Overnight Changes in Lung Function of Obese Patients with Obstructive Sleep Apnoea.

PURPOSE: Obstructive sleep apnoea (OSA) is a prevalent disorder, characterised by collapse of the upper airways during sleep. The impact of sleep-disordered breathing on pulmonary function indices is however currently not well described. The aim of the study was to evaluate diurnal change in lung function indices in a cohort of patients with OSA and relate pulmonary function changes to disease severity. METHODS: 42 patients with OSA and 73 healthy control subjects participated in the study. Asthma and COPD were excluded in all volunteers following a clinical and spirometric assessment. Spirometry was then performed in all subjects in the evening and the morning following a polysomnography study. RESULTS: There was no difference in evening or morning FEV1 or FVC between patients and control subjects (p > 0.05). Neither FEV1 nor FVC changed in control subjects overnight (p > 0.05). In contrast, FEV1 significantly increased from evening (2.18/1.54-4.46/L) to morning measurement (2.26/1.42-4.63/L) in OSA without any change in FVC. The FEV1 increase in OSA was related to male gender, obesity and the lack of treatment with statins or ß-blockers (all p < 0.05). A tendency for a direct correlation was apparent between overnight FEV1 change and RDI (p = 0.05, r = 0.30). CONCLUSIONS: Diurnal variations in spirometric indices occur in patients with OSA and FEV1 appears to increase in subjects with OSA overnight. These changes occur in the absence of change in FVC and are directly related to the severity of OSA. These findings dictate a need to consider time of lung function measurement.

Maternal bonding styles in smokers and non-smokers: a comparative study.

BACKGROUND: Parental bonding has been implicated in smoking behavior, and the quality of maternal bonding (MB) has been associated with poor mental health and substance use. However, little is known about the association of MB and the smoking of the offspring. METHODS: In our study, 129 smokers and 610 non-smoker medical students completed the parental bonding instrument, which measures MB along two dimensions: care and overprotection. Four categories can be created by high and low scores on care and overprotection: optimal parenting (OP; high care/low overprotection); affectionless control (ALC; low care/high overprotection); affectionate constraint (AC; high care/high overprotection), and neglectful parenting (NP; low care/low overprotection). Nicotine dependence was assessed by the Fagerstrom Nicotine Dependence Test, exhaled CO level, and daily cigarette consumption (CPD). RESULTS: Higher CPD was significantly associated with lower overprotection (p = 0.016) and higher care (p = 0.023) scores. The odds for being a smoker were significantly higher in the neglectful maternal bonding style compared to the other rearing styles (p = 0.022). Besides, smokers showed significantly higher care and lower overprotection scores with the Mann-Whitney U-test than non-smokers, although these associations did not remain significant in multiple regression models. CONCLUSION: Our results indicate that focusing on early life relationship between patient and mother can be important in psychotherapeutic interventions for smoking. Registration trials retrospectively registered.

Exhaled breath temperature in patients with stable and exacerbated COPD.

The measurement of the peak exhaled breath temperature (EBT) during multiple tidal breaths offers an easy, non-invasive tool for monitoring airway inflammation. Chronic obstructive pulmonary disease (COPD) is linked to airway inflammation, which is further aggravated by exacerbations of the disease. However, the peak EBT has not been studied in patients with COPD. The breath temperature was measured (X-halo, Delmedica Investments) in 19 control non-smoking subjects (age: 28 ± 11 years, mean ± standard deviation), 19 control smoking/ex-smoking subjects (53 ± 9 years), 20 patients with stable COPD (66 ± 8 years), and 17 patients with COPD at onset and also after recovery from an acute exacerbation (AECOPD; 65 ± 10 years). Spontaneous sputa were collected in AECOPD. The intra-class correlation coefficient of the repeated EBT measurements in non-smokers was 0.87 (95% confidence interval: 0.70-0.95). The peak EBT was different between the subject groups (Kruskal-Wallis test, p = 0.02), with lower values in the patients with stable COPD (34.00/33.35-34.34/°C; median /interquartile range/) than in the smoking/ex-smoking control subjects (34.51/34.20-34.68/°C, p < 0.05). The EBT was higher at the onset of AECOPD (34.58/34.12-34.99/°C, p < 0.05) compared to in a stable condition, and positively correlated with the sputum leukocyte count (p = 0.049, r2 = 0.30; Spearman test) and neutrophil percentage (p = 0.03, r(2) = 0.36). The breath temperature decreased after recovery from AECOPD (34.10/33.72-34.43/°C, p = 0.008; Wilcoxon test). The peak exhaled breath temperature, recorded during multiple tidal breaths, increases with an acute exacerbation of COPD, and may be related to accelerated airway inflammation. The application of exhaled breath temperature measurements when monitoring the activity of COPD should be further assessed in longitudinal studies.