Læknablaðið : fylgirit - 03.01.2017, Blaðsíða 36

36 LÆKNAblaðið/Fylgirit 91 2017/103
fræðileg líkön. Það skortir upp á samvinnu og samtal starfshópa og því
einnig skilning og traust meðal starfsmanna.
Ályktanir: Samvinna ólíkra starfshópa er virkt ferli sem krefst undir-
búnings, skipulags og eftirfylgni. Skilningur á hlutverkum innan teymis,
virðing og traust er grundvallarforsenda árangursríkrar samvinnu.
Starfsfólki verður að vera ljós ávinningur samvinnu innan teymis. Það
krefst stöðugs upplýsingaflæðis og styrkrar leiðsagnar stjórnenda. Þetta
eru veigamikil atriði sem bæta þarf til að samþætting náist að fullu.
E 95 Ófullnægjandi notkun læknisþjónustu eftir fjölskyldutekjum
Rúnar Vilhjálmsson
Hjúkrunarfræðideild, Háskóli Íslands
runarv@hi.is
Inngangur: Gott aðgengi að heilbrigðisþjónustu er grundvallarmark-
mið í vestrænum heilbrigðiskerfum. Samt sem áður sýna innlendar og
erlendar rannsóknir að verulegur munur er á aðgengi að heilbrigðis-
þjónustu eftir tekjum. Í þessari rannsókn er lagt mat á fjórar skýringar
á ófullnægjandi notkun heilbrigðisþjónustu eftir tekjum. Skýringarnar
tengjast fjárhagserfiðleikum, útgjaldabyrði vegna heilbrigðisþjónustu,
kerfisþröskuldi í heilbrigðisþjónustunni og fátæktarmenningu.
Efniviður og aðferðir: Rannsóknin byggir á tveimur landskönnunum
meðal þjóðskrárúrtaks 18-75 ára Íslendinga (Heilbrigði og aðstæður
Íslendinga I og II). Þátttakendur svöruðu báðum könnunum með árs
millibili og voru könnunargögnin samtengd (panel snið). Unnið var úr
gögnum með marghliða (multivariate) greiningaraðferðum.
Niðurstöður: Rannsóknin leiddi í ljós að fjárhagserfiðleikar, útgjaldabyrði
vegna heilbrigðisþjónustu, óánægja með fyrri læknisheimsóknir, og
upplifuð óvissa, skýrðu að fullu þann mun sem fram kom á aðgengi að
læknisþjónustu eftir fjölskyldutekjum. Allar fjórar skýringar sem settar
hafa verið fram á ófullnægjandi heilbrigðisþjónustu lágtekjufólks fengu
nokkurn stuðning í rannsókninni.
Ályktanir: Vinna þarf markvisst að því að draga úr muni á aðgengi
einstaklinga að læknisþjónustu eftir tekjum, í samræmi við markmið fé-
lagslegra heilbrigðiskerfa um sem jafnast aðgengi að heilbrigðisþjónustu.
Í því sambandi þyrfti meðal annars að huga að aðgerðum til tekjujöfnunar
og lækkunar kostnaðar sjúklinga vegna heilbrigðisþjónustu, og ráðstöf-
unum sem miða að jákvæðri reynslu sjúklinga af heilbrigðisþjónustunni.
E 96 Sleepiness is more related to snoring than obstructive sleep
apnea in the general population
Erna S. Arnardóttir1, Erla Björnsdóttir2, Össur I. Emilsson3, Bryndís Benediktsdóttir3,
Þórarinn Gíslason2
1Sleep Research Unit, Faculty of Medicine, University of Iceland, 2Department of Resp
Medicine and Sleep, Landspitali, 3Faculty of Medicine, University of Iceland
ernasif@landspitali.is
Objectives: To compare the role of habitual snoring vs. obstructive sleep
apnea (OSA) on subjective sleepiness and other sleep symptoms in a
general population cohort.
Methods: A general population sample of 40-65 year old Icelanders was
invited to participate in a study protocol that included a type 3 sleep study
and a questionnaire. Habitual snoring was defined as reported snoring ≥3
nights a week and excessive sleepiness as ≥10 on the Epworth Sleepiness
Scale (ESS).
Results: Among 400 participants, not previously diagnosed with OSA,
59.0% had no OSA (apnea-hypopnea index [AHI]<5), 25.0% had mild
OSA (AHI 5-14.9) and 16% had moderate-to-severe OSA (AHI ≥15) (previ-
ously reported in Arnardottir et al 2016 ERJ). Overall, 42% of the subjects
were defined as habitual snorers. They had higher ESS scores on average
than nonsnorers (7.7±4.0 vs. 6.4±4.0, p=0.003) and were more likely to
have excessive sleepiness (31.6% vs. 20.6%, p=0.02). Habitual snorers were
also more likely to report waking up with a dry mouth (24.1% vs. 14.9%,
p=0.03) and nocturnal gastroesophageal reflux compared to nonsnorers
(10.0% vs. 3.8%, p=0.02). These differences were not found in relation to
OSA categories as previously reported. Regression analyses adjusting for
age, gender and BMI confirmed the findings.
Conclusion: Subjective sleepiness in the general population is associated
with reported habitual snoring but not to objectively measured OSA
severity. Habitual snorers are also more likely to have symptoms related
to respiratory effort such as a dry mouth and nocturnal reflux, differences
not found based on the AHI.
E 97 The prevalence of insomnia, excessive daytime sleepiness and
snoring across two generations
Bryndís Benediktsdóttir1, Erla Björnsdóttir2, Erna Sif Arnardóttir1, Þórarinn
Gíslason1
1Medical Faculty, University of Iceland, 2Department of Respiratory Medicine and Sleep,
Landspitali- University Hospital,
brynben@hi.is
Objectives: To compare the prevalence of insomnia, excessive daytime
sleepiness (EDS) and snoring across two generations.
Methods: A general population sample aged 40-70 years (n= 6534, females
54.4%) from the Nordic countries and Estonia and their offsprings
aged 18-50 years. (n=7582, females 57.9%) answered The Nordic Sleep
questionnaire on insomnia, EDS and snoring. Insomnia was defined as
reporting difficulty initiating sleep (DIS), difficulty maintaining sleep
(DMS) or early morning awakening (EMA) ≥3 nights week. Snoring was
defined as reported snoring ≥3 nights/week and EDS as feeling drowsy/
sleepy during daytime ≥3 days/week.
Results: Insomnia and EDS were more frequent among females than
males (p< 0.001) in both generation, but snoring more frequent among
males in both generations (p< 0.001). Among the parents, 41.3% reported
insomnia vs. 32.5% of offsprings. The most frequently reported symptom
of insomnia in both generations was DMS (parents 33.8% vs. offsprings
22.1%). EDS was reported by 20.2% of parents and 34.9% of offsprings.
Habitual snoring was reported by 26.3% of parents and by 11.2% of
offsprings. Offsprings of parents with insomnia, EDS and snoring sign-
ificantly more often reported these symptoms compared to offsprings of
parents without these symptoms ( p< 0.001). The overrepresentation of
EDS and snoring across generations was not explained by BMI.
Conclusion: A large multinational study on two generations shows an
overrepresentation of insomnia, EDS and snoring among offsprings of
parents with these symptoms compared to offsprings of parents without
them.
E 98 Obstructive sleep apnea and cancer: a nationwide
epidemiological survey
Þórarinn Gíslason1, Elías F. Guðmundsson2, Laufey Tryggvadóttir3
1Landspitali University Hospital, Respiratory Medicine and Sleep, 2Pulmonary deptm,
Landspitali, 3University of Iceland, Icelandic Cancer Society
thorarig@landspitali.is
X V I I I V Í S I N D A R Á Ð S T E F N A H Í
F Y L G I R I T 9 1