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Many teenagers are familiar with this: on school days, they have to get up early; during the day, they hardly get any light exposure; in the evening, they go to bed late - and are then tired at school the next day! Around the world, teenagers are sleep deprived, with studies suggesting that almost half (~45%) suffer from inadequate sleep. Previous investigations have shown that people's sleep-wake rhythm is related to the light conditions that they are exposed to during the day and at night. However, little is known about how different light levels in the afternoon can modulate teenagers' sleep and their bodily responses to light in the late evening. Therefore, the investigators aim to study which lighting conditions have a favourable effect on these aspects and how the potentially harmful effects of light at night can be prevented.
Light exposure during adolescence seems to be the critical component of a vicious circle. Due to the maturation of sleep-wake regulatory systems in combination with progressively ill-timed exposure to light and early school start times, teenagers suffer from the accumulation of sleep depth during school days. Therefore, the proposed study investigates whether the physiological and alerting effects of late evening light exposure in adolescents depend on the intensity of light exposure in the preceding afternoon (primary endpoint: evening melatonin concentration).
The investigators aim to describe dose-response relationships, where the "dose" is the preceding (real-world applicable) afternoon light intensity (< 10 lx, ~100 lx, or >1000 lx EDI, 4-hour duration), and the "responses" are the adolescents' physiological and alerting responses to evening light exposure (~100 lx melanopic EDI, 4.5-hour duration). By this route, the researchers can explore whether increasing afternoon light exposure is a feasible target for ameliorating the detrimental effects of artificial light at night and promoting healthier sleep-wake regulation during adolescence.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Crossover sequence 1: Dim, Moderate, Bright | Experimental | All participants will go through all three light conditions in the three experiment sessions: They will receive white fluorescent overhead light (given in melanopic EDI at eye level) as the 4h afternoon light intervention. In the first experimental session, they receive an intensity of <10 lx. In the second experimental session, they receive an intensity of ~100 lx, and in the third experimental session, they receive an intensity of >1000 lx. |
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| Crossover sequence 2: Dim, Bright, Moderate | Experimental | All participants will go through all three light conditions in the three experiment sessions: They will receive white fluorescent overhead light (given in melanopic EDI at eye level) as the 4h afternoon light intervention. In the first experimental session, they receive an intensity of <10 lx. In the second experimental session, they receive an intensity of >1000 lx, and in the third experimental session, they receive an intensity of ~100 lx. |
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| Crossover sequence 3: Moderate, Dim, Bright | Experimental | All participants will go through all three light conditions in the three experiment sessions: They will receive white fluorescent overhead light (given in melanopic EDI at eye level) as the 4h afternoon light intervention. In the first experimental session, they receive an intensity of ~100 lx. In the second experimental session, they receive an intensity of <10 lx, and in the third experimental session, they receive an intensity of >1000 lx. | |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Dim light condition | Other | During the "Dim" light condition, the four-hour afternoon light exposure at the participants' eye level will be dim (<5 lx melanopic EDI). In the 4.5-hour evening light exposure, this will constitute a light intensity of ~100 lx melanopic EDI at the participants' eye level. |
| Measure | Description | Time Frame |
|---|---|---|
| Salivary melatonin | Salivary melatonin. Saliva samples (>1 mL) will be taken from the participants every 30 Minutes using Salivettes. The Salivettes will be centrifuged, the cotton part removed and immediately frozen at -20°C. At a later point, melatonin [in pg] will be determined in these samples by double-antibody radioimmunoassay (RIA). To quantify melatonin suppression, the analytic team will calculate the area under the curve (AUC) for each laboratory condition. | Through study completion, estimated 1.5 years (within 3 weeks for each participant) |
| Measure | Description | Time Frame |
|---|---|---|
| Sleep Onset Latency (PSG-derived) | The investigators will operationalise Sleep Onset Latency according to the American Academy of Sleep Medicine (AASM) Manual for the Scoring of Sleep and Associated Events (time interval from lights out to the first PSG-derived sleep epoch in minutes). | Through study completion, estimated 1.5 years (within 3 weeks for each participant) |
| Measure | Description | Time Frame |
|---|---|---|
| Ambulant light history. | To account for participants' light exposure before they arrive at the experimental site, ambulatory light exposure will be assessed throughout the three weeks of the experiment with actimetry devices (Condor ActTrust). Additionally, participants will be asked to estimate their duration of outdoor light exposure daily. During the experiment, participants will further be instructed to wear a lightweight light sensor. |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Christian Cajochen, PhD | Centre for Chronobiology, University Psychiatric Clinics Basel, Basel, Switzerland | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Psychiatric University Clinics (UPK), Centre for Chronobiology | Basel | Canton of Basel-City | 4002 | Switzerland |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 29590464 | Background | Galland BC, Short MA, Terrill P, Rigney G, Haszard JJ, Coussens S, Foster-Owens M, Biggs SN. Establishing normal values for pediatric nighttime sleep measured by actigraphy: a systematic review and meta-analysis. Sleep. 2018 Apr 1;41(4). doi: 10.1093/sleep/zsy017. | |
| 19546564 | Background | Hagenauer MH, Perryman JI, Lee TM, Carskadon MA. Adolescent changes in the homeostatic and circadian regulation of sleep. Dev Neurosci. 2009;31(4):276-84. doi: 10.1159/000216538. Epub 2009 Jun 17. |
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Deidentified, anonymised, non-sensitive data will be made available in a publicly accessible repository hosted on https://figshare.com/ after data collection, curation, and publication. The data will be licensed under Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). This allows for sharing (copying and redistributing the material in any medium or format) and adapting (remixing, transforming, and building upon the material) under the following terms: Users must give appropriate credit, provide a link to the license, and indicate if changes were made. Users may not use the material for commercial purposes. Parts of the anonymised data can become available even before due to journal publications. Therefore, apart from our research team, the dataset might benefit other research groups working on similar questions in the non-visual processing of light.
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The protocol is a full within-subject trial (cross-over). All participants will conduct three 18-hour experiment sessions and go through the same protocol except for the sequence of the experiment sessions (counter-balanced and randomised).
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Entirely blinding the differences between the experiment's light conditions is unattainable (for both participants and experimenters) because of the visibly perceivable differences in brightness between them. However, the melatonin and objective EEG measurements should not be significantly affected by any expectancy effects. Participants will not be told the expected effects of the different light exposure conditions to minimise the expectancy effects for behavioural measures (i.e., PVT) and subjective measurements. Information on the hypothesized outcomes will be withheld from the volunteers and study helpers until after completing all sessions. During the analysis, light intensity conditions and participant IDs will be coded to withhold information from the analytic team about the light intensity.
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| Crossover sequence 4: Moderate, Bright, Dim |
| Experimental |
All participants will go through all three light conditions in the three experiment sessions: They will receive white fluorescent overhead light (given in melanopic EDI at eye level) as the 4h afternoon light intervention. In the first experimental session, they receive an intensity of ~100 lx. In the second experimental session, they receive an intensity of >1000 lx, and in the third experimental session, they receive an intensity of <10 lx. |
| Crossover sequence 5: Bright, Moderate, Dim | Experimental | All participants will go through all three light conditions in the three experiment sessions: They will receive white fluorescent overhead light (given in melanopic EDI at eye level) as the 4h afternoon light intervention. In the first experimental session, they receive an intensity of >1000 lx. In the second experimental session, they receive an intensity of ~100 lx, and in the third experimental session, they receive an intensity of <10 lx. |
| Crossover sequence 6: Bright, Dim, Moderate | Experimental | All participants will go through all three light conditions in the three experiment sessions: They will receive white fluorescent overhead light (given in melanopic EDI at eye level) as the 4h afternoon light intervention. In the first experimental session, they receive an intensity of >1000 lx. In the second experimental session, they receive an intensity of <10 lx, and in the third experimental session, they receive an intensity of ~100 lx. |
|
| Moderate light condition | Other | During the "Moderate" light condition, the four-hour afternoon light exposure at the participants' eye level will be dim (~100 lx melanopic EDI). In the 4.5-hour evening light exposure, this will constitute a light intensity of ~100 lx melanopic EDI at the participants' eye level. |
|
| Bright light condition | Other | During the "Bright" light condition, the four-hour afternoon light exposure at the participants' eye level will be dim (>1000 lx melanopic EDI). In the 4.5-hour evening light exposure, this will constitute a light intensity of ~100 lx melanopic EDI at the participants' eye level. |
|
| Slow wave activity (PSG-derived) | The investigators will examine slow-wave activity (SWA; delta power density between 0.5 and 4.5 Hz) during the first sleep cycle. EEG slow-wave activity (SWA) (i.e., delta power density between 0.5 and 4.5 Hz) will be calculated as an indicator of sleep propensity across the night within each non-rapid eye movement NREM part of a sleep cycle. | Through study completion, estimated 1.5 years (within 3 weeks for each participant) |
| Sleep stages (PSG-derived) | The investigators will score the PSG-derived sleep stages and arousals according to the American Academy of Sleep Medicine (AASM) Manual for the Scoring of Sleep and Associated Events. | Through study completion, estimated 1.5 years (within 3 weeks for each participant) |
| Subjective sleepiness | The investigators will assess subjective sleepiness using the single-item 9-point Karolinska Sleepiness Scale (KSS) - a well-validated, highly sensitive subjective Likert-type measurement scale for subjective sleepiness. Scores range from 1 to 9 with higher values on the scale corresponding to higher sleepiness. | Through study completion, estimated 1.5 years (within 3 weeks for each participant) |
| Vigilant attention | Objective alertness will be measured using a modified auditory Psychomotor Vigilance Test (aPVT). After a response, the next tone will be played randomly after 2-10 s. The reaction time data will focus on mean 1/reaction time (mean 1/RT), the most sensitive measure for a slight deviation in sleep pressure. Mean 1/RT will be calculated after the removal of false starts and lapses. | Through study completion, estimated 1.5 years (within 3 weeks for each participant) |
| Melanopsin sensitivity (pupillary light response) | The investigators will measure changes in the pupil area using silent substitution pupillography and examine the differences between melanopsin response amplitude before the afternoon light condition (pre-light treatment) and the melanopsin response amplitude after the afternoon light condition (post-light treatment). | Through study completion, estimated 1.5 years (within 3 weeks for each participant) |
| Skin temperature | Skin temperature will be continuously monitored with six surface temperature thermocouples placed on proximal and distal regions of the body surface. Skin temperatures (distal & proximal) and the distal-proximal skin temperature gradient (DPG) will be calculated. | Through study completion, estimated 1.5 years (within 3 weeks for each participant) |
| Objective sleepiness 1 | The volunteers will perform a Karolinska Drowsiness Test (KDT) three times during scheduled wakefulness. During the KDT, participants fixate on a point on the wall from a one-meter distance for five minutes (eyes open). These sessions will provide EEG data with relatively few artefacts. As the first indicator for objective sleepiness, EEG-derived alpha/theta ratio will be calculated. | Through study completion, estimated 1.5 years (within 3 weeks for each participant) |
| Objective sleepiness 2 | The volunteers will perform a Karolinska Drowsiness Test (KDT) three times during scheduled wakefulness. During the KDT, participants fixate on a point on the wall from a one-meter distance for five minutes (eyes open). These sessions will provide EEG data with relatively few artefacts. As the second indicator for objective sleepiness, electro-oculogram-derived (EOG-derived) slow-eye movements will be calculated. | Through study completion, estimated 1.5 years (within 3 weeks for each participant) |
| Through study completion, estimated 1.5 years (within 3 weeks for each participant) |
| Actigraphy | Compliance to regular sleep-wake cycles over three weeks will be monitored with the actimetry device starting five days before the first experimental session (baseline + adaptation night) and ending with the final session. | Through study completion, estimated 1.5 years (within 3 weeks for each participant) |
| Visual comfort & well-being | An adapted German version of the first six items of the Visual Comfort Scale (VCS) will be used to assess the participant's visual comfort under the different lighting conditions. Additionally, participants will rate their momentary affect and well-being in relation to mood, hunger, relaxation, and motivation. Items are rated on a 7-point Likert-type scale (1-7) with higher values corresponding to a higher manifestation of the characteristic (for instance well-being, the brightness of the light etc.) | Through study completion, estimated 1.5 years (within 3 weeks for each participant) |
| Sleep diary | Volunteers will report their sleep and wake episodes using a sleep-wake diary (like a questionnaire). | Through study completion, estimated 1.5 years (within 3 weeks for each participant) |
| Sleep quality | In the mornings after the laboratory sleep, participants will additionally fill in a sleep quality questionnaire (Leeds Sleep Evaluation Questionnaire; LSEQ). The LSEQ is a 10-item, subjective, self-report measure that includes a visual analogue scale, where every item is scored from 0 to 10 where 10 corresponds to a higher manifestation of the characteristic (for instance tiredness). | Through study completion, estimated 1.5 years (within 3 weeks for each participant) |
| Dream recall | In the mornings after the laboratory sleep, participants will additionally fill in a dream recall questionnaire (Sleep Mentation Questionnaire) which addresses numerous characteristics of dream recall, such as the number of dreams, emotionality, vividness, pleasantness, hostility, and colourfulness, on a Likert-point scale (1: greatly, 2: fairly, 3: little, and 4: not at all). Higher values on the scale correspond to a lower frequency of dreams. | Through study completion, estimated 1.5 years (within 3 weeks for each participant) |
| 29648616 | Background | Lo JC, Lee SM, Lee XK, Sasmita K, Chee NIYN, Tandi J, Cher WS, Gooley JJ, Chee MWL. Sustained benefits of delaying school start time on adolescent sleep and well-being. Sleep. 2018 Jun 1;41(6):zsy052. doi: 10.1093/sleep/zsy052. |
| 32771123 | Background | Santhi N, Ball DM. Applications in sleep: How light affects sleep. Prog Brain Res. 2020;253:17-24. doi: 10.1016/bs.pbr.2020.05.029. Epub 2020 Jul 25. |
| 2265922 | Background | Akerstedt T, Gillberg M. Subjective and objective sleepiness in the active individual. Int J Neurosci. 1990 May;52(1-2):29-37. doi: 10.3109/00207459008994241. |
| 31069648 | Background | Gabel V, Kass M, Joyce DS, Spitschan M, Zeitzer JM. Auditory psychomotor vigilance testing in older and young adults: a revised threshold setting procedure. Sleep Breath. 2019 Sep;23(3):1021-1025. doi: 10.1007/s11325-019-01859-7. Epub 2019 May 8. |
| 30538662 | Background | Spitschan M, Woelders T. The Method of Silent Substitution for Examining Melanopsin Contributions to Pupil Control. Front Neurol. 2018 Nov 27;9:941. doi: 10.3389/fneur.2018.00941. eCollection 2018. |
| 6777817 | Background | Parrott AC, Hindmarch I. The Leeds Sleep Evaluation Questionnaire in psychopharmacological investigations - a review. Psychopharmacology (Berl). 1980;71(2):173-9. doi: 10.1007/BF00434408. |
| 19750925 | Background | Chellappa SL, Munch M, Blatter K, Knoblauch V, Cajochen C. Does the circadian modulation of dream recall modify with age? Sleep. 2009 Sep;32(9):1201-9. doi: 10.1093/sleep/32.9.1201. |