| 131. |
- Gunduz, C., et al.
(författare)
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Long-term positive airway pressure therapy is associated with reduced total cholesterol levels in patients with obstructive sleep apnea: data from the European Sleep Apnea Database (ESADA)
- 2020
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Ingår i: Sleep Medicine. - : Elsevier BV. - 1389-9457. ; 75, s. 201-209
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Tidskriftsartikel (refereegranskat)abstract
- Background and aim: Obstructive sleep apnea (OSA) is an independent risk factor for dyslipidemia. The current study examined the effects of positive airway pressure (PAP) treatment on lipid status in the European Sleep Apnea Database (ESADA). Methods: The prospective cohort study enrolled 1564 OSA subjects (74% male, mean age 54 ± 11y, body mass index (BMI) 32.7 ± 6.6 kg/m2 and apnea-hypopnea index (AHI) 40.3 ± 24.4 n/h) undergoing PAP therapy for at least three months (mean 377.6 ± 419.5 days). Baseline and follow-up total cholesterol (TC) from nine centers were analyzed. Repeated measures and logistic regression tests (adjusted for age, sex, weight changes, lipid lowering medication, PAP compliance, and treatment duration) were used to compare changes in TC concentration. Incident risk for a coronary heart disease event (CHD) was used to compute a Framingham CHD risk score (estimated from age, BMI, blood pressure, and TC). Results: Adjusted means of TC decreased from 194.2 mg/dl to 189.3 mg/dl during follow-up (p = 0.019). A clinically significant (10%) reduction of TC at PAP follow-up was observed in 422 patients (27%). Duration of PAP therapy was identified as independent predictor for TC reduction, which implies an approximately 10% risk reduction for incident CHD events (from 26.7% to 24.1% in men and from 11.2% to 10.1% in women, p < 0.001 respectively). Conclusion: This observational study demonstrates a reduction of TC after long-term PAP treatment. The close association between TC concentration and cardiovascular (CV) mortality suggests that identification and treatment of OSA may have a beneficial effect on overall CV risk due to this mechanism. This possibility needs to be evaluated in prospective randomized studies. © 2020 Elsevier B.V.
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| 132. |
- Hedin, G, et al.
(författare)
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Measuring Insomnia Among Adolescents : Analysis of the Minimal Insomnia Symptom Scale (miss) with the Rasch Measurement Model
- 2022
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Ingår i: Sleep Medicine. - : Elsevier BV. - 1389-9457.
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Konferensbidrag (refereegranskat)abstract
- Introduction : The Minimal Insomnia Symptom Scale (MISS) is a three-item screening instrument that has been found to be psychometrically sound and capable of screening for insomnia among adults and older people. This study aimed to test the measurement properties of the MISS together with an additional item focusing on daytime functioning among adolescents using the Rasch measurement model. Materials and Methods : A cross-sectional design were used, and data from adolescents (age 13-17 years, n=3022) was analyzed using the Rasch measurement model. Results : The MISS had good measurement properties. When replacing the original MISS item “not rested by sleep” with the item “daytime disturbance”, the measurement properties slightly improved. We label this new scale the MISS-Revised (MISS-R). The reliability was significantly better for the MISS-R (0.55) compared to the MISS (0.50). The optimal cut-off was found to be >6 points, both for the MISS and the MISS-R. Conclusions : This study provides general support that both the MISS as well as the MISS-R have good fit to the Rasch model. At this stage, neither the MISS nor the MISS-R can be advocated over the other for use among adolescents, although the MISS-R had slightly better reliability than the MISS. Additional studies are needed to determine the clinically optimal cut-off score for identification of insomnia.
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| 133. |
- Hoel, Hans Christian, et al.
(författare)
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Impact of nasal resistance on the distribution of apneas and hypopneas in obstructive sleep apnea
- 2020
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Ingår i: Sleep Medicine. - : Elsevier BV. - 1389-9457. ; 71, s. 83-88
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Tidskriftsartikel (refereegranskat)abstract
- Background: This study aims to investigate how increased nasal resistance affects respiratory variables in obstructive sleep apnea (OSA). In this setting, to assess how nasal resistance, as measured by 4-phase rhinomanometry, affects the distribution of hypopneas and apneas when measured with routine Sleep Polygraphy (PG). Methods: PG recordings were analysed and 4-phase rhinomanometry was conducted. Crude differences between groups were compared using Mann–Whitney Wilkoxon test. Odds for higher nasal resistance were modelled using logistic regression. All tests were two-sided. P < 0.05 was considered statistically significant. Results: In sum, 126 OSA patients referred to our center examined with PG were included. OSA Patients with a higher ratio of hypopneas relative to apneas are more than three times more likely (OR = 3.72, 95%CI [1.30–10.66], p = 0.015) to have increased nasal resistance as measured by 4-phase rhinomanometry, compared to those who have a lower ratio of hypopneas relative to apneas, regardless of OSA severity. The median Hypopnea to Apnea Ratio (HAR) in the low nasal resistance group was 0.8 compared to 2.6 in the high nasal resistance group (p = 0.000). The median apnea index in the low nasal resistance group was 13.6, in the high nasal group it was 5.2 (p = 0.001). Conclusions: Our investigation shows that OSA patients presenting with increased nasal resistance demonstrate significant differences in the distribution of hypopneas and apneas. OSA patients with increased nasal resistance exhibit a significantly lower apnea index and a higher hypopnea to apnea ratio compared to OSA patients presenting with low nasal resistance. Thus, analysis of the HAR in sleep studies is a useful tool to identify patients who may potentially have nasal obstruction as part of their respiratory pathophysiology. We therefore recommend that OSA patients with a predominance of hypopneas relative to apneas should undergo further nasal measurements.
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| 134. |
- Hoel, Hans Christian, et al.
(författare)
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Outcome of nasal measurements in patients with OSA – Mounting evidence of a nasal endotype
- 2023
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Ingår i: Sleep Medicine. - : Elsevier BV. - 1389-9457. ; 103, s. 131-137
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Tidskriftsartikel (refereegranskat)abstract
- Background: Increased nasal resistance as measured by 4-phase rhinomanometry is associated with a paucity of apneas relative to hypopneas in obstructive sleep apnea (OSA) patients. The ratio of hypopneas to apneas for a given apnea hypopnea index (AHI) may influence treatment choice. This study aimed to investigate if OSA patients with an elevated hypopnea apnea ratio are associated with differences in acoustic rhinometry measurements. Methods: One hundred and thirty-nine (n = 139) OSA patients (AHI >5) were enrolled in this prospective case-control study (all male). OSA Diagnosis was established through a type three sleep study. Both acoustic rhinometry and 4-phase rhinomanometry were performed on all patients at baseline and after decongestion. Possible associations between apnea-hypopnea index, oxygen desaturation index, nadir oxygen saturation, apnea index, hypopnea index, hypopnea to apnea ratio and body mass index and were analysed using multiple logistic and linear regression models. Results: The acoustic rhinometry measurements minimal cross-sectional area, total volume and minimal cross-sectional areas are significantly smaller in patients with increased nasal resistance as measured by 4-phase rhinomanometry (P < 0.01). No consistent statistically significant associations were found between the acoustic rhinometry variables, and the respiratory variables analysed in the sleep studies. OSA patients with an elevated hypopnea apnea ratio are more than 4 times more likely to present with increased nasal resistance measured by 4-phase rhinomanometry (OR = 4.4, 95% CI [1.5–13.2], P < 0.01). Conclusions: Acoustic rhinometry is significantly associated with 4-phase rhinomanometry. However, acoustic rhinometry measurements are not associated with the respiratory indices routinely measured in OSA in a clinical setting. 4-phase rhinomanometry is a more suitable method for detecting clinically relevant nasal obstruction in obstructive sleep apnea patients.
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| 135. |
- Hoff, Erik, et al.
(författare)
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The placebo effect in pharmacological treatment of obstructive sleep apnea, a systematic review and meta-analysis
- 2023
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Ingår i: Sleep Medicine. - : Elsevier BV. - 1389-9457. ; 106, s. 1-7
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Tidskriftsartikel (refereegranskat)abstract
- Objective: New drug treatments are under development in obstructive sleep apnea (OSA). The placebo effect is well recognized in various conditions, but its relevance in OSA is debated. In the current study we determined the influence of a placebo effect in studies of drug therapy in OSA.Methods: A systematic review and meta-analysis (PROSPERO CRD42021229410) with searches in MEDLINE, Scopus, Web of Science and Cochrane CENTRAL from inception to 2021-01-19. Inclusion criteria were (i) RCTs of adults with OSA, (ii) drug intervention with placebo baseline and follow-up sleep study (iii) outcomes: apnea hypopnea index (AHI), mean oxygen saturation (mSaO2), oxygen desatura-tion index (ODI) and/or Epworth Sleepiness Scale (ESS). Risk-of-bias was assessed with Cochrane RoB 2.Results: 7436 articles were identified and 29 studies included (n = 413). Studies were generally small (median n = 14), with 78% men, baseline AHI range 9-74 events/h and treatment duration range 1-120 days. Meta-analyses were conducted for main outcomes. Mean change of the primary outcome, AHI, was-0.84 (95% CI-2.98 to 1.30); mSaO2 and ODI estimations were also non-significant. ESS showed a trend towards a reduction of-1 unit. Subgroup analysis did not show significant differences. Risk-of-bias assessment indicated mostly low risk but studies were small with wide confidence intervals. Conclusions: In this meta-analysis we did not identify systematic placebo effects on the AHI, ODI or mSaO2 while ESS score showed a trend for a small reduction. These results have an impact on the design and interpretation of drug trials in OSA.(c) 2023 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
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| 136. |
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| 137. |
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| 138. |
- Holtstrand Hjälm, Henrik, et al.
(författare)
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Obstructive sleep apnea severity and prevalent atrial fibrillation in a sleep clinic cohort with versus without excessive daytime sleepiness
- 2023
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Ingår i: Sleep Medicine. - 1389-9457. ; 112, s. 63-69
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Tidskriftsartikel (refereegranskat)abstract
- Background: Obstructive sleep apnea (OSA) is associated with atrial fibrillation (AF) in cardiac cohorts. Less is known regarding the magnitude of this association in a sleep clinic cohort with vs. without excessive daytime sleepiness (EDS). Objectives: To explore the association of OSA severity with AF in a sleep clinic cohort stratified by EDS. Patients and methods: All consecutive adults (n = 3814) admitted to the Skaraborg Hospital, Sweden between Jan 2005 and December 2011 were registered in a local database, and the follow-up ended in December 2018. OSA was defined as an apnea-hypopnea index (AHI) >= 5 events/h. Mild OSA was defined as AHI >= 5 & AHI<15 events/ h; moderate OSA as AHI >= 15 & AHI<30 events/h; and severe OSA as AHI >= 30 events/h. EDS was defined as an Epworth Sleepiness Scale score >= 11. We conducted cross-sectional analyzes of the prevalent AF across the OSA severity categories and logistic regression analyzes stratified by EDS.Results: In all, 202 patients (5.3%) had AF at baseline, 1.6% in no-OSA, 3.9% in mild OSA, 5.2% in moderate OSA, and 7.6% in severe OSA, respectively (p < 0.001). The stratified analyzes revealed that patients with severe OSA without EDS had an increased risk for prevalent AF (OR 2.54, 95% CI 1.05-6.16; p = 0.039) independent of the confounding factors. Conclusions: There was an independent dose-response relationship between OSA and prevalent AF among the non-sleepy phenotype in this sleep clinic cohort. Since adherence to OSA treatment is challenging in the absence of EDS, these patients may have increased risk for adverse cardiovascular outcomes.
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| 139. |
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