Validation of the Caen Chronotype Questionnaire: Exploring the added value ofamplitude and correlations with actigraphy

Chronotype self-report instruments are time and cost-efficient measures to profile diurnal or time-of-day preferences. The Caen Chronotype Questionnaire (CCQ) captures morningness and eveningness(CCQ-ME) and a circadian amplitude dimension for diurnal variation (distinctiveness; CCQ-DI). This study extends prior multilanguage validations for the English version of the CCQ. In total, 628participants enrolled from a UK working population (mean age 30.34 ± 8.36 years, 61.3% female)including a subset of shift workers (n = 179; mean age 27.62 ± 5.95 years, 49.2% female). A subsample of participants also wore a consumer-grade actigraph device (Fitbit Charge 4) for seven days to compare chronotype estimates with objective sleep-wake parameters (n = 22; mean age 27.05± 3.99 years, 81.8% female, 90.9% worked standard daytime schedules, and 9.1% worked rotating shifts). All participants completed online chronotype measures, including the CCQ and Morningness-Eveningness Questionnaire (MEQ), depressive symptoms (Patient Health Questionnaire; PHQ-9), sleep quality (Pittsburgh Sleep Quality Index; PSQI), and other outcome measures. Results from the Confirmatory Factor Analysis (CFA) offer support for a two-factor structure of the CCQ in an English-speaking sample, highlighting how individual preferences for the timing of activities is associated with chronotype (morningness-eveningness; ME) and a second subjective amplitude dimension (DI). However, in contrast with the original CCQ structure, a more parsimonious solution and best overall fit involved the reduction of the original 16-item questionnaire (8 items per factor) to 4 ME items and 5DI items. Convergent validity with the reduced CCQ scale (rME) and the MEQ was also established. The CCQ was sensitive in discriminating differences in actigraphic sleep-wake timings between morning-and evening-oriented individuals. Regression models demonstrated that amplitude (CCQ-DI) was a significant predictor explaining most of the variance in depressive symptoms (PHQ-9) compared to other variables. Overall, the English version of the CCQ was shown to be a robust tool in estimating chronotype in a sample of adults based in the UK.

Adan A, Archer SN, Hidalgo MP, Di Milia L, Natale V,Randler C. 2012. Circadian typology: a comprehensive review. Chronobiol Int. 29:1153–1175. doi: 10.3109/07420528.2012.719971.

Ahn J, Yeo H, Lee S, Hwang Y, Jeon S, Kim SJ. 2024. Shift schedules and circadian preferences: the association with sleep and mood. Front Public Health. 12:1283543. doi: 10.3389/fpubh.2024.1283543.

Akerstedt T, Anund A, Axelsson J, Kecklund G. 2014.Subjective sleepiness is a sensitive indicator of insufficient sleep and impaired waking function. J Sleep Res.23:240–252. doi: 10.1111/jsr.12158.

Akerstedt T, Gillberg M. 1990. Subjective and objective sleepiness in the active individual. Int J Neurosci. 52:29–37. doi:10.3109/00207459008994241.

Anthoine E, Moret L, Regnault A, Sébille V, Hardouin JB.2014. Sample size used to validate a scale: a review of publications on newly-developed patient reported outcomes measures. Health Qual Life Outcomes. 12:176. doi:10.1186/s12955-014-0176-2.

Au J, Reece J. 2017. The relationship between chronotype and depressive symptoms: a meta-analysis. J Affective Disord.218:93–104. doi: 10.1016/j.jad.2017.04.021.

Bacchetti P. 2010. Current sample size conventions: flaws, harms, and alternatives. BMC Med. 8:17. doi: 10.1186/1741-7015-8-17.

Bagozzi RP, Yi Y. 1988. On the evaluation of structural equa-tion models. J Acad Mark Sci. 16:74–94. doi: 10.1007/BF02723327.

Bauducco S, Richardson C, Gradisar M. 2020. Chronotype, circadian rhythms and mood. Curr Opin Phychol.34:77–83. doi: 10.1016/j.copsyc.2019.09.002.

Bentler PM. 1990. Comparative fit indexes in structural models. Psychol Bull. 107:238–246. doi: 10.1037/0033-2909.107.2.238.

Bentler PM. 1992. On the fit of models to covariances and methodology to the bulletin. Psychol Bull. 112:400–404.doi: 10.1037/0033-2909.112.3.400.

Booker LA, Magee M, Rajaratnam SMW, Sletten TL, Howard ME. 2018. Individual vulnerability to insomnia, excessive sleepiness and shift work disorder amongst healthcare shift workers. A systematic review. Sleep MedRev. 41:220–233. doi: 10.1016/j.smrv.2018.03.005.

Brown SP, Leigh TW. 1996. A new look at psychological climate and its relationship to job involvement, effort, and performance. J Appl Phychol. 81:358–368. doi: 10.1037/0021-9010.81.4.358.

Burns AC, Zellers S, Windred DP, Daghlas I, Sinnott-Armstrong N, Rutter M, Hublin C, Friligkou E,Polimanti R, Phillips AJK, et al. 2024. Sleep inertia drives the association of evening chronotype with psychiatric disorders: epidemiological and genetic evidence. MedRxiv.doi:10.1101/2024.09.10.24313197.

Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. 1989. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res. 28:193–213. doi: 10.1016/0165-1781(89)90047-4.

Chauhan S, Norbury R, Faßbender KC, Ettinger U, Kumari V.2023. Beyond sleep: a multidimensional model of chronotype. Neurosci Biobehav Rev. 148:105114. doi: 10.1016/j.neubiorev.2023.105114.

Cheung GW, Cooper-Thomas HD, Lau RS, Wang LC. 2024.Reporting reliability, convergent and discriminant validity with structural equation modeling: a review and best-practice recommendations. Asia Pac J Manag.41:745–783. doi: 10.1007/s10490-023-09871-y.

Cronbach LJ. 1951. Coefficient alpha and the internal structure of tests. Psychometrika. 16:297–334. doi: 10.1007/BF02310555.

Crouse JJ, Carpenter JS, Song YJC, Hockey SJ, Naismith SL,Grunstein RR, Scott EM, Merikangas KR, Scott J, Hickie IB.2021. Circadian rhythm sleep-wake disturbances and depression in young people: implications for prevention and early intervention. Lancet Psychiatry. 8:813–823. doi:10.1016/S2215-0366(21)00034-1.

Delorme TC, Srivastava LK, Cermakian N. 2020. Are circadian disturbances a core pathophysiological component of schizophrenia? J Biol Rhythms. 35:325–339. doi: 10.1177/0748730420929448.

Díaz-Morales JF, Parra-Robledo Z. 2018. Age and sex differ-ences in morningness/eveningness along the life span: across-sectional study in Spain. J Genet Psychol.179:71–84. doi: 10.1080/00221325.2018.1424706.

Díaz-Morales JF, Randler C, Arrona-Palacios A, Adan A.2017. Validation of the MESSi among adult workers and young students: general health and personality correlates.Chronobiol Int. 34:1288–1299. doi: 10.1080/07420528.2017.1361437.

Di Milia L, Adan A, Natale V, Randler C. 2013. Reviewing thepsychometric properties of contemporary circadian typology measures. Chronobiol Int. 30:1261–1271. doi: 10.3109/07420528.2013.817415.

Dosseville F, Laborde S, Lericollais R. 2013. Validation of a chronotype questionnaire including an amplitude dimension. Chronobiol Int. 30:639–648. doi: 10.3109/07420528.2012.763042.

Evans MA, Hasler BP. 2022. Chapter 3 - CBT-I for patients with phase disorders or insomnia with circadian misalignment. In: Nowakowski S, Garland SN, Grandner MA, Cuddihy LJ, editors. Adapting cognitive behavioral therapy for insomnia. Academic Press. p. 63–95. doi: 10.1016/C2019-0-03656-4.

Faßl C, Quante M, Mariani S, Randler C. 2019. Preliminary findings for the validity of the morningness–eveningness-Stability scale improved (MESSi): correlations with activity levels and personality. Chronobiol Int. 36:135–142. doi: 10.1080/07420528.2018.1519570.

Fischer D, Hilditch CJ. 2022. Chapter 15 - light in ecological settings: entrainment, circadian disruption, and interventions. In: Santhi N, and Spitschan M, editors. Progress in brain research. Vol. 273. Elsevier B.V. p. 303–330. doi: 10.1016/bs.pbr.2022.04.001.

Fornell C, Larcker DF. 1981. Evaluating structural equation models with unobservable variables and measurement error. J Mark Res. 18:39–50. doi: 10.1177/002224378101800104.

Foster RG. 2020. Sleep, circadian rhythms and health. Interface Focus. 10:20190098. doi: 10.1098/rsfs.2019.0098.

Gorgol J, Waleriańczyk W, Stolarski M. 2022. The moderating role of personality traits in the relationship between chronotype and depressive symptoms. Chronobiol Int.39:106–116. doi: 10.1080/07420528.2021.1979995.

Haraden DA, Mullin BC, Hankin BL. 2017. The relationship between depression and chronotype: a longitudinal assessment during childhood and adolescence. Depression and Anxiety. 34:967–976. doi: 10.1002/da.22682.

Harrington D. 2008. Requirements for conducting confirmatory factor analysis: data considerations. In: Confirmatory factor analysis. New York: Oxford University Press. p. 36–49. doi: 10.1093/acprof:oso/9780195339888.001.0001

Hilditch CJ, McHill AW. 2019. Sleep inertia: current insights. NSS. 11:155–165. doi: 10.2147/NSS.S188911.Hittle BM, Gillespie GL. 2018. Identifying shift worker chronotype: implications for health. Ind Health. 56:512–523. doi:10.2486/indhealth.2018-0018.

Horne JA, Ostberg O. 1976. A self-assessment questionnaire to determine morningness-eveningness in human circadian rhythms. Int J Chronobiol. 4:97–110.Hu LT, Bentler PM. 1999. Cut-off criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Modeling. 6:1–55. doi: 10.1080/10705519909540118.

Jones SE, Lane JM, Wood AR, van Hees VT, Tyrrell J,Beaumont RN, Jeffries AR, Dashti HS, Hillsdon M,Ruth KS, et al. 2019. Genome-wide association analyses of chronotype in 697,828 individuals provides insights into circadian rhythms. Nat Commun. 10:343. doi: 10.1038/s41467-018-08259-7.

Juda M, Vetter C, Roenneberg T. 2013. Chronotype modulates sleep duration, sleep quality, and social jet lag in shift workers. J Biol Rhythms. 28:141–151. doi: 10.1177/0748730412475042.

Kervezee L, Gonzales-Aste F, Boudreau P, Boivin DB. 2021.The relationship between chronotype and sleep behavior during rotating shift work: a field study. Sleep. 44. doi: 10.1093/sleep/zsaa225.

Klerman EB, Brager A, Carskadon MA, Depner CM, Foster R,Goel N, Harrington M, Holloway PM, Knauert MP,LeBourgeois MK, et al. 2022. Keeping an eye on circadian time in clinical research and medicine. Clin Transl Med. 12:e1131. doi: 10.1002/ctm2.1131.

Korman M, Tkachev V, Reis C, Komada Y, Kitamura S,Gubin D, Kumar V, Roenneberg T. 2020. COVID-19-mandated social restrictions unveil the impact of social time pressure on sleep and body clock. Sci Rep. 10:22225.doi: 10.1038/s41598-020-79299-7.12

Kroenke K, Spitzer RL. 2002. The PHQ-9: a new depressiondiagnostic and severity measure. Psychiatric Ann.32:509–515. doi: 10.3928/0048-5713-20020901-06.

Laborde S, Dosseville F, Aloui A, Ben Saad H, Bertollo M,Bortoli L, Braun B, Chamari K, Chtourou H, De Kort Y,et al. 2018. Convergent and construct validity and test-retest reliability of the caen chronotype questionnaire in six languages. Chronobiol Int. 35:1294–1304. doi: 10.1080/07420528.2018.1475396.

Leone MJ, Sigman M, Golombek DA. 2020. Effects of lock-down on human sleep and chronotype during the COVID-19 pandemic. Curr Biol. 30:R930–R931. doi: 10.1016/j.cub.2020.07.015.

Levandovski R, Sasso E, Hidalgo MP. 2013. Chronotype: a review of the advances, limits and applicability of the main instruments used in the literature to assess human phenotypes. Trends Psychiatry Psychother. 35:3–11. doi: 10.1590/s2237-60892013000100002.

Lok R, Qian J, Chellappa SL. 2024. Sex differences in sleep, circadian rhythms, and metabolism: implications for precision medicine. Sleep Med Rev. 75:101926. doi: 10.1016/j.smrv.2024.101926.

Manea L, Gilbody S, McMillan D. 2012. Optimal cut-off score for diagnosing depression with the patient health questionnaire (PHQ-9): a meta-analysis. CMAJ. 184:E191–196. doi:10.1503/cmaj.110829.

Marcoen N, Vandekerckhove M, Neu D, Pattyn N,Mairesse O. 2015. Individual differences in subjective circadian flexibility. Chronobiol Int. 32:1246–1253. doi: 10.3109/07420528.2015.1085387.

Melo MCA, Abreu RLC, Linhares Neto VB, de Bruin PFC, deBruin VMS. 2017. Chronotype and circadian rhythm in bipolar disorder: a systematic review. Sleep Med Rev.34:46–58. doi: 10.1016/j.smrv.2016.06.007.

Merikanto I, Kronholm E, Peltonen M, Laatikainen T,Vartiainen E, Partonen T. 2015. Circadian preference links to depression in the general adult population. J Affective Disord. 188:143–148. doi: 10.1016/j.jad.2015.08.061.

Merikanto I, Lahti T, Kronholm E, Peltonen M, Laatikainen T,Vartiainen E, Salomaa V, Partonen T. 2013. Evening types are prone to depression. Chronobiol Int. 30:719–725. doi:10.3109/07420528.2013.784770.

Nowakowska-Domagala K, Mokros L, Jablkowska-Gorecka K,Grzelinska J, Pietras T. 2016. The relationship between chronotype and personality among patients with alcohol dependence syndrome: pilot study. Chronobiol Int.33:1351–1358. doi: 10.1080/07420528.2016.1213738.

Oginska H. 2011. Can you feel the rhythm? A short questionnaire to describe two dimensions of chronotype. PersIndivid Dif. 50:1039–1043. doi: 10.1016/j.paid.2011.01.020.

Oginska H, Mojsa-Kaja J, Mairesse O. 2017. Chronotype description: in search of a solid subjective amplitude scale. Chronobiol Int. 34:1388–1400. doi: 10.1080/07420528.2017.1372469.

Paciello LM, Quante M, Weidenauer C, Rueschman M,Nieratschker V, Poets CF, Randler C. 2022. Validity of chronotype questionnaires in adolescents: correlations with actigraphy. J Sleep Res. 31:e13576. doi: 10.1111/jsr.13576.

Porcheret K, Wald L, Fritschi L, Gerkema M, Gordijn M,Merrrow M, Rajaratnam SMW, Rock D, Sletten TL, Warman G, et al. 2018. Chronotype and environmental light exposure in a student population. Chronobiol Int.35:1365–1374. doi: 10.1080/07420528.2018.1482556.

Potter GDM, Wood TR. 2020. The future of shift work: circadian biology meets personalised medicine and behavioural science. Front Nutr. 7:116. doi: 10.3389/fnut.2020.00116.

Randler C, Díaz-Morales JF, Rahafar A, Vollmer C. 2016.Morningness–eveningness and amplitude – development and validation of an improved composite scale to measure circadian preference and stability (MESSi). Chronobiol Int.33:832–848. doi: 10.3109/07420528.2016.1171233.

Randler C, Engelke J. 2019. Gender differences in chronotype diminish with age: a meta-analysis based on morningness/chronotype questionnaires. Chronobiol Int. 36:888–905.doi: 10.1080/07420528.2019.1585867.

Randler C, Prokop P, Sahu S, Haldar P. 2015. Cross-cultural comparison of seven morningness and sleep-wake measures from Germany, India and Slovakia. Int J Psychol.50:279–287. doi: 10.1002/ijop.12098.

Roenneberg T. 2023. How can social jetlag affect health? NatRev Endocrinol. 19:383–384. doi: 10.1038/s41574-023-00851-2.

Roenneberg T, Foster RG, Klerman EB. 2022. The circadiansystem, sleep, and the health/disease balance: a conceptualreview. J Sleep Res. 31:e13621. doi: 10.1111/jsr.13621.

Roenneberg T, Kuehnle T, Pramstaller PP, Ricken J, Havel M,Guth A, Merrow M. 2004. A marker for the end of adolescence. Curr Biol. 14:R1038–R1039. doi: 10.1016/j.cub.2004.11.039.

Roenneberg T, Pilz LK, Zerbini G, Winnebeck EC. 2019.Chronotype and social jetlag: a (self-) critical review. Biology. 8:54. doi: 10.3390/biology8030054.Roenneberg T, Wirz-Justice A, Merrow M. 2003. Life between clocks: daily temporal patterns of human chronotypes. J Biol Rhythms. 18:80–90. doi: 10.1177/0748730402239679.

Rome O, Sinai L, Sevitt R, Meroody A, Nadolne M, Shilco P,Jacobs GP, Shterenshis M, Sosnow A, Foonberg M, et al.2021. Owls and larks do not exist: COVID-19 quarantine sleep habits. Sleep Med. 77:177–183. doi: 10.1016/j.sleep.2020.09.003.

Roth T, Zammit G, Kushida C, Doghramji K, Mathias SD,Wong JM, Buysse DJ. 2002. A new questionnaire to detect sleep disorders. Sleep Med. 3:99–108. doi: 10.1016/s1389-9457(01)00131-9.

Saksvik IB, Bjorvatn B, Hetland H, Sandal GM, Pallesen S.2011. Individual differences in tolerance to shift work –a systematic review. Sleep Med Rev. 15:221–235. doi: 10.1016/j.smrv.2010.07.002.

Schyvens AM, Van Oost NC, Aerts JM, Masci F, Peters B,Neven A, Dirix H, Wets G, Ross V, Verbraecken J. 2024.Accuracy of Fitbit Charge 4, Garmin vivosmart 4, and WHOOP versus polysomnography: systematic review. JMIR Mhealth Uhealth. 12:e52192. doi: 10.2196/52192.

Shevlin M, Butter S, McBride O, Murphy J, Gibson-Miller J,Hartman TK, Levita L, Mason L, Martinez AP, McKay R, et al. 2022. Measurement invariance of the patient health questionnaire (PHQ-9) and generalized anxiety disorder scale (GAD-7) across four European countries during the COVID-19 pandemic. BMC Psychiatry. 22:154. doi: 10.1186/s12888-022-03787-5.

Simor P, Zavecz Z, Pálosi V, Török C, Köteles F. 2015. The influence of sleep complaints on the association between chronotype and negative emotionality in young adults. Chronobiol Int. 32:1–10. doi: 10.3109/07420528.2014.935786.

Skeldon AC, Phillips AJ, Dijk DJ. 2017. The effects of self-selected light-dark cycles and social constraints on human sleep and circadian timing: a modeling approach. Sci Rep. 7:45158. doi: 10.1038/srep45158.

Sletten TL, Weaver MD, Foster RG, Gozal D, Klerman EB,Rajaratnam SMW, Roenneberg T, Takahashi JS, Turek FW,Vitiello MV, et al. 2023. The importance of sleep regularity: a consensus statement of the National Sleep Foundation Sleep Timing and variability panel. Sleep Health.9:801–820. doi: 10.1016/j.sleh.2023.07.016.

Smith CS, Reilly C, Midkiff K. 1989. Evaluation of three circadian rhythm questionnaires with suggestions for an improved measure of morningness. J Appl Phychol.74:728–738. doi: 10.1037/0021-9010.74.5.728.

Smith TO, McKenna MC, Salter C, Hardeman W, Richardson K, Hillsdon M, Hughes CA, Steel N,Jones AP. 2017. A systematic review of the physical activityassessment tools used in primary care. Fam Pract.34:384–391. doi: 10.1093/fampra/cmx011.

Tabachnick BG, Fidell LS, Ullman JB. 2013. Using multivariable statistics. Vol. 6. Boston, MA: Pearson.Thun E, Bjorvatn B, Osland T, Steen VM, Sivertsen B,Johansen T, Lilleholt TH, Udnes I, Nordhus IH,Pallesen S. 2012. An actigraphic validation study of seven morningness-eveningness inventories. Eur Psychol.17:222–230. doi: 10.1027/1016-9040/a000097.

Vetter C, Fischer D, Matera JL, Roenneberg T. 2015. Aligning work and circadian time in shift workers improves sleep and reduces circadian disruption. Curr Biol. 25:907–911.doi: 10.1016/j.cub.2015.01.064.

Vidafar P, McGlashan EM, Burns AC, Anderson C,Shechter A, Lockley SW, Phillips AJK, Cain SW. 2024.Greater sensitivity of the circadian system of women to bright light, but not dim-to-moderate light. J Pineal Res.76:e12936. doi: 10.1111/jpi.12936.

Walsh NA, Repa LM, Garland SN. 2022. Mindful larks and lonely owls: the relationship between chronotype, mental health, sleep quality, and social support in young adults. J Sleep Res. 31:e13442. doi: 10.1111/jsr.13442.

White M. 2022. Sample size in quantitative instrument validation studies: a systematic review of articles published in Scopus, 2021. Heliyon. 8:e12223. doi: 10.1016/j.heliyon.2022.e12223.

Wickwire EM, Geiger-Brown J, Scharf SM, Drake CL. 2017. Shift work and shift work sleep disorder: clinical and organizational perspectives. Chest. 151:1156–1172. doi: 10.1016/j.chest.2016.12.007.

Windred DP, Burns AC, Lane JM, Saxena R, Rutter MK,Cain SW, Phillips AJK. 2024. Sleep regularity is a stronger predictor of mortality risk than sleep duration: a prospective cohort study. Sleep. 47:zsad253. doi: 10.1093/sleep/zsad253.

Wittmann M, Dinich J, Merrow M, Roenneberg T. 2006.Social jetlag: misalignment of biological and social time. Chronobiol Int. 23:497–509. doi: 10.1080/07420520500545979.

Zuraikat FM, Aggarwal B, Jelic S, St-Onge M-P. 2023.Consistency is key: sleep regularity predicts all-cause mortality. Sleep. 47. doi: 10.1093/sleep/zsad285