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Howarth TP, Sillanmäki S, Karhu T, Rissanen M, Islind AS, Hrubos-Strøm H, de Chazal P, Huovila J, Kainulainen S, Leppänen T. Nocturnal oxygen resaturation parameters are associated with cardiorespiratory comorbidities. Sleep Med 2024; 118:101-112. [PMID: 38657349 DOI: 10.1016/j.sleep.2024.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/12/2024] [Accepted: 03/30/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND There are strong associations between oxygen desaturations and cardiovascular outcomes. Additionally, oxygen resaturation rates are linked to excessive daytime sleepiness independent of oxygen desaturation severity. No studies have yet looked at the independent effects of comorbidities or medications on resaturation parameters. METHODS The Sleep Heart Health Study data was utilised to derive oxygen saturation parameters from 5804 participants. Participants with a history of comorbidities or medication usage were compared against healthy participants with no comorbidity/medication history. RESULTS 4293 participants (50.4% female, median age 64 years) were included in the analysis. Females recorded significantly faster resaturation rates (mean 0.61%/s) than males (mean 0.57%/s, p < 0.001), regardless of comorbidities. After adjusting for demographics, sleep parameters, and desaturation parameters, resaturation rate was reduced with hypertension (-0.09 (95% CI -0.16, -0.03)), myocardial infarction (-0.13 (95% CI -0.21, -0.04)) and heart failure (-0.19 (95% CI -0.33, -0.05)), or when using anti-hypertensives (-0.10 (95% CI -0.17, -0.03)), mental health medications (-0.18 (95% CI -0.27, -0.08)) or anticoagulants (-0.41 (95% CI -0.56, -0.26)). Desaturation to Resaturation ratio for duration was decreased with mental health (-0.21 (95% CI -0.34, -0.08)) or diabetic medications (-0.24 (95% CI -0.41, -0.07)), and desaturation to resaturation ratio for area decreased with heart failure (-0.25 (95% CI -0.42, -0.08)). CONCLUSIONS Comorbidities and medications significantly affect nocturnal resaturation parameters, independent of desaturation parameters. However, the causal relationship remains unclear. Further research can enhance our knowledge and develop more precise and safer interventions for individuals affected by certain comorbidities.
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Affiliation(s)
- Timothy P Howarth
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Australia; College of Health and Human Sciences, Charles Darwin University, Darwin, Australia; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.
| | - Saara Sillanmäki
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland; Faculty of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Tuomas Karhu
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Marika Rissanen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neurophysiology, Seinäjoki Central Hospital, Seinäjoki, Finland
| | | | - Harald Hrubos-Strøm
- Department of Otorhinolaryngology, Akershus University Hospital, Lørenskog, Norway; Clinic for Surgical Research, Campus Ahus, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Philip de Chazal
- School of Biomedical Engineering, The University of Sydney, Sydney, Australia
| | - Juuso Huovila
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Samu Kainulainen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Timo Leppänen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland; School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Australia
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Berezin L, Waseem R, Merikanto I, Benedict C, Holzinger B, De Gennaro L, Wing YK, Bjorvatn B, Korman M, Morin CM, Espie C, Landtblom AM, Penzel T, Matsui K, Hrubos-Strøm H, Mota-Rolim S, Nadorff MR, Plazzi G, Reis C, Chan RNY, Cunha AS, Yordanova J, Bjelajac AK, Inoue Y, Dauvilliers Y, Partinen M, Chung F. Habitual short sleepers with pre-existing medical conditions are at higher risk of Long COVID. J Clin Sleep Med 2024; 20:111-119. [PMID: 37858285 PMCID: PMC10758549 DOI: 10.5664/jcsm.10818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 09/08/2023] [Accepted: 09/08/2023] [Indexed: 10/21/2023]
Abstract
STUDY OBJECTIVES Preliminary evidence suggests that the risk of Long COVID is higher among people with pre-existing medical conditions. Based on its proven adjuvant role in immunity, habitual sleep duration may alter the risk of developing Long COVID. The objective of this study was to determine whether the odds of Long COVID are higher among those with pre-existing medical conditions, and whether the strength of this association varies by habitual sleep duration. METHODS Using data from 13,461 respondents from 16 countries who participated in the 2021 survey-based International COVID Sleep Study II (ICOSS II), we studied the associations between habitual sleep duration, pre-existing medical conditions, and Long COVID. RESULTS Of 2,508 individuals who had COVID-19, 61% reported at least 1 Long COVID symptom. Multivariable logistic regression analysis showed that the risk of having Long COVID was 1.8-fold higher for average-length sleepers (6-9 h/night) with pre-existing medical conditions compared with those without pre-existing medical conditions (adjusted odds ratio [aOR] 1.84 [1.18-2.90]; P = .008). The risk of Long COVID was 3-fold higher for short sleepers with pre-existing medical conditions (aOR 2.95 [1.04-8.4]; P = .043) and not significantly higher for long sleepers with pre-existing conditions (aOR 2.11 [0.93-4.77]; P = .073) compared with average-length sleepers without pre-existing conditions. CONCLUSIONS Habitual short nighttime sleep duration exacerbated the risk of Long COVID in individuals with pre-existing conditions. Restoring nighttime sleep to average duration represents a potentially modifiable behavioral factor to lower the odds of Long COVID for at-risk patients. CITATION Berezin L, Waseem R, Merikanto I, et al. Habitual short sleepers with pre-existing medical conditions are at higher risk of long COVID. J Clin Sleep Med. 2024;20(1):111-119.
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Affiliation(s)
- Linor Berezin
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Rida Waseem
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ilona Merikanto
- SleepWell Research Program, Faculty of Medicine, University of Helsinki, Orton Orthopaedics Hospital, Helsinki, Finland
| | - Christian Benedict
- Department of Pharmaceutical Biosciences, Molecular Neuropharmacology, Uppsala University, Uppsala, Sweden
| | - Brigitte Holzinger
- Institute for Consciousness and Dream Research, Vienna, Austria
- Medical University Vienna, Postgraduate Master Program Medical Sleep Coaching, Vienna, Austria
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, Rome, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Maria Korman
- Department of Occupational Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel
| | - Charles M. Morin
- Centre de Recherche CERVO/Brain Research Center, École de Psychologie, Université Laval, Quebec City, Quebec, Canada
| | - Colin Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Anne-Marie Landtblom
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Thomas Penzel
- Sleep Medicine Center, Charite University Hospital Berlin, Berlin, Germany
| | - Kentaro Matsui
- Department of Clinical Laboratory, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Harald Hrubos-Strøm
- Department of Otorhinolaryngology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sérgio Mota-Rolim
- Brain Institute, Physiology and Behavior Department, and Onofre Lopes University Hospital Federal University of Rio Grande do Norte, Natal, Brazil
| | - Michael R. Nadorff
- Department of Psychology, Mississippi State University, Starkville, Mississippi, Mississippi
| | - Giuseppe Plazzi
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Catia Reis
- Universidade Católica Portuguesa, Católica Research Centre for Psychological Family and Social Wellbeing, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina de Lisboa, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Rachel Ngan Yin Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - Juliana Yordanova
- Institute of Neurobiology, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | | | - Yuichi Inoue
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
- Japan Somnology Center, Institute of Neuropsychiatry, Tokyo, Japan
| | - Yves Dauvilliers
- Sleep-Wake Disorders Center, Department of Neurology, Guide Chauliac Hospital, Institute for Neurosciences of Montpellier INM, INSERM, University of Montpellier, Montpellier, France
| | - Markku Partinen
- Department of Clinical Neurosciences, University of Helsinki Clinicum Unit, Helsinki, Finland
- Helsinki Sleep Clinic, Terveystalo Healthcare Services, Helsinki, Finland
| | - Frances Chung
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Thorshov TC, Øverby CT, Hansen DD, Bong WK, Skifjeld K, Hurlen P, Dammen T, Moen A, Hrubos-Strøm H. Experience with the use of a digital sleep diary in symptom management by individuals with insomnia -a pilot mixed method study. Sleep Med X 2023; 6:100093. [PMID: 38162592 PMCID: PMC10757200 DOI: 10.1016/j.sleepx.2023.100093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/01/2023] [Accepted: 11/08/2023] [Indexed: 01/03/2024] Open
Abstract
Background Insomnia is the most common sleep disorder. The recommended treatment is cognitive behavioural therapy for insomnia (CBTi). A sleep diary is a core tool in CBTi. We have developed a digital sleep diary with a standardised feedback function. Aim To study feasibility of the digital sleep diary in participants of the Akershus Sleep Apnea (ASAP) cohorts with difficulties falling asleep or maintaining sleep. To describe sleep diary engagement and explore experiences with the digital sleep diary with potential influences in insomnia symptom management. Material and methods Twenty participants were recruited from the ASAP. All filled out a digital sleep diary up to 12 weeks. Treatment options provided were a self-help book (N = 11) or electroencephalography neurofeedback (N = 9) in addition to the sleep diary standardised feedback function. We collected quantitative data from the sleep diary reports and we sub-divided insomnia by sleep onset insomnia and non-sleep onset insomnia. Finally, we performed qualitative interviews. Results The median number of entries to the sleep diary was 81 (25th quartile: 26, 75th quartile 84). In the qualitative analysis, we identified two main themes; "structure and overview" and "usability and digital features". Conclusion The sleep diary was found to be feasible when distributed in combination with a self-help book or electroencephalography neurofeedback. The qualitative results emphasised the importance of a timely graphical overview and visualisations of self-recorded sleep.
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Affiliation(s)
- Thea Christine Thorshov
- Division of Surgery, Department of Otorhinolaryngology, Akershus University Hospital, Lørenskog, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway
| | - Caroline Tonje Øverby
- Division of Surgery, Department of Otorhinolaryngology, Akershus University Hospital, Lørenskog, Norway
- Faculty of Medicine, Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway
| | - Diana Dobran Hansen
- Division of Surgery, Department of Otorhinolaryngology, Akershus University Hospital, Lørenskog, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway
| | - Way Kiat Bong
- Faculty of Technology, Art and Design, Department of Computer Science, Human-Computer Interaction and Universal Design of ICT, Oslo Metropolitan University, Oslo, Norway
| | | | - Petter Hurlen
- Division of Clinical Informatics, Department of Diagnostics and Technology, Akershus University Hospital, Lørenskog, Norway
| | - Toril Dammen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway
- Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Anne Moen
- Faculty of Medicine, Institute of Health and Society, Department of Nursing Science, University of Oslo, Norway
| | - Harald Hrubos-Strøm
- Division of Surgery, Department of Otorhinolaryngology, Akershus University Hospital, Lørenskog, Norway
- Faculty of Medicine, Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway
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Chen SJ, Morin CM, Ivers H, Wing YK, Partinen M, Merikanto I, Holzinger B, Espie CA, De Gennaro L, Dauvilliers Y, Chung F, Yordanova J, Vidović D, Reis C, Plazzi G, Penzel T, Nadorff MR, Matsui K, Mota-Rolim S, Leger D, Landtblom AM, Korman M, Inoue Y, Hrubos-Strøm H, Chan NY, Bjelajac AK, Benedict C, Bjorvatn B. The association of insomnia with long COVID: An international collaborative study (ICOSS-II). Sleep Med 2023; 112:216-222. [PMID: 37922783 DOI: 10.1016/j.sleep.2023.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/18/2023] [Accepted: 09/30/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE There is evidence of a strong association between insomnia and COVID-19, yet few studies have examined the relationship between insomnia and long COVID. This study aimed to investigate whether COVID-19 patients with pre-pandemic insomnia have a greater risk of developing long COVID and whether long COVID is in turn associated with higher incident rates of insomnia symptoms after infection. METHODS Data were collected cross-sectionally (May-Dec 2021) as part of an international collaborative study involving participants from 16 countries. A total of 2311 participants (18-99 years old) with COVID-19 provided valid responses to a web-based survey about sleep, insomnia, and health-related variables. Log-binomial regression was used to assess bidirectional associations between insomnia and long COVID. Analyses were adjusted for age, sex, and health conditions, including sleep apnea, attention and memory problems, chronic fatigue, depression, and anxiety. RESULTS COVID-19 patients with pre-pandemic insomnia showed a higher risk of developing long COVID than those without pre-pandemic insomnia (70.8% vs 51.4%; adjusted relative risk [RR]: 1.33, 95% confidence interval [CI]: 1.07-1.65). Among COVID-19 cases without pre-pandemic insomnia, the rates of incident insomnia symptoms after infection were 24.1% for short COVID cases and 60.6% for long COVID cases (p < .001). Compared with short COVID cases, long COVID cases were associated with an increased risk of developing insomnia symptoms (adjusted RR: 2.00; 95% CI: 1.50-2.66). CONCLUSIONS The findings support a bidirectional relationship between insomnia and long COVID. These findings highlight the importance of addressing sleep and insomnia in the prevention and management of long COVID.
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Affiliation(s)
- Si-Jing Chen
- Centre de Recherche CERVO/Brain Research Center, École de Psychologie, Université Laval, Quebec City, Quebec, Canada; Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Charles M Morin
- Centre de Recherche CERVO/Brain Research Center, École de Psychologie, Université Laval, Quebec City, Quebec, Canada.
| | - Hans Ivers
- Centre de Recherche CERVO/Brain Research Center, École de Psychologie, Université Laval, Quebec City, Quebec, Canada
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Markku Partinen
- Department of Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland; Helsinki Sleep Clinic, Terveystalo Healthcare, Helsinki, Finland
| | - Ilona Merikanto
- Research Programs Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Brigitte Holzinger
- Institute for Consciousness and Dream Research, Medical University of Vienna, Wien, Postgraduate Sleep Coaching, Vienna, Austria
| | - Colin A Espie
- Sir Jules Thorn Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, Roma, Lazio, Italy; IRCCS Fondazione Santa Lucia, Roma, Italy
| | - Yves Dauvilliers
- Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, Institute for Neurosciences of Montpellier INM, INSERM, University of Montpellier, Montpellier, France
| | - Frances Chung
- Department of Anesthesiology and Pain Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Juliana Yordanova
- Institute of Neurobiology, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Domagoj Vidović
- University Psychiatric Hospital Vrapče, Bolnička Cesta 32, 10000, Zagreb, Croatia
| | - Catia Reis
- Universidade Católica Portuguesa, Católica Research Centre for Psychological-Family and Social Wellbeing, Lisbon, Portugal; Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina de Lisboa, Universidade de Lisboa, Lisbon, Portugal; Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Giuseppe Plazzi
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Thomas Penzel
- Sleep Medicine Center, Charite University Hospital Berlin, Berlin, Germany
| | - Michael R Nadorff
- Department of Psychology, Mississippi State University, Mississippi State, MS, USA
| | - Kentaro Matsui
- Department of Clinical Laboratory, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Sergio Mota-Rolim
- Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Damien Leger
- APHP, Hôtel-Dieu, Centre du Sommeil et de la Vigilance, Paris, France; Université Paris Cité, VIFASOM (EA 7331 Vigilance Fatigue Sommeil et Santé Publique), Paris, France
| | - Anne-Marie Landtblom
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Sweden
| | - Maria Korman
- Department of Occupational Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel
| | - Yuichi Inoue
- Department of Somnology, Tokyo Medical University, Tokyo, Japan; Japan Somnology Center, Institute of Neuropsychiatry, Tokyo, Japan
| | - Harald Hrubos-Strøm
- Department of Otorhinolaryngology, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ngan Yin Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - Christian Benedict
- Department of Pharmaceutical Biosciences, Molecular Neuropharmacology, Uppsala University, Uppsala, Sweden
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
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Matsui K, Chung F, Bjelajac AK, Merikanto I, Korman M, Mota-Rolim S, Cunha AS, Bjorvatn B, Xue P, Benedict C, Morin CM, Espie CA, Landtblom AM, Penzel T, De Gennaro L, Holzinger B, Hrubos-Strøm H, Leger D, Bolstad CJ, Nadorff MR, Plazzi G, Reis C, Chan NY, Wing YK, Yordanova J, Dauvilliers Y, Partinen M, Inoue Y. Associations between changes in habitual sleep duration and lower self-rated health among COVID-19 survivors: findings from a survey across 16 countries/regions. BMC Public Health 2023; 23:2352. [PMID: 38017498 PMCID: PMC10683140 DOI: 10.1186/s12889-023-17258-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/18/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Self-rated health (SRH) is widely recognized as a clinically significant predictor of subsequent mortality risk. Although COVID-19 may impair SRH, this relationship has not been extensively examined. The present study aimed to examine the correlation between habitual sleep duration, changes in sleep duration after infection, and SRH in subjects who have experienced SARS-CoV-2 infection. METHODS Participants from 16 countries participated in the International COVID Sleep Study-II (ICOSS-II) online survey in 2021. A total of 10,794 of these participants were included in the analysis, including 1,509 COVID-19 individuals (who reported that they had tested positive for COVID-19). SRH was evaluated using a 0-100 linear visual analog scale. Habitual sleep durations of < 6 h and > 9 h were defined as short and long habitual sleep duration, respectively. Changes in habitual sleep duration after infection of ≤ -2 h and ≥ 1 h were defined as decreased or increased, respectively. RESULTS Participants with COVID-19 had lower SRH scores than non-infected participants, and those with more severe COVID-19 had a tendency towards even lower SRH scores. In a multivariate regression analysis of participants who had experienced COVID-19, both decreased and increased habitual sleep duration after infection were significantly associated with lower SRH after controlling for sleep quality (β = -0.056 and -0.058, respectively, both p < 0.05); however, associations between current short or long habitual sleep duration and SRH were negligible. Multinomial logistic regression analysis showed that decreased habitual sleep duration was significantly related to increased fatigue (odds ratio [OR] = 1.824, p < 0.01), shortness of breath (OR = 1.725, p < 0.05), diarrhea/nausea/vomiting (OR = 2.636, p < 0.01), and hallucinations (OR = 5.091, p < 0.05), while increased habitual sleep duration was significantly related to increased fatigue (OR = 1.900, p < 0.01). CONCLUSIONS Changes in habitual sleep duration following SARS-CoV-2 infection were associated with lower SRH. Decreased or increased habitual sleep duration might have a bidirectional relation with post-COVID-19 symptoms. Further research is needed to better understand the mechanisms underlying these relationships for in order to improve SRH in individuals with COVID-19.
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Affiliation(s)
- Kentaro Matsui
- Department of Clinical Laboratory, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Frances Chung
- Department of Anesthesiology and Pain Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Ilona Merikanto
- SleepWell Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Orton Orthopaedics Hospital, Helsinki, Finland
| | - Maria Korman
- Department of Occupational Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel
| | - Sérgio Mota-Rolim
- Brain Institute, Physiology and Behavior Department, and Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Pei Xue
- Department of Pharmaceutical Biosciences, Molecular Neuropharmacology, Uppsala University, Uppsala, Sweden
| | - Christian Benedict
- Department of Pharmaceutical Biosciences, Molecular Neuropharmacology, Uppsala University, Uppsala, Sweden
| | - Charles M Morin
- Centre de recherche CERVO/Brain Research Center, École de psychologie, Université Laval, Quebec City Quebec, Canada
| | - Colin A Espie
- Sir Jules Thorn Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Anne-Marie Landtblom
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Thomas Penzel
- Sleep Medicine Center, Charite University Hospital Berlin, Berlin, Germany
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, Roma, Lazio, Italy
- IRCCS Fondazione Santa Lucia, Roma, Italy
| | - Brigitte Holzinger
- Institute for Consciousness and Dream Research; Medical University of Vienna, Postgraduate Sleep Coaching, WienVienna, Austria
| | - Harald Hrubos-Strøm
- Department of Otorhinolaryngology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Damien Leger
- VIFASOM (EA 7331 Vigilance Fatigue Sommeil et Santé Publique), Université Paris Cité, Paris, France
- APHP, Hôtel-Dieu, Centre du Sommeil et de la Vigilance, Paris, France
| | - Courtney J Bolstad
- Department of Psychology, Mississippi State University, Mississippi State, MS, USA
- South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Michael R Nadorff
- Department of Psychology, Mississippi State University, Mississippi State, MS, USA
| | - Giuseppe Plazzi
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Catia Reis
- Católica Research Centre for Psychological - Family and Social Wellbeing, Universidade Católica Portuguesa, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina de Lisboa, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ngan Yin Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Juliana Yordanova
- Institute of Neurobiology, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Yves Dauvilliers
- Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, Institute for Neurosciences of Montpellier INM, INSERM, University of Montpellier, Montpellier, France
| | - Markku Partinen
- Department of Clinical Neurosciences, University of Helsinki Clinicum Unit, Helsinki, Finland
- Helsinki Sleep Clinic, Terveystalo Healthcare Services, Helsinki, Finland
| | - Yuichi Inoue
- Japan Somnology Center, Institute of Neuropsychiatry, Tokyo, Japan.
- Department of Somnology, Tokyo Medical University, Tokyo, Japan.
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Feng X, Dogg Sigurdardottir F, Øverby C, Thorshov T, Dammen T, Hrubos-Strøm H. Validation of insomnia questionnaire and estimation of COMISA in a large, population based cohort. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Øverby CT, Sutharshan P, Gulbrandsen P, Dammen T, Hrubos-Strøm H. Shared decision making: A novel approach to personalized treatment in obstructive sleep apnea. Sleep Med X 2022; 4:100052. [PMID: 36039181 PMCID: PMC9418975 DOI: 10.1016/j.sleepx.2022.100052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 12/25/2022] Open
Abstract
Study objectives i) To describe a novel approach of phenotyping by shared decision making (SDM) in obstructive sleep apnea (OSA) discharge consultations ii) to describe correlation between patient and observer based evaluations of SDM and iii) to describe treatment adherence. Methods Consecutive patients referred to the otorhinolaryngology department at Akershus University Hospital with suspected OSA between 2015 and 2016 participated. Patients with body mass index >30 were oversampled. Four male communication-trained doctors aged from 30 to 60 years participated. SDM was evaluated by modified content analysis and by the CollaboRATE self-report questionnaire and the “Observer OPTION (Young et al., 2008) [5]” rating scale. Positive airway pressure (PAP) treatment adherence and weight reduction was assessed by interview at six year follow-up. Results Eighteen consultations were video filmed. The content analysis revealed that the patient perspectives only briefly were explored. PAP was chosen by 17 of 18 patients. Median CollaboRATE questionnaire score was 29 (26, 30). Mean OPTION (Young et al., 2008) [5] score was 65.6 (SD 6.6, range 55–80). The correlation between SDM assessed by CollaboRATE self-report and by the “Observer OPTION (Young et al., 2008) [5]” rating scale was low (Pearson's r = 0.09). At follow up, 11 patients (64.7%) were PAP adherent and no one achieved 10% weight loss. Conclusions Despite a high degree of SDM compared to studies of non-OSA populations, the sub-optimal exploration of the patient perspective by communication-trained doctors precluded identification of patients willing to cope actively. SDM assessed by self-report and by a rating scale may represent two different constructs. PAP adherence was good. Obstructive sleep apnea treatment adherence is a clinical challenge. Little is known about the use of phenotyping by shared decision making in sleep research. Phenotyping by shared decision making was found to occur, but the patient perspective was discussed to a small extent. The CollaboRATE questionnaire is not optimal due to a ceiling effect for assessing shared decision making among patients with obstructive sleep apnea.
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Affiliation(s)
- Caroline Tonje Øverby
- Division of Surgery, Department of Otolaryngology, Akershus University Hospital, Lørenskog, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway
| | - Prasanthy Sutharshan
- Division of Psychiatry, Department of Substance Abuse and Addiction, Akershus University Hospital, Åråsen, Norway
| | - Pål Gulbrandsen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway.,HØKH, Department of Health Services Research, Akershus University Hospital, Lørenskog, Norway
| | - Toril Dammen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway.,Division of Mental Health and Addiction, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
| | - Harald Hrubos-Strøm
- Division of Surgery, Department of Otolaryngology, Akershus University Hospital, Lørenskog, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway
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8
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Bjorvatn B, Merikanto I, Reis C, Korman M, Bjelajac AK, Holzinger B, De Gennaro L, Wing YK, Morin CM, Espie CA, Benedict C, Landtblom AM, Matsui K, Hrubos-Strøm H, Mota-Rolim S, Nadorff MR, Plazzi G, Chan RNY, Partinen M, Dauvilliers Y, Chung F, Forthun I. Shift workers are at increased risk of severe COVID-19 compared with day workers: Results from the international COVID sleep study (ICOSS) of 7141 workers. Chronobiol Int 2022; 40:114-122. [PMID: 36412198 DOI: 10.1080/07420528.2022.2148182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The present study had two main aims. First, to investigate whether shift/night workers had a higher prevalence and severity of COVID-19 compared with day workers. Second, to investigate whether people regularly working in face-to-face settings during the pandemic exhibited a higher prevalence and severity of COVID-19 compared with those having no need to be in close contact with others at work. Data consisted of 7141 workers from 15 countries and four continents who participated in the International COVID Sleep Study-II (ICOSS-II) between May and December 2021. The associations between work status and a positive COVID-19 test and several indications of disease severity were tested with chi-square tests and logistic regressions adjusted for relevant confounders. In addition, statistical analyses were conducted for the associations between face-to-face work and COVID-19 status. Results showed that shift/night work was not associated with an increased risk of COVID-19 compared to day work. Still, shift/night workers reported higher odds for moderate to life-threatening COVID-19 (adjusted odds ratio (aOR) = 2.71, 95%-confidence interval = 1.23-5.95) and need for hospital care (aOR = 5.66, 1.89-16.95). Face-to-face work was associated with an increased risk of COVID-19 (aOR = 1.55, 1.12-2.14) but not with higher disease severity. In conclusion, shift/night work was not associated with an increased risk of COVID-19, but when infected, shift/night workers reported more severe disease. Impaired sleep and circadian disruption commonly seen among shift/night workers may be mediating factors. Working face-to-face increased the risk of COVID-19, likely due to increased exposure to the virus. However, face-to-face work was not associated with increased disease severity.
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Affiliation(s)
- Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway and Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Ilona Merikanto
- SleepWell Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland and Orton Orthopaedics Hospital, Helsinki, Finland
| | - Catia Reis
- Universidade Católica Portuguesa, Católica Research Centre for Psychological, Family and Social Wellbeing, Lisbon, Portugal and Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina de Lisboa, Lisboa, Portugal
| | - Maria Korman
- Department of Occupational Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel
| | | | - Brigitte Holzinger
- Institute for Consciousness and Dream Research, Medical University of Vienna, Wien, Postgraduate, Sleep Coaching, Vienna, Austria
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, Roma, Lazio, Italy and IRCCS Fondazione Santa Lucia, Roma, Italy
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Charles M. Morin
- Centre de recherche CERVO/Brain Research Center, École de psychologie, Université Laval, Quebec, Quebec, Canada
| | - Colin A. Espie
- Sir Jules Thorn Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Christian Benedict
- Department of Pharmaceutical Biosciences, Molecular Neuropharmacology, Uppsala University, Uppsala, Sweden
| | - Anne-Marie Landtblom
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Kentaro Matsui
- Department of Clinical Laboratory, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Harald Hrubos-Strøm
- Department of Otorhinolaryngology, Akershus University Hospital, Lørenskog, Norway and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sérgio Mota-Rolim
- Brain Institute, Physiology and Behavior Department and Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Michael R. Nadorff
- Department of Psychology, Mississippi State University, Mississippi, Mississippi, USA
| | - Giuseppe Plazzi
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy; and Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Rachel Ngan Yin Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Markku Partinen
- Department of Clinical Neurosciences, University of Helsinki Clinicum Unit, Helsinki, Finland and Helsinki Sleep Clinic, Terveystalo Healthcare Services, Helsinki, Finland
| | - Yves Dauvilliers
- Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, Institute for Neurosciences of Montpellier INM, INSERM, University of Montpellier, Montpellier, France
| | - Frances Chung
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ingeborg Forthun
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway and Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
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9
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Eide PK, Pripp AH, Berge B, Hrubos-Strøm H, Ringstad G, Valnes LM. Altered glymphatic enhancement of cerebrospinal fluid tracer in individuals with chronic poor sleep quality. J Cereb Blood Flow Metab 2022; 42:1676-1692. [PMID: 35350917 PMCID: PMC9441729 DOI: 10.1177/0271678x221090747] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Chronic sleep disturbance is a risk factor for dementia disease, possibly due to impaired sleep-dependent clearance of toxic metabolic by-products. We compared enrichment of a cerebrospinal fluid (CSF) tracer within brain of patients reporting good or poor sleep quality, assessed by the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Tracer enrichment in a selection of brain regions was assessed using multiphase magnetic resonance imaging up to 48 hours after intrathecal administration of the contrast agent gadobutrol (0.5 ml of 1 mmol/ml) serving as tracer. Tracer enrichment differed between patients with good (PSQI ≤5) and poor (PSQI >5) sleep quality in a cohort of non-dementia individuals (n = 44; age 42.3 ± 14.5 years), and in patients with the dementia subtype idiopathic normal pressure hydrocephalus (n = 24; age 71.0 ± 4.9 years). Sleep impairment was associated with increased CSF tracer enrichment in several brain regions. Cortical brain volume as well as entorhinal cortex thickness was reduced in the oldest cohort and was correlated with the severity of sleep disturbance and the degree of cortical tracer enrichment. We suggest chronic sleep disturbance is accompanied by altered glymphatic function along enlarged perivascular spaces.
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Affiliation(s)
- Per Kristian Eide
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.,Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | | | - Harald Hrubos-Strøm
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Otorhinolaryngology, Surgical Division, Akershus University Hospital, Nordbyhagen, Norway
| | - Geir Ringstad
- Department of Radiology, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Lars Magnus Valnes
- Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
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10
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Arnardottir ES, Islind AS, Óskarsdóttir M, Ólafsdóttir KA, August E, Jónasdóttir L, Hrubos-Strøm H, Saavedra JM, Grote L, Hedner J, Höskuldsson S, Ágústsson JS, Jóhannsdóttir KR, McNicholas WT, Pevernagie D, Sund R, Töyräs J, Leppänen T. The Sleep Revolution project: the concept and objectives. J Sleep Res 2022; 31:e13630. [PMID: 35770626 DOI: 10.1111/jsr.13630] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 12/18/2022]
Abstract
Obstructive sleep apnea is linked to severe health consequences such as hypertension, daytime sleepiness, and cardiovascular disease. Nearly a billion people are estimated to have obstructive sleep apnea with a substantial economic burden. However, the current diagnostic parameter of obstructive sleep apnea, the apnea-hypopnea index, correlates poorly with related comorbidities and symptoms. Obstructive sleep apnea severity is measured by counting respiratory events, while other physiologically relevant consequences are ignored. Furthermore, as the clinical methods for analysing polysomnographic signals are outdated, laborious, and expensive, most patients with obstructive sleep apnea remain undiagnosed. Therefore, more personalised diagnostic approaches are urgently needed. The Sleep Revolution, funded by the European Union's Horizon 2020 Research and Innovation Programme, aims to tackle these shortcomings by developing machine learning tools to better estimate obstructive sleep apnea severity and phenotypes. This allows for improved personalised treatment options, including increased patient participation. Also, implementing these tools will alleviate the costs and increase the availability of sleep studies by decreasing manual scoring labour. Finally, the project aims to design a digital platform that functions as a bridge between researchers, patients, and clinicians, with an electronic sleep diary, objective cognitive tests, and questionnaires in a mobile application. These ambitious goals will be achieved through extensive collaboration between 39 centres, including expertise from sleep medicine, computer science, and industry and by utilising tens of thousands of retrospectively and prospectively collected sleep recordings. With the commitment of the European Sleep Research Society and Assembly of National Sleep Societies, the Sleep Revolution has the unique possibility to create new standardised guidelines for sleep medicine.
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Affiliation(s)
- Erna S Arnardottir
- Reykjavik University Sleep Institute, Reykjavik University, Reykjavik, Iceland.,Landspitali University Hospital, Reykjavik, Iceland
| | - Anna Sigridur Islind
- Reykjavik University Sleep Institute, Reykjavik University, Reykjavik, Iceland.,Department of Computer Science, Reykjavik University, Reykjavik, Iceland
| | - María Óskarsdóttir
- Reykjavik University Sleep Institute, Reykjavik University, Reykjavik, Iceland.,Department of Computer Science, Reykjavik University, Reykjavik, Iceland
| | | | - Elias August
- Reykjavik University Sleep Institute, Reykjavik University, Reykjavik, Iceland.,Department of Engineering, Reykjavik University, Reykjavik, Iceland
| | - Lára Jónasdóttir
- Reykjavik University Sleep Institute, Reykjavik University, Reykjavik, Iceland
| | - Harald Hrubos-Strøm
- Department of Otorhinolaryngology, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jose M Saavedra
- Reykjavik University Sleep Institute, Reykjavik University, Reykjavik, Iceland.,Physical Activity, Physical Education, Sport and Health (PAPESH) Research Group, Department of Sports Science, Reykjavik University, Reykjavik, Iceland
| | - Ludger Grote
- Internal Medicine, Center for Sleep and Wake Disorders, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
| | - Jan Hedner
- Internal Medicine, Center for Sleep and Wake Disorders, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
| | | | | | - Kamilla Rún Jóhannsdóttir
- Reykjavik University Sleep Institute, Reykjavik University, Reykjavik, Iceland.,Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - Walter T McNicholas
- Department of Respiratory and Sleep Medicine, St. Vincent's Hospital Group, School of Medicine, University College Dublin, Dublin, Ireland
| | - Dirk Pevernagie
- Respiratory Diseases, University Hospital Ghent, Ghent, Belgium.,Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Reijo Sund
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Queensland, Australia.,Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Timo Leppänen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Queensland, Australia.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
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11
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Sigurdardottir FD, Øverby CT, Nikkonen S, Karhu T, Dammen T, Nordhus IH, Thorshov T, Einvik G, Kainulainen S, Leppänen T, Arnardottir ES, Töyräs J, Omland T, Hrubos-Strøm H. Novel oxygen desaturation parameters are associated with cardiac troponin I: Data from the Akershus Sleep Apnea Project. J Sleep Res 2022; 31:e13581. [PMID: 35289009 DOI: 10.1111/jsr.13581] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 12/27/2022]
Abstract
Novel diagnostic markers for obstructive sleep apnea beyond the apnea-hypopnea index (AHI) have been introduced. There are no studies on their association with markers of subclinical myocardial injury. We assessed the association between novel desaturation parameters and elevated cardiac troponin I and T. Participants with polysomnography (498) from the Akershus Sleep Apnea study were divided into normal and elevated biomarker groups based on sex-specific concentration thresholds (cardiac troponin I: ≥4 ng/L for women, ≥6 ng/L for men; and cardiac troponin T: ≥7 ng/L for women, ≥8 ng/L for men). Severity of obstructive sleep apnea was evaluated with the AHI, oxygen desaturation index, total sleep time with oxygen saturation below 90% (T90), lowest oxygen saturation (Min SpO2 %), and novel oxygen desaturation parameters: desaturation duration and desaturation severity. How the AHI and novel desaturation parameters predicted elevated cardiac troponin I and cardiac troponin T levels was assessed by the area under the curve (AUC). Based on multivariable-adjusted linear regression, the AHI (β = 0.004, p = 0.012), desaturation duration (β = 0.007, p = 0.004), and desaturation severity (β = 0.147, p = 0.002) were associated with cardiac troponin I levels but not cardiac troponin T. T90 was associated with cardiac troponin I (β = 0.006, p = 0.009) and cardiac troponin T (β = 0.005, p = 0.007). The AUC for the AHI 0.592 (standard error 0.043) was not significantly different from the AUC of T90 (SD 0.640, p = 0.08), desaturation duration 0.609 (SD 0.044, p = 0.42) or desaturation severity 0.616 (SD 0.043, p = 0.26) in predicting myocardial injury as assessed by cardiac troponin I. Oxygen desaturation parameters and the AHI were associated with cardiac troponin I levels but not cardiac troponin T levels. Novel oxygen desaturation parameters did not improve the prediction of subclinical myocardial injury compared to the AHI.
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Affiliation(s)
- Fjola D Sigurdardottir
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Caroline Tonje Øverby
- Department of Ear, Nose and Throat Surgery, Akershus University Hospital, Lørenskog, Norway.,Department of Behavioural Medicine, Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Sami Nikkonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Tuomas Karhu
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Toril Dammen
- Department of Behavioural Medicine, Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Inger Hilde Nordhus
- Department of Behavioural Medicine, Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Thea Thorshov
- Department of Ear, Nose and Throat Surgery, Akershus University Hospital, Lørenskog, Norway.,Department of Behavioural Medicine, Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Gunnar Einvik
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
| | - Samu Kainulainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Timo Leppänen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Queensland, Australia
| | - Erna Sif Arnardottir
- School of Technology, Reykjavik University Sleep Institute, Reykjavik University, Reykjavik, Iceland.,Landspitali University Hospital, Reykjavik, Iceland
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Queensland, Australia.,Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Torbjørn Omland
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Harald Hrubos-Strøm
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Ear, Nose and Throat Surgery, Akershus University Hospital, Lørenskog, Norway
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12
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Olafsson TA, Steinsvik EA, Bachmann-Harildstad G, Hrubos-Strøm H. A validation study of an esophageal probe-based polygraph against polysomnography in obstructive sleep apnea. Sleep Breath 2021; 26:575-584. [PMID: 34181175 PMCID: PMC9130176 DOI: 10.1007/s11325-021-02374-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/02/2021] [Accepted: 04/09/2021] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVES The aim of this study was to validate the automatically scored results of an esophageal probe-based polygraph system (ApneaGraph® Spiro) against manually scored polysomnography (Nox A1, PSG) results. We compared the apnea-hypopnea index, oxygen saturation index, and respiratory disturbance index of the devices. METHODS Consenting patients, referred for obstructive sleep apnea workup, were tested simultaneously with the ApneaGraph® Spiro and Nox A1® polysomnograph. Each participant made one set of simultaneous registrations for one night. PSG results were scored independently. Apnea-hypopnea index, oxygen desaturation index, and respiratory disturbance index were compared using Pearson's correlation and scatter plots. Sensitivity, specificity, and positive likelihood ratio of all indices at 5, 15, and 30 were calculated. RESULTS A total of 83 participants had successful registrations. The apnea-hypopnea index showed sensitivity of 0.83, specificity of 0.95, and a positive likelihood ratio of 5.11 at an index cutoff of 15. At a cutoff of 30, the positive likelihood ratio rose to 31.43. The respiratory disturbance index showed high sensitivity (> 0.9) at all cutoffs, but specificity was below 0.5 at all cutoffs. Scatterplots revealed overestimation in mild OSA and underestimation in severe OSA for all three indices. CONCLUSIONS The ApneaGraph® Spiro performed acceptably when OSA was defined by an AHI of 15. The equipment overestimated mild OSA and underestimated severe OSA, compared to the PSG.
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Affiliation(s)
- Thorarinn Arnar Olafsson
- Department of Otorhinolaryngology, Akershus University Hospital, PO 1000 1470, Lørenskog, Norway. .,Faculty of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Eivind Andreas Steinsvik
- Department of Otorhinolaryngology, Akershus University Hospital, PO 1000 1470, Lørenskog, Norway
| | - Gregor Bachmann-Harildstad
- Department of Otorhinolaryngology, Akershus University Hospital, PO 1000 1470, Lørenskog, Norway.,Faculty of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Harald Hrubos-Strøm
- Department of Otorhinolaryngology, Akershus University Hospital, PO 1000 1470, Lørenskog, Norway.,Faculty of Basic Medical Sciences, University of Oslo, Oslo, Norway
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13
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McIntosh C, Clemm HH, Sewry N, Hrubos-Strøm H, Schwellnus MP. Diagnosis and management of nasal obstruction in the athlete. A narrative review by subgroup B of the IOC Consensus Group on "Acute Respiratory Illness in the Athlete". J Sports Med Phys Fitness 2021; 61:1144-1158. [PMID: 34156184 DOI: 10.23736/s0022-4707.21.12821-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Protection of the health of the athlete is required for high level sporting performance. Acute respiratory illness is the leading cause of illness and can compromise training and competition in athletes. To date the focus on respiratory health in athletes has largely been on acute upper respiratory infections and asthma/exercise induced bronchoconstriction (EIB), while nasal conditions have received less attention. The nose has several important physiological functions for the athlete. Nasal conditions causing obstruction to airflow can compromise respiratory health in the athlete, negatively affect quality of life and sleep, cause mouth breathing and ultimately leading to inadequate recovery and reduced exercise performance. Nasal obstruction can be broadly classified as structural (static or dynamic) or mucosal. Mucosal inflammation in the nose (rhinitis) is the most frequent cause of nasal obstruction and is reported to be higher in athletes (21-74%) than in the general population (20-25%). This narrative review provides the sport and exercise medicine physician with a clinical approach to the diagnosis and management of common nasal conditions that can cause nasal obstruction, ultimately leading to improved athlete health and better sports performance.
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Affiliation(s)
- Cameron McIntosh
- Dr CND McIntosh Inc., Edge Day Hospital, Port Elizabeth, South Africa
| | - Hege H Clemm
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Nicola Sewry
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, South Africa
| | - Harald Hrubos-Strøm
- Department of Otorhinolaryngology, Surgical Division, Akershus University Hospital, Lørenskog, Norway.,Department of Behavioral Sciences, Institute for Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Martin P Schwellnus
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, South Africa - .,International Olympic Committee (IOC) Research Center of South Africa, University of Pretoria, South Africa
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14
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Olafsson T, Hrubos-Strøm H. A validation study of an esophageal based polygraph against manually scored polysomnography. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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15
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Sigurdardottir F, Lyngbakken M, Hveem K, Hrubos-Strøm H, Røsjø H, Omland T. Self-reported insomnia symptoms and subclinical myocardial injury: data from the nord-trøndelag health study (HUNTII). Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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16
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Hrubos-Strøm H. Lettlest og grundig om søvn. Tidsskriftet 2019. [DOI: 10.4045/tidsskr.19.0232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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17
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Värendh M, Andersson M, Björnsdóttir E, Arnardóttir ES, Gislason T, Pack AI, Hrubos-Strøm H, Johannisson A, Juliusson S. PAP treatment in patients with OSA does not induce long-term nasal obstruction. J Sleep Res 2018; 28:e12768. [PMID: 30264448 PMCID: PMC7379236 DOI: 10.1111/jsr.12768] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 11/29/2022]
Abstract
We hypothesized that positive airway pressure treatment would induce nasal obstruction and decrease nasal cavity due to mucosal swelling. We further hypothesized that subjective and objective nasal obstruction at baseline would negatively affect positive airway pressure adherence. A total of 728 patients with sleep apnea were investigated in the Icelandic Sleep Apnea Cohort at baseline and 2 years after starting positive airway pressure. Patients underwent home sleep apnea testing at baseline. Questionnaires were answered and acoustic rhinometry was completed at baseline and follow‐up. The proportion of patients reporting subjective nocturnal nasal obstruction was reduced (baseline: 35% versus follow‐up: 24%; p < 0.001). Small interior nasal dimensions increased (p < 0.001) independent of adherence to treatment. Small nasal volume at baseline was a determinant for becoming a non‐user of positive airway pressure treatment (odds ratio 2.22, confidence interval 95% 1.35–3.67, p = 0.002). Subjective nasal obstruction decreased 2 years after initiating positive airway treatment in sleep apnea, and objectively small nasal dimensions increased. Small nasal volume at baseline was a negative predictor for positive airway pressure treatment adherence. Maybe most importantly, positive airway pressure treatment did not cause long‐term objective or subjective nasal obstruction.
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Affiliation(s)
- Maria Värendh
- Department of Otorhinolaryngology, Head and Neck Surgery, Skåne University Hospital, Lund, Sweden.,Faculty of Medicine, Lund University, Lund, Sweden
| | - Morgan Andersson
- Department of Otorhinolaryngology, Head and Neck Surgery, Skåne University Hospital, Lund, Sweden.,Faculty of Medicine, Lund University, Lund, Sweden
| | - Erla Björnsdóttir
- Sleep Department, Landspitali - The National University Hospital of Iceland, Reykjavík, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Erna S Arnardóttir
- Sleep Department, Landspitali - The National University Hospital of Iceland, Reykjavík, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Thorarinn Gislason
- Sleep Department, Landspitali - The National University Hospital of Iceland, Reykjavík, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Allan I Pack
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Harald Hrubos-Strøm
- Department of Otorhinolaryngology, Akershus University Hospital, Lørenskog, Norway
| | - Arne Johannisson
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Sigurdur Juliusson
- Department of Otolaryngology, Head and Neck Surgery, Landspitali - The National University Hospital of Iceland, Reykjavík, Iceland
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Caspersen NF, Røsjø H, Flyvbjerg A, Bjerre M, Randby A, Hrubos-Strøm H, Omland T, Einvik G. The association between circulating adiponectin levels, lung function and adiposity in subjects from the general population; data from the Akershus Sleep Apnea Project. BMC Pulm Med 2018; 18:54. [PMID: 29609563 PMCID: PMC5879541 DOI: 10.1186/s12890-018-0618-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 03/20/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Circulating adiponectin (ADPN) levels are inversely associated with disease severity in patients with chronic obstructive pulmonary disease (COPD), while studies assessing the relationship between ADPN and lung function in subjects from the general population have shown diverging results. Accordingly, we hypothesized that ADPN would be associated with lung function in a population-based sample and tested how abdominal adiposity, metabolic syndrome, and systemic inflammation influenced this association. METHODS We measured total ADPN in serum, forced vital capacity (FVC) and forced expiratory volume during the 1st second (FEV1) in 529 participants (median 50 years, 54.6% males) recruited from the general population. We assessed the association between ADPN and lung function by multivariate linear regression analyses and adjusted for age, gender, height, smoking habits, weight, body mass index, waist-hip ratio, metabolic syndrome, obstructive sleep apnoea (OSA) and C-reactive protein. RESULTS The median (interquartile range) level of serum ADPN was 7.6 (5.4-10.4) mg/L. ADPN levels were positively associated with FVC % of predicted (beta 3.4 per SD adiponectin, p < 0.001)) in univariate linear regression analysis, but the association was attenuated in multivariate analysis (standardized beta 0.03, p = 0.573)). Among co-variates only WHR significantly attenuated the relationship. ADPN levels were also associated with FEV1% of predicted in bivariate analysis that adjusted for smoking (beta 1.4, p = 0.042)), but this association was attenuated and no longer significant in multivariate analysis (standardized beta -0.06, p = 0.254)). CONCLUSION In this population-based sample no association between ADPN and lung function was evident after adjustment for covariates related to adiposity.
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Affiliation(s)
- Nina F. Caspersen
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Helge Røsjø
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Allan Flyvbjerg
- Steno Diabetes Center Copenhagen (SDCC), the Capital Region of Denmark and University of Copenhagen, Copenhagen, Denmark
| | - Mette Bjerre
- Medical Research Laboratory, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Anna Randby
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Harald Hrubos-Strøm
- Department of Otorhinolaryngology, Division of Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Torbjørn Omland
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gunnar Einvik
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Värendh M, Andersson M, Bjørnsdottir E, Arnardottir E, Gislason T, Hrubos-Strøm H, Johannisson A, Juliusson S. Nasal obstruction decrease after two years of PAP treatment. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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20
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Värendh M, Andersson M, Bjørnsdottir E, Hrubos-Strøm H, Johannisson A, Arnardottir ES, Gislason T, Juliusson S. Nocturnal nasal obstruction is frequent and reduces sleep quality in patients with obstructive sleep apnea. J Sleep Res 2017; 27:e12631. [PMID: 29105874 DOI: 10.1111/jsr.12631] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/26/2017] [Indexed: 11/29/2022]
Abstract
The prevalence and consequences of nasal obstruction in untreated obstructive sleep apnea patients are not known. The study objectives were to investigate the frequency of subjective and objective nasal obstruction in untreated sleep apnea patients and the associations with sleep and quality of life. Patients in the Icelandic Sleep Apnea Cohort were subjected to a type 3 sleep study, answered questionnaires and had their nasal dimensions measured by acoustic rhinometry. In total, 810 patients participated (including 153 females), aged 54.5 ± 10.6 years [mean ± standard deviation (SD)] with an apnea/hypopnea index 44.7 ± 20.7 h-1 . Nocturnal nasal obstruction (greater than or equal to three times per week) was reported by 35% of the patients. These patients had smaller nasal dimensions measured by the minimum cross-sectional area within the smaller nasal valve (0.42 ± 0.17 versus 0.45 ± 0.16 cm2 , P = 0.013), reported more daytime sleepiness (Epworth Sleepiness Scale score 12.5 ± 4.9 versus 10.8 ± 5.0; P < 0.001) and slightly lower mental quality of life than patients without nocturnal nasal obstruction. Nocturnal nasal obstruction is reported in one-third of the sleep apnea patients and they are more likely to suffer from daytime sleepiness and slightly reduced quality of life than other sleep apnea patients.
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Affiliation(s)
- Maria Värendh
- Department of Otorhinolaryngology, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Morgan Andersson
- Department of Otorhinolaryngology, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Erla Bjørnsdottir
- Department of Respiratory Medicine and Sleep, Landspitali - The National University Hospital of Iceland, Reykjavík, Iceland
| | - Harald Hrubos-Strøm
- Department of Otorhinolaryngology, Akershus University Hospital, Lørenskog, Norway
| | - Arne Johannisson
- Occupational Therapy and Occupational Science, Lund University, Lund, Sweden
| | - Erna S Arnardottir
- Department of Respiratory Medicine and Sleep, Landspitali - The National University Hospital of Iceland, Reykjavík, Iceland.,Faculty of Medicine, University of Iceland Reykjavik, Reykjavik, Iceland
| | - Thorarinn Gislason
- Department of Respiratory Medicine and Sleep, Landspitali - The National University Hospital of Iceland, Reykjavík, Iceland.,Faculty of Medicine, University of Iceland Reykjavik, Reykjavik, Iceland
| | - Sigurdur Juliusson
- Department of Otolaryngology - Head and Neck Surgery, Landspitali - The National University Hospital of Iceland Reykjavík, Reykjavík, Iceland
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21
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Värendh M, Johannisson A, Hrubos-Strøm H, Andersson M. Sleep quality improves with endoscopic sinus surgery in patients with chronic rhinosinusitis and nasal polyposis. Rhinology 2017; 55:45-52. [PMID: 28019643 DOI: 10.4193/rhin16.065] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP) is a chronic disease that has a major impact on generic and disease-specific quality of life. Little is known about the influence of CRSwNP on sleep and what effect surgery for CRSwNP has on sleep quality. The aim of the study was to investigate sleep quality in patients with CRSwNP before and after endoscopic surgery. METHODOLOGY Forty-two patients filled out four validated sleep questionnaires and one sino/nasal, disease specific quality of life questionnaire before surgery and three months later. A healthy control group filled out the same questionnaires at baseline and after three months. RESULTS An impact on sleep patterns was found in all sleep questionnaires and surgery clearly improved the quality of sleep. The Sino-nasal outcome test sum score decreased from median 51,5 to 26,5. Epworth sleepiness scale showed a decline in score from score 7.5 to 6.0. Surgery also reduced the risk for obstructive sleep apnoea in 13 patients evaluated by the Berlin Questionnaire and Multivariable Apnea Prediction Index. CONCLUSIONS Patients with CRSwNP had impaired sleep quality, daytime sleepiness, nasal patency, and risk for sleep apnea, all of which improved after corrective surgery.
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Affiliation(s)
- M Värendh
- Department of Otorhinolaryngology, Skane University Hospital and Lund University, Sweden
| | - A Johannisson
- Occupational Therapy and Occupational Science, Lund University, Sweden
| | - H Hrubos-Strøm
- Department of Otorhinolaryngology, Akershus University Hospital, Lorenskog, Norway
| | - M Andersson
- Department of Otorhinolaryngology, Skane University Hospital and Lund University, Sweden
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22
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Pedersen M, Ekstedt M, Småstuen MC, Wyller VB, Sulheim D, Fagermoen E, Winger A, Pedersen E, Hrubos-Strøm H. Sleep-wake rhythm disturbances and perceived sleep in adolescent chronic fatigue syndrome. J Sleep Res 2017; 26:595-601. [PMID: 28470767 DOI: 10.1111/jsr.12547] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/24/2017] [Indexed: 12/23/2022]
Abstract
Chronic fatigue syndrome (CFS) is characterized by long-lasting, disabling and unexplained fatigue that is often accompanied by unrefreshing sleep. The aim of this cross-sectional study was to investigate sleep-wake rhythm and perceived sleep in adolescent CFS patients compared to healthy individuals. We analysed baseline data on 120 adolescent CFS patients and 39 healthy individuals included in the NorCAPITAL project. Activity measures from a uniaxial accelerometer (activPAL) were used to estimate mid-sleep time (mid-point of a period with sleep) and time in bed. Scores from the Karolinska Sleep Questionnaire (KSQ) were also assessed. The activity measures showed that the CFS patients stayed significantly longer in bed, had a significantly delayed mid-sleep time and a more varied sleep-wake rhythm during weekdays compared with healthy individuals. On the KSQ, the CFS patients reported significantly more insomnia symptoms, sleepiness, awakening problems and a longer sleep onset latency than healthy individuals. These results might indicate that disrupted sleep-wake phase could contribute to adolescent CFS; however, further investigations are warranted.
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Affiliation(s)
- Maria Pedersen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Pediatrics, Akershus University Hospital, Lorenskog, Norway
| | - Mirjam Ekstedt
- School of Health and Caring Sciences, Linneaus University, Kalmar, Sweden.,Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Milada C Småstuen
- Faculty of Health, Akershus University College of Applied Sciences, Oslo, Norway
| | - Vegard B Wyller
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Pediatrics, Akershus University Hospital, Lorenskog, Norway
| | - Dag Sulheim
- Department of Pediatrics, Innlandet Hospital Trust, Brumunddal, Norway
| | - Even Fagermoen
- Department of Anesthesiology and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Anette Winger
- Faculty of Health, Akershus University College of Applied Sciences, Oslo, Norway
| | - Edvard Pedersen
- Department of Computer Science, UiT-The Arctic University of Norway, Tromso, Norway
| | - Harald Hrubos-Strøm
- Division of Surgery, Department of Otorhinolaryngology, Akershus University Hospital, Lorenskog, Norway
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23
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Omland T, Randby A, Hrubos-Strøm H, Røsjø H, Einvik G. Relation of Erectile Dysfunction to Subclinical Myocardial Injury. Am J Cardiol 2016; 118:1821-1825. [PMID: 27780552 DOI: 10.1016/j.amjcard.2016.08.070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 08/23/2016] [Accepted: 08/23/2016] [Indexed: 10/21/2022]
Abstract
The circulating concentration of cardiac troponin I (cTnI) is an index of subclinical myocardial injury in several patient populations and in the general population. Erectile dysfunction is associated with greater risk for cardiovascular events, but the association with subclinical myocardial injury is not known. We aimed to test the hypothesis that the presence and severity of erectile dysfunction is associated with greater concentrations of cTnI in the general population. The presence and severity of erectile dysfunction was assessed by administering the International Index of Erectile Function 5 (IIEF-5) questionnaire to 260 men aged 30 to 65 years recruited from a population-based study. Concentrations of cTnI were determined by a high-sensitivity (hs) assay. Hs-cTnI levels were significantly higher in subjects with than in those without erectile dysfunction (median 2.9 vs 1.6 ng/l; p <0.001). Men with erectile dysfunction (i.e., IIEF-5 sum score <22) were also significantly older; had a higher systolic blood pressure, lower estimated glomerular filtration rate, higher augmentation index and N-terminal pro-B-type natriuretic peptide; and had a higher prevalence of hypertension, diabetes mellitus, and previous coronary artery disease than subjects without erectile dysfunction. These covariates were adjusted for in a multivariate linear regression model, yet the IIEF-5 sum score remained significantly negatively associated with the hs-cTnI concentration (standardized β -0.206; p <0.001). In conclusion, the presence and severity of erectile dysfunction is associated with circulating concentrations of hs-cTnI, indicating subclinical myocardial injury independently of cardiovascular risk factors, endothelial dysfunction and heart failure biomarkers.
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24
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Skranes JB, Einvik G, Namtvedt SK, Randby A, Hrubos-Strøm H, Brynildsen J, Hagve TA, Somers VK, Røsjø H, Omland T. Biomarkers of cardiovascular injury and stress are associated with increased frequency of ventricular ectopy: a population-based study. BMC Cardiovasc Disord 2016; 16:233. [PMID: 27875987 PMCID: PMC5118891 DOI: 10.1186/s12872-016-0407-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 11/11/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Asymptomatic ventricular arrhythmias are common and associated with increased risk of cardiovascular mortality. Cardiac troponins, natriuretic peptides and C-reactive protein (CRP) are also predictive of adverse cardiovascular events in the general population, but limited information is available on the relationship between these biomarkers and ventricular ectopy in a community-based population. The objectives were to evaluate the associations between ventricular ectopic activity and N-terminal pro-B-type natriuretic peptide (NT-proBNP), high sensitivity-troponin I (hs-TnI) and hs-CRP in a community-based setting. METHODS We performed a 24 h Holter-recording and blood sampling in 498 subjects. Premature ventricular complexes (PVC) were classified as frequent at >5/h and the presence of any bigeminy, trigeminy or non-sustained ventricular tachycardia were classified as complex ventricular ectopy. The associations between biomarkers and ventricular arrhythmias were investigated by univariate and multivariate logistic regression analyses. RESULTS Frequent PVC's and complex ventricular ectopy were detected in 46 (9%) and 47 (9%) participants respectively, and were associated with significantly (p < 0.001) higher concentrations of NT-proBNP and hs-TnI. The association between NT-proBNP and both frequent PVC's (p = 0.020) and complex ventricular ectopy (p = 0.001) remained significant after adjusting for conventional risk markers in multivariate analyses. CONCLUSION Increased level of NT-proBNP was independently associated with ventricular ectopy, whereas no independent association was observed between hs-TnI and hs-CRP levels and ventricular ectopy in this community-based sample.
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Affiliation(s)
| | - Gunnar Einvik
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | | | - Anna Randby
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | | | - Jon Brynildsen
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Tor-Arne Hagve
- Division of Diagnostics and Technology, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Virend K Somers
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Foundation for Medical Education and Research, Rochester, MN, USA
| | - Helge Røsjø
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torbjørn Omland
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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Engstrøm M, Beiske KK, Hrubos-Strøm H, Aarrestad S, Sand T. Investigation of obstructive respiratory disturbance during sleep. Tidsskr Nor Laegeforen 2015; 135:1962-4. [PMID: 26577325 DOI: 10.4045/tidsskr.15.0391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Hrubos-Strøm H. Re: Er det overvekt eller vektfokus som er helseskadelig? Tidsskriftet 2015; 135:309-10. [DOI: 10.4045/tidsskr.15.0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Einvik G, Røsjø H, Randby A, Namtvedt SK, Hrubos-Strøm H, Brynildsen J, Somers VK, Omland T. Severity of obstructive sleep apnea is associated with cardiac troponin I concentrations in a community-based sample: data from the Akershus Sleep Apnea Project. Sleep 2014; 37:1111-6, 1116A-1116B. [PMID: 24882906 DOI: 10.5665/sleep.3772] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES Previous community-based studies have failed to demonstrate an independent association between OSA and circulating cardiac troponin concentrations, a marker of myocardial injury. However, these studies have used troponin assays with modest analytic sensitivity to detect low-level, chronic increments in troponin levels. Using a highly sensitive troponin I (hs-TnI) assay, we tested the hypothesis that the severity of OSA is associated with myocardial injury independently of comorbidities. DESIGN Cross-sectional study. SETTING Community-based. PARTICIPANTS 514 subjects (54% men, age 48 ± 11 y [mean ± SD]). INTERVENTIONS N/A. MEASUREMENTS AND RESULTS hs-TnI concentrations were measured in fasting morning blood samples and 318 participants (62%) had hs-TnI concentration above the limit of detection ([LoD] 1.2 ng/L). The severity of OSA, expressed as the apnea-hypopnea index (AHI) and nocturnal hypoxemia, was assessed by in-hospital polysomnography. After adjustment for age, gender, estimated creatinine clearance, history of coronary artery disease and hypertension, smoking, diabetes mellitus, systolic blood pressure, heart rate, body mass index, left ventricular hypertrophy, and cholesterol ratio in multivariate linear regression models, higher AHI (standardized β = 0.12, P = 0.006), lower mean SpO2 (β = -0.13, P = 0.012) and higher percentage of total sleep time with SpO2 < 90% (β = 0.12, P = 0.011) were all associated with higher hs-TnI levels in separate models. Additional analyses with hs-TnI categorized in tertiles or using a different strategy for persons with hs-TnI levels below the LoD did not change the results. CONCLUSION Increased obstructive sleep apnea (OSA) severity is independently associated with higher concentrations of hs-TnI, suggesting that frequent apneas or hypoxemia in OSA may cause low-grade myocardial injury.
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Affiliation(s)
- Gunnar Einvik
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway and Center for Heart Failure Research and K.G. Jebsen Cardiac Research Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Helge Røsjø
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway and Center for Heart Failure Research and K.G. Jebsen Cardiac Research Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anna Randby
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway and Center for Heart Failure Research and K.G. Jebsen Cardiac Research Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Silje K Namtvedt
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway and Center for Heart Failure Research and K.G. Jebsen Cardiac Research Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Harald Hrubos-Strøm
- Division of Surgery, Department of Otorhinolaryngology, Akershus University Hospital, Lørenskog, Norway and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jon Brynildsen
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway and Center for Heart Failure Research and K.G. Jebsen Cardiac Research Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Virend K Somers
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Foundation for Medical Education and Research, Rochester, MN
| | - Torbjørn Omland
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway and Center for Heart Failure Research and K.G. Jebsen Cardiac Research Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Randby A, Namtvedt SK, Hrubos-Strøm H, Einvik G, Somers VK, Omland T. Sex-Dependent Impact of OSA on Digital Vascular Function. Chest 2013; 144:915-922. [DOI: 10.1378/chest.12-2283] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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30
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Einvik G, Flyvbjerg A, Hrubos-Strøm H, Randby A, Frystyk J, Bjerre M, Namtvedt SK, Kristiansen HA, Nordhus IH, Somers VK, Dammen T, Omland T. Novel cardiovascular risk markers in depression: no association between depressive symptoms and osteoprotegerin or adiponectin in persons at high risk for sleep apnea. J Affect Disord 2013; 145:400-4. [PMID: 22862888 DOI: 10.1016/j.jad.2012.05.065] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 05/10/2012] [Accepted: 05/12/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Inflammation is believed to play a role in the pathogenesis of both cardiovascular disease and depressive disorders. We hypothesized that circulating concentrations of the novel inflammatory and cardiovascular biomarkers osteoprotegerin (OPG) and adiponectin as well as high sensitivity C-reactive protein (hsCRP) are associated with the severity of depressive symptoms and presence of major depressive disorder (MDD). METHODS In a cross-sectional population-derived study (Akershus Sleep Apnea Project) 520 persons underwent clinical examination and venous blood sampling. Medical history was obtained and the participants completed the Beck Depression Inventory (BDI). Structured clinical interviews for axis-I disorders including MDD were performed in a subgroup of 288 participants. OPG and adiponectin concentrations were determined by in-house time-resolved immunofluorometric assays. RESULTS Despite significant correlation with hsCRP (r=0.162, p<0.001), the sum-score of BDI did not correlate with OPG or adiponectin levels (r=0.011, p=0.811 and r=0.055, p=0.210, respectively). Neither circulating OPG nor adiponectin differed between persons with (n=34) and without (n=246) MDD (median±interquartile range: 1.18 (0.96-1.49) vs. 1.17 (0.93-1.57) ug/l and 7.26 (5.13-9.91) vs. 7.39 (5.23-11.37) mg/l, respectively). LIMITATIONS Causal considerations are not possible, and results in the sub-group of diagnosed participants need careful interpretation due to small sample size. CONCLUSIONS hsCRP was independently associated with depressive symptoms, but no association between depression severity or presence of MDD and OPG- or adiponectin concentrations was observed in community-residing persons at high risk for obstructive sleep apnea.
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Affiliation(s)
- Gunnar Einvik
- Division of Medicine, Akershus University Hospital and Institute of Clinical Medicine, University of Oslo, Norway.
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Hrubos-Strøm H. Kognitiv atferdsterapi i bokform – alternativ til medikamentell behandling ved søvnlidelser? Tidsskriftet 2013. [DOI: 10.4045/tidsskr.13.0785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Randby A, Namtvedt SK, Einvik G, Hrubos-Strøm H, Hagve TA, Somers VK, Omland T. Obstructive sleep apnea is associated with increased high-sensitivity cardiac troponin T levels. Chest 2013; 142:639-646. [PMID: 22406957 DOI: 10.1378/chest.11-1779] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with increased cardiovascular risk. Stress imposed on the myocardium by repeated severe hypoxemia and/or BP surges during sleep may result in subclinical myocardial injury. A high-sensitivity cardiac troponin T (hs-cTnT) assay has been developed. We hypothesized that the severity of OSA, as assessed by the apnea-hypopnea index (AHI), is associated with circulating levels of hs-cTnT in the general population. METHODS Five hundred five subjects drawn from the general population (age range, 30-65 years; 45% women) underwent in-hospital polysomnography and had morning blood samples drawn. Oversampling of subjects at high risk of OSA was performed. RESULTS Overall, hs-cTnT was detectable (≥ 3 ng/L) in 216 subjects (42.8%). After categorizing subjects according to AHI cutoffs that correspond to no, mild to moderate, and severe OSA, the proportion of subjects with detectable hs-cTnT levels increased with increasing severity of OSA (P for trend < .001). Multivariate logistic regression with detectable hs-cTnT as the dependent variable was used to further assess the association between OSA and troponin T. After adjustment for significant univariate predictors of detectable hs-cTnT, the association between AHI and hs-cTnT was no longer statistically significant. CONCLUSIONS The prevalence of detectable hs-cTnT increases in proportion to OSA severity, but this association is likely to be caused by a clustering of cardiovascular risk factors among subjects with OSA.
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Affiliation(s)
- Anna Randby
- Division of Medicine, Akershus University Hospital, Lørenskog, Oslo, Norway; K.G. Jebsen Cardiac Research Centre, Center for Heart Failure Research and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Silje K Namtvedt
- Division of Medicine, Akershus University Hospital, Lørenskog, Oslo, Norway; K.G. Jebsen Cardiac Research Centre, Center for Heart Failure Research and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gunnar Einvik
- Division of Medicine, Akershus University Hospital, Lørenskog, Oslo, Norway; K.G. Jebsen Cardiac Research Centre, Center for Heart Failure Research and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Harald Hrubos-Strøm
- Department of Otorhinopharyngology, Akershus University Hospital, Lørenskog, Oslo, Norway; Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Tor-Arne Hagve
- Division of Diagnostics and Technology, Akershus University Hospital, Lørenskog, Oslo, Norway
| | - Virend K Somers
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, MN
| | - Torbjørn Omland
- Division of Medicine, Akershus University Hospital, Lørenskog, Oslo, Norway; K.G. Jebsen Cardiac Research Centre, Center for Heart Failure Research and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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Einvik G, Dammen T, Namtvedt SK, Hrubos-Strøm H, Randby A, Kristiansen HA, Nordhus IH, Somers VK, Omland T. Type D personality is associated with increased prevalence of ventricular arrhythmias in community-residing persons without coronary heart disease. Eur J Prev Cardiol 2012; 21:592-600. [PMID: 23008135 DOI: 10.1177/2047487312462800] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Type D personality may be a risk factor for poor outcome in patients with cardiovascular disease. The biological mechanisms underlying this association are poorly understood. The objective of the study was to test the hypotheses that Type D personality is associated with biological markers for sympathetic dysregulation. DESIGN Cross-sectional community-based study. METHODS Type D personality was evaluated by DS-14 in 450 persons (46% men), aged between 30 and 65 years. From a Holter-recording, (mean length 18.3 hours), long-term heart rate, ventricular arrhythmias, and heart rate variability (HRV) were registered as markers of sympathetic dysregulation. Traditional cardiovascular risk factors, apnoea-hypopnoea index, medication, and anxiety symptoms were adjusted for. RESULTS Type D persons had higher long-term averaged heart rate (74 vs. 71 beats/min, p = 0.003), but this difference was attenuated and not significant in the multivariate model (p = 0.078)). There was an increased prevalence of complex ventricular ectopy (bigeminy, trigeminy, or non-sustained ventricular tachycardia; 14 vs. 6%, p = 0.005 in multivariate model). HRV indices did not differ significantly between those with or without Type D personality. Anxiety symptoms did not confound these associations. CONCLUSIONS Type D personality is independently associated with a higher likelihood of ventricular arrhythmias, which may be implicated in the increased cardiovascular risk observed in persons with Type D personality.
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Einvik G, Vistnes M, Hrubos-Strøm H, Randby A, Namtvedt SK, Nordhus IH, Somers VK, Dammen T, Omland T. Circulating cytokine concentrations are not associated with major depressive disorder in a community-based cohort. Gen Hosp Psychiatry 2012; 34:262-7. [PMID: 22401706 DOI: 10.1016/j.genhosppsych.2012.01.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 01/21/2012] [Accepted: 01/31/2012] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The objective was to test the hypotheses that cytokine levels are elevated in community-residing persons at high risk for obstructive sleep apnea with major depressive disorder (MDD) compared to nondepressive persons and that cytokine levels show stronger correlations with somatic than psychological symptoms of depression. METHOD A case-control study within the cross-sectional Akershus Sleep Apnea Project was performed. Two controls matched for age, gender, metabolic syndrome and obstructive sleep apnea were drawn for each case of MDD. RESULTS Group comparisons revealed no significant difference in the levels of 17 cytokines [interleukin-1β, -2,-4, -5, -6, -7, -8, -10, -12(p70), -13 and -17; tumor necrosis factor-α; interferon-γ; granulocyte colony-stimulating factor; granulocyte-monocyte colony-stimulating factor; macrophage chemoattractant protein-1 and monocyte inhibitory protein-1β] between persons with (n=34) and without MDD (n=68). There was no association between cytokines levels and MDD in multivariate regression analyses. The concentration of interleukin-4 was significantly more positively correlated with psychological than somatic symptoms (r=0.046 vs. -0.143, respectively, P=0.024), while no different correlations were observed for other cytokines. CONCLUSION The cytokine levels were not elevated in MDD, and cytokine levels were not more strongly associated with somatic than psychological symptoms of depression. The depression-specific effect on inflammation may be weak in community-based samples with prevalent somatic comorbidity.
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Affiliation(s)
- Gunnar Einvik
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway.
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Hrubos-Strøm H, Einvik G, Nordhus IH, Randby A, Pallesen S, Moum T, Omland T, Dammen T. Sleep apnoea, anxiety, depression and somatoform pain: a community-based high-risk sample. Eur Respir J 2012; 40:400-7. [PMID: 22441739 DOI: 10.1183/09031936.00111411] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Community-based studies that measure both psychiatric diagnoses and obstructive sleep apnoea (OSA) are lacking. This study reports current psychiatric disorders in community-dwelling adults at high risk for OSA identified by the Berlin Questionnaire. Furthermore, associations between OSA and current psychiatric disorders, unadjusted and adjusted for putative confounders, are reported. A subsample of the Akershus Sleep Apnoea Project consisting of 290 adults, aged 30-65 yrs, with positive Berlin Questionnaire screening underwent the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, version IV and polysomnography. Auxiliary analyses of depression are provided. The median apnoea/hypopnoea index score in the sample was 7.7 (interquartile range 2.4-22.2). Major depressive disorder, current anxiety and somatoform pain disorder were diagnosed in 12.4%, 14.8% and 19.3% of participants, respectively. At least one psychiatric disorder was diagnosed in 110 participants. The odds ratio of participants with OSA having a psychiatric disorder compared with participants without OSA was 0.54 (95% CI 0.33-0.88). A negative association did not exist among Berlin Questionnaire low-risk participants. In conclusion, more than one-third of participants in a community-based, Berlin Questionnaire high-risk sample were diagnosed with a psychiatric disorder. A negative association between OSA and psychiatric morbidity was found.
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Affiliation(s)
- Harald Hrubos-Strøm
- Dept of Otopharyngeology, Surgical Division, Akershus University Hospital, 1478 Lørenskog, Norway.
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Hrubos-Strøm H, Nordhus IH, Einvik G, Randby A, Omland T, Sundet K, Moum T, Dammen T. Obstructive sleep apnea, verbal memory, and executive function in a community-based high-risk population identified by the Berlin Questionnaire Akershus Sleep Apnea Project. Sleep Breath 2012; 16:223-31. [PMID: 21350844 PMCID: PMC3278612 DOI: 10.1007/s11325-011-0493-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 01/12/2011] [Accepted: 01/31/2011] [Indexed: 10/28/2022]
Abstract
PURPOSE Cognitive functions in community-dwelling adults at high risk of obstructive sleep apnea have not been described and nor are associations between cognitive functions and obstructive sleep apnea severity fully understood. The study aimed to describe verbal memory and executive function in community-dwelling adults identified by the Berlin Questionnaire and to investigate associations between these cognitive domains and different obstructive sleep apnea severity indicators. METHODS Among 29,258 age- and gender-stratified persons 30-65 years who received the Berlin Questionnaire by mail, 16,302 (55.7%) responded. From 654 randomly drawn respondents with BQ high risk who were approached for study participation, 290 participants (55.9% males, mean age 48.2 years) were included. Verbal memory was assessed by Rey Auditory Verbal Learning Test and executive function by Stroop test. Obstructive sleep apnea severity indicators were assessed by polysomnography. RESULTS Mean (standard deviation) verbal learning score was 42.0 (8.9), mean interference time was 31.1 (12.7), median (25th percentile, 75th percentile) apnea-hypopnea index was 7.7 (2.4-22.2), and mean average oxygen saturation was 94.3 (2.0). Verbal learning score was independently associated with average oxygen saturation (β = 0.721, p = 0.025) in multivariate linear regression models adjusted for putative confounders. Interference time was only related to OSA severity indicators in bivariate analyses. CONCLUSIONS Verbal memory and executive function impairments were mild in community-dwelling adults at high risk of obstructive sleep apnea. Average oxygen saturation was the indicator of obstructive sleep apnea severity most strongly associated with cognitive function.
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Affiliation(s)
- Harald Hrubos-Strøm
- Department of Clinical Science, Research Centre, Akershus University Hospital, Lørenskog, Norway.
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Namtvedt SK, Randby A, Einvik G, Hrubos-Strøm H, Somers VK, Røsjø H, Omland T. Cardiac arrhythmias in obstructive sleep apnea (from the Akershus Sleep Apnea Project). Am J Cardiol 2011; 108:1141-6. [PMID: 21798493 DOI: 10.1016/j.amjcard.2011.06.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Revised: 06/09/2011] [Accepted: 06/09/2011] [Indexed: 10/17/2022]
Abstract
Increased prevalence of cardiac arrhythmias has been reported in patients with severe obstructive sleep apnea (OSA), but this may not be generalizable to patients from the general population with a milder form of the condition. The aim of this study was to assess the association between cardiac arrhythmias and OSA of mainly mild and moderate severity. In total, 486 subjects (mean age 49 years, 55% men) recruited from a population-based study in Norway underwent polysomnography for OSA assessment and Holter recordings for arrhythmia assessment. Of these, 271 patients were diagnosed with OSA (apnea-hypopnea index [AHI] ≥5, median AHI 16.8, quartiles 1 to 3 8.9 to 32.6). Mean nadir oxygen saturations were 82% and 89% in patients with and without OSA, respectively. Ventricular premature complexes (≥5/hour) were more prevalent in subjects with OSA compared to subjects without OSA (median AHI 1.4, quartiles 1 to 3 0.5 to 3.0) during the night (12.2% vs 4.7%, p = 0.005) and day (14% vs 5.1%, p = 0.002). In multivariate analysis after adjusting for relevant confounders, AHI was independently associated with an increased prevalence of ventricular premature complexes at night (odds ratio per 1-U increase of log-transformed AHI 1.5, 95% confidence interval 1.1 to 2.0, p = 0.008) and during the day (odds ratio 1.37, 95% confidence interval 1.0 to 1.8, p = 0.035). In conclusion, the prevalence of ventricular premature complexes is increased in middle-aged patients with mainly mild or moderate OSA, suggesting an association between OSA and ventricular arrhythmias even in mild OSA.
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Hrubos-Strøm H, Randby A, Namtvedt SK, Kristiansen HA, Einvik G, Benth J, Somers VK, Nordhus IH, Russell MB, Dammen T, Omland T, Kværner KJ. A Norwegian population-based study on the risk and prevalence of obstructive sleep apnea. The Akershus Sleep Apnea Project (ASAP). J Sleep Res 2011; 20:162-70. [PMID: 20561172 DOI: 10.1111/j.1365-2869.2010.00861.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The Berlin Questionnaire (BQ) is a widely used screening tool for obstructive sleep apnea (OSA), but its performance in the general population setting is unknown. The prevalence of OSA in middle-aged adults is not known in Norway. Accordingly, the aims of the current study were to evaluate the utility of the BQ for OSA screening in the general population and to estimate the prevalence of OSA in Norway. The study population consisted of 29,258 subjects (aged 30-65 years, 50% female) who received the BQ by mail. Of these, 16,302 (55.7%) responded. Five-hundred and eighteen subjects were included in the clinical sample and underwent in-hospital polysomnography. Screening properties and prevalence were estimated by a statistical model that adjusted for bias in the sampling procedure. Among the 16,302 respondents, 24.3% (95% confidence interval (CI)=23.6-25.0%) were classified by the BQ to be at high-risk of having OSA. Defining OSA as an apnea-hypopnea index (AHI) ≥5, the positive predictive value of the BQ was estimated to be 61.3%, the negative predictive value 66.2%, the sensitivity 37.2% and the specificity 84.0%. Estimated prevalences of OSA were 16% for AHI≥5 and 8% for AHI≥15. In conclusion, the BQ classified one out of four middle-aged Norwegians to be at high-risk of having OSA, but the screening properties of the BQ were suboptimal. The estimated prevalence of OSA was comparable to previous estimates from general populations in the USA, Australia and Europe.
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Affiliation(s)
- Harald Hrubos-Strøm
- Department of Clinical Science, Research Centre, Akershus University Hospital, Lørenskog, Norway.
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Einvik G, Dammen T, Hrubos-Strøm H, Namtvedt SK, Randby A, Kristiansen HA, Somers VK, Nordhus IH, Omland T. Prevalence of cardiovascular risk factors and concentration of C-reactive protein in Type D personality persons without cardiovascular disease. ACTA ACUST UNITED AC 2011; 18:504-9. [DOI: 10.1177/1741826710389383] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Gunnar Einvik
- Division of Medicine, Akershus University Hospital and University of Oslo, Norway
- Department of Behavioral Medicine, Institute of Basic Medical Sciences, University of Oslo, Norway
| | - Toril Dammen
- Division of Medicine, Akershus University Hospital and University of Oslo, Norway
- Department of Psychiatry, Oslo University Hospital, Norway
| | - Harald Hrubos-Strøm
- Division of Medicine, Akershus University Hospital and University of Oslo, Norway
- Centre for Clinical Research, Akershus University Hospital, Norway
| | - Silje K Namtvedt
- Department of Behavioral Medicine, Institute of Basic Medical Sciences, University of Oslo, Norway
| | - Anna Randby
- Department of Behavioral Medicine, Institute of Basic Medical Sciences, University of Oslo, Norway
| | - Håvard A Kristiansen
- Head and Neck Research Group, Akershus University Hospital and University of Oslo, Norway
| | | | - Inger H Nordhus
- Department of Clinical Psychology, University of Bergen, Norway
| | - Torbjørn Omland
- Department of Behavioral Medicine, Institute of Basic Medical Sciences, University of Oslo, Norway
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Affiliation(s)
- Helge Skirbekk
- Seksjon for medisinsk etikk, Institutt for allmenn- og samfunnsmedisin, Postboks 1130 Blindern, 0318 Oslo, Norway.
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Hrubos-Strøm H, Hilde Nordhus I. Sleeping with a machine: how can patient education improve adherence in patients with obstructive sleep apnea? Patient Educ Couns 2009; 74:133-134. [PMID: 19138632 DOI: 10.1016/j.pec.2008.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Hrubos-Strøm H. [Epicrisis to the admitting physician]. Tidsskr Nor Laegeforen 2006; 126:2286; author reply 2286. [PMID: 16967076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
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