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Driver State
Published in Motoyuki Akamatsu, Handbook of Automotive Human Factors, 2019
Of late sleep propensity has often been used as an operational definition of sleepiness. Sleep propensity refers to the amount of time it takes to fall asleep. Another operational definition of sleepiness used before the concept of sleep propensity is somnolence (or drowsiness). Somnolence is a drowsy state that occurs when shifting from arousal to sleep. It causes changes in recognition, behavior, performance, subjective experience of sleepiness, and the autonomic nervous system and central nervous system. However, it does not necessary accompany the subjective experience of sleepiness. Although somnolence is correlated with sleep propensity, these two types of sleepiness should be distinguished (Johns, 2010). Most of the currently- developed sleepiness-evaluation methods measure either sleep propensity or somnolence.
The World Trade Center Health Program: Obstructive sleep apnea best practices
Published in Archives of Environmental & Occupational Health, 2023
Iris G. Udasin, Jag Sunderram, Geoffrey Calvert
The events of September 11, 2001 (9-11) exposed nearly half a million people, emergency responders and residents and workers and students attending school in local buildings near the disaster site, to dust and toxic chemicals. The responders included those people involved in search, rescue, recovery and clean-up efforts in the New York City (NYC) and the Pentagon in Washington DC and Shanksville, Pennsylvania. A significant number of people exposed to dust and debris reported new onset or worsening upper airway disease (UAD) and gastroesophageal reflux disease (GERD) and obstructive sleep apnea (OSA). An early study showed upper respiratory symptoms were persisting in 69% of patients surveyed 5 years after 9-11 service.1 Patients reported increases in snoring and daytime somnolence which are both symptoms suggestive of obstructive sleep apnea.2,3 Several studies in NYC responders suggest that chronic rhinosinusitis is present in a majority of 9/11-exposed patients.4 OSA is a chronic medical condition with recurrent episodes of partial and complete upper airway collapse during sleep. The main OSA risk factors are obesity, aging, and male sex. While OSA might be present in 34-50% of the general population, studies show that the rate of OSA is increased in WTC responders who have been diagnosed with 9/11-related chronic rhinosinusitis.4
Salix alba (white willow) medicinal plant presents genotoxic effects in human cultured leukocytes
Published in Journal of Toxicology and Environmental Health, Part A, 2019
Edson Luis Maistro, Peterson Menezes Terrazzas, Fábio Ferreira Perazzo, Isabel O’Neill De Mascarenhas Gaivão, Alexandra Christinie Helena Frankland Sawaya, Paulo Cesar Pires Rosa
Genotoxic studies of natural plant extracts and their active compounds have contributed to the determination of their safety for use in humans. Regulatory agencies such as the Food and Drug Administration (FDA) and Environmental Protection Agency (EPA) in the United States, and the National Health Surveillance Agency (ANVISA) in Brazil, assess and use available toxicity data in risk assessments for regulatory purposes. ANVISA included the extract of SA in the List of Herbal Medicines distributed by SUS (Health Unic System) to the population, being indicated as anti-inflammatory, antipyretic, and analgesic. However, our literature review showed that there are no apparent investigations assessing the genotoxic and cytotoxic potential of SA bark extract alone. In contrast, there is one study involving a formulation with three plant extracts. Nascimento et al. (2009) examined the clinical toxicology of Pasalix®, a phytotherapeutic utilized in the treatment of anxiety and insomnia, which contains Passiflora incarnata (100 mg), Crataegus oxyacantha (30 mg), and Salix alba (100 mg). Some adverse effects were reported by volunteers, such as somnolence, epigastralgia, restlessness, skin rash, and headache. Despite these effects, Pasalix® administration did not show apparent signs of toxicity in clinical, electrocardiographic, and lab tests. To our knowledge, genotoxic, and clastogenic/aneugenic effects were not investigated. Considering the high level of human exposure to Salix alba bark extract, the absence of studies involving its genetic toxicity on human cells, and that some chemical compounds are genotoxic without metabolic activation, while others require metabolic activation, the aim of the present study was to (1) characterize the main chemical compounds present in the bark extract of this plant and (2) evaluate its cytotoxic and genotoxic potential in human leukocytes (without metabolism by liver enzymes) and also after its metabolism by hepatic enzymes of human HepG2 cells, in vitro.
Can real-life driving ability be predicted by the Maintenance of Wakefulness Test?
Published in Traffic Injury Prevention, 2019
Irina Virtanen, Johanna Järvinen, Ulla Anttalainen
For the MWT, an MWT40 protocol with 4 40-min recordings at 8 a.m., 10 a.m., 12 p.m., and 2 p.m. was used with the international 10–20 system EEG electrodes F3, F4, C3, C4, O1, and O2 referred to M1 and M2, in combination with bilateral electrooculogram and submental electromyogram, according to American Academy of Sleep Medicine recommendations (Littner et al. 2005). A technician observed the patient via digital video and marked eye opening and closing on the recording online. Before the MWT, the patients reported subjective total sleep time from the previous night, which was required to be at least 6 h. For the evaluation of daytime somnolence, we used the Epworth Sleepiness Scale (ESS), with scores over 10 points out of 24 considered abnormal. For the evaluation of possible depressive disorders, the patients filled in the General Health Questionnaire-12 in which at least 3 points out of 12 was considered abnormal. Further, we used the depression questionnaire (DEPS) in which at least 9 points out of 30 was considered suggestive of depression. Original MWT data were reanalyzed by an experienced clinical neurophysiologist (I.V.), defining the following:Alpha latency from lights off to the appearance of posterior alpha activity regardless of eye closure of at least 3-s duration.Microsleep latency from lights off to the appearance of N1 sleep theta pattern of at least 3-s duration.Sleep latency from lights off to the appearance of N1 sleep theta pattern of at least 10 consecutive seconds’ duration (odds ratio at least 15-s duration) during a 30-s epoch as defined by Doghramji et al. (1997) instead of the 15-out-of-30-s-only criteria by Littner et al. (2005) that might have yielded longer sleep latencies. This criterion was used because our laboratory has used Doghramji et al.’s (1997) sleep latency criteria to define hypersomnolence in the MWT in clinical practice, and we did not want to deviate very far from the original evaluations, which had been used as a basis for clinical judgment. If the first observed theta paroxysm fulfilled the sleep latency criteria, it was marked both as microsleep and as sleep.N2 sleep latency from lights off to the appearance of sleep spindles and/or K complexes defining N2 sleep (light non-REM sleep) of at least 15-s duration during a 30-s epoch, if applicable.