Proposal of cutoff points for pediatric daytime sleepiness scale to identify excessive daytime sleepiness

The objective of the present study was to propose cutoff points for the Pediatric Daytime Sleepiness Scale (PDSS) through sensitivity and specificity analyses in order to identify excessive daytime sleepiness, considering parameters such as duration and quality of sleep, health perception, stress control and depressive moods (feelings of sadness) in adolescents. A total of 1,132 adolescents, aged 14–19 years old, of both sexes, from the public high school of São José – SC, answered the questionnaire with information on age, daytime sleepiness, sleep duration, health perception, stress management, depressive moods (feelings of sadness) and quality of sleep. The Receiver Operating Characteristic (ROC) curve was used to estimate cutoff points considering the sensitivity and specificity values ??that best identify adolescents with excessive daytime sleepiness, using independent variables as a reference. The majority of the sample was female (54.2%), aged 14–16 years. The girls presented worse quality of sleep (66.4%), and the boys had a more positive perception of health (74.8%), better stress control (64.8%) and lower depressive moods (feelings of sadness) (63.3%). The largest area in the ROC curve was the one that considered sleep quality as a parameter in both sexes (area of the curve = 0.709 and 0.659, respectively, for boys and girls, p < 0.001). Considering sleep quality as a reference, the cutoff point for excessive daytime sleepiness was 15 points. The other parameters used were also significant (p < 0.005). Poor sleep quality was the parameter most strongly related to daytime sleepiness, and a cutoff of 15 points for the PDSS for both sexes should be used in the definition of excessive daytime sleepiness. For the other parameters, stress management, depressive mood (feelings of sadness) and health perception, different cutoff points are suggested for boys and girls.     

Differences in morning–evening type and sleep duration between Black and White adults: Results from a propensity-matched UK Biobank sample

Biological evidence suggests that ethno-racial differences in morning–evening type are possible, whereby Blacks may be more likely to be morning type compared to Whites. However, population-level evidence of ethno-racial difference in morning–evening type is limited. In an earlier study, we reported that morning type was more prevalent in Blacks compared to Whites in the United Kingdom (UK) Biobank cohort (N = 439 933). This study aimed to determine if these ethno-racial differences persisted after accounting for an even broader range of social, environmental and individual characteristics and employing an analytic approach that simulates randomization in observational data, propensity score modeling. Data from UK Biobank participants whose self-identified race/ethnicity was Black/Black British or White; who did not report daytime napping, shift work or night shift work; who provided full mental health information; and who were identified using propensity score matching were used (N = 2044). Each sample was strongly matched across all social, environmental and individual characteristics as indicated by absolute standardized mean differences <0.09 for all variables. The prevalence of reporting nocturnal short, adequate and long sleep as well as morning, intermediate and evening type among Blacks (n = 1022) was compared with a matched sample of Whites (n = 1022) using multinomial logistic regression models. Blacks had a 62% greater odds of being morning type [odds ratio (OR) = 1.620, 95% confidence interval (CI): 1.336–1.964, p < .0001] and a more than threefold greater odds of reporting nocturnal short sleep (OR = 3.453, 95% CI: 2.846–4.190, p < .0001) than Whites. These data indicate that the greater prevalence of morning type and short nocturnal sleep in Blacks compared to Whites is not fully explained by a wide range of social and environmental factors. If sleep is an upstream determinant of health, these data suggest that ethno-racially targeted public health sleep intervention strategies are needed.     

Social jetlag affects subjective daytime sleepiness in school-aged children and adolescents: A study using the Japanese version of the Pediatric Daytime Sleepiness Scale (PDSS-J)

The aim of this study was to elucidate the level of daytime sleepiness in Japanese school-aged children and adolescents, and to examine associated factors including sleep loss and social jetlag using the Japanese version of the Pediatric Daytime Sleepiness Scale (PDSS-J). After the linguistic validation of the PDSS-J with a multi-step translation methodology, consisting of forward translation, back translation, expert review and cognitive debriefing interviews, we conducted a psychometric validation for 492 students aged 11–16 years (46.7% boys) of public elementary school, junior high school and high school, using the PDSS-J, the Karolinska Sleepiness Scale (KSS), and bedtimes and wake-up times on school days and free days. Internal consistency (Cronbach’s alpha) of the PDSS-J was 0.77, and the test–retest reliability demonstrated by the intraclass coefficient was 0.88. Multivariate logistic regression analysis revealed that both short sleep duration and social jetlag were identified as factors associated with daytime sleepiness, after adjustment for age and sex. PDSS-J scores were significantly higher in the group with large social jetlag with or without sufficient sleep duration than in the group with sufficient sleep duration and small social jetlag. The PDSS-J is an important tool for assessing daytime sleepiness, given its ease of administration and robust psychometric properties. The impact of not only sleep loss but also social jetlag on daytime sleepiness among school-aged children and adolescents must be fully taken into account.     

Sleep length,working hours and socio-demographic variables are associated with time attending evening classes among working college students

It is the aim of the present study to assess factors associated with time spent in class among working college students. Eighty-two working students from 21 to 26 years old participated in this study. They were enrolled in an evening course of the University of São Paulo, Brazil. Participants answered a questionnaire on living and working conditions. During seven consecutive days, they wore an actigraph, filled out daily activity diaries (including time spent in classes) and the Karolinska Sleepiness Scale every three hours from waking until bedtime. Linear regression analyses were performed in order to assess the variables associated with time spent in classes. The results showed that gender, sleep length, excessive sleepiness, alcoholic beverage consumption (during workdays) and working hours were associated factors with time spent in class. Thus, those who spent less time in class were males, slept longer hours, reported excessive sleepiness on Saturdays, worked longer hours, and reported alcohol consumption. The combined effects of long work hours (>40 h/week) and reduced sleep length may affect lifestyles and academic performance. Future studies should aim to look at adverse health effects induced by reduced sleep duration, even among working students who spent more time attending evening classes.

     

Relationships between daytime sleepiness and sleep quality,duration, and phase among school-aged children: a cross-sectional survey

A cross-sectional survey was conducted to simultaneously evaluate sleep quality, duration, and phase in school-aged children and correlations between each dimension of sleep and daytime sleepiness were comprehensively examined. A cross-sectional survey was conducted with school-aged children enrolled in four public elementary schools in Joetsu city, Niigata prefecture in Japan (n = 1683). Among the collected responses (n = 1290), 1134 valid responses (547 boys and 587 girls) were analyzed (valid response rate was 87.90%). Data on daytime sleepiness, sleep quality (problems in sleeping at night), sleep duration (the average sleeping time during a week), and sleep phase (sleep timing: bedtime and rising time on weekdays, and sleep regularity: differences in bedtime and rising time between on weekdays and weekends) were collected. The results of multivariate logistic regression analysis indicated that the following dimensions were significantly correlated with daytime sleepiness: the decline in sleep quality [adjusted odds ratio (AOR) = 2.62, 95% confidence interval (CI) = 1.71–4.00], bedtime after 21:30 on weekdays (AOR = 1.58, 95% CI = 1.15–2.18), bedtime delay on weekends, compared to weekdays (AOR = 1.75, 95% CI = 1.27–2.41), and bedtime advance on weekends, compared to weekdays (AOR = 3.33, 95% CI = 1.78–6.20). Sleep dimensions that significantly affected daytime sleepiness in school-aged children are sleep quality, bedtime-timing, and regularity of bedtime. It is important to detect problems in night sleep and establish treatments, as well as to provide support for early bedding on weekdays and for a regular bedtime both on weekdays and on weekends to prevent daytime sleepiness in school-aged children.

     

New Zealanders working non-standard hours also have greater exposure to other workplace hazards

Exposure to workplace hazards, such as dust, solvents, and fumes, has the potential to adversely affect the health of people. However, the effects of workplace hazards on health may differ when exposure occurs at different times in the circadian cycle, and among people who work longer hours or who do not obtain adequate sleep. The aim of the present study was to document exposures to workplace hazards across a national sample of New Zealanders, comparing people who work a standard 08:00 ?17:00 h Monday-to-Friday working week (Std hours) and those who do not (N-Std hours). New Zealanders (n = 10 000) aged 20–64 yrs were randomly selected from the Electoral Roll to take part in a nationwide survey of workplace exposures. Telephone interviews were conducted between 2004 and 2006, using a six-part questionnaire addressing demographics, detailed information on the current or most recent job (including exposures to a range of workplace hazards), sleep, sleepiness, and health status. N-Std hours were categorised on the basis of: being required to start work prior to 07:00 h or finish work after 21:00 h and/or; having a regular on-call commitment (at least once per week) and/or; working rotating shifts and/or; working night shift(s) in the last month. The response rate was 37% (n = 3003), with 22.2% of participants (n = 656) categorised as working N-Std hours. Industry sectors with the highest numbers of participants working N-Std hours were manufacturing, health and community services, and agriculture, fishing, and forestry. Response rate was 37% (n = 3003) with 22.2% (n = 656) categorised as working N-Std hours. Participants working N-Std hours were more likely to be exposed to all identified hazards, including multiple hazards (OR = 2.45, 95% CI = 2.01–3.0) compared to those working Std hours. Participants working N-Std hours were also more likely to report ‘never/rarely’ getting enough sleep (OR = 1.38, 95% CI = 1.15–1.65), ‘never/rarely’ waking refreshed (OR = 1.23, 95% CI = 1.04–1.47), and excessive sleepiness (OR = 1.77, 95% CI = 1.29–2.42). New Zealanders working N-Std hours are more likely to be exposed to hazards in the workplace, to be exposed to multiple hazards, and to report inadequate sleep and excessive sleepiness than their colleagues working a standard 08:00?17:00 h Monday-to-Friday working week. More research is needed on the effects of exposure to hazardous substances outside the usual waking day, on the effects of exposure to multiple hazards, and on the combination of hazard exposure and sleep restriction as a result of shift work.     

The impact of a delayed sleep–wake schedule on depression is greater in women – A web-based cross-sectional study in Japanese young adults

Sleep-related problems, such as symptoms of insomnia, daytime sleepiness, shorter sleep duration, or a delayed sleep–wake schedule, are known to be risk factors for depression. In general, depression is more prevalent in women than in men, but sleep-related problems do not necessarily show similar gender predominance. Hence, it can be speculated that the impact of sleep-related problems on the development process of depression differs between genders; however, so far, few studies have focused on this issue. The aim of this study was to clarify gender differences in the rates of depression of people with the above sleep-related problems, and to examine gender differences in factors associated with depression in Japanese young adults. A web-based questionnaire survey comprising assessments of demographic variables, sleep-related variables (bed time, wake time, sleep onset latency, frequency of difficulty in initiating sleep and that in maintaining sleep, i.e. symptom components of insomnia, and daytime sleepiness), and the 12-item version of the Center for Epidemiologic Studies Depression Scale was administered to 2502 participants (males:females?=?1144:1358, age range?=?19–25 years). Female predominance in the rate of depression was observed only in subjects with a delayed sleep–wake schedule (χ²₍₁₎?=?15.44, p?<?0.001). In men, daytime sleepiness and difficulty in initiating sleep were significantly associated with depression (odds ratio [OR]?=?2.39, 95% confidence interval [CI]?=?[1.69, 3.39], p?<?0.001; OR?=?3.50, 95% CI?=?[2.29, 5.35], p?<?0.001, respectively), whereas in women, significant associations were found between depression and a delayed sleep–wake schedule (OR?=?1.75, 95% CI?=?[1.28, 2.39], p?<?0.001), daytime sleepiness (OR?=?2.13, 95% CI?=?[1.60, 2.85], p?<?0.001), and difficulty in initiating sleep (OR?=?4.37, 95% CI?=?[3.17, 6.03], p?<?0.001). These results indicate that in younger generations, the impact of a delayed sleep–wake schedule on the development of depression is greater in women; specifically, women are vulnerable to depression when they have an eveningness-type lifestyle, which is possibly attributable to the female-specific intrinsic earlier and shorter circadian rhythm. These results suggest the necessity of gender-based approaches to treating sleep-related problems for alleviating or preventing depressive symptoms in young adults.     

Eveningness, sleep patterns, daytime functioning, and quality of life in Israeli adolescents

The purpose of the study was to assess the relationships between eveningness, sleep patterns, measures of daytime functioning, i.e., sleepiness, sleep problem behaviors, and depressed mood, and quality of life (QOL) in young Israeli adolescents. A cross-sectional survey was performed in urban and rural middle schools in Northern Israel. Participants were 470 eighth and ninth grade middle school students (14?±?0.8 yrs of age) in the normative school system. Students completed the modified School Sleep Habits Survey (SSHS) and Pediatric Quality of Life Inventory Short Form, assessing six subscales of physical, emotional, social, school performance, and psychosocial functioning, plus an addition generated total score. During weekdays and weekends, evening types went to bed later, their sleep latency was longer, their wake-up time was later, and their sleep duration was shorter than intermediate and morning types. Evening types exhibited more sleep problem behaviors, sleepiness, depressed mood, and lower QOL compared to intermediate and morning types. Based on the regression model, sleepiness, sleep-problem behaviors, and depressed mood were the variables most strongly associated with QOL, followed by morning-evening preference, weekday sleep duration, and weekend sleep latency. This study is the first to assess QOL in normative, healthy adolescents and to demonstrate strong associations between morning-evening preference and QOL. These findings enhance the need to identify young individuals with an evening preference, and to be aware of the characteristics and manifestations of the evening chronotype on daytime and nighttime behaviors in adolescence.     

Association of sickness absence with poor sleep and depressive symptoms in shift workers

A cross-sectional study was conducted to evaluate the contribution of daily sleep habits and depressive symptoms to sickness absences of shift workers. A self-administered questionnaire that solicited answers about sleep, symptoms of depression, sickness absence, diseases/injuries, and lifestyle factors was submitted to a sample of 522 rotating shift workers between the ages of 18-59 (mean 27) yrs of an electric equipment manufacturing company. The seven features of sleep queried were daily hours of sleep, time to fall asleep, awakening during sleep, early morning awakening, sleep well at night, sufficiency of sleep, and excessive daytime sleepiness at work. The responses were assessed over the subject's previous 1-yr period. Each sleep feature, except daily sleeping hours, was dichotomized by the following responses: (1) taking more than 30min to fall asleep (difficulty initiating sleep; DIS), (2) awakening during sleep almost every day (difficulty maintaining sleep; DMS), (3) early morning awakening almost every day (EMA), (4) sleeping very poorly or not so well at night, (5) definite or somewhat insufficient nightly sleep, and (6) excessive daytime sleepiness at work almost every day (EDS). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. Sickness absence was calculated by asking subjects "How many days in total have you been absent from work due to sickness, including paid vacation, in the last 1-yr period?" The responses were divided into three groups that included no (0 days) sickness absences (reference group, n=235 subjects), 1 to 4 days (short-term, n=199 subjects), and 5 days or more (long-term, n = 88 subjects). Compared to the prevalence of sleep features of the reference group, workers with short-term absence showed a significantly higher prevalence of EMA with an odds ratio (OR) of 5.3, 95% confidence interval (CI) 1.3-22.0. Long-term absence was significantly associated with DMS (OR = 2.1, 95%CI 1.0-4.6), EMA (OR = 5.6, 95%CI 1.0-28.7), sleeping poorly at night (OR= 2.6, 95%CI 1.4-5.0), and high depressive symptoms (OR = 2.0, 95%CI 1.0-3.7) according to the CES-D score of >16, after adjusting for multiple confounding variables. These data point to an association between both the parameters of poor sleep and symptoms of deep depression when self-reported sickness absence is frequent. The association is particularly strong with long-term absence in male shift workers.     

Evening preference is related to the incidence of depressive states independent of sleep-wake conditions

Although evening preference has recently been identified as a risk factor for depression, it has not been substantiated whether evening preference is a direct risk factor for depressive states, or if it is associated secondarily through other factors, such as delayed sleep timing and shortened sleep duration. The objective of this study is to investigate associations in Japanese adult subjects between evening preference and incidence of depressive states, adjusting for various sleep parameters related to depressive states. The Morningness-Eveningness Questionnaire (MEQ), the Pittsburgh Sleep Quality Index (PSQI), and the Center for Epidemiologic Studies Depression Scale (CES-D) were administered to 1170 individuals (493 males/677 females; mean and range 38.5 and 20-59 yrs) to assess their diurnal preferences, sleeping states, and presence of depression symptoms. Subjects were classified into five chronotypes based on MEQ scores. Evening preference was associated with delayed sleep timing, shortened sleep duration, deteriorated subjective sleep quality, and worsened daytime sleepiness. Logistic regression analysis demonstrated that the extreme evening type (odds ratio [OR]?=?1.926, p?=?.018) was associated with increased incidence of depressive states and that the extreme morning type (OR?=?0.342, p?=?.038) was associated with the decreased incidence of depressive states, independent of sleep parameters, such as nocturnal awakening (OR?=?1.844, p?相似文献   

Eveningness,Sleep Patterns,Daytime Functioning,and Quality of Life in Israeli Adolescents

The purpose of the study was to assess the relationships between eveningness, sleep patterns, measures of daytime functioning, i.e., sleepiness, sleep problem behaviors, and depressed mood, and quality of life (QOL) in young Israeli adolescents. A cross-sectional survey was performed in urban and rural middle schools in Northern Israel. Participants were 470 eighth and ninth grade middle school students (14?±?0.8 yrs of age) in the normative school system. Students completed the modified School Sleep Habits Survey (SSHS) and Pediatric Quality of Life Inventory Short Form, assessing six subscales of physical, emotional, social, school performance, and psychosocial functioning, plus an addition generated total score. During weekdays and weekends, evening types went to bed later, their sleep latency was longer, their wake-up time was later, and their sleep duration was shorter than intermediate and morning types. Evening types exhibited more sleep problem behaviors, sleepiness, depressed mood, and lower QOL compared to intermediate and morning types. Based on the regression model, sleepiness, sleep-problem behaviors, and depressed mood were the variables most strongly associated with QOL, followed by morning-evening preference, weekday sleep duration, and weekend sleep latency. This study is the first to assess QOL in normative, healthy adolescents and to demonstrate strong associations between morning-evening preference and QOL. These findings enhance the need to identify young individuals with an evening preference, and to be aware of the characteristics and manifestations of the evening chronotype on daytime and nighttime behaviors in adolescence. (Author correspondence: Orna@yvc.ac.il)     

Level of alpha amylase activity in human saliva as a non-invasive biochemical marker of sleep deprivation

To investigate the usefulness of the enzyme salivary alpha amylase as a biochemical marker of sleep deprivation in human subjects. Total 168 healthy school-going adolescents studying in 9th grade were selected randomly from morning shift (n = 84) and dayshift (n = 84) schools. The study was undertaken longitudinally for a period of 2 years. Study encompassed administration of questionnaire and collection of saliva samples from the participants. Activity of salivary alpha amylase (sAA) activity was estimated spectrophotometrically and statistical analysis was performed to determine the association between sAA activity and sleep duration. Excessive daytime sleepiness among students was also studied in association with sAA activity. sAA activity of students was found to have a negative correlation with the duration of sleep and a positive correlation with their level of sleepiness. Morning shift students were found to have significantly less sleep and correspondingly higher sAA activity as compared to dayshift students. A significant increase in the sAA activity was noticed in the second year as the students progressed from 9th to 10th grade. Higher amylase activity was also observed in sleep deprived students suffering from excessive daytime sleepiness irrespective of school timings. Salivary alpha amylase activity increases in saliva in response to sleep deprivation. School timings may modulate sleep duration of students. Present finding reveals that sAA could be an appropriate non-invasive biochemical marker for the objective assessment of sleep deprivation among individuals as well as at population level.

     

Association of Sickness Absence with Poor Sleep and Depressive Symptoms in Shift Workers

A cross-sectional study was conducted to evaluate the contribution of daily sleep habits and depressive symptoms to sickness absences of shift workers. A self-administered questionnaire that solicited answers about sleep, symptoms of depression, sickness absence, diseases/injuries, and lifestyle factors was submitted to a sample of 522 rotating shift workers between the ages of 18–59 (mean 27) yrs of an electric equipment manufacturing company. The seven features of sleep queried were daily hours of sleep, time to fall asleep, awakening during sleep, early morning awakening, sleep well at night, sufficiency of sleep, and excessive daytime sleepiness at work. The responses were assessed over the subject's previous 1-yr period. Each sleep feature, except daily sleeping hours, was dichotomized by the following responses: (1) taking more than 30 min to fall asleep (difficulty initiating sleep; DIS), (2) awakening during sleep almost every day (difficulty maintaining sleep; DMS), (3) early morning awakening almost every day (EMA), (4) sleeping very poorly or not so well at night, (5) definite or somewhat insufficient nightly sleep, and (6) excessive daytime sleepiness at work almost every day (EDS). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. Sickness absence was calculated by asking subjects “How many days in total have you been absent from work due to sickness, including paid vacation, in the last 1-yr period?” The responses were divided into three groups that included no (0 days) sickness absences (reference group, n = 235 subjects), 1 to 4 days (short-term, n = 199 subjects), and 5 days or more (long-term, n = 88 subjects). Compared to the prevalence of sleep features of the reference group, workers with short-term absence showed a significantly higher prevalence of EMA with an odds ratio (OR) of 5.3, 95% confidence interval (CI) 1.3–22.0. Long-term absence was significantly associated with DMS (OR = 2.1, 95%CI 1.0–4.6), EMA (OR = 5.6, 95%CI 1.0–28.7), sleeping poorly at night (OR = 2.6, 95%CI 1.4–5.0), and high depressive symptoms (OR = 2.0, 95%CI 1.0–3.7) according to the CES-D score of ≥16, after adjusting for multiple confounding variables. These data point to an association between both the parameters of poor sleep and symptoms of deep depression when self-reported sickness absence is frequent. The association is particularly strong with long-term absence in male shift workers.     

CONSEQUENCES OF SHIFTWORKING ON SLEEP DURATION,SLEEPINESS, AND SLEEP ATTACKS

Rotating shift and permanent night work arrangements are known to compromise sleep. This study examined the effects of work schedule on sleep duration, excessive sleepiness, sleep attacks, driving, and domestic/professional accidents. A representative sample of the general population of the state of New York—3,345 individuals ≥18 yrs of age—was interviewed by telephone regarding their sleep and psychiatric and organic disorders. Multivariate models were applied to derive odds ratios (OR) after adjustment for age, sex, physical illness, mental disorders, obstructive sleep apnea, and sleep duration. On average (±SE), workers slept 6.7?±?1.5?h, but 40% slept <6.5?h/main sleep episode. Short-sleep duration (<6?h) was strongly associated with fixed night (OR: 1.7) and day-evening-night shiftwork arrangement (OR: 1.9). Some 20% of the workers manifested excessive sleepiness in situations requiring high attention, and it was associated with the fixed night (OR: 3.3) and day-evening-night work arrangements (OR: 1.5). Overall, 5% of the workers reported sleep attacks; however, they occurred three-times more frequently in the fixed night (15.3%) than other work arrangements (OR: 3.2). Driving accidents during the previous 12 months were reported by 3.6% of the workers and were associated with fixed night (OR: 3.9) and day-evening-night (OR: 2.1) work schedules. The findings of this study indicate that working outside the regular daytime hours was strongly associated with shorter sleep duration, sleepiness, and driving accident risk. Night work is the most disrupting, as it is associated with insufficient sleep during the designated rest span and excessive sleepiness and sleep attacks during the span of activity, with an associated consequence being increased driving accident risk. (Author correspondence: mohayon@stanford.edu)     

Evening chronotype and sleepiness predict impairment in executive abilities and academic performance of adolescents

The study aim was to better understand sleep and sleep-related factors affecting everyday executive capacities and academic performance among healthy adolescents. A cross-sectional survey on sleep, phase preference, academic performance and executive functions of high-school students was conducted. Female gender, grade status, sleepiness and evening chronotype accounted for approximately 25–30% of the variance in daily executive ability. Sleep duration was a weak predictor of executive skills. Lower school grades were associated with increased sleepiness, evening preference and poorer executive skills. These findings support the need for health education on ways to attenuate sleepiness and delayed phase in this population.     

Symptoms of Obstructive Sleep Apnea,Gastroesophageal Reflux and the Risk of Barrett’s Esophagus in a Population-Based Case-Control Study

Background

Gastroesophageal reflux is overrepresented in people with obstructive sleep apnea (OSA) and it has been suggested that OSA worsens gastroesophageal reflux symptoms. Aggravated reflux might lead to an increased risk of Barrett’s esophagus.

Aim

To assess the association between sleep apnea symptoms and Barrett’s esophagus.

Methods

Included in a case-control study in Brisbane, Australia were 237 patients with histologically confirmed Barrett’s esophagus and 247 population controls. The controls were randomly selected from the electoral roll and frequency-matched to the cases by age and sex. Information on OSA symptoms (excessive daytime sleepiness and sleep related apnea symptoms), gastroesophageal reflux symptoms and anthropometric measures were collected through interviews and written questionnaires. Multivariable logistic regression provided odds ratios (OR) and 95% confidence intervals (CI), adjusted for potential confounding by BMI and gastroesophageal reflux.

Results

The prevalence of Barrett’s esophagus was higher among people with excessive daytime sleepiness than those without (24% vs. 18%; p-value 0.1142) and in participants with sleep-related apnea symptoms (20% vs. 13%; p-value 0.1730). However, there were non-significantly increased ORs of Barrett’s esophagus among people with excessive daytime sleepiness (OR 1.42, 95% CI 0.90–2.34) and sleep related apnea symptoms (OR 1.32, 95% CI 0.74–2.36) when adjusting for age, sex and BMI. After further adjustment for gastroesophageal reflux symptoms, the point ORs were no longer increased (OR 1.02, 95% CI 0.61–1.70 for daytime sleepiness and OR 0.72, 95% CI 0.38–1.38 for sleep related apnea symptoms).

Conclusions

Symptoms of OSA are possibly associated with an increased risk of Barrett’s esophagus, an association that appears to be mediated entirely by gastroesophageal reflux.     

Fatigue and mood correlates of sleep length in three age-social groups: School children, students, and employees

The aim of the study was to trace the consequences of insufficient sleep, in terms of chronic sleep reduction rather than acute sleep deprivation, on fatigue, mood, cognitive performance self-estimations, and daytime sleepiness in different age-social groups. The age group of the subjects reflects their social situation and their working time organization: adolescents (n = 191) obeyed the strict school schedules with starting times often before 08:00 h; university students (n = 115) had more flexible timetables; young employees (n = 126) were engaged in regular morning schedules or irregular daytime hours or day and night shifts. A questionnaire study determined the declared need of sleep, self-reported sleep length, chronic fatigue (using a scale comprised of eight fatigue symptoms and four mood and three cognitive items), and daytime sleepiness (Epworth Sleepiness Scale). The declared need for sleep decreased in subsequent age groups from 9 h 23 min in school children to 8 h 22 min in university students and to 7 h 37 min in young employees. Consequently, the discrepancy between preferred and real sleep length (sleep deficit) was the largest in adolescents: 106 min. Females showed a greater need of sleep than males (p = .025) and significantly more fatigue, mood, and cognitive problems; they also exhibited higher level of daytime sleepiness (p < .000). The sleep index (reported sleep length related to requirements) correlated significantly with all health issues in women (p < .000), while only with fatigue symptoms in men (p = .013). Actual sleep length was unrelated to mood and fatigue issues; the declared individual need of sleep and sleep index showed significant associations, especially in the group of adolescents. The most frequent complaints of adolescents included tiredness on awakening (46%), nervousness, and general weakness; university students reported excessive drowsiness (50%), tension, and nervousness; employees suffered mostly from negative moods, such as tension (49%), nervousness, and irritability. The findings of the study indicate that chronic sleep loss seems to affect females more severely than males. The associations of fatigue and mood with sleep need and sleep index were more pronounced in younger subjects. Surprisingly, fatigue symptoms in school children and university students were as frequent as in hard-working adults. Because the problem of insufficient sleep is already present in youngsters, their work time organization needs more attention.     

News and Views

We surveyed the sleep‐wake patterns and lifestyle habits in a sample of Japanese first to third year junior high school children (n=638, age 12 to 15 yrs), of whom 29.3% were evening type, 64.1% intermediate type, and 6.6% morning type in preference. The morningness‐eveningness (M‐E) score was lower (more evening typed), 16.1 vs. 15.4 in first compared to third year students. There were significant gender differences, with girls showing a greater evening preference. Evening preference was associated with longer sleep latency, shortened sleep duration during schooldays and weekends, bad morning feeling, and episodes of daytime sleepiness. In contrast, morning preference was associated with higher sleep drive and better sleep‐wake parameters and lifestyle habits. Our results suggest the morning preference should be promoted among junior high school children to increase the likelihood of more regular sleep‐wake patterns and lifestyle habits.     

Association between morningness-eveningness and behavioral/emotional problems among adolescents

Adolescent eveningness is associated with age, parental monitoring, daytime sleepiness, sleep problems, moodiness, and the use of coffee. This study investigated the association between adolescent morningness-eveningness and psychopathology, substance use, and suicidality in 1332 students ages 12 to 13. Each student-participant completed the Chinese version of the Child Morningness/Eveningness Scale (CMES), the Pubertal Development Scale, and a questionnaire about their sleep schedule, trouble sleeping, habitual substance use, and suicidality. Their mothers completed the Child Behavioral Checklist and Chinese Health Questionnaire. The morning (n = 412), intermediate (n = 740), and evening (n = 180) groups were operationally defined by the CMES t scores. The mixed model was used for data analysis. The evening group had shorter weekday sleep time, longer weekend sleep time, more daytime napping, and greater sleep compensation on weekends and was more likely than the other 2 groups to have behavioral/emotional problems, suicidality, and habitual substance use. Internalizing and externalizing problems partially explained the association between eveningness, substance use, and suicidality. The findings suggest that eveningness may be an indicator for adolescents with behavioral/emotional problems and risky behaviors and suggest an investigation for possible intervention.     

Fatigue and Mood Correlates of Sleep Length in Three Age‐Social Groups: School Children,Students, and Employees

The aim of the study was to trace the consequences of insufficient sleep, in terms of chronic sleep reduction rather than acute sleep deprivation, on fatigue, mood, cognitive performance self‐estimations, and daytime sleepiness in different age‐social groups. The age group of the subjects reflects their social situation and their working time organization: adolescents (n=191) obeyed the strict school schedules with starting times often before 08:00 h; university students (n=115) had more flexible timetables; young employees (n=126) were engaged in regular morning schedules or irregular daytime hours or day and night shifts. A questionnaire study determined the declared need of sleep, self‐reported sleep length, chronic fatigue (using a scale comprised of eight fatigue symptoms and four mood and three cognitive items), and daytime sleepiness (Epworth Sleepiness Scale). The declared need for sleep decreased in subsequent age groups from 9 h 23 min in school children to 8 h 22 min in university students and to 7 h 37 min in young employees. Consequently, the discrepancy between preferred and real sleep length (sleep deficit) was the largest in adolescents: 106 min. Females showed a greater need of sleep than males (p=.025) and significantly more fatigue, mood, and cognitive problems; they also exhibited higher level of daytime sleepiness (p<.000). The sleep index (reported sleep length related to requirements) correlated significantly with all health issues in women (p<.000), while only with fatigue symptoms in men (p=.013). Actual sleep length was unrelated to mood and fatigue issues; the declared individual need of sleep and sleep index showed significant associations, especially in the group of adolescents. The most frequent complaints of adolescents included tiredness on awakening (46%), nervousness, and general weakness; university students reported excessive drowsiness (50%), tension, and nervousness; employees suffered mostly from negative moods, such as tension (49%), nervousness, and irritability. The findings of the study indicate that chronic sleep loss seems to affect females more severely than males. The associations of fatigue and mood with sleep need and sleep index were more pronounced in younger subjects. Surprisingly, fatigue symptoms in school children and university students were as frequent as in hard‐working adults. Because the problem of insufficient sleep is already present in youngsters, their work time organization needs more attention.