Obstruktiivinen uniapnea : oireista seurantaan

The prevalence of snoring is high and snoring affects one s quality of life. Snoring can also be a symptom of obstructive sleep apnea (OSA). Snoring has traditionally been measured to predict OSA, but it has not been quantified in the same way as sleep disordered breathing events are. The objective diagnosis of snoring requires a sleep study. Simple and cost-effective systems are needed to screen for snoring and OSA. Upper airway symptoms are frequent in snorers and patients with obstructive sleep apnea syndrome (OSAS) already prior any treatment. The treatment of choice for obstructive sleep apnea is continuous positive airway pressure (CPAP). Although CPAP treatment is effective for OSA, the challenge is to improve treatment adherence. To evaluate the value of a Moving Picture Experts Group Layer-3 Audio (MP3) recorder device in screening of snoring, we recorded snoring sounds during polysomnography (PSG) in 200 consecutive patients referred for suspected obstructive sleep apnea (OSA). Snoring was recorded during the PSG with two microphones and with the MP3 device. We compared the results of the MP3 snoring recordings to the snoring recordings in PSG. To investigate the frequency of upper airway symptoms in subjects referred for a sleep study, we enrolled 524 consecutive patients and asked them to complete a questionnaire inquiring about current upper airway symptoms and any history of nasal and pharyngeal disorders prior the sleep study. Moreover, we examined 385 consecutive OSAS patients referred for CPAP initiation and ask the patients to complete questionnaires about upper airway symptoms before beginning CPAP and after two months of CPAP treatment. To evaluate predictors of later CPAP use, we finally followed 580 consecutive OSA patients scheduled for CPAP initiation for one year. Patients completed a self-efficacy questionnaire (5 = low, 25 = high score) before CPAP initiation. Immediately after CPAP initiation, we asked about the patients satisfaction with the CPAP trial as well as their eagerness and willingness to continue CPAP therapy (0 = unsatisfied, uneager or refused CPAP, 100 = satisfied, eager or willing to continue CPAP treatment). MP3 recording was technically successful for 87% of the patients. The Pearson correlation between PSG snoring and MP3 snoring was significant at 0.77 (p PIENEMPI 0.001). More than half of the sleep study subjects suffered from throat, mouth and nose dryness as well as from nasal stuffiness. The patients with moderate or severe OSAS (apnea-hypopnea index ≥ 15 and an Epworth sleepiness scale score ≥ 10) more often experienced mouth dryness (71% vs. 40%, p PIENEMPI 0.01) than did those with mild or no OSAS. In addition, patients with moderate to severe OSAS who were beginning CPAP treatment frequently suffered daily or almost daily from upper airway symptoms: dryness of mouth (61%), throat (54%) and nose (51%), nasal stuffiness (52%), sneezing (30%), mucus in the throat (24%), rhinorrhea (17%), and nose bleeds (6%). In CPAP users there was shown a significant reduction in the number of patients with frequent mouth (37%), throat (34%) and nose (28%) dryness and nasal stuffiness (24%). Finally, of the 580 patients 377 (65%) continued CPAP therapies beyond one year. Altogether 77 patients had a low score ( four hours daily after one year, yielding a specificity of 97% in predicting CPAP failure. In conclusion, recording snoring with an MP3 device offers reliable information about the patients snoring. Subjects referred for a sleep study often presented with upper airway symptoms. Nasal stuffiness and airway dryness in particular bothered snorers even before the development of sleep apnea. The most common upper airway symptoms in patients with untreated OSAS were associated with mucosal dryness. These symptoms improved during CPAP treatment. Finally, a low score for willingness to continue CPAP therapy after a short trial predicted CPAP failure and poor CPAP adherence after one year.Kuorsauksen esiintyvyys on suuri ja se huonontaa huomattavasti elämänlaatua. Kuorsaus voi olla myös oire uniapneasta. Kuorsausta on perinteisesti mitattu lähinnä uniapnean ennustamiseksi ja objektiivinen kuorsauksen toteaminen on vaatinut unirekisteröinnin. Lihavuuden lisääntyessä kuorsaus ja uniapnea lisääntyvät ja yksinkertaisia ja kustannustehokkaita kuorsauksen ja uniapnean seulontatutkimuksia tarvitaan. Ylähengitystieoireet ovat tavallisia kuorsaajilla ja uniapneapotilailla jo ennen mitään hoitoa. CPAP (continuous positive airway pressure)- eli ylipainehengityshoito on obstruktiivisen uniapnean hoidon kulmakivi. mutta potilaiden sitoutuminen hoitoon on usein vaatimatonta, vaikka CPAP-hoito on osoitettu tehokkaaksi. Arvioidaksemme MP3 (Moving Picture Experts Groups Layer-3)-laitteen käyttökelpoisuutta kuorsauksen seulonnassa, äänitimme 200 uniapnean vuoksi tutkimuksiin lähetetyn potilaan kuorsausääniä laajan unipolygrafian aikana kahdella mikrofonilla sekä MP3-laitteella ja vertasimme MP3-kuorsaustuloksia laajan unipolygrafian tuloksiin. Tutkiaksemme ylähengitystieoireiden määrä unirekisteröintiin lähetetyillä potilailla, pyysimme 524 suppeaan unitutkimukseen lähetetyn potilaan täyttämään ylähengitystieoireita ja aiempia ylähengitystiesairauksia koskevan kyselykaavakkeen ennen unitutkimusta. Lisäksi pyysimme 385 CPAP-hoidon aloittavaa uniapneapotilasta täyttämään ylähengitystieoireta käsittelevän kyselykaavakkeen ennen CPAP-hoidon aloitusta ja kahden kuukauden hoidon jälkeen. Arvioidaksemme CPAP-hoidon onnistumista ennustavia tekijöitä, seurasimme 580 uniapneapotilasta vuoden ajan CPAP-hoidon aloittamisen jälkeen. Potilaat täyttiävät self-efficacy kyselyn (5 = matalat, 25 = korkeat pisteet) ennen CPAP-hoidon aloittamista. Heti CPAP-hoidon aloittamisen jälkeen kysyimme potilaiden tyytyväisyyttä CPAP-aloitukseen, innokkuutta ja halukkuutta jatkaa CPAP-hoitoa kotona (0 = tyytymätön, innoton/haluton jatkamaan CPAP-hoitoa, 100 = tyytyväinen, innokas/halukas jatkamaan CPAP-hoitoa). MP3 -äänitys onnistui teknisesti 87% potilaista. Pearson korrelaatio PSG-kuorsauksen ja MP3-kuorsauksen välillä oli merkitsevä 0.77 (p < 0.001). Yli puolet unitutkimuspotilaista kärsivät nielun, suun ja nenän kuivumisesta sekä nenän tukkoisuudesta. Keskivaikeaa tai vaikeaa uniapneaa sairastavilla (apnea-hypopnea indeksi ≥ 15 ja Epworth sleepiness scale -pisteet ≥ 10) oli useammin suun kuivumista (71% vs. 40%, p < 0.01) kuin kuorsaajilla tai lievää uniapneaa sairastavilla. Yli puolet CPAP-hoidon aloittavista keskivaikeaa ja vaikeaa uniapneaa sairastavista potilaista valittivat nenän tukkoisuutta (52%) sekä suun (61%), nielun (54%) ja nenän kuivuutta (51%). CPAP-hoidon aikana suun (37%), nielun (34%) ja nenän kuivuminen (28%) sekä nenän tukkoisuus (24%) vähenivät merkitsevästi. Haluttomuus (pisteet PIENEMPI 50) jatkaa CPAP-hoitoa aloituksen jälkeen ennusti 97% spesifisyydellä CPAP-hoidon epäonnistumista vuoden kohdalla. Kuorsauksen äänittäminen MP3-laitteella tarjoaa luotettavaa tietoa potilaan kuorsauksesta. Unirekisteröintiin lähetetyillä potilailla on paljon ylähengitystieoireita. Limakalvojen kuivumisoireet ja nenäntukkoisuus vaivaavat kuorsaajia jo ennen uniapnean kehittymistä. Tavallisimmat ylähengitystieoireet hoitamattomassa uniapneassa liittyvät limakalvojen kuivumiseen ja helpottuvat CPAP-hoidon myötä. Haluttomuus jatkaa CPAP-hoitoa aloituksen jälkeen ennusti CPAP-hoidon epäonnistumista ja huonoa hoitoon sitoutumista yhden vuoden kohdalla

The prevalence of non-invasive ventilation and long-term oxygen treatment in Helsinki University Hospital area, Finland

Background: Chronic respiratory failure (CRF) can be treated at home with non-invasive ventilation (NIV) and/or long-term oxygen (LTOT). The prevalence of these treatments is largely unknown. We aimed to clarify the prevalence and indications of the treatments, and the three-year mortality of the treated patients in the Helsinki University Hospital (HUH) area in Finland. Methods: In this retrospective study we analyzed the prevalence of adult CRF patients treated with NIV and/or LTOT on 1.1.2018 and followed these patients until 1.1.2021. Data collected included the underlying diagnosis, patient characteristics, information on treatment initiation and from the last follow-up visit, and mortality during the three-year follow-up. Patients with home invasive mechanical ventilation or sleep apnea were excluded. Results: On 1.1.2018, we had a total of 815 patients treated with NIV and/or LTOT in the Helsinki University Hospital (HUH) area, with a population of 1.4 million. The prevalence of NIV was 35.4 per 100,000, of LTOT 24.6 per 100,000 and of the treatments combined 60.0 per 100,000. Almost half, 44.5%, were treated with NIV, 41.0% with LTOT, and 14.4% underwent both. The most common diagnostic groups were chronic obstructive pulmonary disease (COPD) (33.3%) and obesity-hypoventilation syndrome (OHS) (26.6%). The three-year mortality in all patients was 45.2%. In the COPD and OHS groups the mortality was 61.3% and 21.2%. In NIV treated patients, the treatment durations varied from COPD patients 5.3 years to restrictive chest wall disease patients 11.4 years. The age-adjusted Charlson co-morbidity index (ACCI) median for all patients was 3.0. Conclusions: NIV and LTOT are common treatments in CRF. The prevalence in HUH area was comparable to other western countries. As the ACCI index shows, the treated patients were fragile, with multiple co-morbidities, and their mortality was high. Treatment duration and survival vary greatly depending on the underlying diagnosis.Peer reviewe

Miten tuberkuloosipotilaiden videovalvottua lääkehoitoa toteutetaan?

Vertaisarvioitu. Käytännöt.• Valtakunnallinen tuberkuloosiohjelma suosittelee videovalvontaa tuberkuloosin lääkehoidon seurantaan. • Huolellinen potilasvalinta edistää videovalvotun hoidon sujuvaa toteutumista. • Hoito voidaan toteuttaa reaaliaikaisena tai pilvitallennuksen avulla. • Pilvitallennuksen avulla toteutettu hoito on joustavaa ja tukee potilaan yksityisyyttä. • Toteutustapa on sidoksissa käytössä oleviin alueellisiin hoidon porrastuksiin, digiteknisiin palveluihin ja hoitohenkilökunnan resursseihin

Lihavuus vaikeuttaa keuhkosairauksia

Vertaisarvioitu.• Uniapnean, obesiteetti-hypoventilaatio-oireyhtymän (OHS), astman ja keuhkoahtaumataudin liitännäissairauksissa lihavuus on yksi merkittävimmistä riskitekijöistä. • Uniapnea- ja OHS-potilaiden hoidossa painonhallinnan tulee aina olla keskeinen osa hoitoa. • Lihavuus lisää hengitysoireilua, huonontaa astmatasapainoa sekä lisää pahenemisvaiheita astma- ja keuhkoahtaumapotilailla. • Laihduttaminen parantaa keuhkoahtaumapotilaiden elämänlaatua.Peer reviewe

Home invasive mechanical ventilation in Finland in 2015-2019

Peer reviewe

Validation of the Finnish Severe Respiratory Insufficiency Questionnaire

Abstract Introduction Chronic respiratory insufficiency impacts patients? lives and reduces quality of life. The Severe Respiratory Insufficiency (SRI) questionnaire examines health-related quality of life and is designed specifically for patients receiving home mechanical ventilation (HMV) for chronic respiratory failure (CRF). Objectives The aim of this study was to validate the Finnish version of the SRI and study its reproducibility in patients with CRF. Methods Our 74 patients receiving HMV or long-term oxygen treatment for CRF or both completed the SRI and St George?s Respiratory questionnaires (SGRQ) three times (at baseline, and then one week and one month later). Reliability and validity of the questionnaires was analyzed with Cronbach?s alpha and intraclass correlation coefficient. Patients were prospectively followed-up for five years, with data collected on their use of hospital services and mortality. Results Cronbach?s alpha in the SRI ranged from 0.67 to 0.88 and was >0.7 on all subscales except the ?attendant symptoms and sleep?. On four subscales, Cronbach?s alpha was >0.8, and on the summary scale, 0.95. The SRI showed high correlation with SGRQ. Both tests showed good reproducibility. During the five-year follow-up, 27 (36%) patients died. Conclusions The Finnish SRI proved valid, reliable, and reproducible. Its psychometric properties were good and similar to those of the original questionnaire and of other validation studies.Peer reviewe

Changes in the societal burden caused by sleep apnoea in Finland from 1996 to 2018 : A national registry study

Background In the current century, sleep apnoea has become a significant public health problem due to the obesity epidemic. To increase awareness, improve diagnostics, and improve treatment, Finland implemented a national sleep apnoea programme from 2002 to 2010. Here, we present changes in the societal burden caused by sleep apnoea from 1996 to 2018. Methods National register data were collected from the Care Register for Health Care, Statistics Finland, the Social Insurance Institution of Finland, and the Finnish Centre for Pensions. Disease prevalence, use of healthcare and social services, and societal costs were estimated. Findings The number of sleep apnoea patients increased in secondary care from 8 600 in 1996 to 61 000 in 2018. There was a continuous increase in outpatient visits in secondary care from 9 700 in 1996 to 122 000 in 2018 (1 160%) and in primary care from 10 000 in 2015 to 29 000 in 2018 (190%). Accordingly, the cumulative annual number of days off work for sleep apnoea increased from 1 100 to 46 000. However, disability pensions for sleep apnoea decreased from 820 to 550 (33%) during the observation period. Societal costs per patient decreased over 50% during the observation period ((sic) 2 800 to (sic)1 200). Interpretation The number of sleep apnoea patients in Finland increased remarkably during the observation period. To control this burden, diagnostic methods and treatment were revised and follow up was reorganised. Consequently, there was a significant decrease in societal costs per patient. The decrease in disability pensions suggests earlier diagnosis and improved treatment. The national sleep apnoea programme was one of the initiators for these improved outcomes. Funding The Finnish Institute for Health and Welfare and the Hospital District of Helsinki and Uusimaa (HUH), Helsinki, Finland. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)Peer reviewe

Male predominance in disease severity and mortality in a low Covid-19 epidemic and low case-fatality area - a population-based registry study

Background Men reportedly suffer from a more severe disease and higher mortality during the global SARS-CoV-2 (Covid-19) pandemic. We analysed sex differences in a low epidemic area with low overall mortality in Covid-19 in a population based setting with patients treated in specialized healthcare. Methods We entered all hospitalized laboratory-confirmed Covid-19 cases of all specialized healthcare hospitals of the Capital Province of Finland, into a population-based quality registry and described demographics, severity and case-fatality by sex of the first Covid-19 wave February-June 2020. Results Altogether 5471 patients (49% male) were identified. Patients hospitalized in the specialist healthcare (N = 585, 54% male, OR 1.25; 95% CI 1.05-1.48) were of the same age. Men had less asthma and thyroid insufficiency and more coronary artery disease compared to women. Mean time from symptom onset to diagnosis was at least one day longer for men (p=.005). Men required intensive care unit (ICU) more often (27% vs. 17%) with longer lengths-of-stays at ICU. Male sex associated with significantly higher case-fatality at 90-days (15% vs. 8%) and all excess male deaths occurring after three weeks from onset. Men with fatal outcomes had delays in both Covid-19 testing and hospital admission after a positive test. The delays in patients with the most severe and fatal outcomes differed markedly by sex. In multivariable analysis, male sex associated independently with case-fatality (OR 2.37; 95% CI 1.22-4.59). Conclusions Male sex associated with higher disease severity and case-fatality. Late presentation of male fatal cases could represent different treatment-seeking behaviour or disease progression by sex.Peer reviewe

Changes in the societal burden caused by sleep apnoea in Finland from 1996 to 2018: A national registry study

BackgroundIn the current century, sleep apnoea has become a significant public health problem due to the obesity epidemic. To increase awareness, improve diagnostics, and improve treatment, Finland implemented a national sleep apnoea programme from 2002 to 2010. Here, we present changes in the societal burden caused by sleep apnoea from 1996 to 2018.MethodsNational register data were collected from the Care Register for Health Care, Statistics Finland, the Social Insurance Institution of Finland, and the Finnish Centre for Pensions. Disease prevalence, use of healthcare and social services, and societal costs were estimated.FindingsThe number of sleep apnoea patients increased in secondary care from 8 600 in 1996 to 61 000 in 2018. There was a continuous increase in outpatient visits in secondary care from 9 700 in 1996 to 122 000 in 2018 (1 160%) and in primary care from 10 000 in 2015 to 29 000 in 2018 (190%). Accordingly, the cumulative annual number of days off work for sleep apnoea increased from 1 100 to 46 000. However, disability pensions for sleep apnoea decreased from 820 to 550 (33%) during the observation period. Societal costs per patient decreased over 50% during the observation period (€2 800 to €1 200).InterpretationThe number of sleep apnoea patients in Finland increased remarkably during the observation period. To control this burden, diagnostic methods and treatment were revised and follow up was reorganised. Consequently, there was a significant decrease in societal costs per patient. The decrease in disability pensions suggests earlier diagnosis and improved treatment. The national sleep apnoea programme was one of the initiators for these improved outcomes.FundingThe Finnish Institute for Health and Welfare and the Hospital District of Helsinki and Uusimaa (HUH), Helsinki, Finland.</p

Lung function and exercise capacity 6 months after hospital discharge for critical COVID-19

Background The significant morbidity caused by COVID-19 necessitates further understanding of long-term recovery. Our aim was to evaluate long-term lung function, exercise capacity, and radiological findings in patients after critical COVID-19. Methods Patients who received treatment in ICU for COVID-19 between March 2020 and January 2021 underwent pulmonary function tests, a 6MWD and CXR 6 months after hospital discharge. Results A restrictive ventilatory defect was found in 35% (23/65) and an impaired diffusing capacity in 52% (32/62) at 6 months. The 6-minute walk distance was reduced in 33% (18/55), and 7% (4/55) of the patients had reduced exercise capacity. Chest X-ray was abnormal in 78% (52/67) at 6 months after hospital discharge. Conclusion A significant number of patients had persisting lung function impairment and radiological abnormalities at 6 months after critical COVID-19. Reduced exercise capacity was rare.Peer reviewe