Sammanfattning Syftet med denna litteraturstudie var att göra en sammanställning och beskriva vad som fanns i vetenskaplig litteratur gällande sömnfrämjande interventioner för äldre personer med demenssjukdom.  Metoden var en deskriptiv litteraturstudie baserad på 14 vetenskapliga artiklar från sju länder, publicerade mellan år 2005- 2010.  Artikelsökning gjordes i databaserna Medline och Cinahl, även en manuell sökning ingick. Inkluderade artiklar i resultatet är granskade och kvalitetsbedömda.  Huvudresultatet visade att det fanns olika interventioner som ljusterapi, melatonin, akupressur, social aktivitet, utbildning och örtmedicin för att främja sömnstörningar för personer med demenssjukdom. De olika interventionerna uppvisade lite skiftande effekt för att främja sömnen, ingen av interventionerna ansågs övertygande däremot upptäcktes andra positiva effekter gällande agitation, dygnsrytmstörningar och vakenheten under dagen. Slutsatsen av denna litteraturstudie är att mer riktad forskning behövs om olika interventioner för att främja sömnstörningar hos äldre personer med demenssjukdomar. Förbättring av sömnkvalitet, livskvalitet och återhämtning är målsättningen med interventionerna. Sjuksköterskan kan förbättra sömnkvaliteten hos patienterna med hjälp av icke farmakologiska interventioner. Sömnhygien, sociala aktiviteter och att förstärka exponeringen av solljus och klart ljus är förstahandsval vid behandling av sömnstörning hos personer med demenssjukdom. / Abstract  The aim of this literature study was to describe the scientific literature for sleep disorder interventions for older people with dementia. The method was a descriptive study based on 14 scientific articles from seven countries, published between the years 2005 - 2010. Article search was made in the databases Medline and Cinahl, and manual searches were included. Included articles in the results were reviewed and quality estimated. The main result showed that there were various interventions as light therapy, melatonin, acupressure, social activity, education and herbal medicine to promote sleep disorders for people with dementia. The various interventions showed varied effect to promote sleep, none of the interventions was convincing, although other positive effects on agitation, circadian rhythm and day- time wake was discovered.  The conclusion of this study is that more research is needed in different interventions to promote sleep disorders for older people with dementia.  The goal of the measures is to improve quality of sleep, quality of life and recovery. Nurses can improve quality of sleep in patients with non-pharmacological interventions. Sleep hygiene, social activities and increase exposure of sunlight and bright light is first choice to treat sleep disorders among persons with dementia.

Background: According to 2010 U.S. Renal Data System 2010Annual Data Report, the incidence and prevalence of End-Stage Renal Disease is the worst of the world in Taiwan. Sleep complaints are common in dialysis patients, and impacts negatively on health. It has become highly important issue. Objectives: This study explored the prevalence of ESRD with sleep disorder. We focused on demography status, comorbidities, dialysis therapies and utilization of health care to define the risk factors of disease. Methods: We conducted secondary data analysis with admnstrative data of National Health Insurance between 2000, 2002, 2004 and 2006. We firstly seleced the patients diagnosed as ESRD and Dyssomnia, and merged the data set and other related variables.The data was analyzed by Chi-square test, t-test and logistic regression. Result: The prevalence of ESRD with sleep disorder for the four years were 2.1%¡B2.7%¡B6.4% and 7.3%, respectively. Female patient has higher risk than male .Higher comorbidity score also lead to higher risk, dialysis therapies in hemodialysis/peritoneal were 16.45¡B16.48¡B8.23 and 7.91 in OR. There were significant differences in regions of hospital organizations (northern compared with the eastern, OR were 3.47, 2.73, 1.94 and 2.29, class of hospital organizations (compared with Physician Clinics), there are more cases in Regional Hospitals, except 2006. Outpatient expenses and visits are both positive correlation in all years. Conclusion: The risk factors of suffering sleep disorder in ESRD patients are sex, comorbidities and dialysis therapies. It is a relatively common but frequently unrecognized, therefore, we strongly suggested further study could be conducted by research questionnaires to make up the weakness of adminstatrative data.

Obstructive sleep apnoea (OSA) is characterised by repetitive reductions or pauses in breathing during sleep due to upper airway narrowing or closure. Due to disruption to normal sleep patterns, many patients with OSA suffer from increased daytime sleepiness. Epidemiological studies have established a link between OSA and driver fatigue and accidents, generally showing a two to seven times increased risk of road traffic accidents in non-commercial drivers with OSA. There is emerging evidence that commercial drivers have a higher prevalence of OSA than the general population, being predominately male, middle-aged and overweight, three important risk factors for OSA. However, little is known about the relationship between OSA and driver sleepiness in commercial drivers, whether road accidents are increased in commercial drivers with OSA, and whether OSA interacts with other fatigue promoting factors, such as sleep deprivation, to further escalate road accident risk. One thousand randomly selected commercial drivers were surveyed in the field. In addition, 61 randomly selected NSW commercial drivers had in hospital sleep studies and daytime performance testing, including a PC based driving simulator task. The prevalence of OSA, defined as Respiratory Disturbance Index (RDI) < 10, was approximately 50% in NSW commercial drivers. Approximately one quarter of the drivers reported pathological daytime sleepiness, and 12-14% had both OSA and pathological daytime sleepiness. A diagnosis of OSA was the most important factor predicting excessive daytime sleepiness in these drivers: OSA was more important than 15 other work-related, lifestyle and medical factors that could be expected to promote, or be associated with, daytime sleepiness. Drivers with sleep apnoea syndrome (both OSA and pathological daytime sleepiness) had an increased driving accident risk, using driving simulator and daytime performance testing as proxy measures for accident risk. These results demonstrate the importance of OSA as a cause of driver fatigue in commercial drivers and suggest that all commercial drivers should be screened for the presence of sleep apnoea syndrome in order to potentially reduce road accident risk through treatment. A separate, but related body of work examined the combined effects of mild OSA and other fatigue promoting factors (sleep deprivation and circadian influences) on driving performance. Twenty nine subjects, consisting of a group with mild OSA and a group of non-OSA controls, were tested on several occasions throughout the night and day using an intensive performance battery, under both baseline conditions and after a period of 36 hours of total sleep deprivation. The results suggest that drivers with mild OSA are not different to the control group in their response to sleep deprivation or time of day influences. However, the subjects with mild OSA were less aware of their impairment due to sleep deprivation, which is of concern if drivers with OSA are relying on their subjective awareness of fatigue to make decisions about when to stop driving. A final perspective on OSA and driver fatigue is provided through a clinical case series of seven fall-asleep fatality associated MVA�s associated with unrecognised or under-treated sleep disorders. As well as demonstrating the day to day potential for devastating road accidents due, at least in part, to un-recognised or untreated sleep disorders, these cases also serve to highlight some of the current medico-legal controversies and difficulties in this area of driver fatigue. In conclusion, this body of work has provided novel information about the epidemiology and implications of OSA in commercial drivers, and about how OSA interacts with other fatigue promoting factors. Finally, it has explored some of the medico-legal issues that relate to sleep disorders and driver fatigue. As well as providing much needed information in the area of driver fatigue, at the same time this work raises many more questions and suggests areas of future research. For instance, such research should examine the relationship between objective accident rates and OSA/sleep apnoea syndrome in commercial drivers, the interaction between mild sleep apnoea syndrome and other fatigue risk factors, and driver perception of sleepiness prior to sleep onset in drivers with sleep disorders.

Syftet med denna systematiska litteraturstudie var att beskriva hur restless legs inverkar på individens sömn och livskvalitet. Syftet var även att granska vilka olika former av behandlingar som finns att tillgå vid restless legs. För att finna information om detta ämne har endast vetenskapliga artiklar använts. Datainsamlingen har skett via databaser, internet samt Högskolans bibliotek, och artiklar från år 1995 och framåt har valts ut. Inklusionskriterier för denna studie var att de valda artiklarna skulle vara internationella vetenskapliga artiklar i fulltext. De funna artiklarna granskades med avseende på vetenskaplig kvalitet och poängsattes utifrån för ändamålet avsedda granskningsmallar. Denna bedömning resulterade i 21 artiklar. Resultatet visade att restless legs patienter upplever sömnbristen som det största problemet. För flertalet individer som drabbas av restless legs försämrades livskvaliteten och patienterna drabbades vanligtvis av psykologiska och fysiologiska besvär. Det vanligaste sättet att behandla restless legs var att använda dopaminerga läkemedel samt bensodiazepiner, antiepileptika och opioider. Andra former av behandlingar var järn, homeopatiska läkemedel, hypnos samt fysisk aktivitet. Det förekom även att restless legs patienter på eget initiativ använde hasch eftersom det ansågs lindra symtomen.

Obstructive sleep apnoea (OSA) is characterised by repetitive reductions or pauses in breathing during sleep due to upper airway narrowing or closure. Due to disruption to normal sleep patterns, many patients with OSA suffer from increased daytime sleepiness. Epidemiological studies have established a link between OSA and driver fatigue and accidents, generally showing a two to seven times increased risk of road traffic accidents in non-commercial drivers with OSA. There is emerging evidence that commercial drivers have a higher prevalence of OSA than the general population, being predominately male, middle-aged and overweight, three important risk factors for OSA. However, little is known about the relationship between OSA and driver sleepiness in commercial drivers, whether road accidents are increased in commercial drivers with OSA, and whether OSA interacts with other fatigue promoting factors, such as sleep deprivation, to further escalate road accident risk. One thousand randomly selected commercial drivers were surveyed in the field. In addition, 61 randomly selected NSW commercial drivers had in hospital sleep studies and daytime performance testing, including a PC based driving simulator task. The prevalence of OSA, defined as Respiratory Disturbance Index (RDI) < 10, was approximately 50% in NSW commercial drivers. Approximately one quarter of the drivers reported pathological daytime sleepiness, and 12-14% had both OSA and pathological daytime sleepiness. A diagnosis of OSA was the most important factor predicting excessive daytime sleepiness in these drivers: OSA was more important than 15 other work-related, lifestyle and medical factors that could be expected to promote, or be associated with, daytime sleepiness. Drivers with sleep apnoea syndrome (both OSA and pathological daytime sleepiness) had an increased driving accident risk, using driving simulator and daytime performance testing as proxy measures for accident risk. These results demonstrate the importance of OSA as a cause of driver fatigue in commercial drivers and suggest that all commercial drivers should be screened for the presence of sleep apnoea syndrome in order to potentially reduce road accident risk through treatment. A separate, but related body of work examined the combined effects of mild OSA and other fatigue promoting factors (sleep deprivation and circadian influences) on driving performance. Twenty nine subjects, consisting of a group with mild OSA and a group of non-OSA controls, were tested on several occasions throughout the night and day using an intensive performance battery, under both baseline conditions and after a period of 36 hours of total sleep deprivation. The results suggest that drivers with mild OSA are not different to the control group in their response to sleep deprivation or time of day influences. However, the subjects with mild OSA were less aware of their impairment due to sleep deprivation, which is of concern if drivers with OSA are relying on their subjective awareness of fatigue to make decisions about when to stop driving. A final perspective on OSA and driver fatigue is provided through a clinical case series of seven fall-asleep fatality associated MVA�s associated with unrecognised or under-treated sleep disorders. As well as demonstrating the day to day potential for devastating road accidents due, at least in part, to un-recognised or untreated sleep disorders, these cases also serve to highlight some of the current medico-legal controversies and difficulties in this area of driver fatigue. In conclusion, this body of work has provided novel information about the epidemiology and implications of OSA in commercial drivers, and about how OSA interacts with other fatigue promoting factors. Finally, it has explored some of the medico-legal issues that relate to sleep disorders and driver fatigue. As well as providing much needed information in the area of driver fatigue, at the same time this work raises many more questions and suggests areas of future research. For instance, such research should examine the relationship between objective accident rates and OSA/sleep apnoea syndrome in commercial drivers, the interaction between mild sleep apnoea syndrome and other fatigue risk factors, and driver perception of sleepiness prior to sleep onset in drivers with sleep disorders.

No description available.

Cognitive behavioural therapy for insomnia (CBT-i) is the most effective treatment for insomnia. Studies show that auricular acupuncture (AA) may alleviate insomnia symptoms. The overall aim of the thesis was to compare treatment effects of auricular acupuncture (AA) with cognitive behavioural therapy for insomnia (CBT-i) on symptoms of insomnia, anxiety, depression, hypnotic drugs consumption and quality of life from short- and long-term perspectives. Paper I had a qualitative approach with a descriptive design. 16 participants received group-treatment with AA during their protracted withdrawal phase and were interviewed about their experiences. They participants experienced a reduction in protracted withdrawal symptoms, improved subjective sleep quality, a strong sensation of peacefulness and increased wellbeing. Paper II, III and IV present results from a randomised controlled trial in where the effects of group-treatment with AA and CBT-i were compared in short- and long-term using subjective (questionnaires and sleep diary) and objective (actigraphy) measurements. The results showed that CBT-i was superior to AA in reducing insomnia symptoms in both the short and long run. Both groups experienced significant long-term reduction of depressive symptoms. Further, both groups managed to maintain a decreased intake of hypnotic drugs at the end of the treatment when compared to baseline measurement. Short-term reduction of symptoms of anxiety and depression improved only in the AA group. The results from the objective actigraph recordings showed that the AA group slept more and the CBT-i group less after the treatment and that sleep patterns in both groups reverted to pre-treatment levels after 6 months. Conclusively: AA, as administered in this study, was not as good as CBT-i in treating insomnia symptoms, and should not be used as a stand-alone treatment for insomnia. Our results also demonstrate that prolonged sleep time does not necessarily yield better sleep, and that the perception of insomnia symptoms is not inevitably affected by sleep duration. AA was as effective as CBT-i in ending hypnotic drugs consumption. Moreover, AA was more successful than CBT-i in reducing symptoms of anxiety and depression in the short run. Further studies investigating AA for anxiety and depression are motivated.

Sömnen är viktig för att kroppen och hjärnan ska kunna återhämta sig. Sömnen är avgörande för välbefinnandet och vår hälsa på många sätt. Det går att påverka sömnen till det bättre och det har verkan på hur kropp och psyke mår och orkar dagen därpå. Som patient inneliggandes på en vårdavdelning är människan utlämnad till personal och vårdmiljö, det kan därför bli svårare att själv påverka sin sömn. Syftet med denna intervjustudie var att undersöka hur patienter inskrivna inom den vuxenpsykiatriska heldygnsvården upplevde nattens timmar på sjukhus. Till studien användes en kvalitativ metod med induktiv ansats, data inhämtades genom enskilda intervjuer med sju stycken patienter. Alla var inskrivna inom den vuxenpsykiatriska heldygnsvården. Intervjuerna var ostrukturerade med öppna frågor. Till analysarbetet tillämpades kvalitativ innehållsanalys enligt Graneheim och Lundman (2004). Resultatet delades in i fyra kategorier; källor till ro; saknad integritet; faktorer som kan störa sömnen och verktyg som hjälpmedel till sömn. Författaren diskuterar resultatet utifrån att främja sömnen för patienter inskrivna inom den vuxenpsykiatriska heldygnsvården. Vad vårdgivaren tillhandahåller innefattar både positiva och negativa omständigheter som påverkar patienternas sömn. Om vissa av dessa förhållanden kan förstärkas och vissa av dem kan reduceras kan det leda till att patienter inom den vuxenpsykiatriska heldygnsvården får en mer fullgod sömn och därmed en större chans till återhämtning, välbefinnande och hälsa.

Background Cardiovascular disease (CVD) remains the number one killer even after years of advances and preventative measures. Identifying and reducing modifiable risk factors is a health care priority. CVD Risk assessments are calculated using several traditional risk factors including age, gender, race, blood pressure, cholesterol, history of diabetes, and smoking to estimate a persons’ risk of developing CVD (heart disease or stroke) in the next 10-years. In addition to the traditional risk factors for CVD, there is increasing evidence of metabolic disorders, depressive symptoms, inflammation and sleep quality posing a greater risk for CVD. However, these factors are not included in the current risk prediction models including the Framingham Risk Score, Reynolds Risk Score, and Pooled Cohort Risk Equations. Therefore, this study examined the effect of depressive symptoms, inflammation, and sleep quality on the independent risk for CVD. Objective The primary objective of this study was to evaluate the independent relationships between traditional cardiac risk factors, depressive symptoms, inflammation, and sleep quality, on long-term risk of major adverse cardiovascular events (MACE). The secondary objective was to evaluate whether gender modifies the relationships between depressive symptoms, inflammation, and sleep quality on long-term risk of MACE. Design A secondary analysis was conducted on data obtained from the Longitudinal prospective cohort study Heart Strategies Concentrating on Risk Evaluation (Heart SCORE) conducted by the University of Pittsburgh. The ongoing Heart SCORE study has been prospectively examining cardiovascular disease (CVD) risk factors and CVD events on an initial cohort of 2,000 enrolled adults ages 45 to 75 at study entry. A Cox proportional-hazard model was used to evaluate the relationship between traditional risk factors as well as independently and collectively for depressive symptoms, inflammation and sleep quality and risk of MACE. Models were reanalyzed adding gender as an interaction term and in stratified analyses to evaluate whether gender modifies the relationships between sleep quality, depressive symptoms, and inflammation and long-term risk of MACE. Results The participants (N= 1,895) included in this study were, 1256 females (66%), 639 males (34%), ranging from 45 to 75 years of age with a median age of 60 years, 42% Blacks, 55% Whites and 3% other race. Six percent, (n =113) of the participants experienced a major cardiac event during a mean of nearly 10 year follow up. Results indicated that men as compared with women with high levels of interleukin-6 had particularly high risk for CVD, as defined by two separate definitions of MACE, MACE1: Hazard Ratio (HR) 3.44 vs. 1.72 for males and females, respectively, MACE6: HR 2.51 vs. 1.69 for males and females, respectively. These results suggest the high inflammation in men is strongly associated with future risk of CVD. The addition of depressive symptoms to the initial traditional risk factor model was associated with a modest increase in the risk of both definitions of MACE (HR range from 1.20 to 1.68) with similar results observed by gender. Sleep quality/Insomnia was not associated with long-term risk of MACE overall or when evaluated separately by gender. Conclusion Primary prevention with early identification of potential modifiable risk factors is a key strategy in planning interventions to reduce the risk of CVD. Results from this study suggest that depression and inflammation (e.g. IL-6) should be studied in other populations to estimate their independent predictive value in risk stratification. Whereas sleep quality was not associated with long-term risk of CVD in this analysis, future studies should consider the use of objective measures of sleep quality, such as actigraphy in addition to standard use of self-report measures and sleep diaries.

CPAP is the most common treatment for moderate to severe sleep apnea in adults. Despite its efficacy, patients’ safety, comfort and compliance are issues to be considered and improved in CPAP design. The issues include condensation, carbon dioxide in inhaled air, humidity and temperature of inhaled air. When a CPAP user breaths deeply, there will be some air not fully expelled and may be driven back into the heated air delivery tube (HADT). An interest has existed in what impacts this so called reverse flow may bring about to the CPAP use. The main objectives of this research are to quantify the reverse flow and its influence on carbon dioxide re-breathing, delivered humidity to the patient and condensation in the HADT. Within this thesis, two computer models of the CPAP system have been constructed on Simulink™ in the Matlab™ environment. One is about the CPAP fluid dynamic performance and carbon dioxide re-breathing and the other is on thermodynamic performance. The models can predict the dynamic behaviour of the CPAP machine. They are able to mimic the breath induced airflow fluctuation, and flow direction changes over wide real working ranges of ambient conditions, settings and coefficients. These models can be used for future analysis, development, improvement and design of the machine. The fluid dynamic and thermodynamic models were experimentally validated and they have proved to be valuable tool in the work. The main conclusions drawn from this study are: • Reverse flow increases when breaths load increases and pressure setting decreases. • Reverse flow does not definitely add exhaled air to the next inhalation unless the reverse flow is relatively too much. • Mask capacity does not influence the reverse flow. • The exhaled air re-breathed is mainly due to that stays in the mask, therefore larger mask capacity increases the exhaled air re-breath and the percentage of exhaled air in next inhalation drops when the breath load increases. • Deep breathing does not significantly change the total evaporation in chamber. • When deep breathing induced reverse flow occurs, condensation occurs or worsens in the HADT near the mask. This happens only when the humidity of the airflow from the CPAP is much lower than that of the exhaled air and the tube wall temperature is low enough for condensation to occur. • The deep breathing and reverse flow do not significantly influence the average inhaled air temperature. • The overall specific humidity in inhaled air is lower under deep breathing. • Mask capacity does not influence the thermal conditions in the HADT and the inhaled air specific humidity. Also the mask capacity does not significantly influences the inhaled air temperature.