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Abstract Background Poor sleep quality is a significant issue among people who inject drugs (PWID). This study aimed to evaluate sleep quality and associated factors among PWID in Iran. Methods Using respondent-driven sampling, 2,652 PWID (2,563 male) were recruited in 11 major cities in Iran between 2019 and 2020. The Pittsburgh Sleep Quality Index was utilized to measure sleep quality, and logistic regression was used to assess associations in RDSAnalyst, a software designed for respondent-driven sampling. Results The overall prevalence of poor sleep quality was 68.4% (68.3% among males and 70.2% among females). Married PWID had higher odds of poor sleep quality (Adjusted Odds Ratio (AOR): 1.41; 95% CI: 1.05, 1.91). Lack of access to sufficient food in the past 12 months was also associated with poor sleep quality (AOR: 1.73; 95% CI: 1.17, 2.57 for sometimes having no access, and AOR: 2.95; 95% CI: 1.93, 4.52 for always having no access compared to always having access). Additionally, good self-rated health was significantly associated with lower odds of poor sleep quality (AOR: 0.19; 95% CI: 0.11, 0.31). Conclusion Poor sleep quality is prevalent among PWID in Iran. It is recommended to mitigate the adverse effects of this issue and enhance the overall quality of life for PWID. Supportive interventions aimed at preventing and treating poor sleep quality, as well as improving overall health outcomes, are essential.

Abstract Reliable obstructive sleep apnea (OSA) prevalence information in Iran is lacking due to inconsistent local study results. To estimate OSA prevalence and identify clinical phenotypes, we conducted a nationally representative study using multi-stage random cluster sampling. We recruited 3198 individuals and extrapolated the results to the entire Iranian population using complex sample survey analyses. We identified 3 clinical phenotypes as “sleepy,” “insomnia,” and “restless legs syndrome (RLS).” The prevalence of OSA was 28.7% (95%CI: 26.8–30.6). The prevalence of “sleepy,” “insomnia,” and “RLS” phenotypes were 82.3%, 77.8%, and 36.5% in women, and 64.8%, 67.5%, and 17.9% in men, respectively. “Sleepy” and “insomnia” phenotypes overlapped the most. Age (OR: 1.9), male sex (OR: 3.8), BMI (OR: 1.13), neck circumference (OR: 1.3), RLS (OR: 2.0), and insomnia (OR: 2.3) were significant OSA predictors (p-values: 0.001). In men, “sleepy” phenotype was associated with youth and unmarried status but not in women. The “insomnia” phenotype was associated with shorter sleep duration in women; cardiovascular diseases (CVD), urban residency, and shorter sleep duration in men. “RLS” phenotype was associated with shorter sleep duration and CVD in women and older age, lower educational level, CVD, and hypertension in men. The findings point to the need for funding of OSA screening in Iran, for a different assessment of men and women, and for future sleep research to consider overlapping phenotypes.

Abstract Background Prevalence of short and long sleep duration varies in different countries and changes over time. There are limited studies on Iranians’ sleep duration, and we aimed to evaluate the prevalence of short and long sleep duration and associated factors among people living in Kermanshah, Iran. Methods This population-based cross-sectional study was conducted between November 2014 and February 2017. Data was collected from 10,025 adults aged 35 to 65 years using census sampling, and we evaluated the short and long sleep duration (≤ 6 and ≥ 9 h, respectively) and its relation with the socio-demographic factors and health-related status of the participants. Results Mean age of participants was 48.1 years (standard deviation = 8.2), and 47.4% of participants were male. Of our participants, 11.6% had short, and 21.9% had long sleep duration. Age ≥ 50 years, female gender, being single, mobile use for longer than 8 h per day, working in night shifts, moderate and good levels of physical activity, BMI ≥ 30, past smoking, and alcohol use were associated with short sleep duration (P

Objective: Several studies confirmed a positive association between obstructive sleep apnea (OSA) and metabolic syndrome. Continuous positive airway pressure (CPAP) is the main treatment for patients with moderate and severe OSA. CPAP therapy in adults with OSA results in reduction in sleepiness, blood pressure and improvement of metabolic profile. In this study, we aimed to evaluate the effects of CPAP therapy on various components of metabolic syndrome and subjective sleep parameters in patients with OSA. Material and Methods: In this prospective trial study, 28 patients with moderate and severe OSA enrolled. Patients were asked to fill out the validated Persian version of questionnaires including Epworth sleepiness scale, insomnia severity index, STOP-BANG and Beck depression inventory - II, before and after treatment with CPAP. Weight and blood pressure were recorded before and after treatment. Only 14 patients agreed to blood sampling before and after CPAP therapy (at least 3 months of treatment). Fasting blood samples were analyzed for measuring the levels of FBS (fasting blood sugar), TG (triglyceride), total cholesterol, HDL, LDL, AST, and ALT. Results: Diastolic blood pressure, ISI and STOP-BANG score significantly decreased after treatment (p-value: 0.008, 0.022 and 0.004, respectively). FBS and TG levels decreased after treatment, but only TG levels had significant difference (p-value: 0.46 and 0.016, respectively). Discussion: CPAP therapy had positive effects on diastolic blood pressure, TG levels and ISI score. More studies with larger sample size and longer follow-up periods are warranted to investigate the effects of CPAP therapy on blood pressure, and metabolic parameters.

Introduction: Sleep quality in nurses along with workplace bullying, are concerned with nursing care quality. There exist a few investigations on workplace bullying and its relationship with sleep quality. This study aims at determining the impact of work schedules, workplace bullying, and some demographic characteristics on nurses’ sleep quality. Material and Methods: This study was conducted on 333 nurses who worked in a hospital in Tehran, Iran. Sampling conducted from February 12 to April 23, 2020. Instruments of this study were Pittsburg sleep quality index and Quine’s workplace bullying scale. Results: 63% of nurses had low sleep quality. Male nurses had lower sleep quality in comparison with females; 90% of nurses had encountered workplace bullying. Bullying and work schedules did not have a statistically significant effect on nurses’ sleep quality. Conclusion: According to this study, work schedules and workplace bullying had no significant effect on nurses’ sleep quality; but regarding that low sleep quality and encountering bullying is a cause of mental and physical problems for nurses and reduces the quality of care, it is recommended that nurses’ sleep quality and facing the bullying behavior should be taken into account by hospital authorities.

Abstract Sleep characteristics vary between populations. Detrimental sleep habits have cognitive consequences leading to daytime functioning debilitation. Until now no study has been done to investigate sleep characteristics in Iran thoroughly. In this study, we aimed to evaluate Iranians’ sleep characteristics and their association with daytime functioning. We conducted a population-based study from January 2017 to May 2019 on people more than 18 years old who lived in 11 urban destricts and 3 rural areas of Tehran, Iran. We randomly selected the participants using a multistage random stratified clustered sampling method. We obtained the participants’ demographic and anthropometric characteristics and details of bedtime, sleep duration, sleep onset latency, wake-up time and sleep impact on daytime functioning. Logistic regression model was used to assess the relationship between sleep characteristics) and daytime functioning. In total, 1830 people with a mean age of 40.83 years participated in the study. The gender distribution of the participants was even, and 70.98% of them were married. After adjusting for age and sex, the following three factors had a significant impact on daytime functioning: bedtime, sleep onset latency, and sleep duration. (OR = 1.12, P

Blind source separation (BSS) methods have received a great deal of attention in electroencephalogram (EEG) artifact elimination as they are routine and standard signal processing tools to remove artifacts and reserve desired neural information. On the other hand, a classifier should follow BSS methods to automatically identify artifactual sources and remove them in the following steps. In addition, removing all detected artifactual components leads to loss of information since some desired information related to neural activity leaks to these sources. So, an approach should be employed to detect and suppress the artifacts and reserve neural activity. This study introduces a novel method based on EEG and Poincare planes in the phase space to detect artifactual components estimated by second-order blind identification (SOBI). Artifacts are detected using a mixture of well-known conventional classifiers and were removed employing stationary wavelet transform (SWT) to reserve neural information. The proposed method is a combination of signal processing techniques and machine learning algorithms, including multi-layer perceptron (MLP), K-nearest neighbor (KNN), naïve Bayes, and support vector machine (SVM) which have significant results while applying our proposed method to different scenarios. Simulated, semi-simulated, and real EEG signals are employed to evaluate the proposed method, and several evaluation criteria are calculated. We achieved acceptable results, for example, 98% average accuracy and 97% average sensitivity in artifactual EEG component detection or about 2% as mean square error in EEG reconstruction after artifact removal. Results showed that the proposed method is effective and can be used in future studies as we have considered different real-world scenarios to evaluate it.

Estimating the prevalence of SARS-CoV-2 antibody seropositivity among health care workers (HCWs) is crucial. In this study, the seroprevalence of anti-SARS-CoV-2 antibodies among HCWs of five hospitals of Tehran, Iran with high COVID-19 patient's referrals from April to June, 2020, was assessed. In this cross-sectional study, HCWs from three public and two private hospitals, selected randomly as a pilot, were included. Participants were asked questions on their demographic characteristics, medical history, hospital role, and usage of personal protective equipment (PPE). Iran FDA-approved SARS-CoV-2 ELISA kits were used to detect IgG and IgM antibodies in blood samples. The seroprevalence was estimated on the basis of ELISA test results and adjusted for test performance. Among the 2,065 participants, 1,825 (88.4%) and 240 (11.6%) HCWs were recruited from public and private hospitals, respectively. A total of 340 HCWs were tested positive for SARS-CoV-2-specific IgG or IgM antibodies, and 17.9% of seropositive individuals were asymptomatic. The overall test performance-adjusted seroprevalence estimate among HCWs was 22.6 (95% CI: 20.2–25.1), and PPE usage was significantly higher among HCWs of public vs. private hospitals (66.5 vs. 20.0%). This study found that seroprevalence of SARS-CoV-2 among HCWs was higher in private hospitals (37.0%; 95% CI: 28.6–46.2) than public hospitals (20.7%; 95% CI: 18.2–23.3), and also highest among assistant nurses and nurses, and lowest among janitor or superintendent categories. The PPE usage was especially suboptimal among HCWs in private hospitals. Continued effort in access to adequate PPE and regular screening of hospital staff for detecting asymptomatic personnel, especially during the upcoming wave of infection, are warranted.

Introduction: Excessive daytime sleepiness is related to significant morbidity and mortality in either the patients or others. Maintenance of Wakefulness Test (MWT) is designed to evaluate the ability to maintenance of wakefulness in standard conditions of the test. Due to the existence of different methods for performing and interpreting the MWT test and the importance of unifying the method of performing and interpreting this test in Iran, the localization of the clinical use guide of the MWT test was considered. Materials and Methods: Initially, it was studied the available guidelines, and one of them was chosen as the main guideline. Then, to standardize the clinical services provided to patients, according to the conditions and facilities in Iran, the localization of the clinical guideline of MWTtest was performed. .Results: This guideline contained recommendations for implementation and interpretation of MWT. For each recommendation, the level of evidence including “standard”, “guideline” and “option” was specified. Conclusion: Given the prevalence of drowsiness and its importance in safety, occupational accidents and road accidents and the role of MWT testing in its evaluation, it is hoped that by providing the most cost-effective diagnostic method in this guide, a step will be taken to better allocate health resources in the country.

Patients with Chiari type I malformation may also present with sleep disordered breathing mainly central sleep apnea. Here, we report a patient with Chiari I malformation referred to our clinic because of snoring and sleep disordered breathing. He was a 28-year-old man referred to us for evaluation of snoring. An overnight polysomnography revealed central sleep apnea. On further evaluation of central sleep apnea, the patient found to have Chiari malformation type I on brain MRI. The patient developed obstructive sleep apnea after surgery for Chiari malformation. Accordingly, pap titration was performed for the patient’s obstructive sleep apnea. In patients with central sleep apnea comprehensive evaluation of predisposing causes is required. Lesions of central nervous system including Chiari malformation should not be overlooked. Furthermore, after treatment of central sleep apnea follow up PSG is warranted to confirm newly emerged sleep breathing disorder such as obstructive sleep apnea.

The factors affecting the dynamics of lengthening of symptoms and serologic responses are not well known. In order to see how the serologic responses change in relation to the clinical features, we selected a group of 472 adults with a positive IgM/IgG antibody test result from a baseline study of the anti-SARS-CoV-2 seropositivity, assessed their COVID-19 and past medical histories, and followed them up in about 3 months. Nearly one-fourth of the subjects were asymptomatic at the baseline; 12.8% subjects became symptomatic at the follow-up (FU) when 39.8% of the subjects had some persisting symptoms. At the baseline, 6.1% showed anti-SARS-CoV-2 IgM positive, 59.3% only for IgG, and 34.5% for both. At the FU, these figures declined to 0.6, 54.0, and 4.4%, respectively, with the mean IgM and IgG levels declining about 6.3 and 2.5 folds. Blood group A was consistently linked to both sustaining and flipping of the gastrointestinal (GI) and respiratory symptoms. The baseline IgM level was associated with GI symptoms and pre-existing cirrhosis in multivariate models. Both of the baseline and FU IgG levels were strongly associated with age, male, and lung involvement seen in chest computed tomography (CT)-scan. Finally, as compared with antibody decayers, IgM sustainers were found to be more anosmic [mean difference (MD): 11.5%; P = 0.047] with lower body mass index (BMI) (MD: 1.30 kg/m2; P = 0.002), while IgG sustainers were more commonly females (MD: 19.2%; P = 0.042) with shorter diarrhea duration in the FU (MD: 2.8 days; P = 0.027). Our findings indicate how the anti-SARS-CoV-2 serologic response and COVID-19 clinical presentations change in relation to each other and basic characteristics.

Background: Insomnia is a prevalent disorder leading to psychological problems such as anxiety and depression. Methods: This study investigates the effect of a combination of herbs (Melissa officinalis L. and Nepeta menthoides Boiss. & Buhse) on anxiety and depression for insomniacs and on insomnia severity. This study is a double-blind randomized placebo-controlled clinical trial. A total number of 67 participants met the inclusion criteria who were diagnosed as cases of insomnia. The patients were randomized into the herbal treatment or placebo groups. The herbal treatment group received a combination of Melissa officinalis and Nepeta menthoides Boiss. & Buhse. The primary outcomes were insomnia, depression and anxiety. We used per-protocol analysis. Results: The all outcomes of herbal treatment were significantly improved compared with placebo in the ISI, BAI and BDI scores after four weeks’ treatment (p value: 0.008, 0.005 and

Objective: Numerous offshore jobs require 24-hour tasks, such as in industrial workplaces (eg, oil rigs). The purpose of this study was to assess shift work disorder (SWD), insomnia, daytime sleepiness, and depression among Iranian offshore oil rig workers in different shift schedules. Method: This cross-sectional study was conducted on Iranian offshore oil workers at the Persian Gulf. A questionnaire package consisted of Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Beck Depression Inventory (BDI- II), and SWD filled. The scores were calculated among different groups of shift schedules (fixed-day, fixed-night, swing and standby shift workers). ISI, BDI-II, and ESS scores were also compared between individuals with or without SWD. Results: A total of 188 participants were recruited in the study, and all were male. The mean age was 37.06 ± 9.2 years. Among different shift schedules, the highest and lowest ISI and ESS scores were related to fixed-night shifts workers and fixed-day shift workers, respectively. ISI, ESS, and BDI mean scores in different shift schedules were not significantly different (p values = 0.14, 0.57, and 0.93, respectively). SWD was diagnosed in 57 (30.3%) of studied shift workers. The difference between SWD prevalence was not significant between different shift schedules (P value =0.13). Workers with SWD had higher ISI, ESS, and BDI-II score (P values

Background and Objective: Idiopathic hypersomnia (IH) manifests with excessive daytime sleepiness (EDS), cogni-tive and autonomic symptoms, debilitating sleep inertia, difficulty awakening, prolonged sleep duration, and non-restorative sleep. Here, we present a case with IH who was a shift worker in an automobile factory. Workplace implications and fitness for work in safety-sensitive jobs are especially important for patients with hypersomnolence, be cause rates of accidents increase in these situations. Case Report: The patient was a 34-year-old man referred to Baharloo Sleep Clinic, Tehran, Iran, because of EDS. He was a shift worker in an automobile factory. The subject underwent multiple sleep latency test (MSLT) after overnight polysomnography (PSG). He had no sleep onset rapid eye movement (REM) periods in MSLT and the mean sleep la-tency (MSL) was 5.75 minutes. According to PSG and MSLT report, the diagnosis of narcolepsy was ruled out. According to his sleep log, the patient slept more than 11 hours per 24 hours and had MSL lower than eight minutes. Our patient used modafinil for improvement of his symptoms and he was unfit for working in night shifts. Conclusion: Here, we reported a case of IH. Attention to past medical history, occupational history, sleep log or actigraphy, PSG, and MSLT findings is very helpful for diagnosis and confirmation of IH. Pre-employment and periodic evaluation of sleepiness, accident analysis, and tracking in an integrative sleepiness or fatigue management system would be very useful.

Background and Objective: Previous studies had examined the effect of learning in young adults with generally worse results in cases with the delayed sleep-wake phase disorder. In this study, the relationship between circadian rhythm preferences and objective structured clinical examination (OSCE) results was examined in medical students. Materials and Methods: This study was conducted during the OSCE for clinical license in medical students who were graduation candidates. The reduced form of the Horne and Ostberg Morningness-Eveningness Questionnaire was used to estimate their circadian chronotype. The OSCE consisted of 12 stations, which evaluated different clinical skills, as well as participant’s medical knowledge. The effect of morningness-eveningness preference of each participant on score was evaluated within each station of OSCE. Results: In total, 78 students participated out of a total of 114 clinically competent candidates (aged 25-34 years) were evaluated. In terms of sex, 56% of the students were girl, who obtained significantly higher grades in three stations (P < 0.05). The grades of students with delayed sleep-wake chronotypes were higher in most of the stations; however, the difference was statistically significant in only one station (P = 0.045), which was the most difficult station of the exam. Nevertheless, the delayed sleep-wake chronotype was associated with excessive daytime sleepiness (P = 0.002). Conclusion: Contrary to other similar studies in medical students, normal circadian chronotype was associated with poorer outcome in the OSCE; which may be explained by unusual student training hours during shifts, and the resultant available time for undisturbed study .

Background and Objective: Obstructive sleep apnea (OSA) is an important health problem, which is commonly under-diagnosed especially in workplace settings. We tried to obtain a model with more objective variables due to the greater reliability in occupational settings. Materials and Methods: A total of 374 suspected patients with OSA who underwent their first olysomnography (PSG) at Baharloo Sleep Clinic in Tehran, Iran, were enrolled in the study. Before PSG, all patients completed a ques-tionnaire including demographic characteristics. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured for all participants. Furthermore, a blood sample was collected for measuring fasting blood sugar (FBS) and hemoglobin A1c (HbA1c). All the patients underwent full PSG. Respiratory Disturbance Index (RDI) was calculated and recorded for all patients. Different multiple adjusted logistic regression models were constructed to find the best model for prediction of OSA. Results: A total of 271 (72.5%) participants were men. The mean age and body mass index (BMI) were 48.58 ± 13.04 years and 30.4 ± 5.0 kg/m2, respectively. The prevalence of RDI ≥ 15 was 78.87% (n = 295). Using regression analysis, several models were obtained, where the best one yielded sensitivity and specificity of 77.29% and 67.09%, respectively. Area under the curve (AUC) of this model was 82%. The variables of this model included SBP, age, neck circumference-height ratio (NHR), FBS, BMI, and gender (PAN apnea index) with a cutoff point ≥ 8 for high-risk individuals. Conclusion: In this study, we considered only objective parameters to predict OSA which enhances reliability for diag-nosis especially in occupational settings.

Background: It has been implicated that obstructive sleep apnea (OSA) is associated with increased risk of cardiovascular disease including stroke, myocardial infarction, coronary artery disease (CAD) and hypertension. The aim of this study was to investigate the correlation between OSA and severity of atherosclerosis assessed by angiography. Methods: This study included 337 patients undergoing diagnostic coronary angiography at Tehran Heart Center, Iran. The Gensini score was obtained from each patient for coronary angiogram, and OSA were assessed by using Multivariable apnea prediction (MAP) risk index on the day of cardiac catheterization. The Gensini scores increased in accordance with increases in the MAP value. Results: The prevalence rates of three-vessel disease were 68.0% in OSA group and 32.0% in non-OSA group. The MAP index was the most significant independent determinant for the Gensini score. Conclusions: The independent association between OSA and CAD, even after adjustment for traditional confounders, suggests that, OSA should be taken into account when considering risk factors for CAD.

Coronavirus disease of 2019 (COVID-19) pandemic originated from Wuhan in December 2019 and has been spread in whole China and the world. Worldwide outbreaks of COVID-19 triggered a large number of morbidities and mortalities beside its economic and social burdens, which are discussed a lot, in scientific literature and different types of media. As a sleep medicine specialist, we may wonder how we can be involved in this field. In this short theoretical essay, we will discuss about the known facts as well as the hypotheses, which associate the sleep medicine to COVID-19. The discussed points may provide a source of research ideas throughout the world for better understanding of novel coronavirus-19 that has devastating effects on humanity.

Background and Objective: Obstructive sleep apnea (OSA) is a common sleep-disordered breathing (SDB) characterized by intermittent hypoxemia (IH). OSA and IH are considered risk factors for increased hearing thresholds as well. Furthermore, thresholds of speech frequency affect personal fitness for driving. Thus, main purpose of this study was to assess the association between speech frequency thresholds and OSA among commercial drivers. Materials and Methods: This cross-sectional study was conducted on 1000 commercial drivers who were referred to obtain a health license at the Occupational Medicine Clinic of Baharloo Hospital, Tehran, Iran. Blood pressure, neck size, weight, and height were recorded. Validated Persian version of Epworth Sleepiness Scale (ESS) and STOP-BANG questionnaire were completed by the participants. STOP-BANG score ≥ 3 was defined as high risk for OSA. Fast blood sugar (FBS), triglyceride (TG), and total cholesterol (TC) were measured for all drivers. Hearing threshold levels of all subjects were recorded by pure tone audiometry (PTA) in frequencies of 500, 1000, 2000, and 3000 Hz for each ear in decibels (dB). Results: The mean age of the participants was 43.0 ± 9.9 years. The mean ESS and STOP-BANG scores of the participants were 3.1 ± 2.8 and 1.8 ± 0.8, respectively. 237 (23.7%) drivers were high-risk for OSA. Participants with OSA had significantly higher thresholds of speech frequencies compared to the low-risk ones (P < 0.0001). Conclusion: OSA may be also considered as a risk factor for increased thresholds of speech frequency among commercial drivers. During drivers’ periodic medical examination, evaluation of OSA as a strong risk factor for increasing hearing thresholds is recommended.

Background and Objective: Continuous positive airway pressure (CPAP) is a standard therapy for patients with moderate to severe obstructive sleep apnea (OSA). Increased demands for polysomnography (PSG) and CPAP titration have led to long waiting lists and high cost. CPAP prediction formulas derived from sleep and anthropometric parameters are used to set the initial CPAP level during CPAP titration. In the current study, we aimed to compare the pressure derived from prediction formulas with the pressure resulted from CPAP titration in a sample of Iranian patients. Materials and Methods: In this cross-sectional study, 90 subjects with confirmed OSA in a full PSG who underwent CPAP titration in Baharloo Sleep Clinic, Tehran, Iran, during 2017, were enrolled. All of the participants had Respiratory Disturbance Index (RDI) ≥ 15 in their PSG test. Then, the optimal pressure obtained from manual CPAP titration was compared with the one calculated by different prediction formulas for each patient. Results: The mean CPAP pressure from manual titration was greater than the pressures calculated by four prediction formulas. The difference between mean CPAP pressure obtained by manual titration and pressures calculated by Hoffstein, Lin, and Hukins formulas was statistically significant, whereas mean CPAP pressure obtained by manual titration was not statistically different from Loredo formula (11.7 ± 2.6 vs. 11.0 ± 2.3, P = 0.110). Conclusion: Estimation of optimal therapeutic pressure for CPAP device using several prediction formulas is very similar to pressure found during manual titration study. These formulas can be used in our setting for estimation of optimal CPAP pressure to save time and cost.

Background: Insomnia is an important problem in medical sciences students and has implications for their educational progress. The current study aimed to estimate the prevalence of sleep disorders and investigating the impact of sweet almond on quality of sleep in students of the Tehran University of Medical Sciences (TUMS), Tehran, Iran who live in dormitories. Methods: This is a before-after study conducted in 2017. At first, using the ISI questionnaire prevalence of sleep disorders was determined. Sweet almond was the study intervention. Each day, 10 almonds were given to 446 students for 14 d. At the end of the second week, again ISI questionnaire was filled. SPSS was used to analyze data. The McNemar, Wilcoxson Signed Ranks, and Repeated Measures tests were used. Results: Out of 442 participants, 217 (49.1%) were female. Before intervention, 343 (77.6%) had insomnia and 99 (22.4%) had normal sleep. After intervention, 306 (69.2%) had insomnia and 136 (30.8%) had normal sleep. Having sweet almond for two weeks is associated with reducing insomnia (P

Background and Objective: Shift work, especially at nights, has negative health outcomes for the workers, their families, and affiliated organizations. Working at night is associated with shortened and disturbed sleep, daytime sleepiness, fatigue, impaired performance, and increased risk of accidents. In this study, we aimed to evaluate sleep quality in different shift schedules of Iranian workers of offshore drilling rigs. Materials and Methods: One hundred and ninety two offshore workers of two oil rigs were enrolled in this crosssectional study. They were asked to fill out the validated and reliable Persian version of Pittsburg Sleep Quality Index (PSQI). Data regarding age, marital status, education level, smoking, shift work schedule, and body mass index (BMI) were recorded as well. Results: Mean age and mean work experience of the participants were 37.0 ± 9.3 and 10.0 ± 8.6 years, respectively. Fifty six participants (29.2%) were fixed day shift workers, 111 (57.8%) were swing shift workers (7 days/7 nights), 6 (3.1%) were fixed night shift workers, and 19 (9.9%) were standby shift workers. Mean PSQI score of all workers was 6.73 ± 3.61, and in 69% of the subjects, total score of PSQI was ≥ 5. Night shift workers had greater score of PSQI than other three groups of shift workers. Conclusion: This study showed that more than half of oil rig workers had poor sleep quality with the highest score among fixed night shift workers. This warrants comprehensive evaluation of the studied participants in terms of sleep disorders and related risk factors. Investigation of contributing occupational and environmental risk factors is also recommended.

Background and Objective: Excessive daytime sleepiness (EDS) is a common problem in patients referred to sleep clinics, which could result in adverse consequences in their personal and social activities including motor vehicle accidents (MVAs). Epworth Sleepiness Scale (ESS) and Multiple Sleep Latency Test (MSLT) are known methods for measuring EDS. In this study, we aimed to evaluate the relationship between EDS and MVAs. Materials and Methods: Medical records of 144 patients (106 men) with EDS referred to Baharloo Sleep Clinic, Tehran, Iran, were assessed in this cross-sectional study. All participants filled out a questionnaire including demographic characteristics, ESS, and history of MVAs due to sleepiness in the last five years and underwent full-night polysomnography (PSG) and MSLT. Sleepiness was categorized to normal, moderate, or severe according to mean sleep latency (MSL) in MSLT. Results: Patients with history of MVAs had a significantly less MSL and higher ESS scores than those without MVAs (6.6 ± 3.9 vs. 9.3 ± 6.5, P = 0.038; and 17.9 ± 4.4 vs. 15.6 ± 5.5, P = 0.030, respectively). MVAs were reported in 41.9%, 31.0%, and 16.1% of patients with severe, moderate, and normal sleepiness, respectively. There was a significant relationship between severity of sleepiness and history of MVAs (P = 0.020). Regression analysis showed that after adjustment for age and sex, ESS and MSL remained significantly different between patients with and without MVAs. Conclusion: ESS score and MSL would help sleep clinicians to find high-risk patients for safety-sensitive jobs, the issue which should not be overlooked by them during visits in sleep clinic.

Background and Objective: Sleep problems in industries can influence workers’ health. Shift work and its associated sleep problems are quite common among workers in different industries. The aim of this study was to assess sleep quality, insomnia, excessive daytime sleepiness (EDS), and obstructive sleep apnea (OSA) in workers of an automobile factory. Materials and Methods: This cross-sectional study was conducted during annual periodic examination of workers from a production unit of an automobile factory. A total of 522 workers filled in questionnaires including demographic characteristics, workplace accidents, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and STOP-BANG [snoring, tiredness, observed stop of breathing in sleep, blood pressure, body mass index (BMI), age, neck circumference, gender]. T-test and descriptive statistics were used for data analysis. Results: The participants had mean and standard deviation (SD) age of 37.24 ± 5.73 years. Of 522 participants, 65.3%, 14.4%, and 3.3% had PSQI ≥ 5, ESS ≥ 13, and STOP-BANG ≥ 4, respectively. Higher scores of PSQI and ISI were associated with significant increase of workplace accidents (P = 0.010 and P = 0.004, respectively). Moreover, participants with rotational shift work significantly had more ISI than the ones with fixed shift work. Conclusion: Poor sleep quality and insomnia were prevalent among studied workers with shift work. Sleep problems also had significant association with workplace accidents. This finding warrants more attention towards shift schedules of the workers and further investigation and management of identified sleep problems.

Purpose: Iran has a high rate of road traffic accidents. Poor quality of sleep brings about loss of attention, which is an important cause of road traffic accidents particularly in monotonous roads. The causes of poor quality of sleep in occupational drivers are multifactorial. The objective of the present study was to assess the prevalence of poor sleep quality among occupational drivers with rotating work schedules and analyze its different risk factors. Methods: 2200 professional long-haul truck drivers who had been referred to the Occupational Health Clinic for routine education course were invited. We obtained data from eight provinces from various parts of Iran during 2012–2013. Data were collected using a questionnaire including questions about demographic and job characteristics. Pittsburg Sleep Quality Index (PSQI) was used to assess drivers' sleep quality. Results: Mean working (driving) time was (9.3 ± 2.5) hours daily and (55.5 ± 18.29) hours weekly. About 23.5% of the drivers reported history of smoking, 14.5% had low job satisfaction and 60% had irregular work schedule. 16.4% of drivers had an accidents leading to injury during the past five years. The mean PSQI score was 4.2 ± 2.7; 54% had a PSQI>5 (poor quality of sleep). Multivariate logistic regression showed that smoking, job satisfaction, history of accidents, shift work and work hours per day were the most important risk factors for poor sleep quality. Conclusion: Results obtained from the current study showed a high prevalence of poor quality of sleep among professional drivers. It warrants more attention to this significant problem using some measures to improve working conditions in professional drivers, as well as health promotion interventions.

Background and Objective: Obstructive sleep apnea syndrome (OSAS) is a common sleep disorder with serious consequences. The best treatment for moderate to severe OSA is continuous positive airway pressure (CPAP), and is associated with reduced OSA-related adverse consequences. However, poor adherence to CPAP is still an important issue in these patients. This study aimed to evaluate CPAP adherence, and predisposing factors for poor adherence. Materials and Methods: In this longitudinal study, 120 patients with confirmed OSAS who underwent positive airway pressure titration study were enrolled. After at least six months of CPAP therapy, the subjects were evaluated for CPAP adherence. Results: Of 120 participants, 40 (33.3%) used CPAP device for at least 4 hours per night in 70% of nights after at least 6 months of prescription (compliant subjects). Older age was associated with more CPAP adherence (54.3 ± 11.3 vs. 49.3 ± 12.0, P = 0.037). Patients with higher prescribed device pressure were less likely to use CPAP regularly (8.7 ± 5.4 vs. 24.3 ± 44.2, P = 0.049). Difficult breathing and discomfort with full-face mask were the most common reported problems by compliant patients. Conclusion: Poor adherence to CPAP therapy is a serious issue in patients with OSAS. Older age and lower CPAPdevice pressure were associated with favorable adherence. More interventions should be evaluated for improving acceptance and adherence of CPAP therapy among the patients with OSAS.

Background and Objective: Obstructive sleep apnea (OSA) is associated with increased sympathetic activity, sleepiness, mood, and psychological alterations. In this study, mood and psychological state of patients referring to sleep laboratory were assessed. Materials and Methods: Fifty-eight consecutive individuals eligible for participation in the study were assigned to one of two groups of normal and mild (n = 19), or moderate to severe OSA (n = 39) with apnea-hypopnea index (AHI) of ≤ 15, or > 15 per hour, respectively, based on their initial polysomnography. The mood status was evaluated using the profile of mood states (POMS). Results: Amongst the six POMS subscales, only power-energy was significantly different between the two groups (P = 0.03). The total score of POMS, however, did not differ across the groups (P = 0.58). Conclusion: According to the obtained results, it may be concluded that mood status and OSA are not related when POMS is used for evaluation of mood status

Background and Objective: Narcolepsy is a disorder recognized by excessive daytime sleepiness (EDS). Several studies demonstrated its association with human leukocyte antigen (HLA) DQB1*0602, DQA1*0102, and DRB1*15. Our study aimed to perform HLA-typing on patients with EDS. Moreover, we performed HLA-typing for family members of the patients. Materials and Methods: We studied 83 patients with EDS and 77 of their first-degree relatives. Patients filled out a questionnaire including Epworth Sleepiness Scale (ESS), and underwent polysomnography (PSG) and multiple sleep latency test (MSLT). The whole blood samples were drawn from the patients and their families for HLA typing (class II). International classification of sleep disorders-2 (ICSD-2) criteria was used as the gold standard for diagnosing narcolepsy. Results: HLA DQB1*0602 was present in 20 (45.5%) of narcoleptic patients and 2 (5.1%) of patients with other causes of EDS. Prevalence of DQB1*0602 in family members of narcoleptic patients were higher than family members of patients with other causes of EDS (38% vs. 11.1%, P = 0.06). DQB1*0602, DQA1*0102, and DRB1*15 were more prevalent in narcoleptic patients with cataplexy than narcoleptic patients without cataplexy and patients with other causes of EDS. The sensitivities of the DQB1*0602 for diagnosing narcolepsy, narcolepsy with cataplexy, and narcolepsy without cataplexy were 40%, 60%, and 20%, respectively; while specificities were 93.9%, 87.9%, and 70.6%, respectively. Conclusion: HLA typing can be helpful in patients with atypical cataplexy and inconclusive MSLT results. More studies of Iranian narcoleptic patients are required for analyzing their HLA sequences.

Abstract Background and Objective: Obstructive sleep apnea (OSA) has been associated with metabolic syndrome, diabe-tes mellitus, and cardiovascular diseases. Insulin resistance and increased leptin levels could explain the impaired meta-bolic conditions in patients with OSA. This study aimed to assess the association of OSA severity with insulin re-sistance and leptin levels in a group of patients referred to a sleep disorders’ clinic. Materials and Methods: Seventeen patients without OSA and 28, 33, and 30 patients with mild, moderate, and se-vere OSA; respectively, were included in this study. All participants underwent full night polysomnography (PSG), and blood samples were collected in the morning after PSG. The insulin resistance index was estimated by homeostasis model assessment (HOMA). Results: HOMA values were not significantly different among the study groups. Significant difference in leptin lev-el was found between patients with severe and mild OSA. Leptin level was significantly correlated with age (r = 33, P = 0.020), apnea–hypopnea index (AHI) (r = 0.41, P = 0.004), and oxygen desaturation index (r = 46, P = 0.030). HOMA was insignificant positive correlation only with triglyceride level (P = 0.010). Stepwise multiple regression analysis showed that AHI, body mass index, and gender were determinants of leptin levels, however, no variable was found for predicting HOMA. Conclusions: Present findings suggest that leptin levels might be independently associated with severity of OSA. Other factors other than insulin resistance should be considered for increasing vascular diseases in patients with OSA.

800x600 Background and Objectives: Poor sleep quality is a common problem among patients with coronary artery bypass surgery. The aim of this study was to assess the effect of cardiac rehabilitation program on improving quality of sleep in patients with poor sleep quality after coronary bypass surgery. Materials and Methods: This was a quasi-experimental study. From 88 patients referred to the cardiac rehabilitation clinic of Tehran Heart Center, 50 patients with poor sleep quality were recruited to the study. patients after complete demographic and sleep quality questionnaires, participated in an 8-weeks cardiac rehabilitation program including exercise training and life style education sessions. Participants were followed-up 4 weeks after the intervention. Data were analyzed in the SPSS-18 using statistical tests such as Paired t-test, Independent samples T test, and One-way ANOVA. Results: After cardiac rehabilitation program, significant differences were shown in the sleep quality (p

Workers′ fatigue is a significant problem in modern industry, largely because of high demand jobs, long duty periods, disruption of circadian rhythms, and accumulative sleep debt that are common in many industries. Fatigue is the end result of integration of multiple factors such as time awake, time of day, and workload. Then, the full understanding of circadian biologic clock, dynamics of transient and cumulative sleep loss, and recovery is required for effective management of workplace fatigue. It can be more investigated in a new field of sleep medicine called occupational sleep medicine. Occupational sleep medicine is concerned with maintaining best productivity and safety in the industrial settings. The fatigue risk management system (FRMS) is a comprehensive approach that is based on applying scientific evidence of sleep knowledge to manage workers fatigue. It is developing rapidly in the highly safety demand jobs; especially truck drivers, pilots, and power plant workers. The objective of this review is to explain about fatigue in the workplace with emphasis on its association work performance and errors/accidents. Also, we discussed about different methods of fatigue measurement and management.

Restless leg syndrome (RLS) is a distressing sleep disorder that is commonly experienced by patients undergoing maintenance hemodialysis. The aim of this study was to assess the prevalence of RLS and its related factors among hemodialysis patients. This was an analytical cross-sectional study that was performed on hemodialysis patients of the Bu"Ali Hospital of Qazvin during 2009 and 2010. One hundred and twelve patients were selected by the census sampling method as the study sample. Data collection was performed using the Insomnia Severity Index (ISI), Pittsburg Sleep Quality Index (PSQI), Berlin, Epworth Sleepiness Scale (ESS) and International Restless Leg Syndrome Study Group criteria (IRRLS) questionnaires. Student′s ttest and chi-square test were applied to analyze the collected data. RLS complaints were very common among patients on long-term dialysis therapy and were reported in about 42.9% of the patients. Patients with RLS had higher daytime sleepiness, insomnia complaints and poorer sleep quality. Percentage of patients in the high-risk group was higher in the RLS group. RLS symptoms appear to be correlated with age (P = 0.012) and use of sedative drugs (P = 0.035). RLS is common in dialysis patients and is associated with a higher prevalence of other sleep disturbances. Therefore, the effective assessment and management of this sleep disturbance has the potential to significantly enhance patient outcomes.

Narcolepsy is a rare, disabling disorder characterized by excessive daytime sleepiness, cataplexy, hypnagogic hallucinations and sleep paralysis. Several studies demonstrated its association with HLA-DQB1*0602 in various ethnic groups. Our study aimed to determine the prevalence of HLA-DQB1*0602 allele in Iranian patients with narcolepsy and assess its predictive parameters for diagnosing narcolepsy. In addition, car accidents and job problems were assessed among narcoleptic patients. We studied 44 narcoleptic patients, 30 patients with other types of excessive daytime sleepiness (EDS) and 50 healthy age and sex matched individuals in this case-control study. Patients and controls filled out a questionnaire including items about car accidents due to sleepiness and job problems. International classification of sleep disorders-2 criteria was used as the gold standard for diagnosis of narcolepsy. The DNAs isolated from whole blood samples were collected from the patients and controls to assess the presence of HLA-DQB1*0602. The results showed that HLA DQB1*0602 was present in 4 (8%) individual of controls and 20 (45.5%) patients with higher prevalence in patients with cataplexy (78.9%) than patients without cataplexy (p

Background and Objective: STOP-BANG questionnaire is a well-known obstructive sleep apnea (OSA) screening tool. This study aimed to evaluate that patients with high probability of OSA in STOP-BANG questionnaire meet the criteria for assessment by split-night polysomnography (PSG). Materials and Methods: Patients who were admitted to three sleep clinics and underwent full-night PSG entered into the study. The patients filled in the STOP questionnaire at their first clinic visit. Weight, height, and neck circumference were measured by technicians for computing STOP-BANG score. The apnea–hypopnea index (AHI) was used for diagnosis of OSA for which 5 ≤ AHI < 15, 15 ≤ AHI < 30, and AHI ≥ 30 were considered as mild, moderate, and severe OSA, respectively. AHI cutoff levels of 20 and 40 were used to evaluate split-night PSG criteria. Sensitivity analysis was performed for identifying predictive parameters. Results: In assessment of 990 patients, the sensitivity of the STOP-BANG ≥ 3 for OSA diagnosis at AHI thresholds of 5, 15 and 30 were 93, 96 and 97.8, and the specificity were 39, 24.5 and 20, respectively. The specificities of the STOP-BANG score ≥ 7 for OSA diagnosis at AHI thresholds of 20 and 40 were 99.2 and 97.9, and the positive predictive values were 90.5 and 64.3, respectively. Conclusion: We found that the STOP-BANG could be considered not only as an OSA screening test, but also as a test to determine proper patients for split-night PSG, the benefit of which is a cost reduction in OSA management.

Background and Objective: Obstructive sleep apnea (OSA) is defined as a sleep disordered breathing due to partial or complete obstruction of upper airways. This study aimed to investigate treatment outcomes and clinical complications among patients with OSA who underwent upper airway surgery in clinical settings. Materials and Methods: All patients undergone upper airway surgery for OSA were called upon to enroll in this follow-up study. Demographic characteristics, Epworth sleepiness scale (ESS), snoring, dry mouth, nocturia, improvement of high blood pressure, and complications of surgery including bleeding, infection, pain, and temporary voice change were recorded at median of 8 months after the surgery. 12 patients accepted to undergo follow-up polysomnography (PSG). Results: Among 41 participants, mean age was 44.2 ± 11.6 years, and 33 (78.6%) were male. In three patients (25%) with follow-up PSG, mean respiratory disturbance index (RDI) was decreased by 50%. The baseline and post-surgery RDI was 34.0 ± 26.2 and 24.8 ± 13.2/hours, respectively. Mean ESS pre-surgery was 9.0 ± 4.5 with a decrease of 3.9 ± 4.2 post-surgery. Most of the participants reported improved snoring. More than half of the patients reported improvement of hypertension, dry mouth, nocturia, and sleep quality. The most common reported complications were temporary changes in voice and pain. Conclusion: Surgery improved snoring, daytime sleepiness, and OSA-related problems. RDI improvement in a small subset of patients indicates importance of follow-up PSG after upper airway surgery and warrants further studies. Moreover, evaluation of the reasons of non-participation for undergoing follow-up PSG requires more investigation.

Background and Objective: Obstructive sleep apnea syndrome (OSAS) is a prevalent disease in adults. Limited evidence regarding the effect of severity of sleep apnea and depression on heart rate variability (HRV) indices exists. Hence, we decided to focus on the association between HRV and severity of OSAS based on depression score. Materials and Methods: A total of 193 patients with confirmed OSAS were selected from a sleep clinic setting. A checklist for demographic data and self-administered questionnaires including the Pittsburgh Sleep Quality Index; Epworth Sleepiness Scale; Beck Depression Inventory; Snoring, Tiredness, Observed apnea, Blood pressure, Body mass index, Age, Neck circumference (STOP-BANG), and Gender questionnaire were filled in. We used two domains of HRV (e.g., frequency and time) estimation. Results: The mean number of pairs of adjacent RR intervals (time between QRS complexes) differing by more than 50 ms in the entire analysis interval (NN50 count) was significantly different among various severity OSAS groups (μ = 2639.12 ± 478.98 for mild and moderate, and 2313.81 ± 670.54 in severe OSAS; P = 0.0200). In frequency do-main, the indices were higher in severe OSAS patients. Statistically significant association was between HRV parame-ters (standard deviation of all RR intervals, mean of the standard deviation of all RR intervals for all 5-minutes segments, NN50 count, the NN50 count divided by the total number of all RR intervals, average total power, low frequency power) and OSAS severity. Conclusion: There are some statistically significant differences between OSAS severity and parameters of HRV.

Background: Insomnia is a common sleep disorder, characterized by difficulties in sleep initiation, sleep maintenance or early morning awakening. Although polysomnography (PSG) is a standard method in the evaluation of sleep disorders, it is not recommended for routine use in the clinical assessment of insomnia. Instead, standard questionnaires could be used in the primary evaluation of insomnia. Objective: The main object of this study was to compare the type and severity of patients′ subjective complaints of insomnia gathered from insomnia severity index (ISI) questionnaire with the result of their polysomnographic evaluation. Materials and Methods: In this cross-sectional study conducted during 2010-2011 in Iran, all patients in one clinic with sleep disorders were evaluated. The study consisted of self-administered questionnaires completed by participants to provide information on demographic characteristics and ISI questionnaire. After completing the questionnaire, all the participants underwent standard overnight PSG. Results: Subjects were 151 patients (47.2 ± 10.8 years old). The average ISS was 6.1 ± 4. There was a significant relationship between the subjective complaint of difficulty in sleep initiation and sleep onset latency in PSG (r = 0.5, P < 0.001). Furthermore, there was a correlation between the subjective complaint of difficulty in sleep maintenance and number of awakening in PSG (r = 0.19, P = 0.01). A low patients′ satisfaction from their sleep was associated with lower total sleep time (r = -0.2, P = 0.02) and a lower percentage of rapid eye movement (REM) sleep in their PSG study (r = -0.25, P = 0.002). No relation was found between patients′ satisfaction and sleep efficiency measured with PSG (r = -0.04, P = 0.6). Conclusions: Our findings suggest that objective insomnia, measured with ISI, is related with PSG variables and ISI could be a useful tool to quantify perceived insomnia severity. Further studies are needed to determine the sensitivity and specificity of this questionnaire.

Road traffic injuries and deaths are among the first leading causes of death around the world (1). In Iran, annual deaths because of road crashes constitute the most common cause of mortality among the youth. The country is estimated to lose more than 17000 persons in traffic accidents an- nually (2). The economic annual burden of road accidents is also estimated considerable in Iran

Introduction: Epilepsy is a complex pervasive neurobehavioral and social condition accompanied by a wide range of comorbid conditions that can adversely affect the quality of life of patients. Sleep complaints are common among patients with epilepsy. The aim of this study was to assess the prevalence of subjective sleep disturbances and its effects on sleep quality in epileptic patients. Methods: In this cross-sectional study, 152 consecutive epileptic patients and 152 controls were interviewed. We used Epworth Sleepiness Scale, Insomnia Severity Index, Berlin Questionnaire and Pittsburg Sleep Quality Index to measure excessive daytime sleepiness, insomnia, obstructive sleep apnea and sleep quality. R estless leg syndrome was diagnosed using three questions. Results: The age, gender and average total sleep time was similar in patients and control group. The frequency of excessive sleepiness scale and subjective complaint of sleep maintenance was higher in epileptic patients than control group (P

Background: This study assessed the effect of lead exposure on the peripheral nervous system in 40 hospitalized patients with lead toxicity [blood lead level (BLL) >70 μg/dl] and compared their electrodiagnostic indices with the results of the control group. Materials and Methods: We assessed signs and symptoms of neuropathy in patients and conducted nerve conduction velocity (NCV) in patients and control groups, then compared the results between the two groups. Results: Average duration of exposure to lead was 10.85 years. The mean BLL of patients was 100.32 μg/dl (SD = 18.42). The most common symptoms in patients were mood and sleep disturbance (64.1%) and paresthesia (47.5%). Among the patients, all of the NCV indices in median, ulnar, and radial nerves were normal. On comparing the average indices of NCV in lead-exposed men with controls, significant reductions were noted in most of the indices and with prolonged distal motor latency and peak latency. Significant but weak correlations were found between BLL and some of the indices (P value < 0.05, r = 0.33-0.52). Conclusion: Comparing electrophysiological study indicators between case vs controls and considering the symptoms of patients, our study showed that patient may progress to sensory neuropathy.

Background and Objective: Sleep deprivation (SD) is caused by a host of reasons and has numerous consequences on cardiac system. In this study, we aimed to assess the preconditioning effects of acute SD on ischemia (IS)-induced ventricular arrhythmias in isolated rat hearts. Materials and Methods: Male Wistar rats randomly were placed into the four groups: IS-group, acute SD group, control group for SD, and sympathectomy group (SYM). SD paradigm in SD was performed 24 hours before IS induction. In SYM groups, the animals were chemically sympathectomized 24 hours before SD. The rat hearts were isolated and perfused with Krebs buffer solution by Langendorff method and subjected to 30 minutes regional IS. Throughout the experiment, the hearts were allowed to beat spontaneously; thereafter, heart rate (HR) and ventricular arrhythmias were measured. Results: No differences were found between the experimental groups for HR at baseline and IS period. As compared to IS group, SD animals showed less incidence of ventricular tachycardia and severity of arrhythmias (P < 0.050). Furthermore, significantly the number of ventricular ectopic beats episodes/min, bigeminy/min,trigeminy/min, and couple/min were less than IS group (P < 0.050). Moreover, sympathectomy could reverse results to IS group level as compared to sleep deprived animals (P < 0.050). Conclusion: It is concluded that induction of acute SD before IS could reduce ventricular arrhythmias, and chemical sympathectomy removed this cardioprotection.

Musculoskeletal disorders are an important occupational health problem in dentistry. Few studies have compared these disorders in dentists with other occupational groups. We assessed musculoskeletal disorders in female dentists in comparison with female pharmacists. A cross-sectional study by means of Musculoskeletal Nordic Questionnaire was performed among 191 female general dentists and 211 female general pharmacists who were at least one year in clinical practice and selected using the random sampling method. Those with a history of a traumatic event causing fracture in spinal column or extremities and connective tissue diseases excluded. The data were analyzed by univariate and multivariate logistic regression analyses. 91.6% of the female dentists and 87.7% of the female pharmacists reported having at least one musculoskeletal symptom in the previous 12 months. 12-month period prevalence symptoms of neck (OR=3.17), upper back (OR=2.19) and upper extremity (OR=1.99) had the most ORs in comparison of dentists to pharmacists. In summary, female dentists are at risk of developing musculoskeletal disorders particularly in the neck, upper back and upper extremities.

Background: Occupational exposure studies indicate that formaldehyde exposure causes temporary and consistent effects on industrial workers exposed to formalin. Case: The case was a 36-year-old man who had developed intravascular hemolytic anemia caused by formalin after inhalation exposure. Formalin is a clear solution of 37% formaldehyde in water. The primary route of exposure to formaldehyde is inhalation. The case was presented with severe Coomb's negative hemolytic anemia with hemoglobinuria and was treated successfully with therapeutic red cell transfusion and exposure removal. Conclusion: All employers must provide a safe and healthy workplace for prevention of harmful effects of formalin. Elimination of formalin from workplace, implementation of local and general ventilation, and using proper protective equipments are the most effective methods in the workplace.

Occupational Sleep Research Center” affiliated with Tehran University of Medical Sciences is pleased to publish the first issue of the Journal of Sleep Sciences (JSS). The main goal of JSS is to promote the knowledge and awareness of clinicians and research professionals about the latest findings in prevention, diagnosis, treatment

Background and Objective: Adult lead poisoning commonly occurs due to workplace exposures. Neuro- psychological symptoms such as insomnia are reported as the early symptoms of chronic lead intoxication. This study aimed to evaluate association between blood lead level (BLL) of workers from lead-zinc factories and their sleep quality. Materials and Methods: A cross-sectional study was performed and 425 workers were enrolled with eligi- bility criteria of the study. BLL of workers were measured using atomic absorption spectrophotometry. Clinical assessment of workers was performed regarding their sleep problems through a self-administered questionnaire consisting of demographic characteristics, Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Pittsburg Sleep Quality Index (PSQI). Multiple linear regression and ANOVA tests were used for analysis of data. Results: Among 425 workers studied, mean (±SD) BLL was 34.7(± 16.7) µg/dl. BLL was significantly asso- ciated with total scores of ISI, ESS, and PSQI questionnaires adjusted for age, sex, job experience, shift work, and body mass index (Adjusted R2 was 0.19, 0.08, and 0.18, respectively; P

Welding is a process in which two or more metals are attached by the use of heat and, in some cases, pressure. Direct exposure and inhalation of welding fumes causes acute and chronic side effects in humans. Kidney damage is one of these important side effects. β2 microglobulin is an 11.8 kilodalton protein and levels increase in the case of some inflammatory and viral diseases, or kidney malfunction and autoimmune diseases. In this study measurements of β2 microglobulin were used as a criterion for assessing effects on the kidneys of workers exposed to welding fumes. The study population were electric arc welders in an industrial plant in Tehran, Iran. For control we selected workers who did not have any exposure to welding fumes. Both groups were selected on the basis of a questionnaire and the consideration of criteria for inclusion and exclusion. In the end 50 cases and 50 controls were chosen. A urine sample was collected from all participants and urinary pH was set to between 6-8 using NaOH (1M). Sample transportation to the laboratory complied with the related standards. The samples were assessed using the ORG 5BM kit. For quantitative assessment of β2 microglobulin we used the Enzyme-linked Immunosorbent Assay (ELISA) method. The ages of the welders ranged from 21 to 48 years (mean=30.5±5.9 yrs) and of controls from 23 to 56 years (mean=31.8±5.9 yrs). Mean employment duration was 7.86±5.01years (range 2 to 27 years) for welders. Mean β2 microglobulin level was 0.10±0.096 μg/ml in welders and 0.11±0.06 in controls. This difference was not statistically significant (P=0.381). In conclusion we don't find that exposure to electric arc welding fumes cause a significant change in urinary β2 microglobulin compared to the control group.

Background: Lead is a metal that has been used by humans since ancient times and it’s over dosage causes an important environmental and professional toxicity. The aim of this study was to evaluate the effectiveness of single therapy with Ethylene diamine tetra acetic acid (EDTA) in lead poisoning. Methods: The study population was all patients with suspected lead poisoning were admitted to Baharloo hospital in Iran from January 20, 2005 to March 21, 2006. Diagnosis of lead poisoning was confirmed after history taking, clinical examinations and blood lead level. After obtaining informed consent, the patients were enrolled in our study. Allowed lead level was considered < 50 µg/dl. These patients were hospitalized for 5 days and treated with EDTA (1 g every 12 hours via slow intravenous infusion). CBC, urea, creatinine, liver function tests, coagulation tests and biochemical tests including glucose, lipids, electrolytes and uric acid, urinalysis, and urine volume was measured daily. The patients would be excluded if there were any contraindication for EDTA treatment, hepatic encephalopathy and blood lead level over than 150 µg/dl were considered as the exclusion criteria. All patients’ blood lead level was measured again 10 and 30 days after treatment. To analyze data, Wilcoxon test and SPSS software (version 16) were used. Findings: Forty one patients were studied. All were male. The patients’ mean age was 32 ± 6 years. The patients’ average blood lead level was 110.3 ± 5 37 µg/dl before the treatment. The patients’ average blood lead level was 63.4 ± 27.1 µg/dl ten days after treatment and 79.3 ± 28 µg/dl one month after treatment. The patients’ average blood lead level decreased significantly 10 days and one month after the treatment compared to begining (P < 0.001 and P < 0.012 respectively). Conclusion: EDTA is an effective drug for the treatment of patients with lead poisoning as single therapy.

OBJECTIVE: About 20% of workers in industrialized countries are shift workers and more than half of them work on night or rotating shifts. Most night workers complain of sleepiness due to lack of adjustment of the circadian rhythm. In simulated night-work experiments, scheduled exposure to bright light has been shown to reduce these complaints. Our study assessed the effects of bright light exposure on sleepiness during night work in an industrial setting. METHODS: In a cross-over design, 94 workers at a ceramic factory were exposed to either bright (2500 lux) or normal light (300 lux) during breaks on night shifts. We initiated 20-minute breaks between 24.00 and 02.00 hours. Sleepiness ratings were determined using the Stanford Sleepiness Scale at 22.00, 24.00, 02.00 and 04.00 hours. RESULTS: Under normal light conditions, sleepiness peaked at 02:00 hours. A significant reduction (22% compared to normal light conditions) in sleepiness was observed after workers were exposed to bright light. CONCLUSION: Exposure to bright light may be effective in reducing sleepiness among night workers.

Traffic fatalities are a major cause of morbidity and mortality in Iran. Occupational sleep medicine field needs more cost-effective and applicable tests for screening purposes. This study reports on a pilot screening study for drowsy drivers in an urban Iranian sample of commercial drivers. The Maintenance of Wakefulness Test (MWT) measures the ability to remain awake objectively. Sleep latency in MWT is a reasonable predictor of driving simulator performance in drivers. In this study, we evaluate whether the Epworth Sleepiness Scale (ESS) and MWT are equally useful in drivers with possible Excessive Daytime Sleepiness (EDS). 46 consecutive road truck drivers in a transportation terminal entered into this study. The ESS score of patients with normal and abnormal MWT was 3.24±2.4 and 4.08±3 respectively which was not significantly differenced (P value = 0.34). No significant correlation was found between the ESS and sleep latency in MWT (r=-0.28, 95%CI= -0.58 to 0.02). By using the receiver operating characteristic analysis, the area under the curve was found to be 0.57 (95% confidence interval = 0.37- 0.77) which is not statistically acceptable (P value=0.46). Our finding showed that the MWT and ESS do not measure the same parameter.