Dissertations / Theses on the topic 'Sleep – Health aspects'

Background Insomnia is a common and increasing illness among general population all over the world. With insomnia, patients would more likely to have physical, social dysfunction and mood disorders, and even have increased risk of accidents. Therefore, identifying the harm of insomnia and improving the quality of life of patients are very important. Objectives The objective of this systematic review is to evaluate quality of life in patients affected with insomnia. Particularly focuses on the following two question: 1) How insomnia impact quality of life in patients with insomnia. 2) What factors affect quality of life among people with insomnia, such as demographic factors, physical and psychological factors. Methods Systematic reviewing the articles from 1990 to 2013 in PubMed and Medline, which evaluated the quality of life in patients affected with insomnia, using the keywords “insomnia” AND “quality of life”. Results and Discussion There were 9 articles have been included in this review. The year were ranged from 1998 to 2012,8 out of 9 papers had the average age ranged from 42-57 year old. Insomnia significantly related to all of the eight domains and PCS,MCS of QOL negatively, and both of the severity of insomnia and the number of sleep problems have negative impact on QOL. Moreover, regarding the factors which affect QOL of patients, older, female, not married, smoking, drinking, psychiatric disorders and without treatment were associated with lower QOL. Furthermore, regarding the future directions, in Hong Kong the application of the results in this review is appropriate but still need more studies which evaluating the associated factors of insomniacs’ QOL with validated Chinese version QOL measures. Conclusion There was a negative relationship between insomnia and quality of life, and the severity of insomnia and the number of sleep problems had negative impact on quality of life. Particularly, older, female, single statuse, smoking, drinking, psychiatric disorders had negative influence on patients’s QOL. Regarding the control strategies, using appropriate medical treatment under physician guidance, consultation of mental disorders, increasing the public awareness of the harm of insomnia play a pivotal role in reduce the impairment of insomnia.
published_or_final_version
Public Health
Master
Master of Public Health

Few studies to date have investigated associations among work, family, and sleep outcomes. The following dissertation includes three studies that attempt to further understanding of such relationships by utilizing data from information technology workers within the Work, Family, and Health Network study. In Study 1, which is published in the Journal of Occupational Health Psychology, associations between work-to-family conflict, family-to-work conflict, family-supportive supervisor behaviors, and sleep outcomes, measured both subjectively and objectively, are examined in a cross-sectional sample. Study 2 investigates associations among work-to-family conflict, family-supportive supervisor behaviors, and subjective sleep outcomes within a seven-day daily diary framework. Furthermore, workplace characteristics are examined as moderators of these relationships. Study 3 explores the effect of a work-family intervention on sleep outcomes at the 18-month follow-up time point, in addition to mediators of the intervention effect on sleep outcomes over time.

The health-promoting influence of high-quality, supportive close relationships has been extensively documented, yet the mechanisms of this effect are less well-understood. Leading researchers have galvanized the field to test particular relationship processes and the mediating psychological processes they facilitate to pinpoint how close relationships exert their salutary effects. The purpose of this study was to investigate the influence of the intimacy process on health outcomes of sleep and pain and if this effect depends on the facilitation of psychological processes in a sample of veterans and spouses (collectively called military-connected couples; N=147). Sleep problems are highly prevalent among military-connected couples and pain is highly prevalent among veterans. Results of actor-partner interdependence models revealed that perceived partner responsiveness (PPR), a core component of the intimacy process, was found to predict sleep for military-connected couples and to predict pain for veterans. Indirect effects of PPR on sleep via the psychological process of downregulation of vigilance for military-connected couples emerged. The indirect effect of PPR on pain via the psychological process of emotion-regulation was found for veterans only. Partner effects were observed for veteran PPR on spouse positive affect. Overall, greater PPR was associated with positive health outcomes for military-connected couples. The implications of this study include further establishing the intimacy process as a particular mechanism by which close relationships promote health as well as providing insights for holistic interventions for sleep problems and pain in military-connected couples.

Introduction: Dementia is an age-associated neurodegenerative disorder characterized by a progressive loss of neuro-cognitive function and the emergence of a wide variety of behavioral symptoms. Alzheimer's disease (AD) is the most common types of dementia. Sleep disturbances in patients with Alzheimer's disease is common and previous studies from North America, Europe and Japan reported light therapy could improve the sleep circadian rhythm ( rest-activity) disturbances in AD. However, there was no previous Chinese study on light exposure and sleep quality nor the circadian rhythm in Chinese Alzheimer's disease patients. Objective : The objective of the present study was to investigate the association of light exposure intensity with the quality of sleep and behavioural symptoms in Chinese Alzheimer’s disease (AD) patients Method: This was a cross-sectional observational study. 203 Chinese elderly patients with Alzheimer's disease were recruited from the Memory Clinic in Queen Mary Hospital, the University of Hong Kong, from July 2014 to December 2014. Socio-demographic data and comorbid diseases information were collected from all subjects. Their sleep qualities, quantities and conditions of light exposure were recorded with a sleep logbook and light meter. Their cognitive function, disturbing behaviour, depressive mood and quality of life scales were assessed by a semi-structured questionnaire. Light exposure intensity measured by Light meter (Model SDL 400). Measure for cognitive function were the Abbreviated Mental Test (AMT), Behavioral symptoms measured by the Neuropsychiatric Inventory (NPI) and mood by Geriatric Depression Scale. (GDS-15) The association of outdoor or indoor light exposure with sleep quality and quantities were analyzed by descriptive, bivariate and multivariate analyses. Main outcome measures: The main outcome measure was the sleep quality and quantities of patient, measured by Pittsburgh Sleep Quality Index. (PSQI) Results: 203 subjects (60 males and 143 females) were recruited. 70.4 % of the studied subjects were females. Male to female ratio is 1:2.38. Mean age of them was 81.6 years. The mean (SD) scores of the recruited were: AMT = 4.5 (2.9); PSQI = 6.9 (3.4); NPI =14.4 (17.2); GDS-15= 4.3 (2.8); QOL-AD (patients) = 30.7 (4.9); QOL-AD (caregivers) = 29.5 (4.7) respectively. In bivariate analysis, the Global PSQI score was significantly associated with the morning and afternoon outdoor light exposure. (r = -0.634 and -0.466, respectively) For the total light exposure and mean light exposure, both of them showed strong significant negative correlation with Global PSQI score. (r = -0.769 and -0.769 respectively). Mean (SD) light exposure per day for morning and afternoon outdoor setting were 2372.9 lux (2564.7) and 1090.8 lux (1894.6) respectively. Mean(SD) light exposure per day was 1196.7 lux (866.1) Gender identity showed significant correlation with Global PSQI score (r = 0.034). Global PSQI score was significantly associated with the NPI total score (r = 0.261, p<0.001), the GDS-15 score (r = 0.336, p<0.001), the QOL-AD for patients (r = -0.257, p<0.001), and the QOL-AD for caregivers. (-0.313, p<0.001) In multivariate analyses, using general linear models, the Global PSQI score was highly independent associated with the total light exposure (p=0.000), and significantly associated with the NPI score and Gender (p = 0.011 and 0.021), after adjusting for potential confounders in bivariate analysis. (i.e. gender, activity of daily living status, hypertension and Chronic obstructive airway disease). Confounding factors were NPI and gender. Conclusion: In the present study, We found the intensity of natural light exposure was related to good sleep quality in older Chinese Alzheimer’s disease patients with age 65 years and above in Hong Kong as well as lesser episode of behavioural symptoms. Hence, daily outdoor light exposure is highly recommended for persons with Alzheimer’s disease.
published_or_final_version
Medicine
Master
Master of Medical Sciences

The study of fatigue in the health and transport sectors has predominantly been focused on night shift or day shift operations. This study has been applied to the hours of operation of Ambulance Officers who perform both night and day shifts, while also being required for on-call. The Officer on-call is on stand-by between shifts, to be available to respond for duties from the completion of one shift until the commencement of the next, usually a ten-hour shift. Studies of a similar focus have not been identified so a comparison of these specific findings has not been possible. However trends in sleep debt, peaks in the drive for sleep and recognition of fatigue are consistent with findings of other studies. The initial impetus for the study, to compare the degree of fatigue between air and road long distance transports, provided no significant output. The data collected did however provide clear identification of the various precipitators of fatigue in the Ambulance Officers workplace. To adequately address the hazard of fatigue, the introduction of integrated systems that address sleep deprivation and circadian cycles are required to aid in managing fatigue. The identification and control of fatigue in the workplace is to the benefit of both the employer and the employee. The study consists of fourteen Ambulance Officers utilising both road and helicopter transport mechanisms to undertake transfers to major medical facilities. The Officers were required to answer questionnaires at the completion of each shift to record the precipitators and indicators of fatigue. Findings indicate there is no significant difference between the levels of fatigue induced by air or road transport. The influences of the time of day and the degree of sleep deprivation are however indicative of fatigue in the individual. Day shifts accounted for 70% of data collected with results of fatigue as more prevalent in the 1501-1800 hours period, coinciding with a trough in performance and alertness. Their adherence to non-performance indicators suggests an unwillingness to identify anomalies in their performance or an inability to self-determine a level of fatigue. Performance of duty during "on-call periods" induces sleep deprivation that may develop into a sleep debt if the restorative sleep is not obtained. Individuals generally function for 16-hollrs and sleep for 8-hours, to replenish the organism. When this ratio is redistributed the individual develops a sleep debt and left unaddressed develops into fatigue. Performance of long distance transports and reliance on on-call officers removes their ability to address their sleep debt. The introduction of rescheduling of transports and fatigue breaks reduces the influence of fatigue in the Ambulance Officers workplace. The magnitude of fatigue is only evident when the consequences are realised. Officers performing transfers on empty expressways can wander on the lanes with only a fright to remember the experience. However a patient, of the belief that they are safe when in an Ambulance, will have more to remember if the expressway has a car in the other lane. Fatigue is evident in the Ambulance Officers workplace and remedies to address it, which incorporate a Safety Management System, have been outlined in the recommendations of the study.

The majority of literature on the work-family interface has focused on, and provided evidence of, the conflict associated with engagement in both work and family roles (Eby, Casper, Lockwood, Bordeaux, & Brinley, 2005). Research examining the positive aspects of work and family participation remains limited. The current study investigated how work-family positive spillover is transferred between members of the supervisor-employee dyad and subsequently how this affects employee sleep outcomes. It was hypothesized that work-to-family affective positive spillover experienced by supervisors would crossover to employees and increase their experiences of work-to-family affective positive spillover. In turn, this would allow for better employee sleep. It was also proposed that these relationships would depend on the level of employee perceptions of family-supportive supervisor behaviors (FSSB), such that higher levels of FSSB would result in higher levels of employee positive spillover and better employee sleep. As part of a larger study, survey data were collected in a sample of 696 workers supervised by 180 managers in the information technology sector. Contrary to expectations, results indicated that supervisor positive spillover was negatively related to employee positive spillover. Furthermore, FSSB moderated the association between supervisor positive spillover and employee sleep duration, such that the relationship between supervisor positive spillover and employee sleep duration was positive under high levels of FSSB, but negative under low levels of FSSB. Again, this finding was contrary to expectations. Alternative explanations are discussed.

Aims. This research investigated the health status (e. g. weight perception and BMI, mental health conditions and general health complaints), and the lifestyle behaviours (e. g. smoking, alcohol consumption, and dietary behaviour) of Libyan higher education students (HES). The objectives were to compare their health status and lifestyle behaviours in the different regions of Libya; and to compare Libyan HES with those from other countries. In addition to this, the study aimed to determine if any association existed between demographic and academic variables and health and lifestyle variables. Purpose. The purpose of the study was to provide baseline data required by university health programmes in Libya for planning related to the health needs of students. Methods. The sample consisted of 1300 higher education students from different higher education institutes and different disciplines. The self-administered health questionnaire used included questions on health and health-related behaviours and their associated social and economic factors. It was conducted during lecture time. Data were analysed with SPSS. Binary logistic regression analysis was used to identify sociodemographic variables associated with health and lifestyle variables. Results. In this sample of students, the prevalence of overweight was higher than the prevalence of underweight and obesity (14.5%, 18.2%, and 4.2% respectively), and 40% of students were trying to lose weight. High rates (45%) of depressive symptoms were found, however; overall 8.8% of respondents reported being diagnosed with anxiety, and 4.3% with depression. The findings of this study also indicated that students reported high levels of subjective health complaints. The majority of students reported that their physical activity levels were insufficient; only 5% of students met the international recommended levels of physical activity. Only one in ten students was found to be consuming an adequate amount of fruit and vegetables (at least five times a day). About 6% of the students self-identified themselves as current smokers, and the results revealed that smoking was a male phenomenon in Libya. Alcohol consumption is not very common among Libyan students, and only 3.5% reported drinking alcohol; overall, 1.6% reported using drugs, and all students who reported using drugs reported cannabis use. A gender difference was noticeable and consistent across types of complaints; depressive symptoms, dietary behaviour, physical activity, smoking and alcohol and drug consumption. Females reported significantly worse health status than males in terms of health complaints, and depressive symptoms. Males reported higher levels of physical activity and higher levels of smoking and alcohol and drug consumption than females. Students in North Libya showed the highest levels of physical activity, and also the highest levels of smoking, alcohol and drug consumption, whereas students in East Libya had the highest levels of fruit and vegetable consumption. Logistic regression analysis revealed substantial associations between females and depressive symptoms, dietary behaviour and higher levels of complaints, and also between social support and anxiety and depression. The comparisons with other survey data showed that the Libyan rates of overweight and obesity were similar to rates reported amongst students at Alexandria University in Egypt, and much higher than those reported in other countries such as Poland, Japan and Korea. Depressive symptom rates were similar to the rates reported among university students in Bulgaria and higher than those reported in Germany, Denmark and Poland with respect to male students, and Libyan HES reported lower rates of health complaints than students in certain other European countries. In addition, the levels of fruit and vegetable consumption amongst Libyan HES were lower than those reported amongst Australian students. The prevalence of physical activity levels was lower than that reported amongst university students in the United Arab Emirates. The results of this study clearly indicate that the prevalence of smoking and alcohol and drug consumption among students in Libya was " lower than among those from other Arabic countries such as the United Arab Emirates and Saudi Arabia. Conclusion. Efforts to promote a healthy lifestyle among students are needed and should place greater emphasis on physical activity and increased fruit and vegetable consumption, and on discouraging smoking and body dissatisfaction. There is a need for future research on student health, which should be carried out with a larger sample group to develop a national standardized instrument. Future research will be helpful for accurately identifying perceived barriers to, and recommending changes to enhance, physical activity among HES.

The thesis describes investigations into two contrasting aspects of Slow Wave Sleep (SWS). The first is a laboratory based study of the effects of passive heating on the subsequent SWS of six healthy subjects, and the second employs home sleep recording techniques to investigate the prevalence and characteristics of the 'alpha sleep anomaly' in volunteers from the local community.

Cardiovascular disease is the leading cause of death in the United States. Chronic short sleep duration is also a significant public health problem and has been linked to several markers and outcomes of cardiovascular disease. To date, inconsistency of assessments of sleep duration and insufficiency, use of covariates, and cardiovascular disease measurement across studies limits strong conclusions about the relationship between sleep duration, sleep insufficiency, and cardiovascular disease. The current study examined the association between sleep duration, sleep insufficiency, and a marker of preclinical coronary heart disease (i.e., carotid intima-media thickness) in a community sample using a cross-sectional design. Some evidence for a relationship between sleep duration and cIMT was found, with longer sleep duration predicting higher cIMT in some segments. Additionally, the interaction between sleep duration and sleep insufficiency was significant. However, neither of these effects were significant after adjusting for age and in some cases race/ethnicity, suggesting demographics may explain this association. Actigraphy and sleep diary duration assessments demonstrated significantly different correlations with cIMT in some segments, suggesting the nature of the assessment method may impact the strength or direction of the relationship between sleep duration and cIMT. Limitations and future directions are discussed.

Le principal objectif de ce travail est l’étude de l’influence de la pesanteur sur la mécanique

respiratoire et le contrôle de la respiration, ainsi que sur les interactions cardio-respiratoires pendant les différents stades du sommeil.

Le chapitre introductif présente le contexte général et les objectifs de la thèse. Des sections abordant le sommeil, la respiration, et l’interaction cardio-respiratoire y sont présentées, résumant l’état actuel des connaissances sur les effets de la pesanteur sur chacun de ces systèmes.

Dans le deuxième chapitre, l’expérience “Sleep and Breathing in microgravity”, qui constitue la source des données à la base de ce travail, est présentée en détail.

L’étude des signaux de longue durée requiert avant tout de disposer d’outils performants

d’analyse des signaux. La première partie de la thèse présente en détail deux algorithmes :un

algorithme de détection automatique d’événements respiratoires (inspiration / expiration)

basé sur des réseaux neuronaux artificiels, et un algorithme de quantification de l’amplitude

et de la phase de l’arythmie sinusale pendant le sommeil, utilisant la méthode des ondelettes.

La validation de chaque algorithme est présentée, et leur performance évaluée. Cette partie

inclut aussi des courtes introductions théoriques aux réseaux de neurones artificiels ainsi

qu’aux méthodes d’analyse temps–fréquence (Fourier et ondelettes).

Une approche similaire à celle utilisée pour la détection automatique d’événements respiratoires a été appliquée à la détection d’événements dans des signaux de vitesse du sang

dans l’artère cérébrale moyenne, mesures obtenues par Doppler transcrânien. Ceci est le

sujet de la thèse annexe.

Ces deux algorithmes ont été appliqués aux données expérimentales pour extraire des

informations physiologiques quant à l’impact de la pesanteur sur la mécanique respiratoire et

l’interaction cardio-respiratoire. Ceci constitue la deuxième partie de la thèse. Un chapitre

est consacré aux effets de l’apesanteur sur la mécanique respiratoire pendant le sommeil.

Ce chapitre a mis en évidence, pour tous les stades de sommeil, une augmentation de la

contribution abdominale en microgravité, suivi d’un retour progressif vers des valeurs observées avant le vol. L’augmentation initiale était attendue, mais l’adaptation progressive

observée ne peut pas être expliquée par un effet purement mécanique, et nous suggère la

présence d’un mécanisme d’adaptation central. Un deuxième chapitre présente les résultats

comparant l’arythmie sinusale pendant le sommeil avant le vol, en apesanteur et après le retour sur terre. Le rythme cardiaque pendant le sommeil dans l’espace présente une moindre

variabilité. Les différences NREM–REM observées sur terre pour les influences vagales et sympathiques sont accentuées dans l’espace. Aucun changement significatif n’est présent pour

le gain et la différence de phase entre les les signaux cardiaque et respiratoire en comparant

le sommeil sur terre et en apesanteur.

La dissertation termine par une discussion générale du travail effectué, incluant les prin-

cipales conclusions ainsi que les perspectives qui en découlent.
Doctorat en Sciences biomédicales et pharmaceutiques
info:eu-repo/semantics/nonPublished

Orientador: Mônica Fernandes Gomes
Banca: Albano Porto Cunha Júnior
Banca: José Benedito Oliveira Amorim
Resumo: Objetivo: Esta pesquisa analisou os aspectos biomédicos da doença de Alzheimer, considerando as condições gerais e bucais, conduta terapêutica, propriedades físico-químicas da saliva, presença de distúrbios do sono e capacidade funcional em relação aos cuidados pessoais e mobilidade. Metodologia: Trinta e nove (39) pacientes com doença de Alzheimer, entre 62 e 100 anos, sexo masculino e feminino, participaram deste estudo. As manifestações clínicas gerais e bucais foram investigadas. As propriedades físico-químicas da saliva, incluindo a taxa de fluxo salivar, valor de pH e a capacidade tampão, e a os níveis de cortisol salivar diurno foram determinadas. Em adição, a sonolência excessiva diurna, o risco de Apneia Obstrutiva do Sono (AOS) e o desempenho das atividades básicas da vida diária (ABVD) foram analisadas a partir da aplicação dos questionários Escala de Sonolência de Epworth (ESE), STOP-BANG e Índice de Barthel Modificado (IBM), respectivamente. Os resultados obtidos foram submetidos à uma análise exploratória, utilizando estatística descritiva e inferencial. O nível de significância adotado foi de 5%. Conclusão: os transtornos mentais e os distúrbios circulatórios foram as patologias sistêmicas mais encontradas nos pacientes com DA, sendo os homens mais comprometidos. A maioria dos pacientes eram dentados (com presença de doença periodontal, raízes residuais e cárie). Todos os pacientes com alto risco para AOS apresentaram distúrbios circulatórios. O uso de medicame... (Resumo completo, clicar acesso eletrônico abaixo)
Mestre

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Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES
This study provides to evaluate the association between the psychosocials aspects of work and sleep quality between professors of a public university from Bahia. It?s a epidemiologic study, cross-sectional, realized with 423 professors randomly selected for department and kind of employee. For date collection, used a standardized questionnaire, private and self-applicable, constituted for nine questions blocs. The psychosocials aspects were availed for Job Content Questionnaire (JCQ) and the sleep quality was measured for scale Mini-Sleep Questionnaire (MSQ).The covariables of interest were that belonging to blocs with general information about the work, the habits of life and health and the general identification. Realized a descriptive analyze, bivariate and multivariate. This study, the prevalence estimated of bad sleep quality was 61,3% . The difficult to sleep, wake up tired, wake up headache and don?t have time to sleep during the day were the complaints more frequently between the professors. They were statistically associated with bad sleep quality, the variations: irregular time and/or insufficient for the practice of recreation activity, sleep hours ? 6 hours, musculoskeletal pain, headache and high requirement experience of Demand-Control Model (DMC). The results indicate the psychosocial aspects of work are associated factors with the bad sleep quality. On analyze of effects modifiers, it was found that the practical variable of physical activity modified the main association in test. In the final analyze, the high exigency and passive work were associate experience to bad sleep quality between the professors didn?t practice physic activity. However, is possible to confirm the psychosocial aspects of work are related to negative effects on sleep quality of professors.
Esta disserta??o objetiva avaliar a associa??o entre os aspectos psicossociais do trabalho e a qualidade do sono entre docentes de educa??o superior de uma universidade p?blica na Bahia. Trata-se de um estudo epidemiol?gico, de corte transversal, realizado com 423 docentes aleatoriamente selecionados por departamento e tipo de v?nculo empregat?cio. Para a coleta de dados, utilizou-se um question?rio padronizado, an?nimo e autoaplic?vel, constitu?do por nove blocos de quest?es. Os aspectos psicossociais do trabalho foram avaliados pelo Job Content Questionnaire (JCQ) e a qualidade do sono foi mensurada pela escala Mini-Sleep Questionnaire (MSQ). As covari?veis de interesse foram aquelas pertencentes aos blocos com informa??es gerais sobre o trabalho, os h?bitos de vida e sa?de e a identifica??o geral. Empregou-se procedimento de an?lise descritiva, bivariada e multivariada. Neste estudo, a preval?ncia estimada de qualidade do sono ruim foi de 61,3%. A dificuldade de adormecer, acordar cansado/a, acordar com dor de cabe?a e n?o ter tempo para dormir durante o dia foram as queixas mais frequentes entre os docentes estudados. Mantiveram-se estatisticamente associadas com a qualidade do sono ruim, as vari?veis: tempo irregular e/ou insuficiente para a pr?tica de atividades de lazer, horas de sono ? 6 horas, dor musculoesquel?tica, dor de cabe?a e a experi?ncia de alta exig?ncia do Modelo Demanda-Controle (MDC). Os resultados indicam que os aspectos psicossociais do trabalho s?o fatores associados com a qualidade do sono ruim. Na an?lise de modificadores de efeito, constatou-se que a vari?vel pr?tica de atividade f?sica modificava a associa??o principal sob teste. Na an?lise final, a alta exig?ncia e o trabalho passivo foram experi?ncias associadas ? qualidade do sono ruim entre os docentes que n?o praticavam atividade f?sica. Contudo, ? poss?vel confirmar que os aspectos psicossociais do trabalho relacionam-se a efeitos negativos na qualidade do sono dos docentes de educa??o superior.

L'objectif était de développer un outil individuel de management de la fatigue. Cet outil, dénommé Scextan®, a été conçu sous la forme d'une application informatique. Pour cela, plusieurs étapes de développement et de validation ont été franchies. Dans un premier temps, nous avons choisi d'observer le sommeil des navigateurs à la voile en solitaire qui doivent gérer une forte privation de sommeil. Les résultats ont montré que ces marins sont soumis aux mêmes principes de régulation de sommeil que l'adulte sain. Nous avons retenu ces sujets comme population expérimentale. Dans un deuxième temps, nous avons validé le logiciel Scextan® pour la mesure du rythme veille-sommeil qui s'est révélée plus précise qu'avec un agenda de sommeil manuscrit. Puis, nous avons évalué la pertinence de l'implémentation d'un modèle de prédiction mathématique de performances dans Scextan®. Chez des marins en course, le modèle a su prédire 70% de la variance des mesures. Dans un dernier temps, Scextan® a été proposé aux skippers de la course transatlantique "Route du Rhum". Seul le vainqueur de la course a utilisé de façon quasi systématique le logiciel Scextan® pour gérer son état de forme. L'agenda de Sommeil Interactif Scextan® est toujours en cours de développement, mais a déjà démontré qu'il pouvait être un outil de recherche à part entière, et qu'il tendrait rapidement à devenir un outil pédagogique
The goal of the thesis was to develop an individual fatigue management tool called Scextan® and designed as a software application. The development of this system involved several research and validation steps. We first describe sleep patterns of single-handed sailors, who have to manage severe sleep deprivation. Results suggested that single-handed sailors are subject to the same principles of sleep regulation as healthy adults and we choose these subjects as our mains test population. In a second step, we developed and validated the Scextan® software application. Results revealed that Scextan® is more accurate than a paper-based sleep diary. The third study was to measure fatigue in single-handed ocean race and compare the results with a mathematical prediction model of performances, which was able to predict 67% of the measured fatigue. Lastly, skippers of the 2010 "Route du Rhum" single-handed transatlantic race were offered use of Scextan®. The race winner was the only sailor to use it intensively to manage and rationallyanticipate his state of alertness. Although Scextan® is still being improved, it has already proved itself to be a valuable research tool and is on the way to becoming an individual management tool

Sleep has been recognized as a major determinant of physical and mental health. Emerging studies suggested that social and built environments should be considered as important determinants of sleep health, however causal mechanisms between neighborhood factors and sleep health still remain unclear. The proposed dissertation is a connected set of papers including a systematic review and longitudinal studies investigating associations between neighborhood stressors and sleep health as well as potential causal mechanisms via psychological distress and physical activity. The longitudinal studies employed comprehensive measures of neighborhood characteristics and sleep health along with g-estimation and mediation analysis techniques. Neighborhood social and built environments may contribute to poor sleep health, particularly in low-income and racial/ethnic minority neighborhoods, and psychological distress can be a salient pathway linking these neighborhood characteristics and sleep health. Based on our findings, interventions to improve sleep should target modifiable factors and enhance neighborhood environments. These sorts of strategies have the potential to improve not only sleep health but also other health outcomes.

University attendance includes various activities and experiences that can have a unique impact on psychosocial development and adult health behaviors, and can influence life course outcomes such as short- and long-term health and quality of life. College attendance and health are cyclical and reinforcing factors. Healthier students do better while at college, which allows them to effectively progress through university. College graduation is closely associated with improved health status in later life. In addition, students' personal development as part of their transition to adulthood during college, which includes psychosocial and interpersonal growth, is associated with greater gains in health and personal success in later life. Identifying the factors associated with enhanced health status while in college would ensure that a greater number of the overall population has access to the potential health benefits of progressing through and graduating from an institution of higher education. Because health behaviors can have a significant impact on how well a student progresses through college, as well as future quality of life, colleges and universities should recognize the role health is playing in the student experience. This study explored the connection of how factors such as student sub-group participation, health behaviors, and particular negative experiences affect the health status of college students attending a large, urban, top-tier university. It investigated which students were at an increased risk for negative mental health symptoms and overall lower general health and how students' participation in various groups (student athletes, students who are members of sororities and fraternities, and students who volunteer) is associated with health behavior (alcohol and other drug use, sexual behavior, and sleep), negative experiences (bias/discrimination and interpersonal violence), and health outcomes. In addition, the study analyzed how personal development at college mediates those relationships. This study is based on non-experimental cross-sectional survey data from the National College Health Assessment that was collected in collaboration with the American College Health Association at Columbia University (CU). All enrolled undergraduate students at CU in Columbia College or the School of Engineering and Applied Sciences in the spring semester of 2009 (n=5708) were invited to participate in the survey, and 31.8% of the sample responded. This research used the Baron and Kenny model to examine the mediation effects of personal development on general health and mental health via a series of bivariate and regression analyses. While the overall general and mental health of respondents was good, particular groups were less likely to report overall excellent or very good general health and more likely to report mental health symptoms. Negative experiences and health behaviors varied significantly between student sub-groups. Health behaviors and negative experiences were predictive of overall general health and mental health symptoms. Sleep, drug use, and experiences of bias/discrimination and interpersonal violence (IPV) were most predictive of health. Personal development was found to partially mediate the relationship between IPV, sleep and overall general health. In addition, personal development was found to partially mediate the relationship between IPV, drug use other than or in addition to marijuana, and sleep and mental health symptoms. The findings from this study suggest that college and university administrators should consider directing resources into targeting particular groups of students for focused health promotion interventions related to specific topics as a method for improving overall general health and reducing mental health symptoms of students. College and university administrators are encouraged to consider the role of personal development as a unique factor in improving student health.

Many studies have shown that short sleep duration and/or poor sleep quality is associated with increasing rates of cardiovascular (CVD) mortality and morbidity. One hypothesized explanation for this association has been that sleep loss is a type of chronic stress that induces dysregulation of biological systems that ultimately increase the risk of CVD. One biological system that has been thought to link sleep loss and CVD is the hypothalamus-pituitary-adrenal (HPA) axis. A number of studies using small or convenience samples have addressed the effects of sleep deprivation on cortisol. Only a few studies have examined the association of habitual short sleep duration and/or poor sleep quality with changes in the diurnal cortisol in population based-samples; those studies vary in their methodology and in findings. Another biological system that has been thought to link sleep loss and CVD is the autonomic nervous system (ANS), through overactivation of the sympathetic nervous system (SNS) and/or probably a withdrawal of the parasympathetic nervous system. Experimental studies have shown an association between the sleep stages and markers of the sympathetic system. However, very few studies of habitual sleep duration/sleep quality and ANS markers have been conducted. Even fewer studies have examined the association of habitual sleep duration and/or sleep quality and ANS responses to a stress challenge in a population-based sample. The findings again have been inconsistent probably due to the use of different methodology and different samples. This dissertation used measures of salivary diurnal cortisol as well as cortisol responses to a stress challenge protocol to assess the relationship of habitual sleep duration and/or sleep quality with diurnal cortisol profile in natural conditions and in response to a stress challenge protocol in a laboratory setting. Diurnal cortisol was assessed from up to 16 samples of salivary cortisol for two days. Cortisol responses to a stress challenge were assessed from four salivary samples taken during the stress challenge that was performed in a different day than the diurnal cortisol collection. To examine the relationship of habitual sleep duration and/or sleep quality and markers of the ANS, this dissertation used continuous cardiovascular measures (heart rate and heart rate variability) and four salivary amylase samples obtained during the stress challenge. The stress challenge included mental stress and orthostatic stress. Sleep duration and sleep efficiency (an objective measure of sleep quality) were assessed from 7-day actigraphy and sleep diaries. Insomnia symptoms (a subjective measure of sleep quality) were also assessed using a questionnaire that included the Women’s Health Initiative Insomnia rating scale (WHIIRS). We used mixed models so as to account for the repeated measures of diurnal salivary cortisol levels as well as the responses (reactivity and recovery) to the stress challenge tests. Chapter 1 presents an introduction to this dissertation discussing the relationship between short sleep duration and/or poor sleep quality and CVD morbidity and mortality. Chapter 2 presents a systematic literature review of studies of the association between habitual sleep duration and/or sleep efficiency and markers of neuro-endocrine systems: HPA and ANS. These are plausible mechanisms that link short and/or poor sleep to CVD morbidity and mortality. Chapter 3 presents our analyses of the relationship between short sleep duration and/or poor sleep quality and features of the diurnal cortisol. We hypothesized that those participants whose slept < 6 hours per night or whose sleep efficiency was < 85% would have higher cortisol levels on awakening, flatter cortisol awakening responses (CAR), and higher evening cortisol levels than participants who slept longer or slept better. We found that short sleepers had higher evening cortisol than the longer sleepers and that this association persisted after the adjustment for several known confounders. In chapter 4, we examined how the same groups of participants responded in terms of hormones (cortisol and amylase) and cardiovascular indices (heart rate (HR) and HR variability (HRV)) to a stress challenge test. We hypothesized that those participants who slept for a shorter time or whose sleep was of poorer quality would have more exaggerated responses to and less recovery from a stress challenge test than participants who slept longer or slept better. We found that participants with insomnia had exaggerated high frequency-HRV (HF-HRV) orthostatic reactivity. In an extended analysis, we found that participants who slept less than 7 hours/night had exaggerated heart rate reactivity to a mental stress test compared to participants who slept 7 or more hours/night, but this association was attenuated after adjustment for naps. Paradoxically, we also found that participants who slept less than 7 hours had higher HF-HRV recovery from mental stress compared to longer sleepers (≥7 hours). Short sleep duration or low sleep efficiency was not associated with cortisol or amylase responses to the stress challenge protocol. These findings suggest that sustained high evening cortisol levels and cardiovascular responses to a stress challenge may be among the mechanisms linking short/poor sleep and CV disease.

Submitted in fulfilment of the requirements for the Degree of Masters in Technology: Environmental Health, Durban University of Technology, 2017.
Shift work is a necessity for many organizations. Reasons for shift work are mainly to ensure continuous and optimized operations. Many studies on shift workers have concluded that it can lead to adverse physiological, social and psychological health effects. This study examines challenges associated with working shifts at a biscuits manufacturing factory. Results should be able to assist the employer in implementing effective interventions directed at limiting the negative effects of shift work on employees. This is a convergent parallel design multi method stud among 152 shift workers in a biscuits manufacturer located in Durban, KwaZulu Natal. An abbreviated and modified form of the validated SSI questionnaire was used (Barton et al. 1995). The questionnaire contained a battery of items designed to examine the relationship of health and personal adjustment to shift work. Owing to the exploratory nature of the study, a focus group methodology was also used and this allowed for in-depth qualitative research which catered for a more comprehensive understanding of the current shift work issues. A retrospective review of injury records of employees who sustained occupational injuries between 2012 and 2013 was also conducted. The sample comprised of 85 (56%) males and 63 (42%) females. Logistic regression was used to estimate the association between shift work and the likelihood of sleep disturbance, poor health outcomes and limited time for social and domestic activities, adjusting for age, sex, partner working, years working night shift, marital status, job class and years employed. Odds ratio (OR) for reported sleep disturbance was slightly higher among women (OR=1.65; 95% CI = 0.25; 10.84; p < 0.05) compared to males, but this was not statistically significant. Longer shift work experience (i.e.11-20 years) was significantly associated with better health status (OR=0.18; 95%CI = 0.06; 0.46; p < 0.05). Shift work experience (11 to 20 years) was also found to be significantly associated with limited time for both social (OR = 0.10; 95%CI = 0.03; 0.30) and domestic activities (OR= 0.25; 95% CI = 0.11; 0.57; p < 0.05) (Table 4). Age had no effect on social and domestic activities, but those 40 years and above were more likely to have limited time for social and domestic activities (OR = 3.06; 95%CI =0.60; 15.60 and OR= 2.5; 95%CI=0.47; 13.06). Those with more shift work experience seemed to have more time for social and domestic activities compared to those with less than 10 years experience. Findings from the FGD’s revealed that most participants (91%) did not get sufficient sleep time after night shift; this was mainly because of the chores they had to do after getting home form night shift and disturbances from the household and neighbours. The average time spent sleeping by majority of participants after night shift was 5 hours. Swollen feet, gastric, sleep disorders, indigestion and headaches were some common complaints experienced by shift workers in this study. About 27% of participants reported to have been injured at work before. These incidents were reported to be related to drowsiness and fatigue. The company’s incident records showed a total of 160 injuires between 2012 and 2013, of which 38 occurred during night shift. In 2012, the company recorded 65 injuries which included 51 first aid (FA) injuries, 6 minor injuries (MI) and 8 lost time (LT) injuries, as categorized by the company. 2013 had the highest number of incidents, with 95 total injuries, averaging to 7.9 injuries annually. There were 84 first aid incidents recorded for year 2013, 9 minor injuries and only 2 lost time injuries. Twenty three percent (15, n=65) incidents occurred during night shift in year 2012, of which 11% (7, n=65) were females. The number of night shift incidents slightly increased to 24% (23, n=95) in 2013 and females accounted for 9.40%. The records showed that majority of injuries happened between 17h00 and 21h00 at night. Results of this study provides evidence that shift work impacts negatively on the lives of the employees and can lead to adverse health outcomes such as poor dietary intake, headaches and swollen feet to mention but a few.
M

Primary dysmenorrhoea, or painful menstruation in the absence of pelvic pathology, is a common, and often debilitating, gynaecological condition that affects between 45 to 95% of menstruating women. Despite the high prevalence, dysmenorrhoea is often poorly treated, and even disregarded, by health professionals, pain researchers, and the women themselves, who may accept it as a normal part of the menstrual cycle. The overall purpose of this thesis is two-fold: first, to contribute knowledge about the impact and consequences of recurrent severe menstrual pain on pain sensitivity, mood, quality of life and sleep in women with primary dysmenorrhoea, and secondly, to investigate day-time and night-time treatment of recurrent primary dysmenorrhoeic pain. For this thesis, I completed five separate studies on three different groups of young, otherwise healthy women with a history of severe primary dysmenorrhoea, and age-matched controls without dysmenorrhoea. The first two studies, presented in Chapter 2, addressed the question of whether women with primary dysmenorrhoea are hypersensitive to experimental pain. I used clinically-relevant experimentally-induced muscle pain stimuli (intramuscular injection of hypertonic saline and ischaemia) in referred and non-referred sites of menstrual pain, at different phases of the menstrual cycle. Women with dysmenorrhoea, compared to women without dysmenorrhoea, had increased sensitivity to deep-muscle pain both within the area of referred menstrual pain and at a remote pain-free site. Further, the increased muscle pain sensitivity was evident even in phases of the menstrual cycle when women did not have menstrual pain, illustrating that the changes in pain perception extend outside of the painful menstruation phase. These findings suggest that women with dysmenorrhoea show long-lasting changes in pain processing possibly because of the recurrent dysmenorrhoeic pain. A secondary aim of the study presented in Chapter 2a, was to determine the impact of menstrual cycle phase on experimentally-induced muscle pain sensitivity in women with and without primary dysmenorrhoea. My results suggest that menstrual cycle phase has no effect on pain sensitivity in either group of women. As part of my studies, I investigated the impact of dysmenorrhoeic pain on quality of life and mood. I found that women with dysmenorrhoea had a significantly reduced quality of life (Chapter 3) and poorer mood (Chapter 2a and Chapter 5), during menstruation compared to their pain-free follicular phase, and compared to the menstruation phase of the pain-free control women. These data highlight the negative impact that primary dysmenorrhoea has on young women, for up to a few days every month. Non-steroidal anti-inflammatory drugs (NSAIDs) are often prescribed as the first-line therapy for menstrual pain. Yet, severe dysmenorrhoeic pain is often poorly managed, especially at night, when the pain likely disrupts sleep. I conducted two studies investigating the effectiveness of diclofenac potassium, a readily-available NSAID with a low side-effect profile, compared to placebo, in alleviating severe primary dysmenorrhoeic pain across the day (Chapter 4), and during the night (Chapter 5). I also investigated the effectiveness of diclofenac potassium in improving subjective and objective sleep quality (Chapter 5). I found that the daily recommended dose (150 mg) of diclofenac potassium, administered at three timepoints across the first 24 hours of menstruation, significantly reduced perceived menstrual pain, compared to placebo. I confirmed that dysmenorrhoeic pain reduces polysomnographic and subjective measures of sleep quality compared with the pain-free follicular phase. I also showed, for the first time, that diclofenac potassium is effective, compared to placebo, in alleviating nocturnal pain, along with restoring subjective sleep quality and polysomnographic measures of objective sleep quality in women with severe primary dysmenorrhoea. My studies have addressed several gaps in the knowledge about primary dysmenorrhoea. I have shown that women with primary dysmenorrhoea are hypersensitive to deep muscle pain, supporting the hypothesis of other researchers that the recurrent menstrual pain experienced by these women is associated with central sensitisation, and may predispose women with primary dysmenorrhoea to other chronic painful conditions. Therefore, limiting the monthly noxious input into the central nervous systems of these women, by means of effective treatment of dysmenorrhoea, may improve their long-term health. The research presented in this thesis further highlights the efficacy of diclofenac potassium in relieving not only day-time and night-time dysmenorrhoeic pain, but also in restoring objective and subjective pain-induced sleep disturbances in women with dysmenorrhoea. Further, my research has shown that dysmenorrhoeic pain has an immediate negative impact on quality of life and mood during menstruation. The results of this thesis show the multi-factorial impact of dysmenorrhoea and should stimulate further research about the long-term benefits of effective treatment of menstrual pain.

This thesis deals with the mental and social health of adolescents in relation to their circadian rhythm. The theoretical part is focused on the fundamental insight into the problems of mental and social health, the definition and characterization of adolescence, the idea of circadian rhythms and sleep hygiene is also included. As for the research section, the default file survey was formed by 300 adolescents aged 15-18 years from secondary schools in České Budějovice in proportion of 150 girls and 150 boys. The average age of respondents was 16 years. Data were obtained under the project No. GAJU 101/2011/S "psychosocial and somatic parameters in comparison to the circadian rhythm" during the period September 2011 - March 2012. The method of research questions was formed by the selection of 2 standardized questionnaires. The questions of the concept of social quality of life questionnaire, Cummins (1997), ComQoL - S5 which was translated and adapted for the conditions of the Czech Republic. The issues related to the circadian rhythms are selected from the circadian typology questionnaire, CIT (Harada, Krejci, 2010). The data obtained were analyzed by using basic statistical methods and calculations.