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Biomedical subjects

P O Haraldsson

Publications and source records attributed to P O Haraldsson.

At least 19 recordsLinked to original sources
PubMed2002

Uvulopalatopharyngoplasty versus laser uvulopalatoplasty: prospective long-term follow-up of self-reported symptoms.

No study to date has prospectively compared the results of uvulopalatopharyngoplasty (UPPP) and CO2 laser palatal surgery. This study investigates and compares outcomes in 121 consecutive patients suffering from rhonchopathy, the majority of whom reported apneas. Sixty-one patients underwent UPPP and 60 laser uvulopalatoplasty (LUPP). Patients were requested to assess the frequency of symptoms associated with obstructive sleep apnea syndrome prior to surgery, at 3-month follow-up and 5-8 years postoperatively. All symptoms were significantly improved for the two patient groups, both short and long term (p < 0.01) although short-term results were generally better. However, UPPP was superior to LUPP in terms of all clinical effect parameters. Although patients treated with UPPP had more severe symptoms preoperatively they also had a better long-term outcome. Side-effects such as minor swallowing disturbances were frequent, using either surgical modality, but few patients were bothered if surgery was successful.

Body Mass Index↗
PubMed2001

[International consensus meeting on fatigue and the risk of traffic accidents. The significance of fatigue for transportation safety is underestimated].

Recently there has been a sizeable increase in research on fatigue and accidents in transportation. Therefore a meeting was convened last year to discuss prevalence, mechanisms and countermeasures, with the intention to produce an international consensus document. It was concluded that official statistics strongly underestimate prevalence, and that a reasonable estimate, based on research, lies between 10 and 20% for accidents on the road, in the air and at sea. The main causes are disturbed sleep and work at the circadian low, caused by night work, morning work, sleep/wake disorders (including sleep apnea) or social obstacles to sleep. Suggested countermeasures include information/education of the public and of transportation companies, as well as enforcement of existing work hour regulation. Additional countermeasures include strategic use of napping and caffeine, as well as implementation of rumble strips and--possibly--electronic devices for drowsiness detection.

Accidents, Occupational↗
PubMed2001

[Drowsiness--greater traffic hazard than alcohol. Causes, risks and treatment].

Stress and shortage of sleep may cause daytime somnolence and impaired vigilance at the wheel, especially among those suffering from sleep disturbances. According to the international consensus meeting in Stockholm in May of 2000 on "The sleepy driver and pilot--causes, risks and countermeasures", drowsy driving is an underestimated risk factor in official statistics, and as many as 15-30 percent of today's traffic accidents are related to drowsiness; thus it is an even greater risk factor than alcohol. Drowsy drivers suffer from inattention, impaired concentration and may even fall asleep at the wheel. Accidents during dozing result in three times as many fatalities as other accidents. There are a number of reasons for habitual drowsiness at the wheel aside from sleep deprivation, including rhonchopathy, shift work and jet lag, mental depression, insomnia, narcolepsy, endocrinological diseases, periodic limb movement disorder, medication, pain-disordered sleep, and heart disease. Among the most active drivers, i.e. middle aged men, obstructive sleep apnea syndrome (OSAS) has been found to be the most common reason for habitually drowsy driving. OSAS causes a 2-3 fold increased risk of traffic accidents, and it impairs simulated driving. Palatoplasty as well as nasal CPAP have been shown to improve vigilance and driving performance to an extent that the increase in risk is eliminated. Drivers suffering from habitual drowsiness and micro-sleep attacks forcing them to take repeated rests are at special risk. Even if they are as dangerous as drivers with unlawful blood alcohol levels they cannot be caught in a police checkpoint. However they often seek medial advice, and properly treated they may often return safely to traffic. If not, there could be a need to report them to the authorities so as to limit or prohibit their driving.

Accidents, Traffic↗
PubMed2001

A randomized controlled study evaluating medical treatment versus surgical treatment in addition to medical treatment of nasal polyposis.

BACKGROUND: Controlled prospective studies are needed to determine whether surgical treatment in fact has an effect additive to that of medical treatment of nasal polyposis. OBJECTIVE: We sought to compare the effect of medical treatment versus combined surgical and medical treatment on olfaction, polyp score, and symptoms in nasal polyposis. METHODS: Thirty-two patients with nasal polyposis and symmetrical nasal airways were randomized to unilateral endoscopic sinus surgery after pretreatment with oral prednisolone for 10 days and local nasal budesonide bilaterally for 1 month. Postoperatively, patients were given local nasal steroids (budesonide). Patients were evaluated with nasal endoscopy, symptom scores, and olfactory thresholds. They were followed for 12 months. RESULTS: The sense of smell was improved by the combination of local and oral steroids. Surgery had no additional effect. Symptom scores improved significantly with medical treatment alone, but surgery had additional beneficial effects on nasal obstruction and secretion. After surgery, the polyp score decreased significantly on the operated side but remained the same on the unoperated side. Twenty-five percent of the patients were willing to undergo an operation also on the unoperated side at the end of the study. CONCLUSIONS: Medical treatment seems to be sufficient to treat most symptoms of nasal polyposis. When hyposmia is the primary symptom, no additional benefit seems to be gained from surgical treatment. If nasal obstruction is the main problem after steroid treatment, surgical treatment is indicated. Selection of those who will benefit from surgery should be based on the patient's symptoms and not on the examiner's polyp score.

Budesonide↗
PubMed2000

Long-term survival after uvulopalatopharyngoplasty in nonobese heavy snorers: a 5- to 9-year follow-up of 400 consecutive patients.

BACKGROUND: Heavy snoring and the obstructive sleep apnea syndrome are associated with increased morbidity and mortality in patients with cardiovascular disease. The effect of uvulopalatopharyngoplasty on mortality has been questioned. OBJECTIVE: To investigate long-term survival after palatal surgery. DESIGN: An observational retrospective case-control study with a 5- to 9-year follow-up. SETTING: A university medical center. PATIENTS: Four hundred consecutive heavy snorers (median age, 47 years), 256 of whom had obstructive sleep apnea syndrome. The mean +/- SD body mass index (calculated as weight in kilograms divided by the square of height in meters) of all included patients was 27.1+/-4.2. Comparison was made with 744 control patients (median age, 43 years) who underwent nasal surgery during the same period and a matched general control population. INTERVENTION: Uvulopalatopharyngoplasty or laser uvulopalatoplasty between 1986 and 1990. MAIN OUTCOME MEASURES: Mortality and causes of death up to 9 years after surgery. RESULTS: High blood pressure at the time of surgery and subsequent death due to cardiovascular disease were 3 times more frequent in the patients with obstructive sleep apnea syndrome than in both control groups (P<.01), but the overall long-term mortality was not increased either in snorers or in persons with sleep apnea. The cumulative survival rate was more than 96% for the 400 patients, the 744 controls, and the matched general population. CONCLUSIONS: No increased mortality was seen following palatal surgery in this long-term follow-up of 400 consecutive, on average, nonobese snorers, 256 of whom had obstructive sleep apnea syndrome. This might indicate a positive survival effect of surgery.

Adult↗
PubMed1995

Long-term effect of uvulopalatopharyngoplasty on driving performance.

OBJECTIVE: It has been questioned whether the effect of uvulopalatopharyngoplasty lasts as years go by. From a previous study it is known that patients with severe rhonchopathy, complaining of sleepiness at the wheel, improve their vigilance and driving performance immediately following uvulopalatopharyngoplasty, but is this effect persisting? DESIGN: In a cohort study, the long-term effect of surgical treatment on driving vigilance was evaluated on 13 middle-aged (median, 52 years) male patients and five matched controls. Three to 4 years postoperatively, they were subjected to a boring 90-minute-long retest in an advanced driving simulator and daytime polysomnography, identical to those performed preoperatively. Factors measured were brake reaction time, lateral position deviation, and off-road incidents. The patients were also asked to assess their driving skills on a self-report and their vigilance on a visual analogue scale. RESULTS: All but one patient reported themselves as being more vigilant and safe drivers following surgery. Objective results showed that the initial improvement in brake reaction time, lateral position deviation, and number of off-road incidents was sustained, but not always in concordance with the apnea index. CONCLUSION: The positive effect of uvulopalatopharyngoplasty on vigilance and driving performance remains after 4 years. This may have a substantial impact on traffic safety.

Accidents, Traffic↗
PubMed1995

Does uvulopalatopharyngoplasty inhibit automobile accidents?

Patients with rhonchopathy, which includes obstructive sleep apnea syndrome (OSAS), who report sleepy spells at the wheel do poorly on simulated monotonous driving tests and have a twofold to threefold increase in traffic accidents. To assess whether drivers with rhonchopathy (heavy snoring, sleep disturbances, and daytime sleepiness) cause fewer automobile accidents after uvulopalatopharyngoplasty (UPPP), the car accident rate for the first 5 years after surgery was compared to the rate of the 5 years immediately before the operation. Data were collected by means of a self-report questionnaire. Fifty-six patients with rhonchopathy were compared to 142 controls without rhonchopathy who had been subjected to nasal surgery. The response rates were 96% and 94%, respectively. The reported habitual sleepiness while driving had disappeared in 87% (P < .001) of drivers who had the problem preoperatively. The accident risk reduction (corrected for mileage) in patients was almost four times greater than the reduction in controls (P < .001) after surgery. The relative rate of patients involved in any single-car accident fell by 77% (P < .05), and the relative rate of single-car accidents fell by 83% (P < .001). It is concluded that drivers with rhonchopathy have an increased risk for car accidents, especially single-car accidents, but that this risk returns to normal after UPPP.

Accidents, Traffic↗
PubMed1992

Sleep apnea syndrome symptoms and automobile driving in a general population.

Automobile accidents are reported as being overrepresented in those suffering from the obstructive sleep apnea syndrome (SAS), evident by snoring, sleep disturbances and diurnal hypersomnia. An estimation of the prevalence of these symptoms amongst an adult population, predominantly automobile drivers, was assessed by using a one-stage questionnaire procedure. From a national random sample of 1214 persons a weighted reply rate of 76% was achieved. Snoring, breath cessations, mid-sleep awakenings, and diurnal hypersomnia were reported in 24, 3.8, 27 and 9.1%, respectively. The maximum prevalence of SAS was estimated as 2.8-5.5% among men, aged 30-69 years, depending on definition used. Driving frequency in potential sleep apneics was similar to that of the entire population studied. Diurnal hypersomnia, considered a consequence of SAS, was reported as an overall 2.2%, corresponding to 100,000 automobile drivers in Sweden.

Adult↗
PubMed1992

Preliminary report: validity of symptom analysis and daytime polysomnography in diagnosis of sleep apnea.

The aim of this study was twofold: first, to see if the prevalence of the sleep apnea syndrome (SAS) in a given population could be fairly estimated by our patient questionnaire, mainly based upon the 1979 American Sleep Association definition of SAS; and second, to investigate whether the severity of SAS could be similarly accurately measured by daytime polysomnography (DPSG), as an alternative to the more demanding all-night polysomnography (NPSG). Of 42 patients consecutively examined due to rhonchopathy, 18 had the clinical diagnosis of SAS, which was based on the three symptoms--snoring, sleep disturbances and diurnal hypersomnia--if reported to occur habitually. In 11 patients the diagnosis was established by NPSG [apnea index (AI) greater than 10]. However, in only 10 of the 18 cases NPSG indicated the diagnosis giving a positive predictive value of 56%. When comparing DPSG versus NPSG in 36 patients, the AI ranged from -23 to +65, and the mean AI value was found to be twice as high in the former (mean difference 9.0 +/- 18.4; p less than 0.01). The positive predictive value of DPSG was 63% (10/16). Both the self-report and DPSG were burdened with some 25% false-positive results, and DPSG gave far too variable AI values to be reliable in staging the disease. On the other hand, the negative predictive values were high, 96% (23/24) and 100% (20/20), respectively, indicating their usefulness for screening purposes.

Adult↗
PubMed1991

Simulated long-term driving performance before and after uvulopalatopharyngoplasty.

To investigate whether automobile drivers with the clinical features of sleep apnea syndrome (SAS) perform worse than controls in a simulated long-term test drive, and to see if their driving improves after uvulopalatopharyngoplasty (UPPP), 15 male drivers with SAS, suffering from sleep spells whilst driving, and 10 matched controls without a history of SAS or hypersomnia at the wheel were tested in an advanced driving simulator. Brake reaction time, lateral position deviation and off-road episodes were measured during a 90-min rural drive at twilight conditions. The clinical evaluation was made by a questionnaire scoring symptoms of snoring, sleep disturbances and diurnal sleepiness before and after surgery. Before UPPP the patient group showed impaired performance in all three effect measures compared to controls. UPPP resulted in improved reaction time performance (average mean improvement: 0.5 s, average 90th percentile improvement 0.8 s). Furthermore, 12 of the 15 patients reported a marked improvement regarding sleepiness whilst driving. For these clinically successful cases the number of off-road episodes decreased substantially. We conclude that most patients improve their long-term driving performance as a result of UPPP.

Accidents, Traffic↗
PubMed1990

Clinical symptoms of sleep apnea syndrome and automobile accidents.

Patients with clinical features of sleep apnea syndrome (SAS) and self-reported sleep spells at the wheel do poorly in simulated monotonous driving. To evaluate whether drivers with defined symptoms of SAS (heavy snoring, sleep disturbances and daytime sleepiness) compensate in real traffic by careful driving or not, the rate of car accidents over a 5-year period was investigated. A questionnaire was addressed to 140 patients with and 142 controls without symptoms associated to SAS. Seventy-three of the patients had a complete triad of SAS-associated symptoms. Fifty-two percent of these patients reported habitual sleep spells at the wheel, as opposed to less than one percent by the controls. The ratio of drivers being involved in one or more combined-car accident was similar for patients and control drivers, but for single-car accidents the ratio was about 7 times higher for patients with a complete triad of symptoms of SAS compared to controls (p less than 0.001). When corrected for mileage driven, the total number of single-car accidents was almost 12 times higher among patients with sleep spells whilst driving, compared to controls (p less than 0.001). It is concluded that drivers with the clinical features of SAS are at increased risk especially for single-car accidents and that the risk seems to vary with the severity of symptoms.

Accidents, Traffic↗
PubMed1987

Long-term results after septal surgery--submucous resection versus septoplasty.

Postoperative controls, 5-9 years after surgery, were made in two groups of patients who had undergone submucous septal resection and septoplasty, respectively. The rate of subjective improvement after septoplasty was higher (77%) than after septal resection (66%). In the septoplasty group, however, the experienced surgeons had an improvement rate of 90%, whereas the untrained surgeons had no better results than after submucous septal resection. Postoperative complications, including septal perforation and deformation of the external nose, were significantly fewer after septoplasty. There were no clear-cut correlations between rhinoscopy findings and subjective results at postoperative examinations. The septoplasty technique is advocated, but in the hands of a trained surgeon.

Adolescent↗