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An Official American Thoracic Society Statement: the Importance Of AMERICAN THORACIC SOCIETY DOCUMENTS An Official American Thoracic Society Statement: The Importance of Healthy Sleep Recommendations and Future Priorities Sutapa Mukherjee, Sanjay R. Patel, Stefanos N. Kales, Najib T. Ayas, Kingman P. Strohl, David Gozal, and Atul Malhotra; on behalf of the American Thoracic Society ad hoc Committee on Healthy Sleep THIS OFFICIAL POLICY STATEMENT OF THE AMERICAN THORACIC SOCIETY (ATS) WAS APPROVED BY THE ATS BOARD OF DIRECTORS,APRIL 2015 Rationale: Despite substantial public interest, few recommendations on Main Results: We focus on sleep health in both children and adults, the promotion of good sleep health exist to educate health care providers including the impact of occupation on sleep, the public health implications and the general public on the importance of sleep for overall health. of drowsy driving, and the common sleep disorders of obstructive sleep apnea and insomnia. This ATS statement also delineates gaps in Objectives: The aim of this American Thoracic Society (ATS) statement fi research and knowledge that should be addressed and lead to new focused is to provide a review of the current scienti c literature to assist health care research priorities to advance knowledge in sleep and sleep health. providers, especially pulmonologists and sleep physicians, in making recommendations to patients and the general public about the importance Conclusions: Good quality and quantity of sleep are essential of achieving good quality and adequate quantity of sleep. for good health and overall quality of life; therefore a strong recommendation was made for the implementation of public Methods: ATS members were invited, based on their expertise in education programs on the importance of sleep health. sleep medicine, and their conclusions were based on both empirical evidence identified after comprehensive literature review and clinical Keywords: sleep health in children and adults; drowsy driving; experience. sleep apnea; sleep and occupation; insomnia Contents Adult Obstructive Sleep Apnea substantial interest from the general Overview Insomnia public, there are few health promotion Major Conclusions of This Future Directions: Research recommendations on good sleep health to Statement Priorities to Advance Sleep Health educate the general public and health care Key Recommendations Conclusions providers about the importance of sleep Introduction for overall health. In addition, there is Methods a lack of formal sleep education globally for How Much Sleep Is Enough for Long- physicians and other health care providers. Term Health? The purpose of this document is Sleep in Children Overview to (1) provide a review of the current Short Sleep Duration scientific literature to make general Recommendations Sleep is an essential biological function recommendations on the importance of Long Sleep Duration with major roles in recovery, energy achieving good-quality sleep with a focus Recommendation conservation, and survival (1). Sleep also on sleep health in adults and children; Drowsy Driving appears to be important for vital functions the impact of work schedules on sleep; the Recommendations such as neural development, learning, public health impact of drowsy driving; the Sleep and Occupation memory, emotional regulation, diagnosis and treatment of the common Recommendations cardiovascular and metabolic function, and sleep disorders of obstructive sleep apnea Sleep Disorders cellular toxin removal (2–5). It is clear that and insomnia; and to (2) identify research Pediatric Obstructive Sleep good-quality sleep is critical for good and knowledge gaps to direct further Apnea health and overall quality of life. Despite work in these areas. Am J Respir Crit Care Med Vol 191, Iss 12, pp 1450–1458, Jun 15, 2015 Copyright © 2015 by the American Thoracic Society DOI: 10.1164/rccm.201504-0767ST Internet address: www.atsjournals.org 1450 American Journal of Respiratory and Critical Care Medicine Volume 191 Number 12 | June 15 2015 AMERICAN THORACIC SOCIETY DOCUMENTS Major Conclusions of This Statement education on sleep hygiene and Introduction encourage patients to maximize their d Good-quality sleep is critical for good sleep time. Sleep is a homeostatically regulated health and overall quality of life. d We recommend that public education biological function, and is universally d The amount of sleep needed by an programs be developed to emphasize the experienced as a state of unawareness. We individual varies significantly with age importance of sleep for good health. spend approximately one-third of our lives across the life span. d Sleeping longer than 9–10 hours per asleep (6), and sleep has major roles in d Children are not merely smaller adults 24-hour period may be normal, but may recovery, energy conservation, and survival regarding sleep and differ importantly also be associated with various causes of (7) based on rat studies where total sleep from adults, thereby requiring specific ill health. We recommend that health deprivation leads to death within 3 weeks attention to sleep maturational processes. care providers be aware of reported (1). Sleep also appears to be important d Disparities exist in sleep health related in associations and investigate individuals for vital functions such as neural part to modifiable factors for adequate for underlying causes as appropriate. development; learning; memory; emotional, sleep quality and quantity such as having d We recommend that all drivers cardiovascular, and metabolic regulation; a safe, predictable place for sleep and (occupational or nonoccupational) and cellular toxin removal (2–5). There is a being able to devote adequate time to receive education about how to recognize complex relationship between sleep and the obtain sufficient sleep. the symptoms and consequences of circadian system, which can be impacted d Short sleep duration (<6 h per 24-h drowsiness. by the environment (e.g., artificial light, period) is associated with adverse d Adolescents may be a particularly alcohol, organizational and behavioral outcomes including mortality. susceptible group to drowsy driving; factors) (2). What is clear by these and d Long sleep duration (.9–10 h per 24-h therefore, we recommend inclusion of other studies is that quality sleep is essential period) may be associated with adverse sleep awareness during their driving for good health and overall quality of life. health outcomes. education. Of major concern is the widely reported d As such, the committee believes that the d Some data also suggest that sleep- decline over the past century, particularly optimal sleep duration for adults for good deprived individuals may be particularly during the past 20–30 years, in the United health at a population level is 7–9 hours, susceptible to the effects of alcohol from States and internationally in the relative although individual variability exists. the standpoint of driving risk, and thus importance the population assigns to sleep d Drowsy driving is an important cause of particular caution is recommended in (as measured by reported sleep duration) fatal and nonfatal motor vehicle crashes. this context. compared with other daily activities such d Occupational demands are a frequent d We recommend better education for the as work, commuting, and the use of cause of insufficient sleep and can general public and health care providers electronics such as television, computers, contribute to accident risk in the regarding the impact of working hours and mobile phones (8, 9). This societal workplace. and shift work on sleep duration and trend has coincided with increased rates of d Sleep disorders are common, cause quality and the association of sleepiness obesity, diabetes, and the development of significant morbidity, and have with workplace injuries. other chronic debilitating diseases. It has substantial economic impact, but are d We recommend better education of been postulated that the reduction in sleep treatable. professional transportation operators duration may be a contributing factor to the d Many individuals with sleep disorders regarding obstructive sleep apnea (OSA), development of these and other common remain undiagnosed and untreated. other sleep disorders, and medications complex diseases (10, 11). d At present, health care providers receive that may interfere with alertness. little formal education on the importance d We recommend better education/ of sleep to health or on the evaluation awareness for the general public and Methods and management of common sleep physicians regarding the importance disorders. of early identification of high-risk American Thoracic Society (ATS) members OSA groups (in children and adults) of the Sleep and Respiratory Neurobiology Key Recommendations because of the profound public health Assembly were invited to contribute to implications of untreated OSA. this document to develop health promotion d For children, we suggest that age-based d We recommend better education of recommendations on good sleep health and recommendations for sleep duration be physicians as to the effectiveness of to determine priority areas for education developed. These should enable the child cognitive behavior therapy for insomnia of the general public and/or health care to awaken spontaneously at the desired (CBT-I) rather than immediate providers about the importance of sleep for time through implementation of regular implementation of hypnotics and overall health. wake and sleep schedules. sedatives. Panelists were chosen on the basis d For
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