Sleep quality,chronotype and metabolic syndrome components in bipolar disorders during the remission period: Results from the FACE-BD cohort

Data on sleep or circadian abnormalities and metabolic disturbances in euthymic bipolar disorders are scarce and based on small sample sizes. The aim of this study was to explore the associations between sleep disturbances, chronotype and metabolic components in a large sample of euthymic patients with bipolar disorders (BD). From 2009 to 2015, 752 individuals with bipolar disorders from the FACE-BD cohort were included and assessed for sleep quality, chronotype and metabolic components. The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) was used to confirm the diagnosis of BD. Subjective sleep quality was measured with the Pittsburgh Sleep Quality Index and chronotype with the Composite Scale of Morningness. Sociodemographic and clinical characteristics, psychotropic treatment, psychiatric comorbidities and blood samples were collected. In our sample, 22.4% of individuals with BD presented with a metabolic syndrome, 53.7% had sleep disturbances, 25.4% were considered as having an evening chronotype and 12.6% as having a morning chronotype. Independently of potential confounders, euthymic patients with sleep disturbances had a higher abdominal circumference, and patients with evening chronotype had a significantly higher level of triglycerides. There was an association between evening chronotype and an increased atherogenic index of plasma (OR = 4.8, 95%CI = 1.6–14.7). Our findings contribute the scant literature on the relationship between sleep quality, chronotype and cardiometabolic components in euthymic individuals with BD and highlight the need to improve quality of sleep and patient education about healthier sleep-hygiene practices.     

Chronotype influences response to antidepressant chronotherapeutics in bipolar patients

ABSTRACT

Patient diurnal mood fluctuation, sleep characteristics and factors affecting sleep homeostasis predict antidepressant response to the combination of total sleep deprivation and light therapy (TSD + LT). In order to study if chronotype could influence response to TSD+LT, we considered 194 bipolar depressed patients. Severity of depression was rated with Hamilton Depression Rating Scale; perceived mood levels were assessed by a self-administered 10-cm visual analogue scale and chronotype was assessed using the Mornigness-Eveningness Questionnaire.

More than 60% of patients resulted responders to treatment with chronotype influencing the antidepressant response with evening type subjects showing higher response rates.     

Relationships between chronotype,social jetlag,sleep, obesity and blood pressure in healthy young adults

Sleep disturbances, chronotype and social jetlag (SJL) have been associated with increased risks for major chronic diseases that take decades to develop, such as obesity, metabolic syndrome and cardiovascular disease. Potential relationships between poor sleep, chronotype and SJL as they relate to metabolic risk factors for chronic disease have not been extensively investigated. This prospective study examined chronotype, SJL and poor sleep in relation to both obesity and elevated blood pressure among healthy young adults.

SJL and objective sleep measures (total sleep time, sleep onset latency, wake after sleep onset and sleep efficiency) were derived from personal rest/activity monitoring (armband actigraphy) among 390 healthy adults 21–35 years old. Participants wore the device for 6–10 days at 6-month intervals over a 2-year period (n = 1431 repeated observations). Chronotypes were categorized into morning, intermediate and evening groups using repeated measures latent class analysis. Means of SJL and sleep measures among latent chronotype groups were compared using partial F-tests in generalized linear mixed models. Generalized linear mixed models also were used to generate odds ratios (ORs) with 95% confidence intervals (CIs) examining the relationship between repeated measures of chronotype, SJL, sleep and concurrent anthropometric outcome measures (body mass index, percentage of body fat, waist-to-hip ratio, waist-to-height ratio), systolic blood pressure and diastolic blood pressure.

Sleep latency ≥12 min was associated with increased odds of a high waist-to-height ratio (OR = 1.37; CI: 1.03–1.84). Neither chronotype nor SJL was independently associated with anthropometric outcomes or with blood pressure. Relationships between poor sleep and anthropometric outcomes or blood pressure varied by chronotype. Morning types with total sleep time <6 h, sleep efficiency <85% or wake after sleep onset ≥60 min were more likely to have an increased percentage of body fat, waist-to-hip ratio and waist-to-height ratio relative to those with an intermediate chronotype. Similarly, sleep latency ≥12 min was associated with increased odds of elevated systolic blood pressure (OR = 1.90; CI: 1.15–3.16, p_interaction = 0.02) among morning versus intermediate chronotypes. No relationships between poor sleep and obesity or elevated blood pressure were observed among evening chronotypes.

The results from this study among healthy young adults suggest that poor sleep among morning types may be more strongly associated with obesity and elevated blood pressure relative to those with an intermediate (neutral) chronotype. Sleep-related metabolic alterations among different chronotypes warrant further investigation.     

Negative emotional biases in late chronotypes

Increasing evidence suggests evening chronotypes are at increased risk for developing depression. Here, we examined if, similar to acutely depressed patients, evening chronotype individuals display biases in emotional face recognition. Two hundred and twenty-six individuals completed an online survey including measures of sleep quality, depression/anxiety and chronotype followed by a simple emotion recognition task presenting male and female faces morphed in 10 steps between 0 (neutral) and 100% sad or happy. Evening chronotype was associated with increased recognition of sad facial expressions independently of sleep quality, mood, age and gender. The current results extend previous work indicating that negative biases in emotional processing are present in evening chronotypes and may have important implications for the prevention and treatment of depression in these vulnerable individuals.     

Chronotype: implications for sleep quality in medical students

ABSTRACT

Medical students who suffer from poor sleep quality may be afflicted by distress. While the change of chronotype may improve sleep quality, few studies have focused on this association. The objective of this study is to analyze the effects of chronotype on sleep quality in medical students while controlling for confounding covariate factors. A cross-sectional survey on sleep quality was conducted among 5497 medical students. Sleep quality, chronotype, and lifestyle were measured according to the Pittsburgh Sleep Quality Index, Morningness-eveningness Questionnaire and Health-promoting Lifestyle Profile. Hierarchical logistic regression was conducted to analyze the influence of various factors, especially chronotype effect on sleep quality. Our results showed that the total score of sleep quality in evening-types was 5.43 ± 2.66, which was significantly higher than that in morning-types (3.88 ± 2.20, P < .001). Morning-type students (OR = 0.40, 95%CI = 0.29–0.55) and intermediate-type students (OR = 0.53, 95%CI = 0.41–0.69) had a lower risk of poor sleep quality compared to evening-types. The strongest predictor of sleep quality was chronotype while controlling for covariates (grade, gender, father’s educational level, mother’s educational level, internet addiction, mood state, midnight snack frequency, and health-promoting lifestyle profile). Based on the results, we believe that sleep quality among evening-type students may be improved by shifting to keep early hours.     

ASSOCIATIONS BETWEEN CHRONOTYPE,SLEEP QUALITY,SUICIDALITY, AND DEPRESSIVE SYMPTOMS IN PATIENTS WITH MAJOR DEPRESSION AND HEALTHY CONTROLS

Research interest concerning associations between sleep characteristics and suicidality in psychopathology has been growing. However, possible linkages of suicidality to sleep characteristics in terms of sleep quality and chronotypes among depressive patients have not been well documented. In the current study, the authors investigated the possible effects of sleep quality and chronotype on the severity of depressive symptoms and suicide risk in patients with depressive disorder and healthy controls. The study was conducted on 80 patients clinically diagnosed with major depression and 80 healthy subjects who were demographically matched with the patient group. All participants completed a questionnaire package containing self-report measures, including the Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), Morningness–Eveningness Questionnaire (MEQ), and Suicide Ideation Scale (SIS), and subjects were interviewed with the suicidality section of the Mini-International Neuropsychiatric Interview (MINI). Results are as follows: (a) logistic regression analyses revealed that poor sleep quality and depression symptom severity significantly predicted onset of major depression; (b) morningness-type circadian rhythm may play as a significant relief factor after onset of major depression; (c) sleep variables of chronotype and sleep quality did not significantly predict suicide ideation after controlling for depressive symptoms in the major depression group; and (d) suicide ideation and poor sleep quality were antecedents of depression symptom severity in patients with major depression, and in healthy controls. Findings are discussed under the theoretical assumptions concerning possible relations between chronotype, sleep quality, depression, and suicidality. (Author correspondence: dryavuzselvi@yahoo.com)     

The associations between chronotype,a healthy diet and obesity

Unhealthy diet has been associated with obesity. Evening type has been associated with unhealthier food and nutrient intake that could predict a higher risk of obesity among them as compared to morning type. However, thus far no study has examined the interrelationships between chronotype, a healthy diet and obesity. We examined whether a healthy diet mediates the association between chronotype and obesity and whether chronotype modifies the association between a healthy and obesity. The National FINRISK 2007 Study included 4421 subjects aged 25–74 years. Diet was assessed using a validated food frequency questionnaire. Baltic Sea diet score (BSDS), including nine dietary components, was used as a measure of adherence to a healthy Nordic diet. Weight, height, body fat percentage and waist circumference were measured, and body mass index values were calculated. Chronotype was assessed using a shortened version of Horne and Östberg’s morningness–eveningness questionnaire (MEQ). The sum score calculated from MEQ was either used as a continuous variable or divided into tertiles of which the lowest tertile demonstrated evening preference and the highest tertile demonstrated morning preference. A series of regression analyses were conducted to determine whether the BSDS mediates the association between chronotype and obesity. Likelihood ratio test was used to determine whether chronotype modifies the association between the BSDS and the obesity measures. After testing the interaction, chronotype-stratified analysis for the association between the BSDS and obesity measures was determined by linear regression. Generally, the evening types had lower adherence to the BSDS and were more often smokers (men), physically inactive and had lower perceived health than the other chronotypes (p < 0.05). The poorer health behavior of this group, however, was not manifested in their obesity measures, and no evidence that the BSDS would mediate the association between chronotype and obesity was found (p > 0.05). No evidence that chronotype would modify the association between the BSDS and obesity was found either (p > 0.05).     

The association between sleep chronotype and obesity among black and white participants of the Bogalusa Heart Study

ABSTRACT

Research indicates that sleep duration and quality are inter-related factors that contribute to obesity, but few studies have focused on sleep chronotype, representing an individual’s circadian proclivity, nor assessed these factors in racially diverse middle-aged samples. We examined the associations between chronotype and obesity among black and white men and women participating in the Bogalusa Heart Study (BHS).

Body mass index (BMI) and sleep data were available for 1,197 middle-aged men and women (mean age 48.2 ± 5.3 years) who participated in the BHS 2013–2016. Based on the reduced Morningness-Eveningness Questionnaire’s cutoff values for chronotypes, we combined ‘definitely morning’ and ‘moderately morning’ types into ‘morning’ type, ‘definitely evening’ and ‘moderately evening’ types into ‘evening’ type and kept those who were “neither” type in a separate group. We used ‘morning’ type as the referent group. Obesity was defined as a BMI ≥ 30. Multivariable logistic regression models were used to examine associations adjusting for sex, age, education, smoking, alcohol use and drug use, depression, shift work, physical activity and sleep duration.

Evening chronotype, reported by 11.1% of participants, was associated with obesity after multi-variable adjustment, including shift work, physical activity and sleep duration (OR 1.67, 95% CI: 1.08–2.56). However, once stratified by race (black/white), this association was found only among white participants (OR = 1.91, 95% CI = 1.12–3.25) after full adjustment.

In our biracial, community-based population, evening chronotype was independently associated with obesity, specifically among white participants. Further research is needed to identify behavioral, endocrine, nutritional and genetic pathways which underlie these associations.     

The Relationship Between Breakfast Skipping,Chronotype, and Glycemic Control in Type 2 Diabetes

Breakfast skipping is associated with obesity and an increased risk of type 2 diabetes. Later chronotypes, individuals who have a preference for later bed and wake times, often skip breakfast. The aim of the study was to explore the relationships among breakfast skipping, chronotype, and glycemic control in type 2 diabetes patients. We collected sleep timing and 24-h dietary recall from 194 non-shift-working type 2 diabetes patients who were being followed in outpatient clinics. Mid-sleep time on free days (MSF) was used as an indicator of chronotype. Hemoglobin A1C (HbA_1C) values were obtained from medical records. Hierarchical linear regression analyses controlling for demographic, sleep, and dietary variables were computed to determine whether breakfast skipping was associated with HbA_1C. Additional regression analyses were performed to test if this association was mediated by chronotype. There were 22 participants (11.3%) who self-reported missing breakfast. Breakfast skippers had significantly higher HbA_1C levels, higher body mass indices (BMI), and later MSF than breakfast eaters. Breakfast skipping was significantly associated with higher HbA_1C values (B?=?0.108, p?=?0.01), even after adjusting for age, sex, race, BMI, number of diabetes complications, insulin use, depressive symptoms, perceived sleep debt, and percentage of daily caloric intake at dinner. The relationship between breakfast skipping and HbA_1C was partially mediated by chronotype. In summary, breakfast skipping is associated with a later chronotype. Later chronotype and breakfast skipping both contribute to poorer glycemic control, as indicated by higher HbA_1C levels. Future studies are needed to confirm these findings and determine whether behavioral interventions targeting breakfast eating or sleep timing may improve glycemic control in patients with type 2 diabetes.     

Melanopsin gene variations interact with season to predict sleep onset and chronotype

The human melanopsin gene has been reported to mediate risk for seasonal affective disorder (SAD), which is hypothesized to be caused by decreased photic input during winter when light levels fall below threshold, resulting in differences in circadian phase and/or sleep. However, it is unclear if melanopsin increases risk of SAD by causing differences in sleep or circadian phase, or if those differences are symptoms of the mood disorder. To determine if melanopsin sequence variations are associated with differences in sleep-wake behavior among those not suffering from a mood disorder, the authors tested associations between melanopsin gene polymorphisms and self-reported sleep timing (sleep onset and wake time) in a community sample (N?=?234) of non-Hispanic Caucasian participants (age 30-54 yrs) with no history of psychological, neurological, or sleep disorders. The authors also tested the effect of melanopsin variations on differences in preferred sleep and activity timing (i.e., chronotype), which may reflect differences in circadian phase, sleep homeostasis, or both. Daylength on the day of assessment was measured and included in analyses. DNA samples were genotyped for melanopsin gene polymorphisms using fluorescence polarization. P10L genotype interacted with daylength to predict self-reported sleep onset (interaction p?相似文献   

Is the shift in chronotype associated with an alteration in well-being?

The study aimed to test whether a shift in chronotype (determined by mid-sleep on free days) is associated with alterations in psychological well-being and sleep parameters. One hundred and seventeen undergraduates were tested in longitudinal study with four repeated measures. Measurements were taken during spring in three-week intervals and each measurement consisted of self-reported sleep parameters on work and free days (i.e. bedtime, sleep latency, wake time, sleep onset, mid-sleep time, social jetlag), satisfaction with life, and mood (energetic arousal, tense arousal, hedonic tone). Between-subjects analyses revealed earlier chronotypes, as compared to the later ones, showing lower tense arousal, higher energetic arousal and life satisfaction, earlier bedtime, sleep onset and offset on both work and free days, longer sleep duration and shorter sleep latency on workdays, and less social jetlag. Within-subjects analyses revealed increasing photoperiod associated with a shift toward earlier chronotype, decrease in social jetlag, and shortening sleep latency. The seasonal shift toward earlier chronotype was not associated with alterations in mood or life satisfaction, but it was associated with a shift toward earlier bedtimes and longer sleep duration on workdays, decrease in sleep latency, and social jetlag. Results from the within-subjects analyses were consistent with the results of between-subjects analyses regarding sleep–wake functioning, but inconsistent regarding psychological outcomes.     

Impact of obesity on health-related quality of life in schizophrenia and bipolar disorder

Objective: Studies have reported that up to 60% of individuals with schizophrenia and 68% of those with bipolar disorder are overweight/obese. This paper explores the health‐related quality of life (HRQOL) of individuals with schizophrenia or bipolar disorder as a function of obesity status. Methods and Procedures: Two hundred and eleven participants were recruited from four psychiatric programs (outpatient, day treatment, case management, and psychosocial rehabilitation). HRQOL was assessed using both a general measure (Medical Outcomes Study Short‐Form‐36 (SF‐36)) and a weight‐related measure (Impact of Weight on Quality of Life‐Lite (IWQOL‐Lite)). To interpret HRQOL scores obtained by the obese group, we compared scores to those obtained by reference groups from the weight‐loss literature. Results: Sixty‐three percent of participants with schizophrenia and 68% of those with bipolar disorder were obese. Obese participants were more likely to be women, on mood stabilizers, taking a greater number of psychiatric medications, and to have poorer weight‐related and general HRQOL. Weight‐related HRQOL in the obese psychiatric sample was more impaired than in outpatient and day treatment samples seeking weight loss but less impaired than in gastric‐bypass patients. Several of the physical domains of general HRQOL were more impaired for the obese psychiatric sample than for the outpatient weight‐loss sample. However, physical functioning was less impaired for the obese psychiatric sample than for gastric‐bypass patients. Discussion: The presence of obesity among individuals with schizophrenia or bipolar disorder is associated with decreased HRQOL. These results have implications for prevention and management of weight gain in individuals with schizophrenia or bipolar disorder.     

Mood and disruptive behavior disorders and symptoms in the offspring of patients with bipolar I disorder

The study aimed to ascertain the prevalence of mood and disruptive behavior disorders and symptoms in 35 children of 29 adult outpatients with a DSM-IV diagnosis of bipolar I disorder, compared with 33 children of 29 healthy adults, matched with patients on age, socioeconomic status and education. The offspring of bipolar patients had a 9.48 fold higher risk of receiving a psychiatric diagnosis. While only two children of patients with bipolar disorder were diagnosed with a mood disorder, 30.9% displayed mild depressed mood, compared with 8.8% of the controls, a statistically significant difference. The bipolar offspring also scored significantly higher on the hyperactivity and conduct problems subscales as well as the ADHD index of the Conners’ Teacher Rating Scale. The disruptive behavior and mood symptoms observed in early life in the offspring of bipolar patients may indicate the need for early psychosocial intervention.     

Later chronotype is associated with higher hemoglobin A1c in prediabetes patients

The circadian system is known to play a role in glucose metabolism. Chronotype reflects the interindividual variability in the phase of entrainment. Those with later chronotype typically prefer later times in the day for different activities such as sleep or meals. Later chronotype has been shown to be associated with metabolic syndrome, increased diabetes risk and poorer glycemic control in type 2 diabetes patients. In addition, “social jetlag”, a form of circadian misalignment due to a mismatch between social rhythms and the circadian clock, has been shown to be associated with insulin resistance. Other sleep disturbances (insufficient sleep, poor sleep quality and sleep apnea) have also been shown to affect glucose metabolism. In this study, we explored whether there was a relationship between chronotype, social jetlag and hemoglobin A1c (HbA1c) levels in prediabetes patients, independent of other sleep disturbances. A cross-sectional study was conducted at the Department of Family Medicine, Ramathibodi Hospital, Bangkok, from October 2014 to March 2016 in 1014 non-shift working adults with prediabetes. Mid-sleep time on free day adjusted for sleep debt (MSFsc) was used as an indicator of chronotype. Social jetlag was calculated based on the absolute difference between mid-sleep time on weekdays and weekends. The most recent HbA1c values and lipid levels were retrieved from clinical laboratory databases. Univariate analyses revealed that later MSFsc (p = 0.028) but not social jetlag (p = 0.48) was significantly associated with higher HbA1c levels. Multivariate linear regression analysis was applied to determine whether an independent association between MSFsc and HbA1c level existed. After adjusting for age, sex, alcohol use, body mass index (BMI), social jetlag, sleep duration, sleep quality and sleep apnea risk, later MSFsc was significantly associated with higher HbA1c level (B = 0.019, 95% CI: 0.00001, 0.038, p = 0.049). The effect size of one hour later MSFsc on HbA1c (standardized coefficient = 0.065) was approximately 74% of that of the effect of one unit (kg/m²) increase in BMI (standardized coefficient = 0.087). In summary, later chronotype is associated with higher HbA1c levels in patients with prediabetes, independent of social jetlag and other sleep disturbances. Further research regarding the potential role of chronotype in diabetes prevention should be explored.     

“Social Jetlag” in Morning-Type College Students Living On Campus: Implications for Physical and Psychological Well-being

Although on-campus residence allows easier access to campus facilities, existing studies showed mixed results regarding the relationship between college residence and students’ well-being indicators, such as sleep behaviors and mood. There was also a lack of studies investigating the role of chronotype in the relationship between on-campus residence and well-being. In particular, the temporal relationships among these factors were unclear. Hence, this longitudinal study aims to fill in these gaps by first reporting the well-being (measured in terms of mood, sleep, and quality of life) among students living on and off campus across two academic semesters. We explored factors predicting students’ dropout in university residences. Although students living on campus differ in their chronotypes, activities in campus residence (if any) are mostly scheduled in the nighttime. We therefore tested if individual differences in chronotype interact with campus residence in affecting well-being. Our final sample consisted of 215 campus residents and 924 off-campus-living students from 10 different universities or colleges in Hong Kong or Macau. Their mean age was 20.2 years (SD?=?2.3); 6.5% of the participants are female. Participants completed self-reported questionnaires online on their sleep duration, sleep quality, chronotype, mood, and physical and psychological quality of life. Across two academic semesters, we assessed if students living on and off campus differed in our well-being measures after we partialed out the effects of demographic information (including age, sex, family income, and parents’ education) and the well-being measures at baseline (T1). The results showed that, campus residents exhibited longer sleep duration, greater sleep efficiency, better sleep quality, and less feeling of stress than off-campus-living students. From one semester to the next, around 10% of campus residents did not continue to live on campus. Logistic regression showed that a morning type was the strongest factor predicting dropout from campus residence. Chronotype significantly moderated the effects of campus residence on participants’ physical and psychological quality of life. Although morning-type off-campus-living students have better well-being than their evening-type peers living off campus, morning-type campus residents had worse well-being than other campus residents and they were more likely to discontinue living on campus after one semester. Our findings bear practical significance to college management that morning-type campus residents are shown to be experiencing deteriorating well-being. The authorities may need to review and revise the room-allocation policy in campus residence in improving the well-being among campus residents.     

Circadian preference is associated with emotional and affective temperaments

Chronotype has long been associated with mental disorders and temperamental features. This study aims to investigate the association of circadian preference with a new model for emotional and affective temperament. In this Web survey, 6436 subjects (27.2% males) answered the Affective and Emotional Composite Temperament Scale (AFECTS), the Circadian Energy Scale (CIRENS), and questions on subjective sleep parameters for a sleep-based chronotype measure. Temperament was more strongly correlated with daily energy score than with chronotype. For emotional dimensions, Volition, Coping, and Control positively correlated with high and stable daily energy, contrary to Sensitivity. Evening types showed a less adaptive emotional profile than morning and intermediate types, who showed a relatively similar emotional pattern. Focus and order (facets of Control), energy (facet of Volition), caution (facet of Inhibition), and problem facing (facet of Coping) were distinctive for the three circadian types, being particularly low in evening types and high in morning types. Differences between affective temperaments were more pronounced for morning and afternoon than for evening scores. Cyclothymic and euphoric temperaments, which relate to bipolar disorders, and apathetic, volatile, and disinhibited temperaments, which relate to attention-deficit/hyperactivity disorder (ADHD), showed the latest chronotype (i.e., evening preference). In conclusion, temperament was more associated with absolute energy levels than with chronotype. Evening types had less emotional control, coping, volition, and caution, and more affective instability and externalization. The circadian daily energy profile can be very informative about human temperament and vice versa, and their combined assessment may be useful in the evaluation of psychiatric patients.     

Sleep quality,chronotype, temperament and bipolar features as predictors of depressive symptoms among medical students

The assessment of risk factors is a crucial step in the prevention and treatment of affective disorders and should encompass personal dispositions. The aim of this study was to assess the value of chronotype and temperament as independent predictors of depressive symptoms among medical students. The study surveyed 140 students of the Faculty of Medicine with a battery of questionnaires: the Beck Depression Index (BDI), Hypomania Checklist 32 (HCL-32), Pittsburgh Sleep Quality Index (PSQI), Chronotype Questionnaire and Eysenck Personality Questionnaire Revised. The results were tested using Pearson’s correlation quotient and general linear model. Ten percent of the participants demonstrated a BDI score suggestive of clinically significant depressive symptoms. BDI score correlated positively with HCL-32 score. A rise in BDI was independently predicted by elevated Neuroticism and PSQI scores and morningness. Those effects were independent from each other and from other parameters of the model. The presence of depressive symptoms might be associated with bipolar features among medical students. Poor sleep quality predicted depressive symptoms, similarly to Neuroticism and independently of temperament and chronotype. Future studies on the associations between personal dispositions and mood disorders among medical students are required to help identify those at greater risk of developing affective illness. Effective prophylaxis and early intervention are warranted to ensure better treatment results.     

Sleep quality and methylation status of core circadian rhythm genes among nurses and midwives

Poor sleep quality or sleep restriction is associated with sleepiness and concentration problems. Moreover, chronic sleep restriction may affect metabolism, hormone secretion patterns and inflammatory responses. Limited recent reports suggest a potential link between sleep deprivation and epigenetic effects such as changes in DNA methylation profiles. The aim of the present study was to assess the potential association between poor sleep quality or sleep duration and the levels of 5-methylcytosine in the promoter regions of PER1, PER2, PER3, BMAL1, CLOCK, CRY1 CRY2 and NPAS2 genes, taking into account rotating night work and chronotype as potential confounders or modifiers. A cross-sectional study was conducted on 710 nurses and midwives (347 working on rotating nights and 363 working only during the day) aged 40–60 years. Data from in-person interviews about sleep quality, chronotype and potential confounders were used. Sleep quality and chronotype were assessed using Pittsburgh Sleep Quality Questionnaire (PSQI) and Morningness–Eveningness Questionnaire (MEQ), respectively. Morning blood samples were collected. The methylation status of the circadian rhythm genes was determined via quantitative methylation-specific real-time PCR assays (qMSP) reactions using DNA samples derived from leucocytes. The proportional odds regression model was fitted to quantify the relationship between methylation index (MI) as the dependent variable and sleep quality or sleep duration as the explanatory variable. Analyses were carried out for the total population as well as for subgroups of women stratified by the current system of work (rotating night shift/day work) and chronotype (morning type/intermediate type/evening type). A potential modifying effect of the system of work or the chronotype was examined using the likelihood ratio test. No significant findings were observed in the total study population. Subgroup analyses revealed two statistically significant associations between a shorter sleep duration and 1) methylation level in PER2 among day workers, especially those with the morning chronotype (OR = 2.31, 95%CI:1.24–4.33), and 2) methylation level in CRY2 among subjects with the intermediate chronotype, particularly among day workers (OR = 0.52, 95%CI:0.28–0.96). The study results demonstrated a positive association between average sleep duration of less than 6 hours and the methylation level of PER2 among morning chronotype subjects, and an inverse association for CRY2 among intermediate chronotype subjects, but only among day workers. Both the system of work and the chronotype turned out to be important confounders and modifiers in a number of analyses, making it necessary to consider them as potential covariates in future research on sleep deficiency outcomes. Further studies are warranted to explore this under-investigated topic.     

Optimal Sleep Duration in the Subarctic with Respect to Obesity Risk Is 8–9 Hours

Introduction

Sleep duration, chronotype and social jetlag have been associated with body mass index (BMI) and abdominal obesity. The optimal sleep duration regarding BMI has previously been found to be 7–8 hours, but these studies have not been carried out in the subarctic or have lacked some central variables. The aims of our study were to examine the associations between sleep variables and body composition for people living in the subarctic, taking a range of variables into consideration, including lifestyle variables, health variables and biological factors.

Methods

The cross sectional population Tromsø Study was conducted in northern Norway, above the Arctic Circle. 6413 persons aged 30–65 years completed questionnaires including self-reported sleep times, lifestyle and health. They also measured height, weight, waist and hip circumference, and biological factors (non-fasting serum level of cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides and glucose). The study period was from 1 October 2007 to 19 December 2008.

Results

The optimal sleep length regarding BMI and waist circumference was found to be 8–9 hours. Short sleepers (<6 h) had about 80% increased risk of being in the BMI≥25 kg/m2 group and male short sleepers had doubled risk of having waist circumference ≥102 cm compared to 8–9 hours sleepers. We found no impact of chronotype or social jetlag on BMI or abdominal obesity after controlling for health, lifestyle, and biological parameters.

Conclusions

In our subarctic population, the optimal sleep duration time regarding risk of overweight and abdominal obesity was 8–9 hours, which is one hour longer compared to findings from other studies. Short sleepers had 80% increased risk of being overweight, and men had a doubled risk of having abdominal obesity. We found no associations between chronotype or social jetlag and BMI or abdominal obesity, when we took a range of life-style, health and biological variables into consideration.     

Daily rest-activity patterns in the bipolar phenotype: A controlled actigraphy study

This study assessed daily rest-activity patterns in euthymic, medication-naïve bipolar phenotype individuals. The Mood Disorder Questionnaire was used to identify 19 bipolar phenotype individuals and 21 controls. Participants wore an Actiwatch-L for 2 weeks to assess their sleep behaviour and circadian rest-activity rhythmicity. Bipolar phenotype individuals had increased movement during sleep, as assessed by the fragmentation index, greater activity levels during their least active 5?h (2 am–7 am), and lower circadian relative amplitude compared to controls. Higher activity levels during sleep affecting circadian amplitude in young adults with the bipolar phenotype may be associated with vulnerability for developing mood disorder.