P133 Backward Rotating Shifts are Associated with Real-Time Drowsiness During Daytime Drives in Heavy Vehicle Drivers

Purpose While 10–20% of heavy vehicle crashes (HVDs) are drowsiness-related, the contributions of subsequent shifts to chronic drowsiness in HVDs is largely unknown. Eye-blink parameters indicate driver drowsiness reliably. This study examined the association of consecutive shifts and real-time drowsiness in HVDs. Methods Habitual sleep-wake of HVDs (all males, aged 49.5 ± 8 years) was monitored objectively (Philips Actiwatch, N=15) for 5 weeks (5.75± 1.4 hours). Johns Drowsiness Score (JDS, a composite eye-blink parameter in one-min intervals) was monitored for 4 weeks in HVDs (N=14) using an infrared oculography (Optalert, Melbourne, Australia) device. We assessed the association of drowsiness events (JDS equal or larger than 2.6) with consecutive shift types via mixed linear regression models. Results Eigth consecutive shifts increased drowsiness by 1.06 times compared to 2 shifts (8.37 events/h vs 6.77 events/h, P= 0.03). Consecutive shift sequences included afternoons (9%), mornings (29%), nights (5%), mixed rotating shifts (28%), forward-rotating shifts (11%) and backward-rotating shifts (12%). Drowsiness event rates were 1.23 times greater during night consecutive shifts relative to afternoon shifts (8.37 events/h vs 6.67 events/h, P= 0.03). Backward-rotating shifts (morning-night-evening- afternoon) elevated daytime drowsiness between 10 am and 3 pm by 1.55 times (10.01 events/h vs 6.47 events/h, P= 0.016). Conclusions Regardless of the number of consecutive shifts, sequential night shifts increase real-time drowsiness in HVDs, with backward rotating shifts resulting in higher rates of drowsiness events during daytime. The interaction of schedule features should inform the work scheduling of HVDs to reduce the risk of drowsiness.

Whole-genome analysis of monozygotic twins discordant for type 1 narcolepsy

Narcolepsy type 1 (NT1) is a rare and chronic neurological disease characterized by sudden sleep attacks, overwhelming daytime drowsiness, and cataplexy. To contribute to the understanding of NT1 genetic causes, here we describe a whole-genome analysis of a monozygotic twin pair discordant for NT1. Our study revealed that although both twins have the same pathogenic mutations in NT1 associated genes (such as HLA-DQB1*06:02:01, HLA-DRB1*11:01:02/*15:03:01) the unaffected twin has mutations in genes outside the HLA loci that could be suppressing the NT1 phenotype. These results support the notion that NT1 has an immunological basis but that protective mutations in non-HLA might interfere with the clinical manifestation of the disease.

SLEEP QUALITY IN MIDDLE-AGED WOMEN: FOCUS ON THE IMPACT OF DAYTIME DROWSINESS, PRESENCE OR ABSENCE OF DISEASE, AND SUNLIGHT EXPOSURE TIME

Middle age is the stage between maturity and old age among the developmental stages of life. During this period, in addition to physi-cal changes due to aging and endocrine imbalance, adaptation to various psychological and social changes occur including changing roles in the family, social support system, and loss of relationships between individuals. It is also a time to re-evaluate yourself and your life. Purpose of this study was to analyze the effects of daytime drowsiness, presence or absence of disease, and sunlight expo-sure time on the sleep quality of middle-aged women. The subjects of this study were 125 women middle-aged 40-60 years old, wom-en who were not currently receiving any disease or hormone therapy. Subjects personally recorded on the mobile questionnaire using their mobile phone face to face, and data were collected in compliance with ethical guidelines. Data were collected using Pittsburgh Sleep Quality Index (PSQI) for sleep quality and Questionnaire on Daytime Drowsiness. According to research results, presence or absence of disease and daytime drowsiness were variables affecting sleep quality in middle-aged women. These two factors were able to explain the sleep quality of middle-aged women by 17.8% and it was statistically significant. However, the time of exposure to sun-light did not affect. In order to improve the quality of sleep in middle-aged women, non-drug interventions with fewer side effects that can improve sleep effects are needed. Therefore, when developing nursing intervention for improving sleep quality in middle-aged women, it is necessary to consider the conditions of disease and daytime drowsiness identified in this study.

Occurrence of insomnia among patients with diagnosed obstructive sleep apnea

Obstructive sleep apnea (OSA) is a common problem. Excessive daytime sleepiness raises a suspicion of OSA, which can be confirmed by polysomnography (PSG). Insomnia, in patients with OSA, often manifests itself as excessive daytime drowsiness. The incidence of insomnia among patients with OSA differs in different studies. Thus, we investigated the incidence of insomnia among our patients. We included 120 patients who underwent a workup due to a suspicion of OSA in the Polysomnography Laboratory, Department of Otolaryngology, Medical University of Warsaw, Poland. Patients completed the Athens Insomnia Scale (AIS). All-night PSG was done with 14-channel recordings (Grass®, USA). The severity of OSA was classified according to the apnea-hypopnea index (AHI) values. There were 96 patients with OSA and 24 patients without OSA who served as controls (their sleep disorders and daytime drowsiness were not caused by OSA). The total AIS scores tended to indicate insomnia in the entire sample and in all different subgroups. The mean AIS score was significantly different between the subgroups differing in the severity of apnea. The mean AIS score correlated significantly with sleep latency, latent sleep, and N2 latency. The mean AIS score did not correlate significantly with the AHI. In conclusion, in patients with OSA, insomnia, measured with the AIS, was associated with the severity of apnea, although this relationship was weak.

Evaluation of Sleeping Profile in Schizophrenia Patients Treated with Paliperidone-Extended Release: Result From an Open Labeled Perspective Study in South East Asia (Perfect Study)

ObjectiveTo evaluate the impact of treatment with paliperidone extended release for 6 months on sleeping profile in schizophrenia patients.MethodsA total of 984 patients meeting the DSM-IV criteria for schizophrenia who switched their antipsychotics to be paliperidone ER were recruited from 61 sites in five countries in Southeast Asia. We assessed patients in terms of demographic profile, sleep quality and daytime drowsiness as visual analog scale.ResultsPatients in our studies received paliperidone ER treatment for 6 months. About 70% completed the treatment. Sleep quality and also daytime drowsiness were significantly increased in patients compared with their baseline. The predictive factors that have effect on sleep profile improvement were completion of the study and baseline PANSS score.ConclusionPatients receiving paliperidone ER were found to have improvement in sleep quality and also improvement in daytime drowsiness, especially in patients within completion group and the higher baseline PANSS score.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Daytime Drowsiness

Drowsiness is common in those with DLB and PDD, and can interfere with thinking and memory, as well as quality of life. There are a variety of potential reasons for this, many treatable. Getting a little sleepy during a boring task or napping after lunch on the weekend is not a sign of a medical problem. However, daytime drowsiness should draw attention in certain circumstances: 1. More than one nap most days, or near-daily naps that span 2 to 3 hours 2. Falling asleep during conversations or eating 3. Frequently falling asleep during reading, watching TV, doing computer work or other vigilant tasks 4. Returning to sleep after breakfast These are signs that could indicate that nighttime sleep was not adequate (nonrestorative) but could have other explanations. Daytime drowsiness has limited causes: 1. Insomnia at bedtime 2. Awakening during the night 3. Insufficient time spent in bed at night 4. Poor quality sleep at night (despite adequate time in bed) 5. Daytime medications inducing drowsiness 6. A primary sleep disorder directly causing drowsiness (which may be DLB or PDD related) We will explore each of these possible causes and how they might be diagnosed and treated. If a person with DLB or PDD is excessively drowsy, at least one of these could be the problem. Inability to get to sleep at bedtime can translate into sleepiness during the daytime. Many people with DLB or PDD who experience insomnia benefit from nighttime carbidopa/levodopa doses. The benefits of carbidopa/levodopa dosing at bedtime for Lewy-related insomnia were addressed in Chapter 9. Various other factors, however, may contribute to insomnia. Sometimes medications taken in the evening are alerting. Such drugs include duloxetine (Cymbalta) or venlafaxine (Effexor), used for depression and often dosed twice daily. Elimination of all but the morning dose may allow sleep in such cases. Other drugs for depression from the Prozac class (SSRIs; see the list in Chapter 18) may also cause insomnia if taken at bedtime. A simple strategy is to simply switch to morning dosing on a trial basis. The tricyclic antidepressants, such as nortriptyline, amitriptyline, or protriptyline, should not cause insomnia; they may induce sleep. Occasionally, sleepy people are prescribed stimulants with long-acting properties, such as extended-release methylphenidate (Concerta), modafinil (Provigil), or armodafinil (Nuvigil).

Evaluation of Comorbidities in Patients with OSAS and Simple Snoring

Aim. OSAS is a disease characterized by repetitive air flow constraint or cessation due to airway collapse. Diseases that frequently coexist with OSAS and simple snoring were evaluated in this study.Materials and Methods. This study was conducted in the Otorhinolaryngology Department of the Ankara Numune Hospital between April 2008 and April 2010 with 130 patients who presented with the complaints of snoring, witnessed apnea, and daytime drowsiness. Presence of chronic disease was compared to the demographics, BMIs, Epworth Scale scores, polysomnography, and physical examination findings.Results. Comorbid diseases were present in 56 (43.1%) of the patients, and the most presented disease group was cardiovascular system diseases. Age, BMI, daytime drowsiness, and frequency of septum deviation were observed at higher rates in patients with chronic disease. Age, BMI, and frequency of septum deviation were associated with cardiovascular diseases. Endocrine disease was found to increase with decreased oxygen saturation. Neuropsychiatric diseases were associated with daytime drowsiness and age. The mean age was lower in cases with cigarette smoking compared to cases without.Conclusion. Frequency of the comorbidities mostly increased with age as expected. Comorbid diseases were also associated with obesity and daytime drowsiness. Cigarette smoking was associated with early-age disease.