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  • 1.
    Broström, Anders
    et al.
    Omvårdnad, Högskolan i Jönköping.
    Franzén Årestedt, Kristofer
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Hälsouniversitetet.
    Strömberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet.
    Svanborg, Eva
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet.
    The side-effects to CPAP treatment inventory: the development and initial validation of a new tool for the measurement of side-effects to CPAP treatment2010Ingår i: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 19, nr 4, s. 603-611Artikel i tidskrift (Refereegranskat)
    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.

  • 2.
    Broström, Anders
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Fridlund, B
    Jonköping University, Sweden .
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet.
    Sunnergren, O
    County Hospital Ryhov, Sweden .
    Svanborg, Eva
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Effects of a group-based educational programme on adherence to CPAP treatment in obstructive sleep apnoea in JOURNAL OF SLEEP RESEARCH, vol 21, issue SI, pp 348-3482012Ingår i: JOURNAL OF SLEEP RESEARCH, Wiley-Blackwell , 2012, Vol. 21, nr SI, s. 348-348Konferensbidrag (Refereegranskat)
    Abstract [en]

    n/a

  • 3.
    Broström, Anders
    et al.
    Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US. Jönköping University, Sweden.
    Fridlund, Bengt
    Jönköping University, Sweden.
    Hedberg, Berith
    Jönköping Academic Qual Improvement and Leadership Heatlh, Sweden.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US.
    Communication between patients with obstructive sleep apnoea syndrome and healthcare personnel during the initial visit to a continuous positive airway pressure clinic2017Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, nr 3-4, s. 568-577Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 4.
    Broström, Anders
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Fridlund, Bengt
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Sunnergren, Ola
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet.
    Svanborg, Eva
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi.
    A mixed method evaluation of a group-based educational programme for CPAP use in patients with obstructive sleep apnea2013Ingår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 19, nr 1, s. 173-184Artikel i tidskrift (Refereegranskat)
    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.

  • 5.
    Broström, Anders
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Gardner, Benjamin
    University College London, UK.
    Johansson, Peter
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Fridlund, Bengt
    Jönköping University, Sweden.
    Arestedt, Kristofer
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet. Linnaeus University & Palliative Research Centre, Ersta Sköndal University College and Ersta Hospital, Stockholm.
    Validation of the CPAP Habit Index-5: A Tool to Understand Adherence to CPAP Treatment in Patients with Obstructive Sleep Apnea.2014Ingår i: Sleep Disorders, ISSN 2090-3545, E-ISSN 2090-3553, Vol. 2014, s. 1-9, artikel-id 929057Artikel i tidskrift (Refereegranskat)
    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.

  • 6.
    Broström, Anders
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet.
    Johansson, P
    n/a.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet.
    Strömberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Swahnborg, E
    n/a.
    Fridlund, B
    n/a.
    Adherence to CPAP treatment - a qualitative contnt analysis in patients with OSAS.2009Ingår i: 9th Annual Spring Meeting on Cardiovascular Nursing, CCNAP., 2009Konferensbidrag (Refereegranskat)
  • 7.
    Broström, Anders
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Johansson, Peter
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet.
    Strömberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Svanborg, Eva
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Rekonstruktionscentrum, Neurofysiologiska kliniken US.
    Fridlund, Bengt
    Jonköping University.
    Putative facilitators and barriers for adherence to CPAP treatment in patients with obstructive sleep apnea syndrome: A qualitative content analysis2010Ingår i: SLEEP MEDICINE, ISSN 1389-9457, Vol. 11, nr 2, s. 126-130Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Effective treatment of obstructive sleep apnea syndrome (OSAS) with continuous positive airway pressure (CPAP) can reduce morbidity and mortality, but adherence rates are low without a clear consensus Of causes. Objective: To explore the experiences of adherence to CPAP treatment in patients with OSAS. Methods: A qualitative content analysis was employed. Data were collected by in-depth interviews with 23 purposively selected patients. Results: Adherence to CPAP treatment was summarized according to "facilitators" and "barriers" to CPAP treatment. Facilitators for adherence, as described by the patients were a desire to avoid symptoms, knowledge about the risk for medical consequences, fear of negative social consequences and disturbing the sleep of significant others. Other facilitators were a positive attitude to CPAP treatment, trust in healthcare personnel, a sense of engagement from the spouse and a feeling of physical improvement. Barriers included experiencing practical problems, negative psychological effects of the equipment, and negative attitudes to the treatment. Other barriers were side-effects as well as insufficient support from healthcare personnel and the spouse. Conclusion: Adherence to CPAP treatment is a multifaceted problem including patient, treatment, condition, social and healthcare related factors. Knowledge about facilitators and barriers for adherence to CPAP treatment can be used in interventional Strategies.

  • 8.
    Broström, Anders
    et al.
    Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US. Department of Nursing, School of Health and Welfare, Sweden.
    Pakpour, A. H.
    Department of Nursing, School of Health and Welfare, Sweden; Social Determinants of Health Research Center Qazvin, Iran.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Fridlund, B.
    CICE Linneus University, Sweden.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US.
    Psychometric properties of the Ethos Brief Index (EBI) using factorial structure and Rasch Analysis among patients with obstructive sleep apnea before and after CPAP treatment is initiated.2019Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 23, nr 3, s. 761-768Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 9.
    Broström, Anders
    et al.
    Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US. Jonkoping Univ, Sweden.
    Pakpour, Amir H.
    Jonkoping Univ, Sweden; Qazvin Univ Med Sci, Iran.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Gardner, Benjamin
    Kings Coll London, England.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US.
    Promoting CPAP adherence in clinical practice: A survey of Swedish and Norwegian CPAP practitioners beliefs and practices2018Ingår i: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 27, nr 6, artikel-id UNSP e12675Artikel i tidskrift (Refereegranskat)
    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.

  • 10.
    Broström, Anders
    et al.
    Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US. 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
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Hedberg, Berith
    Jönköping Academy for Health and Welfare, Jönköping University, Sweden; Region Jönköpings län, Futurum, Jönköping,Sweden.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US.
    Validation of CollaboRATE and SURE - two short questionnaires to measure shared decision making during CPAP initiation.2019Ingår i: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 28, nr 5, artikel-id UNSP e12808Artikel i tidskrift (Refereegranskat)
    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.

  • 11.
    Broström, Anders
    et al.
    Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US. Jonkoping Univ, Sweden.
    Pakpour, Amir H.
    Jonkoping Univ, Sweden; Qazvin Univ Med Sci, Iran.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Development and psychometric evaluation of the Swedish propensity to achieve healthy lifestyle scale in patients with hypertension2018Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, nr 21-22, s. 4040-4049Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PurposeTo develop and validate a Swedish questionnaire to measure propensity for behaviour change regarding food habits, physical activity and weight reduction in patients with hypertension. DesignCross-sectional design. MethodsA total of 270 consecutive patients with hypertension diagnosed at four primary care centres in Sweden were included. The 6-item Swedish version of the Propensity to Achieve Healthy Lifestyle Scale (PAHLS) was developed to measure propensity for behaviour change regarding food habits, physical activity and weight reduction. The PAHLS (i.e., including three items for preparedness and three items for capacity) was developed by three multiprofessional researchers inspired by the transtheoretical model of behaviour change in collaboration with clinically active nurses. Data were collected by questionnaires on food habits (i.e., the Food Frequency Questionnaire), physical activity (the International Physical Activity Questionnaire), propensity for a healthy lifestyle (the PHLQ), as well as during a clinical examination. Exploratory (EFA) and confirmatory factor analyses (CFA), as well as Rasch analysis, were used. ResultsOf the 270 patients (50% women), 27% scored low levels of physical activity on the International Physical Activity Questionnaire, and 34% of the patients were obese (body mass index 30kg/m(2)). The EFA (explaining 54% of the variance) showed unidimensionality for the PAHLS that was supported by both CFA and Rasch analyses. No floor and 1.9% ceiling effects were found. Multiple group CFA (an extension of structural equationmodelling) showed that the PAHLS operated equivalently across both male and female patients. Internal consistency (Cronbachs alpha 0.83) and composite reliability (0.89) were good. ConclusionThe initial testing of PAHLS provided good validity and reliability scores to measure propensity for behaviour change in patients with hypertension. Relevance to Clinical PracticeThe PAHLS can be used by nurses as a tool to simplify shared decision-making in relation to behavioural changes.

  • 12.
    Broström, Anders
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Strömberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Mårtensson, Jan
    Jönköping.
    Ulander, Martin
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Klinisk Neurofysiologi.
    Harder, Lena
    Svanborg, Eva
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Klinisk Neurofysiologi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Neurofysiologiska kliniken US.
    Association of Type D personality to perceived side effects and adherence in CPAP-treated patients with OSAS2007Ingår i: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 16, nr 4, s. 439-447Artikel i tidskrift (Refereegranskat)
    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.

  • 13.
    Broström, Anders
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Klinisk Neurofysiologi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Neurofysiologiska kliniken US.
    Strömberg, Anna
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Omvårdnad. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Ulander, Martin
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Klinisk Neurofysiologi.
    Fridlund, B
    Mårtensson, J
    Svanborg, Eva
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Klinisk Neurofysiologi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Neurofysiologiska kliniken US.
    Informational needs, side effects and their consequences on adherence: A comparison between swedish healthcare professionals and CPAP-treated patients with obstructive sleep apnoea syndrome2007Ingår i: World Sleep 07,2007, 2007, s. 141-141Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

       

  • 14.
    Broström, Anders
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Strömberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet.
    Fridlund, Bengt
    Vaxjö University.
    Martensson, Jan
    Jönköping University.
    Svanborg, Eva
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Rekonstruktionscentrum, Neurofysiologiska kliniken US.
    Perceived informational needs, side-effects and their consequences on adherence-A comparison between CPAP treated patients with OSAS and healthcare personnel2009Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 74, nr 2, s. 228-235Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To compare perceptions among continuous positive airway pressure (CPAP) treated patients with obstructive sleep apnoea syndrome (OSAS) and healthcare personnel with regard to informational needs, side-effects and their consequences on adherence.

    Methods: A cross-sectional descriptive design was used including 350 CPAP treated OSAS patients from three Swedish hospitals and 105 healthcare personnel from 26 Swedish hospitals. Data collection was performed using two questionnaires covering informational needs, side-effects and adherence to CPAP.

    Results: Both groups perceived all surveyed informational areas as very important. Patients perceived the possibilities to learn as significantly greater in all areas (p < 0.001) compared to healthcare personnel, and scored significantly higher regarding positive effects on adherence of information about pathophysiology (p < 0.05), self-care (p < 0.001) and troubleshooting (p < 0.01). A total of I I out of 15 surveyed side-effects were perceived to be more frequent by healthcare personnel (p < 0.01 - p < 0.001). They also scored all side-effects to cause greater problems and decrease the CPAP use to a greater extent (p < 0.001).

    Conclusion: Knowledge about these differences between patients and healthcare personnel regarding educational needs, side-effects and their effects on adherence can be important when designing educational programmes to increase CPAP adherence.

    Practice implications: Measurement of these parameters before, during and after educational programs are suggested.

  • 15.
    Broström, Anders
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurofysiologi.
    Strömberg, Anna
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Omvårdnad. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Ulander, Martin
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Klinisk Neurofysiologi.
    Mårtensson, J
    Svanborg, Eva
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Klinisk Neurofysiologi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Neurofysiologiska kliniken US.
    Association of type D personality to perceived side effects and adherence in CPAP-treated patients with obstructive sleep apnoea syndrome2007Ingår i: World Sleep 07,2007, 2007, s. 142-142Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

      

  • 16.
    Broström, Anders
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Sunnergren, O
    County Hospital Ryhov, Sweden .
    Johansson, P
    Östergötlands Läns Landsting.
    Svensson, E
    Swedish Defence Research Agency, Sweden .
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Svanborg, Eva
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Symptoms among hypertensive patients with undiagnosed obstructive sleep apnoea in primary care - a structural equation model analysis in JOURNAL OF SLEEP RESEARCH, vol 21, issue SI, pp 230-2302012Ingår i: JOURNAL OF SLEEP RESEARCH, Wiley-Blackwell , 2012, Vol. 21, nr SI, s. 230-230Konferensbidrag (Refereegranskat)
    Abstract [en]

    n/a

  • 17.
    Broström, Anders
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Sunnergren, Ola
    Ryhov County Hospital, Jönköping, Sweden.
    Franzén Årestedt, Kristofer
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Johansson, Peter
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet.
    Riegel, Barbara
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet. University of Pennsylvania School of Nursing, Philadelphia, USA.
    Svanborg, Eva
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Factors associated with undiagnosed obstructive sleep apnoea in hypertensive primary care patients2012Ingår i: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 30, nr 2, s. 107-113Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. In hypertensive primary care patients below 65 years of age, (i) to describe the occurrence of undiagnosed obstructive sleep apnoea (OSA), and (ii) to identify the determinants of moderate/severe OSA. Design. Cross-sectional. Setting. Four primary care health centres in Sweden. Patients. 411 consecutive patients (52% women), mean age 57.9 years (SD 5.9 years), with diagnosed and treated hypertension (BP andgt; 140/90). Main outcome measures. Occurrence of OSA as measured by the apnoea hypopnoea index (AHI). Results. Mild (AHI 5-14.9/h) and moderate/severe (AHI andgt; 15/h) OSA were seen among 29% and 30% of the patients, respectively. Comparing those without OSA with those with mild or moderate/severe OSA, no differences were found in blood pressure, pharmacological treatment (anti-hypertensive, anti-depressive, and hypnotics), sleep, insomnia symptoms, daytime sleepiness, or depressive symptoms. Obesity (BMI andgt; 30 kg/m(2)) was seen in 30% and 68% of the patients with mild and moderate/severe OSA, respectively. Male gender, BMI andgt; 30 kg/m(2), snoring, witnessed apnoeas, and sleep duration andgt; 8 hours were determinants of obstructive sleep apnoea. Conclusion. Previously undiagnosed OSA is common among patients with hypertension in primary care. Obesity, snoring, witnessed apnoeas, long sleep duration, and male gender were the best predictors of OSA, even in the absence of daytime sleepiness and depressive symptoms.

  • 18.
    Broström, Anders
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Sunnergren, Ola
    Länssjukhuset Ryhov, Jönköping.
    Johansson, Peter
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Svensson, Erland
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi.
    Svanborg, Eva
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Symptom profile of undiagnosed obstructive sleep apnoea in hypertensive outpatients in primary care: a structural equation model analysis2012Ingår i: Quality in Primary Care, ISSN 1479-1072, E-ISSN 1479-1064, Vol. 20, nr 4, s. 287-298Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:

    Obstructive sleep apnoea (OSA) has been linked to hypertension in sleep clinic populations, but little is known about the symptom profile of undiagnosed OSA in hypertensive outpatients in primary care.

    AIM:

    To explore characteristics associated with undiagnosed  OSA in hypertensive primary care patients.

    METHODS:

    Cross-sectional design, including 411 consecutive patients (52% women), mean age 57.9 years (standard deviation [SD] 5.9 years), with diagnosed hypertension (blood pressure >140/90 mmHg) from four primary care centres. All subjects  underwent a full-night, home-based, respiratory recording to establish the presence and severity of OSA. Clinical variables, medication and comorbidities, as well as data from self-rating scales regarding symptoms/characteristics, insomnia, excessive daytime sleepiness, depressive symptoms  and health were collected during a clinical examination. Factor analyses and structural equation modelling (SEM) were used to explore the relationships between self-rated symptoms, clinical characteristics and objectively verified diagnosis of OSA. Main outcome: Measures symptom  profile of undiagnosed OSA (as measured by the Apnoea/Hypopnoea Index [AHI]) in hypertensive outpatients in primary care.

    RESULTS:

    Fifty-nine percent of the patients had an AHI ≥ 5/hour indicating OSA. An exploratory factor analysis based on 19 variables yielded a six-factor model  (anthropometrics, blood pressure, OSA-related symptoms, comorbidity, health complaints and physical activity) explaining 58% of the variance. SEM analyses showed strong significant associations between anthropometrics (body mass index, neck circumference, waist circumference) (0.45), OSA-related  symptoms (snoring, witnessed apnoeas, dry mouth) (0.47) and AHI. No direct effects of OSA on comorbidities, blood pressure, dyssomnia or self-rated health were observed.

    CONCLUSION:

    OSA was highly prevalent and was directly associated with anthropometrics and OSA-related symptoms  (snoring, witnessed apnoeas and dry mouth in the morning). When meeting patients with hypertension, these characteristics could be used by general practitioners to identify patients who are in need of referral to a sleep clinic for OSA evaluation.

  • 19.
    Broström, Anders
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Sunnergren, Ola
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Fridlund, Bengt
    Department of Nursing Science, School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Svanborg, Eva
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Gender differences in respiratory disturbance, sleep and daytime sleepiness in hypertensive patients with different degrees of obesity2013Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, nr 2, s. 140-149Artikel i tidskrift (Refereegranskat)
    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.

  • 20.
    Broström, Anders
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Svanborg, Eva
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Franzén Årestedt, Kristofer
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad.
    The attitudes to CPAP treatment inventory: development and initial validation of a new tool for measuring attitudes to CPAP treatment2011Ingår i: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 20, nr 3, s. 460-471Artikel i tidskrift (Refereegranskat)
    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.

  • 21.
    Broström, Anders
    et al.
    Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US. Department of Nursing, School of Health and Welfare, Jönköping University, Sweden.
    Wahlin, Ake
    Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden.
    Alehagen, Urban
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US.
    Johansson, Peter
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin.
    Sex-Specific Associations Between Self-reported Sleep Duration, Cardiovascular Disease, Hypertension, and Mortality in an Elderly Population.2018Ingår i: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 33, nr 5, s. 422-428Artikel i tidskrift (Refereegranskat)
    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.

  • 22.
    Broström, Anders
    et al.
    Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US. Jonkoping Univ, Sweden.
    Wahlin, Ake
    Jonkoping Univ, Sweden.
    Alehagen, Urban
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US.
    Johansson, Peter
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin.
    Sex-specific associations between self-reported sleep duration, depression, anxiety, fatigue and daytime sleepiness in an older community-dwelling population2018Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, nr 1, s. 290-298Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PurposeThe purpose of this study was to explore whether associations between self-reported sleep duration, depressive symptoms, anxiety, fatigue and daytime sleepiness differed in older community-dwelling men and women. DesignCross-sectional. MethodsA community-dwelling sample of 675 older men and women (mean age 77.7years, SD 3.8years) was used. All participants underwent a clinical examination by a cardiologist. Validated questionnaires were used to investigate sleep duration, depressive symptoms, anxiety, fatigue and daytime sleepiness. Subjects were divided into short sleepers (6hours), n=231; normal sleepers (7-8hours), n=338; and long sleepers (9hours), n=61. ancovas were used to explore sex-specific effects. ResultsDepressive symptoms were associated with short sleep in men, but not in women. Fatigue was associated with both short and long sleep duration in men. No sex-specific associations of sleep duration with daytime sleepiness or anxiety were found. ConclusionNurses investigating sleep duration and its correlates, or effects, in clinical practice need to take sex into account, as some associations may be sex specific. Depressive symptoms and fatigue can be used as indicators to identify older men with sleep complaints.

  • 23.
    Eleftheriou, Andreas
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US.
    Lundin, Fredrik
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    Circadian rhythm in idiopathic normal pressure hydrocephalus2018Ingår i: Clinical neurology and neurosurgery (Dutch-Flemish ed. Print), ISSN 0303-8467, E-ISSN 1872-6968, Vol. 164, s. 72-74Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: The pathogenesis of idiopathic normal pressure hydrocephalus (iNPH) takes place in structures close to the cerebral ventricular system. Suprachiasmatic nucleus (SCN), situated close to the third ventricle, is involved in circadian rhythm. Diurnal disturbances are well-known in demented patients. The cognitive decline in iNPH is potentially reversible after a shunt operation. Diurnal rhythm has never been studied in iNPH. We hypothesize that there is a disturbance of circadian rhythm in iNPH-patients and the aim was to study any changes of the diurnal rhythm (mesor and circadian period) as well as any changes of the diurnal amplitude and acrophase of the activity in iNPH-patients before and after a shunt operation. Patients and methods: Twenty consecutive iNPH-patients fulfilling the criteria of the American iNPH-guidelines, 9 males and 11 females, mean age 73 (49-81) years were included. The patients underwent a pre-operative clinical work-up including 10 m walk time (w10mt) steps (w10 ms), TUG-time (TUGt) and steps (TUGs) and for cognitive function an MMSE score was measured. In order to receive circadian rhythm data actigraphic recordings were performed using the SenseWear 2 (BodyMedia Inc Pittsburgh, PA, USA) actigraph. Cosinor analyses of accelerometry data were performed in "R" using non-linear regression with Levenburg-Marquardt estimation. Pre- and post-operative data regarding mesor, amplitude and circadian period were compared using Wilcoxon-Mann-Whitney test for paired data. Results: Twenty patients were evaluated before and three month post-operatively. Motor function (w10mt, w10 ms, TUGt, TUGs) was significantly improved while MMSE was not significantly changed. Actigraphic measurements (mesor, amplitude and circadian period) showed no significant changes after shunt operation. Conclusion: This is the first systematic study of circadian rhythm in iNPH-patients. We found no significant changes in circadian rhythm after shunt surgery. The conceptual idea of diurnal rhythm changes in hydrocephalus is still interesting from a theoretical standpoint and warrants further studies that could include a combination of better designed actigraphic studies in combination with neuroendocrine markers and imaging methods

  • 24.
    Gardner, Benjamin
    et al.
    UCL, England.
    Broström, Anders
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Hrubos Strom, Harald
    Akershus University Hospital, Norway.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neurovetenskap. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Fridlund, Bengt
    Jonköping University, Sweden.
    Skagerström (Malmsten), Janna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Johansson, Peter
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    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 292-2942014Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 13, nr 4, s. 292-294Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    n/a

  • 25.
    Gustafsson, Greta
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US.
    Broström, Anders
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US. Department of Nursing Science, School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US.
    Vrethem, Magnus
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    Svanborg, Eva
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US.
    Occurrence of epileptiform discharges and sleep during EEG recordings in children after melatonin intake versus sleep-deprivation2015Ingår i: Clinical Neurophysiology, ISSN 1388-2457, E-ISSN 1872-8952, Vol. 126, nr 8, s. 1493-1497Artikel i tidskrift (Refereegranskat)
    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.

  • 26.
    Hellstrom, Amanda
    et al.
    Linnaeus Univ, Sweden.
    Hagell, Peter
    Kristianstad Univ, Sweden.
    Broström, Anders
    Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US. Jonkoping Univ, Sweden.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US.
    Luik, Annemarie I.
    Univ Oxford, England; Erasmus MC Univ Med Ctr, Netherlands.
    Espie, Colin A.
    Univ Oxford, England.
    Arestedt, Kristofer
    Linnaeus Univ, Sweden; Reg Kalmar Cty, Sweden.
    A classical test theory evaluation of the Sleep Condition Indicator accounting for the ordinal nature of item response data2019Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, nr 3, artikel-id e0213533Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Insomnia symptoms are common among young adults and affect about 5% to 26% of 19 to 34-year-olds. In addition, insomnia is associated with poor mental health and may affect daily performance. In research, as well as in clinical practice, sleep questionnaires are used to screen for and diagnose insomnia. However, most questionnaires are not developed according to current DSM-5 diagnostic criteria. An exception is the recently developed Sleep Condition Indicator (SCI), an eight-item scale screening for insomnia. Aim The aim of this study was to perform a Classical Test Theory (CTT) based psychometric evaluation of the SCI in a sample of Swedish university students, by taking the ordinal nature of item level data into account. Methods The SCI was translated into Swedish and distributed online to undergraduate students at three Swedish universities, within programs of health, psychology, science or economy. Of 3673 invited students, 634 (mean age 26.9 years; SD = 7.4) completed the questionnaire that, in addition to the SCI, comprised other scales on sleep, stress, lifestyle and students study environment. Data were analyzed according to CTT investigating data completeness, item homogeneity and unidimensionality. Results Polychoric based explorative factor analysis suggested unidimensionality of the SCI, and internal consistency was good (Cronbachs alpha, 0.91; ordinal alpha, 0.94). SCI scores correlated with the Insomnia Severity Index (-0.88) as well as with sleep quality (-0.85) and perceived stress (-0.50), supporting external construct validity. Conclusions These observations support the integrity of the of the SCI. The SCI demonstrates sound CTT-based psychometric properties, supporting its use as an insomnia screening tool.

  • 27.
    Hendriks, Jeroen M. L.
    et al.
    Maastricht University, Netherlands.
    Johansson, Peter
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Strömberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neurovetenskap. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Broström, Anders
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neurovetenskap. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US. Jönköping University, Sweden .
    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 480-4822014Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 13, nr 6, s. 480-482Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    n/a

  • 28.
    Iversen, Clara
    et al.
    Uppsala University, Sweden.
    Broström, Anders
    Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US. Jonköping University, Sweden.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US.
    Balancing task focus and relationship building: asking sleepy patients about traffic risk in treatment initiation consultations2017Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, nr 4, s. 895-903Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BackgroundThe use of traffic risk assessment questions is an understudied area in nursing research. Obstructive sleep apnoea is associated with an increased risk of traffic accidents. Therefore, traffic safety authorities demand adherent continuous positive airway pressure use. Nurses act as coaches to achieve treatment adherence, but they are also obliged to act as state agents by prohibiting obstructive sleep apnoea patients from drowsy driving. ObjectiveTo examine how nurses and obstructive sleep apnoea patients manage traffic risk assessment questions in the relation-building context of treatment initiation consultations. MethodsTo study, in detail, the actual practice of risk assessment, we used conversation analysis of 19 video-recorded initial treatment consultations with nurses and recently diagnosed obstructive sleep apnoea patients. EthicsThe study received ethical approval from the Central Ethical Review Board in Linkoping (registration number 214/231-32) and follows the ethical guidelines for qualitative research. ResultsPatients influence how nurses phrase questions about traffic risk by taking a stance to daytime sleepiness prior to the risk question. Nurses ask traffic risk questions in a way that assumes that driving is unproblematic if patients have not previously indicated problems. It may pose a significant problem when nurses, by accepting patients prior stance when asking about traffic risk, orient to relationship building rather than task focus. ConclusionTo clarify the difference between their two potentially conflicting roles, nurses need to refer to existing laws and official guidelines when they raise the issue of risk in treatment initiation consultations. Nurses should also ask risk assessment questions in a problem-oriented communicative environment. Traffic risk assessment is sensitive yet important, as obstructive sleep apnoea is a highly prevalent problem causing excessive sleepiness. It is essential to acknowledge nurses double roles with regard to coaching continuous positive airway pressure treatment and assessing traffic risk.

  • 29.
    Iversen, Clara
    et al.
    Uppsala Univ, Sweden.
    Broström, Anders
    Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US. School of Health and Welfare, Jönköping University, Jönköping, Sweden.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US.
    Traffic risk work with sleepy patients: from rationality to practice2018Ingår i: Health, Risk and Society, ISSN 1369-8575, E-ISSN 1469-8331, Vol. 20, nr 1-2, s. 23-42Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In this article, we aim to contribute to the emerging field of risk-work studies by examining the relationship between risk rationality and risk practices in nurses conversations with Obstructive Sleep Apnoea patients about traffic risks. Legislation in Sweden towards traffic risk involves clinicians making risk assessment of patients prone to falling asleep while driving. In contrast to an overall care rationale, this means that the health of the patient is not the only risk object in treatment consultations. However, guidelines on how to implement legislation are missing. To examine the practical reality of nurses traffic-risk work, we draw on an analysis of data from a Swedish study in 2015. This study included qualitative interviews with specialist nurses and video-recorded interactions between nurses and Obstructive Sleep Apnoea patients. We found that a lack of clarity in traffic-risk guidelines on how risk should be addressed was evident in both interview accounts and in observed practice. While nurses primarily accounted for risk work as treatment-relevant education, they practised risk work as interrogation. Patients also treated nurses inquiries as assessment - not education - by responding defensively. We conclude that while confusing risk work and treatment enables clinicians to treat patients as competent actors, it obscures the controlling aspects of traffic-risk questions for individual patients and downplays the implications of drowsy driving for general traffic safety.

  • 30.
    Johansson, Peter
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Alehagen, Urban
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet.
    Svanborg, Eva
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Dahlström, Ulf
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Broström, Anders
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Sleep disordered breathing in community dwelling elderly: Associations with cardiovascular disease, impaired systolic function, and mortality after a six-year follow-up2011Ingår i: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 12, nr 8, s. 748-753Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Sleep disordered breathing (SDB), cardiovascular disease (CVD) and impaired cardiac function are common in elderly people. We investigated the association of SDB and mortality in a community dwelling elderly population, considering CVD and objectively measured impaired cardiac function have been poorly studied thus far. less thanbrgreater than less thanbrgreater thanAim: To investigate whether SDB is a factor that affects mortality in elderly people, with a focus on those with CVD and/or signs of impaired cardiac function. less thanbrgreater than less thanbrgreater thanMethods: A prospective cohort design was used and 331 community dwelling elderly aged 71-87 years underwent one-night polygraphic recordings in the subjects homes. CVD and systolic function were objectively established. Mortality data were collected after 6 years. less thanbrgreater than less thanbrgreater thanResults: in the total population there were no significant associations between mortality and SOB. In those with CVD and impaired systolic function, as measured by NT-proBNP, oxygen desaturation index (ODI) andgt;= 10 was associated with mortality. The hazard ratio of 3.0 (Cl 95% 1.1-8.6, p = 0.03) remained statistically significant after adjustments for age, gender, diabetes and plasma values of NT-proBNP. less thanbrgreater than less thanbrgreater thanConclusion: SOB in community dwelling elderly has no overall association to mortality irrespective of degree of SDB. However, hypoxic events (i.e., ODI andgt;= 10) were associated with mortality in the group who had CVD in combination with impaired systolic function.

  • 31.
    Johansson, Peter
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet.
    Alehagen, Urban
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Svanborg, Eva
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Dahlström, Ulf
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Broström, Anders
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Sleep disordered breathing in community dwelling elderly-associations to cardiovascular disease, impaired systolic function and mortality. A six year follow-up in EUROPEAN HEART JOURNAL, vol 31, issue , pp 234-2342010Ingår i: EUROPEAN HEART JOURNAL, Oxford University Press , 2010, Vol. 31, s. 234-234Konferensbidrag (Refereegranskat)
    Abstract [en]

    n/a

  • 32.
    Lundin, Fredrik
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Neurologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet.
    Svanborg, Eva
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Wikkelsø, C.
    Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Leijon, Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Neurologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    How active are patients with idiopathic normal pressure hydrocephalus and does activity improve after shunt surgery? A controlled actigraphic study.2012Ingår i: Clinical neurology and neurosurgery (Dutch-Flemish ed. Print), ISSN 0303-8467, E-ISSN 1872-6968, Vol. 115, nr 2, s. 192-196Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Actigraphy allows long-time evaluation of physical activity and resting behaviour in a normal environment. The aim of this study was, by use of actigraphy, to measure motor function, energy expenditure and resting/sleeping time in idiopathic normal pressure hydrocephalus (iNPH) patients before and after surgery, and compare the results with healthy individuals (HI).

    SUBJECTS AND METHODS: 33 patients (mean 73 year) and 17 HI (mean 73 year) participated. Actigraphy with SenseWear (BodyMedia Inc., Pittsburgh, PA, USA) was recorded in the iNPH patients before and three months postoperatively and twice in the HI with a three-month interval. In addition, gait speed, timed up and Go (TUG) and MMSE were registered pre- and post-operatively.

    RESULTS: During daytime the patients took fewer steps (p<0.001) and their total energy expenditure (TEE) was lower (p<0.01) than in the HI. Twenty patients were evaluated pre- and post-operatively and no change in either the number of steps, TEE, or time spent lying/sleeping after surgery could be detected. iNPH patients had lower gait speed, worse TUG and MMSE compared to the HI. Gait and TUG improved after surgery.

    CONCLUSION: Actigraphy in iNPH patients indicated reduced ambulatory activity and lower energy expenditure compared to HI preoperatively. This did not change postoperatively in spite of improved TUG and gait speed.

  • 33.
    Morales Drissi, Natasha
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Szakacs, Attila
    University of Gothenburg, Sweden.
    Witt, Suzanne
    Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Linköpings universitet, Medicinska fakulteten.
    Wretman, Anna
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US.
    Ståhlbrandt, Henriettae
    Highland Hospital, Sweden.
    Darin, Niklas
    University of Gothenburg, Sweden.
    Hallbook, Tove
    University of Gothenburg, Sweden.
    Landtblom, Anne-Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Neurologiska kliniken. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Uppsala University, Sweden.
    Engström, Maria
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV.
    Altered Brain Microstate Dynamics in Adolescents with Narcolepsy2016Ingår i: Frontiers in Human Neuroscience, ISSN 1662-5161, E-ISSN 1662-5161, Vol. 10, nr 369Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Narcolepsy is a chronic sleep disorder caused by a loss of hypocretin-1 producing neurons in the hypothalamus. Previous neuroimaging studies have investigated brain function in narcolepsy during rest using positron emission tomography (PET) and single photon emission computed tomography (SPECT). In addition to hypothalamic and thalamic dysfunction they showed aberrant prefrontal perfusion and glucose metabolism in narcolepsy. Given these findings in brain structure and metabolism in narcolepsy, we anticipated that changes in functional magnetic resonance imaging (fMRI) resting state network (RSN) dynamics might also be apparent in patients with narcolepsy. The objective of this study was to investigate and describe brain microstate activity in adolescents with narcolepsy and correlate these to RSNs using simultaneous fMRI and electroencephalography (EEG). Sixteen adolescents (ages 13-20) with a confirmed diagnosis of narcolepsy were recruited and compared to age-matched healthy controls. Simultaneous EEG and fMRI data were collected during 10 min of wakeful rest. EEG data were analyzed for microstates, which are discrete epochs of stable global brain states obtained from topographical EEG analysis. Functional fMRI data were analyzed for RSNs. Data showed that narcolepsy patients were less likely than controls to spend time in a microstate which we found to be related to the default mode network and may suggest a disruption of this network that is disease specific. We concluded that adolescents with narcolepsy have altered resting state brain dynamics.

  • 34.
    Svanborg, Eva
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet.
    H1N1 influenza vaccination narcolepsy among Swedish children in JOURNAL OF SLEEP RESEARCH, vol 21, issue SI, pp 315-3152012Ingår i: JOURNAL OF SLEEP RESEARCH, Wiley-Blackwell , 2012, Vol. 21, nr SI, s. 315-315Konferensbidrag (Refereegranskat)
    Abstract [en]

    n/a

  • 35.
    Ulander, M
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin.
    Johansson, Peter
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Franzén, K
    Ståhlkrantz, A
    Albers, J
    Svanborg, Eva
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV.
    Broström, Anders
    Side effects of CPAP treatment at 2 weeks and 6 momths and their correlation to adherence2009Konferensbidrag (Refereegranskat)
  • 36.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neurovetenskap. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Psychometric aspects of obstructive sleep apnea syndrome2013Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    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.

    Delarbeten
    1. The side-effects to CPAP treatment inventory: the development and initial validation of a new tool for the measurement of side-effects to CPAP treatment
    Öppna denna publikation i ny flik eller fönster >>The side-effects to CPAP treatment inventory: the development and initial validation of a new tool for the measurement of side-effects to CPAP treatment
    Visa övriga...
    2010 (Engelska)Ingår i: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 19, nr 4, s. 603-611Artikel i tidskrift (Refereegranskat) Published
    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.

    Ort, förlag, år, upplaga, sidor
    John Wiley & Sons, 2010
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-63451 (URN)10.1111/j.1365-2869.2010.00825.x (DOI)
    Tillgänglig från: 2010-12-20 Skapad: 2010-12-20 Senast uppdaterad: 2017-12-11Bibliografiskt granskad
    2. Association of Type D personality to perceived side effects and adherence in CPAP-treated patients with OSAS
    Öppna denna publikation i ny flik eller fönster >>Association of Type D personality to perceived side effects and adherence in CPAP-treated patients with OSAS
    Visa övriga...
    2007 (Engelska)Ingår i: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 16, nr 4, s. 439-447Artikel i tidskrift (Refereegranskat) Published
    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.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-41182 (URN)10.1111/j.1365-2869.2007.00620.x (DOI)55306 (Lokalt ID)55306 (Arkivnummer)55306 (OAI)
    Tillgänglig från: 2009-10-10 Skapad: 2009-10-10 Senast uppdaterad: 2017-12-13Bibliografiskt granskad
    3. The fairness of the Epworth Sleepiness Scale: two approaches to differential item functioning
    Öppna denna publikation i ny flik eller fönster >>The fairness of the Epworth Sleepiness Scale: two approaches to differential item functioning
    Visa övriga...
    2013 (Engelska)Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 17, nr 1, s. 157-165Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Purpose

    Differential item functioning (DIF) is said to exist in an item if a subject’s response to the item is affected by other aspects than that which the test is intended to assess. DIF might affect the validity of a test. The aim of this study was thus to examine whether any of the items in the Epworth Sleepiness Scale (ESS) exhibits DIF regarding age or gender, and if so, to which degree.

    Methods

    Using previously collected cross-sectional ESS data from 1,168 subjects with different clinical characteristics (61% males, mean age 67.8 year (SD 12.2 year)), ordinal regression as well as Rasch-based DIF analyses were performed.

    Results

    Concerning age, both DIF analyses showed DIF for age in items 3 (inactive in a public place), 4 (passenger in a car), and 8 (in a car that has stopped in traffic). The Rasch model also showed DIF for gender in item 3. The DIF magnitudes as judged by McFadden pseudo-R2 changes were, however, only minor.

    Conclusions

    ESS has small but reproducible DIF for age in items 3, 4, and 8. The detected DIF might be worth to consider in large-sample studies, although it probably has no effect on an individual basis.

    Ort, förlag, år, upplaga, sidor
    Springer, 2013
    Nyckelord
    Epworth Sleepiness Scale, Differential item functioning, Sleep, Daytime sleepiness
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-89964 (URN)10.1007/s11325-012-0664-8 (DOI)000315167200029 ()22367404 (PubMedID)
    Tillgänglig från: 2013-03-12 Skapad: 2013-03-12 Senast uppdaterad: 2018-12-11
    4. Side effects of Continuous Positive Airway Pressure treatment for Obstructive Sleep Apnea: Changes over time and association to adherence
    Öppna denna publikation i ny flik eller fönster >>Side effects of Continuous Positive Airway Pressure treatment for Obstructive Sleep Apnea: Changes over time and association to adherence
    Visa övriga...
    2014 (Engelska)Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 18, nr 4, s. 799-807Artikel i tidskrift (Refereegranskat) 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.

    Ort, förlag, år, upplaga, sidor
    Springer, 2014
    Nyckelord
    Obstructive sleep apnea/adverse effects, Continuous positive airway pressure, Adherence, Side Effects to CPAP Inventory
    Nationell ämneskategori
    Medicin och hälsovetenskap Omvårdnad
    Identifikatorer
    urn:nbn:se:liu:diva-97474 (URN)10.1007/s11325-014-0945-5 (DOI)000344784800018 ()24557772 (PubMedID)
    Tillgänglig från: 2013-09-13 Skapad: 2013-09-13 Senast uppdaterad: 2017-12-06Bibliografiskt granskad
  • 37.
    Ulander, Martin
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet.
    Brostrom, A
    School Health Science, Sweden .
    Arestedt, K
    Linnaeus University, Sweden .
    Svanborg, Eva
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Differences in the level of sleepiness measured by the different items of the Epworth sleepiness scale: a comparison to the Multiple sleep latency test in JOURNAL OF SLEEP RESEARCH, vol 21, issue SI, pp 308-3082012Ingår i: JOURNAL OF SLEEP RESEARCH, Wiley-Blackwell , 2012, Vol. 21, nr SI, s. 308-308Konferensbidrag (Refereegranskat)
    Abstract [en]

    n/a

  • 38.
    Ulander, Martin
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US.
    Broström, Anders
    Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Jonköping University, Sweden.
    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 1345-13452015Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 19, nr 4, s. 1345-1345Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    n/a

  • 39.
    Ulander, Martin
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet.
    Ekegren, A
    School Health Science, Sweden .
    Svensson Johansson, M
    School Health Science, Sweden .
    Svanborg, Eva
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Brostrom, A
    School Health Science, Sweden .
    Continuous positive airway pressure side effects: evolution over time and association to treatment dropout in JOURNAL OF SLEEP RESEARCH, vol 21, issue SI, pp 340-3402012Ingår i: JOURNAL OF SLEEP RESEARCH, Wiley-Blackwell , 2012, Vol. 21, nr SI, s. 340-340Konferensbidrag (Refereegranskat)
    Abstract [en]

    n/a

  • 40.
    Ulander, Martin
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet.
    Franzen, K
    Kalmar University.
    Strömberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Johansson, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Svanborg, Eva
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Rekonstruktionscentrum, Neurofysiologiska kliniken US.
    Broström, Anders
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    VALIDATION OF THE SIDE-EFFECTS TO CPAP TREATMENT INVENTORY - A NEW TOOL FOR THE MEASUREMENT OF SIDE-EFFECTS TO CPAP TREATMENT2009Ingår i: In Sleep, Vol 32, 2009, Vol. 32, s. A227-A228Konferensbidrag (Refereegranskat)
  • 41.
    Ulander, Martin
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet.
    Franzen, K
    School of Nursing, Kalmar.
    Strömberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Stahlkrantz, A
    City Hospital Ryhov.
    Albers, J
    City Hospital Ryhov.
    Svanborg, Eva
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Rekonstruktionscentrum, Neurofysiologiska kliniken US.
    Broström, Anders
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    The Informational Needs to CPAP Treatment Inventory (INCI): a new tool for assessing subjective informational needs among CPAP-treated patients with OSAS2008Ingår i: JOURNAL OF SLEEP RESEARCH,ISSN 0962-1105: Volume 17, 2008, Vol. 17, s. 155-156Konferensbidrag (Refereegranskat)
  • 42.
    Ulander, Martin
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet.
    Franzen, K
    School of Nursing, Kalmar.
    Strömberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Stahlkrantz, A
    City Hospital Ryhov.
    Albers, J
    City Hospital Ryhov.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet.
    Svanborg, Eva
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Rekonstruktionscentrum, Neurofysiologiska kliniken US.
    The side-effects to CPAP treatment inventory (SECI): testing regarding validity and reliability of a new self-assessment inventory of side-effects to CPAP treatment2008Ingår i: JOURNAL OF SLEEP RESEARCH,ISSN 0962-1105: Volume 17, 2008, Vol. 17, s. 173-173Konferensbidrag (Refereegranskat)
  • 43.
    Ulander, Martin
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet.
    Johansson, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Franzen, K
    Kalmar University.
    Stahlkrantz, A
    Ryhov County Hospital.
    Albers, J
    Ryhov County Hospital.
    Svanborg, Eva
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Rekonstruktionscentrum, Neurofysiologiska kliniken US.
    Broström, Anders
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    SIDE EFFECTS OF CPAP TREATMENT AT 2 WEEKS AND 6 MONTHS AND THEIR CORRELATION TO ADHERENCE2009Ingår i: In Sleep, Vol 32, 2009, Vol. 32, s. A226-A226Konferensbidrag (Refereegranskat)
  • 44.
    Ulander, Martin
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet.
    Stahlkrantz, A
    City Hospital Ryhov.
    Albers, J
    City Hospital Ryhov.
    Wiberg, J
    City Hospital Ryhov.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Svanborg, Eva
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Rekonstruktionscentrum, Neurofysiologiska kliniken US.
    Patient education in CPAP initiation - a problem based learning approach using small tutorial groups2008Ingår i: JOURNAL OF SLEEP RESEARCH,ISSN 0962-1105: Volume 17, 2008, Vol. 17, s. 172-172Konferensbidrag (Refereegranskat)
  • 45.
    Ulander, Martin
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neurovetenskap. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Svensson Johansson, Malin
    Department of Nursing, School of Health Sciences, Jönköping University College, Jönköping, Sweden.
    Ekegren Ewaldh, Amanda
    Department of Nursing, School of Health Sciences, Jönköping University College, Jönköping, Sweden.
    Svanborg, Eva
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neurovetenskap. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Broström, Anders
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neurovetenskap. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Side effects of Continuous Positive Airway Pressure treatment for Obstructive Sleep Apnea: Changes over time and association to adherence2014Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 18, nr 4, s. 799-807Artikel i tidskrift (Refereegranskat)
    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.

  • 46.
    Ulander, Martin
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Årestedt, Kristofer
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Svanborg, Eva
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Johansson, Peter
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Broström, Anders
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    The fairness of the Epworth Sleepiness Scale: two approaches to differential item functioning2013Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 17, nr 1, s. 157-165Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose

    Differential item functioning (DIF) is said to exist in an item if a subject’s response to the item is affected by other aspects than that which the test is intended to assess. DIF might affect the validity of a test. The aim of this study was thus to examine whether any of the items in the Epworth Sleepiness Scale (ESS) exhibits DIF regarding age or gender, and if so, to which degree.

    Methods

    Using previously collected cross-sectional ESS data from 1,168 subjects with different clinical characteristics (61% males, mean age 67.8 year (SD 12.2 year)), ordinal regression as well as Rasch-based DIF analyses were performed.

    Results

    Concerning age, both DIF analyses showed DIF for age in items 3 (inactive in a public place), 4 (passenger in a car), and 8 (in a car that has stopped in traffic). The Rasch model also showed DIF for gender in item 3. The DIF magnitudes as judged by McFadden pseudo-R2 changes were, however, only minor.

    Conclusions

    ESS has small but reproducible DIF for age in items 3, 4, and 8. The detected DIF might be worth to consider in large-sample studies, although it probably has no effect on an individual basis.

1 - 46 av 46
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