Felice Gadaleta

Early treatment with noninvasive positive pressure ventilation prolongs survival in Amyotrophic Lateral Sclerosis patients with nocturnal respiratory insufficiency

BackgroundAmyotrophic lateral sclerosis (ALS) is a neurodegenerative disease, which rapidly leads to chronic respiratory failure requiring mechanical ventilation. Currently, forced vital capacity (FVC) < 50% is considered as physiologic marker for admitting patients to Noninvasive Positive Pressure Ventilation (NPPV) intervention, although it has been recently shown the median survival of patients with baseline FVC < 75% much shorter than median survival of patients with baseline FVC > 75%, independently by any treatment.AimTo assess the role of NPPV in improving outcome of ALS, a retrospective analysis was performed to investigate 1 year survival of ALS patients with FVC < 75% and nocturnal respiratory insufficiency, treated with NPPV, compared to a well-matched population of ALS patients, who refused or was intolerant to NPPV.MethodsWe investigated seventy-two consecutive ALS patients who underwent pulmonary function test. Forty-four presented a FVC > 75% and served as control group. Twenty-eight patients presented a FVC < 75% and showed, at polysomnography analysis, nocturnal respiratory insufficiency, requiring NPPV; sixteen were treated with NPPV, while twelve refused or were intolerant.ResultsIncreased survival rate at 1 year in patients with FVC < 75% treated with NPPV, as compared to those who refused or could not tolerate NPPV (p = 0.02), was observed. The median rate of decline in FVC% was slower in NPPV patients than in patients who did not use NPPV (95% CI: 0.72 to 1.85; p < 0.0001).ConclusionThis report demonstrates that early treatment with NPPV prolongs survival and reduces decline of FVC% in ALS.

Exhaled and arterial levels of endothelin-1 are increased and correlate with pulmonary systolic pressure in COPD with pulmonary hypertension

BackgroundEndothelin-1 (ET-1) and Nitric Oxide (NO) are crucial mediators for establishing pulmonary artery hypertension (PAH). We tested the hypothesis that their imbalance might also occur in COPD patients with PAH.MethodsThe aims of the study were to measure exhaled breath condensate (EBC) and circulating levels of ET-1, as well as exhaled NO (FENO) levels by, respectively, a specific enzyme immunoassay kit, and by chemiluminescence analysis in 3 groups of subjects: COPD with PAH (12), COPD only (36), and healthy individuals (15). In order to evaluate pulmonary-artery systolic pressure (PaPs), all COPD patients underwent Echo-Doppler assessment.ResultsSignificantly increased exhaled and circulating levels of ET-1 were found in COPD with PAH compared to both COPD (p < 0.0001) only, and healthy controls (p < 0.0001). In COPD with PAH, linear regression analysis showed good correlation between ET-1 in EBC and PaPs (r = 0.621; p = 0.031), and between arterial levels of ET-1 and PaPs (r = 0.648; p = 0.022), while arterial levels of ET-1 inversely correlated with FEV1%, (r = -0.59, p = 0.043), and PaPs negatively correlated to PaO2 (r = -0.618; p = 0.032). Significantly reduced levels of FENO were found in COPD associated with PAH, compared to COPD only (22.92 ± 11.38 vs.35.07 ± 17.53 ppb; p = 0.03). Thus, we observed an imbalanced output in the breath between ET-1 and NO, as expression of pulmonary endothelium and epithelium impairment, in COPD with PAH compared to COPD only. Whether this imbalance is an early cause or result of PAH due to COPD is still unknown and deserves further investigations.

Association between low sniff nasal-inspiratory pressure (SNIP) and sleep disordered breathing in amyotrophic lateral sclerosis: Preliminary results

Abstract Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that rapidly involves the respiratory system, leading to persistent respiratory insufficiency. Neuromuscular respiratory weakness is also responsible for sleep disordered breathing (SDB), which occurs at an early stage of ALS. Maximal sniff nasal-inspiratory pressure (SNIP) is a sensitive test to early disclose respiratory muscle decline. The aim of this study was to evaluate the role of the SNIP test, compared to FVC, as a marker of SDB in ALS. We studied 31 (18 males) patients with ALS, who were divided into two groups according to the SNIP test value. Ten patients who showed a SNIP value higher than 60 cmH2O were considered as group 1. Twenty-one patients exhibited a SNIP lower than 60 cmH2O and were included in group 2. Both groups of patients were also investigated with nocturnal sleep study. A linear correlation between lower SNIP value and reduced nocturnal SaO2 in patients with a SNIP value less than 60 cmH2O (n = 21; r = 0.449; p = 0.04) was found. A negative correlation between SNIP and time spent in SaO2 below 90% (TST90) (n = 21; r = −0.584; p = 0.0054), and between SNIP and oxyhaemoglobin desaturation index (ODI, events/hour) (n = 21; r = −0.458; p = 0.0368) was also established in all the patients of group 2, while, in this group, FVC did not correlate with any nocturnal parameter observed. A positive correlation between SNIP and PaO2 at baseline of the entire population of patients (n = 31; r = 0.614; p < 0.001) was also seen. In conclusion, the results of this preliminary study show that SNIP < 60 cmH2O might be considered an early predictor of SDB in ALS.

The Epworth Sleepiness Scale: conventional self vs physician administration.

Abstract ABSTRACT BACKGROUND AND AIMS: the Epworth Sleepiness Scale (ESS) is a simple self-administered questionnaire which provides a measurement of the subjects level of daytime sleepiness, and is widely used for patients with obstructive sleep apnea (OSA). Some recent works undermined its accuracy. The aim of this study was to compare self-administered ESS scores to physician-administered scores, in a sample of patients with suspicion of OSA. METHODS: patients were randomly divided into 2 groups: group I or the self-administered group (n=113), and group II or the physician-administered group (n=112). Patients in group I were asked to complete the ESS in the traditional way; in group II, the ESS was administered by a sleep medicine physician. Subjects in both groups underwent diagnostic in-laboratory portable monitoring (PM) within a weeks time. RESULTS: the percentage of questionnaires properly completed was significantly different between groups: 77% (87/113) in the group I vs 100% (112/112) in the group II (p=0.00). Scores obtained by the physician-administered questionnaire were higher than those derived by the self-administered ESS (ESSp:12.09 ± 4.1 vs ESSs:10.37 ± 5.49; p=0.01). The ESSp was more highly correlated with apnea-hypopnea index, and oxygen desaturation index than the ESSs. CONCLUSIONS: our results lead to consider the physician-administered ESS to be more accurate than the traditional ESS; thus, our suggestion is to validate this new method of administration.BACKGROUND The Epworth Sleepiness Scale (ESS) is a simple, self-administered questionnaire that provides a measurement of the subjects level of daytime sleepiness, and is widely used for patients with obstructive sleep apnea (OSA). Some works undermined its accuracy. The aim of this study was to compare self-administered ESS scores to physician-administered scores in a sample of patients with suspicion of OSA. METHODS Patients were randomly divided into two groups: group 1, or the self-administered group (n = 113); and group 2, or the physician-administered group (n = 112). Patients in group 1 were asked to complete the ESS in the traditional way; in group 2, the ESS was administered by a sleep-medicine physician. Subjects in both groups underwent diagnostic in-laboratory portable monitoring (PM) within 1 weeks time. RESULTS The percentage of questionnaires properly completed was significantly different between groups: 77% (87 of 113) in the group 1 vs 100% (112 of 112) in the group 2 (P = .00). Scores obtained when a physician administered the questionnaire (ESSp) were higher than those when the ESS was self administered (ESSs) (ESSp:12.09 ± 4.1 vs ESSs:10.37 ± 5.49; P = .01). The ESSp was more highly correlated with apnea-hypopnea index and oxygen desaturation index than the ESSs. CONCLUSIONS Our results lead us to consider the physician-administered ESS to be more accurate than the traditional ESS; thus, our suggestion is to validate this new method of administration.

Efficacy of bilevel-auto treatment in patients with obstructive sleep apnea not responsive to or intolerant of continuous positive airway pressure ventilation

BACKGROUND Ventilation with continuous positive airway pressure (CPAP) is the gold standard therapy for obstructive sleep apnea (OSA). However, it was recently suggested that a novel mode of ventilation, Bilevel-auto, could be equally effective in treating patients unable to tolerate CPAP. The aim of this study was to investigate the ability of Bilevel-auto to treat OSA patients whose nocturnal ventilatory disturbances are not completely corrected by CPAP. METHODS We enrolled 66 consecutive OSA patients, not responsive to (group A) or intolerant of (group B) CPAP treatment, after a full night of manual CPAP titration in a laboratory. Full polysomnography data and daytime sleepiness score were compared for each group in the three different conditions: basal, during CPAP, and during Bilevel-auto. RESULTS The apnea-hypopnea index decreased significantly during CPAP in both groups; however, in the group A, there was a further significant improvement during Bilevel-auto. The same trend was observed for oxygenation indices, while the distribution and the efficiency of sleep did not differ following the switch from CPAP to Bilevel-auto. CONCLUSIONS This study confirmed the role of Bilevel-auto as an effective therapeutic alternative to CPAP in patients intolerant of this latter mode of ventilation. Moreover, extending the use of Bilevel-auto to those OSA patients not responsive to CPAP, we showed a significantly better correction of nocturnal respiratory disturbances.

The Epworth sleepiness scale: conventional self-administration versus administration by the physician

Abstract ABSTRACT BACKGROUND AND AIMS: the Epworth Sleepiness Scale (ESS) is a simple self-administered questionnaire which provides a measurement of the subjects level of daytime sleepiness, and is widely used for patients with obstructive sleep apnea (OSA). Some recent works undermined its accuracy. The aim of this study was to compare self-administered ESS scores to physician-administered scores, in a sample of patients with suspicion of OSA. METHODS: patients were randomly divided into 2 groups: group I or the self-administered group (n=113), and group II or the physician-administered group (n=112). Patients in group I were asked to complete the ESS in the traditional way; in group II, the ESS was administered by a sleep medicine physician. Subjects in both groups underwent diagnostic in-laboratory portable monitoring (PM) within a weeks time. RESULTS: the percentage of questionnaires properly completed was significantly different between groups: 77% (87/113) in the group I vs 100% (112/112) in the group II (p=0.00). Scores obtained by the physician-administered questionnaire were higher than those derived by the self-administered ESS (ESSp:12.09 ± 4.1 vs ESSs:10.37 ± 5.49; p=0.01). The ESSp was more highly correlated with apnea-hypopnea index, and oxygen desaturation index than the ESSs. CONCLUSIONS: our results lead to consider the physician-administered ESS to be more accurate than the traditional ESS; thus, our suggestion is to validate this new method of administration.BACKGROUND The Epworth Sleepiness Scale (ESS) is a simple, self-administered questionnaire that provides a measurement of the subjects level of daytime sleepiness, and is widely used for patients with obstructive sleep apnea (OSA). Some works undermined its accuracy. The aim of this study was to compare self-administered ESS scores to physician-administered scores in a sample of patients with suspicion of OSA. METHODS Patients were randomly divided into two groups: group 1, or the self-administered group (n = 113); and group 2, or the physician-administered group (n = 112). Patients in group 1 were asked to complete the ESS in the traditional way; in group 2, the ESS was administered by a sleep-medicine physician. Subjects in both groups underwent diagnostic in-laboratory portable monitoring (PM) within 1 weeks time. RESULTS The percentage of questionnaires properly completed was significantly different between groups: 77% (87 of 113) in the group 1 vs 100% (112 of 112) in the group 2 (P = .00). Scores obtained when a physician administered the questionnaire (ESSp) were higher than those when the ESS was self administered (ESSs) (ESSp:12.09 ± 4.1 vs ESSs:10.37 ± 5.49; P = .01). The ESSp was more highly correlated with apnea-hypopnea index and oxygen desaturation index than the ESSs. CONCLUSIONS Our results lead us to consider the physician-administered ESS to be more accurate than the traditional ESS; thus, our suggestion is to validate this new method of administration.

The Epworth Sleepiness Scale

Abstract ABSTRACT BACKGROUND AND AIMS: the Epworth Sleepiness Scale (ESS) is a simple self-administered questionnaire which provides a measurement of the subjects level of daytime sleepiness, and is widely used for patients with obstructive sleep apnea (OSA). Some recent works undermined its accuracy. The aim of this study was to compare self-administered ESS scores to physician-administered scores, in a sample of patients with suspicion of OSA. METHODS: patients were randomly divided into 2 groups: group I or the self-administered group (n=113), and group II or the physician-administered group (n=112). Patients in group I were asked to complete the ESS in the traditional way; in group II, the ESS was administered by a sleep medicine physician. Subjects in both groups underwent diagnostic in-laboratory portable monitoring (PM) within a weeks time. RESULTS: the percentage of questionnaires properly completed was significantly different between groups: 77% (87/113) in the group I vs 100% (112/112) in the group II (p=0.00). Scores obtained by the physician-administered questionnaire were higher than those derived by the self-administered ESS (ESSp:12.09 ± 4.1 vs ESSs:10.37 ± 5.49; p=0.01). The ESSp was more highly correlated with apnea-hypopnea index, and oxygen desaturation index than the ESSs. CONCLUSIONS: our results lead to consider the physician-administered ESS to be more accurate than the traditional ESS; thus, our suggestion is to validate this new method of administration.BACKGROUND The Epworth Sleepiness Scale (ESS) is a simple, self-administered questionnaire that provides a measurement of the subjects level of daytime sleepiness, and is widely used for patients with obstructive sleep apnea (OSA). Some works undermined its accuracy. The aim of this study was to compare self-administered ESS scores to physician-administered scores in a sample of patients with suspicion of OSA. METHODS Patients were randomly divided into two groups: group 1, or the self-administered group (n = 113); and group 2, or the physician-administered group (n = 112). Patients in group 1 were asked to complete the ESS in the traditional way; in group 2, the ESS was administered by a sleep-medicine physician. Subjects in both groups underwent diagnostic in-laboratory portable monitoring (PM) within 1 weeks time. RESULTS The percentage of questionnaires properly completed was significantly different between groups: 77% (87 of 113) in the group 1 vs 100% (112 of 112) in the group 2 (P = .00). Scores obtained when a physician administered the questionnaire (ESSp) were higher than those when the ESS was self administered (ESSs) (ESSp:12.09 ± 4.1 vs ESSs:10.37 ± 5.49; P = .01). The ESSp was more highly correlated with apnea-hypopnea index and oxygen desaturation index than the ESSs. CONCLUSIONS Our results lead us to consider the physician-administered ESS to be more accurate than the traditional ESS; thus, our suggestion is to validate this new method of administration.