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Biomedical subjects

C Janson

Publications and source records attributed to C Janson.

At least 37 records · Page 2Linked to original sources
PubMed1999

Comparison of two methacholine challenge methods using Spira-2 or Mefar dosimeter.

Two bronchial challenge protocols with breath-actuated dosimeters, Spira Elektro-2 and Mefar, with similar cumulative dose steps were compared in 28 patients with mild to moderate asthma. Methacholine challenges were performed after two different protocols at the same time of day in random order 3 or 4 days apart. The provocative dose of methacholine producing a 20% fall in forced expiratory volume in 1 second (PD20) was lower when determined by Spira than with the Mefar dosimeter (P < 0.05). Transition equations calculated by linear regression analysis were: PD20mefar = exp10[0.897 + 0.678(logPD20spira)] (P < 0.05; r = 0.62) and PD20spira = exp10[0.759 + 0.559 (log PD20mefar)] (P < 0.05; r = 0.62). The slopes were calculated by regressing the percentage fall in FEV1 on log10 (dose) and transformed as slope = 100/(regression coefficient + 10). The mean slope (95% CI) for Spira was 3.1 (2.6-3.7) and for Mefar 4.4 (3.6-5.1) (P < 0.005). Regression equations calculated by linear regression analysis were: slope(mefar) = 2.126 + 0.712 slope(spira) (P < 0.05; r = 0.51) and slope(spira) = 1.551 + 0.365 slope(mefar) (P < 0.05; r = 0.51). In conclusion, PD20 was smaller and the decline in FEV1/log(dose) curve steeper using the Spira compared with the Mefar protocol. The dose-response curves should be validated and transition equations calculated when bronchial reactivity to inhaled agents is compared, even while using apparently similar well-standardized dosimeter methods.

Adolescent↗
PubMed1999

Evolution of sleep apnea syndrome in sleepy snorers: a population-based prospective study.

This study followed a small number of men previously studied polysomnographically 10 yr earlier to investigate the relationship between the development of sleep-disordered breathing and age, weight gain, and smoking. In 1984, 3,201 men answered a questionnaire including questions about snoring and excessive daytime sleepiness (EDS). Of those reporting symptoms related to obstructive sleep apnea syndrome (OSAS), a random sample of 61 men was investigated using whole-night polysomnography in 1985. Ten years later, 38 men participated in the present follow-up, which included a structured interview and polysomnography. During the 10-yr period, nine men had been treated for OSAS. Of the 29 untreated subjects, the number of men with OSAS, defined as an apnea-hypopnea index (AHI) of >/= 5/h, increased from four in 1985 to 13 in 1995 (p < 0.01). In this small sample, no significant associations were found between DeltaAHI (i.e., AHI 1995 - AHI 1985) and age, weight gain, or smoking. We conclude that, among this small group of individuals who were selected for original polysomnographic study and follow-up because they were thought to have symptoms of sleep apnea, sleep-disordered breathing became significantly worse over time.

Adult↗
PubMed1999

Asthma-related work disability in Sweden. The impact of workplace exposures.

Work disability due to respiratory disease, especially asthma, is common and costly among working age adults. The goal of this analysis was to characterize the risk factors for such disability. We analyzed data from the Swedish part of the European Community Respiratory Health Survey (ECRHS), a random population-based sample of adults age 20 to 44, enriched with symptomatic subjects at increased likelihood of having asthma. We analyzed structured interview data available for 2,065 subjects and further analyzed methacholine challenge and skin prick test data for 1,562 of these. We defined respiratory work disability as reported job change or work loss due to breathing affected by a job. We used binary generalized linear modeling with a log link to estimate disability risk. Eighty-four subjects (4%) reported such work disability. This increased to 13% among those with asthma (45 of 350 subjects). Adjusting for covariates, occupations at high risk for asthma were associated with disability (prevalence ratio [PR] 1.8; 95% confidence interval [CI] 1.1 to 3.0), as was self-reported regular exposure to environmental tobacco smoke (ETS) at work (PR 1.8; 95% CI 1.1 to 3.1) and self- reported job exposure to vapors, gases, dust, or fumes (VGDF) (PR 4.3; 95% CI 2.2 to 8.6). Workplace ETS exposure was also associated with methacholine challenge-positive asthma reported to be symptomatic at work among male subjects (PR 4. 2; 95% CI 1.8 to 9.8), whereas high asthma-risk occupations were associated with this outcome among female subjects (PR 2.7; 95% CI 1. 05 to 7.1). Respiratory work disability, defined as breathing-related job change due to work loss, was associated with workplace exposures themselves, even after taking into account other covariates. Better control of workplace exposures, including workplace ETS, may reduce work disability caused by respiratory conditions, especially adult asthma.

Adult↗
PubMed1999

Delayed type of hypersensitivity and late allergic reactions in patients with stable COPD.

BACKGROUND: Malnutrition, a common feature among patients with COPD, has adverse effects on the immune system. Delayed type of hypersensitivity (DTH) tests have been used to evaluate the nutritional and immune status of patients and to predict outcome in various conditions. DTH is known to be and late allergic reaction (LAR) has been suggested to be dependent on T-lymphocyte function. STUDY OBJECTIVES: To compare DTH and LAR tests in COPD patients and healthy controls, to investigate whether skin tests have any value in estimating nutritional status and outcome in COPD patients, and to see whether there is any relationship between DTH and LAR. METHODS: Twenty-five patients with stable COPD and 20 healthy controls were tested for DTH and LAR. The patients were investigated with spirometry and anthropometric measurements and were followed for 1 year. RESULTS: Both the LAR and DTH reactions were diminished in the patient group (p < 0.001) compared with controls. The skin tests did not correlate with anthropometric parameters. DTH correlated to lung function, which was expressed as FEV(1) (percent predicted) (r = 0.56; p < 0.01), and LAR correlated to the number of exacerbations (at 3 months, r = - 0.61; p < 0.01). No correlation was found between LAR and DTH reactions. CONCLUSIONS: We conclude that patients with COPD in stable condition have diminished DTHs and LARs. Our results indicate that the magnitude of the LAR may be a prognostic marker in patients with COPD.

Aged↗
PubMed1999

Current asthma and biochemical signs of inflammation in relation to building dampness in dwellings.

SETTING: Study of current asthma in adults in relation to the indoor environment. OBJECTIVES: To assess the effect of building dampness in dwellings on the occurrence of current asthma, and biochemical signs of inflammation. DESIGN: A nested case-control study with 98 prevalent cases of asthma and 357 controls, within a stratified random population sample (20-45 years) from the Uppsala, Sweden, part of the European Community Respiratory Health Survey (ECRHS). Current asthma was defined as a combination of bronchial hyperresponsiveness and at least one asthma symptom (wheeze or attacks of breathlessness). Statistical calculations were made by multiple linear or logistic regression, adjusting for age, sex and smoking. RESULTS: Building dampness was found in 27% of dwellings. Current asthma was more common among subjects living in damp dwellings (odds ratio [OR] 1.8; 95% confidence interval [CI] 1.1-3.0), particularly with dampness in the floor construction (OR = 4.6; 95% CI 2.0-10.5). The average forced expiratory flow in one second (FEV1) was lower and peak expiratory flow (PEF) variability was higher in subjects from dwellings with floor dampness, and blood eosinophil count was increased in damp dwellings. No relation was found between immediate type allergy to house dust mites and current asthma or building dampness. Immediate type allergy to moulds (Cladosporium or Alternaria) was more prevalent in damp dwellings (9.3% vs 3.9%), and was related to current asthma (OR = 3.4; 95% CI 1.4-8.5). CONCLUSIONS: Building dampness is common in dwellings in Sweden, and seems to be related to an increase in current asthma and biochemical signs of inflammation. Immediate type allergy to house dust mites does not seem to be the explanation, but immediate type allergy to moulds could explain some of the findings.

Adult↗
PubMed1998

Atopy and allergic disorders among adults in Tartu, Estonia compared with Uppsala, Sweden.

BACKGROUND: Recent studies in children and adults indicate that the prevalence of atopy and allergic disorders is lower in previously socialist countries in Eastern Europe compared with countries with a market economy while revealed risk factors are similar. OBJECTIVES: To estimate the prevalence of atopy among adults in Tartu, Estonia and to compare the prevalence of risk factors for atopy and allergic respiratory diseases in Estonia and Sweden. METHODS: As a part of cross-sectional study-European Community Respiratory Health Survey-random samples of 20-44 year olds (n = 351 in Tartu and n = 470 in Uppsala) and persons of the same age with asthma like symptoms or on current asthma medication according to a postal questionnaire (n = 95 in Tartu and n = 201 in Uppsala) were interviewed and circulating IgE antibodies were measured. RESULTS: The prevalence of atopy was 19% in Tartu and 32% in Uppsala (P < 0.001). The prevalence of sensitization to pollen was twice lower (11.5 vs 23.2; P<0.001) and the prevalence of pollen associated asthma symptoms was four times lower (1.7 vs 6.8; P<0.001) in Tartu than in Uppsala while sensitization to pollen was an equally large risk factor for asthma in both centres. Age was inversely related to cat and pollen associated symptoms of rhinoconjunctivitis in Uppsala (OR 0.6 and 0.7, respectively, P < 0.05) but not in Tartu. CONCLUSIONS: The prevalence of atopy was lower in Tartu, Estonia than in Uppsala Sweden. Perception of allergic disorders seemed to be lower in Tartu than in Uppsala. Age did not influence the prevalence of atopy nor allergic disorders in Tartu, while in Uppsala age was inversely related to clinical allergy. This could suggest a cohort effect underlying the increasing prevalence of allergy in Western Europe.

Adult↗
PubMed1998

Increased mortality among sleepy snorers: a prospective population based study.

BACKGROUND: The long term health consequences of snoring and sleep apnoea syndrome are still uncertain. This study was conducted to assess the mortality risk associated with snoring and excessive daytime sleepiness (EDS), the two main symptoms of sleep apnoea syndrome, in men. METHODS: In 1984 a sample of 3100 men aged 30-69 responded to a postal questionnaire including questions about snoring, EDS, and the prevalence of various diseases (response rate 77.1%). Mortality data for the period 1985-1995 were collected for the complete sample. RESULTS: During the 10 year follow up period 213 men died, 88 of cardiovascular diseases. Compared with subjects with no snoring or EDS in 1984, men with isolated snoring or EDS displayed no significantly increased mortality. The combination of snoring and EDS was associated with a significant increase in mortality. However, the relative rates decreased with increasing age, and in men aged 60 and above no effect on mortality was found. Men below the age of 60 with both snoring and EDS had an age adjusted total death rate which was 2.7 times higher than men with no snoring or EDS (95% CI 1.6 to 4.5). The corresponding age adjusted hazard ratio for cardiovascular mortality was 2.9 (95% CI 1.3 to 6.7) for subjects with both snoring and EDS. Further adjustment for body mass index and reported hypertension, cardiac disease, and diabetes reduced the relative mortality risk associated with the combination of snoring and EDS to 2.2 (95% CI 1.3 to 3.8) and the relative risk of cardiovascular mortality to 2.0 (95% CI 0.8 to 4.7). CONCLUSION: Snoring without EDS does not appear to carry an increased risk of mortality. The combination of snoring and EDS appears to be associated with an increased mortality rate, but the effects seems to be age dependent. The increased mortality is partly explained by an association between "snoring and EDS" and cardiovascular disease.

Adult↗
PubMed1998

Autoantibodies in Estonia and Sweden, populations with different responses to allergens.

BACKGROUND: There are substantial differences in immune-mediated disease prevalence between different countries and populations which cannot be explained by genetic variability. AIMS: To compare the prevalence of antinuclear (ANA), antimitochondrial, antireticulin, liver-kidney microsomal, parietal cell, thyroid microsomal and double-stranded DNA (dsDNA) antibodies among adults aged 20-44 years in two towns, i.e. in Tartu, Estonia (n = 448) and in Uppsala, Sweden (n = 532) with a low and a high prevalence of allergy. METHODS: For autoantibody detection, standard indirect immunofluorescence tests on tissue and Chritidia lucilia antigenic preparations were used (sera were diluted starting from 1:10). RESULTS: The prevalence of ANA was lower in Tartu than in Uppsala (3 vs. 10% among males and 11 vs. 16% among females; p<0.01 and p<0.1, respectively). Furthermore, dsDNA antibody-positive cases were only identified in Uppsala. The largest difference between the two populations was revealed for IgM type ANA, both among males (1 vs. 6%; p<0.02) and females (5 vs. 11%; p<0.01). In addition, the antibody titers were lower in Tartu than in Uppsala (p<0.05). The prevalence of other autoantibodies was similar in the two towns. CONCLUSIONS: The findings could support that Th2-like immune responses are commoner in Sweden than in Estonia, as previously suggested by the higher prevalence of allergy.

Adult↗
PubMed1998

Snoring and hypertension: a 10 year follow-up.

In many cross-sectional studies an association has been found between snoring and hypertension. However, differing results have been obtained when confounding factors have been taken into account. To establish whether snoring is a risk factor for developing hypertension, a population-based, prospective survey was performed. In 1984 and 1994, 2,668 males, aged 30-69 yrs at baseline, answered questionnaires concerning sleep disturbances and somatic disease. Of the habitual snorers in 1984, 12.5% reported that they had developed hypertension during the period, compared with 7.4% of the remaining subjects (p<0.001). In a multiple logistic regression model persistent snoring, i.e., reported habitual snoring in both 1984 and 1994, was found to be an independent predictor for the development of hypertension among males aged 30-49 yrs (odds ratio 2.6, 95% confidence interval 1.5-4.5) after adjustments for age, body mass index (BMI), weight gain, smoking, alcohol dependence, and physical inactivity. Among the subjects aged 50-69 yrs in 1984, no association between snoring and development of hypertension was found. Although based only on reported data, the results indicate that persistent snoring is an independent risk factor for the development of hypertension among males aged <50 yrs. Prospective surveys, including whole-night sleep recordings, are needed to establish whether this is due to a higher prevalence of obstructive sleep apnoea syndrome among snorers or whether nonapnoeic snorers with increased upper airway resistance also have an increased risk of developing hypertension.

Adult↗
PubMed1998

Individual use of antiasthmatic drugs in the European Community Respiratory Health Survey.

A previous analysis of drug utilization in the European Community Respiratory Health Survey found that only between 8 and 29% of subjects with asthma-related symptoms were using antiasthmatic medication in the different areas studied. The aim of this analysis was to investigate which variables were related to individual use of antiasthmatic medication in different geographical areas. Thirty-three centres in 14 countries were analysed, in which a total of 16,854 people (52.1% females, mean age 33.8 yrs, range 20-48) underwent a structured interview, measurement of specific immunoglobin E, spirometry and methacholine challenge test. The use of antiasthmatic drugs in individuals was, in most countries, independently related to asthma-related respiratory symptoms, bronchial hyperresponsiveness (BHR) and atopy. In all countries smokers with respiratory symptoms were less likely to be using antiasthmatic drugs than nonsmokers and exsmokers. In four of 14 countries females were significantly more likely to use antiasthmatic medication than males, while age and socioeconomic status were unrelated to medication. The use of inhaled anti-inflammatory drugs was positively related to symptoms, BHR and atopy and negatively related to current smoking. In conclusion, in many countries smokers were less likely to be using antiasthmatic drugs than were nonsmokers with comparable levels of symptoms and bronchial hyperresponsiveness. Age and socioeconomic status were unrelated to medication, while in some countries females were more likely than males to use antiasthmatic medication.

Adult↗
PubMed1998

A 10-year follow-up of snoring in men.

STUDY OBJECTIVES: Little is known about the natural development of snoring, and this survey was conducted to study the development of snoring in men over a 10-year period. DESIGN: Population-based prospective survey. SETTING: The Municipality of Uppsala, Sweden. PARTICIPANTS AND MEASUREMENTS: In 1984, 3,201 randomly selected men aged 30 to 69 years answered a questionnaire on snoring and sleep disturbances. Of the 2,975 survivors in 1994, 2,668 (89.7%) answered a new questionnaire with identical questions to those used at baseline. Questions about smoking habits, alcohol, and physical activity were also added. RESULTS: Habitual snoring was reported by 393 men (15.0%) in 1984 and by 529 (20.4%) 10 years later. In both 1984 and 1994, the prevalence of snoring increased until age 50 to 60 years and then decreased. Risk factors for being a habitual snorer at the follow-up were investigated using multiple logistic regression with adjustments for previous snoring status, age, body mass index (BMI), weight gain, smoking habits, and physical activity. In men aged 30 to 49 years at baseline, the predictors of habitual snoring at the follow-up, in addition to previous snoring status, were as follows: persistent smoking (adjusted odds ratio, 95% confidence interval) (1.4, 1.1 to 1.9), BMI 1984 (1.1, 1.02 to 1.1/kg/m2) and weight gain (1.1, 1.03 to 1.2/kg/m2). Among men aged 50 to 69 years, after adjustments for previous snoring status and age, weight gain was the only significant risk factor for developing habitual snoring (1.2, 1.05 to 1.4/kg/m2). CONCLUSIONS: In men, the prevalence of snoring increases up to the age of 50 to 60 years and is then followed by a decrease. Weight gain is a risk factor for snoring in all age groups, while smoking is mainly associated with snoring in men <60 years of age.

Adult↗
PubMed1998

Symptoms related to the sick building syndrome in a general population sample: associations with atopy, bronchial hyper-responsiveness and anxiety.

OBJECTIVE: The sick building syndrome (SBS) is a term mainly applied to irritative symptoms in the eyes, skin and upper airways that are experienced in certain environments. The aim of this study was to investigate the characteristics of subjects from the general population that report SBS-related symptoms. METHODS: The study comprised a randomly selected population of 418 individuals aged 20-45 years. The subjects underwent a structured interview, skin prick tests, a methacholine provocation test and answered two questionnaires respectively assessing psychiatric status and the presence of SBS symptoms. RESULTS: Eighty-seven subjects (21%) reported one or more SBS symptom weekly. Most common were general symptoms reported by 10% of the population. Female sex (odds ratio [OR] = 2.1), atopy (OR = 2.2) and anxiety (OR = 2.6) were significant independent risk factors for reporting at least one SBS-related symptom. Anxiety (OR = 3.2) and depression (OR = 4.4) were significant predictors for general symptoms, while bronchial hyper-responsiveness was a significant predictor for pharyngeal symptoms (dryness in the throat, sore throat and irritating cough) (OR = 5.4). CONCLUSIONS: Sick building symptoms are common in the general population and among women, while atopy and anxiety increase the risk of reporting such symptoms. Psychological factors are mainly related to general symptoms, while bronchial hyperresponsiveness is connected with pharyngeal symptoms.

Adult↗
PubMed1997

Long-term follow-up of patients with obstructive sleep apnea treated with uvulopalatopharyngoplasty.

OBJECTIVE: To study the long-term outcome after treatment with uvulopalatopharyngoplasty (UPPP). DESIGN: Long-term follow-up (4-8 years) with polysomnography. SETTING: Referral center for patients with sleep-disordered breathing. PATIENTS: Thirty-four consecutive patients of whom 25 (22 men and 3 women; mean age, 49 years) participated in the follow-up. All patients had obstructive sleep apnea syndrome. INTERVENTION: Uvulopalatopharyngoplasty. MAIN OUTCOME MEASURES: Symptoms and apnea-hypopnea index (AHI) before and after UPPP. Response to treatment defined as a 50% or more reduction in AHI and a postoperative AHI of 10 or less. RESULTS: Reduced prevalence of snoring and daytime sleepiness and reduction in AHI (mean [+/-SD], 40 +/- 26 to 21 +/- 21) at follow-up (P < .001). Sixteen patients (64%) were responders after 6 months and 12 (48%) at the long-term follow-up. Responders had a lower preoperative AHI (25 +/- 7) than did nonresponders (48 +/- 29) (P < .05). None of the 7 patients with preoperative AHI of more than 40 were responders (P < .01). No difference was seen in preoperative body mass index, lung function, ventilatory response to carbon dioxide, computed tomography scan of upper airways, or change in body mass index between responders and nonresponders. CONCLUSIONS: Four to 8 years after UPPP, about half of our patients were clinically and objectively improved. Uvulopalatopharyngoplasty should be reserved for patients with mild or moderate obstructive sleep apnea. After UPPP, long-term follow-up is recommended because some initially successfully treated patients will relapse in the long term.

Female↗
PubMed1997

Asthma and the indoor environment: the significance of emission of formaldehyde and volatile organic compounds from newly painted indoor surfaces.

As a part of the worldwide European Community Respiratory Health Survey, possible relations between asthma and emissions from newly painted indoor surfaces were studied. The participants (n = 562) answered a self-administered questionnaire, with questions on symptoms and indoor exposures, including indoor painting, during the last 12 months. The participants also underwent a structured interview, spirometry, peak flow measurements at home (PEF), methacholine provocation test for bronchial hyper-responsiveness (BHR), and skin prick tests. In addition, serum concentration of eosinophilic cationic protein (S-ECP), blood eosinophil count (B-EOS), and total immunoglobulin E (S-IgE) were measured. Current asthma was defined as a combination of BHR and at least one asthma-related symptom (wheezing and attacks of breathlessness). The information gathered on indoor painting was compared with exposure measurements of formaldehyde and volatile organic compounds (VOC) performed in a selected sample of the dwellings (n = 62). Relations between exposures, asthma and clinical signs were calculated by multiple linear or logistic regression, adjusting for possible influence of age, gender and tobacco smoking. The prevalence of asthma was increased among subjects with domestic exposure to newly painted surfaces (OR = 1.5; 95% CI 1.0-2.4), particularly newly painted wood details (OR = 2.3; 95% CI 1.2-4.5) and kitchen painting (OR = 2.2; 95% CI 1.1-4.5). Moreover, blood eosinophil concentrations were significantly elevated among subjects living in newly painted dwellings. A significantly increased prevalence of symptoms related to asthma, but not BHR, was observed in relation to workplace exposure to newly painted surfaces. The indoor concentration of aliphatic compounds (C8-C11), butanols, and 2,2,4-trimethyl 1,3-pentanediol diisobutyrate (TXIB) was significantly elevated in newly painted dwellings. The total indoor VOC was about 100 micrograms/m3 higher in dwellings painted in the last year. A significant increase in formaldehyde concentration was observed in dwellings with newly painted wood details. Our results indicate that exposure to chemical emissions from indoor paint is related to asthma, and that some VOCs may cause inflammatory reactions in the airways. To improve asthma management, and to counteract the increasing frequency of asthma, the significance of the indoor environment should not be neglected. Our study suggests that the contribution of emissions from paint to indoor concentrations of formaldehyde and VOCs should be as low as possible.

Adult↗
PubMed1997

Seasonal variation in serum eosinophilic cationic protein (S-ECP) in a general population sample.

The aim of this investigation was to study the seasonal variation in the serum levels of eosinophil cationic protein (S-ECP). The study population comprised a general population sample of 379 individuals (range: 20-45 years) who were investigated with blood sample for the measurement of S-ECP, skin prick test and methacholine challenge. The examination took place between May and October 1991. Of the 379 subjects investigated, 137 (36%) were atopic. A significant seasonal variation in S-ECP was found in the group of birch-pollen-positive subjects (P < 0.05), but not in the non-atopic or birch-negative atopic group. The mean level of S-ECP in birch-positive subjects was about twice as high in June as in birch atopic subjects examined during other months. It is concluded that seasonal variation in birch-pollen-positive subjects must be taken into account when using S-ECP clinically or in epidemiological research.

Adult↗
PubMed1997

Sleep disturbances in a young adult population: can gender differences be explained by differences in psychological status?

To study the prevalence of reported sleep disturbances and the association between these complaints and psychological status, 529 randomly selected subjects aged 20-45 years were questioned about their sleep symptoms and psychological status by means of questionnaires. In this young population, feeling refreshed in the morning almost every day was reported by only 15.3%. Females reported a significantly longer mean total sleep time (TST) than males (F: 425 +/- 58 minutes, M: 403 +/- 50 minutes; p < 0.01). Despite this, the difference compared with the reported need of sleep was greater in females (56 +/- 62 minutes) than in males (40 +/- 51 minutes) (p < 0.05). Difficulties maintaining sleep (DMS, > or = 3/week) (F: 20.1%, M: 10.4%; p < 0.01), the absence of feeling refreshed in the morning (F: 36.2%, M: 26.8%; p < 0.05), and excessive daytime sleepiness (EDS) (F: 23.3%, M: 15.9%; p < 0.05) were significantly more common among females. According to the Hospital Anxiety and Depression scale, females suffered from anxiety more frequently than males (F: 32.8%, M: 18.9%; p < 0.001). An association was found between anxiety and many sleep disturbances. After making adjustments for age, smoking, snoring, gender and psychological status by means of multiple regression, the gender differences mentioned above remained significant. We conclude that despite a longer TST, females report insufficient sleep, EDS, DMS, and the absence of feeling refreshed in the morning more frequently than males. The higher prevalence of anxiety among females alone cannot explain the gender differences in sleep disturbances seen in this population.

Adult↗