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Sammito S, Thielmann B, Klussmann A, Deußen A, Braumann KM, Böckelmann I. Guideline for the application of heart rate and heart rate variability in occupational medicine and occupational health science. J Occup Med Toxicol 2024; 19:15. [PMID: 38741189 DOI: 10.1186/s12995-024-00414-9] [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: 12/10/2023] [Accepted: 04/24/2024] [Indexed: 05/16/2024] Open
Abstract
This updated guideline replaces the "Guideline for the application of heart rate and heart rate variability in occupational medicine and occupational health science" first published in 2014. Based on the older version of the guideline, the authors have reviewed and evaluated the findings on the use of heart rate (HR) and heart rate variability (HRV) that have been published in the meantime and incorporated them into a new version of this guideline.This guideline was developed for application in clinical practice and research purposes in the fields of occupational medicine and occupational science to complement evaluation procedures with respect to exposure and risk assessment at the workplace by the use of objective physiological workload indicators. In addition, HRV is also suitable for assessing the state of health and for monitoring the progress of illnesses and preventive medical measures. It gives an overview of factors influencing the regulation of the HR and HRV at rest and during work. It further illustrates methods for measuring and analyzing these parameters under standardized laboratory and real workload conditions, areas of application as well as the quality control procedures to be followed during the recording and evaluation of HR and HRV.
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Affiliation(s)
- Stefan Sammito
- Department of Occupational Medicine, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
- German Air Force Centre of Aerospace Medicine, Experimental Aerospace Medicine Research, Flughafenstraße 1, Cologne, 51147, Germany.
| | - Beatrice Thielmann
- Department of Occupational Medicine, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Andre Klussmann
- Competence Centre Health (CCG), Department Health Sciences, University of Applied Sciences (HAW) Hamburg, Hamburg, Germany
| | - Andreas Deußen
- Department of Physiology, Medical Faculty, TU Dresden, Dresden, Germany
| | | | - Irina Böckelmann
- Department of Occupational Medicine, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
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Säynäjäkangas P, Mänttäri S, Selander K, Laitinen J. Home Care Workers' Objective and Subjective Recovery From Work. J Occup Environ Med 2024; 66:161-165. [PMID: 37964621 DOI: 10.1097/jom.0000000000003013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
OBJECTIVE The aim of this cross-sectional study was to examine the recovery from work in Finnish home care nurses with objective and subjective recovery measures. METHODS Heart rate and heart rate variability recordings were performed in home care nurses over a period of one work shift and the following night. Following the measurements, the participants ( N = 91) answered a questionnaire including questions about their self-rated recovery from work and sleep disturbances. RESULTS The objectively measured recovery was within the recommended heart rate variability range, yet the self-rated recovery from work was only mediocre. Subjective recovery was not associated with objectively measured recovery. CONCLUSIONS There is a discrepancy between objectively and subjectively measured recovery from work. Therefore, an additional objective method in occupational field studies, along with questionnaires, is recommended to measure physiological recovery.
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Affiliation(s)
- Pihla Säynäjäkangas
- From the Finnish Institute of Occupational Health, Oulu, Finland (P.S., S.M., J.L.); and Finnish Institute of Occupational Health, Kuopio, Finland (K.S.)
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3
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Detection of melatonin-onset in real settings via wearable sensors and artificial intelligence. A pilot study. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2020.102386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Çaltekin I, Hamamcı M. Is working in the emergency department a risk factor for sleep disorders for healthcare workers? Sleep Sci 2021; 14:129-135. [PMID: 34381576 PMCID: PMC8340894 DOI: 10.5935/1984-0063.20200051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/01/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study aims to investigate the relationship between work-related stress and sleep disorders in healthcare personnel working in emergency department and in other departments. MATERIAL AND METHODS This cross-sectional study included 34 emergency department healthcare personnel (emergency group [EG]) and 35 healthcare personnel working in other departments (non-emergency group [NEG]) and was conducted between November 10, 2019 and March 1, 2020. All participants were administered the following questionnaires: work-related strain inventory (WRSI), Epworth sleepiness scale (ESS), Berlin questionnaire, insomnia severity index (ISI), Pittsburgh sleep quality index (PSQI), Beck depression inventory (BDI), and Beck anxiety inventory (BAI). RESULTS While the mean WRSI score of EG was 39.53±7.77, the mean WRSI score of NEG was 30.06±7.26 (t=5.236, p<0.001). According to PSQI, 79.4% of EG and 57.1% of NEG were found to have poor sleep quality (X2=3.938, df=1, p=0.047). Median PSQI overall score was 12 (IQR 25th-75th percentiles: 10-14) in EG, and 7 (IQR 25th-75th percentiles: 4-9) in NEG (U=285.5, p<0.001). While the mean anxiety score of EG was 13.35±5.70, the mean anxiety score of NEG was 9.06±6.00 (t=3.046, p=0.003). Median depression score was 12 (IQR 25th-75th percentiles: 10-16) in EG, and was 8 (IQR 25th-75th percentiles: 4-12) in NEG (U=354, p=0.004). A significant positive correlation was found between work-related strain scores and sleep quality, sleepiness, and insomnia severity scores (r=0.541, p<0.001; r=0.310, p=0.010; r=0.357, p=0.004; respectively). CONCLUSION It was determined that healthcare personnel working in the emergency department were at higher risk of developing sleep disorders compared to healthcare personnel working in other departments and that there was a significant relationship between sleep disorders and work-related stress.
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Affiliation(s)
- Ibrahim Çaltekin
- Yozgat Bozok University Faculty of Medicine, Department of
Emergency Medicine - Yozgat - Center - Turkey. ,Corresponding author: Ibrahim
Çaltekin. E-mail:
| | - Mehmet Hamamcı
- Yozgat Bozok University Faculty of Medicine, Department of
Neurology - Yozgat - Center - Turkey
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Paixão TM, Teixeira LR, Cozendey-Silva EN, Siqueira CEG. Nocturnal awakenings of Brazilian immigrants in Massachusetts. Sleep Sci 2021; 14:39-46. [PMID: 34104336 PMCID: PMC8157785 DOI: 10.5935/1984-0063.20200040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/20/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The purpose of this study was to assess the relationship between the quantity of jobs and nocturnal awakenings of Brazilians living in Massachusetts. MATERIAL AND METHODS We sampled of 48 documented Brazilians around the age of 45.5 years old. 52.1% of them were women. Data gathering occurred for three weeks, using the Pittsburgh Sleep Quality Index. Participants also wore wrist actigraph and filled sleep/wake diary for a week. RESULTS The sleep quality of immigrants with one job (mean=8.58, SD=4.16) is better when compared to immigrants with 2-3 jobs (mean=12.7, SD=3.57) according to the PSQI scores. Immigrants with 2-3 jobs reported dissatisfaction on three components of the scale: sleep duration, sleep efficiency and sleep quality. DISCUSSION There is a positive relationship between the quantity of jobs and nocturnal awakenings and between nocturnal awakenings and complaints related to sleep apnea among Brazilians in Massachusetts. The assessment of systemic morbidities associated with sleep pattern changes should be considered in future research.
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Affiliation(s)
- Talita Monsores Paixão
- Oswaldo Cruz Foundation, National School of Public Health Sergio Arouca - Rio de Janeiro - RJ - Brazil
| | - Liliane Reis Teixeira
- Oswaldo Cruz Foundation, National School of Public Health Sergio Arouca - Rio de Janeiro - RJ - Brazil
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Schilling R, Herrmann C, Ludyga S, Colledge F, Brand S, Pühse U, Gerber M. Does Cardiorespiratory Fitness Buffer Stress Reactivity and Stress Recovery in Police Officers? A Real-Life Study. Front Psychiatry 2020; 11:594. [PMID: 32670116 PMCID: PMC7331850 DOI: 10.3389/fpsyt.2020.00594] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 06/09/2020] [Indexed: 11/13/2022] Open
Abstract
High levels of cardiorespiratory fitness have the potential to buffer against physical and mental health impairments, which can result from exposure to occupational stress. Police officers are especially at risk of high psychosocial stress; therefore, effective intervention strategies are warranted. Given this background, the purpose of the present study was to examine whether police officers with different levels of cardiorespiratory fitness differ with regard to their (a) physiological stress reactivity during acute real-life stress situations, and (b) physiological recovery related to acute and chronic work stress. In total, 201 police officers took part in this study (M = 38.6 years, SD = 10.1, 35.8% females). Officers were contacted eight times on a smartphone during their workday, and asked to report their current level of positive and negative affect, as well as feelings of stress and anger. Physiological stress responses and recovery (heart rate variability) were assessed using Movisens EcgMove3 devices. The Åstrand bicycle ergometer test was used to assess participants' cardiorespiratory fitness. Chronic work stress was assessed using the effort-reward imbalance model and the job strain model. Multilevel modeling was used to test buffering effects of cardiorespiratory fitness on physiological stress reactivity. Linear regression was applied to test stress-buffering effects of cardiorespiratory fitness on physiological recovery. Results showed lowered physiological stress reactivity to acute work stress in officers with higher levels of cardiorespiratory fitness. However, these results were not consistent, with no effects occurring for feelings of anger, positive affect, and negative affect. Chronic work stress (effort-reward imbalance) was related to lower physiological recovery. Cardiorespiratory fitness was positively related to physiological recovery. Data did not support interactions between work stress and cardiorespiratory fitness on physiological recovery. To some extent, cardiorespiratory fitness seems to have the potential to buffer stress reactivity in police officers in acute stress situations. Therefore, we encourage promoting fitness programs which aim to enhance cardiorespiratory fitness in stressful occupations such as law enforcement. Improvements in cardiorespiratory fitness might further enhance physiological recovery from chronic work stress, which is thought to improve cardiovascular health.
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Affiliation(s)
- René Schilling
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | | | - Sebastian Ludyga
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Flora Colledge
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Serge Brand
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland.,Center for Affective, Stress and Sleep Disorders, Psychiatric Clinics, University of Basel, Basel, Switzerland.,Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.,School of Medicine, Tehran University of Medical Sciences, Teheran, Iran
| | - Uwe Pühse
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Burch JB, Alexander M, Balte P, Sofge J, Winstead J, Kothandaraman V, Ginsberg JP. Shift Work and Heart Rate Variability Coherence: Pilot Study Among Nurses. Appl Psychophysiol Biofeedback 2019; 44:21-30. [PMID: 30232570 PMCID: PMC6373270 DOI: 10.1007/s10484-018-9419-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This study used ambient heart rate monitoring among health care workers to determine whether a novel measure of heart rate variability (HRV), as well as sleep disturbances, fatigue, or cognitive performance differed among non-rotating night shift nurses relative to those working permanent day shifts. Continuous ambulatory HRV monitoring was performed among night nurses (n = 11), and a comparison group of permanent day nurses (n = 7), over a 36-h period coinciding with the last two 12-h shifts of each participant's work week. Symptoms and psychomotor vigilance were assessed at the end of the ambient HRV monitoring period, and no differences between shifts were observed. Day nurses exhibited an increase in hourly mean HRV coherence ratios during their sleep period, suggesting a circadian pattern of cardiorespiratory phase coupling, whereas night nurses had no increase in HRV coherence ratios during their sleep period. The HRV coherence patterns were similar to high frequency HRV power among nurses on the same shift. To the authors knowledge, this study was the first to quantify patterns of the HRV coherence ratio among shiftworkers in a non-experimental (work/home) setting. The results suggest a pattern of autonomic dysregulation among night workers during their sleep period relative to those working day shifts. The HRV coherence ratio may serve as a novel indicator of HRV dysregulation among shift workers.
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Affiliation(s)
- James B Burch
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
- WJB Dorn Department of Veterans Affairs Medical Center, Columbia, SC, USA.
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Room 226, Columbia, SC, 29208, USA.
| | - Melannie Alexander
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- WJB Dorn Department of Veterans Affairs Medical Center, Columbia, SC, USA
| | - Pallavi Balte
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- WJB Dorn Department of Veterans Affairs Medical Center, Columbia, SC, USA
- Columbia University, New York, NY, USA
| | - Jameson Sofge
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- WJB Dorn Department of Veterans Affairs Medical Center, Columbia, SC, USA
| | - James Winstead
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- WJB Dorn Department of Veterans Affairs Medical Center, Columbia, SC, USA
| | - Venkat Kothandaraman
- WJB Dorn Department of Veterans Affairs Medical Center, Columbia, SC, USA
- Department of Biological Sciences, University of South Carolina, Columbia, SC, USA
| | - J P Ginsberg
- WJB Dorn Department of Veterans Affairs Medical Center, Columbia, SC, USA
- Department of Pharmacology, Physiology and Neuroscience, School of Medicine, University of South Carolina, Columbia, SC, USA
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Physiological Load and Psychological Stress During a 24-hour Work Shift Among Finnish Firefighters. J Occup Environ Med 2017; 59:41-46. [DOI: 10.1097/jom.0000000000000912] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gluschkoff K, Elovainio M, Kinnunen U, Mullola S, Hintsanen M, Keltikangas-Järvinen L, Hintsa T. Work stress, poor recovery and burnout in teachers. Occup Med (Lond) 2016; 66:564-70. [DOI: 10.1093/occmed/kqw086] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tonello L, Reichert FF, Oliveira-Silva I, Del Rosso S, Leicht AS, Boullosa DA. Correlates of Heart Rate Measures with Incidental Physical Activity and Cardiorespiratory Fitness in Overweight Female Workers. Front Physiol 2016; 6:405. [PMID: 26779034 PMCID: PMC4704056 DOI: 10.3389/fphys.2015.00405] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 12/10/2015] [Indexed: 12/23/2022] Open
Abstract
Previous studies have suggested that physical activity (PA) levels and cardiorespiratory fitness (CRF) impact on the autonomic control of heart rate (HR). However, previous studies evaluating PA levels did not discriminate between incidental PA and regular exercise. We hypothesized that incidental PA “per se” would influence cardiac autonomic indices as assessed via HR variability (HRV) and HR recovery (HRR) in non-exercisers. Thus, the objective of this study was to investigate the relationships between objective PA levels, CRF, and cardiac autonomic indices in adult, regular non-exercising female workers. After familiarization with procedures and evaluation of body composition, 21 women completed a submaximal cycling test and evaluation of HRR on four different days. Resting (2-min seated and standing) and ambulatory (4-h) HRV were also recorded. Levels of PA were assessed by accelerometry over five consecutive days (i.e., Wednesday to Sunday). Maximum oxygen consumption (VO2max) was measured as an index of CRF. As reliability was low to moderate for most HR measures, relationships between these and PA and CRF were examined using the 4-day average measures. Significant correlations were identified between post-exercise HRR in the first min with various PA indices (daily moderate PA, daily vigorous PA, and the sum of vigorous and very vigorous daily PA). Additionally, VO2max was significantly correlated to HRV but not to HRR. The current results indicated that CRF was influential in enhancing HRV while incidental or non-exercise based PA was associated with greater autonomic reactivation in adult overweight women. Therefore, both CRF and non-exercise based PA contribute significant but diverse effects on cardiac health. The use of 4-day averages instead of single measures for evaluation of autonomic control of HR may provide a better indication of regular cardiac autonomic function that remains to be refined.
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Affiliation(s)
- Laís Tonello
- Departamento de Educação Física, Centro Universitário UnirG Gurupi, Brazil
| | - Felipe F Reichert
- Escola Superior de Educação Física, Universidade Federal de Pelotas Pelotas, Brazil
| | - Iransé Oliveira-Silva
- Departamento de Educação Física, UniEVANGÉLICA-Centro Universitário de AnápolisAnápolis, Brazil; Departamento de Educação Física, Universidade Católica de BrasíliaÁguas Claras, Brazil
| | - Sebastián Del Rosso
- Departamento de Educação Física, Universidade Católica de Brasília Águas Claras, Brazil
| | - Anthony S Leicht
- Sport and Exercise Science, James Cook University Townsville, QLD, Australia
| | - Daniel A Boullosa
- Departamento de Educação Física, Universidade Católica de Brasília Águas Claras, Brazil
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Bernardes Souza B, Mussi Monteze N, Pereira de Oliveira FL, Magalhães de Oliveira J, Nascimento de Freitas S, Marques do Nascimento Neto R, Sales ML, Guerra Leal Souza G. Lifetime shift work exposure: association with anthropometry, body composition, blood pressure, glucose and heart rate variability. Occup Environ Med 2014; 72:208-15. [DOI: 10.1136/oemed-2014-102429] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Oldenburg M, Wilken D, Wegner R, Poschadel B, Baur X. Job-related stress and work ability of dispatchers in a metropolitan fire department. J Occup Med Toxicol 2014. [DOI: 10.1186/s12995-014-0031-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Karhula K, Henelius A, Härmä M, Sallinen M, Lindholm H, Kivimäki M, Vahtera J, Puttonen S. Job strain and vagal recovery during sleep in shift working health care professionals. Chronobiol Int 2014; 31:1179-89. [PMID: 25216071 DOI: 10.3109/07420528.2014.957294] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Within sample female nurses/nurse assistants in three shift work, we explored the association of job strain with heart rate variability before and during sleep. The participants (n = 95) were recruited from the Finnish Public Sector Study, from hospital wards that belonged either to the top (high job strain [HJS], n = 42) or bottom quartiles on job strain (low job strain [LJS], n = 53) as rated by Job Content Questionnaire responses. A further inclusion criterion was that participants' own job strain was at least as high (HJS group) or low (LJS group) as their ward's average estimation. Three-week field measurements included sleep diary and actigraphy to study the participants' sleep patterns and sleep-wake rhythm. A subset of three pre-selected, circadian rhythm and recovery controlled measurement days, one morning shift, one night shift and a day off, included 24-h heart rate variability (HRV) measurements. The bootstrapped HRV parameters (HR, HF, LF, LF-to-HF-ratio and RMSSD) 30 min before and during 30 min of sleep with lowest average heart rate showed no statistically significant job strain group differences. No association of exposure to stressful work environment and HRV before and during sleep was found.
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Affiliation(s)
- Kati Karhula
- Centre of Excellence of Development of Work and Work Organizations, Finnish Institute of Occupational Health , Helsinki, Turku , Finland
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Tonello L, Rodrigues FB, Souza JWS, Campbell CSG, Leicht AS, Boullosa DA. The role of physical activity and heart rate variability for the control of work related stress. Front Physiol 2014; 5:67. [PMID: 24600407 PMCID: PMC3931195 DOI: 10.3389/fphys.2014.00067] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 02/04/2014] [Indexed: 01/05/2023] Open
Abstract
Physical activity (PA) and exercise are often used as tools to reduce stress and therefore the risk for developing cardiovascular diseases (CVD). Meanwhile, heart rate variability (HRV) has been utilized to assess both stress and PA or exercise influences. The objective of the present review was to examine the current literature in regards to workplace stress, PA/exercise and HRV to encourage further studies. We considered original articles from known databases (PubMed, ISI Web of Knowledge) over the last 10 years that examined these important factors. A total of seven studies were identified with workplace stress strongly associated with reduced HRV in workers. Longitudinal workplace PA interventions may provide a means to improve worker stress levels and potentially cardiovascular risk with mechanisms still to be clarified. Future studies are recommended to identify the impact of PA, exercise, and fitness on stress levels and HRV in workers and their subsequent influence on cardiovascular health.
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Affiliation(s)
- Laís Tonello
- Department of Physical Education, Catholic University of Brasilia Brasilia, Brazil
| | - Fábio B Rodrigues
- Department of Physical Education, Catholic University of Brasilia Brasilia, Brazil
| | - Jeniffer W S Souza
- Department of Physical Education, Catholic University of Brasilia Brasilia, Brazil
| | - Carmen S G Campbell
- Department of Physical Education, Catholic University of Brasilia Brasilia, Brazil
| | - Anthony S Leicht
- Institute of Sport and Exercise Science, James Cook University Queensland, QLD, Australia
| | - Daniel A Boullosa
- Department of Physical Education, Catholic University of Brasilia Brasilia, Brazil
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Sato M, Yasuhara Y, Tanioka T, Iwasa Y, Yasui T, Miyake M, Kobayashi H, Kongsuwan W, C. Locsin R. Changes before and after improvement of subjective sleep state of a man diagnosed with pre-diabetes and sleep disorder. Health (London) 2013. [DOI: 10.4236/health.2013.53a069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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