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Kuopio, Finland

Papandreou C.,Harokopio University | Tuomilehto H.,Oivauni Sleep Clinic | Tuomilehto H.,University of Eastern Finland
Journal of Human Nutrition and Dietetics | Year: 2014

Background: The present study explored coronary heart disease (CHD) mortality rates in 2011 in countries that participated in the Seven Countries Study (SCS) in relation to several dietary and anthropometric/biochemical risk factors. Special focus was given to Crete and the Ionian Islands. Methods: This was a cross-sectional study of secondary analysis of databases using data from the World Health Organization, the Food and Agriculture Organization database and the Greek National Cadaster and Cartography Organization. Geographically weighted regression was applied to identify the high-risk regions in relation to the significant factors. Results: Crete, the Ionian Islands and Japan had the lowest mortality rates (28.9, 30.1 and 31.2 deaths/100 000 people, respectively) in contrast to Serbia/Montenegro that presented the highest rates (105.1 deaths/100 000 people). Diet, physical inactivity and hypertension were found to be the most significant factors in the model (P < 0.05). Regions of no risk were Crete, Ionian Islands and Japan (exponent B = 0.65; 95% confidence interval = 0.293-0.942; P < 0.001), whereas Serbia/Montenegro and Finland were identified as high-risk areas with a 2.97-fold higher probability for CHD mortality (95% confidence interval = 1.736-4.028; P < 0.001). Conclusions: Observed patterns of CHD mortality and related factors may be helpful for appropriate management by health planners when aiming to reduce its prevalence, particularly in high-risk areas. © 2013 The British Dietetic Association Ltd. Source


Tuomilehto H.,Oivauni Sleep Clinic | Seppa J.,Kuopio University Hospital | Uusitupa M.,University of Eastern Finland | Uusitupa M.,Kuopio University Hospital
Sleep Medicine Reviews | Year: 2013

Obesity is a major health burden that contributes to increased morbidity and mortality. Obesity is also the most important risk factor for obstructive sleep apnea (OSA); at least 70% of patients are obese. OSA as such, has been linked with increased cardiovascular morbidity and mortality, and OSA patients often display metabolic syndrome. The exact underlying mechanisms behind these associations are complex and not fully understood. In obese individuals, weight reduction and increased physical activity form cornerstones for the prevention and treatment of metabolic syndrome, and recent controlled intervention trials strongly suggest that weight reduction together with a healthy diet and increased physical activity may correct or at least improve the symptoms of OSA. However, regardless of promising results in terms of symptoms of OSA and the undoubted metabolic benefits of changing lifestyles, weight reduction as a treatment of OSA is still underrated by many clinicians. Based on the current knowledge, clinicians should revise their previous attitudes, including suspicions about weight reduction as an effective treatment for OSA patients. Nevertheless, we also need large well-controlled trials on the effects of different weight reduction programs among OSA patients to determine the overall efficacy of different treatment modalities and their long-term success. © 2012 Elsevier Ltd. Source


Vaatainen S.,University of Eastern Finland | Tuomilehto H.,Oivauni Sleep Clinic | Saramies J.,South Karelia Central Hospital | Tuomilehto J.,Finnish National Institute for Health and Welfare | And 5 more authors.
Quality of Life Research | Year: 2013

Purpose The aim of the study is to examine the healthrelated quality-of-life (HRQOL) impact of the nocturnal awakenings and the duration of the sleep in the Finnish middle-aged and older population. Methods Cross-sectional sample consisted of 823 community-dwelling persons aged 55-75 living in a single municipality in a rural area of Eastern Finland. Frequency of the nocturnal awakenings was dichotomized as reporting "frequent," if the participant reported subjectively awakening "often" or "very often," and "infrequent" if the participant reported awakening "sometimes" or less frequently. HRQOL was measured with a preference-based HRQOL-index instrument, 15D. Analyses were adjusted for gender, BMI, morbidities, depression, employment and marital status, current smoking and drinking, exercise, recommendation to exercise from a health care professional, and subjective opinion about own exercise habits. Results Frequent nocturnal awakenings had statistically and clinically significant negative impact on HRQOL, the mean (SE) adjusted marginal HRQOL impact being -0.0416 (0.006). More than 10 and less than 6.5 h of daily sleep were associated with higher probability of having low HRQOL, adjusted odd ratios (95 % CI) being 2.65 (1.11-6.33) and 2.65 (1.55-4.52), respectively. However, the changes in daily sleep duration did not have noticeable influence on the significance or magnitude of the negative HRQOL impact of the frequent nocturnal awakenings. Conclusions Nocturnal awakenings displayed a strong independent association with decreased HRQOL. The findings suggest that both clinicians and researchers should pay closer attention to nocturnal awakenings and other sleep problems in order to find ways to improve the quality of life in individuals with such conditions. © Springer Science+Business Media Dordrecht 2013. Source


Peromaa-Haavisto P.,Hatanpaa City Hospital | Tuomilehto H.,Oivauni Sleep Clinic | Tuomilehto H.,University of Eastern Finland | Kossi J.,Kantahame Central Hospital | And 7 more authors.
Obesity Surgery | Year: 2016

Background: Obesity has become one of the greatest public health concerns worldwide and is known to be the most important risk factor for obstructive sleep apnoea (OSA). Prevalence of OSA has increased over the last two decades, but it is estimated that the majority of cases still remain undiagnosed. The aim of this study was to investigate the prevalence of OSA in Finnish bariatric surgery candidates. Methods: In this prospective multicentre study, standard overnight cardiorespiratory recording was conducted in 197 consecutive patients from three different hospitals. A sleep questionnaire was also administered. Anthropometric and demographic measurements included age, weight, body mass index (BMI) and waist and neck circumference. Results: Altogether, 71 % of the patients were diagnosed with OSA. The prevalence was higher in males (90 %) than in females (60 %) (p < 0.001). In OSA patients’ group, the mean neck and waist circumference was larger (p < 0.001) and the body weight higher (p < 0.01) than in non-OSA group. When separating patients by gender, a significant difference remained only concerning neck circumference in female patients. Conclusions: OSA is very common among bariatric surgery patients, especially in men. Considering this and the increased long-term morbidity and mortality generally related to OSA, a routine screening for OSA seems indicated in bariatric patients, particularly men. © 2015, Springer Science+Business Media New York. Source


Pahkala R.,University of Eastern Finland | Seppa J.,Kuopio University Hospital | Ikonen A.,Jyvaskyla Central Hospital | Smirnov G.,Oivauni Sleep Clinic | And 2 more authors.
Sleep and Breathing | Year: 2014

Purpose: Obesity is the most important risk factor for obstructive sleep apnea (OSA); however, the exact underlying mechanisms are still not fully understood. The aim of this study was to examine the morphology of upper airways in overweight habitual snorers and in mild OSA patients. Furthermore, the associations between weight loss, parapharyngeal fat pad area and OSA were assessed in a 1-year randomised, controlled follow-up study originally conducted to determine the effects of lifestyle changes with weight reduction as a treatment of OSA. Methods: Thirty-six overweight adult patients with mild OSA [apnea-hypopnea index (AHI) 5-15 events/h] and 24 weight-matched habitual snorers (AHI<5 events/h) were included in the study. All patients underwent nocturnal cardiorespiratory recordings and multislice computed tomography (CT) of parapharyngeal fat pad area, the smallest diameter and area in naso-, oro- and hypopharynx, the smallest diameter and area of the whole pharyngeal airway, the distance from the hyoid bone to the mandibular plane and to cervical tangent as well as the distance between mandibular symphysis and cervical spine. In addition, OSA patients were further randomised to receive either an active 1-year lifestyle intervention with an early weight loss programme or routine lifestyle counselling. After 1 year, the cardiorespiratory recordings and CT scans were repeated. Results: The pharyngeal fat pad area was significantly larger, and the distance from the hyoid bone to cervical spine was longer in patients with OSA than in habitual snorers (p=0.002 and p=0.018, respectively). The multiple regression analysis showed that besides a large pharyngeal fat pad area and a long distance from the cervical spine to hyoid bone, also a short distance from the mandibular symphysis to cervical tangent increased a risk to OSA. During the 1-year follow-up in OSA patients, the pharyngeal fat pad area and AHI decreased significantly in the intervention group (p=0.003 and p<0.001, respectively). Conclusions: In the early stages of OSA, the pharyngeal fat pad seems to play an important role in the development of disease in overweight patients. Furthermore, weight reduction by lifestyle intervention-based programme reduces both central obesity and pharyngeal fat pads, resulting in an improvement of OSA. © 2013 Springer-Verlag. Source

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