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Introduction Sleep-disordered breathing causes a burden to the sufferer, the health care system and the society. Most studies have focused on obstructive sleep apnea (OSA); however, the prevalence of comorbidities in patients affected by overlap syndrome (OS) and obesity hypoventilation syndrome (OHS) has not been carefully evaluated. Study objectives The principal aim of this study was to identify the presence of comorbidities in patients suffering from OSA, OS, OHS and the differences in three groups of patients. Another purpose was to verify if sleepiness is associated with a greater prevalence of comorbidities. Methods A retrospective analysis in 989 adults referred for sleep diagnostic testing to our sleep center was performed. Patients were classified in OSA (721), OS (123) and OHS (145). Results The prevalence of comorbidities was higher in patients affected by OS and was the highest in the OHS group, while the prevalence of arterial hypertension is the highest in patients affected by OS. The probability of having more than two comorbidities follows the same trend. Excessive daytime sleepiness was associated with an increased rate of arterial hypertension, diabetes mellitus and the presence of multimorbidity in each group of patients. Conclusions The presence and the association of comorbidities seem to be higher in patients suffering from OSA, OS and OHS. Subjects suffering of OHS present a high prevalence of main diseases despite their younger age compared with others patients with SDB. Sleepiness may have a role, at least in a subset of these patients, into the development of comorbidities.

Alberto Capozzolo, Giorgio Castellana, Silvano Dragonieri, Pierluigi Carratù, Vito Liotino, Maria Rosaria Vulpi, Lorenzo Marra, Emanuela Resta, Pierluigi Intiglietta, Onofrio Resta Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, School of Medicine, University of Bari, Bari, Italy Background: Underdiagnosis of COPD is a relevant issue, and most frequently involves patients at early stages of the disease. Physicians do not routinely recommend smokers to undergo spirometry, unless they are symptomatic.Aims: To investigate the effectiveness of voluntary lung function screening in bringing to light patients with previously unknown COPD and to evaluate the relationships among symptoms, smoking status, and airway obstruction.Methods: A voluntary screening study for COPD was conducted during two editions of the annual Fiera del Levante (2014 and 2015), an international trade fair in Bari. Subjects were eligible for the study if they fulfilled the following inclusion criteria: age ≥35 years, smoker/ex-smoker ≥5 pack-years (PYs), or at least one chronic respiratory symptom (cough, sputum production, shortness of breath, and wheezing). A free post-β2-agonist spirometry test was performed by trained physicians for each participant using portable spirometers. Post-β2-agonist forced expiratory volume in 1 second (FEV1):forced vital capacity ratio

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 (FEV 1 n = 183) reported ≥2 exacerbations or ≥1 determining hospitalization during the previous 12 months, and infrequent exacerbators ( n = 162) reported 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.

Summary Background Whether blood eosinophil counts and exhaled nitric oxide (FeNO) are associated with important outcomes in mild asthma is unclear. In this prespecified subgroup analysis of a previously published open-label clinical trial, we aimed to assess associations between blood eosinophil counts and FeNO with outcomes and response to asthma treatment. Methods In the previously reported 52-week, open-label, randomised controlled trial, people with mild asthma receiving only β agonist reliever inhalers were enrolled at one of 16 clinical trials units in New Zealand, the UK, Italy, or Australia. Eligible participants were randomly assigned (1:1:1, stratified by country), to receive inhalers to take as-needed salbutamol (two inhalations of 100 μg in a pressurised metered dose inhaler), maintenance budesonide (200 μg twice per day by inhaler) plus as-needed salbutamol (two inhalations of 100 μg), or as-needed budesonide–formoterol (one inhalation of 200 μg budesonide and 6μg formoterol by inhaler). The primary outcome was the annual rates of asthma exacerbations per patient, and in this prespecified subgroup analysis, we assessed whether annual exacerbation rates in each treatment group were significantly different depending on levels of blood eosinophil count, FeNO, or a composite score of both. Analyses were done for patients with available biomarker measurements The study was registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12615000999538. Findings 675 participants were enrolled between March 17, 2016, and Aug 29, 2017, of whom 656 had results for blood eosinophil analysis and 668 had results for FeNO. Of the patients who received as-needed salbutamol, the proportion of patients having a severe exacerbation increased progressively with increasing blood eosinophil count (two [4%] of 49 participants with Interpretation In patients with mild asthma, the effects of as-needed budesonide–formoterol on exacerbations are independent of biomarker profile, whereas the benefits of maintenance inhaled budesonide are greater in patients with high blood eosinophil counts than in patients with low counts. Funding AstraZeneca, Health Research Council of New Zealand.

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 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.

Background: Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease which early affects the respiratory system, rapidly leading to pulmonary failure, requiring Non Invasive ventilation (NIV). One of the first signs of respiratory failure is diurnal hypercapnia, which appears at an early stage of disease, when the pulmonary function test (PFT) is often within the normal limits. Purpose: Aim of the study was to correlate PFT and Sniff Nasal Inspiratory Pressure (SNIP) test to diurnal PaCO2 and to PaO2, as well as to markers of sleep disordered breathing (SDB), such as Apnea/Hypopnea Index (AHI), Oxygen Desaturation Index (ODI), and Total Sleep Time (TST). Methods: We evaluated anthropometric features, PFT, SNIP, Arterial Blood Gas analysis and Polyomnographic test in 22 consecutive ALS patients (14 M). Results: A statistical negative correlation was found between SNIP and PaCO2 (N=22, p=0.042, r=-043), while FVC did not correlate to PaCO2 in the same ALS population (N=22, p=0.093, r=-0.36). SNIP also negatively correlated to AHI (N=22, p=0.03, r=-0.41), while FVC did not correlate to AHI in the same group of ALS patients (N=22, p=0.08, r=-0.38). A positive correlation was also observed between SNIP and TST (N=22, p=0.03, r=0.7), while FVC did not correlate to TST in our ALS patients (N=22, p=0.07, r=0.41). Conclusion: SNIP test but not FVC is an early marker of diurnal hypercapnia and of nocturnal SDB in ALS patients. This preliminary study suggests that a SNIP test, which is non invasive and easy to reproduce, may early disclose respiratory insufficiency, leading the physicians to early use (NIV) which may prolong survival in ALS.

Background: acute exacerbations are very important events in the clinical history of COPD because are responsible for the decline in lung function. Aims and objectives: we aim to identify whether there are any clinical and functional features of frequent exacerbators in severe COPD patients. Methods: we assessed an observational, cross sectional, case control cohort study. All subjects had GOLD stage 3 or 4. “Frequent exacerbators” (n = 183) reported a number of >2 exacerbations in the last 12 months or > 1 with hospitalization and “infrequent exacerbators” (n = 162) had Results: no significant differences were found in age, sex, body mass index, presence of chronic cough, six minute walking test and Charlson Comorbidity Index between the two groups. Frequent exacerbators had significantly lower inspiratory capacity (IC) % of predicted and higher residual volume/total lung capacity (RV/TLC) ratio. Infrequent exacerbators had lower mMRC score and BODE index than frequent exacerbators. In the multivariate model an increase of RV/TLC ratio and mMRC score were independently associated with frequent exacerbations. Conclusions: static hyperinflation and respiratory disability, misured by mMRC score, were independently associated w ith frequent exacerbations in severe COPD patients.

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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 subject’s 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