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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.
    Akerstedt, T.
    et al.
    Karolinska Inst, Stockholm, Sweden.
    Lindberg, Eva
    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.
    Schwaz, J.
    Stockholm Univ, Stocholm, Sweden.
    What Characterizes the Combination of Seeking Medical Help for Insomnia and Snoring in Terms of PSG and Metabolic Parameters?2017In: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 40, p. A34-A34Article in journal (Other academic)
  • 4.
    Akerstedt, T.
    et al.
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Theorell-Haglöw, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Schwarz, J.
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    The change in sleepiness across 10 years of aging and its relation to changes in polysomnographic variables2017In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 40, no Supplement 1, p. E8-E8Article in journal (Other academic)
  • 5.
    Akerstedt, Torbjorn
    et al.
    Karolinska Inst, Dept Clin Neurosci, S-17177 Stockholm, Sweden;Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Schwarz, Johanna
    Karolinska Inst, Dept Clin Neurosci, S-17177 Stockholm, Sweden;Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Gruber, Georg
    Siesta Grp, Vienna, Austria.
    Theorell-Haglöw, Jenny
    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.
    Women with both sleep problems and snoring show objective impairment of sleep2018In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 51, p. 80-84Article in journal (Refereed)
    Abstract [en]

    Objective: Combined insomnia and obstructive sleep apnea has been the focus of considerable research with respect to its health effects. A related issue is whether sleep disturbances in combination with snoring might exert effects on objective sleep variables in the non-clinical general population. The purpose of the present study was to investigate the polysomnographical characteristics of individuals who had sought medical help for both disturbed sleep and for snoring. No previous work of this type has been carried out. Method: For this study we used a representative set of data of 384 women with one night of in-home PSG. We identified those individuals who had sought medical help for sleep problems (SL), individuals that had sought help for snoring (SN), as well as those that had sought help for either both (Combined), or for neither (Control). Results: Our results yielded an N of 46, 16, 21, and 301 individuals, respectively. A one-factor analysis of variance showed significant main effects on N1% (F = 10.2, p < 0.001), N3% (F = 2.7, p < 0.05), AHI/h (F = 5.5, p < 0.001), and a delta power measure (F = 3.8, p < 0.05). The combined group showed significantly higher levels than the other groups for N1% (29% vs < 21%), AHI/h (19/h vs < 10/h) and lower levels for N3%, and a measure of delta power. Reported sleep quality measures did not show the same pattern, since the highest/lowest value were found for either the group presenting snoring alone or sleep problems alone. Conclusion: We concluded that individuals who had sought help for both insomnia and snoring showed impaired sleep in terms of PSG and that this was not reflected in ratings of sleep or health. This suggests that simultaneous sleep disturbances and snoring may potentiate each other to cause impaired sleep, yet the mechanism still needs to be elucidated.

  • 6.
    Akerstedt, Torbjorn
    et al.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.;Stockholm Univ, Stress Res Inst, Dept Psychol, Stockholm, Sweden.;Karolinska Inst, Clin Neurosci, S-17177 Stockholm, Sweden..
    Schwarz, Johanna
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.;Stockholm Univ, Stress Res Inst, Dept Psychol, Stockholm, Sweden..
    Theorell-Haglöw, Jenny
    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.
    What do women mean by poor sleep?: A large population-based sample with polysomnographical indicators, inflammation, fatigue, depression, and anxiety2023In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 109, p. 219-225Article in journal (Refereed)
    Abstract [en]

    Survey studies indicate that reports of disturbed sleep are prevalent and may be prospectively linked to several major diseases. However, it is not clear what self-reported disturbed sleep represents, since the link with objective sleep measures (polysomnography; PSG) seems very weak. The purpose of the present study was to try to investigate what combination of variables (PSG, inflammation, fatigue, anxiety, depression) that would characterize those who complain of disturbed sleep. This has never been done before. Participants were 319 women in a population-based sample, who gave ratings of sleep quality, fatigue, depression, and anxiety, then had their sleep recorded at home, and had blood drawn the following morning for analysis of immune parameters. Correlations and hierarchical multivariable regression analyses were applied to the data. For ratings of difficulties initiating sleep, the associations in the final step were beta =.22, (p <.001) for fatigue, beta = 0.22 (p <.001) for anxiety, and beta = 0.17 (p <.01) for sleep latency, with R-2 = 0.14. The rating of repeated awakenings was associated with fatigue (beta = 0.35, p <.001) and C-reactive protein (CRP) (beta = 0.12, p <.05), with R-2 = 0.19. The rating of early morning awakenings was associated with fatigue (beta = 0.31, p <.001), total sleep time (TST) (beta = -0.20, p <.01), and CRP (beta = 0.15, p <.05), with R-2 = 0.17. Interleukin-6 and Tumour Necrosis Factor were not associated with ratings of sleep problems. The results indicate that subjective fatigue, rather than objective sleep variables, is central in the perception of poor sleep, together with CRP.

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  • 7.
    Amid Hägg, Shadi
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Elena, Ilieva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Ljunggren, Mirjam
    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, Umeå.
    Middelveld, Roelinde
    Center for Allergy research, Karolinska Institute, Stockholm.
    Lundbäck, Bo
    Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg.
    Janson, Christer
    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.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    The negative health effects of having a combination of snoring and insomnia2022In: Journal of Clinical Sleep Medicine (JCSM), ISSN 1550-9389, E-ISSN 1550-9397, Vol. 18, no 4Article in journal (Refereed)
    Abstract [en]

    Study objectives: Insomnia and snoring are common sleep disorders. The aim was to investigate the association of a combination of insomnia symptoms and snoring with comorbidity and daytime sleepiness. 

    Methods: The study population consisted of 25,901 subjects (16-75 years, 54.4% women) from four Swedish cities, who answered a postal questionnaire that contained questions on snoring, insomnia symptoms (difficulties initiating and/or maintaining sleep and/or early morning awakening), smoking, educational level and respiratory and non-respiratory disorders. 

    Results: Snoring was reported by 4,221 (16.2%), while 9,872 (38.1%) reported ≥ 1 insomnia symptom. A combination of insomnia symptoms and snoring was reported by 2,150 (8.3%). The association with hypertension (OR 1.4, 95% CI: 1.2-1.6), chronic obstructive pulmonary disease (COPD) (OR 1.8, 95% CI: 1.3-2.4), asthma (OR 1.9; 95% CI: 1.6-2.3), daytime sleepiness (OR 7.9, 95% CI 7.1-8.8) and the use of hypnotics (OR 7.5, 95% CI: 6.1-9.1) was highest for the group with both insomnia symptoms and snoring.

    Conclusions: Subjects with snoring and insomnia combined run an increased risk of hypertension, COPD, asthma, daytime sleepiness and the use of hypnotics. It is important to consider snoring in patients seeking medical assistance for insomnia and, vice versa, in patients with snoring enquire about insomnia. 

    Keywords:  Snoring, insomnia, daytime sleepiness, hypertension, COPD, asthma

  • 8.
    Amid Hägg, Shadi
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Emilsson, Össur Ingi
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
    Franklin, Karl
    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.
    Nocturnal gastroesophageal reflux increases the risk of daytime sleepiness in women2019In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 53, p. 94-100Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Daytime sleepiness is common in women and has negative health effects. Nocturnal gastroesophageal reflux (nGER) and snoring are risk factors for daytime sleepiness, but the effect of their interaction remains unknown. The aim of this study was to examine how nGER and snoring combined affected daytime sleepiness and involuntary falling asleep in women.

    METHODS: A questionnaire was sent to randomly selected women in 2000 and 2010. Participants who answered questions regarding both nGER and snoring in both questionnaires were included (N = 4882). Daytime sleepiness was defined as severe or very severe problems with daytime sleepiness. Involuntary falling asleep was defined as sometimes, often or very often falling asleep involuntarily during the day. Respondents snoring loudly and disturbingly sometimes, often or very often were defined as snorers. Having nocturnal heartburn or acid reflux sometimes, often or very often was defined as having nGER.

    RESULTS: Daytime sleepiness was reported by 14% of the participants, involuntary falling asleep by 11%. After adjustment for age, smoking, physical activity, caffeine intake and alcohol dependency, increased odd ratios (ORs) for both daytime sleepiness (adjusted OR 4.2, 95% confidence interval (CI): 1.9-9.2) and involuntary falling asleep (adjusted OR 3.1, 95% CI: 1.5-6.4) were seen in women with the combination of nGER and snoring at both baseline and follow-up. The association with daytime sleepiness was also strong for those with only persistent nGER but not for those with only persistent snoring.

    CONCLUSION: Women with nGER were at increased risk of developing daytime sleepiness and snoring augmented this association. In addition, women with both nGER and snoring were also at increased risk of developing involuntary falling asleep.

  • 9.
    Amid Hägg, Shadi
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    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.
    Holm, Mathias
    Univ Gothenburg, Dept Occupat & Environm Med, Gothenburg, Sweden.
    Franklin, Karl A.
    Umeå Univ, Dept Surg & Perioperat Sci, Umeå, Sweden.
    Gislason, Thorarinn
    Landspitali Univ Hosp, Dept Sleep, Reykjavik, Iceland; Univ Iceland, Fac Med, Reykjavik, Iceland.
    Johannessen, Ane
    Univ Bergen, Dept Global Publ Hlth & Primary Care, Bergen, Norway; Haukeland Hosp, Dept Occupat Med, Bergen, Norway.
    Jõgi, Rain
    Tartu Univ Hosp, Lung Clin, Tartu, Estonia.
    Olin, Anna-Carin
    Univ Gothenburg, Dept Occupat & Environm Med, Gothenburg, Sweden.
    Schlünssen, Vivi
    Aarhus Univ, Danish Ramazzini Ctr, Dept Publ Hlth, Aarhus, Denmark; Natl Res Ctr Working Environm, Copenhagen, Denmark.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Smokers with insomnia symptoms are less likely to stop smoking2020In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 170, article id 106069Article in journal (Refereed)
    Abstract [en]

    Objectives

    Smoking is associated with sleep disturbances. The aim of this study was to analyze whether sleep disturbances are predictors of smoking cessation and whether continued smoking is associated with the development of sleep disturbances.

    Methods

    A questionnaire was sent to randomly selected men and women in Northern Europe in 1999–2001 (RHINE II) and was followed up by a questionnaire in 2010–2012 (RHINE III). The study population consisted of 2568 participants who were smokers at baseline and provided data on smoking at follow-up. Insomnia symptoms were defined as having difficulty initiating and/or maintaining sleep and/or early morning awakening ≥3 nights/week. Multiple logistic regression analyses were performed to calculate odds ratios (OR).

    Results

    Subjects with difficulty initiating sleep (adjusted odds ratio; 95% confidence interval: 0.6; 0.4–0.8), difficulty maintaining sleep (0.7; 0.5–0.9), early morning awakening (0.6; 0.4–0.8), any insomnia symptom (0.6; 0.5–0.8) or excessive daytime sleepiness (0.7; 0.5–0.8) were less likely to achieve long-term smoking cessation after adjustment for age, BMI, pack-years, hypertension, diabetes, chronic bronchitis, rhinitis, asthma, gender and BMI difference. There was no significant association between snoring and smoking cessation. In subjects without sleep disturbance at baseline, continued smoking increased the risk of developing difficulty initiating sleep during the follow-up period compared with those that had quit smoking (adj. OR 1.7, 95% CI 1.2–2.3).

    Conclusions

    Insomnia symptoms and excessive daytime sleepiness negatively predict smoking cessation. Smoking is a risk factor for the development of difficulty initiating sleep. Treatment for sleep disturbances should be included in smoking-cessation programs.

  • 10.
    Amid Hägg, Shadi
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Toren, Kjell
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Role of sleep disturbances in occupational accidents among women2015In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 41, no 4, p. 368-376Article in journal (Refereed)
    Abstract [en]

    Objectives This population-based cohort study was performed to assess the association between sleep disturbances and the risk of occupational accidents among women. Methods Data were collected by questionnaires on two different occasions (2000 and 2010) and data on work injuries were also collected from Swedish government records (ISA). Insomnia symptoms were defined as having severe or very severe problems with (i) difficulty initiating sleep, (ii) difficulty maintaining sleep, or (iii) early morning awakening. Symptom of obstructive sleep apnea syndrome (OSAS) was defined as reporting both snoring and daytime sleepiness. Working-age respondents (20-67 years of age) who responded to both baseline and follow-up questionnaires and had worked for part or all of the 10-year follow-up period (N=4320) were included in the study. Results Of the subjects responding to the questionnaire, 12.2% reported >= 1 accident and 6.3% reported an accident requiring sick leave in the government register. Blue-collar workers and night and shift work were more common in the group with occupational accidents. Subjects with insomnia symptoms both at baseline and follow-up (persistent insomnia symptoms) ran a higher risk of being involved in an self-reported occupational accident [adjusted OR (ORadj) 1.5, 95% confidence interval (95% CI) 1.2-2.0] after adjusting for age, body mass index, smoking, alcohol dependency, white- or blue-collar worker, years at work, night work, and physical activity. Persistent insomnia symptoms did not reach statistical significance as an independent predictor of register-reported occupational accident with sick leave (ORadj 1.4, 95% CI 0.99-2.1). No significant association was found between symptoms of OSAS and self-reported or register-based occupational accidents. Conclusions Persistent insomnia symptoms were associated with an increased risk of self-reported occupational accidents, while no significant association was found with occupational accidents with sick leave reported to government register.

  • 11.
    Andersson Kallin, Sandra
    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.
    Sommar, Johan Nilsson
    Umeå Univ, Dept Publ Hlth & Clin Med, Occupat & Environm Med, Umeå, Sweden.
    Bossios, Apostolos
    Univ Gothenburg, Sahlgrenska Acad, Krefting Res Ctr, Dept Internal Med & Clin Nutr, Gothenburg, Sweden.
    Ekerljung, Linda
    Univ Gothenburg, Sahlgrenska Acad, Krefting Res Ctr, Dept Internal Med & Clin Nutr, Gothenburg, Sweden.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Middelveld, Roelinde
    Karolinska Inst, Ctr Allergy Res, Stockholm, Sweden; Karolinska Inst, Inst Environm Med, Stockholm, Sweden.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Excessive daytime sleepiness in asthma: what are the risk factors?2018In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 55, no 8, p. 844-850Article in journal (Refereed)
    Abstract [en]

    Objective: Previous studies have found that excessive daytime sleepiness (EDS) is a more common problem in asthmatic subjects than in the general population. The aim of this study was to investigate whether the prevalence of EDS is increased in asthmatic subjects and, if so, to analyse the occurrence of potential risk factors for EDS in asthmatics.

    Methods: Cross-sectional epidemiological study. In 2008, a postal questionnaire was sent out to a random sample of 45,000 individuals aged 16–75 years in four Swedish cities.

    Results: Of the 25,160 persons who participated, 7.3% were defined as having asthma. The prevalence of EDS was significantly higher in asthmatic subjects (42.1% vs. 28.5%, p < 0.001) compared with non-asthmatic subjects. Asthma was an independent risk factor for EDS (adjusted OR 1.29) and the risk of having EDS increased with asthma severity. Risk factors for EDS in subjects with asthma included insomnia (OR, 3.87; 95% CI, 3.10–4.84); chronic rhinosinusitis (OR, 2.00; 95% CI, 1.53–2.62); current smoking (OR, 1.60; 95% CI, 1.15–2.22) and obesity (OR, 1.53; 95% CI, 1.09–2.13).

    Conclusions: EDS is a common problem among subjects with asthma. Asthma is an independent risk factor for having EDS. Furthermore, subjects with asthma often have other risk factors for EDS, many of them potentially modifiable.

  • 12. Appelberg, Jonas
    et al.
    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.
    Pavlenko, Tatjana
    Hedenstierna, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Lung aeration during sleep in patients with obstructive sleep apnoea2010In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 30, no 4, p. 301-307Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Previous studies have indicated that patients with obstructive sleep apnoea (OSA) have altered ventilation and lung volumes awake and the results suggest that this may be a determinant of severity of desaturations during sleep. However, little is known about regional lung aeration during sleep in patients with OSA. METHODS: Twelve patients with OSA were included in the study. Computed tomography was used to study regional lung aeration during wakefulness and sleep. Lung aeration was calculated in ml gas/g lung tissue in four different regions of interest (ROI(1-4)), along the border of the lung from ventral to dorsal. RESULTS: Lung aeration in the dorsal (dependent) lung region (ROI(4)) was lower during sleep compared to wakefulness 0.78 +/- 0.19 versus 0.88 +/- 0.19 (mean +/- SD) ml gas/g lung tissue (P = 0.005). Associations were found between awake expiratory reserve volume and change in lung aeration from wakefulness to sleep in ROI(4) (r = -0.69; P = 0.012). In addition, the change in lung aeration in the dorsal region correlated to sleep time (r = 0.69; P = 0.014) but not to time in supine position. The difference in lung aeration between inspiration and expiration (i.e. ventilation), was larger in the ventral lung region when expressed as ml gas per g lung tissue. In two patients it was noted that, during on-going obstructive apnoea, lung aeration tended to be increased rather than decreased. CONCLUSIONS: Aeration in the dorsal lung region is reduced during sleep in patients with OSA. The decrease is related to lung volume awake and to sleep time.

  • 13.
    Baldanzi, Gabriel
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Hammar, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Fall, Tove
    Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Epidemiology.
    Elmståhl, Sölve
    Department of Clinical Sciences in Malmö, Division of Geriatric Medicine, Lund University, Sweden; CRC, Skåne University Hospital, Malmö, Sweden.
    Theorell-Haglöw, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Evening chronotype is associated with elevated biomarkers of cardiometabolic risk in the EpiHealth cohort: a cross-sectional study2022In: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 45, no 2, article id zsab226Article in journal (Refereed)
    Abstract [en]

    Study objectives: Individuals with evening chronotype have a higher risk of cardiovascular and metabolic disorders, although the underlying mechanisms are not well understood. In a population- based cohort, we aimed to investigate the association between chronotype and 242 circulating proteins from three panels of established or candidate biomarkers of cardiometabolic processes. 

    Methods: In 2,471 participants (49.7% men, mean age 61.2±8.4 SD years) from the EpiHealth cohort, circulating proteins were analyzed with a multiplex proximity extension technique. Participants self- reported their chronotype on a five-level scale from extreme morning to extreme evening chronotype. With the intermediate chronotype set as the reference, each protein was added as the dependent variable in a series of linear regression models adjusted for confounders. Next, the chronotype coefficients were jointly tested and the resulting p-values adjusted for multiple testing using false discovery rate (5%). For the associations identified, we then analyzed the marginal effect of each chronotype category. 

    Results: We identified 17 proteins associated with chronotype. Evening chronotype was positively associated with proteins previously linked to insulin resistance and cardiovascular risk, namely retinoic acid receptor protein 2, fatty acid-binding protein adipocyte, tissue-type plasminogen activator, and plasminogen activator inhibitor 1 (PAI-1). Additionally, PAI-1 was inversely associated with the extreme morning chronotype. 

    Conclusions: In this population-based study, proteins previously related with cardiometabolic risk were elevated in the evening chronotypes. These results may guide future research in the relation between chronotype and cardiometabolic disorders. 

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  • 14.
    Baldanzi, Gabriel
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Sayols-Baixeras, Sergi
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab. CIBER Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
    Theorell-Haglöw, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Dekkers, Koen F.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Hammar, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Nguyen, Diem
    Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Lin, Yi-Ting
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab. Division of Family Medicine and Primary Care, Department of Neurobiology, Care Science and Society, Karolinska Institute, Huddinge, Sweden; Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan.
    Ahmad, Shafqat
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab. Preventive Medicine Division, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA.
    Bak Holm, Jacob
    Nielsen, Henrik Bjørn
    Brunkwall, Louise
    Benedict, Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Cedernaes, Jonathan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Transplantation and regenerative medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Koskiniemi, Sanna
    Uppsala University, Disciplinary Domain of Science and Technology, Biology, Department of Cell and Molecular Biology, Microbiology and Immunology.
    Phillipson, Mia
    Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology, Integrative Physiology.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Epidemiology.
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Epidemiology. The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
    Bergström, Göran
    Engström, Gunnar
    Smith, J. Gustav
    Orho-Melander, Marju
    Ärnlöv, Johan
    Kennedy, Beatrice
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Fall, Tove
    Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    OSA Is Associated With the Human Gut Microbiota Composition and Functional Potential in the Population-Based Swedish CardioPulmonary bioImage Study2023In: Chest, ISSN 0012-3692, E-ISSN 1931-3543, Vol. 164, no 2, p. 503-516Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Obstructive sleep apnea (OSA) is a common sleep-breathing disorder linked to increased risk of cardiovascular disease. Intermittent hypoxia and intermittent airway obstruction, hallmarks of OSA, have been shown in animal models to induce substantial changes to the gut microbiota composition and subsequent transplantation of fecal matter to other animals induced changes in blood pressure and glucose metabolism.

    RESEARCH QUESTION: Does obstructive sleep apnea in adults associate with the composition and metabolic potential of the human gut microbiota?

    STUDY DESIGN AND METHODS: We used respiratory polygraphy data from up to 3,570 individuals aged 50-64 from the population-based Swedish CardioPulmonary bioImage Study combined with deep shotgun metagenomics of fecal samples to identify cross-sectional associations between three OSA parameters covering apneas and hypopneas, cumulative sleep time in hypoxia and number of oxygen desaturation events with gut microbiota composition. Data collection about potential confounders was based on questionnaires, on-site anthropometric measurements, plasma metabolomics, and linkage with the Swedish Prescribed Drug Register.

    RESULTS: We found that all three OSA parameters were associated with lower diversity of species in the gut. Further, the OSA-related hypoxia parameters were in multivariable-adjusted analysis associated with the relative abundance of 128 gut bacterial species, including higher abundance of Blautia obeum and Collinsela aerofaciens. The latter species was also independently associated with increased systolic blood pressure. Further, the cumulative time in hypoxia during sleep was associated with the abundance of genes involved in nine gut microbiota metabolic pathways, including propionate production from lactate. Lastly, we observed two heterogeneous sets of plasma metabolites with opposite association with species positively and negatively associated with hypoxia parameters, respectively.

    INTERPRETATION: OSA-related hypoxia, but not the number of apneas/hypopneas, is associated with specific gut microbiota species and functions. Our findings lay the foundation for future research on the gut microbiota-mediated health effects of OSA.

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  • 15.
    Benedict, Christian
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Schiöth: Functional Pharmacology.
    Franklin, Karl A
    Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Sweden.
    Bukhari, Shervin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Ljunggren, Mirjam
    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.
    Sex-specific association of the lunar cycle with sleep2022In: Science of the Total Environment, ISSN 0048-9697, E-ISSN 1879-1026, Vol. 804, article id 150222Article in journal (Refereed)
    Abstract [en]

    Using one-night sleep recordings from 852 subjects all living in Uppsala, Sweden, the present study represents one of the largest polysomnography investigations into the association of the 29.53-day long lunar cycle with sleep among men and women and across a wide age range (22-81 years). Following the day after the new moon until the day of the full moon (also named the waxing period), the moon's illumination increases, and the timing of the meridian of the moon is gradually shifted from noontime toward midnight. In contrast, from the day after the full moon until the day of the new moon (also named the waning period), the moon's illumination decreases, and the timing of the meridian of the moon is gradually shifted from early night hours toward noontime. Thus, we focused on the contrast between the waxing and waning periods. Sleep duration was shorter on nights during the waxing period as compared to waning period (P < 0.001). In addition, a significant interaction effect of participants' sex with the lunar period on sleep was noted (P < 0.05). Men, but not women, exhibited lower sleep efficiency (P < 0.001 and P = 0.748, respectively) and were longer awake after sleep onset (P = 0.010 and P = 0.890, respectively) on nights during the waxing period. All associations were robust to adjustment for confounders (including regular sleep disturbances). Our findings suggest that the effects of the lunar cycle on human sleep are more pronounced among men. Based on the cross-sectional design of the study, no firm conclusions can be drawn on the causality of the relations.

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  • 16. Benedikstdottir, B.
    et al.
    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.
    Arnardottir, E. S.
    Gislason, T.
    What characterizes those with excessive daytime sleepiness?: an epidemiological study on general population in Iceland and Sweden2012In: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 35, no S, p. A272-A272Article in journal (Other academic)
  • 17.
    Benediktsdottir, B.
    et al.
    Univ Iceland, Fac Med, Reykjavik, Iceland.;Landspitali, Dept Resp Med & Sleep, Reykjavik, Iceland.;Primary Hlth Care Ctr, Gardabaer, Iceland..
    Arnardottir, E. S.
    Univ Iceland, Fac Med, Reykjavik, Iceland.;Landspitali, Dept Resp Med & Sleep, Reykjavik, Iceland..
    Schlunssen, V.
    Aarhus Univ, Dept Publ Hlth, Aarhus, Denmark..
    Real, F. Gomez
    Univ Bergen, Dept Gynecol & Obstet, Bergen, Norway..
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Gislason, T.
    Univ Iceland, Fac Med, Reykjavik, Iceland.;Landspitali, Dept Resp Med & Sleep, Reykjavik, Iceland..
    Bjornsdottir, E.
    Landspitali, Dept Resp Med & Sleep, Reykjavik, Iceland..
    The prevalence of insomnia, excessive daytime sleepiness and snoring across two generations - Results from RHINE and RHINESSA, multinational general population studies2016In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 25, p. 304-304Article in journal (Other academic)
  • 18. Benediktsdottir, Bryndis
    et al.
    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.
    Arnardóttir, Erna Sif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Olafsson, Isleifur
    Cook, Elizabeth
    Thorarinsdottir, Elin Helga
    Gislason, Thorarinn
    Prevalence of restless legs syndrome among adults in Iceland and Sweden: Lung function, comorbidity, ferritin, biomarkers and quality of life2010In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 11, no 10, p. 1043-1048Article in journal (Refereed)
    Abstract [en]

    Objective: This study investigates the prevalence and the association between restless legs syndrome (RLS) and a large variety of health variables in two well-characterized random samples from the general population in Reykjavik, Iceland, and Uppsala, Sweden. Methods: Using the national registries of inhabitants, a random sample from adults aged 40 and over living in Reykjavík, Iceland (n= 939), and Uppsala, Sweden (n= 998), were invited to participate in a study on the prevalence of COPD (response rate 81.1% and 62.2%). In addition, the participants were asked to answer the following questionnaires: International RLS Rating Scale, Short Form-12, the Epworth Sleepiness Scale, and questions about sleep, gastroeosophageal reflux, diabetes and hypertension, as well as pharmacological treatment. Interleukin-6 (IL-6), C-reactive protein (CRP) and ferritin were measured in serum. Results: RLS was more commonly reported in Reykjavik (18.3%) than in Uppsala (11.5%). Icelandic women reported RLS almost twice as often as Swedish women (24.4 vs. 13.9% p= 0.001), but there was no difference in prevalence of RLS between Icelandic and Swedish men. RLS was strongly associated with sleep disturbances and excessive daytime sleepiness. Subjects with RLS were more likely to be ex- and current smokers than subjects without RLS (p< 0.001). Respiratory symptoms and airway obstruction were more prevalent among those reporting RLS and they also estimated their physical quality of life lower than those without RLS (p< 0.001). RLS was not associated with symptoms of the metabolic syndrome like hypertension, obesity, markers of systemic inflammation (IL-6 and CRP) or cardiovascular diseases. Ferritin levels were significantly lower in RLS participants (p= 0.0002), but not (p= 0.07) after adjustment for center, age, sex and smoking history. Conclusion: Restless legs syndrome was twice as common among Icelandic women compared to Swedish women. No such difference was seen for men. RLS was strongly associated with smoking and respiratory symptoms, decreased lung function, sleep disturbances, excessive daytime sleepiness, and physical aspects of life quality. RLS was not associated with markers of the metabolic syndrome like hypertension, obesity, cardiovascular diseases or biomarkers of systemic inflammation.

  • 19.
    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.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Jonsson, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Holmström, M.
    Karolinska Inst, Clin Sci Intervent & Technol, Huddinge, Sweden.
    Theorell-Haglöw, Jenny
    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.
    Chronic rhinosinusitis is an independent risk factor for sleeping problems – a 10-year-follow-up study2017In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 40, no Supplement 1, p. E30-E30Article in journal (Other academic)
  • 20.
    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)
  • 21.
    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, Mats
    Karolinska Univ Hosp, Dept Clin Sci Intervent & Technol, Div Ear Nose & Throat Dis, Huddinge, Sweden.
    Hellgren, Johan
    Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Otorhinolaryngol Head & Neck Surg, Gothenburg, Sweden.
    Franklin, Karl
    Umea Univ, Surg, Dept Surg & Penoperat Sci, Umea, Sweden.
    Gislason, Torarinn
    Univ Iceland, Dept Resp Med & Sleep, Reykjavik, Iceland.
    Holm, Mathias
    Univ Gothenburg, Dept Occupat & Environm Med, Gothenburg, Sweden.
    Johannessen, Ane
    Univ Bergen, Ctr Int Hlth, Dept Global Publ Hlth & Primary Care, Bergen, Norway;Haukeland Hosp, Dept Occupat Med, Bergen, Norway.
    Jõgi, Rain
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Schluenssen, Vivi
    Aarhus Univ, Dept Publ Hlth, Aarhus, Denmark;Natl Res Ctr Working Environm, Copenhagen, Denmark.
    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.
    Incident Chronic Rhinosinusitis Is Associated With Impaired Sleep Quality: Results of the RHINE Study2019In: Journal of Clinical Sleep Medicine (JCSM), ISSN 1550-9389, E-ISSN 1550-9397, Vol. 15, no 6, p. 899-905, article id PII jc-18-00575Article in journal (Refereed)
    Abstract [en]

    Study Objectives: Chronic rhinosinusitis (CRS) is a common inflammatory disease of the nasal cavity and paranasal sinuses. Associations between CRS and poor sleep quality have been reported. This 10-year follow-up study investigates possible associations between incident CRS and sleep quality. Methods: A questionnaire was sent to 16,500 individuals in Sweden, Norway, Denmark, Iceland and Estonia in 2000. It included questions on airway diseases, age, sex, body mass index, smoking habits, comorbidities, education and sleep quality. In 2010, a second questionnaire was sent to the same individuals, with a response rate of 53%. A subgroup of 5,145 individuals without nasal symptoms in 2000 was studied. Multiple logistic regression was performed to examine associations between CRS (defined according to the European position paper on rhinosinusitis and nasal polyps epidemiological criteria) at follow-up and sleep quality, with adjustment for potential confounders. Individuals with the respective sleep problem at baseline were excluded. Results: Over 10 years, 141 (2.7%) of the individuals without nasal symptoms in 2000 had developed CRS. CRS was associated with difficulties inducing sleep (adjusted odds ratio 2.81 [95% CI 1.67-4.70]), difficulties maintaining sleep (2.07 [1.35-3.18]), early morning awakening (3.03 [1.91-4.81]), insomnia (2.21 [1.46-3.35]), excessive daytime sleepiness (2.85 [1.79-4.55]), and snoring (3.31 [2.07-5.31]). Three insomnia symptoms at baseline increased the risk of CRS at follow-up by 5.00 (1.93-12.99). Conclusions: Incident CRS is associated with impaired sleep quality and excessive daytime sleepiness. Insomnia symptoms may be a risk factor for the development of CRS.

  • 22.
    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.

  • 23.
    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.
    Theorell-Haglöw, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Holmström, Mats
    Institutionen för klinisk vetenskap,intervention och teknik, Karolinska Institutet.
    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.
    Sinonasal outcome test-22 and peak nasal inspiratory flow: valuable tools in obstructive sleep apnoea2020In: Rhinology, ISSN 0300-0729, E-ISSN 1996-8604, Vol. 58, no 4, p. 341-348Article in journal (Refereed)
    Abstract [en]

    Background: Sinonasal complaints contribute to low adherence to continuous positive airway pressure (CPAP) treatment. We aimed to investigate sinonasal health in obstructive sleep apnoea (OSA) patients, using the sinonasal outcome test-22 (SNOT-22), and to analyse whether SNOT-22 is affected by CPAP adherence. We also aimed to investigate whether peak nasal inspiratory flow (PNIF) was able to predict adherence to CPAP. Methods:The study population comprised 197 OSA patients (60 females) initiating CPAP treatment The SNOT-22, PNIF and the Epworth Sleepiness Scale were assessed at baseline and follow-up. One-night polygraphy, the Hospital Anxiety and Depression Scale, peak expiratory flow and health-related issues were assessed at baseline. At follow-up, the patients were categorised into adherent (>4 hours/night) and non-adherent (<4 hours/night) to CPAP treatment. Results: The average time for following up CPAP treatment was (mean +/- SD) 24.0 +/- 23.9 days and it did not differ significantly between the groups.The SNOT-22 score was elevated among all OSA patients, 36.1 +/- 19.4.There was a larger improvement in the SNOT-22 score at follow-up among adherent CPAP users compared with non-adherent users (-10.4 +/- 13.9 vs. -3.2 +/- 15.4). A PNIF value of < 100 litres/min increased the risk of non-adherence to CPAP with an adjusted odds ratio (OR) of 2.40 ((95% CI 1.16-5.00)). Conclusions: The SNOT-22 was elevated in patients with OSA, indicating a considerable sinonasal disease burden.The SNOT-22 improved with good CPAP adherence. A low PNIF value was able to predict poor CPAP adherence. Both the SNOT-22 and PNIF can be valuable tools in the evaluation of OSA patients and in the management of CPAP treatment.

  • 24.
    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.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    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
    Karolinska Univ Hosp, Dept Clin Sci Intervent & Technol, Div Ear Nose & Throat Dis, Huddinge, Sweden.
    Sundbom, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Hedner, Jan
    Sahlgrens Univ Hosp, Dept Sleep Med Resp Med & Allergol, Gothenburg, Sweden.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Middelveld, Roelinde
    Karolinska Inst, Ctr Allergy Res, Stockholm, Sweden.; Karolinska Inst, Inst Environm Med, Stockholm, Sweden.
    Forsberg, Bertil
    Umea Univ, Dept Publ Hlth & Clin Med, Occupat & Environm Med, Umea, Sweden.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Chronic rhinosinusitis impairs sleep quality: Results of the GA(2)LEN study2017In: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 40, no 1, article id zsw021Article in journal (Refereed)
    Abstract [en]

    STUDY OBJECTIVES: To analyse the prevalence of sleep problems in subjects with CRS and to determine whether the disease severity of CRS affects sleep quality.

    METHODS: Questionnaires were sent to a random sample of 45 000 adults in four Swedish cities. Questions on CRS, asthma, allergic rhinitis, co-morbidities, tobacco use, educational level and physical activity were included. CRS was defined according to the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) epidemiological criteria. The disease severity of CRS was defined by the number of reported CRS symptoms. Sleep quality was assessed using the Basic Nordic Sleep Questionnaire.

    RESULTS: Of the 26 647 subjects, 2249 (8.4%) had CRS. Reported sleep problems were 50-90% more common among subjects with CRS compared with those without or the total population. The prevalence of reported sleep problems increased in conjunction with the severity of CRS. After adjusting for gender, BMI, age, tobacco use, asthma, somatic diseases, physical activity level and educational level, participants with four symptoms of CRS (compared with subjects without CRS symptoms) displayed a higher risk of snoring (adj. OR (95% CI): 3.13 (2.22-4.41)), difficulties inducing sleep (3.98 (2.94-5.40)), difficulties maintaining sleep (3.44 (2.55-4.64)), early morning awakening (4.71 (3.47-6.38)) and excessive daytime sleepiness (4.56 (3.36-6.18)). The addition of persistent allergic rhinitis to CRS further increased the risk of sleep problems.

    CONCLUSIONS: Sleep problems are highly prevalent among subjects with CRS. The disease severity of CRS negatively affects sleep quality.

  • 25.
    Bergstrom, Goran
    et al.
    Sahlgrens Acad, Dept Mol & Clin Med, Gothenburg, Sweden.;Reg Vastra Gotaland, Dept Clin Physiol, Gothenburg, Sweden..
    Persson, Margaretha
    Lund Univ, Dept Clin Sci, Malmö, Sweden.;Skane Univ Hosp, Dept Internal Med, Malmö, Sweden..
    Adiels, Martin
    Univ Gothenburg, Inst Med, Sch Publ Hlth & Community Med, Gothenburg, Sweden..
    Bjornson, Elias
    Sahlgrens Acad, Dept Mol & Clin Med, Gothenburg, Sweden..
    Bonander, Carl
    Univ Gothenburg, Inst Med, Sch Publ Hlth & Community Med, Gothenburg, Sweden..
    Ahlström, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Alfredsson, Joakim
    Linköping Univ, Dept Cardiol Hlth Med & Caring Sci, Linköping, Sweden..
    Angeras, Oskar
    Sahlgrens Acad, Dept Mol & Clin Med, Gothenburg, Sweden.;Reg Vastra Gotaland, Dept Cardiol, Gothenburg, Sweden..
    Berglund, Goran
    Lund Univ, Dept Clin Sci, Malmö, Sweden..
    Blomberg, Anders
    Umeå Univ, Dept Publ Hlth & Clin Med Med, Umeå, Sweden.;Umeå Univ, Heart Ctr, Umeå, Sweden..
    Brandberg, John
    Sahlgrens Acad, Dept Radiol, Inst Clin Sci, Gothenburg, Sweden.;Reg Vastra Gotaland, Dept Radiol, Gothenburg, Sweden..
    Borjesson, Mats
    Sahlgrens Acad, Inst Med, Gothenburg, Sweden.;Univ Gothenburg, Ctr Hlth & Performance, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Reg Vastra Gotaland, Gothenburg, Sweden..
    Cederlund, Kerstin
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Stockholm, Sweden..
    de Faire, Ulf
    Karolinska Inst, Inst Environm Med, Unit Cardiovasc & Nutr Epidemiol, Stockholm, Sweden..
    Duvernoy, Olov
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology. Olov.Duvernoy@radiol.uu.se.
    Ekblom, Orjan
    Swedish Sch Sport & Hlth Sci GIH, Dept Phys Act & Hlth, Stockholm, Sweden..
    Engstrom, Gunnar
    Lund Univ, Dept Clin Sci, Malmö, Sweden..
    Engvall, Jan E.
    Linköping Univ, Dept Cardiol Hlth Med & Caring Sci, Linköping, Sweden.;Linköping Univ, Dept Clin Physiol, Linköping, Sweden.;Linköping Univ, CMIV, Ctr Med Image Sci & Visualizat, Linköping, Sweden..
    Fagman, Erika
    Sahlgrens Acad, Dept Radiol, Inst Clin Sci, Gothenburg, Sweden.;Reg Vastra Gotaland, Dept Radiol, Gothenburg, Sweden..
    Eriksson, Mats
    Karolinska Univ Hosp Huddinge, Dept Endocrinol Metab & Diabet, Stockholm, Sweden.;Karolinska Univ Hosp Huddinge, Clin Res Ctr, Stockholm, Sweden..
    Erlinge, David
    Lund Univ, Cardiol, Dept Clin Sci Lund, Lund, Sweden.;Skane Univ Hosp, Lund, Sweden..
    Fagerberg, Bjorn
    Sahlgrens Acad, Dept Mol & Clin Med, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Reg Vastra Gotaland, Gothenburg, Sweden..
    Flinck, Agneta
    Sahlgrens Acad, Dept Radiol, Inst Clin Sci, Gothenburg, Sweden.;Reg Vastra Gotaland, Dept Radiol, Gothenburg, Sweden..
    Goncalves, Isabel
    Lund Univ, Dept Clin Sci Malmö, Lund, Sweden..
    Hagström, Emil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Uppsala Clinical Research Center (UCR). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Hjelmgren, Ola
    Sahlgrens Acad, Dept Mol & Clin Med, Gothenburg, Sweden.;Reg Vastra Gotaland, Dept Clin Physiol, Gothenburg, Sweden..
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Epidemiology.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Lindqvist, Per
    Umeå Univ, Dept Surg & Perioperat Sci, Umeå, Sweden..
    Ljungberg, Johan
    Umeå Univ, Dept Publ Hlth & Clin Med Med, Umeå, Sweden.;Umeå Univ, Heart Ctr, Umeå, Sweden..
    Magnusson, Martin
    Lund Univ, Dept Clin Sci, Malmö, Sweden.;Skane Univ Hosp, Dept Cardiol, Malmö, Sweden.;Lund Univ, Wallenberg Ctr Mol Med, Lund, Sweden.;North West Univ, Hypertens Africa Res Team HART, Potchefstroom, South Africa..
    Mannila, Maria
    Karolinska Univ Hosp, Dept Cardiol & Clin Genet, Heart & Vasc Theme, Stockholm, Sweden..
    Markstad, Hanna
    Lund Univ, Clin Sci Malmö, Clin Res Ctr, Expt Cardiovasc Res, Malmö, Sweden.;Lund Univ, Ctr Med Imaging & Physiol, Lund, Sweden..
    Mohammad, Moman A.
    Lund Univ, Cardiol, Dept Clin Sci Lund, Lund, Sweden.;Skane Univ Hosp, Lund, Sweden..
    Nystrom, Fredrik H.
    Linköping Univ, Dept Cardiol Hlth Med & Caring Sci, Linköping, Sweden..
    Ostenfeld, Ellen
    Skane Univ Hosp, Lund, Sweden.;Lund Univ, Dept Clin Sci Lund, Clin Physiol, Lund, Sweden..
    Persson, Anders
    Linköping Univ, Dept Cardiol Hlth Med & Caring Sci, Linköping, Sweden.;Linköping Univ, Dept Radiol, Linköping, Sweden.;Linköping Univ, CMIV, Ctr Med Image Sci & Visualizat, Linköping, Sweden..
    Rosengren, Annika
    Sahlgrens Acad, Dept Mol & Clin Med, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Reg Vastra Gotaland, Gothenburg, Sweden..
    Sandstrom, Anette
    Umeå Univ, Dept Publ Hlth & Clin Med Med, Umeå, Sweden.;Umeå Univ, Heart Ctr, Umeå, Sweden..
    Sjalander, Anders
    Umeå Univ, Dept Publ Hlth & Clin Med Med, Umeå, Sweden.;Umeå Univ, Heart Ctr, Umeå, Sweden..
    Skold, Magnus C.
    Karolinska Inst, Dept Med Solna, Resp Med Unit, Stockholm, Sweden.;Karolinska Inst, Ctr Mol Med, Stockholm, Sweden.;Karolinska Univ Hosp Solna, Dept Resp Med & Allergy, Stockholm, Sweden..
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Epidemiology. Univ New South Wales, George Inst Global Hlth, Sydney, NSW, Australia..
    Swahn, Eva
    Linköping Univ, Dept Cardiol Hlth Med & Caring Sci, Linköping, Sweden..
    Soderberg, Stefan
    Umeå Univ, Dept Publ Hlth & Clin Med Med, Umeå, Sweden.;Umeå Univ, Heart Ctr, Umeå, Sweden..
    Toren, Kjell
    Univ Gothenburg, Sch Publ Hlth & Community Med, Occupat & Environm Med, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Reg Vastra Gotaland, Gothenburg, Sweden..
    Ostgren, Carl Johan
    Linköping Univ, Dept Cardiol Hlth Med & Caring Sci, Linköping, Sweden.;Linköping Univ, CMIV, Ctr Med Image Sci & Visualizat, Linköping, Sweden..
    Jernberg, Tomas
    Danderyd Hosp, Karolinska Inst, Dept Clin Sci, Stockholm, Sweden..
    Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population2021In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 144, no 12, p. 916-929Article in journal (Refereed)
    Abstract [en]

    Background: Early detection of coronary atherosclerosis using coronary computed tomography angiography (CCTA), in addition to coronary artery calcification (CAC) scoring, may help inform prevention strategies. We used CCTA to determine the prevalence, severity, and characteristics of coronary atherosclerosis and its association with CAC scores in a general population. Methods: We recruited 30 154 randomly invited individuals age 50 to 64 years to SCAPIS (the Swedish Cardiopulmonary Bioimage Study). The study includes individuals without known coronary heart disease (ie, no previous myocardial infarctions or cardiac procedures) and with high-quality results from CCTA and CAC imaging performed using dedicated dual-source CT scanners. Noncontrast images were scored for CAC. CCTA images were visually read and scored for coronary atherosclerosis per segment (defined as no atherosclerosis, 1% to 49% stenosis, or >= 50% stenosis). External validity of prevalence estimates was evaluated using inverse probability for participation weighting and Swedish register data. Results: In total, 25 182 individuals without known coronary heart disease were included (50.6% women). Any CCTA-detected atherosclerosis was found in 42.1%; any significant stenosis (>= 50%) in 5.2%; left main, proximal left anterior descending artery, or 3-vessel disease in 1.9%; and any noncalcified plaques in 8.3% of this population. Onset of atherosclerosis was delayed on average by 10 years in women. Atherosclerosis was more prevalent in older individuals and predominantly found in the proximal left anterior descending artery. Prevalence of CCTA-detected atherosclerosis increased with increasing CAC scores. Among those with a CAC score >400, all had atherosclerosis and 45.7% had significant stenosis. In those with 0 CAC, 5.5% had atherosclerosis and 0.4% had significant stenosis. In participants with 0 CAC and intermediate 10-year risk of atherosclerotic cardiovascular disease according to the pooled cohort equation, 9.2% had CCTA-verified atherosclerosis. Prevalence estimates had excellent external validity and changed marginally when adjusted to the age-matched Swedish background population. Conclusions: Using CCTA in a large, random sample of the general population without established disease, we showed that silent coronary atherosclerosis is common in this population. High CAC scores convey a significant probability of substantial stenosis, and 0 CAC does not exclude atherosclerosis, particularly in those at higher baseline risk.

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  • 26.
    Bjornsdottir, Erla
    et al.
    Landspitali, Dept Resp Med & Sleep, Reykjavik, Iceland.;Univ Iceland, Fac Med, Reykjavik, Iceland..
    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.
    Arnardottir, Erna Sif
    Landspitali, Dept Resp Med & Sleep, Reykjavik, Iceland.;Univ Iceland, Fac Med, Reykjavik, Iceland..
    Benediktsdottir, Bryndis
    Landspitali, Dept Resp Med & Sleep, Reykjavik, Iceland.;Univ Iceland, Fac Med, Reykjavik, Iceland..
    Garcia-Aymerich, Judith
    ISGlobal, Ctr Res Environm Epidemiol CREAL, Barcelona, Spain.;UPF, Barcelona, Spain.;CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain..
    Elie Carsin, Anne
    ISGlobal, Ctr Res Environm Epidemiol CREAL, Barcelona, Spain.;UPF, Barcelona, Spain.;CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain..
    Gomez Real, Francisco
    Univ Bergen, Dept Clin Sci, Bergen, Norway..
    Toren, Kjell
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Occupat & Environm Med, Gothenburg, Sweden..
    Heinrich, Joachim
    Ludwig Maximilians Univ Munchen, Univ Hosp Munich, Inst & Outpatient Clin Occupat Social & Environm, Munich, Germany.;Helmholtz Zentrum Munchen, German Res Ctr Environm Hlth, Inst Epidemiol 1, Neuherberg, Germany..
    Nowak, Dennis
    Ludwig Maximilians Univ Munchen, Univ Hosp Munich, Inst & Outpatient Clin Occupat Social & Environm, Munich, Germany..
    Luis Sanchez-Ramos, Jose
    Univ Huelva, Dept Nursing, Huelva, Spain..
    Demoly, Pascal
    Univ Hosp Montpellier, Dept Pneumol, Montpellier, France..
    Dorado Arenas, Sandra
    Galdakao Usansolo Hosp, Dept Pulmonol, Biscay, Spain..
    Coloma Navarro, Ramon
    Hosp Gen Univ, Serv Neumol, Unidad Sueno, Albacete, Spain..
    Schlunssen, Vivi
    Aarhus Univ, Dept Publ Hlth, Aarhus, Denmark.;Natl Res Ctr Working Environm, Copenhagen, Denmark..
    Raherison, Chantal
    Bordeaux Populat Hlth Res Ctr, U1219, Bordeaux, France..
    Jarvis, Debbie L.
    Imperial Coll London, Natl Heart & Lung Inst, Populat Hlth & Occupat Dis, London, England.;Imperial Coll London, MRC PHE Ctr Environm & Hlth, London, England..
    Gislason, Thorarinn
    Landspitali, Dept Resp Med & Sleep, Reykjavik, Iceland.;Univ Iceland, Fac Med, Reykjavik, Iceland..
    Respiratory symptoms are more common among short sleepers independent of obesity2017In: BMJ OPEN RESPIRATORY RESEARCH, ISSN 2052-4439, Vol. 4, no 1, article id e000206Article in journal (Refereed)
    Abstract [en]

    Introduction Sleep length has been associated with obesity and various adverse health outcomes. The possible association of sleep length and respiratory symptoms has not been previously described. The aim of this study was to investigate the association between sleep length and respiratory symptoms and whether such an association existed independent of obesity. Methods This is a multicentre, cross-sectional, population-based study performed in 23 centres in 10 different countries. Participants (n=5079, 52.3% males) were adults in the third follow-up of the European Community Respiratory Health Survey III. The mean +/- SD age was 54.2 +/- 7.1 (age range 39-67 years). Information was collected on general and respiratory health and sleep characteristics. Results The mean reported nighttime sleep duration was 6.9 +/- 1.0 hours. Short sleepers (<6 hours per night) were n=387 (7.6%) and long sleepers (>= 9 hours per night) were n=271 (4.3%). Short sleepers were significantly more likely to report all respiratory symptoms (wheezing, waking up with chest tightness, shortness of breath, coughing, phlegm and bronchitis) except asthma after adjusting for age, gender, body mass index (BMI), centre, marital status, exercise and smoking. Excluding BMI from the model covariates did not affect the results. Short sleep was related to 11 out of 16 respiratory and nasal symptoms among subjects with BMI >= 30 and 9 out of 16 symptoms among subjects with BMI <30. Much fewer symptoms were related to long sleep, both for subjects with BMI <30 and >= 30. Conclusions Our results show that short sleep duration is associated with many common respiratory symptoms, and this relationship is independent of obesity.

  • 27.
    Bjornsdottir, Erla
    et al.
    Haskolinn i Reykjavik, Reykjavik, Iceland.;Univ Iceland, Fac Med, Sch Hlth Sci, Reykjavik, Iceland..
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Benediktsdottir, Bryndis
    Univ Iceland, Fac Med, Sch Hlth Sci, Reykjavik, Iceland.;Landspitali Natl Univ Hosp Iceland, Dept Resp Med & Sleep, Reykjavik, Iceland..
    Gislason, Thorarinn
    Univ Iceland, Fac Med, Sch Hlth Sci, Reykjavik, Iceland..
    Larsen, Vanessa Garcia
    Johns Hopkins Bloomberg Sch Publ Hlth, Baltimore, MD USA..
    Franklin, Karl
    Dept Surg Surg & Perioperat Sci, Umea, Sweden..
    Jarvis, Debbie
    Imperial Coll, Dept Resp Epidemiol & Publ Hlth, London, England..
    Demoly, Pascal
    Univ Hosp Montpellier, Pneumol Dept, Montpellier, France..
    Perret, Jennifer L.
    Univ Melbourne, Melbourne, Vic, Australia..
    Garcia Aymerich, Judith
    Inst Salud Global Barcelona, Ctr Res Environm Epidemiol CREAL, Barcelona, Spain..
    Dorado Arenas, Sandra
    Hosp Galdakao Usansolo, Pulmonol Dept, Galdakao, Pais Vasco, Spain..
    Heinrich, Joachim
    Ludwig Maximilians Univ Munchen, Inst & Outpatient Clin Occupat Social & Environm, Comprehens Pneumol Ctr Munich, Clin Ctr,German Ctr Lung Res, Munich, Germany..
    Toren, Kjell
    Univ Gothenburg, Dept Occupat & Environm Med, Gothenburg, Sweden..
    Jogi, Rain
    Tartu Univ, Tartu, Estonia..
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Are symptoms of insomnia related to respiratory symptoms?: Cross-sectional results from 10 European countries and Australia2020In: BMJ Open, E-ISSN 2044-6055, Vol. 10, no 4, article id e032511Article in journal (Refereed)
    Abstract [en]

    Objectives To compare the prevalence of different insomnia subtypes among middle-aged adults from Europe and Australia and to explore the cross-sectional relationship between insomnia subtypes, respiratory symptoms and lung function.

    Design Cross-sectional population-based, multicentre cohort study.

    Setting 23 centres in 10 European countries and Australia.

    Methods We included 5800 participants in the third follow-up of the European Community Respiratory Health Survey III (ECRHS III) who answered three questions on insomnia symptoms: difficulties falling asleep (initial insomnia), waking up often during the night (middle insomnia) and waking up early in the morning and not being able to fall back asleep (late insomnia). They also answered questions on smoking, general health and chronic diseases and had the following lung function measurements: forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and the FEV1/FVC ratio. Changes in lung function since ECRHS I about 20 years earlier were also analysed.

    Main outcome measures Prevalence of insomnia subtypes and relationship to respiratory symptoms and function.

    Results Overall, middle insomnia (31.2%) was the most common subtype followed by late insomnia (14.2%) and initial insomnia (11.2%). The highest reported prevalence of middle insomnia was found in Iceland (37.2%) and the lowest in Australia (22.7%), while the prevalence of initial and late insomnia was highest in Spain (16.0% and 19.7%, respectively) and lowest in Denmark (4.6% and 9.2%, respectively). All subtypes of insomnia were associated with significantly higher reported prevalence of respiratory symptoms. Only isolated initial insomnia was associated with lower FEV1, whereas no association was found between insomnia and low FEV1/FVC ratio or decline in lung function.

    Conclusion There is considerable geographical variation in the prevalence of insomnia symptoms. Middle insomnia is most common especially in Iceland. Initial and late insomnia are most common in Spain. All insomnia subtypes are associated with respiratory symptoms, and initial insomnia is also associated with lower FEV1.

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  • 28.
    Björnsdóttir, E.
    et al.
    Univ Iceland, Dept Med, Reykjavik, Iceland.
    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.
    Arnardóttir, E. S.
    Univ Iceland, Reykjavik, Iceland.
    Benediktsdottir, B.
    Univ Iceland, Reykjavik, Iceland.
    Garcia-Aymerich, J.
    Ctr Res Environm Epidemiol CREAL, Barcelona, Spain.
    Carsin, A. E.
    Ctr Res Environm Epidemiol CREAL, Barcelona, Spain.
    Real, F. Gómez
    Univ Gothenburg, Gothenburg, Sweden.
    Torén, K.
    Univ Gothenburg, Gothenburg, Sweden.
    Heinrich, J.
    Univ Hosp Munich, Munich, Germany.
    Nowak, D.
    Univ Hosp Munich, Munich, Germany.
    Sánchez-Ramos, J. L.
    Univ Huelva, Huelva, Spain.
    Demoly, P.
    Univ Hosp Montpellier, Montpellier, France.
    Arenas, S. D.
    Galdakao Usansolo Hosp, Biscay, Spain.
    Navarro, R. C.
    Hosp Gen Univ, Albacete, Spain.
    Schlünssen, V.
    Aarhus Univ, Aarhus, Denmark.
    Raherison, C.
    Bordeaux Populat Hlth Res Ctr, Bordeaux, France.
    Jarvis, D. L.
    Natl Heart & Lung Inst, London, England.
    Gislason, T.
    Univ Iceland, Reykjavik, Iceland.
    Respiratory symptoms are more common among short sleepers independent of obesity2017In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 40, no Supplement 1, p. E37-E37Article in journal (Other academic)
  • 29.
    Broman, Jan-Erik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. 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.
    An abridged version of the Functional Outcomes of Sleep Questionnaire (FOSQ-5): measurement properties in patients with obstructive sleep apnoea2016In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 25, p. 345-345Article in journal (Other academic)
  • 30.
    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.
    Elmstahl, S.
    Lund Univ, Div Geriatr Med, Dept Hlth Sci, Lund, Sweden.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical 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 study2017In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 40, no Supplement 1, p. E195-E195Article in journal (Other academic)
  • 31.
    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.

  • 32.
    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.

  • 33. Christensson, Eva
    et al.
    Franklin, Karl A
    Sahlin, Carin
    Palm, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Ulfberg, Jan
    Eriksson, Lars I
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Hagel, Eva
    Jonsson Fagerlund, Malin
    Can STOP-Bang and Pulse Oximetry Detect and Exclude Obstructive Sleep Apnea?2018In: Anesthesia and Analgesia, ISSN 0003-2999, E-ISSN 1526-7598, Vol. 127, no 3, p. 736-743Article in journal (Refereed)
    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).

  • 34.
    Delijaj, Florim
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology. Department of Public Health and Caring Sciences (IFV), Uppsala Centre for Clinical Research Sormland (CKFD), Eskilstuna and Department of Primary Care, Tunafors Family Center, Sormland County Council, Sweden.
    Levin, Gustaf
    Department of Surgery, ENT Clinic in Eskilstuna, Sormland County Council, Sweden.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Wang, Eugen
    Department of Surgery Sciences, Uppsala University and Center for Clinical Research, Sormland, Uppsala University, Eskilstuna, Sweden.
    Reduced Apnea-Hypopnea Index in Patients with Severe Sleep Apnea Syndrome as Determined by Cervical Collar and Mandibular Advancement Device Combination Therapy2016In: Journal of Sleep Disorders and Therapy, E-ISSN 2167-0277, no 5, article id 252Article in journal (Other academic)
    Abstract [en]

    Study Objectives: In patients with severe obstructive sleep apnea syndrome (OSAS), continuous positive airway pressure (CPAP) is first-line therapy. Compliance to CPAP is sometimes a problem, and mandibular advancement device (MAD) is then an alternative. However, this alternative is often not effective. It was hypothesized that patients suffering from OSAS would have a freer airway, resulting in a decreased apnea-hypopnea index (AHI), through use of a cervical collar (CC) to extend the neck. To study the effect of this new therapy, a randomized crossover study was conducted to compare MAD monotherapy with CC/MAD combination therapy. Methods: Eight patients with severe OSAS (AHI>30) who had ceased to use CPAP were enrolled in the randomized crossover study. Four patients started with MAD and four with CC/MAD for one week followed by a wash-out period and then cross-over. Polygraphic sleep recordings were performed at baseline and after each therapy. Results: The baseline AHI was 51.5 ± 22.5. AHI was reduced to 30.4 ± 23.2 through MAD monotherapy, and to 14.9 ± 10.2 through CC/MAD combination therapy. The effect of the combination therapy was statistically significantly (p=0.018) better than that of the monotherapy. Four patients were achieved an AHI<10/h through use of the combination therapy. Concusions: The study showed a significant reduction in AHI scores in patients with severe OSAS through use of the CC/MAD combination therapy as compared to the MAD monotherapy. This first report indicates a new possibility for treating severe OSAS in non-compliant CPAP users.

  • 35.
    Delijaj, Florim
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research Sörmland. Department of Patient Safety, Region Sörmland, Sweden..
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Johnsson, Linus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Kristiansson, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Tegelmo, Tove
    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.
    Effects of telemonitoring follow-up, side effects, and other factors on CPAP adherence2023In: Journal of Clinical Sleep Medicine (JCSM), ISSN 1550-9389, E-ISSN 1550-9397, Vol. 19, no 10, p. 1785-1795Article in journal (Refereed)
    Abstract [en]

    Study objectives: This study aimed to investigate the effect of telemonitoring compared with standard clinic visits on adherence to continuous positive airway pressure (CPAP) treatment after 6 months. In addition, the impact of other factors including CPAP side effects on treatment adherence were assessed.

    Methods: Consecutive patients (n = 217) who were prescribed CPAP treatment for obstructive sleep apnea were randomized to either telemonitoring or standard-care follow-up. All patients were followed up 6 months after treatment started. Clinical/anthropometric variables, socioeconomical and lifestyle factors, psychological distress, daily function, and personality traits along with CPAP side effects were assessed. Differences between groups were analyzed using 2-sample t-test, chi-square test, or Fisher's exact test. Regression modeling was used to explore associations between dependent and independent variables.

    Results: There were no differences in CPAP adherence between telemonitoring and standard-care groups after 6 months (53.2% vs 48.7%; P = .54). CPAP side effects such as dry throat (odds ratio = 2.17; 95% confidence interval = 1.25-3.70), increased awakenings (2.50; 1.31-4.76), and exhaling problems (3.70; 1.25-10.1) were independently associated with low CPAP adherence, although these associations were weakened when adding smoking to the model. No other baseline or follow-up factors were associated with CPAP adherence at 6 months.

    Conclusions: We could not show that telemonitoring follow-up improved adherence levels. Dry throat, increased awakenings, exhaling problems, and smoking had negative effects on CPAP adherence. Preventing side effects and assessing smoking status is therefore of importance when wanting to improve CPAP adherence.

  • 36.
    Delijaj, Florim
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research Sörmland. Ctr Clin Res Sormland CKFD, Eskilstuna, Sweden.;Reg Sormland, Dept Patient Safety, Sormland, Sweden.;Uppsala Biomed Ctr BMC, Husargatan 3, Box 564, S-75122 Uppsala, Sweden..
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Johnsson, Linus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research Sörmland.
    Kristiansson, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Tegelmo, Tove
    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.
    Effects of telemonitoring follow-up, side effects, and other factors on CPAP adherence2023In: Journal of Clinical Sleep Medicine (JCSM), ISSN 1550-9389, E-ISSN 1550-9397, Vol. 19, no 10, p. 1785-1795Article in journal (Refereed)
    Abstract [en]

    Study Objectives: This study aimed to investigate the effect of telemonitoring compared with standard clinic visits on adherence to continuous positive airway pressure (CPAP) treatment after 6 months. In addition, the impact of other factors including CPAP side effects on treatment adherence were assessed.

    Methods: Consecutive patients (n = 217) who were prescribed CPAP treatment for obstructive sleep apnea were randomized to either telemonitoring or standard-care follow-up. All patients were followed up 6 months after treatment started. Clinical/anthropometric variables, socioeconomical and lifestyle factors, psychological distress, daily function, and personality traits along with CPAP side effects were assessed. Differences between groups were analyzed using 2-sample t-test, chi-square test, or Fisher's exact test. Regression modeling was used to explore associations between dependent and independent variables.

    Results: There were no differences in CPAP adherence between telemonitoring and standard-care groups after 6 months (53.2% vs 48.7%; P = .54). CPAP side effects such as dry throat (odds ratio = 2.17; 95% confidence interval = 1.25-3.70), increased awakenings (2.50; 1.31-4.76), and exhaling problems (3.70; 1.25-10.1) were independently associated with low CPAP adherence, although these associations were weakened when adding smoking to the model. No other baseline or follow-up factors were associated with CPAP adherence at 6 months.

    Conclusions: We could not show that telemonitoring follow-up improved adherence levels. Dry throat, increased awakenings, exhaling problems, and smoking had negative effects on CPAP adherence. Preventing side effects and assessing smoking status is therefore of importance when wanting to improve CPAP adherence.

  • 37.
    Dratva, Julia
    et al.
    Swiss Trop & Publ Hlth Inst, Dept Epidemiol & Publ Hlth, Socinstr 57,POB 4002, CH-4002 Basel, Switzerland.;Univ Basel, Basel, Switzerland..
    Bertelsen, Randi
    Haukeland Hosp, Dept Occupat Med, Bergen, Norway..
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Johannessen, Ane
    Haukeland Hosp, Dept Occupat Med, Bergen, Norway.;Univ Bergen, Dept Clin Sci, Bergen, Norway..
    Benediktsdottir, Bryndis
    Landspitali Univ Hosp, Dept Allergy Resp Med & Sleep, Reykjavik, Iceland..
    Bråback, Lennart
    Umea Univ, Dept Publ Hlth & Clin Med, Occupat & Environm Med, Umea, Sweden..
    Dharmage, Shyamali C.
    Univ Melbourne, Melbourne Sch Populat & Global Hlth, Ctr Epidemiol & Biostat, Allergy & Lung Hlth Unit, Melbourne, Vic, Australia..
    Forsberg, Bertil
    Umea Univ, Dept Publ Hlth & Clin Med, Occupat & Environm Med, Umea, Sweden..
    Gislason, Thorarinn
    Landspitali Univ Hosp, Dept Allergy Resp Med & Sleep, Reykjavik, Iceland..
    Jarvis, Debbie
    Imperial Coll, Fac Med, Natl Heart & Lung Inst, London, England..
    Jogi, Rain
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology. Fdn Tartu Univ Clin, Lung Clin, Tartu, Estonia.;Univ Tartu, Dept Pulm Med, Tartu, Estonia..
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Norback, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Omenaas, Ernst
    Univ Bergen, Dept Clin Sci, Bergen, Norway..
    Skorge, Trude D.
    Haukeland Hosp, Dept Occupat Med, Bergen, Norway..
    Sigsgaard, Torben
    Aarhus Univ, Dept Publ Hlth, Aarhus, Denmark..
    Toren, Kjell
    Univ Gothenburg, Sahlgrenska Acad, Occupat & Environm Med, Gothenburg, Sweden..
    Waatevik, Marie
    Univ Bergen, Dept Clin Sci, Bergen, Norway..
    Wieslander, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Schlünssen, Vivi
    Aarhus Univ, Dept Publ Hlth, Aarhus, Denmark..
    Svanes, Cecilie
    Haukeland Hosp, Dept Occupat Med, Bergen, Norway.;Univ Bergen, Ctr Int Hlth, Bergen, Norway..
    Real, Francisco Gomez
    Univ Bergen, Dept Clin Sci, Bergen, Norway.;Haukeland Hosp, Dept Gynecol & Obstet, Bergen, Norway..
    Validation of self-reported figural drawing scales against anthropometric measurements in adults2016In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 19, no 11, p. 1944-1951Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of the present study was to validate figural drawing scales depicting extremely lean to extremely obese subjects to obtain proxies for BMI and waist circumference in postal surveys.

    Design: Reported figural scales and anthropometric data from a large population-based postal survey were validated with measured anthropometric data from the same individuals by means of receiver-operating characteristic curves and a BMI prediction model.

    Setting: Adult participants in a Scandinavian cohort study first recruited in 1990 and followed up twice since.

    Subjects: Individuals aged 38-66 years with complete data for BMI (n 1580) and waist circumference (n 1017).

    Results: Median BMI and waist circumference increased exponentially with increasing figural scales. Receiver-operating characteristic curve analyses showed a high predictive ability to identify individuals with BMI > 25.0 kg/m(2) in both sexes. The optimal figural scales for identifying overweight or obese individuals with a correct detection rate were 4 and 5 in women, and 5 and 6 in men, respectively. The prediction model explained 74% of the variance among women and 62% among men. Predicted BMI differed only marginally from objectively measured BMI.

    Conclusions: Figural drawing scales explained a large part of the anthropometric variance in this population and showed a high predictive ability for identifying overweight/obese subjects. These figural scales can be used with confidence as proxies of BMI and waist circumference in settings where objective measures are not feasible.

  • 38.
    Ekbom, Emil
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Quint, Jennifer
    Schöler, Linus
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Franklin, Karl
    Holm, Mathias
    Torén, Kjell
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Jarvis, Deborah
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Population Health and Occupational Disease, National Heart and Lung Institute, Imperial College, London, UK.
    Asthma and treatment with inhaled corticosteroids: associations with hospitalisations with pneumonia2019In: BMC Pulmonary Medicine, E-ISSN 1471-2466, Vol. 19, no 1, article id 254Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Pneumonia is an important cause of morbidity and mortality. COPD patients using inhaled corticosteroids (ICS) have an increased risk of pneumonia, but less is known about whether ICS treatment in asthma also increases the risk of pneumonia. The aim of this analysis was to examine risk factors for hospitalisations with pneumonia in a general population sample with special emphasis on asthma and the use of ICS in asthmatics.

    METHODS: In 1999 to 2000, 7340 subjects aged 28 to 54 years from three Swedish centres completed a brief health questionnaire. This was linked to information on hospitalisations with pneumonia from 2000 to 2010 and treatment with ICS from 2005 to 2010 held within the Swedish National Patient Register and the Swedish Prescribed Drug Register.

    RESULTS: Participants with asthma (n = 587) were more likely to be hospitalised with pneumonia than participants without asthma (Hazard Ratio (HR 3.35 (1.97-5.02)). Other risk factors for pneumonia were smoking (HR 1.93 (1.22-3.06)), BMI < 20 kg/m2 (HR 2.74 (1.41-5.36)) or BMI > 30 kg/m2 (HR 2.54 (1.39-4.67)). Asthmatics (n = 586) taking continuous treatment with fluticasone propionate were at an increased risk of being hospitalized with pneumonia (incidence risk ratio (IRR) 7.92 (2.32-27.0) compared to asthmatics that had not used fluticasone propionate, whereas no significant association was found with the use of budesonide (IRR 1.23 (0.36-4.20)).

    CONCLUSION: Having asthma is associated with a three times higher risk of being hospitalised for pneumonia. This analysis also indicates that there are intraclass differences between ICS compounds with respect to pneumonia risk, with an increased risk of pneumonia related to fluticasone propionate.

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  • 39.
    Ekström, Magnus Par
    et al.
    Lund Univ, Dept Clin Sci Lund, Fac Med, Resp Med & Allergol, Lund, Sweden.
    Blomberg, Anders
    Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden.
    Bergstrom, Goran
    Univ Gothenburg, Sahlgrenska Univ Hosp, Inst Med, Wallenberg Lab,Dept Mol & Clin Med, Gothenburg, Sweden.
    Brandberg, John
    Univ Gothenburg, Inst Clin Sci, Dept Radiol, Gothenburg, Sweden.
    Caidahl, Kenneth
    Univ Gothenburg, Sahlgrenska Acad, Dept Mol & Clin Med, Gothenburg, Sweden.
    Engstrom, Gunnar
    Lund Univ, Dept Clin Sci, Malm, Sweden.
    Engvall, Jan
    Linkoping Univ, Dept Clin Physiol, Linkoping, Sweden;Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden.
    Eriksson, Maria
    Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden.
    Gransbo, Klas
    Lund Univ, Dept Clin Sci Malmo, Lund, Sweden.
    Hansen, Tomas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Jernberg, Tomas
    Karolinska Inst, Danderyd Univ Hosp, Dept Clin Sci, Stockholm, Sweden.
    Nilsson, Lars
    Umea Univ, Unit Med, Dept Publ Hlth & Clin Med, Umea, Sweden.
    Nilsson, Ulf
    Umea Univ, Unit Med, Dept Publ Hlth & Clin Med, Umea, Sweden.
    Olin, Anna-Carin
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Sect Occupat & Environm Med, Gothenburg, Sweden.
    Persson, Lennart
    Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden.
    Rosengren, Annika
    Univ Gothenburg, Sahlgrenska Univ Hosp, Inst Med, Wallenberg Lab,Dept Mol & Clin Med, Gothenburg, Sweden.
    Sandelin, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Skold, Magnus
    Karolinska Inst, Ctr Mol Med, Resp Med Unit, Dept Med, Stockholm, Sweden;Karolinska Inst, Dept Med Solna, Resp Med Unit, Stockholm, Sweden;Karolinska Inst, Ctr Mol Med, Stockholm, Sweden.
    Sundstrom, Johan
    Karolinska Inst, Dept Med Solna, Resp Med Unit, Stockholm, Sweden;Karolinska Inst, Ctr Mol Med, Stockholm, Sweden.
    Swahn, Eva
    Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden.
    Soderberg, Stefan
    Umea Univ, Unit Med, Dept Publ Hlth & Clin Med, Umea, Sweden.
    Tanash, Hanan A.
    Lund Univ, Skane Univ Hosp, Dept Resp Med & Allergol, Malmo, Sweden.
    Toren, Kjell
    Sahlgrens Univ Hosp, Dept Occupat & Environm, Gothenburg, Sweden.
    Ostgren, Carl Johan
    Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    The association of body mass index, weight gain and central obesity with activity-related breathlessness: the Swedish Cardiopulmonary Bioimage Study2019In: Thorax, ISSN 0040-6376, E-ISSN 1468-3296, Vol. 74, no 10, p. 958-964Article in journal (Refereed)
    Abstract [en]

    Introduction Breathlessness is common in the population, especially in women and associated with adverse health outcomes. Obesity (body mass index (BMI) >30 kg/m2) is rapidly increasing globally and its impact on breathlessness is unclear.

    Methods This population-based study aimed primarily to evaluate the association of current BMI and self-reported change in BMI since age 20 with breathlessness (modified Research Council score ≥1) in the middle-aged population. Secondary aims were to evaluate factors that contribute to breathlessness in obesity, including the interaction with spirometric lung volume and sex.

    Results We included 13 437 individuals; mean age 57.5 years; 52.5% women; mean BMI 26.8 (SD 4.3); mean BMI increase since age 20 was 5.0 kg/m2; and 1283 (9.6%) reported breathlessness. Obesity was strongly associated with increased breathlessness, OR 3.54 (95% CI, 3.03 to 4.13) independent of age, sex, smoking, airflow obstruction, exercise level and the presence of comorbidities. The association between BMI and breathlessness was modified by lung volume; the increase in breathlessness prevalence with higher BMI was steeper for individuals with lower forced vital capacity (FVC). The higher breathlessness prevalence in obese women than men (27.4% vs 12.5%; p<0.001) was related to their lower FVC. Irrespective of current BMI and confounders, individuals who had increased in BMI since age 20 had more breathlessness.

    Conclusion Breathlessness is independently associated with obesity and with weight gain in adult life, and the association is stronger for individuals with lower lung volumes.

  • 40.
    Ekström, Magnus
    et al.
    Lund Univ, Inst Clin Sci, Dept Resp Med & Allergol, Lund, Sweden..
    Sundh, Josefin
    Orebro Univ, Sch Med Sci, Dept Resp Med, Orebro, Sweden..
    Schiöler, Linus
    Univ Gothenburg, Sahlgrenska Acad, Sect Occupat & Environm Med, Gothenburg, Sweden..
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Rosengren, Annika
    Univ Gothenburg, Sahlgrenska Univ Hosp, Inst Med, Wallenberg Lab,Dept Mol & Clin Med, Gothenburg, Sweden..
    Bergström, Göran
    Univ Gothenburg, Sahlgrenska Univ Hosp, Inst Med, Wallenberg Lab,Dept Mol & Clin Med, Gothenburg, Sweden..
    Angerås, Oskar
    Univ Gothenburg, Sahlgrenska Univ Hosp, Inst Med, Wallenberg Lab,Dept Mol & Clin Med, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Dept Cardiol, Gothenburg, Sweden..
    Hedner, Jan
    Univ Gothenburg, Inst Med, Dept Internal Med, Gothenburg, Sweden..
    Brandberg, John
    Univ Gothenburg, Inst Clin Sci, Dept Radiol, Gothenburg, Sweden..
    Bake, Björn
    Univ Gothenburg, Dept Resp Med & Allergol, Gothenburg, Sweden..
    Toren, Kjell
    Univ Gothenburg, Sahlgrenska Acad, Sect Occupat & Environm Med, Gothenburg, Sweden..
    Absolute lung size and the sex difference in breathlessness in the general population2018In: PLOS ONE, E-ISSN 1932-6203, Vol. 13, no 1, article id e0190876Article in journal (Refereed)
    Abstract [en]

    Background: Breathlessness is associated with major adverse health outcomes and is twice as common in women as men in the general population. We evaluated whether this is related to their lower absolute lung volumes.

    Methods: Cross-sectional analysis of the population-based Swedish CardioPulmonarybioImage Study (SCAPIS) Pilot, including static spirometry and diffusing capacity (n = 1,013; 49% women). Breathlessness was measured using the modified Medical Research Council (mMRC) scale and analyzed using ordinal logistic regression adjusting for age, pack-years of smoking, body mass index, chronic airway limitation, asthma, chronic bronchitis, depression and anxiety in all models.

    Results: Breathlessness was twice as common in women as in men; adjusted odds ratio (OR) 2.20 (95% confidence interval, 1.32-3.66). Lower absolute lung volumes were associated with increased breathlessness prevalence in both men and women. The sex difference in breathlessness was unchanged when adjusting for lung function in %predicted, but disappeared when controlling for absolute values of total lung capacity (OR 1.12; 0.59-2.15), inspiratory capacity (OR 1.26; 0.68-2.35), forced vital capacity (OR 0.84; 0.42-1.66), forced expiratory volume in one second (OR 0.70; 0.36-1.35) or lung diffusing capacity (OR 1.07; 0.58-1.97).

    Conclusion: In the general population, the markedly higher prevalence of breathlessness in women is related to their smaller absolute lung volumes.

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  • 41.
    Emilsson, Össur Ingi
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Al Yasiry, Hamza
    Uppsala Univ, Dept Med Sci Resp Allergy & Sleep Res, Uppsala, Sweden..
    Theorell-Haglöw, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Ljunggren, Mirjam
    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.
    Insufficient sleep and new onset of nocturnal gastroesophageal reflux among women: a longitudinal cohort study2022In: Journal of Clinical Sleep Medicine (JCSM), ISSN 1550-9389, E-ISSN 1550-9397, Vol. 18, no 7, p. 1731-1737Article in journal (Refereed)
    Abstract [en]

    Study Objectives: Whether short or insufficient sleep are risk factors for new-onset nocturnal gastroesophageal reflux (nGER). Methods: In this 10-year longitudinal study, adult general-population women in Uppsala, Sweden, answered questionnaires on sleep, nGER, and other conditions on 2 occasions. Participants at baseline totaled 6,790, while participants at follow-up totaled 4,925. "Short sleep" was defined as sleeping < 6 hours/night and "insufficient sleep" was defined as reporting an average actual sleep duration below 80% of the self-estimated need for sleep duration but without "short sleep." nGER was defined as reporting heartburn or acid reflux after going to bed sometimes, often, or very often. The confounding factors-age, body mass index, physical activity, caffeine intake, smoking habits, alcohol dependence, depression, anxiety, and snoring-were defined from the questionnaire. Results: At baseline, 839 participants reported short sleep and 1,079 participants were defined as having insufficient sleep. Both participants with insufficient sleep and short sleep had nGER more often than those with sufficient sleep (26% vs 17% vs 10%, respectively). At follow-up, a new onset of nGER was twice as common among those with insufficient or short sleep at baseline and follow-up, compared with those with sufficient sleep at baseline and follow-up, even after adjusting for confounding factors (odds ratio 2.0 [1.5-2.8], P <.001). Conclusions: Insufficient sleep and short sleep are associated with nGER. Persistent insufficient and/or short sleep independently increases the risk of developing nGER over a 10-year follow-up. Women seeking treatment for nGER should be questioned about their sleep habits to identify insufficient sleep as a possible causative factor.

  • 42.
    Emilsson, Össur Ingi
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Akad Sjukhuset, Resp Med & Allergol, Uppsala, Sweden..
    Hägg, Shad Amid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Akad Sjukhuset, Resp Med & Allergol, Uppsala, Sweden..
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Akad Sjukhuset, Resp Med & Allergol, Uppsala, Sweden..
    Franklin, Karl A.
    Umeå Univ, Dept Surg, Perioperat Sci & Surg, Umeå, Sweden..
    Toren, Kjell
    Univ Gothenburg, Occupat & Environm Med, Gothenburg, Sweden..
    Benediktsdottir, Bryndis
    Landspitali, Dept Sleep Med, Reykjavik, Iceland.;Univ Iceland, Fac Med, Reykjavik, Iceland..
    Aspelund, Thor
    Univ Iceland, Ctr Publ Hlth Sci, Reykjavik, Iceland..
    Real, Francisco Gomez
    Univ Bergen, Dept Clin Sci, Bergen, Norway..
    Leynaert, Benedicte
    Univ Paris, Pathophysiol & Epidemiol Resp Dis, Paris, France..
    Demoly, Pascal
    Univ Hosp Montpellier, Dept Pulmonol, Div Allergy, Hop Arnaud de Villeneuve, Montpellier, France.;Sorbonne Univ, INSERM, Equipe EPAR IPLESP, Paris, France..
    Sigsgaard, Torben
    Aarhus Univ, Inst Publ Hlth, Aarhus, Denmark..
    Perret, Jennifer
    Univ Melbourne, Ctr Epidemiol & Biostat, Melbourne, Vic, Australia..
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Jarvis, Deborah
    Imperial Coll London, MRC PHE Ctr Environm & Hlth, London, England..
    Garcia-Aymerich, Judith
    Ctr Res Environm Epidemiol CREAL, ISGlobal, Barcelona, Spain.;Pompeu Fabra Univ UPF, Barcelona, Spain.;CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain..
    Gislason, Thorarinn
    Landspitali, Dept Sleep Med, Reykjavik, Iceland.;Univ Iceland, Fac Med, Reykjavik, Iceland..
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Akad Sjukhuset, Resp Med & Allergol, Uppsala, Sweden..
    Snoring and nocturnal reflux: association with lung function decline and respiratory symptoms2019In: ERJ open research, E-ISSN 2312-0541, Vol. 5, no 2, article id 10Article in journal (Refereed)
    Abstract [en]

    Introduction: The study aim was to examine the association of snoring and nocturnal gastro-oesophageal reflux (nGOR) with respiratory symptoms and lung function, and if snoring and/or nGOR associated with a steeper decline in lung function. Methods: Data from the third visit of the European Community Respiratory Health Survey (ECRHS) was used for cross-sectional analysis. Pre- and post-bronchodilator spirometry was performed, and information on sleep, nGOR and respiratory symptoms was collected (n=5715). Habitual snoring and nGOR were assessed by questionnaire reports. Pre-bronchodilator spirometry from ECRHS I, II and III (20 years follow-up) were used to analyse lung function changes by multivariate regression analysis. Results: Snoring and nGOR were independently associated with a higher prevalence of wheeze, chest tightness, breathlessness, cough and phlegm. The prevalence of any respiratory symptom was 79% in subjects with both snoring and nGOR versus 56% in those with neither (p<0.001). Subjects with both snoring and nGOR had more frequent exacerbations (adjusted prevalence 32% versus 19% among "no snoring, no nGOR", p=0.003). Snoring but not nGOR was associated with a steeper decline in forced expiratory volume in 1 s over 10 years after adjusting for confounding factors (change in % predicted -5.53, versus -4.58 among "no snoring", p=0.04) and forced vital capacity (change in % predicted -1.94, versus -0.99 among "no snoring", p=0.03). Conclusions: Adults reporting both habitual snoring and nGOR had more respiratory symptoms and more frequent exacerbations of these symptoms. Habitual snoring was associated with a steeper decline in lung function over time.

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  • 43.
    Emilsson, Össur Ingi
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Sundbom, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Ljunggren, Mirjam
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Benediktsdottir, Bryndis
    Garcia-Aymerich, Judith
    Bui, Dinh Son
    Jarvis, Deborah
    Olin, Anna-Carin
    Franklin, Karl A.
    Demoly, Pascal
    Lindberg, Eva
    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.
    Aspelund, Thor
    Gislason, Thorarinn
    Association between lung function decline and obstructive sleep apnoea: the ALEC study2021In: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 25, no 2, p. 587-596Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To study changes in lung function among individuals with a risk of obstructive sleep apnoea (OSA), and if asthma affected this relationship.

    METHODS: We used data from the European Community Respiratory Health Survey II and III, a multicentre general population study. Participants answered questionnaires and performed spirometry at baseline and 10-year follow-up (n = 4,329 attended both visits). Subjects with high risk for OSA were identified from the multivariable apnoea prediction (MAP) index, calculated from BMI, age, gender, and OSA symptoms at follow-up. Asthma was defined as having doctor's diagnosed asthma at follow-up. Primary outcomes were changes in forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) from baseline to follow-up.

    RESULTS: Among 5108 participants at follow-up, 991 (19%) had a high risk of OSA based on the MAP index. Participants with high OSA risk more often had wheeze, cough, chest tightness, and breathlessness at follow-up than those with low OSA risk. Lung function declined more rapidly in subjects with high OSA risk (low vs high OSA risk [mean ± SD]: FEV1 = - 41.3 ± 24.3 ml/year vs - 50.8 ± 30.1 ml/year; FVC = - 30.5 ± 31.2 ml/year vs - 45.2 ± 36.3 ml/year). Lung function decline was primarily associated with higher BMI and OSA symptoms. OSA symptoms had a stronger association with lung function decline among asthmatics, compared to non-asthmatics.

    CONCLUSION: In the general population, a high probability of obstructive sleep apnoea was related to faster lung function decline in the previous decade. This was driven by a higher BMI and more OSA symptoms among these subjects. The association between OSA symptoms and lung function decline was stronger among asthmatics.

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  • 44.
    Emtner, Margareta I.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Arnardottir, Harpa R.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Hallin, Runa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    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.
    Walking distance is a predictor of exacerbations in patients with chronic obstructive pulmonary disease2007In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 101, no 5, p. 1037-1040Article in journal (Refereed)
    Abstract [en]

    Background: Patients with chronic obstructive pulmonary disease (COPD) are responsible for a high utilisation of the health care resources, and the cost is expected to increase. Physiological measures of lung function often fail to describe the impact the symptoms have on exacerbations, days of hospitalisation, and on a patient's health. Methods: Twenty-one patients (14 female) with COPD (65 years, 40-79 years) admitted to the Department of Respiratory Medicine in Uppsala, performed a pulmonary function test (FEV1% predicted=37) and health status measurement (St. Georges Respiratory Questionnaire, SGRQ) at discharge. Four to six weeks after discharge, when they were in a stable clinical condition, they performed an exercise test (Incremental Shuttle Walk Test, ISWT) to measure their exercise capacity. Results: Nine of 21 patients (43%) were rehospitalised within 12 month. The mean distance walked in the ISWT was 174 m in patients who were hospitalised and 358 m in non-hospitalised patients (P<0.001). Oxygen saturation ≤88% after the ISWT was found in 73% of hospitalised patients in contrast to only 22% in non-hospitalised patients (P<0.05). Activity related health status (SGRQ-activity) was higher (worse) in hospitalised patients than in non-hospitalised patients (75 vs. 50) (P<0.05). The association between walking distance and the risk of rehospitalisation was significant after adjusting for oxygen saturation and health status (hazard risk ratio 0.8 (0.67-0.97) per 10 m). This study has shown that walking distance is a good and reliable predictor of rehospitalisations in moderately and severely disabled patients with COPD.

  • 45. Engström, G.
    et al.
    Lampa, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Epidemiology.
    Dekkers, Koen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Lin, Yi-Ting
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Ahlm, K.
    Ahlström, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Alfredsson, J.
    Bergström, G.
    Blomberg, A.
    Brandberg, J.
    Caidahl, K.
    Cederlund, K.
    Duvernoy, Olov
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Engvall, J. E.
    Eriksson, M. J.
    Fall, Tove
    Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Gigante, B.
    Gummesson, A.
    Hagström, Emil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Uppsala Clinical Research Center (UCR).
    Hamrefors, V.
    Hedner, J.
    Janzon, M.
    Jernberg, T.
    Johnson, L.
    Lind, Lars
    Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Research and Development, Gävleborg. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Uppsala Clinical Research Center (UCR). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Epidemiology.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Mannila, M.
    Nilsson, U.
    Persson, A.
    Persson, H. L.
    Persson, M.
    Ramnemark, A.
    Rosengren, A.
    Schmidt, C.
    Skoglund Larsson, L.
    Sköld, C. M.
    Swahn, E.
    Söderberg, S.
    Torén, K.
    Waldenström, A.
    Wollmer, P.
    Zaigham, Suneela
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Östgren, C. J.
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Uppsala Clinical Research Center (UCR). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Pulmonary function and atherosclerosis in the general population: causal associations and clinical implications2024In: Eur J Epidemiol, ISSN 1573-7284 Electronic 0393-2990 LinkingArticle in journal (Refereed)
    Abstract [en]

    Reduced lung function is associated with cardiovascular mortality, but the relationships with atherosclerosis are unclear. The population-based Swedish CArdioPulmonary BioImage study measured lung function, emphysema, coronary CT angiography, coronary calcium, carotid plaques and ankle-brachial index in 29,593 men and women aged 50-64 years. The results were confirmed using 2-sample Mendelian randomization. Lower lung function and emphysema were associated with more atherosclerosis, but these relationships were attenuated after adjustment for cardiovascular risk factors. Lung function was not associated with coronary atherosclerosis in 14,524 never-smokers. No potentially causal effect of lung function on atherosclerosis, or vice versa, was found in the 2-sample Mendelian randomization analysis. Here we show that reduced lung function and atherosclerosis are correlated in the population, but probably not causally related. Assessing lung function in addition to conventional cardiovascular risk factors to gauge risk of subclinical atherosclerosis is probably not meaningful, but low lung function found by chance should alert for atherosclerosis.

  • 46. Franklin, FA
    et al.
    Gislason, T
    Omenaas, E
    Jõgi, R
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences. Lungmedicin och allergi.
    Juel Jensen, E
    Lindberg, E
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences. Lungmedicin och allergi.
    Gunnbjörnsdottir, Maria
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences. Lungmedicin och allergi.
    Laerum, BN
    Björnsson, E
    Torén, K
    Janson, Christer
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences. Lungmedicin och allergi.
    The influence of active and passive smoking habitual on snoring2004In: Am J Respir Crit Care Med, Vol. 170, p. 799-803Article in journal (Refereed)
  • 47. Franklin, Karl A
    et al.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Gíslason, Thórarinn
    Gulsvik, Amund
    Gunnbjörnsdottir, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Laerum, Birger N
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Norrman, Eva
    Nyström, Lennarth
    Omenaas, Ernst
    Torén, Kjell
    Svanes, Cecilie
    Early life environment and snoring in adulthood2008In: Respiratory Research, ISSN 1465-9921, E-ISSN 1465-993X, Vol. 9, no 1, p. 63-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: To our knowledge, no studies of the possible association of early life environment with snoring in adulthood have been published. We aimed to investigate whether early life environment is associated with snoring later in life. METHODS: A questionnaire including snoring frequency in adulthood and environmental factors in early life was obtained from 16,190 randomly selected men and women, aged 25-54 years, in Sweden, Norway, Iceland, Denmark and Estonia (response rate 74%). RESULTS: A total of 15,556 subjects answered the questions on snoring. Habitual snoring, defined as loud and disturbing snoring at least 3 nights a week, was reported by 18%. Being hospitalized for a respiratory infection before the age of two years (adjusted odds ratio (OR) = 1.27; 95% confidence interval (CI) 1.01-1.59), suffering from recurrent otitis as a child (OR = 1.18; 95%CI 1.05-1.33), growing up in a large family (OR = 1.04; 95%CI 1.002-1.07) and being exposed to a dog at home as a newborn (OR = 1.26; 95%CI 1.12-1.42) were independently related to snoring later in life and independent of a number of possible confounders in adulthood. The same childhood environmental factors except household size were also related with snoring and daytime sleepiness combined. CONCLUSION: The predisposition for adult snoring may be partly established early in life. Having had severe airway infections or recurrent otitis in childhood, being exposed to a dog as a newborn and growing up in a large family are environmental factors associated with snoring in adulthood.

  • 48.
    Franklin, Karl A.
    et al.
    Umea Univ, Dept Surg & Perioperat Sci, Surg, SE-90186 Umea, Sweden..
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Obstructive sleep apnea is a common disorder in the population: a review on the epidemiology of sleep apnea2015In: Journal of Thoracic Disease, ISSN 2072-1439, E-ISSN 2077-6624, Vol. 7, no 8, p. 1311-1322Article, review/survey (Refereed)
    Abstract [en]

    The prevalence of obstructive sleep apnea (OSA) defined at an apnea-hypopnea index (AHI) >= 5 was a mean of 22% (range, 9-37%) in men and 17% (range, 4-50%) in women in eleven published epidemiological studies published between 1993 and 2013. OSA with excessive daytime sleepiness occurred in 6% (range, 3-18%) of men and in 4% (range, 1-17%) of women. The prevalence increased with time and OSA was reported in 37% of men and in 50% of women in studies from 2008 and 2013 respectively. OSA is more prevalent in men than in women and increases with age and obesity. Smoking and alcohol consumption are also suggested as risk factors, but the results are conflicting. Excessive daytime sleepiness is suggested as the most important symptom of OSA, but only a fraction of subjects with AHI >5 report daytime sleepiness and one study did not find any relationship between daytime sleepiness and sleep apnea in women. Stroke and hypertension and coronary artery disease are associated with sleep apnea. Cross-sectional studies indicate an association between OSA and diabetes mellitus. Patients younger than 70 years run an increased risk of early death if they suffer from OSA. It is concluded that OSA is highly prevalent in the population. It is related to age and obesity. Only a part of subjects with OSA in the population have symptoms of daytime sleepiness. The prevalence of OSA has increased in epidemiological studies over time. Differences and the increase in prevalence of sleep apnea are probably due to different diagnostic equipment, definitions, study design and characteristics of included subjects including effects of the obesity epidemic. Cardiovascular disease, especially stroke is related to OSA, and subjects under the age of 70 run an increased risk of early death if they suffer from OSA.

  • 49. Franklin, Karl A
    et al.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Svensson, Johan
    Larsson, Christel
    Lindahl, Bernt
    Mellberg, Caroline
    Sahlin, Carin
    Olsson, Tommy
    Ryberg, Mats
    Effects of a palaeolithic diet on obstructive sleep apnoea occurring in females who are overweight after menopause-a randomised controlled trial.2022In: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 46, no 10, p. 1833-1839Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/OBJECTIVES: Obesity is the main risk factor for obstructive sleep apnoea, commonly occurring in females who are overweight after menopause. We aimed to study the effect of a palaeolithic diet on sleep apnoea in females with overweight after menopause from the population.

    METHODS: Seventy healthy, non-smoking females with a mean age of 60 years and a mean BMI of 33 kg/m2 were randomised to a palaeolithic diet or to a control low-fat diet according to Nordic Nutritional Recommendations, for 2 years. The apnoea-hypopnoea index was measured and daytime sleepiness was estimated during the intervention.

    RESULTS: The mean apnoea-hypopnoea index at baseline was 11.6 (95% CI 8.6-14.5). The mean weight loss was 7.2 kg (95% CI 5.3-9.2 kg) in the palaeolithic diet group and 3.9 kg in the control group (95% CI 1.9-5.9 kg); p < 0.021 for the group difference. The reduction in weight corresponded to a reduction in the apnoea-hypopnoea index in the palaeolithic diet group (r = 0.38, p = 0.034) but not in the control group (r = 0.08, p = 0.69). The apnoea-hypopnoea index was reduced in the palaeolithic diet group when the weight was reduced by more than 8 kg. Daytime sleepiness according to the Epworth Sleepiness Scale score and the Karolinska Sleepiness Scale score was unaffected by dietary group allocation.

    CONCLUSIONS: A substantial decrease in body weight of 8 kg was needed to achieve a reduction in sleep apnoea in this small trial of women who are overweight after menopause. The palaeolithic diet was more effective for weight reduction than a control low-fat diet and the reduction in sleep apnoea was related to the degree of weight decrement within this diet group.

    TRIAL REGISTRATION: Clinicaltrials.gov: NCT00692536.

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  • 50. Franklin, Karl A.
    et al.
    Sahlin, Carin
    Stenlund, Hans
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Sleep apnoea is a common occurrence in females2013In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 41, no 3, p. 610-615Article in journal (Refereed)
    Abstract [en]

    Obstructive sleep apnoea (OSA) is primarily regarded as a male disorder, presenting with snoring, daytime sleepiness and cardiovascular disease. We aimed to determine the frequency of sleep apnoea among females in the general population. We investigated 400 females from a population-based random sample of 10,000 females aged 20-70 yrs. They answered a questionnaire and performed overnight polysomnography. OSA (apnoea/hypopnoea index (AHI) >= 5) was found in 50% (95% CI 45-55%) of females aged 20-70 yrs. Sleep apnoea was related to age, obesity and hypertension, but not to daytime sleepiness. Severe sleep apnoea (AHI >= 30) was present in 14% (95% CI 8.1-21%) of females aged 55-70 yrs and in 31% (95% CI 12-50%) of obese females with a body mass index of >= 30 kg.m(-2) aged 55-70 yrs. Sleep apnoea with daytime sleepiness and sleep apnoea with hypertension were observed as two different phenotypes of OSA. OSA occurs in 50% of females aged 20-70 yrs. 20% of females have moderate and 6% severe sleep apnoea. Sleep apnoea in females is related to age, obesity and hypertension, but not to daytime sleepiness. When searching for sleep apnoea in females, females with hypertension or obesity should be investigated.

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