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Tankéré P, Taillard J, Armeni MA, Petitjean T, Berthomier C, Strauss M, Peter-Derex L. Revisiting the maintenance of wakefulness test: from intra-/inter-scorer agreement to normative values in patients treated for obstructive sleep apnea. J Sleep Res 2024; 33:e13961. [PMID: 37287324 DOI: 10.1111/jsr.13961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/06/2023] [Accepted: 05/20/2023] [Indexed: 06/09/2023]
Abstract
The Maintenance of Wakefulness Test is widely used to objectively assess sleepiness and make safety-related decisions, but its interpretation is subjective and normative values remain debated. Our work aimed to determine normative thresholds in non-subjectively sleepy patients with well-treated obstructive sleep apnea, and to assess intra- and inter-scorer variability. We included maintenance of wakefulness tests of 141 consecutive patients with treated obstructive sleep apnea (90% men, mean (SD) age 47.5 (9.2) years, mean (SD) pre-treatment apnea-hypopnea index of 43.8 (20.3) events/h). Sleep onset latencies were independently scored by two experts. Discordant scorings were reviewed to reach a consensus and half of the cohort was double-scored by each scorer. Intra- and inter-scorer variability was assessed using Cohen's kappa for 40, 33, and 19 min mean sleep latency thresholds. Consensual mean sleep latencies were compared between four groups according to subjective sleepiness (Epworth Sleepiness Scale score < versus ≥11) and residual apnea-hypopnea index (< versus ≥15 events/h). In well-treated non-sleepy patients (n = 76), the consensual mean (SD) sleep latency was 38.4 (4.2) min (lower normal limit [mean - 2SD] = 30 min), and 80% of them did not fall asleep. Intra-scorer agreement on mean sleep latency was high but inter-scorer was only fair (Cohen's kappa 0.54 for 33-min threshold, 0.27 for 19-min threshold), resulting in changes in latency category in 4%-12% of patients. A higher sleepiness score but not the residual apnea-hypopnea index was significantly associated with a lower mean sleep latency. Our findings suggest a higher than usually accepted normative threshold (30 min) in this context and emphasise the need for more reproducible scoring approaches.
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Affiliation(s)
- Pierre Tankéré
- Reference Center for Rare Pulmonary Diseases, Pulmonary Medicine and Intensive Care Unit, Dijon University Hospital, Dijon, France
- Center for Sleep Medicine and Respiratory Disease, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jacques Taillard
- Sommeil, Addiction et Neuropsychiatrie, Université de Bordeaux, SANPSY, USR 3413, Bordeaux, France
- CNRS, SANPSY, USR 3413, Bordeaux, France
| | - Marc-Antoine Armeni
- Center for Sleep Medicine and Respiratory Disease, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Thierry Petitjean
- Center for Sleep Medicine and Respiratory Disease, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | | | - Mélanie Strauss
- Hôpital Universitaire de Bruxelles, Site Erasme, Services de Neurologie, Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles, Brussels, Belgium
- Neuropsychology and Functional Imaging Research Group (UR2NF), Center for Research in Cognition and Neurosciences and ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Laure Peter-Derex
- Center for Sleep Medicine and Respiratory Disease, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
- Lyon Neuroscience Research Center, PAM Team, INSERM U1028, CNRS UMR 5292, Lyon, France
- Claude Bernard Lyon 1 University, Lyon, France
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Howarth T, Tashakori M, Karhu T, Rusanen M, Pitkänen H, Oksenberg A, Nikkonen S. Excessive daytime sleepiness is associated with relative delta frequency power among patients with mild OSA. Front Neurol 2024; 15:1367860. [PMID: 38645747 PMCID: PMC11026663 DOI: 10.3389/fneur.2024.1367860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/07/2024] [Indexed: 04/23/2024] Open
Abstract
Background Excessive daytime sleepiness (EDS) is a cause of low quality of life among obstructive sleep apnoea (OSA) patients. Current methods of assessing and predicting EDS are limited due to time constraints or differences in subjective experience and scoring. Electroencephalogram (EEG) power spectral densities (PSDs) have shown differences between OSA and non-OSA patients, and fatigued and non-fatigued patients. Therefore, polysomnographic EEG PSDs may be useful to assess the extent of EDS among patients with OSA. Methods Patients presenting to Israel Loewenstein hospital reporting daytime sleepiness who recorded mild OSA on polysomnography and undertook a multiple sleep latency test. Alpha, beta, and delta relative powers were assessed between patients categorized as non-sleepy (mean sleep latency (MSL) ≥10 min) and sleepy (MSL <10 min). Results 139 patients (74% male) were included for analysis. 73 (53%) were categorized as sleepy (median MSL 6.5 min). There were no significant differences in demographics or polysomnographic parameters between sleepy and non-sleepy groups. In multivariate analysis, increasing relative delta frequency power was associated with increased odds of sleepiness (OR 1.025 (95% CI 1.024-1.026)), while relative alpha and beta powers were associated with decreased odds. The effect size of delta PSD on sleepiness was significantly greater than that of either alpha or beta frequencies. Conclusion Delta PSD during polysomnography is significantly associated with a greater degree of objective daytime sleepiness among patients with mild OSA. Further research is needed to corroborate our findings and identify the direction of potential causal correlation between delta PSD and EDS.
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Affiliation(s)
- Timothy Howarth
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, NT, Australia
- College of Health and Human Sciences, Charles Darwin University, Darwin, NT, Australia
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Masoumeh Tashakori
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Tuomas Karhu
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Matias Rusanen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
- HP2 Laboratory, INSERM U1300, Grenoble Alpes University, Grenoble Alpes University Hospital, Grenoble, France
| | - Henna Pitkänen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Arie Oksenberg
- Sleep Disorders Unit, Loewenstein Hospital – Rehabilitation Center, Ra’anana, Israel
| | - Sami Nikkonen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
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Lacaux C, Strauss M, Bekinschtein TA, Oudiette D. Embracing sleep-onset complexity. Trends Neurosci 2024; 47:273-288. [PMID: 38519370 DOI: 10.1016/j.tins.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/17/2024] [Accepted: 02/07/2024] [Indexed: 03/24/2024]
Abstract
Sleep is crucial for many vital functions and has been extensively studied. By contrast, the sleep-onset period (SOP), often portrayed as a mere prelude to sleep, has been largely overlooked and remains poorly characterized. Recent findings, however, have reignited interest in this transitional period and have shed light on its neural mechanisms, cognitive dynamics, and clinical implications. This review synthesizes the existing knowledge about the SOP in humans. We first examine the current definition of the SOP and its limits, and consider the dynamic and complex electrophysiological changes that accompany the descent to sleep. We then describe the interplay between internal and external processing during the wake-to-sleep transition. Finally, we discuss the putative cognitive benefits of the SOP and identify novel directions to better diagnose sleep-onset disorders.
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Affiliation(s)
- Célia Lacaux
- Department of Basic Neurosciences, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Institut du Cerveau (Paris Brain Institute), Institut du Cerveau et de la Moelle Épinière (ICM), Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Sorbonne Université, Paris 75013, France.
| | - Mélanie Strauss
- Neuropsychology and Functional Neuroimaging Research Group (UR2NF), Center for Research in Cognition and Neurosciences (CRCN), Université Libre de Bruxelles, B-1050 Brussels, Belgium; Departments of Neurology, Psychiatry, and Sleep Medicine, Hôpital Universitaire de Bruxelles, Site Erasme, Université Libre de Bruxelles, B-1070 Brussels, Belgium
| | - Tristan A Bekinschtein
- Cambridge Consciousness and Cognition Laboratory, Department of Psychology, University of Cambridge, Cambridge CB2 3EB, UK
| | - Delphine Oudiette
- Institut du Cerveau (Paris Brain Institute), Institut du Cerveau et de la Moelle Épinière (ICM), Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Sorbonne Université, Paris 75013, France; Assistance Publique - Hopitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Service des Pathologies du Sommeil, National Reference Centre for Narcolepsy, Paris 75013, France.
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Andrillon T, Taillard J, Strauss M. Sleepiness and the transition from wakefulness to sleep. Neurophysiol Clin 2024; 54:102954. [PMID: 38460284 DOI: 10.1016/j.neucli.2024.102954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 03/11/2024] Open
Abstract
The transition from wakefulness to sleep is a progressive process that is reflected in the gradual loss of responsiveness, an alteration of cognitive functions, and a drastic shift in brain dynamics. These changes do not occur all at once. The sleep onset period (SOP) refers here to this period of transition between wakefulness and sleep. For example, although transitions of brain activity at sleep onset can occur within seconds in a given brain region, these changes occur at different time points across the brain, resulting in a SOP that can last several minutes. Likewise, the transition to sleep impacts cognitive and behavioral levels in a graded and staged fashion. It is often accompanied and preceded by a sensation of drowsiness and the subjective feeling of a need for sleep, also associated with specific physiological and behavioral signatures. To better characterize fluctuations in vigilance and the SOP, a multidimensional approach is thus warranted. Such a multidimensional approach could mitigate important limitations in the current classification of sleep, leading ultimately to better diagnoses and treatments of individuals with sleep and/or vigilance disorders. These insights could also be translated in real-life settings to either facilitate sleep onset in individuals with sleep difficulties or, on the contrary, prevent or control inappropriate sleep onsets.
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Affiliation(s)
- Thomas Andrillon
- Paris Brain Institute, Sorbonne Université, Inserm-CNRS, Paris 75013, France; Monash Centre for Consciousness & Contemplative Studies, Monash University, Melbourne, VIC 3800, Australia
| | - Jacques Taillard
- Univ. Bordeaux, CNRS, SANPSY, UMR 6033, F-33000 Bordeaux, France
| | - Mélanie Strauss
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), CUB Hôpital Érasme, Services de Neurologie, Psychiatrie et Laboratoire du sommeil, Route de Lennik 808 1070 Bruxelles, Belgium; Neuropsychology and Functional Neuroimaging Research Group (UR2NF), Center for Research in Cognition and Neurosciences (CRCN), Université Libre de Bruxelles, B-1050 Brussels, Belgium.
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Jeppe K, Ftouni S, Nijagal B, Grant LK, Lockley SW, Rajaratnam SMW, Phillips AJK, McConville MJ, Tull D, Anderson C. Accurate detection of acute sleep deprivation using a metabolomic biomarker-A machine learning approach. SCIENCE ADVANCES 2024; 10:eadj6834. [PMID: 38457492 PMCID: PMC11094653 DOI: 10.1126/sciadv.adj6834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/02/2024] [Indexed: 03/10/2024]
Abstract
Sleep deprivation enhances risk for serious injury and fatality on the roads and in workplaces. To facilitate future management of these risks through advanced detection, we developed and validated a metabolomic biomarker of sleep deprivation in healthy, young participants, across three experiments. Bi-hourly plasma samples from 2 × 40-hour extended wake protocols (for train/test models) and 1 × 40-hour protocol with an 8-hour overnight sleep interval were analyzed by untargeted liquid chromatography-mass spectrometry. Using a knowledge-based machine learning approach, five consistently important variables were used to build predictive models. Sleep deprivation (24 to 38 hours awake) was predicted accurately in classification models [versus well-rested (0 to 16 hours)] (accuracy = 94.7%/AUC 99.2%, 79.3%/AUC 89.1%) and to a lesser extent in regression (R2 = 86.1 and 47.8%) models for within- and between-participant models, respectively. Metabolites were identified for replicability/future deployment. This approach for detecting acute sleep deprivation offers potential to reduce accidents through "fitness for duty" or "post-accident analysis" assessments.
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Affiliation(s)
- Katherine Jeppe
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Australia
| | - Suzanne Ftouni
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Australia
| | - Brunda Nijagal
- Metabolomics Australia, Bio21 Molecular Science and Biotechnology Institute, Parkville, Australia
| | - Leilah K. Grant
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Australia
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Steven W. Lockley
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Australia
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Shantha M. W. Rajaratnam
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Australia
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Andrew J. K. Phillips
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Malcolm J. McConville
- Metabolomics Australia, Bio21 Molecular Science and Biotechnology Institute, Parkville, Australia
| | - Dedreia Tull
- Metabolomics Australia, Bio21 Molecular Science and Biotechnology Institute, Parkville, Australia
| | - Clare Anderson
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Australia
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Edgbaston, UK
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Goel R, Tiwari G, Varghese M, Bhalla K, Agrawal G, Saini G, Jha A, John D, Saran A, White H, Mohan D. Effectiveness of road safety interventions: An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1367. [PMID: 38188231 PMCID: PMC10765170 DOI: 10.1002/cl2.1367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Background Road Traffic injuries (RTI) are among the top ten leading causes of death in the world resulting in 1.35 million deaths every year, about 93% of which occur in low- and middle-income countries (LMICs). Despite several global resolutions to reduce traffic injuries, they have continued to grow in many countries. Many high-income countries have successfully reduced RTI by using a public health approach and implementing evidence-based interventions. As many LMICs develop their highway infrastructure, adopting a similar scientific approach towards road safety is crucial. The evidence also needs to be evaluated to assess external validity because measures that have worked in high-income countries may not translate equally well to other contexts. An evidence gap map for RTI is the first step towards understanding what evidence is available, from where, and the key gaps in knowledge. Objectives The objective of this evidence gap map (EGM) is to identify existing evidence from all effectiveness studies and systematic reviews related to road safety interventions. In addition, the EGM identifies gaps in evidence where new primary studies and systematic reviews could add value. This will help direct future research and discussions based on systematic evidence towards the approaches and interventions which are most effective in the road safety sector. This could enable the generation of evidence for informing policy at global, regional or national levels. Search Methods The EGM includes systematic reviews and impact evaluations assessing the effect of interventions for RTI reported in academic databases, organization websites, and grey literature sources. The studies were searched up to December 2019. Selection Criteria The interventions were divided into five broad categories: (a) human factors (e.g., enforcement or road user education), (b) road design, infrastructure and traffic control, (c) legal and institutional framework, (d) post-crash pre-hospital care, and (e) vehicle factors (except car design for occupant protection) and protective devices. Included studies reported two primary outcomes: fatal crashes and non-fatal injury crashes; and four intermediate outcomes: change in use of seat belts, change in use of helmets, change in speed, and change in alcohol/drug use. Studies were excluded if they did not report injury or fatality as one of the outcomes. Data Collection and Analysis The EGM is presented in the form of a matrix with two primary dimensions: interventions (rows) and outcomes (columns). Additional dimensions are country income groups, region, quality level for systematic reviews, type of study design used (e.g., case-control), type of road user studied (e.g., pedestrian, cyclists), age groups, and road type. The EGM is available online where the matrix of interventions and outcomes can be filtered by one or more dimensions. The webpage includes a bibliography of the selected studies and titles and abstracts available for preview. Quality appraisal for systematic reviews was conducted using a critical appraisal tool for systematic reviews, AMSTAR 2. Main Results The EGM identified 1859 studies of which 322 were systematic reviews, 7 were protocol studies and 1530 were impact evaluations. Some studies included more than one intervention, outcome, study method, or study region. The studies were distributed among intervention categories as: human factors (n = 771), road design, infrastructure and traffic control (n = 661), legal and institutional framework (n = 424), post-crash pre-hospital care (n = 118) and vehicle factors and protective devices (n = 111). Fatal crashes as outcomes were reported in 1414 records and non-fatal injury crashes in 1252 records. Among the four intermediate outcomes, speed was most commonly reported (n = 298) followed by alcohol (n = 206), use of seatbelts (n = 167), and use of helmets (n = 66). Ninety-six percent of the studies were reported from high-income countries (HIC), 4.5% from upper-middle-income countries, and only 1.4% from lower-middle and low-income countries. There were 25 systematic reviews of high quality, 4 of moderate quality, and 293 of low quality. Authors' Conclusions The EGM shows that the distribution of available road safety evidence is skewed across the world. A vast majority of the literature is from HICs. In contrast, only a small fraction of the literature reports on the many LMICs that are fast expanding their road infrastructure, experiencing rapid changes in traffic patterns, and witnessing growth in road injuries. This bias in literature explains why many interventions that are of high importance in the context of LMICs remain poorly studied. Besides, many interventions that have been tested only in HICs may not work equally effectively in LMICs. Another important finding was that a large majority of systematic reviews are of low quality. The scarcity of evidence on many important interventions and lack of good quality evidence-synthesis have significant implications for future road safety research and practice in LMICs. The EGM presented here will help identify priority areas for researchers, while directing practitioners and policy makers towards proven interventions.
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Affiliation(s)
- Rahul Goel
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | - Geetam Tiwari
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | | | - Kavi Bhalla
- Department of Public Health SciencesUniversity of ChicagoChicagoIllinoisUSA
| | - Girish Agrawal
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | | | - Abhaya Jha
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | - Denny John
- Faculty of Life and Allied Health SciencesM S Ramaiah University of Applied Sciences, BangaloreKarnatakaIndia
| | | | | | - Dinesh Mohan
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
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Jiang M, Chaichanasittikarn O, Seet M, Ng D, Vyas R, Saini G, Dragomir A. Modulating Driver Alertness via Ambient Olfactory Stimulation: A Wearable Electroencephalography Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:1203. [PMID: 38400361 PMCID: PMC10892239 DOI: 10.3390/s24041203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024]
Abstract
Poor alertness levels and related changes in cognitive efficiency are common when performing monotonous tasks such as extended driving. Recent studies have investigated driver alertness decrement and possible strategies for modulating alertness with the goal of improving reaction times to safety critical events. However, most studies rely on subjective measures in assessing alertness changes, while the use of olfactory stimuli, which are known to be strong modulators of cognitive states, has not been commensurately explored in driving alertness settings. To address this gap, in the present study we investigated the effectiveness of olfactory stimuli in modulating the alertness state of drivers and explored the utility of electroencephalography (EEG) in developing objective brain-based tools for assessing the resulting changes in cortical activity. Olfactory stimulation induced a significant differential effect on braking reaction time. The corresponding effect to the cortical activity was characterized using EEG-derived metrics and the devised machine learning framework yielded a high discriminating accuracy (92.1%). Furthermore, neural activity in the alpha frequency band was found to be significantly associated with the observed drivers' behavioral changes. Overall, our results demonstrate the potential of olfactory stimuli to modulate the alertness state and the efficiency of EEG in objectively assessing the resulting cognitive changes.
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Affiliation(s)
- Mengting Jiang
- N.1 Institute for Health, National University of Singapore, 28 Medical Drive, #05-COR, Singapore 117456, Singapore
- Laboratoire des Systèmes Perceptifs, Département d’Études Cognitives, École Normale Supérieure, PSL University, CNRS, 75005 Paris, France
| | - Oranatt Chaichanasittikarn
- N.1 Institute for Health, National University of Singapore, 28 Medical Drive, #05-COR, Singapore 117456, Singapore
| | - Manuel Seet
- N.1 Institute for Health, National University of Singapore, 28 Medical Drive, #05-COR, Singapore 117456, Singapore
| | - Desmond Ng
- International Operations, Procter & Gamble, 70 Biopolis Street, Singapore 138547, Singapore
| | - Rahul Vyas
- International Operations, Procter & Gamble, 70 Biopolis Street, Singapore 138547, Singapore
| | - Gaurav Saini
- International Operations, Procter & Gamble, 70 Biopolis Street, Singapore 138547, Singapore
| | - Andrei Dragomir
- N.1 Institute for Health, National University of Singapore, 28 Medical Drive, #05-COR, Singapore 117456, Singapore
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Alqurashi YD, Alqarni AS, Albukhamsin FM, Alfaris AA, Alhassan BI, Ghazwani WK, Altammar AA, Aleid ME, Almutary H, Aldhahir AM, Alessy SA, Almusally R, Alsaid A, Mahmoud MI, Qutub HO, Sebastian T, Alghnam S, Polkey MI. Gender Differences in Prevalence of Sleepy Driving Among Young Drivers in Saudi Arabia. Nat Sci Sleep 2024; 16:53-62. [PMID: 38322016 PMCID: PMC10844006 DOI: 10.2147/nss.s439161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/05/2024] [Indexed: 02/08/2024] Open
Abstract
Introduction Sleepy driving is associated with Motor Vehicles Accidents (MVAs). In Saudi Arabia, previous studies have addressed this association among men only. Therefore, the aim of this study was to compare the prevalence of sleepy driving and associated factors between genders. Methods In a cross-sectional study design, we offered a self-administered online questionnaire to 3272 participants from different regions of Saudi Arabia. The questionnaire included 46 questions covering sociodemographics, driving habits, sleeping habits, Epworth Sleepiness Scale, and Berlin questionnaire to assess the risk of sleep apnea. Univariable and multivariable logistic regression analyses were used to determine the significant factors associated with self-reported sleepy driving, defined as operating a motor vehicle while feeling sleepy in the preceding six months. Results Of the 3272 invitees, 2958 (90%) completed the questionnaire, of which 1414 (48%) were women. The prevalence of sleepy driving in the preceding six months was 42% (men: 50% and women 32%, p<0.001). Specifically, participants reported the following: 12% had had to stop their vehicle due to sleepiness (men: 16.2% and women 7%, p<0.001), 12.4% reported near-miss accidents (men: 16.2% and women: 8.2%, p<0.001) and 4.2% reported an accident due to sleepiness (men: 4.3% and women: 4%, p=0.645). In multivariable analysis, being male, younger age, use of any type of medications, shift working, working more than 12 hours per day, driving duration of 3-5 hours per day, driving experience of more than 2 years, excessive daytime sleepiness and risk of having obstructive sleep apnea were all associated with increased likelihood of falling asleep while driving in the preceding 6 months. Conclusion Sleepy driving and MVA are prevalent in both gender but was higher in men. Future public health initiatives should particularly focus on men, since men reported a greater likelihood of both sleep-related MVA and "near miss" events.
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Affiliation(s)
- Yousef D Alqurashi
- Respiratory Care Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdullah S Alqarni
- Respiratory Care Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Faisal Maher Albukhamsin
- Respiratory Care Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdullah Abdulaziz Alfaris
- Respiratory Care Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Bader Ibrahim Alhassan
- Respiratory Care Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Waleed Khalid Ghazwani
- Respiratory Care Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdulaziz Abdulrahman Altammar
- Respiratory Care Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mutlaq Eid Aleid
- Respiratory Care Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hayfa Almutary
- Medical Surgical Nursing Department, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulelah M Aldhahir
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Saleh A Alessy
- Department of Public Health, College of Health Sciences, Saudi Electronic University, Jeddah, Saudi Arabia
| | - Rayyan Almusally
- Internal Medicine Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Abir Alsaid
- Internal Medicine Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Mahmoud Ibrahim Mahmoud
- Internal Medicine Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Hatem Othman Qutub
- Internal Medicine Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Tunny Sebastian
- Clinical Nutrition Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Suliman Alghnam
- Population Health Section-King Abdullah International Medical Research Center (KAIMRC), King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| | - Michael I Polkey
- Royal Brompton Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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Fernandes GL, Tufik S, Andersen ML. Emergence of different dimensions of sleepiness in a general population sample: An EPISONO study. Sleep Med 2023; 112:46-52. [PMID: 37806035 DOI: 10.1016/j.sleep.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/16/2023] [Accepted: 09/23/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Recent evidence supports the idea that sleepiness has several dimensions, comprising psychophysiological phenomena, such as sleep propensity and sleepiness perception. The Epworth Sleepiness Scale (ESS) is among one of the most used sleepiness assessment tools, but recent data suggest that it might not detect problematic impairments in sleep health. More research is warranted investigating sleepiness dimensions with large sample sizes, using both objective and subjective methods of analyzing sleep. METHODS We used data from the Epidemiological Sleep Study (EPISONO), a major study carried out in Brazil using a representative sample of 1042 participants of the general population of Sao Paulo city, who completed questionnaires and underwent type I polysomnography. Sleepiness was measured by the ESS (sleep propensity) and the UNIFESP Sleep Questionnaire, which asked about the frequency of feeling sleepy during the day (sleepiness perception). The participants were distributed into 4 groups in respect of excessive daytime sleepiness (EDS) according to the following criteria: 1) having an ESS score >10 (ESS group). 2) feeling sleepy ≥3 times per week (Frequent EDS group). 3) the combined criteria (Combined EDS group). 4) having no evidence of EDS (no EDS group). The UNIFESP Sleep Questionnaire was used to obtain self-reported sleep duration, sleep debt, and sleep duration variability. Participants also completed the Pittsburgh Sleep Quality Index, the Insomnia Severity Index, and a pre-polysomnography sleep questionnaire. RESULTS After removing participants with missing data, there were 620 participants with no EDS, 255 individuals in the ESS group, 68 in the Frequent EDS group, and 73 in the Combined EDS group. Compared to the no EDS group, the ESS and Combined EDS groups had significantly increased sleep efficiency, diminished sleep latency, wake after sleep onset, and self-reported weekly sleep duration. The Frequent and Combined EDS groups had significantly higher scores in the Insomnia Severity Index and Pittsburgh Sleep Quality Index. All EDS groups had an increased likelihood of nonrestorative sleep. EDS frequency and the ESS scores were significantly correlated. CONCLUSIONS Participants with a high sleep propensity had a profile suggesting prior sleep deprivation, while high sleepiness perception was associated with impaired sleep quality. These findings indicated that, in the general population, these instruments evaluated separate sleepiness dimensions with different associations, highlighting that screening using a combination of instruments might be more effective in detecting impairments in sleep health.
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Affiliation(s)
- Guilherme Luiz Fernandes
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, São Paulo, 04024-002, Brazil
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, São Paulo, 04024-002, Brazil; Sleep Institute, São Paulo, Brazil
| | - Monica Levy Andersen
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, São Paulo, 04024-002, Brazil; Sleep Institute, São Paulo, Brazil.
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Orsini F, Giusti G, Zarantonello L, Costa R, Montagnese S, Rossi R. Driving fatigue increases after the Spring transition to Daylight Saving Time in young male drivers: A pilot study. TRANSPORTATION RESEARCH. PART F, TRAFFIC PSYCHOLOGY AND BEHAVIOUR 2023; 99:83-97. [PMID: 38577012 PMCID: PMC10988525 DOI: 10.1016/j.trf.2023.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 04/06/2024]
Abstract
The Spring transition to Daylight Saving Time (DST) has been associated with several health and road safety issues. Previous literature has focused primarily on the analysis of historical crash and hospitalization data, without investigating specific crash contributing factors, such as driving fatigue. The present study aims to uncover the effects of DST-related circadian desynchrony and sleep deprivation on driving fatigue, by means of a driving simulator experiment. Eighteen participants (all males, age range 21-30 years, mean = 24.2, SD = 2.9) completed two 50-minute trials (at one week distance, same time and same day of the week) on a monotonous highway environment, the second one taking place in the week after the Spring transition to DST. Driving fatigue was evaluated by analysing several different variables (including driving-based, physiological and subjective indices) and by comparison with a historical cohort of pertinent, matched controls who had also undergone two trials, but in the absence of any time change in between. Results showed a considerable rise in fatigue levels throughout the driving task in both trials, but with significantly poorer performance in the post-DST trial, documented by a worsening in vehicle lateral control and an increase in eyelid closure. However, participants seemed unable to perceive this decrease in their alertness, which most likely prevented them from implementing fatigue-coping strategies. These findings indicate that DST has a detrimental effect on driving fatigue in young male drivers in the week after the Spring transition, and provide valuable insights into the complex relationship between DST and road safety.
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Affiliation(s)
- Federico Orsini
- Department of Civil, Environmental and Architectural Engineering, University of Padua, Padua, Italy
- Mobility and Behavior Research Center – MoBe, University of Padua, Padua, Italy
- Department of General Psychology, University of Padua, Padua, Italy
| | - Gianluca Giusti
- Department of Medicine, University of Padua, Padua, Italy
- Chronobiology Section, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | | | - Rodolfo Costa
- Chronobiology Section, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
- Institute of Neuroscience, National Research Council (CNR), Padua, Italy
- Department of Biology, University of Padua, Padua, Italy
| | - Sara Montagnese
- Department of Medicine, University of Padua, Padua, Italy
- Chronobiology Section, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Riccardo Rossi
- Department of Civil, Environmental and Architectural Engineering, University of Padua, Padua, Italy
- Mobility and Behavior Research Center – MoBe, University of Padua, Padua, Italy
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Pratt S, Hagan-Haynes K. Applying a Health Equity Lens to Work-Related Motor Vehicle Safety in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6909. [PMID: 37887647 PMCID: PMC10606728 DOI: 10.3390/ijerph20206909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/30/2023] [Accepted: 10/06/2023] [Indexed: 10/28/2023]
Abstract
Motor vehicle crashes (MVCs) are the leading cause of fatal work-related injuries in the United States. Research assessing sociodemographic risk disparities for work-related MVCs is limited, yet structural and systemic inequities at work and during commutes likely contribute to disproportionate MVC risk. This paper summarizes the literature on risk disparities for work-related MVCs by sociodemographic and employment characteristics and identifies worker populations that have been largely excluded from previous research. The social-ecological model is used as a framework to identify potential causes of disparities at five levels-individual, interpersonal, organizational, community, and public policy. Expanded data collection and analyses of work-related MVCs are needed to understand and reduce disparities for pedestrian workers, workers from historically marginalized communities, workers with overlapping vulnerabilities, and workers not adequately covered by employer policies and safety regulations. In addition, there is a need for more data on commuting-related MVCs in the United States. Inadequate access to transportation, which disproportionately affects marginalized populations, may make travel to and from work less safe and limit individuals' access to employment. Identifying and remedying inequities in work-related MVCs, whether during the day or while commuting, will require the efforts of industry and multiple public sectors, including public health, transportation, and labor.
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Affiliation(s)
- Stephanie Pratt
- National Institute for Occupational Safety and Health, Division of Safety Research, Morgantown, WV 26505, USA;
- Strategic Innovative Solutions, LLC, Clearwater, FL 33760, USA
| | - Kyla Hagan-Haynes
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- National Institute for Occupational Safety and Health, Western States Division, Denver, CO 80225, USA
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12
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Dubessy AL, Arnulf I. Sleepiness in neurological disorders. Rev Neurol (Paris) 2023; 179:755-766. [PMID: 37598089 DOI: 10.1016/j.neurol.2023.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 08/21/2023]
Abstract
Sleepiness is a frequent and underrecognized symptom in neurological disorders, that impacts functional outcomes and quality of life. Multiple and potentially additive factors might contribute to sleepiness in neurological disorders, including sleep quality alterations, circadian rhythm disorders, drugs, and sleep disorders including sleep apnea or central disorders of hypersomnolence. Physician awareness of the possible symptoms of hypersomnolence, and associated causes is of crucial importance to allow proper identification and treatment of underlying causes. This review first provides a brief overview on clinical aspects of excessive daytime sleepiness, and diagnosis tools, then examines its frequency and mechanisms in various neurological disorders, including neurodegenerative disorders, multiple sclerosis, autoimmune encephalitis, epilepsy, and stroke.
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Affiliation(s)
- A-L Dubessy
- Saint Antoine Hospital, Assistance publique des Hôpitaux de Paris (AP-HP), Paris, France.
| | - I Arnulf
- Sleep Disorder Unit, Pitié-Salpêtrière Hospital and Sorbonne University, Paris, France; National Reference Network for Orphan Diseases: Narcolepsy and Rare Hypersomnias, Paris, France
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Johnson T, Gurubhagavatula I. Assessment of Vigilance and Fatigue. Sleep Med Clin 2023; 18:349-359. [PMID: 37532374 DOI: 10.1016/j.jsmc.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
This article summarizes the definitions of vigilance, fatigue, and sleepiness, as well as tools used in their assessment. Consideration is given to the strengths and limitations of the different subjective and objective tools. Future directions for research are also discussed, as well as the public health importance of continued investigation in this subject.
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Affiliation(s)
- Tyler Johnson
- Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, 3624 Market Street, Suite 205, Philadelphia, PA 19104, USA.
| | - Indira Gurubhagavatula
- Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, 3624 Market Street, Suite 205, Philadelphia, PA 19104, USA; Crescenz VA Medical Center, Philadelphia, PA, USA.
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Krestel H, Schreier DR, Sakiri E, von Allmen A, Abukhadra Y, Nirkko A, Steinlin M, Rosenow F, Markhus R, Schneider G, Jagella C, Mathis J, Blumenfeld H. Predictive Power of Interictal Epileptiform Discharges in Fitness-to-Drive Evaluation. Neurology 2023; 101:e866-e878. [PMID: 37414567 PMCID: PMC10501101 DOI: 10.1212/wnl.0000000000207531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/04/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES This study aimed to evaluate and predict the effects of interictal epileptiform discharges (IEDs) on driving ability using simple reaction tests and a driving simulator. METHODS Patients with various epilepsies were evaluated with simultaneous EEGs during their response to visual stimuli in a single-flash test, a car-driving video game, and a realistic driving simulator. Reaction times (RTs) and missed reactions or crashes (miss/crash) during normal EEG and IEDs were measured. IEDs, as considered in this study, were a series of epileptiform potentials (>1 potential) and were classified as generalized typical, generalized atypical, or focal. RT and miss/crash in relation to IED type, duration, and test type were analyzed. RT prolongation, miss/crash probability, and odds ratio (OR) of miss/crash due to IEDs were calculated. RESULTS Generalized typical IEDs prolonged RT by 164 ms, compared with generalized atypical IEDs (77.0 ms) and focal IEDs (48.0 ms) (p < 0.01). Generalized typical IEDs had a session miss/crash probability of 14.7% compared with a zero median for focal and generalized atypical IEDs (p < 0.01). Long repetitive bursts of focal IEDs lasting >2 seconds had a 2.6% miss/crash probabilityIED. Cumulated miss/crash probability could be predicted from RT prolongation: 90.3 ms yielded a 20% miss/crash probability. All tests were nonsuperior to each other in detecting miss/crash probabilitiesIED (zero median for all 3 tests) or RT prolongations (flash test: 56.4 ms, car-driving video game: 75.5 ms, simulator 86.6 ms). IEDs increased the OR of miss/crash in the simulator by 4.9-fold compared with normal EEG. A table of expected RT prolongations and miss/crash probabilities for IEDs of a given type and duration was created. DISCUSSION IED-associated miss/crash probability and RT prolongation were comparably well detected by all tests. Long focal IED bursts carry a low risk, while generalized typical IEDs are the primary cause of miss/crash. We propose a cumulative 20% miss/crash risk at an RT prolongation of 90.3 ms as a clinically relevant IED effect. The IED-associated OR in the simulator approximates the effects of sleepiness or low blood alcohol level while driving on real roads. A decision aid for fitness-to-drive evaluation was created by providing the expected RT prolongations and misses/crashes when IEDs of a certain type and duration are detected in routine EEG.
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Affiliation(s)
- Heinz Krestel
- From the Departments of Neurology (H.K., Y.A., C.J., H.B.), Neuroscience (H.B.), and Neurosurgery (H.B.), Yale School of Medicine, New Haven, CT; Epilepsy Center Frankfurt Rhine-Main (H.K., F.R.), University Hospital Frankfurt, Center for Personalized Translational Epilepsy Research (CePTER), and Institute of Mathematics (G.S.), Department of Computer Science and Mathematics, Goethe University, Frankfurt, Germany; Department of Neurology (D.R.S., A.N., J.M.); Departments of Cardiology (E.S.) and Pediatric Neurology (M.S.), Bern University Hospital and University of Bern; Neurocenter Lucerne (A.N.), Switzerland; and National Centre for Epilepsy (R.M.), Division of Clinical Neuroscience Oslo University Hospital, Norway.
| | - David R Schreier
- From the Departments of Neurology (H.K., Y.A., C.J., H.B.), Neuroscience (H.B.), and Neurosurgery (H.B.), Yale School of Medicine, New Haven, CT; Epilepsy Center Frankfurt Rhine-Main (H.K., F.R.), University Hospital Frankfurt, Center for Personalized Translational Epilepsy Research (CePTER), and Institute of Mathematics (G.S.), Department of Computer Science and Mathematics, Goethe University, Frankfurt, Germany; Department of Neurology (D.R.S., A.N., J.M.); Departments of Cardiology (E.S.) and Pediatric Neurology (M.S.), Bern University Hospital and University of Bern; Neurocenter Lucerne (A.N.), Switzerland; and National Centre for Epilepsy (R.M.), Division of Clinical Neuroscience Oslo University Hospital, Norway
| | - Elmaze Sakiri
- From the Departments of Neurology (H.K., Y.A., C.J., H.B.), Neuroscience (H.B.), and Neurosurgery (H.B.), Yale School of Medicine, New Haven, CT; Epilepsy Center Frankfurt Rhine-Main (H.K., F.R.), University Hospital Frankfurt, Center for Personalized Translational Epilepsy Research (CePTER), and Institute of Mathematics (G.S.), Department of Computer Science and Mathematics, Goethe University, Frankfurt, Germany; Department of Neurology (D.R.S., A.N., J.M.); Departments of Cardiology (E.S.) and Pediatric Neurology (M.S.), Bern University Hospital and University of Bern; Neurocenter Lucerne (A.N.), Switzerland; and National Centre for Epilepsy (R.M.), Division of Clinical Neuroscience Oslo University Hospital, Norway
| | - Andreas von Allmen
- From the Departments of Neurology (H.K., Y.A., C.J., H.B.), Neuroscience (H.B.), and Neurosurgery (H.B.), Yale School of Medicine, New Haven, CT; Epilepsy Center Frankfurt Rhine-Main (H.K., F.R.), University Hospital Frankfurt, Center for Personalized Translational Epilepsy Research (CePTER), and Institute of Mathematics (G.S.), Department of Computer Science and Mathematics, Goethe University, Frankfurt, Germany; Department of Neurology (D.R.S., A.N., J.M.); Departments of Cardiology (E.S.) and Pediatric Neurology (M.S.), Bern University Hospital and University of Bern; Neurocenter Lucerne (A.N.), Switzerland; and National Centre for Epilepsy (R.M.), Division of Clinical Neuroscience Oslo University Hospital, Norway
| | - Yasmina Abukhadra
- From the Departments of Neurology (H.K., Y.A., C.J., H.B.), Neuroscience (H.B.), and Neurosurgery (H.B.), Yale School of Medicine, New Haven, CT; Epilepsy Center Frankfurt Rhine-Main (H.K., F.R.), University Hospital Frankfurt, Center for Personalized Translational Epilepsy Research (CePTER), and Institute of Mathematics (G.S.), Department of Computer Science and Mathematics, Goethe University, Frankfurt, Germany; Department of Neurology (D.R.S., A.N., J.M.); Departments of Cardiology (E.S.) and Pediatric Neurology (M.S.), Bern University Hospital and University of Bern; Neurocenter Lucerne (A.N.), Switzerland; and National Centre for Epilepsy (R.M.), Division of Clinical Neuroscience Oslo University Hospital, Norway
| | - Arto Nirkko
- From the Departments of Neurology (H.K., Y.A., C.J., H.B.), Neuroscience (H.B.), and Neurosurgery (H.B.), Yale School of Medicine, New Haven, CT; Epilepsy Center Frankfurt Rhine-Main (H.K., F.R.), University Hospital Frankfurt, Center for Personalized Translational Epilepsy Research (CePTER), and Institute of Mathematics (G.S.), Department of Computer Science and Mathematics, Goethe University, Frankfurt, Germany; Department of Neurology (D.R.S., A.N., J.M.); Departments of Cardiology (E.S.) and Pediatric Neurology (M.S.), Bern University Hospital and University of Bern; Neurocenter Lucerne (A.N.), Switzerland; and National Centre for Epilepsy (R.M.), Division of Clinical Neuroscience Oslo University Hospital, Norway
| | - Maja Steinlin
- From the Departments of Neurology (H.K., Y.A., C.J., H.B.), Neuroscience (H.B.), and Neurosurgery (H.B.), Yale School of Medicine, New Haven, CT; Epilepsy Center Frankfurt Rhine-Main (H.K., F.R.), University Hospital Frankfurt, Center for Personalized Translational Epilepsy Research (CePTER), and Institute of Mathematics (G.S.), Department of Computer Science and Mathematics, Goethe University, Frankfurt, Germany; Department of Neurology (D.R.S., A.N., J.M.); Departments of Cardiology (E.S.) and Pediatric Neurology (M.S.), Bern University Hospital and University of Bern; Neurocenter Lucerne (A.N.), Switzerland; and National Centre for Epilepsy (R.M.), Division of Clinical Neuroscience Oslo University Hospital, Norway
| | - Felix Rosenow
- From the Departments of Neurology (H.K., Y.A., C.J., H.B.), Neuroscience (H.B.), and Neurosurgery (H.B.), Yale School of Medicine, New Haven, CT; Epilepsy Center Frankfurt Rhine-Main (H.K., F.R.), University Hospital Frankfurt, Center for Personalized Translational Epilepsy Research (CePTER), and Institute of Mathematics (G.S.), Department of Computer Science and Mathematics, Goethe University, Frankfurt, Germany; Department of Neurology (D.R.S., A.N., J.M.); Departments of Cardiology (E.S.) and Pediatric Neurology (M.S.), Bern University Hospital and University of Bern; Neurocenter Lucerne (A.N.), Switzerland; and National Centre for Epilepsy (R.M.), Division of Clinical Neuroscience Oslo University Hospital, Norway
| | - Rune Markhus
- From the Departments of Neurology (H.K., Y.A., C.J., H.B.), Neuroscience (H.B.), and Neurosurgery (H.B.), Yale School of Medicine, New Haven, CT; Epilepsy Center Frankfurt Rhine-Main (H.K., F.R.), University Hospital Frankfurt, Center for Personalized Translational Epilepsy Research (CePTER), and Institute of Mathematics (G.S.), Department of Computer Science and Mathematics, Goethe University, Frankfurt, Germany; Department of Neurology (D.R.S., A.N., J.M.); Departments of Cardiology (E.S.) and Pediatric Neurology (M.S.), Bern University Hospital and University of Bern; Neurocenter Lucerne (A.N.), Switzerland; and National Centre for Epilepsy (R.M.), Division of Clinical Neuroscience Oslo University Hospital, Norway
| | - Gaby Schneider
- From the Departments of Neurology (H.K., Y.A., C.J., H.B.), Neuroscience (H.B.), and Neurosurgery (H.B.), Yale School of Medicine, New Haven, CT; Epilepsy Center Frankfurt Rhine-Main (H.K., F.R.), University Hospital Frankfurt, Center for Personalized Translational Epilepsy Research (CePTER), and Institute of Mathematics (G.S.), Department of Computer Science and Mathematics, Goethe University, Frankfurt, Germany; Department of Neurology (D.R.S., A.N., J.M.); Departments of Cardiology (E.S.) and Pediatric Neurology (M.S.), Bern University Hospital and University of Bern; Neurocenter Lucerne (A.N.), Switzerland; and National Centre for Epilepsy (R.M.), Division of Clinical Neuroscience Oslo University Hospital, Norway
| | - Caroline Jagella
- From the Departments of Neurology (H.K., Y.A., C.J., H.B.), Neuroscience (H.B.), and Neurosurgery (H.B.), Yale School of Medicine, New Haven, CT; Epilepsy Center Frankfurt Rhine-Main (H.K., F.R.), University Hospital Frankfurt, Center for Personalized Translational Epilepsy Research (CePTER), and Institute of Mathematics (G.S.), Department of Computer Science and Mathematics, Goethe University, Frankfurt, Germany; Department of Neurology (D.R.S., A.N., J.M.); Departments of Cardiology (E.S.) and Pediatric Neurology (M.S.), Bern University Hospital and University of Bern; Neurocenter Lucerne (A.N.), Switzerland; and National Centre for Epilepsy (R.M.), Division of Clinical Neuroscience Oslo University Hospital, Norway
| | - Johannes Mathis
- From the Departments of Neurology (H.K., Y.A., C.J., H.B.), Neuroscience (H.B.), and Neurosurgery (H.B.), Yale School of Medicine, New Haven, CT; Epilepsy Center Frankfurt Rhine-Main (H.K., F.R.), University Hospital Frankfurt, Center for Personalized Translational Epilepsy Research (CePTER), and Institute of Mathematics (G.S.), Department of Computer Science and Mathematics, Goethe University, Frankfurt, Germany; Department of Neurology (D.R.S., A.N., J.M.); Departments of Cardiology (E.S.) and Pediatric Neurology (M.S.), Bern University Hospital and University of Bern; Neurocenter Lucerne (A.N.), Switzerland; and National Centre for Epilepsy (R.M.), Division of Clinical Neuroscience Oslo University Hospital, Norway
| | - Hal Blumenfeld
- From the Departments of Neurology (H.K., Y.A., C.J., H.B.), Neuroscience (H.B.), and Neurosurgery (H.B.), Yale School of Medicine, New Haven, CT; Epilepsy Center Frankfurt Rhine-Main (H.K., F.R.), University Hospital Frankfurt, Center for Personalized Translational Epilepsy Research (CePTER), and Institute of Mathematics (G.S.), Department of Computer Science and Mathematics, Goethe University, Frankfurt, Germany; Department of Neurology (D.R.S., A.N., J.M.); Departments of Cardiology (E.S.) and Pediatric Neurology (M.S.), Bern University Hospital and University of Bern; Neurocenter Lucerne (A.N.), Switzerland; and National Centre for Epilepsy (R.M.), Division of Clinical Neuroscience Oslo University Hospital, Norway
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Cheng ESW, Lai DKH, Mao YJ, Lee TTY, Lam WK, Cheung JCW, Wong DWC. Computational Biomechanics of Sleep: A Systematic Mapping Review. Bioengineering (Basel) 2023; 10:917. [PMID: 37627802 PMCID: PMC10451553 DOI: 10.3390/bioengineering10080917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023] Open
Abstract
Biomechanical studies play an important role in understanding the pathophysiology of sleep disorders and providing insights to maintain sleep health. Computational methods facilitate a versatile platform to analyze various biomechanical factors in silico, which would otherwise be difficult through in vivo experiments. The objective of this review is to examine and map the applications of computational biomechanics to sleep-related research topics, including sleep medicine and sleep ergonomics. A systematic search was conducted on PubMed, Scopus, and Web of Science. Research gaps were identified through data synthesis on variants, outcomes, and highlighted features, as well as evidence maps on basic modeling considerations and modeling components of the eligible studies. Twenty-seven studies (n = 27) were categorized into sleep ergonomics (n = 2 on pillow; n = 3 on mattress), sleep-related breathing disorders (n = 19 on obstructive sleep apnea), and sleep-related movement disorders (n = 3 on sleep bruxism). The effects of pillow height and mattress stiffness on spinal curvature were explored. Stress on the temporomandibular joint, and therefore its disorder, was the primary focus of investigations on sleep bruxism. Using finite element morphometry and fluid-structure interaction, studies on obstructive sleep apnea investigated the effects of anatomical variations, muscle activation of the tongue and soft palate, and gravitational direction on the collapse and blockade of the upper airway, in addition to the airflow pressure distribution. Model validation has been one of the greatest hurdles, while single-subject design and surrogate techniques have led to concerns about external validity. Future research might endeavor to reconstruct patient-specific models with patient-specific loading profiles in a larger cohort. Studies on sleep ergonomics research may pave the way for determining ideal spine curvature, in addition to simulating side-lying sleep postures. Sleep bruxism studies may analyze the accumulated dental damage and wear. Research on OSA treatments using computational approaches warrants further investigation.
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Affiliation(s)
- Ethan Shiu-Wang Cheng
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong
- Department of Electronic and Information Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Derek Ka-Hei Lai
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Ye-Jiao Mao
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Timothy Tin-Yan Lee
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Wing-Kai Lam
- Sports Information and External Affairs Centre, Hong Kong Sports Institute, Hong Kong
| | - James Chung-Wai Cheung
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong
- Research Institute for Sports Science and Technology, The Hong Kong Polytechnic University, Hong Kong
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong
- Research Institute for Sports Science and Technology, The Hong Kong Polytechnic University, Hong Kong
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Kurita S, Doi T, Harada K, Katayama O, Morikawa M, Nishijima C, Fujii K, Misu Y, Yamaguchi R, Von Fingerhut G, Kakita D, Shimada H. Motoric Cognitive Risk Syndrome and Traffic Incidents in Older Drivers in Japan. JAMA Netw Open 2023; 6:e2330475. [PMID: 37624598 PMCID: PMC10457720 DOI: 10.1001/jamanetworkopen.2023.30475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/13/2023] [Indexed: 08/26/2023] Open
Abstract
Importance To prevent motor vehicle collisions by older drivers, the increased risk of collisions should be considered early. Cognitive decline increases the risk of car collisions. Motoric cognitive risk syndrome (MCR), characterized by the presence of cognitive concerns and slow gait, can be assessed conveniently and is useful to assess the risk of dementia. Objective To examine the association between MCR assessment findings and car collisions among older drivers in Japan. Design, Setting, and Participants This cross-sectional study used data from a community-based cohort study, the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes, conducted in Japan from 2015 to 2018. Participants were community-dwelling older adults aged at least 65 years. Data were analyzed from February to March 2023. Exposure MCR was defined as having subjective memory concerns (SMC) and slow gait. Participants were classified into 4 groups: no SMC or slow gait, only SMC, only slow gait, and MCR. Main Outcomes and Measures Participants were asked about the experience of car collisions during the last 2 years and near-miss traffic incidents during the previous year through face-to-face interviews. Odds of experiencing a collision or near-miss traffic incident were assessed using logistic regression. Results Among a total of 12 475 participants, the mean (SD) age was 72.6 (5.2) years, and 7093 (56.9%) were male. The group with only SMC and the group with MCR showed a higher proportion of both car collisions and near-miss traffic incidents than the other groups (adjusted standardized residuals > 1.96; P < .001). Logistic regression analysis showed the only SMC and MCR groups had increased odds of car collisions (only SMC group: odds ratio [OR], 1.48; 95% CI, 1.27-1.72; MCR group: OR, 1.73; 95% CI, 1.39-2.16) and near-miss traffic incidents (only SMC group: OR, 2.07; 95% CI, 1.91-2.25; MCR group: OR, 2.13; 95% CI, 1.85-2.45) after adjusting for confounding factors. After stratifying MCR assessments by objective cognitive impairment, significant associations were still observed. In the only slow gait group, objective cognitive impairment was associated with increased odds of car collisions (OR, 1.96; 95% CI, 1.17-3.28). Conclusions and Relevance In this cross-sectional study of community-dwelling older drivers in Japan, SMC and MCR were associated with car collisions and near-miss traffic incidents independent from objective cognitive impairment. Future studies should examine the mechanism of these associations in more detail.
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Affiliation(s)
- Satoshi Kurita
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Takehiko Doi
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kenji Harada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Osamu Katayama
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - Masanori Morikawa
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Chiharu Nishijima
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kazuya Fujii
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Yuka Misu
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Ryo Yamaguchi
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
- Department of Medical Sciences, Medical Science Division, Graduate School of Medicine, Science and Technology, Shinshu University, Matsumoto, Japan
| | - Georg Von Fingerhut
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Daisuke Kakita
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
- Department of Medical Sciences, Medical Science Division, Graduate School of Medicine, Science and Technology, Shinshu University, Matsumoto, Japan
| | - Hiroyuki Shimada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
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Younes M, Gerardy B, Giannouli E, Raneri J, Ayas NT, Skomro R, John Kimoff R, Series F, Hanly PJ, Beaudin A. Contribution of obstructive sleep apnea to disrupted sleep in a large clinical cohort of patients with suspected obstructive sleep apnea. Sleep 2023; 46:zsac321. [PMID: 36591638 PMCID: PMC10334732 DOI: 10.1093/sleep/zsac321] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/23/2022] [Indexed: 01/03/2023] Open
Abstract
STUDY OBJECTIVES The response of sleep depth to CPAP in patients with OSA is unpredictable. The odds-ratio-product (ORP) is a continuous index of sleep depth and wake propensity that distinguishes different sleep depths within sleep stages, and different levels of vigilance during stage wake. When expressed as fractions of time spent in different ORP deciles, nine distinctive patterns are found. Only three of these are associated with OSA. We sought to determine whether sleep depth improves on CPAP exclusively in patients with these three ORP patterns. METHODS ORP was measured during the diagnostic and therapeutic components of 576 split-night polysomnographic (PSG) studies. ORP architecture in the diagnostic section was classified into one of the nine possible ORP patterns and the changes in sleep architecture were determined on CPAP for each of these patterns. ORP architecture was similarly determined in the first half of 760 full-night diagnostic PSG studies and the changes in the second half were measured to control for differences in sleep architecture between the early and late portions of sleep time in the absence of CPAP. RESULTS Frequency of the three ORP patterns increased progressively with the apnea-hypopnea index. Sleep depth improved significantly on CPAP only in the three ORP patterns associated with OSA. Changes in CPAP in the other six patterns, or in full diagnostic PSG studies, were insignificant or paradoxical. CONCLUSIONS ORP architecture types can identify patients in whom OSA adversely affects sleep and whose sleep is expected to improve on CPAP therapy.
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Affiliation(s)
- Magdy Younes
- Sleep Disorders Center, Misericordia Health Center, University of Manitoba, Winnipeg, Canada
- YRT Limited, Winnipeg, Manitoba, Canada
| | | | - Eleni Giannouli
- Sleep Disorders Center, Misericordia Health Center, University of Manitoba, Winnipeg, Canada
| | - Jill Raneri
- Sleep Centre, Foothills Medical Centre, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Najib T Ayas
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Robert Skomro
- Division of Respirology, Critical Care and Sleep Medicine, University of Saskatchewan, Saskatoon, Canada
| | - R John Kimoff
- Respiratory Division, McGill University Health Centre, Respiratory Epidemiology Clinical Research Unit and Meakins-Christie Laboratories, McGill University, Montreal, QC, Canada
| | - Frederic Series
- Unité de Recherche en Pneumologie, Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Patrick J Hanly
- Sleep Centre, Foothills Medical Centre, Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrew Beaudin
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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18
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Covassin N, Lu D, St. Louis EK, Chahal AA, Schulte PJ, Mansukhani MP, Xie J, Lipford MC, Li N, Ramar K, Caples SM, Gay PC, Olson EJ, Silber MH, Li J, Somers VK. Sex-specific associations between daytime sleepiness, chronic diseases and mortality in obstructive sleep apnea. Front Neurosci 2023; 17:1210206. [PMID: 37425007 PMCID: PMC10326268 DOI: 10.3389/fnins.2023.1210206] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/30/2023] [Indexed: 07/11/2023] Open
Abstract
Objective Excessive daytime sleepiness (EDS) is common in obstructive sleep apnea (OSA) and has been linked to adverse outcomes, albeit inconsistently. Furthermore, whether the prognostic impact of EDS differs as a function of sex is unclear. We aimed to assess the associations between EDS and chronic diseases and mortality in men and women with OSA. Methods Newly-diagnosed adult OSA patients who underwent sleep evaluation at Mayo Clinic between November 2009 and April 2017 and completed the Epworth Sleepiness Scale (ESS) for assessment of perceived sleepiness (N = 14,823) were included. Multivariable-adjusted regression models were used to investigate the relationships between sleepiness, with ESS modeled as a binary (ESS > 10) and as a continuous variable, and chronic diseases and all-cause mortality. Results In cross-sectional analysis, ESS > 10 was independently associated with lower risk of hypertension in male OSA patients (odds ratio [OR], 95% confidence interval [CI]: 0.76, 0.69-0.83) and with higher risk of diabetes mellitus in both OSA men (OR, 1.17, 95% CI 1.05-1.31) and women (OR 1.26, 95% CI 1.10-1.45). Sex-specific curvilinear relations between ESS score and depression and cancer were noted. After a median 6.2 (4.5-8.1) years of follow-up, the hazard ratio for all-cause death in OSA women with ESS > 10 compared to those with ESS ≤ 10 was 1.24 (95% CI 1.05-1.47), after adjusting for demographics, sleep characteristics and comorbidities at baseline. In men, sleepiness was not associated with mortality. Conclusion The implications of EDS for morbidity and mortality risk in OSA are sex-dependent, with hypersomnolence being independently associated with greater vulnerability to premature death only in female patients. Efforts to mitigate mortality risk and restore daytime vigilance in women with OSA should be prioritized.
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Affiliation(s)
- Naima Covassin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Dongmei Lu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
- Department of Respiratory and Critical Care Medicine, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Erik K. St. Louis
- Department of Medicine, Mayo Clinic, Rochester, MN, United States
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Anwar A. Chahal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Phillip J. Schulte
- Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Meghna P. Mansukhani
- Department of Medicine, Mayo Clinic, Rochester, MN, United States
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
- Department of Family Medicine, Mayo Clinic, Rochester, MN, United States
| | - Jiang Xie
- Department of Respiratory and Critical Medicine of Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Melissa C. Lipford
- Department of Medicine, Mayo Clinic, Rochester, MN, United States
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Nanfang Li
- Center of Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, The Center of Diagnosis, Treatment and Research of Hypertension in Xinjiang Hypertension Institute of Xinjiang, Urumqi, China
| | - Kannan Ramar
- Department of Medicine, Mayo Clinic, Rochester, MN, United States
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Sean M. Caples
- Department of Medicine, Mayo Clinic, Rochester, MN, United States
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Peter C. Gay
- Department of Medicine, Mayo Clinic, Rochester, MN, United States
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Eric J. Olson
- Department of Medicine, Mayo Clinic, Rochester, MN, United States
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Michael H. Silber
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Jingen Li
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
- Department of Cardiovascular Medicine, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Virend K. Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
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Anund A, Forward S, Sjörs Dahlman A. Seat belt usage in buses - An observation study of usage and travellers' perspectives. ACCIDENT; ANALYSIS AND PREVENTION 2023; 190:107138. [PMID: 37307615 DOI: 10.1016/j.aap.2023.107138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/10/2023] [Accepted: 05/24/2023] [Indexed: 06/14/2023]
Abstract
This study aims to evaluate seat belt usage in buses and to understand travellers' incentives of seat belt usage. Methods used are observational studies (10 cities, with 328 bus observations), focus group discussion (7 groups with a total of 32 participants) and a web survey (n = 1737 respondents). The results show that the seat belt use among bus passengers can be improved especially in regional and commercial bus traffic. It is more common to buckle up on long trips than on short trips. However, even though observations show high usage during long trips, travellers report that they remove the seat belt after a while if they want to sleep or for comfort reasons. For the bus drivers it is not possible to control passengers' usage. Dirty seat belts and technical malfunction might deter some passengers from using them and therefore systematic cleaning and control of seats and belts are recommended. On short trips one reason for not using the belt is related to worries about getting stuck and not being ready to get off in time. In general, it is most important to increase the usage on high-speed roads (>60 km/h), in lower speed it might be more important to provide a seat for each passenger. Based on the results a list of recommendations is presented.
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Affiliation(s)
- Anna Anund
- Swedish National Road and Transport Research Institute (VTI), Linköping, Sweden; Department of Rehabilitation Medicine, Linköping University, Linköping, Sweden.
| | - Sonja Forward
- Swedish National Road and Transport Research Institute (VTI), Linköping, Sweden
| | - Anna Sjörs Dahlman
- Swedish National Road and Transport Research Institute (VTI), Linköping, Sweden; SAFER Vehicle and Traffic Safety Centre, Chalmers University of Technology, Gothenburg, Sweden
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20
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Hall WA, Keys E, Ou C. A call to action about nurses promoting healthy sleep. Sleep Med 2023; 108:53-54. [PMID: 37327660 DOI: 10.1016/j.sleep.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/15/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Wendy A Hall
- UBC School of Nursing, The University of British Columbia, T 201 2211 Wesbrook Mall, Vancouver, BC, V6T2B5, Canada. https://twitter.com/wendyha65734663
| | - Elizabeth Keys
- School of Nursing, Okanagan Campus, ART360 (Arts Building), 1147 Research Road, Kelowna, BC, V1V 1V7, Canada.
| | - Christine Ou
- School of Nursing, University of Victoria, B, Victoria, BC, V8P 5C2, Canada.
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21
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Philip P, Micoulaud-Franchi JA, Taillard J, Coelho J, Tisserand C, Dauvilliers Y, Sagaspe P. The Bordeaux Sleepiness Scale (BOSS): a new questionnaire to measure sleep-related driving risk. J Clin Sleep Med 2023; 19:957-965. [PMID: 36727504 PMCID: PMC10152350 DOI: 10.5664/jcsm.10470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES Sleepiness is a well-known risk factor for traffic accidents. Our study presents a new questionnaire, the Bordeaux Sleepiness Scale (BOSS), specifically designed to evaluate sleep-related driving risk in patients with sleep disorders. METHODS The BOSS was designed by gathering data on sociodemographics, sleepiness, driving items, and traffic accident exposure (kilometers driven) in the past year of 293 patients followed for sleep disorders at a French sleep clinic. It was then validated on data from a large population-based cohort of 7,296 highway drivers. Its performance was compared to the Epworth sleepiness scale and to self-reported episodes of severe sleepiness at the wheel. Receiver operating characteristic curves were computed. RESULTS The sensitivity and specificity of the BOSS (cutoff = 3) to predict sleep-related near-misses or accidents was, respectively, 82% and 74%, with an area under the receiver operating characteristic curve of 0.83. In a cohort of patients and a large population-based cohort, the area under the curve of the BOSS was significantly larger than that of the Epworth sleepiness scale (P < .001). Although the areas under the curve were equivalent between the BOSS and sleepiness at the wheel, the specificity of the BOSS was higher. CONCLUSIONS The BOSS scale combining exposure (kilometers driven) and self-perception of situational sleepiness provides a simple and reliable evaluation of sleep-related driving risk. This short, specific questionnaire should be promoted as a first-line tool to evaluate the risk of traffic accidents in sleepy patients. CITATION Philip P, Micoulaud-Franchi J-A, Taillard J, et al. The Bordeaux Sleepiness Scale (BOSS): a new questionnaire to measure sleep-related driving risk. J Clin Sleep Med. 2023;19(5):957-965.
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Affiliation(s)
- Pierre Philip
- Sleep, Addiction and Neuropsychiatry, University of Bordeaux, Bordeaux, France
- CNRS, SANPSY, UMR 6033, Bordeaux, France
- CHU de Bordeaux, Centre Hypersomnies Rares, Bordeaux, France
- INSERM CIC1401, Université de Bordeaux, CHU de Bordeaux, Bordeaux, France
| | - Jean-Arthur Micoulaud-Franchi
- Sleep, Addiction and Neuropsychiatry, University of Bordeaux, Bordeaux, France
- CNRS, SANPSY, UMR 6033, Bordeaux, France
- CHU de Bordeaux, Centre Hypersomnies Rares, Bordeaux, France
| | - Jacques Taillard
- Sleep, Addiction and Neuropsychiatry, University of Bordeaux, Bordeaux, France
- CNRS, SANPSY, UMR 6033, Bordeaux, France
- CHU de Bordeaux, Centre Hypersomnies Rares, Bordeaux, France
| | - Julien Coelho
- Sleep, Addiction and Neuropsychiatry, University of Bordeaux, Bordeaux, France
- CNRS, SANPSY, UMR 6033, Bordeaux, France
- CHU de Bordeaux, Centre Hypersomnies Rares, Bordeaux, France
| | | | - Yves Dauvilliers
- Reference National Center for Narcolepsy, Sleep Unit, CHU Montpellier, Montpellier, France
- PSNREC, University of Montpellier, INSERM, Montpellier, France
| | - Patricia Sagaspe
- Sleep, Addiction and Neuropsychiatry, University of Bordeaux, Bordeaux, France
- CNRS, SANPSY, UMR 6033, Bordeaux, France
- CHU de Bordeaux, Centre Hypersomnies Rares, Bordeaux, France
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22
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Cellini N, Bruno G, Orsini F, Vidotto G, Gastaldi M, Rossi R, Tagliabue M. The Effect of Partial Sleep Deprivation and Time-on-Task on Young Drivers' Subjective and Objective Sleepiness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4003. [PMID: 36901015 PMCID: PMC10001806 DOI: 10.3390/ijerph20054003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
Despite sleepiness being considered one of the main factors contributing to road crashes, and even though extensive efforts have been made in the identification of techniques able to detect it, the assessment of fitness-to-drive regarding driving fatigue and sleepiness is still an open issue. In the literature on driver sleepiness, both vehicle-based measures and behavioral measures are used. Concerning the former, the one considered more reliable is the Standard Deviation of Lateral Position (SDLP) while the PERcent of eye CLOSure over a defined period of time (PERCLOS) seems to be the most informative behavioral measure. In the present study, using a within-subject design, we assessed the effect of a single night of partial sleep deprivation (PSD, less than 5 h sleeping time) compared to a control condition (full night of sleep, 8 h sleeping time) on SDLP and PERCLOS, in young adults driving in a dynamic car simulator. Results show that time-on-task and PSD affect both subjective and objective sleepiness measures. Moreover, our data confirm that both objective and subjective sleepiness increase through a monotonous driving scenario. Considering that SDLP and PERCLOS were often used separately in studies on driver sleepiness and fatigue detection, the present results have potential implications for fitness-to-drive assessment in that they provide useful information allowing to combine the advantages of the two measures for drowsiness detection while driving.
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Affiliation(s)
- Nicola Cellini
- Department of General Psychology, University of Padova, 35131 Padova, Italy
- Mobility and Behavior Research Center—MoBe, University of Padova, 35131 Padova, Italy
| | - Giovanni Bruno
- Department of General Psychology, University of Padova, 35131 Padova, Italy
| | - Federico Orsini
- Mobility and Behavior Research Center—MoBe, University of Padova, 35131 Padova, Italy
- Department of Civil, Environmental, and Architectural Engineering, University of Padova, 35131 Padova, Italy
| | - Giulio Vidotto
- Department of General Psychology, University of Padova, 35131 Padova, Italy
- Mobility and Behavior Research Center—MoBe, University of Padova, 35131 Padova, Italy
| | - Massimiliano Gastaldi
- Department of General Psychology, University of Padova, 35131 Padova, Italy
- Mobility and Behavior Research Center—MoBe, University of Padova, 35131 Padova, Italy
- Department of Civil, Environmental, and Architectural Engineering, University of Padova, 35131 Padova, Italy
| | - Riccardo Rossi
- Mobility and Behavior Research Center—MoBe, University of Padova, 35131 Padova, Italy
- Department of Civil, Environmental, and Architectural Engineering, University of Padova, 35131 Padova, Italy
| | - Mariaelena Tagliabue
- Department of General Psychology, University of Padova, 35131 Padova, Italy
- Mobility and Behavior Research Center—MoBe, University of Padova, 35131 Padova, Italy
- Department of Civil, Environmental, and Architectural Engineering, University of Padova, 35131 Padova, Italy
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23
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Koopmans I, Doll RJ, van der Wall H, de Kam M, Groeneveld GJ, Cohen A, Zuiker R. Fit for purpose of on-the-road driving and simulated driving: A randomised crossover study using the effect of sleep deprivation. PLoS One 2023; 18:e0278300. [PMID: 36730178 PMCID: PMC9894419 DOI: 10.1371/journal.pone.0278300] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 11/14/2022] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Drivers should be aware of possible impairing effects of alcohol, medicinal substance, or fatigue on driving performance. Such effects are assessed in clinical trials, including a driving task or related psychomotor tasks. However, a choice between predicting tasks must be made. Here, we compare driving performance with on-the-road driving, simulator driving, and psychomotor tasks using the effect of sleep deprivation. METHOD This two-way cross over study included 24 healthy men with a minimum driving experience of 3000km per year. Psychomotor tasks, simulated driving, and on-the-road driving were assessed in the morning and the afternoon after a well-rested night and in the morning after a sleep-deprived night. Driving behaviour was examined by calculating the Standard Deviation of Lateral Position (SDLP). RESULTS SDLP increased after sleep deprivation for simulated (10cm, 95%CI:6.7-13.3) and on-the-road driving (2.8cm, 95%CI:1.9-3.7). The psychomotor test battery detected effects of sleep deprivation in almost all tasks. Correlation between on-the-road tests and simulator SDLP after a well-rested night (0.63, p < .001) was not present after a night of sleep deprivation (0.31, p = .18). Regarding the effect of sleep deprivation on the psychomotor test battery, only adaptive tracking correlated with the SDLP of the driving simulator (-0.50, p = .02). Other significant correlations were related to subjective VAS scores. DISCUSSION The lack of apparent correlations and difference in sensitivity of performance of the psychomotor tasks, simulated driving and, on-the-road driving indicates that the tasks may not be interchangeable and may assess different aspects of driving behaviour.
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Affiliation(s)
- Ingrid Koopmans
- Centre for Human Drug Research, Leiden, The Netherlands
- Leiden University Medical Center, Leiden, The Netherlands
- * E-mail:
| | | | | | | | - Geert Jan Groeneveld
- Centre for Human Drug Research, Leiden, The Netherlands
- Leiden University Medical Center, Leiden, The Netherlands
| | - Adam Cohen
- Centre for Human Drug Research, Leiden, The Netherlands
- Leiden University Medical Center, Leiden, The Netherlands
| | - Rob Zuiker
- Centre for Human Drug Research, Leiden, The Netherlands
- Leiden University Medical Center, Leiden, The Netherlands
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24
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Martin VP, Lopez R, Dauvilliers Y, Rouas JL, Philip P, Micoulaud-Franchi JA. Sleepiness in adults: An umbrella review of a complex construct. Sleep Med Rev 2023; 67:101718. [PMID: 36455433 DOI: 10.1016/j.smrv.2022.101718] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 10/21/2022] [Accepted: 11/10/2022] [Indexed: 11/21/2022]
Abstract
Sleepiness involves many dimensions that require investigation. Since sleepiness is often defined operationally, we exhaustively inventoried all the assessment tools designed to measure it in an umbrella review, without any preconceptions, i.e. a review of reviews. We included all reviews and systematic reviews related to sleepiness assessment tools published up to March 2021. Three investigators independently assessed the eligibility of studies for inclusion and identified 36 relevant reviews. In total, 99 tools were identified and classified into 8 categories. We classified them depending on their category, their publication year and the number of mentions in the 36 included reviews. The 6 most frequently cited were the Epworth sleepiness scale, the multiple sleep latency test, the maintenance of wakefulness test, the Stanford sleepiness scale, the Karolinska sleepiness scale, and the psychomotor vigilance task. Despite the limitation that we may have missed some recently developed tools, this historical perspective on sleepiness measurement is a first step toward a better delineation of the different dimensions underlying the constructs of sleepiness, and will serve as a basis for further discussion in the clinical and research sleep community.
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Affiliation(s)
- Vincent P Martin
- Univ. Bordeaux, CNRS, Bordeaux INP, LaBRI, UMR 5800, F-33400, Talence, France; Université de Bordeaux, SANPSY UMR 6033, F-33000, Bordeaux, France.
| | - Régis Lopez
- National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, Sleep Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France; Institute for Neurosciences of Montpellier (INM), Montpellier University, INSERM, Montpellier, France
| | - Yves Dauvilliers
- National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, Sleep Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France; Institute for Neurosciences of Montpellier (INM), Montpellier University, INSERM, Montpellier, France
| | - Jean-Luc Rouas
- Univ. Bordeaux, CNRS, Bordeaux INP, LaBRI, UMR 5800, F-33400, Talence, France
| | - Pierre Philip
- Service de Médecine Universitaire du sommeil, CHU de Bordeaux, Place Amélie Raba-Leon, Bordeaux, France; Université de Bordeaux, SANPSY UMR 6033, F-33000, Bordeaux, France
| | - Jean-Arthur Micoulaud-Franchi
- Service de Médecine Universitaire du sommeil, CHU de Bordeaux, Place Amélie Raba-Leon, Bordeaux, France; Université de Bordeaux, SANPSY UMR 6033, F-33000, Bordeaux, France.
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Uchiyama Y, Sawai S, Omi T, Yamauchi K, Tamura K, Sakata T, Nakajima K, Sakai H. Convergent validity of video-based observer rating of drowsiness, against subjective, behavioral, and physiological measures. PLoS One 2023; 18:e0285557. [PMID: 37155637 PMCID: PMC10166535 DOI: 10.1371/journal.pone.0285557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 04/26/2023] [Indexed: 05/10/2023] Open
Abstract
Driver drowsiness is a widely recognized cause of motor vehicle accidents. Therefore, a reduction in drowsy driving crashes is required. Many studies evaluating the crash risk of drowsy driving and developing drowsiness detection systems, have used observer rating of drowsiness (ORD) as a reference standard (i.e. ground truth) of drowsiness. ORD is a method of human raters evaluating the levels of driver drowsiness, by visually observing a driver. Despite the widespread use of ORD, concerns remain regarding its convergent validity, which is supported by the relationship between ORD and other drowsiness measures. The objective of the present study was to validate video-based ORD, by examining correlations between ORD levels and other drowsiness measures. Seventeen participants performed eight sessions of a simulated driving task, verbally responding to Karolinska sleepiness scale (KSS), while infra-red face video, lateral position of the participant's car, eye closure, electrooculography (EOG), and electroencephalography (EEG) were recorded. Three experienced raters evaluated the ORD levels by observing facial videos. The results showed significant positive correlations between the ORD levels and all other drowsiness measures (i.e., KSS, standard deviation of the lateral position of the car, percentage of time occupied by slow eye movement calculated from EOG, EEG alpha power, and EEG theta power). The results support the convergent validity of video-based ORD as a measure of driver drowsiness. This suggests that ORD might be suitable as a ground truth for drowsiness.
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Affiliation(s)
- Yuji Uchiyama
- Toyota Central R&D Labs., Inc., Nagakute, Aichi, Japan
- Toyota Motor Corporation, Toyota, Aichi, Japan
| | | | | | | | - Kimimasa Tamura
- Toyota Research Institute Inc., Cambridge, MA, United States of America
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Cori JM, Wilkinson VE, Soleimanloo SS, Westlake J, Stevens B, Rajaratnam SMW, Howard ME. A brief assessment of eye blink drowsiness immediately prior to or following driving detects drowsiness related driving impairment. J Sleep Res 2022; 32:e13785. [PMID: 36478313 DOI: 10.1111/jsr.13785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/10/2022] [Accepted: 10/25/2022] [Indexed: 12/12/2022]
Abstract
Drowsy driving is a major cause of fatal and serious injury motor vehicle accidents. The inability objectively to assess drowsiness has hindered the assessment of fitness to drive and the development of drowsy driving regulations. This study evaluated whether spontaneous eye blink parameters measured briefly pre- and post-drive could be used to detect drowsy driving impairment. Twelve healthy participants (6 female) drove an instrumented vehicle for 2 h on a closed-loop track during a rested (8-10 h awake) and an extended wake condition (32-34 h awake). Pre- and post-drive, the participants completed a 5 min eye blink task, a psychomotor vigilance task (PVT), and the Karolinska sleepiness scale (KSS). Whole drive impairment was defined as >3.5 lane departures per hour. Severe end of drive impairment was defined as ≥2 lane departures in the last 15 min. The pre-drive % of time with eyes closed best predicted the whole drive impairment (area under the curve [AUC] 0.87). KSS had similar prediction ability (AUC 0.85), while PVT reaction time (AUC 0.72) was less accurate. The composite eye blink parameter, the Johns drowsiness scale was the best retrospective detector of severe end of drive impairment (AUC 0.99). The PVT reaction time (AUC 0.92) and the KSS (AUC 0.93) were less accurate. Eye blink parameters detected drowsy driving impairment with an accuracy that was similar to, or marginally better than, PVT and KSS. As eye blink measures are simple to measure, are objective and have high accuracy, they present an ideal option for the assessment of fitness for duty and roadside drowsiness.
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Affiliation(s)
- Jennifer M. Cori
- Institute for Breathing and Sleep, Austin Health Heidelberg Victoria Australia
- Department of Respiratory and Sleep Medicine, Austin Health Heidelberg Victoria Australia
- CRC for Alertness, Safety and Productivity Victoria Australia
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University Clayton Victoria Australia
| | - Vanessa E. Wilkinson
- Institute for Breathing and Sleep, Austin Health Heidelberg Victoria Australia
- Department of Respiratory and Sleep Medicine, Austin Health Heidelberg Victoria Australia
- CRC for Alertness, Safety and Productivity Victoria Australia
| | - Shamsi Shekari Soleimanloo
- Institute for Breathing and Sleep, Austin Health Heidelberg Victoria Australia
- Department of Respiratory and Sleep Medicine, Austin Health Heidelberg Victoria Australia
- CRC for Alertness, Safety and Productivity Victoria Australia
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University Clayton Victoria Australia
- Institute for Social Science Research, The University of Queensland Queensland Australia
| | - Justine Westlake
- Institute for Breathing and Sleep, Austin Health Heidelberg Victoria Australia
- Department of Respiratory and Sleep Medicine, Austin Health Heidelberg Victoria Australia
| | - Bronwyn Stevens
- Institute for Breathing and Sleep, Austin Health Heidelberg Victoria Australia
- Department of Respiratory and Sleep Medicine, Austin Health Heidelberg Victoria Australia
| | - Shantha M. W. Rajaratnam
- CRC for Alertness, Safety and Productivity Victoria Australia
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University Clayton Victoria Australia
| | - Mark E. Howard
- Institute for Breathing and Sleep, Austin Health Heidelberg Victoria Australia
- Department of Respiratory and Sleep Medicine, Austin Health Heidelberg Victoria Australia
- CRC for Alertness, Safety and Productivity Victoria Australia
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University Clayton Victoria Australia
- Department of Medicine, The University of Melbourne Parkville Victoria Australia
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27
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Lloyd R, Morgenthaler TI, Donald R, Gray DD, Lewin D, Revana A, Schutte-Rodin S, Trotti LM. Quality measures for the care of adult patients with obstructive sleep apnea: 2022 update after measure maintenance. J Clin Sleep Med 2022; 18:2673-2680. [PMID: 36308029 PMCID: PMC9622990 DOI: 10.5664/jcsm.10244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022]
Abstract
Obstructive sleep apnea (OSA) remains a highly prevalent disorder that can lead to multiple adverse outcomes when undiagnosed and/or when left untreated. There continue to be gaps and variations in the provision of care for the adult patient population with OSA, which emphasizes the importance of the measure maintenance initiative for The Quality Measures for the Care of Adult Patients with Obstructive Sleep Apnea (originally developed in 2015). The American Academy of Sleep Medicine (AASM) convened the Quality Measures Task Force in 2018 to review the current medical literature, other existing quality measures focused on the same patient population, and any performance data or data in the medical literature that show gaps or variations in care, to inform potential revisions to the quality measure set. These revised quality measures will be implemented in the AASM Sleep Clinical Data Registry (Sleep CDR) to capture performance data and encourage continuous improvement in outcomes associated with diagnosing and managing OSA in the adult population. CITATION Lloyd R, Morgenthaler TI, Donald R, et al. Quality measures for the care of adult patients with obstructive sleep apnea: 2022 update after measure maintenance. J Clin Sleep Med. 2022;18(11):2673-2680.
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Affiliation(s)
| | | | | | | | - Daniel Lewin
- Children’s National Medical Center, Washington, DC
| | - Amee Revana
- Baylor College of Medicine/Texas Children’s Hospital, Houston, Texas
| | - Sharon Schutte-Rodin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lynn Marie Trotti
- Emory Sleep Center and Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
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Anund A, Ihlström J. Threats and violence towards urban bus drivers in Sweden’: Drivers experiences and general recommendations to prevent violence and threats. Work 2022; 72:1279-1287. [DOI: 10.3233/wor-205277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Approximately 30% of Swedish urban bus drivers report having been exposed to threats or violence. As 50% of drivers have voiced concerns about the occurrences, threats and violence also represent contributing factors to driver stress and fatigue. OBJECTIVE: The aim of this study was to explore bus drivers’ experience of threats and violence; how threats and violence manifests and how the problem is handled by drivers. Gaining understanding of the circumstances is important to reduce the number of threats and violent incidents to provide healthy and attractive working conditions for drivers. METHODS: This study is based on in-depth interviews with 12 urban bus drivers in the City of Malmö in Sweden. RESULTS: Urban bus drivers experience threats daily from passengers, although physical violence occurs less often. The most common situations resulting in threats involve asking passengers to show valid tickets, denying child carriages onboard and running late to a bus stop. The drivers have not received clear guidelines as to strategic handling of the invalid ticket situation. CONCLUSIONS: Recommendations include a clear policy and consensus with regard to handling invalid tickets, providing drivers with guidelines for appropriate procedures for passengers refusing to pay, improving reporting routines and establishing a strategy for the Public Transportation provider and operator to follow with regard to reports, in-vehicle surveillance cameras including informing passengers that they are being video recorded as well as harmonizing the location of alarm buttons on buses.
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Affiliation(s)
- Anna Anund
- Swedish National Road and Transport Research Institute, Linköping, Sweden
- Rehabilitation Medicine, Linköping University, Linköping, Sweden
- Stockholm Stress Centre, Stockholm University, Stockholm, Sweden
| | - Jonas Ihlström
- Swedish National Road and Transport Research Institute, Linköping, Sweden
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29
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Correlations of Obstructive Sleep Apnea Syndrome and Daytime Sleepiness with the Risk of Car Accidents in Adult Working Population: A Systematic Review and Meta-Analysis with a Gender-Based Approach. J Clin Med 2022; 11:jcm11143971. [PMID: 35887735 PMCID: PMC9319534 DOI: 10.3390/jcm11143971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/06/2022] [Accepted: 07/06/2022] [Indexed: 01/27/2023] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is an under-recognized clinical condition and is correlated with sleepiness and impaired cognitive function. Objectives: The primary aim of this systematic review, developed within the Sleep@OSA project, was to determine the correlations of obstructive sleep apnea syndrome, daytime sleepiness and sleep-disordered breathing with the risk of car accidents in adult working populations; a secondary aim was to analyze the epidemiologic data with a gender-based approach to identify differences between women and men in the data and in associated risk factors. Methods: Clinical trials and studies reporting data on the frequency of car accidents involving adult working population with daytime sleepiness and/or OSAS compared with a control group of participants were included. Literature searches of free text and MeSH terms were performed using PubMed, Google Scholar, the Cochrane Library and Scopus from 1952 to 3 May 2021. Results and Conclusions: The search strategy identified 2138 potential articles. Of these, 49 papers were included in the qualitative synthesis, and 30 were included in the meta-analysis. Compared with controls, the odds of car accidents were found to be more than double in subjects with OSAS (OR = 2.36; 95% CI 1.92−2.91; p < 0.001), with a similar risk between commercial motor vehicle drivers (OR = 2.80; 95% CI 1.82−4.31) and noncommercial motor vehicle drivers (OR = 2.32; 95% CI 1.84−2.34). No significant correlation was found between sleepiness and car crashes, but subjects with sleep-disordered breathing were at increased risk of car accidents (OR = 1.81; 95% CI 1.42−2.31; p < 0.001). To our surprise, although epidemiological studies on the risk of road accidents in the adult population with OSAS and daytime sleepiness are currently very abundant, specific data on the female population are not available.
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An Ultra-Short Measure of Excessive Daytime Sleepiness Is Related to Circadian Biological Rhythms: The French Psychometric Validation of the Barcelona Sleepiness Index. J Clin Med 2022; 11:jcm11133892. [PMID: 35807176 PMCID: PMC9267909 DOI: 10.3390/jcm11133892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/16/2022] [Accepted: 06/16/2022] [Indexed: 11/24/2022] Open
Abstract
The Barcelona Sleepiness Index (BSI) is an ultra-short instrument with several advantages for assessing excessive daytime sleepiness (EDS). The present study was performed to analyze the validity of the French version of the BSI in screening for EDS. We conducted a cross-sectional study on a population of students using an online questionnaire. The French version of the BSI was developed by a rigorous forward-backward translation process. We computed the discrimination properties of the BSI to predict EDS assessed by the Epworth Sleepiness Scale (ESS), as well as correlations with other sleep measures. In total, 662 students were enrolled in the study (mean age: 20.9 years, 76.0% women). The BSI score (mean = 1.5 ± 1.0) showed a strong correlation with the ESS score (r = 0.47, p < 10−4) and acceptable discrimination of EDS assessed by ESS score ≥ 11 (AUC = 0.742) with an optimal cutoff point of 2, as in the original study. The BSI score was significantly associated with sleep deprivation and social jetlag. Therefore, the French version of the BSI is a valid ultra-short instrument for EDS screening in individuals. In addition, the BSI score may be associated with both homeostatic and circadian processes. Further studies are needed to confirm these findings in general populations and in patients with sleep disorders.
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31
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Gessner N, Shinbashi M, Chuluun B, Heller C, Pittaras E. Handling, task complexity, time-of-day, and sleep deprivation as dynamic modulators of recognition memory in mice. Physiol Behav 2022; 251:113803. [PMID: 35398333 DOI: 10.1016/j.physbeh.2022.113803] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 12/25/2022]
Abstract
Sleep is essential for optimal cognitive functioning. Although we lack a complete understanding of the role of sleep in memory consolidation, we know that various factors that disturb sleep or sleep quality have consequences for cognitive performance. Such factors can be unintended components of behavioral experiments on rodents and other experimental animals that generate differing results from different labs. These experimental variables include habituation to handling, intended or unintended sleep deprivation, task complexity, time of testing, and environmental features. We have examined how these variables impact recognition memory in C57BL/6 mice. Handled mice outperformed their non-handled counterparts across different combinations of delay phase duration and lighting conditions. Results also suggest that simple task recall is more resistant to diurnal variation and the impairing effects of sleep deprivation than is complex task recall. This study underscores the role of protocol and environmental factors in recognition memory and in conflicting results from different laboratories.
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Affiliation(s)
- Nicholas Gessner
- Stanford University Department of Biology, 371 Jane Stanford Way, Stanford, CA 94305-5020
| | - Meagan Shinbashi
- Stanford University Department of Biology, 371 Jane Stanford Way, Stanford, CA 94305-5020
| | - Bayarsaikhan Chuluun
- Stanford University Department of Biology, 371 Jane Stanford Way, Stanford, CA 94305-5020
| | - Craig Heller
- Stanford University Department of Biology, 371 Jane Stanford Way, Stanford, CA 94305-5020
| | - Elsa Pittaras
- Stanford University Department of Biology, 371 Jane Stanford Way, Stanford, CA 94305-5020.
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32
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Hagan-Haynes K, Ramirez-Cardenas A, Wingate KC, Pratt S, Ridl S, Schmick E, Snawder J, Dalsey E, Hale C. On the road again: A cross-sectional survey examining work schedules, commuting time, and driving-related outcomes among U.S. oil and gas extraction workers. Am J Ind Med 2022; 65:749-761. [PMID: 35735247 PMCID: PMC10078245 DOI: 10.1002/ajim.23405] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/20/2022] [Accepted: 05/31/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Oil and gas extraction (OGE) workers in the United States experience high fatality rates, with motor vehicle crashes the leading cause of death. Land-based OGE workers drive frequently to remote and temporary worksites. Limited information is available on factors that may influence crash risk for this workforce. METHODS A cross-sectional survey of 500 land-based OGE workers examined work schedules and hours, commuting, sleep, employer policies, and their relationship to potentially harmful events while driving. RESULTS Over 60% of participants worked 12 or more hours per day. The mean daily roundtrip commuting time was 1.82 h. Longer daily commutes, nonstandard work schedules, less sleep on workdays, and lack of employer policies were associated with one or more risky driving-related outcomes. CONCLUSIONS Implementation and evaluation of OGE employer policies and programs to limit long work hours, reduce long daily commutes, promote sufficient sleep, and reduce drowsy driving among U.S. OGE workers are needed.
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Affiliation(s)
- Kyla Hagan-Haynes
- Western States Division, National Institute for Occupational Safety and Health, Lakewood, Colorado, USA
| | | | - Kaitlin C Wingate
- Western States Division, National Institute for Occupational Safety and Health, Lakewood, Colorado, USA
| | - Stephanie Pratt
- Western States Division, National Institute for Occupational Safety and Health, Lakewood, Colorado, USA
| | - Sophie Ridl
- Western States Division, National Institute for Occupational Safety and Health, Lakewood, Colorado, USA
| | - Emily Schmick
- Western States Division, National Institute for Occupational Safety and Health, Lakewood, Colorado, USA
| | - John Snawder
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Elizabeth Dalsey
- Western States Division, National Institute for Occupational Safety and Health, Lakewood, Colorado, USA
| | - Christa Hale
- Western States Division, National Institute for Occupational Safety and Health, Lakewood, Colorado, USA
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33
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Bowers SJ, Summa KC, Thompson RS, González A, Vargas F, Olker C, Jiang P, Lowry CA, Dorrestein PC, Knight R, Wright KP, Fleshner M, Turek FW, Vitaterna MH. A Prebiotic Diet Alters the Fecal Microbiome and Improves Sleep in Response to Sleep Disruption in Rats. Front Neurosci 2022; 16:889211. [PMID: 35685770 PMCID: PMC9172596 DOI: 10.3389/fnins.2022.889211] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/28/2022] [Indexed: 12/16/2022] Open
Abstract
Sleep disruption is a challenging and exceedingly common physiological state that contributes to a wide range of biochemical and molecular perturbations and has been linked to numerous adverse health outcomes. Modern society exerts significant pressure on the sleep/wake cycle via myriad factors, including exposure to electric light, psychological stressors, technological interconnection, jet travel, shift work, and widespread use of sleep-affecting compounds. Interestingly, recent research has identified a link between the microbiome and the regulation of sleep, suggesting that interventions targeting the microbiome may offer unique therapeutic approaches to challenges posed by sleep disruption. In this study, we test the hypothesis that administration of a prebiotic diet containing galactooligosaccharides (GOS) and polydextrose (PDX) in adult male rats improves sleep in response to repeated sleep disruption and during recovery sleep. We found that animals fed the GOS/PDX prebiotic diet for 4 weeks exhibit increased non-rapid eye movement (NREM) and rapid eye movement (REM) sleep during 5 days of sleep disruption and increased total sleep time during 24 h of recovery from sleep disruption compared to animals fed a control diet, despite similar baseline sleep characteristics. Further, the GOS/PDX prebiotic diet led to significant changes in the fecal microbiome. Consistent with previous reports, the prebiotic diet increased the relative abundance of the species Parabacteroides distasonis, which positively correlated with sleep parameters during recovery sleep. Taken together, these findings suggest that the GOS/PDX prebiotic diet may offer an approach to improve resilience to the physiologic challenge of sleep disruption, in part through impacts on the microbiome.
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Affiliation(s)
- Samuel J. Bowers
- Center for Sleep and Circadian Biology, Northwestern University, Evanston, IL, United States
- Department of Neurobiology, Northwestern University Weinberg College of Arts and Sciences, Evanston, IL, United States
| | - Keith C. Summa
- Center for Sleep and Circadian Biology, Northwestern University, Evanston, IL, United States
- Division of Gastroenterology & Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Robert S. Thompson
- Department of Integrative Physiology, University of Colorado, Boulder, Boulder, CO, United States
- Center for Neuroscience, University of Colorado, Boulder, Boulder, CO, United States
| | - Antonio González
- Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, CA, United States
| | - Fernando Vargas
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy & Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Christopher Olker
- Center for Sleep and Circadian Biology, Northwestern University, Evanston, IL, United States
- Department of Neurobiology, Northwestern University Weinberg College of Arts and Sciences, Evanston, IL, United States
| | - Peng Jiang
- Center for Sleep and Circadian Biology, Northwestern University, Evanston, IL, United States
- Department of Neurobiology, Northwestern University Weinberg College of Arts and Sciences, Evanston, IL, United States
| | - Christopher A. Lowry
- Department of Integrative Physiology, University of Colorado, Boulder, Boulder, CO, United States
- Center for Neuroscience, University of Colorado, Boulder, Boulder, CO, United States
| | - Pieter C. Dorrestein
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy & Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States
- Center for Microbiome Innovation, University of California, San Diego, La Jolla, CA, United States
| | - Rob Knight
- Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, CA, United States
- Center for Microbiome Innovation, University of California, San Diego, La Jolla, CA, United States
- Department of Computer Science and Engineering, University of California, San Diego, La Jolla, CA, United States
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, United States
| | - Kenneth P. Wright
- Department of Integrative Physiology, University of Colorado, Boulder, Boulder, CO, United States
- Center for Neuroscience, University of Colorado, Boulder, Boulder, CO, United States
- Sleep and Chronobiology Laboratory, University of Colorado, Boulder, Boulder, CO, United States
| | - Monika Fleshner
- Department of Integrative Physiology, University of Colorado, Boulder, Boulder, CO, United States
- Center for Neuroscience, University of Colorado, Boulder, Boulder, CO, United States
| | - Fred W. Turek
- Center for Sleep and Circadian Biology, Northwestern University, Evanston, IL, United States
- Department of Neurobiology, Northwestern University Weinberg College of Arts and Sciences, Evanston, IL, United States
- The Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Martha H. Vitaterna
- Center for Sleep and Circadian Biology, Northwestern University, Evanston, IL, United States
- Department of Neurobiology, Northwestern University Weinberg College of Arts and Sciences, Evanston, IL, United States
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34
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Fernandes GL, Araujo P, Tufik S, Andersen ML. SLEEPINESS PROFILES IN MICE SUBMITTED TO ACUTE AND CHRONIC SLEEP DEPRIVATION. Behav Processes 2022; 200:104661. [PMID: 35618241 DOI: 10.1016/j.beproc.2022.104661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/09/2022] [Accepted: 05/16/2022] [Indexed: 11/29/2022]
Abstract
Sleepiness is a behavioural consequence of sleep pressure, which shows interindividual variation, a characteristic possibly related to central sleep mechanisms. However, there is a lack of evidence linking progressive sleep need and sleepiness with factors of individual variability, which could be tested by total acute and chronic sleep deprivation. Thus, the objective of the study was to investigate the development of sleepiness in sleep deprived mice. Male C57BL/6J mice were distributed in sleep deprivation, sleep rebound and control groups. Animals underwent acute sleep deprivation for 3, 6, 9 or 12hours or chronic sleep deprivation for 6hours for 5 consecutive days. Sleep rebound groups had a sleep opportunity for 1, 2, 3, or 4hours after acute sleep deprivation or 24hours after chronic sleep deprivation. During the protocols, sleep attempts were counted to calculate a sleepiness index. After euthanasia, blood was collected for corticosterone assessment. Using the average of group sleep attempts, it was possible to differentiate between sleepy (mean>group average) and resistant animals (mean<group average). Resistant mice were more frequent in all protocols. Individual variation accounted for 52% of sleepiness variance during chronic sleep deprivation and extended wakefulness explained 68% of sleepiness variance during acute sleep deprivation. A normal corticosterone peak was observed at the start of the dark phase, independent of sleep deprivation. Different profiles of sleepiness emerged in sleep deprived mice. Sleep deprivation was the main factor for sleepiness during acute sleep deprivation whereas in chronic deprivation individual variation was more relevant.
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Affiliation(s)
| | - Paula Araujo
- Departamento de Psicobiologia - Universidade Federal de São Paulo - São Paulo, Brazil; Departamento de Ciências Fisiológicas - Escola de Ciências Médicas, Santa Casa de São Paulo - São Paulo, Brazil
| | - Sergio Tufik
- Departamento de Psicobiologia - Universidade Federal de São Paulo - São Paulo, Brazil
| | - Monica Levy Andersen
- Departamento de Psicobiologia - Universidade Federal de São Paulo - São Paulo, Brazil.
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35
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Sandness DJ, McCarter SJ, Dueffert LG, Shepard PW, Enke AM, Fields J, Mielke MM, Boeve BF, Silber MH, St. Louis EK. Cognition and driving ability in isolated and symptomatic REM sleep behavior disorder. Sleep 2022; 45:zsab253. [PMID: 34958375 PMCID: PMC8996024 DOI: 10.1093/sleep/zsab253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/28/2021] [Indexed: 12/30/2022] Open
Abstract
STUDY OBJECTIVES To analyze cognitive deficits leading to unsafe driving in patients with REM Sleep Behavior Disorder (RBD), strongly associated with cognitive impairment and synucleinopathy-related neurodegeneration. METHODS Twenty isolated RBD (iRBD), 10 symptomatic RBD (sRBD), and 20 age- and education-matched controls participated in a prospective case-control driving simulation study. Group mean differences were compared with correlations between cognitive and driving safety measures. RESULTS iRBD and sRBD patients were more cognitively impaired than controls in global neurocognitive functioning, processing speeds, visuospatial attention, and distractibility (p < .05). sRBD patients drove slower with more collisions than iRBD patients and controls (p < .05), required more warnings, and had greater difficulty following and matching speed of a lead car during simulated car-following tasks (p < .05). Driving safety measures were similar between iRBD patients and controls. Slower psychomotor speed correlated with more off-road accidents (r = 0.65) while processing speed (-0.88), executive function (-0.90), and visuospatial impairment (0.74) correlated with safety warnings in sRBD patients. Slower stimulus recognition was associated with more signal-light (0.64) and stop-sign (0.56) infractions in iRBD patients. CONCLUSIONS iRBD and sRBD patients have greater selective cognitive impairments than controls, particularly visuospatial abilities and processing speed. sRBD patients exhibited unsafe driving behaviors, associated with processing speed, visuospatial awareness, and attentional impairments. Our results suggest that iRBD patients have similar driving-simulator performance as healthy controls but that driving capabilities regress as RBD progresses to symptomatic RBD with overt signs of cognitive, autonomic, and motor impairment. Longitudinal studies with serial driving simulator evaluations and objective on-road driving performance are needed.
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Affiliation(s)
- David J Sandness
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, MN, USA
- Mayo Center for Sleep Medicine, Rochester, MN, USA
| | - Stuart J McCarter
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, MN, USA
- Mayo Center for Sleep Medicine, Rochester, MN, USA
- Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Lucas G Dueffert
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, MN, USA
- Park Nicollet Rehabilitation, Maple Grove, MN, USA
| | - Paul W Shepard
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, MN, USA
| | - Ashley M Enke
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, MN, USA
| | - Julie Fields
- Department of Psychiatry, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Michelle M Mielke
- Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
- Department of Health Sciences Research, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Bradley F Boeve
- Mayo Center for Sleep Medicine, Rochester, MN, USA
- Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Michael H Silber
- Mayo Center for Sleep Medicine, Rochester, MN, USA
- Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Erik K St. Louis
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, MN, USA
- Mayo Center for Sleep Medicine, Rochester, MN, USA
- Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
- Department of Medicine, Mayo Clinic and Foundation, Rochester, MN, USA
- Mayo Clinic Health System Southwest Wisconsin, La Crosse, WI, USA
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Kim SK, Yong SY. Relationship Between Poor Sleep Quality and Injury Experience in Korea. Asia Pac J Public Health 2022; 34:537-546. [PMID: 35392671 DOI: 10.1177/10105395221088619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To develop preventive policies to reduce injuries, the responsible factors should be identified. In this study, causative factors were identified by analyzing data from the Korean Community Health Survey. Logistic regression was used to analyze the data of 192 480 individuals in the survey. Correlations were found between the injury experience and the following socioeconomic factors: age, sex, monthly income, smoking status, education, marital status, and neuropsychiatric factors: depressive symptoms, cognitive decline, and stress. The study subjects were divided into two groups based on sleep quality, as determined by Pittsburgh Sleep Quality Indices of ≤5 or >5. Logistic regression analysis adjusted for potential confounders revealed a correlation between sleep quality and injury experience. The odds ratio (OR) of poor sleep quality was associated with higher odds of injury (OR: 1.26, 95% confidence interval [1.19, 1.34]), and it was also associated with higher odds of severe injury (OR: 1.23, 95% confidence interval [1.15, 1.32]), even in the adjustment of socioeconomic factors only as well as in the adjustment of socioeconomic and neuropsychiatric factors. Poor sleep quality was associated with higher odds of several injury mechanisms of severe injury, such as slipping, poisoning, and falling into water.
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Affiliation(s)
- Sung-Kyung Kim
- Department of Occupational and Environmental Medicine, Wonju Severance Christian's Hospital, Yonsei University, Wonju, Republic of Korea
| | - Sang Yeol Yong
- Department of Rehabilitation Medicine, Wonju Severance Christian's Hospital, Yonsei University, Wonju, Republic of Korea.,IOC Research Centre Korea, Republic of Korea
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Leclair-Visonneau L. Orientation diagnostique devant une plainte d’hypersomnolence. Rev Med Interne 2022; 43:429-435. [DOI: 10.1016/j.revmed.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/12/2022] [Accepted: 01/22/2022] [Indexed: 11/17/2022]
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Maghsoudipour M, Moradi R, Moghimi S, Ancoli-Israel S, DeYoung PN, Malhotra A. Time of day, time of sleep, and time on task effects on sleepiness and cognitive performance of bus drivers. Sleep Breath 2022; 26:1759-1769. [DOI: 10.1007/s11325-021-02526-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/08/2021] [Accepted: 11/05/2021] [Indexed: 10/19/2022]
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40
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Felix M, Intriago Alvarez MB, Vanegas E, Farfán Bajaña MJ, Sarfraz Z, Sarfraz A, Michel J, Cherrez-Ojeda I. Risk of obstructive sleep apnea and traffic accidents among male bus drivers in Ecuador: Is there a significant relationship? Ann Med Surg (Lond) 2022; 74:103296. [PMID: 35145670 PMCID: PMC8818532 DOI: 10.1016/j.amsu.2022.103296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/17/2022] [Accepted: 01/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) represents an important occupational health concern in the transportation industry, affecting a substantial percentage of transportation operators. Our study aims to determine the frequency of individuals at high risk of obstructive sleep apnea, and excessive daytime sleepiness, as well as any potential association between these conditions and traffic accidents among a sample of Ecuadorian bus drivers. Methods We conducted a cross-sectional study involving 340 commercial bus drivers from Ecuador. Descriptive statistics were used to determine frequency and proportions for demographic and clinical variables. A Kendall's tau-b was performed to ascertain the relationship between the STOP-Bang score towards the Epworth Sleepiness Scale (ESS) score and the number of accidents and near accidents. Results In general, 18.5% (n = 63) of participants were found to be at high-risk for OSA. There was a weak positive correlation between STOP-Bang score and ESS score (τb = 0.244, p = .000). We also found a statistically significant, although negligible, correlation between the STOP-Bang score and the number of accidents (τb = 0.096, p = .039) and near accidents (τb = 0.120, p = .008). Conclusion Our results suggest that a considerable proportion of Ecuadorian bus drivers were at high-risk for obstructive sleep apnea. Higher STOP-Bang scores were correlated with an increased number of accidents and near accidents. Additional studies are needed to determine whether additional interventions could increase road safety by taking care of undiagnosed and untreated OSA cases in a timely manner. Untreated obstructive sleep apnea is a significant contributor to motor vehicle crashes. The main consequence related to OSA is excessive daytime sleepiness, which is associated with increased risk of accidents. A considerable proportion of Ecuadorian bus drivers were at high-risk for obstructive sleep apnea. Higher STOP-Bang scores were correlated with an increased number of accidents and near accidents.
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Beetz G, Herrero Babiloni A, Jodoin M, Charlebois-Plante C, Lavigne GJ, De Beaumont L, Rouleau DM. Relevance of Sleep Disturbances to Orthopaedic Surgery: A Current Concepts Narrative and Practical Review. J Bone Joint Surg Am 2021; 103:2045-2056. [PMID: 34478407 DOI: 10.2106/jbjs.21.00176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Sleep disturbances can increase the risk of falls and motor vehicle accidents and may reduce bone density. ➤ Poor sleep can lead to worse outcomes after fracture, such as chronic pain and delayed recovery. ➤ Orthopaedic surgeons can play an important role in the screening of sleep disorders among their patients.
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Affiliation(s)
- Gabrielle Beetz
- Montreal Sacré-Coeur Hospital, Montreal, Quebec, Canada.,Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Alberto Herrero Babiloni
- Montreal Sacré-Coeur Hospital, Montreal, Quebec, Canada.,Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Marianne Jodoin
- Montreal Sacré-Coeur Hospital, Montreal, Quebec, Canada.,Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | | | - Gilles J Lavigne
- Montreal Sacré-Coeur Hospital, Montreal, Quebec, Canada.,Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada.,Faculty of Dental Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Louis De Beaumont
- Montreal Sacré-Coeur Hospital, Montreal, Quebec, Canada.,Department of Surgery, University of Montreal, Montreal, Quebec, Canada
| | - Dominique M Rouleau
- Montreal Sacré-Coeur Hospital, Montreal, Quebec, Canada.,Department of Surgery, University of Montreal, Montreal, Quebec, Canada
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Coelho J, Lopez R, Richaud A, Buysse DJ, Wallace ML, Philip P, Micoulaud-Franchi JA. Toward a multi-lingual diagnostic tool for the worldwide problem of sleep health: The French RU-SATED validation. J Psychiatr Res 2021; 143:341-349. [PMID: 34563876 DOI: 10.1016/j.jpsychires.2021.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/24/2021] [Accepted: 09/01/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Sleep health is "a multidimensional pattern of sleep-wakefulness, adapted to individual, social, and environmental demands, that promotes physical and mental well-being". The RU-SATED is a short practical self-reported symptom scale that is a reliable valid tool for the rapid evaluation of sleep health. This study sought to examine the psychometric validity of the French version. METHODS We conducted an observational cross-sectional study. All professionals working in Bordeaux University Hospital were asked to answer an internet-based questionnaire assessing sleep, mental and physical health outcomes. Sleep health was measured using the French RU-SATED scale obtained by a rigorous reverse translation process. Psychometric validity included factor structure, internal structural validity, concurrent validity and external validity of the measure, with sleep, mental and physical health outcomes. RESULTS A total of 1,562 participants were included with 80.5% of women and a mean age of 40.0 (±11.2). Sleep health was within the average range (M = 8.2, SD = 2.4) on the RU-SATED. Confirmatory factor analyses showed acceptable model fit measures. Cronbach's alpha coefficient was 0.57 and ranged from 0.46 to 0.58 when removing each item. The correlation between items with the overall corrected scores ranged from 0.19 to 0.43. The "Efficiency" item showed poor psychometric properties. Most items were highly correlated with their appropriate sleep outcome. All items showed a strong association with positive mental and physical health outcomes. DISCUSSION The French RU-SATED scale is a reliable valid tool for measuring sleep health in adults. Nevertheless, future studies should better evaluate the reliability and validity of the "Efficiency" item. It is also important to explore how the RU-SATED can be used to evaluate the impact of sleep hygiene strategies in promoting public health in accordance with models of sleep behavior change.
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Affiliation(s)
- Julien Coelho
- Univ. Bordeaux, SANPSY, USR 3413, F-33000, Bordeaux, France; CNRS, SANPSY, USR 3413, F-33000, Bordeaux, France; CHU Bordeaux, Service Universitaire de Médecine Du sommeil, F-33000, Bordeaux, France.
| | - Régis Lopez
- Sleep Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France; Inserm, U1061, Université Montpellier 1, Montpellier, France
| | - Alexandre Richaud
- Univ. Bordeaux, SANPSY, USR 3413, F-33000, Bordeaux, France; CNRS, SANPSY, USR 3413, F-33000, Bordeaux, France; CHU Bordeaux, Service Universitaire de Médecine Du sommeil, F-33000, Bordeaux, France
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Pierre Philip
- Univ. Bordeaux, SANPSY, USR 3413, F-33000, Bordeaux, France; CNRS, SANPSY, USR 3413, F-33000, Bordeaux, France; CHU Bordeaux, Service Universitaire de Médecine Du sommeil, F-33000, Bordeaux, France
| | - Jean-Arthur Micoulaud-Franchi
- Univ. Bordeaux, SANPSY, USR 3413, F-33000, Bordeaux, France; CNRS, SANPSY, USR 3413, F-33000, Bordeaux, France; CHU Bordeaux, Service Universitaire de Médecine Du sommeil, F-33000, Bordeaux, France
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Rezaei F, Komasi S. Reconsideration of Driving License Delivery Policies Based on Screening of Personality and Sleep Disorders in Iran. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:1293-1294. [PMID: 34540755 PMCID: PMC8410980 DOI: 10.18502/ijph.v50i6.6435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 11/20/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Farzin Rezaei
- Neurosciences Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Saeid Komasi
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran.,Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran
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Lin CL, Su MC, Lin CP, Sun CA, Chung CH, Chien WC. Obstructive sleep apnea and injury events in Taiwanese adults: A retrospective cohort study. J Nurs Scholarsh 2021; 54:38-45. [PMID: 34396682 DOI: 10.1111/jnu.12697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 06/17/2021] [Accepted: 07/08/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to examine the association between obstructive sleep apnea (OSA) diagnosis and diverse types of injuries. DESIGN This population-based retrospective cohort study compared records from 2000 to 2013 in the Taiwan National Health Insurance Research Database. METHODS 3025 patients identified with OSA were compared against the control cohort consisting of 12,100 age- and sex-matched patients. Cox proportional hazards regression analysis was performed to estimate the effects of OSA on injury risk. FINDINGS Patients with OSA exhibited a significantly higher overall incidence of injury of 2599 per 100,000 person-years compared to the control cohort (2248 per 100,000 person-years). After the confounding factors were considered, subjects with OSA showed a higher risk of injury than subjects in the control group (adjusted hazard ratio [HR] = 1.78, 95% confidence interval [CI] = 1.64-1.93). The risk of unintentional injury (traffic, poisoning, falls) and intentional injury (suicide) in the group of patients with OSA was higher than that in the controls. CONCLUSIONS Our study strongly supports the conclusion that adults with OSA are at increased risk of injury. CLINICAL RELEVANCE The present results indicate the significance of OSA as a predictor of injury risk, which will provide valuable information for clinical practice and injury prevention.
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Affiliation(s)
- Chia-Ling Lin
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan, R.O.C
| | - Mei-Chen Su
- Department of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, R.O.C
| | - Chun-Ping Lin
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, R.O.C
| | - Chien-An Sun
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, R.O.C.,Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, R.O.C
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, R.O.C.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan, R.O.C
| | - Wu-Chien Chien
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan, R.O.C.,Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan, R.O.C.,School of Public Health, Graduate Institute of Science, National Defense Medical Center, Taipei, Taiwan, R.O.C
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45
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Selvaraj S, Eusufzai SZ, Asif JA, Bin Jamayet N, Ahmad WMAW, Alam MK. Comparison of knowledge level and attitude towards obstructive sleep apnoea amongst dental and medical undergraduate students of Universiti Sains Malaysia. Work 2021; 69:173-180. [PMID: 33998580 DOI: 10.3233/wor-213466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Sleep apnoea is a diagnosed condition in which appurtenances interrupt breathing whilst sleeping. The consequence of obstructive sleep apnoea (OSA) includes road traffic accidents due to drowsiness, systemic hypertension, heart disease, diabetes mellitus and neurocognitive disorders. This condition extends the duration of recovery phase after traumatic brain injury. OBJECTIVE This study was intended to assess the knowledge and attitude towards OSA and compare it among dental and medical undergraduate students of University Sains Malaysia (USM). METHODS In this study, a total of 216 clinical undergraduate students (36 from each year; 108 from medical and 108 from dental school) of University Sains Malaysia (USM) Health campus were recruited for the study by non-probability stratified random sampling method. Total study period was October 2017 to October 2018. A self-administered questionnaire was used to assess the sociodemographic status and OSAKA questionnaire was used to assess knowledge and attitude regarding sleep apnoea of the respondents. Descriptive analysis was carried out to assess the knowledge and attitude of OSA amongst dental and medical undergraduate students of USM. The Mann-Whitney U test was carried out to compare the knowledge and attitude of OSA amongst dental and medical undergraduate students of USM. RESULTS Our study findings revealed that 0.9 %and 6.5 %of the dental undergraduate students and medical undergraduate students could answer all the questions correctly regarding knowledge of OSA. Based on the assessment of the difference between medical and dental students in terms of knowledge towards OSA patients, significant difference was observed at the significance level of 95%, where p < 0.05 but no difference found in attitude towards OSA. However, significant difference was found towards attitude on treating OSA patients p < 0.05. CONCLUSIONS A difference was observed in the knowledge and attitude on OSA between dental and medical undergraduate students in USM; however, medical undergraduate students had better knowledge and attitude towards OSA than dental students.
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Affiliation(s)
- Siddharthan Selvaraj
- Department of Community Medicine, Faculty of Medicine, Universiti Sultan Zainal Abidin, Terengganu, Malaysia.,Dental Public Health Unit, School of Dental Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Sumaiya Zabin Eusufzai
- Dental Public Health Unit, School of Dental Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Jawaad Ahmed Asif
- Consultant, Oral and Maxillofacial surgeon, Prince Mutaib Bin Abdul Aziz Hospital, Ministry of Health, Al-Jouf, Kingdom of Saudi Arabia
| | - Nafij Bin Jamayet
- Division of Clinical Dentistry (Prosthodontics), School of Dentistry, International Medical University, Kualalumpur, Malaysia
| | - Wan Muhamad Amir W Ahmad
- Department of Biostatistics, School of Dental Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Mohammad Khursheed Alam
- Department of Preventive Dental Science, Orthodontic Division, College of Dentistry, Jouf University, Kingdom of Saudi Arabia
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Sleepiness Behind the Wheel and the Implementation of European Driving Regulations. Sleep Med Clin 2021; 16:533-543. [PMID: 34325829 DOI: 10.1016/j.jsmc.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Sleep disturbance and sleepiness are established risk factors for driving accidents and obstructive sleep apnea (OSA) is the most prevalent medical disorder associated with excessive daytime sleepiness. Because effective treatment of OSA reduces accident risk, several jurisdictions have implemented regulations concerning the ability of patients with OSA to drive, unless effectively treated. This review provides a practical guide for clinicians who may be requested to certify a patient with OSA as fit to drive regarding the scope of the problem, the role of questionnaires and driving simulators to evaluate sleepiness, and the benefit of treatment on accident risk.
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Wirth M, Bautz M, von Meyer F, Hofauer B, Strassen U, Heiser C. Obstruction level associated with outcome in hypoglossal nerve stimulation. Sleep Breath 2021; 26:419-427. [PMID: 34091793 PMCID: PMC8857010 DOI: 10.1007/s11325-021-02396-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 03/30/2021] [Accepted: 05/04/2021] [Indexed: 01/14/2023]
Abstract
Purpose Selective hypoglossal nerve stimulation (sHNS) constitutes an effective surgical alternative for patients with obstructive sleep apnea (OSA). sHNS results in tongue protrusion and consecutive alleviation of obstructions at the tongue base level (lower obstructions). Furthermore, obstructions at the soft palate level (upper obstructions) may be prevented through palatoglossal coupling as seen on sleep endoscopy. However, it has not been studied if the distribution of obstruction level during a whole night measurement is a relevant factor for the treatment outcome. Methods Obstruction levels were measured with a manometry system during a whole night of sleep in 26 patients with OSA (f = 1, m = 25; age 59.4 ± 11.3; BMI = 29.6 ± 3.6) either before (n = 9) or after sHNS implantation (n = 12). Five patients received a measurement before and after implantation. Obstructions were categorized into velar (soft palate and above), infravelar (below soft palate), and multilevel obstructions. An association between obstruction level and treatment outcome was calculated. Results The mean distribution of preoperative obstruction level could be divided into the following: 38% velar, 46% multilevel, and 16% infravelar obstructions. Patients with a good treatment response (defined as AHI < 15/h and AHI reduction of 50%) had fewer preoperative velar obstructions compared to non-responder (17% vs. 54%, p-value = 0.006). In patients measured after sHNS implantation, a significantly higher rate of multilevel obstructions per hour was measured in non-responders (p-value = 0.012). Conclusions Selective hypoglossal nerve stimulation was more effective in patients with fewer obstructions at the soft palate level. Manometry may be a complementary diagnostic procedure for the selection of patients for HNS.
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Affiliation(s)
- Markus Wirth
- Department of Otolaryngology - Head and Neck Surgery, Technical University of Munich, Klinikum rechts der Isar, Hals-Nasen-Ohren-Klinik, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Maximilian Bautz
- Department of Otolaryngology - Head and Neck Surgery, Technical University of Munich, Klinikum rechts der Isar, Hals-Nasen-Ohren-Klinik, Ismaninger Straße 22, 81675, Munich, Germany
| | - Franziska von Meyer
- Department of Otolaryngology - Head and Neck Surgery, Technical University of Munich, Klinikum rechts der Isar, Hals-Nasen-Ohren-Klinik, Ismaninger Straße 22, 81675, Munich, Germany
| | - Benedikt Hofauer
- Department of Otolaryngology - Head and Neck Surgery, Technical University of Munich, Klinikum rechts der Isar, Hals-Nasen-Ohren-Klinik, Ismaninger Straße 22, 81675, Munich, Germany
| | - Ulrich Strassen
- Department of Otolaryngology - Head and Neck Surgery, Technical University of Munich, Klinikum rechts der Isar, Hals-Nasen-Ohren-Klinik, Ismaninger Straße 22, 81675, Munich, Germany
| | - Clemens Heiser
- Department of Otolaryngology - Head and Neck Surgery, Technical University of Munich, Klinikum rechts der Isar, Hals-Nasen-Ohren-Klinik, Ismaninger Straße 22, 81675, Munich, Germany
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Genetic links between narcolepsy and ADHD. Transl Psychiatry 2021; 11:333. [PMID: 34050129 PMCID: PMC8163763 DOI: 10.1038/s41398-021-01420-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/18/2021] [Accepted: 04/06/2021] [Indexed: 11/08/2022] Open
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Onninen J, Pylkkönen M, Tolvanen A, Sallinen M. Accumulation of sleep loss among shift-working truck drivers. Chronobiol Int 2021; 38:1344-1353. [PMID: 34030528 DOI: 10.1080/07420528.2021.1929280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Sleep loss is known to contribute to road traffic accidents. Professional drivers are vulnerable to curtailment of sleep due to long driving bouts and shift work. To fill in the gap in the literature related to the buildup of sleep loss in irregular shift systems, we recorded the sleep and working hours of 47 shift-working long-haul truck drivers during a two-week period. Sleep (time in bed) was verified by actigraphy and sleep logs. Sleepiness was measured using the Karolinska Sleepiness Scale (KSS). Individual sleep need was based on self-assessments. We examined the accumulated sleep versus self-reported sleep need across the study period, using midnights as points of observation, and the accumulated sleep loss within 72 h prior to shift end (sleep versus need, SVN72). Across the study period, the drivers' sleep was close to their self-reported sleep need, but 45% of the drivers showed accumulated sleep loss of >6 h at least once. SVN72 averaged -1.5 h and was 2.87 h shorter in connection with morning shifts compared to day or evening shifts. Night shifts showed no such difference. During days off, sleep exceeded sleep need by 1.13 h and was not dependent on the type of preceding work shift. SVN72 showed small-to-medium negative associations with on-duty KSS even after accounting for sleep within the 24 h prior to the shift end. Our results show that long-haul truck drivers are exposed to severe levels of accumulated sleep loss while working irregular shifts, but they can catch up on their lost sleep, especially during days off.
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Affiliation(s)
- Jussi Onninen
- Finnish Institute of Occupational Health, Helsinki, Finland.,Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Mia Pylkkönen
- Finnish Institute of Occupational Health, Helsinki, Finland.,Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Asko Tolvanen
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Mikael Sallinen
- Finnish Institute of Occupational Health, Helsinki, Finland.,Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
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Yarlas A, White MK, St Pierre DG, Bjorner JB. The development and validation of a revised version of the Medical Outcomes Study Sleep Scale (MOS Sleep-R). J Patient Rep Outcomes 2021; 5:40. [PMID: 34009504 PMCID: PMC8134597 DOI: 10.1186/s41687-021-00311-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 04/27/2021] [Indexed: 12/22/2022] Open
Abstract
Background The 12-item Medical Outcomes Study Sleep Scale (MOS Sleep Scale) has been used to capture patient-reported sleep problems in hundreds of studies. A revised version of the MOS Sleep Scale (MOS Sleep-R) was developed that uses simplified response sets, provides interpretable norm-based scoring, and has two recall versions (one-week or four-week). The objective of this study was to evaluate the psychometric properties (reliability and construct validity) of the MOS Sleep-R using data from a representative sample of U.S. adults. Methods Standardization of raw scores into norm-based T-scores (mean = 50, standard deviation = 10) was based on data from a 2009 U.S. internet-based general population survey. The internal consistency reliability of multi-item subscales and global sleep problems indices for both one-week and four-week recall forms of the MOS Sleep-R were examined using Cronbach’s alphas and inter-item correlations. Construct validity was tested by comparing item-scale correlations between items within subscales with item-scale correlations across subscales. Scale-level convergent validity was tested using correlations with measures including generic health-related quality of life (i.e., SF-36v2) and other relevant outcomes (e.g., job performance, number of days in bed due to illness or injury, happiness/satisfaction with life, frequency of stress/pressure in daily life, the impact of stress/pressure on health, and overall health). Results The one-week and four-week recall forms of the MOS Sleep-R were completed by 2045 and 2033 respondents, respectively. The psychometric properties of the one-week and four-week forms were similar. All multi-item subscales and global index scores showed adequate internal consistency reliability (all Cronbach’s alpha > 0.75). Patterns of inter-item and item-scale correlations support the scaling assumptions of the MOS Sleep-R. Patterns of correlations between MOS Sleep-R scores with criterion measures of health-related quality of life and other outcomes indicated adequate construct validity. Conclusions The MOS Sleep-R introduces a number of revisions to the original survey, including simplified response sets, the introduction of a one-week recall form, and norm-based scoring that enhances interpretability of scores. Both the one-week and four-week recall period forms of the MOS Sleep-R demonstrated good internal consistency reliability and construct validity in a U.S. general population sample.
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Affiliation(s)
- Aaron Yarlas
- QualityMetric, 1301 Atwood Ave, Suite 216E, Johnston, RI, USA.
| | | | | | - Jakob B Bjorner
- QualityMetric, 1301 Atwood Ave, Suite 216E, Johnston, RI, USA.,Department of Public Health, University of Copenhagen, Gothersgade 160, DK-1123, Copenhagen, Denmark.,The Danish National Research Centre for the Working Environment, Lerso Park Alle 105, DK-2100, Copenhagen, Denmark
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