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1.
J Clin Sleep Med ; 2020 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-32043960

RESUMO

STUDY OBJECTIVES: The association of mild obstructive sleep apnoea (OSA) with important clinical outcomes remains unclear. We aimed to investigate the association between mild OSA and systemic arterial hypertension (SAH) in the European Sleep Apnoea Database (ESADA) cohort. METHODS: In a multicentre sample of 4732 patients we analyzed the risk of mild OSA (sub-classified into two groups: mildAHI 5-<11/h (apnoea-hypopnoea frequency/hour [AHI] 5 to <11/h) and mildAHI 11-<15/hOSA (AHI ≥11 to <15/h ) compared to non-apnoeic snorers for prevalent SAH after adjustment for relevant confounding factors including gender, age, smoking, obesity, daytime sleepiness, dyslipidaemia, chronic obstructive pulmonary disease, type 2 diabetes and sleep test methodology [polygraphy (PG) or polysomnography (PSG)]. RESULTS: SAH prevalence was higher in the mildAHI 11-<15/h OSA group compared with the mildAHI 5-<11/h group and non-apnoeic snorers (52 vs 45 vs 30%, p<0.001). Corresponding adjusted Odds Ratios (OR) for SAH were 1.789 (mildAHI 11-<15/h, 95% confidence interval [CI] 1.49-2.15) and 1.558 (mildAHI 5-<11/h, 95%, CI 1.34-1.82), respectively; p<0.001. In sensitivity analysis, mildAHI 11-<15/h OSA remained a significant predictor for SAH both in PG (OR = 1.779, 95% CI 1.403-2.256; p<0.001) and PSG group (OR = 1.424, 95% CI 1.047-1.939; p=0.025). CONCLUSION: Our data suggest a dose response relationship between mild OSA and SAH risk, starting from 5 events/hour in PG-recordings and continuing with a further risk increase in the 11 to <15 range. These findings potentially introduce a challenge to traditional thresholds of OSA severity and may help to stratify OSA patients according to cardiovascular risk.

2.
Ocul Surf ; 17(4): 771-776, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31226420

RESUMO

PURPOSE: To evaluate ocular surface and Meibomian glands morphology of patients with obstructive sleep apnea syndrome (OSAS). MATERIALS AND METHODS: Based on polysomnography, 36 eyes of 36 patients with severe OSAS (Group 1, apnea-hypopnea index (AHI) ≥30/h) and 24 eyes of 24 patients with primary snoring or mild OSAS (Group 2, AHI<15/h) were enrolled. Detailed eye examination along with ocular surface staining (fluorescein, 2%) according to Oxford scale, tear film break-up time (t-BUT), Schirmer 1 test, ocular surface disease index (OSDI) scoring, and evaluation of upper and lower eyelid Meibomian glands using infrared filter of slit-lamp biomicroscope were performed. In addition to grading Meibomian gland drop-out, the presence morphologic alterations such as Meibomian gland duct distortion, thinning and dilatation were also assessed. RESULTS: The mean ages were 50.8 ± 8.3 (range, 35-68) and 47.9 ± 10.5 (range, 27-69) in Group 1 and Group 2, respectively (p = 0.616). Best-corrected visual acuity, Schirmer 1 test, Oxford scale and OSDI scores, and lower meiboscores did not differ significantly between groups. In Group 1, average t-BUT was lower (p = 0.003), upper and total (upper + lower) meiboscores were higher as compared to Group 2 (p < 0.05). The frequency of Meibomian gland duct distortion, thinning and dilatation were also significantly greater in Group 1 (p < 0.05). CONCLUSION: Morphological changes, in addition to Meibomian glands dropout were significant in severe OSAS patients as demonstrated objectively with meibography. Schirmer 1 and t-BUT tests were in favor of evaporative type dry eye syndrome, which also support Meibomian gland alterations in severe OSAS patients.

5.
Turk Thorac J ; 19(3): 136-140, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-30083405

RESUMO

OBJECTIVES: The primary aim of The Turkish Sleep Apnea Database (TURKAPNE) study is to generate a cross-sectional nationwide database for defining the clinical and polysomnographic characteristics of the patients with obstructive sleep apnea (OSA) in Turkey. MATERIALS AND METHODS: In this ongoing project, all consecutive adults with suspected OSA are recruited from the sleep centers of the university and research hospitals in Turkey. Information on anthropometric data, educational status, driving license, smoking habits, alcohol use, comorbidities, drug use, questionnaires, polysomnographic, and/or cardiorespiratory polygraphic findings are recorded in a systematized Web-based report form. Blood glucose, lipids and other biochemical markers, lung function, and echocardiography measurements are optionally included. Follow-up data regarding treatment modality and compliance is assessed. Cross-sectional and longitudinal associations between OSA phenotypes and metabolic, pulmonary, and cardiovascular comorbidities as well as traffic accidents, and the impact of treatment will be further explored. We target a total sample of 10,000 participants. RESULTS: The study was registered with ClinicalTrials.gov (NCT02784977) in May 2016 and the first patient was recruited in October 2017. A total of 1911 participants from 19 centers have been enrolled in the study by May 31, 2018. CONCLUSION: The TURKAPNE study will contribute to a better understanding of the health-related burden of OSA phenotypes and its association with the comorbidities and adverse outcomes, including traffic accidents in Turkey. The results may also contribute to a more personalized approach and better management of varying OSA phenotypes with concomitant disorders.

6.
Respirology ; 23(12): 1180-1189, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30133061

RESUMO

BACKGROUND AND OBJECTIVE: Obstructive sleep apnoea (OSA) and dyslipidaemia are independent risk factors for cardiovascular disease. This study investigates the association between OSA and plasma lipid concentrations in patients enrolled in the European Sleep Apnea Database (ESADA) cohort. METHODS: The cross-sectional analysis included 8592 patients without physician-diagnosed hyperlipidaemia or reported intake of a lipid-lowering drug (age 50.1 ± 12.7 years, 69.1% male, BMI: 30.8 ± 6.6 kg/m2 , mean apnoea-hypopnoea index (AHI): 25.7 ± 25.9 events/h). The independent relationship between measures of OSA (AHI, oxygen desaturation index (ODI), mean and lowest oxygen saturation) and lipid profile (total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and fasting triglycerides (TG)) was determined by means of general linear model analysis. RESULTS: There was a dose response relationship between TC and ODI (mean ± SE (mg/dL): 180.33 ± 2.46, 184.59 ± 2.42, 185.44 ± 2.42 and 185.73 ± 2.44; P < 0.001 across ODI quartiles I-IV). TG and LDL concentrations were better predicted by AHI than by ODI. HDL-C was significantly reduced in the highest AHI quartile (mean ± SE (mg/dL): 48.8 ± 1.49 vs 46.50 ± 1.48; P = 0.002, AHI quartile I vs IV). Morbid obesity was associated with lower TC and higher HDL-C values. Lipid status was influenced by geographical location with the highest TC concentration recorded in Northern Europe. CONCLUSION: OSA severity was independently associated with cholesterol and TG concentrations.


Assuntos
Doenças Cardiovasculares , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Dislipidemias , Hipolipemiantes/uso terapêutico , Apneia Obstrutiva do Sono , Triglicerídeos/sangue , Adulto , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Estudos de Coortes , Estudos Transversais , Bases de Dados Factuais , Dislipidemias/sangue , Dislipidemias/diagnóstico , Dislipidemias/tratamento farmacológico , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Apneia Obstrutiva do Sono/sangue , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia
7.
J Sleep Res ; 27(6): e12729, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29998568

RESUMO

Obstructive sleep apnea (OSA) and asthma are often associated and several studies suggest a bidirectional relationship between asthma and OSA. This study analyzed the characteristics of patients with suspected OSA from the European Sleep Apnea Database according to presence/absence of physician-diagnosed asthma. Cross-sectional data in 16,236 patients (29.1% female) referred for suspected OSA were analyzed according to occurrence of physician-diagnosed asthma for anthropometrics, OSA severity and sleepiness. Sleep structure was assessed in patients studied by polysomnography (i.e. 48% of the sample). The prevalence of physician-diagnosed asthma in the entire cohort was 4.8% (7.9% in women, 3.7% in men, p < 0.0001), and decreased from subjects without OSA to patients with mild-moderate and severe OSA (p = 0.02). Obesity was highly prevalent in asthmatic women, whereas BMI distribution was similar in men with and without physician-diagnosed asthma. Distribution of OSA severity was similar in patients with and without physician-diagnosed asthma, and unaffected by treatment for asthma or gastroesophageal reflux. Asthma was associated with poor sleep quality and sleepiness. Physician-diagnosed asthma was less common in a sleep clinic population than expected from the results of studies in the general population. Obesity appears as the major factor raising suspicion of OSA in asthmatic women, whereas complaints of poor sleep quality were the likely reason for referral in asthmatic men.


Assuntos
Asma/diagnóstico , Asma/epidemiologia , Papel do Médico , Autorrelato , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Adulto , Idoso , Asma/fisiopatologia , Estudos de Coortes , Estudos Transversais , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia/métodos , Estudos Prospectivos , Apneia Obstrutiva do Sono/fisiopatologia
8.
Turk Thorac J ; 19(2): 73-76, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29755810

RESUMO

OBJECTIVES: Traffic accidents associated with high mortality rate may produce serious problems especially in highways. Obstructive sleep apnea (OSA) has been associated with a high risk for traffic accidents due to excessive daytime sleepiness even in in-city drivers. In the present study, it was aimed to evaluate the rate of OSA symptoms and to identify risk factors associated with traffic accidents in in-city bus drivers. MATERIAL AND METHODS: A self-administered questionnaire including demographic and anthropometric features, sleep and work schedules, Berlin questionnaire, Epworth sleepiness score (ESS), and history of traffic accidents was used. RESULTS: The questionnaire was conducted for 1400 male bus drivers (mean age, 38.0±6.4 y, body mass index, 27.8±3.9 kg/m2). A total of 1058 (75.6%) drivers had one or more accidents while driving bus. According to the Berlin questionnaire, 176 (12.6%) drivers were found to have high OSA risk and the accident rate was 83.0% in high-risk group, whereas 74.5% of low-risk drivers had accidents (p=0.043). The drivers with a history of traffic accident were older (p=0.030), had higher ESS (p=0.019), and were more in the high-risk OSA group according to the Berlin questionnaire (p=0.015). In multivariate linear regression analysis, traffic accident was associated with only Berlin questionnaire (p=0.015). CONCLUSION: The present results support that city bus drivers with high OSA risk according to Berlin questionnaire have increased accident rates. Therefore, we suggest using Berlin questionnaire for screening sleep apnea not only in highway drivers but also in in-city bus drivers.

9.
J Sleep Res ; 27(6): e12705, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29797754

RESUMO

The effect of positive airway pressure treatment on weight and markers of central obesity in patients with obstructive sleep apnea remains unclear. We studied the change in body weight and anthropometric measures following positive airway pressure treatment in a large clinical cohort. Patients with obstructive sleep apnea with positive airway pressure treatment from the European Sleep Apnea Database registry (n = 1,415, 77% male, age 54 ± 11 [mean ± SD] years, body mass index 31.7 ± 6.4 kg/m2 , apnea-hypopnea index 37 ± 24 n per hr, Epworth Sleepiness Scale 10.2 ± 5.0) were selected. Changes in body mass index and neck/waist/hip circumferences at baseline and at follow-up visit were analysed. Overall, body mass index (0.0 [95% confidence interval, -0.1 to 0.2] kg/m2 ) and neck circumference (0.0 (95% confidence interval, -0.1 to 0.1] cm) were unchanged after positive airway pressure treatment compared with baseline (follow-up duration 1.1 ± 1.0 years and compliance 5.2 ± 2.1 hr per day). However, in non-obese (body mass index <30 kg/m2 ) patients, positive airway pressure treatment was associated with an increased body mass index and waist circumference (0.4 [0.3-0.5] kg/m2 and 0.8 [0.4-1.2] cm, respectively, all p < 0.05), and weight gain was significantly associated with higher positive airway pressure compliance and longer positive airway pressure treatment duration. In the obese subgroup, body mass index was reduced after positive airway pressure treatment (-0.3 [-0.5 to -0.1] kg/m2 , p < 0.05) mainly in patients with a strong reduction in Epworth Sleepiness Scale. In conclusion, positive airway pressure therapy was not found to systematically change body mass index in the European Sleep Apnea Database cohort, but the response was heterogeneous. Our findings suggest that weight gain may be restricted to an obstructive sleep apnea phenotype without established obesity. Lifestyle intervention needs to be considered in both lean and obese patients with obstructive sleep apnea receiving positive airway pressure treatment.


Assuntos
Peso Corporal/fisiologia , Pressão Positiva Contínua nas Vias Aéreas/tendências , Obesidade Abdominal/epidemiologia , Obesidade Abdominal/terapia , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/terapia , Adulto , Idoso , Índice de Massa Corporal , Estudos de Coortes , Pressão Positiva Contínua nas Vias Aéreas/métodos , Análise de Dados , Europa (Continente)/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Obesidade Abdominal/diagnóstico , Estudos Prospectivos , Apneia Obstrutiva do Sono/diagnóstico , Fatores de Tempo , Circunferência da Cintura/fisiologia , Ganho de Peso/fisiologia
10.
Chest ; 154(2): 326-334, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29698721

RESUMO

BACKGROUND: The impact of treating OSA on renal function decline is controversial. Previous studies usually included small samples and did not consider specific effects of different CPAP modalities. The aim of this study was to evaluate the respective influence of fixed and autoadjusting CPAP modes on estimated glomerular filtration rate (eGFR) in a large sample of patients derived from the prospective European Sleep Apnea Database cohort. METHODS: In patients of the European Sleep Apnea Database, eGFR prior to and after follow-up was calculated by using the Chronic Kidney Disease-Epidemiology Collaboration equation. Three study groups were investigated: untreated patients (n = 144), patients receiving fixed CPAP (fCPAP) (n = 1,178), and patients on autoadjusting CPAP (APAP) (n = 485). RESULTS: In the whole sample, eGFR decreased over time. The rate of eGFR decline was significantly higher in the subgroup with eGFR above median (91.42 mL/min/1.73 m2) at baseline (P < .0001 for effect of baseline eGFR). This decline was attenuated or absent (P < .0001 for effect of treatment) in the subgroup of patients with OSA treated by using fCPAP. A follow-up duration exceeding the median (541 days) was associated with eGFR decline in the untreated and APAP groups but not in the fCPAP group (P < .0001 by two-way ANOVA for interaction between treatment and follow-up length). In multiple regression analysis, eGFR decline was accentuated by advanced age, female sex, cardiac failure, higher baseline eGFR, and longer follow-up duration, whereas there was a protective effect of fCPAP. CONCLUSIONS: fCPAP but not APAP may prevent eGFR decline in OSA.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Taxa de Filtração Glomerular , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/terapia , Europa (Continente) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Estudos Prospectivos , Sistema de Registros , Fatores de Risco
11.
Sleep Breath ; 22(4): 1013-1020, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29352360

RESUMO

PURPOSE: Obstructive sleep apnea (OSA) is a common sleep disorder affecting health-related quality of life (QoL), and OSA severity is not a reliable indicator for QoL. The aim of this study was (1) to evaluate the impact of gender on QoL and (2) to identify the predictors of QoL in OSA patients. METHODS: World Health Organization Quality of Life Scale short form (WHOQOL-Bref) was used for evaluating QoL in OSA patients undergoing polysomnography in sleep laboratory of a university hospital. RESULTS: Out of 197 patients (age 50.4 ± 12.1 years, AHI 38.5 ± 28.4/h), 139 (70.6%) were men and 79.2% had moderate-to-severe OSA. Female gender, increased BMI, higher Epworth sleepiness score (ESS), and lower oxygen saturations were associated significantly with poor QoL in terms of all domains (physical, psychological, social relationship, and environmental) of WHOQOL-Bref questionnaire. The indicators of OSA severity (AHI and ODI) correlated negatively only with the physical domain. The subjects with comorbid insomnia and OSA had lower physical and social scores than subjects with no insomnia, and women with insomnia had significantly worse QoL scores in all domains than the others. In the multivariate linear regression analysis, female gender, comorbid insomnia, increased sleepiness, and higher BMI were significantly associated with poor QoL. CONCLUSIONS: Female gender, comorbid insomnia, and daytime sleepiness were the outstanding factors affecting health-related QoL negatively in OSA. Besides, the impact of OSA on QoL may be explained by the presence of daytime sleepiness rather than OSA severity.


Assuntos
Distúrbios do Sono por Sonolência Excessiva/epidemiologia , Qualidade de Vida , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Adulto , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Fatores Sexuais , Inquéritos e Questionários
12.
Sleep Breath ; 22(1): 241-249, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28197893

RESUMO

PURPOSE: Obstructive sleep apnea (OSA) is underdiagnosed in females due to different clinical presentation. We aimed to determine the effect of gender on clinical and polysomnographic features and identify predictors of OSA in women. METHODS: Differences in demographic, clinical, and polysomnographic parameters between 2052 male and 775 female OSA patients were compared. RESULTS: In female OSA patients, age (56.1 ± 9.7 vs. 50.4 ± 11.6 years, p < 0.0001) and body mass index (36.3 ± 8.6 vs. 31.8 ± 5.9 kg/m2, p < 0.0001) were increased, whereas men had higher waist-to-hip ratio and neck circumference (p < 0.0001). Hypertension, diabetes mellitus, thyroid disease, and asthma were more common in females (p < 0.0001). Men reported more witnessed apnea (p < 0.0001), but nocturnal choking, morning headache, fatigue, insomnia symptoms, impaired memory, mood disturbance, reflux, nocturia, and enuresis were more frequent in women (p < 0.0001). The indicators of OSA severity including apnea-hypopnea index (AHI) (p < 0.0001) and oxygen desaturation index (p = 0.007) were lower in women. REM AHI (p < 0.0001) was higher, and supine AHI (p < 0.0001) was lower in females. Besides, women had decreased total sleep time (p = 0.028) and sleep efficiency (p = 0.003) and increased sleep latency (p < 0.0001). In multivariate logistic regression analysis, increased REM AHI, N3 sleep, obesity, age, morning headache, and lower supine AHI were independently associated with female gender. CONCLUSIONS: These data suggest that frequency and severity of sleep apnea is lower in female OSA patients, and they are presenting with female-specific symptoms and increased medical comorbidities. Therefore, female-specific questionnaires should be developed and used for preventing underdiagnosis of OSA.


Assuntos
Caracteres Sexuais , Apneia Obstrutiva do Sono/fisiopatologia , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Estudos Retrospectivos , Fases do Sono
13.
Clin Respir J ; 12(1): 105-112, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27148977

RESUMO

BACKGROUND: The co-existence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) is a common phenomenon referred to as overlap syndrome (OS). In this study, we evaluated the prevalence of OS in mild hypoxemic COPD patients without OSA symptoms and compared characteristics of OS and COPD patients. METHODS: Forty-five COPD patients (mean FEV1 1671.3 ± 532.0 mL) with mild hypoxemia presenting no sleep apnea symptoms (96% men, mean age 67.7 ± 8.5 years) were involved in this study. Clinical characteristics were recorded, biochemical analysis and polygraphy were performed. RESULTS: Twenty-six patients with a RDI of ≥15 events/h were defined as OS (58%). When OS (n = 26) and COPD without OSA (n = 19) groups were compared, BMI (29.6 ± 6.6 vs 25.6 ± 4.9 kg/m2 ; P = 0.03), TNF-α level (24.8 ± 8.1 vs 3.6 ± 0.8 ng/mL; P = 0.03) and sleep time with SpO2 < 90% (23.9 ± 29.4 vs 9.7 ± 21.9%; P = 0.02) were significantly increased in OS. Univariate analysis showed a correlation between RDI and BMI (P < 0.01), Epworth score (P = 0.050), COPD exacerbation frequency (P = 0.046) and TNF-α (P = 0.048). However, multivariate linear regression analysis revealed a significant correlation only between RDI and BMI (P < 0.01). BMI as a predictor of OSA was examined through ROC curve analysis and the area under curve was 0.691 (P = 0.03). To identify OS patients, BMI > 27.2 kg/m2 had a sensitivity of 73% and specificity of 68%. CONCLUSIONS: This findings support that high prevalence (58%) of OS in COPD patients without OSA symptoms is related to BMI. Therefore, sleep study should be considered in especially overweight or obese COPD patients, even in those without sleep apnea symptoms.


Assuntos
Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doenças do Tecido Conjuntivo Indiferenciado/epidemiologia , Idoso , Comorbidade/tendências , Feminino , Humanos , Masculino , Curva ROC , Fatores de Risco , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono , Turquia/epidemiologia , Doenças do Tecido Conjuntivo Indiferenciado/diagnóstico
14.
Pulm Pharmacol Ther ; 45: 13-18, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28392320

RESUMO

BACKGROUND: Adenosine 5'-triphosphate (ATP) stimulates pulmonary vagal slow conducting C-fibres and fast conducting Aδ-fibres with rapidly adapting receptors (RARs). Pulmonary C-fibres but not RARs are also sensitive to capsaicin, a potent tussigenic agent in humans. Thus, the aim of this study was to determine the effects of ATP and its metabolite adenosine (given as adenosine 5'-monophosphate, AMP) on capsaicin challenge in asthmatic patients. METHODS: Cough (quantified as visual analogue scale, VAS), dyspnoea (quantified as Borg score), and FEV1 were quantified following bronchoprovocation using capsaicin, adenosine and ATP in healthy non-smokers (age 40±4y, 6 males), smokers (45±4y, 5 males) and asthmatic patients (37±3y, 5 males); n = 10 in each group. RESULTS: None of the healthy non-smokers responded to either AMP or ATP. AMP induced bronchoconstriction in one smoker and eight asthmatics, and ATP in two smokers and all ten asthmatics. The geometric mean of capsaicin causing ≥5 coughs (C5) increased from 134 to 203 µM in non-smokers and from 117 to 287 µM in asthmatics after AMP, whereas it decreased from 203 to 165 µM and 125 to 88 µM, respectively after ATP. AMP decreased C5 from 58 to 29 µM and ATP increased from 33 to 47 µM in smokers. However, due to intergroup variability, these effects of ATP and AMP were not statistically significant (0.125 ≤ p ≤ 0.998). That notwithstanding, in healthy and asthmatic subjects the effects of the ATP showed a tendency to be greater than those of AMP (p < 0.053). Dyspnea, assessed by Borg score, increased after ATP (p < 0.001) and AMP (p < 0.001) only in asthmatic patients. Intensity of cough assessed by VAS increased (p < 0.05) after second capsaicin challenges performed after AMP in all groups, but not after ATP. CONCLUSIONS: Asthmatic patients exhibit hypersensitivity to aerosolized AMP and ATP, but aerosolized AMP does not mimic the effects of ATP and the effects of ATP are not mediated by adenosine.


Assuntos
Monofosfato de Adenosina/administração & dosagem , Trifosfato de Adenosina/administração & dosagem , Asma/fisiopatologia , Capsaicina/administração & dosagem , Adulto , Hiper-Reatividade Brônquica/etiologia , Testes de Provocação Brônquica , Broncoconstrição/efeitos dos fármacos , Estudos de Casos e Controles , Tosse/epidemiologia , Tosse/etiologia , Método Duplo-Cego , Dispneia/epidemiologia , Dispneia/etiologia , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Estudos Prospectivos , Fumar/epidemiologia
15.
J Sleep Res ; 25(6): 739-745, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27191365

RESUMO

The cross-sectional relationship of obstructive sleep apnea with moderate to severe chronic kidney disease, defined as an estimated glomerular filtration rate <60 mL min-1 ∙1.73 m-2 , was investigated in a large cohort of patients with suspected obstructive sleep apnea studied by nocturnal polysomnography or cardiorespiratory polygraphy. Data were obtained from the European Sleep Apnea Database, where information from unselected adult patients with suspected obstructive sleep apnea afferent to 26 European sleep centres had been prospectively collected. Both the Modification of Diet in Renal Disease and the Chronic Kidney Disease-Epidemiology Collaboration equations were used for the assessment of estimated glomerular filtration rate. The analysed sample included 7700 subjects, 71% male, aged 51.9 ± 12.5 years. Severe obstructive sleep apnea (apnea-hypopnea index ≥30) was found in 34% of subjects. The lowest nocturnal oxygen saturation was 81 ± 10.2%. Chronic kidney disease prevalence in the whole sample was 8.7% or 6.1%, according to the Modification of Diet in Renal Disease or the Chronic Kidney Disease-Epidemiology Collaboration equations, respectively. Subjects with lower estimated glomerular filtration rate were older, more obese, more often female, had worse obstructive sleep apnea and more co-morbidities (P < 0.001, each). With both equations, independent predictors of estimated glomerular filtration rate <60 were: chronic heart failure; female gender; systemic hypertension; older age; higher body mass index; and worse lowest nocturnal oxygen saturation. It was concluded that in obstructive sleep apnea, chronic kidney disease is largely predicted by co-morbidities and anthropometric characteristics. In addition, severe nocturnal hypoxaemia, even for only a small part of the night, may play an important role as a risk factor for kidney dysfunction.


Assuntos
Insuficiência Renal Crônica/epidemiologia , Apneia Obstrutiva do Sono/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Estudos de Coortes , Comorbidade , Estudos Transversais , Europa (Continente)/epidemiologia , Feminino , Taxa de Filtração Glomerular , Insuficiência Cardíaca/epidemiologia , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Oxigênio/metabolismo , Polissonografia , Prevalência , Fatores de Risco , Caracteres Sexuais , Apneia Obstrutiva do Sono/metabolismo , Adulto Jovem
16.
J Card Fail ; 21(10): 842-7, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26091958

RESUMO

BACKGROUND: Overnight rostral leg fluid displacement in heart failure (HF) patients is related to the high prevalence and severity of obstructive sleep apnea syndrome (OSAS). We hypothesized that rostral fluid shift would decrease in a semirecumbent (45-degree elevated) position, and evaluated the effect of semirecumbent sleeping on severity of sleep apnea in HF patients with OSAS. METHODS AND RESULTS: Demographic, anthropometric characteristics, and medical history of 30 consecutive patients with HF and OSAS were recorded. The patients underwent 2 polysomnographic procedures within 1 week: 1 while lying flat and the other in a semirecumbent position. Out of 30 patients (mean age 54.7 ± 10.2, 26 men), 16 (53.3%) were obese and 29 (96.7%) had comorbidities other than HF. Mean apnea-hypopnea index was 30.8 ± 20.7 events/h while lying flat which decreased to 17.8 ± 12.1 events/h in semirecumbent position (P < .0001). Similarly, oxygen desaturation index decreased from 22.3 ± 19.8 to 12.7 ± 11.5 events/h (P < .0001), and the percentage of sleep time with oxygen saturation (SpO2) <90% (P = .036) and lowest SpO2 (P = .004) were improved in the semirecumbent position. Furthermore, the percentage of stage N2 sleep decreased from 47.0% while lying flat to 39.6% (P = .014). CONCLUSIONS: The present findings support that the severity of OSAS decreased significantly in a semirecumbent sleep position in patients with HF. Therefore, semirecumbent sleeping may be a promising therapeutic option in the management of HF-related sleep apnea.


Assuntos
Insuficiência Cardíaca/terapia , Polissonografia/tendências , Postura , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/terapia , Fases do Sono/fisiologia , Adulto , Estudos Transversais , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Decúbito Dorsal
17.
Chest ; 148(2): 430-435, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25590209

RESUMO

BACKGROUND: Extracellular adenosine 5'-triphosphate (ATP) stimulates vagal C and Aδ fibers in the lung, resulting in pronounced bronchoconstriction and cough mediated by P2X2/3 receptors located on vagal sensory nerve terminals. We investigated the effects of nebulized ATP on cough and symptoms in control subjects, healthy smokers, and patients with COPD and compared these responses to the effects of inhaled adenosine, the metabolite of ATP. METHODS: We studied the effects of inhaled ATP and adenosine monophosphate (AMP) on airway caliber, perception of dyspnea assessed by the Borg score, cough sensitivity, and ATP in exhaled breath condensate in healthy nonsmokers (n = 10), healthy smokers (n = 14), and patients with COPD (n = 7). RESULTS: In comparison with healthy subjects, ATP induced more dyspnea, cough, and throat irritation in smokers and patients with COPD, and the effects of ATP were more pronounced than those of AMP. The concentration of ATP in the exhaled breath condensate of patients with COPD was elevated compared with that of healthy subjects. CONCLUSIONS: Smokers and patients with COPD manifest hypersensitivity to extracellular ATP, which may play a mechanistic role in COPD.


Assuntos
Monofosfato de Adenosina/efeitos adversos , Trifosfato de Adenosina/efeitos adversos , Tosse/induzido quimicamente , Dispneia/induzido quimicamente , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Fumar/fisiopatologia , Monofosfato de Adenosina/farmacologia , Trifosfato de Adenosina/farmacologia , Administração por Inalação , Adulto , Testes Respiratórios , Brônquios/efeitos dos fármacos , Broncoconstrição/efeitos dos fármacos , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença
18.
Arch Oral Biol ; 60(1): 134-43, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25455127

RESUMO

OBJECTIVES: Despite increasing evidence for an association of obstructive sleep apnea syndrome (OSAS) and periodontal disease, the pathophysiological linking mechanisms remain unclear. This study aims to evaluate the salivary and serum matrix metalloproteinase-2, -8, -9 (MMP-2, -8, -9), tissue inhibitor of matrix metalloproteinase-1 (TIMP-1), myeloperoxidase (MPO), neutrophil elastase (NE), neutrophil gelatinase-associated lipocalin (NGAL), as well as degree of activation of MMP-2, -9 of patients with and without OSAS. DESIGN: A total of 50 individuals were included in the study. There were 13, 17 and 20 individuals, respectively in the control (non-OSAS) group, mild-to-moderate OSAS and severe OSAS groups. Saliva, serum samples and clinical periodontal parameters were collected. Biofluid samples were analysed by immunofluorometric assay (IFMA), enzyme-linked immunosorbent assay (ELISA), western immunoblotting and gelatine zymography. Statistical analyses were performed using D'Agostino-Pearson omnibus normality test, Kruskal-Wallis test and Spearman rho rank correlation analysis. RESULTS: There were no statistically significant differences in clinical periodontal parameters between the study groups. Salivary NE and proMMP-2 levels were significantly lower in the OSAS groups than the control group (p<0.05). Serum proMMP-9 concentration and the degree of MMP-9 activation in saliva were significantly lower in the severe OSAS group than the control group (p<0.05). There were significant correlations between salivary and serum proMMP-9 and -2 concentrations (p<0.05). Serum proMMP-2, NE and salivary proMMP-9 and -2 negatively correlated with indicators of OSAS severity (p<0.05). CONCLUSIONS: The present findings do not support a pathophysiological link between the severity of OSAS and clinical periodontal status via neutrophil enzymes or MMPs.


Assuntos
Colagenases/metabolismo , Doenças Periodontais/enzimologia , Saliva/enzimologia , Apneia Obstrutiva do Sono/enzimologia , Proteínas da Fase Aguda/metabolismo , Adulto , Biomarcadores/metabolismo , Western Blotting , Estudos de Casos e Controles , Precursores Enzimáticos/metabolismo , Ensaio de Imunoadsorção Enzimática , Feminino , Fluorimunoensaio , Humanos , Elastase de Leucócito/metabolismo , Lipocalina-2 , Lipocalinas/metabolismo , Masculino , Metaloproteinase 8 da Matriz/metabolismo , Metaloproteinase 9 da Matriz/metabolismo , Pessoa de Meia-Idade , Peroxidase/metabolismo , Proteínas Proto-Oncogênicas/metabolismo , Índice de Gravidade de Doença , Inibidor Tecidual de Metaloproteinase-1/metabolismo
19.
Sleep Breath ; 19(2): 585-92, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25173794

RESUMO

BACKGROUND: It is claimed that gastroesophageal reflux disease (GERD) increases in patients with obstructive sleep apnea syndrome (OSAS). We aimed to evaluate the prevalence of GERD in patients with OSAS and primary snoring and identify OSAS-related risk factors associated with GERD. METHODS: In this prospective, cross-sectional, multicenter study, in total 1,104 patients were recruited for polysomnography: 147 subjects were in non-OSAS (primary snoring) and 957 patients were in OSAS group. All patients completed a validated GERD questionnaire. Demographic, anthropometric characteristics, and medical history were recorded. RESULTS: The prevalence of GERD was similar in OSAS (38.9%) and non-OSAS (32.0%) groups (p = 0.064). There was no difference in terms of major gastroesophageal reflux (GER) symptoms (heartburn/acid regurgitation) between non-OSAS and mild, moderate, and severe OSAS groups. The prevalence of GERD was increased in female OSAS patients (46.6%) compared to males (35.7%) (p = 0.002). In OSAS patients with GERD, body mass index was greater (34.0 ± 7.0 vs. 33.1 ± 6.8, p = 0.049), waist (115.5 ± 13.9 vs. 113.1 ± 13.4, p = 0.007) and hip (117.9 ± 13.7 vs. 114.2 ± 12.8, p < 0.0001) circumferences were larger, and Epworth sleepiness scores were higher (10.3 ± 6.0 vs. 8.8 ± 5.6, p < 0.0001) than OSAS patients without GERD. Multivariate analysis showed that GERD was significantly associated with female gender, hip circumference, and daytime sleepiness. CONCLUSIONS: In this large cohort, the prevalence of GERD was significantly increased in those with primary snoring and OSAS compared to the general population, but severity of OSAS did not influence GERD prevalence. The present results suggest that OSAS was not likely a causative factor but female gender, obesity, and sleepiness were related with prevalence of GERD in OSAS patients.


Assuntos
Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/epidemiologia , Obesidade/complicações , Obesidade/epidemiologia , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/etiologia , Adulto , Causalidade , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Fatores de Risco , Fatores Sexuais
20.
Int J Otolaryngol ; 2014: 438376, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25349613

RESUMO

Objectives. There are many studies regarding unnecessary polysomnography (PSG) when obstructive sleep apnea syndrome (OSAS) is suspected. In order to reduce unnecessary PSG, this study aims to predict the apnea-hypopnea index (AHI) via simple clinical data for patients who complain of OSAS symptoms. Method. Demographic, anthropometric, physical examination and laboratory data of a total of 390 patients (290 men, average age 50 ± 11) who were subject to diagnostic PSG were obtained and evaluated retrospectively. The relationship between these data and the PSG results was analyzed. A multivariate linear regression analysis was performed step by step to identify independent AHI predictors. Results. Useful parameters were found in this analysis in terms of body mass index (BMI), waist circumference (WC), neck circumference (NC), oxygen saturation measured by pulse oximetry (SpO2), and tonsil size (TS) to predict the AHI. The formula derived from these parameters was the predicted AHI = (0.797 × BMI) + (2.286 × NC) - (1.272 × SpO2) + (5.114 × TS) + (0.314 × WC). Conclusion. This study showed a strong correlation between AHI score and indicators of obesity. This formula, in terms of predicting the AHI for patients who complain about snoring, witnessed apneas, and excessive daytime sleepiness, may be used to predict OSAS prior to PSG and prevent unnecessary PSG.

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