The Effects of Fatigue on Cognitive Performance in Police Officers and Staff During a Forward Rotating Shift Pattern.

BACKGROUND: Few studies have examined the effects of a forward rotating shift pattern on police employee performance and well-being. This study sought to compare sleep duration, cognitive performance, and vigilance at the start and end of each shift within a three-shift, forward rotating shift pattern, common in United Kingdom police forces. METHODS: Twenty-three police employee participants were recruited from North Yorkshire Police (mean age, 43 years). The participants were all working the same, 10-day, forward rotating shift pattern. No other exclusion criteria were stipulated. Sleep data were gathered using both actigraphy and self-reported methods; cognitive performance and vigilance were assessed using a customized test battery, comprising five tests: motor praxis task, visual object learning task, NBACK, digital symbol substitution task, and psychomotor vigilance test. Statistical comparisons were conducted, taking into account the shift type, shift number, and the start and end of each shift worked. RESULTS: Sleep duration was found to be significantly reduced after night shifts. Results showed a significant main effect of shift type in the visual object learning task and NBACK task and also a significant main effect of start/end in the digital symbol substitution task, along with a number of significant interactions. CONCLUSION: The results of the tests indicated that learning and practice effects may have an effect on results of some of the tests. However, it is also possible that due to the fast rotating nature of the shift pattern, participants did not adjust to any particular shift; hence, their performance in the cognitive and vigilance tests did not suffer significantly as a result of this particular shift pattern.

Rates of motorcycle helmet use and reasons for non-use among adults and children in Luang Prabang, Lao People's Democratic Republic.

BACKGROUND: Motorcycles make up 81 % of the total vehicle population and 74 % of road traffic deaths in Lao PDR. Helmets reduce the risk and severity of injuries resulting from motorcycle accidents by 72 %. Although Lao law mandates motorcycle helmet use among drivers and passengers, the prevalence of helmet use in Luang Prabang, Lao PDR is unknown. This project aimed to measure the prevalence of motorcycle helmet use among riders (i.e., drivers and passengers) in Luang Prabang. METHODS: An observational survey in Luang Prabang was conducted in February 2015 to measure the prevalence of motorcycle helmet use among drivers and passengers. Additionally, non-helmet wearing riders were surveyed to identify the reasons for helmet non-use. RESULTS: Of 1632 motorcycle riders observed, only 16.2 % wore helmets. Approximately 29 % of adults wore helmets while less than 1 % of all children wore helmets. When surveyed about attitudes towards helmet use, the majority of adult drivers indicated that they did not like how adult helmets feel or made them look. Additionally, almost half of motorcyclists who did not own child helmets reported that their child was too young to wear a helmet. CONCLUSIONS: Our finding that children wear helmets at significantly lower rates compared to adults is consistent with findings from neighboring countries in Southeast Asia. Results of this study have implications for public health campaigns targeting helmet use, especially among children.

Utility of split-night polysomnography in the diagnosis of upper airway resistance syndrome.

PURPOSE: Split-night polysomnography can both establish the diagnosis and titrate continuous positive airway pressure (CPAP) during a single study in patients with sleep-disordered breathing. We sought to determine if split-night polysomnography could be effectively used in upper airway resistance syndrome (UARS) without diminishing diagnostic accuracy or success of CPAP titration. METHODS: Consecutive patients diagnosed with UARS were included. Split-night studies were performed in patients meeting predefined criteria. We compared data between those undergoing traditional and split-night polysomnography. RESULTS: We included 100 consecutive patients (41.2 +/- 7.4 years, 54% men). Forty-six underwent split-night polysomnography. Groups were similar at baseline. There were no differences in polysomnography or success rate of CPAP titration. Among those not undergoing split-night studies, the mean time between diagnostic polysomnography and CPAP titration was 71.9 +/- 49.0 days. CONCLUSIONS: Split-night polysomnography can be effectively utilized to diagnose UARS and initiate CPAP therapy. This practice can reduce the number of studies needed and obviate the inherent delay in initiating CPAP therapy.

The role of telemedicine in CPAP compliance for patients with obstructive sleep apnea syndrome.

The objective of this study was to compare continuous positive airway pressure (CPAP) use, functional status, and client satisfaction in obstructive sleep apnea syndrome (OSAS) patients randomized to either telemedicine support or traditional care. In our university-affiliated sleep disorders center, patients with OSAS who were initiating CPAP therapy were randomized to receive telemedicine support vs traditional follow-up care for 30 days. The telemedicine group received a "Health Buddy" computer that provided daily Internet-based informational support and feedback for problems experienced with CPAP use. At 30 days, there were no significant differences in the hours of CPAP use between groups receiving traditional care (M = 4.22, SD+/-2.05) and telemedicine support (M = 4.29, SD+/-2.15), p = 0.87, or in the proportion of nights with CPAP use between the traditional (M = 50%+/-33.8) and telemedicine groups (M = 47%+/-34.2), p=0.61. No significant differences were found between groups in functional status (M = 2.27+/-4.56 vs M = 2.03+/-3.88, respectively, p = 0.76) or client satisfaction (M = 28.0+/-3.51 vs M = 28.5+/-3.05, p = 0.43). Patients in the telemedicine and traditional groups had similar CPAP use, functional status, and client satisfaction. The data suggest that telemedicine support as provided by our model compares favorably with traditional care. As a provider-extender, telemedicine support for patients initiating use of CPAP may allow for greater practice efficiency while maintaining quality of care.

Silent upper airway resistance syndrome: prevalence in a mixed military population.

STUDY OBJECTIVES: The upper airway resistance syndrome (UARS) is a recently described form of sleep-disordered breathing in which transient increases in upper airway resistance result in repetitive EEG arousals. UARS is not associated with apnea or diminished airflow, although snoring and excessive daytime somnolence (EDS) are common. This report describes a subset of patients with UARS diagnosed by polysomnography who do not manifest snoring, which we define as silent upper airway resistance syndrome (SUARS). DESIGN: A retrospective review of all polysomnographies performed at our sleep disorders center during 2000. SETTING: Sleep disorders center of a large, academic, military hospital. PATIENTS: Our center serves military personnel, military retirees, and their dependent families. INTERVENTIONS: Esophageal manometry during polysomnography was routinely performed on patients with hypersomnolence (Epworth sleepiness scale > 10) who demonstrated a total arousal index >or= 10/h and a respiratory disturbance index of < 5/h on prior polysomnography. UARS was definitely diagnosed in patients who demonstrated repetitive increased upper airway resistance (IUAR) associated with brief EEG arousals followed by normalization of esophageal pressure (Pes). IUAR was defined by a pattern of crescendo negative inspiratory Pes of