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Sleep apnea and sleep: diagnostic aspects
Umeå University, Faculty of Medicine, Public Health and Clinical Medicine. Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Pulmonary Medicine.
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Patients with sleep apnea have frequent apneas and hypopneas during sleep. Apneas can be either central or obstructive. The apnea-hypopnea index (AHI) is the mean number of apneas and hypopneas per hour of sleep.

Aims: 1) To evaluate the effect of a mandibular advancement device on obstructive apneas and sleep; 2) to evaluate the influence of body position on central apnea frequency; 3) to investigate whether obstructive or central apnea is related to mortality in patients with stroke; and 4) to investigate sleep and sleeping positions in women.

Methods: Subjects were investigated during whole-night sleep respiratory recordings, either polysomnography including continuous recordings of EEG, EOG, EMG, airflow, respiratory effort, ECG, pulse oximetry and body position, or simplified sleep apnea recordings without EEG, EOG and EMG.

Results: The frequency of obstructive apneas, hypopneas and arousals decreased and rapid eye movement (REM) sleep increased in patients with mild, moderate and severe sleep apnea during treatment with a mandibular advancement device.

Central apneas were more prevalent in the supine position compared with the non-supine position in patients with Cheyne-Stokes respiration. The mean ± SD central AHI was 41 ± 13 in the supine position and 26 ± 12 in the non-supine position, p<0.001.

Stroke patients with obstructive sleep apnea ran an increased risk of death during 10 ± 0.6 years of follow-up with an adjusted hazard ratio of 1.76 (95% CI 1.05-2.95) compared with controls, independent of hypertension, age, body mass index, gender, smoking, diabetes mellitus, atrial fibrillation, Mini-Mental State Examination and Barthel-ADL. Central apnea was not related to early death.

Total sleep time, sleep efficiency, rapid eye movement sleep, slow wave and time in the supine position decreased with age in women. Sleep quality in women was reduced with age, body mass index, obstructive sleep apnea, smoking, alcohol and hypertension.

Conclusions: Obstructive sleep apneas and arousals are reduced and REM sleep is increased using a mandibular advancement device in patients with mild, moderate and severe sleep apnea. The frequency of central apneas and hypopneas is increased in the supine position in patients with Cheyne-Stokes respiration. Stroke patients with obstructive sleep apnea run an increased risk of early death. Central sleep apnea was not related to early death among the present patients. Normal values for sleep stages and sleeping positions are presented in a population-based sample of women. Age, body mass index, obstructive sleep apnea, smoking, alcohol and hypertension reduce sleep quality in women.

Place, publisher, year, edition, pages
Umeå: Department of Public Health and Clinical Medicine, Respiratory Medicine and Allegy , 2009. , 63 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1246
Keyword [en]
Sleep apnea, sleep stages, snoring, stroke, polysomnography, Cheyne-Stokes respiration, supine-dependency
National Category
Cardiac and Cardiovascular Systems Respiratory Medicine and Allergy
Research subject
Lung Medicine
Identifiers
URN: urn:nbn:se:umu:diva-18959ISBN: 978-91-7264-702-2 (print)OAI: oai:DiVA.org:umu-18959DiVA: diva2:201030
Public defence
2009-04-03, Sal B, byggnad 1D, Norrlands universitetssjukhus, 90185 Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2009-03-09 Created: 2009-03-02 Last updated: 2010-01-18Bibliographically approved
List of papers
1. The effect of mandibular advancement device on apneas and sleep in patients with obstructive sleep apnea
Open this publication in new window or tab >>The effect of mandibular advancement device on apneas and sleep in patients with obstructive sleep apnea
1998 (English)In: Chest, ISSN 0012-3692, Vol. 113, 707-713 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate the effects of a mandibular advancement device on apneas and sleep in, mild, moderate and severe obstructive sleep apnea.

Design: Prospective study.

Subjects: Forty-four of 47 patients included.

Intervention: Individually adjusted mandibular advancement devices.

Measurements: Polysomnographic sleep recordings for 1 night without the device and 1 night with it, with a median of 1 day and no changes in weight, medication, or sleep position between the recordings.

Results: The device reduced the median apnea-hypopnea index from 11 (range, 7 to 19) to 5 (range, 0 to 17) (p<0.001) in 21 patients with mild sleep apnea, from 27 (range, 20 to 38) to 7 (range 1 to 19) (p<0.001) in 15 patients with moderate sleep apnea, and from 53 (range 44 to 66) to 14 (range, 2 to 32) (p=<0.05) in 8 patients with severe sleep apnea. The arousal index decreased and the sleep stage patterns improved in all severity groups. Twenty-eight of 44 patients were successfully treated with an obstructive apnea-hypopnea index of below 10 and a subjective reduction in snoring. Nine of 16 patients with treatment failure still reported a reduction in snoring. The success rate correlated inversely to the disease severity (r=-0.41; p<0.01).

Conclusions: A mandibular advancement device reduces apnea and improves sleep quality in patients with obstructive sleep apnea, especially in those with mild and moderate disease. A follow-up sleep recording during treatment is necessary because of the risk of silent obstructive apneas without subjective snoring with the device.

Keyword
Dental appiances, polysomnography, sleep apnea, sleep stages, snoring
National Category
Dentistry Dentistry Medical and Health Sciences
Research subject
Lung Medicine; Odontology
Identifiers
urn:nbn:se:umu:diva-18867 (URN)10.1378/chest.113.3.707 (DOI)
Available from: 2009-02-26 Created: 2009-02-26 Last updated: 2009-03-12Bibliographically approved
2. Cheyne-Stokes respiration and supine dependency
Open this publication in new window or tab >>Cheyne-Stokes respiration and supine dependency
2005 (English)In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 25, no 5, 829-33 p.Article in journal (Refereed) Published
Keyword
adult, aged, aged 80 and over, Cheyne-Stokes respiration/etiology/physiopathology, female, heart failure, congestive/complications, humans, male, middle aged, polysomnography, posture, sleep apnea, central/complications/physiopathology, sleep stages, supine position
Identifiers
urn:nbn:se:umu:diva-15017 (URN)10.1183/09031936.05.00107904 (DOI)15863639 (PubMedID)
Available from: 2007-09-20 Created: 2007-09-20 Last updated: 2011-12-06Bibliographically approved
3. Obstructive sleep apnea is a risk factor for death in patients with stroke: a 10-year follow-up
Open this publication in new window or tab >>Obstructive sleep apnea is a risk factor for death in patients with stroke: a 10-year follow-up
Show others...
2008 (English)In: Archives of Internal Medicine, ISSN 0003-9926, E-ISSN 1538-3679, Vol. 168, no 3, 297-301 p.Article in journal (Refereed) Published
Abstract [en]

 

Background: Sleep apnea occurs frequently among stroke patients, but it is still unknown whether a diagnosis of sleep apnea is an independent risk factor for mortality. We aimed to investigate whether obstructive or central sleep apnea was related to a reduced long-term survival among stroke patients.

Methods: One hundred and thirty-two of 151 patients admitted for in-hospital stroke rehabilitation in the catchment area of Umeå from 1 April 1995 to 1 May 1997 underwent overnight sleep apnea recordings at 23 ± 8 days after onset of stroke. All patients were followed-up prospectively for a mean (SD) of 10.0 ± 0.6 years, with death as the primary outcome and no one was lost to follow-up. Obstructive sleep apnea was defined when the obstructive apnea-hypopnea index was over 15 and central sleep apnea when the central apnea-hypopnea index was over 15. Patients with an obstructive and a central apnea-hypopnea index below 15 served as controls.

Results: Of 132 enrolled patients, 116 had died at follow-up. The risk of death was higher among the 23 patients with obstructive sleep apnea than controls (adjusted hazard ratio, 1.76; 95% confidence interval 1.05 to 2.95, p=0.03), independent of age, gender, body-mass index, smoking, hypertension, diabetes mellitus, atrial fibrillation, mini-mental state examination and Barthel activity of daily living There was no difference in mortality between the 28 patients with central sleep apnea and controls (adjusted hazard ratio, 1.07; 95 percent confidence interval 0.65 to 1.76, p=0.053).

Conclusions: Stroke patients with obstructive sleep apnea run an increased risk of early death. Central sleep apnea was not related to early death among the present patients.

Place, publisher, year, edition, pages
Chicago: American medical association, 2008
Keyword
obstructive sleep apnéa, stroke, death, positive airway pressure, Cheyne-Stokes respiration, breathing disorders, ischemic stroke, 1st-ever stroke, prognosis, disease, night
National Category
Cardiac and Cardiovascular Systems Family Medicine
Research subject
Lung Medicine
Identifiers
urn:nbn:se:umu:diva-18814 (URN)10.1001/archinternmed.2007.70 (DOI)000252962300009 ()
Available from: 2009-02-25 Created: 2009-02-25 Last updated: 2016-03-02Bibliographically approved
4. Sleep in women: normal values for sleep stages and position and the effect of age, obesity, sleep apnea, smoking, alcohol and hypertension
Open this publication in new window or tab >>Sleep in women: normal values for sleep stages and position and the effect of age, obesity, sleep apnea, smoking, alcohol and hypertension
2009 (English)In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 123, no 10, 1025-1030 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: To define normal values for total sleep time, sleep latency, sleep efficiency, sleep stages and sleeping positions in women and to investigate how sleep is affected by age, obesity, sleep apnea, smoking, alcohol dependency and hypertension.

Methods: In a population-based study, 400 Swedish women aged 20-70 years were investigated using overnight in-home polysomnography.

Results: The mean normal total sleep time was 392 minutes, sleep latency 22 minutes and sleep efficiency 82%. Women spent 31 minutes in sleep stage 1, 244 minutes in stage 2, 41 minutes in stage 3-4 and 76 minutes in rapid eye movement (REM) sleep. They spent 41% of their sleep time in the supine position, 50% in the lateral position and 9% in the prone position. Multivariate analyses revealed that sleep efficiency was lower in older women and in women with hypertension. Sleep latency was short in women with severe sleep apnea and long in smokers, alcohol-dependent and hypertensive women. Total sleep time was long in severe sleep apnea. Sleep stage 3-4 was inversely related to age and body-mass index. Less REM sleep occurred in alcohol-dependent women. Women younger than 45 years old slept a mean of 42% in the lateral position while women of 45 years and older slept 57% in the lateral position (p<0.001).

Conclusions: In this population-based study of women, we present normal values for sleep stages and sleeping position. We conclude that age, body-mass index, obstructive sleep apnea, smoking, alcohol and hypertension reduce sleep quality. With age, women spend more time sleeping in the lateral position.

Place, publisher, year, edition, pages
Elsevier, 2009
Keyword
sleep stages, sleeping position, normalvalues
National Category
Medical and Health Sciences Cardiac and Cardiovascular Systems Respiratory Medicine and Allergy
Research subject
Lung Medicine
Identifiers
urn:nbn:se:umu:diva-18821 (URN)10.1016/j.sleep.2008.12.008 (DOI)19345643 (PubMedID)
Available from: 2009-02-25 Created: 2009-02-25 Last updated: 2012-08-15Bibliographically approved

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