Senare års forskning visar på att obstruktivt sömnapnésyndrom, OSAS, är en både underdiagnostiserad och underbehandlad sjukdom. Detta beror delvis på att många personer med OSAS är omedvetna om sitt tillstånd. Sjukdomen innebär återkommande totala andningsuppehåll under sömn och en hypoxi som leder till en rad olika komplikationer, däribland hjärtkärlsjukdomar. Syftet med denna studie var att utreda vad som påverkar OSAS och vilken roll sjuksköterskan kan spela i vården av dessa patienter. Metoden som användes var en litteraturundersökning. Resultatet baseras på tio vetenskapliga artiklar som erhölls genom databaserna PUBMED samt SAMSÖK. Teman som utkristalliserades var sömnposition, kroppsvikt och tandstatus. Trots att behandlingen av OSAS till stor del bygger på medicinska åtgärder visar resultaten i denna litteraturundersökning att sjuksköterskor har en viktig funktion i både upptäckten av nya fall samt i behandlingen. Omvårdnadsåtgärder såsom information om förändrad sömnposition och viktnedgång har visat sig ha signifikant betydelse för obstruktiv andning. / Medical research in recent years has shown that Obstructive Sleep Apnea Syndrome, OSAS, is an affliction for which both diagnosis and treatment are often inadequate. In part, this is due to the fact that many people suffering from OSAS are not aware of the problem. The disease causes recurrent complete stops of breathing during sleep and hypoxia that may bring about various complications, for instance cardiovascular disorders. The purpose of this study, carried out as a literature survey, was to determine what factors affect OSAS and what role the nurse may play in the care of patients suffering from this disease. The survey of the literature by means of the data bases PUBMED and SAMSÖK yielded ten scientific articles showing that although various medical measures constitute the treatment of choice of OSAS the nurse plays an important role in the treatment and the diagnosis of new cases. Preventive care measures such as information about appropriate sleeping positions and reduction of weight have proven to be of significant value in the treatment of OSAS.

京都大学 / 新制・課程博士 / 博士(人間健康科学) / 甲第23574号 / 人健博第94号 / 新制||人健||7(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 任 和子, 教授 木下 彩栄, 教授 平井 豊博 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

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BACKGROUND: Sleep apnea (SA) is a common sleep disorder among US adults. Associations of SA with alcohol consumption and some chronic diseases have been inconsistent. OBJECTIVES: This study aimed to estimate prevalence of SA and examine its associations with potential factors including alcohol consumption, asthma, diabetes, and hypertension. PATIENTS AND METHODS: This was a cross-sectional study on 823 adults with SA and 38,638 controls from the 2011 National Survey on Drug Use and Health Data. Weighted univariate and multiple logistic regression analyses were used to examine the associations of SA with the potential factors. RESULTS: The prevalence of SA was higher in males (4.01%) than in females (2.61%), while the prevalence increased with age (0.86%, 3.50%, and 4.47% for age groups of 18-25, 26-64, and ≥ 65, respectively). Univariate analysis revealed that all factors except for income and education were associated with SA (P < 0.05). In multivariable analyses, participants who were current and past alcohol consumers had significantly higher odds of having SA (OR = 1.52, 95% CI = 1.03-2.23; OR = 1.65, 95% CI = 1.09-2.49, respectively) than non-alcohol drinker. Furthermore, asthma (OR = 2.77, 95% CI = 2.04-3.75), diabetes (OR = 2.89, 95% CI = 2.19-3.83), and hypertension (OR = 2.42, 95% CI = 1.91-3.07) were significantly associated with SA. CONCLUSIONS: Age, alcohol consumption, asthma, diabetes, and hypertension, were positively associated with SA. More efforts should be directed to promoting screening for SA and finding possible treatments for SA among these vulnerable groups.

INTRODUCTION: Several studies identified a link between gastroesophageal reflux disease (GERD) and obstructive sleep apnea (OSA). GERD is a condition in which acid reflux from the stomach to the esophagus causes troublesome symptoms. On the other hand, OSA is defined as a sleep-related breathing disorder in which airflow significantly decreases or ceases due to upper airway obstruction, leading to arousal from sleep. OSA was found to be associated with GERD. In this study, we aim to study the characteristics and concurrent risk factors associated with GERD and OSA in a large population-based study. METHODS: Patients with the diagnosis of GERD were extracted from the National Inpatient Database (NIS) for the years 2016 to 2019. Patients' age, gender, race, and hospital information, including region and bed size, were extracted and considered as baseline characteristics. The comorbidities included are hypertension (HTN), atrial fibrillation (AFib), congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), pulmonary hypertension (PHTN), obesity, and smoking. Patients younger than 18 years old were excluded from this study. Results: Out of 22,677,620 patients with the diagnosis of GERD, 12.21% had a concurrent diagnosis of OSA (compared to 4.79% in patients without GERD, p-value <0.001). The mean age of patients with GERD and OSA was 64.47 years vs 65.42 years in patients without OSA (p-value <0.001). The GERD and OSA group had almost identical gender distribution compared to the GERD only group, as it was predominantly female patients. The white and black races were slightly more prevalent in the GERD and OSA group compared to the GERD only group. Regarding comorbidities, the prevalence of obesity was more clear in the GERD and OSA group. It was noted that the group of patients who carry a diagnosis of GERD and OSA have more prevalence of diabetes (DM), hypertension (HTN), obesity, atrial fibrillation (Afib), congestive heart failure (CHF), and pulmonary hypertension (PHTN). Patients with GERD and OSA were 21% less likely to be older than 65 years rather than younger (95% CI: 0.79-0.8, p-value <0.001), 35% less likely to be females (95% CI: 0.65-0.65, p-value <0.001), and 22% less likely to be non-white (95% CI: 0.77-0.8, p-value <0.001). Obesity was found to be the strongest association with this population, followed by PHTN, CHF, DM, HTN, Afib, and lastly smoking. CONCLUSION: Patients with GERD and OSA were found more likely to be female, white, living in the southern part of the United States, obese, diabetes mellitus type 2, and being active smokers.

The consequences of sleep disordered breathing (SDB) in women are fatigue, morning headaches, insomnia, depression, low functional status, daytime sleepiness, mood disturbances, and poor neuro-behavioural performance. Women appear to be more symptomatic at lower disease severity than men. When CPAP is prescribed, women use it less than men, they reduce their usage within the first week of treatment, and they discontinue it more than men. There is a need to understand the factors influencing CPAP therapy uptake and usage in women to meaningfully address their needs. The purpose of this qualitative evidence synthesis was to identify and synthesize the factors influencing the uptake and use of CPAP in women by conducting a qualitative evidence synthesis guided by the Bargaining and Balancing Life with CPAP theory for content, and the Theoretical Domains Framework for data analysis. Twenty-one studies were included. Barrier domains were Skills, Emotions, Social/Professional Role and Identity, and Beliefs about Capabilities, while facilitator domains were Reinforcement, Social Influences, Goals, and Optimism. Seven themes emerged : 1) Expectations about CPAP, 2) Learning to use my CPAP machine, 3) The burden of the technology, 4) Improvement of SDB symptoms, 5) Not feeling (or looking) like myself, 6) Receiving support, and 7) Choosing my attitude. To ensure appropriate and meaningful SDB care for women, practices must be based on knowledge relevant to women with SDB. Findings from this thesis can inform the design and development of interventions to support women with CPAP therapy uptake and usage. Research on this topic is urgently needed because there was no study eligible with a sample comprised of women only.

This thesis explores Gregory Abbott's Remlack Too, particularly in its fusion of surrealism and postmodernism. It addresses the ways in which Remlack Too highlights the artist's experience with sleep apnea, but acknowledges that this is only one level of understanding the painting. Other layers are realized through a study of surrealism and postmodernism. This research analyzes the ways in which surrealism and postmodernism work together, including through their lack of style, fluidity in definition, incorporation of semiotics, distrust in science, reliance on psychoanalysis, and especially through postmodernism's appropriating of earlier artistic movements. This thesis reviews the previously overlooked elements of postmodernism in Abbott's oeuvre. By exploring some of the binary pairs found in Remlack Too, such as life and death, sleep and wake, and logic and irrational, Abbott reveals his hopes for a more open-minded and accepting society.

Objetivo: Comparar el conocimiento, percepción y actitud de ortodoncistas y odontopediatras respecto al síndrome de apnea obstructiva del sueño en niños. Metodología: Se aplicó un cuestionario online mediante el programa Survey Monkey, conformado por dos secciones; datos generales y síndrome de apnea obstructiva del sueño. La segunda parte referida al tema específico, presenta 3 dimensiones: La dimensión conocimiento se trata de preguntas cerradas de alternativa múltiple y de respuesta única (5 ítems). La dimensión percepción (4 ítems) y actitud (5 ítems), están representadas por preguntas tipo Likert, ordenadas de mayor a menor intensidad. Resultados: No se encontró asociación estadísticamente significativa entre las tres dimensiones de ambos grupos profesionales. Conclusiones: Los ortodoncistas y odontopediatras no tienen diferencias significativas con respecto al conocimiento, percepción y actitud sobre el síndrome de apnea obstructiva del sueño en niños.

Obstructive sleep apnea (OSA) is underrecognized. Between 10% and 69% of preoperative patients have undiagnosed OSA. To reduce the risk of peri-operative complications related to undiagnosed OSA, patients planned to undergo bariatric surgery are screened for OSA. To understand the OSA detection rate with screening practices, the prevalence of OSA within patients who underwent publicly funded bariatric surgery in Ontario between 2010 and 2016 was measured. Secondly, to understand the effect of OSA screening practices on perioperative and longer-term health care costs, health care utilization and costs were compared between patients with OSA and matched patients without OSA in the 30 days post-bariatric surgery, as well as in the 1 year post-bariatric surgery. The Ontario Bariatric Registry (OBR) linked to the ICES health administrative databases were used. A diagnosis of OSA was identified if recorded in the OBR at time of initial bariatric consultation, or if recorded in ICES databases from the bariatric surgery admission records. Costs were calculated based on the “Guidelines on Person-Level Costing Using Administrative Databases in Ontario” using ICES costing algorithms. The overall prevalence of OSA was 47% (95% CI 46% to 47%). Total health care costs per patient, in the 30-day post-operative period, were 1% lower (95% CI 1% to 1%, p < 0.001) in patients with OSA compared to matched patients without OSA. Similarly, at 1 year postbariatric surgery, total health care costs per patient, were 1% lower (95% CI 1% to 1%, p < 0.001) in patients with OSA compared to matched patients without OSA. At 30 days and 1 year, this difference was driven by lower hospitalization-related costs. OSA screening practices at surgical centers in our network led to similar rates of OSA detection as reported in the literature. However, the literature suggests that screening practices lead to missed OSA diagnoses. Further study is required to understand the reduced post-bariatric surgery costs in patients with OSA compared to matched controls without OSA; and, we postulate that missed OSA diagnoses may be a contributor. / Thesis / Master of Science (MSc) / Obstructive sleep apnea (OSA) is underrecognized and a good proportion of patients with OSA are undiagnosed. To reduce the risk of peri-operative complications related to undiagnosed OSA, patients planned to undergo bariatric surgery are screened for OSA. To understand the performance of OSA screening practices, using a province-wide registry, the proportion of patients diagnosed with OSA within patients who underwent publicly-funded bariatric surgery in Ontario between 2010 and 2016 was measured at 47%. Furthermore, to understand the effect of OSA screening practices on peri-operative costs and longer-term health care costs, health care utilization and costs were compared between patients with OSA and matched patients without OSA in the 30 days and 1 year post-bariatric surgery. Total health care costs per patient were 1% lower in patients with OSA compared to patients without OSA, and this difference was driven by lower hospitalization-related costs.

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