OMB Appendix E NSS Survey cover

National Sleep Study

The University of Pennsylvania is conducting a survey to understand how noise in your community affects sleep.

This study is funded by the U.S. Federal Aviation Administration.

Survey eligibility:

• You must be 21 years or older

• Only one person per household can take part

• The survey should be completed by the adult in the household who most recently celebrated a birthday

This survey was approved by the Institutional Review Board of the University of Pennsylvania (Protocol number 833863). Your participation is voluntary. All responses you provide will be kept confidential. Your contact information will not be shared.

If you have any questions about the survey:

• Call: 215-573-3815 (Mention National Sleep Study)

• Email: [email protected]

Thank you for your participation!

Mathias Basner, MD, PhD

Associate Professor, Principal Investigator

United States of America

Federal Aviation Administration

If you completed the attached survey: You have the option of also taking part in our 5 night in-home unattended sleep study

The in-home study includes the following:

• Indoor sound recordings at night to measure the noise levels in your bedroom

• Completion of a brief survey (less than 10 minutes to complete) in the morning on your previous night’s sleep

• During the study you can go to sleep and wake up at your normal times

• During the day and evening you can go about your normal activities

• Measurement of body movement and heart rate at night using small, battery operated, non-invasive devices

• Equipment will be mailed to your home

In-Home study eligibility:

Adults aged 21 or older who reside in the household that received this survey and who complete the survey. Additional exclusion criteria may apply.

Compensation:

You will receive $30.00 per night, for a total of $150.00 if all 5 nights are completed.

Additional information about the study and photos of the equipment can be found at: http://www.med.upenn.edu/uep/projects_pcns.html

If you are interested in participating in this study:

• On the last page of the survey check the box

• Call: 215-573-3815 (Mention National Sleep Study)

• Email: [email protected]

United States of America

Federal Aviation Administration