letteratura rilevante


Bonsignore, M.R. et al.



New rules on driver licensing for patients with obstructive sleep apnea: European Union Directive 2014/85/EU


Journal of Sleep Research 2016, 25(1). pp.3-4

The widespread recognition that obstructive sleep apnea(OSA) represents an important risk factor for motor vehicleaccidents, which is reversed by successful therapy withcontinuous positive airway pressure (CPAP), has led to arevision of Annex III of the European Union (EU) Directive onDriving Licences. This directive was the result of recommen-dations from a Working Group established by the Transportand Mobility Directorate of the European Commission in 2012(McNicholas, 2013).


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Ferrie, J.E. et al.



Sleep epidemiology - A rapidly growing field


International Journal of Epidemiology 2011, 40(6). pp.1431-1437

The human body has adapted to daily changes in light such that it anticipates periods of sleep and activity. Deviations from the circadian rhythm come with functional consequences. Thus, 17 h of sustained wakefulness in adults leads to a decrease in performance equivalent to a blood alcohol level of 0.05%; the legal limit for driving in many countries. Rats deprived of sleep die after a month or so, and sleep deprivation is used as a common form of torture.


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Garbarino, S. et al.



Risk of Occupational Accidents in Workers with Obstructive Sleep Apnea: Systematic Review and Meta-analysis


SLEEP 2016, 39(6). pp.1211-1218

Obstructive sleep apnea (OSA) is the single most important preventable medical cause of excessive daytime sleepiness (EDS) and driving accidents. OSA may also adversely affect work performance through a decrease in productivity, and an increase in the injury rate. Nevertheless, no systematic review and meta-analysis of the relationship between OSA and work accidents has been performed thus far.


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Garbarino, S. et al.



The contributing role of sleepiness in highwav vehicle accidents


Sleep 2001, 24(2). pp.203-6

Study Objective: To evaluate the contributing role of sleepiness in Italian highway vehicle accidents during the time span 1993-1997. Design: We analyzed separately the hourly distribution of accidents ascribed by police officers univocally to sleepiness and the rest. Measurements: Using a polynomial regression, we evaluated the relation between accidents (whether sleep-ascribed or not) and sleepiness as derived from a 24-hour sleep propensity curve. The relation between sleep-influenced and non-sleep influenced accidents was analysed using a linear regression. Results: The rate of non-sleep ascribed accidents is closely related with sleep propensity and bears a strong similarity with the pattern of sleep-ascribed accidents. A close relationship between the curves of non-sleep ascribed accidents and sleep-ascribed accidents is confirmed. The regression coefficient, which can be seen as the ratio between the quota of accidents that can be considered as sleep affected and those actually ascribed to sleepiness, results in a value of 5.83. Considering that the rate of sleep ascribed accidents is 3.2%, we can calculate the quota of sleep influenced accidents out of those not officially ascribed to sleepiness as 18.7% reaching an estimate of accidents related in some way to sleepiness equal to 21.9%. Conclusions: Our indirect estimate of sleep influenced accidents approaches data reported by other European countries and highlights the importance of sleepiness as a direct and/or contributing factor in vehicle accident rates.


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Grewal, R.G. & Doghramji, K.



Epidemiology of Insomnia


In Clinical Handbook of Insomnia. Cham: Springer International Publishing 2017, pp. 13-25

Prevalence of insomnia is variable due to inconsistency in defining the syndrome. It can be seen with or without comorbid illnesses and is now recognized as a distinct clinical syndrome even when associated with an underlying medical or psychiatric disorder. It is more common in women and in people who do shift work. Insomnia is present worldwide but appears to be less common in Asians. Individuals who have an anxiety-prone personality and depression are more prone to develop insomnia. It can have a huge economic impact as insomnia sufferers place a significant economic burden on their employers and health care system. Insomnia may be a risk factor for development of depression, hypertension, diabetes, and coronary artery diseases.


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Kerkhof, G. et al.



Epidemiology of Sleep and Sleep Disorders in The Netherlands


Sleep Medicine 2016, 0(0). pp.1431-1437

Objective: There is a surging public interest in The Netherlands concerning sleep, sleep disorders and associated health. For a proper perspective, it is necessary to have reliable information on the prevalence of sleep characteristics at the national level. This study set out to assess prevalence rates and key characteristics of sleep and sleep disorders in The Netherlands. Methods: In 2012, a nationally representative sample of 2089 individuals, aged 18–70 years, responded to a set of 48 questions, including the Holland Sleep Disorders Questionnaire, a validated questionnaire based on the International Classification of Sleep Disorders. Results: Prevalence rates were: 32.1% for a general sleep disturbance (GSD), 43.2% for insufficient sleep, 8.2 for insomnia, 5.3% for circadian rhythm sleep disorder, 6.1% for parasomnia, 5.9% for hypersomnolence, 12.5% for restless legs disorder and limb movements during sleep, 7.1% for sleep related breathing disorder, and 12.2% for the presence of comorbidity, ie, the presence of two or more concurrent sleep disorders. In addition, sleep onset time as well as sleep duration showed U-shaped relationships with GSD prevalence rates, with respectively the 22:00–24:00 period and seven to 8 h as optimal associates. Conclusions: Sleep disorders and insufficient sleep have a high prevalence. As matter of concern, female adolescents reached the highest prevalence rates for most sleep disorders, insufficient sleep and daytime malfunctioning.


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Littner, M. et al.



Practice parameters for the role of actigraphy in the study of sleep and circadian rhythms: an update for 2002


Sleep 2003, 26(3). pp.337-341

Actigraphy is a method used to study sleep-wake patterns and circadian rhythms by assessing movement, most commonly of the wrist. These evidence-based practice parameters are an update to the Practice Parameters for the Use of Actigraphy in the Clinical Assessment of Sleep Disorders, published in 1995. These practice parameters were developed by the Standards of Practice Committee and reviewed and approved by the Board of Directors of the American Academy of Sleep Medicine. Recommendations are based on the accompanying comprehensive review of the medical literature regarding the role of actigraphy, which was developed by a task force commissioned by the American Academy of Sleep Medicine. The following recommendations serve as a guide to the appropriate use of actigraphy. Actigraphy is reliable and valid for detecting sleep in normal, healthy populations, but less reliable for detecting disturbed sleep. Although actigraphy is not indicated for the routine diagnosis, assessment, or management of any of the sleep disorders, it may serve as a useful adjunct to routine clinical evaluation of insomnia, circadian-rhythm disorders, and excessive sleepiness, and may be helpful in the assessment of specific aspects of some disorders, such as insomnia and restless legs syndrome/periodic limb movement disorder. The assessment of daytime sleepiness, the demonstration of multiday human-rest activity patterns, and the estimation of sleep-wake patterns are potential uses of actigraphy in clinical situations where other techniques cannot provide similar information (e.g., psychiatric ward patients). Superiority of actigraphy placement on different parts of the body is not currently established. Actigraphy may be useful in characterizing and monitoring circadian rhythm patterns or disturbances in certain special populations (e.g., children, demented individuals), and appears useful as an outcome measure in certain applications and populations. Although actigraphy may be a useful adjunct to portable sleep apnea testing, the use of actigraphy alone in the detection of sleep apnea is not currently established. Specific technical recommendations are discussed, such as using concomitant completion of a sleep log for artifact rejection and timing of lights out and on; conducting actigraphy studies for a minimum of three consecutive 24-hour periods; requiring raw data inspection; permitting some preprocessing of movement counts; stating that epoch lengths up to 1 minute are usually sufficient, except for circadian rhythm assessment; requiring interpretation to be performed manually by visual inspection; and allowing automatic scoring in addition to manual scoring methods.


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Ohayon, M.M. & Smirne, S.



Prevalence and conseguences of insomnia disorders in the general population of Italy


Sleep Medicine 2002, 3(2). pp.115-120

Objectives: To assess the prevalence of insomnia disorders using DSM-IV classification, and the consequences of insomnia in the Italian general population. Methods: A representative sample of the Italian general population composed of 3970 individuals aged 15 years or older were interviewed by telephone using the Sleep-EVAL system (participation rate: 89.4%). Participants were interviewed about their sleep habits and sleep disorders. DSM-IV classification was used by Sleep-EVAL to determine the sleep disorder diagnosis. Results: Insomnia symptoms were reported by 27.6% of the sample. Sleep dissatisfaction was found in 10.1% and insomnia disorder diagnoses in 7% of the sample. The use of sleep-enhancing medication was reported by 5.7% of the sample. Most of these subjects were using anxiolytics. Dissatisfaction with sleep was associated with daytime sleepiness. Middle-aged drivers dissatisfied with their sleep were three times more likely to have had a road accident in the previous year compared to other drivers. However, fewer than 30% of subjects dissatisfied with their sleep or with an insomnia disorder diagnosis had consulted a physician about their sleep problem. Conclusions: As in other European and non-European countries, insomnia is widespread in Italy. The consequences are important. Appropriate recognition and treatment of insomnia should be part of an educational program for general practitioners everywhere.


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Pallesen, S. et al.



A 10-year trend of insomnia prevalence in the adult Norwegian population


Sleep medicine 2014, 15(2). pp.173-9

Objective: We aimed to investigate the 10-year trend in the prevalence of insomnia symptoms, insomnia cases, and use of hypnotic agents in the adult Norwegian population. Methods: Data from two representative surveys assessing identical insomnia symptoms in the adult population of Norway, one conducted in 1999-2000 (N=2001) and one conducted in 2009-2010 (N=2000), were compared. Results: Controlling for basic demographic variables, significant increases were found over the 10-year study period in the prevalence of sleep-onset insomnia from 13.1% to 15.2%, dissatisfaction with sleep from 8.2% to 13.6%, daytime impairment from 14.8% to 18.8%, Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) insomnia cases from 11.9% to 15.5%, and hypnotic agent use from 6.9% to 11.1%. No secular trend was found for maintenance insomnia or for early morning awakening insomnia. Across the two surveys, women reported a higher prevalence of insomnia than men. Age was positively associated with the prevalence of nocturnal sleep problems and use of hypnotic agents but was inversely associated with daytime impairment. Individuals with low socioeconomic status (SES) reported a higher prevalence of several insomnia symptoms. Conclusions: Insomnia seems to be on the rise in the general adult population, which gives reason for concern. Prevention of insomnia and cost-effective interventions should receive higher priority in the future.


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Sateia, M.



International classification of sleep disorders: highlights and modifications


CHEST Journal 2014

The recently released third edition of the International Classification of Sleep Disorders (ICSD) is a fully revised version of the American Academy of Sleep Medicine’s manual of sleep disorders nosology, published in cooperation with international sleep societies. It is the key reference work for the diagnosis of sleep disorders. The ICSD-3 is built on the same basic outline as the ICSD-2, identifying seven major categories that include insomnia disorders, sleep-related breathing disorders, central disorders of hypersomnolence, circadian rhythm sleep-wake disorders, sleep-related movement disorders, parasomnias, and other sleep disorders. Significant modifications have been made to the nosology of insomnia, narcolepsy, and parasomnias. Major features and changes of the manual are reviewed in this article. The rationales for these changes are also discussed.


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Terzano, M.G. et al.



Studio Morfeo: Insomnia in primary care. a survey conducted on the Italian population


Sleep Medicine 2004, 5(1). pp.67-75

Background and purpose: To carry out an observational epidemiological survey (Studio Morfeo), to determine: (1) the frequency of insomnia in a large Italian population presenting directly to the general physician (GP); (2) the impact of insomnia on the quality of life, on the use of health-care resources and on co-morbidity. Patients and methods: The study was accomplished by GPs, trained by sleep specialists accredited by the Italian Association of Sleep Medicine. Only patients spontaneously presenting to their GP for medical problems were surveyed. Each GP was asked to enroll at least five patients across a routine week of medical activity including both morning and afternoon clinics. The first patient of each weekday was recruited after obtaining written consent. According to the responses to the sleep-related questions, patients were classified into three categories: (1) no insomnia, (2) level 1 insomnia with absence of day-time dysfunction and (3) level 2 insomnia with presence of day-time dysfunction. Results: A total of 3284 patients were enrolled by 738 GPs in this Italian survey. Insomnia was reported by 64% of all interviewed patients, with 20% classified as level 1 and 44% as level 2. Logistic analysis indicated that depression (odds ratio, 2.70), involvement of >1 organ systems (odds ratio, 1.24), female gender (odds ratio, 1.19), unemployment (odds ratio, 1.18), low education (odds ratio, 1.18) and increasing age (odds ratio, 1.02) were the major risk factors for insomnia. Conclusions: Our findings indicate that insomnia is a frequent disturbance in the Italian primary care population, is associated with high risk of co-morbid conditions, and results in increased use of health-care resources.


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