Daytime sleepiness in a population-based sample
Jenny Theorell-Haglöw
Läs abstract
Introduction
Daytime sleepiness is a common complaint within the general population and has been associated with cardiovascular disease and mortality. The overall aim of this study was to assess what factors are related to daytime sleepiness within the general middle-aged population.
Methods
Data from the population-based SCAPIS study (middle-aged males and females randomly identified from the population census at 6 sites across Sweden) was analysed. Excessive daytime sleepiness (EDS) was assessed by the Epworth Sleepiness Scale (ESS) and was used as the main outcome. Habitual sleep duration using the question “How many hours do you habitually sleep during 24 hours?” was the main exposure. Other variables in the final model included age, sex, obesity, physical activity, smoking, alcohol, sleep problems, somatic disease, medication, depression, and socio-economic status. Results Our study included 29,017 participants (51,7% females, mean age 57.5±4.3 years). EDS and severe EDS was present in 4,612 (15.9%, (ESS greater than 10)) and 806 (2.8%, ESS greater than 16) participants, respectively. There was no difference in mean-ESS between gender (6.3±4.1SD versus 6.3± 4.2SD; p=0.58). There was a U-shaped association between sleep duration and presence of EDS (ESS greater than 10). Short sleep (less than 7h|night) remained associated with EDS also after adjusting for confounders (OR=1.51; 95%CI 1.40-1.63). Other sleep-related variables such as presence of insomnia symptoms (1.23; 1.13-1.34), snoring (1.62; 1.46-1.79) and gastroesophageal reflux (1.57; 1.20-2.07) were all associated with EDS after adjustments. Other factors associated with EDS in the adjusted model were obesity (1.11; 1.00-1.23), being born outside of Sweden (1.31; 1.20-1.44), perception of poor general health (1.69; 1.34-2.14), feelings of sadness or depression (1.23; 1.13-1.33) as well as experience of stress, with 2-fold increase shown for people experiencing constant stress over the last 5 years (2.09; 1.68-2.60). Education level along with lifestyle factors such as physical activity level and alcohol dependence were not related to EDS, whereas current smoking and the diagnosis of hypertension were associated with lower odds of EDS.
Conclusion
Daytime sleepiness is common in the middle-aged population and has a multifactorial origin including lifestyle factors and comorbidities. Assessing and treating modifiable factors is important in individuals seeking health care for EDS.
Psychosocial job conditions and insomnia – the scapis
Ding Zou
Läs abstract
Background
Insomnia is the most common sleep disorder and has been associated with poor cardiovascular, metabolic and mental health. Although the link between psychosocial work exposure and poor sleep is well studied in professional groups, data from large population-based cohort are sparse. In the current study, we investigated the relationship between psychosocial work conditions and clinical insomnia in a middle-age population. We hypothesized that high strain work condition is associated with an increased risk of insomnia.
Methods
Participants of the Swedish CArdioPulmonary bioImage Study (SCAPIS) Gothenburg cohort (n=3431, 52% females, 57.2±4.2 years) were included in the cross-sectional analysis. Psychosocial work exposure was assessed using the job demand-control model and categorized into high strain, active, passive and low strain. Insomnia was defined as the Insomnia Severity Index score =15. Characteristics of insomnia symptoms (difficulty initiating sleep, difficulty maintaining sleep and early morning awakening) in different categories were studied.ResultsThe prevalence of insomnia was 20.9%, 14.0%, 10.3% and 6.4% in the high strain, active, passive and low strain group, respectively. A multivariate binary logistic regression model revealed that compared to the low strain group, passive group (odds ratio: 1.42 [95% CI, 1.01-1.98], p=0.044), active group (1.99 [1.45-2.72], p less than 0.001), and high strain group (2.20 [1.56-3.11], p less than 0.001) were associated with increased risk of insomnia. 10.9% of high strain individuals had 3 insomnia symptoms compared to 2.3% in the low strain subgroup (p less than 0.001). High strain insomnia individuals showed a predisposition of having difficulty initiating sleep symptom compared to low strain subjects (61.2% vs. 32.6%, p less than 0.001).
Conclusion
Poor psychosocial job conditions were associated with clinical insomnia and increased overall insomnia burden. Our findings contribute to defining preventive measures for insomnia in the general population and call for mental health prevention program at workplace.
Exploring teen chronotypes and their association with health
Clara Sancho-Domingo
Läs abstract
Background
While morningness and eveningness chronotypes are frequently employed to describe chronotype preferences, a research gap remains in understanding the variety of chronotypes among adolescents and their potential connections to well-being. The aims of this study were to identify the latent chronotype behaviors and to analyze their association with common health complaints in youth.
Method
We used a cross-sectional study in which we evaluated a total of 1449 Swedish students aged 15-17 (55.7% girls). We assessed adolescents’ sleep quality, sleep schedule and duration on both schooldays and weekends as a proxy for chronotype, as well as adolescents’ health complaints using the Psycho Somatic Problem (PSP) scale. Latent Profile Analysis (LPA) and Multinominal Logistic Regressions (MLR) were performed.
Results
Of the total sample, 46% (n=668) of adolescents reported experiencing sleep difficulties within the last month, averaging 7 hours (SD=1) of sleep on school nights. LPA displayed a better fit for a three-chronotype classification model: A) Morning chronotype (57.3%; n=830) with an average sleep duration of 7:30 hours and earlier bed and wake-up times; B) Evening chronotype (21.7%; n=315) characterized by 6:35 hours of sleep and delayed bedtimes patterns; and C) Misaligned chronotype (21%; n=304) indicating 6:15 hours of sleep along with greater social jetlag. MLR analysis showed that, compared to the Morning chronotype, the Eveningness chronotype and the Misaligned chronotype had higher odds of experiencing concentration difficulties (OR=1.6 and OR=2.0, respectively) and that the latter had also higher odds of poor appetite (OR=1.7). No statistically significant effects were found for headaches, stomachache, tension, dizziness, and sadness, nor for gender as a covariate (p great than 0.05).
Discussion
The three distinct sleep chronotypes were associated with concentration difficulties and poor appetite, but not with other health complaints. This highlights the importance of considering individual sleep preferences in understanding and addressing adolescents’ well-being.
Sjuksköterskors erfarenheter av telefonrådgivning vid rls
Alexandra Säwén
Läs abstract
Bakgrund
Restless legs syndrome (RLS) är en vanligt förekommande, underdiagnostiserad neurologisk sjukdom som orsakar stort lidande hos individen, bland annat i form av störd sömn. Både barn och vuxna kan drabbas även om prevalensen ökar med stigande ålder. Tidigare studier har visat att det kan ta lång tid innan personer med RLS-associerade symtom får diagnos och behandling. Primärvården behöver hantera en mängd olika hälsorelaterade problem i vilken sjuksköterskan i telefonrådgivningen ofta är patientens första kontakt med vården. Få, om någon studie, beskriver hur sjuksköterskor inom primärvården erfar telefonkontakt med personer som beskriver RLS-associerade symtom och deras behandlingsbehov.Syfte: Att beskriva hur sjuksköterskor erfar symtombild och behandlingsbehov hos individer med RLS-associerade symtom vid telefonrådgivningen inom primärvården. Detta utifrån 4-habits kommunikationsmodell vars syfte är att erbjuda personcentrerad vård på ett effektivt och säkert sätt baserat på följande aspekter; ”investera i början”, ”ta reda på patientens perspektiv”, ”visa empati” och ”investera i slutet”.
Metod
En kvalitativ intervjustudie med kvalitativ innehållsanalys genomfördes tillsammans med 18 sjuksköterskor|distriktssköterskor yrkesverksamma i sex svenska regioner inom primärvården. Vinjetter baserade på tre fiktiva patientfall med olika grader av RLS-associerade symtom användes för att stimulera sjuksköterskornas berättande. Data analyserades med hjälp av abduktion genom att deduktivt sortera data utifrån 4-habits kommunikationsmodell och därefter induktivt identifiera möjligheter och hinder i respektive kommunikationsdel.
Resultat
”Investera i början” innefattade kategorierna: patientmötets påverkansfaktorer, försöka förstå patientens RLS-associerade symtom och erfarenhet av RLS-associerade symtom. Under ”ta reda på patientens perspektiv” identifierades: patientens symtombeskrivning som utgångspunkt och symtomens inverkan på patientens livssituation. Vidare utgjorde förhålla sig till patientens situation och tillitens betydelse i patientmötet kommunikationsdelen ”visa empati” medan ”investera i slutet” bestod av: triagering av patienter med RLS-associerade symtom, egenvårdsrådgivning vid RLS-associerade symtom och samsyn i slutet av samtalet.
Slutsats
De olika delarna i 4-habits kommunikationsmodell kunde identifieras och utgjorde en tydlig struktur i sjuksköterskornas telefonrådgivningsarbete. Möjligheter att aktivt lyssna och sträva efter att förstå individer med RLS-associerade symtom påvisades. Samtidigt visade det sig att begränsad kunskap om symtom och behandlingsbehov, samt tidspress, utgjorde hinder i sjuksköterskornas telefonrådgivningsarbete.
Modification of endotypic traits in sleep apnea by sulthiam
Erik Hoff
Läs abstract
Background
The carbonic anhydrase inhibitor sulthiame (STM) reduces obstructive sleep apnea (OSA) severity, increases overnight oxygenation and improves sleep quality.(J. Hedner et al., 2022) Insights into how STM modulates OSA pathophysiology (endotypic traits) adds to our understanding of the breathing disorder itself, as well as the effects of carbonic anhydrases in respiratory regulation. Research question: How does STM treatment modify endotypic traits in OSA?
Study design and Methods
Per protocol tertiary analysis of a randomized controlled trial (J. Hedner et al., 2022) with the inclusion criteria: BMI =20 to =35 kg|m2, age 18-75 years, apnea-hypopnea index (AHI) =15 events|h, Epworth sleepiness scale =6 as well as non-acceptance or non-tolerance of positive airway pressure treatment. Patients were randomized to receive placebo (n=22), STM 200 mg (n=12) or 400 mg (n=24) during four weeks of treatment. Polysomnography was applied twice at baseline and follow-up. Endotypic traits were determined from polysomnography tracings using PUPBeta software.(P. I. Terrill et al., 2015) STM plasma concentration was analysed. Differences from baseline to follow-up (?) were analysed with ANCOVA|Kruskal-Wallis H-test and Pearson|Spearman correlation (r|rs).
Results
STM (200 and 400 mg groups) consistently reduced loop gain (LG1) (mean -0.16, [95% CI -0.18 to -0.13], p less than 0.05) in addition to increased ventilation at lowest decile of ventilatory drive (Vmin, median +12 [4 to 20], p less than 0.05) and median ventilation at eupneic ventilatory drive (Vpassive, median +4 [0 to 5], p less than 0.05). ?LG1 correlated with ?AHI% (200 mg: r=0.65, p less than 0.05) and Vmin|Vpassive with ?AHI (all STM: rs=-0.59|-0.65, all p less than 0.05). The reduction of LG1 was seen already in the lower STM concentration range, while changes in Vmin peaked in the higher range.Interpretation: The effect of STM in OSA may be explained by a reduction of ventilatory instability (LG1) as well as upper airway collapsibility (Vmin|Vpassive).Reference:1. Hedner J, Stenlöf K, Zou D, et al. A Randomized Controlled Clinical Trial Exploring Safety and Tolerability of Sulthiame in Sleep Apnea. Am J Respir Crit Care Med. 2022;205(12):1461-1469.2. Terrill PI, Edwards BA, Nemati S, et al. Quantifying the ventilatory control contribution to sleep apnoea using polysomnography. Eur Respir J. 2015;45(2):408-418.
Customizing the mandibular advancement: the “bird” approach
Pilar Rubio-Bueno
Läs abstract
Background
OSA is a prevalent disease, and alternative treatments are necessary specially in patients with intolerance to CPAP. The present study introduces the BIRD Approach, an innovative method for OSA patients. Bilateral Internal Ramus Distraction (BIRD) of the mandible is a slow, progressive, and stable procedure to advance the mandibular bone. The objective of this study was to investigate the effectiveness of this approach in curing OSA. An interventional (surgical) one-arm trial was conducted on OSA patients, evaluating them before and at 12|24|48 months after BIRD. Pre|postoperative polysomnography and 3D scans were performed to assess the patients. The predictor variables included the amount of skeletal advancement, percentage of upper airway volume increase, and postoperative value of mandibular occlusal plane. The main outcome variables measured were the changes in the apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and percentage of time with saturation under 90% (TC90).
Methods
Eighty subjects, with a mean age of 39.9 ± 11.3 years and 69.5% being male, were included in the study and followed up for a period of 48 months. All patients underwent pre- and post-operative polysomnography and three-dimensional scans for evaluation. The predictor variables considered in this study were the amount of skeletal advancement, percentage of upper airway volume increase, and postoperative value of mandibular occlusal plane. The primary outcome variables assessed were changes in the apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and percentage of time withsaturation under 90% (TC90).
Results
Following the BIRD procedure, significant improvements were observed in the OSA patients. The preoperative AHI was 51.9 ± 22.1 per hour, while EES was 15.4 ± 4.1. After 12 months, AHI decreased to 3.9 ± 6.6 per hour (P less than 0.001), and cure rate of 90.6% (P less than 0.001). Three-dimensional scans revealed asubstantial increase in upper airway volume by 201.4% ± 46.5% (P less than 0.001).Conclusions:BIRD appeared to be a highly effective and safe surgical approach. The weekly titration of mandibular advancement using respiratory polygraphy allows for better monitoring of healing and customization of skeletal advancement, ultimately enhancing the aesthetic outcome. The BIRD Approach demonstrates promising potential as a tailored treatment strategy for OSA patients.
Antihypertensive drugs and pap treatment in hypertensive osa
Sven Svedmyr
Läs abstract
Introduction
We analysed longitudinal blood pressure (BP) data from hypertensive obstructive sleep apnea (OSA) patients from the European Sleep Apnea Database (ESADA) cohort. The study investigated the interaction between positive airway pressure (PAP) induced BP change and antihypertensive treatment (AHT).
Methods
Hypertensive patients with AHT (monotherapy|dual therapy n=1283|652, female 29|26%, mean age 59.6±10.7|60.6±10.3 years, body mass index (BMI) 34.2±6.5|34.8±7.0 kg|m2, apnea hypopnea index (AHI) 46±25|46±24 events|h, respectively) started PAP treatment. Office BP at baseline and follow up 2-36 months were assessed. The interaction between AHT drug classes and PAP on BP was quantified and the influence of gender, age, BMI, comorbidities, BP at baseline and study site were evaluated.
Results
Following PAP treatment (5.6±1.6|5.7±1.9 hours|day), systolic BP was reduced by -3.9±15.5|-2.8±17.7 mmHg and diastolic BP by -3.0±9.8|-2.7±10.8 mmHg in mono|dual AHT, respectively (all p less than 0.0001). Systolic and diastolic BP control was improved following PAP treatment (from 38|35% to 54|46%, and 67|67% to 79|74%, mono|dual AHT, respectively). PAP treatment duration predicted a larger BP improvement in the mono therapy group. Intake of Renin-Angiotensin-Blockers (ACEI|ARB) alone or in any AHT combination was associated with better BP control. AHT dependent BP improvement was independent of confounders.ConclusionIn this pan-European OSA patient cohort, BP control improved following initiation of PAP. Duration of PAP treatment was associated with a more favourable effect on BP. Our study suggests that ACEI|ARB, alone or in combination with other drug classes, provides a particularly strong reduction of BP and better BP control when combined with PAP in OSA.
Posters
Sleep researchers’ rankings of sleep journals
Siri Jakobsson Störe
The impact factor is used to rank the quality of scientific journals, but has been criticized for a number of reasons.The aim of the study was to investigate sleep researchers’ perceptions of sleep journals to determine whether subjective rankings of journals were in line with the journals’ impact factors. Clarivate’s Journal Citation Reports website was used to identify journals containing the words “sleep” or “dream” in the titles with an impact factor since 2018, resulting in 12 journals. A survey was developed including questions about which of the 12 sleep journals the respondent considered the three most and the three least prestigious, and which of these journals the respondent considered the most prestigious if having to choose one. The survey also included questions about the respondent’s academic position and country of work. The survey was e-mailed to the corresponding authors of all articles in the 12 sleep journals’ latest two issues (609 e-mails). Data were also gathered at the Swedish Society for Sleep Research and Sleep Medicine’s (SFSS) Congress 2022. Additionally, the survey was e-mailed to all members of SFSS (370 e-mails). 122 sleep researchers completed the survey. Sleep, Sleep Medicine Reviews and Journal of Sleep Research were ranked as the three most prestigious sleep journals, in line with the impact factors of the journals. For the rest of the journals, the subjective rankings and impact factors did not correspond as much.
Parodontalt status hos hypertensiva osa patienter
Christine Kvarnvik
Background
Det finns kopplingar mellan allmänsjukdomar och parodontit så som hos patienter med diabetes och hjärtsjukdom. Ett nytt outforskat fält är sambandet mellan obstruktiv sömnapné [OSA] och parodontit. Genom ökad systemisk inflammation och hyposalivation kan OSA potentiellt påverka parodontalt status över tid.Syfte: Att tio år efter OSA diagnos jämföra parodontalt status hos hypertensiva patienter med eller utan långvarig förekomst av OSA, behandlade eller inte behandlade med övertrycksbehandling; positive airway pressure treatment [PAP].
Material och metod
Mellan åren 2007 och 2009 undersöktes 394 hypertensiva primärvårdspatienter med polygrafi för att screena för OSA. PAP behandling erbjöds enligt kliniska riktlinjer. Tio år senare genomfördes en tandvårdsundersökning innefattande en klinisk och röntgenologisk undersökning samt ett inflammationsmarkörstest (chair side) av saliven med matrix metalloproteinas-8 [MMP-8]. Beroende av AHI samt följsamhet till behandling delades patienterna in i tre grupper av hypertensiva patienter; ingen OSA (1), obehandlad OSA (2) och PAP-behandlad OSA (3). Patienternas parodontala status undersöktes och de delades därefter in i fyra olika stadier av parodontal hälsa|sjukdom beroende på nivå av alveolärt ben, blödning vid sondering [BoP] och ficksonderingsdjup. Parodontal status och stadier jämfördes mellan patienter med hypertoni, obehandlad OSA och PAP-behandlad OSA.
Resultat
De 121 undersökta patienterna (kvinnor, n=64) uppvisade en medelålder på 69,4 år. En statistiskt signifikant skillnad visades vid jämförelse mellan parodontala stadier och OSA gruppering då 70 % utan OSA uppvisade parodontal hälsa|gingivit jämfört med 20 % av patienter med OSA och 10 % av de med PAP-behandlad OSA. Det förekom ingen statistisk skillnad i fördelningen mellan OSA grupperingarna hos patienter som hade parodontal sjukdom. Inga statistiska skillnader framkom vid jämförelse av antal tänder|implantat, PPD, plackindex, BOP, furkationsinvolveringar eller närvaro av MMP-8 som enskilda utfallsmått vid jämförelse mellan grupperna utan OSA, diagnostiserade med OSA eller PAP-behandlad OSA.Slutsats:Vid jämförelse av enskilda parodontala utfallsmått fanns ingen skillnad mellan patienter med eller utan OSA, oberoende av PAP behandling. Vid sammansättning av radiografiskt och kliniskt tillstånd i parodontala stadier kategoriserades dock hypertonipatienter utan OSA oftare med parodontal hälsa|gingivit jämfört med hypertensiva patienter med OSA oavsett PAP-behandling. Vid parodontal sjukdom kunde inget samband mellan grupperna påvisas.
Insomni, hälsa och livstillfredsställelse efter hjärtstopp
Patrik Hellström
Background
Studier visar att hjärtstoppsöverlevare överlag upplever sin hälsa som god, dock ses variationer inom och mellan studier. Många drabbas av kognitiv funktionsnedsättning, psykiska problem och trötthet, vilket även förekommer i samband med insomni. Trots detta har få studier undersökt insomni hos hjärtstoppsöverlevare. Syftet var därför att undersöka om klinisk insomni är relaterad till självrapporterad hälsa och livstillfredsställelse hos personer som överlevt ett hjärtstopp.
Metod
Denna tvärsnittsstudie inkluderade hjärtstoppsöverlevare =18, rekryterade från fem sjukhus i södra Sverige. Deltagarna besvarade skattningsskalorna Minimal Insomnia symptom scale, Health Index, Hospital Anxiety and Depression Scale samt Satisfaction With Life Scale 6 månader efter incidenten. Data analyserades med Mann Whitney U-test samt linjär och ordinal logistisk regression. Regressionsanalyserna justerades för demografiska och medicinska faktorer.
Resultat
Totalt deltog 212 hjärtstoppsöverlevare i studien (67% svarsfrekvens), varav 76% män, medelåldern var 67 år. Klinisk insomni rapporterades av 20%. Komorbiditet var vanligare i denna grupp (p = 0,026). Regressionsanalyserna visade att klinisk insomni var relaterad till lägre generell hälsa (p less than 0,001), sämre livstillfredsställelse (p less than 0,001) samt ångest och depression (p less than 0,001). Insomni förklarade 29% av generell hälsa, 21% av livstillfredställelse, 20% av depression och 19% av ångest. Likaså var fysiska hälsoproblem relaterade till insomni.
Slutsats
Var femte hjärtstoppsöverlevare rapporterade klinisk insomni 6 månader efter hjärtstoppet. Dock kan det föreligga en underrapportering, då de friskaste överlevarna sannolikt är överrepresenterade i urvalet. Resultatet visade att insomni var relaterat till alla aspekter av självrapporterad hälsa och livstillfredsställelse som utvärderades i studien. Orsaken till den höga prevalensen bland överlevande skulle kunna förstås från 3P-modellen. Predisponerande faktorer för insomni kan vara relaterade till tidigare komorbiditet, medan hjärtstilleståndet kan vara den utlösande faktorn för insomni. Oro för framtiden eller ännu ett hjärtstopp kan leda till en rädsla för att somna, vilket vidmakthåller sömnproblemen. Resultatet belyser vikten av screening för sömnproblem i uppföljningen efter hjärtstopp för att identifiera de som behöver ytterligare utredning och behandling samt för att förebygga ytterligare hälsoproblem.
More than an insomnia model? An exploratory investigation of the processes from the Cognitive Model of Insomnia in relation to apnoea, delayed sleep phase, insomnia, narcolepsy, nightmares, and PLMS/RLS
Osame Salim a & Annika Norell a
Introduction: The Cognitive Model of Insomnia by Harvey has gained widespread recognition since 2002 and greatly stimulated treatment development. In short, the model describes how excessive mental focus on sleep creates vicious cycles which maintain insomnia. Little is known about how the model might fit other sleep diagnoses, although the general processes are applicable to other somatic disorders such as chronic pain and IBS. The aim of this study was to investigate the degree of insomnia-related processes in other sleep disorders.
Methods: Participants (n=2370) from a randomly selected sample of the general population completed a survey that included five psychological processes as outlined by Harvey (2002): unhelpful beliefs about sleep, monitoring for sleep-related threats, sleep-related safety behaviours, pre-sleep somatic arousal, and sleep-related worry. The following sleep disorders were classified based on the SLEEP-50 questionnaire: apnoea (n=176), delayed sleep phase (n=93), insomnia (n=367), narcolepsy (n=12) nightmares (n=84), and PLMS/RLS (n=184).
Results: The scores on the five processes were significantly elevated for all sleep disorders compared to people without sleep problems. Compared to insomnia, other sleep disorders were associated with similar or higher scores on all processes. People with narcolepsy reported the highest scores, followed by people with nightmares.
Discussion: The results indicate that sleep-disturbing processes of insomnia might be applicable in other sleep disorders. Clinical implications and limitations will be further discussed.
| Sömnstörning | SAMI | PSAS-S | DBAS-10 | APSQ | SRBQ |
| Apne | 24,28 | 19,48 | 32,06 | 28,82 | 26,92 |
| Insomni | 23,95 | 17,70 | 31,27 | 28,21 | 24,58 |
| Narkolepsi | 28,17 | 25,08 | 37,67 | 36,25 | 35,25 |
| PLMS/RLS | 24,47 | 19,24 | 31,10 | 27,89 | 24,95 |
| Dygnsrytmstörning | 24,39 | 17,68 | 31,33 | 27,07 | 23,90 |
| Mardrömmar | 25,90 | 20,04 | 32,46 | 30,17 | 28,21 |
SEKRETARIAT
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