This study aims to examine the clinical differences between objective short sleep insomniacs (OSSI) and subjective short sleep insomniacs (SSSI). Methods: We enrolled 79 patients (aged 27–74 years) with chronic insomnia disorder (CID) who underwent overnight polysomnography (PSG) and completed sleep-related questionnaires as well as habitual sleep time. All of them completed actigraphy (ACT) recording for one week prior to the PSG study. Objective sleep duration for one-week average sleep was calculated by ACT, and subjective sleep duration was counted through self-reported habitual sleep time. We divided the subjects into three groups; OSSI (<6 hight), SSSI (objective sleep ≥6 hight and subjective sleep <6 h/ night), and normal sleep duration insomniacs (NSDI, subjective sleep ≥6 hight). Results: The three groups namely OSSI, SSSI, and NSDI had 25 (31.6%), 36 (45.6%), and 18 (22.8%) subjects, respectively. The SSSI were significantly older and had higher daytime sleepiness than the OSSI. According to the PSG results, the OSSI showed shorter sleep latency (11.86 min vs. 39.69 min) and N2 sleep % (59.43% vs. 67.96%), and longer rapid eye movement sleep % (20.79% vs. 15.47%) than that in the NSDI. There was no difference in treatment response between groups. Conclusions: 45.6% of CID patients underestimated their sleep relative to objective sleep. However, there were no differences in total sleep time on PSG between groups. The OSSI showed younger age and more daytime sleepiness, and the SSSI showed poorer sleep quality than the NSDI. These findings suggest that long-term ACT recording in a casual environment would be useful to monitor objective sleep in patients with CID, particularly, in subjectively short sleep insomniacs.

Objectives: Sleep issues are more prevalent in healthcare workers compared to workers in other industries. This study investigated sleep-wake pattern, sleep quality, and daytime status in hospital workers using a Galaxy Watch3 (GW3), a wrist-worn device that uses an accelerometer and heart rate sensor to distinguish sleep and wakefulness. Methods: Multiple sleep parameters including total sleep time (TST) were obtained using a GW3. The Epworth sleepiness scale (ESS), insomnia severity index (ISI), Pittsburgh sleep quality index (PSQI), and bedtime procrastination scale (BPS) were used to assess participants’ status. Results: A total of 70 daytime hospital workers (male, 45.7%; mean age, 35.66±7.79 yr) participated in the monitoring of their sleep-wake patterns for 30 consecutive days. Participants had a mean ESS of 8.14±3.62, ISI of 6.13±3.83, and PSQI of 4.86±2.14. The mean TST was 5.75±0.74 hr (range: 3.42–6.88) during workdays and 5.92±0.92 hr (range: 2.87–8.25) during free days. Chronotype (mid-sleep on freedays corrected for sleep debt accumulated over the work week) was 3.60±1.03 clock hr (range: 1.84–6.69). BPS was negatively correlated with age (rho=-0.27, p=0.022), TST of workdays (rho=-0.53, p<0.001), and TST of free days (rho=-0.43, p<0.001). A higher BPS was associated with larger social jetlag (rho=0.28, p=0.018) and later chronotype (rho=0.41, p<0.001). Conclusions In this study, 91.5% of daytime hospital workers suffered from chronic sleep insufficiency (<7 hr during both workdays and free days) although their daytime sleepiness or subjective sleep were not poor. Individuals with a later chronotype had poorer sleep quality and worse sleep procrastination behavior.

BACKGROUND: Minimum alveolar concentration (MAC) is decreased during pregnancy, but there are no data regarding the requirements for intravenous agents. Recently only one study showed that the requirement for thiopental in pregnant women of 7-13 weeks' gestation was less than the requirement obtained in nonpregnant women. Thus we wanted to determine whether pregnant patients needed less propofol for hypnosis and anesthesia than nonpregnant patients. METHODS: One hundred nonpregnant women having gynecologic surgery and 100 pregnant women of 5-13 weeks' gestation undergoing elective abortions were recruited. They were randomly allocated 10 groups according to the doses of propofol and each group had 10 patients. During a period of 30 seconds, one of the doses of propofol 1.0, 1.25, 1.5, 1.75, 2.0, 2.25, 2.5, 2.75, 3.0 or 3.25 mg/kg was administered. Two minutes later, patients were asked to open their eyes as a test for hypnosis. Patients who did not open their eyes were given a 10 seconds, 50-Hz, 80-mA transcutaneous tetanic electrical stimulus to the ulnar nerve as a test for anesthesia. Estimates of ED50 and ED95 for hypnosis and anesthesia were obtained by logistic regression. RESULTS: In the pregnant women, the median effective doses (ED50) (95% confidence interval) for hypnosis and anesthesia were 1.25 (1.13-1.35) mg/kg and 2.71 (2.49-3.04) mg/kg, the ED95 (95% CI) were 1.51 (1.16-1.87) mg/kg and 3.04 (2.80-3.58) mg/kg respectively. Whereas in the nonpregnant women, the ED50 for hypnosis and anesthesia were 1.27 (1.39-1.90) mg/kg and 4.12 (3.50-6.01) mg/kg, the ED95 were 1.53 (1.41-1.93) mg/kg and 4.35 (3.66-7.26) mg/kg respectively. CONCLUSIONS: In early pregnant women, the doses of propofol for hypnosis and anesthesia were 1.6% and 34.2% less compared with those in nonpregnant women.
Anesthesia ; Female ; Gynecologic Surgical Procedures ; Humans ; Hypnosis ; Logistic Models ; Pregnancy* ; Pregnant Women ; Propofol* ; Thiopental ; Ulnar Nerve

Background: Patients with ongoing or expected bleeding require platelet (PLT) transfusions; however, owing to the testing required after a blood donation, manufacturing PLT products may take 1.5–2.0 days after a request is made. This supply-demand mismatch leads clinicians to retain spare PLTs for transfusions, leading to increased PLT discard rates. We developed a PLT inventory management program to supply PLTs more efficiently to patients requiring PLT transfusions within the expiration date, while reducing PLT discard rates. Methods: PLT concentrates (58,863 and 58,357 units) and apheresis products (7,905 and 8,441 units) were analyzed from May 2015 to November 2017 and from December 2017 to January 2020, respectively. We developed a program to manage total PLT inventories and prospective PLT transfusion patients based on blood type, blood product, and remaining period of efficacy; the program facilitates PLT preparation transfer to non-designated patients within the remaining period of efficacy. Results: The overall PLT concentrate discard rate was 3,254 (2.78%): 1,811 (3.07%) units before and 1,443 units (2.41%) after program application (P < 0.001). The discard rate owing to expiration was reduced from 69 units (3.81%) before to two units (0.14%) after program application (P < 0.001). Conclusions This program can guide the allocation of PLT preparations based on the remaining period of efficacy, enabling PLT products to be used before their expiration date and reducing PLT product discard rate.

Objectives: Circadian misalignment may increase the risk of obesity and related obstructive sleep apnea (OSA). Considerable young adults have social jetlag (SJL), which is defined as the time discrepancy between workdays and free days. We aim to evaluate the relationship between SJL and sleep and respiratory disturbance in patients with untreated OSA patients. Methods: A total of 180 OSA patients under the age of 50 [mean 38.3±8.0 y, 93.3% male, mean apnea-hypopnea index (AHI) 38.2±27.4 /h] were recruited from the university affiliated sleep clinic and fulfilled sleep-related questionnaires including Munich Chronotype Questionnaire (MCTQ). SJL was defined as the difference in sleep midpoints between work and free days. Patients were divided into three groups with SJL less than 1 hour, 1–2 hours, and 2 hours or more and the clinical and sleep data of each group were compared. Results: 51.6% (n=93) suffered from significant SJL (≥1 h). Patients with ≥2h of SJL (16.6%, n=30) had the largest neck circumference (NC). AHI and sleep parameters were not significantly different among groups except lowest oxygen saturation (LoS) was the lowest in the group of ≥2 h. SJL was positively correlated with body mass index and NC and negatively correlated with LoS after adjusting for age and sex. Conclusions About a half of young adults with OSA have significant SJL more than 1 h. This study suggests that SJL is associated with being overweight, while it seems not increase the severity of OSA nor deteriorate sleep quality in young adults.

Objectives: To investigate the etiologies of sleep disorders according to sex. Methods: We enrolled 1,270 patients who complained of insomnia (n=328) or sleep apnea (n=942) for more than 6 months and classified them into primary insomnia (PI, n=120), comorbid obstructive sleep apnea with insomnia (COMISA, n=146), and obstructive sleep apnea (OSA, n=884) groups based on their polysomnography (PSG) findings, demographics, sleep-related symptoms, and questionnaire results (Insomnia Severity Index and Epworth Sleepiness Scale). Results: The highest prevalence of females was observed in PI (71.7%), and the lowest in the OSA group (15.6%). Males were more prevalent than females in the COMISA group (58.2% vs. 41.8%). Regarding the etiology of insomnia, half of the male patients with complaints of insomnia had OSA, while only one-third of the females had OSA. Thirteen percent of female who complained of OSA-related symptoms were diagnosed as normal. There were few differences in PSG data between female and male patients in the PI and COMISA groups. Females with OSA showed longer total sleep time than males with OSA in PSG. The self-reported questionnaire responses of patients in the COMISA and PI groups were similar, and PSG data of patients in the COMISA and OSA groups were comparable regardless of sex. Conclusions Females and males have different sleep perceptions and sleep-related complaints. Thus, PSG must be carried out to clarify the etiology of sleep disorders and ensure appropriate treatment is provided.

Objectives: Light at night (LAN) can suppress melatonin secretion and thus disturb normal sleep. The aim of this study was to investigate how the illumination of a smartphone at bedtime affects the circadian rhythm and sleep in patients with insomnia. Methods: We recruited two middle-aged patients (one day worker and one shift worker) with insomnia. They used a smartphone more than 12 hours a day, particularly at bedtime. This was a crossover design study, and each patient spent a night at the light control unit twice at a one-week interval, with or without smartphone use. Patients were instructed to look at a smartphone (5–10 lux) under 150 lux of ceiling illumination from 18:00 until lights-off. During the night, without a smartphone, they read a book or newspaper. Saliva was collected every 30 minutes and analyzed for melatonin. Sleep was monitored by polysomnography. Results: The day worker showed a delayed dim light melatonin onset time (DLMO) (21:30 vs. 22:00) and a 38.7% decrease in melatonin levels with smartphone use. For the shift worker, both melatonin and cortisol showed abnormal patterns, and thus DLMO was not determined in either condition. In the day worker, shorter rapid eye movement (REM) latency and increased REM were observed with smartphone use. Conclusions This study demonstrates that the use of smartphones at bedtime acutely suppresses melatonin secretion and delays the sleep-wake cycle. However, the effect of LAN on melatonin secretion was not apparent in the shift worker with already misaligned circadian rhythm.

To increase the success rate of heart and lung transplantation, appropriate transfusion and desensitization treatment should be performed. In each hospital, transfusion should be performed according to the patient and hospital situation and monitored to ensure that an appropriate amount of transfusion is achieved is necessary. If HLA desensitization treatment is performed using plasmapheresis and immunosuppressants, the incidence of rejection and complications after transplantation can be reduced. For desensitization treatment that considers individual patient characteristics, close cooperation between clinical medical staff, blood bank personnel, and medical staff will be required.

Objectives: Circadian misalignment may increase the risk of obesity and related obstructive sleep apnea (OSA). Considerable young adults have social jetlag (SJL), which is defined as the time discrepancy between workdays and free days. We aim to evaluate the relationship between SJL and sleep and respiratory disturbance in patients with untreated OSA patients. Methods: A total of 180 OSA patients under the age of 50 [mean 38.3±8.0 y, 93.3% male, mean apnea-hypopnea index (AHI) 38.2±27.4 /h] were recruited from the university affiliated sleep clinic and fulfilled sleep-related questionnaires including Munich Chronotype Questionnaire (MCTQ). SJL was defined as the difference in sleep midpoints between work and free days. Patients were divided into three groups with SJL less than 1 hour, 1–2 hours, and 2 hours or more and the clinical and sleep data of each group were compared. Results: 51.6% (n=93) suffered from significant SJL (≥1 h). Patients with ≥2h of SJL (16.6%, n=30) had the largest neck circumference (NC). AHI and sleep parameters were not significantly different among groups except lowest oxygen saturation (LoS) was the lowest in the group of ≥2 h. SJL was positively correlated with body mass index and NC and negatively correlated with LoS after adjusting for age and sex. Conclusions About a half of young adults with OSA have significant SJL more than 1 h. This study suggests that SJL is associated with being overweight, while it seems not increase the severity of OSA nor deteriorate sleep quality in young adults.