Shorter Sleep Latency Research Articles

Bedtimes, bedtime routines, and children's sleep across the first 2 years of life.

The first objective of this study was to determine whether establishing bedtime routines in the first year of life predicts better sleep outcomes (i.e. longer sleep duration, less nighttime waking, earlier bedtime, shorter sleep latency, fewer sleep problems) across the first 2 years of life. The second objective was to determine whether specific adaptive bedtime activities (e.g. book reading) were associated with sleep outcomes. The third objective was to describe changes in adaptive bedtime activities (hug/kiss caregiver, say goodnight to family) across the first 2 years of life. Parents of 468 children from the STRONG Kids 2 birth cohort were surveyed about bedtime and bedtime routines, their child's sleep duration, nighttime waking, sleep latency, and sleep problems at 3, 12, 18, and 24 months of age. Cross-lagged panel models revealed partial evidence for reciprocal associations between bedtime routine consistency and adaptive bedtime activities and better sleep outcomes over time. Specifically, more bedtime routine consistency predicted less nighttime waking and sleep problems, and more bedtime adaptive activities predicted longer sleep duration and fewer sleep problems. The findings are discussed from a developmental perspective to highlight how consistency of bedtime routines established as early as 3 months of age may affect sleep outcomes and that the adaptive activities associated with these routines may increase in frequency over the first 2 years of life.

Prevalence of sleep apnea and daytime sleepiness in professional truck drivers

IntroductionThe prevalence of obstructive sleep apnea (OSA) among professional truck drivers has varied from 28 to 78% in previous studies. In this study we wanted to estimate the prevalence of OSA and OSA with both subjectively measured sleepiness and objectively measured ability to stay awake (ie obstructive sleep apnea syndrome, OSAS) among professional truck drivers in Finland. Subjects and methodsAltogether 2066 professional truck drivers received a structured questionnaire. 175 drivers had a clinical examination and sleep laboratory studies, which included respiratory polygraphy (RP) and maintenance of wakefulness test (MWT). Three groups were formed: 75 subjects with suspected sleep apnea, 75 healthy controls and a random sample of 25 subjects. Results1095 drivers answered the questionnaire. RP was performed on 172 drivers and 167 drivers participated in MWT. The mean age was 40.7 years and the mean BMI was 27.7 kgm−2. The prevalence of sleep apnea in professional truck drivers using various criteria were: AHI ≥5: 40.1%, AHI≥ 15: 16.2% and, AHI≥ 30: 7.2%. The prevalence depended on clinical history. Prevalence of AHI≥5 varied between 20 and 56.9% and prevalence of AHI≥15 was 4.3–25%. Altogether 4.8% of subjects with AHI ≥15 had abnormally short sleep latency in MWT (<19.4 min). ConclusionsModerate sleep apnea is common among professional truck drivers but significant inability to stay awake, defined as MWT <19.4 min, is found in about one of twenty professional drivers.

Sleep and Safety Improve Physicians' Psychological Functioning at Work During Covid-19 Epidemic.

PurposeThe COVID-19 pandemic caused a massive healthcare crisis. To investigate what makes healthcare system resilient and physicians better at coping during a crisis situation, our study investigated the role risk exposure, such as working at COVID-19 entry points, sleep, and perceived work safety played in reducing negative psychological functioning at work, as well as their effects on adverse and potentially fatal incidences of compromised safety and medical errors.MethodsOur study included a representative sample of 1,189 physicians, from all 12 Slovenian regions and all medical occupations, as registered by the Medical Chamber of Slovenia. For the purposes of this study, a Questionnaire of Sleep and Psychological Functioning at Work was developed in the form of an online retrospective self-report. Additionally, our study included items assessing physicians perceived work safety and frequency of negative outcomes (compromised safety and medical errors) during the first month of the Covid-19 epidemic.ResultsPhysicians working at COVID-19 entry points were more likely to experience night awakening, slept less than 5 h per night, experience nightmares, and had lower levels of psychological functioning in comparison to other physicians. Both hypothesized models showed adequate fit. A higher score on the sleep scale (sleep quantity, sleep quality, and shorter sleep latency) has been shown to predict lower levels of negative psychological functioning at work and, indirectly, reduced incidences of compromised safety and medical errors. Contrary to our expectations, no significant direct effect of sleep on compromised safety and medical errors was found. When perceived work safety was added into the model, the model showed improved fit, with perceived work safety predicting better sleep, less negative psychological functioning at work, and less compromised safety.ConclusionSleep and safety both play an important role in reducing negative psychological functioning at work and, by doing so, decreasing the negative and potentially fatal incidents during the pandemic, such as compromised safety and medical errors. Further, research is needed to see how medical guidelines can be updated to ensure physicians sleep and that their safety is protected.

Examining sleep deficiency and disturbance and their risk for incident dementia and all-cause mortality in older adults across 5 years in the United States

Background: Sleep disturbance and deficiency are common among older adults and have been linked with dementia and all-cause mortality. Using nationally representative data, we examine the relationship between sleep disturbance and deficiency and their risk for incident dementia and all-cause mortality among older adults.Methods: The National Health and Aging Trends Study (NHATS) is a nationally-representative longitudinal study of Medicare beneficiaries in the US age 65 and older. Surveys that assessed sleep disturbance and duration were administered at baseline. We examined the relationship between sleep disturbance and deficiency and incident dementia and all-cause mortality over the following 5 years using Cox proportional hazards modeling, controlling for confounders.Results: Among the sample (n = 2,812), very short sleep duration (≤5 hours: HR = 2.04, 95% CI: 1.26 - 3.33) and sleep latency (>30 minutes: HR = 1.45, 95% CI: 1.03 - 2.03) were associated with incident dementia in adjusted Cox models. Difficulty maintaining alertness (“Some Days”: HR = 1.49, 95% CI: 1.13 - 1.94 and “Most/Every Day”: HR = 1.65, 95% CI: 1.17 - 2.32), napping (“Some days”: HR = 1.38, 95% CI: 1.03 - 1.85; “Most/Every Day”: HR = 1.73, 95% CI: 1.29 - 2.32), sleep quality (“Poor/Very Poor”: HR = 1.75, 95% CI: 1.17 - 2.61), and very short sleep duration (≤5 hours: HR = 2.38, 95% CI: 1.44 - 3.92) were associated with all-cause mortality in adjusted Cox models.Conclusions: Addressing sleep disturbance and deficiency may have a positive impact on risk for incident dementia and all-cause mortality among older adults.

Effects of Histamine and Related Compounds on the Central Nervous System

There has been little information about the role of histamine on the central nervous system (CNS), different from dopamine and serotonin. In the present study, therefore, the effects of histamine and related compounds on the CNS were studied using rats. Intracerebroventricular (i.c.v.) injection of histamine and 2-methylhistamine ameliorated memory deficit after long interrution of learning in active avoidance response. First generation H1-antagonists inhibited active avoidance response, whereas newly develpoed H1-antagonists showed little effect. α-Fluoromethylhistidine, an histidine decarboxylase inhibitor, also inhibited active avoidance response. In radial maze performance, almost the same findings were obtained. I.c.v. injection of histamine and H1-agonists inhibited amygdaloid kindled seizures. First generation H1-antagonists attenuated histamine-induced inhibition of amygdaloid kindled seizures. Both i.c.v. and intraperitoneal injections of H3-antagonist, thioperamide, resulted in a dose-related inhibition of amygdaloid kindled seizures. The effect of thioperamide was inhibited by an H3-agonists and H1-antagonists. Similar to nitrazepam, diphenhydramine and chlorpheniramine caused a shortening of sleep latency. On the other hand, no significant effects were observed with second generation H1-antagonists. These findings suggest that histamine plays an important role in learning and memory via H1-receptors, an inhibition of amygdaloid kindled seizures induced by histamine occurred through not only H1-receptors but also H3-receptors, and that classic H1-antagonists can be useful as a effective hypnotic for difficulty in falling asleep.

Sleep during menopausal transition: a 10-year follow-up.

Study ObjectivesA 10-year observational follow-up study to evaluate the changes in sleep architecture during the menopausal transition.MethodsFifty-seven premenopausal women (mean age 46 years, SD 0.9) were studied at baseline and after a 10-year follow-up. At both time points, polysomnography (PSG) was performed, and the serum follicle-stimulating hormone (S-FSH) concentration was measured. Linear regression models were used to study the effects of aging and menopause (assessed as change in S-FSH) on sleep.ResultsAfter controlling for body mass index, vasomotor, and depressive symptoms, higher S-FSH level was associated with longer sleep latency (B 0.45, 95% confidence interval [CI]: 0.07 to 0.83). Aging of 10 years was associated with shorter sleep latency (B −46.8, 95% CI: −77.2 to −16.4), shorter latency to stage 2 sleep (B −50.6, 95% CI: −85.3 to −15.9), decreased stage 2 sleep (B −12.4, 95% CI: −21.4 to −3.4), and increased slow-wave sleep (B 12.8, 95% CI: 2.32 to 23.3) after controlling for confounding factors.ConclusionsThis study suggests that PSG measured sleep of middle-aged women does not worsen over a 10-year time span due to the menopausal transition. The observed changes seem to be rather age- than menopause-dependent.

Insomnia treated with three acupuncture combinations guided by theory of Tongdu Tiaoshen: a randomized controlled trial

To compare the clinical therapeutic effect and safety on insomnia among three acupuncture combinations, named Tongdu Tiaowei (promoting the circulation of the governor vessel and regulating the defensive system), Tongdu Yangxin (promoting the circulation of the governor vessel and nourishing the heart) and Tongdu Tiaozang (promoting the circulation of the governor vessel and regulating zang functions). A total of 90 patients with insomnia were randomized into a Tongdu Tiaowei group (30 cases, 1 case dropped off ), a Tongdu Yangxin group (30 cases, 2 cases dropped off ) and a Tongdu Tiaozang group (30 cases, 1 case dropped off ). Besides electroacupuncture (EA) applied to Baihui (GV 20) and Yintang (GV 29) in all of the three groups, acupuncture was added at Shenmai (BL 62) and Zhaohai (KI 6), Shenmen (HT 7) and Sanyinjiao (SP 6) as well as back-shu points of five zang organs [Feishu (BL 13), Xinshu (BL 15), Ganshu (BL 18), Pishu (BL 20) and Shenshu (BL 23)] in the Tongdu Tiaowei group, the Tongdu Yangxin group and the Tongdu Tiaozang group successively. The treatment was given once every two days, 3 times weekly, consecutively for 4 weeks. The score of Pittsburgh sleep quality index (PSQI) before and after treatment was observed, the therapeutic effect was evaluated and the adverse reactions were recorded in the patients of each group. After treatment, the score of each of 6 factors, named sleep quality, sleep latency, sleep time, sleep efficiency, sleep disturbance and daytime dysfunction, as well as the total score of PSQI scale were all reduced as compared with the scores before treatment in the patients of each group (P<0.05). After treatment, the scores of sleep latency and daytime dysfunction in the Tongdu Tiaowei group were lower than the other two groups (P<0.05). The score of sleep time in the Tongdu Yangxin group was lower than the other two groups (P<0.05) and the score of sleep quality in the Tongdu Tiaozang group was lower than the other two groups (P<0.05). After treatment, the total effective rates were 96.6% (28/29), 96.4% (27/28) and 96.6% (28/29) in the Tongdu Tiaowei group, the Tongdu Yangxin group and the Tongdu Tiaozang group successively, without significant difference in comparison among the three groups (P>0.05). During treatment, 1 case of mild adverse reaction occurred in each group. All of the three acupuncture combinations, named Tongdu Tiaowei, Tongdu Yangxin and Tongdu Tiaozang can effectively improve the sleep conditions in the patients with insomnia and are satisfactory in safety. The acupuncture combinations of Tongdu Tiaowei has the potential advantage in shortening sleep latency and relieving daytime dysfunction, the combinations of Tongdu Yangxin has the potential advantage in increasing sleep time and the combinations of Tongdu Tiaozang has the potential advantage in improving sleep quality.

Daytime sleepiness among Midwestern firefighters

Excessive daytime sleepiness (EDS) is the most common symptom of sleep-disorders. Although high levels of EDS have been reported among firefighters, there is a limited understanding on EDS in firefighters. A cross-sectional survey was conducted in full-time firefighters (n = 275). The survey included the Epworth Sleepiness Scale to assess EDS, as well as other questions related to job characteristics, health history, and demographics. Firefighters reported inadequate sleep hours, extremely short sleep latencies, and high EDS higher than the general population. A majority of firefighters indicated a willingness to consult with a sleep professional. Risk factors associated with EDS included at least five years of professional experiences and depression diagnosis. Our findings suggest that EDS is widespread among firefighters. With increasing time on the job, frequencies of both obesity and EDS increase, which can have severe and compounding effects on health and safety.

TRANSVENOUS PHRENIC NERVE STIMULATION IMPACT ON PATIENTS WITH HEART FAILURE AND CENTRAL SLEEP APNEA

SESSION TITLE: Sleep Disorders Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Epworth Sleepiness Scale (ESS) is used to screen for subjective excessive daytime time sleepiness (EDS) in obstructive sleep apnea (OSA) but has not been validated to define EDS in patients with heart failure (HF) and central sleep apnea (CSA). Our and other laboratories have shown most patients with HF do not report EDS, yet when tested in laboratory by multiple sleep latency test, many exhibit short sleep latency. We hypothesized an ESS of 10-11, the threshold to define EDS in OSA in the general population, is not appropriate for patients with CSA and HF. In the pivotal randomized controlled trial (RCT) of transvenous phrenic nerve stimulation (TPNS), there were 96 patients with CSA and HF with a wide range (0-21) in ESS, with median=8. In this analysis, we investigated the impact of TPNS on outcomes based on ESS ≥8. METHODS: Outcomes were evaluated for subgroups having baseline ESS≥8 vs. ESS<8 within the Treatment (n=30 and 18, respectively) and Control (implanted but therapy inactive for 6 months, n=24 and 24, respectively) groups. Changes in ESS, sleep metrics and quality of life (QoL) were assessed at 6 months. P-values from exploratory analyses comparing results between TPNS ESS subgroups are reported. RESULTS: TPNS treated patients with ESS≥8 had significantly greater ESS improvement (n=30, median 12 at baseline vs 6.5 at 6 months) than the ESS<8 TPNS subgroup (n =18, 5 vs 5) [p<.01]. There were no significant changes in ESS in the Control subgroups with either ESS≥8 (median 13 at baseline vs 12 at 6 months) or ESS<8 (4 vs 4.5). Comparing the ESS≥8 subgroups, 54% of the TPNS subgroup and 19% of Control shifted to from ≥8 to <8 at 6 months (p=0.03). The median apnea hypopnea index (AHI) decreased from 50 to 20 events/hour in the ESS≥8 subgroup (57% of subjects experienced ≥50% reduction in AHI) and from 43 to 28 in the ESS<8 subgroup (60% had ≥50% reduction in AHI) [p=0.98]; the median AHI in both Control subgroups increased at 6 months and ≤10% reduced AHI by ≥50%. In both TPNS subgroups, the arousal and oxygen desaturation indices also improved significantly from baseline whereas Control had minimal change. The Patient Global Assessment improved markedly or moderately in 63% of the TPNS ESS≥8 subgroup compared to 50% of the <8 subgroup (p=0.52). CONCLUSIONS: The results of this RCT suggest in patients with HF and CSA, TPNS significantly improves sleep metrics and QoL independent of ESS. Additionally, TPNS improves EDS significantly in the subgroup with EDS≥8, suggesting ESS≥8 may be a better threshold defining EDS as it identifies a subgroup of HF patients who may benefit most from TPNS therapy in sleepiness and QoL. Similar data with CPAP or ASV are lacking but could be retrieved from previous RCTs which reported no significant change in EDS. CLINICAL IMPLICATIONS: ESS≥8 best defines EDS in patients with HF and may identify potential CSA candidates who could benefit most from therapy. DISCLOSURES: Employee relationship with Respicardia, Inc. Please note: >$100000 Added 04/13/2020 by Robin Germany, source=Web Response, value=Salary no disclosure on file for Lee Goldberg; Consultant relationship with Respicardia Please note: $20001 - $100000 Added 04/09/2020 by Shahrokh Javaheri, source=Web Response, value=Honoraria Employee relationship with Respicardia Please note: >$100000 Added 04/12/2020 by Scott McKane, source=Web Response, value=Salary Employee relationship with Respicardia Please note: >$100000 Added 04/13/2020 by Timothy Meyer, source=Web Response, value=Salary

Clinical Features and Correlates of Poor Nighttime Sleepiness in Patients with Parkinson's Disease.

Objective The present study investigated the clinical features and correlates of poor nighttime sleepiness (PNS) in patients with Parkinson's disease (PD). Methods One hundred ten patients with PD (divided into PD-PNS group and PD-nPNS group) and forty-seven controls (nPD-PNS group) were enrolled in this study. Demographic information was collected. Patients were assessed according to the unified Parkinson's disease rating scale (UPDRS) and Hoehn–Yahr (H&Y) stage scale. Patients were also evaluated according to the Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESS), rapid eye movement sleep behavior disorder screening questionnaire (RBD-SQ), restless leg syndrome (RLS) diagnosis, Hamilton's depression scale (HAMD), and Hamilton's anxiety scale (HAMA). Results The prevalence of PNS was 55.45% (61/110) in patients with PD. The PD-PNS group tended to have a longer duration of disease, higher UPDRS-I and UPDRS-III scores, a higher percentage of RLS patients, and higher HAMA and HAMD scores than those of the PD-nPNS group. The PD-PNS group tended to have a higher percentage of RBD and RLS patients and higher HAMA and HAMD scores than those of the nPD-PNS group. Analysis of the PSQI components and PSQI impact factors showed that the PD-PNS group had worse subjective sleep quality (χ2 = −2.267, P = 0.023), shorter sleep latency (χ2 = −2.262, P = 0.024), fewer sleep medications (χ2 = −4.170, P ≤ 0.001), worse daytime functioning (χ2 = −2.347, P = 0.019), and an even higher prevalence of increased nocturia (χ2 = 4.447, P = 0.035), nightmares (χ2 = 7.887, P = 0.005), and pain (χ2 = 9.604, P = 0.002) than those of the nPD-PNS group. Analysis also indicated that the PSQI global score positively correlated with BMI (r = 0.216, P < 0.05), H&Y stage (r = 0.223, P < 0.05), UPDRS-I (r = 0.501, P < 0.01), UPDRS-III (r = 0.425, P < 0.01), ESS (r = −0.296, P < 0.01), RBD (r = 0.227, P < 0.05), RLS (r = 0.254, P < 0.01), HAMA (r = 0.329, P < 0.01), and HAMD (r = 0.466, P < 0.01). In the final model, H&Y stage, RLS, UPDRS-III, and HAMD remained associated with the PQSI score (P ≤ 0.001, P ≤ 0.001, P = 0.049, P ≤ 0.001, respectively). Conclusions Our data showed that PNS was common in patients with PD. H&Y stage, UPDRS-III, HAMD, and RLS were positively associated with PNS. Attention to the management of motor symptoms, RLS, and depression may be beneficial to nighttime sleep quality in patients with PD.

0867 Gender Differences In The Relationship Between Exercise And Sleep In Young Adults

Abstract Introduction Exercise is widely prescribed as a behavioral treatment for sleep health, but generalizations about the benefits of exercise for sleep do not typically consider gender differences. The present study examined relationships between exercise frequency and self-reported sleep outcomes in undergraduate men and women. Methods Students were recruited from campus fitness facilities immediately after they finished a workout (N=829, 19.5±1.4 y, 38.5% Female) and completed demographic, Pittsburgh Sleep Quality Index (PSQI) and exercise questionnaires. Department of Health and Human Services Physical Activity Guidelines for Americans were used to dichotomize students into those who met recommendations for weekly aerobic and strength training exercise and those who did not. Multiple regression was used to examine the relationships between exercise frequency and PSQI outcomes and analysis of variance was used to compare PSQI outcomes by gender and exercise guideline groups. Results Compared to women, men reported more days of exercise, fewer days of aerobic exercise, more days of strength training, better sleep efficiency and later bedtimes (ps&amp;lt;0.05). Among all participants, exercise frequency associated with an earlier bedtime, higher sleep efficiency, less daytime dysfunction and better sleep quality (ps&amp;lt;0.05). When divided by gender, exercise frequency associated with an earlier bedtime and better sleep quality in women (ps&amp;lt;0.05) but not men and associated with less daytime dysfunction in men (p=0.012) but not women. Approximately 47% of participants met exercise guidelines for both aerobic and strength training. Participants who met the guidelines exhibited an earlier bedtime (p=0.01) and higher sleep efficiency (p=0.08) than those who did not. There was also a significant interaction effect for sleep latency (p=0.042) such that meeting the guidelines associated with a shorter sleep latency in men (p=0.006) but not women. Conclusion These findings highlight the importance of taking an individual’s gender and specific sleep issue into account when implementing an exercise prescription to improve sleep. Support Rutgers University Aresty Foundation

0779 Circadian Entrainment in 12h Night Shift Workers: The Environmental Lights Matter?

Abstract Introduction Shift workers frequently suffer sleep disturbance in relation with the atypical work schedules. In particular, night shift workers are exposed to inevitable sunlight or bright indoor lights during the morning hours that may disturb their daytime sleep. We aimed to find out the optimal environmental lights to facilitate circadian entrainment of 12h-shift workers by assessing melatonin profiles in the morning and daytime sleep quality. Methods We enrolled 12h-shift female nurses working at one hospital (n=10, mean age 29.4±3.5 years). The schedules of participants are identical such as day-day-night-night shifts and four consecutive off days. Participants admitted to the laboratory at 9:00 following 2nd night shift schedule. Saliva melatonin was taken six times every 30 minute from 10:00 to 12:30 under two different lighting conditions with organic light emitting diodes (OLED) or light emitting diodes (LED) with 150 lux of light intensity. Dim light condition (10 lux) was conducted as controls. Three sessions were randomly ordered with 8-10 days intervals. Participants were allowed to sleep after 12:30 with light off and woke up ad libitum. Results Melatonin concentration had decreased gradually from 10.6±11.4 to 5.0±8.2 pg/ml. Among three different lighting conditions, there were no statistical differences in salivary melatonin and sleep parameters recorded by polysomnography. Circadian entrainment in night shift workers was defined as that salivary melatonin concentration had maintained above 5 pg/ml at the time to bed. 20% of sessions (6/30) were classified as circadian entrainment (CE) and 80% (24/30) were as non-entrainment (NE). Mean melatonin concentration was 22.1±11.2 in CE and 3.9±4.1 pg/ml in NE (p&amp;lt;.001). CE showed significantly shorter sleep latency (0.5±0.3 vs. 1.5±1.4 min, p=.025) and wakefulness after sleep onset (13.6±6.3 vs. 27.9±16.8%, p=.015), and higher sleep efficiency (94.6±2.6 vs. 88.7±6.3%, p=.011) than NE. The number of each lighting condition was not different between CE and NE (p=.847). Conclusion This is a preliminary study with small number of participants. We found that environmental lights including dim light did not affect daytime sleep of 12h shift workers. Instead, daytime sleep quality was influenced by circadian entrainment with higher melatonin concentration in the morning. Support

Exploring the bi-directional relationship between sleep and resilience in adolescence

ObjectiveThe study examined whether overall sleep quality and the sleep components comprising the Pittsburgh Sleep Quality Index (PSQI) have a bi-directional relationship with resilience among adolescents, after adjusting for sex, age, depression, and socioeconomic status, and investigated which sleep components have a stronger effect on resilience. MethodsA total of 1299 students (58% females; mean age, 15.79 years) participated at baseline, with 840 finishing all four study waves over the course of 24 months. Data were collected through questionnaires, including socio-demographics, the Pittsburgh Sleep Quality Index, Patient Health Questionnaire 9-item, and the Connor-Davidson Resilience Scale. Cross-lagged models were used to analyze the relationships between sleep and resilience. ResultsBoth daytime dysfunction and sleep disturbance had an independent bi-directional relationship with resilience. Higher resilience scores predicted overall better sleep quality and shorter sleep latency, but not vice versa. Sleep disturbance and daytime dysfunction had stronger effects on resilience. ConclusionsThese findings highlight the importance of future school interventions for sleep to improve students' resilience.

Sleep among primary care physicians-Association with overtime, night duties and strategies to counteract poor sleep quality.

Physicians belong to the risk group for sleep disorders as a result of work related stress, excessive working time, large amount of on-call duties and shift work. Poor sleep quality of healthcare providers threatens not only their safety, but also the safety of their patients. This study examines if there are any differences in how working either long hours or at night duties relates to self-reported sleep time, sleep quality and daytime sleepiness in primary care physicians. We analyzed data from a survey research of 807 participants. Respondents were divided into four groups based on their reported work hours per week and number of nights on duty per month. Overtime was associated with shorter sleep time and worse subjective sleep quality even when compared with that of participants who work on night duties. All investigated groups of participants reported short sleep latencies which suggests that sleep debt is a common problem in this population. Surprisingly in the case of poor sleep quality participants rarely used recommended methods like regular physical activity or specialist advice. The most frequently reported answer was that they do nothing to improve sleep and every third participants uses hypnotics to do that. These results suggest that primary care physicians despite being at high risk for sleep disorders due to working overtime and at night, pay less attention to their sleep quality and do not use recommended strategies to improve it.

Manual acupuncture for patients with major depressive disorder and comorbid insomnia: Evidence from polysomnography and serum biomarkers

ObjectiveThis study is conducted to determine effects of manual acupuncture (MA) in patients with a diagnosis of major depressive disorder (MDD) and comorbid insomnia. MethodsA total of 67 participants who met the inclusion criteria were randomly enrolled in a two-arm randomized, placebo controlled, patients-blind trial and allocated to a real-MA group (patients = 34) and a sham-MA group (patients = 33). Patients in the real-MA group were treated on ‘Five-shen acupoints’, including Sìshéncōng (四神聪 EX-HN 1), Shéntíng (神庭 GV 24), Shéndào (神道 GV 11), bilateral Běnshén (本神 GB 13), and bilateral Shénmén (神门 HT 7). Though being punctured on the same acupoints, patients in the sham-MA group were treated by a placebo acupuncture approach (Streitberger Placebo-needle). Each group received corresponding interventions every other day, three times a week for total eight weeks. Both polysomnography (PSG) and testing of serum biological markers such as neuropeptide Y (NPY) and substance P (SP) were performed at pre- and post-treatment. Additionally, the global scores of Pittsburgh sleep quality index (PSQI) and the global scores of 17-items Hamilton Depression Rating Scale (HAMD17) were used for assessing the subjective sleep and emotion experience of patients, respectively. Meanwhile, adverse effects were monitored and recorded. ResultsAfter eight-week treatment, the global scores of PSQI and global scores of HAMD17 declined significantly (both P < 0.05) in the real-MA group but not in the sham-MA group (both P > 0.05). According to the parameters of PSG, striking decline were observed in sleep latency (SL) and wake after sleep onset (WASO) and striking climb were observed in total sleep time (TST) and sleep efficiency (SE) in the real-MA group after treatment (P < 0.05, respectively) but not in the sham-MA group (P > 0.05, respectively). Additionally, there were no significant differences in awakening times (ATs) and rapid eyes movement sleep latency (REM-SL) in both two groups after treatment (both P > 0.05). Meanwhile, the expression of NPY increased significantly and the expression of SP decreased significantly in the real-MA group after interventions (both P < 0.05) while those indicators only slightly fluctuated in the sham-MA group (P > 0.05). No serious adverse event was reported in either real- or sham- MA group. Conclusion(1) MA may be a potential alternative therapy for improving MDD and comorbid insomnia (particularly in extending total sleep time and shortening wake-up duration and sleep latency) via upregulating the expression of NPY and downregulating the expression of SP; more importantly, this efficacy of acupuncture can not be replaced by sham-acupuncture acting on the same acupoints with the same treatment frequency. (2) There is insufficient evidence to prove that MA can effectively reduce the number of arousals.

Beneficial effect of GABA-rich fermented milk on insomnia involving regulation of gut microbiota

Insomnia is a common health problem in modern societies. GABA, an inhibitory neurotransmitter, can promote relaxation and reduce anxiety. In this study, milk was fermented with Lactobacillus brevis DL1-11, a strain with high GABA-producing capacity. The potential beneficial effects of this fermented milk on anxiety and sleep quality were evaluated in animal experiments. Sixty mice were divided into control, non-GABA fermented milk (NGFM), low-dose GABA fermented milk (LGFM, 8.83 mg/kg.bw), medium-dose GABA fermented milk (MGFM, 16.67 mg/kg.bw), high-dose GABA fermented milk (HGFM, 33.33 mg/kg.bw) and diazepam groups. The results of open field test and elevated plus-maze test indicated decreases in anxiety behavior after oral HGFM administration. Moreover, mice in the HGFM group exhibited a significantly prolonged sleep time after an intraperitoneal injection of sodium pentobarbital and a shortened sleep latency after an intraperitoneal injection of sodium barbital. These results indicate a beneficial effect of HGFM on sleep. Additionally, significant increases in the relative abundances of Ruminococcus, Adlercreutzia and Allobaculum and the levels of some short-chain fatty acids (SCFAs), such as butyric acid, were observed in the HGFM group. The results suggest that GABA-fermented milk may improve sleep and the protective pathways may involve in regulation of gut microbiota and increase of SCFAs level.

Effects of Light on Daytime Sleep in 12 Hours Night Shift Workers: A Field Study

Objectives Night shift workers suffer from sleep and daytime disturbances due to circadian misalignment. To investigate the role of environmental light in daytime sleep following 12 h-night shift work. Methods we enrolled 12 h-shift female nurses working at one university-affiliated hospital (n=10, mean age 26.6 years, shift work duration 3.8 years). This is a cross-over study to compare sleep between under light exposure (30 lux) and in the dark (<5 lux) following 12 h-night duty. Two sessions of experiments were underwent and the interval between sessions was about a month. Psychomotor vigilance test (PVT) had performed on awakening from sleep at each session and sleep-wake pattern had been monitored by actigraphy throughout the study period. Daytime sleep was also compared with night sleep of age-and gender matched daytime workers (n=10). Results Sleep parameters and PVT scores were not different between two light conditions. Activities during sleep seemed to be more abundant under 30 lux condition than in the dark, which was not significant. Compared to night sleep, daytime sleep of shift workers was different in terms of rapid eye movement (REM) sleep. Three shift workers showed sleep onset REM sleep and first REM sleep period was the longest during daytime sleep. Conclusions Unexpectedly, daytime sleep of 12 h night shift workers was well-maintained regardless of light exposure. Early occurrence of REM sleep and shorter sleep latency during daytime sleep suggest that shift workers meet with misalignment of circadian rhythm as well as increased homeostatic sleep pressure drive. Keywords: Shift work, Light exposure, Polysomnography, Sleep, Alertness

Microsleep episodes in the borderland between wakefulness and sleep

The wake-sleep transition zone represents a poorly defined borderland, containing, for example, microsleep episodes (MSEs), which are of potential relevance for diagnosis and may have consequences while driving. Yet, the scoring guidelines of the American Academy of Sleep Medicine (AASM) completely neglect it. We aimed to explore the borderland between wakefulness and sleep by developing the Bern continuous and high-resolution wake-sleep (BERN) criteria for visual scoring, focusing on MSEs visible in the electroencephalography (EEG), as opposed to purely behavior- or performance-defined MSEs. Maintenance of Wakefulness Test (MWT) trials of 76 randomly selected patients were retrospectively scored according to both the AASM and the newly developed BERN scoring criteria. The visual scoring was compared with spectral analysis of the EEG. The quantitative EEG analysis enabled a reliable objectification of the visually scored MSEs. For less distinct episodes within the borderland, either ambiguous or no quantitative patterns were found. As expected, the latency to the first MSE was significantly shorter in comparison to the sleep latency, defined according to the AASM criteria. In certain cases, a large difference between the two latencies was observed and a substantial number of MSEs occurred between the first MSE and sleep. Series of MSEs were more frequent in patients with shorter sleep latencies, while isolated MSEs were more frequent in patients who did not reach sleep. The BERN criteria extend the AASM criteria and represent a valuable tool for in-depth analysis of the wake-sleep transition zone, particularly important in the MWT.

Can real-life driving ability be predicted by the Maintenance of Wakefulness Test?

Objective: Drowsy driving is a profound road safety issue. In patients with excessive daytime sleepiness (EDS), the Maintenance of Wakefulness Test (MWT) is commonly used to evaluate driving ability. However, there is little evidence that MWT predicts driving performance, and several sleep latency cutoffs have been suggested.Methods: Based on a retrospective chart analysis of patients with an MWT and a driving ability assessment between January 2006 and November 2014, we identified 63 studies in 60 patients. The driving ability assessment judged the patients as qualified or disqualified for commercial driving. MWT latencies to 3 s of alpha activity, 3 s of drowsiness (microsleep), and sleep onset were compared between qualified and disqualified patients and their validity to identify driving qualification was evaluated.Results: Disqualified patients had shorter alpha, microsleep, and sleep latencies, but the latency distributions were widely overlapping. MWT accuracy to predict driving performance was poor: two thirds of short sleep latencies were false positives. Adding information from alpha and microsleep latencies added little extra accuracy.Conclusions: MWT results correlate poorly with driving performance in a 2-h test irrespective of sleep latency cutoff or added alpha/microsleep latency data. Better diagnostic tools are needed to evaluate driving performance in patients with EDS.

Microsleep as a marker of sleepiness in obstructive sleep apnea patients.

We hypothesized that: (a) the presence of microsleep (MS) during a Maintenance Wakefulness Test (MWT) trial may represent a reliable marker of sleepiness in obstructive sleep apnea (OSA) patients; (b) the number of MSs will be higher in sleepy versus non-sleepy patients with a borderline MWT mean sleep latency; and (c) scoring MS during MWT analysis may help physicians to recognize patients with a higher degree of sleepiness. We analysed the MWT data of 112 treatment-naïve OSA patients: 20 with short sleep latency (SL, sleep latency <12.8min), 43 with borderline latency (BL, sleep latency between 12.8 and 32.6min) and 49 with normal latency (NL, sleep latency >32.6min). Microsleep was identified in all SL, in 42 BL and in 18 NL patients, with a median latency of 5.6min. Accordingly, patients were classified into two subgroups: group A (n=43) with microsleep latency <5.6min and group B (n=69) with microsleep latency >5.6min when present. The mean sleep latency in the MWT was 14.5±7.5min in group A and 34.6±7.4min in group B (p<0.0001). The number of microsleep episodes during each MWT trial was higher in group A than in group B. Sleep latency survival curves demonstrated different patterns of sleep latency in these groups (log-rank test <0.0001). This finding was confirmed in a Cox proportional hazard analysis: the presence of a mean MS latency <5.6min is associated with an increasing risk of falling asleep during the MWT (RR, 1.93; 95 CI 1.04-3.6; p=0.03). We conclude that the detection of microsleep may help in discriminating OSA patients with and without daytime vigilance impairment.