No description available.

Objectives: To investigate slow wave sleep (SWS) spectral power proportions in distinct clinical conditions sharing non-restorative sleep and fatigue complaints without excessive daytime sleepiness (EDS), namely the Chronic Fatigue Syndrome (CFS) and Primary Insomnia (PI). Impaired sleep homeostasis has been suspected in both CFS and PI. Methods: We compared perceived sleep quality, fatigue and sleepiness symptom-intensities, polysomnography (PSG) and SWS spectral power distributions of drug-free CFS and PI patients without comorbid sleep or mental disorders, with a good sleeper control group.Results: Higher fatigue without EDS and impaired perceived sleep quality were confirmed in both patient groups. PSG mainly differed in sleep fragmentation and SWS durations. Spectral analysis revealed a similar decrease in central ultra slow power (0.3-0.79Hz) proportion during SWS for both CFS and PI and an increase in frontal power proportions of faster frequencies during SWS in PI only. The latter was correlated to affective symptoms whereas lower central ultra slow power proportions were related to fatigue severity and sleep quality impairment. Conclusions: In combination with normal (PI) or even increased SWS durations (CFS), we found consistent evidence for lower proportions of slow oscillations during SWS in PI and CFS. Significance:Observing normal or increased SWS durations but lower proportions of ultra slow power, our findings suggest a possible quantitative compensation of altered homeostatic regulation. / Doctorat en Sciences de la motricité / info:eu-repo/semantics/nonPublished

No description available.

Doctor of Philosophy (Medicine) / Sleepiness is an important source of morbidity in the community, with potentially catastrophic consequences of occupational or driving injuries or accidents. Although many measures of sleepiness exist, there is no gold standard. The electroencephalograph (EEG) has been studied as an indicator of sleep pressure in the waking organism, or sleep depth. A mathematical model has been developed, relating the observed EEG to interactions between groups of neurons in the cortex and thalamus (Robinson, Rennie, Rowe, O'Connor, & Gordon, 2005; Robinson, Rennie, & Wright, 1997). These interactions are thought to be important in the transition from wake to sleep. Sleepiness is common in obstructive sleep apnea (OSA). The measurement of sleepiness would have great utility in quantifying the disease burden, measuring treatment response, or determining fitness for work or driving. This study will evaluate parameters derived from the EEG mathematical model as a measure of sleepiness. It is divided into the following four parts: 1. Subjects with likely OSA based on symptoms and demographics from an international database were compared with matched non-OSA controls. The OSA group showed deficits in executive function and abnormalities on evoked response potential testing. 2. Outcomes from a cross-sectional study in a sleep-clinic OSA population were aggregated by factor analysis into a five summary variables relevant to sleepiness: subjective sleepiness, mood & anxiety, memory & learning, driving, and executive functioning. 3. EEG mathematical model parameters from wake EEG recordings were related to the five summary outcomes. Executive function correlated with a parameter Z, representing the negative feedback loop between the thalamic reticular nucleus and the thalamocortical relay nuclei. 4. EEG model parameters during first NREM sleep cycle of 8 subjects with regular sleep architecture were studied. Net cortical excitation (parameter X) is predicted to increase across the cycle, while there was, as predicted, a greater inhibitory effect of the thalamic reticular nucleus upon thalamocortical relay cells (parameter Z). In this preliminary assessment, EEG model parameters reflecting thalamocortical interactions are sensitive to prefrontal lobe tasks such as executive function, which are known to be vulnerable to sleep loss and sleepiness, and these parameters also show variation with increasing sleep depth.

Doctor of Philosophy (Medicine) / Sleepiness is an important source of morbidity in the community, with potentially catastrophic consequences of occupational or driving injuries or accidents. Although many measures of sleepiness exist, there is no gold standard. The electroencephalograph (EEG) has been studied as an indicator of sleep pressure in the waking organism, or sleep depth. A mathematical model has been developed, relating the observed EEG to interactions between groups of neurons in the cortex and thalamus (Robinson, Rennie, Rowe, O'Connor, & Gordon, 2005; Robinson, Rennie, & Wright, 1997). These interactions are thought to be important in the transition from wake to sleep. Sleepiness is common in obstructive sleep apnea (OSA). The measurement of sleepiness would have great utility in quantifying the disease burden, measuring treatment response, or determining fitness for work or driving. This study will evaluate parameters derived from the EEG mathematical model as a measure of sleepiness. It is divided into the following four parts: 1. Subjects with likely OSA based on symptoms and demographics from an international database were compared with matched non-OSA controls. The OSA group showed deficits in executive function and abnormalities on evoked response potential testing. 2. Outcomes from a cross-sectional study in a sleep-clinic OSA population were aggregated by factor analysis into a five summary variables relevant to sleepiness: subjective sleepiness, mood & anxiety, memory & learning, driving, and executive functioning. 3. EEG mathematical model parameters from wake EEG recordings were related to the five summary outcomes. Executive function correlated with a parameter Z, representing the negative feedback loop between the thalamic reticular nucleus and the thalamocortical relay nuclei. 4. EEG model parameters during first NREM sleep cycle of 8 subjects with regular sleep architecture were studied. Net cortical excitation (parameter X) is predicted to increase across the cycle, while there was, as predicted, a greater inhibitory effect of the thalamic reticular nucleus upon thalamocortical relay cells (parameter Z). In this preliminary assessment, EEG model parameters reflecting thalamocortical interactions are sensitive to prefrontal lobe tasks such as executive function, which are known to be vulnerable to sleep loss and sleepiness, and these parameters also show variation with increasing sleep depth.

Sleep apnea impacts one's mental and physical health, and has social consequences which affect all of society. Not only is there is a weak correlation between the severity of sleep apnea and daytime sleepiness as reported on the Epworth Sleepiness Scale (ESS), but there is also a weak correlation between the severity of sleep apnea and prescribed treatment as indicated by 95th percentile pressure on a continuous positive airway pressure (CPAP) machine. This poses difficulty for providers as well as patients throughout screening and treatment. The purpose of this study was to use a biopsychosocial approach to perform a within-subjects analysis in order to quantitatively investigate methods of calculating the severity of sleep apnea. The study included historical data of 75 participants, each diagnosed with obstructive sleep apnea, prescribed Automatic CPAP therapy, and compliant with treatment. The Apnea Hypopnea Index (AHI) was calculated in the current fashion and also while considering the length of a respiratory event, type of respiratory event, and the combination of these two factors. Linear regression was used to determine if there is a significant difference in the relationships between the AHI and the ESS as well as the AHI and the 95th percentile CPAP pressure. Results endorsed neither a strong relationship between the AHIs and the ESS nor a strong relationship between the AHIs and 95th percentile CPAP pressure either. However, the relationships were somewhat stronger when considering the length and type of the respiratory event. Findings support a need for future research to explore these relationships and offer more accurate screening and treatment of individuals with sleep apnea. Ultimately, those with sleep apnea will experience an improvement in mental, physical and social functioning which may positively impact those without sleep apnea.

Nurses are largely unaware of the problems of night-shift-nurse sleepiness and available strategies to manage night-shift sleepiness. The purpose of this project was to examine nurses' self-perception, awareness of sleepiness, and current strategies to manage this problem in the emergency medicine department of a major academic hospital in the western United States. The validated de-identified Karolinska Sleepiness Scale (KSS) was used to measure the prevalence and intensity of night shift nurses' sleepiness prior to the development of an educational program on strategies to manage sleepiness. Of the 164 registered nurses surveyed, 72 (43.9%) reported sleepiness greater than 7 on the KSS. An educational program was developed and evaluated by a panel of 6 experts who were selected on their clinical, educational, quality improvement, and research in sleep studies. Expert reviews indicated that the education program was 100% relevant, appropriate, and understandable, and provided adequate information on the topic with no recommended changes. The education program was presented to 16 night shift nurses with a pre/posttest survey completed by 14 nurses. Results indicated that participating nurses increased their knowledge of managing strategies for sleepiness from 69% (agree or strongly agree) preintervention to 92% postintervention. Postintervention, there was a 50% increase in the number of nurses who reported benefits from the education intervention. The findings of this project contribute to positive social change by improving nurses' health and quality patient care by advancing nurses' awareness of night shift sleepiness and countermeasure management strategies.

Introdução: Existem algumas evidências relacionando o aumento da sonolência com o aumento do consumo de carboidratos, o que é particularmente relevante para trabalhadores noturnos.Objetivo: Avaliar os efeitos de alterações no conteúdo de proteínas e carboidratos da alimentação noturna na sonolência de trabalhadores noturnos. Métodos: A população era do sexo masculino, com idade média de 32 anos (dp=6,5anos). O estudo foi realizado em duas etapas. A primeira etapa contou com 54 seguranças que foram submetidos à avaliação antropométrica e responderam a um questionário sobre aspectos da vida, trabalho e sintomas de saúde e Recordatório de 24 horas (R24h) de três dias. A segunda etapa durou 3 semanas da qual participaram, após sorteio, 24 seguranças. Nesta etapa foi avaliado o ciclo vigília-sono, através de actigrafia, protocolos diários de atividade e Escala de Sonolência Karolinska (KSS). A mudança do conteúdo da alimentação ocorreu em 2 semanas. Na primeira, foi aumentado o conteúdo de carboidratos por 5 dias; após 2 dias, houve aumento no conteúdo de proteínas, também por 5 dias. Resultados: Os níveis de alerta foram analisados antes e após a refeição na empresa e não revelaram nenhum efeito significativo durante as 3 condições. Porém, quando estes mesmos níveis de alerta foram analisados, levando-se em consideração o IMC verificou-se uma interação entre o IMC acima de 30kg/m2 e o nível de alerta, durante a semana de modificação no conteúdo de carboidratos (p<0,05). O consumo médio de calorias foi de 2.808 kcal (dp=568,6). As médias de consumo foram: proteínas 99,1 gramas (dp=80,9), carboidratos 291,5 gramas (dp=61,7) e lipídeos 38,4 gramas (dp=34,9). Quando comparadas às Dietary References Intakes (DRI), foi verificado que, em relação às calorias, mais da metade dos participantes apresentavam ingestão adequada; quanto às proteínas apenas 11 por cento estavam adequados e 68,5 por cento consumiam carboidratos de forma adequada, o que não ocorreu com os lipídeos, pois 94,4 por cento dos participantes consumiram este nutriente acima das recomendações. Conclusões: O conteúdo de carboidratos da refeição noturna parece exercer um efeito na sonolência dos indivíduos sobrepesos e obesos / Introduction: There is some evidence linking the increased sleepiness with increased consumption of carbohydrates, which is particularly important for night workers. Objective: To evaluate the effects of changes in content of protein and carbohydrate food at night in the sleepiness of night workers. Methods: The population was male security guards, mean age 32 years (SD = 6.5 years). The study was conducted in two stages. The first stage had 54 security guards who underwent anthropometric measurements and answered a questionnaire about aspects of life style, work and health symptoms and 24-hour recall (24HR) for three days. The second stage lasted for 3 weeks which involved randomly assigned, 24 security guards. In this step it was evaluated the sleep-wake cycle through actigraphy, daily activity protocols and Karolinska Sleepiness Scale (KSS). Changing the contents of feeding occurred in 2 weeks. At first it was the carbohydrate content increased by 5 days, after two days, there was an increase in protein content, also for 5 days. Results: Alertness levels were assessed before and after the meal in the company and revealed no significant effect during the three conditions. But when these same alert levels were analyzed, taking into account the BMI there was an interaction between BMI above 30kg/m2 and the level of alert during the week of change in carbohydrate content (p<0.05). The average consumption of calories was 2808 kcal (SD = 568.6). Consumption averages were: 99.1 g protein (SD = 80.9), carbohydrates 291.5 g (sd = 61.7) and 38.4 g fat (SD = 34.9). When compared to the Dietary References Intakes (DRI), it was noted that in relation to calories, more than half of participants had adequate intake, as protein only 11 percent were adequate and 68.5 percent consumed carbohydrates properly, the but not with lipids, because 94.4 percent of participants consumed above this nutrient recommendations. Conclusions: The content of carbohydrates in the evening meal seems to exert an effect on sleepiness among overweight and obese individuals

É crescente a preocupação com as doenças do sono e o seu impacto na saúde da população em geral. Pouco ainda é conhecido e explorado na região Sul de Santa Catarina. Embora a literatura reforce a necessidade de uma avaliação objetiva, existem bons instrumentos clínicos que podem ser utilizados em estudos epidemiológicos. Foi realizado um estudo transversal e observacional com o objetivo de estimar a prevalência de sintomas relacionados a apneia obstrutiva do sono em um grupo de pacientes atendidos no Ambulatório de Clínicas Integradas da Universidade do Extremo Sul Catarinense, um ambulatório geral secundário, na cidade de Criciúma. Foram avaliados 101 pacientes através da aplicação de questões de sintomas de apneia validadas pelo estudo PLATINO e da Escala de Sonolência de Epworth. A amostra estudada tinha 73 (72,3%) mulheres; 47 (48,6%) indivíduos estudados tinham entre 40 e 59 anos. O ronco esteve presente em 65 (64,4%) pacientes e 20 (19,8%) relataram apneias. Dos indivíduos entrevistados, 31 (30,7%) relataram já terem sido questionados pelo seu médico a respeito do seu sono. Quanto ao resultado da ESE, 14 (13,9%) tiveram pontuação superior a 10. No sexo masculino, foi encontrada uma relação entre a presença de ronco e apneia e escores na ESE acima de 10 (p< 0,01). Concluímos que em uma população não selecionada o ronco foi um sintoma bastante prevalente, assim como o relato de apneias. As questões referentes ao sono, sobretudo relacionadas à apneia do sono, ainda são pouco abordadas pelos médicos em consultas gerais. / This observational cross-sectional study was conducted to determine the prevalence of symptoms related to obstructive sleep apnea in a group of patients attending Clínicas Integradas da Universidade do Extremo Sul Catarinense Ambulatory, a secondary ambulatory, in Criciuma, Brazil. Inclusion criteria was age 18 years or older. 101 patients were interviewed, and it were apllied questions related to obstructive apnea symptoms, previously validated in the PLATINO study and Epworth Sleepiness Scale. The sample was compounded by 73 (72,3%) women. 47 (48,6%) individuals were between 40 and 59 years old. Snores were present in 65 (64,4%) patients and 20 (19,8%) referred witnessed apneas during sleep. Thirty one (30,7%)of the participants said their physician have ever asked about sleep. The result on Epworth Sleepiness Scale was greater than 10 in 14 (13,9%) individuals. There was a significant relation between snore, witnessed apneas and Epworth Sleepiness Scale results greater than 10 in males (p<0,01). The prevalence of obstructive sleep apnea symptoms are high in this population, but Epworth Sleepiness Scale values are low. Besides, physicians still don’t ask much about sleep.

Introdução: Existem algumas evidências relacionando o aumento da sonolência com o aumento do consumo de carboidratos, o que é particularmente relevante para trabalhadores noturnos.Objetivo: Avaliar os efeitos de alterações no conteúdo de proteínas e carboidratos da alimentação noturna na sonolência de trabalhadores noturnos. Métodos: A população era do sexo masculino, com idade média de 32 anos (dp=6,5anos). O estudo foi realizado em duas etapas. A primeira etapa contou com 54 seguranças que foram submetidos à avaliação antropométrica e responderam a um questionário sobre aspectos da vida, trabalho e sintomas de saúde e Recordatório de 24 horas (R24h) de três dias. A segunda etapa durou 3 semanas da qual participaram, após sorteio, 24 seguranças. Nesta etapa foi avaliado o ciclo vigília-sono, através de actigrafia, protocolos diários de atividade e Escala de Sonolência Karolinska (KSS). A mudança do conteúdo da alimentação ocorreu em 2 semanas. Na primeira, foi aumentado o conteúdo de carboidratos por 5 dias; após 2 dias, houve aumento no conteúdo de proteínas, também por 5 dias. Resultados: Os níveis de alerta foram analisados antes e após a refeição na empresa e não revelaram nenhum efeito significativo durante as 3 condições. Porém, quando estes mesmos níveis de alerta foram analisados, levando-se em consideração o IMC verificou-se uma interação entre o IMC acima de 30kg/m2 e o nível de alerta, durante a semana de modificação no conteúdo de carboidratos (p<0,05). O consumo médio de calorias foi de 2.808 kcal (dp=568,6). As médias de consumo foram: proteínas 99,1 gramas (dp=80,9), carboidratos 291,5 gramas (dp=61,7) e lipídeos 38,4 gramas (dp=34,9). Quando comparadas às Dietary References Intakes (DRI), foi verificado que, em relação às calorias, mais da metade dos participantes apresentavam ingestão adequada; quanto às proteínas apenas 11 por cento estavam adequados e 68,5 por cento consumiam carboidratos de forma adequada, o que não ocorreu com os lipídeos, pois 94,4 por cento dos participantes consumiram este nutriente acima das recomendações. Conclusões: O conteúdo de carboidratos da refeição noturna parece exercer um efeito na sonolência dos indivíduos sobrepesos e obesos / Introduction: There is some evidence linking the increased sleepiness with increased consumption of carbohydrates, which is particularly important for night workers. Objective: To evaluate the effects of changes in content of protein and carbohydrate food at night in the sleepiness of night workers. Methods: The population was male security guards, mean age 32 years (SD = 6.5 years). The study was conducted in two stages. The first stage had 54 security guards who underwent anthropometric measurements and answered a questionnaire about aspects of life style, work and health symptoms and 24-hour recall (24HR) for three days. The second stage lasted for 3 weeks which involved randomly assigned, 24 security guards. In this step it was evaluated the sleep-wake cycle through actigraphy, daily activity protocols and Karolinska Sleepiness Scale (KSS). Changing the contents of feeding occurred in 2 weeks. At first it was the carbohydrate content increased by 5 days, after two days, there was an increase in protein content, also for 5 days. Results: Alertness levels were assessed before and after the meal in the company and revealed no significant effect during the three conditions. But when these same alert levels were analyzed, taking into account the BMI there was an interaction between BMI above 30kg/m2 and the level of alert during the week of change in carbohydrate content (p<0.05). The average consumption of calories was 2808 kcal (SD = 568.6). Consumption averages were: 99.1 g protein (SD = 80.9), carbohydrates 291.5 g (sd = 61.7) and 38.4 g fat (SD = 34.9). When compared to the Dietary References Intakes (DRI), it was noted that in relation to calories, more than half of participants had adequate intake, as protein only 11 percent were adequate and 68.5 percent consumed carbohydrates properly, the but not with lipids, because 94.4 percent of participants consumed above this nutrient recommendations. Conclusions: The content of carbohydrates in the evening meal seems to exert an effect on sleepiness among overweight and obese individuals