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Sleepiness
Kinds of Sleepiness Terms modified by Sleepiness Selected AbstractsShort sleep duration and long spells of driving are associated with the occurrence of Japanese drivers' rear-end collisions and single-car accidentsJOURNAL OF SLEEP RESEARCH, Issue 2 2010TAKASHI ABE Summary Sleepiness and fatigue are important risk factors for traffic accidents. However, the relation between the accident type and lack of sleep as well as spells of driving has not been examined sufficiently. This study aimed to clarify that short sleep duration and long spells of driving are more associated with rear-end collisions and single-car accidents as compared with accidents of other types in cases of people who cause accidents. After removing drunken driving as a cause of accidents, 1772 parties involved in accidents were questioned. The quantities of rear-end collisions and single-car accidents were, respectively, 240 and 293. Logistic regression analysis showed that short nocturnal sleep (<6 h) and 10-min increments of spells of driving were significantly associated not only with rear-end collisions but also with single-car accidents as compared with accidents of other types. Furthermore, younger age (,25 years old) and nighttime (21:00,06:00 h) driving were significantly associated with single-car accidents as compared with accidents of other types. To prevent such accidents, countermeasures must be considered in light of the characteristics of drivers involved in each type of accident described above. [source] Effects of a combination of napping and bright light pulses on shift workers' sleepiness at the wheel: a pilot studyJOURNAL OF SLEEP RESEARCH, Issue 4 2009DAMIEN LEGER Summary To assess the effects of napping + bright light on shift work drivers sleepiness at the wheel, we performed a pilot study on nine shift workers on three shifts (morning, afternoon, night), driving on a private road circuit. Sleepiness at the wheel was measured by ambulatory polysomnography and assessed using 30-s segments of recordings with a percentage of theta electroencephalogram of at least 50% (15 s) of the period recorded. Sleepiness was also assessed by the Stanford Sleepiness Scale (SSS). Participants drove the same car on two similar 24-h periods of work, with three drivers in each shift (morning, afternoon, night), separated by 3 weeks. During the baseline period, the subjects were told to manage their rest as usual. During the second experimental period, they had to rest lying in a dark room with two naps of 20 min and then exposed to bright light (5000 lux) for 10 min. Subjects showed a significantly decreased sleepiness at the wheel with an average of 10.7 ± 6.7 episodes of theta sleep during the baseline (766 ± 425 s) versus 1.0 ± 1.0 episode lasting 166 ± 96 s during the second period (P = 0.016; P = 0.0109). The percentage of driving asleep was also significantly reduced (3.7% ± 1.9% versus 0.9% ± 0.6%, P = 0.0077). The average SSS score in the group decreased from 2.76 ± 1.27 to 2.28 ± 0.74 (P = 0.09). In this pilot and preliminary study, a combination of napping and bright light pulses was powerful in decreasing sleepiness at the wheel of shift work drivers. [source] Fatigue at sea in Swedish shipping,a field study,AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 7 2010Margareta Lützhöft PhD Abstract Background Today many merchant ships sail with only two nautical officers, working a shift schedule of 6,hr on and 6,hr off. There are concerns that such a shift schedule is related to fatigue. However, little data exist from onboard studies of seafarers. Methods Data were collected on board 13 ships. Fifteen participants worked on a 6-on, 6-off watch system and another 15 on a 4-on, 8-off watch system. Electrooculography, actigraphy, diaries, and reaction time tests were used to measure the effects of shift system on fatigue and sleep. Results and Conclusions Sleepiness was higher during the night shift in the 6-on, 6-off system. Moreover, sleepiness increased more during the watch in the 6-on, 6-off system compared to the 4-on, 8-off system. There was a trend toward shorter sleep episodes in the 6-on, 6-off system and sleep was more often split into two episodes. Am. J. Ind. Med. 53:733,740, 2010. © 2010 Wiley-Liss, Inc. [source] Subjective daytime sleepiness and its predictors in Finnish adolescents in an interview studyACTA PAEDIATRICA, Issue 5 2001O Saarenpää-Heikkilä The purpose of this study is to evaluate the predictors of subjective daytime sleepiness (SDS) and its chronicity in adolescents. Two groups of adolescents (107 with SDS and 107 without SDS) from our first questionnaire study were invited to an interview after 3 y. A follow-up questionnaire had been sent to them one year earlier. The interview included questions about sleep, daytime sleepiness, living habits, physical and mental health, and progress at school. The adolescents were also examined clinically. Interviews were conducted with 66 out of 107 subjects with SDS and 64 out of 107 without SDS (age range 12 to 19 y). In this interview 42 out of the 130 adolescents had SDS. A total of 20 adolescents reported SDS in both questionnaire studies and in the interview (chronic SDS). In a multivariate analysis (logistic regression) sleep disorders, frequent medication and depressive emotions were significantly associated with SDS. Chronic SDS was connected in a bivariate analysis (Pearson's chi-square) with excessive night waking, difficulty in falling asleep, dreaming, frequent medication, frequent alcohol drinking, and irregular breakfast eating, and in our previous studies also with delayed sleep rhythm. Conclusion: Sleep disorders and health problems were more common causes of SDS than undesirable living habits. However, alcohol drinking and delayed sleep rhythm were associated with chronic SDS in addition to sleep disorders and medication. [source] Hypocretin/orexin and narcolepsy: new basic and clinical insightsACTA PHYSIOLOGICA, Issue 3 2010S. Nishino Abstract Narcolepsy is a chronic sleep disorder, characterized by excessive daytime sleepiness (EDS), cataplexy, sleep paralysis and hypnagogic hallucinations. Both sporadic (95%) and familial (5%) forms of narcolepsy exist in humans. The major pathophysiology of human narcolepsy has been recently discovered based on the discovery of narcolepsy genes in animals; the genes involved in the pathology of the hypocretin/orexin ligand and its receptor. Mutations in hypocretin-related genes are rare in humans, but hypocretin ligand deficiency is found in a large majority of narcolepsy with cataplexy. Hypocretin ligand deficiency in human narcolepsy is probably due to the post-natal cell death of hypocretin neurones. Although a close association between human leucocyte antigen (HLA) and human narcolepsy with cataplexy suggests an involvement of autoimmune mechanisms, this has not yet been proved. Hypocretin deficiency is also found in symptomatic cases of narcolepsy and EDS with various neurological conditions, including immune-mediated neurological disorders, such as Guillain,Barre syndrome, MA2-positive paraneoplastic syndrome and neuromyelitis optica (NMO)-related disorder. The findings in symptomatic narcoleptic cases may have significant clinical relevance to the understanding of the mechanisms of hypocretin cell death and choice of treatment option. The discoveries in human cases lead to the establishment of the new diagnostic test of narcolepsy (i.e. low cerebrospinal fluid hypocretin-1 levels for ,narcolepsy with cataplexy' and ,narcolepsy due to medical condition'). As a large majority of human narcolepsy patients are ligand deficient, hypocretin replacement therapy may be a promising new therapeutic option, and animal experiments using gene therapy and cell transplantations are in progress. [source] Activation of the basal forebrain by the orexin/hypocretin neuronesACTA PHYSIOLOGICA, Issue 3 2010E. Arrigoni Abstract The orexin neurones play an essential role in driving arousal and in maintaining normal wakefulness. Lack of orexin neurotransmission produces a chronic state of hypoarousal characterized by excessive sleepiness, frequent transitions between wake and sleep, and episodes of cataplexy. A growing body of research now suggests that the basal forebrain (BF) may be a key site through which the orexin-producing neurones promote arousal. Here we review anatomical, pharmacological and electrophysiological studies on how the orexin neurones may promote arousal by exciting cortically projecting neurones of the BF. Orexin fibres synapse on BF cholinergic neurones and orexin-A is released in the BF during waking. Local application of orexins excites BF cholinergic neurones, induces cortical release of acetylcholine and promotes wakefulness. The orexin neurones also contain and probably co-release the inhibitory neuropeptide dynorphin. We found that orexin-A and dynorphin have specific effects on different classes of BF neurones that project to the cortex. Cholinergic neurones were directly excited by orexin-A, but did not respond to dynorphin. Non-cholinergic BF neurones that project to the cortex seem to comprise at least two populations with some directly excited by orexin-A that may represent wake-active, GABAergic neurones, whereas others did not respond to orexin-A but were inhibited by dynorphin and may be sleep-active, GABAergic neurones. This evidence suggests that the BF is a key site through which orexins activate the cortex and promote behavioural arousal. In addition, orexins and dynorphin may act synergistically in the BF to promote arousal and improve cognitive performance. [source] Characterization of sleep,wake patterns in a novel transgenic mouse line overexpressing human prepro-orexin/hypocretinACTA PHYSIOLOGICA, Issue 3 2010K. A. Mäkelä Abstract Aim:, Orexin/hypocretin peptides are expressed in the lateral hypothalamus and involved in the regulation of autonomic functions, energy homeostasis and arousal states. The sleep disorder narcolepsy, which is characterized by excessive daytime sleepiness and occurrence of sudden rapid eye movement (REM) sleep, is associated with a loss of orexin neurones. Our study investigated the effects of orexins on sleep,wake patterns in a novel transgenic mouse line overexpressing the human prepro-orexin (hPPO) gene under the control of its endogenous promoter. Methods:, Orexin overexpression was investigated by PCR, Southern and Western blotting as well as immunohistochemistry. Polysomnographic recordings were performed for analyses of sleep,wake patterns and for electroencephalographic activity during 24 h baseline and during and after 6 h of sleep deprivation (SD). Results:, Transgenic hPPO mice had increased expression of human prepro-orexin (hPPO) and orexin-A in the hypothalamus. Transgene expression decreased endogenous orexin-2 receptors but not orexin-1 receptors in the hypothalamus without affecting orexin receptor levels in the basal forebrain, cortex or hippocampus. Transgenic mice compared with their wild type littermates showed small but significant differences in the amount of waking and slow wave sleep, particularly during the light,dark transition periods, in addition to a slight reduction in REM sleep during baseline and during recovery sleep after SD. Conclusion:, The hPPO-overexpressing mice show a small reduction in REM sleep, in addition to differences in vigilance state amounts in the light/dark transition periods, but overall the sleep,wake patterns of hPPO-overexpressing mice do not significantly differ from their wild type littermates. [source] Hypocretin/orexin in fish physiology with emphasis on zebrafishACTA PHYSIOLOGICA, Issue 3 2010P. Panula Abstract One hypocretin/orexin (hcrt) gene has been identified in several fish species. The first pufferfish gene was identified in 2002 and the zebrafish gene was cloned in 2004. Its structure is very similar to that of mammals, and it encodes for two active peptides with C-termini similar to those of mammals. The gene is expressed in the brain in only one hypothalamic nucleus, which sends projections to the telencephalon, diencephalon, mesencephalon and rhombencephalon. The terminal fibres are found in close contact with many aminergic cell groups, including those of raphe serotonergic, locus coeruleus noradrenergic, several dopaminergic cell groups and the sole histaminergic hypothalamic cluster. One receptor corresponding to mammalian hcrt 2 receptor has been identified in fish. Overexpression of hcrt in zebrafish has been reported to consolidate wakefulness and inhibit rest. On the other hand, fish lacking the hcrt receptor show short and fragmented sleep instead of sleepiness and cataplexy. Food deprivation increases hcrt mRNA expression in zebrafish brain, and intracerebroventricular hcrt peptides stimulate food consumption and feeding behaviour in goldfish. Hcrt peptides thus have important roles in fish physiology. Many genetic and functional methods available render fish, especially zebrafish, a suitable organism to study new aspects of hcrt physiology in vertebrates. [source] Outcome of craniopharyngioma in children: long-term complications and quality of lifeDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 4 2004Andrea Poretti MB BS Childhood craniopharyngiomas are histologically benign tumours arising from remnants of Rathke's pouch in the hypothalamic,pituitary region. The two common treatment approaches are primary total resection or limited resection followed by radiotherapy. To study the outcome after a primary surgical approach, we followed 25 consecutive patients (10 females, 15 males) under 16 years of age who were treated in a single institution with a management policy of radical tumour excision (mean age at diagnosis 9 years 2 months, SD 4 years 3 months; range 2 years 9 months to 15 years 11 months). Mean follow-up after primary surgery was 11 years 3 months (SD 7 years 7 months). Tumour control, and neurological, endocrine, and hypothalamic complications and their impact on health-related quality of life were assessed (medical follow-up, semi-structured interview, and questionnaires). Results of tumour control were generally good, however, local failure was observed in 6 of 25 patients, and severe late-treatment complications decreased quality of life for many long-time survivors. Endocrine deficiency occurred in 24/25, visual complications in 16/24, neurological complications in 8/24, obesity in 14/23, increased daytime sleepiness in 6/21, and significant school problems in 10/20. Patients with craniopharyngioma rated their health-related quality of life as considerably lower than healthy controls; the domains of social and emotional functioning were particularly affected. Parents'ratings were considerably lower than those of the patients. Poor functional outcome was associated with large tumours infiltrating or displacing the hypothalamus, the occurrence of hydrocephalus, and young age at diagnosis, but also with multiple operations due to tumour recurrence. Alternative treatment strategies should be considered, especially in very young patients with large tumours. [source] A single question for the rapid screening of restless legs syndrome in the neurological clinical practiceEUROPEAN JOURNAL OF NEUROLOGY, Issue 9 2007R. Ferri The purposes of this study were to validate the use of a single standard question for the rapid screening of restless legs syndrome (RLS) and to analyze the eventual effects of the presence of RLS on self-assessed daytime sleepiness, global clinical severity and cognitive functioning. We evaluated a group of 521 consecutive patients who accessed our neurology clinic for different reasons. Beside the answer to the single question and age, sex, and clinical diagnosis, the following items were collected from all patients and normal controls: the four criteria for RLS, the Epworth Sleepiness Scale (ESS), the Clinical Global Impression of Severity (CGI-S), and the Mini-Mental State evaluation. RLS was found in 112 patients (70 idiopathic). The single question had 100% sensitivity and 96.8% specificity for the diagnosis of RLS. ESS and CGI-S were significantly higher in both RLS patient groups than in normal controls. RLS severity was significantly higher in idiopathic than in associated/symptomatic RLS patients. RLS can be screened with high sensitivity and good reliability in large patient groups by means of the single question; however, the final diagnosis should always be confirmed by the diagnostic features of RLS and accompanied by a careful search for comorbid conditions. [source] Effect of Exogenous Melatonin on Mood and Sleep Efficiency in Emergency Medicine Residents Working Night ShiftsACADEMIC EMERGENCY MEDICINE, Issue 8 2000Milan Jockovich MD Abstract. Objective: To determine whether melatonin taken prior to attempted daytime sleep sessions will improve daytime sleep quality, nighttime sleepiness, and mood state in emergency medicine (EM) residents, changing from daytime to nighttime work schedules. Methods: A prospective, randomized, double-blind crossover design was used in an urban emergency department. Emergency medicine residents who worked two strings of nights, of at least three nights' duration each, and separated by at least one week of days were eligible. Subjects were randomized to receive either melatonin 1 mg or placebo, 30 to 60 minutes prior to their daytime sleep session, for three consecutive days after each night shift. Crossover to the other agent occurred during their subsequent night shifts. Objective measures of quality of daytime sleep were obtained using the Actigraph 1000. This device measures sleep motion and correlates with sleep efficiency, total sleep time, time in bed, and sleep latency. The Profile of Mood States (POMS) and the Stanford Sleepiness Scale (SSS) were also used to quantify nighttime mood and sleepiness. Results: Among the 19 volunteers studied, there was no difference in sleep efficiency (91.16% vs 90.98%, NS), sleep duration (379.6 min vs 342.7 min, NS), or sleep latency (7.59 min vs 6.80 min, NS), between melatonin and placebo, respectively. In addition, neither the POMS total mood disturbance (5.769 baseline vs 12.212 melatonin vs 5.585 placebo, NS) nor the SSS (1.8846 baseline vs 2.2571 melatonin vs 2.1282 placebo, NS) demonstrated a statistical difference in nighttime mood and sleepiness between melatonin and placebo. Conclusions: There are no beneficial effects of a 1-mg melatonin dose on sleep quality, alertness, or mood state during night shift work among EM residents. [source] Clinical significance of geriatric sleep apnea syndromeGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 4 2002Shinji Teramoto The prevalence of sleep apnea syndrome (SAS) is known to increase with advancing age, contributing to excessive daytime sleepiness, cardiovascular dysfunction and the impairment of health-related quality of life. However SAS is often undiagnosed and overlooked in the elderly. It is important to note that SAS is a differential diagnosis of insomnia, dementia, and depression in the elderly. For an accurate diagnosis of geriatric SAS, the apnea and hypopnea index as measured by polysomnography must be greater than 10 or 15. Many untoward effects of SAS on the health status of the elderly are considered to be clinically significant. Although it has been suggested that geriatric SAS has less effect on the mortality and morbidity of sufferers than does middle-aged SAS, sleep apnea in any age group, if severe and accompanied by symptoms, should be treated. However, the clinical significance of geriatric SAS should be further elucidated. [source] Population-Based U.S. Study of Severe Headaches in Adults: Psychological Distress and ComorbiditiesHEADACHE, Issue 2 2006Objective.,To examine the associations between severe headaches (SH), psychological distress, and comorbid conditions among U.S. adults. Background.,The lifetime prevalence of headaches is over 90% and headaches, particularly migraines, have been associated with disability, increased healthcare costs, and mood disorders. Methods.,We analyzed data obtained from adults aged 18 years or older (n = 29,828) who participated in the 2002 National Health Interview Survey, an ongoing, computer-assisted personal interview of a representative sample of the U.S. population. Results.,Approximately 15.1% of adults aged 18 years or older reported SH in the previous 3 months. Those reporting such headaches were significantly more likely, than those who did not, to report insomnia, excessive sleepiness, recurrent pain, and depressive or anxiety symptoms during the preceding 12 months. Approximately 88% of those who reported having had SH within the previous 3 months also indicated that they had at least one comorbid medical condition, relative to 67% of those without SH. Conclusion.,Despite their episodic nature, our results suggest that SH are associated with impairments in both physical and mental health. As the presence of SH may serve as an indicator of significant psychological distress and medical comorbidities, eliciting information about their occurrence during a standard medical examination appears to be warranted. [source] Topiramate as an Adjunctive Treatment in Migraine ProphylaxisHEADACHE, Issue 10 2003Héctor R. Martínez MD Background.,Anticonvulsants now are commonly used for headache prevention. Topiramate, one of the newer anticonvulsants, recently has been demonstrated to be effective as monotherapy for migraine prophylaxis. Objective.,To assess the efficacy, safety, and tolerability of topiramate as adjunctive prophylactic therapy for migraine. Material and Methods.,A prospective trial involving patients with more than 3 migraine attacks per month was performed. Patients continued their usual prophylactic treatment. Baseline analgesic use and frequency and duration of migraine attacks were recorded. A 4-point visual analog scale evaluated severity. Laboratory tests, electrocardiogram, and computed tomography or magnetic resonance imaging were performed before study entry. After informed consent was obtained, patients were instructed to take 25 mg of topiramate per day, with 25- to 50-mg weekly increments to a maximum of 100 mg per day. Safety was assessed at the first month; tolerability and efficacy were assessed every week for the first month and then every month for 3 months. Effectiveness was assessed by comparing baseline and on-treatment migraine status, and data were analyzed by the Fisher exact test. Results.,Twenty-five women and 11 men (mean age, 44 years) were evaluated. Existing prophylactic treatment was either propranolol or flunarizine (or both) in 80% of the patients. At 3 months of therapy with topiramate, headache frequency decreased from 17 to 3 episodes per month, headache duration from 559 to 32 minutes, and intensity from 9 to 1 by visual analog scale (P < .001). Improvement in frequency and severity of migraine was observed in 83% of patients. Slight or no changes in headache were observed in 6 patients. Tolerability was good in 30 patients. The most common side effects were acroparesthesias, weight loss, sleepiness, and headache worsening. No adverse interaction with propranolol or flunarizine was observed. Conclusions.,These results suggest that topiramate is efficacious and safe as an adjunctive treatment in patients with migraine whose prior response to prophylactic management has been less than satisfactory. [source] Olanzapine as an Abortive Agent for Cluster HeadacheHEADACHE, Issue 8 2001Todd D. Rozen MD Objective.,To evaluate olanzapine as a cluster headache abortive agent in an open-label trial. Background.,Cluster headache is the most painful headache syndrome known. There are very few recognized abortive therapies for cluster headache and fewer for patients who have contraindications to vasoconstrictive drugs. Methods.,Olanzapine was given as an abortive agent to five patients with cluster headache in an open-label trial. The initial olanzapine dose was 5 mg, and the dose was increased to 10 mg if there was no pain relief. The dosage was decreased to 2.5 mg if the 5-mg dose was effective but caused adverse effects. To be included in the study, each patient had to treat at least two attacks with either an effective dose or the highest tolerated dose. Results.,Five patients completed the investigation (four men, one woman; four with chronic cluster, one with episodic cluster). Olanzapine reduced cluster pain by at least 80% in four of five patients, and two patients became headache-free after taking the drug. Olanzapine typically alleviated pain within 20 minutes after oral dosing and treatment response was consistent across multiple treated attacks. The only adverse event was sleepiness. Conclusions.,Olanzapine appears to be a good abortive agent for cluster headache. It alleviates pain quickly and has a consistent response across multiple treated attacks. It appears to work in both episodic and chronic cluster headache. [source] Sleep apnea and dialysis therapies: Things that go bump in the night?HEMODIALYSIS INTERNATIONAL, Issue 4 2007Mark L. UNRUH Abstract Sleep apnea has been linked to excessive daytime sleepiness, depressed mood, hypertension, and cardiovascular disease in the general population. The prevalence of severe sleep apnea in the conventional thrice-weekly hemodialysis population has been estimated to be more than 50%. Sleep apnea leads to repetitive episodes of hypoxemia, hypercapnia, sleep disruption, and activation of the sympathetic nervous system. The hypoxemia, arousals, and intrathoracic pressure changes associated with sleep apnea lead to sympathetic activation, endothelial dysfunction, oxidative stress, and inflammation. Because sleep apnea has been shown to be widespread in the conventional dialysis population, it may be that sleep apnea contributes substantially to the sleepiness, poor quality of life, and cardiovascular disease found in this population. The causal links between conventional dialysis and sleep apnea remain speculative, but there are likely multiple factors related to volume status and azotemia that contribute to the high rate of severe sleep apnea in dialysis patients. Both nocturnal automated peritoneal dialysis and nocturnal hemodialysis have been associated with reduced severity of sleep apnea. Nocturnal dialysis modalities may provide tools to increase our understanding of the uremic sleep apnea and may also provide therapeutic alternatives for end-stage renal disease patients with severe sleep apnea. In conclusion, sleep apnea is an important, but overlooked, public health problem for the dialysis population. The impact of sleep apnea treatment in this high-risk population may include reduced sleepiness, better mood and blood pressure, and lowered risk of cardiovascular disease. [source] Dissociation between objective psychomotor impairment and subjective sleepiness after diazepam administration in the aged peopleHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 6 2007Masaru Echizenya Abstract The aim of the present study was to clarify whether subjective sleepiness accurately reflects benzodiazepine-related decline in psychomotor function after taking benzodiazepines (BZPs) in aged people. Subjects were eight healthy, young (mean age, 19.8,years) and seven healthy, older (mean age, 60.9,years) men. Placebo and diazepam (DZP) were administered orally in a single-blind crossover manner to the young subjects (placebo, 5,mg DZP and 10,mg DZP) and to the older subjects (placebo and 5,mg DZP). Plasma drug concentration, choice reaction time (CRT) as an objective measure of psychomotor function, and the Stanford Sleepiness Scale (SSS) as a measure of subjective sleepiness were monitored every 20,min from 1000 until 1600,h, being the drug administered at 1200,h. Pharmacokinetic variables did not differ significantly between the two age groups. DZP at 10,mg in young subjects induced significant increases in both the CRT and SSS score. DZP at 5,mg induced no significant increase in SSS score in either age group but did induce a significant increase in CRT only in the older subjects that matched that in young subjects given 10,mg DZP. The older subjects suffered from dissociation between subjective sleepiness and objective psychomotor impairment under DZP treatment. Such individuals may underestimate the detrimental effects on brain function. Copyright © 2007 John Wiley & Sons, Ltd. [source] A high sugar content, low caffeine drink does not alleviate sleepiness but may worsen itHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 5 2006C. Anderson Abstract Although the ingestion of high levels of glucose might have a short acting alerting effect, there is evidence of an ensuing enhancement of sleepiness in people already sleepy. Some ,energy drinks' contain large quantity of sugars. We compared 250 ml of a well known ,energy drink' (42 g sugars, containing a low [30 mg] level of caffeine for ,flavouring') with a nil sugar nil caffeine, similar tasting control. These were given a week apart, in a repeated measures, double blind, balanced design, to 10 participants sleep restricted to 5 h the prior night. They had a light lunch, consumed a drink at 13:50 h, and 10 min later underwent 3,×,30 min consecutive periods at a reaction time (RT) task (the Psychomotor Vigilance Test), separated by 3 min breaks when self-ratings of sleepiness were made. The energy drink did not counteract sleepiness, and led to slower RTs and more lapses during the final 30 min session, around 80 min after consumption. Copyright © 2006 John Wiley & Sons, Ltd. [source] Evaluation of the cognitive, psychomotor and pharmacokinetic profiles of rupatadine, hydroxyzine and cetirizine, in combination with alcohol, in healthy volunteersHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 1 2006Manuel J. Barbanoj Abstract Introduction The Central Nervous System (CNS) impairment induced by moderate alcohol (ALC) ingestion may be enhanced if other drugs are taken simultaneously. Rupatadine (RUP) is a new H1 -antihistamine which also inhibits platelet activating factor (PAF) release in inflammatory reactions. Objective The main aim of the study was to assess the effects of ALC 0.8,g/Kg on RUP (10,mg and 20,mg) CNS effects. An evaluation of alcohol and RUP pharmacokinetics was also attained. Methods Eighteen healthy young volunteers of both sexes participated in a phase I, randomised, crossover, double-blind, placebo-controlled study. At 2-week intervals they received six treatments: (a) placebo (PLA), (b) ALC alone and ALC in combination with: (c) hydroxyzine 25,mg (HYD), (d) cetirizine 10,mg (CET), (e) RUP 10,mg or (f) RUP 20,mg. At baseline and several times thereafter, seven psychomotor performance tests (finger tapping, fine motoric skills, nystagmus, temporal estimation, critical-flicker-fusion frequency, ,d2' cancellation, simple reaction) and eleven subjective self-reports (drunkenness, sleepiness, alertness, clumsiness, anger, inattentiveness, efficiency, happiness, hostility, interest and extraversion) were carried out. Two-way (treatment, time) ANOVAs for repeated measures to each variable together with a multivariate non-parametric approach were applied. Plasma concentrations of alcohol, and of RUP and its metabolites, were quantified by validated immunofluorescence and LC/MS/MS methods, respectively. Plasma-time curves for all compounds were analysed by means of model-independent methods. Results The combination of alcohol with HYD, CET and RUP 20,mg produced more cognitive and psychomotor impairment as compared to alcohol alone, being the combination of alcohol and HYD the one which induced the greatest deterioration. The combination of alcohol and RUP 10,mg could not be differentiated from ALC alone. Subjective self-reports reflect effects on metacognition after the combination of alcohol with HYD and CET i.e. the increased objective impairment observed was not subjectively perceived by the subjects. No significant differences were obtained when comparing alcohol plasma concentrations assessed after the treatments evaluated. RUP showed a lineal kinetic relationship after 10 and 20,mg with a higher exposition to both metabolites assayed. Conclusions Present results showed that single oral doses of rupatadine 10,mg in combination with alcohol do not produce more cognitive and psychomotor impairment than alcohol alone. Higher doses of rupatadine, in combination with alcohol, may induce cognitive and psychomotor deterioration as hydroxyzine and cetirizine at therapeutic doses. Copyright © 2006 John Wiley & Sons, Ltd. [source] Comparing effects of methylphenidate, sertraline and placebo on neuropsychiatric sequelae in patients with traumatic brain injuryHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 2 2005Hoon Lee Abstract Background This study aimed to investigate the effects of methylphenidate and sertraline compared with placebo on various neuropsychiatric sequelae associated with traumatic brain injury (TBI). Methods This was a 4 week, double-blind, parallel-group trial. Thirty patients with mild to moderate degrees of TBI were randomly allocated to one of three treatment groups (n,=,10 in each group) with matching age, gender and education, i.e. methylphenidate (starting at 5,mg/day and increasing to 20,mg/day in a week), sertraline (starting at 25,mg/day and increasing to 100,mg/day in a week) or placebo. At the baseline and at the 4 week endpoint, the following assessments were administered: subjective (Beck Depression Inventory) and objective (Hamilton Depression Rating Scale) measures of depression; Rivermead Postconcussion Symptoms Questionnaire for postconcussional symptoms; SmithKline Beecham Quality of Life Scale for quality of life; seven performance tests (Critical Flicker Fusion, Choice Reaction Time, Continuous Tracking, Mental Arithmetic, Short-Term memory, Digit Symbol Substitution and Mini-Mental State Examination); subjective measures of sleep (Leeds Sleep Evaluation Questionnaire) and daytime sleepiness (Epworth Sleepiness Scale). All adverse events during the study period were recorded and their relationships to the drugs were assessed. Results Neuropsychiatric sequelae seemed to take a natural recovery course in patients with traumatic brain injury. Methylphenidate had significant effects on depressive symptoms compared with the placebo, without hindering the natural recovery process of cognitive function. Although sertraline also had significant effects on depressive symptoms compared with the placebo, it did not improve many tests on cognitive performances. Daytime sleepiness was reduced by methylphenidate, while it was not by sertraline. Conclusions Methylphenidate and sertraline had similar effects on depressive symptoms. However, methylphenidate seemed to be more beneficial in improving cognitive function and maintaining daytime alertness. Methylphenidate also offered a better tolerability than sertraline. Copyright © 2005 John Wiley & Sons, Ltd. [source] Prevalence of snoring and sleep-disordered breathing in a group of commercial bus drivers in Hong KongINTERNAL MEDICINE JOURNAL, Issue 4 2002D. S. C. Hui Abstract Objectives:,To assess the prevalence of sleep-disordered breathing (SDB) and its associated symptoms in a group of commercial bus drivers in Hong Kong. Methods:,Two hundred and sixteen of 410 bus drivers from three different shifts were interviewed with the Sleep & Health Questionnaire (SHQ) and the Epworth sleepiness scale (ESS) at a Hong Kong bus depot. Seventeen subjects from each shift were then randomly selected for at-home sleep study using the Mesam IV device (Madaus Medizin,Elektronik, Freiburg, Germany). Results:,There were 207 men and nine women (mean age 42.4 ± 7.5 years; body mass index (BMI) 25.4 ± 4.5 kg/m2; ESS 5.3 ± 4.2). From the SHQ it was discovered that: (i) daytime sleepiness was reported by 87 subjects (40%), (ii) snoring , 3 times per week was reported by 80 subjects (37%), (iii) witnessed apnoea was reported by 17 subjects (7.9%) and (iv) 29 subjects (13.4%) reported having fallen asleep during driving. Among the 51 subjects who underwent the at-home sleep study: (i) 31 subjects (61%) had respiratory disturbance index (RDI) , 5 per hour of sleep, (ii) 21 subjects (41%) had RDI , 10 per hour of sleep, (iii) 12 subjects (24%) had RDI , 15 per hour of sleep and (iv) 35 subjects (68.6%) snored objectively , 10% of the night. Ten subjects (20%) had RDI , 5 and sleepiness at work, while five subjects (9.8%) had RDI , 5 and ESS > 10. No significant differences were noted in the SHQ responses, ESS, objective snoring or RDI among the three groups. Multiple regression analysis showed that BMI and witnessed apnoea were the only positive independent predictors of RDI. Conclusions:,This study showed a high prevalence of objective snoring and SDB in a group of commercial bus drivers. Neither self-reported sleepiness nor the ESS could identify subjects with SDB. (Intern Med J 2002; 32: 149,157) [source] Sleep patterns, sleep disturbances and sleepiness in retired Iranian eldersINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 11 2009Seyed Kazem Malakouti Abstract Objectives Complaints of sleep disturbance increase with age and many studies have reported on the relationship of sleep problems to the greater use of health services, physical and mental morbidity, functional decline, and all causes of mortality. This study aimed to examine sleep patterns and sleep disturbances in Iranian elders and correlate their sleep quality to their health status. Methods Four hundred men and women, aged 60 years or older, were interviewed by trained interviewers regarding their physical and mental health status. The Pittsburghh Sleep Quality Index, the Epworth Sleepiness Scale (ESS), and a General Health Questionnaire (GHQ) were then administered to each participant. The data gathered were analyzed using ,2 -test, t -test, and one-way analysis of variance and logistic regression. Results The results indicated that the majority of participants (82.6%) suffered from poor sleep quality and approximately one-third (29.2%) experienced sleepiness during the daytime. Difficulty falling asleep (p,,,0.001) and maintaining sleep (p,,,0.01) and the feeling of being too hot at night (p,,,0.005) were significantly more prevalent in women, but men suffered more from leg twitching (p,,,0.01). Being female (OR,=,2.52), and having GHQ scores of more than 11 (OR,=,4.14) increased the risk of poor sleep quality considerably. Conclusion Promoting sleep hygiene education of elders in primary health care services are recommended. Copyright © 2009 John Wiley & Sons, Ltd. [source] Morbidity following dental treatment of children under intubation general anaesthesia in a day-stay unitINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 1 2004S. Atan Summary. Objectives., To determine which variables were best related to the overall morbidity of a child undergoing dental general anaesthetic (GA) and then to use these variables to determine those factors that might influence the extent and severity of morbidity experienced by healthy children following dental GA. Sample and methods., Data were collected on anxiety, pain and morbidity, GA procedure and dental procedure from 121 children attending a day stay GA unit for dental treatment. Patients were interviewed preoperatively, postoperatively before discharge then four further times over the next 148 h. Data were analysed using multivariate regression. Results., Thirty-one per cent of subjects had restorative work, 60% had at least one tooth extracted, 54% had a surgical procedure. Use of local analgesia reduced postoperative pain whilst an increase in the number of surgical procedures increased it. Increase in anaesthetic time was related to increased odds of feeling sleepy and nauseous, females were more likely to complain of sleepiness or weakness. Feelings of dizziness were increased if the patient was given local analgesia during the procedure. Conclusions., Pain following dental GA was the most prevalent and long lasting symptom of postoperative morbidity in this study. Reductions in operating time and improvement in pain control have the potential to reduce reported morbidity following dental GA. [source] Effect of Psychiatric and Other Nonmotor Symptoms on Disability in Parkinson's DiseaseJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2004Daniel Weintraub MD Objectives: To examine the effect of depression and other nonmotor symptoms on functional ability in Parkinson's disease (PD). Design: A cross-sectional study of a convenience sample of PD patients receiving specialty care. Setting: The Parkinson's Disease Research, Education and Clinical Center at the Philadelphia Veterans Affairs Medical Center. Participants: One hundred fourteen community-dwelling patients with idiopathic PD. Measurements: The Unified Parkinson's Disease Rating Scale (UPDRS); Hoehn and Yahr Stage; Mini-Mental State Examination; Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, depression module; probes for psychotic symptoms; Hamilton Depression Rating Scale; Geriatric Depression Scale,Short Form; Apathy Scale; and Epworth Sleepiness Scale. Disability was rated using the UPDRS activity of daily living (ADL) score and the Schwab and England ADL score. Multivariate analysis determined effect of depression and other nonmotor symptoms on disability. Results: The presence of psychosis, depressive disorder, increasing depression severity, age, duration of PD, cognitive impairment, apathy, sleepiness, motor impairment, and percentage of time with dyskinesias were related to greater disability in bivariate analyses. Entering these factors into two multiple regression analyses, only the increasing severity of depression and worsening cognition were associated with greater disability using the UPDRS ADL score, accounting for 37% of the variance in disability (P<.001). These two factors plus increasing severity of PD accounted for 54% of the variance in disability using the Schwab and England ADL score (P<.001). Conclusion: Results support and extend previous findings that psychiatric and other nonmotor symptoms contribute significantly to disability in PD. Screening for nonmotor symptoms in PD is necessary to more fully explain functional limitations. Further study is required to determine whether identifying and treating these symptoms will improve function and quality of life. [source] Sleep in adolescence: a review of issues for nursing practiceJOURNAL OF CLINICAL NURSING, Issue 13 2009Tamara Vallido Aims and objectives., The aim of this review was to explore the literature to determine what is known about adolescent sleep, the causes and consequences of disturbed sleep in adolescence and the implications this has for nursing practice. Background., Sleep disorders are relatively common in young people. Disturbed sleep can be both a cause and a result of ill health and if recognised can indicate psychosocial, psychological or physical difficulties. Design., Literature review. Methods., Searching of key electronic databases. Results., Disturbed sleep in adolescents has several potential consequences, including daytime sleepiness, reduced academic performance and substance use/abuse. However, despite its significance and frequency, sleep disturbance is an area of adolescent health that is almost entirely unaddressed within the nursing literature. Conclusion., Nursing has a role to play in assisting adolescents and their families to recognise the importance of sleep to the general health and well-being of young people. Relevance to clinical practice., There is a need for nursing to develop tools to assess sleep in adolescent clients and non-pharmaceutical interventions to assist adolescents achieve optimum sleep and rest. Nurses may also contribute to educating adolescents and their families regarding the importance of good sleep hygiene. [source] A Multi-Drug Intoxication Fatality Involving Xyrem® (GHB)JOURNAL OF FORENSIC SCIENCES, Issue 2 2009Brianne E. Akins M.S. Abstract:, Gamma-hydroxybutyrate (GHB) is best known as a recreational depressant drug, whose use has also been implicated in drug facilitated sexual assault cases. It is also available as a therapeutic agent (Xyrem®) used for the treatment of daytime sleepiness or cataplexy associated with narcolepsy. This is a report of a case of a 53-year-old woman undergoing treatment with Xyrem® for narcolepsy. The decedent was also prescribed tramadol, gabapentin, cetirizine, modafinil, carisoprodol, and Xyrem®. Toxicological analysis of the blood revealed GHB 165.6 mg/L, and 90.7 mg/L in the urine. Blood GHB concentrations in the range 156,260 mg/L have been reported to induce moderately sound sleep. The combined use of central nervous system depressant drugs, together with her problematic sleep apnea, and snoring (both contraindications for GHB use) were determined to have caused this subject's death. The manner of death was determined to be accidental. [source] Pharmacodynamic differentiation of lorazepam sleepiness and dizziness using an ordered categorical measureJOURNAL OF PHARMACEUTICAL SCIENCES, Issue 8 2010Mohamed A. Kamal Abstract Categorical measures of lorazepam sleepiness and dizziness were modeled to identify differences in pharmacodynamic (PD) parameters between these adverse events (AEs). Differences in data-derived PD parameters were compared with relative incidence rates in the drug label (15.7% and 6.9%, respectively). Healthy volunteers (n,=,20) received single oral doses of 2,mg lorazepam or placebo in a randomized, double-blind, cross-over fashion. A seven-point categorical scale measuring the intensity of AEs was serially administered over 24,h. The maximum score (MaxS), and area under the effect curve (AUEC) were determined by noncompartmental methods and compared using a paired t -test. Individual scores were modeled using a logistic function implemented in NONMEM. AUEC and MaxS for sleepiness were significantly higher than dizziness (20.35 vs. 9.76, p,<,0.01) and (2.35 vs. 1.45, p,<,0.01). Model slope estimates were similar for sleepiness and dizziness (0.21,logits,×,mL/ng vs. 0.19,logits,×,mL/ng), but baseline logits were significantly higher for sleepiness (,2.81 vs. ,4.34,logits). Data-derived PD parameters were in concordance with label incidence rates. The higher intensity of sleepiness may be directly related to baseline (no drug present) while the increase in intensity as a result of drug was relatively similar for both AEs. © 2010 Wiley-Liss, Inc. and the American Pharmacists Association J Pharm Sci 99:3628,3641, 2010 [source] Intoxication With Bourbon Versus Vodka: Effects on Hangover, Sleep, and Next-Day Neurocognitive Performance in Young AdultsALCOHOLISM, Issue 3 2010Damaris J. Rohsenow Background:, This study assessed the effects of heavy drinking with high or low congener beverages on next-day neurocognitive performance, and the extent to which these effects were mediated by alcohol-related sleep disturbance or alcoholic beverage congeners, and correlated with the intensity of hangover. Methods:, Healthy heavy drinkers age 21 to 33 (n = 95) participated in 2 drinking nights after an acclimatization night. They drank to a mean of 0.11 g% breath alcohol concentration on vodka or bourbon one night with matched placebo the other night, randomized for type and order. Polysomnography recordings were made overnight; self-report and neurocognitive measures were assessed the next morning. Results:, After alcohol, people had more hangover and more decrements in tests requiring both sustained attention and speed. Hangover correlated with poorer performance on these measures. Alcohol decreased sleep efficiency and rapid eye movement sleep, and increased wake time and next-day sleepiness. Alcohol effects on sleep correlated with hangover but did not mediate the effects on performance. No effect of beverage congeners was found except on hangover severity, with people feeling worse after bourbon. Virtually no sex differences appeared. Conclusions:, As drinking to this level affects complex cognitive abilities, safety could be affected, with implications for driving and for safety-sensitive occupations. Congener content affects only how people feel the next day so does not increase risk. The sleep disrupting effects of alcohol did not account for the impaired performance so other mechanisms of effect need to be sought. As hangover symptoms correlate with impaired performance, these might be contributing to the impairment. [source] Effects of a Moderate Evening Alcohol Dose.ALCOHOLISM, Issue 8 2007I: Sleepiness Background: Few studies examining alcohol's effects consider prior sleep/wake history and circadian timing. We examined introspective and physiological sleepiness on nights with and without moderate alcohol consumption in well-rested young adults at a known circadian phase. Methods: Twenty-nine adults (males=9), ages 21 to 25 years (M=22.6, SD=1.2), spent 1 week on an at-home stabilized sleep schedule (8.5 or 9 hours), followed by 3 in-lab nights: adaptation, placebo, and alcohol. Alcohol (vodka; 0.54 g/kg for men; 0.49 g/kg for women) or placebo beverage was consumed over 30 minutes ending 1 hour before stabilized bedtime. In addition to baseline, 3 sleep latency tests (SLTs) occurred after alcohol/placebo ingestion (15, 16.5, and 18 hours after waking). Stanford Sleepiness Scales (SSS) and Visual Analog Scales (VAS) of sleepiness were completed before each SLT and approximately every 30 minutes. The Biphasic Alcohol Effects Scale (BAES) was administered a total of 4 times (baseline, 5, 60, and 90 minutes postalcohol/placebo). Subjects' circadian phase was determined from melatonin levels in saliva samples taken at approximately 30-minute intervals. Results: All sleepiness and sedation measures increased with time awake. Only SSS and BAES sedation measures showed higher levels of sleepiness and sedation after alcohol compared with placebo. The mean circadian phase was the same for assessments at both conditions. Conclusions: Alcohol did not increase physiological sleepiness compared with placebo nor was residual sedation evident under these conditions. We conclude that the effects on sleepiness of a moderate dose of alcohol are masked when sleep,wake homeostatic and circadian timing influences promote high levels of sleepiness. [source] Performance monitoring during sleep inertia after a 1-h daytime napJOURNAL OF SLEEP RESEARCH, Issue 3 2010SHOICHI ASAOKA Summary Performance monitoring is an essential function involved in the correction of errors. Deterioration of this function may result in serious accidents. This function is reflected in two event-related potential (ERP) components that occur after erroneous responses, specifically the error-related negativity/error negativity (ERN/Ne) and error positivity (Pe). The ERN/Ne is thought to be associated with error detection, while the Pe is thought to reflect motivational significance or recognition of errors. Using these ERP components, some studies have shown that sleepiness resulting from extended wakefulness may cause a decline in error-monitoring function. However, the effects of sleep inertia have not yet been explored. In this study, we examined the effects of sleep inertia immediately after a 1-h daytime nap on error-monitoring function as expressed through the ERN/Ne and Pe. Nine healthy young adults participated in two different experimental conditions (nap and rest). Participants performed the arrow-orientation task before and immediately after a 1-h nap or rest period. Immediately after the nap, participants reported an increased effort to perform the task and tended to estimate their performance as better, despite no objective difference in actual performance between the two conditions. ERN/Ne amplitude showed no difference between the conditions; however, the amplitude of the Pe was reduced following the nap. These results suggest that individuals can detect their own error responses, but the motivational significance ascribed to these errors might be diminished during the sleep inertia experienced after a 1-h nap. This decline might lead to overestimation of their performance. 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