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Obesity, Sleep and Sleep-disordered Breathing
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
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 [en]
Sleep, Obesity, Obstructive Sleep Apnea, Obesity Hypoventilation syndrome
National Category
Respiratory Medicine and Allergy
Research subject
Medical Science
Identifiers
URN: urn:nbn:se:uu:diva-361345ISBN: 978-91-513-0453-3 (print)OAI: oai:DiVA.org:uu-361345DiVA, id: diva2:1250276
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
List of papers
1. The impact of obesity and weight gain on development of sleep problems in a population-based sample
Open this publication in new window or tab >>The impact of obesity and weight gain on development of sleep problems in a population-based sample
2015 (English)In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 16, no 5, p. 593-597Article in journal (Refereed) Published
Abstract [en]

Objectives: The objective of this study was to investigate the role of obesity and weight gain in the development of sleep problems in a population-based cohort. Material and methods: A population-based sample of men (n = 1896, aged 40-79 years) and women (n = 5116, age = 20 years) responded to questionnaires at baseline and follow-up after 10-13 years. Sleep problems were assessed through questions about difficulties initiating sleep (DIS), difficulties maintaining sleep (DMS), excessive daytime sleepiness (EDS), and insomnia. Body mass index (BMI) was calculated from self-reported weight and height at both baseline and follow-up, while confounding factors (physical activity, tobacco and alcohol use, somatic disease, and snoring) were based on responses at baseline. Results: Although overweight and obese subjects reported more sleep problems at baseline, there was no independent association between BMI level at baseline and development of new sleep problems. Subjects in the quartile with the highest rise in BMI with a weight gain exceeding 2.06 kg/m(2) had a higher risk of developing DMS [adjusted odds ratio (OR) 1.58; 95% confidence interval (CI) 1.25-2.01), EDS (2.25; 1.65-3.06], and insomnia (2.78; 1.60-4.82). Weight gain was not associated with the development of DIS. Conclusions: Weight gain is an independent risk factor for developing several sleep problems and daytime sleepiness. The presence of overweight and weight gain should be considered when treating patients with sleep problems. (C) 2015 Elsevier B.V. All rights reserved.

Keywords
Weight gain, Overweight, Obesity, Sleep problems, Insomnia, Sleepiness
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-255278 (URN)10.1016/j.sleep.2015.01.016 (DOI)000353892800010 ()25819416 (PubMedID)
Funder
Swedish Heart Lung Foundation, 20080526
Available from: 2015-06-22 Created: 2015-06-15 Last updated: 2018-09-25Bibliographically approved
2. Gender differences in patients starting long-term home mechanical ventilation due to obesity hypoventilation syndrome
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
3. The Impact of Continuous Positive Airway Pressure on Circulating IGF-1 in Patients With Obstructive Sleep Apnea
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
Show others...
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
4. 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
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
Show others...
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

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