Thesis (Ph.D.)--University of Wollongong, 2008. / Typescript. Includes bibliographical references: leaf 106-126.

Thesis (M.S.)--Oregon State University, 2004. / Includes bibliographical references. Also available online (PDF file) by a subscription to the set or by purchasing the individual file.

Thesis (Ph.D.) in Psychology--University of Maine, 2008. / Includes vita. Includes bibliographical references (leaves 355-393).

Thesis (Ph. D.)--Drexel University, 2006. / Includes abstract and vita. Includes bibliographical references (leaves 121-134).

Thesis (M.S.)--Oregon State University, 2004. / Includes bibliographical references.

Submitted in partial compliance with the requirements of the Master’s Degree in Technology: Homoeopathy, Durban University of Technology, Durban, South Africa, 2018. / Background : Excessive daytime sleepiness (EDS) is the inclination or compulsion to fall asleep whilst intending to stay awake; it is believed to negatively affect occupational and social functioning and may be a predisposition towards accidents (Hayley et al. 2014), low productivity and interpersonal problems (Fong et al. 2005). Excessive daytime sleepiness is one of the most common sleep-related symptoms and it affects an estimated 20% of the population (Pagel .2009). The causes of EDS are numerous and include intrinsic sleep disorders (e.g. narcolepsy, obstructive apnoea/ hypopnea syndrome, idiopathic hypersomnia), and extrinsic disorders (Banerjee et al. 2004). Sleep deprivation is probably the most common cause of excessive daytime sleepiness. This clinic trial intended to evaluate the effectiveness of a homoeopathic complex (Nux moschata D6, Phosphoricum acidum D30, Helliborus niger D6, Opium D30) in the management of EDS in terms of the Epworth Sleepiness Scale (Johns, 1991) and Stanford Sleepiness Scale (Hoddes et al. 1973). And this randomised, double-blind placebo controlled study also aimed to provide a safe and effective alternative therapy for EDS. Aim of the study : The objective of this study was to determine the efficacy of a homoeopathic complex (Nux moschata D6, Phosphoricum acidum D30, Helliborus niger D6, Opium D30) and placebo in the management of EDS in terms of the Epworth Sleepiness Scale (ESS) and the Stanford Sleepiness Scale (SSS). Materials and Methodology : A sample group of 35 participants was selected voluntarily to conduct the study on basis of the inclusion and exclusion criteria. The participants were than randomly divided into two groups; a treatment group consisting of 23 participants and a placebo group consisting of 12 participants. Each participant had to attend three consultations in total with the researcher over a period of four weeks at the Durban University of Technology (DUT) Homoeopathic Day Clinic. At the first consultation a comprehensive case history (appendix F) was taken and physical examination (appendix E) was performed by the researcher but no medication was handed at that point. At each consultation the participants with the help of the researcher completed the Epworth Sleepiness Scale (ESS), and the seven days’ baseline Stanford Sleepiness Scale (SSS) was handed to the participants at the first and second consultation which the participants completed without the help of the researcher throughout the trial till their last consultation. Results : Results from the two measuring tools were statistically analysed with SPSS version 24.0. the participant’s level of sleepiness improved in both the treatment group and the placebo group. Intra-group analyses of ESS means revealed that both groups improved significantly over time, intergroup ANOVA analysis however revealed no significant differences between the groups. Section analyses however using the Fisher’s Exact Tests did reveal statistically significant differences within certain variables at some points of the study. Intra-group analyses of SSS data revealed no statistically significant change in SSS scores over the three weeks in both the Homoeopathic Complex and the Placebo Groups, as well as the Inter-group Fischer’s Exact tests revealed no statistically significant differences between the groups. Conclusion : Barring a few exceptions described in Chapter 4 & 5 it can be concluded from the results of the study that statistically the Homoeopathic complex (Nux moschata D6, Phosphoricum acidum D30, Helliborus niger D6, Opium D30) was not superior to placebo in the treatment of EDS. The data shows that both the Homoeopathic Complex and the placebo interventions had a positive effect on EDS and were effective in improving the level of excessive daytime Sleepiness. Irrespective of the general lack of statistical significance between groups a closer analysis of the intragroup and inter-group data does reveal a trend suggesting clinical significance in support of the effectiveness of the homoeopathic complex in the treatment of EDS however this needs to be further explored and confirmed in subsequent studies. / M

Made available in DSpace on 2015-07-22T20:50:02Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-05-27. Added 1 bitstream(s) on 2015-08-11T03:25:23Z : No. of bitstreams: 1 Publico-00193a.pdf: 1325647 bytes, checksum: a31afc297a749af25cd92223595f7e5b (MD5). Added 1 bitstream(s) on 2015-08-11T03:25:23Z : No. of bitstreams: 2 Publico-00193a.pdf: 1325647 bytes, checksum: a31afc297a749af25cd92223595f7e5b (MD5) Publico-00193b.pdf: 1348484 bytes, checksum: 8ca1627dc2bafe277d2265dbe4140720 (MD5). Added 1 bitstream(s) on 2015-08-11T03:25:24Z : No. of bitstreams: 3 Publico-00193a.pdf: 1325647 bytes, checksum: a31afc297a749af25cd92223595f7e5b (MD5) Publico-00193b.pdf: 1348484 bytes, checksum: 8ca1627dc2bafe277d2265dbe4140720 (MD5) Publico-00193c.pdf: 1945361 bytes, checksum: 8afe9c00c2c746523142173e1fa6ac24 (MD5). Added 1 bitstream(s) on 2015-08-11T03:25:24Z : No. of bitstreams: 4 Publico-00193a.pdf: 1325647 bytes, checksum: a31afc297a749af25cd92223595f7e5b (MD5) Publico-00193b.pdf: 1348484 bytes, checksum: 8ca1627dc2bafe277d2265dbe4140720 (MD5) Publico-00193c.pdf: 1945361 bytes, checksum: 8afe9c00c2c746523142173e1fa6ac24 (MD5) Publico-00193d.pdf: 899968 bytes, checksum: f23674414f4215749c45f33e0cea327e (MD5) / Introdução: A Escala de Distúrbios do Sono em Crianças (EDSC) é um instrumento com 26 itens para a avaliação do sono em crianças com idades entre 3 e 18 anos. Ela é capaz de diferenciar os seguintes distúrbios: distúrbios de início e manutenção do sono, distúrbios respiratórios do sono, distúrbios do despertar, distúrbios da transição sono–vigília, sonolência excessiva diurna e hiperhidrose do sono. O objetivo deste estudo foi traduzir, adaptar culturalmente e validar a escala para o Português do Brasil. Método: O estudo foi realizado em duas fases: (1) tradução, retrotradução (back translation), pré-teste e cálculo do tamanho da amostra; (2) validação: confiabilidade (Alfa de Cronbach); validade convergente (Correlação de Pearson) e validade discriminante (comparação entre a pontuação da escala e os resultados polissonográficos). Cem crianças, com idades entre 3-18 anos, acompanhadas de seus pais e/ou responsáveis, participaram das fases. Polissonografias foram realizadas para o cálculo do tamanho da amostra e validação. Resultados: As instruções da escala e seus itens foram adaptados, levando-se em consideração as equivalências semânticas, conceituais, experienciais e culturais. A comunicação visual também foi adaptada para a preferência e hábitos da população brasileira, resultando em um questionário com instruções claras e de fácil reconhecimento das perguntas e das possíveis respostas. A análise de confiabilidade mostrou valor maior que 0,55. Há validade convergente razoável. A validade discriminante verificada através do uso do estudo polissonográfico para presença dos Distúrbios Respiratórios do Sono (DRS) foi 8,9 atestando a validade discriminante somente para DRS. As três perguntas da escala sobre DRS foram suficientes para predizer essa condição. Conclusão: A Escala de Distúrbios do Sono em Crianças foi traduzida, adaptada e validada para o português do Brasil, apresentando consistência interna, validade convergente e discriminante. Pode ser utilizada em estudos populacionais para predizer os DRS em crianças. / Introduction: The Sleep Disturbance Scale for Children (SDSC) is a 26-item instrument for evaluating sleep among children aged 3-18 years. It differentiates among conditions such as disorders of initiating and maintaining sleep, sleep breathing disorders, disorders of arousal, sleep-wake transition disorders, excessive somnolence, and sleep hyperhydrosis. The aim os this study was to translate, culturally adapt, and validate it for Brazilian Portuguese. Method: The study was carried out in two phases: (1) forward translation, back translation, pretesting, and calculation of sample size; (2) validation: reliability (Cronbach´s alpha), convergent analysis (Pearson correlation), and discriminatory validity (comparing scores of the test with the results of polysomnography). One hundred children, aged 3-18 years, accompanied by their parents and/or guardians participated in the phases. PSG studies have been done to calculate the sample size and validation. Results: The scale instructions and items were adapted regarding semantic, experiential, conceptual, and cultural equivalence validation. The scale structure related to visual communication was also adapted to Brazilian population preference and habits, and this resulted in a chart with clear instructions and easy recognition of the statements and possible responses. Reliability analysis showed values greater than 0.55. There has been reasonable convergent validity only for SDB. Discriminatory validity using the PSG study for positive sleep-disordered breathing (SDB) was 8.9, attesting discriminatory validity only for SDB.The three questions of the scale can screen SDB. Conclusion: The SDSC was translated and validated for Brazilian Portuguese, and it presented internal consistency, convergent and discriminatory validity. It can be used in population-based studies in order to screen sleep-disordered breathing in children. / TEDE / BV UNIFESP: Teses e dissertações

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A qualidade do sono à um poderoso preditor de saÃde, pois està relacionado com o risco para problemas de saÃde crÃnicos, como diabetes mellitus, hipertensÃo, obesidade e a SM. Esta à uma agregaÃÃo de problemas cardiometabÃlicos que eleva substancialmente a morbi-mortalidade humana independente da causa. O grau da relaÃÃo entre SM e a quantidade/qualidade do sono jà està estabelecido em idosos, pessoas de meia idade, operÃrios e atà crianÃas, mas, em adultos jovens, aparentemente saudÃveis, ainda à desconhecido. Dessa forma, o objetivo geral desta pesquisa foi analisar a relaÃÃo entre SM e indicadores de saÃde com a qualidade do sono de universitÃrios de Fortaleza-CearÃ. Pesquisa observacional, quantitativa, com desenho transversal. Foram avaliados 701 universitÃrios de 24 cursos das seis Ãreas de conhecimento da UFC entre marÃo e junho de 2011 em duas etapas. Na primeira, os alunos preencheram um instrumento sobre indicadores sociodemogrÃficos, de saÃde e uma versÃo validada e adaptada, aos padrÃes brasileiros, do Pittsburgh Sleep Quality Index. Numa data posterior, com os alunos em jejum por doze horas, coletaram-se os seguintes dados bioquÃmicos: glicemia venosa de jejum, triglicerÃdeos, LDL-C, HDL-C e o cortisol. Nessa mesma ocasiÃo, foram mensurados pressÃo arterial, circunferÃncia abdominal, peso corporal e altura. Analisaram-se os componentes da SM consoante o critÃrio da NCEP-ATP III. Os dados sofreram tripla digitaÃÃo e foram analisados no software STATA versÃo 8.0. Parcela substancial dos universitÃrios eram maus dormidores (95,2%) enquanto uma minoria tinha SM (1,6%). Os alunos com menor duraÃÃo do sono foram os da Ãrea de agrÃrias (6,24h DP 1,23h) e tecnologia (6,29h DP 1,24) (p=0,04). Grande maioria dos alunos maus dormidores (39%) tinha uma renda supeior a seis salÃrios mÃnimos (p=0,03). Os universitÃrios que moravam sozinhos (IC-95%- 1,03-1,08) (p<0,001) ou com os pais, (p<0,020), com idade &#8805; 30 anos (IC95%-1,02-1,07) (p<0,001), com mÃdio risco para etilismo (IC95%-1,03-1,07) (p<0,001) e os fumantes diÃrios (IC95%-1,02-1,06) (p<0,001) apresentavam uma chance superior a 1,05, 1,05,1,05, 104 e 1,05, respectivamente, de possuir mà qualidade do sono. Praticamente todos os alunos com cortisol elevado (96,1%) tinham sono com eficiÃncia de 65-74% (p=0,02). Hà um aumento de 5% na probabilidade de universitÃrios maus dormidores apresentarem SM (RP=1,05; IC 95%:1,03-1,07) (p=0,013). Estes alunos tambÃm possuem uma chance superior a 1,05 de apresentar glicemia elevada (RP=1,05; IC95%-1,03-1,07) (p<0,001). NÃo houve correlaÃÃo estatisticamente significante entre os componentes da SM isolados e o PSQI. Portanto, os universitÃrios maus dormidores possuem uma probabilidade maior de apresentar SM comparativamente aos bons dormidores. à importante que os profissionais de saÃde considerem a avaliaÃÃo da qualidade do sono desses jovens na prevenÃÃo e combate à SM, assim como na elaboraÃÃo de estratÃgias individualizadas para a promoÃÃo da saÃde deles. / The quality of sleep is a powerful predictor of health, because it is related with the risk for chronic health problems, such as diabetes, hypertension, obesity and metabolic syndrome. This is an aggregation of cardio-metabolic problems that substantially increases human morbidity and mortality from any cause. The level of relationship between MS and the quantity/quality of sleep is already established in the elderly, middle-aged people, workers and even children, but in young adults, apparently healthy, is still unknown. Thus, the objective of this research was to analyze the relationship between MS and health indicators with the quality of sleep university in Fortaleza-CearÃ. Observational quantitative research using cross-sectional design. We evaluated 701 college students from 24 courses in the six areas of knowledge of the UFC between March and June 2011 in two stages. In the first, students filled an instrument on socio-demographic and health indicators and a validated version adapted to Brazilian standards from the Pittsburgh Sleep Quality Index. In a posterior date with students fasted for twelve hours, we collected the following biochemical data: fasting venous plasma glucose, plasma triglycerides, LDL-C, HDL-C and cortisol. On the same occasion, we measured blood pressure, waist circumference, height and weight. We analyzed the components of MS based on the NCEP-ATP III. Data were triple typed and analyzed in STATA software version 8.0. A substantial amount of the college students were poor sleepers (95.2%) while a minority had MS (1.6%). Students with shorter sleep duration were in the area of land sciences (6.24h SD  1.23 h) and technology (6.29 h SD  1.24) (p=0.04). Most of the poor sleepers students (39%) had an income above six minimum wages (p=0.03). The students who lived alone (95% CI - 1.03-1.08) (p<0.001) or with parents (p<0.020), age &#8805; 30 years (95% CI - 1.02-1.07) (p<0.001), with average risk for alcoholism (95% CI - 1.03-1.07) (p<0.001) and daily smokers (95% CI - 1.02-1.06) (p<0.001) presented a chance of having poor sleep quality more than 1.05, 1.05, 1.05, 1.04 and 1.05, respectively. Virtually all students with elevated cortisol levels (96.1%) had sleep efficiency with 65-74% (p=0.02). There is a 5% increase in the probability of poor sleepers college students develop MS (PR = 1.05, 95% :1,03-1, 07) (p = 0.013). These students also have a chance greater than 1.05 to present high glucose (PR=1.05; 95% CI â 1.03-1.07) (p<0.001). There was no statistically significant correlation between the individual components of MS and the PSQI. Therefore, the college students poor sleepers have a higher relative risk of presenting SM compared to good sleepers. It is important that health professionals consider the assessment of sleep quality of these young people to prevent and combat MS, as well as in developing individualized strategies to promote their health.

Objetivo: Determinar a qualidade de sono de adultos jovens com fissura labiopalatina operada, aferida por meio de três modalidades de questionários validados na literatura, e sua correlação com as variáveis: sexo, índice de massa corpórea (IMC), circunferência abdominal (CA), circunferência cervical (CC), tipo de oclusão (classificação de Angle), cirurgia ortognática (CO), cirurgia nasal (CN), retalho faríngeo (RF) e tipo de fissura (TF). Método: Foram avaliados, prospectivamente, 90 pacientes, com fissura de palato±lábio reparada, com idade média de 24±3 anos (20 a 29), sendo 49 do sexo masculino e 41 do sexo feminino. Dados como raça, peso e altura (IMC), tipo de fissura e cirurgias realizadas (cirurgia nasal, ortognática e retalho faríngeo) foram coletados dos prontuários. Todos pacientes realizaram exame físico, com medidas de CA, CC e classificação de Angle. A qualidade do sono foi investigada pelos questionários: Índice de Qualidade de Sono de Pittsburgh (IQSP), Escala de Sonolência de Epworth (ESE) e Questionário de Berlin (QB). A associação entre as variáveis foi feita por meio do teste do qui-quadrado, sendo aceitos como significantes valores de p<0,05. Local de execução: Laboratório de Fisiologia e Setor de Prótese do HRAC/USP. Resultados: Com a aplicação dos questionários IQSP, ESE e QB observou-se que 62% dos pacientes estudados apresentaram qualidade do sono ruim, 26% apresentaram sonolência diurna excessiva e 33% apresentavam alto risco para síndrome da apneia obstrutiva do sono (SAOS). Observou-se correlação positiva entre alto risco para SAOS, avaliado pelo QB, e as variáveis IMC e RF. Para as demais, não se demonstrou correlação estatisticamente significante. Conclusão: Com base nos resultados obtidos, conclui-se que uma parcela importante dos indivíduos com fissura labiopalatina operada apresentam qualidade do sono ruim, sonolência diurna excessiva e alto risco para SAOS. Os questionários se mostraram instrumentos de fácil aplicação e permitiram obter um panorama geral da qualidade de sono na população estudada, a ser investigada em maior profundidade com o uso da polissonografia, o método padrão-ouro para o diagnóstico das desordens respiratórias do sono / Objectives: To investigate sleep quality in young adults with repaired cleft lip and palate, measured by three different types of validated questionnaires, and its correlation with gender, body mass index (BMI), waist circumference (WC), neck circumference (NC), type of occlusion (Angle classification), orthognathic surgery (OS), pharyngeal flap (PF), nasal surgery (NS) and cleft type (CT). Methods: Ninety patients were analyzed, aged 20-29 years, 49 male and 41 female. The assessment of sleep quality was performed by applying three questionnaires: Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and Berlin Questionnaire (BQ). Results were correlated with gender, BMI, WC, NC, previous OS, PF, NS, CT and type of occlusion (Angle classification). The association between variables was performed using the chi-square test and p<0.05 was considered significant. Setting: Laboratory of Physiology and Clinics of Oral Rehabilitation, HRAC/USP. Results: PSQI, ESS and BQ have shown that 62% of the patients analyzed exhibited poor sleep quality, 26% had excessive daytime sleepiness and 33% had high risk for obstructive sleep apnea (OAS). Statistical analysis showed a positive correlation between high risk for OAS and BMI and PF was observed. The other variables analyzed did not correlate with the results obtained in the questionnaires. Conclusion: Based on these results, it is possible to conclude that a significant number of young adults with repaired cleft palate presented poor sleep quality, excessive daytime sleepiness and high risk for OSA. Questionnaires are tools for easy application and allowed to get an overall view of the sleep quality of the cleft population, to be further investigated by using polysomnography, the gold-standard method for the diagnosis of sleep respiratory disorders

Background and Significance: Narcolepsy is a chronic neurological disorder. These patients experience various psychiatric and physical comorbid diseases and mortality at an increased rate compared to the general population. Additionally, patients with narcolepsy experience approximately a doubling of various annual healthcare related facility visits, transactions, and costs comparatively. Narcolepsy with cataplexy is generally believed to be more prevalent than narcolepsy without cataplexy. However, incidence and prevalence estimates of narcolepsy (with or without cataplexy) vary widely with few large epidemiological studies conducted worldwide and none in the U.S evaluating these proportions in both children and adults utilizing a large health care claims database. One of the main mechanisms underlying narcolepsy, the destruction of hypocretin neurons, is not clear. Two of the more noted hypotheses for this pathology are autoimmune and infection based triggers in allele carrier patients. These have been highlighted since narcolepsy diagnoses increased following the late 2000s influenza vaccinations, especially across Europe. Specific influenza and streptococcal infections have also been considered. Large U.S. healthcare claims database investigations of the association between specific infections and development of narcolepsy were not found in the published scientific literature. Our goals were to enhance the knowledge regarding the epidemiology and possible infection triggers of narcolepsy. The information gained may aid in the overall understanding of the condition, the possible vulnerable populations, and lead to hypotheses regarding which subpopulations research should be focused upon and those triggers that may be avoided or reduced in exposure. Methods: The Truven Health MarketScan Commercial Dissertation Database (THMCDD) was used to estimate prevalence and incidence of narcolepsy, with and without cataplexy, by age groups, gender, and region among patients under age 66 with continuous enrollment for years 2008-2010. THMCDD contains health claims information for over 18 million people. Prevalence was expressed as cases/100,000 persons. Average annual incidence (using varying criteria for latency between the diagnostic tests, polysomnograph coupled with MSLT, and the diagnosis) was expressed as new cases/100,000 persons/year. Subsequently, we conducted a case-control study to assess the differences in respiratory infections between patients with incident narcolepsy diagnosis and controls. Continuously enrolled patients under age 66 were included. Cases of narcolepsy occurring from July 1, 2009 through December 31, 2010 were included based on two diagnosis criteria (using varying criteria for latency between diagnosis and the diagnostic tests). Non-narcolepsy controls were frequency matched on look-back time by assigning an index date equal to a case diagnosis date. Occurrence of prior respiratory infections was compared between cases and controls based on narcolepsy criteria and four different time periods pre-index date. Infections were grouped into 9 types based on pathogen and clinical manifestation. Results: From 2008 through 2010, there were 8,444,517 continuously enrolled patients and 6,703 diagnosed with narcolepsy (prevalence overall:79.4/100,000; without cataplexy:65.4/100,000; with cataplexy: 14.0/100,000). Based on the 3 definitions of incidence, overall average annual incidence was 7.67, 7.13, and 4.87/100,000 persons/year. Incidence for narcolepsy without cataplexy was generally several times higher than narcolepsy with cataplexy. Prevalence and incidence were approximately 50% greater for females compared to males across most age groups. Prevalence was highest among the 21-30 age group, with incidence highest among enrollees in their early 20s and late teens. Regionally, the North Central U.S. had the highest prevalence and incidence, while the West was the lowest. For the case-control study, Adjusted odds ratio (aOR) increases were statistically significant for Group 5 (acute respiratory infections), Group 8 (other pneumonias, bronchopneumonia, etc.) and Group 9 (influenzas) across various time periods pre-index date and for both narcolepsy criteria. Overall, the most significant aORs were for acute respiratory infections during the 3 to 15 months pre-index date for both narcolepsy diagnosis criteria (aOR=1.73, 95% 1.52 to 1.98 and aOR=1.83, 95% CI 1.57 to 2.19). The aORs for acute respiratory infections were approximately 50% greater among females than males. Conclusion: We observed higher prevalence and incidence of narcolepsy compared to most previous studies. Females were associated with approximately 50% increased proportions compared to males. We also found that the greatest prevalence and incidence of narcolepsy occurred in patients in their early 20s, and those residing in the North Central region of the U.S. Perhaps most striking was the observation of much greater proportions of narcolepsy without cataplexy compared to narcolepsy with cataplexy. In the case-control assessment, we found increased occurrences of acute respiratory infections, pneumonias, and influenza prior to incident narcolepsy diagnosis, compared to controls. Generally, these rates appeared higher for females than males and occurred for both narcolepsy diagnosis criteria. Additionally, these associations were observed in the infection assessment periods 3 to 15 months and 6 to 18 months prior to incident narcolepsy diagnosis. Increased awareness and early notification among healthcare providers for signs and symptoms of narcolepsy is critical in helping this population of patients manage this burdensome condition. Also, the identification of potential narcolepsy triggers by certain infections may aid in the understanding of the disease. These findings may have implications in the understanding of mechanisms and causation of other acute onset neurological disorders. Our observations of consistently increased risk of incident narcolepsy related to recent previous viral respiratory infections and the inconsistent results for bacterial infections require additional study to confirm these findings.