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  • 1. Andren, Ann
    et al.
    Hedberg, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Walker-Engström, Marie-Louise
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Wahlen, Petra
    Tegelberg, Åke
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Effects of treatment with oral appliance on 24-h blood pressure in patients with obstructive sleep apnea and hypertension: a randomized clinical trial2013Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 17, nr 2, s. 705-712Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Continuous positive airway pressure treatment has been shown to lower blood pressure (BP) in patients with obstructive sleep apnea (OSA). The aims of the present pilot study were to evaluate the potential effects of oral appliance (OA) therapy on BP, to assess various outcome BP measures, and to inform sample size calculation. Seventy-two patients with OSA and hypertension were randomly assigned to intervention with either an OA with mandibular advancement (active group) or an OA without advancement (control group). Before and after 3 months of treatment, the patients underwent nocturnal somnographic registration and 24-h ambulatory BP monitoring. Among the various BP measures, the largest trend toward effect of OA treatment was seen in 24-h mean systolic BP with a 1.8 mmHg stronger BP reduction in the active group compared with controls. A stronger trend toward effect was seen in a subgroup with baseline ambulatory daytime mean systolic BP > 135/85 mmHg where the mean systolic BP fell, on average, 2.6 mmHg. Additional exclusion of patients with baseline apnea hypopnea index (AHI) a parts per thousand currency sign15 gave a significant reduction in mean systolic BP of 4.4 mmHg (P = 0.044) in the active group compared with controls. In patients with OSA and hypertension, OA treatment had a modest trend toward effect on reducing BP. A stronger trend toward treatment effect was seen after excluding patients with normal baseline ambulatory BP. Additional exclusion of patients with baseline AHI a parts per thousand currency sign15 showed a significant treatment effect. Data to inform sample size for an adequately powered randomized study are provided.

  • 2. Andrén, Ann
    et al.
    Hedberg, Pär
    Walker-Engström, Marie-Louise
    Wahlén, Petra
    Tegelberg, Åke
    Malmö högskola, Odontologiska fakulteten (OD).
    Effects of treatment with oral appliance on 24-h blood pressure in patients with obstructive sleep apnea and hypertension: a randomized clinical trial2013Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 17, nr 2, s. 705-712Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Continuous positive airway pressure treatment has been shown to lower blood pressure (BP) in patients with obstructive sleep apnea (OSA). The aims of the present pilot study were to evaluate the potential effects of oral appliance (OA) therapy on BP, to assess various outcome BP measures, and to inform sample size calculation. Methods Seventy-two patients with OSA and hypertension were randomly assigned to intervention with either an OA with mandibular advancement (active group) or an OA without advancement (control group). Before and after 3 months of treatment, the patients underwent nocturnal somnographic registration and 24-h ambulatory BP monitoring. Results Among the various BP measures, the largest trend toward effect of OA treatment was seen in 24-h mean systolic BP with a 1.8 mmHg stronger BP reduction in the active group compared with controls. A stronger trend toward effect was seen in a subgroup with baseline ambulatory daytime mean systolic BP >135/85 mmHg where the mean systolic BP fell, on average, 2.6 mmHg. Additional exclusion of patients with baseline apnea hypopnea index (AHI) ≤15 gave a significant reduction in mean systolic BP of 4.4 mmHg (P = 0.044) in the active group compared with controls. Conclusions In patients with OSA and hypertension, OA treatment had a modest trend toward effect on reducing BP. A stronger trend toward treatment effect was seen after excluding patients with normal baseline ambulatory BP. Additional exclusion of patients with baseline AHI ≤15 showed a significant treatment effect. Data to inform sample size for an adequately powered randomized study are provided.

  • 3.
    Broström, Anders
    et al.
    Jönköping University, Sweden;Linköping University Hospital, Sweden.
    Pakpour, A. H.
    Jönköping University, Sweden;Qazvin Univ Med Sci, Iran.
    Nilsen, P.
    Linköping University, Sweden.
    Fridlund, Bengt
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Ulander, M.
    Linköping University Hospital, Sweden;Linköping University, Sweden.
    Psychometric properties of the Ethos Brief Index (EBI) using factorial structure and Rasch Analysis among patients with obstructive sleep apnea before and after CPAP treatment is initiated2019Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 23, nr 3, s. 761-768Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Continuous positive airway treatment (CPAP) is the recommended treatment for patients with obstructive sleep apnea (OSA). Outcome measures often focus on clinical and/or self-rated variables related to the medical condition. However, a brief validated instrument focusing on the whole life situation (i.e., ethos) suitable for clinical practice is missing. The aim of this study was to investigate factorial structure, categorical functioning of the response scale, and differential item functioning across sub-populations of the Ethos Brief Index (EBI) among patients with obstructive sleep apnea (OSA) before and after initiation of continuous positive airway pressure (CPAP). Methods A prospective design, including 193 patients with OSA (68% men, 59.66 years, SD 11.51) from two CPAP clinics, was used. Clinical assessment and overnight respiratory polygraphy were used to diagnose patients. Questionnaires administered before and after 6 months of CPAP treatment included EBI, Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale, and global perceived health (initial item in SF-36). The validity and reliability of the EBI were investigated using Rasch and confirmatory factor analysis models. Measurement invariance, unidimensionality, and differential item functioning across gender groups, Apnea-Hypopnea Index, and ESS groups were assessed. Results The reliability of the EBI was confirmed using composite reliability and Cronbach's alpha. The results supported unidimensionality of the EBI in confirmatory factor analysis and the Rasch model. No differential item functioning was found. A latent profile analysis yielded two profiles of patients with low (n = 42) and high (n = 151) ethos. Patients in the low ethos group were younger and had higher depression scores, lower perceived health, and higher body mass index. Conclusions The EBI is a valid tool with robust psychometric properties suitable for use among patients with OSA before and after treatment with CPAP is initiated. Future studies should focus on its predictive validity.

  • 4.
    Broström, Anders
    et al.
    Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US. Department of Nursing, School of Health and Welfare, Sweden.
    Pakpour, A. H.
    Department of Nursing, School of Health and Welfare, Sweden; Social Determinants of Health Research Center Qazvin, Iran.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Fridlund, B.
    CICE Linneus University, Sweden.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US.
    Psychometric properties of the Ethos Brief Index (EBI) using factorial structure and Rasch Analysis among patients with obstructive sleep apnea before and after CPAP treatment is initiated.2019Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 23, nr 3, s. 761-768Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Continuous positive airway treatment (CPAP) is the recommended treatment for patients with obstructive sleep apnea (OSA). Outcome measures often focus on clinical and/or self-rated variables related to the medical condition. However, a brief validated instrument focusing on the whole life situation (i.e., ethos) suitable for clinical practice is missing. The aim of this study was to investigate factorial structure, categorical functioning of the response scale, and differential item functioning across sub-populations of the Ethos Brief Index (EBI) among patients with obstructive sleep apnea (OSA) before and after initiation of continuous positive airway pressure (CPAP).

    METHODS: A prospective design, including 193 patients with OSA (68% men, 59.66 years, SD 11.51) from two CPAP clinics, was used. Clinical assessment and overnight respiratory polygraphy were used to diagnose patients. Questionnaires administered before and after 6 months of CPAP treatment included EBI, Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale, and global perceived health (initial item in SF-36). The validity and reliability of the EBI were investigated using Rasch and confirmatory factor analysis models. Measurement invariance, unidimensionality, and differential item functioning across gender groups, Apnea-Hypopnea Index, and ESS groups were assessed.

    RESULTS: The reliability of the EBI was confirmed using composite reliability and Cronbach's alpha. The results supported unidimensionality of the EBI in confirmatory factor analysis and the Rasch model. No differential item functioning was found. A latent profile analysis yielded two profiles of patients with low (n = 42) and high (n = 151) ethos. Patients in the low ethos group were younger and had higher depression scores, lower perceived health, and higher body mass index.

    CONCLUSIONS: The EBI is a valid tool with robust psychometric properties suitable for use among patients with OSA before and after treatment with CPAP is initiated. Future studies should focus on its predictive validity.

  • 5.
    Broström, Anders
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
    Pakpour, Amir H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    Nilsen, P.
    Department of Health and Society, Division of Social Medicine and Public Health Science, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Fridlund, Bengt
    CICE, Linneus University, Växjö, Sweden.
    Ulander, M.
    Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
    Psychometric properties of the Ethos Brief Index (EBI) using factorial structure and Rasch Analysis among patients with obstructive sleep apnea before and after CPAP treatment is initiated2019Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 23, nr 3, s. 761-768Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Continuous positive airway treatment (CPAP) is the recommended treatment for patients with obstructive sleep apnea (OSA). Outcome measures often focus on clinical and/or self-rated variables related to the medical condition. However, a brief validated instrument focusing on the whole life situation (i.e., ethos) suitable for clinical practice is missing. The aim of this study was to investigate factorial structure, categorical functioning of the response scale, and differential item functioning across sub-populations of the Ethos Brief Index (EBI) among patients with obstructive sleep apnea (OSA) before and after initiation of continuous positive airway pressure (CPAP).

    Methods: A prospective design, including 193 patients with OSA (68% men, 59.66 years, SD 11.51) from two CPAP clinics, was used. Clinical assessment and overnight respiratory polygraphy were used to diagnose patients. Questionnaires administered before and after 6 months of CPAP treatment included EBI, Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale, and global perceived health (initial item in SF-36). The validity and reliability of the EBI were investigated using Rasch and confirmatory factor analysis models. Measurement invariance, unidimensionality, and differential item functioning across gender groups, Apnea-Hypopnea Index, and ESS groups were assessed.

    Results: The reliability of the EBI was confirmed using composite reliability and Cronbach’s alpha. The results supported unidimensionality of the EBI in confirmatory factor analysis and the Rasch model. No differential item functioning was found. A latent profile analysis yielded two profiles of patients with low (n = 42) and high (n = 151) ethos. Patients in the low ethos group were younger and had higher depression scores, lower perceived health, and higher body mass index.

    Conclusions: The EBI is a valid tool with robust psychometric properties suitable for use among patients with OSA before and after treatment with CPAP is initiated. Future studies should focus on its predictive validity. 

  • 6.
    Ding, Zou
    et al.
    Univ Gothenburg, Sahlgrenska Acad, Ctr Sleep & Vigilance Disorders, Gothenburg, Sweden.
    Stehlik, Romana
    Univ Gothenburg, Sahlgrenska Acad, Ctr Sleep & Vigilance Disorders, Gothenburg, Sweden; Akademiska Univ Hosp, Pain Ctr, Uppsala, Sweden.
    Hedner, Jan
    Univ Gothenburg, Sahlgrenska Acad, Ctr Sleep & Vigilance Disorders, Gothenburg, Sweden; Sahlgrens Univ Hosp, Sleep Disorders Ctr, Dept Resp Dis, Gothenburg, Sweden.
    Ulfberg, Jan
    Circadian Hlth, Nora, Sweden.
    Grote, Ludger
    Univ Gothenburg, Sahlgrenska Acad, Ctr Sleep & Vigilance Disorders, Gothenburg, Sweden; Sahlgrens Univ Hosp, Sleep Disorders Ctr, Dept Resp Dis, Gothenburg, Sweden; Sahlgrens Univ Hosp, Resp Med, Gothenburg, Sweden.
    Chronic pulmonary disease is associated with pain spreading and restless legs syndrome in middle-aged women-a population-based study2019Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 23, nr 1, s. 135-142Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Recent studies suggest an increased prevalence of chronic pain conditions and restless legs syndrome (RLS) in patients with chronic pulmonary disease (CPD). We analyzed the prevalence and risk factors for pain and RLS in a population-based sample of females with comorbid CPD.

    Method: Questionnaire-based data from 2745 women aged 18–64 years were analyzed regarding comorbid CPD status (severe bronchitis, emphysema, asthma). Pain status was assessed according to symptoms reflecting severity (Visual Analogue Scale, VAS rating 0–10) and duration and spreading (limited spread or widespread) of pain. A diagnosis of RLS was defined by four validated diagnostic criteria. Anthropometrics and co-morbidities were assessed as covariates in univariate and multivariate analyses.

    Results: Widespread pain was overrepresented in women with CPD (44.6 vs. 24.6%, p < 0.001). The odds ratio for widespread pain in women with CPD was 1.6 (95% confidence interval (CI) 1.2–2.2, p < 0.001) in the fully adjusted model. Severe pain (VAS rating ≥ 7) was more prevalent in females with known CPD (28.8 vs. 15.4%, p < 0.001, odd ratio 1.4 (95% CI 1.0–1.9, p = 0.029)). The prevalence of RLS was 37.4 and 23.8% in subjects with or without CPD, respectively (p < 0.001). In multivariate analysis, CPD was associated with a 30% risk increase for RLS (odds ratio 1.3 (95% CI 1.0–1.7, p = 0.04)).

    Conclusion: This population-based study identified CPD as an independent risk factor for severe and widespread pain as well as for RLS. Further research addressing pathophysiological mechanisms linking CPD and chronic pain conditions/RLS is warranted.

  • 7.
    Eriksson, Eva Wiman
    et al.
    Dept Dent Sleep Med, Postgrad Dent Educ Ctr, Region Örebro County, Örebro, Sweden.
    Leissner, Lena
    Sleep Unit, Dept Neurol, Örebro University Hospital, Örebro, Sweden.
    Isacsson, Göran
    Dept Orofacial Pain, Västmanland Cty Hosp, Västerås, Sweden.
    Fransson, Anette
    Region Örebro län. Dept Orthodont, Postgrad Dent Educ Ctr, , Region Örebro County, Örebro, Sweden; Dent Sleep Med Clin, Postgrad Dent Educ Ctr, Region Örebro County, Örebro, Sweden.
    A prospective 10-year follow-up polygraphic study of patients treated with a mandibular protruding device2015Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 19, nr 1, s. 393-401Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This 10-year follow-up prospective study aimed to evaluate the effects of treatment with a mandibular protruding device (MPD) on respiratory parameters and subjective symptoms in patients with obstructive sleep apnea (OSA) or snoring. Seventy-seven consecutive patients diagnosed with OSA or snoring were treated with an MPD. At baseline and the 10-year follow-up, a polygraphic examination and questionnaires on sleep quality were administrated and weight, and neck size was measured. At the 10-year follow-up, we examined 64 of the 77 patients and recorded their current treatment (45 MPD, 9 continuous positive airway pressure (CPAP), and 10 no treatment). For MPD patients, 89 % reported MPD use every night and 9 % several nights a week. Compared to baseline, MPD users with OSA had a significantly decreased oxygen desaturation index (ODI) (p = 0.006) and increased lowest arterial oxygen saturation, SaO(2) nadir (p = 0.007) after 10 years. MPD treatment was successful for 70 % of OSA patients, yet 89 % subjectively considered themselves cured, indicating overestimation of the treatment effect. OSA patients who responded to treatment maintained baseline weight and neck size, while these increased for non-responders. Of the baseline snorers still using an MPD, 93 % maintained an ODI value of < 5. All CPAP users had an ODI value of < 5. Both OSA and snorers using an MPD had significantly fewer self- and relative reports of snoring, apnea, daytime tiredness, and poor night sleep quality (p < 0.001). MPD treatment is well tolerated and effective in a long-term, 10-year perspective. Weight gain may jeopardize MPD effects. Both patients and relatives reported significantly less snoring and fewer periods of apnea.

  • 8. Eskafi, Mahmoud
    et al.
    Cline, Charles
    Nilner, Maria
    Malmö högskola, Odontologiska fakulteten (OD).
    Israelsson, Bo
    Treatment of sleep apnea in congestive heart failure with a dental device2006Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 10, nr 2, s. 90-97Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of the present study was to investigate the effect of a mandibular advancement device (MAD) for the treatment of sleep apnea (SA) on plasma brain natriuretic peptide (BNP), left ventricular ejection fraction (LVEF), and health-related qualify of life (HRQL) in patients with mild to moderate stable congestive heart failure (CHF). Seventeen male patients aged 68.4±5.5 with an apnea–hypopnea index (AHI) ≥10 were equipped with an individually fitted MAD. SA was evaluated using a portable respiratory multirecording system before and after the initiation of treatment. Eleven patients completed follow-up and were evaluated after 6 months of treatment. The AHI reduced from 25.4±10.3 to 16.5±10.0 (p=0.033) compared to baseline and mean plasma BNP levels decreased from 195.8±180.5 pg/ml to 148.1±139.9pg/ml (p=0.035). SA-related symptoms, e.g., excessive daytime sleepiness, were also reduced (p=0.003). LVEF and HRQL were unchanged. We conclude that SA treatment with a MAD on patients with mild to moderate stable CHF appears to result in the reduction of plasma BNP levels. Further studies to investigate if the observed reduction in BNP concentrations also result in improved prognosis are warranted.

  • 9.
    Igelström, Helena
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Sjukgymnastik.
    Emtner, Margareta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Sjukgymnastik. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lungmedicin och allergologi.
    Lindberg, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lungmedicin och allergologi.
    Åsenlöf, Pernilla
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Sjukgymnastik.
    Physical activity and sedentary time in persons with obstructive sleep apnea and overweight enrolled in a randomized controlled trial for enhanced physical activity and healthy eating2013Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 17, nr 4, s. 1257-1266Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    The aim of the study was to describe the amount of physical activity and sedentary time in patients with obstructive sleep apnea syndrome (OSAS) and overweight, and to explore potential disease-related and psychological correlates.

    Methods

    A descriptive and correlational study was performed. Prospective data of physical activity and sedentary time were collected through accelerometry, and a one-point measurement of body mass index (BMI), daytime sleepiness, exercise self-efficacy, fear of movement, and depressive symptoms. Seventy-three participants with overweight (mean BMI 35kg/m2 SD 5) and moderate/severe OSAS (Apnea-Hypopnea Index >15) were consecutively recruited. Multivariate associations were determined through multiple linear regression analysis.

    Results

    The participants took a daily average of 7734 (SD 3528) steps, spent an average of 77 (SD 54) minutes in moderate-to-vigorous physical activity (MVPA), and spent 11h 45 min (SD 2h 8 min) sedentary. BMI, daytime sleepiness, exercise self-efficacy, fear of movement, and depressive symptoms did not explain variance in MVPA or steps, but explained 22.9% of variance in sedentary time. In backward selection analysis, BMI contributed to the explanatory degree of MVPA with 9% whereas, fear of movement explained 6.3% of the variance in steps and 14.3% of the variance in sedentary time.

    Conclusions

    An important implication for future physical activity interventions is that both physical activity and sedentary behaviors should be targeted, and fear of movement may be an important determinant for change in patients with OSAS and overweight.

  • 10.
    Igelström, Helena
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Sjukgymnastik. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lungmedicin och allergologi.
    Emtner, Margareta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Sjukgymnastik. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lungmedicin och allergologi.
    Lindberg, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lungmedicin och allergologi.
    Åsenlöf, Pernilla
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Sjukgymnastik.
    Tailored behavioral medicine intervention for enhanced physical activity and healthy eating in patients with obstructive sleep apnea syndrome and overweight2014Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 18, nr 3, s. 655-668Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study aims to evaluate the effects on physical activity (PA) and eating behavior (EB) of a tailored behavioral medicine intervention and first-time continuous positive airway pressure (CPAP) treatment compared with first-time CPAP treatment and advice in patients with obstructive sleep apnea syndrome (OSAS) and overweight. Seventy-three patients (mean +/- SD, 55 +/- 12 years) with overweight (body mass index (BMI), 34.5 +/- 4.8) and moderate or severe OSAS (Apnea-Hypopnea Index, 41.7 +/- 20.9) scheduled for CPAP prescription were randomized to a control group (CPAP and advice on the association between weight and OSAS) or an experimental group (CPAP and a 6-month behavioral medicine intervention targeting PA and EB). At baseline and after 6 months, eating behavior (food frequency screening and Dutch Eating Behavior Questionnaire), weight, BMI, and waist circumference were assessed at one point, while PA and sedentary time were measured with accelerometry during 4 days. The experimental group reduced 2.1 kg (+/- 4.6) in weight and 3 cm (+/- 4.9) in waist circumference, significantly more than the control group. At 6 months, the experimental group ate more fruit and fish/shellfish than the control group. Low and moderate to vigorous PA did not change over time either within or between groups. Regarding BMI, steps, and sedentary time, there were within-group differences but no differences between groups. The behavioral medicine intervention did not change physical activity but facilitated changes in EB in patients with OSAS and overweight. The amount of weight loss and reduction in waist circumference favored the participants receiving this treatment. Since the strategies for achieving behavioral changes were tailored according to the individual's goals and personal functional behavioral analyses and progressed slowly in a graded manner, it might require higher PA quotas or a period longer than 6 months to reveal a behavioral change of larger proportions.

  • 11.
    Igelström, Helena
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lung- allergi- och sömnforskning.
    Åsenlöf, Pernilla
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi.
    Emtner, Margareta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lung- allergi- och sömnforskning.
    Lindberg, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lung- allergi- och sömnforskning.
    Improvement in obstructive sleep apnea after a tailored behavioural sleep medicine intervention targeting healthy eating and physical activity: a randomised controlled trial2018Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 22, nr 3, s. 653-661Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: The aim of the present single-centre randomised controlled trial was to assess the effect of a behavioural sleep medicine (BSM) intervention on obstructive sleep apnea (OSA) severity in patients who have been referred for new treatment with continuous positive airway pressure (CPAP).

    METHODS: After baseline assessment including ventilatory and anthropometric parameters, and physical activity monitoring, 86 patients who were overweight (BMI ≥ 25) and had moderate-severe OSA with apnea-hypopnea index (AHI) ≥ 15 were randomised into a control group (CG; CPAP and advice about weight loss) or an experimental group (ExpG; CPAP and BSM intervention targeting physical activity and eating behaviour). The BSM intervention comprised 10 individual sessions with a dietician and a physiotherapist and included behaviour change techniques such as goal setting and self-monitoring. After 6 months, a new recording of ventilatory parameters was performed without CPAP.

    RESULTS: In ExpG, 40% (n = 14) had improved from severe to moderate or mild OSA or from moderate to mild OSA compared to 16.7% in CG (n = 6, p = 0.02). Further, a lower AHI and amount body fat at baseline were correlated with improvement in severity class. Being in ExpG implied a mean improvement in AHI by 9.7 and an odds ratio of 4.5 for improving in severity classification.

    CONCLUSIONS: The results highlight the clinical importance of lifestyle modifications in conjunction with CPAP treatment in patients with OSA.

  • 12.
    Johansson, Peter
    et al.
    Department of Cardiology, Linköping University, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Department of Cardiology, County Council of Östergötland, 58185, Linköping, Sweden .
    Svensson, Erland
    Swedish Defence Research Agency, 58111, Linköping, Sweden.
    Alehagen, Urban
    Department of Cardiology, Linköping University, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden .
    Dahlström, Ulf
    Department of Cardiology, Linköping University, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden .
    Jaarsma, Tiny
    Department of Social and Welfare Studies, Linköping University, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Department of Clinical Neurophysiology, County Council of Östergötland, 58185, Linköping, Sweden .
    Sleep disordered breathing, hypoxia and inflammation: associations with sickness behaviour in community dwelling elderly with and without cardiovascular disease2015Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 19, nr 1, s. 263-271Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:

    Inflammation can induce a cluster of symptoms, referred to as sickness behaviour (e.g., depressive symptoms, sleep disturbances, pain and fatigue). Cardiovascular disease (CVD) and sleep disordered breathing (SDB) are common in older adults. CVD is associated with an increased inflammatory activity and in SDB, hypoxia can also increase inflammation. The purpose of this study is to explore if SDB-related hypoxia is associated differently with inflammation and the presence of sickness behaviour in older adults with and without CVD.

    METHODS:

    Three hundred and thirty-one older adults, whose mean age is 78 years, underwent one-night polygraphic recording to measure SDB and hypoxia. CVD was established by a clinical investigation. Questionnaires were used to measure sickness behaviour and depressive symptoms. High sensitivity C-reactive protein was used as a marker of inflammation.

    RESULTS:

    Structural Equation Modelling showed that SDB-related hypoxia was associated with inflammation (β > 0.40) which mediated indirect associations with sickness behaviour (β = 0.19) and depressive symptoms (β = 0.11), but only in those with CVD (n = 119). In this model, inflammation had a direct effect on sickness behaviour (β = 0.43) and an indirect effect on depressive symptoms (β = 0.24). Hypoxia had the strongest effect (i.e., β = 0.41; significant) on inflammation, whereas the AHI or ODI had weak and non-significant effects (β = 0.03 and β = 0.15).

    CONCLUSIONS:

    Older adults with CVD and SDB are at a particular risk of developing sickness behaviour and depressive symptoms. The effect of SDB was mainly caused by hypoxia, suggesting that hypoxia is an important marker of SDB severity in older adults with CVD.

  • 13.
    Johansson, Peter
    et al.
    Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten.
    Svensson, Erland
    Swedish Defence Research Agency, Linköping .
    Alehagen, Urban
    Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten.
    Dahlström, Ulf
    Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Medicinska fakulteten.
    Broström, Anders
    Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US. Jonköping University, Sweden.
    Sleep disordered breathing, hypoxia and inflammation: associations with sickness behaviour in community dwelling elderly with and without cardiovascular disease2015Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 19, nr 1, s. 263-271Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Inflammation can induce a cluster of symptoms, referred to as sickness behaviour (e.g., depressive symptoms, sleep disturbances, pain and fatigue). Cardiovascular disease (CVD) and sleep disordered breathing (SDB) are common in older adults. CVD is associated with an increased inflammatory activity and in SDB, hypoxia can also increase inflammation. The purpose of this study is to explore if SDB-related hypoxia is associated differently with inflammation and the presence of sickness behaviour in older adults with and without CVD.

    METHODS: Three hundred and thirty-one older adults, whose mean age is 78 years, underwent one-night polygraphic recording to measure SDB and hypoxia. CVD was established by a clinical investigation. Questionnaires were used to measure sickness behaviour and depressive symptoms. High sensitivity C-reactive protein was used as a marker of inflammation.

    RESULTS: Structural Equation Modelling showed that SDB-related hypoxia was associated with inflammation (β > 0.40) which mediated indirect associations with sickness behaviour (β = 0.19) and depressive symptoms (β = 0.11), but only in those with CVD (n = 119). In this model, inflammation had a direct effect on sickness behaviour (β = 0.43) and an indirect effect on depressive symptoms (β = 0.24). Hypoxia had the strongest effect (i.e., β = 0.41; significant) on inflammation, whereas the AHI or ODI had weak and non-significant effects (β = 0.03 and β = 0.15).

    CONCLUSIONS: Older adults with CVD and SDB are at a particular risk of developing sickness behaviour and depressive symptoms. The effect of SDB was mainly caused by hypoxia, suggesting that hypoxia is an important marker of SDB severity in older adults with CVD.

  • 14.
    Marklund, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    Long-term efficacy of an oral appliance in early treated patients with obstructive sleep apnea2016Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 20, nr 2, s. 689-694Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The purpose of the present study was to evaluate the long-term efficacy of oral appliances (OAs) in early treated patients with obstructive sleep apnea (OSA). Polysomnographic sleep recordings without and with an OA were performed at treatment start and in patients who had been continuously treated with OAs for at least 15 years. Nine patients (eight men) with a median age of 68.1 years (interquartile range (IQR) 60.0 to 76.3 years) and a median treatment time of 16.5 years (IQR 16.3 to 18.0 years) were included. The apnea-hypopnea index decreased from a median of 17.3 (IQR 9.7 to 26.5) to 7.2 (IQR 4.0 to 9.6; p = 0.03) at the short-term follow-up. After long-term use, the apnea-hypopnea index was 32.4 (IQR 22.2 to 58.8) without the device and 35.1 (IQR 13.6 to 46.2) with it (p = 0.08). There were increases in the apnea-hypopnea index, both without the device (p = 0.02) and with it (p = 0.008). The degree of mandibular advancement did not differ between the two study occasions (p = 1.0). Patients treated with oral appliances may experience deteriorations in disease severity and treatment efficacy during continuous long-term OA treatment. Regular follow-up schedules with renewed sleep apnea recordings should be considered for these patients in order to avoid suboptimal or a total loss of effects on sleep apneas.

  • 15.
    Marklund, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    Subjective versus objective dental side effects from oral sleep apnea appliances2019Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Occlusal changes are common during long-term treatment with oral appliances (OAs) for sleep apnea. The aim of the present study was to compare subjectively reported bite changes with objective findings.

    Methods: Consecutive adherent treated patients were asked to participate in this study. The patients responded to two questionnaires using numeric visual analogue scales (VAS), ranging from 0 (not at all) to 10 (very much). The first questionnaire included open questions and the second questionnaire comprised specific questions about side effects. Measurements of overjet, overbite, and space for the teeth were made on plaster casts taken before treatment start and at follow-up.

    Results: Thirty-eight (12 women) patients with a median age of 64 years (interquartile range (IQR) 57 to 69 years) and a median treatment time of 9.5 years (IQR 5.8 to 14.3 years) were included. Overjet, overbite, the molar relationship, and the irregularity of the lower front teeth had changed significantly during treatment. There were no associations between any of the patients’ responses and the objectively measured bite changes. Younger patients, those with a small baseline overjet or overbite and those who developed an anterior crossbite were more likely to report bite changes.

    Conclusions: Patients who choose to continue long-term treatment with oral appliances for sleep apnea are unaware of various types of bite changes. Such changes will, however, progressively increase in magnitude and be more difficult to take care of, if needed. It is therefore important continuously to follow up patients in regard to bite changes.

  • 16.
    Marklund, Marie
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    Franklin, Karl A.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Treatment of elderly patients with snoring and obstructive sleep apnea using a mandibular advancement device2015Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 19, nr 1, s. 403-405Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: The simplicity of oral appliance therapy in the treatment of adult patients with snoring and obstructive sleep apnea (OSA) has resulted in a worldwide interest for this treatment modality. Mandibular advancement devices (MADs) that hold the lower jaw forward during sleep are mainly indicated for patients with milder OSA and those with CPAP intolerance. There has been minor attention on age when suggesting treatment alternatives for patients with OSA. Some studies indicate that there is a weak negative relationship between treatment success from MADs and higher age, but no studies have stratified their samples with respect to age.

    OBJECTIVE: The present aim was to compare the effects and side effects from MADs between an elderly group of patients (>65 years of age) and a younger age group that were extracted from two of our previous studies.

    RESULTS: The results showed no difference between the elderly and the younger patients in success rate or the degree of bite changes from MAD treatment.

    CONCLUSION: These findings indicate that MADs represent an alternative to CPAP irrespective of the age of the patient.

  • 17.
    Norrhem, Niclas
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    Marklund, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    An oral appliance with or without elastic bands to control mouth opening during sleep-a randomized pilot study2016Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 20, nr 3, s. 929-938Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Oral appliances (OAs) hold the lower jaw forward to reduce obstructive sleep apneas. Some OA designs allow mouth opening, which influences the forward positioning of the lower jaw. The aim of this pilot study was to compare the efficacy of an adjustable, custom-made OA (NarvalA (R)) in its original design, which allowed mouth opening, with the same OA with elastic bands that restricted mouth opening. Consecutive patients with an apnea-hypopnea index (AHI) of aeyen15 were randomized to start with an OA either with or without elastic bands in a single-blinded, crossover, pilot study. The patients underwent acclimatization and titration. After 3 weeks use of each device, they had renewed sleep apnea recordings and responded to questionnaires. Washout periods took place between the tests. Ten subjects with a median AHI of 19.7 (interquartile range (IQR) 17.3 to 31.8) were included. The AHI decreased to 3.1 (IQR 1.5-14.7) (p < 0.01) with the OA and to 5.1 (IQR 2.4-14.3) (p < 0.01) with the OA with elastic bands, with no difference between them (p = 0.7). The two subjects with severe obstructive sleep apnea (OSA) almost halved their supine AHI with, as compared to without, elastic bands. The majority of the patients preferred to use the elastic bands. This pilot study indicates that elastic bands markedly reduced the supine AHI in two subjects with severe sleep apnea as compared to without elastic bands. The majority of the patients preferred the use of elastic bands, although no significant difference in the AHI was observed with versus without the elastic bands in the whole sample.

  • 18.
    Norrhem, Niclas
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi. Folktandvården Skåne, Lund, Sweden.
    Nemeczek, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    Marklund, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    Changes in lower incisor irregularity during treatment with oral sleep apnea appliances2017Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 21, nr 3, s. 607-613Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: The purpose of this study is to test the hypothesis that a flexible oral appliance without incisor coverage (OAFlex) increases the irregularity of the front teeth compared with a rigid appliance with incisor coverage (OARigid) in patients treated for obstructive sleep apnea (OSA).

    Method and patients: Nineteen patients (10 men) who had used OARigid and 22 patients (19 men) who had used OAFlex with a median age of 61 years (IQR of 56 to 67 years) who had been treated during a median period of 2.9 years (IQR of 2.7 to 3.1 years) were included in the study. There was no difference in age (p = 0.601) or treatment time (p = 0.432) between the two appliance groups. The patients had clinical examinations, responded to a questionnaire, and had impressions taken for plaster casts. The irregularity of the front teeth was measured by Little’s Index, where the combined linear displacement of all the front teeth is assessed. Changes between baseline and follow-up were compared between the two groups.

    Results: The OAFlex group increased the irregularity of their lower front teeth by 0.3 mm (p = 0.018), while the OARigid group had unchanged frontal irregularity (p = 0.717). The difference between the groups was significant (p = 0.035). There were no changes in the irregularity of the upper front teeth in either group. Patient satisfaction with treatment did not differ between the two appliances.

    Conclusions: The present results support the hypothesis that a flexible OA without incisor coverage increases the irregularity of the lower front teeth compared with a rigid OA with incisor coverage.

  • 19. P, Nerfeldt
    et al.
    F, Aoki
    Friberg, Danielle
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Polygraphy vs. polysomnography: missing osas in symptomatic snorers–a reminder for clinicians2014Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709Artikel i tidskrift (Refereegranskat)
  • 20. Palm, Emma
    et al.
    Franklin, Karl A
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Marklund, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    Mandibular tori size is related to obstructive sleep apnea and treatment success with an oral appliance2014Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 18, nr 2, s. 431-438Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: Obstructive sleep apnea (OSA) is a common disorder characterized by repetitive upper airway obstruction during sleep. We aimed to investigate whether mandibular tori, exostoses that appear on the lingual surface of the lower jaw, are related to OSA and the effect of an oral appliance (OA) in OSA patients.

    METHODS: Six hundred snoring patients with a mean age of 52 years (range 23-75 years) and a mean respiratory disturbance index (RDI) of 15 (range 0-76), who were consecutively referred for OA treatment, were included. The size of the tori was measured on plaster casts with a digital sliding caliper.

    RESULTS: Twenty-seven percent of the patients had mandibular tori, with a similar prevalence in snorers and patients with mild, moderate and severe OSA. Tori size differed between severity groups. Thick tori (≥2.9 mm) were associated with an RDI of <30, odds ratio (OR) 4.7 (p = 0.01), adjusted for age, gender and body mass index (BMI; kg/m(2)). Complete treatment response with OA was related to thick tori, OR = 2.5 (p = 0.02), adjusted for disease severity, age, gender, BMI (kg/m(2)), weight changes (kg) and mandibular repositioning.

    CONCLUSIONS: Patients with milder disease are more likely to have larger tori than patients with severe OSA. Treatment success with an OA occurs more frequently in patients with larger tori than in patients with no tori or small tori.

  • 21.
    Sarberg, Maria
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Bladh, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Josefsson, Ann
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Svanborg, Eva
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US.
    Sleepiness and sleep disordered breathing during pregnancy2016Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 20, nr 4, s. 1231-1237Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Study objectives: To investigate if sleep recordings show differences in prevalence of sleep-disturbed breathing among pregnant women compared to non-pregnant controls. To compare the Epworth sleepiness scale (ESS) scores between the two groups. To evaluate obstetric outcomes.

    Setting: At one antenatal care center at an outpatient unit in Linköping, Sweden.

    Participants: One hundred pregnant women (gestational week 24-34) and 80 non-pregnant women age- and body mass index-matched as controls.

    Interventions: Whole-night respiratory recordings were performed in the homes of all participants, who also answered the same questionnaire, including the Epworth Sleepiness Scale.

    Measurements and results: Objectively recorded snoring was more common among the pregnant women (median value 10% of total estimated sleep time) than among the non-pregnant controls (2.5% of total sleep time, p<0.001). The prevalence of obstructive events was low and similar in pregnant and non-pregnant women (1% vs. 3% had obstructive apnea-hypopnea index ≥5). The total ESS score was higher among pregnant women than controls (median 9 vs. 7, p<0.001) but no significant differences were found between the two groups in the scores for the separate items of the ESS. Sleep-disturbed breathing and snoring showed no impact on obstetric outcome. There were no significant associations between either subjectively reported or objectively recorded snoring and ESS scores.

    Conclusion: Snoring increases during pregnancy, but sleep recordings could not verify an increased prevalence of obstructive sleep apnea among pregnant women. Development of obstructive sleep apnea is not a likely explanation for the increased daytime sleepiness seen in pregnant women.

  • 22.
    Schwarz, Johanna F. A.
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet. Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Arbets- och organisationspsykologi. University of Regensburg, Germany.
    Geisler, Peter
    Hajak, Göran
    Zulley, Jürgen
    Rupprecht, Rainer
    Wetter, Thomas C.
    Popp, Roland F. J.
    The effect of partial sleep deprivation on computer-based measures of fitness to drive2016Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 20, nr 1, s. 285-292Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: Using a partial sleep deprivation paradigm, the aim of the study was to investigate the sensitivity of a computer-based test battery of fitness to drive to detect impairments related to sleepiness.

    METHODS: Forty-seven healthy subjects (34 females, mean age 26.0 ± 6.8 years) participated in a counterbalanced within-subject design of two conditions: (i) normal night sleep and (ii) partial sleep deprivation (PSD) with 4 h time in bed. For the assessment of fitness to drive, we used a validated traffic psychological test battery. Moreover, well-established measures of sleepiness highly responsive to sleep deprivation were applied: the Karolinska Sleepiness Scale (KSS), pupillography (Pupil Unrest Index (PUI) as physiological sleepiness indicator) and two sustained attention tasks (psychomotor Vigilance Task and Mackworth Clock Test).

    RESULTS: Subjective and physiological sleepiness were significantly increased after PSD, accompanied by large (d > 1.50 for KSS) and medium (d = 0.55 for PUI) effect sizes. Sleepiness-related performance decrements were found in both sustained attention tasks (d = 0.59-0.77). Assessing driving-related ability, PSD induced decrements only in the test domain Reaction Test (reaction time d = 0.54 and motor time d = 0.45). All other subtests-as well as the overall judgement of fitness to drive-were not significantly affected by PSD.

    CONCLUSION: In contrast to established tests of sustained attention and subjective sleepiness, computer-based test batteries of fitness to drive might lack sensitivity to core aspects of sleepiness as they mainly consist of short and stimulating subtests. Therefore, tasks that require sustained attention should be an essential part of traffic psychological test batteries when sleepiness is a potential issue.

  • 23.
    Sunnergren, Ola
    et al.
    Ear, Nose and Throat Clinic, Ryhov County Hospital, Jönköping.
    Broström, Anders
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Svanborg, Eva
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Rekonstruktionscentrum, Neurofysiologiska kliniken US.
    Positional sensitivity as a confounder in diagnosis of severity of obstructive sleep apnea2013Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 17, nr 1, s. 173-179Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: The apnea–hypopnea index (AHI) is used to grade obstructive sleep apnea (OSA) into mild, moderate, and severe forms. Obstructive events are most common in the supine position. The amount of supine sleep thus influences total AHI. Our aim was to determine the prevalence of position-dependent OSA (POSA) and its relation to OSA severity classification as recommended by the American Academy of Sleep Medicine (AASM).

    Methods: Two hundred sixty-five subjects were recruited from primary care hypertension clinics. Whole-night respiratory recordings were performed to determine the AHI in the supine and non-supine positions, respectively. POSA was defined as supine AHI twice the non-supine AHI with supine AHI ≥5.

    Results: Fifty-three percent had POSA, 22% had non-position-dependent OSA, and 25% had normal respiration. By AASM classification, 81 subjects did not have OSA, but 42% of them had some degree of obstruction when supine, and 5 subjects would have been classified as moderate–severe if they had only slept supine. Conversely, of the 53 classified as mild OSA, 30% would have changed to a more severe classification if they had exclusively slept supine.

    Conclusions: POSA was common both in subjects that by AASM classification had OSA as well as those without. The severity of OSA, as defined by AASM, could be dependent on supine time in a substantial amount of subjects

  • 24.
    Sunnergren, Ola
    et al.
    Linköping University.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Svanborg, Eva
    Linköping University.
    Positional sensitivity as a confounder in diagnosis of severity of obstructive sleep apnea2013Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 17, nr 1, s. 173-179Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: The apnea-hypopnea index (AHI) is used to grade obstructive sleep apnea (OSA) into mild, moderate, and severe forms. Obstructive events are most common in the supine position. The amount of supine sleep thus influences total AHI. Our aim was to determine the prevalence of position-dependent OSA (POSA) and its relation to OSA severity classification as recommended by the American Academy of Sleep Medicine (AASM). METHODS: Two hundred sixty-five subjects were recruited from primary care hypertension clinics. Whole-night respiratory recordings were performed to determine the AHI in the supine and non-supine positions, respectively. POSA was defined as supine AHI twice the non-supine AHI with supine AHI ≥5. RESULTS: Fifty-three percent had POSA, 22% had non-position-dependent OSA, and 25% had normal respiration. By AASM classification, 81 subjects did not have OSA, but 42% of them had some degree of obstruction when supine, and 5 subjects would have been classified as moderate-severe if they had only slept supine. Conversely, of the 53 classified as mild OSA, 30% would have changed to a more severe classification if they had exclusively slept supine. CONCLUSIONS: POSA was common both in subjects that by AASM classification had OSA as well as those without. The severity of OSA, as defined by AASM, could be dependent on supine time in a substantial amount of subjects.

  • 25.
    Takács, Johanna
    et al.
    Semmelwies University, Hungary.
    Bódizs, Róbert
    Semmelwies University, Hungary;Pázmány Péter Catholic University, Hungary.
    Przemyslaw Ujma, Péter
    Semmelwies University, Hungary.
    Horváth, Klára
    Semmelwies University, Hungary.
    Rajna, Péter
    Semmelwies University, Hungary.
    Harmat, László
    Karolinska Institutet.
    Reliability and Validity of the Hungarian version of the Pittsburgh Sleep Quality Index (PSQI-HUN): comparing psychiatric patients with control subjects2016Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 20, nr 3, s. 1045-1051Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose

    The Pittsburgh Sleep Quality Index is used to evaluate subjective sleep quality, and it is commonly used in clinical research. Subjective sleep quality is also an important clinical measure in patients with psychiatric disorders. The aim of the present study was to evaluate the reliability and validity of the Hungarian version of the Pittsburgh Sleep Quality Index (PSQI-HUN) in both clinical and non-clinical samples.

    Methods

    The original version of PSQI was translated into Hungarian according to standard guidelines. The PSQI-HUN and the Athens Insomnia Scale (AIS) were subsequently administered to 53 psychiatric patients (schizophrenia, recurrent depressive disorder, mixed anxiety, and depressive disorder) and 178 healthy controls.

    Results

    Internal consistency as measured by Cronbach’s alpha in the whole sample was 0.79. Pearson’s product-moment correlations between component scores and the global scores were high (0.59–0.88) in the PSQI-HUN indicating the homogeneity of the scale. PSQI-HUN global and component scores differed significantly between psychiatric patients and control subjects. In the psychiatric patient subsample, schizophrenics had lower global scores compared to the other two patient groups. The analysis of convergent validity showed significant correlations between the AIS and the global as well as the component scores of the PSQI-HUN (except the component of sleep latency).

    Conclusions

    The present study concludes that the PSQI-HUN is a reliable, valid, and standardized measure for assessment of the subjective sleep quality in clinical and research settings.

  • 26. Tannheimer, Markus
    et al.
    Tannheimer, Sibylle
    Thomas, Alfred
    Engelhardt, Michael
    Schmidt, Roland
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Klinisk neurofysiologi.
    Auto-PEEP in the therapy of AMS in one person at 4,330 m.2009Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 13, nr 2, s. 195-199Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    The human organism is exposed to considerable hypoxic stress at high altitudes. Our intention was to investigate if a special breathing pattern with expiration against the resistance of pursed lips leads to an elevation in oxygen saturation (SaO2). For the first time ever, oxygen saturation was measured continuosly during the initial situation, during self-performed positive end-expiratory pressure breathing (auto-PEEP) itself, and during observation afterwards.

    Materials and methods

    The investigation was performed on a 33-year-old male suffering from high-altitude illness (Lake Louise Score, 9) after a 4-day rapid ascent from 350 m to 4,330 m during an expedition to Mount McKinley (6,198 m). SaO2 was measured continuously at 4-s intervals. After a rest of 1.5 h in a dorsal recumbent position with a slightly elevated (about 15°) upper body, the patient used a wristwatch to breathe according to a special time pattern (inspiration 2 s, expiration 8 s against the resistance of pursed lips). After 30 min, breathing was then allowed without any restrictions, and the inspiration/expiration ratio was approximately 1:1.

    Results

     

    There was a relatively sharp rise in SaO2 from an average of 62% to 85% within only 5 min after auto-PEEP began. This was followed by a comparable rise to values of 95% at the end of the auto-PEEP period. During normal breathing, SaO2 decreased slowly within half an hour to values of about 70% and remained at this level. The person reported relief in symptoms and no exhaustion. Vertigo—an indication of hypocapnia caused by hyperventilation—was not observed.

    Discussion

    The 30% rise in SaO2 and the improved saturation level after auto-PEEP are remarkable. Elevated intra-thoracal pressure may lead to a reopening of collapsed alveoli in addition to an improved gradient of alveolarcapillary pressure. In addition, a pressure-induced displacement of interstitial fluid resulting in a reduced diffusion distance may lead to improved alveolar-capillary diffusion. This would explain the slower rise in SaO2 after 10 min of auto-PEEP and the elevated level of SaO2 compared to the initial level before auto-PEEP.

    Conclusion

    As a result of the substantial and lasting improvement in SaO2 in combination with relief in AMS symptoms and its easy use, auto-PEEP (30 min every 2 h) can be a useful therapy option in the event of high-altitude-induced hypoxia and AMS.

     

     

     

  • 27.
    Thorarinsdottir, Elin H.
    et al.
    Natl Univ Iceland, Fac Med, Reykjavik, Iceland;Landspitali Natl Univ Hosp Iceland, Sleep Dept E7, IS-108 Reykjavik, Iceland.
    Arnardottir, Erna S.
    Natl Univ Iceland, Fac Med, Reykjavik, Iceland;Landspitali Natl Univ Hosp Iceland, Sleep Dept E7, IS-108 Reykjavik, Iceland.
    Benediktsdottir, Bryndis
    Natl Univ Iceland, Fac Med, Reykjavik, Iceland;Landspitali Natl Univ Hosp Iceland, Sleep Dept E7, IS-108 Reykjavik, Iceland.
    Janson, Christer
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lung- allergi- och sömnforskning.
    Olafsson, Isleifur
    Landspitali Natl Univ Hosp Iceland, Dept Clin Biochem, Reykjavik, Iceland.
    Pack, Allan I.
    Univ Penn, Sch Med, Ctr Sleep & Circadian Neurobiol, Philadelphia, PA 19104 USA;Univ Penn, Sch Med, Div Sleep Med, Dept Med, Philadelphia, PA 19104 USA.
    Gislason, Thorarinn
    Natl Univ Iceland, Fac Med, Reykjavik, Iceland;Landspitali Natl Univ Hosp Iceland, Sleep Dept E7, IS-108 Reykjavik, Iceland.
    Keenan, Brendan T.
    Univ Penn, Sch Med, Ctr Sleep & Circadian Neurobiol, Philadelphia, PA 19104 USA;Univ Penn, Sch Med, Div Sleep Med, Dept Med, Philadelphia, PA 19104 USA.
    Serum ferritin and obstructive sleep apnea-epidemiological study2018Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 22, nr 3, s. 663-672Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose

    Ferritin is an intracellular iron storage protein and a marker of inflammation. Studies have shown that subjects with obstructive sleep apnea (OSA) have higher levels of circulating pro-inflammatory cytokines, but little is known about the association between ferritin and OSA. The aims of the study were to evaluate serum ferritin (S-Ferritin) levels in OSA patients compared to levels in the general population and also examine the effect of obesity level and treatment with positive airway pressure (PAP) on S-Ferritin levels.

    Methods

    The OSA subjects (n=796) were part of the Icelandic Sleep Apnea Cohort. The control subjects (n=637) were randomly chosen Icelanders who participated in an epidemiological study. Propensity score (PS) methodologies were employed to minimize selection bias and strengthen causal inferences when comparing non-randomized groups. S-Ferritin levels were measured and all participants answered the same detailed questionnaire about sleep and health. Only OSA patients underwent a sleep study and were re-invited for a 2-year follow-up.

    Results

    S-Ferritin levels were significantly higher in OSA males than controls (213.3 vs. 197.3g/L, p=0.007). However, after adjusting for confounders and using our PS methodology, no significant difference was found. S-Ferritin levels were not correlated with severity of OSA, obesity level, or clinical symptoms. Also, no significant change in S-Ferritin levels was found with 2years of PAP treatment.

    Conclusions

    S-Ferritin levels are comparable in OSA patients and controls and do not change consistently with obesity level or PAP treatment in our sample.

  • 28.
    Ulander, Martin
    et al.
    Linköping University.
    Arestedt, Kristofer
    Linköping University.
    Svanborg, Eva
    Linköping University.
    Johansson, Peter
    Linköping University.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    The fairness of the Epworth Sleepiness Scale: two approaches to differential item functioning2013Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 17, nr 1, s. 157-165Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Differential item functioning (DIF) is said to exist in an item if a subject’s response to the item is affected by other aspects than that which the test is intended to assess. DIF might affect the validity of a test. The aim of this study was thus to examine whether any of the items in the Epworth Sleepiness Scale (ESS) exhibits DIF regarding age or gender, and if so, to which degree.

    Methods: Using previously collected cross-sectional ESS data from 1,168 subjects with different clinical characteristics (61% males, mean age 67.8 year (SD 12.2 year)), ordinal regression as well as Rasch-based DIF analyses were performed.

    Results: Concerning age, both DIF analyses showed DIF for age in items 3 (inactive in a public place), 4 (passenger in a car), and 8 (in a car that has stopped in traffic). The Rasch model also showed DIF for gender in item 3. The DIF magnitudes as judged by McFadden pseudo-R 2 changes were, however, only minor.

    Conclusions: ESS has small but reproducible DIF for age in items 3, 4, and 8. The detected DIF might be worth to consider in large-sample studies, although it probably has no effect on an individual basis.

  • 29.
    Ulander, Martin
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US.
    Broström, Anders
    Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Jonköping University, Sweden.
    Letter: Response to Akar et al., regarding our study "Side effects to continuous positive airway pressure treatment for obstructive sleep apnoea" in SLEEP AND BREATHING, vol 19, issue 4, pp 1345-13452015Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 19, nr 4, s. 1345-1345Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    n/a

  • 30.
    Ulander, Martin
    et al.
    Linköping University Hospital.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Linköping University Hospital.
    Response to Akar et al., regarding our study "Side effects to continuous positive airway pressure treatment for obstructive sleep apnoea"2015Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 19, nr 4, s. 1345-1345Artikel i tidskrift (Refereegranskat)
  • 31.
    Ulander, Martin
    et al.
    Department of Clinical Neurophysiology, Linköping University Hospital, 581 85, Linköping, Sweden.
    Johansson, Malin Svensson
    Högskolan i Jönköping, Hälsohögskolan.
    Ewaldh, Amanda Ekegren
    Högskolan i Jönköping, Hälsohögskolan.
    Svanborg, Eva
    Department of Clinical Neurophysiology, Linköping University Hospital, 581 85, Linköping, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Side effects to continuous positive airway pressure treatment for obstructive sleep apnoea: changes over time and association to adherence2014Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 18, nr 4, s. 799-807Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Continuous positive airway pressure (CPAP) is an effective treatment against obstructive sleep apnoea, but adherence is often low, and side effects are common. It is unclear from previous research whether side effects are significant causes of nonadherence. No study has examined if side effects vary within subjects over time. The aims were to (1) examine the evolution of CPAP side effects over time, and (2) prospectively assess correlations between early CPAP side effects and treatment adherence. One hundred eighty-six obstructive sleep apnoea patients from three sleep centres were prospectively enrolled. They completed the Side Effects to CPAP Inventory, where the respondent rates the frequency, magnitude and perceived impact on adherence from 15 side effects. Adherence was measured by treatment dropout and machine usage time. The most common side effects were dry mouth, increased number of awakenings, blocked up nose, mask pressure and mask leaks. While some side effects were stable over time, others could both resolve and emerge within subjects. Dry mouth, mask leakage and blocked up nose emerged within 1 year in approximately 30 % of patients who had not experienced them after 2 weeks. Increased number of awakenings and dry mouth after 1-2 weeks were significantly associated to treatment dropout during the first year and machine usage time after 6 months. While some side effects are related to adherence, most are not. Not all side effects are stable over time. This, together with differences in methodology between studies, might explain the conflicting findings in earlier research.

  • 32.
    Ulander, Martin
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neurovetenskap. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Svensson Johansson, Malin
    Department of Nursing, School of Health Sciences, Jönköping University College, Jönköping, Sweden.
    Ekegren Ewaldh, Amanda
    Department of Nursing, School of Health Sciences, Jönköping University College, Jönköping, Sweden.
    Svanborg, Eva
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neurovetenskap. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Broström, Anders
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neurovetenskap. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Side effects of Continuous Positive Airway Pressure treatment for Obstructive Sleep Apnea: Changes over time and association to adherence2014Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 18, nr 4, s. 799-807Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Continuous Positive Airway Pressure is an effective treatment for obstructive sleep apnea, but adherence is often low and side effects are common. It is unclear from previous research whether side effects are significant causes of non-adherence. No study has examined if side effects vary within subjects over time. The aims were to 1) examine the evolution of CPAP side effects over time; and 2) prospectively assess correlations  between early CPAP side effects and treatment adherence. Methods: 186 obstructive sleep apnea patients from three sleep centres were prospectively enrolled. They completed the Side Effects to CPAP Inventory, where the respondent rates the frequency, magnitude and perceived impact on adherence from 15 side effects. Adherence was measured by treatment dropout and machine usage time. Results: The most common side effects were dry mouth, increased number of awakenings, blocked up nose, mask pressure and mask leaks. While some side effects were stable over time, others could both resolve and emerge within subjects. Dry mouth, mask leakage and blocked up nose emerged within one year in approximately 30% of patients who had not experienced them after two weeks. Increased number of awakenings and dry mouth after 1-2 weeks were significantly associated to treatment dropout during the first year and machine usage time after six months. Conclusions: While some side effects are related to adherence, most are not. Not all side effects are stable over time. This, together with differences in methodology between studies, might explain the conflicting findings in earlier research.

  • 33. Ulander, Martin
    et al.
    Årestedt, Kristofer
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Svanborg, Eva
    Johansson, Peter
    Brostrom, Anders
    The fairness of the Epworth Sleepiness Scale: two approaches to differential item functioning2013Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 17, nr 1, s. 157-165Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Differential item functioning (DIF) is said to exist in an item if a subject's response to the item is affected by other aspects than that which the test is intended to assess. DIF might affect the validity of a test. The aim of this study was thus to examine whether any of the items in the Epworth Sleepiness Scale (ESS) exhibits DIF regarding age or gender, and if so, to which degree. Using previously collected cross-sectional ESS data from 1,168 subjects with different clinical characteristics (61% males, mean age 67.8 year (SD 12.2 year)), ordinal regression as well as Rasch-based DIF analyses were performed. Concerning age, both DIF analyses showed DIF for age in items 3 (inactive in a public place), 4 (passenger in a car), and 8 (in a car that has stopped in traffic). The Rasch model also showed DIF for gender in item 3. The DIF magnitudes as judged by McFadden pseudo-R (2) changes were, however, only minor. ESS has small but reproducible DIF for age in items 3, 4, and 8. The detected DIF might be worth to consider in large-sample studies, although it probably has no effect on an individual basis.

  • 34.
    Ulander, Martin
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Årestedt, Kristofer
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Svanborg, Eva
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Johansson, Peter
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Broström, Anders
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    The fairness of the Epworth Sleepiness Scale: two approaches to differential item functioning2013Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 17, nr 1, s. 157-165Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose

    Differential item functioning (DIF) is said to exist in an item if a subject’s response to the item is affected by other aspects than that which the test is intended to assess. DIF might affect the validity of a test. The aim of this study was thus to examine whether any of the items in the Epworth Sleepiness Scale (ESS) exhibits DIF regarding age or gender, and if so, to which degree.

    Methods

    Using previously collected cross-sectional ESS data from 1,168 subjects with different clinical characteristics (61% males, mean age 67.8 year (SD 12.2 year)), ordinal regression as well as Rasch-based DIF analyses were performed.

    Results

    Concerning age, both DIF analyses showed DIF for age in items 3 (inactive in a public place), 4 (passenger in a car), and 8 (in a car that has stopped in traffic). The Rasch model also showed DIF for gender in item 3. The DIF magnitudes as judged by McFadden pseudo-R2 changes were, however, only minor.

    Conclusions

    ESS has small but reproducible DIF for age in items 3, 4, and 8. The detected DIF might be worth to consider in large-sample studies, although it probably has no effect on an individual basis.

  • 35.
    Walker-Engström, Marie-Louise
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Ringqvist, Ivar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Vestling, Olle
    Wilhelmsson, Bo
    Tegelberg, Åke
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    A prospective randomized study comparing two different degrees of mandibular advancement with a dental appliance in treatment of severe obstructive sleep apnea2003Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 7, nr 3, s. 119-130Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The objective of this study was to compare the effect of two different degrees of mandibular advancement (MA), 75% versus 50%, on somnographic variables after 6 months of dental appliance treatment in patients with severe obstructive sleep apnea (OSA). A further purpose was to compare the number of adverse events on the stomatognathic system and the effects of dental appliance treatment on the presence of daytime sleepiness.

    Eighty-six males with severe OSA (apnea index ≥ 20) were randomly allocated to either 75% or 50% MA. Forty patients in the 75% MA group and 37 patients in the 50% MA group completed the 6-month follow-up.

    The effectiveness of treatment in terms of normalization (apnea index < 5 and apnea/hypopnea index < 10) with 75% MA was 52%, which was significantly higher (p = 0.04) than the 31% achieved with 50% MA. The dental appliance had few adverse events on the stomatognathic system regardless of group, and the number of adverse events did not differ between the two groups. Finally, the mean value of Epworth Sleepiness Scale scores decreased significantly from 11.6 at baseline to 8.0 at follow-up (p < 0.001). No significant difference was observed between the two groups. The results indicate that a dental appliance could be an alternative treatment for some patients with severe OSA.

  • 36. Zou, Ding
    et al.
    Wennman, Heini
    Ekblom, Örjan
    Grote, Ludger
    Arvidsson, Daniel
    Blomberg, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Torén, Kjell
    Bergström, Göran
    Börjesson, Mats
    Hedner, Jan
    Insomnia and cardiorespiratory fitness in a middle-aged population: the SCAPIS pilot study2019Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 23, nr 1, s. 319-326Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BackgroundThe relationship between insomnia and cardiorespiratory fitness (CRF), a well-established risk factor for cardiovascular disease, has not been extensively studied. We aimed to assess the independent association between insomnia and CRF in a population-based cohort of subjects aged 50 to 64years.MethodsSubjects participating in the Swedish CArdioPulmonary bioImaging Study (SCAPIS) pilot cohort (n=603, men 47.9%) underwent a submaximal cycle ergometer test for estimation of maximal oxygen consumption (VO(2)max). Data on physical activity and sedentary time were collected via waist-worn accelerometers. An insomnia severity index score 10 was used to define insomnia.ResultsInsomnia was identified in 31.8% of the population. The VO(2)max was significantly lower in insomnia subjects compared with the non-insomnia group (31.26.3 vs. 32.4 +/- 6.5ml*kg(-1)*min(-1), p=0.028). There was no difference in objectively assessed physical activity or time spent sedentary between the groups. In a multivariate generalized linear model adjusting for confounders, an independent association between insomnia status and lower VO(2)max was found in men, but not in women (=-1.15 [95% CI -2.23--0.06] and -0.09 [-1.09-0.92], p=0.038 and 0.866, respectively).Conclusionsp id=ParWe found a modest, but significant, association between insomnia and lower CRF in middle-aged men, but not in women. Our results suggest that insomnia may link to cardiovascular disease via reduced CRF. Insomnia may require a specific focus in the context of health campaigns addressing CRF.

  • 37.
    Zou, Ding
    et al.
    University of Gothenburg.
    Wennman, Heini
    National Institute for Health and Welfare, Helsinki, Finland.
    Ekblom, Örjan
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet.
    Grote, Ludger
    University of Gothenburg.
    Arvidsson, Daniel
    University of Gothenburg.
    Blomberg, Anders
    Umeå University.
    Torén, Kjell
    University of Gothenburg.
    Bergström, Göran
    University of Gothenburg.
    Börjesson, Mats
    University of Gothenburg.
    Hedner, Jan
    University of Gothenburg.
    Insomnia and cardiorespiratory fitness in a middle-aged population: the SCAPIS pilot study.2019Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 23, nr 1, s. 319-326Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The relationship between insomnia and cardiorespiratory fitness (CRF), a well-established risk factor for cardiovascular disease, has not been extensively studied. We aimed to assess the independent association between insomnia and CRF in a population-based cohort of subjects aged 50 to 64 years.

    METHODS: Subjects participating in the Swedish CArdioPulmonary bioImaging Study (SCAPIS) pilot cohort (n = 603, men 47.9%) underwent a submaximal cycle ergometer test for estimation of maximal oxygen consumption (VO2max). Data on physical activity and sedentary time were collected via waist-worn accelerometers. An insomnia severity index score ≥ 10 was used to define insomnia.

    RESULTS: Insomnia was identified in 31.8% of the population. The VO2max was significantly lower in insomnia subjects compared with the non-insomnia group (31.2 ± 6.3 vs. 32.4 ± 6.5 ml* kg-1 *min-1, p = 0.028). There was no difference in objectively assessed physical activity or time spent sedentary between the groups. In a multivariate generalized linear model adjusting for confounders, an independent association between insomnia status and lower VO2max was found in men, but not in women (β = - 1.15 [95% CI - 2.23-- 0.06] and - 0.09 [- 1.09-0.92], p = 0.038 and 0.866, respectively).

    CONCLUSIONS: We found a modest, but significant, association between insomnia and lower CRF in middle-aged men, but not in women. Our results suggest that insomnia may link to cardiovascular disease via reduced CRF. Insomnia may require a specific focus in the context of health campaigns addressing CRF.

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