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Aderman MJ, Meister MR, Roach MH, Dengler BA, Ross JD, Malvasi SR, Cameron KL. Normative Values for Pupillary Light Reflex Metrics Among Healthy Service Academy Cadets. Mil Med 2024; 189:1593-1602. [PMID: 37522744 DOI: 10.1093/milmed/usad271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/19/2023] [Accepted: 07/17/2023] [Indexed: 08/01/2023] Open
Abstract
INTRODUCTION Assessments of the pupil's response to light have long been an integral part of neurologic examinations. More recently, the pupillary light reflex (PLR) has shown promise as a potential biomarker for the diagnosis of mild traumatic brain injury. However, to date, few large-scale normative data are available for comparison and reference, particularly, in military service members. The purpose of this study was to report normative values for eight PLR measurements among healthy service academy cadets based on sex, age, sleep, race, ethnicity, anisocoria, and concussion history. METHODS Freshmen entering a U.S. Service Academy completed a quantitative pupillometric assessment in conjunction with baseline concussion testing. PLR measurements were conducted using a Neuroptics PLR-3000 with a 121 µW light stimulus. The device measured maximum and minimum pupil diameter (mm), latency (time to maximum pupil constriction post-light stimulus [s]), peak and average constriction velocity (mm/s), average dilation velocity (mm/s), percentage pupil constriction, and T75 (time for pupil re-dilation from minimum pupil diameter to 75% maximum diameter [s]). During baseline testing, cadets also reported concussion history (yes and no) and hours slept the night before (<5.5 and ≥5.5). Normative values for each PLR measurement were calculated as mean ± SD, percentiles, and interquartile range. Mann-Whitney U tests were used to assess differences based on sex, concussion history, ethnicity, and hours slept for each PLR measurement. Kruskall-Wallis testing was used to assess differences based on age, race, and anisocoria. Alpha was set at .05 and nonparametric effect sizes (r) were calculated for statistically significant results. Effect sizes were interpreted as no effect (r < .1), small (r ≥.1-<.3), medium (r ≥.3-<.5), or large (r ≥ .5). All procedures were reviewed and approved by the local institutional review board and the U.S. Army Human Research Protection Office before the study was conducted. Each subject provided informed consent to participate in the study before data collection. RESULTS Of the 1,197 participants baselined, 514 cadets (131 female; 18.91 ± 0.96 years) consented and completed a valid baseline pupillometric assessment. Eighty participants reported at least one previous concussion and participants reported an average of 5.88 ± 1.63 h slept the previous night. Mann-Whitney U results suggest females had larger initial (z = -3.240; P = .001; r = .10) and end pupil diameter (z = -3.080; P = .002; r = .10), slower average dilation velocity (z = 3.254; P = .001; r = .11) and faster T75 values (z = -3.342; P = .001; r = .11). Age, sleep, and race stratified by sex, also displayed a significant impact on specific PLR metrics with effect sizes ranging from small to medium, while ethnicity, anisocoria, and concussion history did not display an impact on PLR metrics. CONCLUSION This study provides the largest population-specific normative values for eight PLR measurements. Initial and end pupil diameter, dilation velocity, and the T75 metrics differed by sex; however, these differences may not be clinically significant as small effect size was detected for all metrics. Sex, age, sleep, and race may impact specific PLR metrics and are worth consideration when performing PLR assessments for mild traumatic brain injury management.
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Affiliation(s)
- Michael J Aderman
- John A. Feagin Jr. Sports Medicine Fellowship Department of Orthopaedic Surgery, Keller Army Community Hospital, West Point, NY 10996-1197, USA
| | - Melissa R Meister
- Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Megan H Roach
- DoD-VA Extremity Trauma & Amputation Center of Excellence, Womack Army Medical Center, Fort Bragg, NC 28310, USA
| | - Bradley A Dengler
- Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Jeremy D Ross
- John A. Feagin Jr. Sports Medicine Fellowship Department of Orthopaedic Surgery, Keller Army Community Hospital, West Point, NY 10996-1197, USA
| | - Steven R Malvasi
- John A. Feagin Jr. Sports Medicine Fellowship Department of Orthopaedic Surgery, Keller Army Community Hospital, West Point, NY 10996-1197, USA
| | - Kenneth L Cameron
- John A. Feagin Jr. Sports Medicine Fellowship Department of Orthopaedic Surgery, Keller Army Community Hospital, West Point, NY 10996-1197, USA
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Peter-Derex L, Micoulaud-Franchi JA, Lopez R, Barateau L. Evaluation of hypersomnolence: From symptoms to diagnosis, a multidimensional approach. Rev Neurol (Paris) 2023; 179:715-726. [PMID: 37563022 DOI: 10.1016/j.neurol.2023.07.004] [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: 07/02/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/12/2023]
Abstract
Hypersomnolence is a major public health issue given its high frequency, its impact on academic/occupational functioning and on accidentology, as well as its heavy socio-economic burden. The positive and aetiological diagnosis is crucial, as it determines the therapeutic strategy. It must consider the following aspects: i) hypersomnolence is a complex concept referring to symptoms as varied as excessive daytime sleepiness, excessive need for sleep, sleep inertia, or drowsiness, all of which warrant specific dedicated investigations; ii) the boundary between physiological and abnormal hypersomnolence is blurred, since most symptoms can be encountered in the general population to varying degrees without being considered as pathological, meaning that their severity, frequency, context of occurrence and related impairment need to be carefully assessed; iii) investigation of hypersomnolence relies on scales/questionnaires as well as behavioural and neurophysiological tests, which measure one or more dimensions, keeping in mind the possible discrepancy between objective and subjective assessment; iv) aetiological reasoning is driven by knowledge of the main sleep regulation mechanisms, epidemiology, and associated symptoms. The need to assess hypersomnolence is growing, both for its management, and for assessing the efficacy of treatments. The landscape of tools available for investigating hypersomnolence is constantly evolving, in parallel with research into sleep physiology and technical advances. These investigations face the challenges of reconciling subjective perception and objective data, making tools accessible to as many people as possible and predicting the risk of accidents.
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Affiliation(s)
- L Peter-Derex
- Centre for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France; Lyon Neuroscience Research Centre, PAM Team, INSERM U1028, CNRS UMR 5292, Lyon, France.
| | - J-A Micoulaud-Franchi
- Service Universitaire de médecine du Sommeil, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; UMR CNRS 6033 SANPSY, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - R Lopez
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France; Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, Montpellier, France; Institute of Neurosciences of Montpellier, University of Montpellier, INSERM, Montpellier, France
| | - L Barateau
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France; Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, Montpellier, France; Institute of Neurosciences of Montpellier, University of Montpellier, INSERM, Montpellier, France
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Kerkamm F, Dengler D, Eichler M, Materzok-Köppen D, Belz L, Neumann FA, Zyriax BC, Harth V, Oldenburg M. Sleep Architecture and Sleep-Related Breathing Disorders of Seafarers on Board Merchant Ships: A Polysomnographic Pilot Field Study on the High Seas. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3168. [PMID: 36833863 PMCID: PMC9962439 DOI: 10.3390/ijerph20043168] [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: 11/20/2022] [Revised: 02/02/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
As seafarers are assumed to have an increased risk profile for sleep-related breathing disorders, this cross-sectional observational study measured (a) the feasibility and quality of polysomnography (PSG) on board merchant ships, (b) sleep macro- and microarchitecture, (c) sleep-related breathing disorders, such as obstructive sleep apnea (OSA), using the apnea-hypopnea index (AHI), and (d) subjective and objective sleepiness using the Epworth Sleepiness Scale (ESS) and pupillometry. Measurements were carried out on two container ships and a bulk carrier. A total of 19 out of 73 male seafarers participated. The PSG's signal qualities and impedances were comparable to those in a sleep laboratory without unusual artifacts. Compared to the normal population, seafarers had a lower total sleep time, a shift of deep sleep phases in favor of light sleep phases as well as an increased arousal index. Additionally, 73.7% of the seafarers were diagnosed with at least mild OSA (AHI ≥ 5) and 15.8% with severe OSA (AHI ≥ 30). In general, seafarers slept in the supine position with a remarkable frequency of breathing cessations. A total of 61.1% of the seafarers had increased subjective daytime sleepiness (ESS > 5). Pupillometry results for objective sleepiness revealed a mean relative pupillary unrest index (rPUI) of 1.2 (SD 0.7) in both occupational groups. In addition, significantly poorer objective sleep quality was found among the watchkeepers. A need for action with regard to poor sleep quality and daytime sleepiness of seafarers on board is indicated. A slightly increased prevalence of OSA among seafarers is likely.
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Affiliation(s)
- Fiona Kerkamm
- Institute for Occupational and Maritime Medicine Hamburg (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany
| | - Dorothee Dengler
- Institute for Occupational and Maritime Medicine Hamburg (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany
| | - Matthias Eichler
- Institute for Occupational and Maritime Medicine Hamburg (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany
| | - Danuta Materzok-Köppen
- Institute for Occupational and Maritime Medicine Hamburg (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany
| | - Lukas Belz
- Institute for Occupational and Maritime Medicine Hamburg (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany
| | - Felix Alexander Neumann
- Preventive Medicine and Nutrition, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany
| | - Birgit-Christiane Zyriax
- Preventive Medicine and Nutrition, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany
| | - Volker Harth
- Institute for Occupational and Maritime Medicine Hamburg (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany
| | - Marcus Oldenburg
- Institute for Occupational and Maritime Medicine Hamburg (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany
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Cori JM, Manousakis JE, Koppel S, Ferguson SA, Sargent C, Howard ME, Anderson C. An evaluation and comparison of commercial driver sleepiness detection technology: a rapid review. Physiol Meas 2021; 42. [PMID: 34338222 DOI: 10.1088/1361-6579/abfbb8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/26/2021] [Indexed: 11/11/2022]
Abstract
Objective. Sleepiness-related motor vehicle crashes, caused by lack of sleep or driving during night-time hours, often result in serious injury or fatality. Sleepiness detection technology is rapidly emerging as a sleepiness risk mitigation strategy for drivers. Continuous monitoring technologies assess and alert to driver sleepiness in real-time, while fit for duty technologies provide a single assessment of sleepiness state. The aim of this rapid review was to evaluate and compare sleepiness detection technologies in relation to specifications, cost, target consumer group and validity.Approach. We evaluated a range of sleepiness detection technologies suitable for consumer groups ranging from regular drivers in private vehicles through to work-related drivers within large businesses.Main results. Continuous monitoring technologies typically ranged between $100 and $3000 AUD and had ongoing monthly costs for telematics functionality and manager alerts. Fit for duty technologies had either a one-off purchase cost or a monthly subscription cost. Of concern, the majority of commercial continuous monitoring technologies lacked scientific validation. While some technologies had promising findings in terms of their ability to detect and reduce driver sleepiness, further validation work is required. Field studies that evaluate the sensitivity and specificity of technology alerts under conditions that are regularly experienced by drivers are necessary. Additionally, there is a need for longitudinal naturalistic driving studies to determine whether sleepiness detection technologies actually reduce sleepiness-related crashes or near-crashes.Significance. There is an abundance of sleepiness detection technologies on the market, but a majority lacked validation. There is a need for these technologies and their validation to be regulated by a driver safety body. Otherwise, consumers will base their technology choices on cost and features, rather than the ability to save lives.
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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.,Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Jessica E Manousakis
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Sjaan Koppel
- Monash University Accident Research Centre, Monash University, Melbourne, Australia
| | - Sally A Ferguson
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Wayville, South Australia, 5034, Australia
| | - Charli Sargent
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Wayville, South Australia, 5034, 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.,Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,Department of Medicine, University of Melbourne, Australia
| | - Clare Anderson
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
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von Lukowicz H, Poets CF, Peters T, Wilhelm B, Schlarb A, Urschitz MS. Validity of the Pupillographic Sleepiness Test for the diagnosis of daytime sleepiness in children and adolescents and its relationship to sleepiness-associated outcomes. Sleep Med 2021; 83:145-150. [PMID: 34015717 DOI: 10.1016/j.sleep.2021.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To report validation data for the Pupillographic Sleepiness Test (PST) in children and adolescents, evaluate its applicability for diagnosing excessive daytime sleepiness and its relationship to sleepiness-associated outcomes. METHODS A cross-sectional diagnostic test accuracy study was performed. Patients underwent three PST at 9 a.m. (T1), 11 a.m. (T2) and 1 p.m. (T3) plus the Multiple Sleep Latency Test (MSLT) on a single day. Additionally, two neurocognitive tests were performed and three questionnaires about quality of life, sleep-related self-efficacy and behavioural aspects completed. Gender-stratified z-values of the natural logarithm of the Pupillary Unrest Index (z-lnPUI) were correlated to Sleep Latency (SL) and Mean Sleep Latency (MSL) and to variables of neurocognitive tests and questionnaires using Spearman's rank correlation. Cut-off values were determined by receiver operating characteristic (ROC) analysis. RESULTS 47 patients were recruited (median 10.6 years, range 6-18). Correlation between z-lnPUI and SL was rT1 = -0.373 (p = 0.011); rT2 = -0.320 (p = 0.028) and rT3 = -0.336 (p = 0.022). Correlation between z-lnPUI and MSL was rT1 = -0.338 (p = 0.020); rT2 = -0.202 (p = 0.173); rT3 = -0.117 (p = 0.433). ROC analysis showed an area under the curve of 90.7% and PUI cut-off values of 12.6 mm/min (boys) and 11.6 mm/min (girls). There were moderate correlations between z-lnPUIT1 and reaction time and omission errors in neurocognitive tests (r = 0.394, p = 0.007 and 0.391, p = 0.008). CONCLUSIONS We found satisfactory correlations between PST and MSLT results. The z-lnPUIT1 was related to MSL and objective measures of attention ability. Given this accuracy, the PST may be used as a screening tool for evaluating daytime sleepiness in children and adolescents. Corresponding gender-related reference values are now available.
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Affiliation(s)
| | - Christian F Poets
- Working Group on Pediatric Sleep Medicine, Department of Neonatology, University Children's Hospital, Tuebingen, Germany.
| | - Tobias Peters
- Pupil Research Group, Centre for Ophthalmology, University Hospital, Tuebingen, Germany
| | - Barbara Wilhelm
- Pupil Research Group, Centre for Ophthalmology, University Hospital, Tuebingen, Germany
| | - Angelika Schlarb
- Department of Psychology, University of Bielefeld, Bielefeld, Germany
| | - Michael S Urschitz
- Division of Paediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
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Abstract
This article describes clinical approaches to assessing sleepiness. Subjective sleep scales are used in clinical settings but have significant limitations. Likewise, objective tools may have prohibitive expense, and practical administration considerations may prohibit regular use. Gold standard tests include the multiple sleep latency test and maintenance of wakefulness test. These studies are criticized for a variety of reasons but are useful in appropriate clinical context. New tools suggest novel ways to assess sleepiness and will likely be more prominent in clinical assessments over time. This article outlines subjective scales and objective tools and suggests situations where particular instruments may be appropriate.
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Bhowmik S, Motin MA, Sarossy M, Radcliffe P, Kumar D. Sample entropy analysis of pupillary signals in glaucoma patients and control via light-induced pupillometry. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:280-283. [PMID: 33017983 DOI: 10.1109/embc44109.2020.9176558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This paper evaluated the pupillary light reflex of glaucomatous eyes in the presence of constant lighting via light-induced pupillometry using sample entropy. The study used 20 patients and 15 controls, applied three different light intensities to their eyes, and recorded the behavior of the pupil. This study has validated that there is a difference in the entropy of pupillary data in glaucoma and healthy eyes. We concluded that entropy analysis is an excellent method to differentiate glaucoma eyes with the control through light-induced pupillometry. Hence, pupillometry has potential clinical applications in glaucoma investigation.
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Barbarewicz F, Jensen HJ, Harth V, Oldenburg M. Psychophysical stress and strain of maritime pilots in Germany. A cross-sectional study. PLoS One 2019; 14:e0221269. [PMID: 31415636 PMCID: PMC6695174 DOI: 10.1371/journal.pone.0221269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 08/04/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Maritime pilots work in an irregular deployment system (rotation system) with unpredictable work assignments under high levels of physical and mental stress. Fatigue or chronic diseases, e.g. coronary heart disease, peptic ulcers or gastritis can occur as a consequence. This can lead to long-term limitations of pilots’ work ability. The aim of this study is to analyse current stress and strain in maritime pilots. Methods Initially, all German pilots were interviewed with an online questionnaire about their living and working situation (response rate 43%). Subsequently, a medical and psychological examination of a random sample was carried out with pilots working in a 4-month rotation system compared with those working in a 1-week system. Most of the measurements took place at the beginning and the end of continuous work assignments each lasting several weeks (pre vs post-rotation). The questionnaires RESTQ-work 27, Resilience Scale RS-13 and Berlin Questionnaire were used as well as a sleeping diary. Furthermore, cardiovascular parameters (during rest and under ergometric stress), activity and blood parameters, urine stress hormones, and the pupillary unrest index were surveyed. Results 60 pilots were recorded with an average age of 48.7 years (SD 8.3 years). Among the parameters collected, there were no significant differences between pre and post-rotation examinations. Pilots with a 4-month rotation system experienced a much higher subjective strain level in RESTQ work-27 (OR 10.12 (95% CI 1.21–84.59)). According to the sleep diaries of the pilots working in a 4-month rotation system, reduced levels were found concerning the pre and post-rotation subjective performance level (p = 0.042 and 0.029), subjective sleep duration (p = 0.032) and current subjective feeling post-rotation (p = 0.036). Objectively measured arterial hypertension was significantly more frequent among pilots working 4 months at a time (OR 21.41 (95% CI 1.26–364.05)). In addition, elevated levels of total cholesterol, triglycerides and uric acid were more common among this group of pilots (p = 0.038, p = 0.033 and p = 0.038). In particular, the risk of hypertriglyceridemia was increased (OR 4.41 (95% CI 1.15–16.91)). Discussion Maritime pilotage represents a very straining profession that has been studied very little up to this point. The present results indicate that 4-month rotation systems lead to higher levels of subjective and objective strain than 1-week rotation systems. Interventions are therefore recommended; especially a change in the rotation system should be considered.
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Affiliation(s)
- Filip Barbarewicz
- Institute for Occupational and Maritime Medicine (ZfAM) Hamburg; University Medical Center, Hamburg-Eppendorf, Germany
- * E-mail:
| | - Hans-Joachim Jensen
- Institute for Occupational and Maritime Medicine (ZfAM) Hamburg; University Medical Center, Hamburg-Eppendorf, Germany
| | - Volker Harth
- Institute for Occupational and Maritime Medicine (ZfAM) Hamburg; University Medical Center, Hamburg-Eppendorf, Germany
| | - Marcus Oldenburg
- Institute for Occupational and Maritime Medicine (ZfAM) Hamburg; University Medical Center, Hamburg-Eppendorf, Germany
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Abstract
OBJECTIVES To estimate the prevalence of sleepiness on duty among day workers and watchkeepers on board. DESIGN Cross-sectional survey in a maritime field study. SETTING 10 shipping companies with container vessels under German management. PARTICIPANTS The whole crew (75 day workers and 123 watchkeepers) during 18 voyages on 18 different container ships. OUTCOME MEASURES Sleepiness on duty and efficiency of sleep using pupillometry (in a cross-shift design) and the SenseWear armband activity monitor. RESULTS The watchkeepers showed significantly shorter sleep periods than day workers (5.5 hours vs 5.8 hours). The average efficiency of sleep was 69.6% and significantly lower among watchkeepers (OR 0.48; 95% CI 0.26 to 0.88). 396 pupillometric examinations were carried out and revealed 88 study members (22.2%) with a pupillary unrest index (rPUI) in a range characterised as 'unfit for duty' and 110 seafarers (27.8%) categorised as 'particular attention required'. The average rPUI was similar between day workers and watchkeepers. The Epworth Sleepiness Scale revealed recent daytime sleepiness in 70 seafarers, which was similarly often stated by day workers and watchkeepers. Based on the Stanford Sleepiness Scale (SSS), a measurable cross-shift increase in the SSS value during the examined shift was observed, especially among watchkeepers. The amount of time already spent on the vessel at the time of the present examination was significantly associated with the rPUI (p=0.009). CONCLUSION Sleep periods of both the day workers and the watchkeepers aboard vessels were alarmingly short and sleep efficiency was low. Sleepiness on duty is similarly prevalent among day workers and watchkeepers and seems to depend partly on the cumulative working period on the vessels. Preventive measures need to be taken by the shipping industry to counteract fatigue (eg, by enabling sufficient rest and sleep times).
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Affiliation(s)
- Marcus Oldenburg
- Maritime Medicine, Institute for Occupational and Maritime Medicine, Hamburg, Germany
| | - Hans-Joachim Jensen
- Maritime Medicine, Institute for Occupational and Maritime Medicine, Hamburg, Germany
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Baiardi S, Mondini S. Inside the clinical evaluation of sleepiness: subjective and objective tools. Sleep Breath 2019; 24:369-377. [PMID: 31144154 DOI: 10.1007/s11325-019-01866-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 04/29/2019] [Accepted: 05/13/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To critically review the available tools for evaluating excessive daytime sleepiness (EDS) in clinical practice. METHODS Objective tests and subjective scales were divided into three groups in accordance with the different dimensions of sleepiness they measure, namely physiological, manifest, and introspective. Strengths, weaknesses, and limitations of each test have been analysed and discussed along with the available recommendations for their use in clinical practice. RESULTS The majority of the tests developed for sleepiness evaluation do not have practical usefulness outside the research setting. The suboptimal correlation between different tests mainly depends on the different dimensions of sleepiness they analyse. Most importantly in-laboratory tests poorly correlate with sleepiness in real-life situations and, to date, none is able to predict the risk of injuries related to EDS, especially on an individual level. CONCLUSIONS There exists not the one best test to assess EDS, however, clinicians can choose a more specific test to address a specific diagnostic challenge on the individual level. The development of novel performance tests with low cost and easy to administer is advisable for both screening purposes and fitness for duty evaluations in populations at high risk of EDS-related injuries, for example professional drivers.
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Affiliation(s)
- Simone Baiardi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Via Altura 1/8, 40139, Bologna, Italy.
| | - Susanna Mondini
- Neurology Unit, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
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Microstructure of cortical activity during sleep reflects respiratory events and state of daytime vigilance. SOMNOLOGIE 2019. [DOI: 10.1007/s11818-019-0201-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Abstract
This article describes clinical approaches to assessing sleepiness. Subjective sleep scales are used in clinical settings but have significant limitations. Likewise, objective tools may have prohibitive expense, and practical administration considerations may prohibit regular use. Gold standard tests include the multiple sleep latency test and maintenance of wakefulness test. These studies are criticized for a variety of reasons but are useful in appropriate clinical context. New tools suggest novel ways to assess sleepiness and will likely be more prominent in clinical assessments over time. This article outlines subjective scales and objective tools and suggests situations where particular instruments may be appropriate.
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Affiliation(s)
- Brian James Murray
- Neurology and Sleep Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Room M1-600, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
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13
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Léger D, Ement P. Somnolence et risque accidentel. Presse Med 2015; 44:1022-8. [DOI: 10.1016/j.lpm.2015.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 04/03/2015] [Accepted: 04/10/2015] [Indexed: 11/30/2022] Open
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Monaco A, Cattaneo R, Mesin L, Ortu E, Giannoni M, Pietropaoli D. Dysregulation of the descending pain system in temporomandibular disorders revealed by low-frequency sensory transcutaneous electrical nerve stimulation: a pupillometric study. PLoS One 2015; 10:e0122826. [PMID: 25905862 PMCID: PMC4408101 DOI: 10.1371/journal.pone.0122826] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 02/15/2015] [Indexed: 11/18/2022] Open
Abstract
Using computerized pupillometry, our previous research established that the autonomic nervous system (ANS) is dysregulated in patients suffering from temporomandibular disorders (TMDs), suggesting a potential role for ANS dysfunction in pain modulation and the etiology of TMD. However, pain modulation hypotheses for TMD are still lacking. The periaqueductal gray (PAG) is involved in the descending modulation of defensive behavior and pain through μ, κ, and δ opioid receptors. Transcutaneous electrical nerve stimulation (TENS) has been extensively used for pain relief, as low-frequency stimulation can activate µ receptors. Our aim was to use pupillometry to evaluate the effect of low-frequency TENS stimulation of μ receptors on opioid descending pathways in TMD patients. In accordance with the Research Diagnostic Criteria for TMD, 18 females with myogenous TMD and 18 matched-controls were enrolled. All subjects underwent subsequent pupillometric evaluations under dark and light conditions before, soon after (end of stimulation) and long after (recovery period) sensorial TENS. The overall statistics derived from the darkness condition revealed no significant differences in pupil size between cases and controls; indeed, TENS stimulation significantly reduced pupil size in both groups. Controls, but not TMD patients, displayed significant differences in pupil size before compared with after TENS. Under light conditions, TMD patients presented a smaller pupil size compared with controls; the pupil size was reduced only in the controls. Pupil size differences were found before and during TENS and before and after TENS in the controls only. Pupillometry revealed that stimulating the descending opioid pathway with low-frequency sensory TENS of the fifth and seventh pairs of cranial nerves affects the peripheral target. The TMD patients exhibited a different pattern of response to TENS stimulation compared with the controls, suggesting that impaired modulation of the descending pain system may be involved in TMD.
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Affiliation(s)
- Annalisa Monaco
- University of L’Aquila, Department of Life, Health and Environmental Sciences, Building Delta 6 Dental Unit, St Salvatore Hospital—Via Vetoio 67100 L’Aquila, Italy
| | - Ruggero Cattaneo
- University of L’Aquila, Department of Life, Health and Environmental Sciences, Building Delta 6 Dental Unit, St Salvatore Hospital—Via Vetoio 67100 L’Aquila, Italy
| | - Luca Mesin
- Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Eleonora Ortu
- University of L’Aquila, Department of Life, Health and Environmental Sciences, Building Delta 6 Dental Unit, St Salvatore Hospital—Via Vetoio 67100 L’Aquila, Italy
| | - Mario Giannoni
- University of L’Aquila, Department of Life, Health and Environmental Sciences, Building Delta 6 Dental Unit, St Salvatore Hospital—Via Vetoio 67100 L’Aquila, Italy
| | - Davide Pietropaoli
- University of L’Aquila, Department of Life, Health and Environmental Sciences, Building Delta 6 Dental Unit, St Salvatore Hospital—Via Vetoio 67100 L’Aquila, Italy
- * E-mail:
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15
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Różanowski K, Sondej T, Lewandowski J. Pupillometric sleepiness measurements PST with concurrent video optic sensor of pupillary size. Biocybern Biomed Eng 2015. [DOI: 10.1016/j.bbe.2015.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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BaHammam AS, Alkhunizan MA, Lesloum RH, Alshanqiti AM, Aldakhil AM, Pandi-Perumal SR, Sharif MM. Prevalence of sleep-related accidents among drivers in Saudi Arabia. Ann Thorac Med 2014; 9:236-41. [PMID: 25276244 PMCID: PMC4166072 DOI: 10.4103/1817-1737.140138] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 04/26/2014] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION: The prevalence of sleepy driving and sleep-related accidents (SRA) varies widely, and no data exist regarding the prevalence of sleepy driving in Saudi Arabia. Therefore, this study was designed to determine the prevalence and predictors of sleepy driving, near-misses, and SRA among drivers in Saudi Arabia. MATERIALS AND METHODS: A questionnaire was developed to assess sleep and driving in detail based on previously published data regarding sleepy driving. The questionnaire included 50 questions addressing socio-demographics, the Epworth Sleepiness Scale (ESS), driving items, and the Berlin Questionnaire. In total, 1,219 male drivers in public places were interviewed face-to-face. RESULTS: The included drivers had a mean age of 32.4 ± 11.7 years and displayed a mean ESS score of 7.2 ± 3.8. Among these drivers, 33.1% reported at least one near-miss accident caused by sleepiness. Among those who had actual accidents, 11.6% were attributed to sleepiness. In the past six months, drivers reported the following: 25.2% reported falling asleep at least once during, driving and 20.8% had to stop driving at least once because of severe sleepiness. Young age, feeling very sleepy during driving, and having at least one near-miss accident caused by sleepiness in the past six months were the only predictors of accidents. CONCLUSION: Sleepy driving is prevalent among male drivers in Saudi Arabia. Near-miss accidents caused by sleepiness are an important risk factor for car accidents and should be considered as a strong warning signal of future accidents.
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Affiliation(s)
- Ahmad S BaHammam
- University Sleep Disorders Center, College of Medicine and the National Plan for Science and Technology, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Muath A Alkhunizan
- University Sleep Disorders Center, College of Medicine and the National Plan for Science and Technology, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Rabea H Lesloum
- University Sleep Disorders Center, College of Medicine and the National Plan for Science and Technology, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Amer M Alshanqiti
- University Sleep Disorders Center, College of Medicine and the National Plan for Science and Technology, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Abdulrahman M Aldakhil
- University Sleep Disorders Center, College of Medicine and the National Plan for Science and Technology, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Seithikurippu R Pandi-Perumal
- Department of Population Health, Division of Health and Behavior, Center for Healthful Behavior Change, NYU Langone Medical Center, Clinical and Translational Research Institute, New York, USA
| | - Munir M Sharif
- University Sleep Disorders Center, College of Medicine and the National Plan for Science and Technology, King Saud University, Riyadh, Kingdom of Saudi Arabia
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17
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Urschitz MS, Heine K, Mendler L, Peters T, Wilhelm B, Poets CF. Pilot study on the validity of the pupillographic sleepiness test in children and adolescents. Sleep Med 2014; 15:720-3. [PMID: 24796284 DOI: 10.1016/j.sleep.2014.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 02/12/2014] [Accepted: 02/16/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To report preliminary validation data for the pupillographic sleepiness test (PST) in children and adolescents. METHODS Twelve patients (13.1±4.4 years of age) underwent the multiple sleep latency test (MLST) and three PSTs at 09:00, 11:00, and 13:00 on one single day. Correlations were tested between mean sleep latency and gender-adjusted z-values of the natural logarithm of the pupillary unrest index (zlnPUI). RESULTS Spearman's correlation (P-value) between the zlnPUI values obtained at 09:00 and 11:00 with the MSL was rS = -0.641 (0.025) and r = -0.553 (0.062). CONCLUSION There was satisfactory agreement between PST and the MLST, which is similar to what is found in adults. The PST may be promising for the evaluation of daytime sleepiness in children and adolescents, and should be further evaluated in future studies.
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Affiliation(s)
- Michael S Urschitz
- Unit of Pediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Germany; Working Group on Pediatric Sleep Medicine, University Children's Hospital Tuebingen, Germany.
| | - Katrin Heine
- Working Group on Pediatric Sleep Medicine, University Children's Hospital Tuebingen, Germany
| | - Lea Mendler
- Working Group on Pediatric Sleep Medicine, University Children's Hospital Tuebingen, Germany
| | - Tobias Peters
- Pupil Research Group, Centre for Ophthalmology, University Hospital Tuebingen, Germany
| | - Barbara Wilhelm
- Pupil Research Group, Centre for Ophthalmology, University Hospital Tuebingen, Germany
| | - Christian F Poets
- Working Group on Pediatric Sleep Medicine, University Children's Hospital Tuebingen, Germany
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18
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Monaco A, Cattaneo R, Mesin L, Fiorucci E, Pietropaoli D. Evaluation of autonomic nervous system in sleep apnea patients using pupillometry under occlusal stress: a pilot study. Cranio 2014; 32:139-47. [DOI: 10.1179/0886963413z.00000000022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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