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Sonntag A, Kelbsch C, Jung R, Wilhelm H, Strasser T, Peters T, Stingl K, Wilhelm B. Effect of central and peripheral cone- and rod-specific stimulation on the pupillary light reflex. Int Ophthalmol 2021. [PMID: 34826023 DOI: 10.1007/s10792-021-02132-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 11/12/2021] [Indexed: 11/27/2022]
Abstract
Purpose To assess the effect of central and peripheral stimulation on the pupillary light reflex. The aim was to detect possible differences between cone- and rod-driven reactions. Methods Relative maximal pupil constriction amplitude (relMCA) and latency to constriction onset (latency) to cone- and rod-specific stimuli of 30 healthy participants (24 ± 5 years (standard deviation)) were measured using chromatic pupil campimetry. Cone- and rod-specific stimuli had different intensities and wavelengths according to the Standards in Pupillography. Five filled circles with radii of 3°, 5°, 10°, 20° and 40° and four rings with a constant outer radius of 40° and inner radii of 3°, 5°, 10° and 20° were used as stimuli. Results For cone-and rod-specific stimuli, relMCA increased with the stimulus area for both, circles and rings. However, increasing the area of a cone-specific ring by minimizing its inner radius with constant outer radius increased relMCA significantly stronger than the same did for a rod-specific ring. For cones and rods, a circle stimulus with a radius of 40° created a lower relMCA than the summation of the relMCAs to the corresponding ring and circle stimuli which combined create a 40° circle-stimulus. Latency was longer for rods than for cones. It decreased with increasing stimulus area for circle stimuli while it stayed nearly constant with increasing ring stimulus area for cone- and rod-specific stimuli. Conclusion The effect of central stimulation on relMCA is more dominant for cone-specific stimuli than for rod-specific stimuli while latency dynamics are similar for both conditions. Supplementary Information The online version contains supplementary material available at 10.1007/s10792-021-02132-1.
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Mostafa J, Porter J, Queener HM, Ostrin LA. Intrinsically photosensitive retinal ganglion cell-driven pupil responses in patients with traumatic brain injury. Vision Res 2021; 188:174-183. [PMID: 34352476 DOI: 10.1016/j.visres.2021.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 05/25/2021] [Accepted: 07/14/2021] [Indexed: 10/20/2022]
Abstract
Previous findings regarding intrinsically photosensitive retinal ganglion cell (ipRGC) function after traumatic brain injury (TBI) are conflicting. We examined ipRGC-driven pupil responses in civilian TBI and control participants using two pupillography protocols that assessed transient and adaptive properties: (1) a one second (s) long wavelength "red" stimulus (651 nm, 133 cd/m2) and 10 increasing intensities of 1 s short wavelength "blue" stimuli (456 nm, 0.167 to 167 cd/m2) with a 60 s interstimulus interval, and (2) two minutes of 0.1 Hz red stimuli (33 cd/m2), followed by two minutes of 0.1 Hz blue stimuli (16 cd/m2). For Protocol 1, constriction amplitude and the 6 s post illumination pupil response (PIPR) were calculated. For Protocol 2, amplitudes and peak velocities of pupil constriction and redilation were calculated. For Protocol 1, constriction amplitude and the 6 s PIPR were not significantly different between TBI patients and control subjects for red or blue stimuli. For Protocol 2, pupil constriction amplitude attenuated over time for red stimuli and potentiated over time for blue stimuli across all subjects. Constriction and redilation velocities were similar between groups. Pupil constriction amplitude was significantly less in TBI patients compared to control subjects for red and blue stimuli, which can be attributed to age-related differences in baseline pupil size. While TBI, in addition to age, may have contributed to decreased baseline pupil diameter and constriction amplitude, responses to blue stimulation suggest no selective damage to ipRGCs.
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Affiliation(s)
- Jakaria Mostafa
- University of Houston College of Optometry, 4901 Calhoun Rd, Houston, TX 77004, United States
| | - Jason Porter
- University of Houston College of Optometry, 4901 Calhoun Rd, Houston, TX 77004, United States
| | - Hope M Queener
- University of Houston College of Optometry, 4901 Calhoun Rd, Houston, TX 77004, United States
| | - Lisa A Ostrin
- University of Houston College of Optometry, 4901 Calhoun Rd, Houston, TX 77004, United States.
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von Lukowicz H, Poets CF, Peters T, Wilhelm B, Schlarb A, Urschitz MS. Validity of the Pupillographic Sleepiness Test for the diagnosis of daytime sleepiness in children and adolescents and its relationship to sleepiness-associated outcomes. Sleep Med 2021; 83:145-150. [PMID: 34015717 DOI: 10.1016/j.sleep.2021.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To report validation data for the Pupillographic Sleepiness Test (PST) in children and adolescents, evaluate its applicability for diagnosing excessive daytime sleepiness and its relationship to sleepiness-associated outcomes. METHODS A cross-sectional diagnostic test accuracy study was performed. Patients underwent three PST at 9 a.m. (T1), 11 a.m. (T2) and 1 p.m. (T3) plus the Multiple Sleep Latency Test (MSLT) on a single day. Additionally, two neurocognitive tests were performed and three questionnaires about quality of life, sleep-related self-efficacy and behavioural aspects completed. Gender-stratified z-values of the natural logarithm of the Pupillary Unrest Index (z-lnPUI) were correlated to Sleep Latency (SL) and Mean Sleep Latency (MSL) and to variables of neurocognitive tests and questionnaires using Spearman's rank correlation. Cut-off values were determined by receiver operating characteristic (ROC) analysis. RESULTS 47 patients were recruited (median 10.6 years, range 6-18). Correlation between z-lnPUI and SL was rT1 = -0.373 (p = 0.011); rT2 = -0.320 (p = 0.028) and rT3 = -0.336 (p = 0.022). Correlation between z-lnPUI and MSL was rT1 = -0.338 (p = 0.020); rT2 = -0.202 (p = 0.173); rT3 = -0.117 (p = 0.433). ROC analysis showed an area under the curve of 90.7% and PUI cut-off values of 12.6 mm/min (boys) and 11.6 mm/min (girls). There were moderate correlations between z-lnPUIT1 and reaction time and omission errors in neurocognitive tests (r = 0.394, p = 0.007 and 0.391, p = 0.008). CONCLUSIONS We found satisfactory correlations between PST and MSLT results. The z-lnPUIT1 was related to MSL and objective measures of attention ability. Given this accuracy, the PST may be used as a screening tool for evaluating daytime sleepiness in children and adolescents. Corresponding gender-related reference values are now available.
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Affiliation(s)
| | - Christian F Poets
- Working Group on Pediatric Sleep Medicine, Department of Neonatology, University Children's Hospital, Tuebingen, Germany.
| | - Tobias Peters
- Pupil Research Group, Centre for Ophthalmology, University Hospital, Tuebingen, Germany
| | - Barbara Wilhelm
- Pupil Research Group, Centre for Ophthalmology, University Hospital, Tuebingen, Germany
| | - Angelika Schlarb
- Department of Psychology, University of Bielefeld, Bielefeld, Germany
| | - Michael S Urschitz
- Division of Paediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
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Rai BB, Sabeti F, Carle CF, Rohan EMF, Saraç Ö, van Kleef J, Maddess T. Recovery dynamics of multifocal pupillographic objective perimetry from tropicamide dilation. Graefes Arch Clin Exp Ophthalmol 2019; 258:191-200. [PMID: 31720837 DOI: 10.1007/s00417-019-04523-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/14/2019] [Accepted: 10/23/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To study the pupillary system by combining mydriasis and multifocal pupillographic objective perimetry (mfPOP). In particular, we explored how the dynamics of recovery differ for concurrently measured direct and consensual sensitivity, response delay, and signal-to-noise ratios (SNRs) for binocular mydriasis. METHODS We recruited 26 normal participants, all with brown irides. The dichoptic mfPOP stimuli concurrently assessed 44-region/eye and both pupils. Two pre-dilation tests were followed by pairs of repeated tests at 1, 2, 4, 6, 8, 12, 24, and 48 h following dilation of both pupils with 1% tropicamide. Three subjects were retested with only the right pupil dilated. Linear models determined the independent effects of mydriasis upon the per-region and pupil measures over time. RESULTS Post-dilation, the per-region delays initially decreased by 16.3 ± 6.02 ms (mean ± SE) (p < 0.0001, cf. baseline of 471.1 ± 4.36 ms), then increased to slower than baseline by 17.42 ± 5.57 ms after 4 h (p < 0.002), recovering to baseline at 8 h. By comparison, per-region sensitivities (constriction amplitudes) were still reduced by - 6.20 ± 0.70 μm at 8 h (p < 0.0001, cf. baseline of 21.1 ± 0.55 μm), recovered at 24 h, but rebounded at 48 h (p = 0.005). The SNRs for sensitivities and delays both recovered by 8-12 h. Across all the data, sensitivities reduced by 2.67 ± 0.25 μm/decade of age, and delay increased by 15.4 ± 1.98 ms/decade (both p < 0.00001). Data from 3 of the 26 subjects who repeated the testing for monocular dilation found that consensual response sensitivities were larger than direct for 8 h (p < 0.018). CONCLUSIONS The per-region sensitivities were affected for longer than SNRs or delays. Strong early SNRs indicated proportionately lower pupil noise for larger pupil diameters. Following mydriasis with tropicamide 1%, the constriction amplitude measurements with mfPOP should be considered only after 48 h, but time-to-peak can be measured after 8-12 h.
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Affiliation(s)
- Bhim Bahadur Rai
- Division of Neuroscience, John Curtin School of Medical Research, Australian National University, Building 131 Garran Road, Canberra, ACT, 2601, Australia.
| | - Faran Sabeti
- Division of Neuroscience, John Curtin School of Medical Research, Australian National University, Building 131 Garran Road, Canberra, ACT, 2601, Australia.,School of Optometry, University of Canberra, Bruce, ACT, Australia
| | - Corinne F Carle
- Division of Neuroscience, John Curtin School of Medical Research, Australian National University, Building 131 Garran Road, Canberra, ACT, 2601, Australia.,ANU Medical School, ANU, Canberra, ACT, Australia
| | - Emilie M F Rohan
- Division of Neuroscience, John Curtin School of Medical Research, Australian National University, Building 131 Garran Road, Canberra, ACT, 2601, Australia
| | - Özge Saraç
- Division of Neuroscience, John Curtin School of Medical Research, Australian National University, Building 131 Garran Road, Canberra, ACT, 2601, Australia.,Department of Ophthalmology, Ankara Atatürk Training and Research Hospital, Yildirim Beyazit University, Ankara, Turkey
| | - Joshua van Kleef
- Division of Neuroscience, John Curtin School of Medical Research, Australian National University, Building 131 Garran Road, Canberra, ACT, 2601, Australia
| | - Ted Maddess
- Division of Neuroscience, John Curtin School of Medical Research, Australian National University, Building 131 Garran Road, Canberra, ACT, 2601, Australia
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Schatz A, Kelbsch C, Zeitz C, Kohl S, Zrenner E, Gekeler F, Wilhelm H, Wilhelm B, Willmann G. Disinhibition of intrinsic photosensitive retinal ganglion cells in patients with X-linked congenital stationary night blindness. Graefes Arch Clin Exp Ophthalmol 2019; 257:1207-15. [PMID: 30982101 DOI: 10.1007/s00417-019-04319-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 02/11/2019] [Accepted: 02/15/2019] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To assess the pupil light response (PLR) to chromatic stimulation in patients with different types of X-linked congenital stationary night blindness (CSNB). METHODS Eight patients with CSNB due to CACNA1F and NYX mutations were exposed to blue and red light stimuli, and PLR was evaluated using infrared video pupillography. Pupil responses were compared between CSNB patients and healthy subjects (n = 34) at baseline, at maximum of constriction, for post-illumination pupil responses (PIPR) and the slope of redilation using Cohen's d. A subgroup comparison was performed descriptively between CACNA1F and NYX associated CSNB patients using the same parameters. RESULTS In CSNB, smaller baseline pupil diameters compared to healthy subjects were measured both before blue and red light stimulation (d = 1.44-1.625). The maximum constriction to blue light stimuli was smaller for the CSNB group compared to healthy subjects (d = 1.251) but not for red light stimuli (d = 0.449). Pupil response latencies were prolonged in CSNB for both light stimuli (d = -1.53 for blue and d = -1.011 for red stimulation). No relevant differences were found between the CSNB group and healthy subjects for PIPR (d = 0.01), but the slope of redilation was smaller for CSNB patients (d = 2.12). Paradoxical pupil constriction at light offset was not seen in our patients. CONCLUSION A reduced redilation and smaller baseline pupil diameters for patients with CSNB indicate a disinhibition of intrinsically photosensitive retinal ganglion cells due to affected post-photoreceptor transduction via bipolar cells and can explain the pupillary behavior in our patient group.
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Maa AY, Feuer WJ, Davis CQ, Pillow EK, Brown TD, Caywood RM, Chasan JE, Fransen SR. A novel device for accurate and efficient testing for vision-threatening diabetic retinopathy. J Diabetes Complications 2016; 30:524-32. [PMID: 26803474 PMCID: PMC4853922 DOI: 10.1016/j.jdiacomp.2015.12.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 10/22/2022]
Abstract
AIMS To evaluate the performance of the RETeval device, a handheld instrument using flicker electroretinography (ERG) and pupillography on undilated subjects with diabetes, to detect vision-threatening diabetic retinopathy (VTDR). METHODS Performance was measured using a cross-sectional, single armed, non-interventional, multi-site study with Early Treatment Diabetic Retinopathy Study 7-standard field, stereo, color fundus photography as the gold standard. The 468 subjects were randomized to a calibration phase (80%), whose ERG and pupillary waveforms were used to formulate an equation correlating with the presence of VTDR, and a validation phase (20%), used to independently validate that equation. The primary outcome was the prevalence-corrected area under the receiver operating characteristic (ROC) curve for the detection of VTDR. RESULTS The area under the ROC curve was 0.86 for VTDR. With a sensitivity of 83%, the specificity was 78% and the negative predictive value was 99%. The average testing time was 2.3 min. CONCLUSIONS With a VTDR prevalence similar to that in the U.S., the RETeval device will identify about 75% of the population as not having VTDR with 99% accuracy. The device is simple to use, does not require pupil dilation, and has a short testing time.
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Affiliation(s)
- April Y Maa
- Atlanta VA Medical Center, Ophthalmology, 1670 Clairmont Road MC 112E, Decatur, GA, 30033, USA; Emory University School of Medicine, Emory Eye Center, Comprehensive Ophthalmology, 1365B Clifton Road NE, Atlanta, GA, 30322, USA.
| | - William J Feuer
- University of Miami Miller School of Medicine, Biostatistics, Dominion Tower, Box C210, 1400 NW 10th Avenue, Suite 506, Miami, FL, 33136, USA; Bascom Palmer Eye Institute, 900 NW 17th Street, Miami, FL, 33136, USA.
| | - C Quentin Davis
- LKC Technologies, Inc., 2 Professional Drive, Suite 222, Gaithersburg, MD, 20879, USA.
| | - Ensa K Pillow
- Oklahoma City VA Medical Center, Ophthalmology, 921 NE 13th Street, Oklahoma City, OK 73104, USA; University of Oklahoma College of Medicine, Ophthalmology, 608 Stanton L. Young Blvd, Oklahoma City, OK, 73104, USA; Dean McGee Eye Institute, 608 Stanton L. Young Blvd, Oklahoma City, OK, 73104, USA.
| | - Tara D Brown
- Oklahoma City VA Medical Center, Ophthalmology, 921 NE 13th Street, Oklahoma City, OK 73104, USA.
| | - Rachel M Caywood
- Oklahoma City VA Medical Center, Ophthalmology, 921 NE 13th Street, Oklahoma City, OK 73104, USA.
| | - Joel E Chasan
- Emory University School of Medicine, Emory Eye Center, Comprehensive Ophthalmology, 1365B Clifton Road NE, Atlanta, GA, 30322, USA.
| | - Stephen R Fransen
- University of Oklahoma College of Medicine, Ophthalmology, 608 Stanton L. Young Blvd, Oklahoma City, OK, 73104, USA; Dean McGee Eye Institute, 608 Stanton L. Young Blvd, Oklahoma City, OK, 73104, USA; Inoveon Corporation, 800 Research Parkway, Suite 370, Oklahoma City, OK, 73104, USA.
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Stronks HC, Barry MP, Dagnelie G. Electrically evoked electroretinograms and pupil responses in Argus II retinal implant wearers. Doc Ophthalmol 2016; 132:1-15. [PMID: 26743880 DOI: 10.1007/s10633-015-9522-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 12/30/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE We have recorded the electrically evoked electroretinogram (eERG) and flash ERG in Argus II retinal prosthesis wearers with end-stage retinitis pigmentosa to estimate response properties of the degenerated inner retina to local electrical stimulation. In addition, we have recorded pupil diameters during electrical stimulation. METHODS Raw corneal eERGs were recorded at multiple stimulus levels in three subjects. eERG signals were heavily contaminated with various artifacts, including switching artifacts generated by the implant electronics, stimulus, blink, and eye-movement artifacts. Pupil responses were recorded in one subject using a pupil tracker. RESULTS eERGs were decontaminated by a variety of techniques, including wavelet transformation and response averaging. The dominant component was a negative wave peaking at approximately 200 ms. eERG amplitudes correlated significantly with stimulus level, but peak latencies did not correlate with stimulus level. Pupil constriction correlated significantly with stimulus level and pupil responses could be accurately used to estimate subjective threshold. CONCLUSION eERG recordings hold the potential to be developed further for use as a diagnostic tool for retinal implants. A straightforward approach to increase eERG amplitudes would be the development of intraocular recording methods based on reverse telemetry. The robust pupil response to electrical stimulation in one subject indicates that pupillography can be exploited to assess implant functionality, but reliable pupil recordings could not be obtained in all subjects.
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Affiliation(s)
- H Christiaan Stronks
- Department of Ophthalmology, Johns Hopkins University, Baltimore, MD, USA.
- Computer Vision Research Group, NICTA, Canberra, Australia.
- Department of Neuroscience, John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia.
| | - Michael P Barry
- Department of Ophthalmology, Johns Hopkins University, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Gislin Dagnelie
- Department of Ophthalmology, Johns Hopkins University, Baltimore, MD, USA
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Urschitz MS, Heine K, Mendler L, Peters T, Wilhelm B, Poets CF. Pilot study on the validity of the pupillographic sleepiness test in children and adolescents. Sleep Med 2014; 15:720-3. [PMID: 24796284 DOI: 10.1016/j.sleep.2014.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 02/12/2014] [Accepted: 02/16/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To report preliminary validation data for the pupillographic sleepiness test (PST) in children and adolescents. METHODS Twelve patients (13.1±4.4 years of age) underwent the multiple sleep latency test (MLST) and three PSTs at 09:00, 11:00, and 13:00 on one single day. Correlations were tested between mean sleep latency and gender-adjusted z-values of the natural logarithm of the pupillary unrest index (zlnPUI). RESULTS Spearman's correlation (P-value) between the zlnPUI values obtained at 09:00 and 11:00 with the MSL was rS = -0.641 (0.025) and r = -0.553 (0.062). CONCLUSION There was satisfactory agreement between PST and the MLST, which is similar to what is found in adults. The PST may be promising for the evaluation of daytime sleepiness in children and adolescents, and should be further evaluated in future studies.
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Affiliation(s)
- Michael S Urschitz
- Unit of Pediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Germany; Working Group on Pediatric Sleep Medicine, University Children's Hospital Tuebingen, Germany.
| | - Katrin Heine
- Working Group on Pediatric Sleep Medicine, University Children's Hospital Tuebingen, Germany
| | - Lea Mendler
- Working Group on Pediatric Sleep Medicine, University Children's Hospital Tuebingen, Germany
| | - Tobias Peters
- Pupil Research Group, Centre for Ophthalmology, University Hospital Tuebingen, Germany
| | - Barbara Wilhelm
- Pupil Research Group, Centre for Ophthalmology, University Hospital Tuebingen, Germany
| | - Christian F Poets
- Working Group on Pediatric Sleep Medicine, University Children's Hospital Tuebingen, Germany
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Urschitz MS, Heine K, Brockmann PE, Peters T, Durst W, Poets CF, Wilhelm B. Subjective and objective daytime sleepiness in schoolchildren and adolescents: results of a community-based study. Sleep Med 2013; 14:1005-12. [PMID: 23993873 DOI: 10.1016/j.sleep.2013.05.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 05/17/2013] [Accepted: 05/25/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We aimed to assess subjective and objective sleepiness in schoolchildren and adolescents by using questionnaires and the Pupillographic Sleepiness Test (PST). METHODS An observational, cross-sectional, community-based study was performed. Participants were recruited and balanced by age and gender from schools using stratified random sampling. Sleep problems and subjective sleepiness were assessed using parent- and self-reported questionnaires. Objective sleepiness was assessed in schools under standardized conditions by using the PST and by calculating the natural logarithm of the pupillary unrest index (lnPUI). RESULTS In total 163 children (82 boys; age range, 6.6-17.8 years) were enrolled. Age and sleep problems were predictors of subjective sleepiness. Nine PST recordings (5.5%) were excluded due to artifacts (feasibility, 94%). Gender, sleep problems, and sleep duration were predictors of objective sleepiness. Compared to adults (age range, 20-60 years), the lnPUI was higher in children (mean±standard deviation [SD], 1.5±0.4 vs. 2.0±0.4; P<.001) and showed significant gender differences. There was no agreement between measures of subjective sleepiness and the lnPUI (r<0.3). After excluding children with sleep problems, preliminary reference values (mean±SD) for the lnPUI were 2.01±0.43 for boys and 1.93±0.43 for girls, respectively. CONCLUSIONS The PST is a feasible method in schoolchildren and adolescents. Sleep problems are predictors of both subjective and objective sleepiness; there is no agreement between the latter. Results of the PST are influenced by sleep duration and specific pediatric gender-stratified reference values are definitively needed.
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Affiliation(s)
- Michael S Urschitz
- Unit of Pediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Center, Mainz, Germany; Working Group on Pediatric Sleep Medicine, Department of Neonatology, University Children's Hospital, Tuebingen, Germany.
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