Sleep is an essential component of optimal physiological and psychological functioning in humans. However, numerous studies have identified sleep deficits in patients within the critical care setting. Sleep deprivation has been shown to cause adverse effects including cardiovascular, respiratory, and endocrine variations, and altered psychological functioning such as cognitive dysfunction, decreased concentration, mood variability, and delirium. The critical care environment often contains stimuli that may be a causative factor in sleep alterations such as sleep deprivation, fragmentation or alterations in sleeping patterns. These environmental stimuli include noise, light, pain, discomfort, nursing care activities, medications, psychological stressors and underlying disease and have the capability to severely impact the quantity and quality of sleep in critically ill patients. The integrated research review identifies correlations between environmental stressors and sleep alterations in critically ill patients. Outcomes of interventions including earplugs and eye masks, behavior modification, complementary and alternative medicine and pharmacological considerations are examined. Additionally, implications for nursing education, research and practice are addressed. A current integrated research review incorporating nursing implications and alternative interventions could be significant to the provision of nursing care for the critically ill patient.

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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

Background and Objectives: Alterations in the habitual sleep/wake patterns of women with breast cancer and their informal caregivers may be concurrently exacerbated and co-vary during the patient’s treatment. The current study set out to longitudinally ex-plore sleep-wake patterns of patient-caregiver dyads in the context of adjuvant chemotherapy (CTh) for breast cancer. Taking into consideration the complexity of mechanisms interfering with a care dyad’s sleep, diverse sleep-impairing factors were also investigated. Design and Methods: Descriptive, observational, repeated-measures dyadic study. Forty eight newly diagnosed women receiving outpatient adjuvant CTh for early stage breast cancer (stage I-IIIA) and their nominated primary informal caregiver completed self-reported sleep measures at pre-treatment (week prior to CTh), post-CTh cycle 1, post-CThC4, and approximately 30 days after the end of CTh (total of =6 cycles received). Additional data on the dyads’ sleep hygiene practices (SH), patient physical burden, caregiving burden (CRACB), psychological burden (PSYCH), nocturnal sleep disturbances (SDSTRB), and maladaptive coping strategies were collected at each assessment point. Results: Prior to CTh, 65% of dyads consisted of at least one poor sleeper, a rate further increasing to approximately 88% at CThC4. Multivariate hierarchical linear modelling revealed curvilinear trajectories for most dyads’ sleep/wake parameters that nevertheless reached significance (p<.05) for patients only. In both groups, sleep/wake impairment reached its peak at mid-treatment (CThC4); yet, patients consistently reported significantly more sleep problems than their carers. Partial convergence also emerged as suggested by positive correlations and no between-groups differences in daily disturbance, daytime napping duration, total sleep time, and overall sleep/wake impairment at pre-treatment. At CThC4, rates of change in sleep latency and daytime napping duration were also similar. In exploratory analyses, increased CRACB, poor SH, and SDSTRB consistently predicted poorer outcomes in the dyad members’ own sleep-wake patterns. Cross-partner effects most frequently emerged with regard to the dyads’ PSYCH, as well as for CRACB. Among the most interesting findings, increased patient PSYCH adversely affected caregiver perceived sleep quality and daytime napping. Reversely, increased CRACB was related to worse patient sleep quality, reduced sleep time, and difficulty to fall asleep. Some links might be suggested for own poor sleep hygiene and worse partner outcomes on daytime functioning, sleep efficiency, or wake after sleep onset. Conclusions and Future Implications: This is one of the first studies to show that a dyadic approach in the assessment of sleep/wake patterns in patients with breast cancer and their informal carers is a promising method to enhance exploration of potentially concurrent sleep/wake-impairment and associations with sleep-impairing factors that may co-vary in dyad members. Replication of the current findings in future dyadic sleep research is warranted. Meanwhile, clinicians will need to engage in concurrent systematic and ongoing sleep assessments that synthesise and contrast data to establish a care dyad’s level of sleep quality.

The theoretical part of the diploma thesis deals with the effects of sleep on human health. Lack of sleep has demonstrable effects on a person's physical and mental health. People are succumbing to strong influences of present day society, which degrade their quality of sleep. These influences do not only effect adults, but children and adolescents as well. One can improve sleep quality by following sleep hygiene rules. Nowadays these rules are often violated. The main problem is ignorance. The aim of the practical part of this diploma thesis was to compare satisfaction with quality of sleep between groups of students in elementary schools, students of secondary schools, and adult working people. It was also investigated whether respondents in schools were familiar with sleep hygiene and whether they followed it. The results of the questionnaire surveys found that the group least satisfied with sleep quality was the group with working adults. More than half of the respondents in schools were unaware of sleep hygiene. It was confirmed that more than two thirds of respondents do not follow sleep hygiene rules. In the conclusion, the author has included material on sleep problems for grade eight students of elementary schools. It could be used as a draft chaper for future school textbooks, because...

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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.

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