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)     

Time-of-Day Mediates the Influences of Extended Wake and Sleep Restriction on Simulated Driving

Although a nonlinear time-of-day and prior wake interaction on performance has been well documented, two recent studies have aimed to incorporate the influences of sleep restriction into this paradigm. Through the use of sleep-restricted forced desynchrony protocols, both studies reported a time-of-day?×?sleep restriction interaction, as well as a time-of-day?×?prior wake?×?sleep dose three-way interaction. The current study aimed to investigate these interactions on simulated driving performance, a more complex task with ecological validity for the problem of fatigued driving. The driving performance of 41 male participants (mean?±?SD: 22.8 ±2.2 yrs) was assessed on a 10-min simulated driving task with the standard deviation of lateral position (SDLAT) measured. Using a between-group design, participants were subjected to either a control condition of 9.33?h of sleep/18.66?h of wake, a moderate sleep-restriction (SR) condition of 7?h of sleep/21?h of wake, or a severe SR condition of 4.66?h of sleep/23.33?h of wake. In each condition, participants were tested at 2.5-h intervals after waking across 7?×?28-h d of forced desynchrony. Driving sessions occurred at nine doses of prior wake, within six divisions of the circadian cycle based on core body temperature (CBT). Mixed-models analyses of variance (ANOVAs) revealed significant main effects of time-of-day, prior wake, sleep debt, and sleep dose on SDLAT. Additionally, significant two-way interactions of time-of-day?×?prior wake and time-of-day?×?sleep debt, as well as significant three-way interactions of time-of-day?×?prior wake?×?sleep debt and time-of-day?×?sleep debt?×?sleep dose were observed. Although limitations such as the presence of practice effects and large standard errors are noted, the study concludes with three findings. The main effects demonstrate that extending wake, reducing sleep, and driving at poor times of day all significantly impair driving performance at an individual level. In addition to this, combining either extended wake or a sleep debt with the early morning hours greatly decreases driving performance. Finally, operating under the influence of a reduced sleep dose can greatly decrease performance at all times of the day. (Author correspondence: raymond.matthews@unisa.edu.au)     

Sleep Restriction Masks the Influence of the Circadian Process on Sleep Propensity

Previous forced desynchrony studies have highlighted the close relationship between the circadian rhythms of core body temperature (CBT) and sleep propensity. In particular, these studies have shown that a “forbidden zone” for sleep exists on the rising limb of the CBT rhythm. In these previous studies, the length of the experimental day was either ultrashort (90?min), short (20?h), or long (28?h), and the ratio of sleep to wake was normal (i.e., 1:2). The aim of the current study was to examine the relative effects of the circadian and homeostatic processes on sleep propensity using a 28-h forced desynchrony protocol in which the ratio of sleep to wake was substantially lower than normal (i.e., 1:5). Twenty-seven healthy males lived in a time-isolation sleep laboratory for 11 consecutive days. Participants completed either a control (n?=?13) or sleep restriction (n?=?14) condition. In both conditions, the protocol consisted of 2?×?24-h baseline days followed by 8?×?28-h forced desynchrony days. On forced desynchrony days, the control group had 9.3?h in bed and 18.7?h of wake, and the sleep restriction group had 4.7?h in bed and 23.3?h of wake. For all participants, each 30-s epoch of time in bed was scored as sleep or wake based on standard polysomnography recordings, and was also assigned a circadian phase (360°?=?24?h) based on a cosine equation fitted to continuously recorded CBT data. For each circadian phase (i.e., 72?×?5° bins), sleep propensity was calculated as the percentage of epochs spent in bed scored as sleep. For the control group, there was a clear circadian rhythm in sleep propensity, with a peak of 98.5% at 5° (～05:20?h), a trough of 64.9% at 245° (～21:20?h), and an average of 82.3%. In contrast, sleep propensity for the sleep restriction group was relatively high at all circadian phases, with an average of 96.7%. For this group, the highest sleep propensity (99.0%) occurred at 60° (～09:00?h), and the lowest sleep propensity (91.3%) occurred at 265° (～22:40?h). As has been shown previously, these current data indicate that with a normal sleep-to-wake ratio, the effect of the circadian process on sleep propensity is pronounced, such that a forbidden zone for sleep exists at a phase equivalent to evening time for a normally entrained individual. However, these current data also indicate that when the ratio of sleep to wake is substantially lower than normal, this circadian effect is masked. In particular, sleep propensity is very high at all circadian phases, including those that coincide with the forbidden zone for sleep. This finding suggests that if the homeostatic pressure for sleep is sufficiently high, then the circadian drive for wakefulness can be overridden. In future studies, it will be important to determine whether or not this masking effect occurs with less severe sleep restriction, e.g., with a sleep-to-wake ratio of 1:3. (Author correspondence: charli.sargent@cqu.edu.au)     

WORK HOURS AND SLEEP/WAKE BEHAVIOR OF AUSTRALIAN HOSPITAL DOCTORS

The objective of the study was to describe the work and sleep patterns of doctors working in Australian hospitals. Specifically, the aim was to examine the influence of work-related factors, such as hospital type, seniority, and specialty on work hours and their impact on sleep. A total of 635 work periods from 78 doctors were analyzed together with associated sleep history. Work and sleep diary information was validated against an objective measure of sleep/wake activity to provide the first comprehensive database linking work and sleep for individual hospital doctors in Australia. Doctors in large and small facilities had fewer days without work than those doctors working in medium-sized facilities. There were no significant differences in the total hours worked across these three categories of seniority; however, mid-career and senior doctors worked more overnight and weekend on-call periods than junior doctors. With respect to sleep, although higher work hours were related to less sleep, short sleeps (< 5 h in the 24 h prior to starting work) were observed at all levels of prior work history (including no work). In this population of Australian hospital doctors, total hours worked do impact sleep, but the pattern of work, together with other nonwork factors are also important mediators. (Author correspondence: sally.ferguson@unisa.edu.au)     

Seasonal Effect on Infants' Sleep Regulation: A Preliminary Study in a Mediterranean Climate

Infants' sleep-wake rhythms are influenced by multiple factors, including developmental and contextual aspects, as well as circadian cycles. Empirical studies that address the seasonal impact on infants' sleep are scarce. The present study examined aspects of sleep schedule and quality, comparing summer and winter months in a Mediterranean climate. This report is based on a convenience sample of 34 healthy 7-mo-olds, an age in which sleep is well consolidated and regulated compared with the first few months of life. Sleep was measured with actigraphy, in the home context. It was found that compared with winter, in the summer months, sleep onset occurred at a later hour, and more motor activity during sleep was detected. Although the overall sleep quality, as defined by sleep efficiency score, was similar in the two seasons, in the summer, more active sleep was observed. The authors discuss the finding in terms of circadian rhythms, developmental characteristics, as well as possible environmental factors and family routines, and call for more studies, in different climates and geographical zones, and in different developmental periods. (Author correspondence: cohen.dini@gmail.com or anats@edu.haifa.ac.il)     

Diurnal Variation in Vascular Function: Role of Sleep

Although vascular function is lower in the morning than afternoon, previous studies have not assessed the influence of prior sleep on this diurnal variation. The authors employed a semiconstant routine protocol to study the contribution of prior nocturnal sleep to the previously observed impairment in vascular function in the morning. Brachial artery vascular function was assessed using the flow-mediated dilation technique (FMD) in 9 healthy, physically active males (mean?±?SD: 27?±?9 yrs of age), at 08:00 and 16:00?h following, respectively, 3.29?±?.37 and 3.24?±?.57?h prior sleep estimated using actimetry. Heart rate and systolic and diastolic blood pressures were also measured. The data of the experimental sleep condition were compared with the data of the “normal” diurnal sleep condition, in which FMD measurements were obtained from 21 healthy individuals who slept only during the night, as usual, before the morning test session. The morning-afternoon difference in FMD was 1?±?4% in the experimental sleep condition compared with 3?±?4% in the normal sleep condition (p?=?.04). This difference was explained by FMD being 3?±?3% lower in afternoon following the prior experimental sleep (p?=?.01). These data suggest that FMD is more dependent on the influence of supine sleep than the endogenous circadian timekeeper, in agreement with our previous finding that diurnal variation in FMD is influenced by exercise. These findings also raise the possibility of a lower homeostatic “set point” for vascular function following a period of sleep and in the absence of perturbing hemodynamic fluctuation. (Author correspondence: h.jones1@ljmu.ac.uk)     

How primary health care professionals and residents assess issues related to the oral health of older persons?

doi: 10.1111/j.1741‐2358.2009.00355.x
How primary health care professionals and residents assess issues related to the oral health of older persons? Background and objectives: It is known that older persons need integrated primary health care. However, oral health may not be a frequent concern of multi‐professional teams taking care of older persons. The aim of the present study was to evaluate knowledge and practices related to oral health care, as reported by professionals and residents in a primary health care service. Material and methods: One hundred and seventy‐three health professionals and residents were assessed in this cross‐sectional study by means of a structured questionnaire containing questions pertaining to oral health practices and beliefs. Participants were grouped based on their professions into “primary health care dentists” or “other primary health care professionals” and based on their working status into “permanent team” or “residents”. Results: Permanent team members (other professionals) assessed and recommended dental care more frequently than residents. Permanent team members (other professionals) also reported that they felt they were able to inform older patients in respect to oral health‐related issues more frequently than did residents (68.7% vs. 31.3%, respectively). Conclusion: Oral health‐related knowledge and beliefs were frequent among non‐dentists primary health care workers, suggesting that primary health care which integrates oral health represents an attainable goal.     

THE INFLUENCE OF CIRCADIAN PHASE AND PRIOR WAKE ON NEUROMUSCULAR FUNCTION

Previous forced desynchrony (FD) studies have shown that neurobehavioral function is affected by circadian phase and duration of prior wakefulness. There is some evidence that neuromuscular function may also be affected by circadian phase and prior wake, but these effects have not been systematically investigated. This study examined the effects of circadian phase and prior wake on two measures of neuromuscular function—postural balance (PB) and maximal grip strength (MGS)—using a 28-h FD protocol. Eleven male participants (mean?±?SD: 22.7?±?2.5 yr) lived in a sound-attenuated, light- and temperature-controlled time-isolation laboratory for 12 days. Following two training days and a baseline day, participants were scheduled to seven 28-h FD days, with the ratio between sleep opportunity and wake spans kept constant (i.e., 9.3?h sleep period and 18.7?h wake period). PB was measured during 1?min of quiet standing on a force platform. MGS of the dominant hand was measured using a dynamometer. These two measures were obtained every 2.5?h during wake. Core body temperature was continuously recorded with rectal thermistors to determine circadian phase. For both measures of neuromuscular function, individual data points were assigned a circadian phase and a level of prior wake. Data were analyzed by repeated-measures analysis of variance (ANOVA) with two within-subjects factors: circadian phase (six phases) and prior wake (seven levels). For MGS, there was a main effect of circadian phase, but no main effect of prior wake. For PB, there were no main effects of circadian phase or prior wake. There were no interactions between circadian phase and prior wake for MGS or PB. The significant effect of circadian phase on muscle strength is in agreement with previous reports in the literature. In terms of prior wake, both MGS and PB remained relatively stable across wake periods, indicating that neuromuscular function may be more robust than neurobehavioral function when the duration of wakefulness is within a normal range (i.e., 18.7?h). (Author correspondence: charli.sargent@unisa.edu.au)     

THERMOREGULATORY EFFECT IN HUMANS OF SUPPRESSED ENDOGENOUS MELATONIN BY PRE-SLEEP BRIGHT-LIGHT EXPOSURE IN A COLD ENVIRONMENT

This study investigated the physiological function of suppressed melatonin through thermoregulation in a cold environment. Interactions between thermoregulation directly affected by exposure to a cold environment and indirectly affected by endogenous melatonin suppression by bright-light exposure were examined. Ten male subjects were exposed to two different illumination intensities (30 and 5000 lux) for 4.5?h, and two different ambient temperatures (15 and 27°C) for 2?h before sleep under dark and thermoneutral conditions. Salivary melatonin level was suppressed by bright light (p?<?0.001), although the ambient temperature condition had no significant effect on melatonin. During sleep, significant effects of pre-sleep exposure to a cold ambient temperature (p?<?0.001) and bright light (p?<?0.01) on rectal temperature (T_re) were observed. Pre-sleep, bright-light exposure led to an attenuated fall in T_re during sleep. Moreover, T_re dropped more precipitously after cold exposure than thermoneutral conditions (cold: ?0.54?±?0.07°C/h; thermoneutral: ?0.16?±?0.03°C/h; p?<?0.001). Pre-sleep, bright-light exposure delayed the nadir time of T_re under thermoneutral conditions (p?<?0.05), while cold exposure masked the circadian rhythm with a precipitous decrease in T_re. A significant correlation between the T_re nadir and melatonin level (r?=??0.774, p?<?0.05) indicated that inter-individual differences with higher melatonin levels lead to a reduction in T_re after cold exposure. These results suggest that suppressed endogenous melatonin inhibits the downregulation of the body temperature set-point during sleep. (Author correspondence: ishibasi@design.kyushu-u.ac.jp)     

Trends and Weekly and Seasonal Cycles in the Rate of Errors in the Clinical Management of Hospitalized Patients

Studies on the rate of adverse events in hospitalized patients seldom examine temporal patterns. This study presents evidence of both weekly and annual cycles. The study is based on a large and diverse data set, with nearly 5 yrs of data from a voluntary staff-incident reporting system of a large public health care provider in rural southeastern Australia. The data of 63 health care facilities were included, ranging from large non-metropolitan hospitals to small community and aged health care facilities. Poisson regression incorporating an observation-driven autoregressive effect using the GLARMA framework was used to explain daily error counts with respect to long-term trend and weekly and annual effects, with procedural volume as an offset. The annual pattern was modeled using a first-order sinusoidal effect. The rate of errors reported demonstrated an increasing annual trend of 13.4% (95% confidence interval [CI] 10.6% to 16.3%); however, this trend was only significant for errors of minor or no harm to the patient. A strong “weekend effect” was observed. The incident rate ratio for the weekend versus weekdays was 2.74 (95% CI 2.55 to 2.93). The weekly pattern was consistent for incidents of all levels of severity, but it was more pronounced for less severe incidents. There was an annual cycle in the rate of incidents, the number of incidents peaking in October, on the 282nd day of the year (spring in Australia), with an incident rate ratio 1.09 (95% CI 1.05 to 1.14) compared to the annual mean. There was no so-called “killing season” or “July effect,” as the peak in incident rate was not related to the commencement of work by new medical school graduates. The major finding of this study is the rate of adverse events is greater on weekends and during spring. The annual pattern appears to be unrelated to the commencement of new graduates and potentially results from seasonal variation in the case mix of patients or the health of the medical workforce that alters health care performance. These mechanisms will need to be elucidated with further research. (Author correspondence: david.buckley@gsahs.health.nsw.gov.au)     

Photic Resetting in Night-Shift Work: Impact on Nurses' Sleep

The objective of this study was to quantify daytime sleep in night-shift workers with and without an intervention designed to recover the normal relationship between the endogenous circadian pacemaker and the sleep/wake cycle. Workers of the treatment group received intermittent exposure to full-spectrum bright light during night shifts and wore dark goggles during the morning commute home. All workers maintained stable 8-h daytime sleep/darkness schedules. The authors found that workers of the treatment group had daytime sleep episodes that lasted 7.1?±?.1?h (mean?±?SEM) versus 6.6?±?.2?h for workers in the control group (p?=?.04). The increase in total sleep time co-occurred with a larger proportion of the melatonin secretory episode during daytime sleep in workers of the treatment group. The results of this study showed reestablishment of a phase angle that is comparable to that observed on a day-oriented schedule favors longer daytime sleep episodes in night-shift workers. (Author correspondence: diane.boivin@douglas.mcgill.ca)     

Does the Modern Urbanized Sleeping Habitat Pose a Breast Cancer Risk?

Due to its disruptive effects on circadian rhythms and sleep deprivation at night, shiftworking is currently recognized as a risk factor for breast cancer (BC). As revealed by the present analysis based on a comparative case-control study of 1679 women, exposure to light-at-night (LAN) in the “sleeping habitat” is significantly associated with BC risk (odds ratio [OR]?=?1.220, 95% confidence interval [CI]?=?1.118–1.311; p?<?.001), controlling for education, ethnicity, fertility, and alcohol consumption. The novelty of the present research is that, to the best of the authors' knowledge, it is the first study to have identified an unequivocal positive association between bedroom-light intensity and BC risk. Thus, according to the results of the present study, not only should artificial light exposure in the working environment be considered as a potential risk factor for BC, but also LAN in the “sleeping habitat.” (Author correspondence: ahaim@research.haifa.ac.il)     

Alcohol Consumption Patterns of Shiftworkers Compared With Dayworkers

The detrimental effects of excessive alcohol consumption are well documented. There is some evidence that shiftworkers consume more alcohol than dayworkers as a sleep aid to compensate for sleep difficulties associated with work schedules. This study investigated drinking patterns between shiftworkers and dayworkers using the 2006 and 2007 waves from the Household Income and Labour Dynamics Survey. A subset of workers who were not in full-time study and had a single job were selected; participants who did not drink alcohol (n?=?2090) were excluded. Using the 2001 Australian Government alcohol guidelines, alcohol consumption for risk of short-term harm (7+ standard drinks for men, 5+ for women) was investigated. The number of workers who drank alcohol “nearly every day” or “every day” was also examined. Some 13% of shiftworkers and 10% of those on standard schedules reported consuming alcohol at levels risky for short-term harm. Having a child less than 17 yrs (odds ratio [OR]?=?.39, 95% confidence interval [CI]?=?.22–.69), higher job demands (OR?=?.71, 95% CI?=?.58–.86), being female (OR?=?.45, 95% CI=. 26–.79), and being older (OR?=?.89, 95% CI?=?.87–.92) significantly reduced, whereas being a shiftworker (OR?=?2.10, 95% CI?=?1.08–4.12) significantly increased, the odds of drinking alcohol in short-term risky levels. Nearly 10% of shiftworkers and 8% of those on standard schedules reported consuming alcohol in short-term risky levels at least weekly. Having a child less than 17 yrs (OR?=?.40, 95% CI?=?.22–.74), higher job demands (OR?=?.69, 95% CI?=?.56–.86), being female (OR?=?.28, 95% CI?=?.15–.53), and being older (OR?=?.92, 95% CI?=?.89–.94) were associated with a significant reduction in the odds of consuming alcohol at risky levels at least weekly. Being a shiftworker was not associated with a significant increase in the odds of consuming alcohol at such risky levels at least weekly, but a trend was evident (OR?=?1.47, 95% CI?=?.73–3.00). Some 13.5% of shiftworkers and 21% of those on standard schedules reported consuming alcohol in any amount “near daily” or “daily.” Working more hours than preferred (OR?=?1.80, 95% CI?=?1.12–2.89) and being older (OR?=?1.10, 95% CI?=?1.07–1.13) were associated with a significant increase, and being female (OR?=?.18, 95% CI?=?.10–.33), and being a shiftworker (OR?=?.20, 95% CI?=?.09–.45) were associated with a significant decrease in the odds of consuming alcohol “daily” or “near daily.” Overall, the results suggest that shiftworkers may be more likely to consume alcohol at levels considered to be risky for health in the short term. In contrast, they appear less likely to drink alcohol daily. This pattern is suggestive of “binge drinking” behavior. (Author correspondence: jill.dorrian@unisa.edu.au)     

Alterations of Locomotor Activity Rhythm and Sleep Parameters in Patients With Advanced Glaucoma

The aim of this study was to evaluate the effect of advanced glaucoma on locomotor activity rhythms and related sleep parameters. Nine normal subjects and nine age-matched patients with bilateral advanced primary open-angle glaucoma, >10 yrs since diagnosis, were included in this observational, prospective, case-control study. Patients were required to record the timing and duration of their sleep and daily activities, and wore an actigraph on the wrist of the nondominant arm for 20 d. Activity rhythm period, MESOR (24-h time-series mean), amplitude (one-half peak-to-trough variation), and acrophase (peak time), plus long sleep episodes during the wake state, sleep duration, efficiency, and latency, as well as mean activity score, wake minutes, and mean wake episodes during the sleep interval were assessed in controls and glaucomatous patients. Glaucomatous patients exhibited significant decrease in nighttime sleep efficiency, and significant increase in the mean activity score, wake minutes, and mean wake episode during the night. These results suggest that alterations of circadian physiology could be a risk to the quality of life of patients with glaucoma. (Author correspondence: ruthr@fmed.uba.ar)     

Individual differences in the sleep/wake cycle of Arctic flexitime workers

Daytime workers tend to have shorter sleep duration and earlier sleep onset during work days than on days off. Large individual differences in sleep onset and sleep duration may be observed on work days, but work usually synchronizes sleep offset to a similar time. The present study describes individual differences in sleep behaviour of 48 daytime workers (25 men, aged 20–58 years) from an iron ore mine in Northern Sweden. The aim of the study was to determine whether differences in sleep patterns during work days were associated with the outcomes of sleepiness and sleep complaints. Cluster analysis was used to group workers into two categories of sleep onset and sleep duration. The “Late Sleep Onset” cluster comprised workers who slept 1.30 h later than the “Early Sleep Onset” cluster (p < 0.0001 for all weekdays). The “Long Sleep Duration” cluster slept 1.10 h longer than the “Short Sleep Duration” cluster (p < 0.0002 for work nights). The “Late Sleep Onset” cluster reported less refreshing sleep (p < 0.01) and had lower sufficient sleep scores (p < 0.01) than the “Early Sleep Onset” cluster. The “Short Sleep Duration” cluster also reported lower scores for sufficient sleep (p < 0.04) than the “Long Sleep Duration” cluster. For combined characteristics (phase and duration), workers with a late phase and short sleep duration reported greater sleep debt and sleepiness than workers with an early phase and short sleep duration (p < 0.02). Work schedule and commuting time modulate both sleep phase and sleep duration independently. Workers, classified as having an intermediate sleep phase preference, can organize their sleep time in order to minimize sleep debt and sleepiness symptoms. Individual differences in sleep phase and duration should be considered when promoting well-being at work even among groups with similar sleep needs. In order to minimize sleep debt and sleepiness symptoms, successful sleep behaviour could be promoted involving extend use of flexitime arrangement (i.e. later starting times) and reduce use of alarm clocks.     

Assessment of a New Dynamic Light Regimen in a Nuclear Power Control Room Without Windows on Quickly Rotating Shiftworkers—Effects on Health,Wakefulness, and Circadian Alignment: A Pilot Study

The aim of the study was to test whether a new dynamic light regime would improve alertness, sleep, and adaptation to rotating shiftwork. The illumination level in a control room without windows at a nuclear power station was ～200 lux (straight-forward horizontal gaze) using a weak yellow light of 200 lux, 3000 K (Philips Master TLD 36 W 830). New lighting equipment was installed in one area of the control room above the positions of the reactor operators. The new lights were shielded from the control group by a distance of >6?m, and the other operators worked at desks turned away from the new light. The new lights were designed to give three different light exposures: (i) white/blue strong light of 745 lux, 6000 K; (ii) weak yellow light of 650 lux, 4000 K; and (iii) yellow moderate light of 700 lux, 4000 K. In a crossover design, the normal and new light exposures were given during a sequence of three night shifts, two free days, two morning shifts, and one afternoon shift (NNN?+?MMA), with 7 wks between sessions. The operators consisted of two groups; seven reactor operators from seven work teams were at one time exposed to the new equipment and 16 other operators were used as controls. The study was conducted during winter with reduced opportunities of daylight exposure during work, after night work, or before morning work. Operators wore actigraphs, filled in a sleep/wake diary, including ratings of sleepiness on the Karolinska Sleepiness Scale (KSS) every 2?h, and provided saliva samples for analysis of melatonin at work (every 2nd h during one night shift and first 3?h during one morning shift). Results from the wake/sleep diary showed the new light treatment increased alertness during the 2nd night shift (interaction group?×?light?×?time, p < .01). Time of waking was delayed in the light condition after the 3rd night shift (group?×?light, p < .05), but the amount of wake time during the sleep span increased after the 2nd night shift (p < .05), also showing a tendency to affect sleep efficiency (p < .10). Effects on circadian phase were difficult to establish given the small sample size and infrequent sampling of saliva melatonin. Nonetheless, it seems that appropriate dynamic light in rooms without windows during the dark Nordic season may promote alertness, sleep, and better adaptation to quickly rotating shiftwork. (Author correspondence: arne.lowden@stress.su.se)     

Sleep,Diurnal Preference,Health, and Psychological Well-being: A Prospective Single-Allelic-Variation Study

Individual differences in sleep and diurnal preference associate with physical and mental health characteristics, but few genetic determinants of these differences have been identified. A variable number tandem repeat (VNTR) polymorphism in the PERIOD3 (PER3) gene (rs57875989) has been reported to associate with diurnal preference, i.e., preferred timing of waking and sleep. Here, the authors investigate in a prospective single-candidate genetic variant study whether allelic variation for this polymorphism associates also with reported actual sleep timing and sleep duration, as well as psychological and health measures. Six hundred and seventy-five subjects, aged 20 to 35 yrs, completed questionnaires to assess sleep and psychological and health characteristics and were genotyped for the PER3 VNTR. Homozygosity for the longer allele (PER3^5/5) of the VNTR was associated with increased morning preference, earlier wake time and bedtime, and reduced daytime sleepiness. Separate analyses of work and rest days demonstrated that the increase in time in bed during rest days was greatest in PER3^5/5 homozygotes. PER3 genotype modified the effects of sleep timing and duration on fluid intelligence and body mass index. Genotype was not associated with physical or psychological characteristics as assessed by the SF-36 Health Questionnaire, the General Health Questionnaire, the Big Five Inventory, the Behavioral Inhibition System–Behavioral Activation System scales, and the Positive and Negative Affect Scale, even though these measures varied significantly with diurnal preference as assessed by the Morningness-Eveningness Questionnaire. Whereas diurnal preference also predicts mental health and psychological characteristics, as well as sleep timing, the PER3 VNTR specifically affects measures of sleep timing and may also modify the effects of sleep on health outcome measures. (Author correspondence: a.lazar@surrey.ac.uk)     

Individual Traits and Environmental Factors Influencing Sleep Timing: A Study of 225 Japanese Couples

Behavioral and physiological processes, such as sleep-wakefulness, thermoregulation, and hormone secretion, exhibit 24-h rhythms in most organisms. These biological rhythms are driven by the circadian clock system and are entrained by the external environment, which in the case of humans includes social time schedules. Couples might be ideal experimental subjects to discriminate between individual traits and environmental factors, as they share lifestyle habits but not genetic backgrounds. In this study, sleep timing was compared between married Japanese couples (n?=?225) who had lived together for 1 yr or more (mean 17 yrs). Additionally, the authors evaluated the influence of individual traits and environmental factors on an individual's sleep timing per each couple. The results reveal that the sleep timings of a couple are mainly associated with the chronotypes of the husband and wife, whereas the sleep timings are significantly influenced by certain environmental factors. The findings suggest that chronotype remains one of the major determinants of an individual's sleep onset and wake times. Understanding an individual's chronotype may help improve the quality of life issues surrounding sleep. (Author correspondence: mishima@ncnp.go.jp)     

Actigraphic Analysis of the Sleep–Wake Cycle and Physical Activity Level in Patients with Stroke: Implications for Clinical Practice

Several structures of the central nervous system are essential in the sleep–wake regulation process. This study aimed to identify which actigraphic parameters of the sleep–wake cycle (SWC) are compromised after stroke and determine whether low-level physical activity can influence the expression of sleep-cycle temporal variation, in order to discuss the implications for the clinical practice of patient rehabilitation. The study assessed 22 patients (55?±?12 years) and 24 healthy individuals (57 ± 11 years), of both sexes. The instruments used were the International Physical Activity Questionnaire (IPAQ) and Actigraphy. Data were analyzed by the student t, Mann–Whitney, and Spearman's correlation tests. Patients' activity level was about 28% lower than that of healthy subjects. Furthermore, we recorded around 10% more activity in the sleep phase compared to the controls, indicating that patients suffer from fragmented sleep (p?<?.001). According to IPAQ classification, we observed that healthy individuals were classified more predominantly as active (66.7%) and patients as irregularly active B (72.8%). A significant correlation was found between IPAQ and total activity (R= ?.25; p= .007) and sleep latency (R= .27; p= .0006). In conclusion, the results obtained show a decrease in activity intensity in the SWC and significant sleep alterations related to greater duration, latency, and fragmentation. It is suggested that, in addition to motor impairments, sleep disorder complaints should be given priority during clinical diagnosis of patients with stroke. (Author correspondence: taniacampos@ufrnet.br)     

Association Study of a Variable-Number Tandem Repeat Polymorphism in the Clock Gene PERIOD3 and Chronotype in Norwegian University Students

Circadian rhythms are endogenously generated cycles involving physiological parameters, such as core body temperature, hormone levels, blood pressure, sleep, and metabolism, with a period length of around 24?h. The circadian clock in mammals is regulated by a set of clock genes that are functionally linked together, and polymorphisms in clock genes could be associated with differences in circadian rhythms. A variable-number tandem repeat (VNTR) in the human clock gene PERIOD3 (PER3) has been suggested to correlate with a morning (lark) versus evening (owl) chronotype as well as with the circadian rhythm sleep disorder “delayed sleep phase disorder” (DSPD). The authors examined 432 healthy Norwegian university students in search of further support for an association between the PER3 polymorphism and diurnal preference. The Horne-Östberg Morningness-Eveningness Questionnaire (MEQ) and Preferences Scale (PS) were used to evaluate subjective chronotype. DNA samples were genotyped with respect to the 4-repeat and 5-repeat alleles of the VNTR PER3 polymorphism, and the genotype distribution was 192 (4-4), 191 (4-5), and 49 (5-5). The authors estimated that the power to detect an association of the 4-allele with preference for morningness or eveningness was 75%. The authors found no association between the PER3 clock gene and chronotype, indicating that the proposed role of PER3 needs further clarification. (Author correspondence: teresa.osland@med.uib.no)