Higher Sleepiness Scores Research Articles

"I know when to stop": Sentinels and counter-strategies against drowsy driving in narcolepsy and idiopathic hypersomnia.

To collect prodromal symptoms experienced by participants with narcolepsy and idiopathic hypersomnia (considered "hypersomnolence experts") prior to drowsy driving and counter-strategies used to maintain alertness. Systematic, face-to-face interview (using a semi-structured questionnaire), including clinical measures, frequency of car accidents/near misses, and symptoms experienced before impending drowsy driving episodes and counter-strategies. Among 61 participants (32 with narcolepsy, 29 with idiopathic hypersomnia; 56 drivers), 61% of drivers had at least one lifetime accident/near miss. They had a higher sleepiness score (14 ± 4 vs. 11 ± 5, P<0.04) than those without an accident/near miss, but no other differences in demographics, driving experience, medical conditions, symptoms, sleep tests, and treatment. All but three participants experienced prodromal symptoms of drowsy driving, which included postural and motor changes (86.9%: axial hypotonia - e.g., eyelid droop, stereotyped movements), cognitive impairment (53.3%: automatic steering, difficulty concentrating/shifting, dissociation, mind wandering, dreaming), sensory (65%: paresthesia, pain, stiffness, heaviness, blunted perceptions such as a flat dashboard with loss of 3D, illusions and hallucinations), and autonomic symptoms (10%, altered heart/breath rate, penile erection). Counterstrategies included self-stimulation from external sources (pain, cold air, music, drinks, driving with bare feet), motor changes (upright posture, movements), and surprise (sudden braking). Drowsy driving symptoms can result from "local" NREM, entry in N1 sleep, and hybrid wake/REM sleep states. These rich qualitative insights from participants with narcolepsy and idiopathic hypersomnia, as well as sophisticated counter-strategies, can be gathered to reduce the crash risk in this population, but also in inexperienced healthy drivers.

Associations of mood, stress, and social support with sleep duration and daytime sleepiness among adolescents in semi-rural Georgia

ObjectiveAdolescents are at greater risk for poor sleep compared to childhood; however, there is limited data regarding psychosocial determinants of adverse sleep health among semi-rural adolescents. We investigated associations of mood, stress, and social support with self-reported sleep duration and daytime sleepiness among adolescents. MethodsAdolescents (n = 254) in semi-rural Georgia self-reported depressive and anxiety symptoms, stress, social support, sleep duration and daytime sleepiness in November 2020. Multinomial linear and logistic models were fit to examine associations of psychosocial factors with sleep duration and sleepiness; and effect modification by social support was tested after adjustment for covariates. ResultsMost participants were non-Hispanic White (55 %), female (53 %), and approximately 35 % were eligible for free-reduced lunch. Mean sleep duration (± SD) and daytime sleepiness was 8.04 ± 1.36 and 5.17 ± 2.37, respectively; and 42 % of participants reported insufficient sleep (<8 h). Depressive (β = 0.13, 95 % CI: 0.08, 0.18) and anxiety (β = 1.20, 95 % CI 0.51, 1.88) symptoms, and stress (β = 1.97, 95 % CI 1.21, 2.74) were associated with higher sleepiness scores. The psychosocial factors were associated with higher odds of insufficient sleep duration, but not continuous sleep duration. Higher social support was associated with lower sleepiness, but not sleep duration. There was no observed effect modification by social support. ConclusionsExperiences of psychosocial factors were associated with more sleepiness and insufficient sleep, while social support was associated with less sleepiness. Future studies should explore intervention strategies to enhance mood and social support and reduce stress to improve sleep among semi-rural adolescents.

Revisiting the maintenance of wakefulness test: from intra-/inter-scorer agreement to normative values in patients treated for obstructive sleep apnea.

The Maintenance of Wakefulness Test is widely used to objectively assess sleepiness and make safety-related decisions, but its interpretation is subjective and normative values remain debated. Our work aimed to determine normative thresholds in non-subjectively sleepy patients with well-treated obstructive sleep apnea, and to assess intra- and inter-scorer variability. We included maintenance of wakefulness tests of 141 consecutive patients with treated obstructive sleep apnea (90% men, mean (SD) age 47.5 (9.2) years, mean (SD) pre-treatment apnea-hypopnea index of 43.8 (20.3) events/h). Sleep onset latencies were independently scored by two experts. Discordant scorings were reviewed to reach a consensus and half of the cohort was double-scored by each scorer. Intra- and inter-scorer variability was assessed using Cohen's kappa for 40, 33, and 19 min mean sleep latency thresholds. Consensual mean sleep latencies were compared between four groups according to subjective sleepiness (Epworth Sleepiness Scale score < versus ≥11) and residual apnea-hypopnea index (< versus ≥15 events/h). In well-treated non-sleepy patients (n = 76), the consensual mean (SD) sleep latency was 38.4 (4.2) min (lower normal limit [mean - 2SD] = 30 min), and 80% of them did not fall asleep. Intra-scorer agreement on mean sleep latency was high but inter-scorer was only fair (Cohen's kappa 0.54 for 33-min threshold, 0.27 for 19-min threshold), resulting in changes in latency category in 4%-12% of patients. A higher sleepiness score but not the residual apnea-hypopnea index was significantly associated with a lower mean sleep latency. Our findings suggest a higher than usually accepted normative threshold (30 min) in this context and emphasise the need for more reproducible scoring approaches.

Correlates of Fluctuations in Moderate-Advanced Dementia with Lewy Bodies (P13-6.007)

<h3>Objective:</h3> To assess correlates of fluctuations in moderate-advanced dementia with Lewy bodies [DLB]. <h3>Background:</h3> Cognitive fluctuations (spontaneous episodic deficits in attention, arousal, cognition, and behavior) are a core DLB feature, but remain poorly understood. <h3>Design/Methods:</h3> The PACE-DLB study collected measures of Lewy body disease, demographics, and patient and caregiver experiences from moderate-advanced DLB individual-caregiver dyads. Fluctuations were assessed via the Mayo Fluctuations Scale (MFS, range 0–4) and Clinician Assessment of Fluctuation (CAF, range 0–16). Concordance was assessed using Spearman correlation for raw scores and Cohen’s Kappa for assessing scores above/below the cut-off. Nonparametric methods including Spearman correlation, two-sample Wilcoxon test, and odds ratios assessed factors associated with fluctuations. The FDR method corrected raw scores for multiple testing. <h3>Results:</h3> Patients (n=137) identified as white non-Hispanic (94.9%) and male (79.6%); mean age 75.0 (SD 8.0), disease duration 3.0 years (SD 2.4). Caregivers were typically wives (72.3%) and daughters (13.1%). On the MFS, 116 participants (84.7%) had fluctuations (score ≥3) (mean 3.3, SD 0.8) versus 116 (84.7%) on the CAF (score &gt;0) (correlation: 0.2, p&lt;0.001; fluctuations absent/present: 0.3, p=0.002). The mean CAF score was 8.8 (SD 6.6). Variables associated with a positive MFS included higher sleepiness scores (p=0.02), lower QoL-AD scores (p=0.02), and parkinsonism (p=0.02). No variables associated with a positive CAF. Higher MFS scores associated with higher sleepiness scores (p&lt;0.001), lower QoL-AD, and more autonomic symptoms (p=0.03). Higher CAF scores associated with higher Neuropsychiatric Inventory severity scores (p&lt;0.0001), hallucinations (p=0.045), orthostatic hypotension (p=0.02), more comorbidities (p=0.04), and higher sleepiness scores (p=0.045). Fluctuations associated with worse patient and caregiver quality of life and higher caregiver burden and depression. <h3>Conclusions:</h3> The MFS and CAF correlated weakly. Fluctuations associated with sleepiness, autonomic symptoms, parkinsonism, and neuropsychiatric symptoms. Given the impact of fluctuations on quality of life and caregiver burden and depression, fluctuations are an important target for future pharmacologic therapies. <b>Disclosure:</b> Dr. Tholanikunnel has nothing to disclose. Mr. LaBarre has nothing to disclose. Ms. Sovich has nothing to disclose. Li Zhigang has nothing to disclose. James Galvin has nothing to disclose. Dr. Paulson has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Exicure. The institution of Dr. Paulson has received research support from National Institutes of Health. Dr. Paulson has a non-compensated relationship as a Member, Nominating committee with American Neurological Association that is relevant to AAN interests or activities. An immediate family member of Dr. Maixner has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Law office . The institution of Dr. Manning has received research support from Department of Defense. The institution of Dr. Fields has received research support from National Institutes of Health. The institution of Dr. Fields has received research support from Patient-Centered Outcomes Research Institute. Ms. Lunde has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Mayo Clinic . Dr. Boeve has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Rainwater Charitable Foundation. The institution of Dr. Boeve has received research support from Alector. The institution of Dr. Boeve has received research support from GE Healthcare. The institution of Dr. Boeve has received research support from Transposon. The institution of Dr. Boeve has received research support from Cognition Therapeutics. Dr. Boeve has received publishing royalties from a publication relating to health care. Ms. Forsberg has nothing to disclose. Angela Taylor has received personal compensation for serving as an employee of Lewy Body Dementia Association . The institution of Dr. Armstrong has received research support from National Institute of Aging. The institution of Dr. Armstrong has received research support from Florida Department of Health. The institution of Dr. Armstrong has received research support from Lewy Body Dementia Association. Dr. Armstrong has received research support from Parkinson Foundation. Dr. Armstrong has received personal compensation in the range of $5,000-$9,999 for serving as a DSMB member with Alzheimer’s Clinical Trials Consortium. Dr. Armstrong has received personal compensation in the range of $5,000-$9,999 for serving as a DSMB member with Alzheimer’s Disease Cooperative Study. Dr. Armstrong has a non-compensated relationship as a Member, Scientific Advisory Council with Lewy Body Dementia Association that is relevant to AAN interests or activities.

Self-reported sleepiness associates with greater brain and cortical volume and lower prevalence of ischemic covert brain infarcts in a community sample.

We evaluated if self-reported sleepiness was associated with neuroimaging markers of brain aging and ischemic damage in a large community-based sample. Participants from the Framingham Heart Study Offspring cohort (n = 468, 62.5 ± 8.7 years old, 49.6%M) free of dementia, stroke, and neurological diseases, completed sleep questionnaires and polysomnography followed by magnetic resonance imaging (MRI), 3 years later on average. We used linear and logistic regression models to evaluate the associations between Epworth Sleepiness Scale (ESS) scores and total brain, cortical and subcortical gray matter, and white matter hyperintensities volumes, and the presence of covert brain infarcts. Higher sleepiness scores were associated with larger total brain volume, greater cortical gray matter volume, and a lower prevalence of covert brain infarcts, even when adjusting for a large array of potential confounders, including demographics, sleep profiles and disorders, organic health diseases, and proxies for daytime cognitive and physical activities. Interactions indicated that more sleepiness was associated with larger cortical gray matter volume in men only and in APOE ε4 noncarriers, whereas a trend for smaller cortical gray matter volume was observed in carriers. In longitudinal analyses, those with stable excessive daytime sleepiness over time had greater total brain and cortical gray matter volumes, whereas baseline sleepiness scores were not associated with subsequent atrophy or cognitive decline. Our findings suggest that sleepiness is not necessarily a marker of poor brain health when not explained by diseases or sleep debt and sleep disorders. Rather, sleepiness could be a marker of preserved sleep-regulatory processes and brain health in some cases.

0413 Are High Intellectual Abilities a Protective Factor for Psycho-social Repercussions in Children with Narcolepsy?

Abstract Introduction Narcolepsy can have deleterious impact on cognitive and psychosocial functioning. Adequate intellectual abilities are generally a protective factor for bio-psycho-social adjustments in chronic disorders. The main objective of this study was to describe sleep, cognitive abilities and psychosocial repercussions between children with narcolepsy and controls according to the intellectual abilities’ classification. Methods Children with narcolepsy and controls underwent one-night polysomnography, completed an intellectual abilities assessment (WISC) and filled in the Epworth Sleepiness Scale for children, the Insomnia Severity Index, the Children Depression Inventory and the Conners. Comparisons between children with narcolepsy and controls were made in two subgroups with High intellectual Potentialities (HP; with an IQ or a verbal or reasoning index higher or equal to 130 evaluated by the WISC) or without HP. Results The group with HP consisted of 25 children with narcolepsy (40% boys, median 11,5 years) and 25 controls (68% boys, median 11,7 years). Compared to the controls, the children with narcolepsy did not present the same intellectual profile at the WISC (lower perceptual reasoning index and less discrepancy between verbal and perceptual indexes). They had fewer conduct disorders and a tendency to have fewer school difficulties, learning disabilities, and impulsivity than controls. The group without HP consisted of 22 children with narcolepsy (55% boys, median 12,1 years) and 21 controls (68% boys, median 10 years). The children with narcolepsy presented the same intellectual profile at the WISC as their peers without narcolepsy, but they reported more school difficulties and higher insomnia scores. Compared to controls, both groups of children with narcolepsy had higher sleepiness scores and showed a classic pattern of narcolepsy characteristics on the PSG. There was no difference for the socio-economic level of parents between groups. Conclusion In children with narcolepsy, high intellectual abilities act as protective factor against the impact of the disease on cognitive and adaptive functioning, whereas normal-to-low intellectual abilities predict a greater impact of the pathology on daily-life functioning, highlighting the need for multifactorial management. Support (If Any) This work was supported by a French Grant from the SFRMS to Marine Thieux.

Circadian Rhythm Disorders and Corresponding Functional Brain Abnormalities in Young Female Nurses: A Preliminary Study.

Objective: Shift work is associated with a decrease in melatonin level and perturbation of the circadian rhythm; however, it is unknown if these lead to functional brain changes. In this study, we investigated whether circadian rhythm disorders caused by shift work are related to changes in brain functional connectivity (FC) and regional homogeneity (ReHo) using whole-brain resting-state functional magnetic resonance imaging (fMRI).Methods: This prospective case-control study included nine female night shift nurses and nine age-matched female day work nurses with normal sleep rhythms. To assess sleep quality and mood, participants were asked to complete questionnaires. Serum melatonin and cortisol levels were measured. ReHo of whole-brain resting-state function and seed-based FC of the bilateral hypothalamus were compared between groups. Variables that differed significantly between groups were used to examine the association between questionnaire scores and hormone levels and fMRI data.Results: The night shift nurses had significantly lower sleep quality and melatonin levels; lower ReHo activation in the bilateral cerebellar hemisphere and higher ReHo in the bilateral occipital lobe and left parietal lobe; and higher FC from the hypothalamus to the right cingulate gyrus, right putamen, and vermis than did the day shift nurses. Activation of the right cerebellar hemisphere left superior parietal gyrus, and the right superior occipital gyrus was correlated with sleep quality scores. Moreover, activation of the right cerebellar hemisphere (r = 0.583, P = 0.011) was correlated with melatonin levels, and higher sleepiness scores were associated with stronger FC between the hypothalamus and vermis (r = 0.501, P = 0.034).Conclusions: Circadian rhythm disorder caused by night shift work can lead to a decrease in sleep quality and melatonin level, as well as a series of changes in brain FC and ReHo.

A Method for Napping Time Recommendation Using Electrical Brain Activity

Napping in the workplace has become popular. Knowing how to nap for brain benefits is important. We designed a nap experiment to investigate how napping after different sleep stages impacts procedural memory and sleepiness. In total, 45 nonhabitual nappers were randomly assigned to the Wake group (no napping), N2 group (napping and being woken after enough N2 sleep), and slow-wave sleep (SWS) group (napping and being woken after the end of the first cycle of slow-wave sleep). The results show that the N2 group produces benefits in procedural memory consolidation and sleepiness reduction. In contrast, the SWS group had a lower behavioral performance than the N2 group and their sleepiness. The Wake group had lower performance and higher sleepiness score than the other groups. The results suggest that the ideal napping time is 10–20 min of N2 sleep. Considering that people’s sleep-onset time might be different, we developed a napping time suggestion system using a single-channel electroencephalogram signal. The testing results show that the difference between a 10-min nap of N2 sleep calculated by our system and by an expert is only 0.45 min on average, which demonstrates the feasibility of waking people up at the right time.

Sleepiness among personnel in the Norwegian Air Ambulance Service

Purpose To examine the effects of shift work and extended working hours on sleepiness among pilots and Helicopter Emergency Medical Service (HEMS) crew members in the Norwegian Air Ambulance.MethodsThis field study investigated sleepiness during 3 consecutive weeks: the week before work, the work week, and the week after work. The pilots and HEMS crew members (N = 50) kept a wake diary during all 3 weeks and completed reaction time tests during the work week.ResultsThe overall sleepiness scores were low during all 3 weeks. When comparing the 3 weeks, the lowest sleepiness levels were found for the work week. There was a small difference across work days, in which subjective sleepiness scores were highest the first duty day. No change in the reaction time tests was evident during the work week. The crew members reported being most sleepy at midnight, compared to all the other timepoints over the course of a duty day. Regarding workload and total work time, having larger workload was associated with lower sleepiness scores, while having higher total work time was associated with higher sleepiness score, both compared to the medium category.ConclusionsThe findings indicate that the work schedules and setting for this distinct occupational group do not seem to negatively affect the sleepiness levels.

The Sleepiness Curve of Young Men With and Without Attention-Deficit Hyperactivity Disorder (ADHD)

ABSTRACTObjectives: The present study aimed at comparing the sleepiness curve of young men with attention-deficit hyperactivity disorder (ADHD) to that of young men without ADHD before, during, and after a night of sleep deprivation. Participants: Thirty young men (age 18–30) of whom 14 were diagnosed with ADHD combined type (ADHD-C) and 16 without ADHD. Methods: The participants’ sleep was monitored for 5 days via actigraphy. Subsequently, the participants were kept continuously awake in a controlled environment for 25 hr (8:00 a.m.–9:00 a.m.). The sleepiness of the participants was assessed every hour by the Karolinska Sleepiness Scale (KSS) in order to obtain the sleepiness curve of both study groups. Results: Actigraphy data demonstrated that the two groups did not differ in their total sleep time, sleep onset latency, or sleep efficiency during the 5 nights preceding the experimental session. However, during the experimental session, the ADHD group demonstrated higher sleepiness scores, particularly following midnight and on the morning following the night of sleep deprivation. Moreover, on the morning following sleep deprivation the proportion of participants reporting extreme levels of sleepiness (KSS > 7) was significantly higher in the ADHD group than in the control group. Conclusions: Young men with ADHD suffer from sleepiness more than their counterparts from the general population, and are particularly vulnerable to the effects of sleep deprivation on sleepiness. As excessive daytime sleepiness negatively affects cognition and increases the risk for motor vehicle crash and other accidents, these findings may have important clinical implications.

P 133 Differentiating hypo- and hyperaroused fatigue in major depression and in the context of organic diseases

Introduction Fatigue is a core symptom in patients with major depressive disorder (MDD), and a common symptom in organic diseases involving inflammatory and immunological processes. From a clinical perspective, fatigue in depression is a state with high inner tension and prolonged sleep onset latencies, whereas fatigue in the context of organic diseases describes an anergic state with excessive sleepiness and short sleep latencies. Given that these two states are diametrically opposed in the arousal dimension, it has been proposed to differentiate two subtypes of fatigue ( Hegerl et al., 2013 , Hegerl and Ulke, 2016 ): hyperaroused fatigue (typical for depression) and hypoaroused fatigue (typical in the context of organic diseases). Due to the striking heterogeneity of MDD and frequent occurrence of depressive symptoms in organic diseases, we sought to examine whether both fatigue subtypes can be found within a sample of depressed patients (study 1) and within a sample of subjects with inflammatory-immunological diseases and cancer (study 2). In the first study, we hypothesized that in MDD fatigue with unstable arousal regulation is associated with higher sleepiness scores and more atypical symptoms (e.g. short sleep onset latency) than fatigue with stable arousal regulation. In the second study, we hypothesized that in the context of organic diseases fatigue with stable arousal regulation is associated with higher depression and lower sleepiness scores than fatigue with labile arousal regulation. Methods Sample Study 1: MDD-Patients with clinically relevant fatigue (N = 102). Sample Study 2: Subjects with clinically relevant fatigue in the context of inflammatory-immunological diseases and cancer (N = 127). Arousal regulation was assessed based on 20-min resting-EEG using automatic EEG-vigilance stage classification with the Vigilance Algorithm Leipzig (VIGALL 2.1). Subjects were separated into groups according to their arousal regulation. Results Study 1: According to our hypothesis, fatigue subtypes in the context of MDD differ in regard to daytime sleepiness (ESS: p Conclusions An unstable arousal regulation in MDD-Patients with clinically relevant fatigue could influence the treatment strategy. Stable arousal regulation in persons with clinically relevant fatigue in the context of organic diseases can be an indication of a comorbid depression, which has to be treated according to guidelines.

Sleep characteristics and cognitive impairment in the general population: The HypnoLaus study.

To assess the association between sleep structure and cognitive impairment in the general population. Data stemmed from 580 participants aged >65 years of the population-based CoLaus/PsyCoLaus study (Lausanne, Switzerland) who underwent complete sleep evaluation (HypnoLaus). Evaluations included demographic characteristics, personal and treatment history, sleep complaints and habits (using validated questionnaires), and a complete polysomnography at home. Cognitive function was evaluated using a comprehensive neuropsychological test battery and a questionnaire on the participant's everyday activities. Participants with cognitive impairment (global Clinical Dementia Rating [CDR] scale score > 0) were compared with participants with no cognitive impairment (global CDR score = 0). The 291 participants with a CDR score > 0 (72.5 ± 4.6 years), compared to the 289 controls with CDR = 0 (72.1 ± 4.6 years), had significantly more light (stage N1) and less deep (stage N3) and REM sleep, as well as lower sleep efficiency, higher intrasleep wake, and higher sleepiness scores (all p < 0.05). Sleep-disordered breathing was more severe in participants with cognitive impairment with an apnea/hypopnea index (AHI) of 18.0 (7.8-35.5)/h (p50 [p25-p75]) (vs 12.9 [7.2-24.5]/h, p < 0.001), and higher oxygen desaturation index (ODI). In the multivariate analysis after adjustments for confounding variables, the AHI and the ODI ≥4% and ≥6% were independently associated with cognitive impairment. Participants aged >65 years with cognitive impairment have higher sleepiness scores and a more disrupted sleep. This seems to be related to the occurrence of sleep-disordered breathing and the associated intermittent hypoxia.

SLEEP-RELATED FEATURES AND PERFORMANCE ON A COMPUTERIZED COGNITIVE BATTERY: THE MAYO CLINIC STUDY OF AGING

Several sleep disorders are associated with cognitive impairment and dementia. However, the association between sleep and cognitive function in phenotypically normal individuals in population-based samples has been inadequately characterized. We conducted a cross-sectional study derived from the population-based Mayo Clinic Study of Aging. Subject informants completed the Mayo Sleep Questionnaire, in which an affirmative response to a history of repeatedly “acting out dreams” represents probable REM sleep behavior disorder (pRBD), and the level of alertness was queried on a scale from 0 (poorly alert) to 10 (fully alert). Informants also rated the subject's degree of sleepiness using the Epworth Sleepiness Scale (ESS). The following Cogstate tests were administered: Detection (DET) - measuring simple reaction time, Identification (IDN) - measuring choice reaction time, One Card Learning (OCL) - measuring visual learning, One Back test (ONB) - measuring working memory and attention, and the Graded Maze Learning Test (GMLT) - measuring spatial working memory. Multivariate linear regression analyses were conducted to compute associations corrected for age, sex, education, depression, and obstructive sleep apnea. Among the 599 participants (median age 63.8, range 51-71, 59% male), those rated as more alert took less time to complete the 4 card tasks and the GMLT (p < 0.05) but accuracy measures were not affected. Having a higher sleepiness score was associated with a greater time to complete the IDN task (p<0.05). pRBD was not associated with performance on Cogstate measures in this age group. These findings suggest that alertness and daytime sleepiness are associated with cognitive performance in cognitively-normal individuals. Longitudinal analyses are needed to determine if these sleep related features are predictive of future cognitive decline in this age group. Study supported by: U01 AG06786, P50 Ag016574, K01 AG028573, K01 MH068351, R01 AR0305082, Harold Amos Medical Faculty Development Program (RWJ Foundation), Robert H. and Clarice Smith and Abigail Van Buren Alzheimer's Disease Research Program.

A pilot study exploring the relationship between internists’ self-reported sleepiness, performance on multiple-choice exam items and prefrontal cortex activity

Background: Studies of resident fatigue and performance have shown mixed results. However, research has not examined daytime sleepiness and performance among attending physicians. The purpose of this study was to explore the relationship between sleep, performance and prefrontal cortex (PFC) activity. We hypothesized that sleepiness scores would negatively correlate with multiple-choice question (MCQ) performance and would also correlate with PFC activity.Methods: Board-certified physicians completed an Epworth Sleepiness Scale (ESS) and then answered MCQs from licensing examinations while in a functional Magnetic Resonance Imaging (fMRI) scanner.Results: Seventeen board-certified internists completed the study. The mean number of correct responses was 18.5/32. The correlation between the ESS and MCQ score was −0.30, and higher ESS scores were negatively associated with statistically significant changes in medial PFC (mPFC) activity.Conclusions: Attending physicians who reported higher sleepiness scores performed worse on licensing exam questions. Notably, our cohort had normal to mild sleepiness scores. Moreover, higher sleepiness scores were negatively associated with changes in mPFC activity on fMRI, which is consistent with emerging work implicating the PFC in fatigue-related cognitive impairment. Our findings have implications regarding the impact of sleep on physician performance during examinations and potentially on their care of patients.

Restless leg syndrome in young children with orofacial cleft

Introduction Periodic limb movements (PLMs) and Restless Leg Syndrome (RLS) are related conditions which are increasingly being recognized in children. The prevalence of PLMs is believed to be approximately 8–12% in childhood although it occurs in up to 25% of children with attention- deficit/hyperactivity disorder. Children with orofacial clefts are at increased risk of behavioral difficulties, including inattention and hyperactivity. However, no study has investigated the prevalence of PLMs or RLS in these children and the association with behavioral morbidity. The goal of the current study, therefore, was to investigate the frequency of PLMs and RLS in young children with orofacial cleft and to determine the relationship to inattentive and hyperactive behaviors. Materials and methods Families of children aged 2–6 years with orofacial clefts were invited to participate. All families completed the Pediatric Sleep Questionnaire (PSQ) which included the following subscales: PLMS (6-items), snoring and sleepiness (4 items each). A total score ⩾ 0.33 on any subscale indicated a positive screen. Items about RLS and growing pains were also analyzed separately. In addition, families completed the Conners Early Childhood Assessment questionnaire which included several behavioral domains including hyperactivity/inattention. Results Thus far 36 children have been enrolled. Mean age was 5.0 ± 1.3 years, 53% were boys and 61% Caucasian. Overall 19% of children screened positive for PLMs and a positive response to the RLS and growing pains items was reported in 15% and 12% of children respectively. Children with PLMs had a higher sleepiness score than those without (0.32 vs. 0.06; p = 0.008). Those with RLS, compared to children without, tended towards a higher sleepiness score (0.25 vs. 0.09; p = 0.18), as did those with growing pains (0.25 vs. 0.07; p = 0.12). There were no associations between PLMs or RLS with snoring scores (0.25 vs. 0.21; p = 0.75 and 0.20 vs. 0.21; p = 0.97 respectively). Children with PLMs had higher inattention/hyperactivity scores than those without (66.7 ± 17.0 vs. 53.9 ± 13.5; p = 0.039), as did children with RLS (70.4 ± 19.1 vs. 54.1 ± 13.6; p = 0.026). Conclusion Daytime sleepiness and inattentive/behavioral problems are associated with symptoms of PLMs and RLS in young children with orofacial cleft. Screening for such sleep problems may be important in this pediatric population. Acknowledgements Dr. Moraleda-Cibrian is supported in part by Fundacio Universitaria Agusti Pedro i Pons.

Snoring, sleepiness, inattention, and hyperactivity in preschool and kindergarten children with a repaired cleft palate

School-age children with repaired cleft palate appear to be at high risk for symptoms of sleep-disordered breathing (SDB). In addition, they are also at risk of neurobehavioral morbidity. In typically developing school-age children, SDB symptoms such as snoring are robustly associated with behavioral problems. However, it is currently unknown whether underlying SDB may play a role in neurobehavioral morbidity in young children with a repaired cleft palate. Therefore, the main goal of this study was to investigate the association between cleft palate repair, SDB symptoms, and behavioral problems in children attending preschool and kindergarten. Children aged 2–6 years old with non- syndromic repaired cleft palate were recruited from a Craniofacial Anomalies Clinic. All parents completed the sleep- related breathing disturbance subscale (SRBD) from the Pediatric Sleep Questionnaire, a validated scale for SDB risk. A score on this scale of >=0.33 indicates high risk for SDB. The 4-item snoring and sleepiness scale scores were also calculated. In addition, parents completed the Early Conners ¯ Childhood Assessment which addresses adaptive behavior, development, and cognitive function in children below 6 years of age. A T- score on the Conners questionnaire of 65 (>=1.5 SD above the mean) was considered elevated. Of 36 children thus far, mean age was 4.9iÀ1.3 years and 53% were boys. Overall, 14% of children screened positive for SDB. Positive responses to the snoring and sleepiness subscales were reported in 17% and 8% of children respectively. Inattention/hyperactivity was identified in 25% of children, Defiant/Aggressive Behaviors in 17% and Poor Social Functioning in 11%. There were no correlations between the SRBD scale nor the snoring subscale scores and any behavioral domain. However, the sleepiness score was positively correlated with inattention/hyperactivity ( r = 0.33, p = 0.05). Children with an elevated T-score for inattention/hyperactivity, compared to those without, had a higher SRBD score (0.26 vs. 0.13; p = 0.036) and a higher sleepiness score (0.31 vs. 0.05; p = 0.004). There were no differences in snoring scores (0.28 vs. 0.19; p = 0.50). Inattentive/hyperactive behaviors are common in preschool and kindergarten children with a repaired cleft palate. Although children with poor daytime behavior were more likely to screen positive for SDB, the relationship with behavior was driven by daytime sleepiness rather than snoring. Dr. Moraleda-Cibrian is supported in part by Fundacio Universitaria Agusti Pedro i Pons.

Personality profiles in patients with obstructive sleep apnea

The Minnesota Multiphasic Personality Inventory (MMPI) responses between snorers and obstructive sleep apnea (OSA) may be different. Thus, we compared the MMPI responses between snorers and OSA. A clinical-based cross-sectional survey. This is a survey of 94 treatment-naive sleep-disordered breathing (SDB) subjects. Clinical information, body mass index (BMI), 36-item Short Form Health Survey, the Turkish version of the MMPI, Epworth sleepiness scale (ESS), fatigue scale, attention-deficit scale, and polysomnography were collected. All patients with OSA and snorers was accepted as individuals with SDB (AHI > 0 events/h). The threshold of five apnea and hypopnea per hour of sleep was chosen to define both OSA and snorers. Disability profile is consisting of four or more MMPI clinical scale elevations. OSA patients compared to snorers have significantly higher absolute scores on hypochondriasis (Hs) (65.0 ± 12.0 vs 58.4 ± 7.9, p = 0.01, respectively). OSA patients compared to snorers have significantly higher rate of clinical elevation on both psychopathic deviance (13.0 vs 0 %, p = 0.03, respectively) and Hs (26.1 vs 3.3 %, p = 0.01, respectively). People with disability profile has lower the quality of life, a higher score for inattention, a higher fatigue scores, and higher sleepiness scores. The quality of life and attention deficit and daytime sleepiness scores were associated with total MMPI absolute score in individuals with SDB in bivariate analyses. Present study indicated that patients with OSAS compared to snorers displayed significantly more hyopchondriasis and psychopathic deviance personality characteristics. The daytime functions in individuals with sleep-disordered breathing may be influenced by the severity of psychopathology.

Fatigue, Sleepiness, and Performance in Simulated Versus Real Driving Conditions

To determine whether real-life driving would produce different effects from those obtained in a driving simulator on fatigue, performances and sleepiness. Cross-over study involving real driving (1200 km) or simulated driving after controlled habitual sleep (8 hours) or restricted sleep (2 hours). Sleep laboratory and open French Highway. Twelve healthy men (mean age +/- SD = 21.1 +/- 1.6 years, range 19-24 years, mean yearly driving distance +/- SD = 6563 +/- 1950 miles) free of sleep disorders. Self-rated fatigue and sleepiness, simple reaction time before and after each session, number of inappropriate line crossings from the driving simulator and from video-recordings of real driving. Line crossings were more frequent in the driving simulator than in real driving (P < .001) and were increased by sleep deprivation in both conditions. Reaction times (10% slowest) were slower during simulated driving (P = .004) and sleep deprivation (P = .004). Subjects had higher sleepiness scores in the driving simulator (P = .016) and in the sleep restricted condition (P = .001). Fatigue increased over time (P = .011) and with sleep deprivation (P = .000) but was similar in both driving conditions. Fatigue can be equally studied in real and simulated environments but reaction time and self-evaluation of sleepiness are more affected in a simulated environment. Real driving and driving simulators are comparable for measuring line crossings but the effects are of higher amplitude in the simulated condition. Driving simulator may need to be calibrated against real driving in various condition.

The influence of production systems on self‐reported arousal, sleepiness, physical exertion and fatigue—consequences of increasing mechanization

AbstractThe present study examined the capability of a real‐time assessment routine to sort out the individual impact of three production systems on psychological activation as measured by the Stress‐/Energy Inventory, Karolinska Sleepiness Scale, Borg's CR‐10 Perceived Exertion scale, and the Swedish Occupational Fatigue Inventory. Sixteen women between the ages of 26 and 57 years (mean 43 years) rotated in a counterbalanced order between three production systems: A, B and C. The systems produced the same goods but clearly differed in degree of automation and ergonomic demands. The results show that work at the most automated production system, C, on average generated lower energy index scores and higher sleepiness scores compared to the oldest system, A. Clear weekly and diurnal patterns were found for most rating measures. To conclude, the increasing automation of the production systems is reflected in psychological activation by dampening feelings of positively valued high activity states and increased sleepiness. The expressions of a weekly and diurnal psychological activation, indicates that the subjects are able to unwind both during the weekend and after work, and suggest that the present method is suitable for studying the immediate psychological adaptation to the social and physical work environment. Copyright © 2003 John Wiley &amp; Sons, Ltd.

Nocturnal desaturation in patients with stable heart failure

ObjectiveTo determine the prevalence of sleep disordered breathing within a United Kingdom heart failure population.Subjects104 patients and 21 matched normal volunteers.MethodsOvernight home pulse oximetry with simultaneous ECG recording in the...