Sleep disruption has been implicated in morbidity after major surgery since 1974. Sleep-related upper airway obstruction has been associated with death after upper airway surgery and profound episodic hypoxaemia in the early postoperative period. There is also evidence for a rebound in rapid eye movement (REM) sleep that might be contributing to an increase in episodic sleep-related hypoxaemic events later in the first postoperative week. Speculation regarding the role of REM sleep rebound in the generation of late postoperative morbidity and mortality has evolved into dogma without any direct evidence to support it. The research presented in this thesis involved two main areas: a search for evidence of a clinically important contribution of REM sleep rebound to postoperative morbidity, and a re-examination of the role of sleep in the causation of postoperative episodic hypoxaemic events. To assess the latter, a relationship between airway obstruction under anaesthesia and the severity of sleep-disordered breathing was sought. In 148 consecutive sleep clinic patients, 49% of those with sleep-disordered breathing (SDB) had a number of events in non-rapid eye movement sleep (NREM) that was greater than or equal to that in REM and 51% had saturation nadirs in NREM that were equal to or worse than their nadirs in REM. This suggests SDB is not a REM-predominant phenomenon for most patients. Of 1338 postoperative deaths occurring over 6.5 years in one hospital only 37 were unexpected, most of which were one or two days after surgery with no circadian variation in the time of death, casting further doubt on the potential role of REM rebound. Five of nine subjects studied preoperatively had moderately severe SDB. Unrecognised and significant SDB is common in middle-aged and elderly patients presenting for surgery suggesting overall perioperative risk of important adverse events from SDB is probably small. In 17 postoperative patients, sleep macro-architecture was variably altered with decreases in REM and slow wave sleep while stage 1 sleep and a state of pre-sleep onset drowsiness, both associated with marked ventilatory instability, were increased. Sleep micro-architecture was also changed with an increase in power in the alpha-beta electroencephalogram range. These micro-architectural changes result in ambiguity in the staging of postoperative sleep that may have affected the findings of this and other studies. Twenty-four subjects with airway management difficulty under anaesthesia were all found to have some degree of SDB. Those with the most obstruction-prone airways while anaesthetised had a very high incidence of severe SDB. Such patients warrant referral to a sleep clinic.

Sleep represents a third of our life, from birth to death. Sleep allows our body and mind to rest, and breaking its structure may lead to severe physical and nervous damage. Breathing disorders, like apneas, hypopneas or RERA events, alter the recovering feature of sleep by fragmenting its structure. They usually lead to daytime sleepiness, depression, hypertension, cardiovascular disease,... In order to give the most suitable treatment to a patient, the gold standard polysomnography (PSG) is recorded in a hospital setting and the huge amount of data is visually analyzed the day after. The PSG is expensive, time-consuming for the clinicians and unpleasant for the patient. Thus, portable monitoring devices and automatic analysis methods are welcome. Four physiological parameters are required to score the three breathing disorders mentioned above: nasal airflow, oximetry, arousals and respiratory effort markers. While arousals are defined in the EEG traces, the esophageal pressure is the gold standard but invasive measure of effort. Surrogates (signals) exist for both arousal, like PAT, PTT or ECG, and effort markers, like TAM, PTT or FOT. This thesis was dedicated to a novel one, the maxillo-mandibular movements. This signal is not only able to point arousals and effort, but it has also the capability to distinguish sleep from wake as a mandibular actimeter, like the wrist actigraphy. These three features make it worth of interest. At first, the jaw movements signal essence was extracted, automatic methods 1) to point arousals, 2) to indicate periodic patterns like respiratory effort or salvo of sleep events, 3) to detect and classify apneas, hypopneas and RERA and 4) to separate sleep from wake were developed and evaluated. Then, the sleep apneas/hypopneas and the sleep/wake detectors were then improved by adding the oximetry in a first step. Finally, the nasal airflow brought its potential in both detection and classification of breathing disorders, especially to overcome the inherent classification problem between apneas and hypopneas since the jaw movements sensor is an effort sensor. All the methods developed in this thesis were applied to a huge database of 150 consecutive recordings at the Sleep Laboratory of the University of Liege for sleep apneas and hypopneas detection assessment. Moreover, an APAP device, that applies a regulated pressure throughout a nasal mask to prevent from upper airways collapse, was designed using only features computed from jaw movements in real-time, and showed similar results to the widely tested iS20i from BREAS. In conclusion, the maxillo-mandibular movements signal does bring usefull information about respiratory effort and arousals, and coupled with the nasal flow and oximetry signal provides an accurate detection and classification of sleep apneas, hypopneas and RERA. Besides, this jaw actimeter and its ad-hoc algorithm allows to distinguish sleep from wake. All in all, the jaw movements signal is a very valuable and a unique physiological signal for home sleep studies.

Obstructive sleep apnea syndrome (OSAS) is characterized by snoring, apneas and excessive daytime sleepiness (EDS). Obesity is a risk factor for snoring and sleep apnea, but data on other factors in relation to obesity are ambiguous. Symptoms of sleep apnea in women have not been fully elucidated. OSAS is an important risk factor for cardiovascular disease (CVD). A common feature in patients with CVD and sleep apnea is an increase in systemic inflammation. From the general population 7,051 women ≥ 20 years answered a questionnaire on snoring and sleep disturbances. Habitual snoring was found in 8% of the total population, and influenced by age, obesity and smoking. The highest prevalence (14%) was found in women 50-59 years. In lean women, alcohol dependence was associated with snoring, while physical inactivity was a risk factor for snoring in obese women. Further, 230 snoring women and 170 women regardless of snoring status were investigated with polysomnography, blood sampling and anthropometric measurements. Of these, 132 participants underwent an ocular and endoscopic examination of their upper airways. Several findings in the upper airways characterised normal-weight women with an apnea-hypopnea index (AHI) ≥ 10. In women with BMI of > 25, no pharyngeal characteristics predicted sleep apnea. When adjusting for age, obesity, smoking, AHI and sleep parameters, several aspects of daytime sleepiness correlated to snoring independently of AHI (EDS, falling asleep involuntarily during day, waking up unrefreshed and fatigue). No symptoms correlated to AHI independently of snoring. Blood samples were analysed for systemic inflammation (CRP, TNFα, IL-6, myeloperoxidase (MPO) and lysozyme). Strong correlations were found between obesity and inflammatory markers. AHI and nocturnal hypoxia correlated to all markers except MPO. When adjusting for age, obesity and smoking, only IL-6 and TNFα were independently associated with nocturnal hypoxia. In conclusion, age and obesity influence the prevalence of snoring and sleep apnea in women from the general population. Other risk factors differ according to BMI. Daytime symptoms are independently related to snoring per se. Despite a strong correlation between obesity and inflammation, an independent relationship between sleep apnea and inflammatory markers was found.

Obstructive sleep apnea (OSA) severity is strongly associated with the degree of overnight peripharyngeal fluid accumulation. We hypothesized that intravenous fluid loading would cause upper airway (UA) narrowing or increase the frequency of apneas and hypopneas per hour of sleep (apnea-hypopnea index; AHI). We employed a controlled, randomized double-crossover experiment in 9 healthy men aged 23-46 years. In the control, subjects were administered approximately 80 ml of normal saline intravenously during sleep. In the intervention, subjects were administered approximately 1850 ml of saline during sleep while wearing compression stockings to localize fluid rostrally. The intervention induced nuchal fluid accumulation, resulting in an increase in neck circumference (+0.1 cm during control, +0.6 cm during intervention, P< 0.01 ) and a decrease in UA cross-sectional area (-0.08 cm2 during control, -0.43 cm2 during intervention, P = 0.023). Although the intervention did not increase the AHI (control AHI = 19.5, intervention AHI = 30.3, P = 0.249), the AHI during the intervention correlated with age (r = 0.8, P < 0.01). Thus, intravenous saline loading during sleep can narrow the UA, which in older men may induce or worsen OSA. Further studies are needed to test this hypothesis.

Obstructive sleep apnea (OSA) severity is strongly associated with the degree of overnight peripharyngeal fluid accumulation. We hypothesized that intravenous fluid loading would cause upper airway (UA) narrowing or increase the frequency of apneas and hypopneas per hour of sleep (apnea-hypopnea index; AHI). We employed a controlled, randomized double-crossover experiment in 9 healthy men aged 23-46 years. In the control, subjects were administered approximately 80 ml of normal saline intravenously during sleep. In the intervention, subjects were administered approximately 1850 ml of saline during sleep while wearing compression stockings to localize fluid rostrally. The intervention induced nuchal fluid accumulation, resulting in an increase in neck circumference (+0.1 cm during control, +0.6 cm during intervention, P< 0.01 ) and a decrease in UA cross-sectional area (-0.08 cm2 during control, -0.43 cm2 during intervention, P = 0.023). Although the intervention did not increase the AHI (control AHI = 19.5, intervention AHI = 30.3, P = 0.249), the AHI during the intervention correlated with age (r = 0.8, P < 0.01). Thus, intravenous saline loading during sleep can narrow the UA, which in older men may induce or worsen OSA. Further studies are needed to test this hypothesis.

This thesis aimed at developing and evaluating a tailored behavioural sleep medicine intervention for enhanced physical activity and healthy eating in patients with obstructive sleep apnea syndrome (OSAS) and overweight. Participants with moderate or severe OSAS (apnea-hypopnea index ≥15) and obesity (Studies I-II) or overweight (Studies III-IV), treated with continuous positive airway pressure (CPAP) (Studies I-II) or admitted to CPAP treatment (Studies III-IV), were recruited from the sleep clinic at Uppsala University Hospital, Sweden. Semi-structured individual interviews were analysed using qualitative content analysis (Study I). Data on moderate-to-vigorous physical activity (MVPA) and sedentary time were collected with three measurement methods and analysed regarding the level of measurement agreement (Study II). Potential disease-related and psychological correlates for the amount of MVPA, daily steps and sedentary time were explored using multiple linear regression (Study III). Physical activity and eating behaviour changes were examined after a six month behaviour change trial (Study IV). A tailored behavioural sleep medicine intervention targeting physical activity and healthy eating in combination with first- time CPAP treatment was compared with CPAP treatment and advice on the association between weight and OSAS. According to participants’ conceptions, a strong incentive is needed for a change in physical activity and bodily symptoms, external circumstances and thoughts and feelings influence physical activity engagement (Study I). Compared with accelerometry, the participants overestimated the level of MVPA and underestimated sedentary time when using self-reports (Study II). The participants spent 11 hours 45 minutes (71.6% of waking hours) while sedentary. Fear of movement contributed to the variation in steps and sedentary time. Body mass index was positively correlated to MVPA (Study III). The experimental group increased intake of fruit and fish and reduced more weight and waist circumference compared with controls. There were no changes in physical activity (Study IV). The novel tailored behavioural sleep medicine intervention combined with first-time CPAP facilitated eating behaviour change, with subsequent effects on anthropometrics, but it had no effects on physical activity and sedentary time. Fear of movement may be a salient determinant of sedentary time, which has to be further explored in this population. The results confirm sedentary being a construct necessary to separate from the lower end of a physical activity continuum and highlight the need of developing interventions targeting sedentary behaviours specifically.

Great progress has been made in sleep medical research in recent years and sleep medicine has thus evolved into a specialized medical field. Sleep apnea syndrome is one of the mostly commonly seen sleep disorders. It is now clear that sleep apnea has adverse effects on the heart and is a risk factor for several cardiovascular diseases. Studies have found that decreased heart rate variability (HRV) is a prognostic factor for cardiovascular disease and it also associated with higher mortality rate. Considering the confounding effect of BMI and sleep apnea severity, this work investigates the correlation between heart rate variability and AHI (apnea-hypopnea index which is used to characterize the severity of sleep apnea) by dividing patients into different BMI subgroups. This work includes 1068 male subjects with complete overnight ECG recordings. The low-frequency (LF), the high-frequency (HF) component and the LF/HF ratio of HRV are computed for the 10 BMI subgroups. The Bootstrap method and the BCa technique for confidence interval estimation are employed to verify the linear association between the HRV measures and the severity of sleep apnea. The experimental results show that statically significant correlation exist between LF/HF ratio and AHI for BMI ¡Ù28 patient groups. Statically significant correlation between LF and AHI also exists for BMI ¡Ù27 patient groups. These results demonstrate that the associations between some of the HRV measures and AHI are clearly BMI dependent.

Obstructive Sleep Apnea Syndrome (OSAS) is defined as a sleep related breathing disorder that causes the body to stop breathing for about 10 seconds and mostly ends with a loud sound due to the opening of the airway. OSAS is traditionally diagnosed using polysomnography, which requires a whole night stay at the sleep laboratory of a hospital, with multiple electrodes attached to the patient&#039 / s body. Snoring is a symptom which may indicate presence of OSAS / thus investigation of snoring sounds, which can be recorded in the patient&#039 / s own sleeping environment, has become popular in recent years to diagnose OSAS. In this study, we aim to develop a new method to detect post-apnea snoring episodes with the goal of diagnosing apnea or creating a new criteria similar to apnea / hypopnea index. In this method, first segmentation is done to eliminate the silence parts and only deal with active. Then these episodes are represented by distinctive features / some of these features are available in literature but some of them are novel. Finally, these episodes are classified using supervised and unsupervised methods. We are especially interested in detecting post apnea episodes, hence the apnea periods. False alarm rates are reduced by adding additional constraints into the detection algorithm. These methods are applied to snoring sound signals of OSAS patients, recorded in Gulhane Military Medical Academy, to verify the success of our algorithms.

No description available.

<p><strong>BAKGRUND:</strong> Sömn är ett regelbundet återkommande tillstånd som är livsnödvändigt för att kroppen skall återhämta sig på ett korrekt vis. Personer med insomni och sömnapné är två patientgrupper som lider utav långvariga sömnproblem. Orsakerna till den dåliga sömnen kan vara många, och därför är det viktigt för sjuksköterskan att vara lyhörd och kunna stötta patienterna med hjälp av sina kunskaper gällande de åtgärder och behandlingar som finns att använda sig av.</p><p><strong>SYFTE:</strong> Syftet med denna litteraturöversikt var att belysa vilka åtgärder sjuksköterskan kan tillämpa för att stödja patienter med långvariga sömnproblem.</p><p><strong>METOD:</strong> En litteraturöversikt där 13 vetenskapliga artiklar granskades och analyserades. Fribergs (2006) modell för litteraturöversikter användes vid datainsamling och analysförfarande.</p><p><strong>RESULTAT:</strong> Fyra kategorier framkom ur analysen av de vetenskapliga artiklarna: <em>egenvård, akupunktur, kognitiv beteendeterapi, </em>och <em>stödprogram.</em> Dessa kategorier gör det möjligt för sjuksköterskan att tillämpa stöd till patienterna. Hos patienter med långvariga sömnproblem har de stödjande åtgärderna visat sig ge ökad sömn- och livskvalitet. <em></em></p><p><strong>SLUTSATS: </strong>Forskningen kring de långvariga sömnproblemen har ökat under de senaste åren men trots det finns det bristande kunskap om hur sjuksköterskan kan ge de behandlingar och det stödet som patienterna med insomni och sömnapné behöver.</p> / <p><strong>BACKGROUND:</strong> Sleep is a periodic state which is essential for the body to recover in a proper manner. Insomnia and people with sleep apnea are two groups of patients out of long-term sleep problems. There are many causes of poor sleep, and that’s why there are so important for the nurse to be sensitive and support patients through their knowledge concerning the actions and processes that exist to use.</p><p><strong>AIM:</strong> The purpose of this literature review was to illustrate which measures nurse can apply to support patients with long-term sleep problems.</p><p><strong>METHOD:</strong> A literature overview, including 13 reviewed and analyzed articles. Fribergs (2006) model for literature overview were used in data collection and analysis procedure.</p><p><strong>RESULT:</strong> Four categories emerged from the analysis of the articles: <em>self-care, acupuncture, cognitive behavioral therapy, </em>and<em> support program</em>. These categories make it enable for the nurse to apply support to patients who suffer out of prolonged sleeping problem. Patients perceive that both their sleep and quality of life improves with the help of different treatments.</p><p><strong>CONCLUSION:</strong> Research into long-term sleep problems has increased in recent years. Despite this, there is a lack of knowledge about how nurse can provide treatment and support for patients with insomnia and sleep apnea.</p>