Sleep-Disordered Breathing in Women

Sleep-disordered breathing (SDB) is underdiagnosed in women, probably due to the different gender-related manifestation. We investigated the differences in presentation, symptoms and co-morbidities of SDB in men and in pre- and postmenopausal women by a clinical, retrospective, cross-sectional study of 601 consecutively referred women and 233 age- and BMI-matched male-female pairs studied with the static-chargesensitive bed (SCSB) and an oximeter. Data on the use of nasal CPAP were gathered from the Paimio hospital database, and the co-morbidity information was based on reimbursed medication data from the National Agency for Medicines and the Social Insurance institution. The abnormal breathing episodes at night were more frequent in men than in women, and in postmenopausal women compared to premenopausal ones. Partial upper airway obstruction was the most common type of SDB in both genders but especially in females. BMI and the major symptoms of SDB were similar in pre- and postmenopausal women, and a menopause effect on symptoms was not found. CPAP adherence did not differ between symptomatic patients with partial upper airway obstruction and those presenting with conventional obstructive sleep apnea. Comorbidities were more frequent in SDB patients than in the general Finnish population. Compared to sleep apnea, partial upper airway obstruction was associated with a threefold prevalence of asthma and/or COPD in both genders, and with a 60% reduced prevalence of hypertension in females matched for age and BMI. Our results emphasize that partial upper airway obstruction is not a milder form of SDB but a different entity, the severity of which is underestimated when using the conventional apnea-hypopnea index. It seems clinically relevant to diagnose and treat the co-morbidities and SDB also in patients with partial upper airway obstruction, especially in elderly and symptomatic women.Siirretty Doriast

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

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

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

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

Ikääntyminen ja uniapnea

Uniapnea on kansantauti, jonka esiintyvyys väestössä lisääntyy. Ikääntyneillä esiintyy enemmän uniapneaa kuin nuoremmalla väestöllä. Pääosassa uniapneatutkimuksista tutkittavat ovat olleet alle 65-vuotiaita, ja tätä vanhempien uniapneasta tiedetään vain vähän. Ikääntymisen myötä tapahtuva ylähengitysteiden ahtautuminen ja lisääntyvä kokoonpainumistaipumus voivat selittää ikääntyneiden uniapnean esiintymisen yleistymistä. Uniapneaan liittyy sekä unenaikaisia että päiväaikaisia oireita. Tutkimuksissa on osoitettu, että ikääntyneiden hoitamaton uniapnea lisää muun muassa kaatumis- ja aivohalvausriskiä sekä heikentää muistia ja tiedonkäsittelytoimintoja. Ylipainehengityshoito (continuous positive airway pressure, CPAP) on uniapnean tärkein hoitomuoto. Tutkimuksissa on osoitettu, että iäkkäätkin potilaat sitoutuvat hyvin CPAP-hoitoon

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

Uniapnea (obstruktiivinen uniapnea aikuisilla)

Keskeinen sisältö Obstruktiivisessa uniapneaoireyhtymässä ylähengitystiet ahtautuvat nukkuessa. Apneajaksot johtavat unen häiriintymiseen ja päiväväsymykseen. Hoitamaton uniapnea lisää sydän- ja verisuonitauteja, tapaturmia, sairauspoissaoloja sekä ennenaikaista kuolleisuutta. Kognitiivinen toiminta ja muisti huononevat. Liikenneonnettomuusriski suurenee, vaikka päiväväsymystä ei esiintyisi. Diagnoosi perustuu anamneesiin, kliiniseen tutkimukseen ja yöpolygrafiaan. Lievässä uniapneassa hoidoksi voi riittää laihdutus; keskivaikeassa tai vaikeassa uniapneassa ylipainehengityshoito (CPAP) on ensisijainen. Valikoidut potilaat hyötyvät uniapneakiskosta tai leikkaushoidoista. English summary: Current Care Guideline: Obstructive Sleep Apnoea Syndrome in Adults Diagnosis of obstructive sleep apnoea syndrome (OSAS) is based on the patient history, clinical examination and sleep study. Untreated OSAS increases the risk of cardiovascular diseases, traffic accidents, lost work days and mortality. Weight loss forms the basis of treatment in obese patients. Continuous positive airway pressure (CPAP) therapy is the treatment of choice in moderate/severe cases of OSAS. In selected cases, oral appliances or surgical treatment are of benefit

Munasarjojen monirakkulaoireyhtymä ja unihäiriöt

Munasarjojen monirakkulaoireyhtymää (polycystic ovary syndrome, PCOS) sairastavilla on raportoitu muita naisia enemmän unihäiriöitä, erityisesti obstruktiivista uniapneaa. Sekä PCOS- että uniapneapotilaat ovat usein ylipainoisia. Molempiin oireyhtymiin liittyy samankaltainen merkittävä liitännäissairastavuus, ja ne saattavat pahentaa toistensa oireita. Uniapnean hoidon on lisäksi arvioitu parantavan PCOS-potilaiden aineenvaihduntaa. Unihäiriöiden ja PCOS:n väliset biologiset mekanismit tunnetaan vielä huonosti. Myös eri hoitovaihtoehtojen, niin elintapa- kuin lääkehoitojenkin, vaikutusta PCOS-potilaiden uniapnean ja sen liitännäissairauksien riskiin tulee vielä selvittää. Kaikilta PCOS-potilailta tulisikin herkästi seuloa uniapneaa strukturoidulla kyselyllä ja ohjata oireiset potilaat jatkotutkimuksiin

Gender-specific change in leptin concentrations during long-term CPAP therapy

PurposeNasal continuous positive airway pressure (CPAP) alleviates sleepiness in patients with obstructive sleep apnoea syndrome (OSAS), but part of OSAS patients keep gaining weight. Leptin and insulin-like growth factor-1 (IGF-1) interact with energy balance, and CPAP therapy has been suggested to influence these endocrine factors. We hypothesised that leptin would decrease during long-term CPAP therapy, and weight gain would associate with OSAS severity, lower CPAP adherence, lower IGF-1, and leptin concentrations.MethodsConsecutive patients (n = 223) referred to sleep study with suspected OSAS were enrolled. Patients underwent cardiorespiratory polygraphy at baseline. Questionnaires were completed, and blood samples were drawn both at baseline and after 3 years. A total of 149 (67%; M 65, F 84) patients completed the follow-up. Plasma samples were available from 114 patients, 109 of which with CPAP adherence data (49 CPAP users, 60 non-users).ResultsAt baseline, the CPAP users were more obese and had more severe OSAS than the non-users. Leptin concentrations did not differ. After follow-up, leptin concentrations were higher in CPAP users (30.2 ng/ml vs. 16.8 ng/ml; p = 0.001). In regression analysis, increase in leptin concentrations was independent of age, baseline body mass index (BMI), or the change in BMI. Leptin concentrations increased among females (− 8.9 vs. 12.7 ng/ml; p ConclusionsOur results suggest increase in leptin concentrations during long-term CPAP therapy among females.</p