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ABSTRACT: Drowsy driving is a major public health problem in the United States. Employment characteristics affect sleep, yet little is known about relationships between employment variables and drowsy driving. This study examined employment correlates (specifically, hours worked per week and shift work) and rates of self-reported drowsy driving, falling asleep while driving, and traffic crashes due to sleepiness in 1,000 employed adults who completed a telephone survey conducted by the National Sleep Foundation. Working > 40 hr per week and shift work were associated with increased risk for drowsy driving (ps ≤ .05). Odds ratios for falling asleep behind the wheel were higher in shift workers with symptoms of insomnia or excessive sleepiness relative to day workers and shift workers without sleep complaints (p ≤ .05).
Behavioral Sleep Medicine 10/2012; 10(4):250-7. · 1.55 Impact Factor
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ABSTRACT: Chronic sleep deprivation is common among workers, and has been associated with negative work outcomes, including absenteeism and occupational accidents. The objective of the present study is to characterize reciprocal relationships between sleep and work. Specifically, we examined how sleep impacts work performance and how work affects sleep in individuals not at-risk for a sleep disorder; assessed work performance outcomes for individuals at-risk for sleep disorders, including insomnia, obstructive sleep apnea (OSA) and restless legs syndrome (RLS); and characterized work performance impairments in shift workers (SW) at-risk for shift work sleep disorders relative to SW and day workers. One-thousand Americans who work 30 h per week or more were asked questions about employment, work performance and sleep in the National Sleep Foundation's 2008 Sleep in America telephone poll. Long work hours were associated with shorter sleep times, and shorter sleep times were associated with more work impairments. Thirty-seven percent of respondents were classified as at-risk for any sleep disorder. These individuals had more negative work outcomes as compared with those not at-risk for a sleep disorder. Presenteeism was a significant problem for individuals with insomnia symptoms, OSA and RLS as compared with respondents not at-risk. These results suggest that long work hours may contribute to chronic sleep loss, which may in turn result in work impairment. Risk for sleep disorders substantially increases the likelihood of negative work outcomes, including occupational accidents, absenteeism and presenteeism.
Journal of Sleep Research 09/2010; 20(3):487-94. · 3.16 Impact Factor
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ABSTRACT: The purpose of this study was to determine the risk of DMV documented crashes as a function of physiological sleepiness in a population-based sample.
24-hour laboratory assessment (nocturnal polysomnogram and daytime MSLT) and 10-year crash rate based on DMV obtained accident records.
618 individuals (mean age = 41.6 +/- 12.8; 48.5% male) were recruited from the general population of southeastern Michigan using random-digit dialing techniques.
Subjects were divided into 3 groups based on their average MSLT latency (in minutes) as follows: excessively sleepy, 0.0 to < or = 5.0 (n = 69); moderately sleepy, 5.0 to < or = 10.0 (n = 204); and alert, > 10 (n = 345). Main outcome measures were DMV data on accidents from 1995-2005. Rates for all accidents in the 3 MSLT groups were: excessively sleepy = 59.4%, moderately sleepy = 52.5%, alert = 47.3%. Excessively sleepy subjects were at significantly greater risk of an accident over the 10-year period compared to alert subjects. A similar relation was observed when we limited the database to those accident victims with severe injury (excessively sleepy = 4.3%, moderately sleepy = 0.5%, alert = 0.6%; P = 0.028). When the victim was the only occupant of the car, subjects in the lowest MSLT group (highest sleepiness) had the greatest crash rate compared with alert individuals (excessively sleepy = 52.2%, moderately sleepy = 42.2%, alert = 37.4%; P = 0.022).
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These data demonstrate that the MSLT, a physiological measure of sleepiness, is predictive of an increased risk of DMV documented automotive crashes in the general population.
Sleep 06/2010; 33(6):745-52. · 5.05 Impact Factor
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ABSTRACT: Past studies have shown that acute experimental reduction of time in bed in otherwise healthy, non-sleepy people leads to hyperalgesia. We hypothesized that otherwise healthy, sleepy people may also exhibit hyperalgesia relative to their non-sleepy counterparts.
Between-groups sleep laboratory study.
Hospital-based sleep disorders center.
Twenty-seven, healthy, normal participants (age 18-35 years) were recruited and categorized into sleepy and non-sleepy groups based on their average sleep latencies on a screening multiple sleep latency test (MSLT).
Both groups were then allowed 8 hours time in bed, following which they underwent pain sensitivity testing (10:30 and 14:30) and sleepiness assessments by the MSLT (10:00, 12:00, 14:00, and 16:00). Pain sensitivity assessments were made by measuring finger withdrawal latencies to a radiant heat source delivering 5 different heat intensities.
This study showed that after only one night of 8 hours time in bed, the sleepy participants continued to be sleepy and exhibited a more rapid finger withdrawal response (i.e., increased pain sensitivity) to radiant heat than non-sleepy participants.
This suggests that sleepy individuals experience hyperalgesia in response to a painful stimulus when compared with non-sleepy individuals.
Sleep 09/2009; 32(8):1011-7. · 5.05 Impact Factor
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ABSTRACT: Determine the feasibility of using power spectrum of the sleep electroencephalogram (EEG) as a more sensitive tool than sleep architecture to evaluate the relationship between gastroesophageal reflux disease (GERD) and sleep.
GERD has been shown to adversely affect subjective sleep reports but not necessarily objective sleep parameters.
Data were prospectively collected from symptomatic patients with heartburn. All symptomatic patients underwent upper endoscopy. Patients without erosive esophagitis underwent pH testing. Sleep was polygraphically recorded in the laboratory. Spectral analysis was performed to determine the power spectrum in 4 bandwidths: delta (0.8 to 4.0 Hz), theta (4.1 to 8.0 Hz), alpha (8.1 to 13.0 Hz), and beta (13.1 to 20.0 Hz).
Eleven heartburn patients were included in the GERD group (erosive esophagitis) and 6 heartburn patients in the functional heartburn group (negative endoscopy, pH test, response to proton pump inhibitors). The GERD patients had evidence of lower average delta-power than functional heartburn patients. Patients with GERD had greater overall alpha-power in the latter half of the night (3 hours after sleep onset) than functional heartburn patients. No significant differences were noted in conventional sleep stage summaries between the 2 groups.
Among heartburn patients with GERD, EEG spectral power during sleep is shifted towards higher frequencies compared with heartburn patients without GERD despite similar sleep architecture. This feasibility study demonstrated that EEG spectral power during sleep might be the preferred tool to provide an objective analysis about the effect of GERD on sleep.
Journal of clinical gastroenterology 09/2009; 44(2):91-6. · 2.21 Impact Factor
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ABSTRACT: The aim of this study was to quantify the burden associated with chronic sleep maintenance insomnia characterized by nighttime awakenings (CINA) among women with menopausal symptoms.
Data were obtained from the 2006 US National Health and Wellness Survey, an annual cross-sectional study of US adults 18 years or older. Analyses were limited to female respondents currently experiencing symptoms of menopause. The definition of CINA was experiencing nighttime awakenings at least twice per week for more than 1 month that have moderate to severe impact on daily life and not experiencing difficulty falling asleep. No insomnia was defined as not self-reporting insomnia, sleep difficulties, or sleep symptoms. Outcomes included resource utilization in the past 6 months, Work Productivity and Activity Impairment questionnaire, and Medical Outcomes Study Short-Form Health Survey (SF-8). Linear regression models were developed to assess the independent associations of CINA on outcomes, while adjusting for demographics and comorbidity.
Among women with menopausal symptoms, 141 met the criteria for CINA and 1,305 met the criteria for no insomnia. Adjusting for demographics and comorbidity, those experiencing CINA had 0.1 (P = 0.041) more emergency department visits, 20.8% (P < 0.001) greater activity impairment, and SF-8 physical and mental summary scores that were 4.7 (P < 0.001) and 5.4 (P < 0.001) points, respectively, lower than those of women who are not experiencing insomnia. Among women with menopausal symptoms employed full-time, those experiencing CINA had greater impairment while working (presenteeism; 17.3%, P < 0.001) and overall (16.1%, P < 0.001) than did those who are not experiencing insomnia.
Among women with menopausal symptoms, CINA in relative isolation was associated with a significant negative impact on healthcare utilization and its associated costs, health-related quality of life, and work productivity.
Menopause (New York, N.Y.) 08/2009; 17(1):80-6. · 3.08 Impact Factor
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ABSTRACT: We hypothesized that the non-benzodiazepine hypnotic zolpidem would improve idiopathic central sleep apnea (ICSA) by enhancing sleep stability, resulting in fewer arousals, which in turn would lessen oscillation in arterial CO2 and produce a decrease in central apnea/hypopnea events. Zolpidem might also decrease ventilatory control responsiveness during arousals, thereby reducing hyperpnea, hypocapnia, and subsequent apneas.
This was a case series in which all patients with ICSA seen in the Henry Ford Sleep Disorders Clinic from January 1, 2004, to December 31, 2006, were offered zolpidem, as well as other therapeutic options of acetazolamide, continuous positive airway pressure (CPAP), bilevel pressure support, or assist control ventilatory support. Those 20 patients who chose zolpidem were prescribed 10 mg at bedtime.
After a therapeutic trial averaging 9 weeks, a follow-up polysomnogram showed that the overall apnea/hypopnea index (AHI) and central AHI (CAHI) decreased, 30.0 +/- 18.1 (SD) to 13.5 +/- 13.3 (p = 0.001), and 26.0 +/- 17.2 to 7.1 +/- 11.8 (p < 0.001), respectively, without an overall change in obstructive AHI or arterial oxygen saturation. The total number of arousals per hour decreased with zolpidem use, 24.0 +/- 11.6 to 15.1 +/- 7.7 (p < 0.001), leading to a significant improvement in sleep efficiency. There was a positive correlation between the decrease in CAHI and the arousal index. Consistent with the hypnotic effect of zolpidem, sleep latency decreased, stage 1 sleep percentage decreased, and stage 2 percentage increased (all significant), without changes in stage 3-4 or REM sleep. Excessive daytime sleepiness, measured by the Epworth Sleepiness Scale (ESS) decreased from 13 +/- 5 to 8 +/- 5 (p < 0.001). Three patients experienced a significant increase in obstructive events.
In an open-label trial, ICSA patients studied experienced a decrease in central apnea/hypopneas with zolpidem. They also had improved sleep continuity and decreased subjective daytime sleepiness, without a worsening of oxygenation or obstructive events in the majority of patients. However, in the absence of a randomized, controlled trial, zolpidem cannot be recommended for treatment of ICSA at this time.
Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 04/2009; 5(2):122-9. · 3.23 Impact Factor
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ABSTRACT: There is growing interest in the study of periodic limb movements during sleep and their potential clinical correlates. The aim of the present analysis is to address the lack of population-based studies using polysomnographic (PSG) measures to determine the prevalence of period limb movements during sleep in specific racial groups as well as the general population.
A community-based sample of 592 participants drawn from the general population of tricounty Detroit (mean age = 41.9 +/- 12.6 years; 52.9% F; 31.5% African American). All individuals were assessed using objective and subjective measures in the sleep laboratory.
Participants were evaluated during a 24-h laboratory assessment, including a polysomnogram and multiple sleep latency test. Periodic leg movements were scored using standard criteria. Reports of sleep disturbance and daytime sleepiness were also assessed using standardized measures including the Global Sleep Assessment Questionnaire (GSAQ) and the Epworth Sleepiness Scale (ESS).
The overall prevalence of periodic limb movements during sleep (PLMSI >15) was 7.6%. African Americans had a lower prevalence of PLMSI >15 than Caucasians (4.3% vs. 9.3%; chi2= 4.5, P < 0.05). Regardless of race, symptoms of insomnia were significantly higher in individuals with PLMSI >15 than in those with PLMSI < or =15 (45% vs. 25%; chi2= 6.84, P < 0.01).
This is the first study to determine the prevalence of PLMS in a population-based sample using standardized objective criteria. A key finding of the present study is that racial differences in this PSG parameter do exist, with African Americans being less likely to have elevated PLMS.
Sleep 10/2008; 31(9):1221-7. · 5.05 Impact Factor
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ABSTRACT: Inadequate sleep and sleep disordered breathing (SDB) can impair learning skills. Questionnaires used to evaluate sleepiness in adults are usually inadequate for adolescents. We conducted a study to evaluate the performance of a Spanish version of the Pediatric Daytime Sleepiness Scale (PDSS) and to assess the impact of sleepiness and SDB on academic performance.
A cross-sectional survey of students from 7 schools in 4 cities of Argentina.
A questionnaire with a Spanish version of the PDSS was used. Questions on the occurrence of snoring and witnessed apneas were answered by the parents. Mathematics and language grades were used as indicators of academic performance.
The sample included 2,884 students (50% males; age: 13.3 +/- 1.5 years)
Response rate was 85%; 678 cases were excluded due to missing data. Half the students slept <9 h per night on weekdays. The mean PDSS value was 15.74 +/- 5.93. Parental reporting of snoring occurred in 511 subjects (23%); snoring was occasional in 14% and frequent in 9%. Apneas were witnessed in 237 cases (11%), being frequent in 4% and occasional in 7%. Frequent snorers had higher mean PDSS scores than occasional or nonsnorers (18 +/- 5, 15.7 +/- 6 and 15.5 +/- 6, respectively; P < 0.001). Reported snoring or apneas and the PDSS were significant univariate predictors of failure and remained significant in multivariate logistic regression analysis after adjusting for age, sex, body mass index, specific school attended, and sleep habits.
Insufficient hours of sleep were prevalent in this population. The Spanish version of the PDSS was a reliable tool in middle-school-aged children. Reports of snoring or witnessed apneas and daytime sleepiness as measured by PDSS were independent predictors of poor academic performance.
Sleep 12/2007; 30(12):1698-703. · 5.05 Impact Factor
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Sleep 05/2006; 29(4):424-5. · 5.05 Impact Factor
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ABSTRACT: Traditional epidemiologic studies of insomnia provide valid but fairly rudimentary information regarding the presence, frequency, duration and evolution of sleep problems. Standardized tools such as validated questionnaires (e.g., Pittsburgh Sleep Quality Index and sleep logs) help assess the presence and severity of sleep problems, while other methods (e.g., SLEEP L system) address insomnia diagnoses. Other instruments (e.g., Structured Clinical Interview for DSM-IV [SCID], Short-Form 36 [SF-36], Epworth Sleepiness Scale [ESS]) provide insights into insomnia consequences and co-morbidities. Sleep laboratory studies using polysomnography (PSG) have also provided useful findings (e.g., relating to sleep apnea and excessive daytime sleepiness) in experimental and population-based patient samples containing subgroups enriched for certain variables under investigation. These methods have significantly increased our knowledge about insomnia. Critically, longitudinal studies are needed to further our understanding of the pathophysiology and morbidity of insomnia, defining roles for risk factors, hyperarousal and co-morbidities and the effects of treatment in long-term disease progression. This review summarizes the current available data on the evolution of insomnia and proposes a model that warrants further research attention and discussion.
Sleep Medicine 07/2004; 5 Suppl 1:S23-30. · 3.40 Impact Factor
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ABSTRACT: To determine the presence of a hypothesized trait vulnerability to sleep disturbance and hyperarousal.
Polysomnographic assessment of sleep in response to stress during a first night in the laboratory and subsequent physiologic arousal.
One hundred and four individuals (46% men, mean age 40.4 +/- 12.9 years) drawn from a population-based sample.
Individuals were exposed to a first night in the laboratory.
Participants completed a Likert-scale questionnaire, consisting of 27 items, that assesses sleep disturbance in response to commonly experienced stressful situations. Factor analytic techniques identified a single 9-item factor that was representative of the construct of "stress-related" vulnerability to sleep disturbance. Reliability of the resulting 9-item scale was high (Cronbach's alpha = .83). Individuals with higher scores on this scale, the Ford Insomnia Response to Stress Test (FIRST; median split), had a lower sleep efficiency (P = .001), as well as an increased latency to stage 1 sleep (P = .001) and persistent sleep (P = .002) on the first night of nocturnal polysomnography. Moreover, these high-scoring individuals showed increased arousal as evidenced by an elevated sleep latency on the Multiple Sleep Latency Test compared to individuals with low FIRST scores. Importantly, after controlling for current and past insomnia, the differences between individuals scoring high and low on the FIRST in terms of nocturnal sleep and daytime arousal remained significant. Other stages of sleep (stage 2, slow-wave, and rapid eye movement sleep) were not different between the groups.
These results showing a relationship between FIRST scores and nocturnal polysomnography and Multiple Sleep Latency Test scores have 3 potential implications: (1) the data demonstrate a characteristic that relates to vulnerability to stress-related sleep disturbance as manifested by a first night in the laboratory; (2) the elevated latencies on the Multiple Sleep Latency Test in these individuals, despite significantly disturbed sleep, support the notion of physiologic hyperarousal in these individuals and suggests they may be predisposed to developing chronic primary insomnia; and (3) the vulnerability identified may underlie vulnerability to transient sleep disturbance associated with other sleep-disruptive factors.
Sleep 04/2004; 27(2):285-91. · 5.05 Impact Factor
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ABSTRACT: Studies to assess the risks associated with sleep loss relative to the well-documented risks of alcohol are limited in number and design. This study compared the "dose"-related sedative, performance-impairing, and amnestic effects of sleep loss to those of ethanol ingestion.
Mixed-design experiment with random assignment to a sleep loss (n=12) or ethanol (n=20) group, with each participant assessed under 4 conditions.
Thirty-two healthy normal adult volunteers, aged 21 to 35 years.
In sleep loss, participants had 8, 6, 4, and 0 hours time in bed, producing 0, 2, 4, and 8 hours of sleep loss. For ethanol, participants ingested 0.0 g/kg, 0.3 g/kg, 0.6 g/kg, and 0.9 g/kg ethanol from 8:30 AM to 9:00 AM after 8 hours of time in bed the previous night. Each participant received his or her 4 doses of ethanol or sleep loss in a Latin square design with 3 to 7 days between doses.
All subjects completed the Multiple Sleep Latency Test (MSLT) at 9:30 AM, 11:30 AM, 1:30 PM, 3:30 PM, and 5:30 PM and a performance battery at 10:00 AM, 12:00 NOON, 2:00 PM, and 4:00 PM consisting of memory, psychomotor vigilance, and divided attention tests.
Ethanol and sleep loss reduced the average daily sleep latency on the MSLT, both as a linear function of dose, with sleep loss in hours being 2.7 times more potent than ethanol in grams per kilogram. Ethanol and sleep loss also slowed reaction time on the psychomotor vigilance test in a linear dose-related function with the 2 being equipotent in their impairing effect. On the divided attention test, tracking deviations were increased by both ethanol and sleep loss in an equipotent and linear dose-related function. Memory recall was reduced in a linear dose-related function by both ethanol and sleep loss with ethanol being slightly more potent. Finally, sleep loss doses produced a linear decrease in self-rated quality of performance, while only at the highest ethanol dose was performance rated as poorer.
At the studied doses, sleep loss was more potent than ethanol in its sedative effects but comparable in effects on psychomotor performance. Ethanol produced greater memory deficits, and subjects were less aware of their overall performance impairment.
Sleep 01/2004; 26(8):981-5. · 5.05 Impact Factor
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ABSTRACT: To develop a measure of daytime sleepiness suitable for middle-school children and examine the relationship between daytime sleepiness and school-related outcomes.
Self-report questionnaire.
Four hundred fifty, 11- to 15-year-old students, from grades 6, 7, and 8 of a public middle school in Dayton, Ohio.
A pediatric daytime sleepiness questionnaire was developed using factor analysis of questions regarding sleep-related behaviors. Results of the sleepiness questionnaire were then compared across other variables, including daily sleep patterns, school achievement, mood, and extracurricular activities.
Factor analysis on the 13 questions related to daytime sleepiness yielded 1 primary factor ("pediatric daytime sleepiness"; 32% of variance). Only items with factor loadings above .4 were included in the final sleepiness scale. Internal consistency (Chronbach's alpha) for the final 8-item scale was .80. Separate one-way analyses of variance and trend analyses were performed comparing pediatric daytime sleepiness scores at the 5 different levels of total sleep time and academic achievement. Participants who reported low school achievement, high rates of absenteeism, low school enjoyment, low total sleep time, and frequent illness reported significantly higher levels of daytime sleepiness compared to children with better school-related outcomes.
The self-report scale developed in the present work is suitable for middle-school-age children and may be useful in future research given its ease of administration and robust psychometric properties. Daytime sleepiness is related to reduced educational achievement and other negative school-related outcomes.
Sleep 07/2003; 26(4):455-8. · 5.05 Impact Factor
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ABSTRACT: People with insomnia are not typically treated medically for their insomnia. Studies have reported approximately 30% of insomniacs self-medicate with alcohol or over-the-counter (OTC) medications. This study was done to identify determinants and risks of different insomnia therapeutics.
A random-digit-dial, computer-assisted survey of a representative sample of adults in Metropolitan Detroit, aged 18-65 years, is being conducted. A sample of all respondents over an 18-month period was collected (n=1324) with a 68% response rate. Exclusive past-year use of alcohol for sleep was reported by 10% (n=132), prescription medications by 8% (n=108), and OTC medications by 10% (n=135). Five percent used both alcohol and sleep medications. The three exclusive-use groups formed the comparison groups of the study.
The prescription drug group used medications for more consecutive nights and for more total nights than the alcohol and OTC users. Alcohol users were predominantly male, while OTC and prescription drug users were predominantly female. Alcohol users were more likely to be single than the others, and prescription drug users were older than the others. Prescription drug users had more severe insomnia and had greater disability, neuroticism, and daytime fatigue than the others. In contrast, the alcohol users had greater daytime sleepiness than the others.
In Metropolitan Detroit, insomniacs receiving medical treatment have more severe insomnia and greater disability than those who self-treat. However, while the insomnia of those self-treating is less severe, it is still associated with some risks.
Journal of Psychosomatic Research 08/2002; 53(1):571-6. · 3.30 Impact Factor
