Abstract-Many behavioral and physiological processes, including locomotor activity, blood pressure, body temperature, sleep (fasting)/wake (feeding) cycles, and metabolic regulation display diurnal rhythms.
Circadian Rhythms in PhysiologyCircadian rhythms are variations that occur with a period of approximately 1 day ("circa diem") and allow the organism to anticipate and optimize its metabolic, hormonal, and locomotor activity to predictable environmental daily changes. 1 In mammals, a central clock resides in the suprachiasmatic nuclei of the hypothalamus and synchronizes physiology to day/night cycles. In metabolic organs, output signals from the suprachiasmatic nuclei clock, conveyed by peripheral oscillators, are combined to additional circadian cues, such as food availability, information concerning local fuel availability, and the hormonal milieu to drive circadian rhythms in intermediary metabolites (eg, AMP/ATP or oxidized nicotinamide-adenosine dinucleotide (NAD ϩ )/reduced nicotinamide adenine dinucleotide ratios) and enzymes involved in local physiology. Consequently, many metabolic functions, including lipid and carbohydrate metabolism, and hormone secretion follow circadian variations. 2 The circadian clock also synchronizes the cardiovascular system. The heart and vasculature have an autonomous circadian pacemaker to anticipate physiological demand in heart fuel use and contractile function. 3 For instance, blood pressure displays marked circadian variations, increasing in the morning and decreasing at night. Heart beat and blood flow, vascular tone, fibrinolytic activity, and endothelial function are all naturally subjected to diurnal variations. 4 Interestingly, the incidence of acute myocardial infarction, sudden cardiac death, and ischemic stroke is highest early in the morning.
Adverse Cardiometabolic Consequences of Altered Circadian Rhythms: Clinical EvidenceThe metabolic syndrome comprises a constellation of abnormalities, including dyslipidemia, high fasting blood glucose level, and hypertension. 5 It is precipitated by central obesity and increases the risk for type 2 diabetes mellitus and cardiovascular complications. In addition to genetic risk factors, numerous environmental factors (eg, increased food intake and physical inactivity) contribute to the etiology of the metabolic syndrome. Chronic circadian derangement, experienced by shift workers, also increases the risk of developing features of the metabolic syndrome (Figure 1). 6,7 Interestingly, in humans subjected to a progressive forced desynchrony, circadian misalignment increased blood glucose despite increased insulin, suggestive of decreased insulin sensitivity and increased blood pressure, with a maximal disturbance during maximal misalignment (ie, 180°phase shift). 8 A decrease in sleep duration and poor-quality sleep, although not circadian disorders per se, are often seen in nightshift workers, travelers, and patients with obstructive sleep apnea. Sleep curtailment results in reduced glucose tolerance and