| 1. |
- Bengtsson, Caroline, et al.
(author)
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Chronic rhinosinusitis impairs sleep quality : results of the GA(2)LEN study
- 2017
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In: Sleep. - : Oxford University Press. - 0161-8105 .- 1550-9109. ; 40:1
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Journal article (peer-reviewed)abstract
- STUDY OBJECTIVES: To analyse the prevalence of sleep problems in subjects with CRS and to determine whether the disease severity of CRS affects sleep quality.METHODS: Questionnaires were sent to a random sample of 45 000 adults in four Swedish cities. Questions on CRS, asthma, allergic rhinitis, co-morbidities, tobacco use, educational level and physical activity were included. CRS was defined according to the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) epidemiological criteria. The disease severity of CRS was defined by the number of reported CRS symptoms. Sleep quality was assessed using the Basic Nordic Sleep Questionnaire.RESULTS: Of the 26 647 subjects, 2249 (8.4%) had CRS. Reported sleep problems were 50-90% more common among subjects with CRS compared with those without or the total population. The prevalence of reported sleep problems increased in conjunction with the severity of CRS. After adjusting for gender, BMI, age, tobacco use, asthma, somatic diseases, physical activity level and educational level, participants with four symptoms of CRS (compared with subjects without CRS symptoms) displayed a higher risk of snoring (adj. OR (95% CI): 3.13 (2.22-4.41)), difficulties inducing sleep (3.98 (2.94-5.40)), difficulties maintaining sleep (3.44 (2.55-4.64)), early morning awakening (4.71 (3.47-6.38)) and excessive daytime sleepiness (4.56 (3.36-6.18)). The addition of persistent allergic rhinitis to CRS further increased the risk of sleep problems.CONCLUSIONS: Sleep problems are highly prevalent among subjects with CRS. The disease severity of CRS negatively affects sleep quality.
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| 2. |
- Janson, Christer, et al.
(author)
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Sublingual grass allergen specific immunotherapy : a retrospective study of clinical outcome and discontinuation
- 2018
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In: Clinical and Molecular Allergy. - : Springer Science and Business Media LLC. - 1476-7961. ; 16:14
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Journal article (peer-reviewed)abstract
- Background: Sublingual immunotherapy (SLIT) is effective, tolerable, and convenient for many allergic patients. Still, real-world evidence is scarce and the aim of this study is to assess the patient reported outcome of treatment with SLIT against grass pollen allergy in a consecutive patient population.Methods: Patients (n = 329) who were confirmed to be allergic to timothy grass and had been prescribed SLIT were consecutively enrolled in the study and completed a questionnaire online or in hard copy.Results: 207 (62.9%) patients responded to the questionnaire. The female/male ratio was 105/102 with a mean age of 39 ± 11 years (range 19-70 years). 113 (55%) patients reported they had completed the full 3-year treatment period, 49 (24%) were still on treatment, and 45 (22%) had discontinued treatment prematurely. Respondents who had completed the full treatment period reported that their allergy symptoms in the most recent grass pollen season had improved to a larger extent than subjects still on treatment or discontinuing the treatment prematurely. Improvement of asthma was twice as common among patients who completed compared to discontinued treatment (42 vs. 20%). Younger age (37 ± 12 vs. 41 ± 11 years, p < 0.001) and a higher prevalence of reported oral and/or gastrointestinal side effects (49 vs. 24%, p = 0.02) characterised the group that terminated SLIT. Forgetfulness was the most commonly reported specific reason.Conclusion: Treatment perseverance resulted in improved patient reported outcome. Forgetfulness was the most frequently reported reason for discontinuing SLIT treatment against grass pollen allergy.
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| 3. |
- Johansson, Hans-Erik, 1960-, et al.
(author)
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Energy restriction in obese women suggest linear reduction of hepatic fat content and time-dependent metabolic improvements
- 2019
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In: Nutrition & Diabetes. - : Springer Science and Business Media LLC. - 2044-4052. ; 9:1
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Journal article (peer-reviewed)abstract
- Energy restriction reduces liver fat, improves hepatic insulin resistance and lipid metabolism. However, temporal data in which these metabolic improvements occur and their interplay is incomplete. By performing repeated MRI scans and blood analysis at day 0, 3, 7, 14 and 28 the temporal changes in liver fat and related metabolic factors were assessed at five times during a low-calorie diet (LCD, 800-1100 kcal/day) in ten obese non-diabetic women (BMI 41.7 ± 2.6 kg/m2) whereof 6 had NAFLD. Mean weight loss was 7.4 ± 1.2 kg (0.7 kg/day) and liver fat decreased by 51 ± 16%, resulting in only three subjects having NAFLD at day 28. Marked alteration of insulin, NEFA, ALT and 3-hydroxybuturate was evident 3 days after commencing LCD, whereas liver fat showed a moderate but a linear reduction across the 28 days. Other circulating-liver fat markers (e.g. triglycerides, adiponectin, stearoyl-CoA desaturase-1 index, fibroblast growth factor 21) demonstrated modest and variable changes. Marked elevations of NEFA, 3-hydroxybuturate and ALT concentrations occurred until day 14, likely reflecting increased tissue lipolysis, fat oxidation and upregulated hepatic fatty acid oxidation. In summary, these results suggest linear reduction in liver fat, time-specific changes in metabolic markers and insulin resistance in response to energy restriction.
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| 4. |
- Petrus, P, et al.
(author)
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Depot-specific differences in fatty acid composition and distinct associations with lipogenic gene expression in abdominal adipose tissue of obese women
- 2017
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In: International Journal of Obesity. - : Springer Science and Business Media LLC. - 0307-0565 .- 1476-5497. ; 41:8, s. 1295-1298
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Journal article (peer-reviewed)abstract
- Cardiometabolic diseases are primarily linked to enlarged visceral adipose tissue (VAT). However, some data suggest heterogeneity within the subcutaneous adipose tissue (SAT) depot with potential metabolic differences between the superficial SAT (sSAT) and deep SAT (dSAT) compartments. We aimed to investigate the heterogeneity of these three depots with regard to fatty acid (FA) composition and gene expression. Adipose tissue biopsies were collected from 75 obese women undergoing laparoscopic gastric bypass surgery. FA composition and gene expression were determined with gas chromatography and quantitative real-time-PCR, respectively. Stearoyl CoA desaturase-1 (SCD-1) activity was estimated by product-to-precursor FA ratios. All polyunsaturated FAs (PUFA) with 20 carbons were consistently lower in VAT than either SAT depots, whereas essential PUFA (linoleic acid, 18:2n-6 and α-linolenic acid, 18:3n-3) were similar between all three depots. Lauric and palmitic acid were higher and lower in VAT, respectively. The SCD-1 product palmitoleic acid as well as estimated SCD-1 activity was higher in VAT than SAT. Overall, there was a distinct association pattern between lipid metabolizing genes and individual FAs in VAT. In conclusion, SAT and VAT are two distinct depots with regard to FA composition and expression of key lipogenic genes. However, the small differences between sSAT and dSAT suggest that FA metabolism of SAT is rather homogenous.
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| 5. |
- Petrus, Paul, et al.
(author)
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Saturated fatty acids in human visceral adipose tissue are associated with increased 11-beta-hydroxysteroid-dehydrogenase type 1 expression
- 2015
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In: Lipids in Health and Disease. - : Springer Science and Business Media LLC. - 1476-511X. ; 14
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Journal article (peer-reviewed)abstract
- Background: Visceral fat accumulation is associated with metabolic disease. It is therefore relevant to study factors that regulate adipose tissue distribution. Recent data shows that overeating saturated fatty acids promotes greater visceral fat storage than overeating unsaturated fatty acids. Visceral adiposity is observed in states of hypercortisolism, and the enzyme 11-beta-hydroxysteroid-dehydrogenase type 1 (11 beta-hsd1) is a major regulator of cortisol activity by converting inactive cortisone to cortisol in adipose tissue. We hypothesized that tissue fatty acid composition regulates body fat distribution through local effects on the expression of 11 beta-hsd1 and its corresponding gene (HSD11B1) resulting in altered cortisol activity. Findings: Visceral- and subcutaneous adipose tissue biopsies were collected during Roux-en-Y gastric bypass surgery from 45 obese women (BMI; 41 +/- 4 kg/m(2)). The fatty acid composition of each biopsy was measured and correlated to the mRNA levels of HSD11B1. 11 beta-hsd1 protein levels were determined in a subgroup (n = 12) by western blot analysis. Our main finding was that tissue saturated fatty acids (e.g. palmitate) were associated with increased 11 beta-hsd1 gene- and protein-expression in visceral but not subcutaneous adipose tissue. Conclusions: The present study proposes a link between HSD11B1 and saturated fatty acids in visceral, but not subcutaneous adipose tissue. Nutritional regulation of visceral fat mass through HSD11B1 is of interest for the modulation of metabolic risk and warrants further investigation.
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| 6. |
- Straniero, S., et al.
(author)
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Acute caloric restriction counteracts hepatic bile acid and cholesterol deficiency in morbid obesity
- 2017
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In: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 281:5, s. 507-517
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Journal article (peer-reviewed)abstract
- BackgroundBile acid (BA) synthesis is regulated by BA signalling in the liver and by fibroblast growth factor 19 (FGF19), synthesized and released from the intestine. In morbid obesity, faecal excretion and hepatic synthesis of BAs and cholesterol are strongly induced and caloric restriction reduces their faecal excretion considerably. We hypothesized that the high intestinal food mass in morbidly obese subjects promotes faecal excretion of BAs and cholesterol, thereby creating a shortage of both BAs and cholesterol in the liver.MethodsTen morbidly obese women (BMI 42 ± 2.6 kg m−2) were monitored on days 0, 3, 7, 14 and 28 after beginning a low‐calorie diet (800–1100 kcal day−1). Serum was collected and liver size and fat content determined. Synthesis of BAs and cholesterol was evaluated from serum markers, and the serum levels of lipoproteins, BAs, proprotein convertase subtilisin/kexin type 9 (PCSK9), insulin, glucose and FGF19 were monitored. Fifty‐four nonobese women (BMI <25 kg m−2) served as controls.ResultsAt baseline, synthesis of both BAs and cholesterol and serum levels of BAs and PCSK9 were elevated in the obese group compared to controls. Already after 3 days on a low‐calorie diet, BA and cholesterol synthesis and serum BA and PCSK9 levels normalized, whereas LDL cholesterol increased. FGF19 and triglyceride levels were unchanged, and liver volume was reduced by 10%.ConclusionsThe results suggest that hepatic BAs and cholesterol are deficient in morbid obesity. Caloric restriction rapidly counteracts these deficiencies, normalizing BA and cholesterol synthesis and circulating PCSK9 levels, indicating that overproduction of cholesterol in enlarged peripheral tissues cannot explain this phenotype. We propose that excessive food intake promotes faecal loss of BAs and cholesterol contributing to their hepatic deficiencies.
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| 7. |
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| 8. |
- Sundbom, Fredrik, 1982-
(author)
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Asthma and Sleep Disturbances : Associations to Comorbidities and Asthma Control
- 2019
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Doctoral thesis (other academic/artistic)abstract
- This thesis aimed to investigate the associations between asthma control, asthma-related comorbidity, and sleep. Insomnia symptoms with asthma are common, and have commonly been explained by poor asthma control and asthma symptoms during the night, which affect most asthmatics to some degree. The impact of asthma-related comorbidity, however, is not fully known. Further aims were to analyze the effects of asthma control and comorbidities on asthma-related quality of life, and to analyze the effects of co-existing asthma and obstructive sleep apnea on objective sleep quality. Four different populations were investigated: the two large community-based cohorts GA2LEN (n=25,610) and LifeGene (n=23,875), a cohort of 369 young asthma patients (MIDAS), and a polysomnography study of 384 women (SHE).The GA2LEN study confirmed that insomnia symptoms remain a common problem among asthmatics. Poor asthma control and nasal congestion were important risk factors for insomnia symptoms. Smoking and obesity were other risk factors for insomnia symptoms among asthmatics.Asthma control, as assessed using the Asthma Control Test (ACT), was identified as the most important predictor of asthma-related quality of life in the MIDAS study. Combining the ACT score with data on insomnia, anxiety, and depression showed considerable additive effects of the conditions. In the SHE study, co-existing asthma and OSA were associated with worse objective sleep quality and more profound nocturnal hypoxemia than either of the conditions alone. The group with both asthma and OSA had the highest levels of the markers of systemic inflammation CRP and IL-6. Uncontrolled asthma was a risk factor for all insomnia symptoms in the LifeGene study. Asthma-related comorbidity had a great impact on sleep quality; in particular, the combination of uncontrolled asthma and any comorbidity was unfavorable. Chronic rhinosinusitis was a risk factor for both insomnia symptoms and uncontrolled asthma. These findings have a high clinical relevance and underline the importance of structured evaluation of asthma control and attention to comorbidity in asthma care, as insomnia symptoms are common and affect quality of life. Optimizing asthma control is crucial for sleep quality, but treating asthma-related comorbidity must not be overlooked.
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| 9. |
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| 10. |
- Sundbom, Fredrik, et al.
(author)
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Effects of Coexisting Asthma and Obstructive Sleep Apnea on Sleep Architecture, Oxygen Saturation, and Systemic Inflammation in Women
- 2018
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In: Journal of Clinical Sleep Medicine (JCSM). - : American Academy of Sleep Medicine. - 1550-9389 .- 1550-9397. ; 14:2, s. 253-259
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Journal article (peer-reviewed)abstract
- STUDY OBJECTIVES: Both asthma and obstructive sleep apnea (OSA) are strongly associated with poor sleep. Asthma and OSA also have several features in common, including airway obstruction, systemic inflammation, and an association with obesity. The aim was to analyze the effect of asthma, OSA, and the combination of asthma and OSA on objectively measured sleep quality and systemic inflammation.METHODS: Sleep and health in women is an ongoing community-based study in Uppsala, Sweden. Three hundred eighty-four women ages 20 to 70 years underwent overnight polysomnography and completed questionnaires on airway diseases and sleep complaints. C-reactive protein (CRP), interleukin 6 (IL-6), and tumor necrosis factor α were analyzed.RESULTS: = .04) than the group with OSA alone. The results were consistent after adjusting for age, body mass index, and smoking status. Asthma was independently associated with lower oxygen saturation, whereas OSA was not.CONCLUSIONS: Our data indicate that coexisting asthma and OSA are associated with poorer sleep quality and more profound nocturnal hypoxemia than either of the conditions alone. The results are similar to earlier findings related to OSA and chronic obstructive pulmonary disease, but they have not previously been described for asthma.
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