Jan Hedner

University of Gothenburg | GU · Sleep Medicine, Department of Internal Medicine

Obstructive sleep apnoea (OSA) and its associations with lung function. Background OSA is highly prevalent and characterised by abnormal respiration during sleep. This large, population-based study aimed to investigate the associations between OSA and lung function in subjects aged 50–64 years. Method The population-based Swedish CArdioPulmonary...

Obstructive sleep apnea diagnosis is based on the manual scoring of respiratory events. The agreement in the manual scoring of the respiratory events lacks an in‐depth investigation as most of the previous studies reported only the apnea–hypopnea index or overall agreement, and not temporal, second‐by‐second or event subtype agreement. We hypothesi...

Background The “Baveno classification” replaced the apnoea hypopnoea index (AHI) with symptoms and comorbidities for treatment indication in obstructive sleep apnoea (OSA). This study evaluates a modified Baveno classification which adds a validated cardiovascular disease (CVD) risk score and acknowledges severe breathing disturbances. Method OSA...

Study objectives: Arousal burden (AB) is defined as the cumulative duration of arousals during sleep divided by the total sleep time. However, in-depth analysis of AB related to sleep characteristics is lacking. Based on previous studies addressing the arousal index (ArI), we hypothesized that the AB would peak in the supine sleeping position and...

In‐laboratory polysomnography, the gold‐standard for diagnosing sleep disorders, is resource‐demanding and not conducive to multiple night evaluations. Ambulatory polysomnography, especially when self‐applied, could be a viable alternative. This study aimed to assess the feasibility and reliability of self‐applied polysomnography over three consecu...

Reduced lung function is associated with cardiovascular mortality, but the relationships with atherosclerosis are unclear. The population-based Swedish CArdioPulmonary BioImage study measured lung function, emphysema, coronary CT angiography, coronary calcium, carotid plaques and ankle-brachial index in 29,593 men and women aged 50–64 years. The re...

Aims We analysed longitudinal blood pressure (BP) data from hypertensive obstructive sleep apnoea (OSA) patients in the European Sleep Apnea Database cohort. The study investigated the interaction between positive airway pressure (PAP)-induced BP change and antihypertensive treatment (AHT). Methods and results Hypertensive patients with AHT [monot...

Rationale: Positive airway pressure (PAP) is standard treatment for obstructive sleep apnea (OSA). Telemedicine has been introduced for improved PAP follow-up. Objective: Our study aim was to evaluate clinical utility and patient satisfaction of PAP follow-up with an early intervention telemedical protocol. Methods: Randomized, controlled tria...

Aim The impact of OSA-COPD overlap syndrome (OVS) on sleep quality and cardiovascular outcomes has not been fully explored. We aimed to compare clinical and polysomnographic characteristics of OVS versus OSA patients, and to explore pathophysiological links between OVS and comorbidities. Study design and methods This cross-sectional analysis initi...

Study objectives: Cheyne - Stokes respiration (CSR) is prevalent in patients with chronic heart failure (CHF). Adaptive Servo Ventilation (ASV) alleviates CSR and improves objective sleep quality. We investigated the effects of ASV on neurocognitive function in the symptomatic phenotype of patients with CSR and CHF. Methods: This case series inc...

Introduction: This paper describes the development of "Swedish Guidelines for OSA treatment" and the underlying managed care process. The Apnea Hypopnea Index (AHI) is traditionally used as a single parameter for obstructive sleep apnea (OSA) severity classification, although poorly associated with symptomatology and outcome. We instead implement...

Objective: New drug treatments are under development in obstructive sleep apnea (OSA). The placebo effect is well recognized in various conditions, but its relevance in OSA is debated. In the current study we determined the influence of a placebo effect in studies of drug therapy in OSA. Methods: A systematic review and meta-analysis (PROSPERO C...

Background Coexisting obstructive sleep apnoea (OSA) in patients with chronic obstructive pulmonary disease (COPD), defined as overlap syndrome (OVS), is prevalent and underdiagnosed. Routine assessment of OSA is not common practice in COPD care. Our study assessed the clinical impact of sleep-assessment by peripheral arterial tonometry (PAT) in CO...

Background The prevalence of obstructive sleep apnoea (OSA) is growing as the population is ageing. However, data on the clinical characteristics of elderly OSA patients and their adherence to positive airway pressure (PAP) treatment are scarce. Methods Data of 23,418 30–79-year-old OSA patients prospectively collected into the ESADA database duri...

Background Emerging data suggests that determination of physiological endotypic traits (e.g., loop gain) might enable precision medicine in obstructive sleep apnea (OSA). Research Question Does a single night assessment of PSG-derived endotypic traits provide reliable estimates in moderate-to-severe OSA? Study Design and Methods Two consecutive i...

Objective Blood bicarbonate concentration plays an important role for obstructive sleep apnea (OSA) patients to maintain acid-base balance. We investigated the association between arterial standard bicarbonate ([HCO3⁻]) and nocturnal hypoxia as well as comorbid hypertension in OSA. Methods A cross-sectional analysis of 3329 patients in the Europea...

We recruited 5,970 patients with hypertension with obstructive sleep apnea (OSA) on current antihypertensive treatment from the European Sleep Apnea Database (ESADA) cohort. The group was subdivided into those receiving monotherapy (n = 3,594) and those receiving dual combined therapy (n = 2,376). We studied how major OSA confounders like age, gend...

Introduction : The European Sleep Apnea Database (ESADA) was used to identify distinguishable obstructive sleep apnea (OSA) phenotypes and to investigate the clinical outcome during positive airway pressure (PAP) treatment. Method : Prospective OSA patient data were recruited from 35 sleep clinics in 21 European countries. Unsupervised cluster ana...

Purpose of review: This review provides a condensed description of pharmacological remedies explored in patients with obstructive sleep apnoea (OSA) as well as projections of what we might expect in terms of clinical performance of these drugs. Recent findings: Conventional drug therapies explored in OSA have generally produced disappointing res...

Objectives This analysis characterized changes in weight in participants with obstructive sleep apnea (OSA) or narcolepsy treated with solriamfetol (Sunosi™) 37.5 (OSA only), 75, 150, or 300 mg/d. Methods In two 12-week, randomized, placebo-controlled trials and one 1-year open-label extension study, changes in weight were evaluated from baseline...

Excessive daytime sleepiness (EDS) is a hallmark symptom in obstructive sleep apnea (OSA). It is commonly eliminated by obstructive sleep apnea therapy and constitutes a major treatment indication. This study aimed to identify determinants of excessive daytime sleepiness by the Epworth Sleepiness Scale (ESS) scores in the large, representative nati...

Objective: Studies show a link between short sleep duration and hypertension. The mechanistic associations between sleep duration and blood pressure (BP) are less clear. We studied the association between sleep duration, blood pressure, metabolic profile as well as obstructive sleep apnoea in participants with suspected or confirmed hypertension u...

Obstructive sleep apnea is linked to severe health consequences such as hypertension, daytime sleepiness, and cardiovascular disease. Nearly a billion people are estimated to have obstructive sleep apnea with a substantial economic burden. However, the current diagnostic parameter of obstructive sleep apnea, the apnea–hypopnea index, correlates poo...

Obstructive sleep apnoea (OSA) is challenging medical problem due to its prevalence, its impact on quality of life and performance in school and profession, the implications on risk of accidents and comorbidities and mortality. Current research has carved out a broad spectrum of clinical phenotypes and defined major pathophysiological components. T...

Chronotype reflects individual preferences for timing activities throughout the day, determined by the circadian system, environment and behavior. The relationship between chronotype, physical activity, and cardiovascular health has not been established. We studied the association between chronotype, physical activity patterns, and an estimated 10-...

Rational: Current therapies in obstructive sleep apnea (OSA) are limited by insufficient efficacy, compliance or tolerability. An effective pharmacological treatment in OSA is warranted. Carbonic anhydrase (CA) inhibition has been shown to ameliorate OSA. Objective: To explore safety and tolerability of the CA inhibitor sulthiame (STM) in OSA....

Treatment of obstructive sleep apnoea (OSA) in adults is evolving, as new therapies have been explored and introduced in clinical practice, while other approaches have been refined or reconsidered. In this European Respiratory Society (ERS) guideline on non-continuous positive airway pressure (CPAP) therapies for OSA, we present recommendations det...

The authors’ findings suggest that the sleep medicine community needs to work together to develop strategies for care of patients with both suspected and established sleep-disordered breathing during major events such as the COVID-19 pandemic. Although personnel may be temporarily recruited to other areas of care, remaining activities need to focus...

Patients with obstructive sleep apnea (OSA) are at increased risk of developing metabolic disease such as diabetes. The effects of positive airway pressure on glycemic control are contradictory. We therefore evaluated the change in glycated hemoglobin (HbA1c) in a large cohort of OSA patients after long‐term treatment with positive airway pressure....

Study objectives: Solriamfetol, a dopamine/norepinephrine reuptake inhibitor, is approved in the United States and European Union for excessive daytime sleepiness in adults with narcolepsy (75-150 mg/day) or obstructive sleep apnea (OSA; 37.5-150 mg/day). In 12-week studies, solriamfetol was associated with improvements in quality of life in parti...

Recent evidence supports the use of pulse wave analysis during sleep for assessing functional aspects of the cardiovascular system. The current study compared the influence of pulse wave and sleep study‐derived parameters on cardiovascular risk assessment. In a multi‐centric study design, 358 sleep apnea patients (age 55 ± 13 years, 64% male, body...

Objective Studies have suggested an association between obstructive sleep apnea (OSA) and arterial stiffness. We aimed to further assess this relationship in hypertensive patients. Design and method In all, 199 patients with hypertension (mean age 57 ± 11 years, 73 females, body mass index 27.9 ± 4.4 kg/m2, office blood pressure (BP) 147 ± 19/89 ±...

Objectif Étude sur 1 an, évaluant efficacité sur Somnolence Diurne Excessive (SDE) et tolérance de Pitolisant (P), agent éveillant agoniste inverse des récepteurs H3 (histamine) versus placebo (pl) chez des patients avec syndrome d’apnées obstructives du sommeil (SAOS) modéré à sévère ayant refusé la PPC. Méthodes 2 parties : Double aveugle (DA) 1...

Objectif Évaluer si une perte de poids cliniquement significative (≥ 5 %) chez des participants souffrant de narcolepsie ou d’apnée obstructive du sommeil (AOS) recevant du solriamfétol 75-300 mg/jour améliorait les biomarqueurs de risque cardiométabolique. Méthodes Évaluation, dans un essai d’extension ouvert, des changements de poids, de pressio...

New findings on pathophysiology, epidemiology, and outcome have raised concerns on the relevance of the apnoea-hypopnoea index (AHI) in the classification of obstructive sleep apnoea (OSA) severity. Recently, a multicomponent grading system, decision integrating symptomatology and comorbidities (Baveno classification), was proposed to characterise...

Background and objective To personalize OSA management, several studies have attempted to better capture disease heterogeneity by clustering methods. The aim of this study was to conduct a cluster analysis of 23 000 OSA patients at diagnosis using the multinational ESADA. Methods Data from 34 centres contributing to ESADA were used. An LCA was app...

Background The impact of removing the upper airway lymphoid tissue and in particular, tonsillectomy, in adults with OSA has not been demonstrated in large populations. Aims To compare the severity of OSA and the prevalence of cardiovascular, metabolic and respiratory co-morbidities between patients with OSA who had undergone previous tonsillectomy...

Aims: Arterial hypertension is highly prevalent and difficult to control in patients with obstructive sleep apnea (OSA). High sympathoadrenergic activity is a hallmark physiological phenomenon in OSA. We hypothesized that an antihypertensive drug with inhibitory properties on this activity, such as beta blockers (BBs), may be particularly efficaci...

Insomnia has been associated with increased cardiovascular (CV) risk, which may be linked to sympathetic activation. Non-invasive overnight pulse wave analysis may be a useful tool to detect early signs of autonomic changes during sleep in insomniacs. Fifty-two participants (26 men, 37±13 years, BMI: 24±5 kg/m², 26 insomniacs/ 26 controls) underwen...

Study objectives: Patients with chronic kidney disease (CKD) often report poor sleep quality, but they commonly exhibit obstructive sleep apnea (OSA). The aim of this study was to evaluate the influence of OSA severity and estimated glomerular filtration rate (eGFR) impairment on objective sleep quality in non-dialyzed patients with CKD, defined a...