INTRODUCTION. La charge mondiale des maladies cardiovasculaires (MCV) ne cesse d’augmenter. Une population particulièrement vulnérable à ces maladies est celle des adultes âgés ayant une maladie neurologique : l’épilepsie. Plusieurs études démontrent que les adultes âgés atteints d’épilepsie ont un risque plus élevé de développer une MCV par rapport à la population générale. Cette association est étonnamment peu étudiée chez cette population. Afin de développer des programmes de soins de santé pour prévenir l’apparition de comorbidité de MCV chez les personnes atteintes d’épilepsie, dresser un portrait précis des adultes âgés atteints d’épilepsie est nécessaire. OBJECTIFS. Afin de combler les lacunes de la littérature scientifique sur les causes du fardeau élevé des MCV chez les adultes âgés atteints d’épilepsie, l’objectif de ce mémoire est d’étudier la répartition des facteurs sociaux, mode de vie et comportements, ainsi que des maladies chroniques connues comme étant des facteurs de risque de MCV chez les adultes âgés atteints d’épilepsie comparée à la population générale. En outre, nous visons à mesurer l’association transversale entre l’épilepsie et les MCV chez les adultes âgés, avec et sans ajustement pour des antécédents d’accidents vasculaires cérébraux (AVC), ainsi qu’à trouver des preuves d’interactions entre l’épilepsie et les facteurs de risque de MCV. MÉTHODES. Nous avons analysé les données de 44 817 participants de l’Étude longitudinale canadienne sur le vieillissement (ÉLCV), une cohorte d’étude longitudinale composée d’individus âgés d’au moins 45 ans et plus dont plus de 700 personnes ont des antécédents d’épilepsie autodéclarés au cours de leur vie. En ajustant pour l’âge, le sexe et le statut d’AVC, nous avons utilisé la régression log-binomiale pour modéliser les associations transversales entre les facteurs de risque de MCV, l’épilepsie et les MCV telles que les maladies cardiaques, les maladies vasculaires périphériques et les infarctus du myocarde. Nous avons comparé le fardeau des MCV attribuable par les AVC dans la population avec et sans épilepsie. Des modèles de régression multivariés ont également été stratifiés en fonction du statut d’épilepsie afin d’observer des différences dans ces associations entre les personnes atteintes d’épilepsie et les personnes non atteintes d’épilepsie. Finalement, nous avons testé l’existence d’interactions entre les facteurs de risque de MCV et l’épilepsie, et leur association avec le statut de MCV. Nous avons utilisé l’imputation multiple pour remplacer les données manquantes. RÉSULTATS. La majorité des caractéristiques sociodémographiques, mode de vie et comportements et maladies chroniques, sélectionnées comme facteurs de risque de MCV dans notre étude, étaient significativement plus prévalentes chez les personnes atteintes d’épilepsie comparée à la population générale non atteinte d’épilepsie. Le fardeau des MCV attribuable par les AVC chez les personnes atteintes d’épilepsie n’était que de 36 %, soit un taux similaire à celui de la population générale qui lui s’élevait à 32 %. Même après l’ajustement du statut d’AVC, ainsi que de l’âge et du sexe, les personnes atteintes d’épilepsie présentaient une prévalence significativement plus élevée de maladies cardiaques [ratio de prévalence (PR) = 1,27 (IC à 95 % : 1,02-1,57)] et de maladies vasculaires périphériques [PR = 1,88 (IC à 95 % : 1,50-2,36)]. Bien qu’elle ne soit plus significative, la tendance vers une augmentation de la prévalence des infarctus du myocarde chez les personnes atteintes d’épilepsie était maintenue [PR = 1,19 (IC à 95 % : 0,89-1,60)]. Finalement, parmi tous les facteurs de risque de MCV, seuls l’âge, l’hypertension et la maladie pulmonaire chronique obstructive ont été associés à une augmentation significative de la prévalence d’une ou plusieurs MCV. CONCLUSION. La grande taille de l’échantillon et l’étendue des informations sur la santé saisies par l’ÉLCV (c’est-à-dire démographiques, sociales, physiques, psychologiques, économiques, physiologiques) nous ont permis de modéliser une analyse approfondie et de présenter un reflet juste d’une population d’adultes âgés. Le mémoire présenté démontre que les facteurs de risque de MCV sont plus fréquemment observés chez les personnes atteintes d’épilepsie et l’association entre l’épilepsie et les MCV est indépendante de l’association entre l’épilepsie et les AVC. Ces résultats constituent une première étape importante pour mieux comprendre les origines des MCV chez les personnes atteintes d’épilepsie. L’analyse de médiation aurait pu être un moyen d’approfondir mes analyses. Cela n’a pas été possible avec l’analyse actuelle étant donné que nous n’avions aucun moyen d’établir la séquence temporelle de nos données. Les adultes âgés constituent une population vulnérable à laquelle les prestataires de soins de santé doivent accorder une attention particulière. Mener des études longitudinales sur les personnes dont les crises d'épilepsie viennent d'être diagnostiquées et qui présentent une maladie chronique, des caractéristiques sociodémographiques et un mode de vie entièrement caractérisé (avant et après le diagnostic d'épilepsie) sont nécessaires. / INTRODUCTION. The global burden of cardiovascular disease (CVD) is steadily increasing. A population particularly vulnerable to these diseases are the older adults with a neurological condition: epilepsy. Several studies show that older adults with epilepsy have a higher risk of developing CVD when compared to the general population. This association is surprisingly poorly studied among people with epilepsy. In order to develop health care programs to prevent the onset of CVD comorbidity in people with epilepsy, creating an accurate portrait of older adults with epilepsy is required. OBJECTIVES. In order to fill the gaps in the scientific literature on the causes of the high burden of CVD in older adults with epilepsy, the purpose of this thesis is to investigate the distribution of social factors, lifestyle and behaviors, as well as chronic disease CVD risk factors, in people with epilepsy as compared to the general population. In addition, we aim to measure the cross-sectional association between epilepsy and CVD in older adults, with and without adjustments for a history of stroke as well as looking for evidence of interactions between epilepsy and CVD risk factors. METHODS. We analysed data for 44,817 participants in the Canadian Longitudinal Study on Aging (CLSA), a longitudinal study cohort of individuals aged at least 45 years and where more than 700 individuals have a lifetime self-reported history of epilepsy. Adjusting for age, sex and stroke, we used log-binomial regression to model the cross-sectional associations between CVD risk factors, epilepsy, and CVD such as heart disease, peripheral vascular disease, and myocardial infarction. We compared the CVD burden attributable to stroke in the population with and without epilepsy. Multivariable regression models were also stratified across levels of epilepsy status to observe for differences in these associations between epilepsy and people without epilepsy. Finally, we tested the existence of interactions between CVD risk factors and epilepsy and their association with CVD status. We used multiple imputation to replace missing data. RESULTS. The majority of the sociodemographic characteristics, lifestyle and behavior and chronic diseases, selected as CVD risk factors in our study, were significantly more prevalent in people with epilepsy as compared to the general population without epilepsy. The CVD burden attributable to stroke in people with epilepsy was only 36%, similar to the general population which reached 32%. Even after adjusting for a history of stroke, as well as age and sex, people with epilepsy had a significantly higher prevalence of heart disease [prevalence ratio (PR) = 1.27 (95% CI: 1.02, 1.57)] and peripheral vascular disease [PR = 1.88 (95% CI: 1.50, 2.36)]. Although no longer significant, the trend towards an increase in the prevalence of myocardial infarction in people with epilepsy was maintained [PR = 1.19 (95% CI: 0.89, 1.60)]. Finally, among all the CVD risks factors, only age, hypertension, and chronic obstructive pulmonary disease were associated with significant increases in the prevalence of one or more of the CVD. CONCLUSION. The large sample size and breadth of health information captured by the CLSA (i.e. demographic, social, physical, psychological, economic, physiological) allowed us to model in-depth analysis and present a fair reflection of an older adult population. The presented thesis demonstrates that CVD risk factors are more frequently seen in people with epilepsy and that the association between epilepsy and CVD is independent of the association between epilepsy and stroke. These findings are important first steps in more comprehensively understanding the origins of CVD in people with epilepsy. Mediation analysis could have been a way of further examining my analysis. This was not possible with the current analysis given that we had no way to establish the temporal sequence of our data. Older adults are a vulnerable population in which health care providers should pay particular attention. Conducting longitudinal studies of individuals with newly diagnosed epilepsy seizures and fully characterized chronic disease, sociodemographic characteristics and lifestyle (prior to and post a epilepsy diagnosis) are needed.

No description available.

Missbruk och beroende är idag ett utbrett samhällsproblem, på alla samhällsnivåer. Samtidigt som det finns ett stigma kring missbruk har antalet offentliga personer som berättar om sina erfarenheter av missbruk ökat. Studiens syfte har varit att genom kvalitativ tematisk textanalys analysera självbiografier av sju kända svenska män som berättar om sitt missbruk. Vi har undersökt hur droganvändning och dess orsaker skildras i kändisarnas självbiografier. Resultaten har kodats och tematiserats för att kunna besvara frågeställningen. Analysen innefattar förklaringsmodeller (samsjuklighet, självmedicinering, karriärmodell, skam och vändpunkt) som socialarbetare använder när de beskriver hur det kommer sig att vissa personer använder droger. Resultaten visar att berättelser om samsjuklighet, självmedicinering och tillfrisknande från droganvändning är snarlika, om än med individuella skillnader. Slutsatsen är att de ger en inblick i missbruk som kan vara till hjälp i att förstå och hjälpa personer som använder droger. / Addiction and drug dependency have become widespread social problems in all layers of society. While there is always a stigma around drug abuse, the number of public figures willing to share their experiences on the issue has increased. The purpose of the study was to analyse the autobiographies of seven famous Swedish men, writing about their addiction, using qualitative thematic text analysis. We have explored how we can gain a greater understanding of drug use and its causes, and how it is portrayed in autobiographies. The analysis contains selected explanatory models (comorbidity, self-medication, career model, shame and turning point) that social workers use when describing how and why a person is using drugs. Results have been coded and thematized in order to answer the questions at hand. The results show that stories on recovery from drug use are often quite similar, albeit with individual differences. The results give an insight into addiction which can help understanding and helping people affected by addiction.

Bakgrund: Många patienter har samsjuklighet i psykisk ohälsa och substansbrukssyndrom vilket gör den patientgruppen svårbehandlad. Interaktion i samsjuklighet försämrar oftast båda tillstånd och patienter kan få svårare förlopp av dessa. Under behandling blir det oftast mer fokus på en av diagnoser vilket gör att patienterna inte får en optimal omvårdnad och behandling. Bristfällig kunskap om samsjuklighet leder till stigmatiseringen av denna patientgrupp. Detta leder i sin tur till att patienter undviker att söka vård, blir socialt diskriminerade och isolerade. Patienter med samsjuklighet upplever dessutom mer stigma än patienter med enbart en av dessa diagnoser. Allt detta sätter press på en specialistsjuksköterska i psykiatrisk omvårdnad för att tillgodose att patienter med samsjuklighet får en personcentrerad omvårdnad av god kvalitet.   Syfte: Syftet är att beskriva upplevda erfarenheter av behandling och rehabilitering av substansbrukssyndrom hos personer med psykisk ohälsa. Metod: Allmän litteraturstudie med kvalitativ ansats. Insamlade data analyserades med hjälp av tematisk analys. Resultat: Det identifierades åtta teman, två huvudteman, och sex subteman. Huvudtemat ”Behandling och rehabilitering” hade fyra subteman: “Behandlingsmetoder”, ”Faktorer till en framgångsrik behandling och rehabilitering”, ”Hinder för behandling och rehabilitering” och ”Personalens roll i behandling och rehabilitering”. Därefter följde huvudtemat ”Stigma och lidande” med två subteman: “Självmedicinering av psykisk ohälsa” och “Dubbelt lidande”. Slutsatsen: Patienterna upplevde att en personcentrerad omvårdnad och bemötande samt adekvat kunskap hos vårdpersonalen är viktiga faktorer för en lyckad behandling och rehabilitering. Dessa faktorer bidrar till minskad stigmatisering inom vården och gör att patienter vågar söka vård. Vid samsjuklighet i både psykisk ohälsa och substansbrukssyndrom fördubblas lidande, därför krävs det att sjuksköterskor ökar sin kompetens genom att uppdatera sig med ny evidens inom området. / Background: Many patients have comorbidity in mental illness and substance use syndrome, which makes this patient group difficult to treat. Interaction in co-morbidity usually worsens both conditions and patients may have more severe courses of these. During treatment, there is usually more focus on one of the diagnoses, which means that patients do not receive optimal care and treatment. Insufficient knowledge about co-morbidity leads to the stigmatization of this patient group. This in turn leads to patients avoiding seeking care, becoming socially discriminated against and isolated. Patients with comorbidity also experience more stigma than patients with only one of these diagnoses. All of this puts pressure on a specialist nurse in psychiatric care to ensure that patients with co-morbidities receive good quality person-centred care. Purpose: The purpose is to describe perceived experiences of treatment and rehabilitation of substance use syndrome in people with mental illness. Method: A general literature study with a qualitative approach. Collected data were analyzed using thematic analysis. Results: Eight themes, two main themes, and six subthemes were identified. The main theme "Treatment and rehabilitation" had four sub-themes: "Treatment methods", "Factors for successful treatment and rehabilitation", "Obstacles to treatment and rehabilitation" and "The role of staff in treatment and rehabilitation". Then followed the main theme "Stigma and suffering" with two sub-themes: "Self-medication of mental illness" and "Double suffering". The conclusion: The patients felt that person-centered care and treatment as well as adequate knowledge on the part of the nursing staff are important factors for successful treatment and rehabilitation. These factors contribute to reduced stigma in healthcare and make patients dare to seek care. In the case of co-morbidity in both mental illness and substance use syndrome, suffering is doubled, therefore it is required that nurses increase their competence by updating themselves with new evidence in the field.

BACKGROUND: The correlates of legally significant outcomes that have been identified in people with mental disorders are of limited value in understanding the mechanisms by which these outcomes occur. AIMS: To describe the relationships between mental disorder, impaired psychosocial function, and three legally significant outcomes in a representative sample of the US population. METHODS: We used a population survey, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III, sample size 36,309), to identify people who self-reported serious trouble with the police or the law over the past 12 months and two lifetime outcomes, being incarcerated and engaging in violence to others. DSM-5 categories were generated using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5. Psychosocial function was assessed using social and role-emotional function scores of the 12-Item Short-Form Health Survey Version 2. RESULTS: Participants with mental disorder, but not people with no diagnosis, who reported serious trouble with the police or with the law during the previous 12 months reported significantly worse psychosocial function than those who did not report such trouble. The size of the statistical effect varied by diagnosis, moderate for some forms of mental illness and for alcohol abuse and nonsignificant for drug abuse and the personality disorders. Effect sizes were largest for diagnoses where legally significant outcomes were least common. CONCLUSIONS: The effect of impaired psychosocial function, for instance in disrupting family and social networks that would otherwise protect against these legally significant outcomes, warrants further investigation in studies with longitudinal designs.

Hemlösa personer med samsjuklighet sägs vara en av de mest utsatta målgrupperna inom socialt arbete. Då återfall är ett symtom av skadligt bruk och beroende har målgruppen haft betydande svårigheter att leva upp till nykterhetskraven som ställs inom traditionella insatser. Således har insatsen Bostad först tagits fram med en skademinskningspolicy som prioriterar minimering av de risker som är vanliga för målgruppen över nykterhetskrav. Denna uppsats syftar till att undersöka praktiska erfarenheter av det skademinimerande arbetet i bostad först Data samlades in genom en kvalitativ fokusgruppsintervju med fyra socialarbetare som är anställda som Case managers inom ett svenskt Bostad först-projekt. En tematisk dataanalys gjordes med socialkonstruktionism och nyinstitutionell teori som teoretiskt ramverk. Resultaten visade på ett holistiskt synsätt på skadereducering men också att synen på skadereducering varierar starkt beroende på sammanhanget. Det framkom också att de motstridiga principerna om nolltolerans och skademinskning påverkar det professionella samarbetet på flera sätt. / Homeless persons with comorbidity are among the most vulnerable populations within social work. The relapsing nature of substance abuse has been a significant barrier to the traditional treatment/housing programs that build upon abstinence-based policies. Therefore, there has been a shift toward Housing First, a harm reduction policy that prioritizes the minimization of harms over abstinence. This study aims to explore practical experiences with the harm reduction approach within Housing First.Data was collected through a qualitative focus group interview with four employeeswithin a Housing First project in Sweden. The data was analyzed by a thematic analysis with social constructivism and new institutionalism as theoretical frameworks.The results showed a holistic approach to harm reduction but also that the view on harm reduction varies depending on the social context. It was also revealed that the conflicting principles of zero tolerance and harm reduction have affected professionalcollaboration in various ways

Samsjuklighet i form utav psykisk ohälsa och substansbrukssyndrom är ett nationellt omfattandefolkhälsoproblem. Personer som lever med samsjuklighet söker sig ofta till vården vilket ställerkrav på den vård som erbjuds inom psykiatrisk vård. Patienten som lever med samsjuklighetanses ofta som komplexa och vårdkrävande i kontakt med sjukvården. Vårdpersonalensbemötande i kontakt med den patientgrupp kan uppfattas på olika sätt av patienter.Vårdpersonalens bemötande kan upplevas som värdefull respektive dålig erfarenhet beroende påhur patienter upplever det och vad det tillfört i deras lidande. Syftet: var att beskriva patientensupplevelse av psykiatrisk vård vid samsjuklighet i form av psykiatrisk ohälsa ochsubstansbrukssyndrom. Metod: Studien utfördes som en litteraturstudie med en metod förinnehållsanalys. Sexton vetenskapliga artiklar analyserades. Resultat: Analysen resulterade ifyra kategorier: Att mötas av okunskap och brist på förståelse, Att bli bemött utifrån enhelhetssyn, Att acceptera att man behöver hjälp och ha viljan att kämpa för att ett bättre liv, Attuppleva brist i uppföljnings och behandling. Resultatet visade att patienter upplevde brist avkunskap och kompetens hos vårdpersonalen som ska bidra till att minska / hindra uppkomst avfördomar, stigma i möte med vårdpersonal. Patientgruppen upplevde att en bemötande som ettpräglas av en helhetssyn från vårdpersonal är nyckeln till god vård som främjar derasåterhämtning. Patienter upplevde att egen acceptans och insikt på att de är i behov av hjälp var ien viktig del i behandlingen och brist på kontinuerlig uppföljning och deras behandling var en avde faktorer som försämrade och försvårade återhämtningsprocessen och beslut att sluta medsubstansbruk. Diskussion: Diskussion: Bemötande som speglar av helhetssyn, kontinuerliguppföljning under behandling, kunskap samt kompetensutveckling bör prioriteras inom denpsykiatrisk vården för att förbättra patientens upplevelse av vården som erbjöds.

No description available.

Schizophrenia is a severe neuropsychiatric disorder of largely unknown etiology that is often accompanied by high rates of cigarette smoking, reduced quit success, and high relapse rates. Dysregulated dopamine signaling and aberrant synaptic plasticity in the mesocorticolimbic pathway are implicated in the pathophysiology of schizophrenia and conferred substance abuse disorder and relapse vulnerability. Genetic factors are presumed to play a significant role in the development of schizophrenia, with a 40-50% concordance rate for monozygotic twins, although genetic markers are inconsistent. As such, epigenetic factors have instead been implicated. Specifically, there is strong evidence to suggest DNA methylation at several candidate genes contributes significantly to the pathophysiology of schizophrenia. To investigate this heritable component, our laboratory has developed a novel heritable model of drug abuse vulnerability in psychosis. This model is the first to show heritable increases in dopamine D2 receptor sensitivity via several behavioral and neurobiological markers, including enhanced behavioral responding to nicotine and changes in D2 signaling cascades in brain regions associated with psychosis and comorbid drug abuse. Increased D2 receptor sensitivity is the most consistent biomarker of psychosis found in preclinical animal models and postmortem brain tissue of individuals diagnosed with schizophrenia, lending considerable strength to the validity of the model. This study aimed to further validate the model as a useful and valuable tool for better understanding the pathophysiology of comorbid nicotine use and relapse in psychosis, and to explore more effective therapeutic targets than current antipsychotic medications. Results reveal DNA methylation as an epigenetic mechanism conferring heritability of the psychosis-like phenotype in the model. We additionally demonstrate altered relapse-like behavior, clinically consistent with reduced quit success and elevated relapse vulnerability. Interestingly, changes in relapse-like behavior were correlated to elevated protein levels of brain derived neurotrophic factor (BDNF), a marker of activity-dependent plasticity, in brain areas associated with drug reward. Further, modulation of the metabotropic glutamate type 5 (mGlu5) receptor alleviates the enhanced nicotine conditioned place preference observed in the model. Mechanistically, mGlu5 modulation restores normal dopamine D2 signaling and mitigates aberrant plasticity responses that are thought to drive the behavior in a region-specific manner.

<p>Uvod - Etiologija sindroma gornjeg otvora grudnog ko&scaron;a (thoracic outlet syndrome- TOS) je udruženost vi&scaron;e faktora koji su posledica naru&scaron;avanja anatomsko-topografskih odnosa u nivou gornjeg otvora grudnog ko&scaron;a: kostoklavikularnog prostora, prednjeg skalenskog otvora, kao i same mehanike rebarnih zglobova i hrskavica, koji dovode do suženja prostora kroz koje prolaze neurovaskularne strukture, njihove kompresije, a samim tim i iritacije neurovaskularnih struktura. Sindrom gornjeg otvora grudnog ko&scaron;a je kompleks simptoma uzrokovanih kompresijom brahijalnog spleta, vene subklavije, arterije subklavije i simpatičkih vlakana, koji karakteri&scaron;u bol, parestezije, mi&scaron;ićna slabost i osećaj nelagodnosti u ruci/rukama koji se pojačava podizanjem ruke/ruku ili prekomernim pokretima glave i vrata, te dovode do smanjenja funkcionalne sposobnosti ruke/ruku i pote&scaron;koća u obavljanju svakodnevnih aktivnosti. Pored toga imaju često izraženu tahikardiju, osećaj stezanja u grudima, glavobolju, vrtoglavicu, zujanje u u&scaron;ima. Navedene tegobe su izraženije ponekad noću i dovode do poremećaja spavanja (problemi usnivanja, hrkanje, ka&scaron;ljanje, osećaj toplo/hladno, apnea, poremećaj dnevno/noćnog ritma- hronotipizacija, itd). Kao posledica lo&scaron;eg spavanja moguća je pojava depresivnih simptoma. U raspoloživoj literaturi, spavanje i kvalitet spavanja se uglavnom posmatraju kroz prizmu drugih bolesti i stanja. Materijal i metode - Istraživanjem je obuhvaćeno ukupno 181 (sto osam deset jedna) osoba. Od tog broja 53 mu&scaron;karca i 128 žena. Test grupu sačinjavalo je 82 ispitanika sa dijagnostikovanim TOS, a 99 zdravih osoba/osoba oba pola koji nemaju simptomatologiju TOS, je predstavljalo kontrolnu grupu. Grupe su bile ujednačene po polu i starosti (od 18 do 65). Tokom studije ispitanici su podvrgnuti kliničkom pregledu &ndash; fizikalnom i neurolo&scaron;kom pregledu. Pregled je podrazumevao pregled posture obolelog (posmatranje mi&scaron;ića regije vrata, ramena i ruku- trofika, tonus, konzistencija, mobilnost i kontraktilnost), posmatranje promena na koži (sa posebnim osvrtom na promene boje kože, trofičkih promena kože i noktiju i temperature kože ruku - &scaron;aka), testiranje refleksa, ispitivanje senzibiliteta u regijama inervacije odgovarajućih spinalnih korenova brahijalnog spleta. Takođe vr&scaron;ena je analiza stanja uhranjenosti (telesna visina, telesna masa, indeks telesne mase) i izvođenje provokativnih testova (Adson manevar, Rus test, Halsted test, Elvi test i Kostoklavikularni test). Kao deo ispitivanja obavljeno je i radiolo&scaron;ko snimanje vratne kičme kao i pregled oscilografom. Ispitanici su imali za zadatak da ispune sledeće upitnike: Upitnik o nesposobnosti ruke, ramena i &scaron;ake (DASH), Pitsbur&scaron;ki indeks kvaliteta spavanja (PSQI), Upitnik o hronotipizaciji (MEQ), Bekov upitnik o depresiji (BDI II). Na kraju ispitanici su davali odgovore na pitanja iz vodiča za istraživača sastavljenog sa ciljem evaluacije različitih aspekata spavanja. Rezultati - Rezultati su pokazali da su upotrebljene skale dale zadovoljavajuću pouzdanost. Pokazalo se da osobe sa dijagnozom TOS pored bogate simptomatologije imaju jo&scaron; i probleme sa spavanjem. Analizom rezultata do&scaron;lo se do zaključka da osobe sa dijagnozom TOS su starije, imaju vi&scaron;e problema sa spavanjem i veću nesposobnost ruke, ramena i &scaron;ake. Nije se pokazala razlika u hronotipizaciji kod osoba sa TOS u odnosu na kontrolnu grupu. Takođe može se zaključiti da osobe koje imaju izraženu nesposobnost ruku, ramena i &scaron;ake imaju značajno veću &scaron;ansu da imaju sindrom gornjeg otvora grudnog ko&scaron;a. Ove osobe pri tom imaju i veću &scaron;ansu da razviju depresiju i poremećaj spavanja, te se zaključuje da ova dva parametra svoj uticaj na TOS ostvaruju preko problema sa funkcionisanjem ruke, ramena i &scaron;ake. Dobar prediktor za postavljanje dijagnoze TOS može biti testiranje osoba DASH skalom. Zaključak - Rezultati studije mogu biti putokaz daljim istraživanjima, koja bi otvorila vrata formiranju protokola i opservaciji kvaliteta života osoba sa sindroma gornjeg otvora grudnog ko&scaron;a, sa posebnim osvrtom na poremećaje spavanja.</p> / <p>Etiology of thoracic outlet syndrome (TOS) is an association of several factors which are the result of disruption in the anatomical-topographical relations, in the level of superior thoracic aperture: costoclavicular space, anterior scalene aperture, as well as the mechanics of rib joints and cartilage, causing narrowing of space through which the neurovascular structures pass, their compression, and thus the irritation of neurovascular structures. Thoracic outlet syndrome is a complex of symptoms caused by the compression of the brachial plexus, subclavian vein, subclavian artery and sympathetic fibres, which is characterized by pain, parasthesias, muscle weakness and a feeling of discomfort in the arm / arms, which increases with raising the arm/arms or by excessive head and neck movements leading to a reduction of functional capabilities of the hands / arms and difficulties in everyday activities. In addition, patients often have expressed tachycardia, feeling of tightness in the chest, headache, dizziness, tinnitus. These problems are more pronounced at night and sometimes lead to sleep disorders (difficulty in falling asleep, snoring, coughing, feeling hot/cold, apnea, day/night rhythm disorder - Morningness/Eveningness disorder, etc.). As a result of poor sleeping depressive symptoms may occur. In the available bibliography, sleep and quality of sleep are mainly viewed through other diseases and conditions. The study included a total number of 181 (one hundred eighty one) people. Out of that 53 men and 128 women. The test group consisted of 82 patients diagnosed with TOS, and 99 healthy persons of both genders who had no symptoms of TOS, and constitute the control group. Groups were equalled by gender and age (18 to 65). Throughout the study subjects underwent clinical examination - both physical and neurological. This included an assessment of posture of the patient (observation of muscles in region of the neck, shoulders and arms - trophic, muscle tone, consistency, mobility and contractility), observation of changes on the skin (with a special emphasis on skin colour changes, trophic changes of the skin, nails and skin temperature of arms - hands), reflex testing, sensitivity testing in regions of innervations which correspond to spinal roots of the brachial plexus. Moreover, an analysis was conducted on the body composition analysis (body height, body weight, body mass index) as well as provocative tests (Adson manoeuvre, the Roos test, Halstead test, Elvy test and Costoclavicular test). Radiology scan of the cervical spine as well as oscillograph testing was conducted as a part of the test. The subjects were asked to fulfil the following questionnaires: Questionnaire on Disabilities of the Arm, Shoulder and Hand (DASH), Pittsburgh Sleep Quality Index (PSQI), The Morningness / Eveningness Questionnaire (MEQ), Beck Questionnaire on Depression (BDI II). Finally the subjects answered questions that researcher had drawn up in order to evaluate different aspects of sleep. The results showed that the scales used were reliable. It proved that persons diagnosed with TOS in addition to numerous symptoms also had problems with sleep. By analyzing the results it was concluded that people diagnosed with TOS are older, have more problems with sleep and greater disability of arms, shoulders and hands. There was no difference in Morningness/Eveningness type in patients with TOS in comparison to the control group. It can also be concluded that people who have pronounced disability of arms, shoulders and hands have a significantly greater chance of having thoracic outlet syndrome. These persons are more likely to develop depression and sleep disorders therefore those two entities impact TOS through the problems with the functioning of the arms, shoulders and hands. A good predictor in diagnosis of TOS may be testing people with DASH scale. The study findings can serve as a guideline for further research, opening the door into forming protocols and observation of the quality of life of people with the thoracic outlet syndrome, with special emphasis on sleep disorders.</p>