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Palm, A. & Lindberg, E. (2019). Response to "The dark side of adherence" by Crawford and Vallieres [Letter to the editor]. Sleep Medicine, 59, 97-97
Open this publication in new window or tab >>Response to "The dark side of adherence" by Crawford and Vallieres
2019 (English)In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 59, p. 97-97Article in journal, Letter (Other academic) Published
Place, publisher, year, edition, pages
ELSEVIER SCIENCE BV, 2019
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-390003 (URN)10.1016/j.sleep.2018.10.019 (DOI)000471665700020 ()30551924 (PubMedID)
Available from: 2019-08-05 Created: 2019-08-05 Last updated: 2019-08-05Bibliographically approved
Christensson, E., Franklin, K. A., Sahlin, C., Palm, A., Ulfberg, J., Eriksson, L. I., . . . Jonsson Fagerlund, M. (2018). Can STOP-Bang and Pulse Oximetry Detect and Exclude Obstructive Sleep Apnea?. Anesthesia and Analgesia, 127(3), 736-743
Open this publication in new window or tab >>Can STOP-Bang and Pulse Oximetry Detect and Exclude Obstructive Sleep Apnea?
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2018 (English)In: Anesthesia and Analgesia, ISSN 0003-2999, E-ISSN 1526-7598, Vol. 127, no 3, p. 736-743Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Obstructive sleep apnea (OSA) is related to postoperative complications and is a common disorder. Most patients with sleep apnea are, however, undiagnosed, and there is a need for simple screening tools. We aimed to investigate whether STOP-Bang and oxygen desaturation index can identify subjects with OSA.

METHODS: In this prospective, observational multicenter trial, 449 adult patients referred to a sleep clinic for evaluation of OSA were investigated with ambulatory polygraphy, including pulse oximetry and the STOP-Bang questionnaire in 4 Swedish centers. The STOP-Bang score is the sum of 8 positive answers to Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index >35 kg/m, Age >50 years, Neck circumference >40 cm, and male Gender.

RESULTS: The optimal STOP-Bang cutoff score was 6 for moderate and severe sleep apnea, defined as apnea-hypopnea index (AHI) ≥15, and the sensitivity and specificity for this score were 63% (95% CI, 0.55-0.70) and 69% (95% CI, 0.64-0.75), respectively. A STOP-Bang score of <2 had a probability of 95% (95% CI, 0.92-0.98) to exclude an AHI >15 and a STOP-Bang score of ≥6 had a specificity of 91% (95% CI, 0.87-0.94) for an AHI >15. The items contributing most to the STOP-Bang were the Bang items. There was a positive correlation between AHI versus STOP-Bang and between AHI versus oxygen desaturation index, Spearman ρ 0.50 (95% CI, 0.43-0.58) and 0.96 (95% CI, 0.94-0.97), respectively.

CONCLUSIONS: STOP-Bang and pulse oximetry can be used to screen for sleep apnea. A STOP-Bang score of <2 almost excludes moderate and severe OSA, whereas nearly all the patients with a STOP-Bang score ≥6 have OSA. We suggest the addition of nightly pulse oximetry in patients with a STOP-Bang score of 2-5 when there is a need for screening for sleep apnea (ie, before surgery).

National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-361338 (URN)10.1213/ANE.0000000000003607 (DOI)000452079300035 ()29958223 (PubMedID)
Available from: 2018-09-23 Created: 2018-09-23 Last updated: 2019-01-21Bibliographically approved
Palm, A., Midgren, B., Theorell-Haglöw, J., Ekström, M., Ljunggren, M., Janson, C. & Lindberg, E. (2018). Factors influencing adherence to continuous positive airway pressure treatment in obstructive sleep apnea and mortality associated with treatment failure - a national registry-based cohort study. Sleep Medicine, 51, 85-91, Article ID S1389-9457(18)30401-5.
Open this publication in new window or tab >>Factors influencing adherence to continuous positive airway pressure treatment in obstructive sleep apnea and mortality associated with treatment failure - a national registry-based cohort study
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2018 (English)In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 51, p. 85-91, article id S1389-9457(18)30401-5Article in journal (Refereed) Published
Abstract [en]

Objectives: Adherence to continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA) is crucial. Our aim was to identify protective and risk factors against the discontinuation of CPAP treatment in patients with OSA and to estimate the mortality risk in those who were non-adherent to CPAP therapy.

Methods: This was a registry-based cohort study from 37 centers across Sweden with OSA patients on CPAP in the Swedevox Swedish national registry between July 2010 and March 2017.

Results: In 16,425 patients (70.8% men) with complete follow-up data after 1.2 ± 0.8 years the adjusted relative risk ratio (aRRR) for the discontinuation of CPAP was 0.57 (95% confidence interval (CI) 0.50–0.65) for use of humidifier, 0.87 (95% CI 0.82–0.92) for increasing age per 10 years, 0.80 (95% CI 0.77–0.83) for increasing apnea hypopnea index (AHI) per 5 units/hour, and 0.96 (95% CI 0.95–0.97) per increased unit on the Epworth Sleepiness Scale (ESS). Increasing BMI was associated with increased adherence up to BMI 35. Women and patients with hypertension ran an increased risk of discontinuing CPAP treatment, aRRR 1.28 (95% CI 1.12–1.46) and 1.24 (95% CI 1.12–1.42) respectively. The adjusted hazard ratio (HR) for mortality was 1.74 (95% CI 1.32–2.28) among those who did not adhere to CPAP (median follow-up period 2.4 years after the one year adherence evaluation).

Conclusion: Use of humidifier is associated with greater adherence to CPAP treatment. Other factors predicting adherence are increasing age, more severe OSA and overweight up to BMI 35, whereas female gender and coexisting hypertension are risk factors for discontinuation of CPAP. Failure to adhere to CPAP is associated with increased mortality.

Keywords
Adherence, BMI, Continuous positive airway pressure (CPAP), Gender, Humidifier, Obstructive sleep apnea (OSA)
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-361337 (URN)10.1016/j.sleep.2018.07.007 (DOI)000447778200013 ()30103074 (PubMedID)
Funder
Swedish Association of Local Authorities and Regions
Available from: 2018-09-23 Created: 2018-09-23 Last updated: 2019-01-08Bibliographically approved
Palm, A. (2018). Obesity, Sleep and Sleep-disordered Breathing. (Doctoral dissertation). Uppsala: Acta Universitatis Upsaliensis
Open this publication in new window or tab >>Obesity, Sleep and Sleep-disordered Breathing
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Sleep problems are associated with impaired quality of life and daytime sleepiness. Obstructive sleep apnoea (OSA) and obesity hypoventilation syndrome (OHS), are associated with metabolic changes and an increased cardiovascular morbidity and mortality. The most preferred treatment of OSA and OHS is positive airway pressure (PAP) therapy. Diagnostic delay and non-adherence to PAP therapy are major clinical problems.

Aims and methods: Paper I: A longitudinal population-based cohort study aimed to investigate the role of obesity and weight gain in the development of sleep problems in 1,896 men and 5,116 women who responded to questionnaires at baseline and followed up after 10–13 years.

Paper II: A national registry-based cohort study aimed to analyse gender differences in patients with OHS starting long term mechanical ventilation (LTMV) and to study how the prescription of LTMV due to OHS has changed over time with data on 1,527 patients derived from the Swedish quality registry Swedevox between 1996 and 2014.

Paper III: A longitudinal observational cohort study aimed to investigate the impact of adherence to continuous positive airway pressure (CPAP) treatment on IGF-1 concentration in 69 patients with OSA followed up after 4.8 ± 2.5 months.

Paper IV: A national registry-based cohort study aimed to identify protective and risk factors against the discontinuation of CPAP treatment in patients with OSA and to estimate the mortality risk in those who were non-adherent to CPAP therapy on 16,425 patients derived from the Swedish quality registry Swedevox between July 2010 and March 2017.

Results and conclusions: Weight gain is a risk factor for developing several sleep problems and daytime sleepiness. Women with OHS are older with a more advanced clinical picture at initiation of LTMV and start LTMV more frequently in a non-elective situation than men. CPAP usage ≥ 4 h/night is associated with increased IGF-1 concentration in patients with OSA. Use of humidifier, increasing age, more severe OSA and BMI up to 35 are associated with greater adherence to CPAP treatment. Female gender and coexisting hypertension are risk factors for the discontinuation of CPAP. Failure to adhere to CPAP is associated with increased mortality.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 94
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1496
Keywords
Sleep, Obesity, Obstructive Sleep Apnea, Obesity Hypoventilation syndrome
National Category
Respiratory Medicine and Allergy
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-361345 (URN)978-91-513-0453-3 (ISBN)
Public defence
2018-11-09, Brömssalen, Gävle sjukhus, Lasarettsvägen 1, Gävle, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2018-10-17 Created: 2018-09-23 Last updated: 2018-11-19
Palm, A., Berne, C., Igelström, H., Åsenlöf, P., Janson, C. & Lindberg, E. (2018). The Impact of Continuous Positive Airway Pressure on Circulating IGF-1 in Patients With Obstructive Sleep Apnea. Journal of Clinical Sleep Medicine (JCSM), 385-391
Open this publication in new window or tab >>The Impact of Continuous Positive Airway Pressure on Circulating IGF-1 in Patients With Obstructive Sleep Apnea
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2018 (English)In: Journal of Clinical Sleep Medicine (JCSM), ISSN 1550-9389, E-ISSN 1550-9397, p. 385-391Article in journal (Refereed) Published
Abstract [en]

Study Objectives: Obstructive sleep apnea (OSA) is a disease with metabolic and cardiovascular consequences and is associated with decreased serum concentrations of insulin-like growth factor-1 (IGF-1). The aim of this study was to investigate whether continuous positive airway pressure (CPAP) will increase serum IGF-1 concentration in patients with OSA. Methods: Patients with moderate to severe OSA were recruited from a sleep clinic and serum IGF-1 was measured before initiation of CPAP and at follow-up after 4.8 +/- 2.5 months. Patients adherent to CPAP treatment (usage >= 4 h/night) were compared with those considered to be nonadherent (usage < 4 h/night). Results: Complete data were obtained from 69 patients (86% male, age 56 +/- 12 years, respiratory event index 43 +/- 21 events/h, Epworth Sleepiness Scale score 12 +/- 5). In those adherent to CPAP (n = 42), there was an increase in serum IGF-1 concentration with 21.1 (95% confidence interval [CI]: 13.1 to 29.2) mu g/L compared to 4.7 (95% CI: -4.1 to 13.5) mu g/L in the nonadherent group (n = 27) (P =.0083). In a linear multivariate model adjusting for sex, age, body mass index, respiratory event index, and mean oxygen saturation during the night recording, the change in serum IGF-1 concentration was significantly associated with adherence to CPAP treatment (adjusted beta coefficient: 21.8, 95% CI: 10.2 to 33.4) and inversely associated with change in body mass index (adjusted beta coefficient: -7.1, 95% CI: -11.3 to -3.0) and change in hemoglobin A1c (adjusted beta coefficient: -1.8, 95% CI: - 33 to -0.3). Conclusions: CPAP usage >= 4 h/night is associated with increased serum IGF-1 concentration in male patients with OSA.

Keywords
adherence, continuous positive airway pressure, IGF-1, obstructive sleep apnea
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-343619 (URN)10.5664/jcsm.6982 (DOI)000427477700011 ()29458693 (PubMedID)
Funder
Swedish Research Council
Available from: 2018-02-28 Created: 2018-02-28 Last updated: 2018-09-25
Palm, A., Midgren, B., Theorell-Haglöw, J., Janson, C. & Lindberg, E. (2017). Factors influencing compliance to continuous positive airway pressure treatment in obstructive sleep apnea and mortality associated with treatment failure. Paper presented at The 2017 joint congress of World Association of Sleep Medicine (WASM) and World Sleep Federation (WSF), October 7-11, 2017, Prague, Czech Republic.. Sleep Medicine, 40(Supplement 1), E250-E250
Open this publication in new window or tab >>Factors influencing compliance to continuous positive airway pressure treatment in obstructive sleep apnea and mortality associated with treatment failure
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2017 (English)In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 40, no Supplement 1, p. E250-E250Article in journal, Meeting abstract (Other academic) Published
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-369237 (URN)10.1016/j.sleep.2017.11.730 (DOI)000444558903242 ()
Conference
The 2017 joint congress of World Association of Sleep Medicine (WASM) and World Sleep Federation (WSF), October 7-11, 2017, Prague, Czech Republic.
Available from: 2019-01-07 Created: 2019-01-07 Last updated: 2019-01-07Bibliographically approved
Palm, A., Midgren, B., Janson, C. & Lindberg, E. (2017). Gender differences in patients starting long-term home mechanical ventilation due to obesity hypoventilation syndrome [Letter to the editor]. Respiratory Medicine, 124, 104-105
Open this publication in new window or tab >>Gender differences in patients starting long-term home mechanical ventilation due to obesity hypoventilation syndrome
2017 (English)In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 124, p. 104-105Article in journal, Letter (Other academic) Published
Place, publisher, year, edition, pages
W B SAUNDERS CO LTD, 2017
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-321566 (URN)10.1016/j.rmed.2017.02.003 (DOI)000398647500017 ()28214105 (PubMedID)
Available from: 2017-05-08 Created: 2017-05-08 Last updated: 2017-05-08Bibliographically approved
Magnusson, P., Palm, A., Brandén, E. & Mörner, S. (2017). Misclassification of hypertrophic cardiomyopathy: validation of diagnostic codes. Clinical Epidemiology, 9, 403-410
Open this publication in new window or tab >>Misclassification of hypertrophic cardiomyopathy: validation of diagnostic codes
2017 (English)In: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, Vol. 9, p. 403-410Article in journal (Refereed) Published
Abstract [en]

Purpose: To validate diagnostic codes for hypertrophic cardiomyopathy (HCM), analyze misclassfications, and estimate the prevalence of HCM in an unselected Swedish regional cohort. Patients and methods: Using the hospitals' electronic medical records (used for the Swedish National Patient Register), we identified 136 patients from 2006 to 2016 with the HCM-related codes 142.1 and 142.2 (International Classification of Diseases). Results: Of a total of 129 residents in the catchment area, 88 patients were correctly classified as HCM (positive predictive value 68.2%) and 41 patients (31.8%) were misclassified as HCM. Among the 88 HCM patients (52.2% males), 74 were alive and 14 were dead (15.9%). This yields an HCM prevalence of 74/ 183,337, that is, 4.0 diagnosed cases per 10,000 in the adult population aged =18 years. The underlying diagnoses of misclassified cases were mainly hypertension (31.7%) and aortic stenosis (22.0%). Other types of cardiomyopathies accounted for several cases of misclassification: dilated (nonischemic or ischemic), left ventricular noncompaction, and Takotsubo. Miscellaneous diagnoses were amyloidosis, pulmonary stenosis combined with ventricular septal defect, aortic insufficiency, athelete's heart, and atrioventricular conduction abnormality. The mean age was not significantly different between HCM and misclassified patients (65.8 +/- 15.8 vs 70.1 +/- 13.4 years; P=0.177). There were 47.8% females among HCM and 60.8% females among misclassified (P=0.118). Conclusion: One-third of patients diagnosed as HCM are misclassified, so registry data should be interpreted with caution. A correct diagnosis is important for decision-making and implementation of optimal HCM care; efforts should be made to increase awareness of HCM and diagnostic competence throughout the health care system.

Keywords
diagnostic error, diagnosis, epidemiology, hypertrophic cardiomyopathy, International Classification of Diseases, register
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-333620 (URN)10.2147/CLEP.S139300 (DOI)000407833900001 ()28848363 (PubMedID)
Available from: 2017-11-16 Created: 2017-11-16 Last updated: 2017-11-29Bibliographically approved
Palm, A., Wilander, E., Wallgren, S. & Hillerdal, G. (2017). Sotrökslunga är en ny sjukdom i Sverige: Exponering för rök från biomassa är orsaken. Läkartidningen, 114, Article ID ESC4.
Open this publication in new window or tab >>Sotrökslunga är en ny sjukdom i Sverige: Exponering för rök från biomassa är orsaken
2017 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, article id ESC4Article in journal (Refereed) Published
Abstract [en]

Black smoke lung disease - a new disease in Sweden We describe two elderly female patients, immigrants to Sweden from Afghanistan, with intensive longtime exposure to smoke from biomass, and who presented with bronchial stenosis and severe bronchial obstruction. CT and X-ray showed bizarre perihilar infiltrates in the lungs. Bronchoscopy revealed black narrow bronchi with a middle lobe stenosis in one of the patients. These findings indicate the diagnosis bronchial anthracofibrosis (BAF). The here described findings are seen mainly in elderly never-smoking women from developing countries who have spent years cooking food in poorly ventilated kitchens. With increased immigration from these countries such cases will be seen in industrialized countries as well. Active tuberculosis must always be excluded but otherwise no more active investigations such as biopsies are warranted. We suggest that this disease should be termed »black smoke disease« to differentiate it from coal workers' pneumoconiosis, silicosis, and other classical occupational diseases which can have similar clinical and radiological pictures. This term is easily understood even by non-medical persons and illustratess both the etiology and the black bronchi.

National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-361340 (URN)29292978 (PubMedID)
Available from: 2018-09-23 Created: 2018-09-23 Last updated: 2018-12-12Bibliographically approved
Palm, A., Midgren, B., Janson, C. & Lindberg, E. (2016). Gender differences in patients starting long-term home mechanical ventilation due to obesity hypoventilation syndrome. Respiratory Medicine, 110, 73-78
Open this publication in new window or tab >>Gender differences in patients starting long-term home mechanical ventilation due to obesity hypoventilation syndrome
2016 (English)In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 110, p. 73-78Article in journal (Refereed) Published
Abstract [en]

Background and objectives: Obesity hypoventilation syndrome (OHS) is often diagnosed late. The aim of this study was to analyse gender differences at initiation of long-term mechanical ventilation (LTMV) in patients with (OHS), to analyse gender differences in treatment effect and to study how the prescription of LTMV due to OHS has changed over time. Methods: Data on patients on LTMV due to OHS between 1996 and 2014 were obtained from Swedevox, a nationwide health quality registry of patients on LTMV in Sweden. Results: When starting LTMV, women were generally older (age 64.4 +/- 11.2 vs. 60.1 +/- 12.1 years, p < 0.001), more obese (BMI 43.0 +/- 8.2 vs. 41.5 +/- 7.9 kg/m(2), p < 0.001), more hypoxic (PaO2 7.6 +/- 1.5 vs. 7.9 +/- 1.6 kPa, p +/- 0.001), had more hypercapnia (PaCO2 7.2 +/- 1.3 vs. 6.9 +/- 1.3 kPa, p = 0.001), had higher base excess (6.9 +/- 4.1 vs. 5.8 +/- 4.7 kPa, p < 0.001) and more frequently started LTMV in a non-elective situation (43.2% vs. 37.5%, p = 0.026) than men. Improvement of arterial blood gas values or in age-adjusted mortality at one-year follow-up did not differ. During the study period, the age of patients at the initiation of LTMV rose by 3.4 years/decade (P = 0.001) in women and with 1.9 years/decade (P = 0.048) in men but there were no significant changes in BMI (P = 0.425). Conclusions: Diagnosis of OHS is more delayed in women and as a consequence the disease is more advanced when diagnosed. In spite of this, there is no gender difference in survival rate in patients with OHS treated with LTMV. More and older patients with OHS nowadays gain access to LTMV.

Keywords
Body mass index, Gender differences, Long-term mechanical ventilation, Obesity hypoventilation syndrome
National Category
Respiratory Medicine and Allergy Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-274924 (URN)10.1016/j.rmed.2015.11.010 (DOI)000367380700010 ()26680503 (PubMedID)
Funder
Swedish Association of Local Authorities and Regions
Available from: 2016-01-27 Created: 2016-01-26 Last updated: 2018-09-25Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-0590-0417

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