Postkonferens om lungmedicin - höjdpunkter från ERS. Sömn och andningsrelaterade sjukdomar. Eva Lindberg. Lung- och allergikliniken

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1 Postkonferens om lungmedicin - höjdpunkter från ERS. Sömn och andningsrelaterade sjukdomar Eva Lindberg Lung- och allergikliniken Akademiska sjukhuset, Uppsala

2 Messe München

3 ERS

4 Sömn är stort på ERS! Postgraduate Course : PG11 Sleep and acute respiratory failure (ARF) Postgraduate Course : PG13 Assessment of the obstructive sleep apnoea patient Hot Topic : Diagnosis of paediatric obstructive sleep apnoea (OSA) in settings with limited resources Practical Workshop: Advanced therapies for patients with sleep disordered breathing and complicated breathing patterns Morning Seminar: The sleepy OSA patient Symposium: Sleeping Beauty and Prince Charming: gender differences in sleep disordered breathing (SDB) Symposium: Current controversies in sleep-disordered breathing (SDB) Meet the Expert : Stroke and sleep apnoea: a deadly association? Thematic Poster Session : Best posters in pulmonary rehabilitation 1 Obstructive sleep apnoea: A new indication for pulmonary rehabilitation?

5 Oral Presentation : Three ages of man: OSA in children, adults and the elderly Oral Presentation : Inflammation and obesity: implications for OSA Oral Presentation : Real or not? The impact of OSA and CPAP on comorbid conditions Poster Discussion : Home noninvasive ventilation: still a "work in progress"? Poster Discussion : Of mice and men: physiology and biology of sleep disordered breathing Poster Discussion : The story continues: impact of OSA on cardiometabolic parameters Poster Discussion : The technical and diagnostic agenda in OSA Poster Discussion : Evaluating sleep disordered breathing in children and adults Poster Discussion : Key factors that ensure noninvasive ventilation success Poster Discussion : Sleep disordered breathing: from children to the elderly Thematic Poster Session : Respiratory physiology and sleep disordered breathing in children Thematic Poster Session : Sleep disordered breathing 1 Thematic Poster Session : Sleep disordered breathing 2 Thematic Poster Session : Sleep disordered breathing 3 Thematic Poster Session : Sleep disordered breathing 4 Thematic Poster Session : Sleep disordered breathing 5

6 Symposium : ERS/JAMA lunchtime session: 2014 highlights: 3 föredrag Nr 2: Treating obstructive sleep apnoea to improve control of hypertension F. Barbe Illa (Lleida, Spain) Practical Workshop : Comorbidities in sleep disordered breathing - clinical consequences and therapeutic solution Evening Mini Symposium : Sleep disordered breathing in heart failure : - current practice, latest evidences and road ahead.

7 Trender Ökat intresse för centrala apnéer - Diagnostik och behandlingseffekter - Resultat från RCT väntas OSAS ännu snabbt växande patientgrupp Hur hantera patientflöden? - Screening frågeformulär - Uppföljning - Enklare utrustningar för andningsregistrering - Utredning i primärvård - Ökat intresse kombinationsbehandling - CPAP och läkemedel mot hypertoni - CPAP och viktminskning - CPAP och fysisk aktivitet - Behandlingsresultat hos äldre - Gender differences

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11 Observationsstudie, CSA AHI>15, n=185/550 fick ASV JACC 2013

12 Central sömnapné CSA Cheyne-Stokes respiration CSA påverkar prognos vid hjärtsvikt negativt. Ca 1/3 av pat svarar bra på CPAP CANPAP-studien negativ (CPAP) CSA förbättras av hjärtsviktsmedicinering (gör ej nattlig andningsregistrering i anslutning till akut försämring) CSA kan behandlas med Adaptive Servoventilation Men påverkar detta prognosen? Nu pågår multi-centerstudie m ASV, end-point transplantationsfri överlevnad Beräknas klar 2015

14 Long-term evaluation of positional therapy with the sleep position trainer (SPT) in the treatment of positional obstructive sleep apnea syndrome (POSA) J. P. Van Maanen, N. De Vries (Amsterdam, Netherlands)

15 POSA = Positionsberoende obstruktiv sömnapné SPT vibrerar när ligger på rygg n = 145 varav 106 uppkopplade online RESULTAT: Compliance = > 4 h/natt = 64.4% ESS (median): 11 7 Functional Outcomes of Sleep Questionnaire (FOSQ): Pittsburgh Sleep Quality Index (PSQI): 7 6 Median percentage of supine sleep decreased rapidly after therapy started and this decrease was stable over time

16 Sleep Position Trainer (SPT)

17 Role oft sleep position training in the treatment of the positional obstructive sleep apnoea sydrome Y. Matsuba, U. Straßen, C. Gahrleitner, C. Heiser (Munich, Germany) N=13 med positionsberoende OSAS Sleep position training SPT 4 veckor Resultat alla: Medel-AHI Ryggsömn 48% % 3 tolererade inte beh 4 ingen effekt på AHI 5 god effekt med reduktion AHI >50%

19 Sleep apnea is a systemic disease Chirinos JA et al. CPAP, Weight Loss, or Both for Obstructive Sleep Apnea NEJM 2014; 370: Randomiserad studie Överviktiga med AHI>15 1) Viktnedgång 2) CPAP 3) Viktnedgång + CPAP Blodtryckseffekt bäst i grupp 3

20 Aerobic interval exercise training improves apnea-hypopnea index in obstructive sleep apnea patients S. Steinshamn et.al. Trondheim, Norway 30 patients Age 51±9 years, BMI 37 ± 6, AHI 42 ± 26, 24 CPAP-users Randomized to 12 weeks of aerobic interval exercise (AIT) two times/week or Control. Results: No sign change in body weight In AIT group, but not control group, there was a significantly change in: AHI (31.4 ± 21.7 to 23.9 ± 20) Epworth sleepiness score (10.0 ± 3.6 to 7.3 ± 3.7) VO2max (28.2 ± 7.4 ml kg -1 min -1 to 30.2 ± ml kg -1 min -1 ) S-leptin (1747 ± 1419 pmol l -1 to 1412 ± 1047 pmol l -1 )

21 Spörndly-Nees S, et al. Sleep Med 2014 Sören Spörndly-Nees Sjukgymnast, doktorand

23 Behandlingsresultat hos äldre I Obstructive sleep apnea (OSA) in elderly patients. Role of continuous positive airway pressure (CPAP) treatment. A multicenter randomized controlled clinical trial L. Zamora Molina et. al. Alicante, San Juan, Valencia, Spain Konsekutiv inklusion Pat >70 years (mean 76) AHI > 30 (mean 50) 69% men 38% EDS

24 Behandlingsresultat hos äldre I * Randomization CPAP n=105 Not CPAP n=109 3 months * * Anthropometric data, clinical records, OSA related clinical symptoms, QSQ, neurocognitive, anxiety and depression ( HADS) Intention to treat ananalysis

25 Behandlingsresultat hos äldre I Results: Average use of CPAP: hours/night Compliance (>4 hours/night): 69% CPAP compared to non-cpap group: Significant improvement in: QoL domains (p<0.001) Sleep-related symptoms (all p<001) Anxiety (p=0.016) Depression (p<0.001) Digital Symbol Test (p=0.04)

26 Behandlingsresultat hos äldre II Obstructive sleep apnea in elderly patients: Neuroimage and cognitive function before and after treatment M. Dalmases, C. Sole-Padulles, D. Bartres-Faz, M. D. Nuñez, C. Embid, M. Torres, N. Bargalló, R. Farre, J. M. Montserrat (Barcelona, Spain) 27 elderly patients with severe OSA 15 age-matched healthy volunteers Randomization CPAP No CPAP Neuropsychologic evaluation and magnetic resonance imaging (MRI) at baseline and after 3 months.

27 Behandlingsresultat hos äldre II Results Baseline: OSA patients showed lower volume of cerebellum and cerebellar tonsil when compared to healthy volunteers. Both OSA groups were similar on demographic measures, in terms of neurocognitive performance, grey matter volume and connectivity of the default mode network (DMN). After CPAP treatment, most cognitive domains showed significant improvements in parallel with increases in grey matter intensity within the cerebellum and higher connectivity in the right middle frontal gyrus in comparison with the conservative treatment group.

29 Conclusions Prevalence of SDB is higher in men Women and men with SDB have similar symptoms The cardiovascular risk associated with sleep-disordered breathing is similar between genders Women are still underrepresented in sleep laboratory referrals

30 ÖVRIGT

31 Sleeping on animal fur in the first three months of life reduces the risk of asthma in later childhood C. Tischer et.al. Neuherberg, Leipzig, Bad Honnef, Wesel, Germany n= % sov på djurskinn första 3 mån I livet. Uppföljning vid 10 års ålder: De som sovit på skinn hade lägre risk för: adj OR (95%CI): ever wheezing 0.75 ( ) ever physician-diagnosed asthma 0.62 ( ) ever physician-diagnosed hay fever 0.65 ( ) There was no significant association for physician-diagnosed eczema and allergic sensitization to aero-allergens at 10 years.

32 Obstructive sleep apnea accelerates decline in FEV1 in asthmatic patients T. Y. Wang et. al. Taiwan n=77 with asthma (out of 466 in a sleep lab-cohort) Retrospective FEV1-decline/year: AHI<5 (n=10) 5<AHI<30 (n=33) AHI>30 (n=34): AHI>30 + CPAP (n=13) 24.3±27.5 ml 41.9±45.3 ml 72.4±61.7 ml 41.2±3.6 ml After multivariate stepwise regression analysis, the apnea-hypopnea index and emergency room visits were independent factors for the decline of FEV1.

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