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)     

Circadian Phase,Sleepiness, and Light Exposure Assessment in Night Workers With and Without Shift Work Disorder

Most night workers are unable to adjust their circadian rhythms to the atypical hours of sleep and wake. Between 10% and 30% of shiftworkers report symptoms of excessive sleepiness and/or insomnia consistent with a diagnosis of shift work disorder (SWD). Difficulties in attaining appropriate shifts in circadian phase, in response to night work, may explain why some individuals develop SWD. In the present study, it was hypothesized that disturbances of sleep and wakefulness in shiftworkers are related to the degree of mismatch between their endogenous circadian rhythms and the night-work schedule of sleep during the day and wake activities at night. Five asymptomatic night workers (ANWs) (3 females; [mean?±?SD] age: 39.2?±?12.5 yrs; mean yrs on shift?=?9.3) and five night workers meeting diagnostic criteria (International Classification of Sleep Disorders [ICSD]-2) for SWD (3 females; age: 35.6?±?8.6 yrs; mean years on shift?=?8.4) participated. All participants were admitted to the sleep center at 16:00?h, where they stayed in a dim light (<10 lux) private room for the study period of 25 consecutive hours. Saliva samples for melatonin assessment were collected at 30-min intervals. Circadian phase was determined from circadian rhythms of salivary melatonin onset (dim light melatonin onset, DLMO) calculated for each individual melatonin profile. Objective sleepiness was assessed using the multiple sleep latency test (MSLT; 13 trials, 2-h intervals starting at 17:00?h). A Mann-Whitney U test was used for evaluation of differences between groups. The DLMO in ANW group was 04:42?±?3.25?h, whereas in the SWD group it was 20:42?±?2.21?h (z = 2.4; p?<?.05). Sleep did not differ between groups, except the SWD group showed an earlier bedtime on off days from work relative to that in ANW group. The MSLT corresponding to night work time (01:00–09:00?h) was significantly shorter (3.6?±?.90?min: [M?±?SEM]) in the SWD group compared with that in ANW group (6.8?±?.93?min). DLMO was significantly correlated with insomnia severity (r = ?.68; p < .03), indicating that the workers with more severe insomnia symptoms had an earlier timing of DLMO. Finally, SWD subjects were exposed to more morning light (between 05:00 and 11:00?h) as than ANW ones (798 vs. 180 lux [M?±?SD], respectively z?=??1.7; p?<?.05). These data provide evidence of an internal physiological delay of the circadian pacemaker in asymptomatic night-shift workers. In contrast, individuals with SWD maintain a circadian phase position similar to day workers, leading to a mismatch/conflict between their endogenous rhythms and their sleep-wake schedule. (Author correspondence: vgumeny1@hfhs.org)     

Light Exposure Among Adolescents With Delayed Sleep Phase Disorder: A Prospective Cohort Study

The objective of this study was to compare light exposure and sleep parameters between adolescents with delayed sleep phase disorder (DSPD; n?=?16, 15.3?±?1.8 yrs) and unaffected controls (n?=?22, 13.7?±?2.4 yrs) using a prospective cohort design. Participants wore wrist actigraphs with photosensors for 14 days. Mean hourly lux levels from 20:00 to 05:00?h and 05:00 to 14:00?h were examined, in addition to the 9-h intervals prior to sleep onset and after sleep offset. Sleep parameters were compared separately, and were also included as covariates within models that analyzed associations with specified light intervals. Additional covariates included group and school night status. Adolescent delayed sleep phase subjects received more evening (p?<?.02, 22:00–02:00?h) and less morning (p?<?.05, 08:00–09:00?h and 10:00–12:00?h) light than controls, but had less pre-sleep exposure with adjustments for the time of sleep onset (p?<?.03, 5–7?h prior to onset hour). No differences were identified with respect to the sleep offset interval. Increased total sleep time and later sleep offset times were associated with decreased evening (p?<?.001 and p?=?.02, respectively) and morning (p?=?.01 and p?<?.001, respectively) light exposure, and later sleep onset times were associated with increased evening exposure (p?<?.001). Increased total sleep time also correlated with increased exposure during the 9?h before sleep onset (p?=?.01), and a later sleep onset time corresponded with decreased light exposure during the same interval (p?<?.001). Outcomes persisted regardless of school night status. In conclusion, light exposure interpretation requires adjustments for sleep timing among adolescents with DSPD. Pre- and post-sleep light exposures do not appear to contribute directly to phase delays. Sensitivity to morning light may be reduced among adolescents with DSPD. (Author correspondence: auger.raymond1@mayo.edu)     

Mood,Alertness, and Performance in Response to Sleep Deprivation and Recovery Sleep in Experienced Shiftworkers Versus Non-Shiftworkers

Previous studies have shown increased sleepiness and mood changes in shiftworkers, which may be due to sleep deprivation or circadian disruption. Few studies, however, have compared responses of experienced shiftworkers and non-shiftworkers to sleep deprivation in an identical laboratory setting. The aim of this laboratory study, therefore, was to compare long-term shiftworkers and non-shiftworkers and to investigate the effects of one night of total sleep deprivation (30.5?h of continuous wakefulness) and recovery sleep on psychomotor vigilance, self-rated alertness, and mood. Eleven experienced male shiftworkers (shiftwork ≥5 yrs) were matched with 14 non-shiftworkers for age (mean?±?SD: 35.7?±?7.2 and 32.5?±?6.2 yrs, respectively) and body mass index (BMI) (28.7?±?3.8 and 26.6?±?3.4?kg/m², respectively). After keeping a 7-d self-selected sleep/wake cycle (7.5/8?h nocturnal sleep), both groups entered a laboratory session consisting of a night of adaptation sleep and a baseline sleep (each 7.5/8?h), a sleep deprivation night, and recovery sleep (4-h nap plus 7.5/8?h nighttime sleep). Subjective alertness and mood were assessed with the Karolinska Sleepiness Scale (KSS) and 9-digit rating scales, and vigilance was measured by the visual psychomotor vigilance test (PVT). A mixed-model regression analysis was carried out on data collected every hour during the sleep deprivation night and on all days (except for the adaptation day), at .25, 4.25, 5.25, 11.5, 12.5, and 13.5?h after habitual wake-up time. Despite similar circadian phase (melatonin onset), demographics, food intake, body posture, and environmental light, shiftworkers felt significantly more alert, more cheerful, more elated, and calmer than non-shiftworkers throughout the laboratory study. In addition, shiftworkers showed a faster median reaction time (RT) compared to non-shiftworkers, although four other PVT parameters did not differ between the groups. As expected, both groups showed a decrease in subjective alertness and PVT performance during and following the sleep deprivation night. Subjective sleepiness and most aspects of PVT performance returned to baseline levels after a nap and recovery sleep. The mechanisms underlying the observed differences between shiftworkers and non-shiftworkers require further study, but may be related to the absence of shiftwork the week prior to and during the laboratory study as well as selection into and out of shiftwork. (Author correspondence: sophie.wehrens@surrey.ac.uk)     

PARADOXICAL POST-EXERCISE RESPONSES OF ACYLATED GHRELIN AND LEPTIN DURING A SIMULATED NIGHT SHIFT

Approximately 10% of employees undertake night work, which is a significant predictor of weight gain, possibly because responses to activity and eating are altered at night. It is known that the appetite-related hormone, acylated ghrelin, is suppressed after an acute bout of exercise during the day, but no researcher has explored whether evening exercise alters acylated ghrelin and other appetite-related outcomes during a subsequent night shift. Six healthy men (mean?±?SD: age 30?±?8 yrs, body mass index 23.1?±?1.1?kg/m²) completed two crossover trials (control and exercise) in random order. Participants fasted from 10:00?h, consumed a test meal at 18:00?h, and then cycled at 50% peak oxygen uptake or rested between 19:00–20:00?h. Participants then completed light activities during a simulated night shift which ended at 05:00?h. Two small isocaloric meals were consumed at 22:00 and 02:00?h. Venous blood samples were drawn via cannulation at 1?h intervals between 19:00–05:00?h for the determination of acylated ghrelin, leptin, insulin, glucose, triglyceride, and non-esterified fatty acids concentrations. Perceived hunger and wrist actimetry were also recorded. During the simulated night shift, mean?±?SD acylated ghrelin concentration was 86.5?±?40.8 pg/ml following exercise compared with 71.7?±?37.7 pg/ml without prior exercise (p?=?0.015). Throughout the night shift, leptin concentration was 263?±?242 pg/ml following exercise compared with 187?±?221 pg/ml without prior exercise (p?=?0.017). Mean levels of insulin, triglyceride, non-esterified fatty acids, and wrist actimetry level were also higher during the night shift that followed exercise (p?<?0.05). These data indicate that prior exercise increases acylated ghrelin and leptin concentrations during a subsequent simulated night shift. These findings differ from the known effects of exercise on acylated ghrelin and leptin during the day, and therefore have implications for energy balance during night work. (Author correspondence: c.j.morris@2006.ljmu.ac.uk).     

Dim Light Melatonin Onset in Alcohol-Dependent Men and Women Compared with Healthy Controls

Sleep disturbances in alcohol-dependent (AD) individuals may persist despite abstinence from alcohol and can influence the course of the disorder. Although the mechanisms of sleep disturbances of AD are not well understood and some evidence suggests dysregulation of circadian rhythms, dim light melatonin onset (DLMO) has not previously been assessed in AD versus healthy control (HC) individuals in a sample that varied by sex and race. The authors assessed 52 AD participants (mean?±?SD age: 36.0?±?11.0 yrs of age, 10 women) who were 3–12 wks since their last drink (abstinence: 57.9?±?19.3 d) and 19 age- and sex-matched HCs (34.4?±?10.6 yrs, 5 women). Following a 23:00–06:00?h at-home sleep schedule for at least 5 d and screening/baseline nights in the sleep laboratory, participants underwent a 3-h extension of wakefulness (02:00?h bedtime) during which salivary melatonin samples were collected every 30?min beginning at 19:30?h. The time of DLMO was the primary measure of circadian physiology and was assessed with two commonly used methodologies. There was a slower rate of rise and lower maximal amplitude of the melatonin rhythm in the AD group. DLMO varied by the method used to derive it. Using 3 pg/mL as threshold, no significant differences were found between the AD and HC groups. Using 2 standard deviations above the mean of the first three samples, the DLMO in AD occurred significantly later, 21:02?±?00:41?h, than in HC, 20:44?±?00:21?h (t?=??2.4, p?=?.02). Although melatonin in the AD group appears to have a slower rate of rise, using well-established criteria to assess the salivary DLMO did not reveal differences between AD and HC participants. Only when capturing melatonin when it is already rising was DLMO found to be significantly delayed by a mean 18?min in AD participants. Future circadian analyses on alcoholics should account for these methodological caveats. (Author correspondence: daconroy@med.umich.edu)     

Ring the Bell for Matins: Circadian Adaptation to Split Sleep by Cloistered Monks and Nuns

Cloistered monks and nuns adhere to a 10-century-old strict schedule with a common zeitgeber of a night split by a 2- to 3-h-long Office (Matins). The authors evaluated how the circadian core body temperature rhythm and sleep adapt in cloistered monks and nuns in two monasteries. Five monks and five nuns following the split-sleep night schedule for 5 to 46 yrs without interruption and 10 controls underwent interviews, sleep scales, and physical examination and produced a week-long sleep diary and actigraphy, plus 48-h recordings of core body temperature. The circadian rhythm of temperature was described by partial Fourier time-series analysis (with 12- and 24-h harmonics). The temperature peak and trough values and clock times did not differ between groups. However, the temperature rhythm was biphasic in monks and nuns, with an early decrease at 19:39?±?4:30?h (median?±?95% interval), plateau or rise of temperature at 22:35?±?00:23?h (while asleep) lasting 296?±?39?min, followed by a second decrease after the Matins Office, and a classical morning rise. Although they required alarm clocks to wake-up for Matins at midnight, the body temperature rise anticipated the nocturnal awakening by 85?±?15?min. Compared to the controls, the monks and nuns had an earlier sleep onset (20:05?±?00:59?h vs. 00:00?±?00:54?h, median?±?95% confidence interval, p?=?.0001) and offset (06:27?±?0:22?h, vs. 07:37?±?0:33?h, p?=?.0001), as well as a shorter sleep time (6.5?±?0.6 vs. 7.6?±?0.7?h, p?=?.05). They reported difficulties with sleep latency, sleep duration, and daytime function, and more frequent hypnagogic hallucinations. In contrast to their daytime silence, they experienced conversations (and occasionally prayers) in dreams. The biphasic temperature profile in monks and nuns suggests the human clock adapts to and even anticipates nocturnal awakenings. It resembles the biphasic sleep and rhythm of healthy volunteers transferred to a short (10-h) photoperiod and provides a living glance into the sleep pattern of medieval time. (Author correspondence: isabelle.arnulf@psl.aphp.fr)     

The impact of shift starting time on sleep duration,sleep quality,and alertness prior to injury in the People’s Republic of China

Early shift start time and night shifts are associated with reduced sleep duration and poor sleep quality that often lead to increased fatigue levels, performance decrements and adverse safety and health outcomes. This study investigates the impact of shift starting time on sleep patterns, including the duration and quality of sleep and alertness/sleepiness at the time of injury, in a large epidemiological field study of hospitalized adults with severe work-related hand injury in the People’s Republic of China (PRC) from multiple industries with severe work-related traumatic hand injury were recruited from 11 hospitals in three industrially-developed cities in the PRC: Ningbo, Liuzhou and Wuxi. Analysis of covariance (ANCOVA) was used to compare sleep duration, sleep quality and alertness/sleepiness across 3?h increments of shift start time, while adjusting for age, gender, work hours, shift duration, day of injury and several transient work-related factors. Effect modification by gender was also evaluated. Seven-hundred and three hospitalized adults (96.4%) completed a face-to-face interview within 4 days of injury; 527 (75.0%) were male, with a mean (±SEM) age of 31.8?±?0.4 years. Overall, these adults worked relatively long weekly (55.7?±?0.6?h) and daily hours (8.6?±?0.07?h). Average sleep duration prior to injury was 8.5?h (±0.07), and showed significant variations (p value <0.05) across shift starting time increments. Overall mean prior sleep duration was shortest for individuals starting shifts from “21:00–23:59” (5.6±0.8?h) followed by midnight “00:00–02:59” (6.1?±?0.6?h). However, a statistically significant interaction (p?<?0.05) was observed between gender and shift starting time on mean sleep duration. For males the shortest sleep duration was 5.6?h (“21:00–23:59”) and for females the shortest was 4.3?h (“24:00–02:59” and “15:00–17:59”). Sleep quality (generally quite well) and alertness/sleepiness based on the KSS (generally alert) did not vary significantly across shift starting time. Results suggest that sleep duration is shortest among injured PRC adults starting shifts late night and early morning. However, with more than 8.5?h of sleep on average work days, Chinese slept much longer than typical US day workers (Sleep in America Poll, 2012, 6:44 on workdays, 7:35 on free days), and this may help to explain higher than expected alertness/sleepiness scores at the time of injury.     

Lack of exposure to natural light in the workspace is associated with physiological,sleep and depressive symptoms

The diurnal light cycle has a crucial influence on all life on earth. Unfortunately, modern society has modified this life-governing cycle by stressing maximum production and by giving insufficient attention to the ecological balance and homeostasis of the human metabolism. The aim of this study is to evaluate the effects of exposure or lack of exposure to natural light in a rest/activity rhythm on cortisol and melatonin levels, as well as on psychological variables in humans under natural conditions. This is a cross-sectional study. The subjects were allocated split into two groups according to their workspace (10 employees in the “with window” group and 10 in the “without window” group). All participants were women and wore anactigraph (Actiwatch 2, Philips Respironics), which measures activity and ambient light exposure, for seven days. Concentrations of melatonin and cortisol were measured from the saliva samples. Participants were instructed to collect saliva during the last day of use of the actigraph at 08:00 am, 4:00 pm and 10:00 pm. The subjects answered the Self-Reporting Questionnaire-20 (SRQ-20) to measure the presence of minor psychiatric disorders; the Montgomery-Asberg (MA) scale was used to measure depression symptoms, and the Pittsburgh Sleep Quality Index questionnaire (PSQI) was used to evaluate the quality of sleep. The Rayleigh analysis indicates that the two groups, “with window” an d “without window”, exhibited similar activities and light acrophases. In relation to light exposure, the mesor was significantly higher (t?=??2.651, p?=?0.023) in t he “with window” group (191.04?±?133.36) than in the “without window” group (73.8?±?42.05). Additionally, the “with window” group presented the highest amplitude of light exposure (298.07?±?222.97). Cortisol levels were significantly different between the groups at 10:00 pm (t?=?3.009, p?=?0.008; “without window” (4.01?±?0.91) “with window” (3.10?±?0.30)). In terms of the melatonin levels, the groups differed at two different times of day: 08:00 am (t?=?2.593, p?=?0.018) and 10:00 pm (t?=??2.939, p?=?0.009). The “with window” group had a lower melatonin level at 08:00 am (3.54?±?0.60) but a higher level at 10:00 pm (24.74?±?4.22) than the “without window” group. Higher cortisol levels were positively correlated with minor psychiatric disorders and depressive symptoms (MA) at 10:00 pm. Lower melatonin levels at 10:00 pm were correlated with depressive symptoms and poor quality of sleep (PSQI). Our study demonstrated that not only may light pollution affect human physiology but also lack of exposure to natural light is related to high levels of cortisol and lower levels of melatonin at night, and these, in turn, are related to depressive symptoms and poor quality of sleep.     

Influence of acoustic stimulation on the circadian and ultradian rhythm of premature infants

The aim of the present study was to evaluate the development of the circadian rhythm of the salivary cortisol in premature infants and its correlation with the onset of the sleep–activity behavior pattern during the first 3 weeks of life under controlled light:dark conditions. Furthermore, we investigated the influence of acoustic stimulation by audiotaped lullabies or the maternal voice on the cortisol values and long-term sleep–activity patterns. The study was a block-randomized, prospective clinical trial with a study population of 62 preterm neonates (30?<?37 gestational age). We compared two study groups who listened either to music or to the maternal voice (music: N?=?20; maternal voice: N?=?20) with a matched control group (N?=?22). The acoustic stimulation took place every evening between 20:00 and 21:00?h for 30?min over a period of 2 weeks. The cortisol values and activity–rest behavior of the neonates were determined during the first 3 weeks of life on the 1st, 7th and 14th day. Actigraphic monitoring was used to record the activity pattern continuously over 24?h and a validated algorithm for neonates was used to estimate sleep and wakefulness. The saliva samples were obtained 10?min before and 10?min after the acoustic interventions for the study groups. Additionally, saliva samples were obtained from the control group seven times over a 24-h period (20:00, 21:00, 01:00, 05:00, 08:00, 13:00 and 17:00?h). The cortisol data were analyzed by fast Fourier transformation to assess periodic characteristics and frequencies. Hierarchical linear modeling was further performed for the statistical analysis. Results: The cortisol rhythm analysis indicated a circadian rhythm pattern for only one premature infant, all others of the neonates showed no circadian or ultradian rhythm in cortisol. Cortisol level of the premature neonates was significantly higher during the first day of the study period at night-time (median: 17.1?nmol/L, IQR?=?9.7–24.4?nmol/L) than on days 7 (median: 9.6?nmol/L, IQR?=?4.7–14.6?nmol/L; Tukey-HSD, z?=?4.12, p?<?0.001) and 14 (IQR?=?5.8–13.7?nmol/L; Tukey-HSD, z?=?2.89, p?<?0.05). No significant effect of acoustic stimulation was observed on the cortisol concentration and sleep–wake behavior. The activity–sleep rhythm of preterm neonates was dominated by ultradian rhythm patterns with a prominent period length of 4?h (30.5%). Activity frequencies of neonates were also significantly higher overnight on the first study day (mean: 329?±?185.1?U) than of night seven (mean: 260.2?±?132.4?U; Tukey-HSD, z?=?2.50, p?<?0.05). Quiet-activity patterns increased, whereas high-activity patterns decreased during the observation period. Average sleep time increased significantly during the study time from day 1 to day 7 (Tukey-HSD, z?=?2.51, p?<?0.05). In conclusion, premature infants showed higher cortisol levels – without a circadian rhythmicity – and higher activity frequencies in the first days after birth which may reflect an adaptation process of neonates after birth. Cortisol concentrations and the activity patterns were not influenced by music interventions.     

The Effect of Time-of-Day and Sympathetic α1-Blockade on Orthostatic Tolerance

Tolerance time to a standardized orthostatic stressor is markedly reduced in normotensive individuals in the morning. However, the physiological mechanisms that underpin this phenomenon are unknown. The purpose of this study was to examine the role of α₁-adrenergic activity on orthostatic tolerance and associated cardiorespiratory and cerebrovascular responses, and to determine whether its endogenous modulation is important in the diurnal variation of orthostatic tolerance. In a four-trial, randomized placebo-controlled crossover experiment, 12 normotensive volunteers (aged 25?±?1 yrs; mean?±?SE) completed a 60° head-upward tilt (HUT; 15?min or until onset of presyncope) at 06:00 and 16:00?h, 90?min after the administration of either α₁-blockade (prazosin, 1?mg/20?kg body weight) or placebo. Continuous beat-to-beat measurements of middle cerebral blood flow velocity (transcranial Doppler), blood pressure (Finometer), heart rate, stroke volume, cardiac output, and end-tidal carbon dioxide were obtained. Independent of time-of-day, α₁-blockade markedly reduced the ability to tolerate a 15-min 60° HUT; tolerance time was 229% shorter compared with the placebo condition (p?≤?.0001). Moreover, a marked diurnal variation in orthostatic tolerance was evident following α₁-adrenergic blockade; e.g., tolerance time in the morning (176?±?30 s) was lower than in the afternoon (354?±?75 s; p?=?.04). These findings highlight an important role of α₁-sympathetic vasoconstrictor activity in acutely regulating blood pressure and offsetting syncope, especially in the early morning. (Author correspondence: Nia.Lewis@ubc.ca)     

Sleep,Sleepiness, Fatigue,and Performance of 12-Hour-Shift Nurses

Nurses working 12-h shifts complain of fatigue and insufficient/poor-quality sleep. Objectively measured sleep times have not been often reported. This study describes sleep, sleepiness, fatigue, and neurobehavioral performance over three consecutive 12-h (day and night) shifts for hospital registered nurses. Sleep (actigraphy), sleepiness (Karolinska Sleepiness Scale [KSS]), and vigilance (Performance Vigilance Task [PVT]), were measured serially in 80 registered nurses (RNs). Occupational fatigue (Occupational Fatigue Exhaustion Recovery Scale [OFER]) was assessed at baseline. Sleep was short (mean 5.5?h) between shifts, with little difference between day shift (5.7?h) and night shift (5.4?h). Sleepiness scores were low overall (3 on a 1–9 scale, with higher score indicating greater sleepiness), with 45% of nurses having high level of sleepiness (score ?>?7) on at least one shift. Nurses were progressively sleepier each shift, and night nurses were sleepier toward the end of the shift compared to the beginning. There was extensive caffeine use, presumably to preserve or improve alertness. Fatigue was high in one-third of nurses, with intershift fatigue (not feeling recovered from previous shift at the start of the next shift) being most prominent. There were no statistically significant differences in mean reaction time between day/night shift, consecutive work shift, and time into shift. Lapsing was traitlike, with rare (39% of sample), moderate (53%), and frequent (8%) lapsers. Nurses accrue a considerable sleep debt while working successive 12-h shifts with accompanying fatigue and sleepiness. Certain nurses appear more vulnerable to sleep loss than others, as measured by attention lapses. (Author correspondence: jgeiger@son.umaryland.edu)     

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)     

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)     

Time-of-Day Effect on Cardiac Responses to Progressive Exercise

This study was designed to examine time-of-day effects on markers of cardiac functional capacity during a standard progressive cycle exercise test. Fourteen healthy, untrained young males (mean?±?SD: 17.9?±?0.7 yrs of age) performed identical maximal cycle tests in the morning (08:00–11:00?h) and late afternoon (16:00–19:00?h) in random order. Cardiac variables were measured at rest, submaximal exercise, and maximal exercise by standard echocardiographic techniques. No differences in morning and afternoon testing values at rest or during exercise were observed for oxygen uptake, heart rate, cardiac output, or markers of systolic and diastolic myocardial function. Values at peak exercise for Vo₂ at morning and afternoon testing were 3.20?±?0.49 and 3.24?±?0.55?L min^?1, respectively, for heart rate 190?±?11 and 188?±?15?bpm, and for cardiac output 19.5?±?2.8 and 19.8?±?3.5?L min^?1. Coefficients of variation for morning and afternoon values for these variables were similar to those previously published for test-retest reproducibility. This study failed to demonstrate evidence for significant time-of-day variation in Vo₂max or cardiac function during standard progressive exercise testing in adolescent males. (Author correspondence: thomas.rowland@bhs.org)     

Diurnal Variation in Heart Rate Variability before and after Maximal Exercise Testing

As heart-rate variability (HRV) is under evaluation in clinical applications, the authors sought to better define the interdependent impact of age, maximal exercise, and diurnal variation under physiologic conditions. The authors evaluated the diurnal changes in HRV 24-h pre- and post-maximal aerobic exercise testing to exhaustion in young (19–25 yrs, n?=?12) and middle-aged (40–55 yrs, n?=?12) adults. Subjects wore a portable 5-lead electrocardiogram holter for 48?h (24?h prior to and following a maximal aerobic capacity test). Time-, frequency-, time-frequency-, and scale-invariant-domain measures of HRV were computed from RR-interval data analyzed using a 5-min window size and a 2.5-min step size, resulting in a different set of outputs every 2.5?min. Results were averaged (mean?±?SE) over four prespecified time periods during the morning, afternoon, evening, and night on Day 1 and Day 2. Diurnal changes in HRV in young and middle-aged adults were compared using a two-way, repeated-measures analysis of variance (ANOVA). Young adults demonstrated higher HRV compared to middle-aged adults during periods of wakefulness and sleep prior to maximal exercise stress testing (i.e., high-frequency power during Day 1: young adults: morning 1862?±?496?ms², afternoon 1797?±?384?ms², evening 1908?±?431?ms², and night 3202?±?728?ms²; middle-aged adults: morning 341?±?53?ms², afternoon 405?±?68?ms², evening 469?±?80?ms², and night 836?±?136?ms²) (p < .05). Exercise resulted in reductions in HRV such that multiple measures of HRV were not significantly different between age groups during the afternoon and evening periods. All measures of HRV demonstrated between-group differences overnight on Day 2 (p < .05). Young adults are associated with higher baseline HRV during the daytime. Sleep increases variability equally and proportionally to daytime variability. Given the higher baseline awake HRV and equal rise in HRV during sleep, the change in HRV from sleep to morning with exercise is greater in younger subjects. These physiologic results have clinical significance in understanding the pathophysiology of altered variability in ill patients. (Author correspondence: aseely@ohri.ca)     

Eveningness,Sleep Patterns,Daytime Functioning,and Quality of Life in Israeli Adolescents

The purpose of the study was to assess the relationships between eveningness, sleep patterns, measures of daytime functioning, i.e., sleepiness, sleep problem behaviors, and depressed mood, and quality of life (QOL) in young Israeli adolescents. A cross-sectional survey was performed in urban and rural middle schools in Northern Israel. Participants were 470 eighth and ninth grade middle school students (14?±?0.8 yrs of age) in the normative school system. Students completed the modified School Sleep Habits Survey (SSHS) and Pediatric Quality of Life Inventory Short Form, assessing six subscales of physical, emotional, social, school performance, and psychosocial functioning, plus an addition generated total score. During weekdays and weekends, evening types went to bed later, their sleep latency was longer, their wake-up time was later, and their sleep duration was shorter than intermediate and morning types. Evening types exhibited more sleep problem behaviors, sleepiness, depressed mood, and lower QOL compared to intermediate and morning types. Based on the regression model, sleepiness, sleep-problem behaviors, and depressed mood were the variables most strongly associated with QOL, followed by morning-evening preference, weekday sleep duration, and weekend sleep latency. This study is the first to assess QOL in normative, healthy adolescents and to demonstrate strong associations between morning-evening preference and QOL. These findings enhance the need to identify young individuals with an evening preference, and to be aware of the characteristics and manifestations of the evening chronotype on daytime and nighttime behaviors in adolescence. (Author correspondence: Orna@yvc.ac.il)     

Towards a Characterization of the Locomotor Activity Rhythm of the Supralittoral Isopod Tylos europaeus

Freshly collected samples of Tylos europaeus from Korba beach (northeast of Tunisia) were housed in an environmental cabinet at controlled temperature (18°C?±?.5°C) and photoperiod. Locomotor activity was recorded under two photoperiodic regimens by infrared actography every 20?min by multichannel data loggers. One regimen simulated the natural light-dark cycle on the day of collection, whereas the second imposed a state of continuous darkness on all individuals. Under entraining conditions, the animals displayed rhythmic activity, in phase with the period of darkness, whereas in continuous darkness these isopods exhibited a strong endogenous rhythm with circadian and semidiurnal components at mean periods of τ (h:min)?=?25:09?±?01:02?h and τ?=?12:32?±?00:26?h, respectively. Under free-running conditions, this endogenous rhythm showed significant intraspecific variability. (Author correspondence: bohli.dhouha@gmail.com)     

Time Course of Neurobehavioral Alertness During Extended Wakefulness in Morning- and Evening-Type Healthy Sleepers

The aim of the study was to evaluate the influence of chronotype (morning-type versus evening-type) living in a fixed sleep-wake schedule different from one's preferred sleep schedules on the time course of neurobehavioral performance during controlled extended wakefulness. The authors studied 9 morning-type and 9 evening-type healthy male subjects (21.4?±?1.9 yrs). Before the experiment, all participants underwent a fixed sleep-wake schedule mimicking a regular working day (bedtime: 23:30?h; wake time: 07:30?h). Then, following two nights in the laboratory, both chronotypes underwent a 36-h constant routine, performing a cognitive test of sustained attention every hour. Core body temperature, salivary melatonin secretion, objective alertness (maintenance of wakefulness test), and subjective sleepiness (visual analog scale) were also assessed. Evening-types expressed a higher level of subjective sleepiness than morning types, whereas their objective levels of alertness were not different. Cognitive performance in the lapse domain remained stable during the normal waking day and then declined during the biological night, with a similar time course for both chronotypes. Evening types maintained optimal alertness (i.e., 10% fastest reaction time) throughout the night, whereas morning types did not. For both chronotypes, the circadian performance profile was correlated with the circadian subjective somnolence profile and was slightly phase-delayed with melatonin secretion. Circadian performance was less correlated with circadian core body temperature. Lapse domain was phase-delayed with body temperature (2–4?h), whereas optimal alertness was slightly phase-delayed with body temperature (1?h). These results indicate evening types living in a fixed sleep-wake schedule mimicking a regular working day (different from their preferred sleep schedules) express higher subjective sleepiness but can maintain the same level of objective alertness during a normal waking day as morning types. Furthermore, evening types were found to maintain optimal alertness throughout their nighttime, whereas morning types could not. The authors suggest that evening-type subjects have a higher voluntary engagement of wake-maintenance mechanisms during extended wakefulness due to adaptation of their sleep-wake schedule to social constraints. (Author correspondence: jack.taillard@gmail.com)