Ola Sunnergren

Positional sensitivity as a confounder in diagnosis of severity of obstructive sleep apnea

PurposeThe apnea–hypopnea index (AHI) is used to grade obstructive sleep apnea (OSA) into mild, moderate, and severe forms. Obstructive events are most common in the supine position. The amount of supine sleep thus influences total AHI. Our aim was to determine the prevalence of position-dependent OSA (POSA) and its relation to OSA severity classification as recommended by the American Academy of Sleep Medicine (AASM).MethodsTwo hundred sixty-five subjects were recruited from primary care hypertension clinics. Whole-night respiratory recordings were performed to determine the AHI in the supine and non-supine positions, respectively. POSA was defined as supine AHI twice the non-supine AHI with supine AHI ≥5.ResultsFifty-three percent had POSA, 22% had non-position-dependent OSA, and 25% had normal respiration. By AASM classification, 81 subjects did not have OSA, but 42% of them had some degree of obstruction when supine, and 5 subjects would have been classified as moderate–severe if they had only slept supine. Conversely, of the 53 classified as mild OSA, 30% would have changed to a more severe classification if they had exclusively slept supine.ConclusionsPOSA was common both in subjects that by AASM classification had OSA as well as those without. The severity of OSA, as defined by AASM, could be dependent on supine time in a substantial amount of subjects.

Soft palate sensory neuropathy in the pathogenesis of obstructive sleep apnea

In general, obstructive sleep apnea (OSA) seems to be a progressive disorder whose pathogenesis is not fully understood. One hypothesis is that long‐standing snoring vibrations cause a local neuropathy in the upper airway, which predisposes to obstructive events during sleep. The aim of this study was to investigate sensory function in the upper airway in a cohort of subjects comprising nonsnorers, snorers, and untreated subjects with OSA, and to correlate data to apnea–hypopnea index (AHI) and duration of snoring.

Factors associated with undiagnosed obstructive sleep apnoea in hypertensive primary care patients

Abstract Objective. In hypertensive primary care patients below 65 years of age, (i) to describe the occurrence of undiagnosed obstructive sleep apnoea (OSA), and (ii) to identify the determinants of moderate/severe OSA. Design. Cross-sectional. Setting. Four primary care health centres in Sweden. Patients. 411 consecutive patients (52% women), mean age 57.9 years (SD 5.9 years), with diagnosed and treated hypertension (BP >140/90). Main outcome measures. Occurrence of OSA as measured by the apnoea hypopnoea index (AHI). Results. Mild (AHI 5–14.9/h) and moderate/severe (AHI > 15/h) OSA were seen among 29% and 30% of the patients, respectively. Comparing those without OSA with those with mild or moderate/severe OSA, no differences were found in blood pressure, pharmacological treatment (anti-hypertensive, anti-depressive, and hypnotics), sleep, insomnia symptoms, daytime sleepiness, or depressive symptoms. Obesity (BMI > 30 kg/m2) was seen in 30% and 68% of the patients with mild and moderate/severe OSA, respectively. Male gender, BMI > 30 kg/m2, snoring, witnessed apnoeas, and sleep duration >8 hours were determinants of obstructive sleep apnoea. Conclusion. Previously undiagnosed OSA is common among patients with hypertension in primary care. Obesity, snoring, witnessed apnoeas, long sleep duration, and male gender were the best predictors of OSA, even in the absence of daytime sleepiness and depressive symptoms.

A mixed method evaluation of a group‐based educational programme for CPAP use in patients with obstructive sleep apnea

RATIONALE, AIMS AND OBJECTIVESnContinuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA) has a low long-term adherence. Educational interventions are few and sparsely described regarding content, pedagogical approach and participants perceptions. The aim was to describe adherence to CPAP treatment, knowledge about OSA/CPAP, as well as OSA patients perceptions of participating in a group-based programme using problem-based learning (PBL) for CPAP initiation. EDUCATIONAL PROGRAMME: The PBL programme incorporated elements from theories and models concerning motivation and habits. Tutorial groups consisting of four to eight patients met at six sessions during 6 months.nnnMETHODSnA sequential explanatory mixed method design was used on 25 strategically selected patients. Quantitative data regarding, clinical variables, OSA severity, CPAP use, and knowledge were collected at baseline, after 2 weeks and 6 months. Qualitative data regarding patients perceptions of participation were collected after 6 months by semi-structured interviews using a phenomenographic approach.nnnRESULTSn72% of the patients were adherent to CPAP treatment after 2 weeks and 6 months. All patients improved their baseline knowledge about OSA and CPAP after 2 weeks and sustained it after 6 months. Anxiety and fear, as well as difficulties and needs were motivational factors for participation. Patients described the difficulties of behavioural change, an awareness that improvements do not occur immediately, a realization of the importance of both technical and emotional support and the need for a healthier lifestyle.nnnCONCLUSION AND PRACTICE IMPLICATIONSnA group-based programme using PBL seems to facilitate adaptive and developmental learning and result in acceptable CPAP adherence levels.

Gender differences in respiratory disturbance, sleep and daytime sleepiness in hypertensive patients with different degrees of obesity

Background: Hypertension (HT) and obesity have both been linked to obstructive sleep apnoea (OSA). Difficulties have been described in identifying patients with OSA in primary care, causing low referral rates to sleep clinics. Increased knowledge about gender-specific characteristics and symptoms may help to identify patients. Aim: The aim was to describe gender differences regarding undiagnosed OSA, self-rated sleep, insomnia and daytime sleepiness in middle-aged primary care patients with HT and different degrees of obesity. Methods: A cross-sectional design was used and 394 patients (52.5% women), mean age 57.8 years (SD 6.7 years), with HT (BP >140/90 mmHg) were included. Clinical examinations, respiratory recordings and self-rated scales regarding OSA symptoms, sleep, insomnia and daytime sleepiness were used. Body mass index (BMI) was classified according to the criteria from the National Institutes of Health. Results: Pre-obesity and obesity classes I and II were seen among 53%, 26% and 8% of the men and 37%, 19% and 14% of the women, respectively. Occurrence of mild, moderate and severe OSA increased significantly across the BMI classes for both genders (p<0.01). Ninety percent of the men and 80% of the women in obesity class II had OSA. Insomnia was prevalent in obese patients. Other clinical variables did not differ between BMI classes or genders. Conclusion: The occurrence of overweight/obesity and OSA was high among both genders. A high BMI might be a convenient clinical marker for healthcare personnel to identify hypertensive patients with possible OSA in need of further evaluation and treatment.

How should sensory function in the oropharynx be tested? Cold thermal testing: a comparison of the methods of levels and limits.

OBJECTIVEnSeveral studies indicate an upper airway peripheral neuropathy in obstructive sleep apnea syndrome (OSAS). The sensation of cold, as measured by cold detection thresholds (CDT), in the oropharynx has been shown to be compromised in patients with sleep apnea and, to a lesser extent, habitual snoring. To reveal whether this neuropathy is part of the pathogenetic process of OSAS, longitudinal studies of snorers are needed. The objective of the present study was to establish the test-retest repeatability for the two most commonly used thermal testing methods: the reaction time exclusive method of levels (MLE) and the method of limits (MLI).nnnMETHODSnForty non-snoring subjects were tested at the soft palate and the lip at two separate occasions (mean interval 45days) using a Medoc TSA - 2001 equipment with an intra-oral thermode.nnnRESULTSnWith MLE mean CDTs were lower for both the lip and soft palate than with MLI. However, MLI showed a better test-retest repeatability (r=2.2 vs. 2.6) for the soft palate.nnnCONCLUSIONSnMLI should be used in longitudinal studies. The performance of this method is also faster.nnnSIGNIFICANCEnWe have established a quick, safe and reliable method suitable for longitudinal studies of peripheral neuropathy in sleep apnea pathogenesis.

FP39 Difference in Insomnia Symptoms, Daytime Sleepiness, Fatigue and Global Perceived Health between Hypertensive Patients with or without Risk of Obstructive Sleep Apnoea in a Primary Care Setting:

Purpose: Recovery from a cardiovascular (CV) event occurs between diagnosis and subsequent physical/emotional healing. A patients’ spouse is thought to be key in recovery. In CV patients and spouses, emotional responses, social support, and lack of knowledge regarding self-care are theoretically predictive of physical/emotional healing. The purpose of this study is to measure these three factors at 6 weeks after CV event discharge, and to compare these factors in older patients and their spouses. Methods: This is an exploratory descriptive study that enrolled older adults (> 65 years) and their spouses with 3 common CV events: heart attack (MI), surgery (CABS) and percutaneous coronary intervention (PCI). Dyads completed the Profile of Mood States (POMS), a measure of psychological distress, the Lubben Social Network Scale (SNS), a measure of social networks, and the Moser Needs Assessment (MNA), a measure of self-care need importance and whether need was met. Results: There were 161-paired subjects that were sent questionnaires at 6 weeks, and 88 patients (55% response) and 77 spouses responded (48% response). Mean age for patient was 72.9 years; 85 males/16 females who had a mean length of stay of 1.8 days for PCI, 12.7 days for CABG, and 6.7 days for MI/PCI. There was a statistically significant difference between patients and spouses on the anxiety subscale of the POMS (3.3+2.9 (pt) vs 4.6+4.3 (spouse), t= -2.18, p<0.031). The SNS demonstrated a functional network of family/friends. Patients and spouses ranked the need for honest explanations, hope, specific facts and instructions about heart disease similarly. Spouses rated honest explanations (t= -2.0; p<0.044), hope (t= -2.7, p<0.007) and specific facts as more important than patients (t= -2.59, p<0.010). Additionally, spouses wanted to feel comfortable leaving patient during the early recovery (t= -2.5, p<0.012). There were 10 spouse informational needs that were not met, 5 emotional and 5 knowledge needs. Conclusions: Data identify unmet higher anxiety levels in spouses and a number of unique needs that were unmet during the patient’s recovery. These data indicate that spouses may require interventions during recovery.