Beneficial Effects of CPAP Treatment in High-risk Subgroups of OSA Patients: Some Evidence, at Last

the clinical and pathophysiological links between obstructive sleep apnea (OSA) and cardiovascula

Hyperuricemia and non-dipping blood pressure

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The puzzle of metabolic effects of obstructive sleep apnoea in children

In obese children with obstructive sleep apnoea insulin resistance is common while lipids do not show a clear patter

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, <10% fall from day to night, which may increase cardiovascular risk and occurrence of major cardiovascular events in the nocturnal hours. Also, BP tends to show a large "morning BP surge", a still controversial negative prognostic sign. Increased very short-term BP variability, high morning BP, and nondipping BP profile appear related to the severity of OSA. Treatment of OSA slightly reduces mean 24-hour BP levels and nocturnal beat-by-beat BP variability by abolishing nocturnal BP peaks. In some patients OSA treatment turns a nondipping into a dipping BP profile. Treatment of arterial hypertension in OSA usually requires both antihypertensive pharmacological therapy and treatment of apnea. Addressing BP variability could help improve the management of OSA and reduce cardiovascular risk. Possibly, drug administration at an appropriate time would ensure a dipping-BP profile

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

Editorial, no abstrac

Relationship between mild to moderate renal dysfunction and obstructive sleep apnea: Data from the European sleep apnea database

The relationship between severity of obstructive sleep apnea (OSA) and kidney function was investigated in the European Sleep Apnea Database (ESADA), where clinical, sleep, and biochemical data of patients studied for suspected OSA in 24 sleep centres of 17 European countries are stored. After excluding patients with missing data or extremely high/low creatinine values, data from 8112 subjects (2328 female) with creatinine values ranging between 0.5 and 2.0 mg% were analyzed. Estimated glomerular filtration rate (eGFR) was obtained with the Modified Diet in Renal Disease (MDRD) equation. Patients were subdivided into two groups: group 1 (n = 3709) studied by full polysomnography; group 2 (n = 4403) studied by nocturnal cardiorespiratory monitoring. Altogether, 8.5% subjects had an eGFR<60 ml/min/1.73m2. At univariate analysis, eGFR correlated to age, comorbidities and severity of OSA in both groups. At logistic regression analysis, risk factors for eGFR<60 were in group 1: diabetes, female gender, age, body mass index, and lowest nocturnal SaO2 (r2=0.086); in group 2: hypertension, female gender, age, and lowest nocturnal SaO2 (r2=0.087). In conclusion, as expected, comorbidities, female gender and advanced age are significant risk factors for low eGFR in subjects with OSA. While traditional severity measures of OSA (apnea/hypopnea index, oxygen desaturation index) did not contribute to low eGFR, more severe nocturnal hypoxia captured by lowest nocturnal SaO2 appeared as a significant predictor in this large patient cohort. The ESADA study is supported by ResMed and Philips Respironics

Gender and the systemic hypertension-snoring association: a questionnaire-based case-control study.

Since the role of gender in the association between hypertension and snoring is unknown, we studied it while accounting for age and body mass index (BMI) as confounding variables. A questionnaire on snoring was administered to 90 hypertensive (HT) subjects (45 men and 45 women) and to 90 normotensive (NT) subjects matched for gender, age and BMI. As expected, snoring was more commonly reported by men than by women, but no significant difference was found between HT and NT men, irrespective of age. Conversely, heavy snoring was more frequently reported by HT than NT women; habitual snoring was more common among young (age50 years) HT than NT women; and heavy snoring was more common among older (age50 years) HT than NT women. These data suggest an effect of gender on the hypertension-snoring association: in men, snoring may be accounted for by age and BMI whether or not hypertension is present, whereas in women the natural history of snoring appears different and more severe in HT than in NT. Although the mechanism(s) responsible for the differences between men and women are obscure at present, gender may be an important variable in the systemic hypertension-snoring association

Determinazione di mercurio mediante DMA-80

I fenomeni di contaminazione antropica da mercurio sono sempre più diffusi e preoccupanti, tanto da spingere all’ attivazione di politiche nazionali ed internazionali atte a ridurre o almeno “contenere” i rischi legati a questo metallo tossico. Con quest’obiettivo è prioritaria la necessità di determinare la concentrazione del metallo in maniera veloce, economica ed efficiente. Il seguente report intende fornire informazioni utili nell’utilizzo dello spettrofotometro DMA-80 nell’analisi di Hg in varie matrici ambientali. Lo strumento è stato acquistato dall’IAMC-CNR di Capo Granitola per rispondere alle esigenze progettuali del progetto “Dinamica dei processi di evasione e deposizione del mercurio nell’area industrializzata della Rada di Augusta e definizioni delle mappe di rischio sanitario per le popolazioni residenti” (prot.n°0000466 18/2/2011) finanziato dall’Assessorato alla Salute della Regione Sicilia con l’obbiettivo di verificare il potenziale impatto del mercurio, derivato dalle emissioni dei reflui non trattati dell’impianto di cloro-soda SYNDIAL Priolo-Gargallo sulle popolazioni residenti nell’aria fortemente industrializzata di Augusta-Melilli (Siracusa)

Sleep apnoea and metabolic dysfunction.

Obstructive sleep apnoea (OSA) is a highly prevalent condition often associated with central obesity. In the past few years, several studies have analysed the potential independent contribution of OSA to the pathogenesis of metabolic abnormalities, including type 2 diabetes, the metabolic syndrome and nonalcoholic fatty liver disease. New perspectives in OSA patient care have been opened by the promotion of lifestyle interventions, such as diet and exercise programmes that could improve both OSA and the metabolic profile. The rich clinical literature on this subject, together with the growing amount of data on pathophysiological mechanisms provided by animal studies using the chronic intermittent hypoxia model, urged the organising Committee of the Sleep and Breathing meeting to organise a session on sleep apnoea and metabolic dysfunction, in collaboration with the European Association for the Study of Diabetes. This review summarises the state-of-the-art lectures presented in the session, more specifically the relationship between OSA and diabetes, the role of OSA in the metabolic consequences of obesity, and the effects of lifestyle interventions on nocturnal respiratory disturbances and the metabolic profile in OSA patient

New organisation for follow-up and assessment of treatment efficacy in sleep apnoea

Obstructive sleep apnoea (OSA) is a highly prevalent disease, and there is an increased demand for OSA diagnosis and treatment. However, resources are limited compared with the growing needs for OSA diagnosis and management, and alternative strategies need to be developed to optimise the OSA clinical pathway. In this review, we propose a management strategy for OSA, and in general for sleep-disordered breathing, to be implemented from diagnosis to follow-up. For this purpose, the best current options seem to be: 1) networking at different levels of care, from primary physicians to specialised sleep laboratories; and 2) use of telemedicine. Telemedicine can contribute to the improved cost-effectiveness of OSA management during both the diagnostic and therapeutic phases. However, although the technology is already in place and different commercial platforms are in use, it is still unclear how to use telemedicine effectively in the sleep field. Application of telemedicine for titration of positive airway pressure treatment, follow-up to improve compliance to treatment through early identification and solution of problems, and teleconsultation all appear to be promising areas for improved OSA management