| 1. |
|
|
| 2. |
|
|
| 3. |
- Borgström, A., et al.
(författare)
-
Trends and changes in paediatric tonsil surgery in Sweden 1987-2013: A population-based cohort study
- 2017
-
Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 7:1
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives The objective of this study was to longitudinally describe the history of tonsil surgery in Swedish children and adolescents regarding incidence, indications for surgery, surgical methods and the age and gender distributions. Setting A retrospective longitudinal population-based cohort study based on register data from the Swedish National Patient Register (NPR) and population data from Statistics Sweden. Participants All Swedish children 1-<18â €..years registered in the NPR with a tonsil surgery procedure 1987-2013. Results 167â €..894 tonsil surgeries were registered in the NPR 1987-2013. An increase in the total incidence rate was observed, from 22/10â €..000 person years in 1987 to 47/10â €..000 in 2013. The most marked increase was noted in children 1-3â €..years of age, increasing from 17 to 73/10â €..000 person years over the period. The proportion children with obstructive/sleep disordered breathing (SDB) indications increased from 42.4% in 1987 to 73.6% in 2013. Partial tonsillectomy, tonsillotomy (TT), increased since 1996 and in 2013 55.1% of all tonsil procedures were TTs. Conclusions There have been considerable changes in clinical practice for tonsil surgery in Swedish children over the past few decades. Overall, a doubling in the total incidence rate was observed. This increase consisted mainly of an increase in surgical procedures due to obstructive/SDB indications, particularly among the youngest age group (1-3â €..years old). TT has gradually replaced tonsillectomy as the predominant method for tonsil surgery.
|
|
| 4. |
- Grote, Ludger, 1964, et al.
(författare)
-
National Knowledge-Driven Management of Obstructive Sleep Apnea-The Swedish Approach
- 2023
-
Ingår i: Diagnostics. - : MDPI AG. - 2075-4418. ; 13:6
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction: This paper describes the development of "Swedish Guidelines for OSA treatment" and the underlying managed care process. The Apnea Hypopnea Index (AHI) is traditionally used as a single parameter for obstructive sleep apnea (OSA) severity classification, although poorly associated with symptomatology and outcome. We instead implement a novel matrix for shared treatment decisions based on available evidence. Methods: A national expert group including medical and dental specialists, nurses, and patient representatives developed the knowledge-driven management model. A Delphi round was performed amongst experts from all Swedish regions (N = 24). Evidence reflecting treatment effects was extracted from systematic reviews, meta-analyses, and randomized clinical trials. Results: The treatment decision in the process includes a matrix with five categories from a "very weak"" to "very strong" indication to treat, and it includes factors with potential influence on outcome, including (A) OSA-related symptoms, (B) cardiometabolic comorbidities, (C) frequency of respiratory events, and (D) age. OSA-related symptoms indicate a strong incitement to treat, whereas the absence of symptoms, age above 65 years, and no or well-controlled comorbidities indicate a weak treatment indication, irrespective of AHI. Conclusions: The novel treatment matrix is based on the effects of treatments rather than the actual frequency of respiratory events during sleep. A nationwide implementation of this matrix is ongoing, and the outcome is monitored in a prospective evaluation by means of the Swedish Sleep Apnea Registry (SESAR).
|
|
| 5. |
- P, Nerfeldt, et al.
(författare)
-
A two-year weight reduction program in obese sleep apnea patients
- 2010
-
Ingår i: Journal of Clinical Sleep Medicine (JCSM). - 1550-9389 .- 1550-9397. ; 6:5, s. 479-486
-
Tidskriftsartikel (refereegranskat)abstract
- Study Objectives:To evaluate the effects of a 2-year weight reduction program on respiratory disturbances, arousal index, daytime sleepiness, metabolic status, and quality of life in obese patients with obstructive sleep apnea syndrome (OSAS).Methods:Prospective intervention study of 33 consecutive obese OSAS patients (24 men, 9 women); 19 subjects used continuous positive airway pressure and 4 used mandibular retaining device, except during nights with sleep recording. The program consisted of 8 weeks of low calorie diet followed by group meetings with behavioral change support.Results:Seventy percent of the patients completed the program; 67% completed the sleep recordings. The success rate for the apnea-hypopnea index (AHI) (< 20 and reduction ≥ 50%) was 15% in the intention to treat (ITT) analysis. The AHI showed a nonsignificant decrease in mean values, from 43 to 28. The oxygen desaturation index (ODI) decreased from 42 to 23 (p = 0.010), arousal index from 24 to 11 (p = 0.019), body mass index from 40 to 35 (p = 0.003) and the Epworth Sleepiness Scale (ESS) from 9 to 5 (p = 0.026), all ITT. Metabolic status, physical functioning, and vitality evaluations improved only in the per protocol analysis. Reduction in weight correlated significantly to reductions in ESS (p = 0.038) and insulin levels (p = 0.002), respectively. There were no differences based on gender or use/non-use of OSAS treatment device.Conclusions:Our weight reduction program showed a limited success in reducing AHI. However, there were significant improvements in weight, ODI, arousal index, and subjective symptoms. We recommend the program as an adjunct treatment for well-motivated obese OSAS patients.Citation:Nerfeldt P; Nilsson BY; Mayor L; Uddén J; Friberg D. A two-year weight reduction program in obese sleep apnea patients. J Clin Sleep Med 2010;6(5):479-486.Keywords: Sleep apnea, obesity, weight reduction, diet, quality of life, sleepiness, behavioral therapy
|
|
| 6. |
- P, Nerfeldt, et al.
(författare)
-
Effectiveness of Oral Appliances in Obstructive Sleep Apnea with Respiratory Arousals
- 2016
-
Ingår i: Journal of Clinical Sleep Medicine (JCSM). - : American Academy of Sleep Medicine (AASM). - 1550-9389 .- 1550-9397. ; 15:2
-
Tidskriftsartikel (refereegranskat)abstract
- Study ObjectivesTo compare adherence and treatment effects with an oral appliance (OA) in patients with different types of obstructive sleep apnea (OSA): those with mainly respiratory arousals (“arousers”), and those with oxygen desaturations (“desaturaters”) at polysomnography (PSG).MethodsA prospective intervention study on 72 “tired snorers” with “normal” home sleep study (HSS), but later diagnosed as OSA with PSG, who accepted OA treatment. They were offered evaluation with a follow-up PSG and questionnaires, including the Epworth Sleepiness Scale (ESS), general health (GH), satisfaction, and side effects.ResultsSixty-six patients, 33 arousers and 33 desaturaters, were adapted to OA. The 1-year adherence rate was significantly higher among arousers (85%) than desaturaters (55%) (p = 0.034). Thirty-six of 66 patients underwent follow-up PSG; the apnea-hypopnea index was significantly reduced in 22 arousers from a median of 14 to 3 (p < 0.001), and in 14 desaturaters from 18 to 7 (p = 0.002; no significant group difference). ESS and GH showed no significant improvements in either group, although sleepy “arousers” (ESS ≥ 10) significantly improved their ESS. In total, 77% reported side effects, while 63% were still satisfied with the OA treatment. Gender analysis showed a significant dominance of females classified as “arousers” (p = 0.025).ConclusionsOSA patients with mainly arousals at PSG showed higher adherence to OA treatment, compared to patients with desaturations. Both groups responded similarly to treatment: improved nocturnal respiration, but only a small reduction of symptoms. We suggest that “tired snorers” with “normal HSS” should be offered PSG, and if OSA, also OA treatment.
|
|
| 7. |
|
|
| 8. |
- P, Nerfeldt, et al.
(författare)
-
Weight reduction improves nocturnal respiration in obese sleep apnoea patients- : A randomized controlled pilot study
- 2008
-
Ingår i: Obesity Research and Clinical Practice. - : Elsevier BV. - 1871-403X .- 1878-0318.
-
Tidskriftsartikel (refereegranskat)abstract
- ObjectivesRandomized controlled pilot study of the effect of weight reduction on nocturnal respiratory parameters in obese patients with obstructive sleep apnoea syndrome (OSAS).MethodsTwenty consecutive obese male patients fulfilling OSAS criteria at Karolinska University Hospital were randomized into two groups. Intervention with an 8-week weight reduction programme consisting of a low-calorie diet, together with group meetings, was evaluated compared to expectancy alone for the control group, followed by a crossover. Follow-up at 3 months included anthropometrics and ambulant sleep apnoea recordings.ResultsEleven of twenty men completed the protocol. There were significant differences between the intervention group (n = 6) and the control group (n = 5) in changes of weight (p < 0.01) and oxygen desaturation index (ODI4) (p < 0.05). We also found a significant positive correlation in these 11 males after the crossover between their reduction in weight and their reduction in ODI4 (p < 0.05).ConclusionsThis pilot study indicates that weight reduction improves nocturnal respiration in obese OSAS patients after 3 months’ dietary treatment compared to expectancy.
|
|
| 9. |
- P, Nerfeldt, et al.
(författare)
-
Weight reduction improves sleep, sleepiness and metabolic status in obese sleep apnoea patients.
- 2008
-
Ingår i: Obesity Research and Clinical Practice. - : Elsevier BV. - 1871-403X .- 1878-0318. ; 2:4, s. 251-262
-
Tidskriftsartikel (refereegranskat)abstract
- MethodIn this prospective intervention study, 33 obese patients with obstructive sleep apnoea syndrome (OSAS) (24 men, 9 women) were consecutively enrolled for a weight reduction program at the Obesity Unit, Karolinska University Hospital. 23 of 33 patients used OSAS-device, 19 with Continuous Positive Airway Pressure and 4 with Mandibular Retaining Device. The patients were investigated with questionnaires, blood tests and ambulant nocturnal polysomnography before and after a 6-month program. Patients with OSAS-device slept without it during the sleep studies. The intervention consisted of 8 weeks low calorie diet and group meetings, followed by a day-care program of behaviour change support.Results27 of 33 patients (82%, 21 men and 6 women) completed the study. After the intervention there were highly significant decreases (p < 0.001) in Body Mass Index from mean(S.D.) 40(5) to 34(3), apnoea–hypopnoea index from 43(24) to 26(20) and Epworth Sleepiness Scale (ESS)-score from 9(4) to 6(4). Sleep quality (arousal index, sleep efficiency, percentage deep sleep) and metabolic status (blood pressure, blood glucose levels, lipidemia) were also significantly improved. There was a significant correlation between increased percentage deep sleep and reduced ESS-score. There were no differences due to gender or use/no use of OSAS-device.ConclusionThe results suggest that weight loss, induced by low calorie diet and behaviour change support, significantly improves nocturnal respiratory parameters, sleep quality, daytime sleepiness and metabolic status in obese OSAS patients after 6 months.
|
|
