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Parkinsonism & Related Disorders Jan 2023We aimed to determine the distribution of chronotypes in a cohort of PD patients and to evaluate the relationships between chronotype and PD characteristics, and...
We aimed to determine the distribution of chronotypes in a cohort of PD patients and to evaluate the relationships between chronotype and PD characteristics, and self-reported metrics of sleep and sleepiness. Chronotype was characterized using the Horne-Ostberg Morningness-Eveningness Questionnaire (MEQ). PD participants were categorized as Evening Types (ET), Neither Types (NT), or Morning Types (MT). Sleepiness was assessed by the Epworth Sleepiness Scale. Sleep metrics included self-reported sleep times and latency. 186 participants with PD, age 65.5 ± 9.8 yrs, disease duration 6.17 ± 6.7 yrs completed the MEQ. Most participants were classified as MT (63.4%). Participants in the ET group were younger than those in the NT and MT groups (57.6 ± 6.3 vs 67.3 ± 10.2 vs 64.9 ± 9.5). The mean disease duration was not different among chronotypes. No significant relationship between chronotype and sleepiness was found. MT participants woke up and went to bed significantly earlier than NT participants. There was no significant difference between chronotypes and PD medications. Further studies should examine if PD severity and progression affect the chronotype, and whether certain chronotype differentially affects the quality of life, symptom control, and medication effectiveness in the PD population.
Topics: Humans; Middle Aged; Aged; Circadian Rhythm; Chronotype; Sleepiness; Parkinson Disease; Quality of Life; Sleep; Surveys and Questionnaires
PubMed: 36442363
DOI: 10.1016/j.parkreldis.2022.10.011 -
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 -
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 -
European Journal of Neurology Mar 2023Fatigue, a disabling symptom in many neuromuscular disorders, has been reported also in Charcot-Marie-Tooth disease (CMT). The presence of fatigue and its correlations...
BACKGROUND AND PURPOSE
Fatigue, a disabling symptom in many neuromuscular disorders, has been reported also in Charcot-Marie-Tooth disease (CMT). The presence of fatigue and its correlations in CMT was investigated.
METHODS
The Modified Fatigue Impact Scale (MFIS) was administered to CMT patients from the Italian Registry and a control group. An MFIS score >38 indicated abnormal fatigue. The correlation with disease severity and clinical characteristics, the Hospital Anxiety and Depression Scale and Epworth Sleepiness Scale scores, and drug use was analysed.
RESULTS
Data were collected from 251 CMT patients (136 women) and 57 controls. MFIS total (mean ± standard deviation 32 ± 18.3, median 33), physical (18.9 ± 9.7, 20) and psychosocial (2.9 ± 2.4, 3) scores in CMT patients were significantly higher than controls. Abnormal fatigue occurred in 36% of the patients who, compared to patients with normal scores, had more severe disease (median CMT Examination Score 9 vs. 7), more frequent use of foot orthotics (22% vs. 11%), need of support for walking (21% vs. 8%), hand disability (70% vs. 52%) and positive sensory symptoms (56% vs. 36%). Patients with abnormal fatigue had significantly increased frequency of anxiety/depression/general distress (Hospital Anxiety and Depression Scale), somnolence (Epworth Sleepiness Scale), obesity (body mass index ≥ 30) and use of anxiolytic/antidepressant or anti-inflammatory/analgesic drugs.
CONCLUSIONS
Fatigue is a relevant symptom in CMT as 36% of our series had scores indicating abnormal fatigue. It correlated with disease severity but also with anxiety, depression, sleepiness and obesity, indicating different components in the generation of fatigue. CMT patients' management must include treatment of fatigue and of its different generators, including general distress, sleepiness and obesity.
Topics: Humans; Female; Charcot-Marie-Tooth Disease; Sleepiness; Walking; Fatigue; Upper Extremity
PubMed: 36458502
DOI: 10.1111/ene.15643 -
Annual International Conference of the... Jul 2022Prolonged sleepiness can lead to impairment of cognitive and physical performance and may cause unfortunate accidents. Speech signals are easily accessible using a...
Prolonged sleepiness can lead to impairment of cognitive and physical performance and may cause unfortunate accidents. Speech signals are easily accessible using a simple microphone or other means, hence, automated approaches for accurate sleepiness detection from speech signals are desired to prevent degradation in human performance and accidental injury. Sleepiness is known to affect acoustic patterns of speech so that they are different from those of normal speech, and this change is also independent of the language being spoken. To date, there have been no studies examining linguistic-independent sleepy speech detection. We used two different languages, English and German, to detect sleepy speech, where the former was used to train/validate and the latter to test the effectiveness of machine and deep learning models. Specifically, we trained ResNet50, a deep learning model, and five machine learning models with relevant vocal features. Speech data segments from three English-speaking subjects were used for training the model and segments from an English-speaking subject were used for validation. We then tested ResNet50 and the five different machine-learning models using speech data segments from one German-speaking subject. Deep learning far outperformed all of the machine learning approaches. The accuracy, sensitivity, specificity, and geometric mean values were found to be 0.96, 0.92, 0.99, and 0.95, respectively, using ResNet50 on the test data. Our preliminary results suggest that sleepiness can be accurately detected independently from linguistic speech. Clinical Relevance-It is not known if sleepiness can be detected regardless of the language spoken. Our results show the feasibility of accurate sleepiness detection using deep learning even when tested with a different language than trained on.
Topics: Acoustics; Humans; Language; Linguistics; Sleepiness; Speech
PubMed: 36085715
DOI: 10.1109/EMBC48229.2022.9870900 -
European Journal of Sport Science Mar 2021Daytime napping is a common practice in high-performance athletes, and is widely assumed to reflect sleepiness arising from sports-related sleep debt. The possibility...
Daytime napping is a common practice in high-performance athletes, and is widely assumed to reflect sleepiness arising from sports-related sleep debt. The possibility that athlete naps may also be indicative of 'sleepability', a capacity to nap on demand that is only weakly related to homeostatic sleep pressure, has not previously been tested. The present study compared daytime sleep latencies in high-performance athletes and non-athlete controls using a single nap opportunity model. Elite ( = 10), and sub-elite ( = 10) athletes, and non-athlete controls ( = 10) attended the laboratory for a first adaption trial, and a subsequent experimental trial. Subjective sleepiness was assessed using the Karolinska Sleepiness Scale (KSS) at 14:00, 14:30 and immediately prior to a 20-minute nap opportunity at 15:00. Sleep latencies were measured using polysomnography, and defined as the time from lights out to the first epoch of any stage of sleep (N1, N2, N3, REM). In unadjusted comparisons with non-athlete controls, elite athletes showed significantly shorter sleep latencies in both the adaptation ( < 0.05) and experimental trials ( < 0.05). These significant differences were maintained in models controlling for pre-trial KSS scores and pre-trial total sleep time (all < 0.05). Sleep latency scores for sub-elite athletes showed similar trends, but were more labile. These results are consistent with a conclusion that, among elite athletes, napping behaviour can reflect sleepability and may not necessarily result from nocturnal sleep disruption and daytime sleepiness.
Topics: Analysis of Variance; Athletes; Athletic Performance; Female; Humans; Male; Polysomnography; Rest; Sleep; Sleep Latency; Sleepiness; Time Factors; Young Adult
PubMed: 32174283
DOI: 10.1080/17461391.2020.1743765 -
International Journal of Environmental... Jan 2021Scheduled naps in the workplace are an effective countermeasure to drowsiness in safety-sensitive industries. This quasi-experimental study with a one-group, pre- and...
Scheduled naps in the workplace are an effective countermeasure to drowsiness in safety-sensitive industries. This quasi-experimental study with a one-group, pre- and post-test design aimed to examine the effects of scheduled naps on nurses working 12-h shifts. Nurses in two pediatric intensive care units at a tertiary hospital were provided 30-min scheduled nap opportunities during their shifts. A total of 38 nurses completed pre- and post-test work diaries for sleepiness, fatigue, work demands and pace, and quality of nursing care at the end of each shift. The drowsiness of 13 nurses was continuously assessed during their shifts using infrared reflectance oculography. Nurses who reached naps reported improved levels of fatigue on the first night shift and better quality of nursing care the second night and day shifts post-test, while nurses who did not reach naps showed no significant improvements. The oculography successfully assessed drowsiness during 73% and 61% of the pre- and post-test total work hours, respectively. The total cautionary and cautionary or higher levels of drowsiness decreased. Nurse managers should consider scheduled naps in clinical settings to improve nurses' alertness during their shifts.
Topics: Child; Fatigue; Humans; Sleep; Sleep Disorders, Circadian Rhythm; Sleepiness; Wakefulness; Work Schedule Tolerance
PubMed: 33498593
DOI: 10.3390/ijerph18030891 -
American Journal of Orthodontics and... Aug 2023The study aimed to assess (1) the effect of the treatment with cervical headgear on patients' sleep-related attributes and well-being and (2) whether these sleep-related...
INTRODUCTION
The study aimed to assess (1) the effect of the treatment with cervical headgear on patients' sleep-related attributes and well-being and (2) whether these sleep-related parameters (ie, sleep quality and quantity) were associated with patients' compliance during the orthodontic treatment.
METHODS
The study protocol was based on a prospective longitudinal quasi-experimental design. Participants (n = 26; 9 males; mean age, 12.4 ± 1.68 years) were patients in the Postgraduate Orthodontic Clinic, National and Kapodistrian University of Athens. All patients received treatment with a cervical headgear having an embedded TheraMon microsensor. Sleep was assessed by wrist-worn actigraphy for 59 ± 19 days. The Epworth Sleepiness Scale was used to assess average daytime sleepiness, whereas we used the Athens Insomnia Scale for insomnia symptoms. Oral health-related quality of life (OHRQOL) was assessed by the Oral Health Impact Profile (OHIP-14).
RESULTS
Patients slept on average 7.35 ± 0.42 h/d. Compared with the lowest sleep duration recommended for their age group, patients had an average chronic sleep deficit of 1.40 ± 0.49 h/d. Patients wore the headgear 90.9% of the days for 10.40 ± 4.17 h/d. However, only 7 (28%) patients reached or exceeded the wear-time recommendation of 12 h/d. In contrast, 2 (8%) patients wore headgear <5 h/d, 11 (44%) 5-10 h/d, and 12 (48%) patients wore headgear >10 h/d. Aggregated by participants, the median Epworth Sleepiness Scale score during the study was 3.40 (interquartile range [IQR], 4.85; range, 0.2-13.6), the median Athens Insomnia Scale score was 3.00 (IQR, 4.25; range, 0-7), and the median Oral Health Impact Profile score was 1.40 (IQR, 4.17; range, 0.0-20.8). Compared with patients who wore the orthodontic appliance >7.8 h/d, patients who wore it <7.8 h/d had worse average daytime sleepiness (P = 0.050) and worse OHRQOL (P = 0.019).
CONCLUSIONS
Orthodontic treatment with cervical headgear has no substantive negative effect on sleep attributes (quantity and quality), average daytime sleepiness and OHRQOL. However, poor compliance with orthodontic treatment seems to be associated with higher levels of daytime sleepiness.
Topics: Male; Humans; Child; Adolescent; Sleep Initiation and Maintenance Disorders; Prospective Studies; Quality of Life; Sleepiness; Sleep; Disorders of Excessive Somnolence
PubMed: 37002113
DOI: 10.1016/j.ajodo.2022.12.017 -
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 -
Traffic Injury Prevention 2020The National Highway Traffic Safety Administration in the USA estimated that the effects of drowsiness while driving led to approximately 72,000 crashes, 44,000...
The National Highway Traffic Safety Administration in the USA estimated that the effects of drowsiness while driving led to approximately 72,000 crashes, 44,000 injuries, and 800 deaths in 2013. Keeping this in mind, the risk and injuries of drowsy driving remain a major safety issue that clearly needs to be studied. Our purpose was to conduct a systematic review of international literature including studies on driving behavior associated to drowsy and fatigued drivers. The research focused on the prediction and effects of drowsiness, and particularly on studies based on driving in simulated environments. Additionally, we searched for studies related to driving simulators, in general, to better understand the tool's efficacy and its advantages and disadvantages. This review was made in accordance with PRISMA statement guidelines. After conducting in-depth research in targeted databases, 23 studies met the inclusion criteria; the papers were analyzed regarding the type of experiment and procedures and driving performance of 690 participants was studied. Studies revealed that drowsiness have effects on driving performance and these effects become more relevant with time-on-task and in monotonous scenarios and landscapes. In addition, some documents include validations of several technologies to detect and predict sleepiness. Overall, we can conclude that drowsiness and fatigue impair driving performance, resulting in drivers who are more exposed to risky situations.
Topics: Automobile Driving; Computer Simulation; Humans; Sleepiness
PubMed: 31986057
DOI: 10.1080/15389588.2019.1706088