Association of daytime sleepiness and the morningness/eveningness dimension in young adult subjects in Brazil

Different components of excessive daytime sleepiness and the change with positive airway pressure treatment in patients with obstructive sleep apnea: Results from the Icelandic Sleep Apnea Cohort (ISAC)

Excessive daytime sleepiness includes both an inability to stay awake during the day and a general feeling of sleepiness. We describe different dimensions of daytime sleepiness in adults with moderate-severe obstructive sleep apnea (OSA) before and after 2 years of positive airway pressure (PAP) treatment. Using the Epworth Sleepiness Scale (score >10 defined as "risk of dozing") and Basic Nordic Sleep Questionnaire (feeling sleepy ≥3 times/week defined as "feeling sleepy"), participants were categorised into sleepiness phenotypes labelled non-sleepy, risk of dozing only, feeling sleepy only, or both symptoms. Participants repeated baseline assessments and PAP adherence was evaluated after 2 years. PAP-adherent subjects with sleepiness symptoms at both baseline and follow-up were considered persistently sleepy. Of the 810 participants, 722 (89%) returned for follow-up. At baseline, 17.7% were non-sleepy, 7.7% were at risk of dozing only, 24.7% were feeling sleepy only, and 49.9% had both symptoms. PAP adherence did not differ by baseline sleepiness phenotype. Patients with risk of dozing demonstrated greater PAP benefits for sleepiness symptoms than non-sleepy and feeling sleepy only phenotypes. Using these phenotypes, 42.3% of PAP users had persistent sleepiness; they had less severe OSA (p < 0.001), more persistent OSA symptoms and more often had symptoms of insomnia than patients in whom sleepiness resolved. Our present results, therefore, suggest that measuring the risk of dozing and the feeling of sleepiness reflect different sleepiness components and may respond differently to PAP. Patients feeling sleepy without risk of dozing may need more thorough evaluation for factors contributing to sleepiness before initiating treatment.

Translation and Validation of a Chinese Version of the Cleveland Adolescent Sleepiness Questionnaire

PURPOSE

The Cleveland Adolescent Sleepiness Questionnaire was originally developed and published in English and has served as a valid and effective tool for the assessment of adolescents' experiences with sleepiness in a variety of situations. To allow for comparisons between sleepiness in adolescents from different cultures, and with different linguistic backgrounds, reliable and valid measurement tools are necessary. The purpose of this study was to translate and validate a Chinese version of the Cleveland Adolescent Sleepiness Questionnaire (C-CASQ).

MATERIALS AND METHODS

Sensitivity, specificity, internal consistency, and criterion validity data for the C-CASQ were tested using 458 adolescents in Taiwan. Data from 191 participants were used to establish internal consistency reliability and conduct exploratory factor analysis (EFA), while data from 267 participants were used to establish criterion validity and conduct confirmatory factor analysis (CFA). Initial criterion validity was established through a comparison of the C-CASQ with scores from the Chinese version of the Morningness-Eveningness Scale for Children, a measure of chronotype.

RESULTS

EFA resulted in four factors, consistent with the original English version of the CASQ, while CFA established goodness of fit. The scale demonstrated acceptable to good internal consistency (α = 0.77~0.86). Initial criterion validity was evident as the total score and each of the subscale scores on the C-CASQ was significantly higher (greater sleepiness) in evening-types.

CONCLUSION

The C-CASQ appears to be a psychometrically sound measure to evaluate sleepiness in Chinese-speaking adolescents.

Relationship between temporomandibular dysfunctions, sleep disorders, and anxiety among dentistry students

Introduction: This study aimed to evaluate the relationship between temporomandibular dysfunction (TMD), anxiety, and sleep disorder (DS) among dentistry students, relating the periods in which they are enrolled.Methods: The study consisted of 90 students: Group 1: 30 first-period students; Group 2: 30 fifth-period students; Group 3: 30 students from the ninth period. The participants responded to the RDC/TMD, Fletcher & Luckett questionnaires, and the Beck Anxiety Inventory to analyze symptoms of TMD, DS, and anxiety.Results: There was an association between TMD, DS, and the period studied. When related to moderate and severe anxiety, the group that had the highest incidence was Group 1 (first period students).Conclusion: The apprehension for what is new can influence the TMD and DS indices, while the greater concern for academic/professional performance can generate higher levels of anxiety.

Eveningness is associated with greater subjective cognitive impairment in individuals with self-reported symptoms of unipolar depression

BACKGROUND

Eveningness is associated with depression diagnosis and increased depressive symptom severity. Time-of-day preference has been linked with differences in cognitive function in the general population, with cognitive difficulties being a major factor in psychosocial impairment in depression. We therefore investigated the impact of time-of-day preference and self-reported depressed state on subjective cognitive function.

METHODS

Participants over the age of 18 with a self-reported history of depression completed an online questionnaire. They provided demographic and mental health information, and completed self-report scales assessing depression symptoms, time-of-day preference, and cognition. Participants were classified as "currently" or "previously depressed" based on self-reported symptoms, and as having a morning, neither, or evening time-of-day preference.

RESULTS

A total of 804 participants reporting a history of unipolar depression were included. Currently-depressed participants reported more cognitive difficulties in all areas measured. Evening types reported more complex attentional and retrospective memory difficulties than neither types, and reported more executive and prospective memory difficulties than both neither and morning types. There was an additive effect of mood state and time-of-day preference, with self-reported depressed evening types reporting the most cognitive problems.

LIMITATIONS

Depression history, time-of-day preference, and cognitive function were assessed using unsupervised self-report measures. Time-of-day preference does not necessarily reflect the physiological circadian system.

CONCLUSIONS

Both depressed state and evening preference were individually associated with subjective cognitive complaints in people with a self-reported history of unipolar depression. The additive effect of poor mood and eveningness is important given the high prevalence of eveningness in depression. Assessment of time-of-day preference could help to identify those susceptible to cognitive symptoms, and inform treatment.

Mismatch between perceived family and individual chronotype and their association with sleep-wake patterns

While social zeitgebers are known to shape diurnal preference, little research has been devoted to determining the contribution of the familiar group chronotype as social zeitgeber on individual circadian rhythms and sleep-wake patterns in adult subjects. The current study aimed to examine the matching between perceived family chronotype and individual chronotype and their relationship with sleep-wake patterns on weekdays and weekends, diurnal subjective somnolence, and substance consumption. Nine hundred and forty-two Colombian adults completed the Composite Scale of Morningness, the Epworth Sleepiness Scale, and responded to a questionnaire about circadian preferences of their family nucleus. We found evidence of a mismatch between perceived family and individual chronotype, mainly for morning-type individuals (Cohen's Kappa = -0.231; p < 0.001). This mismatch was associated with diurnal subjective somnolence (β = 0.073; p < 0.001) and specific sleep-wake patterns (p < 0.01). In addition, subjects with evening-type families showed higher caffeine and alcohol consumption (p < 0.001). To our knowledge, this is the first study to assess and report the mismatching between perceived family and individual chronotypes, and it adds to the existing body of knowledge regarding the influence of social zeitgebers on circadian rhythms. This is particularly relevant since mismatching between circadian physiology and environmental cues have been shown to lead to diverse pathologies.

The impact of chronotype on prosocial behavior

INTRODUCTION

Chronotype (morningness/eveningness) is associated with preference for the timing of many types of behavior, most notably sleep. Chronotype is also associated with differences in the timing of various physiologic events as well as aspects of personality. One aspect linked to personality, prosocial behavior, has not been studied before in the context of chronotype. There are many variables contributing to who, when, and why one human might help another and some of these factors appear fixed, while some change over time or with the environment. It was our intent to examine prosocial behavior in the context of chronotype and environment.

METHODS

Randomly selected adults (N = 100, ages 18-72) were approached in a public space and asked to participate in a study. If the participants consented (n = 81), they completed the reduced Morning-Eveningness Questionnaire and the Stanford Sleepiness Scale, then prosocial behavior was assessed.

RESULTS/CONCLUSIONS

We found that people exhibited greater prosocial behavior when they were studied further from their preferred time of day. This did not appear to be associated with subjective sleepiness or other environmental variables, such as ambient illumination. This suggests the importance of appreciating the differentiation between the same individual's prosocial behavior at different times of day. Future studies should aim at replicating this result in larger samples and across other measures of prosocial behavior.

Validation of the Italian Version of the Morningness-Eveningness Questionnaire for Adolescents by A. Lancry and Th. Arbault

Background

This study aimed to validate the Italian version of the Morningness-Eveningness questionnaire for adolescents by Lancry and Arbault.

Material/Methods

The Morningness-Eveningness Questionnaire by Lancry and Arbault was translated from French into Italian by using forward-backward translation. Students aged 11–15 years old were enrolled from two schools in Milan (Italia). Validation of the questionnaire was performed in subsequent phases. A pre-test was given to 66 students aged 11–15 years (males 57.4%, females 42.6%) from a convenience sample. Syntactic aspects of the pre-test were improved, and the questionnaire in a revised version was re-administered to 292 students of same age (males 43.8%, females 54.1%) from a convenience sample.

Results

Factor analysis was performed on pre-test data, using the principal component method accounting for Morningness-Eveningness. Problematic items possibly uncorrelated with the extracted factor were identified, and reliability produced a Cronbach’s Alpha close to 0.7. In the test phase factor analysis was performed using the principal component method. Based on reliability analyses, we excluded a number of items because of their low performance, giving rise to a Cronbach’s Alpha of 0.819. Pearson product-moment external correlations between Morningness-Eveningness disposition and temperament, behavioral, and cognitive aspects were evaluated.

Conclusions

A factor analysis, Cronbach’s alpha and concurrent validity coefficients with disposition, behavior, and cognition, were performed, suggesting potential reliability and validity. The questionnaire is a useful and relevant tool for measuring Morningness-Eveningness disposition in adolescents, which has seldom been investigated with adequate psychometric instruments.

Relationship between chronotype and quality of sleep in medical students at the Federal University of Paraiba, Brazil

OBJECTIVE

The aim of this study was to identify chronotypes of medical students at the Federal University of Paraíba (UFPB) and its relationship to quality of sleep, daytime sleepiness, age, sex and season of birth.

METHODS

The final sample consisted of 221 students, assessed by four questionnaires: demographic questionnaire, Morningness-Eveningness Questionnaire (MEQ), Pittsburgh Sleep Quality lndex (PSQI) and Epworth Sleepiness Scale (ESS).

RESULTS

There was a statistically significant difference between groups with respect to chronotypes and PSQI score (p<0.0005), but not with excessive daytime sleepiness. A significant negative correlation was found between the scores of MEQ and PSQI (rho=-0.3, p<0.0005), demonstrating that the greater the eveningness, the worse the sleep quality. It was observed that 51.6% of students were classified as indifferent chronotype, 61.5% had poor quality of sleep, while 42.1% had excessive daytime sleepiness. Sex and season at birth did not differ between chronotypes.

CONCLUSION

These findings demonstrate that the evening chronotype was associated with poor quality of sleep in medical students, but not with increased daytime sleepiness, with potential impairment to their academic performance and quality of life.

[Sleep patterns and fatigue of nursing students who work]

It has been observed there is currently a growing interest in developing research regarding the sleep patterns of workers who must wake up very early or who work nights. Therefore, the objective of this study was to identify the levels of fatigue and the sleep patterns of nursing students who study during the day and work at night. Participants were thirty students who completed the Epworth Sleepiness Scale and Sleep Journal for thirty days. It was found that sleep duration was longer among men compared to women on days off work, and when on vacation from school compared to the regular school period. Participants showed high levels of fatigue and sleepiness, characterized by the incidence of excessive daytime sleepiness. In conclusion, night workers who endure sleep deprivation have additional wake hours due to studying, thus causing high levels of fatigue, which may harm their performance at school and at work.