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Zhang Y, Zhong Z, Tang Z, Wang R, Wu J, Na N, Zhang J. Insomnia and sleep duration for kidney function: Mendelian randomization study. Ren Fail 2024; 46:2387430. [PMID: 39132818 PMCID: PMC11321106 DOI: 10.1080/0886022x.2024.2387430] [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: 02/28/2024] [Revised: 07/05/2024] [Accepted: 07/29/2024] [Indexed: 08/13/2024] Open
Abstract
OBJECTIVES Extensive researches highlight the detrimental impact of sleep disorders such as insomnia and insufficient sleep duration on kidney function. However, establishing a clear causal relationship between insomnia, sleep duration, and kidney function remains challenging. This study aims to estimate this relationship using Mendelian randomization (MR). METHODS Independent genetic variants strongly associated with insomnia (N = 462,341) and sleep duration (N = 460,099) were selected as instrumental variables from corresponding genome-wide association studies (GWAS). Kidney function parameters, including serum creatinine, estimated glomerular filtration rate by cystatin C (eGFRcys), acute renal failure (ARF), chronic renal failure (CRF), kidney injury molecule-1, neutrophil gelatinase associated lipocalin, microalbuminuria, cystatin C, and β2 microglobulin, were derived from GWAS databases. A two-sample MR study was conducted to assess the causal relationship between sleep disorders and kidney function, and multivariable MR was used to identify potential mediators. The inverse-variance weighted was used as the primary estimate. RESULTS MR analysis found robust evidence indicating that insomnia and short sleep duration were associated with an increased risk of elevated serum creatinine, regardless of adjusting for obesity. Causal links between sleep duration and eGFRcys or cystatin C were also identified. While genetically predicted insomnia and sleep duration were found to potentially impact ARF, CRF, microalbuminuria, and β2 microglobulin, the p-values in multivariable MR analysis became nonsignificant. No pleiotropy was detected. CONCLUSIONS This study demonstrates a causal impact of insomnia on the risk of elevated serum creatinine and a positive effect of sleep duration on serum creatinine, eGFRcys, and cystatin C. Our findings also suggest their potential indirect effects on ARF, CRF, microalbuminuria, and β2 microglobulin mediated by obesity.
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Affiliation(s)
- Yang Zhang
- Department of Kidney Transplantation, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhaozhong Zhong
- Department of Urology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou, Zhejiang, China
| | - Zuofu Tang
- Department of Kidney Transplantation, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Ruojiao Wang
- Department of Kidney Transplantation, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jiaqing Wu
- Department of Kidney Transplantation, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Ning Na
- Department of Kidney Transplantation, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Diabetology, Guangzhou, Guangdong, China
| | - Jinhua Zhang
- Department of Kidney Transplantation, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
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Abd-Alrazaq A, Aslam H, AlSaad R, Alsahli M, Ahmed A, Damseh R, Aziz S, Sheikh J. Detection of Sleep Apnea Using Wearable AI: Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e58187. [PMID: 39255014 PMCID: PMC11422752 DOI: 10.2196/58187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/07/2024] [Accepted: 07/23/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Early detection of sleep apnea, the health condition where airflow either ceases or decreases episodically during sleep, is crucial to initiate timely interventions and avoid complications. Wearable artificial intelligence (AI), the integration of AI algorithms into wearable devices to collect and analyze data to offer various functionalities and insights, can efficiently detect sleep apnea due to its convenience, accessibility, affordability, objectivity, and real-time monitoring capabilities, thereby addressing the limitations of traditional approaches such as polysomnography. OBJECTIVE The objective of this systematic review was to examine the effectiveness of wearable AI in detecting sleep apnea, its type, and its severity. METHODS Our search was conducted in 6 electronic databases. This review included English research articles evaluating wearable AI's performance in identifying sleep apnea, distinguishing its type, and gauging its severity. Two researchers independently conducted study selection, extracted data, and assessed the risk of bias using an adapted Quality Assessment of Studies of Diagnostic Accuracy-Revised tool. We used both narrative and statistical techniques for evidence synthesis. RESULTS Among 615 studies, 38 (6.2%) met the eligibility criteria for this review. The pooled mean accuracy, sensitivity, and specificity of wearable AI in detecting apnea events in respiration (apnea and nonapnea events) were 0.893, 0.793, and 0.947, respectively. The pooled mean accuracy of wearable AI in differentiating types of apnea events in respiration (normal, obstructive sleep apnea, central sleep apnea, mixed apnea, and hypopnea) was 0.815. The pooled mean accuracy, sensitivity, and specificity of wearable AI in detecting sleep apnea were 0.869, 0.938, and 0.752, respectively. The pooled mean accuracy of wearable AI in identifying the severity level of sleep apnea (normal, mild, moderate, and severe) and estimating the severity score (Apnea-Hypopnea Index) was 0.651 and 0.877, respectively. Subgroup analyses found different moderators of wearable AI performance for different outcomes, such as the type of algorithm, type of data, type of sleep apnea, and placement of wearable devices. CONCLUSIONS Wearable AI shows potential in identifying and classifying sleep apnea, but its current performance is suboptimal for routine clinical use. We recommend concurrent use with traditional assessments until improved evidence supports its reliability. Certified commercial wearables are needed for effectively detecting sleep apnea, predicting its occurrence, and delivering proactive interventions. Researchers should conduct further studies on detecting central sleep apnea, prioritize deep learning algorithms, incorporate self-reported and nonwearable data, evaluate performance across different device placements, and provide detailed findings for effective meta-analyses.
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Affiliation(s)
- Alaa Abd-Alrazaq
- AI Center for Precision Health, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Hania Aslam
- AI Center for Precision Health, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Rawan AlSaad
- AI Center for Precision Health, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Mohammed Alsahli
- Health Informatics Department, College of Health Science, Riyadh, Saudi Electronic university, Riyadh, Saudi Arabia
| | - Arfan Ahmed
- AI Center for Precision Health, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Rafat Damseh
- Department of Computer Science and Software Engineering, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates
| | - Sarah Aziz
- AI Center for Precision Health, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Javaid Sheikh
- AI Center for Precision Health, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
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3
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Carra MC, Balagny P, Bouchard P. Sleep and periodontal health. Periodontol 2000 2024. [PMID: 39233377 DOI: 10.1111/prd.12611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/18/2024] [Accepted: 08/19/2024] [Indexed: 09/06/2024]
Abstract
Sleep is fundamental for health and well-being. An adequate amount and quality of sleep is a cardinal component of a healthy lifestyle at the basis of the prevention of many non-communicable chronic diseases. Recent evidence suggests that sleep disorders, particularly obstructive sleep apnea, represent an emerging risk factor for periodontal health. This review article provides a critical appraisal of the existing literature concerning the association between sleep duration, sleep quality, sleep disorders in general, and obstructive sleep apnea with periodontal diseases, including gingivitis and periodontitis. The putative mechanisms underlying these associations are described as well as the potential clinical implications for diagnosis and treatment.
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Affiliation(s)
- Maria Clotilde Carra
- UFR of Odontology, Université Paris Cité, Paris, France
- Service of Odontology, Rothschild Hospital (AP-HP), Paris, France
- METHODS Team, CRESS, INSERM, INRAe, Université Paris Cité, Paris, France
| | - Pauline Balagny
- INSERM, UMS 011 Population-based Cohorts Unit, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France
- Department of Physiology Functional Exploration, Hôpital Bichat (AP-HP), Paris, France
| | - Philippe Bouchard
- UFR of Odontology, Université Paris Cité, Paris, France
- URP 2496, Montrouge, France
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Hall LS, Edwards JP, Dale K, Westbrooke V, Bryant RH, Kuhn-Sherlock B, Eastwood CR. An exploration into the sleep of workers on block-calving, pasture-based dairy farms. J Dairy Sci 2024:S0022-0302(24)00980-9. [PMID: 38968999 DOI: 10.3168/jds.2024-24969] [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: 03/27/2024] [Accepted: 06/13/2024] [Indexed: 07/07/2024]
Abstract
The benefits of sufficient and high-quality sleep for people are well documented. Insufficient sleep increases the risk of accidents, injuries, and negative health implications for people. This is especially relevant for farmers, as they work with large animals and machinery. Dairy farming often requires early start times and long days, particularly over the high workload calving period in block calving, pasture-based systems. However, there is little published data quantifying the sleep quantity and quality of farmers over this period. In this study, the sleep patterns of workers (n = 33) on 10 New Zealand dairy farms was measured for 90 d over the spring calving period using a sleep measuring device (OuraTM ring, Oura Health Ltd., Oulu, Finland). Total sleep time (TST) averaged 6 h 15 min, lower than the required 7 to 9 h for optimal wellbeing and cognitive functioning. TST decreased over the calving period and was significantly correlated with both sleep start and wake times. Factors such as work start time, farm location, and role on farm influenced sleep quantity and quality; indicating adjusting these on-farm factors could positively impact TST. Further research is required to better understand sleep and its effect on dairy farmers, over both the calving period and the remaining months of the year.
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Affiliation(s)
- L S Hall
- Department of Agriculture and Life Science, Lincoln University, PO Box 85084, Lincoln, 7647, New Zealand; DairyNZ Ltd., PO Box 85066, Lincoln, 7647, New Zealand.
| | - J P Edwards
- DairyNZ Ltd., PO Box 85066, Lincoln, 7647, New Zealand
| | - K Dale
- Healthy Lifestyle Ltd., Fendalton, Christchurch, 8041, New Zealand
| | - V Westbrooke
- Department of Agriculture and Life Science, Lincoln University, PO Box 85084, Lincoln, 7647, New Zealand
| | - R H Bryant
- Department of Agriculture and Life Science, Lincoln University, PO Box 85084, Lincoln, 7647, New Zealand
| | | | - C R Eastwood
- DairyNZ Ltd., PO Box 85066, Lincoln, 7647, New Zealand
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Silva de Sousa A, Pereira da Rocha A, Brandão Tavares DR, Frazão Okazaki JÉ, de Andrade Santana MV, Fernandes Moça Trevisani V, Pereira Nunes Pinto AC. Respiratory muscle training for obstructive sleep apnea: Systematic review and meta-analysis. J Sleep Res 2024; 33:e13941. [PMID: 37258418 DOI: 10.1111/jsr.13941] [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: 02/03/2023] [Revised: 04/22/2023] [Accepted: 05/02/2023] [Indexed: 06/02/2023]
Abstract
Obstructive sleep apnea is the most common sleep disorder. This review aims to evaluate the effectiveness and safety of respiratory muscle training in the treatment of patients with obstructive sleep apnea. The study protocol was registered in Prospero Platform (CRD42018096980). We performed searches in the main databases: Medical Literature Analysis and Retrieval System Online (MEDLINE) via Pubmed; Excerpta Medica dataBASE (Embase) via Elsevier; Cochrane Central Register of Controlled Trials (CENTRAL) via Cochrane Library; Latin American and Caribbean Literature on Health Sciences (LILACS) through the Portal of the Virtual Health Library and Physiotherapy Evidence Database (PEDro) for all randomised-controlled trials published before July 2022. The randomised-controlled trials were assessed for risk of bias and certainty of evidence. Thirteen randomised-controlled trials were included. All studies had an overall high risk of bias. Inspiratory muscle training probably improves systolic blood pressure and sleepiness when compared with sham. However, inspiratory muscle training probably does not improve diastolic blood pressure and maximum expiratory pressure, and may not be superior to sham for apnea-hypopnea index, forced expiratory volume in 1 s, forced vital capacity, sleep quality and quality of life. In addition, it is uncertain whether there is any effect of inspiratory muscle training on maximum inspiratory pressure and physical capacity. Inspiratory muscle training may also improve maximum inspiratory pressure and maximum expiratory pressure compared with oropharyngeal exercises. However, it may not be superior for apnea-hypopnea index, sleep quality, sleepiness, quality of life and functional capacity. When associated with physical exercise, inspiratory muscle training may not be superior to physical exercise alone for maximum inspiratory pressure, maximum expiratory pressure, systolic and diastolic blood pressure, and functional capacity. At the same time, when associated with cardiac rehabilitation exercises, inspiratory muscle training may reduce apnea-hypopnea index, improve inspiratory muscle strength, sleepiness and sleep quality compared with cardiac rehabilitation alone. However, it may not be superior for improving quality of life. Regarding expiratory muscle training, it may improve expiratory muscle strength and sleep quality, but not sleepiness when compared with sham. The evidence on the effects of expiratory muscle training in apnea-hypopnea index is very uncertain.
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Affiliation(s)
- André Silva de Sousa
- Programa de Pós- Graduação em Saúde Baseada em Evidências, Universidad Federal de São Paulo, São Paulo, Brazil
| | - Aline Pereira da Rocha
- Programa de Pós- Graduação em Saúde Baseada em Evidências, Universidad Federal de São Paulo, São Paulo, Brazil
| | | | - Jane Érika Frazão Okazaki
- Programa de Pós- Graduação em Saúde Baseada em Evidências, Universidad Federal de São Paulo, São Paulo, Brazil
| | | | - Virgínia Fernandes Moça Trevisani
- Programa de Pós- Graduação em Saúde Baseada em Evidências, Universidad Federal de São Paulo, São Paulo, Brazil
- Universidade de Santo Amaro, São Paulo, Brazil
| | - Ana Carolina Pereira Nunes Pinto
- Programa de Pós- Graduação em Saúde Baseada em Evidências, Universidad Federal de São Paulo, São Paulo, Brazil
- Universidade Federal do Amapá, Macapá, Brazil
- Iberoamerican Cochrane Centre - Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
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Kishi A, Millet GY, Desplan M, Lemarchand B, Bouscaren N. Sleep and Ultramarathon: Exploring Patterns, Strategies, and Repercussions of 1,154 Mountain Ultramarathons Finishers. SPORTS MEDICINE - OPEN 2024; 10:34. [PMID: 38589752 PMCID: PMC11001838 DOI: 10.1186/s40798-024-00704-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/24/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Sleep and physical performance are strongly related and mutually influence each other. Athletes, particularly in disciplines like offshore sailing and ultra-endurance sports, often suffer from sleep deprivation due to factors like irregular training times, travel, and the extended duration of events like 100-mile mountain races. Despite growing interest in sleep's role in sports science, few studies have specifically investigated the sleep patterns of ultramarathon runners. This study aimed to investigate sleep patterns and sleep management strategies in ultramarathons, and the repercussions of sleep deprivation during and after races. METHODS This cross-sectional study using e-survey was conducted on 1154 runners from two ultramarathons (a 165 km race with 9,576 m positive elevation; 2018 finish time [23:18:48-66:04:00], and a 111 km race with 6,433 m elevation; [15:34:56 - 41:54:16]). RESULTS The results revealed that 58% of the runners reported implementing sleep management strategies before or during the race. Most runners began the race with some level of sleep debt (-50 min a week before the race). During the races, 77% of runners slept, with the cumulative sleep duration varying based on race duration and the number of nights spent on the race (76 min at 165 km and 27 min at 111 km). Short naps lasting less than 30 min were the most popular strategy. The prevalence of symptoms attributed to sleep deprivation during the race was high (80%), with reported falls and hallucinations. After the race, runners reported recovering a normal state of wakefulness relatively quickly (within two days); 22% believed that sleep deprivation during the race increased the risk of accidents in everyday life. CONCLUSION This study provides valuable insights into sleep patterns and strategies in ultramarathon running and emphasizes the importance of adequate sleep management for performance and post-race recovery.
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Affiliation(s)
- Anthony Kishi
- Unité Fonctionnelle de Médecine du Sport, CHU de la Réunion, Site Hôpital de Saint-Pierre, BP 350, Saint-Pierre, 97448, France
| | - Guillaume Y Millet
- Inter-university Laboratory of Human Movement Biology, Univ Lyon, UJM-Saint-Etienne, Saint-Etienne, 7424, F-42023, EA, France
- Institut Universitaire de France (IUF), Paris, France
| | - Matthieu Desplan
- Be Sports Clinic, Centre Médical Médimarien, Schaerbeek, 1030, Belgique
| | - Bruno Lemarchand
- Unité Fonctionnelle de Médecine du Sport, CHU de la Réunion, Site Hôpital de Saint-Pierre, BP 350, Saint-Pierre, 97448, France
| | - Nicolas Bouscaren
- Inter-university Laboratory of Human Movement Biology, Univ Lyon, UJM-Saint-Etienne, Saint-Etienne, 7424, F-42023, EA, France.
- Service de santé Publique et soutien à la recherche, INSERM CIC 1410, CHU Réunion, Saint Pierre, France.
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Barateau L, Baillieul S, Andrejak C, Bequignon É, Boutouyrie P, Dauvilliers Y, Gagnadoux F, Geoffroy PA, Micoulaud-Franchi JA, Montani D, Monaca C, Patout M, Pépin JL, Philip P, Pilette C, Tamisier R, Trzepizur W, Jaffuel D, Arnulf I. Guidelines for the assessment and management of residual sleepiness in obstructive apnea-hypopnea syndrome: Endorsed by the French Sleep Research and Medicine Society (SFRMS) and the French Speaking Society of Respiratory Diseases (SPLF). Respir Med Res 2024; 86:101105. [PMID: 38861872 DOI: 10.1016/j.resmer.2024.101105] [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: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 06/13/2024]
Abstract
Excessive daytime sleepiness (EDS) is frequent among patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and can persist despite the optimal correction of respiratory events (apnea, hypopnea and respiratory efforts), using continuous positive airway pressure (CPAP) or mandibular advancement device. Symptoms like apathy and fatigue may be mistaken for EDS. In addition, EDS has multi-factorial origin, which makes its evaluation complex. The marketing authorization [Autorisation de Mise sur le Marché (AMM)] for two wake-promoting agents (solriamfetol and pitolisant) raises several practical issues for clinicians. This consensus paper presents recommendations of good clinical practice to identify and evaluate EDS in this context, and to manage and follow-up the patients. It was conducted under the mandate of the French Societies for sleep medicine and for pneumology [Société Française de Recherche et de Médecine du Sommeil (SFRMS) and Société de Pneumologie de Langue Française (SPLF)]. A management algorithm is suggested, as well as a list of conditions during which the patient should be referred to a sleep center or a sleep specialist. The benefit/risk balance of a wake-promoting drug in residual EDS in OSAHS patients must be regularly reevaluated, especially in elderly patients with increased cardiovascular and psychiatric disorders risks. This consensus is based on the scientific knowledge at the time of the publication and may be revised according to their evolution.
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Affiliation(s)
- Lucie Barateau
- National Reference Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; Sleep and Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac University Hospital, Montpellier, France; Institute of Neurosciences of Montpellier (INM), INSERM, University of Montpellier, France.
| | - Sébastien Baillieul
- Grenoble-Alpes university, HP2 Inserm laboratory, U1300, Pneumology and Physiology department, CHU Grenoble-Alpes, 38000 Grenoble, France; National Competence Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France
| | - Claire Andrejak
- Pneumology department, CHU Amiens-Picardie, 80054 Amiens, France; UR 4294 AGIR, Picardie Jules-Verne University, Amiens, France
| | - Émilie Bequignon
- ENT and oral maxillofacial surgery department, Intercommunal center Créteil, 94000 Créteil, France; CNRS, ERL 7000, Paris-Est Créteil University, 94010 Créteil, France
| | - Pierre Boutouyrie
- Pharmacology, Inserm PARCC U970, Georges-Pompidou European Hospital, Paris-Cité University, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Yves Dauvilliers
- National Reference Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; Sleep and Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac University Hospital, Montpellier, France; Institute of Neurosciences of Montpellier (INM), INSERM, University of Montpellier, France
| | - Frédéric Gagnadoux
- National Competence Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; Pneumology and Sleep Medicine department, Angers CHU, Angers, France; Inserm 1083, UMR CNRS 6015, MITOVASC, Angers university, 49000 Angers, France
| | - Pierre-Alexis Geoffroy
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, 75018 Paris, France; Centre ChronoS, GHU Paris - Psychiatry & Neurosciences, 1 rue Cabanis, 75014 Paris, France; Université de Paris, NeuroDiderot, Inserm U1141, 75019 Paris, France
| | - Jean-Arthur Micoulaud-Franchi
- University Sleep medicine unit, Bordeaux CHU, place Amélie-Raba-Léon, Bordeaux, France; SANPSY UMR 6033, Bordeaux University, 33000 Bordeaux, France
| | - David Montani
- Université Paris-Saclay, AP-HP, INSERM UMR_S 999, Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
| | - Christelle Monaca
- National Competence Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; Clinical neurophysiology, sleep disorders unit, U1172 - LilNCog - Lille, neurosciences & cognition, Lille university, Lille CHU, 59000 Lille, France
| | - Maxime Patout
- R3S department, Sleep pathologies unit, University hospital group, AP-HP-Sorbonne university, AP-HP, Pitié-Salpêtrière site, 75013 Paris, France; Inserm, UMRS1158 experimental and clinical respiratory neurophysiology, Sorbonne university, 75005 Paris, France
| | - Jean-Louis Pépin
- Grenoble-Alpes university, HP2 Inserm laboratory, U1300, Pneumology and Physiology department, CHU Grenoble-Alpes, 38000 Grenoble, France; National Competence Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France
| | - Pierre Philip
- National Reference Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; University Sleep medicine unit, Bordeaux CHU, place Amélie-Raba-Léon, Bordeaux, France; SANPSY UMR 6033, Bordeaux University, 33000 Bordeaux, France
| | - Charles Pilette
- Saint-Luc university clinics, Institute for experimental and clinical research (Pneumology unit), UC Louvain, Brussels, Belgium
| | - Renaud Tamisier
- Grenoble-Alpes university, HP2 Inserm laboratory, U1300, Pneumology and Physiology department, CHU Grenoble-Alpes, 38000 Grenoble, France; National Competence Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France
| | - Wojciech Trzepizur
- National Competence Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; Pneumology and Sleep Medicine department, Angers CHU, Angers, France; Inserm 1083, UMR CNRS 6015, MITOVASC, Angers university, 49000 Angers, France
| | - Dany Jaffuel
- Pneumology department, Arnaud-de-Villeneuve hospital, Montpellier CHRU, Montpellier, France; Inserm U1046, physiology and experimental medicine, heart and muscle, Montpellier university, Montpellier, France
| | - Isabelle Arnulf
- National Reference Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; Pneumology department, Arnaud-de-Villeneuve hospital, Montpellier CHRU, Montpellier, France
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8
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Zimmerman ME, Benasi G, Hale C, Yeung LK, Cochran J, Brickman AM, St-Onge MP. The effects of insufficient sleep and adequate sleep on cognitive function in healthy adults. Sleep Health 2024; 10:229-236. [PMID: 38233280 PMCID: PMC11045317 DOI: 10.1016/j.sleh.2023.11.011] [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: 03/22/2023] [Revised: 11/12/2023] [Accepted: 11/21/2023] [Indexed: 01/19/2024]
Abstract
STUDY OBJECTIVES Although sleep affects a range of waking behaviors, the majority of studies have focused on sleep loss with relatively little attention on sustained periods of adequate sleep. The goal of this study was to use an experimental design to examine the effect of both of these sleep patterns on cognitive performance in healthy adults. METHODS This study used a randomized crossover design. Participants who regularly slept 7-9 hours/night completed two 6-week intervention conditions, adequate sleep (maintenance of habitual bed/wake times) and insufficient sleep (reduction in sleep of 1.5 hours relative to adequate sleep), separated by a 2-6weeks (median=43days) washout period. Cognitive functioning was evaluated at baseline and endpoint of each intervention using the NIH Toolbox Cognition Battery. General linear models contrasted scores following each condition to the baseline of the first condition; the baseline of the second condition was included to evaluate practice effects. RESULTS Sixty-five participants (age 35.9 ± 4.9years, 89% women, 52% non-White race/ethnicity) completed study procedures. There was improvement in performance on the List Sorting Working Memory task after the adequate sleep condition that exceeded practice effects. Cognitive performance after insufficient sleep did not reach the level expected with practice and did not differ from baseline. A similar pattern was found on the Flanker Inhibitory Control and Attention task. CONCLUSIONS These findings contribute to our understanding of the complex interplay between sleep and cognition and demonstrate that consistent, stable sleep of at least 7 hours/night improves working memory and response inhibition in healthy adults. CLINICAL TRIAL REGISTRATION The manuscript reports on data from two clinical trials: Impact of Sleep Restriction on Performance in Adults (URL: https://clinicaltrials.gov/ct2/show/NCT02960776, ID Number: NCT02960776) and Impact of Sleep Restriction in Women (URL: https://clinicaltrials.gov/ct2/show/NCT02835261, ID Number: NCT02835261).
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Affiliation(s)
| | - Giada Benasi
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Christiane Hale
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Lok-Kin Yeung
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Justin Cochran
- Center of Excellence for Sleep & Circadian Research and Division of General Medicine, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Adam M Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA; Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Marie-Pierre St-Onge
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA; Center of Excellence for Sleep & Circadian Research and Division of General Medicine, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.
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9
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Andrillon T, Taillard J, Strauss M. Sleepiness and the transition from wakefulness to sleep. Neurophysiol Clin 2024; 54:102954. [PMID: 38460284 DOI: 10.1016/j.neucli.2024.102954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 03/11/2024] Open
Abstract
The transition from wakefulness to sleep is a progressive process that is reflected in the gradual loss of responsiveness, an alteration of cognitive functions, and a drastic shift in brain dynamics. These changes do not occur all at once. The sleep onset period (SOP) refers here to this period of transition between wakefulness and sleep. For example, although transitions of brain activity at sleep onset can occur within seconds in a given brain region, these changes occur at different time points across the brain, resulting in a SOP that can last several minutes. Likewise, the transition to sleep impacts cognitive and behavioral levels in a graded and staged fashion. It is often accompanied and preceded by a sensation of drowsiness and the subjective feeling of a need for sleep, also associated with specific physiological and behavioral signatures. To better characterize fluctuations in vigilance and the SOP, a multidimensional approach is thus warranted. Such a multidimensional approach could mitigate important limitations in the current classification of sleep, leading ultimately to better diagnoses and treatments of individuals with sleep and/or vigilance disorders. These insights could also be translated in real-life settings to either facilitate sleep onset in individuals with sleep difficulties or, on the contrary, prevent or control inappropriate sleep onsets.
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Affiliation(s)
- Thomas Andrillon
- Paris Brain Institute, Sorbonne Université, Inserm-CNRS, Paris 75013, France; Monash Centre for Consciousness & Contemplative Studies, Monash University, Melbourne, VIC 3800, Australia
| | - Jacques Taillard
- Univ. Bordeaux, CNRS, SANPSY, UMR 6033, F-33000 Bordeaux, France
| | - Mélanie Strauss
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), CUB Hôpital Érasme, Services de Neurologie, Psychiatrie et Laboratoire du sommeil, Route de Lennik 808 1070 Bruxelles, Belgium; Neuropsychology and Functional Neuroimaging Research Group (UR2NF), Center for Research in Cognition and Neurosciences (CRCN), Université Libre de Bruxelles, B-1050 Brussels, Belgium.
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10
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DiNardo LA, Reese AD, Raghavan M, Ma AC, Behar P, Hassinger AB, Carr MM. How Pediatric Sleep Disordered Breathing Impacts Parental Fatigue. Ann Otol Rhinol Laryngol 2024; 133:152-157. [PMID: 37551041 DOI: 10.1177/00034894231191824] [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] [Indexed: 08/09/2023]
Abstract
OBJECTIVE Previous research has indicated that sleep disordered breathing (SDB) can lead to a decreased quality of life in children and their families as compared to children who do not have SDB. The purpose of this study was to examine fatigue levels in parents who had young children who were impacted by sleep symptoms as determined by the OSA-18 scale. STUDY DESIGN Survey. SETTING Three pediatric otolaryngology clinics associated with a tertiary care children's hospital in Buffalo, NY. METHODS Fatigue levels for parents of children with OSA-18 ≥ 60 were assessed using the Fatigue Severity Scale and the Chalder Fatigue Scale. Consecutive parents with at least one child between the ages of 1 and 10 were recruited. Parents scored their youngest child on the OSA-18 scale. RESULTS Of the 261 respondents included, 37 parents had a child with an OSA-18 score ≥60. The majority, 211 (82.1%), of participants reported 2 caregivers in the household while 30 (11.7%) had 1 caregiver in the household. Parents of children with OSA-18 ≥60 had a significantly higher mean fatigue score, 16.5 ± 5.8, compared to their counterparts, 11.9 ± 5.2, on the Chalder Fatigue Scale (P < .001). Similar results were reported for the total score on the Fatigue Severity Scale, 34.7 ± 10.8 compared to 28.9 ± 12.0 (P = .004). CONCLUSION Parents of children with OSA-18 score ≥60 are significantly more fatigued than parents of children with lower scores. Recognition of this is important for the health care community as it impacts not just the child with OSA but also their family.
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Affiliation(s)
- Lauren A DiNardo
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - Alyssa D Reese
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - Maya Raghavan
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - Alison C Ma
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - Philomena Behar
- Department of Otolaryngology - Head and Neck Surgery, Jacobs School of Medicine & Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - Amanda B Hassinger
- Division of Pulmonology and Sleep Medicine, Department of Pediatrics, Jacobs School of Medicine & Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - Michele M Carr
- Department of Otolaryngology - Head and Neck Surgery, Jacobs School of Medicine & Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
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11
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Czeisler CA, Kryger M. The rhythms of light, the rhythms of life. Sleep Health 2024; 10:S1-S3. [PMID: 38262778 DOI: 10.1016/j.sleh.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Affiliation(s)
- Charles A Czeisler
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA; Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
| | - Meir Kryger
- Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
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12
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Chen X, Niu Y, Zhao Y, Qin X. An Efficient Group Federated Learning Framework for Large-Scale EEG-Based Driver Drowsiness Detection. Int J Neural Syst 2024; 34:2450003. [PMID: 37964570 DOI: 10.1142/s0129065724500035] [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] [Indexed: 11/16/2023]
Abstract
To avoid traffic accidents, monitoring the driver's electroencephalogram (EEG) signals to assess drowsiness is an effective solution. However, aggregating the personal data of these drivers may lead to insufficient data usage and pose a risk of privacy breaches. To address these issues, a framework called Group Federated Learning (Group-FL) for large-scale driver drowsiness detection is proposed, which can efficiently utilize diverse client data while protecting privacy. First, by arranging the clients into different levels of groups and gradually aggregating their model parameters from low-level groups to high-level groups, communication and time costs are reduced. In addition, to solve the problem of notable variations in EEG signals among different clients, a global-personalized deep neural network is designed. The global model extracts shared features from various clients, while the personalized model extracts fine-grained features from each client and outputs classification results. Finally, to address special issues such as scale/category imbalance and data pollution, three checking modules are designed for adjusting grouping, evaluating client data, and effectively applying personalized models. Through extensive experimentation, the effectiveness of each component within the framework was validated, and a mean accuracy, F1-score, and Area Under Curve (AUC) of 81.0%, 82.0%, and 87.9% was achieved, respectively, on a publicly available dataset comprising 11 subjects.
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Affiliation(s)
- Xinyuan Chen
- School of Information Science and Engineering, Shandong Normal University, Jinan 250014, P. R. China
| | - Yi Niu
- School of Information Science and Engineering, Shandong Normal University, Jinan 250014, P. R. China
| | - Yanna Zhao
- School of Information Science and Engineering, Shandong Normal University, Jinan 250014, P. R. China
| | - Xue Qin
- School of Information Science and Engineering, Shandong Normal University, Jinan 250014, P. R. China
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13
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Tonn B, Marincic M, Rose E. A dollar well spent: Monetizing the societal benefits of low-income weatherization programs in the United States. ENERGY RESEARCH & SOCIAL SCIENCE 2024; 107:103341. [PMID: 39206377 PMCID: PMC11349305 DOI: 10.1016/j.erss.2023.103341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Low-income residential energy efficiency programs save energy and can yield numerous co-benefits or non-energy impacts (NEIs). This paper presents a two-component framework that can be used to measure and monetize household-related NEIs. Two examples of using the framework are presented, one associated with an evaluation of a low-income single family home weatherization program implemented in the Southeastern United States (U.S.) and a second associated with a broad NEI assessment of weatherized affordable multifamily buildings in the Northeastern and Midwestern regions of the U.S. Seventeen NEIs were subject to monetization, including reductions in medical interventions for being too cold or too hot in one's home and reductions in use of predatory loans. The results of the two monetization exercises indicate that the monetary value of the NEIs is equal to or exceeds the energy efficiency job costs and energy cost savings. It is also clear that the value of the NEIs differs quite substantially based on home type. Future research can focus on better estimating changes in NEI variables and expressing ranges of uncertainty in final monetization values.
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14
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Putilov AA, Sveshnikov DS, Bakaeva ZV, Yakunina EB, Starshinov YP, Torshin VI, Trutneva EA, Lapkin MM, Lopatskaya ZN, Gandina EO, Ligun NV, Puchkova AN, Dorokhov VB. Evening chronotype, insufficient weekday sleep, and weekday-weekend gap in sleep times: What is really to blame for a reduction in self-perceived health among university students? Chronobiol Int 2023; 40:874-884. [PMID: 37314700 DOI: 10.1080/07420528.2023.2222797] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/31/2023] [Accepted: 06/04/2023] [Indexed: 06/15/2023]
Abstract
The association of insufficient sleep with reduced self-perceived health was previously well established. Moreover, it was sometimes shown that the indicators of poorer health were significantly related to chronotype and weekday-weekend gaps in sleep timing and duration. It remains to be elucidated, however, whether chronotype and these gaps can contribute to the reduced health self-ratings independently from shortened sleep duration or, alternatively, their relationship with health can be simply explained by their association with insufficient sleep on weekdays. In an online survey, we tested whether the self-rated health of university students can be predicted by several individual characteristics of the sleep-wake cycles, such as chronotype, weekday and weekend sleep times, weekday-weekend gap in sleep times, sleepability and wakeability at different times of the day, etc. Responses to a question about general health and to items of several questionnaires for chronobiological assessment were collected from smartphones of 1582 university students (mean age ± standard deviation was 19.5 ± 1.7 y). The results of regression analyses suggested that lower odds of having good self-rated health were significantly associated with an earlier weekday risetime, a later weekday bedtime, and, consequently, a shorter weekday time in bed. After accounting for weekday sleep, self-rated health showed significant association with neither chronotype nor weekday-weekend differences in sleep duration and timing. Besides, the adverse health effects of reduced weekday sleep were independent from the significant adverse effects of several other individual sleep-wake characteristics including poorer nighttime sleepability and lower daytime wakeability. We concluded that university students perceive the negative health impacts of losing sleep by waking up early on weekdays irrespective of their night sleep quality and daytime level of alertness. Their chronotype and weekday-weekend difference in sleep times might not be among significant contributors to this perception. It is of practical importance to consider the reduction of weekday sleep losses among the interventions aimed at preventing sleep and health problems.
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Affiliation(s)
- Arcady A Putilov
- Laboratory of Sleep/Wake Neurobiology, Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy of Sciences, Moscow, Russia
- Research Group for Math-Modeling of Biomedical Systems, Research Institute for Molecular Biology and Biophysics of the Federal Research Centre for Fundamental and Translational Medicine, Novosibirsk, Russia
- Laboratory of Nanobiotechnology and Biophysics, North-Caucasus Federal University, Stavropol, Russia
| | - Dmitry S Sveshnikov
- Department of Normal Physiology, Medical Institute of the Peoples' Friendship University of Russia, Moscow, Russia
| | - Zarina V Bakaeva
- Department of Normal Physiology, Medical Institute of the Peoples' Friendship University of Russia, Moscow, Russia
| | - Elena B Yakunina
- Department of Normal Physiology, Medical Institute of the Peoples' Friendship University of Russia, Moscow, Russia
| | - Yuri P Starshinov
- Department of Normal Physiology, Medical Institute of the Peoples' Friendship University of Russia, Moscow, Russia
| | - Vladimir I Torshin
- Department of Normal Physiology, Medical Institute of the Peoples' Friendship University of Russia, Moscow, Russia
| | - Elena A Trutneva
- Department of Physiology, Ryazan State Medical University, Ryazan, Russia
| | - Michael M Lapkin
- Department of Physiology, Ryazan State Medical University, Ryazan, Russia
| | - Zhanna N Lopatskaya
- Department of Physiology, Medical Institute of the of Surgut State University, Surgut, Russia
| | - Eugenia O Gandina
- Laboratory of Sleep/Wake Neurobiology, Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy of Sciences, Moscow, Russia
| | - Natalya V Ligun
- Laboratory of Sleep/Wake Neurobiology, Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy of Sciences, Moscow, Russia
| | - Alexandra N Puchkova
- Laboratory of Sleep/Wake Neurobiology, Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy of Sciences, Moscow, Russia
| | - Vladimir B Dorokhov
- Laboratory of Sleep/Wake Neurobiology, Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy of Sciences, Moscow, Russia
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15
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Johnson DA, Prakash-Asrani R, Lewis BD, Bliwise DL, Lewis TT. Racial/ethnic differences in the beneficial effect of social support on sleep duration. J Clin Sleep Med 2023; 19:1231-1238. [PMID: 36866616 PMCID: PMC10315597 DOI: 10.5664/jcsm.10542] [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: 09/27/2022] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/04/2023]
Abstract
STUDY OBJECTIVES Social support (SS) is associated with better health outcomes, including sleep health. However, the specific sources of SS that benefit sleep are unclear, and whether these associations vary by race/ethnicity or age is unknown. The aim of this study was to examine cross-sectional associations between sources of SS (number of friends, financial, church attendance, and emotional support) and self-reported short sleep duration (< 7 hours) overall and by race/ethnic groups and age among a representative sample. METHODS Using National Health and Nutrition Examination Survey (NHANES) data, logistic regression (marginal standardization) and linear regression models were fit accounting for survey design and weights to test associations between sources of SS (number of friends, financial, church attendance, emotional support) and self-reported short sleep duration (< 7 hours) overall and by race/ethnic groups (Black, Hispanic, and White) and age (< 65 vs ≥ 65 years). RESULTS Among 3,711 participants, the mean (standard error) age was 57 (0.3) years and 37% slept < 7 hours. Black adults had the highest prevalence of short sleep (55%). Overall, participants with financial support compared with those without financial support had a lower prevalence of short sleep: 23% (confidence interval [CI]: 0.68, 0.87). As the number of SS sources increased, the prevalence of short sleep duration decreased and the racial disparity in sleep duration narrowed. Associations between financial support and sleep were most pronounced among Hispanic and White adults and adults < 65 years. CONCLUSIONS In general, financial support was associated with a healthier sleep duration, particularly among those < 65 years of age. Individuals with numerous sources of SS were less likely to be short sleepers. The benefits of SS on sleep duration varied by race. Targeting specific sources of SS may help to improve sleep duration among those most at risk. CITATION Johnson DA, Prakash-Asrani R, Lewis BD, Bliwise DL, Lewis TT. Racial/ethnic differences in the beneficial effect of social support on sleep duration. J Clin Sleep Med. 2023;19(7):1231-1238.
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Affiliation(s)
- Dayna A. Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Radhika Prakash-Asrani
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Billye D. Lewis
- Environmental and Health Sciences, Spelman College, Atlanta, Georgia
| | - Donald L. Bliwise
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Tené T. Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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16
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Gaudier-Diaz MM, Parekh SV, Penton RE, Robertson SD, Thomas A. Sleepy Mice Case Study: Implementation and Assessment. JOURNAL OF UNDERGRADUATE NEUROSCIENCE EDUCATION : JUNE : A PUBLICATION OF FUN, FACULTY FOR UNDERGRADUATE NEUROSCIENCE 2023; 21:A108-A116. [PMID: 37588653 PMCID: PMC10426825 DOI: 10.59390/rhsn3470] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/10/2022] [Accepted: 10/14/2023] [Indexed: 08/18/2023]
Abstract
Case studies are a valuable teaching tool to engage students in course content using real-world scenarios. As part of the High-throughput Discovery Science & Inquiry-based Case Studies for Today's Students (HITS) Research Coordination Network (RCN), our team has created the Sleepy Mice Case Study for students to engage with RStudio and the Allen Institute for Brain Science's open access high-throughput sleep dataset on mice. Sleep is important for health, a familiar concern to college students, and was a basis for this case study. In this case, students completed an initial homework assignment, in-class work, and a final take-home application assignment. The case study was implemented in synchronous and asynchronous Introductory Neuroscience courses, a Biopsychology course, and a Human Anatomy and Physiology course, reflecting its versatility. The case can be used to teach course-specific learning objectives such as sleep-related content and/or science data processing skills. The case study was successful as shown by gains in student scores and confidence in achieving learning objectives. Most students reported enjoying learning about sleep deprivation course content using the case study. Best practices based on instructor experiences in implementation are also included to facilitate future use so that the Sleepy Mice Case Study can be used to teach content and/or research-related skills in various courses and modalities.
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Affiliation(s)
- Monica M. Gaudier-Diaz
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC 25799
| | - Shveta V. Parekh
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC 25799
| | - Rachel E. Penton
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC 25799
| | - Sabrina D. Robertson
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC 25799
| | - Aeisha Thomas
- Department of Biological and Health Sciences, Crown College, St. Bonifacius, MN 55375
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17
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Marquina C, Makarounas-Kirchmann K, Holden K, Sasse A, Ademi Z. The preventable productivity burden of sleep apnea in Australia: a lifetime modelling study. J Sleep Res 2023; 32:e13748. [PMID: 36303525 DOI: 10.1111/jsr.13748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 11/29/2022]
Abstract
Obstructive sleep apnea (OSA) is a common disorder. OSA is associated with cardiovascular disease (CVD), type 2 diabetes mellitus (T2DM) and depression, among other comorbidities. We aim to determine the productivity burden of OSA in Australia using productivity-adjusted life-years (PALYs). Using life table modelling, we built a multistate Markov model to estimate the impact of moderate to severe OSA on the whole working-age Australian population in 2021 (aged 20-65 years) with OSA until retirement (aged 66 years). The model also captured the impact of OSA on CVD, T2DM, depression, and vehicle-related accidents. Data for OSA and comorbidities and Australian specific labour data, were extracted from published sources. A second cohort was then modelled to test the effect of a hypothetical intervention, assuming a 10% reduction in OSA prevalence and a 10% reduction in comorbidities in patients with OSA. The primary outcome of interest were PALYs accrued. All outcomes were discounted 5% annually. Over a lifetime, the Australian population with OSA accrued 193,713,441 years of life lived and 182,737,644 PALYs. A reduction of 10% in OSA prevalence and comorbidities would result in 45,401 extra years of life lived and 150,950 extra PALYs. This resulted in more than AU$25 billion of gained gross domestic product over the lifetime of the working population. Our study highlights the substantial burden of OSA on the Australian population and the need to tailor interventions at the population level to reduce the health and economic impacts.
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Affiliation(s)
- Clara Marquina
- Centre for Medicine Use and Safety (CMUS), Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kelly Makarounas-Kirchmann
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Snoretox Ltd., Melbourne, Victoria, Australia
| | - Karen Holden
- Snoretox Ltd., Melbourne, Victoria, Australia.,School of Health Sciences, Bundoora West Campus, RMIT University, Melbourne, Victoria, Australia
| | - Anthony Sasse
- Snoretox Ltd., Melbourne, Victoria, Australia.,School of Health Sciences, Bundoora West Campus, RMIT University, Melbourne, Victoria, Australia
| | - Zanfina Ademi
- Centre for Medicine Use and Safety (CMUS), Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
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Matsuo R, Tanigawa T, Oshima A, Tomooka K, Ikeda A, Wada H, Maruyama K, Saito I. Decreased psychomotor vigilance is a risk factor for motor vehicle crashes irrespective of subjective daytime sleepiness: the Toon Health Study. J Clin Sleep Med 2023; 19:319-325. [PMID: 36271594 PMCID: PMC9892751 DOI: 10.5664/jcsm.10328] [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: 07/08/2022] [Revised: 10/01/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
STUDY OBJECTIVES Although excessive daytime sleepiness (EDS) has a crucial impact on motor vehicle crashes (MVCs), the assessment of subjective sleepiness as a screening tool for MVC has limitations. Objective daytime sleepiness may be a better predictor of MVCs rather than subjective daytime sleepiness. Therefore, we aimed to examine the association of psychomotor vigilance as a surrogate marker of objective sleepiness and subjective sleepiness with MVCs in a prospective cohort study of the general population. METHODS The study participants were 903 community-dwelling Japanese followed up 5 years after baseline and ascertained history of MVC over the study period. Psychomotor vigilance was measured by the psychomotor vigilance test and categorized into quartiles by the reciprocal of the mean reaction time (mean1/RT). Subjective EDS was defined using the Japanese version of the Epworth Sleepiness Scale. Multivariable logistic regression analysis was used to examine the association between mean1/RT and MVC after stratification by subjective EDS. RESULTS The multivariable-adjusted odds ratio (95% confidence interval) for MVC among the highest quartile group of mean1/RT was 0.31 (0.17-0.57), compared with the lowest group (P for trend < .01). After stratification by subjective EDS, the significant association was found only among the nonsubjective EDS group (P for trend < .01) and not among the subjective EDS group (P for trend = .16). CONCLUSIONS Decreased psychomotor vigilance measured by the psychomotor vigilance test was associated with a higher risk of MVCs, and the association was more evident among the nonsubjective EDS group. The psychomotor vigilance test may be useful to prevent sleep-related MVCs in the general population, particularly for individuals without subjective EDS. CITATION Matsuo R, Tanigawa T, Oshima A, et al. Decreased psychomotor vigilance is a risk factor for motor vehicle crashes irrespective of subjective daytime sleepiness: the Toon Health Study. J Clin Sleep Med. 2023;19(2):319-325.
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Affiliation(s)
- Ryotaro Matsuo
- Department of Public Health, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Juntendo University Hospital, Tokyo, Japan
| | - Takeshi Tanigawa
- Department of Public Health, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akane Oshima
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - Kiyohide Tomooka
- Department of Public Health, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Ai Ikeda
- Department of Public Health, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Hiroo Wada
- Department of Public Health, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Koutatsu Maruyama
- Laboratory of Community Health and Nutrition, Special Course of Food and Health Science, Department of Bioscience, Graduate School of Agriculture, Ehime University, Ehime, Japan
| | - Isao Saito
- Department of Public Health and Epidemiology, Faculty of Medicine, Oita University, Oita, Japan
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19
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De Fazio R, Mattei V, Al-Naami B, De Vittorio M, Visconti P. Methodologies and Wearable Devices to Monitor Biophysical Parameters Related to Sleep Dysfunctions: An Overview. MICROMACHINES 2022; 13:1335. [PMID: 36014257 PMCID: PMC9412310 DOI: 10.3390/mi13081335] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 06/13/2023]
Abstract
Sleep is crucial for human health from metabolic, mental, emotional, and social points of view; obtaining good sleep in terms of quality and duration is fundamental for maintaining a good life quality. Over the years, several systems have been proposed in the scientific literature and on the market to derive metrics used to quantify sleep quality as well as detect sleep disturbances and disorders. In this field, wearable systems have an important role in the discreet, accurate, and long-term detection of biophysical markers useful to determine sleep quality. This paper presents the current state-of-the-art wearable systems and software tools for sleep staging and detecting sleep disorders and dysfunctions. At first, the paper discusses sleep's functions and the importance of monitoring sleep to detect eventual sleep disturbance and disorders. Afterward, an overview of prototype and commercial headband-like wearable devices to monitor sleep is presented, both reported in the scientific literature and on the market, allowing unobtrusive and accurate detection of sleep quality markers. Furthermore, a survey of scientific works related the effect of the COVID-19 pandemic on sleep functions, attributable to both infection and lifestyle changes. In addition, a survey of algorithms for sleep staging and detecting sleep disorders is introduced based on an analysis of single or multiple biosignals (EEG-electroencephalography, ECG-electrocardiography, EMG-electromyography, EOG-electrooculography, etc.). Lastly, comparative analyses and insights are provided to determine the future trends related to sleep monitoring systems.
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Affiliation(s)
- Roberto De Fazio
- Department of Innovation Engineering, University of Salento, 73100 Lecce, Italy
| | - Veronica Mattei
- Department of Innovation Engineering, University of Salento, 73100 Lecce, Italy
| | - Bassam Al-Naami
- Department of Biomedical Engineering, Faculty of Engineering, The Hashemite University, Zarqa 13133, Jordan
| | - Massimo De Vittorio
- Department of Innovation Engineering, University of Salento, 73100 Lecce, Italy
- Center for Biomolecular Nanotechnologies, Italian Technology Institute IIT, 73010 Arnesano, Italy
| | - Paolo Visconti
- Department of Innovation Engineering, University of Salento, 73100 Lecce, Italy
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20
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Mazzotti DR, Haendel MA, McMurry JA, Smith CJ, Buysse DJ, Roenneberg T, Penzel T, Purcell S, Redline S, Zhang Y, Merikangas KR, Menetski JP, Mullington J, Boudreau E. Sleep and circadian informatics data harmonization: a workshop report from the Sleep Research Society and Sleep Research Network. Sleep 2022; 45:zsac002. [PMID: 35030631 PMCID: PMC9189941 DOI: 10.1093/sleep/zsac002] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/21/2021] [Indexed: 01/16/2023] Open
Abstract
The increasing availability and complexity of sleep and circadian data are equally exciting and challenging. The field is in constant technological development, generating better high-resolution physiological and molecular data than ever before. Yet, the promise of large-scale studies leveraging millions of patients is limited by suboptimal approaches for data sharing and interoperability. As a result, integration of valuable clinical and basic resources is problematic, preventing knowledge discovery and rapid translation of findings into clinical care. To understand the current data landscape in the sleep and circadian domains, the Sleep Research Society (SRS) and the Sleep Research Network (now a task force of the SRS) organized a workshop on informatics and data harmonization, presented at the World Sleep Congress 2019, in Vancouver, Canada. Experts in translational informatics gathered with sleep research experts to discuss opportunities and challenges in defining strategies for data harmonization. The goal of this workshop was to fuel discussion and foster innovative approaches for data integration and development of informatics infrastructure supporting multi-site collaboration. Key recommendations included collecting and storing findable, accessible, interoperable, and reusable data; identifying existing international cohorts and resources supporting research in sleep and circadian biology; and defining the most relevant sleep data elements and associated metadata that could be supported by early integration initiatives. This report introduces foundational concepts with the goal of facilitating engagement between the sleep/circadian and informatics communities and is a call to action for the implementation and adoption of data harmonization strategies in this domain.
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Affiliation(s)
- Diego R Mazzotti
- Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Melissa A Haendel
- Center for Health AI, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Julie A McMurry
- Center for Health AI, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Connor J Smith
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA,USA
| | - Till Roenneberg
- Institute and Polyclinic for Occupational-, Social- and Environmental Medicine, LMU Munich, Germany
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charité University Hospital, Berlin, Germany
| | - Shaun Purcell
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Susan Redline
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Ying Zhang
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Kathleen R Merikangas
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA
| | | | - Janet Mullington
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Eilis Boudreau
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
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21
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McCarter SJ, Hagen PT, St Louis EK, Rieck TM, Haider CR, Holmes DR, Morgenthaler TI. Physiological markers of sleep quality: A scoping review. Sleep Med Rev 2022; 64:101657. [PMID: 35753151 DOI: 10.1016/j.smrv.2022.101657] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 05/16/2022] [Accepted: 05/29/2022] [Indexed: 10/18/2022]
Abstract
Understanding the associations between adequate sleep, performance and health outcomes is vital, yet a major limitation in the design and interpretation of studies of sleep and performance is the variability of subjective and objective markers used to assess sleep quality. The aim of this scoping review is to investigate how various physiological signals recorded during sleep or wakefulness relate to objective measures of cognitive or physical performance and subjectively perceived sleep quality to inform conceptual understanding of the elusive, amorphous, and multi-dimensional construct of sleep quality. We also aimed to suggest priorities for future areas of research in sleep quality and performance. We searched six databases ultimately yielding 439 studies after duplicate removal. Sixty-five studies were selected for full review. In general, correlations between objectively measured sleep and objective performance or subjectively assessed sleep quality were weak to moderate. Slow wave sleep was moderately correlated with better performance on tasks of vigilance, motor speed, and executive function as well as better subjective sleep quality and feeling well-rested, suggesting that slow wave sleep may be important for sleep quality and optimal daytime performance. However, these findings were inconsistent across studies. Increased sleep fragmentation was associated with poorer subjective sleep quality in both polysomnographic and actigraphic studies. Studies which simultaneously assessed physiologic sleep measures, performance measures and subjective sleep perception were few, limiting the ability to evaluate correlations between subjective and objective outcomes concurrently in the same individuals. Factors influencing the relationship between sleep quality and performance include circadian variability, sleep inertia, and mismatch between sleep stages studied and outcome measures of choice. Ultimately, the determination of "quality sleep" remains largely subjective and inconsistently quantifiable by current measures. Methods evaluating sleep as a continuous measure rather than traditional sleep stages may provide an intriguing approach to future studies of sleep and performance. Future well-designed studies using novel measures of sleep or multimodal ambulatory wearables assessing the three domains of sleep and performance (objective sleep physiology, objective performance, and subjective sleep quality) are needed to better define quality sleep.
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Affiliation(s)
- Stuart J McCarter
- Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA; Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA.
| | - Philip T Hagen
- Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Erik K St Louis
- Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA; Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA; Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Thomas M Rieck
- Mayo Clinic Healthy Living Program, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Clifton R Haider
- Section of Biostatistics, Mayo Clinic and Foundation, Rochester, MN, USA
| | - David R Holmes
- Section of Biostatistics, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Timothy I Morgenthaler
- Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA; Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, MN, USA; Department of Pulmonology, Mayo Clinic and Foundation, Rochester, MN, USA
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22
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Abstract
Adequate sleep is an important pillar of physical and mental health. Sleep deficiency, resulting from short sleep or suboptimal sleep quality, is highly prevalent in modern society. Occupation, social demands, psychiatric disorders, physical disorders, and sleep disorders are some of the contributing factors to sleep deficiency. Some populations are at increased risk of sleep deficiency based on ethnicity, age, marital status, sex, and hospitalization. Sleep deficiency influences cognition, alertness, mood, behavior, diabetes, cardiovascular health, renal function, immune system, and respiratory physiology. This review summarizes the epidemiology and effects of sleep deficiency.
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Affiliation(s)
- Amir Gohari
- Department of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada
| | - Brett Baumann
- Department of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada
| | - Rachel Jen
- Department of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Judah Blackmore Centre for Sleep Disorders, Univeristy of British Columbia Hospital, Ground Floor, Room G34A Purdy Pavilion, 2221 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada
| | - Najib Ayas
- Department of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Judah Blackmore Centre for Sleep Disorders, Univeristy of British Columbia Hospital, Ground Floor, Room G34A Purdy Pavilion, 2221 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada.
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23
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Kim SK, Yong SY. Relationship Between Poor Sleep Quality and Injury Experience in Korea. Asia Pac J Public Health 2022; 34:537-546. [PMID: 35392671 DOI: 10.1177/10105395221088619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To develop preventive policies to reduce injuries, the responsible factors should be identified. In this study, causative factors were identified by analyzing data from the Korean Community Health Survey. Logistic regression was used to analyze the data of 192 480 individuals in the survey. Correlations were found between the injury experience and the following socioeconomic factors: age, sex, monthly income, smoking status, education, marital status, and neuropsychiatric factors: depressive symptoms, cognitive decline, and stress. The study subjects were divided into two groups based on sleep quality, as determined by Pittsburgh Sleep Quality Indices of ≤5 or >5. Logistic regression analysis adjusted for potential confounders revealed a correlation between sleep quality and injury experience. The odds ratio (OR) of poor sleep quality was associated with higher odds of injury (OR: 1.26, 95% confidence interval [1.19, 1.34]), and it was also associated with higher odds of severe injury (OR: 1.23, 95% confidence interval [1.15, 1.32]), even in the adjustment of socioeconomic factors only as well as in the adjustment of socioeconomic and neuropsychiatric factors. Poor sleep quality was associated with higher odds of several injury mechanisms of severe injury, such as slipping, poisoning, and falling into water.
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Affiliation(s)
- Sung-Kyung Kim
- Department of Occupational and Environmental Medicine, Wonju Severance Christian's Hospital, Yonsei University, Wonju, Republic of Korea
| | - Sang Yeol Yong
- Department of Rehabilitation Medicine, Wonju Severance Christian's Hospital, Yonsei University, Wonju, Republic of Korea.,IOC Research Centre Korea, Republic of Korea
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24
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Obstructive Sleep Apnea and Road Traffic Accidents: A Danish Nationwide Cohort Study. Sleep Med 2022; 96:64-69. [DOI: 10.1016/j.sleep.2022.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/13/2022] [Accepted: 04/06/2022] [Indexed: 01/01/2023]
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25
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Prevalence, Trends, and Correlates of Joint Patterns of Aerobic and Muscle-Strengthening Activity and Sleep Duration: A Pooled Analysis of 359,019 Adults in the National Health Interview Survey 2004-2018. J Phys Act Health 2022; 19:246-255. [PMID: 35272266 DOI: 10.1123/jpah.2021-0682] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 01/23/2022] [Accepted: 01/27/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Physical activity (PA) and sleep duration have established associations with health outcomes individually but tend to co-occur and may be better targeted jointly. This study aimed to describe the cross-sectional prevalence, trends, and population characteristic correlates of activity-sleep patterns in a population-representative sample of US adults from the National Health Interview Survey (2004-2018). METHODS Participants (N = 359,019) self-reported aerobic and muscle-strengthening activity and sleep duration. They were categorized as "meeting both"/"meeting PA only"/"meeting sleep only"/"meeting neither" of the 2018 US PA guidelines and age-based sleep duration recommendations. Trends in activity-sleep patterns were analyzed using weighted multinomial logistic regression, and correlates were identified using weighted binary Poisson regressions, with P ≤ .001 considered significant. RESULTS "Meet sleep only" was most prevalent (46.4%) by 2018, followed by "meet neither" (30.3%), "meet both" (15.6%), and "meet PA only" (7.7%). Many significant sociodemographic, biological, and health-behavior correlates of the activity-sleep groups were identified, and the direction and magnitude of these associations differed between groups. CONCLUSIONS Public health campaigns should emphasize the importance of both sufficient PA and sleep; target women and older adults, current smokers, and those with lower education and poorer physical and mental health; and consider specific barriers experienced by minority ethnic groups.
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26
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Liu W, Zhao D, Wu X, Yue F, Yang H, Hu K. Rapamycin ameliorates chronic intermittent hypoxia and sleep deprivation-induced renal damage via the mammalian target of rapamycin (mTOR)/NOD-like receptor protein 3 (NLRP3) signaling pathway. Bioengineered 2022; 13:5537-5550. [PMID: 35184679 PMCID: PMC8973698 DOI: 10.1080/21655979.2022.2037872] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Rapamycin inhibits the activation of NOD-like receptor protein 3 (NLRP3) by regulating the mammalian target of rapamycin (mTOR) to treat obstructive sleep apnea-related renal injury. Sleep deprivation (SD) and chronic intermittent hypoxia (CIH) mouse models were used to assess the effects of autophagy in vivo. Compared with the control, SD, and CIH groups, the SD+CIH group had lower body weight and higher levels of blood urea nitrogen (BUN), creatinine, and urinary albumin (U-Alb) (P < 0.05); renal injury and oxidative damage occurred in the SD+CIH group, the kidney cell nucleus ruptured, and morphological structure of the cells was unclear in the SD+CIH group. The SD+CIH group demonstrated increased apoptosis compared with the control, SD, and CIH groups using Western blot analysis. Compared to the control, SD, and CIH groups, the SD+CIH group showed a higher degree of microtubule-associated protein light chain 3\ staining. Compared to the SD+CIH group, BUN, creatinine, and U-Alb levels decreased, and apoptosis increased in the SD+CIH+rapamycin group, and the structure of the kidney after rapamycin treatment was well preserved. The mTOR expression was increased in the kidneys of the SD+CIH group. The NLRP3, Gasdermin D (GMDSD), interleukin (IL)-18, IL-1β, and cleaved-caspase-1 protein levels were higher in the SD+CIH group than the SD+CIH+rapamycin group, and the NLRP3, GMDSD, IL-18, IL-1β, and cleaved-caspase-1 mRNA levels were higher in the SD+CIH group than the SD+CIH+rapamycin group. Following rapamycin treatment, pyroptosis was suppressed. Rapamycin ameliorates renal damage by inhibiting the mTOR/NLRP3 signaling pathway.
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Affiliation(s)
- Wei Liu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Dong Zhao
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Xiaofeng Wu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Fang Yue
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Haizhen Yang
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Ke Hu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
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27
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Xie W, Shu Y, Liu X, Li K, Li P, Kong L, Yu P, Huang L, Long T, Zeng L, Li H, Peng D. Abnormal Spontaneous Brain Activity and Cognitive Impairment in Obstructive Sleep Apnea. Nat Sci Sleep 2022; 14:1575-1587. [PMID: 36090000 PMCID: PMC9462436 DOI: 10.2147/nss.s376638] [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: 05/29/2022] [Accepted: 08/28/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study aimed to explore the alterations in spontaneous brain activity in obstructive sleep apnea (OSA) using percent amplitude of fluctuation (PerAF) and investigate the relationship between abnormal spontaneous brain activity and cognitive impairment in OSA. PATIENTS AND METHODS Overall, 52 patients with moderate to severe OSA and 61 healthy controls (HCs) were eventually enrolled in this study. All participants underwent resting-state functional magnetic resonance (rs-fMRI) and T1-weighted imaging. The PerAF was calculated and compared between patients with OSA and HCs, with voxel level P < 0.001 and cluster level P < 0.05 corrected with Gaussian Random Field was be considered statistically different. A partial correlation analysis was used to assess the relationship between altered PerAF and clinical assessments in patients with OSA. RESULTS Compared to HCs, patients with OSA had significantly lower PerAF values in the right rectal gyrus and left superior frontal gyrus, but higher PerAF values in the right cerebellum posterior lobe and left middle frontal gyrus. The PerAF values of some specific regions in patients with OSA correlated with sleep efficiency and Montreal Cognitive Assessment scores. Additionally, support vector machine analysis showed that PerAF values in all differential brain regions could differentiate patients with OSA from HCs with good accuracy. CONCLUSION Specific brain areas in OSA patients may exhibit aberrant neuronal activity, and these anomalies may be linked to decreased cognitive performance. This discovery offers fresh perspectives on these patients' neurocognition.
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Affiliation(s)
- Wei Xie
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Yongqiang Shu
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Xiang Liu
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Kunyao Li
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Panmei Li
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Linghong Kong
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Pengfei Yu
- Big Data Research Center, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Ling Huang
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Ting Long
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Li Zeng
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Haijun Li
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China.,PET Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Dechang Peng
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China.,PET Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
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28
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Beetz G, Herrero Babiloni A, Jodoin M, Charlebois-Plante C, Lavigne GJ, De Beaumont L, Rouleau DM. Relevance of Sleep Disturbances to Orthopaedic Surgery: A Current Concepts Narrative and Practical Review. J Bone Joint Surg Am 2021; 103:2045-2056. [PMID: 34478407 DOI: 10.2106/jbjs.21.00176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Sleep disturbances can increase the risk of falls and motor vehicle accidents and may reduce bone density. ➤ Poor sleep can lead to worse outcomes after fracture, such as chronic pain and delayed recovery. ➤ Orthopaedic surgeons can play an important role in the screening of sleep disorders among their patients.
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Affiliation(s)
- Gabrielle Beetz
- Montreal Sacré-Coeur Hospital, Montreal, Quebec, Canada.,Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Alberto Herrero Babiloni
- Montreal Sacré-Coeur Hospital, Montreal, Quebec, Canada.,Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Marianne Jodoin
- Montreal Sacré-Coeur Hospital, Montreal, Quebec, Canada.,Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | | | - Gilles J Lavigne
- Montreal Sacré-Coeur Hospital, Montreal, Quebec, Canada.,Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada.,Faculty of Dental Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Louis De Beaumont
- Montreal Sacré-Coeur Hospital, Montreal, Quebec, Canada.,Department of Surgery, University of Montreal, Montreal, Quebec, Canada
| | - Dominique M Rouleau
- Montreal Sacré-Coeur Hospital, Montreal, Quebec, Canada.,Department of Surgery, University of Montreal, Montreal, Quebec, Canada
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29
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Rueda-Etxebarria M, Mugueta-Aguinaga I, Rueda JR, Lascurain-Aguirrebena I. Respiratory muscle training for obstructive sleep apnoea. Hippokratia 2021. [DOI: 10.1002/14651858.cd015039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Iranzu Mugueta-Aguinaga
- Respiratory Physiotherapy Unit, Rehabilitation Service, Pneumology; Biocruces Health Research Institute, Cruces University Hospital; Barakaldo Spain
| | - José-Ramón Rueda
- Department of Preventive Medicine and Public Health; University of the Basque Country; Leioa Spain
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30
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Yamazaki EM, Casale CE, Brieva TE, Antler CA, Goel N. Concordance of multiple methods to define resiliency and vulnerability to sleep loss depends on Psychomotor Vigilance Test metric. Sleep 2021; 45:6384814. [PMID: 34624897 DOI: 10.1093/sleep/zsab249] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/08/2021] [Indexed: 01/16/2023] Open
Abstract
STUDY OBJECTIVES Sleep restriction (SR) and total sleep deprivation (TSD) reveal well-established individual differences in Psychomotor Vigilance Test (PVT) performance. While prior studies have used different methods to categorize such resiliency/vulnerability, none have systematically investigated whether these methods categorize individuals similarly. METHODS 41 adults participated in a 13-day laboratory study consisting of 2 baseline, 5 SR, 4 recovery, and one 36h TSD night. The PVT was administered every 2h during wakefulness. Three approaches (Raw Score [average SR performance], Change from Baseline [average SR minus average baseline performance], and Variance [intraindividual variance of SR performance]), and within each approach, six thresholds (±1 standard deviation and the best/worst performing 12.5%, 20%, 25%, 33%, and 50%) classified Resilient/Vulnerable groups. Kendall's tau-b correlations examined the concordance of group categorizations of approaches within and between PVT lapses and 1/reaction time (RT). Bias-corrected and accelerated bootstrapped t-tests compared group performance. RESULTS Correlations comparing the approaches ranged from moderate to perfect for lapses and zero to moderate for 1/RT. Defined by all approaches, the Resilient groups had significantly fewer lapses on nearly all study days. Defined by the Raw Score approach only, the Resilient groups had significantly faster 1/RT on all study days. Between-measures comparisons revealed significant correlations between the Raw Score approach for 1/RT and all approaches for lapses. CONCLUSION The three approaches defining vigilant attention resiliency/vulnerability to sleep loss resulted in groups comprised of similar individuals for PVT lapses but not for 1/RT. Thus, both method and metric selection for defining vigilant attention resiliency/vulnerability to sleep loss is critical.
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Affiliation(s)
- Erika M Yamazaki
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Courtney E Casale
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Tess E Brieva
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Caroline A Antler
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Namni Goel
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
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31
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Gaine ME, Bahl E, Chatterjee S, Michaelson JJ, Abel T, Lyons LC. Altered hippocampal transcriptome dynamics following sleep deprivation. Mol Brain 2021; 14:125. [PMID: 34384474 PMCID: PMC8361790 DOI: 10.1186/s13041-021-00835-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/27/2021] [Indexed: 12/13/2022] Open
Abstract
Widespread sleep deprivation is a continuing public health problem in the United States and worldwide affecting adolescents and adults. Acute sleep deprivation results in decrements in spatial memory and cognitive impairments. The hippocampus is vulnerable to acute sleep deprivation with changes in gene expression, cell signaling, and protein synthesis. Sleep deprivation also has long lasting effects on memory and performance that persist after recovery sleep, as seen in behavioral studies from invertebrates to humans. Although previous research has shown that acute sleep deprivation impacts gene expression, the extent to which sleep deprivation affects gene regulation remains unknown. Using an unbiased deep RNA sequencing approach, we investigated the effects of acute sleep deprivation on gene expression in the hippocampus. We identified 1,146 genes that were significantly dysregulated following sleep deprivation with 507 genes upregulated and 639 genes downregulated, including protein coding genes and long non-coding RNAs not previously identified as impacted by sleep deprivation. Notably, genes significantly upregulated after sleep deprivation were associated with RNA splicing and the nucleus. In contrast, downregulated genes were associated with cell adhesion, dendritic localization, the synapse, and postsynaptic membrane. Furthermore, we found through independent experiments analyzing a subset of genes that three hours of recovery sleep following acute sleep deprivation was sufficient to normalize mRNA abundance for most genes, although exceptions occurred for some genes that may affect RNA splicing or transcription. These results clearly demonstrate that sleep deprivation differentially regulates gene expression on multiple transcriptomic levels to impact hippocampal function.
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Affiliation(s)
- Marie E Gaine
- Department of Neuroscience and Pharmacology, Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Department of Pharmaceutical Sciences and Experimental Therapeutics (PSET), College of Pharmacy, University of Iowa, Iowa City, IA, USA
| | - Ethan Bahl
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Interdisciplinary Graduate Program in Genetics, University of Iowa, Iowa City, IA, USA
| | - Snehajyoti Chatterjee
- Department of Neuroscience and Pharmacology, Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Jacob J Michaelson
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Department of Biomedical Engineering, College of Engineering, University of Iowa, Iowa City, IA, USA
- Department of Communication Sciences and Disorders, College of Liberal Arts and Sciences, University of Iowa, Iowa City, IA, USA
- Iowa Institute of Human Genetics, University of Iowa, Iowa City, IA, USA
| | - Ted Abel
- Department of Neuroscience and Pharmacology, Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Lisa C Lyons
- Department of Neuroscience and Pharmacology, Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
- Department of Biological Science, Program in Neuroscience, Florida State University, Tallahassee, FL, USA.
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32
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Mazzotti DR. Landscape of biomedical informatics standards and terminologies for clinical sleep medicine research: A systematic review. Sleep Med Rev 2021; 60:101529. [PMID: 34455108 DOI: 10.1016/j.smrv.2021.101529] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/14/2021] [Accepted: 07/03/2021] [Indexed: 12/31/2022]
Abstract
A systematic literature review was conducted to understand the current landscape of standards and terminologies used in clinical sleep medicine. Literature search on PubMed, EMBASE, Medline and Web of Science was performed in March 2021 using terms related to sleep, terminologies, standards, harmonization, semantics, ontology, and electronic health records (EHR). Systematic review was carried out according to PRISMA. Among 128 included studies, 35 were eligible for review. Articles were broadly classified into six topics: standard terminology efforts, reporting standards, databases and resources, data integration efforts, EHR abstraction and standards for automated sleep scoring. This review highlights the progress and challenges related to establishing computable terminologies in sleep medicine, and identifies gaps, limitations and research opportunities related to data integration that could improve adoption of clinical research informatics in this field. There is a need for the systematic adoption of standardized terminologies in all areas of sleep medicine. Existing data aggregation resources could be leveraged to support the development of an integrated infrastructure and subsequent deployment in EHR systems within sleep centers. Ultimately, the adoption of standardized practices for documenting sleep disorders and related traits facilitates data sharing, thus accelerating discovery and clinical translation of informatics approaches applied to sleep medicine.
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Affiliation(s)
- Diego R Mazzotti
- Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
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Rosenberg R, Schweitzer PK, Steier J, Pepin JL. Residual excessive daytime sleepiness in patients treated for obstructive sleep apnea: guidance for assessment, diagnosis, and management. Postgrad Med 2021; 133:772-783. [PMID: 34292843 DOI: 10.1080/00325481.2021.1948305] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Excessive daytime sleepiness (EDS) affects approximately half of patients with obstructive sleep apnea (OSA) and can persist in some despite normalization of breathing, oxygenation, and sleep quality with primary OSA therapy, such as continuous positive airway pressure (CPAP). EDS is often overlooked and under discussed in the primary care setting and in the follow-up of CPAP-treated patients due to difficult assessment of such a multi-dimensional symptom. This review aims to provide suggestions for procedures that can be implemented into routine clinical practice to identify, evaluate, and manage EDS in patients treated for OSA, including how to appropriately use various self-report and objective assessments along the clinical pathway and options for pharmacotherapy. In addition, examples of when it is appropriate to refer a patient to a sleep specialist for evaluation are discussed.
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Affiliation(s)
| | - Paula K Schweitzer
- Sleep Medicine and Research Center, St. Luke's Hospital, Chesterfield, MO, USA
| | - Joerg Steier
- Respiratory and Sleep Medicine, Faculty of Life Sciences and Medicine, King's College, London, England
| | - Jean-Louis Pepin
- HP2 Laboratory, Inserm U1042, Grenoble Alpes University, Research Department, Grenoble, France
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Obstructive sleep apnea and risk of motor vehicle accident. Sleep Med 2021; 85:196-203. [PMID: 34348205 DOI: 10.1016/j.sleep.2021.07.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/01/2021] [Accepted: 07/10/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the association between obstructive sleep apnea (OSA) and risk of motor vehicle accident (MVA). METHODS We conducted a cohort study at Kaiser Permanente Washington using electronic health plan data and linked Washington State Department of Transportation MVA records. We included persons 18-79 years of age during 2005-2014. OSA was ascertained via diagnosis codes. The primary outcome, first MVA during cohort follow-up, was ascertained from state MVA records. Risk factors for MVAs, including medical conditions and medication use, were ascertained from health plan data. Multivariable Cox proportional hazards models were used to estimate the adjusted hazard ratio (HR) and 95% confidence interval (CI) for the association between OSA and study outcomes. RESULTS Among the 879,547 eligible persons, the unadjusted rate of MVA in those with and without OSA was 238 and 229 per 10,000 person-years, respectively. A diagnosis of OSA was associated with a 17% increased risk of MVA (adjusted HR = 1.17; 95% CI: 1.13 to 1.20). CONCLUSION In this large population-based study, a diagnosis of OSA was associated with a modestly increased risk of MVA.
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Malhotra A, Ayappa I, Ayas N, Collop N, Kirsch D, Mcardle N, Mehra R, Pack AI, Punjabi N, White DP, Gottlieb DJ. Metrics of sleep apnea severity: beyond the apnea-hypopnea index. Sleep 2021; 44:zsab030. [PMID: 33693939 PMCID: PMC8271129 DOI: 10.1093/sleep/zsab030] [Citation(s) in RCA: 173] [Impact Index Per Article: 57.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/31/2021] [Indexed: 12/13/2022] Open
Abstract
Obstructive sleep apnea (OSA) is thought to affect almost 1 billion people worldwide. OSA has well established cardiovascular and neurocognitive sequelae, although the optimal metric to assess its severity and/or potential response to therapy remains unclear. The apnea-hypopnea index (AHI) is well established; thus, we review its history and predictive value in various different clinical contexts. Although the AHI is often criticized for its limitations, it remains the best studied metric of OSA severity, albeit imperfect. We further review the potential value of alternative metrics including hypoxic burden, arousal intensity, odds ratio product, and cardiopulmonary coupling. We conclude with possible future directions to capture clinically meaningful OSA endophenotypes including the use of genetics, blood biomarkers, machine/deep learning and wearable technologies. Further research in OSA should be directed towards providing diagnostic and prognostic information to make the OSA diagnosis more accessible and to improving prognostic information regarding OSA consequences, in order to guide patient care and to help in the design of future clinical trials.
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Affiliation(s)
- Atul Malhotra
- Department of Medicine, University of California San Diego, La Jolla, CA
| | - Indu Ayappa
- Department of Medicine, Mt. Sinai, New York, NY
| | - Najib Ayas
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nancy Collop
- Department of Medicine, Emory University, Atlanta, GA
| | - Douglas Kirsch
- Department of Medicine, Atrium Health Sleep Medicine, Atrium Health, Charlotte, NC
| | - Nigel Mcardle
- Department of Medicine, The University of Western Australia, Perth, Australia
| | - Reena Mehra
- Department of Medicine, Cleveland Clinic, Cleveland, OH
| | - Allan I Pack
- Department of Medicine, University of Pennsylvania, Philadelphia, PA
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Sleepiness Behind the Wheel and the Implementation of European Driving Regulations. Sleep Med Clin 2021; 16:533-543. [PMID: 34325829 DOI: 10.1016/j.jsmc.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Sleep disturbance and sleepiness are established risk factors for driving accidents and obstructive sleep apnea (OSA) is the most prevalent medical disorder associated with excessive daytime sleepiness. Because effective treatment of OSA reduces accident risk, several jurisdictions have implemented regulations concerning the ability of patients with OSA to drive, unless effectively treated. This review provides a practical guide for clinicians who may be requested to certify a patient with OSA as fit to drive regarding the scope of the problem, the role of questionnaires and driving simulators to evaluate sleepiness, and the benefit of treatment on accident risk.
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Freed SA, Ross LA, Gamaldo AA, Stavrinos D. Use of multilevel modeling to examine variability of distracted driving behavior in naturalistic driving studies. ACCIDENT; ANALYSIS AND PREVENTION 2021; 152:105986. [PMID: 33517207 PMCID: PMC8204745 DOI: 10.1016/j.aap.2021.105986] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 06/12/2023]
Abstract
Current methods of analyzing data from naturalistic driving studies provide important insights into real-world safety-related driving behaviors, but are limited in the depth of information they currently offer. Driving measures are frequently collapsed to summary levels across the study period, excluding more fine-grained differences such as changes that occur from trip to trip. By retaining trip-specific data, it is possible to quantify how much a driver differs from trip to trip (within-person variability) in addition to how he or she differs from other drivers (between-person variability). To the authors' knowledge, the current study is the first to use multilevel modeling to quantify variability in distracted driving behavior in a naturalistic dataset of older drivers. The current study demonstrates the utility of examining within-person variability in a naturalistic driving dataset of 68 older drivers across two weeks. First, multilevel models were conducted for three distracted driving behaviors to distinguish within-person variability from between-person variability in these behaviors. A high percentage of variation in distracted driving behaviors was attributable to within-person differences, indicating that drivers' behaviors varied more across their own driving trips than from other drivers (ICCs = .93). Then, to demonstrate the utility of personal characteristics in predicting daily driving behavior, a hypothetical model is presented using simulated daily sleep duration from the previous night to predict distracted driving behavior the following day. The current study demonstrates substantial variability in driving behaviors within an older adult sample and the promise of individual characteristics to provide better prediction of driving behaviors relevant to safety, which can be applied in investigations of current naturalistic driving datasets and in designing future studies.
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Affiliation(s)
- Sara A Freed
- The Pennsylvania State University, 119 Health and Human Development Building, University Park, PA, 16802, United States.
| | - Lesley A Ross
- Clemson University, 418 Brackett Hall, Clemson, SC, 29634, United States.
| | - Alyssa A Gamaldo
- The Pennsylvania State University, 119 Health and Human Development Building, University Park, PA, 16802, United States.
| | - Despina Stavrinos
- The University of Alabama at Birmingham, 916 19(th) Street South, Birmingham, AL, 35294, United States.
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Cunningham JEA, McCague H, Malin AJ, Flora D, Till C. Fluoride exposure and duration and quality of sleep in a Canadian population-based sample. Environ Health 2021; 20:16. [PMID: 33602214 PMCID: PMC7893939 DOI: 10.1186/s12940-021-00700-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 02/03/2021] [Indexed: 05/31/2023]
Abstract
BACKGROUND Fluoride from dietary and environmental sources may concentrate in calcium-containing regions of the body such as the pineal gland. The pineal gland synthesizes melatonin, a hormone that regulates the sleep-wake cycle. We examined associations between fluoride exposure and sleep outcomes among older adolescents and adults in Canada. METHODS We used population-based data from Cycle 3 (2012-2013) of the Canadian Health Measures Survey. Participants were aged 16 to 79 years and 32% lived in communities supplied with fluoridated municipal water. Urinary fluoride concentrations were measured in spot samples and adjusted for specific gravity (UFSG; n = 1303) and water fluoride concentrations were measured in tap water samples among those who reported drinking tap water (n = 1016). We used multinomial and ordered logistic regression analyses (using both unweighted and survey-weighted data) to examine associations of fluoride exposure with self-reported sleep outcomes, including sleep duration, frequency of sleep problems, and daytime sleepiness. Covariates included age, sex, ethnicity, body mass index, chronic health conditions, and household income. RESULTS Median (IQR) UFSG concentration was 0.67 (0.63) mg/L. Median (IQR) water fluoride concentration was 0.58 (0.27) mg/L among participants living in communities supplied with fluoridated municipal water and 0.01 (0.06) mg/L among those living in non-fluoridated communities. A 0.5 mg/L higher water fluoride level was associated with 34% higher relative risk of reporting sleeping less than the recommended duration for age [unweighted: RRR = 1.34, 95% CI: 1.03, 1.73; p = .026]; the relative risk was higher, though less precise, using survey-weighted data [RRR = 1.96, 95% CI: 0.99, 3.87; p = .05]. UFSG was not significantly associated with sleep duration. Water fluoride and UFSG concentration were not significantly associated with frequency of sleep problems or daytime sleepiness. CONCLUSIONS Fluoride exposure may contribute to sleeping less than the recommended duration among older adolescents and adults in Canada.
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Affiliation(s)
| | - Hugh McCague
- Institute for Social Research, York University, Toronto, Ontario Canada
| | - Ashley J. Malin
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - David Flora
- Faculty of Health, York University, Toronto, Ontario Canada
| | - Christine Till
- Faculty of Health, York University, Toronto, Ontario Canada
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Validation of the STOP-Bang questionnaire for screening of obstructive sleep apnea in the general population and commercial drivers: a systematic review and meta-analysis. Sleep Breath 2021; 25:1741-1751. [PMID: 33507478 PMCID: PMC8590671 DOI: 10.1007/s11325-021-02299-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/05/2021] [Accepted: 01/15/2021] [Indexed: 02/06/2023]
Abstract
Purpose Obstructive sleep apnea (OSA) is a critical occupational health concern, but is often undiagnosed in the general population and commercial drivers. The STOP-Bang questionnaire is a simple, reliable tool to screen for OSA, which could improve public health in a cost-effective manner. The objective of this systematic review and meta-analysis is to assess the validity of the STOP-Bang questionnaire to detect OSA in these key populations. Methods We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO, Journals @ Ovid, Web of Science, Scopus, and CINAHL for relevant articles from 2008 to March 2020. The quality of studies was appraised using Cochrane Methods criteria. To calculate pooled predictive parameters, we created 2 × 2 contingency tables and performed random-effects meta-analyses. Results Of 3871 citations, five studies that evaluated STOP-Bang in the general population (n = 8585) and two in commercial drivers (n = 185) were included. In the general population, prevalence of all OSA (AHI ≥ 5), moderate-to-severe OSA (AHI ≥ 15), and severe OSA (AHI ≥ 30) was 57.6%, 21.3%, and 7.8% respectively. In commercial drivers, the prevalence of moderate-to-severe OSA was 37.3%. The trends of high sensitivity and negative predictive value of a STOP-Bang score ≥ 3 illustrates that the questionnaire helps detect and rule out clinically significant OSA in the general population and commercial drivers. Conclusion This meta-analysis demonstrates that the STOP-Bang questionnaire is a valid and effective screening tool for OSA in the general population and commercial drivers. Trial registration PROSPERO No. CRD42020200379; 08/22/2020 Supplementary Information The online version contains supplementary material available at 10.1007/s11325-021-02299-y.
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Robin F, De Courson H, Roy M, Lemeux J, Philip P, Bioulac S, Nouette-Gaulain K. EQSAR: A national survey of sleep duration among French Anaesthesiologists and Intensivists. Anaesth Crit Care Pain Med 2020; 39:759-764. [DOI: 10.1016/j.accpm.2020.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/08/2020] [Accepted: 04/19/2020] [Indexed: 01/20/2023]
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Rueda JR, Mugueta-Aguinaga I, Vilaró J, Rueda-Etxebarria M. Myofunctional therapy (oropharyngeal exercises) for obstructive sleep apnoea. Cochrane Database Syst Rev 2020; 11:CD013449. [PMID: 33141943 PMCID: PMC8094400 DOI: 10.1002/14651858.cd013449.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is a syndrome characterised by episodes of apnoea (complete cessation of breathing) or hypopnoea (insufficient breathing) during sleep. Classical symptoms of the disease - such as snoring, unsatisfactory rest and daytime sleepiness - are experienced mainly by men; women report more unspecific symptoms such as low energy or fatigue, tiredness, initial insomnia and morning headaches. OSA is associated with an increased risk of occupational injuries, metabolic diseases, cardiovascular diseases, mortality, and being involved in traffic accidents. Continuous positive airway pressure (CPAP) - delivered by a machine which uses a hose and mask or nosepiece to deliver constant and steady air pressure- is considered the first treatment option for most people with OSA. However, adherence to treatment is often suboptimal. Myofunctional therapy could be an alternative for many patients. Myofunctional therapy consists of combinations of oropharyngeal exercises - i.e. mouth and throat exercises. These combinations typically include both isotonic and isometric exercises involving several muscles and areas of the mouth, pharynx and upper respiratory tract, to work on functions such as speaking, breathing, blowing, sucking, chewing and swallowing. OBJECTIVES To evaluate the benefits and harms of myofunctional therapy (oropharyngeal exercises) for the treatment of obstructive sleep apnoea. SEARCH METHODS We identified randomised controlled trials (RCTs) from the Cochrane Airways Trials Register (date of last search 1 May 2020). We found other trials at web-based clinical trials registers. SELECTION CRITERIA We included RCTs that recruited adults and children with a diagnosis of OSA. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We assessed our confidence in the evidence by using GRADE recommendations. Primary outcomes were daytime sleepiness, morbidity and mortality. MAIN RESULTS We found nine studies eligible for inclusion in this review and nine ongoing studies. The nine included RCTs analysed a total of 347 participants, 69 of them women and 13 children. The adults' mean ages ranged from 46 to 51, daytime sleepiness scores from eight to 14, and severity of the condition from mild to severe OSA. The studies' duration ranged from two to four months. None of the studies assessed accidents, cardiovascular diseases or mortality outcomes. We sought data about adverse events, but none of the included studies reported these. In adults, compared to sham therapy, myofunctional therapy: probably reduces daytime sleepiness (Epworth Sleepiness Scale (ESS), MD (mean difference) -4.52 points, 95% Confidence Interval (CI) -6.67 to -2.36; two studies, 82 participants; moderate-certainty evidence); may increase sleep quality (MD -3.90 points, 95% CI -6.31 to -1.49; one study, 31 participants; low-certainty evidence); may result in a large reduction in Apnoea-Hypopnoea Index (AHI, MD -13.20 points, 95% CI -18.48 to -7.93; two studies, 82 participants; low-certainty evidence); may have little to no effect in reduction of snoring frequency but the evidence is very uncertain (Standardised Mean Difference (SMD) -0.53 points, 95% CI -1.03 to -0.03; two studies, 67 participants; very low-certainty evidence); and probably reduces subjective snoring intensity slightly (MD -1.9 points, 95% CI -3.69 to -0.11 one study, 51 participants; moderate-certainty evidence). Compared to waiting list, myofunctional therapy may: reduce daytime sleepiness (ESS, change from baseline MD -3.00 points, 95% CI -5.47 to -0.53; one study, 25 participants; low-certainty evidence); result in little to no difference in sleep quality (MD -0.70 points, 95% CI -2.01 to 0.61; one study, 25 participants; low-certainty evidence); and reduce AHI (MD -6.20 points, 95% CI -11.94 to -0.46; one study, 25 participants; low-certainty evidence). Compared to CPAP, myofunctional therapy may result in little to no difference in daytime sleepiness (MD 0.30 points, 95% CI -1.65 to 2.25; one study, 54 participants; low-certainty evidence); and may increase AHI (MD 9.60 points, 95% CI 2.46 to 16.74; one study, 54 participants; low-certainty evidence). Compared to CPAP plus myofunctional therapy, myofunctional therapy alone may result in little to no difference in daytime sleepiness (MD 0.20 points, 95% CI -2.56 to 2.96; one study, 49 participants; low-certainty evidence) and may increase AHI (MD 10.50 points, 95% CI 3.43 to 17.57; one study, 49 participants; low-certainty evidence). Compared to respiratory exercises plus nasal dilator strip, myofunctional therapy may result in little to no difference in daytime sleepiness (MD 0.20 points, 95% CI -2.46 to 2.86; one study, 58 participants; low-certainty evidence); probably increases sleep quality slightly (-1.94 points, 95% CI -3.17 to -0.72; two studies, 97 participants; moderate-certainty evidence); and may result in little to no difference in AHI (MD -3.80 points, 95% CI -9.05 to 1.45; one study, 58 participants; low-certainty evidence). Compared to standard medical treatment, myofunctional therapy may reduce daytime sleepiness (MD -6.40 points, 95% CI -9.82 to -2.98; one study, 26 participants; low-certainty evidence) and may increase sleep quality (MD -3.10 points, 95% CI -5.12 to -1.08; one study, 26 participants; low-certainty evidence). In children, compared to nasal washing alone, myofunctional therapy and nasal washing may result in little to no difference in AHI (MD 3.00, 95% CI -0.26 to 6.26; one study, 13 participants; low-certainty evidence). AUTHORS' CONCLUSIONS Compared to sham therapy, myofunctional therapy probably reduces daytime sleepiness and may increase sleep quality in the short term. The certainty of the evidence for all comparisons ranges from moderate to very low, mainly due to lack of blinding of the assessors of subjective outcomes, incomplete outcome data and imprecision. More studies are needed. In future studies, outcome assessors should be blinded. New trials should recruit more participants, including more women and children, and have longer treatment and follow-up periods.
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Affiliation(s)
- José-Ramón Rueda
- Department of Preventive Medicine and Public Health, University of the Basque Country, Leioa, Spain
| | - Iranzu Mugueta-Aguinaga
- Respiratory Physiotherapy Unit, Rehabilitation Service, Pneumology, Biocruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain
| | - Jordi Vilaró
- Department of Health Sciences, Ramon Lull University, Barcelona, Spain
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Self-reported sleep duration, sleep quality and sleep problems in Mexicans adults: Results of the 2016 Mexican National Halfway Health and Nutrition Survey. Sleep Health 2020; 7:246-253. [PMID: 33097465 DOI: 10.1016/j.sleh.2020.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 08/18/2020] [Accepted: 08/21/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This study aimed to investigate self-reported sleep duration, sleep quality and sleep problems in a Mexican adult population by considering age, sex, geographical regions and urban/rural residency. DESIGN/MEASUREMENTS Cross-sectional national adult survey based on the 2016 Mexican National Halfway Health and Nutrition Survey data. SETTING Nationally representative survey data. PARTICIPANTS Mexican adults ≥ 18 years, n = 8649 (N weighted = 71,158,260 adults). RESULTS Overall, mean sleep duration was 7:19 hours, from which 37% had sleep problems, and 45.7% reported very good sleep quality. Furthermore, middle-aged adults slept less than younger and older adults, females were at lower risk of being a short sleeper than males, urban residents slept less than rural residents, and those from the center region of the country slept less than from the northern and southern regions. Mainly, participants from the state of Quintana Roo, Aguascalientes, and Baja California reported sleep duration <7 hours (6:26 hours, 6:45 hours, and 6:55 hours, respectively). Overall Mexicans who obtained sufficient sleep (≥8 hours) were more likely to be female, in their 20s, reporting perceived "good" or "very good" sleep quality, possessed no self-reported sleep problems, were not a tobacco user, and resided in rural areas. Furthermore, Mexicans who obtained poor sleep quality were more likely to be females that reported sleep problems, took sleep medications, and resided in urban areas. CONCLUSION The present study's findings have important implications for understanding the nationwide features of sleep in Mexican adults. Education and public health awareness initiatives regarding good sleep may be warranted.
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Falkenstein M, Karthaus M, Brüne-Cohrs U. Age-Related Diseases and Driving Safety. Geriatrics (Basel) 2020; 5:E80. [PMID: 33086572 PMCID: PMC7709672 DOI: 10.3390/geriatrics5040080] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/13/2020] [Accepted: 10/16/2020] [Indexed: 11/16/2022] Open
Abstract
Due to demographic changes, the number of older drivers is steadily increasing. Mobility is highly relevant for leading an independent life in the elderly. It largely depends on car driving, which is a complex task requiring a multitude of cognitive and motor skills vulnerable to age- related functional deterioration. The almost inevitable effects of senescence may be potentiated by age-related diseases, such as stroke or diabetes mellitus. Respective pharmacological treatment may cause side effects, additionally affecting driving safety. The present article reviews the impact of age-related diseases and drug treatment of these conditions on driving fitness in elderly drivers. In essence, we focus on diseases of the visual and auditory systems, diseases of the central nervous system (i.e., stroke, depression, dementia and mild cognitive disorder, and Parkinson's disease), sleep disorders, as well as cardiovascular diseases, diabetes mellitus, musculoskeletal disorders, and frailty. We will outline the role of functional tests and the assessment of driving behavior (by a driving simulator or in real traffic), as well as the clinical interview including questions about frequency of (near) accidents, etc. in the evaluation of driving fitness of the elderly. We also address the impact of polypharmacy on driving fitness and end up with recommendations for physicians caring for older patients.
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Affiliation(s)
- Michael Falkenstein
- Institute for Work Learning and Aging (ALA), Hiltroper Landwehr 136, 44805 Bochum, Germany
| | - Melanie Karthaus
- Leibniz Institute for Working Environment and Human Factors (IfADo), 44139 Dortmund, Germany;
| | - Ute Brüne-Cohrs
- LWL University Hospital, Clinic for Psychiatry, Psychotherapy and Preventive Medicine, 44791 Bochum, Germany;
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Sleep disordered breathing and subjective excessive daytime sleepiness in relation to the risk of motor vehicle crash: the Toon Health Study. Sci Rep 2020; 10:17050. [PMID: 33046826 PMCID: PMC7550326 DOI: 10.1038/s41598-020-74132-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 09/21/2020] [Indexed: 11/08/2022] Open
Abstract
Sleep disordered breathing (SDB) is a significant cause of motor vehicle crash (MVC). We conducted a prospective cohort study among 1047 Japanese community-dwellers to detect whether the presence or absence of subjective excessive daytime sleepiness (EDS) affect the association of SDB with a risk of MVC. SDB was assessed by a single airflow monitor which measured the respiratory disturbance index (RDI) during one-night, and participants were classified into the SDB group (RDI ≥ 10) and non-SDB group (RDI < 10). Subjective EDS was defined as Japanese version of Epworth Sleepiness Scale scores ≥ 11. A follow-up questionnaire five years after the baseline ascertained history of MVC over the period. Multivariable logistic regression analysis examined the association between SDB and MVC after stratification by subjective EDS. The multivariable-adjusted odds ratios (95% confidence interval) for MVC among the female SDB group were 1.66 (1.05-2.63) compared with the non-SDB group, and this association was more evident in females without subjective EDS [1.84(1.02-3.32)], but not among those with subjective EDS. There was no significant association in males. These findings indicate that SDB screening should be recommended regardless of subjective EDS to prevent SDB-related MVC among general population, particularly in females.
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Bonsignore MR, Randerath W, Schiza S, Verbraecken J, Elliott MW, Riha R, Barbe F, Bouloukaki I, Castrogiovanni A, Deleanu O, Goncalves M, Leger D, Marrone O, Penzel T, Ryan S, Smyth D, Teran-Santos J, Turino C, McNicholas WT. European Respiratory Society statement on sleep apnoea, sleepiness and driving risk. Eur Respir J 2020; 57:13993003.01272-2020. [DOI: 10.1183/13993003.01272-2020] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/25/2020] [Indexed: 12/22/2022]
Abstract
Obstructive sleep apnoea (OSA) is highly prevalent and is a recognised risk factor for motor vehicle accidents (MVA). Effective treatment with continuous positive airway pressure has been associated with a normalisation of this increased accident risk. Thus, many jurisdictions have introduced regulations restricting the ability of OSA patients from driving until effectively treated. However, uncertainty prevails regarding the relative importance of OSA severity determined by the apnoea–hypopnoea frequency per hour and the degree of sleepiness in determining accident risk. Furthermore, the identification of subjects at risk of OSA and/or accident risk remains elusive. The introduction of official European regulations regarding fitness to drive prompted the European Respiratory Society to establish a task force to address the topic of sleep apnoea, sleepiness and driving with a view to providing an overview to clinicians involved in treating patients with the disorder. The present report evaluates the epidemiology of MVA in patients with OSA; the mechanisms involved in this association; the role of screening questionnaires, driving simulators and other techniques to evaluate sleepiness and/or impaired vigilance; the impact of treatment on MVA risk in affected drivers; and highlights the evidence gaps regarding the identification of OSA patients at risk of MVA.
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Shen C, Luo Q, Chamberlain SR, Morgan S, Romero-Garcia R, Du J, Zhao X, Touchette É, Montplaisir J, Vitaro F, Boivin M, Tremblay RE, Zhao XM, Robaey P, Feng J, Sahakian BJ. What Is the Link Between Attention-Deficit/Hyperactivity Disorder and Sleep Disturbance? A Multimodal Examination of Longitudinal Relationships and Brain Structure Using Large-Scale Population-Based Cohorts. Biol Psychiatry 2020; 88:459-469. [PMID: 32414481 PMCID: PMC7445427 DOI: 10.1016/j.biopsych.2020.03.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) comorbid with sleep disturbances can produce profound disruption in daily life and negatively impact quality of life of both the child and the family. However, the temporal relationship between ADHD and sleep impairment is unclear, as are underlying common brain mechanisms. METHODS This study used data from the Quebec Longitudinal Study of Child Development (n = 1601, 52% female) and the Adolescent Brain Cognitive Development Study (n = 3515, 48% female). Longitudinal relationships between symptoms were examined using cross-lagged panel models. Gray matter volume neural correlates were identified using linear regression. The transcriptomic signature of the identified brain-ADHD-sleep relationship was characterized by gene enrichment analysis. Confounding factors, such as stimulant drugs for ADHD and socioeconomic status, were controlled for. RESULTS ADHD symptoms contributed to sleep disturbances at one or more subsequent time points in both cohorts. Lower gray matter volumes in the middle frontal gyrus and inferior frontal gyrus, amygdala, striatum, and insula were associated with both ADHD symptoms and sleep disturbances. ADHD symptoms significantly mediated the link between these structural brain abnormalities and sleep dysregulation, and genes were differentially expressed in the implicated brain regions, including those involved in neurotransmission and circadian entrainment. CONCLUSIONS This study indicates that ADHD symptoms and sleep disturbances have common neural correlates, including structural changes of the ventral attention system and frontostriatal circuitry. Leveraging data from large datasets, these results offer new mechanistic insights into this clinically important relationship between ADHD and sleep impairment, with potential implications for neurobiological models and future therapeutic directions.
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Affiliation(s)
- Chun Shen
- Institute of Science and Technology for Brain-Inspired Intelligence, MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China; Shanghai Research Center for Brain Science and Brain-Inspired Intelligence, Institute of Brain-Intelligence Technology, Zhangjiang Laboratory, Shanghai, China
| | - Qiang Luo
- Institute of Science and Technology for Brain-Inspired Intelligence, MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China; State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science and Human Phenome Institute, Fudan University, Shanghai, China; Behavioural and Clinical Neuroscience Institute, Department of Psychology, University of Cambridge, Cambridge, United Kingdom; Shanghai Research Center for Brain Science and Brain-Inspired Intelligence, Institute of Brain-Intelligence Technology, Zhangjiang Laboratory, Shanghai, China.
| | | | - Sarah Morgan
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; Alan Turing Institute, London, United Kingdom
| | | | - Jingnan Du
- Institute of Science and Technology for Brain-Inspired Intelligence, MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Xingzhong Zhao
- Institute of Science and Technology for Brain-Inspired Intelligence, MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Évelyne Touchette
- Department of Psychoeducation, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Jacques Montplaisir
- Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada; Center for Advanced Research in Sleep Medicine, CIUSSS-NIM, Montréal, Québec, Canada
| | - Frank Vitaro
- School of Psychoeducation, Université de Montréal, Montréal, Québec, Canada
| | - Michel Boivin
- School of Psychology, Université Laval, Québec City, Québec, Canada
| | - Richard E Tremblay
- Department of Pediatrics and Psychology, Université de Montréal, Montréal, Québec, Canada; School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Xing-Ming Zhao
- Institute of Science and Technology for Brain-Inspired Intelligence, MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Philippe Robaey
- Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada; Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Jianfeng Feng
- Institute of Science and Technology for Brain-Inspired Intelligence, MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China; Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China; School of Mathematical Sciences, Fudan University, Shanghai, China; Department of Computer Science, University of Warwick, Coventry, United Kingdom; Shanghai Research Center for Brain Science and Brain-Inspired Intelligence, Institute of Brain-Intelligence Technology, Zhangjiang Laboratory, Shanghai, China.
| | - Barbara J Sahakian
- Institute of Science and Technology for Brain-Inspired Intelligence, MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China; Behavioural and Clinical Neuroscience Institute, Department of Psychology, University of Cambridge, Cambridge, United Kingdom; Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
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47
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Skorucak J, Hertig-Godeschalk A, Schreier DR, Malafeev A, Mathis J, Achermann P. Automatic detection of microsleep episodes with feature-based machine learning. Sleep 2020; 43:5574726. [PMID: 31559424 DOI: 10.1093/sleep/zsz225] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 07/14/2019] [Indexed: 12/13/2022] Open
Abstract
STUDY OBJECTIVES Microsleep episodes (MSEs) are brief episodes of sleep, mostly defined to be shorter than 15 s. In the electroencephalogram (EEG), MSEs are mainly characterized by a slowing in frequency. The identification of early signs of sleepiness and sleep (e.g. MSEs) is of considerable clinical and practical relevance. Under laboratory conditions, the maintenance of wakefulness test (MWT) is often used for assessing vigilance. METHODS We analyzed MWT recordings of 76 patients referred to the Sleep-Wake-Epilepsy-Center. MSEs were scored by experts defined by the occurrence of theta dominance on ≥1 occipital derivation lasting 1-15 s, whereas the eyes were at least 80% closed. We calculated spectrograms using an autoregressive model of order 16 of 1 s epochs moved in 200 ms steps in order to visualize oscillatory activity and derived seven features per derivation: power in delta, theta, alpha and beta bands, ratio theta/(alpha + beta), quantified eye movements, and median frequency. Three algorithms were used for MSE classification: support vector machine (SVM), random forest (RF), and an artificial neural network (long short-term memory [LSTM] network). Data of 53 patients were used for the training of the classifiers, and 23 for testing. RESULTS MSEs were identified with a high performance (sensitivity, specificity, precision, accuracy, and Cohen's kappa coefficient). Training revealed that delta power and the ratio theta/(alpha + beta) were most relevant features for the RF classifier and eye movements for the LSTM network. CONCLUSIONS The automatic detection of MSEs was successful for our EEG-based definition of MSEs, with good performance of all algorithms applied.
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Affiliation(s)
- Jelena Skorucak
- Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland.,Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland.,Sleep and Health Zurich, University of Zurich, Zurich, Switzerland
| | - Anneke Hertig-Godeschalk
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - David R Schreier
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Bern, Switzerland.,Department of Medicine, Spital STS AG Thun, Switzerland
| | - Alexander Malafeev
- Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland.,Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Johannes Mathis
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Peter Achermann
- Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland.,Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland.,Sleep and Health Zurich, University of Zurich, Zurich, Switzerland.,The KEY Institute for Brain‑Mind Research, Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Zurich, Switzerland
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Schwartz AR, Cohen-Zion M, Pham LV, Gal A, Sowho M, Sgambati FP, Klopfer T, Guzman MA, Hawks EM, Etzioni T, Glasner L, Druckman E, Pillar G. Brief digital sleep questionnaire powered by machine learning prediction models identifies common sleep disorders. Sleep Med 2020; 71:66-76. [PMID: 32502852 DOI: 10.1016/j.sleep.2020.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/17/2020] [Accepted: 03/05/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION We developed and validated an abbreviated Digital Sleep Questionnaire (DSQ) to identify common societal sleep disturbances including insomnia, delayed sleep phase syndrome (DSPS), insufficient sleep syndrome (ISS), and risk for obstructive sleep apnea (OSA). METHODS The DSQ was administered to 3799 community volunteers, of which 2113 were eligible and consented to the study. Of those, 247 were interviewed by expert sleep physicians, who diagnosed ≤2 sleep disorders. Machine Learning (ML) trained and validated separate models for each diagnosis. Regularized linear models generated 15-200 features to optimize diagnostic prediction. Models were trained with five-fold cross-validation (repeated five times), followed by robust validation testing. ElasticNet models were used to classify true positives and negatives; bootstrapping optimized probability thresholds to generate sensitivities, specificities, accuracies, and area under the receiver operating curve (AUC). RESULTS Compared to reference subgroups, physician-diagnosed sleep disorders were marked by DSQ evidence of sleeplessness (insomnia, DSPS, OSA), sleep debt (DSPS, ISS), airway obstruction during sleep (OSA), blunted circadian variability in alertness (DSPS), sleepiness (DSPS and ISS), increased alertness (insomnia) and global impairment in sleep-related quality of life (all sleep disorders). ElasticNet models validated each diagnosis with high sensitivity (80-83%), acceptable specificity (63-69%), high AUC (0.80-0.85) and good accuracy (agreement with physician diagnoses, 68-73%). DISCUSSION A brief DSQ readily engaged and efficiently screened a large population for common sleep disorders. Powered by ML, the DSQ can accurately classify sleep disturbances, demonstrating the potential for improving the sleep, health, productivity and safety of populations.
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Affiliation(s)
- Alan R Schwartz
- Johns Hopkins Sleep Disorders Center, Baltimore, MD, USA; Johns Hopkins Center for Interdisciplinary Sleep Research and Education, Baltimore, MD, USA(1); University of Pennsylvania Perelman School of Medicine, USA.
| | - Mairav Cohen-Zion
- The Academic College of Tel Aviv-Jaffa, Tel Aviv, Israel; DayZz Live Well Ltd, Herzeliya, Israel
| | - Luu V Pham
- Johns Hopkins Sleep Disorders Center, Baltimore, MD, USA; Johns Hopkins Center for Interdisciplinary Sleep Research and Education, Baltimore, MD, USA(1)
| | - Amit Gal
- The Open University, Raanana, Israel
| | - Mudiaga Sowho
- Johns Hopkins Sleep Disorders Center, Baltimore, MD, USA
| | - Francis P Sgambati
- Johns Hopkins Sleep Disorders Center, Baltimore, MD, USA; Johns Hopkins Center for Interdisciplinary Sleep Research and Education, Baltimore, MD, USA(1)
| | - Tracy Klopfer
- Johns Hopkins Sleep Disorders Center, Baltimore, MD, USA
| | | | - Erin M Hawks
- Johns Hopkins Sleep Disorders Center, Baltimore, MD, USA
| | - Tamar Etzioni
- Carmel Medical Center, Haifa, Israel; Technion School of Medicine, Haifa, Israel
| | - Laura Glasner
- DayZz Live Well Ltd, Herzeliya, Israel; Sheba Medical Center, Ramat Gan, Israel
| | - Eran Druckman
- Druckman Research and Statistics, Rishon Lezion, Israel
| | - Giora Pillar
- Carmel Medical Center, Haifa, Israel; Technion School of Medicine, Haifa, Israel
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Killgore WDS, Kamimori GH. Multiple caffeine doses maintain vigilance, attention, complex motor sequence expression, and manual dexterity during 77 hours of total sleep deprivation. Neurobiol Sleep Circadian Rhythms 2020; 9:100051. [PMID: 33364521 PMCID: PMC7752712 DOI: 10.1016/j.nbscr.2020.100051] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 05/24/2020] [Accepted: 05/27/2020] [Indexed: 12/25/2022] Open
Abstract
Sleep deprivation (SD) and fatigue have detrimental effects on performance in operational settings. Few studies have investigated the cumulative effects of SD and fatigue on performance under heavy workload demands. Therefore, we investigated the efficacy of multiple repeated doses of caffeine as a countermeasure to SD and fatigue during 77 h total SD (TSD) during the early morning hours. Twenty-three males and females, 18 – 35 years of age, who identified as moderate caffeine consumers completed the Psychomotor Vigilance Task (PVT) 141 times during the experimental test period. Caffeine was administered in a multi-dose paradigm over three nights without sleep. Participants received either caffeine (200 mg) or placebo at the beginning of each 2-h test block from 0100 – 0900 (800 mg total per night). While PVT speed declined for both groups across all 3 nights, the caffeine group consistently out-performed the placebo group. Caffeine maintained attentiveness (1-5 s lapses) on night 1, but this advantage was lost on nights 2 and 3. Caffeine outperformed placebo for responsive lapses (5-9 s lapses) across all three nights, but caffeine performance was still notably worse than at baseline. Prolonged non-responsive lapses (beyond 10 s) were only reduced by caffeine on night 2. Caffeine was more effective than placebo across all nights at sustaining completion speed of a complex motor sequence task and a manual coordination task. Essentially, caffeine is an effective countermeasure for SD, as it mitigates declines in speed and failures to respond, and sustains motor planning and coordination. However, caffeine does not restore normal functioning during SD and cannot be considered as a replacement for sleep. Compared caffeine versus placebo during extreme sleep deprived monotony. Caffeine improved psychomotor vigilance speed and reduced lapses of all durations. Caffeine did not maintain normal performance after the first night of sleep loss. Caffeine sustained motor planning and coordination better than placebo. Caffeine mitigates sleep loss deficits but does not sustain performance at normal.
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Affiliation(s)
- William D S Killgore
- Department of Behavioral Biology, Walter Reed Army Institute of Research, USA.,Department of Psychiatry, University of Arizona College of Medicine, USA
| | - Gary H Kamimori
- Department of Behavioral Biology, Walter Reed Army Institute of Research, USA
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50
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Azarbarzin A, Younes M, Sands SA, Wellman A, Redline S, Czeisler CA, Gottlieb DJ. Interhemispheric sleep depth coherence predicts driving safety in sleep apnea. J Sleep Res 2020; 30:e13092. [PMID: 32441843 DOI: 10.1111/jsr.13092] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/29/2020] [Accepted: 05/04/2020] [Indexed: 02/01/2023]
Abstract
Obstructive sleep apnea is associated with increased risk of car crashes; however, conventional measures of sleep apnea severity do not clearly identify those individuals who are at greatest risk. Here we tested whether, among individuals with sleep apnea, those with reduced interhemispheric sleep depth coherence, measured by correlation between right and left hemisphere odds ratio product, are at greater risk. The sample was derived from the Sleep Heart Health Study, a prospective observational cohort study, and included 1,378 adults with sleep apnea. The occurrence of a car crash was ascertained by a questionnaire administered 2 years after the sleep study, which asked about the occurrence of crashes during the year prior to questionnaire administration. We computed the sleep depth coherence from electroencephalograms recorded during baseline sleep studies and after 5 years. The weighted kappa coefficient and Bangdiwala's B were 0.34 and 0.59, respectively, indicating a fair to moderate stability over a 5-year interval. Multivariate logistic regression, adjusted for age, sex, race, body mass index and miles driven per year, was used to assess the risk of a car crash. Compared to the lowest quartile of sleep depth coherence (<0.86), individuals in the highest quartile (>0.93) had a 62% (95% confidence interval, 22%-81%) lower risk of an accident. Further adjustments for usual sleep duration and sleepiness did not meaningfully alter these findings. Higher interhemispheric sleep depth coherence is associated with significantly lower risk of motor vehicle crashes in individuals with sleep apnea. This suggests that high interhemispheric sleep depth coherence may be a marker of resistance to sleep apnea-related adverse neurocognitive outcomes.
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Affiliation(s)
- Ali Azarbarzin
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Magdy Younes
- Sleep Disorders Center, University of Manitoba, Winnipeg, MB, Canada
| | - Scott A Sands
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Andrew Wellman
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Daniel J Gottlieb
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA.,VA Boston Healthcare System, Boston, MA, USA
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