Uneaegsed hingamishäired ja hormoonid

Uneaegsed hingamishäired (UHH) kujutavad endast süsteemset seisundit, mis põhjustab organismis endokriinseid ja metaboolseid muutusi. Järjest enam saadakse tõendeid selle kohta, et UHHd tekitavad muutusi erinevate hormoonide sekretsioonis ja vere kontsentratsioonitasemes, samuti võivad erinevad endokriinsed muutused ja hormoonravi kutsuda esile, süvendada või kergendada UHHd. Enamik teabest hormoonide ja UHHde koostoime kohta pärineb uuringutest, kus on kasutatud nasaalset positiivse õhuvoolu surve (CPAP) ravi, mis on kerge kuni raske obstruktiivse uneapnoe sündroomi valikraviks. Hormoonide ja hingamise seoste parem tundmaõppimine aitab avada uusi suundi UHHde ning nende süsteemsete tagajärgede ärahoidmisel, leevendamisel ja ravistrateegiate väljatöötamisel. Eesti Arst 2005; 84 (7): 488–49

Uniapnean hoidonporrastus ulottuu monelle tasolle

Uniapnean hoidonporrastuksessa määritellään työnjako erikoissairaanhoidon ja perusterveydenhuollon kesken, mutta myös eri erikoisalojen kesken ja erikoisalojen sisällä eri ammattiryhmien kesken. Myös työnjako terveydenhuollon ammattilaisten ja potilaan välillä on tärkeä

Sleep quality, daytime sleepiness and fasting insulin levels in women with chronic obstructive pulmonary disease

SummaryStudy objectives: To test the clinical observations that patients with chronic obstructive pulmonary disease (COPD) have impaired sleep quality without excessive daytime sleepiness (EDS), and to analyse the aetiological factors.Participants: Fifteen non-diabetic postmenopausal women with moderate to severe COPD and 20 community dwelling age-matched control women.Measurements and results: Patients completed questionnaires, had a polysomnography and blood tests. Controls filled in the questionnaires. In the Basic Nordic Sleep Questionnaire, the average (±sd) scores for sleepiness (9.9±3.0 in patients vs. 7.6±3.2 in controls, P=0.025, test range 4–20) and insomnia (18.3±3.4 vs. 16.6±4.4, P=123, test range 7–35) were low. Although 53% had a good night's sleep seldom or never and 70% slept restlessly, only 33% felt tired in the mornings. Controls reported better sleep quality, less tiredness and sleepiness. With polysomnography, the total sleep time was 4h 41min ±1h 20min in patients. Sleep was fragmented, the proportion of stage 1 sleep high and rapid eye movement (REM) latency delayed. Sleepiness correlated with fasting serum insulin levels (r=0.59, P=0.027) and body movements (r=0.52, P=0.047). In stepwise linear regression analyses, sleepiness was positively associated with insulin levels (P=0.025) but not with body movements. Insulin explained 38.0% of the variance in the sleepiness score, when adjusted for body mass index (BMI).Conclusions: Despite short and fragmented sleep, non-diabetic patients with COPD did not have marked EDS. An association between fasting insulin and sleepiness suggests that insulin resistance is involved in EDS

Motor vehicle accidents in CPAP-compliant obstructive sleep apnea patients-a long-term observational study

Purpose Obstructive sleep apnea (OSA) has been associated with a 2- to 7-fold risk of motor vehicle accidents (MVAs). Continuous positive airway pressure (CPAP) treatment may reduce MVA risk. We further explored this issue in long-term CPAP users and untreated controls. Methods We used both before-after and case-control study designs. The observational cohort consisted of CPAP-treated and untreated patients matched for gender, age, and apnea-hypopnea index. All MVAs reported to the police were identified. Results A total of 2060 patients (75.8% male, mean age 56.0 +/- 10.5 years) were included. The CPAP-treated patients (N = 1030) were screened for MVAs for a median of 9.0 years before and after treatment. The median CPAP usage was 6.4 h/day. The control patients (N = 1030) were screened for MVAs for a median of 6.5 years after discontinuation of CPAP. No significant differences were observed between the incidences of MVAs per 1000 person years before treatment (3.2), after treatment (3.9), or in controls (2.6). Compared with controls, patients who had MVA after treatment had a higher body mass index (BMI), but did not differ in terms of other baseline characteristics, sleep study data, or accident conditions. In the majority of these patients, daytime sleepiness was reduced, whereas BMI tended to increase during treatment. Conclusions The MVA incidence did not change after CPAP treatment. Among the patients who had MVA, BMI was the only baseline characteristic that differed between the groups and tended to further increase after CPAP treatment. Differences in sleep study data or accident conditions were not observed

Documentation of the patient's smoking status in common chronic diseases - analysis of medical' narrative reports using the ULMFiT based text classification

Introduction: Smoking cessation is essential part of a successful treatment in many chronic diseases. Our aim was to analyse how actively clinicians discuss and document patients' smoking status into electronic health records (EHR) and deliver smoking cessation assistance.Methods: We analysed the results using a combination of rule and deep learning-based algorithms. Narrative reports of all adult patients, whose treatment started between years 2010 and 2016 for one of seven common chronic diseases, were followed for two years. Smoking related sentences were first extracted with a rule-based algorithm. Subsequently, pre-trained ULMFiT-based algorithm classified each patient's smoking status as a current smoker, ex-smoker, or never smoker. A rule-based algorithm was then again used to analyse the physician-patient discussions on smoking cessation among current smokers.Results: A total of 35,650 patients were studied. Of all patients, 60% were found to have a smoking status in EHR and the documentation improved over time. Smoking status was documented more actively among COPD (86%) and sleep apnoea (83%) patients compared to patients with asthma, type 1&2 diabetes, cerebral infarction and ischemic heart disease (range 44-61%). Of the current smokers (N=7,105), 49% had discussed smoking cessation with their physician. The performance of ULMFiT-based classifier was good with F-scores 79-92.Conclusion: Ee found that smoking status was documented in 60% of patients with chronic disease and that the clinician had discussed smoking cessation in 49% of patients who were current smokers. ULMFiT-based classifier showed good/excellent performance and allowed us to efficiently study a large number of patients' medical narratives.</p

Validation of an Accelerometer Based BCG Method for Sleep Analysis

Sleep problems are one of the most common medical complaints today. Polysomnography (PSG) as the current standard for sleep analysis is expensive, intrusive and complex. Thus, finding a reliable and unobtrusive method for longer-term home use is important. Ballistocardiography (BCG) based methods have shown potential in sleep analysis recently. The usability and performance of a BCG based method in qualitative and quantitative analysis of sleep was evaluated. The method was validated in a clinical test on 20 subjects using PSG as a reference. Heart rate (HR), heart rate variability (HRV), respiratory rate (RR), respiratory rate variability (RRV), respiratory depth (Rdepth) and movement were utilized for sleep stage detection. The BCG parameter accuracy was presented as the mean error from PSG with 95% confidence interval. The errors were -0.1 ± 4.4 beats per minute for HR, -0.9 ± 14.7 ms for high frequency (HF) HRV, -3.0 ± 29.9 ms for low frequency (LF) HRV, 0.3 ± 4.5 breaths per minute for RR and -40 ± 424 ms for RRV respectively. Correlation coefficient was 0.97 for HR, 0.67 for HF HRV, 0.71 for LF HRV, 0.54 for RR and 0.49 for RRV. HR, RRV and Rdepth were typically at an increased level in REM sleep and wakefulness and decreased in deep sleep. RRV was at its highest during wakefulness. HRV was at a decreased level in REM and wakefulness and increased in deep sleep. Movement was higher during wakefulness than in sleep

Kaksoispaineventilaatio kroonisessa ventilaatiovajauksessa

Kajoamaton kaksoispaineventilaatiohoito on viimeisen vuosikymmenen aikana mahdollistanut hengityksen tukemisen tavallisella vuodeosastolla ja potilaan kotona. Kaksoispaineventilaattorilla voidaan usein välttää keinoilmatie ja respiraattorihoito, lyhentää potilaan sairaalassaoloaikaa ja säästää kustannuksia. Kaksoispaineventilaatiohoito vähentää kroonisesta hengitysvajauksesta kärsivän potilaan hengenahdistusta ja väsymystä, jolloin elämänlaatu paranee ja tietyissä tilanteissa myös elinikä pitenee. Hoito vaatii lääkäriltä perustietoja hengitysfysiologiasta ja perehtymistä kaksoispaineventilaattorin säätämiseen. Hoitohenkilökunnalta se edellyttää kokemusta hoidon toteutuksesta ja ohjauksesta

Predictors of sleep disturbance in menopausal transition

Objective: This follow-up study aimed to evaluate risk factors for menopausal sleep disturbances already identifiable before menopause. Methods: At baseline, all 81 women were premenopausal. At year-five follow-up, 27 of the women were premenopausal, 40 postmenopausal, and 14 postmenopausal and using hormone therapy. We used the Basic Nordic Sleep Questionnaire to study sleep; additional questionnaires evaluated risk factors for sleep impairment. Results: Sleep quality differed only marginally between the groups. The following baseline variables were associated with impaired sleep quality at follow-up: depressive symptoms increased the risk of nocturnal awakenings (OR 1.16 (95%CI 1.02-1.32), p = 0.025), morning tiredness (OR 1.22 (95%CI 1.06-1.40), p = 0.007), daytime tiredness (OR 1.24 (95%CI 1.06-1.44), p = 0.007) and propensity to fall asleep during work or leisure time (OR 1.18 (95%CI 1.01-1.37), p = 0.036). Personal crises increased the risk of longer sleep latency (OR 5.46 (95%CI 1.13-26.32), p = 0.035) and of propensity to fall asleep when not active (OR 5.41 (95%CI 1.42-20.83), p = 0.014). Use of medications affecting the CNS increased the risk of worse general sleep quality (OR 11.44 (95% CI 1.07-121.79), p = 0.044). Perceived impaired general health (OR 2.87 (95%CI 1.04-7.94), p = 0.043) and frequent night sweats (OR 10.50 (95%CI 2.25-49.01), p = 0.003) increased the risk of difficulty falling asleep. Conclusions: Various premenopausal health-related factors seem to predict poor sleep in menopausal transition. Menopause itself appears to have only minor effects. Thus, it is essential to identify high risk women to allow timely interventions that may prevent the development of sleep disturbances at menopause. (C) 2016 Elsevier Ireland Ltd. All rights reserved.Peer reviewe

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

Multimorbidity and overall comorbidity of sleep apnoea : a Finnish nationwide study

The prevalence of sleep apnoea is increasing globally; however, population-based studies have reported a wide variation of prevalence estimates, and data on incidence of clinically diagnosed sleep apnoea are scant. Data on the overall burden of comorbidities or multimorbidity in individuals with incident sleep apnoea are scarce, and the pathways to multimorbidity have only marginally been studied. To study the current epidemiology of sleep apnoea in Finland, overall burden of comorbidities, and multimorbidity profiles in individuals with incident sleep apnoea, we conducted a register-based, nationwide, retrospective study of data from January 2016 to December 2019. The prevalence of clinically diagnosed sleep apnoea was 3.7% in the Finnish adult population; 1-year incidence was 0.6%. Multimorbidity was present in 63% of individuals at the time of sleep apnoea diagnosis. Of those with incident sleep apnoea, 34% were heavily multimorbid (presenting with four or more comorbidities). The three most common chronic morbidities before sleep apnoea diagnosis were musculoskeletal disease, hypertension and cardiovascular disease. In multimorbid sleep apnoea patients, hypertension and metabolic diseases including obesity and diabetes, cardiovascular diseases, musculoskeletal diseases and dorsopathies, in different combinations, encompassed the most frequent disease pairs preceding a sleep apnoea diagnosis. Our study adds to the few population-based studies by introducing overall and detailed figures on the burden of comorbidities in sleep apnoea in a nationwide sample and provides up-to-date information on the occurrence of sleep apnoea as well as novel insights into multimorbidity in individuals with incident sleep apnoea.Peer reviewe