In Sweden the National Bureau of Statistics has reported an increase in stress-related disorders and sleep problems since the mid-1990’s. They also report that the number of hours of overtime worked has increased. Previous research on work-related stress and overtime work has demonstrated associations with altered physiological arousal, increased risk for stress related diseases, shorter sleep, greater fatigue and impaired performance. However, there is a lack of knowledge on the effects within individuals. The general aim of the thesis was to investigate the effect of overtime work and increased work stress on sleep, the diurnal pattern of cortisol, sleepiness and subjective stress in a within-subject design. In addition, it examined individual differences in the diurnal cortisol response to stress. We used a combination of methods – questionnaires, sleep and wake diaries, objective measures of sleep, stress hormones (salivary cortisol) and ambulatory measures of heart rate and blood pressure. Studies followed office workers during two different conditions of (I) high/low work stress and (II) overtime work respectively. The individual differences in the cortisol response to stress from study I prompted study III. In this study we examined two groups that showed different cortisol responses to stress. In conclusion, the results (I) demonstrated that a week with higher workload and stress affects physiological stress markers such as cortisol, and is associated with increased sleepiness and problems of unwinding at bedtime, shorter sleep duration and longer work hours. Furthermore (II) overtime work, under conditions of relatively low workload, was shown to be associated with modest effects on physiological markers of arousal. More pronounced effects were found on sleep and fatigue, with greater problems during overtime work. Study III indicated that individual differences in cortisol response to stress maybe related to fatigue and exhaustion.

This master thesis focuses on subjectively percieved quality of sleep and its connections - fatigue, daytime sleepiness and insomnia in older age. Attention is brought to psychological methods of sleep measurement in comparison with objective methods (polysomnography and actigraphy). Theoretical part is based on current scientific knowledge of sleep quality and deals with psychological factors that contribute to improvement or reduction of sleep quality in older age. In context with quality of sleep focus is aimed also at presence of insomnia in older age compared to younger age and possibilities of enhancing sleep quality. Overview of subjective and objective methods of measuring sleep quality and other sleep characteristics is part of the theoretical background. Empirical part of the thesis is divided into two sections. First section compares sleep quality, fatigue, daytime sleepiness and insomnia of younger and older adults. This research is based on following questionnaire data: PSQI (Pittsburgh Sleep Quality Index), FSS (Fatigue Severity Scale), ESS (Epworth Sleepiness Scale) and ISI (Insomnia Severity Index). Second section of the research verifies the validity of psychological methods of measuring sleep quality - questionnaires PSQI, FSS, ESS, ISI and sleep diaries of older adults by...

Syfte: Att utvärdera patientnyttan av behandling med apnébettskena vid obstruktivt sömnapnésyndrom (OSAS) på avdelningen för Orofacial smärta och käkfunktion på Odontologiska fakulteten, Malmö Universitet, samt att undersöka vilka subjektiva och kliniska faktorer som kan förutsäga ett lyckat behandlingsutfall samt om behandlingsbiverkningar uppstår. Material och metod: I en retrospektiv kvalitetsstudie utvärderades 183 konsekutiva patientjournaler mellan 2017/01–2020/05. Data från journalerna granskades avseende subjektiva symtom och kliniska fynd för att kunna besvara på befintliga frågeställningar. Data inhämtades från ett standardiserat formulär och klinisk undersökning från baseline (n=183), 3 månader (n=143) samt 1 årsuppföljning (n=93). Datamaterialet analyserades i SPSS 27. Resultat: En god behandlingseffekt rapporterades av 66% vid 3 månaders och 64% vid 1 årsuppföljningen. En signifikant kvarstående förbättring av morgontrötthet (p<0,000), dagtrötthet (p<0,000) och sömnighet (p<0,000) registrerades. Sömnighet graderades med Epworths sömnighetsskala. Antal uppvaknande per natt minskade (p<0,000). Följsamheten var god, 71% använde skenan 6–7 nätter i veckan. Den vanligaste biverkningen var övergående smärta i tuggsystemet. Bettavvikelser i form av minskad vertikal och horisontell överbitning förekom hos 22 respektive 14 patienter vid 3 månaders uppföljningen. Inga predikterande faktorer för en positiv behandlingseffekt kunde registreras i denna studie. Slutsats: Majoriteten av patienter upplevde en god behandlingseffekt, hade minskad morgon och dagtrötthet och uppvisade en god följsamhet av att använda apnébettskenan. Inga prediktiva värden kunde identifieras för gott behandlingsutfall. Smärta och bettavvikelse rapporterades av var femte patient, minskad horisontell och/eller vertikal överbitning registrerades hos ungefär var 10:e patient / Aim: To evaluate the long-term effect of treatment with an oral appliance in patients withobstructive sleep apnea syndrome (OSAS) at the Department of Orofacial Pain and JawFunction, Faculty of odontology, Malmö University, and to investigate which subjective andclinical factors can predict a successful treatment outcome and whether side effects occur. Material and method: In a retrospective quality study, 183 consecutive patient records wereevaluated between 2017/01-2020/05. Data from the records were examined for subjectivesymptoms and clinical findings in order to answer stated questions. Data were obtained froma standardized inquiry and a clinical examination from baseline (n=183), 3 months (n=143)and a one-year follow-up (n=93). The data material was analysed with SPSS 27. Results: A good treatment effect was reported by 66% at 3 months and 64% at 1 year followup. A significant sustained improvement in morning sleepiness(p<0.000), daytime sleepiness(p<0.000), and sleepiness (p<0.000) was recorded. Sleepiness was graded according to theEpworth sleep index. The number of awakenings per night decreased (p<0.000). Compliancewas good, 71% of patients used the splint 6-7 nights a week. Most common dental sideeffects were transient pain in the masticatory system. Dental side-effects in the form ofreduced vertical and horizontal overbite occurred in 22 respectively 14 patients at the 3months follow up. No predictive factors could be found in this study. Conclusion: The majority of patients experienced a good treatment effect, had reducedmorning fatigue and daytime sleepiness and showed a good consistency of using an oralappliance. No predictive values could be identified for good treatment outcomes. Pain anddental changes were reported by one in five patients, decreased overbite and/or overjet wasrecorded in approximately one in 10 patients.

No description available.

Background: Snoring and obstructive sleep apnea (OSA) are both common disorders with a number of negative health effects. The safety and efficacy of treating snoring and OSA surgically have been questioned and there has been a lack of studies in the field. Aims: 1) To investigate the frequency of serious complications, including death, after surgery for the treatment of snoring and sleep apnea; 2) to evaluate the effect on daytime sleepiness after radiofrequency surgery of the soft palate in snoring men with mild or no OSA; 3) to evaluate the effect of tonsillectomy on sleep apnea in adults with OSA and tonsillar hypertrophy; 4) to investigate the morphology and cytoarchitecture of muscle fibers in human soft palatal muscles with immunohistochemical and morphological techniques. Methods and results: In paper 1, a retrospective database study. All Swedish adults who were treated surgically because of snoring or OSA from January 1997 to December 2005 were identified in the National Patient Register. None of the surgically treated patients died in the peri- and postoperative period. Severe complications were recorded in 37.1 of 1,000 patients treated with uvulopalatopharyngoplasty (UPPP), in 5.6 of 1,000 patients after uvulopalatoplasty (UPP) and in 8.8 of 1,000 patients after nasal surgery. In paper 2, the study was designed as a randomized, controlled trial. 35 snoring men with mild or no OSA were randomized to either radiofrequency or sham surgery of the soft palate. Radiofrequency surgery was not found to be effective since there was no significant difference between the two groups in relation to the Epworth Sleepiness Scale (ESS) or apnea-hypopnea index (AHI) at follow-up. Paper 3 was a prospective study, including 28 patients with an AHI of >10 and with large tonsils. In these patients, tonsillectomy was an effective treatment for OSA; the mean AHI was reduced from 40 units/h to 7 units/h (p<0.001), and the mean ESS was reduced from 10.1 to 6.0 (p<0.001) at the six-month follow-up after surgery. Minor and moderate swallowing dysfunction was found in seven of eight patients investigated before surgery and the swallowing function improved in 5 of them after surgery, while no one deteriorated. In paper 4, we investigated the morphology and cytoarchitecture in normal soft palate muscles. Human limb muscles were used as reference. The findings showed that the soft palate muscle fibers have a cytoskeletal architecture and cellmembrane complex that differs from that of the limb muscles. Conclusions No case of death related to surgery was found among 4,876 patients treated with UPPP, UPP or nasal surgery for snoring or OSA in Sweden between 1997 and 2005. Radiofrequency surgery of the soft palate has no effect on daytime sleepiness, snoring or apnea frequency in snoring men with mild or no OSA. Tonsillectomy can be an effective treatment for OSA in adults with large tonsils. A subgroup of muscle fibers in the human soft palate appears to have special biomechanical properties and their unique cytoarchitecture must be taken into account while assessing function and pathology in oropharyngeal muscles. / Snarkning och obstruktiv sömnapné (OSA) är idag en global folksjukdom. Snarkning är det ”oljud” som uppstår när luftvägen under sömn förminskas och vävnaden börjar vibrera under andning. Vid obstruktiv sömnapné faller vävnaden samman och blockerar luftflödet till lungorna. Ett andningsuppehåll, en s.k. apné inträffar. Ett andningsuppehåll kan pågå allt ifrån några sekunder till mer än en minut och kan uppstå hundratals gånger per natt. För att klassificeras som en patologisk apné enligt internationell standard måste andningsuppehållet vara längre än 10 sek. Snarksjukdomen förvärras sannolikt över tid och övergår succesivt i obstruktiv sömnapné med ökande antal andningsuppehåll under sömn. Detta leder till ett stresspåslag för kroppen med oftast uttalad dagtrötthet och en mängd negativa hälsoeffekter. Snarksjukdom och sömnapné ökar risken för bl.a. högt blodtryck och hjärt-kärlsjukdom samt också för att den drabbade ska orsaka trafikolyckor på grund av försämrad koncentrationsförmåga och trötthet. En del av den negativa utvecklingen från snarkning till sömnapné anses bero på att snarkvibrationer kan ge neuromuskulära skador i gom och svalg. Dessa vävnadsskador anses också vara orsaken till att personer som snarkat länge ofta uppvisar störd sväljningsfunktion i form av felsväljning, där maten i uttalade fall hamnar i luftstrupen istället för i matstrupen. I dagsläget är förstahandsbehandling vid sömnapné CPAP, en mask som placeras över näsa och mun och som skapar ett övertryck i luftvägen vilket förhindrar att luftvägen faller samman och att andningsstopp uppstår. CPAP har enligt flera studier den bästa effekten mot andningsuppehåll. En annan vanlig behandling är en bettskena som för underkäken nedåt och framåt så att luftvägen bli mer öppen. Bettskenan är en vanlig och effektiv behandlingsmetod för personer utan kraftig övervikt vid vanemässig snarkning eller måttlig sömnapné. För ett tjugotal år sedan var kirurgi förstahandsmetoden vid behandling av snarkning och måttlig sömnapné. Man utförde då ofta operationer i svalg och gomm, s.k. gomplastiker. Bruket av kirurgisk behandling har dock minskat med tiden, dels p.g.a. biverkningar men också för att det saknades vetenskapliga studier som bevisade att kirurgin gav önskad och långsiktig effekt. Kirurgi utgör dock fortfarande ett komplement till behandling av snarkning och sömnapné när CPAP eller bettskena av olika skäl inte fungerar eller kan tolereras av patienten. 8 Även barn kan lida av snarkning och sömnapné men behandlingsprinciperna för barn skiljer sig från dem hos vuxna och berörs inte i avhandlingen. I denna avhandling studeras: i) biverkningsfrekvenser efter olika typer av snarkkirurgi, ii) effekten av radiovågsbehandling i mjuka gommen på vuxna män med snarkning, iii) effekten av att operera bort halsmandlarna på vuxna med sömnapné och stora halsmandlar, iv) muskelvävnadens struktur och molekylära uppbyggnad i mjuka gommen hos friska personer som inte snarkar. Avhandlingen består av fyra delstudier: 1. En registerstudie med kartläggning av svåra biverkningar efter kirurgi i form av uvulopalatopharyngoplastik, uvulupalatoplastik samt näskirurgi för behandling av sömnapné och snarkning och utfört i Sverige mellan åren 1997-2005. Studien omfattade 4 876 patienter. Inga dödsfall noterades. Komplikationsrisken var störst vid operationer där man tog bort delar av mjuka gommen samt halsmandlarna, där i snitt 37 av 1000 opererade fick biverkningar, framförallt p.g.a. infektioner eller blödningar. 2. I en prospektiv, randomiserad placebostudie utvärderades effekten av radiovågsbehandling i mjuka gommen vid snarkning och lindrig sömnapne. Trettiotvå patienter lottades till att få radiovågsbehandling eller placebo behandling. Patienterna visste inte vilken grupp de tillhörde. Vid uppföljning efter 12 månader var det inga statistiska belägg för att radiovågsbehandling minskade vare sig antal andningsuppehåll eller dagtrötthet. 3. Effekten av att ta bort halsmandlarna på patienter med stora halsmandlar och olika grad av sömnapné utvärderades i denna studie. Totalt deltog 28 patienter. Vid uppföljning 6 månader efter operationen hade antalet andningsuppehåll sjunkit drastiskt, från i snitt 40 till 7 andningsuppehåll per timme nattsömn. Inga allvarliga biverkningar uppstod. Dessa fynd talar för att man som förstahandsmetod ska erbjuda patienter med sömnapné och stora halsmandlar att ta bort halsmandlarna. 4. I detta projekt undersökte vi utseendet och uppbyggnaden av cellskelettet i två normala muskler i mjuka gommen hos friska personer utan känd snarkning och sömnapné. Muskler från armar och ben användes som referens. Fynden i studien visar att de normala muskelfibrernas uppbyggnad i mjuka gomen skiljer sig från jämförade muskler i armar och ben. Detta kan vara ett uttryck för en evolutionär utveckling för att möjligöra de komplexa funktioner som krävs av svalgets muskulatur. 9 Sammanfattningsvis kan vi konstatera: Att inga dödsfall har skett i Sverige efter operationer i gom, svalg eller näsa, utförda för att behandla snarkning och sömnapné under åren 1997 till 2005. Att radiovågsbehandling av mjuka gommen hos snarkande män med lindrig sömnapné inte har någon effekt på dagtrötthet, snarkning eller andningsuppehåll vid uppföljning efter 12 månader. Metoden kan därför inte rekommenderas. Att när man opererar bort stora halsmandlar på personer med andningsuppehåll så leder detta ofta till att andningsuppehållen minskar drastiskt. Metoden kan därför oftast rekommenderas som en förstahandsbehandling för denna patientgrupp. Att mjuka gommens muskelfibrer är uppbyggda på ett unikt sätt indikerar att deras specifika biomekaniska egenskaper skiljer sig från referens muskler i armar och ben.

研究目的：睡眠遲惰（sleep inertia）指的是剛由睡眠中醒來的一種現象，在這段轉換期間內，個體的警覺力較低、心智較為遲緩，認知和行為表現都較差。過去針對睡眠遲惰的研究顯示，睡眠遲惰是從一個較低生理激發的狀態到較高生理激發的漸進式轉換過渡階段。若睡眠遲惰是與較低的生理激發狀態有關，則若能提高個體的激發狀態，應能減少睡眠遲惰的負面影響。從過去的文獻中可發現，快節奏的音樂可以提高個體的生理激發。因此，本研究針對音樂的節奏快慢做操弄，探討生理激發狀態在睡眠遲惰所扮演的角色，比較不同快慢節奏的音樂刺激對於睡眠遲惰效果的影響。 方法：12名年齡介於18到31歲之間的受試者參與此研究。受試者在20分鐘小睡被喚醒後，分次接受快節奏音樂、慢節奏音樂、以及無音樂控制情境等三種情境安排。睡醒後的實驗期間為1小時，受試者每10分鐘被要求進行加法作業及填寫卡羅連斯加睡意量表（Karolinska Sleepiness Scale）、視覺類比量表（visual analog scales）、以及情緒評估等主觀量表，總計六次。同時，他們的腦電波（electroencephalogram）、心率變異率（heart rate variability）、膚電反應（skin conductance responses）、指溫等生理反應亦被記錄。 結果：受試者在認知表現或主觀評量上的確顯現出睡眠遲惰的效果，其加法作業的完成題數隨著時間增加，而主觀睡意則隨著時間減少。快節奏音樂情境比慢節奏音樂情境有顯著較高的主觀激發程度，並有較清醒的評量。在生理測量部分，受試者在快節奏音樂情境中有顯著較高的非特定刺激引起之膚電反應（Non-specific skin conductance responses）和腦電波較多beta波的趨勢。然而，儘管受試者的主觀評量會受到音樂刺激的影響而有不同，其認知表現並沒有出現類似的效果。 結論：本研究發現藉由音樂提高激發狀態，可使主觀睡意評量降低，但認知表現並不受到影響。此分離的現象顯示睡眠遲惰的消散不能以單一的生理激發狀態來解釋，而必須考慮多種歷程機制同時運作的可能性。 / Objective：Sleep inertia (SI) is a transitional state occurring immediately after awakening from sleep that are associated with sleepiness, decreased alertness and decrement in cognitive performance. It has been suggested that SI may be due to a decline in arousal level. Therefore, it was hypothesized that factors likely increasing arousal would reduce the effects of SI. Previous studies showed that fast-tempo music may enhance the level of arousal. The present study was conducted to clarify the role of arousal in SI by exposure to music with different tempos. Methods：Twelve healthy young adults, aged 18 to 31 years, participated in the study. All subjects went through three conditions: a fast-tempo music, a slow-tempo music, and a control (no music) conditions. Music stimuli were applied to subjects awaked from a 20-mins nap, and the subjects were given an addition task and asked to rate their level of subjective sleepiness and arousal on the Karolinska Sleepiness Scale (KSS), visual analog scales (VAS) and emotional rating scales 6 times over an hour. During the test period, their physiological arousal state was recorded, including electroencephalogram (EEG), heart rate variability (HRV), skin conductance responses (SCR), finger temperature. Results：The effects of SI on cognitive throughput and subjective ratings were evident. Their performance on the addition task increased and sleepiness decreased over time. Subjective sleepiness was significantly reduced and physiological arousal level measured by non-specific skin conductance responses (NS-SCRs) and EEG beta power were elevated when the participants were exposed to fast-tempo music. However, cognitive performance was not influenced by music exposure. Conclusion：The present findings suggest that increased arousal level during SI by manipulating music stimuli may decrease subjective sleepiness but have no impact on cognitive performance. This dissociative effect suggests that the dissipation of sleep inertia may not be a function of a general arousal level. Rather, there may be multiple processes that are responsible for different aspects of SI.

No description available.

Introdução: Trabalhar e estudar têm sido frequentemente observadas entre jovens universitários. Um dos resultados dessa dupla jornada esta população é a restrição aos horários de dormir e acordar, especialmente nos dias de trabalho. Como conseqüência da privação de sono, relatos de sonolência excessiva diurna e queda no desempenho nos estudos e no trabalho são frequentes. Em relação às diferenças entre os sexos, poucos são estudos que abordam as características dos padrões do ciclo vigília-sono e sonolência de universitários trabalhadores, homens e mulheres. Objetivo: Analisar o ciclo vigília-sono e sonolência de homens e mulheres que trabalham e estudam no turno noturno. Metodologia: Participaram deste projeto 82 estudantes universitários trabalhadores, de 21 a 26 anos de idade, que freqüentavam as aulas no período noturno. Na primeira etapa, os participantes preencheram o questionário de caracterização das condições de vida, saúde e trabalho. Na segunda etapa, os participantes utilizaram um actímetro durante 7 dias consecutivos para obtenção de dados de sono e vigília, preencheram a escala de sonolência Karolinska (KSS) e realizaram um teste de vigilância psicomotora (PVT) em diversos momentos do dia. Além disso, os estudantes preencheram um protocolo diário de atividades para obter dados referentes ao tempo dedicado ao trabalho, trabalho doméstico, atividades físicas, atividades extracurriculares, transporte, aulas na faculdade, folga e sono. Neste protocolo também foram incluídas questões relacionadas ao consumo de cafeína, teobromina e bebidas alcoólicas. As análises das variáveis do ciclo vigília sono, sonolência e médias dos tempos de reação foram feitas utilizando a ANOVA para medidas repetidas. As análises das atividades diárias entre os sexos foram realizadas análises de variância (ANOVA) de 2 fatores (sexo e dia da semana) ou teste t-student. As análises das variáveis dependentes relatos de sonolência excessiva nas aulas e tempo dedicado as aulas foram realizadas através, respectivamente, das análises de regressão logística e linear multivariadas. Em todas as análises utilizou-se como nível de significância =5 por cento . Resultados: Os resultados mostraram que nos dias de trabalho as mulheres apresentaram maiores durações de sono que os homens. Também, observou-se que as mulheres apresentaram um inicio de sono e meio da fase do sono mais adiantado e maior eficiência do sono comparadas aos homens. Além disso, nos dias de trabalho as mulheres estavam mais sonolentas e apresentaram tempos de reação mais lentos do que os homens. Aos domingos os estudantes (homens e mulheres) relataram níveis de sonolência menores do que aos sábados. O resultado da análise de regressão logística multivariada mostrou associação entre relatos de sonolência excessiva durante as aulas e: maiores jornadas de trabalho, meio da fase do sono >3:30hs, relatos de fadiga e menor consumo de cafeína nos dias de trabalho. O resultado da análise de regressão linear multivariada mostrou associação entre maior tempo dedicado às aulas na faculdade e: ser do sexo feminino, menores jornadas de trabalho semanal, menores durações de sono nos dias de trabalho, relatos de sonolência excessiva aos sábados e não consumir bebidas alcoólicas. Conclusões: A dupla jornada de trabalho e estudo interfere negativamente no tempo dedicado às aulas e também em outras atividades diárias, podendo comprometer o desempenho acadêmico e o tempo livre dos estudantes, para se dedicar em atividades extracurriculares e atividades físicas. São necessários outros estudos para melhor esclarecer as diferenças entre os sexos relativas aos padrões de sono. Particularmente, as causas da maior sonolência entre as mulheres jovens solteiras e sem filhos comparadas com homens com características sóciodemográficas semelhantes / Introduction: Working and studying are often observed among college students. One of the results of this double journey is the restricted bed and wake up time, especially among work days. This might have as a consequence excessive daytime sleepiness and reduced performance at school and at work. There a few number of studies discussing the sleep-wake patterns and sleepiness patterns of working college students, males and females. Objective: to assess sleep wake patterns among working college students, males and females. Methodology: Eighty-two evening working college students, from 21 to 26 years old participated in this study. Initially, all participants answered a comphreensive questionnaire on living, health and working conditions. Then, students worn for 7 consecutive days an actigraph, to obtain data on sleep-wake patterns. During the same days, they answered the Karolinska Sleepiness Scale and performed a Psychomotor Vigilance Task along the day. Also, participants answered a daily activity protocol to obtain data on time spent doing the following activities: work, domestic work, physical activities, commuting and leisure times, extracurricular activities, college classes, and sleep. Students answered questions about caffeine, theobromine and alcohol beverages consumption. The analyses of the sleep wake patterns, sleepiness and means of reaction time were performed using the ANOVA for repeated measures. To detect sex differences in daily activities a 2 way-ANOVA or a t-student test were performed. Multivariate linear and logistic regression analyses were used to detect the associated variables with time spent in college classes and excessive sleepiness during classes, respectively. In all analyses were considered the level of significance =5 per cent . Results: The results showed that during work days women showed longer sleep length compared to men. Women also showed an advanced sleep onset and midsleep, and higher sleep efficiency compared to men. Beside this, on work days, females were sleepier and showed slower reaction time than men. On Sundays students (males and females) reported to be more alert than on Saturdays. The results of the multivariate logistic regression analyses showed significant association between reported excessive sleepiness during classes and: longer working times, mid sleep >3:30hs, reported fatigue and fewer caffeine intake during work days. The results of the multivariate linear regression analyses showed significant association between more time spent in classes and: sex (females), shorter weekly working hours, shorter sleep length, reported excessive sleepiness on Saturdays and no alcohol consumption. Conclusions: The double burden of studying and working can interfere negatively on time attending classes and other daily activities. Thus, academic performance, and time spent on physical and extracurricular activities might be compromised. Further studies are necessary in order to clarify sex differences on sleep. These studies may explain the causes of higher sleepiness showed by single women with no children compared to male colleagues with similar socio demographic features

研究背景與目的：近年來，有不少研究指出阻塞性睡眠呼吸中止疾患（簡稱OSA）患者呈現出高比例的憂鬱情緒，但其盛行率結果分歧，回顧過往文獻也發現OSA與憂鬱情緒的關聯性之結果亦呈現分歧的結果。值得注意的是，OSA與憂鬱情緒之間存在著類似的症狀表現——白天嗜睡，OSA患者可能依據OSA伴隨的嗜睡症狀，回應憂鬱問卷或診斷中的問題，而使其受到誤診或是使盛行率受到高估。為探討此議題，本研究進行兩項研究，分別以橫斷及長期追蹤的資料，探討（一）OSA患者的憂鬱情緒是否聚焦於身體面向，且OSA與憂鬱情緒之間是否受到白天嗜睡中介，以及（二）OSA患者睡眠檢查長期追蹤資料中憂鬱情緒的改變，是否與白天嗜睡程度有關。 研究方法：研究一以台北醫學大學附設醫院睡眠中心資料庫中，2010至2015年到台北醫學大學附設醫院睡眠中心看診並進行PSG檢測時所收集的資料（AHI、醒覺指標、缺氧指標、平均血氧飽和度、最低血氧飽和度、BDI-IA、ESS）進行分析，在排除小於20歲與睡眠疾患共病之後，共有2140位OSA（364女、1776男）患者資料被納入分析。本研究針對OSA患者的憂鬱情緒（BDI-IA）分數進行探索性因素分析，並以此因素結構與Beck與Steer（1993）所得之憂鬱情緒面向結構進行模型競爭，以求更適配於OSA患者之因素結構。再者，本研究取具輕度以上憂鬱情緒的OSA患者資料，以線性迴歸分析了解OSA嚴重度（AHI）、嗜睡程度（ESS得分）與憂鬱情緒（BDI-IA、身體面向、認知面向）之間的關聯性，並以拔靴法進行中介模型的檢定。此外，欲探討OSA患者的憂鬱情緒可能聚焦於身體面向，本研究亦將OSA患者依症狀嚴重度分組，並比較不同症狀嚴重度OSA患者的認知面向與身體面向憂鬱分數。研究二則是以台北醫學大學附設醫院睡眠中心資料庫追蹤一年至兩年間的OSA患者的資料進行資料分析，由於女性人數過少，因此僅納入81位男性OSA患者資料進行統計分析。 研究結果：研究一探索性因素分析結果顯示，「體重減輕」與「煩躁易怒」在因素分析結果的負荷量相當低，無法歸類至其一面向，予以排除，且「不滿自我」、「社交退縮」、「優柔寡斷」三題（原認知面向題項）在OSA患者樣本中被歸類至身體面向。競爭模型結果顯示，本研究所得之因素結構AIC值較低，因此以本研究所得之因素結構進行後續分析中認知面向與身體面向憂鬱情緒之計分與分析。以具憂鬱情緒的OSA患者資料進行相關分析結果發現，AHI 、覺醒指標、 缺氧指標、平均血氧飽和度、最低血氧飽和度皆與ESS呈現顯著相關；且ESS與BDI、身體面向、認知面向憂鬱情緒皆呈現顯著正相關。值得注意的是，OSA症狀嚴重度AHI雖未與BDI呈現顯著關聯性，但與身體面向憂鬱情緒達顯著正相關，且OSA病理機轉——醒覺指標、缺氧指標、平均血氧飽和度亦與身體面向憂鬱情緒達顯著關聯性。拔靴法結果顯示，在控制年齡與BMI後，ESS僅中介於醒覺指標與身體面向憂鬱情緒間的關聯性。將男女性分組後，女性患者的ESS中介於AHI與身體面向憂鬱情緒、醒覺指標與身體面向憂鬱情緒、以及缺氧指標與身體面向憂鬱情緒之間的關聯性，但男性OSA患者則無此中介效果。將OSA患者依症狀嚴重度分組，針對不同症狀嚴重度OSA患者的認知面向與身體面向憂鬱分數進行重複量數檢定，發現不論AHI為輕、中、重度，身體面向憂鬱分數皆較認知面向來得高。研究二檢視OSA患者一年至兩年間追蹤的結果，發現AHI改變量與BMI改變量，無論對於ESS的改變量、BDI-IA總分的改變量、認知面向以及身體面向憂鬱情緒的改變量，皆無顯著相關性；而ESS改變量則與BDI-IA總分的改變量、認知面向憂鬱情緒的改變量、身體面向憂鬱情緒的改變量呈現顯著相關性。依ESS改變量分組後，進一步以單因子變異數分析對BDI-IA改變量、認知面向憂鬱情緒改變量、身體面向憂鬱情緒改變量進行檢定，結果顯示，無論在BDI-IA改變量、認知面向憂鬱情緒改變量、或身體面向憂鬱情緒改變量，皆達顯著差異；而事後檢定顯示，無論在BDI-IA改變量、認知面向、身體面向憂鬱情緒，ESS升高組與ESS無變化組、ESS降低組呈現顯著差異，而ESS無變化組則與ESS降低組無顯著差異。 結論：本研究OSA患者自評BDI-IA的結果發現有高達35%的患者至少有輕度以上的憂鬱情緒，且本研究發現在女性OSA患者身上，OSA嚴重度、睡眠片段化病理機轉，與憂鬱情緒間，受到白天嗜睡程度中介；且OSA患者的憂鬱情緒明顯聚焦於身體面向上，此結果說明OSA患者的憂鬱情緒可能受到白天嗜睡程度所影響，本研究在於提醒臨床工作者對OSA患者進行憂鬱症臨床診斷時，需注意與釐清OSA患者是否以白天嗜睡的情況，來回應憂鬱症狀相關的嗜睡表現，以降低誤判OSA患者憂鬱情緒的可能性。 / Aims: Recent years, researchers found high prevalence of depression occurred in OSA patients. However, the inconsistency was also found in depression prevalence and in the association between OSA and depressive mood. Notably, excessive daytime sleepiness is one of common symptoms of both OSA and depression. High prevalence of depression might be an overestimation due to excessive daytime sleepiness reported by OSA patients. Two studies (cross-sectional and longitudinal studies) were conducted to examine (1) whether the depressive symptoms in OSA patients are more somatic in nature and whether mediation effect between OSA and depression exist, and (2) whether the changes in depressive mood correlate with the changes in excessive daytime sleepiness showed in long term follow-up data. Methods: Sleep test data (including AHI, arousal index, desaturation index, mean SaO2, lowest SaO2, BDI-IA, ESS) retrieved from database of Taipei Medical University Hospital Sleep Center from year 2010 to 2015 was used in Study 1. 2140 OSA patients (364 F、1776 M) were included after rule out patients who is under 20 year-old or comorbid with other sleep disorders. Exploratory factor analysis was conducted to extract the dimensions of depressive mood in OSA patients and the dimensions obtained were further compared with those of Beck and Steer (1993) through competing models. Furthermore, correlations between OSA severity, OSA pathological mechanism, excessive daytime sleepiness, and depressive mood were analyzed in the data of OSA patients with depressive mood, and boostrapping method was conducted to test mediation effect. For examining whether the depressive symptoms in OSA patients are more somatic in nature, cognitive dimension and somatic dimension were compared within different OSA severity. One to two year follow-up sleep test data retrieved from database of Taipei Medical University Hospital Sleep Center was analyzed in Study 2. There were only 81 male OSA patient data included due to the small numbers of female patients. Results: Exploratory factor analysis in Study 1 showed that “weight loss” and “irritability” should be excluded due to low factor loading in depressive mood of OSA patients. “Dissatisfaction”, “social withdrawal” and “indecisiveness” were categorized into somatic dimension in OSA patients. Competing models indicated the factors obtained in exploratory factor analysis were preferred due to lower AIC value, which suggested the model was better fit to OSA patients. Correlation analysis showed that AHI, arousal index, desaturation index, mean SaO2, lowest SaO2, BDI-IA score, somatic dimension and cognitive dimension significantly correlated with ESS. Notably, although the correlation between AHI and BDI-IA was non-significant, AHI positively correlated with somatic dimension. OSA pathological mechanism (arousal index, desaturation index, mean SaO2) also significantly correlated with somatic dimension on BDI-IA. After controlling age and BMI, mediation effects of excessive daytime sleepiness were only found on the relation of arousal index and somatic dimension. Mediation effects were also found on the relation of AHI and somatic dimension, on the relation of desaturation index and somatic dimension, and on the relation of arousal index and somatic dimension in female OSA patients, but the mediation effect was not found in male OSA patients. Furthermore, 3 X 2 ANOVA repeated measurement showed somatic dimension was significantly higher than cognitive dimension on BDI-IA in different AHI severity group. Follow-up data in Study 2 showed the change of AHI and BMI were not correlated with the change of ESS, BDI-IA, cognitive dimension and somatic dimension on BDI-IA. However, the change of ESS was significantly correlated with the change of BDI-IA, cognitive dimension and somatic dimension on BDI-IA. Furthermore, the change of BDI-IA, cognitive dimension and somatic dimension on BDI-IA were tested in different ESS change group. Results showed that the change of BDI-IA, cognitive dimension and somatic dimension on BDI-IA were significant in different ESS change group. Post-hoc analysis indicated the change of BDI-IA, cognitive dimension and somatic dimension in ESS elevated group were significantly different from ESS maintained group and ESS descend group but the difference between ESS maintained group and ESS descend group was non-significant. Conclusion: 35% of OSA patients were classified as co-occurring depressive mood using BDI-IA. However, mediation effect of excessive daytime sleepiness was found in female patients on the relation of OSA severity and depressive mood, and also on the relation of sleep fragmentation and depressive mood. Furthermore, depressive symptoms in OSA patients are more somatic in nature. The results showed depressive mood in OSA patients was probably affected by the excessive daytime sleepiness. The findings suggested the need to clarify the effect of excessive daytime sleepiness to prevent the overestimation of depressive mood in OSA patients.

Introdução: Trabalhar e estudar têm sido frequentemente observadas entre jovens universitários. Um dos resultados dessa dupla jornada esta população é a restrição aos horários de dormir e acordar, especialmente nos dias de trabalho. Como conseqüência da privação de sono, relatos de sonolência excessiva diurna e queda no desempenho nos estudos e no trabalho são frequentes. Em relação às diferenças entre os sexos, poucos são estudos que abordam as características dos padrões do ciclo vigília-sono e sonolência de universitários trabalhadores, homens e mulheres. Objetivo: Analisar o ciclo vigília-sono e sonolência de homens e mulheres que trabalham e estudam no turno noturno. Metodologia: Participaram deste projeto 82 estudantes universitários trabalhadores, de 21 a 26 anos de idade, que freqüentavam as aulas no período noturno. Na primeira etapa, os participantes preencheram o questionário de caracterização das condições de vida, saúde e trabalho. Na segunda etapa, os participantes utilizaram um actímetro durante 7 dias consecutivos para obtenção de dados de sono e vigília, preencheram a escala de sonolência Karolinska (KSS) e realizaram um teste de vigilância psicomotora (PVT) em diversos momentos do dia. Além disso, os estudantes preencheram um protocolo diário de atividades para obter dados referentes ao tempo dedicado ao trabalho, trabalho doméstico, atividades físicas, atividades extracurriculares, transporte, aulas na faculdade, folga e sono. Neste protocolo também foram incluídas questões relacionadas ao consumo de cafeína, teobromina e bebidas alcoólicas. As análises das variáveis do ciclo vigília sono, sonolência e médias dos tempos de reação foram feitas utilizando a ANOVA para medidas repetidas. As análises das atividades diárias entre os sexos foram realizadas análises de variância (ANOVA) de 2 fatores (sexo e dia da semana) ou teste t-student. As análises das variáveis dependentes relatos de sonolência excessiva nas aulas e tempo dedicado as aulas foram realizadas através, respectivamente, das análises de regressão logística e linear multivariadas. Em todas as análises utilizou-se como nível de significância =5 por cento . Resultados: Os resultados mostraram que nos dias de trabalho as mulheres apresentaram maiores durações de sono que os homens. Também, observou-se que as mulheres apresentaram um inicio de sono e meio da fase do sono mais adiantado e maior eficiência do sono comparadas aos homens. Além disso, nos dias de trabalho as mulheres estavam mais sonolentas e apresentaram tempos de reação mais lentos do que os homens. Aos domingos os estudantes (homens e mulheres) relataram níveis de sonolência menores do que aos sábados. O resultado da análise de regressão logística multivariada mostrou associação entre relatos de sonolência excessiva durante as aulas e: maiores jornadas de trabalho, meio da fase do sono >3:30hs, relatos de fadiga e menor consumo de cafeína nos dias de trabalho. O resultado da análise de regressão linear multivariada mostrou associação entre maior tempo dedicado às aulas na faculdade e: ser do sexo feminino, menores jornadas de trabalho semanal, menores durações de sono nos dias de trabalho, relatos de sonolência excessiva aos sábados e não consumir bebidas alcoólicas. Conclusões: A dupla jornada de trabalho e estudo interfere negativamente no tempo dedicado às aulas e também em outras atividades diárias, podendo comprometer o desempenho acadêmico e o tempo livre dos estudantes, para se dedicar em atividades extracurriculares e atividades físicas. São necessários outros estudos para melhor esclarecer as diferenças entre os sexos relativas aos padrões de sono. Particularmente, as causas da maior sonolência entre as mulheres jovens solteiras e sem filhos comparadas com homens com características sóciodemográficas semelhantes / Introduction: Working and studying are often observed among college students. One of the results of this double journey is the restricted bed and wake up time, especially among work days. This might have as a consequence excessive daytime sleepiness and reduced performance at school and at work. There a few number of studies discussing the sleep-wake patterns and sleepiness patterns of working college students, males and females. Objective: to assess sleep wake patterns among working college students, males and females. Methodology: Eighty-two evening working college students, from 21 to 26 years old participated in this study. Initially, all participants answered a comphreensive questionnaire on living, health and working conditions. Then, students worn for 7 consecutive days an actigraph, to obtain data on sleep-wake patterns. During the same days, they answered the Karolinska Sleepiness Scale and performed a Psychomotor Vigilance Task along the day. Also, participants answered a daily activity protocol to obtain data on time spent doing the following activities: work, domestic work, physical activities, commuting and leisure times, extracurricular activities, college classes, and sleep. Students answered questions about caffeine, theobromine and alcohol beverages consumption. The analyses of the sleep wake patterns, sleepiness and means of reaction time were performed using the ANOVA for repeated measures. To detect sex differences in daily activities a 2 way-ANOVA or a t-student test were performed. Multivariate linear and logistic regression analyses were used to detect the associated variables with time spent in college classes and excessive sleepiness during classes, respectively. In all analyses were considered the level of significance =5 per cent . Results: The results showed that during work days women showed longer sleep length compared to men. Women also showed an advanced sleep onset and midsleep, and higher sleep efficiency compared to men. Beside this, on work days, females were sleepier and showed slower reaction time than men. On Sundays students (males and females) reported to be more alert than on Saturdays. The results of the multivariate logistic regression analyses showed significant association between reported excessive sleepiness during classes and: longer working times, mid sleep >3:30hs, reported fatigue and fewer caffeine intake during work days. The results of the multivariate linear regression analyses showed significant association between more time spent in classes and: sex (females), shorter weekly working hours, shorter sleep length, reported excessive sleepiness on Saturdays and no alcohol consumption. Conclusions: The double burden of studying and working can interfere negatively on time attending classes and other daily activities. Thus, academic performance, and time spent on physical and extracurricular activities might be compromised. Further studies are necessary in order to clarify sex differences on sleep. These studies may explain the causes of higher sleepiness showed by single women with no children compared to male colleagues with similar socio demographic features