The prevalence of sleep impairments and predictors of sleep quality among patients with asthma.

BACKGROUND: Sleep is a significant dimension of daily life. However, only a few studies have examined the sleep quality of asthmatics in a real-world clinical settings. OBJECTIVE: This study is aimed to estimate the prevalence of sleep impairments among asthmatic patients and examine the relationship between sleep quality, asthma control, rhinitis symptoms, and sociodemographic characteristics. METHODS: The present study adopted the observational cross-sectional research design that has been designed by the Italian Respiratory Society and used valid assessments to measure the study variables. RESULTS: Data from 1150 asthmatic patients (mean age 51.01 years ± 16.03) were subjected to analysis. 58.3% of the patients had impaired sleep quality (Pittsburgh Sleep Quality Index [PSQI] total scores > 5), and their mean PSQI score was 5.68 (SD = 3.4). A significant correlation emerged between sleep quality and asthma control (p = 0.0001) and a significant albeit weak correlation emerged between PSQI total scores and Total 5 Symptoms Score (r = 0.24, p = 0.0001). Sleep quality was significantly associated health-related quality of life [HRQoL]. (r = 0.50, p < 0.001). After exclusion of patients at risk for Obstructive Sleep Apnea Syndrome (OSAS) and Gastro Esophageal Reflux Disease (GERD), the most important determinants of PSQI score were HRQoL, In the entire sample asthma control is the strongest predictor of both sleep quality and HRQoL. CONCLUSIONS: The results of this real-world study highlight the prevalence, impact and predictors of sleep disturbances in asthmatic patients and suggest the need for physicians to detect poor sleep quality.

Predictive indexes of nocturnal desaturation in COPD patients not treated with long term oxygen therapy.

Nocturnal oxygen desaturation during the sleep is very frequent in patients affected by chronic obstructive pulmonary disease (COPD). Hypoventilation, rather than sleeping apnea, is commonly considered as the most relevant factor in the onset of nocturnal oxygen desaturation. On this topic, the Authors have carried on a study on the nocturnal hypoxemia in 70 hospitalized COPD patients with a mean FEV1% of 40 +/- 21 and a mean PaO2 of 67.7 +/- 6.1. Anthropometric features (sex, age, body mass index) and functional respiratory parameters (FEV1, FEV1/VC, PaO2, PaCO2, SaO2, pH) were considered. Moreover all the patients were monitorized with transcutaneous pulse oxymetry, while breathing environmental air, in nighttime. Mean oxyhemoglobinic nocturnal saturation (SaO2 noct.%), minimum registered value of nocturnal SaO2 (min SaO2 noct.%) and the minutes of nighttime SaO2 < or = 90% and < or = 85% (tSaO2 < or = 90% e < or = 85%) were considered. Fiftyfour patients (77.15%) were nocturnal desaturating (NOD), whereas 16 (22.85%) were not desaturating (nNOD). A statistically significant difference was found between the two groups as to the values of FEV1 (p < 0.05), PaCO2, pH, SaO2 noct.%, minimum SaO2 noct.% and tSaO2 < or = 90% and < or = 85% (p < 0.0001). A statistically significant correlation was found between tSaO2 < 90% and BMI (r = 0.44), PaCO2 (r = 0.48) and pH (r = -0.44), as well as between tSaO2 < 85% and PaCO2 (r = 0.57) and pH (r= -0.50), between SaO2 noct.% and BMI (r = -0.45), PaCO2 (r = -0,50), FEV1 (r = 0.44) and pH (r = 0.46) and finally between minimum SaO2 noct.% and PaCO2 (r = -0.47) was found. Eighty percent of the NOD patients had PaO2 < 75 mm Hg and PaCO2 > 44 mm Hg. All the patients with PaCO2 > 50 mm Hg were NOD. In conclusion, all COPD subjects with FEV1 < 49% and daytime PaO2 > 60 mm Hg, particularly when associated to elevated PaCO2 values and high BMI, should undergo a nocturnal pulse oxymetry in order to identify possible nocturnal desaturations. In these patients reduced FEV1, high BMI and/or elevated PaCO2 appear to be predictive indexes of nocturnal desaturation. A PaCO2 > 50 mm Hg is highly indicative for a nocturnal oxygen desaturation.

[Amiodarone pulmonary toxicity]. / Tossicità polmonare da amiodarone.

The Authors discuss a case of amiodarone pulmonary toxicity, with simultaneous alveolar and interstitial infiltrates, in a female patient 75 years old, who took the drug for 6 months at a low dosage (200 mg/daily for 5 days a week). It is outlined that the diagnosis can be achieved only by exclusion of other aetiologies, since clinical and diagnostic features are not pathognomonic for such disease. The withdrawal of the drug and the administration of the steroid therapy determined a fast improvement of the clinical and radiological appearance.