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Biomedical subjects

Daniel F Kripke

Publications and source records attributed to Daniel F Kripke.

49 records · Page 3Linked to original sources
PubMed2002

Mortality associated with sleep duration and insomnia.

BACKGROUND: Patients often complain about insufficient sleep or chronic insomnia in the belief that they need 8 hours of sleep. Treatment strategies may be guided by what sleep durations predict optimal survival and whether insomnia might signal mortality risks. METHODS: In 1982, the Cancer Prevention Study II of the American Cancer Society asked participants about their sleep duration and frequency of insomnia. Cox proportional hazards survival models were computed to determine whether sleep duration or frequency of insomnia was associated with excess mortality up to 1988, controlling simultaneously for demographics, habits, health factors, and use of various medications. RESULTS: Participants were more than 1.1 million men and women from 30 to 102 years of age. The best survival was found among those who slept 7 hours per night. Participants who reported sleeping 8 hours or more experienced significantly increased mortality hazard, as did those who slept 6 hours or less. The increased risk exceeded 15% for those reporting more than 8.5 hours sleep or less than 3.5 or 4.5 hours. In contrast, reports of "insomnia" were not associated with excess mortality hazard. As previously described, prescription sleeping pill use was associated with significantly increased mortality after control for reported sleep durations and insomnia. CONCLUSIONS: Patients can be reassured that short sleep and insomnia seem associated with little risk distinct from comorbidities. Slight risks associated with 8 or more hours of sleep and sleeping pill use need further study. Causality is unproven.

Adult↗
PubMed2002

Bright light augments antidepressant effects of medication and wake therapy.

Inpatient studies have suggested that bright light therapy can be used to sustain the antidepressant effects of wake therapy (sleep deprivation). In an outpatient trial, a half night of home wake treatment was followed by 1 week of light treatment. All subjects had Major Depressive Disorders according to DSM-IV criteria and were receiving concomitant antidepressant medication. Subjects were randomly assigned to receive either 10,000 lux bright white light for 30 min between 6 and 9 AM or dim red (placebo) light at a comparable time. Seven subjects completed treatment with bright white light and six completed treatment with placebo. On the Hamilton Depression Rating Scale (HDRS17, SIGH-SAD-SR version), the group receiving bright light improved 27% in 1 week (P=0.002). The group receiving placebo did not improve, except for one outlier. The benefit of bright light was significant compared to placebo with removal of the outlier (P<0.025).

Adult↗
PubMed2002

No association of 6-sulfatoxymelatonin with in-bed 60-Hz magnetic field exposure or illumination level among older adults.

We examined the association of 6-sulfatoxymelatonin (aMT6s) excretion with in-bed 60-Hz magnetic field (MF) exposure and other potential regulators. Adults aged 50-81 years (n=242 years, mean 67.6+/-5.7 years) were monitored for 1 week in their home environments. Mean and maximum MF exposure were assessed with EMDEX Lite instruments. Illumination mesor, amplitude, and acrophase (peak time) were determined from 24-h Actillume wrist monitors. Other regulators of aMT6s assessed were age, usage of melatonin-altering medications, and day length. During two 24-h intervals, all urine voidings were collected. The mesor, amplitude, and acrophase of aMT6s excretion were determined. Multiple regression analyses revealed no association between MF and aMT6s. Medication usage was associated with significantly lower aMT6s mesor and amplitude. Illumination acrophase and amplitude were significantly associated with aMT6s acrophase. These data suggest no influence of nocturnal environmental MF exposure on aMT6s excretion in older adults.

Aged↗
PubMed2002

Depression and endogenous melatonin in postmenopausal women.

BACKGROUND: Previous reports on melatonin secretion in depression are numerous but conflicting. There are very few studies relating the duration of the nocturnal melatonin peak to depression, and the results of those studies have been equivocal. METHODS: We studied mood disorders and urinary melatonin excretion in 382 postmenopausal women. Psychiatric diagnoses and global assessment of functioning (GAF) scores were determined based on a Structured Clinical Interview for DSM-IV Axis I Disorders (SCID). Urinary 6-sulfatoxymelatonin (6-SMT) samples were collected for two 24-h periods at home. RESULTS: A positive family history of depression was significantly related to a longer duration of 6-SMT excretion. There were marginally significant associations between current major depression and delayed offset of 6-SMT excretion and between later acrophase and lifetime major depression, even with control for age, ethnicity, season, and several medications. LIMITATIONS: The subjects were studied in their home environments, where light effects were not controlled. Data were restricted to postmenopausal women, including a limited number of subjects with current major depression. CONCLUSIONS: These results suggest that there might be a familial vulnerability in the endogenous melatonin signal in subjects prone to depression, and an abnormality in the duration of the melatonin signal in those with current major depression.

Aged↗
PubMed2002

Effect of light treatment on sleep and circadian rhythms in demented nursing home patients.

OBJECTIVES: To determine whether fragmented sleep in nursing home patients would improve with increased exposure to bright light. DESIGN: Randomized controlled trial. SETTING: Two San Diego-area nursing homes. PARTICIPANTS: Seventy-seven (58 women, 19 men) nursing home residents participated. Mean age +/- standard deviation was 85.7 +/- 7.3 (range 60-100) and mean Mini-Mental State Examination was 12.8 +/- 8.8 (range 0-30). INTERVENTIONS: Participants were assigned to one of four treatments: evening bright light, morning bright light, daytime sleep restriction, or evening dim red light. MEASUREMENTS: Improvement in nighttime sleep quality, daytime alertness, and circadian activity rhythm parameters. RESULTS: There were no improvements in nighttime sleep or daytime alertness in any of the treatment groups. Morning bright light delayed the peak of the activity rhythm (acrophase) and increased the mean activity level (mesor). In addition, subjects in the morning bright light group had improved activity rhythmicity during the 10 days of treatment. CONCLUSION: Increasing exposure to morning bright light delayed the acrophase of the activity rhythm and made the circadian rhythm more robust. These changes have the potential to be clinically beneficial because it may be easier to provide nursing care to patients whose circadian activity patterns are more socially acceptable.

Aged↗
PubMed2002

Evening light exposure: implications for sleep and depression.

OBJECTIVES: To examine whether dim illumination in the evening is a factor in sleep disturbances of aging, depression, and circadian phase advance. DESIGN: One-week continuous recordings were made to record illumination exposure and to infer 24-hour sleep patterns from wrist activity. SETTING: Recordings took place during normal home and community activities. PARTICIPANTS: Complete data of 154 postmenopausal women, mean age 66.7, were selected from a larger study of participants in the Women's Health Initiative. MEASUREMENTS: Illumination in lux was averaged for 4 hours before bedtime and over 24 hours. Mood was measured using a brief eight-item screen. RESULTS: Illumination in the 4 hours before bedtime was quite dim: median 24 lux. Nevertheless, evening light exposure was not significantly related to sleep amount (in bed or out of bed) sleep efficiency, sleep latency, wake within sleep, or mood. In contrast, the overall amount of light throughout the 24 hours was negatively correlated with sleep latency, wake within sleep, and depressed mood. CONCLUSIONS: Low evening lighting does not appear to be a crucial factor in sleep and mood disturbances of aging, but overall lighting may contribute to these disturbances.

Aged↗
PubMed2002

Illumination of upper and middle visual fields produces equivalent suppression of melatonin in older volunteers.

Bright light treatment has become an important method of treating depression and circadian rhythm sleep disorders. The efficacy of bright light treatment may be dependent upon the position of the light-source, as it determines the relative illumination in each portion of the visual field. This study compared illumination of upper and middle visual fields to determine whether melatonin suppression is different or equivalent. Thirteen older volunteers received three illumination conditions in counterbalanced orders: 1000 lux in the upper visual field, 1000 lux in the middle visual field, or dim diffuse illumination < 5 lux. A four-choice reaction time task was performed during tests to ensure eye direction and illumination of the intended portion of the visual field. Illumination in the upper and middle visual fields significantly suppressed melatonin compared to < 5 lux (p < 0.001). Melatonin suppression was not significantly different with upper or middle field illumination. These results indicate that bright light treatments placed above the eye level might be as effective as those requiring patients to look directly at the light source. Clinical comparative testing would be valuable. In addition, this study demonstrates that significant suppression of melatonin may be achieved through the use of bright light in healthy older volunteers.

Aged↗
PubMed2002

Circadian phase-delaying effects of bright light alone and combined with exercise in humans.

In a within-subjects (n = 18), counterbalanced design, the circadian phase-shifting effects of 3 h of 1) bright light (3,000 lx) alone 2) and bright light combined with vigorous exercise were compared. For each treatment, volunteers spent 3 nights and 2 days in the laboratory, typically receiving the treatment from approximately 2300 to 0200 on night 2. Bedtimes and waketimes were fixed to the volunteers' habits. Illumination was 50 lx during other wake hours and 0 lx during sleep. Bright Light Alone elicited a significant phase delay in rectal temperature minimum (70 min), but not in urinary 6-sulphatoxymelatonin (6-SMT) acrophase (20 min). Bright Light + Exercise elicited a significant phase delay in 6-SMT (68 min), but did not result in a significant difference in shift compared with Bright Light Alone. The study had adequate statistical power (80%) to detect phase-shift differences between treatments of approximately 2-2.5 h. Thus any antagonism of light shifts with exercise could not have been revealed. Within the limited exercise and light parameters of this study, the results suggest that exercise does not reliably modulate phase-shifting effects of late night bright light in humans.

Adolescent↗
PubMed2002

Bright-light mask treatment of delayed sleep phase syndrome.

We treated delayed sleep phase syndrome (DSPS) with an illuminated mask that provides light through closed eyelids during sleep. Volunteers received either bright white light (2,700 lux, n = 28) or dim red light placebo (0.1 lux, n = 26) for 26 days at home. Mask lights were turned on (< 0.01 lux) 4 h before arising, ramped up for 1 h, and remained on at full brightness until arising. Volunteers also attempted to systematically advance sleep time, avoid naps, and avoid evening bright light. The light mask was well tolerated and produced little sleep disturbance. The acrophase of urinary 6-sulphatoxymelatonin (6-SMT) excretion advanced significantly from baseline in the bright group (p < 0.0006) and not in the dim group, but final phases were not significantly earlier in the bright group (ANCOVA ns). Bright treatment did produce significantly earlier phases, however, among volunteers whose baseline 6-SMT acrophase was later than the median of 0602 h (bright shift: 0732-0554 h, p < 0.0009; dim shift: 0746-0717 h, ns; ANCOVA p = 0.03). In this subgroup, sleep onset advanced significantly only with bright but not dim treatment (sleep onset shift: bright 0306-0145 h, p < 0.0002; dim 0229-0211 h, ns; ANCOVA p < .05). Despite equal expectations at baseline, participants rated bright treatment as more effective than dim treatment (p < 0.04). We conclude that bright-light mask treatment advances circadian phase and provides clinical benefit in DSPS individuals whose initial circadian delay is relatively severe.

Adolescent↗
PubMed2002

Delayed and advanced sleep phase symptoms.

Current criteria for circadian rhythm sleep disorders require a mismatch between the endogenous circadian sleep tendency and exogenous environmental requirements for sleep timing. To examine the prevalence of circadian rhythm sleep disorders by DSM-IV criteria, sleep complaints and objectively-measured sleep timing were sampled in a population aged 40-64 years. Randomly selected volunteers were interviewed concerning sleep complaints. Then, objective sleep timing was estimated from wrist activity recordings and environmental illumination data. In this age group, advance-related complaints (trouble staying awake until bedtime and troubled by waking up early in the morning) were found together in 7.4%. Less prevalent were delay-related complaints reported together in 3.1% (trouble falling asleep and trouble waking up in the morning). However, no significant correlations or clusters were found pairing these sleep complaints with recorded sleep timing. The distributions of objectively-recorded lights-out times and arising times were consistently later than the questionnaire-reported times. Thus, complaints suggesting circadian rhythm advance or delay mismatches were common, but evidently such complaints do not usually correspond with objective abnormalities of observed sleep timing.

Circadian Rhythm↗
PubMed2002

Twenty-four-hour pattern of intraocular pressure in young adults with moderate to severe myopia.

PURPOSE: To characterize the 24-hour change of intraocular pressure (IOP) in young adults with moderate to severe myopia. METHODS: Nineteen young adults, ages 18 to 25 years, with moderate to severe myopia (myopia group) and 17 age-matched volunteers with emmetropia or mild myopia (control group) were housed for 1 day in a sleep laboratory. An 8-hour accustomed sleep period was assigned to each volunteer. Twelve measurements of IOP, axial length, blood pressure, and heart rate were taken at 2-hour intervals. In the wake period, blood pressure and heart rate were measured after a 5-minute bed rest. Axial length and IOP were measured in supine volunteers. Volunteers then sat for 5 minutes, after which IOP was measured. In the sleep period, measurements were taken in supine volunteers in bed. RESULTS: In both the myopia and control groups, the average supine IOP in the sleep period was higher than the average sitting IOP in the wake period. However, the magnitude of this IOP elevation at night was significantly less in the myopia group. In the sleep period, IOP was less in the myopia group than in the control group. When only the 24-hour supine IOP data were considered, the trough occurred at 1:30 AM, and the peak occurred around noon in the myopia group. In the control group, the trough was at 9:30 PM, and the peak at 5:30 AM. Least-square cosine fits showed 24-hour rhythms of supine IOP in both groups, but their phase timings were different. Axial length remained unchanged throughout the day and night in both groups. There was no difference in the 24-hour rhythms of mean blood pressure and heart rate between the two groups. CONCLUSIONS: Considering habitual body positions, IOP increases at night in young adults with moderate to severe myopia, but the magnitude of the increase is significantly less than that in the age-matched control subjects. There is a 24-hour rhythm of supine IOP in the myopic group, but the phase timing is different from that in the control subjects. These variations of IOP in young adults with moderate to severe myopia are not related to changes in cardiovascular parameters.

Adolescent↗
PubMedDate not supplied

Self-reported sleep complaints with long and short sleep: a nationally representative sample.

OBJECTIVE: Although the problems associated with insufficient sleep have been thoroughly researched, there has been far less substantiation of problems associated with long sleep. Recent evidence shows that habitual sleep duration greater than 7 hours is associated with increased rates of mortality. This study compared the rates of sleep problems in both long and short sleepers. METHODS: Self-reported sleep complaints (eg, sleep onset latency, awakenings during the night, early morning awakenings, nonrestorative sleep, and daytime sleepiness) of nearly 1000 adults who participated in the National Sleep Foundation's 2001 Sleep in America Poll, were compared with reported hours of weekday sleep. RESULTS: There are U-shaped relationships of sleep complaints with reported weekday total sleep time. More specifically, 8-hour sleepers reported less frequent symptoms than long sleepers or 7-hour sleepers. CONCLUSIONS: Thus, long sleepers, as well as short sleepers, report sleep problems, focusing attention to the often-overlooked problems of the long sleeper.

Adolescent↗