Christer Edling

Headache, snoring and sleep apnoea

To evaluate reported headache prevalence among the general population and patients suffering from snoring and obstructive sleep apnoea syndrome (OSAS), a cross-sectional study was performed among those aged 30–64 years residing in Kopparberg county in central Sweden. Consecutive patients referred to the sleep laboratory in the catchment area who fulfilled objective diagnostic criteria (snorers = 448, OSAS = 324) and a random sample of the general population (n = 583) responded to the same questionnaire. Patients were selected following sleep apnoea screening with 100% specificity for both OSAS and snoring. Responders from the general population were divided into snorers or non-snorers on the basis of self-report. To validate the self-report question on snoring in the questionnaire, 50 males and 49 females, randomly selected from the sample of the general population, underwent sleep apnoea screening in their homes. Headache among both men and women was found to be more prevalent among heavy snorers and OSAS patients compared with the control group. Morning headache, in particular, was at least three times more common among male and female heavy snorers and OSAS patients then among the general population. Headache in the control group was more common among snorers than non-snorers. Among responders, 5% of the general population reported experiencing headache often or very often upon awakening. For the heavy snoring and OSAS groups, 18% reported experiencing headache often or very often upon awakening. The results indicate that headache is common among heavy snorers and OSAS patients regardless of gender.

The validity of reported musculoskeletal problems. A study of questionnaire answers in relation to diagnosed disorders and perception of pain.

The objectives of the present study were to evaluate the validity of answers given in a questionnaire on musculoskeletal pain and conditions by means of a clinical assessment, and to get some understanding of the subjects perception of reported pain. This was performed by using measures of sensitivity and specificity comparing data from the questionnaire with the clinical diagnoses of conditions in the neck, shoulders and thoracic spine. Subjective perception of pain was obtained by the use of visual analogue scale (VAS) and pain drawings. For the combination of neck and shoulders, both sensitivity (95%) and specificity (88%) were high for current pain. The results of the study confirm the validity of the subjective reports of the respondents. A pain assessment instrument including a questionnaire, VAS and pain drawings may be useful to reveal conditions in the neck and shoulders and thoracic spine, common sites of work related musculoskeletal disorders.

Adverse health effects among women living with heavy snorers

Women living with heavy snorers were more frequently affected by symptoms of insomnia, morning headache, daytime sleepiness, and fatigue than women living with non-snorers. Questionnaire data were collected from 1,032 women 30 to 64 years of age residing in Dalarna county, in mid-Sweden. There were indications of a dose-response relationship between the conjectured sound exposure and reported symptoms, regardless of whether the female herself snored. Sleeping in separate bedrooms did not seem to give the women any alleviation. The results point to a possible contributory cause of disturbed sleep, morning headache, and daytime sleepiness among women living with a snoring spouse. The results also indicate that prevention and treatment of snoring are important issues for the couple as well as for the snorer.Women living with heavy snorers were more frequently affected by symptoms of insomnia, morning headache, daytime sleepiness, and fatigue than women living with nonsnorers. Questionnaire data were collected from 1,032 women 30 to 64 years of age residing in Dalarna county, in mid-Sweden. There were indications of a dose-response relationship between the conjectured sound exposure and reported symptoms, regardless of whether the female herself snored. Sleeping in separate bedrooms did not seem to give the women any alleviation. The results point to a possible contributory cause of disturbed sleep, morning headache, and daytime sleepiness among women living with a snoring spouse. The results also indicate that prevention and treatment of snoring are important issues for the couple as well as for the snorer.

AIRWAY SYMPTOMS AMONG HOUSE PAINTERS IN RELATION TO EXPOSURE TO VOLATILE ORGANIC COMPOUNDS (VOCS)—A LONGITUDINAL STUDY

The increased use of water-based paint (WBP) for indoor application during the last decade has drastically changed the exposure conditions for Swedish house painters. WBP has a lower emission of volatile organic compounds (VOCs) than solvent-based paint (SBP), but contains more reactive compounds, such as biocides, glycol ethers, and other high molecular solvents. The aim of this study was to compare the incidence of airway symptoms and self-reported asthma in house painters with a different degree of use of WBP and SBP. The incidence of seven general airway symptoms, and three work-related symptoms, was analysed by means of a self-administered questionnaire, in a cohort of 207 house painters followed from 1989 to 1992. Different airway symptoms were compared with clinical information obtained by a methacholine challenge test and dynamic spirometry in a selected subgroup of 44 painters. Information on the degree of use of SBP and WBP was used to estimate the total exposure to volatile organic compounds (TVOC) for each individual. In total, 175 men in the cohort worked as painters during the study period. No increase of asthma or respiratory symptoms was observed among those 50 painters with a pure exposure to WBP (estimated TVOC 1-3 mg m-3). Most painters (N = 125) had a mixed exposure to SBP and WBP, the main source of the TVOC being the limited use of SBP. WBP was perceived as less irritative than SBP, but complaints on airway irritation from WBP increased during the study period. The most pronounced increase of airway irritation in relation to both SBP and WBP, was observed among those 35 painters with the highest solvent exposure (estimated TVOC 100-380 mg m-3). An increase of respiratory symptom index and shortness of breath, in relation to estimated TVOC exposure was also observed. Selection effects were detected. Painters leaving their job during the study period had more non-specific hyper-reactivity symptoms, and more airway irritation from WBP, as compared to painters remaining at their occupation. Our study indicates that VOC emissions from SBPs may contribute to the development of respiratory symptoms and airway irritation. We found no increase of respiratory symptoms among painters exposed only to WBPs. There were, however, indications that VOC exposure from WBPs may cause airway irritation in some subjects. Because of selection effects, cross-sectional studies on respiratory symptoms in relation to occupational exposure to paint emissions may be inconclusive.

Occupational exposure to water based paint and symptoms from the skin and eyes.

Water based paints contain organic solvents and many additives, such as biocides, surfactants, pigments, binders, amines, and monomers. The chemical complexity may introduce new potential health hazards to house painters, in particular irritative and allergic disorders. This study was performed to compare how house painters experience work with water based paints or solvent based paints, and to evaluate whether exposure to water based paints increases mucous membrane and dermal symptoms among house painters. 255 male house painters aged 20 to 65 were invited to participate in the study. Controls were two industrial populations, in total 302 men, without exposure to water based paints. Self administered questionnaires were used to assess the painters experiences of working with different types of paints and the occurrence of symptoms in the exposed and unexposed groups. Hygiene measurements were performed during normal working days when only water based paints and no solvent based paints were used. The painters were exposed to low concentrations of dust, metals, ammonia, formaldehyde, and volatile organic compounds. The work environment was considered better when working with water based paints than with solvent based paints. There were more complaints of frequent urination when working with water based paint. Taste or olfactory disturbances were less common. General as well as work related eye and skin irritation was more common among the exposed workers. For other symptoms no significant differences were found. The study indicates that the introduction of water based paints has improved the work environment for house painters. Water based paints cause less discomfort and airway irritation than the earlier solvent based paints. Adverse general health effects seem low. Some of the painters may have dermal symptoms caused by the components in water based paints.

Occupational exposure to water-based paints and self-reported asthma, lower airway symptoms, bronchial hyperresponsiveness, and lung function.

The associations between occupational exposure to water-based paints and the prevalence of self-reported asthma, other lower airway symptoms, bronchial hyperresponsiveness (BHR), and lung function were studied in house painters. Symptom prevalences were obtained from a self-administered questionnaire sent to 415 male painters during 1989–1992. Clinical investigations were carried out in three selected groups: 23 painters with asthmatic symptoms, nine painters with other lower airway symptoms, and 12 painters without airway symptoms. The clinical studies included lung function test, methacholine provocation test, and occurrence of atopy, confirmed by skin prick test to common allergens. In addition, a group of 18 young male painters with no occupational exposure to solvent-based paints were followed with dynamic spirometry before and after a workshift, when only water-based paints were used. The prevalence of self-reported asthma (7%) was somewhat, but not statistically, increased compared to an industrial population without exposure to water-based paints or other airway irritants. A decrease in FEV1 and FVC during the workday was observed in the young painters. In the clinical studies the painters exhibited increased BHR compared to the referents and a decreased FEV1. The number of years working as a painter was related to a decrease in FEV1, which was most pronounced in subjects with atopy who also reported lower airway symptoms in relation to the degree of work with water-based paints, but not to the degree of use of solvent-based paints. Our results indicate that house painters have an increased risk of airway problems. A contributory cause could be exposure to volatile organic compounds or other volatile compounds emitted from water-based paints. It is also concluded that painters with atopy should be informed about the increased risk of airway illness. This would be an important task for occupational health services in their aim of preventing the adverse effects of occupational exposures.

Reported neck and shoulder problems in female industrial workers: the importance of factors at work and at home

Abstract A study was performed to determine how exposure to physical and psychosocial factors at work and at home influences self-reported musculoskeletal problems of the neck, shoulders and thoracic spine. A group of 173 Swedish female blue collar workers, aged 20–45xa0yr, with monotonous work tasks in the metal and food industries completed questionnaires with a total of 184 questions relating to health status and demographic factors, exposure factors (work-related and domestic factors, questions on lifestyle e.g. smoking, physical activity level and leisure activities), and outcome (musculoskeletal problems). The women were placed in one case group with ‘continuous’ problems in the ‘neck and shoulder’ region, or one referent group, in a nested case-referent study. Frequencies, mean values, factor analyses, analysis of the correlation between exposure and effect variables, and odds ratios with 95% confidence intervals were all calculated. The results showed that an increased risk of suffering from musculo-skeletal problems of the neck and shoulder region among female blue collar workers was related to working in a monotonous fixed position, working with the hands and arms lifted and unsupported, and having a high decision latitude. Single women without children below the age of 13 reported fewer problems than women with a partner, children Relevance to industry The results of this study indicate the importance of good work place design but that much still needs to be done to provide safe working conditions, and also that factors both at work and at home are of importance in the production of neck and shoulder problems.

Occupational exposure to organic solvents as a cause of sleep apnoea.

A high prevalence of sleep apnoea was found in a group of men occupationally exposed to organic solvents. Workers with long term exposure to organic solvents often report symptoms such as fatigue, forgetfulness, and concentration difficulties. These symptoms are strikingly similar to those reported by patients with obstructive sleep apnoea syndrome (OSAS). This is a frequently diagnosed disorder characterised by disturbed sleep causing psychic or somatic complications and daytime sleepiness. A study was undertaken to evaluate whether people with long term occupational exposure to organic solvents have a higher prevalence of sleep apnoea than the general population. Patients exposed to solvents (66 men) were invited to participate in a screening for sleep apnoea. A static charge sensitive bed was used for the monitoring of respiration movements and pulse oximetry during one night. A classical sleep apnoea was diagnosed if periodic respiration movement exceeded 45% of estimated sleep time and the oxygen desaturation index exceeded 6. The prevalence of sleep apnoea among the men exposed to solvents was compared with the prevalence in the general population (1.4%). The prevalence among the participating exposed men was 19.7% which gave a conservative relative risk estimate of 14.1 (95% confidence interval (95% CI) 7.5-24.2). The results indicate that exposure to organic solvents causes sleep apnoea. An alternative possibility is that people with sleep apnoea are misdiagnosed as cases of solvent induced toxic encephalopathy. The interpretation has importance for the caring of the patient.

Improvement of subjective work performance among obstructive sleep apnea patients after treatment with continuous positive airway pressure

Obstructive sleep apnea syndrome (OSAS) is a significant problem for some patients presenting with snoring and excessive daytime sleepiness. The ‘golden standard’ therapy in OSAS is considered to be nasal continuous positive airway pressure (CPAP). The effects of CPAP on work performance in sleep apnoics has not been studied previously. One hundred and fifty‐two patients with OSAS participated in an open label study. The patients were diagnosed as suffering from severe OSAS after they underwent overnight polysomnography showing that their apnea indexes were at least 20. The participants answered four questions concerning self‐perceived work performance prior to and after using CPAP during 6 months. There were highly statistically significant decreases (P < 0.000001) in work performance difficulties as graded by the patient. The results of this study indicate that CPAP treatment improves subjective work performance in patients suffering from OSAS.

Occupational Exposure to Organic Solvents and Sleep-Disordered Breathing

STUDY OBJECTIVEnTo investigate whether people with occupational exposure to organic solvents have a higher prevalence of obstructive sleep apnea syndrome (OSAS) than the general population and to examine the relationship between snoring and exposure to organic solvents.nnnDESIGN AND PARTICIPANTSnConsecutive patients, aged 30-64 years, referred during a 3-year period to the sleep laboratory at Avesta Hospital, Sweden, because of suspected OSAS made up the patient groups. Following admission, patients underwent a simplified sleep apnea investigation and were divided into two groups, OSAS (n = 320) and snorers (n = 443). A random sample of 296 men and 289 women aged 30-64 years obtained from a register of all country residents maintained by the county tax authority served as referents (controls). Both patients and referents responded to two questionnaires, including questions about occupation, exposure to organic solvents, and other chemical and physical agents.nnnRESULTSnMen with OSAS or snoring and women with snoring had more often been occupationally exposed to organic solvents than the referents, showing an almost twofold increase in risk for those exposed during whole workdays. For men, the risk of OSAS or snoring increased with increasing exposure.nnnCONCLUSIONnThe result indicates that occupational exposure to organic solvents might cause sleep apnea. A new observation is that even snoring could be caused by exposure to organic solvents. It is important to elucidate whether exposure to organic solvents is a cause of OSAS, because such a finding may have important implications for prevention and treatment of sleep disturbances.