Orientadores: Antônio de Azevedo Barros Filho, Rubens Nelson Amaral de Assis Reimão / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T20:31:33Z (GMT). No. of bitstreams: 1 Turco_GiovinaFosco_M.pdf: 1554000 bytes, checksum: 7e248d27f4195b837e42fd75a9e2e214 (MD5) Previous issue date: 2011 / Resumo: Introdução: O modo de vida imperativo na sociedade moderna, caracterizado particularmente pelo consumismo, impõe padrões de comportamento danosos, hábitos e crenças que, uma vez consagrados, depreciam a qualidade de vida, o bem estar e a saúde. Os distúrbios do sono (DS) assim como a alta prevalência da obesidade nos adolescentes estão associados diretamente nos problemas de saúde, sociais e psicossociais desta população. Objetivo: (1) Revisão bibliográfica dos artigos a cerca dos principais aspectos relacionados aos distúrbios do sono, à obesidade e à qualidade de vida na infância e adolescência. (2) Avaliar a qualidade de vida e a qualidade do sono em adolescentes obesos e eutróficos entre 10 e 14 anos. Método: Foi realizado estudo transversal, entre agosto/2009 e agosto/2010 com adolescentes acompanhados no Ambulatório de Obesidade na Infância e na Adolescência do H/C UNICAMP, Campinas/São Paulo. O grupo-controle foi constituído por estudantes de uma escola pública da cidade de Americana/ São Paulo, classificados como eutróficos. Foram utilizadas Ficha de Identificação dos Sujeitos e classificação socioeconômica, bem como Questionário sobre o Comportamento do Sono (SBQ), Questionário genérico sobre Qualidade de vida pediátrica (PedsQLTM 4.0 Generic Core Scales), ambos nas versões específicas para adolescentes. Para a análise estatística foi utilizado Teste Não-Paramétrico de Mann-Whitney e adotada a significância de 5%. Os dados foram analisados no programa SPSS for Windows versão 16.0. Resultados: Os estudos encontrados se relacionam à descrição do sono, obesidade e às interferências que causam no indivíduo, impactando a QV. Os adolescentes obesos apresentaram qualidade de vida inferior em três dos quatro domínios avaliados: físico (p<0, 001), emocional (p=0,03) e social (p=0, 002), não havendo diferenças em questões escolares (p=0,40). Na média geral dos itens avaliados, a qualidade de vida dos adolescentes obesos mostrou-se inferior aos eutróficos, sendo as pontuações 68,8(±15,2) e 78,4(±14,5) respectivamente (p<0, 001). No total geral da média psicossocial, também houve diferença significativa entre os grupos (p=0, 009), os obesos obtiveram pontuação média de 68,5 (±16,0) enquanto os eutróficos 76,2 (±16,7). O grupo obeso apresentou maior número de problemas do sono e, conseqüentemente, pior qualidade do sono (p=0,03). Conclusão. Os DS devem ser diagnosticados e tratados precocemente, a fim de minimizar os impactos sobre o crescimento e o desenvolvimento desta população. Adolescentes obesos apresentaram prejuízo na qualidade de vida e mais problemas de sono quando comparados aos eutróficos / Abstract: Introduction: The imperative lifestyle in modern society characterized by consumerism imposes harmful behavioral patterns, habits and beliefs that once settle, affect the quality of life, well-being and health. The sleep distorders (DS) and the high prevalence of obesity in adolescents are directly associated with health, social, and psychosocial problems. Objective: (1) Review articles in the literature about the main aspects of sleep disorders, obesity, and the quality of life in childhood and adolescence. (2) Assess the quality of life and sleep, in obese and eutrophic adolescents ages 10 to 14. Method: A transversal study conducted between August /2009-2010 with adolescents attending the Childhood and Adolescence Obesity ambulatory at the H/C, UNICAMP, Campinas, São Paulo. The control group was composed of students from the city of Americana/São Paulo, classified as eutrophic. An identification card, socioeconomic classification, a questionnaire about sleep behaviors (SBQ), and a questionnaire about pediatric quality of life (PedsQLTM 4.0 Generic Core Scales) specific for teenagers were used. The statistical analysis used the non-parametric Mann-Whitney test and adopted the significance of 5%. The data were analyzed in the program SPSS for Windows, version 16.0. Results: The identified studies described aspects of sleeping habits and sleep disorders, obesity, and their interference affecting the individuals' QL. The identified studies described aspects of sleeping habits and sleep disorders, obesity, and their interference affecting the individuals'QL. The obese adolescents presented lower quality of life in three of the four areas assessed: physical (p < 0.001), emotional (p = 0.03), and social (p = 0.002), with no differences related to school performance (p = 0.40). The general averages of the evaluated aspects showed that the quality of life of the obese was inferior compared to the eutrophic, with scores of 68.8 (± 15.2) and 78.4 (± 14.5), respectively (p < 0.001). In the total psychosocial averages, a significant difference between groups was also observed (p = 0.009), with average scores of 68.5 (± 16.0) for the obese and 76.2 (± 16.7) for the eutrophic group. The obese group presented greater number of sleep problems and consequently worse sleep quality (p = 0.03). Conclusion. The SD should be diagnosed and treated early, in order to minimize the impact on the growth and development of this population. Obese adolescents presented lower quality of life and more sleeping problems when compared to the eutrophic ones / Mestrado / Saude da Criança e do Adolescente / Mestre em Saude da Criança e do Adolescente

Background: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia. There is a need for new pharmacological treatment strategies since the current antiarrhythmic drugs have a modest efficacy and may have severe side effects. Cardioversion (CV) of AF offers an opportunity to study related conditions in sinus rhythm (SR) and during AF. Since catheter ablation of AF is a symptomatic treatment, it is important to have tools for measurement of arrhythmia-related symptoms. Aims: To evaluate the effect of atorvastatin on maintaining SR after CV of persistent AF. To assess if highsensitivity C-reactive protein (hsCRP) predicts the recurrence of AF after CV in a population randomized to treatment with either atorvastatin or placebo. To quantify the symptomatic effect of left atrial catheter ablation of AF. To assess if the restoration of SR by CV, in a population with persistent AF, affects sleep apnea. Methods: Paper I: A total of 234 patients were randomized to treatment with either high dose atorvastatin or placebo prior to CV. Paper II: In a pre-specified substudy which included 128 of the patients in study I, hsCRP was analyzed before and after CV. Paper III: Umea 22 Arrhythmia Questions (U22) is a questionnaire that quantifies paroxysmal tachycardia symptoms. A total of 105 patients underwent first-time pulmonary vein isolation and answered U22 forms at baseline and follow-up 304 (SD 121) days after ablation. Paper IV: Polysomnography was performed before and after CV in 23 patients with persistent AF scheduled for elective CV. Results: Paper I: An intention-to-treat analysis with the available data, by randomization group, showed that 57 (51%) in the atorvastatin group and 47 (42%) in the placebo group were in SR 30 days after CV (OR 1.44, 95%CI 0.85–2.44, P=0.18). Paper II: HsCRP did not significantly predict recurrence of AF at 30 days. However, after adjusting for treatment with atorvastatin, hsCRP predicted the recurrence of AF (OR 1.14, 95% CI 1.01–1.27). Six months after CV, hsCRP at randomization predicted recurrence of AF in both univariate analysis (OR 1.30, 95% CI 1.06–1.60) and in multivariate logistic regression analysis (OR 1.33, 95% CI 1.06– 1.67). Paper III: The U22 scores for well-being, arrhythmia as cause for impaired well-being, derived timeaspect score for arrhythmia, and discomfort during attack detected relevant improvements of symptoms after the ablation. U22 showed larger improvement in patients undergoing only one procedure than in patients who later underwent repeated interventions. Paper IV: Obstructive sleep apnea occurred in 17/23 patients (74%), and central sleep apnea in 6/23 patients (26%). Five patients had both obstructive and central sleep apnea. SR at follow-up was achieved in 16 patients. The obstructive apnea-hypopnea index, central apneahypopnea index, and the number of patients with obstructive or central sleep apnea did not differ before and after restoration of SR. Conclusions: Atorvastatin is not a treatment option with regards to maintaining SR after CV in patients with persistent AF. HsCRP was associated with AF recurrence 1 and 6 months after successful CV of persistent AF. U22 quantifies the symptomatic improvement after AF ablation with adequate internal consistency and construct validity. Both obstructive and central sleep apneas are highly prevalent in patients with persistent AF. Obstructive sleep apneas are unaffected by the CV of AF to SR.

Bakgrund: Obstruktiv sömnapné en är sjukdom som innebär att man under nattsömnen drabbas av perioder då andningen upphör helt. För den drabbade kan detta leda till konsekvenser för den somatiska hälsan såväl som den psykiska. Tidigare forskning har även kunnat påvisa påverkan på patienternas livskvalité. Syftet med den här studien var att undersöka vilken inverkan obstruktivt sömnapnésyndrom har på hälsorelaterad livskvalitémen också psykisk hälsa hos patienter i Sverige samt om det finns skillnader mellan olika undergrupper Metod: Studien var en deskriptiv tvärsnittsstudie men kvantitativ ansats. I studien deltog 19 patienter med obstruktiv sömnapné och data samlades in via en enkät där det förutom ålder, kön, längd, vikt och dagsömnighet (Epworth sleepiness scale; ESS) också samlades in data om hälsorelaterad livskvalité (SF-12) och psykisk hälsa (HADS). Inklusionskriterier var patienter med obehandlad sömnapné som kom till Sömn- och andningcentrum på Akademiska sjukhuset för att prova ut en CPAP. Materialet analyserades med deskriptiv statistik genom bearbetning i datorprogrammet SPSS och jämförelser mellan grupper gjordes med hjälp av Mann Whitney U-test. Huvudresultat: I resultatet framkom att majoriteten av deltagarna i studien hade en sämre fysisk och psykisk hälsorelaterad livskvalité och att majoriteten upplevde att de hade ångestsymtom. Kvinnor med obstruktiv sömnapné visade mer depression- och ångestsymtom och patienter med sömnapné med samtidig fetma hade sämre fysisk hälsorelaterad livskvalité. Slutsats: Obstruktiv sömnapné är kopplat till både sämre hälsorelaterade livskvalité och psykiska symtom. Vidare forskning och ytterligare arbete med patientgruppen krävs för att förbättra vården för patienter med obstruktiv sömnapné. / Introduction: Obstructive sleep apnea is an illness which means that during nighttime-sleep, the patient experiences episodes in which she cease to breath. To the affected this can result in implications for both the somatic and the mental health. Earlier research also points towards the patient’s quality of life. The aim of this study was to examine how obstructive sleep apnea affect quality of life among patients in Sweden and if these patients experience effect on their mental health and if it’s differences between subgroups. Method: A quantitative cross sectional study was made. 19 patients with obstructive sleep apnea was participating and data was collected via forms that, beside age, sex, height, weight and day-sleepiness (Epworth sleepiness scale; ESS), also was based on the health related quality of life (SF-12) and mental health (HADS). Inclusion criteria was patients with nontreated sleep apnea that attended The Center for Sleep and Breathing at Akademiska sjukhuset to try out a CPAP. Collected data was analyzed with descriptive statistics by processing it in the computer program SPSS and comparisons between groups was made with Mann Whitney U-tests. Result: In the result it became apparent that the majority of the participants of the study had an inferior physical and mental health related quality of life and that the majority experienced anxiety. Women with obstructive sleep apnea showed more depression- and anxiety symptoms and patients with obesity had an inferior physical health related quality of life. Conclusion: Obstructive sleep apnea is tied to both health related quality of life and mental health. Further research and additional work with this patient group is needed to enhance the care of patients with obstructive sleep apnea.Keywords: Obstructive sleep apnea, quality of life, mental hea

A apnéia central do sono (ACS) está associada à insuficiência cardíaca (IC). Objetivos: analisar o comportamento do sono em pacientes com IC e ACS com IAH>15 por hora e a influência dos betabloqueadores sobre o sono. Métodos: os pacientes realizaram duas polissonografias, com nitroglicerina e placebo, ambos transdérmicos. Resultados: em média, houve aumento da saturação de oxigênio e redução dos despertares e da frequência cardíaca, quando os pacientes fizeram uso de nitroglicerina. A prevalência de ACS no grupo betabloqueador foi menor do que relata a literatura. Conclusão: a nitroglicerina teve impacto positivo sobre variáveis polissonográficas. O betabloqueador reduziu a prevalência de apnéia. / The central sleep apnea (CSA) is associated to heart failure (HF). Objectives: Analyze sleeping behavior in patients with HF and CSA with AHI > 15 per hour, and the influence of beta-blocker on the sleep. Methods: patients were submitted to two sleep studies, with transdermic nitroglycerine and placebo. Results: On the average, we observed improvement in oxygen saturation and reduction in awakening episodes and in heart rate when patients slept with nitroglycerin compared to placebo. The prevalence of CSA in patients taking beta-blocker was inferior to that described in medical literature. Conclusion: Nitroglycerin had positive impact on sleep variables. Beta-blocker reduced CSA prevalence.

Les troubles respiratoires du sommeil, notamment le syndrome d’apnée du sommeil, représentent un problème de santé publique. Ils contribuent aux symptômes diurnes comme la somnolence sévère et sont associés à des maladies chroniques.Depuis quelques années, une variété d’appareils de traitement ventilatoire a été développée pour traiter les troubles respiratoires du sommeil, principalement les maladies liées à l’obstruction de la voie aérienne supérieure (apnée obstructive) ou à la commande centrale (apnée centrale). Ces appareils fonctionnent suivant des principes différents, en raison de leurs propres algorithmes, qui sont souvent mal connus et protégés par les fabricants. Les évaluations des appareils de ventilation sont effectuées pendant les traitements cliniques chez des patients. Il est donc difficile de comparer ces différents appareils dans les mêmes conditions à cause des variabilités inter- et intra-patient. Un banc d’essai pourrait permettre de tester les réponses des appareils dans les conditions standardisées et reproductibles.Cette thèse a consisté à construire un banc d’essai qui permet de reproduire les signaux de patients et de respecter de la physiologie humaine. La réaction du banc d’essai prend aussi en compte la réaction de l’appareil à tester sur le système, i.e., ce modèle fonctionne en « boucle fermée ». Avec le banc d’essai construit, les différentes machines de pression positive continue (PPC) autopilotée disponibles sur le marché ont été évaluées pour leurs algorithmes ainsi pour leurs modes confort. De plus, trois machines de ventilation auto-asservie (ASV) ont été soumises aux différents événements respiratoires du sommeil créés par un autre modèle d’un principe similaire. Nous avons montré que les machines de PPC autopilotée ne sont pas équivalentes pour l’efficacité du traitement et la précision des données du rapport. Les modes confort pourraient éventuellement dégrader l’efficacité du traitement de PPC si la pression thérapeutique n’est pas ajustée lors de leur introduction au traitement. Pour les machines ASV, leurs réponses ne sont pas suffisantes pour normaliser la respiration et les réglages des machines peuvent influencer l’efficacité du traitement. Les résultats pourraient compléter les données cliniques et fournir une option complémentaire pour le processus futur de certification de ces dispositifs médicaux. / Sleep disordered breathing including sleep apnea is a major public health problem. It contributes to daytime sleepiness and is associated with chronic diseases. In recent years, a variety of ventilation devices have been developed with the objective of treating sleep disorders related to the upper airway obstruction (obstructive apnea) or the central command (central apnea). These devices operate with different algorithms, which are little known and protected by the device manufacturers. Since most devices are evaluated during patient treatment, it is difficult to compare them in the same conditions due to inter- and intra-patient variability. Bench test has been proposed to evaluate the device responses in standardized and reproducible conditions. This thesis was aimed to develop a respiratory bench model able to reproduce patients’ signals and also in concordance with human physiology. The bench model can take into account the pressure responses of tested devices and works in a “closed loop” setting.With this bench model, several commercially available auto-titrating continuous positive airway pressure devices were evaluated for their auto-titration algorithms as well as their pressure-relief modes. Also, three adaptive servo-ventilation devices were evaluated by subjecting various sleep disordered breathing events that were generated by another bench model of a similar principle. We demonstrated that eleven auto-titrating continuous positive airway pressure devices were not equivalent in terms of their treatment efficacy and the data accuracy in the device report. The pressure-relief modes may attenuate the efficacy if not adjusted at the time of their introduction. The responses of adaptive servo-ventilation devices were not sufficient to normalize the breathing flow and their efficacy depended on the initial settings.The current certification process of these ventilatory devices, which focus mainly on clinical aspects, may be completed by the results of our bench.

L’hypertension artérielle est un problème de santé publique majeur, au centre de nombreuses pathologies. En étudiant la prévalence de l’hypertension, nous nous sommes intéressés à deux points en particulier que nous abordons dans ce manuscrit de thèse. Le premier est l’existence d’une relation bidirectionnelle entre l’hypertension et le syndrome de l’apnée du sommeil (SAS), maladie encore sous-diagnostiquée de nos jours. Le second concerne le fait que les hommes sont plus touchés par ces deux pathologies que les femmes, mais que cette tendance s’inverse au moment de la ménopause, suggérant un rôle protecteur des hormones ovariennes. Les mécanismes sous-jacents de la mise en place de l’hypertension ont été étudiés dans différentes maladies associées (athérosclérose, obésité, diabète), mais ils restent encore méconnus dans le SAS chez la femme ménopausée. Le travail de cette thèse vise à comprendre les mécanismes à l’origine de l’hypertension artérielle chez les femmes ménopausées atteintes du SAS. Pour cela, nous avons utilisé un modèle animal d’hypoxie intermittente (HI; 21%-10% O2 ; 10cycles/h ; 8h/jour). Ce modèle simule le profil physiopathologique observé chez les patients apnéiques, en particulier avec le développement de l’hypertension artérielle. La particularité de nos travaux de recherche est l’utilisation de rats femelles ovariectomisées (OVX), permettant ainsi de mimer la ménopause, contrairement à de nombreux modèles d’HI qui utilisent le rat mâle. Par ailleurs, nous avons également regardé le rôle de l’estradiol (E2) dans le développement de l’hypertension et sur les mécanismes sous-jacents induits par l’HI. Nos principales conclusions sont que l’HI engendre une élévation de la pression artérielle et de la concentration en endothéline-1 (un vasoconstricteur), mais que ceci est réversible avec le traitement à l'E2. Au niveau de l'aorte, l'OVX engendre une augmentation du stress oxydatif, mais, de nouveau, la supplémentation en E2 renverse cet effet. Les mécanismes de réponse à l'E2 sont différents selon le protocole suivi par l’animal ; après l’HI, l’E2 réduit l'activité des enzymes pro-oxydantes alors qu’en condition de normoxie (21% O2), l’E2 augmente l'activité des enzymes anti-oxydantes. Au niveau des poumons, l’HI augmente le stress oxydatif mais l’OVX a un effet chez les animaux en normoxie uniquement. Les effets de l'E2 sur le stress oxydatif sont tissu-dépendants. Le traitement à l'E2 permet de pallier les dysfonctions vasculaires / Arterial hypertension is a major public health problem, which is at the heart of many diseases. In studying the prevalence of hypertension, we focused in two specific points that we address in this thesis manuscript. The first one is the existence of bidirectional relationship between hypertension and sleep apnea syndrome (SAS), a disease that is still underdiagnosed today. The second is that men are more affected by these two conditions than women, but this trend reverses at the time of menopause, suggesting a protective role of ovarian hormones. The underlying mechanisms of the establishment of hypertension have been studied in various associated diseases (atherosclerosis, obesity, diabetes), but they are still unknown in SAS in menopausal women. This work aims to understand the mechanisms underlying high blood pressure in postmenopausal women with SAS. For this, we used an animal model of intermittent hypoxia (IH, 21% -10% O2, 10cycles/h, 8h/day). This model presents the same pathophysiological profile observed in apneic patients, in particular with the development of arterial hypertension. The unusual feature of our study is the use of ovariectomized (OVX) female rats, thus allowing to mimic the menopause, contrary to many models of IH which use the male rats. In addition, we also looked at the role of estradiol (E2) in the development of hypertension and on the underlying mechanisms induced by IH. Our main conclusions are that although IH causes elevation of blood pressure and endothelin-1 concentration (a vasoconstrictor), it is reversible with E2 treatment. In aorta, OVX generates an increase of oxidative stress, but, again, the supplementation in E2 reverses this effect. The mechanisms of response to E2 are different according to the protocol followed by the animal; after IH, E2 reduces the activity of pro-oxidant enzymes whereas in normoxia condition (21% O2), E2 increases the activity of antioxidant enzymes. In the lungs, IH increases oxidative stress, but OVX has an effect only in female rats exposed to normoxia. The effects of E2 on oxidative stress are tissue-dependent. E2 treatment overcomes IH-induced vascular dysfunction and may be clinically relevant in the treatment of SAS in postmenopausal women

Background: Geriatric impairments and obstructive sleep apnea (OSA) are prevalent among patients with atrial fibrillation (AF) and adversely impact patient’s long-term outcomes. Little is known, however, about the association between OSA and frailty, cognitive performance, and AF-related quality of life in older men and women with AF. Objective: To examine the association of OSA with frailty, cognitive performance, and AF- related quality of life among older adults with AF. Methods: Data from the Systemic Assessment of Geriatrics Elements-AF study were used which includes participants ≥ 65 years with AF and a CHA2DS2-VASc ≥ 2. Multivariable adjusted logistic regression models were used to examine the association between OSA, as measured by the STOP-BANG questionnaire, and geriatric impairments including frailty, cognitive performance, and AF-related quality of life. Results: A total of 970 participants with AF (mean age 75 years, 51% male) were included in the analysis. Among the 680 participants without a medical history of OSA, 179 (26%) participants had low risk of OSA, 360 (53%) had an intermediate risk, and 141 participants (21%) had a high risk for OSA. Compared to those with low risk of OSA, those at intermediate or high risk for OSA were significantly more likely to be frail (aOR= 1.66, 95% CI: 1.08–2.56; aOR= 3.00, 95% CI: 1.69-5.32, respectively) after adjusting for sociodemographic, clinical, and health behavioral variables. Risk of OSA was not associated with cognitive performance and AF- related quality of life after adjusting for several potentially confounding factors. Conclusions: Older adults with AF who are at intermediate or high risk for OSA have a greater likelihood of being frail. Our findings identify a group of patients at high risk who would benefit from early screening for OSA. Future longitudinal studies are needed to assess the effect of OSA treatment on frailty, physical functioning, and QoL among patients with AF.

Abstract In Finland, the costs of stroke are approximately 1.1 billion euros annually due to long disability and hospitalization episodes. Sleep apnea is a risk factor for stroke. The prevalence of sleep apnea among stroke patients is unknown because sleep recording is not usually performed on stroke patients. There are no previous studies investigating the association of thrombolysis on the prognosis of sleep apnea. The relation between sleep apnea and cardiovascular events is still unclear. In this prospective, observational study, I recruited voluntary, consecutive ischemic stroke patients over the age of 18 years who were or were not eligible for thrombolysis treatment. The investigators did not affect the treatment and patients were not randomized to thrombolysis. The final analysis included 204 patients; of these, 110 underwent thrombolysis therapy and 94 were treated without thrombolysis. Cardiorespiratory polygraphy was carried out with a portable three-channel device (ApneaLinkPlus™, Resmed, Sydney, Australia) at the ward within 48 hours after the onset of stroke symptoms. The cardiorespiratory polygraphy was repeated at home after a six-month follow-up. Both automatic scoring and manual scoring pointed out excellent agreement in arterial oxyhemoglobin decrease of &#62; 4% (ODI4), lowest arterial oxyhemoglobin saturation (SaO2) or percentage of time spent below 90 percent saturation. The automated scoring underestimated the severity of sleep apnea, recognized poorly the type of event, and missed 18.6% of sleep apnea diagnoses. The total prevalence of sleep apnea in this study was 91.2% on admission to hospital. The stroke patients treated with thrombolysis had more, and more severe sleep apnea in the first sleep recording compared to those without thrombolysis therapy. After follow-up, the prevalence of sleep apnea still remained high, and sleep apnea was aggravated in two thirds of the stroke patients. The study patients without thrombolysis treatment had six-fold higher risk for incident sleep apnea after the follow-up. The stroke patients with thrombolysis therapy and visible stroke on CT had more nocturnal hypoxemia and higher obstructive apnea index than the patients without stroke lesion on follow-up CT 24 hours after thrombolysis treatment. The larger the ischemic stroke volume, the greater the time spent with saturation below 90%. / Tiivistelmä Aivoinfarkti on yleinen ja kansanterveydellisesti sekä taloudellisesti merkittävä sairaus, jonka aiheuttamat kustannukset Suomessa ovat noin 1.1 miljardia euroa pitkistä työkyvyttömyys- ja sairaalajaksoista johtuen. Uniapnea on aivoinfarktille altistava tekijä. Uniapnean esiintyvyys suomalaisilla aivoinfarktipotilailla ei ole arvioitavissa, koska aivoinfarktin sairastaneille ei yleensä tehdä unirekisteröintiä. Kannettavat yöpolygrafialaitteet saattaisivat olla vaihtoehto aivoinfarktipotilaiden uniapnean diagnosoinnille. Tutkittua tietoa liuotushoidon yhteydestä uniapnean ennusteeseen ei ole. Uniapnean sekä sydän- ja verisuonitapahtumien syy-yhteys on edelleen epäselvä. Rekrytoin prospektiiviseen tutkimukseeni vapaaehtoisia, peräkkäisiä yli 18-vuotiaita iskeemiseen aivoinfarktiin sairastuneita liuotushoidettuja ja liuotushoitoon soveltumattomia potilaita. Tutkimuksen lopullinen potilasmäärä oli 204, joista 110 sai liuotushoidon ja 94 hoidettiin ilman liuotusta. Kaikille potilaille tehtiin yöpolygrafia kannettavalla, kolmikanavaisella yöpolygrafialaitteella (Apnealink Plus, Resmed, Sydney, Australia) osastolla 48 tunnin kuluessa sairastumisesta. Yöpolygrafia toistettiin potilaan kotona kuuden kuukauden kuluttua. Sekä automaattitulos että manuaalisesti arvioitu unirekisteröintitulos olivat erittäin yhteneväisiä, kun arvion kohteena olivat happikyllästeisyyden neljän prosenttiyksikön suuruiset pudotukset tuntia kohti, matalin veren happikyllästeisyys tai alle 90 % happikyllästeisyyden osuus yöstä. Automaattianalyysi aliarvioi uniapnean vaikeuden, havaitsi huonosti hengityskatkosten tyypin eikä löytänyt 18,6 prosenttia uniapneadiagnooseista. Uniapnean esiintyvyys koko aineistossa oli sairaalaan tullessa 91,2 %. Liuotushoidetuilla potilailla todettiin ensimmäisessä rekisteröinnissä enemmän uniapneaa ja se oli vaikeampaa kuin ei-liuotushoidetuilla. Seurannassa uniapnean määrä pysyi edelleen korkeana ja uniapnea vaikeutui kahdella potilaalla kolmesta. Liuotushoitoon soveltumattomilla aivoinfarktipotilailla todettiin liuotushoidon saaneisiin verrattuna kuusinkertainen riski sairastua uniapneaan puolen vuoden aikana. Liuotushoidetuilla aivoinfarktipotilailla, joilla oli infarktimuutos kuvantamistutkimuksessa, oli yöllistä valtimoveren happikyllästeisyyden huononemista ja ylähengitysteiden ahtautumisesta johtuvia hengityskatkoksia enemmän kuin niillä potilailla, joilla ei todettu iskeemisiä muutoksia aivokuvantamisessa 24 tuntia liuotushoidon jälkeen. Mitä suurempi aivoinfarktin tilavuus, sitä suuremman osuuden yöstä veren happikyllästeisyys oli alle 90 %.

Commercial vehicle drivers are required to maintain Department Of Transportation medical certification which entails a Commercial Driver Medical Examination (CDME) and optimally leads to a two-year certification. The examination must be performed by a licensed "medical examiner" administered by a variety of health care providers including physicians, advanced registered nurse practitioners, physician assistants and doctors of chiropractic. Unfavorable findings in the examination can yield either a shortened medical certification period or denial of certification. Sleep disorders including sleep apnea are assessed by a single question located in the health history portion of the CDME form which is filled-out by the examinee. A positive response to this single item often prompts the medical examiner to further supplement this question using a subjective questionnaire, such as the Epworth Sleepiness Scale. This particular questionnaire generates a total score based on the examinee's subjective responses to eight items regarding the propensity to doze-off or fall asleep in different scenarios, thus indicating daytime sleepiness. Commercial drivers depend on the medical certification for their livelihood and it is hypothesized that subjective responses regarding daytime sleepiness are distorted in an effort to attain optimal DOT certification.

Nowadays, sleep disorders e.g. sleep apnea —the cessation of airflow at the nose and mouth lasting at least 10 second— are a broadly problem around the world. Direct and indirect costs associated to sleep problems are outsize and the quality of patient life is deteriorated because of it. In addition, Sleep is a fundamental part of everyday life, the lack of it or the poor quality of sleep may lead into the development of important diseases. Sleep studies are usually carried out by specialists by means of polysomnography. Polysomnography is a type of sleep study which is consisting of EEG, EOG, EMG, ECG, respiratory signals and/or many other biosignals which together can be used to determine the state of patient’s sleep and any other issue. Nowadays, visual inspection of these signals forms the “gold standard” in sleep clinics. The cost of monitoring a person overnight, the scarcity of beds available and the uncertainty of whether the results are representative of a normal nights’ sleep means that a move to home diagnostics is likely to be advantageous. Therefore, a necessity for home recorders systems capable of perform this kind of analysis has come out. A state machine based automatic scorer is developed and evaluated in Matlab by using 12 recordings of apnoeic patients from sleep heart health study (SHHS) database. By the analysis of EEG, EOG, EMG, Oxygen saturation (Sao2) and respiratory movements signals, the implemented algorithm is trained and evaluated to detect the five stages of subject’s sleep (Wake, N1, N2, N3, or REM) as well as apnoeic episodes according to guidelines from American Academy of Sleep Medicine (AASM). In the final evaluation of algorithms, the automatic scorer achieved 74±5.27% accuracy for all five stages and Cohen’s kappa of 0.5 for the overall set of 12 patients, being the accuracy better for healthier subjects and reaching in this case 78±4.05%. The analysis of the sleep apnea concluded with a sensitivity of 47.08%, a specificity of 83.38%, and an accuracy of 78.1%. Differences in the performance among patients according to their apnea/hypopnea index were significant.   Key Words: Polysomnography, AASM, Sleep apnea/hypopnea.