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  • 1.
    Andersen Amofah, Hege
    et al.
    Haukeland Hospital, Norway.
    Broström, Anders
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology. Bergen University of Coll, Norway; Jonköping University, Sweden.
    Fridlund, Bengt
    Haukeland Hospital, Norway; Bergen University of Coll, Norway; Jonköping University, Sweden.
    Bjorvatn, Bjorn
    Norwegian Competence Centre Sleep Disorders, Norway; University of Bergen, Norway.
    Haaverstad, Rune
    Haukeland Hospital, Norway; University of Bergen, Norway.
    Ove Hufthammer, Karl
    Haukeland Hospital, Norway.
    Kuiper, Karel K. J.
    Haukeland Hospital, Norway.
    Hylen Ranhoff, Anette
    University of Bergen, Norway; Haraldsplass Hospital, Norway.
    Norekval, Tone M.
    Haukeland Hospital, Norway; Bergen University of Coll, Norway; University of Bergen, Norway.
    Sleep in octogenarians during the postoperative phase after transcatheter or surgical aortic valve replacement2016In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 15, no 2, p. 168-177Article in journal (Refereed)
    Abstract [en]

    Background: Octogenarians with aortic stenosis are an increasing population of patients admitted for surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). Although adequate sleep is important after illness and surgery, it has scarcely been studied in the immediate postoperative phase. Aims: To determine and compare the nature of self-reported sleep and insomnia, and recorded sleep-wake patterns in octogenarians during the in-hospital postoperative phase after SAVR or TAVI. Methods: A prospective cohort design was used that included octogenarian patients undergoing SAVR or TAVI at a regional university hospital. Self-reports were used to document sleep and insomnia, and actigraphy was used to record sleep-wake patterns. Data were collected at baseline preoperatively, and then daily for the first five postoperative days. Results: SAVR patients experienced the most insomnia on postoperative nights later in recovery, while TAVI patients experienced the most insomnia on postoperative nights early in recovery. The median total sleep time, as measured by actigraphy, was 6.4 h, and the median sleep efficiency was 79% for the five postoperative nights, but no differences were found between SAVR and TAVI patients on this parameter. All patients slept more during daytime than at night, with SAVR patients having significantly more total sleep hours for all five days than TAVI patients (p < 0.01). Conclusion: Octogenarians with aortic stenosis had disturbed self-reported sleep, increased insomnia, and disturbed sleep-wake patterns postoperatively, resulting in more daytime sleep and inactivity. In patients undergoing SAVR or TAVI, sleep evolves differently during the in-hospital postoperative phase.

  • 2.
    Broström, A
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Strömberg, A
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Dahlström, U
    Fridlund, B
    Högskolan i Jönköping.
    Decisive situations influencing spouses' support to patients with congestive heart failure in relation to the couple's sleep situation: A critical incident technique analysis.2002Conference paper (Other academic)
  • 3.
    Broström, A
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Strömberg, A
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Dahlström, U
    Fridlund, B
    Högskolan i Jönköping.
    Patients with congestive heart failure and their conception of the sleep situation.1999Conference paper (Refereed)
  • 4.
    Broström, A
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Strömberg, A
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Dahlström, U
    Fridlund, B
    Högskolan i Jönköping.
    Sleeping difficulties, daytime sleepiness and health-related quality of life in patients with chronic heart failure.2003Conference paper (Other academic)
  • 5.
    Broström, A
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Strömberg, A
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Fridlund, B
    Högskolan i Jönköping.
    Dahlström, U
    Sleep, health-related quality of life and daytime sleepiness in patients with chronic heart failure2002Conference paper (Other academic)
  • 6.
    Broström, Anders
    Linköping University, Department of Medicine and Care, Internal Medicine. Linköping University, Faculty of Health Sciences.
    Sleep and health-related quality of life in patients with chronic heart failure and their spouses: a descriptive and interventional study2004Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The general aim of this thesis was to describe and compare the sleep situation and health-related quality of life in patients with chronic heart failure and their spouses, as well as to evaluate the effects of an intervention with 3-months ofhome based oxygen treatment. Descriptive designs were used to describe how patients with chronic heart failure conceived their sleep situation (I), decisive situations that influenced spouses' support to patients with chronic heart failure in relation to the couple's sleep situation (II), and self-assessed sleep difficulties, daytime sleepiness and their relation to health-related quality oflife in men and women with chronic heart failure, as well as to make a comparison with data from a norm population (III). An interventional design was used to determine the effects of 3-months of home based oxygen treatment regarding both subjective and objective outcomes (IV).

    Daily life, the disease itself and cardiac symptoms influenced the sleep situation and led to ensuing effects, such as fatigue, listlessness, loss of temper, loss of concentration, a need for daytime sleep, seclusion, information and counseling. Patients handled their sleep disturbances by means of support from their psychosocial environment as well as coping mechanisms related to developed patterns of daily life (I). Decisive situations inhibited or stimulated spouses' support to patients with heart failure, in relation to the couples' sleep situation (II). Self-assessed sleep difficulties such as difficulties initiating sleep, difficulties maintaining sleep, and excessive daytime sleepiness were common in patients with chronic heart failure and gave a decreased health-related quality of life compared to chronic heart failure patients without sleeping difficulties (III). Sleep disordered breathing, with a dominance of central sleep apnea was a very common problem, with a high prevalence, but patients suffering from objectively registered sleep disordered breathing did not show decreased health-related quality of life compared to chronic heart failure patients without sleep disordered breathing. A long-term intervention with nocturnal home based oxygen improved functional exercise capacity for both the whole group of patients with chronic heart failure, as well as in patients with chronic heart failure where sleep disordered breathing occurred. The intervention did not give any persistent improvements regarding cardiac function, objective sleep, subjective sleep, sleep disordered breathing, or healthrelated quality of life (IV).

    Sleep disturbances are a complex situation where sleep disordered breathing can be seen as one possible organic trigger, together with psychosocial, as well as environmental factors causing a chain reaction with disturbed sleep, daytime sleepiness and decreased health-related quality of life that leads to physical, social, and mental consequences and needs. Further studies are therefore needed from a holistic perspective on both patients with chronic heart failure and their spouses.

  • 7.
    Broström, Anders
    et al.
    Omvårdnad, Högskolan i Jönköping.
    Franzén Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ulander, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences.
    The side-effects to CPAP treatment inventory: the development and initial validation of a new tool for the measurement of side-effects to CPAP treatment2010In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 19, no 4, p. 603-611Article in journal (Refereed)
    Abstract [en]

    Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS), but side-effects are common. No validated self-rating scale measuring side-effects to CPAP treatment exists today. The aim was to develop the side-effects to CPAP treatment inventory (SECI), and investigate the validity and reliability of the instrument among patients with OSAS. SECI was developed on the basis of: (1) in-depth interviews with 23 patients; (2) examination of the scientific literature and (3) consensus agreement of a multi-professional expert panel. This yielded 15 different types of side-effects related to CPAP treatment. Each side-effect has three sub-questions (scales): perceived frequency (a) and magnitude (b) of the side-effect, as well as its perceived impact on CPAP use (c). A cross-sectional descriptive design was used. A total of 329 patients with OSAS with an average use of CPAP treatment for 39 months (2 weeks to 182 months) were recruited. Data were collected with SECI, and obtained from medical records (clinical variables and data related to CPAP treatment). Construct validity was confirmed with factor analysis (principal component analysis with orthogonal rotation). A logical two-factor solution, the device subscale and symptom subscale, emerged across all three scales. The symptom subscale describing physical and psychological side-effects and the device subscale described mask and device-related side-effects. Internal consistency reliability of the three scales was good (Cronbach’s α = 0.74–0.86) and acceptable for the subscales (Cronbach’s α = 0.62–0.86). The satisfactory measurement properties of this new instrument are promising and indicate that SECI can be used to measure side-effects to CPAP treatment.

  • 8.
    Broström, Anders
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Fridlund, B
    Jonköping University, Sweden .
    Ulander, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences.
    Sunnergren, O
    County Hospital Ryhov, Sweden .
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Neurophysiology UHL.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Effects of a group-based educational programme on adherence to CPAP treatment in obstructive sleep apnoea in JOURNAL OF SLEEP RESEARCH, vol 21, issue SI, pp 348-3482012In: JOURNAL OF SLEEP RESEARCH, Wiley-Blackwell , 2012, Vol. 21, no SI, p. 348-348Conference paper (Refereed)
    Abstract [en]

    n/a

  • 9.
    Broström, Anders
    et al.
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology. Jönköping University, Sweden.
    Fridlund, Bengt
    Jönköping University, Sweden.
    Hedberg, Berith
    Jönköping Academic Qual Improvement and Leadership Heatlh, Sweden.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Ulander, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Communication between patients with obstructive sleep apnoea syndrome and healthcare personnel during the initial visit to a continuous positive airway pressure clinic2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 3-4, p. 568-577Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. To describe facilitators and barriers from a patient perspective in communications between patients with obstructive sleep apnoea syndrome and healthcare personnel during the first meeting when continuous positive airway pressure is initiated. Background. Adherence to continuous positive airway pressure treatment tends to be poor, especially at the initial phase of treatment. Communication between the patient and healthcare personnel has not been studied from the patient perspective, as either a barrier or facilitator for adherence. Methods. A descriptive design using qualitative content analysis was used. Interviews with 25 patients with obstructive sleep apnoea syndrome took place after their initial visit at four continuous positive airway pressure clinics. A deductive analysis based on The 4 Habits Model (i.e. emphasise the importance of investing in the beginning of the consultation, elicit the patients perspective, demonstrate empathy and invest in the end of the consultation) was conducted. Results. Building confidence (i.e. structure building, information transfer, commitment) or hindering confidence (i.e. organisational insufficiency, stress behaviour, interaction deficit) was associated with investing in the beginning. Motivating (i.e. situational insight, knowledge transfer, practical training) or demotivating (i.e. expectations, dominance and power asymmetry, barriers) was associated with eliciting the patients perspective. Building hope (i.e. awareness, sensitivity, demonstration of understanding) or hindering hope (i.e. unprepared, uncommitted, incomprehension) was associated with showing empathy. Agreement (i.e. confirmation, responsibilities, comprehensive information) or disagreement (i.e. structural obscurity, irresponsibility, absent-mindedness) was associated with investing in the end. Conclusions. Understanding of facilitators and barriers, as described by patients, can be used to improve contextual conditions and communication skills among healthcare personnel. Relevance to clinical practice. A patient-centred communication technique should be used in relation to all stages of The 4 Habits Model to facilitate shared decision-making and improve adherence to continuous positive airway pressure treatment.

  • 10.
    Broström, Anders
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Fridlund, Bengt
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Ulander, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Sunnergren, Ola
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics.
    A mixed method evaluation of a group-based educational programme for CPAP use in patients with obstructive sleep apnea2013In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 19, no 1, p. 173-184Article in journal (Refereed)
    Abstract [en]

    Rationale, aims and objectives  Continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA) has a low long-term adherence. Educational interventions are few and sparsely described regarding content, pedagogical approach and participants' perceptions. The aim was to describe adherence to CPAP treatment, knowledge about OSA/CPAP, as well as OSA patients' perceptions of participating in a group-based programme using problem-based learning (PBL) for CPAP initiation. Educational programme  The PBL programme incorporated elements from theories and models concerning motivation and habits. Tutorial groups consisting of four to eight patients met at six sessions during 6 months. Methods  A sequential explanatory mixed method design was used on 25 strategically selected patients. Quantitative data regarding, clinical variables, OSA severity, CPAP use, and knowledge were collected at baseline, after 2 weeks and 6 months. Qualitative data regarding patients' perceptions of participation were collected after 6 months by semi-structured interviews using a phenomenographic approach. Results  72% of the patients were adherent to CPAP treatment after 2 weeks and 6 months. All patients improved their baseline knowledge about OSA and CPAP after 2 weeks and sustained it after 6 months. Anxiety and fear, as well as difficulties and needs were motivational factors for participation. Patients described the difficulties of behavioural change, an awareness that improvements do not occur immediately, a realization of the importance of both technical and emotional support and the need for a healthier lifestyle. Conclusion and practice implications  A group-based programme using PBL seems to facilitate adaptive and developmental learning and result in acceptable CPAP adherence levels.

  • 11.
    Broström, Anders
    et al.
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Hübbert, Laila
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Jakobsson, Per
    Linköping University, Department of Medicine and Care, Pulmonary Medicine. Linköping University, Faculty of Health Sciences.
    Johansson, Peter
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Fridlund, Bengt
    Department of Nursing, Lund University, Lund, Sweden and School of Social and Health Sciences, Halmstad University, Halmstad, Sweden.
    Dahlström, Ulf
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Effects of long-term nocturnal oxygen treatment in patients with severe heart failure2005In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 20, no 6, p. 385-396Article in journal (Refereed)
    Abstract [en]

    Sleep-disordered breathing (SDB) is common in patients with heart failure (HF) and leads to disturbed sleep. The objective of this study was to determine the persistent effects of long-term nocturnal oxygen treatment in patients with severe HF regarding (1) objective outcomes, such as sleep, SDB, cardiac function, and functional capacity; (2) subjective outcomes, such as self-assessed sleep difficulties, daytime sleepiness, and health-related quality of life (HRQOL); and (3) the relationship between objective and subjective outcomes. In this open nonrandomized experimental study, 22 patients, median age 71 years, with severe HF were studied before and after 3 months of receiving nocturnal oxygen. The measures used were overnight polysomnography, echocardiography, 6-minute walk test, self-assessed sleep difficulties (Uppsala Sleep Inventory-HF), daytime sleepiness (Epworth Sleepiness Scale), and HRQOL (36-Item Short Form Health Survey and Minnesota Living with Heart Failure Questionnaire). SDB, with a 90% dominance of central sleep apnea, occurred in 41% of the patients with severe HF before intervention. After intervention, functional capacity improved for both the whole group of patients with HF (P < .01) and HF patients with SDB (P < .05). No improvements regarding cardiac function, objective sleep, subjective sleep, or SDB were seen, except for a decrease of > or = 4% desaturations (P < .05). HRQOL did not differ significantly between HF patients with and without SDB before or after intervention with nocturnal oxygen. Long-term nocturnal oxygen treatment improved functional capacity in patients with severe HF, with or without SDB. No improvements were seen regarding sleep, daytime sleepiness, SDB, cardiac function, or HRQOL.

  • 12.
    Broström, Anders
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Johansson, P
    Östergötlands Läns Landsting.
    Riegel, B
    University of Penn, USA .
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Fridlund, B
    Jonköping University, Sweden .
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Neurophysiology UHL.
    Do cardiovascular signs and risk factors differ between hypertensive men and women with high versus low risk on the Berlin sleep apnoea questionnaire in a primary care setting? in JOURNAL OF SLEEP RESEARCH, vol 21, issue SI, pp 230-2312012In: JOURNAL OF SLEEP RESEARCH, Wiley-Blackwell , 2012, Vol. 21, no SI, p. 230-231Conference paper (Refereed)
    Abstract [en]

    n/a

  • 13.
    Broström, Anders
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Johansson, Peter
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    How can nurses objectively measure sleep and sleep disordered breathing in patients with heart failure? A methodological description2005In: Annual spring meeting of the working group on cardiovascular nursing,2005, 2005Conference paper (Other academic)
  • 14.
    Broström, Anders
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Johansson, Peter
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Sleep disturbances in patients with chronic heart failure and their holistic consequences-what different care actions can be implemented?2005In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 4, no 3, p. 183-197Article in journal (Refereed)
    Abstract [en]

    Background: Sleep disturbances are prevalent among elderly, especially among those with chronic heart failure (CHF) and can affect all dimensions of quality of life (QOL) negatively. Aim: To describe the most common causes leading to sleep disturbances in patients with CHF, their consequences from a holistic perspective and different care actions that can be implemented. Methods: MEDLINE and CINAHL databases were searched from 1989 to July 2004. Findings: Sleep disordered breathing (SDB), and insomnia were the most common causes for sleep disturbances and occurs in 45-82% (SDB) and one-third (insomnia) of all patients with CHF. SDB cause a disturbed sleep structure with frequent awakenings, as well as several adverse effects on the cardiovascular system causing increased morbidity and mortality. Insomnia, caused by anxiety, an unknown life situation in relation to the debut of CHF, or symptoms/deteriorations of CHF can lead to negative effects on all aspects of QOL, as well as daytime sleepiness. Conclusion: The high prevalence of sleep disturbances and their holistic consequences should be taken into account when nurses asses and plan the care for patients with CHF. Randomized studies with large sample sizes evaluating non-pharmacological nursing interventions that improve sleep are needed. © 2005 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.

  • 15.
    Broström, Anders
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Johansson, Peter
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Sleep disturbances in patients with chronic heart failure from a holistic perspective - A new nursing topic2005In: Annual spring meeting of the working group on cardiovascular nursing,2005, 2005Conference paper (Other academic)
  • 16.
    Broström, Anders
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science.
    Johansson, Peter
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Albers, Jan
    City Hospital Ryhov.
    Wiberg, Jan
    City Hospital Ryhov.
    Svanborg, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology . Östergötlands Läns Landsting, Reconstruction Centre, Department of Neurophysiology UHL.
    Fridlund, Bengt
    Vaxjö University.
    6-month CPAP-treatment in a young male patient with severe obstructive sleep apnoea syndrome - A case study from the couples perspective2008In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 7, no 2, p. 103-112Article in journal (Refereed)
    Abstract [en]

    Background: Obstructive sleep apnoea syndrome (OSAS) is independently associated with an increased risk for hypertension and cardiovascular disease. Continuous positive airway pressure (CPAP) can reduce mortality and morbidity, but low compliance rates are seen. Aim: To explore and describe the experiences of CPAP-treatment in a young male patient with severe OSAS during a 6-month period from the couples perspective.

    Methods and the case: A single case study with a phenomenographic approach was employed. Diagnostic procedures of OSAS and initiation of treatment with Auto-CPAP, humidifier and a nasal mask were performed during 4 visits. Conceptions were collected at 4 different occasions during the 6-month period (before, and 2 weeks, 3 months, and 6 months after treatment initiation) by means of interviews with a 33-year old male patient and his female partner.

    Findings: Totally 17 different structural aspects were found to fluctuate during the 6-month period in relation to; influence of stressors, social reactions and adaptation to increase compliance.

    Conclusion: An increased knowledge about the influence of stressors, the social reactions, and the adaptation can help healthcare personnel to identify and better understand concerns of other patients and spouses during different time phases of the initial 6-month period of CPAP-treatment.

  • 17.
    Broström, Anders
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Johansson, Peter
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Albers, Jan
    Wiberg, Jan
    Svanborg, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Clinical Neurophysiology. Östergötlands Läns Landsting, Reconstruction Centre, Department of Neurophysiology UHL.
    Fridlund, Bengt
    P374 3-Month CPAP treatment in a young male patient with severe obstructive sleep apnoea syndrome - a qualitative case study from the couple´s perspective2006In: 8th World Congress on Sleep Apnea 27-30 September 2006,2006, 2006, p. 76-76Conference paper (Other academic)
  • 18.
    Broström, Anders
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Clinical Neurophysiology.
    Johansson, Peter
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Kihl, J
    Forslund, P
    Dahlström, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Svanborg, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Clinical Neurophysiology. Östergötlands Läns Landsting, Reconstruction Centre, Department of Neurophysiology UHL.
    Fridlund, B G
    Depressive symptoms in patients with chronic heart failure - effects on insomnia, daytime sleepiness and health-related quality of life2006In: World Congress of Cardiology,2006, 2006, p. 224-224Conference paper (Other academic)
  • 19.
    Broström, Anders
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Johansson, Peter
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Strömberg, Anna
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Albers, J
    County Hospital Ryhov.
    Mårtensson, Jan
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Neurophysiology UHL.
    Obstructive sleep apnoea syndrome - Patients' perceptions of their sleep and its effects on their life situation2007In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 57, no 3, p. 318-327Article in journal (Refereed)
    Abstract [en]

    Title. Obstructive sleep apnoea syndrome - patients' perceptions of their sleep and its effects on their life situation Aim. This paper reports a descriptive study of how untreated patients with obstructive sleep apnoea syndrome perceived their sleep situation and how the syndrome affected their life situation. Background. Obstructive sleep apnoea syndrome is a prevalent problem independently associated with an increased risk for hypertension, cardiovascular disease, chronic heart failure and mortality. Increased consumption of healthcare resources can often be seen among patients over a long period of time since many have been undiagnosed and untreated. Methods. A phenomenographic approach was employed. Data were collected by interviews during 2005 with 20 purposively selected participants with untreated obstructive sleep apnoea syndrome. Findings. Participants described loud snoring, frequent awakenings, dyspnoea, frustration over nocturia, fear of dying during sleep and partners' anxiety about the apnoea, as being night-time effects of obstructive sleep apnoea syndrome. They described dry and sore throats, tiredness and daytime sleepiness, shame about falling asleep and snoring, thoughts about complications and depressed mood as daytime effects. Needs, such as increased alertness, improved ability to concentrate, improved relationship, adequate information as well as effective treatment, were described. Participants tried self-care strategies such as information-seeking about sleep disturbances and treatment, adapted sleeping routines, change of bedroom arrangements, adapted daily schedules, hyperactivity and avoidance of difficult situations. Conclusion. The perceived effects and needs, as well as tried self-care actions by the patients with obstructive sleep apnoea syndrome in this study, could be used to identify and evaluate concerns of other patients with obstructive sleep apnoea syndrome waiting for treatment. © 2007 The Authors.

  • 20.
    Broström, Anders
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Johansson, Peter
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Strömberg, Anna
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Albers, Jan
    Wiberg, Jan
    Mårtensson, Jan
    Svanborg, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Clinical Neurophysiology. Östergötlands Läns Landsting, Reconstruction Centre, Department of Neurophysiology UHL.
    Obstructive sleep apnea syndrome - Patient perceptions of their life situation before initiation of CPAP treatment2006In: 8th World Congress on Sleep Apnea 27-30 September, 2006,2006, 2006, p. 124-124Conference paper (Other academic)
  • 21.
    Broström, Anders
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Gardner, Benjamin
    University College London, UK.
    Johansson, Peter
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Ulander, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Fridlund, Bengt
    Jönköping University, Sweden.
    Arestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Linnaeus University & Palliative Research Centre, Ersta Sköndal University College and Ersta Hospital, Stockholm.
    Validation of the CPAP Habit Index-5: A Tool to Understand Adherence to CPAP Treatment in Patients with Obstructive Sleep Apnea.2014In: Sleep Disorders, ISSN 2090-3545, E-ISSN 2090-3553, Vol. 2014, p. 1-9, article id 929057Article in journal (Refereed)
    Abstract [en]

    Long-term adherence to continuous positive airway pressure (CPAP) is low among patients with obstructive sleep apnea (OSA). The potential role of "habit" in sustaining adherence to CPAP use has not been studied. This study aimed to establish the relevance of habit to CPAP adherence, via validation of an adaptation of the Self-Report Habit Index (the CPAP Habit Index-5; CHI-5). Analyses focused on the homogeneity, reliability, and factor structure of the CHI-5 and, in line with theoretical predictions, its utility as a predictor of long-term CPAP adherence in middle-aged patients with OSA. A prospective longitudinal design was used. 117 patients with objectively verified OSA intended for CPAP treatment were recruited. Data was collected via clinical examinations, respiratory recordings, questionnaires, and CPAP devices at baseline, 2 weeks, 6 months, and 12 months. The CHI-5 showed satisfactory homogeneity interitem correlations (0.42-0.93), item-total correlations (0.58-0.91), and reliability ( α = 0.92). CHI-5 data at 6 months showed a one-factor solution and predicted 63% of variance in total CPAP use hours after 12 months. Based on the satisfactory measurement properties and the high amount of CPAP use variance it explained, the CHI-5 can be seen as a useful tool in clinical practice.

  • 22.
    Broström, Anders
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    Johansson, P
    n/a.
    Ulander, Martin
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Swahnborg, E
    n/a.
    Fridlund, B
    n/a.
    Adherence to CPAP treatment - a qualitative contnt analysis in patients with OSAS.2009In: 9th Annual Spring Meeting on Cardiovascular Nursing, CCNAP., 2009Conference paper (Refereed)
  • 23.
    Broström, Anders
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Johansson, Peter
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Ulander, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology . Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Neurophysiology UHL.
    Fridlund, Bengt
    Jonköping University.
    Putative facilitators and barriers for adherence to CPAP treatment in patients with obstructive sleep apnea syndrome: A qualitative content analysis2010In: SLEEP MEDICINE, ISSN 1389-9457, Vol. 11, no 2, p. 126-130Article in journal (Refereed)
    Abstract [en]

    Introduction: Effective treatment of obstructive sleep apnea syndrome (OSAS) with continuous positive airway pressure (CPAP) can reduce morbidity and mortality, but adherence rates are low without a clear consensus Of causes. Objective: To explore the experiences of adherence to CPAP treatment in patients with OSAS. Methods: A qualitative content analysis was employed. Data were collected by in-depth interviews with 23 purposively selected patients. Results: Adherence to CPAP treatment was summarized according to "facilitators" and "barriers" to CPAP treatment. Facilitators for adherence, as described by the patients were a desire to avoid symptoms, knowledge about the risk for medical consequences, fear of negative social consequences and disturbing the sleep of significant others. Other facilitators were a positive attitude to CPAP treatment, trust in healthcare personnel, a sense of engagement from the spouse and a feeling of physical improvement. Barriers included experiencing practical problems, negative psychological effects of the equipment, and negative attitudes to the treatment. Other barriers were side-effects as well as insufficient support from healthcare personnel and the spouse. Conclusion: Adherence to CPAP treatment is a multifaceted problem including patient, treatment, condition, social and healthcare related factors. Knowledge about facilitators and barriers for adherence to CPAP treatment can be used in interventional Strategies.

  • 24.
    Broström, Anders
    et al.
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Dahlström, Ulf
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Fridlund, Bengt
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Congestive heart failure, spouses' support and the couple's sleep situation: a critical incident technique analysis2003In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 12, no 2, p. 223-233Article in journal (Refereed)
    Abstract [en]

    • Sleep related breathing disorders are common as well as a poor prognostic sign associated with higher mortality in patients with congestive heart failure (CHF). These patients often have a shorter total duration of sleep, disturbed sleep structure and increased daytime sleepiness, which can negatively affect all dimensions of the life situation. The spouse has an important role in supporting the patient in relation to sleep disorders, but this role may be adversely affected by the sleep situation of the couple.

    •  The aim of this study was to describe decisive situations that influence spouses' support to patients with CHF in relation to the couple's sleep situation.

    • A qualitative descriptive design using critical incident technique was employed. Incidents were collected by means of interviews with 25 spouses of patients with CHF, strategically selected from two hospital-based specialist clinics in southern Sweden.

    •  Two main areas emerged in the analysis: support stimulating situations and support inhibiting situations. Support stimulating situations described how spouses' support was positively affected by their own adaptation in psychosocial or practical situations, and receiving help from others. Support inhibiting situations described how the spouses' support was negatively affected by sleep disturbances as a result of the patient's symptoms, anxiety in relation to the disease, limitations as a result of the sleeping habits, dissatisfaction with care related to the sleep situation, and being left to cope alone with the problems.

    •  An increased understanding of the stimulating and inhibiting situations influencing spouses' support for patients with CHF can guide health care personnel in deciding if an intervention is needed to improve the sleep situation for patient and spouse.

  • 25.
    Broström, Anders
    et al.
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Dahlström, Ulf
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Fridlund, Bengt
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Patients with congestive heart failure and their conceptions of their sleep situation2001In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 34, no 4, p. 520-529Article in journal (Refereed)
    Abstract [en]

    Aim. To describe, from a nursing perspective, how patients with CHF conceived their sleep situation.

    Background.  Sleep disturbances are very common in patients with congestive heart failure (CHF). Polysomnographic studies have shown that the total duration of sleep is shorter and the sleep structure disturbed, with frequent arousals and sleep stage changes.

    Methods.  A qualitative descriptive design inspired by a phenomenographic approach was employed. Conceptions were collected through interviews with 20 strategically chosen CHF patients.

    Findings.  The findings showed that the patients’ sleep was affected by their daily activities, the disease itself and cardiac symptoms. The sleep disturbances gave effects such as fatigue, listlessness, loss of concentration and loss of temper. These effects led to a need for daytime sleep, seclusion, counselling and information. Patients handled their sleep disturbances through coping mechanisms related to developed patterns of daily life and through support from their psychosocial environment.

    Conclusions. Through an increased awareness of the causes of sleep disturbances in CHF patients, nurses can more effectively meet their caring needs and reduce the psychological stressors that patients develop. Information and education, both to patients and the next of kin, about the disease and the sleep situation, especially good sleeping habits, can help patients to better cope with sleep disturbances.

  • 26.
    Broström, Anders
    et al.
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Dahlström, Ulf
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Fridlund, Bengt
    Department of Nursing, Lund University, Lund, Sweden and School of Social and Health Sciences, Halmstad University, Halmstad, Sweden.
    Sleep difficulties, daytime sleepiness, and health-related quality of life in patients with chronic heart failure2004In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 19, no 4, p. 234-242Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Normal sleep changes with age in duration, fragmentation, and depth. The prevalence of insomnia is high in the elderly general population. In patients with chronic heart failure (HF) objective sleep assessments have shown disturbances such as a shorter total duration of sleep, frequent arousals, and sleep stage changes.

    OBJECTIVE:

    To describe self-assessed sleep difficulties, daytime sleepiness, and their relation to health-related quality of life (HRQOL) in men and women with HF, as well as to make a comparison to data from a norm population.

    METHODS:

    Cross-sectional design including 223 patients with HF, New York Heart Association classification II-IV, assessed using the Uppsala Sleep Inventory-Chronic Heart Failure, the Epworth Sleepiness Scale, Medical Outcomes Study 36-Item Short Form Health Survey, and Minnesota Living With Heart Failure Questionnaire.

    RESULTS:

    The most commonly reported sleep difficulties were initiating and maintaining sleep. The ratio of habitual sleep to the amount of estimated need for sleep was significantly shorter for women (P < .05), and the number of awakenings per night was significantly increased for men (P < .001). A total of 21% suffered from daytime sleepiness. Patients suffering from difficulties maintaining sleep, initiating sleep, and early morning awakenings reported significantly lower HRQOL in almost all dimensions of the SF-36 (P < .05-P < .001) compared to patients without sleeping difficulties, as well as to the normal population. The disease-specific Minnesota Living With Heart Failure Questionnaire showed significantly reduced (P < .05-P < .001) HRQOL as measured by the total and subscale scores for patients suffering from sleeping difficulties compared to patients without sleeping difficulties.

    CONCLUSION:

    Patients with HF have a reduced HRQOL especially if difficulties maintaining sleep, initiating sleep, and early morning awakenings are involved.

  • 27.
    Broström, Anders
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Mårtensson, Jan
    Jönköping.
    Ulander, Martin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Clinical Neurophysiology.
    Harder, Lena
    Svanborg, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Clinical Neurophysiology. Östergötlands Läns Landsting, Reconstruction Centre, Department of Neurophysiology UHL.
    Association of Type D personality to perceived side effects and adherence in CPAP-treated patients with OSAS2007In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 16, no 4, p. 439-447Article in journal (Refereed)
    Abstract [en]

    Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS), but side effects are common and long-term adherence low. The Type D (distressed) personality is defined as a combination of negative affectivity and social inhibition. The association of Type D personality with adherence has not been studied in CPAP-treated patients with OSAS. This study aimed to describe the prevalence of Type D personality in OSAS patients with CPAP treatment longer than 6 months and the association with self-reported side effects and adherence. A cross-sectional descriptive design was used. A total of 247 OSAS patients with a mean use of CPAP treatment for 55 months (6-182 months) were included. Data collection was achieved by two questionnaires, the Type D scale 14 (DS14) (Type D personality), SECI (side effects of CPAP), as well as from medical records (clinical variables and objective adherence to CPAP treatment). Type D personality occurred in 30% of the patients with OSAS and significantly (P < 0.05-0.001) increased the perceived frequency and severity of a broad range of side effects. The objective adherence was significantly lower (P < 0.001) for OSAS patients with Type D compared to OSAS patients without Type D, both with regard to a mean use of 4 h per night and 85% of the self-rated sleep time per night. The additional effect of a Type D personality on perceived side effects and adherence to CPAP treatment found in this study could be used by healthcare personnel when evaluating patients waiting for treatment. © 2007 European Sleep Research Society.

  • 28.
    Broström, Anders
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Clinical Neurophysiology. Östergötlands Läns Landsting, Reconstruction Centre, Department of Neurophysiology UHL.
    Strömberg, Anna
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Ulander, Martin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Clinical Neurophysiology.
    Fridlund, B
    Mårtensson, J
    Svanborg, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Clinical Neurophysiology. Östergötlands Läns Landsting, Reconstruction Centre, Department of Neurophysiology UHL.
    Informational needs, side effects and their consequences on adherence: A comparison between swedish healthcare professionals and CPAP-treated patients with obstructive sleep apnoea syndrome2007In: World Sleep 07,2007, 2007, p. 141-141Conference paper (Other academic)
    Abstract [en]

       

  • 29.
    Broström, Anders
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Ulander, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology . Linköping University, Faculty of Health Sciences.
    Fridlund, Bengt
    Vaxjö University.
    Martensson, Jan
    Jönköping University.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Neurophysiology UHL.
    Perceived informational needs, side-effects and their consequences on adherence-A comparison between CPAP treated patients with OSAS and healthcare personnel2009In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 74, no 2, p. 228-235Article in journal (Refereed)
    Abstract [en]

    Objective: To compare perceptions among continuous positive airway pressure (CPAP) treated patients with obstructive sleep apnoea syndrome (OSAS) and healthcare personnel with regard to informational needs, side-effects and their consequences on adherence.

    Methods: A cross-sectional descriptive design was used including 350 CPAP treated OSAS patients from three Swedish hospitals and 105 healthcare personnel from 26 Swedish hospitals. Data collection was performed using two questionnaires covering informational needs, side-effects and adherence to CPAP.

    Results: Both groups perceived all surveyed informational areas as very important. Patients perceived the possibilities to learn as significantly greater in all areas (p < 0.001) compared to healthcare personnel, and scored significantly higher regarding positive effects on adherence of information about pathophysiology (p < 0.05), self-care (p < 0.001) and troubleshooting (p < 0.01). A total of I I out of 15 surveyed side-effects were perceived to be more frequent by healthcare personnel (p < 0.01 - p < 0.001). They also scored all side-effects to cause greater problems and decrease the CPAP use to a greater extent (p < 0.001).

    Conclusion: Knowledge about these differences between patients and healthcare personnel regarding educational needs, side-effects and their effects on adherence can be important when designing educational programmes to increase CPAP adherence.

    Practice implications: Measurement of these parameters before, during and after educational programs are suggested.

  • 30.
    Broström, Anders
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Neurophysiology.
    Strömberg, Anna
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Ulander, Martin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Clinical Neurophysiology.
    Mårtensson, J
    Svanborg, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Clinical Neurophysiology. Östergötlands Läns Landsting, Reconstruction Centre, Department of Neurophysiology UHL.
    Association of type D personality to perceived side effects and adherence in CPAP-treated patients with obstructive sleep apnoea syndrome2007In: World Sleep 07,2007, 2007, p. 142-142Conference paper (Other academic)
    Abstract [en]

      

  • 31.
    Broström, Anders
    et al.
    Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Neurology. Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ståhlkrantz, A
    n/a.
    Albers, J
    n/a.
    Nyström, Fredrik
    Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL. Linköping University, Department of Medicine and Health Sciences, Internal Medicine . Linköping University, Faculty of Health Sciences.
    Sunnergren, O
    n/a.
    Uhlin, Fredrik
    Östergötlands Läns Landsting, Centre for Medicine, Department of Nephrology UHL. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences.
    Svanborg, Eva
    Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Neurology. Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology . Linköping University, Faculty of Health Sciences.
    Difference in clinical characteristics, self rated sleep and daytime sleepiness between hypertensive patients with or without risk of obstructive sleep apnoea - a pilot study in a primary care setting2008In: ESC - European Society of Cardiology EruoPRevent Congress, 2008Conference paper (Refereed)
  • 32.
    Broström, Anders
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Sunnergren, O
    County Hospital Ryhov, Sweden .
    Johansson, P
    Östergötlands Läns Landsting.
    Svensson, E
    Swedish Defence Research Agency, Sweden .
    Ulander, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Neurophysiology UHL.
    Symptoms among hypertensive patients with undiagnosed obstructive sleep apnoea in primary care - a structural equation model analysis in JOURNAL OF SLEEP RESEARCH, vol 21, issue SI, pp 230-2302012In: JOURNAL OF SLEEP RESEARCH, Wiley-Blackwell , 2012, Vol. 21, no SI, p. 230-230Conference paper (Refereed)
    Abstract [en]

    n/a

  • 33.
    Broström, Anders
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Sunnergren, Ola
    Ryhov County Hospital, Jönköping, Sweden.
    Franzén Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Johansson, Peter
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Ulander, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences.
    Riegel, Barbara
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. University of Pennsylvania School of Nursing, Philadelphia, USA.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Factors associated with undiagnosed obstructive sleep apnoea in hypertensive primary care patients2012In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 30, no 2, p. 107-113Article in journal (Refereed)
    Abstract [en]

    Objective. In hypertensive primary care patients below 65 years of age, (i) to describe the occurrence of undiagnosed obstructive sleep apnoea (OSA), and (ii) to identify the determinants of moderate/severe OSA. Design. Cross-sectional. Setting. Four primary care health centres in Sweden. Patients. 411 consecutive patients (52% women), mean age 57.9 years (SD 5.9 years), with diagnosed and treated hypertension (BP andgt; 140/90). Main outcome measures. Occurrence of OSA as measured by the apnoea hypopnoea index (AHI). Results. Mild (AHI 5-14.9/h) and moderate/severe (AHI andgt; 15/h) OSA were seen among 29% and 30% of the patients, respectively. Comparing those without OSA with those with mild or moderate/severe OSA, no differences were found in blood pressure, pharmacological treatment (anti-hypertensive, anti-depressive, and hypnotics), sleep, insomnia symptoms, daytime sleepiness, or depressive symptoms. Obesity (BMI andgt; 30 kg/m(2)) was seen in 30% and 68% of the patients with mild and moderate/severe OSA, respectively. Male gender, BMI andgt; 30 kg/m(2), snoring, witnessed apnoeas, and sleep duration andgt; 8 hours were determinants of obstructive sleep apnoea. Conclusion. Previously undiagnosed OSA is common among patients with hypertension in primary care. Obesity, snoring, witnessed apnoeas, long sleep duration, and male gender were the best predictors of OSA, even in the absence of daytime sleepiness and depressive symptoms.

  • 34.
    Broström, Anders
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Sunnergren, Ola
    Länssjukhuset Ryhov, Jönköping.
    Johansson, Peter
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Svensson, Erland
    Ulander, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Neurophysiology UHL.
    Symptom profile of undiagnosed obstructive sleep apnoea in hypertensive outpatients in primary care: a structural equation model analysis2012In: Quality in Primary Care, ISSN 1479-1072, E-ISSN 1479-1064, Vol. 20, no 4, p. 287-298Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Obstructive sleep apnoea (OSA) has been linked to hypertension in sleep clinic populations, but little is known about the symptom profile of undiagnosed OSA in hypertensive outpatients in primary care.

    AIM:

    To explore characteristics associated with undiagnosed  OSA in hypertensive primary care patients.

    METHODS:

    Cross-sectional design, including 411 consecutive patients (52% women), mean age 57.9 years (standard deviation [SD] 5.9 years), with diagnosed hypertension (blood pressure >140/90 mmHg) from four primary care centres. All subjects  underwent a full-night, home-based, respiratory recording to establish the presence and severity of OSA. Clinical variables, medication and comorbidities, as well as data from self-rating scales regarding symptoms/characteristics, insomnia, excessive daytime sleepiness, depressive symptoms  and health were collected during a clinical examination. Factor analyses and structural equation modelling (SEM) were used to explore the relationships between self-rated symptoms, clinical characteristics and objectively verified diagnosis of OSA. Main outcome: Measures symptom  profile of undiagnosed OSA (as measured by the Apnoea/Hypopnoea Index [AHI]) in hypertensive outpatients in primary care.

    RESULTS:

    Fifty-nine percent of the patients had an AHI ≥ 5/hour indicating OSA. An exploratory factor analysis based on 19 variables yielded a six-factor model  (anthropometrics, blood pressure, OSA-related symptoms, comorbidity, health complaints and physical activity) explaining 58% of the variance. SEM analyses showed strong significant associations between anthropometrics (body mass index, neck circumference, waist circumference) (0.45), OSA-related  symptoms (snoring, witnessed apnoeas, dry mouth) (0.47) and AHI. No direct effects of OSA on comorbidities, blood pressure, dyssomnia or self-rated health were observed.

    CONCLUSION:

    OSA was highly prevalent and was directly associated with anthropometrics and OSA-related symptoms  (snoring, witnessed apnoeas and dry mouth in the morning). When meeting patients with hypertension, these characteristics could be used by general practitioners to identify patients who are in need of referral to a sleep clinic for OSA evaluation.

  • 35.
    Broström, Anders
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Neurophysiology UHL.
    Sunnergren, Ola
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Fridlund, Bengt
    Department of Nursing Science, School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Ulander, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Neurophysiology UHL.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Neurophysiology UHL.
    Gender differences in respiratory disturbance, sleep and daytime sleepiness in hypertensive patients with different degrees of obesity2013In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, no 2, p. 140-149Article in journal (Refereed)
    Abstract [en]

    Background: Hypertension (HT) and obesity have both been linked to obstructive sleep apnoea (OSA). Difficulties have been described in identifying patients with OSA in primary care, causing low referral rates to sleep clinics. Increased knowledge about gender-specific characteristics and symptoms may help to identify patients. Aim: The aim was to describe gender differences regarding undiagnosed OSA, self-rated sleep, insomnia and daytime sleepiness in middle-aged primary care patients with HT and different degrees of obesity. Methods: A cross-sectional design was used and 394 patients (52.5% women), mean age 57.8 years (SD 6.7 years), with HT (BP >140/90 mmHg) were included. Clinical examinations, respiratory recordings and self-rated scales regarding OSA symptoms, sleep, insomnia and daytime sleepiness were used. Body mass index (BMI) was classified according to the criteria from the National Institutes of Health. Results: Pre-obesity and obesity classes I and II were seen among 53%, 26% and 8% of the men and 37%, 19% and 14% of the women, respectively. Occurrence of mild, moderate and severe OSA increased significantly across the BMI classes for both genders (p<0.01). Ninety percent of the men and 80% of the women in obesity class II had OSA. Insomnia was prevalent in obese patients. Other clinical variables did not differ between BMI classes or genders. Conclusion: The occurrence of overweight/obesity and OSA was high among both genders. A high BMI might be a convenient clinical marker for healthcare personnel to identify hypertensive patients with possible OSA in need of further evaluation and treatment.

  • 36.
    Broström, Anders
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ulander, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Neurophysiology UHL.
    Franzén Årestedt, Kristofer
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Nursing Science.
    The attitudes to CPAP treatment inventory: development and initial validation of a new tool for measuring attitudes to CPAP treatment2011In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 20, no 3, p. 460-471Article in journal (Refereed)
    Abstract [en]

    ontinuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS), but low adherence rates are common. The aim was to develop the attitudes to CPAP treatment inventory (ACTI), and to investigate the validity and reliability of the instrument among patients with OSAS. ACTI was developed on the basis of: (i) in-depth interviews with 23 patients; (ii) examination of the scientific literature; and (iii) consensus agreement of a multi-professional expert panel. This yielded five different types of attitudes to CPAP treatment. A prospective longitudinal design was used. Two-hundred and eighty-nine patients with OSAS were recruited at three different CPAP centres. Data were collected with ACTI and obtained from medical records. The homogeneity and internal consistency reliability were satisfactorily reflected by the item-total correlations (0.59-0.81) and Cronbachs alpha (0.89), respectively. Construct validity was confirmed with factor analysis (principal component analysis with orthogonal rotation; PCF). The PCF based on baseline data resulted in a one single-factor solution explaining 69% of the total variance. A confirmatory factor analysis was performed 2 weeks after CPAP initiation, resulting in the same factor solution. No indication of uniform differential item functioning was found. The predictive validity was tested with receiver operating characteristic analyses, and a cut-off of 10 on the ACTI gave a sensitivity of 93% and a specificity of 44% for CPAP termination within 6 months. The satisfactory measurement properties of this new pragmatic instrument are promising and indicate that ACTI can be useful in clinical practice to reliably measure attitudes to CPAP treatment.

  • 37.
    Elfström, Maria
    et al.
    Jönköping University.
    Karlsson, Susanne
    Jönköping University.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics.
    Fridlund, Bengt
    Jönköping University.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Neurophysiology UHL.
    Broström, Anders
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Decisive Situations Affecting Partners Support to Continuous Positive Airway Pressure-Treated Patients With Obstructive Sleep Apnea Syndrome A Critical Incident Technique Analysis of the Initial Treatment Phase2012In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 27, no 3, p. 228-239Article in journal (Refereed)
    Abstract [en]

    Background and Research Objective: Effective treatment of obstructive sleep apnea syndrome (OSAS) with continuous positive airway pressure (CPAP) can reduce morbidity and mortality, but adherence rates are low. The partner has an important role in supporting the patient, but this role may be adversely affected by difficulties during the early phase of the CPAP initiation. The aim of this study was to explore and describe decisive situations affecting partners support to patients with OSAS and how the partners manage these situations during the initial phase of CPAP treatment. Subjects and Methods: A qualitative descriptive design using critical incident technique was used. A total of 542 decisive situations affecting partners support and 222 situations describing managing were collected by means of interviews with 25 strategically selected partners of patients with CPAP treated OSAS. Results: Adverse effects, limited effect, practical and psychosocial problems, limited presence, and inappropriate initiation emerged as negative influences on the partners support. A well-functioning treatment, improvements, high motivation, and receiving support from others were identified as positive influences on the partners support. The partner managed the situations by letting the patient handle the CPAP treatment by himself/herself, by handling the treatment together with the patient, or taking over the handling of CPAP treatment. Conclusion: Increased knowledge about the different situations that affect the partners support negatively or positively and how these situations are managed by partners can be used in educational situations involving both patients and partners during CPAP initiation.

  • 38.
    Eriksson, Kerstin
    et al.
    Jonköping University, Sweden Ryhov County Hospital, Sweden .
    Wikstrom, Lotta
    Jonköping University, Sweden Ryhov County Hospital, Sweden .
    Franzén Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Fridlund, Bengt
    Jonköping University, Sweden .
    Broström, Anders
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Numeric rating scale: patients perceptions of its use in postoperative pain assessments2014In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 27, no 1, p. 41-46Article in journal (Refereed)
    Abstract [en]

    Aim: The purpose of this study was to describe how patients perceive the use of the numeric rating scale in postoperative pain assessments. Background: There are recommendations to use a pain scale to follow patients postoperative pain. Most patients prefer the NRS but there is a discrepancy between patients and healthcare professionals how to interpret the ratings from the pain assessments. Methods: A descriptive design with a phenomenographic approach was used. Semi structured interviews were held with 25 patients. Results: Three description categories emerged that illustrate patients perceptions; use of the NRS facilitated communication of pain, it put demands on healthcare professionals and care routines and it contained interpretation difficulties. Conclusion: The NRS has a place in pain management according to the patients but there is a need for a dialogue to give the patients the opportunity to describe their pain and set a common goal.

  • 39.
    Eriksson, Kerstin
    et al.
    Jonköping University, Sweden; Ryhov County Hospital, Sweden.
    Wikström, Lotta
    Jonköping University, Sweden; Ryhov County Hospital, Sweden.
    Fridlund, Bengt
    Jonköping University, Sweden.
    Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Linnaeus University, Sweden.
    Broström, Anders
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology. Jonköping University, Sweden.
    Patients experiences and actions when describing pain after surgery - A critical incident technique analysis2016In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 56, p. 27-36Article in journal (Refereed)
    Abstract [en]

    Background: Postoperative pain assessment remains a significant problem in clinical care despite patients wanting to describe their pain and be treated as unique individuals. Deeper knowledge about variations in patients experiences and actions could help healthcare professionals to improve pain management and could increase patients participation in pain assessments. Objective: The aim of this study was, through an examination of critical incidents, to describe patients experiences and actions when needing to describe pain after surgery. Methods: An explorative design involving the critical incident technique was used. Patients from one university and three county hospitals in both urban and rural areas were included. To ensure variation of patients a strategic sampling was made according to age, gender, education and surgery. A total of 25 patients who had undergone orthopaedic or general surgery was asked to participate in an interview, of whom three declined. Findings: Pain experiences were described according to two main areas: "Patients resources when in need of pain assessment" and "Ward resources for performing pain assessments". Patients were affected by their expectations and tolerance for pain. Ability to describe pain could be limited by a fear of coming into conflict with healthcare professionals or being perceived as whining. Furthermore, attitudes from healthcare professionals and their lack of adherence to procedures affected patients ability to describe pain. Two main areas regarding actions emerged: "Patients used active strategies when needing to describe pain" and "Patients used passive strategies when needing to describe pain". Patients informed healthcare professionals about their pain and asked questions in order to make decisions about their pain situation. Selfcare was performed by distraction and avoiding pain or treating pain by themselves, while others were passive and endured pain or refrained from contact with healthcare professionals due to healthcare professionals large work load. (C) 2015 Elsevier Ltd. All rights reserved.

  • 40.
    Eriksson, Kerstin
    et al.
    Ryhov County Hospital, Jönköping, Sweden.
    Wikström, Lotta
    Ryhov County Hospital, Jönköping, Sweden.
    Lindblad-Fridh, Marianne
    Jönköping University, Sweden .
    Broström, Anders
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Neurophysiology UHL.
    Using mode and maximum values from the Numeric Rating Scale when evaluating postoperative pain management and recovery2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 5-6, p. 638-647Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. To (1) examine the clinical applicability of compiled mode and maximum values from the Numeric Rating Scale (NRS) by comparing the correspondence between patient perceptions of pain and pain values from monitoring records, as well as (2) to study the relationship between mode and maximum values and self-assessed ability for early postoperative recovery. Background. Documentation of pain remains a problem despite recommendations of quality improvements. To examine the correlation between patient perceptions and documented pain therefore becomes important. Few have studied how pain affects recovery. Design. A quantitative cross-sectional design was used in which 157 postoperative patients answered a questionnaire on pain intensity and recovery. A parallel examination of pain in monitoring records was conducted. Results. A total of 57% had a mode value calculated from records between 0 and 3 on postoperative day 1 and 69% on day 2. A maximum value between 4 and 10 was found in monitoring records for 73% on day 1 and for 67% on day 2. The correspondence between mode value from monitoring records and the patients retrospective perceptions was 88% for NRS 03 and 92% between maximum value and NRS 410. The correlation between documented pain and retrospectively identified pain for mode value of the NRS in all (010) was rather weak (r=0 center dot 37), while maximum value had a stronger correlation (r=0 center dot 53). Conclusion. Mode and maximum values could be used as outcome measures when evaluating postoperative pain. Pain affects recovery negatively, but more research is needed to strengthen the evidence for the use and clarify the link between pain and recovery. Relevance to clinical practice. International organisations emphasise the importance of improving pain assessment. Mode and maximum values are easy to compile for nurses and can, together with assessments of how experienced pain levels affect postoperative recovery, improve treatment of postoperative pain.

  • 41.
    Franzén Årestedt, Kristofer
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Broström, Anders
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Design and methodology of the NutriHeart study: an interdisciplinary approach to investigate nutrition and cardiac cachexia in patients with chronic heart failure.2009In: 9th Annual Spring Meeting on Cardiovascular Nursing, CCNAP., 2009Conference paper (Refereed)
  • 42.
    Gardner, Benjamin
    et al.
    UCL, England.
    Broström, Anders
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Hrubos Strom, Harald
    Akershus University Hospital, Norway.
    Ulander, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Fridlund, Bengt
    Jonköping University, Sweden.
    Skagerström (Malmsten), Janna
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Johansson, Peter
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Editorial Material: From does it work? to what makes it work?: The importance of making assumptions explicit when designing and evaluating behavioural interventions in EUROPEAN JOURNAL OF CARDIOVASCULAR NURSING, vol 13, issue 4, pp 292-2942014In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 13, no 4, p. 292-294Article in journal (Other academic)
    Abstract [en]

    n/a

  • 43.
    Gustafsson, Greta
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Broström, Anders
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology. Department of Nursing Science, School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Ulander, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Vrethem, Magnus
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Neurology.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Occurrence of epileptiform discharges and sleep during EEG recordings in children after melatonin intake versus sleep-deprivation2015In: Clinical Neurophysiology, ISSN 1388-2457, E-ISSN 1872-8952, Vol. 126, no 8, p. 1493-1497Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    To determine if melatonin is equally efficient as partial sleep deprivation in inducing sleep without interfering with epileptiform discharges in EEG recordings in children 1-16years old.

    METHODS:

    We retrospectively analysed 129 EEGs recorded after melatonin intake and 113 EEGs recorded after partial sleep deprivation. Comparisons were made concerning occurrence of epileptiform discharges, the number of children who fell asleep and the technical quality of EEG recordings. Comparison between different age groups was also made.

    RESULTS:

    No significant differences were found regarding occurrence of epileptiform discharges (33% after melatonin intake, 36% after sleep deprivation), or proportion of unsuccessful EEGs (8% and 10%, respectively). Melatonin and sleep deprivation were equally efficient in inducing sleep (70% in both groups). Significantly more children aged 1-4years obtained sleep after melatonin intake in comparison to sleep deprivation (82% vs. 58%, p⩽0.01), and in comparison to older children with melatonin induced sleep (58-67%, p⩽0.05). Sleep deprived children 9-12years old had higher percentage of epileptiform discharges (62%, p⩽0.05) compared to younger sleep deprived children.

    CONCLUSION:

    Melatonin is equally efficient as partial sleep deprivation to induce sleep and does not affect the occurrence of epileptiform discharges in the EEG recording. Sleep deprivation could still be preferable in older children as melatonin probably has less sleep inducing effect.

    SIGNIFICANCE:

    Melatonin induced sleep have advantages, especially in younger children as they fall asleep easier than after sleep deprivation. The procedure is easier for the parents than keeping a young child awake for half the night.

  • 44.
    Hendriks, Jeroen M. L.
    et al.
    Maastricht University, Netherlands.
    Johansson, Peter
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Ulander, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Broström, Anders
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology. Jönköping University, Sweden .
    Editorial Material: Sleep disordered breathing - A hidden co-morbidity in patients with atrial fibrillation? in EUROPEAN JOURNAL OF CARDIOVASCULAR NURSING, vol 13, issue 6, pp 480-4822014In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 13, no 6, p. 480-482Article in journal (Other academic)
    Abstract [en]

    n/a

  • 45.
    Hjelm, Carina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Broström, Anders
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology. Jönköping University.
    Dahl, Anna
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Johansson, Boo
    Department of Psychology, University of Gothenburg, Sweden.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Factors Associated With Increased Risk for Dementia in Individuals Age 80 Years or Older With Congestive Heart Failure2014In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 29, no 1, p. 82-90Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND RESEARCH OBJECTIVE:: An increasing body of evidence shows that individuals diagnosed with congestive heart failure (CHF) are at a higher risk for dementia. However, the prevalence rate of dementia among persons with CHF in very old individuals has not been previously reported, and little is known about the comorbidities that place old persons with CHF at a higher risk for dementia. The aim of this study was to compare the prevalence of dementia in individuals 80 years or older who have CHF with that in individuals without CHF and to identify factors related to dementia in individuals diagnosed with CHF.

    METHODS:: A total of 702 participants from a Swedish population-based longitudinal study (Octogenerian Twin) were included. The group consisted of same-sex twin pairs, age 80 years or older, and 138 participants had CHF. Dementia was diagnosed according to criteria in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised. Generalized estimating equations including gender, age and educational level, waist circumference, diabetes, hypertension, smoking, depression, and blood values were used in a case-control analysis.

    RESULTS:: Individuals with CHF had a significantly higher prevalence of vascular dementia, 16% vs 6% (P < 0.001), and of all types of dementia, 40% vs 30% (P < 0.01), than those not diagnosed with CHF. The generalized estimating equation models showed that depression, hypertension, and/or increased levels of homocysteine were all associated with a higher risk for dementia in individuals with CHF. Diabetes was specifically associated with an increased risk for vascular dementia.

    CONCLUSIONS:: The prevalence of dementia was higher among individuals with CHF than in those without CHF. Diabetes, depression, and hypertension in patients with CHF require special attention from healthcare professionals because these conditions are associated with an elevated risk for dementia. Higher levels of homocysteine were also found to be a marker of dementia in patients with CHF. Further research is needed to identify the factors related to dementia in individuals 80 years or older diagnosed with CHF.

  • 46.
    Hjelm, Carina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Broström, Anders
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology. Jonköping University, Sweden.
    Riegel, Barbara
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    The association between self-care and cognitive dysfunction in patients with chronic heart failure2015In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 44, no 4, p. 113-119Article in journal (Refereed)
    Abstract [en]

    Aim: To test the relationship between cognitive function and self-care in patients with heart failure after adjusting for the contribution of age, education, functional status, myocardial stress, sleep and depression. Further, the relationship between cognitive function and self-care was explored with depression and sleep as moderators.

    Background: Self-care can significantly impact functional capacity, well-being, morbidity, and prognosis in patients with heart failure (HF). However, self-care requires the cognitive ability to learn, perceive, interpret and respond. The influence of demographics and clinical symptoms on the relationship between cognition and self-care needs to be further understood.

    Design: Descriptive, cross-sectional study.

    Methods: The study included 142 patients with chronic HF (68% male, median age 72 years, 61% in NYHA II). Self-care was measured with the European Heart Failure Self-Care Behavior Scale. Cognitive function was evaluated with neuropsychological tests measuring global cognitive dysfunction, psychomotor speed, executive function, visual-spatial perception/construct, spatial performance, semantic and episodic memory.

    Findings: Psychomotor function (speed and attention) measured with the Trail Making A was the only dimension of cognitive function significantly associated with self-care. Neither depressive symptoms, nor sleep disturbances  moderated the relation between cognitive function and selfcare.

    Conclusion: Deficits in psychomotor speed have implications for how patients should be educated and supported to perform self-care. A decrease in sustained attention and ability to carry out more than one task at a same time could lead to difficulties in self-care. Screening for psychomotor speed is therefore advocated for patients with HF.

  • 47.
    Hjelm, Carina
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Dahl, A
    n/a.
    Broström, Anders
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Mårtensson, J
    n/a.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Profile of cognitive impairment in chronic heart failure among octogenerians in Sweden.2009In: 9th Annual Spring Meeting on Cardiovascular Nursing, CCNAP., 2009Conference paper (Refereed)
  • 48.
    Hjelm, Carina
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Dahl, Anna
    Jönköping University, Sweden.
    Broström, Anders
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology. Jönköping University, Sweden.
    Mårtensson, Jan
    Jönköping University, Sweden.
    Johansson, Boo
    University of Gothenburg, Sweden.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    The influence of heart failure on longitudinal changes in cognition among individuals 80 years of age and older2012In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 7-8, p. 994-1003Article in journal (Refereed)
    Abstract [en]

    Aim.  The aim of this study was to examine the relationship between heart failure and specific cognitive abilities in octogenarians with regard to level and change over time.

    Background.  Cognitive impairment is influenced by many factors, and the impact of heart failure is debated. Intact cognitive ability is crucial for successful self-care in patients with heart failure. Middle-aged patients with heart failure seem to have an increased risk of cognitive impairment. No studies have examined the association between heart failure and longitudinal cognitive changes in octogenarians (individuals 80 years and older).

    Design.  A prospective longitudinal design.

    Methods.  Cognitive tests were carried out five times (1991–2002) in 702 octogenarians from the Swedish Twin Registry, including same-sex twin pairs. The test battery included the measurement of processing speed, visuospatial ability, short-term, episodic and semantic memory. Latent growth curve modelling was employed to measure change and performance over time and compares the group diagnosed with heart failure to individuals without a heart failure diagnosis.

    Results.  At baseline, the participants’ mean age was 83·5 years, 67% were women and 13% suffered from heart failure. Individuals diagnosed with heart failure scored significantly lower in spatial abilities and episodic memory than participants not diagnosed with heart failure. Moreover, measures of episodic memory declined more over time in individuals diagnosed with heart failure. There were no significant differences between the groups in other cognitive tests.

    Conclusion.  Spatial problems and episodic memory have implications for everyday life. This might contribute to decreased adherence to prescribed therapy and self-care management and lead to socio-behavioural problems because of an impaired capacity to drive, read and write.

    Relevance to clinical practice.  Nurses should take into account in their assessment that cognitive impairment may restrain elderly heart failure patient’s ability to make decisions and perform self-care actions. Patient education strategies should also be adapted to cognitive ability.

  • 49.
    Hjelm, Carina
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Arestedt, K
    University of Kalmar.
    Broström, Anders
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Sleep-disordered breathing and cognitive impairment among patients with heart failure in JOURNAL OF SLEEP RESEARCH, vol 21, issue SI, pp 256-2572012In: JOURNAL OF SLEEP RESEARCH, Wiley-Blackwell , 2012, Vol. 21, no SI, p. 256-257Conference paper (Refereed)
    Abstract [en]

    n/a

  • 50.
    Hjelm, Carina
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Franzén Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Broström, Anders
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Jönköping University .
    Association between sleep-disordered breathing, sleep–wake pattern, and cognitive impairment among patients with chronic heart failure2013In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 15, no 5, p. 496-504Article in journal (Refereed)
    Abstract [en]

    Aims Chronic heart failure (CHF) and sleep-disordered breathing (SDB) are often co-existing problems among the elderly. Apnoeic events may cause cognitive impairment. The aim of the study was to compare sleep and wake patterns, insomnia, daytime sleepiness, and cognitive function in community-dwelling CHF patients, with and without SDB, and to investigate the association between sleep-related factors and cognitive dysfunction.

    Methods and results In this cross-sectional observational study, SDB was measured with an ApneaLink device and defined as an apnoea–hypopnoea index (AHI) ≥15/h of sleep. Sleep and wake patterns were measured with actigraphy for 1 week. Insomnia was measured with the Minimal Insomnia Symptom Scale, daytime sleepiness with the Epworth Sleepiness Scale, and cognitive function with a neuropsychological test battery. A total of 137 patients (68% male, median age 72 years, 58% NYHA functional class II) were consecutively included. Forty-four per cent had SDB (AHI ≥15). The SDB group had significantly higher saturation time below 90%, more difficulties maintaining sleep, and lower levels of daytime sleepiness compared with the non-SDB group. Cognitive function and sleep and wake patterns did not differ between the SDB and the non-SDB group. Insomnia was associated with decreased global cognition.

    Conclusion The prevalence of cognitive dysfunction was low in this population with predominantly mild to moderate CHF. This might have influenced the lack of associations between cognitive function and SDB. Insomnia was the only sleep-related factor significantly influencing cognition.

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