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  • Linköping University Medical Dissertations No. 1378

    Psychometric aspects of obstructive sleep apnea syndrome

    Martin Ulander

    Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden

    Linköping 2013

  • Cover image: Hypnogram (3D), by Martin Ulander Papers I and II are reproduced with permission from Wiley Paper III is reproduced with permission from Springer Printed by LiU-tryck 2013 ISBN 978-91-7519-528-5 ISSN 0345-0082

  • To my family

  • LIST OF PUBLICATIONS............................................................................................... 1

    ABSTRACT..................................................................................................................... 2

    ABBREVIATIONS........................................................................................................... 3

    INTRODUCTION ............................................................................................................. 4

    DEFINING SLEEP RELATED OBSTRUCTIVE BREATHING DISORDERS.................. 5

    Definitions of specific syndroms .................................................................................................................................5

    Definitions of events .....................................................................................................................................................7

    DIAGNOSTIC PROCEDURE .......................................................................................... 9

    EPIDEMIOLOGY........................................................................................................... 11

    Prevalence in various populations ............................................................................................................................11

    Risk factors for obstructive sleep apnea...................................................................................................................15 Obesity ....................................................................................................................................................................15 Age ..........................................................................................................................................................................16 Gender .....................................................................................................................................................................17

    Consequences of obstructive sleep apnea.................................................................................................................17 Mortality..................................................................................................................................................................17 Hypertension ...........................................................................................................................................................21 Other cardiovascular diseases .................................................................................................................................24 Diabetes mellitus .....................................................................................................................................................28 Sleepiness................................................................................................................................................................29

    Cognitive deficits ........................................................................................................................................................30 Accidents.................................................................................................................................................................31

    TREATMENT ................................................................................................................ 32

    Surgery........................................................................................................................................................................32

    Mandibular advancement devices ............................................................................................................................32

    Continuous Positive Airway Pressure ......................................................................................................................33 Adherence to CPAP treatment ................................................................................................................................34

  • AIMS ............................................................................................................................. 38

    PAPER I: DEVELOPMENT AND INITIAL TESTING OF SECI..................................... 39

    Rationale for paper I..................................................................................................................................................39

    Methods.......................................................................................................................................................................39 Item generation........................................................................................................................................................39 Data collection.........................................................................................................................................................40 Statistical processing and analysis...........................................................................................................................41

    Results .........................................................................................................................................................................41 Study population .....................................................................................................................................................41 Validity and reliability of the SECI.........................................................................................................................42

    PAPER II: TYPE D PERSONALITY.............................................................................. 43

    Rationale for paper II ................................................................................................................................................43

    Methods.......................................................................................................................................................................43 Data collection.........................................................................................................................................................43 Questionnaires.........................................................................................................................................................43 Statistical processing and analysis...........................................................................................................................44

    Results .........................................................................................................................................................................44 Study population .....................................................................................................................................................44 Type D personality and side effects ........................................................................................................................45 Type D personality and adherence ..........................................................................................................................45

    PAPER III: DIFFERENTIAL ITEM FUNCTIONING IN THE EPWORTH SLEEPINESS SCALE .......................................................................................................................... 47

    Rationale for paper III ..............................................................................................................................................47

    Methods.......................................................................................................................................................................47 Data collection.........................................................................................................................................................47 Statistical analysis ...................................................................................................................................................48

    Results .........................................................................................................................................................................49 Study population .....................................................................................................................................................49 General psychometric properties of the ESS...........................................................................................................49 Differential item functioning...................................................................................................................................50

  • PAPER IV: CPAP SIDE EFFECTS – E

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