Thesis (M.S.)--University of Michigan, 1984.

Thesis (M.S.)--University of Michigan, 1984.

Whereas sleep is often thought of as a common health issue among college students, few, if any, researchers have comprehensively evaluated correlates and predictors of sleep quality and quantity within this population. Most often, studies of this type are used by researchers to assess particular categories of correlates and predictors (e.g., emotional and mental health, student employment, substance abuse, etc.). The present study was conducted to determine correlates and predictors of sleep quantity and quality using among randomly selected college students at a Midwestern four-year research university with high research activity. A classroom survey comprised of the Pittsburgh Sleep Quality Index, the Medical Outcomes Study - Short Form 36, a sleep journal, and demographic questions was administered to students enrolled in 18 University Core Curriculum classes during the spring 2011 semester. Four hundred and sixty student surveys were used for data analysis. Average weekday sleep length was found to be statistically significantly correlated only with mental wellbeing. No statistically significant correlations were found between any of the potential predictor variables and the dependent variables of average weekend day sleep length. Overall sleep quality was found to be statistically significantly correlated with mental and physical wellbeing. Using path analysis, three reduced models, one for each of the three dependent variables (weekday sleep length, weekend day sleep length, and overall sleep quality, were produced. Through ×2 testing, reduced models for all three models fit the full model's data; deleted paths did not contribute to the model. As a whole, students are getting adequate sleep length, but possess poor sleep quality. Sleep quality and sleep quantity, are influenced by different factors, creating challenges for those wishing to provide education, prevention and intervention services.

Submitted by Rafael Toledo Fernandes de Souza (rafael@ibb.unesp.br) on 2016-04-27T21:08:41Z No. of bitstreams: 1 TeseRafaelTFS.pdf: 24959368 bytes, checksum: f8cc766a544e297b446817f14d467e4e (MD5) / Approved for entry into archive by Felipe Augusto Arakaki (arakaki@reitoria.unesp.br) on 2016-04-29T22:14:03Z (GMT) No. of bitstreams: 1 souza_rtf_dr_bot.pdf: 24959368 bytes, checksum: f8cc766a544e297b446817f14d467e4e (MD5) / Made available in DSpace on 2016-04-29T22:14:03Z (GMT). No. of bitstreams: 1 souza_rtf_dr_bot.pdf: 24959368 bytes, checksum: f8cc766a544e297b446817f14d467e4e (MD5) Previous issue date: 2016-03-10 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O sono (do latim, somnus) é um período que apresenta uma atividade fisiológica característica, que pode ser registrada com o EEG. Algumas ondas em um sinal de EEG são vistas apenas durante o sono, como os fusos do sono e complexos K. O fuso é um dos elementos mais bem conhecidos no estudo do sono. No presente estudo serão estudados fusos globais e potenciais complexos K, os quais são observados simultaneamente em todos os canais de EEG. Para isto, um novo método de investigação foi proposto, que estuda tanto o envelope do sinal quanto a fase/frequência de cada fuso. Através da análise da fase do fuso global, foi mostrado que 90% dos fusos de indivíduos saudáveis sincronizam com um tempo de latência de 0,11s. O método também avalia a frequência de modulação (chirp) de fusos globais, e foi averiguado que não há correlação entre o chirp destes fusos e sua sincronização. Através do estudo do envelope do sinal juntamente com a implementação de um modelo de propagação isotrópico, foi possível estimar a origem do fuso e sua velocidade de propagação. Os resultados obtidos indicam que através desta abordagem simples e não invasiva é possível determinar, com uma precisão razoável, o local de origem dos fusos do sono, e sua velocidade estimada de propagação de 0,12m/s. Os potenciais complexos K detectados foram usados para avaliar a robustez do método desenvolvido, e apresentaram frequências, durações e amplitudes dentro das faixas esperadas para complexos K. A velocidade do propagação encontrada para os potenciais complexos K foi de 0,05m/s, menor do que a dos fusos do sono. Os potenciais complexos K mostraram ter uma tendência de sincronização parcial, propriedade esta descrita para os complexos K na literatura. O método desenvolvido também foi aplicado em indivíduos com Apneia Obstrutiva do Sono (AOS). A maioria dos parâmetros analisados não apresentaram diferenças significativas entre indivíduos saudáveis e com AOS; exceto que, em indivíduos com AOS, a duração da sincronização apresentou um valor 34,18% menor, e a posição de origem dos fusos apresentou dois focos diferentes. Desta maneira, conclui-se que o método desenvolvido foi aplicado com sucesso nos grafoelementos avaliados, pois consegue recuperar as informações esperadas, e pode ser útil como uma ferramenta diagnóstica não invasiva. / Sleep (derived from the Latim, somnus) is a brain state with distinct physiological activity that can be investigated by EEG evaluation. Some waves are unique in sleep EEG such as sleep spindles and K complexes. Spindles are one of the best known elements in sleep studies. In this work we considered global spindles and K complexes, which are spindles that are observed simultaneously in all EEG channels. We propose a method that investigates both the signal envelope and phase/frequency of each global spindle. By analysing the spindle phase we showed that 90% of spindles in healthy subjects synchronize with a median latency time of 0.11 s. The method also measured the frequency slope (chirp) of global spindles and found that global spindle chirp and synchronization are not correlated. By investigating the signal envelopes and implementing a homogeneous and isotropic propagation model, we could estimate both the signal origin and velocity in global spindles. Our results indicate that this simple and non-invasive approach could determine with reasonable precision the spindle origin, and allowed us to estimate a signal speed of 0.12 m/s. Potential K complexes are used to assess the robustness of developed method and shows that frequencies, durations and amplitudes within the K complex expected range. Propagation velocity in potential K complexes are around 0.05 m/s which is lower than spindles velocity. Partial synchronization tendencies were detected in potential K complex, a propriety described for K complex in the literature. Obstructive Sleep Apnea (OSA) subjects were also assessed by our method. The majority of analysed parameters do not present significant difference between healthy and OSA subjects except by synchronization duration (34.18% lower in OSA) and two distinct focal points in OSA spindle origin. The proposed methodology retrieved the expected results, obtained by EEG analysis and other more complex techniques and our results indicate that it can be used as a diagnosis tool and to explore other sleep phenomena, such as K complexes. / FAPESP: 2012/22413-2

INTRODUCTION: Research has consistently shown that sleep apnea is strongly associated with atrial fibrillation, with several lines of evidence demonstrating that this relationship is bidirectional and that each condition predisposes to and/or exacerbates the other. Many studies have suggested potential pathophysiologic mechanisms underlying this relationship, and that sleep apnea and atrial fibrillation share many of the same cardiovascular risk factors further implies that multiple pathways are likely involved in the mechanistic link between the two. Although the sleep apnea-atrial fibrillation relationship is quite established, numerous aspects of this association still require further study, such as the role of gender and the potential impact of positive airway pressure therapy. A deeper understanding of how these individual factors may be involved in the interrelationship between sleep apnea and atrial fibrillation has important clinical implications, such as for risk stratification and screening of patients. Thus, this study aims to further understand the different aspects and modulating factors of the sleep apnea-atrial fibrillation link, focusing on central sleep apnea as less is known about the central sleep apnea-atrial fibrillation relationship. METHODS: A total of 153 patients, originally seen at the cardiac electrophysiology clinic at Beth Israel Deaconess Medical Center and subsequently offered home sleep apnea testing, were included in this study. Several databases – home sleep apnea testing results, polysomnography reports, electrocardiogram reports and patient management systems – were used to obtain a variety of data on sleep pathology, high loop gain status, left ventricular ejection fraction and positive airway pressure therapy efficacy and compliance. Patients were considered to have central sleep apnea if home testing results demonstrated a central apnea-hypopnea index of 5 or greater and/or if the patient was documented as having high loop gain on polysomnography. Data were analyzed using the Statistical Package for Social Sciences software in order to examine how factors such as gender and therapy use may affect the sleep apnea-atrial fibrillation relationship, in a patient population with sleep pathology of at least moderate severity. RESULTS: Statistical analysis revealed significant sleep disturbances in the central sleep apnea patients compared to the non-central sleep apnea patients. Gender was found to be significantly associated with central sleep apnea, but not obstructive sleep apnea. When postmenopausal (age≥51) women were analyzed, very few patients met the study criteria for central sleep apnea, yet the majority were documented as having atrial fibrillation. As expected, positive airway pressure therapy was found to be beneficial for all users, but the common pattern of declining compliance to therapy was seen as adherence decreased over the course of three months. Of the select central sleep apnea patients who had sufficient data available, comparison of positive airway pressure therapy and cardiac data revealed possible benefits to cardiac health with compliant use of positive airway pressure therapy. CONCLUSION: Through examining different aspects of the sleep apnea-atrial fibrillation relationship, this study found promising evidence showing that gender and positive airway pressure therapy play important roles. Further studies, with larger sample sizes, need to be conducted in order to fully understand the specific impact of factors such as gender, gender and age and positive airway pressure therapy on the risks and outcomes in patients with sleep apnea and/or atrial fibrillation, and how these factors may change depending on the type of sleep apnea. Finally, these results further highlight the growing need for an effective collaborative care model between cardiologists and sleep medicine clinicians, as the management of patients with sleep apnea and atrial fibrillation requires an interdisciplinary approach in order to deliver the most optimal patient care.

Relationship functioning in couples has been linked to numerous health outcomes. The purpose of this study was to examine the association between 1) marital functioning and sleep dimensions, 2) marital functioning and cortisol, and 3) sleep dimensions and cortisol. The sample consisted of 108 heterosexual, married couples and was part of a larger marital intervention study. As predicted, poor marital functioning was related to negative sleep outcomes. However, these effects were only significant for wives. There was also evidence to suggest that poor marital functioning was associated with increased cortisol levels in husbands. These effects were independent of age and BMI. Contrary to our hypotheses, cortisol was not linked to sleep outcomes and, therefore, not a mediator of effect between marital functioning and cortisol. However, we did find evidence to suggest that stress and depressive symptomology could mediate the association between dyadic adjustment and sleep. Together, these findings provide evidence for how marital functioning can affect both physical and psychological health.

Patients admitted to an adult intensive care unit (ICU) are at risk of developing an acute condition known as ICU delirium, which can impact patients’ length of hospital stay and increase short term and 6-month mortality. The cause of ICU delirium is multifactorial, and lack of quality sleep is a known risk factor. Patients’ sleep in the ICU is frequently interrupted by clinicians involved in their care and equipment alarms. Sleep hygiene interventions to minimize these interruptions for the patient are one strategy to reduce the risk of ICU delirium. Examples of sleep hygiene interventions include eye masks, earplugs, and grouping patient care to minimize nighttime interruptions. The primary purpose of this thesis was to review the available evidence on non-pharmacological sleeping interventions and how they can prevent the development of ICU delirium in adults hospitalized with a critical illness. A secondary aim of this thesis was to study the impact of non-pharmacological interventions on sleep quality. Seven studies conducted in critical care units were included in this scoping review, which examined how non-pharmacological sleep hygiene interventions impacted both the prevention of ICU delirium, and sleep quality. Study results were analyzed to determine their effectiveness in relation to the two outcome measures. Although this review identified many benefits of non-pharmacological sleep interventions, the results on which are most effective in preventing delirium and improving sleep quality are inconclusive. Future research needs to be done to evaluate which sleep-promoting intervention(s) will benefit critical care patients most in preventing or lowering their risk of delirium. The feasibility of both health care staff consistently and effectively executing the intervention(s) outside of research conditions, and patient compliance to the interventions needs to be further studied. Additionally, there is a need for future studies measuring sleep quality as a result of sleep promoting interventions to be measured by PSG rather than subjective written/oral reports in order to obtain objective, reliable results.

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