Charles A. Czeisler

Sleep-related attentional failures are a significant contributor to road traffic fatalities, with young drivers disproportionately affected. This study explored psychological and behavioral correlates of attentional failures while driving among a geographically diverse sample of high school students. A cross-sectional survey of 923 licensed high school drivers across the United States assessed attentional failure-related behaviors, behavioral intentions, beliefs (attitudes, social norms, self-efficacy), sleep behaviors, and history of both a near miss and crash. Adjusted logistic regressions examined predictors of attentional failure-related behaviors and intentions, as well as associations between the behavior, sleep, and near miss/crash history. Participants were 50.9% female, 43.9% male, and 5.2% other. High school drivers were between 16 and 20 years of age or older, with the most commonly reported age being 18 years (50.5%). Most participants (80.1%) reported never having attentional failures, while 19.9% reported doing so with any frequency. Logistic regression revealed that unfavorable attitudes (aOR: 0.82, 95%CI: 0.75–0.88), social pressure to avoid falling asleep while driving (aOR: 0.58, 95%CI: 0.51–0.66), and self-efficacy beliefs regarding the ability to avoid falling asleep while driving (aOR: 0.64, 95%CI: 0.57–0.73) were inversely associated with reports of attentional failures. Surprisingly, long sleep (> 10 h) on school (aOR: 2.8, 95%CI: 1.6–4.8) and weekend nights (aOR: 4.1, 95%CI: 2.4–6.7) was associated with an increased risk for sleep-related attentional failures. Use of the snooze alarm on school days (aOR: 2.64, 95%CI: 1.71–4.09) and reports of obtaining insufficient sleep duration most nights per month (aOR: 1.78, 95%CI: 1.22–2.59) were associated with increased reports of attentional failures. Reports of attentional failures were associated with near misses (aOR: 2.28, 95% CI: 1.58–3.29) and crashes (aOR: 2.56, 95% CI: 1.69–3.87), with substantially stronger associations observed when attentional failures were due to sleepiness, for near misses (aOR: 5.01, 95% CI: 2.44–10.26) and crashes (aOR: 15.79, 95% CI: 4.61–54.11), respectively. Fortunately, approximately 80% of participants reported never experiencing attentional failures, yet those who did report sleep-related attentional failures were associated with poor sleep health and history of near misses and crashes. Future research is needed to support sleep health in young people.

It has been hypothesized that most mass shootings are suicidal acts, necessitating investigation of potentially common elements. We investigated whether US mass shootings and deaths by suicide during 1 January 2014 through 31 October 2021 exhibited significant seasonal variations. Outcomes included temporal patterns of mass shooting events and deaths by suicide and their relationship, as characterized by multivariable linear regression models detrended to isolate seasonality and estimate peak phases and amplitudes. Overall, 3,305 mass shootings and 360,827 deaths by suicide were analyzed. Detrended models revealed significant seasonal variation in mass shootings and deaths by suicide. Mass shootings and deaths by suicide displayed concurrent estimated annual peaks occurring on 3 July and 23 June, respectively. Detrended models estimated that at peak-versus-nadir, seasonality accounted for 613% increased mass shootings and 12% increased deaths by suicide. US mass shooting events and deaths by suicide exhibited strikingly synchronous seasonality, with concurrent mid-summer peaks and mid-winter nadirs. This finding calls for expanded implementation of summertime gun violence and suicide-prevention programs and for equipping treatment centers to respond to increased summertime demands. Further research is needed to investigate potential mechanisms underlying the shared seasonality and the hypothesis that many mass shootings are both homicidal and suicidal, intended as final acts.

Beijing has undergone profound economic growth and ecological change this century. Given the roles of sleep and mental health in worker performance, the objective of this analysis was to characterize sleep and mental health among adult residents of Beijing. During September 29, 2022, through October 5, 2022, cross‐sectional surveys available in English and Mandarin were administered to 2000 adults with residence in Beijing. Among 1741 adults in the final analytic sample, descriptive statistics and multivariable regression models were used to characterize sleep, mental health, and their relationship. Of 1730 respondents (response rate: 65.4%), 55.9% averaged 7–9 h of sleep duration per 24 h, and 42.1% had symptoms of insomnia or obstructive sleep apnea (OSA). Of respondents diagnosed with insomnia or OSA, 85.2% were untreated. Additionally, 42.5% of respondents were experiencing adverse mental health symptoms. In models adjusted for demographics and sleep characteristics, the variables most strongly associated with adverse mental health symptoms were poor self‐rated health, frequent sleep medication use, low sleep quality, and short sleep duration. Insufficient or impaired sleep, risk of sleep disorders, and adverse mental health symptoms were common among employed adults in Beijing. These findings reveal a significant unmet need to address sleep health and mental health in this population.

Puhrpose: To evaluate the short- and long-term cross-sectional associations between COVID-19 infection and multidimensional sleep health. Methods: Data from the COVID-19 Outbreak Public Evaluation (COPE) initiative were used to examine the association between a novel multidimensional sleep health measure (COPE Multidimensional Sleep Health Scale, CMSHS) modeled from the RuSATED instrument and (1) COVID-19 infection and (2) post-acute sequelae of SARS-CoV-2 infection (PASC). Results: Data from 11,326 respondents were used for this study. The cohort was comprised of 51% women, 61% non-Hispanic White, and 17% Hispanic adults. COVID-19 infection was more prevalent among participants who had not received a booster vaccination (55.4% vs. 30.2%, p<0.001); the number of comorbid conditions was higher among those who had been infected (2.2% vs. 1.7%, p<0.001). Participants with COVID-19 infection had significantly lower CMSHS scores indicative of worse sleep health compared with uninfected participants (3.52 ± 1.37 vs. 3.78 ± 1.30; p < 0.001). Participants with PASC had lower CMSHS scores in comparison to those without PASC (2.72 ± 1.30 vs. 3.82 ± 1.28, p<0.001). In adjusted models, a progressive decline in CMSHS scores was observed over 12 months following infection (3.52 ± 0.05 vs. 2.98 ± 0.04; p < 0.001 for <1 month vs. 6–12 months). Conclusion: Compared with uninfected individuals, multidimensional sleep health was worse among persons who had a COVID-19 infection. Individuals with PASC had greater and persistent reductions in sleep health for up to 12 months post-infection. Brief summary: Several studies have examined the negative effects of COVID-19 on sleep, however the effects of COVID-19 infection on multidimensional sleep health remain poorly understood as do these associations over time. Using a large, population-based cohort, this study evaluates short- and long-term effects of Covid-19 infection on overall sleep health. The study provides evidence that COVID-19 infection is associated with impairments in overall sleep health, with effects persisting up to 12 months post-infection. The findings in this study demonstrate that poor sleep health is an important long-term consequence of COVID-19 infection and emphasizes the need for sleep assessment among patients affected by COVID-19.

Home antiviral treatment (HAVT: nirmatrelvir/ritonavir [Paxlovid] and molnupiravir [Lagevrio]) for COVID-19 was approved in December 2021 by the U.S. Food

Background: Inter-individual variation in response to insufficient or altered timing of sleep presents a challenge for the development of personalized approaches to fatigue monitoring and mitigation. Insufficient sleep has adverse health impacts, can result in impaired neurobehavioral performance, and can substantially increase the risk of injury and even mortality in safety–critical operations such as transportation. The present study provides a detailed exploration of physiological, neurobehavioral, and gene expression changes during sleep restriction, acute total sleep deprivation, and altered timing of sleep among 59 healthy volunteer participants who completed a 10-day inpatient study. Results: Reducing the quantity or altering the timing of sleep significantly impacts self-reported estimates of sleep duration, polysomnography-recorded sleep stages, and neurobehavioral performance test results. Impaired neurobehavioral performance was associated with transcriptomic changes in gene expression. A comparison of current and prior research on total sleep deprivation indicated that reproducible candidate gene expression biomarkers exist for at least one metric of attention, specifically, Psychomotor Vigilance Test (PVT) lapses. Conclusions: Candidate biomarkers of fatigue-related impairment were identified that responded to single neurobehavioral performance endpoints, as well as those that responded to multiple types or metrics of performance. Reproducible identification of biomarker candidates for PVT lapses during total sleep deprivation increases confidence in the ability to develop a molecular approach to fatigue-related impairment detection, while novel discoveries expanded the list of candidate genes to other impairment metrics. Molecular biomarkers for neurobehavioral performance impairment represent a potentially valuable tool to more precisely monitor the neurobehavioral performance deficits resulting from sleep loss, and further research and validation could eventually augment fatigue risk management practices that historically emphasize scheduling and rest opportunities. The data generated from self-assessment, polysomnography, neurobehavioral performance, and molecular investigations provide a wealth of information made publicly available for further data mining and scientific advancements. Trial registration: ClinicalTrials.gov, TRN: NCT04211506, Registered 23 December 2019.

Objectives The COVID-19 pandemic has disrupted sleep health globally. However, the relationship between prior SARS-CoV-2 infection and subjective restorative sleep, measured using validated instruments, remains underexplored. This study evaluated the association between prior SARS-CoV-2 infection and restorative sleep quality using Restorative Sleep Questionnaire (REST-Q) scores in a large, nationally representative U.S. sample. Methods Data were obtained from the September–October 2022 wave of the COVID-19 Outbreak Public Evaluation (COPE) Initiative, a cross-sectional online survey of 4,982 adults approximating the U.S. population by age, sex, race, and ethnicity. Restorative sleep was measured using the 9-item REST-Q. COVID-19 infection status was self-reported and categorized as never infected, one infection, or ≥ 2 infections. General linear models and ordinal logistic regression assessed associations between infection status and REST-Q scores, adjusting for demographic, socioeconomic, comorbidity, sleep-related, and mental health variables (Patient Health Questionnaire-4). Results Participants with prior COVID-19 infection had significantly lower REST-Q scores compared with those without infection (52.1±22.5 vs. 57.9±24.4, pConclusions Prior COVID-19 infection is associated with reduced restorative sleep quality as measured by REST-Q scores, independent of multiple confounders. The association persists although is partly attenuated when adjusted for anxiety and depression. These findings suggest a potential long-term impact of COVID-19 on self-reported restorative sleep and highlight the need for mechanistic and interventional research to address post-COVID sleep impairment. Brief Significance Statement This study is the first to examine the association between prior COVID-19 infection and restorative sleep using the validated Restorative Sleep Questionnaire (REST-Q) in a large, nationally representative U.S. sample. Findings demonstrate that individuals with a history of COVID-19 report significantly poorer restorative sleep, independent of multiple demographic, socioeconomic, and sleep-related factors, underscoring the need for targeted post-COVID sleep interventions.

Objective: Poor sleep and obstructive sleep apnea (OSA) are prevalent among transportation workers. Methods: Forty-five transportation workers from worksites in the Northeast US completed surveys assessing (1) sleepiness, (2) OSA, and (3) OSA stage of change and then participated in focus groups or interviews. Results: Participants were 93.2% male, and 90.1% were White non-Hispanic. Furthermore, 77.8% scored high risk for OSA, whereas 11.1% of those at risk reported an OSA diagnosis. Only 31.4% of high-risk participants reported having contemplated OSA evaluation or treatment. Qualitative themes pertained to difficulty unwinding, uncertain work hours, fears about and barriers to OSA treatment, and misinformation about OSA. Conclusions: Results reveal a high prevalence of OSA risk and a low rate of diagnosis and OSA readiness to change. We identify themes for future interventions to improve awareness about OSA among transportation workers.

Response to: “Mathematical Analysis of Light-sensitivity Related Challenges in Assessment of the Intrinsic Period of the Human Circadian Pacemaker”

Objective: Distracted driving, particularly any activity requiring long glances toward a phone while driving, is common among young drivers and represents a significant road safety concern. This study used a theory-informed approach to design a questionnaire examining beliefs, intentions, and behaviors relating to distracted driving in young people. Methods: Semi-structured interviews with 20 high school students were conducted using the Integrative Model of Behavioral Prediction (IMBP) framework to explore attitudes, social norms, and perceived behavioral control. The beliefs identified were incorporated into a 38-item closed-ended questionnaire. The questionnaire was then administered to a geographically representative sample of US high school students with a driver's license. Statistical analyses included correlation analysis and linear regression to evaluate interrelationships among questionnaire items and their associations with established distracted driving measures. Results: Among the geographically representative survey sample (N = 1,126), 50.5% were 18 years of age and 50.9% were female. Participants reported spending an average of 21.1% (SD = 24.6%) of each trip glancing at their phones while driving, and participants estimated that 26.5% (SD = 28.1%) of these glances were two seconds or longer. Reliability analysis showed Cronbach's alpha ranging from 0.63 (injunctive norms) to 0.83 (negative outcome expectations). Correlation coefficients between proposed measures and Behavioral Risk Factor Surveillance System (BRFSS) questions ranged from 0.22 to 0.50, indicating weak to moderate relationships. Regression analysis demonstrated significant associations between intentions and beliefs: positive outcome expectations (b = 0.01, p < .01), negative outcome expectations (b = -0.01, p < .001), injunctive norms (b = -0.01, p < .01), descriptive norms (b = 0.03, p < .001), and perceived behavioral control (b = -0.01, p < .01). Conclusion: This study investigated the beliefs and behaviors of young drivers regarding making prolonged glances toward a phone while driving, guided by IMBP theory. Findings suggest that the Distracted Driving Belief Questionnaire (DDBQ) is a valuable tool for understanding this high-risk behavior. The DDBQ may help inform interventions to reduce phone-related distractions and enhance road safety among young drivers.