Obstructive sleep apnea and heart disease: the biomarkers point of view.

Obstructive sleep apnea syndrome (OSAS) is a highly prevalent disorder. Important risk factors for this disease are represented by obesity, male gender, smoking, some endocrinological disturbances, alcohol intake, use of benzodiazepines, and craniofacial alterations. It is well known that OSAS is a frequent comorbidity as well as a relevant risk factor for cardiovascular diseases (CVD), especially in patients with hypertension, coronary artery disease (CAD), arrhythmias, and heart failure. Furthermore, therapy with continuous positive airway pressure devices (CPAP) has been shown to significantly reduce the incidence of serious cardiovascular consequences. Interactions between OSAS and the cardiovascular system (CVS) can eventually result mainly in coronary atherosclerosis. These two conditions are connected by a complex biomarkers network. An extensive overview of these pathways could be helpful to better understand the causes of cardiovascular impairment in patients with OSAS

Disturbi respiratori del sonno e fibrosi polmonare idiopatica

Idiopathic pulmonary fibrosis (IPF) is a diffuse interstitial lung disease (ILD) characterized by inflammation and progressive fibrosis of the lung parenchyma. Patients with IPF have sleep breathing disorders (SBD) that are associated with reduced sleep quality, reduced quality of life, worse survival. SBD, sleep related desaturation and obstructive sleep apnea syndrome (OSAS), have a high prevalence in patients with IPF but often remain undiagnosed. The diagnosis and treatment of DRS, particularly OSAS, can improve symptoms, quality of life and survival and should be pursued in all patients with IPF

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

Abstract 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 patients with moderate to severe OSA and 60 control subjects with normal nocturnal respiration were recruited. Morning circulating TSH, fT3, and fT4 were measured in all subjects. In a subsample of patients, nocturnal polysomnography and hormonal determinations were repeated after CPAP treatment for five months. RESULTS: NTIS was found in 13 (10.4%), and SH in ten (8%) OSA subjects, but not in any control subjects. Patients with NTIS showed worse mean nocturnal oxygen saturation and time with saturation <90% (both p < 0.001). After treatment, NTIS subjects (n = 13) showed an increase in fT3 (p < 0.001) to the normal range, and SH subjects (n = 6) a slight decrease in TSH (p = 0.01). In the patients with normal hormones before treatment (n = 45), no change was observed. CONCLUSIONS: NTIS may occur in OSA patients with severe nocturnal hypoxemia. OSA treatment is followed by an improvement in TSH in patients with abnormal baseline levels of this hormone, and by recovery of NTIS

An Unusual Cause Of Bimodal Pattern Of Nocturnal Hypoxemia In An Obstructive Sleep Apnea Patient.

Background. Venous return and right atrial pressure are increased by clinostatism and by the intrathoracic negative pressure during obstructive sleep apneas. In presence of a interatrial defect this may results in right-to-left shunt. Case report. A 51-yrs obese male was admitted to the cardiology department of our hospital for evaluation of arrhythmias and exertional dyspnoea. He was also referred to the Respiratory unit because of dry mouth and sore throat upon awakening, daytime sleepiness and fatigue, snoring, restlessness during sleep, with a story of wheezing and recurrent bronchitis for years. He had a history of former smoking (20pack/yrs) and a prolonged occupational exposure to wheat. Lung function tests documented a mild chronic obstructive pulmonary disease and high values of the carbon monoxide transfer coefficient. Arterial blood gas analysis in ambient air and in spontaneous breathing was normal. A nocturnal cardiorespiratory polygraphy (CRP) documented a severe pattern of obstructive sleep apnoea syndrome (OSAS) (AHI=83/h, ODI=71/h), with hypoxemia (time with SpO2<90%=89%, <80%=53%). There were different fasis of severe prolonged hypoxemia with superimposed typical apnoeic desaturations (Fig.1). After a short awakening in standing position the hypoxemia recurred after about 1 hour of sleep. The deepest desaturations occurred in both right and left lateral positions. The number of hypo-apnoeic episodes was similar in both normoxemic and hypoxemic phases. The distribution of hypoxemia showed a bimodal pattern (Fig.2). A chest TC scan showed signs of COPD and air trapping during the expiratory phase, with no abnormal findings in the pulmonary circulation. A transthoracic ecocardiography documented a suspected interatrial right-to-left shunt with normal values of pulmonary artery systolic pressure (20 mmHg). A transesophageal ecocardiography confirmed the presence of an interatrial right-to-left shunt which occurred only during deep inspirations. After a 4 days progressive pressure titration, we prescribed the application of a continuous positive airway pressure (CPAP) of 13cmH2O with an oronasal mask during sleep. After 6 days a CRP with CPAP documented a marked improvement: AHI=9.3/h, ODI=8.1/h, time with SpO2<90%=7.6%, SpO2<80%=0%, with the usual unimodal pattern. A significant subjective improvement was reported. Conclusion. Our observation confirms the efficacy of CPAP therapy in reducing intermittent right-to-left shunt in interatrial defects in presence of OSAS. In our case sustained but inconstant hypoxemia was not explained by supine position or number of apnoeas and was temporarily reversed by a short standing period. Variable right-to-left shunt is a possible cause of a bimodal pattern of SpO2 distribution

Submental and neck ultrasonography measurements in patients with obstructive sleep apnea

Abstract Introduction: Obstructive sleep apnea syndrome (OSAS) is based on clinical symptoms and apnea-hypopnea events measured by cardiorespiratory polysomnography (PSG) that often has limited availability. Sub-mental (SM) and lateral parapharyngeal wall thickness (LPWT) ultrasound measures (UM) can discriminate the severity of OSA in Chinese patients (Shu C-C. Plos One 2013; 8(5):e62848), (Liu HK. Sleep 2007;30(11):1503-1508). Aim: The principal aim of this study was to correlate UM with OSAS severity and to assess the intra- and interobserver reproducibility of UM. Methods: Eleven caucasian patients with referred symptoms suggesting OSAS were enrolled. Two blinded pulmonologists performed UM in supine position awake patient using a convex probe: bi-LPWT on the lateral neck region, retroglossal (RG) and retropalatal (RP) transverse diameter, tongue thickness (TT) and upper airway length (UAL) on the SM region. After UM, subjects underwent to home PSG. Patients with indication to CPAP treatment performed a 7 days trial with auto-CPAP before a titration PSG. Results: OSAS was diagnosed in all patients: 3 (27%) mild, 3 (27%) moderate, 5 (45%) severe. Apnea-hypopnea index (AHI) was 30 \ub1 24 (mean \ub1 s.d.). There was a low negative correlation between AHI and TT (r =-0.3), AHI and UAL (r=-0.2) (p&lt;0.05). Mean coefficients of variance intraobserver and interobserver for UM were 0.02. In four patients treated with CPAP the selected pressure of CPAP correlated with TT (r=0.8), UAL (r=0.9), and LPWT (r=0.9) (p&lt;0.01). Conclusion: These preliminary data suggest that UM are a reproducible, repeatable and easy accessible technique. UAL, TT and LPWT can be useful measurements useful to predict CPAP titration values

Obstructive sleep apnea and heart disease: the biomarkers point of view.

Obstructive sleep apnea syndrome (OSAS) is a highly prevalent disorder. Important risk factors for this disease are represented by obesity, male gender, smoking, some endocrinological disturbances, alcohol intake, use of benzodiazepines, and craniofacial alterations. It is well known that OSAS is a frequent comorbidity as well as a relevant risk factor for cardiovascular diseases (CVD), especially in patients with hypertension, coronary artery disease (CAD), arrhythmias, and heart failure. Furthermore, therapy with continuous positive airway pressure devices (CPAP) has been shown to significantly reduce the incidence of serious cardiovascular consequences. Interactions between OSAS and the cardiovascular system (CVS) can eventually result mainly in coronary atherosclerosis. These two conditions are connected by a complex biomarkers network. An extensive overview of these pathways could be helpful to better understand the causes of cardiovascular impairment in patients with OSAS

Association between obstructive sleep apnea and serum uric acid levels in obese women

Abstract INTRODUCTION Controversial data exist on association of hyperuricemia both with increased cardiovascular risk, particularly in obese patients, and with the presence and severity of obstructive sleep apnea (OSA). AIM We correlated acid uric (AU) levels with metabolic and polygraphic parameters in obese patients with suspected OSA. METHODS We studied 86 patients (44M) aged 44.3+9.7 yr, BMI 43.9+6.7), all CPAP naïve. At the cardiorespiratory monitoring AHI was >5, >15 and >30 in 90,70,and 46% of them. RESULTS Mean UA was greater in men (7.30+1.7 vs 5.6+0.12, p 0,003) and in the upper versus lowest AHI quartiles (7+1.5vs 5.5+1.6, p 0.007). Men showed also greater values of AHI, ODI, creatinine, haemoglobin and lower HDL cholesterol levels than women, with similar age and BMI. UA was directly correlated with AHI and ODI (r 0.33-0.36, p 0.005), time spent with SpO2<90% (r 0.25, p 0.013), serum creatinine (r 0.29, p 0.014) and triglycerides (0.36, p=0.003), but not with age or BMI, and inversely with HDL cholesterol (r -0.36,p=0.001). Multiple linear regression demonstrated a significant association with AHI independent of age and BMI only in women and with glycated haemoglobin (HbA1c) in both sex subgroups. The correlations with nocturnal OSA parameters were even stronger among women (r 0.46-0.52, p<0.004) but not significant in men. CONCLUSION Our results support the hypothesis of a significant association between UA and OSAS in obese women, both for number of events and for induced hypoxemia, while in obese men the more complex interaction between OSA, UA and classical cardiovascular risk factors requires further clarification

Particolato atmosferico e snoring: il caso studio "Osas" nell'area urbana di Roma

PARTICOLATO ATMOSFERICO E SNORING: IL CASO STUDIO “OSAS” NELL’ AREA URBANA DI ROMA Abstracts : Questo studio focalizza l’attenzione sulle possibili relazioni fra concentrazioni di particolato atmosferico e una patologia respiratoria di lieve entità,lo Snoring (fenomeno legato alla resistenza al flusso d’aria nelle vie aeree superiori),che non rientra ancora nel carico delle patologie di stime sanitarie correlate all’inquinamento atmosferico. Lo studio “OSAS” è stato condotto dal Policlinico Gemelli su oltre 350 pazienti residenti nell’area urbana di Roma.Ogni paziente è stato sottoposto a poligrafia cardiorespiratoria,eseguita a domicilio dal 2008 al 2013,da cui sono state ricavate cinque variabili quantitative. Inoltre per ciascun paziente sono state raccolte informazioni riguardo alcuni fattori di rischio, come fumo o obesità. Questi dati sono stati analizzati con la PCA per ricavarne la struttura di correlazione. Contestualmente, sono stati analizzati i dati di concentrazione oraria di PM10 rilevati in undici stazioni della rete di monitoraggio della qualità dell’aria della città di Roma, dal 2008 al 2011. Mediante cluster analysis sono stati individuati sottogruppi omogenei di stazioni in base ai livelli di particolato osservato nei diversi anni. Infine ogni paziente,in base alla sua residenza negli ultimi 10 anni,è stato associato ad una delle stazioni di monitoraggio,in modo da poter confrontare i risultati dell’analisi dei due insiemi di dati e verificare l’esistenza di possibili legami. I primi risultati ottenuti sono stati significativi. Per il futuro si prevede di realizzare un’analisi delle abitudini dei pazienti e dei luoghi in cui essi risiedono o lavorano. Inoltre si dovranno anche analizzare le concentrazioni del PM2.5 e PM1, sulle quali è maggiormente focalizzata l’attenzione della comunità scientifica internazionale e per le quali i legami con le patologie respiratorie possono essere particolarmente interessanti in quanto veicolo delle sostanze più tossiche per la salute umana. sessione : wg2 Tipo di presentazione : Poster Primary authors : Dr. SALIMBENE, Ornella (Politecnico Torino, Dipartimento di Ingegneria dell’ ambiente, del territorio e delle infrastrutture (DIATI);Torino.) Co-authors : Dr. MORMILE, Flaminio (Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, Reparto Di Pneumologia; Roma.) ; Prof. VALENTE, Salvatore (Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, Reparto Di Pneumologia; Roma.) ; Dr. GIORGIO, Giuseppina Anna (Università degli Studi della Basilicata, Scuola di Ingegneria; Potenza.) ; Dr. SALIMBENE, Ivano (Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, Reparto Di Pneumologia; Roma.) ; Dr. MARIA, Ragosta (Università degli studi della Bsilicata, Scuola di Ingegneria, Dipartimento di Fisica dell'ambiente) Presenter : Dr. SALIMBENE, Ornella (Politecnico Torino, Dipartimento di Ingegneria dell’ ambiente, del territorio e delle infrastrutture (DIATI);Torino.