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Challenging the human circadian clock
by Daylight Saving Time
and Shift-Work
Academic Dissertation (Doctor rerum naturalium)
At the
Centre for Chronobiology
Institute for Medical Psychology
Ludwig-Maximilians-University Munich


Written by
Thomas Kantermann
thBorn 26 of February, 1979 in Gütersloh Arbeit eingereicht am: 17.07.2008
1. Gutachter / Prüfer: Prof. Gisela Grupe
2. Gutachter / Prüfer: Prof. Benedikt Grothe
3. Prüfer: Prof. Susanne Foitzik
4. Prüfer: rof. Gerhard Haszprunar
Sondergutachter: Prof. Till Roenneberg
Tag der mündlichen Prüfung: 15.12.2008
Für meine Schwester
Stefanie
„Probleme kann man niemals mit derselben Denkweise lösen,
durch die sie entstanden sind.“
Albert Einstein
dt.-amerikan. Physiker, 1921 Nobelpreis für Physik
1879 – 1955 Contents
1. INTRODUCTION ..................................................................................... 1
1.1. Biological (circa-) Rhythms..........................................................................................2
1.2. Sleep.............................................................................................................................4
1.2.1. Two Process Model of Sleep..................................................................................6
1.2.2. Circadian Rhythm Sleep Disorders, Sleepiness and Fatigue....................................7
1.3. The Internal Clock ........................................................................................................8
1.3.1. Phase of Entrainment – Chronotype .....................................................................11
1.3.2. Challenges to the circadian clock from real life....................................................14
1.3.2.1. Internal Desynchronisation............................................................................15
1.3.2.2. Social Jetlag..................................................................................................16
2. AIMS OF THIS WORK .......................................................................... 18
2.1. Daylight Saving Time (DST) and the Human Clock (Chapter 3).................................18
2.2. Shift-Work and the Human Clock (Chapter 4).............................................................19
2.2.1. Potential Health Costs from Shift-Work (Chapter 4.7.3).......................................19
2.3. Shift-Work/Social-Jetlag-Model (Chapter 5)...............................................................20
3. DAYLIGHT SAVING TIME (DST) AND THE HUMAN CLOCK –
A FIELD SURVEY ........................................................................................ 21
3.1. Introduction ................................................................................................................21
3.1.1. Brief History of Daylight Saving Time.................................................................21
3.1.2. Brief History of Studies on Daylight Saving Time................................................22
3.2. The Study on Daylight Saving Time ...........................................................................23
3.3. Methods......................................................................................................................24
3.4. Results.....28
3.5. Discussion..................................................................................................................32
4. SHIFT-WORK AND THE HUMAN CLOCK –
A LITERATURE SURVEY .......................................................................... 35
4.1. Introduction ................................................................................................................35
4.1.1. Definition of Shift-Work......................................................................................37
4.1.2. Reasons for doing Shift-Work..............................................................................38
4.1.3. Shift-Work and Social Strata................................................................................39
4.1.4. Epidemiological terms..........................................................................................40
4.2. Rationale for the Study on Shift-Work ........................................................................42
4.3. Methods......................................................................................................................43
4.4. Results.....44
4.4.1. Why no Meta-Analysis?.......................................................................................47
4.4.2. Key epidemiological Studies48
4.4.3. Occupations.........................................................................................................48
4.4.4. Sexes / Genders....................................................................................................49
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4.4.5. Questionnaires and Interviews..............................................................................49
4.4.5.1. Pros and Cons of Questionnaires ...................................................................51
4.5. Findings from the selected Articles .........................................................................52
4.5.1. Shift-Work and Sleep.......................................................................................53
4.5.2. Shift-Work Tolerance - Shift-Work Sleep Disorder (SWSD)............................58
4.5.3. Shift-Work and the Cardiovascular System ......................................................59
4.5.4. Cardiovascular Risk and Lifestyle Factors........................................................64
4.5.5. Shift-Work and Cancer.....................................................................................70
4.5.7. Shift-Work and Metabolism .............................................................................77
4.6. Methodological Difficulties with the Shift-Work Literature ....................................80
4.7. Discussion..................................................................................................................82
4.7.1. The Direction of Shift-Work Rotation ..................................................................92
4.7.1.1. Review of the Literature................................................................................92
4.7.1.2. Evidence from the articles on the effect of the direction in shift rotation........95
4.7.2. Direction of Shift-Work Rotation and Stress ........................................................99
4.7.3. Potential Health Costs from Shift-Work .............................................................101
5. SHIFT-WORK/SOCIAL-JETLAG-MODEL ...................................... 104
5.1. Introduction ..............................................................................................................104
5.2. Rationale for the Shift-Work/Social-Jetlag-Model.....................................................104
5.3. Methods....................................................................................................................105
5.4. Results...111
5.5. Discussion................................................................................................................113
6. CONCLUSION ...................................................................................... 115
6.1. Daylight Saving Time (DST) and the Human Clock (see Chapter 3) .........................115
6.2. Shift-Work and the Human Clock (see Chapter 4).....................................................115
6.2.1. Potential Health Costs from Shift-Work (see Chapter 4.7.3)...................................116
6.3. Shift-Work/Social-Jetlag-Model (see Chapter 5).......................................................116
6.4. Outlook on the applicability of the Shift-Work/Social-Jetlag-Model .........................116
7. SUMMARY............................................................................................ 118
7.1. Appeal: Importance of Chronotype in Medical Research...........................................119
8. REFERENCE LIST............................................................................... 121
9. FIGURE LIST........................................................................................ 134
10. TABLE LIST 138
11. ERKLÄRUNG ..................................................................................... 140
12. CURRICULUM VITAE...................................................................... 141
13. ACKNOWLEDGEMENTS................................................................. 143


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