| 11. |
- Ljunggren, Mirjam, et al.
(author)
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Association between proteomics and obstructive sleep apnea phenotypes in a community-based cohort of women
- 2020
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In: Journal of Sleep Research. - : John Wiley & Sons. - 0962-1105 .- 1365-2869. ; 29:4
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Journal article (peer-reviewed)abstract
- Proteomic‐based technologies offer new opportunities to identify proteins that might reflect the cardiometabolic stress caused by different aspects of sleep‐disordered breathing. We aimed to investigate whether severe obstructive sleep apnea and severe obstructive sleep apnea during rapid eye movement sleep are associated with changed levels of inflammatory and cardiac disease‐related proteins in a population‐based cohort of women. In the community‐based “Sleep and Health in Women” (SHE) cohort study, 400 women underwent polysomnography, anthropometric measurements and blood sampling. Two proteomic assays (Olink Proseek® Inflammation panel and Olink Proseek® Cardiovascular II panel), each measuring 92 proteins, were analysed in a subsample of 253 women. p‐Values were adjusted for multiple testing, with false discovery rate set at 10%. In unadjusted models, 57 proteins were associated with apnea−hypopnea index, 56 proteins with oxygen desaturation index and 64 proteins with rapid eye movement−apnea−hypopnea index. After adjustment for age, body mass index and plate, there were no significant associations between apnea−hypopnea index or oxygen desaturation index and any of the proteins. Severe obstructive sleep apnea during rapid eye movement sleep (rapid eye movement−apnea−hypopnea index ≥ 30) was associated with decreased levels of two anti‐inflammatory proteins; Sirt2 (q‐value .016) and LAP‐TGF‐β1 (q‐value .016). There was also a negative association between rapid eye movement−apnea−hypopnea index of ≥ 30 and Axin1 (q‐value .095), a protein thought to facilitate TGF‐β‐signalling. We conclude that severe obstructive sleep apnea during rapid eye movement sleep is associated with low levels of Sirt2, LAP‐TGF‐β1 and Axin1, anti‐inflammatory proteins involved in metabolic regulation and in the atherosclerotic process. For obstructive sleep apnea based on a whole night, the associations with cardiac and inflammatory proteins are weaker, and explained to a large extent by age and body mass index.
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| 12. |
- Ljunggren, Mirjam, et al.
(author)
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Rapid eye movement sleep apnea and carotid intima thickness in men and women : a SHE-MUSTACHE cohort study
- 2022
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In: Journal of Sleep Research. - : John Wiley & Sons. - 0962-1105 .- 1365-2869. ; 31:5
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Journal article (peer-reviewed)abstract
- Rapid eye movement (REM) obstructive sleep apnea might be particularly harmful to the cardiovascular system. We aimed to investigate the association between sleep apnea during REM sleep and signs of atherosclerotic disease in the form of carotid intima thickness in a community-based sample of men and women and possible sex differences in this association. The association between sleep apnea during REM sleep and intima thickness was analysed cross-sectionally in women from the community-based "Sleep and Health in Women" (SHE) study (n = 253) and age- and body mass index (BMI)-matched men from the "Men in Uppsala; a Study of sleep, Apnea and Cardiometabolic Health" (MUSTACHE) study (n = 338). Confounders adjusted for were age, BMI, gender, alcohol, and smoking. All participants underwent a full-night polysomnography, high-resolution ultrasonography of the common carotid artery, anthropometric measurements, blood pressure measurements, and answered questionnaires. There was an association between sleep apnea during REM sleep and thicker carotid intima that remained after adjustment for confounding (adjusted β = 0.008, p = 0.032). The intima was increased by 9.9% in the group with severe sleep apnea during REM sleep, and this association between severe sleep apnea during REM sleep and increased intima thickness remained after adjustment for confounders (adjusted β = 0.043, p = 0.021). More women than men had severe sleep apnea during REM sleep; moreover, in sex-stratified analyses, the association between sleep apnea during REM sleep and intima thickness was found in women but not in men. We conclude that severe REM sleep apnea is independently associated with signs of atherosclerosis. When stratified by sex, the association is seen in women but not in men.
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| 13. |
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| 14. |
- Olszowka, Maciej, et al.
(author)
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Excessive daytime sleepiness, morning tiredness, and prognostic biomarkers in patients with chronic coronary syndrome
- 2023
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In: International Journal of Cardiology. - : Elsevier. - 0167-5273 .- 1874-1754.
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Journal article (peer-reviewed)abstract
- BackgroundSleep-related breathing disorders (SRBD) are related to cardiovascular outcomes in patients with chronic coronary syndrome (CCS). Whether SRBD-related symptoms are associated with prognostic biomarkers in patients with CCS is not established.MethodsAssociations between frequency (never/rarely, sometimes, often, always) of self-reported SRBD-related symptoms (excessive daytime sleepiness [EDS]; morning tiredness [MT]; loud snoring; multiple awakenings/night; gasping, choking, or apnea when asleep) and levels of biomarkers related to cardiovascular prognosis (high-sensitivity C-reactive protein [hs-CRP], interleukin 6 [IL-6], high-sensitivity cardiac troponin T [hs-cTnT], N-terminal pro B-type natriuretic peptide [NT-proBNP], cystatin C, growth differentiation factor 15 [GDF-15] and lipoprotein-associated phospholipase A2 activity) were assessed at baseline in 15,640 patients with CCS on optimal secondary preventive therapy in the STABILITY trial. Cross-sectional associations were assessed by adjusted linear regression models testing for trends with the never/rarely category serving as reference.ResultsEDS was associated (geometric mean ratio, 95% confidence interval) with increased levels of IL-6 (often 1.07 [1.03–1.10], always 1.15 [1.10–1.21]), GDF-15 (often 1.03 [1.01–1.06], always 1.07 [1.03–1.11]), NT-proBNP (always 1.22 [1.12–1.33]), and hs-cTnT (always 1.07 [1.01–1.12]). MT was associated with increased levels of IL-6 (often 1.05 [1.01–1.09], always 1.09 [1.04–1.15]), and GDF-15 (always 1.06 [1.03–1.10]). All symptoms were to some degree associated with higher levels of hs-CRP and loud snoring was also associated with decreased levels of NT-proBNP and hs-cTnT.ConclusionsIn patients with CCS, stepwise increased frequency of SRBD-related symptoms, such as EDS and MT, were associated with gradually higher levels of IL-6 and GDF-15, each reflecting distinct pathophysiological pathways.
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| 15. |
- Palm, Andreas, 1971-, et al.
(author)
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Association between obstructive sleep apnoea and cancer : a cross-sectional, population-based study of the DISCOVERY cohort
- 2023
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In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 13:3
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Journal article (peer-reviewed)abstract
- OBJECTIVES: Nocturnal hypoxia in obstructive sleep apnoea (OSA) is a potential risk factor for cancer. We aimed to investigate the association between OSA measures and cancer prevalence in a large national patient cohort.DESIGN: Cross-sectional study. SETTINGS: 44 sleep centres in Sweden.PARTICIPANTS: 62 811 patients from the Swedish registry for positive airway pressure (PAP) treatment in OSA, linked to the national cancer registry and national socioeconomic data (the course of DIsease in patients reported to Swedish CPAP, Oxygen and VEntilator RegistrY cohort).OUTCOME MEASURES: After propensity score matching for relevant confounders (anthropometric data, comorbidities, socioeconomic status, smoking prevalence), sleep apnoea severity, measured as Apnoea-Hypopnoea Index (AHI) or Oxygen Desaturation Index (ODI), were compared between those with and without cancer diagnosis up to 5 years prior to PAP initiation. Subgroup analysis for cancer subtype was performed.RESULTS: OSA patients with cancer (n=2093) (29.8% females, age 65.3 (SD 10.1) years, body mass index 30 (IQR 27-34) kg/m2) had higher median AHI (n/hour) (32 (IQR 20-50) vs 30 (IQR 19-45), n/hour, p=0.002) and median ODI (n/hour) (28 (IQR 17-46) vs 26 (IQR 16-41), p<0.001) when compared with matched OSA patients without cancer. In subgroup analysis, ODI was significantly higher in OSA patients with lung cancer (N=57; 38 (21-61) vs 27 (16-43), p=0.012)), prostate cancer (N=617; 28 (17-46) vs 24, (16-39)p=0.005) and malignant melanoma (N=170; 32 (17-46) vs 25 (14-41),p=0.015).CONCLUSIONS: OSA mediated intermittent hypoxia was independently associated with cancer prevalence in this large, national cohort. Future longitudinal studies are warranted to study the potential protective influence of OSA treatment on cancer incidence.
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| 16. |
- Palm, Andreas, 1971-, et al.
(author)
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Course of DISease in patients reported to the Swedish CPAP Oxygen and VEntilator RegistrY (DISCOVERY) with population-based controls
- 2020
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In: BMJ Open. - : BMJ. - 2044-6055. ; 10:11
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Journal article (peer-reviewed)abstract
- Purpose Chronic hypoxic and hypercapnic respiratory failure and obstructive sleep apnoea (OSA) are chronic diseases associated with decreased quality of life and increased mortality. The rationale behind the set up the retrospective nationwide DISCOVERY cohort was to study several questions including disease course and risk factors for incident disease, impaired quality of life, hospitalisation risk and mortality in patients with chronic respiratory failure with long-term oxygen therapy (LTOT), long-term mechanical ventilation (LTMV) and obstructive sleep apnoea (OSA) on treatment with continuous positive airway pressure (CPAP). Participants and settings Data from the national quality registry for respiratory insufficiency and sleep apnoea (Swedevox) and a population-based control group from Statistics Sweden were merged with governmental registries, the Swedish Cancer Registry, the Swedish Cause of Death Registry, the Swedish Drug registry, the Swedish National Patient Registry and the Swedish Dental Health Registry and with national quality registries for diabetes, rheumatic diseases (Swedish Rheumatology Quality Registry), stroke (RiksStroke), heart failure (RiksSvikt), acute heart infarction care (SwedeHeart) and intensive care (SIR) and with socioeconomic data from Statistics Sweden (SCB). Findings to date The cohort comprises 25 804 unique patients with LTOT since 1987 (54.1% females, age 73.3±9.8 years, body mass index (BMI) 26.6±6.5 kg/m 2), 8111 with LTMV since 1996 (48.6% women, age 60.6±16.9 years, BMI 32.9±10.8 kg/m 2), 65 809 with OSA on CPAP since 2010 (29.5% women, age 57.2±12.5 years, BMI 31.9±6.2 kg/m 2) and 145 224 persons in a population-based control group from same time span up to March 2018 (51.7% women, age 49.9±20.4 year, BMI 24.9±4.0 years). Future plans In patients with chronic respiratory failure and sleep apnoea important questions regarding comorbidity burden, hospitalisation rate, mortality and treatment outcomes are still unexplored to a large extent. The DISCOVERY cohort will provide unique opportunities by its size and comprehensiveness to fill this clinically relevant gap of knowledge. © 2020 Author(s). Published by BMJ.
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| 17. |
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| 18. |
- Palm, Andreas, et al.
(author)
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Normalized hypercapnia is a strong predictor of survival in patients with home mechanical ventilation (HMV) - the population-based DISCOVERY study
- 2023
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In: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 62:Suppl. 67
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Journal article (other academic/artistic)abstract
- Background: Long-term outcome studies of home mechanical ventilation (HMV) are sparse. We analysed predictors of survival and survival per se over 26 years in patients treated with HMV.Methods: Population-based cohort study of adult patients starting HMV in the Swedish Registry for Respiratory Failure (Swedevox) 1996–2021, cross-linked with the National Cause of Death registry. Risk factors for mortality were analysed using multivariable Cox regression models.Results: We included 10,190 patients (50.1 % women, age 62.9±14.5 years). Median survival in those with lung disease (n=2,264) was 2,6 years (95% confidence interval (CI) 2.4-2.8), restrictive thoracic disease (n=786) 6.9 years (6.4-7.6), obesity hypoventilation syndrome (n=3,660) 7.0 years (6.6-7.4), neuromuscular disease (n=1,030) 7.6 years (6.9-8.6), amyotrophic lateral sclerosis (n=1,444) 0.8 years (0.8-0.9), and other neurological disorders (n=1,006) 5.2 years (4.4-6.0). Lower mortality was associated with BMI, HR 0.89 (95%CI 0.87-0.92) per 5 units increase, vital capacity, HR 0.92 (0.90-0.94) per 10 percent units, and normalization of PaCO2 at follow-up after 1.3±0.9 years, HR 0.78 (0.69-0.88). Higher mortality was associated with age, HR 1.52 (1.46-1.58) per 10 years, and acute initiation of HMV, HR 1.18 (1.08-1.29). Sex, baseline PaCO2, tracheostomy, and start year did not independently predict mortality.Conclusion: Survival differed markedly between diagnosis groups but was unchanged over the study period of 26 years. Our data suggest that control of PaCO2 at follow-up is a key treatment goal in HMV.
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| 19. |
- Palm, Andreas, et al.
(author)
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Socioeconomic factors and adherence to Continuous Positive Airway Pressure - a population-based cohort study
- 2020
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In: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 56:Suppl. 64
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Journal article (other academic/artistic)abstract
- Background: Poor adherence to continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnea (OSA) is a major clinical problem. The aim of this study was to evaluate the association between socioeconomic factors and adherence to CPAP.Methods: A population-based cohort study on patients with OSA on CPAP reported to the Swedish quality registry Swedevox between 2010 and 2018, cross-linked with demographic data from Statistics Sweden. Independent factors for CPAP adherence were analyzed using multivariable linear regression.Results: Follow-up after 1.3±0.8 year (n=20,521, 70.7% men, age 57.8±12.2 years, body mass index 32.0±6.1 kg/m2, apnea-hypopnea index 36.9±22.1). Socio-economic factors associated with lower CPAP adherence were A) Civil status: Being unmarried (-20.2 minutes [95% confidence interval] -26.0 to -14.59), divorced (-26.1 min; (-32.2- -20.1) or widow/widower (-20.3 min;-31.1- -9.5) compared with being married; B) Education level: Highest educational level primary school (-14.6 min; -21.0- -8.1) or secondary school (-11.0 min;-16.3- -5.9) compared with tertiary education; C) Annual household income: (-2.3 min; -1.0- -3.5) per 10,000 € decrease; D) Country of birth: Being born in Sweden with two foreign parents (-23.5 min; -38.3- -8.6) and being born abroad (-27.9 min; -34.9- -20.9) compared to being born in Sweden by two native parents.Conclusion: Civil status, educational level, household income and foreign background are strong predictors for adherence to CPAP therapy in patients with OSA. To promote adherence, socioeconomic factors should be taken into account when treating patients with OSA.
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| 20. |
- Palm, Andreas, 1971-, et al.
(author)
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Socioeconomic Factors and Adherence to The Population-Based Course of Disease in Patients Reported to the Swedish CPAP Oxygen and Ventilator Registry Study
- 2021
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In: Chest. - : Elsevier BV. - 0012-3692 .- 1931-3543. ; 160:4, s. 1481-1491
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Journal article (peer-reviewed)abstract
- BACKGROUND: Early identification of poor adherence to CPAP treatment is of major clinical importance to optimize treatment outcomes in patients with OSA. RESEARCH QUESTION: How do socioeconomic factors influence CPAP adherence? STUDY DESIGN AND METHODS: Nationwide, population-based cohort study of patients with OSA receiving CPAP treatment reported to the Swedish quality registry Swedevox between 2010 and 2018 was cross-linked with individual socioeconomic data from Statistics Sweden. Socioeconomic factors associated with CPAP adherence were identified using a multivariate linear regression model, adjusted for age and sex. RESULTS: In total, 20,521 patients were included: 70.7% men; mean age +/- SD, 57.8 +/- 12.2 years; BMI, 32.0 +/- 6.1 kg/m2; apnea-hypopnea index, 36.9 +/- 22.1; Epworth Sleepiness Scale, 10.4 +/- 5.0; and median nocturnal CPAP use, 355 min (interquartile range, 240-420 min). Adherence after 1.3 +/- 0.8 years of CPAP use was significantly (all P < .001) associated with civil status (married vs unmarried: +20.5 min/night), education level (high, $ 13 years vs low, # 9 years: +13.2 min/night), total household income (highest/third/second vs lowest quartile: +15.9 min/night, +10.4 min/night, and +6.1 min/night, respectively), and country of birth (born in Sweden with one native parent/born in Sweden with two native parents vs being born abroad: +29.0 min/night and +29.3 min/night, respectively). INTERPRETATION: Civil status, educational level, household income, and foreign background predict CPAP adherence in a clinically significant manner and should be considered when treating OSA with CPAP. CHEST 2021; 160(4):1481-1491
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