2020 |
Dirk, Pevernagie A; Barbara Gnidovec, Strazisar ; Ludger, Grote ; Raphael, Heinzer ; Walter, McNicholas T; Thomas, Penzel ; Winfried, Randerath ; Sophia, Schiza ; Johan, Verbraecken ; Erna, Sif Arnardottir On the rise and fall of the apnea-hypopnea index: A historical review and critical appraisal Journal Article 2020. Abstract | Links | BibTeX | Tags: Diagnosis, Sleep Apnea @article{Dirk2020, title = {On the rise and fall of the apnea-hypopnea index: A historical review and critical appraisal}, author = {Dirk, A Pevernagie and Barbara, Gnidovec, Strazisar and Ludger, Grote and Raphael, Heinzer and Walter, T McNicholas and Thomas, Penzel and Winfried, Randerath and Sophia, Schiza and Johan, Verbraecken and Erna, Sif Arnardottir}, url = {https://pubmed.ncbi.nlm.nih.gov/32406974/}, year = {2020}, date = {2020-05-14}, abstract = {The publication of "The Sleep Apnea Syndromes" by Guilleminault et al. in the 1970s hallmarked the discovery of a new disease entity involving serious health consequences. Obstructive sleep apnea was shown to be the most important disorder among the sleep apnea syndromes (SAS). In the course of time, it was found that the prevalence of obstructive sleep apnea reached the proportions of a global epidemic, with a major impact on public health, safety and the economy. Early on, a metric was introduced to gauge the seriousness of obstructive sleep apnea, based on the objective measurement of respiratory events during nocturnal sleep. The apnea index and later on the apnea-hypopnea index, being the total count of overnight respiratory events divided by the total sleep time in hours, were embraced as principle measures to establish the diagnosis of obstructive sleep apnea and to rate its severity. The current review summarises the historical evolution of the apnea-hypopnea index, which has been subject to many changes, and has been criticised for not capturing relevant clinical features of obstructive sleep apnea. In fact, the application of the apnea-hypopnea index as a continuous exposure variable is based on assumptions that it represents a disease state of obstructive sleep apnea and that evocative clinical manifestations are invariably caused by obstructive sleep apnea if the apnea-hypopnea index is above diagnostic threshold. A critical appraisal of the extensive literature shows that both assumptions are invalid. This conclusion prompts a reconsideration of the role of the apnea-hypopnea index as the prime diagnostic metric of clinically relevant obstructive sleep apnea.}, keywords = {Diagnosis, Sleep Apnea}, pubstate = {published}, tppubtype = {article} } The publication of "The Sleep Apnea Syndromes" by Guilleminault et al. in the 1970s hallmarked the discovery of a new disease entity involving serious health consequences. Obstructive sleep apnea was shown to be the most important disorder among the sleep apnea syndromes (SAS). In the course of time, it was found that the prevalence of obstructive sleep apnea reached the proportions of a global epidemic, with a major impact on public health, safety and the economy. Early on, a metric was introduced to gauge the seriousness of obstructive sleep apnea, based on the objective measurement of respiratory events during nocturnal sleep. The apnea index and later on the apnea-hypopnea index, being the total count of overnight respiratory events divided by the total sleep time in hours, were embraced as principle measures to establish the diagnosis of obstructive sleep apnea and to rate its severity. The current review summarises the historical evolution of the apnea-hypopnea index, which has been subject to many changes, and has been criticised for not capturing relevant clinical features of obstructive sleep apnea. In fact, the application of the apnea-hypopnea index as a continuous exposure variable is based on assumptions that it represents a disease state of obstructive sleep apnea and that evocative clinical manifestations are invariably caused by obstructive sleep apnea if the apnea-hypopnea index is above diagnostic threshold. A critical appraisal of the extensive literature shows that both assumptions are invalid. This conclusion prompts a reconsideration of the role of the apnea-hypopnea index as the prime diagnostic metric of clinically relevant obstructive sleep apnea. |
2019 |
Elín, Þórarinsdóttir H; Erla, Björnsdóttir ; Bryndís, Benediktsdóttir ; Christer, Janson ; Þórarinn, Gíslason ; Thor, Aspelund ; Samuel, Kuna T; Allan, Pack I; Erna, Sif Arnardóttir 2019. Abstract | Links | BibTeX | Tags: Daytime sleepiness @article{Þórarinsdóttir2019, title = {Definition of excessive daytime sleepiness in the general population: Feeling sleepy relates better to sleep‐related symptoms and quality of life than the Epworth Sleepiness Scale score. Results from an epidemiological study}, author = {Elín, H Þórarinsdóttir and Erla, Björnsdóttir and Bryndís, Benediktsdóttir and Christer, Janson and Þórarinn, Gíslason and Thor, Aspelund and Samuel, T Kuna and Allan, I Pack and Erna, Sif Arnardóttir}, url = {https://onlinelibrary.wiley.com/doi/full/10.1111/jsr.12852}, year = {2019}, date = {2019-04-10}, abstract = {Many different subjective tools are being used to measure excessive daytime sleepiness (EDS) but the most widely used is the Epworth Sleepiness Scale (ESS). However, it is unclear if using the ESS is adequate on its own when assessing EDS. The aim of this study was to estimate the characteristics and prevalence of EDS using the ESS and the Basic Nordic Sleep Questionnaire (BNSQ) in general population samples. Participants aged 40 years and older answered questions about sleepiness, health, sleep‐related symptoms and quality of life. Two groups were defined as suffering from EDS: those who scored >10 on the ESS (with increased risk of dozing off) and those reporting feeling sleepy during the day ≥3 times per week on the BNSQ. In total, 1,338 subjects (53% male, 74.1% response rate) participated, 13.1% reported an increased risk of dozing off, 23.2% reported feeling sleepy and 6.4% reported both. The prevalence of restless leg syndrome, nocturnal gastroesophageal reflux, difficulties initiating and maintaining sleep and nocturnal sweating was higher among subjects reporting feeling sleepy compared to non‐sleepy subjects. Also, subjects reporting feeling sleepy had poorer quality of life and reported more often feeling unrested during the day than non‐sleepy subjects. However, subjects reporting increased risk of dozing off (ESS > 10) without feeling sleepy had a similar symptom profile as the non‐sleepy subjects. Therefore, reporting only risk of dozing off without feeling sleepy may not reflect problematic sleepiness and more instruments in addition to ESS are needed when evaluating daytime sleepiness.}, keywords = {Daytime sleepiness}, pubstate = {published}, tppubtype = {article} } Many different subjective tools are being used to measure excessive daytime sleepiness (EDS) but the most widely used is the Epworth Sleepiness Scale (ESS). However, it is unclear if using the ESS is adequate on its own when assessing EDS. The aim of this study was to estimate the characteristics and prevalence of EDS using the ESS and the Basic Nordic Sleep Questionnaire (BNSQ) in general population samples. Participants aged 40 years and older answered questions about sleepiness, health, sleep‐related symptoms and quality of life. Two groups were defined as suffering from EDS: those who scored >10 on the ESS (with increased risk of dozing off) and those reporting feeling sleepy during the day ≥3 times per week on the BNSQ. In total, 1,338 subjects (53% male, 74.1% response rate) participated, 13.1% reported an increased risk of dozing off, 23.2% reported feeling sleepy and 6.4% reported both. The prevalence of restless leg syndrome, nocturnal gastroesophageal reflux, difficulties initiating and maintaining sleep and nocturnal sweating was higher among subjects reporting feeling sleepy compared to non‐sleepy subjects. Also, subjects reporting feeling sleepy had poorer quality of life and reported more often feeling unrested during the day than non‐sleepy subjects. However, subjects reporting increased risk of dozing off (ESS > 10) without feeling sleepy had a similar symptom profile as the non‐sleepy subjects. Therefore, reporting only risk of dozing off without feeling sleepy may not reflect problematic sleepiness and more instruments in addition to ESS are needed when evaluating daytime sleepiness. |
2018 |
Unnur, Diljá Teitsdóttir ; Erna, Sif Arnardóttir ; Erla, Björnsdóttir ; Þórarinn, Gíslason ; Pétur, Henry Petersen 2018. Abstract | Links | BibTeX | Tags: Positive airway pressure, Sleep Apnea @article{Unnur2018, title = {Obesity modulates the association between sleep apnea treatment and CHI3L1 levels but not CHIT1 activity in moderate to severe OSA: an observational study}, author = {Unnur, Diljá Teitsdóttir and Erna, Sif Arnardóttir and Erla, Björnsdóttir and Þórarinn, Gíslason and Pétur, Henry Petersen}, url = {https://pubmed.ncbi.nlm.nih.gov/30311184/}, year = {2018}, date = {2018-10-11}, abstract = {Purpose: The inflammatory markers chitinase-3-like protein 1 (CHI3L1) and chitotriosidase (CHIT1) have both been associated with cardiovascular complications. The aim of this preliminary observational study was to assess the roles and interaction of obstructive sleep apnea (OSA) severity and body mass index (BMI) with plasma CHI3L1 levels and CHIT1 activity in patients with moderate to severe OSA. The second aim was to assess the roles and interaction of positive airway pressure (PAP) treatment and BMI on the expression of the same proteins. Methods: The study included 97 OSA patients with an apnea-hypopnea index (AHI) ≥ 15 and full usage of PAP treatment after 4 months. Plasma CHI3L1 levels and CHIT1 activity were measured before and after treatment. Results: Multiple linear regression analysis demonstrated an independent association of BMI on CHI3L1 levels (p < 0.05) but not on CHIT1 activity. The OSA severity markers (AHI and oxygen desaturation index) did not independently or in interaction with BMI levels associate with CHI3L1 levels or with CHIT1 activity (p > 0.05). A two-way repeated measures ANOVA revealed a significant interaction between PAP treatment effect (before vs. after) and BMI groups (< 35 kg/m2 vs. ≥ 35 kg/m2) on CHI3L1 levels (p = 0.03) but not on CHIT1 activity (p = 0.98). Conclusions: Obesity independently associated with CHI3L1 levels. Association between OSA severity and CHI3L1 levels or CHIT1 activity (independent of or dependent on obesity level) could not be confirmed. However, decrease was observed in CHI3L1 levels after PAP treatment in severely obese OSA patients but not in those less obese.}, keywords = {Positive airway pressure, Sleep Apnea}, pubstate = {published}, tppubtype = {article} } Purpose: The inflammatory markers chitinase-3-like protein 1 (CHI3L1) and chitotriosidase (CHIT1) have both been associated with cardiovascular complications. The aim of this preliminary observational study was to assess the roles and interaction of obstructive sleep apnea (OSA) severity and body mass index (BMI) with plasma CHI3L1 levels and CHIT1 activity in patients with moderate to severe OSA. The second aim was to assess the roles and interaction of positive airway pressure (PAP) treatment and BMI on the expression of the same proteins. Methods: The study included 97 OSA patients with an apnea-hypopnea index (AHI) ≥ 15 and full usage of PAP treatment after 4 months. Plasma CHI3L1 levels and CHIT1 activity were measured before and after treatment. Results: Multiple linear regression analysis demonstrated an independent association of BMI on CHI3L1 levels (p < 0.05) but not on CHIT1 activity. The OSA severity markers (AHI and oxygen desaturation index) did not independently or in interaction with BMI levels associate with CHI3L1 levels or with CHIT1 activity (p > 0.05). A two-way repeated measures ANOVA revealed a significant interaction between PAP treatment effect (before vs. after) and BMI groups (< 35 kg/m2 vs. ≥ 35 kg/m2) on CHI3L1 levels (p = 0.03) but not on CHIT1 activity (p = 0.98). Conclusions: Obesity independently associated with CHI3L1 levels. Association between OSA severity and CHI3L1 levels or CHIT1 activity (independent of or dependent on obesity level) could not be confirmed. However, decrease was observed in CHI3L1 levels after PAP treatment in severely obese OSA patients but not in those less obese. |
Brendan, Keenan T; Jinyoung, Kim ; Bhajan, Singh ; Lia, Bittencourt ; Ning-Hung, Chen ; Peter, Cistulli A; Ulysses, Magalang J; Nigel, McArdle ; Jesse, Mindel W; Bryndís, Benediktsdóttir ; Erna, Sif Arnardóttir ; Lisa, Kristin Prochnow ; Thomas, Penzel ; Bernd, Sanner ; Richard, Schwab J; Chol, Shin ; Kate, Sutherland ; Sergio, Tufik ; Greg, Maislin ; Þórarinn, Gíslason ; Allan, Pack I Recognizable clinical subtypes of obstructive sleep apnea across international sleep centers: a cluster analysis Journal Article 2018. Abstract | Links | BibTeX | Tags: Daytime sleepiness, Insomnia, Sleep Apnea @article{Brendan2018, title = {Recognizable clinical subtypes of obstructive sleep apnea across international sleep centers: a cluster analysis}, author = {Brendan, T Keenan and Jinyoung, Kim and Bhajan, Singh and Lia, Bittencourt and Ning-Hung, Chen and Peter, A Cistulli and Ulysses, J Magalang and Nigel, McArdle and Jesse, W Mindel and Bryndís, Benediktsdóttir and Erna, Sif Arnardóttir and Lisa, Kristin Prochnow and Thomas, Penzel and Bernd, Sanner and Richard, J Schwab and Chol, Shin and Kate, Sutherland and Sergio, Tufik and Greg, Maislin and Þórarinn, Gíslason and Allan, I Pack}, url = {https://academic.oup.com/sleep/article/41/3/zsx214/4791307}, year = {2018}, date = {2018-01-05}, abstract = {Study Objectives A recent study of patients with moderate–severe obstructive sleep apnea (OSA) in Iceland identified three clinical clusters based on symptoms and comorbidities. We sought to verify this finding in a new cohort in Iceland and examine the generalizability of OSA clusters in an international ethnically diverse cohort. Methods Using data on 972 patients with moderate–severe OSA (apnea–hypopnea index [AHI] ≥ 15 events per hour) recruited from the Sleep Apnea Global Interdisciplinary Consortium (SAGIC), we performed a latent class analysis of 18 self-reported symptom variables, hypertension, cardiovascular disease, and diabetes. Results The original OSA clusters of disturbed sleep, minimally symptomatic, and excessively sleepy replicated among 215 SAGIC patients from Iceland. These clusters also generalized to 757 patients from five other countries. The three clusters had similar average AHI values in both Iceland and the international samples, suggesting clusters are not driven by OSA severity; differences in age, gender, and body mass index were also generally small. Within the international sample, the three original clusters were expanded to five optimal clusters: three were similar to those in Iceland (labeled disturbed sleep, minimal symptoms, and upper airway symptoms with sleepiness) and two were new, less symptomatic clusters (labeled upper airway symptoms dominant and sleepiness dominant). The five clusters showed differences in demographics and AHI, although all were middle-aged (44.6–54.5 years), obese (30.6–35.9 kg/m2), and had severe OSA (42.0–51.4 events per hour) on average. Conclusions Results confirm and extend previously identified clinical clusters in OSA. These clusters provide an opportunity for a more personalized approach to the management of OSA.}, keywords = {Daytime sleepiness, Insomnia, Sleep Apnea}, pubstate = {published}, tppubtype = {article} } Study Objectives A recent study of patients with moderate–severe obstructive sleep apnea (OSA) in Iceland identified three clinical clusters based on symptoms and comorbidities. We sought to verify this finding in a new cohort in Iceland and examine the generalizability of OSA clusters in an international ethnically diverse cohort. Methods Using data on 972 patients with moderate–severe OSA (apnea–hypopnea index [AHI] ≥ 15 events per hour) recruited from the Sleep Apnea Global Interdisciplinary Consortium (SAGIC), we performed a latent class analysis of 18 self-reported symptom variables, hypertension, cardiovascular disease, and diabetes. Results The original OSA clusters of disturbed sleep, minimally symptomatic, and excessively sleepy replicated among 215 SAGIC patients from Iceland. These clusters also generalized to 757 patients from five other countries. The three clusters had similar average AHI values in both Iceland and the international samples, suggesting clusters are not driven by OSA severity; differences in age, gender, and body mass index were also generally small. Within the international sample, the three original clusters were expanded to five optimal clusters: three were similar to those in Iceland (labeled disturbed sleep, minimal symptoms, and upper airway symptoms with sleepiness) and two were new, less symptomatic clusters (labeled upper airway symptoms dominant and sleepiness dominant). The five clusters showed differences in demographics and AHI, although all were middle-aged (44.6–54.5 years), obese (30.6–35.9 kg/m2), and had severe OSA (42.0–51.4 events per hour) on average. Conclusions Results confirm and extend previously identified clinical clusters in OSA. These clusters provide an opportunity for a more personalized approach to the management of OSA. |
Grace, Pien W; Lichuan, Ye ; Brendan, Keenan T; Greg, Maislin ; Erla, Björnsdóttir ; Erna, Sif Arnardóttir ; Bryndís, Benediktsdóttir ; Þórarinn, Gíslason ; Pack, Allan I Changing Faces of Obstructive Sleep Apnea: Treatment Effects by Cluster Designation in the Icelandic Sleep Apnea Cohort Journal Article 2018. Abstract | Links | BibTeX | Tags: @article{Pien2018, title = {Changing Faces of Obstructive Sleep Apnea: Treatment Effects by Cluster Designation in the Icelandic Sleep Apnea Cohort}, author = {Grace, W Pien and Lichuan, Ye and Brendan, T Keenan and Greg, Maislin and Erla, Björnsdóttir and Erna, Sif Arnardóttir and Bryndís, Benediktsdóttir and Þórarinn, Gíslason and Allan I Pack}, url = {https://academic.oup.com/sleep/article/41/3/zsx201/4782667}, year = {2018}, date = {2018-01-02}, abstract = {This study examined responses to positive airway pressure (PAP) therapy in people with obstructive sleep apnea (OSA) with three distinct clinical phenotypes (Disturbed Sleep, Minimally Symptomatic, and Sleepy) initially identified using cluster analysis, a novel methodology for grouping similar individuals together and distinguishing them from each other. After 2 years of PAP treatment, patterns of treatment response in the three clinical phenotypes of OSA varied by initial clinical presentation. Thus, traditional practice assessing limited measures of treatment response within all people with OSA probably underestimates treatment effects. These findings underscore the need to recognize that patients with a range of OSA presentations benefit from treatment and to consider initial OSA phenotype in future clinical trials.}, keywords = {}, pubstate = {published}, tppubtype = {article} } This study examined responses to positive airway pressure (PAP) therapy in people with obstructive sleep apnea (OSA) with three distinct clinical phenotypes (Disturbed Sleep, Minimally Symptomatic, and Sleepy) initially identified using cluster analysis, a novel methodology for grouping similar individuals together and distinguishing them from each other. After 2 years of PAP treatment, patterns of treatment response in the three clinical phenotypes of OSA varied by initial clinical presentation. Thus, traditional practice assessing limited measures of treatment response within all people with OSA probably underestimates treatment effects. These findings underscore the need to recognize that patients with a range of OSA presentations benefit from treatment and to consider initial OSA phenotype in future clinical trials. |
2017 |
Dieter, Riemann ; Chiara, Baglioni ; Claudio, Bassetti ; Bjørn, Bjorvatn ; Leja, Dolenc Groselj ; Jason, Ellis G; Colin, Espie A; Diego, Garcia‐Borreguero ; Michaela, Gjerstad ; Marta, Gonçalves ; Elisabeth, Hertenstein ; Markus Jansson, Fröjmark ; Poul, Jennum J; Damien, Leger ; Christoph, Nissen ; Liborio, Parrino ; Tiina, Paunio ; Dirk, Pevernagie ; Johan, Verbraecken ; Hans, Günter Weeß ; Adam, Wichniak ; Irina, Zavalko ; Erna, Sif Arnardottir ; Oana, Claudia Deleanu ; Barbara, Strazisar ; Marielle, Zoetmulder ; Kai, Spiegelhalder European guideline for the diagnosis and treatment of insomnia. Journal Article 2017. Abstract | Links | BibTeX | Tags: Insomnia @article{Dieter2017, title = {European guideline for the diagnosis and treatment of insomnia.}, author = {Dieter, Riemann and Chiara, Baglioni and Claudio, Bassetti and Bjørn, Bjorvatn and Leja, Dolenc Groselj and Jason, G Ellis and Colin, A Espie and Diego, Garcia‐Borreguero and Michaela, Gjerstad and Marta, Gonçalves and Elisabeth, Hertenstein and Markus, Jansson, Fröjmark and Poul, J Jennum and Damien, Leger and Christoph, Nissen and Liborio, Parrino and Tiina, Paunio and Dirk, Pevernagie and Johan, Verbraecken and Hans, Günter Weeß and Adam, Wichniak and Irina, Zavalko and Erna, Sif Arnardottir and Oana, Claudia Deleanu and Barbara, Strazisar and Marielle, Zoetmulder and Kai, Spiegelhalder}, url = {https://onlinelibrary.wiley.com/doi/full/10.1111/jsr.12594}, year = {2017}, date = {2017-09-05}, abstract = {This European guideline for the diagnosis and treatment of insomnia was developed by a task force of the European Sleep Research Society, with the aim of providing clinical recommendations for the management of adult patients with insomnia. The guideline is based on a systematic review of relevant meta‐analyses published till June 2016. The target audience for this guideline includes all clinicians involved in the management of insomnia, and the target patient population includes adults with chronic insomnia disorder. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to grade the evidence and guide recommendations. The diagnostic procedure for insomnia, and its co‐morbidities, should include a clinical interview consisting of a sleep history (sleep habits, sleep environment, work schedules, circadian factors), the use of sleep questionnaires and sleep diaries, questions about somatic and mental health, a physical examination and additional measures if indicated (i.e. blood tests, electrocardiogram, electroencephalogram; strong recommendation, moderate‐ to high‐quality evidence). Polysomnography can be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep‐related breathing disorders), in treatment‐resistant insomnia, for professional at‐risk populations and when substantial sleep state misperception is suspected (strong recommendation, high‐quality evidence). Cognitive behavioural therapy for insomnia is recommended as the first‐line treatment for chronic insomnia in adults of any age (strong recommendation, high‐quality evidence). A pharmacological intervention can be offered if cognitive behavioural therapy for insomnia is not sufficiently effective or not available. Benzodiazepines, benzodiazepine receptor agonists and some antidepressants are effective in the short‐term treatment of insomnia (≤4 weeks; weak recommendation, moderate‐quality evidence). Antihistamines, antipsychotics, melatonin and phytotherapeutics are not recommended for insomnia treatment (strong to weak recommendations, low‐ to very‐low‐quality evidence). Light therapy and exercise need to be further evaluated to judge their usefulness in the treatment of insomnia (weak recommendation, low‐quality evidence). Complementary and alternative treatments (e.g. homeopathy, acupuncture) are not recommended for insomnia treatment (weak recommendation, very‐low‐quality evidence).}, keywords = {Insomnia}, pubstate = {published}, tppubtype = {article} } This European guideline for the diagnosis and treatment of insomnia was developed by a task force of the European Sleep Research Society, with the aim of providing clinical recommendations for the management of adult patients with insomnia. The guideline is based on a systematic review of relevant meta‐analyses published till June 2016. The target audience for this guideline includes all clinicians involved in the management of insomnia, and the target patient population includes adults with chronic insomnia disorder. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to grade the evidence and guide recommendations. The diagnostic procedure for insomnia, and its co‐morbidities, should include a clinical interview consisting of a sleep history (sleep habits, sleep environment, work schedules, circadian factors), the use of sleep questionnaires and sleep diaries, questions about somatic and mental health, a physical examination and additional measures if indicated (i.e. blood tests, electrocardiogram, electroencephalogram; strong recommendation, moderate‐ to high‐quality evidence). Polysomnography can be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep‐related breathing disorders), in treatment‐resistant insomnia, for professional at‐risk populations and when substantial sleep state misperception is suspected (strong recommendation, high‐quality evidence). Cognitive behavioural therapy for insomnia is recommended as the first‐line treatment for chronic insomnia in adults of any age (strong recommendation, high‐quality evidence). A pharmacological intervention can be offered if cognitive behavioural therapy for insomnia is not sufficiently effective or not available. Benzodiazepines, benzodiazepine receptor agonists and some antidepressants are effective in the short‐term treatment of insomnia (≤4 weeks; weak recommendation, moderate‐quality evidence). Antihistamines, antipsychotics, melatonin and phytotherapeutics are not recommended for insomnia treatment (strong to weak recommendations, low‐ to very‐low‐quality evidence). Light therapy and exercise need to be further evaluated to judge their usefulness in the treatment of insomnia (weak recommendation, low‐quality evidence). Complementary and alternative treatments (e.g. homeopathy, acupuncture) are not recommended for insomnia treatment (weak recommendation, very‐low‐quality evidence). |
2016 |
Erna, Sif Arnardóttir ; Þórarinn, Gíslason Quantifying Airflow Limitation and Snoring During Sleep Journal Article 2016. Abstract | Links | BibTeX | Tags: Esophageal pressure, Flow limitation, Snore @article{Erna2016b, title = {Quantifying Airflow Limitation and Snoring During Sleep}, author = {Erna, Sif Arnardóttir and Þórarinn, Gíslason}, url = {https://pubmed.ncbi.nlm.nih.gov/28118867/}, year = {2016}, date = {2016-10-27}, abstract = {Traditional techniques to assess respiratory disturbances during sleep allow the accurate diagnosis of moderate and severe cases of obstructive sleep apnea but have serious limitations in mild obstructive sleep apnea and cases with signs of obstructive breathing during sleep without apneas and hypopneas. This article describes advantages and limitations of available techniques to measure obstructive breathing during sleep by measuring flow limitation, respiratory effort, and snoring. Standardization of these techniques is crucial for moving the field further and understanding the pathophysiologic role of obstructive breathing itself, and not solely focusing on the associated outcomes of arousals and oxygen desaturations.}, keywords = {Esophageal pressure, Flow limitation, Snore}, pubstate = {published}, tppubtype = {article} } Traditional techniques to assess respiratory disturbances during sleep allow the accurate diagnosis of moderate and severe cases of obstructive sleep apnea but have serious limitations in mild obstructive sleep apnea and cases with signs of obstructive breathing during sleep without apneas and hypopneas. This article describes advantages and limitations of available techniques to measure obstructive breathing during sleep by measuring flow limitation, respiratory effort, and snoring. Standardization of these techniques is crucial for moving the field further and understanding the pathophysiologic role of obstructive breathing itself, and not solely focusing on the associated outcomes of arousals and oxygen desaturations. |
Erna, Sif Arnardóttir ; Erla, Björnsdóttir ; Kristín, Ólafsdóttir A; Bryndís, Benediktsdóttir ; Þórarinn, Gíslason Obstructive sleep apnoea in the general population: highly prevalent but minimal symptoms Journal Article 2016. Abstract | Links | BibTeX | Tags: Sleep Apnea @article{Erna2016, title = {Obstructive sleep apnoea in the general population: highly prevalent but minimal symptoms}, author = {Erna, Sif Arnardóttir and Erla, Björnsdóttir and Kristín, A Ólafsdóttir and Bryndís, Benediktsdóttir and Þórarinn, Gíslason}, url = {https://erj.ersjournals.com/content/47/1/194.short}, year = {2016}, date = {2016-01-01}, abstract = {The aim was to assess the prevalence of obstructive sleep apnoea (OSA) as defined by an apnoea–hypopnea index (AHI) ≥15 in the middle-aged general population, and the interrelationship between OSA, sleep-related symptoms, sleepiness and vigilance. A general population sample of 40–65-year-old Icelanders was invited to participate in a study protocol that included a type 3 sleep study, questionnaire and a psychomotor vigilance test (PVT). Among the 415 subjects included in the study, 56.9% had no OSA (AHI <5), 24.1% had mild OSA (AHI 5–14.9), 12.5% had moderate OSA (AHI 15–29.9), 2.9% had severe OSA (AHI ≥30) and 3.6% were already diagnosed and receiving OSA treatment. However, no significant relationship was found between AHI and subjective sleepiness or clinical symptoms. A relationship with objective vigilance assessed by PVT was only found for those with AHI ≥30. Subjects already on OSA treatment and those accepting OSA treatment after participating in the study were more symptomatic and sleepier than others with similar OSA severity, as assessed by the AHI. In a middle-aged general population, approximately one in five subjects had moderate-to-severe OSA, but the majority of them were neither symptomatic nor sleepy and did not have impaired vigilance.}, keywords = {Sleep Apnea}, pubstate = {published}, tppubtype = {article} } The aim was to assess the prevalence of obstructive sleep apnoea (OSA) as defined by an apnoea–hypopnea index (AHI) ≥15 in the middle-aged general population, and the interrelationship between OSA, sleep-related symptoms, sleepiness and vigilance. A general population sample of 40–65-year-old Icelanders was invited to participate in a study protocol that included a type 3 sleep study, questionnaire and a psychomotor vigilance test (PVT). Among the 415 subjects included in the study, 56.9% had no OSA (AHI <5), 24.1% had mild OSA (AHI 5–14.9), 12.5% had moderate OSA (AHI 15–29.9), 2.9% had severe OSA (AHI ≥30) and 3.6% were already diagnosed and receiving OSA treatment. However, no significant relationship was found between AHI and subjective sleepiness or clinical symptoms. A relationship with objective vigilance assessed by PVT was only found for those with AHI ≥30. Subjects already on OSA treatment and those accepting OSA treatment after participating in the study were more symptomatic and sleepier than others with similar OSA severity, as assessed by the AHI. In a middle-aged general population, approximately one in five subjects had moderate-to-severe OSA, but the majority of them were neither symptomatic nor sleepy and did not have impaired vigilance. |
2014 |
Lichuan, Ye ; Grace, Pien W; Sarah, Ratcliffe J; Erla, Björnsdóttir ; Erna, Sif Arnardóttir ; Allan, Pack I; Bryndís, Benediktsdóttir ; Þórarinn, Gíslason The different clinical faces of obstructive sleep apnoea: a cluster analysis Journal Article 2014. Abstract | Links | BibTeX | Tags: Sleep Apnea @article{Lichuan2014, title = {The different clinical faces of obstructive sleep apnoea: a cluster analysis}, author = {Lichuan, Ye and Grace, W Pien and Sarah, J Ratcliffe and Erla, Björnsdóttir and Erna, Sif Arnardóttir and Allan, I Pack and Bryndís, Benediktsdóttir and Þórarinn, Gíslason}, url = {https://erj.ersjournals.com/content/44/6/1600.short}, year = {2014}, date = {2014-11-30}, abstract = {Although commonly observed in clinical practice, the heterogeneity of obstructive sleep apnoea (OSA) clinical presentation has not been formally characterised. This study was the first to apply cluster analysis to identify subtypes of patients with OSA who experience distinct combinations of symptoms and comorbidities. An analysis of baseline data from the Icelandic Sleep Apnoea Cohort (822 patients with newly diagnosed moderate-to-severe OSA) was performed. Three distinct clusters were identified. They were classified as the “disturbed sleep group” (cluster 1), “minimally symptomatic group” (cluster 2) and “excessive daytime sleepiness group” (cluster 3), consisting of 32.7%, 24.7% and 42.6% of the entire cohort, respectively. The probabilities of having comorbid hypertension and cardiovascular disease were highest in cluster 2 but lowest in cluster 3. The clusters did not differ significantly in terms of sex, body mass index or apnoea–hypopnoea index. Patients with OSA have different patterns of clinical presentation, which need to be communicated to both the lay public and the professional community with the goal of facilitating care-seeking and early identification of OSA. Identifying distinct clinical profiles of OSA creates a foundation for offering more personalised therapies in the future.}, keywords = {Sleep Apnea}, pubstate = {published}, tppubtype = {article} } Although commonly observed in clinical practice, the heterogeneity of obstructive sleep apnoea (OSA) clinical presentation has not been formally characterised. This study was the first to apply cluster analysis to identify subtypes of patients with OSA who experience distinct combinations of symptoms and comorbidities. An analysis of baseline data from the Icelandic Sleep Apnoea Cohort (822 patients with newly diagnosed moderate-to-severe OSA) was performed. Three distinct clusters were identified. They were classified as the “disturbed sleep group” (cluster 1), “minimally symptomatic group” (cluster 2) and “excessive daytime sleepiness group” (cluster 3), consisting of 32.7%, 24.7% and 42.6% of the entire cohort, respectively. The probabilities of having comorbid hypertension and cardiovascular disease were highest in cluster 2 but lowest in cluster 3. The clusters did not differ significantly in terms of sex, body mass index or apnoea–hypopnoea index. Patients with OSA have different patterns of clinical presentation, which need to be communicated to both the lay public and the professional community with the goal of facilitating care-seeking and early identification of OSA. Identifying distinct clinical profiles of OSA creates a foundation for offering more personalised therapies in the future. |
2013 |
Erla, Björnsdóttir ; Christer, Janson ; Jón, Sigurðsson F; Philip, Gehrman ; Michael, Perlis ; Sigurður, Júlíusson ; Erna, Sif Arnardóttir ; Samuel, Kuna T; Allan, Pack I; Þórarinn, Gíslason ; Bryndís, Benediktsdóttir Symptoms of Insomnia among Patients with Obstructive Sleep Apnea Before and After Two Years of Positive Airway Pressure Treatment. Journal Article 2013. Abstract | Links | BibTeX | Tags: Insomnia, Positive airway pressure, Sleep Apnea @article{Erla2013, title = {Symptoms of Insomnia among Patients with Obstructive Sleep Apnea Before and After Two Years of Positive Airway Pressure Treatment.}, author = {Erla, Björnsdóttir and Christer, Janson and Jón, F Sigurðsson and Philip, Gehrman and Michael, Perlis and Sigurður, Júlíusson and Erna, Sif Arnardóttir and Samuel, T Kuna and Allan, I Pack and Þórarinn, Gíslason and Bryndís, Benediktsdóttir}, url = {https://academic.oup.com/sleep/article/36/12/1901/2709415}, year = {2013}, date = {2013-12-01}, abstract = {Study Objectives: To assess the changes of insomnia symptoms among patients with obstructive sleep apnea (OSA) from starting treatment with positive airway pressure (PAP) to a 2-y follow-up. Design: Longitudinal cohort study. Setting: Landspitali—The National University Hospital of Iceland. Participants: There were 705 adults with OSA who were assessed prior to and 2 y after starting PAP treatment. Intervention: PAP treatment for OSA. Measurements and Results: All patients underwent a medical examination along with a type 3 sleep study and answered questionnaires on health and sleep before and 2 y after starting PAP treatment. The change in prevalence of insomnia symptoms by subtype was assessed by questionnaire and compared between individuals who were using or not using PAP at follow-up. Symptoms of middle insomnia were most common at baseline and improved signifcantly among patients using PAP (from 59.4% to 30.7%, P < 0.001). Symptoms of initial insomnia tended to persist regardless of PAP treatment, and symptoms of late insomnia were more likely to improve among patients not using PAP. Patients with symptoms of initial and late insomnia at baseline were less likely to adhere to PAP (odds ratio [OR] 0.56, P = 0.007, and OR 0.53, P < 0.001, respectively). Conclusion: Positive airway pressure treatment significantly reduced symptoms of middle insomnia. Symptoms of initial and late insomnia, however, tended to persist regardless of positive airway pressure treatment and had a negative effect on adherence. Targeted treatment for insomnia may be beneficial for patients with obstructive sleep apnea comorbid with insomnia and has the potential to positively affect adherence to positive airway pressure.}, keywords = {Insomnia, Positive airway pressure, Sleep Apnea}, pubstate = {published}, tppubtype = {article} } Study Objectives: To assess the changes of insomnia symptoms among patients with obstructive sleep apnea (OSA) from starting treatment with positive airway pressure (PAP) to a 2-y follow-up. Design: Longitudinal cohort study. Setting: Landspitali—The National University Hospital of Iceland. Participants: There were 705 adults with OSA who were assessed prior to and 2 y after starting PAP treatment. Intervention: PAP treatment for OSA. Measurements and Results: All patients underwent a medical examination along with a type 3 sleep study and answered questionnaires on health and sleep before and 2 y after starting PAP treatment. The change in prevalence of insomnia symptoms by subtype was assessed by questionnaire and compared between individuals who were using or not using PAP at follow-up. Symptoms of middle insomnia were most common at baseline and improved signifcantly among patients using PAP (from 59.4% to 30.7%, P < 0.001). Symptoms of initial insomnia tended to persist regardless of PAP treatment, and symptoms of late insomnia were more likely to improve among patients not using PAP. Patients with symptoms of initial and late insomnia at baseline were less likely to adhere to PAP (odds ratio [OR] 0.56, P = 0.007, and OR 0.53, P < 0.001, respectively). Conclusion: Positive airway pressure treatment significantly reduced symptoms of middle insomnia. Symptoms of initial and late insomnia, however, tended to persist regardless of positive airway pressure treatment and had a negative effect on adherence. Targeted treatment for insomnia may be beneficial for patients with obstructive sleep apnea comorbid with insomnia and has the potential to positively affect adherence to positive airway pressure. |
2012 |
Erna, Sif Arnardóttir ; Greg, Maislin ; Richard, Schwab J; Bethany, Staley ; Bryndís, Benediktsdóttir ; Ísleifur, Ólafsson ; Sigurður, Júlíusson ; Micah, Romer ; Þórarinn, Gíslason ; Allan, Pack I 2012. Abstract | Links | BibTeX | Tags: Sleep Apnea @article{Erna2012, title = {The Interaction of Obstructive Sleep Apnea and Obesity on the Inflammatory Markers C-Reactive Protein and Interleukin-6: The Icelandic Sleep Apnea Cohort}, author = {Erna, Sif Arnardóttir and Greg, Maislin and Richard, J Schwab and Bethany, Staley and Bryndís, Benediktsdóttir and Ísleifur, Ólafsson and Sigurður, Júlíusson and Micah, Romer and Þórarinn, Gíslason and Allan, I Pack}, url = {https://academic.oup.com/sleep/article/35/7/921/2558872}, year = {2012}, date = {2012-07-01}, abstract = {Study Objectives: To assess the relative roles and interaction of obstructive sleep apnea (OSA) severity and obesity on interleukin-6 (IL-6) and C-reactive protein (CRP) levels. Design: Cross-sectional cohort. Setting: The Icelandic Sleep Apnea Cohort. Participants: 454 untreated OSA patients (380 males and 74 females), mean ± standard deviation age 54.4 ± 10.6 yr. Interventions: N/A. Measurements and Results: Participants underwent a sleep study, abdominal magnetic resonance imaging to measure total abdominal and visceral fat volume, and had fasting morning IL-6 and CRP levels measured in serum. A significantly higher correlation was found for BMI than visceral fat volume with CRP and IL-6 levels. Oxygen desaturation index, hypoxia time, and minimum oxygen saturation (SaO2) significantly correlated with IL-6 and CRP levels, but apnea-hypopnea index did not. When stratified by body mass index (BMI) category, OSA severity was associated with IL-6 levels in obese participants only (BMI > 30 kg/m2). A multiple linear regression model with interaction terms showed an independent association of OSA severity with IL-6 levels and an interaction between OSA severity and BMI, i.e., degree of obesity altered the relationship between OSA and IL-6 levels. An independent association of OSA severity with CRP levels was found for minimum SaO2 only. A similar interaction of OSA severity and BMI on CRP levels was found for males and postmenopausal women. Conclusions: OSA severity is an independent predictor of levels of IL-6 and CRP but interacts with obesity such that this association is found only in obese patients.}, keywords = {Sleep Apnea}, pubstate = {published}, tppubtype = {article} } Study Objectives: To assess the relative roles and interaction of obstructive sleep apnea (OSA) severity and obesity on interleukin-6 (IL-6) and C-reactive protein (CRP) levels. Design: Cross-sectional cohort. Setting: The Icelandic Sleep Apnea Cohort. Participants: 454 untreated OSA patients (380 males and 74 females), mean ± standard deviation age 54.4 ± 10.6 yr. Interventions: N/A. Measurements and Results: Participants underwent a sleep study, abdominal magnetic resonance imaging to measure total abdominal and visceral fat volume, and had fasting morning IL-6 and CRP levels measured in serum. A significantly higher correlation was found for BMI than visceral fat volume with CRP and IL-6 levels. Oxygen desaturation index, hypoxia time, and minimum oxygen saturation (SaO2) significantly correlated with IL-6 and CRP levels, but apnea-hypopnea index did not. When stratified by body mass index (BMI) category, OSA severity was associated with IL-6 levels in obese participants only (BMI > 30 kg/m2). A multiple linear regression model with interaction terms showed an independent association of OSA severity with IL-6 levels and an interaction between OSA severity and BMI, i.e., degree of obesity altered the relationship between OSA and IL-6 levels. An independent association of OSA severity with CRP levels was found for minimum SaO2 only. A similar interaction of OSA severity and BMI on CRP levels was found for males and postmenopausal women. Conclusions: OSA severity is an independent predictor of levels of IL-6 and CRP but interacts with obesity such that this association is found only in obese patients. |
2011 |
Erla, Björnsdóttir ; Christer, Janson ; Þórarinn, Gíslason ; Jón, Sigurðsson F; Allan, Pack I; Philip, Gehrman ; Bryndís, Benediktsdóttir Insomnia in untreated sleep apnea patients compared to controls. Journal Article 2011. Abstract | Links | BibTeX | Tags: Insomnia, Risk factors, Sleep Apnea @article{Erla2011, title = {Insomnia in untreated sleep apnea patients compared to controls.}, author = {Erla, Björnsdóttir and Christer, Janson and Þórarinn, Gíslason and Jón, F Sigurðsson and Allan, I Pack and Philip, Gehrman and Bryndís, Benediktsdóttir}, url = {https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2869.2011.00972.x}, year = {2011}, date = {2011-10-12}, abstract = {Insomnia and obstructive sleep apnea (OSA) often coexist, but the nature of their relationship is unclear. The aims of this study were to compare the prevalence of initial and middle insomnia between OSA patients and controls from the general population as well as to study the influence of insomnia on sleepiness and quality of life in OSA patients. Two groups were compared, untreated OSA patients (n = 824) and controls ≥ 40 years from the general population in Iceland (n = 762). All subjects answered the same questionnaires on health and sleep and OSA patients underwent a sleep study. Altogether, 53% of controls were males compared to 81% of OSA patients. Difficulties maintaining sleep (DMS) were more common among men and women with OSA compared to the general population (52 versus 31% and 62 versus 31%, respectively, P < 0.0001). Difficulties initiating sleep (DIS) and DIS + DMS were more common among women with OSA compared to women without OSA. OSA patients with DMS were sleepier than patients without DMS (Epworth Sleepiness Scale: 12.2 versus 10.9, P < 0.001), while both DMS and DIS were related to lower quality of life in OSA patients as measured by the Short Form 12 (physical score 39 versus 42 and mental score 36 versus 41, P < 0.001). DIS and DMS were not related to OSA severity. Insomnia is common among OSA patients and has a negative influence on quality of life and sleepiness in this patient group. It is relevant to screen for insomnia among OSA patients and treat both conditions when they co‐occur.}, keywords = {Insomnia, Risk factors, Sleep Apnea}, pubstate = {published}, tppubtype = {article} } Insomnia and obstructive sleep apnea (OSA) often coexist, but the nature of their relationship is unclear. The aims of this study were to compare the prevalence of initial and middle insomnia between OSA patients and controls from the general population as well as to study the influence of insomnia on sleepiness and quality of life in OSA patients. Two groups were compared, untreated OSA patients (n = 824) and controls ≥ 40 years from the general population in Iceland (n = 762). All subjects answered the same questionnaires on health and sleep and OSA patients underwent a sleep study. Altogether, 53% of controls were males compared to 81% of OSA patients. Difficulties maintaining sleep (DMS) were more common among men and women with OSA compared to the general population (52 versus 31% and 62 versus 31%, respectively, P < 0.0001). Difficulties initiating sleep (DIS) and DIS + DMS were more common among women with OSA compared to women without OSA. OSA patients with DMS were sleepier than patients without DMS (Epworth Sleepiness Scale: 12.2 versus 10.9, P < 0.001), while both DMS and DIS were related to lower quality of life in OSA patients as measured by the Short Form 12 (physical score 39 versus 42 and mental score 36 versus 41, P < 0.001). DIS and DMS were not related to OSA severity. Insomnia is common among OSA patients and has a negative influence on quality of life and sleepiness in this patient group. It is relevant to screen for insomnia among OSA patients and treat both conditions when they co‐occur. |
2010 |
Bryndís, Benediktsdóttir ; Christer, Janson ; Eva, Lindberg ; Erna, Sif Arnardóttir ; Ísleifur, Ólafsson ; Elizabeth, Cook ; Elín, Helga Þórarinsdottir ; Þórarinn, Gíslason Prevalence of restless legs syndrome among adults in Iceland and Sweden: Lung function, comorbidity, ferritin, biomarkers and quality of life Journal Article 2010. Abstract | Links | BibTeX | Tags: Epidemiology, Restless legs syndrome @article{Bryndís2010, title = {Prevalence of restless legs syndrome among adults in Iceland and Sweden: Lung function, comorbidity, ferritin, biomarkers and quality of life}, author = {Bryndís, Benediktsdóttir and Christer, Janson and Eva, Lindberg and Erna, Sif Arnardóttir and Ísleifur, Ólafsson and Elizabeth, Cook and Elín, Helga Þórarinsdottir and Þórarinn, Gíslason}, url = {https://www.sciencedirect.com/science/article/pii/S1389945710003412}, year = {2010}, date = {2010-10-18}, abstract = {Objective This study investigates the prevalence and the association between restless legs syndrome (RLS) and a large variety of health variables in two well-characterized random samples from the general population in Reykjavik, Iceland, and Uppsala, Sweden. Methods Using the national registries of inhabitants, a random sample from adults aged 40 and over living in Reykjavík, Iceland (n = 939), and Uppsala, Sweden (n = 998), were invited to participate in a study on the prevalence of COPD (response rate 81.1% and 62.2%). In addition, the participants were asked to answer the following questionnaires: International RLS Rating Scale, Short Form-12, the Epworth Sleepiness Scale, and questions about sleep, gastroeosophageal reflux, diabetes and hypertension, as well as pharmacological treatment. Interleukin-6 (IL-6), C-reactive protein (CRP) and ferritin were measured in serum. Results RLS was more commonly reported in Reykjavik (18.3%) than in Uppsala (11.5%). Icelandic women reported RLS almost twice as often as Swedish women (24.4 vs. 13.9% p = 0.001), but there was no difference in prevalence of RLS between Icelandic and Swedish men. RLS was strongly associated with sleep disturbances and excessive daytime sleepiness. Subjects with RLS were more likely to be ex- and current smokers than subjects without RLS (p < 0.001). Respiratory symptoms and airway obstruction were more prevalent among those reporting RLS and they also estimated their physical quality of life lower than those without RLS (p < 0.001). RLS was not associated with symptoms of the metabolic syndrome like hypertension, obesity, markers of systemic inflammation (IL-6 and CRP) or cardiovascular diseases. Ferritin levels were significantly lower in RLS participants (p = 0.0002), but not (p = 0.07) after adjustment for center, age, sex and smoking history. Conclusion Restless legs syndrome was twice as common among Icelandic women compared to Swedish women. No such difference was seen for men. RLS was strongly associated with smoking and respiratory symptoms, decreased lung function, sleep disturbances, excessive daytime sleepiness, and physical aspects of life quality. RLS was not associated with markers of the metabolic syndrome like hypertension, obesity, cardiovascular diseases or biomarkers of systemic inflammation.}, keywords = {Epidemiology, Restless legs syndrome}, pubstate = {published}, tppubtype = {article} } Objective This study investigates the prevalence and the association between restless legs syndrome (RLS) and a large variety of health variables in two well-characterized random samples from the general population in Reykjavik, Iceland, and Uppsala, Sweden. Methods Using the national registries of inhabitants, a random sample from adults aged 40 and over living in Reykjavík, Iceland (n = 939), and Uppsala, Sweden (n = 998), were invited to participate in a study on the prevalence of COPD (response rate 81.1% and 62.2%). In addition, the participants were asked to answer the following questionnaires: International RLS Rating Scale, Short Form-12, the Epworth Sleepiness Scale, and questions about sleep, gastroeosophageal reflux, diabetes and hypertension, as well as pharmacological treatment. Interleukin-6 (IL-6), C-reactive protein (CRP) and ferritin were measured in serum. Results RLS was more commonly reported in Reykjavik (18.3%) than in Uppsala (11.5%). Icelandic women reported RLS almost twice as often as Swedish women (24.4 vs. 13.9% p = 0.001), but there was no difference in prevalence of RLS between Icelandic and Swedish men. RLS was strongly associated with sleep disturbances and excessive daytime sleepiness. Subjects with RLS were more likely to be ex- and current smokers than subjects without RLS (p < 0.001). Respiratory symptoms and airway obstruction were more prevalent among those reporting RLS and they also estimated their physical quality of life lower than those without RLS (p < 0.001). RLS was not associated with symptoms of the metabolic syndrome like hypertension, obesity, markers of systemic inflammation (IL-6 and CRP) or cardiovascular diseases. Ferritin levels were significantly lower in RLS participants (p = 0.0002), but not (p = 0.07) after adjustment for center, age, sex and smoking history. Conclusion Restless legs syndrome was twice as common among Icelandic women compared to Swedish women. No such difference was seen for men. RLS was strongly associated with smoking and respiratory symptoms, decreased lung function, sleep disturbances, excessive daytime sleepiness, and physical aspects of life quality. RLS was not associated with markers of the metabolic syndrome like hypertension, obesity, cardiovascular diseases or biomarkers of systemic inflammation. |
2009 |
Erna, Sif Arnardóttir ; Miroslaw, Mackiewicz ; Þórarinn, Gíslason ; Karen, Teff L; Allan, Pack I Molecular signatures of obstructive sleep apnea in adults: a review and perspective Journal Article 2009. Abstract | Links | BibTeX | Tags: Pathophysiology, Sleep Apnea @article{Erna2009, title = {Molecular signatures of obstructive sleep apnea in adults: a review and perspective}, author = {Erna, Sif Arnardóttir and Miroslaw, Mackiewicz and Þórarinn, Gíslason and Karen, L Teff and Allan, I Pack}, url = {https://academic.oup.com/sleep/article/32/4/447/3741709}, year = {2009}, date = {2009-08-01}, abstract = {The consequences of obstructive sleep apnea (OSA) are largely mediated by chronic intermittent hypoxia and sleep fragmentation. The primary molecular domains affected are sympathetic activity, oxidative stress and inflammation. Other affected domains include adipokines, adhesion molecules and molecules that respond to endoplasmic reticulum stress. Changes in molecular domains affected by OSA, assessed in blood and/or urine, can provide a molecular signature for OSA that could potentially be used diagnostically and to predict who is likely to develop different OSA-related comorbidities. High-throughput discovery strategies such as microarrays, assessing changes in gene expression in circulating blood cells, have the potential to find new candidates and pathways thereby expanding the molecular signatures for OSA. More research is needed to fully understand the pathophysiological significance of these molecular signatures and their relationship with OSA comorbidities. Many OSA subjects are obese, and obesity is an independent risk factor for many comorbidities associated with OSA. Moreover, obesity affects the same molecular pathways as OSA. Thus, a challenge to establishing a molecular signature for OSA is to separate the effects of OSA from obesity. We propose that the optimal strategy is to evaluate the temporal changes in relevant molecular pathways during sleep and, in particular, the alterations from before to after sleep when assessed in blood and/or urine. Such changes will be at least partly a consequence of chronic intermittent hypoxia and sleep fragmentation that occurs during sleep.}, keywords = {Pathophysiology, Sleep Apnea}, pubstate = {published}, tppubtype = {article} } The consequences of obstructive sleep apnea (OSA) are largely mediated by chronic intermittent hypoxia and sleep fragmentation. The primary molecular domains affected are sympathetic activity, oxidative stress and inflammation. Other affected domains include adipokines, adhesion molecules and molecules that respond to endoplasmic reticulum stress. Changes in molecular domains affected by OSA, assessed in blood and/or urine, can provide a molecular signature for OSA that could potentially be used diagnostically and to predict who is likely to develop different OSA-related comorbidities. High-throughput discovery strategies such as microarrays, assessing changes in gene expression in circulating blood cells, have the potential to find new candidates and pathways thereby expanding the molecular signatures for OSA. More research is needed to fully understand the pathophysiological significance of these molecular signatures and their relationship with OSA comorbidities. Many OSA subjects are obese, and obesity is an independent risk factor for many comorbidities associated with OSA. Moreover, obesity affects the same molecular pathways as OSA. Thus, a challenge to establishing a molecular signature for OSA is to separate the effects of OSA from obesity. We propose that the optimal strategy is to evaluate the temporal changes in relevant molecular pathways during sleep and, in particular, the alterations from before to after sleep when assessed in blood and/or urine. Such changes will be at least partly a consequence of chronic intermittent hypoxia and sleep fragmentation that occurs during sleep. |
