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  • 1. Akerstedt, T.
    et al.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Gruber, G.
    Theorell-Haglöw, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Schwarz, J.
    What does good sleep mean in terms of macro and microstructure of sleep in women and how does age affect this relation?2014In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 23, p. 240-240Article in journal (Other academic)
  • 2.
    Akerstedt, T.
    et al.
    Karolinska Inst, Clin Neurosci, Stockholm, Sweden.;Stockholm Univ, Stress Res Inst, Stockholm, Sweden..
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Theorell-Haglöw, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Gruber, G.
    Siesta Grp, Vienna, Austria..
    Schwarz, J.
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden..
    The polysomnographical characteristics of women who have sought medical help for sleep problems - a large study of sleep macro and micro architeture2016In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 25, p. 90-90Article in journal (Other academic)
  • 3.
    Bengtsson, Caroline
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Jonsson, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Holmstrom, M.
    Svensson, Malin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Theorell-Haglöw, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Impact of nasal obstruction on sleep quality - a community based study of women2014In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 23, p. 149-149Article in journal (Other academic)
  • 4.
    Bengtsson, Caroline
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Jonsson, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Holmström, Mats
    Svensson, Malin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Theorell-Haglöw, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Impact of nasal obstruction on sleep quality: a community-based study of women2015In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 272, no 1, p. 97-103Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to analyse the impact of self-reported nasal obstruction on sleep quality in women. A community-based sample of 400 women underwent a full night of polysomnography. Airway diseases, allergies and sleep-related symptoms were assessed by questionnaires. Women with subjective nasal obstruction were subdivided into three groups: persistent nasal obstruction (PNO, n = 46), hay fever (n = 88) and nasal obstruction at night (NON, n = 30). Sleep problems and related daytime symptoms were most prevalent among women with NON. After adjusting for age, BMI, smoking and asthma, NON was an independent predictor of 'Difficulties inducing sleep due to nasal obstruction' [adjusted odds ratio (95 % CI): 89.5 (27.0-296.7)], 'Snoring' [4.2 (1.7-10.2)], 'Sweating at night' [2.6 (1.1-6.1)], 'Difficulties maintaining sleep' [2.7 (1.2-6.2)], and 'Waking up hastily gasping for breath' [32.2 (8.7-119.1)]. 'Dry mouth on awakening' [7.7 (3.2-18.4)], 'Waking up unrefreshed' [2.7 (1.2-6.0)], 'Excessive daytime sleepiness' [2.6 (1.1-6.0)], and 'Daytime nasal obstruction' [12.2 (4.8-31.2)] were also associated with NON. Persistent nasal obstruction and hay fever were both associated with some reported sleep problems due to an overlap with NON. When women with NON were excluded, only 'Daytime nasal obstruction' was still significantly associated with PNO, while hay fever was associated with 'Daytime nasal obstruction' and 'Waking up hastily gasping for breath'. There were no significant differences in objectively measured sleep variables between any of the three subgroups and the study cohort. Self-reported nasal obstruction at night in women has a significant effect on several subjective day- and nighttime symptoms, but it does not appear to affect objectively measured sleep quality.

  • 5.
    Cai, Gui-Hong
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Theorell-Haglöw, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Benedict, Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Elmståhl, Sölve
    Lund Univ, Skane Univ Hosp, Sweden CRC, Dept Hlth Sci,Div Geriatr Med, Malmo, Sweden..
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Both Weight at Age 20 and Weight Gain Have an Impact on Sleep Disturbances Later in Life: Results of the EpiHealth Study2018In: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 41, no 1, article id zsx176Article in journal (Refereed)
    Abstract [en]

    Study Objectives: Obesity is often associated with impaired sleep, whereas the impact of body mass index (BMI) at younger age and previous weight gain on sleep problems remains unknown.

    Methods: The present study utilized data from the Swedish EpiHealth cohort study. A total of 15 845 participants (45-75 years) filled out an internet-based questionnaire. BMI was calculated from both measured data at study time and self-reported data at age 20 from the questionnaire.

    Results: Sleep-related symptoms were most common among obese individuals (BMI >30 kg/m(2)). An association between weight gain and sleep problems was found and those with a low BMI at age 20 were most vulnerable to weight gain when it came to risk of sleep problems. Among those who were underweight (BMI <18.5 kg/m(2)) at age 20, weight gain (kg/year) was associated with difficulties initiating sleep with an adjusted OR of 2.64 (95% CI: 1.51-4.62) after adjusting for age, sex, smoking, alcohol consumption, physical activity, education, and civil status. The corresponding adjusted OR's among those who had been normal weight (BMI 18.5-24.99) and overweight (BMI 25-29.99 kg/m(2)) at age 20 were 1.89 (1.47-2.45) and 1.02 (0.48-2.13), respectively. Also difficulties maintaining sleep and snoring were most strongly related to weight gain among those who were underweight at age 20 with decreasing odds with increasing BMI at that age.

    Conclusions: Sleep problems are related to weight gain and obesity. The impact of weight is most pronounced among those who had a low BMI when young.

  • 6.
    Cai, Gui-Hong
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Theorell-Haglöw, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Svartengren, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Elmstahl, Solve
    Lund Univ, Div Geriatr Med, Dept Hlth Sci, Sweden CRC,Skane Univ Hosp, Malmo, Sweden.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Insomnia symptoms and sleep duration and their combined effects in relation to associations with obesity and central obesity2018In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 46, p. 81-87Article in journal (Refereed)
    Abstract [en]

    Objective: Previous studies have shown that both sleep duration and insomnia have an impact on obesity and central obesity. However, studies of the joint effects of these sleep disorders are still sparse. Methods: The present study utilized data from the Swedish EpiHealth cohort study. Participants (45 - 78 y) were asked to fill out an internet-based questionnaire. Body mass index (BMI) and central obesity (calculated from waist circumference) were based on measured data. Results: A total of 18,823 participants (mean age = 60 ys) were included in this study. The reported prevalence of short (<6 h/night) and long (>9 h/night) sleep duration was 8% and 4% respectively, and insomnia symptoms was 19%. Of the study population, 16% were obese (BMI >= 30 kg/m(2)) and 40% had central obesity. There was a U-shaped association between sleep duration and obesity and central obesity, and significant associations between insomnia symptoms and obesity. When stratifying sleep duration by concurrent insomnia symptoms, there were associations (odds ratios, (95% confidence intervals)) between the combination of both short (1.48, (1.22-1.80)) and long sleep duration (1.77 (1.00 - 3.16)) with insomnia symptoms and obesity and central obesity (1.36 (1.16-1.61) and 2.44 (1.41-3.24) respectively). However, there was no significant association between insomnia symptoms and obesity or central obesity in participants with normal sleep duration. For central obesity there was an association with long sleep duration regardless of insomnia symptoms, while the association with short sleep duration was significant only if insomnia symptoms were present. Conclusions: Both short and long sleep duration, as well as insomnia symptoms, are associated with obesity and central obesity. There is an important joint effect of sleep duration and insomnia symptoms and there is no association between insomnia symptoms and obesity, as long as a normal sleeping time can be attained. This indicates that sleep duration rather than insomnia symptoms per se is of importance for the relationship between sleep and obesity.

  • 7.
    Lindberg, Eva
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Theorell-Haglöw, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Svensson, Malin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Gislason, Thorarinn
    Berne, Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Internal Medicine.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Sleep apnea and glucose metabolism: a long-term follow-up in a community-based sample2012In: Chest, ISSN 0012-3692, E-ISSN 1931-3543, Vol. 142, no 4, p. 935-942Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    It has been suggested that sleep-disordered breathing (SDB) is a risk factor for diabetes, but long-term follow-ups are lacking. The aim of this community-based study was to analyze the influence of SDB on glucose metabolism after more than 10 years.

    METHODS:

    Men without diabetes (n=141, mean age 57.5 years) were investigated at baseline, including whole-night respiratory monitoring. After a mean period of 11 years and 4 months, they were followed up with an interview, anthropometric measurements and blood sampling. Insulin resistance was quantified using the homeostasis model assessment (HOMA). ΔHOMA-IR was calculated as (HOMA-IR(follow-up) - HOMA-IR(baseline)). An oral glucose tolerance test was performed in 113 men to calculate the insulin sensitivity index (ISI).

    RESULTS:

    The mean apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) at baseline were 4.7 and 3.3, respectively. At the follow-up, 23 men had diabetes. An oxygen desaturation index (ODI) of >5 was a predictor of developing diabetes (adj. OR 4.4, 95% CI 1.1-18.1 after adjusting for age, BMI(baseline,) ΔBMI, hypertension and years with CPAP during the period). The ODI was inversely related to the ISI at the follow-up (r= -0.27, p=0.003). A deterioration in HOMA-IR was significantly related to all variables of sleep-disordered breathing (AHI, AHI>5, ODI, ODI>5 and MinSaO2) even when adjusting for confounders. When excluding the variable "years on CPAP" from the multivariate model, all associations weakened.

    CONCLUSIONS:

    SDB is independently related to the development of insulin resistance and thereby the risk of manifest diabetes mellitus.

  • 8.
    Ljunggren, Mirjam
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Byberg, Liisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Theorell-Haglöw, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Lindahl, Bertil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Michaelsson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Does sleep disordered breathing in women promote heart failure?: A population based cohort study2014In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 23, p. 119-119Article in journal (Other academic)
  • 9.
    Ljunggren, Mirjam
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Byberg, Liisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Theorell-Haglöw, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Lindahl, Bertil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Michaëlsson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Increased risk of heart failure in women with symptoms of sleep-disordered breathing2016In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 17, p. 32-37Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: An association between obstructive sleep apnea and the incidence of heart failure has been reported in men but not in women. The aim of this study was to investigate whether a combination of snoring and excessive daytime sleepiness, the two main symptoms of obstructive sleep apnea syndrome, was able to predict incident heart failure in a population-based sample of women.

    METHODS: The population-based cohort study Sleep and Health in Women (SHE; n = 5990 women born between 1901 and 1980) was used, with baseline questionnaire data from April 2000 relating to snoring, excessive daytime sleepiness, and covariates. Using data retrieved from the Swedish National Patient Register and Cause of Death Register, the follow-up of incident heart failure continued until 31 December 2011.

    RESULTS: Among women with both snoring and excessive daytime sleepiness at baseline, 5.3% developed heart failure during follow-up compared with 0.9% in the reference group with neither snoring nor excessive daytime sleepiness. After adjustment for age, waist circumference, smoking, alcohol, hypertension, diabetes, previous myocardial infarction, physical inactivity, depressive symptoms, menopausal status, and hormone replacement therapy, women with the combination of snoring and excessive daytime sleepiness had a twofold increase in the risk of incident heart failure (hazard ratio [HR] 2.2 95% confidence interval [CI] 1.1-4.4).

    CONCLUSION: Symptoms of obstructive sleep apnea, that is, the combination of snoring and excessive daytime sleepiness, are associated with an increased risk of developing heart failure in women.

  • 10.
    Ljunggren, Mirjam
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Lindahl, Bertil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Theorell-Haglöw, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Association between obstructive sleep apnea and elevated levels of type B natriuretic peptide in a community-based sample of women2012In: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 35, no 11, p. 1521-1527Article in journal (Refereed)
    Abstract [en]

    Study Objectives:

    Obstructive sleep apnea (OSA) is associated with an increased risk of cardiovascular disease. One contributory factor may be hemodynamic stress due to the negative intrathoracic pressure during each episode of apnea. Type B natriuretic peptide (BNP) is secreted by the cardiac ventricles in response to volume expansion and pressure load and the authors hypothesized that there would be an association between indices of OSA during the night and levels of BNP in the morning.

    Setting:

    Community-based in Uppsala, Sweden.

    Participants:

    There were 349 women who participated.

    Measurements and Results:

    Participants underwent full-night polysomnography and anthropometric measurements, and answered questionnaires about medical conditions and current medication. The morning after the polysomnography, blood samples were drawn for analysis of plasma BNP, C-reactive protein, creatinine, and hemoglobin. There was an increase in mean BNP as the severity of sleep apnea increased, increasing from a mean value of 8.5 ng/L among women with an apnea-hypopnea index (AHI) < 5 to 18.0 ng/L in women with an AHI = 30. Elevated BNP levels (= 20 ng/L) were found in 29.8% of the women, whereas 70.2% had normal levels. The odds ratio was 2.2 for elevated BNP levels for women with an AHI of 5-14.9 in relation to women with an AHI < 5, 3.1 for women with an AHI of 15-29.9, and 4.6 for women with an AHI = 30 after adjustment for age, body mass index, systolic blood pressure, antihypertensive drugs, and creatinine.

    Conclusions:

    There is a dose-response relationship in women between the severity of sleep apnea during the night and the levels of BNP in the morning.

  • 11.
    Ljunggren, Mirjam
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Franklin, Karl A
    Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Sweden.
    Öhagen, Patrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Larsson, Marita
    Theorell-Haglöw, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Naessén, Tord
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Gynecological endocrinology.
    Obstructive sleep apnea during rapid eye movement sleep is associated with early signs of atherosclerosis in women.2018In: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 41, no 7Article in journal (Refereed)
    Abstract [en]

    Study Objectives: Although obstructive sleep apnea (OSA) is associated with overall cardiovascular disease and mortality, the association with atherosclerotic cardiovascular disease is less clear, especially in women. Recently, it has been suggested that OSA during rapid eye movement (REM) sleep, associated with long apneas and deep desaturations, could have severe cardiometabolic consequences. The aim of this study was to investigate whether OSA during REM sleep is associated with early signs of atherosclerosis in a population-based sample of women.

    Methods: In the community-based "Sleep and Health in Women" (SHE) cohort study, 400 women underwent polysomnography, anthropometric measurements, blood sampling, blood pressure measurement, and answered questionnaires. Ten years later, 201 of the original participants, free of known atherosclerotic disease at baseline and without continuous positive airway pressure treatment for OSA, underwent a high-frequency ultrasound of the common carotid artery to assess the individual thickness of the layers of the artery wall.

    Results: Severe OSA during REM sleep (REM apnea-hypopnea index [AHI] ≥ 30) was associated with a thicker intima. This association was still significant after adjustment for age, body mass index, alcohol, and smoking, as well as for further adjustment for systolic blood pressure, low-density lipoprotein, C-reactive protein, and diabetes (β-coefficient, 0.008; p-value, 0.022). The association between a REM AHI of ≥30 and intima thickness was also seen in women with no or mild OSA and normal non-REM AHI.

    Conclusions: In this study of a community-based sample of women, severe OSA during REM sleep was independently associated with early signs of atherosclerosis.

  • 12.
    Palm, Andreas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Midgren, Bengt
    Theorell-Haglöw, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Ekström, Magnus
    Ljunggren, Mirjam
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    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.2018In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 51, p. 85-91, article id S1389-9457(18)30401-5Article in journal (Refereed)
    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.

  • 13.
    Phan, Hang Thi
    et al.
    Hung Vuong Hosp, Ho Chi Minh City, Vietnam.
    Tran, Hang Thi Thuy
    Hung Vuong Hosp, Ho Chi Minh City, Vietnam.
    Tran, Hanh Thi My
    Hung Vuong Hosp, Ho Chi Minh City, Vietnam.
    Dinh, Anh Pham Phuong
    Hung Vuong Hosp, Ho Chi Minh City, Vietnam.
    Ngo, Ha Thanh
    Hung Vuong Hosp, Ho Chi Minh City, Vietnam.
    Theorell-Haglöw, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Gordon, Christopher J.
    Univ Sydney, Sydney Nursing Sch, Sydney, NSW, Australia..
    An educational intervention to improve hand hygiene compliance in Vietnam2018In: BMC Infectious Diseases, ISSN 1471-2334, E-ISSN 1471-2334, Vol. 18, article id 116Article in journal (Refereed)
    Abstract [en]

    Background: Hand hygiene compliance is the basis of infection control programs. In developing countries models to improve hand hygiene compliance to reduce healthcare acquired infections are required. The aim of this study was to determine hand hygiene compliance following an educational program in an obstetric and gynecological hospital in Vietnam.

    Methods: Health care workers from neonatal intensive care, delivery suite and a surgical ward from Hung Vuong Hospital, Ho Chi Minh City, Vietnam undertook a 4-h educational program targeting hand hygiene. Compliance was monitored monthly for six months following the intervention. Hand hygiene knowledge was assessed at baseline and after six months of the study.

    Results: There were 7124 opportunities over 370 hand hygiene recording sessions with 1531 opportunities at baseline and 1620 at 6 months following the intervention. Hand hygiene compliance increased significantly from baseline across all sites (43.6% [95% Confidence interval CI:41.1-46.1] to 63% [95% CI:60.6-65.3]; p < 0.0001). Health care worker hand hygiene compliance increased significantly after intervention (p < 0.0001). There were significant improvements in knowledge scores from baseline to 2 months post educational intervention with mean difference standard deviations (SD):1.5 (2.5); p < 0.001).

    Conclusions: A simple educational model was implemented in a Vietnamese hospital that revealed good hand hygiene compliance for an extended period of time. Hand hygiene knowledge increased during the intervention. This hand hygiene model could be used in developing countries were resources are limited.

  • 14. Schwarz, J.
    et al.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Gruber, G.
    Fischer, H.
    Theorell-Haglöw, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Akerstedt, T.
    Effect of age on the macro- and microstructure of sleep in women2014In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 23, p. 240-240Article in journal (Other academic)
  • 15.
    Schwarz, Johanna F. A.
    et al.
    Stockholm Univ, Stress Res Inst, S-10691 Stockholm, Sweden.;Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Akerstedt, Torbjorn
    Stockholm Univ, Stress Res Inst, S-10691 Stockholm, Sweden.;Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Gruber, Georg
    Siesta Grp, Vienna, Austria..
    Fischer, Hakan
    Stockholm Univ, Dept Psychol, Stockholm, Sweden..
    Theorell-Haglöw, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Age affects sleep microstructure more than sleep macrostructure2017In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 26, no 3, p. 277-287Article in journal (Refereed)
    Abstract [en]

    It is well known that the quantity and quality of physiological sleep changes across age. However, so far the effect of age on sleep microstructure has been mostly addressed in small samples. The current study examines the effect of age on several measures of sleep macro- and microstructure in 211 women (22-71years old) of the Sleep and Health in Women' study for whom ambulatory polysomnography was registered. Older age was associated with significantly lower fast spindle (effect size f(2)=0.32) and K-complex density (f(2)=0.19) during N2 sleep, as well as slow-wave activity (log) in N3 sleep (f(2)=0.21). Moreover, total sleep time (f(2)=0.10), N3 sleep (min) (f(2)=0.10), rapid eye movement sleep (min) (f(2)=0.11) and sigma (log) (f(2)=0.05) and slow-wave activity (log) during non-rapid eye movement sleep (f(2)=0.09) were reduced, and N1 sleep (f(2)=0.03) was increased in older age. No significant effects of age were observed on slow spindle density, rapid eye movement density and beta power (log) during non-rapid eye movement sleep. In conclusion, effect sizes indicate that traditional sleep stage scoring may underestimate age-related changes in sleep.

  • 16.
    Spörndly-Nees, Sören
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Åsenlöf, Pernilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Theorell-Haglöw, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Svensson, Malin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Igelström, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Leisure-time physical activity predicts complaints of snoring in women: a prospective cohort study over 10 years2014In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 15, no 4, p. 415-421Article in journal (Refereed)
    Abstract [en]

    Objective

    We aimed to assess the impact of self-reported physical activity on incidence and remission of snoring complaints in women.

    Methods

    A population-based sample of 4851 women aged >20 years responded to questionnaires in years 2000 and 2010. Based on the responses, the women were categorized into low, medium, or high level of physical activity at baseline and at follow-up.

    Results

    The prevalence of habitual snoring complaints increased from 7.6% at baseline to 9.2% in 2010 (P<.0001). After adjusting for age, body mass index (BMI), waist and neck circumference, weight gain, smoking status, alcohol dependence, and snoring status at baseline, reported physical activity level at baseline had a protective effect on habitual snoring complaints at follow-up. The adjusted odds ratio (OR) (95% confidence intervals]) for complaints of habitual snoring was 0.7 (0.5–0.9) for the reported medium physical activity level and 0.5 (0.4–0.8) for the high activity level. When subdividing the population by changes in reported physical activity level over the follow-up period, an increase in physical activity was followed by a decrease in the complaint of snoring. Similarly a high level of reported physical activity only had a protective effect on snoring in participants who remained at a high or medium level.

    Conclusions

    A low level of self-reported physical activity is a risk factor for future habitual snoring complaints in women, independent of weight, weight gain, alcohol dependence, and smoking. Increased physical activity can modify the risk.

  • 17.
    Theorell-Haglöw, Jenny
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Berglund, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Berne, Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Both habitual short sleepers and long sleepers are at greater risk of obesity: a population-based 10-year follow-up in women2014In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 15, no 10, p. 1204-1211Article in journal (Refereed)
    Abstract [en]

    Objective: To assess how change in sleep duration is related to subsequent obesity. Methods: In this 10-year follow-up, 4903 non-pregnant participants answered a questionnaire on sleeping habits, obesity, and lifestyle factors (questions identical to baseline questionnaire). Habitual normal sleepers were defined as sleeping 6-9 h/night at both baseline and follow-up, whereas women sleeping <6 h/night or >= 9 h/night at both occasions were defined as habitual short sleepers and habitual long sleepers, respectively. Logistic regression was used to analyze associations between changes in sleep duration, general obesity (body mass index >= 30 kg/m(2)), weight gain (>= 10 kg) and also, central obesity (waist circumference >= 88 cm), and increase in waist circumference (>= 10 cm) at follow-up. Results: Among younger women (aged <40 years) both habitual short sleepers and habitual long sleepers had a higher prevalence of general (short: 31.3%, P < 0.0001; long: 38.1%, P = 0.01) and central obesity (short: 60.5%, P = 0.01; long: 82.4%, P = 0.01) compared with habitual normal sleepers (general obesity: 8.9%; central obesity: 35.9%) at follow-up. Younger women who were short sleepers at baseline but normal sleepers at the follow-up had a higher prevalence of both general (19.3%, P = 0.01) and central obesity (45.4%, P = 0.07) compared with habitual normal sleepers at follow-up. In adjusted analyses, both habitual short [adjusted odds ratio (aOR), 6.78; 95% confidence interval (CI), 2.71-17.0] and long (aOR, 4.64; 95% CI, 1.09-19.8) sleep durations were risk factors for general obesity in younger women. In younger women habitual long sleep duration was a risk factor also for central obesity (aOR, 6.05; 95% CI, 1.19-30.7) whereas habitual short sleep duration was not (aOR, 1.93; 95% CI, 0.87-4.81). Similar results were seen also for weight gain and increased waist circumference as dependent variables. In addition, decreased sleep duration from normal to short duration was a risk factor for both weight gain (aOR, 1.85; 95% CI, 1.14-3.02) and increased waist circumference (aOR, 1.84; 95% CI, 1.20-2.81). There were no associations between changes in sleep duration and any of the measures of obesity at the follow-up in women aged >40 years at baseline. Conclusion: In younger women, both habitual short and long sleep duration was a risk factor for obesity, whereas no such relationship was seen in older women.

  • 18.
    Theorell-Haglöw, Jenny
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Berglund, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Sleep duration and central obesity in women: Differences between short sleepers and long sleepers2012In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 13, no 8, p. 1079-1085Article in journal (Refereed)
    Abstract [en]

    Objective: To assess characteristics of short sleepers and long sleepers and to assess association between sleep duration and central obesity in a population-based sample of women. Method: Non-pregnant women >= 20 years that were randomly selected from the population-registry of Uppsala, Sweden, answered a questionnaire (n =6461) including questions on sleeping habits and somatic disorders. Results: There was a U-shaped association between sleep duration and waist circumference. Short sleeping women (<5 h) had a waist circumference of 89.2 +/- 14.9 cm (mean +/- SD) decreasing to 82.9 +/- 11.9 cm for women sleeping 7-<8 h and increasing to 89.0 +/- 16.7 cm for women sleeping >= 10 h. Both short sleepers and long sleepers were more often physically inactive, smokers, ill or taking medication, and psychologically distressed than normal sleepers (6-<9 h). In women <50 years both short and long sleep duration were risk factors for central obesity. Short sleep duration remained a risk factor for central obesity, whereas the association with long sleep duration did not reach statistical significance after adjustments. Conclusions: Short sleepers and long sleepers showed differences in characteristics compared to normal sleepers. Furthermore, we showed an independent association between short sleep duration and central obesity, which was strongest in younger women. It is important to identify short sleepers, especially in younger women.

  • 19.
    Theorell-Haglöw, Jenny
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Berne, Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Syndrome Z: A comparison of prevalence between females and males2012In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 13, no 1, p. 120-120Article in journal (Refereed)
  • 20.
    Theorell-Haglöw, Jenny
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Berne, Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Internal Medicine.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    The role of obstructive sleep apnea in metabolic syndrome: A population-based study in women2011In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 12, no 4, p. 329-334Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was to assess associations between obstructive sleep apnea (USA) and metabolic syndrome in a population-based sample of women.

    Methods: Four hundred women aged 20-70 years underwent a full-night polysomnography, fasting blood sampling and measurement of anthropometric variables. Metabolic syndrome was defined according to the National Cholesterol Education Program (NCEP) criteria.

    Results: The NCEP criteria of metabolic syndrome were fulfilled by 104 (26.0%) of the women. The frequency of metabolic syndrome increased from 10.5% in women with apnea-hypopnea-index (AHI) < 5 to 57.1% in women with AHI >= 30 (p for trend < 0.0001). In the multivariate analysis, the severity of USA measured as AHI, ODI (oxygen desaturation index), minimal saturation or T-90 (percentage of time during night with saturation < 90%) were associated with metabolic syndrome after adjustment for age, level of physical activity, smoking and alcohol consumption. AHI (adj. OR 1.45; 95% CI 1.11-1.91), ODI (1.37; 1.09-1.73) and minimal saturation level (0.93; 0.87-0.99) remained significantly associated with metabolic syndrome also when adjusting for the waist-to-hip-ratio. The three markers of USA were independently associated with central obesity, hypertriglyceridemia and reduced HDL cholesterol concentration.

    Conclusion: Measures of USA were closely associated with metabolic syndrome and its components in this population-based sample of women also after adjustments. Therefore, when the health consequences of sleep-disordered breathing are investigated it is important to consider metabolic syndrome. Sleep-disordered breathing should also be considered when treating patients with metabolic syndrome.

  • 21.
    Theorell-Haglöw, Jenny
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Berne, Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Internal Medicine.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    What is cause and what is effect?2012In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 13, no 2, p. 213-213Article in journal (Refereed)
  • 22.
    Theorell-Haglöw, Jenny
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology. Univ Sydney, Woolcock Inst Med Res, Sleep & Circadian Res Grp, NHMRC Ctr Integrated Res & Understanding Sleep CI, Sydney, NSW, Australia..
    Hoyos, C. M.
    Univ Sydney, Woolcock Inst Med Res, Sleep & Circadian Res Grp, NHMRC Ctr Integrated Res & Understanding Sleep CI, Sydney, NSW, Australia..
    Phillips, C. L.
    Univ Sydney, Woolcock Inst Med Res, Sleep & Circadian Res Grp, NHMRC Ctr Integrated Res & Understanding Sleep CI, Sydney, NSW, Australia.;Royal North Shore Hosp, Dept Resp & Sleep Med, Sydney, NSW, Australia..
    Yee, B. J.
    Univ Sydney, Woolcock Inst Med Res, Sleep & Circadian Res Grp, NHMRC Ctr Integrated Res & Understanding Sleep CI, Sydney, NSW, Australia..
    Grunstein, R. R.
    Univ Sydney, Woolcock Inst Med Res, Sleep & Circadian Res Grp, NHMRC Ctr Integrated Res & Understanding Sleep CI, Sydney, NSW, Australia..
    Liu, P. Y.
    Univ Calif Los Angeles, David Geffen Sch Med, Dept Med, Harbor UCLA Med Ctr,Div Endocrinol, Los Angeles, CA 90095 USA.;Los Angeles Biomed Res Inst, Los Angeles, CA USA..
    CPAP therapy, vitamin D and bone turnover markers - a randomized controlled trial2016In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 25, p. 40-40Article in journal (Other academic)
  • 23.
    Theorell-Haglöw, Jenny
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology. Univ Sydney, Woolcock Inst Med Res, Sleep & Circadian Res Grp, NHMRC Ctr Integrated Res & Understanding Sleep CI, Sydney, NSW, Australia..
    Hoyos, C. M.
    Univ Sydney, Woolcock Inst Med Res, Sleep & Circadian Res Grp, NHMRC Ctr Integrated Res & Understanding Sleep CI, Sydney, NSW, Australia..
    Phillips, C. L.
    Univ Sydney, Woolcock Inst Med Res, Sleep & Circadian Res Grp, NHMRC Ctr Integrated Res & Understanding Sleep CI, Sydney, NSW, Australia.;Royal North Shore Hosp, Dept Resp & Sleep Med, Sydney, NSW, Australia..
    Yee, B. J.
    Univ Sydney, Woolcock Inst Med Res, Sleep & Circadian Res Grp, NHMRC Ctr Integrated Res & Understanding Sleep CI, Sydney, NSW, Australia.;Royal Prince Alfred Hosp, Resp Med & Sleep Unit, Sydney, NSW, Australia..
    Melehan, K. L.
    Univ Sydney, Woolcock Inst Med Res, Sleep & Circadian Res Grp, NHMRC Ctr Integrated Res & Understanding Sleep CI, Sydney, NSW, Australia.;Royal Prince Alfred Hosp, Resp Med & Sleep Unit, Sydney, NSW, Australia..
    Liu, P. Y.
    Univ Calif Los Angeles, David Geffen Sch Med, Dept Med, Div Endocrinol,Harbor UCLA Med Ctr, Los Angeles, CA 90095 USA.;Los Angeles Biomed Res Inst, Los Angeles, CA USA..
    Cistulli, P. A.
    Univ Sydney, Woolcock Inst Med Res, Sleep & Circadian Res Grp, NHMRC Ctr Integrated Res & Understanding Sleep CI, Sydney, NSW, Australia.;Royal North Shore Hosp, Dept Resp & Sleep Med, Sydney, NSW, Australia..
    Grunstein, R. R.
    Univ Sydney, Woolcock Inst Med Res, Sleep & Circadian Res Grp, NHMRC Ctr Integrated Res & Understanding Sleep CI, Sydney, NSW, Australia.;Royal Prince Alfred Hosp, Resp Med & Sleep Unit, Sydney, NSW, Australia..
    Associations between obstructive sleep apnea and measures of arterial stiffness2016In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 25, p. 173-173Article in journal (Other academic)
  • 24.
    Theorell-Haglöw, Jenny
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Univ Sydney, Woolcock Inst Med Res, Sleep & Circadian Res Grp, NHMRC Ctr Integrated Res & Understanding Sleep CI, Glebe, NSW, Australia.
    Hoyos, Camilla M.
    Univ Sydney, Woolcock Inst Med Res, Sleep & Circadian Res Grp, NHMRC Ctr Integrated Res & Understanding Sleep CI, Glebe, NSW, Australia.
    Phillips, Craig L.
    Univ Sydney, Woolcock Inst Med Res, Sleep & Circadian Res Grp, NHMRC Ctr Integrated Res & Understanding Sleep CI, Glebe, NSW, Australia.
    Yee, Brendon J.
    Univ Sydney, Woolcock Inst Med Res, Sleep & Circadian Res Grp, NHMRC Ctr Integrated Res & Understanding Sleep CI, Glebe, NSW, Australia.
    Herrmann, Markus
    Bolzano Hosp, Dept Clin Pathol, Bolzano, Italy.
    Brennan-Speranza, Tara C.
    Univ Sydney, Bosch Inst Med Res, Dept Physiol, Sydney, NSW, Australia.
    Grunstein, Ronald R.
    Univ Sydney, Woolcock Inst Med Res, Sleep & Circadian Res Grp, NHMRC Ctr Integrated Res & Understanding Sleep CI, Glebe, NSW, Australia.
    Liu, Peter Y.
    Los Angeles Biomed Res Inst, Torrance, CA USA;Univ Calif Los Angeles, Harbor UCLA Med Ctr, David Geffen Sch Med, Div Endocrinol,Dept Med, Torrance, CA USA.
    Changes of vitamin D levels and bone turnover markers after CPAP therapy: a randomized sham-controlled trial2018In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 27, no 4, article id e12606Article in journal (Refereed)
    Abstract [en]

    The aim was to investigate whether continuous positive airway pressure treatment could modulate serum vitamin D (25-hydroxyvitamin D) and bone turnover markers (collagen-type 1 cross-linked C-telopeptide, osteocalcin and N-terminal propeptide of type 1 collagen) in secondary analysis from a randomized controlled trial. Sixty-five continuous positive airway pressure-naive male patients with obstructive sleep apnea (age=49 +/- 12years, apnea-hypopnea index=39.9 +/- 17.7events h(-1), body mass index=31.3 +/- 5.2kgm(-2)) were randomized to receive either real (n=34) or sham (n=31) continuous positive airway pressure for 12weeks. At 12weeks, all participants received real continuous positive airway pressure for an additional 12weeks. After 12weeks of continuous positive airway pressure (real versus sham), there were nobetween-group differences for any of the main outcomes [25-hydroxyvitamin D: -0.80 +/- 5.28ngmL(-1) (mean +/- SE) versus 3.08 +/- 3.66ngmL(-1), P=0.42; collagen-type 1 cross-linked C-telopeptide: 0.011 +/- 0.014ngmL(-1) versus -0.004 +/- 0.009ngmL(-1), P=0.48; osteocalcin: 1.13 +/- 1.12ngmL(-1) versus 0.46 +/- 0.75ng mL(-1), P=0.80; N-terminal propeptide of type 1 collagen: 2.07 +/- 3.05gL(-1) versus -1.05 +/- 2.13gL(-1), P=0.48]. There were no further differences in subgroup analyses (continuous positive airway pressure-compliant patients, patients with severe obstructive sleep apnea or sleepy patients). However, after 24weeks irrespective of initial randomization, vitamin D increased in patients with severe obstructive sleep apnea (9.56 +/- 5.51ngmL(-1), P=0.045) and in sleepy patients (14.0 +/- 4.69ngmL(-1), P=0.007). Also, there was a significant increase in osteocalcin at 24weeks (3.27 +/- 1.06ngmL(-1), P=0.01) in compliant patients. We conclude that 12weeks of continuous positive airway pressure did not modulate vitamin D or modulate any of the bone turnover markers compared with sham. However, it is plausible that continuous positive airway pressure may have late beneficial effects on vitamin D levels and bone turnover markers in selected groups of patients with obstructive sleep apnea.

  • 25.
    Theorell-Haglöw, Jenny
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Univ Sydney, Woolcock Inst Med Res, Ctr Sleep & Chronobiol, CIRUS, Sydney, NSW, Australia..
    Miller, Christopher B.
    Univ Sydney, Woolcock Inst Med Res, Ctr Sleep & Chronobiol, CIRUS, Sydney, NSW, Australia..
    Bartlett, Delwyn J.
    Univ Sydney, Woolcock Inst Med Res, Ctr Sleep & Chronobiol, CIRUS, Sydney, NSW, Australia..
    Yee, Brendon J.
    Univ Sydney, Woolcock Inst Med Res, Ctr Sleep & Chronobiol, CIRUS, Sydney, NSW, Australia..
    Openshaw, Hannah D.
    Univ Sydney, Woolcock Inst Med Res, Ctr Sleep & Chronobiol, CIRUS, Sydney, NSW, Australia..
    Grunstein, Ronald R.
    Univ Sydney, Woolcock Inst Med Res, Ctr Sleep & Chronobiol, CIRUS, Sydney, NSW, Australia..
    Gender differences in obstructive sleep apnoea, insomnia and restless legs syndrome in adults - What do we know?: A clinical update2018In: Sleep Medicine Reviews, ISSN 1087-0792, E-ISSN 1532-2955, Vol. 38, p. 28-38Article, review/survey (Refereed)
    Abstract [en]

    Research in sleep medicine over the last decades has involved a broad variety of sleep disorders in both men and women. Gender differences have been identified in sleep physiology as well as in the three most common sleep disorders: obstructive sleep apnoea (OSA), insomnia and restless legs syndrome (RLS). However, research on gender differences in sleep medicine appears limited. This clinical review aims to give an updated overview of gender differences, in relation to prevalence, clinical presentation, treatment and quality of life in OSA, insomnia and RLS. Future research directions in the adult population will also be discussed. (C) 2017 Elsevier Ltd. All rights reserved.

  • 26.
    Theorell-Haglöw, Jenny
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Olafsdottir, Inga Sif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Landspitali Univ Hosp, Dept Resp Med & Sleep, Reykjavik, Iceland.;Univ Iceland, Fac Med, Reykjavik, Iceland..
    Benediktsdottir, Bryndis
    Landspitali Univ Hosp, Dept Resp Med & Sleep, Reykjavik, Iceland.;Univ Iceland, Fac Med, Reykjavik, Iceland..
    Gislason, Thorarinn
    Landspitali Univ Hosp, Dept Resp Med & Sleep, Reykjavik, Iceland.;Univ Iceland, Fac Med, Reykjavik, Iceland..
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Sex differences in reported and objectively measured sleep in COPD2016In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 11, p. 151-160Article in journal (Refereed)
    Abstract [en]

    Background: The aim was to assess and compare reported sleep disturbances and objectively measured sleep in men and women with COPD compared with controls and also explore sex differences. Methods: A total of 96 patients with COPD and 90 age-and sex-matched controls answered a sleep questionnaire, underwent ambulatory polysomnography, a post-bronchodilatory spirometry, and blood sampling. Results: Of the patients with COPD, 51% reported sleep disturbances as compared with 31% in controls (P= 0.008). Sleep disturbances were significantly more prevalent in males with COPD compared with controls, whereas there was no significant difference in females. The use of hypnotics was more common among patients with COPD compared with controls, both in men (15% vs 0%, P= 0.009) and women (36% vs 16%, P= 0.03). The men with COPD had significantly longer recorded sleep latency than the male control group (23 vs 9.3 minutes, P<0.001), while no corresponding difference was found in women. In men with COPD, those with reported sleep disturbances had lower forced vital capacity, higher C-reactive protein, myeloperoxidase, and higher prevalence of chronic bronchitis. Conclusion: The COPD was associated with impaired sleep in men while the association was less clear in women. This was also confirmed by recorded longer sleep latency in male subjects with COPD compared with controls.

  • 27.
    Theorell-Haglöw, Jenny
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Åkerstedt, Torbjörn
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden..
    Schwarz, Johanna
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden.;Stockholm Univ, Dept Psychol, Stockholm, Sweden..
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Predictors for Development of Excessive Daytime Sleepiness in Women: A Population-Based 10-Year Follow-Up2015In: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 38, no 12, p. 1995-2003Article in journal (Refereed)
    Abstract [en]

    Study Objectives: To analyze predictors of excessive daytime sleepiness (EDS) and to analyze how changes within risk factors over time predict incident EDS in women. Design: Population-based prospective study. Setting: General population of the City of Uppsala, Sweden. Participants: From a random, general population sample of 7,051 women from the Sleep and HEalth in women ("SHE") cohort, 4,322 women without EDS at baseline were followed up after 10 y. Interventions: N/A. Measurements and Results: At baseline and follow-up, women answered a questionnaire on sleeping habits, somatic disease, obesity, insomnia, anxiety and depression, lifestyle, and social factors. The risk of incident EDS was analyzed from changes over time in risk factors using logistic regression modeling. Of the women, EDS developed in 7.9%. Incident: insomnia (adjusted odds ratio = 5.01; 95% confidence interval 3.63-6.92), anxiety and/or depression (3.34; 2.22-5.02), somatic disease (1.73; 1.17-2.55), obesity (1.91; 1.14-2.57), snoring (1.91; 1.17-3.10) and smoking (4.31; 1.95-9.54) were all independent risk factors for the development of EDS. In addition, persistent: insomnia (4.44; 2.97-6.65) and anxiety and/or depression (4.91; 3.17-7.62) increased the risk of developing EDS. Apart from incident: snoring and obesity, similar results were obtained when only including women without somatic disease in the analyses. Conclusion: Insomnia, anxiety and/or depression, and smoking were the most important factors for predicting incident excessive daytime sleepiness (EDS) and, in addition, somatic disease, obesity, and snoring predicted EDS. It is important not only to treat these conditions but also to inform women of the importance of a healthy lifestyle in order to prevent and reduce EDS in women.

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