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Circadian phase asessment by ambulatory monitoring in humans: Correlation with dim light melatonin onset
Abstract
The increased prevalence of circadian disruptions due to abnormal coupling between internal and external time makes the detection of circadian phase in humans by ambulatory recordings a compelling need. Here, we propose an accurate practical procedure to estimate circadian phase with the least possible burden for the subject, that is, without the restraints of a constant routine protocol or laboratory techniques such as melatonin quantification, both of which are standard procedures. In this validation study, subjects (N = 13) wore ambulatory monitoring devices, kept daily sleep diaries and went about their daily routine for 10 days. The devices measured skin temperature at wrist level (WT), motor activity and body position on the arm, and light exposure by means of a sensor placed on the chest. Dim light melatonin onset (DLMO) was used to compare and evaluate the accuracy of the ambulatory variables in assessing circadian phase. An evening increase in WT: WTOnset (WTOn) and "WT increase onset" (WTiO) was found to anticipate the evening increase in melatonin, while decreases in motor activity (Activity Offset or AcOff), body position (Position Offset (POff)), integrative TAP (a combination of WT, activity and body position) (TAPOffset or TAPOff) and an increase in declared sleep propensity were phase delayed with respect to DLMO. The phase markers obtained from subjective sleep (R = 0.811), WT (R = 0.756) and the composite variable TAP (R = 0.720) were highly and significantly correlated with DLMO. The findings strongly support a new method to calculate circadian phase based on WT (WTiO) that accurately predicts and shows a temporal association with DLMO. WTiO is especially recommended due to its simplicity and applicability to clinical use under conditions where knowing endogenous circadian phase is important, such as in cancer chronotherapy and light therapy.
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“and are therefore suitable to estimate circadian entrainment, comparable to melatonin or core body temperature, as marker rhythms12,13.”
From Diurnal rhythms of wrist temperature are associated with future disease risk in the UK Biobank (2023) · cites this paper as [13]
In the citing paper
“To underscore the value of wrist temperature as a potential biomarker, we refer to a study in 13 healthy volunteers showing that phase determined by wrist temperature readings correlated strongly (R = 0.756) with the circadian phase assessed by dim light melatonin onset (DLMO), which is the gold standard in the field13.”
From Diurnal rhythms of wrist temperature are associated with future disease risk in the UK Biobank (2023) · cites this paper as [13]
In the citing paper
“Our results indicate that the temperature traces in the UKBB study capture biological signal compellingly and agree with field studies13,23,32.”
From Diurnal rhythms of wrist temperature are associated with future disease risk in the UK Biobank (2023) · cites this paper as [13]
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Melatonina, la hormona de la noche
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Ritmos biológicos, cáncer y cronoterapia
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Self-citationEvaluation and Management of Circadian Rhythm Sleep Disorders
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Feasibility of an At-Home Experimental Circadian Misalignment Induction for Adolescents
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Pérez-Manchón, D., Azpeleta, C., Gal, B., & Ruiz‐Zaldibar, C. (2025) · Research Square · doi:10.21203/rs.3.rs-5804905/v2
Martínez-Martínez, D., González-Romero, P., Rodríguez-Morilla, B., Bonmatí‐Carrión, M., Rol, M. A., & Pagán, P. (2026) · Frontiers in Physiology · doi:10.3389/fphys.2026.1787735
Self-citationDay-to-Day Circadian Phase Fluctuations Shape Sleep and Behavior in Adolescents with ADHDPreprint
Reich, N., Imparato, A., Schneider, M., Eliez, S., Graser, C. J., & Sandini, C. (2026) · medRxiv · doi:10.64898/2026.04.30.26352043
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“On DIM, sampling was performed from 19:30 until 1 h after habitual bedtime, following a modified protocol from [28].”
Self-citationJex, J., Downs, A. L., Kamhout, S., Wright, I. D., Wright, A., Zhang, V., & Duraccio, K. M. (2026) · Frontiers in Sleep · doi:10.3389/frsle.2026.1826938
Wearable sensors offer opportunities for phenotyping perinatal mood disorders: a narrative review
Carrioli, O., Bruce, L. K., Kriplani, S. M., Schaap, T., Stewart, C., & Smarr, B. L. (2026) · Reproduction · doi:10.1093/reprod/xaag115
Pérez-Manchón, D., Azpeleta, C., Gal, B., & Ruiz‐Zaldibar, C. (2026) · JMIR Human Factors · doi:10.2196/85021
Metadata
- Authors
- Bonmati-Carrion, M. A., Middleton, B., Revell, V., Skene, D. J., Rol, M. A., & Madrid, J. A.
- Affiliations
- University of Surrey (GB)
- Universidad de Murcia (ES)
- Corresponding author
- Rol, M. A.
- Venue
- Chronobiology International
- Publisher
- Informa UK Limited
- Published
- 2013-10-28
- Volume
- 31
- Issue
- 1
- Pages
- 37-51
- ISSN
- 0742-0528 (ISSN-L)
- 1525-6073
- OpenAlex
- W2082096003
- Cited by
- 116
- References
- 76
- Citations by year
- 2026: 11 · 2025: 6 · 2024: 5 · 2023: 11 · 2022: 10 · 2021: 9 · 2020: 11 · 2019: 11 · 2018: 11 · 2017: 7 · 2016: 6 · 2015: 10 · 2014: 6 · 2013: 2
- FWCI
- 4.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Chronobiology International (publishedVersion)
- PubMed (publishedVersion)
- Hispana (publishedVersion)
- Surrey Research Insight Open Access (The University of Surrey) (submittedVersion)
- Topics
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- circadian phase, dim light melatonin onset, ambulatory monitoring, motor activity, posture, sleep propensity, circadian misalignment, cancer chronotherapy, phototherapy, sleep diary
- MeSH terms
- Adult, Body Temperature, Circadian Rhythm, Female, Humans, Light, Male, Melatonin, Surveys and Questionnaires, Radioimmunoassay, Saliva, Sleep, Monitoring, Ambulatory, Young Adult, Actigraphy
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