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The Western Journal of Medicine Feb 1995The National Commission on Sleep Disorders Research, in its report to Congress, concluded that the primary care community generally does not understand sleep disorders.... (Review)
Review
The National Commission on Sleep Disorders Research, in its report to Congress, concluded that the primary care community generally does not understand sleep disorders. Obstructive sleep apnea carries a risk of substantial morbidity and mortality. Excessive daytime sleepiness results from fragmented sleep and microarousals associated with apneic events. It causes poor work performance and increases the incidence of automobile accidents due to driving while drowsy. The commission estimates that the loss of productivity in the United States from excessive daytime sleepiness is more than $20 billion per year. Obstructive sleep apnea is strongly associated with hypertension, myocardial infarction, and stroke. Risk factors for obstructive sleep apnea include male sex, obesity, older age, craniofacial anomalies, and familial risk. Treatment is based on documenting the disorder by polysomnography. Medical management of the syndrome includes weight loss and nasal continuous positive airway pressure. A network of follow-up and support is necessary to maintain compliance. Surgical treatment is reserved for those for whom nasal airway pressure treatment fails. A surgical protocol is presented that demonstrates efficacy equal to nasal airway pressure treatment. Primary care physicians should assume the responsibility of identifying patients at risk for obstructive sleep apnea and refer them appropriately.
Topics: Humans; Male; Polysomnography; Positive-Pressure Respiration; Respiratory System; Sleep Apnea Syndromes
PubMed: 7725686
DOI: No ID Found -
Journal of Clinical Sleep Medicine :... Oct 2022Obstructive sleep apnea (OSA) is a common, identifiable, and treatable disorder with serious health, safety, and financial implications-including sleepiness- related...
UNLABELLED
Obstructive sleep apnea (OSA) is a common, identifiable, and treatable disorder with serious health, safety, and financial implications-including sleepiness- related crashes and incidents-in workers who perform safety-sensitive functions in the transportation industry. Up to one-third of crashes of large trucks are attributable to sleepiness, and large truck crashes result in more than 4,000 deaths annually. For each occupant of a truck who is killed, 6 to 7 occupants of other vehicles are killed. Treatment of OSA is cost-effective, lowers crash rates, and improves health and well-being. A large body of scientific evidence and expert consensus supports the identification and treatment of OSA in transportation operators. An Advanced Notice of Proposed Rulemaking regarding the diagnosis and treatment of OSA in commercial truck and rail operators was issued by the Federal Motor Carrier Safety Administration and Federal Railroad Administration, but it was later withdrawn. This reversal of the agencies' position has caused confusion among some, who have questioned whether efforts to identify and treat the disorder are warranted. In response, we urge key stakeholders, including employers, operators, legislators, payers, clinicians, and patients, to engage in a collaborative, patient-centered approach to address the disorder. At a minimum, stakeholders should follow the guidelines issued by a medical review board commissioned by the Federal Motor Carrier Safety Administration in 2016 alone, or in combination with the 2006 criteria, "Sleep Apnea and Commercial Motor Vehicle Operators," a Statement from the Joint Task Force of the American College of Chest Physicians, the American College of Occupational and Environmental Medicine, and the National Sleep Foundation developed by a joint task force. As research in this area continues to evolve, waiting is no longer an option, and the current standard of care demands action to mitigate the burden of serious health and safety risks due to this common, treatable disorder.
CITATION
Das AM, Chang JL, Berneking M, Hartenbaum NP, Rosekind M, Gurubhagavatula I. Obstructive sleep apnea screening, diagnosis, and treatment in the transportation industry. 2022;18(10):2471-2479.
Topics: Accidents, Traffic; Automobile Driving; Humans; Risk Factors; Sleep Apnea, Obstructive; Sleepiness
PubMed: 34546916
DOI: 10.5664/jcsm.9672 -
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 -
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 -
Journal of Clinical Sleep Medicine :... Sep 2019Drowsiness leads to 20% of fatal road crashes, while inability to assess drowsiness has hampered drowsiness interventions. This study examined the accuracy of eye-blink... (Randomized Controlled Trial)
Randomized Controlled Trial
STUDY OBJECTIVES
Drowsiness leads to 20% of fatal road crashes, while inability to assess drowsiness has hampered drowsiness interventions. This study examined the accuracy of eye-blink parameters for detecting drowsiness related driving impairment in real time.
METHODS
Twelve participants undertook two sessions of 2-hour track-driving in an instrumented vehicle following a normal night's sleep or 32 to 34 hours of extended wake in a randomized crossover design. Eye-blink parameters and lane excursion events were monitored continuously.
RESULTS
Sleep deprivation increased the rates of out-of-lane driving events and early drive terminations. Episodes of prolonged eyelid closures, blink duration, the ratio of amplitude to velocity of eyelid closure, and John's Drowsiness Score (JDS, a composite score) were also increased following sleep deprivation. A time-on-task (drive duration) effect was evident for out-of-lane events rate and most eye-blink parameters after sleep deprivation. The JDS demonstrated the strongest association with the odds of out-of-lane events in the same minute, whereas measures of blink duration and prolonged eye closure were stronger indicators of risk for out-of-lane events over longer periods of 5 minutes and 15 minutes, respectively. Eye-blink parameters also achieved moderate accuracies (specificities from 70.12% to 84.15% at a sensitivity of 50%) for detecting out-of-lane events in the same minute, with stronger associations over longer timeframes of 5 minutes to 15 minutes.
CONCLUSIONS
Eyelid closure parameters are useful tools for monitoring and predicting drowsiness-related driving impairment (out-of-lane events) that could be utilized for monitoring drowsiness and assessing the efficacy of drowsiness interventions.
CLINICAL TRIAL REGISTRATION
This study is registered with the Australian New Zealand Clinical Trial Registry (ANCTR), http://www.anzctr.org.au/TrialSearch.aspx ACTRN12612000102875.
CITATION
Shekari Soleimanloo S, Wilkinson VE, Cori JM,Westlake J, Stevens B, Downey LA, Shiferaw BA, Rajaratnam SMW, Howard ME. Eye-blink parameters detect on-road track-driving impairment following severe sleep deprivation. J Clin Sleep Med. 2019;15(9):1271-1284.
Topics: Adult; Australia; Automobile Driving; Blinking; Cross-Over Studies; Disorders of Excessive Somnolence; Female; Humans; Male; Reaction Time; Reproducibility of Results; Sleep Deprivation; Sleepiness
PubMed: 31538598
DOI: 10.5664/jcsm.7918 -
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 -
Sensors (Basel, Switzerland) Dec 2018Drowsiness detection has been studied in the context of evaluating products, assessing driver alertness, and managing office environments. Drowsiness level can be...
Drowsiness detection has been studied in the context of evaluating products, assessing driver alertness, and managing office environments. Drowsiness level can be readily detected through measurement of human brain activity. The electroencephalogram (EEG), a device whose application relies on adhering electrodes to the scalp, is the primary method used to monitor brain activity. The many electrodes and wires required to perform an EEG place considerable constraints on the movement of users, and the cost of the device limits its availability. For these reasons, conventional EEG devices are not used in practical studies and businesses. Many potential practical applications could benefit from the development of a wire-free, low-priced device; however, it remains to be elucidated whether portable EEG devices can be used to estimate human drowsiness levels and applied within practical research settings and businesses. In this study, we outline the development of a drowsiness detection system that makes use of a low-priced, prefrontal single-channel EEG device and evaluate its performance in an offline analysis and a practical experiment. Firstly, for the development of the system, we compared three feature extraction methods: power spectral density (PSD), autoregressive (AR) modeling, and multiscale entropy (MSE) for detecting characteristics of an EEG. In order to efficiently select a meaningful PSD, we utilized step-wise linear discriminant analysis (SWLDA). Time-averaging and robust-scaling were used to fit the data for pattern recognition. Pattern recognition was performed by a support vector machine (SVM) with a radial basis function (RBF) kernel. The optimal hyperparameters for the SVM were selected by the grind search method so as to increase drowsiness detection accuracy. To evaluate the performance of the detections, we calculated classification accuracy using the SVM through 10-fold cross-validation. Our model achieved a classification accuracy of 72.7% using the PSD with SWLDA and the SVM. Secondly, we conducted a practical study using the system and evaluated its performance in a practical situation. There was a significant difference (* < 0.05) between the drowsiness-evoked task and concentration-needed task. Our results demonstrate the efficacy of our low-priced portable drowsiness detection system in quantifying drowsy states. We anticipate that our system will be useful to practical studies with aims as diverse as measurement of classroom mental engagement, evaluation of movies, and office environment evaluation.
Topics: Adult; Electrodes; Electroencephalography; Female; Humans; Male; Prefrontal Cortex; Probability; ROC Curve; Sleep; Support Vector Machine
PubMed: 30567347
DOI: 10.3390/s18124477 -
Environment International Jun 2020To investigate whether exposure to dampness and mold at home and at work induce sleep disturbances and daytime sleepiness among adults.
AIM
To investigate whether exposure to dampness and mold at home and at work induce sleep disturbances and daytime sleepiness among adults.
MATERIALS AND METHODS
Associations between onset of sleep disturbances and dampness, mold and mold odor at home and at work were investigated in a cohort of 11,318 adults from the population in Iceland, Norway, Sweden, Denmark and Estonia. The participants answered a questionnaire at baseline and 10 years later, with questions on sleep disturbances, including difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), early morning awakening (EMA), insomnia symptoms, snoring and excessive daytime sleepiness (EDS). Multiple logistic regression models were applied to estimate associations adjusting for potential confounders including gender, age, smoking habit at baseline, change of smoking habit from baseline to follow up, BMI at baseline, change of BMI from baseline to follow up, education level at follow up, allergic rhinitis at baseline, doctor diagnosed asthma at baseline and chronic bronchitis at baseline.
RESULTS
Baseline floor dampness, visible mold and mold odor at home increased onset of DIS, DMS, EMA, insomnia symptoms and snoring during follow up (OR 1.29-1.87). Any sign of dampness at baseline increased onset of DIS (OR 1.28, 95%CI 1.06-1.55), DMS (OR 1.17, 95%CI 1.02-1.34) and insomnia symptoms (OR 1.18, 95%CI 1.03-1.36). Dampness at home during follow up increased onset of DIS, DMS, EMA, insomnia symptoms and EDS (OR 1.17-1.36). Dampness at work during follow up increased onset of DIS, EMA, insomnia symptoms and EDS (OR 1.16-1.34). Combined dampness at home and at work during follow up increased the risk of onset of DIS, DMS, EMA, insomnia symptoms and EDS (OR 1.29-1.74).
CONCLUSIONS
Dampness and mold at home and at work can increase the development of insomnia symptoms, snoring and EDS among adults.
Topics: Adult; Humans; Norway; Sleep Initiation and Maintenance Disorders; Sleepiness; Snoring; Surveys and Questionnaires; Sweden
PubMed: 32272294
DOI: 10.1016/j.envint.2020.105691 -
Journal of Clinical Sleep Medicine :... Mar 2023Celiac disease (CD), an immune-mediated enteropathy, has a clinical spectrum that is remarkably wide and includes neuropsychiatric manifestations. While studies of...
STUDY OBJECTIVES
Celiac disease (CD), an immune-mediated enteropathy, has a clinical spectrum that is remarkably wide and includes neuropsychiatric manifestations. While studies of adults have shown sleep disturbances, there is limited data in children. Our objectives were to assess the association between sleep disturbances and CD in children, and the effect of a gluten-free diet.
METHODS
Parents of children 3-12 years old referred for endoscopy completed the Sleep Disturbance Scale for Children and modified Epworth Sleepiness Scale. Children with CD were compared with healthy controls and children with abdominal pain but no definitive findings on investigation. Parents of children with CD and abdominal pain were contacted after 6 months for follow-up.
RESULTS
We enrolled 101 patients, mean age 6.5 (2.8), 51% female, 38 with CD, 18 abdominal pain, and 45 healthy. Sleep Disturbance Scale for Children scores were 37.4 (8.7), 41.3 (11.3), and 45.4 (13.7) in healthy controls, CD, and abdominal pain, respectively ( = .024). There was a significant difference in the disorders of arousal domain ( = .044). There were no significant differences on the modified Epworth Sleepiness Scale. A trend toward improvement in Sleep Disturbance Scale for Children scores was seen in children with CD presenting with abdominal pain after 6 months on a gluten-free diet ( = .07).
CONCLUSIONS
In this first prospective study of sleep disturbances in children with CD, we show high rates of disturbed sleep compared with healthy children. Sleep disturbances did not improve on a gluten-free diet and may be driven by abdominal pain.
CITATION
Reiter J, Abuelhija H, Slae M, et al. Sleep disorders in children with celiac disease: a prospective study. . 2023;19(3):591-594.
Topics: Humans; Child; Female; Child, Preschool; Male; Celiac Disease; Prospective Studies; Sleepiness; Abdominal Pain; Sleep Wake Disorders
PubMed: 36546369
DOI: 10.5664/jcsm.10396 -
Neurology India 2023
Topics: Humans; Intracranial Hypotension; Sleepiness; Retrospective Studies; Magnetic Resonance Imaging
PubMed: 38174503
DOI: 10.4103/0028-3886.391367