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Sleep Apnea Syndromes: HELP
Articles from Denmark
Based on 75 articles published since 2008

These are the 75 published articles about Sleep Apnea Syndromes that originated from Denmark during 2008-2019.
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Review Phenotyping the pathophysiology of obstructive sleep apnea using polygraphy/polysomnography: a review of the literature. 2018

Bosi, Marcello / De Vito, Andrea / Kotecha, Bhik / Viglietta, Luca / Braghiroli, Alberto / Steier, Joerg / Pengo, Martino / Sorrenti, Giovanni / Gobbi, Riccardo / Vicini, Claudio / Poletti, Venerino. ·AUSL of Romagna, Department Thoracic Diseases, Pulmonary Operative Unit, Morgagni-Pierantoni Hospital, Forlì, Italy. · AUSL of Romagna, Head and Neck Department, ENT Unit, Morgagni-Pierantoni Hospital, Via Dei Gerolimini 12, 47121, Forlì, Italy. dr.andrea.devito@gmail.com. · Department of Otolaryngology-Head and Neck Surgery, Royal National Throat, Nose and Ear Hospital, London, UK. · AUSL of Romagna, Department of Thoracic Diseases, Pulmonary Operative Unit, Umberto I Hospital, Lugo, Italy. · Department of Pulmonary Rehabilitation, Sleep Laboratory, Istituti Clinici Scientifici Maugeri, SPA SB, IRCCS, Veruno, Italy. · Faculty of Life Sciences and Medicine, King's College London, London, UK. · Lane Fox Respiratory Unit/Sleep Disorders Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK. · AOU of Bologna, ENT Clinic, Faculty of Medicine, Sant'Orsola-Malpighi Hospital, Bologna, Italy. · AUSL of Romagna, Head and Neck Department, ENT Unit, Morgagni-Pierantoni Hospital, Via Dei Gerolimini 12, 47121, Forlì, Italy. · University of Ferrara, Ferrara, Italy. · Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark. ·Sleep Breath · Pubmed #29318567.

ABSTRACT: Continuous positive airway pressure (CPAP) is the first-line treatment for the majority of patients affected by obstructive sleep apnea syndrome (OSA). However, long-term compliance with CPAP therapy may result limited and alternatives to CPAP therapy are required to address the increasing need to provide tailored therapeutic options. Understanding the pathophysiological traits (PTs) of OSA patients [upper airway (UA) anatomical collapsibility, loop gain (LG), arousal threshold (AT), and UA gain (UAG)] lies at the heart of the customized OSA treatment. However, sleep research laboratories capable to phenotype OSA patients are sparse and the diagnostic procedures time-consuming, costly, and requiring significant expertise. The question arises whether the use of routine clinical polysomnography or nocturnal portable multi-channel monitoring (PSG/PM) can provide sufficient information to characterize the above traits. The aim of the present review is to deduce if the information obtainable from the clinical PSG/PM analysis, independently of the scope and context of the original studies, is clinically useful to define qualitatively the PTs of individual OSA patients. In summary, it is possible to identify four patterns using PSG/PM that are consistent with an altered UA collapsibility, three that are consistent with altered LG, two with altered AT, and three consistent with flow limitation/UA muscle response. Furthermore, some PSG/PM indexes and patterns, useful for the suitable management of OSA patient, have been discussed. The delivery of this clinical approach to phenotype pathophysiological traits will allow patients to benefit in a wider range of sleep services by facilitating tailored therapeutic options.

2 Review Co-morbidities in severe asthma: Clinical impact and management. 2017

Porsbjerg, Celeste / Menzies-Gow, Andrew. ·Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark. · Royal Brompton and Harefield NHS Foundation Trust, London, UK. ·Respirology · Pubmed #28328160.

ABSTRACT: Patients with severe asthma represent a minority of the total asthma population, but carry a majority of the morbidity and healthcare costs. Achieving better asthma control in this group of patients is therefore of key importance. Systematic assessment of patients with possible severe asthma to identify treatment barriers and triggers of asthma symptoms, including co-morbidities, improves asthma control and reduces healthcare costs and is recommended by international guidelines on management of severe asthma. This review provides the clinician with an overview of the prevalence and clinical impact of the most common co-morbidities in severe asthma, including chronic rhinosinusitis, nasal polyposis, allergic rhinitis, dysfunctional breathing, vocal cord dysfunction, anxiety and depression, obesity, obstructive sleep apnoea syndrome (OSAS), gastroesophageal reflux disease (GERD), bronchiectasis, allergic bronchopulmonary aspergillosis (ABPA) and eosinophilic granulomatous with polyangiitis (EGPA). Furthermore, the review offers a summary of recommended diagnostic and management approaches for each co-morbidity. Finally, the review links co-morbid conditions to specific phenotypes of severe asthma, in order to guide the clinician on which co-morbidities to look for in specific patients.

3 Review Obesity hypoventilation syndrome, sleep apnea, overlap syndrome: perioperative management to prevent complications. 2017

Raveendran, Raviraj / Wong, Jean / Singh, Mandeep / Wong, David T / Chung, Frances. ·aWest Coast District Health Board, Greymouth, New Zealand bDepartment of Anesthesiology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada. ·Curr Opin Anaesthesiol · Pubmed #27792079.

ABSTRACT: PURPOSE OF REVIEW: The prevalence of sleep disordered breathing (SDB) is increasing proportional to the prevalence of obesity. Although anesthesiologists are familiar with obstructive sleep apnea (OSA) - the most common SDB, anesthesiologists may not be aware of other SDB such as obesity hypoventilation syndrome (OHS) and overlap syndrome (combination of OSA and chronic obstructive pulmonary disease). The present review provides an update of information regarding the perioperative management of OHS and overlap syndrome. RECENT FINDINGS: OHS and overlap syndrome are associated with significant comorbid conditions and more perioperative morbidity than OSA alone. Similar to OSA, most of the OHS patients are undiagnosed. An increase in serum bicarbonate level is a surrogate marker of hypercapnia. Because 90% of OHS patients have OSA, preoperative screening for OSA combined with estimation of serum bicarbonate level may detect the majority of the patients with OHS. In patients with OSA, OHS, and overlap syndrome, improvement in the perioperative outcome has been shown by initiating positive airway pressure therapy. SUMMARY: Identification and preoperative optimization of these high-risk patients are most important. A protocol-based risk mitigation is necessary for improving the intraoperative and postoperative outcome of these patients. As a perioperative physician, anesthesiologists have a key role in the management of patients with SDB.

4 Review Respiratory Manifestations of Hypothyroidism: A Systematic Review. 2016

Sorensen, Jesper Roed / Winther, Kristian Hillert / Bonnema, Steen Joop / Godballe, Christian / Hegedüs, Laszlo. ·1 Department of ORL Head & Neck Surgery, Odense University Hospital , Odense, Denmark . · 2 Department of Endocrinology, Odense University Hospital , Odense, Denmark . ·Thyroid · Pubmed #27673426.

ABSTRACT: BACKGROUND: Hypothyroidism has been associated with increased pulmonary morbidity and overall mortality. A systematic review was conducted to identify the prevalence and underlying mechanisms of respiratory problems among patients with thyroid insufficiency. METHODS: PubMed and EMBASE databases were searched for relevant literature from January 1950 through January 2015 with the following study eligibility criteria: English-language publications; adult subclinical or overt hypothyroid patients; intervention, observational, or retrospective studies; and respiratory manifestations. The Preferred Reporting Items for Systematic reviews and Meta-Analyses statement was followed, and Cochrane's risk of bias tool was used. RESULTS: A total of 1699 papers were screened by two independent authors for relevant titles. Of 109 relevant abstracts, 28 papers underwent full-text analyses, of which 22 were included in the review. Possible mechanisms explaining respiratory problems at multiple physiological levels were identified, such as the ventilator control system, diaphragmatic muscle function, pulmonary gas exchange, goiter caused upper airway obstruction, decreased capacity for energy transduction, and reduced glycolytic activity. Obstructive sleep apnea syndrome was found among 30% of newly diagnosed patients with overt hypothyroidism, and demonstrated reversibility following treatment. The evidence for or against a direct effect on pulmonary function was ambiguous. However, each of the above-mentioned areas was only dealt with in a limited number of studies. Therefore, it is not possible to draw any strong conclusions on any of these themes. Moreover, most studies were hampered by considerable risk of bias due for example to small numbers of patients, lack of control groups, randomization and blinding, and differences in body mass index, sex, and age between subjects and controls. CONCLUSION: Mechanistic data linking hypothyroidism and respiratory function are at best limited. This area of research is therefore open for retesting hypotheses, using appropriate study designs and methods.

5 Review Obstructive sleep apnea in obese children and adolescents, treatment methods and outcome of treatment - A systematic review. 2016

Andersen, Ida Gillberg / Holm, Jens-Christian / Homøe, Preben. ·Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Lykkebækvej 1, 4600 Køge, Denmark; The Children's Obesity Clinic, Department of Pediatrics, Holbæk University Hospital, Smedelundsgade 60, 4300 Holbæk, Denmark. Electronic address: idga@regionsjaelland.dk. · The Children's Obesity Clinic, Department of Pediatrics, Holbæk University Hospital, Smedelundsgade 60, 4300 Holbæk, Denmark; The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Universitetsparken 1, 2200 Copenhagen, Denmark. Electronic address: jhom@regionsjaelland.dk. · Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Lykkebækvej 1, 4600 Køge, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark. Electronic address: prho@regionsjaelland.dk. ·Int J Pediatr Otorhinolaryngol · Pubmed #27368470.

ABSTRACT: OBJECTIVES: To systematically review and discuss the outcome of treating obstructive sleep apnea (OSA) in obese children and adolescents. METHODS: In February 2016 Pub Med was searched using a predetermined string to retrieve all relevant articles. The search identified 518 publications. In total 16 articles were included for review using the selected inclusion and exclusion criteria. The PRISMA guidelines was used. RESULTS: OSA was significantly more likely to persist in obese children after adenotonsillectomy. The prevalence of persistent OSA ranged from 33 to 76% in obese children and from 15 to 37% in non-obese children depending on the definition of OSA, the degree of obesity and the age of the study population. The few studies that investigated the effect of weight loss found that OSA improved significantly after intervention and that the prevalence of persistent OSA varied between 10 and 38%. Positive airway pressure was effective for treating OSA, but the mean nightly use was <4 h in two out of three available studies. CONCLUSION: Obese children benefit less from adenotonsillectomy than normal-weight children. Weight loss improve OSA significantly, but more research is needed to clarify the role of weight loss as treatment for OSA. Positive airway pressure is effective for treating OSA; however, adherence is a challenge.

6 Review Determinants of sexual dysfunction and interventions for patients with obstructive sleep apnoea: a systematic review. 2016

Steinke, E / Palm Johansen, P / Fridlund, B / Broström, A. ·School of Nursing, Wichita State University, Wichita, KS, USA. · Department of Cardiology, Copenhagen University Hospital, Bispebjerg Hospital, and The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark. · Department of Nursing Science, School of Health & Welfare, Jönköping University, Jönköping, Sweden. · Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden. ·Int J Clin Pract · Pubmed #26620672.

ABSTRACT: AIMS: Obstructive sleep apnoea (OSA) may negatively affect a couple's sexual relationship. This systematic review evaluated what characteristics are determinants of sexual function and dysfunction in women and men with OSA, and what interventions are shown to be effective. METHODS: A systematic literature review was conducted using PubMed, CINAHL, Cochrane and TRIP, and articles published between January 2004 and December 2014 in English; original research; adults ≥ 18 years; and both experimental and non-experimental designs. The Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies was used to assess study quality. Of 21 studies, six studies (no randomised control trials, RCTs) included women and 15 (with six RCTs) studies included men. Extracted data were scrutinised and adjusted until consensus was reached; suitable quantitative data were pooled in statistical meta-analysis. RESULTS: Sexual function was affected similarly in both genders, but effective interventions were reported only for men. In some studies, OSA severity and medications contributed to greater sexual dysfunction. In women, menopausal status, hormone levels and SaO2 < 90% were determinants of sexual dysfunction, while for men factors included BMI, hormonal status and inflammatory markers. Continuous positive airway pressure (CPAP) not only improved clinical measures such as excessive daytime sleepiness but also the erectile and orgasmic function. Nevertheless, sildenafil was superior CPAP with regard to erectile dysfunction. CONCLUSIONS: The findings illustrate important contributors to sexual dysfunction; however, firm generalisations cannot be made. There were limited RCTs and none for women, indicating further RCTs are needed to determine how OSA affects sexual function.

7 Review Sleep apnoea and the brain: a complex relationship. 2015

Rosenzweig, Ivana / Glasser, Martin / Polsek, Dora / Leschziner, Guy D / Williams, Steve C R / Morrell, Mary J. ·Sleep and Brain Plasticity Centre, Department of Neuroimaging, IOPPN, King's College and Imperial College, London, UK; Danish Epilepsy Centre, Dianalund, Denmark; Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK. Electronic address: ivana1.rosenzweig@kcl.ac.uk. · Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College, London, UK; NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK. · Sleep and Brain Plasticity Centre, Department of Neuroimaging, IOPPN, King's College and Imperial College, London, UK; Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia. · Sleep and Brain Plasticity Centre, Department of Neuroimaging, IOPPN, King's College and Imperial College, London, UK; Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK; Department of Neurology, Guy's and St Thomas' NHS Foundation Trust, London, UK; Department of Clinical Neuroscience, IOPPN, King's College London, London, UK. · Sleep and Brain Plasticity Centre, Department of Neuroimaging, IOPPN, King's College and Imperial College, London, UK. · Sleep and Brain Plasticity Centre, Department of Neuroimaging, IOPPN, King's College and Imperial College, London, UK; Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College, London, UK; NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK. ·Lancet Respir Med · Pubmed #25887982.

ABSTRACT: Intermittent hypoxia, reoxygenation, and hypercapnia or hypocapnia occur in both adults and children during untreated apnoea and hypopnoea, along with changes in cerebral blood flow and sleep fragmentation. These effects can result in cognitive deficits with functional effects on work and school efficiency. The assessment of how obstructive sleep apnoea affects cognition depends on the specificity and sensitivity of the tests, which are rarely developed specifically for obstructive sleep apnoea. In this Review, we discuss both the neural adaptive and maladaptive processes in response to hypoxaemia. The net result on cognitive and emotional performance depends on the stage of this dynamic process, effects on other body systems, cognitive reserve, and idiosyncratic susceptibility. We also explore the contribution of fragmented sleep, and the disruption of sleep structure, with focus on the effect at different times in the development of disease. This Review will address the gap in the underlying pathophysiology of new clinical and translational findings, and argue their contribution to the inherent complexity of the association between obstructive sleep apnoea and the brain.

8 Review Improved apnea-hypopnea index and lowest oxygen saturation after maxillomandibular advancement with or without counterclockwise rotation in patients with obstructive sleep apnea: a meta-analysis. 2015

Knudsen, Thorkild B / Laulund, Anne S / Ingerslev, Janne / Homøe, Preben / Pinholt, Else M. ·Consultant, Department of Otorhinolaryngology and Maxillofacial Surgery, Køge University Hospital, Køge, Denmark. Electronic address: thorkildk@hotmail.com. · PhD Student, Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark. · Consultant, Department of Oral and Maxillofacial Surgery, Hospital of South West Denmark, Esbjerg, Denmark. · Professor, Department of Otorhinolaryngology and Maxillofacial Surgery, Køge University Hospital, Køge, Denmark. · Professor and Consultant, Department of Oral and Maxillofacial Surgery, Hospital of South West Denmark, Esbjerg, Denmark. ·J Oral Maxillofac Surg · Pubmed #25443377.

ABSTRACT: PURPOSE: This study investigated whether patients with obstructive sleep apnea (OSA) who undergo maxillomandibular advancement (MMA) with counterclockwise (CCW) rotation compared with those who undergo MMA without CCW rotation have better outcomes. MATERIALS AND METHODS: This was a systematic review with meta-analysis. The Medline and Cochrane databases were searched for randomized controlled trials using Medical Subject Headings. The predictor variable was operative technique, namely MMA with or without CCW rotation of the maxillofacial complex. The key outcome variables were changes in pre- and postsurgical values of pharyngeal volume measured on computed tomogram or cone-beam computed tomogram and changes in Apnea-Hypopnea Index (AHI) and lowest oxygen saturation (LSAT) values after surgery. Data were subjected to a meta-analysis based on odds ratios (OR) with 95% confidence intervals (CIs) and P values lower than .05 by χ(2) test were considered significant. RESULTS: Twenty-one randomized controlled trials were identified and 4 were assessed for the variables of interest. Postoperative AHI and LSAT measurements showed vast improvement. The sample was not large enough to make a correlation between pharyngeal volume changes and surgical method used. Postoperative parameters included an AHI lower than 5 (OR = 14.9; 95% CI, 2.7-83.5; P = .002), an AHI lower than 20 (OR = 114.8; 95% CI, 23.5-561.1; P <.00001), pooled results of a 50% decrease in the AHI (OR = 6.1; 95% CI, 2.2-17.0; P = .0006), and an increase greater than 90% in LSAT measurements during sleep (OR = 6.0; 95% CI, 1.8-19.9; P = .003). The funnel plot showed no evidence of publication bias. CONCLUSION: CCW-MMA or MMA in patients with OSA results in a statistically meaningful decrease in postoperative AHI and a statistically meaningful increase in postoperative LSAT.

9 Review Associations of sleep disturbance with ADHD: implications for treatment. 2015

Hvolby, Allan. ·Department of Child and Adolescent Psychiatry, Psychiatry of Southern Denmark, Gl. Vardevej 101, 6715, Esbjerg N, Denmark, allan.hvolby@rsyd.dk. ·Atten Defic Hyperact Disord · Pubmed #25127644.

ABSTRACT: Attention-deficit/hyperactivity disorder (ADHD) is commonly associated with disordered or disturbed sleep. The relationships of ADHD with sleep problems, psychiatric comorbidities and medications are complex and multidirectional. Evidence from published studies comparing sleep in individuals with ADHD with typically developing controls is most concordant for associations of ADHD with: hypopnea/apnea and peripheral limb movements in sleep or nocturnal motricity in polysomnographic studies; increased sleep onset latency and shorter sleep time in actigraphic studies; and bedtime resistance, difficulty with morning awakenings, sleep onset difficulties, sleep-disordered breathing, night awakenings and daytime sleepiness in subjective studies. ADHD is also frequently coincident with sleep disorders (obstructive sleep apnea, peripheral limb movement disorder, restless legs syndrome and circadian-rhythm sleep disorders). Psychostimulant medications are associated with disrupted or disturbed sleep, but also 'paradoxically' calm some patients with ADHD for sleep by alleviating their symptoms. Long-acting formulations may have insufficient duration of action, leading to symptom rebound at bedtime. Current guidelines recommend assessment of sleep disturbance during evaluation of ADHD, and before initiation of pharmacotherapy, with healthy sleep practices the first-line option for addressing sleep problems. This review aims to provide a comprehensive overview of the relationships between ADHD and sleep, and presents a conceptual model of the modes of interaction: ADHD may cause sleep problems as an intrinsic feature of the disorder; sleep problems may cause or mimic ADHD; ADHD and sleep problems may interact, with reciprocal causation and possible involvement of comorbidity; and ADHD and sleep problems may share a common underlying neurological etiology.

10 Review Noncardiac comorbidities in heart failure with reduced versus preserved ejection fraction. 2014

Mentz, Robert J / Kelly, Jacob P / von Lueder, Thomas G / Voors, Adriaan A / Lam, Carolyn S P / Cowie, Martin R / Kjeldsen, Keld / Jankowska, Ewa A / Atar, Dan / Butler, Javed / Fiuzat, Mona / Zannad, Faiez / Pitt, Bertram / O'Connor, Christopher M. ·Duke University, Durham, North Carolina. Electronic address: robert.mentz@duke.edu. · Duke University, Durham, North Carolina. · Oslo University Hospital Ulleval, University of Oslo, and Institute of Clinical Sciences, University of Oslo, Oslo, Norway. · University of Groningen, Groningen, the Netherlands. · Framingham Heart Study, Framingham, Boston University School of Medicine, Boston, Massachusetts. · National Heart and Lung Institute, Imperial College and Imperial College London, Royal Brompton Hospital, London, United Kingdom. · Copenhagen University Hospital (Rigshospitalet), Copenhagen, and Aalborg University, Aalborg, Denmark. · Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland. · Emory University, Atlanta, Georgia. · INSERM, Centre d'Investigations Cliniques, Université de Lorraine and CHU de Nancy, Nancy, France. · University of Michigan School of Medicine, Ann Arbor, Michigan. ·J Am Coll Cardiol · Pubmed #25456761.

ABSTRACT: Heart failure patients are classified by ejection fraction (EF) into distinct groups: heart failure with preserved ejection fraction (HFpEF) or heart failure with reduced ejection fraction (HFrEF). Although patients with heart failure commonly have multiple comorbidities that complicate management and may adversely affect outcomes, their role in the HFpEF and HFrEF groups is not well-characterized. This review summarizes the role of noncardiac comorbidities in patients with HFpEF versus HFrEF, emphasizing prevalence, underlying pathophysiologic mechanisms, and outcomes. Pulmonary disease, diabetes mellitus, anemia, and obesity tend to be more prevalent in HFpEF patients, but renal disease and sleep-disordered breathing burdens are similar. These comorbidities similarly increase morbidity and mortality risk in HFpEF and HFrEF patients. Common pathophysiologic mechanisms include systemic and endomyocardial inflammation with fibrosis. We also discuss implications for clinical care and future HF clinical trial design. The basis for this review was discussions between scientists, clinical trialists, and regulatory representatives at the 10th Global CardioVascular Clinical Trialists Forum.

11 Review The impact of sleep and hypoxia on the brain: potential mechanisms for the effects of obstructive sleep apnea. 2014

Rosenzweig, Ivana / Williams, Steve C R / Morrell, Mary J. ·aSleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, King's College and Imperial College London, UK bDanish Epilepsy Centre, Dianalund, Denmark cAcademic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College London dNIHR Respiratory Disease Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, UK. ·Curr Opin Pulm Med · Pubmed #25188719.

ABSTRACT: PURPOSE OF REVIEW: Obstructive sleep apnea (OSA) is a chronic, highly prevalent, multisystem disease, which is still largely underdiagnosed. Its most prominent risk factors, obesity and older age, are on the rise, and its prevalence is expected to grow further. The last few years have seen an exponential increase in studies to determine the impact of OSA on the central nervous system. OSA-induced brain injury is now a recognized clinical entity, although its possible dual relationship with several other neuropsychiatric and neurodegenerative disorders is debated. The putative neuromechanisms behind some of the effects of OSA on the central nervous system are discussed in this review, focusing on the nocturnal intermittent hypoxia and sleep fragmentation. RECENT FINDINGS: Recent preclinical and clinical findings suggest that neurogenic ischemic preconditioning occurs in some OSA patients, and that it may partly explain variability in clinical findings to date. However, the distinct parameters of the interplay between ischemic preconditioning, neuroinflammation, sleep fragmentation and cerebrovascular changes in OSA-induced brain injury are still largely unclear, and more research is required. SUMMARY: Early diagnosis and intervention in patients with OSA is of paramount importance. Future clinical studies should utilize multimodal investigative approaches to enable more reliable referencing for the acuity of the pathological process, as well as its reversibility following the treatment.

12 Review [Obstructive sleep apnoea syndrome]. 2014

Jennum, Poul / Tønnesen, Philip. ·Center for Søvnforstyrrelser, Klinisk Neurofysiologisk Afdeling, Glostrup Hospital, 2600 Glostrup. poul.jennum@regionh.dk. ·Ugeskr Laeger · Pubmed #25096841.

ABSTRACT: Obstructive sleep apnoea (OSA) and other sleep disordered breathing are common disorders causing significant morbidity, mortality and societal burden. A significant proportion of the patients are undiagnosed and consequently untreated. Due to the wide disease distribution we recommend increased disease awareness, especially among high-risk groups: patients with obesity, metabolic syndrome and cardio- and cerebrovascular diseases. Continuous positive airway pressure (CPAP) is the first-line of treatment together with weight reduction, whereas oral devices may be used for less severe OSA or in cases where CPAP cannot be used.

13 Review The effect of sleep disordered breathing on the outcome of stroke and transient ischemic attack: a systematic review. 2014

Birkbak, Johannes / Clark, Alice J / Rod, Naja Hulvej. ·Department of Public Health, University of Copenhagen, Copenhagen, Denmark. ·J Clin Sleep Med · Pubmed #24426829.

ABSTRACT: STUDY OBJECTIVES: The primary objective was to systematically review the literature on how sleep disordered breathing (SDB) affects recurrence and death among stroke or transient ischemic attack (TIA) patients. A secondary objective was to evaluate how treatment of SDB with continuous positive airway pressure (CPAP) affects the risk of recurrence and death in these patients. METHODS: Adults (18+) with a stroke or TIA diagnosis were eligible for inclusion. Case groups consisted of patients with a sleep disorder. The outcomes of interest were all-cause mortality, recurrent vascular events, and case fatality. RESULTS: Ten articles covering 1,203 stroke and TIA patients were included in the review. The results generally support a dose-response relationship between severity of SDB and risk of recurrent events and all-cause mortality in stroke and TIA patients. Three small-scale articles with substantial risk of bias evaluated the effects of CPAP therapy, and the results are inconclusive. Data on case fatality is too sparse to be conclusive. CONCLUSIONS: Existing studies provide sufficient data to establish obstructive SDB as a negative predictor of all-cause mortality and recurrent vascular events following stroke or TIA. The ability of CPAP treatment to lower the risk of serious adverse outcomes after stroke remains controversial because of substantial risk of bias identified in most of the eligible studies addressing this relation. Additional studies are needed.

14 Review Anesthetizing the obese child. 2011

Mortensen, Anette / Lenz, Katja / Abildstrøm, Hanne / Lauritsen, Torsten L B. ·Department of Anesthesiology, Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. mortensenanette@hotmail.com ·Paediatr Anaesth · Pubmed #21429056.

ABSTRACT: The prevalence of childhood obesity is increasing. The focus of this review is the special anesthetic considerations regarding the perioperative management of obese children. With obesity the risk of comorbidity such as asthma, obstructive sleep apnea, hypertension, and diabetes increases. The obese child has an increased risk of perioperative complications especially related to airway management and ventilation. There is a significantly increased risk of difficult mask ventilation and perioperative desaturation. Furthermore, obesity has an impact on the pharmacokinetics of most anesthetic drugs. This has important implications on how to estimate the optimal drug dose. This article offers a review of the literature on definition, prevalence and the pathophysiology of childhood obesity and provides suggestions on preanesthetic evaluation, airway management and dosage of the anesthetic drugs in these patients. The authors highlight the need of supplemental studies on various areas of the subject.

15 Review Sleep disordered breathing following spinal cord injury. 2009

Biering-Sørensen, Fin / Jennum, Poul / Laub, Michael. ·Clinic for Spinal Cord Injuries, Rigshospitalet, and University of Copenhagen, Denmark. finbs@rh.regionh.dk ·Respir Physiol Neurobiol · Pubmed #19729080.

ABSTRACT: Individuals with spinal cord injury (SCI) commonly complain about difficulty in sleeping. Although various sleep disordered breathing definitions and indices are used that make comparisons between studies difficult, it seems evident that the frequency of sleep disorders is higher in individuals with SCI, especially with regard to obstructive sleep apnea. In addition, there is a correlation between the incidence of sleep disturbances and the spinal cord level injured, age, body mass index, neck circumference, abdominal girth, and use of sedating medications. Regulation of respiration is dependent on wakefulness and sleep. Thus, it is important to be aware of basic mechanisms in the regulation and control of sleep and awake states. Supine position decreases the vital capacity in tetraplegic individuals, and diminished responsiveness to Pa(CO)(2) may further decrease ventilatory reserve. There also may be a potential disparity between daytime and nocturnal ventilation, as individuals with partially reduced muscle tone are susceptible to not only sleep apnea, but also sleep-related hypoventilation which may be aggravated during rapid eye movement sleep.

16 Review Epidemiology of sleep apnoea/hypopnoea syndrome and sleep-disordered breathing. 2009

Jennum, P / Riha, R L. ·Danish Centre for Sleep Medicine, Glostrup, Denmark. poje@glo.regionh.dk ·Eur Respir J · Pubmed #19336593.

ABSTRACT: Epidemiological studies have revealed a high prevalence of sleep-disordered breathing in the community (up to 20%). A subset of these patients has concurrent symptoms of excessive daytime sleepiness attributable to their nocturnal breathing disorder and is classified as having obstructive sleep apnoea/hypopnoea syndrome (4-5% of the middle-aged population). There is strong evidence for an association of sleep apnoea with cardiovascular and cerebrovascular morbidity, as well as adverse public health consequences. Treatment and diagnosis have remained largely unchanged over the past 25 yrs. In moderate-to-severe obstructive sleep apnoea/hypopnoea syndrome, treatment with continuous positive airway pressure has been shown to be effective. Questions remain as to how to screen patients with sleep-disordered breathing. Should time-consuming diagnostic procedures with high sensitivity and specificity be employed, or should simpler methods be applied for screening populations at risk, e.g. in the primary care sector?

17 Clinical Trial Long-term side effects on the temporomandibular joints and oro-facial function in patients with obstructive sleep apnoea treated with a mandibular advancement device. 2017

Knappe, S W / Bakke, M / Svanholt, P / Petersson, A / Sonnesen, L. ·Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. · Section of Oral Medicine (Clinical Oral Physiology), Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. · Section of Radiology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. ·J Oral Rehabil · Pubmed #28094865.

ABSTRACT: Patients with obstructive sleep apnoea (OSA) in long-term treatment with a mandibular advancement device (MAD) to increase the upper airway space may develop changes in the temporomandibular joint (TMJ) and the oro-facial function due to the protruded jaw position during sleep. The aim was to investigate the influence of long-term MAD treatment on the TMJs, oro-facial function and occlusion. This prospective study included 30 men and 13 women (median age 54) with OSA [Apnoea-Hypopnoea Index (AHI): 7-57]. They were examined with the Nordic Orofacial Test Screening (NOT-S), the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and cone beam computed tomography (CBCT) of the TMJs. The examination was performed before MAD treatment (T0), and 3-6 months (T1, no CBCT), 1 year (T2) and 3 years (T3) after treatment start. The results were analysed as long term (T0-T3, n = 14) and short term (T0-T2, n = 24) by t-test, Fisher's exact test and anova. Both long- and short-term analyses revealed a reduction in AHI (P < 0·002). Significant long term were increased scores in the NOT-S Interview (P < 0·045), reduced vertical overbite (P < 0·031) and increased jaw protrusive movement (P < 0·027). TMJ changes were found as joint sounds in terms of reciprocal clicking and crepitus, short term as a decrease and subsequent recurrence (P < 0·053; P < 0·037). No significant radiological changes were found. In conclusion, MAD treatment is beneficial to some OSA patients, but might induce changes in the TMJs, the oro-facial function and the occlusion. However, these changes seemed to be less harmful than previously reported with careful adaptation, control and follow-ups.

18 Clinical Trial Hippocampal hypertrophy and sleep apnea: a role for the ischemic preconditioning? 2013

Rosenzweig, Ivana / Kempton, Matthew J / Crum, William R / Glasser, Martin / Milosevic, Milan / Beniczky, Sandor / Corfield, Douglas R / Williams, Steven C / Morrell, Mary J. ·Department of Neuroimaging, Institute of Psychiatry, King's College, London, United Kingdom ; Danish Epilepsy Centre, Dianalund, Denmark. · Department of Neuroimaging, Institute of Psychiatry, King's College, London, United Kingdom. · Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College London, London, United Kingdom ; NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, United Kingdom. · Department for Environmental and Occupational Health, University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, Zagreb, Croatia. · Danish Epilepsy Centre, Dianalund, Denmark ; Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark. · Manchester Medical School, University of Manchester, Manchester, United Kingdom. ·PLoS One · Pubmed #24349453.

ABSTRACT: The full impact of multisystem disease such as obstructive sleep apnoea (OSA) on regions of the central nervous system is debated, as the subsequent neurocognitive sequelae are unclear. Several preclinical studies suggest that its purported major culprits, intermittent hypoxia and sleep fragmentation, can differentially affect adult hippocampal neurogenesis. Although the prospective biphasic nature of chronic intermittent hypoxia in animal models of OSA has been acknowledged, so far the evidence for increased 'compensatory' neurogenesis in humans is uncertain. In a cross-sectional study of 32 patients with mixed severity OSA and 32 non-apnoeic matched controls inferential analysis showed bilateral enlargement of hippocampi in the OSA group. Conversely, a trend for smaller thalami in the OSA group was noted. Furthermore, aberrant connectivity between the hippocampus and the cerebellum in the OSA group was also suggested by the correlation analysis. The role for the ischemia/hypoxia preconditioning in the neuropathology of OSA is herein indicated, with possible further reaching clinical implications.

19 Article Obstructive sleep apnea in children and adolescents with and without obesity. 2019

Andersen, Ida Gillberg / Holm, Jens-Christian / Homøe, Preben. ·Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Lykkebaekvej 1, 4600, Køge, Denmark. ida_ga@hotmail.com. · Department of Pediatrics, The Children's Obesity Clinic, Holbaek University Hospital, Smedelundsgade 60, 4300, Holbaek, Denmark. ida_ga@hotmail.com. · Department of Pediatrics, The Children's Obesity Clinic, Holbaek University Hospital, Smedelundsgade 60, 4300, Holbaek, Denmark. · The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Blegdamsvej 3A, 2200, Copenhagen, Denmark. · Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Lykkebaekvej 1, 4600, Køge, Denmark. · Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark. ·Eur Arch Otorhinolaryngol · Pubmed #30689039.

ABSTRACT: PURPOSE: To investigate the prevalence of obstructive sleep apnea (OSA) in children referred for obesity treatment, and to compare the prevalence with that of a normal-weight group. Moreover, we examined the association between Body Mass Index Standard Deviation Score (BMI SDS) and the Apnea-Hypopnea Index (AHI). METHODS: This cross-sectional study included 139 children aged 7-18 years with overweight/obesity (BMI SDS >1.28) recruited from an obesity treatment clinic. The normal-weight group consisted of 33 children (BMI SDS ≤ 1.28) aged 7-18 years recruited from schools. Sleep examinations were performed using a type 3 portable sleep monitor (Nox T3). OSA was defined as AHI ≥ 2. Height and weight were measured and the tonsillar size was clinically estimated using the Brodsky scale. RESULTS: The OSA prevalence was 44.6% in children with overweight/obesity compared with 9.1% in the normal-weight group (p = 0.0002), and the relative risk of OSA was 4.9 (95% CI 1.6-14.7). In a logistic regression, a one-unit increase in the BMI SDS increased the odds of having OSA by a factor of 1.92 independent of age, sex, tonsillar hypertrophy, and asthma (95% CI 1.33-2.76, p = 0.0005). A generalized linear regression adjusted for the same variables revealed an association between BMI SDS and AHI (a one-unit increase in the BMI SDS equaled an average increase in the AHI of 35% (95% CI 19-53%, p < 0.0001)). CONCLUSIONS: In this study, children with overweight/obesity had a significantly higher prevalence of OSA compared with a normal-weight group. Increased BMI SDS was associated with increased AHI.

20 Article Arterial stiffness in people with Type 2 diabetes and obstructive sleep apnoea. 2018

Hvelplund Kristiansen, M / Banghøj, A M / Laugesen, E / Tarnow, L. ·Nordsjaellands University Hospital, Hilleroed, Denmark. · Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus C, Denmark. · Steno Diabetes Centre Sjaelland, Holbaek Sygehus, Holbaek, Denmark. ·Diabet Med · Pubmed #29763980.

ABSTRACT: AIMS: To examine whether people with Type 2 diabetes with concurrent obstructive sleep apnoea have increased arterial stiffness as compared with people with Type 2 diabetes without obstructive sleep apnoea. METHODS: In a study with a case-control design, 40 people with Type 2 diabetes and treatment-naïve moderate to severe obstructive sleep apnoea (Apnoea-Hypopnoea Index ≥15) and a control group of 31 people with Type 2 diabetes without obstructive sleep apnoea (Apnoea-Hypopnoea Index <5) were examined. Obstructive sleep apnoea status was evaluated using the ApneaLink RESULTS: Carotid-femoral pulse wave velocity was not significantly different between participants with Type 2 diabetes with obstructive sleep apnoea and those without obstructive sleep apnoea (10.7±2.2 m/s vs 10.3±2.1 m/s; P=0.513), whereas oscillometric pulse wave velocity was significantly higher in participants with Type 2 diabetes with obstructive sleep apnoea than in those without obstructive sleep apnoea (9.5±1.0 m/s vs 8.6±1.4 m/s; P=0.002). In multiple regression analysis, age (P=0.002), gender (men; P=0.018) and HbA CONCLUSION: In conclusion, the present study did not find an age- and blood pressure-independent association between moderate to severe obstructive sleep apnoea and arterial stiffness in non-sleepy people with Type 2 diabetes. (Clinical trial registration number: NCT02482584).

21 Article Automatic, electrocardiographic-based detection of autonomic arousals and their association with cortical arousals, leg movements, and respiratory events in sleep. 2018

Olsen, Mads / Schneider, Logan Douglas / Cheung, Joseph / Peppard, Paul E / Jennum, Poul J / Mignot, Emmanuel / Sorensen, Helge Bjarup Dissing. ·Department of Electrical Engineering, Biomedical Engineering, Technical University of Denmark, Lyngby, Denmark. · Department of Psychiatry and Behavioral Medicine, Stanford University Center for Sleep Sciences and Medicine, Stanford University, CA. · School of Medicine and Public Health, University of Wisconsin, Madison, WI. · Department of Clinical Neurophysiology, Danish Center for Sleep Medicine, Rigshospitalet, Glostrup, Denmark. ·Sleep · Pubmed #29329416.

ABSTRACT: Study Objectives: The current definition of sleep arousals neglects to address the diversity of arousals and their systemic cohesion. Autonomic arousals (AA) are autonomic activations often associated with cortical arousals (CA), but they may also occur in relation to a respiratory event, a leg movement event or spontaneously, without any other physiological associations. AA should be acknowledged as essential events to understand and explore the systemic implications of arousals. Methods: We developed an automatic AA detection algorithm based on intelligent feature selection and advanced machine learning using the electrocardiogram. The model was trained and tested with respect to CA systematically scored in 258 (181 training size/77 test size) polysomnographic recordings from the Wisconsin Sleep Cohort. Results: A precision value of 0.72 and a sensitivity of 0.63 were achieved when evaluated with respect to CA. Further analysis indicated that 81% of the non-CA-associated AAs were associated with leg movement (38%) or respiratory (43%) events. Conclusions: The presented algorithm shows good performance when considering that more than 80% of the false positives (FP) found by the detection algorithm appeared in relation to either leg movement or respiratory events. This indicates that most FP constitute autonomic activations that are indistinguishable from those with cortical cohesion. The proposed algorithm provides an automatic system trained in a clinical environment, which can be utilized to analyze the systemic and clinical impacts of arousals.

22 Article Cerebral blood flow, oxygen metabolism, and lactate during hypoxia in patients with obstructive sleep apnea. 2018

Jensen, M L F / Vestergaard, M B / Tønnesen, P / Larsson, H B W / Jennum, Poul J. ·Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark. · Functional Imaging Unit, Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Glostrup, Denmark. ·Sleep · Pubmed #29309697.

ABSTRACT: Study Objectives: Obstructive sleep apnea (OSA) is associated with increased risk of stroke but the underlying mechanism is poorly understood. We suspect that the normal cerebrovascular response to hypoxia is disturbed in patients with OSA. Methods: Global cerebral blood flow (CBF), cerebral metabolic rate of oxygen (CMRO2), and lactate concentration during hypoxia were measured in patients with OSA and matched controls. Twenty-eight patients (82.1% males, mean age 52.3 ± 10.0 years) with moderate-to-severe OSA assessed by partial polysomnography were examined and compared with 19 controls (73.7% males, mean age 51.8 ± 10.1 years). Patients and controls underwent magnetic resonance imaging (MRI) during 35 min of normoxia followed by 35 min inhaling hypoxic air (10%-12% O2). After 3 months of continuous positive airway pressure (CPAP) treatment, 22 patients were rescanned. Results: During hypoxia, CBF significantly increased with decreasing arterial blood oxygen concentration (4.53 mL (blood)/100 g/min per -1 mmol(O2)/L, p < 0.001) in the control group, but was unchanged (0.89 mL (blood)/100 g/min per -1 mmol(O2)/L, p = 0.289) in the patient group before CPAP treatment. The CBF response to hypoxia was significantly weaker in patients than in controls (p = 0.003). After 3 months of CPAP treatment the CBF response normalized, showing a significant increase during hypoxia (5.15 mL (blood)/100 g/min per -1 mmol(O2)/L, p < 0.001). There was no difference in CMRO2 or cerebral lactate concentration between patients and controls, and no effect of CPAP treatment. Conclusions: Patients with OSA exhibit reduced CBF in response to hypoxia. CPAP treatment normalized these patterns.

23 Article Validation of the Danish STOP-Bang obstructive sleep apnoea questionnaire in a public sleep clinic. 2018

Kørvel-Hanquist, Asbjørn / Andersen, Ida Gillberg / Lauritzen, Elisabeth / Dahlgaard, Susanne / Moritz, Janko. ·asbp@regionsjaelland.dk. ·Dan Med J · Pubmed #29301611.

ABSTRACT: INTRODUCTION: Obstructive sleep apnoea is common; a prevalence of 1-5% was previously reported. However, only few cases are diagnosed and receive treatment. The aim of this study was to validate the Danish translated version of the STOP-Bang screening tool for obstructive sleep apnoea (OSA) in a public sleep clinic. 
 METHODS: A study population of 208 patients who were referred to a public sleep clinic on suspicion of OSA were assessed with the STOP-Bang questionnaire and at-home cardiorespiratory monitoring in order to assess the quality of the questionnaire as an OSA screening tool. 
RESULTS: In the study population, 73% were males, and 51% of the population had an Apnoea-Hypopnoea Index (AHI) ≥ 15. The STOP-Bang screening tool had a sensitivity of 0.98 for detection of OSA with AHI ≥ 15 and a corresponding specificity of 0.09. Hence, the questionnaire is able to detect almost all patients suffering from OSA. However, using the tool will cause many healthy subjects to be falsely classified as having OSA. 
 CONCLUSIONS: The Danish version of the STOP-Bang screening tool does not seem useful for OSA screening of patients in a sleep clinic setup, but it may be useful in primary care. 
 FUNDING: The Zealand Research Foundation. 
 TRIAL REGISTRATION: not relevant.

24 Article Determinants for adherence to continuous positive airway pressure therapy in obstructive sleep apnea. 2017

Jacobsen, Anne Roed / Eriksen, Freja / Hansen, Rasmus Würgler / Erlandsen, Mogens / Thorup, Line / Damgård, Mette Bjerre / Kirkegaard, Martin Glümer / Hansen, Klavs Würgler. ·Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark. · Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark. · Interdisciplinary Research Unit, Elective Surgery Centre, Regional Hospital Silkeborg, Silkeborg, Denmark. · Sleep Disorders Clinic, Elective Surgery Centre, Regional Hospital Silkeborg, Silkeborg, Denmark. ·PLoS One · Pubmed #29253872.

ABSTRACT: BACKGROUND: Continuous positive airway pressure (CPAP) therapy is an efficacious treatment for patients diagnosed with obstructive sleep apnea (OSA). However, there are only few data on long-term adherence. The aim of this study is to quantify the extent of non-adherence and describe the clinical characteristics. METHODS: A retrospective study including 695 patients with newly diagnosed OSA and prescribed CPAP therapy within an inclusion period of 14 months. All patients were offered free of charge individually adjusted CPAP therapy. Data on comorbidity, medication, BMI and Epworth Sleepiness Score (ESS) were obtained by questionnaires and consultation with an otorhinolaryngeal specialist. RESULTS: The median follow-up time after initiating CPAP therapy was 3.0 (range 2.4-3.6) years. An adherence rate of 89% was found for severe OSA, 71% for moderate OSA and 55% for mild OSA. 18% initiated humidification. Patients adherent to CPAP had a significantly higher Body Mass Index (BMI), Apnea Hypopnea Index (AHI), Oxygen Desaturation Index (ODI) and ESS compared to non-adherent patients. Furthermore, adherence was associated with a higher frequency of observed interrupted breathing, a less frequent use of hypnotic drugs, fewer smokers, and they were more often offered humidification. Age, gender and comorbidity were not significantly associated with adherence. In a Cox model only AHI (Hazard Ratio (HR) 0.963, p < 0.001), ESS (HR 0.939, p = 0.001) and smoking (HR 1.576, p = 0.022) were independently associated with CPAP non-adherence. CONCLUSIONS: The severity of OSA, subjective daytime sleepiness and smoking status are independently related to adherence to CPAP therapy.

25 Article Reduced Inspiratory Muscle Strength in Patients with Type 2 Diabetes Mellitus and Obstructive Sleep Apnoea. 2017

Rehling, Thomas / Banghøj, Anne Margareta / Kristiansen, Marie Hvelplund / Tarnow, Lise / Molsted, Stig. ·University College (UCC) Department of Physiotherapy, Hillerød, Denmark. · Department of Clinical Research, Nordsjællands Hospital, Hillerød, Denmark. · Department of Cardiology, Nephrology & Endocrinology, Nordsjællands Hospital, Hillerød, Denmark. · Health, Aarhus University, Aarhus, Denmark. ·J Diabetes Res · Pubmed #29147664.

ABSTRACT: Background: Obstructive sleep apnoea (OSA) is related to type 2 diabetes (T2DM), and it may be associated with reduced inspiratory muscle strength (IMS). The aim of this study was to investigate the IMS in patients with T2DM, with or without OSA. Methods: Patients with T2DM with OSA ( Results: There was no difference in IMS between the OSA group (median (range) 77 (35-124) cmH Conclusion: No difference in IMS between patients with T2DM with or without OSA was found. However, patients with T2DM and OSA had reduced IMS compared with age- and gender-matched references whereas the non-OSA group did not have reduced IMS.