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  • 1.
    Ahlstrom, Christer
    et al.
    Swedish Natl Rd and Transport Res Inst VTI, Linkoping, Sweden.
    Anund, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Swedish Natl Rd and Transport Res Inst VTI, Linkoping, Sweden.
    Fors, Carina
    Swedish Natl Rd and Transport Res Inst VTI, Linkoping, Sweden.
    Akerstedt, Torbjorn
    Stockholm Univ, Sweden; Karolinska Inst, Sweden.
    The effect of daylight versus darkness on driver sleepiness: a driving simulator study2018In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 27, no 3, article id e12642Article in journal (Refereed)
    Abstract [en]

    Driver sleepiness studies are often carried out with alert drivers during daytime and sleep-deprived drivers during night-time. This design results in a mixture of different factors (e.g. circadian effects, homeostatic effects, light conditions) that may confound the results. The aim of this study was to investigate the effect of light conditions on driver sleepiness. Thirty young male drivers (23.6 +/- 1.7years old) participated in a driving simulator experiment where they drove on a rural road. A 2x2 design was used with the conditions daylight versus darkness, and daytime (full sleep) versus night-time (sleep deprived). The results show that light condition had an independent effect on the sleepiness variables. The subjective sleepiness measured by Karolinska Sleepiness Scale was higher, lateral position more left-oriented, speed lower, electroencephalogram alpha and theta higher, and blink durations were longer during darkness. The number of line crossings did not change significantly with light condition. The day/night condition had profound effects on most sleepiness indicators while controlling for light condition. The number of line crossings was higher during night driving, Karolinska Sleepiness Scale was higher, blink durations were longer and speed was lower. There were no significant interactions, indicating that light conditions have an additive effect on sleepiness. In conclusion, Karolinska Sleepiness Scale and blink durations increase primarily with sleep deprivation, but also as an effect of darkness. Line crossings are mainly driven by the need for sleep and the reduced alertness at the circadian nadir. Lane position is, however, more determined by light conditions than by sleepiness.

  • 2.
    Ahlström, Christer
    et al.
    Swedish National Rd and Transport Research Institute VTI, S-58195 Linkoping, Sweden.
    Jansson, Sabina
    Linköping University, Department of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Anund, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine. Swedish National Rd and Transport Research Institute VTI, S-58195 Linkoping, Sweden.
    Local changes in the wake electroencephalogram precedes lane departures2017In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 26, no 6, p. 816-819Article in journal (Refereed)
    Abstract [en]

    The objective of this exploratory study is to investigate if lane departures are associated with local sleep, measured via source-localized electroencephalography (EEG) theta power in the 5-9 Hz frequency range. Thirty participants drove in an advanced driving simulator, resulting in 135 lane departures at high levels of self-reported sleepiness. These lane departures were compared to matching non-departures at the same sleepiness level within the same individual. There was no correspondence between lane departures and global theta activity. However, at the local level an increased risk for lane departures was associated with increased theta content in brain regions related to motor function.

  • 3.
    Ahlström, Christer
    et al.
    Linköping University, Department of Biomedical Engineering. Linköping University, Faculty of Science & Engineering. Swedish Natl Rd and Transport Res Inst VTI, S-58195 Linkoping, Sweden.
    Solis-Marcos, Ignacio
    Swedish Natl Rd and Transport Res Inst VTI, S-58195 Linkoping, Sweden.
    Nilsson, Emma
    Volvo Car Corp, Sweden; Chalmers Univ Technol, Sweden.
    Akerstedt, Torbjorn
    Stockholm Univ, Sweden; Karolinska Inst, Sweden.
    The impact of driver sleepiness on fixation-related brain potentials2020In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 29, no 5, article id e12962Article in journal (Refereed)
    Abstract [en]

    The effects of driver sleepiness are often quantified as deteriorated driving performance, increased blink durations and high levels of subjective sleepiness. Driver sleepiness has also been associated with increasing levels of electroencephalogram (EEG) power, especially in the alpha range. The present exploratory study investigated a new measure of driver sleepiness, the EEG fixation-related lambda response. Thirty young male drivers (23.6 +/- 1.7 years old) participated in a driving simulator experiment in which they drove on rural and suburban roads in simulated daylight versus darkness during both the daytime (full sleep) and night-time (sleep deprived). The results show lower lambda responses during night driving and with longer time on task, indicating that sleep deprivation and time on task cause a general decrement in cortical responsiveness to incoming visual stimuli. Levels of subjective sleepiness and line crossings were higher under the same conditions. Furthermore, results of a linear mixed-effects model showed that low lambda responses are associated with high subjective sleepiness and more line crossings. We suggest that the fixation-related lambda response can be used to investigate driving impairment induced by sleep deprivation while driving and that, after further refinement, it may be useful as an objective measure of driver sleepiness.

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  • 4.
    Ahonen, Hanna
    et al.
    Jonkoping Univ, Sweden.
    Broström, Anders
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology. Jonkoping Univ, Sweden.
    Fransson, Eleonor I.
    Jonkoping Univ, Sweden.
    Neher, Margit
    Jonkoping Univ, Sweden.
    Lindmark, Ulrika
    Jonkoping Univ, Sweden; Karlstad Univ, Sweden.
    "The terrible dryness woke me up, I had some trouble breathing" - Critical situations related to oral health asdescribed by CPAP-treated persons with obstructive sleep apnea2022In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 31, no 6, article id e13670Article in journal (Refereed)
    Abstract [en]

    Continuous positive airway pressure is a common and effective treatment for obstructive sleep apnea, but adherence remains an issue. Both obstructive sleep apnea and oral diseases are associated with cardiovascular diseases, and as oral dryness contributes to treatment abandonment, oral health is of importance for this patient group. The aim was therefore to explore how persons with continuous positive airway pressure-treated obstructive sleep apnea experience situations associated with their oral health, and which actions they take to manage these. An explorative and descriptive design was adopted using the critical incident technique. Based on a purposeful selection, 18 adults with long-term experience of continuous positive airway pressure-treatment were interviewed using a semi-structured interview guide. Both negative and positive situations were described. Negative situations consisted of challenges with breathing, including mouth-breathing, choking sensations, problems with night-time and daytime oral dryness, changes in the saliva composition, and deteriorating oral health. Positive situations included experiences of reduced mouth-breathing and oral dryness. The situations were often successfully managed by mimicking daytime movements, changing sleeping position, adjusting the CPAP-device and mask, increasing oral hygiene efforts, drinking water, using a humidifier or chinstrap, or contacting their oral healthcare clinic. Long-term experience of persons with continuous positive airway pressure-treated obstructive sleep apnea regard situations and actions from everyday life. Successful management can contribute to long-term adherence and decrease negative effects on oral health. More interdisciplinary collaborations could enable identification and adequate recommendations for persons who experience negative situations during their continuous positive airway pressure treatment.

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  • 5.
    Angelhoff, Charlotte
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Children's and Women's Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, H.K.H. Kronprinsessan Victorias barn- och ungdomssjukhus.
    Sjolie, Hege
    Oslo Metropolitan Univ, Norway.
    Mörelius, Evalotte
    School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia; Perth Children’s Hospital, Nedlands, WA, Australia.
    Loyland, Borghild
    Oslo Metropolitan Univ, Norway.
    Like Walking in a Fog: Parents' perceptions of sleep and consequences of sleep loss when staying overnight with their child in hospital2020In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 29, no 2, article id e12945Article in journal (Refereed)
    Abstract [en]

    Disruption of parental sleep in hospital, with frequent awakenings and poor sleep quality, limits the parents resources to meet the childs needs and maintain parental wellbeing. The aim of the study was to explore and describe how parents perceive their sleep when staying overnight with their sick child in hospital. A further aim was to explore and describe parents perception of what circumstances influence their sleep in the hospital. Twenty-two parents who were accommodated with their sick child (0-17 years) in paediatric wards in Norway and Sweden participated. Interviews were conducted during the hospital stay to elicit their perspectives. Phenomenography was used to analyse data. Two descriptive categories were found: (a) "Perceptions of sleep", with two sub-categories: "Sleep in the paediatric ward" and "Consequences of sleep loss"; and (b) "Circumstances influencing sleep in the paediatric ward" with three sub-categories: "The importance of the family", "Information and routines at the paediatric ward", and "Accommodation facilities". Parents sleep and needs must be acknowledged in paediatric wards. An individual plan of care for the upcoming night could be a valuable tool for both the parents and nurses. The childs medical needs must be met with respect to the parents willingness to take part in the childs care during the night, and the need for rest and sleep for both parent and child.

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  • 6.
    Berntsson, Shala Ghaderi
    et al.
    Uppsala Univ, Sweden.
    Kristoffersson, Anna
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Uppsala Univ, Sweden.
    Daniilidou, Makrina
    Uppsala Univ, Sweden.
    Dahl, Niklas
    Uppsala Univ, Sweden.
    Ekstrom, Curt
    Uppsala Univ, Sweden.
    Semnic, Robert
    Uppsala Univ, Sweden.
    Markstrom, Agneta
    Uppsala Univ, Sweden.
    Niemela, Valter
    Uppsala Univ, Sweden.
    Partinen, Markku
    Helsinki Sleep Clin, Finland; Univ Helsinki, Finland.
    Hallbook, Finn
    Uppsala Univ, Sweden.
    Landtblom, Anne-Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Neurologiska kliniken i Linköping. Uppsala Univ, Sweden.
    Aniridia with PAX6 mutations and narcolepsy2020In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 29, no 6, article id e12982Article in journal (Refereed)
    Abstract [en]

    PAX6 gene mutations cause a variety of eye and central nervous system (CNS) abnormalities. Aniridia is often accompanied by CNS abnormalities such as pineal gland atrophy or hypoplasia, leading to disturbed circadian rhythm and sleep disorders. Less is known on the coincidence of narcolepsy in this patient group. We aimed to find out whether the circadian rhythm or sleep-wake structure was affected in patients with aniridia. Four members of a family segregating with congenital aniridia in two generations were included in the study. The patients were subjected to genetic testing for a PAX6 mutation, multiple sleep latency test, whole-brain magnetic resonance imaging (MRI), hypocretin-1 in cerebrospinal fluid, and Human Leukocyte Antigen DQ beta1*06:02. All four members were heterozygous for the pathogenic c.959-1Gamp;gt;A mutation in the PAX6 gene. Sleep disturbance was observed in all family members. The index patient was diagnosed with narcolepsy. MRI showed a hypoplastic pineal gland in all members. We describe the first case of a patient with PAX6 haploinsufficiency, aniridia and pineal gland hypoplasia diagnosed with narcolepsy type-1, suggesting a complex sleep disorder pathogenesis.

  • 7.
    Bjork, Maria
    et al.
    Jonkoping Univ, Sweden.
    Knutsson, Susanne
    Linnaeus Univ, Sweden.
    Odzakovic, Elzana
    Jonkoping Univ, Sweden.
    Hellstrom, Amanda
    Linnaeus Univ, Sweden.
    Sandlund, Christina
    Karolinska Inst, Sweden; Acad Primary Hlth Care Ctr, Sweden.
    Ulander, Martin
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Neurobiology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Lind, Jonas
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Neurobiology. Linköping University, Faculty of Medicine and Health Sciences. Cty Hosp Ryhov, Sweden.
    Pakpour, Amir H.
    Jonkoping Univ, Sweden.
    Broström, Anders
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology. Jonkoping Univ, Sweden; Western Norway Univ Appl Sci, Norway.
    Members of, Jonkoping Univ JU Sleep Well Res Grp
    Validation of two brief instruments (the SURE and CollaboRATE) to measure shared decision-making in patients with restless legs syndrome2023In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869Article in journal (Refereed)
    Abstract [en]

    Restless legs syndrome (RLS) is a common neurological disorder characterised by an urge to move arms and legs, usually associated with discomfort, pain, motor restlessness, and sleep disturbance. An individually adapted treatment is needed but difficult to optimise, which makes shared decision-making (SDM) important. However, brief validated instruments on how patients with RLS perceive their involvement in treatment decisions are lacking. Therefore, the aim was to validate two instruments, SURE (Sure of myself, Understand information, Risk-benefit ratio, Encouragement, i.e., to assess decisional conflict) and CollaboRATE (brief patient survey focused on SDM, i.e., to assess SDM), in patients with RLS. A cross-sectional design, including 788 participants with RLS (65% females, mean [SD] age 70.8 [11.4] years) from a national patient organisation for RLS, was used. A postal survey was sent out to collect data regarding weight, height, comorbidities, demographics, and RLS-related treatment data. The following instruments were included: the SURE, CollaboRATE, Restless Legs Syndrome-6 Scale, and eHealth Literacy Scale. Confirmatory factor analysis and Rasch models were used to assess the validity and reliability of the SURE and CollaboRATE. Measurement invariance, unidimensionality, and differential item functioning (DIF) across age, gender, and medication groups were assessed. The SURE and CollaboRATE were both identified as unidimensional instruments with satisfactory internal consistency. No DIF across age and gender was identified, while significant DIF was observed for both the SURE and CollaboRATE regarding medication use categories. However, both the SURE and CollaboRATE are potential instruments to be used in research, but also as reflection tools by healthcare professionals, patients, and students to explore and assess SDM, and support its development in clinical care.

  • 8.
    Broström, Anders
    et al.
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology. Linköping University, Faculty of Medicine and Health Sciences. Jonkoping Univ, Sweden.
    Alimoradi, Zainab
    Qazvin Univ Med Sci, Iran.
    Lindh, Jonas
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Neurobiology. Linköping University, Faculty of Medicine and Health Sciences. Cty Hosp Ryhov, Sweden.
    Ulander, Martin
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Neurobiology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Lundin, Fredrik
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Neurobiology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Neurologiska kliniken i Linköping.
    Pakpour, Amir
    Jonkoping Univ, Sweden.
    Worldwide estimation of restless legs syndrome: a systematic review and meta-analysis of prevalence in the general adult population2023In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 32, no 3, article id e13783Article, review/survey (Refereed)
    Abstract [en]

    This systematic review, meta-analysis and meta-regression assessed the prevalence of restless legs syndrome (RLS) in the general adult population. Studies identified in Scopus, PubMed, Web of Science, and PsycInfo between January 2000 and February 2022 were included if they used a case-control or cross-sectional design and reported data regarding the prevalence of RLS. The protocol was pre-registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42022300709). A total of 97 studies including 483,079 participants from 33 different countries met the eligibility criteria. The Newcastle Ottawa Scale was used to evaluate the methodological quality, and the fill-and-trim method was used to correct probable publication bias, while the jack-knife method was performed to assess small study effect. The corrected overall pooled prevalence of RLS was 3% (95% confidence interval [CI] 1.4%-3.8%). The pooled prevalence of RLS syndrome was affected by methodological quality (no data from non-respondents in the included studies), gender (higher among women), study design (lower prevalence in case-control versus cohort and cross-sectional studies). The figures for corrected pooled prevalence among men, women, alcohol consumers and smokers were 2.8% (95% CI 2%-3.7%); 4.7% (95% CI 3.2%-6.3%); 1.4% (95% CI 0%-4.2%); and 2.7% (95% CI 0%-5.3%), respectively. The prevalence among male and female participants was lower in community-based versus non-community-based studies. Moreover, the prevalence was higher in developed versus developing countries and among elders versus adults. In conclusion, RLS is a common disorder in the general adult population, with a higher prevalence in women; however, prevalence data are affected by study design and quality.

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  • 9.
    Broström, Anders
    et al.
    Omvårdnad, Högskolan i Jönköping.
    Franzén Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ulander, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences.
    The side-effects to CPAP treatment inventory: the development and initial validation of a new tool for the measurement of side-effects to CPAP treatment2010In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 19, no 4, p. 603-611Article in journal (Refereed)
    Abstract [en]

    Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS), but side-effects are common. No validated self-rating scale measuring side-effects to CPAP treatment exists today. The aim was to develop the side-effects to CPAP treatment inventory (SECI), and investigate the validity and reliability of the instrument among patients with OSAS. SECI was developed on the basis of: (1) in-depth interviews with 23 patients; (2) examination of the scientific literature and (3) consensus agreement of a multi-professional expert panel. This yielded 15 different types of side-effects related to CPAP treatment. Each side-effect has three sub-questions (scales): perceived frequency (a) and magnitude (b) of the side-effect, as well as its perceived impact on CPAP use (c). A cross-sectional descriptive design was used. A total of 329 patients with OSAS with an average use of CPAP treatment for 39 months (2 weeks to 182 months) were recruited. Data were collected with SECI, and obtained from medical records (clinical variables and data related to CPAP treatment). Construct validity was confirmed with factor analysis (principal component analysis with orthogonal rotation). A logical two-factor solution, the device subscale and symptom subscale, emerged across all three scales. The symptom subscale describing physical and psychological side-effects and the device subscale described mask and device-related side-effects. Internal consistency reliability of the three scales was good (Cronbach’s α = 0.74–0.86) and acceptable for the subscales (Cronbach’s α = 0.62–0.86). The satisfactory measurement properties of this new instrument are promising and indicate that SECI can be used to measure side-effects to CPAP treatment.

  • 10.
    Broström, Anders
    et al.
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology. Jonkoping Univ, Sweden.
    Fridlund, Bengt
    Linnaeus Univ, Sweden.
    Fossum, Bjoorn
    Sophiahemmet Univ, Sweden; Soder Sjukhuset, Sweden.
    Pakpour, Amir
    Jonkoping Univ, Sweden; Qazvin Univ Med Sci, Iran.
    Nilsen, Per
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Ulander, Martin
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Neurobiology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Communication during the initial visit to a CPAP clinic Practitioners experiences of facilitators and barriers when talking to patients with obstructive sleep apnea2021In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 30, no 4, article id e13244Article in journal (Refereed)
    Abstract [en]

    Adherence to continuous positive airway pressure treatment for obstructive sleep apnea tends to be poor. Communication influences adherence but has not previously been investigated from a practitioner perspective, although shared decision-making is known to be of great importance. The aim was to describe how practitioners experience communication with patients with obstructive sleep apnea during the initial visit at a continuous positive airway pressure treatment clinic, with focus on facilitators and barriers related to the 4 Habits Model, a communication model comprised of four types of interrelated skills to make encounters more patient-centred: investing in the beginning; exploring the patient perspective; showing empathy; and investing in the end. A descriptive design with qualitative content analysis was used. A deductive analysis was carried out based on interviews with 24 strategically selected practitioners from seven continuous positive airway pressure treatment clinics. The 4 Habits Model was used as a framework for identifying facilitators and barriers to communication. Investments in the beginning was described as creating contact, showing the agenda and being adaptive, while explore the patient perspective included showing awareness, being explorative and creating a participating climate. Show empathy consisted of showing openness, being confirmative and creating acceptance, while showing a structured follow-up plan, being open minded and invitational and creating motivation to build on were descriptions of invest in the end. Awareness of potential facilitators and barriers for patient-centred communication during the beginning, middle and end of a continuous positive airway pressure treatment consultation can be used to improve contextual conditions and personal communication competences among practitioners working with continuous positive airway pressure treatment initiation.

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  • 11.
    Broström, Anders
    et al.
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology. Jonkoping Univ, Sweden.
    Pakpour, Amir H.
    Jonkoping Univ, Sweden; Qazvin Univ Med Sci, Iran.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Gardner, Benjamin
    Kings Coll London, England.
    Ulander, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Promoting CPAP adherence in clinical practice: A survey of Swedish and Norwegian CPAP practitioners beliefs and practices2018In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 27, no 6, article id UNSP e12675Article in journal (Refereed)
    Abstract [en]

    The benefits of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea are well established, but adherence tends to be low. Research exploring CPAP practitioners beliefs around determinants of CPAP adherence, and the actions they use in clinical practice to promote CPAP adherence is lacking. This study aimed to: (i) develop and validate a questionnaire to assess beliefs and current practices among CPAP practitioners; (ii) explore practitioners beliefs regarding the main determinants of patient adherence, and the actions practitioners most commonly use to promote CPAP adherence; and (iii) explore the associations between perceived determinants and adherence-promotion actions. One-hundred and forty-two CPAP practitioners in Sweden and Norway, representing 93% of all Swedish and 62% of all Norwegian CPAP centres, were surveyed via a questionnaire exploring potential determinants (18 items) and adherence-promotion actions (20 items). Confirmatory factor analysis and second-order structural equational modelling were used to identify patterns of beliefs, and potential associations with adherence-promotion actions. Patients knowledge, motivation and attitudes were perceived by practitioners to be the main determinants of CPAP adherence, and educating patients about effects, management and treatment adjustments were the most common practices. Knowledge was shown to predict educational and informational actions (e.g. education about obstructive sleep apnea and CPAP). Educational and informational actions were associated with medical actions (e.g. treatment adjustment), but knowledge, attitude and support had no association with medical actions. These findings indicate that a wide variety of determinants and actions are considered important, though the only relationship observed between beliefs and actions was found for knowledge and educational and informational actions.

  • 12.
    Broström, Anders
    et al.
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology. Department of Nursing, School of Healthand Welfare, Jönköping University, Sweden.
    Pakpour, Amir H.
    School of Healthand Welfare, Jönköping University, Sweden; Social Determinants of Health ResearchCenter, Qazvin University of MedicalSciences, Ira.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Hedberg, Berith
    Jönköping Academy for Health and Welfare, Jönköping University, Sweden; Region Jönköpings län, Futurum, Jönköping,Sweden.
    Ulander, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Validation of CollaboRATE and SURE - two short questionnaires to measure shared decision making during CPAP initiation.2019In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 28, no 5, article id UNSP e12808Article in journal (Refereed)
    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.

  • 13.
    Broström, Anders
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Mårtensson, Jan
    Jönköping.
    Ulander, Martin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Clinical Neurophysiology.
    Harder, Lena
    Svanborg, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Clinical Neurophysiology. Östergötlands Läns Landsting, Reconstruction Centre, Department of Neurophysiology UHL.
    Association of Type D personality to perceived side effects and adherence in CPAP-treated patients with OSAS2007In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 16, no 4, p. 439-447Article in journal (Refereed)
    Abstract [en]

    Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS), but side effects are common and long-term adherence low. The Type D (distressed) personality is defined as a combination of negative affectivity and social inhibition. The association of Type D personality with adherence has not been studied in CPAP-treated patients with OSAS. This study aimed 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. A cross-sectional descriptive design was used. A total of 247 OSAS patients with a mean use of CPAP treatment for 55 months (6-182 months) were included. Data collection was achieved by two questionnaires, the Type D scale 14 (DS14) (Type D personality), SECI (side effects of CPAP), as well as from medical records (clinical variables and objective adherence to CPAP treatment). Type D personality occurred in 30% of the patients with OSAS and significantly (P < 0.05-0.001) increased the perceived frequency and severity of a broad range of side effects. The objective adherence was significantly lower (P < 0.001) for OSAS patients with Type D compared to OSAS patients without Type D, both with regard to a mean use of 4 h per night and 85% of the self-rated sleep time per night. The additional effect of a Type D personality on perceived side effects and adherence to CPAP treatment found in this study could be used by healthcare personnel when evaluating patients waiting for treatment. © 2007 European Sleep Research Society.

  • 14.
    Broström, Anders
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ulander, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Neurophysiology UHL.
    Franzén Årestedt, Kristofer
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Nursing Science.
    The attitudes to CPAP treatment inventory: development and initial validation of a new tool for measuring attitudes to CPAP treatment2011In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 20, no 3, p. 460-471Article in journal (Refereed)
    Abstract [en]

    ontinuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS), but low adherence rates are common. The aim was to develop the attitudes to CPAP treatment inventory (ACTI), and to investigate the validity and reliability of the instrument among patients with OSAS. ACTI was developed on the basis of: (i) in-depth interviews with 23 patients; (ii) examination of the scientific literature; and (iii) consensus agreement of a multi-professional expert panel. This yielded five different types of attitudes to CPAP treatment. A prospective longitudinal design was used. Two-hundred and eighty-nine patients with OSAS were recruited at three different CPAP centres. Data were collected with ACTI and obtained from medical records. The homogeneity and internal consistency reliability were satisfactorily reflected by the item-total correlations (0.59-0.81) and Cronbachs alpha (0.89), respectively. Construct validity was confirmed with factor analysis (principal component analysis with orthogonal rotation; PCF). The PCF based on baseline data resulted in a one single-factor solution explaining 69% of the total variance. A confirmatory factor analysis was performed 2 weeks after CPAP initiation, resulting in the same factor solution. No indication of uniform differential item functioning was found. The predictive validity was tested with receiver operating characteristic analyses, and a cut-off of 10 on the ACTI gave a sensitivity of 93% and a specificity of 44% for CPAP termination within 6 months. The satisfactory measurement properties of this new pragmatic instrument are promising and indicate that ACTI can be useful in clinical practice to reliably measure attitudes to CPAP treatment.

  • 15.
    Engström, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Landtblom, Anne-Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Neurology. Linköping University, Center for Medical Image Science and Visualization (CMIV). Uppsala University, Sweden.
    Karlsson, Thomas
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    New hypothesis on pontine-frontal eye field connectivity in Kleine-Levin syndrome2016In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 25, no 6, p. 716-719Article in journal (Refereed)
    Abstract [en]

    Previous studies have indicated involvement of the thalamus and the pons in Kleine-Levin syndrome. In the present study, functional connectivity of the thalamus and the pons was investigated in asymptomatic patients with Kleine-Levin syndrome and healthy controls. Twelve patients and 14 healthy controls were investigated by functional magnetic resonance imaging during rest. Resting state images were analysed using seed regions of interest in the thalamus and the pons. The results showed significantly lower functional connectivity between the pons and the frontal eye field in persons with Kleine-Levin syndrome compared with healthy controls. There were no connectivity differences involving the thalamus. Based on these findings, a relation is proposed between the sleep disorder Kleine-Levin syndrome and cerebral control of eye movements, which in turn is related to visual attention and working memory. This hypothesis has to be tested in future studies of oculomotor control in Kleine-Levin syndrome.

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  • 16.
    Harder, Lena
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Sarberg, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Harder, Henrik
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Snoring during pregnancy and its relation to pre-eclampsia2008In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 17, no Supplements 1, p. 159-159Article in journal (Refereed)
    Abstract [en]

    Objective: Does snoring during pregnancy influence development of pre-eclampsia?

    Method: Five hundred and three pregnant women were presented a questionnaire concerning snoring, daytime sleepiness and edema. Epworth Sleepiness score (ESS) and symptoms of restless legs syndrome were also included. The questionnaire was presented in the 1st, 2nd and 3rd trimester and blood pressure was recorded. Women snoring often-always at visit 2 and/or 3 were denoted habitual snorers, those snoring never-seldom non-snorers and there was also a category occasional snorers. Habitual snorers were offered a sleep respiratory recording (Embletta); 34 volunteered.

    Results: 36/503 women (7,2%) snored habitually already at the first visit. At the end of pregnancy the fraction had increased to 19,5%. At the first visit BMI of habitual snorers was 25,3 compared to 22,9 for non-snorers (s.), but there was no difference concerning increase during pregnancy. Habitual snorers reported more edema at visit 2 and 3, higher scores in morning and daytime tiredness and ESS score compared to non-snorers at all visits (s.). Their systolic blood pressure increased more (s.) already between 1st and 2nd visit. Weight and Apgar scores of the newborns showed no difference. Pre-eclampsia developed in 18 women, twice as common among habitual snorers than in those snoring never-occasionally (n.s.). Their snoring scores were higher at all visits; the greatest difference at visit 3 (P50,058). Their diastolic pressure increased more already at the 2nd visit (s.), they had more edema and higher increase in BMI (s.). ESS and tiredness scores did not differ. 9/34 sleep recordings showed supine AHI 45. Two women who later developed pre-eclampsia were recorded; both had supine AHI 45.

    Conclusions: Habitual snorers had higher BMI from start, more daytime tiredness, higher ESS scores and their diastolic blood pressure increased more already during early pregnancy. Preeclampsia was twice as common among snorers as non-snorers; not significant due to the low number of cases. The relation between pre-eclampsia and snoring therefore remains elusive.

  • 17.
    Lin, Chung-Ying
    et al.
    Hong Kong Polytech Univ, Peoples R China.
    Cheng, Andy S. K.
    Hong Kong Polytech Univ, Peoples R China.
    Nejati, Babak
    Tabriz Univ Med Sci, Iran.
    Imani, Vida
    Tabriz Univ Med Sci, Iran.
    Ulander, Martin
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Neurobiology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Browall, Maria
    Jonkoping Univ, Sweden.
    Griffiths, Mark D.
    Nottingham Trent Univ, England.
    Broström, Anders
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology. Jonkoping Univ, Sweden.
    Pakpour, Amir H.
    Jonkoping Univ, Sweden; Qazvin Univ Med Sci, Iran.
    A thorough psychometric comparison between Athens Insomnia Scale and Insomnia Severity Index among patients with advanced cancer2020In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 29, no 1, article id e12891Article in journal (Refereed)
    Abstract [en]

    For patients with cancer, sleep disturbance is commonplace. Using classical test theory and Rasch analyses, the present study compared two commonly used psychometric instruments for insomnia - Athens Insomnia Scale and Insomnia Severity Index - among patients with advanced cancer. Through convenience sampling, patients with cancer at stage III or IV (n = 573; 326 males; mean age = 61.3 years; SD = 10.7) from eight oncology units of university hospitals in Iran participated in the study. All the participants completed the Athens Insomnia Scale, Insomnia Severity Index, Edmonton Symptom Assessment Scale, Hospital Anxiety and Depression Scale, General Health Questionnaire-12, Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index. Additionally, 433 participants wore an Actigraph device for two continuous weekdays. Classical test theory and Rasch analysis both supported the construct validity for Athens Insomnia Scale (factor loadings from confirmatory factor analysis = 0.61-0.87; test-retest reliability = 0.72-0.82; infit mean square = 0.81-1.17; outfit MnSq = 0.79-1.14) and for Insomnia Severity Index (factor loadings from confirmatory factor analysis = 0.61-0.81; test-retest reliability = 0.72-0.82; infit mean square = 0.72-1.14; outfit mean square = 0.76-1.11). Both Athens Insomnia Scale and Insomnia Severity Index had significant associations with Edmonton Symptom Assessment Scale, Hospital Anxiety and Depression Scale, General Health Questionnaire-12, Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index, as well as having good sensitivity and specificity. Significant differences in the actigraphy measure were found between insomniacs and non-insomniacs based on Athens Insomnia Scale or Insomnia Severity Index score. With promising results, healthcare providers can use either Athens Insomnia Scale or Insomnia Severity Index to understand the insomnia of patients with advanced cancer.

  • 18. Lowden, A
    et al.
    Akerstedt, T
    Wibom, Roger
    Linköping University, The Institute of Technology. Linköping University, Department of Management and Engineering, Industrial ergonomics .
    Suppression of sleepiness and melatonin by bright light exposure during breaks in night work2004In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 13, no 1, p. 37-43Article in journal (Refereed)
    Abstract [en]

    Night work is non-optimal for performance and recuperation because of a lack of circadian influence that fully promote a night orientation. Our study assessed, in an industrial setting, the effects of bright light exposure (BL) on sleepiness, sleep and melatonin, during night work and during the following readaptation to day work. In a crossover design, 18 workers at a truck production plant were exposed to either BL (2500 lx) during breaks or normal light during four consecutive weeks. Twenty minute breaks were initiated by 67% of the workers between 03:00 and 04:00 hours. Sleep/wake patterns were assessed through actigraphs and ratings were given in a sleep/wake diary. Saliva melatonin was measured at 2-h intervals before, during and after night shift weeks. A significant interaction demonstrated a reduction of sleepiness in the BL condition particularly on the first two nights at 04:00 and 06:00 hours. Day sleep in the BL condition was significantly lengthened. Bright light administration significantly suppressed melatonin levels during night work and most strongly at 02:00 hours. Daytime melatonin during the readaptation after night work remained unaffected. The present findings demonstrate the feasibility and benefits of photic stimulation in industrial settings to increase adaptation to night work.

  • 19.
    Merikanto, Ilona
    et al.
    Univ Helsinki, Finland; Finnish Inst Hlth & Welf, Finland; Orton Orthopaed Hosp, Finland.
    Dauvilliers, Yves
    Univ Montpellier, France.
    Chung, Frances
    Univ Hlth Network, Canada.
    Wing, Yun Kwok
    Chinese Univ Hong Kong, Peoples R China.
    De Gennaro, Luigi
    Sapienza Univ Rome, Italy; IRCCS Fdn Santa Lucia, Italy.
    Holzinger, Brigitte
    Med Univ Vienna, Austria.
    Bjorvatn, Bjorn
    Univ Bergen, Norway; Haukeland Hosp, Norway.
    Morin, Charles M.
    Univ Laval, Canada.
    Penzel, Thomas
    Charite, Germany.
    Benedict, Christian
    Uppsala Univ, Sweden.
    Bjelajac, Adrijana Koscec
    Inst Med Res & Occupat Hlth, Croatia.
    Chan, Ngan Yin
    Chinese Univ Hong Kong, Peoples R China.
    Espie, Colin A.
    Univ Oxford, England.
    Hrubos-Strom, Harald
    Akershus Univ Hosp, Norway; Univ Oslo, Norway.
    Inoue, Yuichi
    Tokyo Med Univ, Japan; Japan Somnol Ctr, Japan.
    Korman, Maria
    Ariel Univ, Israel.
    Landtblom, Anne-Marie
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Neurobiology. Linköping University, Faculty of Medicine and Health Sciences. Uppsala Univ, Sweden.
    Leger, Damien
    Hop Hotel Dieu de Paris, France; Univ Paris, France.
    Matsui, Kentaro
    Natl Ctr Hosp, Japan.
    Mota-Rolim, Sergio
    Univ Fed Rio Grande do Norte, Brazil; Univ Fed Rio Grande do Norte, Brazil.
    Nadorff, Michael R.
    Mississippi State Univ, MS 39762 USA.
    Plazzi, Giuseppe
    IRCCS Ist Sci Neurol Bologna, Italy; Univ Modena & Reggio Emilia, Italy.
    Reis, Catia
    Univ Catolica Portuguese, Portugal; Univ Lisbon, Portugal; Univ Lisbon, Portugal.
    Yordanova, Juliana
    Bulgarian Acad Sci, Bulgaria.
    Partinen, Markku
    Univ Helsinki, Finland; Terveystalo Healthcare, Finland.
    Sleep symptoms are essential features of long-COVID - Comparing healthy controls with COVID-19 cases of different severity in the international COVID sleep study (ICOSS-II)2023In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 32, no 1, article id e13754Article in journal (Refereed)
    Abstract [en]

    Many people report suffering from post-acute sequelae of COVID-19 or "long-COVID", but there are still open questions on what actually constitutes long-COVID and how prevalent it is. The current definition of post-acute sequelae of COVID-19 is based on voting using the Delphi-method by the WHO post-COVID-19 working group. It emphasizes long-lasting fatigue, shortness of breath and cognitive dysfunction as the core symptoms of post-acute sequelae of COVID-19. In this international survey study consisting of 13,628 subjects aged 18-99 years from 16 countries of Asia, Europe, North America and South America (May-Dec 2021), we show that post-acute sequelae of COVID-19 symptoms were more prevalent amongst the more severe COVID-19 cases, i.e. those requiring hospitalisation for COVID-19. We also found that long-lasting sleep symptoms are at the core of post-acute sequelae of COVID-19 and associate with the COVID-19 severity when COVID-19 cases are compared with COVID-negative cases. Specifically, fatigue (61.3%), insomnia symptoms (49.6%) and excessive daytime sleepiness (35.8%) were highly prevalent amongst respondents reporting long-lasting symptoms after hospitalisation for COVID-19. Understanding the importance of sleep-related symptoms in post-acute sequelae of COVID-19 has a clinical relevance when diagnosing and treating long-COVID.

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  • 20.
    Smith, Stephanie
    et al.
    Edith Cowan Univ, Australia; Perth Childrens Hosp, Australia.
    Tallon, Mary
    Curtin Univ, Australia.
    Smith, James
    Edith Cowan Univ, Australia; Macquarie Univ, Australia.
    Angelhoff, Charlotte
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Children's and Women's Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, H.K.H. Kronprinsessan Victorias barn- och ungdomssjukhus.
    Morelius, Evalotte
    Edith Cowan Univ, Australia; Perth Childrens Hosp, Australia.
    Parental sleep when their child is sick: A phased principle-based concept analysis2022In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 31, no 5, article id e13575Article, review/survey (Refereed)
    Abstract [en]

    Sleep is a common challenge for parents with sick children and can impact parents health, wellbeing, and caregiving responsibilities. Despite the vast research around parental sleep when their child is sick, the concept is not clearly defined. A phased principle-based concept analysis that includes triangulation of methods and quality criteria assessment was used to explore how the concept is described, used, and measured in the current literature. The aim was to analyse and clarify the conceptual, operational, and theoretical basis of parental sleep when their child is sick to produce an evidence-based definition and to identify knowledge gaps. A systematic literature search including databases CINAHL, Embase, MEDLINE, PsychARTICLES, PsychINFO, Pubmed, Scopus and Web of Science, identified 546 articles. The final dataset comprised 74 articles published between 2005 and 2021 and was assessed using a criteria tool for principle-based concept analysis. Data were managed using NVivo, and thematic analysis was undertaken. A precise definition is not present in the literature. Various tools have been used to measure parents sleep, as well as exploration via interviews, open-ended questions, and sleep diaries. The terminology used varied. Parental sleep when their child is sick is interrelated with other concepts (e.g., stress). A recommended definition is offered. A conceptual understanding of parental sleep when their child is sick will help to guide translational research and to conduct studies critical to clinical practice and research. Future research includes developing a measurement tool for parental sleep when their child is sick to be used in study design and future interventions.

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  • 21.
    Store, Siri Jakobsson
    et al.
    Karlstad Univ, Sweden.
    Tillfors, Maria
    Karlstad Univ, Sweden.
    Wästlund, Erik
    Karlstad Univ, Sweden.
    Angelhoff, Charlotte
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Children's and Women's Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, H.K.H. Kronprinsessan Victorias barn- och ungdomssjukhus.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Biomedical and Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology. Karolinska Inst, Sweden.
    Norell-Clarke, Annika
    Karlstad Univ, Sweden; Kristianstad Univ, Sweden.
    The effects of a sleep robot intervention on sleep, depression and anxiety in adults with insomnia - A randomized waitlist-controlled trial2023In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 32, no 3, article id e13758Article in journal (Refereed)
    Abstract [en]

    The study objective was to assess if a 3-week intervention with the Somnox sleep robot had effects on symptoms of insomnia, somatic arousal, and/or concurrent symptoms of depression and anxiety in adults with insomnia, compared with a waitlist-control group. The participants (n = 44) were randomized to a 3-week intervention with the sleep robot (n = 22), or to a waitlist-control group (n = 22). The primary outcome measure was the Insomnia Severity Index administered at baseline, mid-intervention, post-intervention and at 1-month follow-up. Secondary outcome measures were the Pre-Sleep Arousal Scale, and the Hospital Anxiety and Depression Scale. Additionally, sleep-onset latency, wake time after sleep onset, total sleep time and sleep efficiency were measured the week prior to and the last week of the intervention, both subjectively with the Consensus Sleep Diary and objectively with wrist actigraphy. Mixed-effects models were used to analyse data. The effect of the sleep robot on the participants insomnia severity was not statistically significant. The differences between the intervention group and the control group on the measures of arousal, anxiety and depression were also not statistically significant, and neither were the sleep diary and actigraphy variables. In conclusion, a 3-week intervention with daily at-home use of the robot was not found to be an effective method to relieve the symptom burden in adults with insomnia.

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  • 22.
    Ulander, Martin
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Neurobiology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Hedner, Jan
    Sahlgrens Univ Hosp, Sweden; Gothenburg Univ, Sweden.
    Stillberg, Göran
    Capio Lakargruppen, Sweden.
    Sunnergren, Ola
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Sensory Organs and Communication. Linköping University, Faculty of Medicine and Health Sciences.
    Grote, Ludger
    Sahlgrens Univ Hosp, Sweden; Gothenburg Univ, Sweden.
    Correlates of excessive daytime sleepiness in obstructive sleep apnea: Results from the nationwide SESAR cohort including 34,684 patients2022In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 31, no 6, article id e13690Article in journal (Refereed)
    Abstract [en]

    Excessive daytime sleepiness (EDS) is a hallmark symptom in obstructive sleep apnea (OSA). It is commonly eliminated by obstructive sleep apnea therapy and constitutes a major treatment indication. This study aimed to identify determinants of excessive daytime sleepiness by the Epworth Sleepiness Scale (ESS) scores in the large, representative national obstructive sleep apnea patient cohort of the Swedish Sleep Apnea Registry (SESAR, ). Data from 34,684 patients with obstructive sleep apnea recruited at 23 sites (33% females, mean age 55.7 +/- 13.7 years, BMI 30.2 +/- 6.3 kg/m(2), AHI 29.1 +/- 22.3, and ODI 24.9 +/- 21.4 events/h) had a mean ESS score in the mild to moderate excessive daytime sleepiness range (9.7 +/- 4.9). The proportion of patients with excessive daytime sleepiness was 41.4% in men and 44.6% in women. Independent predictors of excessive daytime sleepiness included gender, age, and hypoxic markers (high ODI and low mean saturation). Univariate and multivariate analyses were used to identify significant predictors for the ESS score and for excessive daytime sleepiness (ESS &gt;= 10) amongst anthropometric factors, sleep apnea frequency (apnea-hypopnea index (AHI)), markers of intermittent hypoxia (oxygen desaturation index (ODI), mean saturation (mSaO(2))), as well as prevalent comorbidities. Depression was associated with higher ESS scores and hypertension/atrial fibrillation with lower scores. The oxygen desaturation index provided a stronger predictor of excessive daytime sleepiness than the apnea-hypopnea index. The severity of obstructive sleep apnea, captured as the apnea-hypopnea index, was only weakly associated with daytime sleepiness in this representative obstructive sleep apnea patient cohort. Age had different effects in men and women.The impact of obstructive sleep apnea in a wider patient related perspective needs to be determined after the inclusion of factors other than the apnea-hypopnea index.

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  • 23.
    Watling, Christopher N.
    et al.
    Queensland University of Technology, Australia; Stockholm University, Sweden.
    Akerstedt, Torbjorn
    Stockholm University, Sweden; Karolinska Institute, Sweden.
    Kecklund, Goran
    Stockholm University, Sweden; Radboud University of Nijmegen, Netherlands.
    Anund, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine. Swedish National Rd and Transport Research Institute, Linkoping, Sweden.
    Do repeated rumble strip hits improve driver alertness?2016In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 25, no 2, p. 241-247Article in journal (Refereed)
    Abstract [en]

    Driving while sleepy is associated with increased crash risk. Rumble strips are designed to alert a sleepy or inattentive driver when they deviate outside their driving lane. The current study sought to examine the effects of repeated rumble strip hits on levels of physiological and subjective sleepiness as well as simulated driving performance. In total, 36 regular shift workers drove a high-fidelity moving base simulator on a simulated road with rumble strips installed at the shoulder and centre line after a working a full night shift. The results show that, on average, the first rumble strip occurred after 20min of driving, with subsequent hits occurring 10min later, with the last three occurring approximately every 5min thereafter. Specifically, it was found that the first rumble strip hit reduced physiological sleepiness; however, subsequent hits did not increase alertness. Moreover, the results also demonstrate that increased subjective sleepiness levels, via the Karolinska Sleepiness Scale, were associated with a greater probability of hitting a rumble strip. The present results suggest that sleepiness is very resilient to even strongly arousing stimuli, with physiological and subjective sleepiness increasing over the duration of the drive, despite the interference caused by rumble strips.

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