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Biomedical subjects

Henry J Moller

Publications and source records attributed to Henry J Moller.

6 recordsLinked to original sources
PubMed2006

Sleepiness is not the inverse of alertness: evidence from four sleep disorder patient groups.

The constructs "sleepiness" and "alertness" are often assumed to be reciprocal states of consciousness. This distinction is of increasing concern in relation to psychomotor performance tasks such as driving. We developed two separate subjective scales of alertness to complement existing sleepiness scales. Subjective sleepiness and alertness were compared in four groups of sleep-disordered patients. In a 175-patient cohort [25 narcoleptics and 50 each with sleep apnea, insomnia and periodic leg movement disorder (PLMD)], the Epworth Sleepiness Scale (ESS) was used to measure sleepiness while the Toronto Hospital Alertness Test (THAT) and ZOGIM Alertness Scale (ZOGIM-A) were used to measure alertness. Significant differences existed for sleepiness scores, with narcoleptics scoring highest on the ESS, followed by sleep apnea, with similar ESS scores for insomnia and PLMD. By contrast, alertness scores on both the THAT and ZOGIM-A did not differ significantly between the four groups. Sleepiness scores show a correlation of close to nil to alertness scores for the combined sleep disorder patient cohort, with the exception of insomnia patients, where a modest but significant inverse relationship was noted between sleepiness and alertness. Subjective states of impaired alertness and excessive sleepiness are independent constructs in the evaluation of sleep-disordered patients. The specific primary sleep disorder diagnosis may play a relevant role in mitigating this interrelationship.

Adult↗
PubMed2006

Psychomotor disturbance in depression: assessment using a driving simulator paradigm.

BACKGROUND: Psychomotor disturbance is an essential feature of Major Depressive Disorder (MDD) and has been associated with impaired functioning on cognitively demanding tasks. Given the psychomotor demands required to navigate a motor vehicle and the disastrous effects of motor vehicles accidents, patients with MDD present a population of clinical interest. The goal of this investigation was to examine the association between MDD and driving ability assessed within a simulated driving paradigm. METHODS: 18 outpatients currently meeting diagnostic criteria for MDD and 29 control participants completed four 30-min simulated driving trials at 10:00 am, 12:00 pm, 2:00 pm, and 4:00 pm. Participants also completed the Beck Depression Inventory (BDI) to assess for depression severity and the Epworth Sleepiness Scale (ESS) to assess for everyday sleepiness. RESULTS: After controlling for age and sleepiness, the depressed sample exhibited slower steering reaction times across trials (p<.05) and an increased number of crashes across trials (p<.05) when compared to controls. These differences were characterized by a medium effect size. No significant time-of-day effects were found. LIMITATIONS: MDD patients were free of anti-depressant medication and findings may not generalize to medicated populations. Also, a rural highway driving route was used which may not generalize well to urban driving settings. CONCLUSIONS: Patients with untreated MDD demonstrate impaired simulated driving performance. Further research into whether these findings translate into on-the-road impairment is important for public health and safety.

Accidents, Traffic↗
PubMed2006

Simulator performance, microsleep episodes, and subjective sleepiness: normative data using convergent methodologies to assess driver drowsiness.

OBJECTIVE: Our objective was to examine a novel standardized assessment methodology of detecting impaired driving performance due to drowsiness in a normative cohort. METHODS: Thirty-one healthy subjects with no significant sleep, medical, and psychiatric pathology were assessed in a driving simulation paradigm. Thirty-minute simulations were repeated at two-hourly intervals (i.e., at 1000, 1200, 1400, and 1600 h). Convergent data sources included drivers' subjective ratings of sleepiness and alertness, electroencephalogram-verified microsleep (MS) episodes, and a variety of real-time driving simulator performance measures such as speed, lane tracking, reaction time (RT), and off-road events (crashes). RESULTS: Significant diurnal fluctuations were noted on objective measures of RT, velocity, tracking, and MS events, indicating the highest risk of impairment in the afternoon. By contrast, subjective ratings of sleepiness and alertness did not demonstrate significant circadian variation. The mean incidence of MS episodes and crash risk correlated highly (r = .748). CONCLUSIONS: This prospective study demonstrates the relevance of multiple convergent measures for comprehensive assessment. The divergence of subjective and objective assays of impairment implies that healthy individuals may not have full insights into neurophysiologically mediated performance deficits. These results will serve as normative comparators to patients presenting with daytime somnolence and may allow a more accurate prediction of potential crash risk than noninteractive daytime polysomnogram tests such as the mean sleep latency test or the maintenance of wakefulness test.

Accidents, Traffic↗
PubMed2005

What is the driving performance of ambulatory surgical patients after general anesthesia?

BACKGROUND: Ambulatory surgical patients are advised to refrain from driving for 24 h postoperatively. However, currently there is no strong evidence to show that driving skills and alertness have resumed in patients by 24 h after general anesthesia. The purpose of this study was to determine whether impaired driver alertness had been restored to normal by 2 and 24 h after general anesthesia in patients who underwent ambulatory surgery. METHODS: Twenty patients who underwent left knee arthroscopic surgery were studied. Their driving simulation performance, electroencephalographically verified parameters of sleepiness, subjective assessment of sleepiness, fatigue, alertness, and pain were measured preoperatively and 2 and 24 h postoperatively. The same measurements were performed in a matched control group of 20 healthy individuals. RESULTS: Preoperatively, patients had significantly higher attention lapses and lower alertness levels versus normal controls. Significantly impaired driving skills and alertness, including longer reaction time, higher occurrence of attention lapses, and microsleep intrusions, were found 2 h postoperatively versus preoperatively. No significantly differences were found in any driving performance parameters or electroencephalographically verified parameters 24 h postoperatively versus preoperatively. CONCLUSIONS: Patients showed lower alertness levels and impaired driving skills preoperatively and 2 h postoperatively. Based on driving simulation performance and subjective assessments, patients are safe to drive 24 h after general anesthesia.

Adjuvants, Anesthesia↗
PubMed2004

Psychiatric aspects of late-life insomnia.

Epidemiological trends towards a 'graying' population make the issue of insomnia in the elderly an increasingly important research and clinical topic. It is often challenging to determine how much of a psychiatric dimension there is to a clinical condition that is best viewed as both as a symptom and a true psychosomatic entity in its own right. To categorize insomnia as either psychiatric or medically based risks oversimplification of the complexities of sleep disruption in the elderly. Normal senescence-related changes in sleep architecture and circadian rhythms must be considered, as well as the frequent medical comorbidities that may affect sleep. Psychiatric diagnoses to consider include mood and anxiety disorders, which may be affected equally by physiological and psychological changes implicit in old age. Sleep disruption related to dementia is of particular interest to clinicians involved with patients in long-term care facilities. Insomnia may occasionally be iatrogenically induced or exacerbated, and particularly antidepressants must be carefully selected for this reason. Light therapy and behavior therapies are important in multimodal treatment of insomnia, and sleep hygiene includes both regular physical and social activities to preserve entrainment of circadian rhythms affecting sleep.

Aged↗