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Meta-Analysis
. 2018 Mar 2;3(3):CD012243.
doi: 10.1002/14651858.CD012243.pub2.

Workplace lighting for improving alertness and mood in daytime workers

Daniela V Pachito  1 , Alan L Eckeli, Ahmed S Desouky, Mark A Corbett, Timo Partonen, Shantha Mw Rajaratnam, Rachel Riera
Affiliations
Meta-Analysis

Workplace lighting for improving alertness and mood in daytime workers

Daniela V Pachito et al. Cochrane Database Syst Rev. .

Abstract

Background: Exposure to light plays a crucial role in biological processes, influencing mood and alertness. Daytime workers may be exposed to insufficient or inappropriate light during daytime, leading to mood disturbances and decreases in levels of alertness.

Objectives: To assess the effectiveness and safety of lighting interventions to improve alertness and mood in daytime workers.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, seven other databases; ClinicalTrials.gov and the World Health Organization trials portal up to January 2018.

Selection criteria: We included randomised controlled trials (RCTs), and non-randomised controlled before-after trials (CBAs) that employed a cross-over or parallel-group design, focusing on any type of lighting interventions applied for daytime workers.

Data collection and analysis: Two review authors independently screened references in two stages, extracted outcome data and assessed risk of bias. We used standardised mean differences (SMDs) and 95% confidence intervals (CI) to pool data from different questionnaires and scales assessing the same outcome across different studies. We combined clinically homogeneous studies in a meta-analysis. We used the GRADE system to rate quality of evidence.

Main results: The search yielded 2844 references. After screening titles and abstracts, we considered 34 full text articles for inclusion. We scrutinised reports against the eligibility criteria, resulting in the inclusion of five studies (three RCTs and two CBAs) with 282 participants altogether. These studies evaluated four types of comparisons: cool-white light, technically known as high correlated colour temperature (CCT) light versus standard illumination; different proportions of indirect and direct light; individually applied blue-enriched light versus no treatment; and individually applied morning bright light versus afternoon bright light for subsyndromal seasonal affective disorder.We found no studies comparing one level of illuminance versus another.We found two CBA studies (163 participants) comparing high CCT light with standard illumination. By pooling their results via meta-analysis we found that high CCT light may improve alertness (SMD -0.69, 95% CI -1.28 to -0.10; Columbia Jet Lag Scale and the Karolinska Sleepiness Scale) when compared to standard illumination. In one of the two CBA studies with 94 participants there was no difference in positive mood (mean difference (MD) 2.08, 95% CI -0.1 to 4.26) or negative mood (MD -0.45, 95% CI -1.84 to 0.94) assessed using the Positive and Negative Affect Schedule (PANAS) scale. High CCT light may have fewer adverse events than standard lighting (one CBA; 94 participants). Both studies were sponsored by the industry. We graded the quality of evidence as very low.We found no studies comparing light of a particular illuminance and light spectrum or CCT versus another combination of illuminance and light spectrum or CCT.We found no studies comparing daylight versus artificial light.We found one RCT (64 participants) comparing the effects of different proportions of direct and indirect light: 100% direct lighting, 70% direct lighting plus 30% indirect lighting, 30% direct lighting plus 70% indirect lighting and 100% indirect lighting. There was no substantial difference in mood, as assessed by the Beck Depression Inventory, or in adverse events, such as ocular, reading or concentration problems, in the short or medium term. We graded the quality of evidence as low.We found two RCTs comparing individually administered light versus no treatment. According to one RCT with 25 participants, blue-enriched light individually applied for 30 minutes a day may enhance alertness (MD -3.30, 95% CI -6.28 to -0.32; Epworth Sleepiness Scale) and may improve mood (MD -4.8, 95% CI -9.46 to -0.14; Beck Depression Inventory). We graded the quality of evidence as very low. One RCT with 30 participants compared individually applied morning bright light versus afternoon bright light for subsyndromal seasonal affective disorder. There was no substantial difference in alertness levels (MD 7.00, 95% CI -10.18 to 24.18), seasonal affective disorder symptoms (RR 1.60, 95% CI 0.81, 3.20; number of participants presenting with a decrease of at least 50% in SIGH-SAD scores) or frequency of adverse events (RR 0.53, 95% CI 0.26 to 1.07). Among all participants, 57% had a reduction of at least 50% in their SIGH-SAD score. We graded the quality of evidence as low.Publication bias could not be assessed for any of these comparisons.

Authors' conclusions: There is very low-quality evidence based on two CBA studies that high CCT light may improve alertness, but not mood, in daytime workers. There is very low-quality evidence based on one CBA study that high CCT light may also cause less irritability, eye discomfort and headache than standard illumination. There is low-quality evidence based on one RCT that different proportions of direct and indirect light in the workplace do not affect alertness or mood. There is very low-quality evidence based on one RCT that individually applied blue-enriched light improves both alertness and mood. There is low-quality evidence based on one RCT that individually administered bright light during the afternoon is as effective as morning exposure for improving alertness and mood in subsyndromal seasonal affective disorder.

PubMed Disclaimer

Conflict of interest statement

DVP: None known.

ALE: None known.

ASD: None known.

MAC: None known.

TP: Received lecture fees (Dila, Finnair, Helen, Helsinki Fair, Lundbeck, MCD‐Team, MERCURIA, Servier Finland, Speakers Forum Finland, YTHS). Royalties (Kustannus Oy Duodecim, Oxford University Press, Terve Media).

SMWR: Received grant/research support from Philips Respironics, Cephalon, Philips, Vanda Pharmaceuticals, consultancy fees from Edan Safe, Alertness CRC, corporate benefit/equipment donation from Compumedics, Tyco Healthcare, Philips Lighting, Optalert.

RR: None known.

Figures

1
1
PRISMA study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Forest plot of comparison: 4 High correlated colour temperature light versus standard illumination, outcome: alertness.
1.1
1.1. Analysis
Comparison 1 High correlated colour temperature light versus standard illumination, Outcome 1 Alertness ‐ Item Decreased Daytime Alertness from Columbia Jet Lag Scale 14 weeks.
1.2
1.2. Analysis
Comparison 1 High correlated colour temperature light versus standard illumination, Outcome 2 Alertness ‐ Item Sleepiness in Day from Columbia Jet Lag Scale 14 weeks.
1.3
1.3. Analysis
Comparison 1 High correlated colour temperature light versus standard illumination, Outcome 3 Alertness ‐ Karolinska Sleepiness Scale: mean of all time points.
1.4
1.4. Analysis
Comparison 1 High correlated colour temperature light versus standard illumination, Outcome 4 Alertness ‐ meta‐analysis.
1.5
1.5. Analysis
Comparison 1 High correlated colour temperature light versus standard illumination, Outcome 5 Mood ‐ Positive Mood PANAS Scale: mean of all time points.
1.6
1.6. Analysis
Comparison 1 High correlated colour temperature light versus standard illumination, Outcome 6 Mood ‐ Negative Mood PANAS Scale: mean of all time points.
1.7
1.7. Analysis
Comparison 1 High correlated colour temperature light versus standard illumination, Outcome 7 Adverse events ‐ eye discomfort: mean of all time points.
1.8
1.8. Analysis
Comparison 1 High correlated colour temperature light versus standard illumination, Outcome 8 Adverse events ‐ irritability: mean of all time points.
1.9
1.9. Analysis
Comparison 1 High correlated colour temperature light versus standard illumination, Outcome 9 Adverse events ‐ headache: mean of all time points.
1.10
1.10. Analysis
Comparison 1 High correlated colour temperature light versus standard illumination, Outcome 10 Adverse events ‐ eye strain: mean of all time points.
1.11
1.11. Analysis
Comparison 1 High correlated colour temperature light versus standard illumination, Outcome 11 Adverse events ‐ eye fatigue: mean of all time points.
1.12
1.12. Analysis
Comparison 1 High correlated colour temperature light versus standard illumination, Outcome 12 Adverse events ‐ difficult focusing: mean of all time points.
1.13
1.13. Analysis
Comparison 1 High correlated colour temperature light versus standard illumination, Outcome 13 Adverse events ‐ difficulty concentrating: mean of all time points.
1.14
1.14. Analysis
Comparison 1 High correlated colour temperature light versus standard illumination, Outcome 14 Adverse events ‐ blurred vision: mean of all time points.
2.1
2.1. Analysis
Comparison 2 Different proportions of direct and indirect indoor lighting, Outcome 1 Mood BDI: indirect lighting versus direct lighting.
2.2
2.2. Analysis
Comparison 2 Different proportions of direct and indirect indoor lighting, Outcome 2 Adverse events ‐ ocular problems indirect versus direct lighting.
2.3
2.3. Analysis
Comparison 2 Different proportions of direct and indirect indoor lighting, Outcome 3 Mood Beck Depression Inventory (BDI): indirect lighting versus 70% indirect lighting.
2.4
2.4. Analysis
Comparison 2 Different proportions of direct and indirect indoor lighting, Outcome 4 Mood BDI: indirect lighting versus 30% indirect lighting.
2.5
2.5. Analysis
Comparison 2 Different proportions of direct and indirect indoor lighting, Outcome 5 Mood BDI: 70% indirect lighting versus 30% indirect lighting.
2.6
2.6. Analysis
Comparison 2 Different proportions of direct and indirect indoor lighting, Outcome 6 Mood BDI: 70% indirect lighting versus direct lighting.
2.7
2.7. Analysis
Comparison 2 Different proportions of direct and indirect indoor lighting, Outcome 7 Mood BDI: 30% indirect lighting versus direct lighting.
2.8
2.8. Analysis
Comparison 2 Different proportions of direct and indirect indoor lighting, Outcome 8 Adverse events ‐ reading problems indirect versus 30% indirect lighting.
2.9
2.9. Analysis
Comparison 2 Different proportions of direct and indirect indoor lighting, Outcome 9 Adverse events ‐ ocular problems indirect versus 70% indirect lighting.
2.10
2.10. Analysis
Comparison 2 Different proportions of direct and indirect indoor lighting, Outcome 10 Adverse events ‐ ocular problems indirect versus 30% indirect lighting.
2.11
2.11. Analysis
Comparison 2 Different proportions of direct and indirect indoor lighting, Outcome 11 Adverse events ‐ ocular problems 70% indirect versus 30% indirect lighting.
2.12
2.12. Analysis
Comparison 2 Different proportions of direct and indirect indoor lighting, Outcome 12 Adverse events ‐ ocular problems 70% indirect versus direct lighting.
2.13
2.13. Analysis
Comparison 2 Different proportions of direct and indirect indoor lighting, Outcome 13 Adverse events ‐ ocular problems 30% indirect versus direct lighting.
2.14
2.14. Analysis
Comparison 2 Different proportions of direct and indirect indoor lighting, Outcome 14 Adverse events ‐ reading problems indirect versus 70% indirect lighting.
2.15
2.15. Analysis
Comparison 2 Different proportions of direct and indirect indoor lighting, Outcome 15 Adverse events ‐ reading problems indirect versus direct lighting.
2.16
2.16. Analysis
Comparison 2 Different proportions of direct and indirect indoor lighting, Outcome 16 Adverse events ‐ reading problems 70% indirect versus 30% indirect lighting.
2.17
2.17. Analysis
Comparison 2 Different proportions of direct and indirect indoor lighting, Outcome 17 Adverse events ‐ reading problems 70% indirect versus direct lighting.
2.18
2.18. Analysis
Comparison 2 Different proportions of direct and indirect indoor lighting, Outcome 18 Adverse events ‐ reading problems 30% indirect versus direct lighting.
2.19
2.19. Analysis
Comparison 2 Different proportions of direct and indirect indoor lighting, Outcome 19 Adverse events ‐ concentration problems indirect versus 70% indirect lighting.
2.20
2.20. Analysis
Comparison 2 Different proportions of direct and indirect indoor lighting, Outcome 20 Adverse events ‐ concentration problems indirect versus 30% indirect lighting.
2.21
2.21. Analysis
Comparison 2 Different proportions of direct and indirect indoor lighting, Outcome 21 Adverse events ‐ concentration problems indirect versus direct lighting.
2.22
2.22. Analysis
Comparison 2 Different proportions of direct and indirect indoor lighting, Outcome 22 Adverse events ‐ concentration problems 70% indirect versus 30% indirect lighting.
2.23
2.23. Analysis
Comparison 2 Different proportions of direct and indirect indoor lighting, Outcome 23 Adverse events ‐ concentration problems 70% indirect versus direct lighting.
2.24
2.24. Analysis
Comparison 2 Different proportions of direct and indirect indoor lighting, Outcome 24 Adverse events ‐ concentration problems 30% indirect versus direct lighting.
2.25
2.25. Analysis
Comparison 2 Different proportions of direct and indirect indoor lighting, Outcome 25 Adverse events ‐ musculoskeletal symptoms indirect versus 70% indirect lighting.
2.26
2.26. Analysis
Comparison 2 Different proportions of direct and indirect indoor lighting, Outcome 26 Adverse events ‐ musculoskeletal symptoms indirect versus 30% indirect lighting.
2.27
2.27. Analysis
Comparison 2 Different proportions of direct and indirect indoor lighting, Outcome 27 Adverse events ‐ musculoskeletal symptoms indirect versus direct lighting.
2.28
2.28. Analysis
Comparison 2 Different proportions of direct and indirect indoor lighting, Outcome 28 Adverse events ‐ musculoskeletal symptoms 70% indirect versus 30% indirect lighting.
2.29
2.29. Analysis
Comparison 2 Different proportions of direct and indirect indoor lighting, Outcome 29 Adverse events ‐ musculoskeletal symptoms 70% indirect versus direct lighting.
2.30
2.30. Analysis
Comparison 2 Different proportions of direct and indirect indoor lighting, Outcome 30 Adverse events ‐ musculoskeletal symptoms 30% indirect versus direct lighting.
3.1
3.1. Analysis
Comparison 3 Individually applied blue‐enriched light versus no treatment, Outcome 1 Alertness ‐ Epworth Sleepiness Scale.
3.2
3.2. Analysis
Comparison 3 Individually applied blue‐enriched light versus no treatment, Outcome 2 Mood Beck Depression Inventory‐II.
4.1
4.1. Analysis
Comparison 4 Morning bright light versus afternoon bright light, Outcome 1 Alertness (visual analogue scale (VAS)) after 2 weeks of intervention.
4.2
4.2. Analysis
Comparison 4 Morning bright light versus afternoon bright light, Outcome 2 Mood (≥ 50% of reduction of Structured Interview Guide for the Hamilton Depression Rating Scale‐Seasonal Affective Disorders Version (SIGH‐SAD) scores from baseline after 2 weeks of treatment)).
4.3
4.3. Analysis
Comparison 4 Morning bright light versus afternoon bright light, Outcome 3 Mood SIGH‐SAD after 2 weeks of intervention.
4.4
4.4. Analysis
Comparison 4 Morning bright light versus afternoon bright light, Outcome 4 Mood 21‐item Hamilton Depressive Rating Scale after 2 weeks of interventions.
4.5
4.5. Analysis
Comparison 4 Morning bright light versus afternoon bright light, Outcome 5 Mood 17‐item Hamilton Depressive Rating Scale after 2 weeks of intervention.
4.6
4.6. Analysis
Comparison 4 Morning bright light versus afternoon bright light, Outcome 6 Mood Seasonal Affective Disorders subscale after 2 weeks of intervention.
4.7
4.7. Analysis
Comparison 4 Morning bright light versus afternoon bright light, Outcome 7 Mood VAS after 2 weeks of intervention.
4.8
4.8. Analysis
Comparison 4 Morning bright light versus afternoon bright light, Outcome 8 Frequency of adverse events after 2 weeks of intervention.
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Update of

  • doi: 10.1002/14651858.CD012243

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