An approach to excessive daytime sleepiness in adults

Global prevalence of excessive daytime sleepiness among nurses: A systematic review and meta-analysis

BACKGROUND

Nurses face significant risks of excessive daytime sleepiness (EDS), which adversely affects workplace safety and productivity. Yet, the extent of EDS in this workforce remains inadequately characterized.

AIM

The aims of this systematic review were to assess the pooled prevalence of EDS among nurses.

METHODOLOGY

We systematically searched PubMed, Embase, Scopus, and ISI Web of Science for observational studies reporting the prevalence of EDS, as measured by the Epworth Sleepiness Scale (ESS), from database inception to May 1, 2024, with no language restrictions. Study quality was evaluated using JBI's critical appraisal tool. Pooled estimates were calculated through random-effects meta-analysis, with subgroup and meta-regression analyses assessing associations between EDS prevalence and study-level factors. Linear regression modeling was used to assess time trends. This study was registered with PROSPERO (CRD42024535109).

RESULTS

We included 36 unique studies encompassing 2677 nurses from 20 countries. EDS occurred in 14.0%-55.6% of nurses. The results of the meta-analysis showed a pooled prevalence of EDS of 32.2% (95% confidence interval [CI]: 28.5-36.1; I2 = 92.6). Prevalence estimate did not vary substantially in terms of study-level data (i.e., region, country income, pre/post covid era, hospital type, proportion of female nurse, average nursing experience, or proportion of married nurses). The prevalence of EDS in nurses has remained unchanged over time.

CONCLUSIONS

This meta-analysis identifies a high global prevalence of EDS among nurses, affecting nearly one-third of this workforce. The findings underscore the urgent need for targeted interventions to mitigate EDS across diverse geographic and economic contexts.

IMPLICATION FOR NURSING AND NURSING POLICY

This study highlights the pervasive issue of EDS among nurses worldwide, necessitating comprehensive strategies to address this challenge across all regions, income levels, hospital settings, and demographic groups.

Are Sleep Parameters and Chronotype Associated with Eating Disorder Risk? A Cross-Sectional Study of University Students in Spain

Objectives: Eating disorders (EDs) have emerged as a growing public health concern. However, the role of sleep in this context remains underexplored. The aim of this cross-sectional study was to determine the associations between sleep parameters and chronotype with ED risk in a sample of university students in Spain. Methods: ED risk was assessed via the Sick, Control, One stone, Fat, Food Questionnaire, and sleep quality was assessed via the Pittsburgh Sleep Quality Index. Other sleep parameters and chronotypes were self-reported. Sociodemographic, body composition, lifestyle, and depressive symptom data were collected. Logistic and linear regression models adjusted for the main confounders were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of the study associations. Results: A total of 403 students (70.2% female) aged 18 to 30 years participated in the study. Those reporting poor sleep quality (OR = 1.85, 95% CI 1.08-3.17, p = 0.025) and ≤6 h of night-time sleep duration (OR = 4.14, 95% CI 2.00-8.57, p < 0.01) were more likely to be at risk of EDs in the adjusted analyses. The association between night-time sleep duration and the risk of ED did not remain significant when we adjusted for sleep quality. In addition, an evening chronotype was associated with an increased risk of EDs (OR = 1.68, 95% CI 1.07-2.66, p = 0.039) only before adjustment for confounders. Conclusions: Among university students, poorer sleep quality was cross-sectionally associated with EDs. Future prospective studies are needed to examine whether promoting sleep quality may serve as an effective strategy for preventing the risk of EDs.

Online screening for excessive daytime sleepiness: a feasibility study

Purpose

Excessive daytime sleepiness (EDS) can have a significant impact on health and quality of life but may remain undiagnosed due to low awareness and underestimation of the clinical impact of the symptoms. An online screening tool supported by media campaigns might increase awareness and help detect undiagnosed cases of EDS and narcolepsy. The aim of this study was to develop an online screening method, along with a media campaign focusing on EDS, and evaluate its feasibility.

Methods

Online screening supported by a media campaign targeting young and middle-aged adults (18-45 years old) were developed and implemented over a period of 1 year starting from November 2022. The Epworth Sleepiness Scale was used to identify EDS, and the Swiss Narcolepsy Scale was used to identify narcolepsy. In addition, the data on sociodemographic characteristics, selected sleep and health indicators and lifestyle behaviors were collected to indicate the etiology of the EDS. Feasibility, e.g., implementation and practicality, was assessed by the response rate, response to the promotion strategy, time spent on the tool, sample characteristics, and the prevalence of identified EDS and narcolepsy cases.

Results

A total of 2,390 people opened the screening link; 568 of them completed the online screening (23.8%), and most of them (n = 437, 76.9%) left their contact data to receive feedback. We identified 171 (30.1%) respondents at risk of EDS and 61 (10.7%) at risk of narcolepsy. The mean time of the screening was 15 min.

Conclusion

An online screening tool supported with a campaign seems to be a feasible way to increase awareness about EDS and prevent delayed detection of EDS cases.

Longitudinal Associations Between Mild Behavioral Impairment, Sleep Disturbance, and Progression to Dementia

Background

Clinical guidelines recommend incorporating non-cognitive markers like mild behavioral impairment (MBI) and sleep disturbance (SD) into dementia screening to improve detection.

Objective

We investigated the longitudinal associations between MBI, SD, and incident dementia.

Methods

Participant data were from the National Alzheimer's Coordinating Center in the United States. MBI was derived from the Neuropsychiatric Inventory Questionnaire (NPI-Q) using a published algorithm. SD was determined using the NPI-Q nighttime behaviors item. Cox proportional hazard regressions with time-dependant variables for MBI, SD, and cognitive diagnosis were used to model associations between baseline 1) MBI and incident SD (n = 11,277); 2) SD and incident MBI (n = 10,535); 3) MBI with concurrent SD and incident dementia (n = 13,544); and 4) MBI without concurrent SD and incident dementia (n = 11,921). Models were adjusted for first-visit age, sex, education, cognitive diagnosis, race, and for multiple comparisons using the Benjamini-Hochberg method.

Results

The rate of developing SD was 3.1-fold higher in older adults with MBI at baseline compared to those without MBI (95% CI: 2.8-3.3). The rate of developing MBI was 1.5-fold higher in older adults with baseline SD than those without SD (95% CI: 1.3-1.8). The rate of developing dementia was 2.2-fold greater in older adults with both MBI and SD, as opposed to SD alone (95% CI:1.9-2.6).

Conclusions

There is a bidirectional relationship between MBI and SD. Older adults with SD develop dementia at higher rates when co-occurring with MBI. Future studies should explore the mechanisms underlying these relationships, and dementia screening may be improved by assessing for both MBI and SD.

Fatigue, Work Overload, and Sleepiness in a Sample of Spanish Commercial Airline Pilots

Commercial aviation pilots are an occupational group that work in particular conditions, with frequent schedule changes, shift work, unfavorable environmental conditions, etc. These circumstances can lead to fatigue, work overload (WO), and daytime sleepiness, factors that can affect their health and safety. This study aimed to assess the prevalence and the association between these parameters in a sample of Spanish commercial airline pilots. The Raw TLX, Fatigue Severity Scale, and the Epworth Sleepiness Scale questionnaires were administered in a sample of 283 participants. The relationships of the total scores between all the questionnaires were studied by the chi-square test and the risk scores (odds ratio) were calculated. Different models using multiple linear regression were carried out to evaluate the effects of WO, fatigue, and daytime sleepiness, among the total scores, age, and flight hours. Additionally, the internal consistency of each questionnaire was estimated. A total of 28.2% presented WO above the 75th percentile, with mental and temporal demand the dimensions with the greatest weight. A total of 18% of pilots presented fatigue, 15.8% moderate sleepiness, and 3.9% severe sleepiness. We observed an association among WO, fatigue, and daytime sleepiness, important factors related to pilot health and aviation safety.

Efficacy of pillar implants to reduce snoring and daytime sleepiness

OBJECTIVE

To measure the efficacy of pillar implants in reducing snoring.

MATERIALS AND METHODS

A total of 30 adult patients who underwent pillar implants were assessed preoperatively and at 1, 3, 6 and 12 months after the implantation. Improvement was measured using snoring frequency, visual analog scale for snoring loudness, and Epworth sleepiness scale for daytime sleepiness.

RESULTS

The mean snoring frequency, loudness and Epworth score were reduced from 6.9, 9.2 and 7.4 at the baseline to 5, 5.9 and 5.6, respectively, at 12 months postoperatively (all p < 0.03). The partial implant extrusion rate was 6.7%.

CONCLUSION

We suggest that a pillar implant procedure should be considered before proceeding to more morbid surgeries in patients with snoring and daytime sleepiness.