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1
Moss, James. "Physiological effects of treatments in obstructive sleep apnoea syndrome." Thesis, Sheffield Hallam University, 2013. http://shura.shu.ac.uk/20763/.
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The original research in this thesis aimed to investigate physiological effects of different treatment approaches in obstructive sleep apnoea syndrome (OSAS). OSAS is a prevalent public health concern independently associated with increased cardiovascular risk. Specifically, study 1 examined the feasibility of conducting a pragmatic lifestyle intervention in patients reporting compliance with continuous positive airway pressure (CPAP) and collected provisional data about its efficacy, and study 2 investigated the physiological effects of low compliance to CPAP therapy in a four-arm observational study. The intervention in study 1 involved supervised exercise, dietary advice and behaviour change counselling. Primary outcome measures were recruitment, retention and compliance data and secondary outcome measures assessed anthropometrics, cardiovascular risk, quality of life and exercise capacity. Study 2 investigated macro-and microvascular function, anthropometrics, quality of life, cardiovascular risk and exercise capacity. The novel findings of this research were: 1) the lifestyle intervention was feasible to deliver; 2) the intervention improved key health outcomes such as exercise capacity (A +16%) and serum C-reactive protein (A -57%), which were maintained after 3 months of independence (A +22% and -57%, respectively); 3) self-reported CPAP compliance is an unreliable indicator of actual compliance; 4) it is difficult to recruit low-compliance patients onto research trials, and recruiting newly diagnosed patients is also difficult without interrupting the patient pathway; 5) vascular function seems impaired in low-compliance patients versus high-compliance patients, although further work is needed to confirm this. These findings contribute to the growing evidence base for the role of lifestyle intervention in OSAS, and provide provisional data on the effects of low compliance to CPAP therapy on vascular endothelial function. In summary, future research investigating pragmatic lifestyle interventions in OSAS and the physiological effects of low-compliance to CPAP is certainly warranted.
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Espie, Colin A. "A controlled comparative investigation of psychological treatments for chronic sleep-onset insomnia." Thesis, University of Glasgow, 1987. http://theses.gla.ac.uk/822/.
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Seventy, GP-referred, sleep-onset insomniacs were randomly assigned to either progressive relaxation, stimulus control, paradoxical intention, placebo or no treatment control groups. Following baseline assessment of sleep pattern and quality subjects received 8 weeks of treatment, comprising 4 weeks under counterdemand and 4 weeks under positive demand instruction to control for demand characteristics and expectancy effects. A further 14 patients were allocated consecutively to a tailored therapy condition as a development of the main study. Measures of treatment process and outcome were obtained from self-report instruments validated against objective monitoring via the `Somtrak
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Crawford, Megan R. "Behavioural adherence in the treatments of disorders of sleep and wakefulness : a biopsychosocial approach." Thesis, University of Glasgow, 2013. http://theses.gla.ac.uk/4191/.
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Obstructive sleep apnoea (OSA) and insomnia are the two most prevalent sleep disorders. Their respective treatments Continuous Positive Airway Pressure (CPAP) and Cognitive Behaviour Therapy for insomnia (CBT-I), are effective, but at the same time challenging. It is this challenge that may translate to poor adherence, which ultimately leads to a reduction in treatment effectiveness. The evaluation of these treatments should not fall short of understanding effectiveness by only considering efficacy; the effort to establish what influences adherence makes up a large part of that goal. The aim of this thesis is to contribute to the literature by adopting a biopsychosocial approach (BPS). That is, the consideration of biomedical, psychological and social factors and how they interact to influence behaviour. The implications for both CPAP and CBT-I adherence literature were tested in the context of four experimental studies. Semi-structured interviews were conducted with 11 CPAP users, with 5 individuals completing the three required interviews prior to, at 1 week and 3 months after treatment initiation. The core themes emerging from a thematic analysis were ‘internal conflict around acceptance and adherence’, ‘integration of CPAP into life’ and ‘motivators and resources for CPAP use’. The interviews with 11 individuals having completed a CBT-I program revealed three important issues: ‘Making sense of CBT-I’, ‘Ongoing evaluation of components’ and ‘Obstacles to implementation’. Both studies reveal potential psychological and social factors contributing to adherence to CPAP and CBT-I, which need to be considered in a BPS framework. A patient-level meta-analysis of three randomised placebo-control studies showed that the relationship between CPAP adherence and improvements in daytime sleepiness was caused by both physiological (high use of real CPAP reduced sleepiness more than high use of placebo and more than low use of real CPAP) and psychological effects (high use of placebo was superior to low use of placebo), possibly as a result of an expectation of benefit. The results support the importance of considering both biomedical and psychosocial factors and their interactive effects on adherence. The translation of the BPS approach to clinical practice will be facilitated by the development of brief, reliable and valid measures to assess psychological iii and social variables in addition to the existing biomedical tools. The Stage of Change Scale for Insomnia (SOCSI) assessing components of the transtheoretical model (stage of change, self-efficacy, decisional balance and processes of change), was constructed and cognitively pre-tested in 13 individuals completing CBT-I. The reliability and validity of this comprehensible scale was subsequently examined in the context of a sleep restriction trial. Insomnia-related symptoms at post-treatment and follow-up, which were significantly different from baseline in the 27 individuals with insomnia, were associated with actigraphdetermined adherence to the agreed bed window. The SOCSI was deemed a valid tool with participants in the self-identified action/maintenance stage revealing significantly better adherence, higher motivation and self-efficacy than those in the contemplation and preparation stage. Test-retest reliability of the SOCSI was excellent and the content analysis of open-box responses revealed information for further validation of decisional balance and processes of change scales. This thesis provides novel information about the variables that influence adherence to CPAP and CBT-I. It distinguishes itself from previous efforts by acknowledging the need for the adoption of a BPS framework. This approach is necessary to successfully advancing not only the CPAP and CBT-I adherence literature individually, but potentially the adherence field in general.
4
Billiards, Saraid Sheelagh. "Neurosteroid and somnogenic responses to endotoxin and hypoxia treatments in lambs." Monash University, Dept. of Physiology, 2003. http://arrow.monash.edu.au/hdl/1959.1/9553.
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Lundin, Roger, and Maria Nissinen. "Att främja nattsömnen : En allmän litteraturöversikt över vårdåtgärder vid demens." Thesis, Mälardalens högskola, Akademin för hälsa, vård och välfärd, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-47606.
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Background: Dementia is a common disease today and about 10% of the population in Sweden develop dementia. Dementia is associated with cognitive problems and troublesome symptoms, and is evident in the patient as the disease progresses. Problems: Sleep disorders can be a major problem for people with dementia, their relatives and even the healthcare staff. As a consequence of sleep disorders negative symptoms like agitation, depression and apathy can be enhanced. This leads to a greater workload for the healthcare staff and more effort emotionally for the relatives. Purpose: The purpose is to describe interventions that improves night sleep in people with dementia. Method: A literature review. The basis consists of 13 articles with both qualitative and quantitative approach. Result: Three categories appeared where night sleep might be promoted through activities, treatments and closeness. In addition to the enhanced night's sleep, the results also showed that improvement in agitation, depression and apathy might be achieved through these interventions. Conclusion: Night sleep in people with dementia can be improved through the interventions reported in the results. The result indicate that in order to perform good care the interventions have to be based on individual conditions.Bakgrund: Demens är idag en folksjukdom och omkring 10 % av befolkningen i Sverige utvecklar demens. Till demenssjukdomen hör kognitiv problematik samt besvärande symtom och framträder hos den sjuke allt eftersom sjukdomen fortskrider. Problem: Sömnstörningar kan vara ett stort problem för människor med demens, dess anhöriga och även vårdpersonal. Som en konsekvens av sömnstörningar kan negativa symtom såsom agitation, depression och apati förstärkas. Detta leder till större arbetsbörda för vårdpersonalen och mer ansträngning emotionellt för de anhöriga. Syftet: Att beskriva vårdåtgärder som främjar nattsömnen hos människor med demens. Metod: En allmän litteraturöversikt där underlaget består av 13 studier som ligger som grund till resultatet. Resultatet: Det framkommer tre kategorier där nattsömnen kan främjas genom aktiviteter, behandlingar och närhet hos människor med demenssjukdom. Utöver den främjade nattsömnen visade resultatet även att förbättring på agitationen, depressionen och apatin kan ske med hjälp av åtgärderna. Slutsats: Nattsömnen hos människor med demens kan främjas genom vårdåtgärderna som redovisas i resultatet. Resultatet indikerar dock att åtgärderna måste utföras utifrån individuella förutsättningar för att på bästa sätt kunna utföra en god vård.
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gaddam, sathvika, Ali Bokhari, and Deepika 7471363 Nallala. "ACROMEGALY TREATMENT AND RESOLUTION OF SLEEP APNEA." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/asrf/2019/schedule/41.
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Introduction
Acromegaly is an endocrine disorder characterized by excessive growth hormone production.The most common cause is a benign pituitary adenoma, which can be an isolated tumor or part of a group of concomitant endocrine neoplasms. We present a case of a middle aged woman with sleep apnea and a newly diagnosed acromegaly secondary to a pituitary macroadenoma.
Case presentation
A 51-year-old woman was seen in the endocrinology clinic for evaluation of hyperparathyroidism and mild hypercalcemia. She had no symptoms related to hypercalcemia. However, she complained of enlargement of her fingers and toes. She also reported galactorrhea and breast engorgement. There was no hyperhidrosis or frontal bossing present and she denied headaches or vision symptoms. Past medical history was significant for obstructive sleep apnea. Insulin like growth factor level was 630 ng/ml (reference 53 - 190 ng/ml), prolactin level was 109 ng/ml (reference 1.9- 25 ng/ml), and Follicular stimulating hormone was 0.4mIU/ml (reference 1.2 - 21.0 mIU/ml). TSH, free T4, ACTH, and cortisol were normal. The labs were consistent with pituitary macroadenoma secreting growth hormone (GH) and prolactin. MRI pituitary showed a 1.9 cm macroadenoma with no evidence of optic nerve compression. Due to the coexisting diagnoses of hyperparathyroidism and pituitary adenoma, CT abdomen was done to evaluate for neuroendocrine tumor and to rule out Multiple Endocrine Neoplasia (MEN) Type 1. She then underwent transsphenoidal resection of the pituitary, with immunostaining reflecting diffuse prolactin and patchy GH expression. Post-surgery IGF, prolactin, thyroid function tests were normal. She was started on hydrocortisone replacement due to abnormal ACTH and cortisol. Her calcium levels normalized, and further genetic testing for MEN was abandoned. Her repeat sleep study also showed resolution of sleep apnea. She did not suffer from further symptoms of acromegaly and was scheduled for periodic surveillance for thyroid axis dysfunction.
Discussion
Dysregulated growth hormone production seen in acromegaly leads to increased GH and IGF-1 levels. It has many ramifications including debilitating arthritis from osteoarthropathy, glucose intolerance due to insulin resistance, higher propensity for GI neoplasms, and macroglossia with prognathism causing sleep apnea. Average lifespan is decreased by 30% due to cardiovascular and pulmonary dysfunction. Treatment is aimed at decreasing IGF levels and controlling any mass effect or metabolic abnormalities caused by the tumor. Treatment options include invasive procedures for good surgical candidates and medical therapy via somatostatin analogue for patients who are not. Residual or unresectable tumors can be treated with medical therapy or radiation therapy if there is no response to medication.
7
Waters, Karen Ann. "Sleep disordered breathing and its treatment in children." Thesis, The University of Sydney, 1993. https://hdl.handle.net/2123/26603.
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The establishment of a dedicated paediatric sleep unit over the past three years has allowed detailed investigation of a large number of children with sleep associated upper airway obstruction. This thesis explores the characteristics of upper airway obstruction and sleep associated breathing control abnormalities, in children who have been investigated in that unit. The "unit" began with three or four people performing children’s sleep studies at the Sleep Unit (for adults) at RPAH; the results presented here include those studies. The methods used in this thesis have evolved through practical experience acquired in caring for children with breathing disorders in sleep.
This thesis is presented in two parts. The studies in the first section provide an overview of the presentation and treatment of the syndrome of obstructive sleep apnoea (OSA) as it occurs in infants and children. The second section is a more detailed exploration of OSA and its treatment in achondroplasia. These latter studies provide further insights into the disorder in this specific group, and therefore into some aspects of OSA in the broader population of children.
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Durant, Claire Fiona. "Brain and endocrine mechanisms of sleep disruption : sleep and refractory depression ; new approaches to treatment and their effect on sleep." Thesis, University of Bristol, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.574415.
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Sleep disturbance is a distressing and often poorly treated core symptom of major depression. Physiological sleep abnormalities are one of the few biological markers in depression. Reported here are studies in which sleep has been used to further our understanding of two experimental treatments for patients with treatment refractory depression (TRD). The first is a crossover study of the effect of two bolus infusions of hydrocortisone administered in the afternoon on sleep that night in healthy volunteers. This study was undertaken to help interpret results in a comparable patient study, in which the effects of 3 daily, high doses of hydrocortisone on sleep were assessed on night 3 (after hydrocortisone treatment), and 4 weeks later in patients with TRD. In healthy volunteers, hydrocortisone significantly increased slow wave sleep and, in a dose dependent manner, suppressed rapid eye movement sleep (REM), despite a delay of 8-10 hours between infusion and start of sleep recordings. The low dose increased measures of arousal, resulting in delayed sleep onset. In the patient study, it was not possible to confirm any sleep effects of hydrocortisone at a group level because of low patient numbers and large baseline variations in sleep measures attributable to psychotropic medications with differing effects on sleep architecture. However, the data gave some indication that if sleep improvements were observed directly after hydrocortisone, these were sustained, although not necessarily accompanied by mood alterations. The third study was an investigation of sleep effects of deep brain stimulation (DBS) in patients with TRD. Intracerebral electrodes were implanted in the subgenual cingulate (SGC) and nucleus accumbens (NAcc) regions. Continuous stimulation was commenced in one target brain region (randomised order) which could be switched to the second if no clinical response was observed. The main finding was a striking increase in REM sleep and reduction of REM onset latency after acute SGC stimulation, but not with NAcc stimulation. These results could imply previously unknown cortical mechanisms of REM sleep modulation
9
Mehta, Atul S. "Treatment of snoring and obstructive sleep apnoea using a mandibular advancement splint." Master's thesis, Faculty of Dentistry, 1998. http://hdl.handle.net/2123/4904.
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This work was digitised and made available on open access by the University of Sydney, Faculty of Dentistry and Sydney eScholarship . It may only be used for the purposes of research and study. Where possible, the Faculty will try to notify the author of this work. If you have any inquiries or issues regarding this work being made available please contact the Sydney eScholarship Repository Coordinator - ses@library.usyd.edu.au
10
Yang, Qiao. "The effects of acute and short-term continuous positive airway pressure treatment withdrawal on sleep and neurobehavioural function in patients with obstructive sleep apnea." Thesis, The University of Sydney, 2007. https://hdl.handle.net/2123/28138.
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This study systematically examined the changes in sleep parameters, neurobehavioural performance
and markers of objective and subjective sleepiness after an acute (one night) and short-term (seven
nights) period of withdrawal from Continuous Positive Airway Pressure (CPAP) treatment in
patients with obstructive sleep apnea (OSA). The effects of one night of CPAP reintroduction
immediately following CPAP withdrawal on these parameters were also investigated.
CPAP treatment can effectively eliminate upper airway obstruction at night but patients frequently
withdraw from CPAP therapy for short periods. The effects of intermittent CPAP use on sleep and
subsequent neurobehavioural function have not been systematically examined. It is important to
determine the neurobehavioural effects of short-term CPAP withdrawal.
Using a repeated-measurement-within-subject design, 20 participants receiving optimal, long-term
CPAP therapy were withdrawn from routine CPAP therapy. Polysomnograms were performed on
NO (with CPAP), N1 and N7 (without CPAP) and N8_R (with CPAP).
Acute CPAP withdrawal resulted in the recurrence of sleep-disordered breathing (SDB) with sleep
disruption, hypoxemia and increased subjective sleepiness. Short-term CPAP withdrawal
exacerbated hypoxemia and increased delta activity in EEG quantified by power spectral analysis.
Protracted time off CPAP also increased subjective and objective sleepiness, and poor mood
ratings. Autonomic arousals measured using respiratory-related reductions in finger blood volume
by peripheral arterial tonometry (PAT) decreased from N1 to N7.
Neurobehavioural functioning assessed using the psychomotor vigilance task was impaired
following N7 and associated with hypoxemia and changes in morning tumour necrosis factor-alpha
(TNF-a) levels. However, other neurobehavioural measures were not affected. Simulated driving
performance was also unaffected. Interestingly, despite this, EEG recordings demonstrated
neurophysiological evidence of increased sleepiness and greater time-on-task induced EEG
changes.
Resumption of CPAP treatment on N8_R eliminated most airway obstruction, maintained
oxygenation, reversed daytime sleepiness and some vigilance decrements. The immediate benefits
of CPAP treatment on sleep consolidation and subjective sleepiness were marked.
11
胡慧明 and Huie-ming Hou. "Long-term study of sleep apnoea patients treated with MAD." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2005. http://hub.hku.hk/bib/B45012222.
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Wang, David. "Sleep disordered breathing in stable methadone maintenance treatment patients /." Connect to thesis, 2006. http://eprints.unimelb.edu.au/archive/00002992.
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Lawton, Carolyn F. "The treatment of infant sleep disturbance by graduated extinction." Thesis, University of Canterbury. Psychology, 1985. http://hdl.handle.net/10092/6857.
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Infant sleep disturbance has been effectively treated with extinction by removal of parental attention but this procedure can produce adverse side-effects and can meet with parental resistance. This study evaluated an alternative procedure using graduated extinction to treat infant sleep disturbance. Graduated extinction required parents to gradually reduce the amount of time they spent attending to their child, eventually withdrawing attention completely. Baseline measures of sleep-related behaviour, including frequency and duration of night-waking, sleep onset latency and bedtime delay, were made by parents for twelve children between 6 and 19 months. Seven children received graduated extinction, and five received direct extinction in a multiple-baseline across subjects design. Social validation measures were taken during baseline and at the end of treatment, and sleep-related behaviours were again assessed for one week at two-months follow-up.
Clinically significant improvements in infant sleep behaviour were evident for four out of six subjects exposed to graduated extinction and for three out of four given extinction. Data for two subjects were unavailable for analysis. Improvements were maintained at follow-up. Parents reported high satisfaction with the procedures and improved family lifestyles. The quality of parental compliance with treatment was lower for graduated extinction than for extinction. The conclusions revealed that while graduated extinction was effective in treating infant sleep disturbance, it is no more effective than extinction, which has practical and clinical advantages in almost all cases.
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Chung, Valerie Yeung Shi. "The Effect of Choice on Placebo Treatment for Sleep." Thesis, The University of Sydney, 2017. http://hdl.handle.net/2123/16928.
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Thesis title: The Effect of Choice on Placebo Treatment for Sleep Abstract: Recent studies suggest that choice may enhance the placebo effect in the treatment of acute conditions. However, in those studies, there is often a failure to detect a placebo effect in the absence of choice, making it unclear as to whether choice provides an advantage when a significant placebo effect exists without choice. To address this, this thesis examined the role of choice in placebo effects for a chronic condition where placebo effects exist independent of choice. First, a review of the literature on the placebo effect and choice effects is presented. Second, a meta-analysis was conducted to confirm that placebo effects are reliably produced for sleep difficulty without choice. The meta-analysis indicated statistically reliable small to moderate placebo effects in perceived sleep onset latency (SOL), total sleep time (TST), and global sleep quality (GSQ). Finally, an empirical study tested the influence of choice on the placebo effect for sleep difficulty. 117 participants with self-reported sleep difficulty were recruited under the guise of a hypnotic trial and randomized to receive: placebo treatment with single choice, daily choice, or no choice, or no treatment. Significant placebo effects were found for perceived insomnia severity, fatigue, and sleep quality, with treatment-induced expectancy fully mediating the placebo effects for insomnia severity and sleep quality, and partially mediating effects in fatigue. However, placebo effects were not found for perceived SOL and TST, nor for objective SOL and TST measured via actigraphy. There was no evidence of enhancement of the placebo effect by choice on any of the outcomes, nor were there any differences between making a single choice versus daily choices. These findings suggest that choice may not significantly strengthen placebo effects over longer treatment periods, or provide a significant advantage when placebo effects already exist without choice.
15
Wichmann, Mark William. "A device for the treatment of adult Sleep Apnea Syndrome." Thesis, Virginia Tech, 1988. http://hdl.handle.net/10919/45960.
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An electronically-controlled positive-displacement bellows-type air pump has been developed in the Bio-medical Engineering Laboratory for the treatment of adult Sleep Apnea Syndrome (SAS). An electronically-controlled positive-displacement pump has been employed in order to eliminate the pressure regulator and accompanying noise of present therapeutic devices. The positive-displacement pump is found to quietly and effectively provide the required airway pressures for the treatment of adult Sleep Apnea Syndrome. New developments in the reduction of the size and noise levels of current therapeutic devices, however, preclude mass production of the bellows-type pump because of its size disadvantage. The custom nasal mask and exhalation valve, control system, pressure-monitoring alarm system, and the controlled humidifier of the positive-displacement pump should be incorporated within the present fanâ type Nasal Continuous Positive Airway Pressure (NCPAP) system to provide quieter, more comfortable, and safer NCPAP therapy. Before the design and development of the positive displacement NCPAP pump is detailed in this thesis, however, the problem of adult Sleep Apnea Syndrome is introduced, available therapies are investigated, and the current NCPAP therapy system is examined.
Master of Science
16
Ahrens, Anika. "A randomized clinical trial of the treatment of obstructive sleep apnoea using oral appliances." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B47849599.
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Obstructive sleep apnoea (OSA) is the most common sleep-related breathing disorder and is associated with a range of adverse physical, social and psychological outcomes that affect quality of life (QoL). Two systematic reviews of the literature (part of this thesis work) found there is conflicting evidence of how different mandibular advancement device (MAD) designs features may affect clinical and subjective OSA outcomes in certain patients. Therefore, a randomized cross-over trial was conducted. Firstly, the correlation between clinical OSA indicators and QOL was explored among patients referred for OSA treatment using MADs. In addition, associations of OSA risk factors, dental status and demographic variables with clinical OSA indicators and QoL indices were determined. Secondly, the efficacy of two different MADs in the treatment of adult OSA patients was assessed and compared. Thirdly, the efficacy of the two MADs in the treatment of adult OSA patients from the subjective perspective of their bed partners was determined.
A consecutive sample of 45 adult OSA patients referred from Queen Mary Hospital Sleep Centre to the Prince Philip Dental Hospital for oral appliance therapy was recruited and treated with a monobloc MAD and a twinblock MADs for a period of 3 months per MAD (cross-over randomised trial). Changes in clinical OSA outcomes were assessed by polysomnography (PSG) and changes in subjective outcomes by the disease-specific Sleep Apnoea Quality of Life Index (SAQLI) questionnaire, the Functional Outcome of Sleep Questionnaire (FOSQ) and Epworth Sleepiness Scale (ESS). Patient compliance, side-effects and MAD preference, as well as MAD treatment impact on the patients’ bed partner was also assessed.
At baseline, some clinical OSA indicators, subjective QoL and certain OSA risk factors were significantly correlated (p<0.05). There were significant variations in clinical OSA indicators and subjective QoL indices with respect to certain risk factors (p<0.05), demographic variables (p<0.05) and dental status (p<0.01).
There was a significant difference in favour of the monobloc MAD in terms of improving the apnoea-hypopnoea index (AHI) (p<0.05) and oxygen desaturation index (ODI) (p<0.01). Significantly more patients achieved clinical treatment success with the monobloc compared to the twinblock (p<0.05). Both MADs were efficacious in improving patients’ SAQLI score (p<0.01), FOSQ score (p<0.01) and ESS score (p<0.01). Significantly more patients achieved QoL treatment success with the monobloc (p<0.05) compared to the twinblock. More patients were ‘very satisfied’ with the monobloc treatment (p<0.05) and 63% preferred it to the twinblock.
No significant difference was found between patients’ and bed partners perceptions of symptom improvement post treatment, however, the monobloc resulted in a significant reduction in bed partners’ daytime sleepiness (p<0.01) and allowed significantly more co-sleeping at night (p<0.05).
This study concluded that the monobloc is superior in improving subjective QoL and clinical OSA indicators. The monobloc was the preferred MAD and patients were more satisfied with it; bed partners rated this MAD as superior in improving their own daytime sleepiness and co-sleeping.published_or_final_version
Dentistry
Doctoral
Doctor of Philosophy
17
Lai, Yuen-kwan Agnes, and 賴婉君. "Continuous positive airway pressure education on adherence in adults with obstructive sleep apnoea." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/198849.
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Poor adherence to continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnoea (OSA) limits its therapeutic effectiveness and has a major impact on clinical outcomes. Effective education programme is important to enhance CPAP use. However, existing education programmes are either manpower or resource demanding and may not be feasible in clinical practice. Moreover, the Self-Efficacy Measure for Sleep Apnoea (SEMSA) has been widely adopted for assessing adherence-related cognitions on CPAP therapy in OSA patients, but it was not available for Chinese.
The aims of this thesis are: (i) to perform linguistic and psychometric evaluation of a Chinese version of SEMSA (SEMSA-C); (ii) to examine the efficacy of brief motivational enhancement education programme in addition to standard care versus standard care only on improving adherence to CPAP treatment in patients with OSA.
The SEMSA-C was obtained after the standard forward-backward translation process. A randomised controlled trial was then conducted on newly diagnosed OSA patients. Patients in the control group received standard care (SC) comprising advice on the importance of CPAP therapy and its care while those in the intervention group received SC plus motivational enhancement education programme (ME). ME focused to enhance subjects’ knowledge, motivation and self-efficacy to use CPAP, comprising one 45-minute session on the day after CPAP titration and one 10-minute telephone follow-up shortly after commencing CPAP treatment. Epworth Sleepiness Scale (ESS), SEMSA-C, and quality of life were assessed. CPAP usage data were downloaded at the completion of this 3-month study. The primary outcome was the CPAP adherence. Furthermore, 21 patients were randomly sampled at baseline and completed the SEMSA-C at one week.
100 patients (Men : Women, 84 : 16) with OSA indicated for CPAP treatment were recruited, with an average age of 52±10 years, and apnoea hypopnoea index (AHI) of 36.2±22 events/hour. Factor analysis of SEMSA-C identified three factors: risk perception, outcome expectancies and treatment self-efficacy. Their corresponding internal consistency was high with Cronbach’s alpha >0.88, which were larger than all correlations between subscales (Range: 0.14 to 0.58). The correlations between items and their hypothesized subscale (Range: 0.58 to 0.85) were generally higher than the correlations between items and their competing subscales (Range: -0.10 to 0.58). One-week test-retest intra-class correlation ranged from 0.70 to 0.82. CPAP adherence was associated with outcome expectancies and treatment self-efficacy at 3-month assessment. Furthermore, SEMSA-C demonstrated an improvement in self-efficacy (standardised response mean = 0.33, p = .044) but no significant changes were observed in the other two factors, after CPAP use.
The 100 patients were followed for 3 months. The interventional effects maintained during the 3-month study period. There were a better CPAP use [higher daily CPAP usage of 2 hours/day (Cohen d = 1.33, p < .001), four-fold the number of subjects using CPAP for ≥ 70% of days with ≥ 4 hours per day (p < 0.001)], and greater improvements in ESS by 2.2 (p = 0.001) and treatment self-efficacy by 0.2 (p = 0.012) in the intervention group, relative to the control group.
The traditional Chinese SEMSA-C possesses satisfactory psychometric properties. It is a reliable and responsive instrument to measure perceived risks, outcome expectancies and treatment self-efficacy in Chinese patients with OSA. Moreover, the newly developed brief motivational enhancement education programme in addition to standard care is effective in improving adherence to CPAP treatment, treatment self-efficacy and daytime sleepiness.published_or_final_version
Nursing Studies
Doctoral
Doctor of Nursing
18
Moesbergen, Kevin. "THE TREATMENT OF INFANTS AND PRESCHOOL CHILDREN WITH SLEEP DISTURBANCE." Thesis, University of Canterbury. Psychology, 1987. http://hdl.handle.net/10092/1660.
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Sleep disturbance in infants and young children has been treated using three strategies: psychotherapy, medication, and behavior modification. Three experiments were undertaken to treat sleep disturbance with infants and preschool children. In the first study, the effects of extinction was evaluated with 13 infants aged 6 to 18 months. In the second study, the effects of extinction plus reinforcement procedures were evaluated with 22 preschool children aged 2 to 5 years, and in the final study, the effects of reinforcement only was evaluated with 22 preschool children. A multiple baseline across subjects design was used in each experiment. Six dependent variables were monitored, including bedtime delay, sleep onset latency, night-waking, duration of each waking, parental attention, and the duration of sleep across a 24-hour-day. Parents recorded data during baseline, treatment, maintenance, and 18 month followup. Results showed 91% of infants (10/11) maintained treatment gains in the first study, 18 months after the termination of treatment. In the second study, 95% of preschool children (21/22) on the extinction plus reinforcement contingency maintained treatment gains at 18 month followup. Finally, 90% of preschool children (19/21) on the reinforcement contingency alone maintained treatment gains at 18 month followup. These studies demonstrate the efficacy of behavioral procedures in the treatment of sleep disturbance in infants and children.
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Patel, Gita. "Investigating the role and treatment of sleep in relation to psychotic experiences." Thesis, University of Manchester, 2016. https://www.research.manchester.ac.uk/portal/en/theses/investigating-the-role-and-treatment-of-sleep-in-relation-to-psychotic-experiences(473ae105-bd35-4964-80bb-803da583bc30).html.
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Sleep problems are a common complaint in clinical samples. Specifically, the high level of co-occurring sleep disturbances, such as insomnia and hypersomnia, amongst patients with schizophrenia and bipolar disorder suggests a relationship between poor sleep and psychopathology. Furthermore, recent evidence consistently indicates that sleep disturbance may be related to symptoms of psychosis such as hallucinations and delusions. The research described in this thesis attempts to explore the relationship between sleep in psychosis. Paper 1 presents a systematic review entitled: Evaluating the Effectiveness of Sleep Treatments in Severe Mental Illness. The review identified fifteen controlled trials of pharmacological and non-pharmacological interventions for the treatment of sleep disturbance in patients with severe mental illness. The outcomes of the review indicated that sleep could be reliably improved in persons with schizophrenia and bipolar disorder. Significant improvements to sleep were observed for some pharmacological interventions as well as for non-pharmacological interventions. Paper 2 describes an empirical study aimed at exploring the effects of poor sleep on the cognitive mechanisms underlying psychotic experiences. Using an independent groups design, two, well-defined, non-clinical groups comprising good sleepers and poor sleepers (those meeting criteria for insomnia disorder) were recruited to the study. The two groups were compared on a series of questionnaires and computer tasks designed to assess mechanisms underlying hallucinations and delusions, with a view to determine whether there was a difference in performance between groups that could be attributed to sleep. No significant differences were found between groups, although the study was underpowered. The findings are discussed in the context of sample characteristics and tests used to compare groups. The final paper offers a critical reflection on the systematic review and empirical study, drawing together conclusions about the role and treatment of sleep in relation to psychotic experiences.
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Fisher, Christopher Alan. "Anxiety, Depression, and Sleep Disorders: Their Relationship and Reduction with Neurotherapy." Thesis, University of North Texas, 2010. https://digital.library.unt.edu/ark:/67531/metadc31533/.
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This study investigated the relationship among anxiety, depression, and sleep disturbances and the treatment of these three disorders through neurotherapy. Research suggests that these conditions commonly co-occur in the general population and that central nervous system (CNS) arousal may play a primary role in the development and maintenance of these disorders. Several recent studies suggested that neurotherapy, a biofeedback-based treatment for CNS dysregulation, might be an effective treatment for comorbid conditions, particularly the ones of interest here, depression, anxiety, and sleep disturbances. This investigation used a clinical case-series design to assess pre/post neurotherapy changes on objective measures of anxiety, depression, and sleep and to determine whether changes in anxiety and depression then predict improvements in sleep quality. Data for 23 participants (10 males) were obtained from files of adults (Mage = 40.22 years, SD = 16.20) who received at least 15 neurotherapy sessions (M = 47.83 sessions, SD = 22.23) the University of North Texas Neurotherapy Lab. Matched pair t-tests revealed that symptoms of sleep disturbance, depression, and anxiety showed significant improvements following neurotherapy. Neurotherapy treatment effect sizes generally ranged from moderate to large (d = .414 - .849). Multiple regression analysis found that changes in self-reported anxiety symptoms, but not depressive symptoms, predicted observed improvements in sleep quality (adjusted R2 = .26). Last, the implications and limitations were discussed in relation to neurotherapy practice and the associated research.
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Burgess, Mary. "Postal self-exposure treatment of recurrent nightmares : a randomised controlled trial." Thesis, King's College London (University of London), 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.369056.
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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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Germain, Anne. "Sleep pathophysiology and cognitive-behavioral treatment of posttraumatic and idiopathic nightmares." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp05/NQ65340.pdf.
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Atalla, Angela. "Sleep disordered breathing in chronic heart failure : causes, consequences and treatment." Thesis, Imperial College London, 2013. http://hdl.handle.net/10044/1/11672.
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Chronic heart failure (HF) is a prevalent clinical syndrome in which both central and obstructive sleep disordered breathing (SDB) have been described. The aim of this research was to investigate the mechanisms causing central SDB, their consequences with reference to sleep and physical activity, and the way in which treatment modalities may modify these. The first study of this thesis is the SERVE-HF study, a randomised controlled trial of adaptive servoventilation (ASV) to treat central SDB in patients with CHF. This study is ongoing and aims to test the hypothesis that patients randomised to ASV will have a reduction in mortality compared to controls. Data regarding those randomised at the Royal Brompton Hospital are presented alongside data on ventilator compliance in the ASV group. The second study investigated ventilatory control, in HF patients both with and without SDB. It tested the hypothesis that those with central SDB had heightened chemosensitivity (assessed by the hypercapnic ventilatory response, HCVR) compared to those with no SDB and older healthy controls. The third study explored the effect of treatment on ventilatory control by testing the hypothesis that the implantation of a cardiac-resynchronisation therapy pacemaker would be associated with a reduction in the HCVR from baseline to 3 months post implantation. The fourth study investigated the consequences of SDB in CHF. Physical activity, subjective sleepiness and sleep were assessed in patients with CHF and older healthy controls to test the hypothesis that physical activity would be reduced in those with central SDB compared to those without SDB, and reduced in both patient groups compared to the controls. In summary, this thesis investigated the mechanisms underlying central SDB in patients with HF, to elucidate their consequences, both by day and night and to address the ways in which treatment modalities may modify these pathophysiological mechanisms. [For supplementary files please contact author].
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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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Tanner, Brian Charles. "A center for sleep research at Emory University Hospital." Thesis, Georgia Institute of Technology, 1994. http://hdl.handle.net/1853/24124.
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Fridel, Keith. "Adherence and Effectiveness of Positional Therapy for Obstructive Sleep Apnea Syndrome." Diss., The University of Arizona, 2011. http://hdl.handle.net/10150/203486.
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The purpose of this investigation was to explore how adherence to a positional therapy intervention affected therapeutic outcome in participants with positional-related obstructive sleep apnea syndrome. Eighteen adult participants identified as having positional-related obstructive sleep apnea by an initial overnight polysomnography study were recruited. Participants were instructed to use a “tennis ball technique” positional device for three weeks at home and record their sleep habits and adherence before a final post-treatment polysomnography evaluation. A repeated measures MANOVA found significant effects of treatment between pre- and post-test on the objective polysomnography variables of Total Recording Time [F(1,17) = 5.21, p<.05, η²=.24], Total Sleep Time [F(1,17) = 8.59, p<.01, η²=.34], Sleep Efficiency [F(1,17) = 5.42, p<.05, η²=.24], Total REM sleep time [F(1,17) = 9.91, p<.01, η²=.37], and the Apnea- Hypopnea Index [F(1,17) = 14.28, p<.001, η²=.46]. Sleep onset latency was not statistically significant. There were significant effects of treatment on the subjective measures of the Functional Outcome of Sleep Quality [F(1,17) = 8.92, p<.01, η²=.35], Pittsburgh Sleep Quality Index [F(1,17) = 11.2, p<.01, η²=..39], Epworth Sleepiness Scale [F(1,17) = 6.69, p<.05, η²=.28], and the Brief Symptom Inventory [F(1,17) = 5.14, p<.05, η²=.23]. No significant interaction effects were found between treatment and adherence when participants were grouped post-hoc into an adherent or non-adherent categories based on their self-reported daily log data. In summary, the results of this study indicated that the positional device was efficacious for significantly improving both objective polysomnography variables and subjective variables of sleep. The results also indicated even partially adherent participants reported significant improvements in nighttime sleep quality and quality of life after the three week treatment period. Mixed Linear Modeling demonstrated that significant improvements in sleep quality, time to sleep onset, and total sleep time were not seen until the last weeks of treatment. This study found very acceptable adherence rates with this positional device design; all participants were able to utilize the therapeutic device on at least a portion of every night during the three-week intervention.
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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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Williams, Shaun C. J. "Modafinil effects during acute interruption of continuous positive airway pressure in patients with obstructive sleep apnea." Thesis, The University of Sydney, 2009. https://hdl.handle.net/2123/28456.
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Continuous positive airway pressure (CPAP) is associated with a reduction in the risk of motor vehicle accidents in patients with obstructive sleep apnea (OSA). It also improves simulated driving performance in these patients. However, CPAP compliance can be poor and even regular users may temporarily withdraw from therapy due to reasons that might include travel, mask-related problems or upper respiratory tract infections. Acute interruptions of CPAP result in immediate recurrence of OSA and are associated with impairment in neurobehavioural performance. Pharmacotherapy to manage daytime symptoms associated with acute CPAP withdrawal may be warranted. The wakefulness promoter, modafinil, is a candidate for such a treatment approach. Modafinil induces wakefulness primarily by inhibiting dopamine and noradrenaline re-uptake transporters. However, there is substantial inter-individual variability in the neurobehavioural response to modafinil and previous studies have linked this to the Vall158Met polymorphism of the catechol-O-methyl transferase (COMT) gene. The c.1083 T>C polymorphism of the adenosine receptor A2A receptor (ADORAZA) gene is another with which the variability in the response to modafinil may be associated. Adenosine is involved in the regulation of dopamine release and the development of sleepiness through its binding to the adenosine AzA receptor (ADORAZA). Although modafinil does not directly interact with ADORAZA, it is possible that a functional polymorphism of this receptor may predict sensitivity to the action
of modafinil.
In a preliminary study we examined the effects of 200mg modafinil administration on morning simulated driving performance, neurobehavioural performance and subjective alertness in a placebo-controlled crossover trial including N=l2 OSA patients acutely removed from CPAP for one night. In the preliminary study, modafinil administration did not result in a statistically superior simulated driving performance or neurobehavioural performance the morning following CPAP withdrawal, but did result in better subjective sleepiness compared to placebo. However, we were encouraged by the medium to large effect sizes.
In a larger second study, we examined the effects of 200mg modafinil administration on daytime simulated driving performance, neurobehavioural performance and subjective alertness in a randomised, double-blind, cross-over trial including N=21 OSA patients acutely removed from CPAP for 2 nights. Additionally, we investigated the effect of the COMT and ADORAZA polymorphisms on the response to modafinil. Conversely, in the larger scale study modafinil administration did result in an improved simulated driving performance, neurobehavioural performance and subjective alertness. Polymorphisms in the COMT and ADORAZA genes did not explain the variability in the response to modafinil. These findings support the potential use of modafinil as a short-term treatment option in preventing the decline of daytime function in OSA patients who require an acute interruption of their CPAP therapy for up to 2 nights.
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Cheng, Hai-kiu Kelvin. "Evaluation on the quality of life for patients with obstructive sleep apnea using the continuous positive airway pressure device treatment." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B4072041X.
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Sam, Kim. "Short term effects of an oral appliance in the treatment of mild to moderate Obstructive Sleep Apnea in Chinese subjects." Hong Kong : University of Hong Kong, 1999. http://sunzi.lib.hku.hk/hkuto/record.jsp?B21879278.
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Viens, Marcel J. "Generalized anxiety and sleep-onset insomnia: Evaluation of treatment using anxiety management training." Thesis, University of Ottawa (Canada), 1989. http://hdl.handle.net/10393/20931.
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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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Pérez, Trenard Diego Oswaldo. "Optimal control of non-invasive neuromodulation for the treatment of sleep apnea syndromes." Thesis, Rennes 1, 2018. http://www.theses.fr/2018REN1S014/document.
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Le syndrome d'apnée du sommeil (SAS) est une maladie multifactorielle caractérisée par des épisodes récurrents de pauses respiratoires ou des réductions significatives de l'amplitude respiratoire pendant le sommeil. Ces épisodes peuvent provoquer des réactions cardiorespiratoires aiguës; délétères à long terme. Plusieurs thérapies ont été proposées, étant la pression positive continue des voies respiratoires (CPAP) le traitement de référence. Malgré ces excellents résultats chez les patients symptomatiques, le taux de refus initial est de 15% et une adhésion à long terme est difficile à atteindre. Par conséquent, le développement de méthodes de traitement non invasives, avec une meilleure acceptabilité, reste d’une importance majeure. Dans ce contexte, l’hypothèse qui sous-tend ce travail est qu’une stimulation kinesthésique contrôlée, délivrée au cours de la phase précoce de l’apnée, peut réduire la durée des événements respiratoires et, par la suite, limiter les désaturations d’oxygène associées, par une activation contrôlée du réflexe de sursaut. La première partie de ce manuscrit est consacrée à la description d'un nouveau système (PASITHEA) de surveillance en temps réel et de neuromodulation thérapeutique, qui fonctionne comme un dispositif polyvalent de diagnostic et de traitement de SAS par stimulation kinesthésique. Les principales contributions de cette thèse se concentrent sur les aspects du traitement du signal et du contrôle de ce système, ainsi que sur l'électronique associée. Une autre contribution est liée à l'évaluation de ces méthodes et dispositifs par des protocoles cliniques spécifiques. Dans une deuxième partie, nous proposons une première méthode de contrôle On/Off optimale pour délivrer la stimulation, en utilisant comme variable de contrôle la sortie d'un détecteur d'événements respiratoires en temps réel. Lors de la détection d'un événement, une stratégie de stimulation unique avec amplitude de stimulation constante est appliquée, cette dernière a été mise en œuvre dans le cadre d'un premier protocole clinique dédié à l'évaluation de la réponse du patient au traitement. Les résultats ont montré que 75% des patients répondaient correctement au traitement en termes de durées des épisodes respiratoires. De plus, des diminutions significatives de la variabilité du SaO2 ont également été constatées lors de la mise en œuvre d'une nouvelle méthode d'analyse aiguë. Puisque nous avons supposé qu'une sélection inappropriée des patients pourrait expliquer l'absence de réponse observée chez 25% des patients. Nous avons proposé une méthode pour différencier les patients qui pourraient bénéficier de cette thérapie, basée sur l'estimation d'indices de variabilité cardiaque. Les résultats de ces analyses ont montré que l'efficacité de cette thérapie semble corrélée à un système nerveux autonome fonctionnel. Enfin, une méthode améliorée de contrôle en boucle fermée, intégrant des correcteurs proportionnels-dérivés (PD) couplés et simultanés a été proposée afin de modifier de façon adaptative l’amplitude de stimulation kinesthésique délivrée au patient par le système thérapeutique, en utilisant comme variables de contrôle des signaux physiologiques enregistrés en temps réel. Un deuxième protocole clinique visant à valider l'algorithme de contrôle de la stimulation kinesthésique adaptative spécifique au patient a été initié. Plusieurs améliorations ont été effectuées à la première version du système afin de permettre l'intégration du contrôleur proposé. Les résultats préliminaires de cette étude ont validé le fonctionnement de notre contrôleur et ont montré que notre système était capable de fournir une stimulation kinesthésique adaptative en fonction des réponses propres au patient. Une autre phase de cette étude, mettant en œuvre le contrôleur avec un ensemble des paramètres de contrôle présélectionnés, est actuellement en coursSleep apnea syndrome (SAS) is a multifactorial disease characterized by recurrent episodes of breathing pauses or significant reductions in respiratory amplitude during sleep. These episodes may provoke acute cardiorespiratory responses along with alterations of the sleep structure, which may be deleterious in the long term. Several therapies have been proposed for the treatment of SAS, being continuous positive airway pressure the gold standard treatment. Despite its excellent results in symptomatic patients, there is a 15% initial refusal rate and long term adherence is difficult to achieve in minimally symptomatic patients. Therefore, the development of non-invasive SAS treatment methods, with improved acceptability, is of major importance. The objective of this PhD thesis is to propose new signal processing and control methods of non-invasive neuromodulation for the treatment of SAS. The hypothesis underlying this work is that bursts of kinesthetic stimulation delivered during the early phase of apneas or hypopneas may elicit a controlled startle response that can activate sub-cortical centers controlling upper airways muscles and the autonomic nervous system, stopping respiratory events without generating a cortical arousal. In this context, the first part of this manuscript is dedicated to the description of a novel real-time monitoring and therapeutic neuromodulation system, which functions as a multi-purpose device for SAS diagnosis and treatment through kinesthetic stimulation. This system has been developed in the framework of an ANR TecSan project led by our laboratory, with the participation of Sorin CRM SAS. The main contributions in this thesis are focused on the signal processing and control aspects of this system, as well as the electronics associated. Another contribution is related to the evaluation of these methods and devices through specific clinical protocols. In a second part, we propose a first optimal On/Off control method for delivering kinesthetic stimulation, using as control variable the output of a real-time respiratory event detector. A unique stimulation strategy where a constant stimulation amplitude is applied upon event detention was implemented in a first clinical protocol, dedicated to assessing the patient response to therapy. Results showed that 75% of the patients responded correctly to therapy, showing statistically significant reductions in respiratory event durations. Also, significant decreases in the SaO2 variability were also found when implementing a novel acute analysis method. Since we hypothesized that inappropriate patient selection could explain the observed lack of response in 25% of patients, we proposed a method to differentiate patients who could benefit from this therapy based on the estimation of complexity-based indexes of heart rate variability. Results of these analyses showed that the effectiveness of this therapy seems correlated to a functional autonomic nervous system. Finally, an improved closed-loop control method integrating concurrent, coupled proportional-derivative (PD) controllers in order to adaptively change the kinesthetic stimulation was proposed. It uses as control variables three physiological signals recorded in real-time: Nasal pressure, oxygen saturation and the electrocardiogram signal. A second clinical protocol with the main objective of validating the control algorithm for patient-specific adaptive kinesthetic stimulation was launched. Several improvements to the first version of the system were developed to allow the integration of the proposed controller. Preliminary results from the first phase of this study validated the proposed controller operation and showed that the controller was able to provide adaptive kinesthetic stimulation in function of the patient-specific responses. A second phase of this study implementing the proposed controller and the set of the selected control parameters from the first phase is currently ongoing
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Bramble, David John. "The assessment and treatment of common sleep problems in severely learning disabled children." Thesis, University of Leicester, 1996. http://hdl.handle.net/2381/34234.
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This thesis explores by means of a small intervention study based on ordinary clinical practice, the effectiveness and acceptability to carers of an intensive behavioural modification approach to the chronic and severe night-settling and night-waking (NS/NW) sleep problems commonly encountered with severely learning disabled (SLD) children. The principal hypotheses tested were: (i) rapid settling and extinction techniques represent an effective means of treating severe and chronic NS/NW sleep problems presenting in severely learning disabled children; (ii) such an approach will also provide useful generalization effects; (iii) such an approach will prove acceptable to the parents of affected children; and (iv) electronic ambulatory movement monitoring (AM) will yield useful data in this context. Fifteen sleep disordered SLD children were recruited into the trial and there were no drop-outs over its course. The results of the study reflect that the intervention was highly successful and that improvements in the children's sleep problems were evident from subjective and objective assessments within a few days of the commencement of treatment. At long-term follow-up, these improvements were sustained in all but three of the families. Generalization effects were seen in that the children's daytime behaviour improved as did the indices of their mothers' subjective wellbeing. The parents were highly satisfied by both the results and the style of the interventional approach. No adverse effects were reported. The AM data confirmed the trends of improvement detected in the parent and investigator assessments (night-waking patterns; settling times; etc.) and also provided novel information about the duration, movement content and temporal distribution of night-waking episodes over the course of the study for five of the children. These findings are discussed in terms of their implications for clinical practice and future research.
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Shepherd, Kelly. "Gastro-oesophageal reflux in obstructive sleep apnoea : prevalence and mechanisms." University of Western Australia. School of Anatomy and Human Biology, 2009. http://theses.library.uwa.edu.au/adt-WU2009.0085.
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Background. Obstructive Sleep Apnoea (OSA) is associated with an increase in nocturnal gastro-oesophageal reflux (nocturnalGOR) events and symptoms, however the mechanism for this remains undefined. Treatment of OSA with continuous positive airway pressure (CPAP) has been shown to reduce nocturnalGOR in individuals with OSA however the reasons for this reduction are not clear. The combination of OSA and nocturnalGOR could be particularly problematic for individuals who have had a lung transplant in whom Bronchiolitis Obliterans Syndrome (BOS) limits survival. It is thought that GOR plays a role in the development of BOS in these individuals. Methods and Results. Five interrelated studies were undertaken. The first two studies sought to determine and compare the prevalence and risk factors of nocturnalGOR in OSA patients with the general population. To do this, a GOR questionnaire was completed by 2,042 members of the general community as part of the Busselton Health Survey and by 1,116 patients with polysomnography-diagnosed OSA. Risk of OSA in the general population was determined using a standardised sleep questionnaire. 137 of the OSA patients completed the questionnaire before and after treatment with CPAP. The prevalence of nocturnalGOR symptoms reported more than once a week (frequent symptoms) was greater in OSA patients (10.1%) than the general population (5.8%) (p<0.001), in individuals from the general population at high (11.2%) than low risk of OSA (4.5%) (p<0.001) and in patients with severe (14.7%) than mild OSA (5.2%) (p<0.001). Treatment of OSA with CPAP decreased the prevalence of frequent nocturnalGOR from 9.0% to 3.8% (p=0.04). In the general population, high risk of OSA was independently associated with a 2.4-fold increased risk of frequent ABSTRACT vi nocturnalGOR symptoms than low risk. In the OSA group, disease severity was independently associated with nocturnalGOR symptoms, with an adjusted odds ratio of 1.7 for frequent nocturnalGOR symptoms.
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Shifflett, D. Edward Jr. "Physiological Responses in OSA Patients to Ramping Exercise After CPAP Treatment." Thesis, Virginia Tech, 1998. http://hdl.handle.net/10919/9865.
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Continuous positive airway pressure (CPAP) is the primary therapy administered for those afflicted with obstructive sleep apnea (OSA). We examined the effects of CPAP therapy on physiological variables during a ramped exercise. The five male, OSA patients had mean values and standard deviations for RDI=60.7 +/- 19.1, BMI=29.9 +/- 2.9, and age=56 +/- 16.1 yr. Subjects were examined before and after 4 wk of CPAP therapy. After 4 wk of CPAP therapy, patient responses to exercise showed a 17.6%, (p<0.05) improvement in rating of perceived exertion (RPE) at identical power outputs (60% of the individual's apparent functional capacity). Statistical significance was not attained (p>0.05) upon analysis of the following parameters at 60% of the individuals maximum workload although there was a trend showing a decrease in these variables: heart rate (6% improvement), VO2 (11.7% improvement) systolic blood pressure (4% improvement), and rate pressure product (8.6% improvement). This data shows that the decrease in RPE during 60% of the individual's maximum predicted HR reserve corresponded with an increase in sleep quality (mean increase of 40%, 3.2 units) as measured by the Pittsburgh Sleep Quality Index before and after 4 wk of CPAP therapy. It was concluded that the improvement in exercise tolerance could be attributed to the subjective feelings of improved sleep quality after 4 wk of CPAP therapy. Key Words: Obstructive sleep apnea---CPAP--- exercise---physiological responses.Master of Science
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Walker-Engström, Marie-Louise. "Treatment effects with a mandibular advancement appliance and uvulopalatopharyngoplasty in obstructive sleep apnea : randomised controlled trials /." Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3376.
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Ledman, Cassandra A. "The effect of continuous positive airway pressure treatment on physical activity levels in obstructive sleep apnea patients." Virtual Press, 2008. http://liblink.bsu.edu/uhtbin/catkey/1391676.
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Obstructive Sleep Apnea (OSA) is becoming an increasingly prevalent health problem, affecting 4% of men and 2% of women in North America. OSA is associated with many debilitating side-effects and co-morbidities; the most common being excessive daytime sleepiness (EDS), which effects the majority of OSA sufferers. EDS is negatively associated with physical activity (PA) and exercise. As a result, EDS may decrease the levels of PA performed by OSA patients. Previous research has revealed that the OSA population engages in less physical activity than the average healthy population. Studies show that CPAP treatment positively impacts EDS, and therefore; may impact PA. The primary purpose of this study was to objectively measure OSA patients' PA levels prior to CPAP treatment and 8 weeks after treatment initiation to assess whether CPAP treatment' impacts PA levels.Actigraph GT 1 M measures PA was assessed at baseline (prior to CPAP) and 8-weeks after. initiation of CPAP treatment. At each time frame, cardiovascular., blood data, body composition, and maximal cycle ergometer exercise measures were obtained. Also, subjective questionnaires, 1 reflective of sleep apnea and 1 regarding PA, were completed by the subjects.Six male subjects with severe OSA (AHI = 41.2 ± 28.4 events/hr) started and completed the study. No significant changes occurred in PA, represented as steps/day nor mean activity counts/day, throughout the 8 weeks of CPAP treatment. Significant changes were found in diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, and Epworth sleepiness scale scores. No significant changes occurred in any other body composition, heart rate, systolic blood pressure, triglycerides, and blood glucose. Exercise parameters, total test time, peak Watts, and V02max trended toward an increase and maximal heart rate and blood pressure toward a decrease, but none changed significantly.In conclusion, these results demonstrated that 8 weeks of CPAP treatment was not successful in increasing PA levels of severe OSA patients. The OSA subjects were categorized as sedentary according to their steps/day. Compliance to CPAP could have been an issue with subjects' average nightly usage ranging from 1.85 – 6.6hours/night. Consequently, more research regarding OSA patients PA habits and CPAP treatments effects on PA should be investigated.School of Physical Education, Sport, and Exercise Science
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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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Sam, Kim, and 岑儉. "Short term effects of an oral appliance in the treatment of mild to moderate Obstructive Sleep Apnea in Chinese subjects." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1999. http://hub.hku.hk/bib/B31973036.
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鄭希翹 and Hai-kiu Kelvin Cheng. "Evaluation on the quality of life for patients with obstructive sleep apnea using the continuous positive airway pressure device treatment." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B4072041X.
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Dewa, Lindsay. "Insomnia in a prison population : a mixed methods study." Thesis, University of Manchester, 2017. https://www.research.manchester.ac.uk/portal/en/theses/insomnia-in-a-prison-population-a-mixed-methods-study(6f501889-4a7f-4029-beb2-67da832cf14a).html.
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Background: Around a third of the general population experience insomnia at some point in their lives. A lack of good quality sleep can negatively impact upon daytime functioning, relationships and behaviour. Although the issues and management of prisoner's mental health has been assessed thoroughly across the prison literature, the importance of poor sleep prevalence, associated causes and its management has failed to be systematically examined. My systematic integrative review of the sleep-prison literature collated and synthesized the evidence, informing the overall study objectives and design. Aim: The overarching aim of this mixed-methods thesis was to produce a treatment pathway to help manage insomnia in a prison population, acceptable to both staff and prisoners. Study 1: A national survey and telephone interviews examining current insomnia management practice in England and Wales prisons. Eight-four prisons took part (73%). The most common interventions were medication and sleep hygiene education. Analysis of telephone interviews revealed four main themes, insomnia as a normal occurrence in prison; the problem of medication in prison; the negative impact of the prison environment; and effective management of insomnia in prison. Study 2: A cross-sectional study looking at prevalence and associated factors of insomnia in male and female prisons was conducted. Two hundred and thirty seven prisoners completed a questionnaire battery. Around two-thirds had insomnia disorder and clinical, environmental and situational factors were much more likely in this group than those without insomnia. Study 3: Semi-structured interviews were conducted with staff and prisoners to explore perspectives of insomnia management. Three themes were found: value of good sleep, barriers and considerations for good sleep management and future direction of insomnia management in prison. Study 4: A modified Delphi consensus study was conducted with academic sleep researchers, prison staff and service users over three rounds of consultation. Consensus was achieved and a stepped-care treatment pathway was produced. Conclusion: When used in future practice, the treatment pathway should help practitioners to identify, assess and manage insomnia in a population that is twice as likely to experience insomnia as the general population.
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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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Schwartzhaupt, Alexandre Willi. "Estudo da influência da cafeína sobre o efeito antidepressivo da privação de sono em pacientes deprimidos." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2008. http://hdl.handle.net/10183/13193.
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Introdução: A privação de sono (PdS) tem sido utilizada como um estratégia alternativa para o tratamento do Transtorno Depressivo Maior (TDM), contudo sua eficácia e efetividade carecem de estudos homogêneos e de bom delinemento para dar um grau de evidência científica para seu uso na prática diária. Assim sendo, desde a primeira publicação, em 1971, num relato de caso de um paciente com TDM grave tipo melancólico, por Plug e Tölle, o mesmo estava assintomático no dia seguinte à privação total de sono. Contudo, na noite seguinte de sono seus sintomas depressivos retornaram. Nestes quase 40 anos desde esta publicação houve dezenas de estudos em sua maioria relatos de caso, série de casos ou até estudos abertos só que misturando pacientes com TDM com Depressão Bipolar sem mesmo distinguir se tipo I ou II. A cafeína com seu efeito estimulador poderia ser uma alternativa para facilitar a privação de sono. No entanto, não há dados sobre o sua potencial influência no efeito antidepressivo da PdS. O objetivo deste estudo é avaliar o efeito da cafeína na PdS em pacientes deprimidos unipolares moderados a graves não psicóticos. Métodos: Ensaio Clínico randomizado, duplo cego, cruzado, comparando cafeína contra placebo em pacientes deprimidos moderados a graves submetidos à privação total de sono (PdS). Os pacientes foram avaliados por itens da escala de Lader, HAMD- 6 itens, CGI Severidade e Melhora Global. Resultados: Foram avaliados 20 pacientes. Os pacientes que usaram cafeína mantiveram o mesmo escore de energia pré e pós-privação de sono (item energético-letárgico da escala de Lader) enquanto os do grupo placebo diminuíram o escore de energia pós-privação de sono. (p = 0,0045). Não houve diferença entre o grupo cafeína e placebo nos demais itens da escala de Lader. Conclusão: O uso combinado de cafeína e PdS pode ser uma estratégia útil para manter os pacientes mais acordados sem o prejuízo do cansaço da PdS em pacientes ambulatoriais deprimidos. Contudo, mais estudos envolvendo pacientes que tenham 10 respondido à PdS são necessários para verificar se a cafeína também não interfere nos resultados deste grupo.Introduction: Sleep deprivation (SD) has been used as an alternative approach to treat major depressive disorder (MDD), however the efficacy and the effectiveness needs studies with homogeneity and better delineament to strengthen the evidence based medicine to the use in the practical daily use. Besides, since the 1° puplication in 1971 of a case report, by Plug and Tölle, in that one patient with severe melancholic depressive disorder achieved remission in the next day after a total sleep deprivation. However his depressive sintomtology was back after the next night of sleep. Since this almost 40 years, a lot of papers were puplished, and the majority where case report, case reports and open trials with patients with MDD, bipolar depression without make difference between tipe I or II. Caffeine, due to its stimulating effect, could be an alternative to promote sleep deprivation. However, there are no data about its potential influence on the antidepressive effect of SD. The objective of this study is to assess the effect of caffeine on SD in non-psychotic patients with moderate to severe unipolar depression. Methods: Randomized, double-blind, crossover clinical trial comparing caffeine and placebo in moderate to severe depressed patients who underwent total sleep deprivation (SD). The patients were assessed with items of the Bond-Lader Scale, the 6-item Hamilton Depression Rating Scale (HAMD-6), and the Clinical Global Impression (CGI)-Severity/Improvement. Results: Twenty patients participated in this study. The patients who consumed caffeine presented the same score of energy before and after sleep deprivation (lethargicenergetic item of the Bond-Lader scale), while the patients in the placebo group had a reduced score of energy after sleep deprivation (p = 0.0045). There was no difference between the caffeine and placebo groups in the other items of the Bond-Lader scale. Conclusion: The combined use of caffeine and SD can be a useful strategy to keep the 12 patient awake without impairing the effect of SD on depressed outpatients. However, further studies involving patients who have responded to SD are needed in order to verify if caffeine also does not interfere with the results in this group.
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Hill, Elizabeth Anne. "Prevalence and treatment of obstructive sleep apnoea/hypopnoea syndrome in adults with Down syndrome." Thesis, University of Edinburgh, 2016. http://hdl.handle.net/1842/22917.
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Obstructive sleep apnoea/hypopnoea syndrome (OSAHS) is characterised by repeated cycles of upper airway obstruction during sleep, leading to diurnal symptoms. Individuals with Down syndrome (DS) are predisposed to this as the DS phenotype overlaps with OSAHS risk factors. Around 2-4% of the general adult population and 55% of children with DS have OSAHS but, to date, no large-scale study has assessed OSAHS prevalence or efficacy of treatment in DS adults. This study aimed to: 1) Systematically assess subjective and objective OSAHS prevalence; 2) Assess the effectiveness of continuous positive airway pressure (CPAP) in an adult DS population. Standard questionnaires including pictorial Epworth Sleepiness Scale (pESS) and Developmental Behaviour Checklist for Adults (DBC-A) were sent to UK adults aged ≥16yr with DS and their caregivers. All questionnaire responders were invited to undergo home polygraphy. Symptomatic adults with DS with ≥10 apnoeas/hypopnoeas per hour in bed (AH) on home polygraphy were invited to participate in a prospective randomised controlled trial (RCT) of CPAP v. lifestyle advice, with review at 1, 3, 6 and 12m. Participants in the lifestyle arm were offered CPAP at 1m. Standard measurements of sleepiness, behaviour, cognitive function and general health were undertaken. Standard statistical analyses were conducted, with significance set at p < 0.001 to control for multiple testing. Of 5270 questionnaires sent, 1105 responses were valid (21%). Responders (55% males) were overweight/obese young adults: mean BMI 29.0±6.8kg/m2; mean age 28±9 years. Women had a higher BMI (p < 0.0001), but collar size was greater in men (p < 0.0001). Mean pESS scores were broadly within the normal range (7±5/24). No significant gender differences in OSAHS symptoms were noted. Individuals with probable OSAHS had higher pESS and DBC-A scores, and significantly more symptoms of OSAHS. Subjective OSAHS prevalence was estimated at 35%. Of the 790 individuals invited, 149 underwent polygraphy, with 134 valid studies obtained: mean AH 21.8(10.9-42.7); mean oximetry desaturation index (ODI) 6.6(2.3-20.0). No significant gender differences were observed. Forty-two percent of participants met standard clinical diagnostic criteria for OSAHS. Twenty-eight eligible adults with DS (19 male) were randomised: age 28±9yr; BMI 31.5±7.9kg/m2; AH 28.6(14.8-47.9); ODI 7.3(1.8-21.9); pESS 11±6/24. Groups did not differ significantly at baseline. By 12m, 4 participants had withdrawn (all remaining participants on CPAP). The pESS (p=0.001), DBC-A Disruptive (p < 0.0001) and Kaufmann Brief Intelligence Test verbal subscale (p=0.001) scores improved significantly. This first large study of OSAHS prevalence in the adult DS population estimates a prevalence of 35-42% - around 10 times higher than in the general adult population. Sustained, significant improvements in sleepiness, cognitive function and behavioural/emotional outcomes with CPAP use over a 12m period were demonstrated during this first RCT of CPAP in adults with DS. A larger trial of CPAP in this population is warranted.
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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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Harris, Kristie M. "Insomnia, cognitive impairment, and decision-making among patients with heart failure: A randomized study of brief behavioral treatment for insomnia." The Ohio State University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=osu1531350697660812.
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Amato, Juliana Neide 1989. "Assessment of sleep bruxism, orthodontic treatment need, orofacial dysfunctions and salivary biomarkers in asthmatic children." [s.n.], 2014. http://repositorio.unicamp.br/jspui/handle/REPOSIP/289834.
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Orientador: Taís de Souza BarbosaTexto em inglês e português
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Resumo: Objetivo: Este estudo objetivou avaliar a presença de bruxismo do sono, maloclusões e disfunções orofaciais bem como os níveis salivares de cortisol e alfa-amilase em crianças asmáticas. Material e Métodos: A amostra consistiu de 108 crianças, de ambos os gêneros, com idade entre sete e nove anos, selecionados da Policlínica Santa Teresinha Doutor Antonio Haddad Dib (grupo com asma, n=53) e das escolas públicas (grupo controle, n=55), ambos do município de Piracicaba, SP, Brasil. O diagnóstico de bruxismo do sono foi confirmado pelo relato dos pais sobre ranger os dentes (pelo menos três vezes por semana) e pela presença de facetas de desgaste em incisivos e/ou molares permanentes. O Índice de Necessidade de Tratamento Ortodôntico ¿ Componente Dentário (IOTN-DHC) foi utilizado para avaliar a oclusão. As disfunções orofaciais foram avaliadas pela versão Brasileira do Nordic Orofacial Test-Screening (NOT-S). O cortisol salivar (?g/dl) e a alfa-amilase (U/ml) foram analisador por kit enzimaimunoensaio. Os dados foram expressos em "resposta ao acordar" (RA), calculada pela diferença entre os valores imediatamente ao acordar e 30 minutos após acordar, e "declínio diurno" (DD), calculado pela diferença entre os valores 30 minutos após acordar e antes de dormir. Os dados foram analisados utilizando os testes Shapiro Wilk/Kolmogorov-Smirnov, Qui-quadrado, teste t não pareado/Mann-Whitney e teste t pareado/Wilcoxon. Resultados: O bruxismo foi mais prevalente em crianças com asma do que controles (47,2% vs. 27,3%, p<0.05). Mais de metade das crianças com asma apresentaram gravidade intermitente (50,9%, p<0.001). O grupo com asma apresentou maiores escores do NOT-S total e entrevista do que o grupo controle (p<0.05). Sintomas de disfunções orais relacionados a (I) Função Sensorial e (IV) Mastigação e Deglutição foram mais frequentes em crianças com asma do que controles (p<0.05). A RA de cortisol salivar no final de semana foi significativamente maior no grupo com asma do que controles (p<0.05). No grupo controle, o DD de cortisol salivar foi significativamente maior em dia de semana do que no final de semana (p<0.05). Conclusões: A presença de asma em crianças esteve associada com sinais e sintomas de bruxismo do sono, percepção negativa das funções sensoriais, mastigação e deglutição e maior concentração de cortisol salivar no final de semana
Abstract: Objective: This study aimed to evaluate the presence sleep bruxism, malocclusions and orofacial dysfunctions as well as the salivary levels of cortisol and alpha-amylase in asthmatic children. Material and Methods: The sample consisted of 108 children of both genders in the age-range from seven to nine years, selected from Policlinic Santa Teresinha Doutor Antonio Haddad Dib (asthma group, n=53) and from public schools (control group, n=55), both of Piracicaba, SP, Brazil. Sleep bruxism diagnosis was confirmed by parental report of grinding sounds (at least three times a week) and the presence of shiny and polish facets on incisors and/or first permanent molars. The Index of Orthodontic Treatment Need ¿ Dental Health Component (IOTN-DHC) was used for occlusion evaluation. Orofacial dysfunctions were evaluated using the Brazilian Portuguese version of the Nordic Orofacial Test-Screening (NOT-S). Salivary cortisol (?g/dl) and alpha-amylase (U/ml) were assayed using enzyme immunoassay kit. These data were expressed as ``awakening response¿¿ (AR), calculated as the difference between levels immediately after awakening and 30 min after waking, and "diurnal decline" (DD), calculated as the difference between levels at 30 min after waking and at bedtime. Data were analyzed using Shapiro-Wilk/Kolmogorov-Smirnov, Chi-square, unpaired t test/Mann-Whitney and paired t/Wilcoxon tests. Results: Sleep bruxism was more prevalent in children with asthma than controls (47.2% vs. 27.3%, p<0.05). More than half of the asthmatic children had intermittent severity (50.9%, p<0.001). The asthma group had higher scores of NOT-S total and interview than control group (p<0.05). Symptoms of oral dysfunctions related to (I) Sensory Function and (IV) Chewing and Swallowing were more frequent in children with asthma than controls (p<0.05). Salivary cortisol AR on weekend was significantly higher for asthma group than controls (p<0.05). In control group, salivary cortisol DD was significantly higher on weekday than weekend (p<0.05). There were no significant differences in alpha-amylase values in and between groups. Conclusions: The presence of asthma in children was associated with signs and symptoms of sleep bruxism, negative perception of sensory, chewing and swallowing functions, and higher concentrations of salivary cortisol on weekend
Mestrado
Odontopediatria
Mestra em Odontologia
50
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