Einfluss von abendlicher Computerspielnutzung auf Parameter der Alertness und des Schlafs bei Jugendlichen

Background: Playing computer games before bedtime is a common behavior, especially among adolescents. Excessive computer game use can be associated with somatic complaints, attention deficits, and family interaction problems. However, there is little knowledge about the effects of computer games on subsequent sleep. Objectives: The aim of this pilot study was to investigate the effects of playing a computer game in the evening on the alertness and sleep of adolescents. Materials and methods: Twenty-five healthy adolescents (mean age 15 years, f = 20, m = 5) from one school class were included in this pilot study. In a randomized crossover design on two consecutive days, either a jump-and-run computer game or reading a youth magazine was performed for 2 h in the evening. Before and after each intervention, mood (ASTS) and drowsiness (KSS) were assessed by questionnaires and parameters of tonic alertness were measured by the psychomotor vigilance task (PVT). Subsequently, sleep was measured by polysomnography (PSG). Results: Two hours of computer gaming in the evening resulted in reduced alertness levels immediately thereafter: the PVT parameter response time (RT) increased from 272.0 +/- 30.5 ms to 305.2 +/- 41.3 ms (p < 0.01) while it remained unchanged under the reading condition the other evening. In comparison to reading, using computer games in the evening led to an increased amount of light sleep (N1 + N2: 48.9 +/- 9.1%-TST vs. 44.6 +/- 9.8%-TST, p < 0.05) and a reduced amount of deep sleep (N3: 36.0 +/- 10.0%-TST vs. 39.5 +/- 9.0%-TST, p < 0.05) the following night. Sleep latency and sleep efficiency did not differ between the two conditions. Conclusions: In the group of healthy adolescents examined in this pilot study, using computer games in the evening had immediate negative consequences on alertness and on sleep architecture the subsequent night. Together with frequently insufficient sleeping time on school days in adolescents, these findings cumulatively could have relevance for physiological development. Subsequent trials in different groups of adolescents with a sufficient number of subjects are needed in order to further verify these findings and possibly, to adapt sleep-hygiene behavioral recommendations for these age groups.Hintergrund: Computerspielnutzung vor dem Schlafengehen ist vor allem bei Heranwachsenden ein übliches Verhalten. Die exzessive Nutzung kann mit somatischen Beschwerden, Aufmerksamkeitsdefiziten und familiären Interaktionsproblemen verbunden sein. Es gibt aber nur wenige Erkenntnisse über die Auswirkungen auf den nachfolgenden Schlaf. Fragestellung: Ziel dieser Pilotstudie war es, die Auswirkungen eines Computerspiels am Abend auf die Alertness und den Schlaf von Jugendlichen zu untersuchen. Material und Methoden: Fünfundzwanzig gesunde Jugendliche (mittleres Alter 15 Jahre, w= 20, m= 5) aus einer Schulklasse wurden in diese Pilotstudie eingeschlossen. In einem randomisierten Crossover-Design an zwei aufeinanderfolgenden Tagen wurde jeweils am Abend für 2 h entweder ein Jump-and-Run-Computerspiel durchgeführt oder eine Jugendzeitschrift gelesen. Vor und nach der jeweiligen Intervention wurde mittels Fragebögen die Stimmung (Aktuelle Stimmungsskala, ASTS) und die Schläfrigkeit (Karolinska Sleepiness Scale, KSS) erhoben sowie Parameter der tonischen Alertness mittels Psychomotor Vigilance Task (PVT) gemessen. Jeweils im Anschluss wurde der Schlaf mittels Polysomnografie (PSG) untersucht. Ergebnisse: Zweistündiges Computerspielen am Abend führte unmittelbar danach zu einer verringerten Alertness – der PVTParameter Reaktionszeit (RT) erhöhte sich von 272,0± 30,5ms auf 305,2± 41,3ms (p< 0,01) während die RT im gleichen Zeitfenster am anderen Abend unter der Lesebedingung unverändert blieb. Abendliche Computerspielnutzung führte in der darauffolgenden Nacht zu einem erhöhten Leichtschlafanteil (N1+N2: 48,9±9,1%-TST vs. 44,6± 9,8%-TST, p< 0,05) und einem reduzierten Tiefschlafanteil (N3: 36,0± 10,0%-TST vs. 39,5± 9,0%-TST, p< 0,05) gegenüber dem Schlaf nach zweistündigem Lesen. Die Einschlaflatenz und die Schlafeffizienz unterschieden sich zwischen beiden Bedingungen nicht. Diskussion: Bei den in dieser Pilotstudie untersuchten gesunden Jugendlichen wirkten sich abendliche Computerspiele negativ auf die Alertness und die Schlafarchitektur der darauffolgenden Nacht aus. Zusammen mit häufig nicht ausreichenden Schlafzeiten an Schultagen bei Jugendlichen könnten kumulativ diese Befunde entwicklungsphysiologische Relevanz haben. Untersuchungen an Jugendlichen in weiteren Kollektiven mit entsprechender Gruppengröße sind jedoch notwendig, um die Ergebnisse weiter zu verifizieren und ggf. schlafhygienische Verhaltensempfehlungen für diese Altersgruppen entsprechend anzupassen

The Effect of Night Duty of Pharmacists on Sleepiness and Concentration at Daytime

Background: The changing responsibilities of pharmacists contribute to a lack of qualified pharmacists to fill vacant positions, particularly in rural areas. Consequently, pharmacy managers cover various duties, including an increasing number of nights being on duty that can impair daytime concentration and performance. The objective of the study was to assess the effect of night duties on daytime sleepiness, sleep quality, and concentration abilities of pharmacists. Methods: 22 pharmacists, both sexes, aged 27 to 60 years, were recruited and their sleep time, sleep efficiency, and mobility (actigraphy) were assessed during a night on duty and a control night using an actimetry. Daytime sleepiness and concentration were assessed using standardized questionnaires (ESS, KSS, d2‐R). Results: Significant differences were observed between the night shift and control nights with respect to sleep time, sleep efficiency, and mobility. Daytime sleepiness was significantly increased after night shifts (ESS: 11.64 vs. 2.09; KSS: 6.77 vs. 2.41 after a night shift and control night, respectively; p < 0.001) and concentration diminished compared to control nights (d2‐R KL: 220.95 vs. 260.36 after a night shift and control night, respectively; p < 0.001). Conclusions: The results provide evidence that night duties lead to high daytime sleepiness in pharmacists, which in turn may negatively affect their ability to concentrate and their error rate. Existing regulations on emergency pharmacy services should be reconsidered regarding the safety of the pharmaceutical supply.Peer Reviewe

On the use of actigraphy in clinical evaluation of diurnal blood pressure profile

A disturbed diurnal blood pressure profile is one of the most important risk factors of cardiovascular diseases. This review analyzes the use of simultaneous diurnal ambulatory blood pressure monitoring (ABPM) and motion activity monitoring (actigraphy) to obtain additional information for correct interpretation of ABPM results in clinically significant decision-making. The article considers practical aspects of actigraphy in expert ABPM for clock-independent calculation of the parameters of nighttime and daytime blood pressure (BP); detection of BP changes during sleep; connection with respiratory disturbances during sleep, motion activity, and body position; and sleep deprivation in shift workers. Original illustrations of simultaneous ABPM and actigraphy are provided.Ein gestörtes tageszeitabhängiges Blutdruckprofil ist einer der wichtigsten Risikofaktoren für Herz-Kreislauf-Erkrankungen. In der vorliegenden Übersichtsarbeit wird die Bedeutung der gleichzeitigen Durchführung des ambulanten Blutdruckmonitorings (ABPM) und der Messung der Bewegungsaktivität (Aktigraphie) beschrieben. Durch die Aktigraphie werden zusätzliche Informationen für die korrekte Interpretation des ABPM gewonnen, die zu klinisch relevanten Entscheidungen beitragen. In diesem Artikel werden praktische Aspekte der Aktigraphie in der Anwendung durch Experten bei ABPM zur uhrzeitunabhängigen Berechnung der Parameter des Blutdrucks (BP) am Tag und in der Nacht betrachtet, zur Erkennung von BP-Veränderungen während des Schlafs, zum Zusammenhang mit Atmungsstörungen während des Schlafs, zur Bewegungsaktivität und zur Körperposition sowie zum Schlafentzug bei Schichtarbeitern. Originalabbildungen der durchgeführten ABPM und Aktigraphie illustrieren exemplarisch die Daten

‘Sleep Blindness’ in Science Education: How Sleep Health Literacy Can Serve as a Link between Health Education and Education for Sustainable Development

Sleep disorders are risk factors for diseases such as dementia or diabetes, and cause enormous costs. Despite the crucial impacts of sleep on human health, there is little to no research on sleep and health in the field of science education. Although health education is an overarching goal of science education in school, the topic of sleep is rarely addressed. In the related field of medical education, empirical studies shed light on the impact of school projects concerning sleep health but are yet unrecognized by science education research. Systematic reviews demonstrate the effectiveness of school-based sleep education programs for increasing sleep knowledge but show contradicting findings regarding the impact on sleep behaviors. Lacking knowledge about healthy sleep is related to unhealthy sleep behavior. In this perspective article, we prepare the topic of sleep for the field of science education by presenting the state of research concerning sleep education. Using the connection between light pollution and sleep disruption, we present a concept of sleep health literacy in science education, argue for the implementation of sleep health literacy in science education curricula, and describe how the topics of sleep and light can serve as a link between health education and Education for Sustainable Development.Deutsche Forschungsgemeinschaft (DFG, German Research Foundation)Open Access Publication Fund of Humboldt-Universität zu BerlinPeer Reviewe

Effect of a patient engagement tool on positive airway pressure adherence: analysis of a German healthcare provider database

Objective/background: This study investigated the addition of a real-time feedback patient engagement tool on positive airway pressure (PAP) adherence when added to a proactive telemedicine strategy. Patients/methods: Data from a German healthcare provider (ResMed Healthcare Germany) were retrospectively analyzed. Patients who first started PAP therapy between 1 September 2009 and 30 April 2014, and were managed using telemedicine (AirView™; proactive care) or telemedicine + patient engagement tool (AirView™ + myAir™; patient engagement) were eligible. Patient demographics, therapy start date, sleep- disordered breathing indices, device usage hours, and therapy termination rate were obtained and compared between the two groups. Results: The first 500 patients managed by telemedicine-guided care and a patient engagement tool were matched with 500 patients managed by telemedicine-guided care only. The proportion of nights with device usage ≥4 h was 77 ± 25% in the patient engagement group versus 63 ± 32% in the proactive care group (p < 0.001). Therapy termination occurred less often in the patient engagement group (p < 0.001). The apnea-hypopnea index was similar in the two groups, but leak was significantly lower in the patient engagement versus proactive care group (2.7 ± 4.0 vs 4.1 ± 5.3 L/min; p < 0.001). Conclusions: Addition of a patient engagement tool to telemonitoring-guided proactive care was associated with higher device usage and lower leak. This suggests that addition of an engagement tool may help improve PAP therapy adherence and reduce mask leak

Sleep apnea & chronic obstructive pulmonary disease: overlap syndrome dynamics in patients from an epidemiological study

© 2021 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting /republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other worksObstructive sleep apnea (OSA) is a sleep disorder in which repetitive upper airway obstructive events occur during sleep. These events can induce hypoxia, which is a risk factor for multiple cardiovascular and cerebrovascular diseases. Chronic obstructive pulmonary disease (COPD) is a disorder which induces a persistent inflammation of the lungs. This condition produces hypoventilation, affecting the blood oxygenation, and leads to an increased risk of developing lung cancer and heart disease. In this study, we evaluated how COPD affects the severity and characteristics of OSA in a multivariate demographic database including polysomnographic signals. Results showed SpO2 subtle variations, such as more non-recovered desaturations and increased time below a 90% SpO2 level, which, in the long term, could worsen the risk to suffer cardiovascular and cerebrovascular diseases.Peer ReviewedPostprint (author's final draft

Initiation of therapy for obstructive sleep apnea syndrome: a randomized comparison of outcomes of telemetry-supported home-based vs. sleep lab-based therapy initiation

Purpose: Diagnosis and treatment of obstructive sleep apnea are traditionally performed in sleep laboratories with polysomnography (PSG) and are associated with significant waiting times for patients and high cost. We investigated if initiation of auto-titrating CPAP (APAP) treatment at home in patients with obstructive sleep apnea (OSA) and subsequent telemonitoring by a homecare provider would be non-inferior to in-lab management with diagnostic PSG, subsequent in-lab APAP initiation, and standard follow-up regarding compliance and disease-specific quality of life. Methods: This randomized, open-label, single-center study was conducted in Germany. Screening occurred between December 2013 and November 2015. Eligible patients with moderate-to-severe OSA documented by polygraphy (PG) were randomized to home management or standard care. All patients were managed by certified sleep physicians. The home management group received APAP therapy at home, followed by telemonitoring. The control group received a diagnostic PSG, followed by therapy initiation in the sleep laboratory. The primary endpoint was therapy compliance, measured as average APAP usage after 6 months. Results: The intention-to-treat population (ITT) included 224 patients (110 home therapy, 114 controls); the per-protocol population (PP) included 182 patients with 6-month device usage data (89 home therapy, 93 controls). In the PP analysis, mean APAP usage at 6 months was not different in the home therapy and control groups (4.38 +/- 2.04 vs. 4.32 +/- 2.28, p = 0.845). The pre-specified non-inferiority margin (NIM) of 0.3 h/day was not achieved (p = 0.130); statistical significance was achieved in a post hoc analysis when NIM was set at 0.5 h/day (p < 0.05). Time to APAP initiation was significantly shorter in the home therapy group (7.6 +/- 7.2 vs. 46.1 +/- 23.8 days; p < 0.0001). Conclusion: Use of a home-based telemonitoring strategy for initiation of APAP in selected patients with OSA managed by sleep physicians is feasible, appears to be non-inferior to standard sleep laboratory procedures, and facilitates faster access to therapy

Ein optimierter Versorgungsprozess bei Patienten mit schlafbezogenen Atmungsstörungen – Pilotstudie

Background: To date, patients have been instructed in diagnostic polygraphy (PG) by a trained specialist. This process is time- and cost-intensive. In a pilot study, we tested an innovative procedure in sleep-disordered breathing (SDB) to achieve faster diagnoses and more effective referral for treatment. For this purpose, study participants had a PG device delivered at home directly from the provider. Methods: Patients self-administered the PGs independently using a manual, and, if necessary, received telephone support. After the night of recording, the device was sent back to the supplier. Diagnosis by a physician was done online via an encrypted portal. In addition, subjective satisfaction with the process was assessed using a questionnaire and PG results were compared with polysomnography (PSG) within a narrow timescale. Results: Fifty patients middle-aged (50.5 ± 13.7 years), male = 30/female = 20, with suspected SDB were included in the study. The study participants had a similar mean Apnea-Hypopnea Index (AHI; PSG) of M = 20.8 (SD 23.2) and a mean AHI measured using PG of M = 20.2 (SD 18.9) under both measurement methods. At AHI values between ≥15–30/h showed sensitivity of 88% and specificity of 91%. Conclusion: In assessing whether clinically relevant sleep apnea occurred, we found a weak to moderate match between the individual diagnostic categories of the measuring process, with the most frequent matches occurring in the highest and lowest diagnosis groups. However, these results do not allow for a prediction of feasibility in a general or multimorbid patient population because of the selective sample.Hintergrund: Die Einweisung der Patienten in die diagnostische Polygraphie wird bisher von einer medizinisch ausgebildeten Fachkraft durchgeführt. Dieser Prozess ist zeit- und ressourcenintensiv. In dieser Pilotstudie wurde ein innovativer Versorgungsweg bei schlafbezogenen Atmungsstörungen (SBAS) untersucht, um eine beschleunigte Diagnostik und effektivere Therapiezuweisung zu erreichen. Hierfür wurde den Studienteilnehmern ein Polygrafie (PG)-Gerät direkt von der versorgenden Firma nach Hause geliefert. Methodik: Der Patient legte die PG selbstständig nach einer Bedienungsanleitung an und erhielt bei Bedarf telefonische Unterstützung. Nach der Untersuchungsnacht wurde das Gerät zurückgesendet. Die ärztliche Befundung erfolgte online über ein verschlüsseltes Portal. Zusätzlich erfolgte eine Befragung zur subjektiven Zufriedenheit mit dem Ablaufprozess sowie ein Vergleich der PG-Ergebnisse mit einer zeitnahen Polysomnografie (PSG). Ergebnisse: Es wurden 50 Patienten (m = 30/w = 20) mit Verdacht auf SBAS im mittleren Alter von 50,5 ± 13,7 Jahren eingeschlossen. Die Probanden wiesen unter beiden Messverfahren einen ähnlichen mittleren Apnoe-Hypopnoe-Index (AHI) (PSG) von M = 20,8 (SD 23,2) und AHI (PG) von M = 20,2 (SD 18,9) auf. Bei AHI-Werten zwischen ≥15–30/h lag die Sensitivität bei 88 % und die Spezifität bei 91 %. Diskussion: In der Beurteilung, ob eine klinisch relevante Schlafapnoe vorliegt, zeigte sich eine eher schwache, moderate Übereinstimmung zwischen den einzelnen Diagnosekategorien der Messverfahren, wobei sich die häufigsten Übereinstimmungen in den höchsten und niedrigsten Diagnosegruppen zeigten. Die Ergebnisse lassen jedoch aufgrund der selektiven Stichprobe keine Prognosen hinsichtlich der Durchführbarkeit in einer allgemeinen oder multimorbiden Patientengruppe zu

Efficacy and Safety of Daridorexant in Older and Younger Adults with Insomnia Disorder: A Secondary Analysis of a Randomised Placebo-Controlled Trial.

BACKGROUND AND OBJECTIVE The dual orexin receptor antagonist daridorexant, studied in two phase III trials, dose-dependently improved objective and subjective sleep variables and daytime functioning in adults with insomnia. Because treatment of insomnia in older adults is challenging and has limited options, the purpose of the current analysis was to further analyse the phase III trial studying the higher doses of daridorexant, those that showed efficacy (daridorexant 50 mg, daridorexant 25 mg and placebo, nightly for 3 months), and compare the safety and efficacy of daridorexant in patients aged ≥ 65 ('older adults') to those aged < 65 years ('younger adults'). METHODS Analyses by age (≥ 65 years, n = 364; < 65 years, n = 566) were performed on data from the randomised, double-blind, placebo-controlled Trial 1 in adult patients with insomnia (NCT03545191). Efficacy endpoints included a change from baseline at month 1 and month 3 in polysomnography-measured wake after sleep onset (WASO) and latency to persistent sleep (LPS), self-reported total sleep time (sTST) and daytime functioning assessed using the validated Insomnia Daytime Symptoms and Impacts Questionnaire (IDSIQ). Safety endpoints included adverse events and the Visual Analog Scale for morning sleepiness. RESULTS At baseline, mean [standard deviation] WASO was numerically greater (110 [39] vs 92 [38] min) in older than younger adults, while LPS was comparable (~ 65 min). Mean baseline IDSIQ total and all domain scores were numerically lower (i.e. better) in older adults. Daridorexant caused similar reductions in WASO and LPS, and similar increases in sTST, from baseline, in both age groups; improvements were numerically greater with daridorexant 50 mg than 25 mg. At month 3, daridorexant 50 mg, compared with placebo, decreased WASO by a least-squares mean of 19.6 (95% confidence interval 9.7, 29.5) in older patients versus 17.4 min (10.7, 24.0) in younger patients and decreased LPS by a least-squares mean of 14.9 (7.5, 22.3) in older patients versus 9.7 min (3.7, 15.7) in younger patients. Daridorexant 50 mg increased sTST from baseline to month 3 by a least-squares mean of 59.9 (49.6, 70.3) in older patients versus 57.1 min (48.9, 65.3) in younger patients. Daridorexant 50 mg progressively improved IDSIQ total and domain scores from week 1 onwards similarly in both groups; daridorexant 25 mg improved IDSIQ scores, but only in younger adults. In both age groups, in comparison with placebo, the overall incidence of adverse events was comparable, and there were fewer falls on daridorexant. Daridorexant improved Visual Analog Scale morning sleepiness in both groups; daridorexant 50 mg increased the mean (standard deviation) Visual Analog Scale morning sleepiness score by 15.9 (20.7) in older adults and by 14.9 (18.7) in younger adults from baseline to month 3. In older adults, there was one case of sleep paralysis, and no cases of narcolepsy, cataplexy, or complex sleep behaviour. CONCLUSIONS In older patients with insomnia, as in younger patients, the efficacy of daridorexant is maximal on night-time and daytime variables at the higher dose of 50 mg. Older patients particularly require this dose to improve daytime functioning. Older patients are not at an increased risk of adverse events or residual effects the next morning after night-time administration of daridorexant, even at 50 mg. The dose of daridorexant does not need to be decreased for older patients. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov (NCT03545191) [first posted: 4 June, 4 2018], https://clinicaltrials.gov/ct2/show/NCT03545191

Interventional Pneumology in Pulmonary Bleeding; A Review: From the Bronchus to the Vessel

Interventional pneumology includes both bronchological and vascular methods of diagnosis and therapy, especially in emergency situations such as pulmonary hemorrhage. In massive pulmonary hemorrhage bronchological diagnosis is required to determine the site and extent of bleeding, as well as angiography of bronchial arteries, and of pulmonary arteries. Bronchus occlusion by aid of balloon catheter or double lumen tube are holding measures until definitive surgery or embolization of bronchial or pulmonary arteries can be performed. The paper suggests a close relationship between bronchoscopic and angiographic diagnosis and therapy in case of severe pulmonary bleeding