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Introduction: Sleep-disordered breathing (SDB) is a major comorbidity in idiopathic pulmonary fibrosis (IPF) and is associated with a poor outcome. There is a lack of knowledge regarding the impact of SDB treatment on IPF. We assessed at one year: (1) the effect of CPAP and/or nocturnal oxygen therapy on IPF regarding lung function, blood mediators, and quality of life; (2) adherence to SDB treatment and SDB changes., Methodology: This is a prospective study of consecutive newly diagnosed IPF patients initiating anti-fibrotic treatment. Lung function, polysomnography, blood tests and quality of life questionnaires were performed at inclusion and after one year. Patients were classified as obstructive sleep apnoea (OSA), central sleep apnoea (CSA), and sleep-sustained hypoxemia (SSH). SDB therapy (CPAP and/or nocturnal oxygen therapy) was initiated if needed., Results: Fifty patients were enrolled (36% had OSA, 22% CSA, and 12% SSH). CPAP was started in 54% of patients and nocturnal oxygen therapy in 16%. At one-year, polysomnography found improved parameters, though 17% of patients had to add nocturnal oxygen therapy or CPAP, while 33% presented SDB onset at this second polysomnography. CPAP compliance at one year was 6.74 h/night (SD 0.74). After one year, matrix metalloproteinase-1 decreased in OSA and CSA (p = 0.029; p = 0.027), C-reactive protein in OSA (p = 0.045), and surfactant protein D in CSA group (p = 0.074). There was no significant change in lung function., Conclusions: Treatment of SBD with CPAP and NOT can be well tolerated with a high compliance. IPF patients may exhibit SDB progression and require periodic re-assessment. Further studies to evaluate the impact of SDB treatment on lung function and serological mediators are needed., (© 2024. The Author(s).)

Introduction: Obstructive sleep apnea (OSA) is heterogeneous and complex, but its severity is still based on the apnea-hypoapnea index (AHI). The present study explores using cluster analysis (CA), the additional information provided from routine polysomnography (PSG) to optimize OSA categorization., Methods: Cross-sectional study of OSA subjects diagnosed by PSG in a tertiary hospital sleep unit during 2016-2020. PSG, demographical, clinical variables, and comorbidities were recorded. Phenotypes were constructed from PSG variables using CA. Results are shown as median (interquartile range)., Results: 981 subjects were studied: 41% females, age 56 years (45-66), overall AHI 23events/h (13-42) and body mass index (BMI) 30kg/m 2 (27-34). Three PSG clusters were identified: Cluster 1: "Supine and obstructive apnea predominance" (433 patients, 44%). Cluster 2: "Central, REM and shorter-hypopnea predominance" (374 patients, 38%). Cluster 3: "Severe hypoxemic burden and higher wake after sleep onset" (174 patients, 18%). Based on classical OSA severity classification, subjects are distributed among the PSG clusters as severe OSA patients (AHI≥30events/h): 46% in cluster 1, 17% in cluster 2 and 36% in cluster 3; moderate OSA (15≤AHI<30events/h): 57% in cluster 1, 34% in cluster 2 and 9% in cluster 3; mild OSA (5≤AHI<15events/h): 28% in cluster 1, 68% in cluster 2 and 4% in cluster 3., Conclusions: The CA identifies three specific PSG phenotypes that do not completely agree with classical OSA severity classification. This emphasized that using a simplistic AHI approach, the OSA severity is assessed by an incorrect or incomplete analysis of the heterogeneity of the disorder., (Copyright © 2023 SEPAR. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Continuous positive airway pressure (CPAP) titration was dramatically affected by the coronavirus disease 2019 (COVID-19) pandemic due to increased biological risk. This study aimed to compare successful CPAP adaptation and compliance with home telemedicine CPAP titration with the usual method based on face-to-face visits., Methodology: A prospective cohort using telemedicine home CPAP titration and follow-up during the COVID-19 pandemic (TC) was compared with a retrospective cohort receiving face-to-face pre-pandemic home titration (RC). The TC included a subgroup with a smartphone application (TC-APP). Successful CPAP adaptation and compliance at 1 month of follow-up were the main endpoints, while patient satisfaction and costs were secondary endpoints., Results: 210 consecutive patients were evaluated (80 RC and 130 TC). 36 patients were in the TC-APP subgroup. CPAP titration was successful in 90% in RC versus 95% in TC and 100% in TC-APP. No compliance differences between groups were found at 1  month (4.79 h·night -1 RC, 4.33  h·night -1 TC and 4.59 h·night -1 TC-APP). Mean±sd patient satisfaction out of 10 was 7.69±2.05 in RC versus 9.02±0.64 in TC (p<0.001). 64% of the TC-APP subgroup reported that their telemedicine strategy influenced an increase in CPAP use (p=0.011). CPAP adaptation with follow-up had an estimated direct staff cost per patient of EUR 19.61±8.61 in TC with no smartphone application used versus EUR 23.79±9.94 in TC-APP (p=0.048)., Conclusions: Telemedicine in CPAP titration and early follow-up is equivalent to the usual care in terms of successful adaptation and compliance, while achieving greater patient satisfaction., Competing Interests: Conflict of interest: J. Bordas-Martinez participated in the development of the smartphone application. However, this research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The other authors have nothing to disclose., (Copyright ©The authors 2022.)

Background: Obstructive sleep apnea (OSA) is associated with dyslipidemia. However, the effects of continuous positive airway pressure (CPAP) treatment on lipid profiles are unclear., Methods: PubMed/Medline, Embase and Cochrane were searched up to July 2021. Randomized controlled trials (RCTs) of CPAP versus controls with ≥4 weeks treatment and reported pre- and post-intervention lipid profiles were included. Weighted mean difference ( WMD ) was used to assess the effect size. Meta-regression was used to explore the potential moderators of post-CPAP treatment changes in lipid profiles., Results: A total of 14 RCTs with 1792 subjects were included. CPAP treatment was associated with a significant decrease in total cholesterol compared to controls ( WMD = -0.098 mmol/L, 95% CI = -0.169 to -0.027, p = 0.007, I 2 = 0.0%). No significant changes in triglyceride, high-density lipoprotein nor low-density lipoprotein were observed after CPAP treatment (all p > 0.2). Furthermore, meta-regression models showed that age, gender, body mass index, daytime sleepiness, OSA severity, follow-up study duration, CPAP compliance nor patients with cardiometabolic disease did not moderate the effects of CPAP treatment on lipid profiles (all p > 0.05)., Conclusions: CPAP treatment decreases total cholesterol at a small magnitude but has no effect on other markers of dyslipidemia in OSA patients. Future studies of CPAP therapy should target combined treatment strategies with lifestyle modifications and/or anti-hyperlipidemic medications in the primary as well as secondary cardiovascular prevention models.

Introduction: Idiopathic pulmonary fibrosis (IPF) prognosis is heterogeneous despite antifibrotic treatment. Cluster analysis has proven to be a useful tool in identifying interstitial lung disease phenotypes, which has yet to be performed in IPF. The aim of this study is to identify phenotypes of IPF with different prognoses and requirements., Methods: Observational retrospective study including 136 IPF patients receiving antifibrotic treatment between 2012 and 2018. Six patients were excluded due to follow-up in other centres. Cluster analysis of 30 variables was performed using approximate singular value-based tensor decomposition method and comparative statistical analysis., Results: The cluster analysis identified three different groups of patients according to disease behaviour and clinical features, including mortality, lung transplant and progression-free survival time after 3-year follow-up. Cluster 1 (n=60) was significantly associated (p=0.02) with higher mortality. Diagnostic delay was the most relevant characteristic of this cluster, as 48% of patients had ≥2 years from first respiratory symptoms to antifibrotic treatment initiation. Cluster 2 (n=22) had the longest progression-free survival time and was correlated to subclinical patients evaluated in the context of incidental findings or familial screening. Cluster 3 (n=48) showed the highest percentage of disease progression without cluster 1 mortality, with metabolic syndrome and cardiovascular comorbidities as the main characteristics., Conclusion: This cluster analysis of IPF patients suggests that diagnostic and treatment delay are the most significant factors associated with mortality, while IPF progression was more related to metabolic syndrome and cardiovascular comorbidities., Competing Interests: Conflict of interest: J. Bordas-Martínez reports FIS-ISCIII grant PI18/00367 (cofunded by the European Regional Development Fund (ERDF)), Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grants 631/2018 and 685/2018, Emerging ILD Group of SEPAR grant 005 (Boehringer–Roche), Pneumology Foundation of Catalonia grant 2019, Spanish Sleep Society grant 2019, institutional support of the CERCA Programme/Generalitat de Catalunya, and research support BRN-Fundació Ramon Pla Armengol from ISCIII grant CM20/00093 (cofunded by European Regional Development Fund), during the conduct of the study. Conflict of interest: R. Gavaldà reports FIS-ISCIII grant PI18/00367 (cofunded by the European Regional Development Fund (ERDF)), Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grants 631/2018 and 685/2018, Emerging ILD Group of SEPAR grant 005 (Boehringer–Roche), Pneumology Foundation of Catalonia grant 2019, Spanish Sleep Society grant 2019, institutional support of the CERCA Programme/Generalitat de Catalunya, and research support BRN-Fundació Ramon Pla Armengol from ISCIII grant CM20/00093 (cofunded by European Regional Development Fund), during the conduct of the study. Conflict of interest: J.G. Shull reports FIS-ISCIII grant PI18/00367 (cofunded by the European Regional Development Fund (ERDF)), Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grants 631/2018 and 685/2018, Emerging ILD Group of SEPAR grant 005 (Boehringer–Roche), Pneumology Foundation of Catalonia grant 2019, Spanish Sleep Society grant 2019, institutional support of the CERCA Programme/Generalitat de Catalunya, and research support BRN-Fundació Ramon Pla Armengol from ISCIII grant CM20/00093 (cofunded by European Regional Development Fund), during the conduct of the study. Conflict of interest: V. Vicens-Zygmunt reports FIS-ISCIII grant PI18/00367 (cofunded by the European Regional Development Fund (ERDF)), Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grants 631/2018 and 685/2018, Emerging ILD Group of SEPAR grant 005 (Boehringer–Roche), Pneumology Foundation of Catalonia grant 2019, Spanish Sleep Society grant 2019, institutional support of the CERCA Programme/Generalitat de Catalunya, and research support BRN-Fundació Ramon Pla Armengol from ISCIII grant CM20/00093 (cofunded by European Regional Development Fund), during the conduct of the study. Conflict of interest: L. Planas-Cerezales reports FIS-ISCIII grant PI18/00367 (cofunded by the European Regional Development Fund (ERDF)), Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grants 631/2018 and 685/2018, Emerging ILD Group of SEPAR grant 005 (Boehringer–Roche), Pneumology Foundation of Catalonia grant 2019, Spanish Sleep Society grant 2019, institutional support of the CERCA Programme/Generalitat de Catalunya, and research support BRN-Fundació Ramon Pla Armengol from ISCIII grant CM20/00093 (cofunded by European Regional Development Fund), during the conduct of the study. Conflict of interest: G. Bermudo-Peloche reports FIS-ISCIII grant PI18/00367 (cofunded by the European Regional Development Fund (ERDF)), Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grants 631/2018 and 685/2018, Emerging ILD Group of SEPAR grant 005 (Boehringer–Roche), Pneumology Foundation of Catalonia grant 2019, Spanish Sleep Society grant 2019, institutional support of the CERCA Programme/Generalitat de Catalunya, and research support BRN-Fundació Ramon Pla Armengol from ISCIII grant CM20/00093 (cofunded by European Regional Development Fund), during the conduct of the study. Conflict of interest: S. Santos reports FIS-ISCIII grant PI18/00367 (cofunded by the European Regional Development Fund (ERDF)), Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grants 631/2018 and 685/2018, Emerging ILD Group of SEPAR grant 005 (Boehringer–Roche), Pneumology Foundation of Catalonia grant 2019, Spanish Sleep Society grant 2019, institutional support of the CERCA Programme/Generalitat de Catalunya, and research support BRN-Fundació Ramon Pla Armengol from ISCIII grant CM20/00093 (cofunded by European Regional Development Fund), during the conduct of the study. Conflict of interest: N. Salord reports FIS-ISCIII grant PI18/00367 (cofunded by the European Regional Development Fund (ERDF)), Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grants 631/2018 and 685/2018, Emerging ILD Group of SEPAR grant 005 (Boehringer–Roche), Pneumology Foundation of Catalonia grant 2019, Spanish Sleep Society grant 2019, institutional support of the CERCA Programme/Generalitat de Catalunya, and research support BRN-Fundació Ramon Pla Armengol from ISCIII grant CM20/00093 (cofunded by European Regional Development Fund), during the conduct of the study. Conflict of interest: C. Monasterio reports FIS-ISCIII grant PI18/00367 (cofunded by the European Regional Development Fund (ERDF)), Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grants 631/2018 and 685/2018, Emerging ILD Group of SEPAR grant 005 (Boehringer–Roche), Pneumology Foundation of Catalonia grant 2019, Spanish Sleep Society grant 2019, institutional support of the CERCA Programme/Generalitat de Catalunya, and research support BRN-Fundació Ramon Pla Armengol from ISCIII grant CM20/00093 (cofunded by European Regional Development Fund), during the conduct of the study. Conflict of interest: M. Molina-Molina reports FIS-ISCIII grant PI18/00367 (cofunded by the European Regional Development Fund (ERDF)), Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grants 631/2018 and 685/2018, Emerging ILD Group of SEPAR grant 005 (Boehringer–Roche), Pneumology Foundation of Catalonia grant 2019, Spanish Sleep Society grant 2019, institutional support of the CERCA Programme/Generalitat de Catalunya, and research support BRN-Fundació Ramon Pla Armengol from ISCIII grant CM20/00093 (cofunded by European Regional Development Fund), during the conduct of the study. Conflict of interest: G. Suarez-Cuartin reports FIS-ISCIII grant PI18/00367 (cofunded by the European Regional Development Fund (ERDF)), Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grants 631/2018 and 685/2018, Emerging ILD Group of SEPAR grant 005 (Boehringer–Roche), Pneumology Foundation of Catalonia grant 2019, Spanish Sleep Society grant 2019, institutional support of the CERCA Programme/Generalitat de Catalunya, and research support BRN-Fundació Ramon Pla Armengol from ISCIII grant CM20/00093 (cofunded by European Regional Development Fund), during the conduct of the study., (Copyright ©The authors 2021.)

Purpose: Long-term studies comparing the mechanisms of different bariatric techniques for T2DM remission are scarce. We aimed to compare type 2 diabetes (T2DM) remission after a gastric bypass with a 200-cm biliopancreatic limb (mRYGB), sleeve gastrectomy (SG), and greater curvature plication (GCP), and to assess if the initial secretion of gastrointestinal hormones may predict metabolic outcomes at 5 years., Material and Methods: Forty-five patients with mean BMI of 39.4(1.9)kg/m 2 and T2DM with HbA 1c of 7.7(1.9)% were randomized to mRYGB, SG, or GCP. Anthropometric and biochemical parameters, fasting concentrations of PYY, ghrelin, glucagon, and AUC of GLP-1 after SMT were determined prior to and at months 1 and 12 after surgery. At 5-year follow-up, anthropometrical and biochemical parameters were determined., Results: Total weight loss percentage (TWL%) at year 1 and GLP-1 AUC at months 1 and 12 were higher in the mRYGB than in the SG and GCP. TWL% remained greater at 5 years in mRYGB group - 27.32 (7.8) vs. SG - 18.00 (10.6) and GCP - 14.83 (7.8), p = 0.001. At 5 years, complete T2DM remission was observed in 46.7% after mRYGB vs. 20.0% after SG and 6.6% after GCP, p < 0.001. In the multivariate analysis, shorter T2DM duration (OR 0.186), p = 0.008, and the GLP-1 AUC at 1 month (OR 7.229), p = 0.023, were prognostic factors for complete T2DM remission at 5-year follow-up., Conclusions: Long-term T2DM remission is mostly achieved with hypoabsortive techniques such as mRYGB. Increased secretion of GLP-1 after surgery and shorter disease duration were the main predictors of T2DM remission at 5 years.

Study Objectives: To determine whether an intensive weight-loss program (IWLP) is effective for reducing weight, the severity of obstructive sleep apnea (OSA), and metabolic variables in patients with obesity and severe OSA undergoing continuous positive airway pressure treatment., Methods: Forty-two patients were randomized to the control (CG, n = 20) or the intervention group (IG, n = 22), who followed a 12-month IWLP. The primary outcome was a reduction in the apnea-hypopnea index (AHI) as measured at 3 and 12 months by full polysomnography. Metabolic variables, blood pressure, body fat composition by bioimpedance, carotid intima media thickness, and visceral fat by computed tomography were also assessed., Results: Mean age was 49 (6.7) years, body mass index 35 (2.7) kg/m², and AHI 69 (20) events/h. Weight reduction was higher for the IG than the CG at 3 and 12 months, -10.5 versus -2.3 kg (P < .001), and -8.2 versus -0.1 kg (P < .001), respectively, as was loss of visceral fat at 12 months. AHI decreased more in the IG at 3 months (-23.72 versus -9 events/h) but the difference was not significant at 12 months, though 28% of patients from the IG had an AHI < 30 events/h compared to none in the CG (P = .046). At 12 months, the IG showed a reduction in C-reactive protein (P = .013), glycated hemoglobin (P = .031) and an increase in high density lipoprotein cholesterol (P = .027)., Conclusions: An IWLP in patients with obesity and severe OSA is effective for reducing weight and OSA severity. It also results in an improvement in lipid profiles, glycemic control, and inflammatory markers., Clinical Trial Registration: Registry: ClinicalTrials.gov; Title: Effectiveness of an Intensive Weight Loss Program for Obstructive Sleep Apnea Syndrome (OSAS) Treatment; Identifier: NCT02832414; URL: https://clinicaltrials.gov/ct2/show/record/NCT02832414., (© 2020 American Academy of Sleep Medicine.)

Background: Current continuous positive airway pressure (CPAP) devices can be monitored remotely; however, in-person visits are kept for clinical follow-up in order to promote CPAP use and resolve potential side-effects. Mobile health is a promising way to provide remote and easy clinical control for CPAP follow-up and support. We aimed to evaluate the feasibility and acceptance by obstructive sleep apnoea (OSA) patients and healthcare professionals of a newly designed mobile app (Appnea-Q) to promote clinical control through a self-monitoring tool for patients with CPAP supervised by sleep professionals., Methods: Appnea-Q incorporates a simple follow-up questionnaire with automated responses, together with frequent problems and lifestyle recommendations sections. Feasibility, acceptance and usefulness were assessed. First, an internal validation was performed during outpatient CPAP follow-up visits with sleep professionals from various sleep units. Second, an external validation was performed in a subgroup of 15 patients at home., Results: Most patients (n=75) considered the app useful and were willing to use it and recommend it (72-88%). Up to 64.87% agreed on its capacity to reduce hospital visits. Appnea-Q was rated as acceptable (79.37±19.29) by the system usability score. Sleep professionals (n=30) concurred on its usefulness for OSA patient follow-up, particularly during the first month of CPAP therapy. The external validation showed its feasibility among 11 out of 15 patients and their data were received accordingly on the professionals' web platform., Conclusions: According to our validation process, and the viewpoints of the patients and professionals, our new mobile app is a feasible and well-received tool for personal OSA management. Future clinical trials should substantiate its performance and cost-effectiveness in the clinical arena., Competing Interests: Conflict of interest: M. Suarez-Giron has nothing to disclose. Conflict of interest: O. Garmendia has nothing to disclose. Conflict of interest: V. Lugo has nothing to disclose. Conflict of interest: C. Ruiz has nothing to disclose. Conflict of interest: N. Salord has nothing to disclose. Conflict of interest: X. Alsina has nothing to disclose. Conflict of interest: R. Farre reports contracts between the University of Barcelona, ResMed and ANTADIR to evaluate CPAP devices at the bench. Conflict of interest: J.M. Montserrat reports an official government grant from the Ministry of Economy Industry and Competitiveness, and that Philips Respironics supported one of the researchers. Conflict of interest: M. Torres has nothing to disclose., (Copyright ©ERS 2020.)

Central obesity is the main risk factor for obstructive sleep apnea (OSA). Whether there exists a central-obesity anthropometric that better explains apnea-hypopnea index (AHI) variability in the general population and in sleep cohorts is unknown, and this is even less explored among increasing grades of obesity. The objective of the study is to investigate whether there is an anthropometric that better explains AHI variability in a sample of morbidly obese women awaiting bariatric surgery (BS). A prospective multicentre cross-sectional study was conducted in consecutive women before BS. Demographic and anthropometric characteristics included age, body mass index (BMI), neck circumference (NC), waist circumference (WC), hip circumference (HC) and waist-to-hip ratio (WHR). OSA was diagnosed by polysomnography. The capacity of anthropometrics to explain AHI variance was investigated using regression linear models. A total of 115 women were evaluated: age, 44 ± 10 years; BMI, 46 ± 5 kg/m 2 ; AHI, 35 ± 26 events/hr. AHI was associated with all anthropometrics except weight, height and HC. The best univariate predictor was WHR, which accounted for 15% of AHI variance. The simplest model (age + BMI) accounted for 9%, which increased to 20% when applying more complex measurements (age + BMI + NC + WC + HC). The explanatory capacity did not change significantly when applying a simpler model (age + WHR + NC, 19%). In this female morbidly obese cohort, anthropometrics explained one-fifth of AHI variability. WHR is the best univariate parameter and models including waist and neck data provide more information than BMI when explaining AHI variability. Thus, even in young women with extreme obesity, OSA seems to be linked to a specific central-obesity phenotype rather than to a whole-obesity pattern., (© 2019 European Sleep Research Society.)

Introduction: Evidence suggests that food addiction (FA) is prevalent among individuals with obesity seeking bariatric surgery (BS), but there is no evidence about whether FA is a predictor of weight loss (WL). We aimed to analyse the prevalence of FA in patients with obesity seeking BS and to examine whether FA could predict WL following dietary intervention before surgery., Method: The study included 110 patients with obesity who underwent a dietetic intervention. Assessment included endocrinological variables, a semistructured interview to rule out mental disorders, and Yale Food Addiction Scale version 2.0 (YFAS 2.0)., Results: In our sample, the prevalence of FA was 26.4%. Those who met YFAS 2.0 criteria showed less WL after dietetic intervention and regain weight during dietary intervention., Conclusions: FA appears to be prevalent in obesity. Our findings confirmed a lower WL throughout dietary intervention before surgery in patients who fulfilled baseline criteria for FA. Future interventions should include multidisciplinary intervention to maximize WL before and after BS., (© 2018 John Wiley & Sons, Ltd and Eating Disorders Association.)

There is evidence that changes in branched-chain amino acid (BCAA) levels may correlate with the efficacy of therapeutic interventions for affecting improvement in metabolic control. The objective of this study was to evaluate whether serum concentrations of BCAAs (leucine, isoleucine, valine) could mediate in insulin sensitivity and glucose tolerance after continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnea (OSA). A prospective randomized controlled trial of OSA patients with morbid obesity was conducted. Eighty patients were randomized into two groups: 38 received conservative treatment and 42 received CPAP treatment for 12 weeks. Plasma levels of BCAA, glucose tolerance and insulin resistance were evaluated at baseline and after treatment. After treatment, significant decreases of leucine levels were observed in both groups when compared with baseline levels (P < 0.005). With respect to patients with normal glucose tolerance (NGT), patients with impaired glucose tolerance (IGT) had higher baseline levels of isoleucine (78 ± 16 versus 70 ± 13 μmol L -1 , P = 0.014) and valine (286 ± 36 versus 268 ± 41 μmol L -1 , P = 0.049), respectively. Changes in levels of leucine and isoleucine after treatment were related negatively to changes in fasting plasma glucose and glycosylated haemoglobin values only in the conservative group (P < 0.05). In summary, we found that the treatment with CPAP for 12 weeks caused similar changes in circulating BCAAs concentrations to conservative treatment and a differential metabolic response of CPAP and conservative treatment was observed between the relationship of BCAAs and glucose homeostasis. Additional studies are needed to determine the interplay between branched-chain amino acids and glucose metabolism in patients with sleep apnea., (© 2017 European Sleep Research Society.)

This study aimed to explore the empirical trajectories of body mass index (BMI) 1 year following bariatric surgery (BS) and to identify the risk factors for each trajectory. The study included 115 patients with severe obesity who underwent BS. Assessment included metabolic variables, psychopathological and personality measures. Growth mixture modelling identified four separated trajectories for the percentage of total weight loss course shape (namely, T1 'good-fast', T2 'good', T3 'low' and T4 'low-slow'). After adjusting for BS subtype and metabolic baseline state, T1 and T2 registered less eating and general psychopathology. T1 was characterized by the lowest scores in novelty seeking and self-transcendence, whereas T4 was defined by the highest scores in novelty seeking and the lowest scores in persistence. Our findings suggest that psychological state prior to BS is predictive of BMI trajectories during the 12 months following BS. These results could be useful in developing more efficient interventions for these patients. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association., (Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.)

Rationale: Home respiratory polygraphy may be a simpler alternative to in-laboratory polysomnography for the management of more symptomatic patients with obstructive sleep apnea, but its effectiveness has not been evaluated across a broad clinical spectrum., Objectives: To compare the long-term effectiveness (6 mo) of home respiratory polygraphy and polysomnography management protocols in patients with intermediate-to-high sleep apnea suspicion (most patients requiring a sleep study)., Methods: A multicentric, noninferiority, randomized controlled trial with two open parallel arms and a cost-effectiveness analysis was performed in 12 tertiary hospitals in Spain. Sequentially screened patients with sleep apnea suspicion were randomized to respiratory polygraphy or polysomnography protocols. Moreover, both arms received standardized therapeutic decision-making, continuous positive airway pressure (CPAP) treatment or a healthy habit assessment, auto-CPAP titration (for CPAP indication), health-related quality-of-life questionnaires, 24-hour blood pressure monitoring, and polysomnography at the end of follow-up. The main outcome was the Epworth Sleepiness Scale measurement. The noninferiority criterion was -2 points on the Epworth scale., Measurements and Main Results: In total, 430 patients were randomized. The respiratory polygraphy protocol was noninferior to the polysomnography protocol based on the Epworth scale. Quality of life, blood pressure, and polysomnography were similar between protocols. Respiratory polygraphy was the most cost-effective protocol, with a lower per-patient cost of 416.7€., Conclusions: Home respiratory polygraphy management is similarly effective to polysomnography, with a substantially lower cost. Therefore, polysomnography is not necessary for most patients with suspected sleep apnea. This finding could change established clinical practice, with a clear economic benefit. Clinical trial registered with www.clinicaltrials.gov (NCT 01752556).

Study Objectives: Obstructive sleep apnea (OSA) is associated with an increased prevalence of metabolic syndrome (MetS), even in patients with morbid obesity. Our goal was to address whether continuous positive airway pressure (CPAP) treatment improved glucose metabolism in this population., Methods: A prospective randomized controlled trial was performed in severe OSA patients with morbid obesity without diabetes in two university referral hospitals. Patients received conservative (CT) versus CPAP treatment for 12 weeks. MetS components, homeostasis model assessment of insulin resistance (HOMA-IR) and oral glucose tolerance were assessed at baseline and after treatment., Results: A total of 80 patients completed the study (42 CPAP and 38 CT patients). After 12 w of CPAP treatment, weight loss was similar in both groups and physical activity, prevalence of MetS, and HOMA-IR did not change in either group. In the CPAP group impaired glucose tolerance (IGT) reversed in nine patients and IGT developed in none, whereas IGT reversed in five patients and IGT developed in five patients in the CT group (P = 0.039 in the Fisher test). Changes in 2-h plasma glucose after glucose load were greater in the CPAP group than in the CT group (CPAP: -0.5 ± 1.5 versus CT: 0.33 ± 1.9, P = 0.007)., Conclusions: The improvement of glucose tolerance in morbidly obese patients with severe obstructive sleep apnea, without changes in homeostasis model assessment of insulin resistance, supports an improvement in peripheral insulin resistance after continuous positive airway pressure treatment., Clinical Trials Registration: NCT 01029561., (© 2016 Associated Professional Sleep Societies, LLC.)

Background: Compliance with continuous positive airway pressure (CPAP) therapy is essential in patients with obstructive sleep apnoea (OSA), but adequate control is not always possible. This is clinically important because CPAP can reverse the morbidity and mortality associated with OSA. Telemedicine, with support provided via a web platform and video conferences, could represent a cost-effective alternative to standard care management., Aim: To assess the telemedicine impact on treatment compliance, cost-effectiveness and improvement in quality of life (QoL) when compared with traditional face-to-face follow-up., Methods: A randomised controlled trial was performed to compare a telemedicine-based CPAP follow-up strategy with standard face-to-face management. Consecutive OSA patients requiring CPAP treatment, with sufficient internet skills and who agreed to participate, were enrolled. They were followed-up at 1, 3 and 6 months and answered surveys about sleep, CPAP side effects and lifestyle. We compared CPAP compliance, cost-effectiveness and QoL between the beginning and the end of the study. A Bayesian cost-effectiveness analysis with non-informative priors was performed., Results: We randomised 139 patients. At 6 months, we found similar levels of CPAP compliance, and improved daytime sleepiness, QoL, side effects and degree of satisfaction in both groups. Despite requiring more visits, the telemedicine group was more cost-effective: costs were lower and differences in effectiveness were not relevant., Conclusions: A telemedicine-based strategy for the follow-up of CPAP treatment in patients with OSA was as effective as standard hospital-based care in terms of CPAP compliance and symptom improvement, with comparable side effects and satisfaction rates. The telemedicine-based strategy had lower total costs due to savings on transport and less lost productivity (indirect costs)., Trial Register Number: NCT01716676., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Background and Objective: There is compelling evidence that obstructive sleep apnoea (OSA) can affect metabolic syndrome (MetS) and cardiovascular risk, but the intermediate mechanisms through which it occurs have not been well defined. We explored the impact of OSA in morbidly obese patients with MetS on adipokines, pro-inflammatory markers, endothelial dysfunction, and atherosclerosis markers., Methods: We included 52 morbidly obese patients in an observational study matched for age, gender and central obesity in 3 groups (OSA-MetS, Non-OSA-MetS, and Non OSA-non-MetS). Anthropometrical, blood pressure, and fasting blood measurements were obtained the morning after an overnight polysomnography. VEGF, soluble CD40 ligand (sCD40L), TNF-α, IL-6, leptin, adiponectin, and chemerin were determined in serum by ELISA. OSA was defined as apnea/ hypopnea index ≥ 15 and MetS by NCEP-ATP III., Results: Cases and control subjects did not differ in age, BMI, waist circumference, and gender (43 ± 10 years, 46 ± 5 kg/m(2), 128 ± 10 cm, 71% females). The cases had severe OSA with 47 (32-66) events/h, time spent < 90% SpO2 7% (5%-31%). All groups presented similar serum cytokines, adipokines, VEGF, and sCD40L levels., Conclusions: In a morbidly obese population with established MetS, the presence of OSA did not determine any differences in the studied mediators when matched by central obesity. Morbidly obese NonOSA-NonMetS had a similar inflammatory, adipokine VEGF, and sCD40L profile as those with established MetS, with or without OSA. Obesity itself could overwhelm the effect of sleep apnea and MetS in the studied biomarkers., Citation: Salord N; Gasa M; Mayos M; Fortuna-Gutierrez AM; Montserrat JM; Sánchez-de-la-Torre M; Barceló A; Barbé F; Vilarrasa N; Monasterio C. Impact of OSA on biological markers in morbid obesity and metabolic syndrome.

Rationale: Home respiratory polygraphy (HRP) may be a cost-effective alternative to polysomnography (PSG) for diagnosis and treatment election in patients with high clinical probability of obstructive sleep apnea (OSA), but there is conflicting evidence on its use for a wider spectrum of patients., Objectives: To determine the efficacy and cost of OSA management (diagnosis and therapeutic decision making) using (1) PSG for all patients (PSG arm); (2) HRP for all patients (HRP arm); and (3) HRP for a subsample of patients with high clinical probability of being treated with continuous positive airway pressure (CPAP) and PSG for the remainder (elective HRP arm)., Methods: Multicentric study of 366 patients with intermediate-high clinical probability of OSA, randomly subjected to HRP and PSG. We explored the diagnostic and therapeutic decision agreements between the PSG and both HRP arms for several HRP cutoff points and calculated costs for equal diagnostic and/or therapeutic decision efficacy., Results: For equal diagnostic and therapeutic decision efficacy, PSG arm costs were 18% higher than HRP arm costs and 20% higher than elective HRP arm costs. HRP arm costs tended to be lower than elective HRP arm costs, and both tended to be lower than PSG arm costs if patient costs were omitted., Conclusion: Home respiratory polygraphy is a less costly alternative than polysomnography for the diagnosis and therapeutic decision making for patients with suspected obstructive sleep apnea. We found no advantage in cost terms, however, in using home respiratory polygraphy for all patients or home respiratory polygraphy for the most symptomatic patients and polysomnography for the rest.

Background and Objective: The use of continuous positive airway pressure (CPAP) treatment in patients with obesity hypoventilation syndrome (OHS) and obstructive sleep apnoea (OSA) was evaluated, and factors that might predict CPAP treatment failure were determined., Methods: A sleep study was performed in 29 newly diagnosed, clinically stable OHS patients. CPAP treatment was commenced if the apnoea-hypopnoea index was >15. Lung function, night-time oximetry, blood adipokine and C-reactive protein levels were assessed prospectively on enrollment and after 3 months. Treatment failure at 3 months was defined as daytime arterial partial pressure of carbon dioxide (PaCO(2)) >45 mm Hg and/or oxygen saturation (SpO(2)) <90% for >30% of the night-time oximetry study., Results: All patients had severe OSA (median apnoea-hypopnoea index = 74.7 (62-100) with a nocturnal mean SpO(2) of 81.4 ± 7), and all patients were treated with CPAP. The percentage of time spent below 90% saturation improved from 8.4% (0.0-39.0%) to 0.3% (0.4-4.0%). Awake PaCO(2) decreased from 50 (47-53) mm Hg to 43 (40-45) mm Hg. Seven patients failed CPAP treatment after 3 months. PaCO(2) at 1 month and mean night-time SpO(2) during the first night of optimal CPAP were associated with treatment failure at 3 months (odds ratio 1.4 (1.03-1.98); P = 0.034 and 0.6 (0.34-0.93); P = 0.027)., Conclusions: CPAP treatment improves night-time oxygenation and daytime hypoventilation in selected clinically stable OHS patients who also have OSA. Patients with worse night-time saturation while on CPAP and higher daytime PaCO(2) at 1 month were more likely to fail CPAP treatment., (© 2013 The Authors. Respirology © 2013 Asian Pacific Society of Respirology.)

Recent accumulating evidence in animals and humans has shown that memory strengthening occurs, at least partially, during sleep and relies on the covert reactivation of individual memory episodes. However, it remains to be determined whether the hippocampus critically promotes memory consolidation via the reactivation of individual memories during sleep. To investigate the hippocampal-dependent nature of this phenomenon in humans, we selected two groups of chronic temporal lobe epileptic (TLE) patients with selective unilateral (TLE+UHS) or bilateral (TLE+BHS) hippocampal sclerosis and a group of matched healthy controls, and we requested them to learn the association of sounds cueing the appearance of words. On the basis of other similar behavioral paradigms in healthy populations, sounds that cued only half of the learned memories were presented again during the slow-wave sleep stage (SWS) at night, thus promoting memory reactivation of a select set of encoded episodes. A memory test administered on the subsequent day showed that the strengthening of reactivated memories was observed only in the control subjects and TLE+UHS patients. Importantly, the amount of memory strengthening was predicted by the volume of spared hippocampus. Thus, the greater the structural integrity of the hippocampus, the higher the degree of memory benefit driven by memory reactivation. Finally, sleep-specific neurophysiological responses, such as spindles and slow waves, differed between the sample groups, and the spindle density during SWS predicted the degree of memory benefit observed on day 2. Taken together, these findings demonstrate that the hippocampus plays a crucial role in the consolidation of memories via covert reactivation during sleep., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background: Obstructive sleep apnea is common in patients waiting for bariatric surgery (BS). International consensuses have recommended assessment of obstructive sleep apnea in the preoperative evaluation to avoid perioperative complications. Polysomnography is the standard diagnostic method but is expensive and time-consuming. The aim of our study was to detect those patients who merit treatment before BS using a simple predictor model. The study was conducted at 3 university hospitals (Hospital de Bellvitge, Hospital de la Santa Creu i Sant Pau, Hospital Clinic de Barcelona)., Methods: A prospective cross-sectional study was conducted of 136 consecutive bariatric subjects. The outcome variable was severe obstructive sleep apnea, defined as an apnea-hypoapnea index of ≥30 events/hr by polysomnography. The predictors evaluated were anthropometric and clinical in the first model, with an oxygen desaturation index of ≥3% added to the second model. Predictive models were constructed using multivariate logistic regression analysis. The best model was selected according to the area under the receiver operating characteristic curve., Results: The first model identified 4 independent factors: age, waist circumference, systolic blood pressure, and witnessed apnea episodes, with a sensitivity of 78%, specificity of 68%, and area under the receiver operating characteristic curve of .83 (95% confidence interval .76-.90, P < .001). The second model identified 2 independent factors (witness apnea episodes, oxygen desaturation index of ≥3%), with a sensitivity of 91%, specificity of 85%, and area under the receiver operating characteristic curve of .94 (95% confidence interval .89-.98, P < .001). The 2-step model predictive values were sensitivity of 90%, specificity of 91%, and accuracy of 90% (95% confidence interval 84-94%). After applying the first model and then the second, 45% of subjects would have been ruled out (15% and 30%, respectively) and 55% would require additional sleep management before BS., Conclusion: The proposed model could be useful for improving the management of complex patients before BS and optimizing limited polysomnography resources., (Copyright © 2013 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Rationale: Respiratory polygraphy is an accepted alternative to polysomnography (PSG) for sleep apnea/hypopnea syndrome (SAHS) diagnosis, although it underestimates the apnea-hypopnea index (AHI) because respiratory polygraphy cannot identify arousals., Objectives: We performed a multicentric, randomized, blinded crossover study to determine the agreement between home respiratory polygraphy (HRP) and PSG, and between simultaneous respiratory polygraphy (respiratory polygraphy with PSG) (SimultRP) and PSG by means of 2 AHI scoring protocols with or without hyperventilation following flow reduction considered as a surrogate arousal., Methods: We included suspected SAHS patients from 8 hospitals. They were assigned to home and hospital protocols at random. We determined the agreement between respiratory polygraphy AHI and PSG AHI scorings using Bland and Altman plots and diagnostic agreement using receiver operating characteristic (ROC) curves. The agreement in therapeutic decisions (continuous positive airway pressure treatment or not) between HRP and PSG scorings was done with likelihood ratios and post-test probability calculations., Results: Of 366 randomized patients, 342 completed the protocol. AHI from HRP scorings (with and without surrogate arousal) had similar agreement with PSG. AHI from SimultRP with surrogate arousal scoring had better agreement with PSG than AHI from SimultRP without surrogate arousal. HRP with surrogate arousal scoring had slightly worse ROC curves than HRP without surrogate arousal, and the opposite was true for SimultRP scorings. HRP with surrogate arousal showed slightly better agreement with PSG in therapeutic decisions than for HRP without surrogate arousal., Conclusion: Incorporating a surrogate arousal measure into HRP did not substantially increase its agreement with PSG when compared with the usual procedure (HRP without surrogate arousal).

Obstructive sleep apnoea (OSA) seems to worsen metabolism. This effect has not been evaluated in morbid obesity (MO). We hypothesised that the metabolic profile is more impaired in MO patients with OSA than in those without, and investigated whether any specific metabolic dysfunction is related to OSA in MO. A prospective multicentre cross-sectional study was conducted in consecutive subjects before bariatric surgery. OSA was defined as apnoea/hypopnoea index (AHI) ≥15 by overnight polysomnography. Anthropometrical, blood pressure (BP) and fasting blood measurements were obtained the morning after. Metabolic syndrome (MetS) was defined according to National Cholesterol Education Program Adult Treatment Panel III modified criteria. 159 patients were studied: 72% were female and 72% had OSA. MetS prevalence was 70% in OSA versus 36% in non-OSA (p<0.001). As AHI severity increased, metabolic parameters progressively worsened, even in those without type 2 diabetes (DM2). AHI was independently associated with systolic and diastolic BP, triglycerides and the percentage of glycosylated haemoglobin (HbA1c) in the total sample, and with systolic BP, high-density lipoprotein cholesterol and HbA1c in those samples without DM2. OSA increased the adjusted odds ratio of having MetS by 2.8 (95% CI 1.3-6.2; p=0.009). In MO, OSA is associated with major metabolic impairment caused by higher BP and poorer lipid and glucose control, independent of central obesity or DM2.

Introduction: Home respiratory polygraphy (HRP) may be a cost-effective alternative to polysomnography for the diagnosis of sleep apnoea-hypopnoea syndrome (SAHS), but stronger evidence is needed. Normally, patients transport HRP equipment from the hospital to home and back, which may create difficulties for some patients., Objectives: To determine both the diagnostic efficacy and cost of HRP (with and without a transportation service moving the device and telematic transmission of data) in a large sample compared with in-hospital polysomnography., Methods: Patients suspected of having SAHS were included in a multicentre study (eight hospitals). They were assigned to home and hospital protocols in random order. Receiver operating characteristic curves were constructed for manual respiratory polygraphy scoring protocol and different polysomnographic cut-off points. Diagnostic efficacies for several polysomnographic cut-off points were explored and costs for two equally effective alternatives were calculated., Results: Of 366 randomised patients, 348 completed the protocol. The best receiver operating characteristic curve was obtained with a polysomnographic cut-off of the apnoea-hypopnoea index (AHI)≥5. The sensitive HRP AHI cut-off point (<5) had a sensitivity of 96%, a specificity of 57% and a negative likelihood ratio (LR) of 0.07; the specific cut-off (>10) had a sensitivity of 87%, a specificity of 86% and a positive LR of 6.25. The cost of HRP was half that of polysomnography. Telematic transmission costs were similar if the patients' costs were taken in to account., Conclusion: HRP is an alternative to polysomnography in patients with suspected SAHS. Telematic procedures may help patients with limited mobility and those who live a long way from the sleep centre.

Background: The prevalence of obstructive sleep apnea syndrome (OSAS) is high in obese patients. Certain components of metabolic syndrome are linked to OSAS, but there is no information on their association in morbidly obese patients. Our aim was to ascertain the prevalence of respiratory disturbances during sleep in candidates for bariatric surgery and to study their association with metabolic syndrome., Methods: We examined the preoperative records (history, physical examination and laboratory findings, spirometry, and overnight pulse oximetry [arterial oxygen saturation by pulse oximetry, [SpO(2)]]) of patients scheduled for gastric bypass surgery for 1 year in our hospital; an overnight sleep study was performed if SpO(2) readings or symptoms suggested sleep disturbance. Metabolic syndrome was defined according to the criteria of the National Cholesterol Education Program's Adult Treatment Panel III., Results: Of the 31 patients studied, 19 (61.3%) had OSAS, including 15 newly diagnosed cases with a mean +/- standard deviation apnea-hypopnea index of 49 +/- 36. OSAS patients had higher fasting plasma glucose and triglyceride levels and a higher prevalence of diabetes. Metabolic syndrome was also more frequent in subjects with previously untreated OSAS (13/14, 92%) than in those without sleep disturbance (six of 11, 55%; p = 0.033). Conversely, the prevalence of OSAS in patients with metabolic syndrome was higher (13/19, 68%) than in subjects without metabolic syndrome (one of six, 17%; p = 0.026) even though the two groups had similar body mass index., Conclusions: Sleep disordered breathing is very prevalent in obese patients who are candidates for bariatric surgery and its presence is related to metabolic syndrome.

Primitive neoplasms of the pleura are uncommon. Solitary fibrous tumor of the pleura (SFTP) is a benign variety of primitive pleural tumor, which is usually asymptomatic and discovered as an incidental finding. However, these tumors can sometimes become locally aggressive and can even be life-threatening. The treatment of choice is surgical resection. We report a case of SFTP in a 78-year-old woman with no relevant history, who presented with marked respiratory insufficiency and who required extended posterolateral thoracotomy to achieve complete resection of an SFTP weighing 2 kg.

We report a case of a 26 year old man who was diagnosticated of ALS. This case is a graphic example of the pulmonary function evolution through the flow-volume loop. In the first study the espirometric values were in the normal range. The Static pulmonary pressures were weackle decreased. This was the only sign of respiratory muscle impairement. Its important to study close enough the pulmonary function through the flow/volume loop, maximal respiratory pressures and maximal voluntary Ventilation in order to know the empairment rate, and also to detect intercurrent procedures as bulbar involvement, that can affect the prognosis of the disease.