Simon S. Smith

Autonomic activity during human sleep as a function of time and sleep stage.

While there is a developing understanding of the influence of sleep on cardiovascular autonomic activity in humans, there remain unresolved issues. In particular, the effect of time within the sleep period, independent of sleep stage, has not been investigated. Further, the influence of sleep on central sympathetic nervous system (SNS) activity is uncertain because results using the major method applicable to humans, the low frequency (LF) component of heart rate variability (HRV), have been contradictory, and because the method itself is open to criticism. Sleep and cardiac activity were measured in 14 young healthy subjects on three nights. Data was analysed in 2‐min epochs. All epochs meeting specified criteria were identified, beginning 2 h before, until 7 h after, sleep onset. Epoch values were allocated to 30‐min bins and during sleep were also classified into stage 2, slow wave sleep (SWS) and rapid eye movement (REM) sleep. The measures of cardiac activity were heart rate (HR), blood pressure (BP), high frequency (HF) and LF components of HRV and pre‐ejection period (PEP). During non‐rapid eye movement (NREM) sleep autonomic balance shifted from sympathetic to parasympathetic dominance, although this appeared to be more because of a shift in parasympathetic nervous system (PNS) activity. Autonomic balance during REM was in general similar to wakefulness. For BP and the HF and LF components the change occurred abruptly at sleep onset and was then constant over time within each stage of sleep, indicating that any change in autonomic balance over the sleep period is a consequence of the changing distribution of sleep stages. Two variables, HR and PEP, did show time effects reflecting a circadian influence over HR and perhaps time asleep affecting PEP. While both the LF component and PEP showed changes consistent with reduced sympathetic tone during sleep, their pattern of change over time differed.

Detecting insomnia: comparison of four self‐report measures of sleep in a young adult population

The sensitivity and specificity of four self‐report measures of disordered sleep – the Sleep Impairment Index (SII), the Sleep Disorders Questionnaire (SDQ), the Dysfunctional Beliefs and Attitudes About Sleep Scale (DBAS) and the Sleep–Wake Activity Inventory (SWAI) – were compared in subjects with insomnia and normal sleep. Nineteen young adult subjects met DSM‐IV criteria for primary insomnia and another 19 were normal control subjects. Discriminatory characteristics of each measure were assessed using receiver operator characteristic curve analyses. Discriminatory power was maximised for each measure to produce cut‐scores applicable for identification of individuals with insomnia. The DBAS, SII and SDQ psychiatric DIMS subscale were found to correlate, and discriminated well between the two groups. The SWAI nocturnal sleep subscale was not found to be an accurate discriminator. The results suggest differences in the measures in their ability to detect insomnia, and offer guidelines as to the optimal use of test scores to identify young adults suspected of insomnia.

Hazard perception in novice and experienced drivers: The effects of sleepiness

One driver skill that has been found to correlate with crash risk is hazard perception ability. The purpose of this study was to investigate how hazard perception latencies change between high and low sleepiness for a high risk group (novice drivers) and a lower risk group (experienced drivers). Thirty-two novice drivers (aged 17-24 years) and 30 experienced drivers (aged 28-36) completed a validated video-based hazard perception test, in which participants were asked to anticipate genuine traffic conflicts in footage filmed from the drivers perspective, with separate groups tested at either 10a.m. (lower sleepiness) or at 3a.m. (higher sleepiness). We found a significant interaction between sleepiness and experience, indicating that the hazard perception skills of the more experienced drivers were relatively unaffected by mild increases in sleepiness while the inexperienced drivers were significantly slowed. The findings suggest that the disproportionate sleepiness-related accident involvement of young, inexperienced drivers could be partly due to a slowing of their ability to anticipate traffic hazards.

The Circadian Response of Intrinsically Photosensitive Retinal Ganglion Cells

Intrinsically photosensitive retinal ganglion cells (ipRGC) signal environmental light level to the central circadian clock and contribute to the pupil light reflex. It is unknown if ipRGC activity is subject to extrinsic (central) or intrinsic (retinal) network-mediated circadian modulation during light entrainment and phase shifting. Eleven younger persons (18–30 years) with no ophthalmological, medical or sleep disorders participated. The activity of the inner (ipRGC) and outer retina (cone photoreceptors) was assessed hourly using the pupil light reflex during a 24 h period of constant environmental illumination (10 lux). Exogenous circadian cues of activity, sleep, posture, caffeine, ambient temperature, caloric intake and ambient illumination were controlled. Dim-light melatonin onset (DLMO) was determined from salivary melatonin assay at hourly intervals, and participant melatonin onset values were set to 14 h to adjust clock time to circadian time. Here we demonstrate in humans that the ipRGC controlled post-illumination pupil response has a circadian rhythm independent of external light cues. This circadian variation precedes melatonin onset and the minimum ipRGC driven pupil response occurs post melatonin onset. Outer retinal photoreceptor contributions to the inner retinal ipRGC driven post-illumination pupil response also show circadian variation whereas direct outer retinal cone inputs to the pupil light reflex do not, indicating that intrinsically photosensitive (melanopsin) retinal ganglion cells mediate this circadian variation.

Adherence to Continuous Positive Airway Pressure Therapy in Obstructive Sleep Apnoea sufferers: A theoretical approach to treatment adherence and intervention

Obstructive Sleep Apnoea (OSA) is a common sleep disorder associated with significant health, quality of life and psychosocial problems. The aims of this review are to investigate the contribution of psychological constructs and theory to the assessment and treatment of OSA. Adherence to CPAP treatment remains a primary concern for improving treatment outcomes for OSA. Modifiable, psychological constructs of self-efficacy, coping, social support, treatment satisfaction and self-reported daytime sleepiness improve the prediction of CPAP adherence. These predictors are particularly robust in the context of a theoretical model. Social Cognition Theory (SCT) and Health Belief Model (HBM) are emerging as promising psychological models for understanding patient acceptance and adherence to CPAP treatment. An overview of psychologically informed interventions for CPAP use is presented. Education-based interventions have promise, but the strongest and robust findings are emerging from theory-driven interventions. Specifically, Cognitive-Behaviourally informed interventions and Motivational Interventions demonstrate consistent and large effect sizes in improving CPAP adherence rates.

Effects of restricted cochlear lesions in adult cats on the frequency organization of the inferior colliculus

Restricted cochlear lesions in adult animals result in plastic changes in the representation of the lesioned cochlea, and thus in the frequency map, in the contralateral auditory cortex and thalamus. To examine the contribution of subthalamic changes to this reorganization, the effects of unilateral mechanical cochlear lesions on the frequency organization of the central nucleus of the inferior colliculus (ICC) were examined in adult cats. Lesions typically resulted in a broad high‐frequency hearing loss extending from a frequency in the range 15–22 kHz. After recovery periods of 2.5–18 months, the frequency organization of ICC contralateral to the lesioned cochlea was determined separately for the onset and late components of multiunit responses to tone‐burst stimuli. For the late response component in all but one penetration through the ICC, and for the onset response component in more than half of the penetrations, changes in frequency organization in the lesion projection zone were explicable as the residue of prelesion responses. In half of the penetrations exhibiting nonresidue type changes in onset‐response frequency organization, the changes appeared to reflect the unmasking of normally inhibited inputs. In the other half it was unclear whether the changes reflected unmasking or a dynamic process of reorganization. Thus, most of the observed changes were explicable as passive consequences of the lesion, and there was limited evidence for plasticity in the ICC. The implications of the data with respect to the primary locus of the changes and to the manner in which they contribute to thalamocortical reorganization are considered. J. Comp. Neurol. 467:354–374, 2003.

Motivational Interviewing (MINT) Improves Continuous Positive Airway Pressure (CPAP) Acceptance and Adherence: A Randomized Controlled Trial.

OBJECTIVE Adherence to continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea (OSA) is poor. We assessed the effectiveness of a motivational interviewing intervention (motivational interview nurse therapy [MINT]) in addition to best practice standard care to improve acceptance and adherence to CPAP therapy in people with a new diagnosis of OSA. METHOD One hundred six Australian adults (69% male) with a new diagnosis of OSA and a clinical recommendation for CPAP treatment were recruited from a tertiary sleep disorders center. Participants were randomly assigned to receive either 3 sessions of a motivational interviewing intervention (MINT; n = 53; mean age = 55.4 years) or no intervention (control; n = 53; mean age = 57.74 years). The primary outcome was the difference between the groups in objective CPAP adherence at 1-month, 2-month, 3-month, and 12-month follow-ups. RESULTS Fifty (94%) participants in the MINT group and 50 (94%) participants in the control group met all inclusion and exclusion criteria and were included in the primary analysis. The number of hours of CPAP use per night in the MINT group at 3 months was 4.63 hr and was 3.16 hr in the control group (p = .005). This represents almost 50% better adherence in the MINT group relative to the control group. Patients in the MINT group were substantially more likely to accept CPAP treatment. CONCLUSIONS MINT is a brief, manualized, effective intervention that improves CPAP acceptance and objective adherence rates compared to standard care alone.

An examination of the relationship between workload and fatigue within and across consecutive days of work: Is the relationship static or dynamic?

Cognitive-energetical theories of information processing were used to generate predictions regarding the relationship between perceived workload and fatigue within and across consecutive days of work. Repeated measures were taken aboard a naval vessel from a sample of 20 Navy patrol vessel crew members during nonroutine and routine patrols. The hypotheses were tested through growth curve modeling. There was a nonmonotonic relationship between workload and fatigue in the routine patrol; moderate workload was associated with the lowest fatigue. The relationship between workload and fatigue changed over consecutive days in the nonroutine patrol. At the beginning of the patrol, low workload was associated with fatigue. At the end of the patrol, high workload was associated with fatigue. These results suggest that the optimal level of workload can change over time and thus have implications for the management of fatigue, particularly where prolonged operations are involved.

Napping, development and health from 0 to 5 years: a systematic review

Background Duration and quality of sleep affect child development and health. Encouragement of napping in preschool children has been suggested as a health-promoting strategy. Objectives The aim of this study is to assess evidence regarding the effects of napping on measures of child development and health. Design This study is a systematic review of published, original research articles of any design. Subjects Children aged 0–5 years. Method Electronic database search was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and assessment of research quality was carried out following a Grading of Recommendations, Assessment, Development and Evaluations (GRADE) protocol. Results Twenty-six articles met inclusion criteria. These were of heterogeneous quality; all had observational designs (GRADE-low). Development and health outcomes included salivary cortisol, night sleep, cognition, behaviour, obesity and accidents. The findings regarding cognition, behaviour and health impacts were inconsistent, probably because of variation in age and habitual napping status of the samples. The most consistent finding was an association between napping and later onset, shorter duration and poorer quality of night sleep, with evidence strongest beyond the age of 2 years. Limitations Studies were not randomised. Most did not obtain data on the childrens habitual napping status or the context of napping. Many were reliant on parent report rather than direct observation or physiological measurement of sleep behaviour. Conclusions The evidence indicates that beyond the age of 2 years napping is associated with later night sleep onset and both reduced sleep quality and duration. The evidence regarding behaviour, health and cognition is less certain. There is a need for more systematic studies that use stronger designs. In preschool children presenting with sleep problems clinicians should investigate napping patterns.

Examining the influence of biological and psychological factors on cognitive performance in chronic fatigue syndrome: A randomized, double-blind, placebo-controlled, crossover study

The pathophysiology of chronic fatigue syndrome (CFS) remains unclear; however, both biological and psychological factors have been implicated in establishing or maintaining this condition. People with CFS report significant and disabling cognitive difficulties such as impaired concentration that in some cases are exacerbated by exposure to chemical triggers. The aim of this study was to determine if neuropsychological deficits in CFS are triggered by exposure to chemicals, or perceptions about the properties of these substances. Participants were 36 people with a primary diagnosis of CFS, defined according to Centers for Disease Control (CDC) criteria. A randomized, double-blind, placebo-controlled, crossover design was used, with objective assessment of neuropsychological function and participant rating of substance type, before and after exposure to placebo or chemical trigger. Results showed decrements in neuropsychological tests scores on three out of four outcome measures when participants rated the substance they had been exposed to as “chemical. ” No change in performance was found based on actual substance type. These results suggest that cognitive attributions about exposure substances in people with CFS may be associated with worse performance on neuropsychological tasks. In addition, these findings suggest that psychological interventions aimed at modifying substance-related cognitions may reduce some symptoms of CFS.