Background: Geriatric impairments and obstructive sleep apnea (OSA) are prevalent among patients with atrial fibrillation (AF) and adversely impact patient’s long-term outcomes. Little is known, however, about the association between OSA and frailty, cognitive performance, and AF-related quality of life in older men and women with AF. Objective: To examine the association of OSA with frailty, cognitive performance, and AF- related quality of life among older adults with AF. Methods: Data from the Systemic Assessment of Geriatrics Elements-AF study were used which includes participants ≥ 65 years with AF and a CHA2DS2-VASc ≥ 2. Multivariable adjusted logistic regression models were used to examine the association between OSA, as measured by the STOP-BANG questionnaire, and geriatric impairments including frailty, cognitive performance, and AF-related quality of life. Results: A total of 970 participants with AF (mean age 75 years, 51% male) were included in the analysis. Among the 680 participants without a medical history of OSA, 179 (26%) participants had low risk of OSA, 360 (53%) had an intermediate risk, and 141 participants (21%) had a high risk for OSA. Compared to those with low risk of OSA, those at intermediate or high risk for OSA were significantly more likely to be frail (aOR= 1.66, 95% CI: 1.08–2.56; aOR= 3.00, 95% CI: 1.69-5.32, respectively) after adjusting for sociodemographic, clinical, and health behavioral variables. Risk of OSA was not associated with cognitive performance and AF- related quality of life after adjusting for several potentially confounding factors. Conclusions: Older adults with AF who are at intermediate or high risk for OSA have a greater likelihood of being frail. Our findings identify a group of patients at high risk who would benefit from early screening for OSA. Future longitudinal studies are needed to assess the effect of OSA treatment on frailty, physical functioning, and QoL among patients with AF.

Abstract In Finland, the costs of stroke are approximately 1.1 billion euros annually due to long disability and hospitalization episodes. Sleep apnea is a risk factor for stroke. The prevalence of sleep apnea among stroke patients is unknown because sleep recording is not usually performed on stroke patients. There are no previous studies investigating the association of thrombolysis on the prognosis of sleep apnea. The relation between sleep apnea and cardiovascular events is still unclear. In this prospective, observational study, I recruited voluntary, consecutive ischemic stroke patients over the age of 18 years who were or were not eligible for thrombolysis treatment. The investigators did not affect the treatment and patients were not randomized to thrombolysis. The final analysis included 204 patients; of these, 110 underwent thrombolysis therapy and 94 were treated without thrombolysis. Cardiorespiratory polygraphy was carried out with a portable three-channel device (ApneaLinkPlus™, Resmed, Sydney, Australia) at the ward within 48 hours after the onset of stroke symptoms. The cardiorespiratory polygraphy was repeated at home after a six-month follow-up. Both automatic scoring and manual scoring pointed out excellent agreement in arterial oxyhemoglobin decrease of > 4% (ODI4), lowest arterial oxyhemoglobin saturation (SaO2) or percentage of time spent below 90 percent saturation. The automated scoring underestimated the severity of sleep apnea, recognized poorly the type of event, and missed 18.6% of sleep apnea diagnoses. The total prevalence of sleep apnea in this study was 91.2% on admission to hospital. The stroke patients treated with thrombolysis had more, and more severe sleep apnea in the first sleep recording compared to those without thrombolysis therapy. After follow-up, the prevalence of sleep apnea still remained high, and sleep apnea was aggravated in two thirds of the stroke patients. The study patients without thrombolysis treatment had six-fold higher risk for incident sleep apnea after the follow-up. The stroke patients with thrombolysis therapy and visible stroke on CT had more nocturnal hypoxemia and higher obstructive apnea index than the patients without stroke lesion on follow-up CT 24 hours after thrombolysis treatment. The larger the ischemic stroke volume, the greater the time spent with saturation below 90%. / Tiivistelmä Aivoinfarkti on yleinen ja kansanterveydellisesti sekä taloudellisesti merkittävä sairaus, jonka aiheuttamat kustannukset Suomessa ovat noin 1.1 miljardia euroa pitkistä työkyvyttömyys- ja sairaalajaksoista johtuen. Uniapnea on aivoinfarktille altistava tekijä. Uniapnean esiintyvyys suomalaisilla aivoinfarktipotilailla ei ole arvioitavissa, koska aivoinfarktin sairastaneille ei yleensä tehdä unirekisteröintiä. Kannettavat yöpolygrafialaitteet saattaisivat olla vaihtoehto aivoinfarktipotilaiden uniapnean diagnosoinnille. Tutkittua tietoa liuotushoidon yhteydestä uniapnean ennusteeseen ei ole. Uniapnean sekä sydän- ja verisuonitapahtumien syy-yhteys on edelleen epäselvä. Rekrytoin prospektiiviseen tutkimukseeni vapaaehtoisia, peräkkäisiä yli 18-vuotiaita iskeemiseen aivoinfarktiin sairastuneita liuotushoidettuja ja liuotushoitoon soveltumattomia potilaita. Tutkimuksen lopullinen potilasmäärä oli 204, joista 110 sai liuotushoidon ja 94 hoidettiin ilman liuotusta. Kaikille potilaille tehtiin yöpolygrafia kannettavalla, kolmikanavaisella yöpolygrafialaitteella (Apnealink Plus, Resmed, Sydney, Australia) osastolla 48 tunnin kuluessa sairastumisesta. Yöpolygrafia toistettiin potilaan kotona kuuden kuukauden kuluttua. Sekä automaattitulos että manuaalisesti arvioitu unirekisteröintitulos olivat erittäin yhteneväisiä, kun arvion kohteena olivat happikyllästeisyyden neljän prosenttiyksikön suuruiset pudotukset tuntia kohti, matalin veren happikyllästeisyys tai alle 90 % happikyllästeisyyden osuus yöstä. Automaattianalyysi aliarvioi uniapnean vaikeuden, havaitsi huonosti hengityskatkosten tyypin eikä löytänyt 18,6 prosenttia uniapneadiagnooseista. Uniapnean esiintyvyys koko aineistossa oli sairaalaan tullessa 91,2 %. Liuotushoidetuilla potilailla todettiin ensimmäisessä rekisteröinnissä enemmän uniapneaa ja se oli vaikeampaa kuin ei-liuotushoidetuilla. Seurannassa uniapnean määrä pysyi edelleen korkeana ja uniapnea vaikeutui kahdella potilaalla kolmesta. Liuotushoitoon soveltumattomilla aivoinfarktipotilailla todettiin liuotushoidon saaneisiin verrattuna kuusinkertainen riski sairastua uniapneaan puolen vuoden aikana. Liuotushoidetuilla aivoinfarktipotilailla, joilla oli infarktimuutos kuvantamistutkimuksessa, oli yöllistä valtimoveren happikyllästeisyyden huononemista ja ylähengitysteiden ahtautumisesta johtuvia hengityskatkoksia enemmän kuin niillä potilailla, joilla ei todettu iskeemisiä muutoksia aivokuvantamisessa 24 tuntia liuotushoidon jälkeen. Mitä suurempi aivoinfarktin tilavuus, sitä suuremman osuuden yöstä veren happikyllästeisyys oli alle 90 %.

Commercial vehicle drivers are required to maintain Department Of Transportation medical certification which entails a Commercial Driver Medical Examination (CDME) and optimally leads to a two-year certification. The examination must be performed by a licensed "medical examiner" administered by a variety of health care providers including physicians, advanced registered nurse practitioners, physician assistants and doctors of chiropractic. Unfavorable findings in the examination can yield either a shortened medical certification period or denial of certification. Sleep disorders including sleep apnea are assessed by a single question located in the health history portion of the CDME form which is filled-out by the examinee. A positive response to this single item often prompts the medical examiner to further supplement this question using a subjective questionnaire, such as the Epworth Sleepiness Scale. This particular questionnaire generates a total score based on the examinee's subjective responses to eight items regarding the propensity to doze-off or fall asleep in different scenarios, thus indicating daytime sleepiness. Commercial drivers depend on the medical certification for their livelihood and it is hypothesized that subjective responses regarding daytime sleepiness are distorted in an effort to attain optimal DOT certification.

Nowadays, sleep disorders e.g. sleep apnea —the cessation of airflow at the nose and mouth lasting at least 10 second— are a broadly problem around the world. Direct and indirect costs associated to sleep problems are outsize and the quality of patient life is deteriorated because of it. In addition, Sleep is a fundamental part of everyday life, the lack of it or the poor quality of sleep may lead into the development of important diseases. Sleep studies are usually carried out by specialists by means of polysomnography. Polysomnography is a type of sleep study which is consisting of EEG, EOG, EMG, ECG, respiratory signals and/or many other biosignals which together can be used to determine the state of patient’s sleep and any other issue. Nowadays, visual inspection of these signals forms the “gold standard” in sleep clinics. The cost of monitoring a person overnight, the scarcity of beds available and the uncertainty of whether the results are representative of a normal nights’ sleep means that a move to home diagnostics is likely to be advantageous. Therefore, a necessity for home recorders systems capable of perform this kind of analysis has come out. A state machine based automatic scorer is developed and evaluated in Matlab by using 12 recordings of apnoeic patients from sleep heart health study (SHHS) database. By the analysis of EEG, EOG, EMG, Oxygen saturation (Sao2) and respiratory movements signals, the implemented algorithm is trained and evaluated to detect the five stages of subject’s sleep (Wake, N1, N2, N3, or REM) as well as apnoeic episodes according to guidelines from American Academy of Sleep Medicine (AASM). In the final evaluation of algorithms, the automatic scorer achieved 74±5.27% accuracy for all five stages and Cohen’s kappa of 0.5 for the overall set of 12 patients, being the accuracy better for healthier subjects and reaching in this case 78±4.05%. The analysis of the sleep apnea concluded with a sensitivity of 47.08%, a specificity of 83.38%, and an accuracy of 78.1%. Differences in the performance among patients according to their apnea/hypopnea index were significant.   Key Words: Polysomnography, AASM, Sleep apnea/hypopnea.

Background: Sufficiently long and high-quality sleep is necessary for the daily renewal of brain and cognitive activity as well as for the maintenance of the whole organism. Apnea is defined as complete cessation of respiration or reduction of respiratory flow by more than 90% continuously for at least 10 seconds. The repeated respiratory arrest comes in repeated series. They are caused by episodes of upper airway obstruction, caused by an increased tendency of the airway walls to collapse. Sleep is an important lifestyle factor that needs to be addressed along with diet and physical activity. Short sleep leads to greater desire for food and sweets high in fat. Aim: The aim of this work was to determine the eating habits of patients with sleep apnea syndrome (OSA) and to compare the data with patients with simple ronchopathy. Methodology: Data collection took place in a specialized ENT clinic for sleep disorders at the University Hospital Ostrava for three months. A questionnaire was completed with newly arrived patients with regard to the eating habits of patients and anthropometric indicators, and physical activity. After that, the patients were clinically examined, and a limited polygraphy was performed, according to which the patients were divided. The collected data were statistically...

Bakgrund: Sömnapné är en vanlig men underdiagnostiserad sjukdom och kännetecknas av upprepade andningsuppehåll under sömnen. Tillståndet förekommer ofta i samvariation med hjärtsjukdom och är ett ökande hälsoproblem. Patienter med hjärtsjukdom finns på alla vårdnivåer inom hälso- och sjukvården varför det är viktigt att sjuksköterskan har kunskap om sömnapné och dess inverkan. Sömnproblematik har beskrivits som en kunskapslucka för sjuksköterskor. Syftet var att beskriva vuxnas erfarenhet av sömnapné och dess inverkan på dagligt liv vid samtidig hjärtsjukdom. Metod som valdes var en litteraturöversikt. Artikelsökningen genomfördes i PubMed samt Cinahl. Arton vetenskapliga artiklar av både kvalitativ samt kvantitativ ansats inkluderades och analyserades med integrerad analys.  Resultatet av litteraturöversikten visade på tre huvudkategorier: Påverkan på vardagen, Påverkan på den psykiska hälsan och Påverkan av otillräcklig kunskap. Det framkom tydligt en negativ påverkan på det dagliga livet främst genom den överdrivna dagsömnigheten. Den störda sömnen påverkade den fysiska, psykiska och sociala funktionen vilket gav en nedsatt livskvalité. Humöret påverkades och depression var vanligt förekommande. Behandling med Continuous Positive Airway Pressure [CPAP] innebar ofta att livskvalitén påverkades positivt. Slutsatsen: Litteraturöversikten visade att vuxna med sömnapné och hjärtsjukdom kunde få en sämre psykisk och fysisk hälsa vilket påverkade det dagliga livet ur flera aspekter.Överdriven sömnighet under dagtid var det mest framträdande symtomet vilket var kopplat till både nedsatt livskvalitet och depression. Resultatet visade att patienterna var omedvetna och hade otillräcklig kunskap kring att deras symtom kunde bero på sömnapné. Det framkom att sömnapné är en mångfasetterad sjukdom som kunde innebära ett lidande för patienten.Ökad kunskap hos sjuksköterskan kan bidra till upptäckt av sömnrelaterade problem hos patienter med hjärtsjukdom. / Background: Sleep apnea is a common but underdiagnosed disease that is characterised by repeated pauses in breathing during sleep. The condition often occurs in association with heart disease and is a growing health problem. Patients with heart disease are present at all levels of care in health care, which is why it is important that the nurse has knowledge of sleep apnea and its effects. Sleep problems have been described as a knowledge gap for nurses.The aim was to describe adults' experience with sleep apnea and its impact on daily life in concomitant heart disease. The method chosen was a literature review. The article search was conducted in PubMed and Cinahl. Eighteen scientific articles of both qualitative and quantitative approach were included and analysed with integrated analysis.The results of the literature review showed three main categories: Impact on everyday life, Impact on mental health and Impact on insufficient knowledge. There was a clear negative impact on daily life, mainly through excessive daytime sleepiness. The disturbed sleepaffected the physical, mental and social function, which resulted in a reduced quality of life. Mood was affected and depression was commonly. Treatment with Continuous Positive Airway Pressure [CPAP] often meant that the quality of life was positively affected. Conclusion: The literature review showed that adults with sleep apnea and heart disease could have poorer mental and physical health, which affected daily life from several aspects. Excessive daytime sleepiness was the most prominent symptom, which was linked to both reduced quality of life and depression. The results showed that the patients were unconscious and had insufficient knowledge that their symptoms could be due to sleep apnea. It turned out that sleep apnea is a multifaceted disease that could cause suffering for the patient. Increased knowledge of the nurse can contribute to the detection of sleep-related problems in patients with heart disease.

Disruption of sleep causes adverse health outcomes and poor quality of life. People with sleep disruption have higher levels than people without disrupted sleep of depression and anxiety and increased rates of cardiovascular diseases. Women have a higher incidence than men of insomnia and depression related to poor sleep. The types of complaints differ significantly between the sexes. Women are more likely than men to complain of insomnia, headache, irritability, and fatigue than the "typical" symptoms of loud snoring and breathing cessation during sleep. Hormones play an important role in sleep in women. Reproductive hormones were found to have a protective effect on sleep apnea in women of premenopausal age. Pregnancy is another period when the prevalence of sleep apnea and restless leg syndrome increases from hormonal effect. Cardiovascular mortality is high in women with obstructive sleep apnea. Continuous positive airway pressure therapy improves outcomes in most cases of obstructive sleep apnea. The epidemiology, risk factors, diagnostic criteria, and therapies for the three most common sleep disorders (insomnia, obstructive sleep apnea, and restless leg syndrome), along with effects of menopause, pregnancy, and social factors on sleep in women, are key considerations for clinicians caring for female patients across the adult life span.

Disruption of sleep causes adverse health outcomes and poor quality of life. People with sleep disruption have higher levels than people without disrupted sleep of depression and anxiety and increased rates of cardiovascular diseases. Women have a higher incidence than men of insomnia and depression related to poor sleep. The types of complaints differ significantly between the sexes. Women are more likely than men to complain of insomnia, headache, irritability, and fatigue than the "typical" symptoms of loud snoring and breathing cessation during sleep. Hormones play an important role in sleep in women. Reproductive hormones were found to have a protective effect on sleep apnea in women of premenopausal age. Pregnancy is another period when the prevalence of sleep apnea and restless leg syndrome increases from hormonal effect. Cardiovascular mortality is high in women with obstructive sleep apnea. Continuous positive airway pressure therapy improves outcomes in most cases of obstructive sleep apnea. The epidemiology, risk factors, diagnostic criteria, and therapies for the three most common sleep disorders (insomnia, obstructive sleep apnea, and restless leg syndrome), along with effects of menopause, pregnancy, and social factors on sleep in women, are key considerations for clinicians caring for female patients across the adult life span.

Previously, we have shown that chronic intermittent hypoxia (CIH) impairs baroreflex control of heart rate and augments aortic baroreceptor afferent function. In the present study, we examined whether CIH induces structural changes of aortic afferent axons and terminals. Young-adult Fischer 344 (F344, 4 months old) rats were exposed to room air (RA) or CIH for 35-45 days. After 14-24 days of exposure, they received tracer DiI injection into the left nodose ganglion to anterogradely label vagal afferent nerves. After surgery, animals were returned to their cages to continue RA or CIH exposure. Twenty-one days after DiI injection, the animals were sacrificed and the aortic arch was examined using confocal microscopy. In both RA and CIH rats, we found that DiI-labeled vagal afferent axons entered the wall of the aortic arch, then fanned out and branched into large receptive fields with numerous terminals (flower-sprays, end-nets and free endings). Vagal afferent axons projected much more to the anterior wall than to the posterior wall. In general, the flower-sprays, end-nets and free endings were widely and similarly distributed in the aortic arch of both groups. However, several salient differences between RA and CIH rats were found. Compared to RA control, CIH rats appeared to have larger vagal afferent receptive fields. The CIH rats had many abnormal flower-sprays, end-nets, and free endings which were intermingled and diffused into "bush-like" structures. However, the total number of flower-sprays was comparable (P>0.05). Since there was a large variance of the size of flower-sprays, we only sampled the 10 largest flower-sprays from each animal. CIH substantially increased the size of large flower-sprays (P<0.01). Numerous free endings with enlarged varicosities were identified, resembling axonal sprouting structures. Taken together, our data indicate that CIH induces significant remodeling of afferent terminal structures in the aortic arch of F344 rats. We suggest that such an enlargement of vagal afferent terminals may contribute to altered aortic baroreceptor function following CIH.

Background/objectives: Patients with obstructive sleep apnea (OSA) have an increased the risk of developing atrial fibrillation (AF). However, it remains unclear if patients with OSA carry a higher risk of recurrent AF after successful catheter ablation. This meta-analysis was conducted (1) to evaluate the association between OSA and recurrent AF after catheter ablation, and (2) to assess the effect of continuous positive airway pressure (CPAP) on the risk of recurrent AF in patients with OSA. Methods: A comprehensive literature review was conducted using MEDLINE, EMBASE, Cochrane databases from inception through July 2017 to identify studies that evaluated the risk of recurrent AF after successful catheter ablation in patients with OSA were included. Effect estimates from the individual study were extracted and combined using random-effect, generic inverse variance method of DerSimonian and Laird. Results: Seven observational studies with a total of 4572 patients AF after successful catheter ablation were enrolled. Compared to patients without OSA, the pooled OR of recurrent AF in patients with OSA was 1.70 (95% CI, 1.40-2.06, I2 = 0). Among OSA patients with AF after successful catheter ablation, the use of CPAP was significantly associated with decreased risk of recurrent AF with pooled OR of 0.28 (0.19-0.40, I2= 0). Egger's regression asymmetry test was performed and showed no publication bias for the associations of OSA and CPAP with recurrent AF. Conclusions: Our meta-analysis suggested a significant association between OSA and recurrent AF after catheter ablation. The use of CPAP in patients with OSA is associated with reduced risk of recurrent AF after catheter ablation.