Sömn är livsviktigt för att bibehålla hälsa och livskvalitet och innebär en period av återuppbyggnad samt återhämtning. Sömnens struktur förändras med stigande ålder, med en ökad fragmentering och mindre djupsömn. Äldre personer på särskilt boende (SÄBO) upplever en rad sömnstörningar med dagtrötthet och håglöshet som följd. Dessa sömnstörningar lindras i nuläget främst med sömninducerande- och lugnande läkemedel vilket leder till biverkningar och i förlängningen ytterligare sömnstörningar och försämrad livskvalitet. Äldre personer på SÄBO, vilka ofta lider av multisjuklighet och funktionsnedsättningar, har omfattande omvårdnadsbehov vilket kräver att sjuksköterskan har olika icke-farmakologiska åtgärder att tillgå för att främja sömnen hos dessa personer. / Sleep is essential to maintain health and quality of life, and involves a period of recovery. The architecture of sleep evolves with age, with increased fragmentation and less deep sleep as a result. Older persons living in residential facilities experience a range of sleep disorders, which results in daytime sleepiness and dysfunction. These sleep disorders are primarily treated with sleep inducing and sedative drugs, which results in side effects and may lead to further sleep disorders and a deterioration of quality of life. Older persons at SÄBO, who often suffer from comorbidities and disabilities, have extensive care needs, which require the registered nurse to have access to a range of non-pharmacological interventions to utilise, in order to promote sleep in these persons.

There are many studies about problematic of sleep connected with shift work. However, only few studies devoted to the conditions for good rest and sleep in patients hospitalized in intensive care units. Insufficient or poor quality sleep and relaxation are the most common problems reported by patients that were hospitalized at intensive care units (ICU). Sleep is one of the basic biological needs of human. Sleep deficit can lead to psychical and psychological dysfunction that can affect the healing process. The diploma thesis is dealing with sleeping issues of patients hospitalized especially at intensive care units. The aim of the study is to determining the opinions of nurses that work at intensive care units on meeting the needs relating with sleep and rest of hospitalized patients and mapping, what interventions they use to prevent of occurrence of difficulties in this area. The theoretical part at first describes physiology of sleep and biological rhythms, then sleep disorders, then factors affecting sleep along with the consequences of the lack of sleep and last nursing process for patients with sleep disorder. The empirical part presents the results of questionnaire survey and then results of executed statistical analysis. Established hypothesis not have been assumed in results of survey...

Depuis sa première description par James Parkinson dans son essai sur la paralysie agitante, la maladie de Parkinson (PD) a été reconnue comme une maladie du système moteur identifié par une tétrade de symptômes, à savoir : akinésie, rigidité musculaire, tremblement au repos et instabilité posturale. Ces symptômes sont liés à la perte de la dopamine (DA) dans le striatum après la dégénérescence neuronale dans la substance noire (SN). Il est de plus en plus reconnu que les symptômes non moteurs et peut-être non dopaminergiques inévitablement émergent et s'aggravent au cours de la progression de la maladie. Les perturbations du sommeil sont parmi les principaux symptômes non moteurs et ont été reconnus comme marqueurs précliniques de la maladie. Les modèles de régulation du sommeil ont insisté sur deux processus distincts : un mécanisme de contrôle du sommeil, ou homéostat sommeil, et un oscillateur circadien. L'oscillateur circadien, basé dans le noyau suprachiasmatique (NSC) est responsable de la tendance à dormir pendant certaines phases du cycle de 24 heures et la consolidation du sommeil et de réveil en épisodes distincts. L'homéostat sommeil est chargé de surveiller et de réagir à la nécessité pour le sommeil, provoquant l'envie de dormir à dépendre sur les montants avant du sommeil ou de l'éveil. Alors que les perturbations dans les circuits et les processus homéostatiques impliqués dans la régulation du sommeil-éveil comportement sont documenté dans la maladie de Parkinson, l'implication potentielle des altérations du système circadien n'ont pas été étudiés en détail. Le but de ma thèse est d'étudier les modifications dans le système circadien en utilisant deux modèles animaux de PD : la souris et le primate non-humain / Since the first description by James Parkinson in his essay on the shaking palsy, Parkinson’s disease (PD) was recognized as a motor disease identified by a tetrad of symptoms, namely; akinesia, muscular rigidity, resting tremor and postural instability. These symptoms are known to be related to loss of dopamine (DA) in the striatum following neural degeneration in the substantia nigra (SN). It is increasingly recognized that non-motor and perhaps non-dopaminergic related symptoms inevitably emerge and worsen during disease progression. Sleep disruption is one of the major non-motor symptoms and has been suggested as a preclinical marker of the disease. Models of sleep regulation have emphasized two distinct processes: a sleep-control mechanism, or sleep homeostat, and a circadian oscillator. The circadian oscillator, based in the suprachiasmatic nucleus (SCN), is responsible for the tendency to sleep during certain phases of the 24-hour cycle and the consolidation of sleep and wake into distinct episodes. The sleep homeostat is responsible for monitoring and reacting to the need for sleep, causing the urge to sleep to depend on prior amounts of sleep or wakefulness. While disruptions in the circuitry and the homeostatic processes involved in the regulation of sleep-wake behaviour is will documented in PD, the potential involvement of alterations of the circadian system have not been studied in detail. The aim of my thesis is to investigate alterations in the circadian timing system using two animal models of PD: the mouse and the non-human primate. Taken together, the studies show that disturbances of circadian functions occur after MPTP treatment in the non-human primate but not in the mouse model of PD. These results emphasize the limitations of the MPTP-treated mouse model of PD for the study of non-motor symptoms, and reinforce previous studies that question the adequacy of this model to replicate cardinal motor features of the disease. In contrast, results in the non-human primate model stress the importance of dopaminergic degeneration in the circadian organisation of behavioral sleep wake cycle in PD

Introdução: A aplicação de Pressão Positiva Contínua na Via Aérea Superior (CPAP) durante o sono é o tratamento padrão ouro para Apneia Obstrutiva do Sono (AOS) e foi primeiramente descrita utilizando uma máscara nasal. No entanto, na prática clínica a máscara oronasal é comumente utilizada e sua eficácia é variável devido a mecanismos desconhecidos. Nós formulamos a hipótese de que a respiração oral e a transmissão de pressão pela cavidade oral comprometem a eficácia do CPAP com máscara oronasal. Métodos: Treze pacientes com AOS, bem adaptados à máscara oronasal, foram monitorados com polissonografia completa, cateter de pressão faríngea e nasoendoscopia. Os pacientes dormiram com uma máscara oronasal com compartimentos nasal e oral separados e selados entre si. Cada compartimento nasal e oral foi conectado a um pneumotacógrafo e ambos foram conectados a uma válvula multidirecional a fim de ser possível modificar o fluxo de CPAP (nasal ou oronasal), sem a necessidade de acordar o paciente. Um cateter de pressão faríngea e broncoscópio pediátrico ultra-fino foram introduzidos por orifícios independentes através da máscara. O sono foi induzido com baixas doses de midazolam. O CPAP foi titulado até a pressão terapêutica durante as rotas oronasal e nasal. O CPAP foi então reduzido para induzir limitação de fluxo aéreo estável na rota oronasal e abruptamente mudado para a rota nasal e vice-versa. Adicionalmente, o experimento foi repetido com o uso de uma fita selando a boca do paciente a fim de bloquear a transmissão de pressão pela cavidade oral. Resultados: A pressão de titulação de CPAP foi maior na rota oronasal quando comparada à nasal (p=0,005). Cinco de 11 pacientes, com uma alta porcentagem de respiração oral ( > 25%), não obtiveram sucesso na titulação do CPAP com máscara oronasal. Durante limitação de fluxo aéreo estável o pico de fluxo inspiratório foi menor, o delta de pressão faríngea e a resistência inspiratória da via aérea superior foram maiores, enquanto as dimensões nas regiões retropalatal e retroglossal foram menores na rota oronasal comparada à nasal (p < 0,05 para todas as comparações). As diferenças foram observadas mesmo em pacientes sem respiração oral e foram abolidas quando selamos a boca do paciente com uma fita (n=6). Conclusão: Respiração oral e transmissão de pressão positiva pela cavidade oral comprometem a eficácia do CPAP com máscara oronasal / BACKGROUND: Continuous Positive Airway Pressure (CPAP) is the gold standard treatment for obstructive sleep apnea (OSA) and was conceived to be applied by nasal route only. Oronasal mask is frequently used in clinical practice but the effectiveness varies for unknown mechanisms. We hypothesized that oral breathing and pressure transmission through the mouth compromises oronasal CPAP efficacy. METHODS: Thirteen OSA patients, well adapted to oronasal CPAP, were monitored by full polysomnography, pharyngeal pressure catheter and nasoendoscopy. Patients slept with an oronasal mask with sealed nasal and oral compartments. Sleep was induced with low doses of midazolam. CPAP was titrated during both oronasal and nasal routes. CPAP was then reduced to induce stable airflow limitation and abruptly switched to the alternate route. In addition, a tape sealing the mouth was used to block pressure transmission to the oral cavity. RESULTS: Best titrated CPAP was higher in oronasal than nasal route (p=0.005). Five out of 11 patients with a high percentage of oral breathing ( > 25%) failed to achieve stable breathing during oronasal CPAP titration. During stable flow limitation, inspiratory peak flow was lower, driving pressure and upper airway inspiratory resistance were higher, retropalatal and retroglossal dimensions were smaller in oronasal compared to nasal route (p < 0.05 for all comparisons). Differences were observed even among patients with no oral flow and were abolished when a tape sealing the mouth was used (n=6). CONCLUSION: Oral breathing and transmission of positive pressure through the mouth compromises oronasal CPAP

One in three American older adults fall every year, making falls the leading cause of nonfatal injury treated in the emergency department (Centers for Disease Control and Prevention [CDC], 2013). Fall-related injuries cost the United States healthcare system nearly $30 billion a year and result in 27,000 deaths per year (Burns, Stevens, & Lee, 2016). The risk of falls increases with age, occurring more often in women than man. Age-related muscle weakness and functional decline contribute to fall risk. Age-related changes in neuroendocrine hormone production and shifts in circadian rhythms promote sleep disorders, affecting nearly two-thirds of older adults. Poor sleep quality over time leads to drowsiness and impaired attention span and judgment. The purpose of this secondary analysis of a previously collected data set was to describe the relationships among frailty, subjective sleep quality, and falls in community-dwelling older adults. This secondary analysis also sought to determine the extent to which frailty and subjective sleep quality predict risk of future falls among community-dwelling older adults. Correlational analyses were performed to determine the nature and significance of the relationship between sleep quality and falls, frailty and falls, and sleep quality and frailty. A multiple regression analysis was performed to determine if sleep quality and frailty combined could predict falls. Frailty was found to account for a small variance in fall risk. However, sleep quality was not significantly related to falls nor was sleep quality predictive of falls. Risk for falls should be assessed at every clinical encounter and efforts to promote restful sleep should be addressed at least annually to reduce the risks of falls, functional decline, and sleep disorders among older adults in the community. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2017. / FAU Electronic Theses and Dissertations Collection

INTRODUÇÃO: As relações entre sono e epilepsia são complexas e de grande importância clínica. A melhor compreensão das inúmeras lacunas que permeiam essa relação reforçaria os alicerces para o desenvolvimento de abordagens terapêuticas mais eficazes que pudessem contribuir para o bem-estar do paciente portador de epilepsia e transtornos do sono. OBJETIVO: O presente estudo teve como principal objetivo o estudo comportamental e a caracterização eletrofisiológica do ciclo vigília-sono (CVS) de ratos adultos tornados epilépticos por pilocarpina. MÉTODO: Ratos Wistar machos (N=6), tornados epilépticos após status epilepticus (SE) induzido por pilocarpina e não epilépticos (N=6) foram submetidos à cirurgia extereotáxica para implante de elétrodos bipolares nas áreas corticais (A3, somatosensorial) e hipocampais (CA1) de ambos os hemisférios. Registros contínuos de 24 horas foram submetidos à minuciosa análise visual e os seguintes parâmetros foram analisados: identificação e quantificação dos padrões eletrofisiológicos das fases do ciclo CVS; duração dos episódios oníricos ocorridos durante o sono dessincronizado (SD); padrão de ocorrência do CVS assim como do ciclo de sono (CS), e análise do volume do núcleo supraquiasmático. Os estudos da distribuição do CVS e comportamento onírico foram submetidos à Análise de Variância Multivariada - MANOVA, ao passo que as análises da ocorrência dos ciclos (CVS e CS) e volume do núcleo supraquiasmático foram submetidas ao teste da Análise de Variância (ANOVA) de dois fatores e ao teste de Mann- Whitney, respectivamente. RESULTADOS: Todas as fases do CVS foram identificadas nos ratos epilépticos. As fases da vigília e do sono eram permeadas por espículas e outros grafoelementos epileptiformes, como ondas delta espiculadas no SS e potenciais de alta frequência e baixa voltagem durante VA e o SD. Ao contrário do padrão de ocorrência típico das fases de vigília e sono em ratos não epilépticos, o grupo epiléptico apresentou diferenças significativas quanto à distribuição dessas fases em função do período. Foi observada redução significativa de VA (p<0,002) com concomitante aumento de SS (p<0,005) e vigília relaxada (VR) (p=0,021) no escuro, sendo que a VR era preponderante apenas na primeira metade da noite. Durante o dia, a quantidade de SS era maior no período da manhã (p<0,001), ao passo que houve redução do SD (p=0,002) concomitante com aumento de VA (p<0,001) no período da tarde.Os animais tornados epilépticos por pilocarpina apresentaram redução no padrão de ocorrência do CVS e CS (p=0,004 e p=0,003, respectivamente). Não houve diferença estatística na duração dos episódios oníricos, assim como no volume do núcleo supraquiasmático entre os grupos analisados (p>0,63 e p=0,47, respectivamente). CONCLUSÃO: Os animais epilépticos apresentaram alterações na arquitetura do CVS, bem como nos padrões de ciclicidade evidenciado pelas alterações de comportamento, especialmente no ciclo escuro. Esses fatos sugerem possível comprometimento estrutural e/ou funcional das circuitarias responsáveis pela geração e manutenção das fases de vigília e sono, assim como dos sistemas de temporização do CVS. Tomados em conjunto, os dados reproduziram anormalidades do CVS observadas em pacientes epilépticos, sugerindo que o presente modelo pode ser uma importante ferramenta para o estudo de mecanismos subjacentes à epilepsia do lobo temporal e sono. / INTRODUCTION: Relationships between sleep and epilepsy are complex and have great clinical importance as well. The full understanding of the various gaps present in this relationship would pave the ground for new studies that could generate new clinical approaches aiming to contribute to the well-being of the patient suffering from epilepsy and sleep disorders. OBJECTIVE: The present study aimed to carry out a behavioral analysis and electro-oscillographic characterization of the phases of sleep-wake cycle (SWC) of pilocarpine- induced epilepsy in adult rats. METHODS: Male Wistar rats that became epileptic after 60 days of pilocarpine-induced status epilepticus (SE) (N=6) and non epileptic ones (N=6) were submitted to extereotaxic surgery for implantation of bipolar electrodes in cortical (A3, somestesic) and hippocampal (CA1) areas in both hemispheres. Twenty-four hour continuous registers were submitted to detailed visual analysis and the following parameters were studied: identification and quantification of electrophysiological parameters of phases of SWC, duration of oniric episodes during desynchronized sleep (DS), the pattern of occurrence of SWC and cycles of sleep (CS). In addition, the volume of suprachiasmatic nuclei was investigated. To analyze the architecture of sleep-wake phases and oniric behavior, Multivariate Analysis of Variance-MANOVA was utilized, whereas the pattern of cycles (SWC and CS) and volume of suprachiasmatic were submitted to Analysis of Variance with 2 factors-Two-way ANOVA and Mann-Whitney test, respectively. RESULTS: In the epileptic rats all phases of SWC were identified. The phases of wake and sleep were permeated by spikes and graph elements epileptiforms such as spiked delta waves in SS and low frequency waves with high voltage during AW and SD phases. In contrast to the pattern of normal rhythmic activity evident in non-epileptic rats the epileptic group presented significant differences concerning distribution of the phases of SWC according to the period. In the dark cycle significant reduction of AW (p<0.002) was observed concomitantly with an increase of SS (p<0.005), while the relaxed wakefulness (RW) showed an increase during the first half of the night (p=0.021). In the light cycle, the SS was more prominent in the morning period (p<0.001), following by a reduction of DS (p=0.002) concomitantly with an increase of AW (p<0.001) during the afternoon in the epileptic group. The number of cycles with a regular sequence of each phase from awake to sleep (SWC) was significantly decreased (p=0.004), as was the number of cycles of sleep (p=0.003) in epileptic rats. No significant differences were found in duration of oniric episodes and volume of suprachiasmastic nuclei (p>0.63 e p=0.47, respectively) between non epileptic and epileptic groups. CONCLUSION: The data obtained revealed that after SE the epileptic animals presented some alterations in the SWC architecture as well as in the cyclicity patterns mainly in dark cycle. Such facts suggest a possible functional and/or structural impairment in the circuitry responsible for the generation of sleep and wake phases and in the SWC timing system. Taken together the data reproduced the abnormalities observed in patients, suggesting that the pilocarpine model is a suitable one to study sleep dysfunctions in temporal lobe epilepsy.

OBJETIVO: Crianças e adolescentes com câncer apresentam sintomas múltiplos que incluem fadiga, perturbações do sono, dor e náuseas. Esses sintomas estão associados à diminuição da qualidade de vida relacionada à saúde (QVRS). O objetivo desta pesquisa foi avaliar: a) fadiga, padrão de sono e QVRS de crianças e adolescentes hospitalizados com câncer; b) relações entre fadiga, padrão de sono e QVRS; c) fatores como idade, sexo, diagnóstico de câncer, motivo da internação, tempo em quimioterapia, uso de corticosteroides, níveis de hematócrito e hemoglobina e dias pós-quimioterapia que podem ter efeitos significativos na fadiga, sono e QVRS. PRESSUPOSTO TEÓRICO: A Teoria de Gerenciamento de Sintoma (TGS) foi utilizada para fundamentar esta pesquisa. TGS é constituída por três componentes que estão inter-relacionados: a experiência do sintoma, o gerenciamento do sintoma e resultados, que estão inseridas no contexto da pessoa, da saúde-doença e do meio ambiente. MÉTODO: O delineamento da pesquisa foi quantitativo, descritivo e transversal. Participantes preencheram a PedsQL(TM) Escala Multidimensional do Cansaço para mensuração da fadiga, Actigraph de pulso, por no mínimo três dias, como dispositivo para avaliação do padrão de sono e o PedsQL(TM) Inventário Pediátrico de Qualidade de Vida, Módulo Genérico e Módulo Câncer, para avaliação da QVRS. RESULTADOS: Participaram 38 crianças e adolescentes hospitalizados com câncer e em seguimento em um hospital público do interior paulista. Os resultados demonstraram escores muito baixos de fadiga (63,8 ± 18,5) e qualidade de vida (QVRS) (genérica: 61,1 ± 17,0; câncer: 59,1 ± 16,7). Duração do sono foi 3,4 ± 1,9 horas. Variações na fadiga podem ser explicadas por: 1) diagnóstico de tumores de sistema nervoso central, tempo em tratamento quimioterápico e QVRS total (câncer) (81,1%); 2) diagnóstico de sarcoma, tempo em tratamento quimioterápico, dores e machucados, ansiedade a procedimentos, dificuldades cognitivas e aparência física (89,6%); e 3) QVRS total (câncer) e duração do sono (74,7%). CONCLUSÕES: Crianças e adolescentes hospitalizados com câncer experienciam fadiga, distúrbios do sono e baixa QVRS. Enfermeiros precisam avaliar a fadiga, o sono e a QVRS. Futuros estudos são necessários para investigar estratégias de gerenciamento eficazes que podem diminuir a fadiga, melhorar o sono e aumentar a QVRS em crianças e adolescentes hospitalizadas com câncer / PURPOSE: Children and adolescents with cancer experience multiple symptoms, such as fatigue, sleep disturbance, pain, and nausea. These symptoms are associated with lower health-related quality of life (HRQoL). The purpose of this research was to examine: a) fatigue, sleep patterns, and HRQoL in hospitalized children and adolescents with cancer; b) relationships among fatigue, sleep patterns, and HRQoL; c) factors, such as age, gender, cancer diagnosis, reason for hospitalization, length of chemotherapy, use of dexamethasone, hematocrit and hemoglobin levels and days post-chemotherapy that may have significant effects on fatigue, sleep and HRQoL. THEORETICAL FRAMEWORK: The Symptom Management Theory (SMT) was used as a guiding framework for the research. SMT consists of three components that are interrelated: symptom experience, symptom management strategies and outcomes, which are embedded in the context of person, health/illness, and environment. METHODS: The research design was quantitative, descriptive and cross-sectional. Participants completed the PedsQL(TM) Multidimensional Fatigue Scale to measure fatigue, wore the wrist Actigraph for the minimum of three days to assess sleep patterns, and the PedsQL(TM) Pediatric Quality of Life Inventory (Generic and Cancer) to assess HRQoL. RESULTS: The participants were 38 children (9.7 ±1.3 age in years) and adolescents (14.8 ± 1.4 age in years) hospitalized with cancer at a public hospital in the interior of the State of São Paulo, Brazil. The results demonstrated low fatigue scores (63.8 ± 18.5) and quality of life (HRQoL) scores (generic: 61.1± 17.0; cancer: 59.1 ± 16.7). Sleep duration was 3.4 ± 1.9 hours. Variations in fatigue levels may be explained by: 1) a diagnosis of brain tumor, the length of chemotherapy and total HRQoL (81.1%); 2) a diagnosis of sarcoma, length of chemotherapy, pain and hurt, procedural anxiety, cognitive problems and physical appearance (89.6%); and 3) the total HRQoL (cancer) and sleep duration (74.7%). CONCLUSIONS: Hospitalized children and adolescents with cancer experience fatigue, sleep disturbance, and low HRQoL. Nurses need to assess fatigue, sleep, and HRQoL. Future studies are needed to investigate effective management strategies that may decrease fatigue, improve sleep, and increase HRQoL in hospitalized children and adolescents with cancer

Introdução: A aplicação de Pressão Positiva Contínua nas Vias Aéreas Superiores (CPAP) durante o sono é o padrão ouro no tratamento da Apneia Obstrutiva do Sono (AOS) e foi primeiramente descrito utilizando uma máscara nasal. No entanto, na prática clínica a máscara oronasal é comumente. Este estudo foi desenhado para determinar os efeitos agudos da mudança de rota de fluxo do CPAP de nasal para oronasal e oral na patência da via aérea superior durante o sono em pacientes com AOS. Nós hipotetizamos que a pressão transmitida pelo compartimento oral da máscara oronasal pode comprometer a eficácia do CPAP no tratamento da AOS por empurrar a língua posteriormente. Métodos: Dezoito pacientes (idade 44 ± 9 anos, índice de massa corpórea de 33,8 ± 4,7 kg / m², índice de apneia-hipopneia 49,0 ± 39,1 eventos/hora) dormiram com máscara oronasal customizada com dois compartimentos (nasal e oral) selados e independentes conectados a uma válvula multidirecional. O sono dos pacientes foi monitorizado pela polissonografia e induzido por baixas doses de midazolam (3,1 ± 2,2 mg). O CPAP nasal foi titulado até a pressão de manutenção das vias aéreas superiores. A rota de fluxo do CPAP foi mudada de nasal para oronasal (n = 18) e oral (n = 16) durante o sono. A área retroglossal foi continuamente observada durante a nasoendoscopia. Resultados: O CPAP nasal (14,8 ± 4,1 cmH2O) foi suficiente para estabilizar a via aérea superior em todos os pacientes. Em contraste, o CPAP oronasal e oral promoveram eventos obstrutivos em 12 (66,7%) e 14 (87,5%) pacientes, respectivamente. Quando o CPAP foi transmitido pela rota oronasal e oral houve uma redução progressiva e significante na distância entre a epiglote e a base da língua e na área retroglossal em comparação com a respiração estável durante a rota nasal. Conclusões: Mudanças agudas na rota de fluxo do CPAP nasal para as rotas oronasal e oral induzem eventos obstrutivos e diminuem as dimensões da orofaringe em pacientes com AOS durante o sono. A máscara oronasal pode comprometer a efetividade do CPAP no tratamento da AOS / Introduction: Continuous Positive Airway Pressure (CPAP) is the gold standard treatment for obstructive sleep apnea (OSA) and was conceived to be applied by nasal route only. However, in clinical practice the oronasal mask is commonly used. This study was designed to determine the acute effects of changing the nasal CPAP route to oronasal and oral in upper airway patency during sleep in patients with. We hypothesized that the pressure transmitted by the oral compartment of oronasal mask will push the tongue backwards and will compromise CPAP effectiveness in OSA treatment. Methods: Eighteen patients with OSA (age: 44±9 years44±9 years44±9 years44±9 years44±9 years44±9 years44±9 years44±9 years44±9 years , body mass index: 33.8±4.733.8±4.733.8±4.7 33.8±4.7 33.8±4.7 Kg/m², apnea-hypopnea index: 49.0 ± 39.149.0 ± 39.149.0 ± 39.149.0 ± 39.149.0 ± 39.149.0 ± 39.1 49.0 ± 39.149.0 ± 39.149.0 ± 39.1 events/hour) slept with a customized oronasal mask with a nasal and oral sealed compartments connected to a multidirectional valve. Sleep was monitored by full polysomnography and induced by low dosis of midazolam (3.1 ± 2.2 mg). Nasal CPAP was titrated up to holding pressure and flow route was changed to oronasal (n = 18) and oral route (n = 16) during sleep. Retroglossal area was continuously observed by nasoendoscopy. Results: Nasal CPAP (14.8±4.1 cmH2O) was able to stabilize breathing in all patients. In contrast, CPAP delivered by oronasal and oral route promoted obstructive events in 12 (66.7%) and 14 (87.5%) patients, respectively. Compared to stable breathing during nasal route, there was a significant and progressive reduction in the distance between epiglottis and tongue base and the retroglossal area when CPAP was delivered by oronasal and oral route, respectively. Conclusions: CPAP delivered by oronasal route may compromise CPAP effectiveness to treat OSA

Kwan, Yee Mei. / Thesis (D.Nurs.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 152-171). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese; appendixes includes Chinese.

In this thesis we develop data mining techniques to analyze sleep irregularities in humans. We investigate the effects of several demographic, behavioral and emotional factors on sleep progression and on patient's susceptibility to sleep-related and other disorders. Mining is performed over subjective and objective data collected from patients visiting the UMass Medical Center and the Day Kimball Hospital for treatment. Subjective data are obtained from patient responses to questions posed in a sleep questionnaire. Objective data comprise observations and clinical measurements recorded by sleep technicians using a suite of instruments together called polysomnogram. We create suitable filters to capture significant events within sleep epochs. We propose and employ a Window-based Association Rule Mining Algorithm to discover associations among sleep progression, pathology, demographics and other factors. This algorithm is a modified and extended version of the Set-and-Sequences Association Rule Mining Algorithm developed at WPI to support the mining of association rules from complex data types. We analyze both the medical as well as the statistical significance of the associations discovered by our algorithm. We also develop predictive classification models using logistic regression and compare the results with those obtained through association rule mining.