La maladie de Parkinson est une maladie neurodégénérative progressive qui affecte le système nerveux central et se caractérise par des symptômes moteurs et non moteurs. Ces derniers comprennent des troubles du sommeil, des perturbations neuropsychiatriques et comportementales. En particulier, environ 50 % des patients atteints de la maladie de Parkinson (MP) souffrent de troubles du comportement du sommeil paradoxal (TDS), une parasomnie caractérisée par des comportements moteurs liés à des rêves. Les patients atteints de la MP souffrant de RBD ont tendance à présenter des symptômes moteurs et non moteurs plus graves que les patients ne souffrant pas de RBD, ce qui suggère que le RBD est un marqueur d'un processus neurodégénératif plus répandu. Parmi les symptômes non moteurs, les troubles neuropsychiatriques sont fréquents dans la DP et comprennent la dépression, les symptômes d'anxiété, l'apathie et les troubles du contrôle des impulsions (DCI), une complication déclenchée par la thérapie de remplacement de la dopamine (TRP). Pourtant, aucune étude n'a évalué si les patients atteints de MP et de troubles respiratoires chroniques présentent une fréquence accrue de symptômes neuropsychiatriques, en particulier des troubles du contrôle des impulsions et de l'apathie. Objectifs : évaluer si la DBR est associée aux maladies inflammatoires chroniques et/ou à l'apathie dans la maladie de Parkinson et caractériser le profil neuropsychiatrique des patients atteints de DBR. Matériel et méthodes : n=216 patients PD non déments consécutifs consultant une clinique universitaire de troubles du mouvement à Turin et Clermont-Ferrand (130 M, âge moyen : 66,9±10,8 ans) ont rempli des questionnaires pour le RBD et les CIM. En outre, 40 patients atteints de MP ayant reçu un diagnostic clinique de maladie inflammatoire chronique et 40 patients atteints de MP sans maladie inflammatoire chronique, appariés par sexe et âge, ont subi une vidéopolysomnographie (v-PSG) afin de déterminer la fréquence de la DBR. L'apathie a été évaluée chez 36 patients ayant subi une v-PSG (n=18 patients atteints de MP avec DCI, n=18 patients atteints de la MP), et sa relation avec la dépression, avec un large éventail de fonctions neuropsychologiques ainsi qu'avec des symptômes moteurs et non moteurs a été évaluée. Résultats : la DBR probable a été associée à un risque de 2,6 de développer des symptômes de CIM dans l'ensemble (p=0,001) et à un risque de 4,9 pour le jeu pathologique (p= 0,049). La RBD confirmée par le VPSG a été trouvée chez 34/40 (85%) des patients atteints de PD-ICD contre 21/40 (53%) des patients atteints de PD-noICD (p=0,003). L'association était significative après ajustement de la durée de la maladie, de l'âge d'apparition, de la gravité et de la dose de traitement (p=0,01) et l'état de la CIM est associé à un rapport impair de 5,44 pour avoir une DBR. L'apathie était plus élevée chez les patients atteints de DBR que chez les patients atteints de la MP sans DBR. Après 11 ajustements en fonction de l'âge, de la durée de la DP, des doses de DRT, des mesures cognitives et de la dépression, nous avons constaté que les PD-RBD présentent un manque d'initiative (p=0,03) ainsi qu'une tendance à la réduction des intérêts et à la recherche de nouveauté. L'ampleur de l'effet était importante (>0,8) ou presque (>0,75) pour ces variables. De plus, l'apathie était significativement corrélée à la mesure du sommeil paradoxal sans atonie. Conclusions : Nous avons montré pour la première fois que le RBD est associé à des DCI dans le DP. De plus, les patients RBD sans DAI sont plus apathiques que les patients sans RBD. Un traitement dysfonctionnel de la récompense dans le DP-RBD, résultant peut-être d'une altération plus grave de la voie méso-cortico-limbique, peut contribuer à la fois à une apathie accrue et à une fréquence accrue des DAI lorsqu'ils sont traités avec des doses plus élevées de DRT. / Parkinson’s disease is a progressive neurodegenerative disorder affecting the central nervous system characterized by motor and non-motor symptoms. The latter include sleep disorders as well as neuropsychiatric and behavioral disturbances. In particular, about 50% of patients with Parkinson's disease (PD) suffer from REM sleep behavior disorder (RBD), a parasomnia characterized by dream-enactment motor behaviors. PD patients with RBD tends to have more severe both motor and non-motor symptoms than PD without RBD, suggesting that RBD is a marker of a more widespread neurodegenerative process. Among non-motor symptoms, neuropsychiatric disorders are frequent in PD and include depression, anxiety symptoms, apathy and impulse control disorders (ICD), a complication triggered by dopamine replacement therapy (DRT). Yet, no study has assessed whether PD- RBD patients have an increased frequency of neuropsychiatric symptoms, particularly ICD and apathy. Objectives: to assess whether RBD is associated to ICDs and/or apathy in Parkinson’s Disease and to characterize the neuropsychiatric profile of PD patients with RBD. Material and methods: n=216 consecutive non-demented PD patients consulting a university movement disorders clinics in Turin and Clermont-Ferrand (130 M, mean age:66.9±10.8yrs.) filled out questionnaires for RBD and ICDs. Furthermore, 40 consecutive PD patients with a clinical diagnosis of ICD and 40 sex-and age-matched PD patients without ICD underwent to video-polysomnography (v-PSG) in order to determine the frequency of RBD. Apathy was assessed in 36 v-PSG recorded PD patients (n=18 PD with RBD, n=18 age- and sex-matched PD without RBD), and its relationship with depression, with a broad array of neuropsychological functions as well as with motor and non-motor symptoms was evaluated. Results: probable RBD was associated to a risk of 2.6 to develop ICD symptoms as a whole (p=0.001) and a risk of 4.9 for pathological gambling (p= 0.049). VPSG-confirmed RBD was found in 34/40 (85%) PD-ICD patients versus 21/40 (53%) PD-noICD (p=0.003). The association was significant after adjusting for PD duration, age of onset, severity and treatment dose (p=0.01) and the condition of ICD is associated to an odd ratio of 5.44 to have RBD. Apathy was higher in patients with RBD compared to PD without RBD. After 11 adjusting for age, PD duration, DRT doses, cognitive measures and depression, we found that PD-RBD have a lack of Initiative (p=0.03) together with a trend for reduced interests and novelty seeking. The effect size was large (>0.8) or almost large (>0.75) for these variables. Furthermore, apathy significantly correlated with measure of REM sleep without atonia. Conclusions: We showed for the first time that RBD is associated to ICDs in PD. Furthermore, RBD patients without ICD are more apathetic compared to patients without RBD. Dysfunctional reward processing in PD-RBD, possibly resulting from a more severe impairment of the meso-cortico-limbic pathway, may contribute to both increased apathy, and increased frequency of ICDs when treated with higher doses of DRT.

Staging Sleep: Labor, Care, and Rest in Contemporary Performance examines an archive of plays and performances from the past forty years—which I term sleep theatre—including dramatic literature that foregrounds sleep and sleeplessness and performance art in which the artist sleeps in front of an audience. Contemporary theatre about sleep exposes the roots of sleep loss in overwork, healthcare disparities, and housing insecurity and imagines alternative social possibilities for sustainable rest. I understand the concerns and possibilities raised by sleep theatre through the framework of social reproduction theory, a feminist analysis of the vital forms of labor antecedent to commodity production, including housework and dependent care, that keep us all alive. I reorient theatre scholarship on sleep away from psychoanalytic readings of staged dreams and toward an understanding of sleep as a political act shaped by social and material contexts. In Staging Sleep, I argue that studying sleep in theatre and performance art offers new insights into social relations of care and interdependence among performers and spectators, and that sleep onstage not only critiques inhumane economic arrangements but also imagines myriad new social configurations that value rest over work. Staging Sleep begins in 1980, in the immediate aftermath of two decades of international Marxist feminist organizing that saw politicized housewives agitating for recognition of the value of both their work and their leisure. I demonstrate how sleep theatre expands and complicates this political legacy, beginning with the continuing global assault on welfare and unions in the 1980s. In my first chapter, I track how pioneering socialist feminist playwright Caryl Churchill develops the sleepless housewife as a character type, bringing sleep to the stage in a new way as a linchpin of her critique of the family. I then track sleep in theatre as a site of experimentation informed by feminist, queer, and disability studies through the 2010s. Chapter 2 explores sleep in plays by Sarah Kane, Maria Irene Fornes, and Peggy Shaw at the nexus of illness, friendship, and a fraying welfare state. Chapter 3 examines how directors stage homeless sleep in four recent adaptations of Cymbeline from the UK and South Sudan. My final chapter asks how performance itself creates the care and attention necessary to sustain sleep in the globe-touring, iterative performance artworks Best Place to Sleep and Black Power Naps. Sleep performances imagine, enact, and test the limits of very different configurations of labor and rest: ways of life in which caretaking labor is redistributed, and resilience and health become collective concerns rather than individual responsibilities. I suggest that sleep performance is a nascent theatrical phenomenon that will continue to reappear as politically-minded artists work through the theatrical possibilities of spectatorship, site, and immersion in the context of deep questions of everyday justice and equity. Staging Sleep shows how theatre can exploit and transform the weirdness of watching someone sleep, or of falling asleep in the audience, into a restructuring of our practices of work and rest, space and shelter, toward ensuring safe and restorative sleep as a universal right.

Objective: To evaluate the psychometric properties of the Spanish version of Jenkins Sleep Scale with 4 items (JSS-4) of the Peruvian health system's (PHS) nurses and physicians. Methods: We carried out a psychometric study based on secondary analysis in a sample from a nationally representative survey that used acomplex sampling design. The participants were physicians and nurses aged 18–65 years, working in PHS private and public facilities, who have fulfilled all JSS-4 items. We performed a confirmatory factor analysis. Reliability was evaluated via two estimates - classic alpha (α) and categorical omega (ω) coefficients. Also, we tested the invariance across groups of variables. The convergent validity was evaluated based on the relation between JSS-4 and PHQ-2 using Pearson's correlation coefficient and effect size (Cohen's d). Also, we designed normative values based on percentiles. Results: We included 2100 physicians and 2826 nurses in the analysis. We observed that the unidimensional model has adequate goodness-of-fit indices and values of α and ω coefficients. No measurement invariance was found between the groups of professionals and age groups; however, invariance was achieved between sex, monthly income, work-related illness, and chronic illness groups. Regarding the relation with other variables, the JSS-4 has a small correlation with PHQ-2. Also, profession and age-specific normative values were proposed. Conclusion: JSS-4 Spanish version has adequate psychometric properties in PHS nurses and physicians. / Revisión por pares

BACKGROUND: Autism Spectrum Disorder is a range of neurodevelopmental disorders that typical manifest as social deficits, delayed or impaired communication skills, and repetitive behaviors in day-to-day life. Patients with Autism Spectrum Disorder (ASD) often present with other concurrent clinical disorders. Sleep disorders (SD) and sleep issues are highly prevalent in ASD children and rank as one of the most common concurrent clinical disorders. Prevalence rates vary widely, ranging from 40 to 80 percent, as compared with that of typically developing children in which prevalence rates are approximately 30 percent. Sleep problems can have an impact on daytime health and may result in neurocognitive dysfunction and behavioral disruptions. A cyclical pattern arises: individuals with autism are observed to have sleep difficulties, which may exacerbate autistic traits, which can in turn further worsen their quality of sleep. Therefore, sleep disorders may have wide ranging effects on daytime functioning, developmental progress, and quality of life for children with ASD. OBJECTIVES: The purpose of this thesis is to provide a review of the research status of ASD, SD, the interplay between these two disorders, and therapeutic interventions that have been researched or are currently being investigated. A goal of this thesis is also to recommend areas of future investigation based on the current state of autism research. METHODS: A literature review of studies, abstracts, and clinical trial data relating to ASD, SD, and other comorbidities observed in ASD was performed. CONCLUSION: Current models and theories on the relationship between ASD and SD suggest that the underlying etiology of autism itself may contribute to sleep troubles, and might even have wide-reaching impacts on other unrelated aspects of ASD. Gastrointestinal, otolaryngologic, and psychiatric comorbidities are observed in autism and may affect sleep in these patients, but the mechanism by which this occurs is unclear. There are many treatments for sleep troubles in ASD such as melatonin and behavioral interventions, with varying success. Much work is required to understand the underlying mechanism between both autism and sleep disorders. There is also a need for more efficacious therapeutic interventions, but there are multiple clinical trials underway which may have promising results. Future studies should also incorporate robust data-collection instruments such as polysomnography to validate findings. / 2021-06-14T00:00:00Z

Over 71 million Americans will be over the age of 65 by the year 2030. With this rise in adults aged 65 years and older also comes an exponential rise in the estimated number of individuals with Alzheimer’s disease (AD); this number is expected to exceed 24 million Americans by the year 2040. The number one risk factor for AD is older age; this factor is also associated with an increased risk in developing a sleep disturbance. Sleep disturbances have been associated with an increased risk of cancer, heart disease, and decline in overall health. Recent research has examined the association between sleep disturbance and risk for AD; however, these results are mixed. This project analyzed existing data from the population-based longitudinal Cache County Study on Memory and Aging (CCSMA), which included permanent residents of Cache County, Utah who were aged 65 years or older in 1995. The CCSMA consisted of 4-triennal waves and ran from 1995 until 2007; the aim of the original study was to examine antecedents of AD and other forms of dementia. In this thesis, the first study examined whether sleep disturbance was associated with increased risk in developing AD. Sleep disturbance was associated with risk of developing AD, but the results differed between males and females. Among females, endorsing sleep disturbance was associated with a 54.5% decrease in the hazards of developing AD (Hazard Ratio [HR]= .455, p = .0001) compared to females without sleep disturbance. Among males, sleep disturbance was not associated with risk of developing AD (p = 0.498). The second study evaluated if use of sleep medications was associated with increased risk of developing AD and if that association differed between males and females: males who reported use of sleep medication, regardless of having a sleep disturbance, were at increased risk of developing AD (for men without a sleep disturbance HR = 3.604; p = 0.0001). By contrast, in females, risk for developing AD varied by the presence of a sleep disturbance. Compared to the reference group (females without a sleep disturbance and no sleep medication use), females who reported a sleep disturbance and use of sleep medication were at a 35.2% reduced risk of developing AD (HR = 0.648; p = 0.011) while, those not reporting a sleep disturbance but were taking sleep medications were at 3.9 times increased risk in the hazards of developing AD (HR = 3.916; p = 0.0001). Although this study is observational in nature and therefore does not prove that the use of sleep medication is harmful, it is recommended that health care providers consider alternative, nonpharmacological approaches to treat sleep disorders in older adults. Further research is needed to examine sex differences and how they may relate to the differences associated with sleep disturbances and risk for AD.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Objective: The aim is to evaluate the association between sleep quality and perinatal depression in pregnant women between the 12th week of gestation and the 36th week of gestation in a maternity and child centre in Lima. Methods: Analytical cross-sectional study in pregnant women cared for in a primary care centre between August and December 2019. The data were collected through a self-administered survey. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. The evaluation of perinatal depression was performed with the Edinburgh Postnatal Depression Scale (EPDS). For the multivariate analysis, Poisson regression with robust variances was used to calculate the crude and adjusted prevalence ratios and their respective confidence intervals. Results: The sample was composed of 200 participants. The median [IQR] age was 26 [22-32] years, and 111 (55.5%) pregnancies were unplanned. 52% presented a poor quality of sleep and the risk of perinatal depression was 31.5%. Poor quality of sleep was associated with a significantly higher frequency of perinatal depression (aPR = 4.8 for those with poor quality of sleep warranting medical attention, and aPR = 6.6 for those with poor quality of sleep warranting medical attention and treatment). Conclusions: There is a possible association between poor sleep quality and perinatal depression in pregnant women between weeks 12 and 36 of gestation. Operational research should be promoted to assess whether interventions to improve sleep quality could have a positive impact on reducing perinatal depression. / Revisión por pares

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A diagnosis of Autism Spectrum Disorder (ASD) can impact the entire family. Parents of children with ASD reportedly have greater stress levels, family conflict, financial concerns, and poor health habits than parents of neurotypical (NT) children. While many parent-focused interventions have been developed, these interventions focus on parent training and child behavior outcomes rather than the health and well-being of the parents. Therefore, this study aimed to examine the effects of a 15-week family judo program on physical and psychosocial health in parents of children with ASD. A total of 18 parents of children with ASD participated in a weekly judo program, with each session lasting 45 minutes. Parents completed online surveys that asked about sociodemographic information and parental stress and wore wrist accelerometers that measured their physical activity and sleep quality. Paired samples t-tests were used to examine parental stress, physical activity, and sleep quality differences in parents of children with ASD pre- and post-judo program. Both a decrease in parental stress (47.77 vs. 41.61, p High-stress levels can also negatively impact physical health and have been linked to poor sleep and low physical activity levels. This is particularly concerning as research suggests that parents of children with neurodevelopmental disorders already report worse sleep quality and lower levels of physical activity than parents of NT children. Furthermore, the treatment of sleep disorders in children with ASD has been related to reductions in parental stress. Additionally, child engagement in health behaviors has been correlated with parent behaviors. The majority of these studies, however, have utilized self-report measures of sleep and physical activity, which are prone to bias. Furthermore, while there are several components that make up sleep quality, the majority of studies have primarily focused on sleep duration rather than other aspects of sleep, such as sleep efficiency. Parental stress can also spill over into the parent-child relationship, resulting in diminished communication quality and decreased optimism about the future. Furthermore, evidence suggests a bidirectional relationship exists between parent/caregiver stress and child ASD symptoms. In other words, increased stress levels of the parent/caregiver may exacerbate the child's ASD symptoms, further worsening parent/caregiver stress. The immediate need for interventions to ease parents' stress and improve the quality of life for both parents and children is apparent. Physical activity has been deemed an intervention to reduce stress and is associated with improved well-being and mental health for both neurotypical and ASD populations. Several studies have demonstrated the benefits of physical activity interventions incorporating mind-body interaction, such as yoga or martial arts, for children with ASD. Martial arts training, such as judo, benefits participants and their families by encompassing mindfulness, balance, strength, and coordination, emphasizing social interaction. Despite the increasing prevalence of ASD, the reported stress on families of children with ASD, and the negative effects of parent stress on both parents and their children with ASD, there are no studies that have examined the benefits of a family-based, mind-body physical activity program on stress and health behaviors in parents of children with ASD. The current study will address this gap by examining the effects of a family judo intervention on parent stress and sleep patterns of parents of children with ASD. There is a significant decrease in parent-reported stress post-judo program. Parents also have increased levels of physical activity. Finally, we see parents reporting decreased stress and improved self-confidence with their children during the semi-structured interviews at the end of the program. These findings may be used to explore further whether a family judo program may lead to better parent and family outcomes, such as increased parental efficacy, improved parent-child bonding, and strengthened family resiliency.