Showing papers by "Mathias Basner published in 2018"

WHO Environmental Noise Guidelines for the European Region: A Systematic Review on Environmental Noise and Effects on Sleep.

Abstract: To evaluate the quality of available evidence on the effects of environmental noise exposure on sleep a systematic review was conducted. The databases PSYCINFO, PubMed, Science Direct, Scopus, Web of Science and the TNO Repository were searched for non-laboratory studies on the effects of environmental noise on sleep with measured or predicted noise levels and published in or after the year 2000. The quality of the evidence was assessed using GRADE criteria. Seventy four studies predominately conducted between 2000 and 2015 were included in the review. A meta-analysis of surveys linking road, rail, and aircraft noise exposure to self-reports of sleep disturbance was conducted. The odds ratio for the percent highly sleep disturbed for a 10 dB increase in Lnight was significant for aircraft (1.94; 95% CI 1.61–2.3), road (2.13; 95% CI 1.82–2.48), and rail (3.06; 95% CI 2.38–3.93) noise when the question referred to noise, but non-significant for aircraft (1.17; 95% CI 0.54–2.53), road (1.09; 95% CI 0.94–1.27), and rail (1.27; 95% CI 0.89–1.81) noise when the question did not refer to noise. A pooled analysis of polysomnographic studies on the acute effects of transportation noise on sleep was also conducted and the unadjusted odds ratio for the probability of awakening for a 10 dBA increase in the indoor Lmax was significant for aircraft (1.35; 95% CI 1.22–1.50), road (1.36; 95% CI 1.19–1.55), and rail (1.35; 95% CI 1.21–1.52) noise. Due to a limited number of studies and the use of different outcome measures, a narrative review only was conducted for motility, cardiac and blood pressure outcomes, and for children’s sleep. The effect of wind turbine and hospital noise on sleep was also assessed. Based on the available evidence, transportation noise affects objectively measured sleep physiology and subjectively assessed sleep disturbance in adults. For other outcome measures and noise sources the examined evidence was conflicting or only emerging. According to GRADE criteria, the quality of the evidence was moderate for cortical awakenings and self-reported sleep disturbance (for questions that referred to noise) induced by traffic noise, low for motility measures of traffic noise induced sleep disturbance, and very low for all other noise sources and investigated sleep outcomes.

Education Outcomes in a Duty-Hour Flexibility Trial in Internal Medicine

Abstract: Background Concern persists that inflexible duty-hour rules in medical residency programs may adversely affect the training of physicians. Methods We randomly assigned 63 internal medicine residency programs in the United States to be governed by standard duty-hour policies of the 2011 Accreditation Council for Graduate Medical Education (ACGME) or by more flexible policies that did not specify limits on shift length or mandatory time off between shifts. Measures of educational experience included observations of the activities of interns (first-year residents), surveys of trainees (both interns and residents) and faculty, and intern examination scores. Results There were no significant between-group differences in the mean percentages of time that interns spent in direct patient care and education nor in trainees’ perceptions of an appropriate balance between clinical demands and education (primary outcome for trainee satisfaction with education; response rate, 91%) or in the assessments by prog...

Repeated Administration Effects on Psychomotor Vigilance Test Performance.

Abstract: Study objectives The Psychomotor Vigilance Test (PVT) is reported to be free of practice effects that can otherwise confound the effects of sleep loss and circadian misalignment on performance. This differentiates the PVT from more complex cognitive tests. To the best of our knowledge, no study has systematically investigated practice effects on the PVT across multiple outcome domains, depending on administration interval, and in ecologically more valid settings. Methods We administered a validated 3-minute PVT (PVT-B) 16 times in 45 participants (23 male, mean ± SD age 32.6 ± 7.3 years, range 25-54 years) with administration intervals of ≥10 days, ≤5 days, or 4 times per day. We investigated linear and logarithmic trends across repeated administrations in 10 PVT-B outcome variables. Results The fastest 10% of response times (RT; plin = .0002), minimum RT (plog = .0010), and the slowest 10% of reciprocal RT (plog = .0124) increased while false starts (plog = 0.0050) decreased with repeated administration, collectively decreasing RT variability (plog = .0010) across administrations. However, the observed absolute changes were small (e.g., -0.03 false starts per administration, linear fit) and are probably irrelevant in practice. Test administration interval did not modify the effects of repeated administration on PVT-B performance (all p > .13 for interaction). Importantly, mean and median RT, response speed, and lapses, which are among the most frequently used PVT outcomes, did not change systematically with repeated administration. Conclusions PVT-B showed stable performance across repeated administrations. Combined with its high sensitivity, this corroborates the status of the PVT as the de facto gold standard measure of the neurobehavioral effects of sleep loss and circadian misalignment.

Sleep duration in the United States 2003-2016: first signs of success in the fight against sleep deficiency?

Abstract: Study Objectives The high prevalence of chronic insufficient sleep in the population has been a concern due to the associated health and safety risks. We evaluated secular trends in sleep duration over the most recent 14-year period. Methods The American Time Use Survey, representative of US residents ≥15 years, was used to investigate trends in self-reported sleep duration and waking activities for the period 2003-2016 (N = 181335 respondents). Results Sleep duration increased across survey years both on weekdays (+1.40 min/year) and weekends (+0.83 min/year, both p 7-9 hr), and long (>9 hr) sleep changed by -0.44% per year (p < .0001), -0.03% per year (p = .5515), and +0.48% per year (p < .0001), respectively. The change in sleep duration was predominantly explained by respondents retiring earlier in the evening. The percentage of respondents who watched TV or read before bed-two prominent waking activities competing with sleep-decreased over the same time period, suggesting that portions of the population are increasingly willing to trade time in leisure activities for more sleep. The results also suggest that increasing online opportunities to work, learn, bank, shop, and perform administrative tasks from home freed up time that likely contributed to increased sleep duration. Conclusions The findings indicate first successes in the fight against sleep deficiency. Public health consequences of the observed increase in the prevalence of long sleep remain unclear and warrant further investigation.

Impact of long-term daylight deprivation on retinal light sensitivity, circadian rhythms and sleep during the Antarctic winter.

Abstract: Long-term daylight deprivation such as during the Antarctic winter has been shown to lead to delayed sleep timing and sleep fragmentation. We aimed at testing whether retinal sensitivity, sleep and circadian rest-activity will change during long-term daylight deprivation on two Antarctic bases (Concordia and Halley VI) in a total of 25 healthy crew members (mean age: 34 ± 11y; 7f). The pupil responses to different light stimuli were used to assess retinal sensitivity changes. Rest-activity cycles were continuously monitored by activity watches. Overall, our data showed increased pupil responses under scotopic (mainly rod-dependent), photopic (mainly L-/M-cone dependent) as well as bright-blue light (mainly melanopsin-dependent) conditions during the time without direct sunlight. Circadian rhythm analysis revealed a significant decay of intra-daily stability, indicating more fragmented rest-activity rhythms during the dark period. Sleep and wake times (as assessed from rest-activity recordings) were significantly delayed after the first month without sunlight (p < 0.05). Our results suggest that during long-term daylight deprivation, retinal sensitivity to blue light increases, whereas circadian rhythm stability decreases and sleep-wake timing is delayed.

Effects of −12° head-down tilt with and without elevated levels of CO2 on cognitive performance: the SPACECOT study

Abstract: Simulating microgravity with exposure to 21 h of −12° head-down tilt bed rest caused a change in response strategy on a range of cognitive tests, with a statistically significant increase in respon...

Sleep deprivation enhances inter-stimulus interval effect on vigilant attention performance.

Abstract: Study objective Sleep deprivation significantly reduces the ability to maintain a consistent alertness level and impairs vigilant attention. Previous studies have shown that longer inter-stimulus interval (ISI) are associated with faster reaction times (RTs) on the Psychomotor Vigilance Test (PVT). However, whether and how sleep deprivation interacts with this ISI effect remains unclear. Methods N = 70 healthy adults (age range 20-50 years, 41 males) participated in a 5-day and 4-night in-laboratory controlled sleep deprivation study, including N = 54 in the experimental group with one night of total sleep deprivation and N = 16 in the control group without sleep loss. All participants completed a neurobehavioral test battery every 2 hours while awake, including a 10-minute standard PVT (PVT-S, N = 1626) and a 3-minute brief PVT (PVT-B, N = 1622). The linear approach to threshold with ergodic rate (LATER) model was used to fit the RT data. Results RT decreased significantly with longer ISI on the PVT-S and PVT-B. Increased ISI effect was found for both PVT-S and PVT-B during sleep deprivation compared to baseline or recovery sleep in the experimental group, whereas no differences in the ISI effect were found in the control group. The LATER model fitting indicated that changes in perceptual sensitivity rather than threshold adjustment may underlie the ISI effect. Conclusions Both standard and brief PVT showed a similar ISI effect on vigilant attention performance. Sleep deprivation increased the ISI effect on both PVT-S and PVT-B, which may be due to impaired temporal resolution and time estimation after sleep loss.

Development of the individualised Comparative Effectiveness of Models Optimizing Patient Safety and Resident Education (iCOMPARE) trial: a protocol summary of a national cluster-randomised trial of resident duty hour policies in internal medicine.

Abstract: Introduction Medical trainees’ duty hours have received attention globally; restrictions in Europe, New Zealand and some Canadian provinces are much lower than the 80 hours per week enforced in USA. In USA, resident duty hours have been implemented without evidence simultaneously reflecting competing concerns about patient safety and physician education. The objective is to prospectively evaluate the implications of alternative resident duty hour rules for patient safety, trainee education and intern sleep and alertness. Methods and analysis 63 US internal medicine training programmes were randomly assigned 1:1 to the 2011 Accreditation Council for Graduate Medical Education resident duty hour rules or to rules more flexible in intern shift length and number of hours off between shifts for academic year 2015–2016. The primary outcome is calculated for each programme as the difference in 30-day mortality rate among Medicare beneficiaries with any of several prespecified principal diagnoses in the intervention year minus 30-day mortality in the preintervention year among Medicare beneficiaries with any of several prespecified principal diagnoses. Additional safety outcomes include readmission rates, prolonged length of stay and costs. Measures derived from trainees’ and faculty responses to surveys and from time-motion studies of interns compare the educational experiences of residents. Measures derived from wrist actigraphy, subjective ratings and psychomotor vigilance testing compare the sleep and alertness of interns. Differences between duty hour groups in outcomes will be assessed by intention-to-treat analyses. Ethics and dissemination The University of Pennsylvania Institutional Review Board (IRB) approved the protocol and served as the IRB of record for 40 programmes that agreed to sign an Institutional Affiliation Agreement. Twenty-three programmes opted for a local review process. Trial registration number NCT02274818; Pre-results.

Cognitive and Neurophysiological Recovery Following Electroconvulsive Therapy: A Study Protocol.

Abstract: Electroconvulsive therapy (ECT) employs the elective induction of generalizes seizures as a potent treatment for severe psychiatric illness. As such, ECT provides an opportunity to rigorously study the recovery of consciousness, reconstitution of cognition, and electroencephalographic (EEG) activity following seizures. Fifteen patients with major depressive disorder refractory to pharmacologic therapy will be enrolled (Clinicaltrials.gov, NCT02761330). Adequate seizure duration will be confirmed following right unilateral ECT under etomidate anesthesia. Patients will then undergo randomization for the order in which they will receive three sequential treatments: etomidate + ECT, ketamine + ECT, and ketamine + sham ECT. Sessions will be repeated in the same sequence for a total of six treatments. Before each session, sensorimotor speed, working memory, and executive function will be assessed through a standardized cognitive test battery. After each treatment, the return of purposeful responsiveness to verbal command will be determined. At this point, serial cognitive assessments will begin using the same standardized test battery. The presence of delirium and changes in depression severity will also be ascertained. Sixty-four channel EEG will be acquired throughout baseline, ictal, and postictal epochs. Mixed-effects models will correlate the trajectories of cognitive recovery, clinical outcomes, and EEG metrics over time. This innovative research design will answer whether: (1) time to return of responsiveness will be prolonged with ketamine + ECT compared with ketamine + sham ECT; (2) time of restoration to baseline function in each cognitive domain will take longer after ketamine + ECT than after ketamine + sham ECT; (3) postictal delirium is associated with delayed restoration of baseline function in all cognitive domains; and (4) the sequence of reconstitution of cognitive domains following the three treatments in this study is similar to that occurring after an isoflurane general anesthetic (NCT01911195). Sub-studies will assess the relationships of cognitive recovery to the EEG preceding, concurrent, and following individual ECT sessions. Overall, this study will lead the development of biomarkers for tailoring the cogno-affective recovery of patients undergoing ECT.

Study on methodology to perform an environmental noise and health assessment - a guidance document for local authorities in Europe

Abstract: The Environmental Noise Directive (END) is for local authorities the most important instrument to determine the levels of noise pollution. Also, the Directive is aimed at the evaluation of effect of measures and can make the effects of alternative measures visible. The Directive stimulates the Member States to take action to reduce the adverse effects of environmental noise . Annex III of the Directive is currently under revision and will include a method to calculate the effects of different noise sources, such as road- and rail traffic, according to the latest scientific evidence. In preparation of this update, RIVM in collaboration with international partners has prepared a guidance document. Not only annoyance and sleep disturbance are addressed as health effects, but also cardiovascular effects and cognitive impact in children (comprehensive reading impairment). The document is worded in such a way that it is easily used by local authorities. The guidance document was prepared on request of the EU commission. The document describes the steps of a health impact assessment one by one and explains the accompanying decisions and conditions. Next, the actual calculation methods are further explained for two indicators: the number of healthy life years adjusted for disease, disability and death (DALY) and the number of people that experiences adverse effects of noise ((NafP). Finally, as an example, the health impact of noise in Dusseldorf is described.

Response to Letters to the Editor by Dr. Glozier and Grunstein and by Drs. Hertenstein, Riemann, and Nissen in response to our article "Sleep duration in the United States 2003-2016: first signs of success in the fight against sleep deficiency?"

Abstract: We would like to thank Drs. Glozier and Grunstein for carefully reading and commenting on our article [1]. In hindsight, the article title would have better referred to “signs of progress” in the fight against sleep deficiency, which is still widespread in the US population [2]. As pointed out by the authors (and discussed in the introduction of our article), other studies have shown increases in sleep duration assessed with time use surveys in the United States over the past few decades (e.g. Bin et al. [3] and Luckhaupt et al. [4]). We are providing an update based on what is now a massive database of US time use data across 2003–2016. Our analyses show that the trend of increasing sleep duration has continued and probably even accelerated since the last review of the data in 2007. We believe that the strength of our article is not based on being the first to show this or not, but on the thorough investigation of concurrent trends in waking activities, and how they may explain some of the observed trends in sleep duration. Finally, we also agree with the authors (and repeatedly point out in the abstract and body of our article) that the nature and impact of the observed increase in the prevalence of long sleep duration deserve more attention from the research community. We would also like to thank Drs. Hertenstein, Riemann, and Nissen for their helpful comments. We agree that p-values have limited value when operating with large datasets that provide statistical power to find differences significant that are not necessarily also relevant [5]. We understand that an annual increase in sleep duration of 1.4 min per 24 hr on weekdays and 0.8 min per 24 hr on weekends sounds irrelevant. However, over the 14 year observation period it translates to 17.3 min more sleep each night, or 4.4 full days each year, at the end of the observation period compared with the beginning. Considering the cumulative nature of sleep and chronic sleep loss [6] and the fact that alertness increases in a monotonic fashion with prior sleep [7], we believe that this increase in sleep duration to be beneficial for some (especially short sleepers), and thus relevant. The sleep research community should be able to assess the relevance of the size of this increase in sleep duration, and we therefore refrained from providing additional effect size measures. In the multiple regression context, adjusted R2 is a standard effect size metric. Adding survey year to our fully adjusted model increased this metric by 2.1 per cent, and the model explained 9.9 per cent of the total variance in sleep time (ADJRSQ statement in SAS Proc Surveyreg, SAS Institute, Version 9.4, Cary, NC). The authors state that “mean sleep duration was slightly longer than 8 hours on weekdays and SLEEPJ, 2018, 1–2