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Svanborg, Eva
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Publications (10 of 108) Show all publications
Andersson, E., Rackauskaite, D., Svanborg, E., Csajbók, L., Öst, M. & Nellgård, B. (2017). A prospective outcome study observing patients with severe traumatic brain injury over 10-15 years. Acta Anaesthesiologica Scandinavica, 61(5), 502-512
Open this publication in new window or tab >>A prospective outcome study observing patients with severe traumatic brain injury over 10-15 years
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2017 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 5, p. 502-512Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Severe traumatic brain injury (sTBI) can be divided into primary and secondary injuries. Intensive care protocols focus on preventing secondary injuries. This prospective cohort study was initiated to investigate outcome, including mortality, in patients treated according to the Lund Concept after a sTBI covering 10-15 years post-trauma.

METHODS: Patients were included during 2000-2004 when admitted to the neurointensive care unit, Sahlgrenska University Hospital. Inclusion criteria were: Glasgow coma scale score of ≤8, need for artificial ventilation and intracranial monitoring. Glasgow Outcome Scale (GOS) was used to evaluate outcome both at 1-year and 10-15 years post-trauma.

RESULTS: Ninety-five patients, (27 female and 68 male), were initially included. Both improvement and deterioration were noted between 1- and 10-15 years post-injury. Mortality rate (34/95) was higher in the studied population vs. a matched Swedish population, (Standard mortality rate (SMR) 9.5; P < 0.0001). When dividing the cohort into Good (GOS 4-5) and Poor (GOS 2-3) outcome at 1-year, only patients with Poor outcome had a higher mortality rate than the matched population (SMR 7.3; P < 0.0001). Further, good outcome (high GOS) at 1-year was associated with high GOS 10-15 years post-trauma (P < 0.0001). Finally, a majority of patients demonstrated symptoms of mental fatigue.

CONCLUSION: This indicates that patients with severe traumatic brain injury with Good outcome at 1-year have similar survival probability as a matched Swedish population and that high Glasgow outcome scale at 1-year is related to good long-term outcome. Our results further emphasise the advantage of the Lund concept.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2017
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-154601 (URN)10.1111/aas.12880 (DOI)000398561700006 ()28374472 (PubMedID)2-s2.0-85017140991 (Scopus ID)
Available from: 2019-02-21 Created: 2019-02-21 Last updated: 2019-03-01Bibliographically approved
Sarberg, M., Bladh, M., Svanborg, E. & Josefsson, A. (2016). Postpartum depressive symptoms and its association to daytime sleepiness and restless legs during pregnancy. BMC Pregnancy and Childbirth, Article ID 137.
Open this publication in new window or tab >>Postpartum depressive symptoms and its association to daytime sleepiness and restless legs during pregnancy
2016 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, article id 137Article in journal (Refereed) Published
Abstract [en]

Purpose: To investigate the possible association between depressive symptoms in the postpartum period and sleep related problems during pregnancy, using screening instruments.

Methods: In a prospective study 293 women in the last trimester of pregnancy answered a questionnaire about sleep related problems in terms of symptoms of restless legs, snoring and daytime sleepiness. They also completed the Epworth Sleepiness Scale (ESS). The same women were screened for depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) four to ten weeks after giving birth. Additional information about social data, pregnancy and delivery was received from the medical charts.

Results: Women with postpartum depressive symptoms had higher prevalence of sleep related problems including excessive daytime sleepiness defined as ESS score ≥10 (OR 3.84, CI 1.57-9.39), and restless legs syndrome (OR 2.837 CI 1.18-6.84) in last trimester of pregnancy, when adjusted for sociodemographic factors and obstetric risk factors.

Conclusions: Depressive symptoms after childbirth are preceded by disturbed sleep already during pregnancy. The results from Epworth Sleepiness Scale completed during pregnancy might be used for detecting women at risk, enabling preventive interventions.

Place, publisher, year, edition, pages
BioMed Central, 2016
Keywords
Postnatal depression, sleep, restless legs syndrome, pregnancy, Epworth Sleepiness Scale
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-117867 (URN)10.1186/s12884-016-0917-9 (DOI)000377160400001 ()
Note

Funding agencies: This investigation was supported by grants from The Regional Council of Ostergotland, Sweden.

Vid tiden för disputationen förelåg publikationen endast som manuskript

Available from: 2015-05-12 Created: 2015-05-12 Last updated: 2019-06-28Bibliographically approved
Sarberg, M., Bladh, M., Josefsson, A. & Svanborg, E. (2016). Sleepiness and sleep disordered breathing during pregnancy. Sleep and Breathing, 20(4), 1231-1237
Open this publication in new window or tab >>Sleepiness and sleep disordered breathing during pregnancy
2016 (English)In: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 20, no 4, p. 1231-1237Article in journal (Refereed) Published
Abstract [en]

Study objectives: To investigate if sleep recordings show differences in prevalence of sleep-disturbed breathing among pregnant women compared to non-pregnant controls. To compare the Epworth sleepiness scale (ESS) scores between the two groups. To evaluate obstetric outcomes.

Setting: At one antenatal care center at an outpatient unit in Linköping, Sweden.

Participants: One hundred pregnant women (gestational week 24-34) and 80 non-pregnant women age- and body mass index-matched as controls.

Interventions: Whole-night respiratory recordings were performed in the homes of all participants, who also answered the same questionnaire, including the Epworth Sleepiness Scale.

Measurements and results: Objectively recorded snoring was more common among the pregnant women (median value 10% of total estimated sleep time) than among the non-pregnant controls (2.5% of total sleep time, p<0.001). The prevalence of obstructive events was low and similar in pregnant and non-pregnant women (1% vs. 3% had obstructive apnea-hypopnea index ≥5). The total ESS score was higher among pregnant women than controls (median 9 vs. 7, p<0.001) but no significant differences were found between the two groups in the scores for the separate items of the ESS. Sleep-disturbed breathing and snoring showed no impact on obstetric outcome. There were no significant associations between either subjectively reported or objectively recorded snoring and ESS scores.

Conclusion: Snoring increases during pregnancy, but sleep recordings could not verify an increased prevalence of obstructive sleep apnea among pregnant women. Development of obstructive sleep apnea is not a likely explanation for the increased daytime sleepiness seen in pregnant women.

Place, publisher, year, edition, pages
Springer Publishing Company, 2016
Keywords
Pregnancy, snoring, sleep recordings, sleep disordered breathing, obstructive sleep apnea, Epworth Sleepiness Scale
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-117868 (URN)10.1007/s11325-016-1345-9 (DOI)
Note

The previous status of this publication was manuscript, and the working title was: "Snoring, sleepiness and sleep-disordered breathing during pregnancy"

Available from: 2015-05-12 Created: 2015-05-12 Last updated: 2019-06-28Bibliographically approved
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., Alehagen, U., Vrethem, M., Svanborg, E. & Broström, A. (2014). Difficulties in Identification of Sleep Disordered Breathing in an Outpatient Clinic for Heart Failure– A Case Study. Annals of Nursing and Practice, 1(3), Article ID 1011.
Open this publication in new window or tab >>Difficulties in Identification of Sleep Disordered Breathing in an Outpatient Clinic for Heart Failure– A Case Study
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2014 (English)In: Annals of Nursing and Practice, ISSN 2379-9501, Vol. 1, no 3, article id 1011Article in journal (Refereed) Published
Abstract [en]

Sleep disordered breathing (SDB) is prevalent in patients with heart failure (HF). The clinical signs of newly diagnosed HF and untreated SDB may overlap and patients in need of SDB treatment can therefore be difficult to identify in patients participating in disease management programmes (DMP). The aim was to describe the care process of two patients with HF involved in a DMP, focusing on the difficulties to identify and initiate treatment of SDB.A prospective case study design was used to follow one male (70 yrs) and one female (74 yrs) patient during 18 months at a Swedish University hospital. It took 5 to 10 months from diagnosis of HF until optimal treatment was reached for their heart conditions and 12 to 17 months until SDB was treated. None of the patients complained of poor sleep, but suffered from fatigue. In the male SDB was detected by the wife’s complaints of her husband’s snoring, apnoeas and restless sleep. In the female, SDB was detected after a detailed assessment of fatigue which was shown to be sleepiness. After optimal treatment of HF but before imitation of SDB treatment both cases cardiac function improved. For the female case improvements also were found in the blood pressure. SDB treatment improved fatigue in both patients. Initiation of HF treatment and self-care routines, as well as identification of SDB is complex and time consuming. Treatment of HF and SDB can improve sleep, cardiac function as well as disturbing associated symptoms.

Place, publisher, year, edition, pages
JSciMedCentral, 2014
National Category
General Practice
Identifiers
urn:nbn:se:liu:diva-115916 (URN)
Available from: 2015-03-23 Created: 2015-03-23 Last updated: 2018-01-11Bibliographically approved
Suleman Khan, M., Zetterlund, E.-L., Green, H., Oscarsson, A., Zackrisson, A.-L., Svanborg, E., . . . Eintrei, C. (2014). Pharmacogenetics, Plasma Concentrations, Clinical Signs and EEG During Propofol Treatment. Basic & Clinical Pharmacology & Toxicology, 115(6), 565-570
Open this publication in new window or tab >>Pharmacogenetics, Plasma Concentrations, Clinical Signs and EEG During Propofol Treatment
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2014 (English)In: Basic & Clinical Pharmacology & Toxicology, ISSN 1742-7835, E-ISSN 1742-7843, Vol. 115, no 6, p. 565-570Article in journal (Refereed) Published
Abstract [en]

A variety of techniques have been developed to monitor the depth of anaesthesia. Propofols pharmacokinetics and response vary greatly, which might be explained by genetic polymorphisms. We investigated the impact of genetic variations on dosage, anaesthetic depth and recovery after total intravenous anaesthesia with propofol. A total of 101 patients were enrolled in the study. The plasma concentration of propofol during anaesthesia was measured using high-performance liquid chromatography. EEG was monitored during the surgical procedure as a measure of anaesthetic depth. Pyrosequencing was used to determine genetic polymorphisms in CYP2B6, CYP2C9, the UGTIA9-promotor and the GABRE gene. The correlation between genotype and to plasma concentration at the time of loss of consciousness (LOC), the total induction dose, the time to anaesthesia, eye opening and clearance were investigated. EEG monitoring showed that the majority of the patients had not reached a sufficient level of anaesthetic depth (subdelta) at the time of loss of consciousness despite a high induction dose of propofol. Patients with UGT1A9-331C/T had a higher propofol clearance than those without (p=0.03) and required a higher induction dose (p=0.03). The patients with UGT1A9-1818T/C required a longer time to LOC (p=0.03). The patients with CYP2C9*2 had a higher concentration of propofol at the time of LOC (p=0.02). The polymorphisms in the metabolizing enzymes and the receptor could not explain the large variation seen in the pharmacokinetics of propofol and the clinical response seen. At LOC, the patients showed a large difference in EEG pattern.

Place, publisher, year, edition, pages
Wiley, 2014
National Category
Clinical Medicine Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-112995 (URN)10.1111/bcpt.12277 (DOI)000345341900013 ()24891132 (PubMedID)
Note

Funding Agencies|Medical Research Council of Southeast Sweden; Swedish Cancer Society; Swedish Research Council; County Council in Ostergotland

Available from: 2015-01-12 Created: 2015-01-08 Last updated: 2019-02-11
Ulander, M., Svensson Johansson, M., Ekegren Ewaldh, A., Svanborg, E. & Broström, A. (2014). Side effects of Continuous Positive Airway Pressure treatment for Obstructive Sleep Apnea: Changes over time and association to adherence. Sleep and Breathing, 18(4), 799-807
Open this publication in new window or tab >>Side effects of Continuous Positive Airway Pressure treatment for Obstructive Sleep Apnea: Changes over time and association to adherence
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2014 (English)In: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 18, no 4, p. 799-807Article in journal (Refereed) Published
Abstract [en]

Purpose: Continuous Positive Airway Pressure is an effective treatment for obstructive sleep apnea, but adherence is often low and side effects are common. It is unclear from previous research whether side effects are significant causes of non-adherence. No study has examined if side effects vary within subjects over time. The aims were to 1) examine the evolution of CPAP side effects over time; and 2) prospectively assess correlations  between early CPAP side effects and treatment adherence. Methods: 186 obstructive sleep apnea patients from three sleep centres were prospectively enrolled. They completed the Side Effects to CPAP Inventory, where the respondent rates the frequency, magnitude and perceived impact on adherence from 15 side effects. Adherence was measured by treatment dropout and machine usage time. Results: The most common side effects were dry mouth, increased number of awakenings, blocked up nose, mask pressure and mask leaks. While some side effects were stable over time, others could both resolve and emerge within subjects. Dry mouth, mask leakage and blocked up nose emerged within one year in approximately 30% of patients who had not experienced them after two weeks. Increased number of awakenings and dry mouth after 1-2 weeks were significantly associated to treatment dropout during the first year and machine usage time after six months. Conclusions: While some side effects are related to adherence, most are not. Not all side effects are stable over time. This, together with differences in methodology between studies, might explain the conflicting findings in earlier research.

Place, publisher, year, edition, pages
Springer, 2014
Keywords
Obstructive sleep apnea/adverse effects, Continuous positive airway pressure, Adherence, Side Effects to CPAP Inventory
National Category
Medical and Health Sciences Nursing
Identifiers
urn:nbn:se:liu:diva-97474 (URN)10.1007/s11325-014-0945-5 (DOI)000344784800018 ()24557772 (PubMedID)
Available from: 2013-09-13 Created: 2013-09-13 Last updated: 2017-12-06Bibliographically approved
Sarberg, M., Svanborg, E., Wiréhn, A.-B. & Josefsson, A. (2014). Snoring during pregnancy and its relation to sleepiness and pregnancy outcome - a prospective study. BMC Pregnancy and Childbirth, 14(15)
Open this publication in new window or tab >>Snoring during pregnancy and its relation to sleepiness and pregnancy outcome - a prospective study
2014 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 14, no 15Article in journal (Refereed) Published
Abstract [en]

Background: The incidence of snoring and sleepiness is known to increase during pregnancy, and this might impact maternal health and obstetric outcome. However, the association between snoring and sleepiness during pregnancy is not fully understood. This study was aimed at investigating the development of snoring during pregnancy and prospectively assessing if there is an association between snoring and sleepiness or adverse pregnancy outcomes, such as preeclampsia, mode of delivery, and fetal complications. Methods: Consecutively recruited pregnant women (n = 500) received a questionnaire concerning snoring and sleep at the 1st and 3rd trimester of pregnancy. The women who had rated their frequency of snoring at both occasions (n = 340) were divided into subgroups according to the development of snoring they reported and included in the subsequent analyses. Additional medical data were collected from the medical records. Results: The frequency of snoring was 7.9% in the 1st trimester and increased to 21.2% in the 3rd trimester of pregnancy. The women who snored already in early pregnancy had significantly higher baseline BMI (p = 0.001) than the women who never snored, but snoring was not associated with the magnitude of weight gain during pregnancy. Snoring women were more likely to experience edema in late pregnancy than the non-snorers. Women who started to snore during pregnancy had higher Epworth Sleepiness Scores than the non snorers in both early and late pregnancy. No significant association between obstetric outcome and snoring was found. Conclusion: Snoring does increase during pregnancy, and this increase is associated with sleepiness, higher BMI at the start of pregnancy and higher prevalence of edema, but not with weight gain.

Place, publisher, year, edition, pages
BioMed Central, 2014
Keywords
Pregnancy; Snoring; Sleepiness; Epworth sleepiness score; Body mass index; Edema; Pregnancy outcome
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-105253 (URN)10.1186/1471-2393-14-15 (DOI)000331215600004 ()
Available from: 2014-03-14 Created: 2014-03-14 Last updated: 2019-06-28
Broström, A., Fridlund, B., Ulander, M., Sunnergren, O., Svanborg, E. & Nilsen, P. (2013). A mixed method evaluation of a group-based educational programme for CPAP use in patients with obstructive sleep apnea. Journal of Evaluation In Clinical Practice, 19(1), 173-184
Open this publication in new window or tab >>A mixed method evaluation of a group-based educational programme for CPAP use in patients with obstructive sleep apnea
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2013 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 19, no 1, p. 173-184Article in journal (Refereed) Published
Abstract [en]

Rationale, aims and objectives  Continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA) has a low long-term adherence. Educational interventions are few and sparsely described regarding content, pedagogical approach and participants' perceptions. The aim was to describe adherence to CPAP treatment, knowledge about OSA/CPAP, as well as OSA patients' perceptions of participating in a group-based programme using problem-based learning (PBL) for CPAP initiation. Educational programme  The PBL programme incorporated elements from theories and models concerning motivation and habits. Tutorial groups consisting of four to eight patients met at six sessions during 6 months. Methods  A sequential explanatory mixed method design was used on 25 strategically selected patients. Quantitative data regarding, clinical variables, OSA severity, CPAP use, and knowledge were collected at baseline, after 2 weeks and 6 months. Qualitative data regarding patients' perceptions of participation were collected after 6 months by semi-structured interviews using a phenomenographic approach. Results  72% of the patients were adherent to CPAP treatment after 2 weeks and 6 months. All patients improved their baseline knowledge about OSA and CPAP after 2 weeks and sustained it after 6 months. Anxiety and fear, as well as difficulties and needs were motivational factors for participation. Patients described the difficulties of behavioural change, an awareness that improvements do not occur immediately, a realization of the importance of both technical and emotional support and the need for a healthier lifestyle. Conclusion and practice implications  A group-based programme using PBL seems to facilitate adaptive and developmental learning and result in acceptable CPAP adherence levels.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-75943 (URN)10.1111/j.1365-2753.2011.01797.x (DOI)000314114400025 ()22171746 (PubMedID)
Available from: 2012-03-19 Created: 2012-03-19 Last updated: 2017-12-07
Sjöberg, F. & Svanborg, E. (2013). Editorial Material: How do we know when patients sleep properly or why they do not?. Critical Care, 17(3)
Open this publication in new window or tab >>Editorial Material: How do we know when patients sleep properly or why they do not?
2013 (English)In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 17, no 3Article in journal, Editorial material (Other academic) Published
Abstract [en]

The importance of adequate sleep for good health and immune system function is well documented as is reduced sleep quality experienced by ICU patients. In the previous issue of Critical Care, Elliot and co-workers present a well done, largest of its kind, single-center study on sleep patterns in critically ill patients. They base their study on the gold standard, the polysomnography technique, which is resource demanding to perform and often difficult to evaluate. The results are especially interesting as the authors not only used polysomnography in a large sample but also, in contrast to others, excluded patients with prior sleep problems. They also recorded patients subjective sleep experiences in the ICU and thereafter in the ward (validated questionnaires) with simultaneous data collection of factors known to affect sleep in the ICU (mainly treatment interventions, light and sound disturbances). Interestingly, but not surprisingly, sleep was both quantitatively and qualitatively poor. Furthermore, there seemed to be little or no improvement over time when compared to earlier studies. This study stresses the magnitude of the sleep problem despite interventions such as earplugs and/or eyeshades. Sound disturbance was found to be the most significant but improvable factor. The study highlights the challenge and the importance of evaluating sleep in the critical care setting and the present need for alternative methods to measure it. All that in conjunction can be used to solve an important problem for this patient group.

Place, publisher, year, edition, pages
BioMed Central, 2013
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-104141 (URN)10.1186/cc12614 (DOI)000329431100050 ()
Available from: 2014-02-07 Created: 2014-02-07 Last updated: 2017-12-06
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