liu.seSearch for publications in DiVA
Change search
Link to record
Permanent link

Direct link
BETA
Ulander, Martin
Alternative names
Publications (10 of 35) Show all publications
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.
Show others...
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)28060086 (PubMedID)
Available from: 2019-01-24 Created: 2019-01-24 Last updated: 2019-01-24
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
Show others...
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
Gardner, B., Broström, A., Nilsen, P., Hrubos Strom, H., Ulander, M., Fridlund, B., . . . Johansson, P. (2014). Editorial Material: From does it work? to what makes it work?: The importance of making assumptions explicit when designing and evaluating behavioural interventions in EUROPEAN JOURNAL OF CARDIOVASCULAR NURSING, vol 13, issue 4, pp 292-294. European Journal of Cardiovascular Nursing, 13(4), 292-294
Open this publication in new window or tab >>Editorial Material: From does it work? to what makes it work?: The importance of making assumptions explicit when designing and evaluating behavioural interventions in EUROPEAN JOURNAL OF CARDIOVASCULAR NURSING, vol 13, issue 4, pp 292-294
Show others...
2014 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 13, no 4, p. 292-294Article in journal, Editorial material (Other academic) Published
Abstract [en]

n/a

Place, publisher, year, edition, pages
Elsevier / SAGE Publications (UK and US): 12 month Embargo, 2014
National Category
Clinical Medicine Basic Medicine
Identifiers
urn:nbn:se:liu:diva-111759 (URN)10.1177/1474515114531688 (DOI)000342579700001 ()24715537 (PubMedID)
Available from: 2014-10-31 Created: 2014-10-31 Last updated: 2018-01-11
Hendriks, J. M. L., Johansson, P., Strömberg, A., Ulander, M. & Broström, A. (2014). Editorial Material: Sleep disordered breathing - A hidden co-morbidity in patients with atrial fibrillation? in EUROPEAN JOURNAL OF CARDIOVASCULAR NURSING, vol 13, issue 6, pp 480-482. European Journal of Cardiovascular Nursing, 13(6), 480-482
Open this publication in new window or tab >>Editorial Material: Sleep disordered breathing - A hidden co-morbidity in patients with atrial fibrillation? in EUROPEAN JOURNAL OF CARDIOVASCULAR NURSING, vol 13, issue 6, pp 480-482
Show others...
2014 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 13, no 6, p. 480-482Article in journal, Editorial material (Other academic) Published
Abstract [en]

n/a

Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD, 2014
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-112999 (URN)10.1177/1474515114558163 (DOI)000345335600001 ()25336397 (PubMedID)
Available from: 2015-01-12 Created: 2015-01-08 Last updated: 2017-12-05
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
Show others...
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
Broström, A., Nilsen, P., Gardner, B., Johansson, P., Ulander, M., Fridlund, B. & Arestedt, K. (2014). Validation of the CPAP Habit Index-5: A Tool to Understand Adherence to CPAP Treatment in Patients with Obstructive Sleep Apnea.. Sleep Disorders, 2014, 1-9, Article ID 929057.
Open this publication in new window or tab >>Validation of the CPAP Habit Index-5: A Tool to Understand Adherence to CPAP Treatment in Patients with Obstructive Sleep Apnea.
Show others...
2014 (English)In: Sleep Disorders, ISSN 2090-3545, E-ISSN 2090-3553, Vol. 2014, p. 1-9, article id 929057Article in journal (Refereed) Published
Abstract [en]

Long-term adherence to continuous positive airway pressure (CPAP) is low among patients with obstructive sleep apnea (OSA). The potential role of "habit" in sustaining adherence to CPAP use has not been studied. This study aimed to establish the relevance of habit to CPAP adherence, via validation of an adaptation of the Self-Report Habit Index (the CPAP Habit Index-5; CHI-5). Analyses focused on the homogeneity, reliability, and factor structure of the CHI-5 and, in line with theoretical predictions, its utility as a predictor of long-term CPAP adherence in middle-aged patients with OSA. A prospective longitudinal design was used. 117 patients with objectively verified OSA intended for CPAP treatment were recruited. Data was collected via clinical examinations, respiratory recordings, questionnaires, and CPAP devices at baseline, 2 weeks, 6 months, and 12 months. The CHI-5 showed satisfactory homogeneity interitem correlations (0.42-0.93), item-total correlations (0.58-0.91), and reliability ( α = 0.92). CHI-5 data at 6 months showed a one-factor solution and predicted 63% of variance in total CPAP use hours after 12 months. Based on the satisfactory measurement properties and the high amount of CPAP use variance it explained, the CHI-5 can be seen as a useful tool in clinical practice.

National Category
Neurology
Identifiers
urn:nbn:se:liu:diva-115776 (URN)10.1155/2014/929057 (DOI)24876975 (PubMedID)
Available from: 2015-03-19 Created: 2015-03-19 Last updated: 2017-12-04
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
Show others...
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
Broström, A., Sunnergren, O., Nilsen, P., Fridlund, B., Ulander, M. & Svanborg, E. (2013). Gender differences in respiratory disturbance, sleep and daytime sleepiness in hypertensive patients with different degrees of obesity. European Journal of Cardiovascular Nursing, 12(2), 140-149
Open this publication in new window or tab >>Gender differences in respiratory disturbance, sleep and daytime sleepiness in hypertensive patients with different degrees of obesity
Show others...
2013 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, no 2, p. 140-149Article in journal (Refereed) Published
Abstract [en]

Background: Hypertension (HT) and obesity have both been linked to obstructive sleep apnoea (OSA). Difficulties have been described in identifying patients with OSA in primary care, causing low referral rates to sleep clinics. Increased knowledge about gender-specific characteristics and symptoms may help to identify patients. Aim: The aim was to describe gender differences regarding undiagnosed OSA, self-rated sleep, insomnia and daytime sleepiness in middle-aged primary care patients with HT and different degrees of obesity. Methods: A cross-sectional design was used and 394 patients (52.5% women), mean age 57.8 years (SD 6.7 years), with HT (BP >140/90 mmHg) were included. Clinical examinations, respiratory recordings and self-rated scales regarding OSA symptoms, sleep, insomnia and daytime sleepiness were used. Body mass index (BMI) was classified according to the criteria from the National Institutes of Health. Results: Pre-obesity and obesity classes I and II were seen among 53%, 26% and 8% of the men and 37%, 19% and 14% of the women, respectively. Occurrence of mild, moderate and severe OSA increased significantly across the BMI classes for both genders (p<0.01). Ninety percent of the men and 80% of the women in obesity class II had OSA. Insomnia was prevalent in obese patients. Other clinical variables did not differ between BMI classes or genders. Conclusion: The occurrence of overweight/obesity and OSA was high among both genders. A high BMI might be a convenient clinical marker for healthcare personnel to identify hypertensive patients with possible OSA in need of further evaluation and treatment.

Place, publisher, year, edition, pages
Sage Publications, 2013
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-89963 (URN)10.1177/1474515112438163 (DOI)000317855800005 ()22457375 (PubMedID)
Available from: 2013-03-12 Created: 2013-03-12 Last updated: 2017-12-06
Ulander, M. (2013). Psychometric aspects of obstructive sleep apnea syndrome. (Doctoral dissertation). Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Psychometric aspects of obstructive sleep apnea syndrome
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: Obstructive sleep apnea (OSA) is a common chronic disorder consisting of episodes with impaired breathing due to obstruction of the upper airways. Treatment with Continuous Positive Airway Pressure (CPAP) is a potentially effective treatment, but adherence is low. Several potential factors affecting adherence, e.g., subjective sleepiness and personality, are only quantifiable through questionnaires. Better knowledge about psychometric properties of such questionnaires might improve future research on CPAP adherence and thus lead to better treatment options.

Aim: Study I: To describe the devlopment and initial testing of the Side Effects of CPAP treatment Inventory (SECI) questionnaire. Study II: To describe the prevalence of Type D personality in OSAS patients with CPAP treatment longer than 6 months and the association with self-reported side effects and adherence. Study III: To study whether any of the items in the Epworth Sleepiness Scale (ESS) exhibit differential item functioning and, if so, to which degree. Study IV: To examine the evolution of CPAP side effects over time; and prospectively assess correlations between early CPAP side effects and treatment adherence.

Patients and Methods: In study I, SECI items were based on a literature review, an expert panel and interviews with patients. It was then mailed to 329 CPAP-treated OSAS patients. Based on this, a principal component analysis was performed, and SECI results were compared between adherent and non-adherent patients. In study II, the population consisted of 247 OSAS patients with ongoing CPAP treatment. The DS14 was used to assess the prevalence of type D personality, and SECI and adherence data from medical records were used to correlate Type D personality to side effects and adherence. In study III, the population consisted of pooled data from 1,167 subjects who had completed the ESS in five other studies. Ordinal regression and Rasch analysis were used to assess the existence of differential item functioning for age and gender. The cutoff for age was 65 years in the Rasch analysis. In study IV, SECI was sent to 186 subjects with newly diagnosed OSAS three times during the first year on CPAP. SECI results were followed over time within subjects, and were correlated to treatment dropout during the first year and machine usage time after 6 months.

Results: SECI provides a valid and reliable instrument to measure side effects, and non-adherent patients have higher scores (i.e., were more bothered by side effects) than adherent patients (study I). Type D personality was prevalent in approximately 30 % of CPAP treated OSAS patients, and was associated to poorer objective and subjective adherence as well as more side effects (study II). Differential item functioning was present in items 3, 4 and 8 for age in both DIF analyses, and to gender in item 8 the Rasch analysis (study III). Dry mouth and increased number of awakenings were consistently associated to poorer adherence in CPAP treated patients. Side effects both emerged and resolved over time (study IV).

Conclusions: Differences in previous research regarding side effects and CPAP adherence might be explained by differences in how side effects and adherence are defined. While some side effects are related to adherence, others are not. Side effects are furthermore not stable over time, and might be related to personality. ESS scores are also related to CPAP adherence according to previous research, but might be affected by other factors than sleepiness, such as age and possibly gender.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. p. 102
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1378
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-97475 (URN)978-91-7519-528-5 (ISBN)
Public defence
2013-10-04, Victoriasalen, Campus US, Linköpings universitet, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2013-09-13 Created: 2013-09-13 Last updated: 2013-09-13Bibliographically approved
Organisations

Search in DiVA

Show all publications