Obstructive sleep apnea is a chronic illness with increasing prevalence. In addition to associated cardiovascular comorbidities, obstructive sleep apnea syndrome has been linked to poor quality of life, occupational accidents, and motor vehicle crashes secondary to excessive daytime sleepiness. Although continuous positive airway pressure is the gold standard for sleep apnea treatment, its effects on quality of life are not well defined. In the current study we investigated the effects of treatment on quality of life using the data from the Apnea Positive Pressure Long-term Efficacy Study (APPLES), a randomized controlled trial of continuous positive airway pressure (CPAP) versus sham CPAP. The Calgary Sleep Apnea Quality of Life Index (SAQLI) was used to assess quality of life. Overall we found no significant improvement in quality of life among sleep apnea patients after CPAP treatment. However, after stratifying by OSA severity, it was found that long-term improvement in quality of life might occur with the use of CPAP in people with severe and possibly moderate sleep apnea, and no demonstrable improvement in quality of life was noted among participants with mild obstructive sleep apnea.

Introdução - Há evidências de que o aumento do consumo de carboidratos esteja associado à sonolência. Quando realizado à noite, o consumo de carboidratos parece ser um fator que afeta o desempenho no trabalho. Paradoxalmente, o trabalho noturno levaria ao aumento da ingestão de alimentos ricos em carboidratos como consequência da privação de sono. Objetivo - Verificar a existência de correlação entre a sonolência e consumo de carboidratos entre motoristas de caminhão. Métodos - Participaram da primeira etapa do estudo 71 motoristas de caminhão com idade média de 41 anos (DP=9,5), divididos em dois grupos: transferência (turno irregular de trabalho) e distribuição (turno diurno). Esta etapa consistiu na aplicação de um questionário com questões sociodemográficas, hábitos de vida, consumo alimentar e questões relacionadas ao trabalho. Na segunda etapa 49 motoristas (24 da transferência com idade média de 41 anos DP=8,3 e 25 da distribuição com idade média de 39 anos DP=11,4) responderam ao recordatório alimentar de 24h em dois dias de trabalho e um de folga, à escala de sonolência de Karolinska (KSS), o protocolo de atividade diária e usaram actimetros por 10 dias consecutivos. Resultados - Cerca de 70 por cento dos motoristas encontravam-se sobrepesos ou obesos. O teste de Kruskal Wallis demonstrou que os motoristas da transferência apresentaram uma média significativamente maior de consumo de carboidratos (91,8 g DP=53,7) na refeição anterior ao início do trabalho em relação aos motoristas da distribuição (51,3g DP=32,6) (p<0,05). A ANOVA de medidas repetidas que analisou a sonolência segundo área de trabalho revelou um efeito do horário (p<0,001) e uma interação entre horário e área de trabalho (p<0,05). O teste de correlação de Spearman entre o consumo de carboidratos na refeição anterior ao início do trabalho e a medida de KSS imediatamente após esta refeição não foi estatisticamente significante para nenhuma das duas áreas de trabalho. Conclusões - Embora não tenha sido possível estabelecer associação entre o consumo de carboidratos e a sonolência dos motoristas estudados, observou-se que os motoristas da transferência consomem mais carboidratos na refeição que antecede o início do trabalho em comparação aos do turno diurno. De modo geral, pode-se dizer que os motoristas apresentam padrões distintos de sonolência, cuja manifestação parece variar em função da pressão social dos horários de trabalho / Introduction - There is evidence that increased consumption of carbohydrates is associated with sleepiness. When performed at night, carbohydrate intake might be a factor that affects alertness. Paradoxically, night work could lead to increased intake of carbohydrate-rich foods as a result of sleep deprivation. Objective - To verify whether there is a correlation between carbohydrate intake and sleepiness in truck drivers. Methods -The first phase of this study included 71 truck drivers with a mean age of 41 years (SD = 9.5), divided into two groups: long haul drivers (irregular shift work) and short haul drivers (day shift). In this phase, a questionnaire about sociodemographic aspects, lifestyle, food intake and work was filled out. In the second phase, 49 drivers (24 long haul drivers with a mean age of 41 years SD = 8.3 and 25 short haul drivers with a mean age of 39 years SD = 11.4) responded to a 24hr food intake recall (for two working days and one day off) and the Karolinska Sleepiness Scale (KSS). The workers also filled out an activity diary and wore actigraphs for 10 consecutive days. Results - About 70 per cent of the drivers were overweight or obese. The Kruskal Wallis test showed that long haul drivers had a mean consumption of carbohydrates in the meal preceding the work onset (91.8 g ; SD = 53.7) significantly higher than the short haul drivers (mean = 51.3 g ; SD = 32.6) (p <0.05). A repeated measurement ANOVA, revealed an effect of time (p <0.001) and an interaction effect of time and work area (p <0.05) on sleepiness. The Spearman correlation test, between the consumption of carbohydrates in the meal prior to work onset and the sleepiness levels immediately after this meal, was not significant for both groups. Conclusions - Although it was not possible to establish an association between carbohydrate intake and sleepiness, it was observed that, the long haul drivers consume more carbohydrates than the short haul drivers. This occurs in the meal that precedes the work onset. In conclusion, truck drivers have distinct patterns of sleepiness, whose expression seems to vary according to the social pressure of working hours

<p>As more and more people conduct vigilance-based activities at times other than the traditional daytime work hours, the time utilization will continue to escalate in the next century and will further increase the risks of sleepiness-related accidents.</p><p>This project, which is commissioned by Scania CV AB, is to nvestigate the potential of a method for sleepiness detection belonging to esium AB. Our objective is to examine whether Scania CV AB should continue with the investigation of the patent method, and in that case, which patent parameters, that indicate sleepiness, should be more closely inquired. The purpose with the method of patent is to discover a sleepy driving behaviour. This method is based on the interaction that appears between the driver and the vehicle. The interaction consists of small spontaneous corrections with the steering wheel that in this report is called micro communication. How well the interaction is functioning can be measured in degree of interaction, which shows how well the driver and the truck interact with each other. The interaction between the driver and the vehicle is in this report looked upon as answers and questions with a certain reaction time, which appears with a certain answered question frequency. The differences in the signal’s amplitudes are measured in variation in amplitudes.</p><p>Experiments to collect relevant signals have to be conducted in order to investigate the potential with the method of the patent. It is eligible to collect data from a person falling asleep, which implies experiments conducted in a simulator. The experiments are executed in</p><p>a simulator, one test when they are alert and one when they are sleep deprived. Tests are also executed in a Scania truck. The purpose with these experiments is to collect data of the subject’s normal driving pattern in a truck and to investigate if it is possible to obtain</p><p>acceptable data in a truck.</p><p>The sleepiness experiments have indicated that the micro communication takes place in a frequency range of 0.25 to 6.0 Hz. The variables that have been found to detect sleepiness with high reliability are the reaction time and the degree of interaction presented in spectra.</p><p>The validation experiments have shown it is possible to collect exact and accurate data from the lateral acceleration and the steering wheel torque. But, there is more noise in the signals from truck then there is in the signals from the simulator.</p><p>This method for sleepiness detection has, according to the authors, a great potential. However, more experiments have to be conducted. The authors suggest further sleepiness experiments only conducted during night time. The subjects are sufficiently alert in the beginning of the test to receive data from normal driving behaviour. Physiological measurement could be interesting to have by the side of the subjective assessments as an additional base for comparison.</p>

Obstructive sleep apnea syndrome (OSAS) is characterized by snoring, apneas and excessive daytime sleepiness (EDS). Obesity is a risk factor for snoring and sleep apnea, but data on other factors in relation to obesity are ambiguous. Symptoms of sleep apnea in women have not been fully elucidated. OSAS is an important risk factor for cardiovascular disease (CVD). A common feature in patients with CVD and sleep apnea is an increase in systemic inflammation. From the general population 7,051 women ≥ 20 years answered a questionnaire on snoring and sleep disturbances. Habitual snoring was found in 8% of the total population, and influenced by age, obesity and smoking. The highest prevalence (14%) was found in women 50-59 years. In lean women, alcohol dependence was associated with snoring, while physical inactivity was a risk factor for snoring in obese women. Further, 230 snoring women and 170 women regardless of snoring status were investigated with polysomnography, blood sampling and anthropometric measurements. Of these, 132 participants underwent an ocular and endoscopic examination of their upper airways. Several findings in the upper airways characterised normal-weight women with an apnea-hypopnea index (AHI) ≥ 10. In women with BMI of &gt; 25, no pharyngeal characteristics predicted sleep apnea. When adjusting for age, obesity, smoking, AHI and sleep parameters, several aspects of daytime sleepiness correlated to snoring independently of AHI (EDS, falling asleep involuntarily during day, waking up unrefreshed and fatigue). No symptoms correlated to AHI independently of snoring. Blood samples were analysed for systemic inflammation (CRP, TNFα, IL-6, myeloperoxidase (MPO) and lysozyme). Strong correlations were found between obesity and inflammatory markers. AHI and nocturnal hypoxia correlated to all markers except MPO. When adjusting for age, obesity and smoking, only IL-6 and TNFα were independently associated with nocturnal hypoxia. In conclusion, age and obesity influence the prevalence of snoring and sleep apnea in women from the general population. Other risk factors differ according to BMI. Daytime symptoms are independently related to snoring per se. Despite a strong correlation between obesity and inflammation, an independent relationship between sleep apnea and inflammatory markers was found.

BACKGROUND: Sleep problems affect people of all ages, race, gender, and socioeconomic classifications. Undiagnosed sleep disorders significantly and adversely impact a person’s level of academic achievement, job performance, and subsequently, socioeconomic status. Undiagnosed sleep disorders also negatively impact both direct and indirect costs for employers, the national government, and the general public. Sleepiness has significant implications on quality of life by impacting occupational performance, driving ability, cognition, memory, and overall health. The purpose of this study is to describe the prevalence of daytime sleepiness, as well as other quantitative predictors of sleep continuity and quality. METHODS: Population data from the CDC program in fatigue surveillance were used for this secondary analysis seeking to characterize sleep quality and continuity variables. Each participant underwent a standard nocturnal polysomnography and a standard multiple sleep latency test (MSLT) on the subsequent day. Frequency and chi-square tests were used to describe the sample. One-Way Analysis of Variance (ANOVA) was used to compare sleep related variables of groups with sleep latencies of <5 >minutes, 5-10 minutes, and >10 minutes. Bivariate and multivariate logistic regression was used to examine the association of the sleep variables with sleep latency time. RESULTS: The mean (SD) sleep latency of the sample was 8.8 (4.9) minutes. Twenty-four individuals had ≥1 SOREM, and approximately 50% of participants (n = 100) met clinical criteria for a sleep disorder. Individuals with shorter sleep latencies, compared to those with longer latencies reported higher levels of subjective sleepiness, had higher sleep efficiency percentages, and longer sleep times. The Epworth Sleepiness Scale, sleep efficiency percentage, total sleep time, the presence of a sleep disorder, and limb movement index were positively associated with a mean sleep latency of <5 >minutes. CONCLUSIONS: The presence of a significant percentage of sleep disorders within our study sample validate prior suggestions that such disorders remain unrecognized, undiagnosed, and untreated. In addition, our findings confirm questionnaire-based surveys that suggest a significant number of the population is excessively sleepy, or hypersomnolent. Therefore, the high prevalence of sleep disorders and the negative public health effects of daytime sleepiness demand attention. Further studies are now required to better quantify levels daytime sleepiness, within a population based sample, to better understand their impact upon morbidity and mortality. This will not only expand on our current understanding of daytime sleepiness, but it will also raise awareness surrounding its significance and relation to public health.

As more and more people conduct vigilance-based activities at times other than the traditional daytime work hours, the time utilization will continue to escalate in the next century and will further increase the risks of sleepiness-related accidents. This project, which is commissioned by Scania CV AB, is to nvestigate the potential of a method for sleepiness detection belonging to esium AB. Our objective is to examine whether Scania CV AB should continue with the investigation of the patent method, and in that case, which patent parameters, that indicate sleepiness, should be more closely inquired. The purpose with the method of patent is to discover a sleepy driving behaviour. This method is based on the interaction that appears between the driver and the vehicle. The interaction consists of small spontaneous corrections with the steering wheel that in this report is called micro communication. How well the interaction is functioning can be measured in degree of interaction, which shows how well the driver and the truck interact with each other. The interaction between the driver and the vehicle is in this report looked upon as answers and questions with a certain reaction time, which appears with a certain answered question frequency. The differences in the signal’s amplitudes are measured in variation in amplitudes. Experiments to collect relevant signals have to be conducted in order to investigate the potential with the method of the patent. It is eligible to collect data from a person falling asleep, which implies experiments conducted in a simulator. The experiments are executed in a simulator, one test when they are alert and one when they are sleep deprived. Tests are also executed in a Scania truck. The purpose with these experiments is to collect data of the subject’s normal driving pattern in a truck and to investigate if it is possible to obtain acceptable data in a truck. The sleepiness experiments have indicated that the micro communication takes place in a frequency range of 0.25 to 6.0 Hz. The variables that have been found to detect sleepiness with high reliability are the reaction time and the degree of interaction presented in spectra. The validation experiments have shown it is possible to collect exact and accurate data from the lateral acceleration and the steering wheel torque. But, there is more noise in the signals from truck then there is in the signals from the simulator. This method for sleepiness detection has, according to the authors, a great potential. However, more experiments have to be conducted. The authors suggest further sleepiness experiments only conducted during night time. The subjects are sufficiently alert in the beginning of the test to receive data from normal driving behaviour. Physiological measurement could be interesting to have by the side of the subjective assessments as an additional base for comparison.

Purpose: Excessive day time sleepiness, sleep disorders and neurobehavior changes are common clinical observations in the patients with epilepsy. From literature review, they were highly related with epilepsy risk characteristics (age of onset, types or numbers of drugs, seizure frequency), co-morbidities or neuronal network changes. The serological biomarkers have been reported to reflect the phenomenon of seizure, while their correlations with neurobehavior changes were still not concluded. There were two purposes of this thesis. (1) To understand the relationship between sleep disturbance with day time performances (2) To understand the relationships between serological biomarkers, neurobehavior performances and neuronal networks in patients with temporal lobe epilepsy. Material and Methods: The study enrolled patients from epilepsy outpatient clinic. By using self-appreciated questionnaire (The Pittsburgh Sleep Quality Index, The Epworth Sleepiness Scale, Euroqol Quality of Life Scale-5D), we collected the characteristics of sleep related behavior and life quality changes and explored the relationship with epilepsy risk characteristics. In patients with temporal lobe epilepsy, we assessed the neurobehavior performances, measured the serological biomarkers (heat shock protein 70, S100£]protein, neuron specific enolase, brain derived neurotrophic factor, plasma and mitochondrial DNA) and brain magnetic resonance imaging. In statistical analysis, we compared the differences with age matched controls or performed correlation analysis among the parameters Result: One hundred and seventeen patients with epilepsy completed the sleep quality questionnaires. The results showed that 20 percent of patients had day time sleepiness, while the sleep disorder was prolong sleep latency and impaired sleep efficiency. In epilepsy characteristics, patients with complex partial seizure, intractable seizure or with multi-pharmacy were related with poor sleep quality. A total of 34 patients completed the serological, neurobehavior and brain magnetic resonance analysis. The results showed that patients with temporal lobe epilepsy had higher heat shock protein 70 and S100£]protein levels, while those with attacks more than twice per month had significant higher heat shock protein 70, S100£]protein and neuron specific enolase levels. Compared with the matched controls, the regions showing atrophy included hippocampus and parahippocampus, putamen, thalamus and supplementary motor areas. In correlation study, only heat shock protein 70 showed an inverse correlation with hippocampal volume (R square = 0.22, p = 0.007) after controlling for the effect of age. Conclusion: The study suggested that epilepsy risk characteristics, serological biomarkers, brain atrophic regions were important factors for day time sleepiness, sleep disturbances and neurobehavior changes in patients with epilepsy.

Pediatric sleep problems are among the most common yet significant pediatric health issues faced by families. Sleep problems can impact social-emotional and academic functioning of schoolchildren. Once identified, pediatric sleep problems and disorders are treatable with effective and rapid behavioral and medical interventions. The purpose of the current study was to determine the prevalence rates of symptoms of sleep disorders in a diverse school-based sample as well as the relationship between symptoms of sleep disorders and school behavior, academic achievement, and quality of life. The present study examined the relationship between the independent variables of No Sleep Disorders symptoms and Sleep Disorders symptoms derived from the Sleep Disorders Inventory for Students, Children's Form (SDIS-C) and the dependent variables Externalizing and Internalizing scales of the Behavior Assessment System for Children, Second Edition (BASC-2), Curriculum-based Measurement Re ading (R-CBM), Curriculum-based Measurement Math (M-CBM), PedsQL TM 4.0, and Students' Life Satisfaction Scale (SLSS). A Multivariate analysis of variance (MANOVA) was used to identify a significant difference between students with and without symptoms of sleep disorders on behavior, academics, and quality of life. Follow-up analyses using a modified Bonferroni adjustment determined significant differences between students with and without symptoms of sleep disorders on R-CBM, externalizing behaviors and internalizing behaviors. Medium effect sizes were reported for R-CBM, externalizing and internalizing behaviors and M-CBM. Very small effect sizes were found for PedsQL TM 4.0 and SLSS. Implications for School Psychologists and directions for future practice and research are discussed including understanding prevention, early identification and intervention, broadening the scope of school psychology training at the preservice and inservice levels and educating locally and nationall y.

Both alcohol and sleepiness are known to be major contnbutors to road traffic accidents m the UK. There has been much debate on whether the current legal blood alcohol concentration (BAC) limit for driving (008%) should be lowered to 005%, like several other countries in the European Union. The present limit may be sabsfactory when a driver IS fully alert, however the pressures of today's society mean that an mcreasmg number of people may be sleep deprived. The consequences of a sleepy person drivmg after drinking a current legally acceptable amount of alcohol have not been fully investigated. An initial literature review idenbfied specific areas that needed to be investigated throughout this programme of work The research took the form of a "hfelike" scenario, with only moderate sleep restnction (5h in bed at night) and moderate alcohol consumpbOn, producmg BACs of approximately half the UK legal driving limit The drive, on a Simulated dual carriageway, lasted for 2h and was very monotonous The research programme was split into four main areas (i) young men (the most at risk group of drivers for sleep related crashes) driving in the afternoon (a time when the number of sleep related crashes are known to increase), under a 2 x 2 experimental deSIgn, With and without alcohol at lunch-time and with and without the prior night's sleep restncted to 5h, (u) an identical gender comparison usmg young women, (hi) a time-of-day companson using young men, but with the drive and alcohol consumption takmg place m the early evening (a bme of day when we are naturally more alert); (iv) a near-zero BAC, when young men have the same alcohol intake as in (I) but earlier, such that their BACs have reduced to nearly zero before startIng the afternoon drive. Dunng the afternoon circadian trough the driving performance of both men and women is severely impaired when moderate sleep restriction and alcohol consumption are combined Of particular concern, is that men seem to be unable to perceive this greater impairment Women generally appear to have better perception of alcohol impairment, even without sleep loss. Unlike men, women's driving is less impaired by modest amounts of alcohol when they are alert, which seems to be because they know their performance IS affected and thus apply more compensatory effort. On the other hand, their rrnpamnent after alcohol when combmed WIth sleep loss is well in excess of any compensatory effort. Trrne of day also affects imp3lrment after alcohol and/or sleep loss. Driving performance IS generally better during the early evening holtrS, when we are nat\lfally more alert, compared with the afternoon, and for all conditions. Moderate alcohol intake does not impair drivmg performance during the early evening, unlike during the afternoon. However, if combined with sleepiness, mcreased driving impamnent does become apparent during the early evening, although, not to the extent that it does durmg the afternoon. BACs are not a good indicator of alcohol-related driving impairment, especially when combmed with sleepiness. During the afternoon, even when BACs fall almost to zero at the start of a drive, sleepy drivers are still more impaired for the first hour of the drive if they have consumed this modest amount of alcohol at lunchtime An unexpected rebound improvement m dnvmg performance is seen ID the second hour of the drive In non-sleep deprived, alert drivers, these same near zero BAC levels did not affect driving performance or significantly increase subjective sleepiness. Overall the results indicate that, combined WIth modest sleepiness, the current legal dnnk drive limtt (008%) is too htglt Thts outcome supports recent and extensIve findmgs WIth fatal and senous road crashes in France (Philip et al., 2001). During the afternoon, a time of day when people are nat\lfally less alert BACs of less than half this UK limit will impair driving even in non-sleep depnved people If drivers are also sleepy, this combmation produces dangerous levels of Impairment durmg the afternoon; the combination also leads to impairment (but to a lesser extent) in the early evening The research was carried out with only moderate levels of sleepiness and alcohol consumptIon, It is fair to conclude that driving impairment would be greater if the sleep loss was greater and/or BACs were htgher, but just under the legal liemt Greater public awareness is required on the knowledge that driving after consuming any alcohol when tired or sleepy is extremely dangerous.

A relationship between overweight and excessive daytime sleepiness (EDS) has been suggested in the adult population, and to a limited extent in the pediatric population. Daytime sleepiness can interfere with various components of daytime function. In light of the increase in the rates of pediatric overweight and obesity, the aim of this study was to investigate the relationship between weight and EDS in a pediatric population. Using a retrospective approach, data collected in a pediatric sleep clinic was analyzed. Objective measures of EDS were correlated with age, gender, body mass index percentile, and overnight sleep test recording variables. In males and in all children under the age of 13 years old, EDS was more common in those weighing above the normal range, EDS was present particularly during mid-morning hours. Additionally, weight above the normal range correlated with evidence of EDS after adjusting for measures of sleep pathologies.