| 1. |
- Figtree, Gemma A., et al.
(författare)
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Clinical Pathway for Coronary Atherosclerosis in Patients Without Conventional Modifiable Risk Factors JACC State-of-the-Art Review
- 2023
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Ingår i: Journal of the American College of Cardiology. - : ELSEVIER SCIENCE INC. - 0735-1097 .- 1558-3597. ; 82:13, s. 1343-1359
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Forskningsöversikt (refereegranskat)abstract
- Reducing the incidence and prevalence of standard modifiable cardiovascular risk factors (SMuRFs) is critical to tackling the global burden of coronary artery disease (CAD). However, a substantial number of individuals develop coronary atherosclerosis despite no SMuRFs. SMuRFless patients presenting with myocardial infarction have been observed to have an unexpected higher early mortality compared to their counterparts with at least 1 SMuRF. Evidence for optimal management of these patients is lacking. We assembled an international, multidisciplinary team to develop an evidence-based clinical pathway for SMuRFless CAD patients. A modified Delphi method was applied. The resulting pathway confirms underlying atherosclerosis and true SMuRFless status, ensures evidence-based secondary prevention, and considers additional tests and interventions for less typical contributors. This dedicated pathway for a previously overlooked CAD population, with an accompanying registry, aims to improve outcomes through enhanced adherence to evidence-based secondary prevention and additional diagnosis of modifiable risk factors observed. (c) 2023 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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| 2. |
- Manfredini, Daniele, et al.
(författare)
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Standardised Tool for the Assessment of Bruxism
- 2024
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Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842 .- 0305-182X. ; 51:1, s. 29-58
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Forskningsöversikt (refereegranskat)abstract
- Objective: This paper aims to present and describe the Standardised Tool for the Assessment of Bruxism (STAB), an instrument that was developed to provide a multidimensional evaluation of bruxism status, comorbid conditions, aetiology and consequences.Methods: The rationale for creating the tool and the road map that led to the selection of items included in the STAB has been discussed in previous publications.Results: The tool consists of two axes, specifically dedicated to the evaluation of bruxism status and consequences (Axis A) and of bruxism risk and etiological factors and comorbid conditions (Axis B). The tool includes 14 domains, accounting for a total of 66 items. Axis A includes the self-reported information on bruxism status and possible consequences (subject-based report) together with the clinical (examiner report) and instrumental (technology report) assessment. The Subject-Based Assessment (SBA) includes domains on Sleep Bruxism (A1), Awake Bruxism (A2) and Patient's Complaints (A3), with information based on patients' self-report. The Clinically Based Assessment (CBA) includes domains on Joints and Muscles (A4), Intra- and Extra-Oral Tissues (A5) and Teeth and Restorations (A6), based on information collected by an examiner. The Instrumentally Based Assessment (IBA) includes domains on Sleep Bruxism (A7), Awake Bruxism (A8) and the use of Additional Instruments (A9), based on the information gathered with the use of technological devices. Axis B includes the self-reported information (subject-based report) on factors and conditions that may have an etiological or comorbid association with bruxism. It includes domains on Psychosocial Assessment (B1), Concurrent Sleep-related Conditions Assessment (B2), Concurrent Non-Sleep Conditions Assessment (B3), Prescribed Medications and Use of Substances Assessment (B4) and Additional Factors Assessment (B5). As a rule, whenever possible, existing instruments, either in full or partial form (i.e. specific subscales), are included. A user's guide for scoring the different items is also provided to ease administration.Conclusions: The instrument is now ready for on-field testing and further refinement. It can be anticipated that it will help in collecting data on bruxism in such a comprehensive way to have an impact on several clinical and research fields.
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| 3. |
- Inan-Eroglu, Elif, et al.
(författare)
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Comparison of a Thigh-Worn Accelerometer Algorithm With Diary Estimates of Time in Bed and Time Asleep: The 1970 British Cohort Study
- 2021
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Ingår i: Journal for the Measurement of Physical Behaviour. - : Human Kinetics. - 2575-6605 .- 2575-6613. ; 4:1, s. 60-67
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Tidskriftsartikel (refereegranskat)abstract
- Background: Thigh-worn accelerometers have established reliability and validity for measurement of free-living physical activity-related behaviors. However, comparisons of methods for measuring sleep and time in bed using the thigh-worn accelerometer are rare. The authors compared the thigh-worn accelerometer algorithm that estimates time in bed with the output of a sleep diary (time in bed and time asleep). Methods: Participants (N = 5,498), from the 1970 British Cohort Study, wore an activPAL device on their thigh continuously for 7 days and completed a sleep diary. Bland–Altman plots and Pearson correlation coefficients were used to examine associations between the algorithm derived and diary time in bed and asleep. Results: The algorithm estimated acceptable levels of agreement with time in bed when compared with diary time in bed (mean bias of −11.4 min; limits of agreement −264.6 to 241.8). The algorithm-derived time in bed overestimated diary sleep time (mean bias of 55.2 min; limits of agreement −204.5 to 314.8 min). Algorithm and sleep diary are reasonably correlated (ρ = .48, 95% confidence interval [.45, .52] for women and ρ = .51, 95% confidence interval [.47, .55] for men) and provide broadly comparable estimates of time in bed but not for sleep time. Conclusions: The algorithm showed acceptable estimates of time in bed compared with diary at the group level. However, about half of the participants were outside of the ±30 min difference of a clinically relevant limit at an individual level.
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| 4. |
- Sutherland, Kate, et al.
(författare)
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Oral Appliance Treatment for Obstructive Sleep Apnea : An Update
- 2014
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Ingår i: Journal of Clinical Sleep Medicine (JCSM). - : American Academy of Sleep Medicine (AASM). - 1550-9389 .- 1550-9397. ; 10:2, s. 215-227
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Forskningsöversikt (refereegranskat)abstract
- Oral appliances (OA) have emerged as an alternative to continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA) treatment. The most commonly used OA reduces upper airway collapse by advancing the mandible (OA(m)). There is a strong evidence base demonstrating OA m improve OSA in the majority of patients, including some with more severe disease. However OA(m) are not efficacious for all, with approximately one-third of patients experiencing no therapeutic benefit. OA(m) are generally well tolerated, although short-term adverse effects during acclimatization are common. Long-term dental changes do occur, but these are for the most part subclinical and do not preclude continued use. Patients often prefer OA(m) to gold-standard CPAP treatment. Head-to-head trials confirm CPAP is superior in reducing OSA parameters on polysomnography; however, this greater efficacy does not necessarily translate into better health outcomes in clinical practice. Comparable effectiveness of OA(m) and CPAP has been attributed to higher reported nightly use of OA(m), suggesting that inferiority in reducing apneic events may be counteracted by greater treatment adherence. Recently, significant advances in commercially available OA(m) technologies have been made. Remotely controlled mandibular positioners have the potential to identify treatment responders and the level of therapeutic advancement required in single night titration polysomnography. Objective monitoring of OA(m) adherence using small embedded temperature sensing data loggers is now available and will enhance clinical practice and research. These technologies will further enhance efficacy and effectiveness of OA(m) treatment for OSA.
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| 5. |
- Theorell-Haglöw, Jenny, et al.
(författare)
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Associations Between Obstructive Sleep Apnea and Measures of Arterial Stiffness
- 2019
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Ingår i: Journal of Clinical Sleep Medicine (JCSM). - : AMER ACAD SLEEP MEDICINE. - 1550-9389 .- 1550-9397. ; 15:2, s. 201-206
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Tidskriftsartikel (refereegranskat)abstract
- Study Objectives: The aim of this study was to determine whether severity measures of obstructive sleep apnea (OSA) are associated with arterial stiffness and central blood pressure (two important cardiovascular risk factors) in a large group of patients with OSA. Methods: Baseline data from six studies on OSA in which arterial stiffness and central aortic blood pressure measures were determined using applanation tonometry were pooled. Associations between measures of arterial stiffness (heart rate corrected augmentation index [AI75]), central aortic blood pressure (central systolic pressure [CSP] and heart rate corrected central augmentation pressure [CAP75]) and measures of OSA severity were explored using stepwise regression modelling. Results: Data from 362 participants (M:F ratio 13:1) with mean (standard deviation) age 49.2 (11.0) years, body mass index 31.9 (5.3) kg/m(2), apnea-hypopnea index (AHI) 35.7 (20.7) events/h were included in the analyses. The AHI, oxygen desaturation index (ODI3%), and sleep time with SpO(2) < 90% (T90) were all associated with arterial stiffness (AI75), (AHI: adj. beta = .069; P = .01; ODI3%: adj. beta = .072; P = .01; T90: adj. beta = .18; P < .0001) and CAP75 (AHI: adj. beta = .030; P = .01; ODI3%: adj. beta = .027; P = .02; T90: adj. beta = .080; P < .0001). AHI was also associated with CSP (AHI: adj. beta = .11; P = .002). Conclusion: OSA severity was significantly associated with augmentation index and CAP75 although the relationships were not strong.
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| 6. |
- Thorarinsdottir, Elin H., et al.
(författare)
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Polysomnographic characteristics of excessive daytime sleepiness phenotypes in obstructive sleep apnea : results from the international sleep apnea global interdisciplinary consortium
- 2024
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Ingår i: Sleep. - : Oxford University Press. - 0161-8105 .- 1550-9109. ; 47:4
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Tidskriftsartikel (refereegranskat)abstract
- Study Objectives: Excessive daytime sleepiness (EDS) is a major symptom of obstructive sleep apnea (OSA). Traditional polysomnographic (PSG) measures only partially explain EDS in OSA. This study analyzed traditional and novel PSG characteristics of two different measures of EDS among patients with OSA. Methods: Sleepiness was assessed using the Epworth Sleepiness Scale (>10 points defined as "risk of dozing") and a measure of general sleepiness (feeling sleepy >= 3 times/week defined as "feeling sleepy"). Four sleepiness phenotypes were identified: "non-sleepy," "risk of dozing only," "feeling sleepy only," and "both at risk of dozing and feeling sleepy." Results: Altogether, 2083 patients with OSA (69% male) with an apnea-hypopnea index (AHI) >= 5 events/hour were studied; 46% were "non-sleepy," 26% at "risk of dozing only," 7% were "feeling sleepy only," and 21% reported both. The two phenotypes at "risk of dozing" had higher AHI, more severe hypoxemia (as measured by oxygen desaturation index, minimum and average oxygen saturation [SpO(2)], time spent < 90% SpO(2), and hypoxic impacts) and they spent less time awake, had shorter sleep latency, and higher heart rate response to arousals than "non-sleepy" and "feeling sleepy only" phenotypes. While statistically significant, effect sizes were small. Sleep stages, frequency of arousals, wake after sleep onset and limb movement did not differ between sleepiness phenotypes after adjusting for confounders. Conclusions: In a large international group of patients with OSA, PSG characteristics were weakly associated with EDS. The physiological measures differed among individuals characterized as "risk of dozing" or "non-sleepy," while "feeling sleepy only" did not differ from "non-sleepy" individuals.
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