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Cirrhosis has been long considered a risk factor for bleeding due to the co-existence of the so-called ‘coagulopathy’. More recently, however, compelling evidences have been provided on the occurrence of thrombotic events in the portal and systemic circulation.3–5 Portal vein thrombosis (PVT) is predominantly observed in patients with moderate to severe liver failure with a variable prevalence ranging from 0.6 to 25%. Only fewstudies have provided a longitudinal assessment of the PVT incidence and its sequelae, including recurrence and survival.9–14 Due to the variability of PVT incidence and the paucity of data regarding recurrence and survival,15–20 we prospectively analysed the incidence and the recurrence of PVT in the population of Portal vein thrombosis Relevance On Liver cirrhosis: ItalianVenous thromboticEventsRegistry (PROLIVER), a multi-centre study,8 which involved 43 enrolling centres in Italy (ClinicalTrials.gov Identifier: NCT01470547).

Summary: Background/objective: This study aimed to examine the association between body mass index (BMI) and school performance in high school students by controlling for relevant mediators such as sleep quality, sleep duration and socioeconomic status. Methods: Thirty-seven high school students (mean age: 18.16±0.44 years) attending the same school type, i.e. 'liceo scientifico' (science-based high school), were enrolled. Students' self-reported weight and height were used to calculate BMI. Participants wore an actigraph to objectively assess the quality and duration of sleep. School performance was assessed through the actual grade obtained at the final school-leaving exam, in which higher grades indicate higher performance. Results: BMI, get-up time, mean motor activity, wake after sleep onset and number of awakenings were negatively correlated with the grade, while sleep efficiency was positively correlated. When performing a multiple regression analysis, BMI proved the only significant (negative) predictor of grade. Conclusions: When controlling for sleep quality, sleep duration and socioeconomic status, a higher BMI is associated with a poorer school performance in high school students. Copyright

Sleep quality is an important clinical construct since it is increasingly common for people to complain about poor sleep quality and its impact on daytime functioning. Moreover, poor sleep quality can be an important symptom of many sleep and medical disorders. However, objective measures of sleep quality, such as polysomnography, are not readily available to most clinicians in their daily routine, and are expensive, time-consuming, and impractical for epidemiological and research studies., Several self-report questionnaires have, however, been developed. The present review aims to address their psychometric properties, construct validity, and factorial structure while presenting, comparing, and discussing the measurement properties of these sleep quality questionnaires. A systematic literature search, from 2008 to 2020, was performed using the electronic databases PubMed and Scopus, with predefined search terms. In total, 49 articles were analyzed from the 5734 articles found. The psychometric properties and factor structure of the following are reported: Pittsburgh Sleep Quality Index (PSQI), Athens Insomnia Scale (AIS), Insomnia Severity Index (ISI), Mini-Sleep Questionnaire (MSQ), Jenkins Sleep Scale (JSS), Leeds Sleep Evaluation Questionnaire (LSEQ), SLEEP-50 Questionnaire, and Epworth Sleepiness Scale (ESS). As the most frequently used subjective measurement of sleep quality, the PSQI reported good internal reliability and validity; however, different factorial structures were found in a variety of samples, casting doubt on the usefulness of total score in detecting poor and good sleepers. The sleep disorder scales (AIS, ISI, MSQ, JSS, LSEQ and SLEEP-50) reported good psychometric properties; nevertheless, AIS and ISI reported a variety of factorial models whereas LSEQ and SLEEP-50 appeared to be less useful for epidemiological and research settings due to the length of the questionnaires and their scoring. The MSQ and JSS seemed to be inexpensive and easy to administer, complete, and score, but further validation studies are needed. Finally, the ESS had good internal consistency and construct validity, while the main challenges were in its factorial structure, known-group difference and estimation of reliable cut-offs. Overall, the self-report questionnaires assessing sleep quality from different perspectives have good psychometric properties, with high internal consistency and test-retest reliability, as well as convergent/divergent validity with sleep, psychological, and socio-demographic variables. However, a clear definition of the factor model underlying the tools is recommended and reliable cut-off values should be indicated in order for clinicians to discriminate poor and good sleepers.

none 9 si The current study was conducted to provide normative data on actigraphic dichotomy index (I

The relationship between seasonal affective disorder (SAD) and subjective quality of sleep/wake cycle in adolescents was explored. The Seasonal Pattern Assessment Questionnaire for Children and Adolescents (SPAQ-CA) and Mini Sleep Questionnaire (MSQ) were administered to 345 adolescents living in the city of Cesena (Emilia-Romagna region, Italy) (299 females; age range: 14–18 years), to determine SAD and perceived quality of the sleep/wake cycle. The response rate was 92% for females and 90.2% for males. The MSQ includes two factors, sleep and wake, with lower scores corresponding to a lower quality of sleep and wake. The MSQ includes cut-off criteria to detect a good or bad sleep and wake quality. Adolescents with SAD (16±5.7) scored significantly lower than those not affected on wake factor (19.5±4.3), while no effect has been observed on sleep factor. SAD was the only one significant predictor of good/bad wake quality, while it did not reach significant level with reference to good/bad sleep quality. Present results are indications of a possible influence of SAD on wake quality and further studies are necessary to confirm them.

The main goal of the present study was to examine the effects of transition into and out of daylight saving time (DST) on the quality of the sleep/wake cycle, assessed through actigraphy. To this end, 14 healthy university students (mean age: 26.86 ± 3.25 yrs) wore an actigraph for 7 d before and 7 d after the transition out of and into DST on fall 2009 and spring 2010, respectively. The following parameters have been compared before and after the transition, separately for autumn and spring changes: bedtime (BT), get-up time (GUT), time in bed (TIB), sleep onset latency (SOL), fragmentation index (FI), sleep efficiency (SE), total sleep time (TST), wake after sleep onset (WASO), mean activity score (MAS), and number of wake bouts (WB). After the autumn transition, a significant advance of the GUT and a decrease of TIB and TST were observed. On the contrary, spring transition led to a delay of the GUT, an increase of TIB, TST, WASO, MAS, and WB, and a decrease of SE. The present results highlight a more strong deterioration of sleep/wake cycle quality after spring compared with autumn transition, confirming that human circadian system more easily adjusts to a phase delay (autumn change) than a phase advance (spring transition).

According to the A Theory of Magnitude (ATOM) model, time, numbers and space are processed by a common analog magnitude system. The model proposes that time, numbers and space are influenced by each other. Indeed, spatial-temporal (STEARC effect), spatial-numerical (SNARC effect) and temporal-numerical (TiNARC effect) interactions have been observed. However, the processing of time, numbers and space has not yet been studied within the same experimental procedure. The goal of this study is to test the ATOM model using a procedure in which time, numbers and space are all present. The participants were asked to perform temporal estimation (Experiment 1) and reproduction (Experiment 2) tasks in two different conditions, with either numbers or letters as stimuli. In Experiment 1, significant STEARC, SNARC and TiNARC effects were found in general and when numbers were presented. Moreover, a significant triple interaction between space, time and magnitude was observed, indicating associations between the left key, short duration and small magnitudes, as well as between the right key, long duration and large magnitudes. These results were similar in reaction times and accuracy. In Experiment 2, the results of reproduction times mirrored the previous data but the triple interaction was not found on reproduction times. Considering the temporal accuracy, the STEARC, SNARC and TiNARC effects as well as triple interaction were found. The results seem to partially confirm the ATOM model, even if differences between temporal tasks should be posited.

The aim of this study was to explore the relationship between circadian preference and sensation seeking. To this aim 1041 university students (408 males and 633 females), ranging in age between 18 and 30 years, filled the reduced version of the Morningness-Eveningness Questionnaire (MEQr) and the Sensation Seeking Scale-Form V (SSS-V). Males scored higher than females in SSS-V total score and all subscales, except experience seeking (ES). As regards circadian preference, evening types scored higher than morning types in SSS-V total score and all subscales, except boredom susceptibility (BS) where they significantly differed only from intermediate types. On the whole our results highlight a significant relationship between circadian preference and sensation seeking.

The purpose of this study was to explore a possible season of birth effect on big five personality traits, taking into account also gender and circadian typology variables. A sample of 419 healthy young adults (249 females and 170 males) was administered the self-report version of the Big Five Observer (BFO) and the Morningness–Eveningness Questionnaire (MEQ) to determine, respectively, personality features and circadian preference. Participants were subdivided into four season groups, according to their birth date. No significant season of birth effect was observed as regards personality traits even if summer-born participants tended to score lower on the conscientiousness dimension. In regard to the conscientiousness domain, there was a significant interaction between gender and season of birth. Males presented greater conscientiousness variation with summer born participants scoring lower. On the basis of a multiple regression analysis, MEQ score proved to be a better predictor of conscientiousness than gender, age, and season of birth. The results provide no clear evidence for a season of birth effect on the big five personality traits. It is possible that circadian preference may modulate the season of birth effect on personality traits.

We explored the relationship between personality, based on the five-factor model, and circadian preference. To this end, 503 participants (280 females, 223 males) were administered the Morningness-Eveningness Questionnaire (MEQ) and the self-report version of the Big Five Observer (BFO) to determine circadian preference and personality features, respectively. Morning types scored significantly higher than evening and intermediate types on the conscientiousness factor. Evening types were found to be more neurotic than morning types. With reference to the big five personality model, our data, together with those of all the previous studies, indicate that the conscientiousness domain is the one that best discriminates among the three circadian types. Results are discussed with reference to neurobiological models of personality.

The space–time interaction suggests a left-to-right directionality in the mind’s representation of elapsing time. However, studies showing a possible vertical time representation are scarce and contradictory. In Experiment 1, 32 participants had to judge the duration (200, 300, 500, or 600 ms) of the target stimulus that appeared at the top, centre, or bottom of the screen, compared with a reference stimulus (400 ms) that always appeared in the centre of the screen. In Experiment 2, 32 participants were administered the same procedure, but the reference stimulus appeared at the top, centre, or bottom of the screen and the target stimulus was fixed in the centre location. In both experiments, a space–time interaction was found with an association between short durations and bottom response key as well as between long durations and top key. The evidence of a vertical mental timeline was further confirmed by the distance effect with a lower level of performance for durations close to that of the reference stimulus. The results suggest a bottom-to-top mapping of time representation, more in line with the metaphor “more is up.”

Sexual development is a complex mechanism activated by the hypothalamic-pituitary-gonadal axis. Over the last one hundred years there has been a decline in the age at puberty onset in industrialised countries. Some Italian studies showed an increase in diagnoses of Central Precocious Puberty (CPP) during the COVID-19 pandemic. It is thus supposed that in this period there was an increased impact of factors that can influence pubertal development. Our retrospective monocentric study aimed to confirm the existence of this phenomenon and analysed possible related factors. We retrospectively evaluated clinical, laboratory, radiological and ultrasound (US) data of 154 girls referred to our Tertiary Centre of Paediatric Endocrinology from January 2019 to April 2021 for different forms of Precocious Puberty. We subdivided the cases into subgroups according to the final diagnosis: CPP, Early Puberty (EP), isolated thelarche and isolated pubarche. The observation period was subdivided into: Period 1, before lockdown (1 January 2019 – 8 March 2020) and Period 2, lockdown and the following months (9 March 2020 – 30 April 2021). Period 2 was further divided into “restrictive lockdown period” (Period 2.1) (March 2020 – 14 June 2020, in which the schools were closed) and “less restrictive lockdown period” (Period 2.2) (15 June 2020 – 30 April 2021). We analysed data regarding the use of electronic devices before and during lockdown in a group of girls with CPP diagnosed in Period 2 and we compared the data with that of a control group. Our data show an increase in the number of new diagnoses of CPP during lockdown and in the following months, compared with the previous period. We also detected a higher use of PCs and smartphones in girls with CPP diagnosed in Period 2, compared with the control group. The percentage of the presence of endometrial rhyme detected during the pelvic ultrasound was higher in girls with CPP in Period 2, compared with the previous period. Based on our data we assume there was an environmental effect on pubertal timing that calls our attention to factors such as food, use of electronic devices and stress. We will need further studies to better understand this data.

none 6 no First Online: 29 October 2014 Purpose This study aimed at examining the effects of 2 weeks of dawn simulation on attentional performance in adolescents. Methods On the whole, 56 adolescents (24 females and 32 males) took part to the study, with a mean age of 17.68 ± 0.97 years (age ranging between 15 and 20 years). Each adolescent was requested to participate for 5 consecutive weeks and the research design included the baseline and two counterbalanced conditions, dawn simulator and control (no dawn simulator). Attentional performance of adolescents was measured through the attention network test (ANT) that allowed assessing the efficiency of three separable attentional networks, namely alerting, orienting and executive. Overall, participants performed the ANT three times (i.e., one time for each condition), while sleep quality, sleep duration and sleep timing were concurrently monitored by means of actigraphy and were treated as potential confounders. Results The only improvement of the attentional performance attributable to the use of dawn simulator was observed for the efficiency of alerting network (45.97 ± 32.76 ms) that significantly increased in comparison to the baseline (31.57 ± 26.97 ms) (p < 0.05). On the contrary, the sleep quality, sleep quantity and sleep timing did not significantly change. Conclusion These results show for the first time that, controlling for sleep quality, sleep duration and sleep timing, the use of dawn simulator across 2 weeks is able to determine an alerting effect in adolescents. Tonetti L.; Fabbri M.; Erbacci A.; Filardi M.; Martoni M.; Natale V. Tonetti L.; Fabbri M.; Erbacci A.; Filardi M.; Martoni M.; Natale V.

It is well established that temporal events are represented on a spatially oriented mental time line from left to right. Depending on the task characteristics, the spatial representation of time may be linked to different types of dimensions, including manual response codes and physical space codes. The aim of the present study was to analyze whether manual response and physical space codes are independent of each other or whether they interact when both types of information are involved in the task. The participants performed a temporal estimation task with two lateralized response buttons in four experiments. In the first experiment, the target stimuli were presented on the left side, at the center, or on the right side of the space, whereas the reference stimuli were always presented centrally. The reverse situation was presented in the second experiment. In the third experiment, both stimuli were presented in opposite spatial positions (e.g., left-right), whereas in the last experiment, both stimuli were presented in the same spatial position (e.g., left-left). In all experiments, perceptual and motor congruency effects were found, but no modulation of the congruency effects was found when both the perceptual and motor components were congruent. The results indicated that physical, spatial, and manual response codes are independent from each other for time-space associations, even when both codes are involved in the task. These results are discussed in terms of the "intermediate-coding" account.

The spatial-temporal association indicates that time is represented spatially along a left-to-right line. It is unclear whether the spatial-temporal association is mainly related to a perceptual or a motor component. In addition, the spatial-temporal association is not consistently found using a time reproduction task. Our rationale for this finding is that, classically, a non-lateralized button for performing the task has been used. Using two lateralized response buttons, the aim of the study was to find a spatial-temporal association in a time reproduction task. To account for the perceptual component, reference and target stimuli were presented in different spaces through four experiments. In all experiments, a Spatial-Temporal Association of Response Codes (STEARC) effect was found and this effect was not modulated by the spatial position of both reference and target stimuli. The results suggested that the spatial-temporal association was mainly derived from the spatial information provided by response buttons, reflecting a motor but not visuospatial influence.

THE PART OF THE BRAIN THAT ORCHESTRATES RHYTHMICITY IS THE SUPRACHIASMATIC NUCLEUS (SCN) IN THE ANTERIOR HYPOTHALAMUS. THE NEURAL INPUT and output pathways for SCN develop in the fetus and continue to mature during the early neonatal period.1 It has been shown that human SCN grows in cell number and size around the time of birth and during the first few months after birth.2 As a consequence, it has been posited that the environmental variables during pregnancy and the perinatal period could have a decisive effect on the developing circadian system of the fetus. A series of studies have shown that season of birth is an important proxy for such environmental factors vis-a-vis the development of various individual differences and pathologies in adults: handedness,3 personality,4 mental disorders,5 and sleep disorders.6 Etiology of the season of birth effect however is still not completely understood. Neurodevelopmental damage caused by prenatal or postnatal viral infection was one of the first hypotheses7 put forward, though in the last year, the issue of photoperiod has come to the fore. It seems likely that circannual variations of daylight in the late fetal period and the early stages of development influence the maturing neurohormonal system in hypothalamic nuclei.8 Surveys conducted in different countries have demonstrated a relationship between season of birth and circadian typology.9 These studies, in which more evening types were found among people born during spring and summer, have posited the photoperiod around birth as a crucial factor.10,11 As already demonstrated in animals,12 exposure to increasing photoperiod at birth seems to elicit phase delay (eveningness) of the human circadian system. According to this hypothesis, people born in spring (increasing photoperiod) or summer (long photoperiod) would have internal clocks with longer days than people born in autumn (decreasing photoperiod) or winter (short photoperiod). This setting “error” might reflect the fact that the newborn's pineal gland has had only 9 months to develop.13 The melatonin timing mechanism, which codes for day length, is initiated prenatally by the maternal pineal gland and continued postnatally by the infant's pineal gland. Seasonal variation on day length requires 12 months of development (as opposed to the 9-month gestation period). Following this line of thought, it might be expected that people born in the summer season tend to present delayed sleep onset in the first months of their life, and vice versa for people born in autumn. Previous work would seem to point to a season of birth effect on sleep timing. But is this effect equally distributed between onset and offset of sleep? Is a season of birth effect on sleep duration possible? The aim of the present survey was to examine season of birth effect on the sleep-wake cycle in young adult humans. To our knowledge, there are no published scientific studies on this issue. We found only one work on season of birth and schizophrenia, in which an unexpected relationship was found between hours of reported sleep and season of birth: fall births were associated with increased hours of sleep.14 In a recent longitudinal survey on 1,112 children, sleep-wake schedules were not associated with birth season.15 Taking into account the masking effect of social schedules we decided to investigate preferred sleep-wake cycle timing, using the Morningness-Eveningness Questionnaire (MEQ).16 The MEQ, which was the first tool developed to assess circadian typology, consists of 19 mixed-format questions regarding the time individuals get up and go to bed, preferred times for physical and mental activity, and subjective alertness. Although it has been criticized for not just collecting information on morningness, but on other domains as well,17,18 it has proven to be a valid and reliable tool using physiological and psychological parameters.19,20 The MEQ has been translated into many languages and is still the most frequently used self-evaluation tool. Above all, the MEQ is the only circadian questionnaire with open questions, in which subjects can put their preferred time without the limitations of using ordinal scales; it was for this reason we decided to use it in this study. To better estimate the effect of season of birth on sleep timing preference, we ran analyses on the answers to items 1 (preferred arising time) and 2 (preferred going-to-bed time). Using the preferred sleep onset (item 2) and awakening (item 1) times, we also indirectly calculated preferences regarding sleep need21 (or, more properly, time in bed) and midpoint of sleep.22 To better evaluate the relationship between season of birth and sleep timing preference, we collected data from 2 different countries: Spain and Italy. Despite similar latitudes, Spanish social life is organized more towards eveningness than Italian life is.23 In this way, we thought we could simultaneously evaluate biological (gender), social-cultural (nationality), and birth environment (photoperiod) factors in modulating sleep timing preference in humans.

Background: Rhythm disturbances are a frequent clinical manifestation of depression. In recent years a possible relationship between depression and chronotypes has emerged. Specifically eveningness has been proposed as vulnerability factor. The aim of this study was to describe sleep features of depressed patients according to chronotypes and to explore possible associations with the clinical features of depressive episodes. Methods: 100 patients diagnosed with Major Depressive Disorder according to the Mini International Neuropsychiatric Interview (MINI) were included (age: 34 +/- 11.74, range: 18-60 years; female/male:79/21). At admission the Hamilton Rating Scale for Depression (HRSD) was administered. Patients were also administered the Morningness-Eveningness Questionnaire (MEQ), the Epworth Sleepiness Scale, the Athens Insomnia Scale and the Pittsburgh Sleep Quality Index. Results: According to MEQ scores patients were classified in three groups: a) eveningness (n = 18), b) neither (n = 61) and c) morningness type (n = 21). The age was different among chronotypes, being morningness-type patients older. The eveningness-type group showed higher scores in suicidal thoughts, more impaired work and activities, higher paranoid symptoms, higher scores on the anxiety cluster (HRSD), while the morningness-type group showed lower proportion of melancholic symptoms (MINI). We did not find association between sleep parameters and specific chronotypes. Limitations: The relatively small sample size and the concurrent assessment of chronotypes and depression may have biased our findings. Conclusions: Our data suggest the idea that chronotypes have an impact on depressive episodes features, with higher severity for the eveningness-type. (C) 2009 Elsevier B.V. All rights reserved

The aim of this study was to examine sex differences in sleep-time preference by age among Italian pre-adolescents, adolescents, and adults. The final sample consisted of 8,972 participants (5,367 females and 3,605 males) from 10 to 87 yrs of age. To assess preferred sleep habits, we considered the answers to the open-ended questions of the Morningness-Eveningness Questionnaire (MEQ). In agreement with previous studies, we found that sleep-time preference started to shift toward eveningness from the age of 13 yrs. Females reached their peak in eveningness earlier (about 17 yrs of age) than males (about 21 yrs of age). Thereafter, the ideal sleep-time preference advanced in men and women with increasing age. Females presented a more significant advanced sleep phase than males only during the years when sexual hormones are typically active. Moreover, females reported a longer ideal sleep duration than males across all age groups examined, except in over 55 yrs one.

The present study aimed to compare two commercially available actigraphs, with a concurrent polysomnographic (PSG) recording. Twelve healthy volunteers (six women; age range 19–28 yrs) simultaneously wore the Basic Mini-Motionloggerw and Actiwatchw for seven overnight polysomnographic recordings. Comparisons of the following sleep measures were focused on: sleep onset latency (SOL), total sleep time, wake after sleep onset, and sleep efficiency. Both devices underestimated SOL in comparison to PSG, but they had similar performance compared to PSG for the other sleep measures. A limit of the study is that the results can be only generalized to healthy young subjects.

The goal of this study is aimed to investigate a possible effect of time of day on arithmetic fact retrieval in a number-matching task. We tested 96 students (age range 19-33 years) at 9 a.m. and at 1 p.m., in a counterbalanced order. The subjective alertness levels were also recorded. As regards retrieval efficiency, the results showed that the sum interference effect was significantly more pronounced in the morning (9 a.m.) than at midday (1 p.m.). As expected, participants showed higher subjective alertness levels at 1 p.m. than at 9 a.m.. However, the difference of subjective alertness did not completely explain differences in interference at two testing sessions. The results could be explained with respect to the variation of working memory efficiency during the day.

Background: Most of the earlier studies on mood seasonality were conducted in adults and there are few available data on children and adolescents. In two cross sectional surveys, we examined the role of age and gender on seasonal sensitivity in subjects aged 10 to 25 years. Methods: In survey one, the Seasonal Pattern Assessment Questionnaire for Children and Adolescents (SPAQ-CA) was administered to 1709 subjects (845 females and 864 males) from 10 to 17 years. In survey two, the Seasonal Pattern Assessment Questionnaire (SPAQ) was administered to 1867 subjects (1061 females and 806 males) from 18 to 25 years. Results: Only in survey one was a significant positive correlation found between age and Global Seasonality Score (GSS) (r=.29; p

Background/objectives This study aimed to examine the variations of circadian activity rhythm of children according to objective body mass index (BMI) values, using a novel statistical framework (ie, Functional Linear Modeling, FLM), separately for school- and weekend days. Methods A total of 107 participants (60 females; mean age: 10.25 ± 0.48 years) wore an actigraph for seven days during a regular school-week. While valid actigraphic data during school days were available for each of these children, this number decreased to 53 (31 females; mean age: 10.28 ± 0.51 years) during weekend days. Results Examining the school days, significantly higher motor activity in participants with higher BMI was observed from around 4:00 a.m. to 6:00 a.m., with a peak about 5:00 a.m. On the contrary, applying the FLM to the weekend days actigraphic data, no significantly different variation of circadian activity rhythm was observed, according to BMI. Conclusions In this specific sample of children, during school days, higher BMI is associated with higher activity level in a specific time window in the second half of nocturnal sleep. The lack of significant findings during weekend days could be explained because of higher variability of get-up time and/or the reduced sample size. Future longitudinal studies could explore if the higher motor activity in that specific time window qualifies as a predictive marker of the development of overweight and obesity. If so, early preventive strategies directed towards those at higher risk could be effectively implemented.

The aim of this work was to present the Sleep Beliefs Scale (SBS), a 20-item reviewed version of the Sleep Hygiene Awareness by Lacks and Rotert [Behav. Res. Ther., 1986, 28: 104–112]. We also examined for the first time the influence of circadian typology in sleep beliefs. Voluntary and unpaid psychology students rticipated in the study (n = 510; 182 men and 328 women), from Italy and Spain, aged between 18 and 33 (22.80 ± 4.14 years). The mean score of SBS was 13.05 (SD = 3.46; range 2–20) in the total sample, with a distribution positive skewness to high score (correct beliefs) (Z = 1.82; P = 0.003). The internal consistency was good (Cronbach’s a = 0.714) and factor analysis extracted three factors labelled "Sleep-incompatible behaviours" (eight items), "Sleep–wake cycle behaviours" (seven items) and "Thoughts and attitudes to sleep" (five items). Circadian typology influences the total score and that of the three factors, as well the majority of the items that compose the SBS. The morning-type showed the best scores, the evening-type the worst, and the neither-type the medium scores. Moreover, in the men sample, the differences between circadian typology groups were higher than in the women sample. The SBS showed good psychometric properties; however, further studies in other countries, with clinical and non-student samples, and more aged subjects are needed so as to validate this psychometric instrument. The circadian typology is an individual difference that presented significant relationships with the sleep beliefs, the possibility of the evening-type being a risk factor for a worse sleep hygiene, and the maintenance of sleep problems such as insomnia may all be investigated in depth in future research.

The present study analysed the efficiency of postural control after 12 h of nocturnal forced wakefulness using Romberg's test comprising 1 min of recording with eyes-open and 1 min of recording with eyes-closed, with a 1 min break between the two sessions. Our aim was to see if the decreased postural control efficiency after a sleepless night was unspecific (in both eyes-closed and eyes-open conditions) or selective (in only one of the conditions). A total of 55 students spent a whole night awake at our laboratory and were tested at 22:00 and 08:00 h. In general, the results showed that postural sway increased, performing the recording from eyes-open to eyes-closed condition. The statokinesigram length (SL or efficiency of the postural system) increased after the sleepless night, while in eyes-open condition, the length in function of surface (LFS or accuracy of postural control) and Romberg's index (or contribution of vision to maintain posture) significantly decreased. This could indicate that after a night without sleep, there is a slower elaboration of visual inputs in the postural control process. On the basis of these results, the effects of sleep deprivation on cognitive performance were considered from a neuropsychological point of view.

This study aimed to provide evidence of the validity of the Perceived Physical Ability Scale for Children against an external-objective criterion of the 24 h motor activity pattern assessed through actigraphy. A total of 107 children (60 females, mean age 10.25 ± 0.48) were originally enrolled. Children wore the actigraph model Actiwatch AW64 (Cambridge Neurotechnology Ltd., Fenstanton, UK) for seven days, 24 h per day, around the non-dominant wrist. At the beginning of the actigraphic recording, participants filled in the Perceived Physical Ability Scale for Children. Functional Linear Modeling was used to examine variation in the 24 h motor activity pattern according to the total score in the Perceived Physical Ability Scale for Children. Higher physical self-efficacy was significantly related to greater levels of motor activity in the afternoon. Overall, this pattern of results supports the validity of the Perceived Physical Ability Scale for Children against the external-objective criterion of the 24 h motor pattern. The Perceived Physical Ability Scale for Children could represent a promising endpoint for studies assessing the effectiveness of physical activity promotion interventions.

Objective Recently, we observed some cases of Precocious Puberty (PP) with a partial central activation of hypothalamic-pituitary-gonadal (HPG) axis that tended to normalized in 6–12 months. To evaluate the frequency of this form within the spectrum of forms of PP, we retrospectively assessed the clinical, hormonal and ultrasound characteristics of patients attending to our Center for signs of PP, between 2007 and 2017. To hypothesize some causes of this “pubertal poussée” a questionnaire about environmental data was provided to patients. Methods 96 girls were recruited for the study and divided into three Groups. Group 1: 56 subjects with Central PP (CPP) requiring treatment with GnRH analogue; Group 2: 22 subjects with transient activation of pubertal axis, that tended to normalize, “Transient CPP”(T-CPP); Group 3: 18 subjects with Isolated Thelarche (IT). Results Mean age at diagnosis was 6.8 ± 1.0 years in Group 1, 5.9 ± 1.3 years in Group 2 and 5.6 ± 1.5 years in Group 3. A significant increase of diagnosis of T-CPP was observed over the study period. Significantly higher use of some homeopathic medicines and potential exposure to pesticides was reported in Group 2 vs Group 1. Conclusions To our knowledge, we first reported a form defined as T-CPP, characterized by partial activation in the HPG axis normalizing over time. An increased use of homeopathic medicines and exposure to environmental pollutants in these patients was evidenced.

Background: Persons living with HIV (PLWH) frequently report sleep complaints, but objective measurements are still lacking regarding sleep continuity, total sleep time per 24 h, and the links with both prospective memory performance and HIV infection parameters. Methods: PLWH (n = 96) and control (n = 96) groups (balanced for gender and age) were monitored by 24h-actigraphy for at least seven consecutive days. The prospective memory performance was assessed through a naturalistic, activity-based task performed twice a day on the actigraph. Results: PLWH had greater sleep latency and worse sleep continuity (higher fragmentation index) for night-time sleep and longest daytime nap (mean duration of the longest nap). Comparable results were reported for the prospective memory task, better performance scores were associated with several sleep parameters in controls but not in PLWH. Finally, within the PLWH group, being a long sleeper per 24 h (total sleep time &gt, 8 h including more and long daytime naps) was associated with a greater severity of the disease (lower CD4 nadir and more frequent history of AIDS-defining events). Conclusions: These findings indicate that PLWH have more fragmented sleep and that the severity of HIV infection is associated with increased sleep duration.

Prospective memory (PM) is essential in everyday life because it concerns the ability to remember to perform an intended action in the future. This ability could be influenced by poor sleep quality, the role of which, however, is still being debated. To examine the role of sleep quality in PM in depth, we decided to perform a retrospective naturalistic study examining different clinical populations with a primary sleep disorder or comorbid low sleep quality. If sleep is important for PM function, we could expect poor sleep to affect PM performance tasks both directly and indirectly. We examined a total of 3600 nights, recorded using actigraphy in participants belonging to the following groups: primary insomnia (731 nights), narcolepsy type 1 (1069 nights), attention deficit hyperactivity disorder (152 nights in children and 239 in adults), severe obesity (232 nights), essential hypertension (226 nights), menopause (143 nights), healthy controls (808 nights). In a naturalistic activity-based PM task, each participant originally wore an actigraph around the non-dominant wrist and was requested to push the event-marker button at two specific times of day: bedtime (activity 1) and get-up time (activity 2). Each clinical group showed significantly lower sleep quality in comparison to the control group. However, only narcolepsy type 1 patients presented a significantly impaired PM performance at get-up time, remembering to push the event-marker button around half the time compared not only to healthy controls but also to the other clinical groups. Overall, the present results seem to point to sleep quality having no effect on the efficiency of a naturalistic activity-based PM task. Moreover, the data indicated that narcolepsy type 1 patients may show a disease-specific cognitive deficit of PM.

IntroductionThe COVID-19 pandemic forced the Italian government to issue extremely restrictive measures on daily activities since 11 March 2020 (‘lockdown’), which may have influenced the metabolic control of type 1 diabetes mellitus (T1D). The aims of the study were to investigate continuous glucose monitoring (CGM) metrics in children and adults with T1D during lockdown and to identify their potentially related factors.Research design and methodsWe enrolled 130 consecutive patients with T1D (30 children (≤12 years), 24 teenagers (13–17 years), and 76 adults (≥18 years)) using either Dexcom or FreeStyle LibreCGM>70% during the study period, without hybrid closed-loop insulin pump. CGM metrics during the 20 days before and the 20 days after lockdown were calculated. By telephonic contact, we performed validated physical activity and perceived stress questionnaires.ResultsIn children, significantly lower glucose SD (SDglu) (p=0.029) and time below range (TBR)ConclusionIn patients with T1D during lockdown, CGM metrics mostly improved in children and adults, whereas it was unchanged in teenagers. In adults, age, physical activity, and perceived stress may be relevant contributing factors.

The main purpose of the present study was to investigate the individual variables contributing to determine the high variability in the consumption behaviours of caffeine, a psychoactive substance which is still poorly investigated in comparison with other drugs. The effects of a large set of specific personality traits (i.e., Impulsivity, Sensation Seeking, Anxiety, Reward Sensitivity and Circadian Preference) were compared along with some relevant socio-demographic variables (i.e., gender and age) and cigarette smoking behaviour. Analyses revealed that daily caffeine intake was significantly higher for males, older people, participants smoking more cigarettes and showing higher scores on Impulsivity, Sensation Seeking and a facet of Reward Sensitivity. However, more detailed analyses showed that different patterns of individual variables predicted caffeine consumption when the times of day and the caffeine sources were considered. The present results suggest that such detailed analyses are required to detect the critical predictive variables that could be obscured when only total caffeine intake during the entire day is considered.

The present study explores the relationships between functional and dysfunctional impulsivity factors, circadian typology, and sex. A sample of 850 university students (396 men) aged between 18 and 33 yrs of age completed the Dickman's Impulsivity Inventory (DII) and reduced morningness-eveningness questionnaire (rMEQ). Factorial analysis showed a dimensional clustering with satisfactory item saturation for both dimensions of impulsivity, especially in men and evening-type. Men presented higher values than women for functional and dysfunctional impulsivity, while morning-type subjects obtained lower scores in dysfunctional impulsivity than the neither- and evening-types. An interactive effect between circadian typology and sex was obtained for dysfunctional impulsivity. Higher scores in men for dysfunctional impulsivity were found in neither- and evening-types, while no significant differences were obtained between men and women in the morning-type group. The morning-type typology can be considered a protective factor for impulse control disorders, especially in men, but further research is needed on the clinical and neurobiological implications of our results.

Bizarreness in dreams is defined as an unusual combination of features in the phenomenal unified consciousness, that is, an incoherent simulation of the waking world. The present study investigated the specific mechanisms underlying dream image production and the phenomenal unity of consciousness by focusing on size and shape bizarreness. Data were derived from a Dream Data Bank of experimental dream studies. Analyses revealed that feature distortion was quite infrequent. Results are discussed in terms of cognitive processes proposed in a dream production model. Theoretical cognitive constructs, such as Kosslyn's imagery model, memory systems functioning, and binding, were used to speculate about these two specific types of bizarreness.

PurposeTo review the psychometric properties of the questionnaires commonly filled in by children and adolescents to measure circadian preference.MethodsWe examined the Morningness-Eveningness Questionnaire for Children and Adolescents (MEQ-CA), the Morningness-Eveningness Scale for Children (MESC) and the Composite Scale of Morningness (CSM). We critically analyzed the reliability, in term of internal consistency (through the Cronbach's alpha) and test-retest reliability (through the correlation coefficient), and the type of validation against external criteria (objective assessment of the sleep/wake cycle, body temperature, hormones and other questionnaires). Fifty studies that reported these data were included in the review: 7 studies used the MEQ-CA, 28 used the MESC and 15 used the CSM.ResultsThe percentage of studies reporting at least acceptable levels of internal consistency was high and similar between the three questionnaires. Evidence for test-retest reliability was scant, since only 3 studies were available; it was at least acceptable for the MESC (two studies with a time interval of 1 month), not acceptable for the MEQ-CA (one study with a time interval of 6 months), while no information was available for the CSM. As regards the validation evidence, the MEQ-CA has been validated by the highest number of external criteria (actigraphy, oral body temperature and other questionnaires), followed by the CSM (cortisol sampling and other questionnaires). The MESC has been validated only against self-report measures.ConclusionsThe present state of the art would suggest the use of the MEQ-CA to assess circadian preference in children and adolescents.

Objective: The aim of the study was to put forward quantitative criteria for the Consensus Sleep Diary, to differentiate people with insomnia from normal sleepers. Methods: In this retrospective study, we analyzed 295 sleep diaries of patients with primary insomnia (43%weremale, ages ranging between 17 and 76 years) collected in two clinical centers for insomnia and 536 sleep diaries of normal sleepers (47% were male, ages ranging between 15 and 82 years).We considered the following sleep parameters: time in bed, sleep onset latency, total sleep time, wake after sleep onset, sleep efficiency, number of awakenings, terminal wakefulness, and subjective feeling of rest. Using the Youden index, we calculated the quantitative criteria that performed best for each sleep parameter. Finally, we created receiver operating characteristic curves to test the accuracy of each identified criterion. Results: Individuals with insomnia significantly differed from controls on all sleep indices (p < .001). Differentiation between individuals with insomnia from controls was optimal for terminal wakefulness (>15 minutes, area under the curve [AUC] = 0.83), wake after sleep onset (cutoff >20 minutes, AUC = 0.81), total sleep time (

none 5 no Objective: The aim of this study was to examine the effects of sleep timing, quality and duration on school achievement in adolescents. Methods: Thirty-six Italian students (mean age: 18.14 ± 0.49 years) attending their last year of high school participated in the study. They completed the Morningness–Eveningness Questionnaire for Children and Adolescents (MEQ-CA). This was used to determine their ideal sleep timing by computing the total score, with higher scores corresponding to a greater tendency toward morningness. In addition, students underwent two non-consecutive weeks of actigraphy in one-month period to objectively assess: habitual sleep timing through the midpoint of sleep (MS); habitual sleep quality through the parameter of sleep efficiency (SE); and habitual sleep duration through the parameter of total sleep time (TST). Participants also completed the Mini Sleep Questionnaire, which allowed us to assess perceived sleep quality, at the end of each actigraphic-recording week. School performance was assessed using the grades obtained by students in their school leaving exams taken at the end of the school year. Results: A significant positive correlation was observed between SE and exam grades, as well as MEQCA scores and grades. Multiple regression analysis showed that only SE was significantly and positively related to the final grade. Conclusions: Examining objective and ecological measures, SE (indicator of sleep quality) had the strongest effect on school achievement in adolescents. Tonetti, L.; Fabbri, M.; Filardi, M.; Martoni, M.; Natale, V. Tonetti, L.; Fabbri, M.; Filardi, M.; Martoni, M.; Natale, V.

The association between circadian preference and academic achievement has been assessed through a systematic review and meta-analysis. The literature searches retrieved 1647 studies; 31 studies, with a total sample size of 27 309 participants, fulfilled the inclusion criteria and were included in the meta-analysis. With reference to all these 31 studies, before running the meta-analysis, the sign of the correlation between the investigated variables was set in a way that a positive correlation showed that eveningness was related to worse academic performance. The meta-analysis yielded a small overall effect size of 0.143 (CI [0,129; 0,156]) under a fixed effects model (Z = 20.584, p

It has been suggested that being an “evening type” might enhance susceptibility to non-seasonal and seasonal affective disorders (SAD). In a survey and a prospective study, we examine the relationship between mood seasonality and circadian typology. In the survey study, the Morningness–Eveningness Questionnaire (MEQ) and the Seasonal Pattern Assessment Questionnaire (SPAQ) were administered to 1715 university students from Spain and Italy. In the prospective study, 18 subjects, selected from the Italian sample, self-assessed their mood monthly for over a year. A slight but significant negative correlation between the MEQ score and the Global Seasonality Score was found in the survey study, with a significantly higher incidence of evening versus morning types among the students with seasonal depression. These results were not replicated when the Spanish sample was analysed separately. In the prospective study, evening types did not present a higher annual range of mood variations than morning types. Caution should be exercised in ascribing eveningness as a risk factor in SAD since other underestimated factors, including social–cultural conditions, might be involved in the pathogenesis of mood seasonality.

Morningness scales have been translated into several languages, but a lack of normative data and methodological differences make cross-cultural comparisons difficult. This study examines the psychometric properties and factor structure of the Composite Scale of Morningness (CSM) in samples from five countries: France (n = 627), Italy (n = 702), Spain (n = 391), Thailand (n = 503), and Australia (n = 654). Strong national differences are identified. A quadratic relationship between age and CSM total score was apparent in the Australian data with a downward trend after age 35 yrs. There was no age effect in any sample in the range from 18 to 29 yrs. Factor analysis identified a three-factor solution in all groups for both men and women. Tucker's congruence coefficients indicate that: (1) this solution is highly congruent between sexes in each culture, and (2) a morning affect factor is highly congruent between cultures. These results indicate there are national differences in factorial structure and that cut-off scores used to categorize participants as morning- and evening-types should be established for different cultural and age groups.

Aim: The current study was conducted to evaluate the psychometric properties and analyze the convergent validity of the Italian version of the Mini Sleep Questionnaire (MSQ). In addition, it was aimed to put forward cut-off values to be used in screening protocols. Methods: The MSQ was administered to 1830 participants (age range 18–87 years), of whom 1208 also completed the Sleep Disorder Questionnaire (age range 18–87 years). A subgroup of 187 (age range 18–71 years) participants was randomly chosen to test the test–retest reliability. A complete psychometric evaluation was performed on the MSQ. To study the validity of the tool, the Sleep Disorder Questionnaire was used as an external criterion to validate the MSQ. Using the Youden index, we calculated the cut-off values that performed best. Finally, we created receiver–operator curves to test the accuracy of each cut-off value identified. Results: For the MSQ, Cronbach’s alpha score was 0.77 while homogeneity was 0.26. Factorial analyses confirmed the presence of two dimensions: sleep (Cronbach’s alpha 0.75; homogeneity 0.37) and wake (Cronbach’s alpha 0.75; homogeneity 0.44). For each dimension, a cut-off value was identified (>16 and >14, respectively). Both cut-off values obtained an area under the curve higher than 0.80. Conclusions: Psychometric evaluation of the MSQ was satisfactory. The cut-off values analyzed in the present study showed good performance. On the whole, the results of this study suggest that the MSQ can be a useful screening tool.

The interest in the systematic study of the circadian typology (CT) is relatively recent and has developed rapidly in the two last decades. All the existing data suggest that this individual difference affects our biological and psychological functioning, not only in health, but also in disease. In the present study, we review the current literature concerning the psychometric properties and validity of CT measures as well as individual, environmental and genetic factors that influence the CT. We present a brief overview of the biological markers that are used to define differences between CT groups (sleep-wake cycle, body temperature, cortisol and melatonin), and we assess the implications for CT and adjustment to shiftwork and jet lag. We also review the differences between CT in terms of cognitive abilities, personality traits and the incidence of psychiatric disorders. When necessary, we have emphasized the methodological limitations that exist today and suggested some future avenues of work in order to overcome these. This is a new field of interest to professionals in many different areas (research, labor, academic and clinical), and this review provides a state of the art discussion to allow professionals to integrate chronobiological aspects of human behavior into their daily practice.

none 5 si This study explored the relationship between season of birth and handedness, taking into account gender and nationality variables. Young adults from three countries (2120 females and 1353 males; 877 Spanish, 2184 Italian, and 412 French), aged from 18 to 30 years, filled the Edinburgh Handedness Inventory (EHI). According to the literature, the percentage of left-handed participants in the whole sample was 9.30%. The distribution of left- and right-handed participants was not significantly different among the seasons of birth. The present data do not support a significant season of birth effect on handedness in young adults. none L. Tonetti; A. Adan; H. Caci; M. Fabbri; V. Natale L. Tonetti; A. Adan; H. Caci; M. Fabbri; V. Natale

In the present study, the relationship between personality dimensions and Circadian Preference was evaluated using a structural equation modeling approach. Participants (N = 390; 53.8% female, mean age: 26.8 ± 8.1 yrs) completed measures of Circadian Preference, Impulsivity, Sensation Seeking, and the Big Five factors. A mediation structural equation model assessed the direct and indirect effects of the Big Five factors on Circadian Preference. The results showed that Impulsivity and Sensation Seeking were significantly associated with Eveningness, whereas no significant direct effects of the Big Five traits were detected once the effects of Impulsivity and Sensation Seeking were taken into account. (Author correspondence: p.russo@unibo.it)

none 4 no A significant season of birth effect on mood seasonality has been detected in young adults, with higher sensitivity to seasonal changes for people born during spring or summer months (long photoperiod) than those born during autumn or winter months (short photoperiod). The aim of this study was to verify whether the birth season effect on mood seasonality is already present in late childhood and adolescence. To this end, the Seasonal Pattern Assessment Questionnaire for Children and Adolescents (SPAQ-CA) was administered to 1523 Italian participants (870 females, 653 males), ranging from 10 to 17 years of age. The Global Seasonality Score (GSS) was computed as a measure of mood seasonality. Analysis of covariance showed a significant season of birth effect on GSS; although no comparisons were significant when Tukey's posthoc test for unequal samples was performed, it was observed that adolescents born in summer achieved the highest scores while those born in winter obtained the lowest. The present data point out that a significant season of birth effect on mood seasonality is already present in late childhood and adolescence. none L. Tonetti; M. Fabbri; M. Martoni; V. Natale L. Tonetti; M. Fabbri; M. Martoni; V. Natale

The present study explored the possible role of the photoperiod at birth on morningness by collecting data in the northern (Italy) and southern (Australia) hemispheres. To assess circadian typology, the Composite Scale of Morningness (CS) was administered to a sample of 1734 university students (977 Italian and 757 Australian; 1099 females and 635 males; age 24.79 ± 7.45 yrs [mean ± SD]). Consistent with the literature, females reported higher CS scores (morningness) than males, and Australian participants reported higher CS scores than Italian participants. Allowing for the fact the seasons are reversed between the hemispheres, the results are in line with previous studies. The authors found more evening types were born during the seasons associated with longer photoperiod (spring and summer), and more morning types were born during the seasons associated with shorter photoperiod (autumn and winter), indirectly supporting an imprinting-like phenomenon played by the photoperiod at birth. (Author correspon...

Aims: A previous study has reported a significant month-of-birth effect on mood seasonality in the northern hemisphere. Higher mood seasonality was observed for university students born during spring or summer months (long photoperiod) compared to those born during autumn or winter months (short photoperiod). The aim of this study was to test the hypothesized photoperiod effect by comparing the correlation between month of birth and mood seasonality in two countries located at the opposite poles of the terrestrial globe: Italy (northern hemisphere) and New Zealand (southern hemisphere). On the basis of the photoperiod-at-birth hypothesis, we expected to find higher mood seasonality among individuals born in months with longer photoperiods in both countries. Methods: The Seasonal Pattern Assessment Questionnaire was administered to 1514 young adults (1088 women, 426 men; 1027 Italians, 487 New Zealanders), with ages ranging from 18 to 34 years. The Global Seasonality Score, which is a measure of mood seasonality, was calculated from the Seasonal Pattern Assessment Questionnaire. Results: A significant overall month-of-birth effect was observed on the Global Seasonality Score, but only for men. Men born in April and August (corresponding in Italy to a long photoperiod, in New Zealand to a short photoperiod) had higher mood seasonality than those born in February, regardless of country. Conclusions: A significant month-of-birth effect was found on mood seasonality, but results do not support the hypothesis based on the photoperiod effect.

none 4 The aim of the present study was to explore the relationship between season of birth and sleep-timing preferences in adolescence. To this end, the Morningness-Eveningness Questionnaire for Children and Adolescents (MEQ-CA) was administered to 1912 adolescents (1058 females and 854 males), ranging in age between 10 and 17 yrs. To assess preferred sleep habits, the authors considered the answers to the open-ended questions of the MEQ-CA (items 1 and 2), regarding the preferred arising time and the preferred going to bed time. Combining the answers to these two questions, the authors also indirectly computed the preferred sleep duration and preferred midpoint of sleep. Season of birth did not significantly modulate the overall MEQ-CA score; however, spring-born participants preferred to go to bed and reached the preferred midpoint of sleep later than those born in autumn. Agreeing with a previous study on young adults, the present data point to a significant season-of-birth effect on the two parameters of the sleep-timing preferences in adolescents. none L. Tonetti; M. Fabbri; M. Martoni; V. Natale L. Tonetti; M. Fabbri; M. Martoni; V. Natale

Previous research studies indicate that a motor activity in the first half of nocturnal sleep is lateralized to the non-dominant hand. It was suggested that such phenomenon may be due to a more pronounced homeostatic deactivation of the dominant hemisphere (referring to the hypothesis of the use-dependent recovery function of sleep). If this were the case we should expect a reversed pattern of motor activity asymmetries between right- and left-handed subjects. We tested this hypothesis in an ecological study assessing the circadian motor activity in seventeen right- and seventeen left-handed subjects. All subjects wore actigraphs on both the left and right wrists for at least twelve consecutive days. In line with previous studies, right-handed subjects showed higher motor activity in the left vs. the right hand in late evening. We did not however find a reverse pattern of results in left-handed participants. On the whole the results do not seem to support the use-dependent recovery hypothesis, and are suggestive of a different circadian phase relationship between the two hemispheres regardless of handedness.

EPIDEMIOLOGICAL DATA INDICATE THAT INSOMNIA IS THE MOST COMMON SLEEP COMPLAINT IN THE INDUSTRIAL WORLD.1,2 THE FIRST STEP TOWARD EFFECTIVE treatment of insomnia is an initial clinical and instrumental assessment to establish a correct differential diagnosis. Data obtained by history-taking and sleep diaries are often challenging and even confounding as many people with insomnia seriously underestimate how much they really do sleep. A person can sleep well objectively but subjectively feel a poor sleeper (negative misperception) and vice versa (positive misperception).3 Consequently sleep alterations characterizing insomnia are on a continuum, making the diagnostic process very difficult. Thus, an objective assessment of sleep in insomnia is crucially important.4 Although polysomnography (PSG) is the accepted gold standard for sleep assessment, there is considerable variability in the sleep of insomniacs, and first night effect may produce results that are not representative of an individual's usual sleep pattern. Therefore, PSG is not indicated for routine evaluation of chronic insomnia unless the signs or symptoms of another sleep disorders are present.5, For these reasons an alternative means of sleep assessment is desirable. Validation studies against PSG have confirmed that when sleep stage identification is not required actigraphy can provide objective and naturalistic measurements of sleep pattern. Actigraphy allows us to study patients in their own home environment for multiple nights and has a relatively low cost compared to PSG.6,7 Even if no technological solution has as achieved the status of standard as yet, we know that different commercially available actigraphs have very similar performance.8–10 In 1995 the American Academy of Sleep Medicine (at that time American Sleep Disorders Association) founded a working group,7 known today as Standards of Practice Committee (SPC), to review, among other sleep medicine issues, the current knowledge of actigraphy use and to update guidelines. Since then several other updates have been published.11,12 The latest one, published in 2007,12 emphasized that the explosion in the number of studies using actigraphy, together with increased clinical experience in actigraphy use, has led to the inclusion of actigraphy as a possible adjunctive tool for the measurement of sleep duration and sleep patterns for certain sleep disorders in the second edition of the International Classification of Sleep Disorders (ICSD-2),13 including: paradoxical insomnia, idiopathic hypersomnia, and circadian rhythm disorders. One of the unresolved limits of actigraphy is the lack of quantitative criteria for the assessment of sleep quality. Vallieres and Morin14 showed that actigraphy is a reliable method for monitoring treatment response among insomnia patients, i.e., for comparing pre-and post-treatment sleep quality. However, lacking standard quantitative criteria, it is difficult to use actigraphy to aid the diagnosis of sleep disorders, including insomnia. This limit is partially shared with PSG.15 Despite the high prevalence and ubiquity of insomnia,1,2 an attempt to propose specific cut-off values was made only recently,15,16 and will serve to define the so-called research diagnostic criteria (RDC) for assessing insomnia.17 This gap is partially due to the wide inter- and intra-individual variability characterizing sleep and subjective sleep perception. The most defensible quantitative criteria for insomnia are sleep onset latency (SOL) or wake time after sleep onset (WASO) > 30 minutes, occurring ≥ 2 nights per week for > 6 months.15,18 These criteria, obtained by analyzing sleep diaries, cannot be adopted for actigraphy because actigraphic data are very different from subjective sleep estimation. While actigraphy is a single-channel measurement system that bases its analysis on motor activity, the sleep diary provides a measure of subjective sleep evaluations, which do not always agree with objective evaluations. For example actigraphy systematically underestimates SOL in comparison to sleep logs.14,19 The best way to obtain quantitative actigraphic criteria (QAC) would be to have the actigraphic data of a large sample of normal sleepers. By comparing actigraphic data of insomnia patients with those of normal sleepers we would be able to suggest actigraphic cut-off values for the assessment of sleep quality. To this end, Ambulatory Monitoring, Inc. (Ardsley, NY) marketed the Activity Data Bank (ADB) software, subsequently included as a utility in Action W-2 software. This software initially allowed several actigraphic data of normal sleepers to be collected in a database. Later, the software automatically accounted for statistical values of the disagreement between a patient's score and the mean of the group of normal sleeper on a 3-level scale: absent, mild or serious. To our knowledge such a procedure has not been sufficiently developed. The present retrospective study aimed to compare the actigraphic data of insomnia patients with normal sleepers to establish the most efficient actigraphic parameter in assessing insomnia and to put forward preliminary quantitative actigraphic criteria (QAC) for the assessment of insomnia. In addition, we aimed to clarify the usefulness of a specific actigraphic parameter: motor activity (MA). This was in line with the latest recommendation for future research put forward by the Standards of Practice Committee of the American Academy of Sleep Medicine,12 suggesting an analysis of specific actigraphic parameters which do not have PSG correlation and thus are not usually considered during sleep evaluation. To establish whether a panel of actigraphic parameters rather than a single actigraphic sleep parameter could better differentiate insomnia patients from the control group we performed a multivariate discriminant analysis (MDA).

Objective To add to the validity of the French version of the Composite Scale of Morningness (CSM) by comparing its structure with that of the Morningness–Eveningness Questionnaire (MEQ), the most widely used scale to measure circadian typology. Second, to compare the cut-off criteria used to transform the continuous scores into categorical chronotypes. Third, to further test the effects of age and gender on morningness scores. The rMEQ, a shortened version of the MEQ, is also considered. Methods Four hundred and fifty-six students served as volunteer subjects and filled the CSM and the MEQ. Results There was no effect of gender, and the CSM and MEQ scores correlated above +0.90 in both genders. Regarding age, morningness was stable before age 35 and increased afterwards. We replicated the three-factor structure of the CSM previously reported in five different cultures. The MEQ is longer and counted a fourth factor while the first three factors were quite identical to those extracted from the CSM. This comparative study emphasizes the recurrent problem of cut-off scores: the available values for both instruments result in a very poor concordance of chronotypes. Conclusions Belonging to the evening-type is regarded as a risk factor for sleep disorders and its positive predictive value should be correctly assessed. Hence, normative scores standardized in such a way they reflect the effects of age, gender and culture are needed for the total score and the factor scores. To this extent, T-scores (with a mean of 50 and standard deviation of 10) would be suitable, and normative tables for French subjects (N = 1598) are given as supplemental data.

We investigate whether mood seasonality is modulated by season of birth. A sample of 1682 university students were administered the Seasonal Pattern Assessment Questionnaire. We found that subjects born during spring or summer months had significantly higher Global Seasonality scores than those born during autumn or winter months.