Distal-proximal Skin Temperature Gradient Research Articles

Subjective sleep onset latency is influenced by sleep structure and body heat loss in human subjects.

The present study examined the relationship between subjective sleep onset latency (SOL), sleep structure, changes in skin and body temperature, and subjective evaluation of sleep in healthy young adults to elucidate the pathophysiological mechanisms of insomnia. A total of 28 participants (age 21.54 [0.50] years) with no sleep problems participated in a 1-h polysomnographic recording that obtained objective sleep parameters during the daytime while skin and body temperatures were recorded. The distal-proximal skin temperature gradient (DPG) was calculated. Subjective parameters, such as subjective SOL, sleep time, and restorative sleepiness, were evaluated before and after sleep. Most participants estimated their sleep latency as being longer than their actual SOL (13.7 versus 7.6 min). Objective SOL was significantly correlated with each sleep stage parameter whereas subjective SOL was negatively correlated with Stage N2 sleep duration (Rho = -0.454, p = 0.020), slow-wave activity and delta power (Rho = -0.500, p = 0.011 and Rho = -0.432, p = 0.031, respectively), and ΔDPG (the degree of reduction of heat loss before and after lights-off). Stepwise regression analysis showed that ΔDPG was the strongest predictive factor in explaining the length of subjective SOL. The degree of heat dissipation before and after lights-off contributed most to the sensation of falling asleep in healthy young adults. This finding may be helpful for elucidating the physiological mechanisms of insomnia and its treatment.

0011 Daily verses circadian amplitude of the distal-proximal skin temperature gradient

Abstract Introduction Sleep, circadian rhythms, and thermoregulatory physiology are highly integrated and impact each other. The daily rhythm in the distal-proximal skin temperature gradient (DPG) is wider/more negative during wakefulness, and narrower/closer to zero during sleep. The circadian rhythm in the DPG is wider during the biological day and narrower during the biological night. Here we aimed to quantify and compare the amplitude of the daily rhythm in the DPG under wakefulness-sleep conditions versus the amplitude of the circadian rhythm in the DPG under sleep deprivation conditions to examine associations and magnitude differences. Methods Eleven [5 females] healthy adults [aged 27.6±10.2y, BMI 23.1±2.2 (mean±SD)] participated. After one week of at-home ambulatory monitoring with 8h per night sleep opportunities at habitual bedtimes, participants were studied in the laboratory for three days under controlled dim light (< 8 lux maximum) and ambient temperature conditions (22-24°C). Participants arrived in the afternoon, were kept awake 4h later than typical and scheduled to a 4h sleep opportunity. The next day, participants were sleep deprived for 28h followed by recovery sleep. Skin temperature was assessed every min with iButtons placed subclavicular (proximal skin temperature) and foot palmar (distal skin temperature). The DPG was calculated as difference between proximal and distal skin temperatures. A three-harmonic regression model was used to fit DPG data and derive daily and circadian rhythm amplitudes, and percent difference in amplitude was calculated. Pearson correlations were calculated between daily and circadian rhythm DPG amplitudes. Results DPG amplitude was significantly greater for daily versus circadian rhythm (p < 0.05). Percent difference analyses showed daily DPG rhythm was 57% larger than circadian DPG rhythm (SD 30%, range 22-134%). A significant correlation was found between daily and circadian rhythm DPG amplitudes (r = 0.71, p< 0.05). Conclusion The amplitudes of daily and circadian rhythms of the DPG are associated, but the daily rhythm amplitude is larger. Additional research is needed to compare the relative importance of daily versus circadian skin temperature amplitudes for sleep and circadian relevant outcomes. Support (if any) CurAegis Technologies Inc., Fundacio Joan Riera I Gubau, Undergraduate Research Opportunities Program University of Colorado Boulder

0151 Subjective sleep onset latency is influenced by the sleep structure and body heat loss in human subjects

Abstract Introduction Humans can estimate the time that has elapsed during sleep (time estimation ability; TEA). Although research on the TEA during sleep has advanced in the field of sleep research, few studies have focused on the relationship between the subjective sleep onset latency (SOL), which is an indicator of TEA, and objective sleep structures, body heat loss, and body temperature. This paper investigates the association of the subjective SOL with sleep structures such as the objective SOL, duration of each sleep stage, subjective sleep parameters, and body heat loss in healthy young participants. Methods Twenty six participants (7 men and 19 women, mean age of 21.5 ± 0.5 years) having no sleep problems participated in a 1-hour polysomnographic recording that obtained objective sleep parameters during the daytime while temperatures of the skin (i.e., dorsum of the hand and foot, forehead, and subclavian) and eardrum were recorded at intervals of 1 min. The distal–proximal skin temperature gradient (DPG), which is a good predictor of body heat loss and sleepiness, was calculated. Subjective parameters, such as the subjective SOL, sleep time, sleep depth, sleepiness, and mood, were evaluated before and after sleep. We examined the association of the subjective SOL with objective sleep parameters, DPG, and other subjective parameters. Results Most participants estimated their sleep latency to be longer than their actual SOL (mean objective SOL of 7.6 min vs. subjective SOL of 13.7 min). The objective SOL was significantly correlated with each sleep stage parameter whereas the subjective SOL was negatively correlated with the stage N2 sleep duration (Rho = −0.454, p = 0.020) and correlated with the stage N2 sleep latency (Rho = 0.402, p = 0.051). Participants who estimated a shorter subjective SOL had a higher DPG before sleep periods than that after sleep onset (Rho = −0.692, p < 0.001). Additionally, the subjective SOL was correlated with the subjective sleep depth, subjective wake after sleep onset, and restorative sleep. Conclusion The subjective sleep onset latency in the healthy young participants was affected by the degree of body heat loss before sleep onset and stable shallow nonrapid-eye-movement sleep. Support (If Any)

Do ginger footbaths improve symptoms of insomnia more than footbaths with warm water only? – A randomized controlled study

ObjectivesTo compare the effects between warm water (WW) and ginger footbaths (WW+ginger) on sleep quality and warmth regulation in adults with self-reported insomnia symptoms. MethodsA prospective randomized-controlled study in which 28 participants (mean age 50.9 years, 64.3% women, insomnia symptom duration 11.4 years) were randomized to receive WW (n = 13) or WW+ginger (n = 15) daily for 2 weeks. Treatment involved nightly footbaths (12 liters of 38–42 °C warm tap water, maximum duration 20 min) with and without topical ginger (80 g of powdered ginger rhizomes). Main outcome measuresThe primary outcome measure was self-reported sleep quality (global score from Pittsburgh Sleep Quality Index, PSQI) at 2 weeks. Secondary outcomes included measures of insomnia severity (Insomnia Severity Index, ISI) and warmth regulation (Herdecke Warmth Perception Questionnaire, HWPQ and 24-hour distal-proximal skin temperature gradient, DPG). ResultsWW+ginger had no greater effect on PSQI (mean between-difference 0.0 [95% CI −3.0 to 2.9], Cohen’s d=0.0) or ISI (−0.2 [−3.9 to 3.4], 0.0) than WW. Nor were there any significant differences in HWPQ perceived warmth (0.1 ≥d≥0.5) or DPG (0.1 ≥d≥0.4) between WW and WW+ginger. Both groups improved over time in PSQI (WW+ginger: d=0.7, WW: d=1.3) and ISI (WW+ginger: d=0.8, WW: d=1.0). Perceived warmth of the feet increased only in WW+ginger over time (d=0.6, WW: d=0.0). ConclusionsThis dose of ginger (6.67 g/liter) did not have greater effects on sleep quality, insomnia severity or warmth regulation than WW. Considering effect sizes, costs and risks, the use of WW would be recommended over WW+ginger in this patient population.

How Smart Is It to Go to Bed with the Phone? The Impact of Short-Wavelength Light and Affective States on Sleep and Circadian Rhythms.

Previously, we presented our preliminary results (N = 14) investigating the effects of short-wavelength light from a smartphone during the evening on sleep and circadian rhythms (Höhn et al., 2021). Here, we now demonstrate our full sample (N = 33 men), where polysomnography and body temperature were recorded during three experimental nights and subjects read for 90 min on a smartphone with or without a filter or from a book. Cortisol, melatonin and affectivity were assessed before and after sleep. These results confirm our earlier findings, indicating reduced slow-wave-sleep and -activity in the first night quarter after reading on the smartphone without a filter. The same was true for the cortisol-awakening-response. Although subjective sleepiness was not affected, the evening melatonin increase was attenuated in both smartphone conditions. Accordingly, the distal-proximal skin temperature gradient increased less after short-wavelength light exposure than after reading a book. Interestingly, we could unravel within this full dataset that higher positive affectivity in the evening predicted better subjective but not objective sleep quality. Our results show disruptive consequences of short-wavelength light for sleep and circadian rhythmicity with a partially attenuating effect of blue-light filters. Furthermore, affective states influence subjective sleep quality and should be considered, whenever investigating sleep and circadian rhythms.

130 Individual Differences in Skin Temperature Responses to Cold Pressor Stress During Sleep Restriction and Circadian Misalignment

Abstract Introduction Individual differences in cognition during sleep restriction and circadian misalignment have been shown to be trait-like. Here we explored the consistency of individual differences in cardiovascular responses to the cold pressor test (CPT) measured by changes in the distal-proximal skin temperature gradient (DPG) using the contralateral hand to that immersed in the ice water bath, which reflects a reflex cutaneous vasoconstriction. Methods Eighteen healthy participants (8 females) mean (±SD) age 25.28 (±4.3), underwent two identical in-laboratory combined sleep restriction and circadian misalignment protocols preceded by an 8h baseline in-laboratory sleep opportunity. The participants were given a 3h sleep opportunity on night 2 and a 3h sleep opportunity on days 3 and 4 followed by recovery sleep. The CPT occurred the morning after the baseline sleep opportunity and the morning before recovery sleep. Participants maintained a seated posture beginning 30 min prior to the CPT and skin temperature was assessed starting 15 min before until 45 min after the CPT. DPG (proximal=subclavicular; distal=hand palmar) data were averaged into 3 min bins. Changes in DPG from pre-CPT and 5 min post-CPT were assessed as the primary outcome using mixed-model ANOVAs. Intra-class correlation coefficients (ICC) were calculated to measure consistency of individual differences for DPG responses. Results Mixed-model ANOVA revealed significant effects of time and combined sleep restriction and circadian misalignment on DPG during the CPT (both p<0.05), such that the DPG was wider (i.e., more negative) post-CPT and during sleep restriction and circadian misalignment. Participants showed moderately consistent DPG responses across visits 1 and 2 at baseline (ICC=0.59) and substantially consistent DPG responses during sleep restriction and circadian misalignment (ICC=0.67). Further, participants showed moderately consistent DPG responses when comparing changes between baseline and sleep restriction and circadian misalignment across visits (ICC=0.58). Conclusion Findings support that combined sleep restriction and circadian misalignment is associated with sympathetic activation and that individual differences in the DPG response to cold pressor stress are consistent. Support (if any) Office of Naval Research MURI grant N00014-15-1-2809, NIH/NCATS Colorado CTSA Grant UL1TR002535

016 Associations between Circadian Melatonin and Temperature Amplitudes during Constant Routine

Abstract Introduction Circadian amplitude measures the strength or robustness of a rhythm and changes in amplitude may have implications for health. Large individual differences in melatonin amplitude are recognized. Here we aimed to determine the strength of relationships between melatonin and the core body (CBT) and distal-proximal skin temperature gradient (DPG) amplitudes during a constant routine protocol. Additionally, we determined the best fitting harmonic model for the DPG circadian rhythm. Methods 17 young healthy adults [13 males (22.3±3.9yr;mean±SD)] completed a 28-hr constant routine protocol after maintaining 8h habitual sleep schedules for one week at home. Endogenous circadian amplitudes of melatonin and CBT were fit with standard three- and dual-harmonic linear regression models, respectively. The DPG amplitude was analyzed with both dual and three-harmonic regression models to determine which model produced the best fit. Results The DPG was best fit by a three-harmonic regression model with significantly lower standard deviation and higher signal-to-noise ratio compared to the 2-harmonic model (both p<0.05) as well as by visualization of the fitted curves. Melatonin, CBT and DPG amplitudes were not found to be associated with each other during constant routine (all r<0.37; all p>0.10). Conclusion While it is common for melatonin and body temperature circadian phase estimates to be used interchangeably, non-significant findings for associations between circadian amplitudes of melatonin, CBT and DPG indicate that these markers may not provide similar information about circadian amplitude. Further, research is needed to explore possible associations between individual differences in melatonin, CBT and DPG amplitudes with other physiological and behavioral outcomes to determine which measure(s) of circadian amplitude may be functionally relevant. Support (if any) NIH R01 HL081761

Hot-water bathing before bedtime and shorter sleep onset latency are accompanied by a higher distal-proximal skin temperature gradient in older adults.

Passive body heating in controlled settings could shorten sleep onset latency (SOL). The hypothesized mechanism is vasodilation-induced heat loss before bedtime. However, this evidence is based on small sample-sized studies in specific populations. Thus, we analyzed the association of hot-water bathing and its before-bedtime timing with SOL and heat loss in a large study population of older adults. We conducted a longitudinal analysis using repeated measurements of hot-water bathing and sleep among 1,094 older adults (mean age, 72.0 years). SOL was recorded using actigraphy and self-reported sleep estimates and was categorized into conditions (intervals of 1-60, 61-120, 121-180, and > 181 minutes between hot bath and bedtime) and compared with the control condition of no bathing. The heat-loss indicator, distal-proximal skin temperature gradient, was examined in the same categorization. Mixed-effects linear regression models suggested that the bathing conditions of 61-120 minutes and 121-180 minutes showed significantly shorter log-transformed actigraphic SOL by 0.23 log-minutes (95% confidence interval (CI), 0.03-0.42) and 0.32 log-minutes (95% CI, 0.09-0.56), shorter self-reported SOL by 0.16 log-minutes (95% CI, 0.02-0.30) and 0.18 log-minutes (95% CI, 0.01-0.35), and higher distal-proximal skin temperature gradient for 30 minutes before bedtime by 0.49°C (95% CI, 0.22-0.75) and 0.51°C (95% CI, 0.20-0.83), respectively, independent of potential confounders. Hot-water bathing before bedtime is significantly associated with shorter SOL and higher distal-proximal skin temperature gradient among the large-scale older population. This finding could enhance the generalizability of hot-water bathing habits for ameliorating sleep initiation difficulty.

Preliminary Results: The Impact of Smartphone Use and Short-Wavelength Light during the Evening on Circadian Rhythm, Sleep and Alertness.

Smartphone usage strongly increased in the last decade, especially before bedtime. There is growing evidence that short-wavelength light affects hormonal secretion, thermoregulation, sleep and alertness. Whether blue light filters can attenuate these negative effects is still not clear. Therefore, here, we present preliminary data of 14 male participants (21.93 ± 2.17 years), who spent three nights in the sleep laboratory, reading 90 min either on a smartphone (1) with or (2) without a blue light filter, or (3) on printed material before bedtime. Subjective sleepiness was decreased during reading on a smartphone, but no effects were present on evening objective alertness in a GO/NOGO task. Cortisol was elevated in the morning after reading on the smartphone without a filter, which resulted in a reduced cortisol awakening response. Evening melatonin and nightly vasodilation (i.e., distal-proximal skin temperature gradient) were increased after reading on printed material. Early slow wave sleep/activity and objective alertness in the morning were only reduced after reading without a filter. These results indicate that short-wavelength light affects not only circadian rhythm and evening sleepiness but causes further effects on sleep physiology and alertness in the morning. Using a blue light filter in the evening partially reduces these negative effects.

Periocular skin warming promotes body heat loss and sleep onset: a randomized placebo-controlled study

Periocular skin warming was reported to have favorable effects on subjective and objective sleep quality. We hypothesized that enhancing body heat loss by periocular skin warming would reduce sleep onset and improve sleep quality. Eighteen healthy volunteers were asked to maintain wakefulness with their eyes closed for 60 min after applying either a warming or sham eye mask, followed by a 60-min sleep period. Compared to the sham, periocular warming increased the distal skin temperature and distal–proximal skin temperature gradient only during the 30-min thermal manipulation period. In the subsequent sleep period, periocular warming facilitated sleep onset, increased stage 2 sleep and electroencephalographic delta activity during the first half of the sleep period relative to the sham. These results suggest that periocular skin warming may accelerate and deepen sleep by enhancing physiological heat loss via the distal skin, mimicking physiological conditions preceding habitual sleep.

Periocular skin warming elevates the distal skin temperature without affecting the proximal or core body temperature

Periocular skin warming reportedly improves the objective and subjective sleep quality in adults with mild difficulty in falling asleep. To clarify the effects of periocular warming, we examined the distal skin temperatures (hands and feet), proximal skin temperature (infraclavicular region) and core body temperature as well as the distal-proximal skin temperature gradient (DPG). Nineteen healthy males underwent two experimental sessions, wherein they used a warming or sham eye mask under a semi-constant routine protocol in a crossover manner. Participants were instructed to maintain wakefulness with their eyes closed for 60 minutes after wearing the eye mask. The warming eye mask increased the periocular skin temperature to 38–40 °C for the first 20 minutes, whereas the temperature remained unchanged with the sham mask. Compared to that of the sham eye mask, the warming eye mask significantly increased the temperatures of the hands and feet and the DPG, whereas the proximal skin and core body temperatures were unaffected. Subjective sleepiness and pleasantness were significantly increased by the warming eye mask. These results represent physiological heat loss associated with sleep initiation without affecting the proximal skin or core body temperatures, suggesting that thermal stimulation in certain areas can provoke similar changes in remote areas of the body.

Effects of feet warming using bed socks on sleep quality and thermoregulatory responses in a cool environment

BackgroundAs a way of helping to sleep in winter, methods of warming the feet through footbaths or heating pads before bedtime are tried. In particular, bed socks are popular during winter sleeping in Korea, but scientific evidence about the physiological effects of bed socks on sleep quality is rarely reported. The purpose of this study was to evaluate the effect of feet warming using bed socks on sleep quality and thermoregulatory responses during sleep in a cool environment.MethodsSix young males (22.7 ± 2.0 years in age, 175.6 ± 3.5 cm in height, and 73.1 ± 8.5 kg in body weight) participated in two experimental conditions (with and without feet warming) in a random order. The following variables on sleep quality using a wrist actigraphy were measured during a 7-h sleep at an air temperature of 23 °C with 50% RH: sleep-onset latency, sleep efficiency, total sleep time, number of awakenings, wake after sleep onset, average awakening length, movement index, and fragmentation index. Heart rate and rectal and skin temperatures were monitored during the 7-h sleep. Questionnaire on sleep quality was obtained after awakening in the morning.ResultsThe results showed that sleep-onset latency was on average 7.5 min shorter, total sleep time was 32 min longer, the number of awakenings was 7.5 times smaller, and sleep efficiency was 7.6% higher for those wearing feet-warming bed socks during a 7-h sleep than control (no bed socks) (all P < 0.05). Also, their foot temperature was maintained on average 1.3 °C higher and the value in the distal-proximal skin temperature gradient was higher for those wearing feet warming bed socks when compared to the control condition (P < 0.05). However, there were no significant differences in heart rate, rectal and mean skin temperature, or in the questionnaire-based subjective evaluations between the two conditions.ConclusionsFeet warming using bed socks during sleep in a cool environment had positive effects on sleep quality by shortened sleep onset, lengthened sleep time, and lessened awakenings during sleep but had no significant influence on core body temperature. These results imply that sleep quality could be improved by manipulation of the foot temperature throughout sleeping.

Distal-proximal skin temperature gradient prior to sleep onset in infants for clinical use.

The objective of this study was to explore the possibility of using distal-proximal skin temperature gradient (DPG) to predict sleep-onset latency of night-time sleep for infants at home. Foot (for distal) and abdominal (for proximal) skin temperature during sleep onset in healthy infants, aged 4-9 months, was continuously recorded using a temperature logger at home. Sleep-onset latency during each study night was defined as the interval from lights-off to sleep onset, determined on actigraphy. Association of DPG profile after lights-off with sleep-onset latency on the study nights was evaluated. Data for 43 nights from 28 infants were available for analysis. With regard to low DPG (<-2.5°C) at lights-off, >60% of infants fell asleep within 30 min if DPG was increased to ≥-2.5°C within 15 min after lights-off. If DPG remained at <-2.5°C at 15 min after lights-off, however, only 20% of infants fell asleep within 30 min. In addition, if infants were still awake at 15 min after lights-off and the DPG at that time was <-2.5°C, they were not likely to quickly fall asleep (predictive value was 0.875). Increase in DPG by 15 min after lights-off is a key determinant for sleep-onset latency.

Alterations in diurnal rhythmicity in patients treated for nonfunctioning pituitary macroadenoma: a controlled study and literature review.

Patients treated for nonfunctioning pituitary macroadenomas (NFMAs) have fatigue and alterations in sleep characteristics and sleep-wake rhythmicity frequently. As NFMAs often compress the optic chiasm, these complaints might be related to dysfunction of the adjacent suprachiasmatic nucleus (SCN). We aimed to explore whether indirect indices of SCN functioning are altered in the long term after surgery for NFMAs. We studied 17 NFMA patients in long-term remission after transsphenoidal surgery, receiving adequate and stable hormone replacement for hypopituitarism, and 17 control subjects matched for age, gender, and BMI. Indirect indices of SCN function were assessed from 24-h ambulatory recordings of skin and core body temperatures, blood pressure, and salivary melatonin levels. Altered melatonin secretion was defined as an absence of evening rise, considerable irregularity, or daytime values >3 pg/ml. We additionally studied eight patients treated for craniopharyngioma. Distal-proximal skin temperature gradient did not differ between NFMAs and control subjects, but proximal skin temperature was decreased during daytime (P=0.006). Core body temperature and non-dipping of blood pressure did not differ, whereas melatonin secretion was often altered in NFMAs (OR 5.3, 95% CI 0.9-30.6). One or more abnormal parameters (≥2.0 SDS of control subjects) were observed during nighttime in 12 NFMA patients and during daytime in seven NFMA patients. Similar patterns were observed in craniopharyngioma patients. Heterogeneous patterns of altered diurnal rhythmicity in skin temperature and melatonin secretion parameters were observed in the majority of patients treated for NFMAs. On a group level, both NFMA and craniopharyngioma patients showed a lower daytime proximal skin temperature than control subjects, but other group averages were not significantly different. The observations suggest altered function of central (or peripheral) clock machinery, possibly by disturbed entrainment or damage of the hypothalamic SCN by the suprasellar macroadenoma or its treatment.

A two-night comparison in the sleep laboratory as a tool to challenge the relationship between sleep initiation, cardiophysiological and thermoregulatory changes in women with difficulties initiating sleep and thermal discomfort

Cardiovascular and thermophysiological changes accompany the decision to fall asleep. A relationship between core body temperature and heart rate variability (HRV) especially during the sleep onset episode is suggested, but only few data are available, investigating a relationship between skin temperature and HRV at this time span. This study was aimed to elucidate the pattern of body temperature (i.e. distal and proximal skin temperature), heart rate and its variability in a specific population of ten healthy women having both, thermal discomfort from cold extremities and difficulties initiating sleep for two subsequent nights in the laboratory. Furthermore, changes in sleep, temperature or cardiac regulation were examined after 16-h of constant posture conditions.Due to a faster decline of arousals, the build-up of sleep stage 2, slow wave sleep and hence delta power is promoted in the second night compared to the first. Both, proximal and distal skin temperatures show an increase after lights out. Distal skin temperature around lights out is already higher during the second night. Proximal skin temperature starts at the same temperature level for both nights but was significantly reduced in the second hour after lights out during the second night. The distal-proximal skin temperature gradient (DPG), as a measure for distal dilatation of the skin vasculature, starts with a lower level after lights out in the first night, compared to the second. Different dynamics and differences between the two nights in skin temperature or sleep variables, but not in heart rate and HRV variables were found during the sleep initiation episode. Thus, a direct causality between these functions seems rather unlikely in the present study sample. The described differences between both nights might occur from delayed relaxation, reflected in a slower decrease of arousals, prolonged sleep onset latency and a lower DPG at the first night. Especially the latter finding confirms nicely the statement that warm extremities promote a rapid onset of sleep.

Diurnal Blood Pressure Variations Are Associated with Changes in Distal–Proximal Skin Temperature Gradient

It is generally assumed that skin vascular resistance contributes only to a small extent to total peripheral resistance and hence to blood pressure (BP). However, little is known about the impact of skin blood flow (SBF) changes on the diurnal variations of BP under ambulatory conditions. The main aim of the study was to determine whether diurnal patterns of distal SBF are related to mean arterial BP (MAP). Twenty-four-hour ambulatory measurements of BP, heart rate (HR) and distal (mean of hands and feet) as well as proximal (mean of sternum and infraclavicular region) skin temperatures were carried out in 51 patients (men/women = 18/33) during a 2-d eye hospital investigation. The standardized ambulatory protocol allowed measurements with minimal interference from uncontrolled parameters and, hence, some conclusive interpretations. The distal minus proximal skin temperature gradient (DPG) provided a measure for distal SBF. Individual cross-correlation analyses revealed that the diurnal pattern of MAP was nearly a mirror image of DPG and hence of distal SBF. Scheduled lunch and dinner induced an increase in DPG and a decline in MAP, while HR increased. Low daytime DPG (i.e. low distal SBF) levels significantly predicted sleep-induced BP dipping (r = −.436, p = .0014). Preliminary path analysis suggested that outdoor air temperature and atmospheric pressure may act on MAP via changed distal SBF. Changes in distal SBF may contribute to diurnal variation in MAP, including sleep-induced BP dipping and changes related to food intake. This finding might have an impact on individual cardiovascular risk prediction with respect to diurnal, seasonal and weather variations; however, the underlying mechanisms remain to be discovered.

PHASE RELATIONSHIP BETWEEN SKIN TEMPERATURE AND SLEEP-WAKE RHYTHMS IN WOMEN WITH VASCULAR DYSREGULATION AND CONTROLS UNDER REAL-LIFE CONDITIONS

The aim of the study was to investigate whether women with primary vascular dysregulation (VD; main symptoms of thermal discomfort with cold extremities) and difficulties initiating sleep (DIS) exhibit a disturbed phase of entrainment (Ψ) under everyday life conditions. The authors predicted a phase delay of the distal-proximal skin temperature gradient and salivary melatonin rhythms with respect to the sleep-wake cycle in women with VD and DIS (WVD) compared to controls (CON), similar to that found in their previous constant-routine laboratory data. A total of 41 young healthy women, 20 with WVD and 21 matched CON without VD and normal sleep onset latency (SOL), were investigated under ambulatory conditions (following their habitual bedtimes) during 7 days of continuous recording of skin temperatures, sleep-wake cycles monitored by actimetry and sleep-wake diaries, and single evening saliva collections for determining the circadian marker of dim light melatonin onset (DLMO). Compared to CON, WVD showed increased distal vasoconstriction at midday and in the evening, as indicated by lower distal (DIST; hands and feet) and foot-calf skin temperatures, and distal-proximal skin temperature gradients (p < .05). WVD manifested distal vasoconstriction before lights-off that also lasted longer after lights-off than in CON. In parallel, WVD exhibited a longer SOL (p < .05). To define internal phase-relationships, cross-correlation analyses were performed using diurnal rhythms of wrist activity and foot skin temperature. WVD showed a phase delay in foot skin temperature (CON versus WVD: 3.57 ± 17.28 min versus 38.50 ± 16.65 min; p < .05) but not in wrist activity. This finding was validated by additional within-subject cross-correlation analyses using the diurnal wrist activity pattern as reference. DLMO and habitual sleep times did not differ between CON and WVD. The authors conclude that WVD exhibit a phase delay of distal vasodilatation with respect to their habitual sleep-wake cycle and other circadian phase markers, such as DLMO. A full factorial design will have to show whether the finding is specific to primary vascular dysregualtion, to DIS, or to their interaction. (Author correspondence: Kurt.kraeuchi@upkbs.ch)

A warm footbath before bedtime and sleep in older Taiwanese with sleep disturbance.

A single-group crossover design was used to examine the effects of a warm footbath on body temperatures, distal-proximal skin temperature gradient (DPG), and sleep outcomes in 15 Taiwanese elders with self-reported sleep disturbance. Body temperatures and polysomnography were recorded for three consecutive nights. Participants were assigned randomly to receive a 41 degrees C footbath for 40 minutes before sleep onset on night 2 or night 3. Mean DPG before lights off was significantly elevated on the bathing night. There were no significant differences in sleep outcomes between the two nights. However, when the first two non-rapid eye movement (NREM) sleep periods were examined, the amount of wakefulness was decreased in the second NREM period on the bathing night.

Chronobiological characterization of women with primary vasospastic syndrome: body heat loss capacity in relation to sleep initiation and phase of entrainment

Women with primary vasospastic syndrome (VS), but otherwise healthy, exhibit a functional disorder of vascular regulation (main symptom: cold extremities) and often suffer from difficulties initiating sleep (DIS). Diverse studies have shown a close association between distal vasodilatation before lights off and a rapid onset of sleep. Therefore, we hypothesized that DIS in women with VS could be due to a reduced heat loss capacity in the evening, i.e., subjects are physiologically not ready for sleep. The aim of the study was to elucidate whether women having both VS and DIS (WVD) or not (controls) show different circadian characteristics (e.g., phase delay of the circadian thermoregulatory system with respect to the sleep-wake cycle). Healthy young women (n = 9 WVD and n = 9 control) completed a 40-h constant routine protocol (adjusted to habitual bedtime) before and after an 8-h sleep episode. Skin temperatures [off-line calculated as distal-proximal skin temperature gradient (DPG)] and core body temperature (CBT; rectal) were continuously recorded. Half-hourly saliva samples were collected for melatonin assay and subjective sleepiness was assessed on the Karolinska Sleepiness Scale (KSS). Compared with control, WVD showed no differences in habitual bed times, but a 1-h circadian phase delay of dim light-melatonin onset (hours after lights on: WVD 14.6 +/- 0.3 h; control 13.5 +/- 0.2 h; P = 0.01). Similar phase shifts were observed in CBT, DPG, and KSS ratings. In conclusion, WVD exhibit a phase delay of the endogenous circadian system with respect to their habitual sleep-wake cycle, which could be a cause of DIS.

Effect of foot bathing on distal-proximal skin temperature gradient in elders

Increased distal (foot)-proximal (abdominal) skin temperature gradient (DPG) has been associated with better sleep initiation. Warm footbath can affect distal skin temperature to change DPG. However, the optimum water temperature and duration necessary to raise DPG has not been established. This study explored the effects of 1-h foot bathing at two water temperatures of 40 and 41 °C, respectively, on DPG in Taiwanese elders ( n = 6 , ages 60–73 years). Each subject's feet and legs were immersed in a temperature-controlled water tub to 20 cm above the ankles for 60 min in each of two water temperatures. Oral, abdominal, and foot temperatures were taken during (at 10-min intervals), and after (at 1-min intervals) foot bathing. DPG was calculated by subtracting abdominal temperature from foot temperature. Results showed the value of DPG was significantly increased in the 10th min bathing at both water temperatures and maintained above 0 °C. DPG gradually declined after bathing at both water temperatures. The value of DPG with 41 °C water was slightly higher than 40 °C. All subjects tolerated both bathing temperatures well for 1 h. Both 40 and 41 °C foot bathing for 1 h can increase the DPG and may be an effective way to affect whole body skin blood flow and trigger heat dissipation.