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1.
Eur Respir Rev ; 28(153)2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31604817

RESUMO

Central sleep apnoea (CSA) including periodic breathing is prevalent in more than one-third of patients with heart failure and is highly and independently associated with poor outcomes. Optimal treatment is still debated and well-conducted studies regarding efficacy and impact on outcomes of available treatment options are limited, particularly in cardiac failure with preserved ejection fraction. While continuous positive airway pressure and oxygen reduce breathing disturbances by 50%, adaptive servoventilation (ASV) normalises breathing disturbances by to controlling the underlying mechanism of CSA. Results are contradictory regarding impact of ASV on hard outcomes. Cohorts and registry studies show survival improvement under ASV, while secondary analyses of the large SERVE-HF randomised trial showed an excess mortality in cardiac failure with reduced ejection fraction. The current priority is to understand which phenotypes of cardiac failure patients may benefit from treatment guiding individualised and personalised management.

2.
Eur Respir Rev ; 28(153)2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31554703

RESUMO

COPD and obstructive sleep apnoea (OSA) are highly prevalent and different clinical COPD phenotypes that influence the likelihood of comorbid OSA. The increased lung volumes and low body mass index (BMI) associated with the predominant emphysema phenotype protects against OSA whereas the peripheral oedema and higher BMI often associated with the predominant chronic bronchitis phenotype promote OSA. The diagnosis of OSA in COPD patients requires clinical awareness and screening questionnaires which may help identify patients for overnight study. Management of OSA-COPD overlap patients differs from COPD alone and the survival of overlap patients treated with nocturnal positive airway pressure is superior to those untreated. Sleep-related hypoventilation is common in neuromuscular disease and skeletal disorders because of the effects of normal sleep on ventilation and additional challenges imposed by the underlying disorders. Hypoventilation is first seen during rapid eye movement (REM) sleep before progressing to involve non-REM sleep and wakefulness. Clinical presentation is nonspecific and daytime respiratory function measures poorly predict nocturnal hypoventilation. Monitoring of respiration and carbon dioxide levels during sleep should be incorporated in the evaluation of high-risk patient populations and treatment with noninvasive ventilation improves outcomes.

4.
Sleep Med ; 59: 56-65, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30555029

RESUMO

OBJECTIVE/BACKGROUND: The Clinical Global Impression scale (CGI) reflects the clinician's assessment of the disease impact on patient's global functioning. We assessed predictors of CGI scale rating in patients with obstructive sleep apnea (OSA). PATIENTS/METHODS: Consecutive patients with suspected OSA (n = 7581) were identified in the European Sleep Apnea Database (ESADA). Anthropometrics, comorbidities, apnea severity obtained by polygraphy or polysomnography, and daytime sleepiness [Epworth Sleepiness Scale (ESS)] were assessed. The CGI 7-point scale was completed at the end of the diagnostic process (CGI-severity, ie, CGI-S) and, in a subpopulation, at treatment follow-up (CGI-Improvement). RESULTS: CGI-S was rated mild to moderate in 44% of patients. CGI rating at any given apnea intensity was worse in women than in men (p < 0.01). Patients undergoing polygraphy (n = 5075) were more frequently rated as severely ill compared to those studied with polysomnography (19.0% vs 13.0%, p < 0.001). In patients aged ≤65 years, CGI scoring was generally better than in the elderly despite a similar degree of OSA (eg, 'normal, not ill' 24.2% vs 15.3%, p < 0.01, respectively). Independent predictors of CGI rating included age, BMI, AHI, ESS, cardio-metabolic comorbidities, and diagnosis based on polygraphy. CGI-improvement rating (Beta = -0.406, p < 0.01) was superior to sleep apnea severity or ESS-score (Beta = 0.052 and -0.021, p = 0.154 and 0.538 respectively) at baseline for prediction of good CPAP compliance at follow-up. CONCLUSIONS: CGI rating is confounded by gender, age class and the type of sleep diagnostic method. As OSA phenotypes differ, CGI may contribute as a clinical tool to reflect the significance of clinical disease.

5.
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
6.
Eur J Clin Invest ; 43(12): 1299-306, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24147598

RESUMO

BACKGROUND: Growth factors mediate various cellular responses to environmental stimuli. Specifically, exposure of lung epithelium to oxidative stress induced by cigarette smoke stimulates aberrant epidermal growth factor receptor (ERBB) family activation. This study's objective was to evaluate the expression of ERBB1-4 receptors in the lung tissue of smokers with or without chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: ERBBs expression was measured by microarray analysis in lung tissue samples from five patients with COPD and five non-COPD smokers, and by quantitative real-time PCR in additional 20 patients with COPD (GOLD stage II), 15 non-COPD smokers and 10 nonsmoker controls. RESULTS: Microarray data analysis revealed that ERBB receptors expression was elevated in patients with COPD compared to non-COPD smokers, ranging from 1·62- to 2·45-fold, (P < 0·01). Real-time qPCR verified that patients with COPD had higher ERBB1-3 expression levels compared with non-COPD smokers (PERBB1  < 0·001; PERBB2  = 0·003; PERBB3  = 0·003) and nonsmokers (PERBB1  = 0·019; PERBB2  = 0·005; PERBB3  = 0·011). On the other hand, ERBB4 mRNA levels gradually increased from nonsmokers (0·74 ± 0·19) to non-COPD smokers (1·11 ± 0·05) to patients with COPD (1·57 ± 0·28) and were correlated with the degree of airflow obstruction (PFEV1  < 0·001). DISCUSSION: These data suggest that ERBB1-3 overexpression is not related only to smoking exposure but probably to epithelial remodelling and mucociliary system distortion, characterizing COPD. Additionally, the inverse correlation of ERBB4 with FEV1 exhibits a possible link between ERBB4 and COPD severity.


Assuntos
Obstrução das Vias Respiratórias/metabolismo , Receptores ErbB/metabolismo , Doença Pulmonar Obstrutiva Crônica/metabolismo , DNA Complementar/biossíntese , Volume Expiratório Forçado/fisiologia , Humanos , Pulmão/metabolismo , Masculino , Análise em Microsséries , Pessoa de Meia-Idade , RNA/metabolismo , Reação em Cadeia da Polimerase em Tempo Real , Fumar/metabolismo , Capacidade Vital/fisiologia
7.
Sleep Disord ; 2012: 308978, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23471092
8.
J Sleep Res ; 20(1 Pt 1): 92-100, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20629938

RESUMO

Alexithymia refers to dysregulation of affect characterized by difficulty in identifying and expressing emotions. Obstructive sleep apnea (OSA) is characterized by increased medical/psychiatric comorbidity and possibly by affect dysregulation. In the present case-control study, we examined alexithymia levels with the Toronto Alexithymia Scale (TAS-20) in 23 psychiatrically uncomplicated OSA outpatients and 23 same gender controls one-to-one matched for age, education and subjective depressive symptomatology. General health/quality of life was assessed with the Short-Form 36 Health Survey (SF-36) in the patient group. Hierarchical multivariate regression models were used to evaluate the association of alexithymia with the presence of OSA, and clinical and polysomnographic parameters of this condition. TAS-20 total and subscale scores were associated positively with Beck Depression Inventory (BDI)-21 and negatively with SF-36 scores. After adjusting for all confounders, OSA was positively associated with total TAS-20 score, 'expressing feelings' and 'externally oriented thinking' subscales. The latter was associated with increased sleepiness and reduced blood oxygenation in the OSA group. Finally, 'difficulty describing feelings' and 'externally oriented thinking' significantly predicted risk for OSA. Alexithymia is higher in non-psychiatrically ill patients with OSA compared with carefully matched controls even after adjustment for subjective depressive symptoms and demographic confounders. Total alexithymia is associated with greater subjective depression and poor general health/quality of life, while 'externally oriented thinking' is associated with disease severity and together with 'difficulty describing feelings' may be vulnerability factors for OSA, although reverse causality cannot be excluded.


Assuntos
Afeto/fisiologia , Sintomas Afetivos/etiologia , Apneia Obstrutiva do Sono/complicações , Adolescente , Adulto , Estudos de Casos e Controles , Depressão/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Escalas de Graduação Psiquiátrica , Psicometria , Qualidade de Vida , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/psicologia
9.
Respir Med ; 102(5): 774-9, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18304793

RESUMO

BACKGROUND: The role of angiogenesis in the pathogenesis of pleural effusion (PE) has not been determined. The expression of angiogenic factors may represent useful markers for the diagnosis and prediction of disease outcome. To measure the pleural fluid (PF) and serum levels of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and Tie receptor tyrosine kinase (Tie-2) in order to investigate their role in the pathogenesis of PEs. METHODS: Sixty-seven, 17 with transudative PEs due to heart failure and 50 with exudative PEs (malignant, 22; inflammatory, 15; undiagnosed, 13) were included in the study. PF and serum levels of the growth factors (VEGF, bFGF and Tie-2) were measured using enzyme-linked immunosorbent assays. RESULTS: PF and serum VEGF levels but not bFGF and Tie-2 levels were higher (p<0.005) in exudates than in transudates. PF VEGF levels were significantly higher in malignant than inflammatory and undiagnosed PEs (p=0.03). In addition, PF Tie-2 levels were not found different in malignant or in parapneumonic PEs. CONCLUSION: Our results showed that VEGF is one of the main mediators in exudative PEs, but this effect is not mediated through the angiogenetic pathway Ang-1/Tie-2. However, the role of angiogenesis and its pathways in the pathogenesis of exudative PEs needs further exploration.


Assuntos
Derrame Pleural/metabolismo , Receptor TIE-2/análise , Fator A de Crescimento do Endotélio Vascular/análise , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/análise , Biomarcadores/sangue , Ensaio de Imunoadsorção Enzimática/métodos , Exsudatos e Transudatos/química , Feminino , Fator 2 de Crescimento de Fibroblastos/análise , Fator 2 de Crescimento de Fibroblastos/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Neovascularização Patológica , Derrame Pleural/sangue , Derrame Pleural/fisiopatologia , Derrame Pleural Maligno/sangue , Derrame Pleural Maligno/metabolismo , Derrame Pleural Maligno/fisiopatologia , Estudos Prospectivos , Receptor TIE-2/sangue , Estatísticas não Paramétricas , Fator A de Crescimento do Endotélio Vascular/sangue
10.
J Otolaryngol ; 32(3): 174-9, 2003 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-12921136

RESUMO

OBJECTIVE: To determine the efficacy of the laser-assisted uvulopalatoplasty (LAUP) procedure on snoring and Apnea-Hypopnea-Index (AHI) improvement in patients with snoring and mild obstructive sleep apnea syndrome (OSAS). STUDY DESIGN: Prospective, nonrandomized, nonblinded assessment of outcomes after LAUP in patients suffering from benign habitual snoring and/or mild OSAS. METHODS: Fifty-nine patients with habitual snoring and 25 patients with mild OSAS underwent LAUP (6 of them underwent simultaneous classic tonsillectomy and 20 carbon-dioxide laser tonsillotomy). All patients and their bed partners completed pre- and post-treatment questionnaires ranking snoring, whereas the patients with mild OSAS underwent postoperative polysomnography (PSG). RESULTS: During a 6-month to 5-year follow-up (mean 40 months), 91.5% of the patients with habitual snoring reported significant short-term improvement based on post-treatment questionnaires, whereas 79.7% reported long-term subjective improvement. Nineteen of 25 patients (76%) with mild OSAS reported significant improvement of snoring based on posttreatment questionnaires. According to the postoperative PSG, only 2% showed a worse AHI, whereas 60% showed reduction of the AHI to < or = 5. Eight patients (32%) showed little or no improvement of AHI. CONCLUSIONS: LAUP, in combination with carbon-dioxide laser tonsillotomy in some cases, is a safe, cost-effective, outpatient procedure for the treatment of many cases of habitual snoring and mild OSAS when preceded by careful selection of the candidates.


Assuntos
Terapia a Laser/métodos , Palato/cirurgia , Apneia Obstrutiva do Sono/cirurgia , Ronco/cirurgia , Úvula/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Estudos Prospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
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