Association Between Self-Reported Sleep Quality and Musculoskeletal Injury in Male Army Rangers

ABSTRACT Introduction Musculoskeletal injuries and insufficient sleep are common among U.S. Army Rangers. There has been limited research into whether indices of sleep differ between injured and uninjured Rangers. The purpose of this study was to investigate the association between self-reported sleep and musculoskeletal injury in Rangers. Materials and Methods A total of 82 Army Rangers (male, 25.4 ± 4.0 years) were asked if they currently have any musculoskeletal injuries; completed the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), and the Stanford Sleepiness Scale; and were asked about their average sleep quality/sleep duration over the preceding week. Rangers were then dichotomized into groups, one that reported a current musculoskeletal injury and another that did not. Results The reported musculoskeletal injury prevalence was 15.9% (n = 13). The Rangers that reported an injury, compared to those that did not, had a significantly higher Global PSQI score (6.7 ± 3.7 versus 4.5 ± 2.7, P = .012) and ISI score (10.9 ± 3.7 versus 7.2 ± 4.1, P = .003), both indicative of poorer sleep. The group reporting an injury rated their average sleep quality over the preceding week significantly lower compared to those that did not report an injury (50.8 ± 17.5 versus 68.9 ± 18.3, P = .001). There was no significant group difference in the average nightly sleep duration (6.1 ± 1.0 hours versus 6.5 ± 0.9 hours, P = .099). Conclusion In this cohort of male Army Rangers, In this cohort of male Army Rangers, those with a musculoskeletal injury reported poorer sleep quality than uninjured Rangers. Sleep duration was not associated with reported injuries; however, both the injured group and uninjured group averaged less than the recommended amounts of sleep. Further investigation into the relationship between musculoskeletal injury and sleep in military personnel is warranted.

P106 Evaluating the correlation between objective daytime sleepiness, daytime functioning and subjective sleepiness

Introduction Daytime sleepiness is typically assessed in clinical settings with the Multiple Sleep Latency Test (MSLT) and Maintenance of Wakefulness Test (MWT). However, these tests do not necessarily assess daytime functioning. This study aimed to assess the correlation between a 10-min Psychomotor Vigilance Test (PVT), as a measure of daytime functioning, and excessive daytime sleepiness as measured with the MSLT or MWT. Methods Patients attending the sleep clinic for assessments of daytime sleepiness underwent overnight polysomnography (PSG) and completed the Epworth Sleepiness Scale (ESS). The following day, patients completed four test sessions every 2h starting 1.5h after waking. Testing sessions included the Stanford Sleepiness Scale (SSS), PVT, MWT or MSLT. PVT lapses (reaction time >500ms), SSS score and sleep latencies (MSLT and MWT) were averaged within participants across sessions and regression analyses performed to assess the relationship between PVT lapses and sleepiness measures. Results A total of 41 patients (BMI: 33.7±8.7kg/m²; aged 44.8±17.8 years) completed the study. Of these, 22 (19 F) underwent the MSLT and 19 (2 F) underwent the MWT. PVT lapses correlated with MWT mean sleep latency (r²=0.62; p<0.001), ESS (r²= 0.19; p<0.01) and SSS (r²= 0.12; p<0.05) but not MSLT mean sleep latency (r²= 0.02; p = 0.50). Discussion In clinical practice, MWT and ESS are often used in conjunction to assess daytime functioning. Results suggest that the PVT could be used alongside MWT to aid clinical judgments around an individuals’ daytime functioning.

A randomized double-blind pilot study comparing cetirizine with diphenhydramine in the prevention of paclitaxel-associated infusion-related reactions.

e24080 Background: Cetirizine is a less sedative alternative to diphenhydramine for the prevention of infusion-related reactions (IRR) to paclitaxel. However, there is no prospective data to support its use in this context. In this study, we conducted a feasibility study for a future definitive non-inferiority trial comparing cetirizine with diphenhydramine as premedication to prevent paclitaxel-related IRR. Methods: This was a single center randomized double-blind parallel-group prospective pilot study. Participants were paclitaxel-naive cancer patients scheduled to start paclitaxel chemotherapy, alone or in combination. They were assigned to receive either intravenous diphenhydramine 50 mg + oral placebo (diphenhydramine group) or intravenous placebo + oral cetirizine 10 mg (cetirizine group) for their first two paclitaxel treatments. To assess the feasibility of a larger study, the percentage of eligible patients completing a first paclitaxel treatment and the recruitment rate were calculated. IRR events were documented. Change in drowsiness compared with baseline was assessed using the Stanford Sleepiness Scale (SSS). Results: Among 37 eligible patients, 27 were recruited and randomized (control 13; intervention 14) and 25 completed the study. The recruitment rate was 4.8 participants/month, meeting the primary feasibility target of 4 participants per month. One participant had an IRR (cetirizine group, CTCAE grade 2) and no unexpected serious adverse events occurred. Drowsiness was the main adverse effect associated with the premedication. The increase in drowsiness compared to baseline (ΔSSS) was greater in the diphenhydramine group compared to the cetirizine group (median ΔSSS 2 (IQR 3.25) vs median ΔSSS 0 (IQR 1), p < 0.01) when measured one hour after the administration of the premedication. Patient self-assessed moderate or intense discomfort caused by drowsiness was exclusively reported in the diphenhydramine group, by 4 out of 13 participants. Conclusions: The trial methods were feasible in terms of recruitment rate, retention and patient safety. IRR were infrequent and a larger trial is warranted to confirm non-inferiority for IRR prevention. Cetirizine was significantly less sedating than diphenhydramine when administered as premedication to prevent paclitaxel-associated IRR. Clinical trial information: NCT04237090. [Table: see text]

The relationship between alertness and spatial attention under simulated shiftwork

Higher and lower levels of alertness typically lead to a leftward and rightward bias in attention, respectively. This relationship between alertness and spatial attention potentially has major implications for health and safety. The current study examined alertness and spatial attention under simulated shiftworking conditions. Nineteen healthy right-handed participants (M = 24.6 ± 5.3 years, 11 males) completed a seven-day laboratory based simulated shiftwork study. Measures of alertness (Stanford Sleepiness Scale and Psychomotor Vigilance Task) and spatial attention (Landmark Task and Detection Task) were assessed across the protocol. Detection Task performance revealed slower reaction times and higher omissions of peripheral (compared to central) stimuli, with lowered alertness; suggesting narrowed visuospatial attention and a slight left-sided neglect. There were no associations between alertness and spatial bias on the Landmark Task. Our findings provide tentative evidence for a slight neglect of the left side and a narrowing of attention with lowered alertness. The possibility that one’s ability to sufficiently react to information in the periphery and the left-side may be compromised under conditions of lowered alertness highlights the need for future research to better understand the relationship between spatial attention and alertness under shiftworking conditions.

Prevalence of sleep disorders in obese before bariatric surgery.

Introduction: The prevalence of sleep disorders (SD) has increased significantly in recent decades in parallel to the worldwide obesity epidemic. The presence of SD provides an increased risk of postoperative complications, requiring greater care in these patients. The gold standard for evaluation and diagnosis of SD is polysomnography, but it is an expensive and highly complex exam, making the questionnaires and scales more accessible for diagnosis and screening. Objectives: To evaluate the presence of SD and to analyze the influence of anthropometric measures on the scores of the Epworth Sleepiness Scale (ESS), snoring (ERS) and Stanford Sleepiness Scale (SSS) in obese patients. Method: An observational, cross-sectional study performed from August 2015 to August 2016. The patients in the preoperative group of bariatric surgery of the University Hospital were submitted to anthropometric evaluation and application of the ESS, ERS and SSS during the preoperative physiotherapy evaluation. Results: Were evaluated 100 obese (78 women), mean age of 41.4±10.7 years and BMI of 46.1±7.8kg/m2 . SD were identified in 25% by ESS and 21% by SSS of obese. There were no differences between genders for the scales scores. The score of the ERS correlated itself with waist (r=0.20, p=0.04) and neck (r=0.33, p=0.001) circumferences. Conclusion: The use of scales for diagnosis of SD is useful in the follow-up of the preoperative of bariatric surgery and our study found that 25% of patients present daytime somnolence. We also observed the influence of waist and neck circumferences on increasing snoring scale.

0264 The Effects of Previous Night’s Sleep, 12-Hour Shift, and Workload on Sleepiness in Emergency Medical Service Providers

Introduction Shift-work has been shown to be detrimental to workers in many ways, including having negative effects on sleep. Many factors related to shift-work can contribute to these negative effects, including increased workload and less sleep the previous night. The effects of shift-work on sleep have been studied extensively in nurses and physicians, but this research is lacking in paramedics and emergency medical technicians (EMTs). This study assessed the effects of previous night’s sleep, day- versus night-shift, and workload on sleepiness in paramedics and EMTs. Methods Thirty-three EMTs and paramedics were tested before and after their 12-hour (either day- or night-) shift. Testing consisted of questions about previous night’s sleep, pupillometry to assess pupillary response for physiological sleepiness, and the Stanford Sleepiness Scale for subjective sleepiness. The number of calls made per shift was used to quantify workload/call volume. Results An analysis of variance assessed the effect of shift (day/night), previous night’s sleep, and workload on post-shift sleepiness. Pupillometry demonstrated that participants were sleepier after 12-hour shifts, but those who slept 8–9 hours the night before were less affected. Pupillary response indicated higher levels of sleepiness following the night-shift compared to the day-shift. This was contrary to perceived sleepiness, which was higher after the day-shift than the night-shift. Higher call volume resulted in a sleepier physiological response, and this effect was shown to be dependent upon the shift. Conclusion Performing shift-work results in increased sleepiness in workers, especially after a night shift. However, physiological sleepiness does not always correspond to perceived sleepiness. In addition, increased workload results in increased sleepiness, especially during the day shift. This highlights the importance of obtaining 8–9 hours of sleep before a 12-hour shift to protect against the effects of sleepiness on patient care and EMS workers themselves. Support This was funded in part by a UofSC Provost Grant.

0283 Differential Impact of Chronotype on Positive and Negative Affect Following Sleep Restriction

Introduction Previous research indicates sleep deprivation significantly decreases positive affect, while negative affect is often unaffected (Reddy et al., 2017; Schwarz et al., 2019). However, it is unclear whether individual difference factors predict a differential emotional response to sleep loss. Though one study found chronotype predicts decreased positive affect following sleep loss in adolescents (Dagys et al., 2012), the effect of chronotype on emotional response to sleep loss in adults remains unknown. Methods The present study addressed this limitation by examining whether chronotype predicts changes in positive and negative affect following partial sleep restriction. Healthy sleeping adults (N=113; Insomnia Severity Index&lt;8) completed the Morningness-Eveningness Questionnaire (Horne & Ostberg, 1976) on day 1, and were instructed to sleep normally on night 1. On the evening of day 2, participants completed the Positive and Negative Affect Schedule (PANAS; MacKinnon et al., 1999) to sample baseline daily emotions. On night 2, sleep was restricted to 4-8am. On day 3, participants completed the PANAS post-sleep restriction. Compliance was verified with actigraphy (n=22 excluded for noncompliance), and response to the sleep restriction procedure was checked with the Stanford Sleepiness Scale (Hoddes, Dement, & Zarcone, 1972; n=18 excluded for nonresponse). Results Results suggest a significant decrease in positive affect from pre-sleep restriction (M=15.63, SD=4.09) to post-sleep restriction (M=11.08, SD=3.93), t(71)=10.33, p&lt;.01, and a trend decrease in negative affect from pre-sleep restriction (M=7.68, SD=3.62) to post-sleep restriction (M=6.90, SD=2.41), t(71)=1.60, p=07. Chronotype was significantly associated with post-sleep restriction negative affect, controlling for baseline negative affect (β=-.42, p&lt;.01), such that eveningness was associated with increased negative affect following sleep restriction. In contrast, chronotype was unrelated to post-sleep restriction positive affect. Conclusion These findings indicate that evening types may be more likely to experience emotions implicated in anxiety-related disorders following sleep loss, such as fear and nervousness. Support This work was supported by the National Institute of Mental Health of the National Institutes of Health [F31MH113271] and a Graduate Student Summer Research Award from Vanderbilt University. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

The Relationship between Alertness and Spatial Attention under Simulated Shiftwork

Higher and lower levels of alertness typically lead to a leftward and rightward bias in attention, respectively. This relationship between alertness and spatial attention potentially has major implications for health and safety. The current study examined alertness and spatial attention under simulated shiftworking conditions. Nineteen healthy right-handed participants (M=24.6±5.3 years, 11 males) completed a seven-day laboratory based simulated shiftwork study. Measures of alertness (Stanford Sleepiness Scale and Psychomotor Vigilance Task) and spatial attention (Landmark Task and Detection Task) were assessed across the protocol. Detection Task performance revealed slower reaction times and higher omissions of peripheral (compared to central) stimuli, with lowered alertness; suggesting narrowed visuospatial attention and a slight left-sided neglect. There were no associations between alertness and spatial bias on the Landmark Task. Our findings provide tentative evidence for a slight neglect of the left-side and a narrowing of attention with lowered alertness. The possibility that one’s ability to sufficiently react to information in the periphery and the left-side may be compromised under conditions of lowered alertness highlights the need for future research to better understand the relationship between spatial attention and alertness under shiftworking conditions.

Uninterrupted Classroom Sitting is Associated with Increased Discomfort and Sleepiness Among College Students

Acute bouts of uninterrupted sitting has been associated with discomfort and fatigue in adult populations. However, little is known regarding the impact of uninterrupted sitting on such outcomes among college students. Understanding these relations would be useful for informing best practice and future interventions. The present study explored the relation between uninterrupted sitting and perceived levels of physical discomfort and sleepiness among college students in a real classroom setting. We recruited 54 undergraduate students enrolled in a single class at a Midwestern university. Participants remained seated throughout a 2.5 h lecture while completing the Stanford Sleepiness Scale (SSS) and General Comfort Scale (GCS) every 15 min. Linear mixed effect model analyses were used to determine the relations between the independent and dependent variables and the duration at which students reported significant impairments in discomfort and/or sleepiness. Classroom sitting time was associated with increases in discomfort (r = 0.28, p < 0.01) and sleepiness (r = 0.30, p < 0.01). Students reported significant impairments in discomfort and sleepiness after 75 and 15 min, respectively. These findings support further research into the acceptability, feasibility and efficacy of interventions designed to interrupt classroom sitting on discomfort, sleepiness and measures of academic performance.

Sleepiness of day workers and watchkeepers on board at high seas: a cross-sectional study

ObjectivesTo estimate the prevalence of sleepiness on duty among day workers and watchkeepers on board.DesignCross-sectional survey in a maritime field study.Setting10 shipping companies with container vessels under German management.ParticipantsThe whole crew (75 day workers and 123 watchkeepers) during 18 voyages on 18 different container ships.Outcome measuresSleepiness on duty and efficiency of sleep using pupillometry (in a cross-shift design) and the SenseWear armband activity monitor.ResultsThe watchkeepers showed significantly shorter sleep periods than day workers (5.5 hours vs 5.8 hours). The average efficiency of sleep was 69.6% and significantly lower among watchkeepers (OR 0.48; 95% CI 0.26 to 0.88). 396 pupillometric examinations were carried out and revealed 88 study members (22.2%) with a pupillary unrest index (rPUI) in a range characterised as ‘unfit for duty’ and 110 seafarers (27.8%) categorised as ‘particular attention required’. The average rPUI was similar between day workers and watchkeepers. The Epworth Sleepiness Scale revealed recent daytime sleepiness in 70 seafarers, which was similarly often stated by day workers and watchkeepers. Based on the Stanford Sleepiness Scale (SSS), a measurable cross-shift increase in the SSS value during the examined shift was observed, especially among watchkeepers. The amount of time already spent on the vessel at the time of the present examination was significantly associated with the rPUI (p=0.009).ConclusionSleep periods of both the day workers and the watchkeepers aboard vessels were alarmingly short and sleep efficiency was low. Sleepiness on duty is similarly prevalent among day workers and watchkeepers and seems to depend partly on the cumulative working period on the vessels. Preventive measures need to be taken by the shipping industry to counteract fatigue (eg, by enabling sufficient rest and sleep times).