Vito Antonio Falcone

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.

Obstructive Sleep Apnea, Hypertension, and Their Additive Effects on Atherosclerosis

Background and Aims. It is widely accepted that obstructive sleep apnea (OSA) is independently associated with atherosclerosis. Similar to OSA, hypertension (HTN) is a condition associated with atherosclerosis. However, to date, the impact of the simultaneous presence of OSA and HTN on the risk of atherosclerosis has not been extensively studied. The aim of this study was to evaluate the consequences of the coexistence of OSA and HTN on carotid intima-media thickness (IMT) and on inflammatory markers of atherosclerosis (such as interleukin- [IL-] 6 and pentraxin- [PTX-] 3). Methods. The study design allowed us to define 4 groups: (1) controls (n = 30); (2) OSA patients without HTN (n = 30); (3) HTN patients without OSA (n = 30); (4) patients with OSA and HTN (n = 30). In the morning after portable monitoring (between 7 am and 8 am), blood samples were collected, and carotid IMT was measured. Results. Carotid IMT, IL-6, and PTX-3 in OSA normotensive patients and in non-OSA HTN subjects were significantly higher compared to control subjects; in addition, in OSA hypertensive patients they were significantly increased compared to OSA normotensive, non-OSA HTN, or control subjects. Conclusions. OSA and HTN have an additive role in the progression of carotid atherosclerosis and in blood levels of inflammatory markers for atherosclerosis, such as interleukin-6 and pentraxin-3.

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.

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.

Clinical and Functional Lung Parameters Associated With Frequent Exacerbator Phenotype in Subjects With Severe COPD

BACKGROUND: COPD is currently recognized as a syndrome associated with a high prevalence of comorbidities and various phenotypes. Exacerbations are very important events in the clinical history of COPD because they drive the decline in lung function. In the present study, we aim to identify whether there are any clinical and functional specific features of frequent exacerbators in a population of patients with severe COPD. METHODS: We conducted a cross-sectional, case control study. All subjects had Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 3 or 4 COPD (FEV1 < 50% predicted). Frequent exacerbators (n = 183) reported ≥2 exacerbations or ≥1 determining hospitalization during the previous 12 months, and infrequent exacerbators (n = 162) reported <2 exacerbations over the last 12 months without hospitalization. Multivariate logistic regression was performed to determine the clinical and functional factors significantly associated with frequent exacerbator status. RESULTS: Frequent exacerbators had a significantly lower inspiratory capacity percentage predicted. The Motley index (residual volume/total lung capacity percentage) was significantly increased in frequent exacerbators. Infrequent exacerbators had lower Modified Medical Research Council dyspnea scale and BODE index than frequent exacerbators. In the multivariate model, a reduced inspiratory capacity percentage predicted and an increase of residual volume/total lung capacity percentage, BODE index and Modified Medical Research Council dyspnea scale were associated with the frequent exacerbation phenotype. CONCLUSIONS: Static hyperinflation and respiratory disability, measured by Motley index and Modified Medical Research Council dyspnea scale, respectively, in the same way as the multidimensional BODE index staging system, were independently associated with frequent exacerbation status in subjects with severe COPD.

A new approach for the assessment of sleepiness and predictivity of obstructive sleep apnea in drivers: A pilot study

Background: Falling asleep behind the wheel is one of the most relevant consequences of obstructive sleep apnea (OSA). We created a new screening questionnaire, named the Driver Sleepiness Score (DSS), aiming to assess sleepiness in drivers with suspected OSA. The primary aim of our study was to evaluate sleepiness in drivers with a suspicion of OSA by the DSS in order to assess its correlation with the apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and total sleep time with oxyhemoglobin saturation below 90% (TST90). We also aimed to assess the diagnostic accuracy of DSS for three different cutoffs of AHI (AHI = 5, AHI = 15, AHI = 30), which allow stratification of the severity of OSA. Materials and Methods: Seventy-three driving patients at risk for OSA participated in the study. DSS and the Epworth Sleepiness Scale (ESS) were both administered in operator-dependent modality and in randomized sequence. Results: The DSS showed higher accuracy in screening patients with mild OSA [area under curve (AUC): 0.88 vs 0.74] and moderate OSA (AUC: 0.88 vs 0.79), whereas ESS showed higher accuracy in screening patients with severe OSA (AUC: 0.91 vs 0.78). A DSS score ≥ 7 is the optimal cutoff for distinguishing true positives from false positives for the presence of OSA and for its different severity levels. The administration of both questionnaires increases the accuracy for the detection of all OSA severity levels. Conclusions: If validated, DSS may qualify as a new screening tool specifically for drivers with the suspicion of having OSA, in combination with the ESS.

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.