Evening chronotype is associated with poor cardiovascular health and adverse health behaviors in a diverse population of women

ABSTRACT

Chronotype reflects time of day preferences for performing daily activities. Previous research within Asian and European cohorts indicates evening chronotype is associated with elevated cardiometabolic risk. However, evidence is limited from population-based US cohorts, particularly among women in whom evening chronotype prevalence may become higher after middle-age, coinciding with life stages associated with higher cardiovascular disease (CVD) risk. This cross-sectional study evaluated associations of chronotype with overall cardiovascular health (CVH), health behaviors, and cardiometabolic risk factors among 506 women (mean age = 37 ± 16y, 62% racial/ethnic minority) in the American Heart Association (AHA)’s Go Red for Women Strategically-Focused Research Network cohort at Columbia University (New York City, NY, USA). Chronotype was assessed using the validated Morningness-Eveningness Questionnaire (MEQ) and categorized as “evening”, “intermediate”, and “morning” chronotypes. Health behaviors (diet, physical activity, and sleep) were assessed using validated questionnaires. Anthropometrics, clinical blood pressure, and blood biomarkers were assessed at the clinic visit. CVH was evaluated using the AHA Life’s Simple 7 (LS7) metrics; LS7 scores of 0–8 and 9–14 were considered indicative of poor and moderate-to-high CVH, respectively. Linear and logistic regression models adjusted for age, race/ethnicity, education, health insurance, and menopausal status were used to examine associations of MEQ scores and chronotype categories with overall CVH, clinical cardiometabolic risk factors, and health behaviors. Overall, 13% of women identified as evening chronotypes, while 55% and 32% reported being intermediate and morning types. In linear models, higher MEQ scores were associated with higher AHA LS7 scores (β(SE) = 0.02(0.01); p = .014), indicative of more favorable CVH, and with health behaviors not included in the LS7. Higher MEQ scores were also associated with lower Pittsburgh Sleep Quality Index, i.e. better sleep quality, (β(SE) = ?0.07(0.02), p < .0001), lower insomnia severity (β(SE) = ?0.14(0.01), p < .0001), shorter time to fall asleep (β(SE) = ?0.28(0.14), p = .044), and less sedentary time (β(SE) = ?0.11(0.03), p = .001). In logistic regression models, evening chronotype, compared to intermediate/morning type, was associated with higher odds of having poor CVH (OR(95%CI):2.41(1.20–4.85)), not meeting AHA diet (OR(95%CI):2.89(1.59–5.23)) and physical activity guidelines (OR(95%CI):1.78(1.03–3.07)), and having short sleep (OR(95%CI):2.15(1.24–3.73)) or insomnia (OR(95%CI):2.69(1.53–4.75)). The evening type compared to morning type was also associated with being a current smoker (OR(95%CI):2.14(1.02–4.52)) and having poor sleep quality (OR(95%CI:2.35(1.27–4.37)) and long sleep onset latency (OR(95%CI:1.89(1.00–3.56)). In our cohort of women, evening chronotype was related to poor CVH, likely driven by its influence on health behaviors. These findings, although warranting confirmation prospectively in other populations, suggest chronotype is an important factor to consider and possibly target when designing lifestyle interventions for CVD prevention.     

Associations between chronotype,morbidity and mortality in the UK Biobank cohort

Later chronotype (i.e. evening preference) and later timing of sleep have been associated with greater morbidity, including higher rates of metabolic dysfunction and cardiovascular disease (CVD). However, no one has examined whether chronotype is associated with mortality risk to date. Our objective was to test the hypothesis that being an evening type is associated with increased mortality in a large cohort study, the UK Biobank. Our analysis included 433 268 adults aged 38–73 at the time of enrolment and an average 6.5-year follow-up. The primary exposure was chronotype, as assessed through a single self-reported question-defining participants as definite morning types, moderate morning types, moderate evening types or definite evening types. The primary outcomes were all-cause mortality and mortality due to CVD. Prevalent disease was also compared among the chronotype groups. Analyses were adjusted for age, sex, ethnicity, smoking, body mass index, sleep duration, socioeconomic status and comorbidities. Greater eveningness, particularly being a definite evening type, was significantly associated with a higher prevalence of all comorbidities. Comparing definite evening type to definite morning type, the associations were strongest for psychological disorders (OR 1.94, 95% CI 1.86–2.02, p = < 0.001), followed by diabetes (OR 1.30, 95% CI 1.24–1.36, p = < 0.001), neurological disorders (OR 1.25, 95% CI 1.20–1.30, p = < 0.001), gastrointestinal/abdominal disorders (OR 1.23, 95% CI 1.19–1.27, p = < 0.001) and respiratory disorders (OR 1.22, 95% CI 1.18–1.26, p = < 0.001). The total number of deaths was 10 534, out of which 2127 were due to CVD. Greater eveningness, based on chronotype as an ordinal variable, was associated with a small increased risk of all-cause mortality (HR 1.02, 95% CI 1.004–1.05, p = 0.017) and CVD mortality (HR 1.04, 95% CI 1.00–1.09, p = 0.06). Compared to definite morning types, definite evening types had significantly increased risk of all-cause mortality (HR 1.10, 95% CI 1.02–1.18, p = 0.012). This first report of increased mortality in evening types is consistent with previous reports of increased levels of cardiometabolic risk factors in this group. Mortality risk in evening types may be due to behavioural, psychological and physiological risk factors, many of which may be attributable to chronic misalignment between internal physiological timing and externally imposed timing of work and social activities. These findings suggest the need for researching possible interventions aimed at either modifying circadian rhythms in individuals or at allowing evening types greater working hour flexibility.     

Social jetlag and depression status: Results obtained from the Netherlands Study of Depression and Anxiety

Social jetlag, the misalignment between the internal clock and the socially required timing of activities, is highly prevalent, especially in people with an evening chronotype and is hypothesized to be related to the link between the evening chronotype and major depressive disorder. Although social jetlag has been linked to depressive symptoms in non-clinical samples, it has never been studied in patients with major depressive disorder (MDD). This study is aimed to study social jetlag in patients with major depressive disorder and healthy controls, and to further examine the link between social jetlag and depressive symptomatology. Patients with a diagnosis of MDD (n = 1084) and healthy controls (n = 385), assessed in a clinical interview, were selected from the Netherlands Study of Depression and Anxiety. Social jetlag was derived from the Munich Chronotype Questionnaire, by calculating the absolute difference between the midsleep on free days and midsleep on work days. Depression severity was measured with the Inventory of Depressive Symptomatology. It was found that patients with MDD did not show more social jetlag compared to healthy controls, neither in a model without medication use (β = 0.06, 95% CI: ?0.03–0.15, p = 0.17) nor in a model where medication use is accounted for. There was no direct association between the amount of social jetlag and depressive symptoms, neither in the full sample, nor in the patient group or the healthy control group. This first study on social jetlag in a clinical sample showed no differences in social jetlag between patients with MDD and healthy controls.     

Chronotype and its relationship with sleep disorders in children with attention deficit hyperactivity disorder

Chronotype can be classified as morningness types, people who prefer morning hours for their physical and mental activities; eveningness types, people who prefer the afternoon or evening hours; and intermediate types, those who show characteristics of both morningness and eveningness types. Attention deficit hyperactivity disorder (ADHD) has been linked with disturbances in chronotype, particularly increased eveningness. Despite the possibility of an association between chronotypes, sleep disturbances and ADHD symptoms, there is little evidence of this association considering the child population. The purpose of this study was to examine chronotype preferences in children aged between 7 and 12 years who were diagnosed as having ADHD in the context of sleep disturbances. The Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version, Conner’s Rating Scales, Children’s Sleep Habit Questionnaire and Children’s Chronotype Questionnaire were used for the evaluation of children with ADHD and healthy controls. The ADHD group was 73% combined-type, and the eveningness scores of the ADHD group (n = 52) were significantly higher than the control group (n = 52) (p < 0.01). There was a positive correlation between the higher scores of eveningness and total scores on resistance to sleep time (p < 0.09), respiratory problems during sleep and daytime sleepiness in the ADHD group. CSHQ total score was found to be a predictive factor for eveningness among children with ADHD (p < 0.01). These findings highlight possible reciprocal links between ADHD symptoms, sleep disturbances and chronotype in children aged 7–12 years, which might lead to individualized treatment options.     

Association of possible sleep bruxism in children with different chronotype profiles and sleep characteristics

Sleep bruxism (SB) in children has been associated with several sleep characteristics, which may alter their sleep pattern. This change affects the internal biological clock and consequently the chronotype profile. The aim of this study was to evaluate the existence of an association between possible SB in children with specific chronotype profiles and sleep characteristics. The study included 207 parents/guardians of children aged between 3 and 12 years who were waiting for their children’s dental treatment at the Pediatric Dentistry Clinic of the Federal University of Rio de Janeiro, Brazil. A questionnaire on the socio-demographic characteristics of parents and children as well as on the features of the children’s sleep was applied. In addition, the CIRENS scale (Circadian Energy Scale) was completed by the parents to identify the children’s chronotype. A chi-squared test was used to determine the association between possible SB, the chronotype, and sleep characteristics. A multiple logistic regression model was implemented to observe the influence of chronotype, age, and other independent variables on the possible SB. The logistic regression model demonstrated that nocturnal agitation (p = 0.009; OR = 3.42) and nightmares (p = 0.045; OR = 3.24) were associated with possible SB in children. Although no significant association (p = 0 .089) between the chronotype profile and possible SB was observed in the 3 to 5 years age group, a proportional difference was observed between the chronotype categories in this age group—12.5% of children with SB had a morning type, while 26.4% had an intermediate type and 47.8% an evening type compared to those without possible SB. Nocturnal agitation and nightmares were associated with possible SB. In addition, young children with an evening chronotype had a tendency toward possible SB.     

Time-related eating patterns and chronotype are associated with diet quality in pregnant women

Animal studies strongly suggest that timed feeding can have beneficial physiological effects, including protection against the obesogenic and metabolic consequences of a high-fat diet. However, the relationship between variables related to the timing of eating and diet quality in pregnancy women, which is considered as a period of nutritional vulnerability, is still poorly described in the literature. Therefore, the aim of the present study was to investigate the associations between time-related eating patterns and chronotype with diet quality of pregnant women. This cross-sectional study was conducted with 100 pregnant women in the first gestational trimester (≤12 weeks of gestation). The information regarding food intake was obtained by three 24-Hour Dietary Recall (24HR). Time-related eating patterns, i.e., the interval between the first and the last meal (eating duration), nightly fasting, time of the first and last meals, and number of meals eating on a day were determined. Chronotype was derived using the mid-sleep time on free days on weekends, with a further correction for calculated sleep debt. Diet quality was evaluated using the Brazilian Healthy Eating Index-Revised (BHEI-R), validated for the Brazilian population. Linear regression modeling analyses adjusted for confounders were used to investigate the association between time-related eating patterns and chronotype with diet quality. The BHEI-R total score was negatively associated with time of the first meal (β = ?0.355; p = 0.002; r² adjusted = 0.141), and positively associated with eating duration (β = 0.262; p = 0.024; r² adjusted = 0.086) and number of meals (β = 0.273; p = 0.019; r² adjusted = 0.091). In addition, the score of total fruit component was negatively associated with chronotype (β = ?0.236; p = 0.033; r² adjusted = 0.078), time of the first meal (β = ?0.393; p = 0.001; r² adjusted = 0.171), and positively associated with eating duration (β = 0.259; p = 0.022; r² adjusted = 0.087) and number of meals (β = 0.376; p = 0.001; r² adjusted = 0.159). The score for whole fruit component was negatively associated with time of the first meal (β = ?0.388; p = 0.001; r² adjusted = 0.152), and positively associated with number of meals (β = 0.403; p = 0.001; r² adjusted = 0.164). A longer eating duration, earlier time of the first meal, higher number of meals and morningness tendency are associated with a better diet quality in the first gestational trimester – higher scores of the total BHEI-R and/or fruit components. We suggest that nutritional guidelines should consider time-related eating patterns and chronotype to ensure good diet quality of pregnant women since the beginning of gestation, contributing on prevention of metabolic-nutritional complications.     

Relevance of chronotype for eating patterns in adolescents

During adolescence, a shift from morningness to eveningness occurs, yet school continues to start early in the morning. Hence, adolescents are at risk for social jetlag, i.e. a discrepancy between biological and social timing. It remains to be determined whether chronotype associates with daily and daytime-specific eating patterns during this potentially critical period. Therefore, the aim of the present study was to investigate whether chronotype is decisive for daily eating patterns [total energy intake (TEI, kcal), total macronutrient intake (% of TEI), eating occasion frequency (n/day), meal frequency (n/day), snack frequency (n/day), duration of nightly fasting], or daytime-specific eating patterns [morning (before 11 am) energy intake (% of TEI), morning macronutrient intake (% of morning energy intake), regular breakfast skipping (no morning energy intake at least on 2 of 3?days, yes/no), evening (after 6 pm) energy intake (% of TEI), evening macronutrient intake (% of evening energy intake), regular dinner skipping (no evening energy intake at least on 2 of 3?days, yes/no)] in German adolescents. Chronotype was assessed by use of the Munich Chronotype Questionnaire and is defined as the midpoint of sleep corrected for sleep-debt accumulated over the workweek (the later the midpoint of sleep, the later the chronotype). A total of 223 participants (10–18?years) provided 346 questionnaires and concurrent 3-day weighed dietary records. Associations between chronotype and eating patterns were analyzed cross-sectionally using multivariable linear and logistic mixed-effects regression models. Adolescents with earlier and later chronotypes did not differ in their daily eating patterns. With respect to daytime-specific eating patterns, 1?h delay in chronotype was associated with 4.0 (95% CI 2.5–6.6) greater odds of regular breakfast skipping (p < 0.0001). In addition, later chronotype was associated with higher evening energy intake (p = 0.0009). In conclusion, our data show that a later chronotype among adolescents is associated with a shift of food consumption toward later times of the day. Hence, adolescents’ eating patterns appear to follow their internal clock rather than socially determined schedules.     

Association between depressive symptoms and morningness-eveningness,sleep duration and rotating shift work in Japanese nurses

Higher depressive symptoms have been reported in rotating shift workers compared with day workers. Depressive symptoms in adults who do not engage in night work have also been shown to be associated with chronotype and sleep duration. This study examines associations between depressive symptoms, morningness-eveningness (i.e. the degree to which people prefer to be active in the morning or the evening), sleep duration and rotating shift work. Japanese nurses (1252 day workers and 1780 rotating shift workers, aged 20–59) were studied using a self-administered questionnaire. The questionnaire covered depressive symptoms, morningness-eveningness, sleep habits and demographic characteristics of the participants. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to determine the levels of depressive symptoms. A Japanese version of the Morningness-Eveningness Questionnaire (MEQ) was used to measure morningness-eveningness. The CES-D score of shift workers was significantly (p < 0.05) higher than that of day workers. The MEQ score was significantly (p < 0.05) lower (i.e. greater eveningness) in shift workers than in day workers. Sleep duration on the day shift was significantly (p < 0.05) shorter in shift workers than in day workers. Simple linear regression revealed that the MEQ score, sleep duration on the day shift and current work shift (i.e. rotating shift work) were significantly (p < 0.05) associated with the CES-D score. Multivariate linear regression indicated that greater eveningness and shorter sleep duration were independently associated with higher CES-D scores, while rotating shift work was not. These associations between the MEQ score, the sleep duration and the CES-D score were also confirmed in both day workers and shift workers when the groups were analyzed separately. These results suggest that greater eveningness and shorter sleep duration on the day shift were independently associated with higher levels of depressive symptoms, which may explain associations between rotating shift workers and depressive symptoms. These findings have important implications for the development of novel strategies for preventing poor mental health in day workers and rotating shift workers.     

Premature birth and circadian preference in young adulthood: evidence from two birth cohorts

A preference for eveningness (being a “night owl”) and preterm birth (<37 weeks of gestation) are associated with similar adversities, such as elevated blood pressure, impaired glucose regulation, poorer physical fitness, and lower mood. Yet, it remains unclear if and how preterm birth is associated with circadian preference. The aim of this study was to assess this association across the whole gestation range, using both objective and subjective measurements of circadian preference.

Circadian preference was measured among 594 young adults (mean age 24.3 years, SD 1.3) from two cohorts: the ESTER study and the Arvo Ylppö Longitudinal Study. We compared 83 participants born early preterm (<34 weeks) and 165 late preterm (34 to <37 weeks) with those born at term (≥37 weeks, n = 346). We also compared very low birth weight (VLBW, <1500 g) participants with term-born controls. We obtained objective sleep data with actigraphs that were worn for a mean period of 6.8 (SD 1.4) nights. Our primary outcome was sleep midpoint during weekdays and weekend. The sleep midpoint is the half-way time between falling asleep and waking up, and it represents sleep timing. We also investigated subjective chronotype with the Morningness–Eveningness Questionnaire (MEQ) in 688 (n = 138/221/329) ESTER participants. The MEQ consists of 19 questions, which estimates the respondent to be of a “morning”, “evening,” or “intermediate” chronotype, based on the Morningness–Eveningness Score (MES). We analyzed the data from the actigraphs and the MES with three linear regression models, and analyzed distribution of the chronotype class with Pearson χ2.

There were no consistent differences across the study groups in sleep midpoint. As compared with those born at term, the mean differences in minutes:seconds and 95% confidence intervals for the sleep midpoint were: early preterm weekdays 11:47 (?8:34 to 32:08), early preterm weekend 4:14 (?19:45 to 28:13), late preterm weekdays ?10:28 (?26:16 to 5:21), and late preterm weekend ?1:29 (?20:36 to 17:37). There was no difference in sleep timing between VLBW-participants and controls either. The distribution of chronotype in the MEQ among all participants was 12.4% morningness, 65.4% intermediate, and 22.2% eveningness. The distribution of the subjective chronotype class did not differ between the three gestational age groups (p = 0.98). The linear regression models did not show any influence of gestational age group or VLBW status on the MES (all p > 0.5).

We found no consistent differences between adults born early or late preterm and those born at term in circadian preference. The earlier circadian preference previously observed in those born smallest is unlikely to extend across the whole range of preterm birth.     

Late chronotype and high social jetlag are associated with burnout in evening-shift workers: Assessment using the Chinese-version MCTQshift

Chronotypes are associated with shift work tolerance and sleep in shift workers, and sleep mediates the impact of shift work on mental health. However, the role of chronotype in the association between shift work and mental health has not been clarified. In this study, we aimed to examine the association between chronotype and burnout in shift workers, using the validated Munich ChronoType Questionnaire for shift workers (MCTQ^shift). A total of 288 shift workers with irregular shift frequencies were recruited and completed the Chinese-version MCTQ^shift and the Morningness–Eveningness Questionnaire (MEQ). Chronotypes were assessed by the calculation of corrected mid-sleep time (MSF_SC) from mid-sleep time on free days (MSF) based on their exact shift schedules. Another 26 evening-shift nurses were monitored with actigraphy for at least two consecutive evening shifts and the following two free days. Burnout was evaluated using the Copenhagen Burnout Inventory. We found that MSF^E_SC, MSF^E and mid-sleep time on workdays (MSW^E) had normal distributions and correlated significantly with MEQ scores (r = ? 0.47, ?0.45 and ?0.47, respectively; all p < 0.001). MSW was more closely correlated with actigraphy-derived mid-sleep time on the free day before workdays than that on workdays (r = 0.61 and 0.48, respectively, p < 0.05). Sleep duration was significantly longer on workdays among evening-shift workers who slept late on workdays than those who slept early (β = 0.59, p < 0.001). After demographic and work characteristics were adjusted for in linear regression models, late chronotype and high social jetlag were associated with burnout scores in evening-shift workers. In conclusion, the Chinese-version MCTQ^shift is a valid tool for chronotype assessment. Interventions to improve sleep in shift workers should be tailored to chronotype due to variations in sleep behavior. Late chronotype may be an inherent feature of mental health problems, because the association with burnout was significant in both day workers in previous studies and shift workers.     

Resilience,sleep quality and morningness as mediators of vulnerability to depression in medical students with sleep pattern alterations

The medical career is considered highly stressful, especially during internships when academic and clinical demands, combined with changes in sleep patterns, increase students’ likelihood to develop depression. Resilience, which is considered as opposite vulnerability to stress and, along with another protective factor, namely morningness, may cause a student to be less reactive to stimuli and, therefore, less prone to depression. The objective of this study was to evaluate the role of resilience and morningness facing to sleep quality and main risk factors, on the development of depression symptoms in a group of students with sleep pattern alterations. To this end, an observational and longitudinal study was performed with 30 undergraduate interns, with an average age of 22.63 years (SE ± 0.13), 33% men and 67% women. A survey was conducted in three different times during the year of internship: at the beginning (T₁), in the middle (T₂) and the end (T₃). The instruments were the Brief Resilience Scale, Composite Scale of Morningness, Pittsburgh Sleep Quality Index and Patient Health Questionnaire. The path analysis examined the roles of morningness, sleep quality and resilience as potential mediators between family history of depression and depression symptoms at different times. The results showed that resilience had a protective effect on depression symptoms at T₂ (β = ?0.18, p < 0.05) and with greater power at T₃ (β = ?0.41, p < 0.05), as did morningness, although less strongly, on the symptoms at T₃ (β = ?0.13, p < 0.05). A relationship between these two mediating variables was also observed (β = 0.30, p < 0.05). The initial sleep quality had an effect on the increase of depression symptoms at T₁ (β = 0.61, p < 0.05) and T₃ (β = 0.21, p < 0.05), while family history of depression had a direct effect on the measures of depression at T₂ (β = 0.49, p < 0.05) and T₃ (β = 0.19, p < 0.05). Aside from personal risk factors, it is possible to conclude that the levels of resilience, morningness and sleep quality manifested by students at the beginning of their internship may explain the decrease in depression symptoms at the end of the course.     

Why do evening people consider themselves more intelligent than morning individuals? The role of big five,narcissism, and objective cognitive ability

ABSTRACT

Morningness-eveningness, or chronotype, reflects the timing of sleep-wake patterns across a 24-hour day. Extant research has revealed that chronotype correlates with numerous psychological constructs including cognitive ability. In the current research, we examined how people with different chronotypes perceive their intelligence. We expected eveningness to be positively associated with subjectively assessed intelligence (SAI) because evening chronotypes demonstrate slightly higher intelligence than morning individuals. Furthermore, we considered personality traits (Big Five and narcissism) and objective intelligence (measured with standardized tests of fluid and verbal IQ) as potential variables that could account for this relationship. Across two studies (N = 504 and 232), we found that eveningness was associated with higher SAI. This relationship remained significant even after controlling for objective intelligence. In Study 1, we also found that when conscientiousness and neuroticism were analyzed together with chronotype, the magnitude of positive association between eveningness and SAI increased. Furthermore, Study 2 revealed that evening individuals exhibited higher narcissism, which fully accounted for their intelligence self-views. In the discussion, we speculate that daily struggles of evening chronotypes to function in morning-oriented society give them a basis to think positively about their intelligence to the extent of positive bias.     

The relationship between chronotype,sleep disturbance,severity of fibromyalgia,and quality of life in patients with fibromyalgia

ABSTRACT

Patients with fibromyalgia (FM) report high levels of sleep disturbance and chronic diffuse musculoskeletal pain. These patients experience diminished quality of life (QoL) due to pain and other comorbidities. Chronotype preferences have been suggested as a potential factor connecting increased severity of FM, sleep disturbances, and poor overall QoL. The present study is the first study examining the possible association between chronotype preferences, sleep disturbance, severity of FM, and QoL in patients with FM.

One hundred drug-free patients diagnosed with FM participated in this cross-sectional study. Of them, 79 (79%) were females and 21 (21%) were males. The mean age was 41.65 ± 9.17 years (range: 21–62 years). The severity of FM symptoms, chronotype preferences, and QoL was evaluated using the Fibromyalgia Impact Questionnaire (FIQ), Morningness-Eveningness Questionnaire (MEQ), and World Health Organization Questionnaire on Quality of Life: Short Form (WHOQOL-BREF). The participants’ anxiety/depressive symptoms and sleep problems were assessed using the Hospital Anxiety and Depression Scale (HADS) and Pittsburgh Sleep Quality Index (PSQI).

The participants were classified according to their MEQ scores as evening type (score: 16–41), neither type (score: 42–58), and morning type (score: 59–86). It was found that there were significant differences in the FIQ score between the three groups (p < .001). It was determined that the total PSQI score was significantly higher in the evening type than the other two types (p < .05). It was found that there were significant differences in the general health, physical health, psychological, and environmental domain scores of the WHOQOL-BREF between the three groups (p < .05). It was detected that there were significant correlations between MEQ scores, WHOQOL-BREF subscale scores, FIQ scores, HADS-A and HADS-D scores, and PSQI scores. According to hierarchical regression analysis, eveningness preference explained an additional 21.9% of the variation in FM severity, thereby causing a statistically significant change in R-squared.

Our results indicated that eveningness preference was directly related to increased FM symptom severity and poorer QoL. Based on these findings, neglecting to take chronotype preference into account may not result in optimal response to standard treatment for some patients with FM.     

Narrow-band ultraviolet B (NB UV-B) exposures improve mood in healthy individuals differently depending on chronotype

ABSTRACT

The evening chronotype is associated with psychological symptoms such as depressed mood, while skin exposure to ultraviolet radiation (UVR) may affect mood and behavior through neural and humoral routes. This pilot study aimed to investigate the impact of whole-body narrow-band (NB) UV-B exposure on current mood state and circulating 25-hydroxyvitamin D3 (25(OH)D₃), interleukin-6 (IL-6), cortisol and β-endorphin (β-END) levels in healthy participants. Here, eleven healthy women received full-body NB UV-B exposures on four afternoons, and the chronotype was assessed with a shortened version of Horne and Östberg’s Morningness-Eveningness Questionnaire (MEQ). Perceived mood was evaluated using the Visual Analogue Scale (VAS), and serum 25(OH)D₃, IL-6, cortisol and β-END concentrations were monitored daily. Decreasing VAS values showed mood to improve significantly over the five days after the four suberythematous NB UV-B exposures (p = .038), and the more the circadian preference was inclined toward eveningness, the greater the improvement in the mood dimension of wellbeing (p = .021). Baseline mood state was correlated with baseline 25(OH)D₃ (r = ?0.54, 95% CI: ?0.86 to ?0.09) and with baseline cortisol (r = ?0.57, 95% CI: ?0.87 to ?0.04). During the NB UV-B exposures, 25(OH)D₃ increased significantly, as expected, and IL-6 declined significantly by ?0.35 (95% CI: ?0.69 to ?0.07) pg/mL from the initial values of 1.12 ± 0.66 pg/mL (p = .025). In conclusion, in our pilot study, NB UV-B exposure improved mood, especially among those with evening preference for their daily activities, as well as circulating 25(OH)D₃ levels, whereas circulating IL-6 levels decreased.

Abbreviations: UVR: Ultraviolet radiation; NB UV-B: narrow-band UV-B; VAS: Visual Analogue Scales; β-END: β-endorphin; IL-6: Interleukin-6     

Eveningness is associated with skipping breakfast and poor nutritional intake in Brazilian undergraduate students

Some studies have proposed that self-reported eveningness, which reflects the preference of performing activities in the evening, may harm nutritional health and influence the eating behavior and nutritional status of individuals. However, the relationship between these variables (eveningness and nutritional status) and the consumption of breakfast, which is currently considered a marker of health, has been insufficiently explored by studies. The aim of this study was to investigate, in undergraduate students, the association between diurnal preference, being overweight, and food consumption (with special focus on breakfast). The study included 721 undergraduate students from a Brazilian public university. Dietary intake was assessed by 24-hour food recall, and the usual time for breakfast was identified. Body weight, height, and waist circumference were measured by trained researchers. Diurnal preference was determined by the Horne and Ostberg questionnaire validated for the Brazilian population, and the participants were classified into three categories: evening (coefficient: 16–41), intermediate type (coefficient: 42–58) or morning type (coefficient: 59–86). The prevalence of skipping breakfast was higher among the evening types (p = 0.02), when compared with morning and intermediate types. A negative association between the diurnal preference coefficient and total caloric (coefficient ?0.25, p = 0.007, r² adjusted = 0.12), carbohydrate (coefficient ?0.19, p = ?0.04, r² adjusted = 0.04) and lipid intake (coefficient ?0.18, p = 0.04, r² adjusted = 0.05) was also found in the breakfast skippers but not in breakfast eaters. In other words, breakfast skippers with diurnal preference values indicative of eveningness consumed more calories, carbohydrates and fats. Evening types presented significant odds of skipping breakfast (OR = 1.7, CI = 1.1–2.9, p = 0.02) when compared with morning and intermediate chronotypes. We conclude that eveningness is associated with skipping breakfast and a higher consumption of calories, carbohydrates and fats in breakfast skippers. These eating behaviors may predispose these individuals to being overweight.     

Chronotype and energy intake timing in relation to changes in anthropometrics: a 7-year follow-up study in adults

Individuals with a later preference for the daily activities (evening types) tend to have unhealthier behaviors, which could increase their risk for obesity when compared those with an earlier preference (morning types). Furthermore, later food intake timing, another behavior more characteristic of evening types, has been associated with obesity. However, chronotype differences in the long-term weight change and the role of chronotype in the association between energy intake timing and obesity risk are not clear. To study this we first examined the independent associations of chronotype and energy intake timing with anthropometric changes and then whether chronotype modified the association between energy intake timing and obesity risk. Our data included 1097 Finns from DILGOM (DIetary Lifestyle and Genetic Determinants of Obesity and Metabolic syndrome) 2007 (baseline) and 2014 (follow-up) and from Findiet 2007. Chronotype was assessed with a shortened version of Horne and Östberg’s morningness–eveningness questionnaire. Energy intake timing (as percentages of the total energy intake in the morning/evening) was assessed with 48-h dietary recalls. Weight, body mass index (BMI), and waist circumference were based on measured and self-reported values. Analysis of co-variance and multivariable logistic regression models were used for statistical analyses. Evening typed women had greater weight gain (+ 2.3 kg vs. + 0.3 kg, P = 0.016) and increase in BMI (0.7 kg/m² vs. ?0.1 kg/m², P = 0.024) than morning typed women. After excluding participants with depression, these associations attenuated to non-significant. Compared to participants whose energy intake was proportionally lowest during evening, those with proportionally highest energy intake during evening were more likely with obesity (BMI≥ 30 kg/m²) after follow-up (OR 1.97, 95% CI 1.21–3.21, Ptrend = 0.042). Participants’ chronotype did not modify this association (Pinteract = 0.95). In conclusion, our findings indicated that evening energy intake may play a role in obesity regardless of the chronotype. Furthermore, evening typed women were more prone to increases in their anthropometrics, which seem to be at least partly explained by depression. Further studies of this topic are warranted.     

Influence of Chronotype,Season, and Sex of Subject on Sleep Behavior of Young Adults

The aim of this study was to investigate whether sex, season, and/or chronotype influence the sleep behavior of university students. Detailed data were collected on activity/rest patterns by wrist actigraphy combined with diaries. Thirty‐four medical students (19 female and 15 male) were monitored by Actiwatch® actometers for 15 consecutive days in May and again in November. The data of a modified Horne and Östberg chronotype questionnaire, which were collected from 1573 female and 1124 male medical school students surveyed in the spring and autumn over an eight‐year period, were evaluated. Actiwatch® sleep analysis software was used to process the activity data with statistical analyses performed with ANOVA. We found no significant sex‐specific differences in sleep efficiency, sleep onset latency, or actual sleep‐time duration. However, we did find a difference in sleep efficiency between morning and evening types, with morning types having a higher sleep efficiency (87.9%, SD=1.3) than evening types (84.3%, SD=0.87%; p=0.007). Seasonal differences were also detected: the actual sleep‐time duration in autumn was significantly longer (mean 6.9 h, SD=0.13 h) than in spring (6.6 h, SD=0.1 h; p=0.013). Evaluation of the chronotype questionnaire data showed that individuals with no special preference for morningness or eveningness (i.e., so‐called intermediates) were most common. The distribution of chronotypes was related to the sex of subject. Men displayed eveningness significantly more often than women (28.9% males vs. 20.8% females; p<0.001), while females exhibited greater morningness (20.3% females vs.15.6% males; p<0.001). Sex influences chronotype distribution, but not actual sleep time‐duration, sleep onset latency, or sleep efficiency. The latter, however, differed among chronotypes, while actual sleep‐time duration was affected by season.     

Eveningness as a risk for behavioral problems in late adolescence

Circadian preference toward eveningness has been associated with increased risk for mental health problems both in early adolescence and in adulthood. However, in late adolescence, when circadian rhythm naturally shifts to later, its significance for mental health is not clear. Accordingly, we studied how circadian rhythm estimated both by self-reported chronotype and by actigraph-defined midpoint of sleep was associated with self-reported psychiatric problems based on Youth Self Report (YSR). The study builds on a community cohort born in 1998, Helsinki, Finland. At age 17 years (mean age = 16.9, SD = 0.1 years), 183 adolescents (65.6% of the invited) participated in the study. We used the shortened version of the Horne-Östberg morningness–eveningness Questionnaire to define the chronotype, and actigraphs to define the naturally occur circadian rhythm over a 4 to 17 days’ period (mean nights N = 8.3, SD = 1.8). The Achenbach software was used to obtain T-score values for YSR psychiatric problem scales. The analyses were adjusted for important covariates including gender, socioeconomic status, body mass index, pubertal maturation, mother’s licorice consumption during pregnancy, and actigraph-defined sleep duration and quality. Eveningness was associated with higher scores in rule-breaking behavior and conduct problems (as assessed either by midpoint of sleep or by self-reported chronotype, p-values <0.05), attention deficit/hyperactivity problems (by self-reported chronotype, p-values <0.05), with affective problems (by midpoint of sleep and by self-reported chronotype, p-values <0.05) and somatic complaints (by self-reported chronotype, p-values <0.05), as compared to circadian tendency toward morningness. Our results suggest that the association between eveningness and externalizing problem behavior, present in children and younger adolescents, is also present in late adolescence when circadian rhythms shift toward evening.     

Chronotype preference matters for depression in youth

Morningness/eveningness (M/E) preference is an important circadian rhythm indicator with strong individual variation. M/E chronotype has been found to be correlated with depression in adults, yet the relationship is less clear in children and adolescents. Additionally, poor sleep quality is another commonly studied risk factor for depression. The aims of the present study are to investigate the independent effects of M/E chronotype on youth depression using both self-report and parental-report questionnaires. We also evaluated how poor sleep quality may affect the relationship through a mediating or moderating effect. In total, 2,139 students attending grades 1 to 7 participated in this study. They completed questionnaires regarding M/E chronotype, depression, and sleep quality. A total of 1,708 parents also participated and filled out parental-reports of emotional and behavioral problems of their children. The prevalence of self- and parental-report depression was 16.8% and 12.8% among young students, respectively. Overall, 15.4% of the students were the eveningness type. Being an eveningness type was independently associated with self-report depression after adjustment for poor sleep quality (OR = 1.86, 95% CI = 1.07–3.24). We also observed that poor sleep quality mediated the influence of M/E chronotype on self-report depression among students aged 7–13 years (p < 0.001). On the other hand, being an eveningness type was associated with a number of parental-report emotional and behavioral problems in the students, in addition to depression, although these associations become non-significant after adjusted for poor sleep quality. Our results demonstrate the importance of M/E chronotype on youth depression and poor sleep quality partly mediates this effect.     

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.