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Sigurðardóttir ES, Gislason T, Benediktsdottir B, Hustad S, Dadvand P, Demoly P, Franklin KA, Heinrich J, Holm M, van der Plaat DA, Jõgi R, Leynaert B, Lindberg E, Martinez-Moratalla J, Sainz De Aja L, Pesce G, Pin I, Raherison C, Pereira-Vega A, Real FG, Triebner K. Female sex hormones and symptoms of obstructive sleep apnea in European women of a population-based cohort. PLoS One 2022; 17:e0269569. [PMID: 35731786 PMCID: PMC9216532 DOI: 10.1371/journal.pone.0269569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/23/2022] [Indexed: 11/18/2022] Open
Abstract
Background
The prevalence of obstructive sleep apnea is higher in women after menopause. This is suggested to be a result of an altered sex hormone balance but has so far not been confirmed in a population-based study.
Objective
To investigate whether serum concentration of estrogens and progesterone are associated with the prevalence of sleep apnea symptoms in middle-aged women of the general population.
Methods
We analyzed data from 774 women (40–67 years) from 15 study centers in seven countries participating in the second follow-up of the European Community Respiratory Health Survey (2010–2012). Multiple logistic regression models were fitted with self-reported symptoms of sleep apnea as outcomes and serum concentrations of various estrogens and progesterone as predictors. All analyses were adjusted for relevant covariates including age, BMI, education, study center, smoking habits, and reproductive age.
Results
Among all included women, a doubling of serum concentrations of estrone and progesterone was associated with 19% respectively 9% decreased odds of snoring. Among snorers, a doubling of the concentrations of 17β-estradiol, estrone and estrone 3-sulfate was associated with 18%, 23% and 17% decreased odds of breathing irregularly, and a doubling of the progesterone concentration was further associated with 12% decreased odds of waking up suddenly with a chocking sensation. Other evaluated associations were not statistically significant.
Conclusions
Middle-aged women with low serum estrogen and progesterone levels are more likely to snore and report symptoms of obstructive sleep apnea.
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Affiliation(s)
| | - Thorarinn Gislason
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Sleep, Landspitali University Hospital, Reykjavík, Iceland
| | | | - Steinar Hustad
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Core Facility for Metabolomics, University of Bergen, Bergen, Norway
| | - Payam Dadvand
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidomiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Pascal Demoly
- University Hospital of Montpellier, IDESP, INSERM-Univ Montpellier, Montpellier, France
| | - Karl A. Franklin
- Department of Surgical and Perioperative Sciences, Surgery Umeå University, Umeå, Sweden
| | - Joachim Heinrich
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig Maximilians University Munich, Munich, Germany
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Mathias Holm
- Department of Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden
| | | | - Rain Jõgi
- Tartu University Hospital, Lung Clinic, Tartu, Estonia
| | - Benedicte Leynaert
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire intégrative, CESP, 94807, Villejuif, France
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory, allergy and sleep research, Uppsala University, Uppsala, Sweden
| | - Jesus Martinez-Moratalla
- Pulmonology Service, Albacete University Hospital Complex, Health Service of Castilla—La Mancha, Albacete, Spain
- Faculty of Medicine of Albacete, Castilla-La Mancha University, Albacete, Spain
| | - Leire Sainz De Aja
- Unit of Epidemiology and Public Health, Department of Health, Basque Government, Bilbao, Spain
| | - Giancarlo Pesce
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire intégrative, CESP, 94807, Villejuif, France
| | - Isabelle Pin
- Department of Paediatrics, University Hospital Grenoble Alpes, French National Institute of Health and Medical Research, Grenoble, France
- Institute for Advanced Biosciences, Grenoble; University Grenoble Alpes, 38043, Grenoble cedex 9, France
| | - Chantal Raherison
- U1219, Bordeaux Population Health Research, Bordeaux University, 33076, Bordeaux, France
| | - Antonio Pereira-Vega
- Service of Pneumology and Allergy, University Hospital Juan Ramón Jiménez, Huelva, Spain
| | - Francisco Gómez Real
- Department of Gynaecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
- Research Unit for health surveys, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Kai Triebner
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Core Facility for Metabolomics, University of Bergen, Bergen, Norway
- * E-mail:
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2
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Rogers M, Coates A, Huggins CE, Dorrian J, Clark AB, Davis C, Leung GK, Davis R, Phoi YY, Kellow NJ, Iacovou M, Yates CL, Banks S, Sletten TL, Bonham MP. Study protocol for the Shifting Weight using Intermittent Fasting in night shift workers (SWIFt) study: a three-arm randomised controlled trial comparing three weight loss strategies in night shift workers with obesity. BMJ Open 2022; 12:e060520. [PMID: 35473743 PMCID: PMC9045043 DOI: 10.1136/bmjopen-2021-060520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Shift workers are at an increased risk of developing obesity and type 2 diabetes. Eating and sleeping out of synchronisation with endogenous circadian rhythms causes weight gain, hyperglycaemia and insulin resistance. Interventions that promote weight loss and reduce the metabolic consequences of eating at night are needed for night shift workers. The aim of this study is to examine the effects of three weight loss strategies on weight loss and insulin resistance (HOMA-IR) in night shift workers. METHODS AND ANALYSIS A multisite 18-month, three-arm randomised controlled trial comparing three weight loss strategies; continuous energy restriction; and two intermittent fasting strategies whereby participants will fast for 2 days per week (5:2); either during the day (5:2D) or during the night shift (5:2N). Participants will be randomised to a weight loss strategy for 24 weeks (weight loss phase) and followed up 12 months later (maintenance phase). The primary outcomes are weight loss and a change in HOMA-IR. Secondary outcomes include changes in glucose, insulin, blood lipids, body composition, waist circumference, physical activity and quality of life. Assessments will be conducted at baseline, 24 weeks (primary endpoint) and 18 months (12-month follow-up). The intervention will be delivered by research dietitians via a combination of face-to-face and telehealth consultations. Mixed-effect models will be used to identify changes in dependent outcomes (weight and HOMA-IR) with predictor variables of outcomes of group, time and group-time interaction, following an intention-to-treat approach. ETHICS AND DISSEMINATION The study protocol was approved by Monash Health Human Research Ethics Committee (RES 19-0000-462A) and registered with Monash University Human Research Ethics Committee. Ethical approval has also been obtained from the University of South Australia (HREC ID: 202379) and Ambulance Victoria Research Committee (R19-037). Results from this trial will be disseminated via conference presentations, peer-reviewed journals and student theses. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN-12619001035112).
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Affiliation(s)
- Michelle Rogers
- UniSA Justice & Society, University of South Australia, Adelaide, South Australia, Australia
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Alison Coates
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Catherine E Huggins
- Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
| | - Jillian Dorrian
- UniSA Justice & Society, University of South Australia, Adelaide, South Australia, Australia
| | - Angela B Clark
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
| | - Corinne Davis
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
| | - Gloria Kw Leung
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
| | - Rochelle Davis
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
| | - Yan Yin Phoi
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Nicole J Kellow
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
| | - Marina Iacovou
- Centre of Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Molecular and Translational Science, Monash University, Clayton, Victoria, Australia
| | - Crystal L Yates
- UniSA Justice & Society, University of South Australia, Adelaide, South Australia, Australia
- Behaviour-Brain-Body Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Siobhan Banks
- UniSA Justice & Society, University of South Australia, Adelaide, South Australia, Australia
- Behaviour-Brain-Body Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Tracey L Sletten
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Notting Hill, Victoria, Australia
| | - Maxine P Bonham
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
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3
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Riha RL. Defining obstructive sleep apnoea syndrome: a failure of semantic rules. Breathe (Sheff) 2022; 17:210082. [PMID: 35035552 PMCID: PMC8753646 DOI: 10.1183/20734735.0082-2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/27/2021] [Indexed: 12/14/2022] Open
Abstract
Obstructive sleep apnoea syndrome (OSAS) is one of the most ubiquitous medical conditions in industrialised society. Since the recognition that symptoms of excessive daytime somnolence, problems with concentration, mood and cognitive impairment, as well as cardiometabolic abnormalities can arise as a consequence of obstructed breathing during sleep, it has been subject to variation in its definition. Over the past five decades, attempts have been made to standardise the definitions and scoring criteria used for apnoeas and hypopnoea, which are the hallmarks of obstructive sleep apnoea (OSA). However, applying these definitions in clinical and research practice has resulted in over- and under-estimation of the severity and prevalence of OSAS. Furthermore, the definitions may eventually become redundant in the context of rapid technological advances in breathing measurement and other signal acquisition. Increased efforts towards precision medicine have led to a focus on the pathophysiology of obstructed breathing during sleep. However, the same degree of effort has not been focused on how and why the latter does or does not result in diurnal symptoms, integral to the definition of OSAS. This review focuses on OSAS in adults and discusses some of the difficulties with current definitions and the possible reasons behind them. The definition of obstructive sleep apnoea syndrome appears to be in constant flux dependent on the definitions attributed to its diagnostic componentshttps://bit.ly/3zXrWKg
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Affiliation(s)
- Renata L Riha
- Dept of Sleep Medicine, Royal Infirmary Edinburgh, Edinburgh, UK.,Sleep Research Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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4
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Abstract
The authors discuss the challenges of machine- and deep learning-based automatic analysis of obstructive sleep apnea with respect to known issues with the signal interpretation, patient physiology, and the apnea-hypopnea index. Their goal is to provide guidance for sleep and machine learning professionals working in this area of sleep medicine. They suggest that machine learning approaches may well be better targeted at examining and attempting to improve the diagnostic criteria, in order to build a more nuanced understanding of the detailed circumstances surrounding OSA, rather than merely attempting to reproduce human scoring.
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Affiliation(s)
- Jacky Mallett
- Department of Computer Science, Reykjavik University, Menntavegur 1, Reykjavik 102, Iceland.
| | - Erna Sif Arnardottir
- Reykjavik University Sleep Institute, Reykjavik University, Reykjavik, Iceland; Internal Medicine Services, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
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5
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Arnardottir ES, Islind AS, Óskarsdóttir M. The Future of Sleep Measurements: A Review and Perspective. Sleep Med Clin 2021; 16:447-464. [PMID: 34325822 DOI: 10.1016/j.jsmc.2021.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This article provides an overview of the current use, limitations, and future directions of the variety of subjective and objective sleep assessments available. This article argues for various ways and sources of collecting, combining, and using data to enlighten clinical practice and the sleep research of the future. It highlights the prospects of digital management platforms to store and present the data, and the importance of codesign when developing such platforms and other new instruments. It also discusses the abundance of opportunities that data science and machine learning open for the analysis of data.
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Affiliation(s)
- Erna Sif Arnardottir
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Menntavegi 1, 102 Reykjavik, Iceland; Internal Medicine Services, Landspitali University Hospital, E7 Fossvogi, 108 Reykjavik, Iceland.
| | - Anna Sigridur Islind
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Menntavegi 1, 102 Reykjavik, Iceland; Department of Computer Science, Reykjavik University, Menntavegi 1, 102 Reykjavik, Iceland
| | - María Óskarsdóttir
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Menntavegi 1, 102 Reykjavik, Iceland; Department of Computer Science, Reykjavik University, Menntavegi 1, 102 Reykjavik, Iceland
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6
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Stewart NH, Walters RW, Mokhlesi B, Lauderdale DS, Arora VM. Sleep in hospitalized patients with chronic obstructive pulmonary disease: an observational study. J Clin Sleep Med 2021; 16:1693-1699. [PMID: 32620186 DOI: 10.5664/jcsm.8646] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
STUDY OBJECTIVES The aim of this study was to compare the risk of undiagnosed sleep disorders among medical patients with chronic obstructive pulmonary disease (COPD) compared with those without COPD. METHODS In a prospective cohort study, hospitalized medical ward patients without a known sleep disorder were screened, using validated questionnaires, for sleep disorders, such as obstructive sleep apnea and insomnia. Daily sleep duration and efficiency in the hospital were measured via wrist actigraphy. Participants were classified into two groups: those with a primary or secondary diagnosis of COPD and those without a history of COPD diagnosis. Sleep outcomes were compared by COPD diagnosis. RESULTS From March 2010 to July 2015, 572 patients completed questionnaires and underwent wrist actigraphy. On admission, patients with COPD had a greater adjusted risk of obstructive sleep apnea (adjusted odds ratio 1.82, 95% confidence interval 1.12-2.96, P = .015) and clinically significant insomnia (adjusted odds ratio 2.07, 95% confidence interval 1.12-3.83, P = .021); no differences were observed for sleep quality or excess sleepiness on admission. After adjustment, compared with patients without COPD, patients with COPD averaged 34 fewer minutes of nightly sleep (95% confidence interval 4.2-64.0 minutes, P = .026), as well as 22.5% lower odds of normal sleep efficiency while in the hospital (95% confidence interval 3.3%-37.9%, P = .024). No statistically significant differences were observed for in-hospital sleep quality, soundness, or ease of falling asleep. CONCLUSIONS Among hospitalized patients in medical wards, those with COPD have higher risk of OSA and insomnia and worse in-hospital sleep quality and quantity compared with those without COPD.
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Affiliation(s)
- Nancy H Stewart
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Ryan W Walters
- Department of Medicine, Creighton University, Omaha, Nebraska
| | - Babak Mokhlesi
- Section of Pulmonary, Critical Care, and Sleep Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Diane S Lauderdale
- Department of Public Health Studies, University of Chicago, Chicago, Illinois
| | - Vineet M Arora
- Section of General Internal Medicine, University of Chicago Medical Center, Chicago, Illinois
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7
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Santoso AMM, Jansen F, Lissenberg-Witte BI, Baatenburg de Jong RJ, Langendijk JA, Leemans CR, Smit JH, Takes RP, Terhaard CHJ, van Straten A, Verdonck-de Leeuw IM. Poor sleep quality among newly diagnosed head and neck cancer patients: prevalence and associated factors. Support Care Cancer 2021; 29:1035-1045. [PMID: 32566997 PMCID: PMC7767896 DOI: 10.1007/s00520-020-05577-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/11/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Head and neck cancer (HNC) patients often suffer from distress attributed to their cancer diagnosis which may disturb their sleep. However, there is lack of research about poor sleep quality among newly diagnosed HNC patients. Therefore, our aim was to investigate the prevalence and the associated factors of poor sleep quality among HNC patients before starting treatment. MATERIALS AND METHODS A cross-sectional study was conducted using the baseline data from NET-QUBIC study, an ongoing multi-center cohort of HNC patients in the Netherlands. Poor sleep quality was defined as a Pittsburgh Sleep Quality Index (PSQI) total score of > 5. Risk factors examined were sociodemographic factors (age, sex, education level, living situation), clinical characteristics (HNC subsite, tumor stage, comorbidity, performance status), lifestyle factors, coping styles, and HNC symptoms. RESULTS Among 560 HNC patients, 246 (44%) had poor sleep quality before start of treatment. Several factors were found to be significantly associated with poor sleep: younger age (odds ratio [OR] for each additional year 0.98, 95% CI 0.96-1.00), being female (OR 2.6, 95% CI 1.7-4.1), higher passive coping style (OR 1.18, 95% CI 1.09-1.28), more oral pain (OR 1.10, 95% CI 1.01-1.19), and less sexual interest and enjoyment (OR 1.13, 95% CI 1.06-1.20). CONCLUSION Poor sleep quality is highly prevalent among HNC patients before start of treatment. Early evaluation and tailored intervention to improve sleep quality are necessary to prepare these patients for HNC treatment and its consequences.
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Affiliation(s)
- Angelina M M Santoso
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioural and Movement Sciences & Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
- Cancer Center Amsterdam Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Femke Jansen
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioural and Movement Sciences & Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
- Cancer Center Amsterdam Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Otolaryngology - Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Robert J Baatenburg de Jong
- Department of Otolaryngology and Head and Neck Surgery, Erasmus Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - C René Leemans
- Department of Otolaryngology - Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Johannes H Smit
- Department of Psychiatry, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Chris H J Terhaard
- Department of Radiotherapy, University Medical Center, Utrecht, The Netherlands
| | - Annemieke van Straten
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioural and Movement Sciences & Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioural and Movement Sciences & Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
- Cancer Center Amsterdam Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Department of Otolaryngology - Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
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8
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Emilsson ÖI, Sundbom F, Ljunggren M, Benediktsdottir B, Garcia-Aymerich J, Bui DS, Jarvis D, Olin AC, Franklin KA, Demoly P, Lindberg E, Janson C, Aspelund T, Gislason T. Association between lung function decline and obstructive sleep apnoea: the ALEC study. Sleep Breath 2020; 25:587-596. [PMID: 32632893 PMCID: PMC8195766 DOI: 10.1007/s11325-020-02086-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/31/2020] [Accepted: 04/13/2020] [Indexed: 11/25/2022]
Abstract
Purpose To study changes in lung function among individuals with a risk of obstructive sleep apnoea (OSA), and if asthma affected this relationship. Methods We used data from the European Community Respiratory Health Survey II and III, a multicentre general population study. Participants answered questionnaires and performed spirometry at baseline and 10-year follow-up (n = 4,329 attended both visits). Subjects with high risk for OSA were identified from the multivariable apnoea prediction (MAP) index, calculated from BMI, age, gender, and OSA symptoms at follow-up. Asthma was defined as having doctor’s diagnosed asthma at follow-up. Primary outcomes were changes in forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) from baseline to follow-up. Results Among 5108 participants at follow-up, 991 (19%) had a high risk of OSA based on the MAP index. Participants with high OSA risk more often had wheeze, cough, chest tightness, and breathlessness at follow-up than those with low OSA risk. Lung function declined more rapidly in subjects with high OSA risk (low vs high OSA risk [mean ± SD]: FEV1 = − 41.3 ± 24.3 ml/year vs − 50.8 ± 30.1 ml/year; FVC = − 30.5 ± 31.2 ml/year vs − 45.2 ± 36.3 ml/year). Lung function decline was primarily associated with higher BMI and OSA symptoms. OSA symptoms had a stronger association with lung function decline among asthmatics, compared to non-asthmatics. Conclusion In the general population, a high probability of obstructive sleep apnoea was related to faster lung function decline in the previous decade. This was driven by a higher BMI and more OSA symptoms among these subjects. The association between OSA symptoms and lung function decline was stronger among asthmatics. Electronic supplementary material The online version of this article (10.1007/s11325-020-02086-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Össur Ingi Emilsson
- Department of Respiratory, Allergy and Sleep Research, Akademiska Sjukhuset, Uppsala University, 751 85, Uppsala, Sweden. .,Department of Respiratory Medicine and Allergology, Akademiska Sjukhuset, Uppsala, Sweden.
| | - Fredrik Sundbom
- Department of Respiratory, Allergy and Sleep Research, Akademiska Sjukhuset, Uppsala University, 751 85, Uppsala, Sweden.,Department of Respiratory Medicine and Allergology, Akademiska Sjukhuset, Uppsala, Sweden
| | - Mirjam Ljunggren
- Department of Respiratory, Allergy and Sleep Research, Akademiska Sjukhuset, Uppsala University, 751 85, Uppsala, Sweden.,Department of Respiratory Medicine and Allergology, Akademiska Sjukhuset, Uppsala, Sweden
| | - Bryndis Benediktsdottir
- Department of Sleep Medicine, Landspitali, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Judith Garcia-Aymerich
- ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Dinh Son Bui
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Australia
| | - Deborah Jarvis
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Anna-Carin Olin
- Unit of Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Karl A Franklin
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Pascal Demoly
- Department of Pulmonology, Division of Allergy, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France.,Inserm, Sorbonne Université, Equipe EPAR - IPLESP, Paris, France
| | - Eva Lindberg
- Department of Respiratory, Allergy and Sleep Research, Akademiska Sjukhuset, Uppsala University, 751 85, Uppsala, Sweden.,Department of Respiratory Medicine and Allergology, Akademiska Sjukhuset, Uppsala, Sweden
| | - Christer Janson
- Department of Respiratory, Allergy and Sleep Research, Akademiska Sjukhuset, Uppsala University, 751 85, Uppsala, Sweden.,Department of Respiratory Medicine and Allergology, Akademiska Sjukhuset, Uppsala, Sweden
| | - Thor Aspelund
- Centre for Public Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Thorarinn Gislason
- Department of Sleep Medicine, Landspitali, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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De Silva AP, Niriella MA, Ediriweera DS, De Alwis JP, Liyanage IK, Ettickan U, Liyanapathirana KV, Undugodage C, de Silva HA, de Silva HJ. Low-dose melatonin for sleep disturbances in early-stage cirrhosis: A randomized, placebo-controlled, cross-over trial. JGH OPEN 2020; 4:749-756. [PMID: 32782966 PMCID: PMC7411556 DOI: 10.1002/jgh3.12356] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/08/2020] [Accepted: 05/02/2020] [Indexed: 12/16/2022]
Abstract
Background and aim Melatonin is used to treat sleep disturbances (SDs). The aim of this study was to investigate the safety and efficacy of low‐dose melatonin for SDs in early‐stage cirrhosis. Methods In a single‐center, randomized, double‐blind, placebo‐controlled, cross‐over clinical trial, patients with early‐stage (Child‐Turcotte‐Pugh [CTP] class A or B) cirrhosis with SDs, without hepatic encephalopathy, were randomized to placebo or 3 mg of melatonin for 2 weeks. After 2 weeks, the patients were given a washout period of 1 week and crossed over to melatonin or placebo for a further 2 weeks. The Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were used to measure sleep quality and daytime sleepiness, respectively. Analysis of results was based on intention to treat, and linear mixed‐effect models were used to evaluate the effect of melatonin. Analysis was conducted using R‐programming language 3.5.1. Results Seventy one patients were recruited (mean age: 61.9 ± 8.7 years, males: 46 [64.8%], and CTP Class A = 52 [73.2%] and Class B = 19 [26.8%]). Sixty patients completed the study (mean age: 61.7 ± 8.8 years, males: 40 [66.6%], and CTP Class A = 45 [75.0%] and Class‐B = 15 [25.0%]). Two patients dropped out due to adverse events. Nine patients were lost to follow up. Patients given melatonin had a significantly lower PSQI and ESS compared to both pretreatment (P < 0.001) and postplacebo scores (P < 0.001). Incidence of adverse events was similar (two each of abdominal pain, one each of headache, one each of dizziness) in both groups. Conclusion Melatonin seems safe and effective for use in patients with SDs in early‐stage cirrhosis in the short term. However, larger and longer‐term studies to assess efficacy and safety are required before its clinical use can be recommended.
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Affiliation(s)
| | | | | | - Jerome P De Alwis
- University Medical Unit Colombo North Teaching Hospital Ragama Sri Lanka
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10
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Pien GW, Ye L, Keenan BT, Maislin G, Björnsdóttir E, Arnardottir ES, Benediktsdottir B, Gislason T, Pack AI. Changing Faces of Obstructive Sleep Apnea: Treatment Effects by Cluster Designation in the Icelandic Sleep Apnea Cohort. Sleep 2019; 41:4782667. [PMID: 29301021 DOI: 10.1093/sleep/zsx201] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 09/19/2017] [Indexed: 02/06/2023] Open
Abstract
Study Objectives Distinct clinical phenotypes of obstructive sleep apnea (OSA) have been identified: Disturbed Sleep, Minimally Symptomatic, and Sleepy. Determining whether these phenotypes respond differently to standard treatment helps us to create a foundation for personalized therapies. We compared responses to positive airway pressure (PAP) therapy in these clinical OSA phenotypes. Methods The study sample included 706 patients from the Icelandic Sleep Apnea Cohort with moderate-to-severe OSA who were prescribed PAP. Linear and logistic mixed models were used to compare 2-year changes in demographics, comorbid diseases, and sleep-related health issues within and across OSA clinical phenotypes. Relationships between changes in symptoms and PAP adherence were also examined. Results Overall, effect sizes were moderate to large when comparing sleepiness, insomnia-related, and apneic symptom changes in the Sleepy group with changes in other two groups, especially those in the Minimally Symptomatic group. Within the Disturbed Sleep group, PAP users and nonusers demonstrated similar changes in insomnia-related symptoms. The Minimally Symptomatic group remained relatively asymptomatic, but reported significant decreases in daytime sleepiness and physical fatigue; PAP users generally had larger improvements. The Sleepy group had reductions in nearly all measured symptoms, including large reductions in drowsy driving; almost all of these improvements were greater among PAP users than nonusers. Conclusions OSA treatment response patterns differed by initial clinical phenotype and PAP adherence. Individuals with insomnia-related symptoms may require additional targeted therapy for these complaints. These findings underscore the need for a personalized approach to management that recognizes patients with a range of OSA presentations.
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Affiliation(s)
- Grace W Pien
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lichuan Ye
- Bouve College of Health Sciences School of Nursing, Northeastern University, Boston, MA
| | - Brendan T Keenan
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Greg Maislin
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Erla Björnsdóttir
- Department of Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Erna Sif Arnardottir
- Department of Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Bryndis Benediktsdottir
- Department of Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Thorarinn Gislason
- Department of Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Allan I Pack
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Division of Sleep Medicine or Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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11
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Peos JJ, Helms ER, Fournier PA, Sainsbury A. Continuous versus intermittent moderate energy restriction for increased fat mass loss and fat free mass retention in adult athletes: protocol for a randomised controlled trial-the ICECAP trial (Intermittent versus Continuous Energy restriction Compared in an Athlete Population). BMJ Open Sport Exerc Med 2018; 4:e000423. [PMID: 30364484 PMCID: PMC6196972 DOI: 10.1136/bmjsem-2018-000423] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2018] [Indexed: 01/20/2023] Open
Abstract
Introduction Reducing fat mass (FM) while retaining fat free mass (FFM) is a common goal of athletes. Evidence suggests that some-but not all-forms of intermittent energy restriction (IER) may be superior to the conventional method of continuous energy restriction (CER) for people with excess body fat that are sedentary, by reducing some of the adaptive responses to ER. However, it is yet to be established whether this dietary approach is effective for athletes. Methods and analysis A single-blind, parallel group, randomised controlled trial with a 1:1 allocation ratio is proposed. Sixty healthy athletes aged ≥18 years will be recruited from local sporting facilities and randomised to an intervention of either moderate CER (mCER) or moderate IER (mIER). Both interventions will consist of 12 weeks of moderate ER, plus 3 weeks in energy balance (EB). The mCER intervention will entail 12 weeks of continuous moderate ER, followed by 3 weeks in EB. The mIER intervention will entail 12 weeks of moderate ER, administered as 4×3 week blocks of moderate ER, interspersed with 3×1 week blocks of EB. The co-primary outcomes are changes in FM and FFM after 12 weeks of moderate ER. Secondary outcomes will be changes in FM and FFM at 15 weeks after intervention commencement, as well as muscle performance, physical activity, sleep quality, changes in resting energy expenditure, subjective drive to eat, circulating concentrations of appetite-regulating hormones, mood states and diet acceptability. Trial registration ACTRN12618000638235p.
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Affiliation(s)
- Jackson J Peos
- School of Human Sciences, The University of Western Australia (UWA), Crawley, Western Australia, Australia
| | - Eric R Helms
- Sports Performance Institute New Zealand (SPRINZ), Auckland University of Technology, at AUT Millennium, Auckland, New Zealand
| | - Paul A Fournier
- School of Human Sciences, The University of Western Australia (UWA), Crawley, Western Australia, Australia
| | - Amanda Sainsbury
- The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, New South Wales, Australia
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12
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Kurtis MM, Balestrino R, Rodriguez-Blazquez C, Forjaz MJ, Martinez-Martin P. A Review of Scales to Evaluate Sleep Disturbances in Movement Disorders. Front Neurol 2018; 9:369. [PMID: 29896152 PMCID: PMC5986889 DOI: 10.3389/fneur.2018.00369] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/07/2018] [Indexed: 01/09/2023] Open
Abstract
Patients with movement disorders have a high prevalence of sleep disturbances that can be classified as (1) nocturnal sleep symptoms, such as insomnia, nocturia, restless legs syndrome (RLS), periodic limb movements (PLM), obstructive sleep apnea (OSA), and REM sleep behavior disorder; and (2) diurnal problems that include excessive daytime sleepiness (EDS) and sleep attacks. The objective of this review is to provide a practical overview of the most relevant scales that assess these disturbances to guide the choice of the most useful instrument/s depending on the line of research or clinical focus. For each scale, the reader will find a brief description of practicalities and psychometric properties, use in movement disorder cohorts and analyzed strengths and limitations. To assess insomnia, the Pittsburgh Sleep Quality Index, a generic scale, and three disease-specific scales: the Parkinson Disease Sleep Scale (PDSS), the PDSS-2, and Scales for outcomes in Parkinson's disease (PD)-Sleep-Nocturnal Sleep subscale are discussed. To evaluate nocturia, there are no specific tools, but some extensively validated generic urinary symptom scales (the Overall Bladder Questionnaire and the Overactive Bladder Symptom Score) and some PD-specific scales that include a nocturia item are available. To measure RLS severity, there are currently four domain-specific generic scales: The International Restless Legs Scale, the Johns Hopkins Restless Legs Severity Scale, the Restless Legs Syndrome-6 measure, a Pediatric RLS Severity Scale, and the Augmentation Severity Rating Scale (a scale to evaluate augmentation under treatment) and several instruments that assess impact on quality of sleep and health-related quality of life. To evaluate the presence of PLM, no clinical scales have been developed to date. As far as OSA, commonly used instruments such as the Sleep Apnea Scale of the Sleep Disorders Questionnaire, the STOP-Bang questionnaire, and the Berlin Questionnaire are reviewed. Three scales have been extensively used to assess EDS: the generic Epworth Sleepiness Scale, the Stanford Sleepiness Scale, and the PD-specific Scales for outcomes in PD-Sleep-Daytime sleepiness subscale. To date, only the Inappropriate Sleep Composite Score specifically evaluates propensity to sleep attacks.
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Affiliation(s)
- Mónica M. Kurtis
- Movement Disorders Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
| | - Roberta Balestrino
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Turin, Italy
| | - Carmen Rodriguez-Blazquez
- National Center of Epidemiology and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute of Health Carlos III, Madrid, Spain
| | - Maria João Forjaz
- National School of Public Health and Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Institute of Health Carlos III, Madrid, Spain
| | - Pablo Martinez-Martin
- National Center of Epidemiology and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute of Health Carlos III, Madrid, Spain
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13
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Kim CE, Shin S, Lee HW, Lim J, Lee JK, Kang D. Frequency of Loud Snoring and Metabolic Syndrome among Korean Adults: Results from the Health Examinees (HEXA) Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14111294. [PMID: 29072591 PMCID: PMC5707933 DOI: 10.3390/ijerph14111294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/18/2017] [Accepted: 10/22/2017] [Indexed: 11/16/2022]
Abstract
Studies regarding the association between snoring and metabolic abnormalities have been inconsistent. We examine whether snoring frequency and obstructive sleep apnea markers are associated with metabolic syndrome (MetS) among Koreans aged 40-69 years. A total of 72,885 subjects (24,856 men, 48,029 women) from the Health Examinees Gem study between 2009 and 2013 were included. Snoring frequency was grouped into five categories (never, 1-3/month, 1-3/week, 4-5/week, 6+/week). Obstructive sleep apnea markers included breathing interruptions and awakenings. Adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated through logistic regression. Compared with non-snorers, those who snore 6+/week were associated with increased odds for MetS (OR: 2.07, 95% CI: 1.91-2.25, p-trend < 0.0001 among men; OR: 1.45, CI: 1.33-1.58, p-trend < 0.0001 among women). Snoring frequency is associated with MetS and its components in both men and women. Snoring and obstructive sleep apnea markers are important indicators of sleep quality, which may facilitate early detection of sleep disorders and further complications such as MetS.
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Affiliation(s)
- Claire E Kim
- Department of Preventive Medicine, College of Medicine, Seoul National University, 103 Daehakro, Jongnogu, Seoul 03080, Korea.
- Department of Biomedical Sciences, College of Medicine, Seoul National University, 103 Daehakro, Jongnogu, Seoul 03080, Korea.
| | - Sangah Shin
- Department of Food and Nutrition, Chung-Ang University, Gyeonggi-do 17546, Korea.
| | - Hwi-Won Lee
- Department of Preventive Medicine, College of Medicine, Seoul National University, 103 Daehakro, Jongnogu, Seoul 03080, Korea.
- Department of Biomedical Sciences, College of Medicine, Seoul National University, 103 Daehakro, Jongnogu, Seoul 03080, Korea.
| | - Jiyeon Lim
- Department of Preventive Medicine, College of Medicine, Seoul National University, 103 Daehakro, Jongnogu, Seoul 03080, Korea.
| | - Jong-Koo Lee
- JW Lee Center for Global Medicine, College of Medicine, Seoul National University, IhwaJang-gil 71 Jongno-gu, Seoul 03087, Korea 03087.
- Department of Family Medicine, Seoul National University Hospital, 101 Daehakro, Jongnogu, Seoul 03080, Korea.
| | - Daehee Kang
- Department of Preventive Medicine, College of Medicine, Seoul National University, 103 Daehakro, Jongnogu, Seoul 03080, Korea.
- Department of Biomedical Sciences, College of Medicine, Seoul National University, 103 Daehakro, Jongnogu, Seoul 03080, Korea.
- Institute of Environmental Medicine, Seoul National University Medical Research Center, 103 Daehakro, Jongnogu, Seoul 03080, Korea.
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14
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van der Spek A, Luik AI, Kocevska D, Liu C, Brouwer RWW, van Rooij JGJ, van den Hout MCGN, Kraaij R, Hofman A, Uitterlinden AG, van IJcken WFJ, Gottlieb DJ, Tiemeier H, van Duijn CM, Amin N. Exome-Wide Meta-Analysis Identifies Rare 3'-UTR Variant in ERCC1/CD3EAP Associated with Symptoms of Sleep Apnea. Front Genet 2017; 8:151. [PMID: 29093733 PMCID: PMC5651235 DOI: 10.3389/fgene.2017.00151] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 09/28/2017] [Indexed: 12/30/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a common sleep breathing disorder associated with an increased risk of cardiovascular and cerebrovascular diseases and mortality. Although OSA is fairly heritable (~40%), there have been only few studies looking into the genetics of OSA. In the present study, we aimed to identify genetic variants associated with symptoms of sleep apnea by performing a whole-exome sequence meta-analysis of symptoms of sleep apnea in 1,475 individuals of European descent. We identified 17 rare genetic variants with at least suggestive evidence of significance. Replication in an independent dataset confirmed the association of a rare genetic variant (rs2229918; minor allele frequency = 0.3%) with symptoms of sleep apnea (p-valuemeta = 6.98 × 10−9, βmeta = 0.99). Rs2229918 overlaps with the 3′ untranslated regions of ERCC1 and CD3EAP genes on chromosome 19q13. Both genes are expressed in tissues in the neck area, such as the tongue, muscles, cartilage and the trachea. Further, CD3EAP is localized in the nucleus and mitochondria and involved in the tumor necrosis factor-alpha/nuclear factor kappa B signaling pathway. Our results and biological functions of CD3EAP/ERCC1 genes suggest that the 19q13 locus is interesting for further OSA research.
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Affiliation(s)
| | - Annemarie I Luik
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Desana Kocevska
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, Netherlands
| | - Chunyu Liu
- Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, MA, United States.,Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD, United States.,Department of Biostatistics, School of Public Health, Boston University, Boston, MA, United States
| | | | - Jeroen G J van Rooij
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, Netherlands.,Netherlands Consortium for Healthy Ageing, Rotterdam, Netherlands.,Department of Neurology, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Robert Kraaij
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands.,Department of Internal Medicine, Erasmus Medical Center, Rotterdam, Netherlands.,Netherlands Consortium for Healthy Ageing, Rotterdam, Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - André G Uitterlinden
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands.,Department of Internal Medicine, Erasmus Medical Center, Rotterdam, Netherlands.,Netherlands Consortium for Healthy Ageing, Rotterdam, Netherlands
| | | | - Daniel J Gottlieb
- VA Boston Healthcare System, Boston, MA, United States.,Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, United States.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
| | - Henning Tiemeier
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands.,Department of Psychiatry, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Najaf Amin
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands
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15
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Sleep Apnea and Hypertension. Chest 2017; 152:742-750. [DOI: 10.1016/j.chest.2017.03.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 01/16/2017] [Accepted: 03/01/2017] [Indexed: 11/18/2022] Open
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16
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Al-Tannir M, Kobrosly SY, Al-Badr AH, Salloum NA, Altannir YM. Characterizing sleeping habits and disturbances among Saudi adults. Saudi Med J 2017; 37:1372-1380. [PMID: 27874154 PMCID: PMC5303777 DOI: 10.15537/smj.2016.12.17373] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objectives To characterize sleeping habits, assess sleep disturbance prevalence, and identify associated factors among Saudi adults. Methods A total of 1720 adults were approached for this observational cross-sectional study between October 2014 and March 2015. The study took place in Riyadh, the capital of Saudi Arabia. We used a questionnaire to describe sleeping characteristics in relation to existing chronic diseases, smoking status, obesity, daily performance and sociodemographic variables. Results The response rate was 79.6% (1369 participants), 61.6% have or may have sleeping disturbances of which 18.6% claimed either slowed or stopped breathing during sleep. Women reported a higher prevalence of sleep disturbances (65.2%). Feeling tired was significantly associated with sleep disturbance (49% versus 19.7%) (p<0.001). Approximately 78.4% of those with sleep disturbance significantly believed that their ability to perform daily tasks is affected (p=0.005). Moreover, smoking and obesity were significantly associated with sleep disturbances (p<0.01). Participants with asthma, hypertension, chronic heart disease, and diabetes mellitus reported significantly more sleeping disturbance (p=0.016 to p=0.001). Conclusions Sleep disturbances are associated with obesity, smoking, chronic health conditions, and lower performance among Saudi adults.
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Affiliation(s)
- Mohamad Al-Tannir
- Clinical and Translational Research Department, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia. E-mail.
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17
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Arnardottir ES, Isleifsson B, Agustsson JS, Sigurdsson GA, Sigurgunnarsdottir MO, Sigurđarson GT, Saevarsson G, Sveinbjarnarson AT, Hoskuldsson S, Gislason T. How to measure snoring? A comparison of the microphone, cannula and piezoelectric sensor. J Sleep Res 2015; 25:158-68. [PMID: 26553758 DOI: 10.1111/jsr.12356] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/08/2015] [Indexed: 11/28/2022]
Abstract
The objective of this study was to compare to each other the methods currently recommended by the American Academy of Sleep Medicine (AASM) to measure snoring: an acoustic sensor, a piezoelectric sensor and a nasal pressure transducer (cannula). Ten subjects reporting habitual snoring were included in the study, performed at Landspitali-University Hospital, Iceland. Snoring was assessed by listening to the air medium microphone located on a patient's chest, compared to listening to two overhead air medium microphones (stereo) and manual scoring of a piezoelectric sensor and nasal cannula vibrations. The chest audio picked up the highest number of snore events of the different snore sensors. The sensitivity and positive predictive value of scoring snore events from the different sensors was compared to the chest audio: overhead audio (0.78, 0.98), cannula (0.55, 0.67) and piezoelectric sensor (0.78, 0.92), respectively. The chest audio was capable of detecting snore events with lower volume and higher fundamental frequency than the other sensors. The 200 Hz sampling rate of the cannula and piezoelectric sensor was one of their limitations for detecting snore events. The different snore sensors do not measure snore events in the same manner. This lack of consistency will affect future research on the clinical significance of snoring. Standardization of objective snore measurements is therefore needed. Based on this paper, snore measurements should be audio-based and the use of the cannula as a snore sensor be discontinued, but the piezoelectric sensor could possibly be modified for improvement.
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Affiliation(s)
- Erna S Arnardottir
- Department of Respiratory Medicine and Sleep, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | | | | | - Gunnar A Sigurdsson
- Nox Medical, Reykjavik, Iceland.,School of Computer Science, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Magdalena O Sigurgunnarsdottir
- Department of Respiratory Medicine and Sleep, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Gudjon T Sigurđarson
- Nox Medical, Reykjavik, Iceland.,Department of Electrical Engineering and Information Technology, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | | | | | | | - Thorarinn Gislason
- Department of Respiratory Medicine and Sleep, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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18
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Abma IL, van der Wees PJ, Veer V, Westert GP, Rovers M. Measurement properties of patient-reported outcome measures (PROMs) in adults with obstructive sleep apnea (OSA): A systematic review. Sleep Med Rev 2015; 28:18-31. [PMID: 26433776 DOI: 10.1016/j.smrv.2015.07.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/27/2015] [Accepted: 07/28/2015] [Indexed: 01/30/2023]
Abstract
This systematic review summarizes the evidence regarding the quality of patient-reported outcome measures (PROMs) validated in patients with obstructive sleep apnea (OSA). We performed a systematic literature search of all PROMs validated in patients with OSA, and found 22 measures meeting our inclusion criteria. The quality of the studies was assessed using the consensus-based standards for the selection of health status measurement instruments (COSMIN) checklist. The results showed that most of the measurement properties of the PROMs were not, or not adequately, assessed. For many identified PROMs there was no involvement of patients with OSA during their development or before the PROM was tested in patients with OSA. Positive exceptions and the best current candidates for assessing health status in patients with OSA are the sleep apnea quality of life index (SAQLI), Maugeri obstructive sleep apnea syndrome (MOSAS) questionnaire, Quebec sleep questionnaire (QSQ) and the obstructive sleep apnea patient-oriented severity index (OSAPOSI). Even though there is not enough evidence to fully judge the quality of these PROMs as outcome measure, when interpreted with caution, they have the potential to add value to clinical research and clinical practice in evaluating aspects of health status that are important to patients.
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Affiliation(s)
- Inger L Abma
- Radboud University Medical Center, Radboud Institute of Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.
| | - Philip J van der Wees
- Radboud University Medical Center, Radboud Institute of Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Vik Veer
- James Cook University Hospital, Middlesbrough, England, UK
| | - Gert P Westert
- Radboud University Medical Center, Radboud Institute of Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Maroeska Rovers
- Radboud University Medical Center, Radboud Institute of Health Sciences, Department for Health Evidence, Nijmegen, The Netherlands; Radboud University Medical Center, Radboud Institute of Health Sciences, Department for Operating Rooms, Nijmegen, The Netherlands
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19
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Alvarez-Estevez D, Moret-Bonillo V. Computer-Assisted Diagnosis of the Sleep Apnea-Hypopnea Syndrome: A Review. SLEEP DISORDERS 2015; 2015:237878. [PMID: 26266052 PMCID: PMC4523666 DOI: 10.1155/2015/237878] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 06/15/2015] [Accepted: 06/21/2015] [Indexed: 02/07/2023]
Abstract
Automatic diagnosis of the Sleep Apnea-Hypopnea Syndrome (SAHS) has become an important area of research due to the growing interest in the field of sleep medicine and the costs associated with its manual diagnosis. The increment and heterogeneity of the different techniques, however, make it somewhat difficult to adequately follow the recent developments. A literature review within the area of computer-assisted diagnosis of SAHS has been performed comprising the last 15 years of research in the field. Screening approaches, methods for the detection and classification of respiratory events, comprehensive diagnostic systems, and an outline of current commercial approaches are reviewed. An overview of the different methods is presented together with validation analysis and critical discussion of the current state of the art.
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Affiliation(s)
| | - Vicente Moret-Bonillo
- Laboratory for Research and Development in Artificial Intelligence (LIDIA), Department of Computer Science, University of A Coruña, 15071 A Coruña, Spain
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20
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Shear TC, Balachandran JS, Mokhlesi B, Spampinato LM, Knutson KL, Meltzer DO, Arora VM. Risk of sleep apnea in hospitalized older patients. J Clin Sleep Med 2014; 10:1061-6. [PMID: 25317085 DOI: 10.5664/jcsm.4098] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND/OBJECTIVES To assess the prevalence of undiagnosed obstructive sleep apnea (OSA) among general medical inpatients and to investigate whether OSA risk is associated with in-hospital sleep quantity and quality. DESIGN Prospective cohort study. SETTING General medicine ward in academic medical center. PARTICIPANTS 424 hospitalized adult patients ≥ 50 years old without a sleep disorder diagnosis (mean age 65 years, 57% female, 72% African American). MAIN MEASURES The Berlin questionnaire, a validated screen for determining risk of OSA, was administered to hospitalized medical patients. Sleep duration and efficiency were measured via wrist actigraphy. Self-reported sleep quality was evaluated using Karolinska Sleep Quality Index (KSQI). KEY RESULTS Two of every 5 inpatients ≥ 50 years old (39.5%, n = 168) were found to be at high risk for OSA. Mean in-hospital sleep duration was ∼ 5 h and mean sleep efficiency was 70%. Using random effects linear regression models, we found that patients who screened at high risk for OSA obtained ∼ 40 min less sleep per night (-39.6 min [-66.5, -12.8], p = 0.004). These findings remained significant after controlling for African American race, sex, and age quartiles. In similar models, those patients who screened at high risk had ∼ 5.5% less sleep efficiency per night (-5.50 [-9.96, -1.05], p = 0.015). In multivariate analysis, patients at high risk for OSA also had lower self-reported sleep quality on KSQI (-0.101 [-0.164, -0.037], p = 0.002). CONCLUSION Two of every 5 inpatients older than 50 years screened at high risk for OSA. Those screening at high risk have worse in-hospital sleep quantity and quality. COMMENTARY A commentary on this article appears in this issue on page 1067.
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Affiliation(s)
- Talia C Shear
- Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Jay S Balachandran
- Department of Medicine, University of Chicago, Chicago, IL ; Sleep, Metabolism and Health Center, University of Chicago, Chicago, IL
| | - Babak Mokhlesi
- Department of Medicine, University of Chicago, Chicago, IL ; Sleep, Metabolism and Health Center, University of Chicago, Chicago, IL
| | | | - Kristen L Knutson
- Department of Medicine, University of Chicago, Chicago, IL ; Sleep, Metabolism and Health Center, University of Chicago, Chicago, IL
| | | | - Vineet M Arora
- Department of Medicine, University of Chicago, Chicago, IL ; Sleep, Metabolism and Health Center, University of Chicago, Chicago, IL
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Ye L, Pien GW, Ratcliffe SJ, Björnsdottir E, Arnardottir ES, Pack AI, Benediktsdottir B, Gislason T. The different clinical faces of obstructive sleep apnoea: a cluster analysis. Eur Respir J 2014; 44:1600-7. [PMID: 25186268 DOI: 10.1183/09031936.00032314] [Citation(s) in RCA: 298] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Although commonly observed in clinical practice, the heterogeneity of obstructive sleep apnoea (OSA) clinical presentation has not been formally characterised. This study was the first to apply cluster analysis to identify subtypes of patients with OSA who experience distinct combinations of symptoms and comorbidities. An analysis of baseline data from the Icelandic Sleep Apnoea Cohort (822 patients with newly diagnosed moderate-to-severe OSA) was performed. Three distinct clusters were identified. They were classified as the "disturbed sleep group" (cluster 1), "minimally symptomatic group" (cluster 2) and "excessive daytime sleepiness group" (cluster 3), consisting of 32.7%, 24.7% and 42.6% of the entire cohort, respectively. The probabilities of having comorbid hypertension and cardiovascular disease were highest in cluster 2 but lowest in cluster 3. The clusters did not differ significantly in terms of sex, body mass index or apnoea-hypopnoea index. Patients with OSA have different patterns of clinical presentation, which need to be communicated to both the lay public and the professional community with the goal of facilitating care-seeking and early identification of OSA. Identifying distinct clinical profiles of OSA creates a foundation for offering more personalised therapies in the future.
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Affiliation(s)
- Lichuan Ye
- Boston College William F. Connell School of Nursing, Chestnut Hill, MA, USA
| | - Grace W Pien
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sarah J Ratcliffe
- Dept of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Erla Björnsdottir
- Dept of Respiratory Medicine and Sleep, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Erna Sif Arnardottir
- Dept of Respiratory Medicine and Sleep, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Allan I Pack
- Division of Sleep Medicine/Dept of Medicine, Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Bryndis Benediktsdottir
- Dept of Respiratory Medicine and Sleep, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Thorarinn Gislason
- Dept of Respiratory Medicine and Sleep, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
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Spörndly-Nees S, Åsenlöf P, Theorell-Haglöw J, Svensson M, Igelström H, Lindberg E. Leisure-time physical activity predicts complaints of snoring in women: a prospective cohort study over 10years. Sleep Med 2014; 15:415-21. [DOI: 10.1016/j.sleep.2013.09.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 08/28/2013] [Accepted: 09/26/2013] [Indexed: 10/26/2022]
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Arnardottir ES, Janson C, Bjornsdottir E, Benediktsdottir B, Juliusson S, Kuna ST, Pack AI, Gislason T. Nocturnal sweating--a common symptom of obstructive sleep apnoea: the Icelandic sleep apnoea cohort. BMJ Open 2013; 3:bmjopen-2013-002795. [PMID: 23674447 PMCID: PMC3657640 DOI: 10.1136/bmjopen-2013-002795] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To estimate the prevalence and characteristics of frequent nocturnal sweating in obstructive sleep apnoea (OSA) patients compared with the general population and evaluate the possible changes with positive airway pressure (PAP) treatment. Nocturnal sweating can be very bothersome to the patient and bed partner. DESIGN Case-control and longitudinal cohort study. SETTING Landspitali-The National University Hospital, Iceland. PARTICIPANTS The Icelandic Sleep Apnea Cohort consisted of 822 untreated patients with OSA, referred for treatment with PAP. Of these, 700 patients were also assessed at a 2-year follow-up. The control group consisted of 703 randomly selected subjects from the general population. INTERVENTION PAP therapy in the OSA cohort. MAIN OUTCOME MEASURES Subjective reporting of nocturnal sweating on a frequency scale of 1-5: (1) never or very seldom, (2) less than once a week, (3) once to twice a week, (4) 3-5 times a week and (5) every night or almost every night. Full PAP treatment was defined objectively as the use for ≥4 h/day and ≥5 days/week. RESULTS Frequent nocturnal sweating (≥3× a week) was reported by 30.6% of male and 33.3% of female OSA patients compared with 9.3% of men and 12.4% of women in the general population (p<0.001). This difference remained significant after adjustment for demographic factors. Nocturnal sweating was related to younger age, cardiovascular disease, hypertension, sleepiness and insomnia symptoms. The prevalence of frequent nocturnal sweating decreased with full PAP treatment (from 33.2% to 11.5%, p<0.003 compared with the change in non-users). CONCLUSIONS The prevalence of frequent nocturnal sweating was threefold higher in untreated OSA patients than in the general population and decreased to general population levels with successful PAP therapy. Practitioners should consider the possibility of OSA in their patients who complain of nocturnal sweating.
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Affiliation(s)
- Erna Sif Arnardottir
- Department of Respiratory Medicine and Sleep, Landspitali—The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine,School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Christer Janson
- Department of Medical Sciences: Respiratory Medicine and Allergology, Uppsala Universitet, Uppsala, Sweden
| | - Erla Bjornsdottir
- Department of Respiratory Medicine and Sleep, Landspitali—The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine,School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Bryndis Benediktsdottir
- Department of Respiratory Medicine and Sleep, Landspitali—The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine,School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Sigurdur Juliusson
- Department of Otolaryngology, Landspitali—The National University Hospital of Iceland, Reykjavik, Iceland
| | - Samuel T Kuna
- Division of Sleep Medicine/Department of Medicine, Center for Sleep and Circadian Neurobiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Medicine, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Allan I Pack
- Division of Sleep Medicine/Department of Medicine, Center for Sleep and Circadian Neurobiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Thorarinn Gislason
- Department of Respiratory Medicine and Sleep, Landspitali—The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine,School of Health Sciences, University of Iceland, Reykjavik, Iceland
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