Le sommeil est un état dans lequel nous passons environ le tiers de notre vie. Il fait partie des fonctions vitales de l'organisme. Une enquête a été lancée au Liban ayant pour objectifs de connaitre les habitudes du sommeil, les styles de vie des adolescents et de découvrir les troubles de sommeil les plus fréquents et leurs facteurs associés afin de combler les lacunes dans ce domaine. 41.2% des adolescents avaient un temps de sommeil total de moins de 7 heures par nuit durant la semaine, et 34.4% surfaient sur internet avant de se coucher. 13.1% semblaient souffrir d’insomnie et 26.3% semblaient être atteints de syndrome de retard de phase (SRDP). La dépression était le facteur commun associé à ces deux troubles. En conclusion, la réalisation des études longitudinales permettant de découvrir les facteurs de risque de l’insomnie et du SRDP chez les adolescents libanais ainsi que la suggestion / We spend almost the third of our lifetime sleeping. Sleep is part of the body’s vital functions. A nationwide survey was launched in Lebanon in order to examine and evaluate the Lebanese adolescents’ sleep patterns and lifestyles and to assess the most prevalent sleep disorders and their associated factors, with the purpose of filling in the gaps in this area. 41.2% of the teenagers slept less than 7 hours per night during the week, and 34.4% once in bed always surf the internet. Insomnia and delayed sleep phase disorder (DSPD) were the most common sleep disorders among Lebanese adolescents; they had a prevalence of 13.1% and 26.3% respectively. Depression was the common factor associated with these two disorders. In conclusion, conducting longitudinal studies, in order to identify the most common risk factors of insomnia and DSPD in Lebanese adolescents and suggesting solutions to facilitate the prevention of these disorders and their risk factors are currently a must.

<p>Sömnsvårigheter hos ungdomar är ett växande problem i Sverige men det saknas forskning om behandlingsmetoder för åldersgruppen. Syftet med studien var att testa kognitiv terapi med beteendeexperiment (KT-I) på gymnasieungdomar med primär insomni. Studien genomfördes enligt en Single Subject design med för- och eftermätning. Tre ungdomar i åldern 16-18 genomgick en sju veckor lång behandling efter 1-2 veckors baslinjemätning. Resultatet visade att svårighetsgrad av insomni minskade, att funktionsförmågan dagtid förbättrades och behandlingsmålen uppfylldes i hög grad. Dagliga mätningar visade att förändring av sömnrelaterade symtom och dagtidssymtom varierade mellan deltagarna. Graden av vidmakthållande kognitiva processvariabler minskade. Slutsatser som kan dras är att KT-I är en lovande behandlingsmetod för ungdomar med insomni och att metoden bör testas ytterligare i randomiserade kontrollerade studier.</p> / <p>Sleeping difficulties are an increasing problem in Sweden for youths today, but there is a lack of research on treatments for this age group. The aim of the study was to investigate the effects from Cognitive Therapy with Behavioural Experiments (CT-I) on youths with primary insomnia in upper secondary school. The study was conducted according to a Single-Subject design with pre- and posttests. Three youths between the ages of 16-18 participated in a seven week long treatment, after 1-2 weeks of baseline measures. The results showed that the degree of insomnia decreased, that the ability to function during daytime increased, and that the treatment goals were met to a large extent. Daily measures showed that changes in sleep related symptoms and daytime symptoms varied among the participants. The degree of maintaining cognitive processes decreased. The conclusions that can be drawn are that CT-I is a promising treatment for youths with insomnia and that the method should be tested further in randomized controlled studies.</p>

<p>Sömnstörningar hos ungdomar anses vara ett växande problem. Det finns misstankar om att ungdomarnas ökade användning av Informations- och Kommunikationsteknik (IKT) är boven i dramat. Ungdomar upplevs spendera en allt större del av sin tid framför datorn, samtidigt som mobilen går varm av samtal och SMS. Det saknas dock utförlig forskning kring sambanden mellan IKT-användande och sömn. Syfte: Att undersöka huruvida ungdomar lider av sömnstörningar och om det i så fall kan kopplas till deras IKT-användande. De frågeställningar som behandlas är hur ungdomars sömnmönster ser ut och om det finns några kopplingar mellan eventuella negativa sömnmönster och deras IKT-användande. Dessutom undersöker vi om det finns några könsmässiga skillnader i sömn och IKT-användandet. Metod: Den metod som används är kvantitativ och datainsamlingen har skett genom en enkät. Urvalet består av 392 elever i årskurs ett från en gymnasieskola i västra Sverige. Enkäten besvarades och samlades in vid ett och samma tillfälle. Datan har bearbetats och analyserats i statistikprogrammet SPSS. Resultat: Analysen av resultaten visar att deltagarna har sömnproblem och att de upplever negativa effekter av dessa sömnproblem. Resultatet visar även att det finns ett samband mellan deltagarnas IKT-användande och dålig sömnkvalité, ju högre användande desto sämre sömn. Det finns inga direkta könsmässiga skillnader gällande sömnmönstret, däremot finns det skillnader gällande IKT-användandet. Slutsats: Undersökningen visar att deltagarna faktiskt lider av sömnproblem, och att användandet av IKT påverkar sömnen. Samtidigt indikerar resultatet att IKT-användning endast är en av flera påverkansfaktorer. Ytterligare forskning behövs för att till fullo förstå de bakomliggande orsakerna till ungdomarnas sömnproblem.</p> / <p>Sömnstörningar hos ungdomar anses vara ett växande problem. Det finns misstankar om att ungdomarnas ökade användning av Informations- och Kommunikationsteknik (IKT) är boven i dramat. Ungdomar upplevs spendera en allt större del av sin tid framför datorn, samtidigt som mobilen går varm av samtal och SMS. Det saknas dock utförlig forskning kring sambanden mellan IKT-användande och sömn. Syfte: Att undersöka huruvida ungdomar lider av sömnstörningar och om det i så fall kan kopplas till deras IKT-användande. De frågeställningar som behandlas är hur ungdomars sömnmönster ser ut och om det finns några kopplingar mellan eventuella negativa sömnmönster och deras IKT-användande. Dessutom undersöker vi om det finns några könsmässiga skillnader i sömn och IKT-användandet. Metod: Den metod som används är kvantitativ och datainsamlingen har skett genom en enkät. Urvalet består av 392 elever i årskurs ett från en gymnasieskola i västra Sverige. Enkäten besvarades och samlades in vid ett och samma tillfälle. Datan har bearbetats och analyserats i statistikprogrammet SPSS. Resultat: Analysen av resultaten visar att deltagarna har sömnproblem och att de upplever negativa effekter av dessa sömnproblem. Resultatet visar även att det finns ett samband mellan deltagarnas IKT-användande och dålig sömnkvalité, ju högre användande desto sämre sömn. Det finns inga direkta könsmässiga skillnader gällande sömnmönstret, däremot finns det skillnader gällande IKT-användandet. Slutsats: Undersökningen visar att deltagarna faktiskt lider av sömnproblem, och att användandet av IKT påverkar sömnen. Samtidigt indikerar resultatet att IKT-användning endast är en av flera påverkansfaktorer. Ytterligare forskning behövs för att till fullo förstå de bakomliggande orsakerna till ungdomarnas sömnproblem.</p>

<p>During the last 30 years, studies have shown self-help to be effective in a number of areas, and to produce equal or close to equal results compared to face-to-face therapy. The Internet can reach a large number of people at a low cost and add the possibility of two-way communication to self-help, thereby offering cost-effective psychological treatments.</p><p>This thesis is based on four studies and aiming to investigate if self-help treatment conducted through Internet can reduce problems with insomnia, stress and headache and reach effect sizes comparable to previous minimal contact treatment studies. Other aims were to investigate cost-effectiveness, and to examine if adding regular telephone contact would reduce drop-out rates. Treatments involved psychological techniques previously proved to be effective for each problem.</p><p>The first study showed a significant decrease in headache severity, and 50% of the participants in the treatment condition showed a clinically significant improvement. In Study II an Internet-based stress management program resulted in significant reductions of perceived stress, anxiety and depression. Improvements were found in both groups, with stronger effects in the self-help treatment group. Study III, a sleep management program, resulted in statistically significant improvements in the treatment group on all main variables, including total sleep time, total wake time in bed, and sleep efficiency. Some improvements were also found in the control group. Follow-up data indicated that improvements were sustained. Study IV did not confirm the hypothesis that the drop-out rates during headache treatment should decrease significantly if adding short and regular telephone contacts.</p><p>Results from this thesis suggest that Internet is a medium well suited for therapy, with effect sizes comparable to face-to-face therapy, that using Internet as a medium for treatment can reduce costs while still maintaining similar results, and that adding a small amount of telephone contact does not decrease attrition.</p>

De nombreux événements cardiovasculaires se déroulent au cours du sommeil(13).Divers auteurs ont étudié la variabilité du rythme cardiaque durant les différentes phases du sommeil chez le sujet sain (2) ou souffrant de diverses pathologies (3,5). Seules quelques publications décrivent le lien entre le sommeil et la variabilité du rythme cardiaque (4). L’interaction entre la variabilité du rythme cardiaque et les spectres de puissance du signal EEG de sommeil peut être étudiée par une analyse de cohérence (12). Cette méthode donne les fonctions de cohérence, de gain et de décalage de phases entre deux signaux à une fréquence déterminée. Les signaux principaux utilisés pour cette analyse de cohérence sont la bande de puissance de haute fréquence (HF) de la variabilité de l’intervalle RR, reflet de l’activité cardiaque vagale (14), et la bande de puissance de fréquence delta du signal EEG, associée au sommeil lent profond (1), à la fréquence du maximum de cross-spectrum entre ces bandes de puissances. Dans le but de mieux comprendre cette interaction, diverses questions se posent : • Existe-t-il, chez l’homme jeune en bonne santé, une interaction entre les spectres de puissance de l’intervalle RR et du signal EEG ? • Quelle bande de fréquence des puissances du signal EEG est la plus liée à la bande de puissance de haute fréquence de la variabilité de l’intervalle RR au cours du sommeil ? • Quel est l’impact du vieillissement sur ce lien ? • Existe-t-il une altération complète (cohérence, gain, décalage de phase) de l’interaction entre la bande de puissance de HF de l’intervalle RR et la bande de puissance de fréquence delta de sommeil chez l’individu souffrant d’un syndrome d’apnées-hypopnées de sommeil (SAHS) modéré ou sévère ? • Y a-t-il une diminution des valeurs de la cohérence et une modification du décalage de phase entre les signaux de puissance des bandes de HF du signal ECG et de la fréquence delta de l’EEG au cours du sommeil de la personne souffrant d’insomnie chronique primaire? • Les valeurs du gain pourraient-elles être les seules à être altérées chez le patient souffrant d’un trouble dépressif majeur (TDM)? Pour répondre à ces questions, plusieurs groupes ont été constitués : 8 adultes jeunes (18-23 ans)(11), 19 hommes d’âge moyen (36-54 ans) vs. 16 adultes jeunes (16-28 ans)(10), 12 patients souffrant d’un SAHS sévère vs. 12 patients souffrant d’un SAHS modéré à sévère vs. 12 hommes contrôles (9), 14 hommes souffrant d’insomnie chronique primaire vs. 12 adultes contrôles (8), 10 hommes souffrant de TDM vs. 10 hommes contrôles(7). Aucun patient ne présente une autre pathologie que celle décrite et tous ont été sevrés d’éventuelles médications psychotropes. De ces analyses, il apparaît que, chez l’homme jeune en bonne santé, de toutes les bandes de puissance du signal EEG de sommeil, les modifications de la bande de puissance delta est la plus liée aux modifications de la bande de puissance de haute fréquence de la variabilité du rythme cardiaque (11); et que le lien entre les modifications observées entre les bandes de puissance delta et HF est stable malgré l’effet du vieillissement observé dans l’architecture du sommeil et le contrôle de l’activité cardiaque (10). Les patients souffrant de SAHS présentent une perte du contrôle du lien entre le sommeil et la variabilité du rythme cardiaque, avant même l’apparition des symptômes cliniques cardiaques (9). Les personnes souffrant d’insomnie chronique primaire montrent une diminution de la force, voire une instabilité, du lien dynamique entre l’activité cérébrale de sommeil et la variabilité du rythme cardiaque(8). Les patients souffrant de trouble dépressif majeur démontrent une diminution de l’efficacité du lien entre les structures impliquées dans le contrôle du sommeil et les centres cardiovasculaires, mais pas de la force de ce lien (7), comme suggéré par les observations d’une neuroplasticité altérée chez les personnes dépressives (6). L’étude de la relation entre l’activité cérébrale et la variabilité du rythme cardiaque au cours du sommeil pourrait donc permettre une meilleure compréhension des processus neuro-cérébraux impliqués dans le développement des maladies cardiovasculaires mais également des pathologies de sommeil et des maladies psychiatriques. Elle pourrait peut-être, à l’aide d’une technique simple comprenant des enregistrements ECG et EEG au cours du sommeil, anticiper l’apparition de maladies graves cardiovasculaires, bien avant les premiers signes de la pathologie et permettre ainsi l’application de mesures préventives plutôt que curatives. Références. 1. Aeschbach D, Borbély AA. All-night dynamics of the human sleep EEG. J Sleep Res 1993; 2:70-81. 2. Bonnet MH, Arand DL. Heart rate variability: sleep stage, time of night, and arousal influences. Electroencephalogr Clin Neurophysiol 1997; 102(5):390-396. 3. Bonnet MH, Arand DL. Heart rate variability in insomniacs and matched normal sleepers. Psychosom Med. 1998 Sep-Oct;60(5):610-5. 4. Brandenberger G, Viola AU, Ehrhart J, Charloux A, Geny B, Piquard F, Simon C. Age-related changes in cardiac autonomic control during sleep. J Sleep Res. 2003; 12(3):173-80. 5. Dingli K, Assimakopoulos T, Wraith PK, Fietze I, Witt C, Douglas NJ. Spectral oscillations of RR intervals in sleep apnoea/hypopnoea syndrome patients. Eur Respir J. 2003; 22: 943-50. 6. Fossati P, Radtchenko A, Boyer P. Neuroplasticity: from MRI to depressive symptoms. Eur Neuropsychopharmacol. 2004; 14 Suppl 5:S503-10. 7. Jurysta F, Kempenaers C; Lancini J; Lanquart JP; van de Borne P; Linkowski P. Altered interaction between cardiac vagal influence and delta sleep EEG suggests an altered neuroplasticity in patients suffering from major depressive disorder. Acta Psych Scand (in press) 8. Jurysta F, Lanquart J, Sputaels V, Dumont M, Migeotte PF, Leistedt S, Linkowski P, van de Borne P. The Impact of Chronic Primary Insomnia on the Heart Rate - EEG Variability Link. Clin. Neurophysiol. 2009; 120(6):1054-60. 9. Jurysta F, Lanquart JP, van de Borne P, Migeotte PF, Dumont M, Degaute JP, Linkowski P. The link between cardiac autonomic activity and sleep delta power is altered in men with sleep apnea-hypopnea syndrome. Am J Physiol Regul Integr Comp Physiol. 2006; 291(4):R1165-71. 10. Jurysta F, van de Borne P, Lanquart JP, Migeotte PF, Degaute JP, Dumont M, Linkowski P. Progressive aging does not alter the interaction between autonomic cardiac activity and delta EEG power. Clin Neurophysiol. 2005; 116(4):871-7. 11. Jurysta F, van de Borne P, Migeotte PF, Dumont M, Lanquart JP, Degaute JP, Linkowski P. A study of the dynamic interactions between sleep EEG and heart rate variability in healthy young men. Clin. Neurophysiol. 2003; 114(11):2146-55. 12. Koopmans LH. The Spectral Analysis of Time Series. Academic Press. New York and London, 1974. 13. Lavery CE, Mittleman MA, Cohen MC, Muller JE, Verrier RL. Nonuniform nighttime distribution of acute cardiac events: a possible effect of sleep states. Circulation. 1997; 96(10):3321-7. 14. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Eur Heart J 1996; 17: 354-381.

Sleep is a basic need, important to physical and psychological recovery. Insomnia implies sleep-related complaints, such as difficulty falling asleep, difficulty staying asleep, early awakening, or non-restorative sleep (NRS) in an individual who has adequate circumstances and opportunity to sleep.  Insomnia is also related to impairment of daytime functions. The prevalence of reported sleep disturbances varies between 15% and 60% in patients with coronary artery disease (CAD) up to five years after intervention. Disturbed sleep may have a negative impact on self-care capacity and behaviours. Little attention has been given to evaluation of sleep promotion through individualized non-pharmacological interventions among CAD patients. The overall aim of this thesis was to describe the impact of sleep quality and disrupted sleep on health-related quality of life (HRQoL) in patients with stable CAD, in comparison to a population-based group. The objective was also to evaluate an individualized non-pharmacological programme to promote self-care in sleep. Four studies were conducted during seven years, starting in 2001. Patients from six hospitals in the south of Sweden were invited to participate. In addition, an age and gender matched population-based group was randomly selected during the same period as the patients and was used for comparison with the CAD patients in two of the studies. Data was collected through interviews, self-reported questionnaires, a study specific sleep diary and actigraphy registrations. A pretest-posttest control design was used to evaluate whether an individualized non-pharmacological intervention programme could promote self-care in sleep-activity in CAD patients. The results showed a high prevalence of insomniac CAD patients out of whom a large proportion were non-rested insomniacs. This showed that NRS is one of the core symptoms of insomnia. On the other hand there were weak or non-significant gender differences with increasing insomnia severity. Severe insomniac CAD patients displayed a two or threefold higher presleep arousal or anxiety score and were more limited in taking physical exercise than the general population. Generally low sleep efficiency (SE%) was revealed in the studies, particularly among severe non-rested insomniac CAD patients. Among CAD patients, the individualized non-pharmacological programme to promote self-care in sleep-activity indicated improvements in sleep and HRQoL. This thesis elucidates the importance of focusing on the individual’s perception of their sleep-activity and health in their local context and supporting self-care management. Furthermore, it is of importance that nurses set individual goals together with the patient in order to increase self-efficacy to promote HRQoL.

During the last 30 years, studies have shown self-help to be effective in a number of areas, and to produce equal or close to equal results compared to face-to-face therapy. The Internet can reach a large number of people at a low cost and add the possibility of two-way communication to self-help, thereby offering cost-effective psychological treatments. This thesis is based on four studies and aiming to investigate if self-help treatment conducted through Internet can reduce problems with insomnia, stress and headache and reach effect sizes comparable to previous minimal contact treatment studies. Other aims were to investigate cost-effectiveness, and to examine if adding regular telephone contact would reduce drop-out rates. Treatments involved psychological techniques previously proved to be effective for each problem. The first study showed a significant decrease in headache severity, and 50% of the participants in the treatment condition showed a clinically significant improvement. In Study II an Internet-based stress management program resulted in significant reductions of perceived stress, anxiety and depression. Improvements were found in both groups, with stronger effects in the self-help treatment group. Study III, a sleep management program, resulted in statistically significant improvements in the treatment group on all main variables, including total sleep time, total wake time in bed, and sleep efficiency. Some improvements were also found in the control group. Follow-up data indicated that improvements were sustained. Study IV did not confirm the hypothesis that the drop-out rates during headache treatment should decrease significantly if adding short and regular telephone contacts. Results from this thesis suggest that Internet is a medium well suited for therapy, with effect sizes comparable to face-to-face therapy, that using Internet as a medium for treatment can reduce costs while still maintaining similar results, and that adding a small amount of telephone contact does not decrease attrition.

Sömnsvårigheter hos ungdomar är ett växande problem i Sverige men det saknas forskning om behandlingsmetoder för åldersgruppen. Syftet med studien var att testa kognitiv terapi med beteendeexperiment (KT-I) på gymnasieungdomar med primär insomni. Studien genomfördes enligt en Single Subject design med för- och eftermätning. Tre ungdomar i åldern 16-18 genomgick en sju veckor lång behandling efter 1-2 veckors baslinjemätning. Resultatet visade att svårighetsgrad av insomni minskade, att funktionsförmågan dagtid förbättrades och behandlingsmålen uppfylldes i hög grad. Dagliga mätningar visade att förändring av sömnrelaterade symtom och dagtidssymtom varierade mellan deltagarna. Graden av vidmakthållande kognitiva processvariabler minskade. Slutsatser som kan dras är att KT-I är en lovande behandlingsmetod för ungdomar med insomni och att metoden bör testas ytterligare i randomiserade kontrollerade studier. / Sleeping difficulties are an increasing problem in Sweden for youths today, but there is a lack of research on treatments for this age group. The aim of the study was to investigate the effects from Cognitive Therapy with Behavioural Experiments (CT-I) on youths with primary insomnia in upper secondary school. The study was conducted according to a Single-Subject design with pre- and posttests. Three youths between the ages of 16-18 participated in a seven week long treatment, after 1-2 weeks of baseline measures. The results showed that the degree of insomnia decreased, that the ability to function during daytime increased, and that the treatment goals were met to a large extent. Daily measures showed that changes in sleep related symptoms and daytime symptoms varied among the participants. The degree of maintaining cognitive processes decreased. The conclusions that can be drawn are that CT-I is a promising treatment for youths with insomnia and that the method should be tested further in randomized controlled studies.

SammanfattningSömnproblem är vanligt förekommande hälsoproblem i befolkningen. Kognitiv beteendeterapi (KBT) har visats vara en effektiv behandling för personer med insomni men mindre forskning har bedrivits på effekten av KBT i grupp för personer med insomni (KBT-I) och samtidiga depressiva symtom. Studien syftade till att undersöka effekten av KBT-I i grupp med avseende på graden av insomni, depressiva symtom, och samvariationen med transdiagnostiska processer. En single-subject design användes med dagliga skattningar och för-, mellan- och eftermätningar. Resultatet visade att graden av insomni minskade för samtliga deltagare och graden av depressiva symtom minskade för majoriteten. En samvariation mellan sömnrelaterad oro, selektiv uppmärksamhet, och insomni fanns. Det återstår för framtida forskning att undersöka de transdiagnostiska processernas samband med insomni och depressiva symtom närmare. / AbstractSleep disorders are a common health problem in the population. Cognitive behavior therapy for insomnia (CBT-I) have proved to be an effective treatment for people with insomnia, but less research has been conducted on the efficacy of CBT-I in a group of people with insomnia (CBT-I) and comorbid depressive symptoms. The purpose of this study was to investigate the effect of CBT-I in group with respect to insomnia, depressive symptoms, and transdiagnostic processes. A single-subject design was used with daily estimates and pre- between-and posttest measures. The study concluded that the degree of insomnia symtoms decreased for all participants and the degree of depressive symptoms decreased for the majority. A correlation was found between sleep-related worry, selective attention, and insomnia. It remains for future research to investigate transdiagnostic processes associated with insomnia and depressive symptoms further.

While the importance of assessing the occupational consequences of insomnia and other sleep disorders is emphasised in clinical nosologies and research guidelines, there is little consensus on which aspects of occupational performance should be assessed, how such impairment should be measured, and how outcomes should be reported. The research programme described in this thesis aimed to address this issue. Chapter 1 presents a systematic review and methodical critique of studies reporting those aspects of occupational performance most impacted by (or most frequently associated with) insomnia symptoms and degraded sleep quality. Equivocal results, wide variations in reporting conventions, and the overall lack of comparability among studies, strongly indicated the need to develop a standardised metric able to quantify sleep related occupational performance and serve as an assessment and outcome instrument suitable for use in research and clinical settings. Informed by the literature review, Chapters 2-4 describe the development and validation of the Loughborough Occupational Impact of Sleep Scale ( LOISS ), a unidimensional 19 item questionnaire that captures sleep-related occupational impairment across a number of workplace domains over a 4-week reference period. Chapters 5-7 describe LOISS outcomes from: i) surveys in a random population sample; ii) a representative sample of the UK workforce; and iii) a clinical sample of patients with obstructive sleep apnoea (before and after treatment with CPAP). Overall, the scale showed strong internal consistency (Cronbach s alpha range=0.84-0.94) and test-retest reliability (r=0.77, r2=0.59, p<0.001), high levels of criterion validity (significantly discriminating between good and poor sleepers), and proved an effective outcome measure in OSA. From the survey data reported in Chapters 2-7, LOISS score distributions showed no consistent gender difference but did show a significant ageing gradient, with sleep-related occupational impairment declining with increasing age. In conclusion, the work presented here supports the usability, validity and reliability of the LOISS as an assessment and outcome instrument, and also demonstrates the utility of this instrument in exploring the dynamics of sleep-related occupational performance