Altered plasma fibrin clot properties in hypertensive patients with obstructive sleep apnoea are improved by continuous positive airway pressure treatment.

AIM: We investigated plasma fibrin clot properties in high-risk hypertensive patients with obstructive sleep apnoea (OSA) and assessed the impact of continuous positive airway pressure (CPAP) treatment on clot phenotype. METHODS: We studied 50 hypertensive patients with clinically significant OSA (age 50.0 ±â€Š8.8 years, 39 M, 11 F). In total, 38 hypertensive patients without OSA balanced for age, sex, blood pressure, cardiovascular risk factors, and metabolic status served as controls. Plasma fibrin clot properties, including clot permeability coefficient, clot lysis time (CLT), and turbidimetric parameters of clot formation were determined. Patients underwent transthoracic echocardiography, carotid ultrasonography, evaluation of endothelial function and calcium score index of coronary arteries, and Doppler imaging of renal arteries. RESULTS: Compared with controls, OSA patients were characterized by more compact fibrin structure (lower median clot permeability coefficient, 6.00 vs. 7.25 10 cm; P < 0.001), impaired fibrinolysis (longer median CLT, 108.00 vs. 92.50 min; P < 0.001), and by faster clot formation (shorter median lag phase, 40.50 vs. 42.50 s; P = 0.041), and higher median maximum clot absorbency indicating denser fibrin networks (0.87 vs. 0.81; P = 0.028). Clot permeability coefficient and CLT correlated with apnoea-hypopnoea index (r = -0.46; P < 0.001 and r = 0.44; P < 0.001, respectively) as well with mean (r = 0.31; P = 0.003; r = -0.36; P = 0.001, respectively) and minimal oxygen saturation (r = 0.46; P < 0.001; r = -0.49; P < 0.001, respectively). After 3 months of CPAP treatment we observed an increase in clot permeability coefficient (5.95 vs. 7.60 10 cm; P = 0,001), shortened CLT (107.00 vs. 87.00; P = 0.006), a longer lag phase of fibrin formation (40.00 vs. 43.50 s; P = 0.013), and a trend toward lower maximum clot absorbency (0.86 vs. 0.81; P = 0.058). CONCLUSION: In hypertensive patients at high cardiovascular risk, OSA was associated with unfavourable prothrombotic fibrin clot characteristics, including hypofibrinolysis, which significantly improve as early as after 3 months of CPAP treatment.

Pilot program on distance training in spirometry testing - the technology feasibility study.

INTRODUCTION: Office spirometry has been widely used in recent years by general practitioners in primary care setting, thus the need for stricter monitoring of the quality of spirometry has been recognized. MATERIAL AND METHODS: A spirometry counseling network of outpatients clinics was created in Poland using portable spirometer Spirotel. The spirometry data were transferred to counseling centre once a week. The tests sent to the counseling centre were analyzed by doctors experienced in the analysis of spirometric data. In justified cases they sent their remarks concerning performed tests to the centres via e-mail. RESULTS: We received 878 records of spirometry tests in total. Data transmission via the telephone was 100% effective. The quality of spirometry tests performed by outpatients clinics was variable. CONCLUSIONS: The use of spirometers with data transfer for training purposes seems to be advisable. There is a need to proper face-to-face training of spirometry operators before an implementation of any telemedicine technology.

Factors associated with diastolic dysfunction in patients with resistant hypertension: resist-POL study.

BACKGROUND: Diastolic dysfunction has been shown to be an independent factor of cardiovascular diseases in patients with hypertension. Very often, obstructive sleep apnea (OSA) and metabolic syndrome (MS) coexist with resistant hypertension (RHTN) and may lead to diastolic dysfunction. Thus, the purpose of this study was to investigate whether OSA and MS are associated with diastolic dysfunction in patients with RHTN independently from other factors, including age, left ventricular mass index (LVMI), and blood pressure (BP). METHODS: Data from 155 patients (n = 92 men and 63 women) were analyzed. All patients underwent thorough examination, including biochemical evaluations, ambulatory blood pressure monitoring, polysomnography with assessment of apnea/hypopnea index (AHI), and echocardiography. LVMI and diastolic function parameters were obtained. RESULTS: Patients were divided into 2 groups based on the presence or absence of diastolic dysfunction: group 1 (E' < 10cm/second; n=87) and group 2 (E' > 10cm/second; n = 68). AHI, LVMI, and 24-hour systolic BP/diastolic BP values were higher in group 1. E' correlated with AHI (r = -0.25; P < 0.001), LVMI (r = -0.36; P < 0.0001), 24-h systolic BP/24-h diastolic BP (r = -0.28, P < 0.001; r = -0.30, P < 0.001, respectively), glucose level (r = -0.26; P < 0.01), and abdominal obesity (r = -0.28; P < 0.0001). In multivariable models decreased E' was independently related to the presence of MS or abdominal obesity when separate components of MS were included in the model. Age and 24-hour systolic BP were independently associated with decreased E'. However, the relationship of decreased E' with 24-hour systolic BP was nonsignificant if LVMI was included in the multivariable model. CONCLUSIONS: MS and abdominal obesity were independently associated with diastolic dysfunction in patients with RHTN. OSA was not confirmed to be an independent factor of diastolic dysfunction.

Independent association of obstructive sleep apnea with left ventricular geometry and systolic function in resistant hypertension: the RESIST-POL study.

OBJECTIVE: We investigated the impact of obstructive sleep apnea (OSA) and night blood pressure (BP) on left ventricular geometry and systolic function in patients with resistant hypertension (RHTN). METHODS AND RESULTS: Data from 155 patients with RHTN were analyzed. All patients underwent biochemical evaluations, ambulatory blood pressure monitoring (ABPM), and polysomnography. Left ventricular mass index (LVMI), relative wall thickness (RWT), left ventricular ejection fraction (LVEF), midwall fractional shortening (mwFS) and global longitudinal strain (GLS) were measured. Patients were divided into four groups based on the presence of metabolic syndrome (MS) and OSA: group 1: OSA(-), MS(-) [n = 42]; group 2: OSA(+), MS(-) [n = 14]; group 3: OSA(-), MS(+) [n = 46]; and group 4: OSA(+), MS(+) [n = 53]. In group 3 and 4 concentric geometry was present in 53.2% and 79.6% respectively (P = 0.004). There were no differences in LVEF between groups. Group 3 and 4 had lower mwFS as compared with group 1 (16.40 ± 1.9 and 15.38 ± 2.2 vs 17.44 ± 1.9; P < 0.049 and P < 0.0001 respectively). Group 4 had significantly lower GLS as compared with group 1 (-12.64 ± 3.3 vs -15.59 ± 4.0; P < 0.001). In the multivariable analysis, factors independently associated with concentric geometry were age, nighttime SBP (OR -1.04; 95%Cl 1.019-1.082; P < 0.0001) and OSA (OR -3.97; 95%Cl 1.835-8.590; P < 0.0001). In the other multivariable analysis, factors independently associated with GLS were OSA (beta = 0.279; P = 0.001), and nighttime DBP (beta = 0.168; P = 0.048) whereas factors independently associated with mwFS were age, gender, nighttime SBP, concentric geometry, and metabolic syndrome. CONCLUSIONS: In patients with true RHTN without diabetes concentric geometry and systolic dysfunction are independently associated with moderate and severe OSA and nighttime BP levels.

Relationship between primary aldosteronism and obstructive sleep apnoea, metabolic abnormalities and cardiac structure in patients with resistant hypertension.

INTRODUCTION: The aim of this study was to evaluate in patients with resistant hypertension (RHTN) enrolled in the RESIST-POL study the relationship between primary aldosteronism (PA) and obstructive sleep apnoea (OSA) and their effect on metabolic abnormalities and cardiac structure. MATERIAL AND METHODS: We included 204 patients (123 M, 81 F, mean age 48.4 yrs) with true RHTN, eGFR > 60 mL/min/1,73 m(2) and no known diabetes. OSA was defined as an apnoea/hypopnoea index of 15/h or more. Metabolic syndrome components were assessed. On echocardiography, left ventricular hypertrophy (LVH), concentric remodelling (RWT > 0.45), E' velocity, E/E' index and global strain (GLS) were evaluated. RESULTS: PA was diagnosed in 32 patients (15.7%). OSA occurred more frequently in patients with PA (59.4 v. 42.4%; p = 0.058). Patients were divided into four groups: PA+ OSA+ , PA+ OSA-, PA-OSA+ and PA-OSA-. Newly diagnosed diabetes, impaired glucose tolerance and increased fasting glucose were most frequent in the PA+ OSA+ group compared to other groups. The presence of OSA was associated with concentric remodelling, and the presence of PA was associated with higher left ventricular mass and higher frequency of left ventricular hypertrophy. In the PA+ OSA+ and PA+ OSA- groups, the most frequent geometry patterns were concentric hypertrophy (68.4%) and eccentric hypertrophy (54.5%) respectively. E' velocity was lowest and E/E' was highest in PA+ OSA+ compared to other groups. GLS was lower in patients with OSA compared to those without OSA. CONCLUSIONS: Both metabolic abnormalities and target organ damage are more pronounced in patients with RHTN, PA and OSA. OSA and PA influence differently left ventricular geometry.

Effects of renal sympathetic denervation on blood pressure, sleep apnea course, and glycemic control in patients with resistant hypertension and sleep apnea.

Percutaneous renal sympathetic denervation by radiofrequency energy has been reported to reduce blood pressure (BP) by the reduction of renal sympathetic efferent and afferent signaling. We evaluated the effects of this procedure on BP and sleep apnea severity in patients with resistant hypertension and sleep apnea. We studied 10 patients with refractory hypertension and sleep apnea (7 men and 3 women; median age: 49.5 years) who underwent renal denervation and completed 3-month and 6-month follow-up evaluations, including polysomnography and selected blood chemistries, and BP measurements. Antihypertensive regimens were not changed during the 6 months of follow-up. Three and 6 months after the denervation, decreases in office systolic and diastolic BPs were observed (median: -34/-13 mm Hg for systolic and diastolic BPs at 6 months; both P<0.01). Significant decreases were also observed in plasma glucose concentration 2 hours after glucose administration (median: 7.0 versus 6.4 mmol/L; P=0.05) and in hemoglobin A1C level (median: 6.1% versus 5.6%; P<0.05) at 6 months, as well as a decrease in apnea-hypopnea index at 6 months after renal denervation (median: 16.3 versus 4.5 events per hour; P=0.059). In conclusion, catheter-based renal sympathetic denervation lowered BP in patients with refractory hypertension and obstructive sleep apnea, which was accompanied by improvement of sleep apnea severity. Interestingly, there are also accompanying improvements in glucose tolerance. Renal sympathetic denervation may conceivably be a potentially useful option for patients with comorbid refractory hypertension, glucose intolerance, and obstructive sleep apnea, although further studies are needed to confirm these proof-of-concept data.

[Relationship between age and cardiovascular complications in obstructive sleep apnoea]. / Ocena zwiazków pomiedzy wiekiem oraz wystepowaniem powiklan sercowo-naczyniowych u chorych na obturacyjny bezdech senny.

INTRODUCTION: Obstructive sleep apnoea (OSA) is a risk factor for cardiovascular morbidity and mortality. The aim of this study was to assess relations between cardiovascular diseases (CVD) and age in OSA subjects. MATERIAL AND METHODS: Consecutive OSA subjects (AHI/RDI > 10, Epworth score > 9 points) were evaluated. The chest X-ray, spirometry, arterial blood gases, ECG, blood morphology and biochemistry were performed during trial treatment with autoCPAP. RESULTS: We studied 533 consecutive OSA patients, mean age 55.6 +/- 10.3 years (range 24-81), with obesity (BMI 34.4 +/- 6.6 kg/m(2)) and severe OSA (AHI/RDI 37.8 +/- 21.8). To evaluate relations between CVD and age, patients were divided into three groups. Group 1 < 50 years (123 subjects, 23.1%), Group 2 aged 50-60 years (250 subjects, 46.9%) and Group 3 > 60 years (160 subjects, 30%). Subjects < 50 years were more obese and had higher AHI/RDI when compared to older groups. Incidence of arterial hypertension, coronary artery disease, atrial fibrillation, heart failure and stroke increased with age (higher in subjects > 60 years). CONCLUSIONS: Cardiovascular diseases were prevalent in OSA patients > 60 years. However the youngest group presented with more severe obesity and higher AHI/RDI.

[Influence of neck circumference and body mass index on obstructive sleep apnoea severity in males]. / Wplyw obwodu szyi i wskaznika masy ciala na zaawansowanie obturacyjnego bexdechu sennego u mezczyzn.

INTRODUCTION: Obesity and male gender are the main risk factors for the development of obstructive sleep apnoea (OSA); however, some epidemiological data has shown that neck circumference (NC) > or = 43 cm is a better predictor of obstructive event frequency than body mass index (BMI). The aim of this study was to assess the relation between NC and BMI on OSA severity in males. MATERIAL AND METHODS: The subjects completed a sleep questionnaire and Epworth sleepiness scale before the sleep study (full polysomnography or PolyMesam study). Authors studied 133 consecutive males with confirmed OSA (AHI/RDI > 10, Epworth score > 9 points). Chest X-ray, spirometry, arterial blood gases, ECG, blood morphology and biochemistry were performed during treatment trial with autoCPAP. RESULTS: Subjects presented with obesity--BMI = 35.8 +/- 6.1 kg/m2, NC = 46 +/- 3.4 cm and severe disease--AHI/RDI = 45.3 +/- 23.6. Mean age was 52.7 +/- 11.3 years. The majority of subjects had NC > or = 43 cm (116 pts, 87.2% - group 1), 17 pts (12.8% - group 2) had NC < 43 cm had 17 pts. Comparison of both groups showed significant differences only for BMI (group 1 - 36.8 +/- 5.7, group 2 - 28.6 +/- 3.7; p < 0.0001). Linear regression analysis revealed significant correlation between NC and AHI/RDI (R2 = 0.07, r = 0.26; p = 0.003); however, the correlation between BMI and AHI/RDI was stronger (R2 = 0.14, r = 0.37; p < 0.0001). In multiple linear regression analysis we found significant correlation between AHI/RDI and age (beta = -0.31, p = 0.003) and BMI (beta = 0.34, p = 0.02). CONCLUSIONS: The strongest correlation between AHI/RDI, younger age and BMI. Correlation between neck circumference and AHI/RDI was significant but less when compared to BMI.

[Metabolic abnormalities in obstructive sleep apnea patients]. / Zaburzenia metaboliczne u chorych na obturacyjny bezdech senny.

INTRODUCTION: Obstructive sleep apnea (OSA) is a well-recognized risk factor of cardiovascular disorders and is related to metabolic syndrome. The aim of this study was to evaluate the effect of BMI and AHI/RDI on metabolic disturbances in patients suspected of OSA. MATERIAL AND METHODS: Ninety-nine patients referred with suspected OSA underwent standard polysomnography or limited sleep study. AHI/RDI > or = 10/hour was considered relevant for OSA diagnosis. Subjects with AHI/RDI < 10 were considered as controls. We assessed apnea-hypopnea index or respiratory disturbances index (AHI/RDI), Epworth sleepiness scale (ESS), body mass index (BMI), C-reactive protein (CRP, mg/l), glycosylated haemoglobin (HbA1c, %), fasting serum total cholesterol, HDL-, LDL-cholesterol, triglycerides (TG), glucose (G), insulin (INS, IU/ml) and HOMA index. RESULTS: Data are presented as mean +/- SD or median (interquartile range) for parametric and nonparametric data respectively. Twenty-two patients were included as controls (age 51.8 +/- 10 vs. 55 +/- 11 in OSA; p = NS). AHI/RDI in the OSA group was 23 (16-31.3) and 7 (3.8-8.1) in controls (p < 0.001). BMI in OSA 32.2 +/- 5.8 vs. 30.4 +/- 4.6 in controls (p = NS). Patients with OSA had higher TG (160 +/- 75.9 vs. 130.2 +/- 51.9 mg/dl, p = 0.046), G (5.04 +/- 0.6 vs. 4.47 +/- 0.6, p = 0.0037), HOMA (2.31 +/- 1.5 vs. 1.85 +/- 1.7, p = 0.046). G correlated best with AHI/RDI (p < 0.001, r = 0.41). Significant differences were observed in OSA patients between obese (51 pts, BMI 35.2 +/- 4.8) and non-obese (26 pts, BMI 26.61 +/- 1.9) pts in: HDL-cholesterol (50.8 +/- 13.2 vs. 60.9 +/- 18.4 mg/dl; p = 0.02), TG (178.7 +/- 69.9 vs. 124 +/- 75.3 mg/dl, p < 0.001), G (5.15 +/- 0.7 vs. 4.8 +/- 0.5 mmol/l, p = 0.01), INS (11.7 +/- 5.9 vs. 6.57 +/- 4.7, p < 0.001), HOMA (2.7 +/- 1.4 vs. 1.4 +/- 1.2, p < 0.001), HbA(1c) (5.89 +/- 0.9 vs. 5.4 +/- 0.8, p = 0.03), CRP (2.2 +/- 2.9 vs. 1.09 +/- 1.2, p = 0.01). CONCLUSIONS: Our findings support the results of previous studies showing the influence of OSA alone on metabolic disturbances. However, BMI has major impact on metabolic variables.

[Six-minute walk test in obstructive sleep apnoea]. / Test 6-minutowego chodu u chorych na obturacyjny bezdech senny.

INTRODUCTION: The aim of this study was to assess results of 6MWT in non-selected group of obstructive sleep apnoea (OSA) patients. In healthy adult subjects 6-minute walking distance (6MWD) range from 400 to 700 m. Obesity, the main symptom of OSA, is one of the factors associated with reduction of 6MWD (another common factors: older age, shorter height, female sex, pulmonary, cardiovascular and musculoskeletal diseases). MATERIAL AND METHODS: Subjects completed sleep questionnaire and Epworth sleepiness scale before sleep studies (full polysomnography [PSG] or PolyMesam study [PM]). Consecutive OSA subjects (AHI/RDI >10, Epworth score > 9 points) were evaluated. The 6MWT, chest X-ray, spirometry, arterial blood gases, ECG, blood morphology and biochemistry were performed during trial treatment with autoCPAP. RESULTS: We studied 151 subjects (119 males - 78.8% and 32 females - 21.2%), mean age 53.4 +/- 10.5 years. Subjects were obese - BMI = 35.7 +/- 6.2 kg/m(2) and presented severe OSA - AHI/RDI = 42.4 +/- 23.2. To assess relations between 6MWD and AHI/RDI, BMI, age and concomitant diseases we divided subjects in two groups: 1(st) with 6MWD > or = lower limit of normal (LLN) (123 pts; 81.5%) and 2(nd) with 6MWD < LLN (28 pts; 18.5%). Significant differences between groups were found for BMI, FVC (% of predicted) and Borg dyspnea scale before and after 6MWT. In multiple linear regression analysis we found significant correlation between 6MWD and BMI (beta = 0.41, p < 0.0001) and arterial hypertension (beta = -0.16, p = 0.04). Females had significantly shorter 6MWD than males (401.1 +/- 83.6 m and 451.8 +/- 107 m, respectively; p = 0.01). Difference was significant after adjustment for BMI and age (analysis of covariance) - R = 0.61, R2 = 0.38 (p < 0.0001). CONCLUSIONS: BMI, female sex, arterial hypertension and lower FVC (% of predicted) were related to shorter 6-minute walking distance in OSA patients.

[Menopausal status and severity of obstructive sleep apnoea (OSA) in females]. / Wplyw menopauzy na nasilenie obturacyjnego bezdechu sennego (OBS) u kobiet.

INTRODUCTION: Prevalence of obstructive sleep apnoea (OSA) is higher in postmenopausal females. The aim of this study was to compare OSA severity in postmenopausal females (group E-) and females with preserved estrogen activity (premenopausal or on hormonal replacement therapy - group E+). MATERIAL AND METHODS: We studied 147 OSA females in mean age 58.1 +/- 9.4 years. Subjects presented obesity (BMI = 34 +/- +/- 7.9 kg/m2) and moderate or severe disease (AHI = 35.9 +/- 20.9), SaO(2) mean - 89.4 +/- 5.8%. Group (E-) consisted of 116 pts (75.5%) and group (E+) of 36 pts (24.5%). RESULTS: Group (E+) presented more severe OSA (AHI/RDI = 42 +/- 26.6) and obesity (BMI = 37.6 +/- 10.1 kg/m(2)) when compared to group E- (AHI/RDI = 33.9 +/- 18.4; p = 0.04 and BMI - 32.8 +/- 6.7 kg/m(2); p = 0.001). In multiple linear regression analysis we found significant negative correlation between AHI and age (beta = -0.29, p = 0.03). After adjustment for BMI and age (analysis of covariance) significant difference was still present between both groups (R = 0.24, p = 0.03). CONCLUSIONS: Majority of OSA females qualified to CPAP therapy were postmenopausal (75.5%). Severity of OSA (AHI/RDI) after adjustment for age and BMI was higher in group (E+).

[Nocturia in obstructive sleep apnoea (OSA)]. / Nykturia u chorych na obturacyjny bezdech senny (OBS).

INTRODUCTION: Nocturia (two or more urinations per night) is a common symptom in OSA subjects. Higher secretion of atrial natriuretic peptide, increased intra-abdominal pressure, diuretics, diabetes, excessive fluid intake, awakenings are responsible for nocturnal urination. The aim of this study was to evaluate incidence of nocturia in moderate and severe OSA. MATERIAL AND METHODS: We studied 171 consecutive OSA patients (135 males and 36 females) - means: age - 53.6 +/- +/- 10.8 years, AHI/RDI - 43.6 +/- 23.2, BMI - 35.8 +/- 6.3 kg/m(2). RESULTS: To assess relations between nocturia and AHI/RDI, overnight saturation, BMI and daytime sleepiness we divided subjects in two groups: 1(st) - without nocturia - 60 pts; 35.1% (group N-) and 2(nd) - with nocturia - 111 pts; 64.9% (group N+). Group N+ presented with higher AHI/RDI, 48 +/- 22.8 vs. 35.4 +/- 21.7 (p = 0.0006), higher BMI, 36.8 +/- 6.5 vs. 34 +/- 5.5 kg/m(2) (p = 0.004), lower mean overnight SaO(2), 88.6 +/- 5.6 vs. 90.4 +/- 4.3% (p = 0.03) and daytime sleepiness, Epworth score - 14.4 +/- 5.1 vs. 11.3 +/- 5.5 points (p = 0.0002). Multiple linear regression analysis revealed significant correlation between nocturia and Epworth sleepiness score (beta = 0.26, p = 0.0009), coronary artery disease (beta = 0.23, p = 0.004) and AHI/RDI (beta = 0.21, p = 0.04). CONCLUSIONS: Nocturia is frequent in OSA patients (64.9%). Nocturnal urination was related to severity of OSA, excessive daytime sleepiness and coronary artery disease.

Community-acquired pneumonia complications in a patient with hereditary glucose-6-phosphate dehydrogenase deficiency.

Severe complications of lower respiratory tract infection in a patient with hereditary glucose-6-phosphate dehydrogenase (G-6-PD) deficiency may occur. The case of a 68-year-old man with hereditary glucose-6-phosphate dehydrogenase (G6PD) deficiency who developed severe haemolysis after community-acquired pneumonia is presented. G6PD deficiency in our patient was diagnosed during childhood. We observed complications of community-acquired pneumonia: empyema, haemolytic crisis and renal failure. Videopleuroscopy and pleural drainage were successfully performed. Community-acquired streptococcal pneumonia may also lead to haemolysis in G6PD deficient patients. Acute haemolysis, severe anaemia and renal insufficiency secondary to haemoglobinuria can be observed. Severe purulent complications of pneumonia in G6PD deficient patients may suggest granulocyte function impairment.

[Influence of treatment with continuous positive airway pressure on respiratory muscle function and physical fitness in patients with obstructive sleep apnoea and overlap syndrome]. / Wplyw leczenia dodatnim cisnieniem w drogach oddechowych (CPAP) na czynnosc miesni oddechowych oraz wydolnosc fizyczna u chorych na obturacyjny bezdech senny i zespól nakladania.

INTRODUCTION: The aim of this study was to evaluate the effect of CPAP treatment on respiratory muscle strength and exercise tolerance in patients with obstructive sleep apnoea (OSA) and overlap syndrome (OS). MATERIAL AND METHODS: 9 patients with OSA and 9 patients with OS were studied. Respiratory muscle assessment, 6 minute walking distance (6MWD) and cycloergometry exercise test were performed before and after six month period of CPAP treatment. RESULTS: In OSA group exercise tolerance did not change after the treatment. Mean 6MWD was 571.8 +/- 76.6 m before and 554.0 +/- 125.5 m after treatment, mean W(max) was 142 +/- 41 W before and 139 +/- 38 W after treatment. PI(max) in OSA group did not change significantly, 140.4 +/- 32.0 cm H(2)O before and 155.9 +/- 31.5 after treatment (p = 0.14). PE(max) improved from 170.5 +/- 49.2 cm H(2)O, to 199.9 +/- 27.6 cm H(2)O (p = 0.067). Handgrip force in OSA group improved from 50.5 +/- 16.5 kg to 61.0 +/- 17.0 kg (left hand) (p = 0.05) and from 53.3 +/- 14.2 to 58.9 +/- 15.9 (right hand) (p < 0.05). In OS group exercise tolerance improved by 17% after CPAP treatment from W(max) = 81 +/- 33 W before to 95 +/- 38 W after. Mean 6MWD was at the same level before (504 +/- 144 m) and after treatment (492 +/- 108 m). PI(max) in OS group improved from 89.2 +/- 35.7 cm H(2)O to 106.3 +/- 31.4 cm H(2)O (p < 0.05). PE(max) in OS group did not change significantly, 159.9 +/- 45.8 cm H(2)O before and 184.2 +/- 45.0 cm H(2)O after treatment (NS). Handgrip force in OS group improved from 38.1 +/- 15.9 kg to 46.9 +/- 11.1 kg (left hand) (p < 0.05) and did not change in right hand (44.5 +/- 17.7 kg vs. 47.9 +/- 10.4 kg) (NS). Data analysis of the whole group (18 pts) showed clear tendency to improve strength of respiratory muscles in patients treated with CPAP. Mean PI(max) improved from 123 to 133 cm H(2)O (p = 0.006) and PE(max) improved from 168.1 to 192 cm H(2)O (p = 0.02). CONCLUSIONS: CPAP treatment improved strentgh of respiratory and skeletal muscles in patients with OSA and OS and improved exercise tolerance in patients with OS.

[Central sleep apnoea (CSA) in male with heart failure]. / Centralny bezdech senny (CBS) u chorego z niewydolnoscia serca.

We studied 44-year old man with heart failure (ejection fraction -25%). Obesity, arterial hypertension, snoring and excessive daytime sleepiness suggested concomitant obstructive sleep apnoea. Limited polysomnography with Polymesam revealed typical Cheyne-Stokes respiration with mainly central apnoeas (RDI=48/hour). We did not find any obstructive episodes during sleep study. Patient responded to CPAP therapy and apnoea hypopnoe index decreased to 12/hour on 8 mbar pressure.

[The variability of clinical presentation of chronic obstructive pulmonary disease in patients with hereditary alpha-1 antitrypsin deficiency]. / Zmiennosc obrazu klinicznego przewleklej obturacyjnej choroby pluc u chorych z wrodzonym niedoborem alfa-1 antytrypsyny.

Four patients with alpha-1 antitrypsin (alpha-1 AT) deficiency are presented: one woman with severe (phenotype PiZ) and 3 men with moderate (phenotype PiMZ) deficiency of alpha-1 AT. The variability of clinical presentation of hereditary emphysema is described. In all patients tobacco smoking history, spirometric and 6-minutes walking tests as well as HRCT of the lung were performed and compared. The influence of smoking on the functional status is underlined.

[Diaphragm electrical activation in COPD patients]. / Ocena aktywnosci elektrycznej przepony u chorych na POCHP.

Several studies have demonstrated relatively moderate increase in Pdi during exhaustive exercise in COPD patients. The present study was designed to determine whether the small increase in Pdi is due to a central inhibition of respiratory drive, or an inability of the diaphragm to develop pressure. Diaphragm electrical activation (Edi) and transdiaphragmatic (Pdi) pressure were measured in 19 patients with severe COPD using an esophageal catheter. End-expiratory lung volume (EELV) was assessed by inspiratory capacity (IC) maneuvers. Maximal voluntary Edi (Edimax) was obtained during these maneuvers. EELV increased during exercise (p < 0.001) causing end-inspiratory lung volume to attain 98 +/- 5% of TLC at end-exercise. Pdi at rest was 8.4 +/- 2.6 cm H2O. Edi was 19 +/- 4% of Edimax at rest and increased progressively during exercise (p < 0.001) to reach 78 +/- 3% of Edimax at end-exercise. In conclusion, dynamic hyperinflation during exhaustive exercise in patients with COPD, reduces diaphragm pressure generating capacity, promoting near maximal levels of diaphragm activation without evidence of central inhibition.

[Role of expiratory muscles in COPD patients]. / Ocena czynnosci miesni wydechowych u chorych na przewlekla obturacyjna chorobe pluc.

Expiratory muscle recruitment is common in stable COPD patients. However, physiological significance of expiratory muscle recruitment in COPD remains unclear. The purpose of this study was to assess the effect of expiratory muscle contraction on force generating ability of the diaphragm in COPD patients breathing at rest. The force generating ability of the diaphragm was evaluated from its pressure swing (Pdi) for a given diaphragm electrical activity (Edi), where Edi was normalized as % of its maximal value [Pdi/(Edi/Edimax)]. Phasic expiratory muscle contraction was measured as the total expiratory rise in gastric pressure (Pgaexp.rise). Nineteen patients with severe COPD, participated in the study but only 10 exhibited phasic rise in Pga during expiration with a mean Pgaexp.rise of 1.91 +/- 0.89 cmH2O. Patients were divided into passive expiration (PE) and active expiration (AE) groups. There was no significant difference in lung function and breathing pattern parameters between the two groups. Pdi/(Edi/Edimax) was 0.63 +/- 0.07 and 0.54 +/- 0.07 cm cmH2O/% in PE and AE groups, respectively, and was not significantly different between each other. Compared with PE group, AE group not only recruited expiratory muscles, but also preferentially recruited inspiratory rib cage muscles and derecruited the diaphragm. In conclusion phasic contraction of expiratory muscles at rest in COPD patients do not improve the force-generating ability of the diaphragm.