Postpartum depressive symptoms and its association to daytime sleepiness and restless legs during pregnancy.

BACKGROUND: Postpartum depression is a common condition, which consequences might be harmful for both mother and child. Since sleep and depression are closely related it is possible that women who suffer from sleep related problems during pregnancy are more likely to develop depression in the postpartum period. This study aims to investigate the possible association between depressive symptoms in the postpartum period and sleep related problems during pregnancy. METHODS: In this study 293 women in the last trimester of pregnancy answered a questionnaire about symptoms of restless legs, snoring and daytime sleepiness. They also completed the Epworth Sleepiness Scale (ESS). The same women were screened for depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) four to ten weeks after giving birth. Additional information about social data, pregnancy and delivery was received from the medical charts. RESULTS: Women with postpartum depressive symptoms had higher prevalence of excessive daytime sleepiness defined as ESS score ≥10 (OR 3.84, CI 1.57-9.39), and restless legs syndrome (OR 2.837 CI 1.18-6.84) in last trimester of pregnancy, when adjusted for socio-demographic factors and obstetric risk factors. No association was found between postpartum depressive symptoms and snoring. CONCLUSIONS: Depressive symptoms after childbirth are preceded by sleep related problems such as daytime sleepiness and restless legs, already during pregnancy. The results from Epworth Sleepiness Scale and a questionnaire concerning Restless Legs Syndrome completed during pregnancy might be a valuable contribution for detecting women at risk for postpartum depression, enabling preventive interventions.

Sleepiness and sleep-disordered breathing during pregnancy.

PURPOSE: This study aimed to examine if there is a difference in the prevalence of obstructive sleep apnea (OSA) and sleepiness between pregnant and non-pregnant women. It also aimed to evaluate if obstetric outcomes were associated to sleep-disordered breathing among the pregnant women. METHODS: One hundred pregnant women (gestational weeks 24-34) and 80 age- and body mass index-matched non-pregnant women underwent whole-night respiratory recordings (airflow, snoring, respiratory movements, body position, pulse oximetry). The women also answered a questionnaire including the Epworth sleepiness scale. RESULTS: Eighty-nine percent of the pregnant women had normal body mass index (BMI). Objectively, recorded snoring was more common among the pregnant women (median 9 % of total estimated sleep time) than among the controls (4 % of total sleep time, p = 0.005). Three of the pregnant women had OSA (apnea/hypopnea index (AHI) >5), but in two cases, this was mainly due to central hypopneas. None had AHI >10. Two controls were diagnosed as OSA. Respiratory parameters including snoring showed no impact on obstetric outcomes. Total Epworth sleepiness scale (ESS) score was higher among pregnant women than among controls (median 9 vs 7, p < 0.001). There was no difference concerning the separate items. There were no significant associations between either subjectively reported or objectively recorded snoring and ESS scores. CONCLUSION: There was no increased prevalence of obstructive sleep apnea among pregnant women. One reason for this could be that the majority of the women in this study were non-obese. Neither OSA nor snoring was likely an explanation for the increased daytime sleepiness seen in the pregnant women.

Snoring during pregnancy and its relation to sleepiness and pregnancy outcome - a prospective study.

BACKGROUND: The incidence of snoring and sleepiness is known to increase during pregnancy, and this might impact maternal health and obstetric outcome. However, the association between snoring and sleepiness during pregnancy is not fully understood. This study was aimed at investigating the development of snoring during pregnancy and prospectively assessing if there is an association between snoring and sleepiness or adverse pregnancy outcomes, such as preeclampsia, mode of delivery, and fetal complications. METHODS: Consecutively recruited pregnant women (n = 500) received a questionnaire concerning snoring and sleep at the 1st and 3rd trimester of pregnancy. The women who had rated their frequency of snoring at both occasions (n = 340) were divided into subgroups according to the development of snoring they reported and included in the subsequent analyses. Additional medical data were collected from the medical records. RESULTS: The frequency of snoring was 7.9% in the 1st trimester and increased to 21.2% in the 3rd trimester of pregnancy. The women who snored already in early pregnancy had significantly higher baseline BMI (p = 0.001) than the women who never snored, but snoring was not associated with the magnitude of weight gain during pregnancy. Snoring women were more likely to experience edema in late pregnancy than the non-snorers. Women who started to snore during pregnancy had higher Epworth Sleepiness Scores than the non snorers in both early and late pregnancy. No significant association between obstetric outcome and snoring was found. CONCLUSION: Snoring does increase during pregnancy, and this increase is associated with sleepiness, higher BMI at the start of pregnancy and higher prevalence of edema, but not with weight gain.

Side effects to continuous positive airway pressure treatment for obstructive sleep apnoea: changes over time and association to adherence.

PURPOSE: Continuous positive airway pressure (CPAP) is an effective treatment against obstructive sleep apnoea, but adherence is often low, and side effects are common. It is unclear from previous research whether side effects are significant causes of nonadherence. No study has examined if side effects vary within subjects over time. The aims were to (1) examine the evolution of CPAP side effects over time, and (2) prospectively assess correlations between early CPAP side effects and treatment adherence. METHODS: One hundred eighty-six obstructive sleep apnoea patients from three sleep centres were prospectively enrolled. They completed the Side Effects to CPAP Inventory, where the respondent rates the frequency, magnitude and perceived impact on adherence from 15 side effects. Adherence was measured by treatment dropout and machine usage time. RESULTS: The most common side effects were dry mouth, increased number of awakenings, blocked up nose, mask pressure and mask leaks. While some side effects were stable over time, others could both resolve and emerge within subjects. Dry mouth, mask leakage and blocked up nose emerged within 1 year in approximately 30% of patients who had not experienced them after 2 weeks. Increased number of awakenings and dry mouth after 1-2 weeks were significantly associated to treatment dropout during the first year and machine usage time after 6 months. CONCLUSIONS: While some side effects are related to adherence, most are not. Not all side effects are stable over time. This, together with differences in methodology between studies, might explain the conflicting findings in earlier research.

How do we know when patients sleep properly or why they do not?

The importance of adequate sleep for good health and immune system function is well documented as is reduced sleep quality experienced by ICU patients. In the previous issue of Critical Care, Elliot and co-workers present a well done, largest of its kind, single-center study on sleep patterns in critically ill patients. They base their study on the 'gold standard', the polysomnography technique, which is resource demanding to perform and often difficult to evaluate. The results are especially interesting as the authors not only used polysomnography in a large sample but also, in contrast to others, excluded patients with prior sleep problems. They also recorded patients' subjective sleep experiences in the ICU and thereafter in the ward (validated questionnaires) with simultaneous data collection of factors known to affect sleep in the ICU (mainly treatment interventions, light and sound disturbances). Interestingly, but not surprisingly, sleep was both quantitatively and qualitatively poor. Furthermore, there seemed to be little or no improvement over time when compared to earlier studies. This study stresses the magnitude of the sleep problem despite interventions such as earplugs and/or eyeshades. Sound disturbance was found to be the most significant but improvable factor. The study highlights the challenge and the importance of evaluating sleep in the critical care setting and the present need for alternative methods to measure it. All that in conjunction can be used to solve an important problem for this patient group.

Positional sensitivity as a confounder in diagnosis of severity of obstructive sleep apnea.

PURPOSE: The apnea-hypopnea index (AHI) is used to grade obstructive sleep apnea (OSA) into mild, moderate, and severe forms. Obstructive events are most common in the supine position. The amount of supine sleep thus influences total AHI. Our aim was to determine the prevalence of position-dependent OSA (POSA) and its relation to OSA severity classification as recommended by the American Academy of Sleep Medicine (AASM). METHODS: Two hundred sixty-five subjects were recruited from primary care hypertension clinics. Whole-night respiratory recordings were performed to determine the AHI in the supine and non-supine positions, respectively. POSA was defined as supine AHI twice the non-supine AHI with supine AHI ≥5. RESULTS: Fifty-three percent had POSA, 22% had non-position-dependent OSA, and 25% had normal respiration. By AASM classification, 81 subjects did not have OSA, but 42% of them had some degree of obstruction when supine, and 5 subjects would have been classified as moderate-severe if they had only slept supine. Conversely, of the 53 classified as mild OSA, 30% would have changed to a more severe classification if they had exclusively slept supine. CONCLUSIONS: POSA was common both in subjects that by AASM classification had OSA as well as those without. The severity of OSA, as defined by AASM, could be dependent on supine time in a substantial amount of subjects.

The fairness of the Epworth Sleepiness Scale: two approaches to differential item functioning.

PURPOSE: Differential item functioning (DIF) is said to exist in an item if a subject's response to the item is affected by other aspects than that which the test is intended to assess. DIF might affect the validity of a test. The aim of this study was thus to examine whether any of the items in the Epworth Sleepiness Scale (ESS) exhibits DIF regarding age or gender, and if so, to which degree. METHODS: Using previously collected cross-sectional ESS data from 1,168 subjects with different clinical characteristics (61% males, mean age 67.8 year (SD 12.2 year)), ordinal regression as well as Rasch-based DIF analyses were performed. RESULTS: Concerning age, both DIF analyses showed DIF for age in items 3 (inactive in a public place), 4 (passenger in a car), and 8 (in a car that has stopped in traffic). The Rasch model also showed DIF for gender in item 3. The DIF magnitudes as judged by McFadden pseudo-R (2) changes were, however, only minor. CONCLUSIONS: ESS has small but reproducible DIF for age in items 3, 4, and 8. The detected DIF might be worth to consider in large-sample studies, although it probably has no effect on an individual basis.

Sleep-wake activity rhythm and health-related quality of life among patients with coronary artery disease and in a population-based sample--an actigraphy and questionnaire study.

The aim of this study was to explore whether there are gender differences in sleep and health-related quality of life in patients with coronary artery disease (CAD) and a matched population-based sample and to see how subjectively rated sleep is associated with actigraphy. Secondly, to explore whether factors that predict patients' sleep quality could be identified. Fifty-seven patients with stable CAD and 47 participants from a population-based sample were included. All participants completed the Uppsala Sleep Inventory (USI), the Epworth Sleepiness Scale and the SF-36. Actigraphy recordings and a sleep diary were performed for seven 24-h periods. Multiple stepwise regression analysis showed that sleep duration, sleep onset latency, nocturnal awakenings, vitality (SF-36) and body mass index explained 60% of the sleep quality outcome (USI). Sleep duration, sleep efficiency and fragmentation index assessed with actigraphy and sleep diary accounted for 36% of the sleep quality outcome (diary). The result can form the basis for a non-pharmacological, self-care programme supported and led by nurses.

Clinical characteristics and mortality risk in relation to obstructive and central sleep apnoea in community-dwelling elderly individuals: a 7-year follow-up.

BACKGROUND: little is known about demographic and clinical characteristics associated with sleep-disordered breathing (SDB) and obstructive sleep apnoea (OSA) or central sleep apnoea (CSA) in community-dwelling elderly. We also examined these (OSA and CSA) associations to all-cause and cardiovascular (CV) mortality. METHODS: a total of 331 community-dwelling elderly aged 71-87 years underwent a clinical examination and one-night polygraphic recordings in their homes. Mortality data were collected after seven years. RESULTS: a total of 55% had SDB, 38% had OSA and 17% had CSA. Compared with those with no SDB and OSA, more participants with CSA had a left ventricular ejection fraction <50% (LVEF <50%) ischaemic heart disease (IHD) and transient ischaemic attack (TIA)/stroke. There was no difference in the rate of IHD and TIA/stroke between OSA and no SDB, but more LVEF <50% was found in those with OSA. CSA significantly increased the risk for all-cause (P=0.002) and CV mortality (P=0.018) by more than two times. After adjustments for CV disease, diabetes and the biomarker NT-pro-brain natriuretic peptide CSA associations to all-cause mortality and CV mortality lost significance. CONCLUSION: OSA, in persons >75 years does not appear to be associated with cardiovascular disease (CVD) disease or mortality, whereas CSA might be a pathological marker of CVD and impaired systolic function associated with higher mortality.

Restless legs syndrome during and after pregnancy and its relation to snoring.

OBJECTIVE: To study development of restless legs syndrome (RLS) during and after pregnancy, and whether RLS is related to snoring or other pregnancy-related symptoms. DESIGN: Prospective study. SETTING: Antenatal care clinics in the catchment area of Linköping university hospital, Sweden. POPULATION: Five hundred consecutively recruited pregnant women. METHODS: Sleep disturbances, including symptoms of RLS and snoring, were assessed with questionnaires in each trimester. A complementary questionnaire was sent three years after delivery to women experiencing symptoms of RLS during pregnancy. MAIN OUTCOME MEASURES: Symptoms of RLS in relation to snoring in each trimester. RESULTS: Symptoms of RLS were reported by 17.0% of the women in the first trimester, by 27.1% in the second trimester and by 29.6% in the third trimester. Snoring in the first trimester was correlated to increased prevalence of RLS in all three trimesters (p= 0.003, 0.017 and 0.044 in the first, second and third trimester, respectively). No correlation was found between RLS and anemia, parity or body mass index. Among the women who experienced RLS, 31% still had symptoms three years after delivery. Fifty-eight per cent of those whose symptoms had disappeared stated that this happened within one month after delivery. CONCLUSIONS: Symptoms of RLS progressed most between the first and second trimester. Women who snored in the first or second trimester of pregnancy had a higher prevalence of RLS in the third trimester, which indicates that snoring in early pregnancy might predict RLS later. Symptoms of RLS disappear quite soon after delivery, but about one-third of women with RLS during pregnancy may still have symptoms three years after childbirth.

Factors associated with undiagnosed obstructive sleep apnoea in hypertensive primary care patients.

OBJECTIVE: In hypertensive primary care patients below 65 years of age, (i) to describe the occurrence of undiagnosed obstructive sleep apnoea (OSA), and (ii) to identify the determinants of moderate/severe OSA. DESIGN: Cross-sectional. SETTING: Four primary care health centres in Sweden. PATIENTS: 411 consecutive patients (52% women), mean age 57.9 years (SD 5.9 years), with diagnosed and treated hypertension (BP >140/90). MAIN OUTCOME MEASURES: Occurrence of OSA as measured by the apnoea hypopnoea index (AHI). RESULTS: Mild (AHI 5-14.9/h) and moderate/severe (AHI > 15/h) OSA were seen among 29% and 30% of the patients, respectively. Comparing those without OSA with those with mild or moderate/severe OSA, no differences were found in blood pressure, pharmacological treatment (anti-hypertensive, anti-depressive, and hypnotics), sleep, insomnia symptoms, daytime sleepiness, or depressive symptoms. Obesity (BMI > 30 kg/m2) was seen in 30% and 68% of the patients with mild and moderate/severe OSA, respectively. Male gender, BMI > 30 kg/m2, snoring, witnessed apnoeas, and sleep duration >8 hours were determinants of obstructive sleep apnoea. CONCLUSION: Previously undiagnosed OSA is common among patients with hypertension in primary care. Obesity, snoring, witnessed apnoeas, long sleep duration, and male gender were the best predictors of OSA, even in the absence of daytime sleepiness and depressive symptoms.

Decisive situations affecting partners' support to continuous positive airway pressure-treated patients with obstructive sleep apnea syndrome: a critical incident technique analysis of the initial treatment phase.

BACKGROUND AND RESEARCH OBJECTIVE: Effective treatment of obstructive sleep apnea syndrome (OSAS) with continuous positive airway pressure (CPAP) can reduce morbidity and mortality, but adherence rates are low. The partner has an important role in supporting the patient, but this role may be adversely affected by difficulties during the early phase of the CPAP initiation. The aim of this study was to explore and describe decisive situations affecting partners' support to patients with OSAS and how the partners manage these situations during the initial phase of CPAP treatment. SUBJECTS AND METHODS: A qualitative descriptive design using critical incident technique was used. A total of 542 decisive situations affecting partners' support and 222 situations describing managing were collected by means of interviews with 25 strategically selected partners of patients with CPAP treated OSAS. RESULTS: Adverse effects, limited effect, practical and psychosocial problems, limited presence, and inappropriate initiation emerged as negative influences on the partners' support. A well-functioning treatment, improvements, high motivation, and receiving support from others were identified as positive influences on the partners' support. The partner managed the situations by letting the patient handle the CPAP treatment by himself/herself, by handling the treatment together with the patient, or taking over the handling of CPAP treatment. CONCLUSION: Increased knowledge about the different situations that affect the partners' support negatively or positively and how these situations are managed by partners can be used in educational situations involving both patients and partners during CPAP initiation.

Everyday life for the spouses of patients with untreated OSA syndrome.

The aim of this study was to generate a theoretical model describing concerns for spouses of patients with untreated obstructive sleep apnoea syndrome (OSAS) and how they manage these concerns in their everyday life. Twelve spouses were interviewed about their experiences and how they manage everyday life. The interviews were analysed according to the Grounded Theory method as described by Strauss and Corbin. Two main categories emerged from the data: 'Social adjustment' and 'New feelings'. 'Social adjustment' reveals how the spouses made adjustments in their daily lives, both according to their partners' tiredness and owing to their own fatigue. 'New feelings' reveals emotional reactions related to the effects of their partner's illness and the impact it had on the spouse's everyday life. These two main categories could be seen in relation to four dimensions describing how the spouses manage their everyday life: 'Sacrificing', 'Controlling', 'Changing' and 'Understanding'. The results show how the spouses made adjustments in everyday life and how their feelings were affected by their partner's OSAS. Healthcare personnel could use information from this study to gain a deeper understanding and knowledge of what spouses of untreated patients with OSAS experience as their main concerns and how they manage their everyday life. This knowledge can be used to improve the support to the spouses, as well as in the educational situation concerning the illness, as well as the treatment.

Symptom profile of undiagnosed obstructive sleep apnoea in hypertensive outpatients in primary care: a structural equation model analysis.

BACKGROUND: Obstructive sleep apnoea (OSA) has been linked to hypertension in sleep clinic populations, but little is known about the symptom profile of undiagnosed OSA in hypertensive outpatients in primary care. AIM: To explore characteristics associated with undiagnosed OSA in hypertensive primary care patients. METHODS: Cross-sectional design, including 411 consecutive patients (52% women), mean age 57.9 years (standard deviation [SD] 5.9 years), with diagnosed hypertension (blood pressure >140/90 mmHg) from four primary care centres. All subjects underwent a full-night, home-based, respiratory recording to establish the presence and severity of OSA. Clinical variables, medication and comorbidities, as well as data from self-rating scales regarding symptoms/characteristics, insomnia, excessive daytime sleepiness, depressive symptoms and health were collected during a clinical examination. Factor analyses and structural equation modelling (SEM) were used to explore the relationships between self-rated symptoms, clinical characteristics and objectively verified diagnosis of OSA. MAIN OUTCOME: Measures symptom profile of undiagnosed OSA (as measured by the Apnoea/Hypopnoea Index [AHI]) in hypertensive outpatients in primary care. RESULTS: Fifty-nine percent of the patients had an AHI ≥ 5/hour indicating OSA. An exploratory factor analysis based on 19 variables yielded a six-factor model (anthropometrics, blood pressure, OSA-related symptoms, comorbidity, health complaints and physical activity) explaining 58% of the variance. SEM analyses showed strong significant associations between anthropometrics (body mass index, neck circumference, waist circumference) (0.45), OSA-related symptoms (snoring, witnessed apnoeas, dry mouth) (0.47) and AHI. No direct effects of OSA on comorbidities, blood pressure, dyssomnia or self-rated health were observed. CONCLUSION: OSA was highly prevalent and was directly associated with anthropometrics and OSA-related symptoms (snoring, witnessed apnoeas and dry mouth in the morning). When meeting patients with hypertension, these characteristics could be used by general practitioners to identify patients who are in need of referral to a sleep clinic for OSA evaluation.

The attitudes to CPAP treatment inventory: development and initial validation of a new tool for measuring attitudes to CPAP treatment.

Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS), but low adherence rates are common. The aim was to develop the attitudes to CPAP treatment inventory (ACTI), and to investigate the validity and reliability of the instrument among patients with OSAS. ACTI was developed on the basis of: (i) in-depth interviews with 23 patients; (ii) examination of the scientific literature; and (iii) consensus agreement of a multi-professional expert panel. This yielded five different types of attitudes to CPAP treatment. A prospective longitudinal design was used. Two-hundred and eighty-nine patients with OSAS were recruited at three different CPAP centres. Data were collected with ACTI and obtained from medical records. The homogeneity and internal consistency reliability were satisfactorily reflected by the item-total correlations (0.59-0.81) and Cronbach's alpha (0.89), respectively. Construct validity was confirmed with factor analysis (principal component analysis with orthogonal rotation; PCF). The PCF based on baseline data resulted in a one single-factor solution explaining 69% of the total variance. A confirmatory factor analysis was performed 2 weeks after CPAP initiation, resulting in the same factor solution. No indication of uniform differential item functioning was found. The predictive validity was tested with receiver operating characteristic analyses, and a cut-off of 10 on the ACTI gave a sensitivity of 93% and a specificity of 44% for CPAP termination within 6 months. The satisfactory measurement properties of this new pragmatic instrument are promising and indicate that ACTI can be useful in clinical practice to reliably measure attitudes to CPAP treatment.

Sleep, arousal and health-related quality of life in men and women with coronary artery disease.

AIM: To evaluate whether there are gender differences in insomnia, sleep quality, sleep efficiency (%), general arousal, disease-specific and health-related quality of life in patients with coronary artery disease, compared with an age- and gender-matched randomly selected group from the general population. BACKGROUND: There are gender difference effects of sleep disturbances in the general population, but this perspective among patients with coronary artery disease has been poorly analysed. DESIGN: In this prospective study, comparative, descriptive and model testing designs were used. METHOD: The patients with coronary artery disease, 556 men and 324 women aged 25-86, were compared with a matched population-based group. Data were collected by validated and reliability-tested questionnaires. RESULTS: The prevalence of severe insomnia varied between 17-44% in all four groups. The severe insomniac coronary artery disease patients displayed a two- or threefold higher presleep arousal, had two hours shorter nocturnal sleep duration/night and were more limited in their physical exercise level than the population-based group. Gender differences in sleep quality, sleep efficiency (%) and general arousal disappeared with increased insomnia severity. CONCLUSIONS: Independent of gender, age and comorbidity, physical exercise, general arousal behaviour and delayed poststress recovery after mental stress were found to have a negative impact on the coronary artery disease patients' sleep quality and sleep efficiency (%), interfering with their health-related quality of life. The variables significantly explained 41% of the sleep quality outcome and 29% of the sleep efficiency (%). RELEVANCE TO CLINICAL PRACTICE: Insomnia because of hyperarousal behaviour can be an important factor in the development of an individual self-care management programme supported by a healthcare team.

Sleep-related sweating in obstructive sleep apnoea: association with sleep stages and blood pressure.

The aim of this study was to investigate sleep-related sweating as a symptom of obstructive sleep apnoea (OSA). Fifteen otherwise healthy male non-smoking patients with untreated moderate-to-severe OSA underwent polysomnography, including measurements of skin and core body temperature and electrodermal activity (EDA) as an objective indicator of sweating. Evening and morning blood pressure was measured as well as catecholamines in nocturnal urine. All measurements were repeated after 3 months on successful continuous positive airway pressure (CPAP) treatment. The untreated OSA subjects had a mean (+/-SD) apnoea-hypopnoea index of 45.3 +/- 3.9 and a mean EDA index during sleep of 131.9 +/- 22.4 events per hour. Patients with higher EDA indices had higher systolic blood pressure in the evening and morning (P = 0.001 and 0.006) and lower rapid eye movement (REM) sleep percentage (P = 0.003). The EDA index decreased significantly to 78.5 +/- 17.7 in the patients on CPAP treatment (P = 0.04). The decrease correlated with lower evening systolic and diastolic blood pressure (P = 0.05 and 0.006) and an increase in REM% (P = 0.02). No relationship was observed between EDA and skin or core body temperature, or to catecholamine levels in urine. OSA patients who experience sleep-related sweating may have increased blood pressure and decreased REM sleep compared with other OSA patients. CPAP treatment appears to lower blood pressure and increase REM sleep to a higher extent in these patients compared with other OSA patients.

The side-effects to CPAP treatment inventory: the development and initial validation of a new tool for the measurement of side-effects to CPAP treatment.

Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS), but side-effects are common. No validated self-rating scale measuring side-effects to CPAP treatment exists today. The aim was to develop the side-effects to CPAP treatment inventory (SECI), and investigate the validity and reliability of the instrument among patients with OSAS. SECI was developed on the basis of: (1) in-depth interviews with 23 patients; (2) examination of the scientific literature and (3) consensus agreement of a multi-professional expert panel. This yielded 15 different types of side-effects related to CPAP treatment. Each side-effect has three sub-questions (scales): perceived frequency (a) and magnitude (b) of the side-effect, as well as its perceived impact on CPAP use (c). A cross-sectional descriptive design was used. A total of 329 patients with OSAS with an average use of CPAP treatment for 39 months (2 weeks to 182 months) were recruited. Data were collected with SECI, and obtained from medical records (clinical variables and data related to CPAP treatment). Construct validity was confirmed with factor analysis (principal component analysis with orthogonal rotation). A logical two-factor solution, the device subscale and symptom subscale, emerged across all three scales. The symptom subscale describing physical and psychological side-effects and the device subscale described mask and device-related side-effects. Internal consistency reliability of the three scales was good (Cronbach's α = 0.74-0.86) and acceptable for the subscales (Cronbach's α = 0.62-0.86). The satisfactory measurement properties of this new instrument are promising and indicate that SECI can be used to measure side-effects to CPAP treatment.

Determinants of global perceived health in community-dwelling elderly screened for heart failure and sleep-disordered breathing.

The relationships between heart failure (HF), sleep-disordered breathing (SDB), insomnia, depressive symptoms, and excessive daytime sleepiness (EDS), as well as their relationship to Global Perceived Health (GPH) in an elderly community-dwelling population, have not been explored. Data from 331 community-dwelling elderly (71-87 years old) were collected by echocardiography, polygraphy, and specific questionnaires. Factor analyses and structural equation modeling were used to explore the relationships between HF, SDB, sleep, psychosocial factors, and GPH. Exploratory and confirmatory factor analyses derived a 5-factor model representing SDB, insomnia, systolic function, breathlessness/physical function, and psychosocial function. Structural equation modeling analyses were used to explore the relationships between the 5 factors and to GPH. Sleep-disordered breathing had a weak effect on systolic function, but no effects on any of the other factors or GPH were found. Psychosocial function and breathlessness/physical function directly affected GPH. Indirect effects on GPH, mediated by psychosocial function, were found for breathlessness/physical function and insomnia. Systolic function also had an indirect effect on GPH. The fact that SDB in the elderly has no obvious negative associations to sleep complaints or GPH does not exclude them from being adequately treated for SDB. However, the present study has shown that SDB, by means of self-rated sleep complaints and health-related quality of life, can be problematic to detect. Psychosocial function was the most important factor for perceived GPH as it had a direct effect, as well as mediated the factors breathlessness/physical function and insomnia effects, on GPH. This study indicates that interventions in clinical practice targeting psychosocial dysfunction, such as depressive symptoms, could help to improve GPH in the elderly with or without HF.

Long-term effects of radiofrequency ablation of the soft palate on snoring.

The objective of the study was to evaluate short- and long-term effects of radiofrequency treatment of the soft palate on snoring. Twenty-nine patients with habitual snoring were studied prospectively and treated up to four times at 4-6 week intervals with an Ellman Surgitrone®. Electromyography (EMG) of m. palatoglossus was performed in ten patients. Patients and partners evaluated snoring, sleep quality and daytime sleepiness 1 week preoperatively, 6 months and 3-4 years postoperatively. Snoring was reduced postoperatively (P < 0.0001). Sleep time increased, daytime sleepiness was reduced, and the partners slept better after 6 months. However, 3-4 years postoperatively only 25% of patients were satisfied. Another 25% had received additional treatment. EMG was normal in 6/10 patients preoperatively. They all continued to snore postoperatively. Four patients had pathological EMGs; three were responders. In conclusion, radiofrequency treatment for snoring may lead to long-term improvement in one out of four cases. Pre-evaluation with EMG may predict the outcome.