| 1. |
- Grunstein, Ronald R, et al.
(author)
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Two year reduction in sleep apnea symptoms and associated diabetes incidence after weight loss in severe obesity.
- 2007
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In: Sleep. - 0161-8105. ; 30:6, s. 703-10
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Journal article (peer-reviewed)abstract
- STUDY OBJECTIVES: To evaluate the effect of bariatric surgery on sleep apnea symptoms and obesity-associated morbidity in patients with severe obesity. DESIGN: Prospective study. SETTING: University hospitals and community centers in Sweden. Intervention: We investigated the influence of weight loss surgery (n=1729) on sleep apnea symptoms and obesity-related morbidity using a conservatively treated group (n=1748) as a control. MEASUREMENTS AND RESULTS: Baseline BMI in surgical group (42.2+/-4.4 kg/m(2)) and control group (40.1+/-4.6 kg/m(2)) changed -9.7+/-5 kg/m(2) and 0+/-3 kg/m(2), respectively, at 2-year follow-up. In the surgery group, there was a marked improvement in all obstructive sleep apnea (OSA) symptoms compared with the control group (P <0.001). Persistence of snoring (21.6 vs 65.5%, adjusted OR 0.14, 95% CI 0.10-0.19) and apnea (27.9 vs 71.3%, adjusted OR 0.16, 95% I 0.10-0.23) were much less in the surgery group compared with controls. Compared with subjects with no observed apnea at follow-up (n=2453), subjects who continued to have or developed observed apnea (n=404) had a higher incidence of diabetes (adjusted OR 2.03, 95% CI 1.19-3.47) and hypertriglyceridemia (adjusted OR 1.86, 95% CI 1.07-3.25) but not hypertension (adjusted OR 1.09, 95% CI 0.65-1.83) or hypercholesterolemia (adjusted OR 0.91, 95% CI 0.53-1.58). CONCLUSION: Bariatric surgery results in a marked improvement in sleep apnea symptoms at 2 years. Despite adjustment for weight change and baseline central obesity, subjects reporting loss of OSA symptoms had a lower 2-year incidence of diabetes and hypertriglyceridemia. Improvement in OSA in patients losing weight may provide health benefits in addition to weight loss alone.
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| 2. |
- Hellgren, Johan, 1965, et al.
(author)
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Altered positional regulation of nasal patency in patients with obstructive sleep apnoea syndrome.
- 2009
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In: European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. - : Springer Science and Business Media LLC. - 1434-4726. ; 266:1, s. 83-7
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Journal article (peer-reviewed)abstract
- We assessed the regulation of nasal patency supine in subjects with obstructive sleep apnoea syndrome (OSAS) compared to healthy controls. Healthy subjects increase nasal obstruction when changing body position from sitting to supine, possibly due to increased hydrostatic pressure in the head supine. Limited data indicate that this response is altered in patients with OSAS, suggesting that supine nasal patency is actively regulated. This study examined the nasal response to recumbent body position using acoustic rhinometry in OSAS patients and healthy controls. Twenty subjects (16 men and 4 women, mean age 55 +/- 16 years), with diagnosed OSAS [mean apnoea hypopnoea index (AHI) 46 +/- 22 events/h] without nasal obstruction and continuous positive airway pressure (CPAP)-naive, underwent measurement of intra-nasal cross sectional area by acoustic rhinometry at sitting and after 5 min supine. Twenty healthy controls (13 men, 7 women, mean age 35 +/- 9 years) were also included in the study. In the patients with OSAS, the mean minimal cross sectional area (MCA, left + right nasal cavity) was unchanged between sitting (1.18 +/- 0.41 cm(2)) and supine (1.21 +/- 0.35 cm(2), P = 0.5). In the healthy controls, the mean MCA decreased from 1.06 +/- 0.18 to 0.94 +/- 0.21 cm(2) supine, P = 0.01. This study showed that the normal decrease in nasal patency following a change in body position from sitting to supine is absent in patients with OSAS. The results indicate that there is an active regulation of supine nasal patency.
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| 3. |
- Marshall, N.S., et al.
(author)
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Changes in sleep duration and changes in weight in obese patients: The Swedish Obese Subjects Study
- 2010
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In: Sleep and Biological Rhythms. - : Springer Science and Business Media LLC. - 1479-8425 .- 1446-9235. ; 8:1, s. 63-71
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Journal article (peer-reviewed)abstract
- Sleep duration has been linked to obesity and/or weight gain in a number of cross-sectional and longitudinal observational studies. The Swedish Obese Subjects Study (SOS) is a non-randomized controlled trial of surgical interventions (surgical group) for weight-loss compared with standard conservative weight loss management (control group). We investigated whether changes in sleep duration were associated with weight loss in severely obese patients. This is a longitudinal treatment study reanalyzed as two 10-year cohorts, surgical (n= 1139) and control (n= 952). Self-reported habitual sleep duration, body weight, total cholesterol, HDL (high density lipoprotein) cholesterol, triglycerides, fasting glucose, and blood pressure were measured at baseline, 2 years, and 10 years. At baseline patients were obese (inclusion: body mass index [BMI]≥34 for men and ≥38 for women) and middle aged (37–60 years). The surgical group had substantially greater weight reduction after 10 years (–19.1 kg) compared with the control group (+1.2 kg). Changes in sleep duration between baseline, 2 years, and 10 years were not associated with body mass or with changes in weight in either cohort. Changes in cardiovascular disease (CVD) risk factors were not associated with changes in sleep duration. Changes in sleep duration over 2 and 10 years were not associated with weight loss in these obese patients. The data from the SOS study offers no support to the hypothesis that sleep-duration modification is associated with obesity reduction in severely obese people.
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| 4. |
- Marshall, N.S., et al.
(author)
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Self-reported sleep apnoea and mortality in patients from the Swedish Obese Subjects study
- 2011
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In: European Respiratory Journal. - : European Respiratory Society (ERS). - 0903-1936 .- 1399-3003. ; 38:6, s. 1349-1354
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Journal article (peer-reviewed)abstract
- Sleep apnoea is associated with increased mortality in sleep clinic and community population groups. It is unclear whether a clinical report of sleep apnoea results in additional mortality risk in patients with severe obesity. The Swedish Obese Subjects (SOS) study is a nonrandomised controlled trial of bariatric surgery versus conventional treatment for the treatment of severe obesity and its complications (mean±sd body mass index 41±5 kg·m−2). The presence or absence of sleep apnoea (witnessed pauses in breathing) was determined by self-reporting at baseline in 3,953 patients who were observed for 54,236 person-yrs (mean 13.5 maximum 21.0 yrs). Sleep apnoea was reported by 934 (23.6%) patients at baseline and was a significant univariate predictor of mortality (hazard ratio (95% CI) 1.74 (1.40–2.18)). In a range of multivariate models of mortality risk, controlling for ≤16 other potential confounders and established mortality risk factors, sleep apnoea remained a significant prognostic factor (fully adjusted model 1.29 (1.01–1.65)). Self-reported sleep apnoea is an independent prognostic marker of all-cause mortality in obese patients.
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| 5. |
- Phillips, Craig L, et al.
(author)
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Effects of continuous positive airway pressure treatment and withdrawal in patients with obstructive sleep apnea on arterial stiffness and central BP.
- 2008
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In: Chest. - : Elsevier BV. - 0012-3692. ; 134:1, s. 94-100
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Journal article (peer-reviewed)abstract
- BACKGROUND: Obstructive sleep apnea (OSA) is associated with increased BP and other cardiometabolic risk factors. The aim of the present study was to determine whether arterial stiffness and central BP (two important cardiovascular risk factors) would change, independent of peripheral BP following either the initiation of or withdrawal from nasal continuous positive airway pressure (CPAP) treatment in subjects with OSA. METHODS AND RESULTS: Arterial stiffness and peripheral and central BP were measured at baseline, and then either at 2 months after starting CPAP therapy (intervention group, n=20) or 7 nights after withdrawal from CPAP therapy (withdrawal group, n=20) using pulse wave analysis. In the intervention group, there were reductions in arterial stiffness (ie, the aortic augmentation index fell by 2.5%) and central systolic BP (fell by 4.2 mm Hg) without a concomitant reduction in peripheral BP. The change in arterial stiffness was associated with CPAP compliance (r=-0.47). In contrast, in the withdrawal group there were no overall changes in arterial stiffness or BP. However, there was an early morning increase in diastolic BP and heart rate relative to late evening. CONCLUSION: These results suggest that clinically important changes in arterial stiffness and central BP may occur following effective CPAP treatment of OSA without parallel changes in peripheral BP.
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| 6. |
- Theorell-Haglöw, Jenny, et al.
(author)
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Associations Between Obstructive Sleep Apnea and Measures of Arterial Stiffness
- 2019
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In: Journal of Clinical Sleep Medicine (JCSM). - : AMER ACAD SLEEP MEDICINE. - 1550-9389 .- 1550-9397. ; 15:2, s. 201-206
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Journal article (peer-reviewed)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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| 7. |
- Theorell-Haglöw, Jenny, et al.
(author)
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Changes of vitamin D levels and bone turnover markers after CPAP therapy : a randomized sham-controlled trial
- 2018
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In: Journal of Sleep Research. - : WILEY. - 0962-1105 .- 1365-2869. ; 27:4
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Journal article (peer-reviewed)abstract
- The aim was to investigate whether continuous positive airway pressure treatment could modulate serum vitamin D (25-hydroxyvitamin D) and bone turnover markers (collagen-type 1 cross-linked C-telopeptide, osteocalcin and N-terminal propeptide of type 1 collagen) in secondary analysis from a randomized controlled trial. Sixty-five continuous positive airway pressure-naive male patients with obstructive sleep apnea (age=49 +/- 12years, apnea-hypopnea index=39.9 +/- 17.7events h(-1), body mass index=31.3 +/- 5.2kgm(-2)) were randomized to receive either real (n=34) or sham (n=31) continuous positive airway pressure for 12weeks. At 12weeks, all participants received real continuous positive airway pressure for an additional 12weeks. After 12weeks of continuous positive airway pressure (real versus sham), there were nobetween-group differences for any of the main outcomes [25-hydroxyvitamin D: -0.80 +/- 5.28ngmL(-1) (mean +/- SE) versus 3.08 +/- 3.66ngmL(-1), P=0.42; collagen-type 1 cross-linked C-telopeptide: 0.011 +/- 0.014ngmL(-1) versus -0.004 +/- 0.009ngmL(-1), P=0.48; osteocalcin: 1.13 +/- 1.12ngmL(-1) versus 0.46 +/- 0.75ng mL(-1), P=0.80; N-terminal propeptide of type 1 collagen: 2.07 +/- 3.05gL(-1) versus -1.05 +/- 2.13gL(-1), P=0.48]. There were no further differences in subgroup analyses (continuous positive airway pressure-compliant patients, patients with severe obstructive sleep apnea or sleepy patients). However, after 24weeks irrespective of initial randomization, vitamin D increased in patients with severe obstructive sleep apnea (9.56 +/- 5.51ngmL(-1), P=0.045) and in sleepy patients (14.0 +/- 4.69ngmL(-1), P=0.007). Also, there was a significant increase in osteocalcin at 24weeks (3.27 +/- 1.06ngmL(-1), P=0.01) in compliant patients. We conclude that 12weeks of continuous positive airway pressure did not modulate vitamin D or modulate any of the bone turnover markers compared with sham. However, it is plausible that continuous positive airway pressure may have late beneficial effects on vitamin D levels and bone turnover markers in selected groups of patients with obstructive sleep apnea.
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| 8. |
- Theorell-Haglöw, Jenny, et al.
(author)
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Gender differences in obstructive sleep apnoea, insomnia and restless legs syndrome in adults - What do we know? : A clinical update
- 2018
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In: Sleep Medicine Reviews. - : Saunders Elsevier. - 1087-0792 .- 1532-2955. ; 38, s. 28-38
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Research review (peer-reviewed)abstract
- Research in sleep medicine over the last decades has involved a broad variety of sleep disorders in both men and women. Gender differences have been identified in sleep physiology as well as in the three most common sleep disorders: obstructive sleep apnoea (OSA), insomnia and restless legs syndrome (RLS). However, research on gender differences in sleep medicine appears limited. This clinical review aims to give an updated overview of gender differences, in relation to prevalence, clinical presentation, treatment and quality of life in OSA, insomnia and RLS. Future research directions in the adult population will also be discussed. (C) 2017 Elsevier Ltd. All rights reserved.
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| 9. |
- Vedam, Hima, et al.
(author)
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Short-term hypoxia reduces arterial stiffness in healthy men.
- 2009
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In: European journal of applied physiology. - : Springer Science and Business Media LLC. - 1439-6319 .- 1439-6327. ; 105:1, s. 19-25
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Journal article (peer-reviewed)abstract
- This study examined the effects of hypoxia (80% arterial oxyhaemoglobin saturation for 20 min) and the accompanying changes in heart rate and blood pressure on two components of arterial stiffness in healthy men. Augmentation index (AIx) and time to reflection (Tr) representing measures of muscular artery and aortic stiffness, respectively, were continuously measured. At first, subjects were exposed to either hypoxia (n = 12) or room air (n = 5). During early hypoxia AIx increased by 6% before decreasing to baseline. After hypoxia AIx decreased by a further 6%. In contrast there was no change in Tr. Six subjects were then exposed to hypoxia following infusion with the nitric oxide (NO) synthase inhibitor NG-mono-methyl-L: -arginine (L-NMMA) or saline. During hypoxia AIx decreased by 12% following saline but increased by 14% after L-NMMA and Tr did not change. These findings suggest that hypoxia may induce NO-mediated vasodilatation of small muscular arteries but not the aorta.
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