The interest in the systematic study of the circadian typology (CT) is relatively recent and has developed rapidly in the two last decades. All the existing data suggest that this individual difference affects our biological and psychological functioning, not only in health, but also in disease. In the present study, we review the current literature concerning the psychometric properties and validity of CT measures as well as individual, environmental and genetic factors that influence the CT. We present a brief overview of the biological markers that are used to define differences between CT groups (sleep-wake cycle, body temperature, cortisol and melatonin), and we assess the implications for CT and adjustment to shiftwork and jet lag. We also review the differences between CT in terms of cognitive abilities, personality traits and the incidence of psychiatric disorders. When necessary, we have emphasized the methodological limitations that exist today and suggested some future avenues of work in order to overcome these. This is a new field of interest to professionals in many different areas (research, labor, academic and clinical), and this review provides a state of the art discussion to allow professionals to integrate chronobiological aspects of human behavior into their daily practice.

Circadian typology: a comprehensive review.

The expanding science of circadian rhythm biology and a growing literature in human clinical research on circadian rhythm sleep disorders (CRSDs) prompted the American Academy of Sleep Medicine (AASM) to convene a task force of experts to write a review of this important topic. Due to the extensive nature of the disorders covered, the review was written in two sections. The first review paper, in addition to providing a general introduction to circadian biology, addresses "exogenous" circadian rhythm sleep disorders, including shift work disorder (SWD) and jet lag disorder (JLD). The second review paper addresses the "endogenous" circadian rhythm sleep disorders, including advanced sleep phase disorder (ASPD), delayed sleep phase disorder (DSPD), irregular sleep-wake rhythm (ISWR), and the non-24-hour sleep-wake syndrome (nonentrained type) or free-running disorder (FRD). These practice parameters were developed by the Standards of Practice Committee and reviewed and approved by the Board of Directors of the AASM to present recommendations for the assessment and treatment of CRSDs based on the two accompanying comprehensive reviews. The main diagnostic tools considered include sleep logs, actigraphy, the Morningness-Eveningness Questionnaire (MEQ), circadian phase markers, and polysomnography. Use of a sleep log or diary is indicated in the assessment of patients with a suspected circadian rhythm sleep disorder (Guideline). Actigraphy is indicated to assist in evaluation of patients suspected of circadian rhythm disorders (strength of recommendation varies from "Option" to "Guideline," depending on the suspected CRSD). Polysomnography is not routinely indicated for the diagnosis of CRSDs, but may be indicated to rule out another primary sleep disorder (Standard). There is insufficient evidence to justify the use of MEQ for the routine clinical evaluation of CRSDs (Option). Circadian phase markers are useful to determine circadian phase and confirm the diagnosis of FRD in sighted and unsighted patients but there is insufficient evidence to recommend their routine use in the diagnosis of SWD, JLD, ASPD, DSPD, or ISWR (Option). Additionally, actigraphy is useful as an outcome measure in evaluating the response to treatment for CRSDs (Guideline). A range of therapeutic interventions were considered including planned sleep schedules, timed light exposure, timed melatonin doses, hypnotics, stimulants, and alerting agents. Planned or prescribed sleep schedules are indicated in SWD (Standard) and in JLD, DSPD, ASPD, ISWR (excluding elderly-demented/nursing home residents), and FRD (Option). Specifically dosed and timed light exposure is indicated for each of the circadian disorders with variable success (Option). Timed melatonin administration is indicated for JLD (Standard); SWD, DSPD, and FRD in unsighted persons (Guideline); and for ASPD, FRD in sighted individuals, and for ISWR in children with moderate to severe psychomotor retardation (Option). Hypnotic medications may be indicated to promote or improve daytime sleep among night shift workers (Guideline) and to treat jet lag-induced insomnia (Option). Stimulants may be indicated to improve alertness in JLD and SWD (Option) but may have risks that must be weighed prior to use. Modafinil may be indicated to improve alertness during the night shift for patients with SWD (Guideline).

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Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders. An American Academy of Sleep Medicine report.

Objective:
This the first of two articles reviewing the scientific literature on the evaluation and treatment of circadian rhythm sleep disorders (CRSDs), employing the methodology of evidence-based medicine. In this first part of this paper, the general principles of circadian biology that underlie clinical evaluation and treatment are reviewed. We then report on the accumulated evidence regarding the evaluation and treatment of shift work disorder (SWD) and jet lag disorder (JLD).

https://faculty.washington.edu/vitiello/Recent%20Publications/AASM%20CRSD%20I.pdf

Circadian Rhythm Sleep Disorders: Part I, Basic Principles, Shift Work and Jet Lag Disorders An American Academy of Sleep Medicine Review

The global impact of breast cancer is large and growing. It seems clear that something about modern life is the culprit, yet there is thus far a lack of satisfactory explanations for most of the increases in risk as societies industrialize. Support has developed for a possible role of "circadian disruption," particularly from an altered-lighted environment (such as light at night). Lighting during the night of sufficient intensity can disrupt circadian rhythms, including reduction of circulating melatonin levels and resetting of the circadian pacemaker of the suprachiasmatic nuclei. Reduced melatonin may increase breast cancer risk through several mechanisms, including increased estrogen production and altered estrogen receptor function. The genes that drive the circadian rhythm are emerging as central players in gene regulation throughout the organism, particularly for cell-cycle regulatory genes and the genes of apoptosis. Aspects of modern life that can disrupt circadian rhythms during the key developmental periods (eg, in utero and during adolescence) may be particularly harmful. Epidemiologic studies should consider gene and environment interactions such as circadian gene variants and shift work requirements on the job.

Circadian disruption and breast cancer: from melatonin to clock genes.

Melatonin is of great importance to the investigation of human biological rhythms. Its rhythm in plasma or saliva provides the best available measure of the timing of the internal circadian clock. Its major metabolite 6-sulphatoxymelatonin is robust and easily measured in urine. It thus enables long-term monitoring of human rhythms in real-life situations where rhythms may be disturbed, and in clinical situations where invasive procedures are difficult. Melatonin is not only a "hand of the clock"; endogenous melatonin acts to reinforce the functioning of the human circadian system, probably in many ways. Most is known about its relationship to sleep and the decline in core body temperature and alertness at night. Current perspectives also include a possible influence on major disease risk, arising from circadian rhythm disruption. Melatonin clearly has the ability to induce sleepiness and lower core body temperature during "biological day" and to change the timing of human rhythms when treatment is appropriately timed. It can entrain free-running rhythms and maintain entrainment in most blind and some sighted people. Used therapeutically it has proved a successful treatment for circadian rhythm disorder, particularly the non-24-h sleep wake disorder of the blind. Numerous other clinical applications are under investigation. There are, however, areas of controversy, large gaps in knowledge, and insufficient standardization of experimental conditions and analysis for general conclusions to be drawn with regard to most situations. The future holds much promise for melatonin as a therapeutic treatment. Most interesting, however, will be the dissection of its effects on human genes.

Melatonin: characteristics, concerns, and prospects.

Die Vergleichbarkeit mit der internationalen Literatur ist ein entscheidendes Kriterium bei der Wahl von Testinstrumenten. Zur Identifizierung der subjektiven zirkadianen Phasenlage (Chronotyp) werden im deutschen Sprachraum daher meist Ubersetzungen des Morningness-Eveningness-Questionnaires (MEQ, Horne & Ostberg, Int J Chronobiol 4:97–110, 1976) angewendet. In der vorliegenden Arbeit wurde die Validitat einer deutschen Ubersetzung des MEQ (D-MEQ) gepruft. Als Kriterien dienten der validierte Fragebogen zur subjektiven zirkadianen Phasenlage (SCP, R Moog, in Reinberg, Vieux, Andlauer (eds): night and shift work. Biological and social aspects. Pergamon Press Oxford, 1981) sowie der Nadir der Korperkerntemperatur und der Beginn der nachtlich erhohten Melatoninkonzentration im Speichel.

Zur Validität der deutschen Übersetzung des Morningness-Eveningness-Questionnaires von Horne und Östberg

Every fire fighter needs to wear fire-protective clothing and a self-contained breathing apparatus (SCBA) several times a year while carrying out various fire-fighting and rescue operations in hazardous work environments. The aim of the present study was to quantify the effects of a multilayer turnout suit designed to fulfil European standard EN 469 used over standardized (Nordic) clothing and with SCBA (total mass 25.9 kg) on maximal physical work performance, and to evaluate the relationship between individual characteristics and power output with the fire-protective clothing system and SCBA. The subjects were 12 healthy firemen aged 26–46 years. The range of their body mass, body fat and maximal oxygen consumption was 69–101 kg, 10–20% and 2.70–5.86 1·min−1, respectively. The maximal tests without (control) and with the fire-protective clothing system and SCBA were carried out on a treadmill in a thermoneutral environment. When compared to the control test, the decrease in the maximal power output in terms of maximal working time and walking speed averaged 25% (P < 0.001) varying from 18% to 34% with the fire-protective clothing system and SCBA. At maximum, no significant differences were found in pulmonary ventilation, absolute oxygen consumption, the respiratory exchange ratio, heart rate, systolic blood pressure, the rate-pressure product, mechanical efficiency, and the rating of perceived exertion between the tests with and without the fire-protective clothing system and SCBA. The reduction of the power output was related to the extra mass of the fire protective clothing and SCBA. In this study, robust build and parameters associated with good anaerobic capacity were the most powerful individual characteristics contributing to the smallest drop in the power output with the fire-protective clothing system and SCBA. All possible means to decrease the mass of both the fire-protective clothing system and SCBA for maintaining the sufficient power output in physically demanding fire-fighting and rescue tasks need to be considered.

Maximal physical work performance with European standard based fire-protective clothing system and equipment in relation to individual characteristics.

Evaluation of performance and load in simulated rescue tasks for a novel design SCBA: effect of weight, volume and weight distribution.

The impact of draught related to air velocity, air temperature and workload.

Hypothesis Melatonin synthesis, which is directly controlled by the central circadian pacemaker indicates the circadian phase better than rectal temperature. Methods Thirty four men (16-32 years, 7 morning, 13 neither, 14 evening types) performed a constant routine (24-26-hr bedrest, <30 lux, 18-20degreesC, hourly isocaloric diet). Salivary melatonin level was determined hourly and rectal temperature was continuously recorded. Results The nadir of rectal temperature occurred 1.5 hr (P = 0.017), the onset of melatonin synthesis 3 hr earlier (P < 0.0001) in morning than in evening types. Morningness was not related to the quantitative but significantly to the temporal parameters, closer to those of melatonin than of rectal temperature. Conclusions The melatonin onset is a more reliable indicator of the diurnal type than the nadir of rectal temperature. As morningness has been associated with intolerance to shiftwork, melatonin profiling provides a suitable basis for the establishment of directed preventive measures. (C) 2002 Wiley-Liss, Inc.

Christa Künemund

Papers

Zur Validität der deutschen Übersetzung des Morningness-Eveningness-Questionnaires von Horne und Östberg

Maximal physical work performance with European standard based fire-protective clothing system and equipment in relation to individual characteristics.

Evaluation of performance and load in simulated rescue tasks for a novel design SCBA: effect of weight, volume and weight distribution.

The impact of draught related to air velocity, air temperature and workload.

Melatonin synthesis: a possible indicator of intolerance to shiftwork.