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Mood and cognition, along with numerous other physiological processes, are under circadian regulation. The synthesis and secretion rhythm of the pineal hormone melatonin is under the direct regulation of the central circadian pacemaker and the secretion rhythm of melatonin can be used to assess circadian alterations. In this thesis, it was demonstrated that low levels of endogenous nocturnal melatonin was associated with subsyndromal depression and alterations in sleep architecture. Studies in individuals with endogenous circadian rhythm disorder, with and without comorbid depressive symptoms, revealed that individuals with depressive symptoms had a greater phase delay in melatonin profiles as compared to individuals without depressive symptoms. Furthermore, in the same study, exogenous melatonin administered to induce phase advances significantly improved depression scores and sleep initiation. In addition to endogenous circadian disruption, circadian rhythms can also be disrupted by repeated atypical alterations in environmental time cues. In mammals, light is the strongest environmental cue that can modulate circadian rhythms. Recent studies suggest that circadian response to photic stimuli is preferentially sensitive to short wavelengths in the range of 450-480 nm. Using an animal model it was demonstrated that filtering a 10 nm bandwidth between 470-480 nm from polychromatic white light prevents nocturnal light exposure induced disruptions in melatonin and corticosterone secretion as well as central and peripheral clock gene expression. These findings were further investigated in humans and revealed that filtering short wavelengths below 480 nm attenuates 12 h nocturnal light exposure induced suppression of melatonin secretion, increased cortisol secretion and disrupted peripheral clock gene expression. Furthermore, attenuation of these changes was associated with improvements in mood, alertness and vigilance at a time close to the endogenous circadian wake drive. However, filtering short wavelengths below 460 nm or reducing the optical transmission by up to 30% below 480 nm did not attenuate the disruptive effects of nocturnal light exposure on physiological and behavioural variables. Overall, the results presented in this thesis support the role of circadian dysfunction in neuropsychometric impairment and presents evidence supporting spectral modulation as a promising approach to attenuate light-mediated chronodisruption.

Mood and cognition, along with numerous other physiological processes, are under circadian regulation. The synthesis and secretion rhythm of the pineal hormone melatonin is under the direct regulation of the central circadian pacemaker and the secretion rhythm of melatonin can be used to assess circadian alterations. In this thesis, it was demonstrated that low levels of endogenous nocturnal melatonin was associated with subsyndromal depression and alterations in sleep architecture. Studies in individuals with endogenous circadian rhythm disorder, with and without comorbid depressive symptoms, revealed that individuals with depressive symptoms had a greater phase delay in melatonin profiles as compared to individuals without depressive symptoms. Furthermore, in the same study, exogenous melatonin administered to induce phase advances significantly improved depression scores and sleep initiation. In addition to endogenous circadian disruption, circadian rhythms can also be disrupted by repeated atypical alterations in environmental time cues. In mammals, light is the strongest environmental cue that can modulate circadian rhythms. Recent studies suggest that circadian response to photic stimuli is preferentially sensitive to short wavelengths in the range of 450-480 nm. Using an animal model it was demonstrated that filtering a 10 nm bandwidth between 470-480 nm from polychromatic white light prevents nocturnal light exposure induced disruptions in melatonin and corticosterone secretion as well as central and peripheral clock gene expression. These findings were further investigated in humans and revealed that filtering short wavelengths below 480 nm attenuates 12 h nocturnal light exposure induced suppression of melatonin secretion, increased cortisol secretion and disrupted peripheral clock gene expression. Furthermore, attenuation of these changes was associated with improvements in mood, alertness and vigilance at a time close to the endogenous circadian wake drive. However, filtering short wavelengths below 460 nm or reducing the optical transmission by up to 30% below 480 nm did not attenuate the disruptive effects of nocturnal light exposure on physiological and behavioural variables. Overall, the results presented in this thesis support the role of circadian dysfunction in neuropsychometric impairment and presents evidence supporting spectral modulation as a promising approach to attenuate light-mediated chronodisruption.

Após a lesão medular (LM) ocorre reorganização estrutural local e em múltiplos níveis do sistema nervoso central (SNC). Comprometimento das funções sensório-motoras bem como alterações significativas de outras funções neurais são normalmente relatadas após um trauma seguido de LM. Os ritmos circadianos, em especial, o ciclo vigília-sono são freqüentemente afetados após um trauma ou intervenção no SNC, no entanto, poucos estudos tem relacionado a influência da lesão medular sobre a fisiologia do sono. Estudos fisiopatológicos são atualmente baseados em modelos experimentais os quais tem possibilitado o esclarecimento dos mecanismos subjacentes a vários fenômenos biológicos. Dessa forma, o presente estudo teve como objetivo apresentar, primeiramente, uma análise sistemática do ciclo vigíliasono em um modelo animal de LM contusa moderada e, em segundo lugar, por ser o sono dessincronizado uma fase importante pela ocorrência de movimentos espontâneos, estudar detalhamente a influencia da LM sobre os eventos tônicos e fásicos desta fase. Para tal, foram realizados registros eletroscilográficos das áreas corticais sensório-motora (A7) e hipocampais (CA1) de ambos os hemisférios e, registros eletromiográficos dos trapézios, elevadores da asa do nariz, gastrocnêmios e epicantos oculares. Os resultados mostraram significativo aumento na quantidade total das fases sono sincronizado (p<0,002, Dunn) e SD (p<0,03, Dunn), bem como, presença dos eventos fásicos inerentes ao SD após a lesão medular. A arquitetura dos ciclos sofreu forte influencia da LM manifestada pela desorganização das fases (p<0.05). Os resultados apresentados neste estudo demonstraram que o trauma medular provoca alterações qualitativas e quantitativas nos ciclos vigília-sono dos ratos portadores LM contusa moderada. / After a spinal cord injury (SCI), structural reorganization occurs locally and at multiple levels of the central nervous system (CNS). Compromising of sensory motor functions and significant alterations of other neural functions are normally related after a SCI. The circardians rhythms, specially the sleep-wake cycle are frequently affected after a trauma or intervention in CNS. Few studies have approached contusive SCI in sleep physiology. Nowadays, physiopatological studies are based on experimental models which offer several possibilities to obtain new signs related to mechanisms to several biological phenomena. Thus, the present research aimed to present a systematic analysis of the sleep-wake cycle in a SCI animal model to detail the influence of SCI over tonic and phasic events during desynchronized sleep (DS), since this sleep phase is important for the occurrence of spontaneous movements. In order to do that, electroencephalogram (EEG) records of the sensory motor cortex (A7) and dorsal hippocampus (CA1) of both hemispheres were carried out, and electromyography (EMG) records of the trapezium, rostrum, gastrocnemius and eyes. The results showed significant increase of total time of synchronized sleep (p<0.002) and DS (p<0.03) and evidence of phasic events inherent to DS after SCI. The cycle architecture suffered high influence of SCI manifested by disarrangement of phases (p<0.05). The results presented in this study showed that SCI provokes qualitative and quantitative alterations of sleep-wake cycle in contusive moderate SCI rats.

養分與睡眠的關聯是一個在睡眠科學上極具爭議性的課題。減低攝取蛋白質和碳水化合物會導致失眠，增加攝取總脂肪和油份會導致失眠。維生素和礦物質也被認為與失眠有關。此論文嘗試通過研究一般香港中國人的食習慣和失眠情況，進一步了解營養物質與失眠之間的關聯。此論文將會深入探討營養成分對失眠的影響。 / 背景和目標： 失眠是常見的睡眠障礙和公共衛生問題。失眠可分為三個亞型：難以啟動睡眠(DIM)、難以維持睡眠(DMS) 和過早覺醒類型(EMA)。然而，有關的研究多着重於外國人口。針對研究香港中國人口的失眠情況與營養成分關聯的資料相對比較少。此研究目的是找出在香港中國人口失眠與營養成分之間的關聯，有助研究失眠與營養成分之間的機制。據推測，失眠與營養成分之間於香港中國人口有關聯。香港中國人口失眠症患者的食特點跟其他地區人口會有所不同。失眠的三個亞型和營養成分之間的關聯會有所不同。 / 研究方法： 十三間學校被邀請進行了橫斷面研究。一百三十八位青少年(六十一男、七十七女) 以及一百七十三位成年人（八十四男、 八十九女）應邀參加這項研究。有關日常營養攝取量的資料，以自行申報的三天膳食記錄表取得。有關失眠症狀的評估，以自行申報的標準睡眠問卷（ISI）獲得。有關焦慮和抑鬱的評估，以自行申報的醫院焦慮抑鬱量表（HADS）取得。 / 研究結果與結論：分析顯示，失眠與減低攝取維生素A有關聯(成年人組別p = 0.02、青少年組別p = 0.01)，與減低攝取維生素D有關聯(成年人組別p = 0.02、青少年組別p = 0.01）和與減低攝取維生素E有關聯(成年人組別p = 0.02、青少年組別p = 0.01)。失眠綜合症與難以啟動睡眠(DIM)、難以維持睡眠(DMS) 和過早覺醒類型(EMA) 與減低攝取飽和脂肪、碳水化合物、維生素A 、維生素D、和維生素E有關聯。此研究證實了香港中國人口的失眠與營養成分之間有關聯。證實了香港中國人口失眠症患者的食特點跟其他地區人口有不同。證實了失眠的三個亞型和營養成分之間的關聯有不同。我們於這項研究成功找到與失眠有關的營養成分，有助研發以天然營養物質來解決香港中國人的失眠問題。 / The association of nutrients and sleep is a debatable question in sleep science. Some literatures suggest that sleep is enhanced by certain nutrients, while some other literatures suggest that sleep is deprived by certain nutrients causing insomnia. This dissertation attempts to address the association between nutrients and insomnia of Hong Kong Chinese Population. / Background and Objective: Insomnia is a common sleep disorder and a major public health issue. Insomnia could be classified into three subtypes: Difficulty in Initiating Sleep (DIS), Difficulty in Maintaining Sleep (DMS), and Early Morning Awakening (EMA). Vitamins and minerals are thought to be associated with insomnia. From literature reviews, studies in western population and in Asian population found that protein and carbohydrates, fat and oil are associated with insomnia. Insomnia could be affected by the availability of nutritional substances in individual’s diet. However, limited studies are done in Hong Kong Chinese population on the association between insomnia and nutrient components. The aim of this study is to find out the association between insomnia and nutrient components in-take in Hong Kong Chinese population. / Hypothesis: It is hypothesized insomnia and nutrient components would also have association in Hong Kong Chinese population. It is hypothesized the dietary characteristic of insomniac in Hong Kong Chinese population would be different from that of non-Hong Kong Chinese population, and it is hypothesized each insomnia subtype and nutrient components would have different association. / Method: A community-based cross-sectional study is conducted in 13 schools. There are 138 adolescents (61 male and 77 female) and 173 adults (84 male and 89 female) participated in this study. Information of daily nutrient intake is obtained by a self-administrated 3-day food diary, the assessment of insomnia symptom is obtained by a standard sleep questionnaire Insomnia Severity Index (ISI), and the assessment of anxiety and depression is obtained by Hospital Anxiety and Depression Scale (HADS). / Results and Conclusion: Agree with the hypothesis, insomnia and nutrient component have association in Hong Kong Chinese population. The dietary characteristic of insomniac in Hong Kong Chinese population is different from that of non-Hong Kong Chinese population. Each insomnia subtype and nutrient component has different association. Multivariance analysis shows insomnia subtype Difficult Initiating Sleep (DIS), Difficult Maintaining Sleep (DMS), Early Morning Awakening (EMA), and overall insomnia syndrome associate with decreased in-take of vitamin A, vitamin D and vitamin E in both adults and adolescents. Decreased intake of saturated fat associates with insomnia subtype DMS and decreased intake of carbohydrate associates with insomnia subtype EMA in this study. Information from this study shines lights on the relationship of insomnia and nutrients in-take in the general population of Hong Kong Chinese. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Lau, Yin Wah Vivien. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 82-90). / Abstracts also in Chinese. / Abstract: --- p.i-iv / Acknowledgements: --- p.v / Table of contents: --- p.vi-viii / List of Lists: --- p.ix / List of Tables: --- p.ix / List of Figures: --- p.ix / Objective --- p.1 / Chapter Chapter 1: --- Introduction / Chapter 1.1 --- Sleep Research --- p.2 / Chapter 1.1.1 --- Background and History of Sleep Research --- p.2-3 / Chapter 1.1.2 --- Sleep Function and Consequence --- p.3-4 / Chapter 1.1.3 --- Neurotransmitters and Neuromodulators --- p.4-5 / Chapter 1.2 --- Insomnia --- p.5 / Chapter 1.2.1 --- The Definition of Insomnia --- p.6 / Chapter 1.2.1.1 --- Many Different Definitions of Insomnia Diagnostic Criteria --- p.6 / Chapter 1.2.1.2 --- Diagnostic Criteria used for Insomnia in This Study --- p.6-8 / Chapter 1.2.1.3 --- Symptoms and Syndrome of Insomnia --- p.9-10 / Chapter 1.2.2 --- The Cost of Insomnia --- p.10-11 / Chapter 1.2.3 --- The Common Causes of Insomnia --- p.11 / Chapter 1.2.4 --- Cognitive-Behavioral Model of Insomnia --- p.12 / Chapter 1.2.5 --- Treatments of Insomnia --- p.14 / Chapter 1.2.6 --- Confounding Factors of Insomnia --- p.14 / Chapter Chapter 2: --- Age, Education and Body Mass Effect on Sleep Pattern / Chapter 2.1 --- Age --- p.16 / Chapter 2.2 --- Education --- p.17 / Chapter 2.3 --- Body Mass --- p.17 / Chapter Chapter 3: --- Mood, Pain, Sleep Hygiene, Drug, Caffeine and Alcohol Effect on Sleep Pattern / Chapter 3.1 --- Mood --- p.18 / Chapter 3.2 --- Pain --- p.18 / Chapter 3.3 --- Sleep Hygiene --- p.18 / Chapter 3.4 --- Drug --- p.20 / Chapter 3.5 --- Caffeine --- p.20 / Chapter 3.6 --- Alcohol --- p.20 / Chapter Chapter 4: --- Nutrient Components / Chapter 4.1 --- Macro-nutrient --- p.21 / Chapter 4.1.1 --- Carbohydrate --- p.21-22 / Chapter 4.1.2 --- Fatty Acid --- p.22-23 / Chapter 4.1.3 --- Protein --- p.23-24 / Chapter 4.2 --- Micro-nutrient --- p.24 / Chapter 4.2.1 --- Vitamin B₁ (Thiamine) --- p.24 / Chapter 4.2.2 --- Vitamin B₂ (Riboflavin) and Vitamin B₃ (Niacin) --- p.24-25 / Chapter 4.2.3 --- Vitamin B₆ (Pyridoxine) --- p.25 / Chapter 4.2.4 --- Vitamin B₁₂ (Cobalamin, Folate) --- p.25-26 / Chapter 4.2.5 --- Vitamin A and Vitamin D --- p.26-27 / Chapter 4.2.6 --- Tryptophan, Tyrosine, Choline and Phosphatidylcholine (Lecithin) --- p.27-28 / Chapter 4.2.7 --- Vitamin E and Vitamin C --- p.30 / Chapter 4.2.8 --- Iron --- p.30 / Chapter Chapter 5: --- Nutrient Components and Insomnia / Chapter 5.1 --- Introduction --- p.32 / Chapter 5.2 --- Social Perspective of Insomnia and Nutrients --- p.33 / Chapter 5.3 --- Biochemical Perspective of Insomnia and Nutrients --- p.33-34 / Chapter Chapter 6: --- Material and Method / Chapter 6.1 --- Sampling Method --- p.35 / Chapter 6.1.1 --- Background --- p.35 / Chapter 6.1.2 --- Method --- p.35 / Chapter 6.1.3 --- Population --- p.35 / Chapter 6.1.4 --- Questionnaire --- p.36 / Chapter 6.1.5 --- Food Diary --- p.36 / Chapter 6.2 --- Participant Recruitment Criteria --- p.38 / Chapter 6.2.1 --- Major Inclusion Criteria for This Study --- p.38 / Chapter 6.2.2 --- Major Exclusion Criteria for This Study --- p.38 / Chapter 6.2.3 --- Ethical Considerations --- p.38 / Chapter 6.3 --- Statistic Analysis --- p.39 / Chapter 6.4 --- Quality Assessment and Data Extraction --- p.39 / Chapter 6.5 --- Hypothesis --- p.40 / Chapter Chapter 7: --- Results / Chapter 7.1 --- Demographic Data --- p.41 / Chapter 7.2 --- Overall Insomnia --- p.43 / Chapter 7.2.1 --- Difficult Initiating Sleep (DIS) --- p.52 / Chapter 7.2.2 --- Difficulty Maintaining Sleep (DMS) --- p.52 / Chapter 7.2.3 --- Early Morning Awakening (EMA) --- p.61 / Chapter 7.2.4 --- Insomnia Syndrome --- p.61 / Chapter Chapter 8: --- Discussion and Limitation / Chapter 8.1 --- Age and Insomnia --- p.71 / Chapter 8.2 --- Alcohol and Insomnia --- p.72 / Chapter 8.3 --- Caffeine and Insomnia --- p.72 / Chapter 8.4 --- Carbohydrate and Insomnia --- p.72-73 / Chapter 8.5 --- Vitamin E and Insomnia --- p.73 / Chapter 8.6 --- Vitamin A and Insomnia --- p.74 / Chapter 8.7 --- Vitamin D and Insomnia --- p.74 / Chapter 8.8 --- Saturated Fat and Insomnia --- p.75 / Chapter 8.9 --- Summary --- p.76 / Chapter Chapter 9: --- Limitation and Implications / Chapter 9.1 --- Limitation of This Study --- p.77 / Chapter 9.2 --- Implication to Further Study --- p.77-78 / Chapter 9.3 --- Implication to Clinical Intervention --- p.78-79 / Chapter Chapter 10: --- Executive Summary --- p.80-81 / Bibliography --- p.82-90

Após a lesão medular (LM) ocorre reorganização estrutural local e em múltiplos níveis do sistema nervoso central (SNC). Comprometimento das funções sensório-motoras bem como alterações significativas de outras funções neurais são normalmente relatadas após um trauma seguido de LM. Os ritmos circadianos, em especial, o ciclo vigília-sono são freqüentemente afetados após um trauma ou intervenção no SNC, no entanto, poucos estudos tem relacionado a influência da lesão medular sobre a fisiologia do sono. Estudos fisiopatológicos são atualmente baseados em modelos experimentais os quais tem possibilitado o esclarecimento dos mecanismos subjacentes a vários fenômenos biológicos. Dessa forma, o presente estudo teve como objetivo apresentar, primeiramente, uma análise sistemática do ciclo vigíliasono em um modelo animal de LM contusa moderada e, em segundo lugar, por ser o sono dessincronizado uma fase importante pela ocorrência de movimentos espontâneos, estudar detalhamente a influencia da LM sobre os eventos tônicos e fásicos desta fase. Para tal, foram realizados registros eletroscilográficos das áreas corticais sensório-motora (A7) e hipocampais (CA1) de ambos os hemisférios e, registros eletromiográficos dos trapézios, elevadores da asa do nariz, gastrocnêmios e epicantos oculares. Os resultados mostraram significativo aumento na quantidade total das fases sono sincronizado (p<0,002, Dunn) e SD (p<0,03, Dunn), bem como, presença dos eventos fásicos inerentes ao SD após a lesão medular. A arquitetura dos ciclos sofreu forte influencia da LM manifestada pela desorganização das fases (p<0.05). Os resultados apresentados neste estudo demonstraram que o trauma medular provoca alterações qualitativas e quantitativas nos ciclos vigília-sono dos ratos portadores LM contusa moderada. / After a spinal cord injury (SCI), structural reorganization occurs locally and at multiple levels of the central nervous system (CNS). Compromising of sensory motor functions and significant alterations of other neural functions are normally related after a SCI. The circardians rhythms, specially the sleep-wake cycle are frequently affected after a trauma or intervention in CNS. Few studies have approached contusive SCI in sleep physiology. Nowadays, physiopatological studies are based on experimental models which offer several possibilities to obtain new signs related to mechanisms to several biological phenomena. Thus, the present research aimed to present a systematic analysis of the sleep-wake cycle in a SCI animal model to detail the influence of SCI over tonic and phasic events during desynchronized sleep (DS), since this sleep phase is important for the occurrence of spontaneous movements. In order to do that, electroencephalogram (EEG) records of the sensory motor cortex (A7) and dorsal hippocampus (CA1) of both hemispheres were carried out, and electromyography (EMG) records of the trapezium, rostrum, gastrocnemius and eyes. The results showed significant increase of total time of synchronized sleep (p<0.002) and DS (p<0.03) and evidence of phasic events inherent to DS after SCI. The cycle architecture suffered high influence of SCI manifested by disarrangement of phases (p<0.05). The results presented in this study showed that SCI provokes qualitative and quantitative alterations of sleep-wake cycle in contusive moderate SCI rats.

Orientador: Milva Maria Figueiredo De Martino / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T22:18:36Z (GMT). No. of bitstreams: 1 Viduedo_AlecssandradeFatimaSilva_M.pdf: 1985853 bytes, checksum: 7f1e28b659a677aa44b25d03387ce7cd (MD5) Previous issue date: 2007 / Resumo: Este estudo teve como propósito Analisar o ciclo vigília-sono de gestantes nos três trimestres de gestação, o cronótipo e a associação com os trimestres gestacionais. Foi no Centro de Saúde Dr. Lourenço Quillici em Bragança Paulista, SP. Tratou-se de um estudo descritivo, exploratório e transversal. A coleta de dados foi realizada durante seis meses e para tal foram utilizados três instrumentos de coleta de dados: Ficha de caracterização da amostra,questionário de identificação de indivíduos matutinos e vespertinos que eram preenchidos imediatamente após a aceitação da gestante em participar da pesquisa, e o diário de sono onde as gestantes que eram orientadas a respondê-los durante quatro semanas e devolvê-los totalmente preenchidos, os dados foram submetidos a testes estatísticos de acordo com a natureza da variável. A amostra foi composta por 62 gestantes que foram dividas em trimestres gestacionais, havia 21 no primeiro trimestre, 31 no segundo e 10 no terceiro, matriculadas no pré-natal de baixo risco, tinham idade de 15 a 39 anos, 46% tinham de 9 a 11 anos de estudo, 67,7% eram brancas, a maioria 53,2% tinham como ocupação o lar, 24 trabalhavam e 5 estudavam e dessas 69% era em período integral, 48,4% da amostra tinha cronótipo indiferente, as gestantes de todos os trimestres iam deitar-se aproximadamente às 22h, a diferença foi o período de latência, as gestantes do primeiro trimestre dormiam em cerca de 13 minutos mais rápido do que as do terceiro, a média de horas de sono das gestantes foi diminuindo de acordo com o aumento da idade gestacional 512,7minutos no primeiro trimestre, até 416 para o último trimestre, a qualidade de sono também vai diminuindo do primeiro para o terceiro trimestre 8,1 ;7,3; 7.4 respectivamente, para sanar a má qualidade de sono, as gestantes de terceiro trimestre tem maior quantidade de minutos que cochila durante o dia em média 109,4 minutos por dia, contra 79 minutos nas de primeiro, as de cronótipo moderadamente vespertinas, as de faixa etária entre 30 a 35 e as que trabalham no período da manhã tem melhor qualidade de sono,.Espera-se que o resultado dessa pesquisa possa nortear novas pesquisas na área a fim de contribuir para saúde de sono das gestantes. / Abstract: The porpouse of this study was to identify the sleep-wakefulness of pregnant in three trimester of pregnancy, the links between chronotype and pregnant trimester. It was performed at the Central of Health Dr. Lourenço Quillici in the city of Bragança Paulista, S.P. It was based on dexcriptive, exploratory anda transversal study. The collection of datas was made during six month through of three questionnarie: individual index, a self-assesment questionnarie to determine morningness-eveningness in human circadian rhythms it was filled after pregnant to agree to participate of the research and the sleep log, the pregnants was orientate to answer through of four weeks and return it all filled. The informations was analyse depends of datas. The sample was composed by 62 pregnants that was slip up between pregnancy trimesters, 21 in the first trimester, 31 in the second and 10 in the third trimester, register in low riscky care labor, that was between 15 and 39 years old, 46% had studied between 9 and 11 years, 67,6% was white, the majority 53,2% that was house keep, 24 of them worked and 5 studied, that 69% all day, 48,4% among of pregnants was chronothype "indiffernt", the hour that pregnats went to the bed was similar, around 22h , the diference was latency of the sleep, in the first trimester them fall sleep 13 min faster than pregnant of the third trimester, descresed total of sleep time according incresed weeks of pregnancy, 512,7 min. To the first trimester until 416 min to the third trimester, quality of sleep descrese from the first trimester to the third trimester 8,1; 7,3; 7,4 respectivty, the pregnanty of third trimester had major minutes of naps 109,4 min each day in middle and 79 min to the first trimester , the chronotype "moderately morning" was frequently among 30 and 35 years old, the pregnants was worked in the morning shift had better quality of sleep. Wish results of this research help to the sleep of pregnants. / Mestrado / Enfermagem e Trabalho / Mestre em Enfermagem

Background. Habitual short (HSS) and long sleeper (HLS) were very interesting but under-research area. / Conclusion. Our study suggested that sleep duration of human being has marked inter-individual variability with existence of extreme sleepers at both ends. Throughout different phases of the study, there was a consistent negative relationship between sleep duration and socio-economic status. Our finding of unique personality profile between short and long sleepers supported the hypothesis that different personality trait (neuroticism trait) might mediate between sleep duration and socioeconomic variables. Further studies are indicated for investigating genetic as well as biological correlates between personality traits and sleep duration. / Method. Three phases were involved in this research to explore epidemiological, psychological, and PSG characteristics of HSS and HLS. / Phase three: 72 subjects (23 HSS, 41 HNS, and 8 HLS) were assessed by two nights PSG to be followed by multiple sleep latency test (MSLT). 37 subjects (6 HSS, 21 HNS, and 10 HLS) were assessed by four-day Actiwatch. In the first night of PSG assessment, HLS had lower sleep efficiency and longer sleep and REM latency than HSS and HNS. In the second night, REM density in HLS was higher than HSS and HNS. In MSLT, HSS (50.0%) was more likely to have mildly short sleep latency than HLS (0%). Multiple regression of these healthy sleepers suggested that shorter sleep duration was found in those subjects (a) attaining higher education level; (b) suffering from higher life stress; (c) having more sleepiness; and (d) having less neuroticism. / Phase two: 252 subjects attended the face-to-face clinical interview. Among them, there were 33 HSS-7 and 25 HLS-9. After controlling gender and age, HSS had more chance to earn more money, live in larger house, drank more alcohol, and lower neuroticism than HLS. / Result. Phase one: Brief sleep questionnaires with consent were administered to parents of students in 13 primary schools in 2003, and 10381 parents returned their questionnaires (response rate &ap; 67.9%). 593 subjects were excluded because of their incomplete information. Altogether, 9788 subjects were considered as eligible subjects that represented noninstitutionalized Chinese middle-age residents in Hong Kong (47.0% men vs 53.0% women, mean age: 40.9 years +/- 4.9 years [SD]). There were 322 (3.3%) HSS-7 (&le;7 hours), 1415 (14.5%) HLS-9 (&ge;9 hours), and 481 (4.9%) HLS-10 (&ge;10 hours). HSS had more chance to attain higher education level, earn more money and drank more tea/coffee than HLS. / Zhang Bin. / "May 2005." / Advisers: Y. K. Wing; S. O. Chan. / Source: Dissertation Abstracts International, Volume: 67-01, Section: B, page: 0177. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 155-193). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

INTRODUÇÃO: A apneia obstrutiva do sono (AOS) é comum na população geral e é caracterizada pelo colapso recorrente da via aérea superior. Há um interesse crescente no desenvolvimento de métodos para melhor entendimento da fisiopatologia da AOS. A técnica da pressão negativa expiratória (NEP) é um método relativamente simples que avalia a colapsabilidade da via aérea superior durante a vigília. Porém, a metodologia varia muito e a maioria dos estudos utilizou o bocal, que pode não retratar de forma adequada o comportamento da nasofaringe e pode interferir na posição da língua. Adicionalmente, não existem estudos que avaliaram a associação da NEP com variáveis anatômicas da via aérea superior. A pressão crítica de fechamento da faringe (Pcrit) é um método bem estabelecido que reflete o componente anatômico da AOS, porém é realizada durante o sono e envolve metodologia complexa. OBJETIVOS: Realizamos 2 estudos em indivíduos normais e portadores de AOS com o objetivo de: Estudo 1) Determinar a influência da interface e posição sobre a medida da colapsabilidade da via aérea superior durante a vigília avaliada pela NEP. Estudo 2) Avaliar a associação entre a colapsabilidade da via aérea superior durante a vigília medida pela NEP com máscara nasal na posição supina e durante o sono medida pela Pcrit com variáveis anatômicas da via aérea superior avaliadas pela tomografia computadorizada (TC). MÉTODOS: Foram recrutados indivíduos com idade entre 18 e 65 anos com suspeita de AOS referidos do Laboratório do Sono do InCor. Os indivíduos foram submetidos a prova de função pulmonar, polissonografia e NEP em 4 situações: posição sentada e supina utilizando tanto bocal como máscara nasal. A NEP foi avaliada pelo parâmetro V0,2SB/V0,2NEP (relação entre o volume expirado a 0,2 s durante a respiração espontânea (3 expirações precedentes à aplicação da NEP) sobre o volume expirado a 0,2 s durante a aplicação da NEP). Um subgrupo dos indivíduos realizou o exame de Pcrit e TC de via aérea superior. RESULTADOS: Estudo 1) Foram estudados um total de 86 indivíduos (72 homens, idade: 46 ± 12 anos, índice de massa corpórea (IMC): 30,2 ± 4,4 kg/m2, índice de apneia/hipopneia (IAH): 32,9 ± 26,4 eventos/hora). Encontramos uma interação entre interface e posição sobre a colapsabilidade da via aérea superior na análise multivariada (p=0,007), sendo que a via aérea superior foi mais colapsável com bocal do que com máscara nasal na posição sentada. A colapsabilidade da via aérea superior foi maior na posição supina do que sentada quando a NEP foi realizada com máscara nasal. Em contraste, a NEP não foi influenciada pela posição quando avaliada com bocal. A resistência expiratória foi significativamente maior e independente da posição com bocal do que máscara nasal (20,7 cmH2O/L.s-1 vs 8,6 cmH2O/L.s-1 respectivamente, p=0,018). Estudo 2) Vinte e oito indivíduos realizaram a NEP com máscara nasal na posição supina, Pcrit e TC da via aérea superior (idade: 45 ± 13 anos, IMC: 29.4±4.9 kg/m2 e IAH: 30 ± 26 eventos/hora). A NEP e a Pcrit se associaram de maneira semelhante com a área da língua (r=0,646 e r=0,585), volume da língua (r=0,565 e r=0,613), comprimento da faringe (r=0,580 e r=0,611) e IAH (r=0,490 e r=0,531), respectivamente (p < 0,05 para todas as correlações). A NEP e a Pcrit foram significativamente piores em pacientes com AOS grave do que no restante da população (p < 0,05). CONCLUSÕES: Estudo 1) A interface e a posição influenciam a colapsabilidade da via aérea superior medida pela NEP. Propomos que a NEP seja realizada com máscara nasal na posição supina em estudos futuros de avaliação da colapsabilidade da via aérea superior em pacientes sob investigação de AOS. Estudo 2) A NEP avaliada com máscara nasal na posição supina é um método simples e promissor que reflete o componente anatômico da colapsabilidade da via aérea superior de forma similar a Pcrit / INTRODUCTION: Obstructive sleep apnea (OSA) is common in the general population and is characterized by recurrent collapse of the upper airway. There is a growing interest in developing methods for better understanding of OSA pathophysiology. Negative expiratory pressure (NEP) technique is a simple method that evaluates upper airway collapsibility during wakefulness. However, the method of NEP determination varies among published studies and is mostly evaluated with a mouthpiece, which could inadequately reflect the behavior of nasopharynx and also interfere on the tongue position. In addition, there are no studies evaluating the association between NEP and upper airway anatomy. Pharyngeal critical closing pressure (Pcrit) is a well established technique that reflects the anatomical component of OSA, however, it is performed during sleep and requires a complex methodology. OBJECTIVES: We performed 2 studies in OSA and normal subjects with the objectives of: Study 1) To determine the influence of interface and position on the measurement of upper airway collapsibility while awake evaluated by NEP. Study 2) To evaluate the association among upper airway collapsibility while awake evaluated by NEP with nasal mask in supine position and during sleep evaluated by Pcrit with upper airway anatomy evaluated objectively by upper airway computed tomography (CT) scan. METHODS: We recruited subjects with age between 18 and 65 years with suspect OSA referred to the outpatient sleep clinic at the Heart Institute, University of São Paulo. Subjects underwent pulmonary function test, polysomnography and NEP evaluations in four conditions: sitting and supine position either with mouthpiece or with nasal mask. NEP was evaluated by the parameter V0.2SB/V0.2NEP (ratio between the volume exhaled at 0.2 s during stable breathing (3 expirations prior to NEP application) over the volume exhaled at 0.2 s during NEP application). A subgroup of subjects performed Pcrit and upper airway CT evaluations. RESULTS: Study 1) We studied a total of 86 subjects (72 male, age: 46 ± 12 years, body mass index (BMI): 30.2 ± 4.4 kg/m2, apnea/hypopnea index (AHI): 32.9 ± 26.4 events/hour). We found an interaction between interface and position on upper airway collapsibility in multivariate analysis (p=0.007), with the upper airway being more collapsible with mouthpiece than with nasal mask in sitting position. Upper airway collapsibility was higher in supine than in sitting position when NEP was performed with nasal mask. In contrast, NEP was not influenced by position when evaluated with mouthpiece. Expiratory resistance was significantly higher and independent of position with mouthpiece than with nasal mask (20.7 cmH2O/L.s-1 vs 8.6 cmH2O/L.s-1 respectively, p=0.018). Study 2) Twenty-eight subjects performed NEP with nasal mask in supine position, Pcrit and upper airway CT scan (age: 45±13 years, BMI: 29.4 ± 4.9 kg/m2, and AHI: 30 ± 26 events/h). NEP evaluated with nasal mask in supine position and Pcrit were similarly associated with tongue area (r=0.646 and r=0.585), tongue volume (r=0.565 and r=0.613), pharyngeal length (r=0.580 and r=0.611), and AHI (r=0.490 and r=0.531) respectively (p < 0.05 for all comparisons). NEP and Pcrit were significantly worse in patients with severe OSA than the remaining population (p < 0.05). CONCLUSIONS: Study 1) Interface and position influence upper airway collapsibility measured by NEP. We propose NEP to be performed with nasal mask in supine position in future studies of upper airway collapsibility evaluation in patients under investigation for OSA. Study 2) NEP evaluated with nasal mask in supine position is a simple and promising method that is associated with the anatomical component of upper airway collapsibility similarly to Pcrit