| 1. |
- Alonderis, A, et al.
(författare)
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Medico-legal implications of sleep apnoea syndrome: Driving license regulations in Europe.
- 2008
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Ingår i: Sleep medicine. - : Elsevier BV. - 1389-9457 .- 1878-5506. ; 9:4, s. 362-75
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Tidskriftsartikel (refereegranskat)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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| 2. |
- Haja, Göran, et al.
(författare)
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A 2-week efficacy and safety study of gaboxadol and zolpidem using electronic diaries in primary insomnia outpatients.
- 2009
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Ingår i: Sleep medicine. - : Elsevier BV. - 1878-5506 .- 1389-9457. ; 10:7, s. 705-12
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To evaluate the efficacy and safety profile of gaboxadol, a selective extrasynaptic GABA(A) agonist (SEGA) previously in development for the treatment of insomnia. METHODS: This was a randomised, double-blind, placebo-controlled, parallel-group, 2-week, Phase III study of gaboxadol 5, 10 and 15mg in outpatients meeting the DSM-IV criteria of primary insomnia (N=742). Zolpidem 10mg was used as active reference. RESULTS: At weeks 1 and 2, significant improvement in total sleep time (sTST) compared to placebo was seen for all doses of gaboxadol (all p<0.05). In addition, gaboxadol 10 and 15mg decreased the number of awakenings (sNAW) (p<0.05) while only gaboxadol 15mg improved wakefulness after sleep onset (sWASO) (p<0.05). At week 1, all doses of gaboxadol significantly improved time-to-sleep onset (sTSO) (p<0.05). At week 2, a sustained effect on sTSO was observed for gaboxadol 15mg. Zolpidem also showed effect on all of these variables. Gaboxadol and zolpidem improved sleep quality, freshness after sleep, daytime function and energy at both weeks. Transient rebound insomnia was observed following discontinuation of treatment with zolpidem, but not gaboxadol. CONCLUSIONS: Gaboxadol 15mg treatment for 2 weeks significantly improved sleep onset and maintenance variables as well as sleep quality and daytime function, as did zolpidem. Gaboxadol 5 and 10mg also showed benefits on most efficacy variables. Gaboxadol was generally safe and well tolerated, with no evidence of withdrawal symptoms or rebound insomnia after discontinuation of short-term treatment. For zolpidem, transient rebound insomnia was observed.
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| 3. |
- Holmdahl, C., et al.
(författare)
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CPAP treatment in obstructive sleep apnoea : a randomised, controlled trial of follow-up with a focus on patient satisfaction
- 2009
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Ingår i: Sleep Medicine. - : Elsevier. - 1389-9457 .- 1878-5506. ; 10:8, s. 869-874
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Tidskriftsartikel (refereegranskat)abstract
- AIM OF THE STUDY: To assess a simplified model for follow-up in patients undergoing CPAP-treatment for obstructive sleep apnoea syndrome.PATIENTS AND METHODS: A total of 200 patients in stable condition were randomised to annual follow-up visits either by a specialist nurse (intervention) or physician-led visits including oximetry (control). Patients were followed for two years and assessed for the following outcomes: global satisfaction, quality of life, medical events, and resource utilisation.RESULTS: The overall experience of CPAP treatment was rated as excellent or good by 99% in each group. Global satisfaction was high in both groups, and there were no clinically significant differences between the groups. Quality of life did not differ between the groups. No serious medical events related to OSAS occurred during the study period. Extra physician consultations occurred rarely, and were managed within the limits of the follow-up visits.CONCLUSION: For stable patients undergoing CPAP treatment for obstructive sleep apnoea, regular follow-up visits by a specialist nurse can optimise the use of health care resources while retaining high patient satisfaction, without increasing medical risks.
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| 4. |
- Johansson, Peter, 1962-, et al.
(författare)
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Sleep disordered breathing in an elderly community-living population : Relationship to cardiac function, insomnia symptoms and daytime sleepiness
- 2009
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Ingår i: Sleep Medicine. - : Elsevier BV. - 1389-9457 .- 1878-5506. ; 10:9, s. 1005-1011
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The relationship between sleep disordered breathing (SDB), systolic function/heart failure in elderly people living in community has not been investigated, nor has insomnia and excessive daytime sleepiness (EDS). Aim: To describe the prevalence of SDB and its relationship to systolic function, the different insomnia symptoms as well as EDS. Method: 331 subjects (71-87 years) underwent echocardiographic examinations and sleep respiratory recordings. Questionnaires were used to evaluate insomnia symptoms and EDS. Results: Mild SDB (AHI 5-15), was found in 32%. Moderate SDB (AHI 15-30) occurred in 16%, and 7% had severe SDB (AHI >30). Median AHI was significantly higher (p<0.001) in those with mild impaired systolic function (AHI 11.7) and moderate impaired systolic function (AHI 10.9) compared to those with normal systolic function (AHI 5.0). Mild and moderate impaired systolic function was also independently associated to SDB as indicated by an AHI≥10. Concerning insomnia symptoms and EDS, only difficulties in initiating sleep correlated significantly (p<0.05) with AHI. Conclusion: SDB is common among the elderly and may be related to impaired systolic function/heart failure. However, detection of SDB in such population may be problematic since insomnia symptoms and EDS correlated poorly with SDB.
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| 5. |
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| 6. |
- Lindberg, Eva, et al.
(författare)
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CPAP treatment of a population-based sample-what are the benefits and the treatment compliance?
- 2006
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Ingår i: Sleep Medicine. - : Elsevier BV. - 1389-9457 .- 1878-5506. ; 7:7, s. 553-560. Epub 2006 Jun 5.
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Tidskriftsartikel (refereegranskat)abstract
- Background & purpose: Continuous positive airway pressure (CPAP) treatment has positive effects, including improved insulin sensitivity in sleep-laboratory cohorts with obstructive sleep apnea syndrome. There is still a lack of data on benefits obtained and possibilities to treat less symptomatic individuals. The aim of this study was to evaluate the effect of CPAP treatment on metabolic profile and quality of life (QoL) in a population-based sample of men with sleep apnea. Another purpose was to investigate the compliance to CPAP in this population. Patients and methods: A population-based sample of 38 men with an AHI >= 10 were treated with CPAP regardless of symptom profile. The controls included men with AIR < 10 matched for age and hypertension. The effects were evaluated after 3 weeks and 6 months. Insulin resistance was quantified using the homeostasis model assessment (HOMA). Daytime sleepiness, QoL and subjective symptom load was assessed using the Epworth Sleepiness Scale (ESS), the Medical Outcomes Study Short Form Health Survey (SF-36) and the Minor Symptoms Evaluation-Profile (MSE-P) questionnaires, respectively. Results: Complete three-week data were obtained from 28 treated men and 28 controls. Compared with controls, the CPAP group displayed a greater reduction of fasting serum insulin (P=0.02), decrease in insulin resistance (P=0.01) and an increase in IGF-1 (P=0.005). The CPAP group further showed an improvement in the SF-36 domains of mental health (P=0.03) and vitality (P=0.06) and a reduction in symptom load in the sleep dimension of the MSE-P. Only 11 (29%) of subjects starting CPAP were still on treatment after 6 months. Those who still used CPAP had a higher score on ESS at baseline (11.3 (4.4) vs. 5.9 (3.4), P<0.0001). Conclusions: Benefits of short-term treatment included signs of reduced insulin resistance and improved QoL. However, in this population-based sample compliance with CPAP was very low. More severe sleepiness was a positive predictive factor for treatment compliance.
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| 7. |
- Mallon, Lena, et al.
(författare)
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Is usage of hypnotics associated with mortality?
- 2009
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Ingår i: Sleep Medicine. - : Elsevier BV. - 1389-9457 .- 1878-5506. ; 10:3, s. 279-286
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the influence of hypnotic usage on all-cause and cause-specific mortality in a middle-aged population. Methods: A cohort of 1750 men and 1773 women aged 30-65 years who responded to a postal questionnaire in 1983. The questionnaire included questions about hypnotic usage, sleep duration, sleep complaints, medical conditions, depression, demographic and life style variables. Mortality data for the period 1983-2003 were collected. Results: Regular hypnotic usage wits reported by 1.7% of men and 2.2% of women, and was associated with short sleep, sleeping difficulties, several health problems and depression. During the 20-year follow-up period 379 men (21.5%) and 278 women (15.5%) died. After adjustment for potential risk factors in multivariate analyses regular hypnotic usage was associated with significantly increased risk of all-cause mortality in men (Hazard ratios [HR], 4.54; 95% confidence interval [CI], 2.47-8.37) and in women 2.03 (95% CI 1.07-3.86). With regard to cause-specific mortality, regular hypnotic usage in men was a risk factor for coronary artery disease death, cancer death, suicide and death from "all remaining causes." In women it was a risk factor for suicide. Conclusions: Our results show an increased risk of all-cause mortality and cause-specific mortality in regular users of hypnotics.
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| 8. |
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| 9. |
- Sahlin, Carin, 1953-, et al.
(författare)
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Sleep in women : normal values for sleep stages and position and the effect of age, obesity, sleep apnea, smoking, alcohol and hypertension
- 2009
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Ingår i: Sleep Medicine. - : Elsevier. - 1389-9457 .- 1878-5506. ; 123:10, s. 1025-1030
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To define normal values for total sleep time, sleep latency, sleep efficiency, sleep stages and sleeping positions in women and to investigate how sleep is affected by age, obesity, sleep apnea, smoking, alcohol dependency and hypertension.Methods: In a population-based study, 400 Swedish women aged 20-70 years were investigated using overnight in-home polysomnography.Results: The mean normal total sleep time was 392 minutes, sleep latency 22 minutes and sleep efficiency 82%. Women spent 31 minutes in sleep stage 1, 244 minutes in stage 2, 41 minutes in stage 3-4 and 76 minutes in rapid eye movement (REM) sleep. They spent 41% of their sleep time in the supine position, 50% in the lateral position and 9% in the prone position. Multivariate analyses revealed that sleep efficiency was lower in older women and in women with hypertension. Sleep latency was short in women with severe sleep apnea and long in smokers, alcohol-dependent and hypertensive women. Total sleep time was long in severe sleep apnea. Sleep stage 3-4 was inversely related to age and body-mass index. Less REM sleep occurred in alcohol-dependent women. Women younger than 45 years old slept a mean of 42% in the lateral position while women of 45 years and older slept 57% in the lateral position (p<0.001).Conclusions: In this population-based study of women, we present normal values for sleep stages and sleeping position. We conclude that age, body-mass index, obstructive sleep apnea, smoking, alcohol and hypertension reduce sleep quality. With age, women spend more time sleeping in the lateral position.
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