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Proceedings of the National Academy of... Oct 2023Experimental and interventional studies show that light can regulate sleep timing and sleepiness while awake by setting the phase of circadian rhythms and supporting...
Experimental and interventional studies show that light can regulate sleep timing and sleepiness while awake by setting the phase of circadian rhythms and supporting alertness. The extent to which differences in light exposure explain variations in sleep and sleepiness within and between individuals in everyday life remains less clear. Here, we establish a method to address this deficit, incorporating an open-source wearable wrist-worn light logger (SpectraWear) and smartphone-based online data collection. We use it to simultaneously record longitudinal light exposure (in melanopic equivalent daylight illuminance), sleep timing, and subjective alertness over seven days in a convenience sample of 59 UK adults without externally imposed circadian challenge (e.g., shift work or jetlag). Participants reliably had strong daily rhythms in light exposure but frequently were exposed to less light during the daytime and more light in pre-bedtime and sleep episodes than recommended [T. M. Brown , PLoS Biol. , e3001571 (2022)]. Prior light exposure over several hours was associated with lower subjective sleepiness with, in particular, brighter light in the late sleep episode and after wake linked to reduced early morning sleepiness (sleep inertia). Higher pre-bedtime light exposure was associated with longer sleep onset latency. Early sleep timing was correlated with more reproducible and robust daily patterns of light exposure and higher daytime/lower night-time light exposure. Our study establishes a method for collecting longitudinal sleep and health/performance data in everyday life and provides evidence of associations between light exposure and important determinants of sleep health and performance.
Topics: Adult; Humans; Wakefulness; Sleepiness; Sleep; Circadian Rhythm; United Kingdom; Melatonin
PubMed: 37812713
DOI: 10.1073/pnas.2301608120 -
Nutrients Nov 2021This study aimed to investigate the prevalence of excessive daytime sleepiness (EDS) and explore the association between free sugars intake and EDS. In this...
This study aimed to investigate the prevalence of excessive daytime sleepiness (EDS) and explore the association between free sugars intake and EDS. In this cross-sectional study, a total of 1517 middle school students (808 boys and 707 girls) aged 12~14 years were recruited. The study was conducted in Changsha city, China. Adolescents completed an online questionnaire, including the Epworth Sleepiness Scale (ESS), sleep characteristics, a 12-item Food Frequency Questionnaire (FFQ), and other self-reported information. The ESS score ≥ ten was defined as EDS. The anthropometric indices, including height, weight, and waist circumference, were measured and recorded by uniformly trained assistants. Statistical analyses included the Chi-square test and binary logistic regression model. The mean ESS score and free sugars consumption were 6.8 ± 3.9 points and 53.1 ± 44.7 g/d, respectively. The prevalence of EDS among adolescents was 22.5%, and more girls than boys had EDS (26.1% vs. 19.4%, < 0.05). An exceeded free sugars intake was positively associated with EDS, with the adjusted Odds Ratio (OR) with its 95% Confident Interval (95% CI) of 1.366 (1.060~1.761, < 0.05). EDS and excessive consumption of free sugars are commonly found among Chinese adolescents. Further studies are needed to confirm whether free sugars restriction can be meaningful to improve daytime drowsiness in those with EDS.
Topics: Adolescent; Asian People; Child; China; Dietary Sugars; Eating; Female; Humans; Logistic Models; Male; Sleep
PubMed: 34836214
DOI: 10.3390/nu13113959 -
European Respiratory Review : An... Jun 2022Excessive daytime sleepiness (EDS) is a major symptom of obstructive sleep apnoea (OSA), defined as the inability to stay awake during the day. Its clinical descriptors... (Review)
Review
Excessive daytime sleepiness (EDS) is a major symptom of obstructive sleep apnoea (OSA), defined as the inability to stay awake during the day. Its clinical descriptors remain elusive, and the pathogenesis is complex, with disorders such as insufficient sleep and depression commonly associated. Subjective EDS can be evaluated using the Epworth Sleepiness Scale, in which the patient reports the probability of dozing in certain situations; however, its reliability has been challenged. Objective tests such as the multiple sleep latency test or the maintenance of wakefulness test are not commonly used in patients with OSA, since they require nocturnal polysomnography, daytime testing and are expensive. Drugs for EDS are available in the United States but were discontinued in Europe some time ago. For European respiratory physicians, treatment of EDS with medication is new and they may lack experience in pharmacological treatment of EDS, while novel wake-promoting drugs have been recently developed and approved for clinical use in OSA patients in the USA and Europe. This review will discuss 1) the potential prognostic significance of EDS in OSA patients at diagnosis, 2) the prevalence and predictors of residual EDS in treated OSA patients, and 3) the evolution of therapy for EDS specifically for Europe.
Topics: Disorders of Excessive Somnolence; Humans; Reproducibility of Results; Sleep Apnea, Obstructive; Sleepiness; Wakefulness
PubMed: 35613742
DOI: 10.1183/16000617.0230-2021 -
Frontiers in Physiology 2023Drowsy driving is a significant factor causing dire road crashes and casualties around the world. Detecting it earlier and more effectively can significantly reduce the...
Drowsy driving is a significant factor causing dire road crashes and casualties around the world. Detecting it earlier and more effectively can significantly reduce the lethal aftereffects and increase road safety. As physiological conditions originate from the human brain, so neurophysiological signatures in drowsy and alert states may be investigated for this purpose. In this preface, A passive brain-computer interface (pBCI) scheme using multichannel electroencephalography (EEG) brain signals is developed for spatially localized and accurate detection of human drowsiness during driving tasks. This pBCI modality acquired electrophysiological patterns of 12 healthy subjects from the prefrontal (PFC), frontal (FC), and occipital cortices (OC) of the brain. Neurological states are recorded using six EEG channels spread over the right and left hemispheres in the PFC, FC, and OC of the sleep-deprived subjects during simulated driving tasks. In analysis, spectral signatures of the , , , and rhythms are extracted in terms of spectral band powers and their ratios with a temporal correlation over the complete span of the experiment. Minimum redundancy maximum relevance, Chi-square, and ReliefF feature selection methods are used and aggregated with a -score based approach for global feature ranking. The extracted drowsiness attributes are classified using decision trees, discriminant analysis, logistic regression, naïve Bayes, support vector machines, -nearest neighbors, and ensemble classifiers. The binary classification results are reported with confusion matrix-based performance assessment metrics. In inter-classifier comparison, the optimized ensemble model achieved the best results of drowsiness classification with 85.6% accuracy and precision, 89.7% recall, 87.6% F-score, 80% specificity, 70.3% Matthews correlation coefficient, 70.2% Cohen's kappa score, and 91% area under the receiver operating characteristic curve with 76-ms execution time. In inter-channel comparison, the best results were obtained at the F8 electrode position in the right FC of the brain. The significance of all the results was validated with a -value of less than 0.05 using statistical hypothesis testing methods. The proposed scheme has achieved better results for driving drowsiness detection with the accomplishment of multiple objectives. The predictor importance approach has reduced the feature extraction cost and computational complexity is minimized with the use of conventional machine learning classifiers resulting in low-cost hardware and software requirements. The channel selection approach has spatially localized the most promising brain region for drowsiness detection with only a single EEG channel (F8) which reduces the physical intrusiveness in normal driving operation. This pBCI scheme has a good potential for practical applications requiring earlier, more accurate, and less disruptive drowsiness detection using the spectral information of EEG biosignals.
PubMed: 37064914
DOI: 10.3389/fphys.2023.1153268 -
Otolaryngology--head and Neck Surgery :... Oct 2022To characterize the treatment goals and values of adult patients with obstructive sleep apnea (OSA).
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 ( < .0001), excessive daytime sleepiness (Epworth Sleepiness Scale score >10, < .0001), PAP use status ( < .0001), and OSA severity (apnea-hypopnea index, < .0001). Severity of OSA was associated with increasing proportion of patients choosing health risk reduction as the main treatment goal ( < .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.
Topics: Adult; Cross-Sectional Studies; Disorders of Excessive Somnolence; Goals; Humans; Sleep Apnea, Obstructive; Sleepiness; Snoring
PubMed: 35133912
DOI: 10.1177/01945998221075298 -
Current Opinion in Pulmonary Medicine Nov 2022The purpose of this review is to describe the nonclassical symptoms and manifestations occurring in patients with obstructive sleep apnea (OSA), both from a standpoint... (Review)
Review
PURPOSE OF REVIEW
The purpose of this review is to describe the nonclassical symptoms and manifestations occurring in patients with obstructive sleep apnea (OSA), both from a standpoint of prevalence and in terms of clinical relevance. Particular emphasis will be given to nightmares, comorbid insomnia, restless legs syndrome and periodic limb movement disorder, bruxism, morning headache, nocturia, acid reflux, chronic cough and dysphagia.
RECENT FINDINGS
A review of the recent literature suggests that nonclassical symptoms have a high prevalence, are underestimated, and can interact with quality of life. Although these disturbances may occur together by mere coincidence, they may interact reciprocally. However, the degree of symptoms is not always correlated with OSA severity.
SUMMARY
OSA is a heterogeneous disease with variable clinical manifestations. This review highlights the need for detailed evaluation of patients with OSA to diagnose other important sleep disorders and clinical manifestations, given their frequent association.
Topics: Humans; Polysomnography; Prevalence; Quality of Life; Sleep Apnea, Obstructive; Sleep Initiation and Maintenance Disorders; Sleepiness
PubMed: 36101923
DOI: 10.1097/MCP.0000000000000915 -
The Journal of Clinical Psychiatry Oct 2023To determine if there are differences in the number needed to treat (NNT), number needed to harm (NNH), and likelihood to be helped or harmed (LHH) between lemborexant...
Lemborexant and Daridorexant for the Treatment of Insomnia: An Indirect Comparison Using Number Needed to Treat, Number Needed to Harm, and Likelihood to Be Helped or Harmed.
To determine if there are differences in the number needed to treat (NNT), number needed to harm (NNH), and likelihood to be helped or harmed (LHH) between lemborexant and daridorexant and to compare lemborexant with daridorexant indirectly. Dichotomous efficacy and tolerability outcomes reported for Phase 3 daridorexant trials (conducted May 29, 2018-May 14, 2020) for months 1 and 3 were identified from published literature and regulatory documents. Analogous data were extracted for lemborexant from Phase 3 studies (conducted May 31, 2016-January 8, 2019). NNT, NNH, and LHH were then calculated. Lemborexant 5 mg and 10 mg had clinically relevant therapeutic effect sizes, evidenced by most NNT values versus placebo < 10 for Insomnia Severity Index [ISI], subjective total sleep time [sTST], and polysomnography outcomes. NNH values for adverse events (AEs) were > 10, suggesting relative tolerability. Somnolence was the most common AE. Discontinuation rates of lemborexant because of an AE were low, including for somnolence. Efficacy outcomes for daridorexant 25-mg and 50-mg doses pooled resulted in most NNT values versus placebo ≥ 10, with more robust NNT estimates for the 50-mg dose than for the 25-mg dose. Discontinuation rate because of an AE at month 3 was higher for placebo than for daridorexant, rendering favorable LHH calculations. Daridorexant evidenced low rates of somnolence or fatigue. In Phase 3 trials, the benefit-risk ratios for both lemborexant and daridorexant were favorable as measured by NNT, NNH, and LHH. Indirect comparisons of lemborexant with daridorexant suggest an efficacy advantage for lemborexant and a tolerability advantage for daridorexant. NCT02783729, NCT02952820, NCT03545191, NCT03575104.
Topics: Humans; Sleep Initiation and Maintenance Disorders; Sleepiness; Treatment Outcome; Clinical Trials, Phase III as Topic
PubMed: 37796657
DOI: 10.4088/JCP.23m14851 -
International Journal of Environmental... Feb 2023Airline cabin crew operate in dynamic work environments that are continuously changing, from unpredictable shift work hours to travelling through multiple time zones.... (Review)
Review
Airline cabin crew operate in dynamic work environments that are continuously changing, from unpredictable shift work hours to travelling through multiple time zones. These likely impact cabin crews' overall health and may affect their performance on safety-related tasks. Research on this population has been limited; therefore, the aim was to summarise the relevant literature regarding fatigue, sleepiness and mental health of cabin crew. This review followed the PRISMA-ScR guidelines and conducted a systematic search utilising five databases. The initial search identified 1223 studies, and through vigorous screening processes, 27 studies were selected for this review. Over half of the selected studies focused on international or long-haul flights, and a large proportion of the sample participants were women. Findings suggested a high prevalence of fatigue and sleepiness as well as unsatisfactory sleep quality with elevated susceptibility to sleep disorders. Factors identified with health outcomes were associated with flight operations (e.g., rosters) and individual differences (e.g., age and coping strategies). Regarding mental health, cabin crews are potentially at a greater risk for depression and anxiety compared to the general public. This review draws attention to the importance of using a standardised approach, such as validated measures for fair and consistent inferences.
Topics: Humans; Female; Male; Sleepiness; Sleep; Wakefulness; Fatigue
PubMed: 36768014
DOI: 10.3390/ijerph20032652 -
Revista Da Associacao Medica Brasileira... 2022This study aimed to investigate the frequency of fatigue in geriatric patients with primary sarcopenia and to evaluate the relationship between fatigue and symptoms such...
OBJECTIVE
This study aimed to investigate the frequency of fatigue in geriatric patients with primary sarcopenia and to evaluate the relationship between fatigue and symptoms such as depression and sleepiness.
METHODS
This case-control study was conducted between December 2020 and August 2021 in the geriatrics outpatient clinic of Istanbul University-Cerrahpasa. The European Working Group on Sarcopenia in Older People 2 criteria were considered for the diagnosis of sarcopenia. Demographic data, accompanying chronic diseases, comprehensive geriatric assessments, and laboratory values of the patients were noted. Scales used to assess fatigue in all participants include Fatigue Assessment Scale, Fatigue Severity Scale, and Fatigue Impact Scale and associated symptoms include Geriatric Depression Scale and Epworth Sleepiness Scale.
RESULTS
The mean (standard deviation) age was 75.3 (7.1) for 51 primary sarcopenia (38 female) patients and 73.5 (5.8) for 51 control (37 female) patients. There was no significant difference between the two groups in terms of gender and age (p=0.822, p=0.171). The prevalence of hypertension was higher, and the level of education was lower in the sarcopenic group than in the nonsarcopenic group (p=0.017, p=0.013). Fatigue Assessment Scale, Fatigue Severity Scale, Fatigue Impact Scale total, Fatigue Impact Scale cognitive, Fatigue Impact Scale physical, and Fatigue Impact Scale social questionnaire scores were significantly higher in the sarcopenic group (all p<0.001). The Geriatric Depression Scale score was statistically higher in the sarcopenic group; however, there was no significant difference in the Epworth Sleepiness Scale score between the two groups (p=0.014, p=0.072). Multivariate analysis was performed on education level, hypertension, fatigue questionnaires, and Geriatric Depression Scale, which were found to be significant in the univariate logistic regression analysis. In the multivariate logistic regression analysis, only the Fatigue Impact Scale total was determined to be associated with sarcopenia [odds ratio 1.161, 95% confidence interval (1.084-1.242)].
CONCLUSION
In primary sarcopenia, there is mental and social fatigue as well as physical fatigue. Therefore, the prevention and treatment of sarcopenia in geriatric patients is important.
Topics: Humans; Female; Aged; Sarcopenia; Case-Control Studies; Sleepiness; Cross-Sectional Studies; Geriatric Assessment; Fatigue; Hypertension
PubMed: 36383875
DOI: 10.1590/1806-9282.20220662 -
Inflammopharmacology Apr 2023COVID-19 is often associated with long-lasting pulmonary symptoms. Data are scarce about interstitial lung disease (ILD) in patients following COVID-19 hospitalization... (Review)
Review
COVID-19 is often associated with long-lasting pulmonary symptoms. Data are scarce about interstitial lung disease (ILD) in patients following COVID-19 hospitalization with persistent symptoms. We retrospectively reviewed all cases sent to pulmonary post-COVID evaluation due to persistent symptoms between February 2021 and February 2022 (N = 318). All patients with suspected ILD (N = 44) were reviewed at the multidisciplinary discussion. Patient characteristics, symptoms, time since hospitalization, detailed lung function measurements and 6-min walk test (6MWT) were evaluated. The post-COVID ILD suspected group included more men (68.2 vs. 31.8%) with significantly older age compared to the control group (64.0 ± 12.3 vs. 51.3 ± 14.9 years). Most patient needed hospital care for COVID-19 pneumonia (68.6% of all patients and 84.1% of ILD suspected group) and average time since hospitalization was 2.4 ± 2.3 months. Persisting symptoms included fatigue (34%), dyspnoea (25.2%), cough (22.6%), and sleep disorders (insomnia 13.2%; sleepiness 8.2%). Post-COVID ILD presented more often with new symptoms of cough and sleepiness. Functional impairment, especially decreased walking distance and desaturation during 6-min walk test (6MWT) were detected in the ILD-suspected group. Respiratory function test in the post-COVID ILD group showed slight restrictive ventilatory pattern (FVC: 76.7 ± 18.1%, FEV1: 83.5 ± 19.1%, TLC: 85.6 ± 28.1%) and desaturation during 6MWT were detected in 41% of patients. LDCT changes were mainly ground glass opacities (GGO) and/or reticular abnormalities in most cases affecting < 10% of the lungs. Our data indicate that suspected post-COVID ILD is affecting 13.8% of symptomatic patients. High resolution chest CT changes were mainly low extent GGO/reticulation, while long-term lung structural changes need further evaluation.
Topics: Male; Humans; Cough; Retrospective Studies; Sleepiness; COVID-19; Lung Diseases, Interstitial; Lung
PubMed: 36961666
DOI: 10.1007/s10787-023-01191-3