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Conditionally automated vehicles (Level 3 SAE) are emerging on the roads, but long periods without engaging in a non-driving-related task can reduce drivers’ vigilance. This study aims to determine whether driver fatigue can be accurately predicted using physiological signals and machine learning (ML) techniques in such a context. 63 young drivers completed two separate conditional automated drives of 30 min each, in either a rural or a urban area. Half of them had been mildly sleep-deprived the previous night (slept less than six hours). Electrocardiogram (ECG), electrodermal activity (EDA), and respiration were collected, along with subjective measures of sleepiness and affective state. Using ML, sleep deprivation, driving environment, and sleepiness could be predicted from physiological features with an accuracy of 99%, 85%, and 73% respectively. Signal segmentation increased model accuracy, and EDA features were the most predictive. The differences between the results obtained from statistical analyses of sleepiness measures and the accuracy achieved by ML models are discussed. The results of this empirical study indicate that even mild sleep deprivation affects the physiological state of drivers, which can have serious consequences when combined with long periods of inactivity. Car manufacturers and researchers should take this into account when designing intelligent systems capable of providing drivers with appropriate warnings before a critical situation arises.

In adults, nightmare disorder is related to sleep deprivation, drug consumption or abuse, or other comorbid sleep disorders such as insomnia or insufficient sleep syndrome. Behavioral treatment has solid scientific evidence in disorders such as insomnia and, more recently, parasomnias. The aim of the present study was to investigate the clinical effectiveness of a Brief Behavioral Telemedicine Therapy in Nightmare Disorder in a 23-year-old female patient. The procedure consisted of the case study, with pre and posttreatment measures as well as follow-up after 1 month; and the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Paris Arousal Disorders Severity Scale, and a sleep diary were applied. In parallel with changes recorded in the sleep diary, a decrease in nightmares, sleepiness, and insomnia symptoms was observed when the intervention was finished. The behavioral intervention was clinically effective; therefore, the present case report provides information on behavioral treatments for nightmare disorder.

Purpose: This study examined the impact of sleep inertia on physical, cognitive, and subjective performance immediately after a 1- or 2-hour afternoon nap opportunity. Methods: Twelve well-trained male athletes completed 3 conditions in a randomized, counterbalanced order—9 hours in bed overnight without a nap opportunity the next day (9 + 0), 8 hours in bed overnight with a 1-hour nap opportunity the next day (8 + 1), and 7 hours in bed overnight with a 2-hour nap opportunity the next day (7 + 2). Nap opportunities ended at 4:00 PM. Sleep was assessed using polysomnography. Following each condition, participants completed four 30-minute test batteries beginning at 4:15, 4:45, 5:15, and 5:45 PM. Test batteries included a warm-up, self-ratings of readiness to perform, motivation to perform and expected performance, two 10-m sprints, 2 agility tests, a 90-second response-time task, and 5 minutes of seated rest. Results: Total sleep time was not different between conditions (P =.920). There was an effect of condition on readiness (P <.001), motivation (P =.001), and expected performance (P =.004)—all 3 were lower in the 8 + 1 and 7 + 2 conditions compared with the 9 + 0 condition. There was no effect of condition on response time (P =.958), sprint time (P =.204), or agility (P =.240), but a large effect size was observed for agility. Conclusions: After waking from a nap opportunity, agility may be reduced, and athletes may feel sleepy and not ready or motivated to perform. Athletes should schedule sufficient time (∼1 h) after waking from a nap opportunity to avoid the effects of sleep inertia on performance. [ABSTRACT FROM AUTHOR]

Study objectivesWe evaluated if self-reported sleepiness was associated with neuroimaging markers of brain aging and ischemic damage in a large community-based sample.MethodsParticipants from the Framingham Heart Study Offspring cohort (n = 468, 62.5 ± 8.7 years old, 49.6%M) free of dementia, stroke, and neurological diseases, completed sleep questionnaires and polysomnography followed by magnetic resonance imaging (MRI), 3 years later on average. We used linear and logistic regression models to evaluate the associations between Epworth Sleepiness Scale (ESS) scores and total brain, cortical and subcortical gray matter, and white matter hyperintensities volumes, and the presence of covert brain infarcts.ResultsHigher sleepiness scores were associated with larger total brain volume, greater cortical gray matter volume, and a lower prevalence of covert brain infarcts, even when adjusting for a large array of potential confounders, including demographics, sleep profiles and disorders, organic health diseases, and proxies for daytime cognitive and physical activities. Interactions indicated that more sleepiness was associated with larger cortical gray matter volume in men only and in APOE ε4 noncarriers, whereas a trend for smaller cortical gray matter volume was observed in carriers. In longitudinal analyses, those with stable excessive daytime sleepiness over time had greater total brain and cortical gray matter volumes, whereas baseline sleepiness scores were not associated with subsequent atrophy or cognitive decline.ConclusionOur findings suggest that sleepiness is not necessarily a marker of poor brain health when not explained by diseases or sleep debt and sleep disorders. Rather, sleepiness could be a marker of preserved sleep-regulatory processes and brain health in some cases.

OBJECTIVES: To characterize the treatment goals and values of adult patients with obstructive sleep apnea (OSA). STUDY DESIGN: Mixed methods design based on semistructured interviews followed by cross-sectional surveys. SETTING: Academic medical center and integrated managed care consortium. METHODS: Phase 1 involved qualitative analysis of focus groups and interviews to define treatment goal categories. Phase 2 included analysis of cross-sectional surveys on most important treatment goals from patients with OSA presenting to sleep surgery clinic. Positive airway pressure (PAP) use, Epworth Sleepiness Scale score, and apnea-hypopnea index were obtained to determine influences on goal choices. RESULTS: During focus groups and interviews, treatment goal themes identified included improving sleep quality, reducing daytime sleepiness, snoring sound reduction, and health risk reduction. In phase 2, 536 patients were surveyed, and they reported the primary treatment goals of health risk reduction (35%), sleep quality improvement (28%), daytime sleepiness improvement (21%), and snoring sound reduction (16%). The primary treatment goal was associated with age (P < .0001), excessive daytime sleepiness (Epworth Sleepiness Scale score >10, P < .0001), PAP use status (P < .0001), and OSA severity (apnea-hypopnea index, P < .0001). Severity of OSA was associated with increasing proportion of patients choosing health risk reduction as the main treatment goal (P < .05). CONCLUSIONS: Adult OSA treatment goal choices vary with age, symptoms, PAP history, and OSA severity. Understanding patient-specific goals is the essential first step in the shared decision-making process when choosing surgical or nonsurgical treatments. Ultimately, goal-focused discussions ensure alignment of priorities and definitions of success between the patient and the provider.

Yousef D Alqurashi,1 Abdullah S Alqarni,1 Faisal Maher Albukhamsin,1 Abdullah Abdulaziz Alfaris,1 Bader Ibrahim Alhassan,1 Waleed Khalid Ghazwani,1 Abdulaziz Abdulrahman Altammar,1 Mutlaq Eid Aleid,1 Hayfa Almutary,2 Abdulelah M Aldhahir,3 Saleh A Alessy,4 Rayyan Almusally,5 Abir Alsaid,5 Mahmoud Ibrahim Mahmoud,5 Hatem Othman Qutub,5 Tunny Sebastian,6 Suliman Alghnam,7 Michael I Polkey8 1Respiratory Care Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2Medical Surgical Nursing Department, King Abdulaziz University, Jeddah, Saudi Arabia; 3Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; 4Department of Public Health, College of Health Sciences, Saudi Electronic University, Jeddah, Saudi Arabia; 5Internal Medicine Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia; 6Clinical Nutrition Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 7Population Health Section-King Abdullah International Medical Research Center (KAIMRC), King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia; 8Royal Brompton Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UKCorrespondence: Yousef D Alqurashi, Respiratory Care Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, 34221, Saudi Arabia, Email ydalqurashi@iau.edu.saIntroduction: Sleepy driving is associated with Motor Vehicles Accidents (MVAs). In Saudi Arabia, previous studies have addressed this association among men only. Therefore, the aim of this study was to compare the prevalence of sleepy driving and associated factors between genders.Methods: In a cross-sectional study design, we offered a self-administered online questionnaire to 3272 participants from different regions of Saudi Arabia. The questionnaire included 46 questions covering sociodemographics, driving habits, sleeping habits, Epworth Sleepiness Scale, and Berlin questionnaire to assess the risk of sleep apnea. Univariable and multivariable logistic regression analyses were used to determine the significant factors associated with self-reported sleepy driving, defined as operating a motor vehicle while feeling sleepy in the preceding six months.Results: Of the 3272 invitees, 2958 (90%) completed the questionnaire, of which 1414 (48%) were women. The prevalence of sleepy driving in the preceding six months was 42% (men: 50% and women 32%, p< 0.001). Specifically, participants reported the following: 12% had had to stop their vehicle due to sleepiness (men: 16.2% and women 7%, p< 0.001), 12.4% reported near-miss accidents (men: 16.2% and women: 8.2%, p< 0.001) and 4.2% reported an accident due to sleepiness (men: 4.3% and women: 4%, p=0.645). In multivariable analysis, being male, younger age, use of any type of medications, shift working, working more than 12 hours per day, driving duration of 3– 5 hours per day, driving experience of more than 2 years, excessive daytime sleepiness and risk of having obstructive sleep apnea were all associated with increased likelihood of falling asleep while driving in the preceding 6 months.Conclusion: Sleepy driving and MVA are prevalent in both gender but was higher in men. Future public health initiatives should particularly focus on men, since men reported a greater likelihood of both sleep-related MVA and “near miss” events.Keywords: sleepiness, driving, obstructive sleep apnea, OSA, gender differences

OBJECTIVES: This study aimed to test the effect of a 30-minute nap versus a 2-hour nap opportunity taken during a simulated night shift on performance, fatigue, sleepiness, mood, and sleep at the end of shift and during post-night shift recovery. METHODS: We conducted a randomized crossover trial of three nap conditions (30-minute, 2-hour, and no-nap) during 12-hour simulated night shifts. We tested for differences in performance, fatigue, sleepiness, mood, and sleep during in-lab and at-home recovery. Performance was measured with the Brief Psychomotor Vigilance Test (PVT-B). Subjective ratings were assessed with single-item surveys. RESULTS: Twenty-eight individuals consented to participate [mean age 24.4 (standard deviation 7.2) years; 53.6% female; 85.7% Emergency Medical Services clinicians]. PVT-B false starts at the end of the 12-hour night shift (at 07:00 hours) and at the start of in-lab recovery (08:00 hours) were lower following the 2-hour nap versus other conditions (P0.05). Sleepiness, fatigue, and some mood states were lower at most hourly assessments during the in-lab recovery period following the 2-hour nap condition compared to the other conditions. Sleep during recovery did not differ by duration of night shift nap. CONCLUSIONS: A 2-hour nap opportunity versus a 30-minute or no-nap opportunity is beneficial for performance, alertness, and mood post-night shift. No differences were detected in sleep during recovery.

The growing population of older adults in the U.S. is experiencing increased food insecurity and stress, which are associated with nocturnal sleep quality and consequently excessive daytime sleepiness. This study aimed to investigate the relationship between food insecurity and perceived stress on daytime sleepiness in older adults aged 60 and older living in New York City. This cross-sectional, quantitative study utilized the US Household Food Security Survey Module six-item questionnaire, the Perceived Stress Scale (PSS), and Sleepiness Total to collect data. Participants completed an online survey via Qualtrics. Linear and logistic regression models were used to assess the association between demographic variables and food insecurity, perceived stress, and daytime sleepiness outcomes. Three hundred seventy-eight (378) older adults participated in this study. Food insecurity was associated with age (p = 0.045), education (p = 0.022), and daytime sleepiness (p < 0.001). On average, participants with a BMI of over 30 had an increased daytime sleepiness total relative to a BMI < 25 (p = 0.029), and those with two to three health conditions and those with more than four health conditions had higher daytime sleepiness totals relative to those with zero to one condition (p = 0.007 and 0.007, respectively). Participants who had moderate and high stress, regardless of food security status, had higher daytime sleepiness totals than those with low stress (food secure; p = 0.002; food insecure; p < 0.001). Multifaceted interventions are needed to alleviate food insecurity, manage stress, and reduce excessive daytime sleepiness among older adults.

Study objectivesMany people living with human immunodeficiency virus (PLWH) have undiagnosed obstructive sleep apnea (OSA), which may contribute to commonly reported fatigue and the high cardiovascular disease burden in this population. Our objective was to assess the utility of traditional OSA screening tools (STOP-BANG, Berlin Questionnaire, and Epworth Sleepiness Scale) for detecting OSA in PLWH.MethodsAdult PLWH were recruited from sleep/ human immunodeficiency virus clinics and the community into a larger clinical trial that included completion of these questionnaires before in-laboratory polysomnography. Discriminatory performance of these screening tools was assessed using area under receiver operating characteristic curves (AUC). The reference standard for the primary analysis was OSA based on an apnea-hypopnea index ≥ 5 events/h using recommended "1A"-criteria (hypopnea with 3% desaturation and/or arousal). Secondary analyses explored acceptable "1B"-criteria (hypopnea with 4% desaturation) and/or higher apnea-hypopnea index cut-offs (≥ 15 events/h).Results120 PLWH were included (mean age: 50 ± 11 years; body mass index: 27 ± 4 kg/m2, 84% male) and OSA was diagnosed in 75% using 1A-criteria. In the primary analysis, the discriminatory performance of the 3 screening tools was low (AUCs 0.58 to 0.70) and similar across the tools (P ≥ .14). In secondary analyses, STOP-BANG showed moderate-high discriminatory ability (AUCs 0.77-0.80) and performed significantly better (P ≤ .008) than the Berlin Questionnaire or Epworth Sleepiness Scale (AUCs 0.53-0.62).ConclusionsOSA was highly prevalent in our cohort of PLWH. Although STOP-BANG could reasonably identify moderate-severe OSA, the tools were not reliable for mild disease. Specifically, the questionnaires perform poorly for PLWH with mild OSA manifesting with arousals, yet such people may be at risk of fatigue/sleepiness and impaired memory consolidation.Clinical trial registrationRegistry: ClinicalTrials.gov; Title: Obstructive Sleep Apnea Endotypes and Impact on Phenotypes of People Living with HIV (PLWH/OSA); Identifier: NCT03575143; URL: https://clinicaltrials.gov/ct2/show/NCT03575143.CitationSchmickl CN, Bosompra N-O, DeYoung PN, et al. Diagnostic performance of screening tools for the detection of obstructive sleep apnea in people living with HIV. J Clin Sleep Med. 2022;18(7):1797-1804.

Shift work is associated with circadian misalignment, which causes sleep loss, impairs performance, and increases the risk of accidents. Shorter, more frequently shifting watch schedules, widely used in industries such as maritime operation, defense, and mining, may mitigate these risks by reducing shift length and providing sleep opportunities for all workers across the biological night. However, the effects of frequently shifting work on sleep and performance still need to be clarified. The current study investigated the vigilance, sleepiness, and sleep patterns of fifteen participants who lived in a controlled and confined laboratory that mimicked a maritime environment for 14 d following a simulating frequent shift schedule. The results of psychomotor vigilance tasks (PVT) suggest that this shift schedule may lead to an accumulation of vigilance detrimental across watch days, with both reaction speed impairment and error growth. Furthermore, the circadian phase significantly affects PVT performance, with the afternoon shift section showing relatively better performance. Overall, more working hours per day resulted in poorer PVT performance. As the shift progressed, total sleep duration reduced slightly, and wake after sleep onset (WASO) increased. Sleep during the biological night was generally longer than sleep in the daytime. Less on-watch time was linked to longer overall sleep duration. Additionally, although the subjective sleepiness obtained by the Karolinska Sleepiness Scale (KSS) varied insignificantly across days, the KSS score was negatively correlated with PVT performance. This research can serve as a foundation for developing countermeasures to mitigate frequently shifting schedules' potentially detrimental effects and safety risks. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is common but under-recognized after stroke. The aim of this study was to determine whether post-stroke phenotypic OSA subtypes are associated with stroke outcome in a population-based observational cohort. Ischemic stroke patients (n = 804) diagnosed with OSA (respiratory event index ≥10) soon after ischemic stroke were identified from the Brain Attack Surveillance in Corpus Christi (BASIC) project. Functional, cognitive, and quality of life outcomes were assessed at 90 days post-stroke and long-term stroke recurrence was ascertained. Latent profile analysis was performed based on demographic and clinical features, pre-stroke sleep characteristics, OSA severity, and vascular risk factors. Regression models were used to assess the association between phenotypic clusters and outcomes. Four distinct phenotypic clusters provided the best fit. Cluster 1 was characterized by more severe stroke; cluster 2 by severe OSA and higher prevalence of medical comorbidities; cluster 3 by mild stroke and mild OSA; and cluster 4 by moderate OSA and mild stroke. Compared to cluster 3 and after adjustment for baseline stroke severity, cluster 1 and cluster 2 had worse 90-day functional outcome and cluster 1 also had worse quality of life. No difference in cognitive outcome or stroke recurrence rate was noted by cluster. Post-stroke OSA is a heterogeneous disorder with different clinical phenotypes associated with stroke outcomes, including both daily function and quality of life. The unique presentations of OSA after stroke may have important implications for stroke prognosis and personalized treatment strategies. • Patients with post-stroke obstructive sleep apnea are a heterogeneous group. • Among post-stroke patients with OSA, 90-day outcomes differed by phenotypic clusters. • The cluster with the most severe OSA was associated with worse functional outcome. [ABSTRACT FROM AUTHOR]

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• A novel backward prediction study of post-drive sleepiness and real driving events. • Post drive sleepiness does reflect earlier drowsy driving behaviour. • Younger drivers show better awareness relative to older drivers. • Optimal thresholds for post-drive sleepiness assessments are proposed. • These data inform post-crash interviews for suspected fall asleep crashes. Determining causality and driver culpability in fall asleep crashes requires extensive forensic examination, with post-crash interviews forming a critical part of the process. To date, there is no evidence regarding whether drivers' recollection of sleepiness and associated symptoms accurately reflects driving impairment during an earlier drive. To address this, our study examined whether established questionnaires assessing sleepiness (Karolinska Sleepiness Scale) and sleepiness symptoms (Sleepiness Symptoms Questionnaire) taken post-drive accurately reflected earlier driving impairment as characterised by near-crash events and lane deviations during a closed loop track drive. Sixteen younger (21–33 years) and seventeen older (50–65 years) drivers completed two 2 h afternoon track drives under supervision of a licensed driving instructor under two conditions: well rested (8 h sleep opportunity) and sleep deprived (0 h sleep). For younger drivers, all sleepiness symptoms (except mind wandering) significantly predicted prior severe (near-crashes AUC 0.78–1.00) and moderate (lane deviations AUC 0.78–0.94) driving impairment, with good to excellent accuracy. For older drivers, only severe impairment was accurately reflected in post-drive ratings (near crashes AUC 0.86–0.94), and for fewer symptoms (8/9 vs. 6/9). Optimal thresholds for the frequency of these symptoms, in addition to thresholds for minimum acceptable false positives are presented. Our data suggest that post-crash interviews should utilise questions around subjective sleepiness and associated symptoms, providing evidence regarding the presence and awareness of drowsiness while driving, taking into account the reliability of self-report evidence. This may aid in the investigation of fall-asleep crashes where drowsiness is suspected. [ABSTRACT FROM AUTHOR]

Biomathematical models (BMMs) are parametric models that quantitatively predict fatigue and are routinely implemented in fatigue risk management systems in increasingly diverse workplaces. There have been consistent calls for an improved 'next generation' of BMMs that provide more accurate and targeted predictions of human fatigue. This article examines the core characteristics of next-generation advancements in BMMs, including tailoring with field data, individual-level parameter tuning and real-time fatigue prediction, extensions to account for additional factors that influence fatigue, and emerging nonparametric methodologies that may augment or provide alternatives to BMMs. Examination of past literature and quantitative examples suggests that there are notable challenges to advancing BMMs beyond their current applications. Adoption of multi-model frameworks, including quantitative joint modelling and machine-learning, was identified as crucial to next-generation models. We close with general recommendations for researchers, practitioners, and model developers, including focusing research efforts on understanding the cognitive dynamics underpinning fatigue-related vigilance decrements, applying emerging dynamic modelling methods to fatigue data from field settings, and improving the adoption of open scientific practices in fatigue research. [ABSTRACT FROM AUTHOR]

/Background: The change in cerebral hemodynamics induced by sleep apneas and hypopneas may contribute to the daytime sleepiness in patients with obstructive sleep apnea (OSA). However, previous studies failed to discovery their relationship. We propose and test a new parameter, the cumulative brain oxygen desaturation, which may contribute to OSA patient's daytime sleepiness. 22 patients with severe OSA (apnea-hypopnea index (AHI) at diagnosis [mean ± standard deviation, std.]: 52.1 ± 21.6/h, median: 45.1/h, interquartile range: 34.4–60.2/h) were monitored by polysomnography during routine continuous positive airway pressure titration. The reductions of brain tissue oxygen saturation (StO2) in all respiratory events at baseline sleep were measured by frequency-domain near-infrared spectroscopy (NIRS). The cumulative brain desaturation was calculated as AHI times the mean StO2 desaturation (i.e., AHI × Δ StO 2 ‾). Similarly, cumulative peripheral desaturation was also calculated, i.e., AHI × Δ Sp O 2 ‾ where Δ SpO 2 ‾ was the mean reduction of peripheral arterial oxygen saturation (SpO2). The correlations between Epworth sleepiness scale (ESS) and AHI, Δ StO 2 ‾ , AHI × Δ StO 2 ‾ , and AHI × Δ Sp O 2 ‾ were tested, respectively. Linear regression was applied to predict ESS using AHI × Δ StO 2 ‾ and AHI × Δ Sp O 2 ‾ , with age and BMI as covariates. ESS significantly correlates to the cumulative brain desaturation (Pearson's correlation coefficient: 0.68, p = 0.00056), not the other parameters. Regression analysis only finds significant association between ESS and the cumulative cerebral desaturation (p = 0.00195) but not the cumulative peripheral desaturation (p = 0.71). The cumulative brain oxygen desaturation, which comprehensively combines total sleep time, the frequency of apnea and hypopnea events, and the severity of cerebral oxygen desaturation, is a new indicator for daytime sleepiness in severe OSA. • Whether daytime sleepiness in OSA is related to brain oxygen desaturation is unknown. • We propose a new parameter named cumulative brain oxygen desaturation. • This new parameter is highly correlated to subjective daytime sleepiness in OSA. • Their association is confirmed by regression analysis controlling for cofounders. • This new parameter opens a new avenue to study daytime sleepiness in OSA. [ABSTRACT FROM AUTHOR]

Microbial antigens can elicit an immune response leading to the production of autoantibodies cross-reacting with autoantigens. Still, their clinical significance in human sera in the context of brain diseases is unclear. Therefore, assessment of natural autoantibodies reacting with their neuropeptides may elucidate the autoimmune etiology of central hypersomnias. The study aims to determine whether serum autoantibody levels differ in patients with different types of central hypersomnias (narcolepsy type 1 and 2, NT1 and NT2; idiopathic hypersomnia, IH) and healthy controls and if the differences could suggest the participation of autoantibodies in disease pathogenesis. Sera from 91 patients with NT1, 27 with NT2, 46 with IH, and 50 healthy controls were examined for autoantibodies against assorted neuropeptides. Participants were screened using questionnaires related to sleep disorders, quality of life, and mental health conditions. In addition, serum biochemical parameters and biomarkers of microbial penetration through the intestinal wall were determined. A higher prevalence of autoantibodies against neuropeptides was observed only for alpha-melanocytes-stimulating hormone (α-MSH) and neuropeptide glutamic acid-isoleucine (NEI), which differed slightly among diagnoses. Patients with both types of narcolepsy exhibited signs of microbial translocation through the gut barrier. According to the questionnaires, patients diagnosed with NT2 or IH had subjectively worse life quality than patients with NT1. Patients displayed significantly lower levels of bilirubin and creatinine and slightly higher alkaline phosphatase values than healthy controls. Overall, serum anti-neuronal antibodies prevalence is rare, suggesting that their participation in the pathophysiology of concerned sleep disorders is insignificant. Moreover, their levels vary slightly between diagnoses indicating no major diagnostic significance. [Display omitted] • anti-neuronal antibodies' participation in the pathophysiology of central hypersomnias is insignificant • Patients with narcolepsy exhibited signs of microbial translocation through the gut barrier • Bilirubin and creatinine levels were decreased in patients with central hypersomnias • Patients with NT2 or IH had subjectively worse life quality than patients with NT1 • Results of this study support the hypothesis, that narcolepsy type 2 and idiopathic hypersomnia might merge in one diagnosis [ABSTRACT FROM AUTHOR]

Cognitive impairments are described in central disorders of hypersomnolence (CDH), but studies remain very limited and largely focused on narcolepsy type 1 (NT1). The precise nature and origin of these cognitive impairments is poorly understood. Specifically, impaired decision making under ambiguity has been reported in NT1 and suggested to be caused by dysregulation of the direct projections of hypocretin neurons to the dopamine network. However, the decision-making tasks used previously embed different cognitive functions that are difficult to isolate. This study aims to test reinforcement learning in participants with NT1 and with other (non-hypocretin deficient) CDH in a task known to directly depend on the dopamine system. Participants with NT1 (N = 27), other CDH (N = 34, including narcolepsy type 2 and idiopathic hypersomnia, matched with NT1 participants for sleepiness severity), and healthy participants (N = 34) took part in the study. Results showed that all groups had normal and similar positive reinforcement learning, a pattern not suggestive of dopamine deficiency. However, both participants with NT1 and other CDH had decreased learning abilities to avoid losses. This decreased negative reinforcement learning in participants with CDH was associated with the alteration of vigilance. This study provides new insights into the nature of decision making impairment in people with CDH and suggests that these alterations could be minimized by restoring adequate vigilance. • Negative reinforcement learning is altered in central disorder of hypersomnolence. • Altered reinforcement learning is not specific to narcolepsy type 1. • Decreased learning after negative feedback is linked to sleepiness. [ABSTRACT FROM AUTHOR]

to prospectively assess sleep and sleep disorders during pregnancy and postpartum in a large cohort of women. multicenter prospective Life-ON study, recruiting consecutive pregnant women at a gestational age between 10 and 15 weeks, from the local gynecological departments. The study included home polysomnography performed between the 23rd and 25th week of pregnancy and sleep-related questionnaires at 9 points in time during pregnancy and 6 months postpartum. 439 pregnant women (mean age 33.7 ± 4.2 yrs) were enrolled. Poor quality of sleep was reported by 34% of women in the first trimester of pregnancy, by 46% of women in the third trimester, and by as many as 71% of women in the first month after delivery. A similar trend was seen for insomnia. Excessive daytime sleepiness peaked in the first trimester (30% of women), and decreased in the third trimester, to 22% of women. Prevalence of restless legs syndrome was 25%, with a peak in the third trimester of pregnancy. Polysomnographic data, available for 353 women, revealed that 24% of women slept less than 6 h, and 30.6% of women had a sleep efficiency below 80%. Sleep-disordered breathing (RDI≥5) had a prevalence of 4.2% and correlated positively with BMI. The Life-ON study provides the largest polysomnographic dataset coupled with longitudinal subjective assessments of sleep quality in pregnant women to date. Sleep disorders are highly frequent and distributed differently during pregnancy and postpartum. Routine assessment of sleep disturbances in the perinatal period is necessary to improve early detection and clinical management. • Sleep disorders are very frequent during pregnancy and puerperium. • Sleepiness peaks in the first trimester of pregnancy. • Insomnia and low sleep quality peak in the immediate post-partum period. • Multiparity is a risk factor for insomnia and low quality of sleep. • 25% of women reported restless legs syndrome during pregnancy. [ABSTRACT FROM AUTHOR]

Introduction: Students’ mental health disorders are widespread, but it seems that social awareness around the subject is not ideal. The aim of the study was to identify possible causes of depressive and anxiety disorders and the level of drowsiness among medical students in Poland. Material and methods: An online questionnaire was used to gather data. 2339 completed questionnaires were collected. The original questionnaire contained 4 parts: student’s life, the Beck Depression Inventory, the GAD-7 general anxiety questionnaire and the Epworth Sleepiness Scale. Results: More than half (65%) of respondents reported a lack of free time for any non-university activity. Among them, 70.6% achieved a moderate or severe depression result and 55.1% moderate or severe anxiety. 43.6% of students reported spending more than 4 hours per day on studying and the learning effects are satisfactory for only 10.5% of students. Only 11.1% of participants were satisfied with their university lives, although 50.4% of subjects have an average score between 4.01 and 5.00. Out of those who were not satisfied with their lives at university, as many as 94.0% showed signs of moderate or severe depression. Students satisfied with their lives at university more often reported participating in non-university activities and achieved better results in the ESS, Beck Depression Inventory and GAD-7. Conclusions: Overload of responsibilities often caused problems with non-university activities. According to our research, those aspects have a significant impact on well-being and students’ mental health. It would therefore be useful to learn time management and revision of the teaching overload. [ABSTRACT FROM AUTHOR]

Objective: To investigate the subjective risk for obstructive sleep apnea (OSA) in adolescents and young adults with isolated Robin sequence (IRS). Additionally, to investigate the association of OSA risk with respiratory signs/symptoms, and retrognathia. Design: Prospective, observational, and cross-sectional study. Setting: Tertiary reference hospital for the rehabilitation of craniofacial anomalies. Participants: Adolescents and adults (n = 30) with IRS were clinically evaluated and screened through the Berlin Questionnaire (BQ) and Respiratory Symptoms Questionnaire. The maxillomandibular relationship was assessed on lateral cephalograms of those that reached skeletal maturity (n = 13). Polysomnography (PSG) was performed in a subgroup of 4 individuals. Results: The mean age of the sample was 18.2 (±3.4) years, 17 (56.7%) were adolescents (14-19 years), and 16 were (53.3%) female, all presented a repaired cleft palate. Clinical Parameters: Systemic arterial pressure (118.0 ± 4.1/76.3 ± 4.9 mmHg), body mass index (BMI) (20.9 ± 2.8 kg/m2), neck (33.2 ± 2.3 cm), and waist circumferences (72.0 ± 5.8 cm) were within normal ranges. A skeletal class I pattern was observed in 61.5% of the participants while a class II was seen in 15.4% of them. A high risk for OSA was detected in 16.7%, and it was associated with nasal obstruction, snoring and drowsiness, and a skeletal class II pattern (P ≤.05). One patient presented with mild OSA (apnea–hypopnea index [AHI] = 10.1 events/hour) at the PSG exam. Conclusions: A high risk for OSA can be observed with a moderate frequency among adolescents and young adults with IRS, especially among those who are concurrently suffering from nasal obstruction, snoring and retrognathia. [ABSTRACT FROM AUTHOR]

Dim light melatonin onset (DLMO) is considered the most reliable marker of the circadian rhythm phase in humans. DLMO may moderately correlate with sleep onset and sleep offset time. There are no sufficient data about the correlations between DLMO and clinical scales assessing sleep quality and daytime symptoms of poor night sleep. The aim of the study was to determine the association between DLMO and basic sleep parameters from actigraphy and sleep diaries, as well as the association between DLMO and the following insomnia clinical scales: the Athens Insomnia Scale (AIS), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and chronotype questionnaires: Morningness–Eveningness Questionnaire (MEQ) and Composite Scale of Morningness (CSM). Participants of the study were healthy volunteers. Sleep parameters were measured by sleep diaries and actigraphy, and the following clinical scales: the AIS, ISI, and ESS, and chronotype questionnaires: MEQ and CSM. DLMO was calculated based on plasma melatonin concentration. The blood samples were collected hourly at five time points between 20:00 and 00:00 during the session in dim red light (<50 lux). Melatonin concertation was determined by LC-MS/MS. Twenty-one volunteers participated in the study. DLMO was calculated in 12 participants. There was a significant correlation between DLMO and ISI (r = 0.60, p = 0.038) and ESS (r = 0.61, p = 0.034). The correlation coefficient between the DLMO and the AIS was also high, however insignificant (r = 0.57, p = 0.054). There were no significant correlations between DLMO and chronotype scales MEQ and CSM. DLMO did not correlate with sleep onset and sleep offset; however, DLMO correlated with the Sleep Fragmentation Index (SFI) (r = 0.67, p = 0.017). DLMO is associated with poorer sleep maintenance, a stronger feeling of insomnia, and sleepiness during the day. Simultaneously, chronotype pattern and circadian rhythm parameters do not correlate with DLMO. Biological circadian rhythm does not reflect the real-life sleep–wake rhythm, indicating that the lifestyle is more often disconnected from the biological clock. [ABSTRACT FROM AUTHOR]

Aim: The negative effects of the COVID-19 pandemic on a global scale and the resulting changes in daily life habits have significantly influenced the growth and development of adolescents. Adolescents have been deeply affected in physical, mental, and social aspects, both by COVID-19 itself and its psychological impact. This study aims to assess the sleepiness, social anxiety, and blood pressure status of adolescents during the COVID-19 pandemic. Materials and Methods: A total of 412 adolescents in the 6th, 7th, and 8th grades participated in this descriptive cross-sectional study. Data was collected using a questionnaire consisting of socio-demographic characteristics and questions related to COVID-19, the Cleveland Adolescent Sleepiness Scale (CASS), and the Social Anxiety Scale for Adolescents (SAS-A). The students' blood pressure was measured in a classroom setting. Results: It was determined that 23.1% of the adolescents participating in the study had experienced COVID-19, and 42.7% of them had family members who had also had COVID-19. It was found that adolescents who had not experienced COVID-19 reported higher levels of emotions such as fear, distress, and sadness (p<0.05). A positive correlation was identified between the sleepiness status of adolescents and their social anxiety (r = 0.368, p = 0.000). The systolic blood pressure of adolescents was found to be 7.3% high-normal and 9.7% high. Diastolic blood pressure was determined to be 3.6% high-normal and 1.7% high. A significant difference in diastolic blood pressure was identified between those who had experienced COVID-19 and those who had not (p<0.05). Conclusion: According to the results of the study, it is observed that adolescents experience moderate levels of sleepiness and social anxiety. Hence, adolescents have been affected psychologically and physiologically during the COVID-19 pandemic. The short and long-term effects of the pandemic on adolescents should be monitored and supported. [ABSTRACT FROM AUTHOR]

Background: Various physical and mental problems and diseases may develop with aging. Poor sleep quality is the third most common major problem in older adults, affecting all aspects of life. Emotional Freedom Techniques (EFT) can be used to treat the disease in older adults. Objectives: This interventional study attempted to investigate the effect of EFT on sleep quality, sleepiness, and quality of life of older adults. Methods: This was a quasi-experimental study. The selection of the participants was based on the convenience sampling method. Twenty-one people participated in the study and were divided into two groups of interventions. The study was conducted in the adult day-care center. In one group, 11 people and in the other group, 10 people were included. First, an educational session regarding sleep hygiene was held. Then, the EFT was administered for 4 weeks, 2 sessions per week, and each session lasted for 30 - 45 minutes in the intervention group by the student (first author); sleep hygiene training was also provided for the second group. Study measures included the PSQI (Pittsburgh sleep quality index), the Epworth Sleepiness Scale (ESS), and the Quality-of-Life Scale. Follow-ups were performed after the intervention and one month later. The statistical tests used were repeated measures and chi-Square tests. A P-value < 0.05 was considered as statistically significant. Results: The trend of changes in sleep quality (P = 0.001, P = 0.001, respectively) and sleepiness (P = 0.023, P = 0.001, respectively) was incremental and significant before and after the intervention and one month later in each of the groups, but results show that there was no significant interaction effect for any subscale, including subjective sleep quality (P = 0.786), sleepiness (P = 0.568), and quality of life (P = 0.289). Conclusions: According to the results, the EFT was effective on sleep quality, sleepiness, and quality of life of older adults in the adult day-care center, and sleep hygiene was influential. [ABSTRACT FROM AUTHOR]

Acute infections with SARS-CoV-2 variants of concerns (VOCs) differ in clinical presentation. Discrepancies in their long-term sequelae, commonly referred to as long COVID, however, remain to be explored. We retrospectively analyzed data of 287 patients presented at the post-COVID care of the Pulmonology Department, Semmelweis University, Budapest, Hungary, and infected with SARS-CoV-2 during a period of 3 major epidemic waves in Hungary (February–July 2021, VOC: B.1.1.7, Alpha, N = 135; August–December 2021, VOC: B.1.617.2, Delta, N = 89; and January–June 2022, VOC: B.1.1.529, Omicron; N = 63), > 4 weeks after acute COVID-19. Overall, the ratio of long COVID symptomatic (LC) and asymptomatic (NS) patients was 2:1. Self-reported questionnaires on fatigue (Fatigue Severity Scale, FSS), sleepiness (Epworth Sleepiness Scale, ESS) and sleep quality (Pittsburgh Sleep Quality Index, PSQI) showed higher scores for LC (4.79 ± 0.12, 7.45 ± 0.33 and 7.46 ± 0.27, respectively) than NS patients (2.85 ± 0.16, 5.23 ± 0.32 and 4.26 ± 0.29, respectively; p < 0.05 for all vs. LC). By comparing data of the three waves, mean FSS and PSQI scores of LC patients, but not ESS scores, exceeded the normal range in all, with no significant inter-wave differences. Considering FSS ≥ 4 and PSQI > 5 cutoff values, LC patients commonly exhibited problematic fatigue (≥ 70%) and poor sleep quality (> 60%) in all three waves. Comparative analysis of PSQI component scores of LC patients identified no significant differences between the three waves. Our findings highlight the importance of concerted efforts to manage both fatigue and sleep disturbances in long COVID patient care. This multifaceted approach should be followed in all cases infected with either VOCs of SARS-CoV-2. [ABSTRACT FROM AUTHOR]

Consumer sleep trackers issue daily guidance on 'readiness' without clear empirical basis. We investigated how self-rated mood, motivation, and sleepiness (MMS) levels are affected by daily fluctuations in sleep duration, timing, and efficiency and overall sleep regularity. We also determined how temporally specific these associations are. 119 healthy university students (64 female, mean age = 22.54 ± 1.74 years) wore a wearable sleep tracker and undertook twice-daily smartphone-delivered ecological momentary assessment of mood, motivation, and sleepiness at post-wake and pre-bedtime timings for 2–6 weeks. Naps and their duration were reported daily. Nocturnal sleep on 2471 nights were examined using multilevel models to uncover within-subject and between-subject associations between sleep duration, timing, efficiency, and nap duration on following day MMS ratings. Time-lagged analyses examined the temporal specificity of these associations. Linear regression models investigated associations between MMS ratings and sleep variability, controlling for sleep duration. Nocturnal sleep durations were short (6.03 ± 0.71 h), and bedtimes were late (1:42AM ± 1:05). Within-subjects, nocturnal sleep longer than a person's average was associated with better mood, higher motivation, and lower sleepiness after waking. Effects of such longer sleep duration lingered for mood and sleepiness till the pre-bedtime window (all P s <.005) but did not extend to the next day. Between-subjects, higher intraindividual sleep variability, but not sleep duration, was associated with poorer mood and lower motivation after waking. Longer average sleep duration was associated with less sleepiness after waking and lower motivation pre-bedtime (all P s <.05). Longer naps reduced post-nap sleepiness and improved mood. Controlling for nocturnal sleep duration, longer naps also associated with lower post-waking sleepiness on the following day. Positive connections between nocturnal sleep and nap duration with MMS are temporally circumscribed, lending credence to the construction of sleep-based, daily 'readiness' scores. Higher sleep duration variability lowers an individual's post waking mood and motivation. ClinicalTrials.gov NCT04880629. [Display omitted] • Longer nocturnal sleep within-subjects was associated with better mood and motivation, and less sleepiness after waking. • Effects for mood and sleepiness lingered till the pre-bedtime window but did not extend into the next day. • Greater sleep variability, but not mean sleep duration, associated with poorer mood and lower motivation after waking. • Longer naps reduced post-nap sleepiness and improved mood. [ABSTRACT FROM AUTHOR]

Recent evidence supports the idea that sleepiness has several dimensions, comprising psychophysiological phenomena, such as sleep propensity and sleepiness perception. The Epworth Sleepiness Scale (ESS) is among one of the most used sleepiness assessment tools, but recent data suggest that it might not detect problematic impairments in sleep health. More research is warranted investigating sleepiness dimensions with large sample sizes, using both objective and subjective methods of analyzing sleep. We used data from the Epidemiological Sleep Study (EPISONO), a major study carried out in Brazil using a representative sample of 1042 participants of the general population of Sao Paulo city, who completed questionnaires and underwent type I polysomnography. Sleepiness was measured by the ESS (sleep propensity) and the UNIFESP Sleep Questionnaire, which asked about the frequency of feeling sleepy during the day (sleepiness perception). The participants were distributed into 4 groups in respect of excessive daytime sleepiness (EDS) according to the following criteria: 1) having an ESS score >10 (ESS group). 2) feeling sleepy ≥3 times per week (Frequent EDS group). 3) the combined criteria (Combined EDS group). 4) having no evidence of EDS (no EDS group). The UNIFESP Sleep Questionnaire was used to obtain self-reported sleep duration, sleep debt, and sleep duration variability. Participants also completed the Pittsburgh Sleep Quality Index, the Insomnia Severity Index, and a pre-polysomnography sleep questionnaire. After removing participants with missing data, there were 620 participants with no EDS, 255 individuals in the ESS group, 68 in the Frequent EDS group, and 73 in the Combined EDS group. Compared to the no EDS group, the ESS and Combined EDS groups had significantly increased sleep efficiency, diminished sleep latency, wake after sleep onset, and self-reported weekly sleep duration. The Frequent and Combined EDS groups had significantly higher scores in the Insomnia Severity Index and Pittsburgh Sleep Quality Index. All EDS groups had an increased likelihood of nonrestorative sleep. EDS frequency and the ESS scores were significantly correlated. Participants with a high sleep propensity had a profile suggesting prior sleep deprivation, while high sleepiness perception was associated with impaired sleep quality. These findings indicated that, in the general population, these instruments evaluated separate sleepiness dimensions with different associations, highlighting that screening using a combination of instruments might be more effective in detecting impairments in sleep health. • Marked discrepancy in the prevalence of excessive daytime sleepiness with the use of different sleepiness questionnaires. • The groups with high scores on the Epworth Sleepiness Scale had lower sleep duration and higher objective sleep latency. • An association between frequent excessive daytime sleepiness and lower sleep quality was observed. • Correlation results suggest that sleepiness dimensions were oblique for this Brazilian general population sample. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the relationship between sleep, burnout, and psychomotor vigilance in residents working in the medical intensive care unit (ICU). Methods: A prospective cohort study of residents was implemented during a consecutive 4-week. Residents were recruited to wear a sleep tracker for 2 weeks before and 2 weeks during their medical ICU rotation. Data collected included wearable-tracked sleep minutes, Oldenburg burnout inventory (OBI) score, Epworth sleepiness scale (ESS), psychomotor vigilance testing, and American Academy of Sleep Medicine sleep diary. The primary outcome was sleep duration tracked by the wearable. The secondary outcomes were burnout, psychomotor vigilance (PVT), and perceived sleepiness. Results: A total of 40 residents completed the study. The age range was 26–34 years with 19 males. Total sleep minutes measured by the wearable decreased from 402 min (95% CI: 377–427) before ICU to 389 (95% CI: 360–418) during ICU (p < 0.05). Residents overestimated sleep, logging 464 min (95% CI: 452–476) before and 442 (95% CI: 430–454) during ICU. ESS scores increased from 5.93 (95% CI: 4.89, 7.07) to 8.33 (95% CI: 7.09,9.58) during ICU (p < 0.001). OBI scores increased from 34.5 (95% CI: 32.9–36.2) to 42.8 (95% CI: 40.7–45.0) (p < 0.001). PVT scores worsened with increased reaction time while on ICU rotation (348.5 ms pre-ICU, 370.9 ms post-ICU, p < 0.001). Conclusions: Resident ICU rotations are associated with decreased objective sleep and self-reported sleep. Residents overestimate sleep duration. Burnout and sleepiness increase and associated PVT scores worsen while working in the ICU. Institutions should ensure resident sleep and wellness checks during ICU rotation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Atypical working hours have raised serious concerns about health effects, such as sleep disorders and psychological repercussions. These schedules are frequent among health professionals having the obligation to ensure the permanence of health services. OBJECTIVE: To assess the impact of atypical working hours on sleep, sleepiness, and mood among health personnel (HP). METHODS: Comparative descriptive cross-sectional study was carried out among HP of a regional hospital in Southern Tunisia from December 2019 to May 2020. Two groups were defined according to their work schedule: group A had a fixed-day work and group B had atypical working hours. The assessment of sleep, sleepiness, and mood was based respectively on the Spiegel questionnaire, the Epworth Sleepiness Scale, and the Hospital Anxiety and Disorder scale. RESULTS: A total of 101 HP in group A and 135 in group B were included. We found signs of pathological sleep in group B: greater delay in falling asleep (78.1% Vs 53.5%; p = 0.002), altered sleep quality (88.1% Vs 56.4%; p = 0.039), and more frequent occurrence of dreams (37% Vs 31.7%; p = 0.033). The quality of sleep was associated with the professional seniority (p = 0.01), the workplace (p = 0.02), and having dependent children (p = 0.04). The mean score of depression was higher in group B (p = 0.02). Depression was associated with the workplace (p = 0.04) and the quality of sleep (p = 0.01). CONCLUSION: The results of this study indicate that atypical working hours generate both sleep and mood disorders in HP. It is vital to encourage the occupational physicians to estimate sleep and mood disorders in HP. [ABSTRACT FROM AUTHOR]

Although parasomnias are nocturnal phenomena occurring during sleep or during arousals from sleep, there is increasing evidence that they are associated with daytime dysfunction as well. However, systematic studies in this field are scarce. The aim of the current case series was to investigate the sleep–wake, neuropsychological and emotional profiles of patients with parasomnias. Thirty patients with parasomnia (13 NREM, 17 REM) and 30 healthy subjects matched for age, sex and educational status were included. All participants underwent comprehensive neuropsychological, cognitive and behavioral evaluation. We found that parasomnia patients scored higher in all neuropsychological, emotional, sleep–wake and quality of life scales compared to healthy subjects. The presence of a parasomnia was associated with major impact on daytime functioning across several domains with increased levels of fatigue (FSS > 4) in 56%, sleepiness (ESS > 10) in 47%, depressive symptoms (BDI > 20) in 17%, anxiety (PSWQ > 52) in 17%, anger expression out (STAXI A > 16) in 27% and anger expression in (STAXI B > 16) in 23%, as well as a reduced average quality of life score (RAND derived from SF-36). Sleep–wake disturbances were significantly correlated with QoL scores. In the intergroup analysis between REM/NREM, we found that the REM group had worse cognitive performance and lower levels of fatigue/energy compared to NREM patients. These findings suggest that parasomnia is associated with difficulties in several aspects of daytime functioning (cognitive, affective/emotional and physical) and, therefore, parasomnia diagnostic workup should not be limited only to nocturnal phenomena. [ABSTRACT FROM AUTHOR]

Rationale: The apnea-hypopnea index (AHI), used for the diagnosis of obstructive sleep apnea, captures only the frequency of respiratory events and has demonstrable limitations. Objectives: We propose a novel automated measure, termed "ventilatory burden" (VB), that represents the proportion of overnight breaths with less than 50% normalized amplitude, and we show its ability to overcome limitations of AHI. Methods: Data from two epidemiological cohorts (EPISONO [Sao Paolo Epidemiological Study] and SHHS [Sleep Heart Health Study]) and two retrospective clinical cohorts (DAYFUN; New York University Center for Brain Health) were used in this study to 1) derive the normative range of VB, 2) assess the relationship between degree of upper airway obstruction and VB, and 3) assess the relationship between VB and all-cause and cardiovascular disease (CVD) mortality with and without hypoxic burden that was derived using an in-house automated algorithm. Measurements and Main Results: The 95th percentiles of VB in asymptomatic healthy subjects across the EPISONO and the DAYFUN cohorts were 25.2% and 26.7%, respectively (median [interquartile range], VBEPISONO, 5.5 [3.5-9.7]%; VBDAYFUN, 9.8 [6.4-15.6]%). VB was associated with the degree of upper airway obstruction in a dose-response manner (VBuntreated, 31.6 [27.1]%; VBtreated, 7.2 [4.7]%; VBsuboptimally treated, 17.6 [18.7]%; VBoff-treatment, 41.6 [18.1]%) and exhibited low night-to-night variability (intraclass correlation coefficient [2,1], 0.89). VB was predictive of all-cause and CVD mortality in the SHHS cohort before and after adjusting for covariates including hypoxic burden. Although AHI was predictive of all-cause mortality, it was not associated with CVD mortality in the SHHS cohort. Conclusions: Automated VB can effectively assess obstructive sleep apnea severity, is predictive of all-cause and CVD mortality, and may be a viable alternative to the AHI. [ABSTRACT FROM AUTHOR]

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IntroductionLight’s non-visual effects on the biological clock, cognitive performance, alertness, and mental health are getting more recognized. These are primarily driven by blue light, which triggers specific retinal cells containing melanopsin. Traditionally, research on light has relied on correlated color temperature (CCT) as a metric of its biological influence, given that bluer light corresponds to higher Kelvin values. However, CCT proves to be an inadequate proxy of light’s biological effects. A more precise metric is melanopic Equivalent Daylight Illuminance (mel-EDI), which aligns with melanopsin spectrum. Studies have reported positive cognitive impacts of blue-enriched white light. It’s unclear if the mixed results are due to different mel-EDI levels since this factor wasn’t assessed.MethodGiven recent recommendations from experts to aim for at least 250 mel-EDI exposure daily for cognitive benefits, our aim was to assess if a 50-minute exposure to LED light with 250 mel-EDI could enhance concentration and alertness, without affecting visual performance or comfort compared to conventional lighting producing around 150 mel-EDI. To ensure mel-EDI’s impact, photopic lux levels were kept constant across conditions. Conditions were counterbalanced, parameters included subjective sleepiness (KSS; Karolinska Sleepiness Scale), concentration (d2-R test), visual performance (FrACT; Freiburg Visual Acuity and Contrast Test), general appreciation (VAS; Visual Analogous Scale), preferences and comfort (modified OLS; Office Lighting Survey).ResultsThe experimental light significantly reduced sleepiness (p = 0.03, Cohen’s d = 0.42) and also decreased contrast sensitivity (p = 0.01, Cohen’s d = 0.50). The conventional light was found to be more comfortable (p = 0.002, Cohen’s d = 0.62), cheerful (p = 0.02, Cohen’s d = 0.46) and pleasant (p = 0.005, Cohen’s d = 0.55) while the experimental light was perceived as brighter (p = 0.004, Cohen’s d = 0.58) and tended to be more stimulating (p = 0.10). Notably, there was a preference for conventional lighting (p = 0.004, Cohen’s d=0.56) and concentration was equally improved in both conditions.DiscussionDespite the lack of further improvement in concentration from exposure to blue-enriched light, given the observed benefits in terms of vigilance, further research over an extended period would be justified. These findings could subsequently motivate cognitive optimization through lighting for workers that would benefit from artificial lighting such as in northern regions.

IntroductionFatigue is a known issue in aviation due to long and irregular working hours. In some regions, pilots are permitted to sleep during a controlled rest period on the flight deck to manage unexpected sleepiness. We aimed to determine: (1) the relative influence of pre-flight sleep-wake history and time of day on the likelihood to take controlled rest; (2) whether neurobehavioral measures taken pre-flight are predictive of controlled rest use in-flight; and (3) the impact of controlled rest on neurobehavioral measures at top-of-descent.MethodsData from 120 long (>6 h flight duration), unaugmented (two-pilot) flights were analyzed (n = 31 pilots). Pilots wore actiwatches and completed sleep logs before and during trips. At pre-flight and top-of-descent, pilots completed a 5-min psychomotor vigilance task (PVT) and Karolinska Sleepiness Scale (KSS). A series of mixed-effects models with relevant covariates were conducted to assess the likelihood of controlled rest based on several predictors and the impact of controlled rest on outcome measures at top-of-descent.ResultsPilots were more likely to take controlled rest on night flights [p = .01, η2p = .13, OR = 13.81, 95% CI: (1.99, 95.80)] and when pre-flight sleepiness ratings were higher [p = .01, η2p = .14, OR = 4.14, 95% CI: (1.48, 11.57)]. Pilots who took controlled rest had faster response speeds [1000/reaction time (ms)] [p = .03, η2p = 0.07; estimated marginal mean (EMM) = 4.19, standard error (SE) = 0.07, 95% CI: (4.08, 4.29)] than those who did not [EMM = 4.00, SE = 0.05, 95% CI: (3.86, 4.14)].DiscussionOur results suggest that taking controlled rest may improve vigilant attention at critical phases of flight and may be a useful fatigue management tool, particularly during unaugmented night flights. Further research is needed to determine the impact of psychological and cultural influences on controlled rest and to understand how the policy is applied in practice.

ObjectWe explored the circadian preferences of non-shift workers (non-SWs) and various types of shift workers (SWs), and the associations of these preferences with sleep and mood.MethodsIn total, 4,561 SWs (2,419 women and 2,142 men aged 37.00 ± 9.80 years) and 2,093 non-SWs (1,094 women and 999 men aged 37.80 ± 9.73 years) completed an online survey. Of all SWs, 2,415 (1,079 women and 1,336 men aged 37.77 ± 9.96 years) reported regularly rotating or fixed schedules (“regular SWs”), and 2,146 (1,340 women and 806 men aged 36.12 ± 9.64 years) had irregular schedules (“irregular SWs”). Of the regular SWs, 2,040 had regularly rotating schedules, 212 had fixed evening schedules, and 163 had fixed night schedules. All participants completed the Morningness-Eveningness Questionnaire (MEQ) exploring circadian preferences, the short form of the Center for Epidemiological Studies-Depression Scale (CES-D) evaluating depression, the Insomnia Severity Index (ISI), and the Epworth Sleepiness Scale (ESS).ResultsCompared to non-SWs, SWs had lower MEQ scores, i.e., more eveningness, after controlling for age, gender, income, occupation, and weekly work hours (F = 87.97, p

Fatigue (and sleepiness) is a critical factor that plays an important role in a number of incidents in the railway sector. This has been a major issue in Indonesia particularly among freight-train drivers. The goal of the present study was to examine the degree of fatigue among freight train drivers across three different shifts and two types of coal cars loading (empty vs. loaded). A video camera was placed on the dashboard inside the locomotive cabin, capturing the face of the train drivers continuously throughout the duration of the driving tasks. In addition to the use of subjective measures, blink duration and video ratings were analyzed every 30 min to determine the level of fatigue. Findings of this study demonstrated that fatigue risks were moderate to excessive. As predicted, fatigue increased as a function of task duration, and more substantial levels of fatigue were observed during afternoon and evening shifts. Note that fatigue was also found to be associated with empty train cars. This was likely due to the fact that this particular train received the lowest priority and stopped very frequently. Such conditions could result in more monotonous and tiresome driving tasks, which lead to greater levels of fatigue. While driving for up to about four hours continuously was generally acceptable for the morning shift, such duration was not recommended for the rest of the driving conditions. Findings of this study could be used by the company management as a basis for improving operational aspects.

Study objectivesTo determine whether subjective measures of exercise and sleep are associated with cognitive complaints and whether exercise effects are mediated by sleep.MethodsThis study analyzed questionnaire data from adults (18-89) enrolled in a recruitment registry. The Cognitive Function Instrument (CFI) assessed cognitive complaints. Medical Outcomes Study Sleep Scale (MOS-SS) subscales and factor scores assessed sleep quality, daytime sleepiness, nighttime disturbance, and insomnia and obstructive sleep apnea (OSA)-like symptoms. Exercise frequency was defined as the weekly number of exercise sessions. Exercise frequency, MOS-SS subscales, and factor scores were examined as predictors of CFI score, adjusting for age, body mass index, education, sex, cancer diagnosis, antidepressant usage, psychiatric conditions, and medical comorbidities. Analyses of covariance examined the relationship between sleep duration groups (short, mid-range, and long) and CFI score, adjusting for covariates. Mediation by sleep in the exercise-CFI score relationship was tested.ResultsData from 2106 adults were analyzed. Exercise and MOS-SS subscales and factor scores were associated with CFI score. Higher Sleep Adequacy scores were associated with fewer cognitive complaints, whereas higher Sleep Somnolence, Sleep Disturbance, Sleep Problems Index I, Sleep Problems Index II, and factor scores were associated with more cognitive complaints. MOS-SS subscales and factor scores, except Sleep Disturbance and the insomnia factor score, mediated the association between exercise and cognitive complaints.ConclusionsThe relationship between exercise frequency and subjective cognitive performance is mediated by sleep. In particular, the mediation effect appears to be driven by symptoms possibly suggestive of OSA which are negatively associated with exercise engagement, sleep quality, daytime sleepiness, and subjective cognitive performance.

Objective: Premenstrual syndrome and primary dysmenorrhea are common gynecological complaints that are associated with psychological disorders. There is increasing evidence for the neuroprotective properties of curcumin, a polyphenolic natural product. This study aimed to assess the effects of curcumin on sleep complications in women with premenstrual syndrome and dysmenorrhea.Materials and Methods: This triple-masked, placebo-controlled clinical trial comprised 124 patients with both premenstrual syndrome and dysmenorrhea. Participants were randomly assigned to curcumin (n=57) or control (n=60) groups. Each participant received one capsule containing either 500 mg of curcumin plus piperine or placebo, daily, from 7 days before until 3 days after menstruation for three consecutive menstrual cycles. Insomnia and sleepiness were assessed using standard questionnaires.Results: Scores for insomnia and daytime sleepiness were directly correlated with the Premenstrual Syndrome Screening Tool (PSST) score (p0.05). There was a non-significant reduction in insomnia and sleepiness scores in both curcumin and placebo groups after the study intervention. Whilst, improvement rate of insomnia status, daytime sleepiness severity, short sleep duration and difficult sleep initiation was not statistically significant between the curcumin and placebo groups.Conclusion: Curcumin does not significantly affect sleep disorders in young women with premenstrual syndrome and dysmenorrhea.

BackgroundSleep disturbance is common among individuals with Tourette's Disorder (TD). Given that sleep is influenced by the circadian system, this study examined circadian rhythms and sleep in adults with TD, and explored the possible benefit of short-wavelength wearable morning light therapy.MethodsParticipants were 34 adults with TD (n = 14) and age- and sex-matched healthy controls (HC; n = 20). Participants were screened using clinician-rated diagnostic and tic severity interviews, and procedures lasted 3 consecutive weeks. Participants completed a baseline week of actigraphy. Adults with TD completed 2 weeks of Re-Timer™ morning light therapy and continued actigraphy monitoring. Dim light melatonin-onset (DLMO) phase assessment, tic severity interview, and measures of chronotype, sleep disturbance, daytime sleepiness, disability, depression, anxiety, and stress were completed at baseline and post-intervention.ResultsAdults with TD reported significantly greater eveningness and sleep disturbance relative to controls. Per wrist actigraphy, adults with TD exhibited significantly longer sleep-onset latency, lower sleep efficiency, and greater sleep fragmentation than HC. Following morning light therapy, there was a significant advance in DLMO phase, but not self-report or actigraphy sleep variables. There were small, statistically significant decreases in tic severity and impairment. There were also significant reductions in daytime sleepiness, and self-reported anxiety, but not depression, stress, or disability. Participants reported minimal side effects and rated light therapy as acceptable and comfortable.ConclusionsFindings showed some benefits following brief light therapy in TD; further exploration of the impact of spectral tuning the photic environment as part of treatment for TD subjects is warranted.