Periodic psychological examination of train drivers' fitness in Belgium: deficits observed and efficacy of the screening procedure.

OBJECTIVE: We report on a procedure for early detection of individual psychological deficits that adversely influence cognitive driving abilities in train drivers. METHODS: Records of 1266 train drivers sent for recertification examination in 2012 and 2013 were reviewed. Performance on attention and memory tests in the first step of the procedure, and results of extended psychological examination for those not succeeded, are described. RESULTS: Nine percent of train drivers were referred for extended psychological examination; 1.5% was considered unfit for driving. Most frequently, the background was a sleep disorder, intolerance for irregular working hours, psychosocial stress, and depression. CONCLUSIONS: Periodic psychological examinations allow the detection of relevant deficits in functioning in a substantial portion of train drivers. The stepwise procedure adds to the feasibility of such examinations in large groups of professional drivers.

Field study on the impact of nocturnal road traffic noise on sleep: the importance of in- and outdoor noise assessment, the bedroom location and nighttime noise disturbances.

The aim of this field study is to gain more insight into the way nocturnal road traffic noise impacts the sleep of inhabitants living in noisy regions, by taking into account several modifying variables. Participants were tested during five consecutive nights in their homes and comparisons between effective indoor and outdoor noise levels (LAeq, LAmax, number of noise events), sleep (actigraphy and sleep logs) and aspects of well-being (questionnaires) were made. Also, we investigated into what extent nocturnal noise exposure - objectively measured as well as perceived - directly relates to sleep outcomes and how the bedroom location influenced our measurements. We found that subjects living and sleeping in noisy regions correctly perceive their environment in terms of noise exposure and reported an overall discomfort due to traffic noise. In the evaluation of the objective noise levels, the inside noise levels did not follow the outside noise levels, though the different noise patterns could be described as characteristic for a noise and quiet environment. The impact on sleep, however, was only modest and we did not find any influence of noise intrusion on mood or pre-sleep arousal levels. Concerning the subjectively reported noise disturbances during the night, a clear relationship between noise and sleep outcomes could be established; with sleep onset latencies and judged sleep quality being particularly affected. The importance of inside and outside noise assessment as well as the use of multiple noise indicators in a home environment is further described. Additional emphasis is put on the determination of quiet control regions and the bedroom location, as this can alter noise levels and sleep outcomes. Also, including subjective noise evaluations during the night might not only provide crucial information on how participants experience the noise, but also allows for a more qualitative interpretation of the actual noise situation.

Effects of pre-sleep media use on sleep/wake patterns and daytime functioning among adolescents: the moderating role of parental control.

The aim of this cross-sectional study was to investigate the influence of media use in the hour before bedtime on sleep/wake patterns and daytime functioning among adolescents and to examine the moderating role of parental control. A total of 1,926 Belgian students, 55% girls and 45% boys, with a mean age of 16.9 ± 1.5 years, completed a modified version of the School Sleep Habits Survey. Correlational analyses showed that media use, except television viewing, was associated with later bedtimes and longer sleep latencies. Cell phone and computer usage was negatively associated with daytime functioning. On schooldays, parental control had a moderating effect on the relationship between bedtime and computer use (ß = .05; p < .05) and between bedtime and mp3 player use (ß = .08; p < .01). During the weekend, parental control played a moderating role between bedtime and television viewing (ß = .06; p = .01). As media use can influence the sleep of adolescents considerably, parental control is necessary to regulate the exposure of adolescents to media and to moderate the detrimental effect of media use on sleep.

Excitatory versus inhibitory impairments in insomnia patients: an ERP study.

According to the neurocognitive perspective on insomnia, conditioned arousal results in impairment of information processing, as such interfering with normal sleep processes. In the present study, evening event-related potentials N100 and P200 were evaluated to assess hyperarousal in patients with insomnia and controls. 13 patients (mean age = 40.8) with polysomnographically verified sleep disruptions and 11 good sleepers (mean age = 45.4) were included. An auditory oddball paradigm was administered the evening of the polysomnography. N100 and P200 mean amplitudes and peak latencies at Fz and Cz were analyzed as a measure of respectively general arousability and inhibition of information processing. Patients experiencing insomnia were characterized by decreased P200 amplitudes compared to good sleepers. No significant differences were found for N100 amplitudes and latencies of both ERP waves. These results suggest that this group of patients with objectified insomnia is characterized by an arousal impairment. However, there was no evidence of hyperarousal, considering the normal N100 amplitudes. On the other hand, the inhibition of information processing was distorted. As such, the impairment of de-arousal or de-activation in insomnia is put forward as an additional factor within the arousal model.

Sleepiness phenomics: modeling individual differences in subjective sleepiness profiles.

The present study investigates individual differences in subjective sleepiness profiles during 36 h of sustained wakefulness in a modified constant routine protocol. Twenty-three volunteers (11 females), aged between 18 and 47 yrs (M age = 30.41, SD = 10.26) enrolled in the study. Subjective sleepiness ratings were collected every 2 h by means of visual analogue scales. Circadian rhythmicity was assessed by means of salivary cortisol. Subjective sleepiness data were analyzed using functional principal component analysis (fPCA). Our results show that approximately 80% of the variance is accounted for by three functional components. The first component explains 50.28% of the variance and is characterized by a profile of exclusively positive loadings, representing vertical shifts from the mean sleepiness profile. Scores on this component are positively related to self-reported habitual sleep times and mean slow wave activity (SWA) during wake. Positive scores on the second component (18.40% of the variance) are characterized by a higher than average peak-to-trough amplitude in subjective sleepiness profiles. Participants with higher than average scores on this component show a significantly higher amplitude in salivary cortisol profiles as opposed to participants with lower than average scores. Participants with positive scores on the third component (10.09% of the variance) show higher than average levels of subjective sleepiness during morning hours, a buildup of wake effort occurring later and more afternoon sleepiness after sleep deprivation than negative scorers. Peak levels of salivary cortisol occur significantly later in these participants. Taken together, our results suggest that component 1 represents tonic differences in sleepiness profiles primarily related to mechanisms of sleep homeostasis, component 2 to circadian amplitude differences and component 3 to diurnal preference. However, since the components are additions to a mean profile, each of the three components is likely to correspond to a mixture of multiple physiological parameters, rather than to a single process. The approach shows interesting potential for (1) revealing unidentified physiological processes, (2) testing existing assumptions about regulatory mechanisms at the basis of interindividual variability in sleepiness profiles and (3) the specification of sleepiness phenotypes on a quantitative basis.

Effects of pre-sleep simulated on-call instructions on subsequent sleep.

Nightly interventions, prevalent to on-call situations, can have negative consequences for those involved. We investigated if intervention-free-on-call-nights would also mean disturbance-free-sleep for people on-call. 16 healthy sleepers spent three nights in the laboratory: after a habituation night, reference and on-call night were counterbalanced. Subjects were instructed to react to a sound, presented at unpredictable moments during the night. Participants were unaware of the fact that the sound would never be presented. These vigilance instructions resulted in more subjective wake after sleep onset (WASO), lower subjective sleep efficiency and significantly lower experienced sleep quality. Objectively, a longer sleep onset, an increased amount of WASO and significantly lower sleep efficiency were observed. During deep sleep, significantly more beta activity was recorded. Apart from real nightly interventions increased vigilance during the night causes sleep to be less efficient and less qualitative as shown by an increase in wake-activity and a distorted sleep perception.

The influence of pre-sleep cognitive arousal on sleep onset processes.

Cognitive hyperarousal, resulting in enhanced cognitive activation, has been cited as an important contributor to the development and preservation of insomnia. To further understand this process, our study examined the effects of acutely-induced pre-sleep cognitive hyperarousal on sleep onset processes in healthy volunteers. Following an adaptation night, 15 subjects slept two nights in our sleep laboratory: one reference night and another one with cognitive arousal induction, in a counterbalanced order. In the cognitive arousal condition, subjects worked through half an hour of cognitive tasks without interference of an emotional component prior to retiring to bed. Objective sleep onset latency was significantly prolonged in the cognitive arousal condition compared to the reference condition. Significantly more high frequency activity was recorded during the first and second deep-sleep period. Moreover, differences in heart rate and proximal temperature during and after sleep onset were observed in the nights after the cognitive induction. Pre-sleep cognitive activation successfully induced a significant cognitive load and activation in our subjects to influence subsequent sleep (onset) processes.

Elevated variance in heart rate during slow-wave sleep after late-night physical activity.

This study investigates the effect of mild physical activity before bedtime on the sleep pattern and heart rate during the night. Nine healthy subjects underwent a habituation night, a reference night, and a physical induction night. The physical induction night did not alter the sleep pattern. Physical activity before bedtime resulted in higher heart rate variance during slow-wave sleep. The low-frequency/high-frequency component (LF/HF) ratio during slow-wave sleep in the physical induction night was significantly higher than during the reference night. Increased mean heart rate and higher LF/HF ratio are related to decreased parasympathetic dominance. Exercise up to 1 h before bedtime thus seems to modify the quality of sleep.

Ergonomics in bed design: the effect of spinal alignment on sleep parameters.

This study combines concepts of bed design and sleep registrations to investigate how quality of spine support affects the manifestation of sleep in healthy subjects. Altogether, 17 normal sleepers (nine males, eight females; age 24.3±7.1 years) participated in an anthropometric screening, prior to the actual sleep experiments, during which personalised sleep system settings were determined according to individual body measures. Sleep systems (i.e. mattress and supporting structure) with an adjustable stiffness distribution were used. Subjects spent three nights of 8 h in bed in the sleep laboratory in a counterbalanced order (adaptation, personalised support and sagging support). During these nights, polysomnography was performed. Subjective sleep data were gathered by means of questionnaires. Results show that individual posture preferences are a determinant factor in the extent that subjects experience a negative effect while sleeping on a sagging sleep system. STATEMENT OF RELEVANCE: This study investigated how spine support affects sleep in healthy subjects, finding that the relationship between bedding and sleep quality is affected by individual anthropometry and sleep posture. In particular, results indicate that a sagging sleep system negatively affects sleep quality for people sleeping in a prone or lateral posture.

Nocturnal road traffic noise: A review on its assessment and consequences on sleep and health.

Research on the impact of nocturnal road traffic noise on sleep and the consequences on daytime functioning demonstrates detrimental effects that cannot be ignored. The physiological reactions due to continuing noise processing during night time lead to primary sleep disturbances, which in turn impair daytime functioning. This review focuses on noise processing in general and in relation to sleep, as well as methodological aspects in the study of noise and sleep. More specifically, the choice of a research setting and noise assessment procedure is discussed and the concept of sleep quality is elaborated. In assessing sleep disturbances, we differentiate between objectively measured and subjectively reported complaints, which demonstrates the need for further understanding of the impact of noise on several sleep variables. Hereby, mediating factors such as noise sensitivity appear to play an important role. Research on long term effects of noise intrusion on sleep up till now has mainly focused on cardiovascular outcomes. The domain might benefit from additional longitudinal studies on deleterious effects of noise on mental health and general well-being.

Heart rate-based nighttime awakening detection.

Sleep fragmentation is a cause of impaired daytime performance. We have developed an algorithm for detection of nighttime awakenings based on heart rate. As much as 15 healthy normal sleepers, 23 +/- 3 years, participated in this study. The dataset contains 33 nights of polysomnographic (PSG) and electrocardiographic (ECG) measurements. After a habituation night, the subjects underwent a reference night without interventions, followed by some nights with interventions. These included noise, light, physical and cognitive interventions. Nighttime awakenings were subdivided in to awakenings (>15 s) and short awakenings (<15 s). The overall number of awakenings was 18.5 (+/-10.5) and short awakenings 13.2 (+/-10.5). The number of nighttime awakenings did not differ significantly between the reference and intervention nights; a repeated measures ANOVA resulted in a p value of 0.66 for awakenings and 0.57 for short awakenings. As much as 5 reference nights were used as training set, 28 as validation set. The algorithm detects the awakening periods with a sensitivity of 80.5% (confidence interval 77.9-82.9%). Heart rate is an adequate measure that allows for detection of nighttime awakenings and hence sleep quality.

An exploratory study on the effects of tele-neurofeedback and tele-biofeedback on objective and subjective sleep in patients with primary insomnia.

Insomnia is a sleeping disorder, usually studied from a behavioural perspective, with a focus on somatic and cognitive arousal. Recent studies have suggested that an impairment of information processes due to the presence of cortical hyperarousal might interfere with normal sleep onset and/or consolidation. As such, a treatment modality focussing on CNS arousal, and thus influencing information processing, might be of interest. Seventien insomnia patients were randomly assigned to either a tele-neurofeedback (n = 9) or an electromyography tele-biofeedback (n = 8) protocol. Twelve healthy controls were used to compare baseline sleep measures. A polysomnography was performed pre and post treatment. Total Sleep Time (TST), was considered as our primary outcome variable. Sleep latency decreased pre to post treatment in both groups, but a significant improvement in TST was found only after the neurofeedback (NFB) protocol. Furthermore, sleep logs at home showed an overall improvement only in the neurofeedback group, whereas the sleep logs in the lab remained the same pre to post training. Only NFB training resulted in an increase in TST. The mixed results concerning perception of sleep might be related to methodological issues, such as the different locations of the training and sleep measurements.

Simulator driving performance, subjective sleepiness and salivary cortisol in a fast-forward versus a slow-backward rotating shift system.

OBJECTIVES: The objectives of this study were to examine simulator driving and subjective sleepiness after morning, afternoon, and night shifts and to compare these differences, as well as objective stress, between a fast-forward and a slow-backward rotating shift system. METHODS: The participants were male volunteers working in a chemical plant, 18 in a slow-backward rotating system and 18 in a fast-forward rotating system. All of the participants performed a driving simulator test and subjectively estimated sleepiness after a night, afternoon, and morning shift. Salivary cortisol samples, as indicators of the objective stress level, at the beginning of the workweek-after the second morning shift-were compared between the two rotating shift systems. RESULTS: Lane drifting was higher after a night shift than after an afternoon shift. No effect of rotation system on driving performance could be shown. The subjective sleepiness scores were significantly higher in the slow-backward rotating group than in the fast-forward rotating group. A significant effect of shift type was also observed, with lower levels of sleepiness after the afternoon shift than after the morning and night shifts. Salivary cortisol samples taken at the start of the workweek did not significantly differ between the fast-forward and the slow-backward rotation shift systems. CONCLUSIONS: This study indicated that shift type is more important than shift schedule-direction and speed of rotation-in determining driving performance. Performance seemed to be threatened mostly by a night shift and the least by an afternoon shift. In contrast, subjective sleepiness also differed between rotation groups and indicated an advantage of the fast-forward rotation system. The exploratory salivary cortisol measurements suggested that the shift systems studied do not differ in the level of stress they induce, that is to say at the beginning of the workweek.

Individualized and time-variant model for the functional link between thermoregulation and sleep onset.

This study makes use of control system model identification techniques to examine the relationship between thermoregulation and sleep regulation. Specifically, data-based mechanistic (DBM) modelling is used to formulate and experimentally test the hypothesis, put forth by Gilbert et al., that there exists a connection between distal heat loss and sleepiness. Six healthy sleepers each spent three nights and the following day in the sleep laboratory: an adaptation, a cognitive arousal and a neutral testing day. In the cognitive arousal condition, a visit of a television camera crew took place and subjects were asked to be interviewed. During each of the three 25-min driving simulator tasks per day, the distal-to-proximal gradient and the electroencephalogram are recorded. It is observed from these experimental data that there exists a feedback connection between thermoregulation and sleep. In addition to providing experimental evidence in support of the Gilbert et al. (2004) hypothesis, the authors propose that the nature of the feedback connection is determined by the nature of sleep/wake state (i.e. NREM sleep versus unwanted sleepiness in active subjects). Besides this, an individualized and time-variant model for the linkage between thermoregulation and sleep onset is presented. This compact model feeds on real-time data regarding distal heat loss and sleepiness and contains a physically meaningful parameter that delivers an individual- and time-depending quantification of a well known biological features in the field of thermoregulation: the thermoregulatory error signal T(hypo)(t)-T(set)(t). A validation of these physical/biological features emphasizes the reliability and power of DBM in describing individual differences related to the sleep process.

Effect of cognitive arousal on sleep latency, somatic and cortical arousal following partial sleep deprivation.

Emerging research has shown that sleepiness, defined as the tendency to fall asleep, is not only determined by sleep pressure and time of day, but also by physiological and cognitive arousal. In this study we evaluated (i) the impact of experimentally induced cognitive arousal on electroencephalogram (EEG) defined sleep latency, and subjective, somatic and cortical arousal, and (ii) whether experimentally induced cognitive arousal enhances performance on a driving simulator test. Twelve healthy sleepers each spent three nights and the following day in the sleep laboratory: an adaptation, a cognitive arousal and a neutral testing day. In the cognitive arousal condition, a visit of a television camera crew took place and subjects were asked to be interviewed. On each testing day, a 5-min heart rate recording, subjective sleepiness and arousal scales, Multiple Sleep Latency Test and a 25-min driving simulator task were scheduled three times at 2-h intervals. Experimentally induced cognitive arousal resulted in significant increases in objective sleep latency. Significantly elevated levels of subjective and somatic arousal--as indexed by a subjective arousal scale and heart rate--were also evidenced following cognitive arousal induction. A marginally significant trend for increased cortical arousal, measured by EEG beta activity, was also found. No effects were found on driving simulator performance. These findings support the concept of cognitive arousal as a significant component in determining sleep latency. In addition, it was illustrated that cognitively induced arousal can provoke increases in somatic and possibly even cortical arousal in normal sleepers. However, this was not accompanied by an enhanced ability to perform adequately on a driving simulator test.

Effects of slow-release caffeine and a nap on driving simulator performance after partial sleep deprivation.

A driving simulator was used to evaluate the effectiveness of a 30-min. nap and 300-mg slow-release caffeine as countermeasures to drivers' sleepiness induced by partial sleep deprivation. 12 participants were allowed 45 hr. time in bed at the laboratory. Driving performance then was measured twice--at 9 a.m. and at 1 p.m.--by a 45-min. driving task on a simulator. Subjective sleepiness/alertness and mood were assessed four times on the Stanford Sleepiness Scale and the Profile of Mood States. Driving performance was assessed as Lane Drifting, Speed Deviation, and Accident Liability. A 30-min. nap opportunity and 300 mg of slow-release caffeine both were successful in counteracting drivers' sleepiness. The remedial effect of slow-release caffeine lasted longer than that of the nap, that is, it was also effective in the afternoon session. This suggests that slow-release caffeine represents a valuable countermeasure that, in the case of partial sleep deprivation, is preferred to a nap when sleepiness has to be counteracted for a longer time.

Daytime sleepiness and its evaluation.

Basic models of sleepiness, focusing on the homeostatic and circadian components of sleepiness, are able to predict important fluctuations of sleepiness. However, they fail in explaining certain sleepiness phenomena, as for instance in insomnia patients. To meet this shortcoming, modern models incorporate the arousal component of sleepiness, in addition to the sleep drive. While these models mainly concentrate on short-term changes in sleepiness, "state" sleepiness, there are indications that a stable characteristic level of sleepiness, "trait" sleepiness, is also an important determinant of a person's level of sleepiness. This leads to a conceptualization of sleepiness in which situational factors modify a basal level of sleep drive and arousal. It implies that sleepiness is not a unitary concept and can reflect essentially different states. Multiple sleepiness assessment tools have been proposed in the past. The majority of them offer valuable information, but they do not grasp all aspects of sleepiness. We should bear in mind that tools for assessing sleepiness are always operationalizations reflecting the theoretical framework the investigator has on sleepiness. Hence, rather than searching for a gold standard for the measurement of sleepiness, future research effort should be aimed at linking the various measurement techniques with the hypothesized underlying components of sleepiness on a sound empirical basis.