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Nocturnal symptoms are very common in asthma, which is associated with worse sleep quality. The nocturnal oxygen saturation may be decreased in asthma; however, whether this association is dependent on nocturnal asthma symptoms, lung function, coexisting obstructive sleep apnea (OSA), or other asthma-related comorbidities is unknown. The objective of this study was to examine the effects of asthma, OSA, lung function, airway symptoms, and asthma-related comorbidities on the nocturnal oxygen saturation in a cross-sectional community-based population study.In total, 395 women and 392 men underwent overnight polysomnography, performed spirometry, and completed questionnaires on airway symptoms and asthma-related comorbidities.Participants with asthma (n = 88) had a lower nocturnal oxygen saturation than those without asthma (93.8% vs 94.3%,Participants with asthma displayed a lower mean oxygen saturation during sleep, which could not be explained only by coexisting OSA or obesity. Also, asthma symptoms and lung function were associated with lower nocturnal oxygen saturation. The lower oxygen saturation seen in asthma is hence multifactorial in origin and is a result of the combination of symptoms, lung function, and comorbidity.Sundbom F, Janson C, Ljunggren M, Lindberg E. Asthma and asthma-related comorbidity: effects on nocturnal oxygen saturation.

Background Previous research suggests an association between road traffic noise and obesity, but current evidence is inconclusive. We aimed to investigate associations between self-reported traffic noise in bedrooms and self-measured obesity markers. Methods We applied data from the Respiratory Health in Northern Europe (RHINE) cohort. We used self-measured waist circumference (WC) and body mass index (BMI) as outcome values. Noise exposure was assessed as perceived traffic noise in the bedroom and/or the bedroom window’s location towards the street. We applied linear, and logistic regression models and evaluated effect modifications by sex. Results Women, who reported very high traffic noise levels in bedroom, had 1.35 (95% CI 0.32–2.38) kg/m2 higher BMI and 4.66 (95% CI 1.83–7.48) cm higher WC compared to women, who reported no traffic noise in the bedroom. Women who reported higher exposure to road traffic noise had statistically significant higher odds of being overweight, obese or have abdominal obesity with OR varying from 1.16 to 1.67 compared to women, who reported no traffic noise in the bedroom. Among men we did not find any clear associations between noise pollution and obesity measures. Conclusion Our results suggest that self-reported traffic noise in the bedroom may be associated to being overweight or obese among women, but not among men.

STUDY OBJECTIVES: Insomnia and snoring are common sleep disorders. The aim was to investigate the association of having a combination of insomnia symptoms and snoring with comorbidity and daytime sleepiness. METHODS: The study population comprised 25,901 participants (16–75 years, 54.4% women) from 4 Swedish cities, who answered a postal questionnaire that contained questions on snoring, insomnia symptoms (difficulties initiating and/or maintaining sleep and/or early morning awakening), smoking, educational level, and respiratory and nonrespiratory disorders. RESULTS: Snoring was reported by 4,221 (16.2%), while 9,872 (38.1%) reported ≥ 1 insomnia symptom. A total of 2,150 (8.3%) participants reported both insomnia symptoms and snoring. The association with hypertension (adjusted odds ratio [OR], 1.4; 95% confidence interval [CI], 1.2–1.6), chronic obstructive pulmonary disease (adjusted OR, 1.8; 95% CI, 1.3–2.4), asthma (adjusted OR, 1.9; 95% CI, 1.6–2.3), daytime sleepiness (adjusted OR, 7.9; 95% CI, 7.1–8.8), and the use of hypnotics (adjusted OR, 7.5; 95% CI, 6.1–9.1) was highest for the group with both insomnia symptoms and snoring. CONCLUSIONS: Participants with both snoring and insomnia run an increased risk of hypertension, chronic obstructive pulmonary disease, asthma, daytime sleepiness, and use of hypnotics. It is important to consider snoring in patients seeking medical assistance for insomnia and, vice versa, in patients with snoring inquiring about insomnia. CITATION: Hägg SA, Ilieva E, Ljunggren M, et al. The negative health effects of having a combination of snoring and insomnia. J Clin Sleep Med. 2022;18(4):973–981.

Background Sleep-disordered breathing (SDB) may contribute to development of stroke. However, findings are inconclusive. We investigated whether SDB-related symptoms are associated with incidence of stroke and its types in a general community sample of adult men and women as well as to perform Mendelian randomization (MR) analysis. Methods We used data from a cohort of 41,742 Swedish adults (56–94 years of age) who completed questionnaires regarding snoring, cessation of breathing, lifestyle and health characteristics. Participants were followed up for incident stroke and death over 8 years through linkage to the Swedish Registers. Hazard ratios, adjusted for potential confounders, were estimated by Cox proportional hazards regression. MR analyses were performed using single-nucleotide polymorphisms associated with sleep apnea at the genome-wide significance level and summary-level data for stroke and its subtypes from consortia and a meta-analysis of Genome-Wide Association Studies. Results In the cohort study, symptoms of disturbing snoring and/or cessation of breathing were associated with increased risk of total stroke (hazard ratio 1.12, 95% confidence interval 1.02–1.24) and intracerebral hemorrhage (hazard ratio 1.59, 95% confidence interval 1.23–2.05) but not with ischemic stroke or subarachnoid hemorrhage. MR analyses showed no association of genetic liability to sleep apnea with the risk of overall stroke or any specific types of stroke or ischemic stroke subtypes. Conclusions SDB-related symptoms were associated with increased risk of total stroke, specifically intracerebral hemorrhage, in the observational analyses but not in the MR analyses. There was limited evidence of an association of SDB with ischemic stroke and subarachnoid hemorrhage.

Accelerometers placed on the thigh provide accurate measures of daily physical activity types, postures and sedentary behaviours, over 24 h and across consecutive days. However, the ability to estimate sleep duration or quality from thigh-worn accelerometers is uncertain and has not been evaluated in comparison with the ‘gold-standard’ measurement of sleep polysomnography. This study aimed to develop an algorithm for sleep estimation using the raw data from a thigh-worn accelerometer and to evaluate it in comparison with polysomnography. The algorithm was developed and optimised on a dataset consisting of 23 single-night polysomnography recordings, collected in a laboratory, from 15 asymptomatic adults. This optimised algorithm was then applied to a separate evaluation dataset, in which, 71 adult males (mean [SD] age 57 [11] years, height 181 [6] cm, weight 82 [13] kg) wore ambulatory polysomnography equipment and a thigh-worn accelerometer, simultaneously, whilst sleeping at home. Compared with polysomnography, the algorithm had a sensitivity of 0.84 and a specificity of 0.55 when estimating sleep periods. Sleep intervals were underestimated by 21 min (130 min, Limits of Agreement Range [LoAR]). Total sleep time was underestimated by 32 min (233 min LoAR). Our results evaluate the performance of a new algorithm for estimating sleep and outline the limitations. Based on these results, we conclude that a single device can provide estimates of the sleep interval and total sleep time with sufficient accuracy for the measurement of daily physical activity, sedentary behaviour, and sleep, on a group level in free-living settings.

Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder. In animal models, OSA has been shown to alter the gut microbiota; however, little is known about such effects in humans. Here, we used respiratory polygraphy data from 3,570 individuals aged 50–64 from the Swedish CardioPulmonary bioImage Study (SCAPIS) and deep shotgun metagenomics to identify OSA-associated gut microbiota features. We found that OSA-related hypoxia parameters were associated with 128 bacterial species, including positive associations with Blautia obeum and Collinsela aerofacines. The latter was also associated with increased systolic blood pressure. Further, the cumulative time in hypoxia was associated with nine gut microbiota metabolic pathways, including propionate production from lactate, a biomarker of hypoxia. In conclusion, in this first large-scale study on gut microbiota alterations in OSA, we found that OSA-related hypoxia is associated with specific microbiota features. Our findings can direct future research on microbiota-mediated health effects of OSA.

The estimation of species composition and species-specific stem volumes are critical components of many forest inventories. The use of airborne laser scanning with multiple spectral channels may prove instrumental for the cost-efficient retrieval of these forest variables. In this study, we scanned a boreal forest using two channels: 532 nm (green) and 1064 nm (near infrared). The data was used in a two-step methodology to (1) classify species, and (2) estimate species-specific stem volume at the level of individual tree crowns. The classification of pines, spruces and broadleaves involved linear discriminant analysis (LDA) and resulted in an overall accuracy of 91.1 % at the level of individual trees. For the estimation of stem volume, we employed species-specific k-nearest neighbors models and evaluated the performance at the plot level for 256 field plots located in central Sweden. This resulted in root-mean-square errors (RMSE) of 36 m3/ha (16 %) for total volume, 40 m3/ha (27 %) for pine volume, 32 m3/ha (48 %) for spruce volume, and 13 m3/ha (87 %) for broadleaf volume. We also simulated the use of a monospectral near infrared (NIR) scanner by excluding features based on the green channel. This resulted in lower overall accuracy for the species classification (86.8 %) and an RMSE of 41 m3/ha (18 %) for the estimation of total stem volume. The largest difference when only the NIR channel was used was the difficulty to accurately identify broadleaves and estimate broadleaf stem volume. When excluding the green channel, RMSE for broadleaved volume increased from 13 to 26 m3/ha. The study thus demonstrates the added benefit of the green channel for the estimation of both species composition and species-specific stem volumes. In addition, we investigated how tree height influences the results where shorter trees were found to be more difficult to classify correctly.

STUDY OBJECTIVES: Exposure to traffic noise increases the risk of sleeping disturbance, but little is known about the effect of traffic-related air pollution on insomnia symptoms. We aimed to investigate the separate associations of self-reported proximity to traffic and traffic noise with insomnia. METHODS: This is a cross-sectional study of the population included in the Respiratory Health in Northern Europe study, consisting of randomly selected men and women born between 1945 and 1973, from 7 Northern European centers. Hearing traffic noise in the bedroom, bedroom window proximity to traffic, and insomnia symptoms were self-reported. Bedroom window proximity to traffic was used as a surrogate for exposure to traffic-related air pollution. The following insomnia symptoms were assessed: difficulty initiating sleep, difficulty maintaining sleep, and early morning awakening. RESULTS: A total of 12,963 individuals was included. Traffic noise was positively associated with all three insomnia symptoms: difficulty initiating sleep (odds ratio [OR] = 3.54; 95% confidence interval [CI]: 1.85, 6.76), difficulty maintaining sleep (OR = 2.95; 95% CI: 1.62, 5.37), and early morning awakening (OR = 3.25; 95% CI: 1.97, 5.37). Proximity to traffic without disturbing noise was associated with difficulty initiating sleep (OR = 1.62; 95% CI: 1.45, 1.82). CONCLUSIONS: This study adds further support to the identification of traffic noise as a risk factor for insomnia. Proximity to traffic without being exposed to noise was associated with an increased risk of difficulty initiating sleep. Our findings indicate that insomnia may be associated with both traffic noise and traffic-related air pollution. CITATION: Janson E, Johannessen A, Holm M, et al. Insomnia associated with traffic noise and proximity to traffic—a cross-sectional study of the Respiratory Health in Northern Europe III population. J Clin Sleep Med. 2020;16(4):545–552.

The relationship between sleep duration and sleepiness has seen much research, but no data are available on the association between polysomnographically (PSG) determined total sleep time (TST) (or other PSG variables) and subjective sleepiness during the subsequent day in individuals in their habitual life situation. The purpose of the present study was to study the association between TST and sleep efficiency (SE) (and other PSG variables) and next-day sleepiness at 7 times of the day. A large population-based group of women (N = 400) participated. Daytime sleepiness was measured with the Karolinska Sleepiness Scale (KSS). The association was studied through analysis of variance (ANOVA), as well as regression analyses. For SE there was a significant difference in sleepiness across groups with >90%, 80%–89.99%, and 0.45) was seen for both analyses, with maximum sleepiness at bedtime (≈ 7.5 KSS units). A multiple regression analysis, including all PSG variables (adjusted for age and BMI), showed that SE was a significant predictor (β = 0.16, p < .05) of mean sleepiness, even after depression, anxiety, and subjective sleep duration were entered, but this was eliminated by subjective sleep quality. It was concluded that high SE is modestly associated with lower next-day sleepiness in women in a real-life context, but that TST is not.

Subjective sleep reports are widely used research tools in epidemiology. Whether sleep reports can differ between seasons is less clear. Using multivariable binary or multinomial logistic regression analyses, in the present Swedish cross-sectional two-centre cohort study (N = 19,254; mean age 61 years), we found that participants surveyed during the summer (June-August) were more likely to report short sleep duration (defined as ≤ 6 hr) compared with those interviewed during the autumn (odds ratio [95% confidence interval] = 1.14 [1.04-1.25]). Individuals interviewed in the winter (December-February) were less likely to report early awakenings compared with participants surveyed in the autumn (September-November; odds ratio [95% confidence interval] = 0.85 [0.75-0.96]). Complaints of difficulties in falling asleep and disturbed sleep were less common among participants interviewed during spring (March-May) compared with those interviewed during the autumn (odds ratio [95% confidence interval] = 0.86 [0.74-0.99] and 0.88 [0.79-0.98], respectively). No seasonal variations in reports of long sleep, difficulty maintaining sleep, or feeling not rested after sleep were observed. Additional subgroup analysis revealed that summer participants were more likely to report short sleep duration and early morning awakenings than individuals surveyed in winter. In conclusion, this Swedish study indicates that self-reported sleep characteristics may vary across seasons. Further studies are needed to confirm our findings.

IntroductionBreathlessness is common in the population, especially in women and associated with adverse health outcomes. Obesity (body mass index (BMI) >30 kg/m2) is rapidly increasing globally and its impact on breathlessness is unclear.MethodsThis population-based study aimed primarily to evaluate the association of current BMI and self-reported change in BMI since age 20 with breathlessness (modified Research Council score ≥1) in the middle-aged population. Secondary aims were to evaluate factors that contribute to breathlessness in obesity, including the interaction with spirometric lung volume and sex.ResultsWe included 13 437 individuals; mean age 57.5 years; 52.5% women; mean BMI 26.8 (SD 4.3); mean BMI increase since age 20 was 5.0 kg/m2; and 1283 (9.6%) reported breathlessness. Obesity was strongly associated with increased breathlessness, OR 3.54 (95% CI, 3.03 to 4.13) independent of age, sex, smoking, airflow obstruction, exercise level and the presence of comorbidities. The association between BMI and breathlessness was modified by lung volume; the increase in breathlessness prevalence with higher BMI was steeper for individuals with lower forced vital capacity (FVC). The higher breathlessness prevalence in obese women than men (27.4% vs 12.5%; pConclusionBreathlessness is independently associated with obesity and with weight gain in adult life, and the association is stronger for individuals with lower lung volumes.

Aims of the study Neurological impairment after resuscitated cardiac arrest (CA) remains a significant unmet medical need. Brain ischemia associated with CA and subsequent reperfusion is evident as two fundamentally different types of damage on neuropathological examination: frank necrosis (involving all cell types) and selective eosinophilic neuronal death (SEND). These types of damage are not only dissimilar in micromorphology, but also differently detectable with clinical brain imaging methods. In a previous study, SEND was reported in most patients surviving the initial CA. This study was undertaken to further characterize and map SEND in an expanded dataset. Methods A cohort of 46 cases was included from an observational study on targeted temperature management (TTM) of resuscitated CA. Six brain and brain stem regions and 21 subregions were examined, and SEND severity was tested for correlation with time to ROSC. Representativity of all regions vis-a-vis global SEND was assessed, to investigate whether any particular region could be used as a “sentinel site” for overall damage. Results The thalamus, the CA4 subregion of the hippocampus and the Purkinje cell layer of the cerebellum were the most severely affected subregions. Involvement of the hippocampus, cerebellum, cortex or basal ganglia indicated presence of SEND in other regions. There was a significant correlation between time to ROSC and SEND. Conclusion There are regional differences in SEND distribution. Cases free of SEND in the hippocampus or basal ganglia are unlikely to have significant SEND in other regions, suggesting that these regions could be used as “sentinel sites” for global SEND in future studies.

Introduction The study aim was to examine the association of snoring and nocturnal gastro-oesophageal reflux (nGOR) with respiratory symptoms and lung function, and if snoring and/or nGOR associated with a steeper decline in lung function. Methods Data from the third visit of the European Community Respiratory Health Survey (ECRHS) was used for cross-sectional analysis. Pre- and post-bronchodilator spirometry was performed, and information on sleep, nGOR and respiratory symptoms was collected (n=5715). Habitual snoring and nGOR were assessed by questionnaire reports. Pre-bronchodilator spirometry from ECRHS I, II and III (20 years follow-up) were used to analyse lung function changes by multivariate regression analysis. Results Snoring and nGOR were independently associated with a higher prevalence of wheeze, chest tightness, breathlessness, cough and phlegm. The prevalence of any respiratory symptom was 79% in subjects with both snoring and nGOR versus 56% in those with neither (p, Middle-aged adults with habitual snoring have a steeper decline in lung function over 10 years compared to controls. Habitual snorers with nocturnal gastro-oesophageal reflux have a higher prevalence of nocturnal respiratory symptoms than controls. http://ow.ly/YsiK30odcMY

According to the “3P model” of insomnia, the variable that mediates the transition from acute insomnia (AI) to chronic insomnia is “sleep extension” (the behavioural tendency to expand sleep opportunity to compensate for sleep loss). In the present analysis, we sought to evaluate how time in bed (TIB) varies relative to the new onset of AI and chronic insomnia. A total of 1,248 subjects were recruited as good sleepers (GS). Subjects were monitored over 1 year with sleep diaries. State transitions were defined, a priori, for AI, recovered from AI (AI-REC), and for chronic insomnia (AI-CI). Two additional groupings were added based on profiles that were unanticipated: subjects that exhibited persistent poor sleep following AI (AI-PPS [those that neither recovered or developed chronic insomnia]) and subjects that recovered from chronic insomnia (CI-REC). All the groups (GS, AI-REC, AI-CI, AI-PPS and CI-REC) were evaluated for TIB differences with longitudinal mixed effects models. Post hoc analyses for the percentage of the groups that were typed as TIB “restrictors, maintainers, and expanders” were conducted using longitudinal mixed effects models and contingency analyses. Significant differences for pre-post AI TIB were not detected for the insomnia groups. Trends were apparent for the AI-CI group, which suggested that minor increases in TIB occurred weeks before the declared onset of AI. Additionally, it was found that a significantly larger percentage of AI-CI subjects engaged in sleep extension (as compared to GS). The present data suggest that transition from AI to chronic insomnia does not appear to be initiated by sleep extension and the transition may occur before the elapse of 3 months of ≥3 nights of sleep continuity disturbance. Given these findings, it may be that the mismatch between sleep ability and sleep opportunity is perpetuated over time given the failure to “naturally” engage in sleep restriction (as opposed to sleep extension).

Due to the ongoing global warming, European spruce bark beetles has become a serious threat to the spruce forests in Europe and caused serious environmental and economic issues. This study proposes a new vegetation index, Normalized Projected Red & SWIR (NPRS), for detection of spruce bark beetle attacks. 29 healthy and 24 bark beetle attacked plots in southern Sweden were used for evaluating the classification accuracy using NPRS at early-, intermediate- and late-stage attacks. The obtained kappa coefficients were 0.73, 0.80 and 0.88, respectively. It was concluded that the NPRS is a feasible method for continuous bark beetle mapping over large areas.

Sinonasal complaints contribute to low adherence to continuous positive airway pressure (CPAP) treatment. We aimed to investigate sinonasal health in obstructive sleep apnoea (OSA) patients, using the sinonasal outcome test-22 (SNOT-22), and to analyse whether SNOT-22 is affected by CPAP adherence. We also aimed to investigate whether peak nasal inspiratory flow (PNIF) was able to predict adherence to CPAP.The study population comprised 197 OSA patients (60 females) initiating CPAP treatment. The SNOT-22, PNIF and the Epworth Sleepiness Scale were assessed at baseline and follow-up. One-night polygraphy, the Hospital Anxiety and Depression Scale, peak expiratory flow and health-related issues were assessed at baseline. At follow-up, the patients were categorised into adherent (more than 4 hours/night) and non-adherent (less than 4 hours/night) to CPAP treatment.The average time for following up CPAP treatment was (mean plus or minus SD) 24.0 plus or minus 23.9 days and it did not differ significantly between the groups. The SNOT-22 score was elevated among all OSA patients, 36.1 plus or minus 19.4. There was a larger improvement in the SNOT-22 score at follow-up among adherent CPAP users compared with non-adherent users (-10.4 plus or minus 13.9 vs. -3.2 plus or minus 15.4). A PNIF value of less than 100 litres/min increased the risk of non-adherence to CPAP with an adjusted odds ratio (OR) of 2.40 ((95% CI 1.16-5.00)).The SNOT-22 was elevated in patients with OSA, indicating a considerable sinonasal disease burden. The SNOT-22 improved with good CPAP adherence. A low PNIF value was able to predict poor CPAP adherence. Both the SNOT-22 and PNIF can be valuable tools in the evaluation of OSA patients and in the management of CPAP treatment.

Objectives Smoking is associated with sleep disturbances. The aim of this study was to analyze whether sleep disturbances are predictors of smoking cessation and whether continued smoking is associated with the development of sleep disturbances. Methods A questionnaire was sent to randomly selected men and women in Northern Europe in 1999–2001 (RHINE II) and was followed up by a questionnaire in 2010–2012 (RHINE III). The study population consisted of 2568 participants who were smokers at baseline and provided data on smoking at follow-up. Insomnia symptoms were defined as having difficulty initiating and/or maintaining sleep and/or early morning awakening ≥3 nights/week. Multiple logistic regression analyses were performed to calculate odds ratios (OR). Results Subjects with difficulty initiating sleep (adjusted odds ratio; 95% confidence interval: 0.6; 0.4–0.8), difficulty maintaining sleep (0.7; 0.5–0.9), early morning awakening (0.6; 0.4–0.8), any insomnia symptom (0.6; 0.5–0.8) or excessive daytime sleepiness (0.7; 0.5–0.8) were less likely to achieve long-term smoking cessation after adjustment for age, BMI, pack-years, hypertension, diabetes, chronic bronchitis, rhinitis, asthma, gender and BMI difference. There was no significant association between snoring and smoking cessation. In subjects without sleep disturbance at baseline, continued smoking increased the risk of developing difficulty initiating sleep during the follow-up period compared with those that had quit smoking (adj. OR 1.7, 95% CI 1.2–2.3). Conclusions Insomnia symptoms and excessive daytime sleepiness negatively predict smoking cessation. Smoking is a risk factor for the development of difficulty initiating sleep. Treatment for sleep disturbances should be included in smoking-cessation programs.

Background Congenital chloride diarrhea (CLD; OMIM 214700) is a rare autosomal recessive disorder caused by pathogenic variations in the solute carrier family 26 member A3 (SLC26A3) gene. Without salt substitution, this chronic diarrheal disorder causes severe dehydration and electrolyte disturbances. Homozygous variants in the nearby gene SLC26A4 disrupt anion exchange in the inner ear and the thyroid, causing Pendred syndrome (PDS; OMIM 274600), which is the most frequent form of syndromic deafness. Case presentation We report an unusual co-occurrence of two rare homozygous mutations in both the SLC26A3 and SLC26A4 genes, causing a rare combination of both CLD and PDS in two siblings. Although the clinical pictures were typical, the combined loss of these anion transporters might modulate the risk of renal injury associated with CLD. Conclusions Familial presentation of two rare autosomal recessive disorders with loss of function of different SLC26 anion transporters is described. Independent homozygous variants in the SLC26A3 and SLC26A4 genes cause CLD and PDS in siblings, shedding light on co-occurrence of rare recessive traits in the progeny of consanguineous couples.

STUDY OBJECTIVES: To investigate relationships between sleep duration and adherence to healthy diets, but also associations with meal patterns, in a large population-based cohort. METHODS: Participants (n = 23,829, males and females, aged 45 to 75 years) from the Swedish EpiHealth cohort study were included in a cross-sectional analysis. The participants filled out an extensive Internet-based questionnaire, and also visited a test center for anthropometric measurements and blood sampling. Sleep duration was classified as short (< 6 h/night; n = 1,862), normal (6 to less fewer than 9 h/night; n = 19,907) and long sleep (≥ 9 h/night; n = 858). In addition, a combination variable of sleep duration (short/normal/long) and sleep quality (good/poor) was constructed, giving six categories. Adherence to a healthy diet was assessed using the modified Mediterranean diet (mMED) score and the Healthy Nordic Food Index (HNFI) score based on food groups from a food frequency questionnaire. A regular meal pattern was considered if the participant had breakfast, lunch and dinner on a daily basis. RESULTS: Compared with normal sleepers, short sleepers displayed lower adherence to a healthy diet when using both the mMED score (adjusted odds ratio = 0.70; 95% confidence interval 0.56-0.88) and the HNFI score (0.70; 0.56–0.88). When combining sleep duration and sleep quality, short sleepers with poor sleep quality showed an independent relationship with low adherence to a healthy diet (0.67; 0.52–0.86) compared with normal sleepers with good sleep quality. In addition, both short sleepers (0.71; 0.62–0.82) and long sleepers (0.75; 0.62–0.91) showed low adherence to regular meal patterns, compared with normal sleepers. Furthermore, short sleepers with poor sleep quality had reduced odds of having a regular meal pattern (0.67; 0.57–0.79) as compared with normal sleepers with good sleep quality. CONCLUSIONS: Short sleep duration combined with poor sleep quality is associated with low adherence to a healthy diet and regular meal patterns. CITATION: Theorell-Haglöw J, Lemming EW, Michaëlsson K, Elmeståhl S, Lind L, Lindberg E. Sleep duration is associated with healthy diet scores and meal patterns: results from the population-based EpiHealth study. J Clin Sleep Med. 2020;16(1):9–18.

Combined insomnia and obstructive sleep apnea has been the focus of considerable research with respect to its health effects. A related issue is whether sleep disturbances in combination with snoring might exert effects on objective sleep variables in the non-clinical general population. The purpose of the present study was to investigate the polysomnographical characteristics of individuals who had sought medical help for both disturbed sleep and for snoring. No previous work of this type has been carried out.For this study we used a representative set of data of 384 women with one night of in-home PSG. We identified those individuals who had sought medical help for sleep problems (SL), individuals that had sought help for snoring (SN), as well as those that had sought help for either both (Combined), or for neither (Control).Our results yielded an N of 46, 16, 21, and 301 individuals, respectively. A one-factor analysis of variance showed significant main effects on N1% (F = 10.2, p 0.001), N3% (F = 2.7, p 0.05), AHI/h (F = 5.5, p 0.001), and a delta power measure (F = 3.8, p 0.05). The combined group showed significantly higher levels than the other groups for N1% (29% vs 21%), AHI/h (19/h vs 10/h) and lower levels for N3%, and a measure of delta power. Reported sleep quality measures did not show the same pattern, since the highest/lowest value were found for either the group presenting snoring alone or sleep problems alone.We concluded that individuals who had sought help for both insomnia and snoring showed impaired sleep in terms of PSG and that this was not reflected in ratings of sleep or health. This suggests that simultaneous sleep disturbances and snoring may potentiate each other to cause impaired sleep, yet the mechanism still needs to be elucidated.

Objectives Adherence to continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA) is crucial. Our aim was to identify protective and risk factors against the discontinuation of CPAP treatment in patients with OSA and to estimate the mortality risk in those who were non-adherent to CPAP therapy. Methods This was a registry-based cohort study from 37 centers across Sweden with OSA patients on CPAP in the Swedevox Swedish national registry between July 2010 and March 2017. Results In 16,425 patients (70.8% men) with complete follow-up data after 1.2 ± 0.8 years the adjusted relative risk ratio (aRRR) for the discontinuation of CPAP was 0.57 (95% confidence interval (CI) 0.50–0.65) for use of humidifier, 0.87 (95% CI 0.82–0.92) for increasing age per 10 years, 0.80 (95% CI 0.77–0.83) for increasing apnea hypopnea index (AHI) per 5 units/hour, and 0.96 (95% CI 0.95–0.97) per increased unit on the Epworth Sleepiness Scale (ESS). Increasing BMI was associated with increased adherence up to BMI 35. Women and patients with hypertension ran an increased risk of discontinuing CPAP treatment, aRRR 1.28 (95% CI 1.12–1.46) and 1.24 (95% CI 1.12–1.42) respectively. The adjusted hazard ratio (HR) for mortality was 1.74 (95% CI 1.32–2.28) among those who did not adhere to CPAP (median follow-up period 2.4 years after the one year adherence evaluation). Conclusion Use of humidifier is associated with greater adherence to CPAP treatment. Other factors predicting adherence are increasing age, more severe OSA and overweight up to BMI 35, whereas female gender and coexisting hypertension are risk factors for discontinuation of CPAP. Failure to adhere to CPAP is associated with increased mortality.

Obstructive sleep apnea (OSA) is related to postoperative complications and is a common disorder. Most patients with sleep apnea are, however, undiagnosed, and there is a need for simple screening tools. We aimed to investigate whether STOP-Bang and oxygen desaturation index can identify subjects with OSA.In this prospective, observational multicenter trial, 449 adult patients referred to a sleep clinic for evaluation of OSA were investigated with ambulatory polygraphy, including pulse oximetry and the STOP-Bang questionnaire in 4 Swedish centers. The STOP-Bang score is the sum of 8 positive answers to Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index35 kg/m, Age50 years, Neck circumference40 cm, and male Gender.The optimal STOP-Bang cutoff score was 6 for moderate and severe sleep apnea, defined as apnea-hypopnea index (AHI) ≥15, and the sensitivity and specificity for this score were 63% (95% CI, 0.55-0.70) and 69% (95% CI, 0.64-0.75), respectively. A STOP-Bang score of2 had a probability of 95% (95% CI, 0.92-0.98) to exclude an AHI15 and a STOP-Bang score of ≥6 had a specificity of 91% (95% CI, 0.87-0.94) for an AHI15. The items contributing most to the STOP-Bang were the Bang items. There was a positive correlation between AHI versus STOP-Bang and between AHI versus oxygen desaturation index, Spearman ρ 0.50 (95% CI, 0.43-0.58) and 0.96 (95% CI, 0.94-0.97), respectively.STOP-Bang and pulse oximetry can be used to screen for sleep apnea. A STOP-Bang score of2 almost excludes moderate and severe OSA, whereas nearly all the patients with a STOP-Bang score ≥6 have OSA. We suggest the addition of nightly pulse oximetry in patients with a STOP-Bang score of 2-5 when there is a need for screening for sleep apnea (ie, before surgery).

Previous studies have found that excessive daytime sleepiness (EDS) is a more common problem in asthmatic subjects than in the general population. The aim of this study was to investigate whether the prevalence of EDS is increased in asthmatic subjects and, if so, to analyse the occurrence of potential risk factors for EDS in asthmatics.Cross-sectional epidemiological study. In 2008, a postal questionnaire was sent out to a random sample of 45,000 individuals aged 16-75 years in four Swedish cities.Of the 25,160 persons who participated, 7.3% were defined as having asthma. The prevalence of EDS was significantly higher in asthmatic subjects (42.1% vs. 28.5%, p0.001) compared with non-asthmatic subjects. Asthma was an independent risk factor for EDS (adjusted OR 1.29) and the risk of having EDS increased with asthma severity. Risk factors for EDS in subjects with asthma included insomnia (OR, 3.87; 95% CI, 3.10-4.84); chronic rhinosinusitis (OR, 2.00; 95% CI, 1.53-2.62); current smoking (OR, 1.60; 95% CI, 1.15-2.22) and obesity (OR, 1.53; 95% CI, 1.09-2.13).EDS is a common problem among subjects with asthma. Asthma is an independent risk factor for having EDS. Furthermore, subjects with asthma often have other risk factors for EDS, many of them potentially modifiable.

Both asthma and obstructive sleep apnea (OSA) are strongly associated with poor sleep. Asthma and OSA also have several features in common, including airway obstruction, systemic inflammation, and an association with obesity. The aim was to analyze the effect of asthma, OSA, and the combination of asthma and OSA on objectively measured sleep quality and systemic inflammation.Sleep and health in women is an ongoing community-based study in Uppsala, Sweden. Three hundred eighty-four women ages 20 to 70 years underwent overnight polysomnography and completed questionnaires on airway diseases and sleep complaints. C-reactive protein (CRP), interleukin 6 (IL-6), and tumor necrosis factor α were analyzed.The group with both asthma and OSA had higher CRP, higher IL-6, a longer sleeping time in stage N1 sleep and stage N2 sleep, and less time in stage R sleep than the control group with no asthma or OSA. The group with both asthma and OSA had lower mean oxygen saturation (93.4% versus 94.7%,Our data indicate that coexisting asthma and OSA are associated with poorer sleep quality and more profound nocturnal hypoxemia than either of the conditions alone. The results are similar to earlier findings related to OSA and chronic obstructive pulmonary disease, but they have not previously been described for asthma.

Objective: Some studies of women with polycystic ovary syndrome (PCOS) report increased prevalence of hypertensive disorders in pregnancy, while others do not. Several of these studies do not control for obesity. We aimed to study whether PCOS is associated with hypertensive disorders in pregnancy and whether it is dependent on body mass index (BMI). Study design: We present a cross-sectional analysis of 3732 women from Denmark, Estonia, Iceland, Norway and Sweden, born in 1945–72, who participated in the Respiratory Health In Northern Europe (RHINE) study and answered an extensive women's health questionnaire on menstruation, PCOS, infertility, pregnancy history and childbirth. The main outcome measurement was hypertensive disorders of pregnancy. We adjusted for smoking, age, infertility treatment and study center. Effect modification by BMI was assessed. Results: PCOS was related to hypertensive disorders in pregnancy with a relative risk (RR) of 1.62 (95% CI 1.09–2.42). This relationship was found among underweight women with a BMI of 2 [RR = 5.2 (95% CI 1.66–16.5)] and obese women with a BMI of ≥30 kg/m 2 [RR = 2.36 (95% CI 1.29–4.31)], but not among normal-weight women, BMI 18.5–25 kg/m 2 [1.08 (0.53–2.20)], or overweight women, BMI 25–30 kg/m 2 [1.24 (0.50–3.08)] (p-interaction = 0.041). Conclusion: Polycystic ovary syndrome is associated with hypertensive disorders in pregnancy. This association only occurs among underweight and obese women and not among normal-weight and slightly overweight women.

Introduction Preliminary findings suggest that pets may improve the owner’s sleep via companionship, security, physical activity, and relaxation. On the other hand, pets can disrupt the owner’s sleep. Due to the heterogeneity of the results and the low number of studies in this field, more studies with a bigger sample size are needed to explore this association. Methods Using data from the Swedish CArdioPulmonary bIoimage Study (SCAPIS) cohort, we investigated the association of pet ownership with the following self-reported sleep outcomes in 3,788 to 4,574 participants using regression modeling: achieving the recommended daily sleep duration for adults (i.e., at least 7 hours per day); sleep quality as measured by the Pittsburgh Sleep Quality Index (a score of >5 indicating poor sleep quality); and difficulty falling or staying asleep. Results Sleep metrics were not associated with pet ownership, dog ownership, and dog walking when controlling for possible confounders. In contrast, cat ownership was associated with a higher odds ratio of failing to achieve the recommended duration of 7 hours of sleep per day (1.18 [1.02,1.37] vs. non-cat owners). This association persisted even after adjusting for various factors known to affect sleep (e.g., shift work, lack of social interaction, and chronic stress). Conclusion We found that owning a cat was associated with increased odds of sleeping less than the recommended seven hours per day. General pet ownership and dog ownership were not associated with either of the sleep outcomes. Whether this means that cats represent a risk factor for short sleep duration cannot be derived from the present observational study. Future studies should more thoroughly investigate the various aspects of cat ownership, e.g., the cat′s breed, age, and co-sleeping with the cat. Support (if any)

Space-borne LiDAR systems can potentially assist large-area assessments of forest resources, in particular when a subset of the acquired LiDAR footprints is combined with field surveys of forest stand characteristics at footprint location. When combined, space-borne LiDAR geolocation error and the footprint size may however have considerable effects on the estimation accuracy of forest stand variables, such as aboveground biomass (AGB). The aim of this study was to draw recommendations for future space-borne LiDAR systems, which should deliver data for unbiased AGB assessments. The recommendations were drawn from AGB estimations based on space-borne LiDAR waveforms simulated over a 1300 ha large study site in southern Sweden. Large-footprint, nadir-looking satellite waveforms were simulated by stacking individual small-footprint, airborne LiDAR waveforms observed near a predefined sampling pattern. The stacked waveforms, represented by their metrics, were used as input for a two-phase systematic sampling in combination with model-assisted estimation or hybrid inference for estimating AGB and its variance. The second-phase sample included 264 inventory plots, whereas the first-phase sample included 1010 sample locations, where satellite waveforms were simulated. After simulating satellite waveforms with different footprint sizes and analyzing the AGB variance, the recommendation is to have a footprint size that is similar to the size of the field plots used for collecting reference data, i.e. 20 m diameter in our case. For the optimal footprint size, AGB was estimated with a precision of 2.9 Mg per hectare (2.9% of the average). The results also showed that variance estimates increased constantly with increasing geolocation error. For a geolocation error of 14 m, variance estimates increased by 17%, which justifies investing additional efforts in minimizing it.

A glomus tumor of uncertain malignant potential is defined as a glomus tumor with some, but not all, criteria for malignancy and without a known metastasis. Here, we present a rare example presenting in the median nerve in a 40-year-old woman with a long history of severely impaired left median nerve function. A large panel of immunohistochemical stains excluded other diagnoses, and the designation of a "uncertain malignant potential" was based on the high proliferative activity, the tumor size and location, and the lack of WHO malignancy criteria such as marked nuclear atypia, necrosis, or atypical mitoses. A BRAF mutation was found in the tumor. Although extremely rare, both benign and malignant glomus tumors may present in large peripheral nerves and should therefore be considered in the differential diagnosis. .

Purpose of Review: The rapid development of remote sensing technology has made dense 3D data available from airborne laser scanning and recently also photogrammetric point clouds. This paper reviews methods for extraction of individual trees from 3D data and their applications in forestry and ecology.Recent Findings: Methods for analysis of 3D data at tree level have been developed since the turn of the century. The first algorithms were based on 2D surface models of the upper contours of tree crowns. These methods are robust and provide information about the trees in the top-most canopy. There are also methods that use the complete 3D data. However, development of these 3D methods is still needed to include use of geometric properties. To detect a large fraction of the tallest trees, a surface model method generally gives the best results, but detection of smaller trees below the top-most canopy requires methods utilizing the whole point cloud. Several new sensors are now available with capability to describe the upper part of the canopy, which can be used to frequently update vegetation maps. Highly sensitive laser photo detectors have become available for civilian applications, which will enable acquisition of high-resolution 3D laser data for large areas to much lower costs.Summary: Methods for ITC delineation from 3D data provide information about a large fraction of the trees, but there is still a challenge to make optimal use of the information from the whole point cloud. Newly developed sensors might make ITC methods cheaper and feasible for large areas.

Introduction Insomnia disorder has a very weak link to polysomnography (PSG) and so does sleep problems in the general population. The reason for this is not clear. One possibility is that the perception of disturbed sleep may be related to immune activation or anxiety/depression, without impairment of objective sleep. Methods 400 women participated, constituting a representative sample of the city of Uppsala with oversampling of snorers. Insomniacs (N=41) were compared with normal sleepers in terms of polysomnography (PSG), immune parameters, anxiety and depression Results The results (after adjustment for age and BMI) show that C-reactive protein (CRP) reached a higher level (4.4±.5) in insomniacs (vs 2.3±.2 for normal sleepers) (p=.003) and lower subjective health (p=.000), while anxiety (p=.000) and depression (p=.000) (Hospital Anxiety and Depression Scale (HAD)) showed higher levels. PSG sleep continuity variables lacked association with insomnia, as did all sleep stage variables except for REM%, with a lower level in the insomnia group (p=.021). Interleukin 6 and Tumor Necrosis Factor alpha were not related to insomnia. CRP levels did not correlate significantly with anxiety or depression, but with subjective health (r=-.21, p=.000). A logistic regression analysis (excluding the variable subjective health) with insomnia as outcome (0/1) yielded as predictors CRP (OR=1.14, Ci= 1.05; 1.24, p=.000), depression (OR=1.21, Ci=1.06;1.38, p=.000) and anxiety (OR=1.15, Ci=1.02;1.30, p=.021). Conclusion It was concluded that increased CRP levels may be part of the subjective experience of insomnia. Support No external funding

The diagnosis of chronic obstructive pulmonary disease (COPD) is based on chronic airflow limitation (CAL) in addition to respieratory symptoms. We studied the association between key respiratory symptoms and different thresholds of FEV1/FVC as a basis for definition of clinical relevant COPD. The Swedish Cardiopulmonary bioImage Study (SCAPIS) includes data from 15 810 adults aged 50 to 64 years (7625 men, 8 185 women). Questionnaire data include respiratory symptoms, smoking habits and socioeconomic status. Post-bronchodilator spirometry was performed and the Global Lung Initiative (GLI) reference equation was used. A z score threshold of -1.64 for the FEV1/FVC ratio was defined, establishing the 5th percentile of lower limit of normal (LLN5) whereafter successively higher thesholds for the GLI derived LLN from LLN5 to LLN25 were introduced. The associations between the GLI defined strata and respiratory symptoms were assessed using multivariate logistic regression models. When using≥GLI-LLN25 as the reference category, dyspnea, wheeze, and cough with phlegm were elevated within all strata FEV1/FVC In conclusion, the prevalence of key respiratory symptoms were increased also in individuals not regarded as having CAL according to established definitions. Our findings stress a discussion on ideal thresholds for CAL for a clinical definition of COPD.

Body mass index, weight gain and activity-related breathlessness : the Swedish CArdioPulmonary bioImage Study

Emphysema may be used for subclassification of chronic obstructive pulmonary disease (COPD) and is also a risk factor for lung cancer. Emphysema can be directly visualized by low dose computed tomography (CT). As visual assessment of emphysema is time-consuming, our aim was to detect emphysema by quantitative densitometry (% Low Attenuation Value below -950 Hounsfield Units, LAV950) using the software CTPulmo3D (Syngo.via, Siemens Healthineers). Participants from the pilot study of The Swedish CArdioPulmonary Bioimage Study (SCAPIS) with visually detected emphysema (n=100, 56 males and 44 females) and 100 matched controls (gender, age, height and weight) without emphysema were included in this study. In more than 80% of the participants the emphysema was visually graded as mild (1% to ≤25% of the lung parenchyma). Inter- and intraobserver variability for visual assessment of emphysema was reliable with Krippendorff alpha values ranging from 0.80 to 0.85. Patients with emphysema were more obstructive (FEV1/FVC 0.72 versus 0.78) and had a higher tobacco burden (27 versus 20 pack-years) compared to the matched controls. The mean difference in LAV950 between matched pairs of emphysema and controls was -0.1% (CI -1.3 to 1.2%), limits of agreement from -12.3 to 12.1%. When defining emphysema as LAV950 being ≥ 10%, the sensitivity of finding emphysema was 27%. In conclusion, visual assessment of emphysema is reliable. Quantitative measurements of LAV950 by the software used in this study were not able to distinguish patients with or without visually detected mild emphysema. Other quantitative methods need to be evaluated for use in large-scale studies.

Late Breaking Abstract - Ultraviolet radiation and lung function in aging women : A European multi-centre study (ECRHS)

Background Subarachnoid haemorrhage (SAH) is a devastating disease, with high mortality rate and substantial disability among survivors. Its causes are poorly understood. We aimed to investigate risk factors for SAH using a novel nationwide cohort consortium. Methods We obtained individual participant data of 949 683 persons (330 334 women) between 25 and 90 years old, with no history of SAH at baseline, from 21 population-based cohorts. Outcomes were obtained from the Swedish Patient and Causes of Death Registries. Results During 13 704 959 person-years of follow-up, 2659 cases of first-ever fatal or non-fatal SAH occurred, with an age-standardized incidence rate of 9.0 [95% confidence interval (CI) (7.4–10.6)/100 000 person-years] in men and 13.8 [(11.4–16.2)/100 000 person-years] in women. The incidence rate increased exponentially with higher age. In multivariable-adjusted Poisson models, marked sex interactions for current smoking and body mass index (BMI) were observed. Current smoking conferred a rate ratio (RR) of 2.24 (95% CI 1.95–2.57) in women and 1.62 (1.47–1.79) in men. One standard deviation higher BMI was associated with an RR of 0.86 (0.81–0.92) in women and 1.02 (0.96–1.08) in men. Higher blood pressure and lower education level were also associated with higher risk of SAH. Conclusions The risk of SAH is 45% higher in women than in men, with substantial sex differences in risk factor strengths. In particular, a markedly stronger adverse effect of smoking in women may motivate targeted public health initiatives.

Executive function is defined as a set of cognitive skills that are necessary to plan, monitor, and execute a sequence of goal-directed complex actions. Executive function is influenced by a variety of factors, including habitual sleep duration and diabetes. In the present study, we investigated in 18,769 Swedish adults (mean age: 61 y) the association between executive function, diabetes, and self-reported sleep duration. We observed a significant interaction between diabetes and sleep duration for the Trail Making Test (TMT) ratio (P 0.01). This ratio is a measure of executive function where higher values indicate worse performance. Among diabetic participants (n = 1,523), long (defined as ≥9 h per day) vs. normal sleep duration (defined as 7-8 hours per day) was associated with a higher TMT ratio (P 0.05). Similar significant results were observed in diabetic individuals without pharmacological treatment for diabetes (n = 1,062). Among non-diabetic participants (n = 17,246), no association between long sleep duration and the TMT ratio was observed (P 0.05). Instead, short (defined as7 h per day) vs. normal sleep duration was linked to a higher TMT ratio (P 0.05). These findings suggest that the association between sleep duration and executive function differs between diabetic and non-diabetic middle-aged and older adults. Based on the cross-sectional design of the study, no firm conclusions can be drawn on the causality of the relations.

Objective: To assess relationships between sleep and obstructive sleep apnea syndrome (OSAS) with diet in a population-based cohort (EpiHealth). Methods: In total, 24,944 individuals (45-75 years, 43.8% men) answered a questionnaire on sleep, OSAS, diet (adherence to Mediterranean diet (mMEDscore; range 0-8; highest quartile=adherence)), health, and demographical data. Sleep duration (short: =9 h/night), adapted sleep sufficiency index (SSI; sleep duration/sleep need) and a composit variable (normal, short and long sleep combined with perceived adequate, too short or too long sleep, respectively; 9 categories) were used. Results: Short and long sleepers showed lower adherence compared with normal sleepers (27.6 and 27.5%, respectively vs. 31.5%). Participants perceiving too short sleep had a higher adherence (32.9%) and perceived too long sleep displayed a lower adherence (29.3%). Short (23.4%) and long (27.2%) sleepers with perceived adequate sleep duration, but also short sleepers with perceived too short sleep (28.9%) had the lowest adherence. In an adjusted gender stratified multivariate model, short sleep with perceived adequate sleep (adj. OR 0.56 (0.32-0.97) and too short sleep (adj. 0.82 (0.69-0.97)) were associated with low diet adherence in women but not in men. OSAS was related to higher adherence in men (1.27 (1.02-1.58)) but not in women (0.91 (0.70-1.19). Conclusion: Short sleep and perception of sleep may influence diet. The relationship seems gender specific.

Background: Proteomic-based technologies offer new possibilities to identify altered levels of cardiac and inflammatory proteins that might reflect the cardiometabolic stress caused by different measures of OSA. Aim: To investigate the effects of OSA on the cardiovascular system by analysing a broad panel of cardiac and inflammatory proteins in relationship to different measures of OSA in a population based cohort of women. Method: In the “Sleep and Health in Women” (SHE) cohort study, 400 women underwent polysomnography, anthropometric measurements and blood sampling. Two proteomic assays (Olink Proseek® Inflammation panel and Cardiovascular II panel), each measuring 92 proteins, were analysed in a subsample of 253 women. Results: In unadjusted models, with false discovery rate set to 10%, 57 proteins were associated with AHI, 56 proteins with ODI and 64 proteins with REM AHI. After adjustment for age, BMI and plate there were no significant associations between AHI or ODI and any of the proteins. REM AHI>30 was associated with decreased levels of two proteins involved in anti-inflammatory processes; Sirt2 (q-value 0.016) and LAP-TGFs1 (q-value 0.016). There was further a negative association between REM AHI>30 and Axin1 (q-value 0.095), a protein known to facilitate TGFs signalling. Conclusion: Severe OSA during REM sleep affected the plasma levels of Sirt2, LAP-TGFs1 and Axin1. For overall AHI and ODI the associations with cardiac and inflammatory proteins were weaker and to a large extent explained by age and BMI.

Background Pneumonia is an important cause of morbidity and mortality. COPD patients using inhaled corticosteroids (ICS) have an increased risk of pneumonia, but less is known about whether ICS treatment in asthma also increases the risk of pneumonia. The aim of this analysis was to examine risk factors for hospitalisations with pneumonia in a general population sample with special emphasis on asthma and the use of ICS in asthmatics. Methods In 1999 to 2000, 7340 subjects aged 28 to 54 years from three Swedish centres completed a brief health questionnaire. This was linked to information on hospitalisations with pneumonia from 2000 to 2010 and treatment with ICS from 2005 to 2010 held within the Swedish National Patient Register and the Swedish Prescribed Drug Register. Results Participants with asthma (n = 587) were more likely to be hospitalised with pneumonia than participants without asthma (Hazard Ratio (HR 3.35 (1.97–5.02)). Other risk factors for pneumonia were smoking (HR 1.93 (1.22–3.06)), BMI 30 kg/m2 (HR 2.54 (1.39–4.67)). Asthmatics (n = 586) taking continuous treatment with fluticasone propionate were at an increased risk of being hospitalized with pneumonia (incidence risk ratio (IRR) 7.92 (2.32–27.0) compared to asthmatics that had not used fluticasone propionate, whereas no significant association was found with the use of budesonide (IRR 1.23 (0.36–4.20)). Conclusion Having asthma is associated with a three times higher risk of being hospitalised for pneumonia. This analysis also indicates that there are intraclass differences between ICS compounds with respect to pneumonia risk, with an increased risk of pneumonia related to fluticasone propionate.

Insomnia symptoms are common with asthma. The aim of the study was to analyse the associations between insomnia symptoms and asthma control, asthma severity, and asthma-related comorbidity in a community-based population.Adults (n = 23 875, ages 18-45) from the community-based LifeGene study answered a questionnaire on insomnia symptoms, airway symptoms, asthma diagnosis, asthma medication, and asthma-related comorbidities (chronic rhinosinusitis, gastro-oesophageal reflux, anxiety, depression, or obesity).Of the participants, 1272 (5.3%) had asthma. The prevalence of any insomnia symptom was higher in participants with uncontrolled asthma (n = 201) than with controlled or partially controlled asthma (32.2% vs 19.9% and 20.1%, respectively, P .01). There was no significant difference in the prevalence of insomnia symptoms between subjects with controlled asthma and subjects without asthma. Subjects with asthma and any asthma-related comorbidity reported more insomnia symptoms (29.0% vs 22.4%, P .01) compared to asthmatics without comorbidity. Moreover, the prevalence was highest among subjects reporting both uncontrolled asthma and any asthma-related comorbidity (45.1%, P .01). Uncontrolled asthma remained significantly associated with insomnia symptoms (OR 1.72 (1.15-2.56)) after adjusting for age, sex, BMI, smoking history, comorbidities, physical activity, and educational level, while medication level was not. Among asthma-related comorbidities, chronic rhinosinusitis (OR 1.62 (1.20-2.19)), obesity (1.87 (1.07-3.25)), and depression (OR 1.85 (1.34-2.55)) were independently associated with insomnia symptoms.Uncontrolled asthma was significantly associated with insomnia symptoms, while controlled or partially controlled asthma was not. Asthma-related comorbidity is of great importance, and asthma control seems to be more important than asthma severity for insomnia symptoms.

There is a lack of studies on the association between total sleep time (TST) and other polysomnographical parameters. A key question is whether a short sleep is an expression of habitual short sleep, or whether it reflects temporary impairment. The purpose of the present study was to investigate the association between TST and amount of sleep stages and sleep continuity measures, in a large population‐based sample of women (n = 385), sleeping at home in a normal daily life setting. The results show that sleep efficiency, N1 (min), N2 (min), REM (min), REM% and proportion of long sleep segments, increased with increasing TST, whereas the number of awakenings/hr, the number of arousals/hr, N1% and REM intensity decreased. In addition, longer sleep was more associated with TST being perceived as of “usual” duration and with better subjective sleep quality. TST was not associated with habitual reported sleep duration. It was concluded that short TST of a recorded sleep in a real‐life context may be an indicator of poor objective sleep quality for that particular sleep episode. Because individuals clearly perceived this reduction, it appears that self‐reports of poor sleep quality often may be seen as indicators of poor sleep quality. It is also concluded that PSG‐recorded sleep duration does not reflect habitual reported sleep duration in the present real‐life context.

Publisher's version (útgefin grein), Objectives: Menopause involves hypoestrogenism, which is associated with numerous detrimental effects, including on respiratory health. Hormone replacement therapy (HRT) is often used to improve symptoms of menopause. The effects of HRT on lung function decline, hence lung ageing, have not yet been investigated despite the recognized effects of HRT on other health outcomes. Study design: The population-based multi-centre European Community Respiratory Health Survey provided complete data for 275 oral HRT users at two time points, who were matched with 383 nonusers and analysed with a two-level linear mixed effects regression model. Main outcome measures: We studied whether HRT use was associated with the annual decline in forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). Results: Lung function of women using oral HRT for more than five years declined less rapidly than that of nonusers. The adjusted difference in FVC decline was 5.6 mL/y (95%CI: 1.8 to 9.3, p = 0.01) for women who had taken HRT for six to ten years and 8.9 mL/y (3.5 to 14.2, p = 0.003) for those who had taken it for more than ten years. The adjusted difference in FEV1 decline was 4.4 mL/y (0.9 to 8.0, p = 0.02) with treatment from six to ten years and 5.3 mL/y (0.4 to 10.2, p = 0.048) with treatment for over ten years. Conclusions: In this longitudinal population-based study, the decline in lung function was less rapid in women who used HRT, following a dose-response pattern, and consistent when adjusting for potential confounding factors. This may signify that female sex hormones are of importance for lung ageing., Kai Triebner has received a postdoctoral fellowship from the University of Bergen. The present analyses are part of a project funded by the Norwegian Research Council (Project No. 228174) as well as part of the Ageing Lungs in European Cohorts (ALEC) Study (www.alecstudy.org), which has received funding from the European Union's Horizon 2020 research and innovation program (Grant No. 633212). The European Commission supported the European Community Respiratory Health Survey, as part of the “Quality of Life” program. Bodies funding the local studies are listed in the online data supplement. The funding sources had no involvement in the conduct of the research and/or preparation of the article, in study design, in the collection, analysis and interpretation of data, in the writing of the report or in the decision to submit the article for publication.