The new Health 4.0 concept brings the idea of combining modern technologies from field of science and technology with research in healthcare and medicine. This work realizes a system of secured actigraph data transfer and preprocessing based on the concept of Health 4.0. The system is successfully designed, implemented, tested and secured. With the help of a non-invasive method of monitoring the movement and temperature of the subject using the GENEActiv actigraph allows the system to securely transfer, process and evaluate the subject's sleep data using the machine learning algorithm XGBoost. The proposed system is in accordance with the valid law of the Czech Republic and meets legal requirements.

Many actions we observe in nature show some kind of regularity, therefore we call them rhytms. Rhytms with a period of approximately 24 hours, so called circadian rhytms, can be distinguished in many physiological processes, with the sleep-wake cycle being one of the most prominent ones. Light is the main exogenous circadian synchronizator and thanks to the circadian rhytm influence on physiological function, it's also often spoken about an influence of light on the entire organism. Nowadays, when we spend most of the day indoors under artificial light, we often suffer from a lack of natural daylight and its synchronizing potential. This is even more prominent in elderly population living in nursing homes and in other social facilities. Lately, a new type of lighting, so called biodynamic, has been introduced. Biodynamic lighting can simulate changes in natural light conditions throughout the day and therefore partially compensate for the lack of natural daylight we suffer from, and also minimize risks of the night light. In this study we aimed to test changes in the circadian system of seniors living in the Retirement Home of TGM in Beroun using questionnaires and circadian markers. We have shown a positive effect of the installed biodynamic lighting on our participants' circadian markers and...

Les altérations du sommeil et du cycle veille/sommeil au cours du vieillissement constituent des facteurs de risque de l’apparition d’un déclin cognitif et de l’évolution vers une démence. Pour autant, le lien entre ces altérations et les modifications cérébrales liées à l’âge reste encore peu connu. L’objectif de cette thèse a été de déterminer si les modifications du sommeil et du cycle veille/sommeil constituaient un marqueur de fragilité cérébrale pouvant être associé à l'apparition de troubles cognitifs chez des personnes âgées de la population AMImage. Nous avons d’abord montré que le désaccord existant entre les questionnaires de sommeil et les mesures objectives en actimétrie est dépendant de l’état émotionnel, renforçant ainsi l’intérêt d’utiliser une méthode de mesure objective du sommeil (Baillet et al., 2016). Puis, grâce à l’imagerie cérébrale, nous avons observé qu’une faible amplitude du cycle veille/sommeil est associée à une altération de la microstructure de la substance blanche, suggérant ainsi une origine vasculaire (Baillet et al., 2017). Nous avons également observé qu'une faible qualité de sommeil est associée à une charge amyloïde plus importante au sein des régions frontales, suggérant un déficit de clairance du peptide β-amyloïde lors du sommeil. Ainsi, les perturbations du sommeil et du cycle veille sommeil chez les personnes âgées seraient associées à deux processus physiopathologiques distincts aboutissant à une fragilité cérébrale. Considérés comme des facteurs de risque modifiables, des interventions visant à améliorer leur qualité offriraient une stratégie prometteuse afin de réduire le déclin cognitif au cours du vieillissement. / Sleep and activity/rest cycle disturbances represent risk factors for the development of cognitive decline and dementia in aging. However, the association between these disturbances and cerebral modifications during aging remains to be explored. The aim of this thesis was to determine if sleep and activity/rest cycle disturbances could constitute a cerebral frailty factor for the development of cognitive decline and dementia in older adults (AMImage cohort). First, we have shown that the discrepancy measured between self-reported sleep questionnaires and actigraphy - used as an objective technique - is influenced by the subject’s mood (Baillet et al., 2016). These results strengthen the use of an objective technique to measure sleep. Thanks to brain imaging, we observed that a reduced 24-h amplitude of the activity/rest cycle is associated with disruption of white matter structural integrity. Our results suggest that cerebral frailty associated with age-related activity/rest cycle dysfunction has a vascular origin (Baillet et al., 2017). Then, we observed that a poor sleep quality is associated with high cerebral amyloid burden, mainly circumscribed to frontal regions. This may be due to a deficit of amyloid-β peptide clearance from the brain during sleep. To conclude, sleep and activity/rest cycle disturbances in older adults may be associated with two separate physiopathological processes leading to cerebral frailty. As sleep and activity/rest cycle are modifiable risk factors, interventions to improve their quality could offer a potential useful strategy for reducing the burden of cognitive impairment and dementia in old age.

In der langjährigen Nachbetreuung von Kleinkindern sehr niedrigen Geburtsgewichts fiel klinisch ein erhöhtes Aktivitätsverhalten auf. Diese Beobachtung sollte durch ein objektives Messverfahren verifiziert werden. Die Praktikabilität der Aktographie für diese Fragestellung wurde überprüft. In dieser Studie trugen 43 VLBW-Kinder und eine Gruppe von 19 reif geborenen Kindern während der Entwicklungsdiagnostik mit dem Griffiths-Test im korrigierten Alter von 20 Monaten ein Aktometer. Zusätzlich wurde von den Eltern und Untersuchern der Kinder eine subjektive Einschätzung des Aktivitätsverhaltens erhoben. Es zeigte sich, dass die VLBW-Kinder im Rahmen dieser Studie während der Entwicklungsdiagnostik eine signifikant höhere motorische Aktivität als die Kinder der Referenzgruppe hatten. Die Häufigkeit von Ruhemomenten während der Untersuchungssituation korrelierte positiv mit dem Geburtsgewicht und mit dem Gestationsalter. Die subjektiven Einschätzungen der Eltern und Untersucher stimmten gut mit den objektiv ermittelten Daten überein. Kinder mit mehr Ruhemomenten während der Untersuchung erzielten auch günstigere Ergebnisse in ihren Entwicklungsquotienten. Das Geschlecht der Kinder und die Schulbildung der Mutter hatten keinen Einfluss auf das Aktivitätsverhalten der Kinder. Die klinische Beobachtung erhöhter Aktivität bei VLBW-Kindern im Kleinkindalter ließ sich durch den Einsatz des Aktometers im Rahmen dieser Studie objektivieren. Die Verwendung eines Aktometers in der klinischen Routine ist denkbar, auf Grund der gut mit den Messdaten übereinstimmenden Einschätzung erfahrener Untersucher jedoch in diesem Zusammenhang, auch unter ökonomischen Aspekten, nicht erforderlich. Um den Kindern mit erhöhtem Aktivitätsverhalten und/oder niedrigem Entwicklungsstand eine möglichst günstige Weiterentwicklung zu ermöglichen, sollte ihnen und ihren Familien eine angemessene Unterstützung zur Verfügung gestellt werden. / In the longterm follow up of VLBW infants, an increased motor activity has been noted. Verification of this observation was sought by means of an objective measurement. For this purpose, the practicability of actigraphic monitoring was evaluated. In this study, 43 VLBW children and a reference group of 19 mature born children at the corrected age of 20 months wore an actometer during the developmental diagnostics with the Griffithstest. In addition, a subjective assessment of the motor activity was obtained from the parents and examiners. It became clear that within the framework of this study the VLBW children had a significant higher motor activity than the children within the reference group. The frequency of moments where the children rested without movement during the assessment situation correlated positively with the birthweight and the gestational age. The personal evaluation of the parents and the examiners corresponded well with the objectively obtained data. The children with a higher degree of motionless moments during the examination scored better results in their developmental quotients as well. The sex of the children and the level of education of their mothers had no effect on the motor activity of the children. The clinical observation of increased motor activity of VLBW infants in the corrected age of 20 months could have been objectivated during this investigation by the use of actigraphic monitoring. The use of an actometer in the clinical routine might be practical. Considering the evaluation of the results of this study as well as the economical aspects, the use of actigraphic monitoring is not necessarily needed. In order to allow the best possible further development for the children with increased motor activity and /or low state of development, an appropriate support for them and their families should be offered.

Die vorliegende Arbeit stellt das Ergebnis einer prospektiven Studie vor, in der zwei Methoden zur objektiven Erfassung des Schlaf-Wach-Rhythmus miteinander verglichen wurden. Der Standard für die Erfassung des Schlafes ist die Polysomnographie. Die Aktometrie, die Erfassung des Schlafes anhand der motorischen Aktivität eines Probanden, bietet im Vergleich zur Polysomnographie eine Reihe von Vorteilen – das Verfahren ist kostengünstig, einfach durchführbar und die Untersuchungen können über einen langen Zeitraum bis zu mehreren Monaten in der häuslichen Umgebung der Probanden stattfinden. Als nachteilig erweist sich die Gefahr der Überschätzung der Schlafdauer, vor allem bei Schlafstörungen. Dies macht die Entwicklung neuer Geräte, die zusätzlich zur Aktometrie weitere Parameter zur Schlaf-Wach-Klassifikation erheben, notwendig. In dieser Arbeit wurde das klassische und in vielen Studien validierte Aktometer Actiwatch AW7 mit dem neuen Gerät SenseWear Pro 3 verglichen. SenseWear erfasst zusätzlich zur Akzelerometrie weitere Parameter wie Hautleitfähigkeit und Wärmeabgabe. Der Vergleich wurde anhand der Daten durchgeführt, die an 26 Probanden erhoben werden konnten, die beide Geräte gleichzeitig über mindestens fünf Nächte trugen. SenseWear und Actiwatch unterschieden sich dabei signifikant in den Messergebnissen zur Gesamtschlafdauer, Schlafeffizienz und Schlaflatenz. Bei hoher Sensitivität hatte SenseWear eine niedrige Spezifität verglichen mit Actiwatch. Dies könnte ein Hinweis dafür sein, dass SenseWear durch seine multidimensionale Messmethodik wache Phasen eher als solche erkennen kann. Dies muss in weiteren Vergleichsstudien, vor allem im Vergleich zur Polysomnographie, untersucht werden.

Made available in DSpace on 2014-12-17T15:16:13Z (GMT). No. of bitstreams: 1 PatriciaVNN_DISSERT.pdf: 1343694 bytes, checksum: 3e4c49a6f2684888a59c1621bc5412b2 (MD5) Previous issue date: 2011-04-01 / Introduction: The aging process causes quantitative and qualitative changes in sleeping. Such changes affects more than half of the adults above 65 years old, that live in the community and 70% of the institutionalized, a great negative impact in their quality of life. One of the pathological displays of aging, that share some characteristics with sleeping disorders and predict similar results, is the Frailty Syndrome, that characterize the most weakened and vulnerable elderly. The way sleeping disorders play a role in the frailty pathogeneses remains uncertain. Objective: Evaluate the relation between the sleeping and the frailty syndrome on institutionalized elderly. Methodology: A transversal study was performed with 69 elderly in institutions in the city of Jo?o Pessoa PB. Were used the Pittsburgh Sleeping Quality Index and actigraphy to subjective and objective variables, respectively, and questionnaires and specific tests to frailty phenotype variant (Fried Frailty Criteria). In the statistic analysis were used the Pearson correlation test, Chi Square and One-way ANOVA test, with Tukey-Krammer posttest. Subsequently, a Simple Linear Regression model was built. On every statistical analysis were considered a confidence interval of 95% and a p < 0,05. Results: The sample was characterized by the prevalence of the frail (49,3%), women (62,3%), single (50,7%) and 77,52 (?7,82).The frail elderly obtained the worst sleeping quality 10,37 (?4,31) (f = 4,15, p = 0,02), when compared with the non-frail. The sleep latency influenced more the frailty (R2 = 0,13, &#946; standard = 1,76, &#946; = 0,41, p = 0,001). Weren t found differences between the standard resting-activity variable and the frailty phenotype categories. Conclusion: Sleeping alterations, including bad sleeping quality, prolonged sleep latency, low sleep efficiency and day drowsiness, influenced the frailty in institutionalized elderly / Introdu??o: O processo de envelhecimento ocasiona modifica??es na quantidade e qualidade do sono. Tais modifica??es afetam mais da metade dos adultos acima de 65 anos de idade, que vivem na comunidade e 70% dos institucionalizados, gerando impacto negativo na sua qualidade de vida. Uma das manifesta??es patol?gicas do envelhecimento que compartilha algumas caracter?sticas com as desordens do sono e prediz resultados similares ? a S?ndrome da Fragilidade, que caracteriza os idosos mais debilitados e vulner?veis. A maneira como os transtornos do sono desempenham um papel na patog?nese da fragilidade permanece incerta. Objetivo: Avaliar a rela??o entre sono e s?ndrome da fragilidade em idosos institucionalizados. Metodologia: Foi realizado um estudo transversal, com 69 idosos residentes em institui??es no munic?pio de Jo?o Pessoa - PB. Foram utilizados ?ndice de Qualidade de Sono de Pittsburgh e actigrafia para as vari?veis subjetivas e objetivas do sono, respectivamente, e question?rios e testes espec?ficos para as vari?veis do fen?tipo de fragilidade (crit?rios de fragilidade de Fried). Na an?lise estat?stica utilizou-se o teste de correla??o de Pearson, teste Qui Quadrado e ANOVA One-way, com p?steste de Tukey-Kramer. Posteriormente, foi constru?do um modelo de Regress?o Linear Simples. Em toda an?lise estat?stica foi considerado um intervalo de confian?a de 95% e um p < 0,05. Resultados: A amostra foi caracterizada pelo predom?nio de fr?geis (49,3%), mulheres (62,3%), de solteiros (50,7%) e m?dia de idade de 77,52 (?7,82). Os idosos fr?geis obtiveram pior qualidade de sono, 10,37 (?4,31) (f = 4,15, p = 0,02), quando comparados aos n?o fr?geis. A lat?ncia do sono foi a que mais influenciou a fragilidade (R2 = 0,13, &#946; padr?o = 1,76, &#946; = 0,41, p = 0,001). N?o foram encontradas diferen?as entre as vari?veis do padr?o repouso-atividade e as categorias do fen?tipo de fragilidade. Conclus?o: As altera??es do sono, incluindo m? qualidade de sono, lat?ncia de sono prolongada, baixa efici?ncia de sono e sonol?ncia diurna, influenciam a fragilidade em idosos institucionalizados

Die vorliegende Arbeit stellt das Ergebnis einer prospektiven Studie vor, in der zwei Methoden zur objektiven Erfassung des Schlaf-Wach-Rhythmus miteinander verglichen wurden. Der Standard für die Erfassung des Schlafes ist die Polysomnographie. Die Aktometrie, die Erfassung des Schlafes anhand der motorischen Aktivität eines Probanden, bietet im Vergleich zur Polysomnographie eine Reihe von Vorteilen – das Verfahren ist kostengünstig, einfach durchführbar und die Untersuchungen können über einen langen Zeitraum bis zu mehreren Monaten in der häuslichen Umgebung der Probanden stattfinden. Als nachteilig erweist sich die Gefahr der Überschätzung der Schlafdauer, vor allem bei Schlafstörungen. Dies macht die Entwicklung neuer Geräte, die zusätzlich zur Aktometrie weitere Parameter zur Schlaf-Wach-Klassifikation erheben, notwendig. In dieser Arbeit wurde das klassische und in vielen Studien validierte Aktometer Actiwatch AW7 mit dem neuen Gerät SenseWear Pro 3 verglichen. SenseWear erfasst zusätzlich zur Akzelerometrie weitere Parameter wie Hautleitfähigkeit und Wärmeabgabe. Der Vergleich wurde anhand der Daten durchgeführt, die an 26 Probanden erhoben werden konnten, die beide Geräte gleichzeitig über mindestens fünf Nächte trugen. SenseWear und Actiwatch unterschieden sich dabei signifikant in den Messergebnissen zur Gesamtschlafdauer, Schlafeffizienz und Schlaflatenz. Bei hoher Sensitivität hatte SenseWear eine niedrige Spezifität verglichen mit Actiwatch. Dies könnte ein Hinweis dafür sein, dass SenseWear durch seine multidimensionale Messmethodik wache Phasen eher als solche erkennen kann. Dies muss in weiteren Vergleichsstudien, vor allem im Vergleich zur Polysomnographie, untersucht werden.

Objective: Restorative sleep is associated with increased autonomous parasympathetic nervous system activity that might be improved by heart rate variability-biofeedback (HRV-BF) training. Hence the aim of this study was to investigate the effect of a four-week mobile HRV-BF intervention on the sleep quality and HRV of healthy adults. - Methods: In a prospective study, 26 healthy participants (11 females; mean age: 26.04 ± 4.52 years; mean body mass index: 23.76 ± 3.91 kg/m²) performed mobile HRV-BF training with 0.1 Hz breathing over four weeks, while sleep quality, actigraphy and HRV were measured before and after the intervention. - Results: Mobile HRV-BF training with 0.1 Hz breathing improved the subjective sleep quality in healthy adults [t(24) = 4.9127, p ≤ 0.001, d = 0.99] as measured by the Pittsburgh Sleep Quality Index. In addition, mobile HRV-BF training with 0.1 Hz breathing was associated with an increase in the time and frequency domain parameters SDNN, Total Power and LF after four weeks of intervention. No effect was found on actigraphy metrics. - Conclusions: Mobile HRV-BF intervention with 0.1 Hz breathing increased the reported subjective sleep quality and may enhance the vagal activity in healthy young adults. HRV-BF training emerges as a promising tool for improving sleep quality and sleep-related symptom severity by means of normalizing an impaired autonomic imbalance during sleep.

Il NM è una disturbo del movimento spontaneo caratterizzato da un sottoutilizzo dell’arto controlesionale in assenza di un deficit primario che migliora con il comando verbale. Per la sue caratteristiche è difficile da evocare in ambito clini-co e il suo riconoscimento si basa sull'osservazione dei sintomi. Le lesioni associate al NM sono diverse e i suoi mecca-nismi sono sconosciuti. La compromissione selettiva del movimento spontaneo suggerisce un coinvolgimento del si-stema motorio mediale. La ricerca ha lo scopo di studiare il NM con un nuovo metodo quantitativo, basato su actigra-fia, e di esplorare le basi neuroanatomiche. Due accelerometri erano posti su entrambi i polsi per 24 ore. 31 soggetti sani e 38 cerebrolesi, 6 con MN sono stati reclutati. In due casi abbiamo esplorato le lesioni. E’stato validato il nuovo indice di asimmetria AR24h. I MN mostravano un comportamento asimmetrico, simile agli emiplegici e diverso dai sani e dai pazienti non emiplegici. I pazienti mostravano una lesione del cingolo e putamen, parti del sistema motorio mediale, importante per le azioni volontarie. I risultati che l’actigrafia differenziale nel quantifica il movimento spontaneo e valuta il NM. Putamen e il cingolo causano una disfunzione del sistema motorio mediale e induce NM. / The MN is a movement disorder characterized by spontaneous underutilized contralesional limb in the absence of a primary deficit that improves with the verbal command. For its characteristics it is difficult to evoke in the clinical set-ting and its recognition is based on observation of symptoms. The lesions associated with NM are different and its mechanisms are unknown. The selective impairment of spontaneous movement suggests the involvement of the medi-al motor system. Research has the aim of studying the MN with a new quantitative method, based on the actigraphy, and to explore the neuroanatomical bases. Two accelerometers were placed on both wrists for 24 hours. Sog-31 jets and 38 brain-healthy, with 6 MN were recruited. In two cases we analysis lesions. It has been validated new asymmetry index AR24h. The MN showed an asymmetric behavior, similar to and different from the healthy and hemiplegic pa-tients not hemiplegic. Patients showed a lesion of the cingulate and putamen, parts of the medial motor system im-portant for voluntary actions. The differential actigraphy quantifies the spontaneous movement and evaluates the NM. Putamen and the track cause dysfunction of the motor system and causes medial NM.

Actuellement, le diagnostic différentiel du trouble bipolaire (TB) et du trouble de personnalité limite (TPL) à l’adolescence s’avère difficile et complique le choix thérapeutique. Portant sur le TB et le TPL, ce mémoire fait le point sur la littérature scientifique adulte et adolescente, vérifie la faisabilité et présente les résultats d’une étude exploratoire portant sur les variables cliniques (instabilité émotionnelle, hostilité, impulsivité, tempraément) et le rythme veille-sommeil à l’adolescence. L’étude exploratoire comprend sept adolescents TB et huit TPL (12-17 ans), évalués par questionnaires autoadministrés pour les variables cliniques, et par actigraphie et agenda de sommeil pour le rythme veille-sommeil. Aucune différence significative n’existe entre les deux troubles pour les variables cliniques. En moyenne, les adolescents TB ont porté l'actigraphie pendant 9,9 jours et ont rempli un agenda de sommeil pendant 5,7 jours; chez les TPL, les chiffres sont respectivement 9,8 et 8,9 jours. Comparés aux TPL, les TB ont un plus grand intervalle d’éveil (p=0,035), ont un plus grand intervalle de sommeil (p>0,05), et ont une plus grand variabilité intrajournalière (p=0,04). Les données subjectives (agenda de sommeil) semblent refléter les données objectives (actigraphie) : aucune différence statistique n’est observée entre les deux mesures pour le délai d’endormissement, la durée du dernier réveil et le temps total de sommeil. La recension de la littérature montre un manque de données chez l’adolescent quant aux deux troubles. La faisabilité de l’étude est démontrée par la présence de résultats analysables. Ceci encourage la poursuite des recherches sur ces variables, afin de distinguer les deux psychopathologies à l’adolescence. / Presently, differential diagnosis between bipolar disorder (BD) and borderline personality disorder (BPD) in adolescents remains difficult and affects therapeutic choices. This master’s thesis reviews current scientific literature, both in adults and adolescents. It examines feasibility and presents results of a study on clinical dimensions and endophenotypes in adolescent BD and BPD. Seven BD and eight BPD adolescents (12-17 years old) were evaluated by self-reported questionnaires for clinical variables (affective instability, impulsivity, hostility and temperament) and by actigraphy and sleep diary for sleep-wake circadian rhythm. No significant difference was found between BD and BPD for the clinical variables. BD adolescents wore actigraphic device for 9.9 days and completed the sleep diary for 5.7 days on average; for BPD subjects, the numbers were respectively 9.8 days and 8.9 days. Compared to BPD, BD patients had longer active interval (p=0.035), tended to sleep longer, and had more intradaily variability (p=0.04). Subjective data (sleep diary) and objective data (actigraphy) did not significantly differ on sleep onset latency, last awakening duration and total sleep time, which suggested that BD and BPD adolescents had a good estimate of their sleep patterns. Literature review showed a dearth of research done on adolescent BD and BPD. Feasibility of this study was verified, since data was successfully collected. Research on these variables should continue, so differential diagnosis can be done in adolescent BD and BPD.