0000000000007420
AUTHOR
Claudia I. Gruttad'auria
Serum surfactant protein D is a potential biomarker of lung damage in systemic sclerosis
Background: Interstitial lung disease (ILD) complicates the course of systemic sclerosis (SSc) up to two-third of the cases, representing the main cause of death in these patients. Assessment of lung involvement by HRCT and close monitoring of lung function are mandatory. At present no serologic biomarkers are validated for the assessment for lung damage in SSc. The current study was designed to test the hypothesis that the levels of surfactant are altered in SSc compared to healthy controls. To this aim serum levels of SP-A (Surfactant Protein A) and SP-D (Surfactant Protein-D) in serum were assessed. Methods: We enrolled 12 consecutive patients (M/F: 2/10) affected by scleroderma referred…
Liver Steatosis and Fibrosis in OSA patients After Long-term CPAP Treatment: A Preliminary Ultrasound Study.
In cases of morbid obesity, obstructive sleep apnea (OSA) was associated with biopsy-proven liver damage. The role of non-invasive techniques to monitor liver changes during OSA treatment with continuous positive airway pressure (CPAP) is unknown. We used non-invasive ultrasound techniques to assess liver steatosis and fibrosis in severe OSA patients at diagnosis and during long-term CPAP treatment. Fifteen consecutive patients with severe OSA (apnea hypopnea index 52.5 ± 19.1/h) were studied by liver ultrasound and elastography (Fibroscan) at 6-mo (n = 3) or 1-y (n = 12) follow-up. Mean age was 49.3 ± 11.9 y, body mass index (BMI) was 35.4 ± 6.4 kg/m(2). Adherence to CPAP was ≥5 h/night. A…
Compliance to ventilatory treatment in a cohort of patients on home CPAP or NIV: analysis by diagnosis, treatment type, and comorbidities
Background: Patients on home continuous positive airway pressure (CPAP) or noninvasive ventilation (NIV) show large variability in compliance to treatment. Aim: To identify predictors of poor compliance, we evaluated compliance to treatment in patients with obstructive sleep apnea (OSA), obesity hypoventilation syndrome (OHS), and OSA-chronic obstructive pulmonary disease (COPD) overlap syndrome. Methods: We analyzed clinical and compliance data provided by a single home care provider, in 602 patients (n=442 OSA, males (M) 308; 38 OHS M=15, and 122 overlap M=111) on home CPAP/NIV in the province of Agrigento, Italy, after one year of treatment. The following variables were considered: age, …
Automatic bilevel ventilation in sleep-disordered breathing: A real-life experience in southern Italy
Automatic bilevel ventilation (AutoBI) has been recently introduced to treat obstructive sleep-disordered breathing (SDB), but clinical experience is still limited. We revised the charts of patients treated for obstructive SDB in our sleep clinic in 2015 (n=214) to assess the frequency of trials of AutoBI ventilators (ResMed Auto25 or Respironics BiFlex), the clinical characteristics of these patients, the reason to shift from CPAP to AutoBI, and the outcome of AutoBI titration. A trial of domiciliary AutoBI was made in 44 patients (20.5%) intolerant to CPAP due to high CPAP levels (n=11) or who showed incomplete resolution of SDB on CPAP (n=33). The table reports the clinical data accordin…
Use of autobilevel ventilation in patients with obstructive sleep apnea: An observational study.
Continuous positive airway pressure (CPAP) is the first-choice treatment for obstructive sleep-disordered breathing. Automatic bilevel ventilation can be used to treat obstructive sleep-disordered breathing when CPAP is ineffective, but clinical experience is still limited. To assess the outcome of titration with CPAP and automatic bilevel ventilation, the charts of 356 outpatients (obstructive sleep apnea, n = 242; chronic obstructive pulmonary disease + obstructive sleep apnea overlap, n = 80; obesity hypoventilation syndrome [OHS], n = 34; 103 females) treated for obstructive sleep-disordered breathing from January 2014 to April 2017 were reviewed. Positive airway pressure titration was …
Prescription of automatic bilevel ventilation (AutoBI) in sleep-disordered breathing: analysis according to diagnosis and occurrence of comorbidities
CPAP is the first-choice treatment for obstructive sleep-disordered breathing (O-SDB), while the criteria to prescribe AutoBI are undefined. Trials of AutoBI ventilation in patients (pts) treated for O-SDB from January 2015 to October 2016 (64 out of 242 titrations) were reviewed to assess: a) the clinical characteristics of these pts, b) the reason to shift from CPAP to AutoBI, c) the compliance to prescribed treatment. AutoBI was used in cases of intolerance to high therapeutic CPAP levels (n=21) or incomplete resolution of SDB on CPAP (n=43). The Table reports the differences between CPAP or AutoBI pts CPAP SDB diagnosis was: 82% OSA, 18% OSA-COPD Overlap in the CPAP group; 39% OSA, 28% …
Prevalence of physician-diagnosed asthma in patients with suspected obstructive sleep apnea syndrome: A cross-sectional analysis of the ESADA database
It has been reported that bronchial asthma is often associated with obstructive sleep apnea (OSA) and daytime sleepiness. We analyzed the prevalence of physician-diagnosed asthma in 4929 subjects with suspected obstructive sleep apnea (OSA) in the European Sleep Apnea database (ESADA) Cohort. Patients were studied by respiratory polygraphy (PG: n=1624, 66.6% males) or full polysomnography (PSG: n=3305, 70.4% males), and the clinical characteristics of asthmatic (A) and non-asthmatic (non-A) patients were analyzed according to OSA severity. Significance was at p 2 , p=0.0004) and showed more severe daytime sleepiness (Epworth score: 10.4±5.6 vs 9.5±5.3, p=0.0015) and a trend for worse noctur…
Endurance training: Is it bad for you?
Educational aims To illustrate the characteristics of endurance exercise training and its positive effects on health. To provide an overview on the effects of endurance training on airway cells and bronchial reactivity. To summarise the current knowledge on respiratory health problems in elite athletes. Endurance exercise training exerts many positive effects on health, including improved metabolism, reduction of cardiovascular risk, and reduced all-cause and cardiovascular mortality. Intense endurance exercise causes mild epithelial injury and inflammation in the airways, but does not appear to exert detrimental effects on respiratory health or bronchial reactivity in recreational/non-eli…
Sleep disordered breathing in patients with cardiovascular comorbidities hospitalized for pulmonary disease
Sleep disordered breathing (SDB) is often overlooked in hospitalized patients. We screened consecutive patients with cardiovascular (CV) comorbidities hospitalized for respiratory problems to study SDB prevalence and type. Patients did not refer typical clinical signs of SDB. Patients (n=34, 21 M, mean age±SD 71±12 yr, BMI: 31.9±5.8 kg/m2) were studied by polygraphy (SomnoLab, Weinmann, Germany) 4.5±3.2 days after admission for COPD exacerbation (COPD-E, n=20), pleural effusion (n=2), asthma exacerbation (n=2) or other causes (n=10). On admission, 18 patients showed respiratory failure (RF, hypoxemic: n=9, hypercapnic: n=9). CV comorbidities (1.7±0.8/patient) were: hypertension (n= 27), hea…
Automatic bilevel ventilation (AutoBI) in obstructive sleep-disordered breathing (SDB): clinical features and compliance to treatment
CPAP is the first-choice treatment for obstructive SDB, but the criteria to prescribe AutoBI are undefined. Trials of AutoBI ventilation in patients under titration for obstructive SDB from January 2015 to January 2017 ((n=67 out of 265 titrations) were reviewed to assess: a) their clinical features, b) the reason to shift from CPAP to AutoBI, and c) long-term compliance to treatment. AutoBI was used in cases of intolerance to high therapeutic CPAP levels (n=23) or incomplete resolution of SDB on CPAP (n=45). AutoBI failed in 11 patients (16.4%): 2 OSA patients (7.7%), 4 overlap patients (21%), and 5 OHS patients (22.7%). The Table reports the differences at diagnosis between patients presc…
Adipose Tissue in Sleep Apnea
Obesity is increasingly recognized as a very complex metabolic state. Besides visceral obesity and white adipose tissue (WAT) function, the most recent studies point to a major metabolic role of brown adipose tissue (BAT) in energy metabolism. Visceral obesity is associated with hypoxia of adipose tissue and inflammation, both these features being also present in patients with obstructive sleep apnea (OSA). Obesity and OSA may share some common pathogenetic mechanisms, since hypoxia and inflammation are major features of OSA as well. However, the unique pattern of intermittent hypoxia occurring in OSA patients during sleep may modify the response of WAT and BAT in both lean and obese subjec…