Circadian light therapy and light dose for depressed young people: a systematic review and meta-analysis.
Circadian light therapy and light dose for depressed young people: a systematic review and meta-analysis.
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DOI：
10.3389/fpubh.2023.1257093
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发表时间：
2023
影响因子：
5.2
通讯作者：
Cheng, Xiang
中科院分区：
文献类型：
--
作者：
Chen, Ranpeng;Yan, Yonghong;Cheng, Xiang
经验证据表明，光疗（LT）可以通过刺激昼夜节律来减轻抑郁症状。然而，存在怀疑和不确定的结果，以及对剂量的混淆。本研究的目的是量化光对昼夜节律系统的刺激作用，并建立一种有助于减少青少年和年轻人（AYAs）疾病的剂量-反应关系。这将为研究光干预的神经心理机制中至关重要的光暴露和神经反应提供参考。本研究旨在为临床应用提供指导。采用最新的CLA （circadian light）和CSt，f （circadian stimulus）定量模型，量化青年抑郁症相关光治疗中昼夜光导的光剂量。检索Web of Science、Cochrane Library、Medline （OVID）、CINAHL、APA PsycINFO、Embase和Scholars等网站截至2023年发表的文章。采用Stata17.0、CMA3.0 （comprehensive meta-analysis version 3.0）软件和Python 3.9平台对31篇文献（1031名受试者）进行光疗疗效比较和剂量反应定量分析。在光疗（LT）的不同昼夜节律刺激条件下（0.1 < CSt,f < 0.7）， AYAs的疾病减少（pooled SMD = - 1.59, 95%CI = - 1.86 ~ - 1.32; z = - 11.654, p = 0.000; I2 = 92.8%），时间模式（p = 0.044）和联合用药（p = 0.000）被认为是主要的异质性来源。对于具有较高昼夜节律刺激的LT的疗效优势（假定受可视化、联合用药、疾病严重程度和时间模式的影响），随机对照试验（rct）的荟萃分析发现，有证据表明，昼夜节律活跃的明亮光治疗（BLT）比昼夜节律不活跃的昏暗红光治疗(SMD = - 0.65, 95% CI = - 0.96至- 0.34;z = - 4.101, p = 0.000；I2 = 84.9%)或昼夜节律活跃的调光白光（SMD = - 0.37, 95% CI = - 0.68至- 0.06;z = - 2.318, p = 0.02; I2 = 33.8%），而昼夜节律活跃的绿蓝BLT与昼夜节律不活跃的红/琥珀色BLT相比没有显著优势（SMD = - 0.21, 95% CI = - 0.45至0.04;z = - 2.318, p = 0.099; I2 = 0%）。总体而言，与昏暗灯光对照相比，昼夜节律活性BLT显示出更大的临床反应可能性，并且在联合用药的情况下观察到更多的优势。对于治疗前后的改善和相应的剂量-反应关系，累积持续时间比其他分类（联合用药、严重程度、研究设计）或连续（CSt,f）变量更有影响。剂量-反应拟合表明，联合用药患者的治疗效果在32-42天（900 - 1000分钟）达到饱和，未用药的AYAs患者的治疗效果在58-59天（1100 - 1500分钟）达到饱和。当施加高昼夜节律光刺激（0.6 < CSt,f < 0.7）时，累计持续时间1000 - 1500 min的效应量显著大于持续时间< 1000或> 1500 min，这为实际指导提供了一个阈值。结果是基于有限的样本和受小样本效应的影响。安慰剂效应不容忽视。虽然高昼夜节律刺激下的BLT优于较暗的光照控制的优势尚未得到证实，但考虑到联合用药、疾病严重程度、时间模式和视觉特征，在aya中已经注意到具有昼夜节律活性的BLT的反应潜力更大。在不同条件下阐述了量化昼夜节律刺激和时间模式的剂量-反应关系，以支持大流行后时代抑郁症的临床治疗和LT设备的应用。
Empirical evidence has shown that light therapy (LT) can reduce depression symptoms by stimulating circadian rhythms. However, there is skepticism and inconclusive results, along with confusion regarding dosing. The purpose of this study is to quantify light as a stimulus for the circadian system and create a dose-response relationship that can help reduce maladies among adolescents and young adults (AYAs). This will provide a reference for light exposure and neural response, which are crucial in the neuropsychological mechanism of light intervention. The study also aims to provide guidance for clinical application. The latest quantitative model of CLA (circadian light) and CSt,f (circadian stimulus) was adopted to quantify light dose for circadian phototransduction in youth depression-related light therapy. Articles published up to 2023 through Web of Science, Cochrane Library, Medline (OVID), CINAHL, APA PsycINFO, Embase, and Scholars were retrieved. A meta-analysis of 31 articles (1,031 subjects) was performed using Stata17.0, CMA3.0 (comprehensive meta-analysis version 3.0) software, and Python 3.9 platform for light therapy efficacy comparison and dose-response quantification. Under various circadian stimulus conditions (0.1 < CSt,f < 0.7) of light therapy (LT), malady reductions among AYAs were observed (pooled SMD = −1.59, 95%CI = −1.86 to −1.32; z = −11.654, p = 0.000; I2 = 92.8%), with temporal pattern (p = 0.044) and co-medication (p = 0.000) suggested as main heterogeneity sources. For the efficacy advantage of LT with a higher circadian stimulus that is assumed to be influenced by visualization, co-medication, disease severity, and time pattern, sets of meta-analysis among random-controlled trials (RCTs) found evidence for significant efficacy of circadian-active bright light therapy (BLT) over circadian-inactive dim red light (SMD = −0.65, 95% CI = −0.96 to −0.34; z = −4.101, p = 0.000; I2 = 84.9%) or circadian-active dimmer white light (SMD = −0.37, 95% CI = −0.68 to −0.06; z = −2.318, p = 0.02; I2 = 33.8%), whereas green-blue, circadian-active BLT showed no significant superiority over circadian-inactive red/amber light controls (SMD = −0.21, 95% CI = −0.45 to 0.04; z = −2.318, p = 0.099; I2 = 0%). Overall, circadian-active BLT showed a greater likelihood of clinical response than dim light controls, with increased superiority observed with co-medication. For pre-to-post-treatment amelioration and corresponding dose-response relationship, cumulative duration was found more influential than other categorical (co-medication, severity, study design) or continuous (CSt,f) variables. Dose-response fitting indicated that the therapeutic effect would reach saturation among co-medicated patients at 32–42 days (900–1,000 min) and 58–59 days (1,100–1,500 min) among non-medicated AYAs. When exerting high circadian stimulus of light therapy (0.6 < CSt,f < 0.7), there was a significantly greater effect size in 1,000–1,500 min of accumulative duration than <1,000 or >1,500 min of duration, indicating a threshold for practical guidance. The results have been based on limited samples and influenced by a small sample effect. The placebo effect could not be ignored. Although the superiority of LT with higher circadian stimulus over dimmer light controls remains unproven, greater response potentials of circadian-active BLT have been noticed among AYAs, taking co-medication, disease severity, time pattern, and visual characteristics into consideration. The dose-response relationship with quantified circadian stimulus and temporal pattern had been elaborated under various conditions to support clinical depression treatment and LT device application in the post-pandemic era.
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影响因子：
2.5
作者：
Mayer JS;Hees K;Medda J;Grimm O;Asherson P;Bellina M;Colla M;Ibáñez P;Koch E;Martinez-Nicolas A;Muntaner-Mas A;Rommel A;Rommelse N;de Ruiter S;Ebner-Priemer UW;Kieser M;Ortega FB;Thome J;Buitelaar JK;Kuntsi J;Ramos-Quiroga JA;Reif A;Freitag CM
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影响因子：
7.3
作者：
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通讯作者：
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影响因子：
6.7
作者：
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通讯作者：
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