Publications by authors named "Tarja Saaresranta"

75 Publications

Documentation of the patient's smoking status in common chronic diseases - analysis of medical narrative reports using the ULMFiT based text classification.

Eur Clin Respir J 2021 23;8(1):2004664. Epub 2021 Nov 23.

Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland.

Introduction: Smoking cessation is essential part of a successful treatment in many chronic diseases. Our aim was to analyse how actively clinicians discuss and document patients' smoking status into electronic health records (EHR) and deliver smoking cessation assistance.

Methods: We analysed the results using a combination of rule and deep learning-based algorithms. Narrative reports of all adult patients, whose treatment started between years 2010 and 2016 for one of seven common chronic diseases, were followed for two years. Smoking related sentences were first extracted with a rule-based algorithm. Subsequently, pre-trained ULMFiT-based algorithm classified each patient's smoking status as a current smoker, ex-smoker, or never smoker. A rule-based algorithm was then again used to analyse the physician-patient discussions on smoking cessation among current smokers.

Results: A total of 35,650 patients were studied. Of all patients, 60% were found to have a smoking status in EHR and the documentation improved over time. Smoking status was documented more actively among COPD (86%) and sleep apnoea (83%) patients compared to patients with asthma, type 1&2 diabetes, cerebral infarction and ischemic heart disease (range 44-61%). Of the current smokers (N=7,105), 49% had discussed smoking cessation with their physician. The performance of ULMFiT-based classifier was good with F-scores 79-92.

Conclusion: Ee found that smoking status was documented in 60% of patients with chronic disease and that the clinician had discussed smoking cessation in 49% of patients who were current smokers. ULMFiT-based classifier showed good/excellent performance and allowed us to efficiently study a large number of patients' medical narratives.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/20018525.2021.2004664DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8635564PMC
November 2021

Corrigendum to: Sleep during menopausal transition: a 10-year follow-up.

Sleep 2021 Dec;44(12)

Department of Pulmonary Diseases and Clinical Allergology, Sleep Research Center, University of Turku, Turku, Finland.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/sleep/zsab211DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8664568PMC
December 2021

Excessive Daytime Sleepiness in Obstructive Sleep Apnea Patients Treated With Continuous Positive Airway Pressure: Data From the European Sleep Apnea Database.

Front Neurol 2021 9;12:690008. Epub 2021 Aug 9.

Respiratory Function and Sleep Medicine Unit, Scientific Institutes of Pavia and Montescano, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Pavia, Italy.

Excessive daytime sleepiness (EDS) is a symptom of obstructive sleep apnea (OSA) that resolves under treatment with continuous positive airway pressure (CPAP). In some patients, sleepiness persists despite CPAP treatment. We retrospectively analyzed data on subjective residual EDS, assessed as an Epworth Sleepiness Scale score (ESS) >10, in patients from the European Sleep Apnea Database ( = 4,853, mean age ± SD 54.8 ± 11.8 years, 26.1% females), at baseline and at the first visit (median follow-up: 5 months, interquartile range 3-13). An ESS > 10 occurred in 56% of patients at baseline and in 28.2% of patients at follow-up. Residual EDS was analyzed in 2,190 patients (age: 55.1 ± 12.0 years, 26.1% females) with sleep monitoring data (median follow-up: 3 months, interquartile range 1-15). Sleep studies during CPAP use were obtained in 58% of these patients; EDS was reported by 47.2% of patients at baseline and by 30.3% at follow-up. Residual OSA, defined as an apnea-hypopnea index >10/h, and insufficient CPAP adherence, defined as nightly use <4 h, occurred with similar frequency in patients with and without EDS at follow-up. Prevalence of residual EDS was highest (40%) in patients with a first follow-up visit at 0-3 months, then it was 13-19% in patients with a first follow-up visit after 4 months to 2 years. The change in ESS ( = 2,190) was weakly correlated with CPAP use (R = 0.023, < 0.0001). Logistic regression showed that an ESS score >10 at the first follow-up visit was associated directly with ESS at baseline and inversely with duration of follow-up, and CPAP use (R of the model: 0.417). EDS showed heterogeneity in different European countries both at baseline and at the first follow-up visit, suggesting modulation by cultural and lifestyle factors. In conclusion, residual EDS in CPAP-treated OSA occurred in approximately one in four patients at follow-up; its prevalence was highest (40%) in the first 3 months of treatment and subsequently decreased. The finding of residual EDS in a significant percentage of optimally treated OSA patients suggests that wake-promoting agents may be useful, but their indication should be evaluated after at least 3 months of treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fneur.2021.690008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8381644PMC
August 2021

Metabolic dysfunction in OSA: Is there something new under the sun?

J Sleep Res 2022 Feb 21;31(1):e13418. Epub 2021 Jun 21.

Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland.

The growing number of patients with obstructive sleep apnea is challenging healthcare systems worldwide. Obstructive sleep apnea is characterized by chronic intermittent hypoxaemia, episodes of apnea and hypopnea, and fragmented sleep. Cardiovascular and metabolic diseases are common in obstructive sleep apnea, also in lean patients. Further, comorbidity burden is not unambiguously linked to the severity of obstructive sleep apnea. There is a growing body of evidence revealing diverse functions beyond the conventional tasks of different organs such as carotid body and gut microbiota. Chronic intermittent hypoxia and sleep loss due to sleep fragmentation are associated with insulin resistance. Indeed, carotid body is a multi-sensor organ not sensoring only hypoxia and hypercapnia but also acting as a metabolic sensor. The emerging evidence shows that obstructive sleep apnea and particularly chronic intermittent hypoxia is associated with non-alcoholic fatty liver disease. Gut dysbiosis seems to be an important factor in the pathophysiology of obstructive sleep apnea and its consequences. The impact of sleep fragmentation and intermittent hypoxia on the development of metabolic syndrome may be mediated via altered gut microbiota. Circadian misalignment seems to have an impact on the cardiometabolic risk in obstructive sleep apnea. Dysfunction of cerebral metabolism is also related to hypoxia and sleep fragmentation. Therefore, obstructive sleep apnea may alter cerebral metabolism and predispose to neurocognitive impairment. Moreover, recent data show that obstructive sleep apnea independently predicts impaired lipid levels. This mini-review will provide novel insights into the mechanisms of metabolic dysfunction in obstructive sleep apnea combining recent evidence from basic, translational and clinical research, and discuss the impact of positive airway pressure treatment on metabolic disorders.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jsr.13418DOI Listing
February 2022

Positive airway pressure (PAP) treatment reduces glycated hemoglobin (HbA1c) levels in obstructive sleep apnea patients with concomitant weight loss: Longitudinal data from the ESADA.

J Sleep Res 2021 10 14;30(5):e13331. Epub 2021 May 14.

Department of Chest Diseases, Ege University Faculty of Medicine, Izmir, Turkey.

Patients with obstructive sleep apnea (OSA) are at increased risk of developing metabolic disease such as diabetes. The effects of positive airway pressure on glycemic control are contradictory. We therefore evaluated the change in glycated hemoglobin (HbA1c) in a large cohort of OSA patients after long-term treatment with positive airway pressure. HbA1c levels were assessed in a subsample of the European Sleep Apnea Database [n=1608] at baseline and at long-term follow up with positive airway pressure therapy (mean 378.9±423.0 days). In a regression analysis, treatment response was controlled for important confounders. Overall, HbA1c decreased from 5.98±1.01% to 5.93±0.98% (p=0.001). Patient subgroups with a more pronounced HbA1c response included patients with diabetes (-0.15±1.02, p=0.019), those with severe OSA baseline (-0.10±0.68, p=0.005), those with morbid obesity (-0.20±0.81, p<0.001). The strongest HbA1c reduction was observed in patients with a concomitant weight reduction >5 kilos (-0.38±0.99, p<0.001). In robust regression analysis, severe OSA (p=0.038) and morbid obesity (p=0.005) at baseline, and weight reduction >5 kilos (p<0.001) during follow up were independently associated with a reduction of HbA1c following PAP treatment. In contrast, PAP treatment alone without weight reduction was not associated with significant Hb1Ac reduction. In conclusion, positive airway pressure therapy is associated with HbA1c reduction in patients with severe OSA, in morbidly obese patients. and most obviously in those with significant weight lost during the follow-up. Our study underlines the importance to combine positive airway pressure use with adjustments in lifestyle to substantially modify metabolic complications in OSA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jsr.13331DOI Listing
October 2021

The association between high risk of sleep apnea, comorbidities, and risk of COVID-19: a population-based international harmonized study.

Sleep Breath 2021 06 28;25(2):849-860. Epub 2021 Apr 28.

Helsinki Sleep Clinic, Vitalmed Research Center, and Department of Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland.

Purpose: Obstructive sleep apnea (OSA) may increase the risk of severe COVID-19; however, the level of potential modulation has not yet been established. The objective of the study was to determine the association between high risk of OSA, comorbidities, and increased risk for COVID-19, hospitalization, and intensive care unit (ICU) treatment.

Methods: We conducted a cross-sectional population-based web survey in adults in 14 countries/regions. The survey included sociodemographic variables and comorbidities. Participants were asked questions about COVID-19, hospitalization, and ICU treatment. Standardized questionnaire (STOP questionnaire for high risk of OSA) was included. Multivariable logistic regression was conducted adjusting for various factors.

Results: Out of 26,539 respondents, 20,598 (35.4% male) completed the survey. Mean age and BMI of participants were 41.5 ± 16.0 years and 24.0 ± 5.0 kg/m, respectively. The prevalence of physician-diagnosed OSA was 4.1% and high risk of OSA was 9.5%. We found that high risk of OSA (adjusted odds ratio (aOR) 1.72, 95% confidence interval (CI): 1.20, 2.47) and diabetes (aOR 2.07, 95% CI: 1.23, 3.48) were associated with reporting of a COVID-19 diagnosis. High risk for OSA (aOR 2.11, 95% CI: 1.10-4.01), being male (aOR: 2.82, 95% CI: 1.55-5.12), having diabetes (aOR: 3.93, 95% CI: 1.70-9.12), and having depression (aOR: 2.33, 95% CI: 1.15-4.77) were associated with increased risk of hospitalization or ICU treatment.

Conclusions: Participants at high risk of OSA had increased odds of having COVID-19 and were two times more likely to be hospitalized or treated in ICU.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11325-021-02373-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8079162PMC
June 2021

Impact of temperature on obstructive sleep apnoea in three different climate zones of Europe: Data from the European Sleep Apnoea Database (ESADA).

J Sleep Res 2021 10 11;30(5):e13315. Epub 2021 Apr 11.

Pulmonary Department, Sleep Disorders Center, Sahlgrenska University Hospital, Gothenbrug, Sweden.

Recent studies indicate that ambient temperature may modulate obstructive sleep apnoea (OSA) severity. However, study results are contradictory warranting more investigation in this field. We analysed 19,293 patients of the European Sleep Apnoea Database (ESADA) cohort with restriction to the three predominant climate zones according to the Köppen-Geiger climate classification: Cfb (warm temperature, fully humid, warm summer), Csa (warm temperature, summer dry, hot summer), and Dfb (snow, fully humid, warm summer). Average outside temperature values were obtained and several hierarchical regression analyses were performed to investigate the impact of temperature on the apnea-hypopnea index (AHI), oxygen desaturation index (ODI), time of oxygen saturation <90% (T90) and minimum oxygen saturation (MinSpO ) after controlling for confounders including age, body mass index, gender, and air conditioning (A/C) use. AHI and ODI increased with higher temperatures with a standardised coefficient beta (β) of 0.28 for AHI and 0.25 for ODI, while MinSpO decreased with a β of -0.13 (all results p < .001). When adjusting for climate zones, the temperature effect was only significant in Cfb (AHI: β = 0.11) and Dfb (AHI: β = 0.08) (Model 1: p < .001). The presence of A/C (3.9% and 69.3% in Cfab and Csa, respectively) demonstrated only a minor increase in the prediction of the variation (Cfb: AHI, R +0.003; and Csa: AHI, R +0.007; both p < .001). Our present study indicates a limited but consistent influence of environmental temperature on OSA severity and this effect is modulated by climate zones.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jsr.13315DOI Listing
October 2021

Mood, sleepiness, and weight gain after three years on CPAP therapy for sleep apnoea.

Eur Clin Respir J 2021 Feb 17;8(1):1888394. Epub 2021 Feb 17.

Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland.

The prevalence of obstructive sleep apnoea syndrome (OSAS) keeps on rising. Daytime sleepiness resulting from fragmented sleep is the prime symptom, and obesity the major risk factor for OSAS. Quality of life with OSAS is often affected by depressive symptoms and anxiety. Nasal continuous positive airway pressure (CPAP) therapy reduces daytime sleepiness, but the results on the effect on mood, physical activity, and weight are controversial especially on long-term therapy. Purpose of this study was to evaluate these factors and predictors of weight gain during long-term CPAP therapy. Consecutive patients (n = 223), referred to sleep study with suspected OSAS, were enrolled. Patients underwent a cardiorespiratory polygraphy at baseline and a battery of questionnaires was completed, both at baseline, and after three years of follow-up. Total of 149 (67%; M 65, F 84) patients completed the follow-up. Of the 149 patients, 76 (51.0%; M 32, F 44) used CPAP. In this study, depressive symptoms, anxiety, and sleepiness were alleviated during CPAP therapy. However, therapy did not have an influence on cravings of different food categories, or exercise habits and exercise duration. From the various factors studied, solely higher adherence to CPAP therapy was associated with weight gain. This research provides further evidence that long-term CPAP therapy in patients with OSAS not only decreases sleepiness and improves sleep quality but could also alleviate depressive symptoms and anxiety. In addition, our study reinforces that CPAP therapy alone is not sufficient for weight management in patients with OSAS. Regardless of comprehensive battery of questionnaires, we were unable to establish markers predicting weight gain during therapy. We advise on life-style counselling and weight management program to all patients with obesity on CPAP therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/20018525.2021.1888394DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7894421PMC
February 2021

Sleep during menopausal transition: a 10-year follow-up.

Sleep 2021 06;44(6)

Department of Pulmonary Diseases and Clinical Allergology, Sleep Research Center, University of Turku, Turku, Finland.

Study Objectives: A 10-year observational follow-up study to evaluate the changes in sleep architecture during the menopausal transition.

Methods: Fifty-seven premenopausal women (mean age 46 years, SD 0.9) were studied at baseline and after a 10-year follow-up. At both time points, polysomnography (PSG) was performed, and the serum follicle-stimulating hormone (S-FSH) concentration was measured. Linear regression models were used to study the effects of aging and menopause (assessed as change in S-FSH) on sleep.

Results: After controlling for body mass index, vasomotor, and depressive symptoms, higher S-FSH level was associated with longer sleep latency (B 0.45, 95% confidence interval [CI]: 0.07 to 0.83). Aging of 10 years was associated with shorter sleep latency (B -46.8, 95% CI: -77.2 to -16.4), shorter latency to stage 2 sleep (B -50.6, 95% CI: -85.3 to -15.9), decreased stage 2 sleep (B -12.4, 95% CI: -21.4 to -3.4), and increased slow-wave sleep (B 12.8, 95% CI: 2.32 to 23.3) after controlling for confounding factors.

Conclusions: This study suggests that PSG measured sleep of middle-aged women does not worsen over a 10-year time span due to the menopausal transition. The observed changes seem to be rather age- than menopause-dependent.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/sleep/zsaa283DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8193555PMC
June 2021

Medication of comorbidities in females with sleep-disordered breathing during long-term CPAP therapy.

Respir Med 2020 08 12;169:106014. Epub 2020 May 12.

Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, PO Box 52, FIN-20520, Turku, Finland; Department of Pulmonary Diseases and Clinical Allergology, University of Turku, PO Box 52, FIN-20520, Turku, Finland; Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Lemminkäisenkatu 3b, 20520, TURKU, Finland. Electronic address:

Background: Treating sleep disordered breathing (SDB) with nasal continuous positive airway pressure (CPAP) may reduce mortality, but the studies on the effect on medication use are few. Women tend to have more mild sleep apnoea and partial airway obstruction and are therefore expected to have less co-morbidity. The purpose of this study was to evaluate the effect of CPAP therapy on medication use in women as overall medication, and in different subcategories of diseases, and to evaluate the impact of nocturnal airway obstruction type as partial or complete.

Methods: From the database of the Department of Pulmonary Diseases in Turku University Hospital from 1994 to 1998, 601 consecutive females with SDB were enrolled, and the type of SDB was evaluated. All were offered CPAP therapy. The medication use measured as defined daily doses (DDD) in overall medication and in nine subcategories were collected three years before and three years after CPAP initiation.

Results: In final analyses, 182 women were included. In CPAP users (n = 66), comorbidities were more frequent and DDDs higher overall, in asthma, in chronic obstructive pulmonary disease, and in severe mental disorders, both before and after CPAP initiation. The medication use was similar regardless of the type of SDB. The change in medication use was similar as in controls.

Conclusions: CPAP therapy did not decrease medication use in three-year follow-up. However, possibly continuous rise in medication use was prevented, as the change in medication use was similar in controls. Complete and partial obstruction had similar effects.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.rmed.2020.106014DOI Listing
August 2020

Motor vehicle accidents in CPAP-compliant obstructive sleep apnea patients-a long-term observational study.

Sleep Breath 2020 Sep 14;24(3):1089-1095. Epub 2020 Feb 14.

Department of Pulmonary Diseases, Division of Medicine, Turku University Hospital and University of Turku, Hämeentie 11, FI-20520, Turku, Finland.

Purpose: Obstructive sleep apnea (OSA) has been associated with a 2- to 7-fold risk of motor vehicle accidents (MVAs). Continuous positive airway pressure (CPAP) treatment may reduce MVA risk. We further explored this issue in long-term CPAP users and untreated controls.

Methods: We used both before-after and case-control study designs. The observational cohort consisted of CPAP-treated and untreated patients matched for gender, age, and apnea-hypopnea index. All MVAs reported to the police were identified.

Results: A total of 2060 patients (75.8% male, mean age 56.0 ± 10.5 years) were included. The CPAP-treated patients (N = 1030) were screened for MVAs for a median of 9.0 years before and after treatment. The median CPAP usage was 6.4 h/day. The control patients (N = 1030) were screened for MVAs for a median of 6.5 years after discontinuation of CPAP. No significant differences were observed between the incidences of MVAs per 1000 person years before treatment (3.2), after treatment (3.9), or in controls (2.6). Compared with controls, patients who had MVA after treatment had a higher body mass index (BMI), but did not differ in terms of other baseline characteristics, sleep study data, or accident conditions. In the majority of these patients, daytime sleepiness was reduced, whereas BMI tended to increase during treatment.

Conclusions: The MVA incidence did not change after CPAP treatment. Among the patients who had MVA, BMI was the only baseline characteristic that differed between the groups and tended to further increase after CPAP treatment. Differences in sleep study data or accident conditions were not observed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11325-020-02023-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7426312PMC
September 2020

Response to the letter entitled "COPD-and-smoking-induced 'down regulation' of CO2-related vasoconstriction in the brain during CPAP for sleep apnea may paradoxically reduce risk of cardiovascular events".

Sleep Breath 2020 09 11;24(3):1183-1185. Epub 2020 Feb 11.

Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, University of Turku, Hämeentie 11, FIN-20520, Turku, Finland.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11325-020-02028-xDOI Listing
September 2020

Pitolisant for Daytime Sleepiness in Patients with Obstructive Sleep Apnea Who Refuse Continuous Positive Airway Pressure Treatment. A Randomized Trial.

Am J Respir Crit Care Med 2020 05;201(9):1135-1145

Hypoxia-Physiopathology (HP2) Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France; and.

Excessive daytime sleepiness is a common disabling symptom in obstructive sleep apnea syndrome. To evaluate the efficacy and safety of pitolisant, a selective histamine H3 receptor antagonist with wake-promoting effects, for the treatment of daytime sleepiness in patients with moderate to severe obstructive sleep apnea refusing continuous positive airway pressure treatment. In an international, multicenter, double-blind, randomized (3:1), placebo-controlled, parallel-design trial, pitolisant was individually titrated at up to 20 mg/d over 12 weeks. The primary endpoint was the change in the Epworth Sleepiness Scale score. Key secondary endpoints were maintenance of wakefulness assessed on the basis of the Oxford Sleep Resistance test, safety, Clinical Global Impression of severity, patient's global opinion, EuroQol quality-of-life questionnaire, and Pichot fatigue questionnaire. A total of 268 patients with obstructive sleep apnea (75% male; mean age, 52 yr; apnea-hypopnea index, 49/h; baseline sleepiness score, 15.7) were randomized (200 to pitolisant and 68 to placebo) and analyzed on an intention-to-treat basis. The Epworth Sleepiness Scale score was reduced more with pitolisant than with placebo (-2.8; 95% confidence interval, -4.0 to -1.5;  < 0.001). Wake maintenance tests were not improved. The Pichot fatigue score was reduced with pitolisant. The overall impact of pitolisant was confirmed by both physicians' and patients' questionnaires. Adverse event incidence, mainly headache, insomnia, nausea, and vertigo, was similar in the pitolisant and placebo groups (29.5% and 25.4%, respectively), with no cardiovascular or other significant safety concerns. Pitolisant significantly reduced self-reported daytime sleepiness and fatigue and improved patient-reported outcomes and physician disease severity assessment in sleepy patients with obstructive sleep apnea refusing or nonadherent to continuous positive airway pressure.Clinical trial registered with www.clinicaltrials.gov (NCT01072968) and EU Clinical Trials Register (EudraCT 2009-017251-94).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1164/rccm.201907-1284OCDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7193861PMC
May 2020

Unattended sleep study in screening for sleep apnea in the acute phase of ischemic stroke.

Sleep Med 2020 01 8;65:121-126. Epub 2019 Aug 8.

Turku University Hospital, Division of Medicine, Department of Pulmonary Diseases and Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Finland.

Objectives: We aimed to compare the feasibility of automatically and manually scored cardiorespiratory polygraphy results for sleep apnea screening in the acute phase of ischemic stroke.

Methods: Prospective study included 204 ischemic stroke patients, who underwent nocturnal unattended portable monitoring with three-channel device during 48 h after onset of stroke symptoms. Sleep apnea diagnosis was determined as a respiratory event index (REI) ≥5/hour.

Results: The mean age of the patients was 67.7 years and 62.7% were males. Automatic scoring identified sleep apnea in 148/72.5% and manual scoring in 186/91.2% of patients, showing moderate agreement (Kappa value 0.407). Of the cohort, 39 (19.1%) patients fulfilled the criteria for diagnosis of central sleep apnea (CSA) (>50% of events central) and 165 (80.9%) had obstructive sleep apnea (OSA). Automatic scoring identified poorly the type of events, and missed 18.6% of recordings. Oxygen desaturation 4% index (ODI4), interclass correlation coefficient (ICC) value 0.993, (95% CI 0.990-0.994), lowest saturation (ICC value 0.989, 95% CI 0.985-0.991) and percent of time spent <90% (ICC value 0.987, 95% CI 0.982-0.990) showed excellent agreement. Interclass correlation value for REI was 0.869 (95% CI 0.828 to 0.901) and ICC value 0.848 (95% CI 0.800 to 0.885) for obstructive apnea index, both indicating good agreement. Automatic scoring underestimated the severity of sleep apnea.

Conclusions: Both automatically and manually scored results recognized sleep apnea, albeit manual scoring identified more sleep apnea. Sleep apnea diagnosis agreement was moderate. Underestimation of the severity of sleep apnea by automatic scoring may result in undertreatment of sleep apnea.

Clinical Trial Registration: URL:http://www.clinicaltrials.cov. Unique identifier: NCT01861275.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.sleep.2019.08.002DOI Listing
January 2020

Sex differences in obstructive sleep apnoea.

Eur Respir Rev 2019 Dec 6;28(154). Epub 2019 Nov 6.

Dept of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK

Obstructive sleep apnoea (OSA) and obstructive sleep apnoea/hypopnoea syndrome (OSAHS) have long been considered predominantly male-related conditions. The clinical presentation of sleep disordered breathing in females differs from males and can vary with age and physiological status, menopause and pregnancy. Overall, females appear to be more symptomatic, with lower apnoea-hypopnoea index scores compared to males. Furthermore, they appear to have more prolonged partial upper airway obstruction, and may report insomnia as a symptom of OSAHS more frequently. As a consequence of these differences in clinical presentation, females with sleep disordered breathing are often underdiagnosed and undertreated compared to males. This review is aimed at discussing the epidemiology, clinical presentation, pathophysiology and hormonal and metabolic differences in females who present with OSA/OSAHS in comparison to males.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1183/16000617.0030-2019DOI Listing
December 2019

Decreased forced expiratory volume in first second is associated with erectile dysfunction in apparently healthy men. A preliminary study.

Int J Impot Res 2020 Jul 5;32(4):420-425. Epub 2019 Sep 5.

Central Satakunta Health Federation of Municipalities, Harjavalta, Finland.

Although it has been evaluated that even 76% of men with chronic obstructive pulmonary disease suffer from erectile dysfunction, the association has been poorly characterised. The aim of the study was to describe the association between forced expiratory volume in first second and erectile dysfunction in apparently healthy men. All together 331 men aged 45-70 years old were randomly drawn from a cross-sectional population-based study conducted in 2005 in Finland. Decreased forced expiratory volume was defined by performing mini-spirometry and erectile dysfunction by International Index of Erectile Function short form questionnaire. After adjustment for age and depressive symptoms predicted forced expiratory volume (FEV < 65%) was associated with 2.66 (95% CI, 1.18-5.99) increased risk of moderate to severe erectile dysfunction (International Index of Erectile Function short form score < 17). Therefore, the authors highlight the importance of erectile and sexual health evaluation and treatment, if necessary, in men with decreased lung function.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41443-019-0184-1DOI Listing
July 2020

Stroke Volume Predicts Nocturnal Hypoxemia in the Acute Ischemic Stroke after Intravenous Thrombolysis.

J Stroke Cerebrovasc Dis 2019 Sep 3;28(9):2481-2487. Epub 2019 Jul 3.

Department of Neurology, Oulu University Hospital, Oulu, Finland.

The Goal: The aim of the study was to investigate whether stroke volume or the presence of ischemic stroke lesion on follow-up computed tomography 1 day after admission had association with sleep apnea among ischemic stroke patients undergoing thrombolysis.

Materials And Methods: We prospectively recruited 110 consecutive ischemic stroke patients and performed computed tomography on admission and after 24 hours after intravenous thrombolysis. Stroke volume was measured from post-thrombolysis computed tomography scans. Unattended cardiorespiratory polygraphy with a 3-channel device was performed during 48 hours after admission.

Findings: Of 110 ischemic stroke patients treated with thrombolysis 65.5% were men. Mean age was 65.8 years and body mass index 27.5 kg/m. The mean Epworth sleepiness scale score was 4.7. Eight patients (12.7%) with visible acute stroke after thrombolysis and none in the other group had hemorrhage as complication (P ˂ .001). Sleep apnea, determined as a respiratory event index greater than or equal to 5/hour, was diagnosed in 96.4% patients. Respiratory event index greater than 15/h was found in 72.8% of patients. Both mean baseline oxygen desaturation index (23.9 versus 16.5, P = .028) and obstructive apneas/hour (6.2 versus 2.7, P = .007) were higher in visible stroke group. Stroke volume (mean 15.9 mL) correlated with proportion of time spent below saturation less than 90%, P = .025.

Conclusions: Acute ischemic stroke patients treated with thrombolysis with visible stroke were more likely to have nocturnal hypoxemia than patients with not visible strokes. Stroke volume correlated with time spent below saturation of 90%.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2019.06.017DOI Listing
September 2019

Gender-specific change in leptin concentrations during long-term CPAP therapy.

Sleep Breath 2020 Mar 4;24(1):191-199. Epub 2019 May 4.

Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, PO Box 52, FI-20520, Turku, Finland.

Purpose: Nasal continuous positive airway pressure (CPAP) alleviates sleepiness in patients with obstructive sleep apnoea syndrome (OSAS), but part of OSAS patients keep gaining weight. Leptin and insulin-like growth factor-1 (IGF-1) interact with energy balance, and CPAP therapy has been suggested to influence these endocrine factors. We hypothesised that leptin would decrease during long-term CPAP therapy, and weight gain would associate with OSAS severity, lower CPAP adherence, lower IGF-1, and leptin concentrations.

Methods: Consecutive patients (n = 223) referred to sleep study with suspected OSAS were enrolled. Patients underwent cardiorespiratory polygraphy at baseline. Questionnaires were completed, and blood samples were drawn both at baseline and after 3 years. A total of 149 (67%; M 65, F 84) patients completed the follow-up. Plasma samples were available from 114 patients, 109 of which with CPAP adherence data (49 CPAP users, 60 non-users).

Results: At baseline, the CPAP users were more obese and had more severe OSAS than the non-users. Leptin concentrations did not differ. After follow-up, leptin concentrations were higher in CPAP users (30.2 ng/ml vs. 16.8 ng/ml; p = 0.001). In regression analysis, increase in leptin concentrations was independent of age, baseline body mass index (BMI), or the change in BMI. Leptin concentrations increased among females (- 8.9 vs. 12.7 ng/ml; p < 0.001); whereas in men, CPAP did not have an effect, if not opposed the natural decrease in leptin observed in men not using CPAP. Change in IGF-1 levels did not differ.

Conclusions: Our results suggest increase in leptin concentrations during long-term CPAP therapy among females.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11325-019-01846-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7128000PMC
March 2020

Response to letter entitled "CPAP adherence and cardiovascular disease: beware of the healthy adherer effect".

Sleep Breath 2020 06 27;24(2):601-602. Epub 2019 Apr 27.

Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital and University of Turku, Hämeentie 11, FIN-20520, Turku, Finland.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11325-019-01850-2DOI Listing
June 2020

Sleep Parameter Assessment Accuracy of a Consumer Home Sleep Monitoring Ballistocardiograph Beddit Sleep Tracker: A Validation Study.

J Clin Sleep Med 2019 03 15;15(3):483-487. Epub 2019 Mar 15.

Department of Psychology and Speech-Language Pathology, University of Turku, Finland.

Study Objectives: Growing interest in monitoring sleep and well-being has created a market for consumer home sleep monitoring devices. Additionally, sleep disorder diagnostics, and sleep and dream research would benefit from reliable and valid home sleep monitoring devices. Yet, majority of currently available home sleep monitoring devices lack validation. In this study, the sleep parameter assessment accuracy of Beddit Sleep Tracker (BST), an unobtrusive and non-wearable sleep monitoring device based on ballistocardiography, was evaluated by comparing it with polysomnography (PSG) measures. We measured total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), and sleep efficiency (SE). Additionally, we examined whether BST can differentiate sleep stages.

Methods: We performed sleep studies simultaneously with PSG and BST in ten healthy young adults (5 female/5 male) during two non-consecutive nights in a sleep laboratory.

Results: BST was able to distinguish SOL with some accuracy. However, it underestimated WASO and thus overestimated TST and SE. Also, it failed to discriminate between non-rapid eye movement sleep stages and did not detect the rapid eye movement sleep stage.

Conclusions: These findings indicate that BST is not a valid device to monitor sleep. Consumers should be careful in interpreting the conclusions on sleep quality and efficiency provided by the device.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5664/jcsm.7682DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6411173PMC
March 2019

Nonfatal and fatal cardiovascular disease events in CPAP compliant obstructive sleep apnea patients.

Sleep Breath 2019 Dec 8;23(4):1209-1217. Epub 2019 Mar 8.

Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital and University of Turku, Hämeentie 11, FI-20520, Turku, Finland.

Purpose: Obstructive sleep apnea (OSA) is suggested to predispose to cardiovascular disease (CVD) events. It is uncertain whether compliance to continuous positive airway pressure (CPAP) treatment could attenuate the risk. We explored this issue in long-term CPAP users and untreated controls.

Methods: Retrospective observational cohort of CPAP-treated and control patients were pairwise matched for gender, age, and apnea-hypopnea index (AHI). The study end point was a composite of nonfatal and fatal CVD events. Cox regression model was used to determine the association between CPAP treatment and event-free survival.

Results: A total of 2060 patients (75.8% male, mean age 56.0 ± 10.5 years), of which 76.4% had moderate-severe OSA, were included. In the CPAP-treated group (N = 1030), the median use of CPAP was 6.4 h/day during a median follow-up of 8.7 years. The control group (N = 1030) was followed for a median of 6.2 years after the CPAP treatment had ended. The study end point occurred in 14.4% (N = 148) of the CPAP-treated and in 18.8% (N = 194) of the control patients (p = 0.006). Using the Cox regression model adjusted for gender, age, AHI, body mass index, and history of CVD, hypertension, type 2 diabetes, and chronic obstructive pulmonary disease at baseline, a beneficial association between CPAP treatment and CVD risk was observed (hazard ratio 0.64, confidence interval 95% 0.5-0.8, p < 0.001).

Conclusions: CPAP treatment was associated with a decreased risk of nonfatal and fatal CVD events. Majority of the patients were compliant to CPAP. The association was demonstrated independent from common cardiovascular risk factors and AHI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11325-019-01808-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6868046PMC
December 2019

Use of the Clinical Global Impression scale in sleep apnea patients - Results from the ESADA database.

Sleep Med 2019 07 14;59:56-65. Epub 2018 Nov 14.

Department of Sleep Medicine, Sahlgrenska University Hospital, Sweden; Sahlgrenska Academy, Gothenburg University, Sweden. Electronic address:

Objective/background: The Clinical Global Impression scale (CGI) reflects the clinician's assessment of the disease impact on patient's global functioning. We assessed predictors of CGI scale rating in patients with obstructive sleep apnea (OSA).

Patients/methods: Consecutive patients with suspected OSA (n = 7581) were identified in the European Sleep Apnea Database (ESADA). Anthropometrics, comorbidities, apnea severity obtained by polygraphy or polysomnography, and daytime sleepiness [Epworth Sleepiness Scale (ESS)] were assessed. The CGI 7-point scale was completed at the end of the diagnostic process (CGI-severity, ie, CGI-S) and, in a subpopulation, at treatment follow-up (CGI-Improvement).

Results: CGI-S was rated mild to moderate in 44% of patients. CGI rating at any given apnea intensity was worse in women than in men (p < 0.01). Patients undergoing polygraphy (n = 5075) were more frequently rated as severely ill compared to those studied with polysomnography (19.0% vs 13.0%, p < 0.001). In patients aged ≤65 years, CGI scoring was generally better than in the elderly despite a similar degree of OSA (eg, 'normal, not ill' 24.2% vs 15.3%, p < 0.01, respectively). Independent predictors of CGI rating included age, BMI, AHI, ESS, cardio-metabolic comorbidities, and diagnosis based on polygraphy. CGI-improvement rating (Beta = -0.406, p < 0.01) was superior to sleep apnea severity or ESS-score (Beta = 0.052 and -0.021, p = 0.154 and 0.538 respectively) at baseline for prediction of good CPAP compliance at follow-up.

Conclusions: CGI rating is confounded by gender, age class and the type of sleep diagnostic method. As OSA phenotypes differ, CGI may contribute as a clinical tool to reflect the significance of clinical disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.sleep.2018.10.028DOI Listing
July 2019

The Evolution of Sleep Apnea Six Months After Acute Ischemic Stroke and Thrombolysis.

J Clin Sleep Med 2018 12 15;14(12):2005-2011. Epub 2018 Dec 15.

Department of Neurology, Oulu University Hospital and University of Oulu, Oulu, Finland.

Study Objectives: Our goal was to investigate the evolution of prevalence, severity, and type of sleep apnea among patients who had an ischemic stroke, with or without treatment with thrombolysis after 6 months.

Methods: We prospectively studied 204 patients who had an ischemic stroke (110 in the thrombolysis and 94 in the non-thrombolysis group). After follow-up, 177 patients were eligible for a final analysis (98 in the thrombolysis group and 79 in the non-thrombolysis group). An unattended sleep study with a three-channel portable device was performed both on admission and after the 6-month follow-up.

Results: The patients receiving thrombolysis were younger than those in the non-thrombolysis group (mean 65.5 versus 69.6 years = .039). Sleep apnea, defined as a respiratory event index (REI) ≥ 5 events/h, was diagnosed in 92.7% patients, 93.9% versus 91.1% ( = .488) in the thrombolysis and non-thrombolysis groups, respectively. The prevalence remained unchanged during follow-up. Mild sleep apnea progressed to moderate or severe sleep apnea in 69.2% of the patients. Globally, mean central apneas per hour increased by 2.2% ( = .002), whereas obstructive apneas declined by 1.7% ( = .014). The mean change of oxygen desaturation index was -6.1% ( < .001) in the thrombolysis group, -1.8% ( = .327) in the non-thrombolysis group, and 4.2% ( = .001) in the whole group. In the non-thrombolysis group, the risk for new sleep apnea incidence increased by 6.1-fold ( = .024) at follow-up when compared to the thrombolysis group.

Conclusions: Sleep apnea prevalence remained high in patients who had an ischemic stroke at 6 months post-stroke. The risk for developing sleep apnea after stroke was significantly lower among patients undergoing thrombolysis.

Clinical Trial Registration: Registry: ClinicalTrials.gov; Title: Ischaemic Stroke and Sleep Apnea in Northern Part of Finland; Identifier: NCT01861275; URL: https://clinicaltrials.gov/ct2/show/NCT01861275.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5664/jcsm.7524DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6287720PMC
December 2018

Sleep and Sleep Disorders in the Menopausal Transition.

Sleep Med Clin 2018 Sep;13(3):443-456

Department of Pulmonary Diseases and Clinical Allergology, Sleep Research Centre, University of Turku, Turku, Finland; Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, Turku, Finland.

The menopausal transition is associated with an increase in insomnia symptoms, especially difficulty staying asleep, which negatively impacts quality of life. Vasomotor symptoms are a key component of sleep disruption. Findings from polysomnographic studies are less consistent in showing disrupted sleep in menopausal transition independent of aging; further prospective studies are needed. Hormone therapy alleviates subjective sleep disturbances, particularly if vasomotor symptoms are present. However, because of contraindications, other options should be considered. Further work is needed to develop preventive and treatment strategies for alleviating sleep disturbances to ensure better health, quality of life, and productivity in midlife women.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jsmc.2018.04.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6092036PMC
September 2018

Fixed But Not Autoadjusting Positive Airway Pressure Attenuates the Time-dependent Decline in Glomerular Filtration Rate in Patients With OSA.

Chest 2018 08 24;154(2):326-334. Epub 2018 Apr 24.

CNR, Institute of Biomedicine and Molecular Immunology, Palermo, Italy; DiBiMIS, University of Palermo, Palermo, Italy.

Background: The impact of treating OSA on renal function decline is controversial. Previous studies usually included small samples and did not consider specific effects of different CPAP modalities. The aim of this study was to evaluate the respective influence of fixed and autoadjusting CPAP modes on estimated glomerular filtration rate (eGFR) in a large sample of patients derived from the prospective European Sleep Apnea Database cohort.

Methods: In patients of the European Sleep Apnea Database, eGFR prior to and after follow-up was calculated by using the Chronic Kidney Disease-Epidemiology Collaboration equation. Three study groups were investigated: untreated patients (n = 144), patients receiving fixed CPAP (fCPAP) (n = 1,178), and patients on autoadjusting CPAP (APAP) (n = 485).

Results: In the whole sample, eGFR decreased over time. The rate of eGFR decline was significantly higher in the subgroup with eGFR above median (91.42 mL/min/1.73 m) at baseline (P < .0001 for effect of baseline eGFR). This decline was attenuated or absent (P < .0001 for effect of treatment) in the subgroup of patients with OSA treated by using fCPAP. A follow-up duration exceeding the median (541 days) was associated with eGFR decline in the untreated and APAP groups but not in the fCPAP group (P < .0001 by two-way ANOVA for interaction between treatment and follow-up length). In multiple regression analysis, eGFR decline was accentuated by advanced age, female sex, cardiac failure, higher baseline eGFR, and longer follow-up duration, whereas there was a protective effect of fCPAP.

Conclusions: fCPAP but not APAP may prevent eGFR decline in OSA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.chest.2018.04.020DOI Listing
August 2018

Prevalence of sleep apnea at the acute phase of ischemic stroke with or without thrombolysis.

Sleep Med 2017 Dec 7;40:40-46. Epub 2017 Oct 7.

Turku University Hospital, Division of Medicine, Department of Pulmonary Diseases and Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Finland.

Objective: The aim of the study was to compare the prevalence, type, and severity of sleep apnea during the acute phase of ischemic stroke among patients either receiving or not receiving thrombolysis.

Methods: We recruited 246 consecutive adult ischemic stroke patients. Patients underwent cardiorespiratory sleep study with portable three-channel device during the first 48 h after the symptom onset of ischemic stroke.

Results: We enrolled 110 (65.5% male) stroke patients in the thrombolysis group and 94 (59.6% male) in the nonthrombolysis group. In the thrombolysis group, the median National Institutes of Health Stroke Scale (NIHSS) score was higher (5.5) compared to the nonthrombolysis group (2.0) (p < 0.001). There was a lower incidence of lacunar (17.3% vs 36.2%, p = 0.002) and cerebellar (2.7% vs 16.0%, p < 0.001) strokes and a higher frequency of middle cerebral artery syndrome (60.9% vs 33.0%, p < 0.001) in the thrombolysis group compared to the nonthrombolysis group. Sleep apnea defined as an apnea-hypopnea index (AHI) ≥ 5/h was diagnosed in 186 (91.2%) patients, its prevalence being higher in the thrombolysis (96.4%) compared to the nonthrombolysis (85.1%) group (p = 0.007). The mean baseline AHI was 33.7/h in the thrombolysis group compared to 26.8/h in the nonthrombolysis group (p = 0.017).

Conclusion: Sleep apnea was present in the vast majority of ischemic stroke patients. The stroke patients treated with thrombolysis were more likely to have sleep apnea, to have elevated NIHSS score at admission, and to be younger. Sleep apnea was more severe among those receiving thrombolysis as compared to those who were not.

Clinical Trial Registration: URL: http://www.clinicaltrials.cov. Unique identifier: NCT01861275.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.sleep.2017.08.018DOI Listing
December 2017

Sleep During Menopausal Transition: A 6-Year Follow-Up.

Sleep 2017 07;40(7)

Department of Physiology, Sleep Research Centre, University of Turku, Turku, Finland.

Study Objectives: Menopausal transition is associated with increased dissatisfaction with sleep, but the effects on sleep architecture are conflicting. This prospective 6-year follow-up study was designed to evaluate the changes in sleep stages and sleep continuity that occur in women during menopausal transition.

Methods: Sixty women (mean age 46.0 years, SD 0.9) participated. All women were premenopausal at baseline, and at the 6-year follow-up, women were in different stages of menopausal transition. Polysomnography was used to study sleep architecture at baseline and follow-up. The effects of aging and menopause (assessed as change in serum follicle-stimulating hormone [S-FSH]) on sleep architecture were evaluated using linear regression models.

Results: After controlling for body mass index, vasomotor, and depressive symptoms, aging of 6 years resulted in shorter total sleep time (B -37.4, 95% confidence interval [CI] -71.5 to (-3.3)), lower sleep efficiency (B -6.5, 95%CI -12.7 to (-0.2)), as well as in increased transitions from slow-wave sleep (SWS) to wakefulness (B 1.0, 95%CI 0.1 to 1.9), wake after sleep onset (B 37.7, 95%CI 12.5 to 63.0), awakenings per hour (B 1.8, 95%CI 0.8 to 2.8), and arousal index (B 2.3, 95%CI 0.1 to 4.4). Higher S-FSH concentration in menopausal transition was associated with increased SWS (B 0.09, 95%CI 0.01 to 0.16) after controlling for confounding factors.

Conclusions: A significant deterioration in sleep continuity occurs when women age from 46 to 52 years, but change from premenopausal to menopausal state restores some SWS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/sleep/zsx090DOI Listing
July 2017

Predictors of sleep disturbance in menopausal transition.

Maturitas 2016 Dec 5;94:137-142. Epub 2016 Oct 5.

Sleep Research Centre, Department of Physiology, University of Turku, Turku, Finland; Department of Obstetrics and Gynecology, Turku University Hospital, Turku, Finland.

Objective: This follow-up study aimed to evaluate risk factors for menopausal sleep disturbances already identifiable before menopause.

Methods: At baseline, all 81 women were premenopausal. At year-five follow-up, 27 of the women were premenopausal, 40 postmenopausal, and 14 postmenopausal and using hormone therapy. We used the Basic Nordic Sleep Questionnaire to study sleep; additional questionnaires evaluated risk factors for sleep impairment.

Results: Sleep quality differed only marginally between the groups. The following baseline variables were associated with impaired sleep quality at follow-up: depressive symptoms increased the risk of nocturnal awakenings (OR 1.16 (95%CI 1.02-1.32), p=0.025), morning tiredness (OR 1.22 (95%CI 1.06-1.40), p=0.007), daytime tiredness (OR 1.24 (95%CI 1.06-1.44), p=0.007) and propensity to fall asleep during work or leisure time (OR 1.18 (95%CI 1.01-1.37), p=0.036). Personal crises increased the risk of longer sleep latency (OR 5.46 (95%CI 1.13-26.32), p=0.035) and of propensity to fall asleep when not active (OR 5.41 (95%CI 1.42-20.83), p=0.014). Use of medications affecting the CNS increased the risk of worse general sleep quality (OR 11.44 (95% CI 1.07-121.79), p=0.044). Perceived impaired general health (OR 2.87 (95%CI 1.04-7.94), p=0.043) and frequent night sweats (OR 10.50 (95%CI 2.25-49.01), p=0.003) increased the risk of difficulty falling asleep.

Conclusions: Various premenopausal health-related factors seem to predict poor sleep in menopausal transition. Menopause itself appears to have only minor effects. Thus, it is essential to identify high-risk women to allow timely interventions that may prevent the development of sleep disturbances at menopause.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.maturitas.2016.10.004DOI Listing
December 2016

Sleep disordered breathing: is it different for females?

ERJ Open Res 2015 Oct 3;1(2). Epub 2015 Nov 3.

Department of Pulmonary Medicine, Tampere University Hospital, Tampere, Finland; Unesta Research Centre, Tampere, Finland.

http://ow.ly/TKN7d.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1183/23120541.00063-2015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5005124PMC
October 2015
-->