BACKGROUND: Headaches and sleep disorders are common childhood complaints that both have detriments to the proper development of a child. It has been found that children with headaches have an increased association with sleep disorders when compared to their healthy counterparts. It has also been demonstrated that children with other chronic pain conditions, such as gastrointestinal or musculoskeletal conditions, have increased associations with sleep disorders. Neither groups have been compared to one another with regard to prevalence of sleep disturbance. LITERATURE REVIEW FINDINGS: This proposal includes a detailed literature review which is comprised mostly of cross sectional studies. The literature review discusses the large body of evidence that examines the relationship of headaches and sleep disorders in childhood. However, this review also highlights the limitations in the understanding of the importance of sleep to pediatric painful conditions in general, and specifically what difference exist between sleep in different types of chronic pain in children. PROPOSED PROJECT: This cross-sectional study will evaluate the relationship between sleep disturbances and chronic pain disorders in children, which include headaches, inflammatory bowel disease, and juvenile arthritis. The goal of this research is to examine whether sleep disturbance is more common in children with headaches as compared to other pediatric chronic pain conditions. CONCLUSIONS: This research will compare prevalence rates of sleep disturbances to evaluate if the prevalence will be greater in children with headaches as compared to other chronic pain conditions. Additionally, this study will determine if there is a difference in prevalence of sleep disturbances in children with headache subgroups. The completed research will further examine and build upon the existing knowledge regarding the relationship between pain and sleep.

This study explored the cognitive performance of poor and good sleepers in college students and older adults including inhibition, sustained attention, processing speed, spatial ability, attention set shifting, short term and working memory. Demographic measures, health measures, the Pittsburgh Sleep Quality Index, the Sleep Self-Efficacy scale, WAIS III Block Design and Digit Span, Trail Making Test Part A and B, psychomotor Vigilance Task, and the Multisource Interference task were given to participants. Sleep group accounted for the variance in cognitive performance even after controlling for education, depression, health, and age in the older adults. Age differences were not observed in sleep self-efficacy but were observed for self-reported sleep quality and cognitive performance. Sleep onset latency was a significant predictor of cognitive performance in older adults and sleep duration was significant for college students. Implications of the study include accidents, academic performance, and mental well-being as a result of cognitive deficit due to sleep loss.

People with insomnia overestimate how long it takes to fall asleep and underestimate the total amount of sleep they attain. While memory is normally decreased prior to sleep onset, this decrease is smaller in insomnia. Insomnia generally and the phenomena of underestimation of sleep and greater memory prior to sleep area associated with arousal including cortical, autonomic, and cognitive arousal. The goal of the present study was to simultaneously examine arousal across these domains in relation to memory and accuracy of sleep estimation. Forty healthy adults completed baseline measures of sleep, psychopathology, and memory, then maintained a regular sleep schedule for three nights at home before spending a night in the sleep laboratory. On the night of the sleep laboratory study, participants completed measures of cognitive arousal, were allowed to sleep until five minutes of contiguous stage N2 sleep in the third NREM period. They were then awoken and asked to remain awake for fifteen minutes, after which they were allowed to resume sleeping. For the entire duration that they were awake, auditory stimuli (recordings of words) were presented at a rate of one word per 30 seconds. Participants slept until morning, estimated how long they were awake and then completed memory testing, indicating whether they remembered hearing each of the words previously presented along with an equal number of matched distracter words. Memory was greatest for words presented early in the awakening, followed by the middle and end of the awakening. High cortical arousal prior to being awoken was associated with better memory, particularly for the early part of the awakening. High autonomic arousal was associated with better memory for the late part of the awakening. Cognitive arousal was not associated with memory. Longer duration of sleep prior to being awoken was associated with better memory for the middle of the awakening. Better memory at baseline was associated with better memory, specifically in the middle of the awakening. Contrary to expectation, memory for the awakening was not associated with accuracy of the perceived length of the awakening. The present study found complementary associations between cortical and autonomic arousal and memory for an awakening from sleep. This suggests that decreasing arousal in both domains may reduce the discrepancy between subjective and objective sleep in insomnia. This also suggests the initial magnitude of decrements in cognitive performance after being awoken are related to deeper proximal sleep initially, while speed of improvement in cognitive performance is related to longer prior sleep duration.

Sleep problems are a common complaint in clinical samples. Specifically, the high level of co-occurring sleep disturbances, such as insomnia and hypersomnia, amongst patients with schizophrenia and bipolar disorder suggests a relationship between poor sleep and psychopathology. Furthermore, recent evidence consistently indicates that sleep disturbance may be related to symptoms of psychosis such as hallucinations and delusions. The research described in this thesis attempts to explore the relationship between sleep in psychosis. Paper 1 presents a systematic review entitled: Evaluating the Effectiveness of Sleep Treatments in Severe Mental Illness. The review identified fifteen controlled trials of pharmacological and non-pharmacological interventions for the treatment of sleep disturbance in patients with severe mental illness. The outcomes of the review indicated that sleep could be reliably improved in persons with schizophrenia and bipolar disorder. Significant improvements to sleep were observed for some pharmacological interventions as well as for non-pharmacological interventions. Paper 2 describes an empirical study aimed at exploring the effects of poor sleep on the cognitive mechanisms underlying psychotic experiences. Using an independent groups design, two, well-defined, non-clinical groups comprising good sleepers and poor sleepers (those meeting criteria for insomnia disorder) were recruited to the study. The two groups were compared on a series of questionnaires and computer tasks designed to assess mechanisms underlying hallucinations and delusions, with a view to determine whether there was a difference in performance between groups that could be attributed to sleep. No significant differences were found between groups, although the study was underpowered. The findings are discussed in the context of sample characteristics and tests used to compare groups. The final paper offers a critical reflection on the systematic review and empirical study, drawing together conclusions about the role and treatment of sleep in relation to psychotic experiences.

Memories are gradually consolidated after learning, and subsequent offline periods containing sleep are suggested to support the stabilisation, enhancement, reorganisation and integration of representations within long-term memory networks. The spontaneous reactivation of specific memory traces during sleep is proposed as a key mechanism underlying sleep-dependent consolidation, but the neurophysiological underpinnings of this ‘memory replay’ remain unclear. The research described in this thesis utilised a method of manipulating memory reactivation during sleep (targeted memory reactivation), in combination with behavioural experimentation, polysomnography (PSG), electroencephalography (EEG), and functional magnetic resonance imaging (fMRI), to refine current understanding of the neural processes underlying sleep-dependent memory consolidation. In Chapter 2 we developed a motor sequence learning paradigm that combined visuo-motor performance with sound stimuli, which enabled the targeted memory reactivation (TMR) of specific motor memories during sleep in subsequent chapters via the replay of the associated sounds during sleep. Chapter 3 used this task to cue the reactivation of a learned motor sequence during slow-wave sleep (SWS), which enhanced motor skill for the cued sequence relative to an uncued sequence, and also made the sequence of motor movements more available for conscious recall. Furthermore, these effects were associated with key neural features of sleep (slow oscillations and spindles). These findings indicate that reactivation not only enhances procedural memories, but plays a part in the reorganisation of representations that leads to the emergence of explicit knowledge. A great deal of research has shown that the neural systems supporting procedural memories evolve over time, particularly within cortico-striatal and cortico-cerebellar networks. Chapter 4 used fMRI to show that reactivation is instrumental to this neural plasticity by comparing brain activity at retrieval of a sequence that was cued during SWS with a sequence that was not. The cued sequence showed increased activation in bilateral caudate nucleus and left hippocampus, mediated by time spent in slow-wave sleep, while functional connectivity was also altered by TMR between caudate and hippocampus. These findings indicate that the behavioural enhancements associated with TMR of procedural learning are related to overnight plasticity in motor memory networks. Lastly, Chapter 5 expanded on the reorganisation of memories investigated in Chapter 3, asking whether reactivation mediates the generalisation of representations that can sometimes create false memories. Learned lists of semantically associated words were reactivated during NREM sleep, but revealed no evidence that TMR effected false memory formation. However TMR was found to reduce the recognition of studied items, which may indicate that certain TMR procedures can interfere with consolidation rather than enhance it. Collectively these results provide new insights to the role played by reactivation in memory consolidation. We have provided evidence for both the enhancement and reorganisation of procedural memories during sleep, and indicate that such effects are supported by alterations to underlying neural plasticity. We also show the importance of slow-wave sleep and associated neural features in this consolidation process.

Background: Obstructive sleep apnea (OSA) is a sleep disorder characterized by episodes of cessation of breathing (apnea) during sleep. Unfortunately, a significant number of surgical patients are unaware they are afflicted with this disorder increasing the risks of postoperative complications. The lingering effect of general anesthesia causes an increase in frequency of airway collapse, leading to longer periods of apnea. This increasingly common sleep disorder is concerning for many anesthesia providers. Purpose: The purpose of this study was to evaluate the anesthesia provider's knowledge and postoperative management of patients with suspected or diagnosed OSA. Setting: The study setting was a local urban hospital Mountain Vista Medical Center (MVMC) in Gilbert, AZ. The study included (N=7) participants, who were predominantly male (85%) and a majority of the participants were Master’s prepared (85%) anesthesia providers. Method: An online survey was disseminated to participants via email. The survey included questions regarding the anesthesia provider's knowledge and postoperative practice habits of patients with suspected or diagnosed OSA at MVMC. Results: The response rate was (24%). All the respondents acknowledged that OSA was a risk factor for postoperative complications. Over half of the respondents (85%) reported encountering postoperative complications such as desaturation and apnea in their patients with OSA. The main complication that was encountered was postoperative apnea (50%), followed by decreased in saturations (33.33%), and one respondent (16.67%) encountered re-intubation during the postoperative period. However, the most important finding of the study is that over half of the providers did not routinely include continued positive airway pressure (CPAP)/noninvasive positive pressure ventilation (NIPPV) in their postoperative management of patients with suspected or known OSA due to the time needed to initiate the therapy. Conclusion: The study illustrates that a majority of anesthesia providers at MVMC agreed OSA is a significant risk factor for postoperative complications, but time constraints limited the implementation of noninvasive ventilation (NIV) therapies. Recommended strategies would be to establish a task force to examine this barrier to therapy and develop plans to address it.

OBJECTIVE: Our main objective was to evaluate the relationship between Sleep Disordered Breathing (SDB) and dental arch characteristics. Specifically, we explored the relationship between maxillary constriction and SDB in children aged 3 to 18. METHODS: In this case control study, a retrospective review of data was collected over 4 years (2013-2017) was conducted. The data was obtained from a larger ongoing observational study on sleep disturbances in children aged 3 to 18 in the Department of Pediatric Dentistry at the Boston University Henry M. Goldman School of Dental Medicine. Based on parents’ responses in a brief sleep-screening questionnaire, the case group included children with disturbed sleep and the control group included children without any sleep disturbances. Parents of the participating children also completed a detailed questionnaire that collected information on participants’ demographics and sleep patterns. A thorough clinical examination was conducted which consisted of intra-oral and extra-oral examinations that assessed the facial profile, breathing patterns, skeletal and dental classifications, crossbite and transverse maxillary arch. Statistical analysis was conducted to explore differences in the presence of maxillary constriction among children with and without sleep disturbances. RESULTS: Among the sample of 134 subjects, the prevalence of SDB was 33.5%. Snoring and heavy breathing during sleep were significantly higher among children with SDB compared to children without SDB (p<0.001 and p<0.002 respectively). The prevalence of maxillary constriction with or without cross bite among all subjects was 20.9%. Children with SDB had a lower prevalence of maxillary constriction (17%) when compared to children without SDB (22%) (p = 0.81). CONCLUSION: There were no differences in the presence of maxillary constriction between children with SDB and children without SDB in this study. Therefore, there was insufficient statistical evidence in this study to support that the presence of constricted palate as a risk factor for SDB. Larger studies with accurate clinical measurements of the palatal constriction may help to further explore the correlation between maxillary constriction and SDB.

Sleep deprivation is a multifactorial phenomenon, occurring frequently in the intensive care unit (ICU) and linked to adverse patient healthcare outcomes. The key practice question of this project focused on determining if retiming of routine laboratory and imaging testing outside of the designated “quiet time” can improve sleep quality among adult patients in the ICU. The purpose was to evaluate the effectiveness of implementing an evidence-based intervention to improve sleep quality in the ICU setting. The theoretical framework was the plan-do-study-act model, which offered a process for implementing a practice change and reevaluation of the intervention’s sustainability within the organization. A thorough literature search of over 100 scholarly journal articles, book references, and expert scholarly reports was completed to gain an understanding of this phenomenon in the ICU setting. The Richards-Campbell Sleep Questionnaire (RCSQ) was the data collection tool used to measure improvement in sleep quality. There were 72 participants that are included in the project. The Wilcoxon rank sum and chi square tests were used for the statistical analysis. The findings did not show statistical significance in the improvement in the RCSQ scores after implementation of the intervention. The recommendations include sleep deprivation training for nursing staff and providers, routine use of the RCSQ for data collection, and repeating the study with an increased number of participants and redefined inclusion and exclusion criteria to be more representative of the ICU patient population. The implication for social change is that this project empowers nursing to embrace a leadership role in using evidence-based practice to change clinical guidelines and improve patient outcomes.

There is a large body of research showing that sleep disorders are becoming more prevalent, especially in developing children in the United States. The negative effects of sleep disorders are well researched in adults. One such negative effect is the connection between sleep disorders and mental health disorders. Though this connection is well researched in adults, less is known about the connection between sleep disorders and mental health in developing children. The primary purpose of this paper is to review existing literature on the negative effects of sleep disorders, the causes of sleep disorders in children, and how sleep disorders may affect the mental well-being of developing teenagers in their time of vulnerability.

A collection of poems.