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Circadian Rhythms in Medicine

Published online by Cambridge University Press:  07 November 2014

Abstract

Circadian (24-hour) rhythms are important to the practice of medicine. The phasing and amplitude of key physiologic and biochemical circadian rhythms contribute to predict in-time patterns in the manifestation and exacerbation of most medical conditions. Moreover, body rhythms can significantly affect responses of patients to diagnostic tests and medications. Rhythmicity in the pathophysiology of medical conditions is the rationale for chronotherapeutics—the purposeful variance of the concentration of medicines in synchrony with biological rhythm-determinants of disease activity—to optimize treatment outcomes. This article discusses the concept of biological time structure and its relevance to the practice of medicine, with a focus on neurologic issues.

Type
Feature Articles
Copyright
Copyright © Cambridge University Press 2001

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References

REFERENCES

1.Haus, E, Touitou, Y, eds. Biological Rhythms in Clinical and Laboratory Medicine. Heidelberg, Germany: Springer-Verlag; 1992.Google Scholar
2.Martin, RJ, ed. Nocturnal Asthma; Mechanisms and Treatment. Mt. Kisco, NY: Futura Press; 1993.Google Scholar
3.Deedwania, PC, ed. Circadian Rhythms of Cardiovascular Disorders. Armonk, NY: Futura Press; 1997.Google Scholar
4.White, WB, ed. Blood Pressure Monitoring in Cardiovascular Medicine and Therapeutics. Totowa, NJ: Humana; 2001.CrossRefGoogle Scholar
5.Smolensky, MH, Lamberg, L. Body Clock Guide to Better Health. New York, NY: Henry Holt; 2001.Google Scholar
6.Smolensky, MH, Barnes, PJ, Reinberg, A, McGovern, JP. Chronobiology and asthma. I. Day-night differences in bronchial patency and dyspnea and circadian rhythm dependencies. J Asthma. 1986;23:321343.CrossRefGoogle ScholarPubMed
7.Smolensky, MH, Halberg, F. Circadian rhythm in airway patency and lung volume. In: McGovern, JP, Smolensky, MH, Reinberg, A, eds. Chronobiology in Allergy and Immunology. Springfield, Ill: Charles C Thomas; 1977:117138.Google Scholar
8.Moore, RY, Silver, R. Suprachiasmatic nucleus organization. Chronobiol Int. 1998;15:475488.CrossRefGoogle ScholarPubMed
9.Miller, JD. The SCN is comprised of a population of coupled oscillators. Chronobiol Int. 1998;15:489511.CrossRefGoogle ScholarPubMed
10.Rensing, L, Meyer-Grahle, U, Roff, P. Biologicalal timing and clock metaphor: oscillatory and hourglass mechanisms. Chronobiol Int. 2001;18:329369.CrossRefGoogle ScholarPubMed
11.Shirakawa, T, Honma, S, Honma, K. Multiple oscillators in the suprachiasmatic nucleus. Chronobiol Int. 2001;18:371380.CrossRefGoogle ScholarPubMed
12.Wever, RA. The Circadian System of Man: Results of Experiments Under Temporal Isolation. New York, NY: Springer-Verlag; 1979.CrossRefGoogle Scholar
13.Rea, MA. Photic entrainment of circadian rhythms in rodents. Chronobiol Int. 1998;15:395424.CrossRefGoogle ScholarPubMed
14.Hastings, MH, Duffield, GE, Smith, JD, et al.Entrainment of the circadian system of mammals by nonphotic cues. Chronobiol Int. 1998;15:425445.CrossRefGoogle ScholarPubMed
15.Reinberg, A, ed. Chronobiologicalal filed studies of oil refinery shift workers. Chronobiologia. 1979;6(suppl 1):1119. Theme issue.Google Scholar
16.Arendt, J, Deacon, S. Treatment of circadian rhythm disorders—melatonin. Chronobiol Int. 1987;14:185204.CrossRefGoogle Scholar
17.Ashkenazi, IE, Reinberg, AE, Motohashi, Y. Interindividual differences in the flexibility of human temporal organization: pertinence to jet lag and shiftwork. Chronobiol Int. 1997;14:99114.CrossRefGoogle ScholarPubMed
18.Reinberg, A, Smolensky, MH. Biologicalal Rhythms and Medicine. New York, NY: Springer-Verlag; 1983.CrossRefGoogle Scholar
19.Smolensky, MH, Bing, ML. Chronobiology and chronotherapeutics in primary care. Patient Care, Clin Focus. 1997(June suppl):115. Theme issue.Google Scholar
20.Lee, RE, Smolensky, MH, Leach, CS, McGovern, JP. Circadian rhythms in the cutaneous reactivity rhythm to histamine and selected antigens including phase relationship to urinary cortisol excretion. Ann Allergy. 1997;38:231236.Google Scholar
21.McGovern, JP, Smolensky, MH, Reinberg, A. Circadian and circamensual rhythmicity in cutaneous to histamine and allergenic extracts. In: McGovern, JP, Smolensky, MH, Reinberg, A, eds. Chronobiology in Allergy and Immunology. Springfield, Ill: Charles C Thomas; 1971:79116.Google Scholar
22.Gaultier, C, Reinberg, A, Gerbeaux, J, Girard, F. Circadian changes in lung resistance and dynamic compliance in healthy and asthmatic children: effects of two bronchodilators. Respir Physiol. 1977;31:169182.CrossRefGoogle Scholar
23.Jarjour, NN. Circadian variation in allergen and non-specific bronchial responsiveness in asthma. Chronobiol Int. 1999;16:631639.CrossRefGoogle Scholar
24.Liu, JHK, Kripke, DF, Hoffman, RE, et al.Nocturnal elevation of intraocular pressure in young adults. Invest Ophthalmol Vis Sci. 1998;39:27072712.Google ScholarPubMed
25.Sacca, SC, Rolando, M, Marietta, A, et al.Fluctuations of intraocular pressure during the day in open glaucoma, normal-tension glaucoma and normal subjects. Opthalmologica. 1998;212:115119.CrossRefGoogle Scholar
26.Drance, SM. The significance of the diurnal tension variations in normal and glaucomatous eyes. Arch Ophthalmol. 1960;64:494501.CrossRefGoogle ScholarPubMed
27.Portaluppi, F, Smolensky, MH. Time-dependent structure and control of arterial blood pressure. Ann N Y Acad Sci. 1996;783(theme issue):1342.CrossRefGoogle Scholar
28.Baumgart, P. Circadian rhythm of blood pressure: internal and external time triggers. Chronobiol Int. 1991;8:444450.CrossRefGoogle ScholarPubMed
29.Pickering, TG. Ambulatory Monitoring and Blood Pressure Variability. London, England: Science Press; 1991.Google Scholar
30.Portaluppi, F, Smolensky, MH. Circadian rhythm and environmental determinants of blood pressure regulation in normal and hypertensive conditions. In: White, WB, ed. Blood Pressure Monitoring in Cardiovascular Medicine and Therapeutics. Totowa, NJ: Humana; 2001:79138.CrossRefGoogle Scholar
31.Portaluppi, F, Montanari, L, Ferini, M, Gilli, P. Altered circadian rhythms of blood pressure and heart rate in nonhemodialysis chronic renal failure. Chronobiol Int. 1990;7:321327.CrossRefGoogle ScholarPubMed
32.Jarrett, RJ. Circadian variations in blood glucose levels, in glucose tolerance and in plasma immunoreactive insulin levels. Acta Diabetol Lat. 1972;9:263275.CrossRefGoogle ScholarPubMed
33.Zimmet, PZ, Wall, JR, Rome, R, et al.Diurnal variation in glucose tolerance: associated changes in plasma insulin, growth hormone and non-esterified fatty acids. BMJ. 1974;2:485488.CrossRefGoogle Scholar
34.Haus, E, Touitou, Y. Chronobiology in laboratory medicine. In: Touitou, Y, Haus, E, eds. Biological Rhythms in Clinical and Laboratory Medicine. Heidelberg, Germany: Springer-Verlag; 1992: 673708.CrossRefGoogle Scholar
35.Peleg, L, Goldman, B, Ashkenazi, IE. Effects of inter-individual and diurnal variations on the activity of HexA: relevance to screening of Tay-Sachs disease carriers. In: Galteau, M-M, Siest, G, Henny, J, eds. Biologie Proposective (Computes Rendus du 8e Colloque de Pont-a-Mousson). Montrouge, France: Editions John Libbey Eurotext; 1993:309312.Google Scholar
36.Sydenham, T. The works of Thomas Sydenham. RG, Lathan, trans. 1850;2:124.Google Scholar
37.Rigas, B, Torosis, J, McDougall, CJ, et al.The circadian rhythm of biliary colic. J Clin Gastroenterol. 1990;12:409414.CrossRefGoogle ScholarPubMed
38.Moore, JG, Halberg, F. Cireadian rhythm of gastric acid secretion in active duodenal ulcer: chronobiologicalal statistical characteristics and comparison of acid secretory and plasma gastrin patterns in healthy and postvagotomy and pyloroplasty patients. Chronobiol Int. 1987;4:101110.CrossRefGoogle Scholar
39.Cugini, P, DiPalma, L, Battisti, P, et al.Ultradian, cireadian and infradian periodicity of some cardiovascular emergencies. Am J Cardiol. 1990;66:240243.CrossRefGoogle Scholar
40.Kroetz, C. Ein biologiescher 24-Studen-Rhythmus des Blutkreislaufs bei Gesundheit und bei Herzschivache zugleich ein Beitrag zur tageszeitlichen Haufung einiger akuter Kreislaufstorunge. Munch Med Wschr. 1940;87:314317.Google Scholar
41.Turner-Warwick, M. Epidemiology of nocturnal asthma. Am J Med. 1998;85:68.CrossRefGoogle Scholar
42.Dethlefsen, U, Repges, R. Ein neues therapieprinzip bei nachtlichen asthma. Med Klin. 1985;80:4447.Google Scholar
43.Bateman, JRM, Clark, SW. Sudden death in asthma. Thorax. 1979;34:4044.CrossRefGoogle ScholarPubMed
44.Kelmanson, IA. Cireadian variation of the frequency of sudden infant death syndrome and of sudden death from life-threatening conditions in infants. Chronobiologia 1991;18:181186.Google Scholar
45.Reinberg, AE, Gervais, P, Levi, F, et al.Cireadian and circannual rhythms of allergic rhinitis: an epidemiologic study involving chronobiological methods. J Allergy Clin Immunol. 1988;81:5162.CrossRefGoogle Scholar
46.Smolensky, MH, Reinberg, A, Labrecque, G. Twenty-four hour pattern in symptom intensity of viral and allergic rhinitis: treatment implications. J Allergy Clin Immunol. 1995;95:10841096.CrossRefGoogle ScholarPubMed
47.Kowanko, ICR, Knapp, MS, Pownall, R, Swannell, AJ. Domiciliary self-measurement in rheumatoid arthritis and the demonstration of cireadian rhythmicity. Ann Rheum Dis. 1982;41:453455.CrossRefGoogle Scholar
48.Solomon, GD. Cireadian rhythms and migraine. Cleve Clin J Med. 1992;59:326329.CrossRefGoogle Scholar
49.Dexter, JD, Weizman, ED. The relationship between nocturnal headaches to sleep stage patterns. Neurology. 1970;20:513518.CrossRefGoogle ScholarPubMed
50.Rocco, MB, Barry, J, Campbell, S, et al.Cireadian variation of transient myocardial ischemia in patients with coronary artery disease. Circulation. 1987;75:395400.CrossRefGoogle Scholar
51.Mulcahy, D, Cunningham, D, Crean, P, et al.Cireadian variation of total ischemic burden and its alteration with anti-anginal agents. Lancet. 1998;2:755759.Google Scholar
52.Cohen, MC, Rohtla, KM, Lavery, CE, et al.Meta-analysis of the morning excess of acute myocardial infarction and sudden cardiac death. Am J Cardiol. 1997;79:15121516.CrossRefGoogle ScholarPubMed
53.Behrens, S, Ehlers, C, Bruggemann, T, et al.Modification of the cireadian pattern of ventricular tachyarrthythmias by beta-blocker therapy. Clin Cardiol. 1997;20:253257.CrossRefGoogle Scholar
54.Goldstein, S, Zoble, RG, Akiyama, T, et al.Relation of cireadian ventricular ectopic activity to cardiac mortality. Am J Cardiol. 1996;78:881885.CrossRefGoogle Scholar
55.Venditti, FJ Jr, John, RM, Hull, M, et al.Cireadian variation in defibrillation energy requirements. Circulation. 1996;94:16071612.CrossRefGoogle Scholar
56.Elliott, WJ. Cireadian variation in the timing of stroke onset: a meta-analysis. Stroke. 1998;29:992996.CrossRefGoogle Scholar
57.Gallerani, M, Manfredini, R, Ricci, L, et al.Sudden death from pulmonary thromboembolism: chronobiologicalal aspects. Eur Heart J. 1992;6:305323.Google Scholar
58.Gallerani, M, Manfredini, R, Fersini, C. Chronoepidemiology in human disease. Ann Inst Super Sanita. 1993;29:569579.Google Scholar
59.Portaluppi, F, Manfredini, R, Fersini, C. From a static to a dynamic concept of risk: the cireadian epidemiology of cardiovascular risk. Chronobiol Int. 1999;16:3350.CrossRefGoogle Scholar
60.Wehr, TA. Cireadian rhythm disturbances in depression and mania. In: Brown, FM, Graeber, RC, eds. Rhythmic Aspects of Behavior. New Jersey; Erlbaum: 1982:399428.Google Scholar
61.Bellamy, N, Sothern, RB, Campbell, J. Rhythmic variations in pain perception in osteoarthritis of the knee. J Rheumatol. 1990;17:364372.Google ScholarPubMed
62.Folkard, S. Diurnal variation and individual differences in the perception of intractable pain. J Psychosom Res. 1976;20:289304.CrossRefGoogle ScholarPubMed
63.Manfredini, R, Gallerani, M, Salmi, R, et al.Cireadian variation in the time of onset of acute intestinal bleeding. J Emerg Med. 1994;12:59.CrossRefGoogle Scholar
64.Svanes, C, Sothern, RB, Sorbye, H. Rhythmic patterns in incidence of peptic ulcer perforation over 5.5 decades in Norway. Chronobiol Int. 1998;15:241264.CrossRefGoogle ScholarPubMed
65.Langdon-Down, M, Brain, WR. Time of day in relation to convulsion in epilepsy. Lancet. 1929;10291032.Google Scholar
66.Baxil, CW, Walczak, TS. Effects of sleep and sleep stage on epileptic and nonepileptic seizures. Epilepsia. 1997;38:5662.CrossRefGoogle Scholar
67.Dagan, Y, Eisenstein, M. Cireadian rhythm sleep disorders: toward a more precise definition and diagnosis. Chronobiol Int. 1999;16:213222.CrossRefGoogle Scholar
68.Regestein, QR, Monk, TH. Delayed sleep phase syndrome: a review of its clinical aspects. Am J Psychiatry. 1985;152:602608.Google Scholar
69.Weitzman, ED, Czeisler, CA, Coleman, RM. Delayed sleep phase syndrome. Arch Gen Psychiatry. 1981;38:737746.CrossRefGoogle ScholarPubMed
70.Aoki, H, Ozeki, Y, Yamada, N. Hypersensitivity of melatonin suppression in response to light in patients with delayed sleep phase syndrome. Chronobiol Int. 2001;18:262271.CrossRefGoogle ScholarPubMed
71.Kripke, D, Drennan, MD, Elliott, JA. The complex cireadian pacemaker in affective disorder. In: Touitou, Y, Haus, E, eds. Biological Rhythms in Clinic and Laboratory Medicine. Heidelberg, Germany: Springer-Verlag; 1992:265276.CrossRefGoogle Scholar
72.Rossenwasser, AM, Wirz-Justice, A. Cireadian rhythms and depression: clinical and experimental models. In: Redfern, PH, Lemmer, B, eds. Physiology and Pharmacology of Biologicalal Rhythms. Heidelberg, Germany: Springer-Verlag; 1997:457486.CrossRefGoogle Scholar
73.Parry, B, Berga, SL, Mostofi, N, et al.Morning versus evening bright light treatment of late luteal phase dysphoric disorder. Am J Psychiatry. 1989;146:12151217.Google ScholarPubMed
74.Dalton, KD. The Premenstrual Syndrome. Springfield, Ill: Charles C Thomas; 1964.Google Scholar
75.Case, AM, Reid, RL. Effects of the menstrual cycle on medical disorders. Arch Intern Med. 1998;158:14051412.CrossRefGoogle ScholarPubMed
76.Reinberg, AE. Concepts of cireadian chronopharmacology. In: Hrushesky, WJM, Langer, R, Theeuwes, F, eds. Temporal Control of Drug Delivery. Ann N Y Acad Sci. 1991;618(theme issue):102115.CrossRefGoogle Scholar
77.Lemmer, B, ed. Chronopharmacology: Cellular and Biochemical Interactions. New York, NY: Marcel Dekker; 1989.Google Scholar
78.Redfern, P, Lemmer, B, eds. Physiology and Pharmacology of Biologicalal Rhythms. Heidelberg, Germany: Springer-Verlag; 1997.CrossRefGoogle Scholar
79.Bélanger, PM. Chronopharmacology in drug research and therapy. Adv Drug Res. 1993;24:180.Google Scholar
80.Bélanger, PM, Bruguerolle, B, Labrecque, G. Rhythms in pharmacokinetics: absorption, distribution, metabolism. In: Redfern, PH, Lemmer, B, eds. Physiology and Pharmacology of Biologicalal Rhythms. Heidelberg, Germany: Springer-Verlag; 1997:177204.CrossRefGoogle Scholar
81.Moore, J, Merki, H. Gastrointestinal tract. In: Redfern, PH, Lemmer, B, ed. Physiology and Pharmacology of Biologicalal Rhythms. Heidelberg, Germany: Springer-Verlag; 1997:351373.CrossRefGoogle Scholar
82.Reinberg, AE, Smolensky, MH. Circadian changes in drug disposition in man. Clin Pharmacokinetics. 1982;7:401420.CrossRefGoogle ScholarPubMed
83.Lemmer, B, Bruguerolle, B. Chronopharmacokinetics: are they clinically relevant? Clin Pharmacokinetics. 1994;26:419427.CrossRefGoogle ScholarPubMed
84.Hrushesky, WJM, ed. Circadian Cancer Therapy. Boca Raton, FL: CRC Press; 1994.Google Scholar
85.Morgan, T, Anderson, A, Jones, E. The effect on 24-hour blood pressure control of an angiotensin converting enzyme inhibitor (perindopril) administered in the morning or at night. J Hypertens. 1997;15:205211.CrossRefGoogle ScholarPubMed
86.Palatini, P, Racioppa, A, Raule, G, et al.Effect of timing of administration on the plasma Ace inhibitor activity and the antihypertensive effect of quinapril. Clin Pharmacol Ther. 1992;52:378383.CrossRefGoogle ScholarPubMed
87.Hrushesky, WJM, Langer, R, Theeuwes, F, eds. Temporal control of drug delivery. Ann N Y Acad Sci. 1991;618.Google Scholar
88.Lewy, A, Sack, RL, Miller, LS, et al.Antidepressant and circadian phase shifting effects of light. Science. 1997;235:352354.CrossRefGoogle Scholar
89.Eastman, C, Young, M, Fogg, L, et al.Bright light treatment of winter depression: a placebo-controlled trial. Arch Gen Psychiatry. 1998;55:883889.CrossRefGoogle ScholarPubMed
90.Gupta, BD, Deka, AC. Application of chronobiology to radiotherapy of tumor of the oral cavity. Chronobiologia. 1975;2(suppl 1):125.Google Scholar
91.Harter, JG, Reddy, WJ, Thorn, GW. Studies on an intermittent corticosteroid dosage regimen. N Engl J Med. 1963;296:591595.CrossRefGoogle Scholar
92.Neaton, JD, Wentworth, D, for the Multiple risk Ractor Intervention Trial Research Group. Serum cholesterol, cigarette smoking, and death from coronary heart disease: overall findings and differences for 316,099 white men. Arch Intern Med. 1992;152:5664.CrossRefGoogle Scholar
93.Chasen, C, Muller, JE. Cardiovascular triggers and morning events. Blood Press Monit. 1998;3:3542.Google ScholarPubMed
94.Verdecchia, P, Porcellati, C, Schillaci, G, et al.Ambulatory blood pressure: an independent predictor of prognosis in essential hypertension. Hypertension. 1994;24:793801.CrossRefGoogle ScholarPubMed
95.Verdecchia, P, Schillaci, G, Guerrieri, M, et al.Circadian blood pressure changes in left ventricular hypertrophy in essential hypertension. Circulation. 1990;81:528536.CrossRefGoogle ScholarPubMed
96.Kario, K, Matsuo, T, Kobayashi, H, et al.Nocturnal fall of blood pressure and silent cerebrovascular damage in elderly patients: advanced silent cerebrovascular damage in extreme dippers. Hypertension. 1996;27:130135.CrossRefGoogle ScholarPubMed
97.Watanabe, N, Imai, Y, Nagai, K, et al.Nocturnal blood pressure and silent cerebrovascular lesions in elderly Japanese. Stroke. 1996;27:13191327.CrossRefGoogle ScholarPubMed
98.White, WB, Mansoor, GA, Tendler, BE, Anwar, YA. Nocturnal blood pressure: epidemiology, determinants, and effects of antihypertensive therapy. Blood Press Monit. 1998;3:4351.Google ScholarPubMed
99.Hayreh, SS, Zimmerman, B, Podhajsky, P, Alward, WLM. Nocturnal arterial hypotension and its role in optic head nerve and ocular ischemic disorders. Am J Ophthalmol. 1994;117:603624.CrossRefGoogle ScholarPubMed
100.White, WB, Anders, RJ, MacIntyre, JM, et al.Nocturnal dosing of a novel delivery system of verapamil for systemic hypertension. Am J Cardiol. 1995;76:375380.CrossRefGoogle ScholarPubMed
101.Smith, DHG, Neutel, JM, Weber, MA. A new chronother apeutic oral drug absorption system for verapamil optimizes blood pressure control in the morning. Am J Hypertens. 2001;14:1419.CrossRefGoogle Scholar
102.White, WB, Black, HR, Weber, MA, et al.Comparison of effects of controlled-onset extended release-verapamil at bedtime and nifedipine gastrointestinal therapeutic system on arising on early morning blood pressure, heart rate and the heart rate-blood pressure product. Am J Cardiol. 81:1998;424431.CrossRefGoogle ScholarPubMed
103.Deedwania, PC, Nelson, J. Pathophysiology of silent myocardial ischemia during daily life. Circulation. 1990;82:12961304.CrossRefGoogle ScholarPubMed
104.Hermida, RC, Fernández, JR, Ayala, DE, et al.Circadian rhythm of the double (rate-pressure) product in healthy normotensive young adults. Chronobiol Int. 2001;18:475489.CrossRefGoogle Scholar
105.Smolensky, MH. Knowledge and attitudes of American physicians and public about medical chronobiology and chronotherapeutics: findings of two 1996 Gallup surveys. Chronobiol Int. 1998;15:377394.CrossRefGoogle ScholarPubMed