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.

Introduction: The purpose of the study was to evaluate the effects of maxillomandibular advancement (MMA) surgery with counterclockwise rotation on soft tissue oral and nasal structures. Materials and Methods: This retrospective study included 34 subjects diagnosed with OSA who underwent MMA at the Stanford Sleep Clinic. Initial (T1) and Final (T2) CBCTs were evaluated and compared for 10 hard tissue and 15 soft tissue measurements. Additionally, the external nasal valve surface area was measured and compared between the two time points. A 3D superimposition was performed and used to evaluate the relative hard and soft tissue movements. Results: There was a linear correlation in the advancement of the maxilla to the sagittal movement of the upper lip of 75%, while the mandibular soft tissue moved 91-93% of the mandibular sagittal position. The interalar width and mouth width increased significantly following surgery while the lower vermillion border length decreased significantly. There was a clinically significant increase in the average surface area of the external nasal valve by 28%. No correlations were found between maxillary impaction and soft tissue oral or nasal measurements. Conclusion: MMA with CCW results in significant changes to the soft tissue nose and oral region. Soft tissue planning must be considered to maintain desirable esthetics following surgery.

Abstract Sleep Apnea (SA) is a common disorder that affects approximately 2% of middle-aged women and 4% of middle-aged men. It is characterized by repetitive cessation of breathing during sleep. SA has significant health and social consequences such as daytime sleepiness, impaired quality of life, and in the worst case, myocardial infarction and sudden cardiac death. It has been estimated that approximately 80% of individuals with moderate to severe SA syndrome have not been diagnosed. The lack of patient sleep histories has caused low identification of SA and referral rates, especially in primary care facilities. Moreover, due to the inadequate prevalence of overnight polysomnography (PSG) as a standard clinical test of SA, patients suspected of having this sleep disorder have to wait several months for diagnosis and treatment. The costly and time-consuming nature of PSG and the lack of sleep clinics have created a demand for suitable home-based health monitoring devices. Over the years, several devices have been developed to monitor sleep unobtrusively, while an individual is lying in bed. However, most of these devices would either disrupt the sleep of the patient or be disrupted by the patient during routine bed sheet changes. Pressure measurement using a Pressure Sensitive Mat (PSM) enables a non-contact approach for monitoring patient vital signs such as respiration rate. The PSM has the potential to replace obtrusive breathing sensors in the sleep lab and to be used as a pre-screening tool for patients suspected of having sleep apnea. This thesis proposes multiple algorithms applicable to PSM in order to assess sleep quality. First, fusion techniques are proposed to extract a breathing signal from PSM. Second, a wide range of machine learning approaches including a simple threshold-based algorithm, a linear support vector machine (SVM) and two deep learning methods (i.e., a temporal convolutional network (TCN) and a bidirectional long short-term memory (BiLSTM) network) are compared to find a good- iii performing method for automatically detecting central sleep apnea (CSA) events from PSM signals. The results show that the accuracy of the model with the best performance is 95.1% and it is achieved by the BiLSTM network. Finally, by applying SVM, personalized systems are optimized to investigate long-term sleep pattern changes such as central apnea index (CAI), bed occupancy (BO), day-clock, and night-clock from previously recorded data.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18450号 / 医博第3905号 / 新制||医||1004(附属図書館) / 31328 / 京都大学大学院医学研究科医学専攻 / (主査)教授 伊達 洋至, 教授 稲垣 暢也, 教授 森田 智視 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第19367号 / 医博第4044号 / 新制||医||1011(附属図書館) / 32381 / 新制||医||1011 / 京都大学大学院医学研究科医学専攻 / (主査)教授 中山 健夫, 教授 佐藤 俊哉, 教授 横出 正之 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第19400号 / 医博第4051号 / 新制||医||1012(附属図書館) / 32425 / 京都大学大学院医学研究科医学専攻 / (主査)教授 横出 正之, 教授 福原 俊一, 教授 山下 潤 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM