Sensitization of Human Circadian Responses to Light

描述(申请人提供)：睡眠障碍影响35%-40%的成年人，导致生活质量下降，发病率、死亡率以及汽车和职业事故的风险增加。昼夜节律睡眠障碍形成了一类不同的睡眠障碍，其特征是睡眠时间和昼夜节律起搏器之间的不一致。虽然光疗法可以有效地治疗昼夜节律睡眠障碍，但也有许多实际的局限性。光是来自环境的最强大的信号，它影响和调节日常的生物节奏。众所周知，光照的强度、持续时间和时间都会影响昼夜节律系统的反应。虽然曾经认为这些反应是通过视觉系统来调节的，但现在已经知道，存在一个固有的光敏性视网膜神经节细胞网络(IpRGC)来调节昼夜节律对光的反应。其他新的研究表明，最近的光暴露史影响了人类对光的昼夜反应。这些最新发现对用光治疗昼夜节律紊乱有重要意义，包括延迟和晚期睡眠相障碍、轮班工作睡眠障碍和时差，它们也可能与用光治疗季节性情感障碍有关。到目前为止，在这种光处理之前，很少有人关注光暴露的持续时间或强度。我们现在有证据表明，人类的昼夜节律系统在长时间的暴露中可以对光变得不敏感，而且有证据表明，它可以通过事先暴露在昏暗的光线中而对光敏感。这些最新的发现表明，在光治疗之前敏化昼夜节律系统的光治疗方案将比目前使用的方案更有效。我们提出的研究将检验在标准化光治疗之前四种不同持续时间的暗光敏化对人体昼夜节律系统的影响。这些结果将在随机交叉设计研究的受试者中进行比较，在该研究中，每个健康受试者将接受对照治疗和预先进行暗光敏化的光照治疗。我们还将包括一组睡眠相障碍延迟患者，以在目标患者群体中测试这些机制。我们的发现将为理解如何利用有关昼夜节律感光系统的新知识来改进和提供更好的昼夜节律紊乱的治疗选择提供重要的一步。 公共卫生相关性：昼夜节律紊乱是一类睡眠紊乱，其特征是睡眠时间和昼夜节律起搏器之间的不一致。光疗法可以有效地治疗这些疾病，但这样做所需的光暴露强度和持续时间限制了其实际应用。在这里，我们将测试预先暴露在昏暗的光线下如何增强昼夜节律系统对光疗的反应，从而产生更短的治疗，具有更大的实际应用。

DESCRIPTION (provided by applicant): Sleep disorders affect 35-40% of adults, resulting in diminished quality of life, and increased morbidity, mortality, and risk of automobile and occupational accidents. Circadian rhythm sleep disorders form a distinct class of sleep disorders characterized by misalignment between the timing of sleep and the circadian pacemaker. While light therapy can be an effective treatment of circadian rhythm sleep disorders, there are numerous practical limitations. Light is the most powerful signal from the environment that influences and regulates daily biological rhythms. It is well-established that the irradiance, duration, and timing of light exposure all affect the response of the circadian system. While it was once thought that these responses were mediated through the visual system, it is now known that there is a network of intrinsically photosensitive retinal ganglion cells (ipRGCs) that mediate circadian responses to light. Other new studies have demonstrated that recent light exposure history affects the circadian response to light in humans. These recent findings have important implications for the use of light to treat circadian rhythm disorders, including delayed and advanced sleep phase disorders, shift work sleep disorder, and jet lag, and they may also have relevance for the use of light to treat seasonal affective disorder. Up to now, little attention has been paid to the duration or intensity of light exposure prior to such light treatments. We now have evidence that the human circadian system can become desensitized to light during long exposures and evidence that it can be sensitized to light by prior exposure to dim light. These recent findings suggest that light treatment protocols that sensitize the circadian system prior to the light treatment will be more effective than those currently in use. The studies we propose will examine the effect on the human circadian system of four different durations of dim-light sensitization prior to a standardized light treatment. These results will be compared within subjects in a randomized cross-over design study in which each healthy subject will receive a control treatment and a light treatment with prior dim-light sensitization. We will also include one group of delayed sleep phase disorder patients to test these mechanisms in the target patient population. Our findings will provide an important step in understanding how new knowledge about the circadian photoreceptive system can be used to refine and provide better treatment options for circadian rhythm disorders. PUBLIC HEALTH RELEVANCE: Circadian rhythm disorders are a class of sleep disorders characterized by misalignment between the timing of sleep and the circadian pacemaker. Light therapy can effectively treat these disorders, but the intensity and duration of light exposure required to do so has limited its practical use. Here we will test how pre exposure to dim light can enhance the response of the circadian system to light therapy, resulting in shorter treatments that have greater practical application.