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1.
  • Karimi, Mahssa, et al. (author)
  • Increased neck soft tissue mass and worsening of obstructive sleep apnoea after growth hormone treatment in men with abdominal obesity : Growth hormone and obstructive sleep apnoea in abdominally obese men
  • 2010
  • In: Journal of Clinical Sleep Medicine. - 1550-9389. ; 6:3, s. 256-263
  • Journal article (peer-reviewed)abstract
    • Background Risk factors for obstructive sleep apnea (OSA) are male gender, obesity and abnormalities in neck soft tissue mass. OSA is associated with both growth hormone (GH) excess and severe GH deficiency in adults. Adults with abdominal obesity have markedly suppressed GH secretion. Aim To study the effect of GH treatment on OSA in abdominally obese men with impaired glucose tolerance. Patients and Methods Forty men with abdominal obesity and glucose intolerance were randomized in a prospective, 12-month, double-blind trial to receive either GH or placebo. The treatment groups had similar BMI and waist circumference. Overnight polysomnography and computed tomography to assess muscle and fat distribution in the neck and abdomen were performed at baseline and after 12 months. Results GH treatment increased insulin-like growth-factor-1 from (mean (SD)) 168(17) to 292(28) μg/L, the apnea-hypopnea index from (n/h) 31(20) to 43(25) and oxygen-desaturation index from (n/h) 18(14) to 29(21) (p=0.0001, 0.001, 0.002). Neck transverse diameter, circumference and total cross-sectional area (p=0.007, 0.01, 0.02) increased while abdominal visceral adipose tissue (p=0.007) was reduced. No between-group differences in total sleep time, REM sleep, non-REM sleep and time spent in supine position were found. The Epworth sleepiness scale score was unchanged. Conclusions GH treatment increased the severity of OSA in abdominally obese men. The possible mechanism appears to be reflected by the GH-induced increase of measures of neck volume. The present results, to some extent, argue against that low GH/IGF-I activity is a primary cause of OSA in abdominally obese men.
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2.
  • Kobayashi Frisk, Mio, et al. (author)
  • Eveningness is associated with sedentary behavior and increased 10-year risk of cardiovascular disease: the SCAPIS pilot cohort
  • 2022
  • In: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 12:1
  • Journal article (peer-reviewed)abstract
    • Chronotype reflects individual preferences for timing activities throughout the day, determined by the circadian system, environment and behavior. The relationship between chronotype, physical activity, and cardiovascular health has not been established. We studied the association between chronotype, physical activity patterns, and an estimated 10-year risk of first-onset cardiovascular disease (CVD) in the Swedish CArdioPulmonary bioImage Study (SCAPIS) pilot cohort. A cross-sectional analysis was performed in a middle-aged population (n = 812, 48% male). Self-assessed chronotype was classified as extreme morning, moderate morning, intermediate, moderate evening, or extreme evening. Time spent sedentary (SED) and in moderate to vigorous physical activity (MVPA) were derived from hip accelerometer. The newly introduced Systematic COronary Risk Evaluation 2 (SCORE2) model was used to estimate CVD risk based on gender, age, smoking status, systolic blood pressure, and non-HDL cholesterol. Extreme evening chronotypes exhibited the most sedentary lifestyle and least MVPA (55.3 +/- 10.2 and 5.3 +/- 2.9% of wear-time, respectively), with a dose-dependent relationship between chronotype and SED/MVPA (p < 0.001 and p = 0.001, respectively). In a multivariate generalized linear regression model, extreme evening chronotype was associated with increased SCORE2 risk compared to extreme morning type independent of confounders (beta = 0.45, SE = 0.21, p = 0.031). Mediation analysis indicated SED was a significant mediator of the relationship between chronotype and SCORE2. Evening chronotype is associated with unhealthier physical activity patterns and poorer cardiovascular health compared to morning chronotype. Chronotype should be considered in lifestyle counseling and primary prevention programs as a potential modifiable risk factor.
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3.
  • Lombardi, C., et al. (author)
  • Periodic limb movements during sleep and blood pressure changes in sleep apnoea: Data from the European Sleep Apnoea Database
  • 2020
  • In: Respirology. - : Wiley. - 1323-7799 .- 1440-1843. ; 25:8, s. 872-879
  • Journal article (peer-reviewed)abstract
    • Background and objective OSA and PLMS are known to induce acute BP swings during sleep. Our current study aimed to address the independent effect of PLMS on BP in an unselected OSA patient cohort. Methods This cross‐sectional analysis included 1487 patients (1110 males, no previous hypertension diagnosis or treatment, mean age: 52.5years, mean BMI: 30.5kg/m2) with significant OSA (defined as AHI≥10) recruited from the European Sleep Apnoea Cohort. Patients underwent overnight PSG. Patients were stratified into two groups: patients with significant PLMS (PLMSI>25 events/hour of sleep) and patients without significant PLMS (PLMSI<25 events/hour of sleep). SBP, DBP and PP were the variables of interest. For each of these, a multivariate regression linear model was fitted to evaluate the relationship between PLMS and outcome adjusting for sociodemographic and clinical covariates (gender, age, BMI, AHI, ESS, diabetes, smoking and sleep efficiency). Results The univariate analysis of SBP showed an increment of BP equal to 4.70mm Hg (P<0.001) in patients with significant PLMS compared to patients without significant PLMS. This increment remained significant after implementing a multivariate regression model (2.64mm Hg, P = 0.044). No significant increment of BP was observed for DBP and PP. Conclusion PLMS is associated with a rise in SBP regardless of AHI, independent of clinical and sociodemographic confounders. A PLMS phenotype may carry an increased risk for cardiovascular disease in OSA patients.
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4.
  • Peker, Yüksel, 1961, et al. (author)
  • Sleep apnoea and quality of life in growth hormone (GH)-deficient adults before and after 6 months of GH replacement therapy
  • 2006
  • In: Clin Endocrinol (Oxf).. - : Wiley. ; 65:1
  • Journal article (peer-reviewed)abstract
    • OBJECTIVE: To investigate the sleep architecture and breathing as well as quality of life (QoL) in adults with GH deficiency (GHD) before and 6 months after GH replacement therapy. DESIGN: A prospective observational study. PATIENTS: Nineteen consecutive adults with GHD (11 men, eight women; mean age 53, range 21-73 years) were studied. MEASUREMENTS: An overnight sleep study was performed and the Minor Symptom Evaluation Profile (MSEP), Functional Outcome of Sleep Questionnaire (FOSQ), Short Form 36 (SF-36) and Epworth Sleepiness Scale (ESS) questionnaires were applied at baseline and after the treatment period. RESULTS: For the whole group, there were no significant changes in mean total sleep time (TST; 370 min vs. 374 min), proportion of slow-wave sleep (SWS; 17.8%vs. 18.4%) and rapid eye movement (REM) sleep (12.1%vs. 13.9%) on GH replacement. Mean apnoea-hypopnoea index (AHI) was high and remained unchanged (28.2/h before vs. 28.0/h following GH replacement). Twelve patients (63%) were found to have obstructive sleep apnoea (OSA; AHI >or= 10/h) at baseline. Compared with GH-deficient patients without OSA (AHI 3.9/h), the OSA patients (AHI 42.4/h) had less SWS (11.4%vs. 28.6%, P = 0.010) and REM sleep (10.1%vs. 15.5%, P = 0.036). A marginal increase was observed in REM sleep time (10.1% before vs. 12.7% after GH; P = 0.048) while SWS was unchanged in this group. Moreover, MSEP for General Well-being and Responsiveness, FOSQ scores for General Productivity, Activity Level and Vigilance as well as SF-36 domains for Vitality and Mental Health were improved. CONCLUSIONS: Contrary to some previous observations in a smaller group of patients, our data suggest that GH therapy does not induce or aggravate OSA in GH-deficient adults. Moreover, GH therapy may improve some of the QoL dimensions in these patients.
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5.
  • Zou, Ding, 1970, et al. (author)
  • Insomnia and cardiorespiratory fitness in a middle-aged population : the SCAPIS pilot study.
  • 2019
  • In: Sleep and Breathing. - : Springer. - 1520-9512 .- 1522-1709. ; 23:1, s. 319-326
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: The relationship between insomnia and cardiorespiratory fitness (CRF), a well-established risk factor for cardiovascular disease, has not been extensively studied. We aimed to assess the independent association between insomnia and CRF in a population-based cohort of subjects aged 50 to 64 years.METHODS: Subjects participating in the Swedish CArdioPulmonary bioImaging Study (SCAPIS) pilot cohort (n = 603, men 47.9%) underwent a submaximal cycle ergometer test for estimation of maximal oxygen consumption (VO2max). Data on physical activity and sedentary time were collected via waist-worn accelerometers. An insomnia severity index score ≥ 10 was used to define insomnia.RESULTS: Insomnia was identified in 31.8% of the population. The VO2max was significantly lower in insomnia subjects compared with the non-insomnia group (31.2 ± 6.3 vs. 32.4 ± 6.5 ml* kg-1 *min-1, p = 0.028). There was no difference in objectively assessed physical activity or time spent sedentary between the groups. In a multivariate generalized linear model adjusting for confounders, an independent association between insomnia status and lower VO2max was found in men, but not in women (β = - 1.15 [95% CI - 2.23-- 0.06] and - 0.09 [- 1.09-0.92], p = 0.038 and 0.866, respectively).CONCLUSIONS: We found a modest, but significant, association between insomnia and lower CRF in middle-aged men, but not in women. Our results suggest that insomnia may link to cardiovascular disease via reduced CRF. Insomnia may require a specific focus in the context of health campaigns addressing CRF.
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7.
  • Alonderis, A, et al. (author)
  • Medico-legal implications of sleep apnoea syndrome: Driving license regulations in Europe.
  • 2008
  • In: Sleep medicine. - : Elsevier BV. - 1389-9457 .- 1878-5506. ; 9:4, s. 362-75
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Sleep apnoea syndrome (SAS), one of the main medical causes of excessive daytime sleepiness, has been shown to be a risk factor for traffic accidents. Treating SAS results in a normalized rate of traffic accidents. As part of the COST Action B-26, we looked at driving license regulations, and especially at its medical aspects in the European region. METHODS: We obtained data from Transport Authorities in 25 countries (Austria, AT; Belgium, BE; Czech Republic, CZ; Denmark, DK; Estonia, EE; Finland, FI; France, FR; Germany, DE; Greece, GR; Hungary, HU; Ireland, IE; Italy, IT; Lithuania, LT; Luxembourg, LU; Malta, MT; Netherlands, NL; Norway, EC; Poland, PL; Portugal, PT; Slovakia, SK; Slovenia, SI; Spain, ES; Sweden, SE; Switzerland, CH; United Kingdom, UK). RESULTS: Driving license regulations date from 1997 onwards. Excessive daytime sleepiness is mentioned in nine, whereas sleep apnoea syndrome is mentioned in 10 countries. A patient with untreated sleep apnoea is always considered unfit to drive. To recover the driving capacity, seven countries rely on a physician's medical certificate based on symptom control and compliance with therapy, whereas in two countries it is up to the patient to decide (on his doctor's advice) to drive again. Only FR requires a normalized electroencephalography (EEG)-based Maintenance of Wakefulness Test for professional drivers. Rare conditions (e.g., narcolepsy) are considered a driving safety risk more frequently than sleep apnoea syndrome. CONCLUSION: Despite the available scientific evidence, most countries in Europe do not include sleep apnoea syndrome or excessive daytime sleepiness among the specific medical conditions to be considered when judging whether or not a person is fit to drive. A unified European Directive seems desirable.
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8.
  • Arnardottir, E. S., et al. (author)
  • The Sleep Revolution project: the concept and objectives
  • 2022
  • In: Journal of Sleep Research. - : Wiley. - 0962-1105 .- 1365-2869. ; 31:4
  • Journal article (peer-reviewed)abstract
    • Obstructive sleep apnea is linked to severe health consequences such as hypertension, daytime sleepiness, and cardiovascular disease. Nearly a billion people are estimated to have obstructive sleep apnea with a substantial economic burden. However, the current diagnostic parameter of obstructive sleep apnea, the apnea-hypopnea index, correlates poorly with related comorbidities and symptoms. Obstructive sleep apnea severity is measured by counting respiratory events, while other physiologically relevant consequences are ignored. Furthermore, as the clinical methods for analysing polysomnographic signals are outdated, laborious, and expensive, most patients with obstructive sleep apnea remain undiagnosed. Therefore, more personalised diagnostic approaches are urgently needed. The Sleep Revolution, funded by the European Union's Horizon 2020 Research and Innovation Programme, aims to tackle these shortcomings by developing machine learning tools to better estimate obstructive sleep apnea severity and phenotypes. This allows for improved personalised treatment options, including increased patient participation. Also, implementing these tools will alleviate the costs and increase the availability of sleep studies by decreasing manual scoring labour. Finally, the project aims to design a digital platform that functions as a bridge between researchers, patients, and clinicians, with an electronic sleep diary, objective cognitive tests, and questionnaires in a mobile application. These ambitious goals will be achieved through extensive collaboration between 39 centres, including expertise from sleep medicine, computer science, and industry and by utilising tens of thousands of retrospectively and prospectively collected sleep recordings. With the commitment of the European Sleep Research Society and Assembly of National Sleep Societies, the Sleep Revolution has the unique possibility to create new standardised guidelines for sleep medicine.
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9.
  • Arnardottir, E. S., et al. (author)
  • Variability in recording and scoring of respiratory events during sleep in Europe: a need for uniform standards
  • 2016
  • In: Journal of Sleep Research. - : Wiley. - 0962-1105. ; 25:2, s. 144-157
  • Journal article (peer-reviewed)abstract
    • Uniform standards for the recording and scoring of respiratory events during sleep are lacking in Europe, although many centres follow the published recommendations of the American Academy of Sleep Medicine. The aim of this study was to assess the practice for the diagnosis of sleep-disordered breathing throughout Europe. A specially developed questionnaire was sent to representatives of the 31 national sleep societies in the Assembly of National Sleep Societies of the European Sleep Research Society, and a total of 29 countries completed the questionnaire. Polysomnography was considered the primary diagnostic method for sleep apnea diagnosis in 10 (34.5%), whereas polygraphy was used primarily in six (20.7%) European countries. In the remaining 13 countries (44.8%), no preferred methodology was used. Fifteen countries (51.7%) had developed some type of national uniform standards, but these standards varied significantly in terms of scoring criteria, device specifications and quality assurance procedures between countries. Only five countries (17.2%) had published these standards. Most respondents supported the development of uniform recording and scoring criteria for Europe, which might be based partly on the existing American Academy of Sleep Medicine rules, but also take into account differences in European practice when compared to North America. This survey highlights the current varying approaches to the assessment of patients with sleep-disordered breathing throughout Europe and supports the need for the development of practice parameters in the assessment of such patients that would be suited to European clinical practice.
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10.
  • Basoglu, Ozen K, et al. (author)
  • Change in weight and central obesity by positive airway pressure treatment in obstructive sleep apnea patients: longitudinal data from the ESADA cohort.
  • 2018
  • In: Journal of sleep research. - : Wiley. - 1365-2869 .- 0962-1105. ; 27:6
  • Journal article (peer-reviewed)abstract
    • The effect of positive airway pressure treatment on weight and markers of central obesity in patients with obstructive sleep apnea remains unclear. We studied the change in body weight and anthropometric measures following positive airway pressure treatment in a large clinical cohort. Patients with obstructive sleep apnea with positive airway pressure treatment from the European Sleep Apnea Database registry (n=1,415, 77% male, age 54±11 [mean±SD] years, body mass index 31.7±6.4kg/m2 , apnea-hypopnea index 37±24n per hr, Epworth Sleepiness Scale 10.2±5.0) were selected. Changes in body mass index and neck/waist/hip circumferences at baseline and at follow-up visit were analysed. Overall, body mass index (0.0 [95% confidence interval, -0.1 to 0.2]kg/m2 ) and neck circumference (0.0 (95% confidence interval, -0.1 to 0.1]cm) were unchanged after positive airway pressure treatment compared with baseline (follow-up duration 1.1±1.0years and compliance 5.2±2.1hr per day). However, in non-obese (body mass index <30kg/m2 ) patients, positive airway pressure treatment was associated with an increased body mass index and waist circumference (0.4 [0.3-0.5]kg/m2 and 0.8 [0.4-1.2]cm, respectively, all p<0.05), and weight gain was significantly associated with higher positive airway pressure compliance and longer positive airway pressure treatment duration. In the obese subgroup, body mass index was reduced after positive airway pressure treatment (-0.3 [-0.5 to -0.1]kg/m2 , p<0.05) mainly in patients with a strong reduction in Epworth Sleepiness Scale. In conclusion, positive airway pressure therapy was not found to systematically change body mass index in the European Sleep Apnea Database cohort, but the response was heterogeneous. Our findings suggest that weight gain may be restricted to an obstructive sleep apnea phenotype without established obesity. Lifestyle intervention needs to be considered in both lean and obese patients with obstructive sleep apnea receiving positive airway pressure treatment.
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11.
  • Becker, H. F., et al. (author)
  • Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea
  • 2003
  • In: Circulation. ; 107:1
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: There is increasing evidence that obstructive sleep apnea (OSA) is an independent risk factor for arterial hypertension. Because there are no controlled studies showing a substantial effect of nasal continuous positive airway pressure (nCPAP) therapy on hypertension in OSA, the impact of treatment on cardiovascular sequelae has been questioned altogether. Therefore, we studied the effect of nCPAP on arterial hypertension in patients with OSA. METHODS AND RESULTS: Sixty consecutive patients with moderate to severe OSA were randomly assigned to either effective or subtherapeutic nCPAP for 9 weeks on average. Nocturnal polysomnography and continuous noninvasive blood pressure recording for 19 hours was performed before and with treatment. Thirty two patients, 16 in each group, completed the study. Apneas and hypopneas were reduced by approximately 95% and 50% in the therapeutic and subtherapeutic groups, respectively. Mean arterial blood pressure decreased by 9.9+/-11.4 mm Hg with effective nCPAP treatment, whereas no relevant change occurred with subtherapeutic nCPAP (P=0.01). Mean, diastolic, and systolic blood pressures all decreased significantly by approximately 10 mm Hg, both at night and during the day. CONCLUSIONS: Effective nCPAP treatment in patients with moderate to severe OSA leads to a substantial reduction in both day and night arterial blood pressure. The fact that a 50% reduction in the apnea-hypopnea index did not result in a decrease in blood pressure emphasizes the importance of highly effective treatment. The drop in mean blood pressure by 10 mm Hg would be predicted to reduce coronary heart disease event risk by 37% and stroke risk by 56%.
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12.
  • Bengtsson Boström, Kristina, et al. (author)
  • Interaction between the angiotensin-converting enzyme gene insertion/deletion polymorphism and obstructive sleep apnoea as a mechanism for hypertension
  • 2007
  • In: J Hypertens. - 0263-6352. ; 25:4, s. 779-783
  • Journal article (peer-reviewed)abstract
    • OBJECTIVE: Obstructive sleep apnoea (OSA) confers a risk of hypertension and cardiovascular complications. Both the renin-angiotensin-aldosterone system and OSA are important determinants of blood pressure, but it is not fully known how they interact. The aim of this study was to explore the interaction between the angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism and OSA in the association with hypertension. DESIGN: A community-based, case-control design with hypertensive patients in primary care (n = 157) and normotensive population controls (n = 181). METHODS: All subjects underwent ambulatory polysomnography during one night. OSA was defined by a minimum of 10 apnoea/hypopnoea events per hour. Office blood pressure was measured and hypertension status was assessed. The genotypes were determined using polymerase chain reaction. RESULTS: An interaction analysis including sex, ACE I/D polymorphism (DD and ID versus II), and OSA identified a significant interaction between OSA and the ACE I/D polymorphism: odds ratio (OR) 6.3, 95% confidence interval (CI) 1.8-22.5, P = 0.004 as well as between OSA and sex: OR 3.3, 95% CI 1.1-9.6, P = 0.033. OSA was significantly associated with hypertension in men but not in women. CONCLUSION: The interaction between the ACE gene I/D polymorphism and OSA appears to be an important mechanism in the development of hypertension, particularly in men.
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13.
  • Bengtsson, Caroline, et al. (author)
  • Nasal polyposis is a risk factor for nonadherence to CPAP treatment in sleep apnea: the population-based DISCOVERY study
  • 2023
  • In: JOURNAL OF CLINICAL SLEEP MEDICINE. - : American Academy of Sleep Medicine (AASM). - 1550-9389 .- 1550-9397. ; 19:3, s. 573-579
  • Journal article (peer-reviewed)abstract
    • Study Objectives: The aim was to evaluate nasal polyposis as a risk factor for nonadherence to continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnea (OSA). Methods: This was a population-based, longitudinal analysis of patients starting CPAP treatment for OSA in the Swedish quality registry Swedevox between 2010 and 2018. Data were cross-linked with national registries. The impact of nasal polyposis on CPAP adherence was analyzed using uni-and multivariable logistic and linear regression models. Relevant confounders (age, sex, usage of nasal and oral steroids) were identified using a direct acyclic graph. Results: Of 20,521 patients with OSA on CPAP treatment (29.5% females), 331 (1.6%) had a diagnosis of nasal polyposis at baseline. At the 1-year follow-up, nasal polyposis was associated with an increased risk of CPAP usage < 4 hours/night (unadjusted odds ratio [OR] 1.21; 95% confidence interval [CI] 0.95-1.55); adjusted OR 1.38; 95% CI 1.08-1.77). In this group, unadjusted nocturnal mean CPAP usage was 15.4 minutes (95% CI-31.62 to 0.83) shorter and was an adjusted 24.1 minutes (95% CI-40.6 to-7.7) shorter compared with patients with OSA without nasal polyposis. Conclusions: Nasal polyposis is associated with reduced CPAP usage per night. These results highlight the importance of diagnosing nasal polyposis in patients with OSA before the start of CPAP treatment. Treatment of the condition may improve adherence, efficacy, and patient outcomes.
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14.
  • Bikov, A., et al. (author)
  • The relationship between periodic limb movement during sleep and dyslipidaemia in patients with obstructive sleep apnea
  • 2024
  • In: Journal of Sleep Research. - 0962-1105 .- 1365-2869. ; 33:2
  • Journal article (peer-reviewed)abstract
    • Periodic limb movements during sleep and obstructive sleep apnea are both associated with increased sympathetic tone, and have been proposed as risk factors for heart diseases and, in particular, cardiovascular disease. As sympathetic system activation may lead to dyslipidaemia, periodic limb movements during sleep could be an additional risk factor for cardiovascular disease in patients with obstructive sleep apnea. The aim of the study was to determine whether the presence of periodic limb movements during sleep affects serum lipid levels in obstructive sleep apnea. Total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, non- high-density lipoprotein cholesterol and triglyceride levels were investigated in 4138 patients with obstructive sleep apnea in the European Sleep Apnea Database (ESADA) cohort, divided into those with periodic limb movements during sleep index & GE; 15 per hr (n = 628) and controls (n = 3510). ANCOVA adjusted for age, sex, body mass index, apnea-hypopnea index, alcohol intake, smoking status, diabetes, insomnia and study site was used to assess differences in lipids between periodic limb movements during sleep and controls. Patients with periodic limb movements during sleep (24% female, 54.4 & PLUSMN; 12.1 years, body mass index 31.9 & PLUSMN; 5.8 kg m(-2), apnea-hypopnea index 36.7 & PLUSMN; 25.4 per hr) had higher triglyceride (1.81 & PLUSMN; 1.04 versus 1.69 & PLUSMN; 0.90 mmol L-1, p = 0.002) and lower high-density lipoprotein cholesterol (1.19 & PLUSMN; 0.34 versus 1.24 & PLUSMN; 0.37 mmol L-1, p = 0.002) levels, whilst there was no difference in either total cholesterol (4.98 & PLUSMN; 1.10 versus 4.94 & PLUSMN; 1.07 mmol L-1), low-density lipoprotein cholesterol (3.04 & PLUSMN; 0.96 versus 2.98 & PLUSMN; 0.98 mmol L-1) or non- high-density lipoprotein cholesterol (3.78 & PLUSMN; 1.10 versus 3.70 & PLUSMN; 1.05 mmol L-1) concentrations (all p > 0.05). The results remained unchanged after most sensitivity analyses. Patients with obstructive sleep apnea with periodic limb movements during sleep had more prevalent cardiovascular disease (11% versus 6%, p < 0.01). Periodic limb movements during sleep in obstructive sleep apnea is associated with dyslipidaemia independently of important confounders. Our results highlight periodic limb movements during sleep as an additional risk factor for cardiovascular disease in obstructive sleep apnea.
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15.
  • Biselli, P. J. C., et al. (author)
  • Nasal high-flow therapy reduces work of breathing compared with oxygen during sleep in COPD and smoking controls: a prospective observational study
  • 2017
  • In: Journal of Applied Physiology. - : American Physiological Society. - 8750-7587 .- 1522-1601. ; 122:1, s. 82-88
  • Journal article (peer-reviewed)abstract
    • Patients with chronic obstructive pulmonary disease (COPD) endure excessive resistive and elastic loads leading to chronic respiratory failure. Oxygen supplementation corrects hypoxemia but is not expected to reduce mechanical loads. Nasal high-flow (NHF) therapy supports breathing by reducing dead space, but it is unclear how it affects mechanical loads of patients with COPD. The objective of this study was to compare the effects of low-flow oxygen and NHF therapy on ventilation and work of breathing (WOB) in patients with COPD and controls during sleep. Patients with COPD (n = 12) and controls (n = 6) were recruited and submitted to polysomnography to measure sleep parameters and ventilation in response to administration of oxygen and NHF. A subset of six patients also had an esophageal catheter inserted for the purpose of measuring WOB. Patients with COPD had similar minute ventilation (V-E) but lower tidal volumes than matched controls. With oxygen, SaO(2) was increased and V-E was reduced in both controls and patients with COPD, but there was an increase in transcutaneous CO2 levels. NHF produced a greater reduction in V-E and was associated with a reduction in CO2 levels. Although NHF halved WOB, oxygen produced only a minor reduction in this parameter. We conclude that oxygen produced little change in WOB, which was associated with CO2 elevations. On the other hand, NHF produced a large reduction in V-E and WOB with a concomitant decrease in CO2 levels. Our data indicate that NHF improves alveolar ventilation during sleep compared with oxygen and room air in patients with COPD and therefore can decrease their cost of breathing. NEW & NOTEWORTHY Nasal high-flow (NHF) therapy can support ventilation in patients with chronic obstructive pulmonary disease during sleep by decreasing the work of breathing and improving CO2 levels. On the other hand, oxygen supplementation corrects hypoxemia, but it produces only a minimal reduction in work of breathing and is associated with increased CO2 levels. Therefore, NHF can be a useful method to assist ventilation in patients with increased respiratory mechanical loads.
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16.
  • Biselli, P., et al. (author)
  • Reductions in dead space ventilation with nasal high flow depend on physiological dead space volume: metabolic hood measurements during sleep in patients with COPD and controls
  • 2018
  • In: European Respiratory Journal. - : European Respiratory Society (ERS). - 0903-1936 .- 1399-3003. ; 51:5
  • Journal article (peer-reviewed)abstract
    • Nasal high flow (NHF) reduces minute ventilation and ventilatory loads during sleep but the mechanisms are not clear. We hypothesised NHF reduces ventilation in proportion to physiological but not anatomical dead space. 11 subjects (five controls and six chronic obstructive pulmonary disease (COPD) patients) underwent polysomnography with transcutaneous carbon dioxide (CO2) monitoring under a metabolic hood. During stable non-rapid eye movement stage 2 sleep, subjects received NHF (20 L center dot min(-1)) intermittently for periods of 5-10 min. We measured CO2 production and calculated dead space ventilation. Controls and COPD patients responded similarly to NHF. NHF reduced minute ventilation (from 5.6 +/- 0.4 to 4.8 +/- 0.4 L center dot min(-1); p< 0.05) and tidal volume (from 0.34 +/- 0.03 to 0.3 +/- 0.03 L; p< 0.05) without a change in energy expenditure, transcutaneous CO2 or alveolar ventilation. There was a significant decrease in dead space ventilation (from 2.5 +/- 0.4 to 1.6 +/- 0.4 L center dot min(-1); p< 0.05), but not in respiratory rate. The reduction in dead space ventilation correlated with baseline physiological dead space fraction (r(2)=0.36; p< 0.05), but not with respiratory rate or anatomical dead space volume. During sleep, NHF decreases minute ventilation due to an overall reduction in dead space ventilation in proportion to the extent of baseline physiological dead space fraction.
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17.
  • Bonsignore, M. R., et al. (author)
  • Clinical presentation of patients with suspected obstructive sleep apnea and self-reported physician-diagnosed asthma in the ESADA cohort
  • 2018
  • In: Journal of Sleep Research. - : Wiley. - 0962-1105 .- 1365-2869. ; 27:6
  • Journal article (peer-reviewed)abstract
    • Obstructive sleep apnea (OSA) and asthma are often associated and several studies suggest a bidirectional relationship between asthma and OSA. This study analyzed the characteristics of patients with suspected OSA from the European Sleep Apnea Database according to presence/absence of physician-diagnosed asthma. Cross-sectional data in 16,236 patients (29.1% female) referred for suspected OSA were analyzed according to occurrence of physician-diagnosed asthma for anthropometrics, OSA severity and sleepiness. Sleep structure was assessed in patients studied by polysomnography (i.e. 48% of the sample). The prevalence of physician-diagnosed asthma in the entire cohort was 4.8% (7.9% in women, 3.7% in men, p < 0.0001), and decreased from subjects without OSA to patients with mild-moderate and severe OSA (p = 0.02). Obesity was highly prevalent in asthmatic women, whereas BMI distribution was similar in men with and without physician-diagnosed asthma. Distribution of OSA severity was similar in patients with and without physician-diagnosed asthma, and unaffected by treatment for asthma or gastroesophageal reflux. Asthma was associated with poor sleep quality and sleepiness. Physician-diagnosed asthma was less common in a sleep clinic population than expected from the results of studies in the general population. Obesity appears as the major factor raising suspicion of OSA in asthmatic women, whereas complaints of poor sleep quality were the likely reason for referral in asthmatic men.
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18.
  • Bonsignore, M. R., et al. (author)
  • Excessive Daytime Sleepiness in Obstructive Sleep Apnea Patients Treated With Continuous Positive Airway Pressure: Data From the European Sleep Apnea Database
  • 2021
  • In: Frontiers in Neurology. - : Frontiers Media SA. - 1664-2295. ; 12
  • Journal article (peer-reviewed)abstract
    • follow-up visit after 4 months to 2 years. The change in ESS (n = 2,190) was weakly correlated with CPAP use (R2 = 0.023, p 0.0001). Logistic regression showed that an ESS score 10 at the first follow-up visit was associated directly with ESS at baseline and inversely with duration of follow-up, and CPAP use (R2 of the model: 0.417). EDS showed heterogeneity in different European countries both at baseline and at the first follow-up visit, suggesting modulation by cultural and lifestyle factors. In conclusion, residual EDS in CPAP-treated OSA occurred in approximately one in four patients at follow-up; its prevalence was highest (40%) in the first 3 months of treatment and subsequently decreased. The finding of residual EDS in a significant percentage of optimally treated OSA patients suggests that wake-promoting agents may be useful, but their indication should be evaluated after at least 3 months of treatment.
  •  
19.
  • Boström, Kristina Bengtsson, et al. (author)
  • Polymorphisms in alpha - and betaadrenergic receptor genes, hypertension and obstructive sleep apnea. The Skaraborg Sleep Study. J Hypertension
  • 2010
  • In: International Journal of Hypertension. - 2090-0392. ; 2010:Art ID 458410
  • Journal article (peer-reviewed)abstract
    • The sympathetic nervous system and the adrenergic receptors play an important role in regulation of blood pressure. This study explored the associations between functional polymorphisms of the α(2B)-, β(1)-, and β(2)-adrenergic receptor genes and obstructive sleep apnea (OSA) in hypertensive patients and hypertension in patients with OSA in a populationbased sample of 157 hypertensive patients and 181 healthy control subjects. Only the Arg389Gly polymorphism of the β(1)-adrenergic receptor gene was associated with increased risk for mild OSA in hypertensive patients (Arg/Arg versus Gly/Arg/Gly/Gly, 2.1, 95% CI, 1.02-4.7). Hypertensive men carrying the Arg389Arg genotype had higher crude and age-adjusted AHI than carriers of the Arg389Gly/Gly389Gly genotypes. When adjusted also for BMI this difference became borderline significant. This difference was not observed in women. The risk of hypertension in mild OSA was associated with increasing number of Arg-alleles (Arg/Arg OR 5.4, 95% CI 1.4-21.2).
  •  
20.
  • Bouloukaki, I., et al. (author)
  • Mild obstructive sleep apnea increases hypertension risk, challenging traditional severity classification
  • 2020
  • In: Journal of Clinical Sleep Medicine. - : American Academy of Sleep Medicine (AASM). - 1550-9389 .- 1550-9397. ; 16:6, s. 889-898
  • Journal article (peer-reviewed)abstract
    • Study Objectives: The association of mild obstructive sleep apnea (OSA) with important clinical outcomes remains unclear. We aimed to investigate the association between mild OSA and systemic arterial hypertension (SAH) in the European Sleep Apnea Database cohort. Methods: In a multicenter sample of 4,732 participants, we analyzed the risk of mild OSA (subclassified into 2 groups: mild(AHI) (5-<)(11)(/h) (apnea-hypopnea index [AHI], 5 to <11 events/h) and mild(AHI) (1)(1-<15/h) (AHI, >= 11 to <15 events/h) compared with nonapneic snorers for prevalent SAH after adjustment for relevant confounding factors including sex, age, smoking, obesity, daytime sleepiness, dyslipidemia, chronic obstructive pulmonary disease, type 2 diabetes, and sleep test methodology (polygraphy or polysomnography). Results: SAH prevalence was higher in the mild(AHI) (11-<15/h) OSA group compared with the mild(AHI 5-<11/h) group and nonapneic snorers (52% vs 45% vs 30%; P < .001). Corresponding adjusted odds ratios for SAH were 1.789 (mild(AHI) (11-<15/h); 95% confidence interval [CI], 1.49-2.15) and 1.558 (mild 1.34-1.82), respectively (P < .001). In sensitivity analysis, mild(AHI) (11-<15/h) OSA remained a significant predictor for SAH both in the polygraphy (odds ratio, 1.779; 95% CI, 1.403-2.256; P < .001) and polysomnography groups (odds ratio, 1.424; 95% CI, 1.047-1.939; P = .025). Conclusions: Our data suggest a dose-response relationship between mild OSA and SAH risk, starting from 5 events/h in polygraphy recordings and continuing with a further risk increase in the 11- to <150-events/h range. These findings potentially introduce a challenge to traditional thresholds of OSA severity and may help to stratify participants with OSA according to cardiovascular risk.
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21.
  • Dieltjens, Marijke, et al. (author)
  • Use of the Clinical Global Impression scale in sleep apnea patients-Results from the ESADA database.
  • 2019
  • In: Sleep medicine. - : Elsevier BV. - 1878-5506 .- 1389-9457. ; 59, s. 56-65
  • Journal article (peer-reviewed)abstract
    • The Clinical Global Impression scale (CGI) reflects the clinician's assessment of the disease impact on patient's global functioning. We assessed predictors of CGI scale rating in patients with obstructive sleep apnea (OSA).Consecutive patients with suspected OSA (n=7581) were identified in the European Sleep Apnea Database (ESADA). Anthropometrics, comorbidities, apnea severity obtained by polygraphy or polysomnography, and daytime sleepiness [Epworth Sleepiness Scale (ESS)] were assessed. The CGI 7-point scale was completed at the end of the diagnostic process (CGI-severity, ie, CGI-S) and, in a subpopulation, at treatment follow-up (CGI-Improvement).CGI-S was rated mild to moderate in 44% of patients. CGI rating at any given apnea intensity was worse in women than in men (p<0.01). Patients undergoing polygraphy (n=5075) were more frequently rated as severely ill compared to those studied with polysomnography (19.0% vs 13.0%, p<0.001). In patients aged ≤65 years, CGI scoring was generally better than in the elderly despite a similar degree of OSA (eg, 'normal, not ill' 24.2% vs 15.3%, p<0.01, respectively). Independent predictors of CGI rating included age, BMI, AHI, ESS, cardio-metabolic comorbidities, and diagnosis based on polygraphy. CGI-improvement rating (Beta=-0.406, p<0.01) was superior to sleep apnea severity or ESS-score (Beta=0.052 and-0.021, p=0.154 and 0.538 respectively) at baseline for prediction of good CPAP compliance at follow-up.CGI rating is confounded by gender, age class and the type of sleep diagnostic method. As OSA phenotypes differ, CGI may contribute as a clinical tool to reflect the significance of clinical disease.
  •  
22.
  • Eder, Derek, 1959, et al. (author)
  • Self-Reported Features of Sleep, Utilization of Medical Resources, and Socioeconomic Position: A Swedish Population Survey
  • 2011
  • In: Behavioral Sleep Medicine. - 1540-2002. ; 9:3, s. 162-172
  • Journal article (peer-reviewed)abstract
    • This study examined aspects of self reported qualities of sleep and daytime functioning attributed to sleep, including the utilization of physician consultations and prescription medications, and their relationships with age, gender, and educational attainment in the Swedish population using telephone interviews of 1,000 random households. Women were twice as likely to use hypnotics and experienced more poor quality sleep and excessive daytime sleepiness (EDS). Lower educational attainment was associated with twofold increased hypnotic use, life impacts of sleep problems, and EDS, but not dimensions reflecting poor quality sleep. This study demonstrates that educational attainment, gender, and age combine to shape both the attributions of the effects of sleep on wakeful functioning and patterns of using medical resources.
  •  
23.
  • Ekstrom, M., et al. (author)
  • Validation of the Swedevox registry of continuous positive airway pressure, long-term mechanical ventilator and long-term oxygen therapy
  • 2021
  • In: Erj Open Research. - : European Respiratory Society (ERS). - 2312-0541. ; 7:1
  • Journal article (peer-reviewed)abstract
    • Background: The Swedish Registry of Respiratory Failure (Swedevox) collects nationwide data on patients starting continuous positive airway pressure (CPAP) treatment, long-term mechanical ventilator (LTMV) and long-term oxygen therapy (LTOT). We validated key information in Swedevox against source data from medical records. Methods: This was a retrospective validation study of patients starting CPAP (n=175), LTMV (n=177) or LTOT (n=175) across seven centres 2013-2017. Agreement with medical record data was analysed using differences in means (SD) and proportion (%) of a selection of clinically relevant variables. Variables of interest included for CPAP: apnoea-hypopnoea index (AHI), height, weight, body mass index (BMI) and Epworth Sleepiness Scale (ESS) score; for LTMV: date of blood gas, arterial carbon dioxide tension (P-aCO2) (breathing air), weight and diagnosis group; and for LTOT: blood gases breathing air and oxygen, spirometry and main diagnosis. Results: Data on CPAP and LTOT had very high validity across all evaluated variables (all <5% discrepancy). For LTMV, variability was higher against source information for P-aCO2 (>0.5 kPa in 25.9%), weight (>5 kg in 47.5%) and diagnosis group. Inconsistency was higher for patients starting LTMV acutely versus electively (P-aCO2 difference >0.5 kPa in 36% versus 21%, p<0.05, respectively). However, there were no signs of systematic bias (mean differences close to zero) across the evaluated variables. Conclusion: Validity of Swedevox data, compared with medical records, was very high for CPAP, LTMV and LTOT. The large sample size and lack of systematic differences support that Swedevox data are valid for healthcare quality assessment and research.
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24.
  • Ekström, Magnus, et al. (author)
  • Exertional breathlessness related to medical conditions in middle-aged people: the population-based SCAPIS study of more than 25,000 men and women.
  • 2024
  • In: Respiratory research. - : BioMed Central (BMC). - 1465-993X .- 1465-9921. ; 25:1
  • Journal article (peer-reviewed)abstract
    • Breathlessness is common in the population and can be related to a range of medical conditions. We aimed to evaluate the burden of breathlessness related to different medical conditions in a middle-aged population.Cross-sectional analysis of the population-based Swedish CArdioPulmonary bioImage Study of adults aged 50-64years. Breathlessness (modified Medical Research Council [mMRC]≥2) was evaluated in relation to self-reported symptoms, stress, depression; physician-diagnosed conditions; measured body mass index (BMI), spirometry, venous haemoglobin concentration, coronary artery calcification and stenosis [computer tomography (CT) angiography], and pulmonary emphysema (high-resolution CT). For each condition, the prevalence and breathlessness population attributable fraction (PAF) were calculated, overall and by sex, smoking history, and presence/absence of self-reported cardiorespiratory disease.We included 25,948 people aged 57.5±[SD] 4.4; 51% women; 37% former and 12% current smokers; 43% overweight (BMI 25.0-29.9), 21% obese (BMI≥30); 25% with respiratory disease, 14% depression, 9% cardiac disease, and 3% anemia. Breathlessness was present in 3.7%. Medical conditions most strongly related to the breathlessness prevalence were (PAF 95%CI): overweight and obesity (59.6-66.0%), stress (31.6-76.8%), respiratory disease (20.1-37.1%), depression (17.1-26.6%), cardiac disease (6.3-12.7%), anemia (0.8-3.3%), and peripheral arterial disease (0.3-0.8%). Stress was the main factor in women and current smokers.Breathlessness mainly relates to overweight/obesity and stress and to a lesser extent to comorbidities like respiratory, depressive, and cardiac disorders among middle-aged people in a high-income setting-supporting the importance of lifestyle interventions to reduce the burden of breathlessness in the population.
  •  
25.
  • Eskandari, Davoud, et al. (author)
  • Acetazolamide Reduces Blood Pressure and Sleep-Disordered Breathing in Patients with Hypertension and Obstructive Sleep Apnea: A Randomized Controlled Trial
  • 2018
  • In: Journal of Clinical Sleep Medicine. - : American Academy of Sleep Medicine (AASM). - 1550-9389 .- 1550-9397. ; 14:3, s. 309-317
  • Journal article (peer-reviewed)abstract
    • Study Objectives: The carbonic anhydrase inhibitor acetazolamide (AZT) modulates blood pressure at high altitude and reduces sleep-disordered breathing in patients with obstructive sleep apnea (OSA). We aimed to investigate the treatment effect of AZT and in combination with continuous positive airway pressure (CPAP) on blood pressure in patients with hypertension and OSA. Methods: In a prospective, randomized, three-way crossover study, 13 male patients with hypertension and moderate to severe OSA (age 64 ± 7 years, body mass index 29±4 kg/m2, and mean apnea-hypopnea index 37±23 events/h) received AZT, CPAP, or AZT plus CPAP for 2-week periods. Antihypertensive medication was washed out. Office and 24-hour blood pressure, arterial stiffness, polygraphic sleep study data, and blood chemistry were compared. Results: AZT alone and AZT plus CPAP, but not CPAP alone, reduced office mean arterial pressure compared to baseline (-7 [95% CI-11 to-4],-7 [95% CI-11 to-4] and-1 [95% CI-5 to 4] mmHg, respectively; repeated-measures analysis of variance (RM-ANOVA; P = .015). Aortic systolic pressure and augmentation index, assessed by radial artery oscillatory tonometry, were unaffected by CPAP but decreased after AZT and AZT plus CPAP (RM-ANOVA P = .030 and .031, respectively). The apnea-hypopnea index was significantly reduced in all three treatment arms, most prominently by AZT plus CPAP (RM-ANOVA P = .003). The reduction of venous bicarbonate concentration following AZT was correlated with the change of apnea-hypopnea index (r = 0.66, P = .013). Conclusions: AZT reduced blood pressure, vascular stiffness, and sleep-disordered breathing in patients with OSA and comorbid hypertension. Carbonic anhydrase inhibition may constitute a potential target for drug therapy in patients with sleep apnea and comorbid hypertension.
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26.
  • Eskandari, Davoud, et al. (author)
  • Independent associations between arterial bicarbonate, apnea severity and hypertension in obstructive sleep apnea
  • 2017
  • In: Respiratory Research. - : Springer Science and Business Media LLC. - 1465-993X. ; 18
  • Journal article (peer-reviewed)abstract
    • Background: Obstructive sleep apnea is characterized by intermittent hypoxia and hypercapnia. CO2 production, transport and elimination are influenced by the carbonic anhydrase enzyme. We hypothesized that elevated standard bicarbonate, a proxy for increased carbonic anhydrase activity, is associated with apnea severity and higher blood pressure in patients with obstructive sleep apnea. Methods: A retrospective analysis of a sleep apnea cohort (n = 830) studied by ambulatory polygraphy. Office systolic/diastolic blood pressure, lung function, and arterial blood gases were assessed during daytime. Results: Arterial standard bicarbonate was increased with apnea severity (mild/moderate/severe 24.1 +/- 1.8, 24.4 +/- 1.7 and 24.9 +/- 2.9 mmol/l, respectively, Kruskal-Wallis test p < 0.001). Standard bicarbonate was independently associated with apnea hypopnea index after adjustment for sex, age, body mass index, smoking, alcohol, hypertension, pO(2) and pCO(2) (standard bicarbonate quartile 1 vs. quartile 4, beta = 10.6, p < 0.001). Log-transformed standard bicarbonate was associated with a diagnosis of hypertension or diastolic blood pressure but not systolic blood pressure adjusting for cofounders (p = 0.007, 0.048 and 0.45, respectively). Conclusions: There was an independent association between sleep apnea severity and arterial standard bicarbonate. The link between high standard bicarbonate and daytime hypertension suggests that carbonic anhydrase activity may constitute a novel mechanism for blood pressure regulation in sleep apnea.
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27.
  • Eskandari, Davoud, et al. (author)
  • Zonisamide reduces obstructive sleep apnoea: a randomised placebo-controlled study
  • 2014
  • In: European Respiratory Journal. - : European Respiratory Society (ERS). - 0903-1936 .- 1399-3003. ; 44:1, s. 140-149
  • Journal article (peer-reviewed)abstract
    • Carbonic anhydrase inhibition reduces apnoeic events in sleep disordered breathing. Zonisamide inhibits carbonic anhydrase, and induces weight loss in obese patients. This study explored the relative influence of these two properties, which may both alleviate obstructive sleep apnoea (OSA). Continuous positive airway pressure (CPAP) was used as a standard care comparator. 47 patients with moderate-to-severe OSA and a body mass index of 27-35 kg.m(-2) were randomised to receive either zonisamide, placebo or CPAP for 4 weeks. The open extension phase (20 weeks) compared CPAP and zonisamide. Polysomnography, biochemistry and symptoms were evaluated. At 4 weeks, zonisamide reduced apnoea/hypopnoea index (AHI) by a mean +/- SD 33 +/- 39% and oxygen desaturation index by 28 +/- 31% (p=0.02 and 0.014, respectively; placebo adjusted). The mean compliance adjusted reduction of AHI after zonisamide and CPAP was 13 and 61%, respectively, (p=0.001) at 24 weeks. Body weight was marginally changed at 4 weeks, but reduced after zonisamide and increased after CPAP at 24 weeks (-2.7 +/- 3.0 kg versus 2.3 +/- 2.0 kg, p<0.001). Zonisamide decreased bicarbonate at 4 and 24 weeks. Side-effects were more common after zonisamide. Zonisamide reduced OSA independent of body weight potentially by mechanisms related to carbonic anhydrase inhibition. The effect was less pronounced than that obtained by CPAP.
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28.
  • Fietze, I., et al. (author)
  • Management of obstructive sleep apnea in Europe-A 10-year follow-up
  • 2022
  • In: Sleep Medicine. - : Elsevier BV. - 1389-9457. ; 97, s. 64-72
  • Journal article (peer-reviewed)abstract
    • Objective: In 2010, a questionnaire-based study on obstructive sleep apnea (OSA) management in Europe identified differences regarding reimbursement, sleep specialist qualification, and titration procedures. Now, 10 years later, a follow-up study was conducted as part of the ESADA (European Sleep Apnea Database) network to explore the development of OSA management over time.Methods: The 2010 questionnaire including questions on sleep diagnostic, reimbursement, treatment, and certification was updated with questions on telemedicine and distributed to European Sleep Centers to reflect European OSA management practice.Results: 26 countries (36 sleep centers) participated, representing 20 ESADA and 6 non-ESADA countries. All 21 countries from the 2010 survey participated. In 2010, OSA diagnostic procedures were performed mainly by specialized physicians (86%), whereas now mainly by certified sleep specialists and specialized physicians (69%). Treatment and titration procedures are currently quite homogenous, with a strong trend towards more Autotitrating Positive Airway Pressure treatment (in hospital 73%, at home 62%). From 2010 to 2020, home sleep apnea testing use increased (76%-89%) and polysomnography as sole diagnostic procedure decreased (24%-12%). Availability of a sleep specialist qualification increased (52%-65%) as well as the number of certified polysomnography scorers (certified physicians: 36%-79%; certified technicians: 20%-62%). Telemedicine, not surveyed in 2010, is now in 2020 used in diagnostics (8%), treatment (50%), and follow-up (73%). Conclusion: In the past decade, formal qualification of sleep center personnel increased, OSA diagnostic and treatment procedures shifted towards a more automatic approach, and telemedicine became more prominent.(c) 2022 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
  •  
29.
  • Fricke, K., et al. (author)
  • Nasal high flow, but not supplemental O-2, reduces peripheral vascular sympathetic activity during sleep in COPD patients
  • 2018
  • In: International Journal of Chronic Obstructive Pulmonary Disease. - 1178-2005. ; 13, s. 3635-3643
  • Journal article (peer-reviewed)abstract
    • Introduction: Patients with COPD have increased respiratory loads and altered blood gases, both of which affect vascular function and sympathetic activity. Sleep, particularly rapid eye movement (REM) sleep, is known to exacerbate hypoxia and respiratory loads. Therefore, we hypothesize that nasal high flow (NHF), which lowers ventilatory loads, reduces sympathetic activity during sleep and that this effect depends on COPD severity. Methods: We performed full polysomnography in COPD patients (n=17; FEV1, 1.6 +/- 0.6 L) and in matched controls (n=8). Participants received room air (RA) at baseline and single night treatment with O-2 (2 L/min) and NHF (20 L/min) in a random order. Finger pulse wave amplitude (PWA), a measure of vascular sympathetic tone, was assessed by photoplethysmography. Autonomic activation (AA) events were defined as PWA attenuation >= 30% and indexed per hour for sleep stages (AA index [AAI]) at RA, NHF, and O-2). Results: In COPD, sleep apnea improved following O-2 (REM-apnea hypopnea index [AHI] with RA, O-2, and NHF: 18.6 +/- 20.9, 12.7 +/- 18.1, and 14.4 +/- 19.8, respectively; P=0.04 for O-2 and P=0.06 for NHF). REM-AAI was reduced only following NHF in COPD patients (AAI-RA, 21.5 +/- 18.4 n/h and AAI-NHF, 9.9 +/- 6.8 n/h, P=0.02) without changes following O-2 (NFIF-O-2 difference, P=0.01). REM-AAI reduction was associated with lung function expressed as FEV1 and FVC (FEV1: r=-0.59, P=0.001; FEV1/FVC: r=-0.52 and P=0.007). Conclusion: NHF but not elevated oxygenation reduces peripheral vascular sympathetic activity in COPD patients during REM sleep. Sympathetic off-loading by NHF, possibly related to improved breathing mechanics, showed a strong association with COPD severity.
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30.
  • Fridriksson, Benedikt, 1987, et al. (author)
  • Beneficial Effects of Early Intervention Telemedicine-based Follow-Up in Sleep Apnea A Randomized Controlled Multicenter Trial
  • 2023
  • In: Annals of the American Thoracic Society. - 1546-3222. ; 20:10, s. 1499-1507
  • Journal article (peer-reviewed)abstract
    • Rationale: Positive airway pressure (PAP) is standard treatment for obstructive sleep apnea. Telemedicine has been introduced for improved PAP follow-up. Objectives: Our study aim was to evaluate the clinical utility of and patient satisfaction with PAP follow-up with an early intervention telemedical protocol. Methods: A randomized controlled trial was conducted at four sleep clinics of the same county. Treatment-naive patients with obstructive sleep apnea were randomized to standard PAP follow-up (203 patients, fixed follow-up procedures) or early intervention telemedical follow-up (AirView, ResMed; 206 patients, continuous follow-up) for 3 months. Evaluated variables included PAP adherence at 3 months, patient-reported outcome measures (Epworth Sleepiness Scale, 36-item Short Form Health Survey, Insomnia Severity Index, Hospital Anxiety and Depression Scale), and staff time. Group differences were analyzed with linear mixed regression models adjusted for age, body mass index, apnea-hypopnea index, and study center. Results: The study groups were comparable at baseline (N= 409; mean age, 59 +/- 12 yr; body mass index, 31.9 +/- 6 kg/m(2), apnea-hypopnea index, 41.5 +/- 21 events/h). PAP adherence was higher in the proactive telemedicine group than in the control group (4.3 +/- 2.4 and 4.1 +/- 2.6 h/night; P = 0.01, respectively), and mean mask pressure at follow-up was significantly lower in the telemedicine group than in the control group (8.7 +/- 2.1 cm H2O vs. 9.2 +/- 2.5 cm H2O; P = 0.028). In post hoc analysis, the difference in PAP adherence between groups was most pronounced in patients with depression (4.8 +/- 2.6 h/night vs. 2.7 +/- 2.3 h/night; P = 0.03). Relevant mask leakage (>24 L/min) was lower in the telemedicine group (5.4% vs. 12.1%, P = 0.024). Improvement of patient-reported outcome measures and patient satisfaction was equivalent between groups. Conclusions: Proactive telemedical management of the initial follow-up of PAP treatment compared favorably with conventional follow-up in terms of adherence, pressure level, and mask leakage. Patients with depression may particularly benefit from telemedical follow-up. Specific clinical routines are required to establish this practice in sleep clinics.
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31.
  • Fu, Michael, 1963, et al. (author)
  • Optimizing the Management of Heart Failure with Preserved Ejection Fraction in the Elderly by Targeting Comorbidities (OPTIMIZE-HFPEF).
  • 2016
  • In: Journal of cardiac failure. - : Elsevier BV. - 1532-8414 .- 1071-9164. ; 22:7, s. 539-544
  • Journal article (peer-reviewed)abstract
    • The pathophysiology of heart failure with preserved ejection fraction (HFPEF) is not fully understood. A recently proposed mechanism for HFPEF is that it is a systemic pro-inflammatory state induced by comorbidities, leading to microvascular endothelial dysfunction and subsequent cardiac remodelling and dysfunction. We hypothesize that targeting comorbidities will improve outcomes in elderly patients with HFPEF. Thus, the aim of this study is to determine whether the combination of systematic screening of patients with HFPEF and optimal management of comorbidities associated with HFPEF improves outcomes.
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32.
  • Grote, Ludger, 1964, et al. (author)
  • 10-year anniversary of the European Somnologist examination - A historic overview and critical appraisal
  • 2022
  • In: Journal of Sleep Research. - : Wiley. - 0962-1105 .- 1365-2869. ; 31:4
  • Journal article (peer-reviewed)abstract
    • The European Somnologist certification programme was developed by the European Sleep Research Society to improve patient care in sleep medicine by providing an independent evaluation of theoretical and practical knowledge. The examination of eligible experts plays a key role in this procedure. A process was started more than 15 years ago to create the European sleep medicine curriculum, eligibility criteria for certification, and sleep centre accreditation criteria. The process was characterised by interdisciplinary collaboration, consensus, and achieving new solutions. During the past 10 years, experience has been gained by the examination and certification of more than 1000 sleep medicine experts from more than 50 countries. The process has continuously been improved. However, as the programme was designed and administered mainly by medical experts in the field, systematic influence from teaching and pedagogic experts was partially underrepresented. The current critical appraisal pinpoints several missing links in the process - mainly as a missing constructive alignment between learning objectives, learning and teaching activities, and the final assessment. A series of suggestions has been made to further improve the ESRS certification programme.
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33.
  • Grote, Ludger, 1964, et al. (author)
  • A randomized, double-blind, placebo controlled, multi-center study of intravenous iron sucrose and placebo in the treatment of restless legs syndrome.
  • 2009
  • In: Movement disorders : official journal of the Movement Disorder Society. - : Wiley. - 1531-8257. ; 24:10, s. 1445-52
  • Journal article (peer-reviewed)abstract
    • Iron deficiency may exacerbate symptoms in the Restless Legs Syndrome (RLS). We investigated the effect of intravenous iron sucrose or placebo on symptoms in patients with RLS and mild to moderate iron deficit. Sixty patients with primary RLS (seven males, age 46 (9) years, S-ferritin < or =45 microg/L) recruited from a cohort of 231 patients were randomly assigned in a 12-months double-blind, multi-centre study of iron sucrose 1000 mg (n = 29) or saline (n = 31). The primary efficacy variable was the RLS severity scale (IRLS) score at week 11. Median IRLS score decreased from 24 to 7 (week 11) after iron sucrose and from 26 to 17 after placebo (P = 0.123, N.S. for between treatment comparison). The corresponding scores at week 7 were 12 and 20 in the two groups (P = 0.017). Drop out rate because of lack of efficacy at 12 months was 19/31 after placebo and 5/29 patients after iron sucrose (Kaplan-Meier estimate, log rank test P = 0.0006) suggesting an iron induced superior long term RLS symptom control. Iron sucrose was well tolerated. This study showed a lack of superiority of iron sucrose at 11 weeks but found evidence that iron sucrose reduced RLS symptoms both in the acute phase (7 weeks) and during long-term follow up in patients with variable degree of iron deficiency. Further studies on target patient groups, dosing and dosing intervals are warranted before iron sucrose could be considered for treatment of iron deficient patients with RLS.
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34.
  • Grote, Ludger, 1964, et al. (author)
  • Certification of fitness to drive in sleep apnea patients: Are we doing the right thing?
  • 2018
  • In: Journal of Sleep Research. - : Wiley. - 0962-1105. ; 27:6
  • Journal article (peer-reviewed)abstract
    • New European Union (EU) regulations state that untreated moderate to severe obstructive sleep apnea (OSA) coincident with excessive daytime sleepiness (EDS) constitutes a medical disorder leading to unfitness to drive. However, fitness to drive can be re-established by successful treatment of OSA and EDS. The aim of the current study was to compare patients undergoing the certification process with those of an unselected OSA patient cohort. The study compared consecutive patients in the certification group (n=132) with a representative group of OSA patients with a current driving license and an Apnea Hypopnea Index (AHI)≥15n/h (n=790). The adherence to positive airway pressure (PAP) therapy and the change in EDS (Epworth Sleepiness Scale [ESS] score) with treatment were analysed. Patient characteristics and severity of sleep apnea did not differ significantly between groups (certification/reference group: BMI 30±5/31±5kg/m2, AHI 33±20/36±20n/hr, ESS 12±6/11±5). However, the certification group was oversampled with elderly drivers (70–85years: 22% vs. 9%, p=0.001). PAP compliance was higher in the certification group than in the reference group (PAP use≥4hr/night in 96% vs. 53%, p=0.001) and mean ESS reduction was -8.0 (-8.9 – -7.1) versus -4.0 (-4.4 – -3.5), respectively (p<0.001). Patients attending the fitness to drive evaluation reported almost complete adherence to continuous positive airway pressure (CPAP) and elimination of EDS symptoms. Besides possible baseline differences, this strong response may be explained by factors such as a selection process of elderly patients, a self-rating component in the assessment of the treatment response and the threat of a driving license suspension. Our data suggest that an improved certification process with objective rather than subjective components, along with a reduced selection bias, is warranted. © 2018 European Sleep Research Society
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35.
  • Grote, Ludger, 1964, et al. (author)
  • Early atherosclerosis and cardiovascular events.
  • 2010
  • In: Sleep Apnoea Edited by W.T. McNicholas and M.R. Bonsignore. European Respiratory Society Monograph, Vol. 50. - : European Respiratory Society. - 9781849840064 ; , s. 174-188
  • Book chapter (other academic/artistic)abstract
    • There is a substantial body of evidence that obstructive sleep apnoea (OSA) causes vascular dysfunction, promotes early atherosclerosis and increases the incidence of cardiovascular (CV) events. However, this does not seem to be applicable for the population in general. Therefore, OSA may not be classified as a traditional risk factor for the development of CV disease but it can definitely be classified as an important comorbid condition. In studies performed in clinical populations with elevated CV risk profiles, the occurrence of moderate-to-severe OSA was very often accompanied by a worsened vascular function and increased prevalence of structural abnormalities. The use of continuous positive airway pressure treatment could provide significant improvements in vascular functionality and structure. In fact, the majority of data on incidences of CV disease and mortality suggest a disadvantage in patients with untreated OSA or ineffectively treated OSA. Furthermore, the consequences of OSA are more pronounced in patients who are male, young and obese, with some studies suggesting that consequences may be more pronounced in subjects with daytime hypersomnolence. Diagnosis and treatment of these subgroups appear to be very important. It is obvious that obesity, in this context, is a key comorbid condition and that future research may focus on areas where data currently are more sparse, i.e. in subjects without apparent comorbidities, pre- and post-menopausal females, children and adults. Finally, the “age paradox” claiming that OSA has a protective mechanism against CV mortality or CV dysfunctions, needs to be addressed with prospective, mechanistic, and epidemiological research.
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36.
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37.
  • Grote, Ludger, 1964 (author)
  • How to organise teaching activities for the scoring of cardiorespiratory polygraphies? Experiences from three Swedish Sleep Society teaching courses
  • 2019
  • In: Journal of Sleep Research. - : Wiley. - 0962-1105. ; 28:4
  • Journal article (peer-reviewed)abstract
    • Education in the scoring of sleep-disordered breathing is organised differently and data on the evaluation of teaching strategies based on student ratings are sparse. The aim of the study was to analyse the gain in theoretical and practical knowledge achieved during different course settings offered by a national sleep society. The course contained 1 hr of theoretical teaching (scoring rules and recording methodology) and 2.5 hr of practical scoring (physiological breathing, obstructive/central sleep apnea and hypoventilation). Three different settings were provided: a large scoring group including participants with mixed experiences (1), a small scoring group with inexperienced scorers (2), and guided scoring for experienced scorers (3). Evaluation was performed at the end of the course. Data from 67 out of 82 participants (79%) were analysed (42 nurses/technicians and 25 physicians/dentists). Previous scoring experience was limited, moderate and extended in 25, 26, and 15 students, respectively. Gain of practical knowledge and overall course rating were significantly higher in settings 2 and 3 compared with 1 (p = 0.005 and p = 0.018 respectively). Guided scoring was the preferred practical teaching setting in experienced scorers, whereas scoring in large groups together with an experienced student was preferred in newcomers. Profession did not influence gain of knowledge, course satisfaction or preferred course design. From the student's perspective, consensus scoring in groups or guided scoring for all students may have advantages compared with single/small-group scoring settings. Technical teaching knowledge of faculty members is of significant importance.
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38.
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39.
  • Grote, Ludger, 1964 (author)
  • Lessons for sleep medicine learned from the COVID-19 pandemic
  • 2022
  • In: Breathe. - : European Respiratory Society (ERS). - 1810-6838 .- 2073-4735. ; 18:3
  • Journal article (peer-reviewed)abstract
    • During the coronavirus disease 2019 (COVID-19) pandemic, sleep medicine services were dramatically reduced worldwide. Implementation of mitigation strategies was suggested by expert organisations and helped to restart sleep medicine services. Distance communication and monitoring during diagnosis, treatment initiation, and treatment follow-up have been used widely, in particular for patients with sleep apnoea. Follow-up studies demonstrate both advantages and potential disadvantages with the use of these new technologies. Emerging epidemiological evidence suggests that obstructive sleep apnoea may be an independent risk factor for adverse outcome in COVID-19, including an increased risk for hospitalisation and elevated mortality. Experimental studies explaining the underlying mechanisms behind these findings are warranted. © ERS 2022.
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40.
  • Grote, Ludger, 1964, et al. (author)
  • National Knowledge-Driven Management of Obstructive Sleep Apnea-The Swedish Approach
  • 2023
  • In: Diagnostics. - : MDPI AG. - 2075-4418. ; 13:6
  • Journal article (peer-reviewed)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).
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41.
  • Grote, Ludger, 1964, et al. (author)
  • Oximeter-based autonomic state indicator algorithm for cardiovascular risk assessment.
  • 2011
  • In: Chest. - : Elsevier BV. - 1931-3543 .- 0012-3692. ; 139:2, s. 253-259
  • Journal article (peer-reviewed)abstract
    • Background: Cardiovascular (CV) risk assessment is important in clinical practice. An autonomic state indicator (ASI) algorithm based on pulse oximetry was developed and validated for CV risk assessment. Methods: One hundred forty-eight sleep clinic patients (98 men, mean age 50 ± 13 years) underwent an overnight study using a novel photoplethysmographic sensor. CV risk was classified according to the European Society of Hypertension/European Society of Cardiology (ESH/ESC) risk factor matrix. Five signal components reflecting cardiac and vascular activity (pulse wave attenuation, pulse rate acceleration, pulse propagation time, respiration-related pulse oscillation, and oxygen desaturation) extracted from 99 randomly selected subjects were used to train the classification algorithm. The capacity of the algorithm for CV risk prediction was validated in 49 additional patients. Results: Each signal component contributed independently to CV risk prediction. The sensitivity and specificity of the algorithm to distinguish high/low CV risk in the validation group were 80% and 77%, respectively. The area under the receiver operating characteristic curve for high CV risk classification was 0.84. β-Blocker treatment was identified as an important factor for classification that was not in line with the ESH/ESC reference matrix. Conclusions: Signals derived from overnight oximetry recording provide a novel potential tool for CV risk classification. Prospective studies are warranted to establish the value of the ASI algorithm for prediction of outcome in CV disease.
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42.
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43.
  • Grote, Ludger, 1964, et al. (author)
  • Pulse Wave Analysis During Sleep
  • 2017
  • In: Principles and Practice of Sleep Medicine. Meir H. Kryger & Thomas Roth & William C. Dement (eds.). - : Elsevier. - 9780323242882
  • Book chapter (peer-reviewed)
  •  
44.
  • Grote, Ludger, 1964, et al. (author)
  • REM Sleep Imposes a Vascular Load in COPD Patients Independent of Sleep Apnea.
  • 2017
  • In: COPD. - : Informa UK Limited. - 1541-2563. ; 14:6, s. 565-572
  • Journal article (peer-reviewed)abstract
    • Arterial stiffness, a marker for cardiovascular risk, is increased in patients with Chronic Obstructive Pulmonary Disease (COPD) and Obstructive Sleep Apnea (OSA). The specific influence of both on arterial stiffness during sleep is unknown. Nocturnal arterial stiffness (Pulse Propagation Time (PPT) of the finger pulse wave) was calculated in 142 individuals evaluated for sleep apnea: 27 COPD patients (64.7 ± 11y, 31.2 ± 8kg/m2), 72 patients with cardiovascular disease (CVD group, 58.7 ± 13y, 33.6 ± 6kg/m2) and 43 healthy controls (HC group 49.3 ± 12y, 27.6 ± 3kg/m2). Sleep stage related PPT changes were assessed in a subsample of COPD patients and matched controls (n = 12/12). Arterial stiffness during sleep was increased in COPD patients (i.e. shortened PPT) compared to healthy controls (158.2 ± 31 vs. 173.2 ± 38ms, p = 0.075) and to patients with CVD (161.4 ± 41ms). Arterial stiffening was particular strong during REM sleep (145.9 ± 28vs. 172.4 ± 43ms, COPD vs. HC, p = 0.003). In COPD, time SaO2 < 90% was associated with reduced arterial stiffness (Beta +1.7ms (1.1-2.3)/10min, p < 0.001). Sleep apnea did not affect PPT. In COPD, but not in matched controls, arterial stiffness increased from wakefulness to REM-sleep (ΔPPT-8.9 ± 10% in COPD and 3.7 ± 12% in matched controls, p = 0.021). Moreover, REM-sleep related arterial stiffening was correlated with elevated daytime blood pressure (r = -0.92, p < 0.001) and increased myocardial oxygen consumption (r = -0.88, p < 0.01). Hypoxia and REM sleep modulate arterial stiffness. In contrast to healthy controls, REM sleep imposes a vascular load in COPD patients independent of sleep apnea indices, intermittent and sustained hypoxia. The link between REM-sleep, vascular stiffness and daytime cardiovascular function suggests that REM-sleep plays a role for increased cardiovascular morbidity of COPD patients.
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45.
  • Grote, Ludger, 1964 (author)
  • Sleep disordered breathing and hemodynamic function
  • 2001
  • Doctoral thesis (other academic/artistic)abstract
    • This thesis addresses the association between sleep disordered breathing (SDB) and hemodynamic function. A cross sectional study in a sleep laboratory cohort (n=1190) demonstrated a dose-response relationship between the severity of SDB, expressed as respiratory disturbance index (RDI), and office blood pressure, heart rate, and the risk of hypertension. This association was independent of confounding factors like age, Body Mass Index (BMI), and gender. Men aged 50 years or below seemed to be more susceptible for the association between SDB and hypertension. The control of hypertension was assessed in a subgroup of 599 previously diagnosed hypertensive patients. RDI was increased in patients with an actual blood pressure exceeding160/95 mmHg, defined as uncontrolled hypertension. Elevated blood pressure was also associated with age and BMI. In multivariate analysis RDI and age were the only significant predictors for uncontrolled hypertension in younger patients. Hemodynamic function during supine bicycle exercise testing was assessed in 1149 patients of the sleep laboratory cohort. Maximal load tended to decrease by every RDI unit in multivariate analysis. The heart rate response was reduced by SDB activity in a dose related manner. The increase in peripheral arterial resistance after adrenergic a-receptor stimulation with norepinephrine (NE), assessed with forearm venous plethysmography, was attenuated in normotensive patients with obstructive sleep apnea (OSA). The relative increase in resistance following NE was lower in the OSA group and negatively correlated with resting plasma NE concentration. In addition, there was a reduced vascular response to b2-adrenoreceptor stimulation with isoproterenol. The results suggest a functional downregulation of vascular a- and b2-receptors. A fingerplethysmographic device was designed to assess changes in digital blood flow by analysis of pulse wave amplitude (PWA). Arousal following SDB were associated with a markedly reduction in PWA. Fingerplethysmography was provided a tool for continuous non-invasive assessment of changes in a-receptor mediated vasoconstriction in the digital vascular bed and may characterise autonomic activation during disturbed sleep. In conclusion, SDB is associated with acute, intermediate and long-term hemodynamic dysfunction. The high prevalence of cardiovascular disease in SDB patients provides support for consideration of SDB in diagnostic and therapeutic procedures related to cardiovascular disease.
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46.
  • Grote, Ludger, 1964, et al. (author)
  • The Heart Rate Response to Exercise Is Blunted in Patients with Sleep-Related Breathing Disorder
  • 2004
  • In: Cardiology. ; 102:2
  • Journal article (peer-reviewed)abstract
    • Background: This study addressed the hypothesis that cardiovascular reactivity during graded bicycle exercise is influenced by a coexisting sleep-related breathing disorder (SRBD). Methods: Blood pressure and heart rate were assessed at rest and during graded exercise (110 W and maximal load) in 1,149 patients of a Sleep Disorders Center. The degree of SRBD, and potential confounders, including blood gases and pulmonary function, were determined. Results: Maximal exercise capacity tended to decrease with SRBD activity (p = 0.07). The heart rate reactivity was blunted and reduced by -0.07 and -0.09 beats/min for every SRBD unit at 110 W (p < 0.001) and at maximal load (p < 0.001), respectively. Systolic and diastolic blood pressure reactivity at maximal load were positively associated with SRBD severity. These associations were independent of possible confounders. Conclusion: SRBD is associated with reduced physical working capacity and a modified hemodynamic response to exercise. Copyright 2004 S. Karger AG, Basel
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47.
  • Grote, Ludger, 1964 (author)
  • Zirkadiane Einflusse auf die Kreislaufregulation [Influence of circadian rhythms on cardiovascular function]
  • 2004
  • In: Internist (Berl). ; 45:9
  • Journal article (peer-reviewed)abstract
    • The clinical importance of circadian biological rhythms has been strengthened by a number of studies showing a circadian distribution of cardiovascular events like myocardial infarction, stroke, complex arrythmia, or sudden cardiac death. Incidence of diseases showed a maximum during the early morning hours after awakening from sleep. In addition, a number of pathophysiological mechanisms has been identified to coincide with this peak including blood pressure and heart rate surges, decreased endothelial dilatory capacity of peripheral and coronary arteries, enhanced sympathetic activity, decreased cardiac electrical stability, and increased platelet aggregation. This time window of high risk for the incidence of cardiovascular events has been identified as a target for new treatment and prevention strategies including new release forms of antihypertensive and coronar-dilatory drugs. The use of melatonin as an antihypertensive drug has been successfully explored and opens new opportunities for the management of cardiovascular dysfunction and disease from a circadian perspective.
  •  
48.
  • Grotz, Wolfgang, et al. (author)
  • Sleep apnea - Treatment improves hypertension
  • 2006
  • In: Medizinische Klinik. - : Springer Science and Business Media LLC. - 0723-5003 .- 1615-6722. ; 101:11, s. 880-885
  • Research review (peer-reviewed)
  •  
49.
  • Gunduz, C., et al. (author)
  • Long-term positive airway pressure therapy is associated with reduced total cholesterol levels in patients with obstructive sleep apnea: data from the European Sleep Apnea Database (ESADA)
  • 2020
  • In: Sleep Medicine. - : Elsevier BV. - 1389-9457. ; 75, s. 201-209
  • Journal article (peer-reviewed)abstract
    • Background and aim: Obstructive sleep apnea (OSA) is an independent risk factor for dyslipidemia. The current study examined the effects of positive airway pressure (PAP) treatment on lipid status in the European Sleep Apnea Database (ESADA). Methods: The prospective cohort study enrolled 1564 OSA subjects (74% male, mean age 54 ± 11y, body mass index (BMI) 32.7 ± 6.6 kg/m2 and apnea-hypopnea index (AHI) 40.3 ± 24.4 n/h) undergoing PAP therapy for at least three months (mean 377.6 ± 419.5 days). Baseline and follow-up total cholesterol (TC) from nine centers were analyzed. Repeated measures and logistic regression tests (adjusted for age, sex, weight changes, lipid lowering medication, PAP compliance, and treatment duration) were used to compare changes in TC concentration. Incident risk for a coronary heart disease event (CHD) was used to compute a Framingham CHD risk score (estimated from age, BMI, blood pressure, and TC). Results: Adjusted means of TC decreased from 194.2 mg/dl to 189.3 mg/dl during follow-up (p = 0.019). A clinically significant (10%) reduction of TC at PAP follow-up was observed in 422 patients (27%). Duration of PAP therapy was identified as independent predictor for TC reduction, which implies an approximately 10% risk reduction for incident CHD events (from 26.7% to 24.1% in men and from 11.2% to 10.1% in women, p < 0.001 respectively). Conclusion: This observational study demonstrates a reduction of TC after long-term PAP treatment. The close association between TC concentration and cardiovascular (CV) mortality suggests that identification and treatment of OSA may have a beneficial effect on overall CV risk due to this mechanism. This possibility needs to be evaluated in prospective randomized studies. © 2020 Elsevier B.V.
  •  
50.
  • Gündüz, Canan, et al. (author)
  • Obstructive sleep apnoea independently predicts lipid levels: Data from the European Sleep Apnea Database.
  • 2018
  • In: Respirology (Carlton, Vic.). - : Wiley. - 1440-1843 .- 1323-7799. ; 23:12, s. 1180-1189
  • Journal article (peer-reviewed)abstract
    • Obstructive sleep apnoea (OSA) and dyslipidaemia are independent risk factors for cardiovascular disease. This study investigates the association between OSA and plasma lipid concentrations in patients enrolled in the European Sleep Apnea Database (ESADA) cohort.The cross-sectional analysis included 8592 patients without physician-diagnosed hyperlipidaemia or reported intake of a lipid-lowering drug (age 50.1±12.7years, 69.1% male, BMI: 30.8±6.6kg/m2 , mean apnoea-hypopnoea index (AHI): 25.7±25.9 events/h). The independent relationship between measures of OSA (AHI, oxygen desaturation index (ODI), mean and lowest oxygen saturation) and lipid profile (total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and fasting triglycerides (TG)) was determined by means of general linear model analysis.There was a dose response relationship between TC and ODI (mean±SE (mg/dL): 180.33±2.46, 184.59±2.42, 185.44±2.42 and 185.73±2.44; P <0.001 across ODI quartiles I-IV). TG and LDL concentrations were better predicted by AHI than by ODI. HDL-C was significantly reduced in the highest AHI quartile (mean±SE (mg/dL): 48.8±1.49 vs 46.50±1.48; P =0.002, AHI quartile I vs IV). Morbid obesity was associated with lower TC and higher HDL-C values. Lipid status was influenced by geographical location with the highest TC concentration recorded in Northern Europe.OSA severity was independently associated with cholesterol and TG concentrations.
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