Saturday, January 01, 2005

Frontiers of sleep research

From the Canadian Medical Association Journal:

"Incidence of and risk factors for nodding off at scientific sessions"
Kenneth Rockwood, David B. Hogan and Christopher J. Patterson for The Nodding at Presentations (NAP) Investigators

We conducted a surreptitious, prospective, cohort study to explore how often physicians nod off during scientific meetings and to examine risk factors for nodding off. After counting the number of heads falling forward during 2 days of lectures, we calculated the incidence density curves for nodding-off episodes per lecture (NOELs) and assessed risk factors using logistic regression analysis. In this article we report our eye-opening results and suggest ways speakers can try to avoid losing their audience...

Since we were sitting together at the back of the room, we counted the number of heads falling forward as a sign of nodding off. We chose this method because counting is scientific. We carefully recorded data on what we thought seemed like reasonable risk factors; anything we were unsure of we made up. In as much as a single episode of nodding off indicates submaximal attention, we calculated incidence density curves. To be fair to the speakers (after all, we are Canadians), we counted only 1 nodding-off episode per listener-colleague per lecture. For the logistic regression analysis we dichotomized nodding-off events as occurring at a frequency above the median or, at or below, the median or less. Because this was an exploratory study, we also administered a short questionnaire (Appendix 1) to colleagues who had nodded off.

About 120 people attended the 2-day lecture series. We had to adjust our analysis because many had left by the end of the second day. The quality of the lectures varied from entertaining and informative, to monotonous and repetitive, to rushed, to Felliniesque. The incidence density curve ranged from 3 nod-off episodes per lecture (NOELs) to 24 NOELs per 100 attendees (median 16 NOELs per 100)...

Interviews with colleagues who nodded off revealed that they were comforted to know they were not alone. Most had no enthusiasm to attend boring lectures but were inclined to go if influenced by payment, CME credits, guilt or obsessiveness. Being internists, all but 1 were relieved to discover that their falling asleep was not their fault but that of the speakers.

We observed that clinically important proportions of physicians nodded off during the lectures, that there appeared to be a dose–response effect and that speaker characteristics were the strongest risk factors.

Our study had important limitations. Because we sat at the back of the room, we could not see everyone's faces. Thus, people who can sleep without head movement would have been missed. However, since we were counting physicians who were "nodding off" and not "sleeping," we were pretty much covered there...

We were interested to observe that some intrinsically boring talks (those with obscure topics, few data, absent analyses) had unexpectedly low NOEL rates. We attributed this to the bizarreness of the presentation. Factors such as wandering off to inspect the screen, dropping the microphone or just raving — although disconcerting to the audience — helped to keep the physicians awake, as did side bets among attendees on when the speaker's prefatory comments would end and the actual topic of the lecture addressed...

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