Subjective Sleep Evaluation Research Articles

Microsubthalamotomy improves sleep in patients affected by advanced Parkinson’s disease

BackgroundDeep brain stimulation of the subthalamic nucleus (STN-DBS) improves sleep in patients affected by Parkinson’s disease (PD). Since microsubthalamotomy (mSTN) shows positive effects on motor symptoms, it could improve sleep in PD patients. Our goals were: to assess the effects of mSTN on sleep in patients affected by advanced PD; and to look for a correlation between sleep and motor features after the neurosurgical procedure. MethodsFifteen patients who underwent bilateral STN-DBS were enrolled. Subjective sleep evaluation was assessed using the Parkinson’s Disease Sleep Scale (PDSS). Data on sleep schedule and presence of restless legs syndrome (RLS) were obtained. Objective sleep features were investigated by polysomnography (PSG). To evaluate the mSTN effect, we compared motor state and sleep features before and after the neurosurgical procedure, before the programmable pulse generator was switched on. ResultsmSTN had beneficial effects on motor state and sleep features. After the surgery, the mean total PDSS score increased from 84.0±25.2 to 115.2±16.6 (P<0.001). PD patients reported longer total sleep time duration, decreased daytime sleepiness, and improvement in RLS symptoms. PSG data showed an increase in total sleep time and sleep efficiency with a decrease in wakefulness after sleep onset and arousal index. No correlation between motor improvements and sleep features modifications was observed after mSTN. ConclusionsmSTN improves sleep quality and ameliorates several sleep complaints, as well as motor symptoms, in advanced PD patients who have undergone STN-DBS.

Prevalence and clinical correlates of sleep disordered breathing in myotonic dystrophy types 1 and 2

Myotonic dystrophy types 1 (DM1) and 2 (DM2) are the most common muscular dystrophies in adulthood. A high prevalence of excessive daytime sleepiness (EDS) and sleep disordered breathing was documented in DM1; however, there are limited data available regarding DM2. Goals of the study were: (1) to evaluate the prevalence of sleep apnea in a large cohort of patients (71 DM1 and 14 DM2) and (2) to analyze correlations among such disorders and clinical features of myotonic dystrophies. All patients underwent clinical examination, subjective sleep evaluation, and home based cardiorespiratory monitoring, and most of them performed pulmonary function tests and oropharyngeal-oesophageal scintigraphy (OPES). Almost 45% of patients reported poor sleep quality; only 20% of them referred EDS. Sleep studies documented sleep apnea, mostly obstructive, in 69% DM1 patients and 43% DM2 patients; overall, 28% of cases needed non-invasive ventilation. Neither age, gender, illness duration, body mass index, muscle involvement, OPES respiratory function indexes, nor n(CTG) in leukocytes were predictive of sleep apnea in DM1 patients. Conversely, in DM1 the central apnea-hypopnea index is correlated with the oral transit time estimated by OPES, whereas in DM2 apnea indexes are correlated with pulmonary function parameters. Sleep apnea is highly prevalent in both forms of myotonic dystrophies. In DM1, no clinical parameters appear to be predictive, while age appears to influence the severity of the obstructive variant; in DM2, the severity of sleep apnea is correlated with the degree of respiratory muscle involvement. Considering the harmful consequences of sleep apnea on cardiorespiratory function, our findings suggest including PSG in the follow-up of myotonic dystrophies.

Evaluations of effects of high rebound and low rebound mattress pads on nocturanl sleep and its associated physiology

Recently, several new materials for mattresses become introduced. Although some of these, such as low rebound (or pressure-absorbing) and high rebound mattresses have fairly different characteristics, effects of these mattresses on sleep have never evaluated. In the current study, we have evaluated effects of airweave (a high rebound [HR] mattresses using a highly breathable material) on sleep and its associated physiology and the effects were compared to those of a low rebound mattress (LR). The study was conducted in 10 healthy males, with a randomized cross over single-blind design of one night PSG (23:00 to 7:00) at the sleep laboratory with 1–2 day intervals. The mattress pads were placed on regular beds equipped in the laboratory. The mean age ( ± SD) of the 10 subjects was 26.7 ± 7.7 yrs, height, 169.6 ± 6.3 m, weight, 61.9 ± 5.2 kg, BMI, 21.2 ± 1.7, PSQID, 3.0 ± 0.7, 3% ODI, 2.3 ± 1.1, RDI, 1.8 ± 1.2. In addition to the PSG, number of roll-over during sleep, autonomic nerve activity (by monitoring EKG heart rate variability), core rectal temperature monitoring were assessed. Subjective sleep evaluations were done on the following morning, using visual analogue scales (good sleep [VAS-S] and performance [VAS-P] ) and the Stanford sleepiness scale (SSS). Performance was also evaluated with psychomotor vigilance test (PVT). The significances of the effects (between HR and LR) were evaluated with the paired- t test, except effects of rectal temperature monitoring for which a repeated measures ANOVA with a grouping factor (mattress types) was applied. Subjects slept quickly with both HR (7.1 ± 2.1 min) and LR (9.1 ± 2.6 min). Interestingly, the core body temperature was rapidly and continuously decreased with HR and reached the nadir (36.0 °C) at 2:00–3:00 while decline of the temperature with LR was modest and retained 0.4 °C higher than that with HR between 1:00 and 2:00. A significant increase in Stage 4 sleep was found with HR between 23:00 and 1:00. In addition, decrease in sympathetic nerve activity was prominent with HR between 23:00 and 1:00. There was non-significant tendency to decline in numbers of rollover and elapsed time to fall in sleep after the rollover with HR. Subjective wakefulness and performance in the next morning with HR was improved marginally significantly. Our results suggest that effective heat loss during the initial phase of sleep occurred with HR (i.e., Airweave), and this may facilitate restorative sleep. This study is supported by Airweave Inc.

Heart Rate and Heart Rate Variability Modification in Chronic Insomnia Patients

Chronic insomnia is highly prevalent in the general population, provoking personal distress and increased risk for psychiatric and medical disorders. Autonomic hyper-arousal could be a pathogenic mechanism of chronic primary insomnia. The aim of this study was to investigate autonomic activity in patients with chronic primary insomnia by means of heart rate variability (HRV) analysis. Eighty-five consecutive patients affected by chronic primary insomnia were enrolled (38 men and 47 women; mean age: 53.2 ± 13.6). Patients were compared with a control group composed of 55 healthy participants matched for age and gender (23 men and 32 women; mean age: 54.2 ± 13.9). Patients underwent an insomnia study protocol that included subjective sleep evaluation, psychometric measures, and home-based polysomnography with evaluation of HRV in wake before sleep, in all sleep stages, and in wake after final awakening. Patients showed modifications of heart rate and HRV parameters, consistent with increased sympathetic activity, while awake before sleep and during Stage-2 non-REM sleep. No significant differences between insomniacs and controls could be detected during slow-wave sleep, REM sleep, and post-sleep wake. These results are consistent with the hypothesis that autonomic hyper-arousal is a major pathogenic mechanism in primary insomnia, and confirm that this condition is associated with an increased cardiovascular risk.

Effects of exercise and diet interventions on obesity-related sleep disorders in men: study protocol for a randomized controlled trial.

BackgroundSleep is essential for normal and healthy living. Lack of good quality sleep affects physical, mental and emotional functions. Currently, the treatments of obesity-related sleep disorders focus more on suppressing sleep-related symptoms pharmaceutically and are often accompanied by side effects. Thus, there is urgent need for alternative ways to combat chronic sleep disorders. This study will investigate underlying mechanisms of the effects of exercise and diet intervention on obesity-related sleep disorders, the role of gut microbiota in relation to poor quality of sleep and day-time sleepiness, as well as the levels of hormones responsible for sleep-wake cycle regulation.Methods/designParticipants consist of 330 (target sample) Finnish men aged 30 to 65 years. Among them, we attempt to randomize 180 (target sample) with sleep disorders into exercise and diet intervention. After screening and physician examination, 101 men with sleep disorders are included and are randomly assigned into three groups: exercise (n = 33), diet (n = 35), and control (n = 33). In addition, we attempt to recruit a target number of 150 healthy men without sleep disorders as the reference group. The exercise group undergoes a six-month individualized progressive aerobic exercise program based on initial fitness level. The diet group follows a six month specific individualized diet program. The control group and reference group are asked to maintain their normal activity and diet during intervention. Measurements are taken before and after the intervention. Primary outcomes include objective sleep measurements by polysomnography and a home-based non-contact sleep monitoring system, and subjective sleep evaluation by questionnaires. Secondary outcome measures include anthropometry, body composition, fitness, sleep disorder-related lifestyle risk factors, composition of gut microbiota and adipose tissue metabolism, as well as specific hormone and neurotranmitter levels and inflammatory biomarkers from venous blood samples.DiscussionIt is expected that the improvement of sleep quality after exercise and diet intervention will be evident both in subjective and objective measures of quality of sleep. Additionally, the change of sleep quality induced by exercise and diet intervention is expected to be related to the changes in specific hormones and inflammatory biomarkers, and in the composition of gut microbiota.Trial registrationCurrent Controlled Trials ISRCTN77172005

Comparisons of short-term efficacy between individual and group cognitive behavioral therapy for primary insomnia.

The purpose of this study was to compare the efficacy of individual and group cognitive behavioral therapy for insomnia (CBT-I) in outpatients with primary insomnia diagnosed by DSM-IV-TR. The participants were 20 individually treated (I-CBT-I) and 25 treated in a group therapy format (three to five patients per group) (G-CBT-I), which showed no significant difference regarding demographic variables between groups. The same components of CBT-I stimulus control therapy, sleep restriction therapy, cognitive therapy, and sleep hygiene education were applied on both groups. The short-term outcome (4 weeks after treatment) was measured by sleep logs, actigraphy, the Pittsburgh Sleep Quality Index (PSQI), and the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS), and was compared between I-CBT-I and G-CBT-I. The results indicated that CBT-I was effective in improving subjective and objective sleep parameters and subjective sleep evaluations for both individual and group treatment. However, I-CBT-I resulted in significantly better improvements over G-CBT-I, in (i) objective and subjective sleep onset latency time, (ii) objective sleep efficacy and moving time during sleeping, (iii) overall sleep quality and duration of actual sleep time in PSQI, (iv) consequences of insomnia, control and predictability of sleep, sleep requirement expectation, and sleep-promoting practices in DBAS. The present study suggested the superiority of I-CBT-I over G-CBT-I in clinical settings, and further evaluations are necessary.

FASTER: an unsupervised fully automated sleep staging method for mice

Identifying the stages of sleep, or sleep staging, is an unavoidable step in sleep research and typically requires visual inspection of electroencephalography (EEG) and electromyography (EMG) data. Currently, scoring is slow, biased and prone to error by humans and thus is the most important bottleneck for large-scale sleep research in animals. We have developed an unsupervised, fully automated sleep staging method for mice that allows less subjective and high-throughput evaluation of sleep. Fully Automated Sleep sTaging method via EEG/EMG Recordings (FASTER) is based on nonparametric density estimation clustering of comprehensive EEG/EMG power spectra. FASTER can accurately identify sleep patterns in mice that have been perturbed by drugs or by genetic modification of a clock gene. The overall accuracy is over 90% in every group. 24-h data are staged by a laptop computer in 10 min, which is faster than an experienced human rater. Dramatically improving the sleep staging process in both quality and throughput FASTER will open the door to quantitative and comprehensive animal sleep research.

Sleep disordered breathing in a cohort of patients with sporadic inclusion body myositis

ObjectiveThe aims of the study were: (1) to evaluate subjective sleep quality and daytime sleepiness in patients affected by sporadic inclusion-body myositis (IBM); (2) to define the sleep and sleep-related respiratory pattern in IBM patients. MethodsThirteen consecutive adult patients affected by definite IBM were enrolled, six women and seven men, mean age 66.2±11.1years (range: 50–80). Diagnosis was based on clinical and muscle biopsy studies. All patients underwent subjective sleep evaluation (Pittsburgh Sleep Quality Index, PSQI and Epworth Sleepiness Scale, ESS), oro-pharingo-esophageal scintigraphy, pulmonary function tests, psychometric measures, anatomic evaluation of upper airways, and laboratory-based polysomnography. Findings in IBM patients were compared to those obtained from a control group of 25 healthy subjects (13 men and 12 women, mean age 61.9±8.6years). ResultsDisease duration was >10years in all. Mean IBM severity score was 28.8±5.4 (range 18–36). Dysphagia was present in 10 patients. Nine patients had PSQI scores⩾5; patients had higher mean PSQI score (IBM: 7.2±4.7, Controls: 2.76±1.45, p=0.005); one patient (and no controls) had EES>9. Polysomnography showed that IBM patients, compared to controls, had lower sleep efficiency (IBM: 78.8±12.0%, Controls: 94.0±4.5%, p<0.001), more awakenings (IBM: 11.9±11.0, Controls: 5.2±7.5, p=0.009) and increased nocturnal time awake (IBM: 121.2±82.0min., Controls: 46.12±28.8min., p=0.001). Seven Patients (and no controls) had polysomnographic findings consistent with sleep disordered breathing (SDB). ConclusionData suggest that sleep disruption, and in particular SDB, might be highly prevalent in IBM. SignificanceData indicate that IBM patients have poor sleep and high prevalence of SDB.

Effects of zonisamide as add-on therapy on sleep-wake cycle in focal epilepsy: A polysomnographic study

PurposeThe purpose of this study was to evaluate the effects of zonisamide (ZNS) as adjunctive therapy on sleep-wake cycle and daytime somnolence in adult patients affected by focal epilepsy. MethodsThirteen patients affected by focal epilepsy were recruited to undergo a 24-hour ambulatory polysomnography, Multiple Sleep Latency Test (MSLT), and a subjective evaluation of nocturnal sleep by means of the Pittsburgh Sleep Quality Index (PSQI) and daytime somnolence by means of the Epworth Sleepiness Scale (ESS) before and after 3months of treatment with ZNS as add-on therapy. ResultsTwelve patients completed the study. Zonisamide therapy reduced seizures by >50% in 8 out of 12 patients. Zonisamide did not induce any significant changes in nocturnal polysomnographic variables and in PSQI scores. In addition, mean sleep latency and ESS score were unmodified after treatment. ConclusionZonisamide seems to be effective and safe in focal epilepsy. Both subjective and objective sleep parameters showed no detrimental effects on nocturnal sleep and daytime somnolence in patients with focal epilepsy using ZNS. Since some AEDs induce sleep impairment, which is known to trigger EEG abnormalities and seizures and to worsen quality of life, our findings suggest a positive profile of ZNS.

도시지역 노인들의 사회심리적 요인과 그의 관련요인

This study was performed to determine the relationships among self-esteem, state anxiety, interpersonal behavior trait and locus of control, and to reveal its related factors. The interviews were performed, during the period from April 1st, to June 30th, 2011, to 396 elderlies in Daejeon city. As a results, the self-esteem was negatively correlated with state anxiety and interpersonal behavior trait, while it was positively correlated with locus of control. While state anxiety was positively correlated with interpersonal behavior trait, it was negatively correlated with locus of control, and interpersonal behavior trait was positively correlated with locus of control. Multiple stepwise analysis revealed that the factors of influence on self-esteem included IADL, spouse, mastication of food and amnesia. The factors of influence on State anxiety included mastication of food, IADL, spouse, subjective health status, disability of body, subjective sleep evaluation and educational level. The factors of influence on Interpersonal dependent behavior trait included spouse, IADL, monthly income and subjective health status. The factors of influence on locus of control included spouse and visual acuity. Above results suggested that the self-esteem, state anxiety, interpersonal behavior trait and locus of control of subjects were significantly related with the sociodemographic characteristics, health related factors and health status.

Factors Associated with Excessive Daytime Sleepiness in Obstructive Sleep Apnea Syndrome under CPAP Treatment

The purpose of this study was to assess factors associated with subjective sleep evaluation, chiefly excessive daytime sleepiness (EDS) in obstructive sleep apnea syndrome (OSAS) adult outpatients under continuous positive airway pressure (CPAP) treatment. One thousand and forty-eight OSAS outpatients (mean age: 51.4% male: 90.5%) who were treated by CPAP were consecutively collected. Age, sex, CPAP compliance (CPAP usage as their device of nights with application-time of at least 4 hours per night objectively; %usage ≥ 4 h/d), and Japanese version of the Pittsburgh Sleep Quality Index (PSQI-J) of the patients showing EDS (Japanese version of the Epworth Sleepiness Scale; JESS ≥ 11) were compared cross-sectionally with those of the patients who did not show EDS (JESS < 11). Nineteen point two % of all patients showed EDS subjectively. Two hundred one patients were classified to an EDS(+) group and an 847 patients were classified to EDS(–) group. Age and global PSQI-J scores were significantly different between the two groups. Logistic regression showed that EDS was significantly associated with global PSQI-J scores, but not with age. Among PSQI-J components, overall sleep quality, duration of sleep, sleep disturbance, and day dysfunction due to sleepiness were significantly higher in the EDS(+) group. Especially, 19.4% of patient in the EDS(+) group reported actual sleep time during the past month to be less than 5 hours/day. Although functional relationship should be further evaluated, insufficient sleep is the main factor associated with EDS in the OSAS patients under CPAP treatment.

Clinical efficacy of individual cognitive behavior therapy for psychophysiological insomnia in 20 outpatients

Twenty patients (14 of them women) suffering from psychophysiological insomnia (PPI) were enrolled for cognitive behavior therapy (CBT). The mean age of the patients was 56.9 years, and the mean duration of insomnia morbidity was 8.9 years. Each received individual combined CBT treatments consisting of stimulus control, sleep reduction, cognitive therapy and sleep hygiene education over a period of 1 month. Just before the CBT and after its completion, sleep measurements were conducted that involved (i) sleep logs, Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS), and the Pittsburgh Sleep Quality Index (PSQI); (ii) actigraphy measurement; (iii) dissociation between subjective and objective evaluation of sleep calculated from sleep logs and actigraphy results; and (iv) correlation between DBAS and the aforementioned sleep parameters. Because the intention was to focus on patients' incorrect cognition about sleep, the definition 'changes in dissociation between the sleep log and actigraphically measured sleep' was used as the primary outcome and 'changes in DBAS score' as the secondary outcome. After the CBT the following was found: (i) underestimation by PPI patients of the objective evaluation of sleep; (ii) a decrease in the dissociation between the subjective and objective evaluation of sleep; (iii) improvement of the DBAS; and (iv) improvement of sleep logs and actigraphy measurements. Moreover, there was a correlation between the improvement of PSQI, sleep logs and DBAS. CBT for insomnia is able to redress incorrect cognition about sleep, leading to improvement of the disorder.

Early Initiation of Alcohol Drinking, Cigarette Smoking, and Sexual Intercourse Linked to Suicidal Ideation and Attempts: Findings from the 2006 Korean Youth Risk Behavior Survey

PurposeThis study examined the association between early initiation of problem behaviors (alcohol drinking, cigarette smoking, and sexual intercourse) and suicidal behaviors (suicidal ideation and suicide attempts), and explored the effect of concurrent participation in these problem behaviors on suicidal behaviors among Korean adolescent males and females.Materials and MethodsData were obtained from the 2006 Korean Youth Risk Behavior Survey, a nationally representative sample of middle and high school students (32,417 males and 31,467 females) in grades seven through twelve. Bivariate and multivariate logistic analyses were conducted. Several important covariates, such as age, family living structure, household economic status, academic performance, current alcohol drinking, current cigarette smoking, current butane gas or glue sniffing, perceived body weight, unhealthy weight control behaviors, subjective sleep evaluation, and depressed mood were included in the analyses.ResultsBoth male and female preteen initiators of each problem behavior were at greater risk for suicidal behaviors than non-initiators, even after controlling for covariates. More numerous concurrent problematic behaviors were correlated with greater likelihood of seriously considering or attempting suicide among both males and females. This pattern was more clearly observed in preteen than in teen initiators although the former and latter were engaged in the same frequency of problem behavior.ConclusionEarly initiation of alcohol drinking, cigarette smoking, and sexual intercourse, particularly among preteens, represented an important predictor of later suicidal ideation and suicide attempts in both genders. Thus, early preventive intervention programs should be developed and may reduce the potential risks for subsequent suicidal behaviors.

Sleep disordered breathing in facioscapulohumeral muscular dystrophy

Facioscapulohumeral muscular dystrophy (FSHD) is one of the most frequent forms of muscular dystrophy. The aims of this study were: 1) to evaluate the prevalence of sleep disordered breathing (SDB) in patients with FSHD; 2) to define the sleep-related respiratory patterns in FSHD patients with SDB; and 3) to find the clinical predictors of SDB. Fifty-one consecutive FSHD patients were enrolled, 23 women, mean age 45.7 ± 12.3 years (range: 26–72). The diagnosis of FSHD was confirmed by genetic tests. All patients underwent medical and neurological evaluations, subjective evaluation of sleep and full-night laboratory-based polysomnography. Twenty patients presented SDB: 13 presented obstructive apneas, four presented REM related oxygen desaturations and three showed a mixed pattern. Three patients needed positive airways pressure. SDB was not related to the severity of the disease. Body mass index, neck circumference and daytime sleepiness did not allow prediction of SDB. In conclusion, the results suggest a high prevalence of SDB in patients with FSHD. The presence of SDB does not depend on the clinical severity of the disease. SDB is often asymptomatic, and no clinical or physical measure can reliably predict its occurrence. A screening of SDB should be included in the clinical assessment of FSHD.

The Sleep Pattern at Nighttime in Junior High School Student in Hospital : Their Subjective Sleep Evaluation and Actigraphy

The Sleep Pattern at Nighttime in Junior High School Student in Hospital : Their Subjective Sleep Evaluation and Actigraphy

Titration procedures for nasal CPAP: Automatic CPAP or prediction formula?

Background The best method for titration of continuous positive airway pressure (CPAP) therapy in obstructive sleep apnea (OSA) syndrome has not yet been established. The 90th or 95th percentiles of the pressure titrated over time by automatic CPAP (A-CPAP) have been recommended as reference for prescribing therapeutic fixed CPAP (F-CPAP). We compared A-CPAP to F-CPAP, which was determined by a common prediction formula. Methods Forty-five patients who were habituated to F-CPAP underwent titration polysomnography. In a double-blind, randomized order, each patient used an A-CPAP device in the autotitration and in the fixed pressure mode during one half of the night. Apnea–hypopnea index (AHI) and pressure profiles were primary outcomes. Bias and precision were additionally assessed for both CPAP modes. Results No significant differences in various sleep parameters or in subjective sleep quality evaluation were found. The AHI was effectively lowered in both CPAP modes (A-CPAP 7.7 [10.8] events/h versus F-CPAP 5.4 [9.0] events/h, p = 0.061). Comparison of group means showed that F-CPAP closely paralleled mean (Pmean) and median (P50), but not the 95th percentile (P95) pressure, of A-CPAP. While bias was lowest for Pmean and P50, there was a lack of precision in all A-CPAP pressure categories. Conclusions We confirm that F-CPAP set by prediction formula is not worse in terms of AHI control than A-CPAP. On average, F-CPAP parallels Pmean and P50 but not P95. However, due to imprecise matching, individual F-CPAP values cannot be derived from Pmean or P50.

Associations between noise sensitivity and sleep, subjectively evaluated sleep quality, annoyance, and performance after exposure to nocturnal traffic noise

In order to determine the influence of noise sensitivity on sleep, subjective sleep quality, annoyance, and performance after nocturnal exposure to traffic noise, 12 women and 12 men (age range, 19-28 years) were observed during four consecutive nights over a three weeks period. After a habituation night, the participants were exposed with weekly permuted changes to air, rail and road traffic noise. Of the four nights, one was a quiet night (32 dBA), while three were noisy nights with exposure to equivalent noise levels of 39, 44, and 50 dBA in a permuted order. The traffic noise caused alterations of most of the physiological parameters, subjective evaluation of sleep, annoyance, and performance. Correlations were found between noise sensitivity and subjective sleep quality in terms of worsened restoration, decreased calmness, difficulty to fall asleep, and body movements. The results suggest that alterations of subjective evaluation of sleep were determined by physical parameters of the noise but modified by individual factors like noise sensitivity.

Sleep and sleepiness in patients with Parkinson's disease before and after dopaminergic treatment

Sleep disturbances and daytime sleepiness are well-known phenomena in Parkinson's disease (PD). Fifteen previously untreated PD patients underwent clinical evaluation, subjective sleep evaluation and polysomnographic evaluation (PSG) before and after a treatment period of mean 8+/-3.1 months with dopaminergic drugs. Both mean Unified Parkinson's Disease Rating Scale (UPDRS) total score and mean subset III of the UPDRS were significantly improved with dopaminergic treatment. PSG revealed that administration of dopaminergic drugs resulted in significant increase in mean percentage of stages 1 and 2. The mean Epworth Sleepiness Scale (ESS) score was significantly increased and mean Multiple Sleep Latency Test (MSLT) score was significantly decreased after dopaminergic treatment indicating subjective and objective daytime sleepiness. The differences in MSLT scores were best explained by a higher dose of L-dopa, whereas other variables such as disease duration, treatment duration, Hoehn and Yahr stage, sleep efficiency index or dopamine agonists did not increase the significance. In contrast, any of the variables appeared to explain ESS score variability. This study demonstrates that daytime sleepiness is not present in untreated patients but emerges later during dopaminergic treatment. Total daily L-dopa dose is predictive of objective daytime sleepiness. Furthermore, subjective assessment of sleepiness may cause underestimation of the severity of daytime sleepiness.

Self-Report Naps in Irregular Work Schedules

Few studies have examined napping in irregular work schedules such as those experienced by freight locomotive engineers. The current study examined the effect of napping in irregular work schedules on sleep length and three subjective measures: ability to go to sleep, ability to stay asleep, and a feeling of being well-rested upon awakening. One hundred and seventy-nine freight engineers completed a 14-d activity log, providing information on sleep times and subjective evaluations of sleep. The results indicated that days with naps resulted in significantly more total sleep but less sleep in the main sleep period of the day. The days with naps also resulted in somewhat more difficulty with going to sleep, staying asleep and with feeling well-rested upon awakening. It is important to note, however, that when examining the days with naps, nap length was not significantly correlated with main sleep time, ability to go to sleep, ability to stay asleep, or feeling well-rested upon awakening. These results suggest that napping may be useful when working irregular work schedules if the engineer is willing to accept a slight decrease in ability to go to sleep, stay asleep, and feeling rested.

A Study on the Subjective Sleep Evaluation and the Related Factors in the Middle and Advanced Age Women

A Study on the Subjective Sleep Evaluation and the Related Factors in the Middle and Advanced Age Women