Publications by authors named "Marie-Louise Walker-Engström"

11 Publications

  • Page 1 of 1

Effects of treatment with oral appliance on 24-h blood pressure in patients with obstructive sleep apnea and hypertension: a randomized clinical trial.

Sleep Breath 2013 May 21;17(2):705-12. Epub 2012 Jul 21.

Department of Stomatognathic Physiology, Västmanland County Hospital, 729 81 Västerås, Sweden.

Background: Continuous positive airway pressure treatment has been shown to lower blood pressure (BP) in patients with obstructive sleep apnea (OSA). The aims of the present pilot study were to evaluate the potential effects of oral appliance (OA) therapy on BP, to assess various outcome BP measures, and to inform sample size calculation.

Methods: Seventy-two patients with OSA and hypertension were randomly assigned to intervention with either an OA with mandibular advancement (active group) or an OA without advancement (control group). Before and after 3 months of treatment, the patients underwent nocturnal somnographic registration and 24-h ambulatory BP monitoring.

Results: Among the various BP measures, the largest trend toward effect of OA treatment was seen in 24-h mean systolic BP with a 1.8 mmHg stronger BP reduction in the active group compared with controls. A stronger trend toward effect was seen in a subgroup with baseline ambulatory daytime mean systolic BP >135/85 mmHg where the mean systolic BP fell, on average, 2.6 mmHg. Additional exclusion of patients with baseline apnea hypopnea index (AHI) ≤15 gave a significant reduction in mean systolic BP of 4.4 mmHg (P = 0.044) in the active group compared with controls.

Conclusions: In patients with OSA and hypertension, OA treatment had a modest trend toward effect on reducing BP. A stronger trend toward treatment effect was seen after excluding patients with normal baseline ambulatory BP. Additional exclusion of patients with baseline AHI ≤15 showed a significant treatment effect. Data to inform sample size for an adequately powered randomized study are provided.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11325-012-0746-7DOI Listing
May 2013

Impact on quality of life of different lower urinary tract symptoms in men measured by means of the SF 36 questionnaire.

Scand J Urol Nephrol 2006 ;40(6):485-94

Department of Caring Science, Mälardalen University, Västerås, Sweden.

Objective: To describe how different lower urinary tract symptoms (LUTS) affect the quality of life (QOL) in men.

Material And Methods: The study included 1008 men aged 40-80 years living in the community of Surahammar, Sweden who had answered a questionnaire concerning stress incontinence, urgency and post-micturition dribbling 12 months earlier. The occurrence and severity/frequency of 12 specific LUTS were assessed using the Danish Prostatic Symptom Score questionnaire. QOL was evaluated using the Short Form 36 (SF-36) questionnaire.

Results: Post-micturition dribbling was the most frequently reported symptom (71%) and stress incontinence the least common (11%). Men who experienced urge, stress or "other incontinence" had lower mean scores for all of the eight dimensions measured by the SF-36 than men without such symptoms. Furthermore, men who experienced a moderate/severe degree of weak stream or nocturia reported a poorer QOL for all dimensions compared to men with a mild level of the same symptoms. QOL was found to decrease with increasing age. Men aged 66-80 years with "other incontinence" reported lower mean SF-36 scores for physical functioning, role physical, role emotional, social functioning and body pain than 40-65-year-old men.

Conclusions: LUTS in men affect QOL dimensions differently. Storage symptoms appear to reduce QOL more than voiding and post-micturition symptoms. Urinary incontinence affected all eight of the dimensions evaluated. Elderly men with LUTS reported a lower QOL than younger men.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/00365590600830862DOI Listing
March 2007

Patient education in type 2 diabetes: a randomized controlled 1-year follow-up study.

Diabetes Res Clin Pract 2007 Jun 27;76(3):341-50. Epub 2006 Oct 27.

Department of Medical Sciences, Faculty of Medicine, Uppsala University, Uppsala, Sweden.

The aim of the present study was to evaluate the impact of empowerment group education on type 2 diabetes patients' confidence in diabetes knowledge, self-efficacy, satisfaction with daily life, BMI and glycaemic control compared with the impact of routine diabetes care on the same factors at a 1-year follow-up. In this randomized controlled trial, conducted at 7 primary care centres in central Sweden, 101 patients were randomly assigned either to empowerment group education (intervention group) or to routine diabetes care (control group). Out of these, 42 patients in the intervention group and 46 in the control group completed the 1-year follow-up. Before the intervention and at the 1-year follow-up, the patients answered a 27-item questionnaire, and weight, BMI and HbA1c were measured. The questionnaire comprised three domains: confidence in diabetes knowledge, self-efficacy and satisfaction with daily life. At 1-year follow-up, the level of confidence in diabetes knowledge was significantly higher in the intervention group than in the control group (p<0.05). No significant differences were found in self-efficacy, satisfaction with daily life, BMI and HbA1c between the intervention and control group. The empowerment group education did improve patients' confidence in diabetes knowledge with maintained glycaemic control despite the progressive nature of the disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.diabres.2006.09.018DOI Listing
June 2007

Prevalence of distress and symptom severity from the lower urinary tract in men: a population-based study with the DAN-PSS questionnaire.

Fam Pract 2004 Dec 1;21(6):617-22. Epub 2004 Oct 1.

Uppsala University, Department of Public Health and Caring Sciences, Uppsala Science Park, Sweden.

Background: Lower urinary tract symptoms (LUTS) are a common and costly public health issue. The prevalence varies greatly in published reports. The distress caused by each symptom is important to assess the primary care required before therapeutic decisions or a referral to an urologist are made.

Objectives: LUTS are highly prevalent in men, but less is known regarding the distress caused by each symptom. The aim of this study was to examine symptom severity and different levels of distress using the Danish Prostatic Symptom Score (DAN-PSS) questionnaire in men affected by symptoms from the lower urinary tract.

Methods: The study included all men aged 41-81 years (n=504) that, 12 months earlier in a population-based survey, had reported stress incontinence, urgency or post-micturition dribbling in a postal questionnaire. The DAN-PSS questionnaire was used to measure severity and distress from LUTS.

Results: In total, 311 (80%) of the 387 responders who reported at least one symptom experienced some level of distress. The most distressing symptom overall was urinary incontinence. Nine of 10 men with storage symptoms (stress, urge and 'other' urinary incontinence) reported distress even if the symptom occurred only seldom. Moreover, two-thirds of the men with the most frequent symptom, post-micturition dribbling, characterized their symptom as moderate or severe; the most distressing voiding symptom was weak stream. In general, LUTS were well tolerated.

Conclusion: Urge incontinence was the most distressing LUTS even when occurring only seldom. The DAN-PSS questionnaire may be a potentially useful tool for health professionals to identify patients with pronounced distress from LUTS to offer therapeutic and nursing care on the relevant level.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/fampra/cmh607DOI Listing
December 2004

Changes in urinary incontinence and quality of life after four years. A population-based study of women aged 22-50 years.

Scand J Prim Health Care 2004 Jun;22(2):112-7

Centre of Clinical Research, Uppsala University, Central Hospital, Västerås, Sweden.

Objectives: To investigate (a) the incidence and remission rates of female urinary incontinence (UI), (b) changes in type of UI and quality of life (QoL), and (c) whether professional help had been consulted regarding UI.

Design: A 4-year follow-up population-based cohort study.

Setting: Surahammar, Sweden, a community of 10,500 inhabitants.

Subjects: All 118 incontinent and 130 continent women aged between 22 and 50 years.

Main Outcome Measures: Changes in type of UI were measured using the Detrusor Instability Score (DIS), which was used to distinguish between the stress incontinent and the urge incontinent women. Changes in QoL were measured using the SF-36 Health Survey.

Results: The mean annual incidence and remission rates of UI were the same (4%). The majority of women (83%) reported unchanged UI after 4 years and 77% of these women had stress incontinence. At follow-up, the changes in QoL scores were significantly greater in five out of eight dimensions in the persistently incontinent group compared with the persistently continent group. QoL scores did not change significantly from baseline to the 4-year follow-up within the incidence and remission groups. Three of four women with UI had not sought professional help.

Conclusions: At 4-year follow-up the type of UI is fairly stable in women below 50 years of age. The QoL decreases in five dimensions, but the clinical relevance of this might be questioned. Most women with UI had not sought professional help.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/02813430410005676DOI Listing
June 2004

Two different degrees of mandibular advancement with a dental appliance in treatment of patients with mild to moderate obstructive sleep apnea.

Acta Odontol Scand 2003 Dec;61(6):356-62

Department of Stomatognathic Physiology, Centre for Clinical Research, Uppsala University, Västerås, Sweden.

The objective of this study was to evaluate the effect of 2 different degrees of mandibular advancement, 50% vs. 75% of maximum protrusive capacity, on somnographic variables after 1 year of dental appliance treatment in patients with mild to moderate obstructive sleep apnea (OSA). A further purpose was to compare the number of adverse events on the stomatognathic system. In a prospective study, 74 male patients were randomly allocated to receive a dental appliance with either 50% (38 patients) or 75% mandibular advancement (36 patients). After 1 year of treatment, 55 patients completed the follow-up. Somnography was performed to measure treatment effects before and 12 months post-treatment. The apnea, apnea/hypopnea, and oxygen desaturation indices decreased significantly in both groups after 1 year (P < 0.001); however, there were no differences between the groups. Normalization (apnea index < 5 and apnea/hypopnea index < 10) was observed in 79% in group 50 and in 73% in group 75. Few patients (< 5%) reported symptoms from the stomatognathic system except for headache (> once a week), which was reported in one-third of the patients. Headache was significantly more infrequent after 1 year of treatment in both groups (P < 0.001). No serious complications were observed except for 2 patients who reported a painful condition from the temporomandibular joint in either group. In conclusion, mandibular advancement with a dental appliance effectively reduces the sleep-breathing disorder measured as frequency of apneas, and a pronounced mandibular advancement did not show a greater improvement of the medical problem compared to less advancement for patients with mild to moderate OSA. On the basis of few adverse events in the stomatognathic system or other complications we can recommend dental appliance treatment and, for patients with mild to moderate obstructive sleep apnea, not starting treatment by more than 50% mandibular advancement.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/00016350310007130DOI Listing
December 2003

Reasons why women with long-term urinary incontinence do not seek professional help: a cross-sectional population-based cohort study.

Int Urogynecol J Pelvic Floor Dysfunct 2003 Nov 29;14(5):296-304; discussion 304. Epub 2003 Aug 29.

Centre for Clinical Research, Central Hospital, Uppsala University, Västerås, Sweden.

The aims of this study were to investigate the reasons why some women with long-term urinary incontinence (UI) seek professional help whereas others do not, their experiences and satisfactions with the healthcare services, and how women deal with their incontinence. In total, 95 women aged 23-51 years with persistent UI (median 10 years, range 6-20 years) were included in this telephone interview survey. Seventy-four percent of the women with long-term UI had not sought help. The most common reason given was that the disorder was considered a minor problem, which they felt they could cope with on their own. When women did consult professional help they did so because they were afraid of the odor of urine and that they perceived the leakage as shameful and embarrassing. These women felt that the healthcare service offered appropriate care for their condition. Pelvic floor exercises were the most commonly used management methods for all participants.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00192-003-1077-9DOI Listing
November 2003

A prospective randomized study comparing two different degrees of mandibular advancement with a dental appliance in treatment of severe obstructive sleep apnea.

Sleep Breath 2003 Sep;7(3):119-30

Centre for Clinical Research, Central Hospital, Västerå, Sweden.

The objective of this study was to compare the effect of two different degrees of mandibular advancement (MA), 75% versus 50%, on somnographic variables after 6 months of dental appliance treatment in patients with severe obstructive sleep apnea (OSA). A further purpose was to compare the number of adverse events on the stomatognathic system and the effects of dental appliance treatment on the presence of daytime sleepiness. Eighty-six males with severe OSA (apnea index > or = 20) were randomly allocated to either 75% or 50% MA. Forty patients in the 75% MA group and 37 patients in the 50% MA group completed the 6-month follow-up. The effectiveness of treatment in terms of normalization (apnea index < 5 and apnea/hypopnea index < 10) with 75% MA was 52%, which was significantly higher (p = 0.04) than the 31% achieved with 50% MA. The dental appliance had few adverse events on the stomatognathic system regardless of group, and the number of adverse events did not differ between the two groups. Finally, the mean value of Epworth Sleepiness Scale scores decreased significantly from 11.6 at baseline to 8.0 at follow-up (p < 0.001). No significant difference was observed between the two groups. The results indicate that a dental appliance could be an alternative treatment for some patients with severe OSA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11325-003-0119-3DOI Listing
September 2003

Dental and skeletal changes after 4 years of obstructive sleep apnea treatment with a mandibular advancement device: a prospective, randomized study.

Am J Orthod Dentofacial Orthop 2003 Jul;124(1):53-60

Associate professor of clinical orthodontics, Centre for Clinical Research, Central Hospital, Uppsala University, Västerås, Sweden.

The aim of this prospective, randomized study was to analyze dental and skeletal side effects after 4 years of treating obstructive sleep apnea (OSA) patients with a mandibular advancement device (MAD) compared with uvulopalatopharyngoplasty (UPPP). With the appliance in position, the mandible was advanced 50% of maximum protrusion capacity (ie, 4-6 mm); the vertical opening between the incisal edges was, on average, 3 mm. Thirty patients in the MAD group and 37 in the UPPP group completed the 4-year follow-up. There were no differences between the MAD and the UPPP groups in any of the dental or skeletal variables measured after the 4-year treatment period. In the MAD group, small but statistically significant changes were found: there was a posterior rotation of the mandible (mandibular line [ML]/nasion-sella line [NSL]) (mean 0.5 degrees [95% confidence interval (CI) 0.1-0.8 degrees ]). Correlated to the posterior rotation of the mandible, the distances incision superius ML, incision superius-NSL, and incision inferius-NSL increased by means (95% CI) of 0.7 (0.5-1.2), 0.8 (0.4-1.1), and 1.3 (0.8-1.8) mm, respectively. Overjet and overbite did not change significantly, nor was there a significant change in the mandibular length. The observed changes were considered clinically insignificant because overbite and overjet stayed within normal limits. Only the vertical position of the maxillary incisors in relation to ML changed to the extent that the 95% CI of the mean for the change was outside that of the mean of the change in the UPPP group and measurement error. Treatment of OSA with a dental appliance is probably a lifelong process, and long-term follow-up studies should therefore be undertaken to control both the treatment effect on OSA and the side effects on the masticatory system.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/s0889-5406(03)00240-3DOI Listing
July 2003

Prevalence of three lower urinary tract symptoms in men-a population-based study.

Fam Pract 2003 Feb;20(1):7-10

Uppsala University, Department of Public Health and Caring Sciences, Uppsala Science Park, S-75185 Uppsala, Sweden.

Background: Lower urinary tract symptoms are a common and costly public health issue. In earlier studies, the prevalence of urinary symptoms can be seen to fluctuate because there is no consensus about how to define and categorize the severity of the symptoms.

Objectives: The study was undertaken in order to investigate the prevalence of three common lower urinary tract symptoms (urgency, stress incontinence and post-micturition dribbling) and analyse health care-seeking behaviour.

Methods: A self-administered questionnaire was developed to investigate all men aged 40-80 years residing in the community of Surahammar, Sweden. The questionnaire included items on three specific urinary symptoms: urgency, stress incontinence and post-micturition dribbling, and one question about health care-seeking behaviour.

Results: A response rate of 86% was obtained in the questionnaire study. The overall prevalence of the lower urinary tract symptoms was 24%. The prevalence increased from 20% in the group aged 40-49 years to 28% in the group aged 70-80 years (P < 0.01). Post-micturition dribbling (21%) was the most frequent symptom, and stress incontinence (2.4%) was the least frequent symptom. The number of participants who sought health care was low (4%) and increased significantly with age (P < 0.001).

Conclusions: The present study showed that 24% of the Swedish cohort of men of 40-80 years of age reported at least one of the following symptoms: urgency, stress incontinence or post-micturition dribbling. This study is consistent with other research regarding the low consultation frequency for these symptoms. Moreover, the study is also in accord with those findings indicating that for the majority of men with urinary symptoms, their health care providers are not aware of their problem.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/fampra/20.1.7DOI Listing
February 2003

4-year follow-up of treatment with dental appliance or uvulopalatopharyngoplasty in patients with obstructive sleep apnea: a randomized study.

Chest 2002 Mar;121(3):739-46

Center for Clinical Research, Central Hospital, Västerås, Uppsala University, Sweden.

Study Objectives: To evaluate the effects of treatment with a dental appliance or uvulopalatopharyngoplasty (UPPP) on somnographic variables in patients with mild-to-moderate obstructive sleep apnea (OSA) followed up for 4 years, and compliance and complementary treatment.

Design: Randomized study.

Setting: Central Hospital, Västerås, Uppsala University, Sweden.

Patients: Ninety-five male patients with confirmed mild-to-moderate OSA (apnea index [AI] > 5 and < 25) were randomized to treatment with a dental appliance or UPPP. Sleep studies were performed before and 1 year and 4 years after intervention. Thirty-two patients in the dental-appliance group and 40 patients in the UPPP group completed the 4-year follow-up.

Results: The success rate (percentage of patients with at least 50% reduction in AI) in the dental-appliance group was 81%, which was significantly higher than in the UPPP group, 53% (p < 0.05). Normalization (AI < 5 or apnea/hypopnea index < 10) was observed in 63% of the dental-appliance group and 33% of the UPPP group after 4 years. The difference between the groups was significant (p < 0.05). The compliance to use of the dental appliance was 62% at the 4-year follow-up. Thirty patients (75%) in the UPPP group continued without complementary treatment. The dental appliances had few adverse effects on the stomatognathic system, and the number of adjustments and repairs of the appliances over time was moderate. Pronounced complaints of nasopharyngeal regurgitation of fluid and difficulty with swallowing after UPPP were reported by 8% and 10%, respectively.

Conclusions: The dental-appliance group showed significantly higher success and normalization rates regarding the somnographic variables compared to the UPPP group, but the effectiveness of the dental appliance was partly invalidated by the compliance of 62% at the 4-year follow-up. However, the appliances had few adverse effects on the stomatognathic system and required only moderate adjustments. Use of a dental appliance with regular follow-up can be recommended for long-term treatment of OSA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1378/chest.121.3.739DOI Listing
March 2002