Markku Partinen

Women and the Obstructive Sleep Apnea Syndrome

Twenty-seven women referred to a sleep disorders clinic for symptoms of obstructive sleep apnea syndrome (OSAS) during one year were systematically analyzed after polygraphic monitoring of sleep and cephalometric x-ray examination. Our subjects, one-third of whom were premenopausal, comprised approximately 12 percent of the total OSAS population seen. Women with OSAS were compared with 110 OSAS men and with a group of 16 women without OSAS but referred to orthodontists for mild dental malocclusion. Women with OSAS were massively obese, much more so than their male counterparts. There was no significant difference between pre- and postmenopausal women, with the exception of the respiratory disturbance index (RDI), which was lower in the postmenopausal group despite similar morbid obesity (seemingly better tolerated by women with OSAS than by men with the same syndrome) and long mandibular plane-hyoid bone distance. The significantly higher RDI noted in premenopausal women, despite equally massive obesity and upper airway abnormalities, is thought to be related to hormonal status and better arousal response. Chronic obstructive lung disease (COLD) seen in a subgroup of women with OSAS did not differentiate this subgroup from the other OSAS patients when oxygen saturation during sleep, frequency of abnormal respiratory events and sleep variables were considered. Massive obesity is the dominant factor for the appearance of OSAS in women.

Insomnia and global sleep dissatisfaction in Finland

The purpose of this study is to assess the prevalence of insomnia symptoms and diagnoses in the general population of Finland. A total of 982 participants, aged 18u2003years or older and representative of the general population of Finland, were interviewed by telephone using the Sleep‐EVAL system. The participation rate was 78%. The questionnaire included the assessment of sleep habits, insomnia symptomatology according to Diagnostic and Statistical Manual of Mental Disorders‐IV (DSM‐IV) and International Classification of Sleep Disorders (ICSD), associated and sleep/mental disorders and daytime consequences. The overall prevalence of insomnia symptoms occurring at least three nights per week was 37.6%. Difficulty initiating sleep were mentioned by 11.9% of the sample, difficulty maintaining sleep by 31.6%, early morning awakenings by 11.0% and non‐restorative sleep by 7.9% of the sample. Global dissatisfaction with sleep was found in 11.9% of the sample. Daytime consequences (fatigue, mood changes, cognitive difficulties or daytime sleepiness) were reported by 39.9% of participants with insomnia symptoms and 87.6% of those with sleep dissatisfaction. A deterioration of sleep in summer or winter was associated with more complaints of sleep dissatisfaction. Prevalence of any DSM‐IV insomnia diagnosis was 11.7%. More specifically, DSM‐IV diagnosis of primary insomnia had a prevalence of 1.6% and DSM‐IV diagnosis of insomnia related to another mental disorder was at 2.1%. Insomnia was a symptom of another sleep disorder in about 16% of cases and of a mental disorder in about 17% of cases. As reported in other Nordic studies, sleep quality was worse in summer. Insomnia symptomatology was common and was reported by more than a third of Finnish participants. Compared with other European countries studied with the same methodology (France, the UK, Germany, and Italy), the prevalence of DSM‐IV insomnia diagnosis was 1.5 to two times higher in Finland.

Morning Cortisol Levels and Perceived Stress in Irregular Shift Workers Compared with Regular Daytime Workers

The 24/7 work environment and irregular shifts may markedly enhance the psychological pressure of media work. Changes in the hypothalamic-pituitary-adrenal axis reflect adaptation to stress. We analysed the correlation between subjective stress, sleep, salivary cortisol, and melatonin hormones among Finnish media workers with regular daytime work (RDW) and with irregular shift work (ISW) while controlling confounders. From 874 employees with regular daytime work or with irregular shift work, 70 employees from both groups were randomly selected. The final number of employees with a complete salivary cortisol profile was 66 in the RDW group and 65 in the ISW group. Five saliva samples were gathered from each subject before and during a working day. The salivary cortisol level of the sample taken 60 minutes after awakening (T1) was compared to the salivary cortisol level taken immediately after awakening (T0, T1/T0 ratio). The ratio was higher in the ISW group than in RDW group. Irregular shift work (P < 0.001), severe stress (P < 0.05), and less sleep (P < 0.05) were independently associated with an augmented cortisol response after awakening. A stressful work environment and irregular shift work enhance cortisol excretion after waking. In the long run, this may become detrimental to health.