Sleep medicine: Practice, challenges and new frontiers

Sleep medicine is an ambitious cross-disciplinary challenge, requiring the mutual integration between complementary specialists in order to build a solid framework. Although knowledge in the sleep field is growing impressively thanks to technical and brain imaging support and through detailed clinic-epidemiologic observations, several topics are still dominated by outdated paradigms. In this review we explore the main novelties and gaps in the field of sleep medicine, assess the commonest sleep disturbances, provide advices for routine clinical practice and offer alternative insights and perspectives on the future of sleep research

Nobles in Mantua between the Ancien Régime and the Congress of Vienna: the Family of count Francesco Alberto D'Arcy And his Countess Amalia Sanvitale

La ricerca ha messo a tema i diversi aspetti della vita privata e pubblica di una famiglia nobiliare a Mantova nel passaggio dall’Antico Regime alla Restaurazione, indagata in quanto rappresentativa del ceto nobiliare di appartenenza: la famiglia di Francesco Alberto d’Arco e Amalia Sanvitale. Di provincia ma non provinciale, la famiglia d’Arco è stata letta nelle sue varie scelte, come, ad esempio, l’educazione dei figli, i collegi frequentati, le strategie di carriera individuate per i figli maschi o l’assegnazione delle doti e la scelta delle alleanze per i matrimoni delle figlie femmine. Tale lettura è stata resa possibile dalla disponibilità dei carteggi conservati nell’archivio della Fondazione d’Arco, fonte che è stata messa a confronto con la coeva documentazione di tipo istituzionale. Dimensione privata e dimensione pubblica hanno trovato un punto di incontro nella lettura di questi carteggi, che con il loro carattere ibrido, a metà tra la “scrittura di sé” e la trascrizione di notizie, bene si prestano all’incrocio di fonti diverse e apparentemente lontane.The aim of the research is to examine the diverse aspects of the public and private life of a noble family in Mantua in the transition from the Ancien Régime to the period after the Congress of Vienna. The d’Arco were chosen because they were representative of the noble class they belonged to and of the forms of aristocratic life style. From the province but by no means provincial, the d’Arco family has been studied in its various choices, as, for example, the education of its children and the colleges they attended, the strategies employed for the careers of its sons or the dowries and the choice of marriage alliances made for the daughters. Such study has been made possible by access to a privileged source - the family papers and correspondence preserved in the archives of the D’Arco Foundation. A source which was then critically compared with the contemporary institutional documentation. The private and public dimensions meet in the reading of these papers, which with their hybrid character, half way between “writing of oneself” and the transcription of news, lend themselves perfectly to a cross-match between sources that are diverse and apparently distant

Cyclic alternating patterns and arousals: what is relevant in obstructive sleep apnea? In Memoriam Mario Giovanni Terzano

Purpose of review: To review main knowledges and gaps in the field of sleep microstructure, represented by the cyclic alternating pattern (CAP), in obstructive sleep apnea (OSA). Recent findings: The (electroencephalographic and autonomic) 'intensity' of arousals in OSA patients, measured through the metrics of CAP, correlate with OSA severity and with disease burden. Continuous positive airway pressure determines variations in sleep architecture (conventional parameters) and at the microstructural level, at different time points. Summary: CAP is not only an 'attractor' of arousals, but also organizes distribution of K-complexes and delta bursts in non-rapid eye movement sleep. Although attention is always concentrated on the A-phase of CAP, a crucial role is play by the phase B, which reflects a period of transient inhibition. Respiratory events in OSA are a typical example of phase B-associated condition, as they occur during the interval between successive A-phases. Accordingly sleep microstructure provides useful insights in the pathophysiology and estimation of OSA severity and may be exploited to follow-up treatment efficacy. In the complex relationship among sleep fragmentation, excessive daytime sleepiness, cognition and cardiovascular risk the CAP framework can offer an integrative perspective in a multidisciplinary scenario

Obstructive sleep apnea, cpap and COVID-19: a brief review

Obstructive sleep apnea (OSA) is a broadly diffused curable chronic low-grade inflammatory disease sharing impressive clinical and pathogenetic features with Covid-19. Moreover, a potential role of OSA as a detrimental factor for Covid-19 severity has been hypothesized. Continuous positive airway pressure (CPAP) is the mainstay treatment for moderate-severe OSA, but the beneficial effects of ventilation strongly depend on medical expertise and on the patient's adherence and compliance. Although several papers have analyzed the overlaps and outcomes of OSA and Covid-19, limited attention has been dedicated to ventilatory adherence and management of  OSA cohorts exposed to Covid-19. We briefly review the literature data, pointing out the main risks and benefits of CPAP for OSA patients in the pandemic setting