Long-term effects of CPAP therapy on patients with sleep-disordered breathing

The population of patients suffering from sleep-disordered breathing (SDB), especiallyobstructive sleep apnoea (OSA) is rising. OSA is often treated with continuous positive airway pressure (CPAP), but data on the long-term effects are scarce. SDB is an umbrella term for different types of SDB, that may have a similar nocturnal breathingdisorder, while the underlying mechanisms are different as well as the risks that comefrom having an untreated condition. In the future, treatment will be more individualised, and CPAP therapy might not be the first or the best choice for all patients. Thus, more information on the long-term effects of CPAP therapy is needed. In order to study the lifestyle, weight changes, and leptin and Insulin-like GrowthFactor 1 (IGF-1) concentrations during long-term CPAP therapy, patients who were referred to the Pulmonary ward of the Turku University Hospital for suspected sleep apnoea were enrolled in the study (n=223). Patients were given an array of questionnaires on sleep duration and quality, sleepiness, depressive symptoms and anxiety, cravings for different food categories, and exercise habits. All had a cardiorespiratory polygraphy (PG), and their blood was drawn following an overnight fast. After three years of follow-up, the patients were divided into CPAP users (n= 76) and non-users (n= 73), and all measurements except the sleep study, were repeated. The use of medication for comorbidities was evaluated for women referred to Paimio Hospital between 1994-1998 for suspected sleep apnoea (n= 601).The medication data were derived from the National Reimbursement registration three years before, and three years after CPAP initiation or the sleep study. Women were divided into CPAP users (n=66) and the control group (n= 122). The SDB type was also considered in the analysis. In our study, long-term CPAP therapy alleviated SDB symptoms, depressive symptoms, and anxiety efficiently. However, it did not influence lifestyle or exercise habits, and the patients did not lose weight. Increase in weight was associated with a good adherence to CPAP. In women, leptin concentrations increased, especially if they used CPAP. IGF-1 concentrations did not change. Medication use for comorbidities continued to increase regardless of CPAP therapy and CPAP users already had more comorbidities before the CPAP therapy initiation. However, the increase in medicine use did not differ between the CPAP users and non-users. The type of SDB also did not influence medicine use. In conclusion, patients with SDB should have sufficient life-style counselling aswell as CPAP therapy. CPAP therapy does not automatically decrease medication use and thus the cost. Earlier diagnosis and treatment of SDB before end-organ manifestations might instead reduce health care costs. The different profile for female SDB patients should also be noted and remembered.Unenaikaista hengityshäiriötä sairastavien määrä on kasvussa, ja erityisesti obstruktiivista uniapneaa sairastavia potilaita on vuosi vuodelta enemmän. Uniapneaa hoidetaan usein ylipainehengityslaitteella (continuous positive airway pressure, CPAP). Unenaikainen hengityshäiriö on sateenvarjotermi, jonka altalöytyy eri alatyyppejä, joita yhdistävät unenaikaiset hengityskatkokset, mutta niiden syntymekanismit ja riskiprofiili vaihtelevat. Tulevaisuudessa siirryttäneenkin yksilöllisempään hoitoon, jolloin CPAP ei ole ensisijainen hoitomuoto kaikille. Tämän vuoksi lisätieto CPAP-hoidon pitkäaikaisvaikutuksista on erityisen tärkeää. Tutkiaksemme elintapoja, painon muutosta sekä leptiinin ja insuliinikaltaisen kasvutekijä 1:n (IGF-1) pitoisuuksia pitkäaikaisen CPAP-hoidon aikana, Turun yliopistollisen keskussairaalan keuhkoklinikalle uniapneaepäilyn vuoksi lähetetyille223 potilaalle annettiin kyselylomakkeita, joissa kysyttiin unen pituudesta ja laadusta,uneliaisuudesta, masennus-tai ahdistusoireista, erilaisten ruokien mieliteoista sekä liikuntatottumuksista. Lisäksi heille tehtiin yöpolygrafia ja otettiin paastoverinäyte. Potilaat jaettiin kolmen vuoden seuranta-ajan jälkeen CPAP-käyttäjiin (n=76) ja ei-käyttäjiin (n=73) ja heille tehtiin yöpolygrafiaa lukuun ottamatta samat tutkimukset. Lääkkeiden käyttöä tutkittiin Paimion sairaalaan v. 1994-1998 uniapneaepäilyn vuoksiunipatjatutkimukseen tulleiden naisten avulla (n=601). Lääkekäyttötiedot Kelalta pyydettiin kolme vuotta ennen ja kolme vuotta laitehoidon aloituksen tai rekiste¬röintipäivän jälkeen. Naiset jaettiin joko CPAP-käyttäjiin (n=66) tai verrokkeihin (n=122). Myös unenaikaisen hengityshäiriön tyyppi otettiin huomioon. Tutkimuksessamme pitkäaikainen CPAP-hoito lievitti tehokkaasti unenaikaisen hengityshäiriön oireita sekä masennus- ja ahdistuneisuusoireita. Hoidolla ei ollut vaikutusta potilaiden elintapoihin, eivätkä potilaat laihtuneet. Painon nousu oli yhteydessä tehokkaaseen CPAP-laitteen käyttöön. Naisilla leptiinipitoisuudet nousivat hoidon aikana, erityisesti jos he käyttivät CPAP-laitetta. Insuliininkaltaisen kasvutekijä 1:n-pitoisuudet eivät muuttuneet. Liitännäissairauksien lääkekäyttö jatkoi nousuaan CPAP-hoidosta huolimatta, ja CPAP:n käyttäjillä oli jo alkuvaiheessa enemmän sairauksia kuin verrokeilla. Lääkekäytön lisääntyminen ei eronnut CPAP-hoitoa käyttävillä ja ei-käyttäjillä. Unenaikaisen hengityshäiriön tyypillä ei ollut vaikutusta lääkekäyttöön. Tulostemme valossa ehdotamme, että uniapneaa sairastaville tulisi CPAP-hoidon lisäksi tarjota tehokasta elintapavalmennusta. CPAP-hoito ei automaattisesti vähennä lääkekulutusta. Varhaisempi uniapnean diagnosointi ja hoito saattaisi estääliitännäissairauksien kehittymistä ja säästää terveydenhuollon kuluja. Lisäksi naisten erilainen taudinkuva tulisi muistaa

Perussairauksien hoito on avainasemassa aikuisten sentraalisessa uniapneassa

Sentraalisessa uniapneassa unenaikaiset hengityskatkokset johtuvat ­hengityksen säätelyn häiriöstä, eivät ylähengitysteiden ahtautumisesta, kuten obstruktiivisessa uniapneassa.Sentraalinen uniapnea ja sen alatyyppi Cheyne–Stokesin hengitys ovat yleisiä sydämen vajaatoimintaa ja eteisvärinää sairastavilla ja usein merkki huonosta ennusteesta.Opioidien käytön ja korvaushoidon lisääntyminen ovat lisänneet sentraalisen uniapnean esiintyvyyttä myös nuorilla.Altistavan perussairauden hoito on tärkeintä; tarvittaessa hoitoon liitetään yönaikainen hengityslaitehoito tai joskus happihoito.</p

Mood, sleepiness, and weight gain after three years on CPAP therapy for sleep apnoea

Background: The prevalence of obstructive sleep apnoea syndrome (OSAS) keeps on rising. Daytime sleepiness resulting from fragmented sleep is the prime symptom, and obesity the major risk factor for OSAS. Quality of life with OSAS is often affected by depressive symptoms and anxiety. Nasal continuous positive airway pressure (CPAP) therapy reduces daytime sleepiness, but the results on the effect on mood, physical activity, and weight are controversial especially on long-term therapy. Purpose of this study was to evaluate these factors and predictors of weight gain during long-term CPAP therapy.Methods: Consecutive patients (n = 223), referred to sleep study with suspected OSAS, were enrolled. Patients underwent a cardiorespiratory polygraphy at baseline and a battery of questionnaires was completed, both at baseline, and after three years of follow-up. Total of 149 (67%; M 65, F 84) patients completed the follow-up. Of the 149 patients, 76 (51.0%; M 32, F 44) used CPAP.Results: In this study, depressive symptoms, anxiety, and sleepiness were alleviated during CPAP therapy. However, therapy did not have an influence on cravings of different food categories, or exercise habits and exercise duration. From the various factors studied, solely higher adherence to CPAP therapy was associated with weight gain.Conclusions: This research provides further evidence that long-term CPAP therapy in patients with OSAS not only decreases sleepiness and improves sleep quality but could also alleviate depressive symptoms and anxiety. In addition, our study reinforces that CPAP therapy alone is not sufficient for weight management in patients with OSAS. Regardless of comprehensive battery of questionnaires, we were unable to establish markers predicting weight gain during therapy. We advise on life-style counselling and weight management program to all patients with obesity on CPAP therapy

Small airway function in Finnish COVID-19 survivors

Follow-up studies of COVID-19 patients have found lung function impairment up to six months after initial infection, but small airway function has not previously been studied. Patients (n = 20) hospitalised for a severe SARS-CoV-2 infection underwent spirometry, impulse oscillometry, and multiple measurements of alveolar nitric oxide three to six months after acute infection. None of the patients had small airway obstruction, nor increased nitric oxide concentration in the alveolar level. None of the patients had a reduced FEV1/FVC or significant bronchodilator responses in IOS or spirometry. In conclusion, we found no evidence of inflammation or dysfunction in the small airways.Non peer reviewe

Use of primary health care services among older patients with and without diabetes

Background The aim of this study was to compare the utilization of primary healthcare services by older patients with and without type 2 diabetes. Methods Electronic patient records were used to identify persons over 65 years of age with a diagnosis of diabetes. Two age- and sex-adjusted controls without diabetes were extracted for each person with diagnosis of diabetes. A health questionnaire was sent by mail to 527 people with diabetes and 890 controls. Of the persons who answered the questionnaire, 518 persons were randomly selected to participate in a health examination. The study group in this analysis consisted of 187 persons with diabetes and 176 persons without diabetes who attended the health examination. The data on primary health care utilization were extracted from electronic patient records one year before and one after the health examination. Results Before the onset of the study, the patients with diabetes had more doctor's appointments (p < 0.001), nurse's appointments (< 0.001) and laboratory tests taken (p < 0.001) than those without diabetes After 1-year follow-up period the patients with diabetes had more doctor's appointments (p = 0.002), nurse's appointments (p = 0.006), laboratory tests taken (p = 0.006) and inpatient care at the community hospital (p = 0.004) than patients without a diagnosis of type 2 diabetes. The use of the community hospital increased significantly among patients with diabetes (ratio 2.50; 95% Cl 1.16-5.36) but not by patients without diabetes (ratio 0.91; 95% Cl 0.40.2.06). The number of nurse's appointments increased for patients without diabetes (ratio 1.31; 95% Cl 1.07-1.60) but not for those with diabetes (ratio 1.04; 95% Cl 0.88-1.24). Conclusions Patients with diabetes visit more often physicians and nurses compared with those without diabetes. During a 1-year follow-up, the use of community hospital care increased significantly among patients with diabetes. In addition to focusing on prevention and care of diabetes, these results suggest the importance of diabetes in planning community-based health care services.Peer reviewe

Glycemic control and health-related quality of life among older home-dwelling primary care patients with diabetes

Aims: To evaluate the health-related quality of life (HRQoL) and functional capacity in relation to glycemic control among older home-dwelling primary care patients. Methods: Electronic patient records were used to identify 527 people over 65 years with diabetes. Of these, 259 randomly selected subjects were invited to a health examination and 172 of them attended and provided complete data. The participants were divided into three groups based on the HbAlc: good (HbAlc 57 mmol/mol (N=29)) glycemic control. HRQoL was measured with the EuroQol EQ-5D questionnaire. Functional and cognitive capacity and mental well-being were assessed with the Lawton Instrumental Activities of Daily Living (IADL) scale, Mini-Mental State Examination (MMSE) and Geriatric Depression Scale (GDS-15). Results: EQ-5D scores for good, intermediate and poor glycemic control were 0.78; 0.74 and 0.70, p=0.037. Sub-items of mobility (p=0.002) and self-care were the most affected (p=0.031). Corresponding trend was found for IADL, p=0.008. A significant correlation was found between MMSE scores and HbAlc. Conclusion: Older primary care home-dwelling patients with diabetes and poorer glycemic control have lower functional capacity and HRQoL, especially in regard to mobility and self care. (C) 2017 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.Peer reviewe

Pitkään tupakoineiden keuhkosyövän seulontaa tulisi Suomessa selvittää

Keuhkosyöpä aiheuttaa suurimman syöpäkuolleisuuden Suomessa, ja suomalaisten naisten kuollei­suuden keuhkosyöpään ennustetaan lisääntyvän. Keuhkosyöpä voi olla alkuvaiheessa täysin oireeton. Se todetaan usein vasta levinneessä vaiheessa, minkä vuoksi suurelle osalle potilaista leikkaushoito ei ole mahdollinen. Uusien kansainvälisten tutkimusten tulokset viittaavat siihen, että kuolleisuutta voitaisiin laskea seulomalla tupakoitsijoista suuren riskin henkilöitä pieniannoksisella tietokonetomografialla (TT). Eurooppalainen keuhkojärjestö (ERS) on suositellut, että jokaisessa Euroopan maassa perustettaisiin työryhmä, jonka tehtävänä on selvittää keuhkosyöpäseulonnan mahdollisuudet ja kustannustehokkuus

Women report more symptoms and impaired quality of life : a survey of Finnish COVID-19 survivors

Background The long-term sequelae after COVID-19 are not yet fully known. Our aim was to evaluate subjective symptoms and quality of life in Finnish hospitalized COVID-19 patients at six months follow-up. Methods Hospitalised adult patients with laboratory-confirmed SARS-CoV-2 infection from March to June 2020 were recruited. We conducted a survey on demographics and comorbidities, ten specific symptoms, and a RAND-36 quality of life questionnaire six months after hospital discharge. We collected clinical data manually from medical records. Results 101 patients (54 male) out of 246 invited completed the survey. Their median age was 60 years, and the mean hospital length of stay was 15 d. Most patients (90%) experienced symptoms, the most common of which were tiredness (88%), fatigue (79%), sleeping problems (76%), and dyspnoea (70%). In regard to gender, women showed a shorter time of hospitalization (p = .048) and lower peak flow of supplementary oxygen (p = .043). Women reported more frequently dyspnoea, fatigue, tiredness, sleeping problems, and mood problems (p = .008-.033), and a lower quality of life in seven of eight dimensions (p < .001-.015). Five explanatory variables for the reduced quality of life were identified in multivariate analysis: age, female sex, BMI, sleep apnoea, and duration of mechanical ventilation. Of the patients who worked full-time before COVID-19, 11% had not returned to work. Conclusions Most patients experienced symptoms six months after hospital discharge. Women reported more symptoms and a lower quality of life than men. These findings highlight the differences in recovery between men and women and call for active rehabilitation of COVID-19 patients.Peer reviewe

Cardiac manifestations in Finnish gelsolin amyloidosis patients

Introduction Finnish gelsolin amyloidosis (AGel amyloidosis) is an inherited systemic amyloidosis with well-known ophthalmological, neurological and cutaneous symptoms. Additionally, cardiomyopathies, conduction disorders and need of cardiac pacemakers occur in some patients. This study focuses on electrocardiographic (ECG) findings in AGel amyloidosis and their relation to cardiac magnetic resonance (CMR) changes. We also assessed whether ECG abnormalities were associated with pacemaker implantation and mortality. Materials and methods In this cohort study, 51 genetically verified AGel amyloidosis patients (mean age 66 years) without cardiac pacemakers underwent 12-lead ECG and CMR imaging with contrast agent in 2017. Patients were followed-up for 3 years. Results Conduction disturbances were found in 22 patients (43%). Nine (18%) presented with first-degree atrioventricular block, six (12%) with left anterior hemiblock, seven (14%) with left or right bundle branch block and two (4%) with non-specific intraventricular conduction delay. Low QRS voltage was present in two (4%) patients. Late gadolinium enhancement (LGE) concentrating on the interventricular septum and inferior parts of the heart was present in 19 (86%) patients with conduction abnormalities. During the follow-up, only one patient received a pacemaker, and one patient died. Discussion Conduction disorders and septal LGE are common in AGel amyloidosis, whereas other ECG and CMR findings typically observed in most common cardiac amyloidosis types were rare. Septal pathology seen in CMR may interfere with the cardiac conduction system in AGel amyloidosis, explaining conduction disorders, although pacemaker therapy is rarely required.Peer reviewe