Efficacy and hypnotic effects of melatonin in shift-work nurses: double-blind, placebo-controlled crossover trial

<p>Abstract</p> <p>Background</p> <p>Night work is associated with disturbed sleep and wakefulness, particularly in relation to the night shift. Circadian rhythm sleep disorders are characterized by complaints of insomnia and excessive daytime sleepiness that are primarily due to alterations in the internal circadian timing system or a misalignment between the timing of sleep and the 24-h social and physical environment.</p> <p>Methods</p> <p>We evaluated the effect of oral intake of 5 mg melatonin taken 30 minutes before night time sleep on insomnia parameters as well as subjective sleep onset latency, number of awakenings, and duration of sleep. A double-blind, randomized, placebo-controlled crossover study with periods of 1 night and washouts of 4 days comparing melatonin with placebo tablets was conducted. We tried to improve night-time sleep during recovery from night work. Participants were 86 shift-worker nurses aged 24 to 46 years. Each participant completed a questionnaire immediately after awakening.</p> <p>Results</p> <p>Sleep onset latency was significantly reduced while subjects were taking melatonin as compared with both placebo and baseline. There was no evidence that melatonin altered total sleep time (as compared with baseline total sleep time). No adverse effects of melatonin were noted during the treatment period.</p> <p>Conclusion</p> <p>Melatonin may be an effective treatment for shift workers with difficulty falling asleep.</p

Positive Perspectives of the Predicament of COVID-19

Although crises such as pandemic can inflict cascading disasters on a health care system, they can provide opportunities for the emergence of new types of potential and their optimal use and manifesting the best kinds of altruism and philanthropy. The COVID-19 crisis will undoubtedly entail great costs that are both economically and emotionally irretrievable; nevertheless, the present study seeks to highlight the new opportunities that are provided during this disaster and the optimal utilization of all capacities to alleviate this seemingly-terrible condition. This paper presents a brief report of the first weeks of the COVID-19 crisis in Imam Khomeini Hospital Complex (IKHC) affiliated to Tehran University of Medical Sciences as the largest hospital in Iran with approximately 1200 active beds. In addition to lots of problems during the battle for maintaining the treatment quality in this crisis, a strategy was devised to mitigate the challenges. The positive perspectives during the fight with the predicament of COVID-19 in this hospital are detailed in the following nine domains

The effects of CPAP therapy on metabolic profile and subjective sleep parameters in patients with OSA: a prospective trial study

Objective: Several studies confirmed a positive association between obstructive sleep apnea (OSA) and metabolic syndrome. Continuous positive airway pressure (CPAP) is the main treatment for patients with moderate and severe OSA. CPAP therapy in adults with OSA results in reduction in sleepiness, blood pressure and improvement of metabolic profile. In this study, we aimed to evaluate the effects of CPAP therapy on various components of metabolic syndrome and subjective sleep parameters in patients with OSA. Material and Methods: In this prospective trial study, 28 patients with moderate and severe OSA enrolled. Patients were asked to fill out the validated Persian version of questionnaires including Epworth sleepiness scale, insomnia severity index, STOP-BANG and Beck depression inventory - II, before and after treatment with CPAP. Weight and blood pressure were recorded before and after treatment. Only 14 patients agreed to blood sampling before and after CPAP therapy (at least 3 months of treatment). Fasting blood samples were analyzed for measuring the levels of FBS (fasting blood sugar), TG (triglyceride), total cholesterol, HDL, LDL, AST, and ALT. Results: Diastolic blood pressure, ISI and STOP-BANG score significantly decreased after treatment (p-value: 0.008, 0.022 and 0.004, respectively). FBS and TG levels decreased after treatment, but only TG levels had significant difference (p-value: 0.46 and 0.016, respectively). Discussion: CPAP therapy had positive effects on diastolic blood pressure, TG levels and ISI score. More studies with larger sample size and longer follow-up periods are warranted to investigate the effects of CPAP therapy on blood pressure, and metabolic parameters

Obstructive sleep apnea and severity of coronary artery disease

Background: It has been implicated that obstructive sleep apnea (OSA) is associated with increased risk of cardiovascular disease including stroke, myocardial infarction, coronary artery disease (CAD) and hypertension. The aim of this study was to investigate the correlation between OSA and severity of atherosclerosis assessed by angiography. Methods: This study included 337 patients undergoing diagnostic coronary angiography at Tehran Heart Center, Iran. The Gensini score was obtained from each patient for coronary angiogram, and OSA were assessed by using Multivariable apnea prediction (MAP) risk index on the day of cardiac catheterization. The Gensini scores increased in accordance with increases in the MAP value. Results: The prevalence rates of three-vessel disease were 68.0% in OSA group and 32.0% in non-OSA group. The MAP index was the most significant independent determinant for the Gensini score. Conclusions: The independent association between OSA and CAD, even after adjustment for traditional confounders, suggests that, OSA should be taken into account when considering risk factors for CAD

Razine antinuklearnoga antitijela i reumatoidnoga faktora u radnika izloženih silicijevu dioksidu

A lot of workers in industries such as foundry, stonecutting, and sandblasting are exposed to higher than permissible levels of crystalline silica. Various alterations in humoral immune function have been reported in silicosis patients and workers exposed to silica dust. The aim of this study was to measure antinuclear antibody (ANA) and rheumatoid factor (RF) levels in foundry workers exposed to silica and to compare them with a control group without such exposure. ANA and RF were measured in 78 exposed and 73 non-exposed workers, and standard statistical methods were used to compare them. The two groups did not significantly differ in age and smoking. Mean work duration of the exposed and non-exposed workers was (14.9±4.72) years and (12.41±6.3) years, respectively. Ten exposed workers had silicosis. ANA was negative in all workers in either group. Its mean titer did not differ significantly between the exposed and control workers [(0.39±0.15) IU mL-1 vs. (0.36±0.17) IU mL-1, respectively]. RF was positive in two workers of each group. Other studies have reported an increase in ANA and RF associated with exposure to silica dust and silicosis. In contrast, our study suggests that exposure to silica dust does not increase the level of ANA and RF in exposed workers.Mnogi su radnici izloženi kristalnomu silicijevu dioksidu u razinama iznad dopuštenih. U oboljelih od silikoze i radnika izloženih prašinama koje sadržavaju silicijev dioksid zamijećen je niz oštećenja humoralne obrane. Budući da su radnici u ljevaonicama izloženi visokim razinama kristalnoga silicijeva dioksida, u njih bismo očekivali ovakve humoralne poremećaje. Cilj je ovog ispitivanja bio izmjeriti i usporediti razine antinuklearnih protutijela (ANA) i reumatoidnoga faktora (RF) u krvi radnika u ljevaonici izloženih silicijevu dioksidu i neizložene kontrolne skupine. ANA i RF izmjereni su u 78 izloženih radnika i 73 neizložena radnika te su uspoređeni s pomoću standardnih statističkih metoda. Dvije se skupine nisu bitno razlikovale u broju pušača i u dobi. Prosječna duljina radnog vijeka izloženih radnika bila je (14,9±4,72) godine, a neizloženih (12,41±6,3) godine. Deset izloženih radnika imalo je silikozu. Nalazi ANA bili su negativni u obje skupine radnika. Srednja vrijednost titra ANA iznosila je (0,39±0,15) IU mL-1 u izloženih ispitanika, a (0,36±0,17) IU mL-1 u kontrola, što je statistički zanemariva razlika. Nalaz RF-a bio je pozitivan u dva izložena te dva kontrolna radnika. Naše ispitivanje upućuje na to da prašine silicijeva dioksida ne uzrokuju porast razina ANA i RF-a u izloženih radnika

Fatigue management in the workplace

Fatigue management in the workplace Khosro Sadeghniiat-Haghighi1, Zohreh Yazdi2 Abstract Workers' fatigue is a significant problem in modern industry, largely because of high demand jobs, long duty periods, disruption of circadian rhythms, and accumulative sleep debt that are common in many industries. Fatigue is the end result of integration of multiple factors such as time awake, time of day, and workload. Then, the full understanding of circadian biologic clock, dynamics of transient and cumulative sleep loss, and recovery is required for effective management of workplace fatigue. It can be more investigated in a new field of sleep medicine called occupational sleep medicine. Occupational sleep medicine is concerned with maintaining best productivity and safety in the industrial settings. The fatigue risk management system (FRMS) is a comprehensive approach that is based on applying scientific evidence of sleep knowledge to manage workers fatigue. It is developing rapidly in the highly safety demand jobs; especially truck drivers, pilots, and power plant workers. The objective of this review is to explain about fatigue in the workplace with emphasis on its association work performance and errors/accidents. Also, we discussed about different methods of fatigue measurement and management. Keywords: Fatigue management, safety, workplac

Comparison of Two Assessment Tools That Measure Insomnia: The Insomnia Severity Index and Polysomnography

Background: Insomnia is a common sleep disorder, characterized by difficulties in sleep initiation, sleep maintenance or early morning awakening. Although polysomnography (PSG) is a standard method in the evaluation of sleep disorders, it is not recommended for routine use in the clinical assessment of insomnia. Instead, standard questionnaires could be used in the primary evaluation of insomnia. Objective: The main object of this study was to compare the type and severity of patients′ subjective complaints of insomnia gathered from insomnia severity index (ISI) questionnaire with the result of their polysomnographic evaluation. Materials and Methods: In this cross-sectional study conducted during 2010-2011 in Iran, all patients in one clinic with sleep disorders were evaluated. The study consisted of self-administered questionnaires completed by participants to provide information on demographic characteristics and ISI questionnaire. After completing the questionnaire, all the participants underwent standard overnight PSG. Results: Subjects were 151 patients (47.2 ± 10.8 years old). The average ISS was 6.1 ± 4. There was a significant relationship between the subjective complaint of difficulty in sleep initiation and sleep onset latency in PSG (r = 0.5, P < 0.001). Furthermore, there was a correlation between the subjective complaint of difficulty in sleep maintenance and number of awakening in PSG (r = 0.19, P = 0.01). A low patients′ satisfaction from their sleep was associated with lower total sleep time (r = -0.2, P = 0.02) and a lower percentage of rapid eye movement (REM) sleep in their PSG study (r = -0.25, P = 0.002). No relation was found between patients′ satisfaction and sleep efficiency measured with PSG (r = -0.04, P = 0.6). Conclusions: Our findings suggest that objective insomnia, measured with ISI, is related with PSG variables and ISI could be a useful tool to quantify perceived insomnia severity. Further studies are needed to determine the sensitivity and specificity of this questionnaire

Prevalence of Sleep Disorders and their Effects on Sleep Quality in Epileptic Patients

Introduction: Epilepsy is a complex pervasive neurobehavioral and social condition accompanied by a wide range of comorbid conditions that can adversely affect the quality of life of patients. Sleep complaints are common among patients with epilepsy. The aim of this study was to assess the prevalence of subjective sleep disturbances and its effects on sleep quality in epileptic patients.  Methods: In this cross-sectional study,  152 consecutive epileptic patients and 152 controls were  interviewed. We used Epworth Sleepiness Scale, Insomnia Severity Index, Berlin Questionnaire and Pittsburg Sleep Quality Index to measure excessive daytime sleepiness, insomnia, obstructive sleep apnea and sleep quality. R estless leg syndrome was diagnosed using three questions.  Results: The age, gender and average total sleep time was similar in patients and control group. The frequency of excessive sleepiness scale and subjective complaint of sleep maintenance was higher in epileptic patients than control group (P<0.05). The symptoms of restless leg syndrome were reported by 32.3% of patients and 11.8% of controls (P<0.05). Discussion: Daytime sleepiness, dif.culty in sleep maintenance, poor sleep quality and RLS appear to be common in patients with epilepsy. Further con.rmatory studies are needed using objective sleep studies to detect underlying mechanisms of sleep disorders in these patients

Prevalence of Sleep Disorders and Their Impacts on Occupational Performance: A Comparison between Shift Workers and Nonshift Workers

The consequences of sleep deprivation and sleepiness have been noted as the most important health problem in our modern society among shift workers. The objective of this study was to investigate the prevalence of sleep disorders and their possible effects on work performance in two groups of Iranian shift workers and nonshift workers. This study was designed as a cross-sectional study. The data were collected by PSQI, Berlin questionnaire, Epworth Sleepiness Scale, Insomnia Severity Index, and RLS Questionnaire. Occupational impact of different sleep disorders was detected by Occupational Impact of Sleep Disorder questionnaire. These questionnaires were filled in by 210 shift workers and 204 nonshift workers. There was no significant difference in the age, BMI, marital status, and years of employment in the two groups. Shift workers scored significantly higher in the OISD. The prevalence of insomnia, poor sleep quality, and daytime sleepiness was significantly higher in shift workers. Correlations between OISD scores and insomnia, sleep quality, and daytime sleepiness were significant. We concluded that sleep disorders should receive more attention as a robust indicator of work limitation

Cross-Shift Study of Acute Respiratory Effects in Cement Production Workers

Cement dust exposure is associated with increased respiratory impairment. As the major occupational hazard in the cement production industry is cement particles, our aim was to more thoroughly examine the acute effects of occupational exposure to cement dust on the respiratory system. A cross-shift study was conducted in a cement factory in Iran. 100 high exposed workers from production and packing sections and 100 low exposed from office workers were included. Environmental total dust was measured in each section. Assessment of lung function was done by pre and post shift spirometry. At the end of the day shift, acute respiratory symptoms were recorded. The means of total dust among high and low exposed workers were 16.55 mg/m3 and 0.9 mg/m3, respectively. The most common acute respiratory symptoms in high exposed workers were stuffy nose (52%) and shortness of breath (49%). A statistically significant post shift reduction in PEF, FEV1, FEF 25-75, FVC and FEV1/ FVC was demonstrated in high exposed group. Multivariate linear regression showed a significant relationship between the percentage of the cross-shift decrease in spirometric indices and exposure to cement dust. We detected significant relationship between exposure to cement dust and acute respiratory symptoms and pulmonary function indices. Effective dust-control measures and preparing a suitable strategy for respiratory protection are highly recommended