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  • 1. Broström, A
    et al.
    Nilsen, P
    Johansson, P
    Ulander, M
    Strömberg, A
    Svanborg, E
    Fridlund, Bengt
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work.
    Putative facilitators and barriers for adherence to CPAP treatment in patients with obstructive sleep apnea syndrome: a qualitative content analysis2010In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 11, no 2, p. 126-130Article in journal (Refereed)
  • 2.
    Hellstrom, A.
    et al.
    Linnaeus Univ, Dept Hlth & Caring Sci, Kalmar, Sweden.
    Hagell, P.
    Kristianstad Univ, Sch Hlth & Soc, PRO CARE Grp, Kristianstad, Sweden.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden.
    Ulander, M.
    Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden.
    Arestedt, K.
    Linnaeus Univ, Dept Hlth & Caring Sci, Kalmar, Sweden.
    Initial psychometric testing of the sleep condition indicator in a Swedish context2017In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 40, no Suppl. 1, p. E129-E130Article in journal (Refereed)
    Abstract [en]

    Introduction: There are several rating scales for insomnia; however, diagnostic criteria have changed over time. This means that the usefulness and validity of earlier scales may be compromised. The Sleep Condition Indicator (SCI) is a recently designed scale, developed in the UK, based on the DSM-V criteria of insomnia. The aim of this study was to translate and psychometrically evaluate the SCI in a Swedish context, focusing on its dimensionality.

    Materials and methods: The SCI consists of eight items with 5 ordered response categories (scored between 0 and 4). A total score between 0 and 32 is calculated; higher score indicates better sleep. The SCI was distributed through a web-questionnaire to university students and 634 completed the questionnaire . First we replicated the methodology used in the original testing of the UK SCI using principal component analysis (PCA) as the extraction method with varimax rotation and Kaisers eigenvalue >1 criterion for determination of the number of factors. We then continued with a more appropriate method for ordinal data, an exploratory factor analysis (EFA), using an unweighted least squares (ULS) extraction method based on a polychoric correlation matrix. Parallel analysis was conducted to determine the number of factors. Internal consistency was estimated using an ordinal version of Cronbach's alpha.

    Results: The PCA suggested a one factor model, with eigenvalues of 5.0 for the 1st and 0.9 for the 2nd factor, explaining 62% of the variance. Loadings varied between 0.62-0.86. With the EFA (ULS), 70% of the variance was explained by the first factor. Factor loadings varied between 0.66 and 0.92. Eigenvalues for factors 1 and 2 were 5.6 and 0.8, respectively. Corresponding 95th percentile eigenvalues from the parallel analysis were 5.3 (1st factor) and 0.4 (2nd factor). Reliability (ordinal alpha) of the total SCI score was 0.94.

    Conclusions: Both models support a unidimensional SCI structure in our sample of university students. This is a prerequisite for the calculation and validity of a total SCI score. In addition, the total score exhibited good reliability. These observations support the psychometric integrity of the Swedish SCI and provide a starting point for further testing.

  • 3.
    Johansson, Peter
    et al.
    Linköping University.
    Alehagen, Urban
    Linköping University.
    Svanborg, Eva
    Linköping University.
    Dahlström, Ulf
    Linköping University.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Sleep disordered breathing in an elderly community-living population: Relationship to cardiac function, insomnia symptoms and daytime sleepiness.2009In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 10, no 9, p. 1005-1011Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe the prevalence of sleep disordered breathing (SDB) and its relationship to systolic function, different insomnia symptoms as well as excessive daytime sleepiness (EDS) in elderly community-living people. This has not been investigated previously.

    METHOD: Three hundred thirty-one subjects (71-87 years) healthy enough to be independently living in their own homes underwent echocardiographic examinations and sleep respiratory recordings. Questionnaires were used to evaluate insomnia symptoms and EDS.

    RESULTS: Mild SDB (AHI 5-15) was found in 32%. Moderate SDB (AHI 15-30) occurred in 16%, and 7% had severe SDB (AHI>30). Median AHI was significantly higher (p<0.001) in those with mildly impaired systolic function (AHI 11.7) and moderately impaired systolic function (AHI 10.9) compared to those with normal systolic function (AHI 5.0). Impaired systolic function was associated with central sleep apnea (CSA) but not with obstructive sleep apnea. Concerning insomnia symptoms and EDS, only difficulties in initiating sleep correlated significantly (p<0.05) with AHI.

    CONCLUSION: SDB is common among the elderly. CSA may be related to impaired systolic function/heart failure. However, detection of SDB in this population may be problematic since insomnia symptoms and EDS correlated poorly with SDB.

  • 4.
    Johansson, Peter
    et al.
    Linköping University.
    Alehagen, Urban
    Linköping University.
    Ulander, Martin
    Linköping University.
    Svanborg, Eva
    Linköping University.
    Dahlström, Ulf
    Linköping University.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Sleep disordered breathing in community dwelling elderly: Associations with cardiovascular disease, impaired systolic function, and mortality after a six-year follow-up2011In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 12, no 8, p. 748-53Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Sleep disordered breathing (SDB), cardiovascular disease (CVD) and impaired cardiac function are common in elderly people. We investigated the association of SDB and mortality in a community dwelling elderly population, considering CVD and objectively measured impaired cardiac function have been poorly studied thus far.

    AIM: To investigate whether SDB is a factor that affects mortality in elderly people, with a focus on those with CVD and/or signs of impaired cardiac function.

    METHODS: A prospective cohort design was used and 331 community dwelling elderly aged 71-87 years underwent one-night polygraphic recordings in the subjects' homes. CVD and systolic function were objectively established. Mortality data were collected after 6 years.

    RESULTS: In the total population there were no significant associations between mortality and SDB. In those with CVD and impaired systolic function, as measured by NT-proBNP, oxygen desaturation index (ODI) ≥10 was associated with mortality. The hazard ratio of 3.0 (CI 95% 1.1-8.6, p=0.03) remained statistically significant after adjustments for age, gender, diabetes and plasma values of NT-proBNP.

    CONCLUSION: SDB in community dwelling elderly has no overall association to mortality irrespective of degree of SDB. However, hypoxic events (i.e., ODI ≥10) were associated with mortality in the group who had CVD in combination with impaired systolic function.

  • 5.
    Lin, Chung-Ying
    et al.
    Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Strong, Carol
    Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
    Siu, Andrew M. H.
    Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Jalilolghadr, Shabnam
    Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    Nilsen, Per
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Pakpour, Amir H.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Validating the Persian Adolescent Sleep Hygiene Scale-Revised (ASHSr) using comprehensive psychometric testing methods2018In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 50, p. 63-71Article in journal (Refereed)
    Abstract [en]

    Background: This study translated the Adolescent Sleep Hygiene Scale-revised (ASHSr) into Persian and aimed to validate its psychometric properties using classical test theory and Rasch analyses.

    Methods: Adolescents aged 14–18 (n = 389; 199 males) and their parents in Iran participated in the study. Each adolescent wore a wrist actigraphy device during sleep time and completed the ASHSr, the Depression Anxiety Stress Scale (DASS), the General Health Questionnaire (GHQ), the Pediatric Daytime Sleepiness Scale (PDSS), and the Pittsburgh Sleep Quality Index (PSQI). A parent of each adolescent completed the Sleep Disturbance Scale for Children (SDSC).

    Results: The construct validity of the ASHSr was supported by both classical test theory (factor loadings from confirmatory factor analysis [CFA] = 0.64 to 0.88; corrected item-total correlations = 0.70 to 0.92; test-retest reliability = 0.72 to 0.90) and Rasch analyses (infit mean square = 0.73 to 1.30; outfit mean square = 0.74 to 1.32). ASHSr had significantly negative associations with DASS subscales (β = −0.15 to −0.42, ps < 0.001) and GHQ (β = −0.663, p < 0.001). Known-group validity was demonstrated by the significant differences between poor and good sleep hygiene based on ASHSr in the actigraphy measure and scores of PDSS, PSQI, and SDSC. The multigroup CFA and differential item functioning in Rasch analyses suggested that all the participants interpreted the ASHSr similarly, regardless of their gender or living in a private room.

    Conclusions: The Persian ASHSr demonstrated good reliability and validity in assessing sleep hygiene among Iranian adolescents. Healthcare providers may use it to assess the effectiveness of sleep hygiene programs.

  • 6.
    Sindi, Shireen
    et al.
    Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Johansson, Lena
    Institute of Neuroscience and Physiology, Center for Health and Ageing AGECAP, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Skoog, Johan
    Institute of Neuroscience and Physiology, Center for Health and Ageing AGECAP, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Mattsson, Alexander Darin
    Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Sjöberg, Linnea
    Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Wang, Hui-Xin
    Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Fratiglioni, Laura
    Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Kulmala, Jenni
    Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.
    Soininen, Hilkka
    Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland.
    Solomon, Alina
    Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.
    Johansson, Boo
    Department of Psychology, Center for Health and Ageing AGECAP, University of Gothenburg, Gothenburg, Sweden.
    Skoog, Ingmar
    Institute of Neuroscience and Physiology, Center for Health and Ageing AGECAP, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Kivipelto, Miia
    Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Sleep disturbances and later cognitive status: a multi-centre study2018In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 52, p. 26-33, article id S1389-9457(17)31603-9Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the associations between sleep disturbances in mid-life and late-life and late-life cognitive status.

    METHODS: In four population-based studies (three Swedish studies: H70 study, Kungsholmen Project (KP) and The Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD); and one Finnish study: Cardiovascular Risk Factors, Aging and Dementia (CAIDE)), participants provided self-reports on insomnia, nightmares and general sleep problems. Late-life cognitive status was measured by the Mini Mental State Exam (MMSE). The associations between late-life sleep disturbances and cognition 3-11 years later were investigated across all studies (n = 3210). Mean baseline ages were 70 (CAIDE, H70 and SWEOLD), and 84 years (KP). Additional analyses examined the association between midlife sleep and late-life cognition using CAIDE (21 and 31 years follow-up, n = 1306, mean age 50 years), and SWEOLD (20-24 years follow-up, n = 2068, mean age 58 years). Ordered logistic regressions, adjusted for potential baseline confounders, were used in the analyses.

    RESULTS: Late-life sleep disturbances were associated with poorer cognition after 3-11 years (fully adjusted β = -0.12, 95% CI = -0.24 to -0.01). Midlife nightmares and insomnia were also associated with lower MMSE scores (fully adjusted β = -0.28, 95% CI = -0.49 to -0.07 and β = -0.20, 95% CI = -0.39 to -0.01), although the latter association was attenuated after adjusting for lifestyle/health-related confounders. Midlife general sleep problems were not associated with late-life MMSE performance.

    CONCLUSIONS: Sleep disturbances and midlife nightmares were associated with lower MMSE scores, which suggests that sleep disturbances in earlier life stages can be associated with worse late-life cognition.

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