11. |
- Thorarinsdottir, Elin H., et al.
(författare)
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Polysomnographic characteristics of excessive daytime sleepiness phenotypes in obstructive sleep apnea : results from the international sleep apnea global interdisciplinary consortium
- 2024
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Ingår i: Sleep. - : Oxford University Press. - 0161-8105 .- 1550-9109. ; 47:4
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Tidskriftsartikel (refereegranskat)abstract
- Study Objectives: Excessive daytime sleepiness (EDS) is a major symptom of obstructive sleep apnea (OSA). Traditional polysomnographic (PSG) measures only partially explain EDS in OSA. This study analyzed traditional and novel PSG characteristics of two different measures of EDS among patients with OSA. Methods: Sleepiness was assessed using the Epworth Sleepiness Scale (>10 points defined as "risk of dozing") and a measure of general sleepiness (feeling sleepy >= 3 times/week defined as "feeling sleepy"). Four sleepiness phenotypes were identified: "non-sleepy," "risk of dozing only," "feeling sleepy only," and "both at risk of dozing and feeling sleepy." Results: Altogether, 2083 patients with OSA (69% male) with an apnea-hypopnea index (AHI) >= 5 events/hour were studied; 46% were "non-sleepy," 26% at "risk of dozing only," 7% were "feeling sleepy only," and 21% reported both. The two phenotypes at "risk of dozing" had higher AHI, more severe hypoxemia (as measured by oxygen desaturation index, minimum and average oxygen saturation [SpO(2)], time spent < 90% SpO(2), and hypoxic impacts) and they spent less time awake, had shorter sleep latency, and higher heart rate response to arousals than "non-sleepy" and "feeling sleepy only" phenotypes. While statistically significant, effect sizes were small. Sleep stages, frequency of arousals, wake after sleep onset and limb movement did not differ between sleepiness phenotypes after adjusting for confounders. Conclusions: In a large international group of patients with OSA, PSG characteristics were weakly associated with EDS. The physiological measures differed among individuals characterized as "risk of dozing" or "non-sleepy," while "feeling sleepy only" did not differ from "non-sleepy" individuals.
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12. |
- Thorarinsdottir, Elin H., et al.
(författare)
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Serum ferritin and obstructive sleep apnea-epidemiological study
- 2018
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Ingår i: Sleep and Breathing. - : SPRINGER HEIDELBERG. - 1520-9512 .- 1522-1709. ; 22:3, s. 663-672
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Tidskriftsartikel (refereegranskat)abstract
- PurposeFerritin is an intracellular iron storage protein and a marker of inflammation. Studies have shown that subjects with obstructive sleep apnea (OSA) have higher levels of circulating pro-inflammatory cytokines, but little is known about the association between ferritin and OSA. The aims of the study were to evaluate serum ferritin (S-Ferritin) levels in OSA patients compared to levels in the general population and also examine the effect of obesity level and treatment with positive airway pressure (PAP) on S-Ferritin levels.MethodsThe OSA subjects (n=796) were part of the Icelandic Sleep Apnea Cohort. The control subjects (n=637) were randomly chosen Icelanders who participated in an epidemiological study. Propensity score (PS) methodologies were employed to minimize selection bias and strengthen causal inferences when comparing non-randomized groups. S-Ferritin levels were measured and all participants answered the same detailed questionnaire about sleep and health. Only OSA patients underwent a sleep study and were re-invited for a 2-year follow-up.ResultsS-Ferritin levels were significantly higher in OSA males than controls (213.3 vs. 197.3g/L, p=0.007). However, after adjusting for confounders and using our PS methodology, no significant difference was found. S-Ferritin levels were not correlated with severity of OSA, obesity level, or clinical symptoms. Also, no significant change in S-Ferritin levels was found with 2years of PAP treatment.ConclusionsS-Ferritin levels are comparable in OSA patients and controls and do not change consistently with obesity level or PAP treatment in our sample.
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13. |
- Thorarinsdottir, Katrin, et al.
(författare)
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Cartilage destruction in early rheumatoid arthritis patients correlates with CD21−/low double-negative B cells
- 2024
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Ingår i: Arthritis Research and Therapy. - 1478-6354 .- 1478-6362. ; 26:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Involvement of B cells in the pathogenesis of rheumatoid arthritis (RA) is supported by the presence of disease-specific autoantibodies and the efficacy of treatment directed against B cells. B cells that express low levels of or lack the B cell receptor (BCR) co-receptor CD21, CD21−/low B cells, have been linked to autoimmune diseases, including RA. In this study, we characterized the CD21+ and CD21−/low B cell subsets in newly diagnosed, early RA (eRA) patients and investigated whether any of the B cell subsets were associated with autoantibody status, disease activity and/or joint destruction. Methods: Seventy-six eRA patients and 28 age- and sex-matched healthy donors were recruited. Multiple clinical parameters were assessed, including disease activity and radiographic joint destruction. B cell subsets were analysed in peripheral blood (PB) and synovial fluid (SF) using flow cytometry. Results: Compared to healthy donors, the eRA patients displayed an elevated frequency of naïve CD21+ B cells in PB. Amongst memory B cells, eRA patients had lower frequencies of the CD21+CD27+ subsets and CD21−/low CD27+IgD+ subset. The only B cell subset found to associate with clinical factors was the CD21−/low double-negative (DN, CD27−IgD−) cell population, linked with the joint space narrowing score, i.e. cartilage destruction. Moreover, in SF from patients with established RA, the CD21−/low DN B cells were expanded and these cells expressed receptor activator of the nuclear factor κB ligand (RANKL). Conclusions: Cartilage destruction in eRA patients was associated with an expanded proportion of CD21−/low DN B cells in PB. The subset was also expanded in SF from established RA patients and expressed RANKL. Taken together, our results suggest a role for CD21−/low DN in RA pathogenesis.
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14. |
- Thorarinsdottir, Katrin, et al.
(författare)
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CD21(-/low) B cells associate with joint damage in rheumatoid arthritis patients
- 2019
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Ingår i: Scandinavian Journal of Immunology. - : Wiley. - 0300-9475 .- 1365-3083. ; 90:2
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Tidskriftsartikel (refereegranskat)abstract
- Depletion of B cells is beneficial in rheumatoid arthritis (RA) patients with autoantibodies to citrullinated proteins (ACPA) and/or the Fc portion of immunoglobulins (rheumatoid factor [RF]), suggesting a role for B cells in disease pathogenesis. To date, however, the identity of specifically pathogenic B cell subsets has not been discovered. One candidate population is identified by the low expression or absence of complement receptor 2 (CD21(-/low) B cells). In this study, we sought to determine whether there was any correlation between CD21(-/low) B cells and clinical outcome in patients with established RA, either ACPA(+)/RF+ (n = 27) or ACPA(-)/RF- (n = 10). Healthy donors (n = 17) were included as controls. The proportion of the CD21(-/low) CD27(-)IgD(-) memory B cell subset in peripheral blood (PB) was significantly increased in ACPA(+)/RF+ RA patients compared with healthy donors, and the frequency of this subset correlated with joint destruction (r = 0.57, P < 0.04). The levels of the chemokines CXCL-9 and CXCL-10 were higher in synovial fluid than in plasma, and PB CD21(-/low) cells expressed the receptor, CXCR3. In synovial fluid, most of the B cells were CD21(-/low), approximately 40% of that population was CD27(-)IgD(-), and a third of those expressed the pro-osteoclastogenic factor receptor activator of the nuclear factor kappa B ligand (RANKL). This subset also secreted RANKL, in addition to other factors such as IL-6, even in the absence of stimulation. We interpret these data as reason to propose the hypothesis that the CD27(-)IgD(-) subset of CD21(-/low) B cells may mediate joint destruction in patients with ACPA(+)/RF+ RA.
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15. |
- Thorarinsdottir, Katrin, et al.
(författare)
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CD21-/low B cells in human blood are memory cells
- 2016
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Ingår i: Clinical and Experimental Immunology. - : Oxford University Press (OUP). - 0009-9104 .- 1365-2249. ; 185:2, s. 252-262
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Tidskriftsartikel (refereegranskat)abstract
- The complement receptor 2 (CR2, CD21) is part of a complex (CD21/CD19/CD81) acting as a co-receptor to the B-cell receptor (BCR). Simultaneous triggering of the BCR and CD21 lowers the threshold for B-cell activation. Although CD21 is important, B cells that express low amounts or lack surface CD21 (CD21-/low) are increased in conditions with chronic inflammation, e.g. autoimmune diseases. However, little is known about the CD21-/low B-cell subset in peripheral blood from healthy donors. Here, we show that CD21-/low cells represent around 5% of B cells in peripheral blood from adults but are barely detectable in cord blood, after excluding transitional B cells. The CD21-/low subset can be divided into CD38-24+ and CD38-24low cells, where most of the CD38-24+ are CD27+IgM+IgD+ and the CD38-24low are switched CD27-. Expression levels of additional markers, e.g. CD95 and CD62L, are similar to those on classical memory B cells. In contrast to naïve cells, the majority of CD21-/low cells lack expression of the ABCB1 transporter. Stimulation with a combination of BCR, toll-like receptor (TLR) 7/8 and IL-2 induces proliferation and differentiation of the CD21-/low B-cells comparable to CD21+CD27+ memory B cells. The response excluding BCR agonist is not on par with that of classical memory B cells, though clearly above that of naïve B cells. This is ascribed to a weaker response by the CD38-24low subset, implying that some memory B cells require not only TLR but also BCR triggering. We conclude that the CD21-/low B cells in healthy donors are memory B cells.
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16. |
- Thorarinsdottir, Kristjana, et al.
(författare)
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Using a Brief Mental Imagery Competing Task to Reduce the Number of Intrusive Memories : Exploratory Case Series With Trauma-Exposed Women
- 2022
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Ingår i: JMIR Formative Research. - : JMIR Publications. - 2561-326X. ; 6:7
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Tidskriftsartikel (refereegranskat)abstract
- Background:Novel interventions should be developed for people who have undergone psychological trauma. In a previous case study, we found that the number of intrusive memories of trauma could be reduced with a novel intervention. The intervention included a brief memory reminder, a visuospatial task and mental rotation, and targeted trauma memory hotspots one at a time in separate sessions.Objective:This case series (N=3) extended the first case study with 3 new cases to determine whether a similar pattern of beneficial results is observed. We explored whether the brief intervention would result in reduced numbers of intrusive memories and whether it would impact symptoms of posttraumatic stress, depression and anxiety, and general functioning. Acceptability of the intervention was also explored.Methods:A total of 3 women completed the study: 2 with posttraumatic stress disorder and other comorbidities and 1 with subthreshold posttraumatic stress disorder. The primary outcome was the change in the number of intrusive memories from the baseline phase to the intervention phase and at the 1-month follow-up, with an assessment of the intrusion frequency at 3 months. Participants monitored the number of intrusive memories in a daily diary for 1 week at baseline, for maximum of 6 weeks during the intervention phase and for 1 week at the 1-month and 3-month follow-ups. The intervention was delivered in person or digitally, with guidance from a clinical psychologist. A repeated AB design was used (A was a preintervention baseline phase and B intervention phase). Intrusions were targeted individually, creating repetitions of an AB design.Results:The total number of intrusive memories was reduced from the baseline to the intervention phase for all participants. The total number for participant 3 (P3) reduced from 38.8 per week during the baseline phase to 18.0 per week in the intervention phase. It was 13 at the 3-month follow-up. The total number for P4 reduced from 10.8 per week at baseline to 4.7 per week in the intervention phase. It was 0 at the 3-month follow-up. The total number for P5 was reduced from 33.7 at baseline to 20.7 per week in the intervention phase. It was 8 at the 3-month follow-up. All participants reported reduction in posttraumatic stress symptoms in the postintervention phase. Depression and anxiety symptoms reduced in 2 of the 3 participants in the postintervention phase. Acceptability was favorable.Conclusions:We observed good compliance with the intervention and intrusive memory diary in all 3 cases. The number of intrusive memories was reduced for all participants during the intervention phase and at the 1-month follow-up, with some improvement in other symptoms and functioning. Further research should explore the remote delivery of the intervention and whether nonspecialists can deliver the intervention effectively.
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17. |
- Tranberg, A, et al.
(författare)
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Proton pump inhibitor medication is associated with colonisation of gut flora in the oropharynx
- 2018
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172. ; 62:6, s. 791-800
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The normal body exists in mutualistic balance with a large range of microbiota. The primary goal of this study was to establish whether there is an imbalance in the oropharyngeal flora early after hospital or ICU admittance, and whether flora differs between control, ward and critically ill patients. The secondary goal was to explore whether there are patient characteristics that can be associated with a disturbed oropharyngeal flora.METHODS: Oropharyngeal cultures were obtained from three different study groups: (1) controls from the community, (2) ward patients and (3) critically ill patients, the two latter within 24 h after admittance.RESULTS: Cultures were obtained from 487 individuals: 77 controls, 193 ward patients and 217 critically ill patients. Abnormal pharyngeal flora was more frequent in critically ill and ward patients compared with controls (62.2% and 10.4% vs. 1.3%, P < 0.001 and P = 0.010, respectively). Colonisation of gut flora in the oropharynx was more frequent in critically ill patients compared with ward patients or controls (26.3% vs. 4.7% and 1.3%, P < 0.001 and P < 0.001, respectively). Proton pump inhibitor medication was the strongest independent factor associated with the presence of gut flora in the oropharynx in both ward and critically ill patients (P = 0.030 and P = 0.044, respectively).CONCLUSION: This study indicates that abnormal oropharyngeal flora is an early and frequent event in hospitalised patients and more so in the critically ill, compared to controls. Proton pump inhibitor medication is associated with colonisation of gut flora in the oropharynx.
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