Gerard Torres

Estudio de intervención aleatorizado para evaluar la prevalencia de enfermedad ateromatosa y renal ocultas y su impacto en la morbimortalidad: Proyecto ILERVAS

BACKGROUND AND OBJECTIVES Chronic kidney disease (CKD) and atherosclerosis are 2 interrelated diseases that increase the risk of cardiovascular morbidity and mortality. The objectives of the ILERVAS project are: 1) to determine the prevalence of subclinical arterial disease and hidden kidney disease; 2) to assess the impact of early diagnosis of both diseases on cardiovascular morbidity and mortality and also on the progression of CKD; 3) to have a platform of data and biological samples. METHODS Randomized intervention study. From 2015 to 2017, 19,800 people (9,900 in the intervention group and 9,900 in the control group) aged between 45 and 70 years without previous history of cardiovascular disease and with at least one cardiovascular risk factor will be randomly selected from the primary health care centres across the province of Lérida. A team of experts will travel around in a mobile unit to carry out the following baseline tests on the intervention group: Artery ultrasound; (carotid, femoral, transcranial and abdominal aorta); ankle-brachial index; spirometry; determination of advanced glycation end products; dried blood spot and urine spot tests. Additionally, blood and urine samples will be collected and stored in the biobank to identify new biomarkers using omics studies. Participants will be followed up until 2025 for identification of cardiovascular events, treatment changes and changes in lifestyle. CONCLUSIONS The ILERVAS project will reveal the prevalence of subclinical vascular disease and hidden kidney disease, determine whether or not their early diagnosis brings health benefits and will also allow investigation of new risk factors.

Use of Ambulatory Blood Pressure Monitoring for the Screening of Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) is a frequent and underdiagnosed disease in hypertensive individuals who experience cardiovascular events. The aim of this study was to define the best model that combined the ambulatory blood pressure (BP) monitoring (ABPM), anthropometric, sociodemographic, and biological variables to identify moderate to severe OSA. A total of 105 ABPM‐confirmed hypertensive patients were evaluated using their clinical histories, blood analyses, ABPM, and home respiratory polygraphic results. A multivariate logistic regression analysis was performed to identify the significant variables. The best model included sex, presence of obesity (body mass index ≥30 kg/m2 and abdominal obesity), mean daytime BP, mean nocturnal heart rate, and minimal diastolic nighttime BP to achieve an area under the curve of 0.804. Based on this model, a validated scoring system was developed to identify the patients with an apnea‐hypopnea index ≥15. Therefore, in untreated hypertensive patients who snored, ABPM variables might be used to identify patients at risk for OSA.

Non-synonymous polymorphism in the neuropeptide S precursor gene and sleep apnea

BackgroundObstructive sleep apnea syndrome (OSAS) is a complex disease with a strong genetic basis. One of the primary molecular domains affected by OSAS is sympathetic activity. Neuropeptide S (NPS) plays an important role in the regulation of the sleep–wakefulness cycle, anxiety states, and daytime sleepiness. It is important to study neuropeptides related to sympathetic activity regulation and how their function could be modified by genetic variants affecting the expression of these molecules.ObjectivesWe investigated the association of the non-synonymous polymorphism rs4751440 in the NPS precursor gene with OSAS and certain variables related to OSAS (daytime sleepiness, body mass index (BMI), insulin resistance, and blood pressure). This polymorphism causes an amino acid substitution in exon 3 of the human NPS precursor gene.Patients and methodsWe included 253 OSAS patients and 70 healthy subjects. Genotyping was done by polymerase chain reaction using specific flanking primers and agarose gel electrophoresis. Daytime sleepiness, BMI, plasma levels of high-density lipoprotein, glucose, total cholesterol, insulin, triglycerides, and the homeostasis model assessment index were also determined.ResultsA similar genotypic and allelic distribution was found in OSAS patients and controls. The risk of OSAS was not associated with the rs4751440 polymorphism. There was no significant interaction between daytime sleepiness or metabolic variables and the rs4751440 polymorphism.ConclusionGenotypic and allelic frequency distribution of the rs4751440 polymorphism was similar in OSAS patients and controls. In this population-based study, we could not show a significant association between rs4751440 polymorphism and susceptibility to OSAS or certain phenotypes related to OSAS (daytime sleepiness, BMI, systolic blood pressure, and insulin resistance) with the exception of diastolic blood pressure.

Sleep Apnea and Cardiovascular Morbidity—a Perspective

Purpose of ReviewIn this paper, we analyzed the principal mechanisms linking OSA and cardiovascular diseases, the magnitude of this association, and the effect of treatment on cardiovascular risk reduction. Furthermore, we focused on big data and genomic approaches that may expand the innovative horizon aimed at personalized treatment of OSA.Recent FindingsPatients with obstructive sleep apnea (OSA) are more prone to suffer from cardiovascular diseases and their complications. Arousal from sleep, changes in intrathoracic pressures, and intermittent episodes of hypoxemia and re-oxygenation trigger intermediate mechanisms that are responsible for the cardiovascular consequences of OSA.SummaryThe impact of OSA on cardiovascular health, such as the effect of continuous positive airway pressure (CPAP) treatment on cardiovascular risk, may vary among different patient profiles. In spite of increasing interest towards personalized therapy for OSA, observational studies and randomized clinical trials have failed to conclusively determine which OSA phenotypes may benefit most from treatment, particularly in terms of reducing cardiovascular risk.

SLEEP QUALITY AND COGNITION IN PATIENTS WITH ALZHEIMER’S DISEASE

Age, years, mean (SD) 70 (9.0) 69.4 (8.5) 74.2 (6.5) 0.25 Sex, male, N (%) 24 (53.3%) 24 (45.3%) 4 (40.0%) 0.64 Education, years, mean (SD) 17.0 (2.3) 15.8 (2.4) 15.5 (3.0) 0.028 CVLT-II 1-5, mean (SD) 50.0 (10.1) 40.3 (13.5) 29.1(7.3) < 0.001 CVLT-II DR, mean (SD) 10.3 (4.0) 7.1 (5.0) 2.3 (3.7) < 0.001 VR-I copy, mean (SD) 84.7 (11.4) 68.0 (16.9) 42.6 (17.0) < 0.001 VR-II DR, mean (SD) 66.4 (21.2) 38.0 (26.9) 10.8 (24.3) < 0.001 Rey-O copy, mean (SD) 32.0 (2.6) 28.2 (5.9) 24.9 (7.0) < 0.001 Rey-O DR, mean (SD) 20.2 (6.7) 11.3 (7.1) 3.75 (5.3) < 0.001 Poster Presentations: Sunday, July 22, 2018 P415