Sleep quality and maintenance of the optimal cognitive functioning is of crucial importance for aviation safety. Fatigue Risk Management (FRM) enables the operator to achieve the objectives set in their safety and FRM policies. As in any other risk management cycle, the FRM value can be realized by deploying suitable tools that aid robust decision-making. For the purposes of our article, we focus on fatigue hazard identification to explore the possible developments forward through the enhancement of objective tools in air transport operators. To this end we compare subjective and objective tools that could be employed by an FRM system. Specifically, we focus on an exploratory survey on 120 pilots and the analysis of 250 fatigue reports that are compared with objective fatigue assessment based on the polysomnographic (PSG) and neurocognitive assessment of three experimental cases. We highlight the significance of predictive objective tools that should be deployed by contemporary FRM models. We also report the need for utilization of scientific-based tools for predictive FRM, in which objective sleep quality and neurocognitive assessment should be the core aspect. We note the period of restructuring ahead as an opportunity for operators to rethink and restructure their FRM.
INTRODUCTION: Delirium in critically-ill patients is a common multifactorial disorder that is associated with various negative outcomes. It is assumed that sleep disturbances can result in an increased risk of delirium. This study hypothesized that implementing a protocol that reduces overall nocturnal sound levels improves quality of sleep and reduces the incidence of delirium in Intensive Care Unit (ICU) patients.METHODS: This interrupted time series study was performed in an adult mixed medical and surgical 24-bed ICU. A pre-intervention group of 211 patients was compared with a post-intervention group of 210 patients after implementation of a nocturnal sound-reduction protocol. Primary outcome measures were incidence of delirium, measured by the Intensive Care Delirium Screening Checklist (ICDSC) and quality of sleep, measured by the Richards-Campbell Sleep Questionnaire (RCSQ). Secondary outcome measures were use of sleep-inducing medication, delirium treatment medication, and patient-perceived nocturnal noise.RESULTS: A significant difference in slope in the percentage of delirium was observed between the pre- and post-intervention periods (-3.7% per time period, p=0.02). Quality of sleep was unaffected (0.3 per time period, p=0.85). The post-intervention group used significantly less sleep-inducing medication (p<0.001). Nocturnal noise rating improved after intervention (median: 65, IQR: 50-80 versus 70, IQR: 60-80, p=0.02).CONCLUSIONS: The incidence of delirium in ICU patients was significantly reduced after implementation of a nocturnal sound-reduction protocol. However, reported sleep quality did not improve.
Background: Although sleep problems in autistic teenagers are associated with impaired daytime functioning, it remains unclear how sleep and daytime functioning are related. Method: We used a network approach to disentangle patterns between sleep, sleep hygiene, and daytime functioning. Over a three-week period, 31 autistic teenagers answered daily questions about sleep and daytime functioning. Sleep tracker data were collected from 14 of the teenagers. We preregistered the analysis plan for this study at AsPredicted (#34594; https://aspredicted. org/blind.php?x = 3c4t65). Results: Perceived sleep quality seemed to be the most important sleep variable in relation to daytime functioning (self/parent/teacher reports). We also found that sleep onset latency, total sleep time, and wake time after sleep onset were related to daytime functioning, but mostly indirectly through perceived sleep quality. Conclusion: These findings are important for developing sleep interventions because perceived sleep quality would be a logical target for increasing the likelihood of actually improving daytime functioning.
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