Bakgrund: Sömnen är ett av människans viktigaste basala behov och är en förutsättning för kroppens återhämtning. Hos personer med demenssjukdom råder hög förekomst av sömnstörningar, vilket kan leda till negativa konsekvenser. Det är sjuksköterskors ansvara att bedöma och identifiera eventuella sömnstörningar för att sedan kunna planera och utföra eller initiera lämpliga metoder som kan främja sömn. Syfte: Syftet var att beskriva hur sjuksköterskor kan främja sömn hos personer med demenssjukdom. Metod: Metodvalet kom att bli en litteraturstudie som följer Polit och Becks (2016) niostegsstruktur. Databaserna CINAHL och PubMed användes vid sökning efter relevanta artiklar. Databassökningen genererade tio vetenskapliga artiklar varav åtta kvantitativa, en kvalitativ samt en mixed-method. Resultat: Databearbetningen och analysen gav ett resultat med följande tre huvudteman: stimulering av kroppsliga funktioner, utbildning riktad till vårdgivare och parallell genomföring av flera sömnfrämjande metoder samt två subteman. Slutsats: Sjuksköterskor kan främja sömn hos personer med demenssjukdom genom att utföra eller initiera olika sömnfrämjande metoder: fysisk aktivitet, massageterapi, akupressur, ökad ljusexponering, aromaterapi, olika utbildningsprogram för vårdgivare eller genom att parallellt genomföra flera sömnfrämjande metoder.

Out of 60 million Americans suffering from sleep disorder, an estimated 18 million have sleep apnea. According to the U.S. Department of Health & Human Services, sleep apnea is a chronic condition that disrupts a patient’s sleep. While the annual cost of treating sleep apnea patients in the United States is approximately $3.18 billion (including screening costs) it is estimated that untreated sleep apnea may cause $3.4 billion in additional medical costs. A polysomnography (PSG) is an all-night sleep study which monitors various physical functions during sleep including electrical activity of the heart, brain wave patterns, eye movement, muscle tone, body movements, and breathing. It is currently, the most accurate and sophisticated test for the diagnosis of sleep-disordered breathing (SDB), but also, the most expensive. The cost of an overnight sleep study is estimated between $900 and $3,000. In addition, the PSG is not mobile and has to be administered outside a patient’s home. The Long QT Syndrome (LQTS) is a rhythm disorder that causes erratic (unpredictable) heartbeats. The LQTS has been linked to patients with the most severe form of sleep apnea. If LQTS is left untreated, sudden cardiac death may occur. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2014. / FAU Electronic Theses and Dissertations Collection

Diversos trabalhos têm explorado a hipótese de participação do sistema imunológico, via liberação de citocinas, na fadiga e nas alterações no padrão de sono, em adultos com câncer. Entretanto, estudos com crianças e adolescentes acometidos por neoplasias malignas são escassos internacionalmente e ausentes no Brasil. O objetivo desta pesquisa foi investigar os níveis plasmáticos das citocinas IL-8, IL-1?, IL-6, IL-10, TNF-?, IL-12p70 e correlacioná-los com a fadiga, o padrão de sono e a qualidade de vida (QV) em crianças e adolescentes com câncer. Trata-se de um estudo quantitativo, do tipo descritivo, transversal, realizado no Serviço de Oncologia Pediátrica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, de janeiro de 2013 a março de 2014. Foram coletados 4ml de sangue para dosagem das citocinas, além de dados clínicos para caracterização dos pacientes e identificação de variáveis confundidoras para a fadiga, alterações no padrão de sono e citocinas. A técnica utilizada para dosagem das citocinas foi a citometria de fluxo. A amostra final foi composta de 33 crianças e adolescentes hospitalizados, com idade entre 8 e 18 anos. Considerando os 14 domínios do instrumento utilizado para avaliar a fadiga (PedsQLTM), seisse correlacionaram entre si, o que confirma que o mesmo paciente pode experenciar a fadiga de forma multidimensional. Os resultados mostraram ainda uma correlação negativa entre os escores da \"fadiga geral\" e a citocina IL-1? (r=-0,361, p=0.039). Observou-se uma correlação entre o padrão de sono e as citocinas IL-10 e IL-12p70. A eficiência do sono (r=0.452, p=0.018) e a porcentagem do sono (r=0.384, p=0.048) se correlacionaram positivamente com a citocina IL-10. Enquanto que a duração do sono se correlacionou positivamente com a citocina IL-12p70 (r=0.604, p=0.001). Observou- se uma correlação negativa entre a IL-1? e o escore total de qualidade de vida (r=- 0.382, p=0.028). Os resultados dessa pesquisa indicam fortemente que pode haver uma relação entre as citocinas com a fadiga, o padrão de sono e a QV em crianças e adolescentes com câncer / Several studies have explored the hypothesis of involvement of the immune system in the fatigue and changes in sleep patterns in adults with cancer via release of cytokines. However, studies with children and adolescents affected by malignant neoplasms are globally scarce and absent in Brazil. The objective of this research was to investigate the plasma levels of IL-8, IL-1?, IL-6, IL-10, TNF-?, IL-12p70 and correlate them with fatigue, sleep patterns and quality of life (QoL) in children and adolescents with cancer. This is a quantitative, descriptive cross-sectional study, conducted at the Pediatric Oncology Service at the University Hospital of the Ribeirao Preto School of Medicine, from January 2013 to March 2014. It was collected 4ml of blood for measurement of cytokines, and clinical data for patients characterization and identification of misleading variables for fatigue, sleep patterns and cytokines. The technique used for the cytokines dosage was flow cytometry. The final sample consisted of 33 hospitalized children and adolescents aged between 8 and 18 years. Considering the 14 domains of the instrument used to assess fatigue(PedsQLTM), six correlated with each other, confirming that the same patient may experience fatigue in a multidimensional way. The results also demonstrated a negative correlation between the scores of general tiredness and cytokine IL-1? (r=- 0.361, p=0.039). There was a correlation between the sleep pattern and IL-10 and IL- 12p70 cytokines. The sleep efficiency (r=0.452, p=0.018) and percentage of sleep (r=0.384, p=0.048) were positively correlated with IL-10 cytokine. While the duration of sleep was positively correlated with the cytokine IL-12p70 (r=0.604, p=0.001). There was a negative correlation between IL-1? and quality of life total score (r=- 0.382, p=0.028). The results of this research indicate that there may be a relationship between cytokines and fatigue, sleep patterns and QoL in children and adolescents with cancer

Les pathologies dépressives se définissent par des symptômes hétérogènes qui incluent les troubles du sommeil comme facteur de comorbidité. La comorbidité des troubles du sommeil dans la dépression est habituellement marquée d’une diminution de sommeil lent, d’une augmentation de sommeil paradoxal et d’une fragmentation du sommeil, tant chez l’Homme qu’au sein des modèles animaux de la pathologie.Le premier objectif de ce travail expérimental a été de caractériser les troubles du sommeil suspectés dans un modèle animal de souris adultes rendues anxio/dépressives par l’administration chronique de corticostérone. Les résultats obtenus ont montré qu’une administration chronique de corticostérone induit une hypersomnie avec augmentation de sommeil lent, une diminution du sommeil paradoxal et une fragmentation des états de veille et de sommeil. La description du sommeil du modèle de souris CORT enrichit la classification actuelle en modélisant des troubles du sommeil atypiques présents chez près de 20% des sujets dépressifs. Le second objectif a été de corriger ces troubles du sommeil par l’administration chronique d’antidépresseurs classique (fluoxétine) et innovant (agomélatine). Si chacune des molécules antidépressives testées a révélé un effet bénéfique vis-à-vis de la somnolence des souris CORT, l’agomélatine a montré sa supériorité pour prévenir l’inhibition du sommeil paradoxal induite par la corticostérone et accentuée par la fluoxétine. / Depressive disorders are definded by heterogeneous symptoms that include sleep disorders such as comorbid condition. Comorbidity of sleep disorders in depression is usually marked by a decrease in NREM sleep, increased REM sleep and sleep fragmentation, both in humans and within animal models of the disease. The first aim of this experimental work was to characterize sleep problems suspected in an animal model of adult mice rendered anxio/depressive by chronic administration of corticosterone. The results showed that chronic administration of corticosterone induced hypersomnia with increased NREM sleep, decreased REM sleep and led to fragmented sleep/wake states. The description of the sleep cycle of the CORT mouse model of anxiety/depression enriches the current classification by modeling atypical sleep disorders present in nearly 20% of the depressed subjects. The second aim was to correct these sleep disorders by chronic administration of classical (fluoxetine) and innovative (agomelatine) antidepressants. If each antidepressant molecules tested showed a beneficial effect towards drowsiness of CORT-treated mice, agomelatine has shown its superiority to prevent the inhibition of REM sleep induced by chronic corticosterone which was enhanced by chronic fluoxetine treatment.

養分與睡眠的關聯是一個在睡眠科學上極具爭議性的課題。減低攝取蛋白質和碳水化合物會導致失眠，增加攝取總脂肪和油份會導致失眠。維生素和礦物質也被認為與失眠有關。此論文嘗試通過研究一般香港中國人的食習慣和失眠情況，進一步了解營養物質與失眠之間的關聯。此論文將會深入探討營養成分對失眠的影響。 / 背景和目標： 失眠是常見的睡眠障礙和公共衛生問題。失眠可分為三個亞型：難以啟動睡眠(DIM)、難以維持睡眠(DMS) 和過早覺醒類型(EMA)。然而，有關的研究多着重於外國人口。針對研究香港中國人口的失眠情況與營養成分關聯的資料相對比較少。此研究目的是找出在香港中國人口失眠與營養成分之間的關聯，有助研究失眠與營養成分之間的機制。據推測，失眠與營養成分之間於香港中國人口有關聯。香港中國人口失眠症患者的食特點跟其他地區人口會有所不同。失眠的三個亞型和營養成分之間的關聯會有所不同。 / 研究方法： 十三間學校被邀請進行了橫斷面研究。一百三十八位青少年(六十一男、七十七女) 以及一百七十三位成年人（八十四男、 八十九女）應邀參加這項研究。有關日常營養攝取量的資料，以自行申報的三天膳食記錄表取得。有關失眠症狀的評估，以自行申報的標準睡眠問卷（ISI）獲得。有關焦慮和抑鬱的評估，以自行申報的醫院焦慮抑鬱量表（HADS）取得。 / 研究結果與結論：分析顯示，失眠與減低攝取維生素A有關聯(成年人組別p = 0.02、青少年組別p = 0.01)，與減低攝取維生素D有關聯(成年人組別p = 0.02、青少年組別p = 0.01）和與減低攝取維生素E有關聯(成年人組別p = 0.02、青少年組別p = 0.01)。失眠綜合症與難以啟動睡眠(DIM)、難以維持睡眠(DMS) 和過早覺醒類型(EMA) 與減低攝取飽和脂肪、碳水化合物、維生素A 、維生素D、和維生素E有關聯。此研究證實了香港中國人口的失眠與營養成分之間有關聯。證實了香港中國人口失眠症患者的食特點跟其他地區人口有不同。證實了失眠的三個亞型和營養成分之間的關聯有不同。我們於這項研究成功找到與失眠有關的營養成分，有助研發以天然營養物質來解決香港中國人的失眠問題。 / The association of nutrients and sleep is a debatable question in sleep science. Some literatures suggest that sleep is enhanced by certain nutrients, while some other literatures suggest that sleep is deprived by certain nutrients causing insomnia. This dissertation attempts to address the association between nutrients and insomnia of Hong Kong Chinese Population. / Background and Objective: Insomnia is a common sleep disorder and a major public health issue. Insomnia could be classified into three subtypes: Difficulty in Initiating Sleep (DIS), Difficulty in Maintaining Sleep (DMS), and Early Morning Awakening (EMA). Vitamins and minerals are thought to be associated with insomnia. From literature reviews, studies in western population and in Asian population found that protein and carbohydrates, fat and oil are associated with insomnia. Insomnia could be affected by the availability of nutritional substances in individual’s diet. However, limited studies are done in Hong Kong Chinese population on the association between insomnia and nutrient components. The aim of this study is to find out the association between insomnia and nutrient components in-take in Hong Kong Chinese population. / Hypothesis: It is hypothesized insomnia and nutrient components would also have association in Hong Kong Chinese population. It is hypothesized the dietary characteristic of insomniac in Hong Kong Chinese population would be different from that of non-Hong Kong Chinese population, and it is hypothesized each insomnia subtype and nutrient components would have different association. / Method: A community-based cross-sectional study is conducted in 13 schools. There are 138 adolescents (61 male and 77 female) and 173 adults (84 male and 89 female) participated in this study. Information of daily nutrient intake is obtained by a self-administrated 3-day food diary, the assessment of insomnia symptom is obtained by a standard sleep questionnaire Insomnia Severity Index (ISI), and the assessment of anxiety and depression is obtained by Hospital Anxiety and Depression Scale (HADS). / Results and Conclusion: Agree with the hypothesis, insomnia and nutrient component have association in Hong Kong Chinese population. The dietary characteristic of insomniac in Hong Kong Chinese population is different from that of non-Hong Kong Chinese population. Each insomnia subtype and nutrient component has different association. Multivariance analysis shows insomnia subtype Difficult Initiating Sleep (DIS), Difficult Maintaining Sleep (DMS), Early Morning Awakening (EMA), and overall insomnia syndrome associate with decreased in-take of vitamin A, vitamin D and vitamin E in both adults and adolescents. Decreased intake of saturated fat associates with insomnia subtype DMS and decreased intake of carbohydrate associates with insomnia subtype EMA in this study. Information from this study shines lights on the relationship of insomnia and nutrients in-take in the general population of Hong Kong Chinese. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Lau, Yin Wah Vivien. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 82-90). / Abstracts also in Chinese. / Abstract: --- p.i-iv / Acknowledgements: --- p.v / Table of contents: --- p.vi-viii / List of Lists: --- p.ix / List of Tables: --- p.ix / List of Figures: --- p.ix / Objective --- p.1 / Chapter Chapter 1: --- Introduction / Chapter 1.1 --- Sleep Research --- p.2 / Chapter 1.1.1 --- Background and History of Sleep Research --- p.2-3 / Chapter 1.1.2 --- Sleep Function and Consequence --- p.3-4 / Chapter 1.1.3 --- Neurotransmitters and Neuromodulators --- p.4-5 / Chapter 1.2 --- Insomnia --- p.5 / Chapter 1.2.1 --- The Definition of Insomnia --- p.6 / Chapter 1.2.1.1 --- Many Different Definitions of Insomnia Diagnostic Criteria --- p.6 / Chapter 1.2.1.2 --- Diagnostic Criteria used for Insomnia in This Study --- p.6-8 / Chapter 1.2.1.3 --- Symptoms and Syndrome of Insomnia --- p.9-10 / Chapter 1.2.2 --- The Cost of Insomnia --- p.10-11 / Chapter 1.2.3 --- The Common Causes of Insomnia --- p.11 / Chapter 1.2.4 --- Cognitive-Behavioral Model of Insomnia --- p.12 / Chapter 1.2.5 --- Treatments of Insomnia --- p.14 / Chapter 1.2.6 --- Confounding Factors of Insomnia --- p.14 / Chapter Chapter 2: --- Age, Education and Body Mass Effect on Sleep Pattern / Chapter 2.1 --- Age --- p.16 / Chapter 2.2 --- Education --- p.17 / Chapter 2.3 --- Body Mass --- p.17 / Chapter Chapter 3: --- Mood, Pain, Sleep Hygiene, Drug, Caffeine and Alcohol Effect on Sleep Pattern / Chapter 3.1 --- Mood --- p.18 / Chapter 3.2 --- Pain --- p.18 / Chapter 3.3 --- Sleep Hygiene --- p.18 / Chapter 3.4 --- Drug --- p.20 / Chapter 3.5 --- Caffeine --- p.20 / Chapter 3.6 --- Alcohol --- p.20 / Chapter Chapter 4: --- Nutrient Components / Chapter 4.1 --- Macro-nutrient --- p.21 / Chapter 4.1.1 --- Carbohydrate --- p.21-22 / Chapter 4.1.2 --- Fatty Acid --- p.22-23 / Chapter 4.1.3 --- Protein --- p.23-24 / Chapter 4.2 --- Micro-nutrient --- p.24 / Chapter 4.2.1 --- Vitamin B₁ (Thiamine) --- p.24 / Chapter 4.2.2 --- Vitamin B₂ (Riboflavin) and Vitamin B₃ (Niacin) --- p.24-25 / Chapter 4.2.3 --- Vitamin B₆ (Pyridoxine) --- p.25 / Chapter 4.2.4 --- Vitamin B₁₂ (Cobalamin, Folate) --- p.25-26 / Chapter 4.2.5 --- Vitamin A and Vitamin D --- p.26-27 / Chapter 4.2.6 --- Tryptophan, Tyrosine, Choline and Phosphatidylcholine (Lecithin) --- p.27-28 / Chapter 4.2.7 --- Vitamin E and Vitamin C --- p.30 / Chapter 4.2.8 --- Iron --- p.30 / Chapter Chapter 5: --- Nutrient Components and Insomnia / Chapter 5.1 --- Introduction --- p.32 / Chapter 5.2 --- Social Perspective of Insomnia and Nutrients --- p.33 / Chapter 5.3 --- Biochemical Perspective of Insomnia and Nutrients --- p.33-34 / Chapter Chapter 6: --- Material and Method / Chapter 6.1 --- Sampling Method --- p.35 / Chapter 6.1.1 --- Background --- p.35 / Chapter 6.1.2 --- Method --- p.35 / Chapter 6.1.3 --- Population --- p.35 / Chapter 6.1.4 --- Questionnaire --- p.36 / Chapter 6.1.5 --- Food Diary --- p.36 / Chapter 6.2 --- Participant Recruitment Criteria --- p.38 / Chapter 6.2.1 --- Major Inclusion Criteria for This Study --- p.38 / Chapter 6.2.2 --- Major Exclusion Criteria for This Study --- p.38 / Chapter 6.2.3 --- Ethical Considerations --- p.38 / Chapter 6.3 --- Statistic Analysis --- p.39 / Chapter 6.4 --- Quality Assessment and Data Extraction --- p.39 / Chapter 6.5 --- Hypothesis --- p.40 / Chapter Chapter 7: --- Results / Chapter 7.1 --- Demographic Data --- p.41 / Chapter 7.2 --- Overall Insomnia --- p.43 / Chapter 7.2.1 --- Difficult Initiating Sleep (DIS) --- p.52 / Chapter 7.2.2 --- Difficulty Maintaining Sleep (DMS) --- p.52 / Chapter 7.2.3 --- Early Morning Awakening (EMA) --- p.61 / Chapter 7.2.4 --- Insomnia Syndrome --- p.61 / Chapter Chapter 8: --- Discussion and Limitation / Chapter 8.1 --- Age and Insomnia --- p.71 / Chapter 8.2 --- Alcohol and Insomnia --- p.72 / Chapter 8.3 --- Caffeine and Insomnia --- p.72 / Chapter 8.4 --- Carbohydrate and Insomnia --- p.72-73 / Chapter 8.5 --- Vitamin E and Insomnia --- p.73 / Chapter 8.6 --- Vitamin A and Insomnia --- p.74 / Chapter 8.7 --- Vitamin D and Insomnia --- p.74 / Chapter 8.8 --- Saturated Fat and Insomnia --- p.75 / Chapter 8.9 --- Summary --- p.76 / Chapter Chapter 9: --- Limitation and Implications / Chapter 9.1 --- Limitation of This Study --- p.77 / Chapter 9.2 --- Implication to Further Study --- p.77-78 / Chapter 9.3 --- Implication to Clinical Intervention --- p.78-79 / Chapter Chapter 10: --- Executive Summary --- p.80-81 / Bibliography --- p.82-90

INTRODUÇÃO: O desemprego e o trabalho precário podem alterar o sono e comprometer a qualidade de vida e a saúde mental do trabalhador. O trabalho por safra na colheita de café expõe o trabalhador às condições climáticas, ao excesso de atividade física, ao ganho por produtividade e à falta de garantia de estabilidade do trabalho. São elementos que podem acarretar doenças e aumentar a busca por atendimento médico e psicológico, sobrecarregando os serviços de saúde. OBJETIVOS: 1) avaliar o padrão e a qualidade do sono de trabalhadores rurais safristas; 2) investigar a presença e o nível dos sintomas de ansiedade e de depressão; 3) avaliar a percepção da qualidade de vida (QV); 4) verificar possíveis associações entre o trabalho temporário e a presença de sintomas de ansiedade e de depressão e o prejuízo no sono; 5) comparar o padrão e a qualidade do sono, sintomas de ansiedade, de depressão e QV do grupo-estudo com os resultados do grupo-controle. MÉTODOS: O grupo-estudo foi composto por 40 pacientes, com idade média 37,43 (DP= 10,68), sendo sete homens e 33 mulheres, trabalhadores rurais safristas na agricultura cafeeira. Como grupo-controle 40 pacientes trabalhadores rurais fixos. Os dois grupos foram escolhidos entre agricultores do Sul de Minas, nas lavouras cafeeiras da região de Três Pontas. Os instrumentos utilizados foram: entrevista inicial, The Pittsburgh Sleep Quality Index (PSQI ), Beck Anxiety Inventory-BAI, Hamilton Depression Rating Scale (HAM-D) e World Health Organization Quality of Life ( WHOQOL Breve). RESULTADOS: a) houve prejuízo na qualidade do sono, sendo caracterizado como ruim, latência maior que 60 minutos, uso de medicação freqüente e sonolência diurna excessiva. Quanto à qualidade subjetiva do sono consideram muito boa; b) os sinais e sintomas de ansiedade e depressão foram elevados nos dois grupos; sendo maior nos trabalhadores safristas; c) quanto à QV os dois grupos apresentaram bons níveis, havendo perdas na área social entre os safristas; d) não houve associação entre o período de entressafra e o surgimento de sintomas de ansiedade, sintomas de depressão e prejuízo no sono; e) os distúrbios do sono influenciaram no surgimento de sinais e sintomas de ansiedade e depressão, mas não interferiram na qualidade de vida. CONCLUSÕES: Os trabalhadores rurais detentores de trabalho fixo estão menos expostos aos sintomas de ansiedade e depressão acompanhados de distúrbios do sono que os trabalhadores safristas. Isso posto, o nível da qualidade de vida (QV) do primeiro grupo é maior que o do segundo. / INTRODUCTION: Unemployment and precarious work can promote sleep changes and compromise the quality of life and mental health of laborers. Coffee harvesting on a seasonal basis exposes laborers to the elements, physical overwork, productivity-based pay and lack of guarantee of a steady job. These factors can trigger disease and increase the need for medical and psychological care consequently overloading health services. OBJECTIVES: 1) to assess the pattern and quality of sleep in rural seasonal laborers;2) to investigate the presence and degree of anxiety and depression symptoms;3) to assess perceived quality of life (QOL);4) to explore possible associations between seasonal work and the presence of symptoms of anxiety, depression and impaired sleep;5) to compare the sleep patterns and quality of sleep, symptoms of anxiety, depression and QOL in the study group versus the control group. METHODS: The study group comprised 40 patients with mean age of 37.43 years (SD=10.68), consisting of seven men and 33 women, who were rural seasonal harvesters on coffee growing plantations. The control group consisted of 40 patients who were permanent rural laborers. The two groups were recruited from farms in the South of Minas Gerais state among the coffee plantations of the Três Pontas region. The instruments employed were: initial interview, The Pittsburgh Sleep Quality Index (PSQI), Beck Anxiety Inventory-BAI, Hamilton Depression Rating Scale (HAM-D) and the World Health Organization Quality of Life (WHOQOL Brief). RESULTS: a) impaired sleep - characterized as poor, a latency of greater than 60 minutes, frequent use of medication, and excessive daytime drowsiness were observed. Patients rated subjective quality of sleep as very good; b) signs and symptoms of anxiety and depression were elevated in both groups, proving higher in the seasonal workers; c) concerning QOL, both study and control groups presented good levels of QOL, although losses in the social area were detected among seasonal workers; d) no association was found between the inter-harvest period and the emergence of anxiety, depression or impaired sleep symptoms; e) sleep disorders influenced the development of signs and symptoms of anxiety and depression, but did not interfere with the quality of life. CONCLUSIONS: Rural laborers who held permanent positions proved less exposed to symptoms of anxiety and depression accompanied by sleep disorders- than seasonal laborers. Therefore, quality of life (QOL) was higher among permanent laborers than seasonal laborers.

Childhood OSA is increasingly recognized to be associated with a variety of complications including neurocognitive and cardiovascular diseases. The intermediate link between OSA and end organ damage has been suggested to be inflammation, and both local airway and systemic inflammation have been described in adults with OSA. A non-invasive technique of sputum induction was utilised to show that children with OSA also have airway inflammation, as characterized by a significant increase in neutrophils, and the severity of OSA also correlated significantly with the degree of neutrophilic inflammation (Chapter 7). This finding may lead to research on the use of anti-inflammatory therapeutic agents or antibiotics for the treatment of childhood OSA. Another marker of inflammation, C-reactive protein (CRP) was measured in a cohort of children with OSA before and after treatment (Chapter 8). Children with OSA had higher CRP levels compared to their non-OSA counterparts, and the raised CRP decreased significantly following treatment suggesting that the inflammatory response is potentially reversible. The cardiovascular risk factors of insulin levels and blood pressure (BP) were evaluated and children with OSA had higher serum insulin and greater systolic and diastolic BP compared to healthy controls (Chapters 9 and 10). These findings suggest that children with OSA may be at risk of developing metabolic syndrome and its devastating consequence. (Abstract shortened by UMI.) / The original research studies undertaken were based on nocturnal sleep examinations to explore childhood OSA in two main aspects, namely its assessment, and a better understanding of its complications in children. The gold standard for diagnosing OSA is overnight polysomnography (PSG), which is an expensive investigation that is not routinely available at all public hospitals in Hong Kong. Alternative valid assessment tools for OSA that are more cost-effective are needed. The feasibility of using radiographic techniques to assess severity of OSA was explored, and the size of the upper airway, as reflected by the tonsillar pharyngeal (TP) ratio obtained from lateral neck radiograph, correlated well with the severity of OSA (Chapter 4). A defined TP cutoff could accurately predict moderate-to-severe OSA with high sensitivity and specificity. This method could be used in clinical practice to prioritize patients with suspected OSA for further evaluation. A locally applicable questionnaire scale was examined for its validity and accuracy in diagnosing children with OSA (Chapter 5). The presence of three symptoms (snoring, mouth breathing and nocturnal sweating) was found to have high predictive value in correctly identifying children with the condition. The question of whether a single night PSG study is adequate in diagnosing OSA was examined together with the assessment for the presence of night-to-night variability in PSG and respiratory parameters in childhood sleep (Chapter 6). Forty-four obese children and 43 age and sex-matched healthy controls underwent two consecutive nights PSG examination. Although a first night effect was clearly documented, a single night PSG study would have correctly identified over 80% of children with OSA. This finding has significant resource implications. / Albert Martin Li. / Adviser: Tony Nelson. / Source: Dissertation Abstracts International, Volume: 70-06, Section: B, page: 3420. / Thesis (M.D.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves xxxv-lxxx). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract in English only. / School code: 1307.

Orientador: Beatriz Bojikian Matsubara / Coorientador: José Eduardo Corrente / Banca: Carmem Maria Casquel Monti Juliani / Banca: Ana Teresa de Abreu Ramos Cerqueira / Banca: Rita de Cássia Gengo e Silva / Banca: Vanda Elisa Andres Felli / Resumo: Profissionais de enfermagem que trabalham em turnos em hospitais gerais podem apresentar alterações da qualidade do sono e prejuízo da qualidade de vida que podem se constituir como fator de risco cardiovascular. Os objetivos do presente estudo foram avaliar os fatores de risco cardiovascular (RCV) e o risco cardiovascular global (RCVG) em profissionais de enfermagem que trabalham em Hospital de Clínicas Terciário e estudar as associações desses desfechos com as características demográficas e com os escores de qualidade de vida (QV) e de qualidade do sono. Trata-se de estudo prospectivo, transversal, observacional, realizado com os profissionais de enfermagem do Hospital das Clínicas da Faculdade de Medicina de Botucatu. O cálculo amostral levou em consideração o total de 989 profissionais de enfermagem que atuam no Hospital das Clínicas da Faculdade de Medicina de Botucatu, estratificado por local, adotando-se um erro alfa de 5% e uma prevalência de RCVG maior que 10% em 20% dessa população. Para tanto, o tamanho da amostra foi estimado em 250 participantes servidores distribuídos em 46 enfermeiros, 146 auxiliares de enfermagem e 58 técnicos de enfermagem. A população foi composta por 264 profissionais de enfermagem estratificados proporcionalmente em 52 enfermeiros, 60 técnicos de enfermagem e 152 auxiliares de enfermagem. A coleta de dados foi realizada no ano de 2010 por meio de questionários auto aplicáveis como o questionário de Índice de qualidade do sono de Pittsburgh (PSQI), o questionário de qualidade de vida WHOQOL-bref. Também foi avaliada a ficha de avaliação clínica e demográfica, que investigou os fatores de risco cardiovascular como sexo, idade, hipertensão arterial sistêmica (HAS), diabetes mellitus (DM), tabagismo, sobrepeso/obesidade e circunferência abdominal (CA). As variáveis... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Nursing professionals who work in shifts in general hospitals may show changes in quality of sleep and impaired quality of life that may be incurred as a cardiovascular risk factor. This study aimed to evaluate the cardiovascular risk factors (RCV) and the overall cardiovascular risk (RCVG) of the nursing staff working in a Tertiary Clinical Hospital and to study the outcomes of these associations with demographic characteristics and with the quality scores of life (QOL) and the quality of sleep. This is a prospective, transverse and observational study, conducted with the nursing staff of the Clinical Hospital, Medicine School of Botucatu. The sample size calculation took into account a total of 989 nursing professionals working at this Clinical Hospital, stratified by location, by adopting an alpha error of 5% and a prevalence of RCVG greater than 10% in 20 % of this population. Thus, the sample size was estimated at 250 participants distributed in 46 nurses, 146 nursing assistants and 58 nursing technicians. The population consisted of 264 nursing professionals stratified proportionally by 52 nurses, 60 nursing technicians and 152 nursing assistants. Data collection was performed in 2010 using self-applicable questionnaires as the Pittsburgh sleep quality (PSQI) Index questionnaire and the quality of life WHOQOL-bref questionaire. We also evaluated the clinical and demographic evaluation form, which investigated the cardiovascular risk factors such as gender, age, hypertension (HTN), diabetes mellitus (DM), smoking, overweight /obesity and waist circumference (WC). The demographic variables studied were education, occupation and work-related conditions such as shift, day, overtime, another job. Associations between variables were evaluated using the Spearman correlation coefficient, adopting the significance level of p <0.05. There... (Complete abstract click electronic access below) / Doutor

Submitted by PPG Medicina e Ci?ncias da Sa?de (medicina-pg@pucrs.br) on 2018-12-04T18:22:09Z No. of bitstreams: 1 CAMILA_DOS_SANTOS_EL_HALAL.pdf: 6036562 bytes, checksum: 43db97c52dcd3d105fd3916ba1d0f0cd (MD5) / Approved for entry into archive by Sheila Dias (sheila.dias@pucrs.br) on 2018-12-06T10:22:40Z (GMT) No. of bitstreams: 1 CAMILA_DOS_SANTOS_EL_HALAL.pdf: 6036562 bytes, checksum: 43db97c52dcd3d105fd3916ba1d0f0cd (MD5) / Made available in DSpace on 2018-12-06T10:35:35Z (GMT). No. of bitstreams: 1 CAMILA_DOS_SANTOS_EL_HALAL.pdf: 6036562 bytes, checksum: 43db97c52dcd3d105fd3916ba1d0f0cd (MD5) Previous issue date: 2018-08-17 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / The period extending from pregnancy to the months following delivery, although usually associated to positive feelings, represents a moment of great vulnerability to the development of major depressive disorders. Perinatal depression is a frequent pathology, and its consequences extend beyond the mother, potentially affecting the relationship with her partner and family functioning. Early exposure to maternal depression is associated to lower breastfeeding rates, impairment of mother-infant bonding, and consequences over child growth and development. Perinatal depression has been linked to infant sleep disturbances as early as in the neonatal period, with description of more night wakings, shorter sleep duration and more fragmented sleep. Sleep plays a fundamental role in child cognitive, social, and emotional development, and its disturbances, in a crucial moment of brain development, may facilitate significant and persistent dysfunctions. Studies associating maternal depression to child sleep disturbances show important heterogeneity in terms of design as in moment of sleep assessment. Sleep patterns go through important changes throughout the first twelve months of life, rendering impaired the association?s precise evaluation, as well as that of its potential long-term consequences. This study aimed to investigate the association between perinatal depression and altered infant sleep macrostructure at one year of life among participants in a birth cohort. In this population-based study, recruitment was carried out from pregnancy to soon after delivery, aiming to include all livebirths in the municipality of Pelotas throughout the year of 2015. Participants to one or both cohort-nested trials and those lacking information on maternal depression were excluded from these analyses. For the diagnosis of perinatal depression, the Edinburgh Postnatal Depression Scale (EPDS) was completed during pregnancy and 3 months after delivery, having been considered perinatally depressed mothers who scored ?13 points in one or both follow-ups. Infant sleep was assessed at 3 months through the Brief Infant Sleep Questionnaire (BISQ) and, at 12 months, through the same subjective questionnaire added to objective data derived from continuous 24-hour actigraphy. Main sleep outcomes were number of night time wakings, night vigil time and total sleep duration in 24 hours. The sample consisted of 2222 mothers/infants, in which prevalence of perinatal depression was of 22.3% (CI 95% 20.5-24). Adjusted analyses using Poisson?s regression from BISQ-derived data showed greater risk of >3 night time wakings at 12 months among infants of depressed mothers (RR 1.52; CI 95% 1.06-2.18; p=0.02). Actigraphic data did not, however, confirm those findings (adjusted RR=1.24; CI 95% 0.85-1.81; p=0.26). No association was found between perinatal depression and the other investigated sleep variables. This study suggests a potential defining role of dysfunctional cognition among mothers with a history of perinatal depression on infant sleep characteristics at the end of the first year of life. / O per?odo que se estende da gesta??o at? os meses seguintes ao parto, apesar de normalmente associado a sentimentos positivos, representa um momento de grande vulnerabilidade ao desenvolvimento de quadros depressivos maiores. A depress?o perinatal ? um dist?rbio frequente, cujas consequ?ncias se estendem para al?m da mulher acometida, potencialmente exercendo efeito sobre a rela??o com o parceiro e o funcionamento familiar. Exposi??o precoce a depress?o materna associa-se a menores taxas de amamenta??o, preju?zo do v?nculo com o beb?, e consequentes efeitos sobre o crescimento e desenvolvimento infantis. Evid?ncias associam a depress?o perinatal a dist?rbios do sono da crian?a desde o per?odo neonatal, sob a forma de maior n?mero de despertares noturnos, menor dura??o de sono e maior fragmenta??o. O sono, por sua vez, exerce papel primordial no desenvolvimento cognitivo, social e emocional da crian?a, e seus dist?rbios, em um per?odo crucial do desenvolvimento cerebral, podem favorecer disfun??es significativas e permanentes. Existe uma importante heterogeneidade em rela??o tanto ao delineamento dos estudos que associam depress?o materna a dist?rbios do sono na crian?a, quanto ao momento de avalia??o do sono, que sofre mudan?as significativas no decorrer dos primeiros doze meses de vida. Com isso, a avalia??o dessa poss?vel associa??o fica prejudicada, assim como a mensura??o de suas consequ?ncias a longo prazo. Este estudo objetivou investigar a presen?a de associa??o entre depress?o perinatal e altera??es da macroarquitetura do sono de lactentes com um ano de vida, participantes de uma coorte de nascimentos. Neste estudo de base populacional, o recrutamento ocorreu desde a gesta??o at? logo ap?s o parto, visando incluir todos os nascidos vivos na cidade de Pelotas no transcorrer de 2015. Participantes de uma das interven??es aninhadas ? coorte e aqueles sem informa??es referentes ? depress?o materna foram exclu?dos desta an?lise. Para diagn?stico de depress?o perinatal, foi aplicada a Escala de Depress?o P?s-natal de Edimburgo (EPDS) na gesta??o e 3 meses ap?s o parto, tendo sido consideradas deprimidas as m?es com pontua??o ?13 em um ou ambos os acompanhamentos. O sono dos lactentes foi avaliado aos 3 meses atrav?s do Brief Infant Sleep Questionnaire (BISQ) e, aos 12 meses, a partir dos mesmos dados subjetivos somados a informa??es objetivas obtidas a partir de 24 horas cont?nuas de actigrafia. Os principais desfechos de sono analisados foram o n?mero de despertares noturnos, dura??o da vig?lia noturna, e tempo total de sono em 24 horas. A amostra constituiu-se de 2.222 m?es e lactentes, na qual a preval?ncia de depress?o perinatal foi de 22,3% (IC95% 20,5-24). Pelo BISQ, as an?lises ajustadas atrav?s de regress?o de Poisson mostraram maior risco para >3 despertares noturnos aos 12 meses entre filhos de m?es deprimidas (RR 1,52; IC95% 1,06-2,18; p=0,02). No entanto, a avalia??o dos dados actigr?ficos n?o confirmou este achado (RR ajustado=1,24; IC95% 0,85-1,81; p=0,26). N?o houve associa??o entre depress?o perinatal e as demais vari?veis do sono. Este estudo sugere um potencial papel definidor da impress?o disfuncional entre m?es com hist?ria de depress?o perinatal sobre as caracter?sticas do sono dos lactentes ao final do primeiro ano de vida.

Objetivo: Evaluar si existe asociación entre el Síndrome de Desgaste Profesional (SDP) y la mala calidad de sueño (MCS) en médicos que laboran en Instituciones Prestadoras de Servicios de Salud en el Sistema de Salud Peruano (SSP), controlada por variables demográficas, sociales y laborales. Métodos: Realizamos un análisis secundario de datos del Cuestionario 2 de la Encuesta Nacional de Satisfacción de Usuarios en Salud (ENSUSALUD-2016), la cual contó con un muestreo probabilístico, estratificado, bietápico con representatividad nacional. El SDP lo medimos con la versión validada al español del Maslach Burnout Inventory - Human Services Survey, el cual se compone de tres dominios del SDP: Agotamiento Emocional, despersonalización y la falta de realización personal; categorizados en tres niveles de deterioro: alto, moderado y bajo. La MCS fue medida con la versión validad al español del cuestionario de Jenkins. Estimamos Odds Ratio (OR) con IC 95% mediante modelos lineales generalizados, familia binomial link (logit) para muestras complejas. Resultados: Incluimos 2216 médicos, 69,2% fueron varones y la edad promedio fue 45,5 años y de todos ellos, 14,4%, tuvieron agotamiento emocional alto y 16,9% agotamiento emocional moderado. En el caso de la despersonalización, 416 (16,8%) presentaron niveles altos y 337 (16,2%) tuvieron niveles moderados. Mientras que 243 (12,9%) tuvieron falta de realización personal alta y 571(27,1%) moderada. Por otro lado, 269 (10,9%) tuvieron MCS. Encontramos que un agotamiento emocional moderado (ORa1: 5,6; IC95%: 2,1-15,1) y alto (ORa1: 6,6; IC95%: 4,2-10,3) incrementaron la odds de MCS. Asimismo, un alto deterioro en la despersonalización (ORa1: 3,5; IC 95%: 2,0-6,0) se asoció con MCS. En el caso de falta de realización personal, no encontramos evidencia estadística de asociación. Conclusión: Los niveles moderados y altos de agotamiento emocional, así como los niveles altos de despersonalización se asociaron con MCS en médicos que laboran en el SSP. Nuestros hallazgos pueden orientar la toma de decisiones a nivel de recursos humanos en salud. / Objective: To evaluate the association between Burnout Syndrome (BS) and poor sleep quality (PSQ) in physicians working in the Peruvian Health System (PHS) controlled by demographic, social and working variables. Methods: We carried out a secondary analysis of data from questionnaire 2 of the National Survey of Health User Satisfaction (ENSUSALUD-2016), which has a probabilistic, stratified, two-stage sampling with national representativeness. We measured the BS with the validated version in Spanish of Maslach Burnout Inventory - Human Services Survey, which measured three domains of BS: Emotional Exhaustion, depersonalization and the lack of personal achievement; categorized into three deterioration levels: low, moderate and high. The PSQ was measured with the Spanish version of the Jenkins questionnaire. We performed generalized lineal models binomial family link (logit) for complex sampling to estimate Odds Ratio (OR) with 95% CI. Results: We included 2216 doctors, 69.2% were males, and the average age was 45.5 years. Of all of them, 14.4% had high levels of emotional exhaustion. In depersonalization domain, 16.8% had high levels. While 12.9% had high levels of lack of personal achievement. Proportion of doctors with was PSQ was 10.9%. We observed that moderate (ORa1: 5.6, 95% CI: 2.1-15.1) and high (ORa1: 6.6, 95% CI: 4.2-10.3) levels of emotional exhaustion increased the odds of PSQ. Likewise, a high level of depersonalization (ORa1: 3.5, 95% CI: 2.0-6.0) was associated with PSQ. In the case of lack of personal achievement, we did not found statistical evidence of association. Conclusion: Moderate and high levels of emotional exhaustion and high levels of depersonalization were associated with PSQ in doctors working in the PHS. This primary evidence can guide decision-making at the level of human resources in health. / Tesis