Insomnia and sleep-disordered breathing in FKRP-related limb-girdle muscular dystrophy R9. The Norwegian LGMDR9 cohort study (2020)

Limb-girdle muscular dystrophy R9 (LGMDR9) is a progressive and disabling genetic muscle disease. Sleep is relevant in the patient care as it impacts on health, functioning, and well-being. LGMDR9 may potentially afect sleep by physical or emotional symptoms, myalgia, or sleep-disordered breathing (SDB) through cardiorespiratory involvement. The objective was to investigate the occurrence of insomnia and unrecognized or untreated SDB in LGMDR9, associated factors, and relationships with fatigue and health-related quality of life (HRQoL). All 90 adults in a Norwegian LGMDR9 cohort received questionnaires on sleep, fatigue, and HRQoL. Forty-nine of them underwent clinical assessments and 26 without mask-based therapy for respiration disorders additionally underwent polysomnography (PSG) and capnometry. Among 77 questionnaire respondents, 31% received mask-based therapy. The prevalence of insomnia was 32% of both those with and without such therapy but was signifcantly increased in fatigued respondents (54% vs 21%). Insomnia levels correlated inversely with mental HRQoL. Among 26 PSG candidates, an apnea–hypopnea index (AHI)≥5/h was observed in 16/26 subjects (≥15/h in 8/26) with median 6.8 obstructive apneas and 0.2 central apneas per hour of sleep. The AHI was related to advancing age and an ejection fraction<50%. Sleep-related hypoventilation was detected in one subject. Fatigue severity did not correlate with motor function or nocturnal metrics of respiration or sleep but with Maximal Inspiratory Pressure (r=− 0.46). The results indicate that insomnia and SDB are underrecognized comorbidities in LGMDR9 and associated with HRQoL impairment and heart failure, respectively. We propose an increased attention to insomnia and SDB in the interdisciplinary care of LGMDR9. Insomnia and pulmonary function should be examined in fatigued patients

Low oxygen saturation and mortality in an adult cohort; the Tromsø Study

Published version, also available at http://dx.doi.org/10.1186/s12890-015-0003-5Background: Oxygen saturation has been shown in risk score models to predict mortality in emergency medicine. The aim of this study was to determine whether low oxygen saturation measured by a single-point measurement by pulse oximetry (SpO2) is associated with increased mortality in the general adult population. Methods: Pulse oximetry was performed in 5,152 participants in a cross-sectional survey in Tromsø, Norway, in 2001–2002 (“Tromsø 5”). Ten-year follow-up data for all-cause mortality and cause of death were obtained from the National Population and the Cause of Death Registries, respectively. Cause of death was grouped into four categories: cardiovascular disease, cancer except lung cancer, pulmonary disease, and others. SpO2 categories were assessed as predictors for all-cause mortality and death using Cox proportional-hazards regression models after correcting for age, sex, smoking history, body mass index (BMI), C-reactive protein level, self-reported diseases, respiratory symptoms, and spirometry results. Results: The mean age was 65.8 years, and 56% were women. During the follow-up, 1,046 (20.3%) participants died. The age- and sex-adjusted hazard ratios (HRs) (95% confidence intervals) for all-cause mortality were 1.99 (1.33–2.96) for SpO2 ≤ 92% and 1.36 (1.15–1.60) for SpO2 93–95%, compared with SpO2 ≥ 96%. In the multivariable Cox proportional-hazards regression models that included self-reported diseases, respiratory symptoms, smoking history, BMI, and CRP levels as the explanatory variables, SpO2 remained a significant predictor of all-cause mortality. However, after including forced expiratory volume in 1 s percent predicted (FEV1% predicted), this association was no longer significant. Mortality caused by pulmonary diseases was significantly associated with SpO2 even when FEV1% predicted was included in the model. Conclusions: Low oxygen saturation was independently associated with increased all-cause mortality and mortality caused by pulmonary diseases. When FEV1% predicted was included in the analysis, the strength of the association weakened but was still statistically significant for mortality caused by pulmonary diseases

Pulse oximetry in an adult population: Predictors of low oxygen saturation and associations with mortality; The Tromsø Study

Pulsoksymetri er en enkel undersøkelsesmetode for å beregne metningen av oksygen (O2) i arterielt blod (SpO2). Lave verdier kan være indikasjon på hjerte- og/eller lungesykdom. Ingen befolkningsundersøkelser har tidligere sett på oksygenmetning i en voksen befolkning. Avhandlingen er basert på de to befolkningsundersøkelsene, Tromsø 5 (2001/2002) og Tromsø 6 (2007/2008). I disse ble det gjort lungefunksjonstesting med spirometri og oksygenmetning ble målt med pulsoksymetri. Lav oksygenmetning ble definert som SpO2 ≤95 %, og fall i oksygen metning som fall i SpO2 ≥2 % til SpO2 ≤95 % fra Tromsø 5 til Tromsø 6. I Tromsø 5 og 6 hadde henholdsvis 11,5 % og 6,3 % av deltakerne lav SpO2. Mellom undersøkelsene falt 4,9 % i SpO2. Lav SpO2 og fall i SpO2 var forbundet med røyking, overvekt, redusert lungefunksjon (FEV1 % av forventet) og forhøyet betennelsesreaksjon (CRP ≥5mg/L). Fall i SpO2 var også forbundet med reduksjon i lungefunksjonen og økning av betennelsesreaksjonen. Røykeslutt og vektreduksjon tenderte til mindre fall, men denne sammenhengen var ikke signifikant. Etter justering for kjente risikofaktorer fremkom det at lav SpO2 førte til økt 10 års totaldødelighet og dødelighet forårsaket av lungesykdommer. Det ble ikke funnet signifikant sammenheng for totaldødelighet ved justering for spirometriverdier, men en fant fortsatt signifikant sammenheng for dødelighet forårsaket av lungesykdommer. Hos personer som får påvist lave verdier bør en derfor anbefale røykeslutt hos røykende og vektnedgang hos overvektige da det sannsynligvis kan redusere risikoen for død, spesielt av lungesykdommer

Low FEV1, smoking history, and obesity are factors associated with oxygen saturation decrease in an adult population cohort

BACKGROUND: Worsening of pulmonary diseases is associated with a decrease in oxygen saturation (SpO(2)). Such a decrease in SpO(2) and associated factors has not been previously evaluated in a general adult population. AIM: We sought to describe SpO(2) in a sample of adults, at baseline and after 6.3 years, to determine whether factors predicting low SpO(2) in a cross-sectional study were also associated with a decrease in SpO(2) in this cohort. METHODS: As part of the Tromsø Study, 2,822 participants were examined with pulse oximetry in Tromsø 5 (2001/2002) and Tromsø 6 (2007/2008). Low SpO(2) by pulse oximetry was defined as an SpO(2) ≤95%, and SpO(2) decrease was defined as a ≥2% decrease from baseline to below 96%. RESULTS: A total of 139 (4.9%) subjects had a decrease in SpO(2). Forced expiratory volume in 1 second (FEV(1)) <50% of the predicted value and current smoking with a history of ≥10 pack-years were the baseline characteristics most strongly associated with an SpO(2) decrease in multivariable logistic regression (odds ratio 3.55 [95% confidence interval (CI) 1.60–7.89] and 2.48 [95% CI 1.48–4.15], respectively). Male sex, age, former smoking with a history of ≥10 pack-years, body mass index ≥30 kg/m(2), and C-reactive protein ≥5 mg/L were also significantly associated with an SpO(2) decrease. A significant decrease in FEV(1) and a new diagnosis of asthma or chronic obstructive pulmonary disease during the observation period most strongly predicted a fall in SpO(2). A lower SpO(2) decrease was observed in those who quit smoking and those who lost weight, but these tendencies were not statistically significant. CONCLUSION: A decrease in SpO(2) was most strongly associated with severe airflow limitation and a history of smoking. Smoking cessation and reducing obesity seem to be important measures to target for avoiding SpO(2) decreases in the general population

A new diagnosis of asthma or COPD is linked to smoking cessation - The Tromsø study

Background: Patients with COPD have had a lower tendency to quit smoking compared to patients with coronary heart disease (CHD). We wanted to investigate if this is still true in a Norwegian population. Methods: Our data came from the fifth and sixth Tromsø surveys, which took place in 2001–2002 and 2007–2008. The predictors of smoking cessation were evaluated in a cohort of 4,497 participants who had stated their smoking status in both surveys. Results: Of the 4,497 subjects in the cohort, 1,150 (25.6%) reported daily smoking in Tromsø 5. In Tromsø 6, 428 had quit (37.2%). A new diagnosis of obstructive lung disease (asthma or COPD) and CHD were both associated with increased quitting rates, 50.6% (P=0.01) and 52.1% (P=0.02), respectively. In multivariable logistic regression analysis with smoking cessation as outcome, the odds ratios (ORs) of a new diagnosis of obstructive lung disease and of CHD were 1.7 (1.1–2.7) and 1.7 (1.0–2.9), respectively. Male sex had an OR of 1.4 (1.1–1.8) compared to women in the multivariable model, whereas the ORs of an educational length of 13–16 years and ≥17 years compared to shorter education were 1.6 (1.1–2.2) and 2.5 (1.5–4.1), respectively. Conclusion: The general trend of smoking cessation in the population was confirmed. Increased rates of smoking cessation were associated with a new diagnosis of heart or lung disease, and obstructive lung disease was just as strongly linked to smoking cessation as was CHD. This should encourage the pursuit of early diagnosis of COPD. Keywords: smoking cessation, cohort study, COPD, asthma, coronary heart diseas