Full Text Available Excessive daytime sleepiness is one of the most common sleep-related patient symptoms, with preva-lence in the community estimated to be as high as 18%. Patients with excessive daytime sleepiness may exhibit life threatening road and work accidents, social maladjustment, decreased academic and occupational performance and have poorer health than comparable adults. Thus, excessive daytime sleepiness is a serious condition that requires investigation, diagnosis and treatment primarily. As with most medical condition, evaluation of excessive daytime sleepiness begins a precise history and various objective and subjective tools have been also developed to assess excessive daytime sleepiness. The most common causes of excessive daytime sleepiness are insufficient sleep hygiene, chronic sleep deprivation, medical and psychiatric conditions and sleep disorders, such as obstructive sleep apnea, medications, and narcolepsy. Treatment option should address underlying contributors and promote sleep quantity by ensuring good sleep hygiene. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2016; 8(2: 114-132
Samuel J Bolitho
Full Text Available INTRODUCTION: Sleep-wake disturbances and concomitant cognitive dysfunction in Parkinson's disease (PD contribute significantly to morbidity in patients and their carers. Subjectively reported daytime sleep disturbance is observed in over half of all patients with PD and has been linked to executive cognitive dysfunction. The current study used daytime actigraphy, a novel objective measure of napping and related this to neuropsychological performance in a sample of PD patients and healthy, age and gender-matched controls. Furthermore this study aimed to identify patients with PD who may benefit from pharmacologic and behavioural intervention to improve these symptoms. METHODS: Eighty-five PD patients and 21 healthy, age-matched controls completed 14 days of wrist actigraphy within two weeks of neuropsychological testing. Objective napping measures were derived from actigraphy using a standardised protocol and subjective daytime sleepiness was recorded by the previously validated Epworth Sleepiness Scale. RESULTS: Patients with PD had a 225% increase in the mean nap time per day (minutes as recorded by actigraphy compared to age matched controls (39.2 ± 35.2 vs. 11.5 ± 11.0 minutes respectively, p < 0.001. Significantly, differences in napping duration between patients, as recorded by actigraphy were not distinguished by their ratings on the subjective measurement of excessive daytime sleepiness. Finally, those patients with excessive daytime napping showed greater cognitive deficits in the domains of attention, semantic verbal fluency and processing speed. CONCLUSION: This study confirms increased levels of napping in PD, a finding that is concordant with subjective reports. However, subjective self-report measures of excessive daytime sleepiness do not robustly identify excessive napping in PD. Fronto-subcortical cognitive dysfunction was observed in those patients who napped excessively. Furthermore, this study suggests that daytime
Bolitho, Samuel J.; Naismith, Sharon L.; Salahuddin, Pierre; Terpening, Zoe; Grunstein, Ron R.; Lewis, Simon J. G.
Introduction Sleep-wake disturbances and concomitant cognitive dysfunction in Parkinson’s disease (PD) contribute significantly to morbidity in patients and their carers. Subjectively reported daytime sleep disturbance is observed in over half of all patients with PD and has been linked to executive cognitive dysfunction. The current study used daytime actigraphy, a novel objective measure of napping and related this to neuropsychological performance in a sample of PD patients and healthy, age and gender-matched controls. Furthermore this study aimed to identify patients with PD who may benefit from pharmacologic and behavioural intervention to improve these symptoms. Methods Eighty-five PD patients and 21 healthy, age-matched controls completed 14 days of wrist actigraphy within two weeks of neuropsychological testing. Objective napping measures were derived from actigraphy using a standardised protocol and subjective daytime sleepiness was recorded by the previously validated Epworth Sleepiness Scale. Results Patients with PD had a 225% increase in the mean nap time per day (minutes) as recorded by actigraphy compared to age matched controls (39.2 ± 35.2 vs. 11.5 ± 11.0 minutes respectively, p napping duration between patients, as recorded by actigraphy were not distinguished by their ratings on the subjective measurement of excessive daytime sleepiness. Finally, those patients with excessive daytime napping showed greater cognitive deficits in the domains of attention, semantic verbal fluency and processing speed. Conclusion This study confirms increased levels of napping in PD, a finding that is concordant with subjective reports. However, subjective self-report measures of excessive daytime sleepiness do not robustly identify excessive napping in PD. Fronto-subcortical cognitive dysfunction was observed in those patients who napped excessively. Furthermore, this study suggests that daytime actigraphy, a non-invasive and inexpensive objective measure of
Bolitho, Samuel J; Naismith, Sharon L; Salahuddin, Pierre; Terpening, Zoe; Grunstein, Ron R; Lewis, Simon J G
Sleep-wake disturbances and concomitant cognitive dysfunction in Parkinson's disease (PD) contribute significantly to morbidity in patients and their carers. Subjectively reported daytime sleep disturbance is observed in over half of all patients with PD and has been linked to executive cognitive dysfunction. The current study used daytime actigraphy, a novel objective measure of napping and related this to neuropsychological performance in a sample of PD patients and healthy, age and gender-matched controls. Furthermore this study aimed to identify patients with PD who may benefit from pharmacologic and behavioural intervention to improve these symptoms. Eighty-five PD patients and 21 healthy, age-matched controls completed 14 days of wrist actigraphy within two weeks of neuropsychological testing. Objective napping measures were derived from actigraphy using a standardised protocol and subjective daytime sleepiness was recorded by the previously validated Epworth Sleepiness Scale. Patients with PD had a 225% increase in the mean nap time per day (minutes) as recorded by actigraphy compared to age matched controls (39.2 ± 35.2 vs. 11.5 ± 11.0 minutes respectively, p napping duration between patients, as recorded by actigraphy were not distinguished by their ratings on the subjective measurement of excessive daytime sleepiness. Finally, those patients with excessive daytime napping showed greater cognitive deficits in the domains of attention, semantic verbal fluency and processing speed. This study confirms increased levels of napping in PD, a finding that is concordant with subjective reports. However, subjective self-report measures of excessive daytime sleepiness do not robustly identify excessive napping in PD. Fronto-subcortical cognitive dysfunction was observed in those patients who napped excessively. Furthermore, this study suggests that daytime actigraphy, a non-invasive and inexpensive objective measure of daytime sleep, can identify patients with PD
Levine, B; Roehrs, T; Zorick, F; Roth, T
The daytime sleepiness of a large sample (n = 129) of healthy, young (age 18-29) adults with no sleep-wake complaints was measured and compared with that of a sample (n = 47) of older (age 30-80) healthy, normal sleeping, subjects. Each spent 8 h in the laboratory on 1 night and received the Multiple Sleep Latency Test (MSLT) the following day. Sleep latency was measured at 1000, 1200, 1400, and 1600 h. Mean sleep latency ranged from 2 to 20 min within each group, but the shape of the distribution of latency between groups was different. The mean latency of young subjects (particularly college students) was shorter than that of the older subjects, with the differences occurring between the sleepiest 80% of each distribution. Among the college students, those with higher nocturnal sleep efficiencies (the previous night) were sleepier the following day than those with lower sleep efficiencies. The relation between nocturnal sleep efficiency and daytime sleepiness suggests that the increased sleepiness of average young adults is due to mild sleep restriction.
Valérie Cochen De Cock
Full Text Available Excessive daytime sleepiness is a frequent complaint in Parkinson's disease (PD; however the frequency and risk factors for objective sleepiness remain mostly unknown. We investigated both the frequency and determinants of self-reported and objective daytime sleepiness in patients with Parkinson's disease (PD using a wide range of potential predictors.One hundred and thirty four consecutive patients with PD, without selection bias for sleep complaint, underwent a semi-structured clinical interview and a one night polysomnography followed by a multiple sleep latency test (MSLT. Demographic characteristics, medical history, PD course and severity, daytime sleepiness, depressive and insomnia symptoms, treatment intake, pain, restless legs syndrome, REM sleep behaviour disorder, and nighttime sleep measures were collected. Self-reported daytime sleepiness was defined by an Epworth Sleepiness Scale (ESS score above 10. A mean sleep latency on MSLT below 8 minutes defined objective daytime sleepiness.Of 134 patients with PD, 46.3% had subjective and only 13.4% had objective sleepiness with a weak negative correlation between ESS and MSLT latency. A high body mass index (BMI was associated with both ESS and MSLT, a pain complaint with ESS, and a higher apnea/hypopnea index with MSLT. However, no associations were found between both objective and subjective sleepiness, and measures of motor disability, disease onset, medication (type and dose, depression, insomnia, restless legs syndrome, REM sleep behaviour disorder and nighttime sleep evaluation.We found a high frequency of self-reported EDS in PD, a finding which is however not confirmed by the gold standard neurophysiological evaluation. Current treatment options for EDS in PD are very limited; it thus remains to be determined whether decreasing pain and BMI in association with the treatment of sleep apnea syndrome would decrease significantly daytime sleepiness in PD.
Waller, Katja Linda; Mortensen, Erik Lykke; Avlund, Kirsten
) or cognitively impaired (N = 92). METHODS: The Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale measured subjective sleep quality and daytime sleepiness, respectively. Depressive symptoms were determined using Beck's Depression Inventory (BDI-II). A neuropsychological battery was administered....... Our results suggest that sleep quality may be an early marker of cognitive decline in midlife.......UNLABELLED: In an increasingly aged population, sleep disturbances and neurodegenerative disorders have become a major public health concern. Poor sleep quality and cognitive changes are complex health problems in aging populations that are likely to be associated with increased frailty, morbidity...
Li, Liwen; Ren, Jiwei; Shi, Lei; Jin, Xinming; Yan, Chonghuai; Jiang, Fan; Shen, Xiaoming; Li, Shenghui
Nocturnal awakening is the most frequent insomnia complaint in the general population. In contrast to a growing knowledge based on adults, little is known about its prevalence, correlated factors, and associations with subjective sleep perception and daytime sleepiness in children. This study was designed to assess the prevalence and the correlate factors of frequent nocturnal awakening (FNA) among Chinese school-aged children. Furthermore, the associations of FNA with subjective sleep perception and daytime sleepiness were examined. A random sample of 20,505 children aged 5.00 to 11.92 years old (boys: 49.5% vs. girls: 50.5%) participated in a cross-sectional survey, which was conducted in eight cities of China. Parent-administered questionnaires were used to collect information on children's sleep behaviors, sleep perception, and potential influential factors of FNA from six domains. Univariate and multivariate logistic regression models were performed. The prevalence of FNA was 9.8% (10.0% for boys vs. 8.9% for girls) in our sampled children. The prominent FNA-related factors inclued biological health problems, such as overweight/obesity (OR = 1.70), chronic pain during night (OR = 2.47), and chronic respiratory condition (OR = 1.23), poor psychosocial condition, such as poor mental and emotional functioning (OR = 1.34), poor sleep hygiene, such as frequently doing exciting activities before bedtime (OR = 1.24) and bedtime resistance (OR = 1.42), and parents' history of insomnia (OR = 1.31). FNA was associated with subjective poor sleep quality (OR = 1.24), subjective insufficient sleep (OR = 1.21), and daytime sleepiness (OR = 1.35). FNA was associated with poor sleep and daytime sleepiness. Compared to sleep environment and family susceptibility, chronic health problems, poor psychosocial condition, and poor sleep hygiene had greater impact on FNA, indicating childhood FNA could be partly prevented by health promotion, by psychological intervention, and by
Bolitho, Samuel J; Naismith, Sharon L; Salahuddin, Pierre; Terpening, Zoe; Grunstein, Ron R; Lewis, Simon J G
.... The current study used daytime actigraphy, a novel objective measure of napping and related this to neuropsychological performance in a sample of PD patients and healthy, age and gender-matched controls...
Samuel J Bolitho; Sharon L Naismith; Pierre Salahuddin; Zoe Terpening; Ron R Grunstein; Simon J G Lewis
.... The current study used daytime actigraphy, a novel objective measure of napping and related this to neuropsychological performance in a sample of PD patients and healthy, age and gender-matched controls...
Raine, Adrian; Venables, Peter H
While recent cross-sectional research has documented a relationship between sleep problems and antisocial behavior, the longitudinal nature of this relationship is unknown. This study tests both the hypothesis that adolescent daytime sleepiness is associated with later adult criminal offending, and also tests a biopsychosocial mediation model in which social adversity predisposes to sleepiness, which in turn predisposes to attentional impairment, and to adult crime. Schoolboys aged 15 years rated themselves on self-report sleepiness. Age 15 antisocial behavior was assessed by teacher ratings and self-reports, while convictions for crime were assessed at age 29. Attentional capacity at age 15 was assessed by autonomic orienting, with arousal assessed by the electroencephalogram (EEG). Sleepy adolescents were more likely to be antisocial during adolescence, and were 4.5 times more likely to commit crime by age 29. The sleepiness-adult crime relationship withstood control for adolescent antisocial behavior. Self-report sleepiness predicted to adult crime over and above objective measures of daytime sleepiness (EEG theta activity) and age 15 antisocial behavior. Poor daytime attention partly mediated the sleep-crime relationship. Mediation analyses also showed that social adversity predisposed to daytime sleepiness which was associated with reduced attention which in turn predisposed to adult crime. Findings are the first to document a longitudinal association between sleepiness in adolescence and crime in adulthood. The longitudinal nature of this relationship, controlling for age 15 antisocial behavior, is consistent with the hypothesis that adolescent sleepiness predisposes to later antisociality. Findings are also consistent with the notion that the well-established link between social adversity and adult crime is partly explained by sleepiness. Results suggest that a very brief and simple assessment of subjective daytime sleepiness may have prognostic clinical
Lopez, Régis; Jaussent, Isabelle; Dauvilliers, Yves
To objectively measure daytime sleepiness and to assess for clinical and polysomnographic determinants of mean sleep latency in adult patients with somnambulism (sleepwalking [SW]) or sleep terrors (ST) compared with controls. Thirty drug-free adult patients with primary SW or ST, and age-, sex-, and body mass index-matched healthy controls underwent a standardized clinical interview, completed questionnaires including the Epworth Sleepiness Scale, and underwent one night of video polysomnography followed by the Multiple Sleep Latency Test (MSLT). Excessive daytime sleepiness defined as Epworth Sleepiness Scale score >10 was reported in 66.7% of patients and 6.7% of controls. The temporal pattern of sleep latencies in individual MSLT trials differed between patients and controls, with progressive increased sleep latency in patients across the trials in contrast to a "U curve" for controls. We did not find between-group differences regarding the mean sleep latency on the 5 MSLT trials, but did observe reduced sleep latencies in patients for the first 2 trials. Despite increased slow-wave sleep disruptions found in patients (i.e, more micro-arousals and hypersynchronous high-voltage delta waves arousals), we did not find polysomnographic characteristic differences when comparing sleepy patients for either subjective or objective daytime sleepiness on the MSLT compared with alert patients. Excessive daytime sleepiness is a common complaint in subjects with SW or ST and shorter sleep latencies in the early morning hours. Despite an increased slow-wave sleep fragmentation found in these patients, we did not identify any association with the level of daytime sleepiness. © 2014 American Academy of Neurology.
Background and objectives. Short nocturnal sleep duration resulting in sleep debt may be a cause of excessive daytime sleepiness (EDS). Severity of depression (psychopathology) has been found to be directly related to EDS. There is an association between sleep duration and mental health, so there may therefore be an ...
Edd, Ethel Mitty; Flores, Sandi
Excessive daytime somnolence (EDS) is associated with age-related changes, environment, circadian rhythm or sleep pattern disorder, insomnia, medications, lifestyle factors, depression, pain, and illness. The notion of "sleep architecture" connotes a structure that describes the sleep cycle (i.e., stages) and wakefulness during a single sleep period-that is, rapid eye movement (REM) and non-REM sleep. Circadian rhythms perform a variety of functions including regulation of the quality and distribution of the stages of sleep. Insomnia includes delayed sleep onset as well as premature wakening; sleep is nonrestorative. Comorbidities associated with insomnia are Alzheimer's disease and other dementias, delirium, depression, congestive heart failure, chronic obstructive pulmonary disease, gastroesophageal reflux disease, pain, degenerative diseases of the neurological system, and sleep apnea. Continuous inadequate sleep affects cognitive function, physical performance, overall well-being, and quality of life. There is a greater risk of falls from insomnia than is the use of hypnotics to manage it. Sleep disruption among older adults is underrecognized and undertreated. Assessment using valid tools can be performed rapidly. There are a variety of treatment options, including sleep hygiene and pharmacological and alternative modalities.
Marques, D M; Teixeira, H R S; Lopes, A R F; Martins-Pedersoli, T A; Ziviani, L C; Mente, Ê D; Castro-E-Silva, O; Galvão, C M; Mendes, K S
The goal of this study was to evaluate the sleep quality and daytime sleepiness of patients eligible for liver transplants. A cross-sectional prospective study was conducted on liver transplant candidates from a transplant center in the interior of São Paulo State. The Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale questionnaires were applied to obtain demographic and clinical characteristics and to assess sleep quality and daytime sleepiness. The mean (±SD) score on the Epworth Sleepiness Scale of the 45 liver transplantation candidates was 7.00 ± 2.83 points, with 28.89% having scores >10 points, indicating excessive daytime sleepiness. The mean score on the Pittsburgh Sleep Quality Index was 6.64 ± 4.95 points, with 60% of the subjects showing impaired sleep quality, with scores >5 points. The average sleep duration was 07:16 h. Regarding sleep quality self-classification, 31.11% reported poor or very poor quality. It is noteworthy that 73.33% of patients had to go to the bathroom, 53.33% woke up in the middle of the night, and 40.00% reported pain related to sleeping difficulties. Comparison of subjects with good and poor sleep quality revealed a significant difference in time to sleep (P = .0002), sleep hours (P = .0003), and sleep quality self-classification (P = .000072). Liver transplant candidates have a compromised quality of sleep and excessive daytime sleepiness. In clinical practice, we recommend the evaluation and implementation of interventions aimed at improving the sleep and wakefulness cycle, contributing to a better quality of life. Copyright © 2016 Elsevier Inc. All rights reserved.
Fu, Yiqun; Xu, Huajun; Xia, Yunyan; Qian, Yingjun; Li, Xinyi; Zou, Jianyin; Wang, Yuyu; Meng, Lili; Tang, Xulan; Zhu, Huaming; Zhou, Huiqun; Su, Kaiming; Yu, Dongzhen; Yi, Hongliang; Guan, Jian; Yin, Shankai
Excessive daytime sleepiness is a common symptom in obstructive sleep apnea (OSA). Previous studies have showed that excessive daytime sleepiness is associated with some individual components of metabolic syndrome. We performed a large cross-sectional study to explore the relationship between excessive daytime sleepiness and metabolic syndrome in male OSA patients. A total of 2241 suspected male OSA patients were consecutively recruited from 2007 to 2013. Subjective daytime sleepiness was assessed using the Epworth sleepiness scale. Anthropometric, metabolic, and polysomnographic parameters were measured. Metabolic score was used to evaluate the severity of metabolic syndrome. Among the male OSA patients, most metabolic parameters varied by excessive daytime sleepiness. In the severe group, male OSA patients with excessive daytime sleepiness were more obese, with higher blood pressure, more severe insulin resistance and dyslipidemia than non-sleepy patients. Patients with metabolic syndrome also had a higher prevalence of excessive daytime sleepiness and scored higher on the Epworth sleepiness scale. Excessive daytime sleepiness was independently associated with an increased risk of metabolic syndrome (odds ratio =1.242, 95% confidence interval: 1.019-1.512). No substantial interaction was observed between excessive daytime sleepiness and OSA/ obesity. Excessive daytime sleepiness was related to metabolic disorders and independently associated with an increased risk of metabolic syndrome in men with OSA. Excessive daytime sleepiness should be taken into consideration for OSA patients, as it may be a simple and useful clinical indicator for evaluating the risk of metabolic syndrome.
Gaina, Alexandru; Sekine, Michikazu; Hamanishi, Shimako; Chen, Xiaoli; Wang, Hongbing; Yamagami, Takashi; Kagamimori, Sadanobu
To examine daytime sleepiness and sleepiness interrelationship with sleep-wake patterns, eating habits, physical activity, and TV/video game time. A cross-sectional survey with 9,261 school children (mean age of 12.8 years) from 93 junior high schools in Toyama prefecture, Japan. The main outcome measures were daytime sleepiness during schooldays and sleepiness interrelationship with sleep-wake patterns, eating habits, physical activity, and visual media use. A total of 2,328 children (25.2%) reported sleepiness almost always and 4,401 (47.6%) sleepiness often. Regarding sex difference, a higher proportion of girls reported sleepiness in comparison to boys (79% vs 66%, P media use time. Sleep insufficiency represents a main cause for daytime sleepiness in Japanese junior high school children. Proper sleep habits, high physical activity level, and limited TV viewing time should be promoted among school children.
Objective: Excessive daytime sleepiness due to any cause can result in various symptoms similar to those used for the diagnosis of attention deficit/hyperactivity disorder (ADHD). A common treatment for children diagnosed with ADHD is methylphenidate which is also used to treat excessive daytime sleepiness. This paper ...
Campbell, Ian G; Burright, Christopher S; Kraus, Amanda M; Grimm, Kevin J; Feinberg, Irwin
Daytime sleepiness increases across adolescence. This increase is commonly attributed to insufficient sleep durations resulting from increasingly limited time in bed. We tested the effects of 3 sleep schedules on daytime sleepiness and whether these effects changed with age in early adolescence. In 77 children ranging in age from 9.9 to 14 years, objective (multiple sleep latency test [MSLT]) and subjective (Karolinska sleepiness scale [KSS]) sleepiness was measured following 4 consecutive nights of either 7, 8.5, or 10 hours in bed. All participants completed all 3 sleep schedules. The order in which they completed the schedules was not randomized but was accounted for in all statistical analyses. Time in bed restriction decreased sleep duration and increased objective and subjective daytime sleepiness. Although the sleep durations did not change with age, the likelihood of falling asleep during the MSLT increased with age. Nevertheless, sleep restriction produced a greater increase in MSLT-measured sleepiness in younger participants. Subjective sleepiness measured with the KSS increased with shorter sleep duration, but this effect did not change with age. Increasing objective daytime sleepiness in early adolescence cannot simply be attributed to reduced sleep due to restricted sleep schedules. We propose that some of the increased daytime sleepiness of adolescents is a consequence of adolescent brain reorganization driven by synaptic pruning which decreases the intensity of waking brain activity.
Högl, Birgit; Seppi, Klaus; Brandauer, Elisabeth; Glatzl, Susanne; Frauscher, Birgit; Niedermüller, Ulrike; Wenning, Gregor; Poewe, Werner
We evaluated the frequency and severity of excessive daytime sleepiness in an outpatient population with Parkinson's disease in comparison to age-matched controls and examined its relationship with antiparkinsonian drug therapy and sleep history. Increased daytime sleepiness and involuntary sleep episodes have been described in Parkinson's disease, but the etiology is not completely understood. The Epworth Sleepiness Scale (ESS), a validated questionnaire for daytime sleepiness, was prospectively administered to 99 consecutive outpatients with Parkinson's disease and 44 age-matched controls. In addition, a short sleep-screening questionnaire was used. The ESS revealed significantly increased daytime sleepiness in PD patients compared to controls (7.5 +/- 4.6 vs. 5.8 +/- 3.0, P = 0.013). The ESS score was abnormally high (10 or more) in 33 % of PD patients and 11.4% of controls (P = 0.001). ESS was not different between PD patients on levodopa monotherapy and those on levodopa and dopamine agonists, or between patients taking ergoline or non-ergoline dopamine agonists. In PD patients and in controls, sleepiness was significantly associated with reported heavy snoring. Increased daytime sleepiness is more frequent in patients with PD than in elderly controls. Similar to controls, increased daytime sleepiness in PD patients is correlated with heavy snoring. Copyright 2002 Movement Disorder Society
Yang, Boksun; Choe, Kwisoon; Park, Youngrye; Kang, Youngmi
The aim of this study was to examine the effects of daytime sleepiness on depression and suicidal ideation in adolescent high-school students. A survey of 538 high school students aged 16-17 years attending two academic schools was conducted. The Epworth Sleepiness Scale (ESS), the Beck Depression Inventory and the Scale for Suicide Ideation were used to assess subjects' daytime sleepiness, depression and suicidal ideation. The mean score for daytime sleepiness was 8.52, which indicates a sleep deficit. Significant positive correlations were found between daytime sleepiness and depression, between daytime sleepiness and suicidal ideation and between depression and suicidal ideation. Gender and depression were significant predictors of suicidal ideation, accounting for 48% of the variance in this measure. Depression acts as a mediator of the relationship between daytime sleepiness and suicidal ideation. High school students in Korea generally have insufficient sleep time and feel sleepy during the day; insufficient sleep during adolescence may be associated with depression and suicidal ideation.
Sleep and daytime sleepiness in methylphenidate medicated and un-medicated children with attention-deficit/hyperactivity disorder (ADHD) ... with ADHD taking methylphenidate, there was a significant increase in sleepiness a few hours after taking the medication, which may then have a significant impact on their learning.
Full Text Available The aim of the current analysis was to investigate the relationship of daytime sleepiness with alcohol consumption and sleep duration using a population sample of adult Americans. Data was analyzed from adult respondents of the National Health and Nutritional Examination Survey (NHANES 2007-2008 (N=2919 using self-reported variables for sleepiness, sleep duration, and alcohol consumption (quantity and frequency of alcohol use. A heavy drinking episode was defined as the consumption of ≥5 standard alcoholic beverages in a day. Logistic regression models adjusted for sociodemographic variables and insomnia covariates were used to evaluate the relationship between daytime sleepiness and an interaction of alcohol consumption variables with sleep duration. The results showed that daytime sleepiness was reported by 15.07% of the subjects. In univariate analyses adjusted for covariates, an increased probability of daytime sleepiness was predicted by decreased log drinks per day [OR = 0.74 (95% CI, 0.58–0.95], a decreased log drinking frequency [0.90 (95% CI, 0.83–0.98], and lower sleep duration [OR = 0.75 (95% CI, 0.67–0.84]. An interaction between decreased sleep duration and an increased log heavy drinking frequency predicted increased daytime sleepiness (P=0.004. Thus, the effect of sleep duration should be considered when evaluating the relationship between daytime sleepiness and heavy drinking.
Zailinawati, A H; Teng, C L; Chung, Y C; Teow, T L; Lee, P N; Jagmohni, K S
Poor sleep quality and daytime somnolence is reported to be associated with cardiovascular events, road traffic accident, poor academic performance and psychological distress. Some studies documented that it is prevalent in most populations but its frequency among medical students has not been documented in Malaysia. This is a self-administered questionnaire survey of medical students from International Medical University, Malaysia. Daytime sleepiness of medical students was assessed using Epworth Sleepiness Scale (ESS). Student scoring ESS > 11 was regarded as having excessive daytime sleepiness. Psychological distress was measured using 12-item General Health Questionnaire (GHQ-12). A total of 799 medical students participated in this survey (response rate 69.5%). Daytime sleepiness occurred in 35.5%, psychological distress was present in 41.8% and 16.1% reported bad sleep quality. Daytime sleepiness was significantly more common among the clinical students, those with self-reported bad sleep quality and psychological distress; but unrelated to the number of hours sleep at night. We have documented high prevalence of daytime sleepiness, poor sleep quality and psychological distress. Higher frequency among clinical students and the significant relationship with psychological distress suggest possible link to the stressful clinical training.
daytime sleepiness were reported by the parents of the un-medicated children between the hours of 13:00 and 15:00, compared to the medicated children. ... leg syndrome, sleep-disordered breathing and snoring or sleep apnea, all of which ... associated with significantly greater anxiety, daytime fatigue, nocturnal enuresis ...
Baiardi, Simone; La Morgia, Chiara; Sciamanna, Lucia; Gerosa, Alberto; Cirignotta, Fabio; Mondini, Susanna
The significant social and economic impact of excessive daytime sleepiness makes sleep evaluation a primary medical need in commercial drivers. However, the best screening tool is still matter of debate. In our cohort of 221 commercial drivers, only ten (4.5%) had Epworth Sleepiness Scale scores indicative of excessive daytime sleepiness. These findings and the lack of concordance in estimating excessive daytime sleepiness among commercial drivers in previous studies using the same psychometric measure indicate that the Epworth Sleepiness Scale is not a reliable tool. This may be due to the low internal consistency of the scale in non-clinical samples and the possible intentional underscoring of sleepiness due to a perceived threat of driver's license suspension. Moreover, the reliability of the Epworth Sleepiness Scale results may be strongly influenced by the administration setting. The clinical application of inexpensive less time-consuming new tools like performance tests should be considered for the objective evaluation of excessive daytime sleepiness in commercial drivers. Copyright © 2017 Elsevier Ltd. All rights reserved.
Moreno-López, Claudia; Santamaría, Joan; Salamero, Manuel; Del Sorbo, Francesca; Albanese, Alberto; Pellecchia, Maria Teresa; Barone, Paolo; Overeem, Sebastiaan; Bloem, Bastiaan; Aarden, Willemijn; Canesi, Margherita; Antonini, Angelo; Duerr, Susanne; Wenning, Gregor K; Poewe, Werner; Rubino, Alfonso; Meco, Giuseppe; Schneider, Susanne A; Bhatia, Kailash P; Djaldetti, Ruth; Coelho, Miguel; Sampaio, Cristina; Cochen, Valerie; Hellriegel, Helge; Deuschl, Günther; Colosimo, Carlo; Marsili, Luca; Gasser, Thomas; Tolosa, Eduardo
Sleep disorders are common in multiple system atrophy (MSA), but the prevalence of excessive daytime sleepiness (EDS) is not well known. To assess the frequency and associations of EDS in MSA. Survey of EDS in consecutive patients with MSA and comparison with patients with Parkinson disease (PD) and individuals without known neurologic disease. Twelve tertiary referral centers. Eighty-six consecutive patients with MSA; 86 patients with PD matched for age, sex, and Hoehn and Yahr stage; and 86 healthy subject individuals matched for age and sex. Epworth Sleepiness Scale (ESS), modified ESS, Sudden Onset of Sleep Scale, Tandberg Sleepiness Scale, Pittsburgh Sleep Quality Index, disease severity, dopaminergic treatment amount, and presence of restless legs syndrome. Mean (SD) ESS scores were comparable in MSA (7.72 [5.05]) and PD (8.23 [4.62]) but were higher than in healthy subjects (4.52 [2.98]) (P 10) was present in 28% of patients with MSA, 29% of patients with PD, and 2% of healthy subjects (P < .001). In MSA, in contrast to PD, the amount of dopaminergic treatment was not correlated with EDS. Disease severity was weakly correlated with EDS in MSA and PD. Restless legs syndrome occurred in 28% of patients with MSA, 14% of patients with PD, and 7% of healthy subjects (P < .001). Multiple regression analysis (with 95% confidence intervals obtained using nonparametric bootstrapping) showed that sleep-disordered breathing and sleep efficiency predicted EDS in MSA and amount of dopaminergic treatment and presence of restless legs syndrome in PD. More than one-quarter of patients with MSA experience EDS, a frequency similar to that encountered in PD. In these 2 conditions, EDS seems to be associated with different causes.
Thiago de Souza Vilela
Full Text Available Abstract Objective: Sleep deprivation in adolescents has lately become a health issue that tends to increase with higher stress prevalence, extenuating routines, and new technological devices that impair adolescents' bedtime. Therefore, this study aimed to assess the excessive sleepiness frequency and the factors that might be associated to it in this population. Methods: The cross-sectional study analyzed 531 adolescents aged 10–18 years old from two private schools and one public school. Five questionnaires were applied: the Cleveland Adolescent Sleepiness Questionnaire; the Sleep Disturbance Scale for Children; the Brazilian Economic Classification Criteria; the General Health and Sexual Maturation Questionnaire; and the Physical Activity Questionnaire. The statistical analyses were based on comparisons between schools and sleepiness and non-sleepiness groups, using linear correlation and logistic regression. Results: Sleep deprivation was present in 39% of the adolescents; sleep deficit was higher in private school adolescents (p < 0.001, and there was a positive correlation between age and sleep deficit (p < 0.001; r = 0.337. Logistic regression showed that older age (p = 0.002; PR: 1.21 [CI: 1.07–1.36] and higher score level for sleep hyperhidrosis in the sleep disturbance scale (p = 0.02; PR: 1.16 [CI: 1.02–1.32] were risk factors for worse degree of sleepiness. Conclusions: Sleep deficit appears to be a reality among adolescents; the results suggest a higher prevalence in students from private schools. Sleep deprivation is associated with older age in adolescents and possible presence of sleep disorders, such as sleep hyperhidrosis.
Ding, Qinglan; Whittemore, Robin; Redeker, Nancy
Excessive daytime sleepiness (EDS) is a prevalent symptom among stroke survivors. This symptom is an independent risk factor for stroke and may reduce stroke survivors' quality of life, cognitive functioning, and daytime functional performance. The lack of a universally accepted definition of EDS makes it difficult to measure EDS and synthesize research. The purpose of this integrative review is to describe poststroke EDS, ascertain conceptual and operational definitions of EDS, identify factors that contribute to EDS in stroke survivors, and explore outcomes associated with EDS in stroke survivors. We searched the following databases: PubMed and MEDLINE (OvidSP 1946-April; Week 2, 2015), Embase (OvidSP 1974-March; Week 1, 2015), and PsycINFO (OvidSP 1967-April; Week 2, 2015). Our search yielded 340 articles, 27 of which met inclusion criteria. The literature reveals EDS to be a multidimensional construct that is operationalized with both subjective and objective measures. Choosing measures that can quantify both the objective and subjective components is useful for gaining a comprehensive understanding of EDS. The antecedents of EDS are stroke, sleep-disordered breathing, reversed Robin Hood syndrome, and depression. The outcomes associated with EDS in stroke patients are serious and negative. Via synthesis of this research, we propose a possible framework for poststroke EDS, which may be of use in clinical practice and in research to identify valid quantifying methods for EDS as well as to prevent harmful outcomes in stroke survivors. © The Author(s) 2016.
Dec 4, 2011 ... The average adult human sleeps for about 8 of every 24 hours.1. Most of our sleep occurs at night, since we function predominantly during the day and it is necessary to be awake and alert. Under certain conditions, humans are unable to maintain the state of wakefulness needed for daytime functioning.
De Rui, Michele; Schiff, Sami; Aprile, Daniele; Angeli, Paolo; Bombonato, Giancarlo; Bolognesi, Massimo; Sacerdoti, David; Gatta, Angelo; Merkel, Carlo; Amodio, Piero; Montagnese, Sara
The relationship between hepatic encephalopathy (HE) and the sleep-wake disturbances exhibited by patients with cirrhosis remains debated. The aim of this study was to examine the usefulness of sleep-wake interview within the context of HE assessment. One-hundred-and-six cirrhotic patients were asked three yes/no questions investigating the presence of difficulty falling asleep, night awakenings and daytime sleepiness. All underwent formal HE assessment, quantitative electroencephalography and standardised psychometry. Fifty-eight were monitored for 8 ± 6 months in relation to the occurrence of HE. Patients complaining of daytime sleepiness (n = 75, 71 %) had slower EEGs than those who did not report it (relative alpha power: 37 ± 19 vs. 48 ± 17 %, p history (72 vs. 45 %, p < 0.05). Finally, the absence of excessive daytime sleepiness had a Negative Predictive Value of 92 % (64-100) in relation to the development of HE during the follow-up period. These data support the appropriateness of adding a yes/no question on the presence of excessive daytime sleepiness to routine assessment of patients with cirrhosis, to help identify those who do not need further, formal HE screening.
Moreno-Lopez, C.; Santamaria, J.; Salamero, M.; Del Sorbo, F.; Albanese, A.; Pellecchia, M.T.; Barone, P.; Overeem, S.; Bloem, B.R.; Aarden, W.C.C.A.; Canesi, M.; Antonini, A.; Duerr, S.; Wenning, G.K.; Poewe, W.; Rubino, A.; Meco, G.; Schneider, S.A.; Bhatia, K.P.; Djaldetti, R.; Coelho, M.; Sampaio, C.; Cochen, V.; Hellriegel, H.; Deuschl, G.; Colosimo, C.; Marsili, L.; Gasser, T.; Tolosa, E.
BACKGROUND: Sleep disorders are common in multiple system atrophy (MSA), but the prevalence of excessive daytime sleepiness (EDS) is not well known. OBJECTIVE: To assess the frequency and associations of EDS in MSA. DESIGN: Survey of EDS in consecutive patients with MSA and comparison with patients
experimenter.Lpaced tasks and no change on subject-paced tasks. Possible causes for this effect are not clear. Carskadon et al. (28) found 18 that performance on a...there appears to be more than one type of daytime sleepiness. Broughton differentiated sleepiness with respect to cause , i.e., sleep loss vs path- 0ology...conclusions would be inappropriate. Thus, as it is necessary to have corroborative data before narcolepsy can be diagnosed from the appearance of MSLT
Murat Bektas, PhD, RN
Conclusions: The study's results showed that PDSS-T is a valid and reliable instrument for detecting Turkish-speaking children's and adolescents' daytime sleepiness. PDSS-T is convenient for professionals to prevent and manage daytime sleepiness.
Ng, Winda L; Orellana, Liliana; Shaw, Jonathan E; Wong, Evelyn; Peeters, Anna
Through a causal framework, we aim to assess the association between weight change and daytime sleepiness, and the role of obstructive sleep apnoea (OSA) in this relationship. From the Sleep Heart Health Study, we selected individuals who were: (1) 40-64 years old, with (2) body mass index (BMI) ≥18.5 kg/m2, (3) no history of stroke, treatment for OSA, and tracheostomy at baseline. We used multiple linear regression to assess the relationship between five-year weight change and daytime sleepiness (assessed through Epworth Sleepiness Scale (ESS)) at five years, adjusting for daytime sleepiness, demographics, diabetes, subjective sleep duration, sleep disturbance, smoking status, weight, and use of antidepressants and benzodiazepines at baseline, in those with complete data (N = 1468). We further assessed the potential mediating role of OSA in this relationship. At baseline, the study participants were on average 55 years old, 46% males, with mean BMI 28 kg/m2; and 25% had ESS>10. ESS at five years worsened by 0.36 units (95% confidence interval (CI) 0.12-0.61, p = 0.004) with every 10-kg weight gain. When stratified by sex, this relationship was only found in women (0.55, 95% CI 0.25-0.86, p weight change and daytime sleepiness was mediated by severity of OSA at five years. Weight gain has a detrimental effect on daytime sleepiness, mostly through pathways other than OSA. This study provides further evidence and understanding of the relationship between obesity and excessive daytime sleepiness. Copyright © 2017 Elsevier B.V. All rights reserved.
Lia Rita Azeredo Bittencourt
Full Text Available A sonolência é uma função biológica, definida como uma probabilidade aumentada para dormir. Já a sonolência excessiva (SE, ou hipersonia, refere-se a uma propensão aumentada ao sono com uma compulsão subjetiva para dormir, tirar cochilos involuntários e ataques de sono, quando o sono é inapropriado. As principais causas de sonolência excessiva são a privação crônica de sono (sono insuficiente, a Síndrome da Apnéia e Hipopnéia Obstrutiva do Sono (SAHOS, a narcolepsia, a Síndrome das Pernas Inquietas/Movimentos Periódicos de Membros (SPI/MPM, Distúrbios do Ritmo Circadiano, uso de drogas e medicações e a hipersonia idiopática. As principais conseqüências são prejuízo no desempenho nos estudos, no trabalho, nas relações familiares e sociais, alterações neuropsicológicas e cognitivas e risco aumentado de acidentes. O tratamento da sonolência excessiva deve estar voltado para as causas específicas. Na privação voluntária do sono, aumentar o tempo de sono e higiene do sono, o uso do CPAP (Continuous Positive Airway Pressure na Síndrome da Apnéia e Hipopnéia Obstrutiva do Sono, exercícios e agentes dopaminérgicos na Síndrome das Pernas Inquietas/Movimentos Periódicos de Membros, fototerapia e melatonina nos Distúrbios do Ritmo Circadiano, retiradas de drogas que causam sonolência excessiva e uso de estimulantes da vigília.Sleepiness is a physiological function, and can be defined as increased propension to fall asleep. However, excessive sleepiness (ES or hypersomnia refer to an abnormal increase in the probability to fall asleep, to take involuntary naps, or to have sleep atacks, when sleep is not desired. The main causes of excessive sleepiness is chronic sleep deprivation, sleep apnea syndrome, narcolepsy, movement disorders during sleep, circadian sleep disorders, use of drugs and medications, or idiopathic hypersomnia. Social, familial, work, and cognitive impairment are among the consequences of
Ren, Rong; Li, Yun; Zhang, Jihui; Zhou, Junying; Sun, Yuanfeng; Tan, Lu; Li, Taomei; Wing, Yun-Kwok; Tang, Xiangdong
Subjective daytime sleepiness is considered a significant risk factor of hypertension in patients with obstructive sleep apnea (OSA). In this study, our goal was to examine the joint effect on hypertension of OSA and objective daytime sleepiness measured by the multiple sleep latency test (MSLT). A total of 1338 Chinese patients with OSA and 484 primary snorers were included in the study. All subjects underwent 1 night polysomnography followed by MSLT. The MSLT values were classified into 3 categories: >8 minutes, 5 to 8 minutes, and Hypertension was defined based either on direct blood pressure measures or on diagnosis by a physician. After controlling for confounders, OSA combined with MSLT of 5 to 8 minutes increased the odds of hypertension by 95% (odds ratio, 1.95; 95% confidence interval, 1.10-3.46), whereas OSA combined with MSLT hypertension by 111% (odds ratio, 2.11; 95% confidence interval, 1.22-3.31) compared with primary snorers with MSLT >8 minutes. In stratified analyses, the association of hypertension with MSLT in OSA patients was seen among both sexes, younger ages, both obese and nonobese patients, and patients with and without subjective excessive daytime sleepiness. We conclude that objective daytime sleepiness is associated with hypertension in patients with OSA. © 2016 American Heart Association, Inc.
Saletin, Jared M; Hilditch, Cassie J; Dement, William C; Carskadon, Mary A
Napping is a useful countermeasure to the negative effects of acute sleep loss on alertness. The efficacy of naps to recover from chronic sleep loss is less well understood. Following 2 baseline nights (10 hours' time-in-bed), participants were restricted to 7 nights of 5-hour sleep opportunity. Ten adults participated in the No-Nap condition, and a further 9 were assigned to a Nap condition with a daily 45-minute nap opportunity at 1300 h. Sleepiness was assessed using the multiple sleep latency test and a visual analogue scale at 2-hour intervals. Both objective and subjective indexes of sleepiness were normalized within subject as a difference from those at baseline prior to sleep restriction. Mixed-effects models examined how the daytime nap opportunity altered sleepiness across the day and across the protocol. Short daytime naps attenuated sleepiness due to chronic sleep restriction for up to 6-8 hours after the nap. Benefits of the nap did not extend late into evening. Subjective sleepiness demonstrated a similar short-lived benefit that emerged later in the day when objective sleepiness already returned to pre-nap levels. Neither measure showed a benefit of the nap the following morning after the subsequent restriction night. These data indicate a short daytime nap may attenuate sleepiness in chronic sleep restriction, yet subjective and objective benefits emerge at different time scales. Because neither measure showed a benefit the next day, the current study underscores the need for careful consideration before naps are used as routine countermeasures to chronic sleep loss.
Andre S. Giorelli
Full Text Available Background. Sleep complaints are common in patients with epilepsy (PWE. Excessive daytime sleepiness (EDS is one of the most reported complaints and its impact is still a matter of debate. Objective. Evaluate the relationship between EDS and epilepsy, with emphasis on prevalence, assessment, and causes. Methods. A systematic review on PubMed database in the last 10 years (2002 to 2012. The search returned 53 articles and 34 were considered relevant. After citation analysis, 3 more articles were included. Results. Most studies were cross-sectional and questionnaire based. 14 papers addressed EDS as the primary endpoint. 14 adult and 3 children studies used subjective and objective analysis as methodology. The number of studies increased throughout the decade, with 21 in the last 5 years. Adult studies represent almost three times the number of children studies. EDS prevalence in PWE varies from 10 to 47.5%. Prevalence was higher in developing countries. Conclusion. EDS seems to be related more frequently to undiagnosed sleep disorders than to epilepsy-related factors, and although it affects the quality of life of PWE, it can be improved by treating comorbid primary sleep disorders.
Giorelli, Andre S; Passos, Pâmela; Carnaval, Thiago; Gomes, Marleide da Mota
Background. Sleep complaints are common in patients with epilepsy (PWE). Excessive daytime sleepiness (EDS) is one of the most reported complaints and its impact is still a matter of debate. Objective. Evaluate the relationship between EDS and epilepsy, with emphasis on prevalence, assessment, and causes. Methods. A systematic review on PubMed database in the last 10 years (2002 to 2012). The search returned 53 articles and 34 were considered relevant. After citation analysis, 3 more articles were included. Results. Most studies were cross-sectional and questionnaire based. 14 papers addressed EDS as the primary endpoint. 14 adult and 3 children studies used subjective and objective analysis as methodology. The number of studies increased throughout the decade, with 21 in the last 5 years. Adult studies represent almost three times the number of children studies. EDS prevalence in PWE varies from 10 to 47.5%. Prevalence was higher in developing countries. Conclusion. EDS seems to be related more frequently to undiagnosed sleep disorders than to epilepsy-related factors, and although it affects the quality of life of PWE, it can be improved by treating comorbid primary sleep disorders.
Videnovic, Aleksandar; Noble, Charleston; Reid, Kathryn J; Peng, Jie; Turek, Fred W; Marconi, Angelica; Rademaker, Alfred W; Simuni, Tanya; Zadikoff, Cindy; Zee, Phyllis C
Diurnal fluctuations of motor and nonmotor symptoms and a high prevalence of sleep-wake disturbances in Parkinson disease (PD) suggest a role of the circadian system in the modulation of these symptoms. However, surprisingly little is known regarding circadian function in PD and whether circadian dysfunction is involved in the development of sleep-wake disturbances in PD. To determine the relationship between the timing and amplitude of the 24-hour melatonin rhythm, a marker of endogenous circadian rhythmicity, with self-reported sleep quality, the severity of daytime sleepiness, and disease metrics. A cross-sectional study from January 1, 2009, through December 31, 2012, of 20 patients with PD receiving stable dopaminergic therapy and 15 age-matched control participants. Both groups underwent blood sampling for the measurement of serum melatonin levels at 30-minute intervals for 24 hours under modified constant routine conditions at the Parkinson's Disease and Movement Disorders Center of Northwestern University. Twenty-four hour monitoring of serum melatonin secretion. Clinical and demographic data, self-reported measures of sleep quality (Pittsburgh Sleep Quality Index) and daytime sleepiness (Epworth Sleepiness Scale), and circadian markers of the melatonin rhythm, including the amplitude, area under the curve (AUC), and phase of the 24-hour rhythm. Patients with PD had blunted circadian rhythms of melatonin secretion compared with controls; the amplitude of the melatonin rhythm and the 24-hour AUC for circulating melatonin levels were significantly lower in PD patients (P Parkinson's Disease Rating Scale scores, levodopa equivalent dose, and global Pittsburgh Sleep Quality Index score in the PD group were not significantly related to measures of the melatonin circadian rhythm. Circadian dysfunction may underlie excessive sleepiness in PD. The nature of this association needs to be explored further in longitudinal studies. Approaches aimed to strengthen
Yousef A. Taher
Full Text Available Background: The effect of sleep difficulties has achieved a great deal of attention recently, with university students considered as a homogenized population, particularly affected by sleep habits. Aim: The objective of this study was to investigate whether Libyan college students experience sleep disturbance during their academic programmes. Methods: A cross-sectional survey was conducted in the college of Pharmacy, Tripoli University, during February 2010. A total of 201 students, including 179 females (89.05% and 22 males (10.95%, were recruited from different academic levels. Data were collected using a structured questionnaire and included a number of life-style variables. Epworth Sleepiness Scale (ESS was used for the assessment of daytime sleepiness. Results: This study showed that the total sleep time (TST on a weeknight was 6.40 h and 67 students reported napping during daytime. The TST plus naps totalled 7.39 h. Out of eight possible dozing situations, we found that the mean score for ESS was 8.78. In addition, 79 students showed an ESS score of >10. Furthermore, our results showed that the majority of students (>92% reported poor sleep satisfaction with quality and duration of sleep hours. Thinking about difficulty of study but not increasing education programs or tea/coffee consumption is associated with sleep difficulties reported. Moreover, 77.6% of students reported an irregular sleep–wake schedule. Conclusion: These findings indicate that students experienced excessive daytime sleepiness. The TST of pharmaceutical students in Libya, as in other developing countries, is less than those reported by Western students. Students experienced various environmental demands during their college years and, their quality of sleep was negatively affected.
Mahoney, James J.; Jackson, Brian J.; Kalechstein, Ari D.; De La Garza, Richard; Chang, Lee C.; Newton, Thomas F.
The purpose of this study was to evaluate the effects of acute, oral modafinil (200 mg) exposure on daytime sleepiness in methamphetamine (Meth)-dependent individuals. Eighteen Meth-dependent subjects were enrolled in a 7-d inpatient study and were administered placebo or modafinil on day 6 and the counter-condition on day 7 (randomized) of the protocol. Subjects completed several subjective daily assessments (such as the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Beck Depression Inventory and visual analogue scale) throughout the protocol as well as objective assessments on days 5–7, when the Multiple Sleep Latency Test was performed. The results of the current study suggest that short-term abstinence from Meth is associated with increased daytime sleepiness and that a single dose of 200 mg modafinil reduces daytime somnolence in this population. In addition, a positive correlation was found between subjective reporting of the likelihood of taking a nap and craving and desire for Meth, as well as the likelihood of using Meth and whether Meth would make the participant feel better. The results of this study should be considered when investigating candidate medications for Meth-dependence, especially in those individuals who attribute their Meth use to overcoming deficits resulting from sleep abnormalities. PMID:22214752
Happe, Svenja; Baier, Paul Christian; Helmschmied, Kathrin; Meller, Johannes; Tatsch, Klaus; Paulus, Walter
Many patients with Parkinson's disease (PD) report daytime sleepiness. Its etiology, however, is still not fully understood. The aim of this study was to examine if the amount of nigrostriatal dopaminergic degeneration is associated with subjective daytime sleepiness in patients with PD. We investigated 21 patients with PD clinically and by means of [(123)I] FP-CIT-SPECT (DaTSCAN(R)). Each patient filled in the Epworth sleepiness scale (ESS), the Parkinson's Disease Sleep Scale (PDSS), and the self-rating depression scale according to Zung (SDS) to assess sleepiness, sleep quality, and depressive symptoms. The mean specific dopamine transporter binding in the 21 PD patients (60.8 +/- 10.4 years, nine females, median Hoehn and Yahr stage 2.0) was decreased. Nine patients were in Hoehn and Yahr stage 1 (58.7 +/- 6.6 years, four females; ESS score 7.4 +/- 4.5; PDSS score 105.1 +/- 30.9), the other 12 patients were in Hoehn and Yahr stage 2 (62.4 +/- 12.6 years, five females; ESS score 6.7 +/- 4.7, PDSS score 97.1 +/- 25.6). Age, gender, ESS, and PDSS scores were not significantly different in both groups. However, ESS scores showed an inverse correlation with mean DAT binding in the striatum (r = -0.627, p = 0.03), the caudate nucleus (r = -0.708, p = 0.01), and the putamen (r = -0.599, p = 0.04) in patients with Hoehn and Yahr stage 2. There was no correlation of the ESS score with age, disease duration, UPDRS motor score, PDSS score, or depression score. Subjective daytime sleepiness seems to be associated with dopaminergic nigrostriatal degeneration in early PD.
Whittier, Anjalene; Sanchez, Sixto; Castañeda, Benjamín; Sanchez, Elena; GELAYE, Bizu; Yanez, David; Williams, Michelle A
Objectives: The aims of this study were to evaluate patterns of circadian preferences and daytime sleepiness, and to examine the extent to which the consumption of stimulant beverages is associated with daytime sleepiness and evening chronotype among Peruvian college-age students.
Perez-Chada, Daniel; Perez-Lloret, Santiago; Videla, Alejandro J; Cardinali, Daniel; Bergna, Miguel A; Fernández-Acquier, Mariano; Larrateguy, Luis; Zabert, Gustavo E; Drake, Christopher
Inadequate sleep and sleep disordered breathing (SDB) can impair learning skills. Questionnaires used to evaluate sleepiness in adults are usually inadequate for adolescents. We conducted a study to evaluate the performance of a Spanish version of the Pediatric Daytime Sleepiness Scale (PDSS) and to assess the impact of sleepiness and SDB on academic performance. A cross-sectional survey of students from 7 schools in 4 cities of Argentina. A questionnaire with a Spanish version of the PDSS was used. Questions on the occurrence of snoring and witnessed apneas were answered by the parents. Mathematics and language grades were used as indicators of academic performance. The sample included 2,884 students (50% males; age: 13.3 +/- 1.5 years) Response rate was 85%; 678 cases were excluded due to missing data. Half the students slept <9 h per night on weekdays. The mean PDSS value was 15.74 +/- 5.93. Parental reporting of snoring occurred in 511 subjects (23%); snoring was occasional in 14% and frequent in 9%. Apneas were witnessed in 237 cases (11%), being frequent in 4% and occasional in 7%. Frequent snorers had higher mean PDSS scores than occasional or nonsnorers (18 +/- 5, 15.7 +/- 6 and 15.5 +/- 6, respectively; P < 0.001). Reported snoring or apneas and the PDSS were significant univariate predictors of failure and remained significant in multivariate logistic regression analysis after adjusting for age, sex, body mass index, specific school attended, and sleep habits. Insufficient hours of sleep were prevalent in this population. The Spanish version of the PDSS was a reliable tool in middle-school-aged children. Reports of snoring or witnessed apneas and daytime sleepiness as measured by PDSS were independent predictors of poor academic performance.
Jocelyn Y Cheng
Full Text Available Excessive daytime sleepiness (EDS is common in the general population. Etiologies include insufficient sleep and primary sleep disorders. Due to its high prevalence, physicians often overlook EDS as a significant problem. However, EDS may also be the presenting symptom of seizures, in particular Nocturnal Frontal Lobe Epilepsy (NFLE. Due to the clinical similarity between the nocturnal behaviors of NFLE and parasomnias, and poor patient-related history, NFLE remains a challenging diagnosis. We report the case of a patient with NFLE who presented with a primary complaint of EDS, and discuss the differential diagnosis and evaluation of patients with EDS associated with nocturnal behaviors. In the context of a patient presenting with EDS and stereotyped nocturnal events, clinical suspicion should be high for NFLE.
Lee, Jiwon; Na, Geonyoub; Joo, Eun Yeon; Lee, Munhyang; Lee, Jeehun
This study aimed to delineate the clinical and polysomnography (PSG) characteristics of sleep disorders in children with excessive daytime sleepiness (EDS). Between February 2002 and June 2015, 622 pediatric patients with EDS were evaluated with overnight PSG and the Multiple Sleep Latency Test at the Samsung Medical Center. The medical records; questionnaire responses about depression, sleepiness, sleep habits; and sleep study data of 133 patients without obstructive sleep apnea (OSA) were reviewed retrospectively. The patients (63 girls, 70 boys) slept for an average of 7 h 30 min and 8 h 44 min on weekdays and weekends, respectively. The mean Epworth Sleepiness Scale score was 11.01 ± 4.09 and did not differ significantly among sleep disorders. Among the 102 patients who completed the depression questionnaire, 53 showed depressive feelings, which were moderate or severe in 39, with no significant differences among specific sleep disorders. Thirty-four patients exhibited normal PSG results. Seventeen of them were concluded as not having any sleep disorders, and the others as having delayed sleep phase disorder (DSPD). Narcolepsy (n = 78) was the most common disorder, followed by DSPD (n = 17) and idiopathic hypersomnia (n = 12). Pediatric patients with EDS had various sleep disorders and some did not have any sleep disorder despite EDS. More than half the patients with EDS showed depressive feelings affecting their daily lives. For pediatric patients with EDS, a systematic diagnostic approach including questionnaires for sleep habits and emotion and PSG is essential for accurate diagnosis and treatment.
Tran, Jason; Lertmaharit, Somrat; Lohsoonthorn, Vitool; Pensuksan, Wipawan C.; Rattananupong, Thanapoom; Tadesse, Mahlet G.; GELAYE, Bizu; Williams, Michelle A
We conducted this study to evaluate the prevalence of daytime sleepiness and evening chronotype, and to assess the extent to which both are associated with the use of caffeinated stimulants among 3,000 Thai college students. Demographic and behavioral characteristics were collected using a self-administered questionnaire. The Epworth Sleepiness Scale and the Horne and Ostberg Morningness-Eveningness Questionnaire were used to evaluate prevalence of daytime sleepiness and circadian preference....
Kretzschmar, Ute; Werth, Esther; Sturzenegger, Christian; Khatami, Ramin; Bassetti, Claudio L; Baumann, Christian R
Due to extensive clinical and electrophysiological overlaps, the correct diagnosis of disorders with excessive daytime sleepiness is often challenging. The aim of this study was to provide diagnostic measures that help discriminating such disorders, and to identify parameters, which don't. In this single-center study, we retrospectively identified consecutive treatment-naïve patients who suffered from excessive daytime sleepiness, and analyzed clinical and electrophysiological measures in those patients in whom a doubtless final diagnosis could be made. Of 588 patients, 287 reported subjective excessive daytime sleepiness. Obstructive sleep apnea is the only disorder that could be identified by polysomnography alone. The diagnosis of insufficient sleep syndrome relies on actigraphy as patients underestimate their sleep need and the disorder shares several clinical and electrophysiological properties with both narcolepsy type 1 and idiopathic hypersomnia. Sleep stage sequencing on MSLT appears helpful to discriminate between insufficient sleep syndrome and narcolepsy. Sleep inertia is a strong indicator for idiopathic hypersomnia. There are no distinctive electrophysiological findings for the diagnosis of restless legs syndrome. Altogether, EDS disorders are common in neurological sleep laboratories, but usually cannot be diagnosed based on PSG and MSLT findings alone. The diagnostic value of actigraphy recordings can hardly be overestimated. © 2016 European Sleep Research Society.
Randall, Surilla; Johanson, Chris-Ellyn; Tancer, Manuel; Roehrs, Timothy
3,4-Methylenedioxymethamphetamine (MDMA) affects monoamine neurotransmitters that play a critical role in sleep and daytime alertness. However, the acute effects of MDMA on sleep and daytime sleepiness have not been studied under placebo-controlled conditions. This study was designed to establish the effects of acute MDMA or placebo administration and sleep restriction on sleep and daytime sleepiness. Participants with a history of MDMA use were studied on 3 sessions of 3 nights (baseline, treatment, and recovery) and 2 days (following night 2 and 3) per session. On treatment nights (night 2), participants received placebo or 2 mg/kg of MDMA or underwent a restricted bed schedule with placebo. Sleep restriction was a positive control to compare sleep loss and consequent sleepiness associated with MDMA use. The scheduled sleep period was 8 hours long on nonrestricted nights, and standard sleep recordings and daytime sleepiness tests were conducted. Age-matched controls received 1 night and day of standard sleep and daytime sleepiness testing. Sleep laboratory. Seven recreational MDMA-users and 13 matched control subjects. Acute MDMA shortened sleep primarily by increasing sleep latency, and it reduced stage 3/4 sleep and suppressed rapid eye movement (REM) sleep. The MDMA-reduced sleep time was not associated with increased daytime sleepiness the following day, as was seen in the sleep-restriction condition. Compared with control subjects, the MDMA users on the first night in the laboratory had shorter total sleep times and less stage 3/4 sleep. Average daily sleep latency on daytime sleepiness tests the day after nighttime placebo administration was increased in MDMA users compared with the control subjects, and MDMA users had an elevated number of sleep-onset REM periods on these tests, compared with control subjects. Acute MDMA administration disrupts sleep and REM sleep, specifically, without producing daytime sleepiness such as sleep restriction does. Compared
Full Text Available Background. Patients with Chronic Obstructive Pulmonary Disease (COPD suffer from increased daytime sleepiness. The aim of this study was to identify potential predictors of subjective daytime sleepiness with special regard to sleep-related breathing disorder and nocturnal activity. Methods. COPD patients were recruited at the University Hospital Basel, Switzerland. COPD risk groups A–D were determined according to spirometry and COPD Assessment Test (CAT. Breathing disorder evaluation was performed with the ApneaLink device. Nocturnal energy expenditure was measured with the SenseWear Mini Armband. Subjective daytime sleepiness was recorded using the Epworth Sleepiness Scale (ESS. Results. Twenty-two patients (36% were in COPD risk group A, 28 patients (45% in risk group B, and 12 patients (19% in risk groups C + D (n=62. Eleven patients (18% had a pathological ESS ≥ 10/24. ESS correlated positively with CAT (r=0.386, p<0.01 and inversely with age (r=-0.347, p<0.01. In multiple linear regression age (β=-0.254, p<0.05, AHI (β=0.287, p<0.05 and CAT score (β=0.380, p<0.01 were independent predictors of ESS, while nocturnal energy expenditure showed no significant association (p=0.619. Conclusion. These findings provide evidence that daytime sleepiness in COPD patients may partly be attributable to nocturnal respiratory disturbances and it seems to mostly affect younger patients with more severe COPD symptoms.
Doi, Yuriko; Minowa, Masumi
Excessive daytime sleepiness (EDS) is serious concern in the workplace with respect to errors, accidents, absenteeism, reduced productivity and impaired personal or professional life. Previous community studies found a female preponderance of EDS, however, there is little research on EDS and gender in occupational settings. We examined the gender differences in prevalence and risk factors of EDS among employees working at a telecommunications company in the Tokyo metropolitan area. Our outcome measure of EDS was the Epworth Sleepiness Scale (ESS). A self-administered questionnaire on health and sleep including ESS was distributed to 5,571 workers between December 1999 and January 2000, and 5,072 responses were returned (91.0%). A total of 4,722 full-time, non-manual and non-shift employees aged 20-59 were used for analysis (3,909 men and 813 women). Chi-squared tests and multiple logistic regression analyses were applied for examining the gender differences in the prevalence and risk factors of EDS. The prevalence rates of EDS were 13.3% for women and 7.2% for men (Pgenders, and being married worked as a protective factor against EDS for men alone. It is obvious that a ban on overtime work and a provision of mental health hygiene are the general strategies for reducing EDS at worksites. In the case of women, we suggest the formation of effective strategies for improving women's status at home and in the workplace must also be a solution for the prevention of EDS (e.g. promoting gender equality in the division of labor at home and strengthening family care policies for working women).
Yun, Chang-Ho; Kim, Hyun; Lee, Seung Ku; Suh, Sooyeon; Lee, Seung Hoon; Park, Seong-Ho; Thomas, Robert J; Au, Rhoda; Shin, Chol
We aimed to determine the association between psychomotor vigilance task (PVT) performance and sleep-related factors including sleep duration, daytime sleepiness, poor sleep quality, insomnia, and habitual snoring in a population-based sample. This was a cross-sectional analysis from the ongoing prospective cohort study, the Korean Genome and Epidemiology Study. We measured PVT performance and documented demographics, sleep-related factors, life style, and medical conditions in community dwelling adults (N = 2499; mean age 57.1 ± 7.3; male 1259). Associations between PVT parameters and sleep-related factors were tested, adjusting for age, gender, smoking, alcohol use, education, body mass index, hypertension, diabetes, depression, and the interval between mid-sleep time and PVT test. High Epworth Sleepiness Scale (ESS, ≥8) was associated with slower mean reciprocal response speed (mean RRT) (3.69 ± 0.02 vs. 3.77 ± 0.01, p sleep and PVT test were also associated with poor performance. Sleep duration, habitual snoring, insomnia, or poor sleep quality (the Pittsburgh Sleep Quality Index score > 5) was not related to PVT parameters. At the population level, our results revealed important modifiers of PVT performance, which included subjective reports of daytime sleepiness. Copyright © 2014 Elsevier B.V. All rights reserved.
Rakesh Kumar Soni
Full Text Available The present study was aimed to measure the daily routine preference, daytime sleepiness, and psychological distress experiences, because of split shift system job in a sample in traffic police personnel of Raipur city, India. To measure such parameters we used the Morningness-Eveningness Questionnaire, Epworth Sleepiness Scale (ESS, Operational Police Stress Questionnaire (OPSQ, General Health Questionnaire and the Distress. To evaluate differences between age, body mass index, period of service length and drug / alcohol use for all the subjects (traffic police personnel the t-test and chi-square test were used. Total Hundred male traffic police personnel participated and out of which most of them were found to belong in the evening active category. This study also indicates increased prevalence of excessive daytime sleepiness and (EDS high level of psychological distress as measured by the GHQ-12 among few police workers. Moreover, a number of participants reported significant distress levels, when measured with distress thermometer. In nutshell, the study sample suggests adaptive coping strategies of traffic police personnel working in split shift system profession can be attributed to their evening (E-type circadian preferences.
Battan, Gulshan; Kumar, Sanjeev; Panwar, Ajay; Atam, Virendra; Kumar, Pradeep; Gangwar, Anil; Roy, Ujjawal
Obstructive Sleep Apnoea (OSA) is a highly prevalent disease and a major public health issue in India. Excessive daytime sleepiness is an almost ubiquitous symptom of OSA. Epworth Sleepiness Scale (ESS) score is a validated objective score to measure the degree of daytime sleepiness. Continuous Positive Airway Pressure (CPAP) therapy has been established as the gold standard treatment modality for OSA patients. A few Indian studies have reported the effectiveness of CPAP therapy in improving ESS scores after 1st month of CPAP use. To observe both, short-term (one month) and long-term (three month) effects of CPAP therapy on ESS scores in moderate to severe OSA patients. The patients complaining of excessive day-time sleepiness, snoring and choking episodes during sleep, consecutively presenting to medicine OPD over a period of 2 years, were subjected to Polysomnography (PSG). Seventy-three patients with apnoea-hypopnea index (AHI) ≥15 were categorised as having moderate to severe forms of OSA (moderate OSA with AHI=15-30 and severe OSA with AHI >30), and were scheduled for an initial trial of CPAP therapy. Forty-seven patients reported good tolerance to CPAP therapy after a trial period of 2 weeks and comprised the final study group. ESS scores in these patients were recorded at the baseline, and after 1st and 3rd month of CPAP therapy, and statistically analysed for significance. Mean ESS score at the baseline among moderate and severe OSA patients were 13.67±2.29 and 16.56 ±1.87, respectively. ESS score in both these subgroups improved significantly to 11.63±3.79, p=0.022, CI (0.3293-4.0106)} and 14.13 ±3.74, p OSA patients improved significantly to 9.84 ±2.97, p = 0.022, CI (0.3293-4.0106) and 12.29 ±3.97, p OSA. Benefits in daytime sleepiness were observed after short-term as well as long-term use of CPAP therapy.
Langberg, Joshua M; Molitor, Stephen J; Oddo, Lauren E; Eadeh, Hana-May; Dvorsky, Melissa R; Becker, Stephen P
The primary objective of this study was to evaluate the prevalence of multiple types of sleep problems in young adolescents with ADHD. Adolescents comprehensively diagnosed with ADHD (N = 262) and their caregivers completed well-validated measures of sleep problems and daytime sleepiness. Participants also completed measures related to medication use, comorbidities, and other factors that could predict sleep problems. Daytime sleepiness was by far the most common sleep problem, with 37% of adolescents meeting the clinical threshold according to parent report and 42% according to adolescent report. In contrast, prevalence rates for specific nighttime sleep problems ranged from 1.5% to 7.6%. Time spent in bed, bedtime resistance, ADHD inattentive symptoms, and Sluggish Cognitive Tempo (SCT) symptoms were significant in the final model predicting daytime sleepiness. Adolescents with ADHD commonly experience problems with daytime sleepiness that may significantly affect their functioning, but this may not be directly attributable to specific sleep problems.
McClain, James J; Lewin, Daniel S; Laposky, Aaron D; Kahle, Lisa; Berrigan, David
To examine the associations between objectively measured physical activity (PA) or sedentary behavior and self-reported sleep duration or daytime sleepiness in a nationally representative sample of healthy US adults (N=2128...
Whittier, Anjalene; Sanchez, Sixto; Castañeda, Benjamín; Sanchez, Elena; Gelaye, Bizu; Yanez, David; Williams, Michelle A
Objectives: The aims of this study were to evaluate patterns of circadian preferences and daytime sleepiness, and to examine the extent to which the consumption of stimulant beverages is associated with daytime sleepiness and evening chronotype among Peruvian college-age students. Methods: A total of 2,581 undergraduate students completed a self-administered comprehensive questionnaire that gathered information about sleep habits, sociodemographic and lifestyle characteristics, and the use of caffeinated beverages. The Morningness-Eveningness Questionnaire (MEQ) and Epworth Sleepiness Scale (ESS) were used to assess chronotype and daytime sleepiness. We used multivariable linear and logistic regression procedures to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for the associations of sleep disorders with sociodemographic and behavioral factors. Results: The prevalence of daytime sleepiness was 35% [95% CI 32.7-36.4] and eveningness chronotype was 10% [95% CI 8.8-11.1%]. Age, sex, cigarette smoking, and alcohol consumption were significantly associated with an evening chronotype. After adjusting for age, sex, smoking, body mass index, and physical activity, students who reported consumption of any stimulant beverages had 1.25 increased odds of excessive daytime sleepiness (OR=1.25 [95% CI 1.03-1.53]) compared with students who did not consume stimulant beverages. Consumption of any stimulant beverages was not statistically significantly associated with being an evening chronotype (OR=1.30 [95% CI 0.86-1.96]). Conclusions: Excessive daytime sleepiness and eveningness chronotype are common among Peruvian college students. MEQ scores were associated with age, sex, smoking, and alcohol consumption. Regular stimulant beverage consumption tended to be positively associated with excessive daytime sleepiness.
Background: Day time sleepiness remains an unexplored area of research in Nigeria despite its far reaching implication on cognitive function and productivity. This study was carried out to evaluate the prevalence of day time sleepiness among medical students in a Nigerian University. Methods: A questionnaire based ...
Panossian, Lori A; Veasey, Sigrid C
Increasing numbers of overweight children and adults are presenting to sleep medicine clinics for evaluation and treatment of sleepiness. Sleepiness negatively affects quality of life, mental health, productivity, and safety. Thus, it is essential to comprehensively address all potential causes of sleepiness. While many obese individuals presenting with hypersomnolence will be diagnosed with obstructive sleep apnea and their sleepiness will improve with effective therapy for sleep apnea, a significant proportion of patients will continue to have hypersomnolence. Clinical studies demonstrate that obesity without sleep apnea is also associated with a higher prevalence of hypersomnolence and that bariatric surgery can markedly improve hypersomnolence before resolution of obstructive sleep apnea. High fat diet in both humans and animals is associated with hypersomnolence. This review critically examines the relationships between sleepiness, feeding, obesity, and sleep apnea and then discusses the hormonal, metabolic, and inflammatory mechanisms potentially contributing to hypersomnolence in obesity, independent of sleep apnea and other established causes of excessive daytime sleepiness.
Tsai, Shao-Yu; Lin, Jou-Wei; Wu, Wei-Wen; Lee, Chien-Nan; Lee, Pei-Lin
Sleep disturbance, depression, and daytime sleepiness are among the most prevalent symptoms reported by women during pregnancy. However, available data on the association between sleep disturbances and symptoms of depression and daytime sleepiness in pregnant women are sparse and methodological limitations have been acknowledged. The purpose of the study was to examine objective and self-reported sleep disturbances and symptoms of depression and daytime sleepiness in a group of healthy pregnant women. A total of 274 third-trimester pregnant women wore a wrist actigraph continuously for 7 days to assess objective sleep quality and quantity. Self-reported sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI), with self-reported poor sleep quality defined as a PSQI score more than 5. The Center for Epidemiologic Studies-Depression Scale (CES-D) and Epworth Sleepiness Scale were used to evaluate symptoms of depression and daytime sleepiness, respectively. Sixty-four (23.4%) women were at risk for clinical depression and 69 (25.2%) had daytime sleepiness. Risk of clinically meaningful depressive symptomatology was significantly increased in women with objective total nighttime sleep less than 6 hours (OR 2.53 [95% CI 1.26-5.08]) and self-reported poor sleep quality (OR 3.31 [95% CI 1.74-6.30]), even after multiple adjustment. Neither objective nor self-reported sleep disturbances increased daytime sleepiness in this group of pregnant women. Both objective nighttime sleep less than 6 hours and self-reported poor sleep quality in healthy third-trimester pregnant women is associated with significant risks for clinical depression. Improving sleep would likely be associated with a reduction in depression symptom severity and an attenuation of the prevalence of depression in pregnant women. © 2016 Wiley Periodicals, Inc.
Full Text Available This article looks at the issues of excessive daytime sleepiness and unintended sleep episodes in patients with Parkinson’s disease (PD and explores the reasons why patients might suffer from these symptoms, and what steps could be taken to manage them. During the last decade, understanding of sleep/wake regulation has increased. Several brainstem nuclei and their communication pathways in the ascending arousing system through the hypothalamus and thalamus to the cortex play key roles in sleep disorders. Insomnia is the most common sleep disorder in PD patients, and excessive daytime sleepiness is also common. Excessive daytime sleepiness affects up to 50% of PD patients and a growing body of research has established this sleep disturbance as a marker of preclinical and premotor PD. It is a frequent and highly persistent feature in PD, with multifactorial underlying pathophysiology. Both age and disease-related disturbances of sleep-wake regulation contribute to hypersomnia in PD. Treatment with dopamine agonists also contribute to excessive daytime sleepiness. Effective management of sleep disturbances and excessive daytime sleepiness can greatly improve the quality of life for patients with PD.
Langberg, Joshua M.; Dvorsky, Melissa R.; Marshall, Stephen; Evans, Steven W.
This study investigated the relative impact of total time slept per night and daytime sleepiness on the academic functioning of 100 middle school age youth (Mage = 11.9) with Attention-Deficit/Hyperactivity Disorder (ADHD). The primary goal of the study was to determine if total time slept per night and/or daytime sleepiness, as measured by youth self-report on the Pediatric Daytime Sleepiness Scale (PDSS), predicted academic functioning above and beyond symptoms of ADHD and relevant covariates, such as intelligence, achievement scores, and parent education level. Self-reported daytime sleepiness but not self-reported total time slept per night was significantly associated with all academic outcomes. When examined in a hierarchical regression model, self-reported daytime sleepiness significantly predicted parent-rated homework problems and academic impairment and teacher-rated academic competence above and beyond symptoms of ADHD and relevant covariates but did not predict GPA or teacher-rated academic impairment. The implications of these findings for better understanding the association between ADHD and sleep and the functional implications of this relationship are discussed. PMID:23509927
Esther Yuet Ying Lau
Full Text Available We investigated the role of daytime sleepiness and sleep quality in psychosocial outcomes of patients with obstructive sleep apnea (OSA treated with continuous positive airway pressure (CPAP. Thirty-seven individuals with moderate to severe OSA and compliant with CPAP treatment for at least 3 months were compared to 27 age- and education-matched healthy controls. The OSA group and the control group were studied with overnight polysomnography (PSG and compared on measures of daytime sleepiness (Epworth Sleepiness Scale, sleep quality (Pittsburg Sleep Quality Index, mood (Beck Depression Inventory, Profile of Mood States, and functional outcomes (Functional Outcomes of Sleep Questionnaire. After CPAP treatment, the OSA group improved on sleep quality and sleepiness. As a group, they did not differ from controls on sleep architecture after CPAP. The OSA group also showed significant improvements in functional outcomes and was comparable to controls on mood and functional outcomes. Persistent difficulties included lowered activity level and residual sleepiness in some individuals. Sleepiness was found to be a significant predictor of mood and affective states, while both sleepiness and sleep quality predicted functional outcomes. These results highlight the importance of assessment and intervention targeting psychosocial functioning and sleepiness in individuals with OSA after treatment.
Mellor, Gary; Van Vorst, Stephen
This study measured the daytime sleepiness (DS) and work safety of fathers during the first 12 weeks of their babies' lives (i.e., early fatherhood). A questionnaire was developed using the Epworth Sleepiness Scale (ESS), the Safety Behaviour at Work Scale, a self-reported sleep history, and a work-related incident history. Of the 221 participants, the vast majority reported they experienced less than 6 hours of interrupted sleep per night during the 12 weeks of the study, and an increasing frequency and severity of DS. The study also revealed an inverse correlation between ESS and Safety Behaviour at Work scores; fathers were 14% more likely to report a near-miss accident at work at 12 weeks. This study posits that antenatal classes and assessment of fathers' sleepiness at work by occupational health practitioners could assist fathers in reducing daytime sleepiness and mitigating the risk of workplace incidents. © 2015 The Author(s).
Maria Julia Lyra
Full Text Available Abstract Aims: To analyze the average and individual responses of sleep quality and daytime sleepiness in adolescents after four weeks of strength training. Methods: 19 adolescents with sleep problems recruited in the Federal Institute of Pernambuco, were subject to anthropometric evaluations as well as those for body composition assessment, a 1 repetition maximum test, the sleep parameters (Pittsburgh Sleep Quality Index-PSQI and Epworth Sleepiness Scale-ESS and were submitted to four weeks of strength-training, performed alternately by segment, two sessions per week, according to recommendations for this population. Results: A decrease in the average PSQI score was observed (10.3±3.3 vs 8.8±4.0; p=0.006, but not in ESS (p>0.05, after intervention. The individual analyses demonstrated that ~63% of adolescents experienced reductions ≥ 3 points in the PSQI and ~58% of them experienced reductions ≥ 3 points in the measure of daytime sleepiness. The prevalence of poor sleep quality and daytime sleepiness reduced from 84.2% to 68.4% and from 52.6% to 31.6%, respectively. The comparisons of high and low responders to exercise training show that adolescents who reduced ≥3 points in the score of a least one sleep parameter presented lower weight, fat mass, and fat percentage (p<0.05. Conclusion: A short-term strength-training program is able to improve global sleep quality, but not daytime sleepiness in adolescents. Furthermore, the changes after training are highly heterogeneous. Further studies are required to better understand the effects of strength training on sleep parameters of adolescents.
Full Text Available Objectives: Sleep disorders can affect health and occupational performance of physicians as well as outcomes in patients. The purpose of this study was to assess the prevalence of excessive daytime sleepiness (EDS measured by the Epworth Sleepiness Scale (ESS among academic physicians at a tertiary academic medical center in an urban area in the northwest region of Turkey, and to establish a relationship between the self-perceived sleepiness and the quality of life using the EuroQol-5 dimensions (EQ-5D. Material and Methods: A questionnaire prepared by the researchers after scanning the literature on the subject was e-mailed to the academic physicians of a tertiary academic medical center in Istanbul. The ESS and the EQ-5D were also included in the survey. The e-mail database of the institution directory was used to compile a list of active academic physicians who practiced clinical medicine. Paired and independent t tests were used for the data analysis at a significance level of p 10 (p < 0.001. In the case of the EQ-5D index and visual analogue scale of the EQ-5D questionnaire (EQ-5D VAS, the status of sleepiness of academic physicians was associated with a poorer quality of life (p < 0.001. Conclusions: More than a 1/4 of the academic physicians suffered from sleepiness. There was an association between the poor quality of life and daytime sleepiness. There was also a positive relationship between habitual napping and being sleepy during the day.
Langberg, Joshua M; Dvorsky, Melissa R; Becker, Stephen P; Molitor, Stephen J
The primary aim of this study was to evaluate whether school maladjustment longitudinally predicts the daytime sleepiness of college students with ADHD above and beyond symptoms of ADHD and to determine whether internalizing dimensions mediate the relationship between maladjustment and sleepiness. A prospective longitudinal study of 59 college students comprehensively diagnosed with ADHD who completed ratings at the beginning, middle, and end of the school year. School maladjustment at the beginning of the year significantly predicted daytime sleepiness at the end of the year above and beyond symptoms of ADHD. Locus of control mediated the relationship between maladjustment and daytime sleepiness. The significant school maladjustment difficulties that students with ADHD experience following the transition to college may lead to the development of problems with daytime sleepiness, particularly for those students with high external locus of control. This pattern is likely reciprocal, whereby sleep problems in turn result in greater school impairment, reinforcing the idea that life events are outside of one's control. © The Author(s) 2014.
Shen, Quanquan; Huang, Xiaohong; Luo, Zhaofen; Xu, Xiujun; Zhao, Xiang; He, Qiang
To assess the relationship between sleep quality, daytime sleepiness and health-related quality-of-life (HRQoL) in Chinese patients undergoing maintenance haemodialysis (MHD). This cross-sectional study enrolled patients undergoing MHD. Self-reported sleep quality (Pittsburgh Sleep Quality Index [PSQI]), daytime sleepiness (Epworth Sleepiness Scale [ESS]) and HRQoL (36-item Short Form [SF-36]) were recorded for all patients. Sixty eight patients (mean ± SD age = 61.75 ± 16.56 years; 43 male/25 female) who regularly received MHD were included. The prevalence of poor sleepers was 69.1% (47/68) and daytime sleepiness was 11.8% (eight of 68). Poor sleepers had a significantly lower Physical Component Scale (PCS) score, Mental Component Scale (MCS) score and total SF-36 score than good sleepers. The PSQI score correlated inversely with both the PCS and MCS scores and correlated positively with age. Independent variables associated with total SF-36 score were duration of MHD, ESS score and PSQI score. Poor sleep quality is a common and severe issue for MHD patients in east China. Both sleep quality and daytime sleepiness were associated with lower HRQoL scores. © The Author(s) 2016.
Panossian, Lori A.; Veasey, Sigrid C.
Increasing numbers of overweight children and adults are presenting to sleep medicine clinics for evaluation and treatment of sleepiness. Sleepiness negatively affects quality of life, mental health, productivity, and safety. Thus, it is essential to comprehensively address all potential causes of sleepiness. While many obese individuals presenting with hypersomnolence will be diagnosed with obstructive sleep apnea and their sleepiness will improve with effective therapy for sleep apnea, a significant proportion of patients will continue to have hypersomnolence. Clinical studies demonstrate that obesity without sleep apnea is also associated with a higher prevalence of hypersomnolence and that bariatric surgery can markedly improve hypersomnolence before resolution of obstructive sleep apnea. High fat diet in both humans and animals is associated with hypersomnolence. This review critically examines the relationships between sleepiness, feeding, obesity, and sleep apnea and then discusses the hormonal, metabolic, and inflammatory mechanisms potentially contributing to hypersomnolence in obesity, independent of sleep apnea and other established causes of excessive daytime sleepiness. Citation: Panossian LA; Veasey SC. Daytime sleepiness in obesity: mechanisms beyond obstructive sleep apnea—a review. SLEEP 2012;35(5):605-615. PMID:22547886
Adams, Robert J; Appleton, Sarah L; Vakulin, Andrew; Lang, Carol; Martin, Sean A; Taylor, Anne W; McEvoy, R Doug; Antic, Nick A; Catcheside, Peter G; Wittert, Gary A
To determine correlates of excessive daytime sleepiness (EDS) identified with the Epworth Sleepiness Scale (ESS) and a more broad definition, while accounting for obstructive sleep apnoea (OSA) in community dwelling men. Participants of the Men Androgens Inflammation Lifestyle Environment and Stress (MAILES) Study (n = 837, ≥ 40 years) without a prior OSA diagnosis, underwent in-home full unattended polysomnography (PSG, Embletta X100), completed the ESS, STOP questionnaire and Pittsburgh Sleep Quality Index in 2010-2011. In 2007-2010, questionnaires and biomedical assessment (in South Australian public hospital-based clinics) identified medical conditions. An alternate EDS definition (EDSAlt ) consisted of ≥ 2 of 3 problems (feeling sleepy sitting quietly; feeling tired/fatigued/sleepy; trouble staying awake). EDSAlt (30.4%, n = 253), but not ESS ≥ 11 (EDSESS , 12.6%, n = 104), increased significantly across OSA severity and body mass index categories. In adjusted analyses, EDSESS was significantly associated with depression: odds ratio (OR), 95%CI: 2.2 (1.3-3.8) and nocturia: 2.0 (1.3-3.2). EDSAlt was associated with depression, financial stress, relationship, work-life balance problems and associations with nocturia and diabetes were borderline. After excluding men with EDSESS , EDSAlt was associated with oxygen desaturation index (3%) ≥ 16 and the highest arousal index quartile but not with comorbidities. Sleepiness not necessarily leading to dozing, but not ESS ≥ 11, was related to sleep disordered breathing. Clinicians should be alert to (1) differing perspectives of sleepiness for investigation and treatment of OSA, and (2) the presence of depression and nocturia in men presenting with significant Epworth sleepiness regardless of the presence of OSA. © 2016 Asian Pacific Society of Respirology.
Robinson, Darve; Gelaye, Bizu; Tadesse, Mahlet G; Williams, Michelle A; Lemma, Seblewengel; Berhane, Yemane
To estimate the prevalence of daytime sleepiness and circadian preferences, and to examine the extent to which caffeine consumption and Khat (a herbal stimulant) use are associated with daytime sleepiness and evening chronotype among Ethiopian college students. A cross-sectional study was conducted among 2,410 college students. A self-administered questionnaire was used to collect information about sleep, behavioral risk factors such as caffeinated beverages, tobacco, alcohol, and Khat consumption. Daytime sleepiness and chronotype were assessed using the Epworth Sleepiness Scale (ESS) and the Horne & Ostberg Morningness /Eveningness Questionnaire (MEQ), respectively. Linear and logistic regression models were used to evaluate associations. Daytime sleepiness (ESS≥10) was present in 26% of the students (95% CI: 24.4-27.8%) with 25.9% in males and 25.5% in females. A total of 30 (0.8%) students were classified as evening chronotypes (0.7% in females and 0.9% in males). Overall, Overall, Khat consumption, excessive alcohol use and cigarette smoking status were associated with evening chronotype. Use of any caffeinated beverages (OR=2.18; 95%CI: 0.82-5.77) and Khat consumption (OR=7.43; 95%CI: 3.28-16.98) increased the odds of evening chronotype. The prevalence of daytime sleepiness among our study population was high while few were classified as evening chronotypes. We also found increased odds of evening chronotype with caffeine consumption and Khat use amongst Ethiopian college students. Prospective cohort studies that examine the effects of caffeinated beverages and Khat use on sleep disorders among young adults are needed.
Belísio, Aline S.; Kolodiuk, Fernanda F.; Louzada, Fernando M.; Valdez, Pablo; Azevedo, Carolina V. M.
Children tend to sleep and wake up early and to exhibit daytime sleep episodes. To evaluate the impact of school start times on sleepiness and attention in preschool children, this study compared the temporal patterns of sleep, daytime sleepiness, and the components of attention between children aged 4-6 years that study in the morning (n = 66)…
Machado-Duque, Manuel Enrique; Echeverri Chabur, Jorge Enrique; Machado-Alba, Jorge Enrique
Quality of sleep and excessive daytime sleepiness (EDS) affect cognitive ability and performance of medical students. This study attempts to determine the prevalence of EDS, sleep quality, and assess their association with poor academic performance in this population. A descriptive, observational study was conducted on a random sample of 217 medical students from the Universidad Tecnológica de Pereira, who completed the Pittsburgh Sleep Quality Index (PSQI) questionnaire and the Epworth sleepiness scale. Sociodemographic, clinic and academic variables were also measured. Multivariate analyses for poor academic performance were performed. The included students had a mean age of 21.7±3.3 years, of whom 59.4% were men. Almost half (49.8%) had EDS criteria, and 79.3% were poor sleepers (PSQI ≥ 5), while 43.3% had poor academic performance during the last semester. The bivariate analysis showed that having used tobacco or alcohol until intoxicated, fairly bad subjective sleep quality, sleep efficiency < 65%, and being a poor sleeper were associated with increased risk of low performance. Sleep efficiency < 65% was statistically associated with poor academic performance (P=.024; OR = 4.23; 95% CI, 1.12-15.42) in the multivariate analysis. A poor sleep quality determined by low efficiency was related to poor academic achievement at the end of semester in medical students. Copyright © 2015 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.
Barbanti, Piero; Aurilia, Cinzia; Egeo, Gabriella; Fofi, Luisa; Vanacore, Nicola
Excessive daytime sleepiness is a major clinical and health concern that can have varied and sometimes harmful consequences. Findings from uncontrolled studies suggest a high prevalence in patients with chronic migraine. In a case-control study, we compared frequency data for excessive daytime sleepiness in 100 patients with chronic migraine and 100 healthy controls paired for sex and age, and assessed risk factors including lifestyle, sleep quality, anxiety, depression, concomitant disease and medications. The frequency of excessive daytime sleepiness was higher in migraineurs (especially in those with medication overuse) than in controls (20% versus 6%; odds ratio 3.92, 95% CI 1.5-10.22), but was lower than previously reported and correlated with poor quality sleep and anxiolytic and antidepressant use. Again confirming that disability in chronic migraine is multifactorial in origin, excessive daytime sleepiness, especially in migraineurs who overuse medications, adds to the multiple factors known to impair social and working function. Patients with chronic migraine might benefit from diagnostic interviews focussing also on sleep problems and from targeted psychoactive drug prescribing. Copyright © 2012 Elsevier B.V. All rights reserved.
Tieleman, A.A.; Knoop, H.; Logt, A.E. van de; Bleijenberg, G.; Engelen, B.G.M. van; Overeem, S.
BACKGROUND: In myotonic dystrophy type 1 (DM1), sleep disorders are common, with excessive daytime sleepiness (EDS) as a predominant feature. In myotonic dystrophy type 2 (DM2), the presence of sleep disturbances is unknown. OBJECTIVE: To investigate the frequency of EDS, poor sleep quality and
Concepcion, Tessa; Barbosa, Clarita; Vélez, Juan Carlos; Pepper, Micah; Andrade, Asterio; Gelaye, Bizu; Yanez, David; Williams, Michelle A.
Objectives: To evaluate whether daytime sleepiness, poor sleep quality, and morningness and eveningness preferences are associated with common mental disorders (CMDs) among college students. Methods: A total of 963 college students completed self-administered questionnaires that collected information about sociodemographic characteristics, sleep…
Lopes, Johnnatas Mikael; Dantas, Fabio Galvao; Medeiros, Jovany Luis Alves de
To observe the relationship between Excessive Daytime Sleepiness (EDS) and the presence of risk factors for cardiovascular dysfunction, depression and obesity in the elderly. We interviewed 168 elderly from the community of Campina Grande, Paraíba. They were selected according to health districts in the period of 2010. We used the Epworth Sleepiness Scale to diagnose excessive daytime sleepiness (> 10 points); waist circumference for the risk of cardiovascular dysfunction (> 94 or > 80 cm); Geriatric Depression Scale for depression (>10 points) and body mass index for obesity (> 25 kg/m2). Association analysis was performed by the Chi-square test adjusted for sex and age group, adopting α obesity, in 95 (64.46%); and risk of cardiovascular dysfunction, in 129 (79.6%). Depressed men (78.6%, p = 0.0005) and risk of cardiovascular dysfunction (57.1%, p = 0.02) were more prone to EDS. In women, only obesity was related to sleepiness (42.1%, p = 0.01). Only those aged between 70 - 79 years old showed association between sleepiness and obesity. It was found that obesity for women, and depression and cardiovascular dysfunction risking for men were associated with EDS in the elderly. The variable sex is a confusion condition for the association with sleepiness.
Tran, Jason; Lertmaharit, Somrat; Lohsoonthorn, Vitool; Pensuksan, Wipawan C; Rattananupong, Thanapoom; Tadesse, Mahlet G; Gelaye, Bizu; Williams, Michelle A
We conducted this study to evaluate the prevalence of daytime sleepiness and evening chronotype, and to assess the extent to which both are associated with the use of caffeinated stimulants among 3,000 Thai college students. Demographic and behavioral characteristics were collected using a self-administered questionnaire. The Epworth Sleepiness Scale and the Horne and Ostberg Morningness-Eveningness Questionnaire were used to evaluate prevalence of daytime sleepiness and circadian preference. Multivariable logistic regression models were used to evaluate the association between sleep disorders and consumption of caffeinated beverages. Overall, the prevalence of daytime sleepiness was 27.9 % (95% CI: 26.2-29.5%) while the prevalence of evening chronotype was 13% (95% CI: 11.8-14.2%). Students who use energy drinks were more likely to be evening types. For instance, the use of M100/M150 energy drinks was associated with a more than 3-fold increased odds of evening chronotype (OR 3.50; 95% CI 1.90-6.44), while Red Bull users were more than twice as likely to have evening chronotype (OR 2.39; 95% CI 1.02-5.58). Additionally, those who consumed any energy drinks were more likely to be daytime sleepers. For example, Red Bull (OR 1.72; 95% CI 1.08-2.75) or M100/M150 (OR 1.52; 95% CI 1.10-2.11) consumption was associated with increased odds of daytime sleepiness. Our findings emphasize the importance of implementing educational and prevention programs targeted toward improving sleep hygiene and reducing the consumption of energy drinks among young adults.
Posnick, Jeffrey C; Adachie, Anayo; Singh, Neeru; Choi, Elbert
The purposes of this study were to determine the occurrence of undiagnosed "silent" obstructive sleep apnea (OSA) in dentofacial deformity (DFD) patients at initial surgical presentation and to report on the level of daytime sleepiness in DFD patients with OSA and chronic obstructive nasal breathing (CONB) after undergoing bimaxillary, chin, and intranasal surgery. A retrospective cohort study of patients with a bimaxillary DFD and CONB was implemented. Patients were divided into those with no OSA (group I) and those with OSA (group II). Group II was further subdivided into patients referred with polysomnogram (PSG)-confirmed OSA (group IIa) and those with a diagnosis of OSA only after surgical consultation, airway evaluation, and a positive PSG (group IIb). Group II patients were analyzed at a minimum of 1 year after surgery (range, 1 to 10 years) for daytime sleepiness with the Epworth Sleepiness Scale. Patients with postoperative excessive daytime sleepiness were assessed for risk factors and continued need for OSA treatment. Patients in group II were studied to determine which DFD patterns were most associated with OSA. We compared the prevalence of OSA between our study population and the general population. Two hundred sixty-two patients met the inclusion criteria. Of these, 23% (60 of 262) had PSG-confirmed OSA (group II). This rate was much higher than that found in the general population. Of the patients, 7% (19 of 262) were known to have OSA at initial surgical consultation (group IIa). An additional 16% (41 of 262) were later confirmed by PSG to have OSA (group IIb). Patients with primary mandibular deficiency and short face DFDs were most likely to have OSA (P surgery. A significant association was found between group II patients with postoperative excessive daytime sleepiness ("sleepy" or "very sleepy") and a preoperative body mass index category of overweight (P = .026). Our study found silent OSA to be frequent in the DFD population. The
Moreno Linares, Vicente; Diéguez Cantueso, Inmaculada; Lara Carmona, Juan José; Molina Recio, Guillermo
This study is aimed to analyze the factors that affect body composition, nutritional status, dietary habits, substance abuse (alcohol and smoking), physical activity, sleepiness disorders and self-rated health status in people working in nightlife in the city of Cordoba. Representative sample of 144 subjects (88 men and 56 women) with a mean age of 26.88 (± 4.7) years was studied. Individuals were analized for their body composition. Besides, a personal interview was used to administrate validated questionnaires to get other important data related to the aim of the study. The male group showed higher body mass index (p<0.05), showing overweight in more than half of the sample, and higher levels of body fat in 42% of subjects. Adherence to the Mediterranean diet was low and up to 48.6% presents a risk alcohol consumption, being higher in the male group. 40% of the subjects suffer from disorders of daytime sleepiness, however they spend a big amount of time in physical activities. The sample shows a high obesity and overweight prevalence and a low adherence to the mediterranean diet. Although they are not sedentary, the sample has unhealthy habits such as drinking alcohol and smoking and at the same time they suffer from sleepiness daytime disorders. In spite of they seems to have a high self-awareness about their own health status, 1 from every 5 individuals recognize that they could improve it. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.
Full Text Available Sleepiness is common after stroke, but in contrast to its importance for rehabilitation, existing studies focus primarily on the acute state and often use subjective sleepiness measures only. We used quantitative electroencephalography (qEEG to extract physiological sleepiness, as well as subjective reports, in response to motor-cognitive demand in stroke patients and controls. We hypothesised that (a slowing of the EEG is chronically sustained after stroke; (b increased power in lower frequencies and increased sleepiness are associated; and (c sleepiness is modulated by motor-cognitive demand. QEEGs were recorded in 32 chronic stroke patients and 20 controls using a Karolinska Drowsiness Test protocol administered before and after a motor priming task. Subjective sleepiness was measured using the Karolinska Sleepiness Scale. The findings showed that power density was significantly increased in delta and theta frequency bands over both hemispheres in patients which were not associated with subjective sleepiness ratings. This effect was not observed in controls. The motor priming task induced differential hemispheric effects with greater increase in low-frequency bands and presumably compensatory increases in higher frequency bands. The results indicate sustained slowing in the qEEG in chronic stroke, but in contrast to healthy controls, these changes are not related to perceived sleepiness.
Izumi, Satoshi; Hong, Guang; Iwasaki, Koh; Izumi, Masayuki; Matsuyama, Yusuke; Chiba, Mirei; Toda, Takashi; Kudo, Tada-Aki
The taste detection system for oral fatty acid may be related to obesity. In addition, sleep is intrinsically and closely related to food intake and metabolism. However, the association of gustatory salivation with body mass index (BMI), daytime sleepiness, or sleep habits is largely unknown. Therefore, we evaluated the relationship between gustatory salivation and BMI, Epworth sleepiness scale (ESS, a daytime sleepiness scale) or sleep habits among 26 healthy young individuals (20 males and 6 females; mean age: 26.0 ± 4.3 years). We also measured the saliva flow rate (SFR) that was induced by gum-chewing or each of three prototypical tastants (acetic acid, sucrose, and NaCl). Further, the SFR was induced by fatty acid, provided as oleic acid (OA) homogenized in non-fat milk. All participants showed normal rates of salivation during resting and gum-chewing states. The increase in the SFR induced by OA, but not by each of the three tastants, was associated with BMI. Moreover, both daytime sleepiness level and frequency of snoring were associated with the increase in the SFR induced by NaCl. These results suggest that BMI is associated with salivation induced by oral fatty acid exposure. Additionally, the regulatory mechanism for the NaCl-induced salivation reflex may have a relationship with impairments of the respiratory control system that are related to snoring during sleep and lead to daytime sleepiness because of insufficient sleep. Thus, measurement of gustatory salivation might contribute to the evaluation and prevention of obesity and sleep-related breathing disorders.
Ahmed S BaHammam
Full Text Available Background: Ramadan fasting and its associated lifestyle changes have been linked to changes in sleep and daytime sleepiness. This study was designed to assess the effects of Ramadan fasting on patterns of sleep and daytime sleepiness. Methods: The SenseWear Pro Armband™ was used to assess the duration and distribution of sleep in eight Muslim and eight non-Muslim volunteers during the last week of Shaaban [baseline (BL and the first (R1 and second (R2 weeks of Ramadan (1430 H]. OPTALERT™ was used to assess daytime drowsiness objectively using the John Drowsiness Scale (JDS to assess sleepiness, and a visual reaction time test was used to assess mean reaction time (MRT. Results: The mean ages of Muslims and non-Muslims were 36.25 ± 4.46 and 34.75 ± 3.33 years, respectively. Although the start of work was delayed for Muslims from 0730 to 1000 hours, there was no change in working hours for non-Muslims. During Ramadan, bedtime and wake-up time were delayed, and there was a significant reduction in total sleep time for Muslims (5.91 ± 1.36 hours, 4.95 ± 1.46 hours, and 4.78 ± 1.36 hours during BL, R1, and R2, respectively, P < 0.001, but not for non-Muslims. JDS values in both Muslims and non-Muslims were normal at BL (1.70 ± 1.16 and 1.68 ± 1.07, respectively, and no changes occurred during Ramadan (R1 or R2, indicating no increase in daytime sleepiness. There were no significant changes in MRT during R1 and R2 from BL in either group. Conclusion: Although the sleep cycle of the studied sample shifted during Ramadan among fast observers, there was no objective evidence for increased sleepiness during fasting.
Haregu, Alazar; Gelaye, Bizu; Pensuksan, Wipawan C; Lohsoonthorn, Vitool; Lertmaharit, Somrat; Rattananupong, Thanapoom; Tadesse, Mahlet G; Williams, Michelle A
To investigate the relationship between common psychiatric disorders (CPDs) and sleep characteristics (evening chronotype, poor sleep quality and daytime sleepiness) among Thai college students. A cross-sectional study was conducted among 2,970 undergraduate students in Thailand. Students were asked to complete a self-administered questionnaire that collected information about lifestyle and demographic characteristics. The Horne and Ostberg Morningness-Eveningness Questionnaire (MEQ), Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were used to evaluate circadian preference, sleep quality and daytime sleepiness, respectively. The General Health Questionnaire-12 (GHQ-12) was used to evaluate presence of CPDs. Logistic regression models were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) of CPDs in relation to the covariates of interest. A total of 337 students were classified as having CPDs (11.2%; 95% CI 10.1-12.3%). Evening chronotype (OR = 3.35; 95% CI 2.09-5.37), poor sleep quality (OR = 4.89; 95% CI 3.66-6.54) and excessive daytime sleepiness (OR = 1.95; 95% CI 1.54-2.47) were statistically significantly associated with CPDs. Our study demonstrated that CPDs are common among Thai college students. Further, evening chronotype, poor sleep quality and excessive daytime sleepiness were strongly associated with increased risk of CPDs. These findings highlight the importance of educating students and school administrators about the importance of sleep and their impact on mental health. Copyright © 2014 Wiley Publishing Asia Pty Ltd.
Ozder, Aclan; Eker, Hasan Huseyin
Sleep disorders can affect health and occupational performance of physicians as well as outcomes in patients. The purpose of this study was to assess the prevalence of excessive daytime sleepiness (EDS) measured by the Epworth Sleepiness Scale (ESS) among academic physicians at a tertiary academic medical center in an urban area in the northwest region of Turkey, and to establish a relationship between the self-perceived sleepiness and the quality of life using the EuroQol-5 dimensions (EQ-5D). A questionnaire prepared by the researchers after scanning the literature on the subject was e-mailed to the academic physicians of a tertiary academic medical center in Istanbul. The ESS and the EQ-5D were also included in the survey. The e-mail database of the institution directory was used to compile a list of active academic physicians who practiced clinical medicine. Paired and independent t tests were used for the data analysis at a significance level of p rate. There were 84 (33.3%) female and 168 (66.7%) male academic physicians participating in the study. One hundred and eight out of 252 (42.8%) academic physicians were taking night calls (p sleep and 84 (33.3%) reported napping daily (p 10) (p quality of life (p poor quality of life and daytime sleepiness. There was also a positive relationship between habitual napping and being sleepy during the day. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.
Sasazawa, Y.; Kawada, T.; Kiryu, Y.
This study was designed to assess the effects of daytime physical exercise on the quality of objective and subjective sleep by examining all-night sleep EEGs. The subjects were five male students, aged 19 to 20 years, who were in the habit of performing regular daytime exercise. The sleep polygraphic parameters in this study were sleep stage time as a percentage of total sleep time (%S1, %S2, %S(3+4), %SREM, %MT), time in bed (TIB), sleep time (ST), total sleep time (TST), sleep onset latency (SOL), waking from sleep, sleep efficiency, number of awakenings, number of stage shifts, number of spindles, and percentages of α and δ waves, all of which were determined by an automatic computer analysis system. The OSA questionnaire was used to investigate subjective sleep. The five scales of the OSA used were sleepiness, sleep maintenance, worry, integrated sleep feeling, and sleep initiation. Each sleep parameter was compared in the exercise and the non-exercise groups. Two-way analysis of variance was applied using subject factor and exercise factor. The main effect of the subject was significant in all parameters and the main effect of exercise in %S(3+4), SOL and sleep efficiency, among the objective sleep parameters. The main effects of the subject, except sleepiness, were significant, as was the main effect of exercise on sleep initiation, among the subjective sleep parameters. These findings suggest that daytime exercise shortened sleep latency and prolonged slow-wave sleep, and that the subjects fell asleep more easily on exercise days. There were also significant individual differences in both the objective and subjective sleep parameters.
Black, Jed; Duntley, Stephen P; Bogan, Richard K; O'Malley, Mary B
Excessive daytime sleepiness (EDS) is a prevalent complaint among patients in psychiatric care. Patients with conditions of EDS have often been misdiagnosed with depression due to their complaints of lack of energy, poor concentration, memory disturbance, and a reduced interest in life. Impaired alertness associated with EDS can be detrimental to a person's quality of life by causing decreased work performance, self-consciousness, low self esteem, and social isolation. Excessive sleepiness is also associated with various health problems, comorbid medical and psychiatric conditions, and fatal accidents occurring after the driver has fallen asleep at the wheel. Contributing factors leading to EDS range from insufficient sleep hours to central nervous system-mediated debilitating hypersomnolence. Circadian rhythm disorders, sleep disorders such as obstructive sleep apnea and narcolepsy, and medications that cause sleepiness may also contribute to symptoms of EDS. Recognition of the symptoms of sleep deprivation is essential, as many such patients do not have a clear awareness of their own sleepiness. Treatment options, depending upon the condition, include light therapy or appropriate airway management techniques such as nasal continuous positive airway pressure (CPAP). Occasionally, wakefulness-promoting medications are necessary, particularly in patients with narcolepsy. In this expert roundtable supplement, Stephen P. Duntley, MD, reviews the definition and prevalence of EDS and discusses the contributing factors and consequences of daytime sleepiness. Next, Richard K. Bogan, MD, FCCP, gives an overview of the differential diagnosis of EDS and the assessment tools available for identifying sleepiness in symptomatic patients. Finally, Mary B. O'Malley, MD, PhD, reviews treatment of EDS, including counseling on sleep hygiene and duration of sleep, mechanical treatments, bright-light therapy, and wake-promoting medications.
Johnnatas Mikael Lopes
Full Text Available OBJECTIVE: To observe the relationship between Excessive Daytime Sleepiness (EDS and the presence of risk factors for cardiovascular dysfunction, depression and obesity in the elderly. METHODS: We interviewed 168 elderly from the community of Campina Grande, Paraíba. They were selected according to health districts in the period of 2010. We used the Epworth Sleepiness Scale to diagnose excessive daytime sleepiness (> 10 points; waist circumference for the risk of cardiovascular dysfunction (> 94 or > 80 cm; Geriatric Depression Scale for depression (>10 points and body mass index for obesity (> 25 kg/m2. Association analysis was performed by the Chi-square test adjusted for sex and age group, adopting α < 0.05. RESULTS: One hundred and sixty eight elderly individuals with mean age of 72.34 ± 7.8 years old participated in this study, being 122 (72.6% women. EDS was identified in 53 (31.5% of them; depression, in 72 (42.9%; overweight/obesity, in 95 (64.46%; and risk of cardiovascular dysfunction, in 129 (79.6%. Depressed men (78.6%, p = 0.0005 and risk of cardiovascular dysfunction (57.1%, p = 0.02 were more prone to EDS. In women, only obesity was related to sleepiness (42.1%, p = 0.01. Only those aged between 70 - 79 years old showed association between sleepiness and obesity. CONCLUSION: It was found that obesity for women, and depression and cardiovascular dysfunction risking for men were associated with EDS in the elderly. The variable sex is a confusion condition for the association with sleepiness.
Concepcion, Tessa; Barbosa, Clarita; Vélez, Juan Carlos; Pepper, Micah; Andrade, Asterio; Gelaye, Bizu; Yanez, David; Williams, Michelle A
To evaluate whether daytime sleepiness, poor sleep quality, and morningness and eveningness preferences are associated with common mental disorders (CMDs) among college students. A total of 963 college students completed self-administered questionnaires that collected information about sociodemographic characteristics, sleep quality characteristics, CMDs, and other lifestyle behaviors. The prevalence of CMDs was 24.3% (95% confidence interval [CI] [21.5%, 27.1%]) among all students. Prevalence estimates of both excessive daytime sleepiness and poor sleep quality were higher among females (35.4% and 54.4%) than males (22.0% and 45.8%). Cigarette smoking was statistically significantly and positively associated with having CMDs (p = .034). Excessive daytime sleepiness (odds ratio [OR] = 3.65; 95% CI [2.56, 4.91]) and poor sleep quality (OR = 4.76; 95% CI [3.11, 7.29]) were associated with increased odds of CMDs. Given the adverse health consequences associated with both sleep disorders and CMDs, improving sleep hygiene among college students is imperative to public health.
Full Text Available While individuals with insomnia consistently complain of cognitive impairment, previous studies on the effect of insomnia on objective measures of cognitive function have obtained ambiguous results. The relationship between daytime sleepiness and cognitive manifestations in insomnia patients is not clear.Thirty-six primary insomnia patients (PIPs and 26 good sleep controls (GSCs with age and gender matched manner were included in the study. Participants underwent an overnight polysomnography followed by a multiple sleep latency test (MSLT and an examination of the attention network test (ANT. ANT reflected three attentional networks including alerting, orienting and executive control. According to whether accompanied with excessive daytime sleepiness (EDS, the insomnia group were subdivided into PIPs with EDS (n = 12, score on MSLT<10 min and PIPs without EDS (n = 24, score on MSLT≥10 min.PIPs only performed worse on executive control function than GSCs in ANT. PIPs with EDS had longer overall reaction time (RT related to PIPs without EDS. Further analyses with Pearson correlation analysis showed a significant negative correlation between the overall RT and MSLT latency in insomniacs (r = -0.444, p<0.01, whereas no such correlation was found in controls.Results suggest that PIPs do show executive control function deficits compared with GSCs. Daytime sleepiness in terms of MSLT latency was associated with poor cognitive manifestations in patients with insomnia.
Durán Agüero, Samuel; Arroyo Jofre, Patricio; Varas Standen, Camila; Herrera-Valenzuela, Tomas; Moya Cantillana, Cristobal; Pereira Robledo, Rodolfo; Valdés-Badilla, Pablo
the sleep takes part in diverse biological and physiological functions, associating his restriction, with minor performance in the sport, nevertheless the quantity and quality of sleep is not known in paralympic athletes. to determine the sleep quality, insomnia and excessive daytime sleepiness in Chilean paralympic athletes. descriptive transverse Study, the sample included 33 paralympic athletes (24.2% women), those who were practicing swimming, tennis of table, football 5, powerlifting and tennis chair. The studied variables measured up across two surveys of dream: the Questionnaire of Insomnia and the Pittsburgh Sleep Quality Index. the paralympic athletes sleep were 6.9 } 1.4 hours, 27.7% presents daytime sleepiness, 69.6 % insomnia (Survey of insomnia =7), whereas 78.7 % exhibits a bad sleep quality. The age showed a positive correlation with latency to the sleep (r=0.417 *), the insomnia with latency to the sleep (r=0.462 **), the Pittsburg score was correlated negatively by the sleep duration (r =-0.323) and latency to the sleep is correlated positively by the Pittsburgh score (r=0.603 **). the chilean paralympic athletes, present a low sleep quality, insomnia and excessive daytime sleepiness, situation that might influence negatively the sports performance. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.
Komada, Yoko; Adachi, Naomi; Matsuura, Noriko; Mizuno, Koh; Hirose, Kazuhiro; Aritomi, Ryoji; Shirakawa, Shuichiro
Longitudinal studies in Japan indicate that nocturnal sleep onset has become later and sleep duration has been progressively shortened. This study aimed to investigate the relationship between sleep patterns and sleep problems among children, and to determine the association between parents and their children's sleep habits. Questionnaires about sleep problems and life habits were administered to families living in Tokyo metropolitan areas of Japan. We analyzed the data of pre-school-age (1-5 years old; n = 319, including 175 girls) and elementary school-age children (6-11 years; n = 217, including 116 girls) as well as their parents (402 mothers: 37.0 +/- 4.9 years, 402 fathers: 39.0 +/- 5.9 years). Subjects were categorized as morning (evening) type when they answered their lifestyle habit as "definitely or moderately morning (evening) type". Sleep was categorized into regular, irregular, and intermediate from the sleeping-waking regularity scores. The frequency of daytime dozing is significantly high in children with evening-irregular sleep. Moreover, mothers of children (aged 1-5 and 6-11 years) with evening-irregular sleep have significantly more irregular sleep habits than those of children with morning-regular sleep. Likewise, fathers of children (aged 1-5 years) with evening-irregular sleep have significantly more irregular sleep habits. Thus, irregular late bedtime of parents is associated with sleep problems, daytime sleepiness, and irregular dietary habits of children. Mothers' sleep habits have a stronger influence on their children's sleep than fathers'. Our study indicates the importance of promoting sleep hygiene that encourages healthy sleep for all family members.
Lam, Erek M; Shepard, Paul W; St Louis, Erik K; Dueffert, Lucas G; Slocumb, Nancy; McCarter, Stuart J; Silber, Michael H; Boeve, Bradley F; Olson, Eric J; Somers, Virend K; Milone, Margherita
Although sleep disturbances are common in myotonic dystrophy type 1 (DM1), sleep disturbances in myotonic dystrophy type 2 (DM2) have not been well-characterized. We aimed to determine the frequency of sleep disturbances in DM2. We conducted a case-control study of 54 genetically confirmed DM2 subjects and 104 medical controls without DM1 or DM2, and surveyed common sleep disturbances, including symptoms of probable restless legs syndrome (RLS), excessive daytime sleepiness (EDS), sleep quality, fatigue, obstructive sleep apnea (OSA), probable REM sleep behavior disorder (pRBD), and pain. Thirty patients with DM2 and 43 controls responded to the survey. Group comparisons with parametric statistical tests and multiple linear and logistic regression analyses were conducted for the dependent variables of EDS and poor sleep quality. The mean ages of patients with DM2 and controls were 63.8 and 64.5 years, respectively. Significant sleep disturbances in patients with DM2 compared to controls included probable RLS (60.0% vs 14.0%, p DM2 diagnosis (p DM2, while OSA and pRBD symptoms are not. EDS was independently associated with DM2 diagnosis, suggesting possible primary CNS hypersomnia mechanisms. Further studies utilizing objective sleep measures are needed to better characterize sleep comorbidities in DM2.
Sobol, Danielle L; Spector, Andrew R
We discuss the use of levothyroxine for excessive daytime sleepiness (EDS) and prolonged nocturnal sleep time in a euthyroid patient with narcolepsy. After failure of first-line narcolepsy treatments, a 48-year-old female began levothyroxine (25 mcg/day). After 12 weeks of treatment, the patient was evaluated for improvement in total sleep time and subjective daytime sleepiness assessed by Epworth Sleepiness Scale (ESS). At baseline, ESS score was 16 and total sleep time averaged 16 h/day. After 12 weeks, ESS was 13 and reported total sleep time was 13 h/day. Levothyroxine improved EDS and total sleep time in a euthyroid patient with narcolepsy without cataplexy after 12 weeks without side effects. © 2014 American Academy of Sleep Medicine.
Ogeil, Rowan P; Phillips, James G; Rajaratnam, Shantha M W; Broadbear, Jillian H
Sleep problems are commonly reported following alcohol and cannabis abuse, but our understanding of sleep in non-clinical drug using populations is limited. The present study examined the sleep characteristics of alcohol and cannabis users recruited from the wider community. Two hundred forty-eight self-identified alcohol and/or cannabis users (131 women and 117 men) with a mean age of 26.41 years completed an online study that was advertised via online forums, print media and flyers. As part of the study, participants completed validated sleep scales assessing sleep quality (Pittsburgh Sleep Quality Index) and excessive daytime sleepiness (Epworth Sleepiness Scale) in addition to validated drug scales assessing alcohol (Alcohol Use Disorders Identification Test) and cannabis (Marijuana Screening Inventory) use. Problems with sleep quality were more commonly reported than were complaints of excessive daytime sleepiness. Clinically significant poor sleep quality was associated with comorbid problem alcohol and cannabis use. Women reporting problem alcohol and cannabis use had poorer sleep outcomes than men. Social drug users who report risky alcohol and cannabis use also report poor sleep. Poor sleep quality likely exacerbates any drug-associated problems in non-clinical populations. Copyright © 2015 John Wiley & Sons, Ltd.
Groeger, John A; Stanley, Neil; Deacon, Stephen; Dijk, Derk-Jan
To contrast the effects of slow wave sleep (SWS) disruption and age on daytime functioning. Daytime functioning was contrasted in three age cohorts, across two parallel 4-night randomized groups (baseline, two nights of SWS disruption or control, recovery sleep). Sleep research laboratory. 44 healthy young (20-30 y), 35 middle-aged (40-55 y), and 31 older (66-83 y) men and women. Acoustic stimulation contingent on appearance of slow waves. Cognitive performance was assessed before sleep latency tests at five daily time-points. SWS disruption resulted in less positive affect, slower or impaired information processing and sustained attention, less precise motor control, and erroneous implementation, rather than inhibition, of well-practiced actions. These performance impairments had far smaller effect sizes than the increase in daytime sleepiness and differed from baseline to the same extent for each age group. At baseline, younger participants performed better than older participants across many cognitive domains, with largest effects on executive function, response time, sustained attention, and motor control. At baseline, the young were sleepier than other age groups. SWS has been considered a potential mediator of age-related decline in performance, although the effects of SWS disruption on daytime functioning have not been quantified across different cognitive domains nor directly compared to age-related changes in performance. The data imply that two nights of SWS disruption primarily leads to an increase in sleepiness with minor effects on other aspects of daytime functioning, which are different from the substantial effects of age.
Li, Joule J; Appleton, Sarah L; Gill, Tiffany K; Vakulin, Andrew; Wittert, Gary A; Antic, Nick A; Taylor, Anne W; Adams, Robert J; Hill, Catherine L
To investigate the association of musculoskeletal pain with objectively determined obstructive sleep apnea (OSA) and subjective sleep measures in a population-based sample. Participants were community-dwelling men (n = 360) age ≥35 years from the Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) study. Shoulder, back, hip, knee, hand, and foot pain were assessed by computer-assisted telephone interview or self-completed questionnaire. OSA was determined with full in-home unattended polysomnography (Embletta X100) scored by 2007 American Academy of Sleep Medicine alternative criteria. The Epworth Sleepiness Scale assessed daytime sleepiness and the Pittsburgh Sleep Quality Index assessed sleep quality. OSA was not associated with the presence of any joint pain (adjusted odds ratio [OR] 1.03 [95% confidence interval (95% CI) 0.61-1.76]). There was no association between OSA and pain in any specific joint (shoulder, back, hip, knee, hand, or foot), nor was the number of joints in pain associated with OSA. There was, similarly, no association between pain variables and excessive daytime sleepiness, except for hand pain (OR 3.10 [95% CI 1.50-6.39]). However, pain was associated with poor sleep quality: any pain (OR 2.19 [95% CI 1.25-3.82]), shoulder pain (OR 2.16 [95% CI 1.25-3.75]), back pain (OR 2.24 [95% CI 1.41-3.55]), and foot pain (OR 2.47 [95% CI 1.43-4.26]). The number of painful joints was also associated with poor sleep quality (5-6 joints versus no joints OR 7.34 [95% CI 2.30-23.42]). No association between OSA and pain or between daytime sleepiness and pain was found. Consistent with previous reports, poor sleep quality was associated with musculoskeletal pain in this population sample. The etiologic differences between OSA-related sleep disruption and poor subjective sleep quality require further investigation. © 2016, American College of Rheumatology.
Fernandez-Mendoza, Julio; Vgontzas, Alexandros N.; Kritikou, Ilia; Calhoun, Susan L.; Liao, Duanping; Bixler, Edward O.
Study Objectives: Excessive daytime sleepiness (EDS) is highly prevalent in the general population and is associated with occupational and public safety hazards. However, no study has examined the clinical and polysomnographic (PSG) predictors of the natural history of EDS. Design: Representative longitudinal study. Setting: Sleep laboratory. Participants: From a random, general population sample of 1,741 individuals of the Penn State Adult Cohort, 1,395 were followed up after 7.5 years. Measurements and Results: Full medical evaluation and 1-night PSG at baseline and standardized telephone interview at follow-up. The incidence of EDS was 8.2%, while its persistence and remission were 38% and 62%, respectively. Obesity and weight gain were associated with the incidence and persistence of EDS, while weight loss was associated with its remission. Significant interactions between depression and PSG parameters on incident EDS showed that, in depressed individuals, incident EDS was associated with sleep disturbances, while in non-depressed individuals, incident EDS was associated with increased physiologic sleep propensity. Diabetes, allergy/asthma, anemia, and sleep complaints also predicted the natural history of EDS. Conclusions: Obesity, a disorder of epidemic proportions, is a major risk factor for the incidence and chronicity of excessive daytime sleepiness (EDS), while weight loss is associated with its remission. Interestingly, objective sleep disturbances predict incident EDS in depressed individuals, whereas physiologic sleep propensity predicts incident EDS in those without depression. Weight management and treatment of depression and sleep disorders should be part of public health policies. Citation: Fernandez-Mendoza J, Vgontzas AN, Kritikou I, Calhoun SL, Liao D, Bixler EO. Natural history of excessive daytime sleepiness: role of obesity, weight loss, depression, and sleep propensity. SLEEP 2015;38(3):351–360. PMID:25581913
Rodrigues, Tiago Martins; Castro Caldas, Ana; Ferreira, Joaquim J
Daytime sleepiness and sleep disorders are frequently reported in Parkinson's disease (PD). However, their impact on quality of life has been underestimated and few clinical trials have been performed. We aimed to assess the efficacy and safety of pharmacological interventions for daytime sleepiness and sleep disorders in PD. Systematic review of randomized controlled trials comparing any pharmacological intervention with no intervention or placebo for the treatment of daytime sleepiness and sleep problems in PD patients. Ten studies (n = 338 patients) were included. Four trials addressed interventions for excessive daytime sleepiness. Meta-analysis of the three trials evaluating modafinil showed a significant reduction in sleepiness, as assessed by the Epworth Sleepiness Scale (ESS) (- 2.24 points, 95% CI - 3.90 to - 0.57, p sleep Behaviour Disorder (RBD). Single study results suggest that doxepin and YXQN granules might be efficacious, while pergolide may be deleterious for insomnia and that rivastigmine may be used to treat RBD in PD patients. However, there is insufficient evidence to support or refute the efficacy of any of these interventions. No relevant side effects were reported. Whilst providing recommendations, this systematic review depicts the lack of a body of evidence regarding the treatment of sleep disorders in PD patients; hence, further studies are warranted. Copyright © 2016 Elsevier Ltd. All rights reserved.
Langberg, Joshua M; Dvorsky, Melissa R; Marshall, Stephen; Evans, Steven W
This study investigated the relative impact of total time slept per night and daytime sleepiness on the academic functioning of 100 middle school-aged youth (mean age = 11.9) with attention deficit hyperactivity disorder (ADHD). The primary goal of the study was to determine if total time slept per night and/or daytime sleepiness, as measured by youth self-report on the Pediatric Daytime Sleepiness Scale (PDSS), predicted academic functioning above and beyond symptoms of ADHD and relevant covariates, such as intelligence, achievement scores and parent education level. Self-reported daytime sleepiness but not self-reported total time slept per night was associated significantly with all academic outcomes. When examined in a hierarchical regression model, self-reported daytime sleepiness significantly predicted parent-rated homework problems and academic impairment and teacher-rated academic competence above and beyond symptoms of ADHD and relevant covariates, but did not predict grade point average or teacher-rated academic impairment. The implications of these findings for understanding more clearly the association between ADHD and sleep and the functional implications of this relationship are discussed. © 2013 European Sleep Research Society.
Hermann L. Müller
Full Text Available Childhood craniopharyngiomas are rare embryogenic malformations of the sellar region, presumably derived from Rathke cleft epithelium. The overall survival rates after neurosurgical intervention and/or irradiation are high (92%. However, the quality of survival is frequently impaired due to endocrine deficiencies, sleep disturbances, daytime sleepiness, and severe obesity caused by hypothalamic lesions. Based on self-assessment using nutritional diaries, caloric intake was similar in patients and BMI-matched controls. Analyses of physical activity by accelerometric measurements showed a markedly lower level of physical activity. Significant daytime sleepiness and disturbances of circadian rhythms have been demonstrated in obese childhood craniopharyngioma patients. Daytime sleepiness and obesity in these patients were both correlated with low nocturnal and early morning melatonin levels. Polysomnographic studies in patients with severe daytime sleepiness revealed sleeping patterns typical for secondary narcolepsy. Reports on a beneficial effect of treatment with central stimulating agents supported the hypothesis that secondary narcolepsy should be considered as a rare cause for severe daytime sleepiness in patients with childhood craniopharyngioma.
Wilsmore, Bradley R; Grunstein, Ronald R; Fransen, Marlene; Woodward, Mark; Norton, Robyn; Ameratunga, Shanthi
To determine the relationship between sleep complaints, primary insomnia, excessive daytime sleepiness, and lifestyle factors in a large community-based sample. Cross-sectional study. Blood donor sites in New Zealand. 22,389 individuals aged 16-84 years volunteering to donate blood. N/A. A comprehensive self-administered questionnaire including personal demographics and validated questions assessing sleep disorders (snoring, apnea), sleep complaints (sleep quantity, sleep dissatisfaction), insomnia symptoms, excessive daytime sleepiness, mood, and lifestyle factors such as work patterns, smoking, alcohol, and illicit substance use. Additionally, direct measurements of height and weight were obtained. One in three participants report healthy sample) was associated with insomnia (odds ratio [OR] 1.75, 95% confidence interval [CI] 1.50 to 2.05), depression (OR 2.01, CI 1.74 to 2.32), and sleep disordered breathing (OR 1.92, CI 1.59 to 2.32). Long work hours, alcohol dependence, and rotating work shifts also increase the risk of daytime sleepiness. Even in this relatively young, healthy, non-clinical sample, sleep complaints and primary insomnia with subsequent excess daytime sleepiness were common. There were clear associations between many personal and lifestyle factors-such as depression, long work hours, alcohol dependence, and rotating shift work-and sleep problems or excessive daytime sleepiness.
Forogh, Bijan; Rafiei, Maryam; Arbabi, Amin; Motamed, Mohammad Reza; Madani, Seyed Pezhman; Sajadi, Simin
Parkinson is a common and disabling disease that affects patient's and career's quality of life. Unfortunately, medications, such as dopaminergic and sedative-hypnotic drugs, as an effective treatment have unwilling side effects. Recently, Transcranial Direct Current Stimulation (tDCS) in conjunction with medication becomes popular as a complementary safe treatment and several studies have proved its effectiveness on controlling motor and specially non-motor aspects of Parkinson's disease. In this randomized double-blind parallel study, 23 patients with Parkinson's disease divided into two groups of real tDCS plus occupational therapy and sham tDCS plus occupational therapy and the effects of therapeutic sessions (eight sessions tDCS with 0.06 mA/cm(2) current, 20 min on dorsolateral prefrontal cortex) were evaluated on fatigue and daytime sleepiness just after therapeutic course and in 3-month follow-up. tDCS had a significant effect on fatigue and no effect on daytime sleepiness reduction in patients with Parkinson's disease. tDCS is an effective and safe complementary treatment on fatigue reduction in Parkinson's disease.
Full Text Available Farid R Talih,1 Jean J Ajaltouni,1 Hani M Tamim,2 Firas H Kobeissy3 1Department of Psychiatry, 2Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; 3Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon Objectives: This study evaluated the risk of developing obstructive sleep apnea (OSA and excessive daytime sleepiness (EDS in hospitalized psychiatric patients at the American University of Beirut Medical Center (AUB-MC. Factors associated with OSA and EDS occurrence in this sample were also examined. Methods: The Berlin questionnaire and the Epworth sleepiness scale; which respectively evaluate OSA and EDS symptoms, were administered to individuals hospitalized at an acute psychiatric treatment unit at the AUB-MC between the dates of January 2014 and October 2016. Additional data collected included general demographics, psychiatric diagnoses, and questionnaires evaluating depression and anxiety symptoms. Statistical analyses utilizing SPSS were performed to determine the prevalence of OSA and EDS, as well as their respective associations with patient profiles. Results: Our results showed that 39.5% of participants were found to have a high risk of sleep apnea and 9.9% of the participants were found to have abnormal daytime sleepiness. The risk of developing OSA was associated with a higher body mass index (BMI (P=0.02, and depression severity (patient health questionnaire 9 score (P=0.01. Increasing severity of depressive symptoms was associated with a higher risk of sleep apnea (P=0.01. BMI (odds ratio [OR] =5.97, 95% confidence interval [CI] 1.89–18.82 and depression severity (OR =4.04, 95% CI 1.80–9.07 were also found to be predictors of OSA. The psychiatric diagnoses of the participants were not found to have a significant association with the risk of sleep apnea. Conclusion: The risk of OSA is increased among hospitalized
Brandão, Glauber Sá; Gomes, Glaucia Sá Brandão Freitas; Brandão, Glaudson Sá; Callou Sampaio, Antônia A; Donner, Claudio F; Oliveira, Luis V F; Camelier, Aquiles Assunção
Aging causes physiological changes which affect the quality of sleep. Supervised physical exercise is an important therapeutic resource to improve the sleep of the elderlies, however there is a low adherence to those type of programs, so it is necessary to implement an exercise program which is feasible and effective. The study aimed to test the hypothesis that a semi-supervised home exercise program, improves sleep quality and daytime sleepiness of elderlies of the community who present poor sleep quality. This was a randomized controlled trial study, conducted from May to September 2017, in Northeastern Brazil, with elderlies of the community aging 60 years old or older, sedentary, with lower scores or equal to 5 at the Pittsburgh Sleep Quality Index (PSQI) and without cognitive decline. From one hundred ninety-one potential participants twenty-eight refused to participate, therefore, one hundred thirty-one (mean age 68 ± 7 years), and 88% female, were randomly assigned to an intervention group - IG (home exercise and sleep hygiene, n = 65) and a control group - CG (sleep hygiene only, n = 66). Sleep assessment tools were used: PSQI, Epworth sleepiness scale (ESS) and clinical questionnaire of Berlin. The level of physical activity has been assessed by means of International Physical Activity Questionnaire adapted for the elderly (IPAQ) and Mini-Mental State Examination for cognitive decline. All participants were assessed before and after the 12-week intervention period and, also, the assessors were blind. The IG showed significant improvement in quality of sleep with a mean reduction of 4.9 ± 2.7 points in the overall PSQI (p exercise is effective in improving the quality of sleep and self-referred daytime sleepiness of sedentary elderlies of the community who presented sleep disorders. Ensaiosclinicos.gov.br process number: RBR-3cqzfy.
Marklund, Marie; Carlberg, Bo; Forsgren, Lars; Olsson, Tommy; Stenlund, Hans; Franklin, Karl A
Oral appliances that move the mandible forward during sleep are suggested as treatment for mild to moderate obstructive sleep apnea. To test whether an adjustable, custom-made oral appliance improves daytime sleepiness and quality of life in patients with daytime sleepiness and snoring or mild to moderate obstructive sleep apnea. Ninety-six patients with daytime sleepiness and an apnea-hypopnea index (AHI) lower than 30 were included in a randomized, placebo-controlled, parallel trial in Umeå, Sweden, from May 2007 through August 2011. Four months' intervention with an oral appliance or a placebo device. Daytime sleepiness was measured with the Epworth Sleepiness Scale, the Karolinska Sleepiness Scale, and the Oxford Sleep Resistance (OSLER) test. Quality of life was assessed with the Short-Form 36-Item Health Survey (SF-36) and the Functional Outcomes of Sleep Questionnaire (FOSQ). Secondary outcomes included the apnea-hypopnea index, headaches, symptoms of restless legs, and insomnia. Oral appliance therapy was not associated with improvements in daytime sleepiness from baseline to 4-month follow-up when compared with the placebo device; Epworth score >10: 53% at baseline to 24% at follow-up for the oral appliance group vs 54% at baseline to 40% at follow-up for the placebo device group, P = .11; median (IQR) for Karolinska score ≥7/wk: 10 (8 to 14) at baseline to 7 (4 to 9) at follow-up for the oral appliance group vs 12 (6 to 15) at baseline to 8 (5 to 12) at follow-up for the placebo device group, P = .11; mean between-group difference in OSLER test, -2.4 min (95% CI, -6.3 to 1.4). The mean between-group difference for the total FOSQ score was insignificant (-1.2 [95% CI, -2.5 to 0.1]). No domain of the SF-36 differed significantly between the groups. The AHI was below 5 in 49% of patients using the active appliance and in 11% using placebo, with an odds ratio of 7.8 (95% CI, 2.6-23.5) and a number needed to treat of 3. Snoring (P oral appliance
Thompson, Alison; Sardana, Niti; Craig, Timothy J
To investigate the association of rhinitis with stress, fatigue, decrease productivity, inflammation, and sleep disordered breathing. Medical literature obtained from OVID and PubMed searches in February 2013 using the search terms "sleep," "rhinitis," "allergic rhinitis," "somnolence," and "fatigue". Studies were selected based on the US Preventive Services Task Force levels 1, 2, and 3. Allergic rhinitis is a disease that severely affects patients' quality of life and is increasing in prevalence worldwide. Nasal congestion is reported as the most common and bothersome symptom; it is often associated with sleep-disordered breathing, a likely cause of sleep impairment in rhinitis-affected individuals. The end result is a reduced quality of life and productivity and an increase in daytime sleepiness, fatigue, and stress. Current treatment modalities include intranasal corticosteroids, which have been found to reduce nasal congestion. Clinical trials on intranasal corticosteroids have provided data on sleep-related end points, and these studies report that the improved nasal congestion is associated with improved quality of life with better sleep and reduced daytime fatigue. Alternate therapies, including montelukast, also decrease nasal congestion and positively influence sleep, but to a lesser extent. This review examines nasal congestion and cytokine changes and the associated sleep impairment in allergic rhinitis patients and the effect on daytime performance. It elaborates the adverse effects of disturbed sleep on quality of life and how therapies directed at reducing nasal congestion can relieve such effects. Copyright © 2013 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
Pejovic, Slobodanka; Basta, Maria; Vgontzas, Alexandros N; Kritikou, Ilia; Shaffer, Michele L; Tsaoussoglou, Marina; Stiffler, David; Stefanakis, Zacharias; Bixler, Edward O; Chrousos, George P
One workweek of mild sleep restriction adversely impacts sleepiness, performance, and proinflammatory cytokines. Many individuals try to overcome these adverse effects by extending their sleep on weekends. To assess whether extended recovery sleep reverses the effects of mild sleep restriction on sleepiness/alertness, inflammation, and stress hormones, 30 healthy young men and women (mean age ± SD, 24.7 ± 3.5 yr; mean body mass index ± SD, 23.6 ± 2.4 kg/m(2)) participated in a sleep laboratory experiment of 13 nights [4 baseline nights (8 h/night), followed by 6 sleep restriction nights (6 h/night) and 3 recovery nights (10 h/night)]. Twenty-four-hour profiles of circulating IL-6 and cortisol, objective and subjective daytime sleepiness (Multiple Sleep Latency Test and Stanford Sleepiness Scale), and performance (Psychomotor Vigilance Task) were assessed on days 4 (baseline), 10 (after 1 wk of sleep restriction), and 13 (after 2 nights of recovery sleep). Serial 24-h IL-6 plasma levels increased significantly during sleep restriction and returned to baseline after recovery sleep. Serial 24-h cortisol levels during restriction did not change compared with baseline, but after recovery they were significantly lower. Subjective and objective sleepiness increased significantly after restriction and returned to baseline after recovery. In contrast, performance deteriorated significantly after restriction and did not improve after recovery. Extended recovery sleep over the weekend reverses the impact of one work week of mild sleep restriction on daytime sleepiness, fatigue, and IL-6 levels, reduces cortisol levels, but does not correct performance deficits. The long-term effects of a repeated sleep restriction/sleep recovery weekly cycle in humans remain unknown.
Seon kyeong Rhie
Full Text Available Purpose: Korean adolescents have severe nighttime sleep deprivation and daytime sleepiness because of their competitive educational environment. However, daytime sleep patterns and sleepiness have never been studied using age-specific methods, such as the pediatric daytime sleepiness scale (PDSS. We surveyed the daytime sleepiness of Korean adolescents using a Korean translation of the PDSS. Methods: We distributed the 27-item questionnaire, including the PDSS and questions related to sleep pattern, sleep satisfaction, and emotional state, to 3,370 students in grades 5-12. Results: The amount of nighttime sleep decreased significantly with increasing age. During weekday nights, 5- 6th graders slept for 7.95¡?#?.05; h, 7-9th graders for 7.57¡?#?.05; h, and 10-12th graders for 5.78¡?#?.13; h. However, the total amounts of combined daytime and nighttime sleep during weekdays were somewhat greater, 8.15¡?#?.12; h for 5- 6th graders, 8.17¡?#?.20; h for 7-9th graders, and 6.87¡?#?.40; h for 10-12th graders. PDSS scores increased with age, 11.89¡?#?.56; for 5- 6th graders, 16.57¡?#?.57; for 7-9th graders, and 17.71¡?#?.24; for 10-12th graders. Higher PDSS scores were positively correlated with poor school performance and emotional instability. Conclusion: Korean teenagers sleep to an unusual extent during the day because of nighttime sleep deprivation. This negatively affects school performance and emotional stability. A Korean translation of the PDSS was effective in evaluating the severity of daytime sleepiness and assessing the emotional state and school performance of Korean teenagers.
Rhie, Seonkyeong; Lee, Sihyoung; Chae, Kyu Young
Korean adolescents have severe nighttime sleep deprivation and daytime sleepiness because of their competitive educational environment. However, daytime sleep patterns and sleepiness have never been studied using age-specific methods, such as the pediatric daytime sleepiness scale (PDSS). We surveyed the daytime sleepiness of Korean adolescents using a Korean translation of the PDSS. We distributed the 27-item questionnaire, including the PDSS and questions related to sleep pattern, sleep satisfaction, and emotional state, to 3,370 students in grades 5-12. The amount of nighttime sleep decreased significantly with increasing age. During weekday nights, 5-6(th) graders slept for 7.95±1.05 h, 7-9(th) graders for 7.57±1.05 h, and 10-12(th) graders for 5.78±1.13 h. However, the total amounts of combined daytime and nighttime sleep during weekdays were somewhat greater, 8.15±1.12 h for 5-6(th) graders, 8.17±1.20 h for 7-9(th) graders, and 6.87±1.40 h for 10-12(th) graders. PDSS scores increased with age, 11.89±5.56 for 5-6(th) graders, 16.57±5.57 for 7-9(th) graders, and 17.71±5.24 for 10-12(th) graders. Higher PDSS scores were positively correlated with poor school performance and emotional instability. Korean teenagers sleep to an unusual extent during the day because of nighttime sleep deprivation. This negatively affects school performance and emotional stability. A Korean translation of the PDSS was effective in evaluating the severity of daytime sleepiness and assessing the emotional state and school performance of Korean teenagers.
Ahmed S BaHammam
Full Text Available Background: Muslims are required to wake up early to pray (Fajr at dawn (approximately one and one-half hours before sunrise. Some Muslims wake up to pray Fajr and then sleep until it is time to work (split sleep, whereas others sleep continuously (consolidated sleep until work time and pray Fajr upon awakening. Aim: To objectively assess sleep architecture and daytime sleepiness in consolidated and split sleep due to the Fajr prayer. Setting and Design: A cross-sectional, single-center observational study in eight healthy male subjects with a mean age of 32.0 ± 2.4 years. Methods: The participants spent three nights in the Sleep Disorders Center (SDC at King Khalid University Hospital, where they participated in the study, which included (1 a medical checkup and an adaptation night, (2 a consolidated sleep night, and (3 a split-sleep night. Polysomnography (PSG was conducted in the SDC following the standard protocol. Participants went to bed at 11:30 PM and woke up at 7:00 AM in the consolidated sleep protocol. In the split-sleep protocol, participants went to bed at 11:30 PM, woke up at 3:30 AM for 45 minutes, went back to bed at 4:15 AM, and finally woke up at 7:45 AM. PSG was followed by a multiple sleep latency test to assess the daytime sleepiness of the participants. Results: There were no differences in sleep efficiency, the distribution of sleep stages, or daytime sleepiness between the two protocols. Conclusion: No differences were detected in sleep architecture or daytime sleepiness in the consolidated and split-sleep schedules when the total sleep duration was maintained.
Freitas, Ângela M; Portuguez, Mirna Wetters; Russomano, Thaís; Freitas, Marcos de; Silvello, Silvio Luis da Silva; Costa, Jaderson Costa da
To evaluate symptoms of stress and excessive daytime sleepiness (EDS) in air traffic control (ATC) officers in Brazil. Fifty-two ATC officers participated, based at three air traffic control units, identified as A, B and C. Stress symptoms were assessed using the Lipp Inventory of Stress Symptoms for Adults, and EDS by the Epworth Sleepiness Scale. The sample mean age was 37 years, 76.9% of whom were male. Excessive daytime sleepiness was identified in 25% of the ATC officers, with 84.6% of these based at air traffic control unit A, which has greater air traffic flow, operating a 24-hour alternating work shift schedule. A total of 16% of the ATC officers had stress symptoms, and of these, 62% showed a predominance of physical symptoms. The high percentage of ATC officers with EDS identified in group A may be related to chronodisruption due to night work and alternating shifts.
Videnovic, Aleksandar; Klerman, Elizabeth B; Wang, Wei; Marconi, Angelica; Kuhta, Teresa; Zee, Phyllis C
Impaired sleep and alertness are some of the most common nonmotor manifestations of Parkinson disease (PD) and currently have only limited treatment options. Light therapy (LT), a widely available treatment modality in sleep medicine, has not been systematically studied in the PD population. To determine the safety and efficacy of LT on excessive daytime sleepiness (EDS) associated with PD. This randomized, placebo-controlled, clinical intervention study was set in PD centers at Northwestern University and Rush University. Participants were 31 patients with PD receiving stable dopaminergic therapy with coexistent EDS, as assessed by an Epworth Sleepiness Scale score of 12 or greater, and without cognitive impairment or primary sleep disorder. Participants were randomized 1:1 to receive bright LT or dim-red LT (controlled condition) twice daily in 1-hour intervals for 14 days. This trial was conducted between March 1, 2007, and October 31, 2012. Data analysis of the intention-to-treat population was conducted from November 1, 2012, through April 30, 2016. The primary outcome measure was the change in the Epworth Sleepiness Scale score comparing the bright LT with the dim-red LT. Secondary outcome measures included the Pittsburgh Sleep Quality Index score, the Parkinson's Disease Sleep Scale score, the visual analog scale score for daytime sleepiness, and sleep log-derived and actigraphy-derived metrics. Among the 31 patients (13 males and 18 females; mean [SD] disease duration, 5.9 [3.6] years), bright LT resulted in significant improvements in EDS, as assessed by the Epworth Sleepiness Scale score (mean [SD], 15.81 [3.10] at baseline vs 11.19 [3.31] after the intervention). Both bright LT and dim-red LT were associated with improvements in sleep quality as captured by mean (SD) scores on the Pittsburg Sleep Quality Index (7.88 [4.11] at baseline vs 6.25 [4.27] after bright LT, and 8.87 [2.83] at baseline vs 7.33 [3.52] after dim-red LT) and the Parkinson's Disease
Zhou, Junying; Zhang, Jihui; Lam, Siu Ping; Chan, Joey Wy; Mok, Vincent; Chan, Anne; Li, Shirley Xin; Liu, Yaping; Tang, Xiangdong; Yung, Wing Ho; Wing, Yun Kwok
To determine the association of excessive daytime sleepiness (EDS) with the conversion of neurodegenerative diseases in patients with idiopathic REM sleep behavior disorder (iRBD). A total of 179 patients with iRBD (79.1% males, mean age = 66.3 ± 9.8 years) were consecutively recruited. Forty-five patients with Epworth Sleepiness Scale score ≥14 were defined as having EDS. Demographic, clinical, and polysomnographic data were compared between iRBD patients with and without EDS. The risk of developing neurodegenerative diseases was examined using Cox proportional hazards model. After a mean follow-up of 5.8 years (SD = 4.3 years), 50 (27.9%) patients developed neurodegenerative diseases. There was a significantly higher proportion of conversion in patients with EDS compared to those without EDS (42.2 % vs. 23.1%, p = .01). EDS significantly predicted an increased risk of developing neurodegenerative diseases (adjusted hazard ratios [HR] = 2.56, 95% confidence interval [CI] 1.37 to 4.77) after adjusting for age, sex, body mass index, current depression, obstructive sleep apnea, and periodic limb movements during sleep. Further analyses demonstrated that EDS predicted the conversion of Parkinson's disease (PD) (adjusted HR = 3.55, 95% CI 1.59 to 7.89) but not dementia (adjusted HR = 1.48, 95% CI 0.44 to 4.97). EDS is associated with an increased risk of developing neurodegenerative diseases, especially PD, in patients with iRBD. Our findings suggest that EDS is a potential clinical biomarker of α-synucleinopathies in iRBD.
Kim, Jiyoung; Cho, Soo-Jin; Kim, Won-Joo; Yang, Kwang Ik; Yun, Chang-Ho; Chu, Min Kyung
Previous studies have shown that migraine and sleep disturbances are closely associated. Excessive daytime sleepiness (EDS) is a common symptom of various types of sleep disturbance. Findings from clinic-based studies suggest that a high percentage of migraineurs experience EDS. However, the prevalence and clinical impact of EDS among migraineurs at the population level have rarely been reported. The objective of this study was to investigate the prevalence and impact of EDS among migraineurs using a population-based sample in Korea. We selected a stratified random sample of Koreans aged 19 to 69 years and evaluated them using a semi-structured interview designed to identify EDS, headache type, and the clinical characteristics of migraine. If the score on the Epworth Sleepiness Scale (ESS) was more than or equal to 11, the participant was classified as having EDS. Of the 2,695 participants that completed the interview, 143 (5.3 %) and 313 (11.6 %) were classified as having migraine and EDS, respectively. The prevalence of EDS was significantly higher in participants with migraine (19.6 %) and non-migraine headache (13.4 %) compared to non-headache controls (9.4 %). Migraineurs with EDS had higher scores on the Visual Analogue Scale (VAS) for headache intensity (6.9 ± 1.8 vs. 6.0 ± 1.9, p = 0.014) and Headache Impact Test-6 (59.8 ± 10.2 vs. 52.5 ± 8.2, p migraine symptoms.
Huang, Chiu-Mieh; Carter, Patricia A; Guo, Jong-Long
Taiwanese mothers have identified insufficient sleep as a major manifestation of postpartum depression. Few studies have thoroughly examined the relationship between sleep and depression during the early postpartum period, however. The objectives of this study were to compare the characteristics of both the postpartum sleep and daytime sleepiness of depressed first-time mothers and of their non-depressed counterparts, and to determine the factors that significantly increased mothers' risks of being depressed. A non-probability sample of 163 first-time mothers completed a questionnaire between the 13th and 20th days of the postpartum period. The Center of Epidemiological Studies- Depression and Pittsburgh Sleep Quality Index were used to measure mothers' experiences of depression symptoms and sleep. Daytime sleepiness was estimated in four ways, derived from the Roy Adaptation Model. The results indicated that the depressed mothers had poorer sleep quality than the non-depressed mothers, slept less efficiently, reported more sleep disturbances, and exhibited more daytime dysfunctions. Mothers who frequently perceived their daytime sleepiness to be affected by infant-care performance were more likely to be depressed. The study' s findings support the view that there is a connection between depression and poor sleep among postpartum mothers in Taiwan, and indicate that depressed mothers' experiences of poor sleep are multi-faceted, and not simply a matter of insufficient sleep.
Nathan, Nila; Zeitzer, Jamie
Background Mobile phone use is near ubiquitous in teenagers. Paralleling the rise in mobile phone use is an equally rapid decline in the amount of time teenagers are spending asleep at night. Prior research indicates that there might be a relationship between daytime sleepiness and nocturnal mobile phone use in teenagers in a variety of countries. As such, the aim of this study was to see if there was an association between mobile phone use, especially at night, and sleepiness in a group of U...
Amie C Hayley
Full Text Available BACKGROUND: Excessive daytime sleepiness (EDS is often associated with increased adiposity, particularly when assessed in the context of samples of sleep-disordered patients; however, it is unclear if this relationship is sustained among non-clinical, population-based cohorts. This study aimed to investigate the relationship between EDS and a number of body composition markers among a population-based sample of men and women. METHODS: This study assessed 1066 women aged 21-94 yr (median = 51 yr, IQR 35-66, and 911 men aged 24-92 yr (median = 60 yr, IQR 46-73 who participated in the Geelong Osteoporosis Study (GOS between the years 2001 and 2008. Total body fat mass was determined from whole body dual-energy X-ray absorptiometry scans, and anthropometric parameters (weight, height, and waist circumference were measured. Lifestyle and health information was collected via self-report. Sleepiness was assessed using the Epworth Sleepiness Scale (ESS. Scores of ≥ 10 were considered indicative of EDS. RESULTS: Women: After adjusting for age, alcohol intake, antidepressant medication use and physical activity, EDS was associated with greater waist circumference and body mass index (BMI. EDS was also associated with 1.5-1.6-fold increased odds of being overweight or obese. Men: After adjusting for age, alcohol use, physical activity and smoking status, EDS was associated with greater BMI. These findings were not explained by the use of sedative or antidepressant medication. EDS was also associated with 1.5-fold increased likelihood of being obese, independent of these factors. No differences in lean mass, %body fat, or %lean mass were detected between those with and without EDS for men or women. CONCLUSIONS: These data suggest that EDS is associated with several anthropometric adiposity profiles, independent of associated lifestyle and health factors. Among women, symptoms of EDS are pervasive at both overweight and obese BMI classifications
Felden, Érico P G; Carniel, Joana D; Andrade, Rubian D; Pelegrini, Andreia; Anacleto, Tâmile S; Louzada, Fernando M
The aim of this study was to translate and validate the Pediatric Daytime Sleepiness Scale (PDSS) into Brazilian Portuguese. The translation/validation process was carried out through translation, back translation, technical review, assessment of verbal comprehension/clarity of the scale by experts and a focus group, test-retest, and application of the tool. The reproducibility analysis was performed by applying the PDSS in test-retest; internal consistency was verified by applying the scale in 90 children and adolescents. The mean score of the sum of PDSS questions was 15.6 (SD=5.0) points. The PDSS showed appropriate indicators of content validation and clarity for the Brazilian Portuguese version. The internal consistency analysis showed a Cronbach's alpha of 0.784. The PDSS showed adequate reproducibility. The PDSS scores showed a significant and negative correlation with time spent in bed (r=-0.214; p=0.023). The Brazilian Portuguese version of the PDSS shows satisfactory indicators of validity and can be applied in clinical practice and scientific research. Copyright © 2015 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.
Fernandez-Mendoza, Julio; Vgontzas, Alexandros N; Kritikou, Ilia; Calhoun, Susan L; Liao, Duanping; Bixler, Edward O
Excessive daytime sleepiness (EDS) is highly prevalent in the general population and is associated with occupational and public safety hazards. However, no study has examined the clinical and polysomnographic (PSG) predictors of the natural history of EDS. Representative longitudinal study. Sleep laboratory. From a random, general population sample of 1,741 individuals of the Penn State Adult Cohort, 1,395 were followed up after 7.5 years. Full medical evaluation and 1-night PSG at baseline and standardized telephone interview at follow-up. The incidence of EDS was 8.2%, while its persistence and remission were 38% and 62%, respectively. Obesity and weight gain were associated with the incidence and persistence of EDS, while weight loss was associated with its remission. Significant interactions between depression and PSG parameters on incident EDS showed that, in depressed individuals, incident EDS was associated with sleep disturbances, while in non-depressed individuals, incident EDS was associated with increased physiologic sleep propensity. Diabetes, allergy/ asthma, anemia, and sleep complaints also predicted the natural history of EDS. Obesity, a disorder of epidemic proportions, is a major risk factor for the incidence and chronicity of EDS, while weight loss is associated with its remission. Interestingly, objective sleep disturbances predict incident EDS in depressed individuals, whereas physiologic sleep propensity predicts incident EDS in those without depression. Weight management and treatment of depression and sleep disorders should be part of our public health policies. © 2015 Associated Professional Sleep Societies, LLC.
Joo, Soonjae; Shin, Chol; Kim, Jinkwan; Yi, Hyeryeon; Ahn, Yongkyu; Park, Minkyu; Kim, Jehyeong; Lee, SangDuck
The purpose of the present study was to determine the prevalence of excessive daytime sleepiness (EDS) and its associations with sleep habits, sleep problems, and school performance in high school students in South Korea. A total of 3871 students (2703 boys and 1168 girls with a mean age of 16.8 years and 16.9 years, respectively) aged 15-18 years in the 11th grade of high school completed a questionnaire that contained items about individual sociodemographic characteristics, sleep habits, and sleep-related problems. The overall prevalence of EDS was 15.9% (14.9% for boys and 18.2% for girls). Mean reported total sleep time was similar in EDS and non-EDS (6.4 +/- 1.6 and 6.4 +/- 1.3 h/day, respectively). The increased risk of EDS was related to perceived sleep insufficiency (P or = 4 days/week (P or = 1-3 days/week (P or = 4 days/week (P performance (P performance had a 60% excess in the odds of EDS compared to those whose school performance was high. These findings suggest that EDS is associated with multiple sleep-related factors in adolescents. Whether interventions to modify associated correlates can alter EDS warrants consideration, especially because it may also improve academic performance in high school students.
Mak, Yim Wah; Wu, Cynthia Sau Ting; Hui, Donna Wing Shun; Lam, Siu Ping; Tse, Hei Yin; Yu, Wing Yan; Wong, Ho Ting
Screen viewing is considered to have adverse impacts on the sleep of adolescents. Although there has been a considerable amount of research on the association between screen viewing and sleep, most studies have focused on specific types of screen viewing devices such as televisions and computers. The present study investigated the duration with which currently prevalent screen viewing devices (including televisions, personal computers, mobile phones, and portable video devices) are viewed in relation to sleep duration, sleep quality, and daytime sleepiness among Hong Kong adolescents (N = 762). Television and computer viewing remain prevalent, but were not correlated with sleep variables. Mobile phone viewing was correlated with all sleep variables, while portable video device viewing was shown to be correlated only with daytime sleepiness. The results demonstrated a trend of increase in the prevalence and types of screen viewing and their effects on the sleep patterns of adolescents.
Yim Wah Mak
Full Text Available Screen viewing is considered to have adverse impacts on the sleep of adolescents. Although there has been a considerable amount of research on the association between screen viewing and sleep, most studies have focused on specific types of screen viewing devices such as televisions and computers. The present study investigated the duration with which currently prevalent screen viewing devices (including televisions, personal computers, mobile phones, and portable video devices are viewed in relation to sleep duration, sleep quality, and daytime sleepiness among Hong Kong adolescents (N = 762. Television and computer viewing remain prevalent, but were not correlated with sleep variables. Mobile phone viewing was correlated with all sleep variables, while portable video device viewing was shown to be correlated only with daytime sleepiness. The results demonstrated a trend of increase in the prevalence and types of screen viewing and their effects on the sleep patterns of adolescents.
Liu, Jianghong; Liu, Xianchen; Ji, Xiaopeng; Wang, Yingjie; Zhou, Guoping; Chen, Xinyin
This study examined the prevalence of sleep disordered breathing (SDB) symptoms and their associations with daytime sleepiness, emotional problems, and school performance in Chinese children. Participants included 3,979 children (10.99 ± 0.99 years old) from four elementary schools in Jintan City, Jiangsu Province, China. Children completed a self-administered questionnaire on sleep behavior and emotional problems, while parents completed the Child Sleep Habit Questionnaire (CSHQ). SDB sympto...
Neikrug, Ariel B; Liu, Lianqi; Avanzino, Julie A; Maglione, Jeanne E; Natarajan, Loki; Bradley, Lenette; Maugeri, Alex; Corey-Bloom, Jody; Palmer, Barton W; Loredo, Jose S; Ancoli-Israel, Sonia
Obstructive sleep apnea (OSA), common in Parkinson disease (PD), contributes to sleep disturbances and daytime sleepiness. We assessed the effect of continuous positive airway pressure (CPAP) on OSA, sleep, and daytime sleepiness in patients with PD. This was a randomized placebo-controlled, crossover design. Patients with PD and OSA were randomized into 6 w of therapeutic treatment or 3 w of placebo followed by 3 w of therapeutic treatment. Patients were evaluated by polysomnography (PSG) and multiple sleep latency test (MSLT) pretreatment (baseline), after 3 w, and after 6 w of CPAP treatment. Analyses included mixed models, paired analysis, and within-group analyses comparing 3 w to 6 w of treatment. Sleep laboratory. Thirty-eight patients with PD (mean age = 67.2 ± 9.2 y; 12 females). Continuous positive airway pressure. PSG OUTCOME MEASURES: sleep efficiency, %sleep stages (N1, N2, N3, R), arousal index, apnea-hypopnea index (AHI), and % time oxygen saturation sleep-onset latency (MSL). There were significant group-by-time interactions for AHI (P treatment of OSA, improvement in nighttime oxygenation, and in deepening sleep. The paired sample analyses revealed that 3 w of therapeutic treatment resulted in significant decreases in arousal index (t = 3.4, P = 0.002). All improvements after 3 w were maintained at 6 w. Finally, 3 w of therapeutic CPAP also resulted in overall decreases in daytime sleepiness (P = 0.011). Therapeutic continuous positive airway pressure versus placebo was effective in reducing apnea events, improving oxygen saturation, and deepening sleep in patients with Parkinson disease and obstructive sleep apnea. Additionally, arousal index was reduced and effects were maintained at 6 weeks. Finally, 3 weeks of continuous positive airway pressure treatment resulted in reduced daytime sleepiness measured by multiple sleep latency test. These results emphasize the importance of identifying and treating obstructive sleep apnea in patients with
Full Text Available AIM: Sleep is in an active state which is of vital importance for the regeneration of our mental and physical health and which takes up about one third of our lifespan. Sleep disorders are particularly important for specific groups of professionals like health workers. This research aimed to establish the frequency of sleepiness in Gulhane Military Faculty of Medicine students, their sleep disorders and factors that may affect their sleep patterns. It also set out to identify the particular features that may give rise to these conditions and the precautions which may be taken to prevent them. METHOD: The research aimed to encompass all the students in the Gulhane Military Faculty of Medicine. Actual participation was 69% (412/597. The research was cross-sectional with data collected by means of a questionnaire. The Epworth Sleepiness Scale (ESS score was the dependent variable of the research. The sociodemographic particularities of the students, the physical conditions of their sleep area, their habits and health problems were the independent variables. RESULTS: 84.3% of participants stated that they felt the need to sleep during the day. 56.8% of the students revealed that they felt excessively sleepy during the day, whilst 42.8% did not feel excessively sleeply. A significant statistical link has been established in the ESS score between feeling extremely sleepy every day and and #8220;not going to bed at the usual time every day and #8221;, and #8220;not feeling rested upon waking up and #8221;, and #8220;feeling excessively sleepy during the day and #8221; and and #8220;experiencing sleepiness in class because of the classroom environment and #8221; (p<0.05. CONCLUSIONS: Of the students who participated in the survey, 34.5% did experience sleepiness, and this was about 4-6% above the expected level in normal circumstances. The percentage of those Gulhane Military Faculty of Medicine students who had not had enough sleep and those who stated
Nathan, Nila; Zeitzer, Jamie
Mobile phone use is near ubiquitous in teenagers. Paralleling the rise in mobile phone use is an equally rapid decline in the amount of time teenagers are spending asleep at night. Prior research indicates that there might be a relationship between daytime sleepiness and nocturnal mobile phone use in teenagers in a variety of countries. As such, the aim of this study was to see if there was an association between mobile phone use, especially at night, and sleepiness in a group of U.S. teenagers. A questionnaire containing an Epworth Sleepiness Scale (ESS) modified for use in teens and questions about qualitative and quantitative use of the mobile phone was completed by students attending Mountain View High School in Mountain View, California (n = 211). Multivariate regression analysis indicated that ESS score was significantly associated with being female, feeling a need to be accessible by mobile phone all of the time, and a past attempt to reduce mobile phone use. The number of daily texts or phone calls was not directly associated with ESS. Those individuals who felt they needed to be accessible and those who had attempted to reduce mobile phone use were also ones who stayed up later to use the mobile phone and were awakened more often at night by the mobile phone. The relationship between daytime sleepiness and mobile phone use was not directly related to the volume of texting but may be related to the temporal pattern of mobile phone use.
Full Text Available Johan LökkInstitution of Neurobiology, Caring Sciences, and Society, Karolinska Institute, Stockholm, SwedenBackground: Patients with Parkinson’s disease (PD or Parkinsonian syndromes often report excessive daytime sleepiness (EDS. The aim of this study was to evaluate the effects of the psychostimulant modafinil on elderly, institutionalized, severely impaired PD patients with EDS.Method: A three-week open study on ten institutionalized PD patients scoring >10 points on the Epworth Sleepiness Scale (ESS with modafinil eventually on 100 mg twice a day. Patients were assessed at the start, week 1, and week 3 with ESS, Clinical Global Impression (CGI scale severity of PD and appetite.Results: Reduction of ESS score and PD severity over time were found as well as a significant increase in appetite and reduction in CGI score.Conclusion: Modafinil 100 mg twice a day was safe and modestly effective for the treatment of EDS in elderly, institutionalized PD patients. Sustaining wakefulness throughout all stages of PD is crucial for participating in life, maintaining social life, and improving quality of life.Keywords: Parkinson’s disease, daytime sleepiness, Epworth sleepiness scale, psychostimulant
Liu, Jianghong; Liu, Xianchen; Ji, Xiaopeng; Wang, Yingjie; Zhou, Guoping; Chen, Xinyin
This study examined the prevalence of sleep disordered breathing (SDB) symptoms and their associations with daytime sleepiness, emotional problems, and school performance in Chinese children. Participants included 3979 children (10.99±0.99 years old) from four elementary schools in Jintan City, Jiangsu Province, China. Children completed a self-administered questionnaire on sleep behavior and emotional problems, while parents completed the Child Sleep Habit Questionnaire (CSHQ). SDB symptoms included 3 items: loud snoring, stopped breathing, and snorting/gasping during sleep. Teachers rated the children's school performance. The prevalence rates of parent- and self-reported SDB symptoms were 17.2% and 10.1% for "sometimes" and 8.9% and 5.6% for "usually". SDB symptoms, more prevalent in boys than in girls, increased the risks for depression, loneliness, and poor school performance. Daytime sleepiness mediated the relationship between SDB symptoms and depression, loneliness, and poor school performance. This study suggests the importance of early screening and intervention of SDB and daytime sleepiness in child behavioral and cognitive development. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Full Text Available Approximately 30% of the general population suffers from insomnia. Given that insomnia causes many problems, amelioration of the symptoms is crucial. Recently, we found that a nonessential amino acid, glycine subjectively and objectively improves sleep quality in humans who have difficulty sleeping. We evaluated the effects of glycine on daytime sleepiness, fatigue and performances in sleep-restricted healthy subjects. Sleep was restricted to 25% less than the usual sleep time for three consecutive nights. Before bedtime, 3 g of glycine or placebo were ingested, sleepiness and fatigue were evaluated using the visual analogue scale (VAS and a questionnaire, and performance were estimated by personal computer (PC performance test program on the following day. In subjects given glycine, the VAS data showed a significant reduction in fatigue and a tendency toward reduced sleepiness. These observations were also found via the questionnaire, indicating that glycine improves daytime sleepiness and fatigue induced by acute sleep restriction. PC performance test revealed significant improvement in psychomotor vigilance test. We also measured plasma melatonin and the expression of circadian-modulated genes expression in the rat suprachiasmatic nucleus (SCN to evaluate the effects of glycine on circadian rhythms. Glycine did not show significant effects on plasma melatonin concentrations during either the dark or light period. Moreover, the expression levels of clock genes such as Bmal1 and Per2 remained unchanged. However, we observed a glycine-induced increase in the neuropeptides arginine vasopressin and vasoactive intestinal polypeptide in the light period. Although no alterations in the circadian clock itself were observed, our results indicate that glycine modulated SCN function. Thus, glycine modulates certain neuropeptides in the SCN and this phenomenon may indirectly contribute to improving the occasional sleepiness and fatigue induced by sleep
Full Text Available Central nervous system involvement is one important clinical aspect of myotonic dystrophy type 1 and 2 (DM1 and DM2. We assessed CNS involvement DM1 and DM2 by 3T MRI and correlated clinical and neuocognitive symptoms with brain volumetry and voxel-based morphometry (VBM.12 patients with juvenile or classical DM1 and 16 adult DM2 patients underwent 3T MRI, a thorough neurological and neuropsychological examination and scoring of depression and daytime sleepiness. Volumes of brain, ventricles, cerebellum, brainstem, cervical cord, lesion load and VBM results of the patient groups were compared to 33 matched healthy subjects.Clinical symptoms were depression (more pronounced in DM2, excessive daytime sleepiness (more pronounced in DM1, reduced attention and flexibility of thinking, and deficits of short-term memory and visuo-spatial abilities in both patient groups. Both groups showed ventricular enlargement and supratentorial GM and WM atrophy, with prevalence for more GM atrophy and involvement of the motor system in DM1 and more WM reduction and affection of limbic structures in DM2. White matter was reduced in DM1 in the splenium of the corpus callosum and in left-hemispheric WM adjacent to the pre- and post-central gyrus. In DM2, the bilateral cingulate gyrus and subgyral medio-frontal and primary somato-sensory WM was affected. Significant structural-functional correlations of morphological MRI findings (global volumetry and VBM with clinical findings were found for reduced flexibility of thinking and atrophy of the left secondary visual cortex in DM1 and of distinct subcortical brain structures in DM2. In DM2, depression was associated with brainstem atrophy, Daytime sleepiness correlated with volume decrease in the middle cerebellar peduncles, pons/midbrain and the right medio-frontal cortex.GM and WM atrophy was significant in DM1 and DM2. Specific functional-structural associations related morphological changes to cognitive impairment
Maricić, Lana; Visević, Roberta; Vceva, Andrijana; Vcev, Aleksandar; Labor, Slavica
The objective of this study was to examine the risk of sleep apnea syndrome in patients with chronic obstructive pulmonary disease (COPD) and to determine correlation with the associated cardiovascular comorbidity in these patients. Chronic and occasional sleep disturbances represent a problem for millions of people worldwide. COPD is a multisystem disease and the leading cause of mortality and morbidity in the world. It is estimated that it will be the third cause of death in the world by 2020. Poor quality of sleep in patients with COPD occurs as a result of reduced oxygen saturation, hypercapnia, and the use of auxiliary respiratory muscles. The study included 47 patients with COPD, examined at the Department of Pulmonology, Clinical Department of Internal Medicine, Osijek University Hospital Center in 2011. The respondents answered questions from the Croatian version of the Snoring, Tired, Observed, Pressure (STOP) questionnaire, which examines the risk of sleep apnea syndrome, and the Epworth Sleepiness Scale, which examines excessive daytime sleepiness. The respondents also provided data related to the current smoking status, bronchodilation therapy they apply at home, the associated cardiovascular comorbidity related to coronary heart disease (previous myocardial infarction, angina pectoris), cerebrovascular incident, diabetes, asthma, gastroesophageal reflux disease (GERD) and anxiety-depressive disorder. According to the STOP questionnaire, the risk of sleep apnea syndrome was recorded in 35 (74.5%) respondents. Patients at risk had a higher frequency of comorbidities such as hypertension, diabetes mellitus type 2 and GERD. Excessive daytime sleepiness was recorded in 14.9% of patients with COPD and the mean daytime sleepiness scored 4.76 points. In patients at a high risk according to the STOP questionnaire, the mean daytime sleepiness was 6.24 points versus 3.72 points in the group at a low risk. Snoring was present in 23 (49%), excessive tiredness in 27
Rose, Deborah; Gelaye, Bizu; Sanchez, Sixto; Castañeda, Benjamín; Sanchez, Elena; Yanez, N David; Williams, Michelle A
The study was designed to investigate the association between sleep disturbances and common mental disorders (CMDs) among Peruvian college students. A total of 2538 undergraduate students completed a self-administered questionnaire to gather information about sleep characteristics, sociodemographic, and lifestyle data. Evening chronotype, sleep quality, and daytime sleepiness were assessed using the Horne and Ostberg morningness-eveningness questionnaire, Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale, respectivelty. Presence of CMDs was evaluated using the General Health Questionnaire. Logistic regression procedures were used to examine the associations of sleep disturbances with CMDs while accounting for possible confounding factors. Overall, 32.9% of the participants had prevalent CMDs (39.3% among females and 24.4% among males). In multivariable-adjusted logistic models, those with evening chronotype (odds ratios (OR) = 1.43; 95% CI 1.00-2.05), poor sleep quality (OR = 4.50; 95% CI 3.69-5.49), and excessive daytime sleepiness (OR = 1.68; 95% CI 1.41-2.01) were at a relative increased odds of CMDs compared with those without sleep disturbances. In conclusion, we found strong associations between sleep disturbances and CMDs among Peruvian college students. Early education and preventative interventions designed to improve sleep habits may effectively alter the possibility of developing CMDs among young adults.
Full Text Available Background. Evidence shows that blacks exhibit greater daytime sleepiness compared with whites, based on the Epworth Sleepiness Scale. In addition, sleep complaints might differ based on individuals’ country of origin. However, it is not clear whether individuals’ country of origin has any influence on excessive daytime sleepiness (EDS. Study Objectives. We tested the hypothesis that US-born blacks would show a greater level of EDS compared with foreign-born blacks. The potential effects of sociodemographic and medical risk were also determined. Design. We used the Counseling African-Americans to Control Hypertension (CAATCH data. CAATCH is a group randomized clinical trial that was conducted among 30 community healthcare centers in New York, yielding baseline data for 1,058 hypertensive black patients. Results. Results of univariate logistic regression analysis indicated that US-born blacks were nearly twice as likely as their foreign-born black counterparts to exhibit EDS (OR=1.87, 95% CI: 1.30–2.68, P<0.001. After adjusting for effects of age, sex, education, employment, body mass index, alcohol consumption, and smoking habit, US-born blacks were 69% more likely than their counterparts to exhibit EDS (OR=1.69, 95% CI: 1.11–2.57, P<0.01. Conclusion. Findings demonstrate the importance of considering individuals’ country of origin, in addition to their race and ethnicity, when analyzing epidemiologic sleep data.
Jun, Nuri; Lee, Aeri; Baik, Inkyung
The present study investigated caffeinated beverage consumption and screen time in the association with excessive daytime sleepiness (EDS) and sleep duration. We conducted a cross-sectional study including 249 Korean male high school students. These participants responded to a questionnaire inquiring the information on lifestyle factors, consumption of caffeinated beverages, time spent for screen media, and sleep duration as well as to the Epworth Sleepiness Scale (ESS) questionnaire. EDS was defined as ESS scores of 9 or greater. Students with EDS consumed greater amount of chocolate/cocoa drinks and spent longer time for a TV and a mobile phone than those without EDS (p coffee than others whereas students with long sleep (> 8 hours) consumed greater amount of chocolate/cocoa drinks than others (p < 0.05). Screen time did not differ according to the categories of sleep duration. Although these findings do not support causal relationships, they suggest that screen time is associated with EDS, but not with sleep duration, and that consumption of certain types of caffeinated beverages is associated with EDS and sleep duration. Adolescents may need to reduce screen time and caffeine consumption to improve sleep quality and avoid daytime sleepiness.
Kaneita, Yoshitaka; Ohida, Takashi
The aim of the present study was to clarify the current work and sleep situations of physicians in Japan and to clarify the association between these situations and excessive daytime sleepiness as well as medical incidents. A self-administered questionnaire survey was conducted among the members of the Japan Medical Association in 2008. The randomly selected subjects comprised 3,000 male physicians and 1,500 female physicians. Valid responses were obtained from 3,486 physicians (2,298 men and 1,188 women). Mean sleep duration was 6 h 36 min for men and 6 h 8 min for women. The prevalence of lack of rest due to sleep deprivation was 30.4% among men and 36.6% among women; the prevalence of insomnia was 21.0% and 18.1%, respectively; and the prevalence of EDS was 3.5%. The adjusted odds ratio for EDS was high for physicians who reported short sleep duration, lack of rest due to sleep deprivation, and a high frequency of on-call/overnight work. Physicians who had experienced a medical incident within the previous one month accounted for 19.0% of participants. The adjusted odds ratio for medical incidents was high for those subjected to long working hours, high frequency of on-call/overnight works, lack of rest due to sleep deprivation, and insomnia. In order to facilitate optimal health management for physicians as well as securing medical safety, it is important to fully consider the work and sleep situations of physicians.
Chapman, Julia L; Kempler, Liora; Chang, Catherina L; Williams, Shaun C; Sivam, Sheila; Wong, Keith K H; Yee, Brendon J; Grunstein, Ronald R; Marshall, Nathaniel S
Patients with mild to moderate obstructive sleep apnoea (OSA) commonly suffer excessive daytime sleepiness. Continuous positive airway pressure (CPAP) has limited effectiveness in reducing sleepiness in milder OSA. Modafinil is a wake-promoting drug licensed to treat residual sleepiness in CPAP-treated OSA. We hypothesised that modafinil may effectively treat sleepiness in untreated mild to moderate OSA. Untreated sleepy men with mild to moderate OSA (age 18-70, apnoea-hypopnoea index (AHI) 5-30/h, Epworth Sleepiness Scale (ESS) ≥10) were randomised to receive 200 mg modafinil or matching placebo daily for 2 weeks before crossing over to the alternative treatment after a minimum 2-week washout. Mixed model analysis of variance was used to compare the changes on modafinil to placebo while classifying all randomised patients as random factors. 32 patients were randomised (mean (SD) AHI 13 (6.4)/h, age 47 (10.7) years, ESS 13.6 (3.3), body mass index 28.2 (3.6) kg/m(2)), 29 of whom (91%) completed the trial. The primary outcome (ESS) improved more on modafinil than placebo (3.6 points, 95% CI 1.3 to 5.8, p=0.003) and the secondary outcome (40-min driving simulator performance) also improved more on modafinil than placebo (steering deviation 4.7 cm, 95% CI 0.8 to 8.5, p=0.018). Psychomotor Vigilance Task reciprocal reaction time improved significantly over placebo (0.15 (1/ms), 95% CI 0.03 to 0.27, p=0.016). Improvements on the Functional Outcomes of Sleep Questionnaire were not significant (5.3 points over placebo, 95% CI -1 to 11.6, p=0.093). Modafinil significantly improved subjective sleepiness in patients with untreated mild to moderate OSA. The size of this effect is clinically relevant at 3-4 ESS points of improvement compared with only 1-2 points in CPAP clinical trials. Driving simulator performance and reaction time also improved on modafinil. ACTRN#12608000128392.
Full Text Available A group of 53 patients (40 míales, 13 females with mean age of 49 years, ranging from 30 to 70 years, was evaluated in the. following excessive daytime sleepiness (EDS disorders : obstructive sleep apnea syndrome (B4a, periodic movements in sleep (B5a, affective disorder (B2a, functional psychiatric non affective disorder (B2b. We considered all adult patients referred to the Center sequentially with no other distinctions but these three criteria: (a EDS was the main complaint; (b right handed ; (c not using psychotropic drugs for two weeks prior to the all-night polysomnography. EEG (C3/A1, C4/A2 samples from 2 to 10 minutes of each stage of the first REM cycle were chosen. The data was recorded simultaneously in magnetic tape and then fed into a computer for power spectral analysis. The percentage of power (PP in each band calculated in relation to the total EEG power was determined of subsequent sections of 20.4 s for the following frequency bands: delta, theta, alpha and beta. The PP in all EOS patients sample had a tendency to decrease progressively from the slowest to the fastest frequency bands, in every sleep stage. PP distribution in the delta range increased progressively from stage 1 to stage 4; stage REM levels were close to stage 2 levels. In an EDS patients interhemispheric coherence was high in every band and sleep stage. B4a patients sample PP had a tendency to decrease progressively from the slowest to the fastest frequency bands, in¡ every sleep stage; PP distribution in the delta range increased progressively from stage 1 to stage 4; stage REM levels were between stage 1 and stage 2 levels. B2a patients sample PP had a tendency to decrease progressively from the slowest to the fastest frequency bands, in every sleep stage; PP distribution in the delta range increased progressively from stage 1 to stage 4; stage REM levels were close to stage 2 levels. B2b patients sample PP had a tendency to decrease progressively from the
Leone Roberti Maggiore, Umberto; Bizzarri, Nicolò; Scala, Carolina; Tafi, Emanuela; Siesto, Gabriele; Alessandri, Franco; Ferrero, Simone
To assess the impact of endometriosis of the posterior cul-de-sac on quality of sleep, average daytime sleepiness and insomnia. This age-matched case-control study was conducted in a tertiary referral centre for the diagnosis and treatment of endometriosis between May 2012 and December 2013. It included 145 women with endometriosis of the posterior cul-de-sac (cases; group E) and 145 patients referred to our Institution because of routine gynaecologic consultations (controls; group C). This study investigated whether sleep is impaired in patients with endometriosis of the posterior cul-de-sac. Sleep quality, daytime sleepiness and insomnia were assessed using the following self-administered questionnaires: the Pittsburgh Sleep Quality Index, the Epworth sleepiness scale and the Insomnia Severity Index, respectively. The primary objective of the study was to evaluate sleep quality in the two study groups. Secondary outcomes of the study were to assess average daytime sleepiness and insomnia in the two study groups. The prevalence of poor sleep quality was significantly higher in group E (64.8%) than in group C (15.1%; psleep quality, excessive daytime sleepiness and insomnia. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Stores, Gregory; Montgomery, Paul; Wiggs, Luci
Background: Narcolepsy is a predominantly rapid eye movement sleep disorder with onset usually in the second decade but often in earlier childhood. Classically it is characterized by combinations of excessive sleepiness especially sleep attacks, cataplexy, hypnagogic hallucinations, and sleep paralysis. The psychosocial effects of this lifelong…
Mairesse, Olivier; Neu, Daniel; Migeotte, Pierre-Francois; Pattyn, Nathalie; Hofmans, Joeri; Theuns, Peter; Cluydts, Raymond; De Valck, Elke
Sleep-wake behavior, as well as sleepiness, is regulated by the joint action of an exponentially increasing drive for sleep--sleep homeostasis--and by variations in sleep propensity due to a biological circadian oscillator. However, large inter-individual differences remain. Short and long sleepers have been known to differ in the amount of…
Walsh, James K; Snyder, Ellen; Hall, Janine; Randazzo, Angela C; Griffin, Kara; Groeger, John; Eisenstein, Rhody; Feren, Stephen D; Dickey, Pam; Schweitzer, Paula K
To evaluate the impact of enhanced slow wave sleep (SWS) on behavioral, psychological, and physiological changes resulting from sleep restriction. A double-blind, parallel group, placebo-controlled design was used to compare gaboxadol (GBX) 15 mg, a SWS-enhancing drug, to placebo during 4 nights of sleep restriction (5 h/night). Behavioral, psychological, and physiological measures of the impact of sleep restriction were assessed in both groups at baseline, during sleep restriction and following recovery sleep. Sleep research laboratory. Forty-one healthy adults; 9 males and 12 females (mean age: 32.0 +/- 9.9 y) in the placebo group and 10 males and 10 females (mean age: 31.9 +/- 10.2 y) in the GBX group. Both experimental groups underwent 4 nights of sleep restriction. Each group received either GBX 15 mg or placebo on all sleep restriction nights, and both groups received placebo on baseline and recovery nights. Polysomnography documented a SWS-enhancing effect of GBX with no group difference in total sleep time during sleep restriction. The placebo group displayed the predicted deficits due to sleep restriction on the multiple sleep latency test (MSLT) and on introspective measures of sleepiness and fatigue. Compared to placebo, the GBX group showed significantly less physiological sleepiness on the MSLT and lower levels of introspective sleepiness and fatigue during sleep restriction. There were no differences between groups on the psychomotor vigilance task (PVT) and a cognitive test battery, but these measures were minimally affected by sleep restriction in this study. The correlation between change from baseline in MSLT on Day 6 and change from baseline in SWS on Night 6 was significant in the GBX group and in both group combined. The results of this study are consistent with the hypothesis that enhanced SWS, in this study produced by GBX, reduces physiological sleep tendency and introspective sleepiness and fatigue which typically result from sleep
Moderie, Christophe; Van der Maren, Solenne; Dumont, Marie
To assess factors that might contribute to a delayed sleep schedule in young adults with sub-clinical features of delayed sleep phase disorder. Two groups of 14 young adults (eight women) were compared: one group complaining of a delayed sleep schedule and a control group with an earlier bedtime and no complaint. For one week, each subject maintained a target bedtime reflecting their habitual sleep schedule. Subjects were then admitted to the laboratory for the assessment of circadian phase (dim light melatonin onset), subjective sleepiness, and non-visual light sensitivity. All measures were timed relative to each participant's target bedtime. Non-visual light sensitivity was evaluated using subjective sleepiness and salivary melatonin during 1.5-h exposure to blue light, starting one hour after target bedtime. Compared to control subjects, delayed subjects had a later circadian phase and a slower increase of subjective sleepiness in the late evening. There was no group difference in non-visual sensitivity to blue light, but we found a positive correlation between melatonin suppression and circadian phase within the delayed group. Our results suggest that a late circadian phase, a slow build-up of sleep need, and an increased circadian sensitivity to blue light contribute to the complaint of a delayed sleep schedule. These findings provide targets for strategies aiming to decreasing the severity of a sleep delay and the negative consequences on daytime functioning and health. Copyright © 2017 Elsevier B.V. All rights reserved.
Roehrs, Timothy; Diederichs, Christina; Gillis, Mazy; Burger, Amanda J; Stout, Rebecca A; Lumley, Mark A; Roth, Thomas
Fibromyalgia (FM) and rheumatoid arthritis (RA) are associated with sleep disturbance and daytime sleepiness. We sought to determine whether sleep homeostatic mechanisms are blunted in FM by assessing the effects of reduced time in bed (4h) on next day sleepiness and recovery sleep. Fifty women (18 with FM, 16 with RA, and 16 HC) had a baseline 8h time-in-bed (TIB) and Multiple Sleep Latency Test (MSLT) the following day, and 3-7 days later bedtime was reduced (4h) followed by MSLT and an 8h TIB recovery night. Following reduced bedtime the MSLT was reduced relative to baseline in the FM group by an amount (4.3+/-4.8 min) similar to that of the RA (3.1+/-5.2 min) and HC (4.8 +/-3.1 min) groups. Relative to the baseline on the recovery night the FM group showed increased sleep efficiency (83.7+/-7.8 to 88.1+/-9.2%) relative to the RA (83.9+/-8.6 to 80.9+/-13.3%) and HC (90.1+/-5.0 to 87.4+/-7.6%) groups due primarily to reduced wake after sleep onset. The groups did not differ in recovery night sleep stages with the exception that the FM group showed REM rebound (21.6+/-6.5 to 25.2+/-6.0%), which was not found in the RA (20.4+/-7.4 to 17.8+/-6.5%) or HC (16.6+/-6.6 to 17.5+/-6.0%) groups. Compared to RA and HC, people with FM responded to reduced bedtime with a comparable increase in sleepiness and greater recovery sleep efficiency, suggesting that homeostatic sleep mechanisms are functional in FM. People with FM uniquely showed REM rebound on recovery from reduced bedtime suggesting underlying REM pressure. Copyright © 2015 Elsevier Inc. All rights reserved.
Goldman, S. E.; Malow, B. A.; Newman, K. D.; Roof, E.; Dykens, E. M.
Background: Sleep disorders are common in individuals with neurodevelopmental disorders and may adversely affect daytime functioning. Children with Williams syndrome have been reported to have disturbed sleep; however, no studies have been performed to determine if these problems continue into adolescence and adulthood. Methods: This study…
Goodlin-Jones, Beth; Tang, Karen; Liu, Jingyi; Anders, Thomas F.
Background: Sleep problems are a common complaint of parents of preschool children. Children with neurodevelopmental disorders have even more disrupted sleep than typically developing children. Although disrupted nighttime sleep has been reported to affect daytime behavior, the pathway from sleep disruption to sleep problems, to impairments in…
Maas, Anneke P. H. M.; Didden, Robert; Bouts, Lex; Smits, Marcel G.; Curfs, Leopold M. G.
Individuals with Prader-Willi syndrome (PWS) are at risk for excessive daytime sleepiness (EDS) and disruptive behavior. This pilot study explores temporal characteristics of EDS and severe disruptive behavior across time of day and day of week in seven individuals with PWS (aged between 33 and 49 years) of whom five were matched to controls.…
Siengsukon, Catherine F; Aldughmi, Mayis; Kahya, Melike; Bruce, Jared; Lynch, Sharon; Ness Norouzinia, Abigail; Glusman, Morgan; Billinger, Sandra
Nearly 70% of individuals with multiple sclerosis (MS) experience sleep disturbances. Increasing physical activity in people with MS has been shown to produce a moderate improvement in sleep quality, and exercise has been shown to improve sleep quality in non-neurologically impaired adults. The purpose of this pilot randomized controlled trial study was to examine the effect of two exercise interventions on sleep quality and daytime sleepiness in individuals with MS. Twenty-eight individuals with relapsing-remitting or secondary progressive MS were randomized into one of two 12-week exercise interventions: a supervised, moderate-intensity aerobic exercise (AE) program or an unsupervised, low-intensity walking and stretching (WS) program. Only individuals who were ≥ 70% compliant with the programs were included in analysis (n = 12 AE; n = 10 WS). Both groups demonstrated a moderate improvement in sleep quality, although only the improvement by the WS group was statistically significant. Only the AE group demonstrated a significant improvement in daytime sleepiness. Change in sleep quality and daytime sleepiness was not correlated with disease severity or with change in cardiovascular fitness, depression, or fatigue. The mechanisms for improvement in sleep quality and daytime sleepiness need further investigation, but may be due to introduction of zeitgebers to improve circadian rhythm.
Full Text Available Yuki Omori,1 Takashi Kanbayashi,1,2 Aya Imanishi,1 Ko Tsutsui,1 Yohei Sagawa,1 Yuka S Kikuchi,1 Masahiro Takeshima,1 Kazuhisa Yoshizawa,1 Sachiko Uemura,3 Tetsuo Shimizu1,2 1Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan; 2International Institute for Integrative Sleep Medicine (WPI-IIIS, University of Tsukuba, Tsukuba, Japan; 3Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan Purpose: Myotonic dystrophy type 1 (DM1 is often characterized by excessive daytime sleepiness (EDS and sleep-onset rapid eye movement periods caused by muscleblind-like protein 2. The EDS tends to persist even after treatment of sleep apnea. We measured the cerebrospinal fluid (CSF orexin levels in DM1 patients with EDS and compared the clinical characteristics with narcolepsy type 1 and idiopathic hypersomnia (IHS patients.Patients and methods: We measured the CSF orexin levels in 17 DM1 patients with EDS and evaluated subjective sleepiness using the Epworth Sleepiness Scale (ESS, objective sleepiness using mean sleep latency (MSL, and sleep apnea using apnea-hypopnea index (AHI. We compared the ESS scores and MSL between decreased (≤200 pg/mL and normal (>200 pg/mL CSF orexin group in DM1 patients. Furthermore, we compared the CSF orexin levels, ESS scores, MSL, and AHI among patients with DM1, narcolepsy type 1 (n=46, and IHS (n=30.Results: Seven DM1 patients showed decreased CSF orexin levels. There were significant differences in the ESS scores and MSL between decreased and normal CSF orexin groups in DM1 patients. The ESS scores showed no significant difference among patients with DM1, narcolepsy type 1, and IHS. The MSL in DM1 and IHS patients were significantly higher than narcolepsy type 1 patients (p=0.01, p<0.001. The AHI in DM1 patients was significantly higher than narcolepsy type 1 patients (p=0.042 and was insignificantly different from IHS patients. The CSF orexin
Šiarnik, Pavel; Klobučníková, Katarína; Šurda, Pavol; Putala, Matúš; Šutovský, Stanislav; Kollár, Branislav; Turčáni, Peter
Sleep disorders are frequent in stroke patients. The prevalence of sleep-disordered breathing (SDB), excessive daytime sleepiness (EDS), and restless legs syndrome (RLS) among stroke survivors is up to 91%, 72%, and 15%, respectively. Although the relationship between EDS and SDB is well described, there are insufficient data regarding the association of EDS with RLS. The aim of this study was to explore the association between EDS, SDB, and RLS in acute ischemic stroke. We enrolled 152 patients with acute ischemic stroke. Epworth Sleepiness Scale (ESS) was used to assess EDS. SDB was assessed using standard overnight polysomnography. All patients filled in a questionnaire focused on RLS. Clinical characteristics and medication were recorded on admission. EDS was present in 16 (10.5%), SDB in 90 (59.2%) and RLS in 23 patients (15.1%). EDS was significantly more frequent in patients with RLS in comparison with the patients without RLS (26.1% versus 7.8%, P = .008). ESS was significantly higher in the population with RLS compared to the population without RLS (7 [0-14] versus 3 [0-12], P = .032). We failed to find any significant difference in the frequency of EDS and values of ESS in the population with SDB compared to the population without SDB. Presence of RLS (beta = 0.209; P = .009), diabetes mellitus (beta = 0.193; P = .023), and body mass index (beta = 0.171; P = .042) were the only independent variables significantly associated with ESS in multiple linear regression analysis. Our results suggest a significant association of ESS with RLS, diabetes mellitus, and obesity in patients with acute ischemic stroke.
Bogan, Richard K; Roth, Thomas; Schwartz, Jonathan; Miloslavsky, Maja
This post hoc analysis evaluated the time to response that can be expected with sodium oxybate (SXB) for treatment of excessive daytime sleepiness (EDS) and cataplexy in patients with narcolepsy. Data were from a 4-week, double-blind, randomized, placebo-controlled trial (GHB-2; N = 136) of oral SXB 3 g, 6 g, and 9 g nightly, and its 12-month open-label extension (GHB-3). Two response definitions were utilized: ≥ 20% improvement in Epworth Sleepiness Scale (ESS) score (EDS responders), and ≥ 50% reduction in weekly cataplexy attacks (cataplexy responders). These thresholds were previously determined to be clinically relevant based on analysis of the relationship of Clinical Global Impression of Change with ESS and number of cataplexy attacks. Kaplan-Meier curves and median times to first response, based on above criteria, and to maximum response were estimated. Among 86 patients randomized to SXB in GHB-2 and continued into GHB-3, 77.6% and 90.7% were EDS and cataplexy responders, respectively. The median (95% CI) times to first response were 37 (31-50) days for EDS and 25 (17-29) days for cataplexy, and median times to maximum response were 106 (85-164) days for EDS and 213 (94-279) days for cataplexy. GHB-3 results among 31 patients initially randomized to placebo were consistent with those treated with SXB throughout, but with longer times to maximum response. Response onset, assessed as clinically meaningful improvements in EDS and cataplexy, was observed in most patients within 2 months; a longer period is needed to achieve maximum response. Clinicians should recognize that time to initial and maximum response may take weeks to months. © 2015 American Academy of Sleep Medicine.
Li, Fuzhong; Fisher, K John; Harmer, Peter; Irbe, Dainis; Tearse, Robert G; Weimer, Cheryl
To determine the effectiveness of tai chi on self-rated sleep quality and daytime sleepiness in older adults reporting moderate sleep complaints. Randomized, controlled trial with allocation to tai chi or exercise control. General community. One hundred eighteen women and men aged 60 to 92. Participants were randomized into tai chi or low-impact exercise and participated in a 60-minute session, three times per week, for 24 consecutive weeks. Primary outcome measures were the seven subscales of the Pittsburgh Sleep Quality Index (PSQI), PSQI global score, and Epworth Sleepiness Scale (ESS). Secondary outcome measures were physical performance (single leg stand, timed chair rise, 50-foot speed walk) and 12-item short form (SF-12) physical and mental summary scores. Tai chi participants reported significant improvements in five of the PSQI subscale scores (sleep quality, sleep-onset latency, sleep duration, sleep efficiency, sleep disturbances) (Psleep-onset latency of about 18 minutes less per night (95% confidence interval (CI)=-28.64 to -7.12) and sleep duration of about 48 minutes more per night (95% CI=14.71-82.41) than low-impact exercise participants. Tai chi participants also showed better scores in secondary outcome measures than low-impact exercise participants. Both groups reported improvements in SF-12 mental summary scores. Older adults with moderate sleep complaints can improve self-rated sleep quality through a 6-month, low- to moderate-intensity tai chi program. Tai chi appears to be effective as a nonpharmacological approach to sleep enhancement for sleep-disturbed elderly individuals.
Érico Felden Pereira
Full Text Available OBJETIVO: Analisar pesquisas sobre sonolência diurna excessiva em adolescentes e apresentar, por meio de revisão sistemática, as prevalências e os fatores associados. FONTES DE DADOS: Foram analisados estudos encontrados nas bases de dados PubMed e SciELO, que apresentassem resultados originais, sem restrições de período e idioma na pesquisa. SÍNTESE DOS DADOS: A prevalência de sonolência diurna excessiva encontrada variou entre 7,8 e 55,8%. As escalas Epworth Sleepiness Scale e a School Sleep Habits Survey foram os principais instrumentos utilizados. Associações da sonolência diurna excessiva com problemas relacionados ao sono, como o ranger de dentes, apneia e insônia, dentre outros, foram descritas com maior frequência nos estudos analisados. A associação de outros possíveis fatores de cunho biológico, ambiental e comportamental com a sonolência diurna excessiva não foi descrita com clareza. CONCLUSÕES: Vários fatores, como o comportamento sedentário e hábitos alimentares, foram pouco investigados e apresentaram resultados divergentes quando analisados como variáveis associadas à sonolência diurna excessiva. Uma carência de investigações epidemiológicas com amostras brasileiras foi identificadaOBJECTIVE: To assess studies on excessive daytime sleepiness in adolescents and to present a systematic review the prevalence and associated factors. DATA SOURCES: Papers found on PubMed and SciELO databases presenting original results without restriction of time and language were evaluated. DATA SYNTHESIS: The prevalence of excessive daytime sleepiness ranged from 7.8 to 55.8%. The Epworth Sleepiness Scale and the School Sleep Habits Survey were the main tools used in the studies. Associations of excessive daytime sleepiness with sleeping-related problems, such as teeth gnashing, sleep apnea and insomnia, among others, were frequently described. The association of other biological, environmental and behavioral factors
Annemarie eBoschloo; Lydia eKrabbendam; Sanne eDekker; Lee, Nikki C.; Renate ede Groot; Jelle eJolles
This study investigated the relation between sleep and school performance in a large sample of 561 adolescents aged 11-18 years. Three subjective measures of sleep were used: sleepiness, sleep quality and sleep duration. They were compared to three measures of school performance: objective school grades, self-reported school performance, and parent-reported school performance. Sleepiness – ‘I feel sleepy during the first hours at school’ – appeared to predict both school grades and self-repor...
Full Text Available Sleep disturbance is associated with the development of obesity, diabetes and hepatic steatosis in murine models. Hepatic triglyceride accumulation oscillates in a circadian rhythm regulated by clock genes, light-dark cycle and feeding time in mice. The role of the sleep-wake cycle in the pathogenesis of human non-alcoholic fatty liver disease (NAFLD is indeterminate. We sought to detail sleep characteristics, daytime sleepiness and meal times in relation to disease severity in patients with NAFLD.Basic Sleep duration and latency, daytime sleepiness (Epworth sleepiness scale, Pittsburgh sleep quality index, positive and negative affect scale, Munich Chronotype Questionnaire and an eating habit questionnaire were assessed in 46 patients with biopsy-proven NAFLD and 22 healthy controls, and correlated with biochemical and histological parameters.In NAFLD compared to healthy controls, time to fall asleep was vastly prolonged (26.9 vs. 9.8 min., p = 0.0176 and sleep duration was shortened (6.3 vs. 7.2 hours, p = 0.0149. Sleep quality was poor (Pittsburgh sleep quality index 8.2 vs. 4.7, p = 0.0074 and correlated with changes in affect. Meal frequency was shifted towards night-times (p = 0.001. In NAFLD but not controls, daytime sleepiness significantly correlated with liver enzymes (ALAT [r = 0.44, p = 0.0029], ASAT [r = 0.46, p = 0.0017] and insulin resistance (HOMA-IR [r = 0.5, p = 0.0009] independent of cirrhosis. In patients with fibrosis, daytime sleepiness correlated with the degree of fibrosis (r = 0.364, p = 0.019.In NAFLD sleep duration was shortened, sleep onset was delayed and sleep quality poor. Food-intake was shifted towards the night. Daytime sleepiness was positively linked to biochemical and histologic surrogates of disease severity. The data may indicate a role for sleep-wake cycle regulation and timing of food-intake in the pathogenesis of human NAFLD as suggested from murine models.
Bernsmeier, Christine; Weisskopf, Diego M; Pflueger, Marlon O; Mosimann, Jan; Campana, Benedetta; Terracciano, Luigi; Beglinger, Christoph; Heim, Markus H; Cajochen, Christian
Sleep disturbance is associated with the development of obesity, diabetes and hepatic steatosis in murine models. Hepatic triglyceride accumulation oscillates in a circadian rhythm regulated by clock genes, light-dark cycle and feeding time in mice. The role of the sleep-wake cycle in the pathogenesis of human non-alcoholic fatty liver disease (NAFLD) is indeterminate. We sought to detail sleep characteristics, daytime sleepiness and meal times in relation to disease severity in patients with NAFLD. Basic Sleep duration and latency, daytime sleepiness (Epworth sleepiness scale), Pittsburgh sleep quality index, positive and negative affect scale, Munich Chronotype Questionnaire and an eating habit questionnaire were assessed in 46 patients with biopsy-proven NAFLD and 22 healthy controls, and correlated with biochemical and histological parameters. In NAFLD compared to healthy controls, time to fall asleep was vastly prolonged (26.9 vs. 9.8 min., p = 0.0176) and sleep duration was shortened (6.3 vs. 7.2 hours, p = 0.0149). Sleep quality was poor (Pittsburgh sleep quality index 8.2 vs. 4.7, p = 0.0074) and correlated with changes in affect. Meal frequency was shifted towards night-times (p = 0.001). In NAFLD but not controls, daytime sleepiness significantly correlated with liver enzymes (ALAT [r = 0.44, p = 0.0029], ASAT [r = 0.46, p = 0.0017]) and insulin resistance (HOMA-IR [r = 0.5, p = 0.0009]) independent of cirrhosis. In patients with fibrosis, daytime sleepiness correlated with the degree of fibrosis (r = 0.364, p = 0.019). In NAFLD sleep duration was shortened, sleep onset was delayed and sleep quality poor. Food-intake was shifted towards the night. Daytime sleepiness was positively linked to biochemical and histologic surrogates of disease severity. The data may indicate a role for sleep-wake cycle regulation and timing of food-intake in the pathogenesis of human NAFLD as suggested from murine models.
Langberg, Joshua M; Dvorsky, Melissa R; Becker, Stephen P; Molitor, Stephen J
This prospective longitudinal study evaluated the impact of daytime sleepiness on the school performance of 62 college students diagnosed comprehensively with attention deficit hyperactivity disorder. The primary goal of the study was to determine if self-reported daytime sleepiness rated at the beginning of the academic year could predict academic and overall functioning at the end of the academic year while also considering potentially important covariates, including symptoms of inattention, hyperactivity and impulsivity, medication status and whether or not students lived at home or on-campus. Self-reported daytime sleepiness predicted longitudinally school maladjustment, overall functional impairment and the number of D and F grades (i.e. poor and failing) students received in courses above and beyond both self- and parent-report of symptoms, but did not predict overall grade point average. Living at home served as a protective factor and was associated with less school maladjustment and overall impairment. Gender was the only significant predictor in the overall grade point average model, with female gender associated with higher overall grades. The implications of these findings for monitoring and treatment of sleep disturbances in college students with attention deficit hyperactivity disorder are discussed. © 2013 European Sleep Research Society.
Valko, P O; Waldvogel, D; Weller, M; Bassetti, C L; Held, U; Baumann, C R
A comprehensive study of both fatigue and excessive daytime sleepiness (EDS) in association with Parkinson's disease (PD)-related symptoms and treatment has not been performed yet. To assess the frequency and severity of fatigue and EDS in patients with idiopathic PD and to study their relation to motor and non-motor symptoms and dopaminergic treatment. We prospectively assessed Fatigue Severity Scale (FSS) scores, Epworth Sleepiness Scale (ESS) scores, Beck Depression Inventory (BDI) scores, severity (Unified PD Rating Scale, UPDRS, part III; Hoehn & Yahr staging) and duration of the disease, and the current dopaminergic treatment in 88 consecutive patients with idiopathic PD. Fatigue was found in 52 (59%), EDS in 42 (48%), and both complaints in 31 (35%) patients. Fatigued patients had higher UPDRS III scores (23.5 ± 11.1 vs. 18.6 ± 7.6, P = 0.03), higher Hoehn & Yahr staging (2.4 ± 0.9 vs. 2.1 ± 0.7, P = 0.03), and higher BDI scores (13.4 ± 7.1 vs. 9.1 ± 5.8, P = 0.004) than non-fatigued patients. In contrast, UPDRS III, Hoehn & Yahr, and BDI scores did not differ between patients with or without EDS. However, the type of dopaminergic treatment (levodopa monotherapy versus combination of levodopa/dopamine agonists) was associated with significant differences in ESS (8.5 ± 5.2 vs. 10.8 ± 4.3, P = 0.04), but not FSS scores (4.1 ± 1.5 vs. 4.3 ± 1.5, P = 0.55). Disease duration correlated with ESS scores (r = 0.32, P = 0.003), but not with FSS scores (r = -0.02, P = 0.82). In PD, there is a significant overlap of fatigue and EDS, but the two symptoms are differently correlated with the severity of motor symptoms, disease duration, depression, and dopaminergic treatment. © 2010 The Author(s). European Journal of Neurology © 2010 EFNS.
Sarah Laxhmi Chellappa
Full Text Available OBJECTIVE: To evaluate excessive daytime sleepiness in patients with depressive disorder and to examine its association with the severity of depression and suicidal ideation. METHOD: Seventy patients were interviewed and assessed by the Epworth Sleepiness Scale (ESS, the Beck Depression Inventory (BDI and the Beck Scale for Suicidal Ideation (SSI. Descriptive analysis, Pearson correlations and Student's t-test were used for data analyses. RESULTS: Most of the patients (57.1% obtained high scores on the ESS. Correlation was positive and strongly significant between ESS scores and BDI scores, as well as between ESS scores and SSI scores. Patients with high ESS scores obtained higher mean BDI and SSI scores in comparison to patients with lower ESS scores. Significant differences (p 10 and lower (OBJETIVO: Avaliar a incidência de sonolência diurna excessiva em pacientes com transtorno depressivo e examinar sua associação com a gravidade do quadro depressivo e ideação suicida. MÉTODO: Setenta pacientes foram entrevistados e avaliados através da Escala de Sonolência de Epworth (ESE, da Escala de Depressão de Beck BD e da Escala de Ideação Suicida de Beck (EIS. Análises descritivas, análise de correlação de Pearson e teste-t de Student foram utilizados para a análise dos dados. RESULTADOS: A maioria dos paciente (57,1% apresentaram altas pontuações na ESE. Houve correlações positivas e fortes entre scores da ESE e BD e entre scores da ESE e EIS. Pacientes com altas pontuações na ESE obtiveram escores na BD e na EIS mais elevados do que os pacientes com baixos escores de ESE. Houve diferenças significativas (p 10 na ESE, em relação às pontuações totais das ESE, EDB e EIS. CONCLUSÕES: A sonolência diurna excessiva foi freqüente nos pacientes e significativamente associada a maior gravidade da depressão e ideação suicida. Desta maneira, é necessária uma cuidadosa investigação da sonolência diurna excessiva em
Linderup, Mette Werner
Fremlæggelse af projekt med Epworth søvnighedsskema, opgørelse af data fra 2009-2014: "Prevalence of excessive daytime sleepiness in patients treated with orthognathic surgery"......Fremlæggelse af projekt med Epworth søvnighedsskema, opgørelse af data fra 2009-2014: "Prevalence of excessive daytime sleepiness in patients treated with orthognathic surgery"...
Ancoli-Israel, Sonia; Martin, Jennifer L
Insomnia, daytime sleepiness, and napping are all highly prevalent among the elderly, reflecting changes in sleep architecture, sleep efficiency, sleep quality, and circadian sleep-wake cycles. Insomnia is sometimes associated with subjective daytime sleepiness, as well as other clinical and socioeconomic consequences. The daytime sleepiness will at times lead to napping. Although napping is viewed as a common age-related occurrence, little is known about its benefits or consequences. Factors reported to be contributors to daytime napping include sleep-maintenance difficulty and sleep fragmentation with consequent daytime sleepiness, nighttime use of long-acting sedating agents, daytime use of sedating medications, and dementia. However, a correlation between sleep disturbance and daytime napping has not been consistently observed. Whether napping is beneficial, neutral, or detrimental is an important issue, in light of conflicting findings regarding the impact of daytime napping on nighttime sleep and recent reports of an association between napping and adverse clinical outcomes, including increased mortality risk. Further research is needed to determine whether there is a cause-and-effect relationship between napping and insomnia, and between napping and adverse clinical outcomes, and to explore the clinical implications of improving insomnia and reducing daytime napping. Clinical evaluations of hypnotic agents should assess efficacy for both improving insomnia symptoms (particularly sleep-maintenance difficulty, in the case of elderly patients) and reducing daytime sleepiness that would lead to inadvertent napping.
Thompson, Miles D; Comings, David E; Abu-Ghazalah, Rashid; Jereseh, Yousef; Lin, Leo; Wade, Judy; Sakurai, Takeshi; Tokita, Shigeru; Yoshida, Tetsuo; Tanaka, Hirokazu; Yanagisawa, Masashi; Burnham, W McIntyre; Moldofsky, Harvey
The orexin-2/hypocretin-2 (OX2R) receptor gene is mutated in canine narcolepsy and disruption of the prepro-orexin/hypocretin ligand gene results in both an animal model of narcolepsy and sporadic cases of the human disease. This evidence suggests that the structure of the OX2R gene, and its homologue, the OX1R gene, both members of the G protein-coupled receptor (GPCR) family, and the gene encoding the peptide ligands, the prepro-orexin/hypocretin gene, may be variables in the etiology of sleep disorders. We report a single stranded conformational polymorphism (SSCP) analysis of the coding regions of these genes in idiopathic sleep disorder patients diagnosed with excessive daytime sleepiness (EDS) (n = 28), narcolepsy (n = 28), Tourette's syndrome/chronic vocal or motor tic disorder (n = 70), and control subjects (n = 110). Two EDS patients showed a Pro11Thr change. One Tourette's syndrome patient was found to have a Pro10Ser alteration. The Pro10Ser and Pro11Thr variants were not found in non-disease populations. Analysis of the ability of the mutant receptors to mobilize calcium compared to the wild-type receptor in response to orexin agonists indicated that they resulted in decreased potency at high (etaM) concentrations of orexin ligands. Further work is warranted to study the variability of the orexin/hypocretin system in a variety of disorders characterized by EDS. Copyright 2004 Wiley-Liss, Inc.
Full Text Available BACKGROUND: Modafinil is a novel wake-promoting agent approved by the FDA ameliorating excessive daytime sleepiness (EDS in three disorders: narcolepsy, shift work sleep disorder and obstructive sleep apnea. Existing trials of modafinil for fatigue and EDS associated with neurological disorders provided inconsistent results. This meta-analysis was aimed to assess drug safety and effects of modafinil on fatigue and EDS associated with neurological disorders. METHODS: A comprehensive literature review was conducted in order to identify published studies assessing the effects of modafinil on fatigue and EDS associated with neurological disorders. Primary outcomes included fatigue and EDS. Secondary outcomes included depression and adverse effects. FINDINGS: Ten randomized controlled trials were identified including 4 studies of Parkinson's disease (PD, 3 of multiple sclerosis (MS, 2 of traumatic brain injury (TBI and 1 of post-polio syndrome (PPS. A total of 535 patients were enrolled. Our results suggested a therapeutic effect of modafinil on fatigue in TBI (MD -0.82 95% CI -1.54 - -0.11 p=0.02, I(2=0%, while a beneficial effect of modafinil on fatigue was not confirmed in the pooled studies of PD or MS. Treatment results demonstrated a clear beneficial effect of modafinil on EDS in patients with PD (MD -2.45 95% CI -4.00 - -0.91 p=0.002 I(2=14%, but not with MS and TBI. No difference was seen between modafinil and placebo treatments in patients with PPS. Modafinil seemed to have no therapeutic effect on depression. Adverse events were similar between modafinil and placebo groups except that more patients were found with insomnia and nausea in modafinil group. CONCLUSIONS: Existing trials of modafinil for fatigue and EDS associated with PD, MS, TBI and PPS provided inconsistent results. The majority of the studies had small sample sizes. Modafinil is not yet sufficient to be recommended for these medical conditions until solid data are available.
Sheng, Ping; Hou, Lijun; Wang, Xiang; Wang, Xiaowen; Huang, Chengguang; Yu, Mingkun; Han, Xi; Dong, Yan
Modafinil is a novel wake-promoting agent approved by the FDA ameliorating excessive daytime sleepiness (EDS) in three disorders: narcolepsy, shift work sleep disorder and obstructive sleep apnea. Existing trials of modafinil for fatigue and EDS associated with neurological disorders provided inconsistent results. This meta-analysis was aimed to assess drug safety and effects of modafinil on fatigue and EDS associated with neurological disorders. A comprehensive literature review was conducted in order to identify published studies assessing the effects of modafinil on fatigue and EDS associated with neurological disorders. Primary outcomes included fatigue and EDS. Secondary outcomes included depression and adverse effects. Ten randomized controlled trials were identified including 4 studies of Parkinson's disease (PD), 3 of multiple sclerosis (MS), 2 of traumatic brain injury (TBI) and 1 of post-polio syndrome (PPS). A total of 535 patients were enrolled. Our results suggested a therapeutic effect of modafinil on fatigue in TBI (MD -0.82 95% CI -1.54 - -0.11 p=0.02, I(2)=0%), while a beneficial effect of modafinil on fatigue was not confirmed in the pooled studies of PD or MS. Treatment results demonstrated a clear beneficial effect of modafinil on EDS in patients with PD (MD -2.45 95% CI -4.00 - -0.91 p=0.002 I(2)=14%), but not with MS and TBI. No difference was seen between modafinil and placebo treatments in patients with PPS. Modafinil seemed to have no therapeutic effect on depression. Adverse events were similar between modafinil and placebo groups except that more patients were found with insomnia and nausea in modafinil group. Existing trials of modafinil for fatigue and EDS associated with PD, MS, TBI and PPS provided inconsistent results. The majority of the studies had small sample sizes. Modafinil is not yet sufficient to be recommended for these medical conditions until solid data are available.
Kim, Hyun; Thomas, Robert J; Yun, Chang-Ho; Au, Rhoda; Lee, Seung Ku; Lee, Sunghee; Shin, Chol
Research points to impaired cognitive performance in sleep clinic patients with obstructive sleep apnea (OSA). However, inconsistent findings from various epidemiologic studies make this relationship less generalizable. The current study investigated the association between OSA and functional outcome measures, such as cognition, daytime sleepiness, and quality of life, in a Korean general population sample. A total of 1492 participants from the Korean Genome and Epidemiology Study (KoGES) were included in the analyses. The presence of OSA measured by overnight polysomnography (PSG) was defined by apnea-hypopnea index (AHI) >5. Cognitive performance was determined with scores from a comprehensive neuropsychological battery. Excessive daytime sleepiness and quality of life were additionally measured through subjective reports. After adjusting for various demographic and medical characteristics, OSA was independently associated with lower performance in the Digit Symbol Test (52.73 ± 17.08 vs. 58.72 ± 18.03, OSA vs. not, p = .02). Hypoxia measures were not related to cognitive performance. OSA was associated with higher odds of displaying excessive daytime sleepiness (odds ratio = 1.72, 95% CI: 1.05-2.80), but there was no significant relationship between OSA and quality of life. Cognition was unexpectedly unaffected overall. However, OSA was associated with impairment in a multidomain test that taps skills generally associated with frontal lobe function. The results suggest that research on protective and adaptive brain mechanisms to OSA stress can provide unique insights into the brain-sleep interface. As the study runs longitudinally, it will enable future studies on the impact of OSA on cognitive decline.
Edoardo Alessandro Pulixi
Full Text Available BACKGROUND: A high prevalence of obstructive sleep apnea syndrome (OSAS has been reported in severely obese patients with nonalcoholic fatty liver disease (NAFLD, but few studies have evaluated OSAS in non-morbidly obese NAFLD patients. AIMS: To determine the prevalence of risk for OSAS with or without daytime sleepiness in non-morbidly obese patients with NAFLD and evaluate the association with the severity of liver damage. METHODS: We considered 159 consecutive patients with histological NAFLD and body mass index (BMI 1; 9/13, 69% vs. 39/146, 27%; p = 0.003. At multivariate logistic regression analysis, OSAS with sleepiness was strongly associated with NASH and fibrosis>1 independently of known clinical risk factors such as age, gender, BMI, diabetes, and ALT levels (OR 7.1, 95% c.i. 1.7-51, p = 0.005 and OR 14.0, 95% c.i. 3.5-70, p = 0.0002, respectively. CONCLUSIONS: A proportion of NAFLD patients without severe obesity is at risk for OSAS with daytime sleepiness, which is associated with the severity of liver damage independently of body mass and other cofactors.
Boschloo, Annemarie; Krabbendam, Lydia; Dekker, Sanne; Lee, Nikki; De Groot, Renate; Jolles, Jelle
This study investigated the relation between sleep and school performance in a large sample of 561 adolescents aged 11–18 years. Three subjective measures of sleep were used: sleepiness, sleep quality, and sleep duration. They were compared to three measures of school performance: objective school grades, self-reported school performance, and parent-reported school performance. Sleepiness – “I feel sleepy during the first hours at school” – appeared to predict both school grades and self-repo...
José Carlos Souza
Full Text Available OBJETIVO: O sono é um fenômeno que interfere nos aspectos cognitivos. O objetivo deste estudo foi avaliar a prevalência da sonolência diurna excessiva (SDE em pré-vestibulandos de Campo Grande, MS. MÉTODOS: Foram entrevistados 378 alunos com a escala de sonolência Epworth (ESE. As variáveis foram: sexo, uso esporádico de bebidas alcoólicas e fumo, relato de sinais e sintomas depressivos, renda familiar total dos membros do lar e idade. Foram empregados os testes qui-quadrado e de análise de variância. RESULTADOS: Em relação ao gênero, 50,3% eram homens e 49,7% mulheres; 39,2% ingeriam álcool; 6,6% fumavam e 33% já tinham tido depressão na vida. Entre os alunos, 55,8% tinham SDE, 5,3% eram indicativos de ter distúrbio respiratório ou síndrome da apnéia do sono. Foram detectadas associações entre as variáveis consumo de álcool e tabagismo, em relação à ESE. CONCLUSÕES: Foi alta a prevalência de SDE, sendo detectadas associações entre as variáveis uso esporádico de álcool e fumo, em relação à ESE. Novos estudos devem ser realizados a fim de prevenir as alterações cognitivas entre os pré-vestibulandos que apresentam SDE ou outro distúrbio do sono.OBJETIVE: Sleep is a phenomenon that has influence on cognitive aspects. The purpose of the present study was to evaluate the excessive daytime sleepiness (EDS prevalence. METHODS: 378 senior high school students from a school of Campo Grande-MS, Brazil, were interview with the Epworth Sleepiness Scale. The variables that were crosSDE with the scale were: sex, alcohol use, smoking, symptoms of depression, family income and age. For the analysis it was uSDE the chi2 test and the variance analysis test. RESULTS: Our sample consisted of 50,3% boys and 49,7% girls, 39,2% were alcohol drinkers, 6,6% were smokers and 33% had already had depression. The overall prevalence of EDS was 55,8% and of respiratory disturbance or sleep apnea was 5,3%. We found relationships
Chen, Tien-Yu; Chou, Yu-Ching; Tzeng, Nian-Sheng; Chang, Hsin-An; Kuo, Shin-Chang; Pan, Pei-Yin; Yeh, Yi-Wei; Yeh, Chin-Bin; Mao, Wei-Chung
The aim of the study reported here was to clarify the effects of academic pressure on fatigue, sleep problems, daytime sleepiness, and depression among senior high school adolescents in Taiwan. This cross-sectional study enrolled 757 senior high school adolescents who were classified into four groups: Grade 1 (n=261), Grade 2 (n=228), Grade 3T (n=199; Grade 3 students who had another college entrance test to take), and Grade 3S (n=69; Grade 3 students who had succeeded in their college application). Fatigue, sleep quality, daytime sleepiness, and depression were assessed using the Chinese version of the Multidimensional Fatigue Symptom Inventory - Short Form, Pittsburgh Sleep Quality Index-Taiwan Form, the Chinese version of the Epworth Sleepiness Scale, and the Chinese version of the Beck Depression Inventory(®)-II (BDI-II), respectively. Physical, emotional, and mental fatigue scores were all higher in higher-grade groups. The Grade 3T (test) students had the worst fatigue severity, and the Grade 3S (success) students had the least fatigue severity. More than half of the students (60.9%) went to bed after 12 am, and they had on average 6.0 hours of sleep per night. More than 30% of the students in Grade 2 (37.3%) and Grades 3T/S (30.2%/30.4%) possibly had daily sleepiness problems. The students in Grade 3T had the worst BDI-II score (13.27±9.24), and the Grade 3S students had a much lower BDI-II score (7.91±6.13). Relatively high proportions of fatigue, sleep problems, daytime sleepiness, and depression among senior high school adolescents were found in our study. The severities of fatigue, sleep problems, and depression were significantly diminished in the group under less academic stress (Grade 3S). Our findings may increase the understanding of the mental health of senior high school students under academic pressure in Taiwan. Further large sample size and population-based study should be done for better understanding about this topic.
Calhoun, Susan L; Vgontzas, Alexandros N; Fernandez-Mendoza, Julio; Mayes, Susan D; Tsaoussoglou, Marina; Basta, Maria; Bixler, Edward O
We investigated the prevalence and association of excessive daytime sleepiness (EDS) with a wide range of factors (e.g., medical complaints, obesity, objective sleep [including sleep disordered breathing], and parent-reported anxiety/depression and sleep difficulties) in a large general population sample of children. Few studies have researched the prevalence and predictors of EDS in young children, none in a general population sample of children, and the results are inconsistent. Cross-sectional Population -based. 508 school-aged children from the general population. N/A. Children underwent a 9-hour polysomnogram (PSG), physical exam, and parent completed health, sleep and psychological questionnaires. Children were divided into 2 groups: those with and without parent reported EDS. The prevalence of subjective EDS was approximately 15%. Significant univariate relationships were found between children with EDS and BMI percentile, waist circumference, heartburn, asthma, and parent reported anxiety/depression, and sleep difficulties. The strongest predictors of EDS were waist circumference, asthma, and parent-reported symptoms of anxiety/depression and trouble falling asleep. All PSG sleep variables including apnea/hypopnea index, caffeine consumption, and allergies were not significantly related to EDS. It appears that the presence of EDS is more strongly associated with obesity, asthma, parent reported anxiety/depression, and trouble falling asleep than with sleep disordered breathing (SDB) or objective sleep disruption per se. Our findings suggest that children with EDS should be thoroughly assessed for anxiety/depression, nocturnal sleep difficulties, asthma, obesity, and other metabolic factors, whereas objective sleep findings may not be as clinically useful.
Signal, T Leigh; Paine, Sarah-Jane; Sweeney, Bronwyn; Priston, Monique; Muller, Diane; Smith, Alexander; Lee, Kathryn A; Huthwaite, Mark; Reid, Papaarangi; Gander, Philippa
To compare the prevalence of self-reported abnormal sleep duration and excessive daytime sleepiness in pregnancy among Māori (indigenous New Zealanders) and non-Māori women versus the general population, and to examine the influence of socio-demographic factors. Self-reported total sleep time (TST) in 24-hrs, Epworth Sleepiness Scale scores and socio-demographic information were obtained from nullipara and multipara women aged 20-46 yrs at 35-37 weeks pregnant (358 Māori and 717 non-Māori), and women in the general population (381 Māori and 577 non-Māori). After controlling for ethnicity, age, socio-economic status, and employment status, pregnant women average 30 min less TST than women in the general population. The distribution of TST was also greater in pregnant women, who were 3 times more likely to be short sleepers (≤6 h) and 1.9 times more likely to be long sleepers (>9 h). In addition, pregnant women were 1.8 times more likely to report excessive daytime sleepiness (EDS). Pregnant women >30 years of age experienced greater age-related declines in TST. Identifying as Māori, being unemployed, and working at night increased the likelihood of reporting abnormal sleep duration across all women population in this study. EDS also more likely occurred among Māori women and women who worked at night. Pregnancy increases the prevalence of abnormal sleep duration and EDS, which are also higher among Māori than non-Māori women and those who do night work. Health professionals responsible for the care of pregnant women need to be well-educated about the importance of sleep and discuss sleep issues with the women they care for. Copyright © 2014 Elsevier B.V. All rights reserved.
Boschloo, Annemarie; Krabbendam, Lydia; Dekker, Sanne; Lee, Nikki; De Groot, Renate; Jolles, Jelle
This study investigated the relation between sleep and school performance in a large sample of 561 adolescents aged 11–18 years. Three subjective measures of sleep were used: sleepiness, sleep quality, and sleep duration. They were compared to three measures of school performance: objective school
Boschloo, Annemarie; Krabbendam, Lydia; Dekker, Sanne; Lee, Nikki; De Groot, Renate; Jolles, Jelle
This study investigated the relation between sleep and school performance in a large sam- ple of 561 adolescents aged 11–18 years. Three subjective measures of sleep were used: sleepiness, sleep quality, and sleep duration. They were compared to three measures of school performance: objective school
Boschloo, A.; Krabbendam, L.; Dekker, S.; Lee, N.; Groot, R. de; Jolles, J.
This study investigated the relation between sleep and school performance in a large sample of 561 adolescents aged 11-18 years. Three subjective measures of sleep were used: sleepiness, sleep quality, and sleep duration. They were compared to three measures of school performance: objective school
Full Text Available Tien-Yu Chen,1,2 Yu-Ching Chou,3 Nian-Sheng Tzeng,1,2,4 Hsin-An Chang,1,2,4 Shin-Chang Kuo,1,2,5 Pei-Yin Pan,1,2 Yi-Wei Yeh,1,2,5 Chin-Bin Yeh,1,2 Wei-Chung Mao1,2,6 1Department of Psychiatry, Tri-Service General Hospital, 2School of Medicine, National Defense Medical Center, 3School of Public Health, National Defense Medical Center, 4Student Counseling Center, National Defense Medical Center, 5Graduate Institute of Medical Sciences, National Defense Medical Center, 6Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan, Republic of China Objective: The aim of the study reported here was to clarify the effects of academic pressure on fatigue, sleep problems, daytime sleepiness, and depression among senior high school adolescents in Taiwan. Methods: This cross-sectional study enrolled 757 senior high school adolescents who were classified into four groups: Grade 1 (n=261, Grade 2 (n=228, Grade 3T (n=199; Grade 3 students who had another college entrance test to take, and Grade 3S (n=69; Grade 3 students who had succeeded in their college application. Fatigue, sleep quality, daytime sleepiness, and depression were assessed using the Chinese version of the Multidimensional Fatigue Symptom Inventory – Short Form, Pittsburgh Sleep Quality Index-Taiwan Form, the Chinese version of the Epworth Sleepiness Scale, and the Chinese version of the Beck Depression Inventory®-II (BDI-II, respectively. Results: Physical, emotional, and mental fatigue scores were all higher in higher-grade groups. The Grade 3T (test students had the worst fatigue severity, and the Grade 3S (success students had the least fatigue severity. More than half of the students (60.9% went to bed after 12 am, and they had on average 6.0 hours of sleep per night. More than 30% of the students in Grade 2 (37.3% and Grades 3T/S (30.2%/30.4% possibly had daily sleepiness problems. The students in Grade 3T had the worst BDI-II score (13.27±9.24, and the Grade 3S
Efficacy and safety of adjunctive modafinil treatment on residual excessive daytime sleepiness among nasal continuous positive airway pressure-treated japanese patients with obstructive sleep apnea syndrome: a double-blind placebo-controlled study.
Inoue, Yuichi; Takasaki, Yuji; Yamashiro, Yoshihiro
This double-blind study evaluated the efficacy and safety of modafinil for treating excessive daytime sleepiness in Japanese patients with obstructive sleep apnea syndrome (OSAS). Patients with residual excessive sleepiness (Epworth Sleepiness Scale [ESS] ≥ 11) on optimal nasal continuous positive airway pressure (nCPAP) therapy (apnea-hypopnea index ≤ 10) were randomized to either 200 mg modafinil (n = 52) or placebo (n = 62) once daily for 4 weeks. Outcomes included baseline-week 4 changes in ESS total score, sleep latency on maintenance of wakefulness test (SL-MWT), nocturnal polysomnography, Pittsburgh Sleep Quality Index (PSQI), and safety. All 114 randomized patients completed the study. Mean change in ESS total score (-6.6 vs -2.4, p modafinil than with placebo. ESS total score decreased from > 11 to modafinil-treated patients and 30.6% of placebo-treated patients (p modafinil and placebo groups, respectively (p = 0.146). Once-daily modafinil was effective and well tolerated for managing residual daytime sleepiness in Japanese OSAS patients with residual excessive daytime sleepiness on optimal nCPAP therapy.
Full Text Available Natasha J Williams,1 Girardin Jean-Louis,1 Abhishek Pandey,2 Joseph Ravenell,1 Carla Boutin-Foster,3 Gbenga Ogedegbe1 1Center for Healthful Behavior Change, Division of Internal Medicine, NYU Medical Center, New York, 2Department of Family Medicine, SUNY Downstate Medical Center, Brooklyn, 3Center of Excellence in Disparities Research, Weill Cornell Medical College, New York, NY, USA Background: Excessive daytime sleepiness (EDS often occurs as a result of insufficient sleep, sleep apnea, illicit substance use, and other medical and psychiatric conditions. This study tested the hypothesis that blacks exhibiting EDS would have poorer self-reported adherence to hypertensive medication using cross-sectional data from the Counseling African-Americans to Control Hypertension (CAATCH trial. Methods: A total of 1,058 hypertensive blacks (average age 57±12 years participated in CAATCH, a randomized controlled trial evaluating the effectiveness of a multilevel intervention for participants who receive care from community health centers in New York City. Data analyzed in this study included baseline sociodemographics, medical history, EDS, and medication adherence. We used the Epworth Sleepiness Scale, with a cutoff score of ≥10, to define EDS. Medication adherence was measured using an abbreviated Morisky Medication Adherence scale, with a score >0 indicating nonadherence. Results: Of the sample, 71% were female, 72% received at least a high school education, 51% reported a history of smoking, and 33% had a history of alcohol consumption. Overall, 27% of the participants exhibited EDS, and 44% of those who exhibited EDS were classified as adherent to prescribed antihypertensive medications. Multivariable logistic regression analysis, adjusting for effects of age, body mass index, sex, education, and smoking and drinking history indicated that participants who exhibited EDS were more than twice as likely to be nonadherent (odds ratio 2.28, 95
Full Text Available This study investigated the relation between sleep and school performance in a large sample of 561 adolescents aged 11-18 years. Three subjective measures of sleep were used: sleepiness, sleep quality and sleep duration. They were compared to three measures of school performance: objective school grades, self-reported school performance, and parent-reported school performance. Sleepiness – ‘I feel sleepy during the first hours at school’ – appeared to predict both school grades and self-reported school performance. Sleep quality on the other hand – as a measure of (uninterrupted sleep and/or problems falling asleep or waking up – predicted parent-reported school performance. Self- and parent-reported school performance correlated only moderately with school grades. So it turns out that the measures used to measure either sleep or school performance impacts whether or not a relation is found. Further research on sleep and school performance should take this into account. The findings do underscore the notion that sleep in adolescence can be important for learning. They are compatible with the hypothesis that a reduced sleep quality can give rise to sleepiness in the first hours at school which results in lower school performance. This notion could have applied value in counseling adolescents and their parents in changing adolescents’ sleep behavior.
Boschloo, Annemarie; Krabbendam, Lydia; Dekker, Sanne; Lee, Nikki; de Groot, Renate; Jolles, Jelle
This study investigated the relation between sleep and school performance in a large sample of 561 adolescents aged 11-18 years. Three subjective measures of sleep were used: sleepiness, sleep quality, and sleep duration. They were compared to three measures of school performance: objective school grades, self-reported school performance, and parent-reported school performance. Sleepiness - "I feel sleepy during the first hours at school" - appeared to predict both school grades and self-reported school performance. Sleep quality on the other hand - as a measure of (un)interrupted sleep and/or problems falling asleep or waking up - predicted parent-reported school performance. Self- and parent-reported school performance correlated only moderately with school grades. So it turns out that the measures used to measure either sleep or school performance impacts whether or not a relation is found. Further research on sleep and school performance should take this into account. The findings do underscore the notion that sleep in adolescence can be important for learning. They are compatible with the hypothesis that a reduced sleep quality can give rise to sleepiness in the first hours at school which results in lower school performance. This notion could have applied value in counseling adolescents and their parents in changing adolescents' sleep behavior.
Happe, S; Berger, K
Reports that dopamine agonists (DA) precipitate sudden daytime sleep episodes in Parkinson's disease (PD) patients have received widespread attention. It remains unclear if non-ergoline and ergoline DAs have differential sedating effects or if sedation rather represents a class effect of DAs. The aim of this study was the evaluation of sleep disturbances and the quality of life (QoL) in PD patients with different dopaminergic treatment strategies. This analysis is part of the FAQT-study, a prospective German cohort study evaluating determinants of QoL in PD patients. A subgroup of 111 PD patients was evaluated twice, at baseline and after one year of follow-up, using standardised and validated questionnaires (Unified Parkinson's disease rating scale (UPDRS), Hoehn and Yahr classification, Center for Epidemiologic Studies Depression Scale (CESD), Short Form-36 (SF-36), Parkinson Disease Questionnaire (PDQ-39)). The impact of treatment strategies on sleep problems, daytime sleepiness, bad dreams and hallucinations, depression and QoL in PD patients was analysed separately for ergoline DAs, non-ergoline DAs and the patient group taking no DA. At baseline, sleep problems were reported by about one third of the patients with and without DA medication. Excessive daytime sleepiness (EDS) was higher in the two DA groups (ergoline 11.9%, non-ergoline 9.1%) than among patients not taking DAs (4.5 %). At follow-up, sleep problems in general had decreased among patients taking DAs continuously and among those newly taking DAs, while the sleep problems increased in patients discontinuing DAs. However, EDS had increased to 25% in patients newly taking DAs, and decreased to 15.9% in those taking them continuously. QoL scores at follow-up were slightly increased in the patient groups newly taking and discontinuing DAs (the latter except in physical functioning) while those on continuing DA-medication remained unchanged. No differential effects of ergoline or non-ergoline DAs on
Umlauf, Mary Grace; Bolland, Anneliese C; Bolland, Kathleen A; Tomek, Sara; Bolland, John M
Although sleep problems are associated with negative outcomes among adolescents, studies have not focused on sleep disorder symptoms among adolescents living in impoverished neighborhoods and how sleep problems may be related to two factors common in those environments: hopelessness and exposure to violence. This study used data from the longitudinal Mobile Youth Survey (MYS; N = 11,838, 49% female, 93% African-American) to examine trajectories of sleep problems by age (10-18 years) among impoverished adolescents as a function of gender, feelings of hopelessness, and exposure to violence. The results indicate that sleep problems associated with traumatic stress decline with age, with four notable distinctions. First, the steepest decline occurs during the early adolescent years. Second, the rate of decline is steeper for males than for females. Third, exposure to violence impedes the rate of decline for all adolescents, but more dramatically for females than for males. Fourth, the rate of decline is smallest for adolescents with feelings of hopelessness who also had been exposed to violence. To explore the generalizability of these results to other types of sleep disorders, we analyzed cross-sectional data collected from a subsample of 14- and 15-year-old MYS participants (N = 263, 49% female, 100% African-American) who completed a sleep symptoms questionnaire. Four results from the cross-sectional analysis extend the findings of the longitudinal analysis. First, the cross-sectional results showed that symptoms of apnea, insomnia, nightmares, and restless legs syndrome or periodic limb movement disorder (RLS/PLMD), as well as daytime sleepiness, increase as a function of hopelessness. Second, symptoms of insomnia, RLS, and nightmares, as well as daytime sleepiness, increase as function of exposure to violence. Third, symptoms of insomnia and RLS/PLMD are greater under conditions of combined hopelessness and exposure to violence than for either condition alone
Strijkstra, Arjen M.; Beersma, Domien G.M.; Drayer, Berdine; Halbesma, Nynke; Daan, Serge
Subjective sleepiness is part of the system controlling the decision to go to sleep in humans. Extended periods of waking lead to increased sleepiness, as well as to changes in cortical electroencephalogram (EEG) during waking. We investigated the association of sleepiness and awake EEG spectra
Strijkstra, AM; Beersma, DGM; Drayer, B; Halbesma, N; Daan, S
Subjective sleepiness is part of the system controlling the decision to go to sleep in humans. Extended periods of waking lead to increased sleepiness, as well as to changes in cortical electroencephalogram (EEG) during waking. We investigated the association of sleepiness and awake EEG spectra
Montgomery, P; Wiggs, L
Sleep disturbances are common in children with attention-deficit hyperactivity disorder (ADHD). Sleeplessness is frequently reported although results are inconsistent perhaps because different definitions for it are applied. This study looked at maternal functioning and child objective sleep patterns in relation to different definitions of sleeplessness in children with ADHD. The study included 45 children (aged 3-14 years) with ADHD and their mothers. Sleeplessness was defined according to: (i) yes/no report of whether mothers thought their children had a problem with sleeplessness (Maternal definition MD) and (ii) mothers' responses to a quantitative standardized questionnaire (Quantitative definition QD) designed to detect the frequency and duration of parent-reported problems with settling, night waking and early waking. Objective sleep patterns were also assessed by means of actigraphy. Maternal mental health, daytime sleepiness and cognitions related to child sleep were assessed by questionnaire. Both definitions appeared to tap similar although slightly different constructs. There were no group differences in objective sleep patterns. Maternal mental health was found to be significantly worse in the mothers who considered their child to be sleepless (MD) (P children (MD and QD), the mothers had significantly more doubts about their competency as a parent (P children without sleeplessness. Two different maternal assessments of child sleeplessness in children with ADHD may assess subtly different constructs, but both may provide useful information about potential problems across the family. © 2014 John Wiley & Sons Ltd.
José Carlos Souza
Full Text Available The prevalence of excessive daytime sleepiness (EDS in general population was determined by means of 408 home interviews of adults, in a representative sample of Campo Grande city, Brazil. The random sample was stratified by sex, age and economic social status. EDS was considered in those with indexes 11 or more in the Epworth Sleepiness Scale. Statistics used chi-square, Fisher and Pearson tests; and inferences based on binomial distribution parameters; the significance level was 5% and confidence interval (CI was 95%. The prevalence of EDS was 18.9% of the general population ( SD=1.9%; CI 15.1% to 22.7%. No significant association was found between EDS and the use of hypnotics, nor with insomnia, body mass index, sex, age, years of schooling, economic social status, marital status, occupation and the use of alternative means to improve sleep. When the sample was separated according to sex, only the male group showed significant association between EDS and actual insomnia (p=0.005.Buscou-se a prevalência da sonolência diurna excessiva (SDE com 408 entrevistas domiciliares de adultos, em amostra representativa da população geral da cidade de Campo Grande, MS. A amostragem aleatória foi estratificada por sexo, idade e classe social. Tinham SDE as pessoas com 11 ou mais pontos na Escala de Sonolência Epworth. Usaram-se os testes de qui-quadrado, Fisher, Pearson e inferências com base nos parâmetros da distribuição binomial; nível de significância 5% e intervalo de confiança (IC 95%. Tinham SDE 18,9% da população (dp=1,9%; IC 15,1% a 22,7%; não houve associação significativa entre SDE e uso de hipnóticos, nem insônia, índice de massa corporal, sexo, idade, escolaridade, classe sócio-econômica, estado civil, ocupação e uso de meios alternativos para dormir melhor. Ao serem separados de acordo com sexo, apenas no sexo masculino houve associação significativa entre SDE e presença de insônia (p=0,005.
Andrianasolo, Roland M; Menai, Mehdi; Galan, Pilar; Hercberg, Serge; Oppert, Jean-Michel; Kesse-Guyot, Emmanuelle; Andreeva, Valentina A
The potential benefit of physical activity in terms of decreasing excessive daytime sleepiness (EDS) prevalence is unclear, especially in aging adults. We aimed to elucidate the associations among physical activity, sedentariness, and EDS in middle-aged and older adults. We conducted a cross-sectional analysis using data from a subsample of participants in the SU.VI.MAX-2 observational study (2007-2009; N = 4179; mean age = 61.9 years). EDS was defined as a score >10 on the Epworth Sleepiness Scale. Leisure-time physical activity and different types of sedentary behavior were assessed with the Modifiable Activity Questionnaire. The associations were examined with multivariable logistic regression models. In the adjusted multivariable model, total leisure-time physical activity (modeled in quartiles, Q) was significantly, inversely associated with EDS (odds ratios (OR)Q4 vs Q1 = 0.70, 95 % confidence interval (CI) = 0.54-0.89). The association persisted in analyses restricted to individuals not taking sleep medication (ORQ4 vs Q1 = 0.72, 95 % CI = 0.54-0.95). In turn, time spent watching television and time spent reading appeared protective against EDS (ORQ4 vs Q1 = 0.73, 95 % CI = 0.57-0.94; ORQ4 vs Q1 = 0.76, 95 % CI = 0.60-0.97, respectively), whereas time spent on a computer appeared to confer an increased risk for EDS (ORQ4 vs Q1 = 1.30, 95 % CI = 1.05-1.62). When physical activity and sedentariness were modeled jointly, using WHO recommendation-based cutoffs for high/low levels, no significant associations were observed in the fully adjusted models. The findings reinforce public health recommendations promoting behavior modification and specifically moderate-intensity exercise in middle-aged and older adults. The association of high physical activity/low sedentariness with EDS, which was not supported by the data, merits further investigation before firm conclusions could be drawn.
Lafortune, Marjolaine; Gagnon, Jean-François; Latreille, Véronique; Vandewalle, Gilles; Martin, Nicolas; Filipini, Daniel; Doyon, Julien; Carrier, Julie
Cortical synchronization during NREM sleep, characterized by electroencephalographic slow waves (SW 75 µV), is strongly related to the number of hours of wakefulness prior to sleep and to the quality of the waking experience. Whether a similar increase in wakefulness length leads to a comparable enhancement in NREM sleep cortical synchronization in young and older subjects is still a matter of debate in the literature. Here we evaluated the impact of 25-hours of wakefulness on SW during a daytime recovery sleep episode in 29 young (27y ±5), and 34 middle-aged (51y ±5) subjects. We also assessed whether age-related changes in NREM sleep cortical synchronization predicts the ability to maintain sleep during daytime recovery sleep. Compared to baseline sleep, sleep efficiency was lower during daytime recovery sleep in both age-groups but the effect was more prominent in the middle-aged than in the young subjects. In both age groups, SW density, amplitude, and slope increased whereas SW positive and negative phase duration decreased during daytime recovery sleep compared to baseline sleep, particularly in anterior brain areas. Importantly, compared to young subjects, middle-aged participants showed lower SW density rebound and SW positive phase duration enhancement after sleep deprivation during daytime recovery sleep. Furthermore, middle-aged subjects showed lower SW amplitude and slope enhancements after sleep deprivation than young subjects in frontal and prefrontal derivations only. None of the SW characteristics at baseline were associated with daytime recovery sleep efficiency. Our results support the notion that anterior brain areas elicit and may necessitate more intense recovery and that aging reduces enhancement of cortical synchronization after sleep loss, particularly in these areas. Age-related changes in the quality of wake experience may underlie age-related reduction in markers of cortical synchronization enhancement after sustained wakefulness. PMID
Full Text Available Cortical synchronization during NREM sleep, characterized by electroencephalographic slow waves (SW 75 µV, is strongly related to the number of hours of wakefulness prior to sleep and to the quality of the waking experience. Whether a similar increase in wakefulness length leads to a comparable enhancement in NREM sleep cortical synchronization in young and older subjects is still a matter of debate in the literature. Here we evaluated the impact of 25-hours of wakefulness on SW during a daytime recovery sleep episode in 29 young (27 y ± 5, and 34 middle-aged (51 y ± 5 subjects. We also assessed whether age-related changes in NREM sleep cortical synchronization predicts the ability to maintain sleep during daytime recovery sleep. Compared to baseline sleep, sleep efficiency was lower during daytime recovery sleep in both age-groups but the effect was more prominent in the middle-aged than in the young subjects. In both age groups, SW density, amplitude, and slope increased whereas SW positive and negative phase duration decreased during daytime recovery sleep compared to baseline sleep, particularly in anterior brain areas. Importantly, compared to young subjects, middle-aged participants showed lower SW density rebound and SW positive phase duration enhancement after sleep deprivation during daytime recovery sleep. Furthermore, middle-aged subjects showed lower SW amplitude and slope enhancements after sleep deprivation than young subjects in frontal and prefrontal derivations only. None of the SW characteristics at baseline were associated with daytime recovery sleep efficiency. Our results support the notion that anterior brain areas elicit and may necessitate more intense recovery and that aging reduces enhancement of cortical synchronization after sleep loss, particularly in these areas. Age-related changes in the quality of wake experience may underlie age-related reduction in markers of cortical synchronization enhancement after
Full Text Available We aimed to identify novel molecular associations between chronic intermittent hypoxia with re-oxygenation and adverse consequences in obstructive sleep apnea (OSA. We analyzed gene expression profiles of peripheral blood mononuclear cells from 48 patients with sleep-disordered breathing stratified into four groups: primary snoring (PS, moderate to severe OSA (MSO, very severe OSA (VSO, and very severe OSA patients on long-term continuous positive airway pressure treatment (VSOC. Comparisons of the microarray gene expression data identified eight genes up-regulated with OSA and down-regulated with CPAP treatment, and five genes down-regulated with OSA and up-regulated with CPAP treatment. Protein expression levels of two genes related to endothelial tight junction (AMOT P130, and PLEKHH3, and three genes related to anti-or pro-apoptosis (BIRC3, ADAR1 P150, and LGALS3 were all increased in the VSO group, while AMOT P130 was further increased, and PLEKHH3, BIRC3, and ADAR1 P150 were all decreased in the VSOC group. Subgroup analyses revealed that AMOT P130 protein expression was increased in OSA patients with excessive daytime sleepiness, BIRC3 protein expression was decreased in OSA patients with hypertension, and LGALS3 protein expression was increased in OSA patients with chronic kidney disease. In vitro short-term intermittent hypoxia with re-oxygenation experiment showed immediate over-expression of ADAR1 P150. In conclusion, we identified a novel association between AMOT/PLEKHH3/BIRC3/ADAR1/LGALS3 over-expressions and high severity index in OSA patients. AMOT and GALIG may constitute an important determinant for the development of hypersomnia and kidney injury, respectively, while BIRC3 may play a protective role in the development of hypertension.
Wen, Ming-Ching; Ng, Samuel Y E; Heng, Hannah S E; Chao, Yin Xia; Chan, Ling Ling; Tan, Eng King; Tan, Louis C S
Excessive daytime sleepiness (EDS) is a common non-motor symptom in Parkinson's disease (PD), but its neuropathology remains elusive due to the limited studies and the inclusion of medicated patients. This current study examined the neural substrates of EDS in drug naïve PD patients. A total of 76 PD patients in the early disease stages were recruited; 16 of them had EDS, while the remaining 60 did not. Resting state functional magnetic resonance imaging (rs-fMRI) was used to determine group differences (patients with EDS vs. patients without EDS) in spontaneous neural activity indicated by regional homogeneity (ReHo). Additionally, functional connectivity (FC) of the regions showing group differences in ReHo with the entire brain was performed. ReHo analysis controlling for gray matter volume, age, gender, general cognition, depression, postural instability gait difficulty, and rapid eye movement sleep behavior disorder showed decreased ReHo in the left cerebellum and inferior frontal gyrus, but increased ReHo in the left paracentral lobule in PD-EDS patients, compared with patients without EDS. FC analysis controlling for the same variables as in the analysis of ReHo revealed that the three regions showing ReHo differences had decreased FC with regions in the frontal, temporal, insular and limbic lobes and cerebellum in PDs with EDS. While decreases in ReHo and FC were found, increases in ReHo were also noted, implying both neural downregulation and compensatory mechanisms in early PD patients with EDS. Longitudinal studies are warranted to clarify the long-term impact of EDS in PD. Copyright © 2016 Elsevier Ltd. All rights reserved.
Guglielmi, Ottavia; Dini, Guglielmo; Bersi, Francesca; Fornarino, Stefania; Toletone, Alessandra; Chiorri, Carlo
Background Recent research has found evidence of an association between motor vehicle accidents (MVAs) or near miss accidents (NMAs), and excessive daytime sleepiness (EDS) or its main medical cause, Obstructive Sleep Apnea (OSA). However, EDS can also be due to non-medical factors, such as sleep debt (SD), which is common among professional truck drivers. On the opposite side, rest breaks and naps are known to protect against accidents. Study Objectives To investigate the association of OSA, SD, EDS, rest breaks and naps, with the occurrence of MVAs and NMAs in a large sample of truck drivers. Methods 949 male truck drivers took part in a cross-sectional medical examination and were asked to complete a questionnaire about sleep and waking habits, risk factors for OSA and EDS. Results MVAs and NMAs were reported by 34.8% and 9.2% of participants, respectively. MVAs were significantly predicted by OSA (OR = 2.32 CI95% = 1.68–3.20), SD (OR = 1.45 CI95% = 1.29–1.63), EDS (OR = 1.73 CI95% = 1.15–2.61) and prevented by naps (OR = 0.59 CI95% = 0.44–0.79) or rest breaks (OR = 0.63 CI95% = 0.45–0.89). NMAs were significantly predicted by OSA (OR = 2.39 CI95% = 1.47–3.87) and SD (OR = 1.49 CI95% = 1.27–1.76) and prevented by naps (OR = 0.52 CI95% = 0.32–0.85) or rest breaks (OR = 0.49 CI95% = 0.29–0.82). Conclusions When OSA, SD or EDS are present, the risk of MVAs or NMAs in truck drivers is severely increased. Taking a rest break or a nap appear to be protective against accidents. PMID:27902703
Black, Jed; Swick, Todd; Bogan, Richard; Lai, Chinglin; Carter, Lawrence P
Effects of sodium oxybate (SXB) on patients with narcolepsy with cataplexy (NC) or without cataplexy (NWOC) have not been separately evaluated in clinical trials. Retrospective analysis evaluated data from a phase 3, randomized, placebo-controlled trial of SXB, modafinil, and SXB + modafinil versus placebo in adult NC patients (n = 95) or NWOC patients (n = 127). NC patients were identified based on medical history, concomitant medications, and sleep-onset REM periods on nocturnal polysomnography. The studied outcomes were changes from baseline at eight weeks on the Epworth Sleepiness Scale (ESS), the Maintenance of Wakefulness Test (MWT), and the Clinical Global Impression of Change (CGI-C). Among NC and NWOC patients, ESS improvement was significantly greater with SXB and SXB + modafinil versus placebo. In NC patients, mean MWT sleep latency was significantly increased with SXB + modafinil versus placebo. In NWOC patients, mean MWT sleep latency significantly increased in all groups versus placebo. Higher percentages of patients in the SXB and SXB + modafinil groups were "very much improved" or "much improved" on the CGI-C versus placebo in both NC and NWOC populations, although the difference did not reach statistical significance in the NWOC populations. Adverse events were consistent with previously-reported profiles for modafinil and SXB. Nausea was more common in the SXB and SXB + modafinil groups. Dizziness and tremor were more common in the SXB + modafinil group only. SXB alone and in combination with modafinil improved subjective ratings of excessive sleepiness and an objective measure of the ability to stay awake to similar extents in NC patients and NWOC patients. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.
Pejovic, Slobodanka; Basta, Maria; Vgontzas, Alexandros N; Kritikou, Ilia; Shaffer, Michele L; Tsaoussoglou, Marina; Stiffler, David; Stefanakis, Zacharias; Bixler, Edward O; Chrousos, George P
.... To assess whether extended recovery sleep reverses the effects of mild sleep restriction on sleepiness/alertness, inflammation, and stress hormones, 30 healthy young men and women (mean age ± SD, 24.7 ± 3.5 yr...
Full Text Available Objective: To identify self-reported sleep-wake disturbances that increase the risk of cognitive decline over 1-year follow-up in frail participants.Background: Risk factors for cognitive impairment need to be better identified especially at earliest stages of the pathogenesis. Sleep-wake disturbances may be critical factors to consider and were thus being assessed in this at-risk population for cognitive decline.Methods: Frail elderly participants aged ≥70 years were selected from a subsample of the Multi-domain Alzheimer Preventive Trial (MAPT for a sleep assessment (MAPT-sleep study at 18-month follow-up (M18. Sleep-wake disturbances were evaluated using a clinical interview (duration of daytime and nighttime sleep, time in bed, number of naps, and presence of clinically-defined sleep disorders and numerous validated questionnaires [Epworth Sleepiness Scale for excessive daytime sleepiness (EDS, Insomnia Severity Scale and Berlin Questionnaire]. Cognitive decline was defined as a difference between the MMSE and cognitive composite scores at M24 and M36 that was ranked in the lowest decile. Multivariate logistic regression models adjusted for several potential confounding factors were performed.Results: Among the 479 frail participants, 63 developed MMSE-cognitive decline and 50 cognitive composite score decrease between M24 and M36. Subjects with EDS had an increased risk of MMSE decline (OR = 2.46; 95% CI [1.28; 4.71], p = 0.007. A longer time spent in bed during night was associated with cognitive composite score decline (OR = 1.32 [1.03; 1.71], p = 0.03. These associations persisted when controlling for potential confounders. Patients with MMSE score decline and EDS had more naps, clinically-defined REM-sleep Behavior Disorder, fatigue and insomnia symptoms, while patients with cognitive composite score decline with longer time in bed had increased 24-h total sleep time duration but with higher wake time after onset.Conclusions: The risk
Gotts, Zoe M; Ellis, Jason G; Deary, Vincent; Barclay, Nicola; Newton, Julia L
The precise relationship between sleep and physical and mental functioning in chronic fatigue syndrome (CFS) has not been examined directly, nor has the impact of daytime napping. This study aimed to examine self-reported sleep in patients with CFS and explore whether sleep quality and daytime napping, specific patient characteristics (gender, illness length) and levels of anxiety and depression, predicted daytime fatigue severity, levels of daytime sleepiness and cognitive functioning, all key dimensions of the illness experience. 118 adults meeting the 1994 CDC case criteria for CFS completed a standardised sleep diary over 14 days. Momentary functional assessments of fatigue, sleepiness, cognition and mood were completed by patients as part of usual care. Levels of daytime functioning and disability were quantified using symptom assessment tools, measuring fatigue (Chalder Fatigue Scale), sleepiness (Epworth Sleepiness Scale), cognitive functioning (Trail Making Test, Cognitive Failures Questionnaire), and mood (Hospital Anxiety and Depression Scale). Hierarchical Regressions demonstrated that a shorter time since diagnosis, higher depression and longer wake time after sleep onset predicted 23.4% of the variance in fatigue severity (p naps predicted 25.6% of the variance in objective cognitive dysfunction (p napping predicted 32.2% of the variance in subjective cognitive dysfunction (p naps, those who mainly napped in the afternoon, and those with higher levels of anxiety, were more likely to be in the moderately sleepy group. Napping, particularly in the afternoon is associated with poorer cognitive functioning and more daytime sleepiness in CFS. These findings have clinical implications for symptom management strategies.
Ftouni, Suzanne; Sletten, Tracey L; Howard, Mark; Anderson, Clare; Lenné, Michael G; Lockley, Steven W; Rajaratnam, Shantha M W
To assess the relationships between sleepiness and the incidence of adverse driving events in nurses commuting to and from night and rotating shifts, 27 rotating and permanent night shift-working nurses were asked to complete daily sleep and duty logs, and wear wrist-activity monitors for 2 weeks (369 driving sessions). During all commutes, ocular measures of drowsiness, including the Johns Drowsiness Scale score, were assessed using the Optalert™ system. Participants self-reported their subjective sleepiness at the beginning and end of each drive, and any events that occurred during the drive. Rotating shift nurses reported higher levels of sleepiness compared with permanent night shift nurses. In both shift-working groups, self-reported sleepiness, drowsiness and drive events were significantly higher during commutes following night shifts compared with commutes before night shifts. Strong associations were found between objective drowsiness and increased odds of driving events during commutes following night shifts. Maximum total blink duration (mean = 7.96 s) during the drive and pre-drive Karolinska Sleepiness Scale (mean = 5.0) were associated with greater incidence of sleep-related events [OR, 5.35 (95% CI, 1.32, 21.60), OR, 1.69 (95% CI, 1.04, 2.73), respectively]. Inattention was strongly associated with a Johns Drowsiness Scale score equal to or above 4.5 [OR, 4.58 (95% CI, 1.26-16.69)]. Hazardous driving events were more likely to occur when drivers had been awake for 16 h or more [OR, 4.50 (95% CI, 1.81, 11.16)]. Under real-world driving conditions, shift-working nurses experience high levels of drowsiness as indicated by ocular measures, which are associated with impaired driving performance following night shift work. © 2012 European Sleep Research Society.
Pejovic, Slobodanka; Basta, Maria; Vgontzas, Alexandros N.; Kritikou, Ilia; Shaffer, Michele L.; Tsaoussoglou, Marina; Stiffler, David; Stefanakis, Zacharias; Bixler, Edward O.; Chrousos, George P
One workweek of mild sleep restriction adversely impacts sleepiness, performance, and proinflammatory cytokines. Many individuals try to overcome these adverse effects by extending their sleep on weekends. To assess whether extended recovery sleep reverses the effects of mild sleep restriction on sleepiness/alertness, inflammation, and stress hormones, 30 healthy young men and women (mean age ± SD, 24.7 ± 3.5 yr; mean body mass index ± SD, 23.6 ± 2.4 kg/m2) participated in a sleep laboratory ...
Zoe M Gotts
Full Text Available The precise relationship between sleep and physical and mental functioning in chronic fatigue syndrome (CFS has not been examined directly, nor has the impact of daytime napping. This study aimed to examine self-reported sleep in patients with CFS and explore whether sleep quality and daytime napping, specific patient characteristics (gender, illness length and levels of anxiety and depression, predicted daytime fatigue severity, levels of daytime sleepiness and cognitive functioning, all key dimensions of the illness experience.118 adults meeting the 1994 CDC case criteria for CFS completed a standardised sleep diary over 14 days. Momentary functional assessments of fatigue, sleepiness, cognition and mood were completed by patients as part of usual care. Levels of daytime functioning and disability were quantified using symptom assessment tools, measuring fatigue (Chalder Fatigue Scale, sleepiness (Epworth Sleepiness Scale, cognitive functioning (Trail Making Test, Cognitive Failures Questionnaire, and mood (Hospital Anxiety and Depression Scale.Hierarchical Regressions demonstrated that a shorter time since diagnosis, higher depression and longer wake time after sleep onset predicted 23.4% of the variance in fatigue severity (p <.001. Being male, higher depression and more afternoon naps predicted 25.6% of the variance in objective cognitive dysfunction (p <.001. Higher anxiety and depression and morning napping predicted 32.2% of the variance in subjective cognitive dysfunction (p <.001. When patients were classified into groups of mild and moderate sleepiness, those with longer daytime naps, those who mainly napped in the afternoon, and those with higher levels of anxiety, were more likely to be in the moderately sleepy group.Napping, particularly in the afternoon is associated with poorer cognitive functioning and more daytime sleepiness in CFS. These findings have clinical implications for symptom management strategies.
Hershner SD; Chervin RD
Shelley D Hershner, Ronald D ChervinDepartment of Neurology, University of Michigan, Ann Arbor, MI, USAAbstract: Daytime sleepiness, sleep deprivation, and irregular sleep schedules are highly prevalent among college students, as 50% report daytime sleepiness and 70% attain insufficient sleep. The consequences of sleep deprivation and daytime sleepiness are especially problematic to college students and can result in lower grade point averages, increased risk of academic failure, compromised ...
Lindholm, Harri; Sinisalo, Juha; Ahlberg, Jari; Hirvonen, Ari; Hublin, Christer; Partinen, Markku; Savolainen, Aslak
Media work is characterized by information flow, deadlines, and 24/7 alertness. Good recovery prevents stress-related disorders. The standardized questionnaire included items about health, health habits, sleep, work conditions, and work stress. Recordings of 24-hr heart rate variability (HRV) and four salivary samples for cortisol and melatonin levels were analyzed from 70 randomly selected workers with irregular shift work, and 70 workers with normal daytime work. Irregular shift work increased the risk of insufficient recovery when compared to normal daytime work (OR 2.0; P cortisol/melatonin ratio was decreased (P cortisol and melatonin hormones might be involved in the development of chronic exhaustion. Copyright © 2012 Wiley Periodicals, Inc.
Stone, Kristen C; Cuellar, Crystal R; Miller-Loncar, Cynthia L; LaGasse, Linda L; Lester, Barry M
To evaluate associations between actigraphic sleep patterns, subjective sleep quality, and daytime functioning (ie, sleepiness, symptoms of depression, and delinquency and other conduct problems) in at-risk adolescents. Prospective, observational cohort study. Providence, RI, predominantly home and school and 2 visits to the Brown Center for the Study of Children at Risk. A diverse group of low-income 13-year-olds (n = 49) with and without prenatal drug exposure. None. Actigraphy, sleep diaries, and sleep and health questionnaires. Above and beyond the effects of prenatal drug exposure and postnatal adversity, actigraphic daytime sleep was a significant predictor of daytime sleepiness and delinquency. Subjective sleep quality was a significant predictor of daytime sleepiness, delinquency, and depressive symptoms. Later bed times predicted increased delinquency. There was a unique effect of actigraphic daytime sleep duration, subjective nighttime sleep quality, and bedtime on daytime functioning (ie, sleepiness, symptoms of depression, and delinquency and other conduct problems) of at-risk adolescents. In these vulnerable youth, these problematic sleep patterns may contribute to feeling and behaving poorly. Intervention studies with at-risk teens should be conducted to further explore the role of these sleep parameters on daytime functioning. Copyright © 2015 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.
Drowsiness and sleeping at the wheel are now identified as the reasons behind fatal crashes and highway accidents caused by occupational drivers. For many years, fatigue has been associated to risk of accidents but the causes of this symptom were unclear. Extensive or nocturnal driving was associated to accidents but few reports differentiated fatigue from sleepiness. In the early nineties, epidemiological data started investigating sleepiness and sleep deprivation as cause of accidents. Sleepiness at the wheel, sleep restriction and nocturnal driving have been incriminated in 20% of traffic accidents. Drugs affecting the central nervous system (i.e., narcotic analgesics, antihistamine drugs), nocturnal breathing disorders and narcolepsy have been also associated with an increasing risk of accidents. Treatments improving daytime vigilance (i.e., nasal Continuous Positive Airway Pressure) reduce significantly the risk of traffic accidents for a reasonable economical cost. Sleep disorders among occupational drivers need to be systematically investigated. Chronic daytime sleepiness is still under diagnosed and sleep disorders (i.e. obstructive sleep apnea syndrome) are not enough explored and treated in this exposed population of sedentary males. Drivers education and work schedules integrating notions of sleep hygiene as well as promotion of sleep medicine could significantly improve road safety.
Modafinil improves antipsychotic-induced parkinsonism but not excessive daytime sleepiness, psychiatric symptoms or cognition in schizophrenia and schizoaffective disorder: a randomized, double-blind, placebo-controlled study.
Lohr, James B; Liu, Lianqi; Caligiuri, Michael P; Kash, Taylor P; May, Todd A; Murphy, Jody Delapena; Ancoli-Israel, Sonia
To examine the efficacy and safety of modafinil on parkinsonism and excessive daytime sleepiness (EDS), as well as on negative symptoms and cognitive abilities in patients with schizophrenia or schizoaffective disorder (DSM-IV criteria) in a randomized double-blind placebo-controlled 8-week study. Twenty-four male patients, who were aged 20-63 years and on stable dose of second generation antipsychotic medications and with a negative symptom score of ≥ 20 on the Positive and Negative Syndrome Scale (PANSS), were randomized into either the modafinil (n=12) or placebo (n=12) group. The modafinil group received flexible does of modafinil 50-200mg/day. Primary measurements were the Simpson-Angus Scale (SAS) for extrapyramidal side effects (EPS), the Epworth Sleepiness Scale (ESS), the PANSS and a neuropsychological (NP) test battery. Data were collected on Days 0, 14, 28, 42 and 56 for rating scales, and on Days 0, 28 and 56 for NP tests. Mixed model analyses showed a significant group-x-time interaction for total SAS scores (Pmodafinil group but remaining the same in the placebo group. There were no significant group-x-time interactions for scores of ESS (total), PANSS (total, positive and negative), and NP tests (composite and domains) (all P's>0.5). No significant adverse events were observed. The data suggest that modafinil was a safe adjunctive treatment which improved parkinsonian symptoms and signs in patients with schizophrenia or schizoaffective disorder. Further studies in larger samples and with longer study time are needed to test/confirm the beneficial effects of modafinil on motor function. © 2013.
Ahmed, Anwar E; Fatani, Abdulhamid; Al-Harbi, Abdullah; Al-Shimemeri, Abdullah; Ali, Yosra Z; Baharoon, Salim; Al-Jahdali, Hamdan
The Epworth Sleepiness Scale (ESS) is a questionnaire widely used in developed countries to measure daytime sleepiness and diagnose sleep disorders. This study aimed to develop an ESS questionnaire for the Arabic population (ArESS), to determine ArESS internal consistency, and to measure ArESS test-retest reproducibility. It also investigated whether the normal range of ESS scores of healthy people in different cultures are similar. The original ESS questionnaire was translated from English to Arabic and back-translated to English. In both the English and Arabic translations of the survey, ESS consists of eight different situations. The subject was asked to rate the chance of dozing in each situation on a scale of 0-3 with total scores ranging between 0 (normal sleep) and 24 (very sleepy). An Arabic translation of the ESS questionnaire was administered to 90 healthy subjects. Item analysis revealed high internal consistency within ArESS questionnaire (Cronbach's alpha=0.86 in the initial test, and 0.89 in the retest). The test-retest intra-class correlation coefficient (ICC) shows that the test-retest reliability was substantially high: ICC=0.86 (95% confidence interval: 0.789-0.909, p-valueArabic-speaking populations to measure daytime sleepiness. The current study has shown that the average ESS score of healthy Arabian subjects is significantly higher than in Western cultures. Copyright © 2014 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd. All rights reserved.
Abouda, Maher; Turki, Senda; Hachicha, Amani; Yangui, Ferdaous; Triki, Miriam; Charfi, Med Ridha
Excessive daytime sleepiness (EDS) affects 5% to 20% of the population and is involved in a large number of traffic accidents. EDS is a major symptom in sleep disorders, especially obstructive sleep apnea syndrome (OSA). The daytime sleepiness is evaluated subjectively using scales and questionnaires based on perception. This study is aimed to build a new questionnaire more suited to our lifestyle and then to compare it to the Epworth sleepiness scales (ESS). We administered to 91 adult's patients (76 men and 15 women) consulting for sleep disturbance the ESS and a single subjective question tendency to drowsiness during the Friday prayer. Patients were listed in four groups according to their response to the question «During the past month, have you ever doze or fall asleep during the sermon of the Friday prayer? » By G1 never dozes, G2 low chance of falling asleep, G3 average chance of dozing, G4 high chance of falling asleep. Only 63 patients (58 men and 5 women) responded to both questionnaires. Group 1 included 14 patients with a ESS of 5.5 +/- 1.8, Group 2 included 18 patients with a ESS of 7.3 +/- 1.9, Group 3 included 18 patients with a ESS of 11.05 +/- 2 and Group 4 included 13 patients with a ESS of 14.69 +/- 2.3. The Rho correlation coefficient was high (0.86) and shows a strong correlation between the Results of the two questionnaires. the answer to the question " During the past month, have you ever doze or fall asleep during the sermon of the Friday prayer? » seems to be an appropriate Sleepiness Scale among Muslim patients.
Powell, Nelson B; Chau, Jason K M
Sleepiness and drowsiness are neurophysiologic states that may cause attenuation of vigilance and slowing of reaction times, and thus increase the risks of driving. This article reviews selected peer-reviewed publications from the past and present body of knowledge regarding sleepiness and drowsiness while driving and related accidents, injuries, and possible death. Comparative studies of driving drunk and driving sleepy are reviewed because both exhibit similarly dangerous driving behaviors. It is hoped that some of the information from this article could provide new interest in the necessity of education for sleepy drivers.
José Carlos Souza
Full Text Available OBJETIVO: Buscou-se avaliar a prevalência da sonolência excessiva diurna (SED na população geral de um município brasileiro. MÉTODO: Foram feitas 198 entrevistas domiciliares entre os adultos, em amostra representativa da população geral de Ribeirão do Largo, BA. A amostragem foi aleatória simples. Tinham SED as pessoas com 11 ou mais pontos na Escala de Sonolência de Epworth (ESE. Usaram-se os testes de qui-quadrado, Fisher e ANOVA; nível de significância 5%. RESULTADOS: Tinham SED 21,5% da população (DP = 2,9%; IC 15,8% a 27,2%; não houve associação significativa entre SED e idade (p = 0,924, nem IMC (p = 0,197, sexo (p = 0,095, instrução (p = 0,700, estado civil (p = 0,414 e uso de hipnóticos (p = 0,176. Houve associação com o despertar precoce (p = 0,046. CONCLUSÃO: Foi alta a prevalência de SED na população estudada.OBJECTIVE: To assess the prevalence of excessive daytime sleepiness (ESD in general population of a Brazilian city. METHODS: It was determined by means of 198 home interviews of adults, in a representative sample of Ribeirão do Largo city, Brazil. The random sample was simple. ESD was considered in those with index 11 or more in the Epworth Sleepiness Scale (ESS. Statistics used chi-square, Fisher and ANOVA; the significance level was 5%. RESULTS: The prevalence of ESD was 21.5% of population (SD = 2.9%; CI 15.8%-27.2%. No significant association was found between ESD and age (p=0.924, nor with body mass index (p=0.197, sex (p=0.095, schooling (p=0,700, marital status (p=0.414 and the use of hypnotics (p=0.176. There was significant association with early awakening (p=0.046. CONCLUSION: There was a high prevalence of ESD in the population.
Cohen-Zrubavel, Vered; Kushnir, Baruch; Kushnir, Jonathan; Sadeh, Avi
Study Objectives: To assess if sleep patterns and sleepiness are compromised in children with nocturnal enuresis (NE), in comparison with normal control subjects, and to evaluate the role of enuresis-related events during sleep. Design: Assessment of natural sleep patterns at home in a sample of children referred to enuresis clinics and controls. Setting: Children's homes. Participants: Thirty-two children (19 boys and 13 girls aged 5.1 to 9.1 years) who suffer from primary NE and 94 healthy control subjects (49 boys and 45 girls aged 5 to 8.58 years). Interventions: N/A. Measurements and Results: Sleep measures were derived from 3 to 5 nights of actigraphy and daily logs. Additional information on events related to enuresis and daytime sleepiness was collected using daily reports. Children with NE slept significantly worse than did the control subjects. Their compromised sleep patterns were reflected in a higher number of actigraphic nighttime awakenings, the reduced percentages of motionless sleep, the higher number of reported nighttime awakening, and the increased sleep latency. Children with NE also reported higher levels of sleepiness in the morning and in the evening. Conclusions: Compared with the sleep of control subjects, the natural sleep of children with NE is significantly more fragmented, and the children with NE experience higher levels of daytime sleepiness. This phenomenology is associated with bedwetting episodes and attempts to keep the child dry during the night. These findings may suggest that children with NE suffer from sleep fragmentation, which may explain their higher arousal threshold. These findings have clinical implications for enuresis management. Citation: Cohen-Zrubavel V; Kushnir B; Kushnir J; Sadeh A. Sleep and sleepiness in children with nocturnal enuresis. SLEEP 2011;34(2):191-194. PMID:21286252
Sarah Laxhmi Chellappa
Full Text Available A sonolência excessiva diurna (SED é frequentemente associada à depressão, e as possíveis relações entre as duas afecções são numerosas. A SED pode ocorrer devido a insônia ou hiperssonia. A sintomatologia da depressão inclui, notadamente, a insônia e a consequente SED, que podem ser, em alguns casos, sintomas residuais após a resposta ao tratamento antidepressivo. Paralelamente, a insônia e a sonolência diurna podem, inclusive, ser efeitos colaterais de curta ou longa duração do manejo terapêutico antidepressivo. Independente de a SED ser um sintoma de um quadro depressivo atual, sintoma residual de depressão prévia ou efeito colateral de medicação antidepressiva, faz-se necessária uma adequada avaliação clínica da SED na depressão. A fim de discorrer sobre as atuais evidências das investigações da SED na depressão, foi feito um levantamento da literatura médica nos bancos de dados ISI, MEDLINE e SciELO, compreendendo-se o período de 1990 a 2007. Apesar de os mecanismos responsáveis pela relação entre a sonolência diurna e a depressão serem complexos e entrelaçados, a avaliação compreensiva desse transtorno do sono desempenha um papel fundamental na predição de respostas ao manejo terapêutico, recaídas e modelos etiológicos da depressão.Excessive daytime sleepiness (EDS is often related to depression, and there are several possible relationships between them. EDS can usually occur due to either insomnia or hypersomnia. The symptomatology of depression prominently includes insomnia and the resultant EDS, which may, in such cases, be residual symptoms as a response to antidepressant treatment. Furthermore, insomnia and daytime sleepiness may be short- or long-term side effects of antidepressant treatment as well. The clinical assessment of depression should adequately address whether EDS is a symptom of current depression, a prior depression residual symptom, or a side effect of antidepressant
Full Text Available Victoria M Pak,1,2 S-Hakki Onen,3,4 Nalaka S Gooneratne,4 Bruno Falissard,5 Fannie Onen4–6 1Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, 2Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA; 3CHU Lyon, Hôpital Edouard Herriot, Geriatric Sleep Medicine Center, Lyon, France; 4Division of Geriatric Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; 5CHU Bichat Claude Bernard, Gériatrie, APHP, Paris, 6CESP, INSERM 1018 & 1178, Université Paris Sud, Paris, France Introduction: There is no established reference standard for subjective measures of sleepiness in older adults. Methods: This study compares the Observation and Interview-based Diurnal Sleepiness Inventory (ODSI with two existing instruments for measurement of sleepiness and daily functioning, the Epworth Sleepiness Scale (ESS and Functional Outcomes of Sleep Questionnaire (FOSQ. Results: A total of 125 study participants were included in this study and were administered the ODSI, ESS and FOSQ; subjects had a mean age of 70.9 ± 5.27 years, mean Apnea–Hypopnea Index of 31.9 ± 27.9 events/hour and normal cognitive functioning (Mini-Mental State Examination score > 24. The ODSI showed a significant association with the ESS (Spearman’s ρ: 0.67, P < 0.001 and with the FOSQ (Spearman’s ρ: –0.52, P < 0.001. The ODSI 1 item (assessing sleepiness in active situations was borderline significantly correlated with the ESS (β = 0.14; 95% confidence interval [CI], –0.01 to 0.29; P = 0.069. ODSI 2 item (sleepiness in passive situations was correlated with the ESS (β = 1.65; 95% CI, 1.32 to 1.98; P < 0.001. Both ODSI 1 (β = –0.15; 95% CI, –0.24 to –0.07; P < 0.001 and ODSI 2 (β = –0.35; 95% CI, –0.55 to 0.16; P < 0.001 were significantly correlated with the FOSQ. Conclusion: The ODSI is a suitable measure of sleepiness and is appropriate for
Urry, Emily; Jetter, Alexander; Holst, Sebastian C; Berger, Wolfgang; Spinas, Giatgen A; Langhans, Wolfgang; Landolt, Hans-Peter
The purpose of this study was to examine the possible links between type 2 diabetes, daytime sleepiness, sleep quality and caffeine consumption. In this case-control field study, comparing type 2 diabetic ( n=134) and non-type 2 diabetic ( n=230) participants, subjects completed detailed and validated questionnaires to assess demographic status, health, daytime sleepiness, sleep quality and timing, diurnal preference, mistimed circadian rhythms and habitual caffeine intake. All participants gave saliva under standardised conditions for CYP1A2 genotyping and quantification of caffeine concentration. Hierarchical linear regression analyses examined whether type 2 diabetes status was associated with caffeine consumption. Type 2 diabetic participants reported greater daytime sleepiness ( p=0.001), a higher prevalence of sleep apnoea ( p=0.005) and napping ( p=0.008), and greater habitual caffeine intake ( pconsumption of an extra cup of coffee each day. This finding was confirmed by higher saliva caffeine concentration at bedtime ( p=0.01). Multiple regression analyses revealed that type 2 diabetes status was associated with higher self-reported caffeine consumption ( pcaffeine ( pcaffeine intake. Subjective sleep and circadian estimates were similar between case and control groups. Type 2 diabetic patients may self-medicate with caffeine to alleviate daytime sleepiness. High caffeine intake reflects a lifestyle factor that may be considered when promoting type 2 diabetes management.
Background: The effect of sleep difficulties has achieved a great deal of attention recently, with university students considered as a homogenized population, particularly affected by sleep habits. Aim: The objective of this study was to investigate whether Libyan college students experience sleep disturbance during their ...
Surani, Asif Anwar; Ramar, Kannan; Surani, Arif Anwar; Khaliqdina, Jehangir Shehryar; Subramanian, Shyam; Surani, Salim
To translate and validate the Epworth Sleepiness Scale (ESS) for use in Urdu-speaking population. The original Epworth Sleepiness Scale was translated into the Urdu version (ESS-Ur) in three phases - translation and back-translation; committee-based translation; and testing in bilingual individuals. The final was subsequently tested on 89 healthy bilingual subjects between February and April, 2010, to assess the validity of the translation compared to the original version. The subjects were students and employees of Dow University of Health Sciences, Karachi. Both English and Urdu versions of the Epworth Sleepiness Scale were administered to 59 (67%) women and 30 (33%) men. The mean composite Epworth score was 7.53 in English language and 7.7 in the Urdu version (p=0.76). The translated version was found to be highly correlated with the original scale (rho=0.938; pUrdu version as an effective tool for measuring daytime sleepiness in Urdu-speaking population. Future studies assessing the validity of such patients with sleep disorders need to be undertaken.
Giannotti, Flavia; Cortesi, Flavia; Sebastiani, Teresa; Ottaviano, Salvatore
The aim of this study was to determine the relationship between circadian preferences, regularity of sleep patterns, sleep problems, daytime sleepiness and daytime behaviour. As a part of an epidemiological survey on sleep in a representative sample of Italian high-school students, a total of 6631 adolescents, aged 14.1-18.6 years, completed the School Sleep Habits Survey, a comprehensive questionnaire including items regarding sleep, sleepiness, substance use, anxiety and depressed mood, use of sleeping pills, school attendance and a morningness/eveningness scale. The sample consisted of 742 evening-types (315 males and 427 females; mean age 17.1 years) and 1005 morning-types (451 males and 554 females; mean age 16.8 years). No significant sex differences were found for morningness/eveningness score. Eveningness was associated with later bedtime and wake-up time, especially on weekends, shorter time in bed during the week, longer weekend time in bed, irregular sleep-wake schedule, subjective poor sleep. Moreover, evening types used to nap more frequently during school days, complained of daytime sleepiness, referred more attention problems, poor school achievement, more injuries and were more emotionally upset than the other chronotype. They referred also greater caffeine-containing beverages and substances to promote sleep consumption. Our results suggest that circadian preference might be related not only to sleep pattern, but also to other adolescent behaviours.
Abdel-Kader, Khaled; Jhamb, Manisha; Mandich, Lee Anne; Yabes, Jonathan; Keene, Robert M; Beach, Scott; Buysse, Daniel J; Unruh, Mark L
Many patients on maintenance dialysis experience significant sleepiness and fatigue. However, the influence of the hemodialysis (HD) day and circadian rhythms on patients' symptoms have not been well characterized. We sought to use ecological momentary assessment to evaluate day-to-day and diurnal variability of fatigue, sleepiness, exhaustion and related symptoms in thrice-weekly maintenance HD patients. Subjects used a modified cellular phone to access an interactive voice response system that administered the Daytime Insomnia Symptom Scale (DISS). The DISS assessed subjective vitality, mood, and alertness through 19 questions using 7- point Likert scales. Subjects completed the DISS 4 times daily for 7 consecutive days. Factor analysis was conducted and a mean composite score of fatigue-sleepiness-exhaustion was created. Linear mixed regression models (LMM) were used to examine the association of time of day, dialysis day and fatigue, sleepiness, and exhaustion composite scores. The 55 participants completed 1,252 of 1,540 (81%) possible assessments over the 7 day period. Multiple symptoms related to mood (e.g., feeling sad, feeling tense), cognition (e.g., difficulty concentrating), and fatigue (e.g., exhaustion, feeling sleepy) demonstrated significant daily and diurnal variation, with higher overall symptom scores noted on hemodialysis days and later in the day. In factor analysis, 4 factors explained the majority of the observed variance for DISS symptoms. Fatigue, sleepiness, and exhaustion loaded onto the same factor and were highly intercorrelated. In LMM, mean composite fatigue-sleepiness-exhaustion scores were associated with dialysis day (coefficient and 95% confidence interval [CI] 0.21 [0.02 - 0.39]) and time of day (coefficient and 95% CI 0.33 [0.25 - 0.41]. Observed associations were minimally affected by adjustment for demographics and common confounders. Maintenance HD patients experience fatigue-sleepiness-exhaustion symptoms that demonstrate
Wilhelm, Barbara; Bittner, Evelyn; Hofmann, Anna; Koerner, Andreas; Peters, Tobias; Lüdtke, Holger; Wilhelm, Helmut
The pupillographic sleepiness test (PST) measures the amplitude of the fluctuations of pupil size in the dark, which reflects the level of central nervous system activation and thus alertness. The aim of this study was to assess the short-term reproducibility and variability of the results obtained with the PST in normal healthy subjects. The PST was measured at 9.00, 11:00, and 13:00 h on three consecutive days in 13 young adults. Subjective sleepiness was assessed with the Stanford Sleepiness Scale (SSS) and with a Visual Analogue Scale (VAS). The intra-class correlation (ICC), a measure of reproducibility and the intra- and inter-individual variability, was calculated. ANOVA analysis of the data revealed no significant differences in the PST measurements for testing day. Time of day and subject did however significantly affect the results with an ICC 73.1%. For the SSS and VAS, the ICC was 38.8% and 45.9%, respectively. The intra- and inter-individual variability in PST results did not differ considerably between time and days. We conclude that recordings of the PST have a good reproducibility and low intra- and inter-individual variability compared to subjective scales of sleepiness or the Multiple Sleep Latency Test. The PST is thus a viable method to measure daytime sleepiness objectively. © 2015 Wiley Periodicals, Inc.
Hayashi, Mitsuo; Masuda, Akiko; Hori, Tadao
The present study examined whether the combination of a short daytime nap with caffeine, bright light and face washing was effective against mid-afternoon sleepiness. Ten young healthy adults participated in 5 experimental conditions; those experiments were-Nap only: taking a 20 min nap; Caffeine+Nap: taking 200 mg of caffeine followed by a nap; Nap+Bright-light: being exposed to 2000 lx of bright light for 1 min immediately after napping; Nap+Face-washing: washing their faces immediately after napping; and No-Nap: taking a rest without sleep. These naps were taken at 12:40 hours. The subjects engaged in computer tasks for 15 min before napping and for 1 h after napping. Caffeine+Nap was the most effective for subjective sleepiness and performance level; its effects lasted throughout 1 h after napping. Nap+Bright-light was comparable with Caffeine+Nap, except for performance level. Nap+Face-washing showed mild and transient effects, however, it suppressed subjective sleepiness immediately after napping. The effects of a short nap against mid-afternoon sleepiness could be enhanced by combining caffeine intake, exposure to bright light, or face washing. The present study would provide effective countermeasures against mid-afternoon sleepiness and sleepiness related accidents.
Vgontzas, Alexandros N; Bixler, Edward O; Chrousos, George P
Obesity has epidemic proportions in Western societies and, because of its significant association with morbidity and mortality, is a major public health issue. Excessive daytime sleepiness (EDS) and fatigue (tiredness without increased sleep propensity)--which have been associated with obesity--have a significant impact on individual well-being and public safety. In this article, we review data that challenge the belief that sleep apnea and sleep disruption per se are the primary determinants of obesity-related daytime sleepiness and fatigue. Specifically, it appears that obesity per se is associated with objective and subjective daytime sleepiness compared to normal-weight controls regardless of sleep apnea and sleep loss. Indeed, obese patients without sleep apnea are sleepier compared to nonobese controls whereas within the morbidly obese, those who have high sleep efficiency at night are sleepier than those who have low sleep efficiency. In addition, in recent studies based on large random samples of the general population, the primary determinants of subjective EDS were depression and metabolic disturbances, that is, obesity/diabetes, and not sleep apnea or objective sleep disruption. Furthermore, sleepiness and fatigue are very prevalent in conditions associated with insulin resistance, for instance, the polycystic ovary syndrome (PCOS), independently of sleep apnea or obesity, or in conditions of insufficient physical activity. On the basis of these data, we propose that obesity-related objective daytime sleepiness and fatigue are associated primarily with metabolic and psychological factors and less with sleep apnea and sleep disruption per se. Furthermore, we suggest that objective sleepiness is primarily related to metabolic factors, whereas fatigue appears to be related to psychological distress. Finally, based on data from studies in normal controls and patients with sleep disorders, we propose that the interaction of the hypothalamic
Filtness, Ashleigh J; Anund, Anna; Fors, Carina; Ahlström, Christer; Akerstedt, Torbjørn; Kecklund, Göran
The majority of individuals appear to have insight into their own sleepiness, but there is some evidence that this does not hold true for all, for example treated patients with obstructive sleep apnoea. Identification of sleep-related symptoms may help drivers determine their sleepiness, eye symptoms in particular show promise. Sixteen participants completed four motorway drives on two separate occasions. Drives were completed during daytime and night-time in both a driving simulator and on the real road. Ten eye symptoms were rated at the end of each drive, and compared with driving performance and subjective and objective sleep metrics recorded during driving. 'Eye strain', 'difficulty focusing', 'heavy eyelids' and 'difficulty keeping the eyes open' were identified as the four key sleep-related eye symptoms. Drives resulting in these eye symptoms were more likely to have high subjective sleepiness and more line crossings than drives where similar eye discomfort was not reported. Furthermore, drivers having unintentional line crossings were likely to have 'heavy eyelids' and 'difficulty keeping the eyes open'. Results suggest that drivers struggling to identify sleepiness could be assisted with the advice 'stop driving if you feel sleepy and/or have heavy eyelids or difficulty keeping your eyes open'. © 2014 European Sleep Research Society.
Full Text Available Background. Patients with ischemic white matter lesions (WML frequently report nonrestorative sleep or daytime sleepiness. However, subjective estimations of sleep and sleepiness can differ considerably from objective measures. The pupillographic sleepiness test (PST could identify patients with sleep disorders requiring polysomnography (PSG and further treatment. Methods. We performed a PST and a PSG of 35 nondemented patients with WML, who reported nonrestorative sleep or daytime sleepiness, and assessed the diagnostic value of the pupillary unrest index (PUI. Sleep parameters were compared to normative data. Results. The mean PUI of WML patients was normal (5.89 mm/min and comparable to PUIs of patients with other neurological disorders. All 9 of the 35 WML patients (25.7% who had a PUI above normal also had clinically relevant sleep disorders (5: sleep apnea, 7: periodic leg movements, and 4: insomnia. Six patients with a normal PUI had mild to moderate primary insomnia. Conclusion. PST and PSG parameters were physiological in most patients with WML. Age-related changes and affective and neuropsychological disorders might account for their sleep-related complaints. An elevated PUI in patients with WML seems to indicate comorbid sleep disorders that require further diagnostic evaluation and treatment (sleep apnea, insomnia with periodic leg movements, but not primary insomnia.
Hansen, Shana L; Capener, Dale; Daly, Christopher
Insufficient sleep duration and poor sleep quality are common among adolescents. The multidimensional causes of insufficient sleep duration and poor sleep quality include biological, health-related, environmental, and lifestyle factors. The most common direct consequence of insufficient and/or poor sleep quality is excessive daytime sleepiness, which may contribute to poor academic performance, behavioral health problems, substance use, and drowsy driving. Evaluation of sleepiness includes a detailed sleep history and sleep diary, with polysomnography only required for the assessment of specific sleep disorders. Management involves encouraging healthy sleep practices such as having consistent bed and wake times, limiting caffeine and electronics at night before bed, and eliminating napping, in addition to treating any existing sleep or medical disorders. [Pediatr Ann. 2017;46(9):e340-e344.]. Copyright 2017, SLACK Incorporated.
Shekleton, Julia A; Flynn-Evans, Erin E; Miller, Belinda; Epstein, Lawrence J; Kirsch, Douglas; Brogna, Lauren A; Burke, Liza M; Bremer, Erin; Murray, Jade M; Gehrman, Philip; Lockley, Steven W; Rajaratnam, Shantha M W
Despite the high prevalence of insomnia, daytime consequences of the disorder are poorly characterized. This study aimed to identify neurobehavioral impairments associated with insomnia, and to investigate relationships between these impairments and subjective ratings of sleep and daytime dysfunction. Cross-sectional, multicenter study. Three sleep laboratories in the USA and Australia. Seventy-six individuals who met the Research Diagnostic Criteria (RDC) for Primary Insomnia, Psychophysiological Insomnia, Paradoxical Insomnia, and/or Idiopathic Childhood Insomnia (44F, 35.8 ± 12.0 years [mean ± SD]) and 20 healthy controls (14F, 34.8 ± 12.1 years). N/A. Participants completed a 7-day sleep-wake diary, questionnaires assessing daytime dysfunction, and a neurobehavioral test battery every 60-180 minutes during an afternoon/evening sleep laboratory visit. Included were tasks assessing sustained and switching attention, working memory, subjective sleepiness, and effort. Switching attention and working memory were significantly worse in insomnia patients than controls, while no differences were found for simple or complex sustained attention tasks. Poorer sustained attention in the control, but not the insomnia group, was significantly associated with increased subjective sleepiness. In insomnia patients, poorer sustained attention performance was associated with reduced health-related quality of life and increased insomnia severity. We found that insomnia patients exhibit deficits in higher level neurobehavioral functioning, but not in basic attention. The findings indicate that neurobehavioral deficits in insomnia are due to neurobiological alterations, rather than sleepiness resulting from chronic sleep deficiency.
Resolution of sleepiness and fatigue: a comparison of bupropion and selective serotonin reuptake inhibitors in subjects with major depressive disorder achieving remission at doses approved in the European Union.
Cooper, James A; Tucker, Vivian L; Papakostas, George I
Unlike selective serotonin reuptake inhibitors (SSRIs), bupropion may be classified as a dual noradrenaline and dopamine reuptake inhibitor, a difference with potential implications for the treatment of residual sleepiness and fatigue in major depressive disorder (MDD). Post-hoc analysis of subjects with remitted MDD was performed on data pooled from six double-blind, randomized trials comparing the European Union (EU)-approved dose of ≤300 mg/day bupropion with SSRIs (sertraline, paroxetine or escitalopram) for the resolution of sleepiness and fatigue. Hypersomnia score was defined as the sum of scores of the Hamilton Depression Rating Scale (HDRS) items 22, 23, and 24; fatigue score as HDRS item 13 score; and remission as HDRS-17≤7. Similar proportions of bupropion- and SSRI-treated subjects achieved remission at study endpoint (169/343, 49.3% vs 324/656, 49.4%; last observation carried forward (LOCF), p=0.45). Fewer bupropion-treated remitters had residual symptoms of sleepiness (32/169, 18.9% vs 104/324, 32.1%; pBupropion-treated remitters also showed greater improvement (mean change from baseline) in sleepiness (pBupropion treatment at the EU-approved dose of ≤300 mg/day may offer advantages over SSRIs in the resolution of sleepiness and fatigue in remitted MDD patients.
Ozdemir, Pinar Guzel; Karadag, Ayşe Serap; Selvi, Yavuz; Boysan, Murat; Bilgili, Serap Gunes; Aydin, Adem; Onder, Sevda
There are limited comparative studies on classic and new-generation antihistamines that affect sleep quality and mood. The purpose of this study was to determine and compare the effects of classic and new-generation antihistamines on sleep quality, daytime sleepiness, dream anxiety, and mood. Ninety-two patients with chronic pruritus completed study in the dermatology outpatient clinic. Treatments with regular recommended therapeutic doses were administered. The effects of antihistaminic drugs on mood, daytime sleepiness, dream anxiety, and sleep quality were assessed on the first day and 1 month after. Outpatients who received cetirizine and hydroxyzine treatments reported higher scores on the depression, anxiety, and fatigue sub-scales than those who received desloratadine, levocetirizine, and rupatadine. Pheniramine and rupatadine were found to be associated with daytime sleepiness and better sleep quality. UKU side effects scale scores were significantly elevated among outpatients receiving pheniramine. Classic antihistamines increased daytime sleepiness and decreased the sleep quality scores. New-generation antihistamines reduced sleep latency and dream anxiety, and increased daytime sleepiness and sleep quality. Both antihistamines, significantly increased daytime sleepiness and nocturnal sleep quality. Daytime sleepiness was significantly predicted by rupadatine and pheniramine treatment. Cetirizine and hydroxyzine, seem to have negative influences on mood states. Given the extensive use of antihistamines in clinical settings, these results should be more elaborately examined in further studies.
Philip, Pierre; Sagaspe, Patricia; Prague, Mélanie; Tassi, Patricia; Capelli, Aurore; Bioulac, Bernard; Commenges, Daniel; Taillard, Jacques
To evaluate the effects of acute sleep deprivation and chronic sleep restriction on vigilance, performance, and self-perception of sleepiness. Habitual night followed by 1 night of total sleep loss (acute sleep deprivation) or 5 consecutive nights of 4 hr of sleep (chronic sleep restriction) and recovery night. Eighteen healthy middle-aged male participants (age [(± standard deviation] = 49.7 ± 2.6 yr, range 46-55 yr). Multiple sleep latency test trials, Karolinska Sleepiness Scale scores, simple reaction time test (lapses and 10% fastest reaction times), and nocturnal polysomnography data were recorded. Objective and subjective sleepiness increased immediately in response to sleep restriction. Sleep latencies after the second and third nights of sleep restriction reached levels equivalent to those observed after acute sleep deprivation, whereas Karolinska Sleepiness Scale scores did not reach these levels. Lapse occurrence increased after the second day of sleep restriction and reached levels equivalent to those observed after acute sleep deprivation. A statistical model revealed that sleepiness and lapses did not progressively worsen across days of sleep restriction. Ten percent fastest reaction times (i.e., optimal alertness) were not affected by acute or chronic sleep deprivation. Recovery to baseline levels of alertness and performance occurred after 8-hr recovery night. In middle-aged study participants, sleep restriction induced a high increase in sleep propensity but adaptation to chronic sleep restriction occurred beyond day 3 of restriction. This sleepiness attenuation was underestimated by the participants. One recovery night restores daytime sleepiness and cognitive performance deficits induced by acute or chronic sleep deprivation. Philip P; Sagaspe P; Prague M; Tassi P; Capelli A; Bioulac B; Commenges D; Taillard J. Acute versus chronic partial sleep deprivation in middle-aged people: differential effect on performance and sleepiness. SLEEP 2012;35(7):997-1002.
Eliasson, Arn H; Kashani, Mariam D; Howard, Robin S; Vernalis, Marina N; Modlin, Randolph E
Clinical guidelines for the care of obstructive sleep apnea (OSA) recommend evaluation of daytime sleepiness but do not specify evaluation of fatigue. We studied how subjects with and without OSA experience fatigue and sleepiness, examining the role of gender and race. Consecutive subjects entering our heart health registry completed validated questionnaires including Berlin Questionnaire for OSA, Fatigue Scale, and Epworth Sleepiness Scale. Data analysis was performed only with Whites and Blacks as there were too few subjects of other races for comparison. Of 384 consecutive subjects, including 218 women (57 %), there were 230 Whites (60 %) and 154 Blacks (40 %), with average age of 55.9 ± 12.8 years. Berlin Questionnaires identified 221 subjects (58 %) as having high likelihood for OSA. Fatigue was much more common in women (75 %) than in men (46 %) with OSA (p < 0.001), while frequency of fatigue was similar in women (30 %) and men (29 %) without OSA (p = 0.86). In multivariate analysis, men with OSA were sleepier than women; Black men with OSA had higher Epworth scores (mean ± SD, 12.8 ± 5.2) compared to White men (10.6 ± 5.3), White women (10.0 ± 4.5), and Black women (10.5 ± 5.2), p = 0.05. These gender differences were not related to the effects of age, body mass index, perceived stress, sleep duration, or thyroid function. Women report fatigue more commonly with OSA than men. Men experience sleepiness more commonly with OSA than women. The findings suggest that evaluation of sleep disorders must include an assessment of fatigue in addition to sleepiness to capture the experience of women.
Malcolm, Robert; Myrick, L Hugh; Veatch, Lynn M; Boyle, Elizabeth; Randall, Patrick K
Insomnia is a central symptom of alcohol withdrawal and increases relapse potential. The primary objective of this study was to compare the efficacy of gabapentin to lorazepam in alleviating sleep disturbances and daytime sleepiness during an episode of alcohol withdrawal. The secondary objective of this study was to determine if drug treatment efficacy differed by the patient history of previous treatments for alcohol withdrawal. Outpatients in treatment for alcohol withdrawal received a 4-day fixed-dose taper of gabapentin or lorazepam in a double-blind, randomized, controlled trial with an 8-day follow-up. Daily across a 5 day outpatient treatment and Days 7 and 12 post-treatment, patients self-reported daytime sleepiness using the Epworth Sleepiness Scale. Self-reports of depression (Beck Depression Inventory) were completed at Days 1, 5, 7 and 12. Staff assessed daily alcohol withdrawal using the Clinical Institute Withdrawal Assessment for Alcohol. From these instruments, self-reported sleep and sleepiness were extracted and assessed in the context of limited (0-1) or multiple (2 or more) previously treated alcohol withdrawal episodes. Patients with limited previous withdrawals reported similar treatment effects on self-reports of sleep and sleepiness for gabapentin and lorazepam. In contrast, patients with multiple previous alcohol withdrawals receiving gabapentin reported reduced sleep disturbances and sleepiness in comparison to those receiving lorazepam. During treatment for alcohol withdrawal, gabapentin as compared to standard therapy with lorazepam, was superior on multiple sleep measures, in patients who had previous withdrawals. Lorazepam subjects experienced rebound symptoms. Early drinking was related to persisting insomnia with both drugs.
LeBourgeois, Monique K; Avis, Kristin; Mixon, Michele; Olmi, Joe; Harsh, John
To characterize the relationship between pediatric attention-deficit/hyperactivity disorder (ADHD) subtypes, chronic snoring, and indexes of sleep quality and daytime sleepiness. A cross-sectional design with planned comparisons of ADHD (all subtypes) versus general community controls; ADHD Predominantly Inattentive Type (ADHD-I) versus a group with both ADHD Predominantly Hyperactive/Impulsive Type (ADHD-HI) and ADHD Combined Type (ADHD-C); and ADHD-HI versus ADHD-C. Subjects recruited from a pediatric clinic, a university psycholgy clinic, and the general community. Caretakers of 74 children (45 with ADHD, 29 community controls; 53 boys, 21 girls; mean age, 9.6 years; age range, 6 to 16 years). Thirty-two (71.1%) of the children with ADHD were taking stimulant medication and 7 (15.5%) were taking hypnotic medication. N/A. Caretakers completed the Pediatric Sleep Questionnaire (PSQ) and the Children's Sleep-Wake Scale (CSWS). Only the ADHD-HI diagnosis was associated with an increased likelihood of chronic snoring. Sleep quality was poorer among children with ADHD than controls; however, there were no differences in sleep quality across ADHD subtypes. Sleepiness was greater in children with ADHD, especially the ADHD-I Type. Chronic snoring may be a correlated feature in only a subgroup of the ADHD population, possibly those more likely to be diagnosed with ADHD-HI. Although children with ADHD have poorer sleep quality and greater daytime sleepiness, these 2 features of ADHD are not closely related.
Carrier, Julie; Paquet, Jean; Fernandez-Bolanos, Marta; Girouard, Laurence; Roy, Joanie; Selmaoui, Brahim; Filipini, Daniel
Caffeine is the most widely used stimulant to counteract the effects of sleepiness, but it also produces important detrimental effects on subsequent sleep, especially when sleep is initiated at a time when the biological clock sends a strong waking signal such as during daytime. This study compares the effects of caffeine on daytime recovery sleep in young (20-30 y.) and middle-aged subjects (45-60 y.). Subjects participated in both caffeine (200mg) and placebo conditions (double-blind cross-over design), spaced one month apart. For each condition, subjects initially came to the laboratory for a nocturnal sleep episode. Daytime recovery sleep started in the morning after 25h of wakefulness. Subjects were administered either one caffeine (100mg) or placebo capsule three hours before daytime recovery sleep and the remaining dose one hour before daytime recovery sleep. Middle-aged subjects showed greater decrements of sleep duration and sleep efficiency than young subjects during daytime recovery under placebo compared to nocturnal sleep. Caffeine decreased sleep efficiency, sleep duration, slow-wave sleep (SWS) and REM sleep during daytime recovery sleep similarly in both age groups. Caffeine also reduced N-REM sleep EEG synchronization during daytime recovery sleep (reduced delta, theta, and alpha power, and greater beta power). The combined influence of age and caffeine made the sleep of middle-aged subjects particularly vulnerable to the circadian waking signal. We propose that lower brain synchronization due to age and caffeine produces greater difficulty in overriding the circadian waking signal during daytime sleep and leads to fragmented sleep. These results have implications for the high proportion of the population using caffeine to cope with night work and jet lag, particularly the middle-aged.
Shekleton, Julia A.; Flynn-Evans, Erin E.; Miller, Belinda; Epstein, Lawrence J.; Kirsch, Douglas; Brogna, Lauren A.; Burke, Liza M.; Bremer, Erin; Murray, Jade M.; Gehrman, Philip; Lockley, Steven W.; Rajaratnam, Shantha M. W.
Study Objectives: Despite the high prevalence of insomnia, daytime consequences of the disorder are poorly characterized. This study aimed to identify neurobehavioral impairments associated with insomnia, and to investigate relationships between these impairments and subjective ratings of sleep and daytime dysfunction. Design: Cross-sectional, multicenter study. Setting: Three sleep laboratories in the USA and Australia. Patients: Seventy-six individuals who met the Research Diagnostic Criteria (RDC) for Primary Insomnia, Psychophysiological Insomnia, Paradoxical Insomnia, and/or Idiopathic Childhood Insomnia (44F, 35.8 ± 12.0 years [mean ± SD]) and 20 healthy controls (14F, 34.8 ± 12.1 years). Interventions: N/A. Measurements and Results: Participants completed a 7-day sleep-wake diary, questionnaires assessing daytime dysfunction, and a neurobehavioral test battery every 60-180 minutes during an afternoon/evening sleep laboratory visit. Included were tasks assessing sustained and switching attention, working memory, subjective sleepiness, and effort. Switching attention and working memory were significantly worse in insomnia patients than controls, while no differences were found for simple or complex sustained attention tasks. Poorer sustained attention in the control, but not the insomnia group, was significantly associated with increased subjective sleepiness. In insomnia patients, poorer sustained attention performance was associated with reduced health-related quality of life and increased insomnia severity. Conclusions: We found that insomnia patients exhibit deficits in higher level neurobehavioral functioning, but not in basic attention. The findings indicate that neurobehavioral deficits in insomnia are due to neurobiological alterations, rather than sleepiness resulting from chronic sleep deficiency. Citation: Shekleton JA; Flynn-Evans EE; Miller B; Epstein LJ; Kirsch D; Brogna LA; Burke LM; Cremer E; Murray JM; Gehrman P; Lockley SW; Rajaratnam SMW
Kofmel, Nicole C; Schmitt, Wolfgang J; Hess, Christian W; Gugger, Matthias; Mathis, Johannes
Clinical differentiation between organic hypersomnia and non-organic hypersomnia (NOH) is challenging. We aimed to determine the diagnostic value of sleepiness and performance tests in patients with excessive daytime sleepiness (EDS) of organic and non-organic origin. We conducted a retrospective comparison of the multiple sleep latency test (MSLT), pupillography, and the Steer Clear performance test in three patient groups complaining of EDS: 19 patients with NOH, 23 patients with narcolepsy (NAR), and 46 patients with mild to moderate obstructive sleep apnoea syndrome (OSAS). As required by the inclusion criteria, all patients had Epworth Sleepiness Scale (ESS) scores >10. The mean sleep latency in the MSLT indicated mild objective sleepiness in NOH (8.1 ± 4.0 min) and OSAS (7.2 ± 4.1 min), but more severe sleepiness in NAR (2.5 ± 2.0 min). The difference between NAR and the other two groups was significant; the difference between NOH and OSAS was not. In the Steer Clear performance test, NOH patients performed worst (error rate = 10.4%) followed by NAR (8.0%) and OSAS patients (5.9%; p = 0.008). The difference between OSAS and the other two groups was significant, but not between NOH and NAR. The pupillary unrest index was found to be highest in NAR (11.5) followed by NOH (9.2) and OSAS (7.4; n.s.). A high error rate in the Steer Clear performance test along with mild sleepiness in an objective sleepiness test (MSLT) in a patient with subjective sleepiness (ESS) is suggestive of NOH. This disproportionately high error rate in NOH may be caused by factors unrelated to sleep pressure, such as anergia, reduced attention and motivation affecting performance, but not conventional sleepiness measurements.
Gelaye, Bizu; Lohsoonthorn, Vitool; Lertmeharit, Somrat; Pensuksan, Wipawan C; Sanchez, Sixto E; Lemma, Seblewengel; Berhane, Yemane; Zhu, Xiaotong; Vélez, Juan Carlos; Barbosa, Clarita; Anderade, Asterio; Tadesse, Mahlet G; Williams, Michelle A
The Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) are questionnaires used to assess sleep quality and excessive daytime sleepiness in clinical and population-based studies...
Havlikova, Eva; van Dijk, Jitse P.; Rosenberger, Jaroslav; Nagyova, Iveta; Middel, Berrie; Dubayova, Tatiana; Gdovinova, Zuzana; Groothoff, Johan W.
Objectives: Many patients with Parkinson's disease (PD) suffer from non-motor symptoms like sleep disturbances, excessive daytime sleepiness and fatigue. The aim of our research was to explore whether fatigue is related to sleepiness and sleep problems, depression and functional status, controlled
Estudo da capacidade de manter o alerta em pacientes com fibromialgia por meio do teste da manutenção da vigília Degree of daytime sleepiness in patients with fibromyalgia through the awakefulness maintenance test
Djalma Gomes Ribeiro Sobrinho
Full Text Available OBJETIVO: Avaliar, de forma objetiva, a capacidade de manter o alerta em pacientes com fibromialgia por meio do teste da manutenção da vigília (TMV. MÉTODO: Foi realizado um estudo caso-controle de 15 pacientes com diagnóstico de fibromialgia com pelo menos 11 de 18 pontos dolorosos e dor difusa nos últimos três meses. O grupo-controle foi constituído de 15 indivíduos hígidos pareados por idade e sexo, selecionados seqüencialmente. Os participantes responderam à escala de sonolência de Epworth e foram submetidos ao TMV. Foram realizadas quatro captações, cada uma com duração mínima de 20 minutos e com intervalo de duas horas. Considerou-se como normal a latência para o início do sono maior do que 20 minutos, e patológica a latência menor que 11 minutos. RESULTADOS: O grupo com fibromialgia apresentou significante redução da latência para o início do sono no TMV, comparado ao grupo-controle 9,9 ± 4,6 e 14,9 ± 5,1, respectivamente, p = 0,01, sendo que em 66,7% dos casos o resultado foi patológico, em comparação com 26,7% no grupo-controle (p = 0,03. Não se observou correlação entre o resultado do TMV e a idade dos pacientes ou a pontuação na escala de sonolência de Epworth. CONCLUSÃO: Neste estudo-piloto, pacientes com fibromialgia apresentam redução da latência do sono no TMV.OBJECTIVE: To assess in an objective way the degree of alertness in patients with fibromyalgia through the Maintenance Wakefulness Test ( MWT. METHOD: Fifteen patients with fibromyalgia and 15 age and sex- matched healthy controls were sequentially selected. The inclusion criteria for fibromyalgia were the presence of at least 11 of the 18 tender points and diffuse pain during three months prior to evaluation. All participants answered the Epworth Sleepiness Scale (ESS and underwent four 20 minutes sessions of MWT scheduled at 2-hour intervals. Mean sleep latency higher than 20 minutes or lower than 10 minutes was considered normal or
Hershner, Shelley D; Chervin, Ronald D
Daytime sleepiness, sleep deprivation, and irregular sleep schedules are highly prevalent among college students, as 50% report daytime sleepiness and 70% attain insufficient sleep. The consequences of sleep deprivation and daytime sleepiness are especially problematic to college students and can result in lower grade point averages, increased risk of academic failure, compromised learning, impaired mood, and increased risk of motor vehicle accidents. This article reviews the current prevalence of sleepiness and sleep deprivation among college students, contributing factors for sleep deprivation, and the role of sleep in learning and memory. The impact of sleep and sleep disorders on academics, grade point average, driving, and mood will be examined. Most importantly, effective and viable interventions to decrease sleepiness and sleep deprivation through sleep education classes, online programs, encouragement of naps, and adjustment of class time will be reviewed. This paper highlights that addressing sleep issues, which are not often considered as a risk factor for depression and academic failure, should be encouraged. Promotion of university and college policies and class schedules that encourage healthy and adequate sleep could have a significant impact on the sleep, learning, and health of college students. Future research to investigate effective and feasible interventions, which disseminate both sleep knowledge and encouragement of healthy sleep habits to college students in a time and cost effective manner, is a priority. PMID:25018659
Full Text Available Shelley D Hershner, Ronald D ChervinDepartment of Neurology, University of Michigan, Ann Arbor, MI, USAAbstract: Daytime sleepiness, sleep deprivation, and irregular sleep schedules are highly prevalent among college students, as 50% report daytime sleepiness and 70% attain insufficient sleep. The consequences of sleep deprivation and daytime sleepiness are especially problematic to college students and can result in lower grade point averages, increased risk of academic failure, compromised learning, impaired mood, and increased risk of motor vehicle accidents. This article reviews the current prevalence of sleepiness and sleep deprivation among college students, contributing factors for sleep deprivation, and the role of sleep in learning and memory. The impact of sleep and sleep disorders on academics, grade point average, driving, and mood will be examined. Most importantly, effective and viable interventions to decrease sleepiness and sleep deprivation through sleep education classes, online programs, encouragement of naps, and adjustment of class time will be reviewed. This paper highlights that addressing sleep issues, which are not often considered as a risk factor for depression and academic failure, should be encouraged. Promotion of university and college policies and class schedules that encourage healthy and adequate sleep could have a significant impact on the sleep, learning, and health of college students. Future research to investigate effective and feasible interventions, which disseminate both sleep knowledge and encouragement of healthy sleep habits to college students in a time and cost effective manner, is a priority.Keywords: grade point average, GPA, sleep deprivation, academic performance, adolescence, sleep education programs
Hershner, Shelley D; Chervin, Ronald D
Daytime sleepiness, sleep deprivation, and irregular sleep schedules are highly prevalent among college students, as 50% report daytime sleepiness and 70% attain insufficient sleep. The consequences of sleep deprivation and daytime sleepiness are especially problematic to college students and can result in lower grade point averages, increased risk of academic failure, compromised learning, impaired mood, and increased risk of motor vehicle accidents. This article reviews the current prevalence of sleepiness and sleep deprivation among college students, contributing factors for sleep deprivation, and the role of sleep in learning and memory. The impact of sleep and sleep disorders on academics, grade point average, driving, and mood will be examined. Most importantly, effective and viable interventions to decrease sleepiness and sleep deprivation through sleep education classes, online programs, encouragement of naps, and adjustment of class time will be reviewed. This paper highlights that addressing sleep issues, which are not often considered as a risk factor for depression and academic failure, should be encouraged. Promotion of university and college policies and class schedules that encourage healthy and adequate sleep could have a significant impact on the sleep, learning, and health of college students. Future research to investigate effective and feasible interventions, which disseminate both sleep knowledge and encouragement of healthy sleep habits to college students in a time and cost effective manner, is a priority.
Peker, Yüksel; Glantz, Helena; Eulenburg, Christine; Wegscheider, Karl; Herlitz, Johan; Thunström, Erik
RATIONALE: Obstructive sleep apnea is common in patients with coronary artery disease, many of whom do not report daytime sleepiness. First-line treatment for symptomatic obstructive sleep apnea is continuous positive airway pressure, but its value in patients without daytime sleepiness is
Depressão, ansiedade e sonolência diurna em cuidadores primários de crianças com paralisia cerebral Depresión, ansiedad y somnolencia diurna en cuidadores primarios de niños con parálisis cerebral Depression, anxiety and daytime sleepiness of primary caregivers of children with cerebral palsy
Beck, ansiedad estado-rasgo y Epworth, respectivamente. RESULTADOS: La mayoría de los entrevistados eran madres con bajo nivel socioeconómico. Los que se autoevaluaron ansiosos y depresivos presentaron resultados comprobatorios de ansiedad y depresión con los inventarios de estado-rasgo y Beck para los cuidadores de niños con parálisis cerebral. Los niveles de somnolencia diurna excesiva estuvieron estadísticamente relacionados a los elevados niveles de depresión. El comprometimiento neurológico de los niños no influenció los resultados sobre los cuidadores. CONCLUSIONES: Depresión, ansiedad y problemas relacionados al sueño son comunes en cuidadores de niños con parálisis cerebral. El nivel de funcionalidad neurológica del niño no influencia los resultados.OBJECTIVE: To evaluate depression, anxiety and excessive daytime sleepiness (EDS levels in primary caregivers of children with cerebral palsy (CCP and to trace the relationships with their socioeconomic conditions and child neurological characteristics, as compared with caregivers of typical children (CTC. METHODS: 45 CCP and 50 CTC were randomly chosen and answered a semi-structured questionnaire. We evaluated EDS on the Epworth scale. Beck depression inventory (BDI and the state-trait anxiety inventory (STAI identified depressive and anxious symptoms, respectively. RESULTS: The majority of subjects were mothers with low socioeconomic level. Self-perception of anxiety and depressive symptoms of CCP were confirmed through BDI and STAI. EDS was statistically related to high levels of depression. Children's disabilities did not influence the results. CONCLUSIONS: Depression, anxiety symptoms and sleep disruption were common in CCP. Child functional level did not influence the results.
Effect of Continuous Positive Airway Pressure Treatment on Health-Related Quality of Life and Sleepiness in High Cardiovascular Risk Individuals With Sleep Apnea: Best Apnea Interventions for Research (BestAIR) Trial.
Zhao, Ying Y; Wang, Rui; Gleason, Kevin J; Lewis, Eldrin F; Quan, Stuart F; Toth, Claudia M; Morrical, Michael; Rueschman, Michael; Weng, Jia; Ware, James H; Mittleman, Murray A; Redline, Susan
The long-term effect of continuous positive airway pressure (CPAP) on health-related quality of life (HRQOL) in patients with high cardiovascular disease risk and obstructive sleep apnea (OSA) without severe sleepiness is uncertain. We aimed to determine the effect of CPAP treatment on HRQOL in individuals with moderate or severe OSA and cardiovascular disease (CVD) or multiple CVD risk factors without severe sleepiness. In this randomized, controlled, parallel group study, 169 participants were assigned to treatment with CPAP or the control group (conservative medical therapy [CMT] or CMT with sham CPAP). Analyses were based on an intention-to-treat approach. Linear mixed effect models were fitted to compare the changes in the Medical Outcomes Study Short Form-36 (SF-36) and in subjective sleepiness (Epworth Sleepiness Scale [ESS]) between groups from baseline to the average of 6- and 12-month measurements. CPAP improved several domains of HRQOL including bodily pain (treatment effect 9.7 [95% confidence interval, CI 3.9 to 15.4]; p = .001), vitality (5.7 [95% CI 1.5 to 9.9]; p = .008), general health (8.2 [95% CI 3.7 to 12.7]; p < .001), physical functioning (5.5 [95% CI 1.1 to 10.0]; p = .016), and the physical health summary score (3.3 [95% CI 1.4 to 5.3]; p = .001). CPAP also resulted in less daytime sleepiness (mean change in ESS -1.0 point [95% CI -2.0 to -0.0]; p = .040). In patients with moderate-severe OSA at high risk of cardiovascular events and without severe sleepiness, CPAP improved daytime sleepiness and multiple domains of HRQOL over 6 to 12 months of follow-up, with the largest improvement observed for bodily pain.
Full Text Available Sleep disorders are not uncommon and have been widely reported throughout the world. They have a profound impact on industrialized 24-h societies. Consequences of these problems include impaired social and recreational activities, increased human errors, loss of productivity, and elevated risk of accidents. Conditions such as acute and chronic insomnia, sleep loss, excessive sleepiness, shift-work, jet lag, narcolepsy, and sleep apnea warrant public health attention, since residual sleepiness during the day may affect performance of daily activities such as driving a car. Benzodiazepine hypnotics and zopiclone promote sleep, both having residual effects the following day including sleepiness and reduced alertness. In contrast, the non-benzodiazepine hypnotics zolpidem and zaleplon have no significant next-day residual effects when taken as recommended. Research on the effects of wakefulness-promoting drugs on driving ability is limited. Countermeasures for excessive daytime sleepiness have a limited effect. There is a need for a social awareness program to educate the public about the potential consequences of various sleep disorders such as narcolepsy, sleep apnea, shift-work-related sleep loss, and excessive daytime sleepiness in order to reduce the number of sleep-related traffic accidents.
Segal, Ahuva Y; Sletten, Tracey L; Flynn-Evans, Erin E; Lockley, Steven W; Rajaratnam, Shantha M W
While previous studies have demonstrated short-wavelength sensitivity to the acute alerting effects of light during the biological night, fewer studies have assessed the alerting effect of light during the daytime. This study assessed the wavelength-dependent sensitivity of the acute alerting effects of daytime light exposure following chronic sleep restriction in 60 young adults (29 men, 31 women; 22.5 ± 3.1 mean ± SD years). Participants were restricted to 5 h time in bed the night before laboratory admission and 3 h time in bed in the laboratory, aligned by wake time. Participants were randomized for exposure to 3 h total of either narrowband blue (λmax 458-480 nm, n = 23) or green light (λmax 551-555 nm, n = 25) of equal photon densities (2.8-8.4 × 10(13) photons/cm(2)/sec), beginning 3.25 h after waking, and compared with a darkness control (0 lux, n = 12). Subjective sleepiness (Karolinska Sleepiness Scale), sustained attention (auditory Psychomotor Vigilance Task), mood (Profile of Mood States Bi-Polar form), working memory (2-back task), selective attention (Stroop task), and polysomnographic and ocular sleepiness measures (Optalert) were assessed prior to, during, and after light exposure. We found no significant effect of light wavelength on these measures, with the exception of a single mood subscale. Further research is needed to optimize the characteristics of lighting systems to induce alerting effects during the daytime, taking into account potential interactions between homeostatic sleep pressure, circadian phase, and light responsiveness. © 2016 The Author(s).
Berkowski, Joseph Andrew; Shelgikar, Anita Valanju
Central disorders of hypersomnolence are rare conditions with a poorly understood pathophysiology, making the identification and management challenging for sleep clinicians. Clinical history is essential for ruling out secondary causes of hypersomnolence and distinguishing among diagnoses. Current diagnostic criteria rely heavily on the polysomnogram and multiple sleep latency test. The current focus of treatment of hypersomnolence is on drugs that promote alertness. Additionally, in the case of narcolepsy type 1, medication management addresses control of cataplexy, the hallmark symptom of this disorder. Elucidation of pathophysiology of these disorders in the future will be essential to better categorization and management. Published by Elsevier Inc.
Franzen, Peter L; Siegle, Greg J; Buysse, Daniel J
This pilot study examined the relationships between the effects of sleep deprivation on subjective and objective measures of sleepiness and affect, and psychomotor vigilance performance. Following an adaptation night in the laboratory, healthy young adults were randomly assigned to either a night of total sleep deprivation (SD group; n = 15) or to a night of normal sleep (non-SD group; n = 14) under controlled laboratory conditions. The following day, subjective reports of mood and sleepiness, objective sleepiness (Multiple Sleep Latency Test and spontaneous oscillations in pupil diameter, PUI), affective reactivity/regulation (pupil dilation responses to emotional pictures), and psychomotor vigilance performance (PVT) were measured. Sleep deprivation had a significant impact on all three domains (affect, sleepiness, and vigilance), with significant group differences for eight of the nine outcome measures. Exploratory factor analyses performed across the entire sample and within the SD group alone revealed that the outcomes clustered on three orthogonal dimensions reflecting the method of measurement: physiological measures of sleepiness and affective reactivity/regulation, subjective measures of sleepiness and mood, and vigilance performance. Sleepiness and affective responses to sleep deprivation were associated (although separately for objective and subjective measures). PVT performance was also independent of the sleepiness and affect outcomes. These findings suggest that objective and subjective measures represent distinct entities that should not be assumed to be equivalent. By including affective outcomes in experimental sleep deprivation research, the impact of sleep loss on affective function and their relationship to other neurobehavioral domains can be assessed.
Gao, Jianjun; Huang, Xuemei; Park, Yikyung; Hollenbeck, Albert; Blair, Aaron; Schatzkin, Arthur; Chen, Honglei
Preliminary evidence suggests that daytime sleepiness may predate clinical diagnosis of Parkinson disease. The authors examined daytime napping and nighttime sleeping durations, reported in 1996–1997 by 220,934 US NIH-AARP Diet and Health Study participants, in relation to Parkinson disease diagnoses at 3 clinical stages: established (cases diagnosed before 1995, n = 267), recent (1995–1999, n = 396), and prediagnostic (2000 and after, n = 770). Odds ratios and 95% confidence intervals were derived from multivariate logistic regression models. Longer daytime napping was associated with higher odds of Parkinson disease at all 3 clinical stages: the odds ratios comparing long nappers (>1 hour/day) with nonnappers were 3.9 (95% confidence interval: 2.8, 5.6) for established cases, 2.2 (95% confidence interval: 1.7, 3.0) for recent cases, and 1.5 (95% confidence interval: 1.2, 1.9) for prediagnostic cases. Further control for health status or nighttime sleeping duration attenuated the association for established cases but made little difference for recent or prediagnostic cases. In the nighttime sleeping analysis, a clear U-shaped association with Parkinson disease was observed for established cases; however, this association was attenuated markedly for recent cases and disappeared for prediagnostic cases. This study supports the notion that daytime sleepiness, but not nighttime sleeping duration, is one of the early nonmotor symptoms of Parkinson disease. PMID:21402730
Full Text Available Background: Sleepiness that occurs at inappropriate or undesirable times or that interferes with daytime activities is generally considered excessive daytime sleepiness. Obstructive Sleep Apnea (OSA is one of the most common causes of excessive daytime sleepiness. The aim of this study is to finds out the most important nocturnal polysomnographic parameters influencing daytime sleepiness in patients with OSA. Materials and Methods: Considering the inclusion and exclusion criteria, 112 patients referred to Baqiyatallah subspeciality sleep clinic in Qom city were selected. Patients, demographic and Epworth Sleepiness Scale (ESS data were gathered and then comparison among ESS with polysomnography and anthropometric parameter was performed. Chi-square was used for analysis of qualitative parameters. Data analysis was done by SPSS v.18. P value was significant (˂0.05. Results: The mean age of the cases was 55.07 with male frequency 58.9% and female 41.1%. Body mass index was 34.34, apnea hypopnea index 43.62, mean Arousal Index 30.64 and mean ESS was 12.83. There was significant relationship among ESS>10 with arousal index (p=0.009 and mean O2 saturation (p=0.029, But we didn’t detected correlation between ESS>10 with other polysomnographic parameters. Conclusion: According to the data, the most important parameters of sleepiness in obstructive sleep apnea patients were sleep fragmentation and mean O2 saturation.
Ritika Rajkumar Harjani
Full Text Available Purpose: Radiation to brain causes early, early-delayed, and delayed side effects. There is paucity of literature regarding early-delayed effects like somnolence syndrome. Existing studies use general symptom assessment and visual analog scales. Epworth Sleepiness Scale (ESS is a time tested tool to assess daytime sleepiness in various conditions. In this study, the ESS has been used to determine the occurrence of somnolence in patients receiving cranial radiotherapy for primary and metastatic brain tumors. Thus the ESS has been used in a novel setting in our study. The ESS is a simple to administer questionnaire and may be useful in grading the severity of somnolence. To our knowledge, this is the second study to determine post radiation somnolence using ESS. Methods: This prospective study was conducted in 23 patients with primary and metastatic brain tumor. Patient demographics and tumor type and grade was noted. Those with Karnofsky Performance Scale (KPS less than 70 and with pre-existing sleep disorders were excluded. Radiotherapy regimen included palliative whole brain radiation for brain metastases and conformal adjuvant radiotherapy for primary brain tumors as per standard guidelines. All subjects included were administered ESS at baseline and weekly thereafter during and for 6 weeks after radiation. Results: All 23 patients (median age 50 years completed the planned questionnaires until 6 weeks post radiation. Twenty (87% patients had primary brain tumors whereas three (13% patients had metastatic lesions in brain. Of the 23 patients, 14 patients (60.86% had abnormal or increased daytime sleepiness; of which 3 had ESS scores greater than 16. Conclusion: Somnolence was noted in 60.86% of the patients, which is in accordance with existing literature. Epworth sleepiness scale is an effective tool to detect and quantify somnolence, However, it does not consider other symptoms of somnolence syndrome and hence should be combined with visual
Horne, J A; Reyner, L A
Sleepy drivers should "take a break," but the efficacy of feasible additional countermeasures that can be used during the break is unknown. We examined a shorter than 15 min nap, 150 mg of caffeine in coffee, and a coffee placebo, each given randomly across test sessions to 10 sleepy subjects during a 30-min rest period between two 1-hr monotonous early afternoon drives in a car simulator. Caffeine and nap significantly reduced driving impairments, subjective sleepiness, and electroencephalographic (EEG) activity indicating drowsiness. Blink rate was unaffected. Sleep during naps varied, whereas caffeine produced more consistent effects. Subjects acknowledged sleepiness when the EEG indicated drowsiness, and driving impairments were preceded by self-knowledge of sleepiness. Taking just a break proved ineffective.
Sonolência diurna excessiva pós-traumatismo de crânio: associação com movimentos periódicos de pernas e distúrbio de comportamento do sono REM: relato de caso Excessive daytime sleepiness after traumatic brain injury: association with periodic limb movements and REM behavior disorder: case report
Raimundo Nonato D. Rodrigues
Full Text Available Um homem de 52 anos, procurou o Hospital. Universitário de Brasília com queixa de sono agitado. Sua esposa relatava, desde há cerca de 10 anos, intensa movimentação de membros e agressividade em meio a sonhos violentos. Desde então apresentava sonolência diurna excessiva. Havia relato de traumatismo de crânio há 34 anos e coma de 2 meses de duração. A vídeo-polissonografia revelou comportamento agressivo e agitado durante o sono REM, e movimentos periódicos de pernas. Havia importante sonolência diurna no teste de latências de sono. Foi instituído tratamento com levodopa-benzerazida 100/25 mg à noite. Após 10 semanas de evolução, houve melhora da movimentação noturna global, e desaparecimento dos episódios ligados a sonhos de conteúdo violento. Este caso nos permite analisar a associação entre trauma craniano e alterações nas vias dopaminérgicas (movimentos periódicos das pernas e distúrbio de comportamento do sono REM e revisar a importância dos distúrbios na produção de hipocretina hipotalâmica na fisiopatologia desse quadro clínico.A 52 year-old male patient, had complaint of "restless sleep". His wife informed that for the past ten years the patient had presented intense and aggressive body movements, and sometimes, violent dreams. The patient also complained of excessive daytime sleepiness. His relevant previous medical history included a traumatic brain injury at the age of 28 which left him in coma for two months. A video-polysomnography showed periodic leg movements and, during REM sleep, aggressive and agitated behaviour. The multiple sleep latency test revealed extremely short latencies. Initially, he was treated with levodopa-benzerazide, 100/25 mg, 2 hours before bedtime. After 10 weeks his overnight behaviour pattern improved and leg movements diminished. This case supports the hypothesis of an association between cranial trauma and alterations in the dopaminergic pathways represented by periodic
Full Text Available Abstract Background Sleepiness and cognitive dysfunction are recognized as prominent consequences of sleep deprivation. Experimentally induced short-term sleep fragmentation, even in the absence of any reductions in total sleep duration, will lead to the emergence of excessive daytime sleepiness and cognitive impairments in humans. Tumor necrosis factor (TNF-α has important regulatory effects on sleep, and seems to play a role in the occurrence of excessive daytime sleepiness in children who have disrupted sleep as a result of obstructive sleep apnea, a condition associated with prominent sleep fragmentation. The aim of this study was to examine role of the TNF-α pathway after long-term sleep fragmentation in mice. Methods The effect of chronic sleep fragmentation during the sleep-predominant period on sleep architecture, sleep latency, cognitive function, behavior, and inflammatory markers was assessed in C57BL/6 J and in mice lacking the TNF-α receptor (double knockout mice. In addition, we also assessed the above parameters in C57BL/6 J mice after injection of a TNF-α neutralizing antibody. Results Mice subjected to chronic sleep fragmentation had preserved sleep duration, sleep state distribution, and cumulative delta frequency power, but also exhibited excessive sleepiness, altered cognitive abilities and mood correlates, reduced cyclic AMP response element-binding protein phosphorylation and transcriptional activity, and increased phosphodiesterase-4 expression, in the absence of AMP kinase-α phosphorylation and ATP changes. Selective increases in cortical expression of TNF-α primarily circumscribed to neurons emerged. Consequently, sleepiness and cognitive dysfunction were absent in TNF-α double receptor knockout mice subjected to sleep fragmentation, and similarly, treatment with a TNF-α neutralizing antibody abrogated sleep fragmentation-induced learning deficits and increases in sleep propensity. Conclusions Taken together
Background: The burden of obstructive sleep apnea among commercial drivers in Nigeria is not known. Aim: To assess the prevalence of high risk of obstructive sleep apnea (OSA) and excessive daytime sleepiness (EDS) among intra‑city commercial drivers. Setting and Design: A descriptive cross‑sectional study in three ...
Bajpai, Geetika; Shukla, Garima; Pandey, Ravindra M; Gupta, Anupama; Afsar, Mohammed; Goyal, Vinay; Srivastava, Achal; Behari, Madhuri
Since a majority of population in India does not drive automobiles, one item on the Epworth Sleepiness Scale (ESS) requires modification and validation. In addition, data collected by us indicated that a majority of rural and urban Indians regularly spend time in prayer/spiritual activity. The main purpose of this study was to develop a cross-cultural adaptation of the ESS for a North Indian population, in Hindi language (ESS-I). The study also provides evidence of reliability and validity of the modified version. The subjects included were normal volunteers aged 18-75 years (Group 1) (n = 70), compared with patients with complaints of excessive daytime sleepiness, who had undergone polysomnography (Group 2) (n = 22) and patients who had undergone multiple sleep latency test (Group 3) (n = 10). The study was carried out in four phases: Translation and retranslation of the original scale with modification of item 8 (mainly addition of option of question on "while offering prayers or in spiritual activity"); reliability (test-retest) (n = 30); internal consistency (using Cronbach's alpha index) (n = 102); and sensitivity to change (n = 8). Group 1 showed spiritual activity as a significantly more commonly practiced activity than driving. The Cronbach's alpha for the modified version was 0.892 (excellent), and this was not improved by removing the modified item. The alpha value for Group 1 versus Groups 2 and 3 was 0.667 and 0.892, respectively. The scale was reliable over time (test-retest), and it was sensitive to sleepiness change in patients with obstructive sleep apnea during treatment. The ESS-I, is comparable to the original scale. It is reliable, valid, and change-sensitive. It is proposed that the modified version can be very useful for detecting sleepiness among Indian population, especially those who do not drive their own vehicles.
Martin, Jeanne Sophie; Gaudreault, Michael M; Perron, Michel; Laberge, Luc
Adolescent maturation is associated with delays of the endogenous circadian phase. Consequently, early school schedules may lead to a mismatch between internal and external time, which can be detrimental to adolescent sleep and health. In parallel, chronotype is known to play a role in adolescent health; evening chronotype adolescents are at higher risk for sleep problems and lower academic achievement. In the summer of 2008, Kénogami High School (Saguenay, Canada) was destroyed by fire. Kénogami students were subsequently relocated to Arvida High School (situated 5.3 km away) for the 2008-2009 academic year. A dual school schedule was implemented, with Arvida students attending a morning schedule (0740-1305 h) and Kénogami students an afternoon schedule (1325-1845 h). This study aimed to investigate the effects of such school schedules and chronotype on sleep, light exposure, and daytime functioning. Twenty-four morning and 33 afternoon schedule students wore an actigraph during 7 days to measure sleep and light exposure. Academic achievement was obtained from school. Subjects completed validated questionnaires on daytime sleepiness, psychological distress, social rhythms, school satisfaction, alcohol, and chronotype. Overall, afternoon schedule students had longer sleep duration, lower sleepiness, and lower light exposure than morning schedule students. Evening chronotypes (E-types) reported higher levels of sleepiness than morning chronotypes (M-types) in both morning and afternoon schedules. Furthermore, M-types attending the morning schedule reported higher sleepiness than M-types attending the afternoon schedule. No difference was found between morning and afternoon schedule students with regard to academic achievement, psychological distress, social rhythms, school satisfaction, and alcohol consumption. However, in both schedules, M-type had more regular social rhythms and lower alcohol consumption. In summary, this study emphasizes that an early school
Kazemi, Reza; Haidarimoghadam, Rashid; Motamedzadeh, Majid; Golmohammadi, Rostam; Soltanian, Alireza; Zoghipaydar, Mohammad Reza
Background: shift work is associated with both sleepiness and reduced performance. The aim of this study was to examine cognitive performance, sleepiness, and sleep quality among petrochemical control room shift workers. Method: Sixty shift workers participated in this study. Cognitive performance was evaluated using the objective test such as continuous performance test, n-back test, and simple reaction time test; sleepiness scale was measured using the subjective Karolinska Sleepiness Scale...
Mondragón-Rezola, E; Arratíbel-Echarren, I; Ruiz-Martínez, J; Martí-Massó, J F
.... We describe the pathophysiology associated with neurodegeneration, due to symptoms (motor and nonmotor) and drug therapies. This article reviews insomnia, excessive daytime sleepiness, circadian sleep disorders and sleep apnea...
Jackson, Melinda L; Howard, Mark E; Barnes, Maree
Sleep-related breathing disorders encompass a range of disorders in which abnormal ventilation occurs during sleep as a result of partial or complete obstruction of the upper airway, altered respiratory drive, abnormal chest wall movement, or respiratory muscle function. The most common of these is obstructive sleep apnea (OSA), occurring in both adults and children, and causing significant cognitive and daytime dysfunction and reduced quality of life. OSA patients experience repetitive brief cessation of breathing throughout the night, which causes intermittent hypoxemia (reductions in hemoglobin oxygen levels) and fragmented sleep patterns. These nocturnal events result in excessive daytime sleepiness, and changes in mood and cognition. Chronic excessive sleepiness during the day is a common symptom of sleep-related breathing disorders, which is assessed in sleep clinics both subjectively (questionnaire) and objectively (sleep latency tests). Mood changes are often reported by patients, including irritability, fatigue, depression, and anxiety. A wide range of cognitive deficits have been identified in untreated OSA patients, from attentional and vigilance, to memory and executive functions, and more complex tasks such as simulated driving. These changes are reflected in patient reports of difficulty in concentrating, increased forgetfulness, an inability to make decisions, and falling asleep at the wheel of a motor vehicle. These cognitive changes can also have significant downstream effects on daily functioning. Moderate to severe cases of the disorder are at a higher risk of having a motor vehicle accident, and may also have difficulties at work or school. A number of comorbidities may also influence the cognitive changes in OSA patients, including hypertension, diabetes, and stroke. These diseases can cause changes to neural vasculature and result in neural damage, leading to cognitive impairments. Examination of OSA patients using neuroimaging techniques such
Full Text Available This is the first report describing the efficacy of modafinil therapy for narcolepsy in patients in Taiwan. The purpose of this study was to compare the objective Multiple Sleep Latency Test (MSLT and the subjective Epworth Sleepiness Scale (ESS for evaluating the efficacy of modafinil in treating excessive daytime sleepiness in patients with narcolepsy in Taiwan. Ten consecutive patients with narcolepsy-with-cataplexy who were treated with 200 mg/day modafinil for more than 6 months at our sleep center between January 2003 and December 2007 were included in this study. This comparative study was prompted by the requirement of the Bureau of National Health Insurance in Taiwan that modafinil users need to be followed up with MSLTs every 6–12 months. The mean age at onset of narcolepsy onset in these 10 patients was 11.8 ± 3.3 years, and eight (80% were male. We compared the differences in MSLT and ESS between baseline and follow-up at 6–12 months after starting modafinil therapy using paired t tests. ESS scores (p < 0.001 were considerably more sensitive than MSLT scores (p < 0.05 in documenting efficacy of modafinil and that the improvements in MSLT scores were minimal and remained in the pathologically sleepy range. These findings suggest that the ESS is a more sensitive and clinically meaningful tool to evaluate the efficacy of modafinil in narcolepsy.
Erman, Milton K.; Rosenberg, Russell; for the U.S. Modafinil Shift Work Sleep Disorder Study Group
Objective: We evaluated the effects of modafinil, a wake-promoting agent, on patient functioning, health-related quality of life, and nighttime and daytime sleep in patients with excessive sleepiness associated with shift work sleep disorder (SWSD).
Johansson, Ann E E; Petrisko, Maria A; Chasens, Eileen R
Technology has become pervasive in our culture, particularly among adolescents. The purpose of this study is to examine associations between use of technology before sleep and daytime function in adolescents. This study is a secondary analysis of respondents aged 13 to 21 years (N = 259) from the 2011 National Sleep Foundation's Sleep in America Poll. The survey included questions on demographics, sleep habits, and use of technology in the hour before bedtime. Daytime sleepiness was assessed with the Epworth Sleepiness Scale (ESS). Student's t-tests, Mann-Whitney U, and Fischer's exact tests were performed to detect differences in demographics, sleep duration, and technology use in the total sample, and between respondents with "adequate" compared to "inadequate" sleep. Correlations were calculated between technology frequency and daytime function. Adolescents had mean sleep duration of 7.3 ± 1.3 h. Almost all respondents (97%) used some form of technology before sleep. Increased technology use and the frequency of being awoken in the night by a cell phone were significantly associated with waking too early, waking unrefreshed, and daytime sleepiness (p technology use before bedtime, feeling unrefreshed on waking, and greater daytime sleepiness than those reporting "adequate" sleep (all p-values Technology use before sleep by adolescents had negative consequences on nighttime sleep and on daytime function. Healthcare professionals who interact with adolescents should encourage technology to be curtailed before bedtime and for adolescents to value obtaining adequate sleep. Copyright © 2016 Elsevier Inc. All rights reserved.
Anders, Thomas; Iosif, Ana-Maria; Schwichtenberg, A. J.; Tang, Karen; Goodlin-Jones, Beth
This study examined sleep, sleepiness, and daytime performance in 68 children with autism, 57 children with intellectual disability (ID), and 69 typically developing preschool children. Children in the autism and ID groups had poorer daytime performance and behaviors than the typically developing children. Children in the ID group also were…
Moreau, Vincent; Belanger, Lynda; Begin, Gilles; Morin, Charles M.
The main objective of this study was to document sleep patterns and disturbances reported by youths temporarily living in residential care facilities. A secondary objective was to examine the relationships between sleep disturbances and mood and daytime sleepiness. A self-reported questionnaire on sleep patterns and habits assessing duration,…
Sarberg, Maria; Bladh, Marie; Josefsson, Ann; Svanborg, Eva
This study aimed to examine if there is a difference in the prevalence of obstructive sleep apnea (OSA) and sleepiness between pregnant and non-pregnant women. It also aimed to evaluate if obstetric outcomes were associated to sleep-disordered breathing among the pregnant women. One hundred pregnant women (gestational weeks 24-34) and 80 age- and body mass index-matched non-pregnant women underwent whole-night respiratory recordings (airflow, snoring, respiratory movements, body position, pulse oximetry). The women also answered a questionnaire including the Epworth sleepiness scale. Eighty-nine percent of the pregnant women had normal body mass index (BMI). Objectively, recorded snoring was more common among the pregnant women (median 9 % of total estimated sleep time) than among the controls (4 % of total sleep time, p = 0.005). Three of the pregnant women had OSA (apnea/hypopnea index (AHI) >5), but in two cases, this was mainly due to central hypopneas. None had AHI >10. Two controls were diagnosed as OSA. Respiratory parameters including snoring showed no impact on obstetric outcomes. Total Epworth sleepiness scale (ESS) score was higher among pregnant women than among controls (median 9 vs 7, p sleep apnea among pregnant women. One reason for this could be that the majority of the women in this study were non-obese. Neither OSA nor snoring was likely an explanation for the increased daytime sleepiness seen in the pregnant women.
Popp, Roland Fj; Maier, Stefanie; Rothe, Siegfried; Zulley, Jürgen; Crönlein, Tatjana; Wetter, Thomas C; Rupprecht, Rainer; Hajak, Göran
This study aimed to evaluate the impact of traffic noise along the motorway on sleep quality, sleepiness, and vigilant attention in long-haul truck drivers. This was a randomized, crossover, within-subject controlled study. Healthy long-haul truck drivers spent 6 consecutive nights in a real truck berth with full sleep laboratory equipment. During 3 nights, subjects were exposed to replayed traffic noise alongside motorways, whereas the other 3 nights were without traffic noise. Polysomnography was recorded during the nights and numerous sleepiness tests and vigilance examinations were performed during the following standardized working day. Outcome measures were compared between noisy and silent nights using the paired Wilcoxon test. Ten healthy long-haul truck drivers with a mean age of 36.3 ± 7.3 years completed the study as planned. On noisy nights, subjects had greater latencies to the rapid eye movement (REM) phase (90 ± 32 min vs 69 ± 16 min, P = 0.074) and higher percentages of sleep stage 1 (13.7 ± 5.5% vs 11.2 ± 4.4%; P = 0.059). Subjects also rated their sleep quality as having been better during nights without noise (28.1 ± 3.7 vs 30.3 ± 6.2, P = 0.092). The impact of these differences on daytime sleepiness and vigilance was rather low; however, mean Karolinska Sleepiness Scale (KSS) scores measured during the course of the following day were higher on six out of eight occasions after noisy nights. The effects of overnight traffic noise on sleep quality are detectable but unlikely to have any major impact on the vigilant attention and driving performance of long haul-truck drivers with low nocturnal noise sensitivity. This might not be true for subgroups prone to sleeping disorders.
Rives-Lange, C; Karsenty, A; Chantereau, H; Oderda, L; Dubern, B; Lecendreux, M; Tounian, P
Narcolepsy is a disabling disorder, characterized by excessive daytime sleepiness, irresistible sleep attacks, and partial or complete cataplexy. Many cases of obesity and precocious puberty have been reported in narcoleptic children, suggesting that the deficiency of hypocretin in narcolepsy could also be implicated in appetite stimulation. We report the observations of two young girls, who were referred for obesity and who developed narcolepsy accompanied by an abrupt weight gain. In both cases, specific drugs promoted wakefulness and overweight stabilization. Narcolepsy has to be suspected in sleepy obese children and not misdiagnosed as obstructive apnea. A nocturnal polysomnography with multiple sleep latency tests should be performed to confirm the diagnosis and begin specific treatment that is effective for sleep disorders and weight gain. Copyright © 2016. Published by Elsevier SAS.
Full Text Available The aim of the present study was to explore if observer rated sleepiness (ORS is a feasible method for quantification of driver sleepiness in field studies. Two measures of ORS were used: (1 one for behavioural signs based on facial expression, body gestures and body movements labelled B-ORS, and (2 one based on driving performance e.g. if swerving and other indicators of impaired driving occurs, labelled D-ORS. A limited number of observers sitting in the back of an experimental vehicle on a motorway about 2 hours repeatedly 3 times per day (before lunch, after lunch, at night observed 24 participant's sleepiness level with help of the two observer scales. At the same time the participant reported subjective sleepiness (KSS, EOG was recorded (for calculation of blink duration and several driving measure were taken and synchronized with the reporting. Based on mixed model Anova and correlation analysis the result showed that observer ratings of sleepiness based on drivers' impaired performance and behavioural signs are sensitive to extend the general pattern of time awake, circadian phase and time of driving. The detailed analysis of the subjective sleepiness and ORS showed weak correspondence on an individual level. Only 16% of the changes in KSS were predicted by the observer. The correlation between the observer ratings based on performance (D-ORS and behavioural signs (B-ORS are high (r = .588, and the B-ORS shows a moderately strong association (r = .360 with blink duration. Both ORS measures show an association (r>0.45 with KSS, whereas the association with driving performance is weak. The results show that the ORS-method detects the expected general variations in sleepy driving in field studies, however, sudden changes in driver sleepiness on a detailed level as 5 minutes is usually not detected; this holds true both when taking into account driving behaviour or driver behavioural signs.
Rupp, Tracy L; Acebo, Christine; Van Reen, Eliza; Carskadon, Mary A
Few studies examining alcohol's effects consider prior sleep/wake history and circadian timing. We examined introspective and physiological sleepiness on nights with and without moderate alcohol consumption in well-rested young adults at a known circadian phase. Twenty-nine adults (males=9), ages 21 to 25 years (M=22.6, SD=1.2), spent 1 week on an at-home stabilized sleep schedule (8.5 or 9 hours), followed by 3 in-lab nights: adaptation, placebo, and alcohol. Alcohol (vodka; 0.54 g/kg for men; 0.49 g/kg for women) or placebo beverage was consumed over 30 minutes ending 1 hour before stabilized bedtime. In addition to baseline, 3 sleep latency tests (SLTs) occurred after alcohol/placebo ingestion (15, 16.5, and 18 hours after waking). Stanford Sleepiness Scales (SSS) and Visual Analog Scales (VAS) of sleepiness were completed before each SLT and approximately every 30 minutes. The Biphasic Alcohol Effects Scale (BAES) was administered a total of 4 times (baseline, 5, 60, and 90 minutes postalcohol/placebo). Subjects' circadian phase was determined from melatonin levels in saliva samples taken at approximately 30-minute intervals. All sleepiness and sedation measures increased with time awake. Only SSS and BAES sedation measures showed higher levels of sleepiness and sedation after alcohol compared with placebo. The mean circadian phase was the same for assessments at both conditions. Alcohol did not increase physiological sleepiness compared with placebo nor was residual sedation evident under these conditions. We conclude that the effects on sleepiness of a moderate dose of alcohol are masked when sleep-wake homeostatic and circadian timing influences promote high levels of sleepiness.
Watling, Christopher N; Armstrong, Kerry A; Obst, Patricia L; Smith, Simon S
Driver sleepiness is a major contributor to road crashes. The current study sought to examine the association between perceptions of effectiveness of six sleepiness countermeasures and their relationship with self-reports of continuing to drive while sleepy among 309 drivers after controlling for the influence of age, sex, motivation for driving sleepy, and risk perception of sleepy driving. The results demonstrate that the variables of age, sex, motivation, and risk perception were significantly associated with self-reports of continuing to drive while sleepy and only one countermeasure was associated with self-reports of continuing to drive while sleepy. Further, it was found that age differences in self-reports of continuing to drive while sleepy was mediated by participants' motivation and risk perception. These findings highlight modifiable factors that could be focused on with interventions that seek to modify drivers' attitudes and behaviours of driving while sleepy. Copyright © 2014 Elsevier Ltd. All rights reserved.
Bakotic, Marija; Radosevic-Vidacek, Biserka; Koscec Bjelajac, Adrijana
The aim of this study was to explore the mediating role of sleep characteristics in the relationship between morningness-eveningness and three different aspects of daytime functioning: daytime sleepiness, depressive mood and substance use in university students. A multiple mediator model was proposed with sleep debt, poor sleep quality and bedtime delay at weekends as parallel mediators in these relationships. We analysed the data of 1052 university students aged 18-25 years who completed a modified version of the School Sleep Habits Survey, which included questions on sleep and the Composite Scale of Morningness, Sleepiness Scale, Depressive Mood Scale and Substance Use Scale. Students with more pronounced eveningness reported greater daytime sleepiness, greater depressive mood and more frequent substance use, as well as greater sleep debt, poorer sleep quality and greater bedtime delay at weekends. Mediation analyses indicated that morningness-eveningness affected daytime sleepiness and substance use both directly and indirectly through all proposed sleep-related mediators. However, the effect of morningness-eveningness on depressive mood was entirely indirect and was accounted for more by poor sleep than by sleep debt or bedtime irregularity. In conclusion, there are multiple possible mechanisms through which morningness-eveningness affects daytime functioning in university students, and sleep characteristics are a significant mechanism. Sleep debt, poor sleep quality and bedtime irregularity can, to a significant extent, explain the feeling of daytime sleepiness and greater substance use in students with eveningness preferences. However, more depressed mood in the evening-orientated students is primarily a consequence of their poor sleep quality. © 2016 European Sleep Research Society.
Owens, Judith A; Dearth-Wesley, Tracy; Lewin, Daniel; Gioia, Gerard; Whitaker, Robert C
To determine whether shorter school-night sleep duration, greater daytime sleepiness, and greater eveningness chronotype were associated with lower self-regulation among adolescents. An online survey of 7th- to 12th-grade students in 19 schools in Fairfax County, Virginia Public Schools was conducted in 2015. Self-regulation was measured with the Behavior Rating Inventory of Executive Function, 2nd edition, Screening Self-Report Form. Sleep measures included school night-sleep duration (hours between usual bedtime and wake time), daytime sleepiness (Sleepiness Scale in the Sleep Habits Survey, tertiles), and chronotype (Morningness-Eveningness Scale for Children, continuous score and tertiles). Sociodemographic factors and mental health conditions were analyzed as potential confounders. Among 2017 students surveyed, the mean age was 15.0 years (range, 12.1-18.9 years), and 21.7% slept sleep duration (P = .80). Compared with those in the lowest tertile of daytime sleepiness, those in the highest tertile had lower (0.59 SD units; 95% confidence interval, 0.48-0.71) self-regulation, as did those in the eveningness tertile of chronotype compared with those in the morningness tertile (0.35 SD units lower; 95% confidence interval, 0.24-0.46). Among adolescents, greater daytime sleepiness and greater eveningness chronotype were independently associated with lower self-regulation, but shorter sleep duration was not. Aspects of sleep other than school-night sleep duration appear to be more strongly associated with self-regulation. Copyright © 2016 by the American Academy of Pediatrics.
Jarosz, Patricia A; Davis, Jean E; Yarandi, Hossein N; Farkas, Rochelle; Feingold, Edna; Shippings, Sheila H; Smith, Arlanda L; Williams, Dorothy
African-American women (AAW) have the highest prevalence of obesity and therefore are at greater risk for obesity-related symptoms and diseases. Obese individuals frequently report poorer sleep quality, more daytime sleepiness, more severe fatigue, and higher physical inactivity than normal weight individuals. The relationships among these variables have not been well-characterized in obese, urban-dwelling, AAW. This descriptive, correlational study examined the relationships among sleep quality, daytime sleepiness, fatigue, level of physical activity, and body mass index (BMI) in AAW living in an urban setting. A convenience sample of 69 young adult women with a BMI of greater than 30 kg/m(2) completed measures of sleep quality, sleepiness, fatigue severity, sense of community, and physical activity. Further analysis was done to determine if any of the study variables predicted level of physical activity. There was a strong and significant correlation between BMI and overall fatigue severity and a significant, negative correlation between BMI and physical activity performance. BMI was significantly correlated with sleep latency but not global sleep quality. There were significant relationships between fatigue severity and poorer global sleep quality and daytime sleepiness. Multiple regression analysis showed BMI and age accounted for a significant amount of the variance in physical activity. Higher BMI was associated with significant fatigue. Fatigue severity was associated with poorer global sleep quality, daytime sleepiness, and a sense of community. Higher BMI may be a barrier to having an active lifestyle. Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
Sleep restriction therapy for insomnia is associated with reduced objective total sleep time, increased daytime somnolence, and objectively impaired vigilance: implications for the clinical management of insomnia disorder.
Kyle, Simon D; Miller, Christopher B; Rogers, Zoe; Siriwardena, A Niroshan; Macmahon, Kenneth M; Espie, Colin A
To investigate whether sleep restriction therapy (SRT) is associated with reduced objective total sleep time (TST), increased daytime somnolence, and impaired vigilance. Within-subject, noncontrolled treatment investigation. Sleep research laboratory. Sixteen patients [10 female, mean age = 47.1 (10.8) y] with well-defined psychophysiological insomnia (PI), reporting TST ≤ 6 h. Patients were treated with single-component SRT over a 4-w protocol, sleeping in the laboratory for 2 nights prior to treatment initiation and for 3 nights (SRT night 1, 8, 22) during the acute interventional phase. The psychomotor vigilance task (PVT) was completed at seven defined time points [day 0 (baseline), day 1,7,8,21,22 (acute treatment) and day 84 (3 mo)]. The Epworth Sleepiness Scale (ESS) was completed at baseline, w 1-4, and 3 mo. Subjective sleep outcomes and global insomnia severity significantly improved before and after SRT. There was, however, a robust decrease in PSG-defined TST during acute implementation of SRT, by an average of 91 min on night 1, 78 min on night 8, and 69 min on night 22, relative to baseline (P sleep restriction therapy is associated with reduced objective total sleep time, increased daytime sleepiness, and objective performance impairment. Our data have important implications for implementation guidelines around the safe and effective delivery of cognitive behavioral therapy for insomnia.
Kaida, Kosuke; Nittono, Hiroshi; Hayashi, Mitsuo; Hori, Tadao
To investigate the effects of self-awakening on sleep structure and daytime arousal after a short nap, a within-subjects comparison was made of participants in self-awakening and forced-awakening conditions. In the self-awakening condition. participants were instructed to wake up by themselves 15 min. after the experimenter turned the lights off. In the forced-awakening condition, the experimenter awakened them 20 min. after the lights were turned off. To control the maximum sleep time for the two conditions, we used different instructions in each condition. Participants were 10 healthy college students. Their physiological arousal and subjective sleepiness were evaluated using the P300 amplitude of the auditory event-related potential (ERP) and the visual analog scale previously described by Monk and Kathryn, et al. For evaluating sleep structure during the nap, Hori's 1994 hypnagogic EEG stages were used. P300 amplitude was significantly lower, and subjective sleepiness was significantly higher after forced-awakening than self-awakening, indicating that arousal was higher after self-awakening. The EEGs during napping in the forced-awakening condition indicated deeper sleep. Given this deeper sleep, severe sleep inertia occurred after the forced-awakening condition. In conclusion, it appeared a short nap with self-awakening was more effective in reducing a post-lunch dip than one with forced-awakening.
Uysal, Askin; Liendo, Cesar; McCarty, David E; Kim, Paul Y; Paxson, Chad; Chesson, Andrew L; Marino, Andrew A
This study aims to assess the association between excessive daytime sleepiness (EDS) and variables extracted from the pulse-oximetry signal obtained during overnight polysomnography. A cross-sectional design was used to study the relation between four hypoxemia variables and EDS as determined by Epworth Sleepiness Scale scores (ESSS) in 200 consecutive patients, newly diagnosed with obstructive sleep apnea (OSA), as defined by an apnea-hypopnea index (AHI)≥ 15. Hypoxemia measurements were compared between sleepy (ESSS ≥ 10) and nonsleepy (ESSShypoxemia variable (and for AHI) such that there were 35 (165) patients in each of the corresponding higher (lower) subcohorts. The hypoxemia variables were combined into a biomarker, and its accuracy for predicting sleepiness in individual patients was evaluated. We planned to interpret prediction accuracy above 80 % as evidence that hypoxemia predicted EDS. Hypoxemia was unassociated with sleepiness in OSA patients with AHI in the range of 15 to 50. In patients with AHI>50, the hypoxemia biomarker (but not individual hypoxemia variables) predicted sleepiness with 82 % accuracy. Nocturnal hypoxemia as determined by a polyvariable biomarker reliably predicted EDS in patients with severe OSA (AHI>50), indicating that oxygen fluctuation had a direct role in the development of EDS in patients with severe OSA.
Durán Agüero, Samuel; Sánchez Reyes, Hugo; Díaz Narváez, Víctor; Araya Pérez, Mónica
To determine the prevalence of mild and excessive somnolence and the associated factors with the presence of daytime sleepiness in the elderly. A total of 1780 independent individuals 60 years and older of both sexes (70.9±7.9 years old; females 62%), were included, of which 1704 of them completed all the information. All of them were assessed using an Epworth sleepiness scale (ESE), an Pittsburgh sleep quality index, plus information of cigarettes smoking, dinner time, and an anthropometric evaluation. An ESE score>10 was considered drowsiness and scores>15 excessive or severe drowsiness. Among the population under 80 years, 5.3% showed ESE score>15 and 26.2% an ESE score>10. For over 80 years, the prevalence of sleepiness was 6.3% for an ESE score>15 and 32.5% for an ESE score>10. In the adjusted model, the factors associated with increased risk of sleepiness (ESE>10) were age older than 80 years (OR=1.58; 95% CI=1.14 to 2.19) and dinner after 21 hours (OR=1.3; 95% CI=1.01 to 1.68). By contrast, only age older than 80 years was independently associated with severe sleepiness (OR=1.81; 95% CI=1.01 to 3.29). Meals after 21 hours and age above 80 years are associated with increased likelihood of daytime sleepiness. Instead, only older than 80 years is associated with severe daytime sleepiness. Copyright © 2015 SEGG. Published by Elsevier Espana. All rights reserved.
Agostini, Alex; Carskadon, Mary A; Dorrian, Jillian; Coussens, Scott; Short, Michelle A
This laboratory study investigated the impact of restricted sleep during a simulated school week on circadian phase, sleep stages and daytime functioning. Changes were examined across and within days and during a simulated weekend recovery. Participants were 12 healthy secondary school students (six male) aged 15-17 years [mean = 16.1 years, standard deviation (SD) = 0.9]. After 2 nights with 10 h (21:30-07:30 hours), time in bed was restricted to 5 h for 5 nights (02:30-07:30 hours), then returned to 10 h time in bed for 2 nights (21:30-07:30 hours). Saliva was collected in dim light on the first and last sleep restriction nights to measure melatonin onset phase. Sleep was recorded polysomnographically, and the Psychomotor Vigilance Task (PVT) and Karolinska Sleepiness Scale were undertaken 3-hourly while awake. Average phase delay measured by melatonin was 3 h (SD = 50 min). Compared to baseline, sleep during the restriction period contained a smaller percentage of Stages 1 and 2 and rapid eye movement (REM) and a greater percentage of Stage 4. PVT lapses increased significantly during sleep restriction and did not return to baseline levels during recovery. Subjective sleepiness showed a similar pattern during restriction, but returned to baseline levels during recovery. Results suggest that sustained attention in adolescents is affected negatively by sleep restriction, particularly in the early morning, and that a weekend of recovery sleep is insufficient to restore performance. The discrepancy between sleepiness ratings and performance may indicate a lack of perception of this residual impairment. © 2016 European Sleep Research Society.
Ben Ahmed, H; Boussaid, H; Hamdi, I; Longo, S; Baccar, H; Boujnah, M R
Obstructive sleep apnea syndrome (OSAS) is underdiagnosed in cardiologist daily practice, especially in patients with acute coronary syndrome. Its diagnosis is based on a polysomnography study. The Epworth Sleepiness Scale (ESS) stands as a simple and rapid means to select patients for the sleep investigation. The aim of this study was to determine the diagnostic accuracy of the ESS for screening OSAS in patients with ST elevation myocardial infarction. We conducted a prospective study of 120 consecutive patients admitted for acute myocardial infarction, from April 2011 to March 2012. Daytime sleepiness was evaluated using the ESS, when patients were in the intensive care unit. All patients have undergone an overnight sleep study using a portable diagnostic device, in the 15 days following the acute coronary syndrome. The diagnostic of OSA was considered as apnea-hypopnea index (AHI) of ≥5 events/hour, severe OSA was defined as AHI of ≥30. The study included 120 patients comprising 102 men and 18 women. The mean age was 58 ± 12 years. Smoking was the major cardiovascular risk factor with 72% of all patients; prevalence of diabetes was 40% and hypertension was found in 44% of the population. The prevalence of OSA was 79%. Severe OSA was diagnosed in 16% of all patients and mean AHI was 15.76 ± 14.93. Mean ESS was 2.2 ± 1.84 in the global population while it was 5.2 ± 1.2 in patients with severe OSAS. Multivariate analysis showed that ESS score ≥ 4 was an independent predictive factor for severe OSA (OR=28; 95% IC: 8-101; P<0.001). The prevalence of OSA in patients with acute myocardial infarction was very high. ESS score ≥ 4 was an independent predictive factor for severe OSA. Despite its subjective feature, the ESS seems to be an interesting score for screening patients to undergo polysomnography. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
Schwarz, Johanna F A; Ingre, Michael; Fors, Carina; Anund, Anna; Kecklund, Göran; Taillard, Jacques; Philip, Pierre; Åkerstedt, Torbjörn
This study investigated the effects of two very commonly used countermeasures against driver sleepiness, opening the window and listening to music, on subjective and physiological sleepiness measures during real road driving. In total, 24 individuals participated in the study. Sixteen participants received intermittent 10-min intervals of: (i) open window (2 cm opened); and (ii) listening to music, during both day and night driving on an open motorway. Both subjective sleepiness and physiological sleepiness (blink duration) was estimated to be significantly reduced when subjects listened to music, but the effect was only minor compared with the pronounced effects of night driving and driving duration. Open window had no attenuating effect on either sleepiness measure. No significant long-term effects beyond the actual countermeasure application intervals occurred, as shown by comparison to the control group (n = 8). Thus, despite their popularity, opening the window and listening to music cannot be recommended as sole countermeasures against driver sleepiness. © 2012 European Sleep Research Society.
Amaral, Maria Odete Pereira; de Almeida Garrido, António José; de Figueiredo Pereira, Carlos; Master, Nélio Veiga; de Rosário Delgado Nunes, Carla; Sakellarides, Constantino Theodor
To determine the prevalence of insomnia in a sample of Portuguese adolescents and assess its repercussions on HRQoL, daytime sleepiness and depressive symptomatology. We carried out a cross-sectional school-based study evaluating students from Viseu. Students from twenty-six public secondary schools in the county of Viseu, Portugal. Of 9237 questionnaires distributed, 7581 were collected (82.1%). We excluded from analysis all questionnaires from adolescents younger than 12 or older than 18 years of age (211) and unfilled forms (451). The sample comprised 6919 adolescents, the 7th to 12th grade, from 26 public secondary schools. None. Data gathering was done using a self-applied questionnaire. Insomnia was defined based on the Diagnostic and Statistical Manual of Mental Disorders - IV criteria. HRQoL was evaluated with the Quality of Life Health Survey SF-36, depressive symptomatology with BDI-II and daytime sleepiness with the Epworth Sleepiness Scale. Prevalence of insomnia was 8.3% and the prevalence of adolescents with symptoms of insomnia without daytime impairment (disturbed sleepers) was 13.1%. HRQoL was significantly reduced among adolescents with insomnia compared to normal sleepers (p<0.001) and even when compared to disturbed sleepers (p<0.001). There was an increase in daytime sleepiness from normal sleepers to disturbed sleepers and to adolescents with insomnia (p<0.001). There was also an increase in the prevalence and severity of depressive symptoms (p<0.001). Our results show that insomnia is associated with a significantly lower health related quality of life among adolescents. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.
Gigli, G L; Placidi, F; Diomedi, M; Maschio, M; Silvestri, G; Scalise, A; Marciani, M G
It is still debated whether the deterioration of the sleep pattern, frequently reported by elderly subjects, is due only to aging per se. Other factors associated with aging or modifications of biological rhythms could also be involved. Elderly subjects frequently complain of daytime sleepiness, but it is not clear whether this actually represents a return to a polyphasic structure of sleep, or only a consequence of a disturbed night sleep. Ten healthy, independent and active elderly subjects (age > 72 years) were elevated by means of 24-hour ambulatory polysomnography. Findings of nocturnal sleep were compared with sleep of the same group in the 24-hour period and with sleep of young healthy controls. We observed a fragmentation of nocturnal sleep, but a fairly good representation of stages and a preservation of cyclicity. Except for three cases, with early or late times of sleep onset and wake-up, sleep disruption did not seem to be related to modification of circadian rhythms. Only three subjects presented undesired daytime naps, whereas the others either did not show daytime sleep at all, or were used to having their siesta after lunch since their young adulthood. In normal aging, daytime sleep does not constitute a social problem. Ambulatory polysomnography is a valid alternative to laboratory recordings in the identification of daytime sleep.
Sleep Restriction Therapy for Insomnia is Associated with Reduced Objective Total Sleep Time, Increased Daytime Somnolence, and Objectively Impaired Vigilance: Implications for the Clinical Management of Insomnia Disorder
Kyle, Simon D.; Miller, Christopher B.; Rogers, Zoe; Siriwardena, A. Niroshan; MacMahon, Kenneth M.; Espie, Colin A.
Study Objectives: To investigate whether sleep restriction therapy (SRT) is associated with reduced objective total sleep time (TST), increased daytime somnolence, and impaired vigilance. Design: Within-subject, noncontrolled treatment investigation. Setting: Sleep research laboratory. Participants: Sixteen patients [10 female, mean age = 47.1 (10.8) y] with well-defined psychophysiological insomnia (PI), reporting TST ≤ 6 h. Interventions: Patients were treated with single-component SRT over a 4-w protocol, sleeping in the laboratory for 2 nights prior to treatment initiation and for 3 nights (SRT night 1, 8, 22) during the acute interventional phase. The psychomotor vigilance task (PVT) was completed at seven defined time points [day 0 (baseline), day 1,7,8,21,22 (acute treatment) and day 84 (3 mo)]. The Epworth Sleepiness Scale (ESS) was completed at baseline, w 1-4, and 3 mo. Measurement and results: Subjective sleep outcomes and global insomnia severity significantly improved before and after SRT. There was, however, a robust decrease in PSG-defined TST during acute implementation of SRT, by an average of 91 min on night 1, 78 min on night 8, and 69 min on night 22, relative to baseline (P treatment (at four of five assessment points, all P sleep restriction therapy is associated with reduced objective total sleep time, increased daytime sleepiness, and objective performance impairment. Our data have important implications for implementation guidelines around the safe and effective delivery of cognitive behavioral therapy for insomnia. Citation: Kyle SD; Miller CB; Rogers Z; Siriwardena AN; MacMahon KM; Espie CA. Sleep restriction therapy for insomnia is associated with reduced objective total sleep time, increased daytime somnolence, and objectively impaired vigilance: implications for the clinical management of insomnia disorder. SLEEP 2014;37(2):229-237. PMID:24497651
Anderson, Basil; Storfer-Isser, Amy; Taylor, H Gerry; Rosen, Carol L; Redline, Susan
Sleep deprivation and sleepiness are associated with poorer school performance, impaired neurobehavioral functioning, and behavioral problems. To determine if adolescents with high levels of sleepiness or short sleep duration have impaired executive functioning. Ours was a cross-sectional analysis of data from 236 healthy adolescents in a community-based cohort study. Sleepiness was measured by using a modified version of the Epworth Sleepiness Scale. Participants underwent 5- to 7-day wrist actigraphy at home before overnight polysomnography. Exposure variables were excessive sleepiness (Epworth Sleepiness Scale > or = 11) and weekday mean sleep duration. The main outcome measures were the global executive composite scale from the Behavior Rating Inventory of Executive Function and the tower test-total achievement score from the Delis-Kaplan Executive Functioning System. Participants (N = 236) were 13.7 +/- 0.8 years of age, and 52.1% were boys. Mean weekday sleep duration was 7.70 +/- 1.03 hours; 11% slept adolescents had poorer executive functioning on the Behavior Rating Inventory of Executive Function global executive composite scale and the Delis-Kaplan Executive Functioning System tower test-total achievement. Analyses adjusted for potential confounders resulted in a modest attenuation of the association with the Behavior Rating Inventory of Executive Function and a larger attenuation for the Delis-Kaplan Executive Functioning System. Caregiver education modified the association between sleepiness and the Behavior Rating Inventory of Executive Function outcomes. Among sleepy adolescents, those with less-educated caregivers had greater impairment on the Behavior Rating Inventory of Executive Function global executive composite scale. Sleep duration was not significantly associated with executive functioning outcomes. Decrements in selected executive function scales are associated with subjective sleepiness, but not sleep duration, in adolescents. The
Comparative analysis of multiple sleep latency tests (MSLT parameters and occurrence of dreaming in patients with daytime sleepiness of narcoleptic and non-narcoleptic origin Estudo comparativo de parâmetros de testes de latências múltiplas do sono (TLMS e ocorrência de sonhos em pacientes hipersones narcolépticos e não-narcolépticos
Eduardo Siqueira Waihrich
Full Text Available OBJECTIVE: To compare MSLT parameters in two groups of patients with daytime sleepiness, correlated to the occurrence and onset of dreams. METHOD: Patients were submitted to the MSLT between January/1999 and June/2002. Sleep onset latency, REM sleep latency and total sleep time were determined. The occurrence of dreams was inquired following each MSLT series. Patients were classified as narcoleptic (N or non-narcoleptic (NN. RESULTS: Thirty patients were studied, 12 were classified as narcoleptics (N group; 40%, while the remaining 18 as non-narcoleptic (NN group; 60%. Thirty MSLT were performed, resulting in 146 series. Sleep was detected in 126 series (86% and dreams in 56 series (44.44%. Mean sleep time in the N group was 16.0±6.3 min, while 10.5±7.5 min in the NN group (pOBJETIVO: Comparar variáveis do TLMS em dois grupos de pacientes hipersones e correlacionar presença e momento de ocorrência de sonhos. MÉTODO: Os pacientes foram submetidos a TLMS entre janeiro de 1999 e junho de 2002. Analisou-se a média das latências de sono, latências de sono REM e tempo total de sono. A presença de sonhos foi inquirida após cada série. Classificou-se os pacientes em narcolépticos (N e não-narcolépticos (NN. RESULTADOS: Do total de 30 pacientes, 12 foram classificados no grupo N (40% e 18 no NN (60%. Dos 30 TLMS foram obtidas 146 séries. Houve sono em126 (86% e sonho em 56 (44,44%. O tempo médio de sono no grupo N foi 16,0±6,3min e no NN 10,5±7,5min (p<0,0001. A latência média de sono no grupo N foi 2,0±2,2min e no NN 7,2±6,0min (p<0,001. A latência média do sono REM no N foi 3,2±3,1min e no NN 6,9±3,7min (p=0,021. Houve sonhos em 56,9% das séries do grupo N e 28,4% do NN (p=0,0009. A freqüência de sonhos em séries NREM no N foi 29,8 % e no NN 75% (p= 0,0001. CONCLUSÃO: Os pacientes do grupo N dormiram mais e mais rapidamente, apresentaram REM mais precocemente e maior freqüência de sonhos que os NN. Estes apresentaram
Potvin, Olivier; Lorrain, Dominique; Belleville, Geneviève; Grenier, Sébastien; Préville, Michel
Sleep complaints are often associated with anxiety and depression, but the specific complaints related to each syndrome are poorly characterized, especially in older adults. The objective was to identify subjective sleep characteristics specific to anxiety and depression in this population. A random sample of 2393 individuals aged 65 years or older was used. Anxiety and depression were categorized using DSM-V criteria for phobias, panic disorder, generalized anxiety disorder, unspecified anxiety disorder, major depressive episode, and depressive episode with insufficient symptoms. Subjective sleep characteristics were measured using the Pittsburgh Sleep Quality Index. Logistic regression models predicting anxiety or depression were used to determine the independent sleep characteristics associated with each syndrome adjusting for age, sex, education level, cognitive functioning, anxiolytic/sedative/hypnotic use, antidepressants use, subjective health, chronic diseases, cardiovascular conditions, and anxiety or depression (as appropriate). Nearly all Pittsburgh Sleep Quality Index subscales were significantly associated with anxiety, but these subscales shared variance and only sleep duration in hours, sleep disturbance score, and daytime functioning score were independently related to anxiety. Within these significant subscales, the main specific sleep complaints associated with anxiety were daytime sleepiness and sleep disturbances related to coughing/snoring, feeling cold, and bad dreams. The use of sleeping medication was the only specific sleep characteristic associated with depression. These results suggest that in older adults, symptoms of short sleep duration, daytime sleepiness and sleep disturbances are independently related to anxiety while the use of sleep medication is independently associated to depression. Copyright © 2014 John Wiley & Sons, Ltd.
Jarrin, Denise C.; McGrath, Jennifer J.; Quon, Elizabeth C.
Objective Socioeconomic position (SEP) is inversely associated with many health outcomes, yielding a socioeconomic gradient in health. In adults, low SEP is associated with short sleep duration, poorer sleep quality, and difficulty initiating and maintaining sleep. Relatively little is known about this relation in youth. The aim of the present study was to examine whether socioeconomic gradients exist for various sleep indices among a healthy sample of children and adolescents. Method Participants took part in the larger Healthy Heart Project and included 239 youth (69.6% Caucasian; 45.6% female), aged 8–17 years (M =12.6, SD =1.9). Parental income and education were used to measure objective SEP. The Subjective Social Status Scale-Youth Version was used to measure subjective SEP. Sleep duration, sleep quality, daytime sleepiness, and sleep disturbances were assessed through self- and parent-report. Results In children, objective SEP was related with sleep duration (β =.35, p <.01), although subjective SEP was related with daytime sleepiness (βavg =.33, p <.01) and parent-reported sleep duration (β =.23, p <.05). In adolescents, subjective SEPwas related with sleep quality (β =.28, p <.01) and parent-reported sleep duration (β = −.18, p <.05), even after controlling for objective SEP. Conclusions Socioeconomic gradients were observed for multiple sleep measures in youth. Objective parental SEP was related with sleep complaints (e.g., sleep disturbances), and subjective SEP was related with sleep quality and daytime sleepiness. Findings suggest sleep may be one pathway underlying the socioeconomic gradient in health. Future research should aim to elucidate how distinct sleep constructs may explain how socioeconomic status “gets under the skin” to affect health. PMID:23730721
Full Text Available Daytime sleepiness after ingestion of midazolam as a hypnotic was quantitatively studied employing the Multiple Sleep Latency Test (MSLT. We evaluated 20 healthy volunteers, 10 of which received a single oral dose of midazolam (15 mg, one tablet and 10 of which received placebo, in a double-blind design. Tablets were administered at 2200 h, bedtime. On the following day, all subjects were submitted to a clinical evaluation, a subjective checklist and the MSLT. The mean age was 34.7 + 8.9 years in the midazolam and 38.0+10.6 years in the placebo groups (n.s.. Sex and weight distributions were similar in both groups (n.s.. Clinical evaluation and subjective symptom checklist did not make evident significant differences between midazolam and placebo groups (n.s.. The MSTL was performed at 0900, 1100, 1300, 1500 and 1700 h. Mean sleep latencies were 12.0, 12.7, 8.0, 13.5, 17.0 min in the midazolam group; mean sleep latencies were 13.8, 9.0, 6.9, 9.5, 13.6 min in the placebo group (n.s.. In the single dose, double-blind design here evaluated, midazolam did not show differences in relation to placebo on the following day, detectable by the MSLT.
Buckhalt, Joseph A
While causal connections between sleep deprivation and attention, learning, and memory have been well established in adults, much less research has been done with children. Relations between the amount and quality of sleep and daytime sleepiness have been found for a number of cognitive and academic tasks in several groups of children. These relations have been found for children who have sleep disorders, for children with disorders involving cognitive impairment, and for typically developing children with no known disorders. The research is reviewed here with a focus on the types of cognitive and academic tasks that have been related to insufficient sleep. A series of studies is described that relates sleep parameters to the Woodcock-Johnson® III Tests of Cognitive Abilities and other, similar measures. Implications for educators and psychologists who work with children are discussed.
Gibson, Edward S; Powles, A C Peter; Thabane, Lehana; O'Brien, Susan; Molnar, Danielle Sirriani; Trajanovic, Nik; Ogilvie, Robert; Shapiro, Colin; Yan, Mi; Chilcott-Tanser, Lisa
Evidence is growing that sleep problems in adolescents are significant impediments to learning and negatively affect behaviour, attainment of social competence and quality of life. The objectives of the study were to determine the level of sleepiness among students in high school, to identify factors to explain it, and to determine the association between sleepiness and performance in both academic and extracurricular activities A cross-sectional survey of 2201 high school students in the Hamilton Wentworth District School Board and the Near North District School Board in Ontario was conducted in 1998/9. A similar survey was done three years later involving 1034 students in the Grand Erie District School Board in the same Province. The Epworth Sleepiness Scale (ESS) was used to measure sleepiness and we also assessed the reliability of this tool for this population. Descriptive analysis of the cohort and information on various measures of performance and demographic data were included. Regression analysis, using the generalised estimating equation (GEE), was utilized to investigate factors associated with risk of sleepiness (ESS>10). Seventy per cent of the students had less than 8.5 hours weeknight sleep. Bedtime habits such as a consistent bedtime routine, staying up late or drinking caffeinated beverages before bed were statistically significantly associated with ESS, as were weeknight sleep quantity and gender. As ESS increased there was an increase in the proportion of students who felt their grades had dropped because of sleepiness, were late for school, were often extremely sleepy at school, and were involved in fewer extracurricular activities. These performance measures were statistically significantly associated with ESS. Twenty-three percent of the students felt their grades had dropped because of sleepiness. Most students (58-68%) reported that they were "really sleepy" between 8 and 10 A.M. Sleep deprivation and excessive daytime sleepiness were common
.M. Conclusion Sleep deprivation and excessive daytime sleepiness were common in two samples of Ontario high school students and were associated with a decrease in academic achievement and extracurricular activity. There is a need to increase awareness of this problem in the education and health communities and to translate knowledge already available to strategies to address it.
Swinbourne, Richard; Gill, Nicholas; Vaile, Joanna; Smart, Daniel
Despite the perceived importance of sleep for athletes, little is known regarding athlete sleep quality, their prevalence of daytime sleepiness or risk factors for obstructive sleep apnoea (OSA) such as snoring and witnessed apnoeic episodes. The purpose of the present study was to characterise normative sleep quality among highly trained team sport athletes. 175 elite or highly trained rugby sevens, rugby union and cricket athletes completed the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Score (ESS) and Quality of Life questionnaires and an OSA risk factor screen. On average, athletes reported 7.9 ± 1.3 h of sleep per night. The average PSQI score was 5.9 ± 2.6, and 50% of athletes were found to be poor sleepers (PSQI > 5). Daytime sleepiness was prevalent throughout the population (average global score of 8.5) and clinically significant (ESS score of ≥10) in 28% of athletes. OSA may be an important clinical consideration within athletic populations, as a considerable number of athletes (38%) defined themselves as snorers and 8% reported having a witnessed apnoeic episode. The relationship between self-rated sleep quality and actual PSQI score was strong (Pearson correlation of 0.4 ± 0.1, 90% confidence limits). These findings suggest that this cohort of team sport athletes suffer a preponderance of poor sleep quality, with associated high levels of daytime sleepiness. Athletes should receive education about how to improve sleep wake schedules, extend total sleep time and improve sleep quality.
Kanabar, K; Sharma, S K; Sreenivas, V; Biswas, A; Soneja, M
The Epworth Sleepiness Scale (ESS) is one of the most widely used questionnaire for the assessment of excessive daytime sleepiness (EDS) in sleep-disordered breathing (SDB). This study was conducted to assess the validity of ESS in the Hindi language. The Hindi version was developed by translation and back translation by independent translators. The English and Hindi versions were administered to 115 bilingual subjects who presented with symptoms of SDB, of whom 98 underwent a polysomnography at a tertiary care hospital in North India. The questionnaire had a high level of internal consistency as measured by Cronbach's alpha (α = 0.84). There was no significant difference between the mean ESS scores of Hindi and English versions (11.65 ± 5.47 vs 11.70 ± 5.49, respectively; p = 0.80). The Hindi version of ESS showed a strong correlation with the English version (Spearman's correlation ρ = 0.98 and weighted kappa = 0.94). Each of the 8 individual questions of Hindi ESS demonstrated a good agreement with the corresponding English version. The Hindi ESS score was significantly higher in subjects with OSA compared to those without OSA (12.67 ± 5.29 vs 7.76 ± 5.44, respectively; p = 0.002). However, there was no difference in ESS score between mild and moderate OSA or between moderate and severe OSA. The Hindi version of the ESS showed a good internal consistency and a strong correlation with the English version and can be used in the Hindi-speaking population.
Full Text Available Aim: Sleep problems are common in students with one third of university students reporting insufficient sleep. It is known that sleep quality and daytime sleepiness cause decrasing academic performans. For this reason we aimed to investigate the effects of a sleep hygiene education on sleep quality and academic performance of first year medical students. Material and Method: Self-reported sleep data and academic performance of 131 first grade medical students were collected. To all students enrolled Pittsburg Sleep Quality Scale in the assessment of sleep quality and Epworth Sleepiness Scale for assessment of daytime sleepiness in the evaluation.The students were divided into two subgroups and the intervention group received a 30 minute structured sleep hygiene education. Global academic performance was assessed by grade point average at the end of the year. Results: Mean Pittsburgh sleep quality index score of the students was 7.9±3.5 and 106 (82.8% of then had a score %u22655.After intervention, .the worse the initial sleep quality, the more improvement by the sleep hygiene education on sleep quality and academic performance. Discussion: An education on sleep hygiene might improve subjective sleep quality and academic performance of medical students.
PHIPPS‐NELSON, JO; REDMAN, JENNIFER R; RAJARATNAM, SHANTHA M. W
.... We examined the temporal profile of changes in driving performance, electroencephalogram (EEG) activity and subjective measures of sleepiness and fatigue during prolonged nocturnal driving in a car simulator...
Landtblom, Anne-Marie; Engström, Maria
The sleepy teenager puts the doctor in a, often tricky, situation where it must be decided if we deal with normal physiology or if we should suspect pathological conditions. What medical investigations are proper to consider? What differential diagnoses should be considered in the first place? And what tools do we actually have? The symptoms and problems that usually are presented at the clinical visit can be both of medical and psychosocial character - and actually they are often a mixture of both. Subsequently, the challenge to investigate the sleepy teenager often includes the examination of a complex behavioral pattern. It is important to train and develop diagnostic skills and to realize that the physiological or pathological conditions that can cause the symptoms may have different explanations. Research in sleep disorders has shown different pathological mechanisms congruent with the variations in the clinical picture. There are probably also different patterns of involved neuronal circuits although common pathways may exist. The whole picture remains to be drawn in this interesting and challenging area.
Short, Michelle A; Agostini, Alexandra; Lushington, Kurt; Dorrian, Jillian
The aim of this review was to identify which limited wake shift work schedules (LWSW) best promote sleep, alertness, and performance. LWSW are fixed work/rest cycles where the time-at-work does is ≤8 hours and there is >1 rest period per day, on average, for ≥2 consecutive days. These schedules are commonly used in safety-critical industries such as transport and maritime industries. Literature was sourced using PubMed, Embase, PsycInfo, Scopus, and Google Scholar databases. We identified 20 independent studies (plus a further 2 overlapping studies), including 5 laboratory and 17 field-based studies focused on maritime watch keepers, ship bridge officers, and long-haul train drivers. The measurement of outcome measures was varied, incorporating subjective and objective measures of sleep: sleep diaries (N=5), actigraphy (N=4), and polysomnography, (N=3); sleepiness: Karolinska Sleepiness Scale (N=5), visual analog scale (VAS) alertness (N=2) and author-derived measures (N=2); and performance: Psychomotor Vigilance Test (PVT) (N=5), Reaction Time or Vigilance tasks (N=4), Vector and Letter Cancellation Test (N=1), and subjective performance (N=2). Of the three primary rosters examined (6 hours-on/6 hours-off, 8 hours-on/8 hours-off and 4 hours-on/8 hours-off), the 4 hours-on/8 hours-off roster was associated with better sleep and lower levels of sleepiness. Individuals working 4 hours-on/8 hours-off rosters averaged 1 hour more sleep per night than those working 6 hours-on/6 hours-off and 1.3 hours more sleep than those working 8 hours-on/8 hours-off (Pschedules were associated with better sleep and lower sleepines in the case of (i) shorter time-at-work, (ii) more frequent rest breaks, (iii) shifts that start and end at the same clock time every 24 hours, and (iv) work shifts commencing in the daytime (as opposed to night). The findings for performance remain incomplete due to the small number of studies containing a performance measure and the heterogeneity of
Tokizawa, Ken; Sawada, Shin-Ichi; Tai, Tetsuo; Lu, Jian; Oka, Tatsuo; Yasuda, Akinori; Takahashi, Masaya
It is considered that sleep restriction is one of the risk factors for the development of exertional heat stroke and illness. However, how sleep restriction affects exertional heat strain and the nature of the coping strategy involved in this phenomenon remain unclear. Fourteen healthy subjects were studied on four occasions: after a night of normal sleep (NS, 7-8 h) and after a night of partial sleep restriction (PSR, 4 h), each with or without taking a daytime nap during the subsequent experimental day. The laboratory test consisted of two 40 min periods of moderate walking in a hot room in the morning and the afternoon. The increase in rectal temperature during walking was significantly greater in PSR than in NS in the afternoon. The rating scores for physical and psychological fatigue and sleepiness were significantly greater in PSR than in NS, both in the morning and in the afternoon. The reaction times and lapses in the psychomotor vigilance task (PVT) after walking were significantly worse in PSR than in NS in the morning and after lunch. The nap intervention attenuated significantly the scores for fatigue and sleepiness in PSR. Furthermore, the decreased PVT response in PSR was significantly reversed by the nap. These results suggest that PSR augments physiological and psychological strain and reduces vigilance in the heat. Taking a nap seemed to be effective in reducing psychological strain and inhibiting the decrease in vigilance. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Singh, Ruchi; Shriyan, Rhea; Sharma, Renuka; Das, Shobha
College students, who are in a phase of transition from adolescence to adulthood, face numerous challenges. Due to stress overload, students easily fall prey to mood disturbances like stress, anxiety and depression compromising their quality of life. Present study was undertaken to see the effect of choice of professional course on quality of life and mood of the first year students of medical, engineering and arts students. A cross-sectional study was conducted amongst 150 students, 50 participants from each stream. Enrolled subjects were administered questionnaires pertaining to their quality of life (WHOQOL-BREF), mood disorders (DASS-42) and sleepiness (ESS). Medical students showed significantly higher levels of stress (p-value=0.0001), depression (p-value=0.002) and anxiety (p-value=0.002), 30% of medicos labelled their quality of life as very good compared to 48% and 50% of engineering and arts students. A 38% of medical student's reported daytime sleepiness compared to 12% engineering and 6% arts students. Present study shows that medical students are maximally vulnerable to mood disorders and have a poor quality life. As the student community forms the backbone of any nation, we as, educators should try to strengthen each individual by promoting not only physical and mental development but also aiming for overall holistic development.
Shriyan, Rhea; Sharma, Renuka; Das, Shobha
Introduction College students, who are in a phase of transition from adolescence to adulthood, face numerous challenges. Due to stress overload, students easily fall prey to mood disturbances like stress, anxiety and depression compromising their quality of life. Aim Present study was undertaken to see the effect of choice of professional course on quality of life and mood of the first year students of medical, engineering and arts students. Materials and Methods A cross-sectional study was conducted amongst 150 students, 50 participants from each stream. Enrolled subjects were administered questionnaires pertaining to their quality of life (WHOQOL-BREF), mood disorders (DASS-42) and sleepiness (ESS). Results Medical students showed significantly higher levels of stress (p-value=0.0001), depression (p-value=0.002) and anxiety (p-value=0.002), 30% of medicos labelled their quality of life as very good compared to 48% and 50% of engineering and arts students. A 38% of medical student’s reported daytime sleepiness compared to 12% engineering and 6% arts students. Conclusion Present study shows that medical students are maximally vulnerable to mood disorders and have a poor quality life. As the student community forms the backbone of any nation, we as, educators should try to strengthen each individual by promoting not only physical and mental development but also aiming for overall holistic development. PMID:27437246
Flick, Uwe; Garms-Homolová, Vjenka; Röhnsch, Gundula
Are nurses aware that activities can reduce residents' daytime sleepiness and increase sleep quality at night in nursing homes? This question is studied in a project focusing on sleep disorders and multi-morbidity in long-term care. In Germany, episodic interviews with 32 nursing staff members (age 24-60 years) with different qualifications addressed their views on links between residents' daytime structure and activities and their sleep/disorders. Three interpretive and activity patterns (intervention; missed opportunity; ignorance) were found, which differ in relation to how far the interviewees motivate residents' activity. Implications for a training program based on these different premises are discussed.
Mansfield, Lyndon E; Diaz, Gonzalo; Posey, Catherine R; Flores-Neder, Jaime
Nasal obstruction is recognized as an important cause of sleep disordered breathing. Congestion of the nasal mucosa and obstruction are common symptoms of allergic rhinitis. Daytime sleepiness is a common finding in symptomatic allergic rhinitis. Effective therapy of the nasal congestion of allergic rhinitis should alter sleep patterns in patients with symptomatic allergic rhinitis. To measure objective changes in polysomnograms (sleep studies) of children with allergic rhinitis before and after therapy with intranasal budesonide and to measure changes in the quality of life of these patients during treatment. Open clinical trial with objective measurements (polysomnography) and subjective data (Rhinitis Quality of Life Questionnaire [RQLQ]). Evaluations were performed before, during, and at completion of therapeutic intervention. The 14 studied children tolerated the procedures and treatment without problems. The mean number of sleep arousals per hour (all apneas and hypopneas) decreased from a baseline of 8.4 to 1.2 (P = .005) after treatment. The change was mainly in hypopneic episodes (7.5-0.9, P = .003). Objective responses on the RQLQ showed improvements consistent with improved sleep and lessened rhinitis symptoms. Decreasing the nasal congestion associated with allergic rhinitis can improve sleep measured by objective sleep studies and lead to improvement in daytime quality of life.
Matsushita, Masateru; Koyama, Asuka; Ushijima, Hirokage; Mikami, Akira; Katsumata, Yotaro; Kikuchi, Yoko; Ichimi, Naoko; Jono, Tadashi; Fujise, Noboru; Ikeda, Manabu
The Japanese word "ronin-sei" refers to a student who has failed their university entrance examination and is preparing to re-take the examination in the following year. We aimed to determine how sleep duration is associated with daytime sleepiness or depression in ronin-sei because impaired daytime performance is known to result from sleep deprivation. The participants in this cross-sectional study were 1075 ronin-sei and 285 university students. Sleepiness and depressive symptoms were assessed using the Epworth Sleepiness Scale (ESS) and the Center for Epidemiologic Studies Depression Scale (CES-D), respectively. Ronin-sei had significantly shorter sleep duration and earlier bed- and rise-times than university students. There was no significant difference in CES-D between the groups; however, the ESS score of university students was significantly higher than that of ronin-sei. Ronin-sei who slept for 5 to Sleep deprivation appears to be common among ronin-sei. Furthermore, a U-shaped relationship was found between sleep duration and depressive symptoms, revealing that ronin-sei who had too little or too much sleep were more likely to exhibit an increase in depressive symptoms. Copyright © 2014 Elsevier B.V. All rights reserved.
Full Text Available The present study aimed to analyse the autonomic nervous system activity using heart rate variability (HRV to detect sleep disordered breathing (SDB patients with and without excessive daytime sleepiness (EDS before sleep onset.Two groups of 20 patients with different levels of daytime sleepiness -sleepy group, SG; alert group, AG- were selected consecutively from a Maintenance of Wakefulness Test (MWT and Multiple Sleep Latency Test (MSLT research protocol. The first waking 3-min window of RR signal at the beginning of each nap test was considered for the analysis. HRV was measured with traditional linear measures and with time-frequency representations. Non-linear measures -correntropy, CORR; auto-mutual-information function, AMIF- were used to describe the regularity of the RR rhythm. Statistical analysis was performed with non-parametric tests.Non-linear dynamic of the RR rhythm was more regular in the SG than in the AG during the first wakefulness period of MSLT, but not during MWT. AMIF (in high-frequency and in Total band and CORR (in Total band yielded sensitivity > 70%, specificity >75% and an area under ROC curve > 0.80 in classifying SG and AG patients.The regularity of the RR rhythm measured at the beginning of the MSLT could be used to detect SDB patients with and without EDS before the appearance of sleep onset.
Full Text Available The sleepy teenager is a diagnostic challenge because the problems may be physiological or pathological, with behavioural, social and pychological expressions. It is of great importance that health staff that encounter young people with sleep disturbance have good knowledge about the diseases that must be excluded. Narcolepsy, periodic hypersomnia like Kleine Levin syndrome, delayed sleep phase syndrome and obstructive sleep apnoea syndrome, depression and substance use as well as fatigue from chronic disease like multiple sclerosis should be investigated. Clinical assessment, neurophysiological and laboratory investigations constitute important support in these investigations. Functional methods, for example fMRI, are being developed. The role of computer gaming and use of social media in the night is discussed in relation to these diseases. Cognitive dysfunction may develop with several of the conditions. There is need for increased awareness of how to investigate sleep disturbance in children and young people.
Şahin, Erkan Melih
.... It is known that sleep quality and daytime sleepiness cause decrasing academic performans. For this reason we aimed to investigate the effects of a sleep hygiene education on sleep quality and academic performance of first year medical students...
Groeger, John A; Lo, June C Y; Burns, Christopher G; Dijk, Derk-Jan
The effects of executive load on working memory performance during sleep inertia after morning or afternoon naps were assessed using a mixed design with nap/wake as a between-subjects factor and morning/afternoon condition as a within-subject factor. Thirty-two healthy adults (mean 22.5 ± 3.0 years) attended two laboratory sessions after a night of restricted sleep (6 hrs), and at first visit, were randomly assigned to the Nap or Wake group. Working memory (n-back) and subjective workload were assessed approximately 5 and 25 minutes after 90-minute morning and afternoon nap opportunities and at the corresponding times in the Wake condition. Actigraphically assessed nocturnal sleep duration, subjective sleepiness, and psychomotor vigilance performance before daytime assessments did not vary across conditions. Afternoon naps showed shorter EEG assessed sleep latencies, longer sleep duration, and more Slow Wave Sleep than morning naps. Working memory performance deteriorated, and subjective mental workload increased at higher executive loadings. After afternoon naps, participants performed less well on more executive-function intensive working memory tasks (i.e., 3-back), but waking and napping participants performed equally well on simpler tasks. After some 30 minutes of cognitive activity, there were no longer performance differences between the waking and napping groups. Subjective Task Difficulty and Mental Effort requirements were less affected by sleep inertia and dissociated from objective measures when participants had napped in the afternoon. We conclude that executive functions take longer to return to asymptotic performance after sleep than does performance of simpler tasks which are less reliant on executive functions. (PsycINFO Database Record (c) 2011 APA, all rights reserved).
Maglione, Jeanne E.; Ancoli-Israel, Sonia; Peters, Katherine W.; Paudel, Misti L.; Yaffe, Kristine; Ensrud, Kristine E.; Stone, Katie L.
Objectives To examine the relationship between depressive symptoms and subjective and objective sleep in older women. Design Cross-sectional. Setting Four US clinical centers. Participants 3045 community-dwelling women ≥70 years. Measurements Depressive symptoms were assessed with the Geriatric Depression Scale categorizing participants as “normal” (0–2, referent), “some depressive symptoms” (3–5), or “depressed” (≥6). Subjective sleep quality and daytime sleepiness were assessed using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Objective sleep measures were assessed with wrist actigraphy. Results In multivariable-adjusted models, there were graded associations between increased level of depressive symptoms and both worse subjective sleep quality and more subjective daytime sleepiness (p-trends depressive symptoms (OR 1.82, CI 1.48–2.24) and depressed (OR 2.84, CI 2.08–3.86) women had greater odds of reporting poor sleep (PSQI>5). Women with some depressive symptoms (OR 1.97, CI 1.47–2.64) and depressed women (OR 1.70, CI 1.12–2.58) had greater odds of reporting excessive daytime sleepiness (ESS>10). There were also graded associations between increased level of depressive symptoms and objectively measured wake after sleep onset (WASO) (p-trend = 0.030) and long wake episodes >5 minutes (p-trend 0.006). Depressed women had modestly increased odds of WASO ≥1 hour (OR 1.37, CI 1.03–1.83). Women with some depressive symptoms (OR 1.49, CI 1.19–1.86) and depressed women (OR 2.04, CI 1.52–2.74) had greater odds of being in the highest quartile for number of nap episodes >5 minutes. No associations between depressive symptom level and prolonged sleep latency, reduced sleep efficiency, or reduced or increased total sleep time were found. Conclusion Greater depressive symptom levels were associated with more subjective sleep disturbance and objective evidence of sleep fragmentation and napping. PMID
Full Text Available Myotonic dystrophy is the most common type of muscular dystrophy in adults and is characterized by progressive myopathy, myotonia, and multiorgan involvement. Two genetically distinct entities have been identified, myotonic dystrophy type 1 (DM1 or Steinert’s Disease and myotonic dystrophy type 2 (DM2. Myotonic dystrophies are strongly associated with sleep dysfunction. Sleep disturbances in DM1 are common and include sleep-disordered breathing (SDB, periodic limb movements (PLMS, central hypersomnia, and REM sleep dysregulation (high REM density and narcoleptic-like phenotype. Interestingly, drowsiness in DM1 seems to be due to a central dysfunction of sleep-wake regulation more than SDB. To date, little is known regarding the occurrence of sleep disorders in DM2. SDB (obstructive and central apnoea, REM sleep without atonia, and restless legs syndrome have been described. Further polysomnographic, controlled studies are strongly needed, particularly in DM2, in order to clarify the role of sleep disorders in the myotonic dystrophies.
Olawale, Kamildeen Oladimeji; Mume, Celestine Okorome; Osundina, Adeagbo Funminiyi
...). Severity of depression (psychopathology) has been found to be directly related to EDS. There is an association between sleep duration and mental health, so there may therefore be an interrelationship between sleep duration, EDS and psychopathology...
Discussion: Caring for the elderly is a challenge for healthcare systems. The study of sleep disorders is important because of its effects on health and quality of life, so understanding the clinical characteristics of this population will improve the diagnosis, management and referral of these patients.
Full Text Available BACKGROUND: Shift work results in sleep-wake disturbances, which cause sleepiness during night shifts and reduce sleep length and quality in daytime sleep after the night shift. In its serious form it is also called shift work sleep disorder. Various pharmacological products are used to ameliorate symptoms of sleepiness or poor sleep length and quality. OBJECTIVES: To evaluate the effects of pharmacological interventions to reduce sleepiness or to improve alertness at work and decrease sleep disturbances whilst of work, or both, in workers undertaking shift work. METHODS: Search methods: We searched CENTRAL, MEDLINE, EMBASE, PubMed and PsycINFO up to 20 September 2013 and ClinicalTrials.gov up to July 2013. We also screened reference lists of included trials and relevant reviews. Selection criteria: We included all eligible randomised controlled trials (RCTs, including cross-over RCTs, of pharmacological products among workers who were engaged in shift work (including night shifts in their present jobs and who may or may not have had sleep problems. Primary outcomes were sleep length and sleep quality while of work, alertness and sleepiness, or fatigue at work. Data collection and analysis: Two authors independently selected studies, extracted data and assessed risk of bias in included trials. We performed meta-analyses where appropriate. MAIN RESULTS: We included 15 randomised placebo-controlled trials with 718 participants. Nine trials evaluated the effect of melatonin and two the effect of hypnotics for improving sleep problems. One trial assessed the effect of modafinil, two of armodafinil and one examined cafeine plus naps to decrease sleepiness or to increase alertness.
Pylkkönen, M; Sihvola, M; Hyvärinen, H K; Puttonen, S; Hublin, C; Sallinen, M
Driver sleepiness is a prevalent phenomenon among professional drivers working unconventional and irregular hours. For compromising occupational and traffic safety, sleepiness has become one of the major conundrums of road transportation. To further elucidate the phenomenon, an on-road study canvassing the under-explored relationship between working hours and sleepiness, sleep, and use of sleepiness countermeasures during and outside statutory rest breaks was conducted. Testing the association between the outcomes and working hours, generalized estimating equations models were fitted on a data collected from 54 long-haul truck drivers (mean 38.1 ± 10.5 years, one female) volunteering in the 2-week study. Unobtrusive data-collection methods applied under naturalistic working and shift conditions included the Karolinska Sleepiness Scale (KSS) measuring sleepiness, a combination of actigraphy and sleep-log measuring sleep, and self-report questionnaire items incorporated into the sleep-log measuring the use of sleepiness countermeasures during and outside statutory rest breaks. Drivers' working hours were categorized into first and consecutive night, morning and day/evening shifts based on shift timing. The results reveal severe sleepiness (KSS≥7) was most prevalent on the first night (37.8%) and least on the morning (10.0%) shifts. Drivers slept reasonably well prior to duty hours, with main sleep being longest prior to the first night (total sleep time 7:21) and shortest prior to the morning (total sleep time 5:43) shifts. The proportion of shifts whereby drivers reported using at least one sleepiness countermeasure outside statutory rest breaks was approximately 22% units greater for the night than the non-night shifts. Compared to the day/evening shifts, the odds of severe sleepiness were greater only on the first night shifts (OR 6.4-9.1 with 95% confidence intervals, depending on the statistical model), the odds of insufficient daily sleep were higher
Fisher, Samantha; Lewis, Keir E.; Bartle, Iona; Ghosal, Robin; Davies, Lois; Blagrove, Mark
Study Objectives: To assess prospectively the emotional content of dreams in individuals with the obstructive sleep apnea hypopnea syndrome (OSAHS) and sleepy snorers. Methods: Prospective observational study. Forty-seven patients with sleepiness and snoring attending a sleep-disordered breathing clinic, completed a morning diary concerning pleasantness/unpleasantness of their dreams for 10 days, and then had AHI assessed by a limited-channel home sleep study. Participants and groups: Sleepy snorers, AHI dreams and nightmares during the diary period. The AHI ≥ 15 group were significantly higher on dream unpleasantness than were the sleepy snorers (p dream emotions (Levene test for homogeneity of variance between the 3 groups, p = 0.018). Mean daytime anxiety and daytime depression were significantly correlated with mean dream unpleasantness and with mean number of nightmares over the diary period. Conclusions: Patients with AHI ≥ 15 had more emotionally negative dreams than patients with AHI dream emotion decreased with increasing AHI, possibly because sleep fragmentation with increasing AHI results in fewer and shorter dreams, in which emotions are rarer. Citation: Fisher S; Lewis KE; Bartle I; Ghosal R; Davies L Blagrove M. Emotional content of dreams in obstructive sleep apnea hypopnea syndrome patients and sleepy snorers attending a sleep-disordered breathing clinic. J Clin Sleep Med 2011;7(1):69-74. PMID:21344048
Münch, M; Scheuermaier, K D; Zhang, R; Dunne, S P; Guzik, A M; Silva, E J; Ronda, J M; Duffy, J F
Evening bright light exposure is reported to ameliorate daytime sleepiness and age-related sleep complaints, and also delays the timing of circadian rhythms. We tested whether evening light exposure given to older adults with sleep-wake complaints would delay the timing of their circadian rhythms with respect to their sleep timing, thereby reducing evening sleepiness and improving subsequent sleep quality. We examined the impact of evening light exposure from two different light sources on subjective alertness, EEG activity during wakefulness, and sleep stages. Ten healthy older adults with sleep complaints (mean age=63.3 years; 6F) participated in a 13-day study. After three baseline days, circadian phase was assessed. On the evening of days 5-8 the subjects were exposed for 2h to either polychromatic blue-enriched white light or standard white fluorescent light, and on the following day circadian phase was re-assessed. Subjects were allowed to leave the laboratory during all but the two days when the circadian phase assessment took place. Evening assessments of subjective alertness, and wake and sleep EEG data were analyzed. Subjective alertness and wake EEG activity in the alpha range (9.75-11.25 Hz) were significantly higher during light exposures when compared to the pre-light exposure evening (plight exposures produced circadian phase shifts and significantly prolonged latency to rapid eye-movement (REM) sleep for both light groups (plight exposures was negatively correlated with REM sleep duration (plight exposure could benefit older adults with early evening sleepiness, without negatively impacting the subsequent sleep episode. Copyright © 2011 Elsevier B.V. All rights reserved.
Yamada, Tomohide; Shojima, Nobuhiro; Yamauchi, Toshimasa; Kadowaki, Takashi
Adequate sleep is important for good health, but it is not always easy to achieve because of social factors. Daytime napping is widely prevalent around the world. We performed a meta-analysis to investigate the association between napping (or excessive daytime sleepiness: EDS) and the risk of type 2 diabetes or metabolic syndrome, and to quantify the potential dose-response relation using cubic spline models. Electronic databases were searched for articles published up to 2016, with 288,883 Asian and Western subjects. Pooled analysis revealed that a long nap (≥60 min/day) and EDS were each significantly associated with an increased risk of type 2 diabetes versus no nap or no EDS (odds ratio 1.46 (95% CI 1.23–1.74, p nap and 2.00 (1.58–2.53) for EDS). In contrast, a short nap (nap time and the risk of diabetes or metabolic syndrome, with no effect of napping up to about 40 minutes/day, followed by a sharp increase in risk at longer nap times. In summary, longer napping is associated with an increased risk of metabolic disease. Further studies are needed to confirm the benefit of a short nap. PMID:27909305
Kazemi, Reza; Haidarimoghadam, Rashid; Motamedzadeh, Majid; Golmohamadi, Rostam; Soltanian, Alireza; Zoghipaydar, Mohamad Reza
Shift work is associated with both sleepiness and reduced performance. The aim of this study was to examine cognitive performance, sleepiness, and sleep quality among petrochemical control room shift workers. Sixty shift workers participated in this study. Cognitive performance was evaluated using a number of objective tests, including continuous performance test, n-back test, and simple reaction time test; sleepiness was measured using the subjective Karolinska Sleepiness Scale (KSS); and sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. ANCOVA, t-test, and repeated-measures ANOVA were applied for statistical analyses, and the significance level was set at p cognitive performance, except for omission error, significantly decreased at the end of both day and night shifts (p sleep quality on both day and night shifts, and there were significant differences between the day and night shifts in terms of subjective sleep quality and quantity (p sleep, induced cognitive performance decline at the end of both day and night shifts, and increased sleepiness in night shift. It, thus, seems necessary to take ergonomic measures such as planning for more appropriate shift work and reducing working hours.
Qasrawi, Shaden O; Pandi-Perumal, Seithikurippu R; BaHammam, Ahmed S
Studies have shown that experimental fasting can affect cognitive function, sleep, and wakefulness patterns. However, the effects of experimental fasting cannot be generalized to fasting during Ramadan due to its unique characteristics. Therefore, there has been increased interest in studying the effects of fasting during Ramadan on sleep patterns, daytime sleepiness, cognitive function, sleep architecture, and circadian rhythm. In this review, we critically discuss the current research findings in those areas during the month of Ramadan. Available data that controlled for sleep/wake schedule, sleep duration, light exposure, and energy expenditure do not support the notion that Ramadan intermittent fasting increases daytime sleepiness and alters cognitive function. Additionally, recent well-designed studies showed no effect of fasting on circadian rhythms. However, in non-constrained environments that do not control for lifestyle changes, studies have demonstrated sudden and significant delays in bedtime and wake time. Studies that controlled for environmental factors and sleep/wake schedule reported no significant disturbances in sleep architecture. Nevertheless, several studies have consistently reported that the main change in sleep architecture during fasting is a reduction in the proportion of REM sleep.
Tietäväinen, Aino; Gates, Fred K; Meriläinen, Antti; Mandel, Jeff E; Hæggström, Edward
A field-usable sleepiness tester could reduce sleepiness related accidents. 15 subjects' postural steadiness was measured with a Nintendo(®) Wii Fit balance board every hour for 24 h. Body sway was quantified with complexity index, CI, and the correlation between CI and alertness predicted by a three-process model of sleepiness was calculated. The CI group average was 8.9 ± 1.3 for alert and 7.9 ± 1.4 for sleep deprived subjects (p < 0.001, ρ = 0.94). The Wii Fit board detects the impairment of postural steadiness. This may allow large scale sleepiness testing outside the laboratory setting. Copyright © 2013 IPEM. All rights reserved.
Riachy, M; Juvelikian, G; Sleilaty, G; Bazarbachi, T; Khayat, G; Mouradides, C
The Epworth Sleepiness Scale (ESS) is a self-completion questionnaire developed in the English language and used for the evaluation of sleepiness. The objective of this study was to develop an Arabic version of ESS (AESS) and to investigate its reliability and the validity. The AESS was created according to the recommendations of the ISPOR Task Force for Translation and Cultural Adaptation with bilingual individuals. It was applied to 91 patients referred to three sleep Lebanese centers for suspicion of sleep-related breathing diseases, and to 166 controls in good health. AESS scores of 60 patients were compared to 60 matched controls according to their age, sex and body mass index. Reproducibility was tested in 30 controls. The treatment response was tested among 15 patients after one month of CPAP treatment. Principal component analysis showed convergence towards only one latent factor. The AESS had a good internal consistency (Cronbach's alpha 0.76, intraclass correlation coefficient of 0.85 (IC95%: 0.76-0.92), Spearman 0.97, P<0.001). An increase in the severity of sleep apnea was accompanied by an increase in the score on the AESS (P<0.001). AESS scores improved significantly after CPAP. The AESS, a reliable and valid instrument for the evaluation of daytime sleepiness, is a valuable tool for clinical practice and multicenter research. Copyright © 2012 SPLF. Published by Elsevier Masson SAS. All rights reserved.
Sullivan, Shannon S; Guilleminault, Christian
Obstructive sleep apnea (OSA) and narcolepsy are sleep disorders associated with high prevalence and high symptomatic burden including prominent sleepiness, daytime dysfunction and poor nocturnal sleep. Both have elevated risk of poor health outcomes. Current therapies are often underutilized, cumbersome, costly or associated with residual symptoms. This review covers current available therapies for OSA and narcolepsy as well as discusses areas for potential drug development, and agents in the therapeutic pipeline, including the cannabinoid dronabinol (OSA), the histamine inverse agonist/ antagonist pitolisant (narcolepsy), and stimulants with uncertain and/or multiple activities such as JZP-110 and JZP-386 (narcolepsy, possibly OSA). Finally it addresses new approaches and uses for therapies currently on the market such as the carbonic anhydrase inhibitor acetazolamide (OSA). Both OSA and narcolepsy are conditions of sleepiness for which lifelong treatments are likely to be required. In OSA, while continuous positive airway pressure will likely remain the gold standard therapy for the foreseeable future, there is plenty of room for integrating phenotypes and variants of OSA into therapeutic strategies to lead to better, more personalized disease modification. In narcolepsy, unlike OSA, drug therapy is the current mainstay of treatment. Advances using novel mechanisms to treat targeted symptoms such as sleepiness and/or novel agents that can treat more than one symptom of narcolepsy, hold promise. However, cost, convenience and side effects remain challenges.
Sleep loss has been a common practice in modern society. However, it has been only recently that the effects of sleep loss on human health have received more attention. This review summarizes the experimental findings of the effects of total and partial sleep deprivation on stress hormones and pro-inflammatory cytokines. Specifically, studies have consistently demonstrated that total or partial sleep loss is associated with increased sleepiness and decreased performance and elevation of pro-inflammatory cytokines, i. e., IL-6 and TNF-alpha, which have been proposed as mediators of excessive daytime sleepiness and cardiometabolic morbidity in humans. In addition, non-stressful sleep loss is not associated with elevation of cortisol, the end-product of the hypothalamic-pituitary-adrenal (HPA) axis. Also, alertness and performance measured with objective tests (Multiple Sleep Latency Test and Performance Vigilance Test) are significantly impaired following total or partial sleep loss. Furthermore, napping or extended sleep have been shown to decrease sleepiness, improve performance and cause beneficial changes in cortisol and IL-6 secretion. Collectively, these studies show that sleep loss has adverse effects on alertness, performance and inflammation markers suggesting that insufficient sleep may influence health and longevity in a negative manner. On the other hand it appears that more sleep either in the form of napping or extended sleep may protect from these adverse effects of sleep loss.
Jesús Vega Encabo
Full Text Available In this paper, I claim that subjectivity is a way of being that is constituted through a set of practices in which the self is subject to the dangers of fictionalizing and plotting her life and self-image. I examine some ways of becoming subject through narratives and through theatrical performance before others. Through these practices, a real and active subjectivity is revealed, capable of self-knowledge and self-transformation.
... Good daytime sleep is possible, though, if shift work is a necessary part of your work life. To promote better sleep during the day: ... Take naps. Napping late in the day before work might help you make up your sleep debt. ...
Conti, Andrea A; Conti, Antonio; Gensini, Gian Franco
The obstructive sleep apnea syndrome (OSAS) is a clinical condition characterized by the coexistence of irregular breathing at night with excessive daytime sleepiness, and it represents a major social health issue because of its high prevalence and of the growing public awareness of it. The XIX century description of "Fat Joe", the famous character of Charles Dickens's Pickwick Papers, is often retained the first presentation of a person affected by OSAS, since Joe was an obese individual who fell asleep during daytime while performing even extremely simple tasks. However, apart from the fact that Joe's Picwickian syndrome ("the obesity hypoventilation syndrome") needs to be differentiated from true OSAS, already in the Hippocratic Corpus (V-IV century BC) many clues regarding apnea and sleepiness are present, and in 79 AD the Roman author Pliny the Younger clearly reported the death of a man in whom obesity, sleepiness and snoring were co-present in a unique clinical picture. In this paper, elements suggesting OSAS are traced back and evidenced in the XIX and XX centuries in distinguished figures, including Emperor Napoleon Bonaparte, Queen Victoria and President Franklin D. Roosevelt. A posteriori reconstruction of the health status of characters of the past is difficult, and, to an extent, speculative, but the elements here provided appear relevant, since the possible presence of disabling OSAS in important personages of the past may have negatively influenced not only their health status, but also their social life and their work activity.
Hof, T.; Wilschut, E.S.
This report provides an overview of methods to prevent drowsy driving of drivers (Wilschut et al., 2009). Several preventive approaches were discussed such as the use of questionnaires, campaigns and fatigue management plans. A search for law enforcement instruments to prevent sleepiness at the
Coleman, R.M.; Dillingham, J.; Dement, W.C.
Recent evidence that industrial accidents may be caused in part by shiftworkers' lack of alertness has caused growing concern at the US Nuclear Regulatory Commission and within the scientific community. The purpose of the study reported in this paper was threefold: (1) Is sleepiness on the job specific to utility plants (2) Are performance and safety problems caused by sleepiness specific to utility plants (3) Are specific shift schedules associated with a higher prevalence of sleepiness Findings indicate sleepiness on the job among shiftworkers is a widespread problem, not limited to the nuclear power industry. The most common solution in American industry is to overstaff each shift and discipline sleeping employees. Results show this is not effective. A more proactive solution is recommended including some of the following: (1) Provide employees education to assist adjustment to shiftwork. (2) Design and implement shift schedules that are more compatible with human physiological capabilities. (3) Allow officially sanctioned napping on shift as is done in Japan. (4) Divide 6-, 8-, or 12-h shifts into smaller blocks of 2 to 3 h of primary duty. (5) make the environment where employees work more conductive to alertness. (6) Develop a firehouse type of schedule where some employees sleep throughout the night, but are awakened if operational problems arise. (7) Provide incentives to employees to adjust their life style to the night shift and reward them with time off.
Münch, Mirjam; Nowozin, Claudia; Regente, Johannes; Bes, Frederik; De Zeeuw, Jan; Hädel, Sven; Wahnschaffe, Amely; Kunz, Dieter
Light during the day and darkness at night are crucial factors for proper entrainment of the human circadian system to the solar 24-h day. However, modern life and work styles have led to much more time spent indoors, often with lower daytime and higher evening/nighttime light intensity from electrical lighting than outdoors. Whether this has long-term consequences for human health is being currently investigated. We tested if bright blue-enriched morning light over several days could counteract the detrimental effects of inadequate daytime and evening lighting. In a seminaturalistic, within-between subject study design, 18 young participants were exposed to different lighting conditions on 3 evenings (blue-enriched, bright orange, or dim light), after exposure to 2 lighting conditions (mixed blue-enriched light and control light, for 3 days each) in the mornings. Subjective sleepiness, reaction times, salivary melatonin concentrations, and nighttime sleep were assessed. Exposure to the blue-enriched morning lighting showed acute wake-promoting effects and faster reaction times than with control lighting. Some of these effects persisted until the evening, and performance improved over several days. The magnitude of circadian phase shifts induced by combinations of 3 different evening and 2 morning lighting conditions were significantly smaller with the blue-enriched morning light. During the night, participants had longer total sleep times after orange light exposure than after blue light exposure in the evening. Our results indicate that bright blue-enriched morning light stabilizes circadian phase, and it could be an effective counterstrategy for poor lighting during the day and also light exposure at the wrong time, such as in the late evening. © 2017 S. Karger AG, Basel.
Skibitsky, Megan; Edelen, Maria Orlando; Martin, Jennifer L; Harker, Judith; Alessi, Cathy; Saliba, Debra
Excessive daytime sleeping is associated with poorer functional outcomes in rehabilitation populations and may be improved with targeted interventions. The purpose of this study was to test simple methods of screening for excessive daytime sleeping among older adults admitted for postacute rehabilitation. Secondary analysis of data from 2 clinical samples. Two postacute rehabilitation (PAR) units in southern California. Two hundred twenty-six patients older than 65 years with Mini-Mental State Examination (MMSE) score higher than 11 undergoing rehabilitation. The primary outcome was excessive daytime sleeping, defined as greater than 15% (1.8 hours) of daytime hours (8 am to 8 pm) sleeping as measured by actigraphy. Participants spent, on average, 16.2% (SD 12.5%) of daytime hours sleeping as measured by actigraphy. Thirty-nine percent of participants had excessive daytime sleeping. The Pittsburgh Sleep Quality Index (PSQI) was significantly associated with actigraphically measured daytime sleeping (P = .0038), but the Epworth Sleepiness Scale (ESS) was not (P = .49). Neither the ESS nor the PSQI achieved sufficient sensitivity and specificity to be used as a screening tool for excessive daytime sleeping. Two additional models using items from these questionnaires were not significantly associated with the outcome. In an older PAR population, self-report items from existing sleep questionnaires do not identify excessive daytime sleeping. Therefore we recommend objective measures for the evaluation of excessive daytime sleeping as well as further research to identify new self-report items that may be more applicable in PAR populations. Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.
Aljurf, Tareq M; Olaish, Awad H; BaHammam, Ahmed S
No studies have assessed the prevalence of fatigue, depression, sleepiness, and the risk of obstructive sleep apnea (OSA) among commercial airlines pilots in the Gulf Cooperation Council (GCC). This was a quantitative cross-sectional study conducted among pilots who were on active duty and had flown during the past 6 months for one of three commercial airline companies. We included participants with age between 20 and 65 years. Data were collected using a predesigned electronic questionnaire composed of questions related to demographic information in addition to the Fatigue Severity Scale (FSS), the Berlin Questionnaire, the Epworth Sleepiness Scale (ESS), and the Hospital Anxiety and Depression Scale (HADS). The study included 328 pilots with a mean age ± standard deviation of 41.4 ± 9.7 years. Overall, 224 (68.3%) pilots had an FSS score ≥ 36 indicating severe fatigue and 221 (67.4%) reported making mistakes in the cockpit because of fatigue. One hundred and twelve (34.1%) pilots had an ESS score ≥ 10 indicating excessive daytime sleepiness and 148 (45.1%) reported falling asleep at the controls at least once without previously agreeing with their colleagues. One hundred and thirteen (34.5%) pilots had an abnormal HADS depression score (≥ 8), and 96 (29.3%) pilots were at high risk for OSA requiring further assessment. Fatigue, sleepiness, risk of OSA, and depression are prevalent among GCC commercial airline pilots. Regular assessment by aviation authorities is needed to detect and treat these medical problems.
Perez-Lloret, Santiago; Videla, Alejandro J; Richaudeau, Alba; Vigo, Daniel; Rossi, Malco; Cardinali, Daniel P; Perez-Chada, Daniel
A multi-step causality pathway connecting short sleep duration to daytime somnolence and sleepiness leading to reduced attention and poor academic performance as the final result can be envisaged. However this hypothesis has never been explored. To explore consecutive correlations between sleep duration, daytime somnolence, attention levels, and academic performance in a sample of school-aged teenagers. We carried out a survey assessing sleep duration and daytime somnolence using the Pediatric Daytime Sleepiness Scale (PDSS). Sleep duration variables included week-days' total sleep time, usual bedtimes, and absolute weekday to-weekend sleep time difference. Attention was assessed by d2 test and by the coding subtest from the WISC-IV scale. Academic performance was obtained from literature and math grades. Structural equation modeling was used to assess the independent relationships between these variables, while controlling for confounding effects of other variables, in one single model. Standardized regression weights (SWR) for relationships between these variables are reported. Study sample included 1,194 teenagers (mean age: 15 years; range: 13-17 y). Sleep duration was inversely associated with daytime somnolence (SWR = -0.36, p sleep duration influenced attention through daytime somnolence (p sleep duration.
Quera-Salva, Maria-Antonia; Hajak, Goeran; Philip, Pierre; Montplaisir, Jaques; Keufer-Le Gall, Sophie; Laredo, Judith; Guilleminault, Christian
Agomelatine, an MT1/MT2 receptor agonist and 5-HT2C receptor antagonist antidepressant, is known to have beneficial effects on subjective sleep in major depressive disorder patients. This international multicenter, randomized, double-blind study compared the effects of agomelatine (25-50 mg/day) and escitalopram (10-20 mg/day) on sleep polysomnographic parameters in major depressive disorder patients treated up to 24 weeks. A total of 138 outpatients were randomly allocated to agomelatine (n=71) or escitalopram (n=67). Treatment with agomelatine was associated with a reduction in sleep latency from week 2 onward. The difference between treatments was significant on all evaluations. Rapid eye movement latency was increased with escitalopram compared with agomelatine, with significant between-group differences at every visit. Agomelatine preserved the number of sleep cycles, whereas it was decreased with escitalopram with significant between-group differences at every visit. Assessments on visual analogue scales indicated that treatment with agomelatine improved morning condition, and reduced daytime sleepiness compared with escitalopram.17-item Hamilton depression rating scale total score was reduced in both groups, agomelatine was statistically noninferior to escitalopram at 6 weeks. Both treatments were well tolerated. This study showed that the clinical effects of agomelatine on sleep and wake parameters are different from that of escitalopram.
Lo, June C.; Ong, Ju Lynn; Leong, Ruth L.F.; Gooley, Joshua J.; Chee, Michael W.L.
Study Objectives: To investigate the effects of sleep restriction (7 nights of 5 h time in bed [TIB]) on cognitive performance, subjective sleepiness, and mood in adolescents. Methods: A parallel-group design was adopted in the Need for Sleep Study. Fifty-six healthy adolescents (25 males, age = 15–19 y) who studied in top high schools and were not habitual short sleepers were randomly assigned to Sleep Restriction (SR) or Control groups. Participants underwent a 2-w protocol consisting of 3 baseline nights (TIB = 9 h), 7 nights of sleep opportunity manipulation (TIB = 5 h for the SR and 9 h for the control groups), and 3 nights of recovery sleep (TIB = 9 h) at a boarding school. A cognitive test battery was administered three times each day. Results: During the manipulation period, the SR group demonstrated incremental deterioration in sustained attention, working memory and executive function, increase in subjective sleepiness, and decrease in positive mood. Subjective sleepiness and sustained attention did not return to baseline levels even after 2 recovery nights. In contrast, the control group maintained baseline levels of cognitive performance, subjective sleepiness, and mood throughout the study. Incremental improvement in speed of processing, as a result of repeated testing and learning, was observed in the control group but was attenuated in the sleep-restricted participants, who, despite two recovery sleep episodes, continued to perform worse than the control participants. Conclusions: A week of partial sleep deprivation impairs a wide range of cognitive functions, subjective alertness, and mood even in high-performing high school adolescents. Some measures do not recover fully even after 2 nights of recovery sleep. Commentary: A commentary on this article appears in this issue on page 497. Citation: Lo JC, Ong JL, Leong RL, Gooley JJ, Chee MW. Cognitive performance, sleepiness, and mood in partially sleep deprived adolescents: the need for sleep study
Fisher, Samantha; Lewis, Keir E; Bartle, Iona; Ghosal, Robin; Davies, Lois; Blagrove, Mark
To assess prospectively the emotional content of dreams in individuals with the obstructive sleep apnea hypopnea syndrome (OSAHS) and sleepy snorers. Prospective observational study. Forty-seven patients with sleepiness and snoring attending a sleep-disordered breathing clinic, completed a morning diary concerning pleasantness/unpleasantness of their dreams for 10 days, and then had AHI assessed by a limited-channel home sleep study. Participants and groups: Sleepy snorers, AHI dreams and nightmares during the diary period. The AHI ≥ 15 group were significantly higher on dream unpleasantness than were the sleepy snorers (p dream emotions (Levene test for homogeneity of variance between the 3 groups, p = 0.018). Mean daytime anxiety and daytime depression were significantly correlated with mean dream unpleasantness and with mean number of nightmares over the diary period. Patients with AHI ≥ 15 had more emotionally negative dreams than patients with AHI dream emotion decreased with increasing AHI, possibly because sleep fragmentation with increasing AHI results in fewer and shorter dreams, in which emotions are rarer.
Rastad, Cecilia; Ulfberg, Jan; Lindberg, Per
Objective. To investigate the effects of bright light treatment for secondary outcome measures and to explore and validate empirically derived subgroups and treatment effects in subgroups. Methods. A descriptive design. A sample of forty-nine persons (mean age of 45.8) with clinically assessed seasonal affective disorder (SAD) or subsyndromal SAD (S-SAD) participated in a two-group clinical trial evaluating the effects of treatment with bright light therapy. A person-oriented cluster analysis was applied to study treatment effects in subgroups. Results. For the merged group, sleepiness (Epworth Sleepiness Scale), fatigue (fatigue questionnaire), and health-related quality of life (SF-36) were improved at posttreatment, and results were maintained at the one-month followup. Three distinct subgroups had a high level of fatigue in common, while the level of excessive daytime sleepiness and depressed mood differed between the subgroups. Over time, all subgroups improved following ten days treatment in a light room. Conclusion. Fatigue, excessive daytime sleepiness, and health-related quality of life improve in a similar way as depressed mood following treatment with bright light. The treatment was effective irrespective of the severity of the disorder, that is, for persons with SAD and subsyndromal SAD.
Rastad, Cecilia; Ulfberg, Jan; Lindberg, Per
Objective. To investigate the effects of bright light treatment for secondary outcome measures and to explore and validate empirically derived subgroups and treatment effects in subgroups. Methods. A descriptive design. A sample of forty-nine persons (mean age of 45.8) with clinically assessed seasonal affective disorder (SAD) or subsyndromal SAD (S-SAD) participated in a two-group clinical trial evaluating the effects of treatment with bright light therapy. A person-oriented cluster analysis was applied to study treatment effects in subgroups. Results. For the merged group, sleepiness (Epworth Sleepiness Scale), fatigue (fatigue questionnaire), and health-related quality of life (SF-36) were improved at posttreatment, and results were maintained at the one-month followup. Three distinct subgroups had a high level of fatigue in common, while the level of excessive daytime sleepiness and depressed mood differed between the subgroups. Over time, all subgroups improved following ten days treatment in a light room. Conclusion. Fatigue, excessive daytime sleepiness, and health-related quality of life improve in a similar way as depressed mood following treatment with bright light. The treatment was effective irrespective of the severity of the disorder, that is, for persons with SAD and subsyndromal SAD. PMID:21747994
Full Text Available Objective. To investigate the effects of bright light treatment for secondary outcome measures and to explore and validate empirically derived subgroups and treatment effects in subgroups. Methods. A descriptive design. A sample of forty-nine persons (mean age of 45.8 with clinically assessed seasonal affective disorder (SAD or subsyndromal SAD (S-SAD participated in a two-group clinical trial evaluating the effects of treatment with bright light therapy. A person-oriented cluster analysis was applied to study treatment effects in subgroups. Results. For the merged group, sleepiness (Epworth Sleepiness Scale, fatigue (fatigue questionnaire, and health-related quality of life (SF-36 were improved at posttreatment, and results were maintained at the one-month followup. Three distinct subgroups had a high level of fatigue in common, while the level of excessive daytime sleepiness and depressed mood differed between the subgroups. Over time, all subgroups improved following ten days treatment in a light room. Conclusion. Fatigue, excessive daytime sleepiness, and health-related quality of life improve in a similar way as depressed mood following treatment with bright light. The treatment was effective irrespective of the severity of the disorder, that is, for persons with SAD and subsyndromal SAD.
Full Text Available Background: Impaired sleep is associated with negative effects on quality of life and daytime functioning. Higher rates of sleep disturbance are reported in children with various developmental disorders. However, little is known about sleep in children with Developmental Coordination Disorder (DCD, a condition characterized by everyday movement difficulties. Previously, in a preliminary study, we found higher rates of parent-reported sleep disturbance in children with DCD compared to controls. Aims: To examine sleep in DCD using objective measures and to examine links with daytime fatigue and sleepiness. Methods: Two groups (primary and secondary school-aged of 15 children with DCD, plus matched controls, participated. Parent reported child sleep was assessed using the Children’s Sleep Habits Questionnaire and actigraphy provided an objective measure of sleep-wake patterns over one week (including weekdays and weekend. Pediatric Restless Legs Syndrome (RLS Semi-Structured Diagnostic Interview was conducted with each child and parent to capture symptoms of RLS. Aspects of self-rated child functioning were assessed with questionnaires (Pre-sleep Arousal Scale, Pediatric Daytime Sleepiness Scale, PedsQL Multidimensional Fatigue Scale and mothers’ reported thoughts about child sleep with the Maternal Cognitions about Infant Sleep Questionnaire.Results: The DCD groups had greater parent-reported sleep disturbance. Actigraphy results suggested that for secondary aged children with DCD their sleep quality was impaired and there were differences in the timing of sleep compared to controls (including some differences in the variation between weekday and weekend sleep times. The actigraphy of the primary age group with DCD was unremarkable compared to controls. No child in the study met the criteria for RLS. Exploratory analyses suggested that daytime fatigue, aspects of pre-sleep arousal and daytime sleepiness were reported as greater in the DCD
Polos, Peter G; Bhat, Sushanth; Gupta, Divya; O'Malley, Richard J; DeBari, Vincent A; Upadhyay, Hinesh; Chaudhry, Saqib; Nimma, Anitha; Pinto-Zipp, Genevieve; Chokroverty, Sudhansu
This cross-sectional study explored the extent and impact of mobile device-based Sleep Time-Related Information and Communication Technology (STRICT) use among American adolescents (N = 3139, 49.3% female, mean age = 13.3 years). Nearly 62% used STRICT after bedtime, 56.7% texted/tweeted/messaged in bed, and 20.8% awoke to texts. STRICT use was associated with insomnia, daytime sleepiness, eveningness, academic underperformance, later bedtimes and shorter sleep duration. Moderation analysis demonstrated that the association between STRICT use and insomnia increased with age, the association between STRICT use and daytime sleepiness decreased with age, and the association between STRICT use and shorter sleep duration decreased with age and was stronger in girls. Insomnia and daytime sleepiness partially mediated the relationship between STRICT use and academic underperformance. Our results illustrate the adverse interactions between adolescent STRICT use and sleep, with deleterious effects on daytime functioning. These worrisome findings suggest that placing reasonable limitations on adolescent STRICT use may be appropriate. Copyright © 2015 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.
Full Text Available This prospective uncontrolled study evaluated the effect of low-dose adjunctive perampanel therapy (4 mg/day for 3 months on the sleep-wake cycle and daytime somnolence in adult patients (n = 10 with focal seizures. A >50% reduction in the number of seizures was reported in 80% of the study patients; treatment had no significant effect on any sleep parameters as evident by the Maintenance of Wakefulness Test, Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale scores. Two patients reported dizziness with treatment. In conclusion, low-dose perampanel may improve seizure control without affecting the sleep characteristics or daytime somnolence in patients with epilepsy.
Wesensten, Nancy Jo; Balkin, Thomas J; Reichardt, Rebecca M; Kautz, Mary A; Saviolakis, George A; Belenky, Gregory
Pharmacologic enhancement of daytime sleep may help sustain optimal cognitive performance. At effective doses, zolpidem induces sleep but also impairs performance. Combining melatonin with low-dose zolpidem may promote daytime sleep without exacerbating performance impairments seen with high-dose zolpidem alone. Following an 8-hour undisturbed nighttime sleep period, 80 subjects (50 men, 30 women) were administered oral zolpidem 0, 5, 10, or 20 mg at 10:00 am (n = 20 per group) and then oral melatonin 0 or 5 mg at 10:30 am (thus, n = 10 per drug combination) in a double-blind randomized fashion. Subjects napped from 10:00 am to 11:30 am, at which time they were awakened and cognitive tests administered (Restricted Reminding, Paired-Associates, and Psychomotor Vigilance). A second nap ensued from 12:45 pm to 4:00 pm, followed immediately by further testing. Melatonin 5 mg plus zolpidem 0 mg enhanced daytime sleep (P .05). Zolpidem 20 mg plus melatonin 0 mg also enhanced daytime sleep (albeit nonsignificantly), but memory and vigilance were impaired (P sleep-promoting effects were not evident until the second nap. No advantages to administering melatonin plus zolpidem "cocktails" were evident. Unlike zolpidem, melatonin 5 mg alone improved daytime sleep without impairing memory and vigilance. Functional coupling of sleep-inducing and memory-impairing effects may be specific to benzodiazepine-receptor agonists such as zolpidem, suggesting potential advantages to using melatonin in the operational environment. That melatonin's sleep-promoting effects were delayed for several hours presents a practical consideration that may limit melatonin's usefulness when daytime sleep periods cannot be reliably anticipated or planned in advance.
Esther Yuet Ying Lau
Full Text Available The main objective was to study the impact of a daytime sleep opportunity on working memory and the mechanism behind such impact. This study adopted an experimental design in a sleep research laboratory. Eighty healthy college students (Age:17-23, 36 males were randomized to either have a polysomnography-monitored daytime sleep opportunity (Nap-group, n=40 or stay awake (Wake-group, n=40 between the two assessment sessions. All participants completed a sleep diary and wore an actigraph-watch for 5 days before and one day after the assessment sessions. They completed the state-measurement of sleepiness and affect, in addition to a psychomotor vigilance test and a working memory task before and after the nap/wake sessions. The two groups did not differ in their sleep characteristics prior to and after the lab visit. The Nap-group had higher accuracy on the working memory task, fewer lapses on the psychomotor vigilance test and lower state-sleepiness than the Wake-group. Within the Nap-group, working memory accuracy was positively correlated with duration of rapid eye movement sleep (REM and total sleep time during the nap. Our findings suggested that "sleep gain" during a daytime sleep opportunity had significant positive impact on working memory performance, without affecting subsequent nighttime sleep in young adult, and such impact was associated with the duration of REM. While REM abnormality has long been noted in pathological conditions (e.g. depression, which are also presented with cognitive dysfunctions (e.g. working memory deficits, this was the first evidence showing working memory enhancement associated with REM in daytime napping in college students, who likely had habitual short sleep duration but were otherwise generally healthy.
Lau, Esther Yuet Ying; Wong, Mark Lawrence; Lau, Kristy Nga Ting; Hui, Florence Wai Ying; Tseng, Chia-huei
The main objective was to study the impact of a daytime sleep opportunity on working memory and the mechanism behind such impact. This study adopted an experimental design in a sleep research laboratory. Eighty healthy college students (Age:17-23, 36 males) were randomized to either have a polysomnography-monitored daytime sleep opportunity (Nap-group, n=40) or stay awake (Wake-group, n=40) between the two assessment sessions. All participants completed a sleep diary and wore an actigraph-watch for 5 days before and one day after the assessment sessions. They completed the state-measurement of sleepiness and affect, in addition to a psychomotor vigilance test and a working memory task before and after the nap/wake sessions. The two groups did not differ in their sleep characteristics prior to and after the lab visit. The Nap-group had higher accuracy on the working memory task, fewer lapses on the psychomotor vigilance test and lower state-sleepiness than the Wake-group. Within the Nap-group, working memory accuracy was positively correlated with duration of rapid eye movement sleep (REM) and total sleep time during the nap. Our findings suggested that "sleep gain" during a daytime sleep opportunity had significant positive impact on working memory performance, without affecting subsequent nighttime sleep in young adult, and such impact was associated with the duration of REM. While REM abnormality has long been noted in pathological conditions (e.g. depression), which are also presented with cognitive dysfunctions (e.g. working memory deficits), this was the first evidence showing working memory enhancement associated with REM in daytime napping in college students, who likely had habitual short sleep duration but were otherwise generally healthy.
McBean, Amanda L; Kinsey, Steven G; Montgomery-Downs, Hawley E
The maternal postpartum period is characterized by sleep fragmentation, which is associated with daytime impairment, mental health disturbances, and changes in melatonin patterns. In addition to sleep fragmentation, women undergo a complex set of physiological and environmental changes upon entering the postpartum period, confounding our understanding of effects of postpartum sleep disturbance. The primary study aim was to understand the basic impact of a single night of postpartum-like sleep fragmentation on sleep architecture, nocturnal melatonin levels, mood, daytime sleepiness, and neurobehavioral performance. For one week prior to entry into the laboratory, eleven healthy nulliparous women kept a stable sleep-wake schedule (verified via actigraphy). Participants contributed three consecutive nights of laboratory overnight polysomnography: (1) a habituation/sleep disorder screening night; (2) a baseline night; and (3) a sleep fragmentation night, when participants were awakened three times for ~30min each. Self-reported sleep quality and mood (Profile of Mood States survey) both decreased significantly after sleep fragmentation compared to baseline measurements. Unexpectedly, daytime sleepiness (Multiple Sleep Latency Test) decreased significantly after sleep fragmentation. Experimental fragmentation had no significant effect on time spent in nocturnal sleep stages, urinary 6-sulfatoxymelatonin concentration, or psychomotor vigilance test performance. Participants continued to provide actigraphy data, and daily PVTs and self-reported sleep quality assessments at home for one week following sleep fragmentation; these assessments did not differ from baseline values. While there were no changes in measured physiological components of a single night of postpartum-like experimental sleep fragmentation, there were decreases in self-reported measures of mood and sleep quality. Future research should examine the effects of multiple nights of modeling postpartum
Wu, Lora J.; Acebo, Christine; Seifer, Ronald; Carskadon, Mary A.
Study Objectives: Quantify the homeostatic and circadian effects on sleepiness and performance of adolescents. Examine age-related changes in homeostatic and circadian regulation of sleepiness and performance by comparing younger and older adolescent groups. Design: Three-week laboratory study including 12 cycles of a 28-h forced desynchrony protocol. Setting: Controlled laboratory environment with individual sleep and performance testing rooms and shared common areas. Participants: Twenty-seven healthy adolescents including 16 females. Ages ranged from 9.6–15.2 years and participants were split into younger (n = 14 ages 9–12) and older (n = 13 ages 13–15) groups based on median age split of 13.0 years. Interventions: N/A Measurements and Results: Testing occurred every 2 h during scheduled wake periods. Measures included sleep latency during repeated nap opportunities and scores from a computerized neurobehavioral assessment battery including a 10-min psychomotor vigilance task, a digit symbol substitution task, and the Karolinska Sleepiness Scale. Significant main effects of circadian and homeostatic factors were observed, as well as several circadian and homeostatic interaction effects. Age group did not have a significant main effect on sleep and performance data. A significant interaction of circadian phase and age group was found for sleep latency, with younger adolescents showing greater circadian modulation than older teens during the circadian night. Conclusions: Adolescents demonstrated a similar pattern of response to forced desynchrony as reported for adults. Sleepiness and performance were affected by homeostatic and circadian factors, and age group did not interact with homoeostatic and circadian factors for subjective sleepiness and most performance metrics. Younger adolescents had a shorter latency to sleep onset than older during the circadian bin spanning 4 to 8 h after the onset of melatonin secretion. Citation: Wu LJ, Acebo C, Seifer R
Gumenyuk, Valentina; Belcher, Ren; Drake, Christopher L; Roth, Thomas
To characterize and compare insomnia symptoms within two common phenotypes of Shift Work Disorder. Observational laboratory and field study. Hospital sleep center. 34 permanent night workers. Subjects were classified by Epworth Sleepiness Scale and Insomnia Severity Index into 3 subgroups: asymptomatic controls, alert insomniacs (AI), and sleepy insomniacs (SI). Sleep parameters were assessed by sleep diary. Circadian phase was evaluated by dim-light salivary melatonin onset (DLMO). Objective sleepiness was measured using the multiple sleep latency test (MSLT). Brain activity was measured using the N1 event-related potential (ERP). A tandem repeat in PER3 was genotyped from saliva DNA. (1) AI group showed normal MSLT scores but elevated N1 amplitudes indicating cortical hyperarousal. (2) SI group showed pathologically low MSLT scores but normal N1 amplitudes. (3) AI and SI groups were not significantly different from one another in circadian phase, while controls were significantly phase-delayed relative to both SWD groups. (4) AI showed significantly longer sleep latencies and lower sleep efficiency than controls during both nocturnal and diurnal sleep. SI significantly differed from controls in nocturnal sleep parameters, but differences during diurnal sleep periods were smaller and not statistically significant. (5) Genotype × phenotype χ² analysis showed significant differences in the PER3 VNTR: 9 of 10 shift workers reporting sleepiness in a post hoc genetic substudy were found to carry the long tandem repeat on PER3, while 4 of 14 shift workers without excessive sleepiness carried the long allele. Our results suggest that the sleepy insomnia phenotype is comprehensively explained by circadian misalignment, while the alert insomnia phenotype resembles an insomnia disorder precipitated by shift work. © 2014 Associated Professional Sleep Societies, LLC.
Jaussent, Isabelle; Bouyer, Jean; Ancelin, Marie-Laure; Berr, Claudine; Foubert-Samier, Alexandra; Ritchie, Karen; Ohayon, Maurice M; Besset, Alain; Dauvilliers, Yves
To examine the association of sleep complaints reported at baseline (insomnia complaints and excessive daytime sleepiness (EDS)) and medication, with cognitive decline in community-dwelling elderly. An 8-yr longitudinal study. The French Three-City Study. There were 4,894 patients without dementia recruited from 3 French cities and having a Mini-Mental Status Examination (MMSE) score ≥ 24 points at baseline. Questionnaires were used to evaluate insomnia complaints (poor sleep quality (SQ), difficulty in initiating sleep (DIS), difficulty in maintaining sleep (DMS), early morning awakening (EMA)), EDS, and sleep medication at baseline. Cognitive decline was defined as a 4-point reduction in MMSE score during follow-up at 2, 4, and 8 yr. Logistic regression models were adjusted for sociodemographic, behavioral, physical, and mental health variables, and apolipoprotein E genotype. EDS independently increased the risk of cognitive decline (odds ratio (OR) = 1.26, 95% confidence interval (CI) = 1.02-1.56), especially for those patients who also developed dementia during the follow-up period (OR = 1.39, 95% CI = 1.00-1.97). The number of insomnia complaints and DMS were negatively associated with MMSE cognitive decline (OR = 0.77, 95% CI = 0.60-0.98 for 3-4 complaints, OR = 0.81, 95% CI = 0.68-0.96, respectively). The 3 other components of insomnia (SQ, DIS, EMA) were not significantly associated with MMSE cognitive decline. Our results suggest that EDS may be associated independently with the risk of cognitive decline in the elderly population. Such results could have important public health implications because EDS may be an early marker and potentially reversible risk factor of cognitive decline and onset of dementia.
Avaliação da sonolência em estudantes universitários de turnos distintos Evaluación de la somnolencia en estudiantes universitarios de turnos distintos Evaluation of sleepiness in college students from different shifts
Danilo de Freitas Araújo
Full Text Available Estudantes de graduação possuem altas chances de apresentar Sonolência Diurna Excessiva, devido aos horários escolares e às demandas acadêmicas. Por isso, pretendeu-se analisar níveis de sonolência de estudantes de turnos distintos. O universo foi constituído por 109 graduandos do turno matutino e 125 do noturno. Utilizou-se a Escala de Sonolência de Epworth. A amostra apresentou média total de 9,38 (DP=4,03, sendo 9,03 (DP=4,01 para o turno matutino e 9,7 (DP=3,93 para o noturno. Foram detectadas diferenças significativas nos níveis de sonolência entre turnos (η² =0,10;p Estudiantes de graduación poseen altas posibilidades de presentar Somnolencia Diurna Excesiva, debido a los horarios escolares y a las demandas académicas. Por eso, se pretendió analizar niveles de somnolencia de estudiantes de turnos distintos. El universo fue constituido por 109 graduandos del turno matutino y 125 del nocturno. Se utilizó la Escala de Somnolencia de Epworth. La muestra presentó promedio total de 9,38 (DP=4,03, siendo 9,03 (DP=4,01 para el turno matutino y 9,7 (DP=3,93 para el nocturno. Fueron detectadas diferencias significativas en los niveles de somnolencia entre turnos (η²=0,10; pUndergraduate students are a population with high chances of developing Excessive Daytime Sleepiness, due to school schedules and academic demands. Our aim was to examine the levels of sleepiness of students belonging to morning and night classes. The universe has consisted of 109 undergraduate students of the morning shift and 125 of the night shift. We have used the Epworth Sleepiness Scale. The sample had an average of 9.38 (SD=4.03, and 9.03 (SD=4.01 for the morning shift and 9.7 (SD=3.93 for the night shift. Statistical analysis showed significant differences in sleepiness between shifts (η²=0,10; p<0,00, and among male subjects and female in the two shifts (η²=0,45; p<0,00. It should therefore be considered the role of academic demands, since they
Turco, M; Corrias, M; Chiaromanni, F; Bano, M; Salamanca, M; Caccin, L; Merkel, C; Amodio, P; Romualdi, C; De Pittà, C; Costa, R; Montagnese, S
The assessment of diurnal preference, or the preferred timing of sleep and activity, is generally based on comprehensive questionnaires such as the Horne-Östberg (HÖ). The aim of the present study was to assess the reliability of a subject's self-classification as extremely morning (Self-MM), more morning than evening (Self-M), more evening than morning (Self-E) or extremely evening (Self-EE) type, based on the last question of the HÖ (Self-ME). A convenience sample of 461 subjects [23.8 ± 4.7 years; 322 females] completed a full sleep-wake assessment, including diurnal preference (HÖ), night sleep quality (Pittsburgh Sleep Quality Index, PSQI), daytime sleepiness (Karolinska Sleepiness Scale, KSS), and habitual sleep-wake timing (12 d sleep diaries; n = 296). Significant differences in HÖ total score were observed between Self-ME classes, with each class being significantly different from neighboring classes (p classes. Such differences were maintained when sleep-wake habits were analysed separately on work and free days, and also in a smaller group of 67 subjects who completed the Self-ME as a stand-alone rather than as part of the original questionnaire. Significant differences were observed in the time-course of subjective sleepiness by Self-ME class in both the large and the small group, with Self-MM and Self-M subjects being significantly more alert in the morning and sleepier in the evening hours compared with their Self-E and Self-EE counterparts. Finally, significant differences were observed in night sleep quality between Self-ME classes, with Self-EE/Self-E subjects sleeping worse than their Self-MM/Self-M counterparts, and averaging just over the abnormality PSQI threshold of 5. In conclusion, young, healthy adults can define their diurnal preference based on a single question (Self-ME) in a way that reflects their sleep-wake timing, their sleepiness levels over the daytime hours, and their night sleep quality. Validation of the Self
Tzischinsky, Orna; Shochat, Tamar
The purpose of the study was to assess the relationships between eveningness, sleep patterns, measures of daytime functioning, i.e., sleepiness, sleep problem behaviors, and depressed mood, and quality of life (QOL) in young Israeli adolescents. A cross-sectional survey was performed in urban and rural middle schools in Northern Israel. Participants were 470 eighth and ninth grade middle school students (14 ± 0.8 yrs of age) in the normative school system. Students completed the modified School Sleep Habits Survey (SSHS) and Pediatric Quality of Life Inventory Short Form, assessing six subscales of physical, emotional, social, school performance, and psychosocial functioning, plus an addition generated total score. During weekdays and weekends, evening types went to bed later, their sleep latency was longer, their wake-up time was later, and their sleep duration was shorter than intermediate and morning types. Evening types exhibited more sleep problem behaviors, sleepiness, depressed mood, and lower QOL compared to intermediate and morning types. Based on the regression model, sleepiness, sleep-problem behaviors, and depressed mood were the variables most strongly associated with QOL, followed by morning-evening preference, weekday sleep duration, and weekend sleep latency. This study is the first to assess QOL in normative, healthy adolescents and to demonstrate strong associations between morning-evening preference and QOL. These findings enhance the need to identify young individuals with an evening preference, and to be aware of the characteristics and manifestations of the evening chronotype on daytime and nighttime behaviors in adolescence.
Centofanti, Stephanie A; Dorrian, Jillian; Hilditch, Cassie J; Banks, Siobhan
Short, nighttime naps are used as a fatigue countermeasure in night shift work, and may offer protective benefits on the morning commute. However, there is a concern that nighttime napping may impact upon the quality of daytime sleep. The aim of the current project was to investigate the influence of short nighttime naps (sleep. Thirty-one healthy subjects (aged 21-35 y; 18 females) participated in a 3-day laboratory study. After a 9-h baseline sleep opportunity (22:00h-07:00h), subjects were kept awake the following night with random assignment to: a 10-min nap ending at 04:00h plus a 10-min nap at 07:00h; a 30-min nap ending at 04:00h; or a no-nap control. A 40-min driving simulator task was administered at 07:00h and 18:30h post-recovery sleep. All conditions had a 6-h daytime recovery sleep opportunity (10:00h-16:00h) the next day. All sleep periods were recorded polysomnographically. Compared to control, the napping conditions did not significantly impact upon simulated driving lane variability, percentage of time in a safe zone, or time to first crash on morning or evening drives (p>0.05). Short nighttime naps did not significantly affect daytime recovery total sleep time (p>0.05). Slow wave sleep (SWS) obtained during the 30-min nighttime nap resulted in a significant reduction in SWS during subsequent daytime recovery sleep (psleep following a night shift. Further investigation is needed to examine the optimal timing, length or combination of naps for reducing performance decrements on the morning commute, whilst still preserving daytime sleep quality. Copyright © 2015 Elsevier Ltd. All rights reserved.
Hawkins, A N; Filtness, A J
Driver sleepiness is a major contributor to severe crashes and fatalities on our roads. Many people continue to drive despite being aware of feeling tired. Prevention relies heavily on education campaigns as it is difficult to police driver sleepiness. The video sharing social media site YouTube is extremely popular, particularly with at risk driver demographics. Content and popularity of uploaded videos can provide insight into the quality of publicly accessible driver sleepiness information. The purpose of this research was to answer two questions; firstly, how prevalent are driver sleepiness videos on YouTube? And secondly, what are the general characteristics of driver sleepiness videos in terms of (a) outlook on driver sleepiness, (b) tone, (c) countermeasures to driver sleepiness, and, (d) driver demographics. Using a keywords search, 442 relevant videos were found from a five year period (2nd December 2009-2nd December 2014). Tone, outlook, and countermeasure use were thematically coded. Driver demographic and video popularity data also were recorded. The majority of videos portrayed driver sleepiness as dangerous. However, videos that had an outlook towards driver sleepiness being amusing were viewed more often and had more mean per video comments and likes. Humorous videos regardless of outlook, were most popular. Most information regarding countermeasures to deal with driver sleepiness was accurate. Worryingly, 39.8% of videos with countermeasure information contained some kind of ineffective countermeasure. The use of humour to convey messages about the dangers of driver sleepiness may be a useful approach in educational interventions. Copyright © 2015 Elsevier Ltd. All rights reserved.
Lo, June C; Ong, Ju Lynn; Leong, Ruth L F; Gooley, Joshua J; Chee, Michael W L
To investigate the effects of sleep restriction (7 nights of 5 h time in bed [TIB]) on cognitive performance, subjective sleepiness, and mood in adolescents. A parallel-group design was adopted in the Need for Sleep Study. Fifty-six healthy adolescents (25 males, age = 15-19 y) who studied in top high schools and were not habitual short sleepers were randomly assigned to Sleep Restriction (SR) or Control groups. Participants underwent a 2-w protocol consisting of 3 baseline nights (TIB = 9 h), 7 nights of sleep opportunity manipulation (TIB = 5 h for the SR and 9 h for the control groups), and 3 nights of recovery sleep (TIB = 9 h) at a boarding school. A cognitive test battery was administered three times each day. During the manipulation period, the SR group demonstrated incremental deterioration in sustained attention, working memory and executive function, increase in subjective sleepiness, and decrease in positive mood. Subjective sleepiness and sustained attention did not return to baseline levels even after 2 recovery nights. In contrast, the control group maintained baseline levels of cognitive performance, subjective sleepiness, and mood throughout the study. Incremental improvement in speed of processing, as a result of repeated testing and learning, was observed in the control group but was attenuated in the sleep-restricted participants, who, despite two recovery sleep episodes, continued to perform worse than the control participants. A week of partial sleep deprivation impairs a wide range of cognitive functions, subjective alertness, and mood even in high-performing high school adolescents. Some measures do not recover fully even after 2 nights of recovery sleep. A commentary on this article appears in this issue on page 497. © 2016 Associated Professional Sleep Societies, LLC.
Landtblom, Anne-Marie; Engström, Maria
The sleepy teenager puts the doctor in a, often tricky, situation where it must be decided if we deal with normal physiology or if we should suspect pathological conditions. What medical investigations are proper to consider? What differential diagnoses should be considered in the first place? And what tools do we actually have? The symptoms and problems that usually are presented at the clinical visit can be both of medical and psychosocial character – and actually they are often a mixture of both. Subsequently, the challenge to investigate the sleepy teenager often includes the examination of a complex behavioral pattern. It is important to train and develop diagnostic skills and to realize that the physiological or pathological conditions that can cause the symptoms may have different explanations. Research in sleep disorders has shown different pathological mechanisms congruent with the variations in the clinical picture. There are probably also different patterns of involved neuronal circuits although common pathways may exist. The whole picture remains to be drawn in this interesting and challenging area. PMID:25136329
Perfect, Michelle M.; Patel, Priti G.; Scott, Roxanne E.; Wheeler, Mark D.; Patel, Chetanbabu; Griffin, Kurt; Sorensen, Seth T.; Goodwin, James L.; Quan, Stuart F.
Study Hypotheses: 1) Youth with evidence of SDB (total apnea-hypopnea index [Total-AHI] ≥ 1.5) would have significantly worse glucose control than those without SDB; 2) Elevated self-reported sleepiness in youth with T1DM would be related to compromised psychosocial functioning; and 3) Youth with T1DM would have significantly less slow wave sleep (SWS) than controls. Design: The study utilized home-based polysomnography, actigraphy, and questionnaires to assess sleep, and continuous glucose monitors and hemoglobin A1C (HbA1C) values to assess glucose control in youth with T1DM. We compared sleep of youth with T1DM to sleep of a matched control sample. Setting: Diabetic participants were recruited in a pediatric endocrinology clinic. Participants: Participants were youth (10 through 16 years) with T1DM. Controls, matched for sex, age, and BMI percentile, were from the Tucson Children's Assessment of Sleep Apnea study. Results: Participants with a Total-AHI ≥ 1.5 had higher glucose levels. Sleepiness and/or poor sleep habits correlated with reduced quality of life, depressed mood, lower grades, and lower state standardized reading scores. Diabetic youth spent more time (%) in stage N2 and less time in stage N3. Findings related to sleep architecture included associations between reduced SWS and higher HbA1C, worse quality of life, and sleepiness. More time (%) spent in stage N2 related to higher glucose levels/hyperglycemia, behavioral difficulties, reduced quality of life, lower grades, depression, sleep-wake behavior problems, poor sleep quality, sleepiness, and lower state standardized math scores. Conclusions: Sleep should be routinely assessed as part of diabetes management in youth with T1DM. Citation: Perfect MM; Patel PG; Scott RE; Wheeler MD; Patel C; Griffin K; Sorensen ST; Goodwin JL; Quan SF. Sleep, glucose, and daytime functioning in youth with type 1 diabetes. SLEEP 2012;35(1):81-88. PMID:22215921
van der Heide, Astrid; van Schie, Mojca K M; Lammers, Gert Jan; Dauvilliers, Yves; Arnulf, Isabelle; Mayer, Geert; Bassetti, Claudio L; Ding, Claire-Li; Lehert, Philippe; van Dijk, J Gert
To validate the Sustained Attention to Response Task (SART) as a treatment effect measure in narcolepsy, and to compare the SART with the Maintenance of Wakefulness Test (MWT) and the Epworth Sleepiness Scale (ESS). Validation of treatment effect measurements within a randomized controlled trial (RCT). Ninety-five patients with narcolepsy with or without cataplexy. The RCT comprised a double-blind, parallel-group, multicenter trial comparing the effects of 8-w treatments with pitolisant (BF2.649), modafinil, or placebo (NCT01067222). MWT, ESS, and SART were administered at baseline and after an 8-w treatment period. The severity of excessive daytime sleepiness and cataplexy was also assessed using the Clinical Global Impression scale (CGI-C). The SART, MWT, and ESS all had good reliability, obtained for the SART and MWT using two to three sessions in 1 day. The ability to distinguish responders from nonresponders, classified using the CGI-C score, was high for all measures, with a high performance for the SART (r = 0.61) and the ESS (r = 0.54). The Sustained Attention to Response Task is a valid and easy-to-administer measure to assess treatment effects in narcolepsy, enhanced by combining it with the Epworth Sleepiness Scale. © 2015 Associated Professional Sleep Societies, LLC.
Wu, Lora J; Acebo, Christine; Seifer, Ronald; Carskadon, Mary A
Quantify the homeostatic and circadian effects on sleepiness and performance of adolescents. Examine age-related changes in homeostatic and circadian regulation of sleepiness and performance by comparing younger and older adolescent groups. Three-week laboratory study including 12 cycles of a 28-h forced desynchrony protocol. Controlled laboratory environment with individual sleep and performance testing rooms and shared common areas. Twenty-seven healthy adolescents including 16 females. Ages ranged from 9.6-15.2 years and participants were split into younger (n = 14 ages 9-12) and older (n = 13 ages 13-15) groups based on median age split of 13.0 years. N/A. Testing occurred every 2 h during scheduled wake periods. Measures included sleep latency during repeated nap opportunities and scores from a computerized neurobehavioral assessment battery including a 10-min psychomotor vigilance task, a digit symbol substitution task, and the Karolinska Sleepiness Scale. Significant main effects of circadian and homeostatic factors were observed, as well as several circadian and homeostatic interaction effects. Age group did not have a significant main effect on sleep and performance data. A significant interaction of circadian phase and age group was found for sleep latency, with younger adolescents showing greater circadian modulation than older teens during the circadian night. Adolescents demonstrated a similar pattern of response to forced desynchrony as reported for adults. Sleepiness and performance were affected by homeostatic and circadian factors, and age group did not interact with homoeostatic and circadian factors for subjective sleepiness and most performance metrics. Younger adolescents had a shorter latency to sleep onset than older during the circadian bin spanning 4 to 8 h after the onset of melatonin secretion. © 2015 Associated Professional Sleep Societies, LLC.
Anund, Anna; Fors, Carina; Ihlström, Jonas; Kecklund, Göran
Bus drivers often work irregular hours or split shifts and their work involves high levels of stress. These factors can lead to severe sleepiness and dangerous driving. This study examined how split shift working affects sleepiness and performance during afternoon driving. An experiment was conducted on a real road with a specially equipped regular bus driven by professional bus drivers. The study had a within-subject design and involved 18 professional bus drivers (9 males and 9 females) who drove on two afternoons; one on a day in which they had driven early in the morning (split shift situation) and one on a day when they had been off duty until the test (afternoon shift situation). The hypothesis tested was that split shifts contribute to sleepiness during afternoon, which can increase the safety risks. The overall results supported this hypothesis. In total, five of the 18 drivers reached levels of severe sleepiness (Karolinska Sleepiness Scale ≥8) with an average increase in KSS of 1.94 when driving in the afternoon after working a morning shift compared with being off duty in the morning. This increase corresponded to differences observed between shift workers starting and ending a night shift. The Psychomotor Vigilance Task showed significantly increased response time with split shift working (afternoon: 0.337s; split shift 0.347s), as did the EEG-based Karolinska Drowsiness Score mean/max. Blink duration also increased, although the difference was not significant. One driver fell asleep during the drive. In addition, 12 of the 18 bus drivers reported that in their daily work they have to fight to stay awake while driving at least 2-4 times per month. While there were strong individual differences, the study clearly showed that shift-working bus drivers struggle to stay awake and thus countermeasures are needed in order to guarantee safe driving with split shift schedules. Copyright © 2017. Published by Elsevier Ltd.
Cotrim, Teresa; Carvalhais, José; Neto, Catarina; Teles, Júlia; Noriega, Paulo; Rebelo, Francisco
In the last two decades the control of the Portuguese railway network has become much more centralized in three centres, there integrating the functions of route flow management, electrical control and signalling. This study aimed to investigate the influence of work and individual determinants in sleepiness among railway control workers, namely socio-demographic factors, work ability, psychosocial factors, shiftwork characteristics, fatigue perception, and sleep. Sleepiness by shift was associated with quality of sleep, job satisfaction, fatigue perception, quantitative demands, and age. The results indicate a high prevalence of sleepiness during the night shift and show the relevance of the quality of sleep as a predictor in the three models of sleepiness for morning, afternoon and night shifts. This study, done at the major Portuguese railway control centre, alerted managers to the importance of schedule planning as well as sleepiness prevention plans and makes these results a reference for future research. Copyright © 2016 Elsevier Ltd. All rights reserved.
Margolis, Stephen A; Reed, Richard L
Observant Muslims substantially alter their normal routines, including daytime fasting and day-night activity patterns during the month of Ramadan. It is unknown whether observing the religious practices of Ramadan impacts negatively on daytime somnolence, a factor known to impair learning. A cross-sectional survey measuring self-reported sleep time and the Epworth Sleepiness Scale of observant Muslim medical students before, during, and after Ramadan. There was no significant variation in sleep score pre-Ramadan (10.04 +/- 3.47), during Ramadan (10.46 +/- 3.57)m and post Ramadan(9.73 +/- 3.33), F(2,355) = 1.278, p = .280. Night sleep hours were significantly longer both before (6.22 +/- 1.45) and after (6.22 +/- 1.59) than during Ramadan (5.22 +/- 1.85), F(2,366) = 15.289, p sleep hours pre-Ramadan (1.05 +/- 1.36) and post Ramadan (0.70 +/- 1.21) were significantly shorter than during Ramadan (1.48 +/- 1.46; pre: z = 2.654, p = .08; z = -4.940, p sleep hours during Ramadan.
Strohl, Kingman P.; Brown, Daniel B.; Collop, Nancy; George, Charles; Grunstein, Ronald; Han, Fang; Kline, Lawrence; Malhotra, Atul; Pack, Alan; Phillips, Barbara; Rodenstein, Daniel; Schwab, Richard; Weaver, Terri; Wilson, Kevin
Background: Sleepiness may account for up to 20% of crashes on monotonous roads, especially highways. Obstructive sleep apnea (OSA) is the most common medical disorder that causes excessive daytime sleepiness, increasing the risk for drowsy driving two to three times. The purpose of these guidelines is to update the 1994 American Thoracic Society Statement that described the relationships among sleepiness, sleep apnea, and driving risk. Methods: A multidisciplinary panel was convened to develop evidence-based clinical practice guidelines for the management of sleepy driving due to OSA. Pragmatic systematic reviews were performed, and the Grading of Recommendations, Assessment, Development, and Evaluation approach was used to formulate and grade the recommendations. Critical outcomes included crash-related mortality and real crashes, whereas important outcomes included near-miss crashes and driving performance. Results: A strong recommendation was made for treatment of confirmed OSA with continuous positive airway pressure to reduce driving risk, rather than no treatment, which was supported by moderate-quality evidence. Weak recommendations were made for expeditious diagnostic evaluation and initiation of treatment and against the use of stimulant medications or empiric continuous positive airway pressure to reduce driving risk. The weak recommendations were supported by very low–quality evidence. Additional suggestions included routinely determining the driving risk, inquiring about additional causes of sleepiness, educating patients about the risks of excessive sleepiness, and encouraging clinicians to become familiar with relevant laws. Discussion: The recommendations presented in this guideline are based on the current evidence, and will require an update as new evidence and/or technologies becomes available. PMID:23725615
Strohl, Kingman P; Brown, Daniel B; Collop, Nancy; George, Charles; Grunstein, Ronald; Han, Fang; Kline, Lawrence; Malhotra, Atul; Pack, Alan; Phillips, Barbara; Rodenstein, Daniel; Schwab, Richard; Weaver, Terri; Wilson, Kevin
Sleepiness may account for up to 20% of crashes on monotonous roads, especially highways. Obstructive sleep apnea (OSA) is the most common medical disorder that causes excessive daytime sleepiness, increasing the risk for drowsy driving two to three times. The purpose of these guidelines is to update the 1994 American Thoracic Society Statement that described the relationships among sleepiness, sleep apnea, and driving risk. A multidisciplinary panel was convened to develop evidence-based clinical practice guidelines for the management of sleepy driving due to OSA. Pragmatic systematic reviews were performed, and the Grading of Recommendations, Assessment, Development, and Evaluation approach was used to formulate and grade the recommendations. Critical outcomes included crash-related mortality and real crashes, whereas important outcomes included near-miss crashes and driving performance. A strong recommendation was made for treatment of confirmed OSA with continuous positive airway pressure to reduce driving risk, rather than no treatment, which was supported by moderate-quality evidence. Weak recommendations were made for expeditious diagnostic evaluation and initiation of treatment and against the use of stimulant medications or empiric continuous positive airway pressure to reduce driving risk. The weak recommendations were supported by very low-quality evidence. Additional suggestions included routinely determining the driving risk, inquiring about additional causes of sleepiness, educating patients about the risks of excessive sleepiness, and encouraging clinicians to become familiar with relevant laws. The recommendations presented in this guideline are based on the current evidence, and will require an update as new evidence and/or technologies becomes available.
Lin, Diaozhu; Sun, Kan; Li, Feng; Qi, Yiqin; Ren, Meng; Huang, Chulin; Tang, Juying; Xue, Shengneng; Li, Yan; Yan, Li
Our objective was to evaluate the association between habitual daytime napping and the prevalence of metabolic syndrome. We conducted a population-based study of 8,547 subjects aged 40 years or older. Metabolic syndrome was defined according to a harmonized definition from a joint statement and the recommended thresholds for the Chinese population. Information about sleep duration was self-reported. The prevalence of metabolic syndrome in the no daytime napping group, the 0 to 1 hour daytime napping group and the more than 1 hour daytime napping group were 35.0%, 36.0% and 44.5% among the females (Pnapping hours were positively associated with parameters of metabolic syndrome in the female subjects, including waist circumference, systolic blood pressure, triglycerides and fasting plasma glucose (Pnapping females, napping for more than 1 hour was independently associated with an increased prevalence of metabolic syndrome (odds ratio 1.39, 95% confidence interval, 1.13-1.72). Compared to the female subjects in the no daytime napping group, those habitually napped for more than 1 hour exhibited 46% and 26% increases in the prevalence of central obesity and hypertriglyceridemia (all Pnapping hours and metabolic syndrome among the male subjects. Daytime napping is associated with an increased prevalence of metabolic syndrome in middle-aged non-obese Chinese women. Copyright © 2014. Published by Elsevier Inc.
Full Text Available Aims: Medical error is a great concern of the patients and physicians. It usually occurs due to physicians’ exhaustion, distress and fatigue. In this study, we aimed to evaluate frequency of distress and fatigue among emergency medicine residents reporting a medical error. Materials and Methods: The study population consisted of emergency medicine residents who completed an emailed questionnaire including self-assessment of medical errors, the Epworth Sleepiness Scale (ESS score, the Maslach Burnout Inventory, and PRIME-MD validated depression screening tool. Results: In this survey, 100 medical errors were reported including diagnostic errors in 53, therapeutic errors in 24 and following errors in 23 subjects. Most errors were reported by males and third year residents. Residents had no signs of depression, but all had some degrees of sleepiness and burnout. There were significant differences between errors subtypes and age, residency year, depression, sleepiness and burnout scores (p<0.0001. Conclusion: In conclusion, residents committing a medical error usually experience burnout and have some grades of sleepiness that makes them less motivated increasing the probability of medical errors. However, as none of the residents had depression, it could be concluded that depression has no significant role in medical error occurrence and perhaps it is a possible consequence of medical error. Keywords: Residents; Medical error; Burnout; Sleepiness; Depression
Mendelson, W B
As a follow-up to a previous assessment of complications of sleep-disturbed breathing in 265 patients, we have reevaluated measures of sleepiness and hypertension in patients with obstructive sleep apnea (OSA) (n = 518), central sleep apnea (n = 50), and subclinical sleep-disordered breathing (SDB) (n = 107). Both subjective and objective (multiple sleep latency test [MSLT]) measures indicated that OSA patients were sleepier than those with subclinical SDB. The OSA patients weighed significantly more than the patients with central sleep apnea or subclinical SDB. They had a higher proportion of men, described more habitual sleepiness, and had a higher likelihood of feeling unrefreshed in the morning compared with the group with subclinical SDB. Among the OSA patients, there was a significant correlation between subjective and objective assessment of sleepiness, but this relationship was quantitatively very small. A forward stepwise regression analysis revealed that weight, and to a lesser degree waking time after sleep onset, could account for 65.5% of the variance in subjective sleepiness. Seventy-five percent of the variance of the mean sleep latency in the MSLT could be accounted for by the mean minimum arterial oxygen saturation in non-REM sleep and the nocturnal sleep latency. Diastolic BP was significantly higher in OSA patients compared with the patients with central sleep apnea and subclinical SDB. When covarying for weight, age, and gender, this effect lost significance. Among OSA patients taken by themselves, 98.3% of the variance in diastolic blood pressure could be accounted for by the mean minimum arterial oxygen saturation in non-REM sleep, with very small additional contributions of apnea/hypopnea index, weight, and age. In summary, among patients across a spectrum of SDB, differences in diastolic BP were primarily associated with weight, age, and gender. Among OSA patients, perhaps because of a more limited variance in weight, diastolic BP was
Ruger, M; Gordijn, MCM; Beersma, DGM; De Vries, B; Daan, S
In this paper we examine the relationship between melatonin suppression and reduction of sleepiness through light by comparing three different data sets. In total 36 subjects participated in three studies and received 4 h of bright light either from midnight till 4:00 hours (experiments A and B) or
Eddy, Douglas; Barton, Emily; Cardenas, Rebecca; French, Jonathan; Gibbons, John; Hickey, Patrick; Miller, James; Ramsey, Carol; Storm, William
.... This study compared two doses of the hypnotic zolpidem, two doses of melatonin and placebo for their effects on daytime sleep, on nighttime cognitive performance and on mood in an operationally...
Denic-Roberts, Hristina; Costacou, Tina; Orchard, Trevor J
To date, studies on sleep disturbances in type 1 diabetes (T1D) have been limited to youth and/or small samples. We therefore assessed the prevalence of subjective sleep disturbances and their associations with glycemia and estimated insulin sensitivity in individuals with long-standing T1D. We conducted a cross-sectional study including 222 participants of the Epidemiology of Diabetes Complications study of childhood-onset T1D attending the 25-year examination (mean age=52years, diabetes duration=43years). The Berlin Questionnaire (risk of obstructive sleep apnea, OSA), the Epworth Sleepiness Scale (daytime sleepiness), and the Pittsburgh Sleep Quality Index (sleep quality, bad dreams presence, and sleep duration) were completed. Associations between sleep disturbances and poor glycemic control (HbA1c⩾7.5%/58mmol/mol), log-transformed HbA1c, and estimated insulin sensitivity (estimated glucose disposal rate, eGDR, squared) were assessed in multivariable regression. The prevalences of high OSA risk, excessive daytime sleepiness, poor sleep quality, and bad dreams were 23%, 13%, 41%, and 26%, respectively, with more women (51%) reporting poor sleep quality than men (30%, p=0.004). Participants under poor glycemic control were twice as likely to report bad dreams (p=0.03), but not independently (p=0.07) of depressive symptomatology. Sleep duration was directly associated with HbA1c among individuals with poor glycemic control, but inversely in their counterparts (interaction p=0.002), and inversely associated with eGDR (p=0.002). These findings suggest important interrelationships between sleep, gender, depressive symptomatology, and glycemic control, which may have important clinical implications. Further research is warranted to examine the mechanism of the interaction between sleep duration and glycemic control. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Shibagaki, Yumi; Ogawa, Kozue; Hagiwara, Hiroshi
The purpose of the present study was to clarify the ability of physiological indices to reflect the degree of sleepiness or relaxation of an individual due to stress, fatigue and other factors. Several studies have investigated the use of high-frequency (HF) components (0.15-0.40Hz) in heart rate variability to evaluate parasympathetic nervous activity. However, it has been difficult to assess the differences between states of sleepiness and relaxation using this method. In the present study, in order to evaluate the indices, two experimental illuminance conditions, 100 and 1,500 lx, reflecting differing states of arousal, were used during a cognitive judgment test lasting for 30 minutes. During the cognitive judgment test, electroencephalograms (EEG), electrocardiograms (ECG), physiological state and reaction time were measured, and results indicated that the two illuminance conditions could be differentiated from the recorded physiological data. More specifically, in the 1,500-lx condition, arousal level, activity level and test performance increased, and the level of HF components decreased. Opposite tendencies were observed in the 100-lx condition. Two indices of Lorenz plots (LP) at ECG RR intervals, center (C of LP) and ellipse area (S of LP), were subsequently determined from the physiological data. Subjects were then divided according to these LP indices based on their exhibited physiological responses, and we evaluated the effectiveness of the indices in differentiating between states of sleepiness and relaxation by comparing arousal level, psychological state, and reaction time. Results indicated that the C of LP and S of LP are possible indices for evaluating sleepiness or relaxation and suggest that these two indices may also be able to evaluate the relationship between physiological changes and other, subjective feelings.
Inocente, Clara; Arnulf, Isabelle; Bastuji, Hélène; Thibault-Stoll, Anne; Raoux, Aude; Reimão, Rubens; Lin, Jian-Sheng; Franco, Patricia
Narcolepsy is a rare disabling sleep disorder characterized by excessive daytime sleepiness and cataplexy (sudden loss of muscle tone). Drugs such as pitolisant, which block histamine H3 autoreceptors, constitute a newly identified class of stimulants because they increase brain histamine and enhance wakefulness in animal and human adult narcolepsy. We report our experience with the off-label use of pitolisant in 4 teenagers with narcolepsy/cataplexy with severe daytime sleepiness, refractory to available treatments (modafinil, methylphenidate, mazindol, sodium oxybate, and D-amphetamine). All teenagers developed their disease during childhood (11.3 ± 2.4 years; 50% boys) and were 17.3 ± 0.8 years old at the time of pitolisant therapy. Pitolisant treatment was increased from 10 to 30 mg (n = 1) and 40 mg (n = 3). The adapted Epworth Sleepiness Score decreased from 14.3 ± 1.1 to 9.5 ± 2.9 (P = 0.03) with pitolisant alone to 7 ± 3.4 when combined with mazindol (n = 1), methylphenidate (n = 1), or sodium oxybate plus modafinil (n = 1). Mean sleep onset latency increased from 31 ± 14 minutes to 36 ± 8 minutes (P = 0.21) on the maintenance of wakefulness test. The severity and frequency of cataplexy were slightly improved. Adverse effects were minor (insomnia, headache, hot flushes, leg pain, and hallucinations) and transitory, except for insomnia, which persisted in 2 teenagers. The benefit was maintained after a mean of 13 months. Pitolisant could constitute an acceptable alternative for the treatment of refractory sleepiness in teenagers with narcolepsy.
Ahlstrom, Christer; Kircher, Katja; Fors, Carina; Dukic, Tania; Patten, Christopher; Anund, Anna
Snow was falling heavily when Sarah was driving on a slippery road to her cousin's country cottage. It was dark outside, and the visibility was poor. She had planned to arrive before sunset, but the rental service had made a mistake, and it took hours before she got her rental car at the airport. It was past midnight now, and after a long day of traveling, Sarah was starting to get sleepy. Fortunately, there were only 15 km to go, but her eyelids were starting to feel heavy. To stay awake, she put her favorite CD on, turned up the volume, and started to sing along. This seemed to help a little-good-only 10 km to go. This was when Sarah's phone started ringing, and she awkwardly tried to find the mute button for the car stereo while answering the phone. As she looked up again, she barely caught a glimpse of the red brake lights of the car in front of her as she smashed into it.
Yim Wah Mak; Cynthia Sau Ting Wu; Donna Wing Shun Hui; Siu Ping Lam; Hei Yin Tse; Wing Yan Yu; Ho Ting Wong
Screen viewing is considered to have adverse impacts on the sleep of adolescents. Although there has been a considerable amount of research on the association between screen viewing and sleep, most studies have focused on specific types of screen viewing devices such as televisions and computers. The present study investigated the duration with which currently prevalent screen viewing devices (including televisions, personal computers, mobile phones, and portable video devices) are viewed in ...
Penner, Iris-Katharina; Sivertsdotter, Eva Catharina; Celius, Elisabeth G
BACKGROUND: Fatigue is a frequent symptom in multiple sclerosis (MS) and often interrelated with depression and sleep disorders making symptomatic treatment decisions difficult. In the single-arm, observational phase IV TYNERGY study, relapsing-remitting MS patients showed a clinically meaningful...... were significantly related to improved fatigue. CONCLUSION: Our findings highlight the importance of patient-reported outcomes in identifying potential benefits of drug treatment beyond its well-established effects on disease activity and disability progression....
Langberg, Joshua M; Dvorsky, Melissa R; Marshall, Stephen; Evans, Steven W
...‐report on the P ediatric D aytime S leepiness S cale ( PDSS ), predicted academic functioning above and beyond symptoms of ADHD and relevant covariates, such as intelligence, achievement scores and parent education level. Self...
15.5 to 38.6. Based on their Body Mass Index (BMI), participants were classified as underweight (n=12, 1.88%), normal weight (n=310, 48.4...inches) 2. Classification was performed using the World Health Organization’s BMI cutoffs: underweight for BMI less than 18.50 kg/m2, normal range...National Health and Nutrition Examination Survey (NHANES), approximately 64% of adults 20 years old and over are either overweight or obese (Center for
Lichtor J Lance
Full Text Available Abstract Background Nitrous oxide (N2O provides sedation for procedures that result in constant low-intensity pain. How long do individuals remain sleepy after receiving N2O? We hypothesized that drug effects would be apparent for an hour or more. Methods This was a randomized, double blind controlled study. On three separate occasions, volunteers (N = 12 received 100% oxygen or 20% or 40% N2O for 30 min. Dependent measures included the multiple sleep latency test (MSLT, a Drug Effects/Liking questionnaire, visual analogue scales, and five psychomotor tests. Repeated measures analysis of variance was performed with drug and time as factors. Results During inhalation, drug effects were apparent based on the questionnaire, visual analogue scales, and psychomotor tests. Three hours after inhaling 100% oxygen or 20% N2O, subjects were sleepier than if they breathed 40% N2O. No other drug effects were apparent 1 hour after inhalation ceased. Patients did not demonstrate increased sleepiness after N2O inhalation. Conclusion We found no evidence for increased sleepiness greater than 1 hour after N2O inhalation. Our study suggests that long-term effects of N2O are not significant.
Neu, D; Mairesse, O; Newell, J; Verbanck, P; Peigneux, P; Deliens, G
We investigated effects of NREM and REM predominant sleep periods on sleepiness and psychomotor performances measured with visual analog scales and the psychomotor vigilance task, respectively. After one week of stable sleep-wake rhythms, 18 healthy sleepers slept 3hours of early sleep and 3hours of late sleep, under polysomnographic control, spaced by two hours of sustained wakefulness between sleep periods in a within subjects split-night, sleep interruption protocol. Power spectra analysis was applied for sleep EEG recordings and sleep phase-relative power proportions were computed for six different frequency bands (delta, theta, alpha, sigma, beta and gamma). Both sleep periods presented with similar sleep duration and efficiency. As expected, phasic NREM and REM predominances were obtained for early and late sleep conditions, respectively. Albeit revealing additive effects of total sleep duration, our results showed a systematic discrepancy between psychomotor performances and sleepiness levels. In addition, sleepiness remained stable throughout sustained wakefulness during both conditions, whereas psychomotor performances even decreased after the second sleep period. Disregarding exchanges for frequency bands in NREM or stability in REM, correlations between outcome measures and EEG power proportions further evidenced directional divergence with respect to sleepiness and psychomotor performances, respectively. Showing that the functional correlation pattern changed with respect to early and late sleep condition, the relationships between EEG power and subjective or behavioral outcomes might however essentially be related to total sleep duration rather than to the phasic predominance of REM or NREM sleep. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
Sánchez-de-la-Torre, M; Barceló, A; Piérola, J; Esquinas, C; de la Peña, M; Durán-Cantolla, J; Capote, F; Masa, J F; Marin, J M; Vilá, M; Cao, G; Martinez, M; de Lecea, L; Gozal, D; Montserrat, J M; Barbé, F
Obstructive sleep apnea (OSA) is related to obesity and metabolic disorders. The main clinical symptoms are excessive daytime sleepiness (EDS) and snoring. However, not all patients with OSA manifest EDS. Hypocretin-1, neuropeptide Y, leptin, ghrelin and adiponectin are implicated in both metabolic and sleep regulation, two conditions affected by OSA. We hypothesized that levels of these peptides may be related to EDS in OSA patients. We included 132 patients with EDS, as defined by an Epworth Sleepiness Scale (ESS) score ≥ 13 (mean ± SD, 15.7 ± 2.3) and 132 patients without EDS as defined by an ESS score ≤ 9 (6.5 ± 1.9). All patients had an apnea-hypopnea index (AHI) ≥ 20 h(-1). Both groups were matched for gender (males; 83.3% vs. 85.6%), age (50.15 ± 11.2 yrs vs. 50.7 ± 9.9 yrs), body mass index (BMI) (31.8 ± 5.6 kg m(-2) vs. 32.1 ± 4.8 kg m(-2)), and apnea-hypopnea index (AHI) (45.5 ± 19.1 h(-1) vs. 43 ± 19.2 h(-1)). OSA patients with EDS showed significantly higher plasma hypocretin-1 levels (p sleep time. Our study shows that EDS in patients with OSA is associated with increased circulating hypocretin-1 and decreased circulating ghrelin levels, two peptides involved in the regulation of body weight, energy balance, sympathetic tone and sleep-wake cycle. This relationship is independent of AHI and obesity (two key phenotypic features of OSA). Copyright © 2011 Elsevier Ltd. All rights reserved.
Full Text Available The aim of this study was to explore changes in cognitive function, sleep propensity, and sleep-related hormones (growth hormone, cortisol, prolactin, and thyrotropin and to investigate the factors related to the ability to maintain wakefulness in the daytime after one block of fast forward rotating shift work (2 days, 2 evenings, and 2 nights. Twenty female nurses (mean age: 26.0 ± 2.0 years; range: 22–30 years were recruited from an acute psychiatric ward. The nurses completed the Maintenance of Wakefulness Test (MWT, State Anxiety Inventory (SAI, Stanford Sleepiness Scale (SSS, Digit Symbol Substitution Test, Symbol Searching Test, Taiwan University Attention Test, Wisconsin Card Sorting Test (WCST, and Multiple Sleep Latency Test (MSLT four times throughout the day at 2-hour intervals, and their hormone levels were measured at the same time. There was no time of day effect on sleep propensity as measured by the MWT or MSLT despite an increase in self-reported sleepiness. Anxiety state and neuropsychological tasks, including executive function, attention, and perceptual and motor abilities were not affected during the daytime sleep restriction period. The number of omissions and perceptual and motor abilities showed a practice effect. The thyrotropin levels were significantly elevated, and cortisol levels significantly decreased during the daytime sleep restriction period. There were no significant changes in growth hormone or prolactin throughout the daytime period. Age was negatively associated with the mean sleep latency (MSL of the MWT and positively associated with the MSL of the MSLT. The perseverative errors in WCST and SSS scores were negatively associated with the MSL of the MWT. SAI scores and thyrotropin levels were positively associated with the MSL of the MWT. In conclusion, there was no change in sleep propensity in the daytime after one block of rotating shift work. An attempt to preserve daytime alertness was also related
Viitasalo, Katriina; Kuosma, Eeva; Laitinen, Jaana; Härmä, Mikko
A controlled intervention study was conducted to evaluate the effects of two changes in shift characteristics on alertness and cardiovascular risk factors: a change in shift rotation (direction and speed) and a change in the flexibility of the shift system. Altogether 84 male workers currently working in a backward-rotating shift system volunteered for the study. A total of 40 men changed to a rapidly forward-rotating shift system, 22 changed to a more flexible shift system, and 22 remained with the old shift system. Health effects were studied with the use of clinical measurements, blood tests, and questionnaires before and after the shift changes. Analyses of variance were used with repeated measures to study associations of cardiovascular risk factors and daytime sleepiness according to the change in shift systems. The mean number of days on which the workers reported sleepiness decreased in the group with the forward-rotating shift system when compared with that of the group on the old shift system (from 2.9 to 2.1 days/week, P=0.02). Systolic blood pressure decreased (from 142 to 136 mm Hg, P=0.049), and heart rate showed a declining trend (from 66 to 60 beats/minute, P=0.06) in the flexible shift system when the three groups were compared. The study indicates that a faster speed, together with a change to the forward direction, in shift rotation alleviates daytime sleepiness. Combining individual flexibility with company-based flexibility in a shift system may have favorable effects on shift workers' blood pressure.
Rossi, Sergio; Isabel, Nathalie
Global warming is diurnally asymmetric, leading to a less cold, rather than warmer, climate. We investigated the effects of asymmetric experimental warming on plant phenology by testing the hypothesis that daytime warming is more effective in advancing bud break than night-time warming. Bud break was monitored daily in Picea mariana seedlings belonging to 20 provenances from Eastern Canada and subjected to daytime and night-time warming in growth chambers at temperatures varying between 8 and 16 °C. The higher advancements of bud break and shorter times required to complete the phenological phases occurred with daytime warming. Seedlings responded to night-time warming, but still with less advancement of bud break than under daytime warming. No advancement was observed when night-time warming was associated with a daytime cooling. The effect of the treatments was uniform across provenances. Our observations realized under controlled conditions allowed to experimentally demonstrate that bud break can advance under night-time warming, but to a lesser extent than under daytime warming. Prediction models using daily timescales could neglect the diverging influence of asymmetric warming and should be recalibrated for higher temporal resolutions. © 2016 John Wiley & Sons Ltd.
Konin, C; Boka, B; Adoubi, A; N'guetta, R; Coulibaly, I; N'djessan, J J; Koffi, J; Ekou, A; Yao, H; Angoran, I; Adoh, M
Sleep apnea syndrome (SAS) is very little described in the hypertensive black African. To screen sleep apnea syndrome using the rating scale of Epworth daytime sleepiness, and to investigate the determinant factors and to infer therapeutic consequences. This is a retrospective and prospective study with descriptive and analytical purpose that focused on 200 hypertensive outpatients of the Cardiology Institute of Abidjan. The primary endpoint studied was the SAS. The diagnostic approach of SAS was performed using the rating scale of Epworth daytime sleepiness. The prevalence of sleep apnea was 45%. The average age of sleep apnea carriers was 56.1 years, with a male predominance (60%). The determinant factors of sleep apnea syndrome were male gender (60% versus 40%, P=0.021), obesity (77.8% versus 62.7%, P<0.0001), diabetes (26.7% versus 15.5%, P=0.5) and dyslipidemia (54.4% versus 27.3%, P=0.0009). Life in urban areas, occupation and smoking were not correlated with SAS in our series. The control of hypertension was better in non-apneic patients compared to apneic patients (63.6% versus 38.9%, P=0.04). The visceral impact of hypertension in apneic patients was highly significant (77.8% versus 41.7%, P=0.014). Therapeutically, it was noted the preferential prescription of combination therapy in apneic patients compared to non-apneic patients (82.3% versus 74.4%). Copyright © 2015 Elsevier Masson SAS. All rights reserved.
SIMONE FAGONDES CANANI
Full Text Available Objetivo: Este artigo tem por finalidade apresentar uma sucinta revisão sobre as repercussões da sonolência excessiva no desempenho dos motoristas no trânsito, enfatizando a necessidade da maior valorização do tema abordado. Métodos: Revisão bibliográfica da literatura nacional e internacional, abrangendo artigos originais e publicações oficiais da American Thoracic Society e da American Sleep Apnea Association. Resultados: As evidências de que a sonolência é um fator que pode contribuir de forma decisiva para a ocorrência de acidentes automobilísticos são crescentes. As dificuldades com relação à caracterização da sonolência precedendo o acidente são discutidas no texto. Muitas são as causas de sonolência excessiva; felizmente, sua maioria é passível de identificação e manejo adequado. Conclusões: É importante que haja maior entendimento do problema em nosso meio, para que possam ocorrer modificações na abordagem do paciente com sonolência excessiva e também discussões acerca das leis de trânsito vigentes e das obrigações legais do médico com relação a este problema.Objective: The purpose of this article is to present a brief review of the effects of excessive sleepiness on driving performance, and to emphasize the importance of the subject. Methods: Bibliographic review of national and international literature, including original articles and official publications from the American Thoracic Society and the American Sleep Apnea Association. Results: There is growing evidence that excessive sleepiness may be an important factor related to the occurrence of motor vehicle accidents. Difficulties regarding the identification of sleepiness as a preceding factor related to motor vehicle crashes are discussed on the text. There are many causes for excessive sleepiness. Fortunately most of them are easy to recognize and have specific treatment. Conclusions: A better understanding of the problem is fundamental
Burin, Michael J.
This century's transits of Venus (2004, 2012) captured significant public attention, reminding us that the wonders of astronomy need not be confined to the night. And while nighttime telescope viewing gatherings (a.k.a. "star parties") are perennially popular, astronomy classes are typically held in the daytime. The logistics of…
Wolfson, Amy R.; Carskadon, Mary A.
Studied relationship between adolescents' sleep/wake habits and daytime functioning. Found that self-reported total sleep times decreased from age 13 to 19 years. Struggling or failing students obtained less sleep, went to bed later, and had greater weekend delays of sleep than those with better grades. Students with inadequate sleep reported…
Retrospective in-depth accident studies from several countries confirm that human perception errors are the main causal factor in road accidents. The share of accident types which are relevant for the effect of daytime running lights (DRL), such as overtaking and crossing accidents, in the total of
Sadler, Philip M.; Night, Christopher
What kinds of astronomical lab activities can high school and college astronomy students carry out easily in daytime? The most impressive is the determination of latitude and longitude from observations of the Sun. The "shooting of a noon sight" and its "reduction to a position" grew to become a daily practice at the start of the 19th century…
Tromp, Marilou Dp; Donners, Anouk Amt; Garssen, Johan; Verster, Joris C
OBJECTIVE: To investigate the relationship between eating disorders, body mass index (BMI), sleep disorders, and daytime functioning. DESIGN: Survey. SETTING: The Netherlands. PARTICIPANTS: N=574 Dutch young adults (18-35 years old). MEASUREMENTS: Participants completed a survey on eating and sleep
Edelmann, Cathrin; Ghiassi, Ramesh; Vogt, Deborah R; Partridge, Martyn R; Khatami, Ramin; Leuppi, Jörg D; Miedinger, David
The aim of this study was to evaluate the validity of a new pictorial form of a screening test for obstructive sleep apnea syndrome (OSAS) - the pictorial Sleepiness and Sleep Apnoea Scale (pSSAS). Validation was performed in a sample of patients admitted to sleep clinics in the UK and Switzerland. All study participants were investigated with objective sleep tests such as full-night-attended polysomnography or polygraphy. The pSSAS was validated by taking into account the individual result of the sleep study, sleep-related questionnaires and objective parameters such as body mass index (BMI) or neck circumference. Different scoring schemes of the pSSAS were evaluated, and an internal validation was undertaken. The full data set consisted of 431 individuals (234 patients from the UK, 197 patients from Switzerland). The pSSAS showed good predictive performance for OSAS with an area under the curve between 0.77 and 0.81 depending on which scoring scheme was used. The subscores of the pSSAS had a moderate-to-strong correlation with widely used screening questionnaires for OSAS or excessive daytime sleepiness as well as with BMI and neck circumference. The pSSAS can be used to select patients with a high probability of having OSAS. Due to its simple pictorial design with short questions, it might be suitable for screening in populations with low health literacy and in non-native English or German speakers.
Atsuhiko Ota; Hiroshi Yatsuya; Junji Mase; Yuichiro Ono
Evidence is limited concerning the influences of high psychological job strain and low social support at work on daytime secretion of dehydroepiandrosterone (DHEA), which demonstrates anti-cortisol effects. We carried out a cross-sectional study to examine the associations of job strain and social support with daytime secretion amounts of DHEA and cortisol and daytime variation of the cortisol-to-DHEA ratio (C/D ratio) in healthy female workers. Study subjects comprised 115 healthy female nur...
Philip, P; Ghorayeb, I; Leger, D; Menny, J C; Bioulac, B; Dabadie, P; Guilleminault, C
The study investigated whether sleepiness at the wheel is a problem in non-commercial drivers going on summer vacation. All drivers, who stopped at a rest area on a large European freeway while one of the interviewers was available, were systematically approached and asked to respond to a questionnaire. All subjects who had driven at least 400 km (240 miles), whose age was between 20 and 46 years of age, and who agreed to participate were asked to undergo a longer investigation that included a short sleep/wake diary describing overall sleep habits during the year, a sleep/wake log covering the days just prior to departure, an analog visual scale indicating sleepiness at time of interview, and a polygraphically monitored two nap sleep test (TNST). A control group was recruited that consisted of subjects of the same age range, normal sleep habits, and normal nocturnal sleep time before administration of the TNST. One hundred and four drivers (2 women) participated between 08:00 and 20:00 h. The total group was subdivided into 6 subgroups based upon the time of day of their investigation (08:00-10:00 h, 10:01-12:00 h, etc.). The control group included 50 men with 50-55% of control subjects, relative to the total number of index-cases, in each subgroup. Eighty-eight percent (n = 92) of studied drivers had experienced acute sleep deprivation within one day prior to departure due to the planned long driving. The TNST demonstrated that, overall, drivers had a significantly shorter sleep latency in nap 1 and nap 2 than controls, had a significantly longer sleep duration in nap 1 and nap 2, and there was a significant correlation between the sleep debt prior to departure and the sleep stage reached during the TNST. It is concluded that the TNST is a test which allows the objective study of sleepiness in drivers without the burden of the multiple sleep latency test. Many drivers are excessively sleepy when making long summer vacation journeys.
Herman, Josephine; Ameratunga, Shanthi N; Wainiqolo, Iris; Kafoa, Berlin; Robinson, Elizabeth; McCaig, Eddie; Jackson, Rod
Sleepiness has been shown to be a risk factor for road crashes in high-income countries, but has received little attention in low- and middle-income countries. We examined the prevalence of sleepiness and sleep-related disorders among drivers of four-wheel motor vehicles in Fiji. Using a two-stage cluster sampling roadside survey conducted over 12 months, we recruited a representative sample of people driving four-wheel motor vehicles on the island of Viti Levu, Fiji. A structured interviewer-administered questionnaire sought self-report information on driver characteristics including sleep-related measures. The 752 motor vehicle drivers recruited (84% response rate) were aged 17-75 years, with most driving in Viti Levu undertaken by male subjects (93%), and those identifying with Indian (70%) and Fijian (22%) ethnic groups. Drivers who reported that they were not fully alert accounted for 17% of driving, while a further 1% of driving was undertaken by those who reported having difficulty staying awake or feeling sleepy. A quarter of the driving time among 15-24-year-olds included driving while sleepy or not fully alert, with a similar proportion driving while chronically sleep deprived (ie, with less than five nights of adequate sleep in the previous week=27%). Driving while acutely or chronically sleep deprived was generally more common among Fijians compared with Indians. Driving while not fully alert is relatively common in Fiji. Sleepiness while driving may be an important contributor to road traffic injuries in this and other low- and middle-income countries.
Herrera, Christopher P
Ramadan is a period in which Muslims fast during daylight hours and is associated with disturbances in sleep-wake behaviour and adverse effects on physical and mental health in normal volunteers. Studies using athletes are rare and remain equivocal as to whether Ramadan influences sleep-wake patterns. Notably, the standardized assessment of subjective sleep quality and daytime sleepiness in athletes has not been established. This study employed the Arabic version of the Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Epworth Sleepiness Scale in nine football players aged 20-35 years (mean ± s: 26 ± 4) one week before and during the last week of Ramadan. Compliance rates with self-administration were high (71%) and the results demonstrated a robust decline in total sleep time (before Ramadan: 6.6 ± 2 h; at the end of Ramadan: 5.3 ± 1 h; P effect size 0.81). Compared with previous research, the study questionnaires offer improved methodology, including less time constraints plus standardization in scoring. Thus, this study demonstrates a framework for greater reproducibility and reliability in the assessment of subjective sleep-wake patterns in athletes before and during Ramadan.
... You are here Home » Products for Children with Enuresis and Daytime Urinary Incontinence The products listed here are designed for children with bedwetting (enuresis) or daytime bladder control problems (incontinence or ...
Full Text Available Marilou DP Tromp,1 Anouk AMT Donners,1 Johan Garssen,1,2 Joris C Verster1,31Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands; 2Nutricia Research, Utrecht, the Netherlands; 3Center for Human Psychopharmacology, Swinburne University, Melbourne, VIC, AustraliaObjective: To investigate the relationship between eating disorders, body mass index (BMI, sleep disorders, and daytime functioning.Design: Survey.Setting: The Netherlands.Participants: N=574 Dutch young adults (18–35 years old.Measurements: Participants completed a survey on eating and sleep habits including the Eating Disorder Screen for Primary care (ESP and SLEEP-50 questionnaire subscales for sleep apnea, insomnia, circadian rhythm disorder (CRD, and daytime functioning. SLEEP-50 outcomes of participants who screened negative (≤2 and positive (>2 on the ESP were compared. In addition, SLEEP-50 scores of groups of participants with different ESP scores (0–4 and different BMI groups (ie, underweight, healthy weight, overweight, and obese were compared using nonparametric statistics.Results: Almost 12% (n=67 of participants screened positive for having an eating disorder. Relative to participants without eating disorders, participants who screened positive for eating disorders reported significantly higher scores on sleep apnea (3.7 versus 2.9, P=0.012, insomnia (7.7 versus 5.5, P<0.0001, CRD (2.9 versus 2.3, P=0.011, and impairment of daytime functioning (8.8 versus 5.8, P=0.0001. ESP scores were associated with insomnia (r=0.117, P=0.005, sleep apnea (r=0.118, P=0.004, sleep quality (r=−0.104, P=0.012, and daytime functioning (r=0.225, P<0.0001, but not with CRD (r=0.066, P=0.112. BMI correlated significantly with ESP scores (r=0.172, P<0.0001 and scores on sleep apnea (r=0.171, P<0.0001. When controlling for BMI, the partial correlation between ESP and sleep apnea remained significant (r=0.10, P=0.015.Conclusion
ClÃ©lia Maria Ribeiro Franco
Full Text Available Background: Obstructive sleep apnoea-hypopnoea syndrome (OSAHS is a respiratory disorder with high morbidity and mortality. Continuous positive airway pressure (CPAP is the most commonly prescribed conservative treatment for adults with OSAHS. CPAP therapy normalises or decreases OSAHS symptoms and can reduce and prevent OSAHS complications. Aims: To evaluate adherence to nasal CPAP treatment and CPAP impact on daytime drowsiness. Method: A sample of 20 patients evaluated for daytime drowsiness using the Epworth sleepiness scale and interviewed for adherence to nasal CPAP use. Results: There was a significant decrease in the level of daytime sleepiness of the patients users of nasal CPAP (p=0.017; patients not using nasal CPAP experienced a decrease without statistical significance (p=0.162. 100% of CPAP users reported benefits and 50% of these reported related discomforts. Conclusions: Patients with OSAHS that use CPAP have a greater reduced level of sleepiness than those who do not use it. Resumo: IntroduÃ§Ã£o: A sÃndroma da apneia-hipopneia obstrutiva do sono (SAHOS Ã© um distÃºrbio respiratÃ³rio de elevada morbimortalidade. A terapia com pressÃ£o positiva contÃnua das vias aÃ©reas (CPAP representa o tratamento conservador mais prescrito para a SAHOS e tem o intuito de restabelecer a patÃªncia das vias aÃ©reas, normalizando o Ãndice de eventos respiratÃ³rios obstrutivos, corrigindo os sintomas. Objectivo: Avaliar o impacto do uso do CPAP nasal sobre a hipersonia diurna em portadores de SAHOS. MÃ©todo: Amostra de vinte doentes portadores de SAHOS diagnosticados por estudo de polissonografia de noite inteira, usuÃ¡rios ou nÃ£o de CPAP nasal, todos avaliados quanto Ã hipersonia diurna atravÃ©s da escala de sonolÃªncia de Epworth. Resultados: O decrÃ©scimo do nÃvel de sonolÃªncia diurna dos usuÃ¡rios de CPAP nasal foi significante (p=0,017, enquanto para nÃ£o usuÃ¡rios de CPAP nasal a m
Kazemi, Reza; Haidarimoghadam, Rashid; Motamedzadeh, Majid; Golmohamadi, Rostam; Soltanian, Alireza; Zoghipaydar, Mohamad Reza
Shift work is associated with both sleepiness and reduced performance. The aim of this study was to examine cognitive performance, sleepiness, and sleep quality among petrochemical control room shift workers...
Full Text Available Cathrin Edelmann,1 Ramesh Ghiassi,2 Deborah R Vogt,3 Martyn R Partridge,2 Ramin Khatami,4 Jörg D Leuppi,1,5 David Miedinger1,5 1Medical Faculty, University of Basel, Basel, Switzerland; 2National Heart and Lung Institute, Imperial College London, London, UK; 3Clinical Trial Unit, University of Basel, University Hospital Basel, Basel, 4Barmelweid Clinic, Barmelweid, 5University Clinic of Medicine, Kantonsspital Baselland, Liestal, Switzerland Purpose: The aim of this study was to evaluate the validity of a new pictorial form of a screening test for obstructive sleep apnea syndrome (OSAS – the pictorial Sleepiness and Sleep Apnoea Scale (pSSAS. Validation was performed in a sample of patients admitted to sleep clinics in the UK and Switzerland.Patients and methods: All study participants were investigated with objective sleep tests such as full-night-attended polysomnography or polygraphy. The pSSAS was validated by taking into account the individual result of the sleep study, sleep-related questionnaires and objective parameters such as body mass index (BMI or neck circumference. Different scoring schemes of the pSSAS were evaluated, and an internal validation was undertaken.Results: The full data set consisted of 431 individuals (234 patients from the UK, 197 patients from Switzerland. The pSSAS showed good predictive performance for OSAS with an area under the curve between 0.77 and 0.81 depending on which scoring scheme was used. The subscores of the pSSAS had a moderate-to-strong correlation with widely used screening questionnaires for OSAS or excessive daytime sleepiness as well as with BMI and neck circumference.Conclusion: The pSSAS can be used to select patients with a high probability of having OSAS. Due to its simple pictorial design with short questions, it might be suitable for screening in populations with low health literacy and in non-native English or German speakers. Keywords: questionnaire, excessive daytime sleepiness
Full Text Available The Pittsburgh Sleep Quality Index (PSQI and the Epworth Sleepiness Scale (ESS are questionnaires used to assess sleep quality and excessive daytime sleepiness in clinical and population-based studies. The present study aimed to evaluate the construct validity and factor structure of the PSQI and ESS questionnaires among young adults in four countries (Chile, Ethiopia, Peru and Thailand.A cross-sectional study was conducted among 8,481 undergraduate students. Students were invited to complete a self-administered questionnaire that collected information about lifestyle, demographic, and sleep characteristics. In each country, the construct validity and factorial structures of PSQI and ESS questionnaires were tested through exploratory and confirmatory factor analyses (EFA and CFA.The largest component-total correlation coefficient for sleep quality as assessed using PSQI was noted in Chile (r = 0.71 while the smallest component-total correlation coefficient was noted for sleep medication use in Peru (r = 0.28. The largest component-total correlation coefficient for excessive daytime sleepiness as assessed using ESS was found for item 1 (sitting/reading in Chile (r = 0.65 while the lowest item-total correlation was observed for item 6 (sitting and talking to someone in Thailand (r = 0.35. Using both EFA and CFA a two-factor model was found for PSQI questionnaire in Chile, Ethiopia and Thailand while a three-factor model was found for Peru. For the ESS questionnaire, we noted two factors for all four countries.Overall, we documented cross-cultural comparability of sleep quality and excessive daytime sleepiness measures using the PSQI and ESS questionnaires among Asian, South American and African young adults. Although both the PSQI and ESS were originally developed as single-factor questionnaires, the results of our EFA and CFA revealed the multi- dimensionality of the scales suggesting limited usefulness of the global PSQI and ESS
Gelaye, Bizu; Lohsoonthorn, Vitool; Lertmeharit, Somrat; Pensuksan, Wipawan C; Sanchez, Sixto E; Lemma, Seblewengel; Berhane, Yemane; Zhu, Xiaotong; Vélez, Juan Carlos; Barbosa, Clarita; Anderade, Asterio; Tadesse, Mahlet G; Williams, Michelle A
The Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) are questionnaires used to assess sleep quality and excessive daytime sleepiness in clinical and population-based studies. The present study aimed to evaluate the construct validity and factor structure of the PSQI and ESS questionnaires among young adults in four countries (Chile, Ethiopia, Peru and Thailand). A cross-sectional study was conducted among 8,481 undergraduate students. Students were invited to complete a self-administered questionnaire that collected information about lifestyle, demographic, and sleep characteristics. In each country, the construct validity and factorial structures of PSQI and ESS questionnaires were tested through exploratory and confirmatory factor analyses (EFA and CFA). The largest component-total correlation coefficient for sleep quality as assessed using PSQI was noted in Chile (r = 0.71) while the smallest component-total correlation coefficient was noted for sleep medication use in Peru (r = 0.28). The largest component-total correlation coefficient for excessive daytime sleepiness as assessed using ESS was found for item 1 (sitting/reading) in Chile (r = 0.65) while the lowest item-total correlation was observed for item 6 (sitting and talking to someone) in Thailand (r = 0.35). Using both EFA and CFA a two-factor model was found for PSQI questionnaire in Chile, Ethiopia and Thailand while a three-factor model was found for Peru. For the ESS questionnaire, we noted two factors for all four countries. Overall, we documented cross-cultural comparability of sleep quality and excessive daytime sleepiness measures using the PSQI and ESS questionnaires among Asian, South American and African young adults. Although both the PSQI and ESS were originally developed as single-factor questionnaires, the results of our EFA and CFA revealed the multi- dimensionality of the scales suggesting limited usefulness of the global PSQI and ESS scores
Arnulf, Isabelle; Neutel, Dulce; Herlin, Bastien; Golmard, Jean-Louis; Leu-Semenescu, Smaranda; Cochen de Cock, Valérie; Vidailhet, Marie
To determine whether patients with idiopathic and symptomatic RBD were sleepier than controls, and if sleepiness in idiopathic RBD predicted earlier conversion to Parkinson disease. The Epworth Sleepiness Scale (ESS) and its determinants were compared at the time of a video-polysomnography for an RBD diagnosis in patients with idiopathic RBD, in patients with Parkinson disease, and in controls. Whether sleepiness at time of RBD diagnosis predicted an earlier conversion to neurodegenerative diseases was retrospectively analyzed in the followed-up patients. The 75 patients with idiopathic RBD were sleepier (ESS: 7.8 ± 4.6) at the time of RBD diagnosis than 74 age- and sex-matched controls (ESS: 5.0 ± 3.6, P sleep measures. Among the 69 patients with idiopathic RBD who were followed up for a median 3 years (1-15 years), 16 (23.2%) developed parkinsonism (n = 6), dementia (n = 6), dementia plus parkinsonism (n = 2), and multiple system atrophy (n = 2). An ESS greater than 8 at time of RBD diagnosis predicted a shorter time to phenoconversion to parkinsonism and dementia, from RBD onset, and from RBD diagnosis (when adjusted for age and time between RBD onset and diagnosis). Sleepiness is associated with idiopathic REM sleep behavior disorder and predicts more rapid conversion to parkinsonism and dementia, suggesting it is an early marker of neuronal loss in brainstem arousal systems. © 2015 Associated Professional Sleep Societies, LLC.
Travel time of Hostellers was a maximum 40 minutes while day scholars was up to 4 hours/day. Poor sleep quality was reported by 20.7% students and Excessive Day time Sleepiness (ESS) by 24.4% students. More number of MBBS day scholars reported poor sleep quality and ESS than the hostellers. No student reported ...
Wilschut, E.S.; Caljouw, C.J.; Valk, P.J.L.
This report provides an overview of methods to prevent drowsy driving of drivers (Wilschut et al., 2009). Several preventive approaches were discussed such as the use of questionnaires, campaigns and fatigue management plans. A search for law enforcement instruments to prevent sleepiness at the
Full Text Available Objectives: The mechanisms underlying sleep spindles (~11-15Hz; >0.5s help to protect sleep. With age, it becomes increasingly difficult to maintain sleep at a challenging time (e.g. daytime, even after sleep loss. This study compared spindle characteristics during daytime recovery and nocturnal sleep in young and middle-aged adults. In addition, we explored whether spindles characteristics in baseline nocturnal sleep were associated with the ability to maintain sleep during daytime recovery periods in both age groups.Methods: Twenty-nine young (15 women and 14 men; 27.3 ± 5.0 and 31 middle-aged (19 women and 13 men; 51.6 y ± 5.1 healthy subjects participated in a baseline nocturnal sleep and a daytime recovery sleep after 25 hours of sleep deprivation. Spindles were detected on artefact-free NREM sleep epochs. Spindle density (nb/min, amplitude (μV, frequency (Hz and duration (s were analyzed on parasagittal (linked-ears derivations. Results: In young subjects, spindle frequency increased during daytime recovery sleep as compared to baseline nocturnal sleep in all derivations, whereas middle-aged subjects showed spindle frequency enhancement only in the prefrontal derivation. No other significant interaction between age group and sleep condition was observed. Spindle density for all derivations and centro-occipital spindle amplitude decreased whereas prefrontal spindle amplitude increased from baseline to daytime recovery sleep in both age groups. Finally, no significant correlation was found between spindle characteristics during baseline nocturnal sleep and the marked reduction in sleep efficiency during daytime recovery sleep in both young and middle-aged subjects.Conclusion: These results suggest that the interaction between homeostatic and circadian pressure module spindle frequency differently in aging. Spindle characteristics do not seem to be linked with the ability to maintain daytime recovery sleep.
Slanger, Tracy E; Gross, J Valérie; Pinger, Andreas; Morfeld, Peter; Bellinger, Miriam; Duhme, Anna-Lena; Reichardt Ortega, Rosalinde Amancay; Costa, Giovanni; Driscoll, Tim R; Foster, Russell G; Fritschi, Lin; Sallinen, Mikael; Liira, Juha; Erren, Thomas C
, revealed a mean reduction 0.83 score points of sleepiness (measured via the Stanford Sleepiness Scale (SSS) (95% confidence interval (CI) -1.3 to -0.36, very low quality evidence). Another trial did not find a significant difference in overall sleepiness on another sleepiness scale (16 participants, low quality evidence).Bright light during the night plus sunglasses at dawn did not significantly influence sleepiness compared to normal light (1 study, 17 participants, assessment via reaction time, very low quality evidence).Bright light during the day shift did not significantly reduce sleepiness during the day compared to normal light (1 trial, 61 participants, subjective assessment, low quality evidence) or compared to normal light plus placebo capsule (1 trial, 12 participants, assessment via reaction time, very low quality evidence). Napping during the night shiftA meta-analysis on a single nap opportunity and the effect on the mean reaction time as a surrogate for sleepiness, resulted in a 11.87 ms reduction (95% CI 31.94 to -8.2, very low quality evidence). Two other studies also reported statistically non-significant decreases in reaction time (1 study seven participants; 1 study 49 participants, very low quality evidence).A two-nap opportunity resulted in a statistically non-significant increase of sleepiness (subjective assessment) in one study (mean difference (MD) 2.32, 95% CI -24.74 to 29.38, 1 study, 15 participants, low quality evidence). Other interventionsPhysical exercise and sleep education interventions showed promise, but sufficient data to draw conclusions are lacking. Given the methodological diversity of the included studies, in terms of interventions, settings, and assessment tools, their limited reporting and the very low to low quality of the evidence they present, it is not possible to determine whether shift workers' sleepiness can be reduced or if their sleep length or quality can be improved with these interventions.We need better and
Gonçalves, Marta; Amici, Roberto; Lucas, Raquel; Åkerstedt, Torbjörn; Cirignotta, Fabio; Horne, Jim; Léger, Damien; McNicholas, Walter T; Partinen, Markku; Téran-Santos, Joaquín; Peigneux, Philippe; Grote, Ludger
The European Sleep Research Society aimed to estimate the prevalence, determinants and consequences of falling asleep at the wheel. In total, 12 434 questionnaires were obtained from 19 countries using an anonymous online questionnaire that collected demographic and sleep-related data, driving behaviour, history of drowsy driving and accidents. Associations were quantified using multivariate logistic regression. The average prevalence of falling asleep at the wheel in the previous 2 years was 17%. Among respondents who fell asleep, the median prevalence of sleep-related accidents was 7.0% (13.2% involved hospital care and 3.6% caused fatalities). The most frequently perceived reasons for falling asleep at the wheel were poor sleep in the previous night (42.5%) and poor sleeping habits in general (34.1%). Falling asleep was more frequent in the Netherlands [odds ratio = 3.55 (95% confidence interval: 1.97; 6.39)] and Austria [2.34 (1.75; 3.13)], followed by Belgium [1.52 (1.28; 1.81)], Portugal [1.34 (1.13, 1.58)], Poland [1.22 (1.06; 1.40)] and France [1.20 (1.05; 1.38)]. Lower odds were found in Croatia [0.36 (0.21; 0.61)], Slovenia [0.62 (0.43; 0.89)] and Italy [0.65 (0.53; 0.79)]. Individual determinants of falling asleep were younger age; male gender [1.79 (1.61; 2.00)]; driving ≥20 000 km year [2.02 (1.74; 2.35)]; higher daytime sleepiness [7.49 (6.26; 8.95)] and high risk of obstructive sleep apnea syndrome [3.48 (2.78; 4.36) in men]. This Pan European survey demonstrates that drowsy driving is a major safety hazard throughout Europe. It emphasizes the importance of joint research and policy efforts to reduce the burden of sleepiness at the wheel for European drivers.
Blackwell, Terri; Yaffe, Kristine; Laffan, Alison; Ancoli-Israel, Sonia; Redline, Susan; Ensrud, Kristine E; Song, Yeonsu; Stone, Katie L
To examine associations of objectively and subjectively measured sleep with subsequent cognitive decline. A population-based longitudinal study. Six centers in the United States. Participants were 2,822 cognitively intact community-dwelling older men (mean age 76.0 ± 5.3 y) followed over 3.4 ± 0.5 y. None. OBJECTIVELY MEASURED SLEEP PREDICTORS FROM WRIST ACTIGRAPHY: total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), number of long wake episodes (LWEP). Self-reported sleep predictors: sleep quality (Pittsburgh Sleep Quality Index [PSQI]), daytime sleepiness (Epworth Sleepiness Scale [ESS]), TST. Clinically significant cognitive decline: five-point decline on the Modified Mini-Mental State examination (3MS), change score for the Trails B test time in the worse decile. Associations of sleep predictors and cognitive decline were examined with logistic regression and linear mixed models. After multivariable adjustment, higher levels of WASO and LWEP and lower SE were associated with an 1.4 to 1.5-fold increase in odds of clinically significant decline (odds ratio 95% confidence interval) Trails B test: SE sleep efficiency, greater nighttime wakefulness, greater number of long wake episodes, and poor self-reported sleep quality were associated with subsequent cognitive decline.
Ota, Atsuhiko; Yatsuya, Hiroshi; Mase, Junji; Ono, Yuichiro
Evidence is limited concerning the influences of high psychological job strain and low social support at work on daytime secretion of dehydroepiandrosterone (DHEA), which demonstrates anti-cortisol effects. We carried out a cross-sectional study to examine the associations of job strain and social support with daytime secretion amounts of DHEA and cortisol and daytime variation of the cortisol-to-DHEA ratio (C/D ratio) in healthy female workers. Study subjects comprised 115 healthy female nursery school teachers. Area under the curve with respect to ground (AUCG) of salivary DHEA, cortisol and C/D ratio was calculated for estimation of daytime secretion and variation. Social support scores were negatively associated with daytime DHEA secretion (standardized partial regression coefficient = -0.343, P cortisol secretion was additionally adjusted. Social support was not associated with daytime variation of the C/D ratio. Significant association between social support and daytime cortisol secretion was not confirmed. Job strain was not associated with DHEA, cortisol or the C/D ratio. In summary, we found that daytime DHEA secretion was increased in healthy workers with low social support, perhaps independent of daytime cortisol secretion.
Full Text Available BACKGROUND: Increasing evidence demonstrates that motor-skill memories improve across a night of sleep, and that non-rapid eye movement (NREM sleep commonly plays a role in orchestrating these consolidation enhancements. Here we show the benefit of a daytime nap on motor memory consolidation and its relationship not simply with global sleep-stage measures, but unique characteristics of sleep spindles at regionally specific locations; mapping to the corresponding memory representation. METHODOLOGY/PRINCIPAL FINDINGS: Two groups of subjects trained on a motor-skill task using their left hand - a paradigm known to result in overnight plastic changes in the contralateral, right motor cortex. Both groups trained in the morning and were tested 8 hr later, with one group obtaining a 60-90 minute intervening midday nap, while the other group remained awake. At testing, subjects that did not nap showed no significant performance improvement, yet those that did nap expressed a highly significant consolidation enhancement. Within the nap group, the amount of offline improvement showed a significant correlation with the global measure of stage-2 NREM sleep. However, topographical sleep spindle analysis revealed more precise correlations. Specifically, when spindle activity at the central electrode of the non-learning hemisphere (left was subtracted from that in the learning hemisphere (right, representing the homeostatic difference following learning, strong positive relationships with offline memory improvement emerged-correlations that were not evident for either hemisphere alone. CONCLUSIONS/SIGNIFICANCE: These results demonstrate that motor memories are dynamically facilitated across daytime naps, enhancements that are uniquely associated with electrophysiological events expressed at local, anatomically discrete locations of the brain.
Shao, I-Hung; Wu, Chia-Chen; Hsu, Hueih-Shing; Chang, Shyh-Chyi; Wang, Hsu-Hsiang; Chuang, Heng-Chang; Tam, Yuan-Yun
Nocturia has been proven to have a negative impact on the quality of life and sleep quality in general elderly population. However, there are limited studies on the quantitative effect of nocturia on sleep quality and daytime dysfunction, specifically in patients with lower urinary tract symptoms. During March 1, 2015 to December 31, 2015, a total of 728 patients who visited our urology department due to voiding dysfunction and experienced nocturia at least once per night were enrolled. Three questionnaires were administered to them after obtaining their written consents. Pittsburgh Sleep Quality Index (PSQI) questionnaire, Epworth Sleepiness Scale (ESS) questionnaire, and International Prostate Symptom Score (IPSS) questionnaire were applied to evaluate their sleep quality, daytime dysfunction, and voiding problems, respectively. Statistical analysis of the impact of nocturia on sleep quality and daytime dysfunction was performed. The mean age of patients was 61 years, with a male-to-female ratio of 2.7. The mean nocturia number was 3.03. The IPSS, PSQI, and ESS scores were 17.56, 8.35, and 8.22, respectively. The nocturia number increased with age and was significantly correlated to ESS score (daytime dysfunction) and PSQI total score (sleep quality) in overall group. Among subgroups divided by age and sex, there was a significant correlation between nocturia number and daytime dysfunction in male patients or patients younger than 65 years. In patients with lower urinary tract symptoms, nocturia number increased with age and was significantly correlated with poor sleep quality. Nocturia plays an important role in patients younger than 65 years in daytime dysfunction.
Gander, Philippa H; Marshall, Nathaniel S; Harris, Ricci B; Reid, Papaarangi
To assess the role of sleep-related factors, ethnicity and socioeconomic deprivation in self-reported motor vehicle accidents while driving, after controlling for gender, age and driving exposure. Mail survey to a random electoral roll sample of 10,000 people aged 30-60 years, stratified by age decades and ethnicity (71% response rate). The analytical sample included 5,534 current drivers (21.6% Maori men, 21.2% Maori women, 30% non-Maori men, 27.2% non-Maori women). Multiple logistic regression analyses revealed the following independent risk factors for accident involvement while driving (last three years): being younger; higher average weekly driving hours; never/rarely getting enough sleep (OR=1.26, 95% CI 1.06-1.49); reporting any chance of dozing in a car while stopped in traffic (Epworth Sleepiness Scale question 8, OR=1.52, 95% CI 1.15-2.02); and among women, being non-Maori. Total Epworth score was not significantly related to reported accident involvement. Chronic sleep restriction, and any likelihood of dozing off at the wheel of a motor vehicle, were significant independent predictors of self-reported involvement in all types of motor vehicle accidents, not only those identified as fatigue-related. The Epworth Sleepiness Scale alone is not a reliable clinical tool for identifying individuals at higher risk of crashes. Factors relating to chronic sleepiness were as important as established demographic risk factors for self-reported motor vehicle accident involvement among 30-60 year-old drivers. The findings reinforce the need for multi-faceted campaigns to reduce sleepy driving.
Tanabe, Naohito; Iso, Hiroyasu; Seki, Nao; Suzuki, Hiroshi; Yatsuya, Hiroshi; Toyoshima, Hideaki; Tamakoshi, Akiko
Daytime napping is associated with elevated risk of all-cause mortality in the elderly. However, the association with cardiovascular disease (CVD) risk is inconsistent. From 1988 to 1990, a total of 67 129 Japanese non-workers or daytime workers (27 755 men and 39 374 women) aged 40-79 years, without a history of stroke, heart disease or cancer, completed a lifestyle questionnaire. They were followed for mortality until the end of 2003. During the 879 244 person-year follow-up, 9643 deaths (2852 from CVD, 3643 from cancer, 2392 from other internal causes, 738 from external causes and 18 from unspecified causes) were observed. After adjustment for possible confounders, subjects with a daytime napping habit had elevated hazard ratios (HRs) for mortality from all causes [HR 1.19, 95% confidence interval (CI) 1.14-1.24, P napping was diminished among overweight subjects, but pronounced in those with weight loss after age 20 years, with non-regular employment, with lower education level and with a follow-up period napping is associated with elevated risk of CVD mortality as well as non-cardiovascular/non-cancer and external deaths. Daytime napping may elevate risk of CVD death through some biological effects but, to a larger extent, some comorbid disorders causing weight loss or associated with non-regular employment and low education level could explain this association.
Filippo S. Giorgi
Full Text Available Our aim was to evaluate the EEG and clinical modifications induced by the new antiepileptic drug lacosamide (LCM in patients with epilepsy. We evaluated 10 patients affected by focal pharmacoresistant epilepsy in which LCM (mean 250 mg/day was added to the preexisting antiepileptic therapy, which was left unmodified. Morning waking EEG recording was performed before (t0 and at 6 months (t1 after starting LCM. At t0 and t1, patients were also administered questionnaires evaluating mood, anxiety, sleep, sleepiness, and fatigue (Beck Depression Inventory; State-Trait Anxiety Inventory Y1 and Y2; Pittsburgh Sleep Quality Index; Epworth Sleepiness Scale; Fatigue Severity Scale. We performed a quantitative analysis of EEG interictal abnormalities and background EEG power spectrum analysis. LCM as an add-on did not significantly affect anxiety, depression, sleepiness, sleep quality, and fatigue scales. Similarly, adding LCM to preexisting therapy did not modify significantly patient EEGs in terms of absolute power, relative power, mean frequency, and interictal abnormalities occurrence. In conclusion, in this small cohort of patients, we confirmed that LCM as an add-on does not affect subjective parameters which play a role, among others, in therapy tolerability, and our clinical impression was further supported by evaluation of EEG spectral analysis.
Phipps-Nelson, Jo; Redman, Jennifer R; Schlangen, Luc J M; Rajaratnam, Shantha M W
This study examined the effects of nocturnal exposure to dim, narrowband blue light (460 nm, approximately 1 lux, 2 microW/cm2), compared to dim broad spectrum (white) ambient light ( approximately 0.2 lux, 0.5 microW/cm2), on subjective and objective indices of sleepiness during prolonged nighttime performance testing. Participants were also exposed to a red light (640 nm, approximately 1 lux, 0.7 microW/cm2) placebo condition. Outcome measures were driving simulator and psychomotor vigilance task (PVT) performance, subjective sleepiness, salivary melatonin, and electroencephalographic (EEG) activity. The study had a repeated-measures design, with three counterbalanced light conditions and a four-week washout period between each condition. Participants (n = 8) maintained a regular sleep-wake schedule for 14 days prior to the approximately 14 h laboratory study, which consisted of habituation to light conditions followed by neurobehavioral performance testing from 21:00 to 08:30 h under modified constant-routine conditions. A neurobehavioral test battery (2.5 h) was presented four times between 21:00 and 08:30 h, with a 30 min break between each. From 23:30 to 05:30 h, participants were exposed to blue or red light, or remained in ambient conditions. Compared to ambient light exposure, blue light exposure suppressed EEG slow wave delta (1.0-4.5 Hz) and theta (4.5-8 Hz) activity and reduced the incidence of slow eye movements. PVT reaction times were significantly faster in the blue light condition, but driving simulator measures, subjective sleepiness, and salivary melatonin levels were not significantly affected by blue light. Red light exposure, as compared to ambient light exposure, reduced the incidence of slow eye movements. The results demonstrate that low-intensity, blue light exposure can promote alertness, as measured by some of the objective indices used in this study, during prolonged nighttime performance testing. Low intensity, blue light exposure has
Yousef Khalida; Basaleem Huda; Al-Sakkaf Khaled
Daytime urinary incontinence is an involuntary or intentional voiding of urine in an awake child who is old enough to have developed control, and has a variable prevalence throughout the world. In Yemen, data regarding this problem are almost absent. In this study from the capital city of Aden, we aimed to: (1) determine the prevalence of daytime incontinence in kindergarten children aged 4-6 years, (2) identify the relation between daytime enuresis with personal and family characte-ristics o...
Kraus, Ute; Breitner, Susanne; Hampel, Regina; Wolf, Kathrin; Cyrys, Josef; Geruschkat, Uta; Gu, Jianwei; Radon, Katja; Peters, Annette; Schneider, Alexandra
Numerous studies showed that chronic noise exposure modeled through noise mapping is associated with adverse health effects. However, knowledge about real individual noise exposure, emitted by several sources, is limited. To explain the variation in individual daytime noise exposure regarding different microenvironments, activities and individual characteristics. In a repeated measures study in Augsburg, Germany (March 2007-December 2008), 109 individuals participated in 305 individual noise measurements with a mean duration of 5.5h. Whereabouts and activities were recorded in a diary. One-minute averages of A-weighted equivalent continuous sound pressure levels (Leq) were determined. We used mixed additive models to elucidate the variation of Leq by diary-based information, baseline characteristics and time-invariant variables like long-term noise exposure. Overall noise levels were highly variable (median: 64 dB(A); range: 37-105 dB(A)). Highest noise levels were measured in traffic during bicycling (69 dB(A); 49-97 dB(A)) and lowest while resting at home (54 dB(A); 37-94 dB(A)). Nearly all diary-based information as well as physical activity, sex and age-group had significant influences on individual noise. In an additional analysis restricted to times spent at the residences, long-term noise exposure did not improve the model fit. Individual exposures to day-time noise were moderate to high and showed high variations in different microenvironments except when being in traffic. Individual noise levels were greatly determined by personal activities but also seemed to depend on environmental noise levels. Copyright © 2015 Elsevier Inc. All rights reserved.
Hansen, Isabella P; Langhorn, Leanne; Dreyer, Pia
Sleep is essential to the recovery of patients in the intensive care unit. Patients in the intensive care unit frequently experience poor sleep, characterized by sleep deprivation, sleep fragmentation and abnormal sleep architecture. Factors affecting sleep are multifactorial. To investigate the effects of music on self-reported quality of sleep during daytime rest among patients in the intensive care unit. A randomized controlled trial. The study was conducted between February and April 2016 in two Danish multidisciplinary intensive care units. The study sample consisted of 37 patients (19 in the control group and 18 in the intervention group) who complied with the criteria of inclusion for the study. Patients were randomly assigned to either an intervention group or a control group. The intervention group listened to music for 30 min during daytime rest while the control group rested without music. The Richards-Campbell Sleep Questionnaire was used to measure the subjective quality of sleep. Significant differences in the mean scores of the subjective quality of sleep were found between the intervention group and the control group (p music during daytime rest improves subjective sleep in patients in the intensive care unit. Furthermore, there are indications that listening to music reduces the subjective experience of noise in some patients. The result of this study implies that music can be an effective practice for nurses to improve sleep among patients in the intensive care unit. © 2017 British Association of Critical Care Nurses.
Härmä, M; Knauth, P; Ilmarinen, J
Daytime napping and its effects on 145 female shiftworkers were studied by comparing the individual characteristics, alertness, and short-term memory performance of subjects who took or did not take naps. Of the subjects 56% (n = 82) took a nap before a night shift and 21% (n = 30) after a morning shift. After a morning shift, napping was more frequent among evening types and subjects living alone (not married). Before a night shift, daytime napping was not connected to individual characteristics, but the total sleep time of nappers during the preceding night was shorter than that of non-nappers. At 10.00 and at 04.00-08.00, at the end of the night shift, nappers were significantly more alert than subjects who had not taken naps. The length and timing of the daytime nap did not correlate to either alertness or performance during the following night. In a questionnaire, nappers before a night shift had less sleep disturbances than non-nappers.
In Australia, approximately 20% of motor vehicle collisions result from fatigue or sleepiness-related driving, making it one of the most common causes of preventable motor vehicle crashes (MVC). The shift working population is found to be overrepresented in sleepiness-related vehicle crashes due to the effect of circadian misalignment and sleep loss, resulting in excessive sleepiness and neurobehavioural performance decline during waking hours. It is therefore essential that effective counter...
Bro, Della; O'Hara, Ruth; Primeau, Michelle; Hanson-Kahn, Andrea; Hallmayer, Joachim; Bernstein, Jonathan A
The aims of this study were to document sleep disturbances in individuals with Phelan-McDermid syndrome (PMS), to assess whether these individuals had been evaluated for sleep disorders, and to examine relationships between the sleep behavior of these individuals and the sleep behavior and daytime functioning of their caregivers. Participants were 193 caregivers of individuals with PMS recruited by the Phelan-McDermid Syndrome Foundation. Data were collected through a survey comprising 2 questionnaires: the Children's Sleep Habits Questionnaire (CSHQ) and the Parents' Sleep Habits Questionnaire. Data were analyzed using multiple linear regression analyses, Pearson correlation analyses, and independent-samples t-tests. Ninety percent of individuals with PMS showed evidence of marked sleep disturbance based on caregiver responses to the CSHQ. However, only 22% of individuals had undergone a formal sleep assessment. Reported increased sleep disturbance in individuals with PMS was a statistically significant predictor of reported increased sleep disturbance and daytime sleepiness in their caregivers. Sleep disturbance may be present in a substantial proportion of individuals with PMS and is negatively associated with caregivers' well-being. However, most individuals with PMS have not been evaluated for sleep disorders. When properly diagnosed, many sleep disorders can be alleviated with intervention. Thus, routine screening for and evaluation of sleep disturbances in individuals with PMS may have long-term positive impacts on the well-being of these individuals and their caregivers.
Poirier, Abbey; Gendron, Melissa; Vriend, Jennifer; Davidson, Fiona; Corkum, Penny
The current study investigated the link between poor sleep and ADHD symptomatology. The effects of extending versus restricting sleep on subjective (questionnaires) and objective (actigraphy) measures of daytime movement were examined in 25 typically developing children aged 8-12 years. Subjective measures demonstrated an increase in ADHD symptomology following sleep restriction, with follow-up analyses indicating that findings were due to poorer attention, not changes in hyperactivity. The results of actigraphy data indicated that there were no differences found for mean or median daytime activity, but the standard deviation of activity was found to be significantly higher following sleep restriction. Contrary to the popular belief that sleep restriction results in increased overall activity, this study instead found an increase in variability of activity. This suggests that a sleep-restricted child's activity level may appear as alternating periods of high and low activity levels throughout the day.
... 47 Telecommunication 4 2010-10-01 2010-10-01 false Limitation on daytime radiation. 73.187 Section... BROADCAST SERVICES AM Broadcast Stations § 73.187 Limitation on daytime radiation. (a)(1) Except as..., subsequent changes of facilities which do not involve a change in frequency, an increase in radiation toward...
Theadom, Alice; Cropley, Mark; Kantermann, Thomas
Background: Previous qualitative research has revealed that people with fibromyalgia use daytime napping as a coping strategy for managing symptoms against clinical advice. Yet there is no evidence to suggest whether daytime napping is beneficial or detrimental for people with fibromyalgia. The
Gander, Philippa; van den Berg, Margo; Signal, Leigh
Seafaring is a hazardous occupation with high death and injury rates, but the role of seafarer fatigue in these events is generally not well documented. The International Maritime Organization has identified seafarer fatigue as an important health and safety issue. Most research to date has focused on more regularly scheduled types of operations (e.g., merchant vessels, ferries), but there is relatively little information on commercial fishing, which often involves high day-to-day and seasonal variability in work patterns and workload. The present study was designed to monitor the sleep and sleepiness of commercial fishermen at home and during extended periods at sea during the peak of the hoki fishing season, with a view to developing better fatigue management strategies for this workforce. Sleep (wrist actigraphy and sleep diaries) and sleepiness (Karolinska Sleepiness Scale [KSS] before and after each sleep period) of 20 deckhands were monitored for 4-13 days at home and for 5-9 days at sea while working a nominal 12 h on/6 h off schedule. On the 12 h on/6 hoff schedule, there was still a clear preference for sleep at night. Comparing the last three days at home and the first three days at sea showed that fishermen were more likely to have split sleep at sea (Wilcoxon signed ranks p or= 7 on 24% of days at sea vs. 9% of days at home (Wilcoxon signed ranks p fishing season increases the risk of performance impairment due to greater cumulative sleep loss than would be expected on typical three-day trips. Key fatigue management strategies in this environment include that fishermen report to work as well rested as possible. Once at sea, the day-to-day variability in activities due to uncontrollable factors, such as fishing success, repairing gear, and weather conditions, mean that contingency planning is required for managing situations where the entire crew have experienced long periods of intensive work with minimum recovery opportunities.
Full Text Available Daytime urinary incontinence is an involuntary or intentional voiding of urine in an awake child who is old enough to have developed control, and has a variable prevalence throughout the world. In Yemen, data regarding this problem are almost absent. In this study from the capital city of Aden, we aimed to: (1 determine the prevalence of daytime incontinence in kindergarten children aged 4-6 years, (2 identify the relation between daytime enuresis with personal and family characte-ristics of the children studied, and (3 describe the severity and characteristics of daytime enuresis in the studied children. A cross-sectional comparative study was undertaken in all kindergarten children aged 4-6 years in Aden Governorate and 1061 responded. Data were obtained by using a precoded self-administered questionnaire completed by the parents. The questionnaire consisted of two parts: personal and family characteristics of the studied children and the presence of daytime incontinence. The second part was responded if there was history of daytime incontinence, and contained information on the severity and possible associated factors. Daytime incontinence was encountered in 34 cases (3.2%; 18 were females. Significant differences between cases and incontinence-free children were encountered in birth order and type of kindergarten (P < 0.05. Majority (85.3% had severe form of daytime incontinence. Bed wetting and combined day and night wetting were more frequent among males, whereas urinary symptoms (urgency, squatting, dysuria, dribbling were more frequent among females. Working mother and frightening and emotionally stressful events in the 6 months preceding the study were significantly associated with daytime incontinence, while parents′ education, punish-ment for daytime incontinence, and the presence of family history of incontinence were insignificant. In conclusion, this is the first study from Yemen reporting the prevalence of enuresis, similar to
Sadeghniiat-Haghighi, Khosro; Moller, Henry J; Saraei, Maryam; Aminian, Omid; Khajeh-Mehrizi, Ahmad
Traffic fatalities are a major cause of morbidity and mortality in Iran. Occupational sleep medicine field needs more cost-effective and applicable tests for screening purposes. This study reports on a pilot screening study for drowsy drivers in an urban Iranian sample of commercial drivers. The Maintenance of Wakefulness Test (MWT) measures the ability to remain awake objectively. Sleep latency in MWT is a reasonable predictor of driving simulator performance in drivers. In this study, we evaluate whether the Epworth Sleepiness Scale (ESS) and MWT are equally useful in drivers with possible Excessive Daytime Sleepiness (EDS). 46 consecutive road truck drivers in a transportation terminal entered into this study. The ESS score of patients with normal and abnormal MWT was 3.24±2.4 and 4.08±3 respectively which was not significantly differenced (P value = 0.34). No significant correlation was found between the ESS and sleep latency in MWT (r=-0.28, 95%CI= -0.58 to 0.02). By using the receiver operating characteristic analysis, the area under the curve was found to be 0.57 (95% confidence interval = 0.37- 0.77) which is not statistically acceptable (P value=0.46). Our finding showed that the MWT and ESS do not measure the same parameter.
Full Text Available Traffic fatalities are a major cause of morbidity and mortality in Iran. Occupational sleep medicine field needs more cost-effective and applicable tests for screening purposes. This study reports on a pilot screening study for drowsy drivers in an urban Iranian sample of commercial drivers. The Maintenance of Wakefulness Test (MWT measures the ability to remain awake objectively. Sleep latency in MWT is a reasonable predictor of driving simulator performance in drivers. In this study, we evaluate whether the Epworth Sleepiness Scale (ESS and MWT are equally useful in drivers with possible Excessive Daytime Sleepiness (EDS. 46 consecutive road truck drivers in a transportation terminal entered into this study. The ESS score of patients with normal and abnormal MWT was 3.24±2.4 and 4.08±3 respectively which was not significantly differenced (P value = 0.34. No significant correlation was found between the ESS and sleep latency in MWT (r=-0.28, 95%CI= -0.58 to 0.02. By using the receiver operating characteristic analysis, the area under the curve was found to be 0.57 (95% confidence interval = 0.37- 0.77 which is not statistically acceptable (P value=0.46. Our finding showed that the MWT and ESS do not measure the same parameter.
Harrison, Elizabeth M; Gorman, Michael R; Mednick, Sara C
Naps frequently take place during the daytime under some ambient light. People are commonly advised to wear eyeshades, or use black-out curtains while sleeping, as light is thought to inhibit sleep. Little is known, however, about how light during daytime sleep may affect the quality or architecture of that sleep. The present within-subjects design administered green narrowband light via light masks to 17 young adults (23.2 ± 4.7 years) during four 90-minute afternoon naps. Subjects were exposed to each of four light conditions that approximate the intensity of 1) physiological darkness (~0 lx), 2) moonlight (~1 lx), 3) typical indoor lighting (~80 lx) and 4) indirect outdoor light (~6400 lx). All subjects were able to sleep in all lighting conditions, with no differences in sleep quality or architecture. Power analysis revealed sufficient power to detect meaningful differences. Sleep inertia measured upon waking showed a general effect of the nap, independent of condition. Although light has various alerting effects at night, 500 nm LED light presented via light mask does not appear to inhibit daytime sleep. The finding that this light had no effect on the ability of individuals to fall asleep or stay asleep during an afternoon nap may inform decisions regarding the use of the nap as a facilitator of schedule adjustment, and challenges the assumption of light as a barrier to napping. Copyright © 2011 Elsevier Inc. All rights reserved.
Shen, Yeru; Zhang, Mengmeng; Wang, Yu; Wang, Lanlan; Xu, Xiangjun; Xiao, Gairong; Chen, Jing; Zhang, Ting; Zhou, Nong
As well as being a very common neurological disease worldwide, epilepsy significantly impairs patients' emotional, behavioral, and cognitive functioning. Sleep disturbances are the most frequent complaint in patients with epilepsy. The present study assesses the impact of a range of affective symptoms on subjective sleep quality and sleep disturbances in Chinese adults with epilepsy. Adults with epilepsy who visited our epilepsy clinic from July 2015 to March 2016 were enrolled in our study. Both patients and healthy controls completed the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and Mini-mental State Examination (MMSE). Subjective sleep quality and sleep disturbances were examined with regard to self-reported symptoms of depression and anxiety, seizure-related factors, and demographic factors. The PSQI scores and ISI scores of patients were significantly higher (indicating lower quality sleep and more serious insomnia) than those of the control group. Symptoms associated with depression and anxiety were independently related to impaired subjective sleep quality and insomnia. Affective symptoms explained more of the variance in PSQI scores and ISI scores than did seizure-related or demographic variables. In addition, these variables also seemed to be less powerful contributing factors to subjective sleep quality and insomnia than affective symptoms, several seizure-related factors, such as seizure control, partial seizures and duration of epilepsy, which are also significantly associated with subjective sleep quality and insomnia. In addition, use of lamotrigine (LTG) was also associated with insomnia and use of clonazepam (CZP) and phenobarbital (PB) with daytime sleepiness in patients with epilepsy. Chinese adults with epilepsy have poorer self-reported subjective sleep quality and a higher prevalence of insomnia than the control group
Aim: Sleep problems are common in students with one third of university students reporting insufficient sleep. It is known that sleep quality and daytime sleepiness cause decrasing academic performans. For this reason we aimed to investigate the effects of a sleep hygiene education on sleep quality and academic performance of first year medical students. Material and Method: Self-reported sleep data and academic performance of 131 first grade medical students were collected. To all students e...
Teixeira, Liliane; Lowden, Arne; da Luz, Andrea Aparecida; Turte, Samantha Lemos; Valente, Daniel; Matsumura, Roberto Jun; de Paula, Leticia Pickersgill; Takara, Meire Yuri; Nagai-Manelli, Roberta; Fischer, Frida Marina
The double journey (work and study) may result or aggravate health problems, including sleep disturbances, as observed in previous studies with high school students. The aim of this study is to analyze the sleep-wake cycle and perceived sleepiness of working college students during weekdays. Twenty-three healthy college male students, 21-24 years old, working during the day and attending classes in the evening, participated in this study. During five consecutive days, the students filled out daily activities logs and wore actigraphs. Mean sleeping time was lower than 6 hours per night. No significant differences were observed in the sleep-wake cycle during the weekdays. The observed lack of changes in the sleepwake cycle of these college students might occur as participants were not on a free schedule, but exposed to social constraints, as was the regular attendance to evening college and day work activities. Sleepiness worsened over the evening school hours. Those results show the burden carried by College students who perform double activities - work and study.
Zhou, Junmin; Kessler, Asia Sikora; Su, Dejun
To explore the relationship between daytime napping and incidence of chronic diseases over the past 6 months among adults in China. Based on data collected from 13,469 respondents over age 40 in the Chinese Family Panel Studies in 2010, logistic regression models were estimated to examine the association between daytime napping and the incidence of any chronic diseases and 3 specific chronic diseases (hypertension, diabetes, and heart disease) after adjusting for confounders. Differences of risks by sex and age were also investigated. In the sample, 50.8% were women and 32.2% were over 60 years old. Adjusted estimates show respondents with daytime napping had elevated odds of developing any chronic diseases, hypertension, and diabetes compared to those who did not nap; having over 60 minutes of daytime napping had weaker association compared with shorter duration of daytime napping. The association between daytime napping and hypertension was found in women but not in men. Daytime napping appears to be associated with elevated risk of incidence of any chronic diseases, hypertension, and diabetes.
Theadom, Alice; Cropley, Mark; Kantermann, Thomas
Previous qualitative research has revealed that people with fibromyalgia use daytime napping as a coping strategy for managing symptoms against clinical advice. Yet there is no evidence to suggest whether daytime napping is beneficial or detrimental for people with fibromyalgia. The purpose of this study was to explore how people use daytime naps and to determine the links between daytime napping and symptom severity in fibromyalgia syndrome. A community based sample of 1044 adults who had been diagnosed with fibromyalgia syndrome by a clinician completed an online questionnaire. Associations between napping behavior, sleep quality and fibromyalgia symptoms were explored using Spearman correlations, with possible predictors of napping behaviour entered into a logistic regression model. Differences between participants who napped on a daily basis and those who napped less regularly, as well as nap duration were explored. Daytime napping was significantly associated with increased pain, depression, anxiety, fatigue, memory difficulties and sleep problems. Sleep problems and fatigue explained the greatest amount of variance in napping behaviour, p naps for >30 minutes had higher memory difficulties (t = -3.45) and levels of depression (t = -2.50) than those who napped for shorter periods (napping was linked with greater symptom severity in people with fibromyalgia. Given the common use of daytime napping in people with fibromyalgia evidence based guidelines on the use of daytime napping in people with chronic pain are urgently needed.
Müller, Matthias J; Olschinski, Christiane; Kundermann, Bernd; Cabanel, Nicole
Sleep complaints and sleep disturbances are common in depression; however, the association of sleep duration and subjective sleep quality has been rarely investigated. Thus, subjective sleep quality and sleep duration were analyzed in depressed inpatients. Questionnaire data comprising clinical and sleep-related questions were sampled over a one-year period from adult inpatients with depressive syndromes. Sleep duration and items related to sleep quality were analyzed by means of group comparisons (sleep duration categories) and correlation analyses. Data of 154 patients (age 58.2±17.0 years, 63.6% women) were analyzed. Mean sleep duration was 7.2±2.1 h (16.9% of patients were below and 7.1% above age-specific recommendations), 25-40% of patients reported almost always daytime sleepiness, non-restorative sleep, attention deficits, or memory complaints with significant correlations between all variables (Pdepression, and both were associated with poor sleep quality and subjectively impaired cognitive functions. Clinicians should be aware of these relationships. During hospitalization, a more individualized sleep-wake schedule should be applied. Copyright © 2016 Elsevier Inc. All rights reserved.
Yousef, Khalida Anwer; Basaleem, Huda Omer; Al-Sakkaf, Khaled Abdulla Zain
Daytime urinary incontinence is an involuntary or intentional voiding of urine in an awake child who is old enough to have developed control, and has a variable prevalence throughout the world. In Yemen, data regarding this problem are almost absent. In this study from the capital city of Aden, we aimed to: (1) determine the prevalence of daytime incontinence in kindergarten children aged 4-6 years, (2) identify the relation between daytime enuresis with personal and family characteristics of the children studied, and (3) describe the severity and characteristics of daytime enuresis in the studied children. A cross-sectional comparative study was undertaken in all kindergarten children aged 4-6 years in Aden Governorate and 1061 responded. Data were obtained by using a precoded self-administered questionnaire completed by the parents. The questionnaire consisted of two parts: personal and family characteristics of the studied children and the presence of daytime incontinence. The second part was responded if there was history of daytime incontinence, and contained information on the severity and possible associated factors. Daytime incontinence was encountered in 34 cases (3.2%); 18 were females. Significant differences between cases and incontinence-free children were encountered in birth order and type of kindergarten (P incontinence. Bed wetting and combined day and night wetting were more frequent among males, whereas urinary symptoms (urgency, squatting, dysuria, dribbling) were more frequent among females. Working mother and frightening and emotionally stressful events in the 6 months preceding the study were significantly associated with daytime incontinence, while parents' education, punishment for daytime incontinence, and the presence of family history of incontinence were insignificant. In conclusion, this is the first study from Yemen reporting the prevalence of enuresis, similar to previous reports. Further studies are needed to explore this problem in
Czeisler, Charles A.
Sleep disorders and sleep deficiency are important causes of adverse health effects and increased mortality in the United States and worldwide. Sleep deficiency can also result in myriad adverse behavioral consequences, including profound sleepiness, cognitive slowing, automatic behavior, attentional failures and performance degradation, errors, and accidents. It is important to recognize that sleepiness and sleep deficiency are not synonymous.
Bruhn, Dan; Mikkelsen, Teis Nørgaard; Herbst, Mathias
To understand what governs the patterns of net ecosystem exchange of CO2, an understanding of factors influencing the component fluxes, ecosystem respiration and gross primary production is needed. In the present paper, we introduce an alternative method for estimating daytime ecosystem respiration...... based on whole ecosystem fluxes from a linear regression of photosynthetic photon flux density data vs. daytime net ecosystem exchange data at forest ecosystem level. This method is based on the principles of the Kok-method applied at leaf level for estimating daytime respiration. We demonstrate...... the method with field data and provide a discussion of the limitations of the method....
Kidd, Sharon A.; Corbett, Blythe A.; Granger, Douglas A.; Boyce, W. Thomas; Anders, Thomas F.; Tager, Ira B.
We examined daytime salivary cortisol and salivary alpha-amylase (sAA) secretion levels and variability in preschool-aged children with autism (AUT) and typically developing children (TYP). Fifty-two subjects (26 AUT and 26 TYP) were enrolled. Salivary samples were obtained at waking, midday, and bedtime on two consecutive days at three phases…
Garde, Anne Helene; Hansen, Åse Marie; Hansen, Johnni
Sleep problems are common effects of shift work. The aim of the present study was to evaluate how different types of shift affect sleep and sleepiness, and to relate sleepiness to urinary 6-sulfatoxymelatonin....
Schreier, David R; Banks, Christina; Mathis, Johannes
Road traffic injuries are projected to be the leading cause of death for those aged between 15 and 29 years by the year 2030, and sleepiness is estimated to be the underlying cause in up to 15-20% of all motor vehicle accidents. Sleepiness at the wheel is most often caused by socially induced sleep deprivation or poor sleep hygiene in otherwise healthy individuals, medical disorders, or the intake of drugs. Validated methods for objectifying sleepiness are urgently sought, particularly in the context of driving. Based on the assumption that the identification and treatment of sleepiness, and its causes, may prevent motor vehicle accidents, driving simulators are a seemingly promising diagnostic tool. Despite the rising use of these in research, the reliability of their conclusions in healthy sleepy individuals and patients is still unclear. This systematic review aims to evaluate the practical value of driving simulators in a clinical environment when judging fitness to drive in sleepy individuals. From the 1674 records screened, 12 studies in sleepy individuals containing both simulated and real driving data were included. In general, simulated driving did not reliably predict real-life motor vehicle accidents, and especially not on an individual level, despite the moderate relationship between simulated and real-road test driving performance. The severity of sleepiness is most likely not the critical factor leading to motor vehicle accidents, but rather the perception of sleepiness. The self-perception of sleepiness related impairment, and risky behaviour while at the wheel should also be considered as key influencing factors. Copyright © 2017 Elsevier Ltd. All rights reserved.
Full Text Available We present a novel Smoothed Particle Hydrodynamics (SPH based algorithm for efficiently simulating compressible and weakly compressible particle fluids. Prior particle-based methods simulate all fluid pa