| 1. |
- Westerlund, Anna, 1980-, et al.
(författare)
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Sleep duration does not predict major adverse cardiac events in the Swedish National March cohort study
- 2011
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Ingår i: Sleep Medicine. - Amsterdam : Elsevier. - 1389-9457 .- 1878-5506. ; 12:Supplement 1, s. S22-S22
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Tidskriftsartikel (refereegranskat)abstract
- Introduction and Objectives: Experimental research suggests that sleep deprivation may alter physiological factors associated with an increased risk for cardiovascular diseases (CVDs). Prior observational studies examining the effects of sleep duration have focused on narrowly defined CVD outcomes, such as myocardial infarction or stroke only. A more comprehensive measure of CVDs is lacking. Therefore, we examined the relationship between sleep duration and Major Adverse Cardiac Events (MACE).Materials and Methods: In 1997, 39,047 Swedish residents (women: 64%, age: 18-94 years) were enrolled in the National March cohort study and asked to self-report their habitual sleep duration in a questionnaire. They were followed-up over approximately 7 years to study incidents of MACE. Events were defined as death from all CVDs, nonfatal myocardial infarction, stroke, or heart failure. The relationship between sleep duration and MACE was analyzed using Cox proportional hazards models.Results: A total of 1,730 events were observed during a median follow-up period of 7.25 years. We found 665 nonfatal myocardial infarctions, 641 nonfatal strokes, 212 nonfatal heart failures, and 198 deaths from all CVDs. Age- and sex-adjusted hazard ratios (95% confidence intervals) of MACE (with 7 hours of sleep/day as the reference group) for individuals reporting ≤5, 6, and ≥ 8 hours of sleep were 1.24 (1.05-1.47), 1.03 (0.91-1.16), and 1.09 (0.97-1.23), respectively. Adjusting for BMI and physical activity did not change the hazard ratios. When adjusting for additional confounders, e.g., depressive symptoms, sleep apnea, and smoking, the association between ≤5h of sleep and MACE was attenuated (HR: 1.22, 95% CI: 0.98-1.52).Conclusion: Sleep duration was not associated with the risk of Major Adverse Cardiac Events. Sleep duration, however, may not in itself explain the effects of inadequate sleep on cardiovascular diseases. Yet, it may serve as an essential component in the understanding of cardiovascular diseases. Copyright © 2011 Elsevier B.V. All rights reserved.
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| 2. |
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| 3. |
- Benediktsdottir, Bryndis, et al.
(författare)
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Prevalence of restless legs syndrome among adults in Iceland and Sweden : Lung function, comorbidity, ferritin, biomarkers and quality of life
- 2010
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Ingår i: Sleep Medicine. - : Elsevier BV. - 1389-9457 .- 1878-5506. ; 11:10, s. 1043-1048
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This study investigates the prevalence and the association between restless legs syndrome (RLS) and a large variety of health variables in two well-characterized random samples from the general population in Reykjavik, Iceland, and Uppsala, Sweden. Methods: Using the national registries of inhabitants, a random sample from adults aged 40 and over living in Reykjavík, Iceland (n= 939), and Uppsala, Sweden (n= 998), were invited to participate in a study on the prevalence of COPD (response rate 81.1% and 62.2%). In addition, the participants were asked to answer the following questionnaires: International RLS Rating Scale, Short Form-12, the Epworth Sleepiness Scale, and questions about sleep, gastroeosophageal reflux, diabetes and hypertension, as well as pharmacological treatment. Interleukin-6 (IL-6), C-reactive protein (CRP) and ferritin were measured in serum. Results: RLS was more commonly reported in Reykjavik (18.3%) than in Uppsala (11.5%). Icelandic women reported RLS almost twice as often as Swedish women (24.4 vs. 13.9% p= 0.001), but there was no difference in prevalence of RLS between Icelandic and Swedish men. RLS was strongly associated with sleep disturbances and excessive daytime sleepiness. Subjects with RLS were more likely to be ex- and current smokers than subjects without RLS (p< 0.001). Respiratory symptoms and airway obstruction were more prevalent among those reporting RLS and they also estimated their physical quality of life lower than those without RLS (p< 0.001). RLS was not associated with symptoms of the metabolic syndrome like hypertension, obesity, markers of systemic inflammation (IL-6 and CRP) or cardiovascular diseases. Ferritin levels were significantly lower in RLS participants (p= 0.0002), but not (p= 0.07) after adjustment for center, age, sex and smoking history. Conclusion: Restless legs syndrome was twice as common among Icelandic women compared to Swedish women. No such difference was seen for men. RLS was strongly associated with smoking and respiratory symptoms, decreased lung function, sleep disturbances, excessive daytime sleepiness, and physical aspects of life quality. RLS was not associated with markers of the metabolic syndrome like hypertension, obesity, cardiovascular diseases or biomarkers of systemic inflammation.
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| 4. |
- Broström, Anders, et al.
(författare)
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Putative facilitators and barriers for adherence to CPAP treatment in patients with obstructive sleep apnea syndrome: A qualitative content analysis
- 2010
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Ingår i: SLEEP MEDICINE. - : Elsevier BV. - 1389-9457 .- 1878-5506. ; 11:2, s. 126-130
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Effective treatment of obstructive sleep apnea syndrome (OSAS) with continuous positive airway pressure (CPAP) can reduce morbidity and mortality, but adherence rates are low without a clear consensus Of causes. Objective: To explore the experiences of adherence to CPAP treatment in patients with OSAS. Methods: A qualitative content analysis was employed. Data were collected by in-depth interviews with 23 purposively selected patients. Results: Adherence to CPAP treatment was summarized according to "facilitators" and "barriers" to CPAP treatment. Facilitators for adherence, as described by the patients were a desire to avoid symptoms, knowledge about the risk for medical consequences, fear of negative social consequences and disturbing the sleep of significant others. Other facilitators were a positive attitude to CPAP treatment, trust in healthcare personnel, a sense of engagement from the spouse and a feeling of physical improvement. Barriers included experiencing practical problems, negative psychological effects of the equipment, and negative attitudes to the treatment. Other barriers were side-effects as well as insufficient support from healthcare personnel and the spouse. Conclusion: Adherence to CPAP treatment is a multifaceted problem including patient, treatment, condition, social and healthcare related factors. Knowledge about facilitators and barriers for adherence to CPAP treatment can be used in interventional Strategies.
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| 6. |
- Fietze, I, et al.
(författare)
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Management of obstructive sleep apnea in Europe
- 2011
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Ingår i: Sleep Medicine. - : Elsevier. - 1389-9457 .- 1878-5506. ; 12:2, s. 190-197
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: In Europe, the services provided for the investigation and management of obstructive sleep apnoea (OSA) varies from country to country. The aim of this questionnaire-based study was to investigate the current status of diagnostic pathways and therapeutic approaches applied in the treatment of OSA in Europe, qualification requirements of physicians involved in diagnosis and treatment of OSA, and reimbursement of these services. Methods: Two questionnaires were sent to 39 physicians in 22 countries in Europe. In order to standardize the responses, the questionnaire was accompanied by an example. Results: Sleep centers from 21 countries (38 physicians) participated. A broad consistency among countries with respect to the following was found: pathways included referral to sleep physicians/sleep laboratories, necessity for objective diagnosis (primarily by polysomnography), use of polygraphic methods, analysis of polysomnography (PSG), indications for positive airway pressure (PAP) therapy, application of standard continuous PAP (CPAP) therapy (100% with an CPAP/APAP ratio of 2.24:1), and the need (90.5%) and management of follow-up. Differences were apparent in reimbursement of the diagnostic procedures and follow-up, in the procedures for PAP titration from home APAP titration with portable sleep apnea monitoring (38.1%) up to hospital monitoring with PSG and APAP (85.7%), and in the qualification requirements of sleep physicians. Conclusions: Management of OSA in different European countries is similar except for reimbursement rules, qualification of sleep specialists and procedures for titration of the CPAP treatment. A European network (such as the one accomplished by the European Cooperation in Science and Technology [COST] B26 Action) could be helpful for implementing these findings into health-service research in order to standardize management in a cost effective perspective.
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| 7. |
- Gomez-Olive, Francesc Xavier, et al.
(författare)
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Sleep problems and mortality in rural South Africa : novel evidence from a low-resource setting
- 2014
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Ingår i: Sleep Medicine. - : Elsevier BV. - 1389-9457 .- 1878-5506. ; 15:1, s. 56-63
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Sleep problems are associated with mortality in Western populations. In low-resource settings, evidence of sleep problems and their potential association with mortality is lacking. Our study aimed to fill this gap by examining the prospective association of sleep problems with mortality among older adults in rural South Africa, as well as potential sex differences in this association.Methods: The study was conducted in 2006 in Agincourt (South Africa), as part of the Health and Demographic Surveillance System. A community-wide sample of 4044 men and women aged 50 years or older participated in the survey. Two measures of sleep quality over the last 30 days were assessed alongside sociodemographic variables, measures of quality of life (QoL), and functional ability. Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for mortality risk over time associated with the two sleep measures at baseline, while allowing adjustment for other covariates.Results: Overall, 394 deaths occurred during 3 years of follow-up. Both men and women reporting severe/extreme nocturnal sleep problems (vs none/mild/moderate) experienced a significantly greater mortality risk in models adjusted for sociodemographic variables only (HR, 1.65 [95% CI, 1.18-2.31] and HR, 1.42 [95% CI, 1.07-1.88], respectively). However, these associations were nonsignificant in fully adjusted models (HR, 1.23 [95% CI, 0.85-1.79] and HR, 1.07 [95% CI, 0.78-1.47], respectively). Men who reported severe/extreme difficulty related to daytime function (vs none/mild/moderate) experienced a 2-fold increased mortality risk (HR, 2.01 [95% CI, 1.32-3.07]) in fully adjusted models, whereas no significant association was observed for women (1.16 [95% CI, 0.80-1.67]).Conclusions: In this population, nocturnal sleep problems were not associated with mortality once analyses were adjusted for QoL, functional ability, and psychologic comorbidities. By contrast, severe or extreme problems with feeling unrested or unrefreshed during the day were associated with a 2-fold increased mortality risk, but this association was only significant in men.(C) 2013 Elsevier B. V. All rights reserved.
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| 9. |
- Janszky, Imre, et al.
(författare)
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Daylight saving time shifts and incidence of acute myocardial infarction - Swedish Register of Information and Knowledge About Swedish Heart Intensive Care Admissions (RIKS-HIA)
- 2012
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Ingår i: Sleep Medicine. - : Elsevier. - 1389-9457 .- 1878-5506. ; 13:3, s. 237-242
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Tidskriftsartikel (refereegranskat)abstract
- Background: Daylight saving time shifts can be looked upon as large-scale natural experiments to study the effects of acute minor sleep deprivation and circadian rhythm disturbances. Limited evidence suggests that these shifts have a short-term influence on the risk of acute myocardial infarction (AMI), but confirmation of this finding and its variation in magnitude between individuals is not clear. less thanbrgreater than less thanbrgreater thanMethods: To identify AMI incidence on specific dates, we used the Register of Information and Knowledge about Swedish Heart Intensive Care Admission, a national register of coronary care unit admissions in Sweden. We compared AMI incidence on the first seven days after the transition with mean incidence during control periods. To assess effect modification, we calculated the incidence ratios in strata defined by patient characteristics. less thanbrgreater than less thanbrgreater thanResults: Overall, we found an elevated incidence ratio of 1.039 (95% confidence interval, 1.003-1.075) for the first week after the spring clock shift forward. The higher risk tended to be more pronounced among individuals taking cardiac medications and having low cholesterol and triglycerides. There was no statistically significant change in AMI incidence following the autumn shift. Patients with hyperlipidemia and those taking statins and calcium-channel blockers tended to have a lower incidence than expected. Smokers did not ever have a higher incidence. less thanbrgreater than less thanbrgreater thanConclusions: Our data suggest that even modest sleep deprivation and disturbances in the sleep-wake cycle might increase the risk of AMI across the population. Confirmation of subgroups at higher risk may suggest preventative strategies to mitigate this risk.
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| 10. |
- Johansson, Peter, et al.
(författare)
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Sleep disordered breathing in community dwelling elderly: Associations with cardiovascular disease, impaired systolic function, and mortality after a six-year follow-up
- 2011
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Ingår i: Sleep Medicine. - : Elsevier. - 1389-9457 .- 1878-5506. ; 12:8, s. 748-753
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Sleep disordered breathing (SDB), cardiovascular disease (CVD) and impaired cardiac function are common in elderly people. We investigated the association of SDB and mortality in a community dwelling elderly population, considering CVD and objectively measured impaired cardiac function have been poorly studied thus far. less thanbrgreater than less thanbrgreater thanAim: To investigate whether SDB is a factor that affects mortality in elderly people, with a focus on those with CVD and/or signs of impaired cardiac function. less thanbrgreater than less thanbrgreater thanMethods: A prospective cohort design was used and 331 community dwelling elderly aged 71-87 years underwent one-night polygraphic recordings in the subjects homes. CVD and systolic function were objectively established. Mortality data were collected after 6 years. less thanbrgreater than less thanbrgreater thanResults: in the total population there were no significant associations between mortality and SOB. In those with CVD and impaired systolic function, as measured by NT-proBNP, oxygen desaturation index (ODI) andgt;= 10 was associated with mortality. The hazard ratio of 3.0 (Cl 95% 1.1-8.6, p = 0.03) remained statistically significant after adjustments for age, gender, diabetes and plasma values of NT-proBNP. less thanbrgreater than less thanbrgreater thanConclusion: SOB in community dwelling elderly has no overall association to mortality irrespective of degree of SDB. However, hypoxic events (i.e., ODI andgt;= 10) were associated with mortality in the group who had CVD in combination with impaired systolic function.
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