Circadian (C) and homeostatic (H) regulation of sleep timing inspired by 1 and 23 and modification of strength of external factors (arrow thickness) responsible for the circadian misalignment and ...consequences.
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Sleep timing is controlled by the subtle interplay between circadian and homeostatic oscillators which, according to their endogenous properties, allow beings to feel spontaneously that it is time to go to bed or wake up in synchrony with the earth’s light/dark cycle. In humans, however, social time and nocturnal artificial light modify sleep timing. Our modern lifestyle and artificial nocturnal light delay our bedtime, make us wake up, and lead to a greater intraindividual variability in sleep timing. Depending on the constraints that social time places on us, our sleep timing may be in or out of phase with the internal circadian timing determined by the circadian clock. When a person’s social time is out of phase with their circadian time, they may be considered to suffer from circadian disruption or ‘social jetlag’. There are interindividual differences in sleep timing that are known as morningness-eveningness preferences or chronotype, e.g. late chronotypes go to bed later. Chronotype may be assessed in terms of differences in kinetic homeostatic sleep pressure, intrinsic circadian period (ICP) and/or phase angle entrainment. In addition, chronotype depends on genetic and age-related factors, e.g. it gets earlier as people grow older. The social time of late chronotype individuals during week days is not adapted to their circadian time, unlike on free days. This results in social jetlag and circadian disruption, which in turn induces a chronic sleep debt due to a late bedtime and an early wake time, which is compensated on free days but only partially. Sleep and circadian clock disruption generally alter cognitive performance (alertness, attention, memory, higher-order executive functions such as response inhibition and decision-making) but their impact remains to be clarified. When subjects adopt their preferred sleep timing, a “synchrony effect” often appears with chronotypes performing better during daytime at optimal than at suboptimal timing (late chronotypes perform better in the evening, early chronotypes in the morning). Evening types appear to be cognitively more vulnerable to suboptimal times than morning types, probably because they have to deal with social jetlag and the “wake effort” period after awakening. Circadian disruption, but not chronotype, may impact attentional/inhibitory performance (more impulsivity and inattention). Strong associations have been found between mood disorders or attention deficit hyperactivity disorder (ADHD) and chronotype, with these psychiatric disorders typically being overrepresented in evening types. The association between social jetlag and these psychiatric disorders is less obvious. Social jetlag can be corrected by reducing exposure to evening light, although eveningness may be considered as a lifelong factor predisposing to depression or inattention.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract
Study Objectives
High rates of sleep and mental health problems have been reported during the COVID-19 pandemic, but most of the evidence is retrospective without pre-pandemic data. This ...study documented rates of prevalent, incident, and persistent insomnia and psychological symptoms during the COVID-19 pandemic (2020) compared to pre-pandemic data (2018).
Methods
Data were derived from a longitudinal, population-based study of insomnia in Canada. When the first lockdown started in the province of Quebec, a subsample of participants who had completed the latest 2018 follow-up were surveyed (April to May 2020) about their sleep, insomnia, and psychological symptoms since the beginning of the pandemic. Prevalence, incidence, and persistence rates of insomnia, and severity of stress, anxiety, and depressive symptoms were estimated, as well as their associations with confinement, loneliness, social support, use of electronics, and other lifestyle changes occurring during the pandemic. A sleep/health survey and validated questionnaires of insomnia, sleep quality, stress, fatigue, anxiety, and depression were administered at both assessments.
Results
The sample consisted of 594 adults (mean age: 48.3 ± 13.1 years; 64.0% women). Prevalence of insomnia increased from 25.4% to 32.2% (symptoms) and from 16.8% to 19% (syndrome) from 2018 to 2020, for an overall 26.7% increase in insomnia rates. Of those classified as good sleepers in 2018 (n = 343), 32.6% (n = 112) had developed new insomnia during the COVID-19 pandemic. Among participants who had insomnia in 2018, the persistence rate was 76.5% 2 years later. There was a significant worsening of sleep quality, fatigue, anxiety, and depression (all ps < .005) during the COVID-19 pandemic compared to 2018. Significant associations were found between sleep and psychological symptoms and with living alone and being in confinement, lower social support, increased time using electronic devices, reduced physical exercise, and higher financial stress.
Conclusions
The COVID-19 pandemic is associated with significant increases in insomnia and psychological symptoms compared to the pre-pandemic period. Large scale public sleep and mental health intervention programs should be prioritized during and after a pandemic such as the COVID-19.
Sleepiness at the wheel is widely believed to be a cause of motor vehicle accidents. Nevertheless, a systematic review of studies investigating this relationship has not yet been published. The ...objective of this study was to quantify the relationship between sleepiness at the wheel and motor vehicle accidents.
A systematic review was performed using Medline, Scopus, and ISI Web of Science. The outcome measure of interest was motor vehicle accident defined as involving four- or two-wheeled vehicles in road traffic, professional and nonprofessional drivers, with or without objective consequences. The exposure was sleepiness at the wheel defined as self-reported sleepiness at the wheel. Studies were included if they provided adjusted risk estimates of motor vehicle accidents related to sleepiness at the wheel. Risk estimates and 95% confidence intervals (95% CIs) were extracted and pooled as odds ratios (ORs) using a random-effect model. Heterogeneity was quantified using Q statistics and the I2 index. The potential causes of heterogeneity were investigated using meta-regressions.
Ten cross-sectional studies (51,520 participants), six case-control studies (4904 participants), and one cohort study (13,674 participants) were included. Sleepiness at the wheel was associated with an increased risk of motor vehicle accidents (pooled OR 2.51 95% CI 1.87; 3.39). A significant heterogeneity was found between the individual risk estimates (Q = 93.21; I2 = 83%).
Sleepiness at the wheel increases the risk of motor vehicle accidents and should be considered when investigating fitness to drive. Further studies are required to explore the nature of this relationship.
PROSPERO 2015 CRD42015024805.
This study explores the association between specific insomnia symptoms (sleep onset, sleep maintenance and early morning awakenings symptoms) and self-efficacy (perceived self-confidence in the ...ability to use CPAP) with CPAP compliance in French patients with obstructive sleep apnea syndrome (OSAS). We performed a retrospective, cross-sectional analysis of CPAP compliance in a cohort of 404 patients diagnosed with OSAS. Patients completed mailed questionnaires on sleepiness (ESS), insomnia (ISI) and self-efficacy in sleep apnea (SEMSA). Linear regression modeling analyses were performed to explore the impact of measured variables on the number of hours of CPAP use. Of the initial pool of 404 patients, 288 returned the questionnaires (71% response rate). Their mean age was 63.16±12.73 yrs, 31% were females, mean BMI was 30.39±6.31 kg/m2, mean daily CPAP use was 6.19±2.03 h, mean number of years of use was 6.58±6.03 yrs, and mean initial AHI before CPAP use was 34.61±20.71 /h. Age (p<0.01), BMI (p<0.01), sleep onset insomnia symptoms (p<0.01), sleep maintenance insomnia symptoms (p<0.01) and self-efficacy (p<0.01) were significantly associated with mean daily CPAP use. We found that specific insomnia symptoms and self-efficacy were associated with CPAP compliance. Our findings underline the need to demonstrate that interventions that reduce insomnia symptoms and improve self-efficacy will increase CPAP compliance.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To the Editor, About 20% of acute respiratory distress syndrome (ARDS) survivors suffer from anxiety, depression or post-traumatic stress disorder (PTSD) 1 with a negative impact on long-term quality ...of life 2. The aim of this pilot study is to assess the feasibility of an early psychological evaluation and sustained support in COVID-19 patients admitted to intensive care unit (ICU) and describe their mental health outcomes during a 6-month follow-up. ...this study shows that, even in the context of a pandemic situation, it is possible to provide an early and sustained psychological support in critically ill patients.
This study aimed to determine the sleepiness-related factors associated with road traffic accidents.
A population based case-control study was conducted in 2 French agglomerations. 272 road accident ...cases hospitalized in emergency units and 272 control drivers matched by time of day and randomly stopped by police forces were included in the study. Odds ratios were calculated for the risk of road traffic accidents.
As expected, the main predictive factor for road traffic accidents was having a sleep episode at the wheel just before the accident (OR 9.97, CI 95%: 1.57-63.50, p<0.05). The increased risk of traffic accidents was 3.35 times higher in subjects who reported very poor quality sleep during the last 3 months (CI 95%: 1.30-8.63, p<0.05), 1.69 times higher in subjects reporting sleeping 6 hours or fewer per night during the last 3 months (CI 95%: 1.00-2.85, p<0.05), 2.02 times higher in subjects reporting symptoms of anxiety or nervousness in the previous day (CI 95%: 1.03-3.97, p<0.05), and 3.29 times higher in subjects reporting taking more than 2 medications in the last 24 h (CI 95%: 1.14-9.44, p<0.05). Chronic daytime sleepiness measured by the Epworth Sleepiness Scale, expressed heavy snoring and nocturnal leg movements did not explain traffic accidents.
Physicians should be attentive to complaints of poor sleep quality and quantity, symptoms of anxiety-nervousness and/or drug consumption in regular car drivers.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
In the context of geriatric research, a growing body of evidence links normal age-related changes in sleep with many adverse health outcomes, especially a decline in cognition in older adults. The ...most important sleep alterations that continue to worsen after 60 years involve sleep timing, (especially early wake time, phase advance), sleep maintenance (continuity of sleep interrupted by numerous awakenings) and reduced amount of sigma activity (during non-rapid eye movement (NREM) sleep) associated with modifications of sleep spindle characteristics (density, amplitude, frequency) and spindle–Slow Wave coupling. After 60 years, there is a very clear gender-dependent deterioration in sleep. Even if there are degradations of sleep after 60 years, daytime wake level and especially daytime sleepiness is not modified with age. On the other hand, under sleep deprivation condition, older adults show smaller cognitive impairments than younger adults, suggesting an age-related lower vulnerability to extended wakefulness. These sleep and cognitive age-related modifications would be due to a reduced homeostatic drive and consequently a reduced sleep need, an attenuation of circadian drive (reduction of sleep forbidden zone in late afternoon and wake forbidden zone in early morning), a modification of the interaction of the circadian and homeostatic processes and/or an alteration of subcortical structures involved in generation of circadian and homeostatic drive, or connections to the cerebral cortex with age. The modifications and interactions of these two processes with age are still uncertain, and still require further investigation. The understanding of the respective contribution of circadian and homeostatic processes in the regulation of neurobehavioral function with aging present a challenge for improving health, management of cognitive decline and potential early chronobiological or sleep-wake interventions.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Healthcare workers often have irregular work schedules and experience significant stress, which can lead to poor sleep quality and frequent mental health issues, especially in the context of the ...COVID-19 pandemic. In this cross-sectional study, we aimed to assess the prevalence of poor sleep hygiene and mental health complaints among healthcare workers and examine their associations. We investigated participants' typical sleep-wake patterns on workdays and free days as indicators of sleep hygiene. Sleep efficiency and social jetlag were calculated as the ratio of mean sleep duration to time spent in bed, while sleep rebound was defined as the difference in mean sleep duration between workdays and free days. Social jetlag was determined as the difference in mid-sleep timing between workdays and free days, with mid-sleep defined as the midpoint between bedtime and wake-up time. Insomnia severity was assessed using the Insomnia Severity Index (ISI), daytime sleepiness using the Epworth Sleepiness Scale (ESS), and symptoms of anxiety and depression using the Patient Health Questionnaire 4 (PHQ-4). Fatigue was measured using a single item inspired by the Maslach Burnout Inventory (MBI). A total of 1562 participants (80.5% women, mean age 40.0 years) were included in the study. The results revealed that 25.9% of participants slept less than 6 h, 24.3% had a sleep efficiency of less than 85%, 27.3% experienced a sleep rebound of more than 2 h, and 11.5% reported a social jetlag exceeding 2 h. Additionally, 33.9% of participants reported insomnia, 45.1% reported excessive daytime sleepiness, 13.1% reported fatigue, 16.5% reported symptoms of depression, and 35.7% reported symptoms of anxiety. After adjustment, mean sleep duration and sleep efficiency were associated with most mental health complaints. Sleep rebound and social jetlag were associated with significant insomnia but not with anxiety or depression symptoms. Our findings underscore the high prevalence of poor sleep hygiene and mental health complaints among healthcare workers, exacerbated by the COVID-19 crisis. We advocate for the promotion of sleep health through behavioral sleep strategies to safeguard the well-being of healthcare professionals.
Virtual agents have demonstrated their ability to conduct clinical interviews. However, the factors influencing patients' engagement with these agents have not yet been assessed. The objective of ...this study is to assess in outpatients the trust and acceptance of virtual agents performing medical interviews and to explore their influence on outpatients' engagement. In all, 318 outpatients were enroled. The agent was perceived as trustworthy and well accepted by the patients, confirming the good engagement of patients in the interaction. Older and less-educated patients accepted the virtual medical agent (VMA) more than younger and well-educated ones. Credibility of the agent appeared to main dimension, enabling engaged and non-engaged outpatients to be classified. Our results show a high rate of engagement with the virtual agent that was mainly related to high trust and acceptance of the agent. These results open new paths for the future use of VMAs in medicine.
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