Corneal Viscous Properties Cannot Be Determined From Air-Puff Applanation.

PURPOSE: To assess whether corneal viscous properties are measureable with air-puff applanation in patients. METHODS: The study had 312 normal eyes, 107 fellow eyes of patients with keratoconus, and 289 keratoconic eyes. The Corvis ST (Oculus Optikgeräte GmbH, Wetzlar, Germany) deformation data for all eyes were analyzed using two models. First, a standard linear solid model (SLM) assumed the cornea was an elastic material only. Second, a two-compartment Kelvin-Voigt model (KVM) assumed the cornea was a visco-elastic material. Corneal stiffness and viscosity were calculated. Further, the deflection amplitude was phase shifted virtually relative to the air-puff applanation force to assess whether the KVM was capable of detecting corneal viscous properties from air-puff applanation. This was similar in concept to measured viscoelastic deformations in other soft tissues. The hysteresis area was also calculated with deformation (cornea and whole globe) and deflection (cornea only) amplitude. The greater the magnitude of the hysteresis area, the greater was the magnitude of corneal viscosity (µc). RESULTS: Both the SLM and KVM reported similar magnitudes of corneal stiffnesses (correlation coefficient > 0.99). However, for a given model, corneal stiffness was significantly different between normal, fellow, and keratoconic eyes (P = .001). From the KVM, the corneal viscosity was different between groups (P = .001) but was small in magnitude (order of 10-9). The deflection hysteresis area was also small in magnitude (order of 10-6). In contrast, the KVM detected significant corneal viscosity only when the deflection amplitude was virtually phase shifted with respect to the air-puff applanation force. CONCLUSIONS: No significant corneal viscous response was detected in patients who had air-puff applanation. [J Refract Surg. 2019;35(11):730-736.].

In Vivo Prediction of Air-Puff Induced Corneal Deformation Using LASIK, SMILE, and PRK Finite Element Simulations.

Purpose: To simulate deformation amplitude after laser-assisted in situ keratomileusis (LASIK), small incision lenticule extraction (SMILE), and photorefractive keratectomy (PRK) with finite element models. Methods: Finite element simulations of air-puff applanation on LASIK, SMILE, and PRK models were performed on a cohort of normal eyes, which had undergone refractive treatments. Short- and long-term wound healing responses were considered for SMILE and LASIK models based on evidence of microdistortions in Bowman's layer and crimping of collagen fibers. First, inverse simulations were performed to derive the preoperative properties of the cornea. Using these properties and planned refractive treatment, postoperative air-puff deformation amplitude was predicted and compared with the in vivo measurements. Results: The predicted postoperative corneal stiffness parameters agreed very well with in vivo values of SMILE, LASIK, and PRK eyes. Intraclass correlations (ICC) were greatest in PRK eyes (ICC > 0.95). This agreement was lower for peak deformation amplitude and peak deflection amplitude in SMILE and LASIK eyes (ICC < 0.9). In PRK eyes, peak deformation and deflection amplitude predictions were the best relative to in vivo magnitudes. Also, linear correlation (r) between in vivo measurement and predicted biomechanical parameters indicated strong agreement between them (SMILE: r ≥ 0.89, LASIK: r ≥ 0.83, PRK: r ≥ 0.87). Conclusions: The is the first study to present predictive simulations of corneal deformation changes after different procedures. Patient-specific preoperative corneal biomechanical properties and finite element models were a significant determinant of accurate postoperative deformation amplitude prediction.

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.

Characterization of the respiratory and heart beat signal from an air pressure-based ballistocardiographic setup.

Off-body detection of respiratory and cardiac activity presents an enormous opportunity for general health, stress and sleep quality monitoring. The presented setup detects the mechanical activity of both heart and lungs by measuring pressure difference fluctuations between two air volumes underneath the chest area of the subject. The registered signals were characterized over four different sleep postures, three different base air pressures within the air volumes and three different mattress top layer materials. Highest signal strength was detected in prone posture for both the respiratory and heart beat signal. Respiratory signal strength was the lowest in supine posture, while heart beat signal strength was lowest for right lateral. Heart beat cycle variability was highest in prone and lowest in supine posture. Increasing the base air pressure caused a reduction in signal amplitude for both the respiratory and the heart beat signal. A visco-elastic poly-urethane foam top layer had significantly higher respiration amplitude compared to high resilient poly-urethane foam and latex foam. For the heart beat signal, differences between the top layers were small. The authors conclude that, while the influence of the mattress top layer material is small, the base air pressure can be tuned for optimal mechanical transmission from heart and lungs towards the registration setup.

Modelling the effect of repositioning on the evolution of skeletal muscle damage in deep tissue injury.

Deep tissue injury (DTI) is a localized area of tissue necrosis that originates in the subcutaneous layers under an intact skin and tends to develop when soft tissue is compressed for a prolonged period of time. In clinical practice, DTI is particularly common in bedridden patients and remains a serious issue in todays health care. Repositioning is generally considered to be an effective preventive measure of pressure ulcers. However, limited experimental research and no computational studies have been undertaken on this method. In this study, a methodology was developed to evaluate the influence of different repositioning intervals on the location, size and severity of DTI in bedridden patients. The spatiotemporal evolution of compressive stresses and skeletal muscle viability during the first 48 h of DTI onset was simulated for repositioning schemes in which a patient is turned every 2, 3, 4 or 6 h. The model was able to reproduce important experimental findings, including the morphology and location of DTI in human patients as well as the discrepancy between the internal tissue loads and the contact pressure at the interface with the environment. In addition, the model indicated that the severity and size of DTI were reduced by shortening the repositioning intervals. In conclusion, the computational framework presented in this study provides a promising modelling approach that can help to objectively select the appropriate repositioning scheme that is effective and efficient in the prevention of DTI.

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.

Experiential versus analytical emotion regulation and sleep: breaking the link between negative events and sleep disturbance.

Despite a long history of interest in emotion regulation as well as in the mechanisms that regulate sleep, the relationship between emotion regulation and sleep is not yet well understood. The present study investigated whether "an experiential approach"-defined by coping through affectively acknowledging, understanding, and expressing actual emotional experience and affective feeling about a situation-compared with a "cognitive analytical approach"-defined by the cognitive analysis of the causes, meanings and implications of the situation for the own self-would buffer the impact of an emotional failure experience on (1) emotional experience and (2) sleep structure assessed by EEG polysomnography. Twenty-eight healthy volunteers participated in this study. A direct comparison of the two emotion regulation strategies revealed that participants who were instructed to apply an experiential approach showed less fragmentation of sleep than participants who were instructed to apply an analytical approach. The use of an experiential approach resulted in a longer sleep time, higher sleep efficiency, fewer awakenings, less % time awake, and fewer minutes wake after sleep onset. Implications of the differential effects of these two forms of emotion regulation on sleep are discussed.

Automatic sleep stage classification based on easy to register signals as a validation tool for ergonomic steering in smart bedding systems.

Ergonomic sleep studies benefit from long-term monitoring in the home environment to cope with daily variations and habituation effects. Polysomnography allows to asses sleep accurately, but is costly, time-consuming and possibly disturbing for the sleeper. Actigraphy is cheap and user friendly, but for many studies lacks accuracy and detailed information. This proof-of-concept study investigates Least-Squares Support Vector Machines as a tool for automatic sleep stage classification (Wake-N1-Rem to N2-N3 separation), using automatic trainingset-specific filtered features as derived from three easy to register signals, namely heart rate, breathing rate and movement. The algorithms are trained and validated using 20 nights out of a 600 night database from over 100 different healthy persons. Different training and test set strategies were analyzed leading to different results. The more person-specific the training nights to the test nights, the better the classification accuracy as validated against the hypnograms scored by experts from the full polysomnograms. In the limit of complete person-specific training, the accuracy of the algorithm on the test set reached 94%. This means that this algorithm could serve its use in long-term monitoring sleep studies in the home environment, especially when prior person-specific polysomnographic training is performed.

Modeling human-bed interaction: the predictive value of anthropometric models in choosing the correct bed support.

The sleep system (i.e. the combination of mattress and bed base) is an important factor of the sleep environment since it allows physical recuperation during sleep by providing proper body support. However, various factors influence the interaction between the human body and the sleep system. Contributing factors include body dimensions, distribution of body weight and stiffness of the sleep system across the mattress surface. During the past decade, the rise of several new bedding technologies has made it increasingly difficult for the consumer to select a proper sleep system. Therefore, this study presents a method to model human-bed interaction in order to objectively predict the ideal sleep system for a particular individual. The proposed method combines a personalized anthropometric model with standardized load-deflection characteristics of mattress and bed base. Results for lateral sleep positions show a root mean square deviation of 11.9 ± 6.1 mm between modeled spine shapes and validation shapes, derived from 3D surface scans of the back surface. The method showed to be a reliable tool to individually identify the sleep system providing superior support from a variety of possible mattress-bed base combinations.

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.

Reliability and validity of 4D rasterstereography under dynamic conditions.

Purpose of this study was to evaluate the reliability and validity of 4D rasterstereography under dynamic conditions. Therefore simulated anatomical fixed points on a wooden plate were measured during different movements. Seven different motion patterns in all three angles of space were evaluated. The simulated parameter trunk length was measured with an accuracy of 3.58 mm (SD±3.29 mm) and the dimple distance was detected with an accuracy of 0.88 mm (SD±1.04 mm). With this rasterstereographic prototype it is possible to examine dynamically the spinal posture with adequate accuracy.

Unobtrusive assessment of motor patterns during sleep based on mattress indentation measurements.

This study investigates how integrated bed measurements can be used to assess motor patterns (movements and postures) during sleep. An algorithm has been developed that detects movements based on the time derivate of mattress surface indentation. After each movement, the algorithm recognizes the adopted sleep posture based on an image feature vector and an optimal separating hyperplane constructed with the theory of support vector machines. The developed algorithm has been tested on a dataset of 30 fully recorded nights in a sleep laboratory. Movement detection has been compared to actigraphy, whereas posture recognition has been validated with a manual posture scoring based on video frames and chest orientation. Results show a high sensitivity for movement detection (91.2%) and posture recognition (between 83.6% and 95.9%), indicating that mattress indentation provides an accurate and unobtrusive measure to assess motor patterns during 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.

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.