| 1. |
- Hagell, Peter, et al.
(författare)
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Measurement properties and hierarchical item structure of the Epworth Sleepiness Scale in Parkinson's disease
- 2007
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Ingår i: Journal of Sleep Research. - : Wiley. - 0962-1105 .- 1365-2869. ; 16:1, s. 102-109
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this work was to evaluate the measurement properties and hierarchical item structure of the Epworth Sleepiness Scale (ESS) in patients with Parkinson's disease (PD). Data were taken from a cross-sectional study regarding fatigue and sleep-related aspects of PD. One hundred and eighteen consecutive patients with neurologist-diagnosed PD without significant co-morbidities (54% men; mean age, 64 years; mean PD duration, 8.4 years) from four Swedish neurological outpatient clinics participated. The ESS displayed good data quality with few missing items (0–2.5%): good reliability (Cronbach's alpha, 0.84), marginal floor and no ceiling effects (1.7% and 0% respectively), and differentiated between those reporting problems staying awake during the past month and those who did not. Item–total correlations, factor and Rasch analyses indicated that items tap a single underlying construct. Rasch analysis supported basic rating scale assumptions and demonstrated an item hierarchy similar to that previously found in patients with other sleep disorders. Gaps in the levels of sleep propensity covered by ESS items and their response options were identified at the higher and lower ends of the underlying sleepiness continuum. This study provides an evidence base for using the ESS in PD by demonstrating good psychometric properties and a stable hierarchical item structure. However, addition of new items and use of Rasch scoring has potential to further enhance the clinical usefulness of the ESS.
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| 2. |
- Jensen, Elmo, et al.
(författare)
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Insomnia in an 80-year-old population: relationship to medical, psychological and social factors
- 1998
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Ingår i: Journal of Sleep Research. - : Wiley. - 1365-2869 .- 0962-1105. ; 7:3, s. 183-189
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Tidskriftsartikel (refereegranskat)abstract
- In this study, insomnia in 80-year-olds was related to medical, psychological and social factors. The data were based on examinations every year in people aged between 80 and 89 years. Of 333 people living in the city of Lund and born in 1908, 67% participated. Increased severity of insomnia was significantly associated with use of diuretics, other cardiovascular drugs, hypnotics and laxatives, and with nervousness, difficulty relaxing, anorexia, nausea, constipation, backache, feeling cold, sweating, loss of weight, dizziness, depression, general fatigue, exhaustion, angina pectoris, cardiac insufficiency, worsened objective and subjective health, presence of negative T-waves on ECG, anxiety, total life satisfaction, neuroticism, disbelief in a just world, feeling lonely and lower survival rates. Thus insomnia has widespread associations with different aspects of life in 80-year-olds.
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| 3. |
- Åkerstedt, Torbjörn, et al.
(författare)
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Reaction of sleepiness indicators to partial sleep deprivation, time of day and time on task in a driving simulator - the DROWSI project
- 2010
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Ingår i: Journal of Sleep Research. - : Wiley. - 1365-2869 .- 0962-1105. ; 19:2, s. 298-309
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Tidskriftsartikel (refereegranskat)abstract
- Studies of driving and sleepiness indicators have mainly focused on prior sleep reduction. The present study sought to identify sleepiness indicators responsive to several potential regulators of sleepiness: sleep loss, time of day (TOD) and time on task (TOT) during simulator driving. Thirteen subjects drove a high-fidelity moving base simulator in six 1-h sessions across a 24-h period, after normal sleep duration (8 h) and after partial sleep deprivation (PSD; 4 h). The results showed clear main effects of TOD (night) and TOT but not for PSD, although the latter strongly interacted with TOD. The most sensitive variable was subjective sleepiness, the standard deviation of lateral position (SDLAT) and measures of eye closure [duration, speed (slow), amplitude (low)]. Measures of electroencephalography and line crossings (LCs) showed only modest responses. For most variables individual differences vastly exceeded those of the fixed effects, except for subjective sleepiness and SDLAT. In a multiple regression analysis, SDLAT, amplitude/peak eye-lid closing velocity and blink duration predicted subjective sleepiness bouts with a sensitivity and specificity of about 70%, but were mutually redundant. The prediction of LCs gave considerably weaker, but similar results. In summary, SDLAT and eye closure variables could be candidates for use in sleepiness-monitoring devices. However, individual differences are considerable and there is need for research on how to identify and predict individual differences in susceptibility to sleepiness.
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| 4. |
- Pevernagie, Dirk, et al.
(författare)
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European guidelines for the certification of professionals in sleep medicine: report of the task force of the European Sleep Research Society
- 2009
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Ingår i: Journal of Sleep Research. - : Wiley. - 1365-2869 .- 0962-1105. ; 18:1, s. 136-141
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Tidskriftsartikel (refereegranskat)abstract
- In recent years, sleep medicine has evolved into a full-grown discipline, featuring a multidisciplinary approach to diagnosis and treatment of patients with sleep disorders. Sleep medicine cuts across the boundaries of different conventional disciplines and is therefore open to medical and non-medical professionals with different specialty backgrounds. The aim of the current paper is to introduce a qualification for those professionals whose main occupation is to practice sleep medicine in the setting of a sleep medicine centre. The drafting of guidelines dealing with requirements for such qualification was entrusted to a task force by the European Sleep Research Society. The guidelines are the result of a progressive consensus procedure in which standards were defined for education, training, and evaluation. The final step along this pathway is a theoretical and practical examination, providing proof of proficiency in the field of sleep medicine. This paper describes the object of specific competences, the scope of sleep medicine, and the qualification procedures that pertain to three professional categories: medical specialists, non-medical professionals with a university master degree (such as psychologists and biologists), and nurses and technologists. Indices of preceding practical experience and theoretical knowledge are presented in Appendices 1 and 2. These guidelines are a European standard. They may be adapted in the future according to new scientific insights. National certification programs that comply with these guidelines may be subject to homologation by the ESRS.
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| 5. |
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| 6. |
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| 7. |
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| 8. |
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| 9. |
- Akerstedt, Torbjorn, et al.
(författare)
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Predicting long-term sickness absence from sleep and fatigue.
- 2007
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Ingår i: J Sleep Res. - : Wiley. - 0962-1105 .- 1365-2869. ; 16:4, s. 341-5
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Predicting long-term sickness absence from sleep and fatigue.Akerstedt T, Kecklund G, Alfredsson L, Selen J.Institute for Psychosocial Medicine, Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. torbjorn.akerstedt@ipm.ki.seDisturbed or shortened sleep is prospectively related to disease. One might also expect that sickness absence would be another consequence but very little data seem to exist. The present study used 8300 individuals in a national sample to obtain information on reports of disturbed sleep and fatigue 1 year and merged this with data on long-term sickness absence 2 years later. A logistic regression analysis was applied to the data with adjustments for demographic and work environment variables. The results showed that individuals without registered sickness absence at the start had a higher probability of entering a period of long-term (>/=90 days, odds ratio [OR] = 1.24 with 95% confidence interval [CI] = 1.02-1.51) sickness absence 2 years later if they reported disturbed sleep at the start. The figure for fatigue was OR = 1.35 (CI = 1.14-1.60). When fatigue or disturbed sleep was separately excluded the OR increased to OR = 1.44 and OR = 1.47, respectively. Intermediate sickness absence (14-89 days) showed similar but slightly weaker results. The results indicate that disturbed sleep and fatigue are predictors of long-term absence and it is suggested that impaired sleep may be part of a chain of causation, considering its effects on fatigue.PMID: 18036078 [PubMed - in process]
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| 10. |
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| 11. |
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| 12. |
- Anund, Anna, et al.
(författare)
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Driver sleepiness and individual differences in preferences for countermeasures.
- 2008
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Ingår i: J Sleep Res. - : Wiley. - 1365-2869 .- 0962-1105. ; 17:1, s. 16-22
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- 1: J Sleep Res. 2008 Mar;17(1):16-22. LinksDriver sleepiness and individual differences in preferences for countermeasures.Anund A, Kecklund G, Peters B, Akerstedt T.Swedish National Road and Transport Research Institute (VTI), Linköping, Sweden. anna.anund@vti.seThe aim of the present national questionnaire study was to relate the use of sleepiness countermeasures among drivers to possible explanatory factors such as age, sex, education, professional driving, being a shift worker, having experience of sleepy driving, sleep-related crashes, problems with sleep and sleepiness in general and sleep length during working days. Also the attitude to countermeasures related to information or driver support system was studied. A random sample of 3041 persons was drawn from the national register of vehicle owners. The response rate was 62%. The most common countermeasures were to stop to take a walk (54%), turn on the radio/stereo (52%), open a window (47%), drink coffee (45%) and to ask passengers to engage in conversation (35%). Logistic regression analysis showed that counteracting sleepiness with a nap (a presumably efficient method) was practiced by those with experience of sleep-related crashes or of driving during severe sleepiness, as well as by professional drivers, males and drivers aged 46-64 years. The most endorsed means of information to the driver about sleepiness was in-car monitoring of driving performance providing drivers with information on bad or unsafe driving. This preference was related to experience of sleepy driving, not being a professional driver and male gender. Four clusters of behaviours were identified: alertness-enhancing activity while driving (A), stopping the car (S), taking a nap (N) and ingesting coffee or other sources of caffeine (C) (energy drinks, caffeine tablets). The participants were grouped according to their use of any of the four categories of countermeasures. The most common cluster was those who used activity, as well as stopping and drinking caffeine.PMID: 18275551 [PubMed - in process]
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| 13. |
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| 14. |
- Arnardottir, Erna S I F, et al.
(författare)
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Sleep-related sweating in obstructive sleep apnoea: association with sleep stages and blood pressure
- 2010
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Ingår i: JOURNAL OF SLEEP RESEARCH. - : Wiley. - 0962-1105 .- 1365-2869. ; 19:1, s. 122-130
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Tidskriftsartikel (refereegranskat)abstract
- Pandgt;The aim of this study was to investigate sleep-related sweating as a symptom of obstructive sleep apnoea (OSA). Fifteen otherwise healthy male non-smoking patients with untreated moderate-to-severe OSA underwent polysomnography, including measurements of skin and core body temperature and electrodermal activity (EDA) as an objective indicator of sweating. Evening and morning blood pressure was measured as well as catecholamines in nocturnal urine. All measurements were repeated after 3 months on successful continuous positive airway pressure (CPAP) treatment. The untreated OSA subjects had a mean (+/- SD) apnoea-hypopnoea index of 45.3 +/- 3.9 and a mean EDA index during sleep of 131.9 +/- 22.4 events per hour. Patients with higher EDA indices had higher systolic blood pressure in the evening and morning (P = 0.001 and 0.006) and lower rapid eye movement (REM) sleep percentage (P = 0.003). The EDA index decreased significantly to 78.5 +/- 17.7 in the patients on CPAP treatment (P = 0.04). The decrease correlated with lower evening systolic and diastolic blood pressure (P = 0.05 and 0.006) and an increase in REM% (P = 0.02). No relationship was observed between EDA and skin or core body temperature, or to catecholamine levels in urine. OSA patients who experience sleep-related sweating may have increased blood pressure and decreased REM sleep compared with other OSA patients. CPAP treatment appears to lower blood pressure and increase REM sleep to a higher extent in these patients compared with other OSA patients.
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| 15. |
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| 16. |
- Björnsdóttir, Erla, et al.
(författare)
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Insomnia in untreated sleep apnea patients compared to controls
- 2012
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Ingår i: Journal of Sleep Research. - : Wiley. - 0962-1105 .- 1365-2869. ; 21:2, s. 131-138
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Tidskriftsartikel (refereegranskat)abstract
- Insomnia and obstructive sleep apnea (OSA) often coexist, but the nature of their relationship is unclear. The aims of this study were to compare the prevalence of initial and middle insomnia between OSA patients and controls from the general population as well as to study the influence of insomnia on sleepiness and quality of life in OSA patients. Two groups were compared, untreated OSA patients (n = 824) and controls ≥ 40 years from the general population in Iceland (n = 762). All subjects answered the same questionnaires on health and sleep and OSA patients underwent a sleep study. Altogether, 53% of controls were males compared to 81% of OSA patients. Difficulties maintaining sleep (DMS) were more common among men and women with OSA compared to the general population (52 versus 31% and 62 versus 31%, respectively, P < 0.0001). Difficulties initiating sleep (DIS) and DIS + DMS were more common among women with OSA compared to women without OSA. OSA patients with DMS were sleepier than patients without DMS (Epworth Sleepiness Scale: 12.2 versus 10.9, P < 0.001), while both DMS and DIS were related to lower quality of life in OSA patients as measured by the Short Form 12 (physical score 39 versus 42 and mental score 36 versus 41, P < 0.001). DIS and DMS were not related to OSA severity. Insomnia is common among OSA patients and has a negative influence on quality of life and sleepiness in this patient group. It is relevant to screen for insomnia among OSA patients and treat both conditions when they co-occur.
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| 17. |
- Broström, Anders, et al.
(författare)
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Association of Type D personality to perceived side effects and adherence in CPAP-treated patients with OSAS
- 2007
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Ingår i: Journal of Sleep Research. - : Wiley. - 0962-1105 .- 1365-2869. ; 16:4, s. 439-447
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 18. |
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| 19. |
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| 20. |
- RODENSTEIN, DANIEL, et al.
(författare)
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Driving in Europe: the need of a common policy for drivers with obstructive sleep apnoea syndrome
- 2008
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Ingår i: Journal of sleep research. - : Wiley. - 1365-2869 .- 0962-1105. ; 17:3, s. 281-284
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Tidskriftsartikel (refereegranskat)abstract
- Obstructive sleep apnoea syndrome (OSA) increases the risk of motor vehicle crashes, and of all medical disorders, has greatest risk in this respect. There is no consistency in the way OSA is considered by the national 'Physical Fitness to Drive' legislations within the 27 member countries of the European Union (EU), and most ignore OSA. This is further reflected by the absence of any reference to OSA in Annex III of the Directive 91/439/EEC, harmonizing Driving License regulations in the EU. A recent meeting brought together experts from several European and other countries, together with a representative of the European Commission. They discussed the best way to design and implement a uniform policy within Europe, for OSA and driving. It was agreed that: (i) other forms of pathological sleepiness be included, (ii) it covers both private and professional drivers, (iii) police accident report forms should explicitly consider sleepiness as a potential cause, (iv) sleep-wake education should be incorporated into the mandatory program of continuous education for professional drivers, ideally from 2010, (v) driver screening methods should contain questions on sleepiness at the wheel, habitual snoring and witnessed apneas during sleep, as well as the Epworth Sleepiness Score and Body Mass Index and (vi) following effective and efficient treatment, patients should be permitted to drive. In the light of medical, scientific and technical progress, EU procedures exist to enable the rapid modification of existing legislation. If such a procedure could be enacted for these aspects of driver sleepiness, then roads would be safer for 400 million people.
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| 21. |
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| 22. |
- Schwarz, Johanna F. A., et al.
(författare)
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In-car countermeasures open window and music revisited on the real road : popular but hardly effective against driver sleepiness
- 2012
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Ingår i: Journal of Sleep Research. - : Wiley. - 0962-1105 .- 1365-2869. ; 21:5, s. 595-599
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Tidskriftsartikel (refereegranskat)abstract
- This study investigated the effects of two very commonly used countermeasures against driver sleepiness, opening the window and listening to music, on subjective and physiological sleepiness measures during real road driving. In total, 24 individuals participated in the study. Sixteen participants received intermittent 10-min intervals of: (i) open window (2 cm opened); and (ii) listening to music, during both day and night driving on an open motorway. Both subjective sleepiness and physiological sleepiness (blink duration) was estimated to be significantly reduced when subjects listened to music, but the effect was only minor compared with the pronounced effects of night driving and driving duration. Open window had no attenuating effect on either sleepiness measure. No significant long-term effects beyond the actual countermeasure application intervals occurred, as shown by comparison to the control group (n = 8). Thus, despite their popularity, opening the window and listening to music cannot be recommended as sole countermeasures against driver sleepiness.
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| 23. |
- Svensson, Malin, et al.
(författare)
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Relationship Between Sleep-Disordered Breathing and Markers of Systemic Inflammation in Women From the General Population
- 2012
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Ingår i: Journal of Sleep Research. - : Wiley. - 0962-1105 .- 1365-2869. ; 21:2, s. 147-154
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Tidskriftsartikel (refereegranskat)abstract
- Sleep-disordered breathing (SDB) is a risk factor for cardiovascular disease (CVD). The underlying pathogenesis is not clear. In patients with obstructive sleep apnoea syndrome (OSAS) elevated levels of inflammatory markers, such as C-reactive protein (CRP), interleukin-6 (IL-6) and tumour necrosis factor a (TNFa) have been found. These markers have also been shown as independent markers of CVD in other populations. The aim of the study was to investigate the association between SDB and systemic inflammation in a population-based cohort of women. From 6817 women who previously answered a questionnaire concerning snoring habits, 230 habitually snoring women and 170 women regardless of snoring status went through polysomnography, anthropometric measurements and blood sampling. Analyses were made for CRP, TNFa, IL-6, myeloperoxidase (MPO) and lysozyme. The levels of CRP, IL-6 and lysozyme were significantly higher in subjects with apnoeahypopnoea index (AHI) =15 compared with women with lower AHI. All inflammatory markers except MPO correlated to AHI and oxygen desaturation measures, and to waist circumference. In multiple linear regressions adjusting for age, waist circumference and smoking, independent correlations between oxygen desaturation indices (ODI) and inflammation were found for IL-6 (P = 0.03 for % sleep time with saturation <90%) and TNFa (P = 0.03 for ODI 3%). No significant correlations were found between AHI and inflammation. Also, for women from the general population there is an independent correlation between SDB and inflammation, even after adjusting for obesity. The results indicate that intermittent hypoxia, and not the AHI, is related to systemic inflammation seen in OSAS.
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| 24. |
- Valli, Katja, et al.
(författare)
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Can observers link dream content to behaviours in rapid eye movement sleep behaviour disorder? : A cross-sectional experimental pilot study
- 2012
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Ingår i: Journal of Sleep Research. - : Wiley-Blackwell. - 0962-1105 .- 1365-2869. ; 21:1, s. 21-29
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Tidskriftsartikel (refereegranskat)abstract
- Motor activity in rapid eye movement (REM) sleep behaviour disorder (RBD) has been linked to dream content. Systematic and controlled sleep laboratory studies directly assessing the relation between RBD behaviours and experienced dream content are, however, largely lacking. We aimed to investigate whether a link can be established between RBD behaviours and dream content when both are systematically sampled in a controlled setting. We investigated six patients with Parkinson syndrome and RBD who underwent 23 nights of videopolysomnographic recording during which they were awakened from REM sleep (10 min after the onset of the second and successive REM periods). Spontaneous free-worded dream reports and a structured dream questionnaire were obtained. Video recordings of motor manifestations were each combined with four dream reports, and seven judges had to match the video clip with the correctly reported dream content from a choice of four possibilities. Of the 35 REM sleep awakenings performed, a total of 17 (48.6%) motor-behavioural episodes with recalled dream content were obtained. The mean of correctly identified video-dream pairs was 39.5% (range 0100%). Our data showed that reported dream content can be linked to motor behaviours above chance level. Matching accuracy was affected mainly by the clarity of dream reports and the specific nature of movements manifest in video recordings.
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| 25. |
- Gillberg, M., et al.
(författare)
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Longitudinal changes in the sleep habits of Swedish adolescents
- 2006
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Ingår i: Journal of Sleep Research. - : Wiley. - 0962-1105 .- 1365-2869. ; 15:Suppl. 1, s. 83-
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Sleep habits change during adolescence both for biological and psychological/social reasons. Longitudinal studies on suchhabits are, however, scarce. The aim of the present study was toinvestigate the longitudinal changes of subjective sleep habits in Swedish adolescents.Method: The present study was part of a larger investigation mainlyon food habits that originally included all (about 2500) 14 year oldfrom three representative middle-sized Swedish towns. The adolescents filled in questionnaires at 14, 15 and 18 years of age. The 638 adolescents that answered all the questions on their sleephabits at each of the three occasions were included in the present study.Results and discussion: The adolescents developed later weekday bed- and rise times with increasing age (bedtimes from 22:35 h to23:20 h; risetimes from 06:50 h to 07:05 h). Consequently, time inbed on weekday nights decreased (from 8:15 h to 7:45 h). On weekends the adolescents went to bed later (around 2 h) and stayed in bed longer (around 1:20 h) than during the weekdays. Weekend time in bed decreased with increasing age. Differences between genders indicated that the changes observed were more obvious among boys. A dropout analysis implied that those adolescents that only participated at one occasion (at the age of 14) or at two occasions (at 14 and 15 years of age), respectively, went to bed later, woke up later and had shorter sleep compared to those who participated at all three occasions. Hence, the results might not be completely representative.Conclusions: A delay of bedtimes and of shortening of sleep duration as a function of age was observed. Weekend changes showed a delay of bedtimes and a (presumably) compensatory increase in sleep duration. Boys seemed 'worse off'.
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| 26. |
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| 27. |
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| 28. |
- Broström, Anders, et al.
(författare)
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The attitudes to CPAP treatment inventory: development and initial validation of a new tool for measuring attitudes to CPAP treatment
- 2011
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Ingår i: Journal of Sleep Research. - : Blackwell Publishing Ltd. - 0962-1105 .- 1365-2869. ; 20:3, s. 460-471
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 29. |
- Broström, Anders, et al.
(författare)
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The side-effects to CPAP treatment inventory : the development and initial validation of a new tool for the measurement of side-effects to CPAP treatment.
- 2010
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Ingår i: Journal of Sleep Research. - : Wiley. - 0962-1105 .- 1365-2869. ; 19:4, s. 603-611
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 30. |
- Donadio, Vincenzo, et al.
(författare)
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Daytime sympathetic hyperactivity in OSAS is related to excessive daytime sleepiness.
- 2007
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Ingår i: Journal of sleep research. - : Wiley. - 0962-1105 .- 1365-2869. ; 16:3, s. 327-32
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate the relationships among sympathetic hyperactivity, excessive daytime sleepiness (EDS) and hypertension in obstructive sleep apnoea syndrome (OSAS). Ten newly diagnosed OSAS patients with untreated EDS and daytime hypertension underwent polysomnography (PSG) and daytime measurements of plasma noradrenaline (NA), ambulatory blood pressure (BP), muscle sympathetic nerve activity (MSNA) by microneurography and objective assessment of EDS before and during 6 months of compliance-monitored continuous positive airway pressure (CPAP) treatment. One month after the start of CPAP, BP, MSNA and NA were significantly lowered, remaining lower than baseline also after 3 and 6 months of treatment. CPAP use caused a significant improvement of sleep structures, and reduced EDS. A statistical correlation analysis demonstrated that EDS was not correlated with sleep measures obtained from baseline PSG (% sleep stages, apnoea and arousal index, mean oxygen saturation value), whereas daytime sleepiness was significantly correlated with MSNA. Furthermore, MSNA and BP showed no correlation. Our data obtained from selected patients suggest that the mechanisms inducing EDS in OSAS are related to the degree of daytime sympathetic hyperactivity. Additionally, resting MSNA was unrelated to BP suggesting that factors other than adrenergic neural tone make a major contribution to OSAS-related hypertension. The results obtained in this pilot study need, however, to be confirmed in a larger study involving more patients.
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| 31. |
- Donadio, Vincenzo, et al.
(författare)
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Sympathetic and cardiovascular activity during cataplexy in narcolepsy.
- 2008
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Ingår i: Journal of sleep research. - : Wiley. - 1365-2869 .- 0962-1105. ; 17:4, s. 458-63
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Tidskriftsartikel (refereegranskat)abstract
- Autonomic nervous system activity changes have been described during cataplexy as playing a role in triggering it. To confirm these previous findings, we investigated the time course of sympathetic and cardiovascular activities during cataplexy. We made for the first time microneurographic recordings of 10 cataplectic episodes in three patients with hypocretin-deficient narcolepsy. During microneurography, muscle sympathetic nerve activity (MSNA) was recorded simultaneously with heart rate (HR), respiratory movements, arterial finger blood pressure (BP), electroencephalography, electro-oculogram and superficial electromyogram. Results showed no significant autonomic changes before the onset of the cataplectic episodes. Cataplexy was associated with a significant increase in MSNA and BP compared with baseline, whereas HR was markedly decreased. An irregular breathing pattern mainly characterized by apnea typically occurred during the attacks. In conclusion, our findings did not show significant changes in autonomic activity prior to cataplexy onset, ruling out a triggering role of the autonomic system. However, cataplexy was associated with co-activation of sympathetic and parasympathetic autonomic systems, a pattern reminiscent of that reported during the vigilance reaction in animals.
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| 32. |
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| 33. |
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| 34. |
- Harder, Lena, et al.
(författare)
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Snoring during pregnancy and its relation to pre-eclampsia
- 2008
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Ingår i: Journal of Sleep Research. - : John Wiley & Sons. - 0962-1105 .- 1365-2869. ; 17:Supplements 1, s. 159-159
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Does snoring during pregnancy influence development of pre-eclampsia?Method: Five hundred and three pregnant women were presented a questionnaire concerning snoring, daytime sleepiness and edema. Epworth Sleepiness score (ESS) and symptoms of restless legs syndrome were also included. The questionnaire was presented in the 1st, 2nd and 3rd trimester and blood pressure was recorded. Women snoring often-always at visit 2 and/or 3 were denoted habitual snorers, those snoring never-seldom non-snorers and there was also a category occasional snorers. Habitual snorers were offered a sleep respiratory recording (Embletta); 34 volunteered.Results: 36/503 women (7,2%) snored habitually already at the first visit. At the end of pregnancy the fraction had increased to 19,5%. At the first visit BMI of habitual snorers was 25,3 compared to 22,9 for non-snorers (s.), but there was no difference concerning increase during pregnancy. Habitual snorers reported more edema at visit 2 and 3, higher scores in morning and daytime tiredness and ESS score compared to non-snorers at all visits (s.). Their systolic blood pressure increased more (s.) already between 1st and 2nd visit. Weight and Apgar scores of the newborns showed no difference. Pre-eclampsia developed in 18 women, twice as common among habitual snorers than in those snoring never-occasionally (n.s.). Their snoring scores were higher at all visits; the greatest difference at visit 3 (P50,058). Their diastolic pressure increased more already at the 2nd visit (s.), they had more edema and higher increase in BMI (s.). ESS and tiredness scores did not differ. 9/34 sleep recordings showed supine AHI 45. Two women who later developed pre-eclampsia were recorded; both had supine AHI 45.Conclusions: Habitual snorers had higher BMI from start, more daytime tiredness, higher ESS scores and their diastolic blood pressure increased more already during early pregnancy. Preeclampsia was twice as common among snorers as non-snorers; not significant due to the low number of cases. The relation between pre-eclampsia and snoring therefore remains elusive.
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| 40. |
- Petersen, Helena, et al.
(författare)
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Stress vulnerability and the effects of moderate daily stress on sleep polysomnography and subjective sleepiness
- 2013
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Ingår i: Journal of Sleep Research. - : Wiley. - 0962-1105 .- 1365-2869. ; 22:1, s. 50-57
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to investigate if and how sleep physiology is affected by naturally occurring high work stress and identify individual differences in the response of sleep to stress. Probable upcoming stress levels were estimated through weekly web questionnaire ratings. Based on the modified FIRST-scale (Ford insomnia response to stress) participants were grouped into high (n = 9) or low (n = 19) sensitivity to stress related sleep disturbances (Drake et al., 2004). Sleep was recorded in 28 teachers with polysomnography, sleep diaries and actigraphs during one high stress and one low stress condition in the participants home. EEG showed a decrease in sleep efficiency during the high stress condition. Significant interactions between group and condition were seen for REM sleep, arousals and stage transitions. The sensitive group had an increase in arousals and stage transitions during the high stress condition and a decrease in REM, whereas the opposite was seen in the resilient group. Diary ratings during the high stress condition showed higher bedtime stress and lower ratings on the awakening index (insufficient sleep and difficulties awakening). Ratings also showed lower cognitive function and preoccupation with work thoughts in the evening. KSS ratings of sleepiness increased during stress for the sensitive group. Saliva samples of cortisol showed no effect of stress. It was concluded that moderate daily stress is associated with a moderate negative effect on sleep sleep efficiency and fragmentation. A slightly stronger effect was seen in the sensitive group.
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| 42. |
- Tucker, P., et al.
(författare)
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Sleep quality as a mediator in the relationship between doctors' worktime control and patient safety
- 2012
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Ingår i: Journal of Sleep Research. - : Wiley-Blackwell. - 0962-1105 .- 1365-2869. ; 21:Suppl. 1, s. 273-273
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Objective: Poorer worktime control is associated with greater sleep disturbances. The fatigue that results from poor quality sleep may pose a threat job performance. Thus the current study seeks to determine whether the relationship between doctors' worktime control and their perceptions of the risk of medical error is mediated by sleep quality.Method: A representative sample of doctors in Sweden (N = 1534) completed a questionnaire about working conditions, wellbeing and patient safety (response rate 53.1%). Worktime control was measured by two items which asked respondents: (1) whether they could influence their work hours; and (2) whether they had access to flexitime (response options ‘‘yes’’, ‘‘yes, to some extent’’ and ‘‘no’’). Concerns about patient safety were measured by two items which asked respondents: (1) how much they worried about the risk of making mistakes (five response options from ‘‘no, never’’ to ‘‘yes, constantly’’); and (2) how often they felt that their workload increased the risk of malpractice (four response options from ‘‘daily’’ to ‘‘less than once a month’’). Sleep quality was measured by the Karolinska Sleep Quality Index (KSQI), calculated as the mean score of responses to four items which asked participants how often they had experienced each of the following sleep symptoms in the last three months: difficulty falling asleep, repeated awakenings with difficulty falling back to sleep, too early (final) awakening and interrupted / restless sleep (range of possible scores: 1 – Never; 5 – Always/5 times or more per week).Results: There were significant associations between both worktime control measures, both patient safety measures and scores on the KSQI. Mediation analyses (Sobel test for mediation) indicated that the associations between each worktime control measure and each patient safety measure were mediated by sleep quality (P < 0.0001 in each case).Conclusion: Worktime control allows doctors to optimise the fit between the demands of their work schedule, and their own personal needs and circumstances. In doing so, it facilitates sleep and recovery between duty periods, thereby enhancing job performance and promoting patient safety.
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| 44. |
- Abdollahi, Anna M., et al.
(författare)
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Comparison of actigraphy-measured and parent-reported sleep in association with weight status among preschool children
- 2024
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Ingår i: Journal of Sleep Research. - : John Wiley & Sons. - 0962-1105 .- 1365-2869. ; 33:1
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Tidskriftsartikel (refereegranskat)abstract
- This study compared weekday and weekend actigraphy-measured and parent-reported sleep in relation to weight status among preschool-aged children. Participants were 3–6 years old preschoolers from the cross-sectional DAGIS-study with sleep data for ≥2 weekday and ≥2 weekend nights. Parents-reported sleep onset and wake-up times were gathered alongside 24 h hip-worn actigraphy. An unsupervised Hidden-Markov Model algorithm provided actigraphy-measured night time sleep without the guidance of reported sleep times. Waist-to-height ratio and age-and-sex-specific body mass index characterised weight status. Comparison of methods were assessed with consistency in quintile divisions and Spearman correlations. Associations between sleep and weight status were assessed with adjusted regression models. Participants included 638 children (49% girls) with a mean ± SD age of 4.76 ± 0.89. On weekdays, 98%–99% of actigraphy-measured and parent-reported sleep estimates were classified in the same or adjacent quintile and were strongly correlated (rs = 0.79–0.85, p < 0.001). On weekends, 84%–98% of actigraphy-measured and parent-reported sleep estimates were respectively classified and correlations were moderate to strong (rs = 0.62–0.86, p < 0.001). Compared with actigraphy-measured sleep, parent-reported sleep had consistently earlier onset, later wake-up, and greater duration. Earlier actigraphy-measured weekday sleep onset and midpoint were associated with a higher body mass index (respective β-estimates: −0.63, p < 0.01 and −0.75, p < 0.01) and waist-to-height ratio (−0.004, p = 0.03 and −0.01, p = 0.02). Though the sleep estimation methods were consistent and correlated, actigraphy measures should be favoured as they are more objective and sensitive to identifying associations between sleep timing and weight status compared with parent reports.
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| 45. |
- Ahlström, Christer, 1977-, et al.
(författare)
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Development of sleepiness in professional truck drivers : Real‐road testing for driver drowsiness and attention warning (DDAW) system evaluation
- 2024
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Ingår i: Journal of Sleep Research. - : John Wiley & Sons. - 0962-1105 .- 1365-2869.
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Tidskriftsartikel (refereegranskat)abstract
- All new vehicle types within the European Union must now be equipped with a driver drowsiness and attention warning system starting from 2022. The specific requirements for the test procedure necessary for type approval are defined in the Annex of EU Regulation C/2021/2639. The objectives of this study were to: (i) investigate how sleepiness develops in professional truck drivers under real-road driving conditions; and (ii) assess the feasibility of a test procedure for validating driver drowsiness and attention warning systems according to the EU regulation. Twenty-four professional truck drivers participated in the test. They drove for 180 km on a dual-lane motorway, first during daytime after a normal night's sleep and then at nighttime after being awake since early morning. The results showed higher sleepiness levels during nighttime driving compared with daytime, with a faster increase in sleepiness with distance driven, especially during the night. Psychomotor vigilance task results corroborated these findings. From a driver drowsiness and attention warning testing perspective, the study design with sleep-deprived drivers at night was successful in inducing the targeted sleepiness level of a Karolinska Sleepiness Scale score of ≥ 8. Many drivers who reported a Karolinska Sleepiness Scale ≥ 8 during the drives also acknowledged feeling sleepy in the post-drive questionnaire. Reaching high levels of sleepiness on real roads during daytime is more problematic, not the least from legal and ethical perspectives as higher traffic densities during the daytime lead to increased risks.
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| 46. |
- Ahlström, Christer, 1977-, et al.
(författare)
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Local changes in the wake electroencephalogram precedes lane departures
- 2017
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Ingår i: Journal of Sleep Research. - : Blackwell Publishing. - 0962-1105 .- 1365-2869. ; 26:6, s. 816-819
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this exploratory study is to investigate if lane departures are associated with local sleep, measured via source-localized electroencephalography (EEG) theta power in the 5-9 Hz frequency range. Thirty participants drove in an advanced driving simulator, resulting in 135 lane departures at high levels of self-reported sleepiness. These lane departures were compared to matching non-departures at the same sleepiness level within the same individual. There was no correspondence between lane departures and global theta activity. However, at the local level an increased risk for lane departures was associated with increased theta content in brain regions related to motor function.
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| 47. |
- Ahlström, Christer, 1977-, et al.
(författare)
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The effect of daylight versus darkness on driver sleepiness : A driving simulator study
- 2018
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Ingår i: Journal of Sleep Research. - : Wiley-Blackwell Publishing Inc.. - 0962-1105 .- 1365-2869. ; 27:3
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Tidskriftsartikel (refereegranskat)abstract
- Driver sleepiness studies are often carried out with alert drivers during daytime and sleep-deprived drivers during night-time. This design results in a mixture of different factors (e.g. circadian effects, homeostatic effects, light conditions) that may confound the results. The aim of this study was to investigate the effect of light conditions on driver sleepiness. Thirty young male drivers (23.6 ± 1.7 years old) participated in a driving simulator experiment where they drove on a rural road. A 2 × 2 design was used with the conditions daylight versus darkness, and daytime (full sleep) versus night-time (sleep deprived). The results show that light condition had an independent effect on the sleepiness variables. The subjective sleepiness measured by Karolinska Sleepiness Scale was higher, lateral position more left-oriented, speed lower, electroencephalogram alpha and theta higher, and blink durations were longer during darkness. The number of line crossings did not change significantly with light condition. The day/night condition had profound effects on most sleepiness indicators while controlling for light condition. The number of line crossings was higher during night driving, Karolinska Sleepiness Scale was higher, blink durations were longer and speed was lower. There were no significant interactions, indicating that light conditions have an additive effect on sleepiness. In conclusion, Karolinska Sleepiness Scale and blink durations increase primarily with sleep deprivation, but also as an effect of darkness. Line crossings are mainly driven by the need for sleep and the reduced alertness at the circadian nadir. Lane position is, however, more determined by light conditions than by sleepiness.
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| 48. |
- Ahlström, Christer, 1977-, et al.
(författare)
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The impact of driver sleepiness on fixation-related brain potentials
- 2020
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Ingår i: Journal of Sleep Research. - : Wiley. - 0962-1105 .- 1365-2869. ; 29:5
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Tidskriftsartikel (refereegranskat)abstract
- The effects of driver sleepiness are often quantified as deteriorated driving performance, increased blink durations and high levels of subjective sleepiness. Driver sleepiness has also been associated with increasing levels of electroencephalogram (EEG) power, especially in the alpha range. The present exploratory study investigated a new measure of driver sleepiness, the EEG fixation-related lambda response. Thirty young male drivers (23.6 +/- 1.7 years old) participated in a driving simulator experiment in which they drove on rural and suburban roads in simulated daylight versus darkness during both the daytime (full sleep) and night-time (sleep deprived). The results show lower lambda responses during night driving and with longer time on task, indicating that sleep deprivation and time on task cause a general decrement in cortical responsiveness to incoming visual stimuli. Levels of subjective sleepiness and line crossings were higher under the same conditions. Furthermore, results of a linear mixed-effects model showed that low lambda responses are associated with high subjective sleepiness and more line crossings. We suggest that the fixation-related lambda response can be used to investigate driving impairment induced by sleep deprivation while driving and that, after further refinement, it may be useful as an objective measure of driver sleepiness.
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| 49. |
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| 50. |
- Ahonen, Hanna, et al.
(författare)
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"The terrible dryness woke me up, I had some trouble breathing"-Critical situations related to oral health as described by CPAP-treated persons with obstructive sleep apnea
- 2022
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Ingår i: Journal of Sleep Research. - : John Wiley & Sons. - 0962-1105 .- 1365-2869. ; 31:6
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Tidskriftsartikel (refereegranskat)abstract
- Continuous positive airway pressure is a common and effective treatment for obstructive sleep apnea, but adherence remains an issue. Both obstructive sleep apnea and oral diseases are associated with cardiovascular diseases, and as oral dryness contributes to treatment abandonment, oral health is of importance for this patient group. The aim was therefore to explore how persons with continuous positive airway pressure-treated obstructive sleep apnea experience situations associated with their oral health, and which actions they take to manage these. An explorative and descriptive design was adopted using the critical incident technique. Based on a purposeful selection, 18 adults with long-term experience of continuous positive airway pressure-treatment were interviewed using a semi-structured interview guide. Both negative and positive situations were described. Negative situations consisted of challenges with breathing, including mouth-breathing, choking sensations, problems with night-time and daytime oral dryness, changes in the saliva composition, and deteriorating oral health. Positive situations included experiences of reduced mouth-breathing and oral dryness. The situations were often successfully managed by mimicking daytime movements, changing sleeping position, adjusting the CPAP-device and mask, increasing oral hygiene efforts, drinking water, using a humidifier or chinstrap, or contacting their oral healthcare clinic. Long-term experience of persons with continuous positive airway pressure-treated obstructive sleep apnea regard situations and actions from everyday life. Successful management can contribute to long-term adherence and decrease negative effects on oral health. More interdisciplinary collaborations could enable identification and adequate recommendations for persons who experience negative situations during their continuous positive airway pressure treatment.
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