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Sleep Medicine Clinics Dec 2019Obstructive sleep apnea is associated with excessive daytime sleepiness in about 50% of cases, and with increased risk of driving accidents. Treatment with continuous... (Review)
Review
Obstructive sleep apnea is associated with excessive daytime sleepiness in about 50% of cases, and with increased risk of driving accidents. Treatment with continuous positive airway pressure effectively decreases such risk, but compliance with continuous positive airway pressure treatment is often suboptimal. According to the European Union Directive on driving risk, retention of a driving license in patients with obstructive sleep apnea requires assessment of sleepiness and adherence to continuous positive airway pressure treatment, but there remains uncertainty on the optimal methods to assess sleepiness on a large scale.
Topics: Automobile Driving; Continuous Positive Airway Pressure; Humans; Patient Compliance; Risk Factors; Sleep Apnea Syndromes; Sleepiness; Wakefulness
PubMed: 31640871
DOI: 10.1016/j.jsmc.2019.08.001 -
Sleep Medicine Clinics Jun 2020Unlike other reviews written on this topic, the focus of this article is primarily on nonpharmacologic treatments for daytime sleepiness that is not secondary to other... (Review)
Review
Unlike other reviews written on this topic, the focus of this article is primarily on nonpharmacologic treatments for daytime sleepiness that is not secondary to other medical or psychological conditions. To provide an appropriate background on primary excessive daytime sleepiness, what is considered optimal sleep in terms of sleep duration, sleep insufficiency, and sleep need is discussed in detail. This discussion is followed by an examination of the behavioral strategy of banking sleep. After briefly discussing behavioral interventions for sleepiness associated with narcolepsy, a new behavioral method of treating daytime somnolence is proposed and described.
Topics: Behavior Therapy; Disorders of Excessive Somnolence; Humans; Narcolepsy; Sleep; Sleepiness; Wakefulness
PubMed: 32386694
DOI: 10.1016/j.jsmc.2020.02.018 -
Sleep Nov 2023To examine whether drivers are aware of sleepiness and associated symptoms, and how subjective reports predict driving impairment and physiological drowsiness.
STUDY OBJECTIVES
To examine whether drivers are aware of sleepiness and associated symptoms, and how subjective reports predict driving impairment and physiological drowsiness.
METHODS
Sixteen shift workers (19-65 years; 9 women) drove an instrumented vehicle for 2 hours on a closed-loop track after a night of sleep and a night of work. Subjective sleepiness/symptoms were rated every 15 minutes. Severe and moderate driving impairment was defined by emergency brake maneuvers and lane deviations, respectively. Physiological drowsiness was defined by eye closures (Johns drowsiness scores) and EEG-based microsleep events.
RESULTS
All subjective ratings increased post night-shift (p < 0.001). No severe drive events occurred without noticeable symptoms beforehand. All subjective sleepiness ratings, and specific symptoms, predicted a severe (emergency brake) driving event occurring in the next 15 minutes (OR: 1.76-2.4, AUC > 0.81, p < 0.009), except "head dropping down". Karolinska Sleepiness Scale (KSS), ocular symptoms, difficulty keeping to center of the road, and nodding off to sleep, were associated with a lane deviation in the next 15 minutes (OR: 1.17-1.24, p<0.029), although accuracy was only "fair" (AUC 0.59-0.65). All sleepiness ratings predicted severe ocular-based drowsiness (OR: 1.30-2.81, p < 0.001), with very good-to-excellent accuracy (AUC > 0.8), while moderate ocular-based drowsiness was predicted with fair-to-good accuracy (AUC > 0.62). KSS, likelihood of falling asleep, ocular symptoms, and "nodding off" predicted microsleep events, with fair-to-good accuracy (AUC 0.65-0.73).
CONCLUSIONS
Drivers are aware of sleepiness, and many self-reported sleepiness symptoms predicted subsequent driving impairment/physiological drowsiness. Drivers should self-assess a wide range of sleepiness symptoms and stop driving when these occur to reduce the escalating risk of road crashes due to drowsiness.
Topics: Humans; Female; Accidents, Traffic; Automobile Driving; Sleepiness; Wakefulness; Sleep
PubMed: 37158173
DOI: 10.1093/sleep/zsad136 -
Sleep Medicine Reviews Dec 2021Driver drowsiness contributes to 10-20% of motor vehicle crashes. To reduce crash risk, ideally drivers would be aware of the drowsy state and cease driving. The extent... (Review)
Review
Driver drowsiness contributes to 10-20% of motor vehicle crashes. To reduce crash risk, ideally drivers would be aware of the drowsy state and cease driving. The extent to which drivers can accurately identify sleepiness remains under much debate. We systematically examined whether individuals are aware of sleepiness while driving, and whether this accurately reflects driving impairment, using meta-analyses and narrative review. Within this scope, there is high variability in measures of subjective sleepiness, driving performance and physiologically-derived drowsiness, and statistical analyses. Thirty-four simulated/naturalistic driving studies were reviewed. To summarise, drivers were aware of sleepiness, and this was associated to physiological drowsiness and driving impairment, such that high levels of sleepiness significantly predicted crash events and lane deviations. Subjective sleepiness was more strongly correlated (i) with physiological drowsiness compared to driving outcomes; (ii) under simulated driving conditions compared to naturalistic drives; and (iii) when examined using the Karolinska sleepiness scale (KSS) compared to other measures. Gaps remain in relation to how age, sex, and varying degrees of sleep loss may influence this association. This review provides evidence that drivers are aware of drowsiness while driving, and stopping driving when feeling 'sleepy' may significantly reduce crash risk.
Topics: Accidents, Traffic; Automobile Driving; Humans; Sleepiness; Surveys and Questionnaires; Wakefulness
PubMed: 34461582
DOI: 10.1016/j.smrv.2021.101533 -
Journal of Sleep Research Oct 2023The orexin 2 receptor-selective agonist danavorexton (TAK-925) has been shown to produce wake-promoting effects in wild-type mice, narcolepsy-model mice, and individuals... (Randomized Controlled Trial)
Randomized Controlled Trial
The orexin 2 receptor-selective agonist danavorexton (TAK-925) has been shown to produce wake-promoting effects in wild-type mice, narcolepsy-model mice, and individuals with narcolepsy type 1 and type 2. Here, we report wake-promoting effects of danavorexton in non-human primates and healthy men during their sleep phase. Electroencephalogram analyses revealed that subcutaneous administration of danavorexton significantly increased wakefulness in common marmosets (p < 0.05 at 0.1 mg kg , and p < 0.001 at 1 mg kg and 10 mg kg ) and cynomolgus monkeys (p ≤ 0.05 at 1 mg kg and 3 mg kg ). In a phase 1b crossover, randomized, double-blind, placebo-controlled and active-controlled study in sleep-deprived healthy participants (ClinicalTrials.gov identifier: NCT03522506), modafinil 300 mg (used to demonstrate assay sensitivity) and continuous infusion of danavorexton 44 mg and danavorexton 112 mg showed statistically superior wake-promoting effects to placebo (n = 18). Measured using the Maintenance of Wakefulness Test, mean (standard deviation) sleep latencies during infusion of danavorexton 44 mg, danavorexton 112 mg and placebo were 21.4 (8.9), 31.8 (3.2) and 9.2 (6.4) min, respectively. Least-squares mean difference from placebo in average sleep latency was 16.8 min with danavorexton 44 mg and 30.2 min with danavorexton 112 mg (both p < 0.001). Karolinska Sleepiness Scale scores were statistically significantly lower (indicating decreased sleepiness) for participants receiving danavorexton than for those receiving placebo during infusion (danavorexton 44 mg, p = 0.010; danavorexton 112 mg, p < 0.001). Together, these results indicate that an orexin 2 receptor agonist increases wakefulness in non-human primates and healthy individuals during their sleep phase.
Topics: Animals; Double-Blind Method; Narcolepsy; Orexins; Primates; Sleepiness; Treatment Outcome; Wakefulness; Humans; Male
PubMed: 36934366
DOI: 10.1111/jsr.13878 -
JAMA Sep 2020
Topics: Humans; Patient Reported Outcome Measures; Polysomnography; Sleep Apnea, Obstructive; Sleepiness
PubMed: 32886089
DOI: 10.1001/jama.2020.9332 -
BMC Public Health Feb 2024Low-quality sleep and obstructive sleep apnea (OSA) can result in series of chronic diseases. Healthy diet has been considered as an effective and simple strategy to...
BACKGROUND
Low-quality sleep and obstructive sleep apnea (OSA) can result in series of chronic diseases. Healthy diet has been considered as an effective and simple strategy to optimize sleep quality. However, current evidence on the correlation of dietary composite antioxidant intake with sleep health remained obscure.
AIM OF THE STUDY
To determine the relationship of composite dietary antioxidant index (CDAI) and sleep health.
METHODS
Cross-sectional analyses were based on National Health and Nutrition Examination Survey (NHANES) 2005-2008. Dietary consumption was assessed by trained staff using 24-h diet recall method and CDAI was calculated based on previous validated approach that included six antioxidants. Sleep-related outcomes were self-reported by a set of questionnaires and classified into OSA, day sleepiness, and insufficient sleep. Weighted logistic regression was conducted to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Restricted cubic spline (RCS) regressions were also used to evaluate the dose-response of CDAI and three sleep-related outcomes.
RESULTS
A total of 7274 subjects included (mean age: 46.97 years) were enrolled in our study, including 3658 were females (52.54%) and 3616 were males (47.46%). Of them, 70.6%, 29.51%, and 35.57% of the subjects reported that they had OSA, day sleepiness and insufficient sleep, respectively. Logistic regression showed the highest quartile of CDAI was inversely associated with the risk of OSA (OR: 0.69, 95%CI: 0.49-0.97), day sleepiness (OR: 0.64, 95%CI: 0.44-0.94) and insufficient sleep (OR: 0.68, 95%CI: 0.50-0.92) compared with the lowest quartile. RCS showed linear relationship of CDAI and insufficient sleep but non-linear relationship of CDAI with OSA and day sleepiness.
CONCLUSIONS
Our results show that CDAI was non-linearly associated with lower risk of OSA and day sleepiness whereas a linear inverse association between CDAI and insufficient sleep was observed. These findings implicate that combined intake of antioxidants could be a promising and effective approach to optimize sleep quality for public.
Topics: Male; Female; Humans; Middle Aged; Antioxidants; Cross-Sectional Studies; Nutrition Surveys; Sleep Deprivation; Sleepiness; Sleep; Sleep Apnea, Obstructive; Diet
PubMed: 38408934
DOI: 10.1186/s12889-024-18047-2 -
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 -
Journal of Safety Research Feb 2022Drowsiness is one of the main contributors to road-related crashes and fatalities worldwide. To address this pressing global issue, researchers are continuing to develop...
INTRODUCTION
Drowsiness is one of the main contributors to road-related crashes and fatalities worldwide. To address this pressing global issue, researchers are continuing to develop driver drowsiness detection systems that use a variety of measures. However, most research on drowsiness detection uses approaches based on a singular metric and, as a result, fail to attain satisfactory reliability and validity to be implemented in vehicles.
METHOD
This study examines the utility of drowsiness detection based on singular and a hybrid approach. This approach considered a range of metrics from three physiological signals - electroencephalography (EEG), electrooculography (EOG), and electrocardiography (ECG) - and used subjective sleepiness indices (assessed via the Karolinska Sleepiness Scale) as ground truth. The methodology consisted of signal recording with a psychomotor vigilance test (PVT), pre-processing, extracting, and determining the important features from the physiological signals for drowsiness detection. Finally, four supervised machine learning models were developed based on the subjective sleepiness responses using the extracted physiological features to detect drowsiness levels.
RESULTS
The results illustrate that the singular physiological measures show a specific performance metric pattern, with higher sensitivity and lower specificity or vice versa. In contrast, the hybrid biosignal-based models provide a better performance profile, reducing the disparity between the two metrics.
CONCLUSIONS
The outcome of the study indicates that the selected features provided higher performance in the hybrid approaches than the singular approaches, which could be useful for future research implications. Practical Applications: Use of a hybrid approach seems warranted to improve in-vehicle driver drowsiness detection system. Practical applications will need to consider factors such as intrusiveness, ergonomics, cost-effectiveness, and user-friendliness of any driver drowsiness detection system.
Topics: Automobile Driving; Humans; Machine Learning; Reproducibility of Results; Sleepiness; Wakefulness
PubMed: 35249601
DOI: 10.1016/j.jsr.2021.12.001 -
Seminars in Pediatric Neurology Dec 2023While sleepiness is common among children, and particularly adolescents, profound sleepiness in the setting of apparently adequate sleep should prompt consideration of a... (Review)
Review
While sleepiness is common among children, and particularly adolescents, profound sleepiness in the setting of apparently adequate sleep should prompt consideration of a central disorder of hypersomnolence. These disorders, which include narcolepsy, idiopathic hypersomnia, Kleine-Levin syndrome, and others, are likely underrecognized in the pediatric population. Narcolepsy in particular should be of interest to child neurologists as the unique signs and symptoms of this disease often prompt evaluation in pediatric neurology clinics. While sleepiness may appear to be a straightforward complaint, its evaluation requires a nuanced approach. Cataplexy, a hallmark of narcolepsy, can be confused for other neurologic conditions, though understanding its various manifestations makes it readily identifiable. Clinicians should be aware of these symptoms, as delay in diagnosis and misdiagnosis are common in childhood narcolepsy. While treatment options have been limited in the past, many new therapeutic options have become available and can result in significant improvement in symptoms. Given the age at presentation, paroxysmal and chronic features, diagnostic modalities, and available treatment options, the field of child neurology is well equipped to see patients with narcolepsy. In this review, I will focus on the presentation, evaluation, and management of pediatric patients with narcolepsy.
Topics: Humans; Child; Adolescent; Sleepiness; Narcolepsy; Disorders of Excessive Somnolence; Idiopathic Hypersomnia
PubMed: 38065636
DOI: 10.1016/j.spen.2023.101089