The effects of frequently rotating shiftwork on sleep and the family life of hospital nurses

The effects of three frequently rotating shifts in an irregular sequence on the daily activities of 239 Japanese female hospital nurses were studied by the time-budget method. The nurses recorded their daily activities for several consecutive days. The questionnaire was returned by 80.8% of the participants, and recordings of 1016 days were analysed. A two-way analysis of variance clarified that the shift combination influenced the daily activities. The most distinct result was that nurses spent significantly more time on free-time activities on the day when they worked the night shift followed by the evening shift than they did on the day when they worked any other shift combination. Nurses offset sleep deprivation either by sleeping during the day before and after working the night shift (82-100%) or by sleeping 2 to 4 h later in the morning after working the evening shift and on days off. There was a strong positive correlation between total sleep time (including day sleep) and the length of the interval between two consecutive shifts (r = 0.95, p < 0.001). This result suggests that more than 16 h between work shifts is required to allow more than 7 h of total sleep time. In an analysis by household status, nurses who had young children (average age, 2.8 years) slept less and spent less time on free-time activities than did other nurses.     

Effects of sleep and circadian rhythm on human circulating immune cells

The role of nocturnal sleep for normal immune regulation and its relation to circadian rhythm was examined in 10 men participating in two 51-h sessions. One session included two regular wake-sleep cycles; the other included a night of sustained wakefulness followed by a night of recovery sleep. Blood was collected every 3 h to determine PBMC counts, including the enumeration of monocytes, NK cells, and lymphocyte subsets (CD19+, CD3+, CD4+, CD8+, HLA-DR+). Production of IL-1beta, TNF-alpha, IL-2, and IFN-gamma was determined after stimulation of whole blood samples with LPS and PHA, respectively. Concentrations of IL-6 and cortisol were assessed in plasma. Enumeration of cells indicated significant circadian rhythms for all PBMC subsets under conditions of sustained wakefulness. Compared with sustained wakefulness, nocturnal sleep acutely reduced the numbers of monocytes, NK cells, and counts of all lymphocyte subsets. However, in the afternoon and evening of the day following sleep, counts of NK cells and lymphocytes were significantly higher than after nocturnal wakefulness, indicating that effects of sleep interacted with those of the circadian pacemaker. Sleep markedly enhanced production of IL-2 by T cells (CD3+) but did not influence production of IL-1beta and TNF-alpha, or IL-6 concentrations. Effects of sleep were not mediated by changes in cortisol. The decrease in monocytes, NK cells, and lymphocytes, together with an increased production of IL-2 during sleep, may serve to support ongoing immune defense in extravascular lymphoid tissue during a time of diminished acute Ag challenge.     

Platelet alpha 2-adrenoceptors and diurnal changes of platelet aggregability in hypertensive patients

OBJECTIVE: To analyse whether platelets from hypertensive patients have an increased responsiveness to aggregating agents during morning hours and whether these changes might be related to concurrent changes in platelet membrane alpha 2-adrenoceptor characteristics, plasma catecholamine and cortisol levels, and blood pressure values. DESIGN AND METHODS: Blood samples from 14 mild-to-moderate essential hypertensive males were collected in the morning (0700-0900 h) and the evening (1900-2100 h) to determine platelet aggregability responses to adrenaline and ADP, platelet alpha 2-adrenoceptor number and binding affinity to [3H]-yohimbine, plasma catecholamines and cortisol. During the same day patients underwent 24-h ambulatory blood pressure monitoring. RESULTS: The lowest concentration of adrenaline required to induce biphasic aggregation was significantly lower in the morning than in the evening, indicating an increased morning platelet aggregability to adrenaline; the minimum ADP concentration inducing aggregation was similar in morning and evening samples. There were no significant differences between morning and evening samples in platelet alpha 2-adrenoceptor number and binding affinity. Plasma adrenaline, noradrenaline and cortisol levels were higher in the morning than in the evening, but no correlation was observed between hormonal changes and the morning increase in platelet sensitivity to adrenaline. Ambulatory blood pressure recording showed abrupt morning elevations in systolic and diastolic blood pressures over sleeping values. However, morning blood pressure readings were not significantly different from those recorded during the rest of the day and in the evening. The morning rise in mean arterial pressure displayed a significant inverse correlation with the increased platelet sensitivity to adrenaline that was observed during the same hours. CONCLUSIONS: The results indicate that the increased morning responsiveness to adrenaline that was observed in platelets obtained from hypertensive patients does not appear to be mediated by changes in the characteristics of platelet membrane alpha 2-adrenoceptors, but morning blood pressure elevations might play some role in inducing this platelet hyper-reactivity.     

Delta sleep-inducing peptide in normal humans and in patients with sleep apnea and narcolepsy

We measured morning plasma concentrations of delta sleep-inducing-peptide-like-immunoreactivity (DSIP-LI) in 9 sleep apnea patients, 10 narcolepsy patients, and 11 normal controls. Comparisons between the three groups showed no significant differences, although there was a trend toward association with low levels of DSIP-LI in the narcoleptic group, particularly in patients not using medications. No differences were found in the morning or evening plasma DSIP-LI levels in a second group of 11 normal controls and 8 sleep apneics. Our findings do not appear to support a biological marker role of disease activity for single measures of plasma DSIP in sleep apnea.     

Elevation of plasma cytokines in disorders of excessive daytime sleepiness: role of sleep disturbance and obesity

Excessive daytime sleepiness (EDS) and fatigue are frequent symptoms in the general population and the chief complaint of the majority of patients at Sleep Disorders Centers. There is evidence that the inflammatory cytokines tumor necrosis factor-alpha (TNF alpha), interleukin-1beta (IL-1beta), and IL-6 are involved in physiological sleep regulation and that their administration to humans is associated with sleepiness and fatigue. To explore whether plasma levels of TNF alpha, IL-1beta, and IL-6 are elevated in patients with EDS, we measured morning plasma levels of TNF alpha, IL-1beta, and IL-6 in 12 sleep apneics, 11 narcoleptics, 8 idiopathic hypersomniacs, and 10 normal controls. TNF alpha was significantly elevated in sleep apneics and narcoleptics compared to that in normal controls (P < 0.001 and P = 0.001, respectively). Plasma IL-1beta concentrations were not different between sleep disorder patients and controls, whereas IL-6 was markedly and significantly elevated in sleep apneics compared to that in normal controls (P = 0.028). The primary factor influencing TNF alpha values was the degree of nocturnal sleep disturbance, whereas the primary determinant for IL-6 levels was the body mass index. Our findings suggest that TNF alpha and IL-6 might play a significant role in mediating sleepiness and fatigue in disorders of EDS in humans.     

Circadian and homeostatic influences on sleep in the squirrel monkey: sleep after sleep deprivation

A series of sleep deprivation (SD) experiments were performed to examine the relative influence of circadian and homeostatic factors on the timing of sleep in squirrel monkeys free-running in constant illumination. All SDs started at the beginning of subjective night and lasted 0, 1/4, 1/2, 1, 1 1/4, or 1 1/2 circadian cycles. These six lengths represented three pairs: (0.1), (1/4, 1 1/4), (1/2, 1 1/2). Within each pair, SD ended at the same circadian phase but differed by one circadian cycle in duration. Both before and after SD, consolidated sleep (CS) episodes occurred predominantly during subjective night, even after long SDs ending at the beginning of subjective day. CS duration was strongly influenced by circadian phase but had no overall correlation with prior wake duration. Sleep loss incurred during SDs longer than 1/4 cycle was only partially recovered over the next two circadian cycles, though total sleep duration was closer to baseline levels after the second circadian cycle after SD. There was a trend toward a positive correlation between prior wake duration and the amount of NREM and delta activity measures during subjective day. Delta activity was not increased in the first 2 hours of CS after the SD. Relatively high levels of delta activity occurred immediately after the SD ended and again at the time of baseline CS onset. These data indicate that the amount of sleep and delta activity after SD in squirrel monkeys is weakly dependent on prior wake duration. Circadian factors appear to dominate homeostatic processes in determining the timing, duration and content of sleep in these diurnal primates.     

Platelets inhibit the induction of nitric oxide synthesis by interleukin-1 beta in vascular smooth muscle cells

We have investigated the role of platelets in regulating the hemostatic and vasomotor properties of vascular smooth muscle. Experiments were performed to examine the effect of the releasate from activated platelets on the production of nitric oxide from interleukin-1 beta (IL-1 beta)-treated cultured rat aortic smooth muscle cells. Treatment of vascular smooth muscle cells with IL-1 beta resulted in significant accumulation of nitrite in the culture media and in marked elevation of intracellular cyclic guanosine monophosphate (GMP) levels. The releasate from collagen-aggregated platelets blocked the IL-1 beta-mediated production of nitrite and the accumulation of cyclic GMP in smooth muscle cells in a platelet number-dependent manner. In functional assays, the perfusates from columns containing IL-1 beta-treated smooth muscle cells relaxed detector blood vessels without endothelium and the addition of IL-1 beta-treated smooth muscle cells to suspensions of platelets inhibited their thrombin-induced aggregation. The simultaneous treatment of smooth muscle cells with IL-1 beta and the platelet releasate abolished both the vasorelaxing activities of the perfusates and the inhibition of platelet aggregation. Platelet releasates treated with a neutralizing antibody to platelet-derived growth factor (PDGF) failed to block IL-1 beta-induced nitric oxide production by the smooth muscle cells, as measured by both biochemical and functional assays. The platelet releasate from a patient with gray platelet syndrome likewise failed to block IL-1 beta-induced nitrite release by smooth muscle cells. These results demonstrate that platelets downregulate the production of nitric oxide by IL-1 beta-treated vascular smooth muscle cells through the release of PDGF. This effect may represent a novel mechanism by which platelets regulate vasomotor tone and thrombus formation at sites of vascular injury.     

Effects of 42 hr of total sleep deprivation on component processes of verbal working memory.

The current investigation examined changes in working memory (WM) component processes following total sleep deprivation (TSD) in a sample of healthy young persons. Forty subjects were administered a verbal form of a continuous recognition test (CRT) before and after 42 hr of TSD. Parameters of a computational model of the CRT reflecting attention, WM span, and rate of episodic memory encoding were estimated for each individual. Subjects made more errors on the test following sleep deprivation. Analysis of model parameters revealed statistically independent declines in both the attention and WM span parameters, with a larger effect observed for the decline in WM span. Examination of individual profiles suggested that the effects of TSD on verbal WM component processes vary from person to person. Declines in global verbal WM functioning appear to be primarily driven by reduced WM span and attention; however, these effects may be individual-specific. Further applications of the computational model for examining WM component processes with sleep deprivation and other clinical populations are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Estimating sleep parameters: A multitrait-multimethod analysis.

All-night sleep recordings were obtained from 12 good sleepers and 12 sleep-maintenance insomniacs (aged 20–60 yrs) on three consecutive postadaptation nights. Ss completed a sleep diary each morning and evening. Spouses of good sleepers completed independent reports of Ss' sleep. Insomniacs reported significantly more minutes to onset of Stage 1 sleep, more minutes awake after sleep onset, and fewer awakenings than were observed in the sleep recordings. Good sleepers' self-report values for minutes to sleep onset and minutes awake after sleep onset were not significantly different from recorded values. Good sleepers reported fewer number of awakenings than were observed in the recording. Spouses of good sleepers agreed with recorded and reported estimates of minutes to sleep onset but reported significantly different values for minutes awake after sleep onset and number of awakenings. The multitrait-multimethod analysis showed that data from self- and spouse reports provided valid information for estimates of minutes to sleep onset for good sleepers and for minutes to sleep onset and minutes awake after sleep onset for insomniacs. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of sleep deprivation and other stressors on the immune and inflammatory responses of influenza-infected mice

Many stressors have well-documented effects on host immune competence. However, two important stressors that have not been extensively characterized in terms of their immune-modulatory properties are sleep deprivation and alterations in light:dark cycles. We therefore evaluated the effects of these stressors on the immune and inflammatory responses of mice inoculated intranasally with influenza virus. In contrast to a previous report, sleep deprivation did not significantly alter viral clearance or antibody titers of either virus-naive or immunized mice. Exposure to constant light also failed to affect these variables. However, repeated overnight restraint, a well-characterized stressor, reduced the pulmonary inflammatory response elicited by influenza virus, as previously reported. The data indicate that sleep deprivation and altered light cycles do not markedly influence selected host defense responses to influenza infection under the conditions tested.     

Heterogeneous effects of rapid eye movement sleep deprivation on binding to alpha- and beta-adrenergic receptor subtypes in rat brain

Quantitative receptor autoradiography was used to map alterations in binding to alpha1-, alpha2-, beta1- and beta2-adrenergic receptors throughout the brain of rats deprived of rapid eye movement sleep for 96 h. Binding of [3H]prazosin to alpha1 sites, while not significantly different in any of 46 brain regions examined, showed a clear overall tendency towards decreased values after sleep deprivation. [3H]UK-14,314-labeled alpha2 binding sites were not significantly affected by sleep deprivation in any of 91 brain regions analysed, despite a trend towards increased values. In contrast, beta-adrenergic binding was significantly reduced throughout the brain. Binding to beta1 sites labeled by [125I]iodopindolol in the presence of ICI-11855 was significantly reduced in 13 of 69 brain areas examined; binding to beta2 sites labeled by [125I]iodopindolol in the presence of CGP-20712A was likewise reduced throughout the brain and significantly so in 25 of the 72 brain areas analysed. Rank ordering of the binding changes indicated that reductions in beta1 vs beta2 binding were maximal in different brain areas. This pattern of results may reflect a particular configuration of effects specifically associated with sleep loss stress. The results are consistent with evidence of persisting noradrenergic cell activity during sleep deprivation. The observed heterogeneity of effects suggests that not all norepinephrine receptors are equally affected by rapid eye movement sleep deprivation.     

Changes in EEG power density during sleep laboratory adaptation

First- and second-night effects on the electroencephalogram (EEG) were investigated by means of polygraphic sleep recordings and all-night spectral analysis. Eighteen normal subjects were studied for three consecutive nights in a hospital sleep laboratory. Visual sleep scoring showed that there was a first-night effect in normal subjects similar to that reported previously [increased wakefulness; decreased total sleep time, sleep efficiency, and rapid eye movement (REM) sleep]. Spectral analysis of the sleep EEG revealed important changes, most of which occurred in REM sleep. Increased delta, theta, and beta1 power densities accompanied by decreased mean frequency were seen in REM sleep in the second night. On the basis of REM sleep deprivation results previously published, our data suggest that the second night could be affected by partial REM sleep deprivation that occurred in the first night. Delta and theta power density values decreased in the first non-rapid eye movement episode of nights 1 and 2; this could result from increased REM sleep pressure. The overall consistency of spectral data in the first and second night with REM sleep findings derived from visual scoring in the first night lends further support to this hypothesis. The sleep disturbance experienced during the first night in a sleep laboratory may be a useful and valid model of transient insomnia. Therefore, we conclude that data from all nights recorded should be included in assessing a subject's sleep.     

5- to 18-year follow-up study of cemented total knee arthroplasty for patients 55 years old or younger

BACKGROUND: Although both expectant mothers and expectant fathers complain of fatigue during the last trimester of pregnancy, studies have focused exclusively on mothers. This pilot study examined parents' levels of morning or evening fatigue, number of uninterrupted sleep periods and length of sleep during the last trimester of pregnancy; and the relationship of sleep to parents' reports of fatigue. METHODS: Data were collected from 24 midwestern, nulliparous couples, who completed the Visual Analog Scale for Fatigue each morning and each evening on 4 consecutive days during the last trimester. Concurrently, the couples recorded sleep and wake periods in an activity diary. RESULTS: Expectant mothers but not expectant fathers reported increasing levels of fatigue, especially morning fatigue, as the pregnancy progressed. Expectant fathers and mothers did not differ either in the night-time mean number of minutes of sleep obtained, or in the mean number of night-time uninterrupted 90-minute sleep cycles obtained. Fatigue and sleep were not significantly related for either mothers or fathers. CONCLUSIONS: These findings support the multidimensional nature of fatigue and indicate a need for perinatal health caregivers to develop individualized interventions for mothers during the last trimester of pregnancy. Fathers should also participate in future research of factors influencing the prenatal and postpartum experience.     

Dynamics of EEG spindle frequency activity during extended sleep in humans: relationship to slow-wave activity and time of day

The dynamics of EEG spindle frequency activity (SFA; spectral power density in the 12.25-15.0 Hz range) and its relationship to slow-wave activity (SWA; 0.75-4.5 Hz) were investigated in long sleep episodes (> 12 h). Young healthy men went to bed at either 19:00 h (early sleep; prior waking 36 h, n = 9) or 24:00 h (late sleep; prior waking 17 h, n = 8). In both nights, SWA in non-rapid-eye-movement sleep (NREMS) decreased over the first three to four 1.5-h intervals and remained at a low level in the subsequent five to six 1.5-h intervals. In contrast, the changes of SFA were more variable and differed between the lower (12.25-13.0 Hz), middle (13.25-14.0 Hz) and higher frequency bin (14.25-15.0 Hz). A pronounced influence of time of day was present in the lower and higher SFA bin, when the dynamics were analyzed with respect to clock time. In both the early and late sleep condition, power density in the lower bin was highest between 2:00 and 5:00 h in the morning and decreased thereafter. In the higher bin, power density was low in the early morning hours and increased as sleep was extended into the daytime hours. The results provide further evidence for a frequency-specific circadian modulation of SFA which becomes more evident at a time when SWA is low.     

Treatment of clozapine induced hypertension and possible mechanisms

The effects of physical exercises taken at different times in the day upon subjective sleep feeling were examined in five healthy university students (aged 20-22 years); morning exercise, evening exercise, and late evening exercise. The late evening exercise with the strength of 50-60% VO2max of 1 h has the effect of getting better subjective sleep feeling in the morning and the effect of the decreased daytime sleepiness.     

Effects of sleep deprivation and user interface on complex performance: a multilevel analysis of compensatory control

This study was carried out to test the compensatory control model, which predicts performance maintenance under stress at the expense of effort and increased selectivity. It examined the effects of sleep deprivation on performance in an automated process control task based on a simplified life support system with two types of operator control panel interface: machine centered (M-C), in which access to the system was scheduled by the computer, and human-centered (H-C), in which access was ad-lib. The task environment also permitted the analysis of changes in strategy and in subsidiary activities (alarm reaction time, prospective memory). In a 2 x 2 repeated-measures design, 16 participants carried out the task with each interface after both normal sleep and one night of sleep deprivation (SD). No effects of SD were observed on primary task performance. As predicted, SD effects were confined to strategy changes and subsidiary task impairment and occurred only under the (low control) M-C interface. Subjective effort was increased under SD, with greater increases of effort associated with high levels of performance protection. The findings provide strong evidence in favor of the compensatory control model and argue for the use of complex, multilevel tasks in the analysis of performance under stress. Actual or potential applications include the development of more sensitive performance-testing systems based on multilevel analysis of decrement, and the design of interfaces for shift work and other suboptimal work conditions.     

Spectral analysis in cyclic changes of human sleep evaluation

In this study cyclic changes of human sleep structure were examined. For whole-night polysomnograms of 35 healthy volunteers of both sexes, manual hypnograms were created and divided into NREM-REM cycles. EEG signals from C3-A2 derivation were analysed by computer using a Fast Fourier Transform (FFT). For consecutive NREM-REM cycles of individual sleep stages, EEG power density contents for delta, theta, alpha, sigma and beta waves were analysed. For consecutive sleep cycles, a clear decrease in NREM sleep duration, especially slow wave sleep duration, was obtained. In addition, a decrease in power density of delta waves was observed. For consecutive sleep cycles, increases in REM sleep duration and in power density of theta and alpha waves were obtained. In consecutive sleep cycles, high amplitude delta slow waves are replaced by higher frequency and lower amplitude waves. Thus stages of NREM sleep are replaced by stages of REM.     

Effect of sleep quality on symptoms of irritable bowel syndrome

A prospective, one-month diary study was conducted with 23 adult irritable bowel syndrome (IBS) patients in order to determine the relationship between IBS and the quality of sleep. Subjects were screened through history and diagnostic studies. Accepted patients then completed a daily diary of IBS symptoms and sleep quality. At baseline, most subjects (74%) characterized themselves as "poor sleepers." Using pooled time series analysis, the study found a significant correlation between morning IBS symptoms and the quality of the prior night's sleep (P < 0.001), a finding not previously reported in the literature. A less strong but still significant correlation (P < 0.05) was found between end of day IBS symptoms and the quality of sleep during the prior evening. Morning IBS symptoms seem to rise or fall in close association with the prior night's quality of sleep. The study supports the hypothesis that IBS symptoms are related to a disturbance in sleep.