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Tomzig M, Wörle J, Gary S, Baumann M, Neukum A. Strategic naps in automated driving - Sleep architecture predicts sleep inertia better than nap duration. ACCIDENT; ANALYSIS AND PREVENTION 2024; 209:107811. [PMID: 39427445 DOI: 10.1016/j.aap.2024.107811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 09/06/2024] [Accepted: 10/07/2024] [Indexed: 10/22/2024]
Abstract
At higher levels of driving automation, drivers can nap during parts of the trip but must take over control in others. Awakening from a nap is marked by sleep inertia which is tackled by the NASA nap paradigm in aviation: Strategic on-flight naps are restricted to 40 min to avoid deep sleep and therefore sleep inertia. For future automated driving, there are currently no such strategies for addressing sleep inertia. Given the disparate requirements, it is uncertain whether the strategies derived from aviation can be readily applied to automated driving. Therefore, our study aimed to compare the effects of restricting the duration of nap opportunities following the NASA nap paradigm to the effects of sleep architecture on sleep inertia in takeover scenarios in automated driving. In our driving simulator study, 24 participants were invited to sleep during three automated drives. They were awakened after 20, 40, or 60 min and asked to manually complete an urban drive. We assessed how napping duration, last sleep stage before takeover, and varying proportions of light, stable, and deep sleep influenced self-reported sleepiness, takeover times, and the number of driving errors. Takeover times increased with nap duration, but sleepiness and driving errors did not. Instead, all measures were significantly influenced by sleep architecture. Sleepiness increased after awakening from light and stable sleep, and takeover times after awakening from light sleep. Takeover times also increased with higher proportions of stable sleep. The number of driving errors was significantly increased with the proportion of deep sleep and after awakenings from stable and deep sleep. These results suggest that sleep architecture, not nap duration, is crucial for predicting sleep inertia. Therefore, the NASA nap paradigm is not suitable for driving contexts. Future driver monitoring systems should assess the sleep architecture to predict and prevent sleep inertia.
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Affiliation(s)
- Markus Tomzig
- Wuerzburg Institute for Traffic Sciences, WIVW GmbH, Robert-Bosch-Straße 4, 97209 Veitshöchheim, Germany; Ulm University, Albert-Einstein-Allee 41, 89081 Ulm, Germany.
| | - Johanna Wörle
- Wuerzburg Institute for Traffic Sciences, WIVW GmbH, Robert-Bosch-Straße 4, 97209 Veitshöchheim, Germany; Singapore-ETH Centre, 1 Create Way, CREATE Tower 138602, Singapore
| | - Sebastian Gary
- Wuerzburg Institute for Traffic Sciences, WIVW GmbH, Robert-Bosch-Straße 4, 97209 Veitshöchheim, Germany
| | - Martin Baumann
- Ulm University, Albert-Einstein-Allee 41, 89081 Ulm, Germany
| | - Alexandra Neukum
- Wuerzburg Institute for Traffic Sciences, WIVW GmbH, Robert-Bosch-Straße 4, 97209 Veitshöchheim, Germany
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2
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McCauley ME, McCauley P, Kalachev LV, Riedy SM, Banks S, Ecker AJ, Dinges DF, Van Dongen HPA. Biomathematical modeling of fatigue due to sleep inertia. J Theor Biol 2024; 590:111851. [PMID: 38782198 PMCID: PMC11179995 DOI: 10.1016/j.jtbi.2024.111851] [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: 11/26/2023] [Revised: 04/13/2024] [Accepted: 05/12/2024] [Indexed: 05/25/2024]
Abstract
Biomathematical models of fatigue capture the physiology of sleep/wake regulation and circadian rhythmicity to predict changes in neurobehavioral functioning over time. We used a biomathematical model of fatigue linked to the adenosinergic neuromodulator/receptor system in the brain as a framework to predict sleep inertia, that is, the transient neurobehavioral impairment experienced immediately after awakening. Based on evidence of an adenosinergic basis for sleep inertia, we expanded the biomathematical model with novel differential equations to predict the propensity for sleep inertia during sleep and its manifestation after awakening. Using datasets from large laboratory studies of sleep loss and circadian misalignment, we calibrated the model by fitting just two new parameters and then validated the model's predictions against independent data. The expanded model was found to predict the magnitude and time course of sleep inertia with generally high accuracy. Analysis of the model's dynamics revealed a bifurcation in the predicted manifestation of sleep inertia in sustained sleep restriction paradigms, which reflects the observed escalation of the magnitude of sleep inertia in scenarios with sleep restriction to less than ∼ 4 h per day. Another emergent property of the model involves a rapid increase in the predicted propensity for sleep inertia in the early part of sleep followed by a gradual decline in the later part of the sleep period, which matches what would be expected based on the adenosinergic regulation of non-rapid eye movement (NREM) sleep and its known influence on sleep inertia. These dynamic behaviors provide confidence in the validity of our approach and underscore the predictive potential of the model. The expanded model provides a useful tool for predicting sleep inertia and managing impairment in 24/7 settings where people may need to perform critical tasks immediately after awakening, such as on-demand operations in safety and security, emergency response, and health care.
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Affiliation(s)
- Mark E McCauley
- Sleep and Performance Research Center, Washington State University, 412 E. Spokane Falls Blvd., Spokane, WA 99202-2131, USA; Department of Translational Medicine and Physiology, Washington State University Health Sciences Spokane, 412 E. Spokane Falls Blvd., Spokane, WA 99202, USA.
| | - Peter McCauley
- Sleep and Performance Research Center, Washington State University, 412 E. Spokane Falls Blvd., Spokane, WA 99202-2131, USA
| | - Leonid V Kalachev
- Department of Mathematical Sciences, University of Montana, Mathematics Building, Missoula, MT 59812, USA.
| | - Samantha M Riedy
- Sleep and Performance Research Center, Washington State University, 412 E. Spokane Falls Blvd., Spokane, WA 99202-2131, USA
| | - Siobhan Banks
- Behaviour-Brain-Body Research Centre, University of South Australia, Adelaide, SA 5048, Australia.
| | - Adrian J Ecker
- Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, University of Pennsylvania Perelman School of Medicine, 1013 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA.
| | - David F Dinges
- Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, University of Pennsylvania Perelman School of Medicine, 1013 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA.
| | - Hans P A Van Dongen
- Sleep and Performance Research Center, Washington State University, 412 E. Spokane Falls Blvd., Spokane, WA 99202-2131, USA; Department of Translational Medicine and Physiology, Washington State University Health Sciences Spokane, 412 E. Spokane Falls Blvd., Spokane, WA 99202, USA.
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3
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Aria M, Khazim I, Ilyas M, Kekalih A, Fuady A. Work-Related Fatigue Among Indonesian Offshore Oil and Gas Workers. Occup Med (Lond) 2024; 74:364-369. [PMID: 38809608 DOI: 10.1093/occmed/kqae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Work-related fatigue, combined with shift work and prolonged work hours, has a significant effect, contributing to increasing accident rate by 50-100%. AIMS To assess the level of work-related fatigue over a 4-week work period among offshore rig oil and gas workers in Indonesia. METHODS This cohort study evaluated acute fatigue, chronic fatigue, and intershift recovery scores among offshore oil and gas rig workers using the Occupational Fatigue Exhaustion Recovery 15 (OFER15) questionnaire. Fatigue levels were assessed weekly throughout the study duration, which was 4-week work period. Additionally, at the fourth week, participants were asked about psychosocial factors that could be potentially related to fatigue. RESULTS Of 67 participants, the average scores of acute and chronic fatigue were 30.0 and 33.3, and the scores had significantly increased over 4 weeks (P < 0.001). The intershift recovery scores statistically significantly decreased over 4 weeks (P < 0.001), and the differences between weeks (Week 1 versus 2, Week 1 versus 3 and Week 1 versus 4) were also statistically significant (P < 0.001). Acute and chronic fatigue scores had a significant positive correlation with psychological job demands and negatively correlated with influence at work and job satisfaction. Over 4 weeks, acute fatigue augmented chronic fatigue, while acute and chronic fatigue demanded a longer recovery. CONCLUSIONS Workers at the offshore rig experienced work fatigue during their on-duty periods, with the level of fatigue significantly increasing over the 4 weeks. Comprehensive fatigue management at offshore rigs is vital to mitigate work fatigue and minimize the risk of work-related accidents.
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Affiliation(s)
- M Aria
- Faculty of Medicine, Universitas Indonesia, Jakarta 10320, Indonesia
| | - I Khazim
- Faculty of Medicine, Universitas Indonesia, Jakarta 10320, Indonesia
| | - M Ilyas
- Faculty of Medicine, Universitas Indonesia, Jakarta 10320, Indonesia
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta 10320, Indonesia
| | - A Kekalih
- Faculty of Medicine, Universitas Indonesia, Jakarta 10320, Indonesia
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta 10320, Indonesia
| | - A Fuady
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta 10320, Indonesia
- Evidence-Based Health Policy Centre, Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia
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4
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Ruby P, Evangelista E, Bastuji H, Peter-Derex L. From physiological awakening to pathological sleep inertia: Neurophysiological and behavioural characteristics of the sleep-to-wake transition. Neurophysiol Clin 2024; 54:102934. [PMID: 38394921 DOI: 10.1016/j.neucli.2023.102934] [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: 09/30/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 02/25/2024] Open
Abstract
Sleep inertia refers to the transient physiological state of hypoarousal upon awakening, associated with various degrees of impaired neurobehavioral performance, confusion, a desire to return to sleep and often a negative emotional state. Scalp and intracranial electro-encephalography as well as functional imaging studies have provided evidence that the sleep inertia phenomenon is underpinned by an heterogenous cerebral state mixing local sleep and local wake patterns of activity, at the neuronal and network levels. Sleep inertia is modulated by homeostasis and circadian processes, sleep stage upon awakening, and individual factors; this translates into a huge variability in its intensity even under physiological conditions. In sleep disorders, especially in hypersomnolence disorders such as idiopathic hypersomnia, sleep inertia may be a daily, serious and long-lasting symptom leading to severe impairment. To date, few tools have been developed to assess sleep inertia in clinical practice. They include mainly questionnaires and behavioral tests such as the psychomotor vigilance task. Only one neurophysiological protocol has been evaluated in hypersomnia, the forced awakening test which is based on an event-related potentials paradigm upon awakening. This contrasts with the major functional consequences of sleep inertia and its potentially dangerous consequences in subjects required to perform safety-critical tasks soon after awakening. There is a great need to identify reproducible biomarkers correlated with sleep inertia-associated cognitive and behavioral impairment. These biomarkers will aim at better understanding and measuring sleep inertia in physiological and pathological conditions, as well as objectively evaluating wake-promoting treatments or non-pharmacological countermeasures to reduce this phenomenon.
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Affiliation(s)
- Perrine Ruby
- Lyon Neuroscience Research Centre, INSERM U1028, CNRS UMR 5292, Lyon, France
| | - Elisa Evangelista
- Sleep disorder Unit, Carémeau Hospital, Centre Hospitalo-universitaire de Nîmes, France; Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France
| | - Hélène Bastuji
- Lyon Neuroscience Research Centre, INSERM U1028, CNRS UMR 5292, Lyon, France; Centre for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France
| | - Laure Peter-Derex
- Lyon Neuroscience Research Centre, INSERM U1028, CNRS UMR 5292, Lyon, France; Centre for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France.
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Campanella C, Byun K, Senerat A, Li L, Zhang R, Aristizabal S, Porter P, Bauer B. The Efficacy of a Multimodal Bedroom-Based 'Smart' Alarm System on Mitigating the Effects of Sleep Inertia. Clocks Sleep 2024; 6:183-199. [PMID: 38534801 DOI: 10.3390/clockssleep6010013] [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: 01/05/2024] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 03/28/2024] Open
Abstract
Previous work has demonstrated the modest impact of environmental interventions that manipulate lighting, sound, or temperature on sleep inertia symptoms. The current study sought to expand on previous work and measure the impact of a multimodal intervention that collectively manipulated light, sound, and ambient temperature on sleep inertia. Participants slept in the lab for four nights and were awoken each morning by either a traditional alarm clock or the multimodal intervention. Feelings of sleep inertia were measured each morning through Psychomotor Vigilance Test (PVT) assessments and ratings of sleepiness and mood at five time-points. While there was little overall impact of the intervention, the participant's chronotype and the length of the lighting exposure on intervention mornings both influenced sleep inertia symptoms. Moderate evening types who received a shorter lighting exposure (≤15 min) demonstrated more lapses relative to the control condition, whereas intermediate types exhibited a better response speed and fewer lapses. Conversely, moderate evening types who experienced a longer light exposure (>15 min) during the intervention exhibited fewer false alarms over time. The results suggest that the length of the environmental intervention may play a role in mitigating feelings of sleep inertia, particularly for groups who might exhibit stronger feelings of sleep inertia, including evening types.
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Affiliation(s)
- Carolina Campanella
- Delos Living LLC, New York, NY 10014, USA
- Well Living Lab, Inc., Rochester, MN 55902, USA
| | - Kunjoon Byun
- Delos Living LLC, New York, NY 10014, USA
- Well Living Lab, Inc., Rochester, MN 55902, USA
| | - Araliya Senerat
- Well Living Lab, Inc., Rochester, MN 55902, USA
- International Society for Urban Health, New York, NY 10003, USA
| | - Linhao Li
- Delos Living LLC, New York, NY 10014, USA
- Well Living Lab, Inc., Rochester, MN 55902, USA
| | | | - Sara Aristizabal
- Delos Living LLC, New York, NY 10014, USA
- Well Living Lab, Inc., Rochester, MN 55902, USA
| | - Paige Porter
- Well Living Lab, Inc., Rochester, MN 55902, USA
- School of Environment and Sustainability, University of Michigan, Ann Arbor, MI 48109, USA
| | - Brent Bauer
- Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
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6
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Kovac K, Vincent GE, Paterson JL, Hilditch CJ, Ferguson SA. A preliminary framework for managing sleep inertia in occupational settings. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2023; 4:zpad050. [PMID: 38046222 PMCID: PMC10693319 DOI: 10.1093/sleepadvances/zpad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/26/2023] [Indexed: 12/05/2023]
Abstract
Sleep inertia, the temporary period of impairment experienced upon waking, is a safety hazard that has been implicated in serious work-related incidents resulting in injuries as well as the loss of life and assets. As such, sleep inertia warrants formal management in industries where personnel are required to undertake their role soon after waking (e.g. emergency services, engineers, and health care). At present, there is a lack of practical, evidence-based guidance on how sleep inertia could be formally managed at an organizational level. We propose a preliminary framework for managing sleep inertia based on the translation of research findings into specific work procedure modifications/control mechanisms. Within the framework, work procedure modifications/control mechanisms to manage sleep inertia are organized into three levels: (1) modifications/controls that eliminate the chance of sleep inertia, (2) modifications/controls that reduce sleep inertia severity, and (3) modifications/controls that manage the risk of errors during sleep inertia. Practical considerations, limitations, and areas of further research are highlighted for each modification/control to help determine how readily each control measure could be implemented by industries at present. A guide for organizations to use this preliminary framework of sleep inertia management is put forward, as well as the next research priorities to strengthen the utility and evidence base of the framework. This paper is part of the Sleep and Circadian Rhythms: Management of Fatigue in Occupational Settings Collection.
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Affiliation(s)
- Katya Kovac
- School of Health, Medical and Applied Sciences, Appleton Institute, Central Queensland University, Wayville, SA, Australia
| | - Grace E Vincent
- School of Health, Medical and Applied Sciences, Appleton Institute, Central Queensland University, Wayville, SA, Australia
| | - Jessica L Paterson
- Flinders University Institute of Mental Health and Wellbeing, College of Education, Psychology and Social Work, Flinders University, Bedford Park, SA, Australia
| | - Cassie J Hilditch
- Fatigue Countermeasures Laboratory, San José State University, San José, CA, USA
| | - Sally A Ferguson
- School of Health, Medical and Applied Sciences, Appleton Institute, Central Queensland University, Wayville, SA, Australia
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7
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Song YM, Choi SJ, Park SH, Lee SJ, Joo EY, Kim JK. A real-time, personalized sleep intervention using mathematical modeling and wearable devices. Sleep 2023; 46:zsad179. [PMID: 37422720 DOI: 10.1093/sleep/zsad179] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/03/2023] [Indexed: 07/10/2023] Open
Abstract
The prevalence of artificial light exposure has enabled us to be active any time of the day or night, leading to the need for high alertness outside of traditional daytime hours. To address this need, we developed a personalized sleep intervention framework that analyzes real-world sleep-wake patterns obtained from wearable devices to maximize alertness during specific target periods. Our framework utilizes a mathematical model that tracks the dynamic sleep pressure and circadian rhythm based on the user's sleep history. In this way, the model accurately predicts real-time alertness, even for shift workers with complex sleep and work schedules (N = 71, t = 13~21 days). This allowed us to discover a new sleep-wake pattern called the adaptive circadian split sleep, which incorporates a main sleep period and a late nap to enable high alertness during both work and non-work periods of shift workers. We further developed a mobile application that integrates this framework to recommend practical, personalized sleep schedules for individual users to maximize their alertness during a targeted activity time based on their desired sleep onset and available sleep duration. This can reduce the risk of errors for those who require high alertness during nontraditional activity times and improve the health and quality of life for those leading shift work-like lifestyles.
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Affiliation(s)
- Yun Min Song
- Department of Mathematical Sciences, KAIST, Daejeon, Republic of Korea
- Biomedical Mathematics Group, Institute for Basic Science, Daejeon, Republic of Korea
| | - Su Jung Choi
- Graduate School of Clinical Nursing Science, Sungkyunkwan University, Seoul, Republic of Korea
| | - Se Ho Park
- Biomedical Mathematics Group, Institute for Basic Science, Daejeon, Republic of Korea
- Department of Mathematics, University of Wisconsin-Madison, Madison, WI, USA
| | - Soo Jin Lee
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Samsung Biomedical Research Institute, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Eun Yeon Joo
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Samsung Biomedical Research Institute, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jae Kyoung Kim
- Department of Mathematical Sciences, KAIST, Daejeon, Republic of Korea
- Biomedical Mathematics Group, Institute for Basic Science, Daejeon, Republic of Korea
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8
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Patterson PD, Okerman TS, Roach DGL, Weaver MD, Patterson CG, Martin SE, Okwiya N, Nong L, Eyiba C, Huff JR, Ruzicka A, Ruggieri J, McIlvaine Q, Weiss LS. Effect of Short versus Long Duration Naps on Blood Pressure during Simulated Night Shift Work: A Randomized Crossover Trial. PREHOSP EMERG CARE 2023; 27:815-824. [PMID: 37347964 DOI: 10.1080/10903127.2023.2227891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/02/2023] [Accepted: 06/11/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE Blunting of the sleep-related dip in blood pressure (BP) has been linked to numerous cardiovascular outcomes including myocardial infarction. Blunting of BP dipping occurs during night shift work and previous research suggest that a 60-min or longer on-shift nap is needed to restore normal/healthy BP dipping. We sought to determine the effect of different durations of napping on BP during and following simulated night shifts. We hypothesized that the greatest benefit in terms of restoration of normal BP dipping during night shift work would be observed during a longer duration nap versus a shorter nap opportunity. METHODS We used a randomized crossover laboratory-based study design. Participants consented to complete three separate 72-hr conditions that included a 12-hr simulated night shift. Nap conditions included a 30-min and 2-hr nap compared to a no-nap condition. Ambulatory BP monitoring was assessed hourly and every 10-30 mins during in-lab naps. Blunted BP dipping during in-lab naps was the primary outcome. Goal enrollment of 25 (35 with attrition) provided 80% power to detect a mean difference of 5 mmHg in BP between nap conditions. RESULTS Of the 58 screened, 28 were consented, and 26 completed all three 72-hr conditions. More than half (53.6%) were female. Mean age was 24.4 years (SD7.2). Most (85.7%) were certified as emergency medical technicians or paramedics. The mean percentage dip in systolic BP (SBP) and diastolic BP (DBP) did not differ between the 30-min and 2-hr nap conditions (p > 0.05), yet a greater proportion of participants experienced a 10-20% dip in SBP or DBP during the 2-hr nap versus the 30-min nap (p < 0.05). For every additional minute of total sleep during the 30-min nap, the percentage of SBP dip improved by 0.60%, and the percentage of DBP dip improved by 0.68% (p < 0.05). These improvements approximate to a 6% per minute relative advancement toward normal/healthy BP dipping. CONCLUSIONS Restoration of a normal/healthy dip in BP is achievable during short and long duration nap opportunities during simulated night shift work. Our findings support the hypothesis that BP dipping is more common during longer 2-hr versus shorter 30-min naps. TRIAL REGISTRATION ClinicalTrials.gov, NCT04469803. Registered on 9 July 2020.
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Affiliation(s)
- P Daniel Patterson
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- School of Health and Rehabilitation Sciences, Emergency Medicine Program, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tiffany S Okerman
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- School of Health and Rehabilitation Sciences, Emergency Medicine Program, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David G L Roach
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Matthew D Weaver
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Charity G Patterson
- School of Health and Rehabilitation Sciences, SHRS Data Center, and Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sarah E Martin
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nicholas Okwiya
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lily Nong
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- School of Health and Rehabilitation Sciences, Emergency Medicine Program, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Chinemeh Eyiba
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jordan R Huff
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- School of Health and Rehabilitation Sciences, Emergency Medicine Program, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anna Ruzicka
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Julia Ruggieri
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Quentin McIlvaine
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- School of Health and Rehabilitation Sciences, Emergency Medicine Program, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Leonard S Weiss
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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9
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Ma Z, Chen XY, Wang D, Zhu Z, Niu H, Huang S, Zhou X, Yang Z, Fan F. Who is the hardest to wake up from sleep? An investigation of self-reported sleep inertia using a latent profile analysis. J Sleep Res 2022; 31:e13552. [PMID: 35112414 DOI: 10.1111/jsr.13552] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/02/2022] [Accepted: 01/03/2022] [Indexed: 11/30/2022]
Abstract
Few studies have assessed the overall nature and profiles of subjective sleep inertia (SI) within the general population. This study was designed to identify subjective SI profiles and examine the associations between profiles of subjective SI with sociodemographic and sleep-related characteristics. A total of 11 colleges and universities were surveyed from May 30 to June 17, 2021, by convenience sampling. A total of 1,240 participants provided usable data regarding sociodemographic information, Sleep Inertia Questionnaire, and sleep-related characteristics via an online platform. Latent profile analysis was utilised to identify profiles of SI. Multinomial logistic regression was further performed to examine the predisposing factors of profiles of SI. Four profiles of SI were identified: (1) "Low SI", 20%; (2) "Mild SI", 31%; (3) "Moderate SI", 33%; and (4) "Severe SI", 16%. Compared to a Low SI profile, younger, individuals with an evening chronotype, and individuals who had <6 h sleep/night, experienced poor sleep quality, and moderate-to-severe sleep disturbance were at increased risk of experiencing severe SI. Individuals with more languid types tended to show more severe SI, while individuals reporting greater flexibility experienced less SI. This study is the first effort to examine the profiles of subjective SI using latent profile analysis and identified four profiles of SI in the general population. This effort may contribute to a greater understanding of SI, including the development of a screening tool and interventions to reduce SI.
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Affiliation(s)
- Zijuan Ma
- School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China.,Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China
| | - Xiao-Yan Chen
- School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China.,Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China
| | - Dongfang Wang
- School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China.,Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China
| | - Zhiyi Zhu
- School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China.,Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China
| | - Haiquan Niu
- School of Psychology, Nanjing Normal University, Nanjing, China
| | - Shuiqing Huang
- School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China.,Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China
| | - Xiuzhu Zhou
- School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China.,Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China
| | - Zheng Yang
- School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China.,Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China
| | - Fang Fan
- School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China.,Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China
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10
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Kovac K, Vincent GE, Paterson JL, Reynolds A, Aisbett B, Hilditch CJ, Ferguson SA. The impact of a short burst of exercise on sleep inertia. Physiol Behav 2021; 242:113617. [PMID: 34606883 DOI: 10.1016/j.physbeh.2021.113617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/16/2021] [Accepted: 09/29/2021] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVES Determine whether 30 s (s) of exercise performed upon waking can reduce sleep inertia and accelerate an increase in the cortisol awakening response (CAR) and core body temperature (CBT), compared to when sedentary. METHODS Fifteen participants (mean age ± SD, 25.9 ± 5.9 years; six females) completed a counterbalanced, repeated measures, in-laboratory study involving three single experimental nights, each separated by a four-night recovery period. Participants were woken following a 2-h nap (2400-0200) and completed a cycling bout of high-intensity (30-s sprint), low-intensity (30 s at 60% maximum heart rate), or no exercise (sedentary). Sleep inertia testing (eight batteries, 15-min intervals) began immediately following and included measures of subjective sleepiness (Karolinska Sleepiness Scale) and cognitive performance tasks (psychomotor vigilance, serial addition and subtraction, and spatial configuration). CBT was measured continuously via an ingestible telemetric capsule. The CAR was determined using salivary cortisol samples collected at 0, 30 and 45 min post-waking. Data were analysed using mixed effects analysis of variance. RESULTS There was no difference in cognitive performance or CBT between conditions. Participants felt less sleepy in the high-intensity condition, followed by the low-intensity and sedentary conditions (p = .003). The CAR was greatest in the high-intensity condition, followed by the sedentary condition, and low-intensity condition (p < 0.001), with no differences between the low-intensity and sedentary conditions. CONCLUSIONS Those who exercise upon waking should be aware that while they may feel more alert, they may not be performing better than if they had not exercised. Future research should investigate whether exercise of different duration or timing may impact sleep inertia.
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Affiliation(s)
- Katya Kovac
- Central Queensland University, Appleton Institute, School of Health, Medical and Applied Sciences, Wayville, Adelaide, Australia.
| | - Grace E Vincent
- Central Queensland University, Appleton Institute, School of Health, Medical and Applied Sciences, Wayville, Adelaide, Australia
| | - Jessica L Paterson
- Central Queensland University, Appleton Institute, School of Health, Medical and Applied Sciences, Wayville, Adelaide, Australia
| | - Amy Reynolds
- Central Queensland University, Appleton Institute, School of Health, Medical and Applied Sciences, Wayville, Adelaide, Australia
| | - Brad Aisbett
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
| | - Cassie J Hilditch
- Fatigue Countermeasures Laboratory, San José State University, San José, CA, USA
| | - Sally A Ferguson
- Central Queensland University, Appleton Institute, School of Health, Medical and Applied Sciences, Wayville, Adelaide, Australia
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11
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Patterson PD, Liszka MK, Mcilvaine QS, Nong L, Weaver MD, Turner RL, Platt TE, Opitz SE, Guyette FX, Martin-Gill C, Weiss LS, Buysse DJ, Callaway CW. Does the evidence support brief (≤30-mins), moderate (31-60-mins), or long duration naps (61+ mins) on the night shift? A systematic review. Sleep Med Rev 2021; 59:101509. [PMID: 34116386 DOI: 10.1016/j.smrv.2021.101509] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 11/15/2022]
Abstract
We performed a systematic review of four databases to determine if the evidence supports a short or long duration nap during night shifts to mitigate fatigue, and/or improve health, safety, or performance for emergency services and public safety personnel (PROSPERO CRD42020156780). We focused on experimental research and evaluated the quality of evidence with the grading of recommendations, assessment, development, and evaluation (GRADE) framework. We used the Cochrane Collaboration's risk of bias tool to assess bias and reported findings using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Our search yielded n = 10,345 records and n = 44 were reviewed in full-text. Inter-rater agreement during screening was substantial (Kappa = 0.66). We retained n = 11 publications, reporting on n = 7 experimental studies with a cumulative sample size of n = 140. We identified wide variation in study design, napping interventions (i.e., timing, placement, and duration), and outcomes. We identified mixed findings comparing brief, moderate, and long duration naps on outcomes of interest. All seven studies presented serious risk of bias and the quality of evidence was rated as low. Based on the best available evidence, decisions regarding nap duration during night shift work should be based on time (post-nap) and outcome.
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Affiliation(s)
- P Daniel Patterson
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, PA, 15261, USA; University of Pittsburgh, School of Health and Rehabilitation Sciences, Division of Community Health Services, Emergency Medicine Program, Pittsburgh, PA, 15261, USA.
| | - Mary K Liszka
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, PA, 15261, USA
| | - Quentin S Mcilvaine
- University of Pittsburgh, School of Health and Rehabilitation Sciences, Division of Community Health Services, Emergency Medicine Program, Pittsburgh, PA, 15261, USA
| | - Lily Nong
- University of Pittsburgh, School of Health and Rehabilitation Sciences, Division of Community Health Services, Emergency Medicine Program, Pittsburgh, PA, 15261, USA
| | - Matthew D Weaver
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Boston, MA, 02115, USA; Harvard Medical School, Division of Sleep Medicine, Boston, MA, 02115, USA
| | - Rose L Turner
- University of Pittsburgh, Health Sciences Library System, Pittsburgh, PA, 15261, USA
| | - Thomas E Platt
- University of Pittsburgh, School of Health and Rehabilitation Sciences, Division of Community Health Services, Emergency Medicine Program, Pittsburgh, PA, 15261, USA
| | - Samantha E Opitz
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, PA, 15261, USA
| | - Francis X Guyette
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, PA, 15261, USA
| | - Christian Martin-Gill
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, PA, 15261, USA
| | - Leonard S Weiss
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, PA, 15261, USA
| | - Daniel J Buysse
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, 15261, USA
| | - Clifton W Callaway
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, PA, 15261, USA
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Patterson PD, Weiss LS, Weaver MD, Salcido DD, Opitz SE, Okerman TS, Smida TT, Martin SE, Guyette FX, Martin-Gill C, Callaway CW. Napping on the night shift and its impact on blood pressure and heart rate variability among emergency medical services workers: study protocol for a randomized crossover trial. Trials 2021; 22:212. [PMID: 33726840 PMCID: PMC7962082 DOI: 10.1186/s13063-021-05161-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/27/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND There is an emerging body of evidence that links exposure to shift work to cardiovascular disease (CVD). The risk of coronary events, such as myocardial infarction, is greater among night shift workers compared to day workers. There is reason to believe that repeated exposure to shift work, especially night shift work, creates alterations in normal circadian patterns of blood pressure (BP) and heart rate variability (HRV) and that these alterations contribute to increased risk of CVD. Recent data suggest that allowing shift workers to nap during night shifts may help to normalize BP and HRV patterns and, over time, reduce the risk of CVD. The risk of CVD related to shift work is elevated for emergency medical services (EMS) shift workers due in part to long-duration shifts, frequent use of night shifts, and a high prevalence of multiple jobs. METHODS We will use a randomized crossover trial study design with three study conditions. The targeted population is comprised of EMS clinician shift workers, and our goal enrollment is 35 total participants with an estimated 10 of the 35 enrolled not completing the study protocol or classified as lost to attrition. All three conditions will involve continuous monitoring over 72 h and will begin with a 36-h at-home period, followed by 24 total hours in the lab (including a 12-h simulated night shift), ending with 12 h at home. The key difference between the three conditions is the intra-shift nap. Condition 1 will involve a simulated 12-h night shift with total sleep deprivation. Condition 2 will involve a simulated 12-h night shift and a 30-min nap opportunity. Condition 3 will involve a simulated 12-h night shift with a 2-h nap opportunity. Our primary outcomes of interest include blunted BP dipping and reduced HRV as measured by the standard deviation of the inter-beat intervals of normal sinus beats. Non-dipping status will be defined as sleep hours BP dip of less than 10%. DISCUSSION Our study will address two indicators of cardiovascular health and determine if shorter or longer duration naps during night shifts have a clinically meaningful impact. TRIAL REGISTRATION ClinicalTrials.gov NCT04469803 . Registered on 9 July 2020.
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Affiliation(s)
- P. Daniel Patterson
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine, 3600 Forbes Ave., Iroquois Building, Suite 400A, Pittsburgh, PA 15261 USA
- Division of Community Health Services, Emergency Medicine Program, University of Pittsburgh, School of Health and Rehabilitation Sciences, Pittsburgh, PA 15261 USA
| | - Leonard S. Weiss
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine, 3600 Forbes Ave., Iroquois Building, Suite 400A, Pittsburgh, PA 15261 USA
| | - Matthew D. Weaver
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA 02115 USA
- Harvard Medical School, Division of Sleep Medicine, Boston, MA 02115 USA
| | - David D. Salcido
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine, 3600 Forbes Ave., Iroquois Building, Suite 400A, Pittsburgh, PA 15261 USA
| | - Samantha E. Opitz
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine, 3600 Forbes Ave., Iroquois Building, Suite 400A, Pittsburgh, PA 15261 USA
| | - Tiffany S. Okerman
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine, 3600 Forbes Ave., Iroquois Building, Suite 400A, Pittsburgh, PA 15261 USA
- Division of Community Health Services, Emergency Medicine Program, University of Pittsburgh, School of Health and Rehabilitation Sciences, Pittsburgh, PA 15261 USA
| | - Tanner T. Smida
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine, 3600 Forbes Ave., Iroquois Building, Suite 400A, Pittsburgh, PA 15261 USA
| | - Sarah E. Martin
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine, 3600 Forbes Ave., Iroquois Building, Suite 400A, Pittsburgh, PA 15261 USA
| | - Francis X. Guyette
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine, 3600 Forbes Ave., Iroquois Building, Suite 400A, Pittsburgh, PA 15261 USA
| | - Christian Martin-Gill
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine, 3600 Forbes Ave., Iroquois Building, Suite 400A, Pittsburgh, PA 15261 USA
| | - Clifton W. Callaway
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine, 3600 Forbes Ave., Iroquois Building, Suite 400A, Pittsburgh, PA 15261 USA
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13
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Dorokhov VB, Tkachenko ON, Sakharov DS, Arsenyev GN, Taranov AO. [Effects of weak low-frequency electromagnetic field on sleep structure during daytime sleep]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:65-70. [PMID: 33580764 DOI: 10.17116/jnevro202112101165] [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: 11/17/2022]
Abstract
OBJECTIVE To test the hypothesis that weak electromagnetic fields of low frequencies (0.5-26 Hz) could affect daytime sleep features and structure. MATERIAL AND METHODS Parameters of daytime sleep continuity were compared in the study with counterbalanced control/exposition (40 min exposure to electromagnetic field at 1 Hz/0.004 μT) scheme in 22 healthy volunteers. Nonlinear regression model was used to assess daytime sleep continuity. RESULTS Exposure to a weak electromagnetic field of ultra-low frequency significantly improved the quality of sleep, assessed by the indicator of sleep continuity, namely, there were fewer transitions from the second and deeper stages of sleep to the first stage and to the state of wakefulness (p<0.0001). CONCLUSION The results can be used to develop non-pharmacological methods of sleep correction, as well as to improve the quality of short-term sleep and its positive effect on well-being, cognitive function and working capacity.
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Affiliation(s)
- V B Dorokhov
- Institute of Higher Nervous Activity and Neurophysiology, Moscow, Russia
| | - O N Tkachenko
- Institute of Higher Nervous Activity and Neurophysiology, Moscow, Russia
| | - D S Sakharov
- Institute of Higher Nervous Activity and Neurophysiology, Moscow, Russia
| | - G N Arsenyev
- Institute of Higher Nervous Activity and Neurophysiology, Moscow, Russia
| | - A O Taranov
- Institute of Higher Nervous Activity and Neurophysiology, Moscow, Russia
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14
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Alshabibi AS, Suleiman ME, Tapia KA, Heard R, Brennan PC. Impact of Hours Awake and Hours Slept at Night on Radiologists' Mammogram Interpretations. J Am Coll Radiol 2021; 18:730-738. [PMID: 33482116 DOI: 10.1016/j.jacr.2020.12.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine whether radiologists' mammogram reading performance varies according to how long they have been awake ("hours awake") and the number of hours they slept ("hours slept") the night before a reading session. METHODS Retrospective data were retrieved from the BreastScreen Reader Assessment Strategy database. Malignancy-enriched mammographic readings were performed by 133 radiologists. Information on their hours awake and hours slept was collected. Analysis of covariance was performed to determine whether these two variables influenced radiologists' sensitivity, specificity, lesion sensitivity, receiver operating characteristic (ROC) curve, and jackknife alternative free-response ROC. Radiologists were divided into a more experienced and a less experienced groups (based on reading ≥2,000 and <2,000 mammogram readings per year, respectively). RESULTS The hours awake significantly influenced less experienced radiologists' lesion sensitivity (F6,63 = 2.51; P = .03). Those awake for <2 hours had significantly lower lesion sensitivity than those awake for 8 to 10 hours (P = .01), and those awake for 4 to 6 hours had significantly lower lesion sensitivity than those awake for 8 to 10 hours (P = .002) and 10 to 12 hours (P = .02). The hours slept also influenced the ROC values of less experienced radiologists (F1,68 = 4.96; P = .02). Radiologists with up to 6 hours of sleep had a significantly lower value (0.72) than those who had slept more than 6 hours (0.77). No statistically significant findings were noted for more experienced radiologists. CONCLUSION Inexperienced radiologists' performance may be influenced by the hours awake and hours slept before reading sessions.
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Affiliation(s)
- Abdulaziz S Alshabibi
- Medical Image Optimisation and Perception Group (MIOPeG), Faculty of Health Sciences, University of Sydney, Cumberland Campus, Lidcombe, Australia; Department of Radiology and Medical Imaging, College of Applied Medical Sciences of King Saud University, Riyadh, Saudi Arabia.
| | - Mo'ayyad E Suleiman
- Medical Image Optimisation and Perception Group (MIOPeG), Faculty of Health Sciences, University of Sydney, Cumberland Campus, Lidcombe, Australia
| | - Kriscia A Tapia
- Australian Council on Healthcare Standards, Ultimo, Australia
| | - Robert Heard
- Medical Image Optimisation and Perception Group (MIOPeG), Faculty of Health Sciences, University of Sydney, Cumberland Campus, Lidcombe, Australia
| | - Patrick C Brennan
- Medical Image Optimisation and Perception Group (MIOPeG), Faculty of Health Sciences, University of Sydney, Cumberland Campus, Lidcombe, Australia
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15
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Alarm Tones, Voice Warnings, and Musical Treatments: A Systematic Review of Auditory Countermeasures for Sleep Inertia in Abrupt and Casual Awakenings. Clocks Sleep 2020; 2:416-433. [PMID: 33118526 PMCID: PMC7711682 DOI: 10.3390/clockssleep2040031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 11/16/2022] Open
Abstract
Sleep inertia is a measurable decline in cognition some people experience upon and following awakening. However, a systematic review of the current up to date evidence of audio as a countermeasure has yet to be reported. Thus, to amend this gap in knowledge, the authors conducted this systematic review beginning with searches in three primary databases for studies published between the inception date of each journal and the year 2020. Search terms contained “Sleep Inertia” paired with: “Sound”; “Noise”; “Music”; “Alarm”; “Alarm Tone”; “Alarm Sound”; “Alarm Noise”; “Alarm Music”; “Alarm Clock”; “Fire Alarm”, and “Smoke Alarm”. From 341 study results, twelve were identified for inclusion against a priori conditions. A structured narrative synthesis approach generated three key auditory stimulus themes-(i) Noise, (ii) Emergency tone sequences; Voice Alarms and Hybrids, and (iii) Music. Across themes, participants have been assessed in two situational categories: emergency, and non-emergency awakenings. The results indicate that for children awakening in emergency conditions, a low pitch alarm or voice warnings appear to be more effective in counteracting the effects of sleep inertia than alarms with higher frequencies. For adults abruptly awakened, there is insufficient evidence to support firm conclusions regarding alarm types and voice signals. Positive results have been found in non-emergency awakenings for musical treatments in adults who preferred popular music, and alarms with melodic qualities. The results observed reflect the potential for sound, voice, and musical treatments to counteract sleep inertia post-awakening, and emphasize the requirements for further research in this domain.
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16
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Patterson PD, Weaver MD, Guyette FX, Martin‐Gill C. Should public safety shift workers be allowed to nap while on duty? Am J Ind Med 2020; 63:843-850. [PMID: 32761915 PMCID: PMC7540594 DOI: 10.1002/ajim.23164] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 12/12/2022]
Abstract
Fatigue and sleep deficiency among public safety personnel are threats to wellness, public and personal safety, and workforce retention. Napping strategies may reduce work-related fatigue, improve safety and health, yet in some public safety organizations it is discouraged or prohibited. Our aim with this commentary is to define intra-shift napping, summarize arguments for and against it, and to outline potential applications of this important fatigue mitigation strategy supported by evidence. We focus our discussion on emergency medical services (EMS); a key component of the public safety system, which is comprised of police, fire, and EMS. The personnel who work in EMS stand to benefit from intra-shift napping due to frequent use of extended duration shifts, a high prevalence of personnel working multiple jobs, and evidence showing that greater than half of EMS personnel report severe fatigue, poor sleep quality, inadequate inter-shift recovery, and excessive daytime sleepiness. The benefits of intra-shift napping include decreased sleepiness and fatigue, improved recovery between shifts, decreased anxiety, and reduced feelings of burnout. Intra-shift napping also mitigates alterations in clinician blood pressure associated with disturbed sleep and shift work. The negative consequences of napping include negative public perception, acute performance deficits stemming from sleep inertia, and the potential costs associated with reduced performance. While there are valid arguments against intra-shift napping, we believe that the available scientific evidence favors it as a key component of fatigue mitigation and workplace wellness. We further believe that these arguments extend beyond EMS to all sectors of public safety.
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Affiliation(s)
- P. Daniel Patterson
- Department of Emergency Medicine, School of Medicine University of Pittsburgh Pittsburgh Pennsylvania
- Division of Community Health Services, Emergency Medicine Program, School of Health and Rehabilitation Sciences University of Pittsburgh Pittsburgh Pennsylvania
| | - Matthew D. Weaver
- Division of Sleep and Circadian Disorders Brigham and Women's Hospital Boston Massachusetts
- Division of Sleep Medicine Harvard Medical School Boston Massachusetts
| | - Francis X. Guyette
- Department of Emergency Medicine, School of Medicine University of Pittsburgh Pittsburgh Pennsylvania
| | - Christian Martin‐Gill
- Department of Emergency Medicine, School of Medicine University of Pittsburgh Pittsburgh Pennsylvania
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17
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Kovac K, Vincent GE, Paterson JL, Aisbett B, Reynolds AC, Ferguson SA. Can an increase in noradrenaline induced by brief exercise counteract sleep inertia? Chronobiol Int 2020; 37:1474-1478. [PMID: 32946288 DOI: 10.1080/07420528.2020.1803900] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Emergency responders often credit 'adrenaline' (i.e. sympathetic activity) as the reason they respond quickly upon waking, unimpaired by sleep inertia. Movement upon waking may promote sympathetic activity in this population. This pilot study (n = 4 healthy males) tested the effects of a 30 s exercise bout (maximal sprint) upon waking during the night (02:00 h) on sympathetic activity and sleep inertia. When compared to sedentary conditions, exercise reduced subjective sleepiness levels and elicited a temporary increase in sympathetic activity, measured by plasma noradrenaline levels. These findings provide preliminary support for exercise as a potential sleep inertia countermeasure.
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Affiliation(s)
- Katya Kovac
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Wayville, Adelaide, Australia
| | - Grace E Vincent
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Wayville, Adelaide, Australia
| | - Jessica L Paterson
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Wayville, Adelaide, Australia
| | - Brad Aisbett
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Amy C Reynolds
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Wayville, Adelaide, Australia
| | - Sally A Ferguson
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Wayville, Adelaide, Australia
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Souissi M, Souissi Y, Bayoudh A, Knechtle B, Nikolaidis PT, Chtourou H. Effects of a 30 min nap opportunity on cognitive and short-duration high-intensity performances and mood states after a partial sleep deprivation night. J Sports Sci 2020; 38:2553-2561. [PMID: 32734824 DOI: 10.1080/02640414.2020.1793651] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This study evaluated the effects of partial-sleep-deprivation (SDN) and a 30 min nap opportunity on physical and cognitive performances and mood states. Fourteen physically active students (BMI = 232.8 ± 0.4 kg/m2) performed the reaction time, the number cancellation (i.e., assessing vigilance) and the 5-m shuttle run tests and responded to the Profile of Mood States (POMS-f) questionnaire at 18h00 after a normal-sleep (NSN) and a SDN) and after two nap conditions (Nap and no-Nap) realized between 13h00 and 13h30. Vigilance and the reaction time were better after Nap compared to no-Nap opportunity following NSN and SDN and during NSN compared to SDN only during no-Nap. Total and peak distance during the 5-m shuttle run test were higher and the fatigue index was lower during Nap compared to no-Nap condition after NSN and SDN and during NSN compared to SDN during Nap and no-Nnap. Anxiety, fatigue, confusion, and depression were lower and vigour was higher during Nap compared to no-Nap after NSN and SDN and during NSN compared to SDN during Nap and no-Nap. In conclusion, a 30-min of nap opportunity helps to overcome the negative effect of SDN on mood states as well as physical and cognitive performances.
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Affiliation(s)
- Makram Souissi
- Laboratory of Pharmacology, Faculty of Medicine, University of Sfax , Sfax, Tunisia
| | - Youssef Souissi
- Research Laboratory, Education, Motricité, Sport Et Santé, LR19JS01, High Institute of Sport and Physical Education, University of Sfax , Sfax, Tunisia
| | - Amel Bayoudh
- Research Laboratory, Education, Motricité, Sport Et Santé, LR19JS01, High Institute of Sport and Physical Education, University of Sfax , Sfax, Tunisia
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich , Zurich, Switzerland
| | | | - Hamdi Chtourou
- Institut Supérieur Du Sport Et De L'éducation Physique De Sfax, Université De Sfax , Sfax, Tunisie.,Activité Physique, Sport Et Santé, UR18JS01, Observatoire National Du Sport , Tunis, Tunisie
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Vincent GE, Gupta CC, Sprajcer M, Vandelanotte C, Duncan MJ, Tucker P, Lastella M, Tuckwell GA, Ferguson SA. Are prolonged sitting and sleep restriction a dual curse for the modern workforce? a randomised controlled trial protocol. BMJ Open 2020; 10:e040613. [PMID: 32718927 PMCID: PMC7389768 DOI: 10.1136/bmjopen-2020-040613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Prolonged sitting and inadequate sleep are a growing concern in society and are associated with impairments to cardiometabolic health and cognitive performance. However, the combined effect of prolonged sitting and inadequate sleep on measures of health and cognitive performance are unknown. In addition, the circadian disruption caused by shiftwork may further impact workers' cardiometabolic health and cognitive performance. This protocol paper outlines the methodology for exploring the impact of simultaneous exposure to prolonged sitting, sleep restriction and circadian disruption on cardiometabolic and cognitive performance outcomes. METHODS AND ANALYSIS This between-subjects study will recruit 208 males and females to complete a 7-day in-laboratory experimental protocol (1 Adaptation Day, 5 Experimental Days and 1 Recovery Day). Participants will be allocated to one of eight conditions that include all possible combinations of the following: dayshift or nightshift, sitting or breaking up sitting and 5 hour or 9 hour sleep opportunity. On arrival to the laboratory, participants will be provided with a 9 hour baseline sleep opportunity (22:00 to 07:00) and complete five simulated work shifts (09:00 to 17:30 in the dayshift condition and 22:00 to 06:30 in the nightshift condition) followed by a 9 hour recovery sleep opportunity (22:00 to 07:00). During the work shifts participants in the sitting condition will remain seated, while participants in the breaking up sitting condition will complete 3-min bouts of light-intensity walking every 30 mins on a motorised treadmill. Sleep opportunities will be 9 hour or 5 hour. Primary outcome measures include continuously measured interstitial blood glucose, heart rate and blood pressure, and a cognitive performance and self-perceived capacity testing battery completed five times per shift. Analyses will be conducted using linear mixed models. ETHICS AND DISSEMINATION The CQUniversity Human Ethics Committee has approved this study (0000021914). All participants who have already completed the protocol have provided informed consent. Study findings will be disseminated via scientific publications and conference presentations. TRIAL REGISTRATION DETAILS This study has been registered on Australian New Zealand Clinical Trials Registry (12619001516178) and is currently in the pre-results stage.
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Affiliation(s)
- Grace E Vincent
- Appleton Institute, Central Queensland University - Adelaide Campus, Wayville, South Australia, Australia
| | - Charlotte C Gupta
- Appleton Institute, Central Queensland University - Adelaide Campus, Wayville, South Australia, Australia
| | - Madeline Sprajcer
- Appleton Institute, Central Queensland University - Adelaide Campus, Wayville, South Australia, Australia
| | - Corneel Vandelanotte
- School of Health Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Mitch J Duncan
- School of Medicine & Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW, Australia
| | - Phil Tucker
- Psychology Department, Swansea University, Swansea, United Kingdom
- Stress Research Institute, Department of Psychology, Stocklholm University, Stockholm, Sweden
| | - Michele Lastella
- Appleton Institute, Central Queensland University - Adelaide Campus, Wayville, South Australia, Australia
| | - Georgia A Tuckwell
- Appleton Institute, Central Queensland University - Adelaide Campus, Wayville, South Australia, Australia
| | - Sally A Ferguson
- Appleton Institute, Central Queensland University - Adelaide Campus, Wayville, South Australia, Australia
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Dutheil F, Bessonnat B, Pereira B, Baker JS, Moustafa F, Fantini ML, Mermillod M, Navel V. Napping and cognitive performance during night shifts: a systematic review and meta-analysis. Sleep 2020; 43:5850954. [DOI: 10.1093/sleep/zsaa109] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 05/08/2020] [Indexed: 12/11/2022] Open
Abstract
Abstract
Study Objectives
To examine the benefits of napping during night shifts on cognitive performance.
Methods
Medline, Cochrane Library, Science direct, and Embase databases were searched up to July 1, 2019. Cognitive performance during night shifts, both before and following napping or under control conditions (no nap), in working-aged adults, were analyzed by time and by type of cognitive function (executive function, attention, instrumental function, and memory). Estimates were pooled using random-effects meta-analysis.
Results
A total of 18 articles (6 in real-work and 12 in laboratory) with a total of 494 participants were included. The mean nap duration was 41.6 ± 28.3 min, occurring between 12.00 am and 4.10 am, with a mean time set at 2.12 am. Cognitive performance did not differ at baseline between the groups (effect size 0.02, 95% CI −0.09 to 0.13). There was an overall improvement in performance following a nap compared to the control condition without a nap (0.25, 0.10 to 0.41). Positioning naps early in the night and activity (simulated work tasks) tended to improve cognitive performance (−0.57, −1.16 to 0.002, and 0.082, −0.04 to 0.33, respectively). The improvements were primarily seen 30 min after awakening. Only memory deteriorated immediately after awakening without an overall change in global cognitive performance.
Conclusion
Napping during night shifts seems to improve cognitive performance. Napping early in the night and activity may benefit cognitive performance over time. Considering lack of data in real work environments, further studies are warranted before preconizing napping during night shifts as a preventive strategy (safety, health, and economic outcomes).
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Affiliation(s)
- Frédéric Dutheil
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Preventive and Occupational Medicine, Clermont-Ferrand, France
- Faculty of Health, School of Exercise Science, Australian Catholic University, Melbourne, Australia
| | - Brice Bessonnat
- CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Preventive and Occupational Medicine, Clermont-Ferrand, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Biostatistics Unit, The Clinical Research and Innovation Direction, Clermont-Ferrand, France
| | - Julien S Baker
- Centre for Health and Exercise Science Research, Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Fares Moustafa
- CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Emergency, Clermont-Ferrand, France
| | - Maria Livia Fantini
- Université Clermont Auvergne, NPsy-Sydo, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Martial Mermillod
- Université Grenoble Alpes, France & CNRS, Grenoble, France
- Institut Universitaire de France, Paris, France
| | - Valentin Navel
- CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Ophthalmology, Clermont-Ferrand, France
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21
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McFarlane SJ, Garcia JE, Verhagen DS, Dyer AG. Auditory Countermeasures for Sleep Inertia: Exploring the Effect of Melody and Rhythm in an Ecological Context. Clocks Sleep 2020; 2:208-224. [PMID: 33089201 PMCID: PMC7445849 DOI: 10.3390/clockssleep2020017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/27/2020] [Indexed: 12/02/2022] Open
Abstract
Sleep inertia is a decline in cognition one may experience upon and following awakening. A recent study revealed that an alarm sound perceived as melodic by participants displayed a significant relationship to reports of reductions in perceived sleep inertia. This current research builds on these findings by testing the effect melody and rhythm exhibit on sleep inertia for subjects awakening in their habitual environments. Two test Groups (A and B; N = 10 each) completed an online psychomotor experiment and questionnaire in two separate test sessions immediately following awakening from nocturnal sleep. Both groups responded to a control stimulus in the first session, while in the second session, Group A experienced a melodic treatment, and Group B a rhythmic treatment. The results show that the melodic treatment significantly decreased attentional lapses, false starts, and had a significantly improved psychomotor vigilance test (PVT) performance score than the control. There was no significant result for reaction time or response speed. Additionally, no significant difference was observed for all PVT metrics between the control-rhythmic conditions. The results from this analysis support melodies' potential to counteract symptoms of sleep inertia by the observed increase in participant vigilance following waking from nocturnal sleep.
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Affiliation(s)
- Stuart J McFarlane
- School of Media and Communication, RMIT University, Melbourne 3001, Australia; (J.E.G.); (A.G.D.)
| | - Jair E Garcia
- School of Media and Communication, RMIT University, Melbourne 3001, Australia; (J.E.G.); (A.G.D.)
| | | | - Adrian G Dyer
- School of Media and Communication, RMIT University, Melbourne 3001, Australia; (J.E.G.); (A.G.D.)
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22
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Kovac K, Ferguson SA, Paterson JL, Aisbett B, Hilditch CJ, Reynolds AC, Vincent GE. Exercising Caution Upon Waking-Can Exercise Reduce Sleep Inertia? Front Physiol 2020; 11:254. [PMID: 32317980 PMCID: PMC7155753 DOI: 10.3389/fphys.2020.00254] [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: 12/07/2019] [Accepted: 03/05/2020] [Indexed: 11/13/2022] Open
Abstract
Sleep inertia, the transitional state of reduced alertness and impaired cognitive performance upon waking, is a safety risk for on-call personnel who can be required to perform critical tasks soon after waking. Sleep inertia countermeasures have previously been investigated; however, none have successfully dissipated sleep inertia within the first 15 min following waking. During this time, on-call personnel could already be driving, providing advice, or performing other safety-critical tasks. Exercise has not yet been investigated as a sleep inertia countermeasure but has the potential to stimulate the key physiological mechanisms that occur upon waking, including changes in cerebral blood flow, the cortisol awakening response, and increases in core body temperature. Here, we examine these physiological processes and hypothesize how exercise can stimulate them, positioning exercise as an effective sleep inertia countermeasure. We then propose key considerations for research investigating the efficacy of exercise as a sleep inertia countermeasure, including the need to determine the intensity and duration of exercise required to reduce sleep inertia, as well as testing the effectiveness of exercise across a range of conditions in which the severity of sleep inertia may vary. Finally, practical considerations are identified, including the recommendation that qualitative field-based research be conducted with on-call personnel to determine the potential constraints in utilizing exercise as a sleep inertia countermeasure in real-world scenarios.
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Affiliation(s)
- Katya Kovac
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Adelaide, SA, Australia
| | - Sally A Ferguson
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Adelaide, SA, Australia
| | - Jessica L Paterson
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Adelaide, SA, Australia
| | - Brad Aisbett
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Cassie J Hilditch
- Fatigue Countermeasures Laboratory, San José State University Research Foundation, Moffett Field, CA, United States
| | - Amy C Reynolds
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Adelaide, SA, Australia
| | - Grace E Vincent
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Adelaide, SA, Australia
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23
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Vincent GE, Sargent C, Roach GD, Miller DJ, Kovac K, Scanlan AT, Waggoner LB, Lastella M. Exercise before bed does not impact sleep inertia in young healthy males. J Sleep Res 2019; 29:e12903. [PMID: 31621995 DOI: 10.1111/jsr.12903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 06/17/2019] [Accepted: 07/17/2019] [Indexed: 02/01/2023]
Abstract
Sleep inertia is the transitional state marked by impaired cognitive performance and reduced vigilance upon waking. Exercising before bed may increase the amount of slow-wave sleep within the sleep period, which has previously been associated with increased sleep inertia. Healthy males (n = 12) spent 3 nights in a sleep laboratory (1-night washout period between each night) and completed one of the three conditions on each visit - no exercise, aerobic exercise (30 min cycling at 75% heart rate), and resistance exercise (six resistance exercises, three sets of 10 repetitions). The exercise conditions were completed 90 min prior to bed. Sleep was measured using polysomnography. Upon waking, participants completed five test batteries every 15 min, including the Karolinska Sleepiness Scale, a Psychomotor Vigilance Task, and the Spatial Configuration Task. Two separate linear mixed-effects models were used to assess: (a) the impact of condition; and (b) the amount of slow-wave sleep, on sleep inertia. There were no significant differences in sleep inertia between conditions, likely as a result of the similar sleep amount, sleep structure and time of awakening between conditions. The amount of slow-wave sleep impacted fastest 10% reciprocal reaction time on the Psychomotor Vigilance Task only, whereby more slow-wave sleep improved performance; however, the magnitude of this relationship was small. Results from this study suggest that exercise performed 90 min before bed does not negatively impact on sleep inertia. Future studies should investigate the impact of exercise intensity, duration and timing on sleep and subsequent sleep inertia.
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Affiliation(s)
- Grace E Vincent
- Appleton Institute, Central Queensland University, Adelaide, SA, Australia
| | - Charli Sargent
- Appleton Institute, Central Queensland University, Adelaide, SA, Australia
| | - Gregory D Roach
- Appleton Institute, Central Queensland University, Adelaide, SA, Australia
| | - Dean J Miller
- Appleton Institute, Central Queensland University, Adelaide, SA, Australia
| | - Katya Kovac
- Appleton Institute, Central Queensland University, Adelaide, SA, Australia
| | - Aaron T Scanlan
- Human Exercise and Training Laboratory, Central Queensland University, Rockhampton, QLD, Australia
| | - Lauren B Waggoner
- Operational Fatigue Research, Institutes for Behavior Resources, Inc., Baltimore, MD, USA
| | - Michele Lastella
- Appleton Institute, Central Queensland University, Adelaide, SA, Australia
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24
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Arzilli C, Cerasuolo M, Conte F, Bittoni V, Gatteschi C, Albinni B, Giganti F, Ficca G. The Effect of Cognitive Activity on Sleep Maintenance in a Subsequent Daytime Nap. Behav Sleep Med 2019; 17:552-560. [PMID: 29368954 DOI: 10.1080/15402002.2018.1425870] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background/Objective: The aim of this study is to assess the effects of a learning task on the characteristics of a subsequent daytime nap. Participants and Methods: Thirty-eight subjects were administered a control nap (C) and one preceded by a cognitive training session (TR). Results: Relative to C, TR naps showed significantly increased sleep duration with decreased sleep latency, as well as significantly increased sleep efficiency due to reduced awakening frequency. Meaningful trends were also found toward an increase of Stage 2 sleep proportion and a reduction of Stage 1 sleep, percentage of wake after sleep onset (WASO), and frequency of state transitions. Conclusions: Our results indicate that presleep learning favors sleep propensity and maintenance, offering the possibility to explore planned cognitive training as a low-cost treatment for sleep impairments.
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Affiliation(s)
- Cinzia Arzilli
- a Department of Neuroscience, Psychology, Drug Research and Child Health, University of Firenze , Firenze , Italy
| | - Mariangela Cerasuolo
- b Department of Psychology, University of Campania "Luigi Vanvitelli," , Caserta , Italy
| | - Francesca Conte
- b Department of Psychology, University of Campania "Luigi Vanvitelli," , Caserta , Italy
| | - Valentina Bittoni
- a Department of Neuroscience, Psychology, Drug Research and Child Health, University of Firenze , Firenze , Italy
| | - Claudia Gatteschi
- a Department of Neuroscience, Psychology, Drug Research and Child Health, University of Firenze , Firenze , Italy
| | - Benedetta Albinni
- b Department of Psychology, University of Campania "Luigi Vanvitelli," , Caserta , Italy
| | - Fiorenza Giganti
- a Department of Neuroscience, Psychology, Drug Research and Child Health, University of Firenze , Firenze , Italy
| | - Gianluca Ficca
- b Department of Psychology, University of Campania "Luigi Vanvitelli," , Caserta , Italy
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25
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Abstract
Sleep inertia, or the grogginess felt upon awakening, is associated with significant cognitive performance decrements that dissipate as time awake increases. This impairment in cognitive performance has been observed in both tightly controlled in-laboratory studies and in real-world scenarios. Further, these decrements in performance are exaggerated by prior sleep loss and the time of day in which a person awakens. This review will examine current insights into the causes of sleep inertia, factors that may positively or negatively influence the degree of sleep inertia, the consequences of sleep inertia both in the laboratory and in real-world settings, and lastly discuss potential countermeasures to lessen the impact of sleep inertia.
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Affiliation(s)
- Cassie J Hilditch
- Fatigue Countermeasures Laboratory, San Jose State University Research Foundation, Moffett Field, San Jose, CA94035, USA
| | - Andrew W McHill
- Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, OR97239, USA
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26
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Wong LR, Flynn-Evans E, Ruskin KJ. Fatigue Risk Management: The Impact of Anesthesiology Residents' Work Schedules on Job Performance and a Review of Potential Countermeasures. Anesth Analg 2019; 126:1340-1348. [PMID: 29049076 DOI: 10.1213/ane.0000000000002548] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Long duty periods and overnight call shifts impair physicians' performance on measures of vigilance, psychomotor functioning, alertness, and mood. Anesthesiology residents typically work between 64 and 70 hours per week and are often required to work 24 hours or overnight shifts, sometimes taking call every third night. Mitigating the effects of sleep loss, circadian misalignment, and sleep inertia requires an understanding of the relationship among work schedules, fatigue, and job performance. This article reviews the current Accreditation Council for Graduate Medical Education guidelines for resident duty hours, examines how anesthesiologists' work schedules can affect job performance, and discusses the ramifications of overnight and prolonged duty hours on patient safety and resident well-being. We then propose countermeasures that have been implemented to mitigate the effects of fatigue and describe how training programs or practice groups who must work overnight can adapt these strategies for use in a hospital setting. Countermeasures include the use of scheduling interventions, strategic naps, microbreaks, caffeine use during overnight and extended shifts, and the use of bright lights in the clinical setting when possible or personal blue light devices when the room lights must be turned off. Although this review focuses primarily on anesthesiology residents in training, many of the mitigation strategies described here can be used effectively by physicians in practice.
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Affiliation(s)
- Lily R Wong
- From the San Jose State University Research Foundation, San Jose, California.,Human Factors Research Division, NASA Ames Research Center, Moffett Field, California
| | - Erin Flynn-Evans
- Human Factors Research Division, NASA Ames Research Center, Moffett Field, California
| | - Keith J Ruskin
- Department of Anesthesia and Critical Care, University of Chicago School of Medicine, Chicago, Illinois
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27
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McHill AW, Hull JT, Cohen DA, Wang W, Czeisler CA, Klerman EB. Chronic sleep restriction greatly magnifies performance decrements immediately after awakening. Sleep 2019; 42:zsz032. [PMID: 30722039 PMCID: PMC6519907 DOI: 10.1093/sleep/zsz032] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 01/29/2019] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES Sleep inertia, subjectively experienced as grogginess felt upon awakening, causes cognitive performance impairments that can require up to 1.5 hr to dissipate. It is unknown, however, how chronic sleep restriction (CSR) influences the magnitude and duration of sleep inertia-related performance deficits. METHODS Twenty-six healthy participants were enrolled in one of two in-laboratory sleep restriction protocols (one 32 day randomized control and one 38 day protocol) that separated the influence of sleep and circadian effects on performance using different "day"-lengths (20 and 42.85 hr day-lengths, respectively). The sleep opportunity per 24 hr day was the equivalent of 5.6 hr for each CSR condition and 8 hr for the Control condition. Participant's performance and subjective sleepiness were assessed within ~2 min after electroencephalogram-verified awakening and every 10 min thereafter for 70 min to evaluate performance and subjective sleepiness during sleep inertia. RESULTS Performance within 2 min of awakening was ~10% worse in CSR conditions compared with Control and remained impaired across the dissipation of sleep inertia in the CSR conditions when compared with Control. These impairments in performance during sleep inertia occurred after only chronic exposure to sleep restriction and were even worse after awakenings during the biological nighttime. Interestingly, despite differences in objective performance, there were no significant differences between groups in subjective levels of sleepiness during sleep inertia. CONCLUSIONS CSR worsens sleep inertia, especially for awakenings during the biological night. These findings are important for individuals needing to perform tasks quickly upon awakening, particularly those who obtain less than 6 hr of sleep on a nightly basis. CLINICAL TRIAL The study "Sleep Duration Required to Restore Performance During Chronic Sleep Restriction" was registered as a clinical trial (#NCT01581125) at clinicaltrials.gov (https://clinicaltrials.gov/ct2/show/NCT01581125?term=NCT01581125.&rank=1).
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Affiliation(s)
- Andrew W McHill
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR
| | - Joseph T Hull
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Daniel A Cohen
- Sentara Health Care, Eastern Virginia Medical School, Norfolk, VA
| | - Wei Wang
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Elizabeth B Klerman
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
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28
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Shumov DE, Yakovenko IA, Dorokhov VB, Sveshnikov DS, Yakunina EB, Bakaeva ZV, Vinokurov AV, Putilov AA. Napping between scylla and charybdis of N1 and N3: latency to N2 in a brief afternoon nap can be reduced by binaural beating. BIOL RHYTHM RES 2019. [DOI: 10.1080/09291016.2019.1587839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Dmitry E. Shumov
- Laboratory of Sleep/Wake Neurobiology, Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russia
| | - Irina A. Yakovenko
- Laboratory of Sleep/Wake Neurobiology, Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russia
| | - Vladimir B. Dorokhov
- Laboratory of Sleep/Wake Neurobiology, Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russia
| | - Dmitry S. Sveshnikov
- Department of Normal Physiology, Medical institute of the People’s Friendship University of Russia, Moscow, Russia
| | - Elena B. Yakunina
- Department of Normal Physiology, Medical institute of the People’s Friendship University of Russia, Moscow, Russia
| | - Zarina V. Bakaeva
- Department of Normal Physiology, Medical institute of the People’s Friendship University of Russia, Moscow, Russia
| | | | - Arcady A. Putilov
- Laboratory of Sleep/Wake Neurobiology, Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russia
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29
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Keramidas ME, Siebenmann C, Norrbrand L, Gadefors M, Eiken O. A brief pre-exercise nap may alleviate physical performance impairments induced by short-term sustained operations with partial sleep deprivation – A field-based study. Chronobiol Int 2018; 35:1464-1470. [PMID: 29985669 DOI: 10.1080/07420528.2018.1490316] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Michail E. Keramidas
- Division of Environmental Physiology, Swedish Aerospace Physiology Center, Royal Institute of Technology-KTH, Stockholm, Sweden
| | - Christoph Siebenmann
- Division of Environmental Physiology, Swedish Aerospace Physiology Center, Royal Institute of Technology-KTH, Stockholm, Sweden
| | - Lena Norrbrand
- Division of Environmental Physiology, Swedish Aerospace Physiology Center, Royal Institute of Technology-KTH, Stockholm, Sweden
| | | | - Ola Eiken
- Division of Environmental Physiology, Swedish Aerospace Physiology Center, Royal Institute of Technology-KTH, Stockholm, Sweden
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30
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Jay SM, Carley DM, Aisbett B, Ferguson SA, Paterson JL. Can stress act as a sleep inertia countermeasure when on-call? BIOL RHYTHM RES 2018. [DOI: 10.1080/09291016.2018.1464245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Sarah M. Jay
- Appleton Institute, CQUniversity, Adelaide, Australia
| | | | - Brad Aisbett
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
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31
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Davy J, Göbel M. The effects of extended nap periods on cognitive, physiological and subjective responses under simulated night shift conditions. Chronobiol Int 2017; 35:169-187. [PMID: 29144168 DOI: 10.1080/07420528.2017.1391277] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Extended nap opportunities have been effective in maintaining alertness in the context of extended night shifts (+12 h). However, there is limited evidence of their efficacy during 8-h shifts. Thus, this study explored the effects of extended naps on cognitive, physiological and perceptual responses during four simulated, 8-h night shifts. In a laboratory setting, 32 participants were allocated to one of three conditions. All participants completed four consecutive, 8-h night shifts, with the arrangements differing by condition. The fixed night condition worked from 22h00 to 06h00, while the nap early group worked from 20h00 to 08h00 and napped between 00h00 and 03h20. The nap late group worked from 00h00 to 12h00 and napped between 04h00 and 07h20. Nap length was limited to 3 hours and 20 minutes. Participants performed a simple beading task during each shift, while also completing six to eight test batteries roughly every 2 h. During each shift, six test batteries were completed, in which the following measures were taken. Performance indicators included beading output, eye accommodation time, choice reaction time, visual vigilance, simple reaction time, processing speed and object recognition, working memory, motor response time and tracking performance. Physiological measures included heart rate and tympanic temperature, whereas subjective sleepiness and reported sleep length and quality while outside the laboratory constituted the self reported measures. Both naps reduced subjective sleepiness but did not alter the circadian and homeostatic-related changes in cognitive and physiological measures, relative to the fixed night condition. Additionally, there was evidence of sleep inertia following each nap, which resulted in transient reductions in certain perceptual cognitive performance measures. The present study suggested that there were some benefits associated with including an extended nap during 8-h night shifts. However, the effects of sleep inertia need to be effectively managed to ensure that post-nap alertness and performance is maintained.
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Affiliation(s)
- Jonathan Davy
- a Department of Human Kinetics and Ergonomics , Rhodes University , Grahamstown , South Africa
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32
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Trotti LM. Waking up is the hardest thing I do all day: Sleep inertia and sleep drunkenness. Sleep Med Rev 2017; 35:76-84. [PMID: 27692973 PMCID: PMC5337178 DOI: 10.1016/j.smrv.2016.08.005] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/28/2016] [Accepted: 08/23/2016] [Indexed: 11/24/2022]
Abstract
The transition from sleep to wake is marked by sleep inertia, a distinct state that is measurably different from wakefulness and manifests as performance impairments and sleepiness. Although the precise substrate of sleep inertia is unknown, electroencephalographic, evoked potential, and neuroimaging studies suggest the persistence of some features of sleep beyond the point of awakening. Forced desynchrony studies have demonstrated that sleep inertia impacts cognition differently than do homeostatic and circadian drives and that sleep inertia is most intense during awakenings from the biological night. Recovery sleep after sleep deprivation also amplifies sleep inertia, although the effects of deep sleep vary based on task and timing. In patients with hypersomnolence disorders, especially but not exclusively idiopathic hypersomnia, a more pronounced period of confusion and sleepiness upon awakening, known as "sleep drunkenness", is common and problematic. Optimal treatment of sleep drunkenness is unknown, although several medications have been used with benefit in small case series. Difficulty with awakening is also commonly endorsed by individuals with mood disorders, disproportionately to the general population. This may represent an important treatment target, but evidence-based treatment guidance is not yet available.
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Affiliation(s)
- Lynn M Trotti
- Emory Sleep Center and Department of Neurology, Emory University School of Medicine, 12 Executive Park Dr NE, Atlanta, GA 30329, USA.
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33
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A review of short naps and sleep inertia: do naps of 30 min or less really avoid sleep inertia and slow-wave sleep? Sleep Med 2017; 32:176-190. [DOI: 10.1016/j.sleep.2016.12.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 12/28/2016] [Indexed: 12/15/2022]
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34
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Weisgerber DM, Nikol M, Mistlberger RE. Driving home from the night shift: a bright light intervention study. Sleep Med 2017; 30:171-179. [DOI: 10.1016/j.sleep.2016.09.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/22/2016] [Accepted: 09/12/2016] [Indexed: 02/08/2023]
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35
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Hilditch CJ, Dorrian J, Centofanti SA, Van Dongen HP, Banks S. Sleep inertia associated with a 10-min nap before the commute home following a night shift: A laboratory simulation study. ACCIDENT; ANALYSIS AND PREVENTION 2017; 99:411-415. [PMID: 26589387 DOI: 10.1016/j.aap.2015.11.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 10/14/2015] [Accepted: 11/06/2015] [Indexed: 06/05/2023]
Abstract
Night shift workers are at risk of road accidents due to sleepiness on the commute home. A brief nap at the end of the night shift, before the commute, may serve as a sleepiness countermeasure. However, there is potential for sleep inertia, i.e. transient impairment immediately after awakening from the nap. We investigated whether sleep inertia diminishes the effectiveness of napping as a sleepiness countermeasure before a simulated commute after a simulated night shift. N=21 healthy subjects (aged 21-35 y; 12 females) participated in a 3-day laboratory study. After a baseline night, subjects were kept awake for 27h for a simulated night shift. They were randomised to either receive a 10-min nap ending at 04:00 plus a 10-min pre-drive nap ending at 07:10 (10-NAP) or total sleep deprivation (NO-NAP). A 40-min York highway driving task was performed at 07:15 to simulate the commute. A 3-min psychomotor vigilance test (PVT-B) and the Samn-Perelli Fatigue Scale (SP-Fatigue) were administered at 06:30 (pre-nap), 07:12 (post-nap), and 07:55 (post-drive). In the 10-NAP condition, total pre-drive nap sleep time was 9.1±1.2min (mean±SD), with 1.3±1.9min spent in slow wave sleep, as determined polysomnographically. There was no difference between conditions in PVT-B performance at 06:30 (before the nap). In the 10-NAP condition, PVT-B performance was worse after the nap (07:12) compared to before the nap (06:30); no change across time was found in the NO-NAP condition. There was no significant difference between conditions in PVT-B performance after the drive. SP-Fatigue and driving performance did not differ significantly between conditions. In conclusion, the pre-drive nap showed objective, but not subjective, evidence of sleep inertia immediately after awakening. The 10-min nap did not affect driving performance during the simulated commute home, and was not effective as a sleepiness countermeasure.
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Affiliation(s)
- Cassie J Hilditch
- Centre for Sleep Research, University of South Australia, Adelaide, South Australia 5001, Australia.
| | - Jillian Dorrian
- Centre for Sleep Research, University of South Australia, Adelaide, South Australia 5001, Australia
| | - Stephanie A Centofanti
- Centre for Sleep Research, University of South Australia, Adelaide, South Australia 5001, Australia
| | - Hans P Van Dongen
- Sleep and Performance Research Center, Washington State University, Spokane, WA, USA
| | - Siobhan Banks
- Centre for Sleep Research, University of South Australia, Adelaide, South Australia 5001, Australia
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Santa Cecília Silva AA, Lopes TDVC, Teixeira KR, Mendes JA, de Souza Borba ME, Mota MC, Waterhouse J, Crispim CA. The association between anxiety, hunger, the enjoyment of eating foods and the satiety after food intake in individuals working a night shift compared with after taking a nocturnal sleep: A prospective and observational study. Appetite 2017; 108:255-262. [DOI: 10.1016/j.appet.2016.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 10/03/2016] [Accepted: 10/04/2016] [Indexed: 01/20/2023]
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HILDITCH CJ, DORRIAN J, BANKS S. Time to wake up: reactive countermeasures to sleep inertia. INDUSTRIAL HEALTH 2016; 54:528-541. [PMID: 27193071 PMCID: PMC5136610 DOI: 10.2486/indhealth.2015-0236] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 05/11/2016] [Indexed: 06/05/2023]
Abstract
Sleep inertia is the period of impaired performance and grogginess experienced after waking. This period of impairment is of concern to workers who are on-call, or nap during work hours, and need to perform safety-critical tasks soon after waking. While several studies have investigated the best sleep timing and length to minimise sleep inertia effects, few have focused on countermeasures -especially those that can be implemented after waking (i.e. reactive countermeasures). This structured review summarises current literature on reactive countermeasures to sleep inertia such as caffeine, light, and temperature and discusses evidence for the effectiveness and operational viability of each approach. Current literature does not provide a convincing evidence-base for a reactive countermeasure. Caffeine is perhaps the best option, although it is most effective when administered prior to sleep and is therefore not strictly reactive. Investigations into light and temperature have found promising results for improving subjective alertness; further research is needed to determine whether these countermeasures can also attenuate performance impairment. Future research in this area would benefit from study design features highlighted in this review. In the meantime, it is recommended that proactive sleep inertia countermeasures are used, and that safety-critical tasks are avoided immediately after waking.
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Affiliation(s)
| | - Jillian DORRIAN
- Centre for Sleep Research, University of South Australia, Australia
| | - Siobhan BANKS
- Centre for Sleep Research, University of South Australia, Australia
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Segal AY, Sletten TL, Flynn-Evans EE, Lockley SW, Rajaratnam SMW. Daytime Exposure to Short- and Medium-Wavelength Light Did Not Improve Alertness and Neurobehavioral Performance. J Biol Rhythms 2016; 31:470-82. [PMID: 27474192 DOI: 10.1177/0748730416659953] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
While previous studies have demonstrated short-wavelength sensitivity to the acute alerting effects of light during the biological night, fewer studies have assessed the alerting effect of light during the daytime. This study assessed the wavelength-dependent sensitivity of the acute alerting effects of daytime light exposure following chronic sleep restriction in 60 young adults (29 men, 31 women; 22.5 ± 3.1 mean ± SD years). Participants were restricted to 5 h time in bed the night before laboratory admission and 3 h time in bed in the laboratory, aligned by wake time. Participants were randomized for exposure to 3 h total of either narrowband blue (λmax 458-480 nm, n = 23) or green light (λmax 551-555 nm, n = 25) of equal photon densities (2.8-8.4 × 10(13) photons/cm(2)/sec), beginning 3.25 h after waking, and compared with a darkness control (0 lux, n = 12). Subjective sleepiness (Karolinska Sleepiness Scale), sustained attention (auditory Psychomotor Vigilance Task), mood (Profile of Mood States Bi-Polar form), working memory (2-back task), selective attention (Stroop task), and polysomnographic and ocular sleepiness measures (Optalert) were assessed prior to, during, and after light exposure. We found no significant effect of light wavelength on these measures, with the exception of a single mood subscale. Further research is needed to optimize the characteristics of lighting systems to induce alerting effects during the daytime, taking into account potential interactions between homeostatic sleep pressure, circadian phase, and light responsiveness.
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Affiliation(s)
- Ahuva Y Segal
- Monash Institute of Cognitive and Clinical Neurosciences, Sleep and Circadian Medicine Laboratory, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Tracey L Sletten
- Monash Institute of Cognitive and Clinical Neurosciences, Sleep and Circadian Medicine Laboratory, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Erin E Flynn-Evans
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, USA Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Steven W Lockley
- Monash Institute of Cognitive and Clinical Neurosciences, Sleep and Circadian Medicine Laboratory, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, USA Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Shantha M W Rajaratnam
- Monash Institute of Cognitive and Clinical Neurosciences, Sleep and Circadian Medicine Laboratory, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Hilditch CJ, Short M, Van Dongen HPA, Centofanti SA, Dorrian J, Kohler M, Banks S. Sleep inertia during a simulated 6-h on/6-h off fixed split duty schedule. Chronobiol Int 2016; 33:685-96. [PMID: 27078176 DOI: 10.3109/07420528.2016.1167724] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Sleep inertia is a safety concern for shift workers returning to work soon after waking up. Split duty schedules offer an alternative to longer shift periods, but introduce additional wake-ups and may therefore increase risk of sleep inertia. This study investigated sleep inertia across a split duty schedule. Sixteen participants (age range 21-36 years; 10 females) participated in a 9-day laboratory study with two baseline nights (10 h time in bed, [TIB]), four 24-h periods of a 6-h on/6-h off split duty schedule (5-h TIB in off period; 10-h TIB per 24 h) and two recovery nights. Two complementary rosters were evaluated, with the timing of sleep and wake alternating between the two rosters (2 am/2 pm wake-up roster versus 8 am/8 pm wake-up roster). At 2, 17, 32 and 47 min after scheduled awakening, participants completed an 8-min inertia test bout, which included a 3-min psychomotor vigilance test (PVT-B), a 3-min Digit-Symbol Substitution Task (DSST), the Karolinska Sleepiness Scale (KSS), and the Samn-Perelli Fatigue Scale (SP-Fatigue). Further testing occurred every 2 h during scheduled wakefulness. Performance was consistently degraded and subjective sleepiness/fatigue was consistently increased during the inertia testing period as compared to other testing times. Morning wake-ups (2 am and 8 am) were associated with higher levels of sleep inertia than later wake-ups (2 pm and 8 pm). These results suggest that split duty workers should recognise the potential for sleep inertia after waking, especially during the morning hours.
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Affiliation(s)
- Cassie J Hilditch
- a Centre for Sleep Research , University of South Australia , Adelaide , South Australia , Australia
| | - Michelle Short
- a Centre for Sleep Research , University of South Australia , Adelaide , South Australia , Australia.,b School of Psychology , Flinders University , Adelaide , South Australia , Australia
| | - Hans P A Van Dongen
- c Sleep and Performance Research Center , Washington State University , Spokane , WA , USA.,d Elson S. Floyd College of Medicine , Washington State University , Spokane , WA , USA
| | - Stephanie A Centofanti
- a Centre for Sleep Research , University of South Australia , Adelaide , South Australia , Australia
| | - Jillian Dorrian
- a Centre for Sleep Research , University of South Australia , Adelaide , South Australia , Australia
| | - Mark Kohler
- a Centre for Sleep Research , University of South Australia , Adelaide , South Australia , Australia
| | - Siobhan Banks
- a Centre for Sleep Research , University of South Australia , Adelaide , South Australia , Australia
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Hilditch CJ, Centofanti SA, Dorrian J, Banks S. A 30-Minute, but Not a 10-Minute Nighttime Nap is Associated with Sleep Inertia. Sleep 2016; 39:675-85. [PMID: 26715234 PMCID: PMC4763354 DOI: 10.5665/sleep.5550] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 11/21/2015] [Indexed: 12/21/2022] Open
Abstract
STUDY OBJECTIVES To assess sleep inertia following 10-min and 30-min naps during a simulated night shift. METHODS Thirty-one healthy adults (aged 21-35 y; 18 females) participated in a 3-day laboratory study that included one baseline (BL) sleep (22:00-07:00) and one experimental night involving randomization to either: total sleep deprivation (NO-NAP), a 10-min nap (10-NAP) or a 30-min nap (30-NAP). Nap opportunities ended at 04:00. A 3-min psychomotor vigilance task (PVT-B), digit-symbol substitution task (DSST), fatigue scale, sleepiness scale, and self-rated performance scale were undertaken pre-nap (03:00) and at 2, 17, 32, and 47 min post-nap. RESULTS The 30-NAP (14.7 ± 5.7 min) had more slow wave sleep than the 10-NAP (0.8 ± 1.5 min; P < 0.001) condition. In the NO-NAP condition, PVT-B performance was worse than pre-nap (4.6 ± 0.3 1/sec) at 47 min post-nap (4.1 ± 0.4 1/sec; P < 0.001). There was no change across time in the 10-NAP condition. In the 30-NAP condition, performance immediately deteriorated from pre-nap (4.3 ± 0.3 1/sec) and was still worse at 47 min post-nap (4.0 ± 0.5 1/sec; P < 0.015). DSST performance deteriorated in the NO-NAP (worse than pre-nap from 17 to 47 min; P < 0.008), did not change in the 10-NAP, and was impaired 2 min post-nap in the 30-NAP condition (P = 0.028). All conditions self-rated performance as better than pre-nap for all post-nap test points (P < 0.001). CONCLUSIONS This study is the first to show that a 10-min (but not a 30-min) nighttime nap had minimal sleep inertia and helped to mitigate short-term performance impairment during a simulated night shift. Self-rated performance did not reflect objective performance following a nap.
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Affiliation(s)
- Cassie J. Hilditch
- Centre for Sleep Research, University of South Australia, Adelaide, South Australia, Australia
| | - Stephanie A. Centofanti
- Centre for Sleep Research, University of South Australia, Adelaide, South Australia, Australia
| | - Jillian Dorrian
- Centre for Sleep Research, University of South Australia, Adelaide, South Australia, Australia
| | - Siobhan Banks
- Centre for Sleep Research, University of South Australia, Adelaide, South Australia, Australia
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Vyazovskiy VV, Cui N, Rodriguez AV, Funk C, Cirelli C, Tononi G. The dynamics of cortical neuronal activity in the first minutes after spontaneous awakening in rats and mice. Sleep 2014; 37:1337-47. [PMID: 25083014 DOI: 10.5665/sleep.3926] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
STUDY OBJECTIVE Upon awakening from sleep, a fully awake brain state is not reestablished immediately, but the origin and physiological properties of the distinct brain state during the first min after awakening are unclear. To investigate whether neuronal firing immediately upon arousal is different from the remaining part of the waking episode, we recorded and analyzed the dynamics of cortical neuronal activity in the first 15 min after spontaneous awakenings in freely moving rats and mice. DESIGN Intracortical recordings of the local field potential and neuronal activity in freely-moving mice and rats. SETTING Basic sleep research laboratory. PATIENTS OR PARTICIPANTS WKY adult male rats, C57BL/6 adult male mice. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS In both species the average population spiking activity upon arousal was initially low, though substantial variability in the dynamics of firing activity was apparent between individual neurons. A distinct population of neurons was found that was virtually silent in the first min upon awakening. The overall lower population spiking initially after awakening was associated with the occurrence of brief periods of generalized neuronal silence (OFF periods), whose frequency peaked immediately after awakening and then progressively declined. OFF periods incidence upon awakening was independent of ongoing locomotor activity but was sensitive to immediate preceding sleep/wake history. Notably, in both rats and mice if sleep before a waking episode was enriched in rapid eye movement sleep, the incidence of OFF periods was initially higher as compared to those waking episodes preceded mainly by nonrapid eye movement sleep. CONCLUSION We speculate that an intrusion of sleep-like patterns of cortical neuronal activity into the wake state immediately after awakening may account for some of the changes in the behavior and cognitive function typical of what is referred to as sleep inertia. CITATION Vyazovskiy VV, Cui N, Rodriguez AV, Funk C, Cirelli C, Tononi G. The dynamics of cortical neuronal activity in the first minutes after spontaneous awakening in rats and mice.
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Affiliation(s)
- Vladyslav V Vyazovskiy
- University of Oxford, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Nanyi Cui
- University of Oxford, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | | | - Chadd Funk
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI
| | - Chiara Cirelli
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI
| | - Giulio Tononi
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI
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Matchock RL, Mordkoff JT. Effects of sleep stage and sleep episode length on the alerting, orienting, and conflict components of attention. Exp Brain Res 2013; 232:811-20. [DOI: 10.1007/s00221-013-3790-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 11/19/2013] [Indexed: 10/25/2022]
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Rajaratnam SMW, Howard ME, Grunstein RR. Sleep loss and circadian disruption in shift work: health burden and management. Med J Aust 2013; 199:S11-5. [PMID: 24138359 DOI: 10.5694/mja13.10561] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 07/24/2013] [Indexed: 11/17/2022]
Abstract
About 1.5 million Australians are shift workers. Shift work is associated with adverse health, safety and performance outcomes. Circadian rhythm misalignment, inadequate and poor-quality sleep, and sleep disorders such as sleep apnoea, insomnia and shift work disorder (excessive sleepiness and/or insomnia temporally associated with the work schedule) contribute to these associations. Falling asleep at work at least once a week occurs in 32%-36% of shift workers. Risk of occupational accidents is at least 60% higher for non-day shift workers. Shift workers also have higher rates of cardiometabolic diseases and mood disturbances. Road and workplace accidents related to excessive sleepiness, to which shift work is a significant contributor, are estimated to cost $71-$93 billion per annum in the United States. There is growing evidence that understanding the interindividual variability in sleep-wake responses to shift work will help detect and manage workers vulnerable to the health consequences of shift work. A range of approaches can be used to enhance alertness in shift workers, including screening and treating sleep disorders, melatonin treatment to promote sleep during the daytime, and avoidance of inappropriate use of sedatives and wakefulness-promoters such as modafinil and caffeine. Short naps, which minimise sleep inertia, are generally effective. Shifting the circadian pacemaker with appropriately timed melatonin and/or bright light may be used to facilitate adjustment to a shift work schedule in some situations, such as a long sequence of night work. It is important to manage the health risk of shift workers by minimising vascular risk factors through dietary and other lifestyle approaches.
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Santhi N, Groeger JA, Archer SN, Gimenez M, Schlangen LJM, Dijk DJ. Morning sleep inertia in alertness and performance: effect of cognitive domain and white light conditions. PLoS One 2013; 8:e79688. [PMID: 24260280 PMCID: PMC3832615 DOI: 10.1371/journal.pone.0079688] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 09/24/2013] [Indexed: 01/15/2023] Open
Abstract
The transition from sleep to wakefulness entails a temporary period of reduced alertness and impaired performance known as sleep inertia. The extent to which its severity varies with task and cognitive processes remains unclear. We examined sleep inertia in alertness, attention, working memory and cognitive throughput with the Karolinska Sleepiness Scale (KSS), the Psychomotor Vigilance Task (PVT), n-back and add tasks, respectively. The tasks were administered 2 hours before bedtime and at regular intervals for four hours, starting immediately after awakening in the morning, in eleven participants, in a four-way cross-over laboratory design. We also investigated whether exposure to Blue-Enhanced or Bright Blue-Enhanced white light would reduce sleep inertia. Alertness and all cognitive processes were impaired immediately upon awakening (p<0.01). However, alertness and sustained attention were more affected than cognitive throughput and working memory. Moreover, speed was more affected than accuracy of responses. The light conditions had no differential effect on performance except in the 3-back task (p<0.01), where response times (RT) at the end of four hours in the two Blue-Enhanced white light conditions were faster (200 ms) than at wake time. We conclude that the effect of sleep inertia varies with cognitive domain and that it’s spectral/intensity response to light is different from that of sleepiness. That is, just increasing blue-wavelength in light may not be sufficient to reduce sleep inertia. These findings have implications for critical professions like medicine, law-enforcement etc., in which, personnel routinely wake up from night-time sleep to respond to emergency situations.
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Affiliation(s)
- Nayantara Santhi
- Surrey Sleep Research Centre, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
- * E-mail:
| | - John A. Groeger
- Department of Psychology, University of Hull, Hull, United Kingdom
| | - Simon N. Archer
- Surrey Sleep Research Centre, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | | | | | - Derk-Jan Dijk
- Surrey Sleep Research Centre, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
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Signal TL, Gander PH, van den Berg MJ, Graeber RC. In-flight sleep of flight crew during a 7-hour rest break: implications for research and flight safety. Sleep 2013; 36:109-15. [PMID: 23288977 DOI: 10.5665/sleep.2312] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To assess the amount and quality of sleep that flight crew are able to obtain during flight, and identify factors that influence the sleep obtained. DESIGN Flight crew operating flights between Everett, WA, USA and Asia had their sleep recorded polysomnographically for 1 night in a layover hotel and during a 7-h in-flight rest opportunity on flights averaging 15.7 h. SETTING Layover hotel and in-flight crew rest facilities onboard the Boeing 777-200ER aircraft. PARTICIPANTS Twenty-one male flight crew (11 Captains, mean age 48 yr and 10 First Officers, mean age 35 yr). INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Sleep was recorded using actigraphy during the entire tour of duty, and polysomnographically in a layover hotel and during the flight. Mixed model analysis of covariance was used to determine the factors affecting in-flight sleep. In-flight sleep was less efficient (70% vs. 88%), with more nonrapid eye movement Stage 1/Stage 2 and more frequent awakenings per h (7.7/h vs. 4.6/h) than sleep in the layover hotel. In-flight sleep included very little slow wave sleep (median 0.5%). Less time was spent trying to sleep and less sleep was obtained when sleep opportunities occurred during the first half of the flight. Multivariate analyses suggest age is the most consistent factor affecting in-flight sleep duration and quality. CONCLUSIONS This study confirms that even during long sleep opportunities, in-flight sleep is of poorer quality than sleep on the ground. With longer flight times, the quality and recuperative value of in-flight sleep is increasingly important for flight safety. Because the age limit for flight crew is being challenged, the consequences of age adversely affecting sleep quantity and quality need to be evaluated.
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Affiliation(s)
- T Leigh Signal
- Sleep/Wake Research Centre, Massey University, Wellington, New Zealand.
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Mulrine HM, Signal TL, van den Berg MJ, Gander PH. Post-Sleep Inertia Performance Benefits of Longer Naps in Simulated Nightwork and Extended Operations. Chronobiol Int 2012; 29:1249-57. [PMID: 23002951 DOI: 10.3109/07420528.2012.719957] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Hannah M Mulrine
- Sleep/Wake Research Centre, Massey University, Wellington, New Zealand
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