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Fridriksson B, Berndtson M, Hamnered H, Faeder E, Ding Z, Hedner J, Grote L. Beneficial effects of telemedicine-based follow up in sleep apnea - a randomized controlled multi-center trial. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Zou D, Grote L, Basoglu O, Verbraecken J, Schiza S, Sliwinski P, Steiropoulos P, Lombardi C, Hein H, Pépin JL, Parati G, McNicholas W, Hedner J. Arterial bicarbonate is associated with hypoxic burden and hypertension in obstructive sleep apnea - the ESADA cohort. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hoff E, Strassberger C, Stenlof K, Zou D, Grote L, Hedner J. Sulthiame reduces loop gain and increases the arousal threshold - Insights from a RCT in patients with moderate to severe OSA. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Strassberger C, Zou D, Marciniak A, Hedner J, Grote L. Night-to-night variability of automatically derived physiological endotypic traits in patients with Obstructive Sleep Apnea. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hedner J, Stenlöf K, Zou D, Hoff E, Hansen C, Kuhn K, Lennartz P, Grote L. A randomized controlled trial exploring safety and tolerability of sulthiame in sleep apnea. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Richardson PG, Schjesvold F, Weisel K, Moreau P, Anderson LD, White D, Rodriguez-Otero P, Sonneveld P, Engelhardt M, Jenner M, Corso A, Dürig J, Pavic M, Salomo M, Beksac M, Oriol A, Lindsay J, Liberati AM, Galli M, Robak P, Larocca A, Yagci M, Vural F, Kanate AS, Jiang R, Grote L, Peluso T, Dimopoulos M. Pomalidomide, bortezomib, and dexamethasone at first relapse in lenalidomide-pretreated myeloma: A subanalysis of OPTIMISMM by clinical characteristics. Eur J Haematol 2021; 108:73-83. [PMID: 34496096 PMCID: PMC9293199 DOI: 10.1111/ejh.13706] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/02/2021] [Accepted: 09/06/2021] [Indexed: 01/17/2023]
Abstract
Objective We evaluated the efficacy and safety of pomalidomide, bortezomib, and dexamethasone (PVd) vs bortezomib and dexamethasone (Vd) by age, renal function, and high‐risk cytogenetic abnormalities in lenalidomide‐pretreated patients with multiple myeloma at first relapse. Methods OPTIMISMM was a phase 3, multicenter, open‐label, randomized study (NCT01734928; N = 559). The primary endpoint was progression‐free survival (PFS). Results Overall, 226 patients had received one prior line of therapy. PVd significantly prolonged PFS vs Vd in patients aged ≤65 years (median, 22.0 vs 13.1 months; P = .0258) and >65 years (median, 17.6 vs 9.9 months; P = .0369). Median PFS in patients with renal impairment (RI; creatinine clearance <60 mL/min) was 15.1 months with PVd vs 9.5 months with Vd (hazard ratio [HR], 0.67 [95% CI, 0.34‐1.34]). In patients without RI, median PFS was 22.0 vs 13.1 months (HR, 0.45 [95% CI, 0.27‐0.76]). In patients with high‐risk cytogenetics, median PFS was 14.7 vs 9.9 months (HR, 0.39 [95% CI, 0.13‐1.17]). PVd significantly improved overall response rate vs Vd in all subgroups. The safety profile of PVd was consistent with previous reports. Conclusions These findings confirmed the benefits of PVd at first relapse, including in patients with poor prognostic factors.
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Affiliation(s)
- Paul G Richardson
- Department of Medical Oncology, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Fredrik Schjesvold
- Oslo Myeloma Center at Oslo University Hospital, KG Jebsen Center for B-Cell Malignancies, University of Oslo, Oslo, Norway
| | - Katja Weisel
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Larry D Anderson
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Darrell White
- Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | | | | | | | | | | | - Jan Dürig
- University Hospital Essen, Essen, Germany
| | - Michel Pavic
- Centre Hospitalier Universitaire De Sherbrooke (CHUS), Centre de Recherche Clinique Etienne-Le Bel (CRCELB) Hopital Fleurimont, Sherbrooke, QC, Canada
| | - Morten Salomo
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Albert Oriol
- Institut Català d'Oncologia I Institut Josep Carreras, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Jindriska Lindsay
- East Kent Hospitals University NHS Foundation Trust, Kent and Canterbury Hospital, Canterbury, UK
| | | | - Monica Galli
- Ospedale Papa Giovanni XXIII, U.O. di Ematologia, Ispedali Riuniti di Bergamo, Bergamo, Italy
| | | | | | - Munci Yagci
- Gazi University Medical Faculty, Ankara, Turkey
| | | | | | - Ruiyun Jiang
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Lara Grote
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Teresa Peluso
- Celgene International Sàrl, a Bristol-Myers Squibb Company, Boudry, Switzerland
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Gunduz C, Basoglu OK, Kvamme JA, Verbraecken J, Anttalainen U, Marrone O, Steiropoulos P, Roisman G, Joppa P, Hein H, Trakada G, Hedner J, Grote L, Steiropoulos P, Verbraecken J, Petiet E, Trakada G, Montserrat J, Fietze I, Penzel T, Ondrej L, Rodenstein D, Masa J, Bouloukaki I, Schiza S, Kent B, McNicholas W, Ryan S, Riha R, Kvamme J, Hein H, Schulz R, Grote L, Hedner J, Zou D, Pépin J, Levy P, Bailly S, Lavie L, Lavie P, Basoglu O, Tasbakan M, Varoneckas G, Joppa P, Tkacova R, Staats R, Barbé F, Lombardi C, Parati G, Drummond M, van Zeller M, Bonsignore M, Marrone O, Petitjean M, Roisman G, Pretl M, Vitols A, Dogas Z, Galic T, Pataka A, Anttalainen U, Saaresranta T, Plywaczewski R, Sliwinski P, Bielicki P. Long-term positive airway pressure therapy is associated with reduced total cholesterol levels in patients with obstructive sleep apnea: data from the European Sleep Apnea Database (ESADA). Sleep Med 2020; 75:201-209. [DOI: 10.1016/j.sleep.2020.02.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/02/2020] [Accepted: 02/25/2020] [Indexed: 12/18/2022]
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Svedmyr S, Hedner J, Zou D, Parati G, Ryan S, Hein H, Pepin J, Tkacova R, Marrone O, Schiza S, Basoglu O, Grote L. Superior hypertension control with betablockade in the European Sleep Apnea Database. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Arterial hypertension is highly prevalent and frequently difficult to control in patients with obstructive sleep apnea (OSA). High sympathetic activity is a hallmark physiological phenomenon in OSA. We hypothesized that antihypertensive drugs with sympathetic inhibitory properties, in particular beta blockers (BB), may be particularly efficacious in OSA patients.
Methods
Hypertensive OSA patients receiving blood pressure lowing treatment in the European Sleep Apnea Database (ESADA) were analyzed (n=5818, 69% men, age 58±11 years, body mass index 33±7 kg/m2, apnea hypopnea index 34±26 events/h). Antihypertensive medications (BB, diuretic, renin-angiotensin blocker [RAB], calcium channel blocker [CCB], and centrally acting antihypertensive [CAH]) were classified according to ATC code. Office blood pressure was compared in patients with mono- or combination therapy controlling for confounders.
Results
Poorly controlled systolic blood pressure according to the ESC/ESH guidelines was found in 66% of patients. Patients receiving monotherapy with RAB, CCB or CAH had 2.2 [95% CI, 1.4–3.0], 3.0 [1.9–4.1] and 3.0 [1.7–4.7] mmHg higher systolic blood pressure compared with those on BB (adjusted model, p=0.007, 0.008 and 0.017, respectively). In those with a combination of two antihypertensive drugs, systolic blood pressure was 3.3 [2.4–4.3], 2.2 [1.3–4.3] and 2.3 [1.4–3.3] mmHg higher in those on CCB/RAB, diuretic/RAB or BB/RAB compared with those on BB/diuretic (adjusted model, p<0.001, 0.019 and 0.001, respectively).
Conclusions
Uncontrolled blood pressure was common in OSA patients with antihypertensive medication. Patients treated with BB alone or in combination with diuretic was associated with a lower systolic pressure in this large clinical cohort.
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): European Respiratory Society funded Clinical Research Collaboration (2015-2020)
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Affiliation(s)
- S Svedmyr
- Institute of Medicine - Sahlgrenska Academy - University of Gothenburg, Gothenburg, Sweden
| | - J Hedner
- Institute of Medicine - Sahlgrenska Academy - University of Gothenburg, Gothenburg, Sweden
| | - D Zou
- Institute of Medicine - Sahlgrenska Academy - University of Gothenburg, Gothenburg, Sweden
| | - G Parati
- Istituto Auxologico Italiano, Milan, Italy
| | - S Ryan
- St Vincent's University Hospital, Dublin, Ireland
| | - H Hein
- St, Adolf Stift, Sleep Disorders Center, Reinbeck, Germany
| | - J.L Pepin
- Grenoble Alpes University Hospital, Grenoble, France
| | - R Tkacova
- Louis Pasteur University Hospital of Kosice, Kosice, Slovakia
| | - O Marrone
- CNR Institute for Biomedical Research and Innovation, Palermo, Italy
| | - S Schiza
- University of Crete, Heraklion, Greece
| | | | - L Grote
- Institute of Medicine - Sahlgrenska Academy - University of Gothenburg, Gothenburg, Sweden
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Svedmyr S, Grote L, Zou D, Bailly S, Lombardi C, Ludka O, Bonsignore M, Schiza S, Kvamme J, Basoglu O, Verbraecken J, Hedner J. Blood pressure reduction following treatment with positive airway pressure in sleep apnea: data from the European Sleep Apnea Database. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Positive airway pressure (PAP) treatment modifies blood pressure (BP) in patients with obstructive sleep apnea (OSA). We aimed to explore which factors that influence the BP response to PAP therapy in the European Sleep Apnea Database (ESADA).
Methods
A total of 2662 OSA patients with PAP therapy ≥90 days were included in the analysis (74% male, age 55±11 years, body mass index 32.3±6.1 kg/m2, 47% hypertensives, apnea-hypopnea index 40±24 events/h, treatment duration 1.0±1.1 years, PAP compliance 5.2±1.9 h/day). Anthropometric data, co-medications and office BP were assessed at baseline and follow-up visit.
Results
Systolic and diastolic BP were modestly reduced after PAP therapy compared to baseline (133±17 vs. 134±17 mmHg, 78±11 vs. 81±11 mmHg, p<0.001, respectively). In a generalized linear model controlling for anthropometric, PAP compliance and follow-up time, severe OSA at baseline (β [95% CI] −3.2 [−5.1 to −1.3], p=0.001), hypertension status (−2.0 [−3.3 to −0.7], p=0.003), weight reduction >2 kg at follow up (−2.0 [−3.7 to −0.4], p=0.016), and use of auto-adjusted PAP (−1.3 [−2.5 to −0.02], p=0.046) were associated with a reduction of systolic BP at follow-up.
Conclusions
BP reduction following PAP treatment in patients with moderate to severe OSA was modest. We identified several predictors of a favorable BP response including the use of auto adjusted PAP. Our findings suggest that weight reduction strategies in addition to PAP treatment should be considered to obtain adequate BP control in OSA patients.
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): European Respiratory Society funded Clinical Research Collaboration (2015-2020)
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Affiliation(s)
- S Svedmyr
- Institute of Medicine - Sahlgrenska Academy - University of Gothenburg, Gothenburg, Sweden
| | - L Grote
- Institute of Medicine - Sahlgrenska Academy - University of Gothenburg, Gothenburg, Sweden
| | - D Zou
- Institute of Medicine - Sahlgrenska Academy - University of Gothenburg, Gothenburg, Sweden
| | - S Bailly
- Grenoble Alpes University Hospital, Grenoble, France
| | - C Lombardi
- Istituto Auxologico Italiano, Milan, Italy
| | - O Ludka
- University Hospital Brno, Department of Cardiology, Brno, Czechia
| | | | - S Schiza
- University of Crete, Heraklion, Greece
| | | | | | | | - J Hedner
- Institute of Medicine - Sahlgrenska Academy - University of Gothenburg, Gothenburg, Sweden
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Schjesvold F, Dimopoulos MA, Beksac M, Oriol A, Lindsay J, Liberati AM, Galli M, Robak P, Weisel K, Larocca A, Yagci M, Vural F, Anderson, Jr LD, Kanate AS, Casal Mendez E, Jiang R, Srinivasan S, Grote L, Biyukov TN, Richardson PG. Pomalidomide, bortezomib, and dexamethasone (PVd) in lenalidomide (LEN)-pretreated relapsed refractory multiple myeloma: Subanalysis of patients with renal impairment in OPTIMISMM. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e20562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20562 Background: Upfront LEN until disease progression is a standard treatment (Tx) in multiple myeloma (MM). Data are limited on optimal Tx after first-line LEN, especially in LEN-refractory patients (pts), a growing population. In OPTIMISMM (phase 3, NCT01734928), PVd significantly improved median PFS at first relapse in relapsed refractory MM (RRMM) pts, of whom 100% were LEN pretreated and 57% were LEN refractory (median, 20.7 vs 11.6 mos; HR = 0.54 [95% CI, 0.36-0.82]; P = .0027) vs Vd (Richardson, 2019). Pd has shown efficacy and safety in RRMM pts with moderate or severe renal impairment (RI), including those on dialysis (Dimopoulos, 2018). However, outcomes with second-line PVd in RRMM pts with RI have not been assessed. Here we report efficacy and safety of PVd vs Vd at first relapse by renal status (CrCl < 60 vs ≥ 60 mL/min). Methods: Pts received PVd or Vd (1:1) in 21-day (D) cycles (C); POM 4 mg/D on D1-14 (PVd arm only); BORT 1.3 mg/m2 on D1, 4, 8, 11 of C1-8 and on D1, 8 of C9+; and DEX 20 mg/D (10 mg/D for pts aged > 75 yrs) on days of and after BORT. Pts on dialysis were excluded. Results: Of 559 pts enrolled, 226 (40%) had 1 prior line of therapy; of whom 28% had CrCl < 60 mL/min and 4% had severe RI (CrCl < 30 mL/min). In pts with CrCl < 60 mL/min (PVd vs Vd), median age was 74 vs 73 yrs. In pts with CrCl ≥ 60 mL/min (PVd vs Vd), median age was 62 vs 64 yrs. A higher proportion of pts with baseline CrCl < 60 (23% vs 43%) than ≥ 60 mL/min (7% vs 8%) had ISS stage III at study entry. Data cutoff was Oct 26, 2017. Median PFS was improved with PVd in both renal groups (Table). ORR significantly improved regardless of renal status. Depth of response also improved with PVd vs Vd; ≥ VGPR occurred in 54% vs 21% in the CrCl < 60 mL/min group and 64% vs 23% in the CrCl ≥ 60 mL/min group. Myelosuppression was the most common grade 3/4 TEAE (Table). Conclusions: Second-line PVd led to improved vs Vd in pts with RRMM and RI; however, the PFS difference was not statistically significant. Safety was consistent for PVd with no new signals in pts with RI. These findings further support the earlier use of POM-based Tx in RRMM pts, including those with mild to moderate RI. Clinical trial information: NCT01734928. [Table: see text]
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Affiliation(s)
- Fredrik Schjesvold
- Oslo Myeloma Center, Oslo University Hospital, Oslo Norway, and KG Jebsen Center for B Cell Malignancies, University of Oslo, Oslo, Norway
| | | | | | - Albert Oriol
- Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Jindriska Lindsay
- East Kent Hospitals University NHS Foundation Trust, Canterbury, United Kingdom
| | | | - Monica Galli
- A.O. Ospedale Papa Giovanni XXIII, U.O. di Ematologia, Ospedali Riuniti di Bergamo, Bergamo, Italy
| | - Pawel Robak
- Medical University of Lodz Poland, Lodz, Poland
| | - Katja Weisel
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Münci Yagci
- Gazi Üniversitesi Tıp Fakültesi Hastanesi, Ankara, Turkey
| | - Filiz Vural
- Ege University Medical Faculty, Department of Hematology, Izmir, Turkey
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Bassetti CLA, Randerath W, Vignatelli L, Ferini‐Strambi L, Brill A, Bonsignore MR, Grote L, Jennum P, Leys D, Minnerup J, Nobili L, Tonia T, Morgan R, Kerry J, Riha R, McNicholas WT, Papavasileiou V. EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke. Eur J Neurol 2020; 27:1117-1136. [DOI: 10.1111/ene.14201] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/04/2020] [Indexed: 02/06/2023]
Affiliation(s)
- C. L. A. Bassetti
- Neurology Department Medical Faculty University Hospital Bern Switzerland
- Department of Neurology Sechenov First Moscow State Medical University Moscow Russia
| | - W. Randerath
- Clinic of Pneumology and Allergology Center for Sleep Medicine and Respiratory Care Bethanien Hospital Institute of Pneumology at the University of Cologne Solingen Germany
| | - L. Vignatelli
- Servizio di Epidemiologia e Biostatistica IRCCS Istituto delle Scienze Neurologiche di Bologna Ospedale Bellaria BolognaItaly
| | - L. Ferini‐Strambi
- Department of Neurology OSR‐Turro Sleep Disorder Center Vita‐Salute San Raffaele University Milan Italy
| | - A.‐K. Brill
- Department of Pulmonary Medicine University and University Hospital Bern Bern Switzerland
| | - M. R. Bonsignore
- PROMISE Department Division of Respiratory Medicine DiBiMIS University of Palermo and IBIM‐CNR Palermo Italy
| | - L. Grote
- Sleep Disorders Center Department of Pulmonary Medicine Sahlgrenska University Hospital Göteborg Sweden
| | - P. Jennum
- Danish Center for Sleep Medicine Rigshospitalet Copenhagen Denmark
| | - D. Leys
- Department of Neurology University of Lille Lille France
| | - J. Minnerup
- Department of Neurology and Institute for Translational Neurology University of Muenster Muenster Germany
| | - L. Nobili
- Child Neuropsychiatry Unit Gaslini Institute DINOGMI University of Genova Genoa Italy
| | - T. Tonia
- Institute of Social and Preventive Medicine Universtity of Bern Bern Switzerland
| | - R. Morgan
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton ON Canada
| | - J. Kerry
- Library and Information Service Leeds Teaching Hospitals NHS Trust LeedsUK
| | - R. Riha
- Sleep Research Unit Centre for Clinical Brain Sciences University of Edinburgh EdinburghUK
- Department of Sleep Medicine Royal Infirmary of Edinburgh Edinburgh UK
| | - W. T. McNicholas
- Department of Respiratory and Sleep Medicine St Vincent’s University Hospital DublinIreland
- School of Medicine University College Dublin Dublin Ireland
- First Affiliated Hospital of Guangzhou Medical University Guangzhou China
| | - V. Papavasileiou
- Leeds Teaching Hospital NHS Trust LeedsUK
- Medical School University of Leeds Leeds UK
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Weisel K, Dimopoulos M, Moreau P, Yagci M, Larocca A, Kanate AS, Vural F, Cascavilla N, Basu S, Johnson P, Byeff P, Hus M, Rodríguez-Otero P, Muelduer E, Anttila P, Hayden PJ, Krauth MT, Lucio P, Ben-Yehuda D, Mendeleeva L, Guo S, Yu X, Grote L, Biyukov T, Dhanasiri S, Richardson P. Health-related quality-of-life results from the phase 3 OPTIMISMM study: pomalidomide, bortezomib, and low-dose dexamethasone versus bortezomib and low-dose dexamethasone in relapsed or refractory multiple myeloma. Leuk Lymphoma 2020; 61:1850-1859. [DOI: 10.1080/10428194.2020.1747066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Katja Weisel
- University Medical Center of Hamburg-Eppendorf, Hamburg, Germany and University Hospital of Tuebingen, Tuebingen, Germany
| | | | | | - Munci Yagci
- Gazi Universitesi Tip Fakultesi Hastanesi, Besevler, Turkey
| | - Alessandra Larocca
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Abraham S. Kanate
- Mary Babb Randolph Cancer Center, West Virginia University, Morgantown, WV, USA
| | | | - Nicola Cascavilla
- Fondazione IRCSS Casa Sollievo Della Sofferenza, San Giovanni Rotundo, Italy
| | - Supratik Basu
- New Cross Hospital, Wolverhampton, University Of Wolverhampton, United Kingdom
| | - Peter Johnson
- Department of Haematology, Western General Hospital, Edinburgh, United Kingdom
| | - Peter Byeff
- Cancer Center of Central Connecticut, Southington, CT, USA
| | - Marek Hus
- Samodzielny Publiczny Szpital Nr 1 W Lublinie, Lublin, Poland
| | | | | | - Pekka Anttila
- Division of Hematology, Helsinki University and Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | | | - Maria-Theresa Krauth
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Paulo Lucio
- Champalimaud Center for the Unknown, Lisbon, Portugal
| | | | - Larisa Mendeleeva
- National Research Center for Hematology of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | | | - Xin Yu
- Bristol Myers Squibb, Summit, NJ, USA
| | | | - Tsvetan Biyukov
- Celgene International Sàrl, a Bristol Myers Squibb Company, Boudry, Switzerland
| | - Sujith Dhanasiri
- Celgene International Sàrl, a Bristol Myers Squibb Company, Boudry, Switzerland
| | - Paul Richardson
- Jerome Lipper Multiple Myeloma Center, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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13
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Gunduz C, Basoglu OK, Hedner J, Bonsignore MR, Hein H, Staats R, Bouloukaki I, Roisman G, Pataka A, Sliwinski P, Ludka O, Pepin JL, Grote L. Hyperlipidaemia prevalence and cholesterol control in obstructive sleep apnoea: Data from the European sleep apnea database (ESADA). J Intern Med 2019; 286:676-688. [PMID: 31260567 DOI: 10.1111/joim.12952] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVE Obstructive sleep apnoea (OSA) and hyperlipidaemia are independent risk factors for cardiovascular disease. This study investigates the association between OSA and prevalence of hyperlipidaemia in patients of the European Sleep Apnea Database (ESADA) cohort. METHODS The cross-sectional analysis included 11 892 patients (age 51.9 ± 12.5 years, 70% male, body mass index (BMI) 31.3 ± 6.6 kg/m2 , mean oxygen desaturation index (ODI) 23.7 ± 25.5 events/h) investigated for OSA. The independent odds ratio (OR) for hyperlipidaemia in relation to measures of OSA (ODI, apnoea-hypopnoea index, mean and lowest oxygen saturation) was determined by means of general linear model analysis with adjustment for important confounders such as age, BMI, comorbidities and study site. RESULTS Hyperlipidaemia prevalence increased from 15.1% in subjects without OSA to 26.1% in those with severe OSA, P < 0.001. Corresponding numbers in patients with diabetes were 8.5% and 41.5%, P < 0.001. Compared with ODI quartile I, patients in ODI quartiles II-IV had an adjusted OR (95% CI) of 1.33 (1.15-1.55), 1.37 (1.17-1.61) and 1.33 (1.12-1.58) (P < 0.001), respectively, for hyperlipidaemia. Obesity was defined as a significant risk factor for hyperlipidaemia. Subgroups of OSA patients with cardio-metabolic comorbidities demonstrated higher prevalence of HL. In addition, differences in hyperlipidaemia prevalence were reported in European geographical regions with the highest prevalence in Central Europe. CONCLUSION Obstructive sleep apnoea, in particular intermittent hypoxia, was independently associated with the prevalence of hyperlipidaemia diagnosis.
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Affiliation(s)
- C Gunduz
- From the, Department of Chest Diseases, Biruni University, Istanbul, Turkey.,Department of Chest Diseases, Ege University, Izmir, Turkey
| | - O K Basoglu
- Department of Chest Diseases, Ege University, Izmir, Turkey
| | - J Hedner
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Sleep Disorders Center, Pulmonary Department, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - M R Bonsignore
- Biomedical Department of Internal and Specialist Medicine (DiBiMIS), Section of Pneumology, University of Palermo, Palermo, Italy.,CNR Institute of Biomedicine and Molecular Immunology, Palermo, Italy
| | - H Hein
- Sleep Disorders Center, St. Adolf Stift, Reinbeck, Germany
| | - R Staats
- Department of Respiratory Medicine, Hospital de Santa Maria, Lisbon, Portugal
| | - I Bouloukaki
- Sleep Disorders Unit, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | - G Roisman
- Sleep Disorders Center, Antoine-Beclere Hospital, Clamart, France
| | - A Pataka
- Respiratory Failure Unit, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - P Sliwinski
- 2nd Department of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - O Ludka
- Department of Cardiology, University Hospital Brno, Brno, Czech Republic.,International Clinical Research Center, St. Ann's University Hospital, Brno, Czech Republic
| | - J L Pepin
- INSERM U1042, CHU de Grenoble, Université Grenoble Alpes, Grenoble, France
| | - L Grote
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Sleep Disorders Center, Pulmonary Department, Sahlgrenska University Hospital, Gothenburg, Sweden
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Zou D, Wennman H, Ekblom Ö, Grote L, Arvidsson D, Blomberg A, Torén K, Bergström G, Börjesson M, Hedner J. Insomnia and cardiorespiratory fitness in a middle-aged population: the swedish cardiopulmonary bioimaging pilot study. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.1241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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15
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Dieltjens M, Verbraecken JA, Hedner J, Vanderveken OM, Steiropoulos P, Kvamme JA, Saaresranta T, Tkacova R, Marrone O, Dogas Z, Schiza S, Grote L, Steiropoulos P, Verbraecken J, Petiet E, Trakada G, Montserrat J, Fietze I, Penzel T, Ludka O, Rodenstein D, Masa J, Bouloukaki I, Schiza S, Kent B, McNicholas W, Ryan S, Riha R, Kvamme J, Schulz R, Grote L, Hedner J, Zou D, Pépin J, Levy P, Bailly S, Lavie L, Lavie P, Hein H, Basoglu O, Tasbakan M, Varoneckas G, Joppa P, Tkacova R, Staats R, Barbé F, Lombardi C, Parati G, Drummond M, van Zeller M, Bonsignore M, Marrone O, Escourrou P, Roisman G, Pretl M, Vitols A, Dogas Z, Galic T, Pataka A, Anttalainen U, Saaresranta T, Sliwinski P, Plywaczewski R, Bielicki P, Zielinski J. Use of the Clinical Global Impression scale in sleep apnea patients – Results from the ESADA database. Sleep Med 2019; 59:56-65. [DOI: 10.1016/j.sleep.2018.10.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/16/2018] [Accepted: 10/18/2018] [Indexed: 12/20/2022]
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Anttalainen U, Grote L, Fietze I, Riha RL, Ryan S, Staats R, Hedner J, Saaresranta T. Insomnia symptoms combined with nocturnal hypoxia associate with cardiovascular comorbidity in the European sleep apnea cohort (ESADA). Sleep Breath 2018; 23:805-814. [PMID: 30467691 PMCID: PMC6700053 DOI: 10.1007/s11325-018-1757-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/01/2018] [Accepted: 11/13/2018] [Indexed: 01/03/2023]
Abstract
Purpose The aim of the current study was to further investigate the concept of previously reported high occurrence of comorbidities in obstructive sleep patients (OSA) with insomnia-like symptoms. We hypothesized that this finding at least partly is mediated by nocturnal hypoxia. Moreover, we speculated that the spectrum of the clinical OSA phenotypes differs between European geographical regions. Methods Cohort of the European Sleep Apnea Database (n = 17,325; 29.9% females) was divided into five subcohorts according to geographical region (North, East, South, West, Central) and further into four clinical presentation phenotypes based on daytime symptoms (EDS) and characteristics suggestive of insomnia. Results The insomnia phenotype (alone or together with EDS) dominated in all European regions. Isolated insomnia, however, was less common in the West. Insomnia phenotype was associated with the highest proportion of cardiovascular comorbidity (51.7% in the insomnia vs. 43.9% in the EDS type). Measures of nocturnal hypoxemia were independently associated with cardiovascular comorbidity in phenotypes with insomnia-like symptoms. The burden of comorbidities was high across all geographical regions and clinical phenotypes. Regional differences were clinically relevant for age (48 vs. 54 years), BMI (29 vs. 34 kg/m2), and ODI (15 vs. 32/h). Conclusion High prevalence of particularly cardiovascular comorbidity among patients with insomnia-like symptoms was linked to nocturnal hypoxemia. Considerable differences in clinical presentation were found among OSA patients across Europe. Our data underline that physicians should ask their patients with suspected OSA also for insomnia symptoms. It remains to be explored if a reduction of nocturnal hypoxemia predicts the improvement of insomnia symptoms. Electronic supplementary material The online version of this article (10.1007/s11325-018-1757-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ulla Anttalainen
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, P.O. Box 52, SF-20521, Turku, Finland.
- Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland.
| | - L Grote
- Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - I Fietze
- Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Luisenstrasse 13, 101 17, Berlin, Germany
| | - R L Riha
- Department of Sleep Medicine, Royal Infirmary Edinburgh, 51 Little France Crescent EH, Edinburgh, 164 SA, Scotland
| | - S Ryan
- Department of Respiratory Medicine, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - R Staats
- Department of Respiratory Medicine, Hospital de Santa Maria, Lisbon, Portugal
| | - J Hedner
- Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - T Saaresranta
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, P.O. Box 52, SF-20521, Turku, Finland
- Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
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Fricke K, Schneider H, Biselli P, Hansel NN, Zhang ZG, Sowho MO, Grote L. Nasal high flow, but not supplemental O 2, reduces peripheral vascular sympathetic activity during sleep in COPD patients. Int J Chron Obstruct Pulmon Dis 2018; 13:3635-3643. [PMID: 30464446 PMCID: PMC6220426 DOI: 10.2147/copd.s166093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction Patients with COPD have increased respiratory loads and altered blood gases, both of which affect vascular function and sympathetic activity. Sleep, particularly rapid eye movement (REM) sleep, is known to exacerbate hypoxia and respiratory loads. Therefore, we hypothesize that nasal high flow (NHF), which lowers ventilatory loads, reduces sympathetic activity during sleep and that this effect depends on COPD severity. Methods We performed full polysomnography in COPD patients (n=17; FEV1, 1.6±0.6 L) and in matched controls (n=8). Participants received room air (RA) at baseline and single night treatment with O2 (2 L/min) and NHF (20 L/min) in a random order. Finger pulse wave amplitude (PWA), a measure of vascular sympathetic tone, was assessed by photoplethysmography. Autonomic activation (AA) events were defined as PWA attenuation ≥30% and indexed per hour for sleep stages (AA index [AAI]) at RA, NHF, and O2). Results In COPD, sleep apnea improved following O2 (REM-apnea hypopnea index [AHI] with RA, O2, and NHF: 18.6±20.9, 12.7±18.1, and 14.4±19.8, respectively; P=0.04 for O2 and P=0.06 for NHF). REM-AAI was reduced only following NHF in COPD patients (AAI-RA, 21.5±18.4 n/h and AAI-NHF, 9.9±6.8 n/h, P=0.02) without changes following O2 (NHF-O2 difference, P=0.01). REM-AAI reduction was associated with lung function expressed as FEV1 and FVC (FEV1: r=−0.59, P=0.001; FEV1/FVC: r=−0.52 and P=0.007). Conclusion NHF but not elevated oxygenation reduces peripheral vascular sympathetic activity in COPD patients during REM sleep. Sympathetic off-loading by NHF, possibly related to improved breathing mechanics, showed a strong association with COPD severity.
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Affiliation(s)
- K Fricke
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA, .,Department for Pulmonary, Sleep, and Intensive Care Medicine, Helios Klinikum, Wuppertal, Germany
| | - H Schneider
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA,
| | - P Biselli
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA, .,Intensive Care Unit, Medical Division, University Hospital, University of Sao Paolo, Sao Paolo, Brazil
| | - N N Hansel
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA,
| | - Z G Zhang
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA, .,Department for Geriatrics, Peking University First Hospital, Beijing, China
| | - M O Sowho
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA,
| | - L Grote
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA, .,Sleep Disorders Center, Department for Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.,Center for Sleep and Wake Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Caylor RC, Grote L, Thiffault I, Farrow EG, Willig L, Soden S, Amudhavalli SM, Nopper AJ, Horii KA, Fleming E, Jenkins J, Welsh H, Ilyas M, Engleman K, Abdelmoity A, Saunders CJ. Incidental diagnosis of tuberous sclerosis complex by exome sequencing in three families with subclinical findings. Neurogenetics 2018; 19:205-213. [PMID: 29926239 DOI: 10.1007/s10048-018-0551-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/12/2018] [Accepted: 06/13/2018] [Indexed: 12/19/2022]
Abstract
Tuberous sclerosis complex (TSC) is an autosomal-dominant neurocutaneous disorder characterized by lesions and benign tumors in multiple organ systems including the brain, skin, heart, eyes, kidneys, and lungs. The phenotype is highly variable, although penetrance is reportedly complete. We report the molecular diagnosis of TSC in individuals exhibiting extreme intra-familial variability, including the incidental diagnosis of asymptomatic family members. Exome sequencing was performed in three families, with probands referred for epilepsy, autism, and absent speech (Family 1); epileptic spasms (Family 2); and connective tissue disorders (Family 3.) Pathogenic variants in TSC1 or TSC2 were identified in nine individuals, including relatives with limited or no medical concerns at the time of testing. Of the nine individuals reported here, six had post-diagnosis examinations and three met clinical diagnostic criteria for TSC. One did not meet clinical criteria for a possible or definite diagnosis of TSC, and two had only a possible clinical diagnosis following post-diagnosis workup. These individuals as well as their mothers demonstrated limited features that would not raise concern for TSC in the absence of molecular results. In addition, three individuals exhibited epilepsy with normal brain MRIs, and two without seizures or intellectual disability had MRI findings fulfilling major criteria for TSC highlighting the difficulty providers face when relying on clinical criteria to guide genetic testing. Given the importance of a timely TSC diagnosis for clinical management, such cases demonstrate a potential benefit for clinical criteria to include seizures and an unbiased molecular approach to genetic testing.
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Affiliation(s)
- R C Caylor
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
| | - L Grote
- Division of Clinical Genetics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
- Department of Pediatrics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
| | - I Thiffault
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
- Center for Pediatric Genomic Medicine, Children's Mercy Hospitals, 2420 Pershing Rd., Kansas City, MO, 64108, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, 64108, USA
| | - E G Farrow
- Department of Pediatrics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
- Center for Pediatric Genomic Medicine, Children's Mercy Hospitals, 2420 Pershing Rd., Kansas City, MO, 64108, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, 64108, USA
| | - L Willig
- Department of Pediatrics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
- Center for Pediatric Genomic Medicine, Children's Mercy Hospitals, 2420 Pershing Rd., Kansas City, MO, 64108, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, 64108, USA
- Division of Nephrology, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
| | - S Soden
- Department of Pediatrics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
- Center for Pediatric Genomic Medicine, Children's Mercy Hospitals, 2420 Pershing Rd., Kansas City, MO, 64108, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, 64108, USA
| | - S M Amudhavalli
- Division of Clinical Genetics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
- Department of Pediatrics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, 64108, USA
| | - A J Nopper
- Department of Pediatrics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, 64108, USA
- Division of Dermatology, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
| | - K A Horii
- Department of Pediatrics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, 64108, USA
- Division of Dermatology, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
| | - E Fleming
- Division of Clinical Genetics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
- Department of Pediatrics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
| | - J Jenkins
- Division of Clinical Genetics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
- Department of Pediatrics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
| | - H Welsh
- Division of Clinical Genetics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
- Department of Pediatrics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
| | - M Ilyas
- Department of Pediatrics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, 64108, USA
- Division of Neurology, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
| | - K Engleman
- Division of Clinical Genetics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
- Department of Pediatrics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
| | - A Abdelmoity
- Department of Pediatrics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, 64108, USA
- Division of Neurology, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
| | - C J Saunders
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospitals, Kansas City, MO, 64108, USA.
- Center for Pediatric Genomic Medicine, Children's Mercy Hospitals, 2420 Pershing Rd., Kansas City, MO, 64108, USA.
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, 64108, USA.
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Herkenrath SD, Treml M, Grote L, Hedner J, Sommermeyer D, Ficker JH, Nilius G, Randerath WJ. Prospektive Studie zum Einfluss der CPAP-Therapie bei Schlafapnoe auf einzelne Parameter der nächtlichen Pulswelle. Pneumologie 2018. [DOI: 10.1055/s-0037-1619316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- SD Herkenrath
- Institut für Pneumologie an der Universität zu Köln; Klinik für Lungen- und Bronchialerkrankungen, Krankenhaus Bethanien gGmbH
| | - M Treml
- Institut für Pneumologie an der Universität zu Köln
| | - L Grote
- Dept. of Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - J Hedner
- Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - D Sommermeyer
- Fakultät für Informationstechnik, Hochschule Mannheim
| | - JH Ficker
- Südmedizinische Klinik III, Paracelsus Medizinische Privatuniversität Nürnberg, Klinikum Nürnberg
| | - G Nilius
- Helios-Klinik Hagen Ambrock, Universität Witten/Herdecke
| | - WJ Randerath
- Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Krankenhaus Bethanien GmbH
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Värri AO, Grote L, Penzel T, Cassel W, Peter JH, Hasan J. A New Method to Study Blood Pressure, Heart Rate and EEG as a Function of Reaction Time. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1634960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Abstract:A new method is presented to study the relationship between reaction time and blood pressure, heart rate and EEG. The method consists of a simultaneous recording of continuous invasive or non-invasive arterial blood pressure, ECG, EEG, EMG and EOG in a sound-isolated chamber while a monotonous visual reaction time test is running for about 90 minutes. The signals are A/D-converted and analyzed digitally after recording. One second average amplitudes are computed. Systolic, mean and diastolic blood pressure values are calculated, and the EEG is divided into the delta, theta, alpha, sigma and beta frequency bands. The signal amplitudes are averaged in three different reaction time categories, i. e., when the reaction is normal, delayed or missing. Preliminary tests suggest that interesting differences can be observed in the studied variables in different reaction time classes. This method can also be applied to the investigation of autonomic control and to treatment studies.
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Siedler R, Grote L, Kauert E, Werner U, Bittrich HJ. Zur Thermodynamik der binären Systeme von Benzol mit Diäthylamin und Triäthylamin. ACTA ACUST UNITED AC 2017. [DOI: 10.1515/zpch-1969-24127] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kent BD, Gildeh N, Drakatos P, Grote L, Hedner J, McNicholas WT. S22 Severity of sleep disordered breathing independently predicts metabolic dysfunction in a large population of severely obese subjects: the esada study. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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23
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Dimopoulos MA, Petrucci MT, Foà R, Catalano J, Kropff M, Terpos E, Zhang J, Grote L, Jacques C, Palumbo A. Impact of maintenance therapy on subsequent treatment in patients with newly diagnosed multiple myeloma: use of "progression-free survival 2" as a clinical trial end-point. Haematologica 2015; 100:e328-30. [PMID: 25840600 PMCID: PMC5004436 DOI: 10.3324/haematol.2014.120790] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
| | | | | | - John Catalano
- Frankston Hospital, Monash University, Victoria, Australia
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Stehlik R, Ulfberg J, Hedner J, Grote L. High prevalence of restless legs syndrome among women with multi-site pain: a population-based study in Dalarna, Sweden. Eur J Pain 2014; 18:1402-9. [PMID: 24700622 DOI: 10.1002/ejp.504] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND The chronic pain (CP) and chronic multi-site pain (CMP) condition is a highly prevalent health problem. Several studies have reported a high (31-64%) prevalence of co-morbid restless legs syndrome (RLS) in patients with fibromyalgia, one specifically defined form of chronic widespread pain. The current study explored the association between CMP and RLS. METHOD The study included 4040 respondents to a postal questionnaire sent to 10,000 women in the age range of 18-64 years and randomly selected from the general population. Complete questionnaire data on type (acute/chronic), degree (mild to severe) and spreading (0-5 body zones) of pain, as well as RLS symptoms (validated questionnaire), were obtained from 3060 subjects. Information on lifestyle, anthropometrics, co-morbidities and medication was collected. RESULTS RLS prevalence increased from 9.6% in subjects with no report of pain to 23,9%, 26.4%, 39.2%, 44.9% and 54.8% in those reporting one, two, three, four and five pain areas, respectively (p < 0.001). Further, RLS prevalence increased from 9.6% (no pain) to 27.9%, 37.9% and 42.4% in subjects with mild, moderate and severe chronic pain (p < 0.001). Multi-site pain, pain localized in the leg, extended pain duration and co-morbid psychiatric disorder were all independently associated with a RLS diagnosis in a multiple regression analysis. CONCLUSION The prevalence of RLS increased progressively with pain severity and even more sharply with the degree of pain spreading in women recruited from the general population. Both acute and chronic pain was associated with RLS-related symptoms.
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Affiliation(s)
- R Stehlik
- Pain Center, Skonvik Medical Rehabilitation Clinic, Säter, Sweden; Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Sweden
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Eskandari D, Zou D, Karimi M, Stenlof K, Grote L, Hedner J. Zonisamide reduces obstructive sleep apnoea: a randomised placebo-controlled study. Eur Respir J 2014; 44:140-9. [DOI: 10.1183/09031936.00158413] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Treml M, Grote L, Hedner J, Sommermeyer D, Ficker JH, Fietze I, Penzel T, Sanner B, Priegnitz C, Randerath WJ. Einfluss der CPAP-Therapie bei Schlafapnoepatienten auf einzelne Parameter der nächtlichen Pulswellenanalyse. Pneumologie 2014. [DOI: 10.1055/s-0034-1367936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Trenkwalder C, Benes H, Garcia-Borreguero D, Grote L, Hopp M, Kohnen R. Opioid treatment is efficacious in the short- and long-term in patients with severe restless legs syndrome after failure of previous medications. Sleep Med 2013. [DOI: 10.1016/j.sleep.2013.11.699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Trenkwalder C, Benes H, Grote L, Högl B, Winkelmann J, Allen R, Hopp M, Bosse B, Kohnen R. Opioid treatment is effective in patients with severe RLS after failure of previous medications —/INS; Results of a 1-year study. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Karimi M, Hedner J, Grote L. Erratum to: Is a polysomnographic recording prior to MSLT worth the effort? Somnologie 2012. [DOI: 10.1007/s11818-012-0585-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Grote L, Sommermeyer D, Zou D, Eder DN, Ficker JH, Randerath WJ, Penzel T, Sanner B, Hedner J. Can a composite analysis of autonomic and vascular signals predict cardiovascular risk? – The ASI approach. Pneumologie 2012. [DOI: 10.1055/s-0032-1302793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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31
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Karimi M, Hedner J, Grote L. Is a polysomnographic recording prior to MSLT worth the effort? Somnologie 2011. [DOI: 10.1007/s11818-011-0534-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hedner J, Grote L, Bonsignore M, McNicholas W, Lavie P, Parati G, Sliwinski P, Barbe F, De Backer W, Escourrou P, Fietze I, Kvamme JA, Lombardi C, Marrone O, Masa JF, Montserrat JM, Penzel T, Pretl M, Riha R, Rodenstein D, Saaresranta T, Schulz R, Tkacova R, Varoneckas G, Vitols A, Vrints H, Zielinski J. The European Sleep Apnoea Database (ESADA): report from 22 European sleep laboratories. Eur Respir J 2011; 38:635-42. [DOI: 10.1183/09031936.00046710] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Zou D, Grote L, Eder D, Radlinski J, Peker Y, Hedner J. 303 PERIPHERAL VASOCONSTRICTION AND NOCTURNAL BLOOD PRESSURE CONTROL IN HYPERTENSIVE SLEEP APNEA PATIENTS. Sleep Med 2009. [DOI: 10.1016/s1389-9457(09)70305-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Grote L. Erfahrungen mit dem peroralen Diabetespräparat Anticoman. Dtsch Med Wochenschr 2009. [DOI: 10.1055/s-0028-1124876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Grote L. Wirkungen der Fastenbehandlung. Dtsch Med Wochenschr 2009. [DOI: 10.1055/s-0028-1123222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Alonderis A, Barbé F, Bonsignore M, Calverley P, De Backer W, Diefenbach K, Donic V, Fanfulla F, Fietze I, Franklin K, Grote L, Hedner J, Jennum P, Krieger J, Levy P, McNicholas W, Montserrat J, Parati G, Pascu M, Penzel T, Riha R, Rodenstein D, Sanna A, Schulz R, Sforza E, Sliwinski P, Tomori Z, Tonnesen P, Varoneckas G, Zielinski J, Kostelidou K. Medico-legal implications of sleep apnoea syndrome: Driving license regulations in Europe. Sleep Med 2008; 9:362-75. [PMID: 17765641 DOI: 10.1016/j.sleep.2007.05.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2007] [Revised: 05/09/2007] [Accepted: 05/13/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sleep apnoea syndrome (SAS), one of the main medical causes of excessive daytime sleepiness, has been shown to be a risk factor for traffic accidents. Treating SAS results in a normalized rate of traffic accidents. As part of the COST Action B-26, we looked at driving license regulations, and especially at its medical aspects in the European region. METHODS We obtained data from Transport Authorities in 25 countries (Austria, AT; Belgium, BE; Czech Republic, CZ; Denmark, DK; Estonia, EE; Finland, FI; France, FR; Germany, DE; Greece, GR; Hungary, HU; Ireland, IE; Italy, IT; Lithuania, LT; Luxembourg, LU; Malta, MT; Netherlands, NL; Norway, EC; Poland, PL; Portugal, PT; Slovakia, SK; Slovenia, SI; Spain, ES; Sweden, SE; Switzerland, CH; United Kingdom, UK). RESULTS Driving license regulations date from 1997 onwards. Excessive daytime sleepiness is mentioned in nine, whereas sleep apnoea syndrome is mentioned in 10 countries. A patient with untreated sleep apnoea is always considered unfit to drive. To recover the driving capacity, seven countries rely on a physician's medical certificate based on symptom control and compliance with therapy, whereas in two countries it is up to the patient to decide (on his doctor's advice) to drive again. Only FR requires a normalized electroencephalography (EEG)-based Maintenance of Wakefulness Test for professional drivers. Rare conditions (e.g., narcolepsy) are considered a driving safety risk more frequently than sleep apnoea syndrome. CONCLUSION Despite the available scientific evidence, most countries in Europe do not include sleep apnoea syndrome or excessive daytime sleepiness among the specific medical conditions to be considered when judging whether or not a person is fit to drive. A unified European Directive seems desirable.
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Affiliation(s)
- A Alonderis
- Institute of Psychophysiology and Rehabilitation, Palanga, Lithuania
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Eder D, Zou D, Grote L, Hedner J. O0071 Impaired attentional alerting in untreated sleep related disordered breathing. Sleep Med 2007. [DOI: 10.1016/s1389-9457(07)70250-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Dursunoglu N, Grote L, Becker H, Hedner J, Peter J. L0059 Menopause and cardiovascular risk factors in sleep apnea. Sleep Med 2007. [DOI: 10.1016/s1389-9457(07)70426-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Grote L, Zou D, Radlinski J, Eder D, Hedner J. O0061 Nocturnal heart rate entropy is related to daytime blood pressure. Sleep Med 2007. [DOI: 10.1016/s1389-9457(07)70243-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ulfberg J, Leissner L, Grote L, Hedner J. S12.C Beneficial effects of iron sucrose in restless legs syndrome; a randomised, double-blind, placebo-controlled comparison. One year follow-up. Sleep Med 2007. [DOI: 10.1016/s1389-9457(07)70058-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Peker Y, Svensson J, Hedner J, Grote L, Johannsson G. Sleep apnoea and quality of life in growth hormone (GH)-deficient adults before and after 6 months of GH replacement therapy. Clin Endocrinol (Oxf) 2006; 65:98-105. [PMID: 16817827 DOI: 10.1111/j.1365-2265.2006.02555.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the sleep architecture and breathing as well as quality of life (QoL) in adults with GH deficiency (GHD) before and 6 months after GH replacement therapy. DESIGN A prospective observational study. PATIENTS Nineteen consecutive adults with GHD (11 men, eight women; mean age 53, range 21-73 years) were studied. MEASUREMENTS An overnight sleep study was performed and the Minor Symptom Evaluation Profile (MSEP), Functional Outcome of Sleep Questionnaire (FOSQ), Short Form 36 (SF-36) and Epworth Sleepiness Scale (ESS) questionnaires were applied at baseline and after the treatment period. RESULTS For the whole group, there were no significant changes in mean total sleep time (TST; 370 min vs. 374 min), proportion of slow-wave sleep (SWS; 17.8%vs. 18.4%) and rapid eye movement (REM) sleep (12.1%vs. 13.9%) on GH replacement. Mean apnoea-hypopnoea index (AHI) was high and remained unchanged (28.2/h before vs. 28.0/h following GH replacement). Twelve patients (63%) were found to have obstructive sleep apnoea (OSA; AHI >or= 10/h) at baseline. Compared with GH-deficient patients without OSA (AHI 3.9/h), the OSA patients (AHI 42.4/h) had less SWS (11.4%vs. 28.6%, P = 0.010) and REM sleep (10.1%vs. 15.5%, P = 0.036). A marginal increase was observed in REM sleep time (10.1% before vs. 12.7% after GH; P = 0.048) while SWS was unchanged in this group. Moreover, MSEP for General Well-being and Responsiveness, FOSQ scores for General Productivity, Activity Level and Vigilance as well as SF-36 domains for Vitality and Mental Health were improved. CONCLUSIONS Contrary to some previous observations in a smaller group of patients, our data suggest that GH therapy does not induce or aggravate OSA in GH-deficient adults. Moreover, GH therapy may improve some of the QoL dimensions in these patients.
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Affiliation(s)
- Y Peker
- Sleep Medicine Unit, Department of Neurorehabilitation, Skaraborg Hospital, Skoevde, Sweden.
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Hedner J, Bengtsson-Boström K, Peker Y, Grote L, Råstam L, Lindblad U. Hypertension prevalence in obstructive sleep apnoea and sex: a population-based case-control study. Eur Respir J 2006; 27:564-70. [PMID: 16507857 DOI: 10.1183/09031936.06.00042105] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Obstructive sleep apnoea (OSA) is a recognised risk factor for hypertension (HT). The current authors investigated confounders of this association in a sex-balanced community-based sample of patients with HT (n=161) from the Skaraborg Hypertension and Diabetes Project (n=1,149) and normotensive controls (n=183) from an age and sex stratified community-based population sample (n=1,109). All participants underwent ambulatory home polysomnography. Severe OSA (apnoea-plus-hypopnoea index (AHI)>or=30 events.h-1) was found in 47 and 25% of hypertensive and normotensive males, respectively. The corresponding numbers in females were 26 and 24%, respectively. The odds ratio (OR) for HT increased across AHI tertiles from 1.0 to 2.1 (95% confidence interval: 0.9-4.5) and 1.0 to 3.7 (95% CI: 1.7-8.2) in males, but not in females where the OR increased from 1.0 to 1.8 (95% CI: 0.8-3.9) and 1.0 to 1.6 (95% CI: 0.7-3.5). Regression analysis correcting for age, body mass index (or waist-hip ratio) and smoking did not eliminate the association between OSA and HT in males. The present data suggest that obstructive sleep apnoea is highly prevalent in both the general population and in patients with known hypertension. The contribution of obstructive sleep apnoea to hypertension risk may be sex dependent and higher in males than in females.
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Affiliation(s)
- J Hedner
- Sleep Laboratory, Department of Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Abstract
The clinical importance of circadian biological rhythms has been strengthened by a number of studies showing a circadian distribution of cardiovascular events like myocardial infarction, stroke, complex arrhythmia, or sudden cardiac death. Incidence of diseases showed a maximum during the early morning hours after awakening from sleep. In addition, a number of pathophysiological mechanisms has been identified to coincide with this peak including blood pressure and heart rate surges, decreased endothelial dilatory capacity of peripheral and coronary arteries, enhanced sympathetic activity, decreased cardiac electrical stability, and increased platelet aggregation. This time window of high risk for the incidence of cardiovascular events has been identified as a target for new treatment and prevention strategies including new release forms of antihypertensive and coronary-dilatory drugs. The use of melatonin as an antihypertensive drug has been successfully explored and opens new opportunities for the management of cardiovascular dysfunction and disease from a circadian perspective.
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Affiliation(s)
- L Grote
- Sleep Disorders Center, Department of Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Heitmann J, Ehlenz K, Penzel T, Becker HF, Grote L, Voigt KH, Peter JH, Vogelmeier C. Sympathetic activity is reduced by nCPAP in hypertensive obstructive sleep apnoea patients. Eur Respir J 2004; 23:255-62. [PMID: 14979500 DOI: 10.1183/09031936.04.00015604] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is increasing evidence that nasal continuous positive airway pressure (nCPAP) lowers blood pressure in obstructive sleep apnoea (OSA) patients, not only during sleep but also in the daytime. However, both the mechanisms of blood pressure reduction and the considerable differences in the magnitude of the effect in the studies presented to date are not fully understood. Therefore, the authors prospectively studied the effect of nCPAP on noradrenaline plasma levels (NApl), blood pressure and heart rate (HR) in 10 normotensive and eight hypertensive OSA patients before and after 41.6 +/- 16.9 days of nCPAP therapy. Polysomnography and invasive blood pressure were continuously monitored over 24 h in the supine position before and with nCPAP. NApl were analysed every 15 min. In hypertensives, nCPAP reduced NApl by 36 +/- 25%, lowered mean arterial blood pressure substantially (night-time: -8.89 +/- 14.09 mmHg; daytime: -7.94 +/- 10.47 mmHg) and decreased HR by 6.6 +/- 5.4 beats x min(-1), whereas in normotensives there were only minor changes. The decrease in heart rate was associated with a decrease in mean arterial blood pressure and noradrenaline plasma levels, suggesting a causal effect of nasal continuous positive airway pressure therapy. This nasal continuous positive airway pressure effect occurs mainly in hypertensive obstructive sleep apnoea patients, whereas the effect is small in normotensives. This may explain, at least in part, some of the discrepant results in previous treatment studies.
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Affiliation(s)
- J Heitmann
- Sleep Laboratory, Division of Pulmonary Diseases, Dept of Internal Medicine, Marburg University, Germany.
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Grote L. Stroke alert: sleep disordered breathing predicts survival? Eur Respir J 2004; 24:195-6. [PMID: 15332383 DOI: 10.1183/09031936.04.00055704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
There is increasing epidemiological and experimental evidence that Sleep Disordered Breathing (SDB) is associated with cardiovascular disease such as hypertension, ischaemic heart disease, heart failure and stroke. Due to the high prevalence of SDB in the general population (5% to 10%) there is increasing demand for cost-effective and reliable diagnostic tools for the assessment of cardiovascular function during sleep in patients with SDB. The first part of this review focuses on our present knowledge about the association between SDB and cardiovascular disease. In the second part various methods for the assessment of cardiac function, blood pressure, sympathetic activity, as well as vascular and cerebrovascular function in patients with SDB are discussed. Current developments such as ECG analysis for SDB screening or arterial tonometry are introduced. Further improvements in the diagnostic tools for the investigation of cardiovascular function in patients with SDB may to advantage be coupled with epidemiological studies. This approach may demonstrate the predictive value or superiority of a specific diagnostic parameter in the diagnosis of SDB and its cardiovascular consequences.
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Affiliation(s)
- L Grote
- Sleep Disorders Center, Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Abstract
Sleep apnoea (SA) is a common sleep disorder affecting 4 to 25% of the adult population. The most common form, obstructive SA, is characterised by recurrent upper airway obstruction during sleep associated with sleep disruption and hypoxaemia. There is increasing evidence that SA leads to impaired vigilance, quality of life, driving accidents and probably represents a vascular disease risk factor. Currently, the most effective treatments are aimed at increasing upper airway space by either air pressure [(continuous positive airway pressure (CPAP)], upper airway surgery or oral appliances. CPAP is the main treatment modality for moderate to severe SA but noncompliance approaches 50% in clinic populations. A number of pharmacological agents have been used in SA but at this stage, none are indicated in moderate to severe SA.
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Affiliation(s)
- R R Grunstein
- Centre for Respiratory Failure and Sleep Disorders, Royal Prince Alfred Hospital and University of Sydney, Australia.
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