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Obstructive sleep apnea: the relationship to cardiovascular disease, diabetes mellitus, motor vehicle driving and ambient temperature
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Obstructive sleep apnea is a common disorder, especially in men. Patients with this condition often snore and suffer from excessive daytime sleepiness. It is a treatable condition related to cardiovascular disease, road traffic accidents and obesity.

Aims: To study whether snoring and witnessed sleep apnea are related to diabetes mellitus and whether sleepy subjects who snore or report sleep apneas drive more than others. To investigate whether sleep apnea is related to stroke, mortality and myocardial infarction in patients with coronary artery disease. To study the effect of ambient temperature on sleep apnea, morning alertness and sleep quality in patients with obstructive sleep apnea.

Methods and results: Questions on snoring, sleep apnea, daytime sleepiness and yearly driving distance were included in the northern Sweden component of the WHO MONICA study. Analyzed were 7905 randomly selected men and women aged 25-79 years. Snoring and witnessed sleep apnea were related to diabetes mellitus in women, (OR 1.58, p = 0.041 and OR 3.29, p = 0.012 respectively), independent of obesity, age and smoking, but not in men. Sleepy snoring men drove a mean of 22566 km per year which was more than others who drove 17751 km per year independent of age, BMI, smoking and physical activity (p = 0.02). Sleepy men reporting sleep apnea also drove more (p = 0.01). 392 men and women with coronary artery disease referred for coronary angiography were examined with overnight sleep apnea recordings and followed for 10 years. Sleep apnea was recorded in 211 (54%) of patients at baseline. Stroke occurred in 47 (12%) patients at follow up. Sleep apnea was associated with an increased risk of stroke (HR 2.89, 95% CI 1.37 - 6.09, p = 0.005) independent of age , BMI, left ventricular function, diabetes mellitus, gender, intervention, hypertension, atrial fibrillation, a previous stroke or TIA and smoking. The risk of stroke increased with the severity of sleep apnea. 40 patients with obstructive sleep apnea were investigated with overnight polysomnography in ambient temperatures of 16°C, 20°C and 24°C in random order. Total sleep time was a mean of 30 minutes longer (p = 0.009), sleep efficiency higher (p = 0.012), patients were more alert in the morning (p = 0.028), but sleep apnea was more severe when sleeping in 16°C (p = 0.001) and 20°C (p = 0.033) vs. 24°C. The AHI was 30 ± 17 in 16ºC room temperature, 28 ± 17 in 20°C and 24 ± 18 in 24°C.

Conclusions: Snoring and witnessed sleep apneas are related to diabetes mellitus in women. Sleepy men who snore or report sleep apnea drive more than others. Sleep apnea is independently associated with the risk of stroke among patients with coronary artery disease. Subjects with obstructive sleep apnea sleep longer, are more alert in the morning after a night’s sleep, but sleep apnea is more severe when sleeping in a colder environment.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2011. , 61 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1452
Keyword [en]
Obstructive sleep apnea. Snoring. Cardiovascular disease. Stroke. Diabetes mellitus. Traffic accidents. Ambient temperature.
National Category
Respiratory Medicine and Allergy
Research subject
Medicine
Identifiers
URN: urn:nbn:se:umu:diva-48616ISBN: 978-91-7459-291-7 (print)OAI: oai:DiVA.org:umu-48616DiVA: diva2:451994
Public defence
2011-11-18, Sal B, Målpunkt T9, Norrlands universitetssjukhus 901 85, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2011-10-28 Created: 2011-10-26 Last updated: 2011-10-28Bibliographically approved
List of papers
1. Snoring and witnessed sleep apnea is related to diabetes mellitus in women
Open this publication in new window or tab >>Snoring and witnessed sleep apnea is related to diabetes mellitus in women
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2009 (English)In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 10, no 1, 112-117 p.Article in journal (Refereed) Published
Abstract [en]

Background

Gender differences in the relationship of snoring and diabetes mellitus are mainly unknown. We aimed to analyze the relationship between snoring, witnessed sleep apnea and diabetes mellitus and to analyze possible gender related differences in an unselected population.

Methods

Questions on snoring and witnessed sleep apneas were included in the Northern Sweden component of the WHO, MONICA study. Invited were 10,756 men and women aged 25–79 years, randomly selected from the population register.

Results

There were 7905 (73%) subjects, 4047 women and 3858 men who responded to the questionnaire and attended a visit for a physical examination. Habitual snoring was related to diabetes mellitus in women, with an adjusted odds ratio (OR) = 1.58 (95% confidence interval (CI) 1.02–2.44, p = 0.041) independent of smoking, age, body mass index and waist circumference. Witnessed sleep apnea was also independently related to diabetes mellitus in women, with an adjusted OR = 3.29 (95% CI 1.20–8.32, p = 0.012). Neither snoring, nor witnessed sleep apneas were associated with diabetes mellitus among men, except for witnessed sleep apnea in men aged 25–54 years old. They had an adjusted OR = 3.84 (95% CI 1.36–10.9, p = 0.011) for diabetes mellitus.

Conclusions

Snoring and witnessed sleep apneas are related to diabetes mellitus in women. Witnessed sleep apnea is related to diabetes mellitus in men younger than 55 years old.

Keyword
Diabetes mellitus; Sleep apnea; Snoring; Gender; Epidemiology; Population
National Category
Respiratory Medicine and Allergy
Research subject
Medicine
Identifiers
urn:nbn:se:umu:diva-8756 (URN)10.1016/j.sleep.2007.11.005 (DOI)18207451 (PubMedID)
Available from: 2008-02-08 Created: 2008-02-08 Last updated: 2017-12-14Bibliographically approved
2. Snoring men with daytime sleepiness drive more than others: a population-based study
Open this publication in new window or tab >>Snoring men with daytime sleepiness drive more than others: a population-based study
2009 (English)In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 10, no 9, 1012-1015 p.Article in journal (Refereed) Published
Abstract [en]

Objective

To investigate whether subjects with daytime sleepiness who snore or report witnessed sleep apneas drive more than others.

Methods

Questions on snoring, witnessed sleep apnea, excessive daytime sleepiness and driving distance per year were included in the Northern Sweden component of the WHO, MONICA study. Invited were 10756 subjects aged 25–79 years, randomly selected from the population register.

Results

There were 7905 (73%) subjects, 3858 men and 4047 women who responded to the questionnaire and attended a visit for a physical examination. Habitually snoring men with daytime sleepiness drove a mean of 22566 (95% CI 18550–26582) km a year, which was significantly more than non-snoring men without excessive daytime sleepiness who drove 17751 (95% CI 17076–18427) km a year, p = 0.02, after adjustments for age, body mass index, smoking and physical activity. Men reporting witnessed sleep apnea and excessive daytime sleepiness also drove more than their counterparts in adjusted analysis, p = 0.01. Women reporting daytime sleepiness and witnessed apnea tended to drive more, while snoring women with daytime sleepiness did not.

Conclusions

Men suffering from excessive daytime sleepiness who snore habitually or report witnessed sleep apneas drive significantly more than others.

National Category
Respiratory Medicine and Allergy
Research subject
Medicine
Identifiers
urn:nbn:se:umu:diva-27681 (URN)10.1016/j.sleep.2008.09.020 (DOI)19345642 (PubMedID)
Available from: 2009-11-13 Created: 2009-11-13 Last updated: 2017-12-12Bibliographically approved
3. Increased risk of stroke in patients with coronary artery disease and sleep apnea: a 10-year follow-up
Open this publication in new window or tab >>Increased risk of stroke in patients with coronary artery disease and sleep apnea: a 10-year follow-up
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2008 (English)In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 118, no 9, 955-960 p.Article in journal (Refereed) Published
Abstract [en]

Background The effect of sleep apnea on mortality and cardiovascular morbidity is mainly unknown. We aimed to study whether sleep apnea is related to stroke, death, or myocardial infarction in patients with symptomatic coronary artery disease.

Methods and Results A total of 392 men and women with coronary artery disease referred for coronary angiography were examined by use of overnight sleep apnea recordings. Sleep apnea, defined as an apnea-hypopnea index ≥5, was recorded in 54% of the patients. All patients were followed up prospectively for 10 years, and no one was lost to follow-up. Stroke occurred in 47 (12%) of 392 patients during follow-up. Sleep apnea was associated with an increased risk of stroke, with an adjusted hazard ratio of 2.89 (95% confidence interval 1.37 to 6.09, P=0.005), independent of age, body mass index, left ventricular function, diabetes mellitus, gender, intervention, hypertension, atrial fibrillation, a previous stroke or transient ischemic attack, and smoking. Patients with an apnea-hypopnea index of 5 to 15 and patients with an apnea-hypopnea index ≥15 had a 2.44 (95% confidence interval 1.08 to 5.52) and 3.56 (95% confidence interval 1.56 to 8.16) times increased risk of stroke, respectively, than patients without sleep apnea, independent of confounders (P for trend=0.011). Death and myocardial infarction were not related to sleep apnea. Intervention in the form of coronary artery bypass grafting or percutaneous coronary intervention was related to a longer survival but did not affect the incidence of stroke.

Conclusions Sleep apnea is significantly associated with the risk of stroke among patients with coronary artery disease who are being evaluated for coronary intervention.

Place, publisher, year, edition, pages
New York: American Heart Association, 2008
Keyword
sleep apnea syndromes, coronary disease, stroke, prognosis, risk factors, myocardial infarction
National Category
Respiratory Medicine and Allergy
Research subject
Medicine
Identifiers
urn:nbn:se:umu:diva-19444 (URN)10.1161/CIRCULATIONAHA.108.783290 (DOI)18697817 (PubMedID)
Available from: 2009-03-05 Created: 2009-03-05 Last updated: 2017-12-13Bibliographically approved
4. Ambient temperature and obstructive sleep apnea: effects on sleep, sleep apnea and morning alertness
Open this publication in new window or tab >>Ambient temperature and obstructive sleep apnea: effects on sleep, sleep apnea and morning alertness
2012 (English)In: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 35, no 4, 513-517 p.Article in journal (Refereed) Published
Abstract [en]

Study Objectives: The aim of the study was to investigate the effect of ambient temperature on sleep, sleep apnea, and morning alertness in patients with obstructive sleep apnea. Design: Randomized controlled trial. Setting: In-hospital investigations. Participants: Forty patients with obstructive sleep apnea naive to treatment, with an apnea-hypopnea index of 10-30. Interventions: Three different nights in room temperatures of 16 degrees C, 20 degrees C, and 24 degrees C. Measurements: Overnight polysomnography and Karolinska Sleepiness Scale. Results: The obstructive apnea-hypopnea index was 30 +/- 17 at 16 degrees C room temperature, 28 +/- 17 at 20 degrees C, and 24 +/- 18 at 24 degrees C. The obstructive apnea-hypopnea index was higher at 16 degrees C room temperature versus 24 degrees C (P = 0.001) and at 20 degrees C room temperature versus 24 degrees C (P = 0.033). Total sleep time was a mean of 30 min longer (P = 0.009), mean sleep efficiency was higher (77 +/- 11% versus 71 +/- 13% respectively, P = 0.012), and the patients were significantly more alert according to the Karolinska Sleepiness Scale (P < 0.028) in the morning at 16 degrees C room temperature versus 24 degrees C. The amount of sleep in different sleep stages was not affected by room temperature. Conclusions: Untreated patients with obstructive sleep apnea sleep longer, have better sleep efficiency, and are more alert in the morning after a night's sleep at 16 degrees C room temperature compared with 24 degrees C, but obstructive sleep apnea is more severe at 16 degrees C and 20 degrees C compared with 24 degrees C.

Place, publisher, year, edition, pages
Westchester: American Academy of Sleep Medicine, 2012
Keyword
Sleep apnea syndromes, sleep quality, daytime sleepiness, treatment, ambient temperature, polysomnography, sleep stages, sleep time, randomized controlled trial
National Category
Respiratory Medicine and Allergy
Research subject
Medicine
Identifiers
urn:nbn:se:umu:diva-48612 (URN)10.5665/sleep.1736 (DOI)000303154400012 ()
Available from: 2011-10-26 Created: 2011-10-26 Last updated: 2017-12-08Bibliographically approved

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