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International audience; A ‘compressed’ shift schedule (substitution of a rest day by a shift, shortening the duration of work breaks) was introduced for a better fit with aircraft traffic load. Thereafter, the company asked for a survey assessing the effects of the compressed shift system. Air traffic controllers (ATCOs) completed retrospectively a specific questionnaire assessing the effects of shift schedule (modified vs. initial) and of traffic load on fatigue, alertness (on-shift, upon awakening, during daily non-work activities), and sleep (duration, satisfaction). Work organization had marginal and unexpected effects, which might indicate ATCOs’ disapproval of the intervention. Traffic load affected sleep satisfaction and alertness during work and non-work activities. Specific effects of shift included reduced sleep time prior to morning shifts compared to night shifts, whereas alertness and fatigue were rated at comparable levels for both shifts. Results suggest that shiftwork features which favor sleep loss across a work cycle have deleterious consequences on alertness and increase the need for recovery, which are further enhanced by traffic load.

A tendency for experiencing unusual dream and sleep-wake transition phenomena (e.g., recurrent dreams, hypnagogic hallucinations, and confusion upon awakening), labeled general sleep experiences (GSEs), is linked with stress as well as psychological distress, explicit as well as covert. We hypothesized that alexithymia may moderate the relationship between stress and GSEs. Undergraduate students (N = 187) completed online questionnaires; Three months later, n = 78 of them reported perceived stress and dreaming each day for 14 days. Regression analyses for trait data and multilevel modeling for daily diary data both revealed a pattern of two competing alexithymic mechanisms: difficulty in identifying feelings was related to increased GSEs, whereas externally-oriented thinking was related to decreased GSEs. As hypothesized, a cross-level interaction was found: daily stress predicted daily GSEs of the following night, only among those who reported difficulty identifying their emotions. It seems that those who experience GSEs following stress, tend to be internally-oriented (i.e., notice their inner experiences), yet find it difficult to understand and identify those experiences. GSEs seem to represent a nocturnal manifestation of unprocessed emotion.

Cortisol awakening response (CAR) has been studied in children with ADHD, and some authors have reported morning cortisol differences among ADHD subtypes. Despite, only half of the children with ADHD continue to exhibit the disorder into adulthood, CAR has not been studied in adults so far. One hundred and nine adults with ADHD according to the DSM-IV criteria (46 inattentive and 63 combined) ranging in age from 18 to 55 years, and 27 healthy controls were included. Psychiatric and organic comorbidities were excluded. Salivary cortisol samples were obtained at 0, 30, 45 and 60 minutes after awakening. CAR was present in 84% of the healthy controls but in only 64% of the adults with ADHD (68% of the inattentive and 61% of the combined were CAR-positive). There were no significant differences in any of the morning cortisol measures between patients and controls or between the combined and inattentive subtypes of ADHD. Among the inattentive subtype but not in the combined patients, significant positive correlations were observed between the CAR and emotional lability (p=0.05), or self-concept (p=0.014) CAARS subscales, as well as with the cognitive impulsivity subscale of the Barratt impulsiveness scale (p=0.028). These results suggest that adults with ADHD exhibit normal cortisol responses upon awakening and thus cannot be defined in terms of hypo-arousal. Neurobiological differences between the combined and inattentive subtypes involving cortisol, are discussed.

Objective Behavioral and physiological indexes of high sleep inertia (SI) characterize the awakening from recovery (REC) sleep after prolonged wakefulness, but the associated electroencephalogram (EEG) topography has never been investigated. Here, we compare the EEG topography following the awakening from baseline (BSL) and REC sleep. Methods We have recorded the EEG waking activity of 26 healthy subjects immediately after the awakening from BSL sleep and from REC sleep following 40 h of prolonged wakefulness. In both BSL and REC conditions, 12 subjects were awakened from stage 2 sleep, and 14 subjects from rapid eye movement (REM) sleep. The full-scalp waking EEG (eyes closed) was recorded after all awakenings. Results Subjects awakened from REC sleep showed a reduction of fronto-central alpha and beta-1 activities, while no significant effects of the sleep stage of awakening have been observed. Positive correlations between pre- and post-awakening EEG modifications following REC sleep have been found in the posterior and lateral cortices in the frequency ranges from theta to beta-2 and (only for REM awakenings) extending to the fronto-central regions in the beta-1 band, and in the midline central and parietal derivations for the alpha and delta bands, respectively. Conclusions These findings suggest that the higher SI after REC sleep may be due to the fronto-central decrease of alpha and beta-1 activity and to the persistence of the sleep EEG features after awakening in the posterior, lateral, and fronto-central cortices, without influences of the sleep stage of awakening.

Little is known about the associations between physical activity (PA) and hypothalamic-pituitary-adrenocortical axis (HPAA) activity in adolescents. This knowledge could offer insight into the links between PA and well-being in youth. We studied whether objectively-measured PA is associated with diurnal salivary cortisol responses and morning salivary cortisol responses after a low-dose overnight dexamethasone suppression test (DST) in adolescent girls and boys. We conducted a cross-sectional birth cohort study in Helsinki, Finland. At a mean age of 12.4 (SD=0.5) years, 150 girls and 133 boys wore wrist-worn accelerometers over at least 4 days to measure PA. Their salivary cortisol was measured across 1 day and upon awakening after a low-dose overnight DST (3 μg/kg of weight). Girls with higher overall PA and vigorous PA (VPA), and less sedentary time had lower salivary cortisol upon awakening and/or after (decreases between |0.17| and |0.25| SDs per SD increase in overall PA, VPA and decrease in sedentary time; P-values

Brain functions express rhythmic fluctuations accompanied by sleep and wakefulness each day, but how sleep regulates brain rhythms remains unclear. Following the dose-dependent local sleep concept, two succeeding questions emerge: (1) is the sleep regulation a network-specific process; and (2) is the awakening state dependent on the previous sleep stages? To answer the questions, we conducted simultaneous EEG and fMRI recordings over 22 healthy male participants, along pre-sleep, nocturnal sleep and awakening. Using paired comparisons between awakening and pre-sleep conditions, three scenarios of the regional specificity were demonstrated on awakening: (1) the default-mode and hippocampal networks maintained similar connectivity and spectral power; (2) the sensorimotor network presented reduced connectivity and spectral power; and (3) the thalamus demonstrated substantially enhanced connectivity to the neo-cortex with decreased spectral power. With regard to the stage effect, the deep sleep group had significant changes in both functional connectivity and spectral power on awakening, whereas the indices of light sleep group remained relatively quiescent after sleep. The phenomena implied that slow-wave sleep could be key to rebooting the BOLD fluctuations after sleep. In conclusion, the regional specificity and the stage effect were verified in support of the local awakening concept, indicating that sleep regulation leads to the reorganization of brain networks upon awakening.

We investigated whether inconsistencies in previous studies regarding emotional experiences in dreams derive from whether dream emotions are self-rated or externally evaluated. Seventeen subjects were monitored with polysomnography in the sleep laboratory and awakened from every rapid eye movement (REM) sleep stage 5 min after the onset of the stage. Upon awakening, participants gave an oral dream report and rated their dream emotions using the modified Differential Emotions Scale, whereas external judges rated the participants' emotions expressed in the dream reports, using the same scale. The two approaches produced diverging results. Self-ratings, as compared to external ratings, resulted in greater estimates of (a) emotional dreams; (b) positively valenced dreams; (c) positive and negative emotions per dream; and (d) various discrete emotions represented in dreams. The results suggest that this is mostly due to the underrepresentation of positive emotions in dream reports. Possible reasons for this discrepancy are discussed.

The current study assessed which specific burnout symptoms were most predictive of distinct diurnal cortisol profiles. Participants included 401 day-shift workers employed in a random sampling of 34 Canadian workplaces. The 16-item Maslach Burnout Inventory was used to extract burnout sub-scales that included emotional exhaustion, cynicism, professional inefficacy, as well as a global burnout average. Consenting workers provided five saliva samples a day (awaking, 30 min after awaking, 1,400 h, 1,600 h, and bedtime) repeated three times over the course of a week (Saturday, Tuesday, Thursday) to capture workday and non-workday variations. Multilevel regression models were estimated from cortisol measurements at each occasion within a day at level-1, workers at level-2, and workplaces at level-3. Multilevel regression analyses found that emotional exhaustion and a global burnout showed the strongest and consistent negative associations to cortisol in the afternoon and evening. In a separate analysis using regression coefficients, emotional exhaustion and a global burnout average were associated with low cortisol levels 30 min upon awakening. By contrast, professional inefficacy was associated only with lower bedtime cortisol. No associations were detected for cynicism and sex did not emerge as a moderator in secondary analyses. Our findings are discussed in a theoretical framework postulating different pathophysiological stages of burnout development. Specifically, professional inefficacy may be the earliest warning signal culminating with emotional exhaustion that may dampen diurnal cortisol levels.

This study investigated the extent to which trait anxiety and state anxiety in response to stress are associated with the cortisol awakening response (CAR). Fifty-one healthy participants were recruited. State anxiety measures were taken in anticipation of and during a laboratory stressor. Salivary cortisol levels were measured immediately upon awakening (at 0, 15, 30, and 45 min) on two consecutive mornings. Cortisol awakening response was assessed by the area under the curve with respect to zero (AUCG). The magnitude of the CAR was found to be negatively associated with both trait anxiety and anticipatory anxiety. Moreover, regression analysis showed that the effects of trait anxiety on the AUCG were mediated by anticipatory anxiety. These results suggest that the CAR is influenced by trait anxiety. Moreover, the effect of trait anxiety on the CAR seems to operate by impacting on psychological stress reactivity (i.e., anticipatory anxiety).

Summary This study concerned the possible influence of experimental shift work, morningness and sleep length on the cortisol awakening response (CAR). Eight morning-oriented (MT) and eight evening-oriented (ET) healthy young men (19–27 years) slept after three consecutive day shifts during the night and after three consecutive night shifts during the day in the laboratory. Salivary cortisol concentrations were ascertained after each sleep period upon awakening and half an hour later, half-hourly during work shifts, and hourly during two 24-h periods, after the three day shift/night sleep sequences and after the three night shift/day sleep sequences. Statistical analyses considered the temporal position of sleep (night, day), the succession of sleep periods, the diurnal type and the polysomnographically verified total sleep time. The CAR was significantly smaller after day than after night sleep and increased significantly with total sleep time in ET. MT had moderately higher cortisol concentrations upon awakening than ET probably because they wake up at a later time of their circadian rhythm. But neither the CARs nor the cortisol concentrations during the following work shifts or during the 24 h profiles were different in both diurnal types. The cortisol concentrations during work shifts correlated significantly with the previous post-awakening concentrations in MT but not in ET. Due to the small samples further studies are needed.

The purpose of this study was to examine the effects of maternal depression and anxiety on the cortisol awakening response (CAR), a marker of the hypothalamic-pituitary-adrenal (HPA) axis function, during pregnancy. Sixty-six pregnant women were studied between 25 and 33 weeks of gestation and were identified as either Depressed (n=33) or healthy, Control (n=33), based on depression scores and lifetime psychiatric history. Saliva samples were collected (passive drool) upon awakening and at +30 and +60 min thereafter. The CAR was not significantly different between women who were depressed during pregnancy compared to healthy control women. However, women taking antidepressant (AD) medication showed an attenuated CAR (time x AD use interaction, p=0.06). Childhood maltreatment (as measured with the Childhood Trauma Questionnaire) was associated with a lower baseline cortisol concentration explaining 12% of the variance, controlling for wake-up time and AD use. There is a complex interplay of factors involved in the HPA axis regulation of vulnerable women during pregnancy, including depression, anxiety, early life stress and psychotropic medication use, which remain unclear. The CAR may provide important information about the maternal HPA axis during pregnancy and warrants further investigation in larger cohorts.

Hypothalamo-pituitary-adrenocorticoid (HPA)-axis reactivity to psychosocial or pharmacological stimulants is diminished in alcohol-dependent patients during early abstinence but recovers after several months of abstention. In order to assess the physiological reactivity in the morning we used the cortisol awakening response (CAR) in saliva to compare 24 early abstainers (mean 21.9+/-7.6, range 10-36 days) with 12 alcohol-dependent patients with longer abstention periods (mean 116.8+/-45.7, range 59-230 days) and looked for an association with sleep, especially rapid eye movement (REM) sleep of the preceding night. Both groups did not differ with respect to age, duration of alcohol dependence, daily drinking dosage before detoxification, body mass index, depressivity, level of anxiety, daily cigarette consumption or sleep quality during the preceding 14 days. Sleep in the night before cortisol assessment did not differ with respect to total sleep time (412.4+/-35.9 vs. 407.0+/-38.7 min). Immediately upon awakening and 15, 30, 45 and 60 min later, specimens of salivary cortisol were collected. While starting from equal levels upon awakening longer abstaining patients with alcohol dependence showed a stronger CAR (ANOVA with repeated measurement, time x group effect: F=4.33, p0.01) with distinctly higher cortisol levels 45 and 60 min after awakening (T=3.79, p0.001 and T=3.06, p0.005, respectively). Across both groups the time spent in REM-sleep only correlated with cortisol levels upon awakening (r=0.33, p0.05). Our data indicate that CAR is a useful tool for investigating alterations in the HPA-axis regulation in abstaining alcohol-dependent patients.

The aim of the present study was to characterize the regional electroencephalographic substratum of the awakening process by means of a Hz-by-Hz EEG spectral power analysis. For this purpose, we recorded a group of 25 female subjects who slept for at least two consecutive nights in the laboratory. The post-sleep waking EEG was compared to the one recorded during the presleep wakefulness from four midline derivations (Fz-A1, Cz-A1, Pz-A1, Oz-A1). Results indicated that the first 10 min after awakening are characterized by an increase of EEG power in the low-frequency range (1-9 Hz) compared to the corresponding presleep waking period, and by a significant decrease of EEG power in the beta range (18-24 Hz). As regards topographic differences, the increase of EEG power upon awakening in the delta-theta range showed a parieto-occipital prevalence. Moreover, the occipital derivation showed a larger decrease of power in the beta range as compared to the other derivations. In conclusion, the EEG substratum of the sleep offset period is characterized by a pattern of increased EEG power in the delta-theta and low-alpha bands, and of decreased power in the beta range. This pattern could be considered as the spectral EEG signature of the sleep inertia phenomenon. The state of post-sleep EEG hypo-arousal does not subside in the first 10-min period after awakening considered in the present analysis. Finally, according to our results, the more posterior scalp locations show stronger EEG signs of sleep inertia, and could be the last ones to properly wake up.

A previous experimental study showed that the cortisol response upon awakening was reduced following nights with low-frequency noise exposure. This study comprised a larger number of subjects and an extended period of acclimatisation nights. In total, 26 male subjects slept during five consecutive nights in a sleep laboratory. Half of the subjects were exposed to low-frequency noise (40 dBA) on the 4th night and had their reference night (24 dBA) on the 5th night, while the reverse conditions were present for the other half of the group. Subjective sleep disturbances were recorded by questionnaires and cortisol response upon awakening was measured in saliva. The results showed that subjects were more tired and felt less socially orientated in the morning after nights with low-frequency noise. Mood was negatively affected in the evening after nights with low-frequency noise. No effect of noise condition was found on the cortisol secretion. There was a significant effect of group and weekday, indicating that further methodological developments are necessary before saliva cortisol secretion can be reliably used as an indicator of noise-disturbed sleep

The effects of night-time exposure to traffic noise (TN) or low frequency noise (LFN) on the cortisol awakening response and subjective sleep quality were determined. Twelve male subjects slept for five consecutive nights in a noise-sleep laboratory. After one night of acclimatisation and one reference night, subjects were exposed to either TN (35dB L(Aeq), 50dB L(Amax)) or LFN (40dB L(Aeq)) on alternating nights (with an additional reference night in between). Salivary free cortisol concentration was determined in saliva samples taken immediately at awakening and at three 15-minute intervals after awakening. The subjects completed questionnaires on mood and sleep quality. The awakening cortisol response on the reference nights showed a normal cortisol pattern. A significant interaction between night time exposure and time was found for the cortisol response upon awakening. The awakening cortisol response following exposure to LFN was attenuated at 30 minutes after awakening. Subjects took longer to fall asleep during exposure to LFN. Exposure to TN induced greater irritation. Cortisol levels at 30 minutes after awakening were related to "activity" and "pleasantness" in the morning after exposure to LFN. Cortisol levels 30 minutes after awakening were related to sleep quality after exposure to TN. This study thus showed that night time exposure to LFN may affect the cortisol response upon wake up and that lower cortisol levels after awakening were associated with subjective reports of lower sleep quality and mood.

Objectives : To assess auditory evoked potentials (AEPs) before sleep and upon 3 awakenings during an undisturbed baseline night and to compare them to AEPs during a night characterized by a recuperative increase in the amount of slow-wave sleep (SWS) as a consequence of two consecutive nights of selective SWS deprivation. Methods : Ten male subjects slept in the laboratory for 6 consecutive nights. The first 2 nights were undisturbed. The 3rd night was considered as baseline. During the 4th and 5th nights, selective SWS deprivation was obtained by means of acoustic stimulation. The 6th night was a recovery. The data reported here were collected during the baseline and the recovery night. Subjects were awakened 3 times: after 2 h, 5 h (nocturnal awakenings) and 7.5 h (final morning awakening) of sleep, respectively. All the awakenings were carried out from stage 2. The AEP recordings were carried out in bed, while subjects were performing a simple auditory reaction time task. Results : The amplitude of the N1-P2 complex decreased upon the first awakening of the baseline night as compared to pre-sleep wakefulness levels; during the recovery night, the decrease of N1-P2 amplitude was present also upon the second and final awakening. N1 latency increased upon the two nocturnal awakenings regardless of the night, while P2 latency was not affected. Moreover, the N1-P2 amplitude increased during recovery at the frontal midline derivation as compared to baseline, while it decreased at Pz and Oz. Conclusions : The N1-P2 amplitude and, to a lesser extent, the N1 latency, are sensitive in showing a state of brain deactivation during the sleep-wake transition. The decrease of N1-P2 amplitude at the parieto-occipital locations during recovery is coherent with the hypothesis of a functional link between SWS amount and cortical hypoarousal upon awakening. The unexpected increase of the same variable at Fz can be interpreted as the effect of a compensatory effort of the frontal areas for the increased homeostatic drive for sleep during the recovery night.

Background: Patients with winter depression, (seasonal affective disorder, SAD) frequently complain of difficulty awakening in the morning. Dawn simulation has been found effective in treating SAD, but its effect on difficulty awakening has not been assessed. Methods: Fifty medication-free patients with SAD associated with hypersomnia were randomized to receive either 1 week of dawn simulation (250 lux) or a dim (0.2–2 lux) placebo signal. The patients assessed their level of drowsiness upon awakening during the baseline week and during the treatment week using the Stanford sleepiness scale (SSS). A psychiatrist rated difficulty awakening after the baseline week and after the treatment week. Results: Dawn simulation lowered both the difficulty awakening score (P

Background and Purpose Up to 15–25% of patients with ischemic stroke wake up with their deficits. Because of the uncertainty about the time of onset, these patients are generally not offered thrombolytic therapy. Some of these wake-up stroke patients may be eligible for acute endovascular stroke therapy based on hyperacute CT or MR imaging independent of the time window. Report We report two patients with acute ischemic stroke whose symptoms were present upon awakening and who were successfully treated with endovascular interventions. Results The first patient was discharged with complete neurological recovery on second day after endovascular intervention. The second patient went home on fifth day with a mild left facial paresis and left arm drift. Both these patients did not have any neurological deficit on 18-month follow up. Conclusions Some patients who present with stroke on awakening may be candidates for thrombolytic therapy or recanalization techniques irrespective of mode of therapy (intravenous, intravenous + intra-arterial or intra-arterial tPA alone). Further randomized, controlled studies are warranted to safely identify those candidates who would benefit from thrombolysis and endovascular interventions in ischemic wake-up strokes.

The hypothesis that a state of hypoarousal upon awakening should lead to a decrease in amplitude and an increase in latency of the N1-P2 components of the Auditory Evoked Potentials (AEPs) as compared to presleep wakefulness levels, was evaluated after two nocturnal awakenings and after the final morning awakening from a 7.5-h night of sleep. The amplitude of the N1-P2 complex was reduced upon awakening as compared to presleep wakefulness levels, but only following the first nocturnal awakening, scheduled after the first 2 h of sleep. This result is interpreted as indicating a link between slow wave sleep amount, mainly present during the first part of the night, and lowered levels of brain activation upon awakening. The reaction times, recorded concomitantly to AEPs, were more sensitive to the negative effects of sleep inertia.

A 41-year-old man presented with acute bilateral loss of vision upon awakening after elective surgery. After thorough evaluation it was determined that he had suffered bilateral posterior ischemic optic neuropathies secondary to hypotension while under general anesthesia. One eye showed significant improvement over the next 4 weeks, whereas the other remained unchanged.

In contrast to the many neural studies into the mechanisms of sleep onset and maintenance, few studies have focused specifically on awakening from sleep. However, the abrupt electrographic changes and large brief cardio-respiratory activation at awakening suggest that a distinct, transiently aroused, awake state may exist compared to later wakefulness. To test this hypothesis we utilized the acoustic startle reflex, a standard un-conditioned reflex elicited by a sudden loud noise. This reflex is modulated under specific conditions, one being a diminution of startle when a quieter pre-stimulus is presented immediately before the loud stimulus. This pre-pulse inhibition (PPI) is used as a measure of sensorimotor gating, with smaller PPI indicating less filtering of sensory inputs and increased responsiveness to external stimuli. Eight rats with electrodes for recording sleep-wake state were studied. An accelerometer measured startle responses. The startle reflex was elicited by 115 dB, 40 ms tones. PPI was produced by 74 dB, 20 ms tones preceding the 115 dB tone by 100 ms. Responses within 100 ms were measured. Stimuli were applied either 3-10 s after spontaneous awakenings, or in established wakefulness (30 s). Responses to the startle stimuli alone were similar in the different awake states (P = 0.821). However, PPI was smaller at awakening from non-REM sleep compared to established wakefulness (45.4 +/- 7.5% vs. 74.3 +/- 6.1%, P = 0.0002). PPI after awakening from REM sleep (52.8 +/- 17.9%) was not significantly different than established wakefulness (P = 0.297). Reduced PPI of the startle reflex at awakening from non-REM sleep supports the hypothesis that wakefulness immediately after spontaneous sleep episodes is neurophysiologically distinct from later wakefulness and associated with reduced gating of motor responses to sensory inputs. Spontaneous activation of this distinct, transiently aroused, state upon awakening may serve a protective function, preparing an animal to respond immediately to potentially threatening stimuli.

The main purpose of this study was to evaluate the correlations between retrospective and prospective assessments of sleep. Subjective reports of sleep characteristics and sleep quality were obtained from 146 young (20–40 years, average age 29.15) healthy men ( n = 43), nonpregnant ( n = 70) and pregnant women ( n = 33). Three types of subjective sleep reports were obtained: (1) general estimates of sleep habits (retrospective measures); (2) sleep logs completed upon awakening on three successive workdays (prospective measures); and (3) general sleep complaints. Men showed the greatest stability in the sleep log reports, followed by nonpregnant women, with pregnant women showing the least stability. Significant positive correlations between prospective (log reported) and retrospective (general estimates) sleep measures were found only for men. However, for measures of sleep quality, such as feelings of fatigue upon awakening, women showed greater agreement between their general estimates and three nightly reports. The limitations of using retrospective estimates in sleep surveys are discussed.

S A T U R D A Y Cathryn J. Luria, MD, Alexandra R. Sitarik, MS, Suzanne Havstad, MA, Ganesa R. Wegienka, PhD, Haejin Kim, MD, Edward M. Zoratti, MD, FAAAAI, Christine L. M. Joseph, PhD, AndreaCassidy-Bushrow, PhD; Division of Allergy and Clinical Immunology, Henry Ford Health System, Detroit, MI, Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, Henry Ford Health System, Division of Allergy and Clinical Immunology, Detroit, MI, Henry Ford Health System, Detroit, MI. RATIONALE: The relationship between asthma symptoms and perceived stress and trait anxiety is not well understood. METHODS: Adolescents ages 14-17 years were recruited to examine the effect of stress on health measures. They were included in the present analysis if they reported current asthma, defined as self-reported cliniciandiagnosed asthma plus one or more episodes of asthma in the past year. Asthma symptomswere assessed on a 7-point Likert scale using six asthma control questionnaire items targeting nocturnal awakening due to asthma, symptoms upon awakening, activity limitation, shortness of breath, time spent wheezing, and short-acting bronchodilator (SABA) use. Stress was measured using the perceived stress scale (PSS), and trait anxiety was measured using the State-Trait Anxiety Inventory. Linear regression was used to associate asthma symptoms with PSS and trait anxiety. RESULTS: Of335adolescents recruited, 38 (11.3%) reportedcurrent asthma. Four of the six asthma symptom assessments had significant associations with PSS: symptoms upon awakening (b54.8, p-value

S A T U R D A Y Cathryn J. Luria, MD, Alexandra R. Sitarik, MS, Suzanne Havstad, MA, Ganesa R. Wegienka, PhD, Haejin Kim, MD, Edward M. Zoratti, MD, FAAAAI, Christine L. M. Joseph, PhD, AndreaCassidy-Bushrow, PhD; Division of Allergy and Clinical Immunology, Henry Ford Health System, Detroit, MI, Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, Henry Ford Health System, Division of Allergy and Clinical Immunology, Detroit, MI, Henry Ford Health System, Detroit, MI. RATIONALE: The relationship between asthma symptoms and perceived stress and trait anxiety is not well understood. METHODS: Adolescents ages 14-17 years were recruited to examine the effect of stress on health measures. They were included in the present analysis if they reported current asthma, defined as self-reported cliniciandiagnosed asthma plus one or more episodes of asthma in the past year. Asthma symptomswere assessed on a 7-point Likert scale using six asthma control questionnaire items targeting nocturnal awakening due to asthma, symptoms upon awakening, activity limitation, shortness of breath, time spent wheezing, and short-acting bronchodilator (SABA) use. Stress was measured using the perceived stress scale (PSS), and trait anxiety was measured using the State-Trait Anxiety Inventory. Linear regression was used to associate asthma symptoms with PSS and trait anxiety. RESULTS: Of335adolescents recruited, 38 (11.3%) reportedcurrent asthma. Four of the six asthma symptom assessments had significant associations with PSS: symptoms upon awakening (b54.8, p-value

reduction of asleep BP by bedtime hypertension treatment significantly reduces the risk of cardiovascular events. Whether such benefits might also apply to other conditions remains uncertain. We evaluated the potential differential administration-time-dependent effects on the risk of chronic kidney disease (CKD) of the various classes of hypertension medications. We conducted a prospective, randomized, open-label, blinded endpoint trial on 2078 hypertensive patients without CKD, 1017 men/ 1061 women, 53.6 13.7 years of age. Patients were randomized to ingest all their prescribed hypertension medications upon awakening or the entire daily dose of 1 of them at bedtime. At baseline and annually (or more frequently if hypertension treatment was adjusted based on ambulatory BP) thereafter, BP and physical activity (wrist actigraphy) were simultaneously monitored for 48h. During a 5.9-year median follow-up, 368 patients developed CKD (estimated glomerular filtration rate

Introduction Nightmares are terrifying dreams – sometimes recurring and with drawn out plots – which wake up the sleeper. The CEAD is a useful test for evaluating nightmares which has been specifically designed to measure anxiety upon awakening. The original sample for the CEAD was composed of subjects who recalled a dream at the time of awakening. This could have introduced biases to the results. The first aim is to confirm whether there is a difference in scores obtained on the CEAD between dream recallers and non-recallers. The second aim is analyse the relationship between the CEAD and criteria involved in nightmares (anxiety and fear on awakening, awakening due to dreamed content, recurrence of content and recall quality). Materials and methods 252 Spanish-speaking volunteers were questioned about their awakening that same day. 70 of them were men and 181 were women. The mean age was 39.6 years (Sd = 13.6). Results 22.2% of participants recalled a dream with several scenes and 9.1% recalled several dreams during the night. 38.9% had no recall. No significant differences were found on the CEAD between recallers and non-recallers, F(1, 175) = .172, p = .679. 9.9% of participants reported that they woke up because of what they were dreaming about. On comparing them with those who awoke for some other reason, no significant differences were found on the CEAD, F(1, 237) = 3.48, p = .063. 17.1% of awakenings were accompanied by fear, anxiety or both. This produced significant differences on the CEAD, F(3, 247) = 4.59, p = .004. 5.6% stated that they had a nightmare and 9.9% were not sure if what they dreamed was a nightmare. There were differences compared to those who had not had a nightmare or did not recall their dream, F(1, 249) = 16.7, p Conclusion Dream recall is not a symptom of anxiety. No significant differences in anxiety were found between dreamers and non-dreamers. CEAD scores were related to reports of nightmares, to a feeling of fear or anxiety caused by the dream, and to recurring content. The CEAD was not related to report length or to awakening as a result of dream content.

Severe traumatic brain injury (TBI) produces permanent personality and cognitive changes. Grief, although traditionally conceptualized as a bereavement-related reaction, is also experienced by significant others in response to profound changes in their loved-one. Grief may be a key emotional process underlying neuroendocrine and inflammatory alterations among partners responding to changes in their loved-one following TBI. The purpose of this study was to determine whether grief is associated with alterations in cortisol awakening response (CAR) and levels of a proinflammatory cytokine (TNF-alpha) in partners of veterans with TBI. A cross-sectional sample of 40 women (mean age = 42 years) caring for a significant other who suffered a moderate or severe TBI from 6 months to 10 years ago were enrolled. Subjects completed the Perceived Stress Scale and Hogan Grief Reaction Checklist and provided saliva samples upon awakening and 30 min after awakening to measure CAR and TNF-alpha. Controlling for BMI and caregiving frequency and duration, CAR was inversely associated with perceived stress (r = −.522, p = .007) and with the grief subscale of panic behavior (r = −.489, p = .013). TNF-alpha was positively associated with grief subscales: detachment (r = .436, p = .030) and blame/anger (r = .480, p = .015). A blunted CAR may reflect “burnout” resulting from the chronic stress and grief experienced by caregivers. This may unleash proinflammatory cytokines and predispose caregivers to future inflammatory-related health risks.

An implicit assumption, that the post-absorptive resting metabolic rate (RMR) after light physical activity frequently permitted in the determination of basal metabolic rate (BMR) would not differ substantially from that measured upon awakening, was questioned as a possible factor of overestimation in the BMR standards. The supine RMRs measured with 15 overnight fasting subjects (males, aged 20–29) 10 and 20 min after awakening were 0.91 and 0.97 kcal/kg fat-free mass/h, indicating the rise of metabolic rate with time (a 7% increase in 10 minutes). After a 10-min walk, the RMRs increased by 20% as compared to the RMR taken 10-min after awakening and remained constant. The RMRs 1 to 3 h after breakfast were essentially the same as the Japanese BMR standards. All predicted basal energy expenditure from the Japanese BMR standards, Harris-Benedict equation, Robertson-Reid standards and Boothby-Sandiford standards overestimated the post-absorptive resting energy expenditure determined after a 10-min walk by 9 to 18%. Our findings suggest a possibility that the BMRs previously determined have not been rigorously standardized, and raise questions regarding the accuracy of widely used BMR standards in predicting basal energy requirements.

The effects of ebdosulfan on the weights of the liver, adrenal and ovary, on pentobarbital blood and brain levels and on sleeping time (ST) have been investigated in female rats after daily oral doses of 0, 1.0, 2.5 and 5.0 mg/kg for a period of 7 or 15 days. No significant change in body weight was observed. With higher doses (2.5–5.0 mg/kg) the liver weight was significantly increased, but ovary and adrenal weights did not increase. Endosulfan treatment shortened sleeping time, while induction time was significantly increased. The concentration of pentobarbital in the blood and brain of rats after 30 min and upon awakening indicated that there was a significant decrease at 30 min. No change at awakening was observed in endosulfan-treated rats as compared to controls. It is suggested that endosulfan may shorten the duration of pentobarbital-induced sleep, perhaps by induction of hepatic microsomal enzyme activity.