Effects of two types of clothing on the day-night variation of core temperature and salivary immunoglobulin A

Circadian variations in core temperature, skin temperatures, heart rate, and salivary immunoglobulin A (IgA) were compared in subjects wearing two different types of clothing that covered, or left uncovered, their extremities. The experiments were carried out on six female subjects at an ambient temperature of 24 +/- 0.5 degrees C and relative humidity of 50 +/- 5%. One type of clothing consisted of long-sleeved shirts, full-length trousers, and socks (Type L: 1042 g, 1.048 clo); the other was half-sleeved shirts and knee-length trousers (Type H: 747 g, 0.744 clo). The main results were as follows: (i) The level of rectal temperature during night sleep was significantly lower with Type H than Type L clothing, and cosinor analysis indicated a significantly higher circadian amplitude with Type H clothing. (ii) Skin temperatures in the lower extremities increased significantly more on retiring to sleep with Type H than Type L clothing. (iii) Heart rate was significantly lower with Type H than Type L clothing during the sleep period. (iv) The day-night variation of salivary IgA showed a pattern that was the inverse of that of rectal temperature (i.e., low in the daytime and high in the nighttime), and the concentration of salivary IgA was significantly higher with Type H than Type L clothing at 02:30. (v) Subjectively, the self-assessed sleep quality was better with Type H clothing. These results suggest that clothing that leaves the extremities uncovered might be regarded as favorable at the moderate temperature since it induces good sleep and activates the immune response.     

Effects of sleeping in a chemical protective mask on sleep quality and cognitive performance

PURPOSE: We wanted to determine whether sleep is disrupted when soldiers sleep in a new chemical protective mask, the M40. Sleep quantity and quality, extent of protection provided by the mask during sleep, and next day performance were assessed. METHOD: After several days of training, 9 male soldiers slept with and without the M40 mask on four occasions. RESULTS: Soldiers were able to tolerate the mask for most or all of the night. However, sleep, as assessed by wrist-worn activity monitors, was significantly disturbed. Minutes (mean +/- SEM) of waking significantly increased, from 25 +/- 2.1 to 86 +/- 8.5 per night (p < 0.001), and number of awakenings rose from 8 +/- 0.6 to 20 +/- 0.9 (p < 0.0001). Soldiers reported that it took longer and was more difficult to fall asleep when wearing the mask. Errors on a choice reaction time task increased significantly and subjects reported greater fatigue and sleepiness the day after sleeping in the mask. Protection provided by the masks varied substantially among subjects and declined over the course of the study. Some soldiers were protected throughout the night but others were only protected intermittently. CONCLUSION: We conclude that sleeping in the chemical protective mask should only be done when necessary, given the adverse effects on sleep and daytime function, as well as the variability of protection, of the mask.     

The effects of two different kinds of quilt on human core temperature during night sleep

Effects of two kinds of quilt with different thermal insulation properties between the upper and lower halves on human core temperature during night sleep were compared at an ambient temperature of 16 degrees C and a relative humidity of 50% in five healthy adult women. One quilt has a thick part (110 mm) in the upper half and a thin part (63 mm) in the lowest half (Quilt A), and the other has a thin part (63 mm) in the upper half and a thick part (110 mm) in the lower half (Quilt B). Subjects, wearing shirts with half-sleeves and breeches, slept on a bed with sleeping mat, being fully covered by either Quilt A or Quilt B from 22:00 to 06:00. The major finding was that rectal temperature fell more quickly in Quilt B after retiring at 22:00, being kept at a lower level during one third of the whole night. We suggest that the reduced level of rectal temperature in Quilt B might be ascribed to lower thermal insulation in the upper half side of the Quilt B and partly to different core-peripheral blood redistribution in the lower extremities between the two kinds of quilt. Rapid fall and lowered level rectal temperature in Quilt B might be of significance for ease in sleep onset and sleep depth.     

A finger-tapping task and a reaction time task as behavioral measures of the transition from wakefulness to sleep: which task interferes less with the sleep onset process

The aim of this study was to assess whether a finger-tapping task (FTT), in which normal subjects repeatedly tap on a button while falling asleep, could be less disturbing and provide comparable information on the sleep onset period (SOP) with respect to a reaction-time task (RTT) to acoustic stimuli, in which the onset of sleep can be delayed by the arousing effect of the acoustic stimuli. Twelve subjects slept at their homes and six slept in a sleep laboratory for four consecutive nights. After one adaptation night and one baseline night, subjects were required to fall asleep in the third and fourth nights, bimanually performing either a RTT or a FTT. The results indicate that the FTT interfaces less with the SOP compared to the RTT and suggest that the FTT provides further advantages as a behavioral measure of the transition from wakefulness to sleep. In fact, the tapping task is associated with significantly shorter behavioral and polysomnographic sleep onset latencies and with a greater proportion of slow-wave sleep (SWS) during the transition from wakefulness to sleep compared with the RTT. Furthermore, correlations among subjective, behavioral, and electroencephalograph (EEG) latencies confirm the validity of the finger-tapping task as a behavioral measure of sleep onset.     

The effect of one night's sleep deprivation on temperature, mood, and physical performance in subjects with different amounts of habitual physical activity

Eleven healthy males were studied twice. On one occasion (control, C), they slept (night 1) and then underwent a battery of tests at 4 h intervals from 06:00 day 1 to 02:00 day 2; then, after a normal sleep (night 2), they were tested from 10:00 to 22:00 on day 2. On the second occasion (sleep deprivation, SD), the subjects remained awake during night 1. Each battery of tests consisted of measurements of tympanic membrane temperature, profile of mood states (POMS), muscle strength, self-chosen work rate (SCWR), perceived exertion, and heart rate (HR) while exercising on a stationary cycle ergometer. Subjects also kept a diary of their activities during the two days and answered a questionnaire about their habitual physical activity. Results showed a significant negative effect of sleep deprivation on most mood states on day 1, but no effect on the other variables. By day 2, mood had tended to recover, though muscle strength tended to be worse in both control and sleep-deprivation experiments. There was also a more general tendency for negative effects to be present at the end of day 1 (02:00) or at the beginning of day 2 (10:00). There was limited support for the view that subjects who were habitually more active showed less negative effects after sleep deprivation and responded less adversely to the poor sleep achieved on the university premises (night 2). These results stress the considerable interindividual variation in the responses to sleep loss and, therefore, the difficulty associated with giving general advice to individuals about work or training capability after sleep loss.     

Corneal shape changes after pars plana vitrectomy

BACKGROUND: The modern practice of using artificial light to extend waking activities into the nighttime hours might be expected to precipitate or exacerbate bipolar illness, because it has been shown that modifying the timing and duration of sleep can induce mania in susceptible individuals. With this possibility in mind, we treated a patient with rapidly cycling bipolar illness by creating an environment that was likely to increase and to stabilize the number of hours that he slept each night. METHODS: We asked the patient to remain at bed rest in the dark for 14 hours each night (later this was gradually reduced to 10 hours). Over a period of several years, his clinical state was assessed with twice-daily self-ratings, once-weekly observer ratings, and continuous wrist motor activity recordings. Times of sleeping and waking were recorded with sleep logs, polygraphic recordings, and computer-based event recordings. RESULTS: The patient cycled rapidly between depression and mania and experienced marked fluctuations in the timing and duration of sleep when he slept according to his usual routine, but his sleep and mood stabilized when he adhered to a regimen of long nightly periods of enforced bed rest in the dark. CONCLUSIONS: Fostering sleep and stabilizing its timing by scheduling regular nightly periods of enforced bed rest in the dark may help to prevent mania and rapid cycling in bipolar patients.     

Decreased epinephrine responses to hypoglycemia during sleep

BACKGROUND: In patients with type I diabetes mellitus, hypoglycemia occurs commonly during sleep and is frequently asymptomatic. This raises the question of whether sleep is associated with reduced counterregulatory-hormone responses to hypoglycemia. METHODS: We studied the counterregulatory-hormone responses to insulin-induced hypoglycemia in eight adolescent patients with type I diabetes and six age-matched normal subjects when they were awake during the day, asleep at night, and awake at night. In each study, the plasma glucose concentration was stabilized for 60 minutes at approximately 100 mg per deciliter (5.6 mmol per liter) and then reduced to 50 mg per deciliter (2.8 mmol per liter) and maintained at that concentration for 40 minutes. Plasma free insulin, epinephrine, norepinephrine, cortisol, and growth hormone were measured frequently during each study. Sleep was monitored by polysomnography. RESULTS: The plasma glucose and free insulin concentrations were similar in both groups during all studies. During the studies when the subjects were asleep, no one was awakened during the hypoglycemic phase, but during the final 30 minutes of the studies when the subjects were awake both the patients with diabetes and the normal subjects had symptoms of hypoglycemia. In the patients with diabetes, plasma epinephrine responses to hypoglycemia were blunted when they were asleep (mean [+/-SE] peak plasma epinephrine concentration, 70+/-14 pg per milliliter [382+/-76 pmol per liter]; P=0.3 for the comparison with base line), as compared with when they were awake during the day or night (238+/-39 pg per milliliter [1299+/-213 pmol per liter] P=0.004 for the comparison with base line, and 296+/-60 pg per milliliter [1616+/-327 pmol per liter], P=0.004, respectively). The patients' plasma norepinephrine responses were also reduced during sleep, whereas their plasma cortisol concentrations did not increase and their plasma growth hormone concentrations increased slightly. The patterns of counterregulatory-hormone responses in the normal subjects were similar. CONCLUSIONS: Sleep impairs counterregulatory-hormone responses to hypoglycemia in patients with diabetes and normal subjects.     

The effect of low flow oxygen on sleep-disordered breathing and oxygen desaturation. A study of patients with chronic obstructive lung disease

Oxygen desaturation occurs during sleep in many patients with chronic obstructive lung disease (COLD) and is often caused by sleep-disordered breathing (SDB). Nocturnal oxygen therapy should improve nighttime hypoxemia, but might also worsen SDB. Using standard polysomnographic techniques, we evaluated the frequency and duration of oxygen desaturation and SDB during sleep in 11 patients with stable COLD. During half of the night the patients breathed air through a nasal cannula and during the other half of the night they breathed oxygen at 2 liters per minute. Five patients had arterial lines inserted for determination of arterial blood gas levels during periods of SDB or desaturation. The ten men and one woman slept 70 minutes (52 percent of time in bed) while on air and 111 minutes (80 percent of time in bed) while on oxygen (p < 0.001). Oxygen therapy reduced the number of episodes of desaturation per hour and the time spent in desaturation. However, there was no difference between air and oxygen in episodes of SDB per hour, the duration of episodes of SDB, baseline sleeping PaCO2 or PaCO2 during episodes of desaturation or SDB. Therefore, in most patients with stable COLD, administration of oxygen at 2 liters per minute improves oxygenation, prolongs sleep, but does not adversely affect SDB.     

Early evaluation of results from systemic thrombolysis in acute myocardial infarct: the value of troponin I

STUDY OBJECTIVES: This paper compares the performance of an experimental nasal positive airway pressure device that automatically adjusts the level of applied pressure (APAP) with the performance of a conventional continuous positive airway pressure (CPAP) in a sleep laboratory study. DESIGN: In a randomized sequence, conventional CPAP therapy was applied for 1 night (CPAP night) and APAP therapy the following night (APAP night). SETTING: The study was conducted in an accredited sleep disorders center. PATIENTS OR PARTICIPANTS: Twenty-six men and 5 women between the ages of 35 to 73 (51 +/- 9.6) years with body mass index 35.82 +/- 8.35 (kg/m2) who were diagnosed (using standard nocturnal polysomnography [NPSG] methods) as having OSA syndrome were studied. The subjects were treated with conventional CPAP for approximately 8 (7.79 +/- 3.16) weeks at home prior to their participation in this study. MEASUREMENTS AND RESULTS: All standard polysomnography data and nasal mask pressures were recorded using a computer-based data acquisition system. Sleep and respiratory data were scored by a registered polysomnographer. The mean apnea-hypopnea index (AHI) for subjects for the NPSG night was 55.2 +/- 33.7. It dropped to 4.2 +/- 3.8 for the CPAP night and to 5.4 +/- 5.4 for the APAP night. There was no significant (p = 0.05) difference between mean AHI indices, sleep stages, sleep stage shifts, and snore arousals for CPAP night and APAP night. However, all the measures showed significant (p = 0.05) improvement over NPSG night. The mean of APAP applied pressure (8.4 +/- 3.3 cm H2O) was significantly (p = 0.05) lower than the prescribed pressure (11.5 +/- 3.1 cm H2O), but there was no significant (p = 0.05) difference between the maximum APAP applied pressure (12.8 +/- 4.3 cm H2O) and the prescribed pressure (11.5 +/- 3.1 cm H2O). All mean comparison tests were carried out using two-tailed statistics. CONCLUSIONS: APAP appears to be as effective as CPAP in treating OSA patients. APAP delivers the same level of therapy as CPAP, but it reduces the average airway pressure while providing needed peak pressures.     

Sleep problems of junior high school students in Taipei

The objective of this work was to study the relationship between daily sleep time and characteristics of students, e.g. grade level, gender, and academic program. A sleep habit questionnaire was designed to survey students at two junior high schools, one from northern Taipei and the other from southern Taipei. The impact of shortened duration of sleep on daily function was also evaluated. A total of 965 students and their parents were selected randomly in December 1993 for the questionnaire study. The response rate was 96.4% (930) for students and 88.6% (855) for parents. The self-reported daily sleep time of students declined, and daytime sleepiness and moodiness increased in the higher grades. The girls slept fewer hours than the boys and did not show an increase in daytime sleepiness. Those students not taking the senior high school joint entrance examination slept more hours at night and maintained more alertness in the daytime than those who were taking the examination. The more academic pressures that adolescents faced, the fewer hours they slept. Students not participating in the joint entrance examination seemed to show a healthier sleep pattern. Little sleep at night made the students feel sleepy in the daytime and tired, drowsy, moody and difficult at arising in the morning. The reason why girls slept less than boys needs further investigation.     

Effect of flurenizide on adaptive reactions in patients with chronic obstructive pulmonary disease

Studies on the wake-sleep cycle with participation of eight female volunteers were performed before, during, and after a 120-day bed rest with the head-end of bed tilted down at 6 degrees (HDT). Methods of polysomnography and actography were applied. The test-subjects were assigned into 2 groups. Group A was prescribed to use countermeasures throughout the experiment; no countermeasures was administered by group B. Evidence of significant alteration in sleep structure at different time points in HDT is given in comparison with data about females of the control group under the conditions of everyday activity. Sleep deviations in the subjects were reordered at each of the three points of investigation and differed from those in control. HDT was shown to modify the sleep structure in experimental groups A and B. A supposition is made that under these conditions the dynamics of physical activity during night sleep had an adaptive character.     

Auto-CPAP treatment in obstructive sleep apnea syndrome: a prospective randomized study during initiation of treatment

OBJECTIVE: The efficacy and acceptance of self-regulated continuous positive airway pressure (auto-CPAP) ventilation was compared with conventional CPAP administration in the treatment of patients with obstructive sleep apnoea. PATIENTS AND METHODS: Using a cross-over design, under polysomnographic monitoring in a sleep laboratory, 25 patients with obstructive sleep apnoea underwent conventional CPAP or auto-CPAP treatment. Using a questionnaire, patients gave their assessment of its acceptability and efficacy after each treatment session. RESULTS: The mean pressure during treatment was the same in the two groups (7.2 +/- 1.9 versus 7.1 +/- 1.9 mbar; no significant difference). Maximal pressure during auto-CPAP averaged 3.7 +/- 2.1 mbar higher than during conventional CPAP ventilation. The mean apnoea-hypopnoea index (AHI) during auto-CPAP, 4.4 +/- 4.3 mbar, during auto-CPAP was significantly higher than during conventional CPAP treatment (2.8 +/- 2.8 mbar; P = 0.044). In eight patients on auto-CPAP an AHI of 5 or less could not be reached, while an AHI of 5 or less was obtained in all but three patients under conventional CPAP. In a subgroup of 17 patients, in whom a reduction of AHI to at most 5 was achieved with both conventional and auto-CPAP, analysis of sleep pattern and of arousals was similar with the two forms of ventilation. Several patients reported that with auto-CPAP falling in sleep was more difficult and they slept less well. None of the patients preferred auto-CPAP. CONCLUSION: By means of the auto-CPAP neither a pressure reduction nor an improvement in compliance could be achieved. Therapeutic effectiveness was significantly less as with conventional CPAP therapy.     

Stability, controllability and observability of arterial circulation

Six subjects exercised on a bicycle ergometer at 60-70% of maximal aerobic power in a 25 degrees C ambient. Experiments on each subject were conducted at night (4:00-5:30 A.M.) and in daytime (noon-4:30 P.M.). Chest sweating rate (msw) was measured with resistance hygrometry. Forearm blood flow (BF), with an arm skin temperature of 35.5 +/- 1.2 degrees C (SD), was measured with electrocapacitance plethysmography. Esophageal temperature (Tes) was measured with a thermocouple at the level of the left atrium, and mean skin temperature (Tsk) was calculated from a weighted average of temperatures at three sites. Tes was corrected to a skin temperature of 33 degrees C as follows: T'es = Tes + (Tsk - 33 degrees C)/8. This correction reflects the relative contributions of Tes and Tsk to control of msw:T'es and BF:T'es relations were not consistently changed. In any given subject, thresholds for sweating and vasodilation were shifted about equally. These shifts averaged 0.57 degrees C (range: 0.23-0.93 degrees C)for msw and 0.63 degrees C (range: 0.17-0.98 degrees C) for BF.     

Circadian and ultradian variations of leptin in normal man under continuous enteral nutrition: relationship to sleep and body temperature

To determine the influence of circadian rhythmicity and sleep on the 24-h leptin diurnal variations, plasma leptin levels were measured at 10-min intervals over 24 h in seven normal subjects, once during nocturnal sleep, and once after an 8-h shift of sleep. The subjects were submitted to constant conditions (continuous enteral nutrition and bed rest in controlled chambers). Body temperature and plasma glucose and insulin levels were measured simultaneously. During nighttime sleep, leptin levels increased to a maximum (109.9 +/- 2.5% of the 24-h mean) and then decreased to reach a nadir in the late afternoon. The mean diurnal variation was 18.0 +/- 3.8% of the 24-h mean. In the daytime sleep condition, leptin levels rose during the night of deprivation to a maximum of 104.7 +/- 2.3% of the 24-h mean, decreased to a minimum around 0700 h, and then rose again during diurnal sleep (108.4 +/- 3.1% of the 24-h mean); the mean diurnal variation was 13.4 +/- 3.6% of the 24-h mean. ANOVA revealed a significant interaction between time of day and sleep effects (P < 0.05). The diurnal and the sleep-related variations of plasma leptin mirrored those of body temperature and roughly paralleled those of plasma glucose and insulin; the amplitudes of the diurnal leptin variations were significantly correlated with the amplitudes of the diurnal body temperature variations (P < 0.05). Plasma leptin levels also displayed irregular pulses of low amplitude (mean duration, 70 min) that were not affected by sleep, but were associated with a significant decrease in glucose and insulin levels (P < 0.01). These results demonstrate that under continuous enteral nutrition, plasma leptin levels are modulated by both a slight circadian component and sleep, which interact under normal conditions, and suggest that leptin is implicated in circadian thermoregulatory adjustments.     

A controlled study of additional sr-L-dopa in L-dopa-responsive restless legs syndrome with late-night symptoms

OBJECTIVE: To investigate whether a combination treatment of regular-release levodopa (rr-L-dopa) and sustained-release levodopa (sr-L-dopa) compared with monotherapy of rr-L-dopa improves sleep quality and reduces periodic limb movements (PLM) in patients with restless legs syndrome (RLS) and problems with maintaining sleep. BACKGROUND: Reappearance of RLS symptoms during the second half of the night while being treated with rr-L-dopa is a common problem in the treatment of sleep disturbances caused by RLS. METHODS: A randomized, controlled, double-blind crossover trial was undertaken. Eligible patients fulfilled the diagnostic criteria of the International RLS Study Group, and met an actigraphically confirmed higher number of PLM per hour time in bed (PLM index) during the second half compared with the first half of the night under treatment with rr-L-dopa. During the crossover periods the patients received 100 to 200 mg rr-L-dopa plus either placebo or 100 to 200 mg sr-L-dopa at bedtime for 4 weeks each period. RESULTS: Thirty patients with RLS (11 men and 19 women) were assessed by actigraphy and subjective sleep quality, and showed a significant improvement in PLM index (p < 0.0001), in "time in bed without movements" (p < 0.0001), and in subjective sleep quality (p < 0.001). Eight of 30 patients reported an altered pattern of RLS symptoms, characterized by a time shift of RLS symptoms into the afternoon or evening, five of these during monotherapy with rr-L-dopa. CONCLUSIONS: A combination therapy of rr-L-dopa and sr-L-dopa is better than monotherapy with rr-L-dopa in reducing the frequency of PLM and problems maintaining sleep, even in patients who are severely affected.     

Oliguria, an unusual presentation of primary signet ring-cell adenocarcinoma of the urinary bladder: a case report and review of the literature

OBJECTIVE: To evaluate whether improved nasal breathing changes the quality of life in snoring men and improves the female sleeping partners' well-being in the morning. DESIGN: During 1 month, 42 heavily snoring men slept with a nostril dilator. Before and after 1 month, the snorers rated their daytime tiredness and completed the Nottingham Health Profile questionnaire. Female sleeping partners rated the snoring, the quality of their sleep, and their sense of well-being in the morning. A population sample was used for comparison. SETTING: The Central Hospital, Sk?vde, Sweden. RESULTS: The snorers' quality of life before the study was significantly worse (P<.001) than that of the comparison population and improved significantly (P = .001). The men were significantly (P<.001) less tired during the day when their nasal airflow was increased. Female sleeping partners had significantly (P = .005) better sleep and an improved sense of well-being in the morning during the test period. Both were correlated with a significant reduction in the snoring (P<.001). CONCLUSIONS: When nasal breathing of snoring men was improved at night, their quality of life was significantly improved. The female sleeping partners had a reduction in sleep disturbance that correlated well with an improvement in their own sleep and feelings of well-being in the morning.     

Spontaneous platelet activation and aggregation during obstructive sleep apnea and its response to therapy with nasal continuous positive airway pressure. A preliminary investigation

STUDY OBJECTIVE: To determine whether alterations of platelet reactivity occur during obstructive sleep apnea (OSA) and, if so, whether therapy with nasal-continuous positive airway pressure (N-CPAP) alters this reactivity. DESIGN: Patients with suspected moderate to severe OSA had blood drawn for spontaneous platelet aggregation (sAGG) and activation (sACT) measurements at hourly intervals during diagnostic polysomnography (PSG) and, in those with confirmed OSA, on a separate night during which N-CPAP was applied. SETTING: Tertiary care center sleep laboratory. PATIENTS: Six patients with OSA had matched blood samples drawn on both diagnostic and N-CPAP treatment nights. Five patients without confirmed OSA served as controls. INTERVENTIONS: N-CPAP was applied to those patients with OSA and pressures adjusted with goals of eliminating apneas; N-CPAP was then maintained through the night. MEASUREMENTS AND RESULTS: sACT and sAGG were measured using flow cytometric determination of P-selectin expression using a monoclonal antibody. Platelet aggregation was assessed by measuring the proportion of platelets larger than resting platelets by light scatter techniques. Mean values for sACT and sAGG were higher on the diagnostic night compared with treatment night (p = 0.001 and p = 0.003, analysis of variance, respectively). The mean baseline supine sACT compared with completion supine sACT for both diagnostic and N-CPAP nights also revealed significant differences (mean = 16.6 +/- 3.5% vs 36.9 +/- 7.5%, p = 0.04; and 11.9 +/- 3% vs 39.5 +/- 9.1%, p = 0.04). Platelet activation during sleep in five subjects without OSA resembles that found in patients with OSA during N-CPAP. CONCLUSIONS: Increased platelet sACT and sAGG occur during sleep in patients with OSA. This effect is greatly reduced by N-CPAP.     

Mood and sleep in aging women.

Examined the possible covariations of mood and sleep in a 5-yr follow-up of 25 normal, aging women (aged 56–66 yrs) who had originally participated in the 2nd author's (1982) study. Ss slept in the laboratory for 4 nights. Wiring for EEG recording began at 10:00 PM and a mood inventory was administered at 10:30 PM on the last 3 nights. Ss went to sleep at 11:00 PM, and EEG recording was continuous from bedtime until wake-up the following morning. Results show that mood assessments were independently related to both before and after sleep night. Only 2 sleep variables, sleep efficiency and latency to 1st REM period, were reliably related to daytime moods. The relative paucity of relation between mood and sleep variables was interpreted as reflecting a general insulation of sleep from day-to-day mood variations. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.     

Residual effect of nCPAP applied for part of the night in patients with obstructive sleep apnoea

The aim of the present study was to assess whether nasal continuous positive airway pressure (nCPAP) treatment, applied for only a few hours at the beginning of the night, has any residual effect on sleep and breathing during the ensuing hours of unassisted sleep in patients with obstructive sleep apnoea syndrome (OSAS). In 27 patients with newly-diagnosed OSAS, effective nCPAP was applied during the first part of the night and then withdrawn. Polysomnographic parameters after nCPAP withdrawal were compared with those of the corresponding part of the diagnostic polysomnography performed a few days or weeks before and with those of the first part of night on nCPAP. After 255+/-63 (mean+/-SD) min of sleep with normalization of sleep and breathing parameters under nCPAP, there was partial improvement of OSAS severity during the remaining 124+/-56 min of nocturnal sleep without treatment; mean oxygen saturation, desaturation index (equivalent to the apnoea/hypopnoea index) and movement arousal index all improved significantly with respect to the diagnostic night (p=0.001). This improvement was not accounted for by a change in sleep architecture. We conclude that there is an improvement in severity of obstructive sleep apnoea syndrome after only 4 h of nasal continuous positive airway pressure. This carryover effect could explain why a number of patients with obstructive sleep apnoea syndrome apply nasal continuous positive airway pressure for only part of the night or not every night.