Vitaliano Nicola Quaranta

Correlation between Inflammatory Markers of Atherosclerosis and Carotid Intima-Media Thickness in Obstructive Sleep Apnea

Obstructive Sleep Apnea (OSA) is a sleep-related breathing disorder associated with the development of cardiovascular diseases and atherosclerosis. Systemic inflammation plays an important role in the development of cardiovascular complications in OSA patients. The aim of the study was to evaluate the relationship between carotid intima-media thickness (cIMT) and inflammatory markers plasma levels in OSA patients. We enrolled 80 OSA patients and 40 controls matched for age and body mass index (BMI). The presence and severity of sleep apnea was determined by in-laboratory portable monitoring (PM). Demographic data, blood pressure, heart rate, and cIMT were measured. High-sensitive C-Reactive Protein (hsCRP), interleukin (IL)-6, tumor necrosis factor (TNF)-α and pentraxin (PTX)-3 serum concentrations were detected. cIMT was higher in OSA patients than controls (0.89 ± 0.13 mm vs. 0.65 ± 0.1 mm, p < 0.01). Moderate-severe OSA patients (0.95 ± 0.09 mm) had significantly increased cIMT than mild OSA (0.76 ± 0.1 mm; p < 0.01) and control (0.65 ± 0.1 mm; p < 0.01). hsCRP, IL-6, TNF-α, and PTX-3 in patients with OSA (1.67 ± 0.66 mg/L, 2.86 ± 1.39 pg/mL, 20.09 ± 5.39 pg/mL, 2.1 ± 0.59 ng/mL, respectively) were significantly higher than in controls (1.08 ± 0.53 mg/L, p < 0.01; 1.5 ± 0.67 pg/mL, p < 0.01; 12.53 ± 3.48 pg/mL, p < 0.01; 1.45 ± 0.41 ng/mL, p < 0.01, respectively). Carotid IMT was significantly correlated to CRP (r = 0.44; p < 0.01), IL-6 (r = 0.42; p < 0.01), TNF-α (r = 0.53; p < 0.01), and PTX-3 (r = 0.49; p < 0.01). OSA patients showed increased cIMT, CRP, IL-6, TNF-α, and PTX-3 levels. Inflammatory markers levels are correlated to cIMT in OSA patients.

An electronic nose in the discrimination of obese patients with and without obstructive sleep apnoea.

Exhaled breath contains thousands of volatile organic compounds (VOCs) in gaseous form, which may be used as markers of airway inflammation and lung disease. Electronic noses enable quick and real-time pattern analysis of VOC spectra. It has been shown that the exhaled breath of patients with obstructive sleep apnoea (OSA) differs from that of non-obese controls. We aimed to assess the influence of obesity in the composition of exhaled VOCs by comparing obese subjects with and without OSA. Moreover, we aimed to identify the discriminant VOCs in the two groups.19 obese patients with established OSA (OO; age 51.2 ± 6.8; body mass index (BMI) 34.3 ± 3.5), 14 obese controls without OSA (ONO; age 46.5 ± 7.6; BMI 33.5 ± 4.1) and 20 non-obese healthy controls (HC; age 41.1 ± 12.6; BMI 24.9 ± 3.8) participated in a cross-sectional study. Exhaled breath was collected by a previously described method and sampled by using an electronic nose (Cyranose 320) and by gas chromatography-mass spectrometry (GC-MS) analysis. Breathprints were analyzed by canonical discriminant analysis on principal component reduction. Cross-validation accuracy (CVA) was calculated. Breathprints from the HC group were separated from those of OO (CVA = 97.4%) and ONO (CVA = 94.1%). Breathprints from OO were moderately separated from those of ONO (CVA = 67.6%).The presence of OSA alters the exhaled VOC pattern in obese subjects. The incomplete separation of breathprints between OO and ONO may be due to the same underlying inflammation caused by obesity.

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.

Exhaled breath profiling in patients with COPD and OSA overlap syndrome: A pilot study

The analysis of volatile organic compounds (VOCs) by an electronic nose (e-nose) is a groundbreaking method that provides distinct exhaled molecular patterns in several respiratory and systemic diseases. It has been shown that an e-nose can detect obstructive sleep apnea (OSA) as well as chronic obstructive pulmonary disease (COPD). OSA and COPD are sometimes associated into the so-called overlap syndrome (OVS). In this pilot study we hypothesized that an e-nose could discriminate the exhaled breath of patients with OVS from that of subjects with OSA and COPD alone. Thirteen patients with OSA, 15 patients with COPD and 13 with OVS participated in a cross-sectional study. Exhaled breath was collected by a formerly validated method and sampled by using an electronic nose (Cyranose 320). Raw data were analyzed by canonical discriminant analysis on principal component reduction. Cross-validation accuracy (CVA) and ROC-curves were calculated. External validation in newly recruited patients (6 OSA, 6 OVS and 6 COPD) was tested using the previous training set. Breathprints of patients with OSA clustered distinctly from those with OVS (CVA  =  96.2%) as well as those with COPD (CVA  =  82.1%). Breathprints from OVS were not significantly separated from those of COPD (CVA  =  67.9%). External validation confirmed the above findings. The e-nose can distinguish with high accuracy the exhaled VOC-profile of patients with OSA from those with OVS as well as those with COPD. This warrants future studies to confirm the potential of this technique in the non-invasive detection of sleep apnea.

Polysomnograph Chart View by Patients: A New Educational Strategy to Improve CPAP Adherence in Sleep Apnea Therapy

BACKGROUND: CPAP is currently the treatment of choice for obstructive sleep apnea syndrome, but therapy adherence is poor. Many educational trials have been proposed to increase CPAP adherence. We tested the hypothesis that polysomnograph chart viewing by patients would improve CPAP adherence. METHODS: A controlled parallel group study was performed with 206 newly diagnosed obstructive sleep apnea syndrome patients, randomized into 2 groups (n = 103 each): standard support group, and educational support group. Each educational support group subject viewed 2 consecutive polysomnograms on the computer screen: the first recorded during a standard diagnostic overnight polysomnography, and the second during a full-night polysomnography with nasal CPAP. The subjects attention was drawn only to the flow and oxyhemoglobin saturation curves. Clinical outcomes were assessed via polysomnography at CPAP initiation and after 1, 3, and 12 months. RESULTS: After 12 months of CPAP, 76% of the educational support group and 52% of the standard support group returned for a follow-up visit (P < .001). Statistical significance had already been reached after 1 and 3 months. Moreover, CPAP use (measured as hours of use per night) was higher in the educational support group at each control visit. CONCLUSIONS: Polysomnograph chart viewing by obstructive sleep apnea patients can increase CPAP adherence, as evaluated by rate of return for the follow-up visit and mean nightly CPAP use.

Titration effectiveness of two autoadjustable continuous positive airway pressure devices driven by different algorithms in patients with obstructive sleep apnoea

Nocturnal application of continuous positive airway pressure (CPAP) is the standard treatment for patients with obstructive sleep apnoea (OSA). Determination of the therapeutic pressure (CPAP titration) is usually performed by a technician in the sleep laboratory during attended polysomnography. One possible alternative to manual titration is automated titration. Indeed, during the last 15 years, devices have been developed that deliver autoadjustable CPAP (A‐CPAP). The aim of the present study was to compare the titration effectiveness of two A‐CPAP devices using different flow‐based algorithms in patients with OSA.

Influence of obstructive sleep apnea on endothelial function in obese patients.

www.chestpubs.org (Mr Day), Kingston General Hospital, and Department of Community Health and Epidemiology (Mr Day), Queen’s University. Financial/nonfi nancial disclosures: The authors have reported to CHEST that no potential confl icts of interest exist with any companies/organizations whose products or services may be discussed in this article . Correspondence to: Renee D. Stapleton, MD, PhD, FCCP, Department of Medicine, University of Vermont College of Medicine, 149 Beaumont Ave, HSRF 222, Burlington, VT 05405; e-mail: renee.stapleton@uvm.edu

The Prognostic Role of Obstructive Sleep Apnea at the Onset of Amyotrophic Lateral Sclerosis

Background/Objective: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by the progressive loss of central and peripheral motor neurons. Some studies have found discordant data in the presence of sleep apnea in ALS patients. An obstructive component also occurs with upper airways hypotonia and muscle weakness that may result in an excessive reduction of airway lumen, leading to obstructive sleep apnea (OSA). The aim of this study was to assess the role of obstructive apneic events at disease onset in the ALS prognosis. Methods: A longitudinal retrospective study was conducted on 42 clinically diagnosed ALS patients. The study population was divided into 2 groups according to their obstructive apnea/hypopnea index (AHIo): group 1 consisted of 20 patients with an AHIo ≥5 and group 2 consisted of 22 patients with an AHIo <5. Both groups were compared with regard to demographic, polygraphic, and respiratory function parameters as well as ALS characteristics (bulbar onset, time between onset and first check-up, time between diagnosis and first check-up, time between first check-up and death or tracheostomy). Results: The mean survival in ALS patients with an AHIo ≥5 was significantly shorter than in ALS without OSA (p = 0.0237). The sniff nasal inspiratory pressure test was significantly correlated with AHIo, time of oxyhemoglobin saturation below 90% and the oxyhemoglobin desaturation index (p < 0.0001). Conclusions: Our study highlights the importance of an early diagnosis of OSA in ALS patients, allowing the identification of ALS patients with an OSA phenotype (AHIo ≥5), who are characterized by a worse prognosis.

Clinical Characteristics Associated with Conjunctival Inflammation in Allergic Rhinoconjunctivitis

BACKGROUND Allergic rhinitis affects up to 30% of the general population worldwide and is increasing in prevalence. Among several comorbidities, conjunctivitis is probably the most common and occurs so frequently with allergic rhinitis that the term allergic rhinoconjunctivitis (ARC) has been coined. OBJECTIVES The cytological characteristics of conjunctival inflammation in patients with ARC were assessed and then correlated to clinical characteristics. METHODS Fifty-one patients with clinically diagnosed ARC (23 men; 32.4 ± 13.5 years old) underwent a detailed clinical history and standard diagnostic allergy workup as well as nasal and conjunctival scraping for cytological analysis. Patients were subdivided into 3 groups on the basis of cytological phenotype: (1) nasal and conjunctival inflammation, (2) nasal inflammation only, and (3) no mucosal inflammation. RESULTS Group 1 patients reported significantly higher eye itching scores (5.8 ± 2.9 on a 0-10 scale) than did patients in group 2 (3.8 ± 2.8; P = .06) or 3 (2.6 ± 2.9; P = .018) and were mostly men (81.8%). Male sex (odds ratio, 8.4; P = .005) and eye itching (odds ratio, 1.3; P = .019) significantly correlated with conjunctival inflammation. The odds of exhibiting conjunctival inflammation, at multivariate analysis, increased 13-fold for men and 1.5-fold for each point on the eye itching scale. A cutoff value of 3 or more for eye itching effectively identified patients with conjunctival inflammation. CONCLUSIONS Our study demonstrates that some clinical manifestations of ARC correlate well with conjunctival inflammation.

An electronic nose may sniff out amyotrophic lateral sclerosis

Amyothrophic lateral Sclerosis (ALS) is a neurodegenerative disease characterized by a progressive degeneration of the cortical and spinal motor neuron. Exhaled molecular profiles that have potential in the diagnosis of several respiratory and systemic diseases can be obtained by analyzing human breath with an electronic nose. We hypothesized that exhaled molecular profiling may discriminate well-characterized patients with ALS from controls. 20 ALS patients (age: 63.5±12.3), and 20 healthy controls (age: 58.1±4.4) participated in a cross-sectional study. A Tedlar bag was used to collect exhaled breath by using a validated method. Bags were then sampled by an electronic nose (Cyranose 320). Statistical analysis on sensor responses was performed off-line by principal component analysis, linear discriminant analysis and ROC curves. Breathprints from patients with ALS were discriminated from healthy controls (CVA: 75.0%; p=0.003; AUC 0.795). Based on our results, patients with ALS can be discriminated from healthy controls. This suggests that exhaled breath analysis has potential for screening and/or diagnosis of this neuromuscular disease.