Brief digital sleep questionnaire powered by machine learning prediction models identifies common sleep disorders.

INTRODUCTION: We developed and validated an abbreviated Digital Sleep Questionnaire (DSQ) to identify common societal sleep disturbances including insomnia, delayed sleep phase syndrome (DSPS), insufficient sleep syndrome (ISS), and risk for obstructive sleep apnea (OSA). METHODS: The DSQ was administered to 3799 community volunteers, of which 2113 were eligible and consented to the study. Of those, 247 were interviewed by expert sleep physicians, who diagnosed ≤2 sleep disorders. Machine Learning (ML) trained and validated separate models for each diagnosis. Regularized linear models generated 15-200 features to optimize diagnostic prediction. Models were trained with five-fold cross-validation (repeated five times), followed by robust validation testing. ElasticNet models were used to classify true positives and negatives; bootstrapping optimized probability thresholds to generate sensitivities, specificities, accuracies, and area under the receiver operating curve (AUC). RESULTS: Compared to reference subgroups, physician-diagnosed sleep disorders were marked by DSQ evidence of sleeplessness (insomnia, DSPS, OSA), sleep debt (DSPS, ISS), airway obstruction during sleep (OSA), blunted circadian variability in alertness (DSPS), sleepiness (DSPS and ISS), increased alertness (insomnia) and global impairment in sleep-related quality of life (all sleep disorders). ElasticNet models validated each diagnosis with high sensitivity (80-83%), acceptable specificity (63-69%), high AUC (0.80-0.85) and good accuracy (agreement with physician diagnoses, 68-73%). DISCUSSION: A brief DSQ readily engaged and efficiently screened a large population for common sleep disorders. Powered by ML, the DSQ can accurately classify sleep disturbances, demonstrating the potential for improving the sleep, health, productivity and safety of populations.

Snoring: a source of noise pollution and sleep apnea predictor.

Snoring is a highly prevalent condition associated with obstructive sleep apnea (OSA) and sleep disturbance in bed partners. Objective measurements of snoring in the community, however, are limited. The present study was designed to measure sound levels produced by self-reported habitual snorers in a single night. Snorers were excluded if they reported nocturnal gasping or had severe obesity (BMI > 35 kg/m2). Sound was measured by a monitor mounted 65 cm over the head of the bed on an overnight sleep study. Snoring was defined as sound ≥40 dB(A) during flow limited inspirations. The apnea hypopnea index (AHI) and breath-by-breath peak decibel levels were measured. Snore breaths were tallied to determine the frequency and intensity of snoring. Regression models were used to determine the relationship between objective measures of snoring and OSA (AHI ≥ 5 events/h). The area under the curve (AUC) for the receiver operating characteristic (ROC) was used to predict OSA. Snoring intensity exceeded 45 dB(A) in 66% of the 162 participants studied, with 14% surpassing the 53 dB(A) threshold for noise pollution. Snoring intensity and frequency were independent predictors of OSA. AUCs for snoring intensity and frequency were 77% and 81%, respectively, and increased to 87% and 89%, respectively, with the addition of age and sex as predictors. Snoring represents a source of noise pollution in the bedroom and constitutes an important target for mitigating sound and its adverse effects on bed partners. Precise breath-by-breath identification and quantification of snoring also offers a way to risk stratify otherwise healthy snorers for OSA.

The Efficacy of Low-Level Continuous Positive Airway Pressure for the Treatment of Snoring.

STUDY OBJECTIVES: To assess effects of low-level continuous positive airway pressure (CPAP) on snoring in habitual snorers without obstructive sleep apnea (OSA). METHODS: A multicenter prospective in-laboratory reversal crossover intervention trial was conducted between September 2013 and August 2014. Habitual snorers were included if they snored (inspiratory sound pressure level ≥ 40 dBA) for ≥ 30% all sleep breaths on a baseline sleep study (Night 1), and if significant OSA and daytime somnolence were absent. Included participants then underwent a CPAP titration study at 2, 4, or 6 cm H2O (Night 2) to examine snoring responses to step-increases in nasal pressure, a treatment night at optimal pressure (Night 3), followed by baseline night (Night 4). At each pressure, snoring intensity was measured on each breath. Snoring frequency was quantified as a percentage of sleep breaths at thresholds of 40, 45, 50, and 55 dBA. Sleep architecture and OSA severity were characterized using standard measurements. RESULTS: On baseline sleep studies, participants demonstrated snoring at ≥ 40 dBA on 53 ± 3% and ≥ 45 dBA on 35 ± 4% of breaths. Snoring frequency decreased progressively as nasal pressure increased from 0 to 4 cm H2O at each threshold, and plateaued thereafter. CPAP decreased snoring frequency by 67% and 85% at 40 and 45 dBA, respectively. Intervention did not alter sleep architecture and sleep apnea decreased minimally. CONCLUSIONS: Low-level CPAP below the range required to treat OSA diminished nocturnal snoring, and produced uniform reduction in nightly noise production below the World Health Organization's limit of 45 dBA. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT01949584.

Incômodo causado pelo ruído a uma população de bombeiros / Annoyance caused by noise to a population of firefighters

OBJETIVO: Identificar o incômodo causado pelo ruído e queixas relacionadas à saúde auditiva em uma corporação de bombeiros do município Santo André (SP). MÉTODOS: Tratou-se de um estudo epidemiológico transversal de inquérito na população de 72 bombeiros do 8º Grupamento, 28 do setor administrativo, 20 do centro de ocorrência e 24 do atendimento operacional. Foi aplicado um protocolo composto por 57 questões referentes a dados pessoais, queixas auditivas, não auditivas e de incômodo. Também foi realizado o mapeamento sonoro do local. RESULTADOS: Os níveis de pressão sonora no local da corporação ultrapassaram 67 dB (A), chegando a níveis maiores de 82 dB (A) na avenida. A maioria (83,3 por cento) dos sujeitos relatou o cotidiano ruidoso no trabalho, sendo o ruído urbano citado como maior fonte. Quando vistos separadamente por área de atuação, a maior ocorrência foi para ruído urbano (73,9 por cento), ruído da viatura (68,0 por cento) e ruído do telefone (38,2 por cento) para o setor administrativo, divisão operacional e atendimento de ocorrências, respectivamente. CONCLUSÃO: Os bombeiros analisados, além da exposição a ruídos provenientes da ocupação no ambiente de trabalho como viaturas, rádios de comunicação e telefones, também sofrem as consequências do ruído urbano, que altera atividades no trabalho e provoca incômodo.

PURPOSE: To identify annoyance caused by occupational and urban noises and auditory health complaints of a group of firefighters from a corporation in Santo André (SP), Brazil. METHODS: A cross-sectional epidemiological study was carried out with a population of 72 firefighters from the 8th Brigade: 28 firefighters from the administrative section, 20 from the occurrence center and 24 from the operational call center. It was used a protocol which consisted of 57 questions regarding personal data, auditory and non-auditory complaints and annoyance. A sound mapping from the surrounding area was also carried out. RESULTS: The sound pressure levels in the firefighter corporation area exceeded 67 dB (A), reaching more than 82 dB (A) at the main avenue. Most of the subjects (83.3 percent) reported noisy routine at work, and urban noise was reported as the major source of annoyance. When evaluated separately by performance section, the highest occurrences of complaints were for urban noise (73.9 percent), firefighter vehicle noise (68 percent) and telephone noise (38.2 percent), for the administrative section, operational call center and occurrence center, respectively. CONCLUSION: The firefighters interviewed, besides being exposed to noises deriving from work activities, like vehicles, walk-talk radios and telephones, are liable to consequences from urban noise, which disturbs work activities and also causes health problems.