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  • 1.
    Blomstrand, Peter
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Biomedical Platform.
    Ekedahl, Susanne
    Rosenlund Primary Care Unit, Jönköping, 551 85, Sweden.
    Schmekel, Birgitta
    Division of Clinical Physiology, Department of Medicine and Health, Faculty of Health Sciences, Linköping University; and Department of Clinical Physiology, County Council of Östergötland, Linköping, Sweden.
    Bronchial responsiveness to dry air hyperventilation in smokers may predict decline in airway status using indirect methods2013In: Lung, ISSN 0341-2040, E-ISSN 1432-1750, Vol. 191, no 2, p. 183-190Article in journal (Refereed)
    Abstract [en]

    Background

    Disabling respiratory symptoms and rapid decline of lung function may occur in susceptible tobacco smokers. Bronchial hyperresponsiveness (BHR) elicited by direct challenge methods predicts worse lung function outcomes. The aim of this study was to evaluate whether BHR to isocapnic hyperventilation of dry air (IHDA) was associated with rapid deterioration in airway status and respiratory symptoms.

    Methods

    One hundred twenty-eight smokers and 26 age- and sex-matched healthy individuals with no history of smoking were investigated. All subjects completed a questionnaire. Spirometry and impulse oscillometry (IOS) measurements were recorded before and after 4 min of IHDA. The tests were repeated after 3 years in 102 smokers and 11 controls.

    Results

    Eighty-five smokers (66 %) responded to the challenge with a ≥2.4-Hz increase in resonant frequency (F res), the cutoff limit defining BHR, as recorded by IOS. They had higher F res at baseline compared to nonresponding smokers [12.8 ± 3.2 vs. 11.5 ± 3.4 Hz (p < 0.05)] and lower FEV1 [83 ± 13 vs. 89 ± 13 % predicted (p < 0.05)]. Multivariable logistic regression analysis indicated that wheezing (odds ratio = 3.7, p < 0.01) and coughing (odds ratio = 8.1, p < 0.05) were significantly associated with hyperresponsiveness. An increase in F res was recorded after 3 years in responding smokers but not in nonresponders or controls. The difference remained when subjects with COPD were excluded.

    Conclusions

    The proportion of hyperresponsive smokers was unexpectedly high and there was a close association between wheezing and coughing and BHR. Only BHR could discriminate smokers with rapid deterioration of airway status from others.

  • 2.
    Johansson, Peter
    et al.
    Department of Cardiology, Linköping University, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Department of Cardiology, County Council of Östergötland, 58185, Linköping, Sweden .
    Svensson, Erland
    Swedish Defence Research Agency, 58111, Linköping, Sweden.
    Alehagen, Urban
    Department of Cardiology, Linköping University, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden .
    Dahlström, Ulf
    Department of Cardiology, Linköping University, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden .
    Jaarsma, Tiny
    Department of Social and Welfare Studies, Linköping University, Sweden.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Clinical Neurophysiology, County Council of Östergötland, 58185, Linköping, Sweden .
    Sleep disordered breathing, hypoxia and inflammation: associations with sickness behaviour in community dwelling elderly with and without cardiovascular disease2015In: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 19, no 1, p. 263-271Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Inflammation can induce a cluster of symptoms, referred to as sickness behaviour (e.g., depressive symptoms, sleep disturbances, pain and fatigue). Cardiovascular disease (CVD) and sleep disordered breathing (SDB) are common in older adults. CVD is associated with an increased inflammatory activity and in SDB, hypoxia can also increase inflammation. The purpose of this study is to explore if SDB-related hypoxia is associated differently with inflammation and the presence of sickness behaviour in older adults with and without CVD.

    METHODS:

    Three hundred and thirty-one older adults, whose mean age is 78 years, underwent one-night polygraphic recording to measure SDB and hypoxia. CVD was established by a clinical investigation. Questionnaires were used to measure sickness behaviour and depressive symptoms. High sensitivity C-reactive protein was used as a marker of inflammation.

    RESULTS:

    Structural Equation Modelling showed that SDB-related hypoxia was associated with inflammation (β > 0.40) which mediated indirect associations with sickness behaviour (β = 0.19) and depressive symptoms (β = 0.11), but only in those with CVD (n = 119). In this model, inflammation had a direct effect on sickness behaviour (β = 0.43) and an indirect effect on depressive symptoms (β = 0.24). Hypoxia had the strongest effect (i.e., β = 0.41; significant) on inflammation, whereas the AHI or ODI had weak and non-significant effects (β = 0.03 and β = 0.15).

    CONCLUSIONS:

    Older adults with CVD and SDB are at a particular risk of developing sickness behaviour and depressive symptoms. The effect of SDB was mainly caused by hypoxia, suggesting that hypoxia is an important marker of SDB severity in older adults with CVD.

  • 3.
    Johansson, Peter
    et al.
    Department of Medicine and Health Sciences, Linköping University, Sweden.
    Svensson, Erland
    Swedish Defence Research Agency, Sweden.
    Alehagen, Urban
    Department of Medicine and Health Sciences, Linköping University, Sweden; Department of Cardiology, Linkoping University, Sweden .
    Jaarsma, Tiny
    Department of Cardiology, Linköping University, Sweden.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    The contribution of hypoxia to the association between sleep apnoea, insomnia, and cardiovascular mortality in community-dwelling elderly with and without cardiovascular disease2015In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 14, no 3, p. 222-231Article in journal (Refereed)
    Abstract [en]

    Aims: This study explores if nightly hypoxia (i.e. percentage of sleep time with oxygen saturation lower than 90% (SaO2<90%)) contributed to the association between sleep-disordered breathing (SDB) and insomnia in community-dwelling elderly with and without cardiovascular disease (CVD). A second aim was to explore a potential cut-off score for hypoxia to predict insomnia and the association of the cut-off with clinical characteristics and cardiovascular mortality. Method: A total of 331 community-dwelling elderly aged 71-87 years underwent one-night polygraphic recordings. The presence of insomnia was recorded by a self-report questionnaire. The presence of CVD was objectively established and mortality data were collected after three and six years. Results: In both patients with CVD (n=119) or without CVD (n=212) SDB was associated with hypoxia (p<0.005). Only in the patients with CVD was hypoxia associated with insomnia (p<0.001) which mediated an indirect effect (p<0.05) between SDB and insomnia. Hypoxia of more than 1.5% of sleep time with SaO2<90% was found to be a critical level for causing insomnia. According to this criterion 32% (n=39) and 26% (n=55) of those with and without CVD had hypoxia, respectively. These groups did not differ with respect to age, gender, body mass index, diabetes, hypertension, respiratory disease or levels of SDB. However, in the CVD group, hypoxia was associated with cardiovascular mortality at the three-year follow-up (p=0.008) and higher levels of insomnia (p=0.002). Conclusion: In the elderly with CVD, SDB mediated by hypoxia can be associated with more insomnia and a worse prognosis.

  • 4.
    Ulander, Martin
    et al.
    Linköping University Hospital.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Linköping University Hospital.
    Response to Akar et al., regarding our study "Side effects to continuous positive airway pressure treatment for obstructive sleep apnoea"2015In: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 19, no 4, p. 1345-1345Article in journal (Refereed)
  • 5.
    Ulander, Martin
    et al.
    Department of Clinical Neurophysiology, Linköping University Hospital, 581 85, Linköping, Sweden.
    Johansson, Malin Svensson
    Jönköping University, School of Health and Welfare.
    Ewaldh, Amanda Ekegren
    Jönköping University, School of Health and Welfare.
    Svanborg, Eva
    Department of Clinical Neurophysiology, Linköping University Hospital, 581 85, Linköping, Sweden.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Side effects to continuous positive airway pressure treatment for obstructive sleep apnoea: changes over time and association to adherence2014In: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 18, no 4, p. 799-807Article in journal (Refereed)
    Abstract [en]

    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. 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. 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. 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.

  • 6.
    Wang, Lan
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Nursing, School of Nursing, Tianjin Medical University, Tianjin, People's Republic of China.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Zhao, Yue
    Department of Nursing, School of Nursing, Tianjin Medical University, Tianjin, People's Republic of China.
    Nygårdh, Annette
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Experiences of a health coaching self-management program in patients with COPD: a qualitative content analysis.2018In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 13, p. 1527-1536Article in journal (Refereed)
    Abstract [en]

    Purpose: To describe the experiences of patients with COPD participating in a health coaching self-management program.

    Patients and methods: Twenty patients who had participated in a 6-month health coaching self-management program intervention were purposefully selected for a qualitative evaluation of the program using semi-structured interviews. The interviews were analyzed using inductive qualitative content analysis.

    Results: Four categories and 13 subcategories emerged describing the participants' experiences of the program. Their experiences were expressed as gaining insight into the importance of knowledge and personal responsibilities in the management of COPD, taking action to maintain a healthy lifestyle, feeling supported by the program, and being hindered by individual and program limitations.

    Conclusion: Iterative interactions between patients and health care professionals together with the content of the program are described as important to develop skills to manage COPD. However, in future self-management programs more awareness of individual prerequisites should be considered.

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