A. Metlaine

Insomnia and accidents: cross-sectional study (EQUINOX) on sleep-related home, work and car accidents in 5293 subjects with insomnia from 10 countries.

The link between sleepiness and the risk of motor vehicle accidents is well known, but little is understood regarding the risk of home, work and car accidents of subjects with insomnia. An international cross‐sectional survey was conducted across 10 countries in a population of subjects with sleep disturbances. Primary care physicians administered a questionnaire that included assessment of sociodemographic characteristics, sleep disturbance and accidents (motor vehicle, work and home) related to sleep problems to each subject. Insomnia was defined using the International Classification of Sleep Disorders (ICSD‐10) criteria. A total of 5293 subjects were included in the study, of whom 20.9% reported having had at least one home accident within the past 12 months, 10.1% at least one work accident, 9% reported having fallen asleep while driving at least once and 4.1% reported having had at least one car accident related to their sleepiness. All types of accident were reported more commonly by subjects living in urban compared to other residential areas. Car accidents were reported more commonly by employed subjects, whereas home injuries were reported more frequently by the unemployed. Car accidents were reported more frequently by males than by females, whereas home accidents were reported more commonly by females. Patients with insomnia have high rates of home accidents, car accidents and work accidents related to sleep disturbances independently of any adverse effects of hypnotic treatments. Reduced total sleep time may be one factor explaining the high risk of accidents in individuals who complain of insomnia.

Sleep-Disordered Breathing in Ehlers-Danlos Syndrome: A Genetic Model of OSA

OBJECTIVES The objective of this study was to investigate the presence of sleep-disordered breathing (SDB) in patients with Ehlers-Danlos syndrome. Ehlers-Danlos syndrome is a genetic disorder characterized by cartilaginous defects, including nasal-maxillary cartilages. METHODS A retrospective series of 34 patients with Ehlers-Danlos syndrome and complaints of fatigue and poor sleep were evaluated by clinical history, physical examination, polysomnography (PSG), and, in some cases, anterior rhinomanometry. Additionally, a prospective clinical investigation of nine patients with Ehlers-Danlos syndrome was performed in a specialized Ehlers-Danlos syndrome clinic. RESULTS All patients with Ehlers-Danlos syndrome evaluated had SDB on PSG. In addition to apneas and hypopneas, SDB included flow limitation. With increasing age, flow limitation decreased in favor of apnea and hypopnea events, but clinical complaints were similar independent of the type of PSG finding. In the subgroup of patients who underwent nasal rhinomanometry, increased nasal resistance was increased relative to normative values. Nasal CPAP improved symptoms. Patients with Ehlers-Danlos syndrome presenting to the medical clinic had symptoms and clinical signs of SDB, but they were never referred for evaluation of SDB. CONCLUSIONS In patients with Ehlers-Danlos syndrome, abnormal breathing during sleep is commonly unrecognized and is responsible for daytime fatigue and poor sleep. These patients are at particular risk for SDB because of genetically related cartilage defects that lead to the development of facial structures known to cause SDB. Ehlers-Danlos syndrome may be a genetic model for OSA because of abnormalities in oral-facial growth. Early recognition of SDB may allow treatment with orthodontics and myofacial reeducation.

Effects of a combination of napping and bright light pulses on shift workers' sleepiness at the wheel: a pilot study

To assess the effects of napping + bright light on shift work drivers sleepiness at the wheel, we performed a pilot study on nine shift workers on three shifts (morning, afternoon, night), driving on a private road circuit. Sleepiness at the wheel was measured by ambulatory polysomnography and assessed using 30‐s segments of recordings with a percentage of theta electroencephalogram of at least 50% (15 s) of the period recorded. Sleepiness was also assessed by the Stanford Sleepiness Scale (SSS). Participants drove the same car on two similar 24‐h periods of work, with three drivers in each shift (morning, afternoon, night), separated by 3 weeks. During the baseline period, the subjects were told to manage their rest as usual. During the second experimental period, they had to rest lying in a dark room with two naps of 20 min and then exposed to bright light (5000 lux) for 10 min. Subjects showed a significantly decreased sleepiness at the wheel with an average of 10.7 ± 6.7 episodes of theta sleep during the baseline (766 ± 425 s) versus 1.0 ± 1.0 episode lasting 166 ± 96 s during the second period (P = 0.016; P = 0.0109). The percentage of driving asleep was also significantly reduced (3.7% ± 1.9% versus 0.9% ± 0.6%, P = 0.0077). The average SSS score in the group decreased from 2.76 ± 1.27 to 2.28 ± 0.74 (P = 0.09). In this pilot and preliminary study, a combination of napping and bright light pulses was powerful in decreasing sleepiness at the wheel of shift work drivers.

Association between insomnia symptoms, job strain and burnout syndrome: a cross-sectional survey of 1300 financial workers

Objectives Professional burnout is closely related to work stress but less frequently associated with disturbed sleep. This study determines whether job strain and sleep disturbances are associated risk factors of burnout among financial workers. Design Observational study. Participants 1300 employees (725 female) of a financial company. Primary measures Self-reported questionnaires (Maslach Burnout Inventory, Job Content Questionnaire, Sleep questionnaire based on ICSD-3 classification), the Epworth sleepiness scale and the Hospital Anxiety and Depression Scale (HADS). Result The prevalence of burnout was 10.2% (9.0% moderate and 1.2% severe). 23.3% of workers were considered with high job strain, and 93.1% had a high level of job satisfaction. 16.8% of individuals had insomnia and 97% reported non-restorative sleep. The bivariate analyses demonstrate a higher risk of burnout in participants with insomnia (OR=14.7, 95% CI 9.8 to 21.9), non-restorative sleep (OR=9.9, 95% CI 5.1 to 19.5) and anxiety (OR=10.2, 95% CI 6.8 to 15.3). High job strain was associated with burnout (OR=1.9, 95% CI 1.1 to 3.6). This association was not maintained after adjustment for sleep parameters. Job satisfaction was another independent risk factor for burnout (OR=124, 95% CI 65 to 237). Conclusions In our sample of financial workers, job strain represents a burnout risk factor only if associated with insomnia. Insomnia can be considered as a relevant clinical marker that should be targeted in mental health prevention programmes at the workplace.

ActiWave : nouvelle technologie d’enregistrement du sommeil Test et faisabilité

Resume Dix sujets ont beneficie d’un enregistrement polygraphique ambulatoire de sommeil par la nouvelle technologie ActiWave. Tous les resultats des dix patients ont ete telecharges avec succes. Les signaux EEG/EOG et EMG sont d’une qualite acceptable. La legerete et l’ergonomie de l’appareillage permettent au patient de dormir d’une maniere confortable. Des etudes complementaires, comparant cette nouvelle technologie aux mesures standard de reference, sont necessaires afin de valider l’utilisation de ce materiel.

Évaluation d’un nouvel Actigraphe MotionWatch8 en comparaison à la Polysomnographie sur 20 bons dormeurs et 50 patients suspectés d’avoir des troubles du sommeil

Le Karolinska Drowsiness Test (KDT) est une méthode itérative d’évaluation objective de la somnolence. Ce test repose sur le calcul de la puissance spectrale dans la bande de fréquence alphatheta de l’électroencéphalogramme (EEG) purifié. La réjection visuelle d’artefacts (mouvements, clignements) est réalisée par un expert de l’EEG de veille. Cette procédure, longue et fastidieuse, est un obstacle à l’utilisation de ce test. L’objet de l’étude est la mise au point d’un algorithme automatique de réjection d’artefact de l’EEG de veille. Vingt-cinq volontaires (20—75 ans) ont participé à cette étude incluant deux protocoles de 40 h de constant routine, comprenant chacun 11 KDT de quatre minutes, réalisés toutes les 3h45. L’analyse visuelle repose sur les signaux EEG Fz, Cz, Oz référencés à A2, ainsi que sur les signaux EOG, EMG et ECG. L’algorithme automatique, qui utilise uniquement le signal Fz, a été mis au point sur les KDT de trois sujets, soit 66 tests. Il a ensuite été évalué sur 20 autres KDT venant de 20 sujets. La réjection d’artefact a été réalisée automatiquement (A) et manuellement à deux reprises espacées d’un mois (M1 et M2l) La puissance spectrale du signal Fz dans la bande 6—9 Hz est calculée par époques de quatre secondes d’EEG purifié, puis moyennée pour arriver à une valeur par test. Ce calcul est réalisé sur chaque EEG purifié par A, M1, M2. La comparaison des méthodes porte sur le nombre d’époques rejetées et le résultat du test qui en découle. Les pourcentages moyens d’époques rejetées sont de 33 % (A), 45 % (M1), et 44 % (M2). L’ANOVA sur les résultats des tests n’a montré aucun effet scoreur. En conclusion, il n’y a pas de différence significative entre les valeurs de puissance theta-alpha selon que le type de purification des signaux EEG a été réalisé par l’algorithme ou par l’expert. Bien que l’analyse automatique rejette une plus faible quantité d’époques, elle fournit un résultat d’analyse spectrale comparable à celui de l’expert avec un gain significatif de temps. Ce résultat suggère que l’information contenue dans une seule dérivation EEG est suffisante réaliser un test KDT.