Publications by authors named "Shantha M W Rajaratnam"

128 Publications

In-person vs. home schooling during the COVID-19 pandemic: Differences in sleep, circadian timing, and mood in early adolescence.

J Pineal Res 2021 Jul 17:e12757. Epub 2021 Jul 17.

Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.

During the COVID-19 pandemic, schools around the world rapidly transitioned from in-person to remote learning, providing an opportunity to examine the impact of in-person vs. remote learning on sleep, circadian timing, and mood. We assessed sleep-wake timing using wrist-actigraphy and sleep diaries over 1-2 weeks during in-person learning (n=28) and remote learning (n=58, where n=27 were repeat assessments) in adolescents (age M±SD =12.79±0.42 years). Circadian timing was measured under a single condition in each individual using salivary melatonin (Dim Light Melatonin Onset; DLMO). Online surveys assessed mood (PROMIS Pediatric Anxiety and Depressive Symptoms) and sleepiness (Epworth Sleepiness Scale - Child and Adolescent) in each condition. During remote (vs. in-person) learning: (i) on school days, students went to sleep 26 min later and woke 49 min later, resulting in 22 min longer sleep duration (all p<0.0001); (ii) DLMO time did not differ significantly between conditions, although participants woke at a later circadian phase (43 minutes, p=0.03) during remote learning; and (iii) participants reported significantly lower sleepiness (p=0.048) and lower anxiety symptoms (p=0.006). Depressive symptoms did not differ between conditions. Changes in mood symptoms were not mediated by sleep. Although remote learning continued to have fixed school start times, removing morning commutes likely enabled adolescents to sleep longer, wake later, and to wake at a later circadian phase. These results indicate that remote learning, or later school start times, may extend sleep and improve some subjective symptoms in adolescents.
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http://dx.doi.org/10.1111/jpi.12757DOI Listing
July 2021

Home-based light therapy for fatigue following acquired brain injury: a pilot randomized controlled trial.

BMC Neurol 2021 Jul 5;21(1):262. Epub 2021 Jul 5.

Monash Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia.

Background And Objectives: Fatigue and sleep disturbance are debilitating problems following brain injury and there are no established treatments. Building on demonstrated efficacy of blue light delivered via a lightbox in reducing fatigue and daytime sleepiness after TBI, this study evaluated the efficacy of a novel in-home light intervention in alleviating fatigue, sleep disturbance, daytime sleepiness and depressive symptoms, and in improving psychomotor vigilance and participation in daily productive activity, following injury METHODS: The impact of exposure to a dynamic light intervention (Treatment) was compared to usual lighting (Control) in a randomized within-subject, crossover trial. Outcomes were fatigue (primary outcome), daytime sleepiness, sleep disturbance, insomnia symptoms, psychomotor vigilance, mood and activity levels. Participants (N = 24, M ± SD = 44.3 ± 11.4) had mild-severe TBI or stroke > 3 months previously, and self-reported fatigue (Fatigue Severity Scale ≥ 4). Following 2-week baseline, participants completed each condition for 2 months in counter-balanced order, with 1-month follow-up. Treatment comprised daytime blue-enriched white light (CCT > 5000 K) and blue-depleted light (< 3000 K) 3 h prior to sleep.

Results: Random-effects mixed-model analysis showed no significantly greater change in fatigue on the Brief Fatigue Inventory during Treatment, but a medium effect size of improvement (p = .33, d = -0.42). There were significantly greater decreases in sleep disturbance (p = .004), insomnia symptoms (p = .036), reaction time (p = .004) and improvements in productive activity (p = .005) at end of Treatment relative to Control, with large effect sizes (d > 0.80). Changes in other outcomes were non-significant.

Conclusions: This pilot study provides preliminary support for in-home dynamic light therapy to address sleep-related symptoms in acquired brain injury.

Trial Registration: This trial was registered with the Australian and New Zealand Clinical Trials Registry on 13 June 2017, www.anzctr.org.au , ACTRN12617000866303.
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http://dx.doi.org/10.1186/s12883-021-02292-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8256500PMC
July 2021

The impact of 7-hour and 11-hour rest breaks between shifts on heavy vehicle truck drivers' sleep, alertness and naturalistic driving performance.

Accid Anal Prev 2021 Jun 27;159:106224. Epub 2021 Jun 27.

Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Victoria, Australia; Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Australia; Department of Medicine, University of Melbourne, Australia.

Background: An inadequate rest break between shifts may contribute to driver sleepiness. This study assessed whether extending the major rest break between shifts from 7-hours (Australian industry standard) to 11-hours, improved drivers' sleep, alertness and naturalistic driving performance.

Methods: 17 heavy vehicle drivers (16 male) were recruited to complete two conditions. Each condition comprised two 13-hour shifts, separated by either a 7- or 11-hour rest break. The initial 13-hour shift was the drivers' regular work. The rest break and following 13-hour shift were simulated. The simulated shift included 5-hours of naturalistic driving with measures of subjective sleepiness, physiological alertness (ocular and electroencephalogram) and performance (steering and lane departures).

Results: 13 drivers provided useable data. Total sleep during the rest break was greater in the 11-hour than the 7-hour condition (median hours [25 to 75 percentile] 6.59 [6.23, 7.23] vs. 5.07 [4.46, 5.38], p = 0.008). During the simulated shift subjective sleepiness was marginally better for the 11-hour condition (mean Karolinska Sleepiness Scale [95 CI] = 4.52 [3.98, 5.07] vs. 5.12 [4.56, 5.68], p = 0.009). During the drive, ocular and vehicle metrics were improved for the 11-hour condition (p<0.05). Contrary to expectations, mean lane departures p/hour were increased during the 11-hour condition (1.34 [-0.38,3.07] vs. 0.63 [-0.2,1.47], p = 0.027).

Conclusions: Extending the major rest between shifts substantially increases sleep duration and has a modest positive impact on driver alertness and performance. Future work should replicate the study in a larger sample size to improve generalisability and assess the impact of consecutive 7-hour major rest breaks.
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http://dx.doi.org/10.1016/j.aap.2021.106224DOI Listing
June 2021

The impact of 7-hour and 11-hour rest breaks between shifts on heavy vehicle truck drivers' sleep, alertness and naturalistic driving performance.

Accid Anal Prev 2021 Jun 27;159:106224. Epub 2021 Jun 27.

Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Victoria, Australia; Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Australia; Department of Medicine, University of Melbourne, Australia.

Background: An inadequate rest break between shifts may contribute to driver sleepiness. This study assessed whether extending the major rest break between shifts from 7-hours (Australian industry standard) to 11-hours, improved drivers' sleep, alertness and naturalistic driving performance.

Methods: 17 heavy vehicle drivers (16 male) were recruited to complete two conditions. Each condition comprised two 13-hour shifts, separated by either a 7- or 11-hour rest break. The initial 13-hour shift was the drivers' regular work. The rest break and following 13-hour shift were simulated. The simulated shift included 5-hours of naturalistic driving with measures of subjective sleepiness, physiological alertness (ocular and electroencephalogram) and performance (steering and lane departures).

Results: 13 drivers provided useable data. Total sleep during the rest break was greater in the 11-hour than the 7-hour condition (median hours [25 to 75 percentile] 6.59 [6.23, 7.23] vs. 5.07 [4.46, 5.38], p = 0.008). During the simulated shift subjective sleepiness was marginally better for the 11-hour condition (mean Karolinska Sleepiness Scale [95 CI] = 4.52 [3.98, 5.07] vs. 5.12 [4.56, 5.68], p = 0.009). During the drive, ocular and vehicle metrics were improved for the 11-hour condition (p<0.05). Contrary to expectations, mean lane departures p/hour were increased during the 11-hour condition (1.34 [-0.38,3.07] vs. 0.63 [-0.2,1.47], p = 0.027).

Conclusions: Extending the major rest between shifts substantially increases sleep duration and has a modest positive impact on driver alertness and performance. Future work should replicate the study in a larger sample size to improve generalisability and assess the impact of consecutive 7-hour major rest breaks.
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http://dx.doi.org/10.1016/j.aap.2021.106224DOI Listing
June 2021

Mental Health Among Parents of Children Aged <18 Years and Unpaid Caregivers of Adults During the COVID-19 Pandemic - United States, December 2020 and February-⁠March 2021.

MMWR Morb Mortal Wkly Rep 2021 Jun 18;70(24):879-887. Epub 2021 Jun 18.

Early during the COVID-19 pandemic, nearly two thirds of unpaid caregivers of adults reported adverse mental or behavioral health symptoms, compared with approximately one third of noncaregivers (1). In addition, 27% of parents of children aged <18 years reported that their mental health had worsened during the pandemic (2). To examine mental health during the COVID-19 pandemic among U.S. adults on the basis of their classification as having a parenting role (i.e., unpaid persons caring for children and adolescents aged <18 years, referred to as children in this report) or being an unpaid caregiver of adults (i.e., persons caring for adults aged ≥18 years), CDC analyzed data from cross-sectional surveys that were administered during December 2020 and February-March 2021 for The COVID-19 Outbreak Public Evaluation (COPE) Initiative. Respondents were categorized as parents only, caregivers of adults only, parents-caregivers (persons in both roles), or nonparents/noncaregivers (persons in neither role). Adjusted odds ratios (aORs) for any adverse mental health symptoms, particularly suicidal ideation, were higher among all respondents who were parents, caregivers of adults, or both compared with respondents who were nonparents/noncaregivers and were highest among persons in both roles (parents-caregivers) (any adverse mental health symptoms: aOR = 5.1, 95% confidence interval [CI] = 4.1-6.2; serious suicidal ideation: aOR = 8.2, 95% CI = 6.5-10.4). These findings highlight that parents and caregivers, especially those balancing roles both as parents and caregivers, experienced higher levels of adverse mental health symptoms during the COVID-19 pandemic than adults without these responsibilities. Caregivers who had someone to rely on for support had lower odds of experiencing any adverse mental health symptoms. Additional measures are needed to improve mental health among parents, caregivers, and parents-caregivers.
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http://dx.doi.org/10.15585/mmwr.mm7024a3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8220951PMC
June 2021

Prediction Of Shiftworker Alertness, Sleep, And Circadian Phase Using A Model Of Arousal Dynamics Constrained By Shift Schedules And Light Exposure.

Sleep 2021 Jun 10. Epub 2021 Jun 10.

The University of Sydney, School of Physics, Camperdown, Australia.

Study Objectives: The study aimed to, for the first time, (i) compare sleep, circadian phase, and alertness of Intensive Care Unit (ICU) nurses working rotating shifts with those predicted by a model of arousal dynamics; and (ii) investigate how different environmental constraints affect predictions and agreement with data.

Methods: The model was used to simulate individual sleep-wake cycles, urinary 6-sulphatoxymelatonin (aMT6s) profiles, subjective sleepiness on the Karolinska Sleepiness Scale (KSS), and performance on a Psychomotor Vigilance Task (PVT) of 21 ICU nurses working day, evening, and night shifts. Combinations of individual shift schedules, forced wake time before/after work and lighting, were used as inputs to the model. Predictions were compared to empirical data. Simulations with self-reported sleep as an input were performed for comparison.

Results: All input constraints produced similar prediction for KSS, with 56-60% of KSS scores predicted within ±1 on a day and 48-52% on a night shift. Accurate prediction of an individual's circadian phase required individualised light input. Combinations including light information predicted aMT6s acrophase within ±1 h of the study data for 65% and 35-47% of nurses on diurnal and nocturnal schedules. Minute-by-minute sleep-wake state overlap between the model and the data was between 81±6% and 87±5% depending on choice of input constraint.

Conclusions: The use of individualised environmental constraints in the model of arousal dynamics allowed for accurate prediction of alertness, circadian phase and sleep for more than half of the nurses. Individual differences in physiological parameters will need to be accounted for in the future to further improve predictions.
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http://dx.doi.org/10.1093/sleep/zsab146DOI Listing
June 2021

Prevalence of Probable Shift Work Disorder in Non-Standard Work Schedules and Associations with Sleep, Health and Safety Outcomes: A Cross-Sectional Analysis.

Nat Sci Sleep 2021 31;13:683-693. Epub 2021 May 31.

Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia.

Purpose: We aimed to estimate the prevalence of probable shift work disorder (pSWD) in a representative sample of Australian workers and identify sleep, health and safety correlates.

Patients And Methods: In 2019, data were collected from working respondents as part of a cross-sectional national sleep health survey conducted online (n=964 total; n=448 individuals on non-standard work schedules). We established the prevalence of pSWD according to International Classification of Sleep Disorders criteria (ICSD-R, ICSD-2 and ICSD-3). Poisson regression was used to determine crude and adjusted prevalence association (prevalence ratio, PR) of pSWD with sleep, health and safety outcomes.

Results: Overall prevalence of pSWD in workers on non-standard work schedules was 10.5%, ranging from 9.6% in early morning workers to 12.7% in rotating shift workers. In adjusted models, workers who met the criteria for pSWD were 1.8 times more likely to report both depression/bipolar disorder, and anxiety/panic disorder, and 1.7 times more likely to report work errors due to a sleep problem.

Conclusion: The prevalence of pSWD in employees engaged in non-standard work schedules is influenced by selection of factors used to quantify pSWD, including sleep/wake patterns. Higher likelihoods of mental health problems and workplace errors in those with pSWD highlight the importance of intervention and management of this under-recognised sleep disorder.
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http://dx.doi.org/10.2147/NSS.S301493DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8178694PMC
May 2021

A Blue-Enriched, Increased Intensity Light Intervention to Improve Alertness and Performance in Rotating Night Shift Workers in an Operational Setting.

Nat Sci Sleep 2021 24;13:647-657. Epub 2021 May 24.

Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia.

Purpose: This study examined the efficacy of a lighting intervention that increased both light intensity and short-wavelength (blue) light content to improve alertness, performance and mood in night shift workers in a chemical plant.

Patients And Methods: During rostered night shifts, 28 workers (46.0±10.8 years; 27 male) were exposed to two light conditions each for two consecutive nights (~19:00-07:00 h) in a counterbalanced repeated measures design: traditional-spectrum lighting set at pre-study levels (43 lux, 4000 K) versus higher intensity, blue-enriched lighting (106 lux, 17,000 K), equating to a 4.5-fold increase in melanopic illuminance (24 to 108 melanopic illuminance). Participants completed the Karolinska Sleepiness Scale, subjective mood ratings, and the Psychomotor Vigilance Task (PVT) every 2-4 hours during the night shift.

Results: A significant main effect of time indicated KSS, PVT mean reaction time, number of PVT lapses (reaction times > 500 ms) and subjective tension, misery and depression worsened over the course of the night shift (p<0.05). Percentage changes in KSS (p<0.05, partial η=0.14) and PVT mean reaction time (p<0.05, partial η=0.19) and lapses (p<0.05, partial η=0.17) in the middle and end of night shift, expressed relative to start of shift, were significantly improved during the lighting intervention compared to the traditional lighting condition. Self-reported mood did not significantly differ between conditions (p>0.05).

Conclusion: Our findings, showing improvements in alertness and performance with exposure to blue-enriched, increased intensity light, provide support for light to be used as a countermeasure for impaired alertness in night shift work settings.
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http://dx.doi.org/10.2147/NSS.S287097DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8163632PMC
May 2021

Uncovering survivorship bias in longitudinal mental health surveys during the COVID-19 pandemic.

Epidemiol Psychiatr Sci 2021 May 26;30:e45. Epub 2021 May 26.

Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia.

Aims: Markedly elevated adverse mental health symptoms were widely observed early in the coronavirus disease-2019 (COVID-19) pandemic. Unlike the U.S., where cross-sectional data indicate anxiety and depression symptoms have remained elevated, such symptoms reportedly declined in the U.K., according to analysis of repeated measures from a large-scale longitudinal study. However, nearly 40% of U.K. respondents (those who did not complete multiple follow-up surveys) were excluded from analysis, suggesting that survivorship bias might partially explain this discrepancy. We therefore sought to assess survivorship bias among participants in our longitudinal survey study as part of The COVID-19 Outbreak Public Evaluation (COPE) Initiative.

Methods: Survivorship bias was assessed in 4039 U.S. respondents who completed surveys including the assessment of mental health as part of The COPE Initiative in April 2020 and were invited to complete follow-up surveys. Participants completed validated screening instruments for symptoms of anxiety, depression and insomnia. Survivorship bias was assessed for (1) demographic differences in follow-up survey participation, (2) differences in initial adverse mental health symptom prevalence adjusted for demographic factors and (3) differences in follow-up survey participation based on mental health experiences adjusted for demographic factors.

Results: Adjusting for demographics, individuals who completed only one or two out of four surveys had significantly higher prevalence of anxiety and depression symptoms in April 2020 (e.g. one-survey v. four-survey, anxiety symptoms, adjusted prevalence ratio [aPR]: 1.30, 95% confidence interval [CI]: 1.08-1.55, p = 0.0045; depression symptoms, aPR: 1.43, 95% CI: 1.17-1.75, p = 0.00052). Moreover, individuals who experienced incident anxiety or depression symptoms had significantly higher adjusted odds of not completing follow-up surveys (adjusted odds ratio [aOR]: 1.68, 95% CI: 1.22-2.31, p = 0.0015, aOR: 1.56, 95% CI: 1.15-2.12, p = 0.0046, respectively).

Conclusions: Our findings reveal significant survivorship bias among longitudinal survey respondents, indicating that restricting analytic samples to only respondents who provide repeated assessments in longitudinal survey studies could lead to overly optimistic interpretations of mental health trends over time. Cross-sectional or planned missing data designs may provide more accurate estimates of population-level adverse mental health symptom prevalence than longitudinal surveys.
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http://dx.doi.org/10.1017/S204579602100038XDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8207539PMC
May 2021

Light-based methods for predicting circadian phase in delayed sleep-wake phase disorder.

Sci Rep 2021 May 25;11(1):10878. Epub 2021 May 25.

Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton, VIC, 3800, Australia.

Methods for predicting circadian phase have been developed for healthy individuals. It is unknown whether these methods generalize to clinical populations, such as delayed sleep-wake phase disorder (DSWPD), where circadian timing is associated with functional outcomes. This study evaluated two methods for predicting dim light melatonin onset (DLMO) in 154 DSWPD patients using ~ 7 days of sleep-wake and light data: a dynamic model and a statistical model. The dynamic model has been validated in healthy individuals under both laboratory and field conditions. The statistical model was developed for this dataset and used a multiple linear regression of light exposure during phase delay/advance portions of the phase response curve, as well as sleep timing and demographic variables. Both models performed comparably well in predicting DLMO. The dynamic model predicted DLMO with root mean square error of 68 min, with predictions accurate to within ± 1 h in 58% of participants and ± 2 h in 95%. The statistical model predicted DLMO with root mean square error of 57 min, with predictions accurate to within ± 1 h in 75% of participants and ± 2 h in 96%. We conclude that circadian phase prediction from light data is a viable technique for improving screening, diagnosis, and treatment of DSWPD.
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http://dx.doi.org/10.1038/s41598-021-89924-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8149449PMC
May 2021

Adverse impact of polyphasic sleep patterns in humans: Report of the National Sleep Foundation sleep timing and variability consensus panel.

Sleep Health 2021 Jun 29;7(3):293-302. Epub 2021 Mar 29.

Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA. Electronic address:

Polyphasic sleep is the practice of distributing multiple short sleep episodes across the 24-hour day rather than having one major and possibly a minor ("nap") sleep episode each day. While the prevalence of polyphasic sleep is unknown, anecdotal reports suggest attempts to follow this practice are common, particularly among young adults. Polyphasic-sleep advocates claim to thrive on as little as 2 hours of total sleep per day. However, significant concerns have been raised that polyphasic sleep schedules can result in health and safety consequences. We reviewed the literature to identify the impact of polyphasic sleep schedules (excluding nap or siesta schedules) on health, safety, and performance outcomes. Of 40,672 potentially relevant publications, with 2,023 selected for full-text review, 22 relevant papers were retained. We found no evidence supporting benefits from following polyphasic sleep schedules. Based on the current evidence, the consensus opinion is that polyphasic sleep schedules, and the sleep deficiency inherent in those schedules, are associated with a variety of adverse physical health, mental health, and performance outcomes. Striving to adopt a schedule that significantly reduces the amount of sleep per 24 hours and/or fragments sleep into multiple episodes throughout the 24-hour day is not recommended.
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http://dx.doi.org/10.1016/j.sleh.2021.02.009DOI Listing
June 2021

The impact of the wake maintenance zone on attentional capacity, physiological drowsiness, and subjective task demands during sleep deprivation.

J Sleep Res 2021 Mar 18:e13312. Epub 2021 Mar 18.

School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia.

We aimed to investigate the impact of the Wake Maintenance Zone (WMZ) on measures of drowsiness, attention, and subjective performance under rested and sleep deprived conditions. We studied 23 healthy young adults (18 males; mean age = 25.41 ± 5.73 years) during 40 hr of total sleep deprivation under constant routine conditions. Participants completed assessments of physiological drowsiness (EEG-scored slow eye movements and microsleeps), sustained attention (PVT), and subjective task demands every two hours, and four-hourly ocular motor assessment of inhibitory control (inhibition of reflexive saccades on an anti-saccade task). Tests were analyzed relative to dim light melatonin onset (DLMO); the WMZ was defined as the 3 hr prior to DLMO, and the preceding 3 hr window was deemed the pre-WMZ. The WMZ did not mitigate the adverse impact of ~37 hr sleep deprivation on drowsiness, sustained attention, response inhibition, and self-rated concentration and difficulty, relative to rested WMZ performance (~13 hr of wakefulness). Compared to the pre-WMZ, though, the WMZ improved measures of sustained attention, and subjective concentration and task difficulty, during sleep deprivation. Cumulatively, these results expand on previous work by characterizing the beneficial effects of the WMZ on operationally-relevant indices of drowsiness, inhibitory attention control, and self-rated concentration and task difficulty relative to the pre-WMZ during sleep deprivation. These results may inform scheduling safety-critical tasks at more optimal circadian times to improve workplace performance and safety.
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http://dx.doi.org/10.1111/jsr.13312DOI Listing
March 2021

Early public adherence with and support for stay-at-home COVID-19 mitigation strategies despite adverse life impact: a transnational cross-sectional survey study in the United States and Australia.

BMC Public Health 2021 03 15;21(1):503. Epub 2021 Mar 15.

Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, 3800, Australia.

Background: Governments worldwide recommended unprecedented measures to contain the coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As pressure mounted to scale back measures, understanding public priorities was critical. We assessed initial public adherence with and support for stay-at-home orders in nations and cities with different SARS-CoV-2 infection and COVID-19 death rates.

Methods: Cross-sectional surveys were administered to representative samples of adults aged ≥18 years from regions with different SARS-CoV-2 prevalences from April 2-8, 2020. Regions included two nations [the United States (US-high prevalence) and Australia (AU-low prevalence)] and two US cities [New York City (NY-high prevalence) and Los Angeles (LA-low prevalence)]. Regional SARS-CoV-2 and COVID-19 prevalence (cumulative SARS-CoV-2 infections, COVID-19 deaths) as of April 8, 2020: US (363,321, 10,845), AU (5956, 45), NY (81,803, 4571), LA (7530, 198). Of 8718 eligible potential respondents, 5573 (response rate, 63.9%) completed surveys. Median age was 47 years (range, 18-89); 3039 (54.5%) were female.

Results: Of 5573 total respondents, 4560 (81.8%) reported adherence with recommended quarantine or stay-at-home policies (range of samples, 75.5-88.2%). Additionally, 29.1% of respondents screened positive for anxiety or depression symptoms (range of samples, 28.6-32.0%), with higher prevalences among those of younger age, female gender, and those in quarantine or staying at home most of the time versus those who did not report these behaviours. Despite elevated prevalences of adverse mental health symptoms and significant life disruptions, 5022 respondents (90.1%) supported government-imposed stay-at-home orders (range of samples, 88.9-93.1%). Of these, 90.8% believed orders should last at least three more weeks or until public health or government officials recommended, with support spanning the political spectrum.

Conclusions: Public adherence with COVID-19 mitigation policies was highly prevalent, in both highly-affected (US, NY) and minimally-affected regions (AU, LA). Despite disruption of respondents' lives, the vast majority supported continuation of extended stay-at-home orders. Despite common support, these two countries diverged in stringent mitigation implementation, which may have contributed to subsequent outcomes. These results reveal the importance of surveillance of public support for and adherence with such policies during the COVID-19 pandemic and for future infectious disease outbreaks.
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http://dx.doi.org/10.1186/s12889-021-10410-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7957462PMC
March 2021

The impact of shift work schedules on PVT performance in naturalistic settings: a systematic review.

Int Arch Occup Environ Health 2021 Mar 11. Epub 2021 Mar 11.

Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia.

Objective: The Psychomotor Vigilance Test (PVT) is considered the gold standard for detecting sleep loss and circadian misalignment related changes in performance in laboratory and field settings. This short 3-, 5- or 10-min test appraises an individual's sustained vigilant attention on a visual stimulus through reaction time, false starts and performance lapses. The PVT has been widely used as a measure to assess vigilant attention among shift workers, but information evaluating the application and performance of this test in different naturalistic shift work settings is limited. The purpose of this review is to synthesise and evaluate existing literature which has used the PVT to assess and monitor psychomotor performance in response to shift work schedules and rosters performed in real-world settings.

Methods: A systematic search of studies examining PVT performance in response to 24/7 shift work schedules (e.g., day, afternoon, evening and night shifts) performed under naturalistic conditions was conducted. Articles were identified by searching Medline, Embase, CINHAL and PsycINFO databases in April 2020.

Results: The search yielded 135 results, of which 16 publications were suitable to be included in this review. Articles were grouped according to when the PVT was applied to a research cohort, which included (a) multiple instances per shift, (b) commencement and cessation of shift and (c) other varying times.

Conclusions: This review suggests PVT performance is typically congruent across studies when the test is applied at generally consistent time intervals. The lack of research concerning the use of the PVT during extended duty shifts (e.g., shifts and on call work > 30 h) is an area for future research.
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http://dx.doi.org/10.1007/s00420-021-01668-0DOI Listing
March 2021

Poorer sleep quality predicts melatonin response in TBI patients: findings from a randomized controlled trial.

J Clin Sleep Med 2021 Mar 11. Epub 2021 Mar 11.

Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Richmond, VIC, Australia.

Study Objectives: A recent clinical trial demonstrated that melatonin treatment was effective in improving self-perceived sleep quality in patients with TBI; however, it remains unclear which patients benefited from melatonin treatment. To that end, findings from the clinical trial were re-examined to identify possible predictors of treatment response.

Methods: Hierarchical multiple regression was utilized to identify patient characteristics, TBI injury characteristics, and self-report measures assessing sleep, fatigue, mood, and anxiety symptomatology that may uniquely explain a change in self-reported sleep quality scores (follow-up minus baseline score) as assessed by the Pittsburgh Sleep Quality Index(PSQI).

Results: After controlling for patient demographic and TBI injury-related variables, baseline self-report measures of sleep, fatigue, mood, and anxiety explained an additional 32% of the variance in change in PSQI scores. However, only baseline PSQI score made a unique and statistically significant contribution (β = -.56, p = .006). After controlling for patient and TBI characteristics, baseline PSQI scores further explained 27% of the variance in change in PSQI scores, R squared change = .27, F change (1, 27) = 11.79, p = .002). The standardized beta for baseline PSQI score revealed a statistically significant negative relationship with change in PSQI score (β = -.54, p = .002) revealing that higher PSQI score at baseline was associated with better sleep outcomes.

Conclusions: In a sample comprising predominately severe TBI and comorbid insomnia, participants who report poorer sleep quality have the most to gain from melatonin treatment irrespective of time since injury, demographics, fatigue, daytimes sleepiness, mood, and anxiety symptomology.

Clinical Trial Registration: The manuscript reports on a clinical trial which was prospectively registered with the Australian New Zealand Clinical Trials Registry on the 13th of July, 2011. Identifier: ACTRN12611000734965 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=343083&showOriginal=true&isReview=true.
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http://dx.doi.org/10.5664/jcsm.9234DOI Listing
March 2021

Poorer sleep quality predicts melatonin response in TBI patients: findings from a randomized controlled trial.

J Clin Sleep Med 2021 Mar 11. Epub 2021 Mar 11.

Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Richmond, VIC, Australia.

Study Objectives: A recent clinical trial demonstrated that melatonin treatment was effective in improving self-perceived sleep quality in patients with TBI; however, it remains unclear which patients benefited from melatonin treatment. To that end, findings from the clinical trial were re-examined to identify possible predictors of treatment response.

Methods: Hierarchical multiple regression was utilized to identify patient characteristics, TBI injury characteristics, and self-report measures assessing sleep, fatigue, mood, and anxiety symptomatology that may uniquely explain a change in self-reported sleep quality scores (follow-up minus baseline score) as assessed by the Pittsburgh Sleep Quality Index(PSQI).

Results: After controlling for patient demographic and TBI injury-related variables, baseline self-report measures of sleep, fatigue, mood, and anxiety explained an additional 32% of the variance in change in PSQI scores. However, only baseline PSQI score made a unique and statistically significant contribution (β = -.56, p = .006). After controlling for patient and TBI characteristics, baseline PSQI scores further explained 27% of the variance in change in PSQI scores, R squared change = .27, F change (1, 27) = 11.79, p = .002). The standardized beta for baseline PSQI score revealed a statistically significant negative relationship with change in PSQI score (β = -.54, p = .002) revealing that higher PSQI score at baseline was associated with better sleep outcomes.

Conclusions: In a sample comprising predominately severe TBI and comorbid insomnia, participants who report poorer sleep quality have the most to gain from melatonin treatment irrespective of time since injury, demographics, fatigue, daytimes sleepiness, mood, and anxiety symptomology.

Clinical Trial Registration: The manuscript reports on a clinical trial which was prospectively registered with the Australian New Zealand Clinical Trials Registry on the 13th of July, 2011. Identifier: ACTRN12611000734965 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=343083&showOriginal=true&isReview=true.
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http://dx.doi.org/10.5664/jcsm.9234DOI Listing
March 2021

Mental Health During the COVID-19 Pandemic: Challenges, Populations at Risk, Implications, and Opportunities.

Am J Health Promot 2021 02;35(2):301-311

Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia.

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http://dx.doi.org/10.1177/0890117120983982bDOI Listing
February 2021

Sleep and mental health in athletes during COVID-19 lockdown.

Sleep 2021 05;44(5)

Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.

The global coronavirus 19 (COVID-19) pandemic and associated lockdown restrictions resulted in the majority of sports competitions around the world being put on hold. This includes the National Basketball Association, the UEFA Champions League, Australian Football League, the Tokyo 2020 Olympic Games, and regional competitions. The mitigation strategies in place to control the pandemic have caused disruption to daily schedules, working environments, and lifestyle factors. Athletes rely on regular access to training facilities, practitioners, and coaches to maintain physical and mental health to achieve maximal performance and optimal recovery. Furthermore, participation in sport at any level increases social engagement and promotes better mental health. It is, therefore, critical to understanding how the COVID-19 pandemic and associated lockdown measures have affected the lives of athletes. We surveyed elite and sub-elite athletes (n = 565) across multiple sports. Significant disruptions were reported for all lifestyle factors including social interactions, physical activity, sleep patterns, and mental health. We found a significant increase in total sleep time and sleep latency, as well as a delay in mid-sleep times and a decrease in social jetlag. Training frequency and duration significantly decreased. Importantly, the changes to training and sleep-related factors were associated with mental health outcomes. With spikes in COVID-19 cases rising around the world and governments reinstituting lockdowns (e.g. United Kingdom; Melbourne, Australia; California, USA) these results will inform messaging and strategies to better manage sleep and mental health in a population for whom optimal performance is critical.
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http://dx.doi.org/10.1093/sleep/zsaa261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7928674PMC
May 2021

Demographic Characteristics, Experiences, and Beliefs Associated with Hand Hygiene Among Adults During the COVID-19 Pandemic - United States, June 24-30, 2020.

MMWR Morb Mortal Wkly Rep 2020 Oct 16;69(41):1485-1491. Epub 2020 Oct 16.

Frequent hand hygiene, including handwashing with soap and water or using a hand sanitizer containing ≥60% alcohol when soap and water are not readily available, is one of several critical prevention measures recommended to reduce the spread of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19).* Previous studies identified demographic factors associated with handwashing among U.S. adults during the COVID-19 pandemic (1,2); however, demographic factors associated with hand sanitizing and experiences and beliefs associated with hand hygiene have not been well characterized. To evaluate these factors, an Internet-based survey was conducted among U.S. adults aged ≥18 years during June 24-30, 2020. Overall, 85.2% of respondents reported always or often engaging in hand hygiene following contact with high-touch public surfaces such as shopping carts, gas pumps, and automatic teller machines (ATMs). Respondents who were male (versus female) and of younger age reported lower handwashing and hand sanitizing rates, as did respondents who reported lower concern about their own infection with SARS-CoV-2 and respondents without personal experience with COVID-19. Focused health promotion efforts to increase hand hygiene adherence should include increasing visibility and accessibility of handwashing and hand sanitizing materials in public settings, along with targeted communication to males and younger adults with focused messages that address COVID-19 risk perception.
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http://dx.doi.org/10.15585/mmwr.mm6941a3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7561087PMC
October 2020

Delay or Avoidance of Medical Care Because of COVID-19-Related Concerns - United States, June 2020.

MMWR Morb Mortal Wkly Rep 2020 Sep 11;69(36):1250-1257. Epub 2020 Sep 11.

Temporary disruptions in routine and nonemergency medical care access and delivery have been observed during periods of considerable community transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (1). However, medical care delay or avoidance might increase morbidity and mortality risk associated with treatable and preventable health conditions and might contribute to reported excess deaths directly or indirectly related to COVID-19 (2). To assess delay or avoidance of urgent or emergency and routine medical care because of concerns about COVID-19, a web-based survey was administered by Qualtrics, LLC, during June 24-30, 2020, to a nationwide representative sample of U.S. adults aged ≥18 years. Overall, an estimated 40.9% of U.S. adults have avoided medical care during the pandemic because of concerns about COVID-19, including 12.0% who avoided urgent or emergency care and 31.5% who avoided routine care. The estimated prevalence of urgent or emergency care avoidance was significantly higher among the following groups: unpaid caregivers for adults* versus noncaregivers (adjusted prevalence ratio [aPR] = 2.9); persons with two or more selected underlying medical conditions versus those without those conditions (aPR = 1.9); persons with health insurance versus those without health insurance (aPR = 1.8); non-Hispanic Black (Black) adults (aPR = 1.6) and Hispanic or Latino (Hispanic) adults (aPR = 1.5) versus non-Hispanic White (White) adults; young adults aged 18-24 years versus adults aged 25-44 years (aPR = 1.5); and persons with disabilities versus those without disabilities (aPR = 1.3). Given this widespread reporting of medical care avoidance because of COVID-19 concerns, especially among persons at increased risk for severe COVID-19, urgent efforts are warranted to ensure delivery of services that, if deferred, could result in patient harm. Even during the COVID-19 pandemic, persons experiencing a medical emergency should seek and be provided care without delay (3).
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http://dx.doi.org/10.15585/mmwr.mm6936a4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7499838PMC
September 2020

Delay or Avoidance of Medical Care Because of COVID-19-Related Concerns - United States, June 2020.

MMWR Morb Mortal Wkly Rep 2020 Sep 11;69(36):1250-1257. Epub 2020 Sep 11.

Temporary disruptions in routine and nonemergency medical care access and delivery have been observed during periods of considerable community transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (1). However, medical care delay or avoidance might increase morbidity and mortality risk associated with treatable and preventable health conditions and might contribute to reported excess deaths directly or indirectly related to COVID-19 (2). To assess delay or avoidance of urgent or emergency and routine medical care because of concerns about COVID-19, a web-based survey was administered by Qualtrics, LLC, during June 24-30, 2020, to a nationwide representative sample of U.S. adults aged ≥18 years. Overall, an estimated 40.9% of U.S. adults have avoided medical care during the pandemic because of concerns about COVID-19, including 12.0% who avoided urgent or emergency care and 31.5% who avoided routine care. The estimated prevalence of urgent or emergency care avoidance was significantly higher among the following groups: unpaid caregivers for adults* versus noncaregivers (adjusted prevalence ratio [aPR] = 2.9); persons with two or more selected underlying medical conditions versus those without those conditions (aPR = 1.9); persons with health insurance versus those without health insurance (aPR = 1.8); non-Hispanic Black (Black) adults (aPR = 1.6) and Hispanic or Latino (Hispanic) adults (aPR = 1.5) versus non-Hispanic White (White) adults; young adults aged 18-24 years versus adults aged 25-44 years (aPR = 1.5); and persons with disabilities versus those without disabilities (aPR = 1.3). Given this widespread reporting of medical care avoidance because of COVID-19 concerns, especially among persons at increased risk for severe COVID-19, urgent efforts are warranted to ensure delivery of services that, if deferred, could result in patient harm. Even during the COVID-19 pandemic, persons experiencing a medical emergency should seek and be provided care without delay (3).
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http://dx.doi.org/10.15585/mmwr.mm6936a4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7499838PMC
September 2020

A PERIOD3 variable number tandem repeat polymorphism modulates melatonin treatment response in delayed sleep-wake phase disorder.

J Pineal Res 2020 Nov 16;69(4):e12684. Epub 2020 Sep 16.

Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.

We examined whether a polymorphism of the PERIOD3 gene (PER3; rs57875989) modulated the sleep-promoting effects of melatonin in Delayed Sleep-Wake Phase Disorder (DSWPD). One hundred and four individuals (53 males; 29.4 ±10.0 years) with DSWPD and a delayed dim light melatonin onset (DLMO) collected buccal swabs for genotyping (PER3 n = 43; PER3 5 allele [heterozygous and homozygous] n = 60). Participants were randomised to placebo or 0.5 mg melatonin taken 1 hour before desired bedtime (or ~1.45 hours before DLMO), with sleep attempted at desired bedtime (4 weeks; 5-7 nights/week). We assessed sleep (diary and actigraphy), Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Patient-Reported Outcomes Measurement Information System (PROMIS: Sleep Disturbance, Sleep-Related Impairment), Sheehan Disability Scale (SDS) and Patient- and Clinician-Global Improvement (PGI-C, CGI-C). Melatonin treatment response on actigraphic sleep onset time did not differ between genotypes. For PER3 carriers, self-reported sleep onset time was advanced by a larger amount and sleep onset latency (SOL) was shorter in melatonin-treated patients compared to those receiving placebo (P = .008), while actigraphic sleep efficiency in the first third of the sleep episode (SE T1) did not differ. For PER3 5 carriers, actigraphic SOL and SE T1 showed a larger improvement with melatonin (P < .001). Melatonin improved ISI (P = .005), PROMIS sleep disturbance (P < .001) and sleep-related impairment (P = .017), SDS (P = .019), PGI-C (P = .028) and CGI-C (P = .016) in PER3 individuals only. Melatonin did not advance circadian phase. Overall, PER3 DSWPD patients have a greater response to melatonin treatment. PER3 genotyping may therefore improve DSWPD patient outcomes.
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http://dx.doi.org/10.1111/jpi.12684DOI Listing
November 2020

Public Attitudes, Behaviors, and Beliefs Related to COVID-19, Stay-at-Home Orders, Nonessential Business Closures, and Public Health Guidance - United States, New York City, and Los Angeles, May 5-12, 2020.

MMWR Morb Mortal Wkly Rep 2020 Jun 19;69(24):751-758. Epub 2020 Jun 19.

SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), is thought to be transmitted mainly by person-to-person contact (1). Implementation of nationwide public health orders to limit person-to-person interaction and of guidance on personal protective practices can slow transmission (2,3). Such strategies can include stay-at-home orders, business closures, prohibitions against mass gatherings, use of cloth face coverings, and maintenance of a physical distance between persons (2,3). To assess and understand public attitudes, behaviors, and beliefs related to this guidance and COVID-19, representative panel surveys were conducted among adults aged ≥18 years in New York City (NYC) and Los Angeles, and broadly across the United States during May 5-12, 2020. Most respondents in the three cohorts supported stay-at-home orders and nonessential business closures* (United States, 79.5%; New York City, 86.7%; and Los Angeles, 81.5%), reported always or often wearing cloth face coverings in public areas (United States, 74.1%, New York City, 89.6%; and Los Angeles 89.8%), and believed that their state's restrictions were the right balance or not restrictive enough (United States, 84.3%; New York City, 89.7%; and Los Angeles, 79.7%). Periodic assessments of public attitudes, behaviors, and beliefs can guide evidence-based public health decision-making and related prevention messaging about mitigation strategies needed as the COVID-19 pandemic evolves.
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http://dx.doi.org/10.15585/mmwr.mm6924e1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7302477PMC
June 2020

The impact of heart rate-based drowsiness monitoring on adverse driving events in heavy vehicle drivers under naturalistic conditions.

Sleep Health 2020 06 25;6(3):366-373. Epub 2020 Apr 25.

Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton, VIC, Australia; Institute for Breathing and Sleep, Department of Respiratory and Sleep Medicine, Austin Health, 145 Studley Road, PO Box 5555, Heidelberg, VIC, Australia. Electronic address:

Objectives: This study examined the influence of a wrist-worn heart rate drowsiness detection device on heavy vehicle driver safety and sleep and its ability to predict driving events under naturalistic conditions.

Design: Prospective, non-randomized trial.

Setting: Naturalistic driving in Malaysia.

Participants: Heavy vehicle drivers in Malaysia were assigned to the Device (n = 25) or Control condition (n = 34).

Intervention: Both conditions were monitored for driving events at work over 4-weeks in Phase 1, and 12-weeks in Phase 2. In Phase 1, the Device condition wore the device operated in the silent mode (i.e., no drowsiness alerts) to examine the accuracy of the device in predicting driving events. In Phase 2, the Device condition wore the device in the active mode to examine if drowsiness alerts from the device influenced the rate of driving events (compared to Phase 1).

Measurements: All participants were monitored for harsh braking and harsh acceleration driving events and self-reported sleep duration and sleepiness daily.

Results: There was a significant decrease in the rate of harsh braking events (Rate ratio = 0.48, p < 0.05) and a fall in subjective sleepiness (p < 0.05) when the device was operated in the active mode (compared to the silent mode). The device predicted when no driving events were occurring (specificity=98.81%), but had low accuracy in detecting when a driving event did occur (sensitivity=6.25%).

Conclusions: Including drowsiness detection devices in fatigue management programs appears to alter driver behaviour, improving safety despite the modest accuracy. Longer term studies are required to determine if this change is sustained.
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http://dx.doi.org/10.1016/j.sleh.2020.03.005DOI Listing
June 2020

A pre-drive ocular assessment predicts alertness and driving impairment: A naturalistic driving study in shift workers.

Accid Anal Prev 2020 Feb 2;135:105386. Epub 2019 Dec 2.

School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Australia; Institute for Breathing and Sleep, Austin Health, Victoria, Australia. Electronic address:

Sleepiness is a major contributor to motor vehicle crashes and shift workers are particularly vulnerable. There is currently no validated objective field-based measure of sleep-related impairment prior to driving. Ocular parameters are promising markers of continuous driver alertness in laboratory and track studies, however their ability to determine fitness-to-drive in naturalistic driving is unknown. This study assessed the efficacy of a pre-drive ocular assessment for predicting sleep-related impairment in naturalistic driving, in rotating shift workers. Fifteen healthcare workers drove an instrumented vehicle for 2 weeks, while working a combination of day, evening and night shifts. The vehicle monitored lane departures and behavioural microsleeps (blinks >500 ms) during the drive. Immediately prior to driving, ocular parameters were assessed with a 4-min test. Lane departures and behavioural microsleeps occurred on 17.5 % and 10 % of drives that had pre-drive assessments, respectively. Pre-drive blink duration significantly predicted behavioural microsleeps and showed promise for predicting lane departures (AUC = 0.79 and 0.74). Pre-drive percentage of time with eyes closed had high accuracy for predicting lane departures and behavioural microsleeps (AUC = 0.73 and 0.96), although was not statistically significant. Pre-drive psychomotor vigilance task variables were not statistically significant predictors of lane departures. Self-reported sleep-related and hazardous driving events were significantly predicted by mean blink duration (AUC = 0.65 and 0.69). Measurement of ocular parameters pre-drive predict drowsy driving during naturalistic driving, demonstrating potential for fitness-to-drive assessment in operational environments.
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http://dx.doi.org/10.1016/j.aap.2019.105386DOI Listing
February 2020

Associations between shift work characteristics, shift work schedules, sleep and burnout in North American police officers: a cross-sectional study.

BMJ Open 2019 12 1;9(11):e030302. Epub 2019 Dec 1.

Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia

Objectives: To examine associations between shift work characteristics and schedules on burnout in police and whether sleep duration and sleepiness were associated with burnout.

Methods: Police officers (n=3140) completed the Maslach Burnout Inventory (emotional exhaustion, depersonalisation, personal accomplishment) and self-reported shift schedules (irregular, rotating, fixed), shift characteristics (night, duration, frequency, work hours), sleep duration and sleepiness.

Results: Irregular schedules, long shifts (≥11 hours), mandatory overtime, short sleep and sleepiness were associated with increased risk of overall burnout in police. Police working a greater frequency of long shifts were more likely to have emotional exhaustion (adjusted OR 1.91, 95% CI 1.35 to 2.72) than those not working long shifts. Night shifts were associated with depersonalisation (1.32, 1.05 to 1.66) compared with not working nights. Police working mandatory overtime had increased risk of emotional exhaustion (1.37, 1.14 to 1.65) than those who did not. Compared with fixed schedules, irregular schedules were associated with emotional exhaustion and depersonalisation (1.91, 1.44 to 2.54 and 1.39, 1.02 to 1.89, respectively). Police sleeping <6 hours were more likely to have emotional exhaustion (1.60, 1.33 to 1.93) than those sleeping longer, and excessive sleepiness was associated with emotional exhaustion (1.81, 1.50 to 2.18).

Conclusions: Irregular schedules and increased night shifts, sleep disturbances and work hours were related to higher burnout risk in police. Future research should evaluate work schedules in law enforcement that optimise shift duration and frequency, and increase consistency in scheduling and control over work hours to limit burnout in police.
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http://dx.doi.org/10.1136/bmjopen-2019-030302DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6924705PMC
December 2019

Menstrual phase-dependent differences in neurobehavioral performance: the role of temperature and the progesterone/estradiol ratio.

Sleep 2020 02;43(2)

Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA.

Study Objectives: Women in the luteal phase of the menstrual cycle exhibit better cognitive performance overnight than women in the follicular phase, although the mechanism is unknown. Given the link between core body temperature (CBT) and performance, one potential mechanism is the thermoregulatory role of progesterone (P4), estradiol (E2), and their ratio (P4/E2), which change across the menstrual cycle. We examined the role of P4/E2 in modulating performance during extended wake in premenopausal women. Additionally, we compared the acute effects of nighttime light exposure on performance, CBT, and hormones between the menstrual phases.

Methods: Participants were studied during a 50 h constant routine and a 6.5 h monochromatic nighttime light exposure. Participants were 16 healthy, naturally cycling women (eight follicular; eight luteal). Outcome measures included reaction time, attentional failures, self-reported sleepiness, CBT, melatonin, P4, and E2.

Results: As compared to women in the luteal phase, women in the follicular phase exhibited worse performance overnight. CBT was significantly associated with performance, P4, and P4/E2 but not with other sex hormones. Sex hormones were not directly related to performance. Light exposure that suppressed melatonin improved performance in the follicular phase (n = 4 per group) to levels observed during the luteal phase and increased CBT but without concomitant changes in P4/E2.

Conclusions: Our results underscore the importance of considering menstrual phase when assessing cognitive performance during sleep loss in women and indicate that these changes are driven predominantly by CBT. Furthermore, this study shows that vulnerability to sleep loss during the follicular phase may be resolved by exposure to light.
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http://dx.doi.org/10.1093/sleep/zsz227DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457328PMC
February 2020