Epidemiological and pathogenic relationship between sleep apnea and ischemic heart disease

Obstructive sleep apnea is recognized as having high prevalence and causing remarkable cardiovascular risk. Coronary artery disease has been associated with obstructive sleep apnea in many reports. The pathophysiology of coronary artery disease in obstructive sleep apnea patients probably includes the activation of multiple mechanisms, as the sympathetic activity, endothelial dysfunction, atherosclerosis, and systemic hypertension. Moreover, chronic intermittent hypoxia and oxidative stress have an important role in the pathogenesis of coronary disease and are also fundamental to the development of atherosclerosis and other comorbidities present in coronary artery diseases such as lipid metabolic disorders. Interestingly, the prognosis of patients with coronary artery disease has been associated with obstructive sleep apnea and the severity of sleep disordered breathing may have a direct relationship with the morbidity and mortality of patients with coronary diseases. Nevertheless, treatment with CPAP may have important effects, and recent reports have described the benefits of obstructive sleep apnea treatment on the recurrence of acute heart ischaemic events in patients with coronary artery diseas

Asthma diagnosis is not associated with obesity in a population of adults from Madrid

Background: Several studies have suggested a relationship between asthma and obesity; however, this relationship is unclear when obesity is compared with bronchial hyperresponsiveness to methacholine. Aim: To determine whether obesity is associated with a diagnosis of asthma. Methods: We conducted a cross-sectional study in a population of Spanish adults in the north of Madrid, Spain between 2003 and 2007. The patients included had experienced asthma symptoms during the previous year, but had a ratio of forced expiratory volume in the fi rst second of expiration (FEV1) to forced vital capacity (FVC) of >70%. Diagnosis was confi rmed by the presence of symptoms and demonstration of bronchial hyperresponsiveness to methacholine. Obesity was measured by body mass index (BMI). Adjusted odd ratios (OR) were obtained by logistic regression. Results: Of a total of 1424 patients included, 251 (17.6%) were diagnosed with asthma. These patients were younger (P<.001) and had lower BMI (P<.001) and lung function parameters (FEV1 and FEV1/FVC ratio) than individuals without asthma (P<.001). After adjusting the model for age, gender, baseline FEV1, and FEV1/FVC ratio, patients with overweight or obesity were not more frequently diagnosed with asthma than those with normal weight (OR, 0.848 [95% confi dence interval (CI), 0.59-1.20]; and OR, 0.616 [95% CI, 0.38-0.99], respectively). In addition, obese males were more frequently diagnosed with asthma than obese females (P<.041). Conclusions: In this study, obesity and overweight were not associated with a diagnosis of asthma based on the presence of consistent symptoms and demonstration of airway responsiveness to methacholineFundamento: Varios estudios sugieren que la obesidad es un factor de riesgo para padecer asma, lo que no siempre se confi rma cuando se compara la obesidad con la hiperreactividad bronquial (HRB) en pacientes con síntomas de asma. Objetivo: Determinar si la obesidad se asocia con el diagnóstico de asma, confi rmado por presencia de síntomas e HRB a metacolina. Pacientes y Métodos: Se realizó un estudio transversal en población adulta del Área Norte de Madrid entre 2003 y 2007. Se incluyeron sujetos que habían padecido síntomas de asma en el último año, con un FEV1/FVC>70% y que precisaban una prueba de metacolina para confi rmar el diagnóstico. La obesidad se defi nió según el índice de masa corporal (IMC). Se aplicó un modelo de regresión logística para calcular odd ratios (OR) ajustadas. Resultados: Se estudiaron 1.424 sujetos y se diagnosticaron de asma 251 sujetos (17,6%) que, comparados con los 1.173 no diagnosticados de asma, eran más jóvenes y presentaban un IMC y parámetros de función pulmonar (FEV1, FEV1/FVC) más bajos (p<0,001). Tras ajustar el modelo por edad, sexo, FEV1 basal y FEV1/FVC el diagnóstico de asma no fue más prevalente en los sujetos obesos o con sobrepeso que en los sujetos con peso normal (OR 0,848, IC95% 0,59-1,20 y OR 0,616, IC95% 0,38-0,99, respectivamente). El diagnóstico de asma fue más frecuente en hombres obesos que en mujeres obesas (p=0,041). Conclusiones: La obesidad y el sobrepeso no se asociaron con el diagnóstico de asma establecido por la presencia de síntomas e HRB a metacolinaThis research project was carried out with a grant from Fundación para la Investigación Biomédica del Hospital Universitario La Paz (FIBHULP

Effects of weight loss after bariatric surgery on pulmonary function tests and aobtructive sleep apnea in morbidly obese women

Introducción: la obesidad afecta a la función respiratoria e incrementa el riesgo de síndrome de apneas-hipopneas del sueño (SAHS). Objetivo: evaluar el efecto de la cirugía bariátrica, en mujeres con obesidad mórbida, sobre la función respiratoria y sobre el índice de apneas-hipopneas (IAH) tras dos años de seguimiento. Métodos: se incluyeron 15 mujeres (índice de masa corporal [IMC] medio 50,52 ± 12,71 kg.m-2, edad media 40,13 ± 10,06 años). Los enfermos fueron analizados en dos fases: previo a la cirugía bariátrica y tras dos años de la misma. En cada visita se valoraron las medidas antropométricas y se realizaron pruebas de función respiratoria consistentes en espirometría, pletismografía, medida de la presión inspiratoria máxima y del índice de tensión-tiempo de los músculos inspiratorios, así como análisis de gases arteriales. Por último, también se efectuó una poligrafía cardiorrespiratoria durante el sueño. Resultados: tras la cirugía bariátrica el IMC disminuyó en 44,07 kg.m-2 (IC 95% 38,32 – 49,81). De igual forma, se observaron incrementos significativos en el volumen espiratorio forzado al primer segundo (FEV1) (p < 0,01), la capacidad vital forzada (FVC) (p < 0,01), el volumen de reserva espiratorio (ERV) (p = 0,040), la capacidad funcional residual (FRC) (p = 0,009) y la resistencia de las vías aéreas (Raw) (p = 0,018). Por otra parte, el IAH (p = 0,001) y el índice de desaturación de oxígeno (p = 0,001) disminuyeron tras la cirugía. Se observó una correlación significativa entre el grado de pérdida de peso y el incremento del ERV (0,774, p = 0,024). Conclusiones: tras dos años desde la cirugía bariátrica se siguen observando mejorías significativas en la función respiratoria y en la gravedad del SAHS. La mejoría del ERV estaría en relación directa con los niveles de peso perdidoIntroduction: obesity impacts on respiratory function and also it acts as a risk factor for obstructive sleep apnea (OSA). Aims: to study the effects of bariatric surgery on pulmonary function tests and on OSA in morbidly obese women over 4 years. Methods: fifteen morbidly obese women (mean body mass index [BMI] 50.52 ± 12.71 kg.m-2, mean age 40.13 ± 10.06 years) underwent pulmonary function tests (PFT) in two opportunities (before and after weight loss surgery). PFT included spirometry, body plethysmography and measure of maximal inspiratory mouth pressure (PImax) and of tension-time index for inspiratory muscles. Also, in both opportunities, resting arterial blood gas tensions were evaluated and a full night sleep register was performed. Results: BMI significantly decreased after bariatric surgery (-44.07 kg.m-2 [CI 95% -38.32 – -49.81]). Also, there was a significantly increase in forced expiratory volume in 1 second (FEV1) (p < 0.01), forced vital capacity (FVC) (p < 0.01), expiratory reserve volume (ERV) (p = 0.040), functional residual capacity (FRC) (p = 0.009) and a decline in airways resistance (Raw) (p = 0.018). Concerning sleep registers, apnea hypopnea index (p = 0.001) and desaturation index (p = 0.001) were also reduced after weight loss. Improve in ERV had a significant correlation with weight loss (r = 0.774, p = 0.024). Conclussions: pulmonary function tests and apnea hypopnea index improve after bariatric surgery in mor- bidly obese women. Improvement of ERV is well correlated with weight los

How are the ancient cystic fibrosis patients?: Cystic fibrosis diagnosed over 60 years-old

Background and aims To specify the prevalence of patients diagnosed with CF at age of ≥60 year-old and to analyze their characteristics. Patients and methods Observational study of CF patients which were diagnosed at age ≥60 year-old. The analyzed variables were: age, sex, nationality, lung function parameters, conditions present at diagnosis, microbiological characteristics and genetic findings. Results eight patients were included. 7 patients were female (87.5%) with a mean age of 70.6 years (median 71.5 years, range 60–78 years). The most important findings were: sweat test &gt; 60 mEq/l; heterozygotes F508del; bronchiectasis in CT; methicillin-sensitive Staphylococcus aureus (50%) in sputum. The most patients presented a normal or mild obstructive lung function. Conclusions CF must also be considered a disease diagnosed in adulthood, incorporating the sweat test within the usual techniques of differential diagnosis in patients with different diseases associated with CF, because genetic counselling is esencial

A Phase 3 Study to Compare Delafloxacin With Moxifloxacin for the Treatment of Adults With Community-Acquired Bacterial Pneumonia (DEFINE-CABP)

The clinical and economic burden of community-acquired bacterial pneumonia (CABP) is significant and is anticipated to increase as the population ages and pathogens become more resistant. Delafloxacin is a fluoroquinolone antibiotic approved in the United States for the treatment of adults with acute bacterial skin and skin structure infections. Delafloxacin's shape and charge profile uniquely impact its spectrum of activity and side effect profile. This phase 3 study compared the efficacy and safety of delafloxacin with moxifloxacin for the treatment of CABP. A randomized, double-blind, comparator-controlled, multicenter, global phase 3 study compared the efficacy and safety of delafloxacin 300 mg twice daily or moxifloxacin 400 mg once daily in adults with CABP. The primary end point was early clinical response (ECR), defined as improvement at 96 (±24) hours after the first dose of study drug. Clinical response at test of cure (TOC) and microbiologic response were also assessed. In the intent-to-treat analysis population (ITT), ECR rates were 88.9% in the delafloxacin group and 89.0% in the moxifloxacin group. Noninferiority of delafloxacin compared with moxifloxacin was demonstrated. At TOC in the ITT population, the success rates were similar between groups. Treatment-emergent adverse events that were considered at least possibly related to the study drug occurred in 65 subjects (15.2%) in the delafloxacin group and 54 (12.6%) in the moxifloxacin group. Intravenous/oral delafloxacin monotherapy is effective and well tolerated in the treatment of adults with CABP, providing coverage for Gram-positive, Gram-negative, and atypical pathogens. NCT03534622. This Phase-3 study showed IV/oral delafloxacin monotherapy is well tolerated without QT restrictions or major drug interactions and effective in treatment of adults with CABP due to gram positive and negative as well as atypical pathogens

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Pathophysiologic Mechanisms of Cardiovascular Disease in Obstructive Sleep Apnea Syndrome

Obstructive sleep apnea syndrome (OSAS) is a highly prevalent sleep disorder, characterized by repeated disruptions of breathing during sleep. This disease has many potential consequences including excessive daytime sleepiness, neurocognitive deterioration, endocrinologic and metabolic effects, and decreased quality of life. Patients with OSAS experience repetitive episodes of hypoxia and reoxygenation during transient cessation of breathing that provoke systemic effects. Furthermore, there may be increased levels of biomarkers linked to endocrine-metabolic and cardiovascular alterations. Epidemiological studies have identified OSAS as an independent comorbid factor in cardiovascular and cerebrovascular diseases, and physiopathological links may exist with onset and progression of heart failure. In addition, OSAS is associated with other disorders and comorbidities which worsen cardiovascular consequences, such as obesity, diabetes, and metabolic syndrome. Metabolic syndrome is an emerging public health problem that represents a constellation of cardiovascular risk factors. Both OSAS and metabolic syndrome may exert negative synergistic effects on the cardiovascular system through multiple mechanisms (e.g., hypoxemia, sleep disruption, activation of the sympathetic nervous system, and inflammatory activation). It has been found that CPAP therapy for OSAS provides an objective improvement in symptoms and cardiac function, decreases cardiovascular risk, improves insulin sensitivity, and normalises biomarkers. OSAS contributes to the pathogenesis of cardiovascular disease independently and by interaction with comorbidities. The present review focuses on indirect and direct evidence regarding mechanisms implicated in cardiovascular disease among OSAS patients

Psycho-demographic profile in severe asthma and effect of emotional mood disorders and hyperventilation syndrome on quality of life

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliationsBackground: Severe asthma affects a small population but carries a high psychopathological risk. Therefore, the psychodemographic profile of these patients is of interest. A substantial prevalence of anxiety, depression, alexithymia and hyperventilation syndrome in severe asthma is known, but contradictory results have been observed. These factors can also affect patients’ quality of life. For this reasons, our purpose is to evaluate the psychodemographic profile of patients with severe asthma and assess the prevalence of anxiety, depression, alexithymia and hyperventilation syndrome and their impact on the quality of life of patients with severe asthma. Methods: A cross‑sectional study of 63 patients with severe asthma. Their psychodemographic profile was evaluated using the Hospital Anxiety and Depression Scale (HADS), Toronto Alexithymia Scale (TAS‑20), Nijmegen questionnaire and Asthma Control Test (ACT) to determine the state of anxiety and depression, alexithymia, hyperventilation syndrome and control of asthma, respectively. Quality of life was assessed with the Mini Asthma Quality of Life Questionnaire (Mini‑AQLQ). Results: The mean age was 60 ± 13.6 years. Personal psychopathological histories were found in 65.1% of participants, and 8% reported previous suicidal attempts. The rate of anxiety and/or depression (HADS ≥ 11) was 68.3%. These patients present higher scores on the TAS‑20 (p < 0.001) for the level of dyspnea (p = 0.021), and for emotional function (p = 0.017) on the Mini‑AQLQ, compared with patients without anxiety or depression. Alexithymia (TAS‑20 ≥ 61) was observed in 42.9% of patients; these patients were older (p = 0.037) and had a higher HADS score (p = 0.019) than patients with asthma without alexithymia. On the other hand, patients with hyperventilation syndrome (Nijmegen ≥ 23) scored higher on the HADS (p < 0.05), on the Mini‑AQLQ (p = 0.002) and on the TAS‑20 (p = 0.044) than the group without hyperventilation syndrome. Quality of life was related to anxiety‑depression symptomatology (r = − 0.302; p = 0.016) and alexithymia (r = − 0.264; p = 0.036). Finally, the Mini‑AQLQ total score was associated with the Nijmegen questionnaire total score (r = − 0.317; p = 0.011), and the activity limitation domain of the Mini‑AQLQ correlated with the ACT total score (r = 0.288; p = 0.022). Conclusions: The rate of anxiety, depression, alexithymia and hyperventilation syndrome is high in patients with severe asthma. Each of these factors is associated with a poor quality of lifeThis research was a zero cost economic report. There were no financial costs, given the activity of this cross‑sectional descriptive study consisted of the application of a series of questionnaires and their statistical analysi