Browsing by Subject "Sleep"

Ever since the initial discovery of general anesthetics almost 170 years ago, how general anesthesia (GA) induces loss of consciousness remains a century-long mystery. In addition, whether diverse anesthetic drugs and sleep share a common neural pathway is hotly debated and largely unknown. Previous studies have established that many GA drugs inhibit neural activity through targeting GABA receptors. Here, by using Fos staining, ex vivo brain slice recording, and eventually in vivo multichannel extracellular electrophysiology, we discovered a core ensemble of hypothalamic neurons in and near the supraoptic nucleus, consisting primarily of peptidergic neuroendocrine cells, which are surprisingly and persistently activated by multiple classes of GA drugs. Strikingly, chemogenetic or optogenetic stimulation of these anesthesia-activated neurons (AANs) strongly potentiated slow-wave sleep and prolonged GA, whereas conditional ablation through diphtheria toxin receptor strategy or inhibition of AANs with optogenetics led to reduced slow-wave oscillation in the brain, significant loss of slow-wave and rapid-eye movement sleep, and shortened durations under GA. Together, these findings identify a previously unknown common neural substrate underlying diverse GA drugs and natural sleep, and further illustrate a crucial role of the neuroendocrine system in regulating global brain states.

Parents who give birth (e.g., mothers, birthing parents, primary caregivers) experience a vast array of needs during the early postpartum period. While unique needs across all individuals are likely innumerable, generally needs focus on taking care of oneself, taking care of one's infant, and dyadic needs such as feeding an infant. One example of a generalized health need is the physiologic need for the birthing parent to receive sufficient sleep. Yet, birthing parents may experience significant deficits in sleep during the early postpartum period, and these unmet sleep needs can significantly impact the parent’s physical and mental well-being during this crucial and transformative period of life. Therefore, this dissertation study explores the concept of postpartum needs and how they emerge and, in particular, investigates maternal experiences of sleep during the first days postpartum. These topics are explored through two studies. First, in a qualitative descriptive study of 22 birthing parents we assessed their perspectives of postpartum needs and how these needs emerge. Then, using videotaped recordings of 15 postpartum families during an in-depth multiple case study, we used behavioral observation methods to code the experiences of 15 postpartum families and their health care team members as videotaped during postpartum hospitalizations. This study provided key insights into the patterns and context of postpartum maternal sleep and awakenings. These findings include describing the interactions that contributed to a median 2.6 hours of sleep for the birthing parents during the last 24 hours of their inpatient stay. In conclusion, we found that parents experience numerous unmet needs during the postpartum period, best understood within the complex socioecologic context in which they arise. These patient-focused findings elevate the importance of aligning health care services in hospital settings and at home with birthing parent needs.

Patients undergoing intensive treatments for life-limiting chronic illnesses such as cancer often experience severe cognitive, affective, and sleep disturbance symptoms. Immunotherapies such as high-dose Interleukin-2 (IL-2) can result in severe alterations in cognition, affect, and sleep. These alterations not only prevent patients from receiving their full course of treatment but also severely impact the quality of life of patients and their care partners. A mixed-method case study approach was used to investigate the trajectory of these symptoms from three key informants (the patient receiving IL-2, the care partner, and the primary nurse) in ten IL-2 cases over up to four treatment hospitalizations. Quantitative measurement scores and qualitative reports of symptom change were compiled to understand the symptom trajectory within and across treatment hospitalizations.

This dissertation includes a systematic literature review in Chapter 2 that highlights the lack of trajectory analysis surrounding cognitive, affective, and sleep disturbance symptoms in patients undergoing IL-2, as well as the gravity and impact that these symptoms have on patients and their families. Chapter 3 features the study team’s evaluation of methods using a case study approach to collect quantitative and qualitative data from one patient, care partner, and primary nurse as a case triad to examine cognitive, affective, and sleep disturbance symptoms one patient diagnosed with MRCC experienced during one hospitalization for IL-2 treatment and served as the foundation for the larger study. Chapters 4 and 5 synthesized data from case informants in the larger study and described the trajectory of cognitive symptoms and affective and sleep disturbance symptoms, respectively, that patients receiving IL-2 therapy for renal cell carcinoma experienced within and across hospitalizations.

Cognitive, affective, and sleep disturbance symptoms are often synergistic and interdependent. Of these symptoms, fatigue and anxiety were the most frequently reported, worsening with each subsequent dose of IL-2, suggesting a cumulative dosing effect. Interventions should be uniquely designed to target patients receiving IL-2, care partners, nurses, and the healthcare team with the aim of reducing commonly reported yet severely incapacitating symptoms. A reduction in these symptoms can reduce other cognitive, affective, and sleep disturbance symptoms, improving the patient’s overall symptom trajectory experience.

Background

Methods

Results

Conclusions

Background

Methods

Results

Conclusions

Study design

Objectives

Summary of background data

Materials and methods

Results

Conclusion