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Broström, Anders
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Publications (10 of 104) Show all publications
Broström, A., Pakpour, A. H., Nilsen, P., Fridlund, B. & Ulander, M. (2018). Psychometric properties of the Ethos Brief Index (EBI) using factorial structure and Rasch Analysis among patients with obstructive sleep apnea before and after CPAP treatment is initiated.. Sleep and Breathing
Open this publication in new window or tab >>Psychometric properties of the Ethos Brief Index (EBI) using factorial structure and Rasch Analysis among patients with obstructive sleep apnea before and after CPAP treatment is initiated.
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2018 (English)In: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Continuous positive airway treatment (CPAP) is the recommended treatment for patients with obstructive sleep apnea (OSA). Outcome measures often focus on clinical and/or self-rated variables related to the medical condition. However, a brief validated instrument focusing on the whole life situation (i.e., ethos) suitable for clinical practice is missing. The aim of this study was to investigate factorial structure, categorical functioning of the response scale, and differential item functioning across sub-populations of the Ethos Brief Index (EBI) among patients with obstructive sleep apnea (OSA) before and after initiation of continuous positive airway pressure (CPAP).

METHODS: A prospective design, including 193 patients with OSA (68% men, 59.66 years, SD 11.51) from two CPAP clinics, was used. Clinical assessment and overnight respiratory polygraphy were used to diagnose patients. Questionnaires administered before and after 6 months of CPAP treatment included EBI, Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale, and global perceived health (initial item in SF-36). The validity and reliability of the EBI were investigated using Rasch and confirmatory factor analysis models. Measurement invariance, unidimensionality, and differential item functioning across gender groups, Apnea-Hypopnea Index, and ESS groups were assessed.

RESULTS: The reliability of the EBI was confirmed using composite reliability and Cronbach's alpha. The results supported unidimensionality of the EBI in confirmatory factor analysis and the Rasch model. No differential item functioning was found. A latent profile analysis yielded two profiles of patients with low (n = 42) and high (n = 151) ethos. Patients in the low ethos group were younger and had higher depression scores, lower perceived health, and higher body mass index.

CONCLUSIONS: The EBI is a valid tool with robust psychometric properties suitable for use among patients with OSA before and after treatment with CPAP is initiated. Future studies should focus on its predictive validity.

Keywords
Continuous positive airway treatment, Ethos, Obstructive sleep apnea, Reliability, Validity
National Category
Neurology
Identifiers
urn:nbn:se:liu:diva-154639 (URN)10.1007/s11325-018-1762-z (DOI)30523558 (PubMedID)
Funder
Swedish Heart Lung Foundation
Available from: 2019-02-24 Created: 2019-02-24 Last updated: 2019-02-24
Broström, A., Wahlin, A., Alehagen, U., Ulander, M. & Johansson, P. (2018). Sex-Specific Associations Between Self-reported Sleep Duration, Cardiovascular Disease, Hypertension, and Mortality in an Elderly Population.. Journal of Cardiovascular Nursing, 33(5), 422-428
Open this publication in new window or tab >>Sex-Specific Associations Between Self-reported Sleep Duration, Cardiovascular Disease, Hypertension, and Mortality in an Elderly Population.
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2018 (English)In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 33, no 5, p. 422-428Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Both short and long sleep durations have been associated to increased mortality. Knowledge about sex-specific differences among elderly regarding associations between sleep duration, cardiovascular health, and mortality is sparse.

OBJECTIVE: The aims of this study are to examine the association between self-reported sleep duration and mortality and to investigate whether this association is sex specific and/or moderated by cardiovascular morbidity, and also to explore potential mediators of sleep duration effects on mortality.

METHODS: A population-based, observational, cross-sectional design with 6-year follow-up with mortality as primary outcome was conducted. Self-rated sleep duration, clinical examinations, echocardiography, and blood samples (N-terminal fragment of proBNP) were collected. A total of 675 persons (50% women; mean age, 78 years) were divided into short sleepers (≤6 hours; n = 231), normal sleepers (7-8 hours; n = 338), and long sleepers (≥9 hours; n = 61). Data were subjected to principal component analyses. Cardiovascular disease (CVD) and hypertension factors were extracted and used as moderators and as mediators in the regression analyses.

RESULTS: During follow-up, 55 short sleepers (24%), 68 normal sleepers (20%), and 21 long sleepers (34%) died. Mediator analyses showed that long sleep was associated with mortality in men (hazard ratio [HR], 1.8; P = .049), independently of CVD and hypertension. In men with short sleep, CVD acted as a moderator of the association with mortality (HR, 4.1; P = .025). However, when using N-terminal fragment of proBNP, this effect became nonsignificant (HR, 3.1; P = .06). In woman, a trend to moderation involving the hypertension factor and short sleep was found (HR, 4.6; P = .09).

CONCLUSION: Short and long sleep duration may be seen as risk markers, particularly among older men with cardiovascular morbidity.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2018
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-154038 (URN)10.1097/JCN.0000000000000393 (DOI)000457865500009 ()28060086 (PubMedID)
Available from: 2019-01-24 Created: 2019-01-24 Last updated: 2019-02-26
Broström, A., Pakpour, A. H., Nilsen, P., Hedberg, B. & Ulander, M. (2018). Validation of CollaboRATE and SURE - two short questionnaires to measure shared decision making during CPAP initiation.. Journal of Sleep Research, Article ID e12808.
Open this publication in new window or tab >>Validation of CollaboRATE and SURE - two short questionnaires to measure shared decision making during CPAP initiation.
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2018 (English)In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, article id e12808Article in journal (Refereed) Epub ahead of print
Abstract [en]

Adherence to continuous positive airway pressure (CPAP) treatment tends to be low. Brief validated instruments focusing on shared decision making have not been used in a CPAP context. The aim was to investigate factorial structure, categorical functioning of the response scale and differential item functioning across sub-populations of the CollaboRATE and Sure questionnaires among patients with obstructive sleep apnea (OSA) before CPAP treatment is initiated. A prospective design, including 193 objectively diagnosed (polygraphy) OSA patients (68% men, 59.7 years, SD 11.5) from two CPAP clinics was used. Data were collected with the following questionnaires; Sure, CollaboRATE, Attitudes to CPAP Inventory, Epworth sleepiness scale, minimal insomnia symptoms scale, and hospital anxiety and depression scale. Objective CPAP use was collected after 6 months; 49% demonstrated decisional conflict on SURE and 51% scored low levels of shared decision making on CollaboRATE. Unidimensionality was found for both CollaboRATE (one factor explaining 57.4%) and SURE (one factor explaining 53.7%), as well as local independence. Differential item functioning showed both to be invariant across both male and female patients. Internal consistency (Cronbach's alpha 0.83) and composite reliability (0.89) were good. Latent class analyses showed that patients with low decisional conflict and high shared decision making were more adherent to CPAP treatment. CollaboRATE and SURE provided good validity and reliability scores to measure shared decision making and decisional conflict in relation to CPAP treatment. The questionnaires can be used by healthcare personnel as a tool to simplify the assessment of shared decision making.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
adherence, continuous positive airway pressure treatment, obstructive sleep apnea, shared decision making, validation
National Category
Neurology
Identifiers
urn:nbn:se:liu:diva-154638 (URN)10.1111/jsr.12808 (DOI)30549161 (PubMedID)
Available from: 2019-02-24 Created: 2019-02-24 Last updated: 2019-02-24
Broström, A., Fridlund, B., Hedberg, B., Nilsen, P. & Ulander, M. (2017). Communication between patients with obstructive sleep apnoea syndrome and healthcare personnel during the initial visit to a continuous positive airway pressure clinic. Journal of Clinical Nursing, 26(3-4), 568-577
Open this publication in new window or tab >>Communication between patients with obstructive sleep apnoea syndrome and healthcare personnel during the initial visit to a continuous positive airway pressure clinic
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2017 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 3-4, p. 568-577Article in journal (Refereed) Published
Abstract [en]

Aims and objectives. To describe facilitators and barriers from a patient perspective in communications between patients with obstructive sleep apnoea syndrome and healthcare personnel during the first meeting when continuous positive airway pressure is initiated. Background. Adherence to continuous positive airway pressure treatment tends to be poor, especially at the initial phase of treatment. Communication between the patient and healthcare personnel has not been studied from the patient perspective, as either a barrier or facilitator for adherence. Methods. A descriptive design using qualitative content analysis was used. Interviews with 25 patients with obstructive sleep apnoea syndrome took place after their initial visit at four continuous positive airway pressure clinics. A deductive analysis based on The 4 Habits Model (i.e. emphasise the importance of investing in the beginning of the consultation, elicit the patients perspective, demonstrate empathy and invest in the end of the consultation) was conducted. Results. Building confidence (i.e. structure building, information transfer, commitment) or hindering confidence (i.e. organisational insufficiency, stress behaviour, interaction deficit) was associated with investing in the beginning. Motivating (i.e. situational insight, knowledge transfer, practical training) or demotivating (i.e. expectations, dominance and power asymmetry, barriers) was associated with eliciting the patients perspective. Building hope (i.e. awareness, sensitivity, demonstration of understanding) or hindering hope (i.e. unprepared, uncommitted, incomprehension) was associated with showing empathy. Agreement (i.e. confirmation, responsibilities, comprehensive information) or disagreement (i.e. structural obscurity, irresponsibility, absent-mindedness) was associated with investing in the end. Conclusions. Understanding of facilitators and barriers, as described by patients, can be used to improve contextual conditions and communication skills among healthcare personnel. Relevance to clinical practice. A patient-centred communication technique should be used in relation to all stages of The 4 Habits Model to facilitate shared decision-making and improve adherence to continuous positive airway pressure treatment.

Place, publisher, year, edition, pages
WILEY, 2017
Keywords
communication; continuous positive airway pressure; obstructive sleep apnoea; shared decision-making
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-136331 (URN)10.1111/jocn.13592 (DOI)000396479700026 ()27685080 (PubMedID)
Note

Funding Agencies|FORSS (Medical Research Council of Southeast Sweden) [DNR.566401, 376541]

Available from: 2017-04-10 Created: 2017-04-10 Last updated: 2018-05-03
Steinke, E., Palm Johansen, P., Fridlund, B. & Broström, A. (2016). Determinants of sexual dysfunction and interventions for patients with obstructive sleep apnoea: a systematic review. International journal of clinical practice (Esher), 70(1), 5-19
Open this publication in new window or tab >>Determinants of sexual dysfunction and interventions for patients with obstructive sleep apnoea: a systematic review
2016 (English)In: International journal of clinical practice (Esher), ISSN 1368-5031, E-ISSN 1742-1241, Vol. 70, no 1, p. 5-19Article, review/survey (Refereed) Published
Abstract [en]

Aims: Obstructive sleep apnoea (OSA) may negatively affect a couples sexual relationship. This systematic review evaluated what characteristics are determinants of sexual function and dysfunction in women and men with OSA, and what interventions are shown to be effective. Methods: A systematic literature review was conducted using PubMed, CINAHL, Cochrane and TRIP, and articles published between January 2004 and December 2014 in English; original research; adults >= 18 years; and both experimental and non-experimental designs. The Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies was used to assess study quality. Of 21 studies, six studies (no randomised control trials, RCTs) included women and 15 (with six RCTs) studies included men. Extracted data were scrutinised and adjusted until consensus was reached; suitable quantitative data were pooled in statistical meta-analysis. Results: Sexual function was affected similarly in both genders, but effective interventions were reported only for men. In some studies, OSA severity and medications contributed to greater sexual dysfunction. In women, menopausal status, hormone levels and SaO(2) < 90% were determinants of sexual dysfunction, while for men factors included BMI, hormonal status and inflammatory markers. Continuous positive airway pressure (CPAP) not only improved clinical measures such as excessive daytime sleepiness but also the erectile and orgasmic function. Nevertheless, sildenafil was superior CPAP with regard to erectile dysfunction. Conclusions: The findings illustrate important contributors to sexual dysfunction; however, firm generalisations cannot be made. There were limited RCTs and none for women, indicating further RCTs are needed to determine how OSA affects sexual function.

Place, publisher, year, edition, pages
WILEY-BLACKWELL, 2016
National Category
General Practice Psychiatry
Identifiers
urn:nbn:se:liu:diva-126859 (URN)10.1111/ijcp.12751 (DOI)000371231100002 ()26620672 (PubMedID)
Available from: 2016-04-05 Created: 2016-04-05 Last updated: 2018-01-10
Eriksson, K., Wikström, L., Fridlund, B., Årestedt, K. & Broström, A. (2016). Patients experiences and actions when describing pain after surgery - A critical incident technique analysis. International Journal of Nursing Studies, 56, 27-36
Open this publication in new window or tab >>Patients experiences and actions when describing pain after surgery - A critical incident technique analysis
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2016 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 56, p. 27-36Article in journal (Refereed) Published
Abstract [en]

Background: Postoperative pain assessment remains a significant problem in clinical care despite patients wanting to describe their pain and be treated as unique individuals. Deeper knowledge about variations in patients experiences and actions could help healthcare professionals to improve pain management and could increase patients participation in pain assessments. Objective: The aim of this study was, through an examination of critical incidents, to describe patients experiences and actions when needing to describe pain after surgery. Methods: An explorative design involving the critical incident technique was used. Patients from one university and three county hospitals in both urban and rural areas were included. To ensure variation of patients a strategic sampling was made according to age, gender, education and surgery. A total of 25 patients who had undergone orthopaedic or general surgery was asked to participate in an interview, of whom three declined. Findings: Pain experiences were described according to two main areas: "Patients resources when in need of pain assessment" and "Ward resources for performing pain assessments". Patients were affected by their expectations and tolerance for pain. Ability to describe pain could be limited by a fear of coming into conflict with healthcare professionals or being perceived as whining. Furthermore, attitudes from healthcare professionals and their lack of adherence to procedures affected patients ability to describe pain. Two main areas regarding actions emerged: "Patients used active strategies when needing to describe pain" and "Patients used passive strategies when needing to describe pain". Patients informed healthcare professionals about their pain and asked questions in order to make decisions about their pain situation. Selfcare was performed by distraction and avoiding pain or treating pain by themselves, while others were passive and endured pain or refrained from contact with healthcare professionals due to healthcare professionals large work load. (C) 2015 Elsevier Ltd. All rights reserved.

Place, publisher, year, edition, pages
PERGAMON-ELSEVIER SCIENCE LTD, 2016
Keywords
Critical incident technique; Pain assessment; Patients experiences; Postoperative pain
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-126797 (URN)10.1016/j.ijnurstu.2015.12.008 (DOI)000371844700004 ()26772655 (PubMedID)
Note

Funding Agencies|Futurum, the Academy for Health and Care, County Council of Jonkoping, Sweden; FORSS, Medical Research Council of Southeast Sweden

Available from: 2016-04-07 Created: 2016-04-05 Last updated: 2017-11-30
Andersen Amofah, H., Broström, A., Fridlund, B., Bjorvatn, B., Haaverstad, R., Ove Hufthammer, K., . . . Norekval, T. M. (2016). Sleep in octogenarians during the postoperative phase after transcatheter or surgical aortic valve replacement. European Journal of Cardiovascular Nursing, 15(2), 168-177
Open this publication in new window or tab >>Sleep in octogenarians during the postoperative phase after transcatheter or surgical aortic valve replacement
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2016 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 15, no 2, p. 168-177Article in journal (Refereed) Published
Abstract [en]

Background: Octogenarians with aortic stenosis are an increasing population of patients admitted for surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). Although adequate sleep is important after illness and surgery, it has scarcely been studied in the immediate postoperative phase. Aims: To determine and compare the nature of self-reported sleep and insomnia, and recorded sleep-wake patterns in octogenarians during the in-hospital postoperative phase after SAVR or TAVI. Methods: A prospective cohort design was used that included octogenarian patients undergoing SAVR or TAVI at a regional university hospital. Self-reports were used to document sleep and insomnia, and actigraphy was used to record sleep-wake patterns. Data were collected at baseline preoperatively, and then daily for the first five postoperative days. Results: SAVR patients experienced the most insomnia on postoperative nights later in recovery, while TAVI patients experienced the most insomnia on postoperative nights early in recovery. The median total sleep time, as measured by actigraphy, was 6.4 h, and the median sleep efficiency was 79% for the five postoperative nights, but no differences were found between SAVR and TAVI patients on this parameter. All patients slept more during daytime than at night, with SAVR patients having significantly more total sleep hours for all five days than TAVI patients (p < 0.01). Conclusion: Octogenarians with aortic stenosis had disturbed self-reported sleep, increased insomnia, and disturbed sleep-wake patterns postoperatively, resulting in more daytime sleep and inactivity. In patients undergoing SAVR or TAVI, sleep evolves differently during the in-hospital postoperative phase.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD, 2016
Keywords
Aortic stenosis; SAVR; TAVI; in-hospital sleep; octogenarian
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-127419 (URN)10.1177/1474515115620992 (DOI)000373286900009 ()26635329 (PubMedID)
Note

Funding Agencies|Kavli Research Center for Aging and Dementia; University of Bergen; Bergen University College; Norwegian Nurses Association

Available from: 2016-05-01 Created: 2016-04-26 Last updated: 2017-11-30
Ulander, M. & Broström, A. (2015). Letter: Response to Akar et al., regarding our study "Side effects to continuous positive airway pressure treatment for obstructive sleep apnoea" in SLEEP AND BREATHING, vol 19, issue 4, pp 1345-1345 [Letter to the editor]. Sleep and Breathing, 19(4), 1345-1345
Open this publication in new window or tab >>Letter: Response to Akar et al., regarding our study "Side effects to continuous positive airway pressure treatment for obstructive sleep apnoea" in SLEEP AND BREATHING, vol 19, issue 4, pp 1345-1345
2015 (English)In: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 19, no 4, p. 1345-1345Article in journal, Letter (Other academic) Published
Abstract [en]

n/a

Place, publisher, year, edition, pages
SPRINGER HEIDELBERG, 2015
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-123792 (URN)10.1007/s11325-015-1169-z (DOI)000365744500032 ()25893321 (PubMedID)
Available from: 2016-01-11 Created: 2016-01-11 Last updated: 2017-11-30
Gustafsson, G., Broström, A., Ulander, M., Vrethem, M. & Svanborg, E. (2015). Occurrence of epileptiform discharges and sleep during EEG recordings in children after melatonin intake versus sleep-deprivation. Clinical Neurophysiology, 126(8), 1493-1497
Open this publication in new window or tab >>Occurrence of epileptiform discharges and sleep during EEG recordings in children after melatonin intake versus sleep-deprivation
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2015 (English)In: Clinical Neurophysiology, ISSN 1388-2457, E-ISSN 1872-8952, Vol. 126, no 8, p. 1493-1497Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE:

To determine if melatonin is equally efficient as partial sleep deprivation in inducing sleep without interfering with epileptiform discharges in EEG recordings in children 1-16years old.

METHODS:

We retrospectively analysed 129 EEGs recorded after melatonin intake and 113 EEGs recorded after partial sleep deprivation. Comparisons were made concerning occurrence of epileptiform discharges, the number of children who fell asleep and the technical quality of EEG recordings. Comparison between different age groups was also made.

RESULTS:

No significant differences were found regarding occurrence of epileptiform discharges (33% after melatonin intake, 36% after sleep deprivation), or proportion of unsuccessful EEGs (8% and 10%, respectively). Melatonin and sleep deprivation were equally efficient in inducing sleep (70% in both groups). Significantly more children aged 1-4years obtained sleep after melatonin intake in comparison to sleep deprivation (82% vs. 58%, p⩽0.01), and in comparison to older children with melatonin induced sleep (58-67%, p⩽0.05). Sleep deprived children 9-12years old had higher percentage of epileptiform discharges (62%, p⩽0.05) compared to younger sleep deprived children.

CONCLUSION:

Melatonin is equally efficient as partial sleep deprivation to induce sleep and does not affect the occurrence of epileptiform discharges in the EEG recording. Sleep deprivation could still be preferable in older children as melatonin probably has less sleep inducing effect.

SIGNIFICANCE:

Melatonin induced sleep have advantages, especially in younger children as they fall asleep easier than after sleep deprivation. The procedure is easier for the parents than keeping a young child awake for half the night.

Place, publisher, year, edition, pages
Elsevier, 2015
National Category
Pediatrics Neurology
Identifiers
urn:nbn:se:liu:diva-115914 (URN)10.1016/j.clinph.2014.10.015 (DOI)000357488800008 ()25453612 (PubMedID)
Available from: 2015-03-23 Created: 2015-03-23 Last updated: 2017-12-04
Johansson, P., Svensson, E., Alehagen, U., Dahlström, U., Jaarsma, T. & Broström, A. (2015). Sleep disordered breathing, hypoxia and inflammation: associations with sickness behaviour in community dwelling elderly with and without cardiovascular disease. Sleep and Breathing, 19(1), 263-271
Open this publication in new window or tab >>Sleep disordered breathing, hypoxia and inflammation: associations with sickness behaviour in community dwelling elderly with and without cardiovascular disease
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2015 (English)In: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 19, no 1, p. 263-271Article in journal (Refereed) Published
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.

Place, publisher, year, edition, pages
Springer Berlin/Heidelberg, 2015
Keywords
Sleep disordered breathing, Hypoxia, Inflammation, Cardiovascular disease, Sickness behaviour
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-108602 (URN)10.1007/s11325-014-1006-9 (DOI)000349983900044 ()24859483 (PubMedID)
Available from: 2014-07-01 Created: 2014-07-01 Last updated: 2017-12-05
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