and leptin displayed diurnal rhythms with the ghrelin peak preceding and the leptin peak following the major daily feeding peak in hour 1 after dark onset. RF reversed the diurnal rhythm of these hormones and the rhythm of rapid-eye-movement sleep (REMS) and significantly altered the rhythm of Tcrt. In contrast, the duration and intensity of non-REMS (NREMS) were hardly responsive to RF. SD failed to change leptin concentrations, but it promptly stimulated plasma ghrelin and induced eating. SD elicited biphasic variations in the hypothalamic ghrelin contents. SD increased plasma corticosterone, but corticosterone did not seem to influence either leptin or ghrelin. The results suggest a strong relationship between feeding and the diurnal rhythm of leptin and that feeding also fundamentally modulates the diurnal rhythm of ghrelin. The variations in hypothalamic ghrelin contents might be associated with sleep-wake activity in rats, but, unlike the previous observations in humans, obvious links could not be detected between sleep and the diurnal rhythms of plasma concentrations of either ghrelin or leptin in the rat.     

Integration of human sleep-wake regulation and circadian rhythmicity.

The human sleep-wake cycle is generated by a circadian process, originating from the suprachiasmatic nuclei, in interaction with a separate oscillatory process: the sleep homeostat. The sleep-wake cycle is normally timed to occur at a specific phase relative to the external cycle of light-dark exposure. It is also timed at a specific phase relative to internal circadian rhythms, such as the pineal melatonin rhythm, the circadian sleep-wake propensity rhythm, and the rhythm of responsiveness of the circadian pacemaker to light. Variations in these internal and external phase relationships, such as those that occur in blindness, aging, morning and evening, and advanced and delayed sleep-phase syndrome, lead to sleep disruptions and complaints. Changes in ocular circadian photoreception, interindividual variation in the near-24-h intrinsic period of the circadian pacemaker, and sleep homeostasis can contribute to variations in external and internal phase. Recent findings on the physiological and molecular-genetic correlates of circadian sleep disorders suggest that the timing of the sleep-wake cycle and circadian rhythms is closely integrated but is, in part, regulated differentially.     

Masking effects of posture and sleep onset on core body temperature have distinct circadian rhythms: results from a 90-min/day protocol

Both recumbency and sleep affect core body temperature (CBT). To characterize their circadian effects and interactions, the authors examined the bedtime temperature drops (TDs) of nine men and eight women (aged 20 to 30) who repeated 90-min sleep-wake cycles over 2.5 days. While awake, subjects were exposed to 50 to 250 lux; while asleep, lights were off. Electroencephalogram-monitored time inbed lasted 30 min during each cycle. Cosinor nonlinear mixed-effects regressions modeled the circadian rhythm of TDs. The circadian maximum of TDs occurred approximately 4 h before the time of circadian CBT minimum, in a model that included the effects of baseline expected CBT, deviations from baseline CBT, time in study, and gender-dependent 24- and 12-h adjustments. Rates of temperature drops were faster during initial periods of lying awake than during periods of initially sleeping. Both rates followed separate circadian rhythms. The circadian maximum of TDs was located near customary nocturnal bedtimes, suggesting its role in fostering sleep during a normal bedtime routine. The apparent deceleration of temperature dropping at sleep onset supports the notion that the sleep onset period has complicated circadian neuroregulatory dynamics. These findings confirm the need for nonlinear models of temperature responses to postural changes and sleep that incorporate circadian variability in these masking effects.     

Analysis of urinary immunoreactive steroid metabolites and gonadotropins for characterization of the estrous cycle,breeding period,and seasonal estrous activity of captive killer whales (Orcinus orca)

To increase the basic understanding of killer whale (Orcinus orca) reproductive physiology necessary for the development of artificial breeding programs, we utilized radioimmunoassays (RIA) to detect urinary immunoreactive steroid metabolites (pregnanediol-3α-glucuronide [PdG] and estrone-conjugates [EC]) and gonadotropins (luteinizing hormone [LH] and follicle-stimulating hormone [FSH]) in urine samples from six female killer whales. Urine samples were collected from the whales by voluntary presentation behavior over a 2- to 4-year period. All urinary hormone values were corrected for intersample urine concentration variations by indexing with creatinine. Daily urine samples from four whales were collected during two conceptions and 18 complete estrous cycles. LH, FSH, EC, and PdG immunoreactive levels were determined and combined with observed copulatory activity in five cycles, including two conceptive cycles from two whales. Mean luteal phase lengths ranged from 9.7 to 19.2 days. Mean follicular phase lengths ranged from 6.5 to 16.8 days. Mean estrous cycle lengths based on the first detectable PdG levels were 41.6 ± 6.72 S.E.M. days. After PdG nadir, immunoreactive FSH levels showed a bimodal pattern with the first peak being greater in size, and both preceding a follicular phase EC increase. LH levels > the 95% confidence interval of the mean were considered significant. Combined LH immunoreactive values from whales 2 and 6 during two and three estrous cycles, respectively, had significant LH peak concentrations on day minus 2. These significant LH peaks were assumed to represent the preovulatory LH surge. Eight copulations during two conceptive cycles were observed between whales 2 and 6 and a breeding male. Six of these copulations (3 with each female whale) occurred within 72 hours of the beginning or the end of the presumptive preovulatory LH surge. Estrous activity was seen throughout the year for the herd. However, individuals had varying periods of anestrus that could not be linked to environmental, social, or nutritional influences. The whales that were reproductively successful had anestrus intervals that were usually influenced by gestation, postparturient period, or lactation. The information obtained during this research enhances the foundation for future artificial reproductive management techniques. © 1993 Wiley-Liss, Inc.     

RETINAL CIRCADIAN RHYTHMS IN HUMANS*

Circadian rhythms in the retina may reflect intrinsic rhythms in the eye. Previous reports on circadian variability in electrophysiological human retinal measures have been scanty, and the results have been somewhat inconsistent. We studied the circadian variation of the electrooculography (EOG), electroretinography (ERG), and visual threshold (VTH) in subjects undergoing a 36h testing period. We used an ultrashort sleep-wake cycle to balance effects of sleep and light-dark across circadian cycles. Twelve healthy volunteers (10 males, 2 females; mean age 26.3 years, standard deviation [SD] 8.0 years, range 19–40 years) participated in the study. The retinal functions and oral temperature were measured every 90 min. The EOG was measured in the light, whereas the ERG and the VTH were measured in the dark. Sleep was inferred from activity detected by an Actillume monitor. The EOG peak-to-peak responses followed a circadian rhythm, with the peak occurring late in the morning (acrophase 12:22). The ERG b-wave implicit time peaked in the early morning (acrophase 06:46). No statistically significant circadian rhythms could be demonstrated in the ERG a-wave implicit time or peak-to-peak amplitude. The VTH rhythm peaked in the early morning (acrophases 07:59 for blue and 07:32 for red stimuli). All retinal rhythms showed less-consistent acrophases than the temperature and sleep rhythms. This study demonstrated several different circadian rhythms in retinal electrophysiological and psychophysical measures of healthy subjects. As the retinal rhythms had much poorer signal-to-noise ratios than the temperature rhythm, these measures cannot be recommended as circadian markers. (Chronobiology International, 18(6), 957–971, 2001)     

The Pattern of Entrainment of the Human Sleep-Wake Rhythm by the Natural Photoperiod in the North

Recently, it was shown that the sleep-wake rhythm of the inhabitants of the temperate zone is entrained to sun time. In the North, significant seasonal changes in the photoperiod may interfere with entrainment of the circadian system to sunlight. This investigation assessed the influence of photoperiod characteristics on the sleep length and sleep-wake rhythm of residents of high latitude. The study was conducted in four towns and six villages located between 59.5°N and 67.6°N latitude between the months of October and May from 2009 through 2011 and included 2822 subjects aged 10 to 97 yrs, 1621 of whom were females and 1201 males. The chronotype and sleep length of the subjects were assessed using the Munich Chronotype Questionnaire. The instructions for the questionnaire stressed the need to specify the sleep-wake schedule during the week preceding the date of completing the questionnaire. The study found that the length of sleep and the chronotype of the inhabitants surveyed in Northern European Russia depend on age, sex, type of settlement, and place of residence. The time of sunrise was a stronger predictor of sleep length and chronotype than the time of sunset and day length. A later chronotype and shorter sleep length were found for the subjects during the equinox (sunrise at 06:00?h) than under long-photoperiod conditions (sunrise at 04:00–05:00?h). During short-photoperiod conditions (sunrise at 07:00–10:00?h), no significant changes in the self-reported sleep-wake rhythm were found. The time of sunrise had the strongest impact on the sleep-wake rhythm of 30- to 97-yr-old persons. Sunrise had a stronger influence on chronotype and sleep length in January to May, when the days become longer, than in October to December, when the days become shorter. Age- and season-associated changes were found in the entrainment of the sleep-wake rhythm by photoperiod in the North. (Author correspondence: borisenkov@physiol.komisc.ru)     

Case study of circadian rhythm sleep disorder following haloperidol treatment: reversal by risperidone and melatonin

A patient with Gilles de la Tourette syndrome treated with haloperidol, ingested once daily after awakening from sleep, exhibited an irregular sleep-wake pattern with a free-running component of approximately 48 h. Transfer to risperidone, ingested once daily after awakening from sleep, was beneficial resulting in a sleep-wake cycle more synchronized at the appropriate phase to the external zeitgebers, and fewer nocturnal disturbances. The circadian sleep-wake schedule was fully synchronized when the patient had been subsequently treated with melatonin at 21:00h, before intended nocturnal sleep, in addition to risperidone in the morning. Restoration of the sleep-wake circadian pattern was accompanied by the patient's subjective report of significant improvement in his quality of life, social interactions, and occupational status. This observation suggests that circadian rhythm sleep disorders can be related to the typical neuroleptic haloperidol and restored by the atypical neuroleptic risperidone. Similar findings reported in patients suffering from other disorders support the hypothesis that the described disruption of the sleep-wake schedule is medication rather than illness-related. Therefore, it is very important to realize that circadian rhythm sleep disorders may be a side effect of neuroleptics.     

The suitability of actigraphy, diary data, and urinary melatonin profiles for quantitative assessment of sleep disturbances in schizophrenia: a case report

Sleep disruption is a commonly encountered clinical feature in schizophrenic patients, and one important concern is to determine the extent of this disruption under "real" life situations. Simultaneous wrist actigraphy, diary records, and repeated urine collection for urinary 6-sulphatoxymelatonin (aMT6s) profiles are appropriate tools to assess circadian rhythms and sleep patterns in field studies. Their suitability for long-term recordings of schizophrenic patients living in the community has not been evaluated. In this case report, we document long-term simultaneous wrist actigraphy, light detection, repeated urine collection, and diary records as a suitable combination of non-invasive techniques to quantify and assess changes in sleep-wake cycles, light exposure, and melatonin profiles in a schizophrenic patient. The actigraph was well-tolerated by the patient, and compliance to diary records and 48 h urine collection was particularly good with assistance from family members. The data obtained by these techniques are illustrated, and the results reveal remarkable abnormal patterns of rest-activity patterns, light exposure, and melatonin production. We observed various rest-activity patterns, including phase-shifts, highly delayed sleep on- and offsets, and irregular rest-activity phases. The period of the rest-activity rhythm, light-dark cycle, and melatonin rhythm was longer than 24 h. These circadian abnormalities may reinforce the altered sleep patterns and the problems of cognitive function and social engagement associated with schizophrenic.