Nikolaos Chavouzis

Exercise capacity in idiopathic pulmonary fibrosis: the effect of pulmonary hypertension.

Background and objective:  Increased pulmonary arterial pressure (PAP) usually coexists with impaired lung function in IPF. Data on the effect of pulmonary hypertension (PH) on cardiopulmonary responses during exercise in IPF patients is very limited. We sought to investigate the impact of PH on exercise capacity and the correlation between systolic PAP (sPAP) and pulmonary function testing, as well as cardiopulmonary exercise parameters, in patients with IPF and PH.

The Impact of Pulmonary Arterial Pressure on Exercise Capacity in Mild-to-Moderate Cystic Fibrosis: A Case Control Study

Background. Pulmonary hypertension (PH) is an often complication of severe cystic fibrosis (CF); however, data on the presence and impact of pulmonary vasculopathy in adult CF patients with milder disease, is very limited. Aim. To investigate, for the first time, the impact of systolic pulmonary arterial pressure (PASP) on maximal exercise capacity in adults with mild-to-moderate cystic fibrosis, without PH at rest. Methods. This is a Case Control study. Seventeen adults with mild-to-moderate CF, without PH at rest (cases) and 10 healthy, nonsmoking, age, and height matched controls were studied. All subjects underwent maximal cardiopulmonary exercise testing and echocardiography before and within 1 minute after stopping exercise. Results. Exercise ventilation parameters were similar in the two groups; however, cases, compared to controls, had higher postexercise PASP and decreased exercise capacity, established with lower peak work rate, peak O2 uptake, anaerobic threshold, and peak O2 pulse. Furthermore, the change in PASP values before and after exercise was strongly correlated to the parameters of exercise capacity among cases but not among controls. Conclusions. CF adults with mild-to-moderate disease should be screened for the presence of pulmonary vasculopathy, since the elevation of PASP during exercise might contribute to impaired exercise capacity.

Phenotyping Exercise Limitation in Systemic Sclerosis: The Use of Cardiopulmonary Exercise Testing

Background: Exercise impairment is a common symptom of systemic sclerosis (SSc), a disorder which is frequently complicated by cardiopulmonary involvement. Objectives: This studys aims were: (a) to define the prevalence and the potential causes of limited exercise capacity and (b) to study potential differences in clinical, radiological and functional characteristics and blood serology among SSc patients with exercise limitation of different etiology. Methods: Prospectively collected data on SSc patients who had conducted full lung function testing, blood serology, thorax high-resolution computed tomography, Doppler echocardiogram and a maximal cardiopulmonary exercise testing (CPET) were retrospectively analyzed. Using a CPET algorithm, patients were characterized as having normal or subnormal exercise capacity (N), respiratory limitation (RL), left ventricular dysfunction (LVD) or pulmonary vasculopathy (PV). Group comparisons were conducted using either one-way ANOVA or the Kruskal-Wallis test. A p value <0.05 was considered significant. Results: The study population consisted of 78 patients (53.7 ± 13.7 years old; 10.3% male). PV was present in 32.1%, LVD in 25.6% and RL in 10.2%, while 32.1% of the patients constituted the N group. The presence of antisclero-70 antibodies, low anaerobic threshold and low peak exercise capacity measures could discriminate LVD from the other groups. Low end-tidal carbon dioxide pressure and its change from rest to anaerobic threshold could discriminate between the PV, LVD and N groups, while respiratory restriction along with ventilatory inefficiency indices could differentiate the RL group from the rest. Conclusions: The combined evaluation of CPET gas exchange patterns with baseline measurements could discriminate the causes of exercise limitation among SSc patients.

Successful Up-front Combination Therapy in a Patient With Idiopathic Pulmonary Hypertension and Patent Foramen Ovale: An Alternative to Epoprostenol Therapy?

Pulmonary arterial hypertension (PAH) is a life-threatening disease of the pulmonary arterioles, which, in the absence of effective therapy, progresses rapidly to right heart failure and death. Opening of a patent foramen ovale (PFO) is common in patients with severe pulmonary hypertension (PH), resulting in resistive hypoxemia. We report the case of a 40-year-old woman with idiopathic pulmonary hypertension (iPAH) in New York Heart Association (NYHA) class III to IV, who was admitted in the intensive care unit with hemodynamic compromise and severe hypoxemia due to right-to-left shunt throughout a PFO. Combination therapy initially with inhaled iloprost and sildenafil, and then addition of an endothelin A receptor-selective antagonist (sitaxsentan), resulted in impressive improvement in oxygenation with reversal of the right-to-left shunt and marked improvement in functional class of the patient.

Resolution of nocturnal periodic breathing in pulmonary hypertension after optimal treatment.

Case report A 46-year-old woman was admitted to the hospital with progressive dyspnea during minimal physical exercise (New York Heart Association class III). On admission the patient presented with tachycardia (about 110 beats per minute) and tachypnea (25 breaths per minute). She was a premenopausal, ex-smoker and she did not report any pathologic conditions in her medical history. Clinical examination revealed lower limb edema and a holosystolic murmur over the tricuspid valve, while auscultation of the lungs was normal. Blood gas analysis showed marked hypoxemia (oxygen partial pressure 51 mmHg) and hypocapnia (carbon dioxide partial pressure 29 mmHg).

The clinical presentation of obstructive sleep apnea syndrome is different in diabetic patients

Background: Obstructive sleep apnea (OSA) is a highly prevalent disease with different clinical presentations. Diabetes and OSA may coexist. Objectives: To evaluate the possible different clinical presentations of OSA in diabetic patients. Methods: Retrospective analysis of the data of patients visiting a Sleep Clinic. Antropometric data, Epworth Sleepiness Scale (ESS), STOP BANG(SB), Athens Insomnia Scale (AIS) were completed and sleep studies were performed. Results: From 1248 included, 27(2%) had type 1 diabetes and 176(14%) type 2 with no gender difference. Diabetic patients were older (61±10 vs 52.2±14 p 2 =0.002). Significant differences were found in ESS (10.25 ± 5 vs 9.4 ±4.6, P=0.02), SB (5.5 ±1.5 vs 4.4 ±1.6, p Conclusions: Diabetic OSA patients were older, more obese, and sleepier,with more insomnia symptoms and arousals than non diabetic.

Rosenberg self-esteem evaluation is correlated with insomnia, not with sleep apnea

Introduction: The Rosenberg self-esteem scale (RSES) is widely used to evaluate ones level of confidence in social sciences and medicine and is a parameter of ones level of quality of life. Chronic illness may have a negative effect on RSES. Sleep Disordered Breathing (SDB) and insomnia are chronic conditions that could influence patients self-esteem. Aims and objectives: To investigate if SDB and / or insomnia affect the RSES Methods: Four hundred sixty subjects (115 women) referred for SDB from Jun13 to Dec14 tested with polysomnography and SDB evaluated using Apnea / Hypopnea Index (AHI). We screened for insomnia symptoms using the Athens insomnia scale (AIS), had the RSES completed and kept data for smoking habit and Epworth Sleepiness Scale (ESS). Correlation and regression analyses performed with IBM SPSS v22. Results: There is negative correlation of medium magnitude between RSES and AIS ( r = -0,36 p < 0,0005) with low levels of self-esteem associated with more insomnia symptoms and no significant correlation between RSES and AHI. Smoking habit, gender, age and ESS show significant correlations with RSES but of small strength, while Body Mass Index (BMI) has no significant effect. In a hierarchical multiple regression model, AIS keeps predicting 15,6% of RSES variability when controlled for the above-mentioned variables (R square = 0,156 beta = -0,282 p < 0,0005). Conclusions: Among all variables stored in our sleep lab database, AIS has the strongest correlation with RSES, leaving behind other more or less obvious candidates, e.g. SDB, sleepiness, obesity, height, gender, smoking habit. We consider this a surprising result since we found no publications relating the RSES with insomnia.