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Fernandes GL, da Silva Vallim JR, D'Almeida V, Tufik S, Andersen ML. The effects of social jetlag and sleep variability on sleepiness in a population-based study: The mediating role of sleep debt. J Sleep Res 2024; 33:e14043. [PMID: 37691450 DOI: 10.1111/jsr.14043] [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: 04/18/2023] [Revised: 07/25/2023] [Accepted: 08/25/2023] [Indexed: 09/12/2023]
Abstract
Sleepiness is a multicausal condition, and previous research has highlighted associations between this symptom and the circadian timing system, specifically concerning social jetlag and sleep variability. Recent inquiries have shown that the effects of social jetlag on sleepiness can be confounded with the consequences of sleep debt. In light of the current evidence, we aimed to assess the effects of social jetlag and sleep variability on sleepiness and the potential mediating role of sleep debt. We used data from the EPISONO study, a cross-sectional population-based study with a sample size of 1042 participants, representative of the city of Sao Paulo, Brazil. Participants completed the UNIFESP Sleep Questionnaire (self-reported bedtime and get-up time) and the Epworth Sleepiness Scale (subjective daytime sleepiness). Subsequently, sleep-corrected mid-sleep time (chronotype), total sleep time, social jetlag (absolute difference between the mid-sleep time on workdays and mid-sleep time on free days), sleep variability (standard deviation of mid-sleep time), and sleep debt (difference between total sleep time on workdays and free days) were calculated. Generalised linear models were used to test whether social jetlag and sleep variability affected sleepiness. Mediation models were used to determine if any observed significant effects were mediated by sleep debt. The prevalence of social jetlag was 23% for >1 h and 12% for >2 h. The mean sleep variability was 41 ± 30 min. Social jetlag had a significant effect on the Epworth Sleepiness Scale scores. This association was no longer statistically significant after controlling for age, sex, body mass index, work schedule, and chronotype. A significant indirect effect of social jetlag on sleep debt and subsequently on the Epworth Sleepiness Scale scores was found. No effect of sleep variability on sleepiness could be identified. In conclusion, the association between social jetlag and sleepiness was mediated by sleep debt but was not independent of demographic, work, and chronotype variables. This study provides new evidence on the importance of circadian misalignment and sleep debt for sleep health on a population level.
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Affiliation(s)
| | | | - Vânia D'Almeida
- Departamento de Psicobiologia, Universidade Federal 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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2
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Fjell AM, Walhovd KB. Individual sleep need is flexible and dynamically related to cognitive function. Nat Hum Behav 2024; 8:422-430. [PMID: 38379065 DOI: 10.1038/s41562-024-01827-6] [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: 05/25/2023] [Accepted: 01/15/2024] [Indexed: 02/22/2024]
Abstract
Given that sleep deprivation studies consistently show that short sleep causes neurocognitive deficits, the effects of insufficient sleep on brain health and cognition are of great interest and concern. Here we argue that experimentally restricted sleep is not a good model for understanding the normal functions of sleep in naturalistic settings. Cross-disciplinary research suggests that human sleep is remarkably dependent on environmental conditions and social norms, thus escaping universally applicable rules. Sleep need varies over time and differs between individuals, showing a complex relationship with neurocognitive function. This aspect of sleep is rarely addressed in experimental work and is not reflected in expert recommendations about sleep duration. We recommend focusing on the role of individual and environmental factors to improve our understanding of the relationship between human sleep and cognition.
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Affiliation(s)
- Anders M Fjell
- Center for Lifespan Changes in Brain and Cognition, University of Oslo, Oslo, Norway.
- Center for Computational Radiology and Artificial Intelligence, Oslo University Hospital, Oslo, Norway.
| | - Kristine B Walhovd
- Center for Lifespan Changes in Brain and Cognition, University of Oslo, Oslo, Norway
- Center for Computational Radiology and Artificial Intelligence, Oslo University Hospital, Oslo, Norway
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3
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Fjell AM, Sørensen Ø, Wang Y, Amlien IK, Baaré WFC, Bartrés-Faz D, Boraxbekk CJ, Brandmaier AM, Demuth I, Drevon CA, Ebmeier KP, Ghisletta P, Kievit R, Kühn S, Madsen KS, Nyberg L, Solé-Padullés C, Vidal-Piñeiro D, Wagner G, Watne LO, Walhovd KB. Is Short Sleep Bad for the Brain? Brain Structure and Cognitive Function in Short Sleepers. J Neurosci 2023; 43:5241-5250. [PMID: 37365003 PMCID: PMC10342221 DOI: 10.1523/jneurosci.2330-22.2023] [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: 10/21/2022] [Revised: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 06/28/2023] Open
Abstract
Many sleep less than recommended without experiencing daytime sleepiness. According to prevailing views, short sleep increases risk of lower brain health and cognitive function. Chronic mild sleep deprivation could cause undetected sleep debt, negatively affecting cognitive function and brain health. However, it is possible that some have less sleep need and are more resistant to negative effects of sleep loss. We investigated this using a cross-sectional and longitudinal sample of 47,029 participants of both sexes (20-89 years) from the Lifebrain consortium, Human Connectome project (HCP) and UK Biobank (UKB), with measures of self-reported sleep, including 51,295 MRIs of the brain and cognitive tests. A total of 740 participants who reported to sleep <6 h did not experience daytime sleepiness or sleep problems/disturbances interfering with falling or staying asleep. These short sleepers showed significantly larger regional brain volumes than both short sleepers with daytime sleepiness and sleep problems (n = 1742) and participants sleeping the recommended 7-8 h (n = 3886). However, both groups of short sleepers showed slightly lower general cognitive function (GCA), 0.16 and 0.19 SDs, respectively. Analyses using accelerometer-estimated sleep duration confirmed the findings, and the associations remained after controlling for body mass index, depression symptoms, income, and education. The results suggest that some people can cope with less sleep without obvious negative associations with brain morphometry and that sleepiness and sleep problems may be more related to brain structural differences than duration. However, the slightly lower performance on tests of general cognitive abilities warrants closer examination in natural settings.SIGNIFICANCE STATEMENT Short habitual sleep is prevalent, with unknown consequences for brain health and cognitive performance. Here, we show that daytime sleepiness and sleep problems are more strongly related to regional brain volumes than sleep duration. However, participants sleeping ≤6 h had slightly lower scores on tests of general cognitive function (GCA). This indicates that sleep need is individual and that sleep duration per se is very weakly if at all related brain health, while daytime sleepiness and sleep problems may show somewhat stronger associations. The association between habitual short sleep and lower scores on tests of general cognitive abilities must be further scrutinized in natural settings.
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Affiliation(s)
- Anders M Fjell
- Center for Lifespan Changes in Brain and Cognition, University of Oslo, 0373 Oslo, Norway
- Computational Radiology and Artificial Intelligence, Department of Radiology and Nuclear Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | - Øystein Sørensen
- Center for Lifespan Changes in Brain and Cognition, University of Oslo, 0373 Oslo, Norway
| | - Yunpeng Wang
- Center for Lifespan Changes in Brain and Cognition, University of Oslo, 0373 Oslo, Norway
| | - Inge K Amlien
- Center for Lifespan Changes in Brain and Cognition, University of Oslo, 0373 Oslo, Norway
| | - William F C Baaré
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital-Amager and Hvidovre, 2650 Hvidovre, Copenhagen, Denmark
| | - David Bartrés-Faz
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, and Institut de Neurociències, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Carl-Johan Boraxbekk
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital-Amager and Hvidovre, 2650 Hvidovre, Copenhagen, Denmark
- Umeå Center for Functional Brain Imaging, Umeå University, 907 36 Umeå, Sweden
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, 907 36 Umeå, Sweden
- Institute of Sports Medicine Copenhagen (ISMC), Copenhagen University Hospital Bispebjerg, 2400 Copenhagen, Denmark
- Institute for Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, 2020 Copenhagen, Denmark
| | - Andreas M Brandmaier
- Center for Lifespan Psychology, Max Planck Institute for Human Development, 14195 Berlin, Germany
- Department of Psychology, MSB Medical School Berlin, Berlin, Germany
| | - Ilja Demuth
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Endocrinology and Metabolic Diseases (including Division of Lipid Metabolism), Biology of Aging working group, Augustenburger Platz 1, 13353 Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, 10178 Berlin, Germany
- BCRT - Berlin Institute of Health Center for Regenerative Therapies, 13353 Berlin, Germany
| | - Christian A Drevon
- Vitas AS, The Science Park, 0349 Oslo, Norway
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of 0372 Oslo, Norway
| | - Klaus P Ebmeier
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, United Kingdom
| | - Paolo Ghisletta
- Faculty of Psychology and Educational Sciences, University of Geneva, 1205 Geneva, Switzerland
- UniDistance Suisse, 3900 Brig, Switzerland
- Swiss National Centre of Competence in Research LIVES, University of Geneva, 1205 Geneva, Switzerland
| | - Rogier Kievit
- Cognitive Neuroscience Department, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Simone Kühn
- Center for Lifespan Psychology, Max Planck Institute for Human Development, 14195 Berlin, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Kathrine Skak Madsen
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital-Amager and Hvidovre, 2650 Hvidovre, Copenhagen, Denmark
- Radiography, Department of Technology, University College Copenhagen, 1799 Copenhagen, Denmark
| | - Lars Nyberg
- Center for Lifespan Changes in Brain and Cognition, University of Oslo, 0373 Oslo, Norway
- Umeå Center for Functional Brain Imaging, Umeå University, 907 36 Umeå, Sweden
| | - Cristina Solé-Padullés
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, and Institut de Neurociències, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Didac Vidal-Piñeiro
- Center for Lifespan Changes in Brain and Cognition, University of Oslo, 0373 Oslo, Norway
| | - Gerd Wagner
- Department of Psychiatry and Psychotherapy, Jena University Hospital, 07743 Jena, Germany
| | - Leiv Otto Watne
- Oslo Delirium Research Group, Oslo University Hospital, 0424 Oslo, Norway
- Department of Geriatric Medicine, Akershus University Hospital, 1478 Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, 1478, Lørenskog, Norway
| | - Kristine B Walhovd
- Center for Lifespan Changes in Brain and Cognition, University of Oslo, 0373 Oslo, Norway
- Computational Radiology and Artificial Intelligence, Department of Radiology and Nuclear Medicine, Oslo University Hospital, 0424 Oslo, Norway
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Bruno S, Ceccanti S, Bazzani A, d'Ascanio P, Frumento P, Faraguna U. Handling shifts during an overnight sailing regatta: Comparison between sleep management strategies. Scand J Med Sci Sports 2023; 33:503-511. [PMID: 36403189 DOI: 10.1111/sms.14273] [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: 02/09/2022] [Revised: 08/29/2022] [Accepted: 11/08/2022] [Indexed: 11/21/2022]
Abstract
The study aims to investigate the association between different sleep management strategies and the final ranking during a one-night sailing race. A large sample of 190 teams participating in the overnight sailing regatta (151 Miglia) were included in the study. The experimental design consisted of two surveys, administered one before the start of the race and the other after the arrival. The questionnaires provided general information on the sailboat, its crew, and the strategy adopted to manage sleep during the race. In this one-night regatta, the self-management of sleep/wake timing emerged as the most successful strategy. Among participants who adopted a shift-based racing strategy, a short night shift duration (i.e., 2 h) significantly predicted a better placement. These findings confirmed the relevance of sleep management in sport performance and provided new insights into the most suitable sleep management strategy during a relatively short offshore regatta. The conclusions might apply also to similar continuous-cycle activities. Further investigations are needed to explore best sleep management strategy in team regattas of longer duration.
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Affiliation(s)
- Simone Bruno
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Serena Ceccanti
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Andrea Bazzani
- Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Paola d'Ascanio
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Paolo Frumento
- Department of Political Sciences, University of Pisa, Pisa, Italy
| | - Ugo Faraguna
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy.,Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
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5
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Alfonsi V, D'Atri A, Scarpelli S, Gorgoni M, Giacinti F, Annarumma L, Salfi F, Amicucci G, Corigliano D, De Gennaro L. The effects of bifrontal anodal transcranial direct current stimulation (tDCS) on sleepiness and vigilance in partially sleep-deprived subjects: A multidimensional study. J Sleep Res 2023:e13869. [PMID: 36871580 DOI: 10.1111/jsr.13869] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/21/2023] [Accepted: 02/21/2023] [Indexed: 03/07/2023]
Abstract
In recent years, transcranial electrical stimulation techniques have demonstrated their ability to modulate our levels of sleepiness and vigilance. However, the outcomes differ among the specific aspects considered (physiological, behavioural or subjective). This study aimed to observe the effects of bifrontal anodal transcranial direct current stimulation. Specifically, we tested the ability of this stimulation protocol to reduce sleepiness and increase vigilance in partially sleep-deprived healthy participants. Twenty-three subjects underwent a within-subject sham-controlled stimulation protocol. We compared sleepiness and vigilance levels before and after the two stimulation conditions (active versus sham) by using behavioural (reaction-time task), subjective (self-report scales) and physiological (sleep-onset latency and electroencephalogram power [n = 20] during the Maintenance of Wakefulness Test) measures. We showed the efficacy of the active stimulation in reducing physiological sleepiness and preventing vigilance drop compared with the sham stimulation. Consistently, we observed a reduction of perceived sleepiness following the active stimulation for both self-report scales. However, the stimulation effect on subjective measures was not statistically significant probably due to the underpowered sample size for these measures, and to the possible influence of motivational and environmental factors. Our findings confirm the ability of this technique to influence vigilance and sleepiness, pointing out the potential for new treatment developments based on transcranial electrical stimulation.
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Affiliation(s)
| | - Aurora D'Atri
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Serena Scarpelli
- Department of Psychology, University of Rome Sapienza, Rome, Italy
| | - Maurizio Gorgoni
- Department of Psychology, University of Rome Sapienza, Rome, Italy.,Body and Action Lab, IRCCS Fondazione Santa Lucia, Rome, Italy
| | | | | | - Federico Salfi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giulia Amicucci
- Department of Psychology, University of Rome Sapienza, Rome, Italy
| | | | - Luigi De Gennaro
- Department of Psychology, University of Rome Sapienza, Rome, Italy.,Body and Action Lab, IRCCS Fondazione Santa Lucia, Rome, Italy
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6
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Baril AA, Beiser AS, DeCarli C, Himali D, Sanchez E, Cavuoto M, Redline S, Gottlieb DJ, Seshadri S, Pase MP, Himali JJ. Self-reported sleepiness associates with greater brain and cortical volume and lower prevalence of ischemic covert brain infarcts in a community sample. Sleep 2022; 45:zsac185. [PMID: 35917199 PMCID: PMC9548673 DOI: 10.1093/sleep/zsac185] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES We evaluated if self-reported sleepiness was associated with neuroimaging markers of brain aging and ischemic damage in a large community-based sample. METHODS Participants from the Framingham Heart Study Offspring cohort (n = 468, 62.5 ± 8.7 years old, 49.6%M) free of dementia, stroke, and neurological diseases, completed sleep questionnaires and polysomnography followed by magnetic resonance imaging (MRI), 3 years later on average. We used linear and logistic regression models to evaluate the associations between Epworth Sleepiness Scale (ESS) scores and total brain, cortical and subcortical gray matter, and white matter hyperintensities volumes, and the presence of covert brain infarcts. RESULTS Higher sleepiness scores were associated with larger total brain volume, greater cortical gray matter volume, and a lower prevalence of covert brain infarcts, even when adjusting for a large array of potential confounders, including demographics, sleep profiles and disorders, organic health diseases, and proxies for daytime cognitive and physical activities. Interactions indicated that more sleepiness was associated with larger cortical gray matter volume in men only and in APOE ε4 noncarriers, whereas a trend for smaller cortical gray matter volume was observed in carriers. In longitudinal analyses, those with stable excessive daytime sleepiness over time had greater total brain and cortical gray matter volumes, whereas baseline sleepiness scores were not associated with subsequent atrophy or cognitive decline. CONCLUSION Our findings suggest that sleepiness is not necessarily a marker of poor brain health when not explained by diseases or sleep debt and sleep disorders. Rather, sleepiness could be a marker of preserved sleep-regulatory processes and brain health in some cases.
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Affiliation(s)
- Andrée-Ann Baril
- The Framingham Heart Study, Framingham, MA, USA
- Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Alexa S Beiser
- The Framingham Heart Study, Framingham, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Charles DeCarli
- Department of Neurology, University of California, Davis, CA, USA
| | | | - Erlan Sanchez
- Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Marina Cavuoto
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, VIC, Australia
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Daniel J Gottlieb
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Sudha Seshadri
- The Framingham Heart Study, Framingham, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX, USA
| | - Matthew P Pase
- The Framingham Heart Study, Framingham, MA, USA
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, VIC, Australia
- Harvard T.H. Chan School of Public Health, MA, USA
| | - Jayandra J Himali
- The Framingham Heart Study, Framingham, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX, USA
- Department of Population Health Sciences, University of Texas Health Science Center, San Antonio, TX, USA
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7
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Ye H, Ji M, Wang C, Wang C, Li Y, Chen Y, Cheng L, Li Y, Yang JJ. Integrated Functional Neuroimaging, Monoamine Neurotransmitters, and Behavioral Score on Depressive Tendency in Intensive Care Unit Medical Staffs Induced by Sleep Deprivation After Night Shift Work. Front Psychiatry 2022; 13:848709. [PMID: 35392383 PMCID: PMC8980607 DOI: 10.3389/fpsyt.2022.848709] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Intensive care unit (ICU) medical staffs undergoing sleep deprivation with perennial night shift work were usually at high risk of depression. However, shift work on depression-related resting-state functional magnetic resonance imaging was still not fully understood. The objective of this study was to explore the effects of sleep deprivation in ICU medical staffs after one night of shift work on brain functional connectivity density (FCD) and Hamilton Depression Rating Scale (HAMD) scores. Also, serum neurotransmitter concentrations of serotonin (5-HT) and norepinephrine (NE) were obtained simultaneously. METHODS A total of 21 ICU medical staffs without psychiatric history were recruited. All participants received HAMD score assessment and resting-state functional magnetic resonance imaging scans at two time points: one at rested wakefulness and the other after sleep deprivation (SD) accompanied with one night of shift work. Global FCD, local FCD, and long-range FCD (lrFCD) were used to evaluate spontaneous brain activity in the whole brain. In the meantime, peripheral blood samples were collected for measurement of serum 5-HT and NE levels. All these data were acquired between 7:00 and 8:00 am to limit the influence of biological rhythms. The correlations between the FCD values and HAMD scores and serum levels of neurotransmitters were analyzed concurrently. RESULTS Functional connectivity density mapping manifested that global FCD was decreased in the right medial frontal gyrus and the anterior cingulate gyrus, whereas lrFCD was decreased mainly in the right medial frontal gyrus. Most of these brain areas with FCD differences were components of the default mode network and overlapped with the medial prefrontal cortex. The lrFCD in the medial frontal gyrus showed a negative correlation with HAMD scores after SD. Compared with rested wakefulness, serum levels of 5-HT and NE decreased significantly, whereas HAMD scores were higher after SD within subjects. CONCLUSIONS Our study suggested that sleep deprivation after night shift work can induce depressive tendency in ICU medical staffs, which might be related to alterative medial prefrontal cortex, raised HAMD scores, and varying monoamine neurotransmitters.
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Affiliation(s)
- Haotian Ye
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Muhuo Ji
- Department of Anesthesiology, The Second Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Chaoyan Wang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Cong Wang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying Li
- Department of Anesthesiology, Jiangyin Hospital, Affiliated to Southeast University Medical School, Jiangyin, China
| | - Yuan Chen
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lisha Cheng
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanfei Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jian-Jun Yang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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8
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Zhang H, Wang J, Geng X, Li C, Wang S. Objective Assessments of Mental Fatigue During a Continuous Long-Term Stress Condition. Front Hum Neurosci 2021; 15:733426. [PMID: 34858151 PMCID: PMC8631328 DOI: 10.3389/fnhum.2021.733426] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/21/2021] [Indexed: 12/31/2022] Open
Abstract
Prolonged periods of cognitive workload will cause mental fatigue, but objective, quantitative, and sensitive measurements that reflect long-term, stress-induced mental fatigue have yet to be elucidated. This study aims to apply a potential marker of Rényi entropy to investigate the mental fatigue changes in a long-term, high-level stress condition and compare three different instruments for assessment of mental fatigue: EEG, the oddball task, and self-scoring. We recruited nine individuals who participated in a 5-day intellectually challenging competition. The participants were assessed for mental fatigue each day of the competition using prefrontal cortex electroencephalogram (EEG). Reaction time in an oddball task and self-rated scoring were used comparatively to evaluate the performance of the EEG. Repeated measures ANOVA was utilized to analyze the differences among score, reaction time, and wavelet Rényi entropy. The results demonstrated that both wavelet Rényi entropy extracted from EEG and self-rated scoring revealed significant increases in mental fatigue during the 5 days of competition (P < 0.001). The reaction time of the oddball task did not show significant changes during the five-day competition (P = 0.066). Moreover, the wavelet Rényi entropy analysis of EEG showed greater sensitivity than the self-rated scoring and reaction time of the oddball task for measuring mental fatigue changes. In conclusion, this study shows that mental fatigue accumulates during long-term, high-level stress situations. The study also indicates that EEG wavelet Rényi entropy is an efficient metric to reflect the change of mental fatigue under a long-term stress condition and that EEG is a better method to assess long-term mental fatigue.
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Affiliation(s)
- Han Zhang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Jingying Wang
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Xinyi Geng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Chuantao Li
- Naval Medical Center of PLA, Department of Aviation Medicine, Naval Military Medical University, Shanghai, China
| | - Shouyan Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China
- MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
- Zhangjiang Fudan International Innovation Center, Shanghai, China
- Shanghai Engineering Research Center of AI and Robotics, Fudan University, Shanghai, China
- Engineering Research Center of AI and Robotics, Ministry of Education, Fudan University, Shanghai, China
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9
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Axelsson J, Ingre M, Kecklund G, Lekander M, Wright KP, Sundelin T. Sleepiness as motivation: a potential mechanism for how sleep deprivation affects behavior. Sleep 2021; 43:5648004. [PMID: 31782961 PMCID: PMC7294403 DOI: 10.1093/sleep/zsz291] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/16/2019] [Indexed: 01/07/2023] Open
Abstract
STUDY OBJECTIVES To determine how sleepiness and sleep deprivation drive the motivation to engage in different behaviors. METHODS We studied the sleepiness of 123 participants who had been randomized to sleep deprivation or normal sleep, and their willingness to engage in a range of everyday behaviors. RESULTS Self-reported sleepiness was a strong predictor of the motivation to engage in sleep-preparatory behaviors such as shutting one's eyes (OR = 2.78, 95% CI: 2.19-3.52 for each step up on the Karolinska Sleepiness Scale) and resting (OR = 3.20, CI: 2.46-4.16). Sleepiness was also related to the desire to be cared for by a loved one (OR = 1.49, CI: 1.22-1.82), and preparedness to utilize monetary and energy resources to get to sleep. Conversely, increased sleepiness was associated with a decreased motivation for social and physical activities (e.g. be with friends OR = 0.71, CI: 0.61-0.82; exercise OR = 0.65, CI: 0.56-0.76). Sleep deprivation had similar effects as sleepiness on these behaviors. Neither sleepiness nor sleep deprivation had strong associations with hunger, thirst, or food preferences. CONCLUSIONS Our findings indicate that sleepiness is a dynamic motivational drive that promotes sleep-preparatory behaviors and competes with other drives and desired outcomes. Consequently, sleepiness may be a central mechanism by which impaired alertness, for example, due to insufficient sleep, contributes to poor quality of life and adverse health. We propose that sleepiness helps organize behaviors toward the specific goal of assuring sufficient sleep, in competition with other needs and incentives. A theoretical framework on sleepiness and its behavioral consequences are likely to improve our understanding of several disease mechanisms.
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Affiliation(s)
- John Axelsson
- Stress Research Institute, Stockholm University, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Michael Ingre
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Institute for Globally Distributed Research and Education (IGDORE), Stockholm, Sweden
| | - Göran Kecklund
- Stress Research Institute, Stockholm University, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lekander
- Stress Research Institute, Stockholm University, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Kenneth P Wright
- Department of Integrative Physiology, University of Colorado Boulder, CO
| | - Tina Sundelin
- Stress Research Institute, Stockholm University, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Psychology, New York University, NY
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10
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Gupta L, Morgan K, North C, Gilchrist S. Napping in high-performance athletes: Sleepiness or sleepability? Eur J Sport Sci 2020; 21:321-330. [PMID: 32174283 DOI: 10.1080/17461391.2020.1743765] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Daytime napping is a common practice in high-performance athletes, and is widely assumed to reflect sleepiness arising from sports-related sleep debt. The possibility that athlete naps may also be indicative of 'sleepability', a capacity to nap on demand that is only weakly related to homeostatic sleep pressure, has not previously been tested. The present study compared daytime sleep latencies in high-performance athletes and non-athlete controls using a single nap opportunity model. Elite (n = 10), and sub-elite (n = 10) athletes, and non-athlete controls (n = 10) attended the laboratory for a first adaption trial, and a subsequent experimental trial. Subjective sleepiness was assessed using the Karolinska Sleepiness Scale (KSS) at 14:00, 14:30 and immediately prior to a 20-minute nap opportunity at 15:00. Sleep latencies were measured using polysomnography, and defined as the time from lights out to the first epoch of any stage of sleep (N1, N2, N3, REM). In unadjusted comparisons with non-athlete controls, elite athletes showed significantly shorter sleep latencies in both the adaptation (p < 0.05) and experimental trials (p < 0.05). These significant differences were maintained in models controlling for pre-trial KSS scores and pre-trial total sleep time (all p < 0.05). Sleep latency scores for sub-elite athletes showed similar trends, but were more labile. These results are consistent with a conclusion that, among elite athletes, napping behaviour can reflect sleepability and may not necessarily result from nocturnal sleep disruption and daytime sleepiness.
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Affiliation(s)
- Luke Gupta
- English Institute of Sport, The High Performance Centre, Bisham Abbey National Sports Centre, Buckinghamshire, UK.,Clinical Sleep Research Unit, School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, LE113TU, UK
| | - Kevin Morgan
- Clinical Sleep Research Unit, School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, LE113TU, UK
| | - Courtney North
- Clinical Sleep Research Unit, School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, LE113TU, UK
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11
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Mantua J, Brager AJ, Alger SE, Adewale F, Skeiky L, Balkin TJ, Capaldi VF, Simonelli G. Self-Reported Sleep Need, Subjective Resilience, and Cognitive Performance Following Sleep Loss and Recovery Sleep. Psychol Rep 2020; 124:210-226. [DOI: 10.1177/0033294119899896] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Individuals vary in response to sleep loss: some individuals are “vulnerable” and demonstrate cognitive decrements following insufficient sleep, while others are “resistant” and maintain baseline cognitive capability. Physiological markers (e.g., genetic polymorphisms) have been identified that can predict relative vulnerability. However, a quick, cost-effective, and feasible subjective predictor tool has not been developed. The objective of the present study was to determine whether two factors—“subjective sleep need” and “subjective resilience”—predict cognitive performance following sleep deprivation. Methods Twenty-seven healthy, sleep-satiated young adults participated. These individuals were screened for sleep disorders, comorbidities, and erratic sleep schedules. Prior to 40 hours of in-laboratory total sleep deprivation, participants were questioned on their subjective sleep need and completed a validated resilience scale. During and after sleep deprivation, participants completed a 5-minute psychomotor vigilance test every 2 hours. Results Both subjective resilience and subjective sleep need individually failed to predict performance during sleep loss. However, these two measures interacted to predict performance. Individuals with low resilience and low sleep need had poorer cognitive performance during sleep loss. However, in individuals with medium or high resilience, psychomotor vigilance test performance was not predicted by subjective sleep need. Higher resilience may be protective against sleep loss-related neurobehavioral impairments in the context of subjective sleep need. Conclusions Following sleep loss (and recovery sleep), trait resilient individuals may outperform those with lower resiliency on real-world tasks that require continuous attention. Future studies should determine whether the present findings generalize to other, operationally relevant tasks and additional cognitive domains.
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Affiliation(s)
- Janna Mantua
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Allison J. Brager
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Sara E. Alger
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Folarin Adewale
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Lillian Skeiky
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Thomas J. Balkin
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Vincent F. Capaldi
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Guido Simonelli
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
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12
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Geissmann Q, Beckwith EJ, Gilestro GF. Most sleep does not serve a vital function: Evidence from Drosophila melanogaster. SCIENCE ADVANCES 2019; 5:eaau9253. [PMID: 30801012 PMCID: PMC6382397 DOI: 10.1126/sciadv.aau9253] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 01/10/2019] [Indexed: 06/09/2023]
Abstract
Sleep appears to be a universally conserved phenomenon among the animal kingdom, but whether this notable evolutionary conservation underlies a basic vital function is still an open question. Using a machine learning-based video-tracking technology, we conducted a detailed high-throughput analysis of sleep in the fruit fly Drosophila melanogaster, coupled with a lifelong chronic and specific sleep restriction. Our results show that some wild-type flies are virtually sleepless in baseline conditions and that complete, forced sleep restriction is not necessarily a lethal treatment in wild-type D. melanogaster. We also show that circadian drive, and not homeostatic regulation, is the main contributor to sleep pressure in flies. These results offer a new perspective on the biological role of sleep in Drosophila and, potentially, in other species.
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13
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Mantua J, Skeiky L, Prindle N, Trach S, Doty TJ, Balkin TJ, Brager AJ, Capaldi VF, Simonelli G. Sleep extension reduces fatigue in healthy, normally-sleeping young adults. ACTA ACUST UNITED AC 2019; 12:21-27. [PMID: 31105891 PMCID: PMC6508947 DOI: 10.5935/1984-0063.20190056] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective To assess the effects of one week of sleep extension on mood, fatigue and
subjective sleepiness in normal-sleeping young adults. Methods Twenty-seven adults (age 24.4±5.4 years, 11 female) participated.
At-home baseline sleep/wake patterns were recorded with wrist actigraphy for
14 days. This was followed by two nights of in-lab baseline sleep with 8
hours time in bed (TIB), then 7 nights with TIB extended to 10 hours
(2100-0700 hours). Fatigue, mood, and sleepiness were assessed following the
2nd and 9th nights of in-laboratory sleep (i.e., 2
nights with 8hTIB and 7 nights with 10 hours TIB, respectively) using the
Automated Neuropsychological Assessment Metric and Karolinska Sleepiness
Scale. Paired t-tests were used to compare mood, fatigue, and sleepiness
ratings between conditions. Results At-home wrist actigraphy revealed a mean nightly total sleep time (TST) of
7.53 +/- 0.88 hours of sleep per night. Mean in-lab baseline sleep duration
(7.76 +/- 0.59) did not differ from at-home sleep. However, during sleep
extension, mean TST was 9.36 +/- 0.37 hours per night, significantly more
than during the in-lab baseline (p < .001). Following
sleep extension, fatigue ratings were significantly reduced, relative to
baseline (p = .03). However, sleep extension had no other
significant effects on subjective ratings of mood or sleepiness. Conclusions Sleep extension resulted in reduced fatigue in healthy, normal-sleeping
young adults, although subjective sleepiness and mood were not improved.
Implications include the possibility that (a) the effects of sleep extension
on various aspects of mood depend upon the extent to which those aspects of
mood are made salient by the study design and methodology; and (b) sleep
extension may prove beneficial to fatigue-related conditions such as
“burnout.”
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Affiliation(s)
- Janna Mantua
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Lillian Skeiky
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Nora Prindle
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Sara Trach
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Tracy Jill Doty
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Thomas J Balkin
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Allison Joy Brager
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Vincent F Capaldi
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Guido Simonelli
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
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14
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A review of developmental consequences of poor sleep in childhood. Sleep Med 2018; 60:3-12. [PMID: 30660750 DOI: 10.1016/j.sleep.2018.11.021] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 11/01/2018] [Accepted: 11/03/2018] [Indexed: 12/13/2022]
Abstract
Sleep is a fairly diverse and complex construct to operationalize in a scientific and naturalistic context. We report a systematic review and meta-analysis of reviews published in the last 5 years on poor sleep and developmental outcomes. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, 42 articles (or 1117 studies) qualified. They reported outcomes related to poor sleep investigated as sleep disorders (38.1%), sleep 'in general' (26.2%), sleep duration (23.8%), in terms of circadian rhythm (4.8%), intra-individual variability (2.4%), and napping (2.4%). Sleep was primarily subjectively reported (30.2%), yet the methodology of sleep assessment was often neither tabulated nor discussed. Overall, most papers had a health-scope, being primarily weight problems expressed as body mass index. Its relationship with performance was measured with the Wechsler intelligence tests, the child behavior checklist and the continuous performance test, whereas meta-analytic papers specifically focused on cognition with sleep disorder (i.e. sleep-disordered breathing; 38.6%), on health (i.e. weight) with sleep duration (25%) and behavior with sleep 'in general' (15.9%), having a high true variance. Nevertheless, an aggregated effect size d of 0.35 (95% confidence interval: 0.27-0.42) suggests that poor sleep is moderately affecting a child's performance and health. In conclusion, poor sleep can no longer be disregarded, yet methodologies that are more rigorous and a scope beyond health may foster a better understanding of the role of (poor) sleep across childhood neurodevelopment.
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15
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Abstract
The objective of this narrative review paper is to discuss about sleep duration needed across the lifespan. Sleep duration varies widely across the lifespan and shows an inverse relationship with age. Sleep duration recommendations issued by public health authorities are important for surveillance and help to inform the population of interventions, policies, and healthy sleep behaviors. However, the ideal amount of sleep required each night can vary between different individuals due to genetic factors and other reasons, and it is important to adapt our recommendations on a case-by-case basis. Sleep duration recommendations (public health approach) are well suited to provide guidance at the population-level standpoint, while advice at the individual level (eg, in clinic) should be individualized to the reality of each person. A generally valid assumption is that individuals obtain the right amount of sleep if they wake up feeling well rested and perform well during the day. Beyond sleep quantity, other important sleep characteristics should be considered such as sleep quality and sleep timing (bedtime and wake-up time). In conclusion, the important inter-individual variability in sleep needs across the life cycle implies that there is no "magic number" for the ideal duration of sleep. However, it is important to continue to promote sleep health for all. Sleep is not a waste of time and should receive the same level of attention as nutrition and exercise in the package for good health.
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Affiliation(s)
- Jean-Philippe Chaput
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada,
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada,
- School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada,
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada,
| | - Caroline Dutil
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada,
- School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada,
| | - Hugues Sampasa-Kanyinga
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada,
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada,
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16
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17
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Matricciani L, Bin YS, Lallukka T, Kronholm E, Dumuid D, Paquet C, Olds T. Past, present, and future: trends in sleep duration and implications for public health. Sleep Health 2017; 3:317-323. [PMID: 28923186 DOI: 10.1016/j.sleh.2017.07.006] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/10/2017] [Accepted: 07/12/2017] [Indexed: 12/14/2022]
Abstract
Sleep is important for the physical, social and mental well-being of both children and adults. Over the years, there has been a general presumption that sleep will inevitably decline with the increase in technology and a busy 24-hour modern lifestyle. This narrative review discusses the empirical evidence for secular trends in sleep duration and the implications of these trends.
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Affiliation(s)
- Lisa Matricciani
- Sansom Institute, Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia; Murdoch Children's Research Institute, Melbourne, Australia.
| | - Yu Sun Bin
- Sleep Group, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia; Central Clinical School, Sydney Medical School, NSW, Australia
| | - Tea Lallukka
- Finnish Institute of Occupational Health, Helsinki, Finland; Department of Public Health, University of Helsinki, Finland
| | - Erkki Kronholm
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Dorothea Dumuid
- Sansom Institute, Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Catherine Paquet
- Sansom Institute, Centre for Population Health Research, University of South Australia, Adelaide, SA, Australia
| | - Tim Olds
- Sansom Institute, Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia; Murdoch Children's Research Institute, Melbourne, Australia
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18
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Wey D, Garefelt J, Fischer FM, Moreno CR, Lowden A. Individual differences in the sleep/wake cycle of Arctic flexitime workers. Chronobiol Int 2016; 33:1422-1432. [DOI: 10.1080/07420528.2016.1227331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Daniela Wey
- Stress Research Institute, Stockholm University, Stockholm, Sweden
- School of Public Health, São Paulo University, São Paulo, Brazil
- Faculdades Metropolitanas Unidas, São Paulo, Brazil
| | - Johanna Garefelt
- Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Frida M. Fischer
- School of Public Health, São Paulo University, São Paulo, Brazil
| | - Claudia R. Moreno
- Stress Research Institute, Stockholm University, Stockholm, Sweden
- School of Public Health, São Paulo University, São Paulo, Brazil
| | - Arne Lowden
- Stress Research Institute, Stockholm University, Stockholm, Sweden
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19
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Rabat A, Gomez-Merino D, Roca-Paixao L, Bougard C, Van Beers P, Dispersyn G, Guillard M, Bourrilhon C, Drogou C, Arnal PJ, Sauvet F, Leger D, Chennaoui M. Differential Kinetics in Alteration and Recovery of Cognitive Processes from a Chronic Sleep Restriction in Young Healthy Men. Front Behav Neurosci 2016; 10:95. [PMID: 27242464 PMCID: PMC4876616 DOI: 10.3389/fnbeh.2016.00095] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 05/02/2016] [Indexed: 01/01/2023] Open
Abstract
Chronic sleep restriction (CSR) induces neurobehavioral deficits in young and healthy people with a morning failure of sustained attention process. Testing both the kinetic of failure and recovery of different cognitive processes (i.e., attention, executive) under CSR and their potential links with subject's capacities (stay awake, baseline performance, age) and with some biological markers of stress and anabolism would be useful in order to understand the role of sleep debt on human behavior. Twelve healthy subjects spent 14 days in laboratory with 2 baseline days (B1 and B2, 8 h TIB) followed by 7 days of sleep restriction (SR1-SR7, 4 h TIB), 3 sleep recovery days (R1-R3, 8 h TIB) and two more ones 8 days later (R12-R13). Subjective sleepiness (KSS), maintenance of wakefulness latencies (MWT) were evaluated four times a day (10:00, 12:00 a.m. and 2:00, 4:00 p.m.) and cognitive tests were realized at morning (8:30 a.m.) and evening (6:30 p.m.) sessions during B2, SR1, SR4, SR7, R2, R3 and R13. Saliva (B2, SR7, R2, R13) and blood (B1, SR6, R1, R12) samples were collected in the morning. Cognitive processes were differently impaired and recovered with a more rapid kinetic for sustained attention process. Besides, a significant time of day effect was only evidenced for sustained attention failures that seemed to be related to subject's age and their morning capacity to stay awake. Executive processes were equally disturbed/recovered during the day and this failure/recovery process seemed to be mainly related to baseline subject's performance and to their capacity to stay awake. Morning concentrations of testosterone, cortisol and α-amylase were significantly decreased at SR6-SR7, but were either and respectively early (R1), tardily (after R2) and not at all (R13) recovered. All these results suggest a differential deleterious and restorative effect of CSR on cognition through biological changes of the stress pathway and subject's capacity (ClinicalTrials-NCT01989741).
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Affiliation(s)
- Arnaud Rabat
- Fatigue and Vigilance Unit, Department of Neurosciences and Operational Constraints, Armed Forces Biomedical Research Institute (IRBA)Brétigny-sur-Orge, France; VIFASOM team (EA 7330), University of Paris 5 DescartesParis, France
| | - Danielle Gomez-Merino
- Fatigue and Vigilance Unit, Department of Neurosciences and Operational Constraints, Armed Forces Biomedical Research Institute (IRBA)Brétigny-sur-Orge, France; VIFASOM team (EA 7330), University of Paris 5 DescartesParis, France
| | - Laura Roca-Paixao
- Fatigue and Vigilance Unit, Department of Neurosciences and Operational Constraints, Armed Forces Biomedical Research Institute (IRBA)Brétigny-sur-Orge, France; University of Paris 11Orsay, France
| | - Clément Bougard
- Fatigue and Vigilance Unit, Department of Neurosciences and Operational Constraints, Armed Forces Biomedical Research Institute (IRBA)Brétigny-sur-Orge, France; VIFASOM team (EA 7330), University of Paris 5 DescartesParis, France
| | - Pascal Van Beers
- Fatigue and Vigilance Unit, Department of Neurosciences and Operational Constraints, Armed Forces Biomedical Research Institute (IRBA)Brétigny-sur-Orge, France; VIFASOM team (EA 7330), University of Paris 5 DescartesParis, France
| | - Garance Dispersyn
- Fatigue and Vigilance Unit, Department of Neurosciences and Operational Constraints, Armed Forces Biomedical Research Institute (IRBA)Brétigny-sur-Orge, France; VIFASOM team (EA 7330), University of Paris 5 DescartesParis, France
| | - Mathias Guillard
- Fatigue and Vigilance Unit, Department of Neurosciences and Operational Constraints, Armed Forces Biomedical Research Institute (IRBA)Brétigny-sur-Orge, France; VIFASOM team (EA 7330), University of Paris 5 DescartesParis, France
| | - Cyprien Bourrilhon
- Department of Operational Environments, Armed Forces Biomedical Research Institute (IRBA) Brétigny-sur-Orge, France
| | - Catherine Drogou
- Fatigue and Vigilance Unit, Department of Neurosciences and Operational Constraints, Armed Forces Biomedical Research Institute (IRBA)Brétigny-sur-Orge, France; VIFASOM team (EA 7330), University of Paris 5 DescartesParis, France
| | - Pierrick J Arnal
- Fatigue and Vigilance Unit, Department of Neurosciences and Operational Constraints, Armed Forces Biomedical Research Institute (IRBA)Brétigny-sur-Orge, France; VIFASOM team (EA 7330), University of Paris 5 DescartesParis, France
| | - Fabien Sauvet
- Fatigue and Vigilance Unit, Department of Neurosciences and Operational Constraints, Armed Forces Biomedical Research Institute (IRBA)Brétigny-sur-Orge, France; VIFASOM team (EA 7330), University of Paris 5 DescartesParis, France
| | - Damien Leger
- VIFASOM team (EA 7330), University of Paris 5 DescartesParis, France; Alertness and Sleep Center, Hôtel Dieu de Paris, Public Assistance of Paris Hospitals, University of Paris 5 DescartesParis, France
| | - Mounir Chennaoui
- Fatigue and Vigilance Unit, Department of Neurosciences and Operational Constraints, Armed Forces Biomedical Research Institute (IRBA)Brétigny-sur-Orge, France; VIFASOM team (EA 7330), University of Paris 5 DescartesParis, France
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20
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Blunden S, Galland B. The complexities of defining optimal sleep: empirical and theoretical considerations with a special emphasis on children. Sleep Med Rev 2014; 18:371-8. [PMID: 24629828 DOI: 10.1016/j.smrv.2014.01.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 01/10/2014] [Accepted: 01/10/2014] [Indexed: 01/01/2023]
Abstract
The main aim of this paper is to consider relevant theoretical and empirical factors defining optimal sleep, and assess the relative importance of each in developing a working definition for, or guidelines about, optimal sleep, particularly in children. We consider whether optimal sleep is an issue of sleep quantity or of sleep quality. Sleep quantity is discussed in terms of duration, timing, variability and dose-response relationships. Sleep quality is explored in relation to continuity, sleepiness, sleep architecture and daytime behaviour. Potential limitations of sleep research in children are discussed, specifically the loss of research precision inherent in sleep deprivation protocols involving children. We discuss which outcomes are the most important to measure. We consider the notion that insufficient sleep may be a totally subjective finding, is impacted by the age of the reporter, driven by socio-cultural patterns and sleep-wake habits, and that, in some individuals, the driver for insufficient sleep can be viewed in terms of a cost-benefit relationship, curtailing sleep in order to perform better while awake. We conclude that defining optimal sleep is complex. The only method of capturing this elusive concept may be by somnotypology, taking into account duration, quality, age, gender, race, culture, the task at hand, and an individual's position in both sleep-alert and morningness-eveningness continuums. At the experimental level, a unified approach by researchers to establish standardized protocols to evaluate optimal sleep across paediatric age groups is required.
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Affiliation(s)
- Sarah Blunden
- CQUniversity Australia, 44 Greenhill Road, Wayville, Adelaide, SA 5034, Australia.
| | - Barbara Galland
- Department of Women's & Children's Health, University of Otago, PO Box 913, Dunedin, New Zealand.
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21
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Wilhelmsen-Langeland A, Saxvig IW, Pallesen S, Nordhus IH, Vedaa Ø, Lundervold AJ, Bjorvatn B. A randomized controlled trial with bright light and melatonin for the treatment of delayed sleep phase disorder: effects on subjective and objective sleepiness and cognitive function. J Biol Rhythms 2013; 28:306-21. [PMID: 24132057 DOI: 10.1177/0748730413500126] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Delayed sleep phase disorder (DSPD) is a circadian rhythm sleep disorder. Patients with DSPD have problems initiating sleep if they go to bed at a conventional time, and they often have problems waking at desired times. If they rise early in the morning, they usually experience severe sleepiness during morning hours. In the present study, we investigated the short- and long-term effects on measures of subjective and objective sleepiness and cognitive function of bright light and melatonin treatment alongside gradually advanced rise times in adolescents and young adults. Four treatment conditions were used in the short-term intervention (2 weeks): dim light (placebo) + placebo capsule, bright light + placebo capsule, dim light (placebo) + melatonin capsule, and bright light + melatonin capsule. This was followed by a long-term intervention (3 months) including 2 conditions: no treatment and combined bright light + melatonin treatment. Effects of treatment on sleepiness and fatigue were the primary outcome measures, and effects on cognitive function were secondary outcome measures. On a gradual advancement of the rise time schedule, all treatment conditions (bright light, melatonin, combination, and placebo) were almost equally effective in improving subjective daytime sleepiness, fatigue, and cognitive function in the 2-week study. The 2-week intervention showed no effect on objective sleepiness. Long-term treatment increased some of the positive effects seen after 2 weeks. The combined bright light and melatonin treatment improved subjective daytime sleepiness, fatigue, and cognitive function in the 3-month study. The no-treatment group returned to baseline values on most variables. In conclusion, a gradual advancement of rise times seems to produce positive effects on subjective sleepiness, fatigue, and cognitive performance during short-term treatment of patients with DSPD. However, the benefits from gradually advanced rise times seem to wear off, suggesting that the continuation of bright light and melatonin treatment is beneficial to maintain positive effects over time.
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Randler C, Vollmer C. Aggression in Young Adults — A Matter of Short Sleep and Social Jetlag? Psychol Rep 2013; 113:754-65. [DOI: 10.2466/16.02.pr0.113x31z7] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Evening orientation and sleep duration have been linked with aggression and problematic behaviors, but no study has used an explicit aggression questionnaire. The present study used the Buss-Perry Aggression Questionnaire based on physical aggression, verbal aggression, anger, and hostility, as well as questionnaires on the timing of sleep and sleep duration to assess this relationship in young adult men. The Composite Scale of Morningness was used to assess circadian preference; sleep-wake variables (wake time and sleep onset time on weekdays and on weekend days) were used to calculate midpoint of sleep, social jetlag, and sleep duration. Results indicated that sleep duration correlated negatively with verbal aggression, physical aggression, and anger. Short sleepers were more aggressive. Using multivariate analysis of variance, shorter sleep duration was a significant predictor of verbal aggression and anger. Concerning physical aggression, social jetlag also contributed to the model. Morningness-eveningness was associated with the hostility scale with eveningness related to higher hostility. Men scored higher than women in physical and verbal aggression.
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Affiliation(s)
- Lee K Brown
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicien, Albuquerque, NM; Program in Sleep Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM.
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Matricciani L, Blunden S, Rigney G, Williams MT, Olds TS. Children's sleep needs: is there sufficient evidence to recommend optimal sleep for children? Sleep 2013; 36:527-34. [PMID: 23564999 DOI: 10.5665/sleep.2538] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
It is widely recognized that sleep is important for children's health and well-being and that short sleep duration is associated with a wide range of negative health outcomes. Recently, there has been much interest in whether or not there are sufficient data to support the specific recommendations made for how much sleep children need. In this article we explore concepts related to children's sleep need, discuss the theory, rationale, and empirical evidence for contemporary sleep recommendations, and outline future research directions for sleep recommendations. If sleep is to be treated as a therapeutic intervention, then consensus guidelines, statements, and evidence-based best-practice documents are needed to underpin sleep recommendations for children.
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Affiliation(s)
- Lisa Matricciani
- School of Health Sciences, University of South Australia, Adelaide, Australia.
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State-trait arousal and daytime sleepiness after sleep restriction. Int J Psychophysiol 2013; 88:164-70. [PMID: 23541996 DOI: 10.1016/j.ijpsycho.2013.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 02/20/2013] [Accepted: 03/20/2013] [Indexed: 10/27/2022]
Abstract
The importance of an arousal system in the regulation of sleepiness has been widely recognised in contexts of insomnia theory and research. Arousal is also incorporated in some general models of sleepiness and is considered one of the principal factors regulating sleepiness in a model by De Valck and Cluydts (2003), in which arousal has both state and trait components. In the present experimental study, we explored the effects of state and trait components of arousal on subjective sleepiness and sleep latency during daytime. On a day after partial sleep deprivation, 28 good sleepers aged 18-26 years took part in two successive experimental conditions, in which the state arousal was manipulated by laboratory tasks. We measured physiological (heart rate, frequency of skin conductance responses) and subjective (Energy, Tension, Anxiety) indices of state arousal, while trait arousal was operationalised as electrodermal lability. After a moderately stressful task, which induced a relatively higher state arousal, the participants reported lower sleepiness and took longer to fall asleep than after a simple psychomotor task. Trait arousal was not associated with daytime sleepiness. The results of this study support the idea that short-term changes of state arousal are important for the regulation of sleepiness in good sleepers, even in a situation which is only moderately stressful.
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Horne J. Working throughout the night: beyond 'sleepiness'--impairments to critical decision making. Neurosci Biobehav Rev 2012; 36:2226-31. [PMID: 22935776 DOI: 10.1016/j.neubiorev.2012.08.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 08/06/2012] [Accepted: 08/09/2012] [Indexed: 11/29/2022]
Abstract
By the end of the first night on a 12h night-shift, wakefulness may have lasted up to 24h since the previous sleep. Although most work situations requiring critical decisions are foreseen and effectively resolved by well trained staff, such wakefulness can produce impairments in dealing with unexpected challenging situations involving uncertainty, change, distractions and capacity to evaluate risks. Also compromised can be the ability to engage in and keep abreast of protracted negotiations undertaken throughout the night. These effects, which are not just 'sleepiness', seem due to deteriorations with 'supervisory executive functions' of the prefrontal cortex; a region that appears particularly vulnerable to prolonged wakefulness. Recent research findings are presented to support this case, and some evidence-based recommendations made about practical countermeasures.
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Affiliation(s)
- Jim Horne
- Sleep Research Centre, Loughborough University, Leicestershire LE11 3TU, UK.
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HURDIEL R, MONACA C, MAUVIEUX B, MCCAULEY P, VAN DONGEN HPA, THEUNYNCK D. Field study of sleep and functional impairments in solo sailing races. Sleep Biol Rhythms 2012. [DOI: 10.1111/j.1479-8425.2012.00570.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Horne J. Sleep debt – Where is the answer – In or outside the laboratory? Biol Psychol 2011; 87:314-5; author reply 316. [DOI: 10.1016/j.biopsycho.2011.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Horne J, Moseley R. Sudden early-morning awakening impairs immediate tactical planning in a changing 'emergency' scenario. J Sleep Res 2010; 20:275-8. [PMID: 21518064 DOI: 10.1111/j.1365-2869.2010.00904.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This was a realistic military-type exercise assessing unexpected, abrupt early-morning awakening effects on immediate 'executive function' and the ability to comprehend and deal with a sudden emergency under a changing situation. Twenty (average age 21years) healthy, highly motivated junior officer reservists were assigned randomly to two equal, independent groups, unforewarned as to what would happen. The experimental group was woken abruptly at 03:00h (<3h sleep) and confronted immediately with a 'paper exercise' of an enemy attack, requiring a feasible plan of engagement with minimal loss of resources, to be completed within 15min. A control group slept until 07:30h; they were then presented with the identical emergency 1h later. Participants worked individually, under time pressure, receiving written information, map and other details, all containing relevant, irrelevant and misleading information. Halfway through, they were given (unexpectedly) a critical update necessitating a change of tactics. Performance was scored blind by instructors, under five categories. Eight of the experimental group versus three controls failed overall, with significant group differences on three specific categories relying on flexible decision-making: 'identification of available cover', 'use of available assets' and 'extraction of relevant from irrelevant information'. Other, logical and highly trained skills were unimpaired. Ours was a 'worst case scenario', combining short sleep, circadian 'trough' and sleep inertia, all of which differentiated the two groups, unlike typical laboratory studies. Nevertheless, it was relevant to real-life situations involving highly motivated, trained individuals making critical innovative decisions in the early morning versus the normal waking day.
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Affiliation(s)
- Jim Horne
- Sleep Research Centre, Loughborough University, Loughborough, Leicestershire, UK.
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Buysse DJ, Grunstein R, Horne J, Lavie P. Can an improvement in sleep positively impact on health? Sleep Med Rev 2010; 14:405-10. [DOI: 10.1016/j.smrv.2010.02.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 01/28/2010] [Accepted: 02/02/2010] [Indexed: 10/19/2022]
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The end of sleep: 'sleep debt' versus biological adaptation of human sleep to waking needs. Biol Psychol 2010; 87:1-14. [PMID: 20955760 DOI: 10.1016/j.biopsycho.2010.10.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 09/14/2010] [Accepted: 10/07/2010] [Indexed: 01/02/2023]
Abstract
It is argued that the latter part of usual human sleep is phenotypically adaptable (without 'sleep debt') to habitual shortening or lengthening, according to environmental influences of light, safety, food availability and socio-economic factors, but without increasing daytime sleepiness. Pluripotent brain mechanisms linking sleep, hunger, foraging, locomotion and alertness, facilitate this time management, with REM acting as a 'buffer' between wakefulness and nonREM ('true') sleep. The adaptive sleep range is approximately 6-9h, although, a timely short (<20 min) nap can equate to 1h 'extra' nighttime sleep. Appraisal of recent epidemiological findings linking habitual sleep duration to mortality and morbidity points to nominal causal effects of sleep within this range. Statistical significance, here, may not equate to real clinical significance. Sleep durations outside 6-9h are usually surrogates of common underlying causes, with sleep associations taking years to develop. Manipulation of sleep, alone, is unlikely to overcome these health effects, and there are effective, rapid, non-sleep, behavioural countermeasures. Sleep can be taken for pleasure, with minimal sleepiness; such 'sleepability' is 'unmasked' by sleep-conducive situations. Sleep is not the only anodyne to sleepiness, but so is wakefulness, inasmuch that some sleepiness disappears when wakefulness becomes more challenging and eventful. A more ecological approach to sleep and sleepiness is advocated.
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Malmberg B, Kecklund G, Karlson B, Persson R, Flisberg P, Ørbaek P. Sleep and recovery in physicians on night call: a longitudinal field study. BMC Health Serv Res 2010; 10:239. [PMID: 20712854 PMCID: PMC2928216 DOI: 10.1186/1472-6963-10-239] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Accepted: 08/15/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is well known that physicians' night-call duty may cause impaired performance and adverse effects on subjective health, but there is limited knowledge about effects on sleep duration and recovery time. In recent years occupational stress and impaired well-being among anaesthesiologists have been frequently reported for in the scientific literature. Given their main focus on handling patients with life-threatening conditions, when on call, one might expect sleep and recovery to be negatively affected by work, especially in this specialist group. The aim of the present study was to examine whether a 16-hour night-call schedule allowed for sufficient recovery in anaesthesiologists compared with other physician specialists handling less life-threatening conditions, when on call. METHODS Sleep, monitored by actigraphy and Karolinska Sleep Diary/Sleepiness Scale on one night after daytime work, one night call, the following first and second nights post-call, and a Saturday night, was compared between 15 anaesthesiologists and 17 paediatricians and ear, nose, and throat surgeons. RESULTS Recovery patterns over the days after night call did not differ between groups, but between days. Mean night sleep for all physicians was 3 hours when on call, 7 h both nights post-call and Saturday, and 6 h after daytime work (p < 0.001). Scores for mental fatigue and feeling well rested were poorer post-call, but returned to Sunday morning levels after two nights' sleep. CONCLUSIONS Despite considerable sleep loss during work on night call, and unexpectedly short sleep after ordinary day work, the physicians' self-reports indicate full recovery after two nights' sleep. We conclude that these 16-hour night duties were compatible with a short-term recovery in both physician groups, but the limited sleep duration in general still implies a long-term health concern. These results may contribute to the establishment of safe working hours for night-call duty in physicians and other health-care workers.
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Affiliation(s)
- Birgitta Malmberg
- Occupational and Environmental Medicine, Dept of Laboratory Medicine, Lund University, Lund, Sweden.
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Pandi-Perumal SR, Spence DW, Brown GM, Thorpy MJ. Great challenges to sleep medicine: problems and paradigms. Front Neurol 2010; 1:7. [PMID: 21206765 PMCID: PMC3009452 DOI: 10.3389/fneur.2010.00007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 03/30/2010] [Indexed: 11/13/2022] Open
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Horne J, Burley C. We know when we are sleepy: Subjective versus objective measurements of moderate sleepiness in healthy adults. Biol Psychol 2010; 83:266-8. [DOI: 10.1016/j.biopsycho.2009.12.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2009] [Accepted: 12/21/2009] [Indexed: 01/10/2023]
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Horne J. Primary insomnia: A disorder of sleep, or primarily one of wakefulness? Sleep Med Rev 2010; 14:3-7. [DOI: 10.1016/j.smrv.2009.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2009] [Accepted: 09/15/2009] [Indexed: 11/29/2022]
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