Thesis (M.S.)--Oregon State University, 2004. / Includes bibliographical references.

Inhibitory GABAergic neurons in the parafacial zone (PZGABA) are essential for slow wave sleep (SWS). Since existing literature about the heterogenous population of PZ neurons is lacking, questions remain regarding the non-GABAergic sleep active PZ neurons. This study seeks to determine if glutamatergic PZ neurons expressing the transcription factor Phox2B (PZPhox2B) participate in sleep-wake control. Phox2B-IRES-Cre mice received injections of adeno-associated virus containing Cre-dependent diphtheria toxin subunit A (DTA) DNA into the PZ (PZPhox2B-DTA). Analysis of injection sites revealed transfection covering the PZ and the locus coeruleus, also known to express Phox2B. We recorded the sleep-wake cycle of PZPhox2B-DTA mice and compared them with control mice, analyzing their sleep-wake quantity, fragmentation, and power spectral distribution. We found total amounts and cortical power for wakefulness, SWS, and REM sleep of PZPhox2B-DTA mice were unaffected. There was fragmentation in wakefulness during the active period for PZPhox2B-DTA mice, seen as a significant reduction in the amount of time and number of episodes spent in the longest bout; however, wakefulness during the rest period was not significantly altered. No significant change was found in the bout numbers and amounts for SWS and REM sleep of PZPhox2B-DTA mice. I was unable to confirm targeted ablation of PZPhox2B-DTA neurons due to a lack of reliable antibody staining. Therefore, it remains possible that ablation of PZPhox2B neurons was incomplete and the wakeful fragmentation is due to neuronal ablation outside of the PZ, such as in the neighboring LC.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Objective: The aim is to evaluate the association between sleep quality and perinatal depression in pregnant women between the 12th week of gestation and the 36th week of gestation in a maternity and child centre in Lima. Methods: Analytical cross-sectional study in pregnant women cared for in a primary care centre between August and December 2019. The data were collected through a self-administered survey. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. The evaluation of perinatal depression was performed with the Edinburgh Postnatal Depression Scale (EPDS). For the multivariate analysis, Poisson regression with robust variances was used to calculate the crude and adjusted prevalence ratios and their respective confidence intervals. Results: The sample was composed of 200 participants. The median [IQR] age was 26 [22-32] years, and 111 (55.5%) pregnancies were unplanned. 52% presented a poor quality of sleep and the risk of perinatal depression was 31.5%. Poor quality of sleep was associated with a significantly higher frequency of perinatal depression (aPR = 4.8 for those with poor quality of sleep warranting medical attention, and aPR = 6.6 for those with poor quality of sleep warranting medical attention and treatment). Conclusions: There is a possible association between poor sleep quality and perinatal depression in pregnant women between weeks 12 and 36 of gestation. Operational research should be promoted to assess whether interventions to improve sleep quality could have a positive impact on reducing perinatal depression. / Revisión por pares

The daily sleep-wake cycle usually consists of three distinct states: wakefulness, non-rapid-eye-movement (NREM) and rapid-eye-movement (REM). The process of switching between different states is complex, but a common assumption is that it is regulated primarily by two processes (the circadian and the homeostatic process) via reciprocal interactions of several downstream neuron groups. These interactions not only result in often rapid transitions from one state to another, but also allow for a certain degree of bi-stability that locks the organism in a given state for some while before it switches back. In order to better understand how the behavioral states are regulated by different neuron groups, I describe how to use the S-system method for the development of a mathematical model consisting of two phases. The first phase covers the switch between wakefulness and sleep, which is controlled by the interactions between wake- and sleep-promoting neurons, whereas the second phase addresses the generation of NREM-REM alternation, which is believed to be regulated by REM-OFF and REM-ON neurons. In this set-up I interpret the circadian rhythm as external input and homeostatic regulation as a feedback controller. Both open-loop and closed-loop forms of the two-phase model are investigated and implemented. Discharging activities of the corresponding neuron groups and the switches of behavioral states are shown in the simulation results, from which we can easily identify the basic roles of wake- and sleep-promoting neurons, REM-OFF and REM-ON neurons. The special regulatory function of the neuropeptide orexin is also tested by simulation.

Introdução - A sonolência é descrita como a interação entre o momento circadiano para adormecer e o aumento da necessidade de sono, e está em geral, associada ao decréscimo do alerta, do tempo de reação, da memória, da coordenação psicomotora, do entendimento da informação, do tempo para se tomar decisões, da maior incidência de uso de substâncias estimulantes e de substâncias álcoolicas. Na adolescência, a sonolência limita as perspectivas dos adolescentes quanto ao seu desenvolvimento intelectual. Muito pouco se conhece sobre a percepção da sonolência em estudantes trabalhadores. Objetivo - Verificar variações da sonolência ao longo do dia e o possível impacto das atividades diárias e estilos de vida na sonolência em estudantes. Metodologia - A população estudada compreendem estudantes trabalhadores e não-trabalhadores, alunos do ensino médio do período noturno de uma escola pública estadual da cidade de São Paulo, SP. Participaram estudantes entre 14 e 21 anos de idade incompletos. Os estudantes selecionados preencheram os questionários de: caracterização das condições de vida, saúde e sono, matutinidade-vespertinidade, caracterização das condições de trabalho e freqüência alimentar. Em seguida foi realizada a obtenção de registros sobre o ciclo vigília-sono dos estudantes através de métodos subjetivos (Protocolo diário de atividades, diário de sono e escala de sonolência) e objetivos (Actimetria). As variáveis sócio-demográficas, estilos de vida, condições de trabalho e do ciclo vigília-sono foram testadas através do teste t-Student, ANOVA para três fatores (dia da semana, horário e trabalho), Qui-Quadrado de Pearson (c2) e análise de regressão. Resultados - 1) a duração média do sono nos dias da semana para os estudantes trabalhadores foi em torno de 7h, enquanto a duração do sono dos estudantes não trabalhadores foi em torno de 9h; 2) os padrões de sonolência de estudantes trabalhadores são diferentes dos estudantes não-trabalhadores. Verificamos que os estudantes trabalhadores são mais sonolentos que os estudantes não-trabalhadores no primeiro registro diário (07├ 09 h) e no último (22├ 24 h). Verificamos que os estudantes trabalhadores são mais sonolentos que estudantes não-trabalhadores na segunda-feira após o almoço (13├ 15 h), na quarta-feira durante as aulas (19├ 21 h) e na sexta-feira antes de dormir (22├ 24 h). Aos domingos, entre 22├ 24 h foi encontrada o maior nível de sonolência entre os estudantes trabalhadores. Também, neste momento, os trabalhadores são mais sonolentos que os estudantes não-trabalhadores em todos os outros dias e horários; 3) os fatores independentemente associados a estar sonolento foram: trabalhar, ser do sexo feminino, consumir álcool, ter maior dificuldade para adormecer e ir dormir após as 24h. Conclusões - Os padrões de sonolência de estudantes trabalhadores são diferentes dos estudantes não-trabalhadores e as variáveis do ciclo vigília-sono interferem nos níveis de sonolência ao longo do dia. Além dos fatores cronobiológicos outros fatores estão relacionados às mudanças nos níveis da sonolência: a) fatores individuais; b) fatores sociais; c) fatores sócio-demográficos e d) estilos de vida. Essa gama de fatores acaba levando ao aumento da sonolência no início e fim do dia para os estudantes trabalhadores, podendo interferir no rendimento escolar e prejudicar o desenvolvimento físico e mental, característicos da adolescência. Programas de intervenção tais como, o conhecimento sobre a higiene do sono e as políticas de inserção social que permitam aos estudantes manter um padrão de vida adequado sem ter que sujeitar a longas jornadas de trabalho enquanto na adolescência, devem ser implementados. / Introduction – Sleepiness is described as an interaction between the circadian phase and the increase in pressure to sleep. In general, it is associated with a decrease in alertness levels, reaction time, memory, psychomotor coordination, information assimilation, time to take decisions, and larger consumption of stimulant and alcoholic substances. In adolescence, sleepiness restricts the adolescent’s perspectives as to his/her intellectual development. Knowledge on perception of sleepiness in working students is poor. Objective – Verifying patterns of sleepiness along the day and the possible impact of daily activities and life styles on sleepiness among working and non-working students. Methods – The population studied comprised working and non-working high school students attending evening classes (19:00-22.30pm) at a public school in São Paulo, Brazil. The study group consisted of working and non-working students aged 14-21. The students selected filled in a questionnaire on living conditions, health and sleep, morningness-eveningness, characterization of working conditions, and frequency of food consumption. As a second step, records of their sleep-wake cycle were obtained through subjective methods (daily protocol of activities, sleep diary and sleepiness scale), as well as objective methods (Actigraphy). Socio-demographic, life style, work conditions and sleep-wake cycle variables were tested with the use of three-way ANOVA test (week day, time and work), Person’s Qui-Square test (c2) and regression analysis. Results - 1) The average sleep duration for working students during weekdays was around 7 hours, whereas the sleep duration for non-working students was around 9 hours; 2) working students’ sleepiness patterns are different from those of non-working students. We found that working students were sleepier than non-working students in the first period (07:00am-09:00am) and in the last period recorded (10:00pm-12:00pm). We also found that working students were sleepier on specific days: on Mondays after lunch time (01:00pm-03:00pm), on Wednesdays during classes (07:00pm-09:00pm) and on Fridays before bedtime (10:00pm-12:00pm). The highest level of sleepiness among students was found on Sundays, between 10:00pm-12:00pm. Also, at this time period working students in general were sleepier than non-working students, independently of the period and time of the day. 3) Other factors associated with sleepiness were: work, being a female, alcohol consumption, easiness of sleeping and going to bed after midnight. Conclusions – The sleepiness patterns for working students are different from those for non-working students, and the sleep-wake cycle variables interfere in sleepiness levels during the day. In addition to chronobiological factors, there are other factors associated with changes in sleepiness levels: a) individual factors; b) social factors; c) socio-demographic factors; and d) life style. All these factors contribute to increase in working students’ sleepiness at the beginning and end of the day; this may interfere in their school performance, impairing their physical and mental development, which is characteristic of adolescence. Intervention programs, such as those that provide information on sleep hygiene, and those related to social insertion, which would allow students to maintain and adequate life standard without having to be submitted to extended work journeys, should be implemented.

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

Childhood OSA is increasingly recognized to be associated with a variety of complications including neurocognitive and cardiovascular diseases. The intermediate link between OSA and end organ damage has been suggested to be inflammation, and both local airway and systemic inflammation have been described in adults with OSA. A non-invasive technique of sputum induction was utilised to show that children with OSA also have airway inflammation, as characterized by a significant increase in neutrophils, and the severity of OSA also correlated significantly with the degree of neutrophilic inflammation (Chapter 7). This finding may lead to research on the use of anti-inflammatory therapeutic agents or antibiotics for the treatment of childhood OSA. Another marker of inflammation, C-reactive protein (CRP) was measured in a cohort of children with OSA before and after treatment (Chapter 8). Children with OSA had higher CRP levels compared to their non-OSA counterparts, and the raised CRP decreased significantly following treatment suggesting that the inflammatory response is potentially reversible. The cardiovascular risk factors of insulin levels and blood pressure (BP) were evaluated and children with OSA had higher serum insulin and greater systolic and diastolic BP compared to healthy controls (Chapters 9 and 10). These findings suggest that children with OSA may be at risk of developing metabolic syndrome and its devastating consequence. (Abstract shortened by UMI.) / The original research studies undertaken were based on nocturnal sleep examinations to explore childhood OSA in two main aspects, namely its assessment, and a better understanding of its complications in children. The gold standard for diagnosing OSA is overnight polysomnography (PSG), which is an expensive investigation that is not routinely available at all public hospitals in Hong Kong. Alternative valid assessment tools for OSA that are more cost-effective are needed. The feasibility of using radiographic techniques to assess severity of OSA was explored, and the size of the upper airway, as reflected by the tonsillar pharyngeal (TP) ratio obtained from lateral neck radiograph, correlated well with the severity of OSA (Chapter 4). A defined TP cutoff could accurately predict moderate-to-severe OSA with high sensitivity and specificity. This method could be used in clinical practice to prioritize patients with suspected OSA for further evaluation. A locally applicable questionnaire scale was examined for its validity and accuracy in diagnosing children with OSA (Chapter 5). The presence of three symptoms (snoring, mouth breathing and nocturnal sweating) was found to have high predictive value in correctly identifying children with the condition. The question of whether a single night PSG study is adequate in diagnosing OSA was examined together with the assessment for the presence of night-to-night variability in PSG and respiratory parameters in childhood sleep (Chapter 6). Forty-four obese children and 43 age and sex-matched healthy controls underwent two consecutive nights PSG examination. Although a first night effect was clearly documented, a single night PSG study would have correctly identified over 80% of children with OSA. This finding has significant resource implications. / Albert Martin Li. / Adviser: Tony Nelson. / Source: Dissertation Abstracts International, Volume: 70-06, Section: B, page: 3420. / Thesis (M.D.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves xxxv-lxxx). / 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. / Abstract in English only. / School code: 1307.

Introdução - A sonolência é descrita como a interação entre o momento circadiano para adormecer e o aumento da necessidade de sono, e está em geral, associada ao decréscimo do alerta, do tempo de reação, da memória, da coordenação psicomotora, do entendimento da informação, do tempo para se tomar decisões, da maior incidência de uso de substâncias estimulantes e de substâncias álcoolicas. Na adolescência, a sonolência limita as perspectivas dos adolescentes quanto ao seu desenvolvimento intelectual. Muito pouco se conhece sobre a percepção da sonolência em estudantes trabalhadores. Objetivo - Verificar variações da sonolência ao longo do dia e o possível impacto das atividades diárias e estilos de vida na sonolência em estudantes. Metodologia - A população estudada compreendem estudantes trabalhadores e não-trabalhadores, alunos do ensino médio do período noturno de uma escola pública estadual da cidade de São Paulo, SP. Participaram estudantes entre 14 e 21 anos de idade incompletos. Os estudantes selecionados preencheram os questionários de: caracterização das condições de vida, saúde e sono, matutinidade-vespertinidade, caracterização das condições de trabalho e freqüência alimentar. Em seguida foi realizada a obtenção de registros sobre o ciclo vigília-sono dos estudantes através de métodos subjetivos (Protocolo diário de atividades, diário de sono e escala de sonolência) e objetivos (Actimetria). As variáveis sócio-demográficas, estilos de vida, condições de trabalho e do ciclo vigília-sono foram testadas através do teste t-Student, ANOVA para três fatores (dia da semana, horário e trabalho), Qui-Quadrado de Pearson (c2) e análise de regressão. Resultados - 1) a duração média do sono nos dias da semana para os estudantes trabalhadores foi em torno de 7h, enquanto a duração do sono dos estudantes não trabalhadores foi em torno de 9h; 2) os padrões de sonolência de estudantes trabalhadores são diferentes dos estudantes não-trabalhadores. Verificamos que os estudantes trabalhadores são mais sonolentos que os estudantes não-trabalhadores no primeiro registro diário (07├ 09 h) e no último (22├ 24 h). Verificamos que os estudantes trabalhadores são mais sonolentos que estudantes não-trabalhadores na segunda-feira após o almoço (13├ 15 h), na quarta-feira durante as aulas (19├ 21 h) e na sexta-feira antes de dormir (22├ 24 h). Aos domingos, entre 22├ 24 h foi encontrada o maior nível de sonolência entre os estudantes trabalhadores. Também, neste momento, os trabalhadores são mais sonolentos que os estudantes não-trabalhadores em todos os outros dias e horários; 3) os fatores independentemente associados a estar sonolento foram: trabalhar, ser do sexo feminino, consumir álcool, ter maior dificuldade para adormecer e ir dormir após as 24h. Conclusões - Os padrões de sonolência de estudantes trabalhadores são diferentes dos estudantes não-trabalhadores e as variáveis do ciclo vigília-sono interferem nos níveis de sonolência ao longo do dia. Além dos fatores cronobiológicos outros fatores estão relacionados às mudanças nos níveis da sonolência: a) fatores individuais; b) fatores sociais; c) fatores sócio-demográficos e d) estilos de vida. Essa gama de fatores acaba levando ao aumento da sonolência no início e fim do dia para os estudantes trabalhadores, podendo interferir no rendimento escolar e prejudicar o desenvolvimento físico e mental, característicos da adolescência. Programas de intervenção tais como, o conhecimento sobre a higiene do sono e as políticas de inserção social que permitam aos estudantes manter um padrão de vida adequado sem ter que sujeitar a longas jornadas de trabalho enquanto na adolescência, devem ser implementados. / Introduction – Sleepiness is described as an interaction between the circadian phase and the increase in pressure to sleep. In general, it is associated with a decrease in alertness levels, reaction time, memory, psychomotor coordination, information assimilation, time to take decisions, and larger consumption of stimulant and alcoholic substances. In adolescence, sleepiness restricts the adolescent’s perspectives as to his/her intellectual development. Knowledge on perception of sleepiness in working students is poor. Objective – Verifying patterns of sleepiness along the day and the possible impact of daily activities and life styles on sleepiness among working and non-working students. Methods – The population studied comprised working and non-working high school students attending evening classes (19:00-22.30pm) at a public school in São Paulo, Brazil. The study group consisted of working and non-working students aged 14-21. The students selected filled in a questionnaire on living conditions, health and sleep, morningness-eveningness, characterization of working conditions, and frequency of food consumption. As a second step, records of their sleep-wake cycle were obtained through subjective methods (daily protocol of activities, sleep diary and sleepiness scale), as well as objective methods (Actigraphy). Socio-demographic, life style, work conditions and sleep-wake cycle variables were tested with the use of three-way ANOVA test (week day, time and work), Person’s Qui-Square test (c2) and regression analysis. Results - 1) The average sleep duration for working students during weekdays was around 7 hours, whereas the sleep duration for non-working students was around 9 hours; 2) working students’ sleepiness patterns are different from those of non-working students. We found that working students were sleepier than non-working students in the first period (07:00am-09:00am) and in the last period recorded (10:00pm-12:00pm). We also found that working students were sleepier on specific days: on Mondays after lunch time (01:00pm-03:00pm), on Wednesdays during classes (07:00pm-09:00pm) and on Fridays before bedtime (10:00pm-12:00pm). The highest level of sleepiness among students was found on Sundays, between 10:00pm-12:00pm. Also, at this time period working students in general were sleepier than non-working students, independently of the period and time of the day. 3) Other factors associated with sleepiness were: work, being a female, alcohol consumption, easiness of sleeping and going to bed after midnight. Conclusions – The sleepiness patterns for working students are different from those for non-working students, and the sleep-wake cycle variables interfere in sleepiness levels during the day. In addition to chronobiological factors, there are other factors associated with changes in sleepiness levels: a) individual factors; b) social factors; c) socio-demographic factors; and d) life style. All these factors contribute to increase in working students’ sleepiness at the beginning and end of the day; this may interfere in their school performance, impairing their physical and mental development, which is characteristic of adolescence. Intervention programs, such as those that provide information on sleep hygiene, and those related to social insertion, which would allow students to maintain and adequate life standard without having to be submitted to extended work journeys, should be implemented.

Sleep represents a third of our life, from birth to death. Sleep allows our body and mind to rest, and breaking its structure may lead to severe physical and nervous damage. Breathing disorders, like apneas, hypopneas or RERA events, alter the recovering feature of sleep by fragmenting its structure. They usually lead to daytime sleepiness, depression, hypertension, cardiovascular disease,... In order to give the most suitable treatment to a patient, the gold standard polysomnography (PSG) is recorded in a hospital setting and the huge amount of data is visually analyzed the day after. The PSG is expensive, time-consuming for the clinicians and unpleasant for the patient. Thus, portable monitoring devices and automatic analysis methods are welcome. Four physiological parameters are required to score the three breathing disorders mentioned above: nasal airflow, oximetry, arousals and respiratory effort markers. While arousals are defined in the EEG traces, the esophageal pressure is the gold standard but invasive measure of effort. Surrogates (signals) exist for both arousal, like PAT, PTT or ECG, and effort markers, like TAM, PTT or FOT. This thesis was dedicated to a novel one, the maxillo-mandibular movements. This signal is not only able to point arousals and effort, but it has also the capability to distinguish sleep from wake as a mandibular actimeter, like the wrist actigraphy. These three features make it worth of interest. At first, the jaw movements signal essence was extracted, automatic methods 1) to point arousals, 2) to indicate periodic patterns like respiratory effort or salvo of sleep events, 3) to detect and classify apneas, hypopneas and RERA and 4) to separate sleep from wake were developed and evaluated. Then, the sleep apneas/hypopneas and the sleep/wake detectors were then improved by adding the oximetry in a first step. Finally, the nasal airflow brought its potential in both detection and classification of breathing disorders, especially to overcome the inherent classification problem between apneas and hypopneas since the jaw movements sensor is an effort sensor. All the methods developed in this thesis were applied to a huge database of 150 consecutive recordings at the Sleep Laboratory of the University of Liege for sleep apneas and hypopneas detection assessment. Moreover, an APAP device, that applies a regulated pressure throughout a nasal mask to prevent from upper airways collapse, was designed using only features computed from jaw movements in real-time, and showed similar results to the widely tested iS20i from BREAS. In conclusion, the maxillo-mandibular movements signal does bring usefull information about respiratory effort and arousals, and coupled with the nasal flow and oximetry signal provides an accurate detection and classification of sleep apneas, hypopneas and RERA. Besides, this jaw actimeter and its ad-hoc algorithm allows to distinguish sleep from wake. All in all, the jaw movements signal is a very valuable and a unique physiological signal for home sleep studies.

Thesis (Au. D.)--Missouri State University, 2008. / "May 2008." Includes bibliographical references (leaves 76-86). Also available online.