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Introduction Sleep health is “a multidimensional pattern of sleep-wakefulness, adapted to individual, social, and environmental demands, that promotes physical and mental well-being”. The RU-SATED is a short practical self-reported symptom scale that is a reliable valid tool for the rapid evaluation of sleep health. This study sought to examine the psychometric validity of the French version. Methods We conducted an observational cross-sectional study. All professionals working in Bordeaux University Hospital were asked to answer an internet-based questionnaire assessing sleep, mental and physical health outcomes. Sleep health was measured using the French RU-SATED scale obtained by a rigorous reverse translation process. Psychometric validity included factor structure, internal structural validity, concurrent validity and external validity of the measure, with sleep, mental and physical health outcomes. Results A total of 1,562 participants were included with 80.5% of women and a mean age of 40.0 (±11.2). Sleep health was within the average range (M = 8.2, SD = 2.4) on the RU-SATED. Confirmatory factor analyses showed acceptable model fit measures. Cronbach's alpha coefficient was 0.57 and ranged from 0.46 to 0.58 when removing each item. The correlation between items with the overall corrected scores ranged from 0.19 to 0.43. The “Efficiency” item showed poor psychometric properties. Most items were highly correlated with their appropriate sleep outcome. All items showed a strong association with positive mental and physical health outcomes. Discussion The French RU-SATED scale is a reliable valid tool for measuring sleep health in adults. Nevertheless, future studies should better evaluate the reliability and validity of the “Efficiency” item. It is also important to explore how the RU-SATED can be used to evaluate the impact of sleep hygiene strategies in promoting public health in accordance with models of sleep behavior change.

The third edition of the International Classification of Sleep Disorders (ICSD-3) is the authoritative clinical text for the diagnosis of sleep disorders. An important issue of sleep nosology is to better understand the relationship between symptoms found in conventional diagnostic manuals and to compare classifications. Nevertheless, to our knowledge, there is no specific exhaustive work on the general structure of the networks of symptoms of sleep disorders as described in diagnostic manuals. The general aim of the present study was to use symptom network analysis to explore the diagnostic criteria in the ICSD-3 manual. The ICSD-3 diagnostic criteria related to clinical manifestations were systematically identified, and the units of analysis (symptoms) were labelled from these clinical manifestation diagnostic criteria using three rules ("Conservation", "Splitting", "Lumping"). A total of 37 of the 43 main sleep disorders with 160 units of analysis from 114 clinical manifestations in the ICSD-3 were analysed. A symptom network representing all individual ICSD-3 criteria and connections between them was constructed graphically (network estimation), quantified with classical metrics (network inference with global and local measures) and tested for robustness. The global measure of the sleep symptoms network shows that it can be considered as a small world, suggesting a strong interconnection between symptoms in the ICSD-3. Local measures show the central role of three kinds of bridge sleep symptoms: daytime sleepiness, insomnia, and behaviour during sleep symptoms. Such a symptom network analysis of the ICSD-3 structure could provide a framework for better systematising and organising symptomatology in sleep medicine.

The Self-Efficacy Measure for Sleep Apnea (SEMSA) is a 26-item questionnaire that investigates perceived risks, outcome expectancies and self-efficacy, i.e., the confidence to undertake treatment, in the context of continuous positive airway pressure (CPAP) interventions for sleep apnea syndrome. This questionnaire can be considered too lengthy for clinical practice; therefore, a shortened version is needed. 290 adults undergoing CPAP treatment completed the SEMSA-26. An item reduction process took into account both the results of statistical analyses and the expertise of a steering committee. Construct validity, reliability and external validity were tested for a 15-item short version. Additionally, CPAP adherence (usage more than 4 h per night) was collected, and receiver operating characteristics analyses were performed to establish the cut-off point of the SEMSA-15 that would best classify patients depending on their adherence. The structure of the SEMSA-15 was confirmed by principal components factor analysis. Cronbach’s alpha coefficients ranged from 0.66 to 0.86. The SEMSA-15 dimension scores were highly correlated with their respective SEMSA-26 dimension scores. The self-efficacy sub-score of the SEMSA-15 obtained the best classification performance, with a cut-off point of 2.78 to predict CPAP adherence. The SEMSA-15 seems to be appropriate for use in clinical practice to investigate beliefs and perception of self-efficacy in CPAP interventions. It is, therefore, a useful tool to predict long-term adherence to treatment.

AbdelKebir Sabil,1 Remi Bignard,2 Chloé Gervès-Pinquié,3 Pierre Philip,4 Marc Le Vaillant,3 Wojciech Trzepizur,2 Nicole Meslier,2 Frédéric Gagnadoux2 1Clinical Research Department, Cloud Sleep Lab, Paris, France; 2Department of Respiratory and Sleep Medicine, University Hospital of Angers, Angers, France; 3Biostatistics Department, Pays de la Loire Respiratory Health Research Institute, Beaucouzé, France; 4Sleep, Attention and Neuropsychiatry Unit, University of Bordeaux, CNRS, SANPSY USR 3413, and CHU Pellegrin, Bordeaux, FranceCorrespondence: AbdelKebir SabilClinical Research Department, Cloud Sleep Lab, 29 rue Louis Braille, Paris, FranceTel +33 648 01 00 21Email kebir.sabil@cloudsleeplab.comPurpose: We aimed to determine the risk factors of sleepiness at the wheel among patients with obstructive sleep apnea (OSA) and to determine factors that were independently associated with reported sleep-related near-miss accidents or car accidents.Patients and Methods: This retrospective study was conducted on 843 OSA patients from the French Pays de la Loire sleep cohort database. Each patient completed surveys including anthropometric data, medical history, professional status, and data on alcohol and tobacco use. Epworth sleepiness scale (ESS) and sleep quality questionnaires were administered. Regarding driving, data were collected on occurrence of sleepiness-related near-misses or car accidents, and on distance driven per year. The primary dependent variable of interest was reported sleepiness at the wheel.Results: On multivariable regression analysis, reported sleepiness at the wheel (n=298) was independently associated with younger age (p=0.02), male gender (p=0.009), marked nocturnal hypoxemia (p=0.006), lower BMI (p=0.03), absence of cardiovascular disease (p=0.022), executives or high degree jobs (p=0.003) and reported difficulty-maintaining sleep (p=0.03). Only past experience of sleepiness at the wheel (OR 12.18, [6.38– 23.25]) and an ESS ≥ 11 (OR 4.75 [2.73– 8.27]) were independently associated with reported car accidents (n=30) or near-miss accidents (n=137).Conclusion: In patients newly diagnosed with OSA, the risk of car accident seems multifactorial, and its evaluation should include multiple parameters such as patient self-reported sleepiness at the wheel, occurrence of sleepiness-related accidents, anthropometry, professional status, and insomnia complaints. Thus, it is possible to evaluate this risk and advise patients as early as the first visit at the sleep medicine clinic without waiting for the results of the sleep study.Keywords: sleepiness, accidents, near-miss accidents, French drivers, OSA, early risk prediction

Study Objectives To determine whether the feeling of having slept or not during the Maintenance of Wakefulness Test (MWT) is associated with the occurrence of self-reported sleep-related traffic near misses and accidents in patients with sleep disorders. Methods This study was conducted in patients hospitalized in a French sleep center to perform a 4 × 40 min MWT. Relationship between mean sleep latency on the MWT, feeling of having slept or not during MWT trials and sleep-related near misses and accidents reported during the past year was analyzed. Results One hundred and ninety-two patients suffering from OSAS, idiopathic hypersomnia, narcolepsy, restless leg syndrome or insufficient sleep syndrome were included. One hundred and sixty-five patients presented no or one misjudgment of feeling of having slept during MWT trials while 27 presented more than two misjudgments. Almost half of the latter (48.1%) reported a sleepiness-related traffic near miss or accident in the past year versus only one third (27.9%) for the former (p < 0.05). Multivariate logistic regression showed that patients with more than two misjudgments had a 2.52-fold (95% CI, 1.07–5.95, p < 0.05) increase in the risk of reporting a sleepiness-related near miss/accident. Conclusions Misjudgment in self-perceived sleep during the MWT is associated with the occurrence of self-reported sleepiness-related traffic near misses and accidents in the past year in patients suffering from sleep disorders. Asking about the perception of the occurrence of sleep during the MWT could be used to improve driving risk assessment in addition to sleep latencies.

Sleep is involved in the regulation of inflammation, healing, and digestion. The pathophysiology of Crohn’s disease (CD) is unclear, and the role of sleep disturbances has recently been suggested. The present study investigated a putative association between sleep disturbances and CD activity. We conducted a prospective observational monocenter translational study, recruiting major CD patients from 2013 to 2015. Disease activity was assessed by the Harvey-Bradshaw index and the CD activity index. Objective sleep quantity and quality were measured by wrist actigraphy over a period of 7 days. The primary objective was to look for an association between wrist actigraphy parameters and CD activity. Thirty-four CD patients, including 14 with active disease and 20 in remission, were included. Sleep efficiency measured by wrist actigraphy was lower in patients with active CD compared to patients in remission. Wake after sleep onset time best predicted CD activity with an AUROC of 0.83. Patients with active CD were more frequently characterized as “poor sleepers” and frequently suffered from excessive daytime sleepiness. Sleep efficiency is lower in patients with active CD than in those in remission. Further studies aimed at better characterizing CD patients’ sleep are warranted.

Obstructive sleep apnea (OSA) is one of the leading non-psychiatric comorbidities in bipolar disorders (BD). We sought to explore associations between risk of OSA in BD, clinical characteristics alongside with both subjective sleep complaints and objective sleep abnormalities.Euthymic patients with BD (n = 144) were assessed over a three-week period, by actigraphy, clinical interviews and questionnaires.Of the study sample, 32 (22%) individuals were at high risk of OSA (HR-OSA) and 112 (78%) had a low risk (LR-OSA), as assessed with the Berlin questionnaire. HR-OSA, compared to LR-OSA, were older (p = 0.031), had higher BMI (p 0.0005), larger neck circumference (p = 0.002), and more residual depressive symptoms (p 0.0005). HR-OSA was also associated with greater sleepiness (p = 0.003), poorer sleep quality (p = 0.003), insomnia complaints (p = 0.027), "languid" chronotype (p = 0.002), and higher actigraphy-derived fragmentation index (p = 0.015). Backward stepwise linear regression retained BMI and depressive symptoms (correct classification of 83% of participants). Classification increased up to 85.4% when adding sleepiness and languid-vigorous scales and up to 87.8% when adding fragmentation index. Combining ROC curve analysis and Youden Index provided best cut-offs (HR-OSA if cut-off greater than or equal to) of 29.84 for BMI (Sensibility(Se) = 0.47, Specificity(Spe) = 0.96) and 1.5 for MADRS total score (Se = 0.84, Spe = 0.58).No confirmation of OSA diagnosis with polysomnography.Higher BMI and residual depressive symptoms are the two best independent predictors of OSA in BD. Such information contributes to improving the screening and management of OSA in BD.NCT02627404.

Substance use disorders are under-detected and not systematically diagnosed or screened for by primary care. In this study, we present the acceptability and validity of an Embodied Conversational Agent (ECA) designed to screen tobacco and alcohol use disorder, in individuals who did not seek medical help for these disorders.Individuals were included from June 2016 to May 2017 in the Outpatient Sleep Clinic of the University Hospital of Bordeaux. DSM-5 diagnoses of tobacco and alcohol use disorders were assessed by human interviewers. The ECA interview integrated items from the Cigarette Dependence Scale-5 (CDS-5) for tobacco use disorder screening, and the "Cut Down, Annoyed, Guilty, Eye-opener" (CAGE) questionnaire for alcohol use disorder screening. Paper version of CDS-5 and CAGE questionnaires and acceptability questionnaire was also self-administered.Of the 139 participants in the study (mean age 43.0 [SD = 13.7] years), 71 were women, and 68 were men. The ECA was well accepted by the patients. Paper self-administered CDS-5 and CAGE scores had a strong agreement with the ECA (p 0.0001). The Receiver Operating Characteristic (ROC) analysis of the ECA interview showed AUC of 0.97 (95% CI, 0.93-1.0) and 0.84 (95% CI, 0.69-0.98) for CDS-5 and CAGE respectively with p-value0.0001.This ECA was acceptable and valid to screen tobacco or alcohol use disorder among patients not requesting treatment for addiction. The ECA could be used in hospitals and potentially in primary care settings to help clinicians to better screen their patients for alcohol and tobacco use disorders.

Non-24-hour sleep-wake disorder is 1 of several chronic circadian rhythm sleep-wake disorders. It is defined as progressive daily shifts in sleep onset and wake times. It mainly affects patients who are sight-impaired, is relatively rare in sighted patients, and is difficult to treat, with no guidelines. This case report discusses non-24-hour sleep-wake disorder in a sighted young man who complained of alternating severe insomnia and excessive sleepiness, with a sleep agenda and actigraphic data showing a daily delay of approximately 2 hours. A novel therapy by total sleep deprivation followed by a combination of morning light therapy and nocturnal melatonin administration was efficient in stopping his free-running sleep-wake pattern both immediately and in the long term. The treatment combination for 6 months resulted in stable circadian entrainment to a 24-hour cycle. Compliance with chronotherapy was maintained over the course of follow-up. CITATION: Guichard K, Micoulaud-Franchi J-A, Philip P, Taillard J. Sleep deprivation therapy to reset the circadian pacemaker in a non-24-hour sleep-wake disorder: a case report. J Clin Sleep Med. 2021;17(7):1503–1506.

Study objectives Emotional reactivity to negative stimuli has been investigated in insomnia, but little is known about emotional reactivity to positive stimuli and its neural representation. Methods We used 3 Tesla functional magnetic resonance imaging (fMRI) to determine neural reactivity during the presentation of standardized short, 10- to 40-seconds, humorous films in patients with insomnia (n = 20, 18 females, aged 27.7 +/− 8.6 years) and age-matched individuals without insomnia (n = 20, 19 females, aged 26.7 +/− 7.0 years) and assessed humor ratings through a visual analog scale. Seed-based functional connectivity was analyzed for the left and right amygdalas (lAMYG and rAMYG, respectively) networks: group-level mixed-effects analysis (FLAME; FMRIB Software Library [FSL]) was used to compare amygdala connectivity maps between groups. Results fMRI seed-based analysis of the amygdala revealed stronger neural reactivity in patients with insomnia than in controls in several brain network clusters within the reward brain network, without humor rating differences between groups (p = 0.6). For lAMYG connectivity, cluster maxima were in the left caudate (Z = 3.88), left putamen (Z = 3.79), and left anterior cingulate gyrus (Z = 4.11), whereas for rAMYG connectivity, cluster maxima were in the left caudate (Z = 4.05), right insula (Z = 3.83), and left anterior cingulate gyrus (Z = 4.29). Cluster maxima of the rAMYG network were correlated with hyperarousal scores in patients with insomnia only. Conclusions The presentation of humorous films leads to increased brain activity in the neural reward network for patients with insomnia compared with controls, related to hyperarousal features in patients with insomnia, in the absence of humor rating group differences. These novel findings may benefit insomnia treatment interventions. Clinical trial The Sleepless Brain: Neuroimaging Support for a Differential Diagnosis of Insomnia (SOMNET). ClinicalTrials.gov identifier: NCT02821234; https://clinicaltrials.gov/ct2/show/NCT02821234.

Introduction: Insomnia and circadian rhythm disorders, such as the delayed sleep phase syndrome, are frequent in psychiatric disorders and their evaluation and management in early stages should be a priority. The aim of this paper was to express recommendations on the use of exogenous melatonin, which exhibits both chronobiotic and sleep-promoting actions, for the treatment of these sleep disturbances in psychiatric disorders.Methods: To this aim, we conducted a systematic review according to PRISMA on the use of melatonin for the treatment of insomnia and circadian sleep disorders in neuropsychiatry. We expressed recommendations for the use of melatonin in psychiatric clinical practice for each disorder using the RAND/UCLA appropriateness method.Results: We selected 41 studies, which included mood disorders, schizophrenia, substance use disorders, attention deficit hyperactivity disorders, autism spectrum disorders, neurocognitive disorders, and delirium; no studies were found for both anxiety and eating disorders.Conclusion: The administration of prolonged release melatonin at 2–10 mg, 1–2 h before bedtime, might be used in the treatment of insomnia symptoms or comorbid insomnia in mood disorders, schizophrenia, in adults with autism spectrum disorders, neurocognitive disorders and during sedative-hypnotics discontinuation. Immediate release melatonin at

International audience; Study objective: To determine whether the objective level of alertness measured by the Maintenance of Wakefulness Test (MWT) is associated with the occurrence of self-reported sleepiness-related traffic near misses and accidents related to sleepiness in patients with sleep disorders.Methods: This case-control study was conducted over a three-year period in four French sleep centers during a 4∗40 min MWT in patients driving more than 5000 Km/year. Relationship between mean sleep latency on the MWT (MWT latency) and age, sex, driving, sleepiness-related near misses and accidents reported during the previous year, and sleep disorder characteristics was analyzed.Results: Of 377 patients suffering from OSAS, idiopathic hypersomnia, narcolepsy, restless leg syndrome or insufficient sleep syndrome, 176 were included. 74 cases reported an accident or near miss related to sleepiness at the wheel in the past year, and 102 reported no accident/near miss (control patients). Thirty-one (37.8 %) cases and 9 (8.8 %) controls reported being sleepy at the wheel more than once a week (p < 0.0001). After adjusted regression analyses, patients with MWT latency between 19 and 33 minutes had a 3.2- (CI 95%[1.5; 6.8], p < 0.0001) fold increase in risk of reporting a near miss/ accident and patients with MWT latency 33 min).Conclusions: MWT latency is associated with self-reported, sleepiness-related near misses and accidents related to sleepiness in the past year in patients routinely investigated in sleep clinics. The MWT could be used to assess driving risk together with clinical interviews assessing sleepiness at the wheel.

Sleep timing is controlled by the subtle interplay between circadian and homeostatic oscillators which, according to their endogenous properties, allow beings to feel spontaneously that it is time to go to bed or wake up in synchrony with the earth's light/dark cycle. In humans, however, social time and nocturnal artificial light modify sleep timing. Our modern lifestyle and artificial nocturnal light delay our bedtime, make us wake up, and lead to a greater intraindividual variability in sleep timing. Depending on the constraints that social time places on us, our sleep timing may be in or out of phase with the internal circadian timing determined by the circadian clock. When a person's social time is out of phase with their circadian time, they may be considered to suffer from circadian disruption or 'social jetlag'. There are interindividual differences in sleep timing that are known as morningness-eveningness preferences or chronotype, e.g. late chronotypes go to bed later. Chronotype may be assessed in terms of differences in kinetic homeostatic sleep pressure, intrinsic circadian period (ICP) and/or phase angle entrainment. In addition, chronotype depends on genetic and age-related factors, e.g. it gets earlier as people grow older. The social time of late chronotype individuals during week days is not adapted to their circadian time, unlike on free days. This results in social jetlag and circadian disruption, which in turn induces a chronic sleep debt due to a late bedtime and an early wake time, which is compensated on free days but only partially. Sleep and circadian clock disruption generally alter cognitive performance (alertness, attention, memory, higher-order executive functions such as response inhibition and decision-making) but their impact remains to be clarified. When subjects adopt their preferred sleep timing, a "synchrony effect" often appears with chronotypes performing better during daytime at optimal than at suboptimal timing (late chronotypes perform better in the evening, early chronotypes in the morning). Evening types appear to be cognitively more vulnerable to suboptimal times than morning types, probably because they have to deal with social jetlag and the "wake effort" period after awakening. Circadian disruption, but not chronotype, may impact attentional/inhibitory performance (more impulsivity and inattention). Strong associations have been found between mood disorders or attention deficit hyperactivity disorder (ADHD) and chronotype, with these psychiatric disorders typically being overrepresented in evening types. The association between social jetlag and these psychiatric disorders is less obvious. Social jetlag can be corrected by reducing exposure to evening light, although eveningness may be considered as a lifelong factor predisposing to depression or inattention.

International audience; Introduction: The US National Sleep Foundation recommends more than 7 hours of sleep per night for adults. Anaesthesiologists and intensivists (AI) are at high risk of short sleep time. The aim of this present survey was to assess the sleep duration of French AI and to identify independent factors related to a sleep time less than the recommended 7 hours.Methods: This prospective observational study was conducted between April and June 2018 and included 6,210 French AI with night-work obligations. The primary outcome variable was sleep duration strictly inferior to 7 hours per night. The covariables included in the multivariable model were selected after the univariate analysis, with those with a p < 0.05 included in the final model.Results: Of the 6,210 AI, 3,699 responded to the survey, and 2,483 were included in the analysis. Of the 2,483 responders, 1,533 (61.7%) reported sleep duration strictly less than 7 hours per night. After the multivariate analysis, the following risk factors were independently associated with sleep duration strictly under 7 hours: age (OR: 1.28 ; IC [1.19 - 1.37]), more than 5 on-call shifts per month, (OR: 1.41 ; IC [1.30 - 1.50]), active smoking (OR: 1.37 ; IC [1.07 - 1.75]), and screen consultation at bedtime (OR: 1.85 ; IC [1.31 - 2.62]).Conclusion: This study gives a recent overview of sleep time and quality of French AI. It could be a useful tool for monitoring sleep disorders among the practitioners and their impact on quality of life.

To assess the importance of sleep for health, this chapter proposes that sleep should be analyzed through the prism of the physiology, behaviors and representations that impact sleep health, sleep complaints and sleep disorders. This chapter proposes the following roadmap: (i) to develop and evaluate an integrative model of the center of the prism in order to predict and simulate successfully the relationship between sleep and health, functioning and longevity; (ii) to develop an iterative approach between the sleep behavior change model, sleep health/complaints/disorder/representation psychometric models, and a physiological model; and (iii) to provide the evidence that specific interventions or programs that improve sleep health truly impact health, functioning and longevity outcomes. It is essential for clinicians to be able to help patients get their sleep back on track by using a multifaceted tool. Improving the sleep health of the public at large can only have a positive knock-on effect for us all.

Voice-guided digital assistant THALIE; International audience; Background: Generally, little information is available on the cognitive status of institutionalized elderly persons. The intelligent voice-guided digital assistant THALIE is a computer-based device measuring memory, executive functions, language, visuo-spatial skills, and attention, developed to facilitate the cognitive assessment of residents in nursing homes. Objective: The objective was to determine its feasibility of implementation for the clinical assessment of cognitive functioning in residents in nursing homes. Methods: The computerized battery THALIE consisting of five neuropsychological tests and the traditional paper-and-pencil MMSE were administered to 14 elderly participants residing in three French nursing homes (EHPAD) who had mild-to-moderate cognitive impairment, potentially due to Alzheimer's disease or related disorders. Non-parametric Spearman's correlations were performed to assess the association between THALIE and MMSE scores. Individual neuropsychological performance profiles were determined. Results: THALIE performances were weakly correlated with MMSE score. THALIE gave a better overview per resident of the extent of impairment of their various cognitive functions than the MMSE used alone, and made it possible to identify less impaired functions. Conclusion: The feasibility of THALIE computerized cognitive assessment of residents in nursing homes is confirmed. It allows to evaluate various neurocognitive functions in nursing-home residents and holds much promise for setting up personalized cognitive care plans for these subjects.

Background: The COVID-19 crisis induces psychosocial stress and sleep complaints that require early management. KANOPEE is a smartphone-based application, providing an interaction with a virtual agent dedicated to screen and deliver behavioral interventions to fight sleep disorders. This paper describes the feasibility study of this application, during the context of COVID-19 confinement in France. Method: 2,069 users of aged 18 years and over downloaded the app during the inclusion period (between 22 April and 5 May 2020). Users first answered a screening interview based on the insomnia severity index (ISI) that was conducted by the virtual agent. If participants were positive for insomniac complaints (ISI > 14), they could join a two-stage intervention program: a) complete an electronic sleep diary for one week, and b) follow personalized sleep recommendations for 10 days. Measures collected included socio-demographic information, ISI and sleep/wake schedules; and acceptance and trust of the agent. Findings: Of all participants, 80% (n=1,574) completed the screening interview with the virtual agent. The virtual agent was well accepted by users regarding its usability, satisfaction, benevolence, and credibility. Of the 773 screened subjects who reported sleep complaints (ISI>14), 214 of them followed the first step of the intervention (34%). Of these, 47 (31%) followed the second step. Users who completed step 1 found that their insomnia complaints (p > .001) and nocturnal sleep improved significantly after one week. Subjects who completed step 2 also showed an improvement compared to the initial measure (p 21) did not respond to either intervention. Interpretation: These preliminary results show that KANOPEE is a promising solution to screen populations for sleep complaints, and that it provides practical and effective behavioral advice for subjects reporting moderately severe insomnia. Funding: LABEX BRAIN, EQUIPEX PHENOVIRT, and Region Nouvelle-Aquitaine. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Following prior approval by the University and Hospital scientific committees, we obtained authorizations to be registered on the University Hospital register for GDPR approval by the French authorities (CNIL). Informed consent was obtained from all persons downloading the app according to the General Data Protection Regulation and CNIL regulations.

Emotional reactivity in insomnia is affected both subjectively and on a physiological level for negative emotional material, but little is known about reactions to positive stimuli. We here investigated whether in younger adult insomnia patients, presentation of short humorous films would lead to heart rate decreases during and after film viewing, as compared to heart rate changes when falling asleep. Investigating 20 participants with DSM-5-diagnosed insomnia and 18 participants without insomnia, we found that heart rate decreased when falling asleep, increased when watching humorous films and returned to normal values afterwards for all participants. Film-related heart rate increases were strongly related to humour ratings of the films. No differences were found between those with and without insomnia on subjective ratings of the films, film-related heart rate changes or when falling asleep. We conclude that the experience of positive daily life stimuli in younger adults is not affected by insomnia in our study, despite insomnia having a known more profound effect on negative stimuli. Future studies exploring insomnia-related autonomous nervous system responses combining different neurophysiological modalities should confirm our findings.

The Self-Efficacy Measure for Sleep Apnea (SEMSA) is a 26-item self-questionnaire composed of three factors: risk perception of obstructive sleep apnea syndrome (OSAS), benefit of continuous positive airway pressure (CPAP), and self-efficacy (the confidence to engage in CPAP use). It is used to evaluate health beliefs about OSAS and CPAP in order to optimize CPAP use. The purpose of this study was to design and validate a French version of the SEMSA. A forward-backward translation of the SEMSA was performed. Subjects with OSAS treated by CPAP and followed by our sleep clinic were invited to complete the questionnaire. The psychometric properties of the French SEMSA version were analyzed in terms of its construct validity (with confirmatory factor analysis, CFA), internal structural validity (Cronbach’s alpha coefficient), and external validity (Pearson’s correlation between SEMSA score and duration of CPAP use). Two hundred eighty-eight subjects filled in the questionnaire. The mean age was 63.16 ± 12.73 years. The number of years since the beginning of CPAP treatment was 6.58 ± 6.03 years. The mean CPAP use duration was 6.19 ± 2.03 h/night. CFA was unsatisfactory (RMSEA = 0.066 and CFI = 0.88). The exploratory factor analysis revealed a fourth factor named “cardiovascular risk” factor. Cronbach’s alpha coefficient was 0.886. The correlation between the “self-efficacy” factor and the duration of CPAP use was significant (r = 0.26, p ≤ 0.001). The French version of the SEMSA is a psychometrically acceptable self-report questionnaire for measuring health beliefs and behavior in French patients with OSAS treated with CPAP. Such translation and validation should lead to the adoption of validated psychosocial methods for improving CPAP use.

Virtual reality is a relatively new technology that enables individuals to immerse themselves in a virtual world. It offers several advantages including a more realistic, lifelike environment that may allow subjects to "forget" they are being assessed, allow a better participation and an increased generalization of learning. Moreover, the virtual reality system can provide multimodal stimuli, such as visual and auditory stimuli, and can also be used to evaluate the patient's multimodal integration and to aid rehabilitation of cognitive abilities. The use of virtual reality to treat various psychiatric disorders in adults (phobic anxiety disorders, post-traumatic stress disorder, eating disorders, addictions…) and its efficacy is supported by numerous studies. Similar research for children and adolescents is lagging behind. This may be particularly beneficial to children who often show great interest and considerable success on computer, console or videogame tasks. This article will expose the main studies that have used virtual reality with children and adolescents suffering from psychiatric disorders. The use of virtual reality to treat anxiety disorders in adults is gaining popularity and its efficacy is supported by various studies. Most of the studies attest to the significant efficacy of the virtual reality exposure therapy (or in virtuo exposure). In children, studies have covered arachnophobia social anxiety and school refusal phobia. Despite the limited number of studies, results are very encouraging for treatment in anxiety disorders. Several studies have reported the clinical use of virtual reality technology for children and adolescents with autistic spectrum disorders (ASD). Extensive research has proven the efficiency of technologies as support tools for therapy. Researches are found to be focused on communication and on learning and social imitation skills. Virtual reality is also well accepted by subjects with ASD. The virtual environment offers the opportunity to administer controlled tasks such as the typical neuropsychological tools, but in an environment much more like a standard classroom. The virtual reality classroom offers several advantages compared to classical tools such as more realistic and lifelike environment but also records various measures in standardized conditions. Most of the studies using a virtual classroom have found that children with Attention Deficit/Hyperactivity Disorder make significantly fewer correct hits and more commission errors compared with controls. The virtual classroom has proven to be a good clinical tool for evaluation of attention in ADHD. For eating disorders, cognitive behavioural therapy (CBT) program enhanced by a body image specific component using virtual reality techniques was shown to be more efficient than cognitive behavioural therapy alone. The body image-specific component using virtual reality techniques boots efficiency and accelerates the CBT change process for eating disorders. Virtual reality is a relatively new technology and its application in child and adolescent psychiatry is recent. However, this technique is still in its infancy and much work is needed including controlled trials before it can be introduced in routine clinical use. Virtual reality interventions should also investigate how newly acquired skills are transferred to the real world. At present virtual reality can be considered a useful tool in evaluation and treatment for child and adolescent disorders.

Selective upper-airway stimulation (UAS) is a novel therapy for patients with obstructive sleep apnea (OSA). The aim of this study was to compare changes in sleep architecture during the diagnostic polysomnography and the post-implantation polysomnography in UAS in patients with OSA. Twenty-six patients who received a UAS device (Inspire Medical Systems) were included. Treatment outcome was evaluated 2 and 3 months after surgery. Data collection included demographics, body mass index (BMI), apnea hypopnea index (AHI), oxygen saturation and desaturation index (ODI), Epworth sleepiness score (ESS), arousal parameter, and sleep patterns. The mean age was 60.2 years, 25 patients were male, 1 patient was female. Mean BMI was 29.0 kg/m2. The mean pre-implantation AHI of 33.9/h could be reduced to 9.1/h at 2 months post-implantation (p

Psychiatric diagnostic relies on physician's ability to create an empathic interaction with the patient (i.e., engage the patient in the conversation with empathic sentences, while keeping an emotional distance) in order to accurately extract semiology (i.e., clinical manifestations). Virtual patients (VPs) offer new ways to train these skills but need to be validated in terms of accuracy to measure the skills of interest, and be perceived positively by its users. We recruited 34 medicine students, who interacted with a VP suffering from depressive disorders. Results suggest good abilities for the students to use empathic sentences to communicate with the VP, but results varied regarding semiology extraction, students having a specialty in psychiatry performing better than their counterparts. Additionally, results suggest that students managed to keep an emotional distance during the interaction with the VP, but they let their emotions out when answering semiology questions. Positive feedbacks and limitations raised by students during debriefing interviews provide suggestions for improvements and ideas for future works.

Study Objectives The study objectives were to examine accidental risks associated with insomnia or hypnotic medications, and how these risk factors interact with sex and age. Methods A population-based sample of 3,413 adults (Mage = 49.0 years old; 61.5% female), with or without insomnia, were surveyed annually for five consecutive years about their sleep patterns, sleep medication usage, and road collisions. Results There was a significant risk of reporting road collisions associated with insomnia (hazard ratio [HR] = 1.20; 95% confidence interval [CI] = 1.00–1.45) and daytime fatigue (HR = 1.21; 95% CI = 1.01–1.47). Insomnia and its daytime consequences were perceived to have played some contributory role in 40% of the reported collisions. Both chronic (HR = 1.50; 95% CI = 1.17–1.91) and regular use of sleep medications (HR = 1.58; 95% CI = 1.16–2.14) were associated with higher accidental risks, as well as being young female with insomnia and reporting excessive daytime sleepiness. Conclusions Both insomnia and use of sleep medications are associated with significant risks of road collisions, possibly because of or in association with some of their residual daytime consequences (i.e. fatigue and poor concentration). The findings also highlight a new group of at-risk patients, i.e. young women reporting insomnia and excessive daytime sleepiness.

International audience; Objective: Recent research suggests that sleep disorders or changes in sleep stages or EEG waveform precede over time the onset of the clinical signs of pathological cognitive impairment (e.g., Alzheimer's disease). The aim of this study was to identify biomarkers based on EEG power values and spindle characteristics during sleep that occur in the early stages of mild cognitive impairment (MCI) in older adults.Methods: This study was a case-control cross-sectional study with 1-year follow-up of cases. Patients with isolated subjective cognitive complaints (SCC) or MCI were recruited in the Bordeaux Memory Clinic (MEMENTO cohort). Cognitively normal controls were recruited. All participants were recorded with two successive polysomnography 1 year apart. Delta, theta, and sigma absolute spectral power and spindle characteristics (frequency, density, and amplitude) were analyzed from purified EEG during NREM and REM sleep periods during the entire second night. Results: Twenty-nine patients (8 males, age = 71 +/- 7 years) and 29 controls were recruited at T0. Logistic regression analyses demonstrated that age-related cognitive impairment were associated with a reduced delta power (odds ratio (OR) 0.072, P < 0.05), theta power (OR 0.018, P < 0.01), sigma power (OR 0.033, P < 0.05), and spindle maximal amplitude (OR 0.002, P < 0.05) during NREM sleep. Variables were adjusted on age, gender, body mass index, educational level, and medication use. Seventeen patients were evaluated at 1-year follow-up. Correlations showed that changes in self-reported sleep complaints, sleep consolidation, and spindle characteristics (spectral power, maximal amplitude, duration, and frequency) were associated with cognitive impairment (P < 0.05).Conclusion: A reduction in slow-wave, theta and sigma activities, and a modification in spindle characteristics during NREM sleep are associated very early with a greater risk of the occurrence of cognitive impairment. Poor sleep consolidation, lower amplitude, and faster frequency of spindles may be early sleep biomarkers of worsening cognitive decline in older adults.

To assess the relationship between real and simulated driving performance and the objective level of alertness as measured by the Maintenance of Wakefulness Test (MWT) in patients suffering from narcolepsy or idiopathic hypersomnia.Twenty-seven patients (10 patients with narcolepsy, type 1 (n = 7) and type 2 (n = 3), and 17 patients with idiopathic hypersomnia, mean age = 33.8 ± 11.1 years, range = 18-65 y; four males) were recruited in a randomized, crossover, double-blind placebo-controlled trial, and compared to 27 matched healthy controls. Patients were randomly assigned to receive modafinil (400 mg) or placebo before the driving test (2 h of real and 2 h of simulated highway driving for each patient). Standard deviation of lateral position (SDLP) of the vehicle in real and simulated driving and mean sleep latency in a 4 × 40 min MWT were assessed.Untreated patients presented shorter sleep latencies on the MWT (20.8 (IQ range 16.1-32.9) vs. 34.9 min (IQ range 28.1-40.0)) and worse simulated driving performance (P 0.001) than treated patients. Nevertheless, treated patients still exhibited shorter mean sleep latencies on the MWT than controls (34.9 (IQ range 28.1-40.0) vs. 40 min (IQ range 37.1-40.0), P 0.05), but driving performance was identical in both groups. The SDLP of the vehicle in real driving conditions and the MWT score correlated with the SDLP in simulated driving (respectively, r = 0.34, P 0.05 and r = -0.56, P 0.001).In patients with narcolepsy/idiopathic hypersomnia, simulated driving and MWT explore different dimensions of fitness-to-drive and could be used complementarily to better evaluate sleep-related driving impairment.

Despite an increasing level of evidence supporting the individual beneficial effect of polyphenols on cognitive performance, information related to the potential synergistic action of these phytonutrients on cognitive performance during a prolonged cognitive effort is currently lacking. This study investigated the acute and sustained action of a polyphenols-rich extract from grape and blueberry (PEGB), on working memory and attention in healthy students during a prolonged and intensive cognitive effort. In this randomised, cross-over, double blind study, 30 healthy students consumed 600 mg of PEGB or a placebo. Ninety minutes after product intake, cognitive functions were assessed for one hour using a cognitive demand battery including serial subtraction tasks, a rapid visual information processing (RVIP) task and a visual analogical scale. Flow-mediated dilation (FMD) and plasma flavan-3-ols metabolites quantification were also performed. A 2.5-fold increase in serial three subtraction variation net scores was observed following PEGB consumption versus placebo (p &lt, 0.001). A trend towards significance was also observed with RVIP percentage of correct answers (p = 0.058). No treatment effect was observed on FMD. Our findings suggest that consumption of PEGB coupled with a healthy lifestyle may be a safe alternative to acutely improve working memory and attention during a sustained cognitive effort.

Introduction A new approach to treat obstructive sleep apnea (OSA) is upper airway stimulation therapy (UAS). Electrical pulses applied to the hypoglossal nerve induce tongue protrusion, increase airway patency and decrease the frequency of apneic and hypopneic events. Thus, the main objective of this study was to design a standardized evaluation of endobuccal adverse events induced by repeated tongue protrusion with both a dedicated questionnaire and an endobuccal examination. Method This study has designed the Tongue Adverse Event and Satisfaction Questionnaire (TAESQ) and an endobuccal examinations divided into an endobuccal lesion examination (ELE) and an endobuccal risk factor examination (ERFE). Evaluations were conducted at month 6 post-implantation. Results The study population after implantation of UAS device consisted of ten Caucasian males with a mean age of 51.9 ± 11.8 years, and a mean BMI of 28.6 ± 3.3. The AHI of the ten participants ranged from 46.7 ± 12.2/h at baseline to 14.5 ± 8.9/h with the Inspire therapy at the 6-month follow-up. The TAESQ revealed pain (30%), followed by less tongue sensitivity (20%) and tongue weakness (10%). The ELE did not reveal any lesions. The ERFE revealed that some participants had tissue and dental risk factors but not associated to more adverse events. Conclusion The TAESQ, ELE and ERFE have been designed and studied on a small number of participants. These evaluations could systematically be included in the care pathway of patients treated by UAS to better investigate tongue discomfort and tongue lesion for patients treated with this technology.

Background The COVID-19 crisis and consequent confinement restrictions have caused significant psychosocial stress and reports of sleep complaints, which require early management, have increased during recent months. To help individuals concerned about their sleep, we developed a smartphone-based app called KANOPEE that allows users to interact with a virtual agent dedicated to autonomous screening and delivering digital behavioral interventions. Objective Our objective was to assess the feasibility of this app, in terms of inclusion rate, follow-up rate, perceived trust and acceptance of the virtual agent, and effects of the intervention program, in the context of COVID-19 confinement in France. Methods The virtual agent is an artificial intelligence program using decision tree architecture and interacting through natural body motion and natural voice. A total of 2069 users aged 18 years and above downloaded the free app during the study period (April 22 to May 5, 2020). These users first completed a screening interview based on the Insomnia Severity Index (ISI) conducted by the virtual agent. If the users were positive for insomnia complaints (ISI score >14), they were eligible to join the 2-stage intervention program: (1) complete an electronic sleep diary for 1 week and (2) follow personalized sleep recommendations for 10 days. We collected and analyzed the following measures: sociodemographic information, ISI scores and sleep/wake schedules, and acceptance and trust of the agent. Results Approximately 76% (1574/2069) of the app users completed the screening interview with the virtual agent. The virtual agent was well accepted by 27.4% (431/1574) of the users who answered the acceptance and trust questionnaires on its usability, satisfaction, benevolence, and credibility. Of the 773 screened users who reported sleep complaints (ISI score >14), 166 (21.5%) followed Step 1 of the intervention, and only 47 of those (28.3%) followed Step 2. Users who completed Step 1 found that their insomnia complaints (baseline mean ISI score 18.56, mean ISI score after Step 1 15.99; P21) did not respond to either intervention. Conclusions These preliminary results suggest that the KANOPEE app is a promising solution to screen populations for sleep complaints and that it provides acceptable and practical behavioral advice for individuals reporting moderately severe insomnia.

Resume Les recommandations pour la prise en charge du syndrome d’apnee obstructive du sommeil (SAHOS) preconisent la realisation d’un examen otorhinolaryngologique (ORL) des voies aeriennes superieures (VAS) chez tous les patients, etant donne la participation d’anomalies anatomiques et fonctionnelles des VAS dans la survenue des apnees et hypopnees. Cette fiche pratique detaille un examen clinique simple et minimal des VAS que tout medecin du sommeil non specialiste ORL peut realiser. La conduite de cet examen impliquera 3 etapes : l’observation de la respiration du patient, la recherche de modifications dento-squelettiques et l’examen endo-buccal. L’ensemble de cet examen permettra, par la description semiologique precise, d’orienter au mieux le patient vers le specialiste ORL et d’echanger avec lui sur la base d’une evaluation clinique rigoureuse de depistage. Le specialiste ORL pourra par la suite completer cet examen et faire une evaluation en s’aidant d’un materiel adapte et indiquer des prises en charges specifiques du SAHOS.

Resume Le syndrome d’apnees et hypopnees obstructives du sommeil (SAHOS) constitue un probleme de sante publique majeur de par sa frequence et ses consequences notamment cardiovasculaires. La ventilation en pression positive continue est le traitement de reference (600 000 malades appareilles en France), cependant son observance n’est pas optimale. L’orthese d’avancee mandibulaire et les traitements chirurgicaux ont des indications restreintes, une efficacite inconstante et de potentiels effets secondaires irreversibles. La stimulation du nerf hypoglosse qui innerve le muscle genioglosse, muscle protrusor de la langue, est desormais une nouvelle option therapeutique en cas de SAHOS modere a severe. Deux types de stimulation sont actuellement disponibles : la stimulation synchrone a l’inspiration et la stimulation continue. L’indication specifique de chaque stimulation et les effets a long terme doivent encore etre evalues, mais la stimulation nerveuse implantable est un traitement prometteur pour les patients jusque-la sans solution de traitement.

Objective/background It has been shown that actigraphy may have a discriminant function (DS) for the diagnosis of narcolepsy type 1 patients (NT1), based on a combination of nighttime and daytime parameters. Here, we aimed to test those findings using another actigraph model with a different clinical sample as control (ie, primary insomniacs, PI), carrying out a secondary analysis of previously collected data. Patients/methods The study sample consisted of 13 NT1 (nine females; mean age 39.38 ± 11.48), 13 PI (nine females; mean age 38.69 ± 10.72) and 13 Healthy Controls (HC) (nine females; mean age 38 ± 10.77). Participants wore the Actiwatch AW64 (Cambridge Neurotechnology Ltd, Cambridge, UK) around the non-dominant wrist for seven consecutive days. Results Significant differences between groups were observed with a higher number of episodes of wakefulness (wake bouts, WB) in PI than HC, a higher fragmentation index (FI) in NT1 than HC and PI, a higher duration of the longest nap (LNAP) in NT1 than HC and PI and higher DS in PI and NT1 than HC. A new DS (NDS), with LNAP and FI as independent variables, was proposed; which was higher in NT1 than HC and PI. Conclusions The present study confirms that actigraphy discriminates NT1 from HC. However, considering PI, a new discriminant function NDS which takes into account LNAP and FI is better for this actigraph model.

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OBJECTIVE To quantify the objective level of sleepiness in adult attention-deficit/hyperactivity disorder (ADHD) patients and to determine the relationship between excessive daytime sleepiness and simulated driving performance. METHOD Forty adult ADHD patients (DSM-IV criteria) and 19 matched healthy control subjects were included between June 30, 2010, and June 19, 2013. All participants completed the Epworth Sleepiness Scale and the Manchester Driving Behavior Questionnaire. After nocturnal polysomnography, they performed 2 neuropsychological tests, a 4 × 40-minute Maintenance of Wakefulness Test, and a 1-hour driving session. The primary outcome measure was the mean sleep latency on the Maintenance of Wakefulness Test. ADHD patients were divided into 3 groups defined by their Maintenance of Wakefulness Test scores. Participants (patients and control subjects) were allocated as follows: sleepy ADHD (0-19 min), intermediate ADHD (20-33 min), alert ADHD (34-40 min), and control group (34-40 min). The driving performance outcome was the mean standard deviation of lateral position of the vehicle during the simulated session. RESULTS The group mean (SD) Epworth Sleepiness Scale score was higher in ADHD patients (12.1 [4.4]) than in controls (6.0 [2.7]) (P < .001). On the basis of the Maintenance of Wakefulness Test scores, 14 patients (35%) were in the sleepy group, 20 (50%) were in the intermediate group, and only 6 (15%) were in the alert group. Sleepy ADHD patients exhibited significantly deteriorated driving performance compared to the other 3 groups (P < .01). CONCLUSIONS Our study shows that a significant proportion of adult ADHD patients exhibit an objective excessive daytime sleepiness, which, in addition, has an impact on simulated driving performance. Excessive daytime sleepiness, therefore, may be a key element needed to better evaluate these ADHD patients. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01160874.

Virtual reality and simulation tools enable us to assess daytime functioning in environments that simulate real life as close as possible. Simulator sickness, however, poses a problem in the application of these tools, and has been related to pre-existing health problems. How sleep problems contribute to simulator sickness has not yet been investigated. In the current study, 20 female chronic insomnia patients and 32 female age-matched controls drove in a driving simulator covering realistic city, country and highway scenes. Fifty percent of the insomnia patients as opposed to 12.5% of controls reported excessive simulator sickness leading to experiment withdrawal. In the remaining participants, patients with insomnia showed overall increased levels of oculomotor symptoms even before driving, while nausea symptoms further increased after driving. These results, as well as the realistic simulation paradigm developed, give more insight on how vestibular and oculomotor functions as well as interoceptive functions are affected in insomnia. Importantly, our results have direct implications for both the actual driving experience and the wider context of deploying simulation techniques to mimic real life functioning, in particular in those professions often exposed to sleep problems.

Study objectives Sleepiness at the wheel is widely believed to be a cause of motor vehicle accidents. Nevertheless, a systematic review of studies investigating this relationship has not yet been published. The objective of this study was to quantify the relationship between sleepiness at the wheel and motor vehicle accidents. Methods A systematic review was performed using Medline, Scopus, and ISI Web of Science. The outcome measure of interest was motor vehicle accident defined as involving four- or two-wheeled vehicles in road traffic, professional and nonprofessional drivers, with or without objective consequences. The exposure was sleepiness at the wheel defined as self-reported sleepiness at the wheel. Studies were included if they provided adjusted risk estimates of motor vehicle accidents related to sleepiness at the wheel. Risk estimates and 95% confidence intervals (95% CIs) were extracted and pooled as odds ratios (ORs) using a random-effect model. Heterogeneity was quantified using Q statistics and the I2 index. The potential causes of heterogeneity were investigated using meta-regressions. Results Ten cross-sectional studies (51,520 participants), six case-control studies (4904 participants), and one cohort study (13,674 participants) were included. Sleepiness at the wheel was associated with an increased risk of motor vehicle accidents (pooled OR 2.51 [95% CI 1.87; 3.39]). A significant heterogeneity was found between the individual risk estimates (Q = 93.21; I2 = 83%). Conclusions Sleepiness at the wheel increases the risk of motor vehicle accidents and should be considered when investigating fitness to drive. Further studies are required to explore the nature of this relationship. Systematic review registration number PROSPERO 2015 CRD42015024805.

Background Since the clinical presentation of obstructive sleep apnea syndrome (OSAS) shares common features with major depressive (MDE), the screening of OSAS is challenging in this population. The aim of this study was to assess the effectiveness of the NoSAS score in predicting the presence of OSAS among participants with current MDE and to compare it with the performance of existing screening tools. Methods A random sample of the population-based cohort CoLaus (Lausanne, Switzerland) underwent a psychiatric evaluation (PsyCoLaus) and a complete polysomnography at home (HypnoLaus). The effectiveness of the NoSAS score in detecting the risk of significant OSAS among current MDE participants was assessed and compared with STOP-BANG and Berlin scores. Results Among the 1761 subjects (58,75 ± 11 y.o.; 47,8%men) who underwent polysomnography, significant OSAS was present in 24.0% with and 26.1% without current MDE. Using a threshold of ≥ 8 points, the NoSAS score identified OSAS in MDE participants with a sensitivity of 0.79, a specificity of 0.66, a negative predictive value of 0.91, and a positive predictive value of 0.41. The area under the ROC curve was 0.72 for NoSAS, 0.66 for STOP-BANG and 0.69 for the Berlin score (NS). Limitations Only 44% of the PsyCoLaus participants had a polysomnography. The studied population was mainly of Caucasian ancestry and above 40 years of age. Conclusions This is the first study assessing the performance of screening tools for OSAS in MDE. The NoSAS score is a simple and efficient screening tool for OSAS in this population, and may be a helpful instrument for clinicians.

Hyperarousal is a 24-h state of elevated cognitive and physiological activation, and is a core feature of insomnia. The extent to which sleep quality is affected by stressful events—so-called sleep reactivity—is a vulnerability factor for developing insomnia. Given the increasing prevalence of insomnia with age, we aimed to investigate how hyperarousal and sleep reactivity were related to insomnia severity in different adult age groups. Data were derived from a large cohort study investigating the natural history of insomnia in a population-based sample (n = 1693). Baseline data of the Arousal Predisposition Scale (APS) and Ford Insomnia Response to Stress Test (FIRST) were examined across age and sleep/insomnia subgroups: 25–35 (n = 448), 35–45 (n = 528), and 45–55 year olds (n = 717); good sleepers (n = 931), individuals with insomnia symptoms (n = 450), and individuals with an insomnia syndrome (n = 312). Results from factorial analyses of variance (ANOVA) showed that APS scores decreased with increasing age, but increased with more severe sleep problems. FIRST scores were not significantly different across age groups, but showed the same strong increase as a function of sleep problem severity. The findings indicate that though arousal predisposition and sleep reactivity increase with more severe sleep problems, only arousal decreases with age. How arousing events affect an individual during daytime thus decreases with age, but how this arousal disrupts sleep is equivalent across different adult age groups. The main implication of these findings is that treatment of insomnia could be adapted for different age groups and take into consideration vulnerability factors such as hyperarousal and stress reactivity.

International audience; In the new international classification of sleep disorders (ICSD-3), narcolepsy is differentiated into two distinct pathologies: type 1 narcolepsy (NT1) and type 2 narcolepsy (NT2). NT1 is characterised by periods of an irrepressible need to sleep, cataplexy (a sudden loss of muscle tone triggered by emotion) and in some cases the presence of symptoms such as hypnagogic hallucinations, sleep paralysis and disturbed night-time sleep. Its physiopathology is based on the loss of hypocretin neurons in the hypothalamus, seemingly connected to an auto-immune process. By definition, cataplexy is absent and the hypocretin levels in the CSF are normal in NT2. Confirming the diagnosis requires polysomnography and multiple sleep latency tests. The choice of further investigations is based on the presence or absence of typical cataplexy. Further investigations include HLA typing, lumbar puncture to measure the hypocretin level in the CSF, or even brain imagery in the case of narcolepsy suspected to be secondary to an underlying pathology. In this consensus we propose recommendations for the work-up to be carried out during diagnosis and follow-up for patients suffering from narcolepsy.

The links between sleep and attention-deficit hyperactivity disorder (ADHD) have been a topic of ongoing research and clinical interest in children over the last three decades and more recently in adults suffering from ADHD. Clinically, psychiatrists are faced with frequent reports of sleep disorders in adults and children with ADHD and conversely, sleep specialists report certain symptoms of ADHD (attention deficits, urge for fidgeting) in patients suffering from primary sleep disorders. Excessive sleepiness is found in ADHD and sleep disorders such as hypersomnia, sleep breathing disorder (SDB), periodic limb movements in sleep (PLMS) and circadian rhythm disorders. This has encouraged authors to suggest a model of ADHD involving a deficit in alertness. The aim of this article is to clarify the pathophysiological rationale for the relationship between sleep/arousal and attention-deficit/hyperactivity disorder and to explore future perspectives in terms of management, treatment and development of research fields.

Objective To investigate the evolution over 15 years of sleep schedules, sleepiness at the wheel and driving risk among highway drivers. Methods Comparative survey including questions on usual sleep schedules and before the trip, sleepiness at the wheel, the Epworth sleepiness scale, Basic Nordic Sleep Questionnaire (BNSQ) and a travel questionnaire. Results 80% of drivers stopped by the highway patrol agreed to participate in both studies with a total of 3545 drivers in 2011 and 2196 drivers in 1996 interviewed. After standardisation based on sex, age and mean annual driving distance, drivers in 2011 reported shorter sleep time on week days (p15 indicating severe sleepiness. Conclusions Even if drivers in 2011 reported good sleep hygiene prior to a highway journey, drivers have reduced their mean weekly sleep duration over 15 years and have a higher risk of sleepiness at the wheel. Sleep hygiene for automobile drivers remains an important concept to address.

Studies assessing the impact of epilepsy and its medication on the risk of road traffic crashes have shown inconsistent results. The aim in this study was to assess this risk using French databases. Data from three French national databases were extracted and matched: the national health care insurance database, police reports, and the national police database of injurious crashes. Only antiepileptics prescribed predominantly in epilepsy were studied (phenobarbital, phenytoin, ethosuximide, valproic acid, vigabatrin, tiagabin, levitiracetam, zonisamide, and lacosamide). A case-control analysis comparing responsible and non-responsible drivers and a case-crossover analysis were performed. Drivers (72 685) involved in an injurious crash in France between July 2005 and May 2008, were included. Drivers exposed to prescribed antiepileptic medicines (n = 251) had an increased risk of being responsible for a crash (OR 1.74 [1.29-2.34]). The association was also significant for the most severe epileptic patients (n = 99; OR = 2.20 [1.31-3.69]). Case-crossover analysis found no association between crash risk and treatment prescription. Patients with prescription of antiepileptic drugs should be cautioned about their potential risk of road traffic crash. This risk is however more likely to be related to seizures than to the effect of antiepileptic medicines.

The Sensory Gating Inventory (SGI) is a questionnaire composed of 36 items designed to investigate abnormal perception related to the inability to control sensitivity to sensory stimuli frequently reported in adult with ADHD. This questionnaire can be considered too lengthy to be taken by people with ADHD, and a shortened version is needed. One hundred and sixty-three adults with ADHD responded to the SGI-36. An item reduction process took into account both the results of statistical analyses and the expertise of a steering committee. Construct validity, reliability, and external validity were tested for a short version (16 items). The structure of the SGI-16 was confirmed by principal components factor analysis. Cronbach’s alpha coefficients ranged from 0.78 to 0.89. The SGI-16 dimension scores were highly correlated with their respective SGI-36 dimension scores. The SGI-16 seems to be both appropriate and useful for use in clinical practice to investigate perceptual abnormalities in adults with ADHD.