Depression in Medical School: The Influence of Morningness‐Eveningness

Medical students are at higher risk for depression, affecting not only their lives but also patient care. This article studied a population of medical students engaged in lecture‐based learning regarding the presence of depressive symptoms and its relation to morningness‐eveningness. Depressive symptoms were assessed by the Beck Depressive Inventory scale (BDI>10), and diurnal preference was assessed by the Horne & Östberg Morningness/Eveningness Questionnaire (MEQ). Family history of depression and involvement in regular physical activity were also investigated. A total of 161 students, 77 (47.8%) males, aged 19 to 30 yrs (22.1±2.1) living in a city close to the equator were evaluated. Fifty‐three individuals (32.9%) had depressive symptoms. Depressive individuals showed a trend to be female (p=0.07). Also, female gender showed a non‐significant shift toward morningness. Fifty‐eight (36.0%) subjects participated in regular physical activity. In 57 cases (35.4%), there was a history of depression in the family. Fifteen individuals (9.3%) were definitely evening type, 42 (26.1%) were moderately evening type, 44 (27.3%) were indifferent, 42 (26.1%) were moderately morning type, and 18 (11.2%) were definitely morning type. Family history of depression (OR=0.29, 95% CI=1.37–6.12) and sedentary life (OR=0.28, 95% CI=0.12–0.65) were associated with depressive symptoms. Eveningness was associated with depressive symptoms (OR=0.66, 95% CI=0.50–0.88), and this association remained significant after adjusting for the presence of familial depression and physical activity (OR=0.71, 95% CI=0.52–0.95). In conclusion, depressive symptoms are independently associated with “eveningness” in medical students. These results should be confirmed by future studies involving a larger number of subjects.     

Morningness‐Eveningness Comparison in Adolescents from Different Countries around the World

Very few studies have focused on differences in chronotype around the globe. In this study, morningness‐eveningness was measured using the Composite Scale of Morningness and the midpoint of sleep on free days (corrected for sleep debt, MSF_sc) in adolescents of sixteen German schools abroad, dispersed all over the world, and for comparison pupils attending German schools. There was no influence of duration of residence in the respective locality, and sex differences were weak. Age correlated negatively with morningness. A significant influence of climate zone (temperate, subtropics, tropics) was found, with adolescents in the subtropics being the latest chronotypes, and an interaction of age×climate zone was identified. Significant associations between chronotype and longitude and latitude were identified within the time zone of central Europe. Adolescents were found to be more morning oriented both toward the East and North. The results indicate that climate, longitude, and latitude contribute to chronotype.     

Sleep Length as a Function of Morning Shift‐Start Time in Irregular Shift Schedules for Train Drivers: Self‐Rated Health and Individual Differences

Forty‐six male train drivers (mean age=46.5, SD=5.1) were recruited to participate in a diary study for 14 consecutive days with questions about their sleep and working hours. A polynomial mixed‐effect regression model showed a curvilinear relation (p <. 001) between shift‐start time and sleep duration for shifts starting at 03∶00–12∶00 h and with a near linear increase for ones starting between 04∶30 and 09∶00 h of approximately 0.7 h for every 1 h the shift was delayed. The longest sleeps were estimated at ～8 h before shifts that started at ～10∶00 h. The shortest sleeps were found for shifts that started before 04∶30 h and were estimated at ～5 h. Individual differences were estimated with a random-effect standard deviation of 0.51 h, independent of shift‐start time (p =.005). One‐half of the between‐subject variance was explained by subjective health. A one‐step decrease in health was associated with a 26 min increase in sleep length. The results have practical implications for constructing shift schedules. Early morning shifts reduced sleep length substantially and should be mixed with later start hours to avoid the accumulation of sleep dept. Delaying the shift‐start past 10∶00 h had little effect on sleep opportunity; however, delaying shift‐start to between 04∶30 and 9∶00 h had a strong impact on sleep length, with 70% of the extra time used for sleep, suggesting large positive effects for this range of shift‐start times.     

Effects of Context on Sleepiness Self‐Ratings during Repeated Partial Sleep Deprivation

Ratings of subjective sleepiness are often used in laboratory and field studies of sleep loss and shifted sleep hours. Some studies suggest that such ratings might fail to reflect sleepiness as shown in physiology or performance. One reason for this may be the influence of the context of the rating. Social interaction or physical activity may mask latent sleepiness. The present study attempted to approach this question. Nine subjects participated in a partial sleep‐deprivation experiment (five days of 4 h of time in bed [TIB]), preceded by two baseline days (8 h TIB) and followed by three recovery days (8 h TIB). Sleepiness was self‐rated on the Karolinska Sleepiness Scale (KSS; scores of 1–9) after a period of relaxation, after a reaction‐time test, and after 30 min of free activities. The results showed a strong increase in subjective sleepiness during sleep restriction and a significant difference between conditions. Free activity reduced the self‐rated subjective sleepiness by 1.1 KSS units compared to the level of sleepiness self‐rated at the end of the reaction‐time test. Thus, the results of this study indicate that the context of a sleepiness rating affects the outcome of the rating.     

Effects of a Two‐Hour Change in Bedtime on the Sleep of Healthy Seniors

Some of the sleep disruption seen in seniors (>65 yrs) may be due to alteration of the circadian pacemaker phase and/or its phase angle with bedtime. The purpose of this study was to determine the effects of 2 h changes in the timing of bedtime (both earlier and later) on the sleep of seniors. Ten healthy seniors (9 F, 1 M, age 70–82 yrs) were each studied individually during three 120 h sessions (each separated by >2 weeks) in a time‐isolation laboratory. On nights 1 and 2, bedtime and rise‐time occurred at the subjects' habitual times; on nights 3–5, bedtime was specified by the experiment, but rise‐time was at the subjects' discretion (without knowledge of clock time). Under the control condition, subjects went to bed at their habitual bedtime (HBT), under the earlier bedtime condition at (HBT?2 h), and under the later bedtime condition at (HBT+2 h). Sleep was polysomnnographically recorded and rectal temperature continuously monitored. Although total sleep time increased in the earlier compared to the later condition (p<0.01), sleep efficiency decreased and wake after sleep onset increased (p<0.01). Subjective ratings of sleep were also worse under the earlier (HBT?2 h) than under later (HBT+ 2 h) condition (p<0.05). Performance did not differ between the earlier and later conditions. The larger the phase angle between actual bedtime and circadian temperature minimum (Tmin), the longer the time spent in bed and total sleep time, and the worse the sleep efficiency and subjective sleep ratings. There were no effects related to the phase angle between Tmin and rise‐time. The relative benefits of longer vs. more efficient sleep in the elderly require further investigation.     

Age‐related Changes in the Circadian and Homeostatic Regulation of Human Sleep

The reduction of electroencephalographic (EEG) slow‐wave activity (SWA) (EEG power density between 0.75–4.5 Hz) and spindle frequency activity, together with an increase in involuntary awakenings during sleep, represent the hallmarks of human sleep alterations with age. It has been assumed that this decrease in non‐rapid eye movement (NREM) sleep consolidation reflects an age‐related attenuation of the sleep homeostatic drive. To test this hypothesis, we measured sleep EEG characteristics (i.e., SWA, sleep spindles) in healthy older volunteers in response to high (sleep deprivation protocol) and low sleep pressure (nap protocol) conditions. Despite the fact that the older volunteers had impaired sleep consolidation and reduced SWA levels, their relative SWA response to both high and low sleep pressure conditions was similar to that of younger persons. Only in frontal brain regions did we find an age‐related diminished SWA response to high sleep pressure. On the other hand, we have clear evidence that the circadian regulation of sleep during the 40 h nap protocol was changed such that the circadian arousal signal in the evening was weaker in the older study participants. More sleep occurred during the wake maintenance zone, and subjective sleepiness ratings in the late afternoon and evening were higher than in younger participants. In addition, we found a diminished melatonin secretion and a reduced circadian modulation of REM sleep and spindle frequency—the latter was phase‐advanced relative to the circadian melatonin profile. Therefore, we favor the hypothesis that age‐related changes in sleep are due to weaker circadian regulation of sleep and wakefulness. Our data suggest that manipulations of the circadian timing system, rather than the sleep homeostat, may offer a potential strategy to alleviate age‐related decrements in sleep and daytime alertness levels.     

Shift Work and Inter‐Individual Differences in Sleep and Sleepiness

Inter‐individual differences in tolerance for shift work have been studied primarily in terms of external factors affecting alertness on the job or the ability to rest and sleep while at home. However, there is increasing evidence that neurobiological factors play a role as well, particularly the major processes involved in the regulation of sleep and wakefulness. These include a sleep homeostatic process seeking to balance wakefulness and sleep and a circadian process seeking to promote wakefulness during the day and sleep during the night. Shift work is associated with a temporal misalignment of these two endogenous processes. During nightwork, this misalignment makes it difficult to stay awake during the nightshift and sleep during the day. However, inter‐individual variability in the processes involved in sleep/wake regulation is substantial. Recent studies have demonstrated the existence of inter‐individual differences in vulnerability to cognitive deficits from sleep loss. Moreover, these inter‐individual differences were shown to constitute a trait. Interestingly, self‐evaluations of sleepiness did not correspond well with the trait inter‐individual variability in objective levels of performance impairment during sleep deprivation. Perhaps because of this discrepancy, in operational settings, the inter‐individual differences in vulnerability to sleep loss do not appear to be limited due to self‐selection mechanisms. Indeed, even among a highly select group of active‐duty jet fighter pilots flying a series of simulated night missions, systematic inter‐individual differences in performance impairment from sleep loss were still observed. There are significant personal and economic consequences to human error and accidents caused by performance deficits due to sleep loss. It is important, therefore, to study the inter‐individual differences in the regulation of sleep and wakefulness in the work environment so that cognitive impairment during shift work may be better anticipated and prevented.     

Self‐selection of photoperiod as a technique for studying endogenous rhythms in fish

Abstract

Drawing on work with passerine birds, investigations on the self‐selection of photoperiod in a constant environment by pumpkinseed sunfish (Lepomis gibbosus) capable of controlling their lighting have been carried out. Each aquarium with lighting equipment was set up in a separate, light‐tight compartment in a quiet, constant‐temperature room. Under one treatment, an overhead fluorescent light could be turned on and off by breaking a photobeam. Under two further treatments, breaking the photobeam turned the light on for three minutes. Fish were fed daily at a regular hour. The latter two treatments, but not the first, resulted in data containing diurnal rhythmic components as analyzed by autocorrelation techniques. The results are discussed in the context of different methods of measuring “internal clock” mechanisms.     

In Sync with the Family: Children and Partners Influence the Sleep‐Wake Circadian Rhythm and Social Habits of Women

Different factors have been proposed to influence morningness‐eveningness, biological rhythms, and sleep‐wake cycles, but few studies focused on the influence of social habits. Here, we focus on the influence of children and partners on the social habits of women at different stages of their lives and on synchronization within the family. One hundred and seventy‐nine women participated in the study and were allocated into four groups: women without children, pregnant women without children, pregnant women with children, and non‐pregnant mothers. Morningness was predicted by the presence of children, and earlier chronotype was predicted by the presence of children, pregnancy, and age. Average sleep duration was longest in pregnant women. The presence of children was responsible for a difference in rise times of approximately 1.5 h on the weekend. Subjective sleep‐onset latencies were shortest in women with children. The synchrony between partners (husband/wife) was 0.46 in women without children, 0.79 in pregnant women, 0.40 in women with children, and 0.56 between mother and child. Partners’ chronotypes were highly correlated, as were those of mother and child. This study suggests children have a strong influence on their mother's lifestyle and sleep‐wake rhythm, far beyond the first months of life, and that children are a more important social factor than the male partner.     

Sex Difference in Sleep‐Time Preference and Sleep Need: A Cross‐Sectional Survey among Italian Pre‐Adolescents,Adolescents, and Adults

The aim of this study was to examine sex differences in sleep‐time preference by age among Italian pre‐adolescents, adolescents, and adults. The final sample consisted of 8,972 participants (5,367 females and 3,605 males) from 10 to 87 yrs of age. To assess preferred sleep habits, we considered the answers to the open‐ended questions of the Morningness‐Eveningness Questionnaire (MEQ). In agreement with previous studies, we found that sleep‐time preference started to shift toward eveningness from the age of 13 yrs. Females reached their peak in eveningness earlier (about 17 yrs of age) than males (about 21 yrs of age). Thereafter, the ideal sleep‐time preference advanced in men and women with increasing age. Females presented a more significant advanced sleep phase than males only during the years when sexual hormones are typically active. Moreover, females reported a longer ideal sleep duration than males across all age groups examined, except in over 55 yrs one. (Author correspondence: vincenzo.natale@unibo.it)     

Predicting the actigraphy-based acrophase using the Morningness–Eveningness Questionnaire (MEQ) in college students of North Italy

Actigraphy is the reference objective method to measure circadian rhythmicity. One simpler subjective approach to assess the circadian typology is the Morningness–Eveningness Questionnaire (MEQ) by Horne and Ostberg. In this study, we compared the MEQ score against the actigraphy-based circadian parameters MESOR, amplitude and acrophase in a sample of 54 students of the University of Milan in Northern Italy. MEQ and the acrophase resulted strongly and inversely associated (r = ?0.84, p < 0.0001), and their relationship exhibited a clear-cut linear trend. We thus used linear regression to develop an equation enabling us to predict the value of the acrophase from the MEQ score. The parameters of the regression model were precisely estimated, with the slope of the regression line being significantly different from 0 (p < 0.0001). The best-fit linear equation was: acrophase (min) = 1238.7–5.49·MEQ, indicating that each additional point in the MEQ score corresponded to a shortening of the acrophase of approximately 5 min. The coefficient of determination, R², was 0.70. The residuals were evenly distributed and did not show any systematic pattern, thus indicating that the linear model yielded a good, balanced prediction of the acrophase throughout the range of the MEQ score. In particular, the model was able to accurately predict the mean values of the acrophase in the three chronotypes (Morning-, Neither-, and Evening-types) in which the study subjects were categorized. Both the confidence and prediction limits associated to the regression line were calculated, thus providing an assessment of the uncertainty associated with the prediction of the model. In particular, the size of the two-sided prediction limits for the acrophase was about ±100 min in the midrange of the MEQ score. Finally, k-fold cross-validation showed that both the model’s predictive ability on new data and the model’s stability to changes in the data set used for parameter estimation were good. In conclusion, the actigraphy-based acrophase can be predicted using the MEQ score in a population of college students of North Italy.     

Melanopsin as a Sleep Modulator: Circadian Gating of the Direct Effects of Light on Sleep and Altered Sleep Homeostasis in Opn4?/? Mice

Light influences sleep and alertness either indirectly through a well-characterized circadian pathway or directly through yet poorly understood mechanisms. Melanopsin (Opn4) is a retinal photopigment crucial for conveying nonvisual light information to the brain. Through extensive characterization of sleep and the electrocorticogram (ECoG) in melanopsin-deficient (Opn4^−/−) mice under various light–dark (LD) schedules, we assessed the role of melanopsin in mediating the effects of light on sleep and ECoG activity. In control mice, a light pulse given during the habitual dark period readily induced sleep, whereas a dark pulse given during the habitual light period induced waking with pronounced theta (7–10 Hz) and gamma (40–70 Hz) activity, the ECoG correlates of alertness. In contrast, light failed to induce sleep in Opn4^−/− mice, and the dark-pulse-induced increase in theta and gamma activity was delayed. A 24-h recording under a LD 1-h∶1-h schedule revealed that the failure to respond to light in Opn4^−/− mice was restricted to the subjective dark period. Light induced c-Fos immunoreactivity in the suprachiasmatic nuclei (SCN) and in sleep-active ventrolateral preoptic (VLPO) neurons was importantly reduced in Opn4^−/− mice, implicating both sleep-regulatory structures in the melanopsin-mediated effects of light. In addition to these acute light effects, Opn4^−/− mice slept 1 h less during the 12-h light period of a LD 12∶12 schedule owing to a lengthening of waking bouts. Despite this reduction in sleep time, ECoG delta power, a marker of sleep need, was decreased in Opn4^−/− mice for most of the (subjective) dark period. Delta power reached after a 6-h sleep deprivation was similarly reduced in Opn4^−/− mice. In mice, melanopsin''s contribution to the direct effects of light on sleep is limited to the dark or active period, suggesting that at this circadian phase, melanopsin compensates for circadian variations in the photo sensitivity of other light-encoding pathways such as rod and cones. Our study, furthermore, demonstrates that lack of melanopsin alters sleep homeostasis. These findings call for a reevaluation of the role of light on mammalian physiology and behavior.     

Explaining Sleep Duration in Adolescents: The Impact of Socio‐Demographic and Lifestyle Factors and Working Status

Previous studies found students who both work and attend school undergo a partial sleep deprivation that accumulates across the week. The aim of the present study was to obtain information using a questionnaire on a number of variables (e.g., socio‐demographics, lifestyle, work timing, and sleep‐wake habits) considered to impact on sleep duration of working (n=51) and non‐working (n=41) high‐school students aged 14–21 yrs old attending evening classes (19:00–22:30 h) at a public school in the city of São Paulo, Brazil. Data were collected for working days and days off. Multiple linear regression analyses were performed to assess the factors associated with sleep duration on weekdays and weekends. Work, sex, age, smoking, consumption of alcohol and caffeine, and physical activity were considered control variables. Significant predictors of sleep duration were: work (p < 0.01), daily work duration (8–10 h/day; p < 0.01), sex (p=0.04), age 18–21 yrs (0.01), smoking (p=0.02) and drinking habits (p=0.03), irregular physical exercise (p < 0.01), ease of falling asleep (p=0.04), and the sleep‐wake cycle variables of napping (p < 0.01), nocturnal awakenings (p < 0.01), and mid‐sleep regularity (p < 0.01). The results confirm the hypotheses that young students who work and attend school showed a reduction in night‐time sleep duration. Sleep deprivation across the week, particularly in students working 8–10 h/day, is manifested through a sleep rebound (i.e., extended sleep duration) on Saturdays. However, the different roles played by socio‐demographic and lifestyle variables have proven to be factors that intervene with nocturnal sleep duration. The variables related to the sleep‐wake cycle—naps and night awakenings—proved to be associated with a slight reduction in night‐time sleep, while regularity in sleep and wake‐up schedules was shown to be associated with more extended sleep duration, with a distinct expression along the week and the weekend. Having to attend school and work, coupled with other socio‐demographic and lifestyle factors, creates an unfavorable scenario for satisfactory sleep duration.     

Birth Month and Risk of Glioma in Adults: A Registry‐Based Study in Bavaria

The aim of the present study was to evaluate the possible seasonality of birth in adult patients suffering from glioma. For this purpose, data from the database of the population‐based cancer registry of Bavaria (Germany) were retrieved. For the period 2002–2005, we identified a total of 2174 patients born between 1931 and 1986 diagnosed with malignant glioma. Statistical analyses failed to document a significant annual periodicity of glioma risk in either men or women with respect to birth month in the observed cohort. Thus, we found no association between month of birth and the risk of glioma. In contrast, an analysis of the official birth rate data of Bavaria revealed marked annual variation in birth rates up until 1965, which decreased markedly in prominence in the years thereafter. Our findings confirm the results of a recent similar study conducted in The Netherlands. Therefore, we support the hypothesis of possible etiological factors of glioma acting in adulthood rather than in the perinatal period.     

Effect of Time of Day and Partial Sleep Deprivation on Short‐Term,High‐Power Output

The purpose of this study was to determine whether delaying bedtime or advancing rising time by 4 h affects anaerobic performance of individuals the following day in the morning and afternoon. Eleven subjects participated in the study, during which we measured the maximal, peak, and mean powers (i.e., P_max [force‐velocity test], P_peak, and P_mean [Wingate test], respectively). Measurements were performed twice daily, at 07∶00 and 18∶00 h, following a reference normal sleep night (RN), a partial sleep deprivation timed at the beginning of the night (SDB), and a partial sleep deprivation timed at the end of the night (SDE), and oral temperature was measured every 4 h. Each of the three experimental conditions was separated by a one‐week period. Our results showed a circadian rhythm in oral temperature, and analysis of variance revealed a significant sleep×test‐time effect on peak power (P_peak), mean power (P_mean), and maximal power (P_max). These variables improved significantly from the morning to the afternoon for all three experimental conditions. Whereas the morning‐afternoon improvement in the measures was similar after the RN and SDB conditions, it was smaller following the SDE condition. There was no significant difference in the effect of the two sleep‐deprivation conditions on anaerobic performances at 07∶00 and at 18∶00 h under the SDB condition in comparison with the post‐reference night. However, the performance variables were significantly lower at 18∶00 h after the SDE condition. In conclusion, a 4 h partial sleep deprivation at the end of the night appears to be more disturbing than partial sleep deprivation at the beginning of the night.     

Self Inflicted Injuries among Children in United States – Estimates from a Nationwide Emergency Department Sample

Objective

The objectives of the current study are to provide nationally representative estimates of hospital based emergency department visits (ED) attributed to self inflicted injuries and attempted suicides among children in United States; and to identify potential methods of such intentional self inflicted injuries and attempted suicides.

Methods

The Nationwide Emergency Department Sample (year 2007) was used. All ED visits occurring among children (aged ≤18 years) with an External Cause of Injury for any of self inflicted injuries were selected. Outcomes examined include hospital ED charges and hospitalization charges. All estimates were projected to national levels.

Results

77,420 visits to hospital based emergency departments were attributed to self inflicted injuries among children (26,045 males and 51,370 females). The average age of the ED visits was 15.7 years. 134 patients died in ED’s (106 males and 28 females) and 93 died in hospitals following in-patient admission (75 males and 18 females). A greater proportion of male ED visits were discharged routinely as opposed to female ED visits (51.1% versus 44%). A greater proportion of male ED visits also died in the emergency departments compared to female visits (0.4% versus 0.05%). 17,965 ED visits necessitated admission into same hospital. The mean charge for each ED visit was $1,874. Self inflicted injuries by poisoning were the most frequently reported sources accounting for close to 70% of all ED visits.

Conclusions

Females comprise a greater proportion of ED visits attributed to self inflicted injuries. 227 children died either in the ED’s or in hospitals. The current study results highlight the burden associated with such injuries among children.     

Accounting for Partial Sleep Deprivation and Cumulative Sleepiness in the Three‐Process Model of Alertness Regulation

Mathematical models designed to predict alertness or performance have been developed primarily as tools for evaluating work and/or sleep‐wake schedules that deviate from the traditional daytime orientation. In general, these models cope well with the acute changes resulting from an abnormal sleep but have difficulties handling sleep restriction across longer periods. The reason is that the function representing recovery is too steep—usually exponentially so—and with increasing sleep loss, the steepness increases, resulting in too rapid recovery. The present study focused on refining the Three‐Process Model of alertness regulation. We used an experiment with 4 h of sleep/night (nine participants) that included subjective self‐ratings of sleepiness every hour. To evaluate the model at the individual subject level, a set of mixed‐effect regression analyses were performed using subjective sleepiness as the dependent variable. These mixed models estimate a fixed effect (group mean) and a random effect that accounts for heterogeneity between participants in the overall level of sleepiness (i.e., a random intercept). Using this technique, a point was sought on the exponential recovery function that would explain maximum variance in subjective sleepiness by switching to a linear function. The resulting point explaining the highest amount of variance was 12.2 on the 1–21 unit scale. It was concluded that the accumulation of sleep loss effects on subjective sleepiness may be accounted for by making the recovery function linear below a certain point on the otherwise exponential function.     

Heritability and heterochrony of polychromatism in a Lake Victoria Cichlid fish: Stepping stones for speciation?

In many haplochromine cichlid fish, male nuptial coloration is subject to female mate choice and plays a central role in the evolution of reproductive isolation between incipient species. Intraspecific variation in male coloration may serve as a target for diversifying sexual selection and provide a starting point for species divergence. Here, we investigated a polychromatism in Neochromis omnicaeruleus, a haplochromine from Lake Victoria, East-Africa. In this species, male coloration ranges from skyblue to yellow-red and females are grey-blue to yellow. We found that both genetic and environmental factors influence the expression of these colours during individual development. In a natural population, we found that male colour was associated with size and sexual maturity: yellow males were smaller than blue males and tended to be sexually immature. In females, size and maturity did not differ between colour types. Laboratory crosses revealed that there is a heritable component to the observed colour variation: yellow parents produced more yellow offspring than blue parents. Together with repeated aquarium observations of yellow individuals that gradually become blue, these data suggest that yellow males change to blue as they approach sexual maturity, and that the occurrence and timing of this transition is influenced by both environmental and genetic effects. The significance of this mechanism of colour expression as a possible target for divergent selection remains to be evaluated.