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.

[Is Widal syndrome always a severe disease?]. / Sindromul Widal este totdeauna o maladie severa?

CONTEXT: the Widal syndrome (WS) is known as the association of bronchial asthma to aspirin intolerance, nasal polyposis and/or allergic rhinitis, typical considered to have a difficult course. OBJECTIVES: finding the prevalence and severity of WS in general medical practice. VENUE: data bases from a private pneumology practice and the ambulatory of a pneumology clinic in Timisoara. PARTICIPANTS: 473 asthma patients, among which 41 (8.66%) matched the criteria for WS. There were 31 women (75.6%) and 10 men (24.39%). MAIN PARAMETERS EVALUATED: spirometry, ENT examination, skin allergy tests, serum IgE. RESULTS: most cases (22 pts., 53.65%) had mild to moderate asthma. Monitoring the cases for 4 years didn't show any worsening. The 19 severe cases (46.35%) had a progressive course, despite a complex treatment (anti-leukotrienes + systemic corticosteroids in high doses + long acting beta 2 agonists + long acting theophylline). The results don't match the classical description of WS, with a dominance of severe forms. CONCLUSIONS: in general medical practice WS has a frequency of 8.66% among asthmatic population, and the mild and moderate forms represent 53.65% and it seems they keep like that a long time.

[Cigarette smoke extract induces endothelium dysfunction in isolated rabbit pulmonary arteries via an oxidative mechanism]. / Extractul de fum de tigara induce disfunctie endoteliala în arterele pulmonare izolate de iepure printr-un mecanism oxidativ.

In early stages of COPD, lacking hypoxemia, pulmonary arteries yet show endothelial abnormalities. This vascular impairment could be assigned to noxious effects of some cigarette smoke components. The aim of the present study was to investigate the effect of cigarette smoke extract (CSE) on endothelial vasomotor function in isolated rabbit pulmonary arteries in the presence or absence of a natural antioxidant with superoxide dismutase activity (SODn). After incubation of vascular rings with CSE (5% in organ bath) vascular responses to acetylcholine (endothelial-dependent vasodilator agent) and sodium nitroprusside (endothelial-independent vasodilator agent) were evaluated. Our results showed the impairment of endothelial dependent vasodilation (maximal relaxation expressed as % was 28.32 +/- 10.15 vs. 46.36 +/- 8.04 in the group coincubated with SODn, p < 0.01) while endothelial independent relaxation was preserved (maximal response expressed as % was 95.04 +/- 7.40 vs. 97.54 +/- 4.58 in the group coincubated with natural antioxidant, p = NS). In conclusion, the hydrosoluble components of CSE induced endothelial vasomotor function impairment, most probable, via an oxidative mechanism.

[Test for determination of attention in patients with sleep apnea syndrome]. / Test pentru determinarea atentiei la pacientii cu sindrom de apnee în somn.

To investigate the daytime sleepiness in patients with sleep apnea syndrome, we used a test for measurement of sustained attention. The present study was performed on 65 participants: 10 healthy non-snoring volunteers, 25 snoring volunteers and 30 patients with symptoms of sleep apnea. The error rate (percentage of incorrect responses) appears to be most suitable for the evaluation of the test. The difference between the habitual snorers and the healthy non-snoring volunteers was statistically significant. At the apneic patients, there are significant differences in age, sex, and body mass index; attention decreases significantly in the last 10 minutes of the test. The attention test can be helpful for the measurement of daytime sleepiness in apneic patients.