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

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

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

Health outcomes of continuous positive airway pressure versus mandibular advancement device for the treatment of severe obstructive sleep apnea:an individual participant data meta-analysis

Study Objectives: The impact of therapy with continuous positive airway pressure (CPAP) and mandibular advancement device (MAD) has not been directly compared in patients with severe obstructive sleep apnea (OSA). The purpose of this individual participant data meta-analysis was to compare the treatment effects of CPAP and titratable MAD on sleepiness, quality of life, sleep-disordered breathing severity, and sleep structure in patients with severe OSA. Methods: Randomized controlled trials (RCTs) that included severe OSA patients were identified in order to compare the impact of the two treatments. Individual data from severe OSA patients were extracted from the databases and pooled for analysis. Results: Of the seven studies identified, three crossover RCT and one parallel-group RCT corresponding to 151 patients and 249 observations (125 in the CPAP treatment arm and 124 in the MAD treatment arm) were included in the analysis. Titratable MAD had a similar impact to CPAP on major patient-centered outcomes (sleepiness and quality of life). CPAP was more effective in reducing AHI and ODI. However, the two treatments had a similar impact on sleep structure with an increase of N3 and REM sleep. Finally, treatment adherence and preference were largely in favor of MAD. Conclusion: This meta-analysis suggests that MAD represents an effective alternative treatment in severe OSA patients intolerant to CPAP or who prefer alternate therapy

Unexpected Hydrolytic Instability of N-Acylated Amino Acid Amides and Peptides

Remote amide bonds in simple N-acyl amino acid amide or peptide derivatives 1 can be surprisingly unstable hydrolytically, affording, in solution, variable amounts of 3 under mild acidic conditions, such as trifluoroacetic acid/water mixtures at room temperature. This observation has important implications for the synthesis of this class of compounds, which includes N-terminal-acylated peptides. We describe the factors contributing to this instability and how to predict and control it. The instability is a function of the remote acyl group, R2CO, four bonds away from the site of hydrolysis. Electron-rich acyl R2 groups accelerate this reaction. In the case of acyl groups derived from substituted aromatic carboxylic acids, the acceleration is predictable from the substituent’s Hammett σ value. N-Acyl dipeptides are also hydrolyzed under typical cleavage conditions. This suggests that unwanted peptide truncation may occur during synthesis or prolonged standing in solution when dipeptides or longer peptides are acylated on the N-terminus with electron-rich aromatic groups. When amide hydrolysis is an undesired secondary reaction, as can be the case in the trifluoroacetic acid-catalyzed cleavage of amino acid amide or peptide derivatives 1 from solid-phase resins, conditions are provided to minimize that hydrolysis

The Different Facets of Heart Rate Variability in Obstructive Sleep Apnea

Obstructive sleep apnea (OSA), a heterogeneous and multifactorial sleep related breathing disorder with high prevalence, is a recognized risk factor for cardiovascular morbidity and mortality. Autonomic dysfunction leads to adverse cardiovascular outcomes in diverse pathways. Heart rate is a complex physiological process involving neurovisceral networks and relative regulatory mechanisms such as thermoregulation, renin-angiotensin-aldosterone mechanisms, and metabolic mechanisms. Heart rate variability (HRV) is considered as a reliable and non-invasive measure of autonomic modulation response and adaptation to endogenous and exogenous stimuli. HRV measures may add a new dimension to help understand the interplay between cardiac and nervous system involvement in OSA. The aim of this review is to introduce the various applications of HRV in different aspects of OSA to examine the impaired neuro-cardiac modulation. More specifically, the topics covered include: HRV time windows, sleep staging, arousal, sleepiness, hypoxia, mental illness, and mortality and morbidity. All of these aspects show pathways in the clinical implementation of HRV to screen, diagnose, classify, and predict patients as a reasonable and more convenient alternative to current measures.Peer Reviewe

Contactless recording of sleep apnea and periodic leg movements by nocturnal 3-D-video and subsequent visual perceptive computing

Contactless measurements during the night by a 3-D-camera are less time-consuming in comparison to polysomnography because they do not require sophisticated wiring. However, it is not clear what might be the diagnostic benefit and accuracy of this technology. We investigated 59 persons simultaneously by polysomnography and 3-D-camera and visual perceptive computing (19 patients with restless legs syndrome (RLS), 21 patients with obstructive sleep apnea (OSA), and 19 healthy volunteers). There was a significant correlation between the apnea hypopnea index (AHI) measured by polysomnography and respiratory events measured with the 3-D-camera in OSA patients (r = 0.823; p < 0.001). The receiver operating characteristic curve yielded a sensitivity of 90% for OSA with a specificity of 71.4%. In RLS patients 72.8% of leg movements confirmed by polysomnography could be detected by 3-D-video and a significant moderate correlation was found between PLM measured by polysomnography and by the 3-D-camera (RLS: r = 0.654; p = 0.004). In total, 95.4% of the sleep epochs were correctly classified by the machine learning approach, but only 32.5% of awake epochs. Further studies should investigate, if this technique might be an alternative to home sleep testing in persons with an increased pre-test probability for OSA