Differences In Sleepiness Research Articles

P007 A Comparison of Sleep Study Parameters between COPD+OSA (Overlap Syndrome) and Obstructive Sleep Apnoea

Abstract Background Comorbid Chronic Obstructive Pulmonary Disease (COPD) and Obstructive Sleep Apnoea (OSA)—Overlap Syndrome (OVS) is associated with worse sleep study parameters than OSA alone. The patient demographics and severity of OSA often confound these sleep study parameters. Aim: In this study, we aim to compare OVS to OSA PSG parameters in a case-control study. Methods We matched OVS and OSA patients for age, sex, BMI, and AHI, then compared the PSG data. We also compared additional measures of hypoxic burden, including desaturation severity, desaturation slope, and desaturation recovery. Results We suitably matched a total of 83 patients in each group. There were no differences in sleepiness (Epworth Sleepiness Scale; OVS 10±5 vs. OSA 10±5, P = 0.978), PVT lapses (OVS 30±30 vs. OSA 25±30, P = 0.260), or comorbidity. The OVS group has poorer quality of life (SF36 Physical Component Score (OVS 37±11 vs. OSA 41±11, P = 0.001). There were no differences in sleep duration (OVS 274±82 min vs. OSA 284±78 min, P = 0.383) or sleep efficiency (OVS 63% vs. OSA 66%, P = 0.204). There were no differences in the number of ≥3% desaturations scored (OVS 149±117 vs. OSA 125±126, P = 0.072). The OVS had greater desaturation severity (0.40% vs. 0.25%; P<0.035) and greater sleep time below SpO2 90% (11% vs. 1%; P<0.001). There were no differences in desaturation duration, desaturation slope, or recovery slope. Discussion/Conclusion When controlling for demographics and AHI, OVS shows no differences in sleep study parameters except for oxygen saturation.

Gender differences in oral appliance treatment of obstructive sleep apnea

PurposeAlthough overall success rates for treating obstructive sleep apnea (OSA) with an oral appliance (OA) are high, they are significantly higher among females. To verify published data, the study’s purpose was to evaluate a participant sample after one year of OA use. The primary outcome was treatment response, with responders defined as having an apnea-hypopnea index (AHI) < 10 at follow-up and/or reduced by ≥50% of baseline. Secondary measures were from standardized questionnaires.MethodsA sample of 314 participants, predominately with moderate-to-severe OSA, were enrolled and instructed to use an OA every night. At baseline and one-year follow-up, polygraphic recordings and questionnaires, including sleepiness (measured using the Epworth sleepiness scale) and quality-of-life (measured using the Functional Outcomes of Sleep Questionnaire), were collected.ResultsAmong the 314 participants, 192 completed the one-year evaluation: 51 females (27%) and 141 males (73%). Overall, OA treatment resulted in 78% and 77% responders among females and males, respectively. Neither the difference in improvement nor the absolute change in AHI differed significantly based on gender, at any OSA severity level. There were no significant gender differences in sleepiness or quality of life. Treatment-related adverse reactions were more common among females.ConclusionBoth females and males with OSA respond well to OA therapy, with nonsignificant gender differences in outcomes. Thus, the hypothesis that females respond better to OA treatment is rejected.

Air quality in the car: How CO2 and body odor affect drivers' cognition and driving performance?

Elevated indoor levels of CO2 and the presence of body odor have been shown to have adverse effects on the cognitive function of building occupants. These factors may also contribute to impaired in-car driving performance, potentially posing a threat to transportation and public safety. To investigate the effects of CO2 and body odor on driving performance, we enrolled 25 participants in highway driving tasks under three indoor CO2 levels (800, 1800, and 3500 ppm) and two body odor conditions (presence and absence). CO2 was injected in the cabin to increase CO2 levels. In addition, we assessed working memory and reaction time using N-back tasks during driving. We found that driving speed, acceleration, and lateral control were not significantly affected by either CO2 or body odor. We observed no significant differences in sleepiness or emotion under varying CO2 or body odor conditions, except for a lower level of emotion valence with exposure to body odor. Task load was also not significantly impacted by CO2 or body odor levels, except for a higher reported effort at 1800 ppm compared to 800 ppm CO2. However, participants did demonstrate significantly higher accuracy with increased body odor exposure, suggesting a complex effect of volatile organic compounds on driver cognition. Our findings also revealed moderating effects of task difficulty of N-back tests and exposure duration on cognition and driving performance. This is one of the first few in-depth studies regarding environmental factors and their effect on drivers' cognition and driving performance, and these results provide valuable insights for car-cabin environmental design for air quality and driving safety.

0836 Chronic Pain worsens Daytime Sleepiness, Insomnia and Quality of Life in Veterans with Obstructive Sleep Apnea

Abstract Introduction Chronic noncancer pain (CP) commonly co-occurs with obstructive sleep apnea (OSA) and may contribute to greater symptom burden. The study aim was to examine differences in sleepiness (Epworth Sleepiness Scale, ESS), insomnia symptoms (Insomnia Severity Index [ISI]), and quality of life (Short Form Health Survey 20, SF-20) in veterans with OSA with or without pre-existing CP. Methods An observational, cross-sectional, study of veterans with newly diagnosed, untreated OSA was conducted. Unadjusted between-group comparisons (i.e., OSA-only versus OSA + CP) were conducted using the Welch’s t-test and Pearson Chi-Square. Regression analyses were performed to determine the influence of self-reported CP on sleep-related symptoms and quality of life while controlling for potential confounders (i.e., age, sex, OSA severity, body mass index, percentage of total sleep time spent with SpO2 &amp;lt; 90%, and presence of psychiatric/mental health comorbidities). The Hochberg (step-up) method was used to control for the family-wise error rate at 5%. Results The final sample included N=111 participants with complete survey responses. Compared to the group with OSA-only (n=40), veterans with comorbid OSA and CP (n=71) experienced significantly higher ESS (12.7 ± 5.5 vs 10.2 ± 5.2; p = .021) and ISI scores (18.1 ± 6.2 vs. 13.7 ± 7.4; p = .002), and worse quality of life across all SF-20 domains. Of note, clinically significant insomnia (ISI score &amp;gt; 15) was most common among veterans with comorbid OSA and CP (68.7% vs. 45.5%, p = .010). In adjusted analyses, CP diagnosis was significantly associated with higher ESS (adjusted mean difference [95% CI] = 2.72 [0.55, 4.88], p = .014) and ISI scores (adjusted mean difference [95% CI] = 3.82 [1.27, 6.37], p =.004). Conclusion There is a high prevalence of CP among veterans with OSA and symptom burden is higher in patients with OSA and CP. Future investigations should address symptom response and burden to OSA treatment in comorbid OSA and CP to guide outcome expectancies and residual OSA symptom treatment plans. Support (if any) SRSF Small Research Grant Award: 05-SRG-20. University of Pennsylvania School of Nursing, Office of Nursing Research.

Self‐reported OSA risk, but not daytime sleepiness, is related to memory decline in autosomal dominant Alzheimer’s disease: Preliminary findings from the COLBOS biomarker study

AbstractBackgroundSleep disturbances may increase the risk of developing Alzheimer’s Disease (AD). Research suggests that excessive daytime sleepiness and obstructive sleep apnea (OSA) may be linked to increased AD pathology and cognitive dysfunction. This study aimed to investigate the relation between subjective sleepiness and OSA risk, memory, and amyloid and tau, as measured by PET in preclinical AD.MethodOur ongoing sleep study includes members of a Colombian kindred with a Presenilin1 (PSEN1) E280A mutation for autosomal dominant AD. PSEN1 mutation carriers develop dementia in their late forties. 19 carriers (mean age 38+‐6,12 females) and 15 non‐carrier family members (mean age 36+‐5,10 females) completed the Epworth Sleepiness Scale and the STOP‐BANG for OSA risk, and underwent cognitive testing and PET examinations. A subset (n=15, 8 carriers, 7 non‐carriers) also completed these tests after 18mo. Mann‐Whitney tests were used to test between‐group differences in sleepiness and OSA risk. Spearman correlations were used to examine associations among outcome measures and cortical amyloid, entorhinal tau, and verbal memory (delayed word list recall). Change scores between baseline and follow‐up were calculated (timepoint2‐timepoint1) to assess longitudinal relations.ResultCross‐sectional results showed no differences between carriers and non‐carriers in daytime sleepiness or OSA risk (p’s&lt;0.34). Sleep metrics were not related to cortical amyloid, entorhinal tau, or verbal memory (r’s&gt;0.14, p’s&lt;0.62). Longitudinal results revealed an increase in OSA risk score from baseline to 1.5‐year follow‐up was correlated to lower verbal memory performance for all subjects who had two time points (r=‐0.73,p=0.002). A change in sleepiness score was not associated with any of the variables of interest (r’s&gt;0.44,p’s&lt;0.10).ConclusionPreliminary baseline results showed that carriers and non‐carriers from a kindred with autosomal dominant AD did not differ in sleep‐related risk factors, such as self‐reported daytime sleepiness and OSA risk. These results suggest that baseline daytime sleepiness and OSA risk may not be related to pathology burden in early AD. In contrast, preliminary longitudinal results suggest that an increase in self‐reported OSA risk within a 1.5‐year timeframe may be related to memory decline. Future research with a larger sample is required to further assess sleep metrics in this population.

Factors affecting sleep quality in Intensive Care Units

ObjectiveTo report sleep quality and identify related factors. DesignA descriptive cross-sectional study was made with a convenience sample of 129 patients. The differences between 3 periods were evaluated using the Wilcoxon test and Spearman correlation r. Multiple regression analyses were performed to relate independent variables to sleep quality. SettingThe Department of Intensive Care Medicine of a tertiary hospital. ParticipantsPatients admitted between February 2016 and December 2017. InterventionsQuestionnaire administration. VariablesItems of the modified Freedman questionnaire, and demographic and clinical variables. ResultsExternal factors interfering with sleep quality were noise and constant light exposure in the 3 periods, with significant differences between these periods in nursing care (P = 0.005) and nursing activities (P = 0.019). The other factors affecting sleep quality and identified by the multivariate regression model were age (P = 0.012), daily alcohol intake (P = 0.023), benzodiazepine use during admission to the ICU (P = 0.01) and comorbidities (P = 0.005). There were significant differences in sleepiness between discharge and the first day (P ≤ 0.029) and between discharge and half stay (P = 0.001). ConclusionsNoise and light were the most annoying factors, but statistical significance was only reached for nursing activities and care. Age, alcohol intake, benzodiazepine use in the ICU and a higher comorbidity index had a negative impact upon sleep. Sleepiness was reduced at the end of stay.

Individuals with and without military-related PTSD differ in subjective sleepiness and alertness but not objective sleepiness

Posttraumatic stress disorder-related sleep disturbances may increase daytime sleepiness and compromise performance in individuals with posttraumatic stress disorder. We investigated nighttime sleep predictors of sleepiness in Veterans with and without posttraumatic stress disorder. Thirty-seven post-9/11 Veterans with posttraumatic stress disorder and 47 without posttraumatic stress disorder (Control) completed a 48-h lab stay. Nighttime quantitative EEG and sleep architecture parameters were collected with polysomnography. Data from daytime sleepiness batteries assessing subjective sleepiness (global vigor questionnaire), objective sleepiness (Multiple Sleep Latency Tests) and alertness (psychomotor vigilance task) were included in analyses. Independent samples t-tests and linear regressions were performed to identify group differences in sleepiness and nighttime sleep predictors of sleepiness in the overall sample and within each group. Participants with posttraumatic stress disorder had higher subjective sleepiness (t = 4.20; p < .001) and lower alertness (psychomotor vigilance task reaction time (t = -3.70; p < .001) and lapses: t = -2.13; p = .04) than the control group. Objective daytime sleepiness did not differ between groups (t = -0.79, p = .43). In the whole sample, higher rapid eye movement delta power predicted lower alertness quantified by psychomotor vigilance task reaction time (β = 0.372, p = .013) and lapses (β = 0.388, p = .013). More fragmented sleep predicted higher objective sleepiness in the posttraumatic stress disorder group (β = −.467, p = .005) but no other nighttime sleep measures influenced the relationship between group and sleepiness. Objective measures of sleep and sleepiness were not associated with the increased subjective sleepiness and reduced alertness of the posttraumatic stress disorder group.

089 Impact of A Single Sleep Education Session on Beliefs and Attitudes Among People with Excessive Daytime Sleepiness: A Pilot Study

Abstract Introduction Excessive daytime sleepiness is associated with adverse health outcomes and substantial functional deficits. However, little is known about experiences among these individuals and whether some education about sleep health would be helpful. Methods N=28 participants with excessive daytime sleepiness (ESS&amp;gt;=10) but no other major medical problems were recruited from the community. The intervention was a single 2-hour sleep education workshop. Participants were randomized to either the education session or a wait-list control. Change from baseline on Epworth Sleepiness Scale (ESS), Dysfunctional Beliefs About Sleep (DBAS) scale, Fatigue Severity Scale (FSS), Insomnia Severity Index (ISI),pHQ9 depression scale, and GAD7 anxiety scale were evaluated versus controls, adjusted for age, sex, and race/ethnicity. Also,participants were asked whether they agree to a range of beliefs/attitudes about sleep before and after the session (as part of intervention or following wait list). Posttest-Pretest difference scores were compared to determine if any were changed by the session (nominal significance p&amp;lt;0.05). Results Compared to the wait-list control, those who received the education session did not show differences in sleepiness (4.2% reduction,p=0.73) or dysfunctional beliefs about sleep (52.1% reduction,p=0.07), but they did demonstrate a 26.5% reduction in fatigue (p=0.01), a 55.2% reduction in insomnia severity (p=0.004), a 59.1% reduction in depression score (p=0.02), and a 54.5% reduction in anxiety score (p=0.04). The single session resulted in increased agreement with the statements, “People with daytime sleepiness should discuss their problems with their doctor or health care provider” (t=-2.3,p=0.03), “I understand the basics of how sleep works” (t=-2.2,p=0.04), “I understand the basics of how sleepiness works” (t=-2.7,p=0.01), “Excessive daytime sleepiness is something that can be improved with psychological treatment” (t=-2.3,p=0.03), and “I know what to do if…” “I have trouble falling asleep” (t=-4.3,p=0.0003), “I have trouble with poor quality sleep” (t=-5.1,p=0.0001), and “I experience daytime sleepiness” (t=-3.0,p=0.007). Conclusion A brief sleep health education session improved sleep and mental health in individuals with daytime sleepiness, even if it did not improve sleepiness. Further, the session did likely provide useful educational information. Support (if any) This work was supported by Jazz Pharmaceuticals

365 Cognitive Behavioral Therapy and Light Dark Therapy for Postpartum Insomnia Symptoms: Findings from a Randomized Controlled Trial

Abstract Introduction Symptoms of insomnia are common in the postpartum period and are associated with a range of negative outcomes. Despite this, interventions to improve maternal postpartum sleep remain scarce. Cognitive Behavioral Therapy (CBT) and Light Dark Therapy (LDT) target two different mechanisms to reduce sleep disturbance. This randomized controlled trial examined the efficacy of CBT and LDT against a treatment-as-usual (TAU) condition in reducing maternal postpartum insomnia symptoms. Methods Nulliparous women 4–12 months postpartum with self-reported symptoms of insomnia (Insomnia Severity Index scores [ISI] &amp;gt;7) were included; excluded were those with: current severe health/psychiatric conditions, unsettled infant behaviors, sleep-affecting medication use and photosensitivity. Eligible women were randomized 1:1:1 to 6 weeks of CBT (CBT for insomnia and fatigue), LDT (morning bright light therapy, evening light hygiene), or TAU. Interventions were therapist-assisted and personalized through two telephone calls and included automated self-help intervention materials (i.e., emails) delivered over six weeks. Symptoms of insomnia (ISI; primary outcome), fatigue, sleepiness, depression, and anxiety were assessed at baseline, mid-intervention, post-intervention, and 1-month post-intervention. Analyses were intention-to-treat latent growth models. Results 114 women were randomized (mean age = 32.20 ± 4.62 years) and 108 women completed the intervention. Compared to TAU, symptoms of insomnia significantly reduced from baseline to post-intervention in both CBT and LDT groups (p-values &amp;lt;.001), with very large effect sizes (d &amp;gt; 1.5) at post-intervention; gains were maintained at follow-up. Fatigue symptoms significantly reduced in the CBT group (p&amp;lt;.0001; d = 0.85) but not LDT (p = 0.11) compared to TAU at post-intervention; gains were maintained for CBT at follow-up. Group differences in sleepiness, depression, and anxiety were nonsignificant (all p &amp;gt; 0.08). Conclusion Therapist-assisted self-help CBT and LDT with different therapeutic mechanisms are both efficacious for reducing maternal insomnia symptoms during the postpartum period. Findings were mixed for fatigue, sleepiness and mood. Future research on predictors of treatment responses is needed. Support (if any) Australian National Health and Medical Research Council, Department of Education RTP Scholarship. Lucimed SA supplied light therapy glasses. Funders had no role in design/implementation of the trial. ANZCTR: ACTRN12618000842268.

Closed-Loop Acoustic Stimulation During Sedation with Dexmedetomidine (CLASS-D): Protocol for a Within-Subject, Crossover, Controlled, Interventional Trial with Healthy Volunteers.

IntroductionThe relative power of slow-delta oscillations in the electroencephalogram (EEG), termed slow-wave activity (SWA), correlates with level of unconsciousness. Acoustic enhancement of SWA has been reported for sleep states, but it remains unknown if pharmacologically induced SWA can be enhanced using sound. Dexmedetomidine is a sedative whose EEG oscillations resemble those of natural sleep. This pilot study was designed to investigate whether SWA can be enhanced using closed-loop acoustic stimulation during sedation (CLASS) with dexmedetomidine.MethodsClosed-Loop Acoustic Stimulation during Sedation with Dexmedetomidine (CLASS-D) is a within-subject, crossover, controlled, interventional trial with healthy volunteers. Each participant will be sedated with a dexmedetomidine target-controlled infusion (TCI). Participants will undergo three CLASS conditions in a multiple crossover design: in-phase (phase-locked to slow-wave upslopes), anti-phase (phase-locked to slow-wave downslopes) and sham (silence). High-density EEG recordings will assess the effects of CLASS across the scalp. A volitional behavioral task and sequential thermal arousals will assess the anesthetic effects of CLASS. Ambulatory sleep studies will be performed on nights immediately preceding and following the sedation session. EEG effects of CLASS will be assessed using linear mixed-effects models. The impacts of CLASS on behavior and arousal thresholds will be assessed using logistic regression modeling. Parametric modeling will determine differences in sleepiness and measures of sleep homeostasis before and after sedation.ResultsThe primary outcome of this pilot study is the effect of CLASS on EEG slow waves. Secondary outcomes include the effects of CLASS on the following: performance of a volitional task, arousal thresholds, and subsequent sleep.DiscussionThis investigation will elucidate 1) the potential of exogenous sensory stimulation to potentiate SWA during sedation; 2) the physiologic significance of this intervention; and 3) the connection between EEG slow-waves observed during sleep and sedation.

Evaluation of a multicomponent grading system for obstructive sleep apnoea: the Baveno classification.

New findings on pathophysiology, epidemiology, and outcome have raised concerns on the relevance of the apnoea–hypopnoea index (AHI) in the classification of obstructive sleep apnoea (OSA) severity. Recently, a multicomponent grading system decision integrating symptomatology and comorbidities (Baveno classification), was proposed to characterise OSA and to guide therapeutic decisions. We evaluated whether this system reflects the OSA population, whether it translates into differences in outcomes, and whether the addition of AHI improves the scheme. A total of 14 499 OSA patients from the European Sleep Apnoea Database cohort were analysed. The groups were homogeneously distributed and were found to clearly stratify the population with respect to baseline parameters. Differences in sleepiness and blood pressure between the groups were analysed in a subgroup of patients after 24–36 months of treatment. Group A (minor symptoms and comorbidities) did not demonstrate any effect of treatment on outcome. However, groups B (severe symptoms, minor comorbidities), C (minor symptoms, severe comorbidities) and D (severe symptoms and comorbidities) were associated with improvement in either or both parameters with treatment. The AHI is an essential prerequisite of the diagnosis; however, adding the AHI did not improve the classification. Rather, it was inferior with respect to guiding the treatment decision. Thus, the Baveno classification allows a better stratification of the OSA population and may provide a better guidance for therapeutic decisions in OSA.

Why Are Undergraduate Students Sleepy and Sleep Deprived

Sleep problems are an increasingly prevalent health condition in modern society and studies have shown that university period is a landmark for sleepiness and poor sleep quality. These sleep changes could be responsible not just for poor academic performance, but also be the cause of health issues, especially mental diseases. Sleep deprivation in university students arises from multiple factors. In this study we aimed to describe social aspects, academic workload and the correlation between daytime sleepiness and the quality of sleep between students of different academic degrees. This research analyzed the correlation between the levels of daytime sleepiness (Epworth Sleepiness Scale - ESS), sleep quality (Pittsburgh Sleep Quality Index - PSQI) and academic workload and applied a sociodemographic questionnaire to university students. The sample (mean age: 22.2 years, SD=4.4) was made up of 55 students of law, 107 of civil engineering and 167 of medicine. The results of the average daytime sleepiness, researched using the Epworth Sleepiness Scale was 11.5 points (SD= 4.8) in Law, 10.5 (SD= 4.1) in Civil Engineering and 11.1 (SD= 4.1) in Medicine, as the quality of sleep, investigated with the Pittsburgh Index, the results were 8.7 (SD=2.6), 7.1 (SD=2.8) and 8.6 (SD=3.1), respectively. There were no significant differences in sleepiness (f=1.1; p>0.05) between courses, but in sleep quality there were significant differences (f=8.1; p 0.05), Civil Engineering (r= 0.09; p>0.05) and Medicine (r=0.17; p>0.05). In our sample, we found poor sleep quality and daytime sleepiness, regardless of degree and the workload required by it. Besides the discrepancies of workload and work activities our findings reinforce the idea that the cause of somnolence, poor sleep and sleep deprivation is multifactorial and highly prevalent in undergraduate students.

Factors affecting sleep quality in Intensive Care Units.

To report sleep quality and identify related factors. A descriptive cross-sectional study was made with a convenience sample of 129 patients. The differences between 3periods were evaluated using the Wilcoxon test and Spearman correlation r. Multiple regression analyses were performed to relate independent variables to sleep quality. The Department of Intensive Care Medicine of a tertiary hospital. Patients admitted between February 2016 and December 2017. Questionnaire administration. Items of the modified Freedman questionnaire, and demographic and clinical variables. External factors interfering with sleep quality were noise and constant light exposure in the 3periods, with significant differences between these periods in nursing care (P=0.005) and nursing activities (P=0.019). The other factors affecting sleep quality and identified by the multivariate regression model were age (P=0.012), daily alcohol intake (P=0.023), benzodiazepine use during admission to the ICU (P=0.01) and comorbidities (P=0.005). There were significant differences in sleepiness between discharge and the first day (P≤0.029) and between discharge and half stay (P=0.001). Noise and light were the most annoying factors, but statistical significance was only reached for nursing activities and care. Age, alcohol intake, benzodiazepine use in the ICU and a higher comorbidity index had a negative impact upon sleep. Sleepiness was reduced at the end of stay.

0382 Sex Differences in Sleep and Quality of Life in Healthcare Shift Workers

Abstract Introduction Shift work is associated with insufficient and disrupted sleep and impaired quality of life due to misalignment between the timing of internal biological clock and work/sleep schedule. There are reported sex differences in the circadian timing system, in sleep, and in reported sleep complaints, but how these impact female shift workers remains unclear. Furthermore, relatively little is known about sex differences in quality of life in shift workers. The objective of this study is to investigate sex differences in sleepiness, insomnia and quality of life in healthcare shift workers. Methods Forty women (31 ± 6.4 yo) and 70 men (31.2 ± 6.7 yo) who work at least 4 night shifts a month, completed the Shift Worker Sleep and Health Survey. This REDcap administered survey included the Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), and Functional Outcomes of Sleep Questionnaire (FOSQ-10). Independent samples T-tests were carried out using SAS. Results Women reported significantly higher scores on the ESS compared to men (13 ± 4 vs. 11 ± 3.4, respectively; t(108)=-2.74,P=0.007), as on the ISI (13 ± 5.2 vs. 9.8 ± 5.4; t(108)=-3.05,P=0.003), indicating greater levels of daytime sleepiness and insomnia-like symptoms in female shift workers. In addition, women scored significantly lower on the FOSQ-10 than men (13.9 ± 2.9 vs. 15.3 ± 2.5; t(108)=2.68,P=0.009), suggesting a lower functional status related to activities of daily living in female shift workers. Conclusion These preliminary analyses suggest that in this group of healthcare shift workers, women are less tolerant to irregular work hours compared to men, in terms of sleep, sleepiness and quality of life. Our future goal is to understand how sleep quality and duration, daytime sleepiness, and quality of life interact, and what role sex plays in those interactions. Support The study was supported by NIH grant R01 AG044416.

Efficacy of CPAP for Improvements in Sleepiness, Cognition, Mood, and Quality of Life in Elderly Patients With OSA: Systematic Review and Meta-analysis of Randomized Controlled Trials

OSA is found commonly in the elderly population (≥65 years old), and CPAP improves sleepiness and health-related quality of life (HRQoL) in the middle-aged population; however, data about its efficacy in elderly patients are unclear. The purpose of this study was to evaluate the efficacy of CPAP for sleepiness, HRQoL, mood, and cognition in elderly patients with OSA. In elderly patients (≥65 years old) with OSA, is CPAP, compared with usual care or sham CPAP, effective at improving sleepiness, HRQoL, mood, and neurocognitive function? We conducted a systematic review and meta-analysis of randomized controlled trials that included trials performed in elderly patients with OSA. As an intervention, we compared CPAP vsa control group. Two independent reviewers explored several databases; risk of bias (RoB) was evaluated with the Cochrane tool. Changes in sleepiness (Epworth Sleepiness Scale), HRQoL (Quebec Sleep Questionnaire), mood (Hospital Anxiety-Depression Scale), and neurocognitive tests after treatment were the outcomes. The meta-analysis was conducted according to the DerSimonian-Laird method, and the quality of evidence was rated according to the GRADE guidelines. A total of 4 randomized controlled trials (680 participants) were included. RoB was high for performance and detection bias. CPAP was associated with a 2.62-point improvement in the Epworth Sleepiness Scale (1.93 to 3.30; I2= 52%). All domains of the Quebec Sleep Questionnaire were improved: hypersomnolence, 0.67 points (0.31 to 1.03; I2= 75%); diurnal symptoms, -0.71 points (-0.98 to -0.44; I2= 58%); nocturnal symptoms, 1.09 points (0.9 to 1.27; I2= 9%); emotions, 0.45 points (0.30 to 0.61; I2= 11%); and social interaction, 0.55 points (0.1 to 0.99; I2= 82%). CPAP also improved the Hospital Anxiety-Depression Scale depression domain, and there were reports of a slight improvement in neurocognitive tests. The quality of evidence was low and very low for all outcomes. Although CPAP therapy reportedly results in important clinical differences in sleepiness, HRQoL, and mood and a slight improvement in neurocognitive tests, concerns regarding the RoB and quality of the evidence do not support the benefit in all patients. PROSPERO ID CRD42019146947.

Trading while sleepy? Circadian mismatch and mispricing in a global experimental asset market

Traders in global markets operate at different local times-of-day. This implies heterogeneity in circadian timing and likely sleepiness or alertness of those traders operating at less or more optimal times of the day, respectively. This, in turn, may lead to differences in both individual-level trader behavior as well as market level outcomes. We examined these factors by administering single-location and global sessions of an online asset market experiment that regularly produces mispricing and valuation bubbles. Global sessions involved real time trades between subjects in New Zealand and the U.S (i.e., “global” markets) with varied local times of day for each location. Individual traders at suboptimal times of day (or, “circadian mismatched” traders) engaged in riskier trading strategies, such as holding shares (the riskier asset) in later trading rounds and mispricing shares to a greater degree. These strategies resulted in lower earnings for circadian mismatched traders, especially in heterogeneous markets that also included traders at more optimal times-of-day. These differences were also reflected in market level outcomes. Markets with higher circadian mismatch heterogeneity across traders were more likely to exhibit longer lasting asset bubbles and greater share turnover volume. Overall, our results draw attention to a unique, but underappreciated, factor present across traders in global market environments, namely, differences in sleepiness across traders. Thus, this study hopes to highlight the role of circadian mismatch in attempting to understand trader behavior and, ultimately, market volatility.

0632 Time of Day and Time on Task Effects on Working Memory and Sleepiness of Bus Drivers

Abstract Introduction Fatigue and sleepiness have direct effects on vigilance, and cognitive functions of drivers. The objective of this study was to analyze individual bus drivers' characteristics and work shift parameters and relation to the working memory performance and sleepiness. Methods This prospective study was conducted on 35 inter-city bus drivers by convenience sampling. We collected data during the time span of a 24-hour round trip by using the demographic questionnaire, Epworth Sleepiness Scale (ESS), Karolinska Sleepiness Scale (KSS), and reversed digit span memory test (part of the Wechsler-Adult Intelligence Test). A linear mixed model was used for statistic analysis. Results The mean (± SD) of Epworth Sleepiness Scale score was 6.4 (±2.7). 12.5% of drivers had excessive daytime sleepiness according to ESS results. The circadian effect of time of day on the drivers' working memories was statistically significant (P=0.001), and the working memory was minimum at 04:00 am (± 1). Additionally, the differences in sleepiness at different times of day were statistically significant (P=0.001); with the highest score at 04:00 am (± 1). Time on task and time of sleep parameters did not show a significant effect on working memory (p&gt; 0.05). Time on task parameter affected sleepiness significantly (p=0.024). Conclusion The circadian factor was the most important predictor of cognitive performance compared to time on task (fatigue) and time of sleep. Although, time on task had a significant effect on sleepiness and sleepiness significantly decreased working memory. We conclude that optimizing the drivers' schedule is the most important intervention to optimize drivers' performance and increase road safety. Support (If Any) Not

Association of job strain with working hours, shift-dependent perceived workload, sleepiness and recovery

We explored the relationship of job strain with working hours, shift-dependent perceived workload, sleepiness and recovery. Nurses/nursing assistants (n = 95) were recruited from wards that belonged to either the top (high-strain group, HJS) or the bottom (low-strain group, LJS) job strain quartiles of a Job Content Questionnaire survey of employees in five health care districts and four cities in Finland. Three-week field measurements during naturally occurring shift schedules and a subset of pre-selected shift arrangements consisted of the Karolinska Sleepiness Scale, perceived workload and recovery. The HJS group (n = 42) had more single days off and quick returns than the LJS group (n = 53, p < 0.01), and both mental workload and physical workload were rated as higher (p < 0.01). During naturally occurring shift arrangements, severe sleepiness was more common in the HJS group only in quick returns (p = 0.04) and the HJS group recovered on average more poorly from work after all shifts (p = 0.01) and morning shifts (p = 0.02). During pre-selected shift arrangements, the differences between the groups were only minor. In conclusion, job strain-related differences in sleepiness and recovery were mostly attributable to differences in shift arrangements.

Subjective sleepiness and daytime functioning in bariatric patients with obstructive sleep apnea

The purpose of this study was to evaluate associations between obstructive sleep apnea (OSA) severity and self-reported sleepiness and daytime functioning in patients considering bariatric surgery for treatment of obesity. Using a retrospective cohort design, we identified 342 patients who had sleep evaluations prior to bariatric surgery. Our final sample included 269 patients (78.6 % of the original cohort, 239 females; mean age = 42.0 ± 9.5 years; body mass index = 50.2 ± 7.7 kg/m(2)) who had overnight polysomnography and completed the Epworth Sleepiness Scale (ESS) and the Functional Outcomes of Sleep Questionnaire (FOSQ). Patients' OSA was classified as none/mild (apnea-hypopnea index (AHI) < 15, n = 112), moderate (15 ≤ AHI < 30, n = 77), or severe (AHI ≥ 30, n = 80). We calculated the proportion of unique variance (PUV) for the five FOSQ subscales. ANOVA was used to determine if ESS and FOSQ were associated with OSA severity. Unpaired t tests compared ESS and FOSQ scores in our sample with published data. The average AHI was 29.5 ± 31.5 events per hour (range = 0-175.8). The mean ESS score was 6.3 ± 4.8, and the mean global FOSQ score was 100.3 ± 18.2. PUVs for FOSQ subscales showed moderate-to-high unique contributions to FOSQ variance. ESS and global FOSQ score did not differ by AHI group. Only the FOSQ vigilance subscale differed by OSA severity with the severe group reporting more impairment than the moderate and none/mild groups. Our sample reported less sleepiness and daytime impairment than previously reported means in patients and controls. Subjective sleepiness and functional impairment were not associated significantly with OSA severity in our sample of patients considering surgery for obesity. Further research is needed to understand individual differences in sleepiness in patients with OSA. If bariatric patients underreport symptoms, self-report measures are not an adequate substitute for objective assessment and clinical judgment when evaluating bariatric patients for OSA. Patients with severe obesity need evaluation for OSA even in the absence of subjective complaints.

The BDNF Val66Met polymorphism modulates sleep intensity: EEG frequency- and state-specificity.

EEG slow waves are the hallmark of deep NREM sleep and may reflect the restorative functions of sleep. Evidence suggests that increased sleep slow waves after sleep deprivation reflect plastic synaptic processes, and that brain-derived neurotrophic factor (BDNF) is causally involved in their homeostatic regulation. The functional Val66Met polymorphism of the gene encoding pro-BDNF causes impaired activity-dependent secretion of mature BDNF protein. We investigated whether this polymorphism contributes to the pronounced inter-individual variation in sleep slow wave activity (SWA) in humans. Sleep laboratory in temporal isolation unit. Eleven heterozygous Met allele carriers and 11 individually sex- and age-matched Val/Val homozygotes. Forty hours prolonged wakefulness. Cognitive performance, subjective state, and waking and sleep EEG in baseline and after sleep deprivation were studied. Val/Val homozygotes showed better response accuracy than Met allele carriers on a verbal 2-back working memory task. This difference did not reflect genotype-dependent differences in sleepiness, well-being, or sustained attention. In baseline and recovery nights, deep stage 4 sleep and NREM sleep intensity as quantified by EEG SWA (0.75-4.5 Hz) were higher in Val/Val compared to Val/Met genotype. Similar to sleep deprivation, the difference was most pronounced in the first NREM sleep episode. By contrast, increased activity in higher EEG frequencies (> 6 Hz) in wakefulness and REM sleep was distinct from the effects of prolonged wakefulness. BDNF contributes to the regulation of sleep slow wave oscillations, suggesting that genetically determined variation in neuronal plasticity modulates NREM sleep intensity in humans.