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1
Corkum, Penny. "Attention-deficit/hyperactivity disorder and sleep problems." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape10/PQDD_0015/NQ45712.pdf.
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Kamara, Dana Eliya. "Characterizing the Sleep Phenotype in 16p11.2 Deletion and Duplication." The Ohio State University, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=osu1590253282112184.
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Alder, Megan Lynn. "Sleep in Young Children with Autism Spectrum Disorder." Case Western Reserve University School of Graduate Studies / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=case1619540173790598.
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Couston, M. C. "Sleep disorder following traumatic brain injury : an investigation of the predictors of sleep disorder 12 months or more following traumatic brain injury." Thesis, University of Edinburgh, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.645042.
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Objective: The purpose was to identify the characteristics predictive of sleep disorder in a sample of traumatic brain injury (TBI) patients, twelve months or more following trauma. Design: A between-subject design explored the relationship between the participant’s sleep disturbance and the severity of TBI. A within-subjects design investigated reliability of the sleep disorder self-report and explored differences between ratings of the participant and a significant other. In addition, qualitative analysis based on content analysis, investigated themes relating to sleep experiences generated by a semi-structured interview. (A) Participants: Eighteen males and 15 significant others were recruited from patients who were admitted to The Scottish Brain Injury Unit (SBIRS) between June 2002 and June 1997. The participants were predominantly in the severe TBI category. Measures: The following were the factors measured, and the instruments used for this purpose: sleep quality (The Pittsburgh Sleep Index; PSQI), psychological distress (Hamilton rating Scale for Depression, HRSD; Hospital Anxiety and Depression Scale, HADS) and fatigue (Bentall fatigue inventory and a Visual Analogue Scale, VAS-F). Significant others completed only the PSQL. (B) Results: Fifty per cent of the sample reported poor sleep quality and 22 per cent of the participants had insomnia. Among the demographic, affective and injury variables examined, the strongest relationship with sleep quality was linked to depression. The significant other ratings were no different to the participant’s self-ratings. Interestingly, sleep quality rather than TBI severity appeared linked to depression. Conclusions: This sample has reported slightly lower rates of sleep disturbance than a comparable post acute population but this is still more than double the rate of sleep disturbance in the normal population. There was evidence that links may be between poor sleep quality and depression, perhaps even depression secondary to insomnia, rather than TBI. In addition TBI is considered as a model for depression. The importance of evaluating treatments for insomnia in this group is discussed.
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Ng, Ho-yee, and 伍浩沂. "Sleep-wake disturbance in people with interepisode bipolar disorder." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/208056.
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Boland, Elaine. "Sleep Disruption in Cognitive and Occupational Functioning in Bipolar Disorder." Diss., Temple University Libraries, 2014. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/283354.
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PsychologyPh.D.
Bipolar Disorder is frequently associated with a number of poor outcomes including, but not limited to, a significant impairment in the ability to return to premorbid levels of occupational and psychosocial functioning, often despite the remission of mood symptoms. An extensive line of research has pointed toward deficits in cognitive functioning as playing an important role in this persistent disability, with a number of studies demonstrating the presence of numerous cognitive impairments during the inter-episode period. Also present during affective episodes as well as the inter-episode periods are reports of pervasive sleep disturbance. Sleep disturbance has been associated with the onset of manic episodes and is an oft-reported prodrome of illness onset. Despite the presence of deficits in these two domains of functioning during affective episodes as well as the inter-episode phase, there has been no evaluation of the degree to which these systems may interact to maintain such high rates of functional disability. The current study attempted to integrate these three separate lines of research to examine the role sleep disruption plays in both cognitive and occupational functioning in individuals with bipolar disorder. Seventy-two males and females with bipolar disorder in the euthymic phase (n=24), primary insomnia (n=24) or no psychological or medical diagnoses (n=24) completed a week of prospective assessment of sleep disruption via self-report and actigraphy. At the culmination of the sleep assessment period, all participants were administered a battery of neuropsychological tests of executive functioning, working memory, verbal learning, and attention. Additionally, participants completed self-reports of mood symptoms and current and lifetime occupational functioning. Results were mixed relative to hypotheses. Data supports persistent sleep disturbance among individuals with bipolar disorder when assessed via self-report, but no significant differences were observed compared to controls when assessed via actigraphy. Bipolar participants exhibited significantly poorer performance on measures of verbal learning and working memory, but no other cognitive deficits were observed relative to insomnia and control participants. Bipolar participants had a greater lifetime history of being fired compared to insomnia or control participants, and deficits in executive inhibition and switching were associated with increased lifetime firings across the sample. Sleep disturbance, either subjective or objective, failed to mediate this association. Findings are partially consistent with previous reports of persistent sleep disturbance and cognitive impairment among individuals with BD in the euthymic phase. More research should be conducted to better understand the underpinnings of functional impairment in BD.
Temple University--Theses
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Swaden, Lewis Katie. "Sleep disruption as a pathway to mania in bipolar disorder." Thesis, Cardiff University, 2017. http://orca.cf.ac.uk/110545/.
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Sleep loss may act as a trigger or early warning sign of manic episodes in individuals with bipolar disorder (BD) but the nature of this relationship remains unclear. The aim of this thesis was to explore the relationship between sleep disruption and mania in individuals with BD. The datasets used in this thesis were obtained from the Bipolar Disorder Research Network (BDRN), an ongoing research programme of over 6000 individuals with mood disorders recruited from across the UK. Psychiatric diagnoses were determined using a semi-structured diagnostic research interview and case notes. First, in 3140 BDRN participants with bipolar-I disorder (BD-I) or bipolar-II disorder (BD-II), I found that 20% of participants reported that sleep loss had triggered episodes of high mood. This was more commonly reported by individuals with BD-I than those with BD-II, and more commonly reported by women than men. Second, I found that women were more likely to have experienced episodes of mania or psychosis after childbirth (termed postpartum psychosis, PP) if sleep loss had triggered episodes of high mood. This effect suggested that a tendency for sleep loss to trigger episodes of high mood might be associated with vulnerability to PP. Third, in BDRN participants who had used an online mood monitoring system to track symptoms of mania and depression, I found that participants could be grouped into three classes based on their trajectories in symptoms of insomnia prior to episodes of high mood. Finally, I designed and conducted a pilot study using actigraphy to measure perinatal sleep in pregnant women at high risk of developing PP. I found that this methodology was challenging to implement in this population but can produce detailed information on sleep during the perinatal period. The findings of this thesis could help inform clinical practice by expanding current knowledge on how sleep loss affects individuals with BD.
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Eder, Derek N. "A naturalistic study of sleep regulation in seasonal affective disorder : SAD, asleep, and unresponsive /." Thesis, Connect to this title online; UW restricted, 1998. http://hdl.handle.net/1773/9072.
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Williamsson, Frida. "Physical and psychosocial effects related to sleep inchildren with neurodevelopmental disorders : A study of the relationship between motor proficiency, sleep efficiency and possible influencing factors." Thesis, Linnéuniversitetet, Institutionen för psykologi (PSY), 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-60387.
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The purpose of the study was to examine the relationship between sleep patterns, motor proficiency and commonly co-occurring neurodevelopmental disorders in children, attitude to physical activity, mental health, and age. The study also looked at differences in sleep efficiency, as well as, perceived adequacy in physical activity between typically developing children and children with low motor proficiency. The sample consisted of 127 participants, 6-12 years old living in Perth, Western Australia. 51% participants were considered typically developing and 49% to have low motor proficiency. Motor proficiency, indications of Attention-Deficit/Hyperactivity Disorder, Autism Spectrum Disorder and anxiety/depression, adequacy in, or predilection for physical activity did not show a relationship to sleep efficiency. Significant differences between groups in sleep efficiency or adequacy in physical activity were not found. No interaction effect of neurodevelopmental disorders were identified. Sleep in children with movement impairments caused by neurodevelopmental disorders is an area where continued studies are of great importance. Although no relationship was identified in the current study, previous research has suggested sleep may play an important role for development and optimal everyday functioning. A better understanding of physical and psychological consequences and possible contributing factors of low motor proficiency in childhood is important as the risk of long-term dysfunction in emotional, cognitive and physical areas may be reduced in an optimal environment.
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Allik, Hiie. "Asperger syndrome and high-functioning autism in school-age children : the children's sleep and behaviour, and aspects of their parents' well-being /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-856-8/.
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Beauchemin, Kathleen Mary. "Nocturnal psychopathology : sleep, dreaming, mood and light-therapy in bipolar disorder /." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/nq22949.pdf.
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Lipinska, Malgorzata. "Associations between sleep and cognitive-affective functioning in Posttraumatic Stress Disorder." Doctoral thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/24904.
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The current research tested the proposition that the sleep disruption characteristic of posttraumatic stress disorder (PTSD) has discrete, predictable, and significant effects on the processing of neutral declarative memory, emotional memory, and emotional reactivity. Research spanning multiple neuroscientific literatures demonstrates that healthy, uninterrupted sleep is critical for memory consolidation and emotional regulation, and that PTSD-diagnosed individuals experience sleep disruption, memory deficits, and emotional dysregulation. To test whether these behavioral, cognitive, and affective characteristics of PTSD are meaningfully related, I recruited three groups of participants: PTSD (n = 21), trauma-exposed non-PTSD (TE; n = 19), and healthy controls (HC; n = 20). Each participant was assessed before and after an 8-hour period of sleep and an 8-hour period of waking activity. The assessment featured measures of neutral declarative memory (learning of stimuli before the delay, and a free recall task afterward), emotional memory (exposure to highly-arousing negatively valenced, highly-arousing positively valenced, and low arousing neutral pictures before the delay, and a recognition task afterward), and emotional reactivity (physiological responses to the emotional pictures, both before and after the delay). The results are presented under the headings of four investigations. Investigation 1, which focused on objective and subjective sleep quality, suggested that PTSD-diagnosed participants had decreased sleep depth in comparison to HC participants, but presented with no other evidence of objective sleep disruption. Furthermore, PTSD-diagnosed participants reported better subjective sleep quality in the sleep laboratory than in their home environment, an effect not observed in TE and HC participants. Investigation 2, which focused on neutral declarative memory, suggested that after a sleep-filled, but not wake-filled, delay, PTSD-diagnosed participants retained less neutral declarative information than TE and HC participants. Furthermore, increased fragmentation of rapid eye movement (REM) sleep in PTSD-diagnosed individuals was a significant predictor of post-sleep memory retention deficits. In contrast, Investigations 3 and 4 suggested no significant between-group differences in emotional memory or emotional reactivity. However, Investigation 3 suggested that, after a sleep-filled delay, pictures of all valence and arousal categories were recognized equally accurately by all participants. In contrast, after a wake-filled delay all participants had higher recognition accuracy for negative pictures. Furthermore, Investigation 4 suggested that a sleep-filled delay attenuated emotional reactivity to pictures of all arousal and valence categories, whereas a wake-filled delay was associated with a rise in emotional reactivity across the day. Together, these results suggest that fairly small sleep disruptions (specific to REM-related changes) in PTSD-diagnosed individuals will affect retention of neutral declarative information, but will have no significant effects on the processing of, or reactivity toward, arousing and valenced stimuli. Overall, these findings allow the conclusion that, in PTSD, the co-occurrence of sleep and neutral declarative memory difficulties is not accidental – that is, these two symptom clusters are meaningfully related. Furthermore, the results demonstrate that a reasonable, not necessarily perfect, night of sleep in PTSD is associated with intact functioning within certain cognitive and affective domains. The research bolsters the neuroscientific view of sleep as a critical biological process linked integrally to psychological well-being.
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Vranish, Jennifer R. "Obstructive Sleep Apnea: Daytime Assessment And Treatment Of A Nighttime Disorder." Diss., The University of Arizona, 2015. http://hdl.handle.net/10150/566239.
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Obstructive sleep apnea (OSA) is a disease characterized by nighttime airflow limitation, hypoxemia, arousal from sleep, and elevated sympathetic activity and blood pressure. With time, this nighttime dysfunction gives rise to daytime hypertension and a heightened risk for cardiovascular disease. Current treatment options for OSA are not always effective for all patients and the gold-standard intervention, continuous positive airway pressure, has discouraging compliance rates. The work set forth in this dissertation has as its focus a novel intervention for sleep apnea known as inspiratory muscle training (IMT). IMT improves respiratory function and cardiovascular health but has not been implemented previously as a treatment for OSA. As such, Study 1 implements IMT in individuals with mild and moderate OSA, with the objective of assessing the effects of training on the cardio- respiratory parameters of this disease. We randomly assigned 24 individuals with mild- moderate OSA into one of two groups: training vs. placebo, to assess the effects of 6 weeks of training on overnight polysomnography, subjective sleep quality, blood pressure, circulating inflammatory T cells, and plasma catecholamine content. Our results show IMT- related improvements in sleep quality, reduction in the number of arousals from sleep and in periodic limb movements following 6 weeks of training. Most important, IMT was associated with a significant reduction in systolic (~12 mmHg) and diastolic (~5 mmHg) blood pressure, relative to sleep apneics who undertook 6 weeks of placebo training. Additionally, individuals in the training group exhibited ~30% lower levels of sympathetic activity, as measured by plasma catecholamines, relative to placebo trained peers. The mechanism(s) that underlie the IMT-related reductions in blood pressure and sympathetic activity remain to be determined. However, in an effort to determine the precise respiratory stimulus that contributes to the results obtained in Study 1, we subsequently assessed the specific respiratory components of IMT to determine which component (large intrathoracic pressures and/or large lung volumes) likely contributes to the reduction in blood pressure in Study 1. The results of this study conducted in normotensive adults show that respiratory training that entails either large negative or positive intrathoracic pressures reduces systolic and diastolic blood pressure in healthy young adults. Importantly, neither the generation of large lung volumes alone nor performance of daily paced breathing is sufficient to lower blood pressure. Study 3 is a methodologic study that has as its focus upper airway electromyography (EMG) and the utility of assessing EMG activity across a range of conditions and breathing tasks in wakefulness. Because OSA traditionally has been viewed as the result of neuromuscular dysfunction of the upper airway that occurs during sleep, the aim of this work was to develop a "fingerprint" of healthy electromyographic activities during the day in healthy adults across a range of breathing tasks, body positions, and from two different muscle compartments of the upper airway. The findings from this study demonstrate regional differences in muscle activity that vary as a function of body position and task. These data from healthy subjects provide the basis of comparison for subsequent studies in individuals with obstructive sleep apnea.
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Franzen, Peter. "Psychophysiological responses to auditory stimuli during sleep in posttraumatic stress disorder." Diss., The University of Arizona, 2003. http://hdl.handle.net/10150/280350.
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Sleep complaints are common in people who develop Post Traumatic Stress Disorder (PTSD). PTSD-related information processing abnormalities evident during wakefulness might continue into sleep. A group of Vietnam veterans with and without PTSD (patients and combat-controls) were studied to examine psychophysiological responses to auditory stimuli during stage 2 NREM sleep. Three stimuli (500 ms) categories were presented in an oddball paradigm: pure tones (standard, 60% probability of occurring); trauma-related (i.e., combat sounds) and affectively neutral, environmental stimuli (20% each). The effects of stimulus presentation on evoked K-complexes, heart rate (HR), and cortical activity (power spectra ratio of fast to slow EEG activity, and beta-band power) were examined; the impact of evoking a K-complex (KC+ and KC- trials) on these last two measures was also examined. Significantly fewer K-complexes were elicited in patients; there were no within group differences in the proportion of K-complexes elicited between tone and trauma stimuli. Patients unexpectedly produced significantly more K-complexes to neutral stimuli. Examination of the N550 component of the evoked K-complex revealed significantly longer latencies in the control group, who also had longer latency for trauma stimuli relative to tone and neutral stimuli. There were no findings on N550 amplitude. Cortical arousal results ran contrary to predictions. Rather, controls demonstrated modest increases in overall cortical activity post-stimulus, while patients demonstrated decreases that were even more pronounced for KC+ trials. Beta activity was marginally higher in controls, and for KC+ trials for both groups. The smallest beta power increase was to trauma stimuli for both groups; in controls, beta activity increased most to neutral stimuli. Tonic heart rate was found to be (marginally) elevated in patients. There was no impact on initial HR decelerations, but analysis of the ensuing HR acceleration revealed a main effect of K-complex type (greater HR increases for K+ trials) and stimulus type (significantly higher increases to neutral stimuli), Results suggest sleep-related information processing is altered in PTSD and conflicting evidence for cortical and autonomic hyperarousal during sleep in PTSD, although further research is necessary to establish the generalizability to other populations (such as acute PTSD or other anxiety disorders).
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Ríos, Hernández Alejandra Margarita. "Diet and sleep in children and adolescents with Attention-Deficit Hyperactivity Disorder." Doctoral thesis, Universitat de Barcelona, 2017. http://hdl.handle.net/10803/400880.
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Attention-deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders in early childhood and adolescence and its consequences can persist through adulthood. It is characterized by continuous inattention and/or hyperactivity- impulsivity. Cognitive impairments are also associated with this disorder. The etiology of ADHD continues to be debated, although several contributing factors have been acknowledged, including diet and sleep.
Several studies have analyzed the association between dietary patterns and ADHD. The common result is that unhealthy dietary patterns (i.e. high in saturated fat, refined sugars and low in fruits and vegetables) are associated with ADHD. Although the mechanisms linking low quality diet and ADHD are still unknown, an unbalanced diet, can lead to deficiencies in essential nutrients or higher intakes of certain food components. For instance, low levels of serum iron, ferritin, and long-chain omega-3 seem to have a relationship with ADHD. Specifically, iron deficiency has been reported to be a possible risk factor in the pathophysiology of ADHD. However, to date, the results regarding the potential relationship between iron deficiency and ADHD have shown some inconsistency.
On the other hand, sleep disturbances are particularly widespread in ADHD and they contribute to ADHD symptomatology. Moreover, there is evidence that suggest an additional and independent relationship between diet and sleep. The data on this topic are really scarce but associations between more sleep disturbance and higher intakes of carbohydrates, fat, and, most particularly, sugar have been reported. Serum iron levels and long-chain polyunsaturated fatty acid also seem to play a role in the sleep quality of children and adolescents with ADHD.
Therefore, the aim of the present thesis project is to assess the possible relationship between our characteristic and healthy dietary pattern, the Mediterranean diet, and the incidence of ADHD. Moreover, the influence of the dietary intake and nutrient deficiencies in children and adolescents with ADHD on their behavioral symptoms and their cognitive abilities as well as their sleep quality will be also analyzed
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Cavusoglu, Mustafa. "An Efficient And Fast Method Of Snore Detection For Sleep Disorder Investigation." Master's thesis, METU, 2007. http://etd.lib.metu.edu.tr/upload/12608236/index.pdf.
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Snores are breath sounds that most people produce during sleep and they are reported to be a risk factor for various sleep disorders, such as obstructive sleep apnea syndrome (OSAS). Diagnosis of sleep disorders relies on the expertise of the clinician that inspects whole night polysomnography recordings. This inspection is time consuming and uncomfortable for the patient. There are surgical and therapeutic treatments. However, evaluation of the success of these methods also relies on subjective criteria and the expertise of the clinician. Thus, there is a strong need for a tool to analyze the snore sounds automatically, and to produce objective criteria and to assess the success of the applied treatment by comparing these criteria obtained before and after the treatment. In this thesis, we proposed a new algorithm to detect snoring episodes from the sleep sound recordings of the individuals, and created a user friendly interface to process snore recordings and to produce simple objective criteria to evaluate the results. The algorithm classifies sleep sound segments as snores and nonsnores according to their subband energy distributions. It was observed that inter- and intra-individual spectral energy distributions of snore sounds show significant similarities. This observation motivated the representation of the feature vectors in a lower dimensional space which was achieved using principal component analysis. Sleep sounds can be efficiently represented and classified as snore or nonsnore in a two dimensional space. The sound recordings were taken from patients that are suspected of OSAS pathology while they were connected to the polysomnography in Gülhane Military Medical Academy Sleep Studies Laboratory. The episodes taken from 30 subjects (18 simple snorers and 12 OSA patients) with different apnea/hypopnea indices were classified using the proposed algorithm. The system was tested by using the manual annotations of an ENT specialist as a reference. The system produced high detection rates both in simple snorers and OSA patients.
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Danielsson, Katarina. "Delayed Sleep Phase Disorder : Prevalence, Diagnostic aspects, Associated factors and Treatment concepts." Doctoral thesis, Uppsala universitet, Psykiatri, Akademiska sjukhuset, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-299887.
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Delayed sleep phase disorder (DSPD) is the most common circadian rhythm sleep disorder. Persons with DSPD have great difficulties falling asleep and waking up at conventional times. To diagnose DSPD this delayed sleep-wake rhythm should cause social impairment and distress for the individual. Evening melatonin and morning bright light are the recommended treatments. The overall aim of this thesis was to evaluate at-home treatment with Light therapy (LT) and the feasibility of adding cognitive behavior therapy (CBT) to LT in DSPD, furthermore prevalence, diagnostic aspects and associated factors were investigated. Study I included 673 randomly selected individuals aged 16–26 years. The prevalence of DSPD was 4.0%. Unemployment (defined as an absence of educational or work activities) and an elevated level of anxiety were associated with DSPD. In study II, dim light melatonin onset (DLMO) was measured in healthy adults. Time for DLMO DLMO (Mean±SD) was 20:58±55 minutes. Studies III, IV, and V present results from a randomized controlled trial examining the feasibility of CBT as an additive treatment to LT with scheduled rise times, in persons with DSPD. Sleep onset and sleep offset was significantly advanced from baseline (03:00±1:20; 10:22±2:02 respectively) to the end of LT (01:27±1:41; 08:05±1:29, p<0.001 respectively). This advancement was predicted by consistent daily usage of the LT-lamp. At the follow-ups after LT and CBT or LT alone, sleep onset remained stable, sleep offset was delayed, and sleep difficulties were further improved, but there was no significant group interaction over time. There was a significant group interaction over time in the severity of anxiety and depressive symptoms, both in favor of the LT+CBT group. Conclusively, DSPD was common among adolescents and young adults and it was associated with unemployment and elevated levels of anxiety. DLMO appeared in the expected time range in healthy working adults. At-home treatment with LT with scheduled rise times advanced sleep-wake rhythm and improved sleep difficulties in DSPD. Even though sleep-wake rhythm was not further advanced or better preserved in the participants that received LT+CBT compared to LT alone, the addition of CBT to the treatment regimen was feasible and well accepted.
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Michaels, Stase Mikalajunas. "Incorporating the Feedback of Combat Veterans with Post-Traumatic Stress Disorder in the Construction of a Sleep Disorders Inventory." W&M ScholarWorks, 1995. https://scholarworks.wm.edu/etd/1539626010.
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Britchford, Rachel. "Sleep in children with attention deficit hyperactivity disorder : an exploratory family based study." Thesis, University of Southampton, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.438516.
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Espie, Colin A. "Behavioural sleep medicine conceptualisations and associated treatment of clinical insomnia disorder in adults." Thesis, University of Glasgow, 2013. http://theses.gla.ac.uk/4620/.
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This thesis summarises a selection of forty-two studies [1-42], published by the author during the period 2000-2012, investigating the conceptual basis of Insomnia Disorder, and its evaluation and treatment, principally using cognitive and behavioural interventions. The work reflects a range of research methodologies including experimental, psychometric, qualitative and population-based studies, and randomised controlled trials. Important theoretical contributions to the literature published in this period are also included and reference is made to major textbooks, position papers, and influential chapter contribution.
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Clarkson, Emma Louise. "The relationship between sleep and daytime behaviour in children with Autism Spectrum Disorder." Thesis, University of Birmingham, 2016. http://etheses.bham.ac.uk//id/eprint/6962/.
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This thesis presents the work completed over the course of the author’s doctorate of clinical psychology, and consists of two volumes. The first volume includes three chapters, the first of which is a systematic literature review and meta-analysis of the prevalence of insomnia in clinical and non-clinical populations of children and adolescents. The second chapter is an empirical paper exploring the relationship between sleep problems and daytime challenging behaviour in children with Autism Spectrum Disorders. The final chapter is a document summarising chapters one and two for the purpose of public dissemination. The second volume constitutes each of the five clinical practice reports completed over the course of the doctoral training and will be available online in December 2026.
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Strzedulla, Isabella Adrianna [Verfasser]. "Sympathische Dysregulation bei Patienten mit einer REM sleep behavior disorder / Isabella Adrianna Strzedulla." Gießen : Universitätsbibliothek, 2020. http://d-nb.info/1223462161/34.
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Strzedulla, Isabella [Verfasser]. "Sympathische Dysregulation bei Patienten mit einer REM sleep behavior disorder / Isabella Adrianna Strzedulla." Gießen : Universitätsbibliothek, 2020. http://d-nb.info/1223462161/34.
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Pooler, Tammy. "Genome-Wide Association Study on the Sleep Symptom of Post Traumatic Stress Disorder." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1273.
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Posttraumatic stress disorder (PTSD) is a psychiatric condition that presents with 3 main symptoms're-experiencing, avoidance/numbing, and hyper arousal'after an individual experiences a traumatic event. Recent evidence suggests a potential genetic basis for PTSD and a sub symptom of hyper arousal, sleep, as a potential pathway for PTSD development, but no study has identified candidate genes associated with specific symptoms such as sleep difficulty. Based on a conceptual framework in which specific genes are associated with the onset of PTSD, this study used a genome-wide association
study (GWAS) method with a case control study design to compare the genomes of individuals with and without PTSD. A secondary GWAS dataset from a study on alcohol dependence in European and African Americans was obtained from the National Center for Biotechnology Information. PTSD cases and controls were analyzed using PLINK software. Signals from 2 single nucleotide polymorphisms (SNPs), which have not been previously associated with PTSD, exceeded the established genome-wide threshold: SNP rs13160949 on chromosome 5 (p = 7.33x10-9, OR: 1.565) and SNP rs2283877 on chromosome 22 (p = 2.55x10-8, OR: 1.748). Neither SNP, though, maintained genomewide significance following corrected tests for multiple testing, population stratification, and false discovery, so the planned analysis for possible associations with PTSD by symptom category then by the sub symptom of sleep could not be completed. The results of this study suggest that PTSD may be the result of polygenic SNPs with weak effects, which supports a recent study indicating the disease may be highly polygenic. Positive social change implications include bringing attention to the clinical and research community that PTSD may involve complex polygenic factors in need of further study.
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Franceschini, Christian <1980>. "REM sleep behavior disorder nella narcolessia: ricerca di un marker clinico e strumentale." Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2009. http://amsdottorato.unibo.it/1839/1/file_unico_tesi.pdf.
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Franceschini, Christian <1980>. "REM sleep behavior disorder nella narcolessia: ricerca di un marker clinico e strumentale." Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2009. http://amsdottorato.unibo.it/1839/.
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Engvall, Eva, and Mari Lundin. "Restless legs syndrome - en beskrivning av dess inverkan på individens sömn, livskvalitet samt olika behandlingsformer : En systematisk litteraturstudie." Thesis, Högskolan Dalarna, Omvårdnad, 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:du-1659.
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Syftet med denna systematiska litteraturstudie var att beskriva hur restless legs inverkar på individens sömn och livskvalitet. Syftet var även att granska vilka olika former av behandlingar som finns att tillgå vid restless legs. För att finna information om detta ämne har endast vetenskapliga artiklar använts. Datainsamlingen har skett via databaser, internet samt Högskolans bibliotek, och artiklar från år 1995 och framåt har valts ut. Inklusionskriterier för denna studie var att de valda artiklarna skulle vara internationella vetenskapliga artiklar i fulltext. De funna artiklarna granskades med avseende på vetenskaplig kvalitet och poängsattes utifrån för ändamålet avsedda granskningsmallar. Denna bedömning resulterade i 21 artiklar. Resultatet visade att restless legs patienter upplever sömnbristen som det största problemet. För flertalet individer som drabbas av restless legs försämrades livskvaliteten och patienterna drabbades vanligtvis av psykologiska och fysiologiska besvär. Det vanligaste sättet att behandla restless legs var att använda dopaminerga läkemedel samt bensodiazepiner, antiepileptika och opioider. Andra former av behandlingar var järn, homeopatiska läkemedel, hypnos samt fysisk aktivitet. Det förekom även att restless legs patienter på eget initiativ använde hasch eftersom det ansågs lindra symtomen.
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Gerdes, S. "Post traumatic stress disorder and psychological therapies." Thesis, University of Exeter, 2018. http://hdl.handle.net/10871/35103.
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Literature Review: The current review presents a recent review of the effectiveness of psychological therapies to treat sleep difficulties (such as insomnia and nightmares) in sufferers of posttraumatic stress disorder (PTSD). The review also aimed to investigate whether there are differences in the effectiveness of specific psychological therapies to treat sleep disturbances in PTSD, such as between the different types of psychological therapies such as cognitive behavioural therapy for insomnia (CBT-I) and imagery rehearsal therapy (IRT). Eleven studies were included in the review that met the inclusion and exclusion criteria. Results are presented in tables and a descriptive account is included. The review demonstrates that psychological therapies are effective for the treatment of insomnia and other sleep difficulties such as nightmares. However, firm conclusions cannot be drawn about the effectiveness of different types of psychological therapies as studies predominantly used CBT and only one non-CBT study was included in the review. Comparisons between the effectiveness of different CBT approaches is also not possible as there was a large range of diversity in the study characteristics and also there were only a small number of studies for each intervention, which therefore limits the generalisability of results in the current review. It may be that different CBT interventions such as CBT-I or EERT and IRT may be better suited to treat insomnia and nightmares respectively, but further research needs to be conducted into which of these approaches are beneficial for different PTSD specific sleep difficulties. Empirical Paper: Initial studies demonstrate that self-compassion reduces symptoms of PTSD in Armed Forces Veterans (AFV), however the use of self-compassion approaches in AFV is under-researched. The current study utilised self-report and psychophysiological measures to investigate whether a single self-compassion experimental induction reduced hyperarousal symptoms (PTSD Cluster E symptoms) and increased feelings of social connectedness in AFV. The study hypothesised that there would be a decrease in hyperarousal symptoms and an increase in social connectedness, which would be associated with PTSD severity. Fifty-three AFV who had been deployed to a combat zone took part in the study, of which n = 15 (28.3%) currently met criteria for PTSD and n = 4 (7.5%) met criteria for Subsyndromal PTSD on the PCL-5. Participants listened to a recording of a Loving Kindness Meditation for self-compassion (LKM-S) and psychophysiological recordings were taken throughout. Participants completed state measures of hyperarousal and social connectedness before and after the LKM-S. Findings partially demonstrated that self-compassion can be elicited in an AFV population. However, changes on the self-report measures were largely not supported by psychophysiological measures, apart from skin conductance levels (SCL). The longevity of the effects observed in the study were not measured and should be investigated in future studies. Although this study has demonstrated that self-compassion can be elicited within the AFV population, further research is needed including to test a longer self-compassion intervention.
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Edwards, Kristin Lynn. "Sleep Disorders in Children with Autism Spectrum Disorder: A Pilot Study of an Assessment of Pediatric Providers' Practices and Perceptions." Scholar Commons, 2018. https://scholarcommons.usf.edu/etd/7502.
Full textAbstract:
Children with Autism Spectrum Disorder (ASD) have increased rates for sleep problems compared with typically developing children. Although physicians practicing in pediatric primary care settings have the potential to detect and address sleep problems at an early age, research investigating the sleep management practices of pediatricians in primary care is scant and does not particularly address children with ASD. This study investigated the frequency of sleep screening measures utilized by pediatric providers during well-child examinations, the most frequently recommended treatments, the barriers and facilitators to screening for sleep problems, and the perceived confidence of pediatricians with regard to screening for sleep problems in children ages 2-10 years with ASD. Survey data from members of the Hillsborough County Medical Association were collected and analyzed. Seventy-three percent of participants reported almost always screening for a sleep problem during well-child examinations. Findings indicate that pediatric healthcare providers acknowledge the importance of managing sleep problems in primary care settings. Barriers to screening for sleep problems during routine exams included lack of time, resources, and awareness of screening tools. Facilitators to screening for sleep problems during routine exams included shorter sleep screening tools and longer exams. Pediatric providers were moderately confident in their ability to manage sleep problems in primary care settings. A significant relationship was found between confidence level and a number of perceived barriers. Implications of the findings are discussed.
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Rock, Philippa L. "Emotional processing and bipolar disorder." Thesis, University of Oxford, 2010. http://ora.ox.ac.uk/objects/uuid:f4a311fe-3bda-40cc-852a-11dbde8f436c.
Full textAbstract:
The aetiology of bipolar disorder remains unclear and investigation to date has focussed largely on bipolar patients. Whilst ultimately of huge value, such studies may also be confounded by current mood or experience of repeated illness episodes or current or past medication; using at-risk samples may bypass some of these problems. The current research therefore assessed the efficacy of the Mood Disorder Questionnaire (MDQ) as a screening tool for vulnerability to bipolar disorder. The MDQ was used with two sets of criteria to identify two sub-groups of medication-naïve young bipolar phenotype subjects who were at risk for bipolar disorder by virtue of experience of mood elevation. Analysis of data from the Student Stress Survey was carried out to characterise the bipolar phenotype. Compared to a control group with no experience of mood elevation, the two bipolar phenotype sub-groups showed a gradient of prevalence of bipolar diagnosis and associated co-morbidity. Behavioural and functional magnetic resonance imaging (fMRI) techniques were employed to investigate emotional processing, decision-making, and sleep and circadian rhythmicity in bipolar phenotype students. Analyses revealed that positive emotional processing biases, disrupted decision-making, and increased activity during sleep were associated with the bipolar phenotype and, therefore, may represent vulnerability markers for bipolar disorder. Finally, a psychopharmacological investigation of quetiapine, which stabilises mood, was carried out in healthy volunteers. One-week quetiapine administration resulted in biases away from both positive and negative emotional stimuli (i.e. a mood-stabilising effect), reduced discrimination between different magnitudes of gains and losses during risky decision-making (consistent with an antidepressant effect), and increased sleep duration. In sum, this research has developed our understanding of vulnerability markers associated with the bipolar phenotype and provided a first step towards uncovering the psychological mechanisms through which quetiapine’s clinical effects may be mediated.
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Sutton, Amy M. "Executive Function in the Presence of Sleep Disordered Breathing." Digital Archive @ GSU, 2008. http://digitalarchive.gsu.edu/cps_diss/16.
Full textAbstract:
The purpose of the study was to investigate whether sleep-disordered breathing (SDB) impairs executive functioning in children. Additionally, the study sought to identify the executive functions at risk in SDB and the contribution of daytime sleepiness. SDB represents a spectrum of upper airway conditions that can be mild, such as snoring, or severe, such as obstructive sleep apnea (OSA). Children with these problems may present with excessive sleepiness, failure to thrive, and a variety of cognitive and behavioral dysfunctions including impaired executive functioning. Beebe and Gozal (2002) developed a theoretical model to explain the impact of sleepiness and hypoxia on executive functioning. This model provided a framework to examine links between the medical disorder and the neuropsychological consequences. Twenty-seven children with suspected SDB were tested with polysomnography (PSG) and a neuropsychological battery. Parents completed subjective measures of cognitive function and sleep symptoms. The children were ages 8 to 18 and had no congenital or acquired brain damage. They were matched for age and gender with 21 healthy controls. The executive function protocol included subtests from the Delis-Kaplan Executive Function System (D-KEFS), the digit span subtest from the Wechsler Intelligence Scale for Children (WISC-IV), the Tower of London-II-Drexel University (TOL-II), the Behavioral Rating Inventory of Executive Functioning (BRIEF), and the Conners’ Continuous Performance Test (CPT-II). Statistical analysis was performed using 2 statistical software packages, SAS and NCSS. Regression analysis was used to evaluate all variables. Due to significant group differences in socio-economic status (SES), SES was included as a covariate, along with IQ. No group differences in IQ were found. Significantly less robust executive function in children with SDB was identified in the domains of cognitive flexibility and impulsivity. Additionally, poorer executive planning and overall inattentiveness was also associated with SDB. Level of significance was set at 0.05 and trends (0.05 < p < 0.10) were acknowledged. Other areas of executive function, including working memory, behavioral and emotional inhibition, and processing speed were not associated with SDB. Moreover, academic functioning was significantly lower in children with SDB, although the differences can be shared equally with SDB, SES and IQ.
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Desai, Anup Vijayendra. "Obstructive sleep apnoea and driver performance: prevalence, correlates and implications for driver fatigue." University of Sydney. Medicine, 2003. http://hdl.handle.net/2123/589.
Full textAbstract:
Obstructive sleep apnoea (OSA) is characterised by repetitive reductions or pauses in breathing during sleep due to upper airway narrowing or closure. Due to disruption to normal sleep patterns, many patients with OSA suffer from increased daytime sleepiness. Epidemiological studies have established a link between OSA and driver fatigue and accidents, generally showing a two to seven times increased risk of road traffic accidents in non-commercial drivers with OSA. There is emerging evidence that commercial drivers have a higher prevalence of OSA than the general population, being predominately male, middle-aged and overweight, three important risk factors for OSA. However, little is known about the relationship between OSA and driver sleepiness in commercial drivers, whether road accidents are increased in commercial drivers with OSA, and whether OSA interacts with other fatigue promoting factors, such as sleep deprivation, to further escalate road accident risk. One thousand randomly selected commercial drivers were surveyed in the field. In addition, 61 randomly selected NSW commercial drivers had in hospital sleep studies and daytime performance testing, including a PC based driving simulator task. The prevalence of OSA, defined as Respiratory Disturbance Index (RDI) < 10, was approximately 50% in NSW commercial drivers. Approximately one quarter of the drivers reported pathological daytime sleepiness, and 12-14% had both OSA and pathological daytime sleepiness. A diagnosis of OSA was the most important factor predicting excessive daytime sleepiness in these drivers: OSA was more important than 15 other work-related, lifestyle and medical factors that could be expected to promote, or be associated with, daytime sleepiness. Drivers with sleep apnoea syndrome (both OSA and pathological daytime sleepiness) had an increased driving accident risk, using driving simulator and daytime performance testing as proxy measures for accident risk. These results demonstrate the importance of OSA as a cause of driver fatigue in commercial drivers and suggest that all commercial drivers should be screened for the presence of sleep apnoea syndrome in order to potentially reduce road accident risk through treatment. A separate, but related body of work examined the combined effects of mild OSA and other fatigue promoting factors (sleep deprivation and circadian influences) on driving performance. Twenty nine subjects, consisting of a group with mild OSA and a group of non-OSA controls, were tested on several occasions throughout the night and day using an intensive performance battery, under both baseline conditions and after a period of 36 hours of total sleep deprivation. The results suggest that drivers with mild OSA are not different to the control group in their response to sleep deprivation or time of day influences. However, the subjects with mild OSA were less aware of their impairment due to sleep deprivation, which is of concern if drivers with OSA are relying on their subjective awareness of fatigue to make decisions about when to stop driving. A final perspective on OSA and driver fatigue is provided through a clinical case series of seven fall-asleep fatality associated MVA�s associated with unrecognised or under-treated sleep disorders. As well as demonstrating the day to day potential for devastating road accidents due, at least in part, to un-recognised or untreated sleep disorders, these cases also serve to highlight some of the current medico-legal controversies and difficulties in this area of driver fatigue. In conclusion, this body of work has provided novel information about the epidemiology and implications of OSA in commercial drivers, and about how OSA interacts with other fatigue promoting factors. Finally, it has explored some of the medico-legal issues that relate to sleep disorders and driver fatigue. As well as providing much needed information in the area of driver fatigue, at the same time this work raises many more questions and suggests areas of future research. For instance, such research should examine the relationship between objective accident rates and OSA/sleep apnoea syndrome in commercial drivers, the interaction between mild sleep apnoea syndrome and other fatigue risk factors, and driver perception of sleepiness prior to sleep onset in drivers with sleep disorders.
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Desai, Anup Vijayendra. "Obstructive sleep apnoea and driver performance: prevalence, correlates and implications for driver fatigue." Thesis, The University of Sydney, 2002. http://hdl.handle.net/2123/589.
Full textAbstract:
Obstructive sleep apnoea (OSA) is characterised by repetitive reductions or pauses in breathing during sleep due to upper airway narrowing or closure. Due to disruption to normal sleep patterns, many patients with OSA suffer from increased daytime sleepiness. Epidemiological studies have established a link between OSA and driver fatigue and accidents, generally showing a two to seven times increased risk of road traffic accidents in non-commercial drivers with OSA. There is emerging evidence that commercial drivers have a higher prevalence of OSA than the general population, being predominately male, middle-aged and overweight, three important risk factors for OSA. However, little is known about the relationship between OSA and driver sleepiness in commercial drivers, whether road accidents are increased in commercial drivers with OSA, and whether OSA interacts with other fatigue promoting factors, such as sleep deprivation, to further escalate road accident risk. One thousand randomly selected commercial drivers were surveyed in the field. In addition, 61 randomly selected NSW commercial drivers had in hospital sleep studies and daytime performance testing, including a PC based driving simulator task. The prevalence of OSA, defined as Respiratory Disturbance Index (RDI) < 10, was approximately 50% in NSW commercial drivers. Approximately one quarter of the drivers reported pathological daytime sleepiness, and 12-14% had both OSA and pathological daytime sleepiness. A diagnosis of OSA was the most important factor predicting excessive daytime sleepiness in these drivers: OSA was more important than 15 other work-related, lifestyle and medical factors that could be expected to promote, or be associated with, daytime sleepiness. Drivers with sleep apnoea syndrome (both OSA and pathological daytime sleepiness) had an increased driving accident risk, using driving simulator and daytime performance testing as proxy measures for accident risk. These results demonstrate the importance of OSA as a cause of driver fatigue in commercial drivers and suggest that all commercial drivers should be screened for the presence of sleep apnoea syndrome in order to potentially reduce road accident risk through treatment. A separate, but related body of work examined the combined effects of mild OSA and other fatigue promoting factors (sleep deprivation and circadian influences) on driving performance. Twenty nine subjects, consisting of a group with mild OSA and a group of non-OSA controls, were tested on several occasions throughout the night and day using an intensive performance battery, under both baseline conditions and after a period of 36 hours of total sleep deprivation. The results suggest that drivers with mild OSA are not different to the control group in their response to sleep deprivation or time of day influences. However, the subjects with mild OSA were less aware of their impairment due to sleep deprivation, which is of concern if drivers with OSA are relying on their subjective awareness of fatigue to make decisions about when to stop driving. A final perspective on OSA and driver fatigue is provided through a clinical case series of seven fall-asleep fatality associated MVA�s associated with unrecognised or under-treated sleep disorders. As well as demonstrating the day to day potential for devastating road accidents due, at least in part, to un-recognised or untreated sleep disorders, these cases also serve to highlight some of the current medico-legal controversies and difficulties in this area of driver fatigue. In conclusion, this body of work has provided novel information about the epidemiology and implications of OSA in commercial drivers, and about how OSA interacts with other fatigue promoting factors. Finally, it has explored some of the medico-legal issues that relate to sleep disorders and driver fatigue. As well as providing much needed information in the area of driver fatigue, at the same time this work raises many more questions and suggests areas of future research. For instance, such research should examine the relationship between objective accident rates and OSA/sleep apnoea syndrome in commercial drivers, the interaction between mild sleep apnoea syndrome and other fatigue risk factors, and driver perception of sleepiness prior to sleep onset in drivers with sleep disorders.
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Gómez, Rebecca L., and Jamie O. Edgin. "The extended trajectory of hippocampal development: Implications for early memory development and disorder." ELSEVIER SCI LTD, 2016. http://hdl.handle.net/10150/615110.
Full textAbstract:
Hippocampus has an extended developmental trajectory, with refinements occurring in the trisynaptic circuit until adolescence. While structural change should suggest a protracted course in behavior, some studies find evidence of precocious hippocampal development in the first postnatal year and continuity in memory processes beyond. However, a number of memory functions, including binding and relational inference, can be cortically supported. Evidence from the animal literature suggests that tasks often associated with hippocampus (visual paired comparison, binding of a visuomotor response) can be mediated by structures external to hippocampus. Thus, a complete examination of memory development will have to rule out cortex as a source of early memory competency. We propose that early memory must show properties associated with full function of the trisynaptic circuit to reflect "adult-like" memory function, mainly (1) rapid encoding of contextual details of overlapping patterns, and (2) retention of these details over sleep-dependent delays. A wealth of evidence suggests that these functions are not apparent until 18-24 months, with behavioral discontinuities reflecting shifts in the neural structures subserving memory beginning approximately at this point in development. We discuss the implications of these observations for theories of memory and for identifying and measuring memory function in populations with typical and atypical hippocampal function. (C) 2015 The Authors. Published by Elsevier Ltd.
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Liukkonen, T. (Timo). "Low-grade inflammation in depression, anxiety and sleep disturbances." Doctoral thesis, Oulun yliopisto, 2011. http://urn.fi/urn:isbn:9789514296475.
Full textAbstract:
Abstract Depression, anxiety and sleep disorders have been reported to be associated with low level of inflammation, i.e., low-grade inflammation, but mainly in males. The evidence has mainly been based on laboratory or clinical studies with small sample sizes or epidemiological studies with elderly subpopulations. In this study the association of low-grade inflammation with depression, anxiety, and sleep disturbances was investigated using the Northern Finland 1966 Birth Cohort (NFBC 1966). In women, the effect of hormonal factors, menopause and the use of oral contraceptives/hormone replacement therapy on the association between low-grade inflammation and depression was also studied by using the Pieksämäki Study data. In 31-year follow-up of NFBC 1966 (N=6007), the depressive and anxiety symptoms were assessed by Hopkins Symptom Checklist-25 (HSCL-25) and sleep disorders by 15-D questionnaires, while the marker of low-grade inflammation, plasma concentration of high sensitivity C-reactive protein (hs-CRP), was measured. In the Pieksämäki study a representative sample of inhabitants in the town of Pieksämäki were invited to clinical examination. Depressive symptoms were obtained by Beck’s Depression Inventory-21, and hs-CRP was measured (512 women). The results of this study revealed that at epidemiological level, elevated hs CRP levels of ≥1.0 mg/L increased the probability of current depressive symptoms of single depressive episode in the two highest subgroups (i.e., HSCL-25 mean scores ≥1.75 and ≥2.01) 1.4- and 1.7- fold in males, respectively. In addition, anxiety symptoms (HSCL-25 anxiety scale mean score ≥1.75) increased independently the probability of elevated hs-CRP levels (>3.0 mg/L) in males over 2-fold. Risk ratio of 1.3 was found for males with moderate to severe sleep disturbances and elevated hs-CRP levels (≥1.0 mg/L). Regarding females, a positive correlation between elevated hs-CRP levels and depressive symptoms was found only among peri- and postmenopausal women not using exogenous hormones. The results suggest that low-grade inflammation is associated not only with depression but also with anxiety and sleep disturbances in young adult men. In women, hormonal factors may have an effect on the association between low-grade inflammation and depression. Further investigations are called for to confirm these findings and furthermore, to determine the possible role of low-grade inflammation in the pathophysiology of these disordersTiivistelmä Depressio, ahdistuneisuushäiriöt ja unihäiriöt on yhdistetty elimistön matala-asteiseen tulehdustilaan, joskin pääasiallisesti vain miehillä. Tulosten yleistettävyyttä ovat rajoittaneet tutkimusten pienet otoskoot tai painottuminen iäkkäisiin väestöaineistoihin. Tässä tutkimuksessa selvitettiin matala-asteisen tulehduksen yhteyttä depressioon, ahdistuneisuuteen ja unihäiriöihin Pohjois-Suomen syntymäkohortti 1966 -aineistossa. Lisäksi Pieksämäki-tutkimuksen aineistossa selvitettiin naisilla menopaussin ja ehkäisyvalmisteiden/vaihdevuosihormonikorvaushoidon vaikutusta depression ja matala-asteisen tulehduksen väliseen yhteyteen. Pohjois-Suomen syntymäkohortti 1966 -tutkimuksen 31-vuotisseurannassa kartoitettiin 6007 henkilöltä masennus- ja ahdistuneisuusoireita Hopkins Symptom Checklist-25 -arviointiasteikolla (HSCL-25) ja unihäiriöitä 15-D-kyselyllä. Lisäksi mitattiin matala-asteisen tulehduksen mittarina käytetyn herkän C-reaktiivisen proteiinin (CRP) pitoisuus. Pieksämäki-tutkimuksessa edustava otos Pieksämäen asukkaista kutsuttiin kliiniseen tutkimukseen ja depressiivisiä oireita kartoitettiin Beckin 21-osioisella arviointiasteikolla ja mitattiin herkkä CRP (512 naista). Nuorilla aikuisilla miehillä, joiden herkkä CRP oli kohonnut (≥1.0 mg/l), todettiin 1.7-kertainen masennusoireiden riski, kun katkaisupisteenä käytettiin HSCL-25-kyselyn masennuskeskiarvopistettä ≥2.01. Ahdistuneisuusoireet (HSCL-25-kyselyn ahdistuneisuuskeskiarvopisteet ≥1.75) lisäsivät kohonneen herkän CRP:n riskiä (>3.0 mg/l) yli kaksinkertaiseksi miehillä. Keskivaikeasta tai vaikeasta unihäiriöstä kärsivillä todettiin 1.3-kertainen kohonneen herkän CRP:n (≥1.0 mg/l) riski. Naisilla positiivinen yhteys masennuksen ja kohonneen herkän CRP:n välillä todettiin vain peri- ja postmenopausaalisilla naisilla, jotka eivät käyttäneet hormonikorvaushoitoa tai suun kautta otettavia ehkäisyvalmisteita. Tutkimustulokset viittaavat matala-asteisen tulehduksen liittyvän depressioon, ahdistukseen ja unihäiriöön nuorilla aikuisilla miehillä. Naisilla hormonaaliset seikat mahdollisesti vaikuttavat depression ja matala-asteisen tulehduksen väliseen yhteyteen. Tulevaisuuden tutkimushaasteena on selvittää matala-asteisen inflammaation mahdollinen merkitys depression, ahdistuneisuuden ja unihäiriöiden patofysiologiassa
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Sanchez, S. E., Sixto E. Sanchez, Lauren E. Friedman, Marta B. Rondon, Christopher L. Drake, Michelle A. Williams, and Bizu Gelaye. "Association of stress-related sleep disturbance with psychiatric symptoms among pregnant women." Elsevier B.V, 2020. http://hdl.handle.net/10757/651714.
Full textAbstract:
Background: Physiological changes during pregnancy are often accompanied by reduced sleep quality, sleep disruptions, and insomnia. Studies conducted among men and non-pregnant women have documented psychiatric disorders as common comorbidities of insomnia and other sleep disorders. However, no previous study has examined the association between stress-related sleep disturbances and psychiatric disorders among pregnant women. Methods: This cross-sectional study included a total of 2051 pregnant women in Peru. The Spanish-language version of the Ford Insomnia Response to Stress Test (FIRST-S) was used to assess sleep disruptions due to stressful situations. Symptoms of antepartum depression, generalized anxiety disorder, and posttraumatic stress disorder (PTSD) were examined using the Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale-7 and PTSD Checklist – Civilian Version, respectively. High risk for psychosis was assessed using the Prodromal Questionnaire. Multivariable logistic regression procedures were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CI). Results: Stress-related sleep disturbance was reported by 33.2% of women. Of all women, 24.9% had antepartum depression, 32.2% had generalized anxiety disorder, 30.9% had PTSD, and 27.6% were assessed as having a high risk of psychosis. After adjusting for confounders, women with stress-related sleep disturbances were more likely to experience antepartum depression (OR = 2.74; 95%CI: 2.22–3.38), generalized anxiety disorder (OR = 2.48; 95%CI: 2.04–3.02), PTSD (OR = 2.36; 95%CI: 1.93–2.88), and high risk for psychosis (OR = 2.07; 95%CI: 1.69–2.54) as compared to women without stress-related sleep disturbances. Conclusions: Stress-related sleep disturbances during pregnancy are associated with increased odds of psychiatric disorders. Inquiring about stress related sleep disturbances during antenatal care may be beneficial for identifying and caring for women at high risk of psychiatric disorders.Revisión por pares
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Miner, Stacy. "EVALUATION OF THE RELATIONSHIP OF SLEEP DISTURBANCES TO SEVERITY AND COMMON BEHAVIORS IN AUTISM SPECTRUM DISORDER." Case Western Reserve University School of Graduate Studies / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=case160769321512457.
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Thunström, Malena. "Severe Sleep Problems among Infants : A Five-Year Prospective Study." Doctoral thesis, Uppsala University, Department of Women's and Children's Health, 2002. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-1631.
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The aim of this thesis was to explore the prevalence of parentally experienced infant sleep problems, with special interest in severe problems, in a total community sample of 2 518 infants aged between 6 and 18 months. Factors associated with severe sleep problems were sought. Parents reported 16 % of the infants to have difficulties in falling asleep at night, and 30 % to have frequent night waking. Severe sleep problems were associated with frequent night meals, psychosocial problems in the family, exhaustion and depression in the mother, and parental stress. An association with infant difficultness, high activity and problematic behaviour was also found.
In a five-year prospective study a group of children fulfilling specific criteria for severe sleep problems in infancy (N=27) was followed after an interventional sleep programme and compared with a control group regarding sleep characteristics, behaviour and development. One month after an interdisciplinary treatment programme, combining behavioural technique with family work, the average number of times the case babies woke up had diminished from 6.0 to 1.8 times per night. A 92 % rate of improvement was reported.
The changes were stable over time. Comparisons with the controls during five years revealed no significant group difference in sleep characteristics. Concerning behaviour and development, however, there were significant differences. At the age of 5.5 years, seven of the children in the former sleep problem group met the criteria for the diagnosis of attention-deficit/hyperactivity disorder. No control child qualified for the diagnosis.
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Thunberg, Malin, and Nathalie Ferno. "Arbetsterapeuters erfarenheter av interventioner för klienter med sömnstörning : En kvalitativ studie med fördjupad inriktning mot tyngdtäcken." Thesis, Luleå tekniska universitet, Institutionen för hälsa, lärande och teknik, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-84806.
Full textAbstract:
Syfte: Att beskriva arbetsterapeuters erfarenheter av interventioner för klienter med sömnstörning, med en fördjupad inriktning mot tyngdtäcken. Metod: En kvalitativ studie med semistrukturerade intervjuer som datainsamlingsmetod. Deltagarna i studien utgjordes av åtta arbetsterapeuter, från samma geografiska område, med klinisk erfarenhet av arbete med interventioner vid sömnstörning. Insamlade data analyserades med induktiv ansats. Resultat: Analysen av data resulterade i fem kategorier: Vikten av en arbetsterapeutisk kartläggning för en framgångsrik intervention, Att kombinera interventioner vid sömnstörning, Tyngdtäckets inverkan på symptom kopplade till sömnstörning, Sömnstörningens och tyngdtäckets inverkan på möjlighet till delaktighet i aktivitet samt Organisatoriska förutsättningar för arbetsterapeutiska interventioner vid sömnstörning. Arbetsterapeuternas kliniska erfarenhet påvisade i denna studie att tyngdtäcke och sömnhygiensiska råd var betydande interventioner för klienter med sömnstörning. Resultatet visade att dessa interventioner kunde ha en positiv inverkan på klientens hälsa samt bidra till ökad förmåga att utföra vardagsaktiviteter. Slutsats: Studien har bidragit med kunskap kring arbetsterapeuters erfarenheter av interventioner vid sömnstörning och dess inverkan på klienterna. Vidare forskning krävs inom området för att ytterligare kunna styrka sömnhygieniska råden och tyngdtäckes positiva inverkan på individer med sömnstörning.
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Budur, Kumaraswamy. "Prevalence and correlates of alpha-delta sleep in major depressive disorders." Case Western Reserve University School of Graduate Studies / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=case1274987413.
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Hollway, Jill Ann. "CORRELATES AND RISK MARKERS FOR SLEEP DISTURBANCE IN CHILDREN WITH AUTISM SPECTRUM DISORDERS." The Ohio State University, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=osu1339639912.
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Matsson, Carola, and Eva Söderhäll. "Interventioner för att främja sömnen hos äldre personer med demenssjukdom : - en ltteraturstudie." Thesis, Högskolan i Gävle, Akademin för hälsa och arbetsliv, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-7956.
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Sammanfattning Syftet med denna litteraturstudie var att göra en sammanställning och beskriva vad som fanns i vetenskaplig litteratur gällande sömnfrämjande interventioner för äldre personer med demenssjukdom. Metoden var en deskriptiv litteraturstudie baserad på 14 vetenskapliga artiklar från sju länder, publicerade mellan år 2005- 2010. Artikelsökning gjordes i databaserna Medline och Cinahl, även en manuell sökning ingick. Inkluderade artiklar i resultatet är granskade och kvalitetsbedömda. Huvudresultatet visade att det fanns olika interventioner som ljusterapi, melatonin, akupressur, social aktivitet, utbildning och örtmedicin för att främja sömnstörningar för personer med demenssjukdom. De olika interventionerna uppvisade lite skiftande effekt för att främja sömnen, ingen av interventionerna ansågs övertygande däremot upptäcktes andra positiva effekter gällande agitation, dygnsrytmstörningar och vakenheten under dagen. Slutsatsen av denna litteraturstudie är att mer riktad forskning behövs om olika interventioner för att främja sömnstörningar hos äldre personer med demenssjukdomar. Förbättring av sömnkvalitet, livskvalitet och återhämtning är målsättningen med interventionerna. Sjuksköterskan kan förbättra sömnkvaliteten hos patienterna med hjälp av icke farmakologiska interventioner. Sömnhygien, sociala aktiviteter och att förstärka exponeringen av solljus och klart ljus är förstahandsval vid behandling av sömnstörning hos personer med demenssjukdom.Abstract The aim of this literature study was to describe the scientific literature for sleep disorder interventions for older people with dementia. The method was a descriptive study based on 14 scientific articles from seven countries, published between the years 2005 - 2010. Article search was made in the databases Medline and Cinahl, and manual searches were included. Included articles in the results were reviewed and quality estimated. The main result showed that there were various interventions as light therapy, melatonin, acupressure, social activity, education and herbal medicine to promote sleep disorders for people with dementia. The various interventions showed varied effect to promote sleep, none of the interventions was convincing, although other positive effects on agitation, circadian rhythm and day- time wake was discovered. The conclusion of this study is that more research is needed in different interventions to promote sleep disorders for older people with dementia. The goal of the measures is to improve quality of sleep, quality of life and recovery. Nurses can improve quality of sleep in patients with non-pharmacological interventions. Sleep hygiene, social activities and increase exposure of sunlight and bright light is first choice to treat sleep disorders among persons with dementia.
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Ullah, M. Hafeez. "Effects of Sleep Disturbance on Cognitive Functioning in Bipolar Disorder Type 1| A Correlational Study Design." Thesis, Grand Canyon University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10638751.
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It was not known if and to what extent there was a relationship exists between an affirmative presence of insomnia and less need for sleep to cognitive impairments in bipolar disorder type 1 patient population. Lacanian topology and memory consolidation theory provides a comprehensive theoretical foundation for this quantitative correlational study design to determine whether a correlation exists between impaired sleep and cognitive impairments in BP-1 patients. This study included a convenience sample of 286 BP-1 patients collected from the Genetics of Bipolar Disorder in Latino population study. The Schedule for Affective Disorders and Schizophrenia Change in Symptomology was used to measure presence of insomnia and decrease need for sleep, and the South Texas Assessment of Neurocognition was used to measure cognitive functioning related to verbal memory, spatial memory, attention, executive function, speed of processing and inhibition. Spearman’s rank order correlation analysis was conducted to answer the first and second research questions, and multiple regression to answer the third research question. The results of the study showed significant inverse correlations between insomnia, speed of processing (rs = -.129; p = .029), executive functioning (rs = -.116; p = .05), decreased need for sleep and speed of processing (rs = -.118; p = .046). Moreover, it revealed that insomnia and decreased need for sleep as a set were significant predictors for the speed of processing, F (2, 283) = 3.08, p = .048. The findings of this study added to the literature on how sleep disturbances effects cognitive functioning in BP-1 patients and resulted in several implications for clinicians and researchers.
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Bollu, Vamsi, Andrew G. Bushmakin, Joseph C. Cappelleri, Chwen-Cheng Chen, Douglas Feltner, and Hans-Ulrich Wittchen. "Pregabalin reduces sleep disturbance in patients with generalized anxiety disorder via both direct and indirect mechanisms." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2012. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-99859.
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Background and Objectives: To characterize the impact of pregabalin on sleep in patients with generalized anxiety disorder (GAD) and to determine whether the impact is a direct or an indirect effect, mediated through the reduction of anxiety symptoms.
Methods: A post-hoc analysis of data from a randomized, double-blind, placebo- and active-controlled study in patients with GAD was conducted. Patients received pregabalin 300 mg/day, venlafaxine XR 75 mg/day or placebo for a week, followed by pregabalin 300-600 mg/day, venlafaxine XR 75-225 mg/day, or placebo for 7 weeks. Treatment effect on sleep was evaluated using the Medical Outcomes Study Sleep Scale. Anxiety symptoms were assessed with the Hamilton Anxiety Rating Scale. A mediation model was used to estimate separately for both treatment arms the direct and indirect treatment effects on sleep disturbance.
Results: Compared with placebo (n = 128), treatment with pregabalin (n = 121) significantly reduced scores on the sleep disturbance subscale and Sleep Problems Index II at both week 4 and week 8, and the sleep adequacy subscale at week 8. Venlafaxine XR (n = 125) had no significant effect on these measures. The mediation model indicated that 53% of the total pregabalin effect on sleep disturbance was direct (p < 0.01) and 47% indirect, mediated through anxiety symptoms (p < 0.05).
Conclusions: Pregabalin decreased sleep disturbance in patients with GAD both directly, and indirectly by reducing anxiety symptoms. Given the drug specificity of the results, this study provides evidence of an additional important pathway of action for pregabalin and its efficacy in GAD.
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Bollu, Vamsi, Andrew G. Bushmakin, Joseph C. Cappelleri, Chwen-Cheng Chen, Douglas Feltner, and Hans-Ulrich Wittchen. "Pregabalin reduces sleep disturbance in patients with generalized anxiety disorder via both direct and indirect mechanisms." Universidad de Zaragoza, 2010. https://tud.qucosa.de/id/qucosa%3A26262.
Full textAbstract:
Background and Objectives: To characterize the impact of pregabalin on sleep in patients with generalized anxiety disorder (GAD) and to determine whether the impact is a direct or an indirect effect, mediated through the reduction of anxiety symptoms.
Methods: A post-hoc analysis of data from a randomized, double-blind, placebo- and active-controlled study in patients with GAD was conducted. Patients received pregabalin 300 mg/day, venlafaxine XR 75 mg/day or placebo for a week, followed by pregabalin 300-600 mg/day, venlafaxine XR 75-225 mg/day, or placebo for 7 weeks. Treatment effect on sleep was evaluated using the Medical Outcomes Study Sleep Scale. Anxiety symptoms were assessed with the Hamilton Anxiety Rating Scale. A mediation model was used to estimate separately for both treatment arms the direct and indirect treatment effects on sleep disturbance.
Results: Compared with placebo (n = 128), treatment with pregabalin (n = 121) significantly reduced scores on the sleep disturbance subscale and Sleep Problems Index II at both week 4 and week 8, and the sleep adequacy subscale at week 8. Venlafaxine XR (n = 125) had no significant effect on these measures. The mediation model indicated that 53% of the total pregabalin effect on sleep disturbance was direct (p < 0.01) and 47% indirect, mediated through anxiety symptoms (p < 0.05).
Conclusions: Pregabalin decreased sleep disturbance in patients with GAD both directly, and indirectly by reducing anxiety symptoms. Given the drug specificity of the results, this study provides evidence of an additional important pathway of action for pregabalin and its efficacy in GAD.
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Cohen-Zion, Mairav. "Sleep and circadian rhythms in children with attention deficit-hyperactivity disorder : before and after stimulant treatment /." Diss., Connect to a 24 p. preview or request complete full text in PDF format. Access restricted to UC campuses, 2005. http://wwwlib.umi.com/cr/ucsd/fullcit?p3169322.
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Sidol, Craig. "Evaluating the Effect of Poor Sleep Efficiency and Next-Day Behavior Among Children with Attention Deficit/Hyperactivity Disorder." University of Cincinnati / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1593266430686674.
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BALIAN, ARAXI. "EFFECTIVENESS OF ORTHODONTIC TREATMENT WITH PREFABRICATED MYOFUNCTIONAL APPLIANCES IN CHILDREN WITH SLEEP-RELATED BREATHING DISORDERS AND OBSTRUCTIVE SLEEP APNEA: AN 18-MONTH FOLLOW-UP." Doctoral thesis, Università degli Studi di Milano, 2022. http://hdl.handle.net/2434/915635.
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Sleep-Related Breathing Disorders (SRBD) include various clinical entities, from primary snoring to Obstructive Sleep Apnea Syndrome (OSAS). They are characterized by intermittent partial or complete (hypopnea/apnea) upper airway obstruction during sleep which lead to sleep disturbance, cardio-respiratory, and neuro-behavioral impairments. Malocclusion and oral-facial dysfunctions such as having a retrusive bite, narrow maxilla, mandibular hypoplasia, oral breathing, or visceral swallowing are considered risk factors for SRBD and OSAS in pre-schoolers.
The present study aims to assess the effectiveness of orthodontic treatment in childhood SRBD and the changes which occur in oral functions and cranio-facial structures.
Participants were recruited if they were less than 6 years of age, presented signs and symptoms of SRBD together with malocclusion and/or oral dysfunctions, and had a baseline apnea index < 5 event/h. Children were assigned to a 12-month treatment with a preformed myofunctional appliance (EFline®, Orthoplus), then to an additional 6-month retention period. At baseline, all children underwent physical examination, orthodontic assessment, nocturnal polygraphy, lateral cephalograms and dental casts. A 6-month nocturnal polygraphy was performed only in OSAS patients. Validated tools for assessing risk of SRBD and OSAS (Sleep Clinical Score, SCS), frequency of sleep disturbances (Sleep Disturbances Scale for Children, SDSC) and neuro-behavioral impairment (Child Behavior Checklist, CBCL) were performed at baseline (T0) and after 12 months (T1). Custom cephalometric analyses and dental arch width measurements were digitally performed at baseline and after 18 months (T2).
Of the 12 patients initially recruited (4 females, 8 males; mean age 5.0±0.47 years), one child dropped-out. Overall, children tolerated the treatment well and recovered from oral dysfunctions (p<0.001). The OSAS subgroup completely recovered from apnea (AHI<1). Significant improvements were seen in respiratory, sleep and dento-skeletal variables: mean SCS (p<0.001), SDSC and CBCL (p<0.01) scores decreased after 12 months; a mean increase of 2-3 mm occurred in pharyngeal airway widths (p<0.01) and 6 mm in mandibular length (p<0.001), a less hyperdivergent facial growth pattern and favourable advancement of the hyoid bone occurred; mean inter-canine widths increased by 2.3-3 mm in the mandible (p<0.001) and in the maxilla (p<0.05). No significant differences were detected between OSAS and SRBD non-OSAS subgroups with the exception of the SCS and CBCL scores at baseline which were resolved after treatment.
Orthodontic treatment with PMAs may produce significant improvements in respiratory and sleep patterns together with significant cranio-facial and dental changes. PMAs might be an effective tool in the multidisciplinary treatment of SRBD and mild-to-moderate OSAS in pre-schooled children.
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PERGER, ELISA. "SLEEP APNEA AND HYPOXIA: NEW THERAPEUTIC PROSPECTIVES." Doctoral thesis, Università degli Studi di Milano-Bicocca, 2023. https://hdl.handle.net/10281/404617.
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Un terzo della popolazione europea è affetta da apnee ostruttive del sonno (OSA), patologia che ha conseguenze negative su morbilità cardiovascolare e qualità della vita. L’OSA è caratterizzata da ripetuti episodi di collasso delle alte vie respiratorie che determinano ipossia intermittente, modifiche della pressione intratoracica e risvegli corticali. L’ipossia intermittente ha un ruolo chiave nel determinare le conseguenze cardiovascolari dei disturbi del respiro nel sonno e può sovrapporsi, peggiorandone la prognosi, a condizioni caratterizzate da ipossia tonica quali l’alta quota o le patologie respiratorie croniche o infettive, esacerbando lo stress ossidativo, l’angiogenesi e quindi l’attivazione del sistema nervoso simpatico con conseguenti incrementi della pressione arteriosa, della frequenza cardiaca e dell’infiammazione.
Il trattamento gold standard per l’OSA è la terapia ventilatoria che risulta però non tollerata dalla metà dei pazienti che ne fanno uso. Nuove strategie terapeutiche sono pertanto auspicabili.
Recentemente sono stati identificati specifici fattori fisiopatologici che contribuiscono allo sviluppo dell’OSA: un’elevata collassabilità delle vie aeree superiori, l’instabilità del sistema di controllo del respiro, una ridotta soglia di arousal ed una ridotta risposta compensatoria dei muscoli dilatatori della faringe. Quest’ultima è dovuta alla perdita di attività noradrenergica e aumento delle influenze muscariniche alle alte vie aeree. Il riconoscimento di questi tratti fisiopatologici ha permesso di ipotizzare e sviluppare nuove strategie terapeutiche per l’OSA.
Obiettivo: Valutare l’efficacia della somministrazione per 1 settimana della combinazione di reboxetina (noradrenergico) ed ossibutinina (antimuscarinico) sul trattamento dell’OSA e dell’effetto dei farmaci sugli endotipi fisiopatologici.
Metodi: E’ stato condotto uno studio randomizzato controllato cross-over in doppio cieco per comparare 4mg di reboxetina più 5mg di ossibutinina (reb-oxy) in pazienti con OSA. I pazienti sono stati sottoposti ad una polisonnografia basale (PSG), una dopo 7 notti di assunzione di reb-oxy ed una dopo 7 notti di assunzione di placebo per confrontare l’indice di apnea-ipopnea (AHI–outcome primario). Outcome secondari comprendevano il carico ipossico, modifiche degli endotipi, la variabilità della frequenza cardiaca, test di vigilanza.
Risultati: Hanno completato lo studio 16 pazienti con età 57 [51-61] anni (mediana [range interquartilico]) ed indice di massa corporea 30 [26-36] kg/m2. Reb-oxy ha determinato una riduzione di AHI da 49 [35-57] eventi/h al basale a 18 [13-21] eventi/h (59% di riduzione mediana) e 39 [29-48] eventi/h (6% riduzione mediana) confrontato con il placebo (p<0·001). La frequenza cardiaca mediana durante la PSG è stata 65 [60-69] bpm al basale ed è aumentata fino a 69 [64-77] bpm dopo reb-oxy e 66 [59-70] bpm dopo placebo (p=0.02). La somministrazione di reb-oxy non ha comportato modifiche di variabilità della frequenza cardiaca, pressione arteriosa nelle 24 ore. Il test di vigilanza si è ridotto da 250 [239-312] ms al basale a 223 [172-244] ms dopo reb-oxy versus 264 [217-284] ms dopo placebo (p<0·001).
Conclusioni: Il miglioramento delle conoscenze della fisiopatologia dell’OSA ha permesso di identificare la responsività muscolare delle alte vie come target principale di strategia terapeutica per l’OSA, predisponendo il percorso verso la medicina di precisione anche nel contesto dei disturbi del respiro nel sonno. Il nostro studio ha evidenziato il dato pionieristico dell’effetto positivo della somministrazione di reboxetina più ossibutinina sulla gravità dell’OSA e sull’ipossia associata agli eventi ostruttivi nel sonno. I risultati del nostro studio sottolineano la possibilità di una terapia personalizzata con farmaci per trattare l’OSA ed il carico ipossico ad essa relato.Introduction: Obstructive sleep apnea (OSA) affects one third of the population in Europe and has major negative consequences for cardiovascular disease and quality of life. OSA is characterized by recurrent episodes of apneas and hypopneas associated with repetitive episodes of intermittent hypoxemia, intrathoracic pressure changes, and arousals. Intermittent hypoxemia, particularly with concomitant hypercapnia, activates the sympathetic nervous system and it is the major contributor to negative cardiovascular consequences. Intermittent hypoxia might also worsen concomitant tonic hypoxia due to high altitude or due to acute or chronic respiratory diseases by promoting oxidative stress and angiogenesis, thus increasing sympathetic activation with blood pressure elevation, inflammation and endothelial dysfunction. Although OSA and its hypoxic consequence are effectively alleviated with positive airways pressure, this treatment is yet unsatisfactory, being poorly tolerated by up to half of patients. Thus, new treatment strategies are strongly needed. With the aim of better understand OSA physiopathology, key contributors of its development have been identified and include upper airway collapsibility, ventilatory instability, low arousal threshold and reduced pharyngeal dilator muscle responsiveness during sleep, due to loss of noradrenergic drive and enhanced muscarinic influences to upper airway muscles. The recognition of these pathophysiological traits permitted to advance the research in the field of OSA new therapeutic perspectives. Aim: The aim of this study was to evaluate the effect of 1-week of reboxetine (a noradrenergic) plus oxybutynin (an antimuscarinic) on OSA severity (primary outcome) and their effect on endotypic traits and cardiovascular autonomic modulation. Methods: We performed a randomized, placebo-controlled, double-blind, crossover trial comparing 4 mg reboxetine plus 5 mg oxybutynin (reb–oxy) to placebo in OSA subjects. After a baseline in-lab polysomnogram (PSG), patients performed PSGs after 7 nights of reb-oxy and 7 nights of placebo to compare apnea-hypopnea index (AHI, primary outcome). Secondary outcomes included hypoxic burden, heart rate variability, blood pressure and heart rate changes and psychomotor vigilance test. Home oximetry evaluated overnight oxygen desaturation throughout treatment. Results: 16 subjects aged 57[51-61] years (median [interquartile range]) with body mass index 30[26-36] kg/m2 completed the study. Reb-oxy lowered AHI from 49[35-57] events/h at baseline to 18[13-21] events/h (59% median reduction) compared with 39[29-48] events/h (6% median reduction) on placebo (p<0·001). Response rate for reb-oxy was 81% versus 13% for placebo p<0·001). Median nocturnal heart rate during the PSG was 65 [60-69] bpm at baseline and increased to 69 [64-77] bpm on reb-oxy vs 66 [59-70] bpm on placebo (p=0.02). Reb-oxy administration was not associated with any modification in heart rate variability, 24-hour, day-time and night-time systolic and diastolic blood pressure. The psychomotor vigilance test decreased from 250[239-312] ms on baseline to 223[172-244] ms on reb-oxy versus 264[217-284] ms on placebo (p<0·001). Home oximetry illustrated acute and sustained improvement in oxygen desaturation index on reb-oxy versus placebo. Conclusions: The recent understanding of OSA pathophysiological mechanisms brought to hypothesize that, among the others, muscle responsiveness would be the main target to develop a precision medicine to treat OSA. We demonstrated that OSA severity and OSA-related hypoxic consequences are greatly decrease by the administration of reboxetine-plus-oxybutynin. These results highlight potential possibilities for personalized medicine with pharmacological therapy to treat OSA and its related hypoxic burden.
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Belke, Marcus [Verfasser], and Susanne [Akademischer Betreuer] Knake. "Diffusion Tensor Imaging (DTI) bei Patienten mit REM Sleep Behavior Disorder (RBD) / Marcus Belke. Betreuer: Susanne Knake." Marburg : Philipps-Universität Marburg, 2013. http://d-nb.info/1045729868/34.
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