Sleepiness Score Research Articles

Criteria for gauging response to sodium oxybate for narcolepsy.

Our objective was to define responder criteria using an anchor-based approach for frequency of cataplexy attacks and excessive daytime sleepiness in patients with narcolepsy undergoing sodium oxybate treatment. We used pooled data from two randomized, placebo-controlled, double-blind, multicentre 4- and 8-week trials of sodium oxybate for narcolepsy with cataplexy and analysed using receiver operator characteristics analysis. The percentage change in frequency of weekly cataplexy attacks and the Epworth Sleepiness Scale outcomes were compared with Clinical Global Impression of Change ratings, used as the anchor to define true response. Participants (n=336) were 39% male, 89% white, with a mean age of 41.5 (15.3)years, reporting a median of 20.5 cataplexy attacks per week and a mean Epworth Sleepiness score of 17.5 at baseline. A majority (51%) were Much Improved or Very Much Improved based on Clinical Global Impression of Change ratings, considered a true response to treatment. Area under the curve values for % reduction in cataplexy attacks (77%) and % change in sleepiness score (78%) supported response definition thresholds of 46% and 12%, respectively. Classification using either response definition agreed with the anchor for approximately 71% of participants. Cataplexy response definition was more sensitive (cataplexy=0.77, Epworth Sleepiness Scale=0.69), while sleepiness was more specific (cataplexy=0.66, Epworth Sleepiness Scale=0.75). Both responder definitions showed a dose-response relationship with sodium oxybate, demonstrating their validity using an external criterion. Weekly cataplexy attacks and Epworth Sleepiness Scale can be used to help document clinical response to narcolepsy treatment using criteria of 46% and 12% reductions, respectively.

Effect of biliopancreatic diversion on sleep quality and daytime sleepiness in patients with obesity and type 2 diabetes.

The poor quality of sleep and the deprivation thereof have been associated with disruption of metabolic homeostasis, favoring the development of obesity and type 2 diabetes (T2DM). We aimed to evaluate the influence of biliopancreatic diversion (BPD) surgery on sleep quality and excessive daytime sleepiness of obese patients with T2DM, comparing them with two control groups consisting of obese and normal weight individuals, both normal glucose tolerant. Forty-two women were divided into three groups: LeanControl (n = 11), ObeseControl (n = 13), and ObeseT2DM (n = 18). The LeanC and ObeseC groups underwent all tests and evaluations once. The ObeseT2DM underwent BPD and were reassessed after 12 months. Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were applied before and 12 months after BPD. Before surgery, there was less daytime sleepiness in LeanC group (p = 0.013) compared with ObeseC and T2DMObese groups. The two obese groups did not differ regarding daytime sleepiness, demonstrating that the presence of T2DM had no influence on daytime sleepiness. After surgery, the daytime sleepiness (p = 0.002) and the sleep quality (p = 0.033) improved. The score for daytime sleepiness of operated T2DMObese group became similar to LeanC and lower than ObeseC (p = 0.047). BPD surgery has positively influenced daytime sleepiness and sleep quality of obese patients with T2DM, leading to normalization of daytime sleepiness 12 months after surgery. These results reinforce previously identified associations between sleep, obesity and T2DM in view of the importance of sleep in metabolic homeostasis, quality of life and health.

Sleep onset latency on overnight PSG is complementary to epworth sleepiness score for predicting shorter mean MSLT sleep latency and OSA severity

Sleep onset latency on overnight PSG is complementary to epworth sleepiness score for predicting shorter mean MSLT sleep latency and OSA severity

Screening for obstructive sleep apnoea using the STOPBANG questionnaire and the Epworth sleepiness score in patients admitted on the unselected acute medical take in a UK hospital

Obstructive sleep apnoea (OSA), which is often overlooked in patients presenting to primary and secondary care, is an increasingly common comorbidity. The prevalence of OSA has not been studied in the unselected acute medical take. The aim of this study was to screen for the prevalence of undiagnosed OSA using the STOPBANG Questionnaire and the Epworth sleepiness scale (ESS) score in an unselected acute medical take. This was a cross-sectional study in a busy UK general hospital. Patient demographics, comorbidities, ESS and STOPBANG scores on unselected acute medical takes were reviewed and analysed to assess the prevalence of OSA. Of 93 patients screened, more than 50% were obese. The STOPBANG score was ≥3 in 73%. The ESS was significantly increased (≥11) in 20%. On multivariate analysis, ESS continued to remain independently associated with the STOPBANG score with a p-value of 0.04. The routine use of the STOPBANG questionnaire followed by an ESS score in those with a score of ≥3 may focus evaluation for undetected OSA in the acute medical care setting.

The relationship between epworth sleepiness score and visual analog scale in fibromyalgia patients

The relationship between epworth sleepiness score and visual analog scale in fibromyalgia patients

The reliability of the epworth sleepiness score in a sleep clinic population

Despite the Epworth Sleepiness Score being widely used, there are limited studies of its reliability in clinical practice. The aim of this study was to assess the reliability of the Epworth Sleepiness Score in a clinical population. The study included patients referred to Middlemore Hospital sleep service between October and November 2014, aged over 17 years, with at least two Epworth Sleepiness Score measurements at up to three different points on the diagnostic pathway: on General Practitioner referral (GP Epworth Sleepiness Score); at overnight oximetry assessment (Oximetry Epworth Sleepiness Score); and at a specialist clinic (Specialist Epworth Sleepiness Score). No treatment was administered between scores. One-hundred and thirty-three patients were included in the study. There was a median of 91 days from GP Epworth Sleepiness Score to Oximetry Epworth Sleepiness Score, and 11 days from Oximetry Epworth Sleepiness Score to Specialist Epworth Sleepiness Score. There was poor test-retest reliability between GP Epworth Sleepiness Score and Specialist Epworth Sleepiness Score; 72.4% and 17.8% of patients had an absolute difference of more than 2 and 8 Epworth Sleepiness Score points, respectively. A Bland-Altman plot of mean Epworth Sleepiness Score versus the difference between GP Epworth Sleepiness Score and Specialist Epworth Sleepiness Score demonstrated a wide scatter of data and 95% confidence interval for the difference in Epworth Sleepiness Score for an individual patient of -14 to +10. There was similar variability between GP Epworth Sleepiness Score and Oximetry Epworth Sleepiness Score. The reliability of the Epworth Sleepiness Score is unproven in clinical settings. This study shows poor test-retest reliability of Epworth Sleepiness Score, particularly between primary and secondary care, arguing against the use of Epworth Sleepiness Score for clinical decision-making or prioritisation of services without first assessing the reliability of the Epworth Sleepiness Score in the relevant clinical population.

Sleep pattern, sleep problems and comorbidities among resident doctors at a tertiary care institution in India: a cross sectional study

Background: Sleep problems are a major concern in population working under stress such as resident doctors. Sleep has many health benefits; sleep problems are linked with short and long term adverse health outcomes. Aim was to study sleep pattern, problems and comorbidities among resident doctors. Methods: A cross-sectional study design with a pre-validated sleep assessment proforma was used to collect information on socio-demographics, sleep pattern, sleep problems and comorbidities from 428 resident doctors found eligible for the study. Results: 350 subjects returned the filled proforma (82% response rate). Mean daily sleep hours were 6.21 (SD, 1.39) and work hours 12.77 (SD, 3.63). Sleep time was night in 64.6%, day in 12%, and both in 23.4%. Monthly average of 5.8 night shifts and 2.03 duty offs were found. Visual analogue scale (0-10) mean scores for sleepiness and tiredness were 4.41 (SD, 2.55; 95% CI, 4.14-4.68; P<0.01) and 4.73 (SD, 2.62; 95% CI, 4.45-5.00; P<0.01) respectively. Presence of different symptoms related to sleep problems ranged from 7 to 26% and various problems interfering with sleep ranged from 10 to 25%. Comorbidities such as allergy (29.4%), jerky legs (24.3%), sinus infections (22.8%), restless leg syndrome (16.3%), snoring (8.3%), asthma/lung diseases (5.8%), chronic diseases (3.4%), severe snoring disturbing others (1.8%), and obstructive sleep apnoea (0.9%) were present. Conclusions: Sleep problems were highly prevalent among resident doctors. The resident doctors were sleep-deprived, overworked, tired, excessively sleepy, and had significant presence of factors affecting circadian rhythm and sleep fragmentation. Various comorbidities were also present with varying prevalence.

Bilateral 5\u2009Hz transcranial alternating current stimulation on fronto-temporal areas modulates resting-state EEG

Rhythmic non-invasive brain stimulations are promising tools to modulate brain activity by entraining neural oscillations in specific cortical networks. The aim of the study was to assess the possibility to influence the neural circuits of the wake-sleep transition in awake subjects via a bilateral transcranial alternating current stimulation at 5 Hz (θ-tACS) on fronto-temporal areas. 25 healthy volunteers participated in two within-subject sessions (θ-tACS and sham), one week apart and in counterbalanced order. We assessed the stimulation effects on cortical EEG activity (28 derivations) and self-reported sleepiness (Karolinska Sleepiness Scale). θ-tACS induced significant increases of the theta activity in temporo-parieto-occipital areas and centro-frontal increases in the alpha activity compared to sham but failed to induce any online effect on sleepiness. Since the total energy delivered in the sham condition was much less than in the active θ-tACS, the current data are unable to isolate the specific effect of entrained theta oscillatory activity per se on sleepiness scores. On this basis, we concluded that θ-tACS modulated theta and alpha EEG activity with a topography consistent with high sleep pressure conditions. However, no causal relation can be traced on the basis of the current results between these rhythms and changes on sleepiness.

Prevalence of obstructive sleep apnea among obese toddlers and preschool children.

Obstructive sleep apnea (OSA) is a common disorder estimated at 1-5% in the school-aged children. With the obesity prevalence reaching staggering rates globally, OSA in obese adolescents is estimated to be 4-5-folds higher than their lean peers. There is a paucity of data regarding obesity-related OSA in children 6years and less. This is particularly relevant as OSA is associated with neurocognitive deficits. The aim of this study is to evaluate the prevalence of OSA among obese toddlers and preschool children and further to determine what other factors may be associated with the presence of OSA. A retrospective study involving children ≤6years, identified from two Canadian pediatric tertiary care centers who had an in-lab polysomnography (PSG). Obesity was defined by a BMI of >95th percentile for age and gender or a z-score of >2. OSA was diagnosed if the obstructive apnea-hypopnea index (OAHI) was greater than 2 events per hour. There were 60 participants included; the mean age was 4.4years (standard deviation [SD] ±1.7), mean BMI z-score was 3.0 (SD ±1.2). Of these, 22/60 (36.6%) had OSA. Compared with the non-OSA group, the OSA group had a higher Epworth sleepiness score (p=0.03) and were more likely to snore (p=0.01). Young obese children should be assessed for OSA. A history of snoring and daytime sleepiness may be useful indicators to facilitate triage for a PSG, especially in resource-limited settings.

Prevalence and risk factors of excessive daytime sleepiness in insomnia sufferers: A study with 1311 individuals

BackgroundSeveral studies have investigated the prevalence and risk factors of excessive daytime sleepiness in the general population. However, few studies have investigated these in the particular subpopulation of insomnia sufferers. Thus, the aim of this study was to examine the prevalence and risk factors of excessive daytime sleepiness in a large sample of insomnia sufferers. MethodsData from 1311 insomnia sufferers with age≥18years and recruited from the research database of the sleep laboratory of the Erasme Hospital were analysed. A score>10 on the Epworth scale was used as the cut-off score for excessive daytime sleepiness. Logistic regression analyses were conducted to examine clinical and demographic risk factors of excessive daytime sleepiness in insomnia sufferers. ResultsThe prevalence of excessive daytime sleepiness in our sample was 45.61%. Multivariate logistic regression analysis revealed that non-use of Z-drugs, non-use of Trazodone alone or in combination, body mass index≥25 & <30kg/m2, body mass index≥30kg/m2, age≥18 & <40years, age≥40 & <65years, Beck depression inventory score≥5 & <16, Beck depression inventory score≥16, apnea-hypopnea index≥15/h, and use of selective serotonin reuptake inhibitors were significant risk factors of excessive daytime sleepiness in the subpopulation of insomnia sufferers. ConclusionExcessive daytime sleepiness is a common complaint for individuals with insomnia. In this subpopulation, most of the risk factors for excessive daytime sleepiness are reversible, which justifies better management of this complaint to avoid its negative consequences.

Mood disorders are highly prevalent in patients investigated with a multiple sleep latency test.

Excessive daytime sleepiness (EDS) is a debilitating symptom which occurs commonly in both primary sleep and mood disorders. The prevalence of mood disorders in patients with EDS, evaluated objectively with a mean sleep latency test (MSLT), has not been reported. We hypothesize that mood disorders are highly prevalent in patients being investigated for EDS. This study aims to report the prevalence of mood disorder in the MSLT population and investigate the association between mood disorder and objective and subjective scores of sleepiness. A retrospective multicenter study of adults with a MSLT and Hospital Anxiety and Depression Score (HADS) identified over a 3-year period. The HADS is a validated questionnaire in detecting depression (HADS-D≥8) and anxiety (HADS-A≥11) in the sleep clinic population. Data collected included demographics, medical, and sleep study information. Mood disorder prevalence was compared to the general sleep clinic population. Correlation between measures of sleepiness and mood was performed. Two hundred twenty patients were included with mean age 41.1±15.7years, mean body mass index 28.6kg/m2 of whom 30% had anxiety (HADS-A>11) and 43% depression (HADS-D>8). Mean results for the cohort are ESS 13.7, mean sleep latency 11.5min, HADS-A 8.2, and HADS-D 7. There was no significant correlation between objective sleepiness, as measured by the mean sleep latency, and either HADS-A (-0.006, p=0.93) or HADS-D score (0.002, p=0.98). There was, however, a weak correlation between subjective sleepiness, as measured by the ESS, and the mean sleep latency (-0.25, p<0.01), HADS-A (0.15, p=0.03), and HADS-D (0.2, p= 0.004). There was no significant association between diagnosis of hypersomnia disorders and presence of anxiety (p= 0.71) or depression (p=0.83). Mood disorders are highly prevalent in the MSLT population. There was a weak correlation found between subjective measures of sleepiness and mood disorders, but not between objective measures of sleepiness and mood disorders. Routine screening for mood disorders in patients with hypersomnolence should be considered.

Remote consulting with telemonitoring of continuous positive airway pressure usage data for the routine review of people with obstructive sleep apnoea hypopnoea syndrome: A systematic review

Introduction Telehealth has the potential to offer more convenient care and reduce travel. We aimed to systematically review studies that assessed the effectiveness of teleconsultation plus telemonitoring in the review of people with obstructive sleep apnoea hypopnoea syndrome receiving continuous positive airway pressure therapy versus face-to-face care. Methods Following Cochrane methodology, we searched 10 electronic databases (November 2015), trial registries, and reference lists of included studies, for trials testing interventions that combined remote consultations with telemonitoring of usage/continuous positive airway pressure data. Outcomes measures were: proportion reviewed, continuous positive airway pressure adherence, symptom control, and satisfaction/acceptability and cost effectiveness. Results From 362 potentially relevant papers, we identified five randomised controlled trials (n = 269 patients): four from North America and one from Spain. Risk of bias was moderate in one, and moderate/high in four trials. Two trials reported number/duration of reviews with inconsistent results. The teleconsultation/telemonitoring improved continuous positive airway pressure adherence in two trials (n = 19; n = 75); two (n = 114 and n = 75) reported no between-groups differences. Two studies, both at moderate/high risk of bias, showed no between-group difference in the Epworth Sleepiness Score. Satisfaction was generally reported positively in all five trials; one trial reported that the teleconsultation/telemonitoring patients were ‘more likely to continue’ with continuous positive airway pressure therapy treatment. One study reported teleconsultation/telemonitoring as cost effective. Discussion The evidence for teleconsultation/telemonitoring in continuous positive airway pressure users is limited; however, no safety concerns have been raised. Adequately powered, well-designed trials are needed to establish whether real-time telemonitoring and remote teleconsultation is a clinically and cost effective option for people using continuous positive airway pressure therapy.

Autoadjusted versus fixed CPAP for obstructive sleep apnoea: a multicentre, randomised equivalence trial

BackgroundThe obstructive sleep apnoea syndrome (OSAS) is conventionally treated by continuous positive airway pressure set at a fixed level (fCPAP). Automatic mask pressure adjustment (autoCPAP) is increasingly used during home...

The reliability of the epworth sleepiness score in a sleep clinic population

The reliability of the epworth sleepiness score in a sleep clinic population

Driver sleepiness, fatigue, careless behavior and risk of motor vehicle crash and injury: Population based case and control study

A few studies have been conducted to determine the relationship between road motor vehicle crashes (MVC) and serious injuries related to tiredness, fatigues and sleeping. To determine the effects of aggressive behaviour, driver sleepiness and fatigue on MVC and related injuries among Turkish population. Population-based case and control study conducted at the accident emergency departments of hospitals and roads. 515 car drivers involved in crashes with injury were admitted to hospital and 1030 car drivers involved while driving on public roads as control group during the study period. The Manchester driver behaviour questionnaire (DBQ) measured the aberrant driving behaviours leading to accidents. Participants completed a fatigue severity scale (FSS) and Stanford Sleeping questionnaire an epworth scale with items related to socio-demographic information, driving experiences, adherence to traffic laws (such as speed limits and seat belt), and drivers’ driving records. In a representative sampling, participant’s age ranged from 25 to 65 and the mean and standard deviation were 36.5 ± 7.8 for cases and 37.0 ± 8.0 for controls. There was a significant difference in both group of drivers regarding BMI, level of education, marital status, driving experience, seat belt use, excessive speed limits, physical activity number of sleeping hours, mobile phone use, and cigarette smoking habit (p = 0.017). Also, there was a significant higher mean score on all the DBQ violation questions among case group in comparison with the control group (p < 0.001). Further, cases had higher prevalence of Epworth sleeping disorders (p < 0.001) and fatigue severity (p = 0.003) compared to control drivers. Multivariate logistic regression revealed that excessive speed, fatigue, lapses, errors, Stanford sleepiness score, violations, mobile phone use and Epworth sleepiness scale were significantly associated with injury involvement in vehicle crash, after adjusting for driving experience and annual mileage. The current study confirmed that drivers with chronic fatigue, acute sleepiness, and careless driver behavior may significantly increases the risk of road crash which can be lead to serious injury.

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.

A Study on Correlation between Severity of Depression and Quality of Sleep

Objective: To study the correlation between severity of depression and the quality of sleep disturbances in patients with non psychotic depression. Method: A cross-sectional study of a cohort of 30 outpatient sample with non psychotic depression were recruited for the study. Controls were the accompanying relatives of the patients. Study was conducted at a government hospital in Tamil Nadu, South India. Inclusion criteria in the study group required fulfillment of ICD 10 criteria for major depressive disorder. Patients who were 18yrs of age and above and both male and female genders were included in the study. Both study and control groups were administered the Pittsburg Sleep Quality Index (PSQI) and the Epworth sleepiness scale to measure the quality of sleep disturbances in the sample. Correlation between HAMD depression severity and the PSQI sleep quality scores and the Epworth sleepiness scale scores in the depressive patients and the correlation between nocturnal sleep disturbances and day-time sleepiness among depressed patients were analyzed using Pearson correlation coefficient. Results: Analysis revealed significant inverse correlation between the severity of depression and components of quality of sleep such as subjective sleep quality, total sleep duration and habitual sleep efficiency and positive correlation with sleep latency. Conclusions: Study shows that as the severity of depression increases the severity of sleep disturbances also increases which also was significant when compared with the various components of sleep quality on the PSQI scale.

Prevalence and predictors of sleep apnea in patients with stable coronary artery disease: a cross-sectional study.

BackgroundSleep apnea (SA) is increasingly recognized as being important in the prognosis of patients with coronary artery disease (CAD); however, symptoms of SA are not easily identified, and as many as 80% of sufferers remain undiagnosed.AimThis cross-sectional study investigated the prevalence and predictors of SA that may help to increase the awareness and diagnosis of SA in stable CAD patients.Materials and methodsPolysomnography was performed in 772 medically stable CAD patients with untreated SA recruited from the Clinic of Cardiovascular Rehabilitation. Patients were predominantly male (76%), median age was 58 years (32–81). All subjects completed the Epworth sleepiness scale (ESS). The frequency of all apneas and hypopneas associated with 3% oxygen desaturation is referred to as the apnea–hypopnea index (AHI). Mild-to-severe SA was defined as AHI ≥5/h, moderate-to-severe SA as AHI ≥15/h.ResultsAHI was within a range of values that was considered normal or only mildly elevated. The median AHI was 3.4 (interquartile range [IQR 1–9]), and 39% of patients had unrecognized mild-to-severe SA (moderate-to-severe in 14%), which was not higher than other known risk indicators for CAD such as hypertension and obesity (83% and 47%, respectively). These patients did not show sleepiness and the risk-related cut-off score for excessive daily sleepiness was lower than the official for ESS.ConclusionHypertension, age, male gender, obesity, ESS ≥6, and left ventricular ejection fraction ≤45% were the best predictors of mild-to-severe SA. While, male gender, age 50–70 years and, mainly, the presence of obesity but not hypertension were clinical predictors for moderate-to-severe SA. In addition, association between mild-to-severe SA and obesity was not evident in women. SA is prevalent comorbidity in the stable CAD patients, especially in its asymptomatic mild form. We suggest that SA should be considered in the secondary prevention protocols for CAD.

Assessment of Sleep Deprivation and Fatigue Among Chemical Transportation Drivers in Chonburi, Thailand.

BackgroundFatigue and sleepiness are inter-related and common among road transport drivers. In this study, sleep deprivation and fatigue among chemical transportation drivers were examined.MethodsA cross-sectional study surveying 107 drivers from three hazardous types of chemical production and transportation industries (nonflammable gases, flammable gases, and flammable liquids) was conducted. Data on sleep deprivation were collected using questionnaires of the Stanford Sleeping Scale and the Groningen Sleep Quality Scale. Fatigue was assessed using an interview questionnaire and a flicker fusion instrument.ResultsChemical drivers had a mean sleeping scale (Stanford Sleeping Scale) of 1.98 (standard deviation 1.00) and had a mean score of 1.89 (standard deviation 2.06) on the Groningen Sleep Quality Scale. High-risk drivers had higher scores in both the Stanford Sleeping Scale and the Groningen Sleep Quality Scale with a mean score of 2.59 and 4.62, respectively, and those differences reached statistical significance (p < 0.05). The prevalence of fatigue, as assessed through a critical flicker fusion analyzer, subjective fatigue question, and either of the instruments, was 32.32%, 16.16%, and 43.43%, respectively. Drivers who slept <7 hours and had poor sleep quality were found to have more fatigue than those who slept enough and well. Drivers who had a more sleepiness score resulted in significantly more objective fatigue than those who had a less sleepiness score.ConclusionSleep quality and sleeping hour can affect a driver's fatigue. Optimization of work–rest model should be considered to improve productivity, driver retention, and road safety.

Associations of Sleep Duration and Disturbances With Hypertension in Metropolitan Cities of Delhi, Chennai, and Karachi in South Asia: Cross-Sectional Analysis of the CARRS Study.

Sleep duration and disturbances may be risk factors for hypertension. Despite the high burden of hypertension in South Asia, little is known about this relationship in this region. We analyzed population-level cross-sectional data from the Centre for Cardiometabolic Risk Reduction in South Asia (CARRS) study that recruited representative samples of adults ≥ 20 years from three cities-Delhi, Chennai (India), and Karachi (Pakistan) during 2010-2011. We defined hypertension as self-reported treatment or measured blood pressure (BP) ≥140/90 mm Hg. Data on usual duration of sleep, insomnia, and snoring were collected using "The Sleep Habits Questionnaire" and excessive daytime sleepiness (EDS) using Epworth Sleepiness Score. Logistic and linear regression were done with hypertension and BP as outcome variables, respectively. Age, gender, education, wealth index, family history, and body mass index (BMI) were included as covariates. We used multiple imputation to account for missing variables. Prevalence of hypertension was 30.1%. The mean (SD) sleep duration was 7.3 (1.2) hours. Insomnia, snoring, and EDS were present in 13.6%, 28.7%, and 4.6%, respectively. Moderate and habitual snoring were associated with increased odds of hypertension (odds ratio [OR] = 1.18, 95% confidence interval [CI] [1.04 to 1.33] and 1.47 [1.29 to 1.67], respectively), after adjusting for covariates. Rare, occasional, and frequent insomnia were associated with increased hypertension (OR 1.41 [1.12 to 1.77], 1.39 [1.16 to 1.67], and 1.34 [1.09 to 1.65], respectively). Sleep duration and EDS were not associated with hypertension. Self-reported snoring and insomnia were associated with hypertension in South Asia. This relationship needs further exploration through robust longitudinal studies in this region.