Made available in DSpace on 2015-07-22T20:50:31Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-05-27 / A restrição de sono de maneira crônica é uma condição observada por parte da população em geral e esta condição é regida por mecanismos reguladores fisiológicos do sono. Dados do nosso laboratório revelam que animais submetidos ao protocolo de restrição de sono crônica ao longo de 21 dias, com oportunidade de sono de 6h diárias não apresentaram prejuízo de memória. Entretanto, neste estudo a avaliação do desempenho dos animais na tarefa de esquiva inibitória ocorreu apenas na fase clara. Além disso, recentemente, foi demonstrado, que o desempenho dos animais privados de sono (96h) varia de acordo com a fase circadiana em que ocorreu a oportunidade de sono. O objetivo do presente estudo foi investigar a possibilidade da restrição crônica de sono prejudicar o desempenho de ratos na tarefa de esquiva inibitória quando os animais tivessem oportunidade de dormir em diferentes fases circadianas, ou seja, nas fases, clara e escura. Além disso, foi realizado o registro de sono para análise dos padrões de sono durante a fase clara e na fase escura. A restrição de sono crônica foi realizada pelo método das plataformas múltiplas e os animais foram treinados na tarefa de esquiva inibitória. Uma hora após o treino, os animais foram submetidos ao teste. Demonstramos que seis horas de oportunidade de sono (fase clara e escura) não produziu prejuízo no desempenho da tarefa de memória. Entretanto, nós observamos um déficit no desempenho na tarefa de esquiva inibitória após 4h de oportunidade de sono somente na fase escura, ou seja, quando a oportunidade de dormir ocorreu no período de maior atividade dos animais. As análises do padrão de sono revelam que apesar dos animais terem apresentado rebote de sono nos dois momentos circadiano, observamos maior aumento na porcentagem, no número de episódios e na duração média do sono paradoxal durante a fase escura. Quando reduzimos a oportunidade de sono para 3h o prejuízo no desempenho na tarefa de memória já é observado na fase clara. Estes resultados sugerem que a restrição de sono crônica produz prejuízo de memória dependendo da duração da oportunidade de sono, mudanças na duração e no número de episódios de sono paradoxal e da coincidência entre os fatores homeostático e circadiano. / There are numerous studies suggesting that sleep deprivation induce deleterious effects in the rat performance on memory tasks. However, there are but a few studies on the effects of experimental chronic sleep restriction on those tasks. Recently, we observed that rats submitted to a protocol of chronic sleep restriction in which the animals were sleep-deprived for 18h/day and allowed to sleep for 6h in the light phase, during 21 consecutive days, showed no deficits on memory. Here, we investigated the possibility that chronic sleep restriction would impair the performance on the inhibitory avoidance task when rats are allowed to sleep in different circadian phases. Rats were deprived of sleep using the platform method and then trained in a step-through inhibitory avoidance task. One hour after training, the animals were given a retention test. Neither 6h of sleep opportunity (light and dark phase) nor 4h sleep opportunity (light phase) induced impairment on inhibitory avoidance. However, we observed a deficit on performance on inhibitory avoidance task after 4h of sleep opportunity in the dark phase, when there is no coincidence between circadian and homeostatic pressure. Also, 3h of sleep, even in the light phase were not enough to prevent the memory impairment. These results suggest that the memory impairment of sleep deprived rats could be a result of disrupted coincidence between circadian and homeostatic drivers to sleep. / TEDE / BV UNIFESP: Teses e dissertações

Introdução: A utilidade de questionários para o diagnóstico de apneia obstrutiva do sono está bem estabelecida em adultos, mas permanece indefinida em idosos. Objetivo: Avaliar as propriedades preditivas dos questionários mais comumente empregados na população em geral em idosos fisicamente independentes. Desenho: Transversal. Local: Unidade de cuidados primários de saúde pública filiada a hospital universitário. Participantes: Roncadores fisicamente independentes com idade entre 65 a 80 anos cadastrados em um hospital universitário foram abordados por telefone e convidados a participar. Métodos: Os participantes foram submetidos à polissonografia portátil. Sensibilidade, especificidade, razão de verossimilhança positiva e negativa, área sob a curva ROC e psicometria clássica foram utilizados para avaliar a precisão e a medição de propriedades diagnósticas de três instrumentos validados para uso na população geral, sendo incerta sua utilização em idosos. Resultados: A amostra de 131 idosos fisicamente independentes, 50% homens, 58% aposentados, foram incluídos. Epworth>6 apresentou uma precisão de 61% para identificar IAH≥15. Epworth>10, ponto de corte usualmente empregado em adultos, apresentou pior desempenho diagnóstico. Sexo masculino e ser aposentado tiveram menor probabilidade de estarem associados com apneia obstrutiva do sono grave. Para prever IAH≥15, a área sob a curva ROC para Epworth>6 foi significativa, mas não para STOP-bang>2 e Atenas>5. Na regressão logística para prever IAH≥15, controlando para diversos fatores, apenas Epworth>6 e Atenas>5 permaneceram significativas no modelo. Conclusão: Em idosos independentes, uma escala de sonolência de Epworth com ponto de corte de 6 tem melhor desempenho diagnóstico do que questionários comumente empregados para prever um IAH≥15. / Background: The usefulness of questionnaires for diagnosis of sleep apnea is well established in adults, but remains undefined in the elderly population. Objective: To evaluate the predictive properties of the most commonly employed questionnaires in physically independent elderly people from the general population. Design: Cross-sectional. Setting: Public health primary care unit affiliated to university hospital. Participants: Physically independent snorers aged 65 to 80 years adscript to a university hospital were approached by telephone and invited to participate. Measurements: Participants underwent portable polysomnography. Sensitivity, specificity, positive and negative likelihood ratios, area under the ROC curve, and classical psychometrics were used to assess diagnostic accuracy and measurement properties of three validated instruments for use in the general population, making their usability in elderly populations uncertain. Results: A sample of 131 independently-living elderly people, 50% male, 58% retired, was included. For identifying AHI≥15, an Epworth>6 had an accuracy of 61%. Epworth>10, the usually employed cut-off point in adults, had poorer diagnostic performance. Male gender and retirement were protective of more severe OSA. For predicting AHI≥15, the area under the ROC curve for Epworth>6 was significant, but not for STOP-Bang>2 and Athens>5. In logistic regression to predict AHI≥15, after controlling for several confounders, Epworth>6, and Athens>5 were the only variables that remained significant in the model. Conclusion: In independent elderly, an Epworth sleepiness scale cut-point of 6 has better diagnostic performance than commonly employed questionnaires to predict an AHI≥15.

Introdução: A utilidade de questionários para o diagnóstico de apneia obstrutiva do sono está bem estabelecida em adultos, mas permanece indefinida em idosos. Objetivo: Avaliar as propriedades preditivas dos questionários mais comumente empregados na população em geral em idosos fisicamente independentes. Desenho: Transversal. Local: Unidade de cuidados primários de saúde pública filiada a hospital universitário. Participantes: Roncadores fisicamente independentes com idade entre 65 a 80 anos cadastrados em um hospital universitário foram abordados por telefone e convidados a participar. Métodos: Os participantes foram submetidos à polissonografia portátil. Sensibilidade, especificidade, razão de verossimilhança positiva e negativa, área sob a curva ROC e psicometria clássica foram utilizados para avaliar a precisão e a medição de propriedades diagnósticas de três instrumentos validados para uso na população geral, sendo incerta sua utilização em idosos. Resultados: A amostra de 131 idosos fisicamente independentes, 50% homens, 58% aposentados, foram incluídos. Epworth>6 apresentou uma precisão de 61% para identificar IAH≥15. Epworth>10, ponto de corte usualmente empregado em adultos, apresentou pior desempenho diagnóstico. Sexo masculino e ser aposentado tiveram menor probabilidade de estarem associados com apneia obstrutiva do sono grave. Para prever IAH≥15, a área sob a curva ROC para Epworth>6 foi significativa, mas não para STOP-bang>2 e Atenas>5. Na regressão logística para prever IAH≥15, controlando para diversos fatores, apenas Epworth>6 e Atenas>5 permaneceram significativas no modelo. Conclusão: Em idosos independentes, uma escala de sonolência de Epworth com ponto de corte de 6 tem melhor desempenho diagnóstico do que questionários comumente empregados para prever um IAH≥15. / Background: The usefulness of questionnaires for diagnosis of sleep apnea is well established in adults, but remains undefined in the elderly population. Objective: To evaluate the predictive properties of the most commonly employed questionnaires in physically independent elderly people from the general population. Design: Cross-sectional. Setting: Public health primary care unit affiliated to university hospital. Participants: Physically independent snorers aged 65 to 80 years adscript to a university hospital were approached by telephone and invited to participate. Measurements: Participants underwent portable polysomnography. Sensitivity, specificity, positive and negative likelihood ratios, area under the ROC curve, and classical psychometrics were used to assess diagnostic accuracy and measurement properties of three validated instruments for use in the general population, making their usability in elderly populations uncertain. Results: A sample of 131 independently-living elderly people, 50% male, 58% retired, was included. For identifying AHI≥15, an Epworth>6 had an accuracy of 61%. Epworth>10, the usually employed cut-off point in adults, had poorer diagnostic performance. Male gender and retirement were protective of more severe OSA. For predicting AHI≥15, the area under the ROC curve for Epworth>6 was significant, but not for STOP-Bang>2 and Athens>5. In logistic regression to predict AHI≥15, after controlling for several confounders, Epworth>6, and Athens>5 were the only variables that remained significant in the model. Conclusion: In independent elderly, an Epworth sleepiness scale cut-point of 6 has better diagnostic performance than commonly employed questionnaires to predict an AHI≥15.

Estrutura central do hipocampo, o corno de Ammon pode ser subdividido em pelo menos três áreas: CA1, CA2 e CA3. Enquanto CA1 e CA3 foram extensamente estudados, dado o envolvimento do hipocampo em processos cognitivos como a memória e patológicos como a epilepsia, CA2 tem sido largamente ignorado na literatura. Entretanto, este campo possui características específicas, tanto neuroanatômicas como bioquímicas e fisiológicas, sendo resistente à indução de plasticidade e recebendo aferência específica do núcleo supramamilar do hipotálamo, envolvido na circuitaria geradora/mantenedora do ritmo teta, oscilações centrais ao funcionamento do hipocampo. O objetivo deste estudo foi, portanto, caracterizar no animal em livre movimentação os padrões de atividade eletrofisiológica nas três áreas do corno de Ammon bilateralmente. Os resultados demonstraram que CA2 possui, em média, intervalos entre disparos mais prolongados que CA1 e CA3 durante o sono de ondas lentas e o sono REM. Nestas fases do ciclo a coerência entre CA1-CA2 foi mais elevada que entre CA1-CA3 e CA2-CA3 nos três ratos avaliados, em três faixas de freqüência: teta (6 a 12 Hz), gama lento (30 a 50 Hz) e gama rápido (90 a 110 Hz) ipsilateralmente. A coerência entre campos contralaterais é predominante no teta, sendo quase zero nas demais freqüências. Estes resultados corroboram trabalhos recentes que apontam CA2 como área distinta e sugerem que esta pequena região do corno de Ammon possa exercer papéis importantes na modulação da atividade das demais estruturas hipocampais e parahipocampais em processos de memória e em patologias como a epilepsia / The Ammons horn, central structure of the hippocampus, can be subdivided in at least three regions: CA1, CA2 and CA3. While CA1 and CA3 have been extensively studied given the hippocampus involvement in cognitive processes such as memory and pathological ones such as epilepsy, CA2 remains largely ignored. However, this sector contains specific neuroanatomical, biochemical e physiological characteristics, being resistant to induction of plasticity and receiving a specific afference from the supramammillary nucleus in the hypothalamus, involved in the generation/maintenance of the theta rhythm, central oscillations to hippocampal functioning. Therefore, the objective of this study was to characterize electrophysiological patterns of interaction in the three areas of the Ammons horn bilaterally. Results revealed that CA2 has a mean interspike interval larger than CA1 and CA3 during slow wave and REM sleep. During these stages of the sleep-wake cycle, coherence between CA1-CA2 was higher than CA1-CA3 and CA2-CA3 in the three animals evaluated, in three frequency bands: theta (6 to 12 Hz), slow gamma (30 to 50 Hz) and fast gamma (90 to 110 Hz) ipsilaterally. Coherence between contralateral fields was predominant in the theta band and almost zero in other frequencies. These results add to some previous published data showing that CA2 is distinct from the other subfields and that this small region of the Ammons horn may exert important roles in modulating activity in the other hippocampal fields and parahippocampal regions during memory and pathologies such as epilepsy

Sleep undergoes important changes during adolescence and many teenagers experience problems sleeping. These in turn affect adolescents´ academic, physical and psychosocial functioning. Moreover, there are some indications that sleep problems in this age group may be increasing, possibly as a consequence of societal changes, e.g., internet availability. Research on adolescents´ sleep is growing, but more epidemiological studies are needed to clarify the prevalence of poor sleep, long and short-term outcomes associated with it, and potential risk and protective factors to target in preventive interventions. The aim of this dissertation was to contribute to each of these goals; Study I investigated the longitudinal association between sleep problems, defined as symptoms of insomnia, and school absenteeism; Study II explored the prevalence of poor sleep, defined as sleep deficit, in an adolescent population and psychosocial and contextual factors associated with it, including emotional and behavioral problems, stress, sleep hygiene and technology use; finally, Study III evaluated the short-term effects of a novel universal school-based intervention to improve adolescents´ sleep health. The findings show that poor sleep was strongly related to adolescents´ functioning, including emotional and behavioral problems and school attendance, and that sleep deficit was prevalent in adolescents. This supports the need for prevention. Moreover, sleep deficit was associated with stress, technology use and arousal at bedtime, which may represent important barriers to sleep. A preventive intervention targeting these barriers to promote adolescents´ sleep health was successful with the individuals most at risk. However, it remains to be seen whether these changes will be maintained after the intervention and whether incidence of sleep problems will be lower relative to a control group. Implications for theory and practice are discussed.

Although some studies have investigated the correlation between sleeping habits andvoice problems, it is not completely established. Yet, studies have pointed out that bothsleep quality and sleep deprivation can increase the risk for developing voice problems.In order to observe any correlation, the present study aims to investigate sleep qualityand the number of sleeping hours in relation to subjective voice problems. An internetbasedsurvey was spread mostly on social media and recruited 146 participants betweenthe ages of 20-50. The survey contained questions regarding the participantsbackground as well as questions about sleeping habits and subjective voice problems.Voice problems were revealed to correlate with both sleeping habits and subjectivevoice problems for men. However, correlation analyses did not find any connectionsbetween sleeping habits and voice problems among women or the group as a whole. Apossible cause could be the generally low occurrence of both sleeping- and voiceproblems among the participants. Hence this study did not reveal any correlations withgeneral applicability between sleeping habits and voice problems. However, it did giveindications that sleeping habits and voice problems are co-existent among men. / Även om vissa studier har undersökt om sömnvanor och röstbesvär står i relation tillvarandra är något samband inte helt fastställt. Studier har ändock pekat på att bådesömnbrist och dålig sömnkvalitet kan öka risken för att utveckla röstbesvär.Förevarande studie syftar därför till att undersöka sömnkvalitet och antal sömntimmar irelation till upplevda röstbesvär för att utröna ett eventuellt samband mellan dessafaktorer. En internetbaserad enkät spreds främst på sociala medier och svarades av 146deltagare i åldrarna 20 till 50 år. Enkäten innehöll såväl frågor rörande deltagarnasbakgrund som frågor beträffande sömnvanor och upplevda röstbesvär. Röstbesvärvisade sig korrelera med både sömnkvalitet och antal sömntimmar hos män men intehos kvinnor. Att korrelationsanalyser inte anträffade några samband mellan sömnvanoroch röstbesvär på den totala gruppen eller hos kvinnor kan tänkas bero på den generelltsett låga förekomsten av både röst- och sömnbesvär hos deltagarna. Denna studieupptäckte således inga tydliga generaliserbara samband mellan sömnvanor ochröstbesvär, men gav indikationer på att sömnvanor och röstbesvär samvarierar hos män.

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Many U.S. adolescents suffer from sleep disorders. Although poor sleep habits may contribute to health issues, less is known about how parental perspectives influence sleep health in adolescents. The purpose of this descriptive phenomenological study was to address a knowledge gap in understanding parental views to promote better sleep habits in adolescents. The blended theoretical framework included the theories of caring science, social learning, advocacy paradigm, and repair and restoration of sleep. Twenty parents in the Southeastern United States participated in open-ended interviews. Research questions were designed to elicit parental perspectives about recognizing unhealthy sleep habits, improving daily sleep health routines, and identifying conditions that led to consultation with health professionals. Colaizzi's data analysis strategy demonstrated thematic parental reports of declines in attitudes, behaviors, and performances as factors for recognizing unhealthy sleep habits; consistent and routine schedules as options for promoting improved sleep habits; and irregular sleep or health problems as reasons for consultation with health professionals. Recommendations for future research include exploring other geographical locations and investigating school bus schedules interfering with early morning sleep loss. To affect positive social change, dissemination of this study's findings to health practitioners may influence enhanced provider-patient communications and ultimately contribute to improved sleep habits among adolescents. Additionally, this study's findings may inform health care administrators with strategies to develop effective parent and provider education programs while reducing unnecessary health services' utilization and resulting costs for adolescent health.

Purpose: Restoring Effective Sleep Time in Post Cardiac Surgery Patients: A Quality Improvement Project Brooke Watts, BSN, RN, DNP Student, Murray State University Dr. Kristin Reid, DNP, APRN, ACNS-BC, DNP Program Director/Assistant Professor Murray State University Aims: This quality improvement project was developed using DNP project guidelines provided through Murray State University and was designed to improve sleep in hospitalized cardiac surgery patients. Processes: IRB approval was obtained from the healthcare institution and academic institution. This two-phase quality improvement project was designed to analyze the effects of a change in normalized hospital routines on self-reported sleep in post-cardiac surgery patients. Phase one involved no change in unit nursing routines to draw baseline data. Phase two involved the quality improvement intervention where routine patient assessments and vital signs were executed at 11:00 p.m., and at 04:00 a.m. Any non-timed lab work or routine radiological studies were postponed until after 04:00am. Patient participation for both phase one (n=4) and phase two (n=3) were determined by exclusion criteria. The Richards Campbell Sleep Questionnaire (RCSQ) was utilized for data collection and patients were asked to complete the questionnaire daily. Results: Comparison of mean patient-reported sleep scores between the pre-intervention and intervention groups showed a positive association between the quality improvement intervention and patient reported sleep. Limitations: Limitations for this project included a small sample size in both phases. IRB stipulations required a low-risk profile which limited eligible participants. There was a limited timeframe for project execution due to time required for IRB approval and to meet course-related timelines. The project was further limited by lack of on-site dedicated project staff overseeing qualifying patient enrollment. Conclusions: Key findings were in alignment with sleep-related findings in comparable studies and projects where unit routines were adjusted. Execution of similar projects should occur to provide more substantial evidence supporting this quality change. With evidence of this project in mind, providers and nurses can practice mindfully and incorporate creative approaches to safely care for patients and improve sleep.

The goals of the dissertation studies were to allow for psychologists and educators to better understand the relationship between non-clinical narcissism and creativity, and to develop two promising creativity measures. The results confirmed the hypothesis that there would be a positive, moderate correlation between non-clinical narcissism and creativity. Consequently, this could allow for researchers to more fully understand the components of creativity, and support the need for creativity measures to better account for non-clinical narcissism. Two measures were introduced to consider creativity in terms of feelings and thoughts, and non-clinical narcissism attributes of past creative individuals. The Creativity Attributes List (CAL) and the Creative Individual Assessment (CIA) differ from previously established creativity measurements, which use the current impressions of the achievements of contemporary people as their criterion. There were 147 participants in a study that examined the two measures and the relationship between non-clinical narcissism and creativity. Additionally, the experimenter attempted to increase short-term creativity by exposing participants to photographs of paintings with unconventional shape designs that depict both the mindsets and art of creative persons; albeit, the results did not indicate a significant difference in the movement of creativity scores for either the experimental or control group. The double-blind experiment with 80 participants was conducted independently from the aforementioned studies. The Appendices include three papers that were based on the data collected from the psychometric studies and experiment. They were submitted to refereed psychology journals. The first paper pertains to emotional arousal and creativity, the second paper pertains to sleep deprivation in graduate school students, and the third paper explores variables that have a significant relationship with creativity in graduate students. There are graphs and tables in the Appendices that explain the MANOVA and correlation results of the CIA attributes that had a significant relationship to either the Khatena Torrance - Creative Perception Inventory Something About Myself measurement (KTCPI-SAM) and/or the Khatena - Morse Multitalent Perception Inventory Creative Imagination scale (KMMPI - CI). Additionally, tables in the Appendices present the results of multiple regression analyses performed on selected attributes from the CAL assessment and factor analyses of the measurements introduced in the studies.