Longitudinal Study of Mothers’ Sleep-Wake Behaviors and Circadian Time Patterns from Late Pregnancy to Postpartum – Monitoring of Wrist Actigraphy and Sleep Logs

This longitudinal study investigated sleep-wake behavior patterns during and after pregnancy, using an actimeter worn on the non-dominant wrist and a sleep log. Records were obtained from ten mothers, from the 34th week of gestation until the 15th week postpartum. Ten non-pregnant women were used as a control group, data being collected from them for 2 weeks. The sleep-wake behavior after delivery, obtained from wrist actigraphy, was greater in the postpartum period. Total sleep time, sleep efficiency, and circadian amplitude decreased in the weeks immediately following parturition, but wake after sleep onset increased. Subsequently, all the sleep and circadian variables improved slightly, but they had not returned to the levels of the non-pregnant control group even by the 15th postpartum week. The length of daytime naps increased, in order to make up for nocturnal sleep deprivation when the number of awakenings during nighttime had increased. There were significant positive correlations between total sleep time, sleep efficiency, wake after sleep onset, and the length of daytime naps, but the numbers of awakenings at night and daytime naps did not show this correlation. The total sleep time indicated by sleep logs tended to be greater than that indicated by actigraphy, but wake after sleep onset tended to be underestimated by the sleep logs. The implications of these results are discussed.     

Sleep logs of young adults with self-selected sleep times predict the dim light melatonin onset

The purpose of this study was to determine whether a sleep log parameter could be used to estimate the circadian phase of normal, healthy, young adults who sleep at their normal times, and thus naturally have day-to-day variability in their times of sleep. Thus, we did not impose any restrictions on the sleep schedules of our subjects (n = 26). For 14 d, they completed daily sleep logs that were verified with wrist activity monitors. On day 14, salivary melatonin was sampled every 30 min in dim light from 19:00 to 07:30 h to determine the dim light melatonin onset (DLMO). Daily sleep parameters (onset, midpoint, and wake) were taken from sleep logs and averaged over the last 5, 7, and 14 d before determination of the DLMO. The mean DLMO was 22:48 +/- 01:30 h. Sleep onset and wake time averaged over the last 5 d were 01:44 +/- 01:41 and 08:44 +/- 01:26 h, respectively. The DLMO was significantly correlated with sleep onset, midpoint, and wake time, but was most strongly correlated with the mean midpoint of sleep from the last 5 d (r = 0.89). The DLMO predicted using the mean midpoint of sleep from the last 5 d was within 1 h of the DLMO determined from salivary melatonin for 92% of the subjects; in no case did the difference exceed 1.5 h. The correlation between the DLMO and the score on the morningness-eveningness questionnaire was significant but comparatively weak (r = -0.48). We conclude that the circadian phase of normal, healthy day-active young adults can be accurately predicted using sleep times recorded on sleep logs (and verified by actigraphy), even when the sleep schedules are irregular.     

Variation in Meals and Sleep-Activity Patterns in Aged Subjects; its Relevance to Orcadian Rhythm studies

The study was performed upon a sample of aged and non-institutionalized subjects. Information was obtained by questionnaires and diaries on personal factors during a typical week. A random subset was subjected to a more detailed analysis of the composition of their meals.

Results showed that increasing age was correlated with: a decreased day-by-day variability in an individual's time of retiring, rising and eating meals; earlier sleep times; increased frequency of daytime naps and nocturnal awakenings; and decreased physical activity. These results occurred both in subjects living alone and in those living with company. Day-by-day differences in the composition of meals tended to decrease with age. When differences between individuals were considered then these tended to increase with age.

Some implications of these findings for studies of circadian rhythmicity in aged subjects-in whom the timing of circadian rhythms becomes more erratic and amplitude falls-are discussed.     

SLEEP LOGS OF YOUNG ADULTS WITH SELF-SELECTED SLEEP TIMES PREDICT THE DIM LIGHT MELATONIN ONSET

The purpose of this study was to determine whether a sleep log parameter could be used to estimate the circadian phase of normal, healthy, young adults who sleep at their normal times, and thus naturally have day-to-day variability in their times of sleep. Thus, we did not impose any restrictions on the sleep schedules of our subjects (n=26). For 14 d, they completed daily sleep logs that were verified with wrist activity monitors. On day 14, salivary melatonin was sampled every 30 min in dim light from 19:00 to 07:30h to determine the dim light melatonin onset (DLMO). Daily sleep parameters (onset, midpoint, and wake) were taken from sleep logs and averaged over the last 5, 7, and 14 d before determination of the DLMO. The mean DLMO was 22:48±01:30 h. Sleep onset and wake time averaged over the last 5 d were 01:44±01:41 and 08:44±01:26 h, respectively. The DLMO was significantly correlated with sleep onset, midpoint, and wake time, but was most strongly correlated with the mean midpoint of sleep from the last 5 d (r=0.89). The DLMO predicted using the mean midpoint of sleep from the last 5 d was within 1 h of the DLMO determined from salivary melatonin for 92% of the subjects; in no case did the difference exceed 1.5 h. The correlation between the DLMO and the score on the morningness-eveningness questionnaire was significant but comparatively weak (r=-0.48). We conclude that the circadian phase of normal, healthy day-active young adults can be accurately predicted using sleep times recorded on sleep logs (and verified by actigraphy), even when the sleep schedules are irregular.     

Circadian and Ultradian Time Patterns in Human Behaviour: Part 1: Activity Monitoring of Families from Prepartum to Postpartum

Time patterns of activity-rest rhythms during and after pregnancy are increasingly recognised as important factors for the well-being and health of young families. This longitudinal study examined activity-rest patterns of couples during late pregnancy and subsequently the alterations in the periodic structure of parental and neonatal time patterns during the first four months after birth. Part I concentrates on the effects of late pregnancy and birth to the mother's rest-activity patterns and those of the father and, after birth, what time pattern the infant developed. Part II attempts to clarify how activity patterns of the entire family agree or disagree with each other and investigates how the infant synchronises with the environment that includes the process of parent-infant interaction. Activity data of, so far, seven families (father, mother and child) were continuously recorded using non-invasive Actiwatch units. Recordings of parental activity started at the beginning of the 37th week of gestation, and were continued in parallel with the infants' recordings in three series of three weeks each until four months after birth: 1st to 3rd week, 7th to 9th week and 13th to 15th week of life. In a standardised diary, record was kept of household routines, parental activities, type of feeding, initiation of sleep or waking up. Activity data of seven non-pregnant women were collected and used as a control. Irregular nocturnal activity epochs occurred frequently in pregnant women and were absent in non-pregnant women. Period lengthenings and shortenings of the circadian rhythms appeared in both parents from prepartum to postpartum. Activity at night increased from prepartum to postpartum in mothers and fathers. Three infants showed a marked circadian rhythm between day 3 and 14 after birth. All seven infants showed a predominant circadian rhythm between day 8 and 19 after birth. The onset of daytime activity of mothers and their infants corresponded well to each other. Postpartum frequency spectra of parents and child always had some ultradian components in common. Time patterns of activity-rest rhythms of couples and parents are shown to be altered during and after pregnancy and we suggest that the infants' adaptation to the environment begins during the first week that includes the process of mother-infant interaction.     

Circadian regulation gene polymorphisms are associated with sleep disruption and duration,and circadian phase and rhythm in adults with HIV

Genes involved in circadian regulation, such as circadian locomotor output cycles kaput [CLOCK], cryptochrome [CRY1] and period [PER], have been associated with sleep outcomes in prior animal and human research. However, it is unclear whether polymorphisms in these genes are associated with the sleep disturbances commonly experienced by adults living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). Thus, the purpose of this study was to describe polymorphisms in selected circadian genes that are associated with sleep duration or disruption as well as the sleep–wake rhythm strength and phase timing among adults living with HIV/AIDS. A convenience sample of 289 adults with HIV/AIDS was recruited from HIV clinics and community sites in the San Francisco Bay Area. A wrist actigraph was worn for 72?h on weekdays to estimate sleep duration or total sleep time (TST), sleep disruption or percentage of wake after sleep onset (WASO) and several circadian rhythm parameters: mesor, amplitude, the ratio of mesor to amplitude (circadian quotient), and 24-h autocorrelation. Circadian phase measures included clock time for peak activity (acrophase) from actigraphy movement data, and bed time and final wake time from actigraphy and self-report. Genotyping was conducted for polymorphisms in five candidate genes involved in circadian regulation: CLOCK, CRY1, PER1, PER2 and PER3. Demographic and clinical variables were evaluated as potential covariates. Interactions between genotype and HIV variables (i.e. viral load, years since HIV diagnosis) were also evaluated. Controlling for potentially confounding variables (e.g. race, gender, CD4+ T-cell count, waist circumference, medication use, smoking and depressive symptoms), CLOCK was associated with WASO, 24-h autocorrelation and objectively-measured bed time; CRY1 was associated with circadian quotient; PER1 was associated with mesor and self-reported habitual wake time; PER2 was associated with TST, mesor, circadian quotient, 24-h autocorrelation and bed and wake times; PER3 was associated with amplitude, 24-h autocorrelation, acrophase and bed and wake times. Most of the observed associations involved a significant interaction between genotype and HIV. In this chronic illness population, polymorphisms in several circadian genes were associated with measures of sleep disruption and timing. These findings extend the evidence for an association between genetic variability in circadian regulation and sleep outcomes to include the sleep–wake patterns experienced by adults living with HIV/AIDS. These results provide direction for future intervention research related to circadian sleep–wake behavior patterns.     

Circadian and Ultradian Time Patterns in Human Behaviour: Part 1: Activity Monitoring of Families from Prepartum to Postpartum

Time patterns of activity-rest rhythms during and after pregnancy are increasingly recognised as important factors for the well-being and health of young families. This longitudinal study examined activity-rest patterns of couples during late pregnancy and subsequently the alterations in the periodic structure of parental and neonatal time patterns during the first four months after birth. Part I concentrates on the effects of late pregnancy and birth to the mother's rest-activity patterns and those of the father and, after birth, what time pattern the infant developed. Part II attempts to clarify how activity patterns of the entire family agree or disagree with each other and investigates how the infant synchronises with the environment that includes the process of parent-infant interaction. Activity data of, so far, seven families (father, mother and child) were continuously recorded using non-invasive Actiwatch units. Recordings of parental activity started at the beginning of the 37th week of gestation, and were continued in parallel with the infants' recordings in three series of three weeks each until four months after birth: 1st to 3rd week, 7th to 9th week and 13th to 15th week of life. In a standardised diary, record was kept of household routines, parental activities, type of feeding, initiation of sleep or waking up. Activity data of seven non-pregnant women were collected and used as a control. Irregular nocturnal activity epochs occurred frequently in pregnant women and were absent in non-pregnant women. Period lengthenings and shortenings of the circadian rhythms appeared in both parents from prepartum to postpartum. Activity at night increased from prepartum to postpartum in mothers and fathers. Three infants showed a marked circadian rhythm between day 3 and 14 after birth. All seven infants showed a predominant circadian rhythm between day 8 and 19 after birth. The onset of daytime activity of mothers and their infants corresponded well to each other. Postpartum frequency spectra of parents and child always had some ultradian components in common. Time patterns of activity-rest rhythms of couples and parents are shown to be altered during and after pregnancy and we suggest that the infants' adaptation to the environment begins during the first week that includes the process of mother-infant interaction.     

Longitudinal Change in Sleep and Daytime Sleepiness in Postpartum Women

Sleep disruption strongly influences daytime functioning; resultant sleepiness is recognised as a contributing risk-factor for individuals performing critical and dangerous tasks. While the relationship between sleep and sleepiness has been heavily investigated in the vulnerable sub-populations of shift workers and patients with sleep disorders, postpartum women have been comparatively overlooked. Thirty-three healthy, postpartum women recorded every episode of sleep and wake each day during postpartum weeks 6, 12 and 18. Although repeated measures analysis revealed there was no significant difference in the amount of nocturnal sleep and frequency of night-time wakings, there was a significant reduction in sleep disruption, due to fewer minutes of wake after sleep onset. Subjective sleepiness was measured each day using the Karolinska Sleepiness Scale; at the two earlier time points this was significantly correlated with sleep quality but not to sleep quantity. Epworth Sleepiness Scores significantly reduced over time; however, during week 18 over 50% of participants were still experiencing excessive daytime sleepiness (Epworth Sleepiness Score ≥12). Results have implications for health care providers and policy makers. Health care providers designing interventions to address sleepiness in new mothers should take into account the dynamic changes to sleep and sleepiness during this initial postpartum period. Policy makers developing regulations for parental leave entitlements should take into consideration the high prevalence of excessive daytime sleepiness experienced by new mothers, ensuring enough opportunity for daytime sleepiness to diminish to a manageable level prior to reengagement in the workforce.     

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 effect of consecutive transmeridian flights on alertness,sleep–wake cycles and sleepiness: A case study

ABSTRACT

Travel across time zones disrupts circadian rhythms causing increased daytime sleepiness, impaired alertness and sleep disturbance. However, the effect of repeated consecutive transmeridian travel on sleep–wake cycles and circadian dynamics is unknown. The aim of this study was to investigate changes in alertness, sleep–wake schedule and sleepiness and predict circadian and sleep dynamics of an individual undergoing demanding transmeridian travel. A 47-year-old healthy male flew 16 international flights over 12 consecutive days. He maintained a sleep–wake schedule based on Sydney, Australia time (GMT + 10?h). The participant completed a sleep diary and wore an Actiwatch before, during and after the flights. Subjective alertness, fatigue and sleepiness were rated 4 hourly (08:00–00:00), if awake during the flights. A validated physiologically based mathematical model of arousal dynamics was used to further explore the dynamics and compare sleep time predictions with observational data and to estimate circadian phase changes. The participant completed 191?h and 159 736?km of flying and traversed a total of 144 time-zones. Total sleep time during the flights decreased (357.5?min actigraphy; 292.4?min diary) compared to baseline (430.8?min actigraphy; 472.1?min diary), predominately due to restricted sleep opportunities. The daily range of alertness, sleepiness and fatigue increased compared to baseline, with heightened fatigue towards the end of the flight schedule. The arousal dynamics model predicted sleep/wake states during and post travel with 88% and 95% agreement with sleep diary data. The circadian phase predicted a delay of only 34?min over the 16 transmeridian flights. Despite repeated changes in transmeridian travel direction and flight duration, the participant was able to maintain a stable sleep schedule aligned with the Sydney night. Modelling revealed only minor circadian misalignment during the flying period. This was likely due to the transitory time spent in the overseas airports that did not allow for resynchronisation to the new time zone. The robustness of the arousal model in the real-world was demonstrated for the first time using unique transmeridian travel.     

Working Under Daylight Intensity Lamp: An Occupational Risk for Developing Circadian Rhythm Sleep Disorder?

A 47‐yr‐old male was admitted to the Institute for Fatigue and Sleep Medicine complaining of severe fatigue and daytime sleepiness. His medical history included diagnosis of depression and chronic fatigue syndrome. Antidepressant drugs failed to improve his condition. He described a gradual evolvement of an irregular sleep‐wake pattern within the past 20 yrs, causing marked distress and severe impairment of daily functioning. He had to change to a part‐time position 7 yrs ago, because he was unable to maintain a regular full‐time job schedule. A 10‐day actigraphic record revealed an irregular sleep-wake pattern with extensive day‐to‐day variability in sleep onset time and sleep duration, and a 36 h sampling of both melatonin level and oral temperature (12 samples, once every 3 h) showed abnormal patterns, with the melatonin peak around noon and oral temperature peak around dawn. Thus, the patient was diagnosed as suffering from irregular sleep‐wake pattern. Treatment with melatonin (5 mg, 2 h before bedtime) did not improve his condition. A further investigation of the patient's daily habits and environmental conditions revealed two important facts. First, his occupation required work under a daylight intensity lamp (professional diamond‐grading equipment of more than 8000 lux), and second, since the patient tended to work late, the exposure to bright light occurred mostly at night. To recover his circadian rhythmicity and stabilize his sleep‐wake pattern, we recommended combined treatment consisting of evening melatonin ingestion combined with morning (09:00 h) bright light therapy (0800 lux for 1 h) plus the avoidance of bright light in the evening. Another 10‐day actigraphic study done only 1 wk after initiating the combined treatment protocol revealed stabilization of the sleep‐wake pattern with advancement of sleep phase. In addition, the patient reported profound improvement in maintaining wakefulness during the day. This case study shows that chronic exposure to bright light at the wrong biological time, during the nighttime, may have serious effects on the circadian sleep‐wake patterns and circadian time structure. Therefore, night bright light exposure must be considered to be a risk factor of previously unrecognized occupational diseases of altered circadian time structure manifested as irregularity of the 24 h sleep‐wake cycle and melancholy.     

Validation of an innovative method,based on tilt sensing,for the assessment of activity and body position

Since there is less movement during sleep than during wake, the recording of body movements by actigraphy has been used to indirectly evaluate the sleep–wake cycle. In general, most actigraphic devices are placed on the wrist and their measures are based on acceleration detection. Here, we propose an alternative way of measuring actigraphy at the level of the arm for joint evaluation of activity and body position. This method analyzes the tilt of three axes, scoring activity as the cumulative change of degrees per minute with respect to the previous sampling, and measuring arm tilt for the body position inference. In this study, subjects (N?=?13) went about their daily routine for 7 days, kept daily sleep logs, wore three ambulatory monitoring devices and collected sequential saliva samples during evenings for the measurement of dim light melatonin onset (DLMO). These devices measured motor activity (arm activity, AA) and body position (P) using the tilt sensing of the arm, with acceleration (wrist acceleration, WA) and skin temperature at wrist level (WT). Cosinor, Fourier and non-parametric rhythmic analyses were performed for the different variables, and the results were compared by the ANOVA test. Linear correlations were also performed between actimetry methods (AA and WA) and WT. The AA and WA suitability for circadian phase prediction and for evaluating the sleep–wake cycle was assessed by comparison with the DLMO and sleep logs, respectively. All correlations between rhythmic parameters obtained from AA and WA were highly significant. Only parameters related to activity levels, such as mesor, RA (relative amplitude), VL5 and VM10 (value for the 5 and 10 consecutive hours of minimum and maximum activity, respectively) showed significant differences between AA and WA records. However, when a correlation analysis was performed on the phase markers acrophase, mid-time for the 10 consecutive hours of highest (M10) and mid-time for the five consecutive hours of lowest activity (L5) with DLMO, all of them showed a significant correlation for AA (R?=?0.607, p?=?0.028; R?=?0.582, p?=?0.037; R?=?0.620, p?=?0.031, respectively), while for WA, only acrophase did (R?=?0.621, p?=?0.031). Regarding sleep detection, WA showed higher specificity than AA (0.95?±?0.01 versus 0.86?±?0.02), while the agreement rate and sensitivity were higher for AA (0.76?±?0.02 versus 0.66?±?0.02 and 0.71?±?0.03 versus 0.53?±?0.03, respectively). Cohen’s kappa coefficient also presented the highest values for AA (0.49?±?0.04) and AP (0.64?±?0.04), followed by WT (0.45?±?0.06) and WA (0.37?±?0.04). The findings demonstrate that this alternative actigraphy method (AA), based on tilt sensing of the arm, can be used to reliably evaluate the activity and sleep–wake rhythm, since it presents a higher agreement rate and sensitivity for detecting sleep, at the same time allows the detection of body position and improves circadian phase assessment compared to the classical actigraphic method based on wrist acceleration.     

How well does a commercially available wearable device measure sleep in young athletes?

ABSTRACT

The validity of a commercially available wearable device for measuring total sleep time was examined in a sample of well-trained young athletes during night-time sleep periods and daytime naps. Participants wore a FitBit HR Charge on their non-dominant wrist and had electrodes attached to their face and scalp to enable polysomnographic recordings of sleep in the laboratory. The FitBit automatically detected 24/30 night-time sleep periods but only 6/20 daytime naps. Compared with polysomnography, the FitBit overestimated total sleep time by an average of 52 ± 152 min for night-time sleep periods, and by 4 ± 8 min for daytime naps. It is important for athletes and practitioners to be aware of the limitations of wearable devices that automatically detect sleep duration.     

The effect of age on sleep/wake behavior of shift workers assessed by wrist actigraphy

The purpose of this study was to investigate changes in the sleep/wake behavior during on-duty and off-duty periods in three age groups whilst performing shift work. The subjects (29 male shift workers in an electronics assembly plant) were examined using wrist actigraphy. They were monitored during a continuous full-day, three-team, three-shift system involving a forward rotation. The wrist actigraphic data were obtained for 21 days (1 shift cycle) for each subject. The number of episodes of dozing and total time spent dozing during the night shift significantly increased in the group aged more than 36 years, but the activity count significantly decreased. Time asleep at home during the night or evening shifts significantly decreased in those aged more than 36 years as compared to the younger groups, but the activity count in the daytime was significantly increased. From these results, we suggest that the adaptation of sleep behavior during a night shift becomes poorer with increasing age.     

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.     

Myotonic dystrophytype 1 – report of non-24-h sleep-wake disorder with excessive daytime sleepiness

ABSTRACT

Myotonic dystrophy (MD) is a neuromuscular disease with myotonia, progressive weakness, and involvement of CNS, heart, and gastrointestinal system. Excessive daytime sleepiness (EDS) in myotonic dystrophy type 1 (MD1) is related to sleep breathing diseases, restless leg syndrome, periodic limb movements during sleep and narcoleptic-like phenotype. However, authors highlight a central dysfunction of sleep regulation.

We describe a 26-year-old, female, MD1 patient with EDS. Sleep diary/actigraphy evidenced two different circadian periods with values of 1442 and 1522 min. Agomelatine, 50 mg at night, was prescribed with improvement of the circadian rhythm and complaints of sleepiness.

The identification of unanticipated causes of EDS, such as circadian rhythm disorders permits an appropriated treatment. As we know, it is the first relate of non-24-h sleep-wake disorder in patient with MD1. Sleep diary and actigraphy could be good options to investigate sleep-wake cycle disorder in patients with MD and EDS.     

Performance assessment of new-generation Fitbit technology in deriving sleep parameters and stages

ABSTRACT

We compared performance in deriving sleep variables by both Fitbit Charge 2?, which couples body movement (accelerometry) and heart rate variability (HRV) in combination with its proprietary interpretative algorithm (IA), and standard actigraphy (Motionlogger® Micro Watch Actigraph: MMWA), which relies solely on accelerometry in combination with its best performing ‘Sadeh’ IA, to electroencephalography (EEG: Zmachine® Insight+ and its proprietary IA) used as reference. We conducted home sleep studies on 35 healthy adults, 33 of whom provided complete datasets of the three simultaneously assessed technologies. Relative to the Zmachine EEG method, Fitbit showed an overall Kappa agreement of 54% in distinguishing wake/sleep epochs and sensitivity of 95% and specificity of 57% in detecting sleep epochs. Fitbit, relative to EEG, underestimated sleep onset latency (SOL) by ~11 min and overestimated sleep efficiency (SE) by ~4%. There was no statistically significant difference between Fitbit and EEG methods in measuring wake after sleep onset (WASO) and total sleep time (TST). Fitbit showed substantial agreement with EEG in detecting rapid eye movement and deep sleep, but only moderate agreement in detecting light sleep. The MMWA method showed 51% overall Kappa agreement with the EEG one in detecting wake/sleep epochs, with sensitivity of 94% and specificity of 53% in detecting sleep epochs. MMWA, relative to EEG, underestimated SOL by ~10 min. There was no significant difference between Fitbit and MMWA methods in amount of bias in estimating SOL, WASO, TST, and SE; however, the minimum detectable change (MDC) per sleep variable with Fitbit was better (smaller) than with MMWA, respectively, by ~10 min, ~16 min, ~22 min, and ~8%. Overall, performance of Fitbit accelerometry and HRV technology in conjunction with its proprietary IA to detect sleep vs. wake episodes is slightly better than wrist actigraphy that relies solely on accelerometry and best performing Sadeh IA. Moreover, the smaller MDC of Fitbit technology in deriving sleep parameters in comparison to wrist actigraphy makes it a suitable option for assessing changes in sleep quality over time, longitudinally, and/or in response to interventions.     

Repeated exposures to daytime bright light increase nocturnal melatonin rise and maintain circadian phase in young subjects under fixed sleep schedule

Effects of two different light intensities during daytime were examined on human circadian rhythms in plasma melatonin, core body temperature, and wrist activity under a fixed sleep schedule. Sleep qualities as indicated by polysomnography and subjective sleepiness were also measured. In the first week, under dim light conditions ( approximately 10 lx), the onset and peak of nocturnal melatonin rise were significantly delayed, whereas the end of melatonin rise was not changed. The peak level of melatonin rise was not affected. As a result, the width of nocturnal melatonin rise was significantly shortened. In the second week, under bright light conditions ( approximately 5,000 lx), the phases of nocturnal melatonin rise were not changed further, but the peak level was significantly increased. Core body temperature at the initial sleep phase was progressively elevated during the course of dim light exposure and reached the maximum level at the first night of bright light conditions. Subjective sleepiness gradually declined in the course of dim light exposure and reached the minimum level at the first day of bright light. These findings indicate that repeated exposures to daytime bright light are effective in controlling the circadian phase and increasing the peak level of nocturnal melatonin rise in plasma and suggest a close correlation between phase-delay shifts of the onset of nocturnal melatonin rise or body temperature rhythm and daytime sleepiness.     

Circadian Eating and Sleeping Patterns in the Night Eating Syndrome

Objective: To compare the eating and sleep‐wake patterns of persons with the night eating syndrome (NES) with those of matched control subjects. Research Methods and Procedures: Forty‐six overweight/obese NES subjects (mean age 43.3 ± 9.8 years; 32 women) and 43 similar controls (mean age 39.0 ± 11.0 years; 28 women) wore wrist actigraphs for 7 days and completed sleep and food diaries at home. Results: There was no difference between the total energy intake of the NES and the control subjects, but the pattern of energy intake differed greatly. Relative to control subjects, the temporal pattern of food intake of night eaters was delayed. Food intake after the evening meal, as a proportion of the 24‐hour intake, was more than 3‐fold greater in NES subjects than in controls (34.6 ± 10.1% vs. 10.0 ± 6.9%, p = 0.001). NES subjects had sleep onset, offset, and total sleep duration times comparable with those of controls. NES subjects reported more nocturnal awakenings than did controls (1.5 ± 1.0 per night vs. 0.5 ± 0.5; p < 0.001), and their actigraphically monitored arousals occurred earlier during sleep (at 128 minutes after sleep onset vs. 193 minutes, p = 0.01). NES subjects consumed food on 74% of the awakenings vs. 0% for the controls. Discussion: The pattern of cumulative energy intake of the night eaters suggests a phase delay in energy consumption relative to sleep‐wake times. NES may involve a dissociation of the circadian control of eating relative to sleep.     

Effects of Transitions into and out of Daylight Saving Time on the Quality of the Sleep/Wake Cycle: an Actigraphic Study in Healthy University Students

The main goal of the present study was to examine the effects of transition into and out of daylight saving time (DST) on the quality of the sleep/wake cycle, assessed through actigraphy. To this end, 14 healthy university students (mean age: 26.86?±?3.25?yrs) wore an actigraph for 7?d before and 7?d after the transition out of and into DST on fall 2009 and spring 2010, respectively. The following parameters have been compared before and after the transition, separately for autumn and spring changes: bedtime (BT), get-up time (GUT), time in bed (TIB), sleep onset latency (SOL), fragmentation index (FI), sleep efficiency (SE), total sleep time (TST), wake after sleep onset (WASO), mean activity score (MAS), and number of wake bouts (WB). After the autumn transition, a significant advance of the GUT and a decrease of TIB and TST were observed. On the contrary, spring transition led to a delay of the GUT, an increase of TIB, TST, WASO, MAS, and WB, and a decrease of SE. The present results highlight a more strong deterioration of sleep/wake cycle quality after spring compared with autumn transition, confirming that human circadian system more easily adjusts to a phase delay (autumn change) than a phase advance (spring transition).