Effect of Inadequate Sleep on Clinician Performance.

The negative impacts of sleep deprivation and fatigue have long been recognized. Numerous studies have documented the ill effects of impaired alertness associated with the disruption of the sleep-wake cycle; these include an increased incidence of human error-related accidents, increased morbidity and mortality, and an overall decrement in social, financial, and human productivity. While there are multiple studies on the impact of sleep deprivation and fatigue in resident physicians, far fewer have examined the effects on attending physicians, and only a handful addresses the accumulated effects of chronic sleep disturbances on acute sleep loss during a night call-shift. Moreover, the rapid and unprecedented spread of coronavirus disease 2019 (COVID-19) pandemic significantly increased the level of anxiety and stress on the physical, psychological, and the economic well-being of the entire world, with heightened effect on frontline clinicians. Additional studies are necessary to evaluate the emotional and physical toll of the pandemic in clinicians, and its impact on sleep health, general well-being, and performance.

Sleep in Residents: A Comparison between Anesthesiology and Occupational Medicine Interns.

Sleep deprivation is a significant risk to the health and judgment of physicians. We wanted to investigate whether anesthesiology residents (ARs) who work only one night shift per week have different physical and mental health from occupational medicine residents (OMRs) who do not work at night. A total of 21 ARs and 16 OMRs attending a university general hospital were asked to wear an actigraph to record sleep duration, heart rate and step count and to complete a questionnaire for the assessment of sleep quality, sleepiness, fatigue, occupational stress, anxiety, depression and happiness. ARs had shorter sleep duration than OMRs; on average, they slept 1 h and 20 min less (p < 0.001). ARs also had greater daytime sleepiness, a higher heart rate and lower happiness than OMRs. These results should be interpreted with caution given the cross-sectional nature of the study and the small sample size, but they are an incentive to promote sleep hygiene among residents.

Toxic Habits and Well-Being Measures in Spanish Healthcare University Students during the COVID-19 Pandemic.

BACKGROUND: Unhealthy lifestyles are strongly entrenched in healthcare universities and have sometimes been linked to stress or lack of sleep. This study investigated the prevalence of toxic habits (smoking, patterns of harmful alcohol use, and illicit drug use), stress levels, perceived health status, and sleep duration and assessed the connections between toxic habits and said well-being measures, as well as healthcare students' perception of the influence of the COVID-19 pandemic on these health-related behaviors. METHODS: In a cross-sectional study, healthcare students from Alfonso X University (Spain) completed a health survey composed of Alcohol Use Disorders Identification Test (AUDIT-C), Perceived Stress Scale (PSS-10), self-perceived health status, and the number of hours of sleep. RESULTS: A total of 997 healthcare students completed the survey, of which 982 were analyzed. Being a smoker (32.2%) was associated with worse health status and insufficient sleep. Risk drinkers (33.2%) were associated with being female, and the consumption of cannabinoids (6.7%), with being male. These three toxic habits were related to each other. High levels of stress (28.2%) were correlated with worse ratings in the perception of health status (29.2%) and with insufficient sleep (45.8%), and all of them were associated with the female sex. Respectively, 49.3% and 44.2% of students recognized a worsening in their perception of stress and their sleep habits during the pandemic. CONCLUSION: Healthcare universities must carry out health promotion programs for stress management, sleep habits, and unhealthy lifestyles.

Flight crew fatigue risk assessment for international flights under the COVID-19 outbreak response exemption policy.

BACKGROUND: In response to the COVID-19 outbreak, the Civil Aviation Administration of China (CAAC) has formulated Implementation Measures for Exemption of Crew Duty Periods and Flight Time Restrictions during the COVID-19 Outbreak. This exemption policy imposes temporary deviations from the approved crew duty periods and flight time restrictions for some transport airlines and regulates the use of multiple crews for continuous round-trip flights. However, no research has been conducted on flight crew fatigue under this exemption policy. That is, the exemption policy lacks theoretical analysis and scientific validation. METHODS: Firstly, flight plans for international flights under both the exemption and the CCAR-121 Policy schemes (with three flight departure scenarios: early morning, midday and evening) are designed, and flight plans are simulated based on the SAFE model. The Karolinska Sleepiness Scale (KSS) and the PVT objective test of alertness, both of which are commonly used in the aviation industry, are then selected for use in an empirical experimental study of flight crew fatigue on two flights subject to the exemption and CCAR-121 policies. RESULTS: The SAFE model simulation found that the fatigue risk results based on flight crews for flights departing in the early morning (4:00), at noon (12:00) and in the evening (20:00) indicate that the fatigue risk levels of flight crews operating under the exemption policy are overwhelmingly lower than or similar to those operating under the CCAR-121 policy. However, there were a few periods when the fatigue risk of crews flying under the exemption policy was higher than that of crews flying under the CCAR-121 policy, but at these times, the crews flying under both policies were either at a lower level of fatigue risk or were in the rest phase of their shifts. In the experimental study section, 40 pilots from each of the early morning (4:00), noon (12:00) and evening (20:00) departures operating under the exemption policy were selected to collect KSS scale data and PVT test data during their duty periods, and a total of 120 other pilots operating under the CCAR-121 policy were selected for the same experiment. First, the KSS scale data results found that flight pilots, whether flying under the exemption policy or under the CCAR-121 policy, had overall similar KSS scores, maintained KSS scores below the fatigue risk threshold (i.e., KSS score < 6) during the flights and that the empirical KSS data and the model simulation results from the KSS data were overall identical at the test nodes during the flight and had nearly identical trends. Finally, the results of the PVT objective test indicators showed that the overall change in 1/RT of the crews flying under the exemption policy was less than or similar to that of the crews flying under the CCAR-121 policy, while the maximum change in 1/RT of the crews under both policies was between 1 and 1.5. This indicates that the overall level of alertness of the crew flying under the exemption policy is higher than or similar to that of the crew flying under the CCAR-121 policy, while the change in alertness level of the crew before and after the mission is relatively small when flying under either policy. CONCLUSION: Based on the model simulation results and the results of the empirical study, it was verified that the overall fatigue risk level of flight crews operating under the exemption policy is lower than or similar to the fatigue risk level of flight crews operating under the CCAR-121 policy. Therefore, the exemption policy in response to the COVID-19 outbreak does not result in an overall increase in the level of flight crew fatigue risk compared to the original CCAR-121 policy.

Impact of the coronavirus pandemic on mental prosperity of medical care laborers in tertiary consideration hospital: A case report.

Since the outbreak of the Corona pandemic in December 2019, many people affected, especially medical care laborers, who deal with the treated cases. Coronavirus disease 2019 not only affects the body parts, but also extends to the psychological symptoms. The purpose of this research is to explore the impact of the pandemic on the mental prosperity of the laborers. Clinical staff members from the administration emergency clinic, Lahore, were enlisted. A poll was used to collect data on the segment information, a sleeping disorder, despondency and stress manifestations. Correlation of the segment information and the mental factors were done among the sleeping and non-sleeping disorder samples. All 356 medical service laborers were selected for this investigation. There were manifestations of misery in 222 (62.35%), nervousness in 227 (64.76%), stress in 197 (55.33%) and sleep deprivation in 190 (53.37%) of members. Gentle to extreme side effects of melancholy (91.65% vs 28.9%), nervousness (83.1% vs 41.6%) and stress (84.26% vs 22.22%) were seen predominately in the sleep deprivation gathering (P < .001). Insomnia was more pronounced in the members with low training levels (78.08%) versus post-advanced education (30.9%). Paramedics, attendants, and medical service laborers in confinement/serious consideration units were more inclined to the sleep deprivation (P < .001). Mental prosperity of medical care laborers was influenced because of Coronavirus pandemic. Attendants, paramedics, and those working in the detachment unit showed a critical sleeping disorder. The results and indicators have proven that there is a relationship between the infection with the Corona pandemic and occurrence of disorders in psychological behavior. Therefore, the psychological rehabilitation sessions must be conducted for those infected and those in contact with the Corona cases to relieve the burden of that patients to raise their psychological conditions and support the immune system such that resist against the infection.

PaLS Study of Sleep Deprivation and Mental Health Consequences of the COVID-19 Pandemic among University Students: A Cross-Sectional Survey.

The COVID-19 pandemic has changed the way many people live. To assess its impact on sleep quality and quantity, blue light exposure, and the mental health of Polish university students, a cross-sectional survey was conducted. Almost half of the participants were medical students (47.62%; n = 630). The majority of students were suffering from insomnia (58.13%, n = 769). Almost every third student was sleeping less than 7 h a day (30.39%, n = 402). Our study showed that a short sleep duration correlates with poorer mental health outcomes. Respondents who declared sadness and depression were more likely to suffer from insomnia (OR = 5.6997, 95% CI: 4.3641-7.4441). Difficulty with tasks was also more likely to co-occur with insomnia (OR = 5.4723, 95% CI: 4.3007 to 6.9630). The results of this study showed that the COVID-19 pandemic contributed to the deterioration of sleep quality and quantity as well as the psychological well-being of Polish students. It is important to take steps to promote proper sleeping habits to alleviate the risk of mental health disorders in this group of people.

High sleep fragmentation parallels poor subjective sleep quality during the third wave of the Covid-19 pandemic: An actigraphic study.

Studies on sleep during the Covid-19 pandemic have mostly been conducted during the first wave of contagion (spring 2020). To follow up on two Italian studies addressing subjective sleep features during the second wave (autumn 2020), here we assess sleep during the third wave (spring 2021) in a sample of healthy adults from Campania (Southern Italy). Actigraphic data (on 2 nights) and the Pittsburgh Sleep Quality Index were collected from 82 participants (40 F, mean age: 32.5 ± 11.5 years) from 11 March to 18 April 2021, when Campania was classified as a "red zone", i.e. it was subjected to strict restrictions, only slightly looser than those characterizing the first national lockdown (spring 2020). Although objective sleep duration and architecture appeared in the normal range, the presence of disrupted sleep was indexed by a relevant degree of sleep fragmentation (number of awakenings ≥ 1 min: 12.7 ± 6.12; number of awakenings ≥ 5 min: 3.04 ± 1.52), paralleled by poor subjective sleep quality (Pittsburgh Sleep Quality Index global score: 5.77 ± 2.58). These data suggest that the relevant subjective sleep impairments reported during the first wave could have relied on subtle sleep disruptions that were undetected by the few objective sleep studies from the same period. Taken together with sleep data on previous phases of the pandemic, our findings show that the detrimental effects on sleep determined by the initial pandemic outbreak have not abated across the subsequent waves of contagion, and highlight the need for interventions addressing sleep health in global emergencies.

Physical activity, screen exposure and sleep among students during the pandemic of COVID-19.

This study aimed to determine the levels of health-related behaviours (physical activity, screen exposure and sleep status) among Chinese students from primary, secondary and high schools during the pandemic of COVID-19, as well as their changes compared with their status before the pandemic. A cross-sectional online survey of 10,933 students was conducted among 10 schools in Guangzhou, China, between 8th and 15th March, 2020. After getting the informed consent from student's caregivers, an online questionnaire was designed and used to obtain time spending on health-related behaviours during the pandemic of COVID-19, as well as the changes compared with 3 months before the pandemic, which was completed by students themselves or their caregivers. Students were stratified by regions (urban, suburban, exurban), gender (boys and girls), and grades (lower grades of primary school, higher grades of primary schools, secondary schools and high schools). Data were expressed as number and percentages and Chi-square test was used to analyse difference between groups. Overall, the response rate of questionnaire was 95.3% (10,416/10,933). The median age of included students was 13.0 (10.0, 16.0) years and 50.1% (n = 5,219) were boys. 41.4%, 53.6% and 53.7% of total students reported less than 15 min per day in light, moderate and vigorous activities and 58.7% (n = 6,113) reported decreased participation in physical activity compared with the time before pandemic. Over 5 h of screen time spending on online study was reported by 44.6% (n = 4,649) of respondents, particular among high school students (81.0%). 76.9% of students reported increased screen time compared with the time before pandemic. Inadequate sleep was identified among 38.5% of students and the proportion was highest in high school students (56.9%). Our study indicated that, during the COVID-19 pandemic, the school closure exerted tremendous negative effects on school-aged children's health habits, including less physical activity, longer screen exposure and irregular sleeping pattern.

Climate change and epilepsy: Insights from clinical and basic science studies.

Climate change is with us. As professionals who place value on evidence-based practice, climate change is something we cannot ignore. The current pandemic of the novel coronavirus, SARS-CoV-2, has demonstrated how global crises can arise suddenly and have a significant impact on public health. Global warming, a chronic process punctuated by acute episodes of extreme weather events, is an insidious global health crisis needing at least as much attention. Many neurological diseases are complex chronic conditions influenced at many levels by changes in the environment. This review aimed to collate and evaluate reports from clinical and basic science about the relationship between climate change and epilepsy. The keywords climate change, seasonal variation, temperature, humidity, thermoregulation, biorhythm, gene, circadian rhythm, heat, and weather were used to search the published evidence. A number of climatic variables are associated with increased seizure frequency in people with epilepsy. Climate change-induced increase in seizure precipitants such as fevers, stress, and sleep deprivation (e.g. as a result of more frequent extreme weather events) or vector-borne infections may trigger or exacerbate seizures, lead to deterioration of seizure control, and affect neurological, cerebrovascular, or cardiovascular comorbidities and risk of sudden unexpected death in epilepsy. Risks are likely to be modified by many factors, ranging from individual genetic variation and temperature-dependent channel function, to housing quality and global supply chains. According to the results of the limited number of experimental studies with animal models of seizures or epilepsy, different seizure types appear to have distinct susceptibility to seasonal influences. Increased body temperature, whether in the context of fever or not, has a critical role in seizure threshold and seizure-related brain damage. Links between climate change and epilepsy are likely to be multifactorial, complex, and often indirect, which makes predictions difficult. We need more data on possible climate-driven altered risks for seizures, epilepsy, and epileptogenesis, to identify underlying mechanisms at systems, cellular, and molecular levels for better understanding of the impact of climate change on epilepsy. Further focussed data would help us to develop evidence for mitigation methods to do more to protect people with epilepsy from the effects of climate change.

Profiles of sleep changes during the COVID-19 pandemic: Demographic, behavioural and psychological factors.

This study aimed to evaluate changes in sleep during the COVID-19 outbreak, and used data-driven approaches to identify distinct profiles of changes in sleep-related behaviours. Demographic, behavioural and psychological factors associated with sleep changes were also investigated. An online population survey assessing sleep and mental health was distributed between 3 April and 24 June 2020. Retrospective questions were used to estimate temporal changes from before to during the outbreak. In 5,525 Canadian respondents (67.1% females, 16-95 years old: Mean ± SD = 55.6 ± 16.3 years), wake-up times were significantly delayed relative to pre-outbreak estimates (p < .001, ηp2  = 0.04). Occurrences of clinically meaningful sleep difficulties significantly increased from 36.0% before the outbreak to 50.5% during the outbreak (all p < .001, g ≥ 0.27). Three subgroups with distinct profiles of changes in sleep behaviours were identified: "Reduced Time in Bed", "Delayed Sleep" and "Extended Time in Bed". The "Reduced Time in Bed" and "Delayed Sleep" subgroups had more adverse sleep outcomes and psychological changes during the outbreak. The emergence of new sleep difficulties was independently associated with female sex, chronic illnesses, being employed, family responsibilities, earlier wake-up times, higher stress levels, as well as heavier alcohol use and television exposure. The heterogeneity of sleep changes in response to the pandemic highlights the need for tailored interventions to address sleep problems.

Sleep of preschoolers during the coronavirus disease 2019 (COVID-19) outbreak.

Coronavirus disease 2019 (COVID-19) has resulted in a significantly large number of psychological consequences, including sleep health. The present study evaluated sleep patterns, sleep disturbances, and associated factors in Chinese preschoolers confined at home during the COVID-19 outbreak. Caregivers of 1619 preschoolers (aged 4-6 years) recruited from 11 preschools in Zunyi, Guizhou province completed the Children's Sleep Habit Questionnaire (CSHQ) between 17th and 19th February 2020. Data were compared to a sociodemographically similar sample of preschoolers (included in the 11 preschools) in 2018. Compared to the 2018 sample, the confined preschoolers demonstrated changes in sleep patterns characterized by later bedtimes and wake times, longer nocturnal and shorter nap sleep durations, comparable 24-hr sleep duration, and fewer caregiver-reported sleep disturbances. Moreover, behavioural practices (sleeping arrangement, reduced electronic device use, regular diet) and parenting practices (harmonious family atmosphere and increased parent-child communication) were associated with less sleep disturbances in the confined sample. The present study provides the first description of the impact of prolonged home confinement during the COVID-19 outbreak on sleep patterns and sleep disturbances in preschoolers, as well as highlighting the importance of the link between sleep health and family factors. Given that disrupted and insufficient sleep has been linked to immune system dysfunction, our findings also have potential implications for resilience to infection in young children during the COVID-19 pandemic. Future studies should further explore deficient sleep as a risk factor for coronavirus infection.