Sleep apnoea phenotypes in women: A cluster analysis from the ESADA cohort.

INTRODUCTION: and Objectives: The clinical presentation of Obstructive Sleep Apnoea (OSA) differs between genders. This study aimed to identify the specific OSA phenotypes of women in the European Sleep Apnoea Database (ESADA) cohort. MATERIALS AND METHODS: Latent class cluster analysis was applied to data from 9710 female OSA patients. Variables used included age, Body Mass Index (BMI), Epworth Sleepiness Scale (ESS), comorbidities (cardiovascular, pulmonary, psychiatric, metabolic, other) and the Apnoea Hypopnea Index (AHI). RESULTS: Four different clusters were found: Cluster 1"Women with ischemic heart disease" (38.3 %):middle aged (59 years [53-65]),overweight to obese (BMI 30.1 kg/m2 [26.9-33.5]), AHI 22.9 events/h[17.4-30], ESS 9 [5,12] with the highest prevalence of ischemic heart disease (56 %). Cluster 2"Elderly women with comorbidities" (23 %): oldest (66 years[60-71]), obese (BMI 36 kg/m2 [31.6-40.4]),AHI 46 events/h [30-60.1]),ESS 9 [6-13] with the highest prevalence of comorbidities. Cluster 3"Sleepy obese women" (16.2 %): the youngest (49 years [42-55]), sleepiest (ESS 12 [8-16]), most obese(BMI 43 kg/m2[37.6-48.9]) females with severe OSA (AHI 53.3 events/h [32-80.5]). Cluster 4 "Women with mild OSA and low comorbidities" (22.5 %): middle aged (53.5 years [46-60]) with BMI 29 kg/m2[25-34.1],ESS9 [5,13]),AHI 8.6events/h[6.9-10.4])and low prevalence of comorbidities. The distribution of the clusters differed across Europe. PAP administration was higher in Clusters 2 and 3 but low in Cluster 4. CONCLUSION: Four distinct female phenotypes were identified with different clinical presentation and comorbidities. Sex-based phenotyping may provide improved risk stratification and personalized treatment.

Burden of hospital-acquired SARS-CoV-2 infections in Germany: occurrence and outcomes of different variants.

BACKGROUND: Avoiding in-hospital transmissions has been crucial in the COVID-19 pandemic. Little is known on the extent to which hospital-acquired SARS-CoV-2 variants have caused infections in Germany. AIM: To analyse the occurrence and the outcomes of HAI with regard to different SARS-CoV-2 variants. METHODS: Patients with SARS-CoV-2 infections hospitalized between March 1st, 2020 and May 17th, 2022 in 79 hospitals of the Helios Group were included. Information on patients' characteristics and outcomes were retrieved from claims data. In accordance with the Robert Koch Institute, infections were classified as hospital-acquired when tested positive >6 days after admission and if no information hinted at a different source. FINDINGS: In all, 62,875 SARS-CoV-2 patients were analysed, of whom 10.6% had HAI. HAIs represented 14.7% of SARS-CoV-2 inpatients during the Wildtype period, 3.5% during Alpha (odds ratio: 0.21; 95% confidence interval: 0.19-0.24), 8.8% during Delta (2.70; 2.35-3.09) and 10.1% during Omicron (1.10; 1.03-1.19). When age and comorbidities were accounted for, HAI had lower odds for death than community-acquired infections (0.802; 0.740-0.866). Compared to the Wildtype period, HAIs during Omicron were associated with lower odds for ICU (0.78; 0.69-0.88), ventilation (0.47; 0.39-0.56), and death (0.33; 0.28-0.40). CONCLUSION: Hospital-acquired SARS-CoV-2 infections occurred throughout the pandemic, affecting highly vulnerable patients. Although transmissibility increased with newer variants, the proportion of HAIs decreased, indicating improved infection prevention and/or the effect of immunization. Furthermore, the Omicron period was associated with improved outcomes. However, the burden of hospital-acquired SARS-CoV-2 infections remains high.

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke.

BACKGROUND: Sleep disorders are highly prevalent in the general population and may be linked in a bidirectional fashion to stroke, which is one of the leading causes of morbidity and mortality. AIM: Four major scientific societies established a task force of experts in neurology, stroke, respiratory medicine, sleep medicine and methodology to critically evaluate the evidence regarding potential links and the impact of therapy. MATERIALS AND METHODS: Thirteen research questions were evaluated in a systematic literature search using a stepwise hierarchical approach: first, systematic reviews and meta-analyses; second, primary studies post-dating the systematic reviews/meta-analyses. A total of 445 studies were evaluated and 88 were included. Statements were generated regarding current evidence and clinical practice. RESULTS: Severe obstructive sleep apnoea (OSA) doubles the risk for incident stroke, especially in young to middle-aged patients. Continuous positive airway pressure (CPAP) may reduce stroke risk, especially in treatment-compliant patients. The prevalence of OSA is high in stroke patients and can be assessed by polygraphy. Severe OSA is a risk factor for recurrence of stroke and may be associated with stroke mortality, whilst CPAP may improve stroke outcome. It is not clear if insomnia increases stroke risk, whilst the pharmacotherapy of insomnia may increase it. Periodic limb movements in sleep (PLMS), but not restless limb syndrome (RLS), may be associated with an increased risk of stroke. Preliminary data suggest a high frequency of post-stroke insomnia and RLS and their association with a less favourable stroke outcome, whilst treatment data are scarce. DISCUSSION/CONCLUSION: Overall, the evidence base is best for OSA relationship with stroke and supports active diagnosis and therapy. Research gaps remain especially regarding insomnia and RLS/PLMS relationships with stroke.

Italian Association of Sleep Medicine (AIMS) position statement and guideline on the treatment of menopausal sleep disorders.

Insomnia, vasomotor symptoms (VMS) and depression often co-occur after the menopause, with consequent health problems and reductions in quality of life. The aim of this position statement is to provide evidence-based advice on the management of postmenopausal sleep disorders derived from a systematic review of the literature. The latter yielded results on VMS, insomnia, circadian rhythm disorders, obstructive sleep apnea (OSA) and restless leg syndrome (RLS). Overall, the studies show that menopausal hormone therapy (MHT) improves VMS, insomnia, and mood. Several antidepressants can improve insomnia, either on their own or in association with MHT; these include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and mirtazapine. Long-term benefits for postmenopausal insomnia may also be achieved with non-drug strategies such as cognitive behavioral therapy (CBT) and aerobic exercise. Continuous positive airway pressure (CPAP) and mandibular advancement devices (MADs) both reduce blood pressure and cortisol levels in postmenopausal women suffering from OSA. However, the data regarding MHT on postmenopausal restless legs syndrome are conflicting.

Hyperlipidaemia prevalence and cholesterol control in obstructive sleep apnoea: Data from the European sleep apnea database (ESADA).

BACKGROUND AND OBJECTIVE: Obstructive sleep apnoea (OSA) and hyperlipidaemia are independent risk factors for cardiovascular disease. This study investigates the association between OSA and prevalence of hyperlipidaemia in patients of the European Sleep Apnea Database (ESADA) cohort. METHODS: The cross-sectional analysis included 11 892 patients (age 51.9 ± 12.5 years, 70% male, body mass index (BMI) 31.3 ± 6.6 kg/m2 , mean oxygen desaturation index (ODI) 23.7 ± 25.5 events/h) investigated for OSA. The independent odds ratio (OR) for hyperlipidaemia in relation to measures of OSA (ODI, apnoea-hypopnoea index, mean and lowest oxygen saturation) was determined by means of general linear model analysis with adjustment for important confounders such as age, BMI, comorbidities and study site. RESULTS: Hyperlipidaemia prevalence increased from 15.1% in subjects without OSA to 26.1% in those with severe OSA, P < 0.001. Corresponding numbers in patients with diabetes were 8.5% and 41.5%, P < 0.001. Compared with ODI quartile I, patients in ODI quartiles II-IV had an adjusted OR (95% CI) of 1.33 (1.15-1.55), 1.37 (1.17-1.61) and 1.33 (1.12-1.58) (P < 0.001), respectively, for hyperlipidaemia. Obesity was defined as a significant risk factor for hyperlipidaemia. Subgroups of OSA patients with cardio-metabolic comorbidities demonstrated higher prevalence of HL. In addition, differences in hyperlipidaemia prevalence were reported in European geographical regions with the highest prevalence in Central Europe. CONCLUSION: Obstructive sleep apnoea, in particular intermittent hypoxia, was independently associated with the prevalence of hyperlipidaemia diagnosis.

Biodegradation ability of two selected microbial autochthonous consortia from a chronically polluted marine coastal area (Priolo Gargallo, Italy).

The aims of this study were: (i) the characterization of the structure of the indigenous microbial community associated with the sediments under study; (ii) the isolation and characterization of microbial consortia able to degrade the aged hydrocarbons contaminating the sediments, and (iii) the assessment of related biodegradation capability of selected consortia. Samples of surface sediments were collected in Priolo Gargallo harbour (Sicily, Italy). The samples were analysed for physical, chemical (GC-FID analysis) and microbiological characteristics (qualitative (16S rDNA clone library) and quantitative (DAPI, CFU and MPN count) analysis). The sediment samples were used for the selection of two microbial consortia (indicated as PSO and PSM) with high biodegradation capacity for crude oil (∼95%) and PAHs (∼63%) respectively. Genetic analysis showed that Alcanivorax and Cycloclasticus were the dominant genera in both the PSO and PSM consortia. Oil-polluted environments naturally develop an elevated biorecovery potential. The presence of a highly specialized microbial flora (adapted to support the contamination) and their stimulation through favourable induced conditions provides a promising recovery strategy. The chance to identify and select indigenous bacteria and/or consortia with a high biodegradation capacity is fundamental for the development and optimization of bioaugmentation strategies especially for those concerning in situ applications.

[Perspectives for anesthesiologists in hospital hygiene]. / Perspektiven für Anästhesisten in der Krankenhaushygiene.

BACKGROUND: It is mandatory for hospitals in Germany to employ infection control physicians and have an external consultation. The recommended coverage has substantially increased in the last years. Typically, infection control physicians are specialists for hygiene and environmental medicine and/or for microbiology. As there is already a shortage of these specialists, a curricular educational program in infection control was developed by the German Medical Association in 2011. This program addresses specialists of different clinical disciplines. It covers a period of 24 months and includes 200 h of courses, divided into 6 modules. In addition, 7 weeks of internships must be absolved in hospital hygiene, in a microbiological laboratory and in the public health service. During the program, the trainee must be accompanied by a qualified supervisor, who is a specialist in hygiene. The aim of this article is to describe the current status of this program. METHODS: A total of 91 infection control physicians, organized in different networks, were invited by email to take part in a survey with the online tool Survey Monkey (San Mateo, USA). The questions in the survey aimed at the characteristics of the participants as well as the conditions of the program. Further information about the various general regulations and conditions of the course was gathered through internet research, and from telephone and email contact with the State Medical Associations. RESULTS: Approximately 250 physicians completed the program between 2011 and 2017. The graduates were mostly anesthesiologists (45%) and 81% had a leading position (consultant or higher) before beginning the program. Most of them also had further education in antibiotic stewardship and/or infectious diseases. The requirements regarding training hours, examination and certification varied between the State Medical Associations. The supervision, a mandatory part of the program, is also implemented differently from state to state. Of the participants 49% felt well-qualified for the challenges ahead after finishing this program. DISCUSSION: The program was able to increase the number of infection control physicians in a relatively short period of time; however, to guarantee a comparable quality of education it is necessary to standardize the requirements on a national level. The supervision also needs to be further specified. A new program is currently being developed by the German Medical Association, which will hopefully lead to an improvement of the educational program. Special strengths of the new infection control physicians are the broad clinical experience as well as the additional qualifications in antibiotic stewardship and/or infectious diseases. The weaknesses are the lack of practical experience and knowledge of technical hygiene. A mandatory inclusion of antibiotic stewardship and infectious diseases in the program would increase its impact. Anesthesiologists are well-suited for training as infection control physicians. For them, a new, exciting field of activity has opened up with the chance to be the head of their own department.

[Antibiotic stewardship in a basic care hospital : A retrospective observational study]. / Antibiotic stewardship an einem Krankenhaus der Grund- und Regelversorgung : Eine retrospektive Observationsstudie.

BACKGROUND: In response to the global increase in antibiotic resistance, the concept of antibiotic stewardship (ABS) has become increasingly important in recent years. Several publications have demonstrated the effectiveness of ABS, mainly in university facilities. This retrospective observational study describes the implementation of ABS in a basic care hospital. MATERIAL AND METHODS: Following existing national guidelines, an ABS team was set up and measures were launched. These included: hospital guidelines, teaching, weekly antibiotic ward rounds and the restriction of definite substances. The preinterventional/postinterventional data analysis compared the use of antibiotics and blood culture sets as well as the development of resistance, infection with Clostridium difficile (CDI), costs, mortality and length of hospital stay. RESULTS: The measures introduced led to a significant and continuous decline in total antibiotic use of initially 43 recommended daily doses (RDD)/100 patient days (PD) to 31 RDD/100 PD (p < 0.001). The largest decrease was observed in second generation (2G) cephalosporins (-67.5%), followed by 3G cephalosporins (-52.7%), carbapenems (-42.0%) and quinolones (-38.5%). The resistance rate of E. coli to 3G cephalosporins in blood cultures decreased from 26% to 9% (p = 0.021). The rate of blood cultures taken increased from 1.8 sets/100 PD to 3.2 sets/100 PD (+77%, p < 0.001). The pathogen detection rate, defined as one count when a minimum of one sample taken in a day is positive, also increased significantly from 4.0/1000 PD to 6.8/1000 PD (p < 0.001). The ABS had no effect on the overall mortality, the mean dwell time, and the preintervention low CDI incidence. CONCLUSION: The preinterventional/postinterventional comparison showed a significant reduction in the overall consumption of antibiotics with a redistribution in favor of antibiotics with a lower resistance selection. At the same time, the resistance rate of E. coli decreased. The increase of the blood culture rate indicates the optimization of diagnostic procedures. This ABS program had to be established with reduced resources but this seems to have been compensated by the more personal contact addressing the care takers and short chain of commands, as is possible in smaller hospitals. Presumably, the structure of basic care hospitals is particularly suitable for concepts covering entire hospitals. Further clusters of randomized studies are necessary to confirm this.

Carbocysteine counteracts the effects of cigarette smoke on cell growth and on the SIRT1/FoxO3 axis in bronchial epithelial cells.

BACKGROUND: Cigarette smoke may accelerate cellular senescence by increasing oxidative stress. Altered proliferation and altered expression of anti-aging factors, including SIRT1 and FoxO3, characterise cellular senescence. The effects of carbocysteine on the SIRT1/FoxO3 axis and on downstream molecular mechanisms in human bronchial epithelial cells exposed to cigarette smoke are largely unknown. AIMS: Aim of this study was to explore whether carbocysteine modulated SIRT1/FoxO3 axis, and downstream molecular mechanisms associated to cellular senescence, in a bronchial epithelial cell line (16-HBE) exposed to cigarette smoke. METHODS: 16HBE cells were stimulated with/without cigarette smoke extracts (CSE) and carbocysteine. Flow cytometry and clonogenic assay were used to assess cell proliferation; western blot analysis was used for assessing nuclear expression of SIRT1 and FoxO3. The nuclear co-localization of SIRT1 and FoxO3 was assessed by fluorescence microscopy. Beta galactosidase (a senescence marker) and SIRT1 activity were assessed by specific staining and colorimetric assays, respectively. ChiP Assay and flow cytometry were used for assessing survivin gene regulation and protein expression, respectively. RESULTS: CSE decreased cell proliferation, the nuclear expression of SIRT1 and FoxO3 and increased beta galactosidase staining. CSE, reduced SIRT1 activity and FoxO3 localization on survivin promoter thus increasing survivin expression. In CSE stimulated bronchial epithelial cells carbocysteine reverted these phenomena by increasing cell proliferation, and SIRT1 and FoxO3 nuclear expression, and by reducing beta galactosidase staining and survivin expression. CONCLUSIONS: The study shows for the first time that carbocysteine may revert some senescence processes induced by oxidative stress due to cigarette smoke exposure.

Biodegradation potentiality of psychrophilic bacterial strain Oleispira antarctica RB-8(T).

The present study is focused on assessing the growth and hydrocarbon-degrading capability of the psychrophilic strain Oleispira antarctica RB-8(T). This study considered six hydrocarbon mixtures that were tested for 22days at two different cultivation temperatures (4 and 15°C). During the incubation period, six sub-aliquots of each culture at different times were processed for total bacterial abundance and GC-FID (gas chromatography-flame ionization detection) hydrocarbon analysis. Results from DNA extraction and DAPI (4',6-diamidino-2-phenylindole) staining showed a linear increase during the first 18days of the experiment in almost all the substrates used; both techniques showed a good match, but the difference in values obtained was approximately one order of magnitude. GC-FID results revealed a substantial hydrocarbon degradation rate in almost all hydrocarbon sources and in particular at 15°C rather than 4°C (for commercial oil engine, oily waste, fuel jet, and crude oil). A more efficient degradation was observed in cultures grown with diesel and bilge water at 4°C.

Metal-Free Reduction of Aromatic and Aliphatic Nitro Compounds to Amines: A HSiCl3-Mediated Reaction of Wide General Applicability.

A new, mild, metal-free, HSiCl3-mediated reduction of both aromatic and aliphatic nitro groups to amines that is of wide general applicability, tolerant of many functional groups, and respectful of the stereochemical integrity of stereocenters is reported.

Tracing mercury pathways in Augusta Bay (southern Italy) by total concentration and isotope determination.

The mercury (Hg) pollution of sediments is the main carrier of Hg for the biota and, subsequently, for the local fish consumers in Augusta Bay area (SE Sicily, Italy), a coastal marine system affected by relevant sewage from an important chlor-alkali factory. This relationship was revealed by the determination of Mass Dependent (MDF) and Mass Independent Fractionation (MIF) of Hg isotopes in sediment, fish and human hair samples. Sediments showed MDF but no MIF, while fish showed MIF, possibly due to photochemical reduction in the water column and depending on the feeding habitat of the species. Benthic and demersal fish exhibited MDF similar to that of sediments in which anthropogenic Hg was deposited, while pelagic organisms evidenced higher MDF and MIF due to photoreduction. Human hair showed high values of δ(202)Hg (offset of +2.2‰ with respect to the consumed fish) and Δ(199)Hg, both associated to fish consumption.

The sea-air exchange of mercury (Hg) in the marine boundary layer of the Augusta basin (southern Italy): concentrations and evasion flux.

The first attempt to systematically investigate the atmospheric mercury (Hg) in the MBL of the Augusta basin (SE Sicily, Italy) has been undertaken. In the past the basin was the receptor for Hg from an intense industrial activity which contaminated the bottom sediments of the Bay, making this area a potential source of pollution for the surrounding Mediterranean. Three oceanographic cruises have been thus performed in the basin during the winter and summer 2011/2012, where we estimated averaged Hgatm concentrations of about 1.5±0.4 (range 0.9-3.1) and 2.1±0.98 (range 1.1-3.1) ng m(-3) for the two seasons, respectively. These data are somewhat higher than the background Hg atm value measured over the land (range 1.1±0.3 ng m(-3)) at downtown Augusta, while are similar to those detected in other polluted regions elsewhere. Hg evasion fluxes estimated at the sea/air interface over the Bay range from 3.6±0.3 (unpolluted site) to 72±0.1 (polluted site of the basin) ng m(-2) h(-1). By extending these measurements to the entire area of the Augusta basin (~23.5 km(2)), we calculated a total sea-air Hg evasion flux of about 9.7±0.1 g d(-1) (~0.004 tyr(-1)), accounting for ~0.0002% of the global Hg oceanic evasion (2000 tyr(-1)). The new proposed data set offers a unique and original study on the potential outflow of Hg from the sea-air interface at the basin, and it represents an important step for a better comprehension of the processes occurring in the marine biogeochemical cycle of this element.

Plasma leptin and vascular endothelial growth factor (VEGF) in normal subjects at high altitude (5050 m).

CONTEXT: High altitude (HA) is a model of severe hypoxia exposure in humans. We hypothesized that nocturnal hypoxemia or acute maximal exercise at HA might affect plasma leptin and VEGF levels. OBJECTIVES: Plasma leptin, VEGF and other metabolic variables were studied after nocturnal pulse oximetry and after maximal exercise in healthy lowlanders on the 3rd-4th day of stay in Lobuche (5050 m, HA) and after return to sea level (SL). RESULTS: Leptin was similar at SL or HA in both pre- and post-exercise conditions. Pre-exercise VEGF at HA was lower, and cortisol was higher, than at SL, suggesting that nocturnal intermittent hypoxia associated with periodic breathing at HA might affect these variables. CONCLUSIONS: Leptin levels appear unaffected at HA, whereas nocturnal hypoxic stress may affect plasma VEGF. Future HA studies should investigate the possible role of nocturnal intermittent hypoxemia on metabolism.

Mercury in fishes from Augusta Bay (southern Italy): risk assessment and health implication.

Our study reports on the total mercury (HgT) concentrations measured in the muscles and livers of several benthic, demersal and pelagic fish species caught inside and outside of Augusta Bay (southern Italy), a semi-enclosed marine area, highly contaminated by the uncontrolled (since the 1950s to 1978s) discharge of the largest European petrochemical plant. Mercury levels in fish tissues are discussed with regard to specific habitat, size and/or age of the specimens and HgT distribution in the bottom sediments. Results suggest a still active Hg release mechanism from the polluted sediments to the marine environment. Also, the high HgT concentrations measured in fishes caught in the external area of the bay imply a potential role of Augusta Bay as a pollutant source for the Mediterranean ecosystem. Finally, values of hazard target quotient (THQ) and estimated weekly intake (EWI) demonstrate that consumption of fishes caught inside the bay represents a serious risk for human health. Also, data indicate that intake of fishes caught from the external area of the bay, especially for that concern demersal and benthic species, could be represent a significant component of risk for the local population.

Adipose tissue in obesity and obstructive sleep apnoea.

A European Respiratory Society research seminar on "Metabolic alterations in obstructive sleep apnoea (OSA)" was jointly organised in October 2009 together with two EU COST actions (Cardiovascular risk in the obstructive sleep apnoea syndrome, action B26, and Adipose tissue and the metabolic syndrome, action BM0602) in order to discuss the interactions between obesity and OSA. Such interactions can be particularly significant in the pathogenesis of metabolic abnormalities and in increased cardiovascular risk in OSA patients. However, studying the respective role of OSA and obesity is difficult in patients, making it necessary to refer to animal models or in vitro systems. Since most OSA patients are obese, their management requires a multidisciplinary approach. This review summarises some aspects of the pathophysiology and treatment of obesity, and the possible effects of sleep loss on metabolism. OSA-associated metabolic dysfunction (insulin resistance, liver dysfunction and atherogenic dyslipidaemia) is discussed from the perspective of both obesity and OSA in adults and children. Finally, the effects of treatment for obesity or OSA, or both, on cardio-metabolic variables are summarised. Further interdisciplinary research is needed in order to develop new comprehensive treatment approaches aimed at reducing sleep disordered breathing, obesity and cardiovascular risk.

The European Sleep Apnoea Database (ESADA): report from 22 European sleep laboratories.

The European Sleep Apnoea Database (ESADA) reflects a network of 22 sleep disorder centres in Europe enabled by a COST action B26 programme. This ongoing project aims to describe differences in standard clinical care of patients with obstructive sleep apnoea (OSA) and to establish a resource for genetic research in this disorder. Patients with suspected OSA are consecutively included and followed up according to local clinical standards. Anthropometrics, medical history, medication, daytime symptoms and sleep data (polysomnography or cardiorespiratory polygraphy) are recorded in a structured web-based report form. 5,103 patients (1,426 females, mean±sd age 51.8±12.6 yrs, 79.4% with apnoea/hypopnoea index (AHI) ≥5 events·h(-1)) were included from March 15, 2007 to August 1, 2009. Morbid obesity (body mass index ≥35 kg·m(-2)) was present in 21.1% of males and 28.6% of females. Cardiovascular, metabolic and pulmonary comorbidities were frequent (49.1%, 32.9% and 14.2%, respectively). Patients investigated with a polygraphic method had a lower AHI than those undergoing polysomnography (23.2±23.5 versus 29.1±26.3 events·h(-1), p<0.0001). The ESADA is a rapidly growing multicentre patient cohort that enables unique outcome research opportunities and genotyping. The first cross-sectional analysis reveals a high prevalence of cardiovascular and metabolic morbidity in patients investigated for OSA.

Obstructive sleep apnoea and metabolic impairment in severe obesity.

Obstructive sleep apnoea (OSA) seems to worsen metabolism. This effect has not been evaluated in morbid obesity (MO). We hypothesised that the metabolic profile is more impaired in MO patients with OSA than in those without, and investigated whether any specific metabolic dysfunction is related to OSA in MO. A prospective multicentre cross-sectional study was conducted in consecutive subjects before bariatric surgery. OSA was defined as apnoea/hypopnoea index (AHI) ≥15 by overnight polysomnography. Anthropometrical, blood pressure (BP) and fasting blood measurements were obtained the morning after. Metabolic syndrome (MetS) was defined according to National Cholesterol Education Program Adult Treatment Panel III modified criteria. 159 patients were studied: 72% were female and 72% had OSA. MetS prevalence was 70% in OSA versus 36% in non-OSA (p<0.001). As AHI severity increased, metabolic parameters progressively worsened, even in those without type 2 diabetes (DM2). AHI was independently associated with systolic and diastolic BP, triglycerides and the percentage of glycosylated haemoglobin (HbA1c) in the total sample, and with systolic BP, high-density lipoprotein cholesterol and HbA1c in those samples without DM2. OSA increased the adjusted odds ratio of having MetS by 2.8 (95% CI 1.3-6.2; p=0.009). In MO, OSA is associated with major metabolic impairment caused by higher BP and poorer lipid and glucose control, independent of central obesity or DM2.