The study was aimed at estimating the effect of alcohol consumption, time of day, and their inter... more The study was aimed at estimating the effect of alcohol consumption, time of day, and their interaction on traffic crashes in a real regional context. Blood alcohol concentration (BAC) data were collected from drivers involved in traffic accidents during one year in an Italian region and in a control group of drivers over the same road network. Mean circadian sleep propensity was estimated from a previous study as function of time of day. Accident risk was analyzed by logistic regression as function of BAC and circadian sleep propensity. BAC values greater than zero were found in 72.0% of the drivers involved in crashes and in 40.4% of the controls. Among the former 23.6% of the drivers exceeded the BAC legal threshold of 0.05 g/dL, while illegal values were found in 10.4% of the controls. The relative risk showed a significant increase with both BAC and circadian sleep propensity (as estimated from time of day) and their interaction was significant. Due to the significant interaction, even low BAC levels strongly increased accident risk when associated with high sleep propensity.
Sensory and cognitive impairments and inflammatory processes are contributing factors to the path... more Sensory and cognitive impairments and inflammatory processes are contributing factors to the pathogenesis of schizophrenia. A previous study found that an elevated CRP level (≥5mg/L) was associated with higher cognitive impairments in schizophrenia. We aimed to investigate the association between an elevated CRP level and sensory impairments defined by a sensory gating deficit (abnormal P50 suppression) in 55 outpatients. Fifteen patients (27.3%) had an elevated CRP level that was associated with higher rate of sensory gating deficit (60% vs. 12.5%, p<0.001). This is the first study suggesting a relationship between sensory gating deficit and inflammatory processes in schizophrenia.
A standardized clinical evaluation and questionnaire was, beginning in 1985, applied to infants r... more A standardized clinical evaluation and questionnaire was, beginning in 1985, applied to infants referred for an apparent life-threatening event (ALTE). All children who underwent this “core evaluation protocol” during a 10-year period were reviewed. Documentation of clinical complaints, symptoms and signs of sleep-disordered breathing, sleep/wake evaluation, systematic evaluation of the face and naso-oro-pharynx, nocturnal polygraphic recording, and systematic follow-up was
Morningness and eveningness preference, an endogenous component of the circadian clock, is charac... more Morningness and eveningness preference, an endogenous component of the circadian clock, is characterized by an interindividual difference in circa- dian phase and requires of humans a specific timing of behavior. The biological rhythms of morning and evening types are consequently phase shifted with fixed socioeconomic constraints. The impact of this phase shift on health is widely debated. The purpose of
We aimed to investigate sleepiness, sleep hygiene, sleep disorders, and driving risk among highwa... more We aimed to investigate sleepiness, sleep hygiene, sleep disorders, and driving risk among highway drivers. We collected data using cross-sectional surveys, including the Epworth Sleepiness Scale (ESS) questionnaire, Basic Nordic Sleep Questionnaire (BNSQ), and a travel questionnaire; we also obtained sleep data from the past 24 h and information on usual sleep schedules. Police officers invited automobile drivers to participate. There were 3051 drivers (mean age, 46±13 y; 75% men) who completed the survey (80% participation rate). Eighty-seven (2.9%) drivers reported near-miss sleepy accidents (NMSA) during the trip; 8.5% of NMSA occurred during the past year and 2.3% reported sleepiness-related accidents occurring in the past year. Mean driving time was 181±109 min and mean sleep duration in the past 24 h was 480±104 min; mean sleep duration during workweeks was 468±74 min. Significant risk factors for NMSA during the trip were NMSA in the past year, nonrestorative sleep and snori...
Although ADHD and excessive video game playing have received some attention, few studies have exp... more Although ADHD and excessive video game playing have received some attention, few studies have explored the performances of ADHD children when playing video games. The authors hypothesized that performances of ADHD children would be as good as those of control children in motivating video games tasks but not in the Continuous Performance Test II (CPT II). The sample consisted of 26 ADHD children and 16 control children. Performances of ADHD and control children were compared on three commercially available games, on the repetition of every game, and on the CPT II. ADHD children had lower performances on the CPT II than did controls, but they exhibited equivalent performances to controls when playing video games at both sessions and on all three games. When playing video games, ADHD children present no difference in inhibitory performances compared with control children. This demonstrates that cognitive difficulties in ADHD are task dependent.
In daily life, adults with attention-deficit/hyperactivity disorder (ADHD) report abnormal percep... more In daily life, adults with attention-deficit/hyperactivity disorder (ADHD) report abnormal perceptual experiences that can be related to sensory gating deficit. This study investigated and compared P50 suppression (a neurophysiological measure of sensory gating) and perceptual abnormalities related to sensory gating deficit in ADHD and schizophrenias patients. Three groups were compared: 24 adults with ADHD, 24 patients with schizophrenia and 24 healthy subjects. The Sensory Gating Inventory (SGI), a validated self-report questionnaire, was used to measure perceptual abnormalities related to sensory gating deficit. P50 suppression was measured by P50 amplitude changes in a dual-click conditioning-testing auditory event-related potential procedure. Adults with ADHD had significantly higher scores on the SGI and significantly lower P50 suppression than healthy subjects. These deficits were similar to those found in patients with schizophrenia. A correlation was found between both the ...
To assess the diagnostic accuracy of portable polygraphy (PG) for the detection of sleep apnea (S... more To assess the diagnostic accuracy of portable polygraphy (PG) for the detection of sleep apnea (SA) in multiple system atrophy (MSA). Thirty consecutive patients with probable MSA underwent PG (overnight recording of nasal flow, thoracic/abdominal movements and pulse oximetry), followed 4 weeks later by full polysomnography (PSG) (reference standard). The accuracy of PG was first assessed using the same threshold as for PSG (apnea-hypopnea index [AHI]≥5), then for all possible AHI thresholds using the area under the receiver operating characteristics (AUROC) curve. Inter-rater reliability of PG was assessed using the kappa coefficient. Among 30 patients enrolled, seven were excluded for technical problems on PG or PSG and 23 were included in the main analysis. Eight out of 23 had an AHI≥5 on PSG. With the same threshold, sensitivity, specificity, positive and negative predictive values of PG for the diagnosis of SA were 87.5% (95% confidence interval: 47-99), 80% (52-96), 70% (35-93...
This study aimed to determine the sleepiness-related factors associated with road traffic acciden... more This study aimed to determine the sleepiness-related factors associated with road traffic accidents. A population based case-control study was conducted in 2 French agglomerations. 272 road accident cases hospitalized in emergency units and 272 control drivers matched by time of day and randomly stopped by police forces were included in the study. Odds ratios were calculated for the risk of road traffic accidents. As expected, the main predictive factor for road traffic accidents was having a sleep episode at the wheel just before the accident (OR 9.97, CI 95%: 1.57-63.50, p<0.05). The increased risk of traffic accidents was 3.35 times higher in subjects who reported very poor quality sleep during the last 3 months (CI 95%: 1.30-8.63, p<0.05), 1.69 times higher in subjects reporting sleeping 6 hours or fewer per night during the last 3 months (CI 95%: 1.00-2.85, p<0.05), 2.02 times higher in subjects reporting symptoms of anxiety or nervousness in the previous day (CI 95%: ...
Patients with excessive daytime sleepiness (EDS) are at high risk for driving accidents, and phys... more Patients with excessive daytime sleepiness (EDS) are at high risk for driving accidents, and physicians are concerned by the effect of alerting drugs on driving skills of sleepy patients. No study has up to now investigated the effect of modafinil (a reference drug to treat EDS in patients with hypersomnia) on on-road driving performance of patients suffering from central hypersomnia. The objective is to evaluate in patients with central hypersomnia the effect of a wake-promoting drug on real driving performance and to assess the relationship between objective sleepiness and driving performance. Randomized, crossover, double-blind placebo-controlled trial conducted among 13 patients with narcolepsy and 14 patients with idiopathic hypersomnia. Patients were randomly assigned to receive modafinil (400 mg) or placebo for 5 days prior to the driving test. Each condition was separated by at least 3 weeks of washout. Mean number of Inappropriate Line Crossings, Standard Deviation of Lateral Position of the vehicle and mean sleep latency in the Maintenance of Wakefulness Test were assessed. Modafinil reduced the mean number of Inappropriate Line Crossings and Standard Deviation of Lateral Position of the vehicle compared to placebo (F(1,25) = 4.88, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05 and F(1,25) = 3.87, P = 0.06 tendency). Mean sleep latency at the Maintenance of Wakefulness Test significantly correlated with the mean number of Inappropriate Line Crossings (r = -0.41, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Modafinil improves driving performance in patients with narcolepsy and idiopathic hypersomnia. The Maintenance of Wakefulness Test is a suitable clinical tool to assess fitness to drive in this population.
Respiratory events during sleep usually lead to micro arousals resulting in consecutive daytime s... more Respiratory events during sleep usually lead to micro arousals resulting in consecutive daytime sleepiness even in healthy snorers. The present study investigated the evolution of subjective and objective daytime sleepiness and reaction time in healthy snorers submitted to acute and chronic sleep deprivation.
Studies assessing the impact of epilepsy and its medication on the risk of road traffic crashes h... more Studies assessing the impact of epilepsy and its medication on the risk of road traffic crashes have shown inconsistent results. The aim in this study was to assess this risk using French databases. Data from three French national databases were extracted and matched: the national health care insurance database, police reports, and the national police database of injurious crashes. Only antiepileptics prescribed predominantly in epilepsy were studied (phenobarbital, phenytoin, ethosuximide, valproic acid, vigabatrin, tiagabin, levitiracetam, zonisamide, and lacosamide). A case-control analysis comparing responsible and non-responsible drivers and a case-crossover analysis were performed. Drivers (72 685) involved in an injurious crash in France between July 2005 and May 2008, were included. Drivers exposed to prescribed antiepileptic medicines (n = 251) had an increased risk of being responsible for a crash (OR 1.74 [1.29-2.34]). The association was also significant for the most severe epileptic patients (n = 99; OR = 2.20 [1.31-3.69]). Case-crossover analysis found no association between crash risk and treatment prescription. Patients with prescription of antiepileptic drugs should be cautioned about their potential risk of road traffic crash. This risk is however more likely to be related to seizures than to the effect of antiepileptic medicines.
The study was aimed at estimating the effect of alcohol consumption, time of day, and their inter... more The study was aimed at estimating the effect of alcohol consumption, time of day, and their interaction on traffic crashes in a real regional context. Blood alcohol concentration (BAC) data were collected from drivers involved in traffic accidents during one year in an Italian region and in a control group of drivers over the same road network. Mean circadian sleep propensity was estimated from a previous study as function of time of day. Accident risk was analyzed by logistic regression as function of BAC and circadian sleep propensity. BAC values greater than zero were found in 72.0% of the drivers involved in crashes and in 40.4% of the controls. Among the former 23.6% of the drivers exceeded the BAC legal threshold of 0.05 g/dL, while illegal values were found in 10.4% of the controls. The relative risk showed a significant increase with both BAC and circadian sleep propensity (as estimated from time of day) and their interaction was significant. Due to the significant interaction, even low BAC levels strongly increased accident risk when associated with high sleep propensity.
Sensory and cognitive impairments and inflammatory processes are contributing factors to the path... more Sensory and cognitive impairments and inflammatory processes are contributing factors to the pathogenesis of schizophrenia. A previous study found that an elevated CRP level (≥5mg/L) was associated with higher cognitive impairments in schizophrenia. We aimed to investigate the association between an elevated CRP level and sensory impairments defined by a sensory gating deficit (abnormal P50 suppression) in 55 outpatients. Fifteen patients (27.3%) had an elevated CRP level that was associated with higher rate of sensory gating deficit (60% vs. 12.5%, p<0.001). This is the first study suggesting a relationship between sensory gating deficit and inflammatory processes in schizophrenia.
A standardized clinical evaluation and questionnaire was, beginning in 1985, applied to infants r... more A standardized clinical evaluation and questionnaire was, beginning in 1985, applied to infants referred for an apparent life-threatening event (ALTE). All children who underwent this “core evaluation protocol” during a 10-year period were reviewed. Documentation of clinical complaints, symptoms and signs of sleep-disordered breathing, sleep/wake evaluation, systematic evaluation of the face and naso-oro-pharynx, nocturnal polygraphic recording, and systematic follow-up was
Morningness and eveningness preference, an endogenous component of the circadian clock, is charac... more Morningness and eveningness preference, an endogenous component of the circadian clock, is characterized by an interindividual difference in circa- dian phase and requires of humans a specific timing of behavior. The biological rhythms of morning and evening types are consequently phase shifted with fixed socioeconomic constraints. The impact of this phase shift on health is widely debated. The purpose of
We aimed to investigate sleepiness, sleep hygiene, sleep disorders, and driving risk among highwa... more We aimed to investigate sleepiness, sleep hygiene, sleep disorders, and driving risk among highway drivers. We collected data using cross-sectional surveys, including the Epworth Sleepiness Scale (ESS) questionnaire, Basic Nordic Sleep Questionnaire (BNSQ), and a travel questionnaire; we also obtained sleep data from the past 24 h and information on usual sleep schedules. Police officers invited automobile drivers to participate. There were 3051 drivers (mean age, 46±13 y; 75% men) who completed the survey (80% participation rate). Eighty-seven (2.9%) drivers reported near-miss sleepy accidents (NMSA) during the trip; 8.5% of NMSA occurred during the past year and 2.3% reported sleepiness-related accidents occurring in the past year. Mean driving time was 181±109 min and mean sleep duration in the past 24 h was 480±104 min; mean sleep duration during workweeks was 468±74 min. Significant risk factors for NMSA during the trip were NMSA in the past year, nonrestorative sleep and snori...
Although ADHD and excessive video game playing have received some attention, few studies have exp... more Although ADHD and excessive video game playing have received some attention, few studies have explored the performances of ADHD children when playing video games. The authors hypothesized that performances of ADHD children would be as good as those of control children in motivating video games tasks but not in the Continuous Performance Test II (CPT II). The sample consisted of 26 ADHD children and 16 control children. Performances of ADHD and control children were compared on three commercially available games, on the repetition of every game, and on the CPT II. ADHD children had lower performances on the CPT II than did controls, but they exhibited equivalent performances to controls when playing video games at both sessions and on all three games. When playing video games, ADHD children present no difference in inhibitory performances compared with control children. This demonstrates that cognitive difficulties in ADHD are task dependent.
In daily life, adults with attention-deficit/hyperactivity disorder (ADHD) report abnormal percep... more In daily life, adults with attention-deficit/hyperactivity disorder (ADHD) report abnormal perceptual experiences that can be related to sensory gating deficit. This study investigated and compared P50 suppression (a neurophysiological measure of sensory gating) and perceptual abnormalities related to sensory gating deficit in ADHD and schizophrenias patients. Three groups were compared: 24 adults with ADHD, 24 patients with schizophrenia and 24 healthy subjects. The Sensory Gating Inventory (SGI), a validated self-report questionnaire, was used to measure perceptual abnormalities related to sensory gating deficit. P50 suppression was measured by P50 amplitude changes in a dual-click conditioning-testing auditory event-related potential procedure. Adults with ADHD had significantly higher scores on the SGI and significantly lower P50 suppression than healthy subjects. These deficits were similar to those found in patients with schizophrenia. A correlation was found between both the ...
To assess the diagnostic accuracy of portable polygraphy (PG) for the detection of sleep apnea (S... more To assess the diagnostic accuracy of portable polygraphy (PG) for the detection of sleep apnea (SA) in multiple system atrophy (MSA). Thirty consecutive patients with probable MSA underwent PG (overnight recording of nasal flow, thoracic/abdominal movements and pulse oximetry), followed 4 weeks later by full polysomnography (PSG) (reference standard). The accuracy of PG was first assessed using the same threshold as for PSG (apnea-hypopnea index [AHI]≥5), then for all possible AHI thresholds using the area under the receiver operating characteristics (AUROC) curve. Inter-rater reliability of PG was assessed using the kappa coefficient. Among 30 patients enrolled, seven were excluded for technical problems on PG or PSG and 23 were included in the main analysis. Eight out of 23 had an AHI≥5 on PSG. With the same threshold, sensitivity, specificity, positive and negative predictive values of PG for the diagnosis of SA were 87.5% (95% confidence interval: 47-99), 80% (52-96), 70% (35-93...
This study aimed to determine the sleepiness-related factors associated with road traffic acciden... more This study aimed to determine the sleepiness-related factors associated with road traffic accidents. A population based case-control study was conducted in 2 French agglomerations. 272 road accident cases hospitalized in emergency units and 272 control drivers matched by time of day and randomly stopped by police forces were included in the study. Odds ratios were calculated for the risk of road traffic accidents. As expected, the main predictive factor for road traffic accidents was having a sleep episode at the wheel just before the accident (OR 9.97, CI 95%: 1.57-63.50, p<0.05). The increased risk of traffic accidents was 3.35 times higher in subjects who reported very poor quality sleep during the last 3 months (CI 95%: 1.30-8.63, p<0.05), 1.69 times higher in subjects reporting sleeping 6 hours or fewer per night during the last 3 months (CI 95%: 1.00-2.85, p<0.05), 2.02 times higher in subjects reporting symptoms of anxiety or nervousness in the previous day (CI 95%: ...
Patients with excessive daytime sleepiness (EDS) are at high risk for driving accidents, and phys... more Patients with excessive daytime sleepiness (EDS) are at high risk for driving accidents, and physicians are concerned by the effect of alerting drugs on driving skills of sleepy patients. No study has up to now investigated the effect of modafinil (a reference drug to treat EDS in patients with hypersomnia) on on-road driving performance of patients suffering from central hypersomnia. The objective is to evaluate in patients with central hypersomnia the effect of a wake-promoting drug on real driving performance and to assess the relationship between objective sleepiness and driving performance. Randomized, crossover, double-blind placebo-controlled trial conducted among 13 patients with narcolepsy and 14 patients with idiopathic hypersomnia. Patients were randomly assigned to receive modafinil (400 mg) or placebo for 5 days prior to the driving test. Each condition was separated by at least 3 weeks of washout. Mean number of Inappropriate Line Crossings, Standard Deviation of Lateral Position of the vehicle and mean sleep latency in the Maintenance of Wakefulness Test were assessed. Modafinil reduced the mean number of Inappropriate Line Crossings and Standard Deviation of Lateral Position of the vehicle compared to placebo (F(1,25) = 4.88, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05 and F(1,25) = 3.87, P = 0.06 tendency). Mean sleep latency at the Maintenance of Wakefulness Test significantly correlated with the mean number of Inappropriate Line Crossings (r = -0.41, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Modafinil improves driving performance in patients with narcolepsy and idiopathic hypersomnia. The Maintenance of Wakefulness Test is a suitable clinical tool to assess fitness to drive in this population.
Respiratory events during sleep usually lead to micro arousals resulting in consecutive daytime s... more Respiratory events during sleep usually lead to micro arousals resulting in consecutive daytime sleepiness even in healthy snorers. The present study investigated the evolution of subjective and objective daytime sleepiness and reaction time in healthy snorers submitted to acute and chronic sleep deprivation.
Studies assessing the impact of epilepsy and its medication on the risk of road traffic crashes h... more Studies assessing the impact of epilepsy and its medication on the risk of road traffic crashes have shown inconsistent results. The aim in this study was to assess this risk using French databases. Data from three French national databases were extracted and matched: the national health care insurance database, police reports, and the national police database of injurious crashes. Only antiepileptics prescribed predominantly in epilepsy were studied (phenobarbital, phenytoin, ethosuximide, valproic acid, vigabatrin, tiagabin, levitiracetam, zonisamide, and lacosamide). A case-control analysis comparing responsible and non-responsible drivers and a case-crossover analysis were performed. Drivers (72 685) involved in an injurious crash in France between July 2005 and May 2008, were included. Drivers exposed to prescribed antiepileptic medicines (n = 251) had an increased risk of being responsible for a crash (OR 1.74 [1.29-2.34]). The association was also significant for the most severe epileptic patients (n = 99; OR = 2.20 [1.31-3.69]). Case-crossover analysis found no association between crash risk and treatment prescription. Patients with prescription of antiepileptic drugs should be cautioned about their potential risk of road traffic crash. This risk is however more likely to be related to seizures than to the effect of antiepileptic medicines.
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