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Physiological Measurement Jul 2021. Sleepiness-related motor vehicle crashes, caused by lack of sleep or driving during night-time hours, often result in serious injury or fatality. Sleepiness detection... (Review)
Review
. Sleepiness-related motor vehicle crashes, caused by lack of sleep or driving during night-time hours, often result in serious injury or fatality. Sleepiness detection technology is rapidly emerging as a sleepiness risk mitigation strategy for drivers. Continuous monitoring technologies assess and alert to driver sleepiness in real-time, while fit for duty technologies provide a single assessment of sleepiness state. The aim of this rapid review was to evaluate and compare sleepiness detection technologies in relation to specifications, cost, target consumer group and validity.. We evaluated a range of sleepiness detection technologies suitable for consumer groups ranging from regular drivers in private vehicles through to work-related drivers within large businesses.. Continuous monitoring technologies typically ranged between $100 and $3000 AUD and had ongoing monthly costs for telematics functionality and manager alerts. Fit for duty technologies had either a one-off purchase cost or a monthly subscription cost. Of concern, the majority of commercial continuous monitoring technologies lacked scientific validation. While some technologies had promising findings in terms of their ability to detect and reduce driver sleepiness, further validation work is required. Field studies that evaluate the sensitivity and specificity of technology alerts under conditions that are regularly experienced by drivers are necessary. Additionally, there is a need for longitudinal naturalistic driving studies to determine whether sleepiness detection technologies actually reduce sleepiness-related crashes or near-crashes.. There is an abundance of sleepiness detection technologies on the market, but a majority lacked validation. There is a need for these technologies and their validation to be regulated by a driver safety body. Otherwise, consumers will base their technology choices on cost and features, rather than the ability to save lives.
Topics: Accidents, Traffic; Automobile Driving; Humans; Sleep; Sleepiness; Wakefulness
PubMed: 34338222
DOI: 10.1088/1361-6579/abfbb8 -
Neurology India 2023
Topics: Humans; Intracranial Hypotension; Sleepiness; Retrospective Studies; Magnetic Resonance Imaging
PubMed: 38174503
DOI: 10.4103/0028-3886.391367 -
Sleep Medicine Sep 2023The Epworth Sleepiness Scale (ESS) is one of the most used self-reported instruments to assess sleepiness. Thus, several adaptations into different Languages have been... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE/BACKGROUND
The Epworth Sleepiness Scale (ESS) is one of the most used self-reported instruments to assess sleepiness. Thus, several adaptations into different Languages have been performed worldwide over the years. The scale has produced disparate psychometric properties when applied in different settings. In the current study, our aim was to perform a Reliability Generalization meta-analysis of the Cronbach᾽s alphas of all published studies on ESS, specifically with a psychometric focus.
PATIENTS/METHODS
Three reference databases (Scopus, PubMed and Web of Science) were searched since 1991 to October 2022 and all the records on psychometric or validation studies that reported Cronbach's alphas, from clinical and nonclinical groups, were included. In total, data from 46 publications (63 estimates) were extracted, comprising 92,503 participants.
RESULTS
Using a Random-Effects Model, the cumulative Cronbach's alpha for the 63 estimates was about 0.82 (CI: 0.798, 0.832) which can be considered as a good measure. However, and as expected, it was observed a high level of heterogeneity (I = 98.96%). Moderation analyses considering setting, date, continent, risk of bias, sex, age and language were performed in order to account for the heterogeneity. Even so, only the variables study setting and continent were significant, and had little importance in explaining the heterogeneity.
CONCLUSIONS
The ESS is a reliable tool to measure sleepiness; however, further studies are needed to investigate what variables might explain the observed variability. Moreover, it will be important to include empirical studies beyond psychometric ones.
Topics: Humans; Sleepiness; Reproducibility of Results; Surveys and Questionnaires; Psychometrics; Wakefulness
PubMed: 37487279
DOI: 10.1016/j.sleep.2023.07.008 -
Sleep Oct 2021Assess the validity of a subjective measure of sleepiness as an indicator of sleep drive by quantifying associations between intraindividual variation in evening...
STUDY OBJECTIVES
Assess the validity of a subjective measure of sleepiness as an indicator of sleep drive by quantifying associations between intraindividual variation in evening sleepiness and bedtime, sleep duration, and next morning and subsequent evening sleepiness, in young adults.
METHODS
Sleep timing and sleepiness were assessed in 19 students in late autumn and late spring on a total of 771 days. Karolinska Sleepiness Scales (KSS) were completed at half-hourly intervals at fixed clock times starting 4 h prior to participants' habitual bedtime, and in the morning. Associations between sleepiness and sleep timing were evaluated by mixed model and nonparametric approaches and simulated with a mathematical model for the homeostatic and circadian regulation of sleepiness.
RESULTS
Intraindividual variation in evening sleepiness was very large, covering four or five points on the 9-point KSS scale, and was significantly associated with subsequent sleep timing. On average, a one point higher KSS value was followed by 20 min earlier bedtime, which led to 11 min longer sleep, which correlated with lower sleepiness next morning and the following evening. Associations between sleepiness and sleep timing were stronger in early compared to late sleepers. Model simulations indicated that the directions of associations between sleepiness and sleep timing are in accordance with their homeostatic and circadian regulation, even though much of the variance in evening sleepiness and details of its time course remain unexplained by the model.
CONCLUSION
Subjective sleepiness is a valid indicator of the drive for sleep which, if acted upon, can reduce insufficient sleep.
Topics: Circadian Rhythm; Humans; Sleep; Sleep Deprivation; Sleepiness; Wakefulness; Young Adult
PubMed: 33991415
DOI: 10.1093/sleep/zsab123 -
BMC Public Health Aug 2023Insomnia disorder is a highly prevalent, significant public health concern associated with substantial and growing health burden. There are limited real-world data...
BACKGROUND
Insomnia disorder is a highly prevalent, significant public health concern associated with substantial and growing health burden. There are limited real-world data assessing the burden of insomnia disorder on daytime functioning and its association with comorbidities. The objective of this study was to leverage large-scale, real-world data to assess the burden of untreated insomnia disorder in terms of daytime impairment and clinical outcomes.
METHODS
This United States medical claims database study compares patients diagnosed with insomnia disorder but not receiving treatment ('untreated insomnia' cohort) to patients without an insomnia disorder diagnosis and without treatment ('non-insomnia' cohort). International Classification of Disease, Tenth Revision codes were used as a proxy to represent the three symptom domains (Sleepiness, Alert/Cognition, Mood) of the Insomnia Daytime Symptoms and Impacts Questionnaire (IDSIQ), a newly developed and validated tool used in clinical studies to assess daytime functioning in insomnia disorder. Chronic Fatigue (R53.83) and Other Fatigue (R53.83), Somnolence (R40.0) and Disorientation (R41.0) were selected as categories representing one or more IDSIQ domains. Clinical outcomes included cardiovascular events, psychiatric disorders, cognitive impairment and metabolic disorders.
RESULTS
Approximately 1 million patients were included (untreated insomnia: n = 139,959; non-insomnia: n = 836,975). Compared with the 'non-insomnia' cohort, the 'untreated insomnia' cohort was more likely to experience daytime impairments, with mean differences in occurrences per 100 patient-years for: (a) fatigue, at 27.35 (95% confidence interval [CI] 26.81, 27.77, p < 0.01); (b) dizziness, at 4.66 (95% CI 4.40, 4.90, p < 0.01); (c) somnolence, at 4.18 (95% CI 3.94, 4.43, p < 0.01); and (d) disorientation, at 0.92 (95% CI 0.77, 1.06, p < 0.01). During the 1-year look-back period, patients in the 'untreated insomnia' cohort were also more likely to have been diagnosed with arterial hypertension (40.9% vs. 26.3%), psychiatric comorbidities (40.1% vs. 13.2%), anxiety (29.2% vs. 8.5%), depression (26.1% vs. 8.1%) or obesity (21.3% vs. 11.1%) compared with those in the 'non-insomnia' cohort.
CONCLUSIONS
This large-scale study confirms the substantial burden of insomnia disorder on patients in a real-world setting, with significant daytime impairment and numerous comorbidities. This reinforces the need for timely insomnia disorder diagnosis and treatments that improve both sleep, as well as daytime functioning.
Topics: Humans; Adult; Sleep Initiation and Maintenance Disorders; Sleepiness; Cohort Studies; Wakefulness; Sleep
PubMed: 37537544
DOI: 10.1186/s12889-023-16329-9 -
The Laryngoscope Jan 2024Orofacial myofunctional therapy (OMT) is an alternative form of treatment of obstructive sleep apnea (OSA), that incorporates various exercises to optimize tongue... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Orofacial myofunctional therapy (OMT) is an alternative form of treatment of obstructive sleep apnea (OSA), that incorporates various exercises to optimize tongue placement and increase oropharyngeal tone. The objective of this systematic review and meta-analysis is to determine the efficacy of OMT in OSA patients.
DATA SOURCES
PubMed/Medline, EMBASE, Cochrane, Web of Science.
REVIEW METHODS
Using PRISMA guidelines, a directed search strategy was performed for randomized control trials (RCTs) published prior to March 24, 2023, featuring 10+ patients with OSA undergoing mono-therapeutic OMT. The primary outcome of interest was apnea-hypopnea index (AHI). Secondary outcomes included subjective sleepiness, sleep-related quality-of-life, and snoring frequency.
RESULTS
Of the 1244 abstracts that were identified, 7 RCTs involving 310 patients met inclusion criteria. Adult OMT patients had a statistically significant improvement in AHI (MD -10.2; 95% CI, -15.6, -4.8, p < 0.05), subjective sleepiness (Epworth Sleepiness Scale; MD -5.66; 95% CI, -6.82, -4.5, p < 0.05), sleep-related quality-of-life (Pittsburgh Sleep Quality Index; MD -3.00; 95% CI, -4.52, -1.49, p < 0.05), and minimum oxygen saturation (MD 2.71; 95% CI, 0.23, 5.18, p < 0.05) when compared with sham OMT or no therapy. Within the single RCT featuring pediatric OMT patients, patients had poor compliance (<50%) and did not show any improvements in AHI, minimum oxygen saturation, or snoring frequency.
CONCLUSION
OMT may provide a reasonable alternative for OSA patients who cannot tolerate CPAP or other more established treatment options. OMT benefits appear limited in children due to poor compliance. More studies are required to evaluate compliance and the long-term effects of OMT on OSA outcomes.
LEVEL OF EVIDENCE
1 Laryngoscope, 134:480-495, 2024.
Topics: Adult; Humans; Child; Snoring; Myofunctional Therapy; Sleepiness; Sleep Apnea, Obstructive; Oropharynx
PubMed: 37606313
DOI: 10.1002/lary.30974 -
Human Psychopharmacology Jul 2023Driver drowsiness detection technology that assesses eye blinks is increasingly being used as a safety intervention in the transport industry. It is unclear how alcohol...
INTRODUCTION
Driver drowsiness detection technology that assesses eye blinks is increasingly being used as a safety intervention in the transport industry. It is unclear how alcohol consumption to common legal driving limits impacts upon this technology. The aim of the study was to assess the impact of a blood alcohol content (BAC) of 0.05% and of 0.08% on drowsiness detection technology during simulated driving.
METHODS
Participants completed a 60-min driving simulation and sleepiness questionnaire under three conditions: 1-0.00% BAC, 2-0.05% BAC and 3-0.08% BAC. During the driving simulation task participants wore a commercial eye blink drowsiness detection technology (Optalert) with the drowsiness alarms silenced.
RESULTS
Twelve participants (3 female) completed all alcohol conditions. Relative to baseline, all eye blink parameters were affected at 0.08% BAC (all p < 0.05), whereas 0.05% BAC only affected the composite eye blink drowsiness measure (the Johns Drowsiness Scale).
CONCLUSIONS
Alcohol consumption to 0.08% BAC impaired eye blink measures to a level that would be considered a moderate drowsiness risk. Therefore, employers should be aware that drowsiness alerts from these technologies may increase after alcohol consumption.
Topics: Humans; Female; Sleepiness; Wakefulness; Blinking; Alcohol Drinking; Blood Alcohol Content; Technology; Automobile Driving
PubMed: 37291082
DOI: 10.1002/hup.2870 -
Sleep Medicine Clinics Sep 2021Sleep disturbance and sleepiness are established risk factors for driving accidents and obstructive sleep apnea (OSA) is the most prevalent medical disorder associated... (Review)
Review
Sleep disturbance and sleepiness are established risk factors for driving accidents and obstructive sleep apnea (OSA) is the most prevalent medical disorder associated with excessive daytime sleepiness. Because effective treatment of OSA reduces accident risk, several jurisdictions have implemented regulations concerning the ability of patients with OSA to drive, unless effectively treated. This review provides a practical guide for clinicians who may be requested to certify a patient with OSA as fit to drive regarding the scope of the problem, the role of questionnaires and driving simulators to evaluate sleepiness, and the benefit of treatment on accident risk.
Topics: Accidents, Traffic; Automobile Driving; Disorders of Excessive Somnolence; Europe; Humans; Risk Factors; Sleep Apnea, Obstructive; Sleepiness
PubMed: 34325829
DOI: 10.1016/j.jsmc.2021.05.003 -
Sleep Medicine May 2022The role of the sleep environment and presleep conditions that may influence adolescents' sleep are understudied. The aims of the current study were to examine linear...
OBJECTIVE/BACKGROUND
The role of the sleep environment and presleep conditions that may influence adolescents' sleep are understudied. The aims of the current study were to examine linear and nonlinear associations between the sleep environment and presleep conditions and adolescents' daytime sleepiness and sleep/wake problems.
METHOD
Participants included 313 adolescents (M = 17.39 years, SD = 10.38 months; 51.4% girls, 48.6% boys; 59.1% White/European American, 40.3% Black/African American) from a wide range of socioeconomic backgrounds living in the southeastern United States. Adolescents completed surveys assessing the sleep environment (eg, light, bedding), four presleep conditions (ie, general worries, family concerns, arousal, somatic complaints), and sleep (daytime sleepiness, sleep/wake problems).
RESULTS
Sleep environment disruptions and worse presleep conditions were positively associated with sleepiness and sleep/wake problems in a linear fashion. Nonlinear associations emerged such that levels of sleepiness increased rapidly between low and average levels of the sleep environment and two presleep conditions (worries, arousal); the slope leveled off between average and high levels. Moreover, linear effects of environmental disruptions, family concerns, somatic complaints, and presleep arousal on sleep/wake problems were moderated by race and/or SES, indicating that positive associations between some presleep conditions and sleep/wake problems were more pronounced for Black and lower SES youth.
CONCLUSIONS
Results support the importance of the sleep environment and multiple presleep conditions and assessments of both linear and nonlinear effects for a better understanding of factors that may contribute to sleep. Additionally, results indicate the sleep environment and some presleep conditions may be more consequential for disadvantaged youth.
Topics: Adolescent; Disorders of Excessive Somnolence; Female; Humans; Male; Sleep; Sleep Initiation and Maintenance Disorders; Sleep Wake Disorders; Sleepiness; Social Class
PubMed: 34879983
DOI: 10.1016/j.sleep.2021.11.004 -
PloS One 2023Driver drowsiness is a widely recognized cause of motor vehicle accidents. Therefore, a reduction in drowsy driving crashes is required. Many studies evaluating the...
Driver drowsiness is a widely recognized cause of motor vehicle accidents. Therefore, a reduction in drowsy driving crashes is required. Many studies evaluating the crash risk of drowsy driving and developing drowsiness detection systems, have used observer rating of drowsiness (ORD) as a reference standard (i.e. ground truth) of drowsiness. ORD is a method of human raters evaluating the levels of driver drowsiness, by visually observing a driver. Despite the widespread use of ORD, concerns remain regarding its convergent validity, which is supported by the relationship between ORD and other drowsiness measures. The objective of the present study was to validate video-based ORD, by examining correlations between ORD levels and other drowsiness measures. Seventeen participants performed eight sessions of a simulated driving task, verbally responding to Karolinska sleepiness scale (KSS), while infra-red face video, lateral position of the participant's car, eye closure, electrooculography (EOG), and electroencephalography (EEG) were recorded. Three experienced raters evaluated the ORD levels by observing facial videos. The results showed significant positive correlations between the ORD levels and all other drowsiness measures (i.e., KSS, standard deviation of the lateral position of the car, percentage of time occupied by slow eye movement calculated from EOG, EEG alpha power, and EEG theta power). The results support the convergent validity of video-based ORD as a measure of driver drowsiness. This suggests that ORD might be suitable as a ground truth for drowsiness.
Topics: Humans; Automobile Driving; Sleepiness; Wakefulness; Accidents, Traffic; Eye Movements; Electroencephalography; Sleep Stages
PubMed: 37155637
DOI: 10.1371/journal.pone.0285557