Britt Øverland - Academia.edu (original) (raw)
Papers by Britt Øverland
Tidsskrift For Den Norske Laegeforening, Sep 1, 2009
Sleep-related breathing disorders (SRBD) is a term that includes several different diagnoses. Thi... more Sleep-related breathing disorders (SRBD) is a term that includes several different diagnoses. This paper describes aetiology, diagnostics, treatment options and consequences of untreated disease, in children and adults. The paper is based on own clinical experience and literature identified through a non-systematic search of PubMed and various books. The prevalence of SRDB in children and adults is about 10-15% and that for the most serious type, OSAS (Obstructive Sleep Apnoea Syndrome), is about 2-4%. A sleep study is required to confirm the diagnosis. The clinical symptoms of SRBD in adults are heavy snoring, observed apnoeas, gasping for air leading to frequent arousals, disturbed sleep and daytime sleepiness. Children are often hyperactive and have learning and behaviour difficulties. Untreated patients have increased mortality and morbidity. The primary treatment option for patients with medium to serious breathing disorders is continuous positive-pressure ventilation. Other treatment options are oral devices and surgery. In children, surgery (adenotonsilectomy) is the treatment of choice. OSAS is the most severe diagnosis among SRBD. Both adults and children show reduced cognitive function and quality of life. Various treatment options are available.
Tidsskr Norske Laegeforen, 2009
Sleep and Breathing, 2014
The purpose of this study is to explore the effect of a moderate dose of alcohol on sleep archite... more The purpose of this study is to explore the effect of a moderate dose of alcohol on sleep architecture and respiration in chronic obstructive pulmonary disease (COPD). Alcohol depresses both hypercapnic and hypoxic ventilatory drives in awake, normal individuals and reduces the amount of rapid eye movement (REM) sleep and oxygen saturation (SpO2) in sleeping COPD subjects. Prospectively designed, open-label interventional study in a pulmonary rehabilitation hospital. Twenty-six (nine males) stable inpatients, median forced expiratory volume first second (FEV1) 40.5 % of predicted, median age 65 years, investigated by polysomnography including transcutaneous measurement of carbon dioxide pressure increase (ΔPtcCO2) in randomized order of either control sleep or intervention with 0.5 g of ethanol/kilogram bodyweight, taken orally immediately before lights off. Alcohol induced a mean increase (95 % confidence interval, [CI]) in the mean ΔPtcCO2 of 0.10 kPa (0.002-0.206, P = 0.047) and a mean decrease (CI) in the REM-sleep percentage of total sleep time (REM % of TST) of 3.1 % (0.2-6.0), (P = 0.020). Six subjects with apnea/hypopnea index (AHI) ≥15 had fewer apneas/hypopneas during alcohol versus control sleep (mean reduction of AHI 11 (1-20), P = 0.046). Alcohol-sleep changes in SpO2, but not in ΔPtcCO2, correlated with daytime arterial pressures of carbon dioxide (PaCO2) and oxygen (PaO2). Occasional use of a moderate, bedtime dose of alcohol has only minor respiratory depressant effects on the majority of COPD subjects, and in a minority even slightly improves respiration during sleep. However, caution is appropriate as this study is small and higher doses of alcohol may result in major respiratory depressive and additional negative health effects.
Sleep and Breathing, 2014
More than half of patients with chronic obstructive pulmonary disease (COPD) experiences sleep-re... more More than half of patients with chronic obstructive pulmonary disease (COPD) experiences sleep-related problems and about one fourth uses hypnotics regularly. We explored what the effect zopiclone, a commonly used hypnotic, had on nocturnal gas exchange and the apnea/hypopnea frequency in stable COPD. Randomized crossover study of 31 (ten males) inpatients at a pulmonary rehabilitation hospital, median age 64 years, of which 20 had a forced expiratory volume first second <50 % of predicted. Subjects investigated in randomized order of either baseline sleep or intervention with 5 mg zopiclone by polysomnography including transcutaneous measurement of carbon dioxide pressure increased (ΔPtcCO2). Zopiclone increased the mean ΔPtcCO2 from baseline both in rapid eye movement (REM) sleep, non-REM sleep, and even in stage N0 (awake after sleep onset) with a mean (SD) of 0.25 (0.40) kPa, 0.22 (0.32) kPa, and 0.14 (0.27) kPa, respectively. Subjects with sleep hypoventilation as defined by the American Academy of Sleep Medicine increased from 6 subjects (19 %) to 13 subjects (42 %) (P = 0.020). REM sleep minimum oxygen saturation (minSpO2) did not change significantly from baseline median (interquartile range [IQR]) minSpO2 81.8 (12.1) % to zopiclone sleep median (IQR) minSpO2 80.0 (12.0) % (P = 0.766). Interestingly, zopiclone reduced the number of apneas/hypopneas per hour (AHI) in subjects with overlap (AHI ≥ 15) with a median difference (IQR) of -8.5 (7.8) (N = 11, P = 0.016). In stable COPD, zopiclone moderately increases the mean ΔPtcCO2 without changing minSpO2 at night and reduces AHI in overlap (COPD and obstructive sleep apnea) subjects.
International Journal of Pediatric Otorhinolaryngology, 2013
To determine the prevalence of otitis media with effusion (OME) in children with Down syndrome (D... more To determine the prevalence of otitis media with effusion (OME) in children with Down syndrome (DS), and the associated to hearing loss at the age of 8 years. A national population based clinical study of all children with DS born in Norway in 2002. OME was found in 20 out of 52 (38%) children. Those with OME had a significant lower hearing level with a mean pure tone average (PTA) of 33.4 dB HL compared to children with no OME whose mean PTA was 21.7 dB HL (p < 0.0001). Verified hearing loss above 25 dB HL in the better hearing ear was found in 12 out of the 20 with OME, compared to 5 out 31 without OME. The findings of this present study uncover the increased risk of OME in eight year old children with DS as current otitis media was found in one of three. This reduced hearing ability in children with DS due to OME at age of 8 strongly emphasizes the need for optimal treatment and follow up to optimize hearing rehabilitation. The findings are further supported by the population based study design, the focus on the narrow age band and the high response rate.
The journal of headache and pain, 2011
The main objective of this study is to investigate the relationship between tension-type headache... more The main objective of this study is to investigate the relationship between tension-type headache and obstructive sleep apnea in the general population. The method involves a cross-sectional population-based study. A random age and gender stratified sample of 40,000 persons aged 20-80 years residing in Akershus, Hedmark or Oppland County, Norway were drawn by the National Population Register. A postal questionnaire containing the Berlin Questionnaire was used to classify respondents to be of either high or low risk of obstructive sleep apnea. Included in this study were 297 persons with high risk and 134 persons with low risk of sleep apnea, aged 30-65 years. They underwent an extensive clinical interview, a physical and a neurological examination by physicians, and in-hospital polysomnography. Those with apnea hypopnoea index (AHI) ≥5 were classified with obstructive sleep apnea. Tension-type headache was diagnosed according to the International Classification of Headache Disorders...
The journal of headache and pain, 2011
Objective is to investigate the relationship between migraine and obstructive sleep apnea in the ... more Objective is to investigate the relationship between migraine and obstructive sleep apnea in the general population. A cross-sectional population-based study. A random age and gender stratified sample of 40,000 persons aged 20-80 years residing in Akershus, Hedmark or Oppland County, Norway, were drawn by the National Population Register. A postal questionnaire containing the Berlin Questionnaire was used to classify respondents to be of either high or low risk of obstructive sleep apnea. 376 persons with high risk and 157 persons with low risk of sleep apnea aged 30-65 years were included for further investigations. They underwent an extensive clinical interview, a physical and a neurological examination by physicians, and in-hospital polysomnography. Those with apnea hypopnoea index (AHI) ≥5 were classified with obstructive sleep apnea. Migraine without aura (MO) and migraine with aura (MA) was diagnosed according to the International Classification of Headache Disorders. MO and M...
International Journal of Pediatric Otorhinolaryngology, 2014
Tidsskrift for Den norske legeforening, 2009
Sleep-related breathing disorders (SRBD) is a term that includes several different diagnoses. Thi... more Sleep-related breathing disorders (SRBD) is a term that includes several different diagnoses. This paper describes aetiology, diagnostics, treatment options and consequences of untreated disease, in children and adults. The paper is based on own clinical experience and literature identified through a non-systematic search of PubMed and various books. The prevalence of SRDB in children and adults is about 10-15% and that for the most serious type, OSAS (Obstructive Sleep Apnoea Syndrome), is about 2-4%. A sleep study is required to confirm the diagnosis. The clinical symptoms of SRBD in adults are heavy snoring, observed apnoeas, gasping for air leading to frequent arousals, disturbed sleep and daytime sleepiness. Children are often hyperactive and have learning and behaviour difficulties. Untreated patients have increased mortality and morbidity. The primary treatment option for patients with medium to serious breathing disorders is continuous positive-pressure ventilation. Other treatment options are oral devices and surgery. In children, surgery (adenotonsilectomy) is the treatment of choice. OSAS is the most severe diagnosis among SRBD. Both adults and children show reduced cognitive function and quality of life. Various treatment options are available.
The Laryngoscope, 2014
Sleep apnea is associated with hypertension and diabetes, putting these patients at high risk for... more Sleep apnea is associated with hypertension and diabetes, putting these patients at high risk for developing cardiovascular disease. The goal of this study was to identify the individual cardiovascular risk profile and to detect premature and undiagnosed disease in patients with various degrees of sleep apnea. Cross-sectional. Over a 6-month period, we consecutively characterized all patients referred to our sleep laboratory for an initial evaluation of sleep apnea. Clinical history; blood tests with oral glucose tolerance test, when appropriate; test for microalbuminuria; and an electrocardiogram (ECG) were performed. The Framingham general cardiovascular risk score was assessed in each patient. A total of 255 patients were evaluated. Of those, 190 (75%) were diagnosed with sleep apnea. Patients with sleep apnea had a significantly higher Framingham risk score than patients without sleep apnea. Adjusted for age and gender, severe sleep apnea was associated with a 60% increased cardiovascular risk compared with not having sleep apnea. In sleep apnea patients without previously diagnosed hypertension, an additional 45% had significant elevated blood pressure. Among sleep apnea patients without known diabetes, we tested 48% with a pathological glucose disposal. Twenty percent of sleep apnea patients without known heart disease had significant ECG changes. High Framingham score, undiagnosed hypertension, and pathological glucose disposal were highly prevalent in patients with sleep apnea. Appropriate screening routines are important to detect cardiovascular risk factors in patients with sleep apnea.
Sleep Medicine, 2002
To assess the clinical value of pulseoximetry in the diagnosis of sleep apnea when satisfactory a... more To assess the clinical value of pulseoximetry in the diagnosis of sleep apnea when satisfactory agreement with polysomnography is obtained. This was a prospective clinical study, set in the Department of Otorhinolaryngology, Ullevaal University Hospital, Oslo, Norway. One hundred consecutive patients were investigated for sleep related breathing disorders. The main outcome measurements were: measurement success rate, oxygen desaturation thresholds, sensitivity and specificity at apnea-hypopnea-index (AHI) thresholds of 5 and 15. Pulseoximetry was successfully performed in 93%. When different oxygen desaturation thresholds were calculated, optimal agreement with polysomnography was found at a 3% oxygen desaturation level. The sensitivity and specificity of diagnosing moderate/severe sleep apnea (AHI above 15) were 0.86 and 0.88, respectively. The corresponding figures for milder sleep apnea (AHI above 5) were 0.91 and 0.67. Good agreement was found between the AHI and the oxygen desaturation index (ODI) at the 3% level, with a mean AHI-ODI difference of 2.6 (SD, 7.3), a Pearson correlation of 0.95 and a weighted kappa of 0.86. The best agreement was found for AHI values below 15, where the estimated AHI-ODI difference was only -0.4 (SD, 3.3). Pulseoximetry is a simple, non-invasive procedure, which is easy to perform and well suited for outpatient registration. When adjusted to polysomnography with high sensitivity of hypopnea registrations, an ODI at the 3% level is optimal to diagnose sleep apnea. In patients with moderate/severe sleep apnea with AHI values above 15, it is sufficient to establish the diagnosis and subsequent treatment. A negative pulseoximetry does not rule out sleep disorders; the patients should complete a full examination.
Respiration, 2005
Portable recording devices without electroencephalogram recordings are frequently used for diagno... more Portable recording devices without electroencephalogram recordings are frequently used for diagnosis of sleep-disordered breathing. However, an exact measure of sleep is important, since the diagnosis is based on the average number of events per hour of sleep, the apnea/hypopnea index (AHI). Actimetry is a simplified method for distinguishing sleep and wakefulness by measurements of activity. In this study, recording with a portable recording device (Reggie) including an incorporated actimeter and polysomnography were done simultaneously in order to test the effect of the actimeter. The study was performed at the sleep-related breathing disorder unit at the Ullevaal University Hospital, Oslo, Norway. Fifty-two consecutive patients referred to the hospital for diagnosis of sleep-disordered breathing were included. There is agreement between the AHI obtained from the polysomnography and the AHI obtained from the Reggie system. The estimated mean difference is 3.5, with an SD of 5.3 (r = 0.98). The sleep time calculated with the Reggie system is greater than the sleep time obtained by polysomnography, the mean difference being 46 min, SD 56 min (r = 0.45). Sleep time calculations with the Reggie system overestimate the sleep time. Still, the AHIs obtained by the two systems show good agreement. There is a slight tendency for the Reggie system to provide an AHI which is too low. This difference is small, and in most cases, it will be of no clinical significance.
Research in Developmental Disabilities, 2013
This study examines the prevalence of hearing loss in children with Down syndrome at the age of 8... more This study examines the prevalence of hearing loss in children with Down syndrome at the age of 8. All children were examined in the ENT-departments of public hospitals in Norway and the study population consisted of children born in Norway in 2002 with Down syndrome. Hearing loss was defined as pure-tone air-conduction reduction by on average more than 25 dB HL in the best hearing ear. A cross sectional clinical and audiological population based study was chosen as study design. Hearing loss more than 25 dB HL in the best hearing ear was found in 17/49 children (35%). Mild hearing loss was found in 13 children (26%), moderate in 3 (6%) children and severe hearing loss in 1 child (2%). Conductive hearing loss was found in 8 children (16%), 9 children (18%) had a sensory-neural hearing loss, and mixed hearing loss was found in 3 children. Mean hearing level among boys and girls were 30.0 dB HL (SD 15.7) and 25.5 dB HL (SD13.7) respectively, a non-significant difference (p=0.139). In conclusion this study indicates that both conductive and sensorineural hearing loss, is still common in children with Down syndrome children at the age of eight and as much as two thirds of the children may have a bilateral impairment. The study population was under diagnosed in terms of hearing loss and thus our findings underline the importance of continuous audiological follow up of this group of children throughout childhood.
The Journal of the Acoustical Society of America, 2011
The aim of this study was to explore and compare the effect of noise from railway and road traffi... more The aim of this study was to explore and compare the effect of noise from railway and road traffic on sleep in subjects habitually exposed to nocturnal noise. Forty young and middle aged healthy subjects were studied with polysomnography (PSG) during two consecutive nights in their own bedroom. Noise measurements and recordings were conducted concurrently outside of the bedroom façade as well as inside the bedroom of each participant. Different noise exposure parameters were calculated (L p,A,eq,night , L p,A,Fmax,night , and L AF5,night ) and analyzed in relation to whole-night sleep parameters. The group exposed to railway noise had significantly less Rapid eye movement, (REM) sleep than the group exposed to road traffic noise. A significant association was found between the maximum level (L p,A,Fmax,night ) of railway noise and time spent in REM sleep. REM sleep was significantly shorter in the group exposed to at least a single railway noise event above 50 dB inside the bedroom. These results, obtained in an ecological valid setting, support previous laboratory findings that railway noise has a stronger impact than road traffic noise on physiological parameters during sleep, and that the maximum noise level is an important predictor of noise effects on sleep assessed by PSG, at least for railway noise.
Journal of Cardiac Failure, 2011
Background: Sleep-disordered breathing (SDB) is common in patients with reduced ejection fraction... more Background: Sleep-disordered breathing (SDB) is common in patients with reduced ejection fraction (EF). However, little is known about the prevalence of SDB in a general heart failure population including patients with preserved EF (HFPEF). Methods: We prospectively enrolled stable heart failure outpatients from our heart failure clinic to assess the prevalence of SDB independent of systolic left ventricular function. Results: Among 115 patients (62% with reduced EF, 38% with preserved EF, New York Heart Association Class II-IV) SDB was present in 81% (27% central sleep apnea, 54% obstructive sleep apnea [OSA]). HFPEF patients had SDB in 80% of the cases, 62% had OSA. This group had significantly more hypertension. Conclusions: This study shows a high prevalence of SDB in a general heart failure population, also in patients with HFPEF. These patients have predominantly OSA. Especially in patients with HFPEF SDB should be kept in mind and referral to a sleep specialist should be considered. (J Cardiac Fail 2011;17:420e425)
International Journal of Clinical Practice, 2014
Sleep-disordered breathing (SDB) is common in heart failure patients. Many of them still remain u... more Sleep-disordered breathing (SDB) is common in heart failure patients. Many of them still remain undiagnosed. The aim of this study was to detect clinical predictors of sleep apnoea which may help to identify patients with SDB at a heart failure clinic. We performed an in-home sleep study on 115 consecutive patients from our heart failure clinic. Clinical characteristics, blood samples, daytime sleepiness and quality of life were registered. Among 115 patients, 52% had moderate to severe SDB. Body Mass Index (BMI) ≥ 30 kg/m² was the only independent predictor of moderate to severe SDB [Odds ratio (OR) = 3.62, 95% Confidence interval (CI) 1.40-9.36, p = 0.008]. Quality of life and level of sleepiness were not significantly associated with SDB. Patients with mild to moderate chronic obstructive pulmonary disease (COPD) were unlikely to have SDB compared with patients without COPD (OR = 0.10, 95% CI 0.02-0.43, p = 0.002). Hypertension was a predictor of having obstructive sleep apnoea (OR = 2.78, 95% CI 1.15-6.75, p = 0.02), while haemoglobin ≥ 15 g/dl was associated with central sleep apnoea (OR = 6.71, 95% CI 1.96-22.99, p = 0.002). BMI ≥ 30 kg/m(2) is associated with moderate to severe SDB, both obstructive and central sleep apnoea. Thus, BMI may be used as one of the selection criteria for referral of heart failure patients to a sleep specialist.
The European Journal of Orthodontics, 2013
BACKGROUND: In individuals with simple hypodontia, congenital absence of teeth commonly affects j... more BACKGROUND: In individuals with simple hypodontia, congenital absence of teeth commonly affects just one tooth of a pair, not both. However, patterns of hypodontia have not been fully explored in children with Down syndrome (DS). OBJECTIVE: We describe the frequency and left-right symmetry of hypodontia in the permanent dentition of 8-to 9-year-old Norwegian children with DS. MATERIALS AND METHODS: This population-based cross-sectional study was part of a national prospective study evaluating upper airway function, hearing, dental, and craniofacial characteristics in a cohort of children with DS born in 2002. The cohort consisted of 29 children with DS and represented 57 per cent of all children born with DS in Norway in 2002. Hypodontia was assessed using panoramic and/or dental radiographs. Data were collected prospectively at TAKO-Centre, National Resource Centre for Oral Health in Rare Medical Conditions, Lovisenberg Diakonale Hospital, Oslo, Norway. RESULTS: Hypodontia of permanent teeth, excluding third molars, was found in 61.5 per cent of the 26 children included in the final sample. Among the 16 children with hypodontia, 75.0 per cent were missing two or more permanent teeth. Two children (7.7 per cent) had severe hypodontia (oligodontia). The teeth most often missing were the maxillary lateral incisors, followed by the mandibular second premolars and maxillary second premolars. Most (68.9 per cent) cases of hypodontia occurred bilaterally. CONCLUSIONS: The majority of the children with DS were missing one or more permanent teeth. Unlike in the general population, bilateral hypodontia was more common than unilateral hypodontia in this sample of children with DS.
European Archives of Oto-Rhino-Laryngology, 2005
The reference method for measuring respiratory effort and for differentiating between obstructive... more The reference method for measuring respiratory effort and for differentiating between obstructive and central apneas in the diagnosis of sleep-related breathing disorders is overnight monitoring of esophageal pressure. Despite this being the reference method, it is not widely used because it is considered invasive and uncomfortable for the patients. The aim of this study was to assess patient discomfort and insertion difficulty when using an esophageal catheter during polysomnography. We have performed a prospective questionnaire-based clinical study in 799 consecutive patients where polysomnography with an esophageal catheter was routinely performed in the diagnosis of sleep-related breathing disorders. The main outcome measures were the catheter-related discomfort experienced by the patient and difficulty of catheter insertion reported by the sleep technician. Ninety-six percent of the patients accepted the insertion of the catheter, and most of the patients considered it acceptable to sleep with the catheter. Correspondingly, in most of the patients, the catheter was easily inserted, and there were difficulties in only a few patients. Specifically, no complications or side effects were reported when using the catheter. To optimize the diagnosis of sleep-related breathing disorders, an esophageal sensor catheter can be used during polysomnography, without causing major patient discomfort.
European Archives of Oto-Rhino-Laryngology, 2012
The aim of the present study was to investigate the prevalence of obstructive sleep apnea syndrom... more The aim of the present study was to investigate the prevalence of obstructive sleep apnea syndrome (OSAS) among the Norwegian population with Treacher Collins syndrome (TCS). A secondary aim was to establish whether TCS phenotype severity is associated with OSAS severity. A prospective case study design was used. Individuals who were 5 years old and above with a known diagnosis of TCS in Norway were invited to participate in a study. The study included genetic testing, medical and dental examinations and polysomnography. All participants demonstrated disturbed respiration during sleep; 18/19 met the diagnostic criteria for OSAS. Subjectively evaluated snoring was not a reliable predictor of OSAS. We found no significant association between TCS phenotype severity and the severity of OSAS. OSAS is common in TCS, but there is no association with the phenotype severity. Individuals diagnosed with TCS must undergo sleep studies to identify the presence of OSAS.
Tidsskrift For Den Norske Laegeforening, Sep 1, 2009
Sleep-related breathing disorders (SRBD) is a term that includes several different diagnoses. Thi... more Sleep-related breathing disorders (SRBD) is a term that includes several different diagnoses. This paper describes aetiology, diagnostics, treatment options and consequences of untreated disease, in children and adults. The paper is based on own clinical experience and literature identified through a non-systematic search of PubMed and various books. The prevalence of SRDB in children and adults is about 10-15% and that for the most serious type, OSAS (Obstructive Sleep Apnoea Syndrome), is about 2-4%. A sleep study is required to confirm the diagnosis. The clinical symptoms of SRBD in adults are heavy snoring, observed apnoeas, gasping for air leading to frequent arousals, disturbed sleep and daytime sleepiness. Children are often hyperactive and have learning and behaviour difficulties. Untreated patients have increased mortality and morbidity. The primary treatment option for patients with medium to serious breathing disorders is continuous positive-pressure ventilation. Other treatment options are oral devices and surgery. In children, surgery (adenotonsilectomy) is the treatment of choice. OSAS is the most severe diagnosis among SRBD. Both adults and children show reduced cognitive function and quality of life. Various treatment options are available.
Tidsskr Norske Laegeforen, 2009
Sleep and Breathing, 2014
The purpose of this study is to explore the effect of a moderate dose of alcohol on sleep archite... more The purpose of this study is to explore the effect of a moderate dose of alcohol on sleep architecture and respiration in chronic obstructive pulmonary disease (COPD). Alcohol depresses both hypercapnic and hypoxic ventilatory drives in awake, normal individuals and reduces the amount of rapid eye movement (REM) sleep and oxygen saturation (SpO2) in sleeping COPD subjects. Prospectively designed, open-label interventional study in a pulmonary rehabilitation hospital. Twenty-six (nine males) stable inpatients, median forced expiratory volume first second (FEV1) 40.5 % of predicted, median age 65 years, investigated by polysomnography including transcutaneous measurement of carbon dioxide pressure increase (ΔPtcCO2) in randomized order of either control sleep or intervention with 0.5 g of ethanol/kilogram bodyweight, taken orally immediately before lights off. Alcohol induced a mean increase (95 % confidence interval, [CI]) in the mean ΔPtcCO2 of 0.10 kPa (0.002-0.206, P = 0.047) and a mean decrease (CI) in the REM-sleep percentage of total sleep time (REM % of TST) of 3.1 % (0.2-6.0), (P = 0.020). Six subjects with apnea/hypopnea index (AHI) ≥15 had fewer apneas/hypopneas during alcohol versus control sleep (mean reduction of AHI 11 (1-20), P = 0.046). Alcohol-sleep changes in SpO2, but not in ΔPtcCO2, correlated with daytime arterial pressures of carbon dioxide (PaCO2) and oxygen (PaO2). Occasional use of a moderate, bedtime dose of alcohol has only minor respiratory depressant effects on the majority of COPD subjects, and in a minority even slightly improves respiration during sleep. However, caution is appropriate as this study is small and higher doses of alcohol may result in major respiratory depressive and additional negative health effects.
Sleep and Breathing, 2014
More than half of patients with chronic obstructive pulmonary disease (COPD) experiences sleep-re... more More than half of patients with chronic obstructive pulmonary disease (COPD) experiences sleep-related problems and about one fourth uses hypnotics regularly. We explored what the effect zopiclone, a commonly used hypnotic, had on nocturnal gas exchange and the apnea/hypopnea frequency in stable COPD. Randomized crossover study of 31 (ten males) inpatients at a pulmonary rehabilitation hospital, median age 64 years, of which 20 had a forced expiratory volume first second <50 % of predicted. Subjects investigated in randomized order of either baseline sleep or intervention with 5 mg zopiclone by polysomnography including transcutaneous measurement of carbon dioxide pressure increased (ΔPtcCO2). Zopiclone increased the mean ΔPtcCO2 from baseline both in rapid eye movement (REM) sleep, non-REM sleep, and even in stage N0 (awake after sleep onset) with a mean (SD) of 0.25 (0.40) kPa, 0.22 (0.32) kPa, and 0.14 (0.27) kPa, respectively. Subjects with sleep hypoventilation as defined by the American Academy of Sleep Medicine increased from 6 subjects (19 %) to 13 subjects (42 %) (P = 0.020). REM sleep minimum oxygen saturation (minSpO2) did not change significantly from baseline median (interquartile range [IQR]) minSpO2 81.8 (12.1) % to zopiclone sleep median (IQR) minSpO2 80.0 (12.0) % (P = 0.766). Interestingly, zopiclone reduced the number of apneas/hypopneas per hour (AHI) in subjects with overlap (AHI ≥ 15) with a median difference (IQR) of -8.5 (7.8) (N = 11, P = 0.016). In stable COPD, zopiclone moderately increases the mean ΔPtcCO2 without changing minSpO2 at night and reduces AHI in overlap (COPD and obstructive sleep apnea) subjects.
International Journal of Pediatric Otorhinolaryngology, 2013
To determine the prevalence of otitis media with effusion (OME) in children with Down syndrome (D... more To determine the prevalence of otitis media with effusion (OME) in children with Down syndrome (DS), and the associated to hearing loss at the age of 8 years. A national population based clinical study of all children with DS born in Norway in 2002. OME was found in 20 out of 52 (38%) children. Those with OME had a significant lower hearing level with a mean pure tone average (PTA) of 33.4 dB HL compared to children with no OME whose mean PTA was 21.7 dB HL (p < 0.0001). Verified hearing loss above 25 dB HL in the better hearing ear was found in 12 out of the 20 with OME, compared to 5 out 31 without OME. The findings of this present study uncover the increased risk of OME in eight year old children with DS as current otitis media was found in one of three. This reduced hearing ability in children with DS due to OME at age of 8 strongly emphasizes the need for optimal treatment and follow up to optimize hearing rehabilitation. The findings are further supported by the population based study design, the focus on the narrow age band and the high response rate.
The journal of headache and pain, 2011
The main objective of this study is to investigate the relationship between tension-type headache... more The main objective of this study is to investigate the relationship between tension-type headache and obstructive sleep apnea in the general population. The method involves a cross-sectional population-based study. A random age and gender stratified sample of 40,000 persons aged 20-80 years residing in Akershus, Hedmark or Oppland County, Norway were drawn by the National Population Register. A postal questionnaire containing the Berlin Questionnaire was used to classify respondents to be of either high or low risk of obstructive sleep apnea. Included in this study were 297 persons with high risk and 134 persons with low risk of sleep apnea, aged 30-65 years. They underwent an extensive clinical interview, a physical and a neurological examination by physicians, and in-hospital polysomnography. Those with apnea hypopnoea index (AHI) ≥5 were classified with obstructive sleep apnea. Tension-type headache was diagnosed according to the International Classification of Headache Disorders...
The journal of headache and pain, 2011
Objective is to investigate the relationship between migraine and obstructive sleep apnea in the ... more Objective is to investigate the relationship between migraine and obstructive sleep apnea in the general population. A cross-sectional population-based study. A random age and gender stratified sample of 40,000 persons aged 20-80 years residing in Akershus, Hedmark or Oppland County, Norway, were drawn by the National Population Register. A postal questionnaire containing the Berlin Questionnaire was used to classify respondents to be of either high or low risk of obstructive sleep apnea. 376 persons with high risk and 157 persons with low risk of sleep apnea aged 30-65 years were included for further investigations. They underwent an extensive clinical interview, a physical and a neurological examination by physicians, and in-hospital polysomnography. Those with apnea hypopnoea index (AHI) ≥5 were classified with obstructive sleep apnea. Migraine without aura (MO) and migraine with aura (MA) was diagnosed according to the International Classification of Headache Disorders. MO and M...
International Journal of Pediatric Otorhinolaryngology, 2014
Tidsskrift for Den norske legeforening, 2009
Sleep-related breathing disorders (SRBD) is a term that includes several different diagnoses. Thi... more Sleep-related breathing disorders (SRBD) is a term that includes several different diagnoses. This paper describes aetiology, diagnostics, treatment options and consequences of untreated disease, in children and adults. The paper is based on own clinical experience and literature identified through a non-systematic search of PubMed and various books. The prevalence of SRDB in children and adults is about 10-15% and that for the most serious type, OSAS (Obstructive Sleep Apnoea Syndrome), is about 2-4%. A sleep study is required to confirm the diagnosis. The clinical symptoms of SRBD in adults are heavy snoring, observed apnoeas, gasping for air leading to frequent arousals, disturbed sleep and daytime sleepiness. Children are often hyperactive and have learning and behaviour difficulties. Untreated patients have increased mortality and morbidity. The primary treatment option for patients with medium to serious breathing disorders is continuous positive-pressure ventilation. Other treatment options are oral devices and surgery. In children, surgery (adenotonsilectomy) is the treatment of choice. OSAS is the most severe diagnosis among SRBD. Both adults and children show reduced cognitive function and quality of life. Various treatment options are available.
The Laryngoscope, 2014
Sleep apnea is associated with hypertension and diabetes, putting these patients at high risk for... more Sleep apnea is associated with hypertension and diabetes, putting these patients at high risk for developing cardiovascular disease. The goal of this study was to identify the individual cardiovascular risk profile and to detect premature and undiagnosed disease in patients with various degrees of sleep apnea. Cross-sectional. Over a 6-month period, we consecutively characterized all patients referred to our sleep laboratory for an initial evaluation of sleep apnea. Clinical history; blood tests with oral glucose tolerance test, when appropriate; test for microalbuminuria; and an electrocardiogram (ECG) were performed. The Framingham general cardiovascular risk score was assessed in each patient. A total of 255 patients were evaluated. Of those, 190 (75%) were diagnosed with sleep apnea. Patients with sleep apnea had a significantly higher Framingham risk score than patients without sleep apnea. Adjusted for age and gender, severe sleep apnea was associated with a 60% increased cardiovascular risk compared with not having sleep apnea. In sleep apnea patients without previously diagnosed hypertension, an additional 45% had significant elevated blood pressure. Among sleep apnea patients without known diabetes, we tested 48% with a pathological glucose disposal. Twenty percent of sleep apnea patients without known heart disease had significant ECG changes. High Framingham score, undiagnosed hypertension, and pathological glucose disposal were highly prevalent in patients with sleep apnea. Appropriate screening routines are important to detect cardiovascular risk factors in patients with sleep apnea.
Sleep Medicine, 2002
To assess the clinical value of pulseoximetry in the diagnosis of sleep apnea when satisfactory a... more To assess the clinical value of pulseoximetry in the diagnosis of sleep apnea when satisfactory agreement with polysomnography is obtained. This was a prospective clinical study, set in the Department of Otorhinolaryngology, Ullevaal University Hospital, Oslo, Norway. One hundred consecutive patients were investigated for sleep related breathing disorders. The main outcome measurements were: measurement success rate, oxygen desaturation thresholds, sensitivity and specificity at apnea-hypopnea-index (AHI) thresholds of 5 and 15. Pulseoximetry was successfully performed in 93%. When different oxygen desaturation thresholds were calculated, optimal agreement with polysomnography was found at a 3% oxygen desaturation level. The sensitivity and specificity of diagnosing moderate/severe sleep apnea (AHI above 15) were 0.86 and 0.88, respectively. The corresponding figures for milder sleep apnea (AHI above 5) were 0.91 and 0.67. Good agreement was found between the AHI and the oxygen desaturation index (ODI) at the 3% level, with a mean AHI-ODI difference of 2.6 (SD, 7.3), a Pearson correlation of 0.95 and a weighted kappa of 0.86. The best agreement was found for AHI values below 15, where the estimated AHI-ODI difference was only -0.4 (SD, 3.3). Pulseoximetry is a simple, non-invasive procedure, which is easy to perform and well suited for outpatient registration. When adjusted to polysomnography with high sensitivity of hypopnea registrations, an ODI at the 3% level is optimal to diagnose sleep apnea. In patients with moderate/severe sleep apnea with AHI values above 15, it is sufficient to establish the diagnosis and subsequent treatment. A negative pulseoximetry does not rule out sleep disorders; the patients should complete a full examination.
Respiration, 2005
Portable recording devices without electroencephalogram recordings are frequently used for diagno... more Portable recording devices without electroencephalogram recordings are frequently used for diagnosis of sleep-disordered breathing. However, an exact measure of sleep is important, since the diagnosis is based on the average number of events per hour of sleep, the apnea/hypopnea index (AHI). Actimetry is a simplified method for distinguishing sleep and wakefulness by measurements of activity. In this study, recording with a portable recording device (Reggie) including an incorporated actimeter and polysomnography were done simultaneously in order to test the effect of the actimeter. The study was performed at the sleep-related breathing disorder unit at the Ullevaal University Hospital, Oslo, Norway. Fifty-two consecutive patients referred to the hospital for diagnosis of sleep-disordered breathing were included. There is agreement between the AHI obtained from the polysomnography and the AHI obtained from the Reggie system. The estimated mean difference is 3.5, with an SD of 5.3 (r = 0.98). The sleep time calculated with the Reggie system is greater than the sleep time obtained by polysomnography, the mean difference being 46 min, SD 56 min (r = 0.45). Sleep time calculations with the Reggie system overestimate the sleep time. Still, the AHIs obtained by the two systems show good agreement. There is a slight tendency for the Reggie system to provide an AHI which is too low. This difference is small, and in most cases, it will be of no clinical significance.
Research in Developmental Disabilities, 2013
This study examines the prevalence of hearing loss in children with Down syndrome at the age of 8... more This study examines the prevalence of hearing loss in children with Down syndrome at the age of 8. All children were examined in the ENT-departments of public hospitals in Norway and the study population consisted of children born in Norway in 2002 with Down syndrome. Hearing loss was defined as pure-tone air-conduction reduction by on average more than 25 dB HL in the best hearing ear. A cross sectional clinical and audiological population based study was chosen as study design. Hearing loss more than 25 dB HL in the best hearing ear was found in 17/49 children (35%). Mild hearing loss was found in 13 children (26%), moderate in 3 (6%) children and severe hearing loss in 1 child (2%). Conductive hearing loss was found in 8 children (16%), 9 children (18%) had a sensory-neural hearing loss, and mixed hearing loss was found in 3 children. Mean hearing level among boys and girls were 30.0 dB HL (SD 15.7) and 25.5 dB HL (SD13.7) respectively, a non-significant difference (p=0.139). In conclusion this study indicates that both conductive and sensorineural hearing loss, is still common in children with Down syndrome children at the age of eight and as much as two thirds of the children may have a bilateral impairment. The study population was under diagnosed in terms of hearing loss and thus our findings underline the importance of continuous audiological follow up of this group of children throughout childhood.
The Journal of the Acoustical Society of America, 2011
The aim of this study was to explore and compare the effect of noise from railway and road traffi... more The aim of this study was to explore and compare the effect of noise from railway and road traffic on sleep in subjects habitually exposed to nocturnal noise. Forty young and middle aged healthy subjects were studied with polysomnography (PSG) during two consecutive nights in their own bedroom. Noise measurements and recordings were conducted concurrently outside of the bedroom façade as well as inside the bedroom of each participant. Different noise exposure parameters were calculated (L p,A,eq,night , L p,A,Fmax,night , and L AF5,night ) and analyzed in relation to whole-night sleep parameters. The group exposed to railway noise had significantly less Rapid eye movement, (REM) sleep than the group exposed to road traffic noise. A significant association was found between the maximum level (L p,A,Fmax,night ) of railway noise and time spent in REM sleep. REM sleep was significantly shorter in the group exposed to at least a single railway noise event above 50 dB inside the bedroom. These results, obtained in an ecological valid setting, support previous laboratory findings that railway noise has a stronger impact than road traffic noise on physiological parameters during sleep, and that the maximum noise level is an important predictor of noise effects on sleep assessed by PSG, at least for railway noise.
Journal of Cardiac Failure, 2011
Background: Sleep-disordered breathing (SDB) is common in patients with reduced ejection fraction... more Background: Sleep-disordered breathing (SDB) is common in patients with reduced ejection fraction (EF). However, little is known about the prevalence of SDB in a general heart failure population including patients with preserved EF (HFPEF). Methods: We prospectively enrolled stable heart failure outpatients from our heart failure clinic to assess the prevalence of SDB independent of systolic left ventricular function. Results: Among 115 patients (62% with reduced EF, 38% with preserved EF, New York Heart Association Class II-IV) SDB was present in 81% (27% central sleep apnea, 54% obstructive sleep apnea [OSA]). HFPEF patients had SDB in 80% of the cases, 62% had OSA. This group had significantly more hypertension. Conclusions: This study shows a high prevalence of SDB in a general heart failure population, also in patients with HFPEF. These patients have predominantly OSA. Especially in patients with HFPEF SDB should be kept in mind and referral to a sleep specialist should be considered. (J Cardiac Fail 2011;17:420e425)
International Journal of Clinical Practice, 2014
Sleep-disordered breathing (SDB) is common in heart failure patients. Many of them still remain u... more Sleep-disordered breathing (SDB) is common in heart failure patients. Many of them still remain undiagnosed. The aim of this study was to detect clinical predictors of sleep apnoea which may help to identify patients with SDB at a heart failure clinic. We performed an in-home sleep study on 115 consecutive patients from our heart failure clinic. Clinical characteristics, blood samples, daytime sleepiness and quality of life were registered. Among 115 patients, 52% had moderate to severe SDB. Body Mass Index (BMI) ≥ 30 kg/m² was the only independent predictor of moderate to severe SDB [Odds ratio (OR) = 3.62, 95% Confidence interval (CI) 1.40-9.36, p = 0.008]. Quality of life and level of sleepiness were not significantly associated with SDB. Patients with mild to moderate chronic obstructive pulmonary disease (COPD) were unlikely to have SDB compared with patients without COPD (OR = 0.10, 95% CI 0.02-0.43, p = 0.002). Hypertension was a predictor of having obstructive sleep apnoea (OR = 2.78, 95% CI 1.15-6.75, p = 0.02), while haemoglobin ≥ 15 g/dl was associated with central sleep apnoea (OR = 6.71, 95% CI 1.96-22.99, p = 0.002). BMI ≥ 30 kg/m(2) is associated with moderate to severe SDB, both obstructive and central sleep apnoea. Thus, BMI may be used as one of the selection criteria for referral of heart failure patients to a sleep specialist.
The European Journal of Orthodontics, 2013
BACKGROUND: In individuals with simple hypodontia, congenital absence of teeth commonly affects j... more BACKGROUND: In individuals with simple hypodontia, congenital absence of teeth commonly affects just one tooth of a pair, not both. However, patterns of hypodontia have not been fully explored in children with Down syndrome (DS). OBJECTIVE: We describe the frequency and left-right symmetry of hypodontia in the permanent dentition of 8-to 9-year-old Norwegian children with DS. MATERIALS AND METHODS: This population-based cross-sectional study was part of a national prospective study evaluating upper airway function, hearing, dental, and craniofacial characteristics in a cohort of children with DS born in 2002. The cohort consisted of 29 children with DS and represented 57 per cent of all children born with DS in Norway in 2002. Hypodontia was assessed using panoramic and/or dental radiographs. Data were collected prospectively at TAKO-Centre, National Resource Centre for Oral Health in Rare Medical Conditions, Lovisenberg Diakonale Hospital, Oslo, Norway. RESULTS: Hypodontia of permanent teeth, excluding third molars, was found in 61.5 per cent of the 26 children included in the final sample. Among the 16 children with hypodontia, 75.0 per cent were missing two or more permanent teeth. Two children (7.7 per cent) had severe hypodontia (oligodontia). The teeth most often missing were the maxillary lateral incisors, followed by the mandibular second premolars and maxillary second premolars. Most (68.9 per cent) cases of hypodontia occurred bilaterally. CONCLUSIONS: The majority of the children with DS were missing one or more permanent teeth. Unlike in the general population, bilateral hypodontia was more common than unilateral hypodontia in this sample of children with DS.
European Archives of Oto-Rhino-Laryngology, 2005
The reference method for measuring respiratory effort and for differentiating between obstructive... more The reference method for measuring respiratory effort and for differentiating between obstructive and central apneas in the diagnosis of sleep-related breathing disorders is overnight monitoring of esophageal pressure. Despite this being the reference method, it is not widely used because it is considered invasive and uncomfortable for the patients. The aim of this study was to assess patient discomfort and insertion difficulty when using an esophageal catheter during polysomnography. We have performed a prospective questionnaire-based clinical study in 799 consecutive patients where polysomnography with an esophageal catheter was routinely performed in the diagnosis of sleep-related breathing disorders. The main outcome measures were the catheter-related discomfort experienced by the patient and difficulty of catheter insertion reported by the sleep technician. Ninety-six percent of the patients accepted the insertion of the catheter, and most of the patients considered it acceptable to sleep with the catheter. Correspondingly, in most of the patients, the catheter was easily inserted, and there were difficulties in only a few patients. Specifically, no complications or side effects were reported when using the catheter. To optimize the diagnosis of sleep-related breathing disorders, an esophageal sensor catheter can be used during polysomnography, without causing major patient discomfort.
European Archives of Oto-Rhino-Laryngology, 2012
The aim of the present study was to investigate the prevalence of obstructive sleep apnea syndrom... more The aim of the present study was to investigate the prevalence of obstructive sleep apnea syndrome (OSAS) among the Norwegian population with Treacher Collins syndrome (TCS). A secondary aim was to establish whether TCS phenotype severity is associated with OSAS severity. A prospective case study design was used. Individuals who were 5 years old and above with a known diagnosis of TCS in Norway were invited to participate in a study. The study included genetic testing, medical and dental examinations and polysomnography. All participants demonstrated disturbed respiration during sleep; 18/19 met the diagnostic criteria for OSAS. Subjectively evaluated snoring was not a reliable predictor of OSAS. We found no significant association between TCS phenotype severity and the severity of OSAS. OSAS is common in TCS, but there is no association with the phenotype severity. Individuals diagnosed with TCS must undergo sleep studies to identify the presence of OSAS.