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Background: Endometriosis, dysmenorrhea, and respiratory symptoms affect large numbers of women. A possible association between asthma and endometriosis has been suggested; however, this relationship is unclear. Dysmenorrhea is very common, and potential associations with asthma symptoms are not known.

Aim: To study asthma symptoms associated with endometriosis and dysmenorrhea in women.

Methods: We used data from the main and women's questionnaires of the Respiratory Health in Northern Europe study, which included data from women (aged 39-65 years) from Aarhus, Gothenburg, Ume & aring;, Uppsala, Reykjavik, Tartu, and Bergen. Current asthma status was defined by asthma medication usage or asthma attacks in the past 12 months. Asthma symptoms were defined as having >= 3 asthma symptoms in the last 12 months. The data were analyzed using logistic regressions adjusted for age, body mass index, and smoking status.

Results: Among 4778 study participants, 201 had endometriosis, and 2154 had dysmenorrhea. Current asthma and asthma symptoms were reported by 14.9% and 12.9%, respectively, of women with endometriosis compared with 9.1% and 9.2%, respectively, of women without endometriosis. The associations of current asthma and asthma symptoms with endometriosis were statistically significant (odds ratio [OR]: 1.87, 95% confidence interval [CI]: 1.25-2.81; and OR: 1.56, 95% CI: 1.01-2.39, respectively). Similar associations were found for dysmenorrhea (current asthma: OR: 1.48, 95% CI: 1.21-1.81; ≥ 3 asthma symptoms: OR: 1.61, 95% CI: 1.31-1.97).

Conclusion: Our study revealed that asthma symptoms were associated with both endometriosis and dysmenorrhea. The associations with dysmenorrhea, which affects a large proportion of women, were almost as strong as the associations with diagnosed endometriosis.

Objectives:Although continuous positive airway pressure (CPAP) effectively prevents sleep apnea and reduces blood pressure, many patients do not use CPAP every night. This trial investigates cardiovascular effects after sleeping five nights without CPAP.

Methods:We randomized 100 patients (67 men and 33 women with a mean age 64 +/- 9 years) using CPAP treatment for moderate-to-severe sleep apnea to either withdraw treatment for five nights (n = 50) or to continue with CPAP (n = 50). The primary outcomes were arterial stiffness and 24 h blood pressure.

Results:The 24 h SBP increased by a mean of 2.8 mmHg [95% confidence interval (CI) 0.2-5.4 mmHg] (P = 0.035) and DBP increased by a mean of 1.7 mmHg (95% CI 0.1-3.3 mmHg) (P = 0.032) in the group without CPAP compared to the CPAP group. There was a significant effect on blood pressure in women but not in men. In women, SBP increased by 5.1 mmHg (95% CI 1.0-9.5 mmHg) (P = 0.017) and DBP by 2.9 mmHg (95% CI 0.4-5.6 mmHg) (P = 0.029). Arterial stiffness remained unaffected. Secondary outcomes that worsened in patients without CPAP included apnea-hypopnea index, oxygen desaturation index, hemoglobin levels, and daytime sleepiness.

Conclusion:Blood pressure is affected after five nights of CPAP interruption, along with a rapid return of sleep apneas, nocturnal hypoxic events, daytime sleepiness and increased hemoglobin levels, but arterial stiffness was not affected. Blood pressure was affected in women only, suggesting a sex-related CPAP effect on blood pressure.

BACKGROUND: Low lung function has been consistently associated with increased cardiovascular disease (CVD) risk, with emerging evidence suggesting a potential causal relationship. However, underlying biological mechanisms remain unclear.

AIM: To investigate relationships between CVD-associated plasma proteins and lung function.

METHODS: We analysed plasma protein profiles in two Swedish population-based cohorts: the Swedish CArdioPulmonary bioImage Study (SCAPIS) (n = 4,982, mean age 57.6 years) as the discovery cohort and the SCAPIS pilot study (n = 1,054, mean age 57.7 years) for replication. Multiple linear regression models were used to assess associations between 92 CVD-associated proteins and z-scores of FEV₁, FVC, and FEV₁/FVC, adjusting for known confounders. P-values were corrected using the Benjamini-Hochberg method (5% FDR). Significantly associated proteins were validated in the replication cohort.

RESULTS: A total of 69 proteins were associated with FEV₁, 57 with FVC, and 9 with FEV₁/FVC. Several inflammatory proteins and adipokines, including leptin, interleukin-6, fatty acid-binding protein (adipocyte), were consistently linked to lower lung function. Leptin had the strongest negative association (FEV₁: β = -0.50, 95 % CI: [-0.69, -0.31], p < 0.001; FVC: β = -0.52, 95 % CI: [-0.68, -0.35], p < 0.001 per-SD increase).

CONCLUSIONS: Multiple CVD-associated proteins, mainly reflecting inflammatory and metabolic processes, were associated with reduced FEV₁ and FVC, supporting a link between systemic inflammation, adipokine metabolism and impaired lung function. Leptin had the strongest association, suggesting that its effects on lung function may extend beyond adiposity. Further research is needed to clarify the mechanisms driving these associations and to assess whether these proteins could serve as early biomarkers or intervention targets.

PURPOSE: Myocardial infarctions (MIs) can occur in underlying obstructive coronary artery disease (MI-CAD) or in non-obstructive coronary arteries (MINOCA). The primary objectives of the study were to investigate the prevalence of MI-CAD and MINOCA in people with CAL, and to explore if CAL is an independent risk factor for MI-CAD and MINOCA. Secondary objectives were to explore these research questions stratified by sex and by smoking history.

PATIENTS AND METHODS: Cross-sectional analysis of the population-based Swedish CArdioPulmonary bioImage Study (SCAPIS) of people aged 50-64 years. CAL was defined as a post-bronchodilator ratio of forced expiratory volume in one second and forced vital capacity below 0.70. MI-CAD was defined as a self-reported MI with coronary computed tomography angiography findings of previous revascularization or at least one significant coronary stenosis (>50%), and MINOCA as self-reported MI with no previous revascularization and no significant coronary stenosis.

RESULTS: In total, 1735 (8.3%) of 20,882 included participants had CAL. MI-CAD was more common than MINOCA both in people with (2.8 vs 0.6%) and without CAL (1.2 vs 0.3%). Compared with those without CAL, people with CAL had an almost doubled independent risk of both MI-CAD ([adjusted OR] 1.72; [95% CI] 1.22-2.42) and MINOCA (1.99; 1.02-3.86). In men, CAL was associated with increased risk of MINOCA (2.63; 1.23-5.64), and in women with increased risk for MI-CAD (3.43; 1.68-1.26).

CONCLUSION: Middle-aged people with CAL have an almost doubled risk of both MI-CAD and MINOCA, compared with people without CAL. In contrast to people without CAL, the risk of MINOCA is increased in men and the risk of MI-CAD is increased in women. In a clinical context, both MI types should be considered in CAL.

Background: Preserved ratio impaired spirometry (PRISm) is a spirometry pattern of interest regarding incident airflow obstruction and higher mortality risk. We applied a proteomic approach to gain more insight into the biological mechanisms associated with PRISm.

Methods: From the population-based Swedish Cardiopulmonary Bioimage Study (SCAPIS), participants in the Main (n=4835) and Pilot (n=1054) studies, were included as discovery and replication cohorts. The lower limit of normal (LLN) of post-bronchodilator forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC was defined as the fifth percentile in healthy, never-smoking SCAPIS participants. Participants were subdivided into five groups: reference: FEV1/FVC >= LLN and FEV1 LLN and FVC >= LLN (n=4084)); mild chronic airflow limitation (CAL): FEV1/FVC1 LLN (n=278); moderate-severe CAL: FEV1/FVC1170); restrictive spirometric pattern (RSP): FEV1/FVC ,LLN and FVC238); and PRISm: FEV1/FVC >= LLN and FEV1238). Proximity extension assays were used to measure 168 proteins. The associations of each standardised protein were assessed with each study group by multiple linear regression models, adjusting for age, sex, body mass index (BMI), smoking, physical activity and study centres, and corrected for multiple testing to control for a false discovery rate of 5%.

Results: Eight proteins were associated with PRISm and replicated: tumour necrosis factor receptor superfamily member 10A, interleukin-6, paraoxonase 3 (negative association), renin, urokinase plasminogen activator surface receptor (U-PAR), E-selectin, matrix metalloproteinase 7 and chitinase-3-like protein 1. Interleukin-6 and U-PAR were also associated with moderate-severe CAL and E-selectin with RSP. In addition, five other proteins were associated with moderate-severe CAL and three with RSP.

Conclusion: Protein profile in PRISm differs from other spirometric patterns suggesting specific disease mechanisms.

Objectives: Sleep apnea is suggested to be associated with cancer risk, but results are heterogenous, and few studies are population-based. We aimed to assess risk associations between self-reported witnessed apnea during sleep and specific cancers in a population-based cohort.

Methods: This retrospective cohort study analyzed questions on witnessed sleep apnea in relation to incident cancer in the Northern Sweden Health and Disease Study. Cancer diagnoses were derived from the Swedish Cancer Registry and characterized as 12 different cancer types. Cox regression models adjusted for age, sex, ever smoking, body mass index, and education were used to assess risk associations.

Results: In total, 82,059 participants were included, and 10,668 (13 %) reported witnessed sleep apnea. They were followed for 9.0 (SD 4.7) years and 4030 incident cancers were diagnosed. Self-reported witnessed sleep apnea was independently associated with incident lung cancer with an adjusted hazard ratio (aHR), 1.78 (95 %CI 1.16, 2.73) p = 0.008 and breast cancer aHR, 1.39 (95 %CI 1.04, 1.84) p = 0.023. The risk for lung cancer was driven by an association with lung adenocarcinoma aHR, 2.16 (95 %CI 1.19, 3.91) p = 0.01. There was a multiplicative effect on ever smoking and reporting witnessed apnea for lung cancer with an aHR, 5.27 (95 %CI 3.07, 9.05) p < 0.001.

Conclusions: Self-reported witnessed sleep apnea is associated with an increased risk of developing lung-and breast cancer. There is a multiplicative effect of reporting witnessed sleep apnea and ever-smoking with an over 5 times increase on the hazard for lung cancer.

As available treatments in obstructive sleep apnea (OSA) are all associated with side effects or adherence problems, there is a need for alternative treatment options.

In this randomised, open, parallel-group intervention study the effect of head extension by cervical collar was evaluated in patients with moderate OSA. 

One hundred patients with moderate OSA (apneas and hypopneas per estimated hours asleep = respiratory events index: 15–30) were randomised to either lifestyle intervention (LS) or cervical collar in combination with lifestyle intervention (CC/LS). Both groups received lifestyle advice. In addition, the treatment group were treated with a cervical collar, which allows adjustment of head extension, during sleep. Assessment with questionnaires and polygraphy were performed at baseline and after 6 ± 2 weeks.

A linear regression model was used to assess a total effect on respiratory events index, which was the primary endpoint. 

In the intention to treat (ITT) analysis, the CC/LS group decreased their respiratory events index (P = 0.008) and oxygen desaturation index (P = 0.008) more than the LS group with a mean difference of -4.5 and -4.3, respectively. In the sub-analysis, there was a clear effect on respiratory events index in the supine position (mean difference between the groups -9.1, p=0.018) but not on non-supine AHI (-2.3, p=0.17).  

We conclude that head extension by cervical collar during sleep resulted in improved respiratory events index and oxygen desaturation index values in patients with moderate OSA. Cervical collar can be a second-line treatment option in this group, especially in positional OSA.

Excessive daytime sleepiness (EDS) is a common complaint in the general population and is associated with cardiovascular disease and increased mortality. We aimed to investigate whether sleep duration is related to excessive daytime sleepiness in the general population, both in itself and in combination with other factors. We performed a cross-sectional analysis in the population-based Swedish CArdioPulmonary bioImage Study (SCAPIS) cohort (n = 27,976; 14,436 females; aged 50-64 years) to assess how sleep-related factors along with anthropometric, lifestyle, socioeconomic factors as well as somatic disease and psychological distress, were related with EDS assessed by the Epworth sleepiness scale (ESS). Analyses were performed using logistic regression modelling with EDS defined by an ESS score of ≥11 as the main outcome. Both short and long sleep duration were related to EDS with increasing ORs for decreasing sleep duration (7 h vs. reference (8 h): OR 1.2, 95% CI 1.02-1.3 to ≤4 h: 1.9; 1.4-2.5). In addition to sleep-related factors such as insomnia (1.3; 1.2-1.4), poor sleep quality (1.2; 1.04-1.4), snoring (1.5; 1.4-1.6), and nocturnal gastro-oesophageal reflux (1.5; 1.21-1.8), psychological distress showed a strong association with EDS. This included sadness/depression (1.2; 1.1-1.3), stress (some stress: 1.4; 1.1-1.7 to constant stress over 5 years: 1.7; 1.3-2.2), and self-rated "control in life" (lowest quartile: 1.7; 1.6-2.0). Daytime sleepiness is multifactorial and associated with both sleep duration and sleep quality. Strong associations were also established with factors related to psychological distress. Further research may investigate interventions targeting both sleep and psychological health to reduce daytime sleepiness at the societal level.

Objectives: To explore the relationship between physical activity over a 10-year period and current symptoms of insomnia, daytime sleepiness and estimated sleep duration in adults aged 39-67.

Design: Population-based, multicentre cohort study.

Setting: 21 centres in nine European countries.

Methods: Included were 4339 participants in the third follow-up to the European Community Respiratory Health Survey (ECRHS III), who answered questions on physical activity at baseline (ECRHS II) and questions on physical activity, insomnia symptoms, sleep duration and daytime sleepiness at 10-year follow-up (ECRHS III). Participants who reported that they exercised with a frequency of at least two or more times a week, for 1 hour/week or more, were classified as being physically active. Changes in activity status were categorised into four groups: persistently non-active; became inactive; became active; and persistently active.

Main outcome measures: Insomnia, sleep time and daytime sleepiness in relation to physical activity.

Results: Altogether, 37% of participants were persistently non-active, 25% were persistently active, 20% became inactive and 18% became active from baseline to follow-up. Participants who were persistently active were less likely to report difficulties initiating sleep (OR 0.60, 95% CI 0.45-0.78), a short sleep duration of <= 6 hours/night (OR 0.71, 95% CI 0.59-0.85) and a long sleep of >= 9 hours/night (OR 0.53, 95% CI 0.33-0.84) than persistently non-active subjects after adjusting for age, sex, body mass index, smoking history and study centre. Daytime sleepiness and difficulties maintaining sleep were not related to physical activity status.

Conclusion: Physically active people have a lower risk of some insomnia symptoms and extreme sleep durations, both long and short.