Higher Daytime Sleepiness Research Articles

Development and Validation of Machine Learning Models to Predict Postoperative Delirium Using Clinical Features and Polysomnography Variables.

Background: Delirium affects up to 50% of patients following high-risk surgeries and is associated with poor long-term prognosis. This study employed machine learning to predict delirium using polysomnography (PSG) and sleep-disorder questionnaire data, and aimed to identify key sleep-related factors for improved interventions and patient outcomes. Methods: We studied 912 adults who underwent surgery under general anesthesia at a tertiary hospital (2013-2024) and had PSG within 5 years of surgery. Delirium was assessed via clinical diagnoses, antipsychotic prescriptions, and psychiatric consultations within 14 days postoperatively. Sleep-related data were collected using PSG and questionnaires. Machine learning predictions were performed to identify postoperative delirium, focusing on model accuracy and feature importance. Results: This study divided the 912 patients into an internal training set (700) and an external test set (212). Univariate analysis identified significant delirium risk factors: midazolam use, prolonged surgery duration, and hypoalbuminemia. Sleep-related variables such as fewer rapid eye movement (REM) episodes and higher daytime sleepiness were also linked to delirium. An extreme gradient-boosting-based classification task achieved an AUC of 0.81 with clinical variables, 0.60 with PSG data alone, and 0.84 with both, demonstrating the added value of PSG data. Analysis of Shapley additive explanations values highlighted important predictors: surgery duration, age, midazolam use, PSG-derived oxygen saturation nadir, periodic limb movement index, and REM episodes, demonstrating the relationship between sleep patterns and the risk of delirium. Conclusions: The artificial intelligence model integrates clinical and sleep variables and reliably identifies postoperative delirium, demonstrating that sleep-related factors contribute to its identification. Predicting patients at high risk of developing postoperative delirium and closely monitoring them could reduce the costs and complications associated with delirium.

Decrease of excessive daytime sleepiness after shunt treatment for normal pressure hydrocephalus.

Sleepiness and apathy are often reported in patients with normal pressure hydrocephalus. However, research on outcomes after shunt surgery has mainly focused on the classical triad symptoms, that is, gait, cognition, and bladder dysfunction. This study aimed to describe the effects of shunt treatment on excessive daytime sleepiness and whether there was a relation to changes in ventricular volume. Pre- and postsurgical excessive daytime sleepiness was investigated using the Epworth sleepiness scale in a sample of 32 patients with normal pressure hydrocephalus who underwent shunt surgery. Data were gathered before surgery and at 1, 2, and 3 months after surgery and with different settings of the shunt. In the total sample, the Epworth sleepiness scale improved by a median of 1.5 points at 1 month after surgery, p = 0.026. The improvement was predominately found in the group (n = 6) with high presurgical daytime sleepiness (Epworth sleepiness scale >12) (median = 12 points, p = 0.035) compared with a median change of 0 points (p = 0.47) in the group with Epworth sleepiness scale ≤12 (n = 26). Between the postsurgical follow-ups, no further change in the Epworth sleepiness scale score was observed. The Epworth sleepiness scale score did not correlate with clinical tests nor with ventricular volume. Daytime sleepiness seems to be another domain of normal pressure hydrocephalus symptomatology in addition to the classical triad that is responsive to treatment, at least when pronounced. The Epworth sleepiness scale is a quick test to administer and could be a valuable addition to pre-surgical screening for treatable symptoms.

The prevalence of, and factors associated with, a risk of depression in residential aged care services residents: Findings from the FIRST study.

Depression is common amongst Australian residential aged care services (RACS) residents. This study aimed to estimate the risk of depression amongst residents and identify factors associated with this risk. In care settings such as RACS, time-efficient screening tools to identify depression risk may be a preferred tool. The two-item Patient Health Questionnaire (PHQ-2), derived from the nine-item PHQ-9 used commonly in the United States (US), was employed in this study. A resident was identified as being at risk of depression where the score was ≥3. Multivariable logistic regression analysis was used to identify independent factors associated with being at risk of depression. Residents' mean age was 87.7 (standard deviation: 7.3) years and 73% were female. One-fifth of residents (n = 108 or 20%) were at risk of depression. Age (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.93-0.99); Pain Assessment in Advanced Dementia (PAINAD) score (OR 1.55, 95% CI 1.11-2.16); Epworth Sleepiness Scale (ESS) score (OR 1.08, 95% CI 1.03-1.13); and 38-item Frailty Index (FI) score (OR 1.07, 95% CI 1.03-1.10) were significantly associated with being at risk of depression, whilst sex, urinary incontinence, polypharmacy,Dementia Severity Rating Scale (DSRS) and Nursing Home Life Space Diameter (NHLSD) score were not. One in five residents were at risk of depression. Younger age, higher pain, higher daytime sleepiness and higher frailty status were associated with depressive risk. Future studies focusing on interventions targeting these factors may contribute to improved health outcomes.

Prevalence of obstructive sleep apnea and its associated factors in primary health care in Morocco.

Obstructive sleep apnea is a common respiratory disorder that is still underdiagnosed in Morocco. This study aims to determine the prevalence of obstructive sleep apnea and its associated factors in primary healthcare. In this cross-sectional study, 815 adults aged 18 years and older consulting in the primary health care services in Marrakech, Morocco, were included. We evaluated the risk of obstructive sleep apnea syndrome using the modified STOP-BANG questionnaire. The prevalence of the high risk of obstructive sleep apnea in our sample is 24.8% (CI 95%: 21.7 - 27.6%). The variables independently associated with the high suspicion of obstructive sleep apnea were: gender male (p = 0.001), age ≥ 45 years (p = 0.001), high blood pressure (p = 0.005), hyperlipidemia (p = 0.042), daytime sleepiness (p = 0.003), snoring (p = 0.001), tiredness (p = 0.001) and mandibular retrognathia (p = 0.025). This survey revealed a significant prevalence of obstructive sleep apnea in Morocco. Therefore, we propose to generalize the screening of obstructive sleep apnea in hypertensive patients who report symptoms including daytime sleepiness, snoring, nocturnal choking, and tiredness that are unexplained by other known factors.

Relationships between internet addiction, quality of life and sleep problems: a structural equation modeling analysis

ObjectiveTo assess the relationship between internet addiction, quality of life, and sleep problems among adolescents. MethodThis research was conducted with a representative sample of 875 adolescents. This cross-sectional study used the Internet Addiction Test, Pediatric Quality of Life Inventory™ version 4.0, Pediatric Daytime Sleepiness Scale, and sleep duration. Sociodemographic factors were also analyzed. Structural equation modeling was used to investigate relationships between variables. ResultsAfter adjusting the model for covariances between the latent variables of daytime sleepiness and correlations between the physical and emotional domains of quality of life, the authors obtained satisfactory fit indices (RMSEA = 0.031, CFI = 0.926, TLI = 0.909, SRMR = 0.058). Internet addiction was positively associated with daytime sleepiness (rho = 0.549, p < 0.001) and negatively associated with quality of life (rho = −0.173, p < 0.001). By contrast, sleep duration was negatively associated with daytime sleepiness (rho = −0.089, p = 0.007), positively associated with quality of life (rho = 0.105, p = 0.014), and dependent on school shift (rho = 0.453, p < 0.001). ConclusionsAdolescents with higher levels of internet addiction had lower perceptions of quality of life and higher daytime sleepiness. Moreover, sleep duration had a positive correlation with quality of life. Given its detrimental effects on quality of life and daytime sleepiness, parents should better supervise internet use in adolescents.

Modern view on the effectiveness of surgical methods for treating obstructive sleep apnea syndrome

Obstructive sleep apnea (OSA) syndrome is not only a widespread pathology, but also has far-reaching social consequences due to patients' poor quality of nighttime sleep and high daytime sleepiness. To date, a large number of methods, both conservative and surgical, have been developed for the treatment of OSA. Surgeries performed for OSA are aimed at correcting the structures of the nose, pharynx, larynx, as well as the hyoid and jaw bones and the muscles attached to them. Despite the seventy-five-year history of the use of surgical treatment methods, there is still no complete clarity regarding the advisability of certain types of operations. The article presents data from meta-analyses published over the last ten years and devoted to various types of surgical procedures aimed at combating OSA in adult and pediatric populations. Rhinosurgical approaches, uvulopalatopharyngoplasty, surgical advancement of the lower jaw in adults and expansion of the upper jaw in children, interventions on the hyoid bone and mental tubercle, removal of the palatine and pharyngeal tonsils, operations for laryngomalacia and bariatric surgery are considered. Data on the effectiveness of the most common operations: tonsillectomy in adults (85%), multilevel pharyngoplasty (60%); and about a wide range of data on the effectiveness of uvulopalatoplasty (25 to 94%) are presented. Effective surgical options and criteria for a positive prognosis of such treatment, the possibility of complete cure of OSA, that is, reducing the apnea/hypopnea index (AHI) below 5 events per hour in adults, are discussed. In conclusion, the need to continue research using Sher's criteria for the effectiveness of surgical operations is emphasized: a reduction in AHI by 50% or more or below 20 events per hour. Research that includes long-term postoperative follow-up is especially important.

Excessive daytime sleepiness in nursing technicians: association with sleep quality and memory.

to investigate excessive daytime sleepiness prevalence among nursing technicians and the association with sleep quality and memory. a cross-sectional, inferential study, carried out in a hospital unit in the state of Goiás between December 2020 and January 2021. Assessments were carried out using the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index and the Prospective and Retrospective Memory Questionnaire, instruments validated for the Brazilian context. Bivariate and multivariate logistic regression analyzes were performed. the sample consisted of 189 nursing technicians with a 40.9% excessive daytime sleepiness prevalence. In multivariate models, excessive daytime sleepiness was not associated with sleep quality, however there was a significant association with overall memory failures. study results demonstrate a high excessive daytime sleepiness occurrence, an association with overall memory failures and the need for psychosocial interventions for nursing technicians.

Impact of school start time and sleep pattern of adolescents on their mood and sleep quality

Objective: The physiological delay in bedtime among adolescents, compounded with the early start of school, results in insufficient sleep, especially on school days. The present study compared the sleep pattern and moods of students attending two schools with different start timing. Materials and Methods: The study involved adolescents from two schools with different start times: School A (7 am) and School B (8 am). Pittsburgh Sleep Quality Index, Depression Anxiety Stress Scales-21, and Pediatric Daytime Sleepiness Scale questionnaires were used to assess students’ mood, sleep duration, sleep quality, and daytime sleepiness. The clinical trial registry number is CTRI/2022/06/043556. Result: A total of 640 students (mean age 13.7 ± 2.0 years; 47.5% male) participated in this study. Students from School B had longer sleep duration, with 72.9% reporting sleep deprivation compared to 87.1% of School A (P = 0.00001). School A students reported having (P ≤ 0.001) higher daytime sleepiness, higher daytime dysfunction (P = 0.023), and poorer sleep quality. Students at School A scored higher for all mood derangements, with significantly higher scores for depression (P = 0.041). Conclusion: The study illustrates that though not much differences are observed in the bedtime of adolescents of the two schools, however, due to the early school start time of School A, students have to compulsorily wake up early, leading to higher sleep deprivation and greater mood derangements among them.

Delayed sleep-wake rhythm due to staying at home during the COVID-19 pandemic and sleep debt after returning to campus among Japanese nursing university students: A longitudinal study

This study aimed to investigate sleep problems during staying at home due to the coronavirus disease 2019 (COVID-19) pandemic and after returning to campus among university nursing students. We analyzed data from self-reported sleep surveys conducted during a nursing course at a university in Tokyo between 2019 and 2021. During staying at home due to COVID-19, we observed delayed sleep-wake rhythm, prolonged sleep duration on weekdays, a decreased sleep debt, improved daytime sleepiness, and worsened insomnia, especially in terms of difficulty initiating sleep (Study 1; 18 paired data). After returning to campus, we found advanced wake-up time, shortened sleep duration, increased sleep debt, worsened insomnia, and increased daytime sleepiness (Study 2; 91 paired data). The association between advanced midpoint of sleep and commute time over an hour (aOR, 3.29; 95%CI: 1.24–8.72) was confirmed. Furthermore, sleep paralysis and nightmares were more prevalent among nursing students with an advanced midpoint of sleep, whereas nursing students whose midpoint of sleep was delayed had higher daytime sleepiness after returning to campus. To maintain regular sleep-wake rhythms and sufficient sleep duration, the educational environment surrounding nursing university students (e.g., curriculum, class schedule, style of class) should be established considering their age-dependent biological rhythm in addition to sleep hygiene education for students.

Different sleep patterns during the COVID-19 pandemic: association with mood, exercise and light exposure

ABSTRACT The aim was to evaluate the sleep-wake cycle pattern, mood, perceived stress and some behaviors, such as physical exercise and exposure to natural light of college students during the COVID-19 pandemic. This is a cross-sectional study conducted between June and August 2020 using an electronic form provided by Google. The sample consisted of undergraduate students aged between 18 and 30 years old and residents of the northeast region of Brazil. The students generally had sleepiness and poor sleep quality, high levels of anxiety, mild to moderate depressive symptoms and moderate perceived stress. Some of these aspects were worse in women. The college students showed three sleep patterns: one group had good sleep quality without excessive daytime sleepiness; another group had poor sleep quality, but no excessive daytime sleepiness; and a third group had high daytime sleepiness, and less expressive sleep quality impairment. Greater exposure to sunlight and practicing physical exercise predominated in individuals with better sleep quality, suggesting that they are protective factors. In addition, excessive daytime sleepiness and poor sleep quality were separately associated with higher anxiety, depression and stress perception levels, proving to be important aspects for care in order to favor mental health during the pandemic. In conclusion, it is suggested that the COVID-19 pandemic affected the sleep of college students in a heterogeneous way. The differentiated sleep patterns are associated with exposure to natural light and exercising.

Less daytime sleepiness and slow wave activity during sleep predict better physical readiness in military personnel

BackgroundMilitary personnel must maintain physical performance despite exposure to operational stressors such as sleep loss, caloric restriction and high cognitive load. Habitual sleep and specific sleep features are positively associated with fitness and may contribute to physical performance in operational settings. Further, by affecting muscle recovery, sleep may contribute to the ability to maintain performance across multiple days of exposure to operational stressors. ObjectivesWe examined the role of individual differences in baseline sleep on baseline physical performance and on change in physical performance throughout exposure to simulated military operational stress (SMOS). MethodsMilitary personnel (36 male, 9 female, 26.3 ± 5.3 years) completed a 5-day SMOS protocol during which they completed a tactical mobility test daily. Sleep questionnaires were administered at intake and sleep was monitored each night with polysomnography. Lasso regressions were used to identify meaningful predictors of physical performance at baseline and of change in physical performance across SMOS. ResultsBetter aerobic fitness, lower daytime sleepiness (Epworth Sleepiness Scale), and lower absolute slow wave activity (0.5-4 Hz) predicted better physical performance at baseline (66.1% of variance explained), but did not relate to changes in performance. ConclusionsCollectively, higher daytime sleepiness and slow wave activity may reflect more chronic exposure to insufficient sleep and higher baseline sleep drive, which in turn led to compromised physical performance. The findings suggest that low self-report sleepiness and low objective slow wave activity may reflect two quantifiable markers of healthy sleep behaviors that have implications for operational performance.

Alexithymia, Phosphorus Levels, and Sleep Disorders in Patients on Hemodialysis.

Alexithymia, or the inability to distinguish between bodily feelings and emotions, has been linked to poor sleep quality in some studies. Rare studies examined the associations between electrolyte phosphorus in patients on hemodialysis and their sleep quality, daytime sleepiness, and alexithymia with inflammatory factors. Hemodialysis is a treatment method for terminal renal patients that involves the diffusion of unwanted metabolic products through the dialyzer membrane. Our study aimed to examine whether there was a difference in phosphorus levels, inflammatory factors, and daytime sleepiness according to the hemodialysis patients’ levels of alexithymia. The study involved 170 HD patients that had been treated with chronic dialysis for more than three months. Prior to the hemodialysis procedure, laboratory findings were sampled. Respondents completed the Pittsburgh Sleep Quality Index, the Toronto Alexithymia Scale 26, and the Epworth Sleepiness Scale, and were questioned about depression. The results showed that alexithymic HD patients exhibited significantly higher leukocyte counts, lower predialysis phosphorus values, and more pronounced daily sleepiness than the alexithymia-free group (Mann–Whitney U test, p = 0.02, p = 0.005, and p < 0.001, respectively). We concluded that alexithymia was an independent predictor of high daytime sleepiness in HD patients (OR = 1.05, 95% CI 1.02 to 1.09).

Non-Right Handedness is Associated with More Time Awake After Sleep Onset and Higher Daytime Sleepiness Than Right Handedness: Objective (Actigraphic) and Subjective Data from a Large Community Sample.

PurposeHandedness has been linked to various physiological and pathological phenomena including memory function and psychiatric disorders. Also for sleep, several studies have reported associations. However, large-scale studies including a broad age span of participants and studies analyzing women and men separately are lacking.MethodsTherefore, objective sleep data were determined using at-home actigraphy from 1764 healthy participants (18 to 80 years, 908 women), averaging five consecutive nights. In addition, subjective sleep-related data were captured by self-report diaries, the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS) and the Morningness-Eveningness-Questionnaire (MEQ). Handedness was determined with the Edinburgh Handedness Inventory (EHI) providing information on the direction (left vs right) and the degree of handedness (strong vs weak). To address the potential endocrine effects, premenopausal women (≤45 years) and postmenopausal women (≥55 years) were analyzed separately. This was also done for men.ResultsThe degree and direction of handedness were correlated with “wake after sleep onset” (WASO) in the total sample and all women (the more right-handed/lateralized the shorter WASO). In postmenopausal women, additionally, time in bed (TIB) and total sleep time (TST) were correlated. There were no other significant associations between an objective sleep variable and handedness. In both premenopausal women and >55-year-old men subjective quality of sleep (PSQI) was correlated with direction and degree of handedness (the more right-handed/lateralized the better). In the total sample and postmenopausal women, the degree and direction of handedness were negatively correlated with daytime sleepiness. The chronotype was not associated with handedness in any group.ConclusionWhile associations were not consistent in all groups, overall, right-handedness tended to be associated with better sleep and less daytime sleepiness. Handedness and sleep seemed to be differentially associated in women and men, being in line with endocrine interactions.

Clinical Differences of Insomnia Subtype According to Actigraphy Based Objective Short Sleep, Subjective Short Sleep, and Normal Sleep

Objectives: This study aims to examine the clinical differences between objective short sleep insomniacs (OSSI) and subjective short sleep insomniacs (SSSI). Methods: We enrolled 79 patients (aged 27–74 years) with chronic insomnia disorder (CID) who underwent overnight polysomnography (PSG) and completed sleep-related questionnaires as well as habitual sleep time. All of them completed actigraphy (ACT) recording for one week prior to the PSG study. Objective sleep duration for one-week average sleep was calculated by ACT, and subjective sleep duration was counted through self-reported habitual sleep time. We divided the subjects into three groups; OSSI (&lt;6 h/night), SSSI (objective sleep ≥6 h/night and subjective sleep &lt;6 h/ night), and normal sleep duration insomniacs (NSDI, subjective sleep ≥6 h/night). Results: The three groups namely OSSI, SSSI, and NSDI had 25 (31.6%), 36 (45.6%), and 18 (22.8%) subjects, respectively. The SSSI were significantly older and had higher daytime sleepiness than the OSSI. According to the PSG results, the OSSI showed shorter sleep latency (11.86 min vs. 39.69 min) and N2 sleep % (59.43% vs. 67.96%), and longer rapid eye movement sleep % (20.79% vs. 15.47%) than that in the NSDI. There was no difference in treatment response between groups. Conclusions: 45.6% of CID patients underestimated their sleep relative to objective sleep. However, there were no differences in total sleep time on PSG between groups. The OSSI showed younger age and more daytime sleepiness, and the SSSI showed poorer sleep quality than the NSDI. These findings suggest that long-term ACT recording in a casual environment would be useful to monitor objective sleep in patients with CID, particularly, in subjectively short sleep insomniacs.

Associations of Chronic Burden, Sleep Characteristics, and Metabolic Syndrome in the Coronary Artery Risk Development in Young Adults Study.

Chronic exposure to stress is associated with metabolic syndrome (MetS), but the mechanism is unclear. We investigated the associations between chronic burden, sleep, and MetS in the Coronary Artery Risk Development in Young Adults Study. Chronic burden was self-reported (2000-2001) according to experiences with stressors for longer than 6 months. Wrist actigraphy-measured sleep duration and sleep efficiency were collected for 6 days; sleep duration, sleep quality, and daytime sleepiness were self-reported (2003-2004). MetS was measured during the clinic visit, from 2005 to 2006. Multivariable logistic and Cox proportional hazard models were fit to determine the associations of interest. Mediation by sleep was assessed using the product of coefficients approach. Among participants ( n = 606), the average (standard deviation) age was 40 (3.6) years, 58% were female, and 43% were Black. The prevalences of chronic burden, short sleep (≤6 hours), and MetS were 35%, 43% and 20.5%, respectively. High versus low chronic burden was associated with shorter self-reported sleep duration and higher daytime sleepiness. Chronic burden was associated with 1.85 higher odds (95% confidence interval = 1.11-3.09) of MetS. Sleep characteristics were not associated with MetS. There was no evidence that sleep mediated the chronic burden-MetS relation. Burden of chronic stress may be an emerging novel risk factor for both poor sleep and MetS.

Evaluation of the Relationship between Occupational Accidents and Obstructive Sleep Apnea Risk among Employees of a University Hospital.

Context:Occupational accidents are still one of the important causes of morbidity and mortality. Sleep apnea is a significant risk factor for occupational accidents in hospitals.Aims:To determine the frequency of occupational accidents and their relationship with the risk of obstructive sleep apnea (OSAS).Settings and Design:Cross-sectional study in a hospital setting.Methods and Material:This study was conducted on 331 hospital workers between 2019-2020. Accidents from the Social Security Institution records were used. The risk of OSAS was evaluated with Berlin Survey, daytime sleepiness with Epworth Sleepiness Scale, sleep quality with Pittsburg Sleep Quality Scale.Statistical Analysis:The Chi-square test was used for analysis; P < 0.05 was accepted as a statistical significance value.Results:Of the participants, 231 (69.8%) were female. Their ages ranged between 19 and 55; the mean age was 33.8 ± 8.0 years. The frequency of occupational accidents was 8.8%, 51.4% had a high risk of OSAS, 80.4% had high daytime sleepiness, and 53.5% had poor sleep quality.Conclusion:The study group had a high risk of sleep disorders. No relationship was found between sleep disorders and occupational accidents. More comprehensive studies are needed to clarify this relationship.

Sleep quality and sleep hygiene in preclinical medical students of tertiary care center amidst COVID-19 pandemic: a cross-sectional observational study.

Objectives: Due to the long-lasting pandemic measures, such as lockdown and stay-at-home orders, the COVID-19 pandemic has had a negative impact on higher education. In this study, we aimed to determine sleep quality, excessive daytime sleepiness, and sleep hygiene, and their association with anxiety, and their correlation in preclinical medical students during the COVID-19 pandemic.Materials and Methods: We included 101 medical students, aged between 17–20 years of both sex from a tertiary care medical institute. Standard questionnaires were used to assess sleep quality, sleep hygiene, daytime sleepiness, and anxiety among medical students.Results: Fifty-one percent of the medical students had good sleep quality, but 35% had borderline poor sleep quality, and 13% had poor sleep quality during the lockdown. Six percent of medical students had alarmingly high daytime sleepiness. The total Adolescent Sleep Hygiene Scale (ASHS) score was grouped into poor sleep hygiene (ASHS score ≤ 3.8) and good sleep hygiene (ASHS score ≥ 4.9). Overall, sleep hygiene of medical students was poor due to behavioral arousal and bedtime routine factors, and the scores for anxiety and sleep hygiene were significantly negatively correlated, whereas daytime sleepiness showed a significant positive correlation.Conclusion: Our study revealed a high prevalence of poor sleep quality among medical students during the lockdown. Poor sleep hygiene is an eye-opener for the mostly ignored aspect of altered sleep patterns.

Association Between Evening Light Exposure and Subjective Sleep Measures Among People Living With Dementia

Excessive light exposure before bedtime can disrupt one’s circadian rhythm and can lead to poor sleep. The purpose of this study was to describe the relationship between evening light exposure and subjective sleep measures in people living with dementia (PLWD). We conducted secondary data analysis using the baseline data from Healthy Patterns Clinical Trial (N=137). We used Actiwatch Spectrum Plus to collect light data over three consecutive days. We defined evening light exposure as the average white light intensity for 4 hours before sleep. Sleep measures included Epworth Sleepiness Scale and PROMIS Sleep-Related Impairment. We used univariate regression analysis. We found that that greater evening intensity of light exposure was associated with higher daytime sleepiness (β=0.209, p=0.015) and more sleep impairment (β=0.228, p=0.014). The results of our study suggest that exposure to bright light during evening can disturb nighttime sleep and increase daytime sleepiness in PLWD.

The effect of sleep restriction therapy for insomnia on sleep pressure and arousal: a randomized controlled mechanistic trial.

Sleep restriction therapy (SRT) effectively treats insomnia but mechanisms are poorly understood. Theoretical models suggest that potentiation of sleep pressure and reduction of arousal are key mechanisms of action. To our knowledge, this has never been directly tested. We designed a randomized controlled trial with embedded mechanistic measurement to investigate if SRT causally modifies multidimensional assessments of sleep pressure and arousal. Participants aged 25-55 who met DSM-5 diagnostic criteria for insomnia disorder were randomized to four weeks of SRT or time in bed regularization (TBR), a control intervention that involves prescription of a regular but not reduced time in bed. Sleep pressure was assessed through daily diary appraisal of morning and evening sleepiness, weekly Epworth sleepiness scale (ESS) scores, psychomotor vigilance, and non-rapid eye movement (NREM) delta power (0.75-4.5 Hz) from ambulatory polysomnographic recordings. Arousal was assessed through daily diary appraisal of cognitive arousal, the pre-sleep arousal scale (PSAS), and NREM beta power (15-32 Hz). Outcomes were assessed at baseline (2-week period prior to randomization), during the intervention phase (1-4 weeks post-randomization), and at 12-week follow-up. We performed intention-to-treat analyses using linear mixed models. For continuous daily measures, the treatment period was split into early (weeks 1-2) and late (weeks 3-4) treatment. Fifty-six participants (39 females, mean age = 40.78 ± 9.08) were assigned to SRT (n = 27) or TBR (n = 29). The SRT group showed enhanced sleep pressure relative to TBR, reflected in (1) enhanced sleepiness in the evening during early (d = 1.17) and late treatment (d = 0.92), and in the morning during early treatment (d = 0.47); (2) higher daytime sleepiness on the ESS at weeks-1 and -2 (d = 0.54, d = 0.45); and (3) reduced psychomotor vigilance at week-1 (d = 0.34). The SRT group also showed reduced arousal relative to TBR, reflected in lower levels of daily-monitored cognitive arousal during early treatment (d = 0.53) and decreased PSAS total score at week-4 and week-12 (ds ≥ 0.39). Power spectral analysis of all night NREM sleep revealed an increase in relative, but not absolute, EEG delta power at week-1 and week-4 (ds ≥ 0.52) and a decrease of relative EEG beta power at week-4 (d = 0.11). For the first time, we show that SRT increases sleep pressure and decreases arousal during acute implementation, providing support for mechanism-of-action.

The Effect of Night Duty of Pharmacists on Sleepiness and Concentration at Daytime.

Background: The changing responsibilities of pharmacists contribute to a lack of qualified pharmacists to fill vacant positions, particularly in rural areas. Consequently, pharmacy managers cover various duties, including an increasing number of nights being on duty that can impair daytime concentration and performance. The objective of the study was to assess the effect of night duties on daytime sleepiness, sleep quality, and concentration abilities of pharmacists. Methods: 22 pharmacists, both sexes, aged 27 to 60 years, were recruited and their sleep time, sleep efficiency, and mobility (actigraphy) were assessed during a night on duty and a control night using an actimetry. Daytime sleepiness and concentration were assessed using standardized questionnaires (ESS, KSS, d2-R). Results: Significant differences were observed between the night shift and control nights with respect to sleep time, sleep efficiency, and mobility. Daytime sleepiness was significantly increased after night shifts (ESS: 11.64 vs. 2.09; KSS: 6.77 vs. 2.41 after a night shift and control night, respectively; p < 0.001) and concentration diminished compared to control nights (d2-R KL: 220.95 vs. 260.36 after a night shift and control night, respectively; p < 0.001). Conclusions: The results provide evidence that night duties lead to high daytime sleepiness in pharmacists, which in turn may negatively affect their ability to concentrate and their error rate. Existing regulations on emergency pharmacy services should be reconsidered regarding the safety of the pharmaceutical supply.