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Background. This study investigates the competence of patients with dementia, depression and schizophrenia to make treatment decisions. The outcome of an objective test instrument is presented and compared with clinical assessment of competence by the attending physician. Method. The MacArthur Competence Assessment Tool-Treatment (MacCAT-T), a test instrument to assess abilities in different standards of competence, was administered to patients with diagnoses of dementia (N=31), depression (N=35) and schizophrenia (N=43). Statistical significance of group differences in the MacCAT-T results were tested with the chi-square test. The concordance of the test and clinical assessment of competence by the attending physician were evaluated by Cohen's kappa coefficient. Results. Patients with dementia, as a group, showed significantly more often impaired performance than those with schizophrenia who were still more impaired than depressed patients. Patients were classified as impaired or not depending on the standards used. By combination of all standards substantially more patients were classified as impaired than by clinical assessment (67·7 v. 48·4% of patients with dementia, 20·0 v. 2·9% of patients with depression, 53·5 v. 18·4% of patients with schizophrenia). Conclusions. Using different standards of competence the study showed substantial differences among patients with dementia, depression and schizophrenia. The high proportion of patients identified as incompetent raises several ethical questions, in particular, those referring to the selection of standards or the definition of cut-offs for incompetence. The discrepancy between clinical and formal evaluations points out the influence of the used procedure on competence judgements. [ABSTRACT FROM AUTHOR]

Background: The objective of this review is to evaluate the associations between short-term exposure to radiofrequency electromagnetic fields (RF-EMF) and cognitive performance in human experimental studies., Methods: Online databases (PubMed, Embase, Scopus, Web of Science and EMF-Portal) were searched for studies that evaluated effects of exposure to RF-EMF on seven domains of cognitive performance in human experimental studies. The assessment of study quality was based on the Risk of Bias (RoB) tool developed by the Office of Health Assessment and Translation (OHAT). Random effects meta-analyses of Hedges's g were conducted separately for accuracy- and speed-related performance measures of various cognitive domains, for which data from at least two studies were available. Finally, the certainty of evidence for each identified outcome was assessed according to Grading of Recommendations Assessment, Development, and Evaluation (GRADE)., Results: 57,543 records were identified and 76 studies (80 reports) met the inclusion criteria. The included 76 studies with 3846 participants, consisting of humans of different age, sex and health status from 19 countries, were conducted between 1989 and 2021. Quantitative data from 50 studies (52 reports) with 2433 participants were included into the meta-analyses. These studies were performed in 15 countries between 2001 and 2021. The majority of the included studies used head exposure with GSM 900 uplink. None of the meta-analyses observed a statistically significant effect of RF-EMF exposure compared to sham on cognitive performance as measured by the confidence interval surrounding the Hedges's g or the significance of the z-statistic. For the domain Orientation and Attention, subclass Attention - Attentional Capacity RF-EMF exposure results in little to no difference in accuracy (Hedges's g 0.024, 95 % CI [-0.10; 0.15], I 2  = 28 %, 473 participants). For the domain Orientation and Attention, subclass Attention - Concentration / Focused Attention RF-EMF exposure results in little to no difference in speed (Hedges's g 0.005, 95 % CI [-0.17; 0.18], I 2  = 7 %, 132 participants) and probably results in little to no difference in accuracy; it does not reduce accuracy (Hedges's g 0.097, 95 % CI [-0.05; 0.24], I 2  = 0 %, 217 participants). For the domain Orientation and Attention, subclass Attention - Vigilance RF-EMF exposure probably results in little to no difference in speed and does not reduce speed (Hedges's g 0.118, 95 % CI [-0.04; 0.28], I 2  = 41 %, 247 participants) and results in little to no difference in accuracy (Hedges's g 0.042, 95 % CI, [-0.09; 0.18], I 2  = 0 %, 199 participants). For the domain Orientation and Attention, subclass Attention - Selective Attention RF-EMF exposure probably results in little to no difference in speed and does not reduce speed (Hedges's g 0.080, 95 % CI [-0.09; 0.25], I 2  = 63 %, 452 participants); it may result in little to no difference in accuracy, but it probably does not reduce accuracy (Hedges's g 0.178, 95 % CI [-0.02; 0.38], I 2  = 68 %, 480 participants). For the domain Orientation and Attention, subclass Attention - Divided Attention RF-EMF exposure results in little to no difference in speed (Hedges's g -0.010, 95 % CI [-0.14; 0.12], I 2  = 5 %, 307 participants) and may result in little to no difference in accuracy (Hedges's g -0.089, 95 % CI [-0.35; 0.18], I 2  = 53 %, 167 participants). For the domain Orientation and Attention, subclass Processing Speed - Simple Reaction Time Task RF-EMF exposure results in little to no difference in speed (Hedges's g 0.069, 95 % CI [-0.02; +0.16], I 2  = 29 %, 820 participants). For the domain Orientation and Attention, subclass Processing Speed - 2-Choice Reaction Time Task RF-EMF exposure results in little to no difference in speed (Hedges's g -0.023, 95 % CI [-0.13; 0.08], I 2  = 0 %, 401 participants), and may result in little to no difference in accuracy (Hedges's g -0.063, 95 % CI [-0.38; 0.25], I 2  = 63 %, 117 participants). For the domain Orientation and Attention, subclass Processing Speed - >2-Choice Reaction Time Task RF-EMF exposure results in little to no difference in speed (Hedges's g -0.054, 95 % CI [-0.14; 0.03], I 2  = 0 %, 544 participants) and probably results in little to no difference in accuracy (Hedges's g -0.129, 95 % CI [-0.30; 0.04], I 2  = 0 %, 131 participants). For the domain Orientation and Attention, subclass Processing Speed - Other Tasks RF-EMF exposure probably results in little to no difference in speed and does not reduce speed (Hedges's g 0.067, 95 % CI [-0.12; 0.26], I 2  = 38 %, 249 participants); it results in little to no difference in accuracy (Hedges's g 0.036, 95 % CI [-0.08; 0.15], I 2  = 0 %, 354 participants). For the domain Orientation and Attention, subclass Working Memory - n-back Task (0-3-back) we found Hedges's g ranging from -0.090, 95 % CI [-0.18; 0.01] to 0.060, 95 % CI [-0.06; 0.18], all I 2  = 0 %, 237 to 474 participants, and conclude that RF-EMF exposure results in little to no difference in both speed and accuracy. For the domain Orientation and Attention, subclass Working Memory - Mental Tracking RF-EMF exposure results in little to no difference in accuracy (Hedges's g -0.047, 95 % [CI -0.15; 0.05], I 2  = 0 %, 438 participants). For the domain Perception, subclass Visual and Auditory Perception RF-EMF exposure may result in little to no difference in speed (Hedges's g -0.015, 95 % CI [-0.23; 0.195], I 2  = 0 %, 84 participants) and probably results in little to no difference in accuracy (Hedges's g 0.035, 95 % CI [-0.13; 0.199], I 2  = 0 %, 137 participants). For the domain Memory, subclass Verbal and Visual Memory RF-EMF exposure probably results in little to no difference in speed and does not reduce speed (Hedges's g 0.042, 95 % CI [-0.15; 0.23], I 2  = 0 %, 102 participants); it may result in little to no difference in accuracy (Hedges's g -0.087, 95 % CI [-0.38; 0.20], I 2  = 85 %, 625 participants). For the domain Verbal Functions and Language Skills, subclass Verbal Expression, a meta-analysis was not possible because one of the two included studies did not provide numerical values. Results of both studies did not indicate statistically significant effects of RF-EMF exposure on both speed and accuracy. For the domain Construction and Motor Performance, subclass Motor Skills RF-EMF exposure may reduce speed, but the evidence is very uncertain (Hedges's g -0.919, 95 % CI [-3.09; 1.26], I 2  = 96 %, 42 participants); it probably results in little to no difference in accuracy and does not reduce accuracy (Hedges's g 0.228, 95 % CI [-0.01; 0.46], I 2  = 0 %, 109 participants). For the domain Concept Formation and Reasoning, subclass Reasoning RF-EMF exposure results in little to no difference in speed (Hedges's g 0.010, 95 % CI [-0.11; 0.13], I 2  = 0 %, 263 participants) and probably results in little to no difference in accuracy and does not reduce accuracy (Hedges's g 0.051, 95 % CI [-0.14; 0.25], I 2  = 0 %, 100 participants). For the domain Concept Formation and Reasoning, subclass Mathematical Procedures RF-EMF exposure results in little to no difference in speed (Hedges's g 0.033, 95 % CI [-0.12; 0.18], I 2  = 0 %, 168 participants) and may result in little to no difference in accuracy but probably does not reduce accuracy (Hedges's g 0.232, 95 % CI [-0.12; +0.59], I 2  = 86 %, 253 participants). For the domain Executive Functions there were no studies., Discussion: Overall, the results from all domains and subclasses across their speed- and accuracy-related outcome measures according to GRADE provide high to low certainty of evidence that short-term RF-EMF exposure does not reduce cognitive performance in human experimental studies. For 16 out of 35 subdomains some uncertainty remains, because of limitations in the study quality, inconsistency in the results or imprecision of the combined effect size estimate. Future research should focus on construction and motor performance, elderly, and consideration of both sexes., Other: This review was partially funded by the WHO radioprotection programme. The protocol for this review was registered in Prospero reg. no. CRD42021236168 and published in Environment International (Pophof et al. 2021)., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. BP is member of the ICNIRP Scientific Expert Group (SEG) on environment, BfS observer in the working group SSK-A630 of the German Commission on Radiological Protection and was German delegate of European Cost Actions BM0704 and BM1309 “EMF-MED”. GS is member of the Committee “Non-Ionizing Radiation” (SSK-A6) and member of the working group SSK-A630 of the German Commission on Radiological Protection. GS is chair of the Austrian Standardization Sub-Committee TSK-EMV-EMF “Electromagnetic Fields”. HDHs research is entirely funded by public or not-for-profit foundations. She has served as advisor to a number of national and international public advisory groups concerning the potential health effects of exposure to non-ionizing radiation, including the World Health Organization, the German Commission on Radiological Protection (member of the committee “Non-Ionizing Radiation” (SSK-A6) and member of the working group 5G (SSK-A630)) and the Independent Expert Group of the Swedish Radiation Safety Authority. JK is member of the ICNIRP Scientific Expert Group (SEG) on ultrasound and BfS observer in the working group SSK-A630 of the German Commission on Radiological Protection., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: GHB (gammahydroxybutyrate) and its precursors are popular recreational drugs due to their sedative, anxiolytic and sexually stimulating effects. Their use has been steadily increasing in recent years. The detoxification process is complex and prone to high rates of complications while little is known about the pathophysiology. This study aims to elucidate the characteristics of GHB-addicted patients and to evaluate the risks and complications of GHB withdrawal treatment., Methods: This observational study describes prospectively the socioeconomic status, clinical history and course of inpatient detoxification treatment of a group of 39 patients suffering from GHB substance use disorder. Detoxification treatment took place in a highly specialized psychiatric inpatient unit for substance use disorders., Results: GHB patients were characterised by being young, well-educated and by living alone. More than 50% of the patients had no regular income. The patients were male and female in equal numbers. Detoxification treatment was complicated, with high rates of delirium (30.8%) and high need for intensive care (20.5%)., Conclusions: In our sample, GHB users were young, well-educated people and male and female in equal number. Detoxification proved to be dangerous for GHB-addicted patients. The presence of delirium and the need for transfer to an intensive care unit during detoxification treatment was extraordinarily high, even with appropriate clinical treatment. The reasons for this remain unknown. Therefore an intensive care unit should be available for GHB detoxification treatment. Further studies are needed to evaluate the options for prophylactic treatment of delirium during detoxification., (© 2023. Evans Medical Foundation, Inc. and BioMed Central Ltd.)

Background: There are only limited reports on the prevalence of restless legs syndrome (RLS) in patients with psychiatric disorders. The present study aimed to evaluate the prevalence and clinical correlates in psychiatric inpatients in Germany and Switzerland., Methods: This is a multicenter cross-sectional study of psychiatric inpatients with an age above 18 years that were diagnosed and evaluated face-to-face using the International RLS Study Group criteria (IRLSSG) and the International RLS severity scale (IRLS). In addition to sociodemographic and biometric data, sleep quality and mood were assessed using the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS), and the Patient Health Questionnaire (PHQ-9). In addition to univariate statistics used to describe and statistically analyze differences in variables of interest between patients with and without RLS, a logistic model was employed to identify predictors for the occurrence of RLS., Results: The prevalence of RLS in a sample of 317 psychiatric inpatients was 16.4%, and 76.9% of these were diagnosed with RLS for the first time. RLS severity was moderate to severe (IRLS ± SD: 20.3 ± 8.4). The prevalences in women ( p = 0.0036) and in first-degree relatives with RLS ( p = 0.0108) as well as the body mass index (BMI, p = 0.0161) were significantly higher among patients with RLS, while alcohol consumption was significantly lower in the RLS group. With the exception of atypical antipsychotics, treatment with psychotropic drugs was not associated with RLS symptoms. Regarding subjective sleep quality and mood, scores of the PSQI ( p = 0.0007), ISI ( p = 0.0003), and ESS ( p = 0.0005) were higher in patients with RLS, while PHQ-9 scores were not different. A logistic regression analysis identified gender (OR 2.67; 95% CI [1.25; 5.72]), first-degree relatives with RLS (OR 3.29; 95% CI [1.11; 9.73], ESS score (OR 1.09; 95% CI [1.01; 1.17]), and rare alcohol consumption (OR 0.45; 95% CI [0.22; 0.94] as predictors for RLS., Conclusions: Clinically significant RLS had a high prevalence in psychiatric patients. RLS was associated with higher BMI, impaired sleep quality, and lower alcohol consumption. A systematic assessment of restless legs symptoms might contribute to improve the treatment of psychiatric patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Weber, Danker-Hopfe, Dogan-Sander, Frase, Hansel, Mauche, Mikutta, Nemeth, Richter, Schilling, Sebestova, Spath, Nissen and Wetter.)

Purpose: The quantitative sleep EEG has been considered as electroencephalographic "fingerprint", ie, it is stable within but differs between individuals. So far, however, almost all studies addressing this aspect have been conducted in young men. It was therefore of interest to know whether the sleep EEG fingerprint concept holds true in older samples of both sexes., Patients and Methods: Data from three different subsamples of 30 healthy individuals each were reused for the present secondary analysis (young men (YM) = 25.6 ± 2.4 years, elderly men (EM) = 69.1 ± 5.5 years, elderly women (EW) = 67.8 ± 5.7 years). Individuals slept ten times in the sleep laboratory, resulting in a total of 900 study nights. However, to avoid misinterpretation due to intervention-related changes in sleep EEG power spectra, only the 3 sham nights without any intervention were included, reducing the datasets to 270. To determine stability of NREM sleep EEG power spectra between sham night pairs, within- and between-subject Manhattan distance measures were computed separately by sample., Results: Regardless of subsample and sham night pair, lowest distance measures, ie, largest similarity, were observed for within-subject power spectra comparisons (range of mean distance measures for EW from 3.82 to 4.06, for EM from 3.55 to 3.63, and for YM from 3.04 to 3.62). Moreover, intraindividual similarity did not differ substantially between samples. Between-subject power spectra distance measures were considerably larger (range of mean distance measures for EW from 12.95 to 13.15, for EM from 12.21 to 12.57, and for YM from 10.33 to 10.78) and varied significantly between young and elderly individuals., Conclusion: The present results support the view that the sleep EEG power spectrum is an individual trait-like characteristic that remains unique up until old age. This finding may help to increase the sensitivity in measuring intervention effects., Competing Interests: The authors declare neither financial nor non-financial competing interests., (© 2022 Eggert et al.)

Background: The World Health Organization (WHO) is currently assessing the potential health effects of exposure to radiofrequency electromagnetic fields (RF-EMFs) in the general and working population. Related to one such health effect, there is a concern that RF-EMFs may affect cognitive performance in humans. The systematic review (SR) aims to identify, summarize and synthesize the evidence base related to this question. Here, we present the protocol for the planned SR., Objectives: The main objective is to present a protocol for a SR which will evaluate the associations between short-term exposure to RF-EMFs and cognitive performance in human experimental studies., Data Sources: We will search the following databases: PubMed, Embase, Web of Science, Scopus, and the EMF-Portal. The reference lists of included studies and retrieved review articles will be manually searched., Study Eligibility and Criteria: We will include randomized human experimental studies that assess the effects of RF-EMFs on cognitive performance compared to no exposure or lower exposure. We will include peer-reviewed articles of any publication date in any language that report primary data., Data Extraction and Analysis: Data will be extracted according to a pre-defined set of forms developed and piloted by the review author team. To assess the risk of bias, we will apply the Rating Tool for Human and Animal Studies developed by NTP/OHAT, supplemented with additional questions relevant for cross-over studies. Where sufficiently similar studies are identified (e.g. the heterogeneity concerning population, exposure and outcome is low and the studies can be combined), we will conduct random-effects meta-analysis; otherwise, we will conduct a narrative synthesis., Assessment of Certainty of Evidence: The certainty of evidence for each identified outcome will be assessed according to Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Performing the review according to this protocol will allow the identification of possible effects of RF-EMFs on cognitive performance in humans. The protocol has been registered in PROSPERO, an open-source protocol registration system, to foster transparency., (Copyright © 2021. Published by Elsevier Ltd.)

Purpose: Quantification of nocturnal EEG activity has emerged as a promising extension to the conventional sleep evaluation approach. To date, studies focusing on quantitative sleep EEG data in relation to age and sex have revealed considerable variation across lifespan and differences between men and women. However, sleep EEG power values from elderly individuals are still rare. The present secondary analysis aimed to fill this gap., Participants and Methods: Sleep EEG data of 30 healthy elderly males (mean age ± SD: 69.1 ± 5.5 years), 30 healthy elderly females (67.8 ± 5.7 years), and of 30 healthy young males (25.6 ± 2.4 years) have been collected in three different studies with the same experimental design. Each individual contributed three polysomnographic recordings without any intervention to the analysis. Sleep recordings were performed and evaluated according to the standard of the American Academy of Sleep Medicine. Sleep EEG signals were derived from 19 electrode sites. Sleep-stage specific global and regional EEG power were compared between samples using a permutation-based statistic in combination with the threshold-free cluster enhancement method., Results: The present results showed pronounced differences in sleep EEG power between older men and women. The nocturnal EEG activity of older women was generally larger than that of older men, confirming previously reported variations with sex in younger individuals. Aging was reflected by differences in EEG power between young and elderly men for lower frequencies and for the sleep spindle frequency range, again consistent with prior studies., Conclusion: The findings of this investigation complement those of earlier studies. They add to the understanding of nocturnal brain activity manifestation in senior adulthood and show how it differs with age in males. Unfortunately, the lack of information on young women prevents a similar insight for females., Competing Interests: The authors declare neither financial nor non-financial competing interests., (© 2021 Eggert et al.)

Studies have reported that exposure to radiofrequency electromagnetic fields (RF-EMF) emitted by mobile telephony might affect specific sleep features. Possible effects of RF-EMF emitted by Wi-Fi networks on sleep-dependent memory consolidation processes have not been investigated so far. The present study explored the impact of an all-night Wi-Fi (2.45 GHz) exposure on sleep-dependent memory consolidation and its associated physiological correlates. Thirty young males (mean ± standard deviation [SD]: 24.1 ± 2.9 years) participated in this double-blind, randomized, sham-controlled crossover study. Participants spent five nights in the laboratory. The first night was an adaptation/screening night. The second and fourth nights were baseline nights, each followed consecutively by an experimental night with either Wi-Fi (maximum: psSAR10g = <25 mW/kg; 6 min average: <6.4 mW/kg) or sham exposure. Declarative, emotional and procedural memory performances were measured using a word pair, a sequential finger tapping and a face recognition task, respectively. Furthermore, learning-associated brain activity parameters (power spectra for slow oscillations and in the spindle frequency range) were analysed. Although emotional and procedural memory were not affected by RF-EMF exposure, overnight improvement in the declarative task was significantly better in the Wi-Fi condition. However, none of the post-learning sleep-specific parameters was affected by exposure. Thus, the significant effect of Wi-Fi exposure on declarative memory observed at the behavioural level was not supported by results at the physiological level. Due to these inconsistencies, this result could also be a random finding., (© 2020 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.)

Background: Although there are several human experimental studies on short-term effects of radiofrequency electromagnetic fields (RF-EMF) on sleep, the role of effect modification by sex or age in this context has not yet been considered. In an earlier study, we observed sex differences in RF-EMF effects in elderly subjects. The present study investigated possible RF-EMF effect modifications by age in men., Methods: Data available for the present analysis come from three double-blind, randomized cross-over studies, in which effects of different RF-EMF exposure signals on sleep were investigated in young [sample 1: 25.3 (mean) ± 2.6 (SD) years; sample 2: 25.4 ± 2.6 years; n = 30, respectively] and older (69.1 ± 5.5 years; n = 30) healthy male volunteers. Studies comprised a screening/adaptation night followed by nine experimental nights at two-week intervals. RF-EMF exposure effect modifications by age were analysed for two different exposure signals (GSM900 at 2 W/kg, TETRA at 6 W/kg), each compared to a sham exposure. Polysomnography, during which the exposure signals were delivered by a head worn antenna, as well as sleep staging were performed according to the AASM standard. Four subjective and 30 objective sleep parameters were statistically analysed related to possible RF-EMF effects., Results: Comparisons of sleep parameters observed under sham exposure revealed highly pronounced physiological differences between young and elderly men. A consistent exposure effect in both age groups was found for a shorter latency to persistent sleep under TETRA exposure reflecting a sleep-promoting effect. Exposure effect modifications by age were observed for two of the four self-reported sleep parameters following GSM900 exposure and for arousals during REM sleep under TETRA exposure., Conclusions: As effects of a short-term all-night RF-EMF exposure on sleep occurred only sporadically in young and elderly men, it seems that age doesn't matter in this respect. However, as long as there are no corresponding data from young healthy women that would allow a comparison with the data from elderly women, this assumption cannot be conclusively verified. Nevertheless, the present results are not indicative of any adverse health effects., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Difficulties in falling asleep and maintaining sleep, nonrestorative sleep and decreased daytime wakefulness represent very common but relatively unspecific health complaints. Around 100 specific sleep-related disorders will be classified in their own major chap. 7 (sleep wake disorders) for the first time in the upcoming 11th version of the International Classification of Diseases (ICD 11). With respect to the disciplines of psychiatry and psychotherapy there is a bidirectional relationship between mental health and sleep wake disorders. Sleep wake disorders can be an independent risk factor for the onset of a mental disorder and have a negative influence on the course of the disease. In addition, sleep wake disorders can also precede a mental disease as an early symptom and therefore be an important indication for early recognition. Many sleep wake disorders can be diagnosed based on the anamnesis and routine clinical investigations. In special cases, examination in a specialized sleep laboratory and treatment in a sleep medicine center following a staged care approach can be mandatory. Polysomnography represents the gold standard for the differential diagnostics; however, there is no legal foundation in the field of neuropsychiatric disorders for remuneration in the German healthcare system. This review summarizes the current guidelines with respect to the criteria for an investigation in a sleep laboratory from the perspective of the disciplines of psychiatry and psychotherapy. From this the requirements for guideline-conform diagnostics and treatment are derived.

Background: The use of wireless telecommunication systems such as wireless fidelity (Wi-Fi)-enabled devices has steadily increased in recent years. There are persistent concerns that radiofrequency electromagnetic field (RF-EMF) exposure might affect health. Possible effects of RF-EMF exposure on human sleep were examined with regard to mobile phones and base stations, but not with regard to Wi-Fi exposure., Objectives: The present double-blind, sham-controlled, randomized, fully counterbalanced cross-over study addressed for the first time the question whether a whole night Wi-Fi exposure has an effect on sleep., Methods: Thirty-four healthy young male subjects (mean ± SD: 24.1 ± 2.9 years) spent five nights in the sleep laboratory. A screening and adaptation night was followed by two experimental nights. Each of the experimental nights was preceded by a baseline night. Sleep was evaluated at the subjective level by a questionnaire and at the objective level (macro- and microstructure) by polysomnography. Either 2.45 GHz Wi-Fi (max psSAR10g of 6.4 mW/kg) or sham signals were delivered by a newly developed head exposure facility., Results: Results showed no statistically significant acute effects of a whole-night Wi-Fi exposure on subjective sleep parameters as well as on parameters characterizing the macrostructure of sleep. Analyses of the microstructure of sleep revealed a reduction in global EEG power in the alpha frequency band (8.00-11.75 Hz) during NREM sleep under acute Wi-Fi exposure compared to sham., Discussion: The results of the present human experimental study are well in line with several other neurophysiological studies showing that acute RF-EMF exposure has no effect on the macrostructure of sleep. The slight physiological changes in EEG power observed under Wi-Fi exposure are neither reflected in the subjective assessment of sleep nor at the level of objective measurements. The present results are not indicative of a sleep disturbing effect of Wi-Fi exposure., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier GmbH. All rights reserved.)

Increasing evidence supports a close link between REM sleep and the consolidation of emotionally toned memories such as traumatic experiences. In order to investigate the role of sleep for the development of symptoms related to traumatic experiences, beyond experimental models in the laboratory, sleep of acutely traumatised individuals may be examined on the first night after trauma. This might allow us to identify EEG variables predicting the development of posttraumatic stress disorder (PTSD) symptoms, and guide the way to novel sleep interventions to prevent PTSD. Based on our experience, patients' acceptance of polysomnography in the first hours after treatment in an emergency room poses obstacles to such a strategy. Wearable, self-applicable sleep recorders might be an option for the investigation of sleep in the aftermath of trauma. They would considerably decrease the perceived burden for patients and thus increase the likelihood of successful patient recruitment. As one potential sleep intervention, sleep deprivation directly after trauma has been suggested to reduce the consolidation of traumatic memories and hence act as a secondary preventive measure. However, experimental data from sleep deprivation studies in healthy volunteers with the trauma film paradigm have been inconclusive regarding the beneficial or detrimental effects of sleep on traumatic memory processing. Depending on further insights into the role of sleep in traumatic memory consolidation through observational and experimental studies, several options for therapeutic sleep interventions are conceivable: besides behavioural sleep deprivation, selective REM sleep suppression or enhancement by a pharmacological intervention into the serotonergic, noradrenergic or cholinergic systems might provide novel therapeutic options. While REM-modulating drugs have been used with some success for the prevention of PTSD after trauma, they have never been tried before the first night of sleep. In conclusion, more experimental and observational research is needed before sleep interventions are performed in actual trauma victims., (© 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Background: Results from human experimental studies investigating possible effects of radiofrequency electromagnetic fields (RF-EMF) on sleep are heterogeneous. So far, there is no study on possible sex-differences in RF-EMF effects., Objectives: The present study aimed at analyzing differences in RF-EMF effects on the macrostructure of sleep between healthy elderly males and females., Methods: With a double-blind, randomized, sham-controlled cross-over design effects of two RF-EMF exposures (GSM900 and TETRA) on sleep were investigated in samples of 30 elderly healthy male and 30 healthy elderly female volunteers. Participants underwent each of the three exposure conditions on three occassions following an individually randomized order resulting in a total of nine study nights per participant. Exposure was delivered for 30 min prior to sleep and for the whole night (7.5 h) by a head worn antenna specifically designed for the projects. The peak spatial absorption rate averaged over time in head tissues (psSAR10g) was 6 W/kg for TETRA and 2 W/kg for GSM900. Thirty variables characterising the macrostructure of sleep and arousals as well as four subjective sleep variables were considered for statistical analyses., Results: Multivariate analyses revealed that exposure to GSM900 and/or TETRA resulted in a significant reduction in arousals, a shorter latency to sleep stage N3, and a shorter self-reported time awake after sleep in both males and females. Exposure effects depending on sex (significant interactions) were observed. Latency to sleep stage R was shorter in females and tended to be longer in males under both exposures. Latency to stage N3 was shorter in females under TETRA exposure and almost not affected in males. The time awake within the sleep period under TETRA exposure was shorter in females and only slightly longer in males. Under GSM exposure, the self-rated total sleep time tended to be longer in females and to be shorter in males. Finally, the number of awakenings was lower only in females and tended to be higher in males under GSM exposure., Discussion: With regard to RF-EMF effects on human sleep it seems that gender matters since GSM900 and TETRA led to significantly more exposure effects in females. Regardless of gender, none of the observed changes is indicative of a sleep disturbing effect of RF-EMF exposure. Observed effects might be mediated by skin related thermoregulatory mechanisms., (Copyright © 2020 Elsevier Inc. All rights reserved.)

A new head exposure system for double-blind provocation studies investigating possible effects of 2.45 GHz Wi-Fi exposure on human sleep was developed and dosimetrically analyzed. The exposure system includes six simultaneously radiating directional antennas arranged along a circle (radius 0.6 m) around the test subject's head, and enables a virtually uniform head exposure, i.e. without any preferred direction of incidence, during sleep. The system is fully computer-controlled and applies a real wireless local area network (WLAN) signal representing different transmission patterns as expected in real WLAN scenarios, i.e. phases of "beacon only" as well as phases of different data transmission rates. Sham and verum are applied in a double-blind crossover study design and all relevant exposure data, i.e. forward and reverse power at all six antenna inputs, are continuously recorded for quality control. For a total antenna input power (sum of all antennas) of 220 mW, typical specific absorption rate (SAR) in cortical brain regions is approximately 1-2 mW/kg (mass average SAR over respective brain region), which can be seen as a realistic worst-case exposure level in real WLAN scenarios. Taking into account variations of head positions during the experiments, the resulting exposure of different brain regions may deviate from the given average SAR levels up to 10 dB. Peak spatial 10 g average SAR in all brain and all head tissues is between 1.5-3.5 and 10.4-25 mW/kg, respectively. Bioelectromagnetics. © 2020 Bioelectromagnetics Society., (© 2020 Bioelectromagnetics Society.)

Sufficient and refreshing sleep is important for good health, physical and cognitive functioning as well as quality of life. An assessment of sleep quality and sleep disorders is therefore mandatory in geriatric patients. Despite a variety of clinical assessment tools for screening and diagnosing sleep disorders, only some of them have been validated in older subjects and nearly none in geriatric patients or in individuals with dementia. Therefore, the aim of this review is to present a concise overview of assessment tools for sleep disorders that are widely used in sleep medicine and to briefly discuss the suitability and limitations in geriatric patients and subjects with dementia.

Background: The manipulation of specific brain oscillations by applying transcranial electrical stimulation techniques in order to enhance memory processes during sleep has become an intriguing field of research. A seminal study found a positive effect of slow-oscillatory transcranial direct current stimulation (so-tDCS) on sleep-dependent consolidation of declarative memories. Since then several studies have tried to replicate this result with inconsistent findings., Objective/hypothesis: This study aimed to reexamine effects of so-tDCS on declarative memory observed in young participants based on a previously described stimulation protocol used in elderly subjects., Methods: 23 healthy participants (mean ± SD: 23.2 ± 1.9 years; 13 women) completed a word-pair test and a sequential finger tapping test before and after sleep. Participants received anodal so-tDCS bifrontaly at a frequency of 0.75 Hz or sham stimulation during NREM sleep N2, following a double-blind, placebo controlled, counterbalanced, randomized crossover design. Data were analyzed with respect to possible effects of stimulation on memory performances, sleep staging, spindle densities and EEG power in eight frequency bands., Results: Stimulation had no significant effect on sleep dependent memory consolidation or on sleep macro- and microstructure. Independent of stimulation, procedural memory performances increased and declarative memory performances decreased overnight. This decline was less pronounced when participants had more than one learning opportunity. Fast parietal but not slow frontal spindle densities diminished from baseline to stimulation-free intervals under both stimulation conditions., Conclusion: The present study could not reproduce the results of the seminal study in young subjects, but it is consistent with results observed in elderly subjects using the same protocol. Irrespective of stimulation, re-encoding opportunities in the word-pair test had an impact on memory strength and retrieval performance., (Copyright © 2019 Elsevier Inc. All rights reserved.)

The results of studies on possible effects of radiofrequency electromagnetic fields (RF-EMFs) on human waking electroencephalography (EEG) have been quite heterogeneous. In the majority of studies, changes in the alpha-frequency range in subjects who were exposed to different signals of mobile phone-related EMF sources were observed, whereas other studies did not report any effects. In this review, possible reasons for these inconsistencies are presented and recommendations for future waking EEG studies are made. The physiological basis of underlying brain activity, and the technical requirements and framework conditions for conducting and analyzing the human resting-state EEG are discussed. Peer-reviewed articles on possible effects of EMF on waking EEG were evaluated with regard to non-exposure-related confounding factors. Recommendations derived from international guidelines on the analysis and reporting of findings are proposed to achieve comparability in future studies. In total, 22 peer-reviewed studies on possible RF-EMF effects on human resting-state EEG were analyzed. EEG power in the alpha frequency range was reported to be increased in 10, decreased in four, and not affected in eight studies. All reviewed studies differ in several ways in terms of the methodologies applied, which might contribute to different results and conclusions about the impact of EMF on human resting-state EEG. A discussion of various study protocols and different outcome parameters prevents a scientifically sound statement on the impact of RF-EMF on human brain activity in resting-state EEG. Further studies which apply comparable, standardized study protocols are recommended. Bioelectromagnetics. 2019;40:291-318. © 2019 The Authors. Bioelectromagnetics Published by Wiley Periodicals, Inc., (© 2019 The Authors. Bioelectromagnetics Published by Wiley Periodicals, Inc.)

Study Objectives: To develop and evaluate a brief manual-based sleep health program within the workplace health promotion of the German Armed Forces., Methods: The sleep health program comprised four weekly group sessions. Sixty-three members (48 males) were randomly allocated to either a treatment group or a waiting control group matching for age, sex, and baseline Pittsburgh Sleep Quality Index (PSQI). The control group had to wait before participating in the sleep health program until the treatment group finished the intervention. Sleep was assessed by ambulatory polysomnography (PSG) as well as with evening and morning protocols at baseline (t0), directly after the treatment group participated in the sleep health program (t1), and after the control group finished participation (t2). The PSQI, the Insomnia Severity Index (ISI), and the Epworth Sleepiness Scale (ESS) were applied at the same three time points, and during a 3-month follow-up evaluation (t3)., Results: Fifty-seven out of the 63 randomized individuals (42 males, mean age = 40.6 years; complete PSG data: n = 36; complete questionnaire data: n = 39) participated in the sleep health program. Objective wake after sleep onset, sleep efficiency, latency to persistent sleep, self-reported sleep latency, restfulness, PSQI, and ISI scores improved with medium or large effects in both groups. ESS scores decreased with moderate effects in the treatment group only., Conclusions: The sleep health program had a positive and stable effect on objective and self-reported sleep parameters, and it is suitable as a preventive measure in members of the German Armed Forces., Clinical Trial Registration: Registry: ClinicalTrials.gov; Title: Development and Evaluation of a Sleep-coaching Program; Identifier: NCT02896062; URL: https://clinicaltrials.gov/ct2/show/record/NCT02896062., (© 2019 American Academy of Sleep Medicine.)

Aims. Sleep disturbances are common in addiction and withdrawal. This study examined the course of sleep quality in a population of alcohol dependent patients during qualified detoxification treatment in a psychiatric hospital. Methods. The Pittsburgh Sleep Quality Index (PSQI) was administered to 77 electively admitted alcohol dependent patients hospitalized for qualified detoxification treatment. Sleep quality was measured at admission and at discharge. Results. The prevalence of bad sleep as measured by a PSQI-score > 5 was 70.1% at admission. During detoxification, male and female patients were equally affected by sleep disturbances and improvement of sleep was not significantly different between males and females. The PSQI score at admission predicted the change of the PSQI score during qualified detoxification treatment. After inpatient detoxification, sleep disturbances persisted in 59.7% of the patients. Conclusions. Contrary to our expectations, the average patient's sleep quality improved in our study after two weeks of detoxification treatment. Sleep disturbances nevertheless persisted in almost two-thirds of the patients. In the view of that finding, patients may require individual evaluation of sleep quality and insomnia-specific treatment in the course of detoxification therapy.

The aim of the present study was to investigate the effect of experiencing potentially traumatic events during deployment on post-deployment sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI) and the Addendum for Post-Traumatic Stress Disorder (PTSD) of the Pittsburgh Sleep Quality Index (PSQI-A). Deployment related experiences were quantified on a standardised list of the Mental Health Advisory Team of the U.S. armed forces. The original sample consisted of 118 soldiers of the German armed forces who were deployed to Afghanistan for six months. The present analyses focused on data assessed after deployment (n = 70) and in a three-month follow-up (n = 51). Results indicate that immediately after return experiences during deployment had an independent significant effect on sleep quality but not three months later. Immediately after return depressive and stress symptoms significantly affected sleep quality while three months later somatic symptoms were significant. At both time points sleep prior to deployment was a significant predictor of sleep quality following deployment. Given the importance of sleep quality prior to deployment as a known independent risk factor for newly occurring mental disorders after deployment, these results underline the need to improve sleep quality already at an early stage., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Sleep-related breathing disorders seriously impair well-being and increase the risk for relevant somatic and psychiatric disorders. Moreover, risk factors for sleep-related breathing disorders are highly prevalent in psychiatric patients. The aim of this study was for the first time in Germany to study the prevalence of obstructive sleep apnea syndrome (OSAS) as the most common form of sleep-related breathing disorder in patients with psychiatric disorders., Methods: In 10 psychiatric hospitals in Germany and 1 hospital in Switzerland, a total of 249 inpatients underwent an 8‑channel sleep polygraphy to investigate the prevalence of sleep apnea in this group of patients., Results: With a conspicuous screening result of 23.7% of the subjects, a high prevalence of sleep-related breathing disorders was found to occur among this group of patients. Male gender, higher age and high body mass index (BMI) were identified as positive risk factors for the detection of OSAS., Discussion: The high prevalence indicates that sleep apnea is a common sleep disorder among psychiatric patients. Although OSAS can lead to substantial disorders of the mental state and when untreated is accompanied by serious somatic health problems, screening procedures are not part of the routine work-up in psychiatric hospitals; therefore, sleep apnea is presumably underdiagnosed in psychiatric patients. In view of the results of this and previous studies, this topic complex should be the subject of further research studies.

Objectives: To conduct a first detailed analysis of the pattern of leg movement (LM) activity during sleep in adult subjects with Attention-Deficit/Hyperactivity Disorder (ADHD) compared to healthy controls. Methods: Fifteen ADHD patients and 18 control subjects underwent an in-lab polysomnographic sleep study. The periodic character of LMs was evaluated with established markers of "periodicity," i.e., the periodicity index, intermovement intervals, and time distribution of LM during sleep, in addition to standard parameters such as the periodic leg movement during sleep index (PLMSI) and the periodic leg movement during sleep arousal index (PLMSAI). Subjective sleep and psychiatric symptoms were assessed using several, self-administered, screening questionnaires. Results: Objective sleep parameters from the baseline night did not significantly differ between ADHD and control subjects, except for a longer sleep latency (SL), a longer duration of the periodic leg movements during sleep (PLMS) in REM sleep and a higher PLMSI also in REM sleep. Data from the sleep questionnaires showed perception of poor sleep quality in ADHD patients. Conclusions: Leg movements during sleep in ADHD adults are not significantly more frequent than in healthy controls and the nocturnal motor events do not show an increased periodicity in these patients. The non-periodic character of LMs in ADHD has already been shown in children and seems to differentiate ADHD from other pathophysiological related conditions like restless legs syndrome (RLS) or periodic limb movement disorder (PLMD). The reduced subjective sleep quality reported by ADHD adults contrasted with the normal objective polysomnographic parameters, which could suggest a sleep-state misperception in these individuals or more subtle sleep abnormalities not picked up by the traditional sleep staging.

Objective: Smoking is a highly preventable risk factor. The present study investigates whether military operations abroad, as compared to deployment preparation, increase the risk of starting to smoke, enhance tobacco dependence and moderator variables can be identified on smoking behavior., Method: The study was conducted at 2 mechanized infantry battalions with N=264 soldiers. The task force completed a deployment in Afghanistan, the control group performed a deployment training. Assessments of tobacco dependence, posttraumatic symptoms, depression and stress were done before (t1) and after (t3) deployment. In addition, one assessment was done at mid-point (t2) during deployment and during the pre-deployment training, respectively., Results: The prevalence rate of smoking soldiers was 56,4%. 51,1% (n=135) of all examined soldiers smoked more than 20 cigarettes per day. The results show a significant increase of tobacco dependence in the task force from t1 to t3 (p=0,040) as compared to the control group. For both groups, there was no increase in starting to smoke during the period of investigation (χ²<1; n. s.). Moderator variables on smoking were not found, but there was a significant increase in posttraumatic stress symptoms in the deployed group (p=0,006)., Conclusions: Perhaps the increase in tobacco dependence in the experimental group can be attributed to the specific burdens of deployment. If high smoking rates were to be found also in other branches of the armed services, effective smoking cessation programs should be offered more widely., Competing Interests: Interessenkonflikt:: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)