Narcolepsy Patient Presenting as Drop Attack without Emotional Triggering and Subjective Sleepiness

Abstract Introduction Seltorexant (JNJ-42847922), a potent and selective antagonist of the human orexin-2 receptor, is being developed for the treatment of major depressive disorder. Seltorexant also has sleep-promoting properties. Investigating the effects of sleep-promoting medications on driving is important because some of these agents (e.g. GABAA receptor agonists) may be associated with increased risk of motor vehicle accidents. We evaluated the effect of seltorexant on driving after forced awakening at night, using a validated driving simulator. Methods This double-blind, placebo and active-controlled, randomized, 3-way cross-over study was conducted in 18 male and 18 female healthy subjects. All subjects received seltorexant 40 mg, zolpidem 10 mg, or placebo 15 minutes before bedtime. Eighteen subjects were awakened at 2- and 6-hours post-dose, and the other 18 at 4- and 8-hours post-dose. At those timepoints, pharmacokinetics, objective (standard deviation of the lateral position [SDLP]) and subjective effects (using Perceived Driving Quality and Effort Scales) on driving ability, postural stability and subjective sleepiness were assessed. Results For seltorexant, the SDLP difference from placebo (95% confidence interval) at 2-, 4-, 6- and 8-hours post-dose was 3.9 cm (1.26, 6.60), 0.9 cm (-1.08, 2.92), 1.1 cm (-0.42, 2.63), and 0.6 cm (-2.75, 1.55), respectively vs. 9.6 cm (6.97, 12.38), 6.6 cm (3.53, 9.60), 4.7 cm (1.46, 7.85), and 1.3cm (-1.16, 3.80), respectively for zolpidem. The difference from placebo was significant at 2-hours after taking seltorexant, while the difference from placebo was significant at 2, 4 and 6-hours after zolpidem. Subjective driving quality was decreased for both drugs at all time points and driving effort was increased up to 4-hours post-dose for both medications. Subjective sleepiness showed a significant increase compared to placebo 2- and 4-hours after administration of either drug. Postural stability was decreased up to 2-hours after administration of seltorexant, and up to 4-hours after administration of zolpidem. Conclusion Compared to zolpidem, objective effects on driving performance were more transient after seltorexant administration and largely normalized by 4–6 hours post-dose. Support (if any) This work was sponsored by Janssen R&D.

Download Full-text

Thermal Comfort and Sleep Quality of Indonesian Students Living in Japan during Summer and Winter

Buildings ◽

10.3390/buildings11080326 ◽

2021 ◽

Vol 11 (8) ◽

pp. 326

Author(s):

Wiwik Budiawan ◽

Kazuyo Tsuzuki

Keyword(s):

Sleep Quality ◽

Thermal Comfort ◽

Thermal Sensation ◽

Thermal Conditions ◽

Physical Conditions ◽

Subjective Sleepiness ◽

Adaptive Action ◽

Quality Sleep ◽

Sleep Parameters

Thermal comfort is crucial in satisfaction and maintaining quality sleep for occupants. In this study, we investigated the comfort temperature in the bedroom at night and sleep quality for Indonesian students during summer and winter. Eighteen male Indonesian students aged 29 ± 4 years participated in this study. The participants had stayed in Japan for about six months. We evaluated the sleep parameters using actigraphy performed during summer and winter. All participants completed the survey regarding thermal sensation, physical conditions, and subjective sleepiness before sleep. The temperature and relative humidity of participants’ bedrooms were also measured. We found that the duration on the bed during winter was significantly longer than that during summer. However, sleeping efficiency during winter was significantly worse than that during summer. The bedroom temperature of the participants was in the range of comfort temperature in Indonesia. With the average bedroom air temperature of 22.2 °C, most of the participants still preferred “warm” and felt “slightly comfortable” during winter. The average comfort temperature each season calculated using the Griffiths method was 28.1 °C during summer and 23.5 °C during winter. In conclusion, differences in adaptive action affect bedroom thermal conditions. Furthermore, habits encourage the sleep performance of Indonesian students.

Download Full-text

Subjective and Objective Appraisal of Activity in Adults with Obstructive Sleep Apnea

Journal of Aging Research ◽

10.4061/2011/751819 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6 ◽

Cited By ~ 19

Author(s):

Eileen R. Chasens ◽

Susan M. Sereika ◽

Martin P. Houze ◽

Patrick J. Strollo

Keyword(s):

Physical Activity ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Epworth Sleepiness Scale ◽

Functional Outcomes ◽

Apnea Hypopnea Index ◽

Sleep Study ◽

Obstructive Sleep ◽

Subjective Sleepiness ◽

Aging Adults

Objective.This study examined the association between obstructive sleep apnea (OSA), daytime sleepiness, functional activity, and objective physical activity.Setting.Subjects (N=37) being evaluated for OSA were recruited from a sleep clinic.Participants. The sample was balanced by gender (53% male), middle-aged, primarily White, and overweight or obese with a mean BMI of 33.98 (SD=7.35;median BMI=32.30). Over 40% reported subjective sleepiness (Epworth Sleepiness Scale (ESS) ≥10) and had OSA (78% with apnea + hypopnea index (AHI) ≥5/hr).Measurements.Evaluation included questionnaires to evaluate subjective sleepiness (Epworth Sleepiness Scale (ESS)) and functional outcomes (Functional Outcomes of Sleep Questionnaire (FOSQ)), an activity monitor, and an overnight sleep study to determine OSA severity.Results.Increased subjective sleepiness was significantly associated with lower scores on the FOSQ but not with average number of steps walked per day. A multiple regression analysis showed that higher AHI values were significantly associated with lower average number of steps walked per day after controlling patient's age, sex, and ESS.Conclusion.Subjective sleepiness was associated with perceived difficulty in activity but not with objectively measured activity. However, OSA severity was associated with decreased objective physical activity in aging adults.

Download Full-text

Vestibular syncope: A disorder associated with drop attack in Ménière’s disease

Auris Nasus Larynx ◽

10.1016/j.anl.2017.03.023 ◽

2018 ◽

Vol 45 (2) ◽

pp. 234-241 ◽

Cited By ~ 5

Author(s):

Ilmari Pyykkö ◽

Vinaya Manchaiah ◽

Jing Zou ◽

Hilla Levo ◽

Erna Kentala

Keyword(s):

Meniere’S Disease ◽

Menière’S Disease ◽

Meniere's Disease ◽

Ménière’S Disease ◽

Menière's Disease ◽

Drop Attack ◽

Ménière's Disease

Download Full-text

Yawning and subjective sleepiness in the elderly

Journal of Sleep Research ◽

10.1111/j.1365-2869.2008.00666.x ◽

2008 ◽

Vol 17 (3) ◽

pp. 303-308 ◽

Cited By ~ 22

Author(s):

IOLE ZILLI ◽

FIORENZA GIGANTI ◽

VALERIA UGA

Keyword(s):

The Elderly ◽

Subjective Sleepiness

Download Full-text

Sleep Loss and Temporal Memory

The Quarterly Journal of Experimental Psychology Section A ◽

10.1080/713755870 ◽

2000 ◽

Vol 53 (1) ◽

pp. 271-279 ◽

Cited By ~ 99

Author(s):

Yvonne Harrison ◽

James A. Horne

Keyword(s):

Young Adults ◽

Recognition Memory ◽

Sleep Deprivation ◽

Neuropsychological Test ◽

Optimal Performance ◽

Historical Evidence ◽

Temporal Memory ◽

Short Novel ◽

Subjective Sleepiness ◽

Insight Into

Historical evidence suggests that sleep deprivation affects temporal memory, but this has not been studied systematically. We explored the effects of 36 hr of sleep deprivation on a neuropsychological test of temporal memory. To promote optimal performance, the test was short, novel, and interesting, and caffeine was used to reduce “sleepiness”. A total of 40 young adults were randomized into four groups: control + caffeine (Cc), control + placebo (Cp), sleep deprived + caffeine (SDc), and sleep deprived + placebo (SDp). Controls slept normally. Caffeine (350 mg) or placebo were given just prior to testing. The task comprised colour photographs of unknown faces and had two components: recognition memory (distinction between previously presented and novel faces), and recency discrimination (temporal memory), when a previously shown face was presented. An interpolated task, self-ordered pointing, acted as a distraction. Caffeine had no effects within control conditions, but significantly reduced subjective sleepiness in SDc. Recognition was unaffected by sleep deprivation, whereas for recency, sleep deprivation groups scored significantly lower than controls. There was no significant improvement of recency with caffeine in the SDc group. Both sleep deprivation groups had poorer insight into their performance with recency. Self-ordered pointing remained unchanged. In conclusion, sleep deprivation impairs temporal memory (i.e. recency) despite other conditions promoting optimal performance.

Download Full-text

Design and Efficient Network Investigation of Passive Periodic Drop Attack

Oriental journal of computer science and technology ◽

10.13005/ojcst13.0203.08 ◽

2021 ◽

Vol 13 (0203) ◽

pp. 110-116

Author(s):

Sunil Kumar ◽

Maninder Singh

Keyword(s):

Network Performance ◽

Ad Hoc ◽

Mobile Ad Hoc Network ◽

Denial Of Service ◽

High Mobility ◽

Network Simulator ◽

Denial Of Service Attack ◽

Drop Attack ◽

Service Attack ◽

The Impact

A Mobile Ad Hoc Network (MANET) is much more vulnerable to various security attacks due to its high mobility, multi-hop communication and the absence of centralized administration. In this paper, we investigate the impact of Jellyfish periodic dropping attack on MANETs under different routing protocols. This investigate is under the class of denial-of-service attack and targets closed loop flows which results in delay and data loss. In this paper, the simulation results are gathered using OPNET network simulator and its effect on network performance is studied by analysing re-transmission attempts, network load and throughput. The results have shown that the impact of Jellyfish periodic dropping attack which reduces the network performance. Performance shows OLSR performs better than AODV under periodic drop attack.

Download Full-text

Effect of shift work on fatigue and sleep in neonatal registrars

PLoS ONE ◽

10.1371/journal.pone.0245428 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245428

Author(s):

Ajay P. Anvekar ◽

Elizabeth A. Nathan ◽

Dorota A. Doherty ◽

Sanjay K. Patole

Keyword(s):

Reaction Time ◽

Vigilance Task ◽

Sleep Diary ◽

Secondary Outcome ◽

Subjective Sleepiness ◽

Working Day ◽

Psychomotor Vigilance ◽

Night Shifts ◽

Mean Reaction Time

Objective We aimed to study fatigue and sleep in registrars working 12-hour rotating shifts in our tertiary neonatal intensive unit. Methods and participants This study involved neonatal registrar’s working day (08:00–21:00) and night (20:30–08:30) shifts. Participants maintained a sleep diary, answered a self-reported sleepiness questionnaire assessing subjective sleepiness, and performed a 10-minute psychomotor vigilance task (PVT) at the start and end of each shift. Primary outcomes: (1) Fatigue at the (i) “start vs end” of day and night shifts, (ii) end of the “day vs night” shifts, and (iii) end of “first vs last shift” in block of day and night shifts. (2) Duration and quality of sleep before the “day vs night” shifts. Mean reaction time (RTM), relative coefficient of variation (RTCV), and lapses (reaction time > 500ms) were used as measures of fatigue on PVT. Secondary outcome: Subjective sleepiness (self-reported sleepiness questionnaire) at the ‘start vs end” of day and night shifts. Results Fifteen registrars completed the study. Acuity was comparable for all shifts. (1) Psychomotor responses were impaired at the end vs start of day shifts [RTM (p = 0.014), lapses (p = 0.001)], end vs start of night shifts [RTM (p = 0.007), RTCV (p = 0.003), lapses (p<0.001)] and end of night vs day shifts [RTM (p = 0.007), RTCV (p = 0.046), lapses (p = 0.001)]. Only lapses were significantly increased at the end of the last (p = 0.013) vs first shift (p = 0.009) in a block of day and night shifts. (2) Duration of sleep before the night (p = 0.019) and consecutive night shifts was decreased significantly (p = 0.034). Subjective sleepiness worsened after day (p = 0.014) and night shifts (p<0.001). Conclusion Fatigue worsened after the 12-hour day and night shifts with a greater change after night shifts. Lapses increased after block of day and night shifts. Sleep was decreased before night shifts. Our findings need to be confirmed in larger studies.

Download Full-text