Abnormal thyroid hormones and non-thyroidal illness syndrome in obstructive sleep apnea, and effects of CPAP treatment

Objective In obstructive sleep apnea (OSA), while both hypothyroidism and hyperthyroidism have been studied, the occurrence of non-thyroidal illness syndrome (NTIS) (normal thyroid stimulating hormone [TSH] with low triiodotironine) has not been investigated. We explored the occurrence of NTIS in patients with moderate to severe OSA and its relationship to the severity of nocturnal respiratory disorders. We also studied the occurrence of subclinical hypothyroidism (SH, ie, high TSH with normal thyroxine) in OSA and changes in circulating TSH, free triiodotironine (fT3) and free thyroxine (fT4) after CPAP treatment. Methods After a nocturnal respiratory polysomnography, 125 consecutive patie…

Mild obstructive sleep apnea increases hypertension risk, challenging traditional severity classification

STUDY OBJECTIVES: The association of mild obstructive sleep apnea (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 Apnea Database cohort. METHODS: In a multicenter sample of 4,732 participants, we analyzed the risk of mild OSA (subclassified into 2 groups: mild(AHI 5-<11/h) (apnea-hypopnea index [AHI], 5 to <11 events/h) and mild(AHI 11-<15/h) (AHI, ≥11 to <15 events/h) compared with nonapneic snorers for prevalent SAH after adjustment for relevant confounding factors including sex, age, smoking, obesity, daytime sleepiness, dyslipidemia, chronic obstructive pulmona…

Is kidney a new organ target in patients with obstructive sleep apnea? Research priorities in a rapidly evolving field.

Abstract The bidirectional relationship between sleep disordered breathing and chronic kidney disease (CKD) has recently gained a lot of interest. Several lines of evidence suggest the high prevalence of coexistent obstructive sleep apnea (OSA) in patients with CKD and end-stage renal disease (ESRD). In addition, OSA seems to result in loss of kidney function in some patients, especially in those with cardio-metabolic comorbidities. Treatment of CKD/ESRD and OSA can alter the natural history of each other; still better phenotyping with selection of appropriate treatment approaches is urgently needed. The aim of this narrative review is to provide an update of recent studies on epidemiologic…

Clinical presentation of patients with suspected obstructive sleep apnea and self-reported physician-diagnosed asthma in the ESADA cohort.

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, …

Autonomic cardiac regulation in obstructive sleep apnea syndrome: evidence from spontaneous baroreflex analysis during sleep

Objective. To assess spontaneous baroreceptor-heart rate reflex sensitivity during sleep in patients with obstructive sleep apnea syndrome, a condition associated with increased cardiovascular morbidity and mortality and characterized by marked sympathetic activation, which is believed to originate from hypoxic chemoreceptor stimulation, although little is known of other possible mechanisms such as baroreflex impairment. Design and methods. In 11 patients with severe obstructive sleep apnea syndrome (mean ± SD age 46.8 ± 8.1 years, apnea/hypopnea index 67.9 ± 19.1 h), who were normotensive or borderline hypertensive during wakefulness by clinic blood pressure measurements, finger blood pres…

Hyperuricemia and non-dipping blood pressure

Dear editor The strong association between the metabolic derangements that characterize the metabolic syndrome with arterial hypertension is very well-known, as it is the common finding of hyperuricemia in the patients with the metabolic syndrome. Besides, hyperuricemia has been found to be associated with cardiovascular, renal, and metabolic diseases; including not only gout but also type 2 diabetes mellitus, although its role as a risk factor is still debated.1 We were not aware of previous studies describing an association between uric acid levels and the non-dipping 24-hour blood pressure (BP) pattern, and for that reason we were intrigued by Tutal et al’s article, regarding hypertensiv…

Driving habits and risk factors for traffic accidents among sleep apnea patients - a European multi-centre cohort study

Obstructive sleep apnea is associated with increased motor vehicle accident risk, and improved detection of patients at risk is of importance. The present study addresses potential risk factors in the European Sleep Apnea Database and includes patients with suspected obstructive sleep apnea [n = 8476, age 51.5 (12.5) years, body mass index 31.0 (6.6) kg m(-2) , 82.4% driver's licence holders]. Driving distance (km year(-1) ), driver's licence type, sleep apnea severity, sleepiness and comorbidities were assessed. Previously validated risk factors for accident history: Epworth Sleepiness Scale ≥16; habitual sleep time ≤5 h; use of hypnotics; and driving ≥15 000 km year(-1) were analysed acro…

Long-term positive airway pressure therapy is associated with reduced total cholesterol levels in patients with obstructive sleep apnea : data from the European Sleep Apnea Database (ESADA)

Background and aim: Obstructive sleep apnea (OSA) is an independent risk factor for dyslipidemia. The current study examined the effects of positive airway pressure (PAP) treatment on lipid status in the European Sleep Apnea Database (ESADA). Methods: The prospective cohort study enrolled 1564 OSA subjects (74% male, mean age 54 ± 11y, body mass index (BMI) 32.7 ± 6.6 kg/m2 and apnea-hypopnea index (AHI) 40.3 ± 24.4 n/h) undergoing PAP therapy for at least three months (mean 377.6 ± 419.5 days). Baseline and follow-up total cholesterol (TC) from nine centers were analyzed. Repeated measures and logistic regression tests (adjusted for age, sex, weight changes, lipid lowering medication, PAP …

Sleep Apnea, Sleepiness, and Driving Risk

Obstructive sleep apnea is associated with excessive daytime sleepiness in about 50% of cases, and with increased risk of driving accidents. Treatment with continuous positive airway pressure effectively decreases such risk, but compliance with continuous positive airway pressure treatment is often suboptimal. According to the European Union Directive on driving risk, retention of a driving license in patients with obstructive sleep apnea requires assessment of sleepiness and adherence to continuous positive airway pressure treatment, but there remains uncertainty on the optimal methods to assess sleepiness on a large scale.

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…

P1013 : Chronic intermittent hypoxia is associated with liver damage and atherosclerosis in patients with non-alcoholic fatty liver disease

all the steatosis grades, except S2 vs S3. The diagnostic performances of CAP in quantifying each steatosis grade was: for S ≥1 AUC=0.813 (cutoff 260dB/m, Se = 64.84%, Sp =87.27%, PPV=80.8%, NPV=75%, +LR =5.09, −LR =0.40, DA=76.11%); for S ≥2 AUC=0.822 (cutoff 285dB/m, Se = 69.70%, Sp =85.12%, PPV=47.9%, NPV=93.5%, +LR =4.68, −LR =0.36, DA=82.08%); for S ≥3 AUC=0.838 (cutoff 294dB/m, Se =83.33%, Sp =82.54%, PPV=23.3%, NPV=98.7%, +LR =4.77, −LR =0.20, DA=81.59%). AUCs calculated between two steatosis grades only were: 0.772 (for S0 vs S1), 0.874 (S0 vs S2), 0.904 (S0 vs S3), 0.659 (S1 vs S2), 0.777 (S1 vs S3), and 0.665 (S2 vs S3) respectively. Conclusions: Maximal diagnostic accuracy could …

Reticulocytes in untreated obstructive sleep apnoea.

Background and Aim. The short, repetitive hypoxaemic episodes observed in obstructive sleep apnoea (OSA) may determine small augmentations in mature red blood cells. It is unknown whether they affect reticulocyte release. This study explored whether the number and degree of maturation of circulating reticulocytes may be altered in OSA, possibly through the effect of erythropoietin. Methods. Fifty male adult patients with suspected OSA, normoxic during wakefulness, were studied. After nocturnal polysomnography, a blood sample was withdrawn for blood cells count, erythropoietin, iron and transferrin determination. Reticulocyte concentration and degree of immaturity [high (H), medium (M), or l…

Early and rapidly progressing respiratory failure in a patient with amyotrophic lateral sclerosis: when FVC% is misleading

Introduction Respiratory failure is the leading cause of death in amyotrophic lateral sclerosis (ALS) [1]. The involvement of respiratory function is a negative predictor of survival, which can be in part overcome by a prompt initiation of non-invasive mechanical ventilation (NIV). Seated forced vital capacity (FVC%) is a widely used measure to monitor respiratory function, and it is often taken as a surrogate outcome measure in clinical trials. However, it may be within a normal range in ALS patients with respiratory dysfunction [2]. Here we report on a case of an ALS patient with a rapidly evolving respiratory insufficiency, despite a rather normal FVC%. Case presentation The patient, a 6…

Chronic kidney disease in patients with obstructive sleep apnea. A narrative review.

Prevalence of both chronic kidney disease (CKD) and obstructive sleep apnea (OSA) is continuously increasing. Moreover, the prevalence of OSA increases as kidney function declines and is higher among patients with end-stage renal disease (ESRD). In addition, OSA is recognized as a potential nontraditional risk factor for development and progression of CKD. Continuous positive airway pressure (CPAP) plays a pivotal role in the management of OSA, eliminating patients' symptoms and improving their quality of life. Recent studies suggested that CPAP treatment may have beneficial effects on kidney function among patients with OSA. This narrative review summarizes the existing knowledge on the as…

Personalised medicine in sleep respiratory disorders: focus on obstructive sleep apnoea diagnosis and treatment

In all fields of medicine, major efforts are currently dedicated to improve the clinical, physiological and therapeutic understanding of disease, and obstructive sleep apnoea (OSA) is no exception. The personalised medicine approach is relevant for OSA, given its complex pathophysiology and variable clinical presentation, the interactions with comorbid conditions and its possible contribution to poor outcomes. Treatment with continuous positive airway pressure (CPAP) is effective, but CPAP is poorly tolerated or not accepted in a considerable proportion of OSA patients. This review summarises the available studies on the physiological phenotypes of upper airway response to obstruction durin…

Pulmonary haemodynamics in obstructive sleep apnoea.

In patients with obstructive sleep apnoea syndrome (OSAS), pulmonary haemodynamics can show both transient perturbations during sleep and permanent alterations. During sleep, repeated fluctuations in pulmonary artery pressure and pulmonary wedge pressure, coincident with apnoeas, can be observed. Calculation of transmural pressure values is preferable to intravascular pressures in OSAS, due to the marked swings in intrathoracic pressure associated with obstructive apnoeas. Pulmonary artery pressure may progressively increase during sleep, particularly in close sequences of highly desaturating apnoeas. Apnoea-induced hypoxia appears as the most important determinant of this pulmonary artery …

Blood-pressure variability in patients with obstructive sleep apnea: current perspectives

Obstructive sleep apnea (OSA) is often associated with hypertension and other cardiovascular diseases. Blood pressure (BP) variability is part of the assessment of cardiovascular risk. In OSA, BP variability has been studied mainly as very short-term (beat-by-beat) and short-term (24-hour BP profile) variability. BP measured on consecutive heartbeats has been demonstrated to be highly variable, due to repeated peaks during sleep, so that an accurate assessment of nocturnal BP levels in OSA may require peculiar methodologies. In 24-hour recordings, BP frequently features a "nondipping" profile, ie, &lt;10% fall from day to night, which may increase cardiovascular risk and occurrence of major…

Obstructive Sleep Apnea Is Associated with Liver Damage and Atherosclerosis in Patients with Non-Alcoholic Fatty Liver Disease

Background/Aims We assessed whether obstructive sleep apnea (OSA) and nocturnal hypoxemia are associated with severity of liver fibrosis and carotid atherosclerosis in patients with biopsy-proven NAFLD and low prevalence of morbid obesity. Secondary aim was to explore the association of OSA and hypoxemia with NASH and severity of liver pathological changes. Methods Consecutive patients (n = 126) with chronically elevated ALT and NAFLD underwent STOP-BANG questionnaire to estimate OSA risk and ultrasonographic carotid assessment. In patients accepting to perform cardiorespiratory polygraphy (PG, n = 50), OSA was defined as an apnea/hypopnea index ≥5. A carotid atherosclerotic plaque was defi…

Importance of Sniff Nasal Pressure (SNIP) as predictor of nocturnal respiratory function in amyotrophic lateral sclerosis (ALS)

Background: In ALS, respiratory disturbances during sleep have an important role in the natural history of the disease. Diurnal and nocturnal blood gases are weakly correlated, but nocturnal respiratory disorders are difficult to predict. Aim: To evaluate if SNIP, an important parameter reflecting respiratory muscle strength, is related to nocturnal respiratory disorders and whether it contributes to predict nocturnal blood gas alterations in addition to daytime blood gas levels in ALS. Methods: Forty patients with ALS, after a daytime respiratory function evaluation, including arterial blood gases and SNIP, underwent a polysomnography with transcutaneous capnography (tcPCO2). The patients …

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 …

Brain and Breathing

Breathing is an essential feature of living organisms, and control of breathing is a very complex topic in human physiology. Breathing is differently modulated under conditions of wakefulness and sleep, and ventilation decreases during sleep in normal subjects. In patients with respiratory diseases, sleep represents a very vulnerable condition, since gas exchange usually worsens, especially in REM sleep. Several types of respiratory events can occur during sleep, and knowledge of control of breathing is essential to understand their pathophysiology. This chapter summarizes the main characteristics of ventilation during both wakefulness and sleep, the differences found between genders, and t…

Mild obstructive sleep apnoea (OSA) and arterial hypertension in the EuropeanSleep Apnoea Database (ESADA) cohort study.

Background: Mild obstructive sleep apnoea (OSA) is highly prevalent, however its association with important clinical outcomes like arterial hypertension remains unknown. Aims and Objectives: To investigate the association between mild OSA and arterial hypertension in the European Sleep Apnoea Database (ESADA) cohort after adjusting for relevant confounding factors. Methods: A multicentric sample of 4974 adults from the ESADA cohort who showed simple snoring or mild OSA at cardiorespiratory polygraphy was studied. We compared the predictive value of mild OSA (AHI 5- Results: Arterial hypertension prevalence was 37% in mild OSA patients (n=2457) compared to 20% in non-apnoeic snorers (n=2517,…

Obstructive sleep apnea and cancer: a complex relationship

Purpose of review Obstructive sleep apnea (OSA) has been recognized as a risk factor for cancer mainly through hypoxia, based on studies that did not distinguish among cancer types. The purpose of this review is to discuss the most recent data on epidemiology and pathophysiology of the OSA-cancer association. Recent findings According to epidemiological studies, OSA may have different influences on each type of cancer, either increasing or decreasing its incidence and aggressiveness. Time spent with oxygen saturation below 90% appears the polysomnographic variable most strongly associated with unfavorable effects on cancer. Experimental studies support the role of hypoxia as an important ri…

Chronic Intermittent Hypoxia is associated with Liver Damage and Atherosclerosis in Patients with Non-alcoholic Fatty Liver Disease

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…

Determinants of Sleepiness at Wheel and Missing Accidents in Patients With Obstructive Sleep Apnea

Study ObjectivesMotor-vehicle crashes are frequent in untreated OSA patients but there is still uncertainty on prevalence as well as physiological or clinical determinants of sleepiness at the wheel (SW) in OSA patients. We assessed determinants of SW or sleepiness related near-miss car accident (NMA) in a group of non-professional drivers with OSA.MethodsA 237 consecutive, treatment-naïve PSG-diagnosed OSA patients (161 males, 53.1 ± 12.6 years) were enrolled. Self-reported SW was assessed by positive answer to the question, “Have you had episodes of falling asleep while driving or episodes of drowsiness at wheel that could interfere with your driving skill in the last year?” Occurrence of…

Sleep Apnea and the Kidney

Abstract Purpose of Review There are some uncertainties about the interactions between obstructive sleep apnea (OSA) and chronic kidney disease (CKD). We critically reviewed recent studies on this topic with a focus on experimental and clinical evidence of bidirectional influences between OSA and CKD, as well as the effects of treatment of either disease. Recent Findings Experimental intermittent hypoxia endangers the kidneys, possibly through activation of inflammatory pathways and increased blood pressure. In humans, severe OSA can independently decrease kidney function. Treatment of OSA by CPAP tends to blunt kidney function decline over time, although its effect may vary. OSA may increa…

Obstructive sleep apnea and chronic kidney disease: open questions on a potential public health problem

To determine the relationship between obstructive sleep apnea (OSA) and chronic kidney disease (CKD). Previous population studies of the association are sparse, conflicting and confined largely to studies of administrative data.Cross-sectional analysis in unselected participants of the Men Androgens Inflammation Lifestyle Environment and Stress (MAILES) study, aged40 years. Renal data were available for 812 men without a prior OSA diagnosis who underwent full in-home polysomnography (Embletta X100) in 2010-2011. CKD was defined as an estimated glomerular filtration rate (eGFR)60 mL/min/1.73m2 or eGFR≥60 and albuminuria (albumin-creatinine ratio ≥3.0 mg/mmol).CKD (10.5%, n = 85 [Stage 1-3, 9…

Baroreflex control of heart rate during sleep in severe obstructive sleep apnoea: effects of acute CPAP

Baroreflex control of heart rate during sleep (baroreflex sensitivity; BRS) has been shown to be depressed in obstructive sleep apnoea (OSA), and improved after treatment with continuous positive airway pressure (CPAP). Whether CPAP also acutely affects BRS during sleep in uncomplicated severe OSA is still debatable. Blood pressure was monitored during nocturnal polysomnography in 18 patients at baseline and during first-time CPAP application. Spontaneous BRS was analysed by the sequence method, and estimated as the mean sequence slope. CPAP did not acutely affect mean blood pressure or heart rate but decreased cardiovascular variability during sleep. Mean BRS increased slightly during CPAP…

Comment to the Editorial by KS Park and EW Kang “Is only fixed positive airway pressure a robust tool for kidney protection in patients with obstructive sleep apnea?”

We thank doctors Park and Kang for their editorial that well summarized our article. Our common belief is that one of the possible consequences of untreated obstructive sleep apnea (OSA) is an accelerated deterioration of kidney function, and that more knowledge would be necessary on the possible protective effects of OSA treatments. To our knowledge, so far the only OSA therapy whose effects on renal function have been tested is continuous positive airway pressure (CPAP), and most , although not all studies, have demonstrated its benefits. Our own study, while confirming benefits of fixed CPAP, has demonstrated little effect of auto-adjusting CPAP (APAP). This finding may be of relevance a…

Obstructive sleep apnoea in adult patients post-tonsillectomy

Background: The impact of removing the upper airway lymphoid tissue and in particular, tonsillectomy, in adults with OSA has not been demonstrated in large populations. Aims: To compare the severity of OSA and the prevalence of cardiovascular, metabolic and respiratory co-morbidities between patients with OSA who had undergone previous tonsillectomy and those who had not. Methods: The 19,711 participants in this study came from the European sleep apnea database (ESADA) which comprises data from unselected adult patients aged 18–80 years with a history of symptoms suggestive of OSA referred to sleep centers throughout Europe. Results: There were no differences between the two groups in terms…

Fixed But Not Autoadjusting Positive Airway Pressure Attenuates the Time-dependent Decline in Glomerular Filtration Rate in Patients With OSA

Abstract: 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 = 14…

Excessive Daytime Sleepiness in Obstructive Sleep Apnea Patients Treated With Continuous Positive Airway Pressure: Data From the European Sleep Apnea Database

Excessive daytime sleepiness (EDS) is a symptom of obstructive sleep apnea (OSA) that resolves under treatment with continuous positive airway pressure (CPAP). In some patients, sleepiness persists despite CPAP treatment. We retrospectively analyzed data on subjective residual EDS, assessed as an Epworth Sleepiness Scale score (ESS) >10, in patients from the European Sleep Apnea Database (n = 4,853, mean age +/- SD 54.8 +/- 11.8 years, 26.1% females), at baseline and at the first visit (median follow-up: 5 months, interquartile range 3-13). An ESS > 10 occurred in 56% of patients at baseline and in 28.2% of patients at follow-up. Residual EDS was analyzed in 2,190 patients (age: 55.1 +/- 12…

Relaxin in Obstructive Sleep Apnea: Relationship with Blood Pressure and Inflammatory Mediators

&lt;b&gt;&lt;i&gt;Background:&lt;/i&gt;&lt;/b&gt; Obstructive sleep apnea (OSA) is associated with nocturnal intermittent hypoxia, which may be responsible for increased circulating levels of vascular endothelial growth factor (VEGF) and inflammatory mediators, such as metalloproteinases (MMPs), and which contributes to the pathogenesis of systemic hypertension. Why some OSA patients remain normotensive is poorly understood. Relaxin-2, a pregnancy hormone, may sometimes circulate in men and could increase in hypoxic conditions. It exerts a vasodilatory activity and can modulate the release of molecules, such as MMPs and VEGF. &lt;b&gt;&lt;i&gt;Objectives:&lt;/i&gt;&lt;/b&gt; The objective o…

Resumption of Ventilation at the End of Obstructive Sleep Apneas is not Determined by Diaphragmatic Fatigue

In patients affected by obstructive sleep apnea syndrome (OSAS) a progressive increase of the force developed by the respiratory muscles is usually observed during the occlusive phase before upper airway patency is resumed (Onal and Lopata, 1986).

Blood pressure responsiveness to obstructive events during sleep after chronic CPAP

The aim of this study was to investigate whether chronic continuous positive airway pressure (CPAP) affects blood pressure (BP) responsiveness to obstructive events occurring on the first night of CPAP withdrawal in obstructive sleep apnoea (OSA) after chronic treatment. Thirteen male subjects with severe OSA underwent nocturnal polysomnography with beat­by­beat BP monitoring before treatment and after 4.9±3.4 months of home CPAP (mean daily use 5.1±1.7 h). Variations in oxyhaemoglobin saturation (Δ S a,O2), systolic (Δ P s), and diastolic (Δ P d) BP within nonrapid eye movement apnoeas and hypopnoeas were measured on a sample of pre­ and post­treatment events. In addition, a pretreatment s…

Obstructive sleep apnoea and metabolic syndrome in Mediterranean countries.

To the Editors: Obstructive sleep apnoea (OSA) is often associated with metabolic disturbances, including altered glucose metabolism and dyslipidaemia, which probably contribute to the increased cardiovascular risk in these patients 1. The concept of the metabolic syndrome (MetS) as a cluster of cardiometabolic risk factors has gained popularity in recent years, and a much higher prevalence of the MetS has been found in OSA patients compared with the general population in several studies 1. While the MetS largely reflects the effects of visceral obesity, environmental factors, i.e. the type of diet, could also play some role. The Mediterranean diet, rich in olive oil and fish, is protective…

Unique sleep-stage transitions determined by obstructive sleep apnea severity, age and gender

In obstructive sleep apnea, patients' sleep is fragmented leading to excessive daytime sleepiness and co-morbidities like arterial hypertension. However, traditional metrics are not always directly correlated with daytime sleepiness, and the association between traditional sleep quality metrics like sleep duration and arterial hypertension is still ambiguous. In a development cohort, we analysed hypnograms from mild (n = 213), moderate (n = 235) and severe (n = 277) obstructive sleep apnea patients as well as healthy controls (n = 105) from the European Sleep Apnea Database. We assessed sleep by the analysis of two-step transitions depending on obstructive sleep apnea severity and anthropom…

Diabetes Mellitus Prevalence and Control in Sleep-Disordered Breathing

BACKGROUND OSA is associated with an increased risk of cardiovascular morbidity. A driver of this is metabolic dysfunction and in particular type 2 diabetes mellitus (T2DM). Prior studies identifying a link between OSA and T2DM have excluded subjects with undiagnosed T2DM, and there is a lack of population-level data on the interaction between OSA and glycemic control among patients with diabetes. We assessed the relationship between OSA severity and T2DM prevalence and control in a large multinational population. METHODS We performed a cross-sectional analysis of 6,616 participants in the European Sleep Apnea Cohort (ESADA) study, using multivariate regression analysis to assess T2DM preva…

Hypoxemia during Sleep

In most normal subjects arterial oxyhemoglobin saturation (SaO2) remains substantially stable throughout all sleep time: some exceptions however, may be observed especially in elderly subjects, who may show desaturations, sometimes associated with apneas (Block et al., 1979; Krieger et al., 1983; Catterall et al., 1985). Conversely, SaO2 drops during part of, or even the whole sleep time, are a common finding in pathological conditions like obstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD).

Obstructive sleep apnea and comorbidities: a dangerous liaison

Obstructive sleep apnea (OSA) is a highly prevalent disease, and is traditionally associated with increased cardiovascular risk. The role of comorbidities in OSA patients has emerged recently, and new conditions significantly associated with OSA are increasingly reported. A high comorbidity burden worsens prognosis, but some data suggest that CPAP might be protective especially in patients with comorbidities. Aim of this narrative review is to provide an update on recent studies, with special attention to cardiovascular and cerebrovascular comorbidities, the metabolic syndrome and type 2 diabetes, asthma, COPD and cancer. Better phenotypic characterization of OSA patients, including comorbi…

Blood pressure changes after automatic and fixed CPAP in obstructive sleep apnea. Relationship with nocturnal sympathetic activity.

Treatment of obstructive sleep apnea (OSA) by continuous positive airway pressure (CPAP) usually causes a reduction in blood pressure (BP), but several factors may interfere with its effects. In addition, although a high sympathetic activity is considered a major contributor to increased BP in OSA, a relationship between changes in BP and in sympathetic nervous system activity after OSA treatment is uncertain. This study was undertaken to assess if, in OSA subjects under no pharmacologic treatment, treatment by CPAP applied at variable levels by an automatic device (APAP) may be followed by a BP reduction, and if that treatment is associated with parallel changes in BP and catecholamine exc…

Excessive Daytime Sleepiness and Sleep Disorders in a Population of Patients with Epilepsy: a Case-Control Study

Background and purpose There are several primary causes for excessive daytime sleepiness (EDS) and sleep disorders in patients with epilepsy. Up to now, studies in the literature report conflicting data in terms of both prevalence and aetiology. The aim of our study was therefore to evaluate the prevalence of EDS and some sleep disorders in a population of patients with epilepsy treated with no more than two antiepileptic drugs (AEDs). We also investigated the role of the depression of mood as a variable that can negatively affect EDS. Methods We prospectively and consecutively recruited 99 patients with a diagnosis of epilepsy, sleep disorders and EDS, belonging to the Centre for Epilepsy …

Blood-pressure variability in patients with obstructive sleep apnea: current perspectives

Oreste Marrone,1 Maria R Bonsignore1,2 1National Research Council of Italy, Institute of Biomedicine and Molecular Immunology, 2DiBiMIS, University of Palermo, Palermo, Italy Abstract: Obstructive sleep apnea (OSA) is often associated with hypertension and other cardiovascular diseases. Blood pressure (BP) variability is part of the assessment of cardiovascular risk. In OSA, BP variability has been studied mainly as very short-term (beat-by-beat) and short-term (24-hour BP profile) variability. BP measured on consecutive heartbeats has been demonstrated to be highly variable, due to repeated peaks during sleep, so that an accurate assessment of nocturnal BP levels in OSA may require peculia…

Mild OSA and arterial hypertension in the European Sleep Apnoea Database cohort study

Background: Mild obstructive sleep apnoea (OSA) is highly prevalent; however its association with important clinical outcomes like arterial hypertension remains unknown. Aims: To investigate the association between mild OSA and hypertension in the European Sleep Apnoea Database (ESADA) cohort after adjusting for relevant confounding factors. Methods: A multicentric sample of 7995 adults from the ESADA cohort with simple snoring or mild OSA at PG or PSG was studied. We compared the predictive value of mild OSA (AHI 5- Results: Arterial hypertension prevalence was 37% in mild OSA  (n=1566) compared to 22% in non-apnoeic snorers (n=793, p Conclusion: Our results suppport the hypothesis that mi…

Effects of sleep apnea and kidney dysfunction on objective sleep quality in nondialyzed patients with chronic kidney disease: an ESADA study

Study Objectives: Patients with chronic kidney disease (CKD) often report poor sleep quality, but they commonly exhibit OSA. The aim of this study was to evaluate the influence of OSA severity and of estimated glomerular filtration rate impairment on objective sleep quality in nondialyzed patients with CKD, defined as an estimated glomerular filtration rate &lt;60 mL/min/1.73m2. Methods: Polysomnographic sleep characteristics were compared between patients with (n = 430) and without CKD (n = 6,639) in the European Sleep Apnea Database cohort. Comparisons were repeated in 375 patients with CKD and 375 control patients without CKD matched for sleep center, age, sex, and AHI, and in 310 matche…

The puzzle of metabolic effects of obstructive sleep apnoea in children.

In adults, obstructive sleep apnoea (OSA) is often associated with metabolic alterations. Although obesity is a major culprit [1], large epidemiological studies have reported a metabolic risk associated with OSA that is independent of obesity. In particular, meta-analyses have shown that effective treatment of OSA by continuous positive airway pressure (CPAP) improves glycaemic control in both diabetic [2] and nondiabetic patients [3]. In obese children with obstructive sleep apnoea insulin resistance is common while lipids do not show a clear pattern

Gender-specific anthropometric markers of adiposity, metabolic syndrome and visceral adiposity index (VAI) in patients with obstructive sleep apnea

Obstructive sleep apnea often coexists with visceral adiposity and metabolic syndrome. In this study, we analysed gender-related differences in anthropometrics according to sleep apnea severity and metabolic abnormalities. In addition, the visceral adiposity index, a recently introduced marker of cardiometabolic risk, was analysed. Consecutive subjects with suspected obstructive sleep apnea (n = 528, 423 males, mean age ± standard deviation: 51.3 ± 12.8 years, body mass index: 31.0 ± 6.2 kg m(-2) ) were studied by full polysomnography (apnea-hypopnea index 43.4 ± 27.6 h(-1) ). Variables of general and visceral adiposity were measured (body mass index, neck, waist and hip circumferences, wai…

Cardiometabolic impact and symptom profile of obstructivesleep apnea: does gender matter?

European-Respiratory-Society (ERS) International Congress -- SEP 28-OCT 02, 2019 -- Madrid, SPAIN

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…

Decrease in blood pressure during continuous positive airway pressure treatment for obstructive sleep apnoea: still searching for predictive factors

High blood pressure (BP) and non-dipping 24-hour BP profile may help to predict BP decrease after obstructive sleep apnoea treatment by CPAP. However, specific, highly reproducible traits associated with BP responsiveness to CPAP must still be identified.http://bit.ly/2LbS4uV