3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Sleep quality and immune changes in HIV positive people in the first six months of starting highly active antiretroviral therapy (HAART)(2016) Redman, KirstenIntroduction: South Africa has the highest absolute number of persons living with HIV in the world. Previous research has shown that untreated and treated HIV positive patients have sleep disturbances. In a cross sectional pilot study I ran during honours, I showed that sleep disturbances were associated with increased current CD4+ T lymphocyte counts, which may point at a role for immune activation during CD4 reconstitution in the sleep disturbances of South African HIV positive patients. In this study, to better understand sleep disturbances in patients with HIV, I used a longitudinal design and investigated the changes in sleep quality, daytime sleepiness, and the risk of having sleep apnoea as well as the predictors of these changes in HAART-naïve HIV patients, up until at least six months on treatment. Methods: 84 participants were originally enrolled into the study but only 23 (16 women, average age ± SD = 34.4 ± 7.8) came for 3 visits or more after treatment initiation. At all visits, the patients were asked to fill in questionnaires assessing sleep disruption (Pittsburgh Sleep Quality Index, PSQI), daytime sleepiness (Epworth Sleepiness Scale, ESS), risk of sleep apnoea (Berlin Questionnaire, BQ), depression (Beck Depression Inventory, BDI) and pain. In addition, CD4+ T lymphocyte counts, viral loads, body mass index and blood pressure were recorded. We used mixed models analyses in SAS for statistical analyses. Results: The patients had low sleep disruption at baseline (PSQI average ± SD = 5.8 ± 3.3, 52% having a PSQI>5) and when adjusting for depression, sleep quality improved slightly over time (p<0.01). There was moderate daytime sleepiness at baseline (ESS average ± SD = 8.4 ± 4.9) which subsequently decreased over time with patients who had higher log viral loads (>2) showing lower daytime sleepiness than those with low viral loads throughout the study (p<0.01). Higher daytime sleepiness was also reported in patients with higher depression scores (p<0.01). Depression was high at baseline (average BDI score ± SD = 17.8 ± 11) and decreased at 3 months, thereafter with no significant change from baseline (<0.01). BMI was on average high at baseline (25.5± 7.1), in particular in women, and further increased over time (p<0.01), which was associated with a significant increase in the odds of having high risk for sleep apnoea (p<0.01). Rating of pain in the past month decreased over time (p=0.02) and increased pain was associated with increased sleep disruption (p=0.02). Conclusion: Overall, modifiers of sleep-related outcomes (PSQI, ESS, risk of sleep apnoea on the BQ) included depression, pain, viral loads and BMI. Further research would need to assess more metabolic developments in this cohort. Objective measurements of sleep such as polysomnography, and immune measurements such as cytokines will need to be conducted to better explain the underlying mechanisms at play.Item The relationships between pain and sleep in spinal cord injury patients(2016) Pillay, Diana SubramonySpinal cord injury (SCI) is a devastating injury affecting many South Africans. The purpose of the study was to investigate the relationship between SCI pain and sleep issues during acute inpatient rehabilitation. Seventeen participants were recruited. There were 2 interviews in the study; the 1st interview was done on the day participants were recruited. The 2nd interview was conducted a day before participants were discharged. The time elapsed between the first and second interview was 7.9±2.4. The patients were discharged from the Auckland Rehabilitation hospital (Hope ward). In the 2nd interview the questionnaires for pain, sleep and mood measures were repeated, and two additional questions were asked and the answers recorded for analysis of content. The key findings were; majority of the participants were Black, male (82%). The main cause of traumatic SCI was motor vehicle accident (59%). The common sites of injury were in the legs and neck/shoulder areas in both assessment (admission and discharge). The verbal descriptors that were commonly chosen in both assessments were, “sharp, shooting and tight.” Below level neuropathic pain, followed by musculoskeletal pain were the common types of pain reported. Pain interference was reported greatest in sleep and on average pain intensity was moderate (4-6 on 11-point Numerical Rating Scale). Strong correlations and positive relationships between Pain Catastrophizing Scale and subscales, and with the Pittsburgh Insomnia Rating total scale and subscales were reported in this study. Environmental factors were reported to affect sleep. A high incidence of Restless Leg Syndrome was reported in this study (24%). Depression was commonly reported by participants in both assessments. No significant association was found for the measures of sleep, Restless Leg Syndrome, depression and quality of life and the injury characteristics that were assessed. Significant associations were found at the 95% confidence levels for pain scores and injury characteristics (completeness of injury, level of injury and pain sites). Further studies in this area of pain and sleep management is warranted. It is important that clinicians and researchers in this area find appropriate management for secondary issues which have a severe impact on the daily activities of SCI people, decreasing their quality of life. Key words: SCI pain, sleep disturbances, mood