Structural and serum surrogate markers of cerebrovascular disease in obstructive sleep apnea (OSA): association of mild OSA with early atherosclerosis.

There is increasing evidence of a causal interaction between obstructive sleep apnea (OSA) and cerebrovascular disease. The aim of the study was to elucidate the relationship between the polysomnographically (PSG) measured severity of OSA and carotid atherosclerosis determined by ultrasonography and serum surrogate markers. 147 patients (102 males, 45 females) referred to our sleep laboratory for evaluation of snoring and sleep-disordered breathing were investigated. Carotid atherosclerosis was evaluated by serum analysis of high-sensitivity C-reactive protein (hs-CRP) and fibrinogen and four sonographic indices: intima-media thickness (IMT) of the common carotid artery (CCA), IMT from bulb to internal carotid artery (Bulb-ICA), combined IMT measurements from all segments and a plaque score (PlaS). Pearson correlation analysis, intergroup comparison (ANOVA), covariance analysis and a multiple regression were performed to assess the association between surrogate markers and respiratory variables. 44 patients had no OSA (apnea-hypopnea index AHI < 5/h), 27 mild (AHI 5-15), 25 moderate (AHI 15-30) and 51 severe OSA (AHI > 30). After adjusting for potential confounders, significant differences between the controls and all three OSA groups were observed in the CCA-IMT (p = 0.032) and in the PlaS between the controls and the severe group (p = 0.034). Multiple regression revealed the AHI as an independent predictor of CCA-IMT (p = 0.001) and combined IMT (p = 0.001), whereas the percentage of total sleep time with an oxygen saturation below 90 % was associated with Bulb-ICA IMT (p = 0.018) and hs-CRP (p = 0.015). OSA is associated with higher surrogate levels of cerebrovascular disease. Even mild OSA seems to predispose to early atherosclerosis.

Effects of socio-demographic variables on health-related quality of life determined by the quality of life index--German version.

STUDY OBJECTIVE: The purpose of this study was to determine subjective health-related quality of life (HRQoL) in a sample of the Austrian population over 14 years of age in order to evaluate the effect of socio-demographic variables on HRQoL. DESIGN/SETTING: HRQoL was determined by means of the quality of life index-German version (QLI-Ge). The influence of socio-demographic variables on HRQoL was assessed by statistical analysis using the Kruskal-Wallis test and an analysis of variance. PARTICIPANTS: A random-quota procedure was used to get balanced representation from regions and demographic groups of the Austrian population. The sample consisted of 1049 participants, 493 men and 556 women. MAIN RESULTS: Age was found to influence the QLI-Ge total score (index score) and most individual items, with increasing age resulting in a decrease in HRQoL. Differences between the sexes were observed in three dimensions: males scored higher in 'physical well-being', 'psychological well-being' and 'occupational functioning'. Marital status impacted most items with married persons showing better values than divorced persons or singles. Profession had only a minor effect on HRQoL, the level of education showed no influence at all. CONCLUSIONS: The socio-demographic variables age, sex and objective living conditions had a major influence on subjectively rated HRQoL, whereas profession and education were found to play a minor role in this context. It is recommended that in the interpretation of studies assessing HRQoL the above-mentioned objective factors be considered. This will be of particular importance when determining the effect of a pharmacotherapy on HRQoL in patients.

Sleeping habits in the Austrian population.

OBJECTIVES: To gain reliable data on sleeping habits and sleep disturbances of the Austrian population. BACKGROUND: Exact data on sleeping habits are of interest in relation to assessment of sleep disturbance-related illnesses and general social processes. METHODS: A prospective, cross-sectional study was performed with recruitment of a representative sample of 1049 Austrians (aged 15-82 years), according to the Federal Statistics population characteristics. Interviews were conducted in the households of the participants by specially trained interviewers of an institute for empirical research. RESULTS: Men consider their quality of sleep to be significantly better than women (P=0.00234), and younger persons consider their quality of sleep to be significantly better than older persons (P=0.00001). In comparison, women and people over the age of 50 report worse subjective sleep quality, worse sleep efficiency, more difficulty in falling asleep and sleep maintenance, more apneic events, more pathologic limb movements, more daytime dysfunction, and more intake of sleeping medication. Other sociodemographic factors influence sleep reports to a lesser extent. CONCLUSIONS: Subjectively disturbed sleep (prevalence in the total population 24.9%), excessive hypnotic drug intake (prevalence 13.0%), and daytime dysfunction (prevalence 17.4%) are a widespread problem, especially in women and older people. With increasing life expectancy in Western societies, the prevalence of sleep disturbances will increase.

Sleep and quality of life in the Austrian population.

PURPOSE: To compare the self-reported estimation of sleep quality evaluated by the Pittsburgh Sleep Quality Index (PSQI) and life quality assessed by the Quality of Life Index (QLI). BACKGROUND: The PSQI comprised 19 questions and assessed a wide variety of factors relating to sleep quality. The QLI consisted of 10 items for self assessment of different dimensions of life quality. SUBJECTS: A representative Austrian sample (n = 1049) aged above 15 years. PROCEDURE: Interviews in the homes of the participants. RESULTS: 32.1% could be classified as poor sleepers (37% females, 26.5% males). Sleep quality decreased with increasing age, especially in women. Overall quality of life was highest in younger (15-29 years) and lowest in elderly subjects (over 50 years). Life quality decreased with increasing age. Between subjective sleep quality and quality of life a moderate, significant correlation was found (r2= 0.6721). CONCLUSIONS: Complaints about a bad quality of sleep could be used as a screening method in the exploration of patients' quality of life (QoL).

[Sleep apnea as a risk factor]. / Die Schlafapnoe als Risikofaktor.

Sleep apnea and snoring are widely discussed as risk factors for internal and neurological diseases. The prevalence of snoring in an Austrian population survey is about 27.2% (males 36.5%, females 18.9%), and that of apnea (respectively irregularity and/or cessation of breathing) about 8.5% (31% of all snorers). Clinical symptoms like naps, daytime sleepiness, unquiet sleep, hypertonia, headache in the morning and psychological symptoms may be characteristics of sleep apnea. They should lead to further diagnosis and removal of this risk factor for ischemic heart disease and stroke.

[Epidemiology of sleep disorders in Austria]. / Zur Epidemiologie von Schlafstörungen in Osterreich.

UNLABELLED: Epidemiologic data on sleep disturbances in Austria were collected for the first time in March/April 1993 in a representative inquiry ( SAMPLE: n = 1000, 471 males, 529 females). 26% of the subjects reported sleep disturbances which were mostly chronic (21% had suffered from sleep disturbance for more than one year). The incidence of sleep disturbances increased with age, namely 13% in 14-30 year-old subjects, 22% in 31-50 year-old ones and 41% in subjects over 50. 7% suffered from disturbances in sleep initiation, i.e., they had a sleep latency of over 30 minutes. 19% of them had difficulties in getting to sleep at least once a week. Disturbances in maintaining sleep were reported by 28% of subjects, 56% of them needing longer than one hour to get back to sleep. 30% suffered from daytime sleepiness, 43% of the subjects were impaired by their sleep disturbances in some way, but only 34% had consulted their doctor.

A computerized system for acquisition and evaluation of polysomnographic recordings.

A computer system has been designed for acquisition and evaluation of polysomnographic recordings. The aim is to create a system running on a microcomputer emulating all functions of a conventional chart recorder and offering the advantage of making computer assisted evaluations. We have done 87 investigations in the first year of operation and were fully satisfied by the performance of the system. The standard signals we recorded were SaO2, heart rate, respiratory effort, nasal and oral airflow and ECG, as well as EOG, EMG and EEG. Due to this new method, evaluation of the recording can be done in less time than with strip chart recordings and the use of hundreds of pages of paper per night can be avoided.

[Results of preventive screening of chimney sweeps]. / Ergebnisse von Vorsorgeuntersuchungen bei Rauchfangkehrern.

In a prospective study, 18 chimney sweeps aged between 21 and 57 years were examined with the aim of detecting the presence of heavy metals in the blood and urine, and identifying cardiopulmonary diseases. Elevated concentrations of cadmium were found in three cases, and of lead in two cases, the concentrations being such that damage to health could not be excluded. None of the chimney sweeps showed any signs of bronchial hyper-reactivity or coronary heart disease. With respect to risk factors for coronary heart disease, elevated cholesterol and/or triglyceride levels were observed in 7/16 patients. These figures are compatible with the average figures for the Austrian population at large.

[Comparison of an oxygen-conserving module "Oxytron" and the reservoir cannula "Oxymizer Pendant" with continuous oxygen administration via nasal prong in hypoxemic patients]. / Vergleich des Sauerstoff-Sparmoduls "Oxytron" und der Reservoirbrille "Oxymizer Pendant" mit kontinuierlicher Sauerstoffzufuhr über Nasenbrille bei hypoxämischen Patienten.

High costs involved in administering continuous long-term oxygen therapy to patients with chronic lung diseases and limited portability of oxygen sources stimulated research into and development of oxygen conserving devices. Oxytron (Weinmann, Hamburg) is a new electronic demand oxygen delivery system which limits oxygen flow to the early phase of inspiration. The reservoir cannula Oxymizer Pendant (Chad-Therapeutics Inc.) is a nasal prong system incorporating a pendant reservoir which stores oxygen during expiration and delivers it as a bolus at the onset of inspiration. Ten patients with significant hypoxaemia at rest received oxygen delivered at various breath interval settings with the Oxytron method and at flow rates of 2, 3 and 41/min with the reservoir cannula Oxymizer Pendant and with continuous flow. The results indicate that significantly less oxygen was required to provide equivalent oxygen saturation with Oxytron as compared with steady flow delivery: an oxygen flow reduction of greater than 75% was achieved at all Oxytron settings tested. With the reservoir cannula oxygen saving was most evident at low oxygen flows: 29.3, 19.4 and 4.7% less oxygen was required than with continuous flow at 2, 3 and 41/min. Individual patient acceptance of various drug delivery systems and response to therapy should be considered when prescribing home oxygen therapy. The use of oxygen saving techniques could result in a substantial cost saving and greater mobility may help to improve compliance in patients requiring continuous oxygen therapy.

[Effectiveness and tolerance of disodium cromoglycate capsules in pellet form]. / Uber die Wirksamkeit und Verträglichkeit von Dinatriumcromoglycat-Kapseln in pelletierter Form.

The efficacy of, and tolerance to lactose-free sodium cromoglycate capsules was investigated in a multicentre trial. Data of 154 patients with asthma treated at 41 centres were evaluated over an observation period of 5 weeks. During treatment there was a significant reduction in the required dosage of concomitant medication, a marked improvement with regard to the severity of symptoms and a significant increase in peak flow rates. Assessment of treatment was "good" or "very good" in 86% of patients. Mild side effects such as cough or throat irritation were seen in only 2.6% of patients.