| 1. |
- Andren, Ann, et al.
(författare)
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Effects of treatment with oral appliance on 24-h blood pressure in patients with obstructive sleep apnea and hypertension : a randomized clinical trial
- 2013
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Ingår i: Sleep and Breathing. - : Springer Science and Business Media LLC. - 1520-9512 .- 1522-1709. ; 17:2, s. 705-712
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Tidskriftsartikel (refereegranskat)abstract
- Continuous positive airway pressure treatment has been shown to lower blood pressure (BP) in patients with obstructive sleep apnea (OSA). The aims of the present pilot study were to evaluate the potential effects of oral appliance (OA) therapy on BP, to assess various outcome BP measures, and to inform sample size calculation. Seventy-two patients with OSA and hypertension were randomly assigned to intervention with either an OA with mandibular advancement (active group) or an OA without advancement (control group). Before and after 3 months of treatment, the patients underwent nocturnal somnographic registration and 24-h ambulatory BP monitoring. Among the various BP measures, the largest trend toward effect of OA treatment was seen in 24-h mean systolic BP with a 1.8 mmHg stronger BP reduction in the active group compared with controls. A stronger trend toward effect was seen in a subgroup with baseline ambulatory daytime mean systolic BP > 135/85 mmHg where the mean systolic BP fell, on average, 2.6 mmHg. Additional exclusion of patients with baseline apnea hypopnea index (AHI) a parts per thousand currency sign15 gave a significant reduction in mean systolic BP of 4.4 mmHg (P = 0.044) in the active group compared with controls. In patients with OSA and hypertension, OA treatment had a modest trend toward effect on reducing BP. A stronger trend toward treatment effect was seen after excluding patients with normal baseline ambulatory BP. Additional exclusion of patients with baseline AHI a parts per thousand currency sign15 showed a significant treatment effect. Data to inform sample size for an adequately powered randomized study are provided.
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| 3. |
- Igelström, Helena, 1976-, et al.
(författare)
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Physical activity and sedentary time in persons with obstructive sleep apnea and overweight enrolled in a randomized controlled trial for enhanced physical activity and healthy eating
- 2013
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Ingår i: Sleep and Breathing. - : Springer Science and Business Media LLC. - 1520-9512 .- 1522-1709. ; 17:4, s. 1257-1266
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe aim of the study was to describe the amount of physical activity and sedentary time in patients with obstructive sleep apnea syndrome (OSAS) and overweight, and to explore potential disease-related and psychological correlates.MethodsA descriptive and correlational study was performed. Prospective data of physical activity and sedentary time were collected through accelerometry, and a one-point measurement of body mass index (BMI), daytime sleepiness, exercise self-efficacy, fear of movement, and depressive symptoms. Seventy-three participants with overweight (mean BMI 35kg/m2 SD 5) and moderate/severe OSAS (Apnea-Hypopnea Index >15) were consecutively recruited. Multivariate associations were determined through multiple linear regression analysis.ResultsThe participants took a daily average of 7734 (SD 3528) steps, spent an average of 77 (SD 54) minutes in moderate-to-vigorous physical activity (MVPA), and spent 11h 45 min (SD 2h 8 min) sedentary. BMI, daytime sleepiness, exercise self-efficacy, fear of movement, and depressive symptoms did not explain variance in MVPA or steps, but explained 22.9% of variance in sedentary time. In backward selection analysis, BMI contributed to the explanatory degree of MVPA with 9% whereas, fear of movement explained 6.3% of the variance in steps and 14.3% of the variance in sedentary time.ConclusionsAn important implication for future physical activity interventions is that both physical activity and sedentary behaviors should be targeted, and fear of movement may be an important determinant for change in patients with OSAS and overweight.
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| 4. |
- Igelström, Helena, 1976-, et al.
(författare)
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Tailored behavioral medicine intervention for enhanced physical activity and healthy eating in patients with obstructive sleep apnea syndrome and overweight
- 2014
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Ingår i: Sleep and Breathing. - : Springer Science and Business Media LLC. - 1520-9512 .- 1522-1709. ; 18:3, s. 655-668
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Tidskriftsartikel (refereegranskat)abstract
- This study aims to evaluate the effects on physical activity (PA) and eating behavior (EB) of a tailored behavioral medicine intervention and first-time continuous positive airway pressure (CPAP) treatment compared with first-time CPAP treatment and advice in patients with obstructive sleep apnea syndrome (OSAS) and overweight. Seventy-three patients (mean +/- SD, 55 +/- 12 years) with overweight (body mass index (BMI), 34.5 +/- 4.8) and moderate or severe OSAS (Apnea-Hypopnea Index, 41.7 +/- 20.9) scheduled for CPAP prescription were randomized to a control group (CPAP and advice on the association between weight and OSAS) or an experimental group (CPAP and a 6-month behavioral medicine intervention targeting PA and EB). At baseline and after 6 months, eating behavior (food frequency screening and Dutch Eating Behavior Questionnaire), weight, BMI, and waist circumference were assessed at one point, while PA and sedentary time were measured with accelerometry during 4 days. The experimental group reduced 2.1 kg (+/- 4.6) in weight and 3 cm (+/- 4.9) in waist circumference, significantly more than the control group. At 6 months, the experimental group ate more fruit and fish/shellfish than the control group. Low and moderate to vigorous PA did not change over time either within or between groups. Regarding BMI, steps, and sedentary time, there were within-group differences but no differences between groups. The behavioral medicine intervention did not change physical activity but facilitated changes in EB in patients with OSAS and overweight. The amount of weight loss and reduction in waist circumference favored the participants receiving this treatment. Since the strategies for achieving behavioral changes were tailored according to the individual's goals and personal functional behavioral analyses and progressed slowly in a graded manner, it might require higher PA quotas or a period longer than 6 months to reveal a behavioral change of larger proportions.
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| 6. |
- Palm, Emma, et al.
(författare)
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Mandibular tori size is related to obstructive sleep apnea and treatment success with an oral appliance
- 2014
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Ingår i: Sleep and Breathing. - : Springer Berlin/Heidelberg. - 1520-9512 .- 1522-1709. ; 18:2, s. 431-438
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Obstructive sleep apnea (OSA) is a common disorder characterized by repetitive upper airway obstruction during sleep. We aimed to investigate whether mandibular tori, exostoses that appear on the lingual surface of the lower jaw, are related to OSA and the effect of an oral appliance (OA) in OSA patients.METHODS: Six hundred snoring patients with a mean age of 52 years (range 23-75 years) and a mean respiratory disturbance index (RDI) of 15 (range 0-76), who were consecutively referred for OA treatment, were included. The size of the tori was measured on plaster casts with a digital sliding caliper.RESULTS: Twenty-seven percent of the patients had mandibular tori, with a similar prevalence in snorers and patients with mild, moderate and severe OSA. Tori size differed between severity groups. Thick tori (≥2.9 mm) were associated with an RDI of <30, odds ratio (OR) 4.7 (p = 0.01), adjusted for age, gender and body mass index (BMI; kg/m(2)). Complete treatment response with OA was related to thick tori, OR = 2.5 (p = 0.02), adjusted for disease severity, age, gender, BMI (kg/m(2)), weight changes (kg) and mandibular repositioning.CONCLUSIONS: Patients with milder disease are more likely to have larger tori than patients with severe OSA. Treatment success with an OA occurs more frequently in patients with larger tori than in patients with no tori or small tori.
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| 7. |
- Sunnergren, Ola, 1971-, et al.
(författare)
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Positional sensitivity as a confounder in diagnosis of severity of obstructive sleep apnea
- 2013
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Ingår i: Sleep and Breathing. - : Springer. - 1520-9512 .- 1522-1709. ; 17, s. 173-179
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Tidskriftsartikel (refereegranskat)abstract
- PurposeThe apnea–hypopnea index (AHI) is used to grade obstructive sleep apnea (OSA) into mild, moderate, and severe forms. Obstructive events are most common in the supine position. The amount of supine sleep thus influences total AHI. Our aim was to determine the prevalence of position-dependent OSA (POSA) and its relation to OSA severity classification as recommended by the American Academy of Sleep Medicine (AASM).MethodsTwo hundred sixty-five subjects were recruited from primary care hypertension clinics. Whole-night respiratory recordings were performed to determine the AHI in the supine and non-supine positions, respectively. POSA was defined as supine AHI twice the non-supine AHI with supine AHI ≥5.ResultsFifty-three percent had POSA, 22% had non-position-dependent OSA, and 25% had normal respiration. By AASM classification, 81 subjects did not have OSA, but 42% of them had some degree of obstruction when supine, and 5 subjects would have been classified as moderate–severe if they had only slept supine. Conversely, of the 53 classified as mild OSA, 30% would have changed to a more severe classification if they had exclusively slept supine.ConclusionsPOSA was common both in subjects that by AASM classification had OSA as well as those without. The severity of OSA, as defined by AASM, could be dependent on supine time in a substantial amount of subjects.
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| 8. |
- Ulander, Martin, et al.
(författare)
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Side effects to continuous positive airway pressure treatment for obstructive sleep apnoea : changes over time and association to adherence
- 2014
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Ingår i: Sleep and Breathing. - : Springer Science and Business Media LLC. - 1520-9512 .- 1522-1709. ; 18:4, s. 799-807
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Tidskriftsartikel (refereegranskat)abstract
- Continuous positive airway pressure (CPAP) is an effective treatment against obstructive sleep apnoea, but adherence is often low, and side effects are common. It is unclear from previous research whether side effects are significant causes of nonadherence. No study has examined if side effects vary within subjects over time. The aims were to (1) examine the evolution of CPAP side effects over time, and (2) prospectively assess correlations between early CPAP side effects and treatment adherence. One hundred eighty-six obstructive sleep apnoea patients from three sleep centres were prospectively enrolled. They completed the Side Effects to CPAP Inventory, where the respondent rates the frequency, magnitude and perceived impact on adherence from 15 side effects. Adherence was measured by treatment dropout and machine usage time. The most common side effects were dry mouth, increased number of awakenings, blocked up nose, mask pressure and mask leaks. While some side effects were stable over time, others could both resolve and emerge within subjects. Dry mouth, mask leakage and blocked up nose emerged within 1 year in approximately 30 % of patients who had not experienced them after 2 weeks. Increased number of awakenings and dry mouth after 1-2 weeks were significantly associated to treatment dropout during the first year and machine usage time after 6 months. While some side effects are related to adherence, most are not. Not all side effects are stable over time. This, together with differences in methodology between studies, might explain the conflicting findings in earlier research.
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| 9. |
- Ulander, Martin, et al.
(författare)
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The fairness of the Epworth Sleepiness Scale : two approaches to differential item functioning
- 2013
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Ingår i: Sleep and Breathing. - : Springer Science and Business Media LLC. - 1520-9512 .- 1522-1709. ; 17:1, s. 157-165
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Tidskriftsartikel (refereegranskat)abstract
- Differential item functioning (DIF) is said to exist in an item if a subject's response to the item is affected by other aspects than that which the test is intended to assess. DIF might affect the validity of a test. The aim of this study was thus to examine whether any of the items in the Epworth Sleepiness Scale (ESS) exhibits DIF regarding age or gender, and if so, to which degree. Using previously collected cross-sectional ESS data from 1,168 subjects with different clinical characteristics (61% males, mean age 67.8 year (SD 12.2 year)), ordinal regression as well as Rasch-based DIF analyses were performed. Concerning age, both DIF analyses showed DIF for age in items 3 (inactive in a public place), 4 (passenger in a car), and 8 (in a car that has stopped in traffic). The Rasch model also showed DIF for gender in item 3. The DIF magnitudes as judged by McFadden pseudo-R (2) changes were, however, only minor. ESS has small but reproducible DIF for age in items 3, 4, and 8. The detected DIF might be worth to consider in large-sample studies, although it probably has no effect on an individual basis.
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