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Filosa J, Omland PM, Hagen K, Langsrud K, Engstrøm M, Sand T. Validation of Trøndelag Apnoea Score Proxy for Obstructive Sleep Apnoea in the General Population of Norway: The HUNT Study. SLEEP DISORDERS 2024; 2024:1242505. [PMID: 38961856 PMCID: PMC11222008 DOI: 10.1155/2024/1242505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 07/05/2024]
Abstract
The aim was to validate a new seven-item "TASC" (Trøndelag Apnoea Score) proxy for obstructive sleep apnoea (OSA) against polysomnography in the general population. Objectives included validation against different polysomnographic criteria, stratification by age and gender, and estimation of OSA prevalence. From the fourth wave of the Trøndelag Health Study (HUNT4), 1,201 participants were randomly invited to a substudy focusing on sleep and headaches, of whom 232 accepted and 84 (64% women, mean age 55.0 years, and standard deviation 11.5 years) underwent polysomnography. The TASC proxy sums seven binary items for snoring, observed breathing pauses, restricted daytime activities, hypertension, body mass index (≥30 kg/m2), age (≥50 years), and gender (male). A single night of ambulatory (home) polysomnography was analysed using both the recommended and optional hypopnoea criteria of the American Academy of Sleep Medicine (AASM). We found 65% sensitivity and 87% specificity (Cohen's κ = 0.53, 95% confidence interval 0.34-0.72) for TASC ≥ 3 against AHI ≥ 15 (recommended AASM criteria). Validity was similar against AHI ≥ 30 but lower against AHI ≥ 5 and against the optional AASM criteria. Sensitivity and overall validity were higher among men and those above 50 years of age. The prevalence of an apnoea-hypopnoea index (AHI) of at least 5, 15, or 30 using the recommended (and optional) AASM criteria was 73% (46%), 37% (18%), or 15% (5%). A seven-item TASC proxy for OSA showed good validity and may be useful in screening and epidemiological settings. Sensitivity, specificity, and validity vary considerably by cut-off, by polysomnographic scoring criteria, and by gender and age strata.
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Affiliation(s)
- James Filosa
- Department of Neuromedicine and Movement ScienceFaculty of Medicine and Health SciencesNorwegian University of Science and Technology, Trondheim, Norway
| | - Petter Moe Omland
- Department of Neuromedicine and Movement ScienceFaculty of Medicine and Health SciencesNorwegian University of Science and Technology, Trondheim, Norway
- Department of Neurology and Clinical NeurophysiologySt. Olavs HospitalTrondheim University Hospital, Trondheim, Norway
- Department of Radiology and Nuclear MedicineSt. Olavs HospitalTrondheim University Hospital, Trondheim, Norway
- Norwegian Headache Research Centre (NorHEAD), Trondheim, Norway
| | - Knut Hagen
- Department of Neuromedicine and Movement ScienceFaculty of Medicine and Health SciencesNorwegian University of Science and Technology, Trondheim, Norway
- Norwegian Headache Research Centre (NorHEAD), Trondheim, Norway
- Clinical Research Unit Central NorwaySt. Olavs HospitalTrondheim University Hospital, Trondheim, Norway
| | - Knut Langsrud
- St. Olavs HospitalTrondheim University HospitalØstmarka, Trondheim, Norway
| | - Morten Engstrøm
- Department of Neuromedicine and Movement ScienceFaculty of Medicine and Health SciencesNorwegian University of Science and Technology, Trondheim, Norway
- Department of Neurology and Clinical NeurophysiologySt. Olavs HospitalTrondheim University Hospital, Trondheim, Norway
| | - Trond Sand
- Department of Neuromedicine and Movement ScienceFaculty of Medicine and Health SciencesNorwegian University of Science and Technology, Trondheim, Norway
- Department of Neurology and Clinical NeurophysiologySt. Olavs HospitalTrondheim University Hospital, Trondheim, Norway
- Norwegian Headache Research Centre (NorHEAD), Trondheim, Norway
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Li Y, Miao Y, Tan J, Zhang Q. Association of modifiable risk factors with obstructive sleep apnea: a Mendelian randomization study. Aging (Albany NY) 2023; 15:14039-14065. [PMID: 38085646 PMCID: PMC10756101 DOI: 10.18632/aging.205288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/16/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND The risk factors involved in obstructive sleep apnea (OSA) have not been clearly identified yet. We attempted to systematically investigate genetically predicted modifiable risk factors and lifestyle behaviors associated with OSA. METHODS The association between 34 risk factors and OSA was evaluated using the two-sample Mendelian randomization (MR). Genetic variants for risk factors were acquired from European-descent genome-wide studies. Data sources for OSA were extracted from FinnGen study with 16,761 cases and 201,194 controls. The primary analysis chosen was the inverse-variance weighted method. RESULTS MR analyses provide evidence of genetically predicted poor overall health rating (odds ratio (OR), 2.82; 95% confidence interval (CI), 1.95-4.08), nap during day (OR, 2.01; 95% CI, 1.37-2.93), high body mass index (BMI) (OR, 1.14; 95% CI, 1.09-1.19), increased body fat mass (OR, 1.83; 95% CI, 1.83-2.05), elevated body water mass (OR, 1.50; 95% CI, 1.31-1.70) and hypertension (OR, 1.81; 95% CI, 1.34-2.45) were associated with higher OSA risk, while high education level (OR, 0.55; 95% CI, 0.40-0.75) correlated with reduced OSA risk. Suggestive evidence was obtained for smoking and waist-to-hip ratio (WHR) with higher OSA odds, and vigorous physical activity, and HDL cholesterol with lower OSA odds. After adjusting for BMI using multivariable MR analysis, the effects of smoking, WHR, vigorous physical activity, and HDL-cholesterol were fully attenuated. CONCLUSIONS This MR study indicates that overall health rating, nap during day, BMI, body fat mass, body water mass, hypertension, and education are causally associated with the risk of OSA, which means that these modifiable risk factors are key targets for OSA prevention.
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Affiliation(s)
- Ye Li
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin 300052, China
- Tianjin Geriatrics Institute, Tianjin 300052, China
| | - Yuyang Miao
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin 300052, China
- Tianjin Geriatrics Institute, Tianjin 300052, China
| | - Jin Tan
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin 300052, China
- Tianjin Geriatrics Institute, Tianjin 300052, China
| | - Qiang Zhang
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin 300052, China
- Tianjin Geriatrics Institute, Tianjin 300052, China
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Wan Y, Lv M, Zhou K, Li Z, Du X, Wu W, Xue R. Mood Disorders are Correlated with Autonomic Nervous Function in Chronic Insomnia Patients with OSA. Nat Sci Sleep 2023; 15:511-522. [PMID: 37426309 PMCID: PMC10327906 DOI: 10.2147/nss.s396773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/21/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose To evaluate the correlation between sleep microstructure, autonomic nervous system activity, and neuropsychological characteristics in chronic insomnia (CI) patients with obstructive sleep apnea (OSA). Patients and Methods Forty-five CI-OSA patients, forty-six CI patients and twenty-two matched healthy control subjects (HCs) were enrolled. CI-OSA patients were then divided into two groups: mild OSA and moderate-to-severe OSA. All participants completed neuropsychological tests, which included the Hamilton Depression and Anxiety Scales (HAMD and HAMA), the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS), and the Mini-mental State Examination (MMSE). The autonomic nervous system activity and sleep microstructure were examined by the PSM-100A. Results The CI-OSA patients exhibited higher scores on the PSQI, ESS, ISI, HAMA, and HAMD than HCs and CI patients (all p < 0.01). The CI-OSA patients had a lower proportion of stable sleep, REM sleep and a higher proportion of unstable sleep ratio (all p < 0.01) than HCs and CI patients (all p < 0.01). The CI-OSA patients had higher ratios of LF and LF/HF, and lower ratios of HF and Pnn50% (all p < 0.01) than HCs and CI patients (all p < 0.01). Compared to CI-mild OSA patients, the CI-moderate-to-severe OSA patients presented with a higher ESS scores, higher ratios of LF and LF/HF, and lower ratios of HF (all p < 0.05). In CI-OSA patients, higher HAMD scores were correlated with decreased MMSE scores (r=-0.678, p < 0.01). A higher LF ratio was correlated with higher HAMD and HAMA scores (r=0.321, p=0.031, r =0.449, p =0.002), and a higher HF ratio was correlated with lower HAMD and HAMA scores (r=-0.321, P =0.031, r =-0.449, p =0.002). Conclusion OSA exacerbates the abnormalities of sleep microstructure and the autonomic nervous dysfunction in CI patients. Dysfunction of the autonomic nervous system could contribute to mood deterioration in CI with OSA patients.
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Affiliation(s)
- Yahui Wan
- Departments of Neurology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, 300308, People’s Republic of China
| | - Mengdi Lv
- Departments of Neurology, Tianjin First Central Hospital, Tianjin, 300190, People’s Republic of China
| | - Kaili Zhou
- Departments of Neurology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, 300308, People’s Republic of China
| | - Zheng Li
- Departments of Neurology, Binhai Hospital, Peking University, Tianjin, 300450, People’s Republic of China
| | - Xueyun Du
- Departments of Neurology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, 300308, People’s Republic of China
| | - Wei Wu
- Departments of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China
| | - Rong Xue
- Departments of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China
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Dahl AG, Havang S, Hagen K. Reliability of a self-administrated musculoskeletal questionnaire: The fourth Trøndelag health study. Musculoskelet Sci Pract 2022; 57:102496. [PMID: 34933232 DOI: 10.1016/j.msksp.2021.102496] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 12/08/2021] [Accepted: 12/14/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND The reliability of the Nordic Musculoskeletal Questionnaire (NMQ) has not been evaluated in an unselected general population. The aim of this population-based follow-up study was to estimate the reliability between a self-administered NMQ-based questionnaire and a face-to-face interview performed approximately two months later. To interpret the results, we assessed the 1-year prevalence of various pain musculoskeletal pain locations. METHODS A random sample of 1201 participants in the fourth wave of the Trøndelag Health Survey were invited to a follow-up interview focusing on sleep and pain. A total of 232 (19%) participated a semi-structured interview, and the agreement with the corresponding answers in the musculoskeletal questionnaire in HUNT4 were evaluated by Cohen's kappa statistics with 95% confidence interval (CI). The 1-year prevalence of the various pain sites was stratified by age and gender. RESULTS The reliability was good for chronic musculoskeletal pain (CMSP), chronic widespread musculoskeletal pain (CWMSP) and pain in hip and knee (kappa values between 0.63 and 0.68). Moderate kappa values between 0.51 and 0.60 were found for pain in the neck, shoulder, elbow, wrist/hand, upper back, lower back, calf, ankle/feet, and ≥7 pain sites. The 1-year prevalence was 54.3% for CMSP and 17.2 for CWMSP, substantially higher for women and among those aged 50 years or more. CONCLUSION In this population-based study the reliability between interview and questionnaire was good to moderate for most pain locations. In particular, the self-administered musculoskeletal questionnaire seems to be a useful tool in identifying individuals with CMSP, CWMSP, and pain in hip and knee.
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Affiliation(s)
- Astri Grøtan Dahl
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sara Havang
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Knut Hagen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway; Clinical Research Unit Central Norway, St. Olavs Hospital, Trondheim, Norway.
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Duarte RLM, Magalhães-da-Silveira FJ, Gozal D. Influence of nocturnal insomnia symptoms on obstructive sleep apnea diagnosis in a clinical referral cohort. J Clin Sleep Med 2021; 18:1271-1278. [PMID: 34931605 PMCID: PMC9059600 DOI: 10.5664/jcsm.9842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To assess whether nocturnal symptoms of insomnia influence the prevalence of obstructive sleep apnea (OSA) in a clinical referral cohort. METHODS Insomnia was defined by the presence of one or more of the following complaints: difficulty initiating sleep, difficulty maintaining sleep, and/or early morning awakenings. OSA severity was based on an apnea-hypopnea index: ≥ 5.0/h (any OSA), ≥ 15.0/h (moderate/severe OSA), and ≥ 30/h (severe OSA). Multivariate logistic regression analysis was used to evaluate predictive factors for OSA diagnosis and severity. RESULTS Overall, 12,021 outpatients referred for polysomnography (PSG) were grouped into two cohorts: without insomnia (58.2%) and with insomnia (41.8%). Individuals without insomnia had a higher prevalence of OSA than those with insomnia (p < 0.001, for all OSA severity levels). The presence of insomnia was negatively associated with diagnosis of any OSA (adjusted odds ratio [OR]: 0.852; 95% confidence interval [CI]: 0.769-0.944), moderate/severe OSA (adjusted OR: 0.819; 95% CI: 0.751-0.892), and severe OSA (adjusted OR: 0.816; 95% CI: 0.746-0.892). Moreover, the number of nocturnal symptoms of insomnia was associated with a lower likelihood of OSA, even when adjusted for other confounders such as sex, age, body mass index, neck circumference, excessive daytime sleepiness, hypertension, and type 2 diabetes mellitus. CONCLUSIONS In this present study that included a large sample of consecutive outpatients, there was an inverse relationship between the number of nocturnal symptoms of insomnia and OSA diagnosis.
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Affiliation(s)
- Ricardo L M Duarte
- SleepLab - Laboratório de Estudo dos Distúrbios do Sono, Centro Médico BarraShopping, Rio de Janeiro, Brazil.,Instituto de Doenças do Tórax - Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - David Gozal
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO
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Lechat B, Appleton S, Melaku YA, Hansen K, McEvoy RD, Adams R, Catcheside P, Lack L, Eckert DJ, Sweetman A. Co-morbid insomnia and obstructive sleep apnoea is associated with all-cause mortality. Eur Respir J 2021; 60:13993003.01958-2021. [PMID: 34857613 DOI: 10.1183/13993003.01958-2021] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/16/2021] [Indexed: 11/05/2022]
Abstract
STUDY OBJECTIVES Increased mortality has been reported in people with insomnia and in those with obstructive sleep apnoea (OSA). However, these conditions commonly co-occur and the combined effect of co-morbid insomnia and sleep apnoea (COMISA) on mortality risk is unknown. This study used Sleep Heart Health Study (SHHS) data to assess associations between COMISA and all-cause mortality risk. METHODS Insomnia was defined as difficulties falling asleep, maintaining sleep, and/or early morning awakenings from sleep ≥16 times a month and daytime impairment. OSA was defined as an apnoea-hypopnoea index ≥15 events/h sleep. COMISA was defined if both conditions were present. Multivariable adjusted Cox proportional hazard models were used to determine the association between COMISA and all-cause mortality (n=1210) over 15 years of follow-up. RESULTS 5236 participants were included. 2708 (52%) did not have insomnia/OSA (control), 170 (3%) had insomnia-alone, 2221 (42%) had OSA-alone, and 137 (3%) had COMISA. COMISA participants had a higher prevalence of hypertension (ORs [95%CI]; 2.00 [1.39, 2.90]) and cardiovascular disease compared to controls (1.70 [1.11, 2.61]). Insomnia-alone and OSA-alone were associated with higher risk of hypertension but not cardiovascular disease compared to controls. Compared to controls, COMISA was associated with a 47% (HR, 95% CI; 1.47 (1.06, 2.07)) increased risk of mortality. The association between COMISA and mortality was consistent across multiple definitions of OSA and insomnia. CONCLUSIONS Co-morbid insomnia and sleep apnoea was associated with higher rates of hypertension and cardiovascular disease at baseline, and an increased risk of all-cause mortality compared to no insomnia/OSA.
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Affiliation(s)
- Bastien Lechat
- College of Science and Engineering, Flinders University, Adelaide, Australia .,Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Sarah Appleton
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Yohannes Adama Melaku
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Kristy Hansen
- College of Science and Engineering, Flinders University, Adelaide, Australia
| | - R Doug McEvoy
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - Robert Adams
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - Peter Catcheside
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Leon Lack
- National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia.,College of Education, Psychology and Social Work, Flinders University, , Adelaide, South Australia, Australia
| | - Danny J Eckert
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Alexander Sweetman
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
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Neverdahl JP, Uglem M, Matre D, Hansen JO, Engstrøm M, Tronvik E, Stovner LJ, Sand T, Omland PM. Pain thresholds and suprathreshold pain after sleep restriction in migraine - A blinded crossover study. Cephalalgia 2021; 42:466-480. [PMID: 34786965 PMCID: PMC9039317 DOI: 10.1177/03331024211056565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE There is an unexplained association between disturbed sleep and migraine. In this blinded crossover study, we investigate if experimental sleep restriction has a different effect on pain thresholds and suprathreshold pain in interictal migraineurs and controls. METHODS Forearm heat pain thresholds and tolerance thresholds, and trapezius pressure pain thresholds and suprathreshold pain were measured in 39 interictal migraineurs and 31 healthy controls after two consecutive nights of partial sleep restriction and after habitual sleep. RESULTS The effect of sleep restriction was not significantly different between interictal migraineurs and controls in the primary analyses. Pressure pain thresholds tended to be lower (i.e., increased pain sensitivity) after sleep restriction in interictal migraineurs compared to controls with a 48-hour preictal-interictal cut-off (p = 0.061). We found decreased pain thresholds after sleep restriction in two of seven migraine subgroup comparisons: heat pain thresholds decreased in migraineurs with lower pain intensity during attacks (p = 0.005) and pressure pain thresholds decreased in migraineurs with higher severity of photophobia during attacks (p = 0.031). Heat pain thresholds tended to decrease after sleep restriction in sleep-related migraine (p = 0.060). Sleep restriction did not affect suprathreshold pain measurements in either group. CONCLUSION This study could not provide strong evidence for an increased effect of sleep restriction on pain sensitivity in migraineurs compared to healthy controls. There might be a slightly increased effect of sleep restriction in migraineurs, detectable using large samples or more pronounced in certain migraine subgroups.
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Affiliation(s)
- Jan Petter Neverdahl
- Department of Neuromedicine and Movement Sciences, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Martin Uglem
- Department of Neuromedicine and Movement Sciences, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
| | - Dagfinn Matre
- Norwegian National Headache Centre, St. Olavs Hospital, Trondheim, Norway
| | - Johannes Orvin Hansen
- Department of Neuromedicine and Movement Sciences, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Morten Engstrøm
- Department of Neuromedicine and Movement Sciences, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
| | - Erling Tronvik
- Department of Neuromedicine and Movement Sciences, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway.,Norwegian National Headache Centre, St. Olavs Hospital, Trondheim, Norway
| | - Lars Jacob Stovner
- Department of Neuromedicine and Movement Sciences, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway.,Norwegian National Headache Centre, St. Olavs Hospital, Trondheim, Norway
| | - Trond Sand
- Department of Neuromedicine and Movement Sciences, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
| | - Petter Moe Omland
- Department of Neuromedicine and Movement Sciences, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
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Duarte RLM, Magalhães-da-Silveira FJ, Gozal D. Predictive Factors for Obstructive Sleep Apnea Diagnosis in Bariatric Surgery Candidates with or Without Chronic Insomnia Complaints. Obes Surg 2021; 32:33-41. [PMID: 34633613 DOI: 10.1007/s11695-021-05748-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/29/2021] [Accepted: 10/05/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aims to evaluate the frequency of insomnia complaints in bariatric patients and to assess obstructive sleep apnea (OSA) predictors according to the presence or absence of chronic insomnia. METHODS Insomnia was defined as the presence of at least one specific symptom: difficulty falling asleep, difficulty maintaining sleep, and/or waking up earlier than expected. Diagnosis of OSA was objectively obtained from in-laboratory polysomnography. Multivariate logistic regression analysis was used to assess OSA predictors. RESULTS This cross-sectional study contains 1,737 bariatric surgery candidates: 59.6% without insomnia and 40.4% with insomnia. OSA prevalence was similar among participants with or without insomnia either for any OSA (p = 0.168) or for moderate-to-severe OSA (p = 0.185). Patients without insomnia showed a higher prevalence of severe OSA than those with insomnia (p = 0.005). In both cohorts, five parameters were independent OSA predictors: sex, age, body mass index (BMI), neck circumference (NC), and excessive daytime sleepiness (EDS). Male sex was the most important predictor, whether in individuals without insomnia (adjusted odds ratio [OR] ranging from 4.874 to 8.369) or in those with insomnia (adjusted OR ranging from 5.672 to 12.441). CONCLUSIONS A considerable proportion of bariatric patients report insomnia complaints. The probability of suffering from OSA was similar among bariatric candidates with or without insomnia, except for severe OSA diagnosis. Sex, age, BMI, NC, and EDS were independent predictors for OSA diagnosis irrespective of insomnia symptoms, and male sex was the main predictor for OSA in bariatric individuals with or without insomnia.
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Affiliation(s)
- Ricardo L M Duarte
- SleepLab - Laboratório de Estudo Dos Distúrbios Do Sono, Centro Médico BarraShopping, Rio de Janeiro, Brazil.
- Instituto de Doenças Do Tórax da Universidade Federal Do Rio de Janeiro, Rio de Janeiro, Brazil.
| | | | - David Gozal
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
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Frangopoulos F, Zannetos S, Nicolaou I, Economou NT, Adamide T, Georgiou A, Nikolaidis PT, Rosemann T, Knechtle B, Trakada G. The Complex Interaction Between the Major Sleep Symptoms, the Severity of Obstructive Sleep Apnea, and Sleep Quality. Front Psychiatry 2021; 12:630162. [PMID: 33716827 PMCID: PMC7947685 DOI: 10.3389/fpsyt.2021.630162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/29/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Little information exists in the general population whether clinical presentation phenotypes of obstructive sleep apnea (OSA) differ in terms of sleep quality and comorbidities. Aim: The purpose of our study was to assess possible differences between symptomatic and asymptomatic OSA patients concerning syndrome's severity, patients' sleep quality, and comorbidities. Subjects and methods: First, in a nationwide, stratified, epidemiological survey, 4,118 Cypriot adult participants were interviewed about sleep habits and complaints. In the second stage of the survey, 264 randomly selected adults underwent a type III sleep study for possible OSA. Additionally, they completed the Greek version of Pittsburgh Sleep Quality Index (Gr-PSQI), Epworth Sleepiness Scale (ESS), Athens Insomnia Scale (AIS), and Hospital Anxiety and Depression Scale (HADS). Results: From 264 enrolled participants, 155 individuals (40 females and 115 males) were first diagnosed with OSA. Among these 155 patients, 34% had ESS ≥ 10 and 49% AIS ≥ 6. One or both symptoms present categorized the individual as symptomatic (60%) and neither major symptom as asymptomatic (40%). There were no significant statistical differences (SSDs) between the two groups (symptomatic-asymptomatic) with regard to anthropometrics [age or gender; neck, abdomen, and hip circumferences; and body mass index (BMI)]. The two groups had no differences in OSA severity-as expressed by apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and mean oxyhemoglobin saturation (SaO2)-and in cardiometabolic comorbidities. Symptomatic patients expressed anxiety and depression more often than asymptomatics (p < 0.001) and had poorer subjective sleep quality (Gr-PSQI, p < 0.001). According to PSQI questionnaire, there were no SSDs regarding hours in bed and the use of sleep medications, but there were significant differences in the subjective perception of sleep quality (p < 0.001), sleep efficiency (p < 0.001), duration of sleep (p = 0.001), sleep latency (p = 0.007), daytime dysfunction (p < 0.001), and finally sleep disturbances (p < 0.001). Conclusion: According to our data, OSA patients reporting insomnia-like symptoms and/or sleepiness do not represent a more severe phenotype, by the classic definition of OSA, but their subjective sleep quality is compromised, causing a vicious cycle of anxiety or depression.
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Affiliation(s)
| | - Savvas Zannetos
- Health Economics and Statistics, Neapolis University, Paphos, Cyprus
| | - Ivi Nicolaou
- Respiratory Department, Nicosia General Hospital, Nicosia, Cyprus
| | - Nicholas-Tiberio Economou
- Division of Pulmonology, Department of Clinical Therapeutics, School of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Tonia Adamide
- Respiratory Department, Nicosia General Hospital, Nicosia, Cyprus
| | - Andreas Georgiou
- Respiratory Department, Nicosia General Hospital, Nicosia, Cyprus
| | | | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Georgia Trakada
- Division of Pulmonology, Department of Clinical Therapeutics, School of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Filosa J, Omland PM, Langsrud K, Hagen K, Engstrøm M, Drange OK, Knutsen AJ, Brenner E, Kallestad H, Sand T. Validation of insomnia questionnaires in the general population: The Nord-Trøndelag Health Study (HUNT). J Sleep Res 2020; 30:e13222. [PMID: 33111452 DOI: 10.1111/jsr.13222] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/14/2020] [Accepted: 09/30/2020] [Indexed: 01/26/2023]
Abstract
The primary aim was to validate questionnaire-based insomnia diagnoses from a modified Karolinska Sleep Questionnaire (KSQ) and the Insomnia Severity Index (ISI), by age category (< or >65 years), against a semi-structured face-to-face interview. Secondary aims were to split validity by diagnostic certainty of the interview and to compare prevalence estimates of questionnaire- and interview-based diagnoses. A total of 232 out of 1,200 invited (19.3%) from the fourth Nord-Trøndelag Health Study (HUNT4) completed questionnaires, including the KSQ and ISI, shortly before attending a face-to-face diagnostic interview for insomnia based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Both a tentative (DSM-5 criteria A-E) and a definite (criteria A-H) interview diagnosis was evaluated. Cohen's kappa statistic quantified questionnaire validity. In all, 33% (95% confidence interval 27-39%) of participants had definite insomnia: 40% of women and 21% of men. The ISI (cut-off 12) and several KSQ-based diagnoses showed very good validity (κ ≤0.74) against the tentative, versus good validity (κ ≤0.61) against the definite interview diagnosis. Short questionnaires, requiring a daytime symptom at least three times a week, may underestimate insomnia prevalence. Validity was consistently higher for persons aged below versus above 65 years (definite insomnia: κ ≤0.64 vs. κ ≤0.56). Our results have implications for epidemiological population-based studies utilising insomnia questionnaires.
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Affiliation(s)
- James Filosa
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Petter Moe Omland
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
| | - Knut Langsrud
- Division of Mental Health Care, St. Olavs Hospital, Trondheim, Norway
| | - Knut Hagen
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
| | - Morten Engstrøm
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
| | - Ole Kristian Drange
- Division of Mental Health Care, St. Olavs Hospital, Trondheim, Norway.,Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Eiliv Brenner
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
| | - Håvard Kallestad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Division of Mental Health Care, St. Olavs Hospital, Trondheim, Norway
| | - Trond Sand
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
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Agudelo C, Ramos AR, Williams NJ, Wallace DM. Do symptoms of sleepiness and insomnia in US veterans with obstructive sleep apnea vary by age? Sleep Breath 2020; 24:159-166. [PMID: 31044372 PMCID: PMC6824916 DOI: 10.1007/s11325-019-01845-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/06/2019] [Accepted: 04/15/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The influence of aging on the clinical presentation of obstructive sleep apnea (OSA) is not well characterized in US veterans. Our aims were to (1) examine age and established predictors of sleepiness and insomnia symptoms in veterans with OSA and (2) determine if the relationship between predictors of the Epworth sleepiness scale (ESS) and insomnia severity index (ISI) depended on age. METHODS We performed a retrospective analysis of veterans diagnosed with OSA at the Miami VA in 2014. On polysomnography (PSG) night, questionnaires were completed querying socio-demographics, insomnia (ISI), sleepiness (ESS), and self-reported sleep duration. Regression modeling was performed to explore association of variables with (1) ESS and (2) ISI. Analyses were performed in two steps: (1) variables were tested for main effects and (2) product of age and each variable found to have an association at a significance level of p < 0.10 with primary outcome were entered separately to test for interaction. RESULTS The sample consisted of 483 veterans (93% male, age 52 ± 13 years, 41% black, 34% Hispanic). Having a regular bed partner, higher weighted medical comorbidities, chronic pain diagnosis, and shorter sleep duration were associated with ESS. Age did not moderate the relationship between these variables and ESS. Younger age, Hispanic ethnicity, higher educational level, shorter sleep duration, mood, and pain diagnoses were each associated with the ISI. Furthermore, an age-sleep duration interaction term was associated with the ISI (b = - 0.03; p = 0.005). For all participants, there was an inverse relationship between sleep duration and ISI. However, for any sleep duration, older veterans reported lower levels of insomnia than younger veterans. DISCUSSION Older veterans with OSA may report lower ISI scores. Alternative assessment methods for comorbid insomnia among older individuals with OSA may be needed.
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Affiliation(s)
- C Agudelo
- Department of Neurology, Sleep Medicine Division, University of Miami Miller School of Medicine, Miami, FL, USA
- Neurology Service, Bruce W. Carter Department of Veterans Affairs Medical Center, 1201 NW 16th Street, Miami, FL, 33125, USA
| | - A R Ramos
- Department of Neurology, Sleep Medicine Division, University of Miami Miller School of Medicine, Miami, FL, USA
| | - N J Williams
- Department of Population Health, New York Langone Health, Center for Healthful Behavior Change, New York, NY, USA
| | - D M Wallace
- Department of Neurology, Sleep Medicine Division, University of Miami Miller School of Medicine, Miami, FL, USA.
- Neurology Service, Bruce W. Carter Department of Veterans Affairs Medical Center, 1201 NW 16th Street, Miami, FL, 33125, USA.
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Hagen K, Åsberg AN, Uhlig BL, Tronvik E, Brenner E, Sand T. The HUNT4 study: the validity of questionnaire-based diagnoses. J Headache Pain 2019; 20:70. [PMID: 31195960 PMCID: PMC6734226 DOI: 10.1186/s10194-019-1021-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 06/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Questionnaire-based headache diagnoses should be validated against diagnoses made by the gold standard, which is personal interview by a headache expert. The diagnostic algorithm with the best diagnostic accuracy should be used when later analysing the data. METHODS The Nord-Trøndelag Health Study (HUNT4) was performed between 2017 and 2019. Among HUNT4 participants, a total of 232 (19.3%) out of 1201 randomly invited were interviewed by a headache expert to assess the sensitivity, specificity and kappa value of the questionnaire-based headache diagnoses. RESULTS The median interval between answering the headache questions and the validation interview was 60 days (95% CI 56-62 days). The best agreements were found for self-reported lifetime migraine (sensitivity of 59%, specificity of 99%, and a kappa statistic of 0.65, 95% CI 0.55-0.75), self-reported active migraine (sensitivity of 50%, specificity of 97%, and a kappa statistic of 0.55, 95% 0.39-0.71), liberal criteria of migraine (sensitivity of 64%, specificity of 93%, and a kappa statistic of 0.58, 95% CI 0.43-0.73) and ICDH3-based migraine ≥1 days/month (sensitivity of 50%, specificity of 94%, and a kappa statistic of 0.49, 95% CI 0.30-0.68). For headache suffering ≥1 days/month a sensitivity of 90%, specificity 80%, and a kappa statistic of 0.55, 95% CI 0.41-0-69 were found. For tension-type headache (TTH) ≥ 1 days/month the agreement was 0.33 (95% CI 0.17-0.49). CONCLUSION The HUNT4 questionnaire is a valid tool for identifying persons with lifetime migraine, self-reported active migraine and active migraine applying liberal modified criteria. The agreement for TTH was fair.
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Affiliation(s)
- Knut Hagen
- Department of Neuromedicine and Movement science, Faculty of Medicine, Norwegian University of Science and Technology, 7489, Trondheim, Norway. .,Norwegian Advisory Unit on Headaches, St. Olavs University Hospital, Trondheim, Norway. .,Clinical Trial Unit, St. Olavs Hospital, Trondheim, Norway.
| | - Anders Nikolai Åsberg
- Department of Neuromedicine and Movement science, Faculty of Medicine, Norwegian University of Science and Technology, 7489, Trondheim, Norway
| | - Benjamin L Uhlig
- Department of Neuromedicine and Movement science, Faculty of Medicine, Norwegian University of Science and Technology, 7489, Trondheim, Norway
| | - Erling Tronvik
- Department of Neuromedicine and Movement science, Faculty of Medicine, Norwegian University of Science and Technology, 7489, Trondheim, Norway.,Norwegian Advisory Unit on Headaches, St. Olavs University Hospital, Trondheim, Norway
| | - Eiliv Brenner
- Department of Neurology and Clinical Neurophysiology, St. Olavs University Hospital, Trondheim, Norway
| | - Trond Sand
- Department of Neuromedicine and Movement science, Faculty of Medicine, Norwegian University of Science and Technology, 7489, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St. Olavs University Hospital, Trondheim, Norway
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