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1. Hypertension treatment in patients with sleep apnea from the European Sleep Apnea Database (ESADA) cohort – towards precision medicine.

Author

Svedmyr, Sven, Hedner, Jan, Bonsignore, Maria Rosaria, Lombardi, Carolina, Parati, Gianfranco, Ludka, Ondrej, Zou, Ding, Grote, Ludger, Anttalainen, U., Bailly, S., Basoglu, O. K., Bonsignore, M. R., Bouloukaki, I., Buskova, J., Dogas, Z., Drummond, M., Fanfulla, Francesco, Fietze, I., Gouveris, Haralampos, and Grote, L.

Subjects
SLEEP apnea syndromes, SYSTOLIC blood pressure, ANTIHYPERTENSIVE agents, DIASTOLIC blood pressure, HYPERTENSION, BLOOD pressure
Abstract

Summary: We recruited 5,970 hypertensive patients with obstructive sleep apnea (OSA) on current antihypertensive treatment from the European Sleep Apnea Database (ESADA) cohort. The group was subdivided into those receiving monotherapy (n = 3,594) and those receiving dual combined therapy (n = 2,376). We studied how major OSA confounders like age, gender, and body mass index as well as the degree of sleep apnea modified office systolic and diastolic blood pressure. Beta‐blockers alone or in combination with a diuretic were compared with other antihypertensive drug classes. Monotherapy with beta‐blocker was associated with lower systolic blood pressure, particularly in non‐obese middle‐aged males with hypertension. Conversely, the combination of a beta‐blocker and a diuretic was associated with lower systolic and diastolic blood pressure in hypertensive patients with moderate–severe OSA. Systolic blood pressure was better controlled in female patients using this combined treatment. Our cross‐sectional data suggest that specific clinical characteristics and type of antihypertensive medication influence the degree of blood pressure control in hypertensive OSA patients. Controlled trials are warranted. [ABSTRACT FROM AUTHOR]

Published
2023
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2. Metabolic Consequences of Obstructive Sleep Apnea

Author

Bonsignore M. R. and Bonsignore M.R.

Subjects
Inflammation, Diabetes mellitu, Cholesterol, Free fatty acid, Insulin resistance, Continuous positive airway pressure (CPAP), Settore MED/10 - Malattie Dell'Apparato Respiratorio, Cardiovascular risk, Metabolic syndrome, Nonalcoholic fatty liver disease (NAFLD)
Abstract

The effects of OSA on metabolism are quite complex, and obesity, diabetes, nonalcoholic fatty liver disease and dyslipidemia often coexist with OSA, making it difficult to tease out the independent effects of OSA on metabolic variables. There is firm experimental evidence of a detrimental impact of OSA on adipose tissue dysfunction, with intermittent hypoxia, sympathetic hyperactivity, and oxidative stress as the most important intermediate mechanisms. Sleep fragmentation or deprivation may also contribute to the metabolic dysfunction of OSA. This work reviews the current knowledge on this topic, as well as the results of studies on the effects of CPAP treatment.

Published
2022

4. Pathophysiology of Obstructive Sleep Apnea (OSA)

Author

Bonsignore M. R., Francesco Lo Russo, Salvatore Gallina, Guzzo O, Bonsignore, MR, Marchese, D, Torrente, A, Mistretta, A, Rossetto, L, Mattina, A, Panzarella, V, Ortenzio, P, Immordino, A, Cammaroto, G, Martorana, S, Priola, R., and Bonsignore M.R.

Subjects
sympathetic nervous system, obesity, intermittent hypoxia, Settore MED/10 - Malattie Dell'Apparato Respiratorio
Abstract

Obstructive sleep apnea (OSA) is a complex disorder characterized by total or partial collapse of the upper airways (UA) during sleep, causing obstructive apneas or hypopneas, respectively. During respiratory events, respiratory efforts occur against the restricted or collapsed upper airway, hypoxia and hypercapnia develop, and sympathetic activation increases. The main symptoms of OSA are intermittent snoring and excessive daytime sleepiness. OSA is often associated with obesity, hypertension, and increased cardiovascular risk. Pathophysiological aspects include: anatomical and physiological determinants of UA closure, and immediate and long-term consequences of chronic intermittent hypoxia (CIH), which is believed to be the most relevant alteration induced by OSA. This chapter will briefly review OSA pathophysiology, with special attention to physiological phenotypes of OSA, and the role of intermittent hypoxia in the pathogenesis of cardiometabolic abnormalities.

Published
2021

5. Obstructive sleep apnoea in adult patients post-tonsillectomy

Author

Riha, R, Kotoulas, S, Pataka, A, Kvamme, J, Joppa, P, Hedner, J, Anttalainen, U, Barbe, F, Bonsignore, M, Basoglu, O, Bielicki, P, Bouloukaki, I, Dogas, Z, Dorkova, Z, Escourrou, P, Fietze, I, Esquinas, C, Grote, L, Kent, B, Lena, L, Lavie, P, Levy, P, Lombardi, C, Marrone, O, Masa, J, Mcnicholas, W, Montserrat, J, Parati, G, Penzel, T, Pepin, J, Plywaczewski, R, Pretl, M, Rodenstein, D, Roisman, G, Ryan, S, Saaresranta, T, Schiza, S, Schulz, R, Sliwinski, P, Staats, R, Steiropoulos, P, Tasbakan, M, Tkacova, R, Varoneckas, G, Verbraecken, J, Vitols, A, Vrints, H, Zielinski, J, Riha R. L., Kotoulas S. -. C., Pataka A., Kvamme J. A., Joppa P., Hedner J., Anttalainen U., Barbe F., Bonsignore M. R., Basoglu O., Bielicki P., Bouloukaki I., Dogas Z., Dorkova Z., Escourrou P., Fietze I., Esquinas C., Grote L., Kent B. D., Lena L., Lavie P., Levy P., Lombardi C., Marrone O., Masa J. F., McNicholas W. T., Montserrat J. M., Parati G., Penzel T., Pepin J. L., Plywaczewski R., Pretl M., Rodenstein D., Roisman G., Ryan S., Saaresranta T., Schiza S. E., Schulz R., Sliwinski P., Staats R., Steiropoulos P., Tasbakan M. S., Tkacova R., Varoneckas G., Verbraecken J., Vitols A., Vrints H., Zielinski J., Riha, R, Kotoulas, S, Pataka, A, Kvamme, J, Joppa, P, Hedner, J, Anttalainen, U, Barbe, F, Bonsignore, M, Basoglu, O, Bielicki, P, Bouloukaki, I, Dogas, Z, Dorkova, Z, Escourrou, P, Fietze, I, Esquinas, C, Grote, L, Kent, B, Lena, L, Lavie, P, Levy, P, Lombardi, C, Marrone, O, Masa, J, Mcnicholas, W, Montserrat, J, Parati, G, Penzel, T, Pepin, J, Plywaczewski, R, Pretl, M, Rodenstein, D, Roisman, G, Ryan, S, Saaresranta, T, Schiza, S, Schulz, R, Sliwinski, P, Staats, R, Steiropoulos, P, Tasbakan, M, Tkacova, R, Varoneckas, G, Verbraecken, J, Vitols, A, Vrints, H, Zielinski, J, Riha R. L., Kotoulas S. -. C., Pataka A., Kvamme J. A., Joppa P., Hedner J., Anttalainen U., Barbe F., Bonsignore M. R., Basoglu O., Bielicki P., Bouloukaki I., Dogas Z., Dorkova Z., Escourrou P., Fietze I., Esquinas C., Grote L., Kent B. D., Lena L., Lavie P., Levy P., Lombardi C., Marrone O., Masa J. F., McNicholas W. T., Montserrat J. M., Parati G., Penzel T., Pepin J. L., Plywaczewski R., Pretl M., Rodenstein D., Roisman G., Ryan S., Saaresranta T., Schiza S. E., Schulz R., Sliwinski P., Staats R., Steiropoulos P., Tasbakan M. S., Tkacova R., Varoneckas G., Verbraecken J., Vitols A., Vrints H., and Zielinski J.

Abstract

Background: The impact of removing the upper airway lymphoid tissue and in particular, tonsillectomy, in adults with OSA has not been demonstrated in large populations. Aims: To compare the severity of OSA and the prevalence of cardiovascular, metabolic and respiratory co-morbidities between patients with OSA who had undergone previous tonsillectomy and those who had not. Methods: The 19,711 participants in this study came from the European sleep apnea database (ESADA) which comprises data from unselected adult patients aged 18–80 years with a history of symptoms suggestive of OSA referred to sleep centers throughout Europe. Results: There were no differences between the two groups in terms of sex ratio and age (146 patients with previous tonsillectomy vs. 19565 patients without). Patients who had undergone tonsillectomy had a lower body mass index (29.3 ± 5.2 kg/m2 vs 32.2 ± 6.6 kg/m2, p < 0.001), lower subjective sleep latency (17.1 ± 17.8 min vs 25.5 ± 30.4 min, p = 0.001), lower ODI (15.7 ± 18.3 events/hour vs 30.7 ± 26.1 events/hour, p < 0.001), and SpO2<90% time during sleep (21.8 ± 47.5 min vs 52.6 ± 80.8 min, p < 0.001). OSA patients with tonsillectomy had a lower prevalence of Type II diabetes mellitus (p = 0.001), hypertension (p < 0.001) and a higher prevalence of hyperlipidemia (p < 0.001) and were less likely to be commenced on CPAP (p < 0.001). Conclusion: In a large population of almost 20,000 OSA patients from across Europe, patients who had undergone tonsillectomy presented with less severe OSA at time of diagnosis, and had a lower prevalence of Type II diabetes mellitus and cardiovascular co-morbidities.

Published
2021

6. EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke [guidelines]

Author

Bassetti, C. L. A., Randerath, W, Vignatelli, L, Ferini-Strambi, L, Brill, A.-K., Bonsignore, M R, Grote, L, Jennum, P, Leys, D, Minnerup, J, Nobili, L, Tonia, T., Morgan, R, Kerry, J, Riha, R, McNicholas, W T, and Papavasileiou, V

Subjects
mental disorders, cardiovascular diseases, 610 Medicine & health, 360 Social problems & social services
Abstract

BACKGROUND Sleep disorders are highly prevalent in the general population and may be linked in a bidirectional fashion to stroke, which is one of the leading causes of morbidity and mortality. AIM Four major scientific societies established a task force of experts in neurology, stroke, respiratory medicine, sleep medicine and methodology to critically evaluate the evidence regarding potential links and the impact of therapy. MATERIALS AND METHODS Thirteen research questions were evaluated in a systematic literature search using a stepwise hierarchical approach: first, systematic reviews and meta-analyses; second, primary studies post-dating the systematic reviews/meta-analyses. A total of 445 studies were evaluated and 88 were included. Statements were generated regarding current evidence and clinical practice. RESULTS Severe obstructive sleep apnoea (OSA) doubles the risk for incident stroke, especially in young to middle-aged patients. Continuous positive airway pressure (CPAP) may reduce stroke risk, especially in treatment-compliant patients. The prevalence of OSA is high in stroke patients and can be assessed by polygraphy. Severe OSA is a risk factor for recurrence of stroke and may be associated with stroke mortality, whilst CPAP may improve stroke outcome. It is not clear if insomnia increases stroke risk, whilst the pharmacotherapy of insomnia may increase it. Periodic limb movements in sleep (PLMS), but not restless limb syndrome (RLS), may be associated with an increased risk of stroke. Preliminary data suggest a high frequency of post-stroke insomnia and RLS and their association with a less favourable stroke outcome, whilst treatment data are scarce. DISCUSSION/CONCLUSION Overall, the evidence base is best for OSA relationship with stroke and supports active diagnosis and therapy. Research gaps remain especially regarding insomnia and RLS/PLMS relationships with stroke.

Published
2020
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8. Insomnia symptoms combined with nocturnal hypoxia associate with cardiovascular comorbidity in the European sleep apnea cohort (ESADA)

Author

Anttalainen, Ulla, Grote, L., Fietze, I., Riha, R. L., Ryan, S., Staats, R., Hedner, J., Saaresranta, T., Anttalainen, U., Barbe, F., Bonsignore, M. R., Basoglu, O., Bielicki, P., Bouloukaki, I., Dogas, Z., Dorkova, Z., Escourrou, P., Fietze, I, Esquinas, C., Hayes, L., Joppa, P., Kurki, S., Kvamme, J. A., Tamisier, R., Lombardi, C., Marrone, O., Masa, J. F., McNicholas, W. T., Montserrat, J. M., Parati, G., Pataka, A., Penzel, T., Pepin, J. L., Pretl, M., Roisman, G., Schiza, S. E., Schulz, R., Sliwinski, P., Steiropoulos, P., Tasbakan, M. S., Tkacova, R., Varoneckas, G., Verbraecken, J., Vrints, H., Anttalainen, U, Grote, L, Fietze, I, Riha, R, Ryan, S, Staats, R, Hedner, J, Saaresranta, T, Barbe, F, Bonsignore, M, Basoglu, O, Bielicki, P, Bouloukaki, I, Dogas, Z, Dorkova, Z, Escourrou, P, Esquinas, C, Hayes, L, Joppa, P, Kurki, S, Kvamme, J, Tamisier, R, Lombardi, C, Marrone, O, Mcnicholas, W, Montserrat, J, Parati, G, Pataka, A, Penzel, T, Pepin, J, Pretl, M, Roisman, G, Schiza, S, Schulz, R, Sliwinski, P, Tasbakan, M, Tkacova, R, Varoneckas, G, Verbraecken, J, Vrints, H, Anttalainen U., Grote L., Fietze I., Riha R.L., Ryan S., Staats R., Hedner J., Saaresranta T., Barbe F., Bonsignore M.R., Basoglu O., Bielicki P., Bouloukaki I., Dogas Z., Dorkova Z., Escourrou P., Esquinas C., Hayes L., Joppa P., Kurki S., Kvamme J.A., Tamisier R., Lombardi C., Marrone O., McNicholas W.T., Montserrat J.M., Parati G., Pataka A., Penzel T., Pepin J.L., Pretl M., Roisman G., Schiza S.E., Schulz R., Sliwinski P., Tasbakan M.S., Tkacova R., Varoneckas G., Verbraecken J., Vrints H., Ege Üniversitesi, and ESADA Study Collaborators

Subjects
Adult, Male, medicine.medical_specialty, Insomnia, Neurology, Comorbidity, Settore MED/10 - Malattie Dell'Apparato Respiratorio, Nocturnal, Hypoxemia, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Sleep Initiation and Maintenance Disorders, Internal medicine, mental disorders, Prevalence, Humans, Medicine, Hypoxia, Sleep Apnea, Obstructive, business.industry, Sleep Breathing Physiology and Disorders • Original Article, Sleep apnea, Middle Aged, Cardiovascular disease, Phenotype, Hypoxia (medical), medicine.disease, Circadian Rhythm, nervous system diseases, Europe, 030228 respiratory system, Otorhinolaryngology, Cardiovascular Diseases, Cohort, Female, Human medicine, Neurology (clinical), medicine.symptom, business, 030217 neurology & neurosurgery
Abstract

WOS: 000482433800011, PubMed ID: 30467691, Purpose The aim of the current study was to further investigate the concept of previously reported high occurrence of comorbidities in obstructive sleep patients (OSA) with insomnia-like symptoms. We hypothesized that this finding at least partly is mediated by nocturnal hypoxia. Moreover, we speculated that the spectrum of the clinical OSA phenotypes differs between European geographical regions. Methods Cohort of the European Sleep Apnea Database (n = 17,325; 29.9% females) was divided into five subcohorts according to geographical region (North, East, South, West, Central) and further into four clinical presentation phenotypes based on daytime symptoms (EDS) and characteristics suggestive of insomnia. Results The insomnia phenotype (alone or together with EDS) dominated in all European regions. Isolated insomnia, however, was less common in the West. Insomnia phenotype was associated with the highest proportion of cardiovascular comorbidity (51.7% in the insomnia vs. 43.9% in the EDS type). Measures of nocturnal hypoxemia were independently associated with cardiovascular comorbidity in phenotypes with insomnia-like symptoms. The burden of comorbidities was high across all geographical regions and clinical phenotypes. Regional differences were clinically relevant for age (48 vs. 54 years), BMI (29 vs. 34 kg/m(2)), and ODI (15 vs. 32/h). Conclusion High prevalence of particularly cardiovascular comorbidity among patients with insomnia-like symptoms was linked to nocturnal hypoxemia. Considerable differences in clinical presentation were found among OSA patients across Europe. Our data underline that physicians should ask their patients with suspected OSA also for insomnia symptoms. It remains to be explored if a reduction of nocturnal hypoxemia predicts the improvement of insomnia symptoms., European Union COST action B26; European Respiratory Society (ERS); ResMed Inc.; Philips Respironics Inc., The ESADA network has received support from the European Union COST action B26. The European Respiratory Society (ERS) supports the ESADA for the second period as a Clinical Research Collaboration (CRC) (2015-2017 and 2018-2020). Unrestricted seeding grants from ResMed Inc. and Philips Respironics Inc. for establishment of the organization and the database are gratefully acknowledged.

Published
2018

9. EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

Author

Bassetti, C. L. A., Randerath, W., Vignatelli, L., Ferini-Strambi, L., Brill, A. -K., Bonsignore, M. R., Grote, L., Jennum, P., Leys, D., Minnerup, J., Nobili, L., Tonia, T., Morgan, R., Kerry, J., Riha, R., McNicholas, W. T., Papavasileiou, V., Bassetti, C. L. A., Randerath, W., Vignatelli, L., Ferini-Strambi, L., Brill, A. -K., Bonsignore, M. R., Grote, L., Jennum, P., Leys, D., Minnerup, J., Nobili, L., Tonia, T., Morgan, R., Kerry, J., Riha, R., McNicholas, W. T., and Papavasileiou, V.

Abstract

Background Sleep disorders are highly prevalent in the general population and may be linked in a bidirectional fashion to stroke, which is one of the leading causes of morbidity and mortality. Aim Four major scientific societies established a task force of experts in neurology, stroke, respiratory medicine, sleep medicine and methodology to critically evaluate the evidence regarding potential links and the impact of therapy. Materials and methods Thirteen research questions were evaluated in a systematic literature search using a stepwise hierarchical approach: first, systematic reviews and meta-analyses; second, primary studies post-dating the systematic reviews/meta-analyses. A total of 445 studies were evaluated and 88 were included. Statements were generated regarding current evidence and clinical practice. Results Severe obstructive sleep apnoea (OSA) doubles the risk for incident stroke, especially in young to middle-aged patients. Continuous positive airway pressure (CPAP) may reduce stroke risk, especially in treatment-compliant patients. The prevalence of OSA is high in stroke patients and can be assessed by polygraphy. Severe OSA is a risk factor for recurrence of stroke and may be associated with stroke mortality, whilst CPAP may improve stroke outcome. It is not clear if insomnia increases stroke risk, whilst the pharmacotherapy of insomnia may increase it. Periodic limb movements in sleep (PLMS), but not restless limb syndrome (RLS), may be associated with an increased risk of stroke. Preliminary data suggest a high frequency of post-stroke insomnia and RLS and their association with a less favourable stroke outcome, whilst treatment data are scarce. Discussion/Conclusion Overall, the evidence base is best for OSA relationship with stroke and supports active diagnosis and therapy. Research gaps remain especially regarding insomnia and RLS/PLMS relationships with stroke.

Published
2020

10. Sleep apnoea management in Europe during the COVID-19 pandemic – Data from the European Sleep Apnoea Database (ESADA)

Author

Grote, L, Mcnicholas, W, Hedner, J, Anttalainen, U, Saaresranta, T, Basoglu, O, Gunduz, C, Tasbakan, S, Bouloukaki, I, Schiza, S, Bonsignore, M, Marrone, O, Petitjean, M, Roisman, G, Fietze, I, Laharnar, N, Penzel, T, Zou, D, Kent, B, Ryan, S, Kvamme, J, Bailly, S, Pepin, J, Tamisier, R, Lombardi, C, Parati, G, Pataka, A, Plywaczewski, R, Sliwinski, P, Pretl, M, Riha, R, Staats, R, Steiropoulos, P, Joppa, P, Verbraecken, J, Petiet, E, Trakada, G, Ludka, O, Buskova, J, Hein, H, Drummond, M, van Zeller, M, Dogas, Z, Galic, T, Gouveris, H, Mihaicuta, S, Randerath, W, Herkenrath, S, Fanfulla, F, Testelmans, D, Grote L., McNicholas W. T., Hedner J., Anttalainen U., Saaresranta T., Basoglu O. K., Gunduz C., Tasbakan S., Bouloukaki I., Schiza S. E., Bonsignore M. R., Marrone O., Petitjean M., Roisman G., Fietze I., Laharnar N., Penzel T., Zou D., Kent B. D., Ryan S., Kvamme J. A., Bailly S., Pepin J. -L., Tamisier R., Lombardi C., Parati G., Pataka A., Plywaczewski R., Sliwinski P., Pretl M., Riha R., Staats R., Steiropoulos P., Joppa P., Verbraecken J., Petiet E., Trakada G., Ludka O., Buskova J., Hein H., Drummond M., van Zeller M., Dogas Z., Galic T., Gouveris H., Mihaicuta S., Randerath W., Herkenrath S., Fanfulla F., Testelmans D., Grote, L, Mcnicholas, W, Hedner, J, Anttalainen, U, Saaresranta, T, Basoglu, O, Gunduz, C, Tasbakan, S, Bouloukaki, I, Schiza, S, Bonsignore, M, Marrone, O, Petitjean, M, Roisman, G, Fietze, I, Laharnar, N, Penzel, T, Zou, D, Kent, B, Ryan, S, Kvamme, J, Bailly, S, Pepin, J, Tamisier, R, Lombardi, C, Parati, G, Pataka, A, Plywaczewski, R, Sliwinski, P, Pretl, M, Riha, R, Staats, R, Steiropoulos, P, Joppa, P, Verbraecken, J, Petiet, E, Trakada, G, Ludka, O, Buskova, J, Hein, H, Drummond, M, van Zeller, M, Dogas, Z, Galic, T, Gouveris, H, Mihaicuta, S, Randerath, W, Herkenrath, S, Fanfulla, F, Testelmans, D, Grote L., McNicholas W. T., Hedner J., Anttalainen U., Saaresranta T., Basoglu O. K., Gunduz C., Tasbakan S., Bouloukaki I., Schiza S. E., Bonsignore M. R., Marrone O., Petitjean M., Roisman G., Fietze I., Laharnar N., Penzel T., Zou D., Kent B. D., Ryan S., Kvamme J. A., Bailly S., Pepin J. -L., Tamisier R., Lombardi C., Parati G., Pataka A., Plywaczewski R., Sliwinski P., Pretl M., Riha R., Staats R., Steiropoulos P., Joppa P., Verbraecken J., Petiet E., Trakada G., Ludka O., Buskova J., Hein H., Drummond M., van Zeller M., Dogas Z., Galic T., Gouveris H., Mihaicuta S., Randerath W., Herkenrath S., Fanfulla F., and Testelmans D.

Published
2020

11. Long-term positive airway pressure therapy is associated with reduced total cholesterol levels in patients with obstructive sleep apnea: data from the European Sleep Apnea Database (ESADA)

Author

Gunduz, C, Basoglu, O, Kvamme, J, Verbraecken, J, Anttalainen, U, Marrone, O, Steiropoulos, P, Roisman, G, Joppa, P, Hein, H, Trakada, G, Hedner, J, Grote, L, Petiet, E, Montserrat, J, Fietze, I, Penzel, T, Ludka, O, Rodenstein, D, Masa, J, Bouloukaki, I, Schiza, S, Kent, B, Mcnicholas, W, Ryan, S, Riha, R, Schulz, R, Zou, D, Pepin, J, Levy, P, Bailly, S, Lavie, L, Lavie, P, Tasbakan, M, Varoneckas, G, Tkacova, R, Staats, R, Barbe, F, Lombardi, C, Parati, G, Drummond, M, van Zeller, M, Bonsignore, M, Petitjean, M, Pretl, M, Vitols, A, Dogas, Z, Galic, T, Pataka, A, Saaresranta, T, Plywaczewski, R, Sliwinski, P, Bielicki, P, Gunduz C., Basoglu O. K., Kvamme J. A., Verbraecken J., Anttalainen U., Marrone O., Steiropoulos P., Roisman G., Joppa P., Hein H., Trakada G., Hedner J., Grote L., Petiet E., Montserrat J. M., Fietze I., Penzel T., Ludka O., Rodenstein D., Masa J. F., Bouloukaki I., Schiza S., Kent B., McNicholas W. T., Ryan S., Riha R. L., Schulz R., Zou D., Pepin J. L., Levy P., Bailly S., Lavie L., Lavie P., Tasbakan M. S., Varoneckas G., Tkacova R., Staats R., Barbe F., Lombardi C., Parati G., Drummond M., van Zeller M., Bonsignore M. R., Petitjean M., Pretl M., Vitols A., Dogas Z., Galic T., Pataka A., Saaresranta T., Plywaczewski R., Sliwinski P., Bielicki P., Gunduz, C, Basoglu, O, Kvamme, J, Verbraecken, J, Anttalainen, U, Marrone, O, Steiropoulos, P, Roisman, G, Joppa, P, Hein, H, Trakada, G, Hedner, J, Grote, L, Petiet, E, Montserrat, J, Fietze, I, Penzel, T, Ludka, O, Rodenstein, D, Masa, J, Bouloukaki, I, Schiza, S, Kent, B, Mcnicholas, W, Ryan, S, Riha, R, Schulz, R, Zou, D, Pepin, J, Levy, P, Bailly, S, Lavie, L, Lavie, P, Tasbakan, M, Varoneckas, G, Tkacova, R, Staats, R, Barbe, F, Lombardi, C, Parati, G, Drummond, M, van Zeller, M, Bonsignore, M, Petitjean, M, Pretl, M, Vitols, A, Dogas, Z, Galic, T, Pataka, A, Saaresranta, T, Plywaczewski, R, Sliwinski, P, Bielicki, P, Gunduz C., Basoglu O. K., Kvamme J. A., Verbraecken J., Anttalainen U., Marrone O., Steiropoulos P., Roisman G., Joppa P., Hein H., Trakada G., Hedner J., Grote L., Petiet E., Montserrat J. M., Fietze I., Penzel T., Ludka O., Rodenstein D., Masa J. F., Bouloukaki I., Schiza S., Kent B., McNicholas W. T., Ryan S., Riha R. L., Schulz R., Zou D., Pepin J. L., Levy P., Bailly S., Lavie L., Lavie P., Tasbakan M. S., Varoneckas G., Tkacova R., Staats R., Barbe F., Lombardi C., Parati G., Drummond M., van Zeller M., Bonsignore M. R., Petitjean M., Pretl M., Vitols A., Dogas Z., Galic T., Pataka A., Saaresranta T., Plywaczewski R., Sliwinski P., and Bielicki P.

Abstract

Background and aim: Obstructive sleep apnea (OSA) is an independent risk factor for dyslipidemia. The current study examined the effects of positive airway pressure (PAP) treatment on lipid status in the European Sleep Apnea Database (ESADA). Methods: The prospective cohort study enrolled 1564 OSA subjects (74% male, mean age 54 ± 11y, body mass index (BMI) 32.7 ± 6.6 kg/m2 and apnea-hypopnea index (AHI) 40.3 ± 24.4 n/h) undergoing PAP therapy for at least three months (mean 377.6 ± 419.5 days). Baseline and follow-up total cholesterol (TC) from nine centers were analyzed. Repeated measures and logistic regression tests (adjusted for age, sex, weight changes, lipid lowering medication, PAP compliance, and treatment duration) were used to compare changes in TC concentration. Incident risk for a coronary heart disease event (CHD) was used to compute a Framingham CHD risk score (estimated from age, BMI, blood pressure, and TC). Results: Adjusted means of TC decreased from 194.2 mg/dl to 189.3 mg/dl during follow-up (p = 0.019). A clinically significant (10%) reduction of TC at PAP follow-up was observed in 422 patients (27%). Duration of PAP therapy was identified as independent predictor for TC reduction, which implies an approximately 10% risk reduction for incident CHD events (from 26.7% to 24.1% in men and from 11.2% to 10.1% in women, p < 0.001 respectively). Conclusion: This observational study demonstrates a reduction of TC after long-term PAP treatment. The close association between TC concentration and cardiovascular (CV) mortality suggests that identification and treatment of OSA may have a beneficial effect on overall CV risk due to this mechanism. This possibility needs to be evaluated in prospective randomized studies.

Published
2020

12. Mild obstructive sleep apnea increases hypertension risk, challenging traditional severity classification

Author

Bouloukaki, I, Grote, L, Mcnicholas, W, Hedner, J, Verbraecken, J, Parati, G, Lombardi, C, Basoglu, O, Pataka, A, Marrone, O, Steiropoulos, P, Bonsignore, M, Schiza, S, Bouloukaki I., Grote L., McNicholas W. T., Hedner J., Verbraecken J., Parati G., Lombardi C., Basoglu O. K., Pataka A., Marrone O., Steiropoulos P., Bonsignore M. R., Schiza S. E., Bouloukaki, I, Grote, L, Mcnicholas, W, Hedner, J, Verbraecken, J, Parati, G, Lombardi, C, Basoglu, O, Pataka, A, Marrone, O, Steiropoulos, P, Bonsignore, M, Schiza, S, Bouloukaki I., Grote L., McNicholas W. T., Hedner J., Verbraecken J., Parati G., Lombardi C., Basoglu O. K., Pataka A., Marrone O., Steiropoulos P., Bonsignore M. R., and Schiza S. E.

Abstract

Study Objectives: The association of mild obstructive sleep apnea (OSA) with important clinical outcomes remains unclear. We aimed to investigate the association between mild OSA and systemic arterial hypertension (SAH) in the European Sleep Apnea Database cohort. Methods: In a multicenter sample of 4,732 participants, we analyzed the risk of mild OSA (subclassified into 2 groups: MildAHI 5-<11/h (apnea-hypopnea index [AHI], 5 to <11 events/h) and mildAHI 11-<15/h (AHI, .11 to <15 events/h) compared with nonapneic snorers for prevalent SAH after adjustment for relevant confounding factors including sex, age, smoking, obesity, daytime sleepiness, dyslipidemia, chronic obstructive pulmonary disease, type 2 diabetes, and sleep test methodology (polygraphy or polysomnography). Results: SAH prevalence was higher in the mildAHI 11-<15/h OSA group compared with the mildAHI 5-<11/h group and nonapneic snorers (52% vs 45% vs 30%; P < -001). Corresponding adjusted odds ratios for SAH were 1.789 (mildAHI 11-<15/h; 95% confidence interval [CI], 1.49.2.15) and 1.558 (mildAHI 5-<11/h; 95%, CI, 1.34.1.82), respectively (P <.001). In sensitivity analysis, mildAHI 11-<15/h OSA remained a significant predictor for SAH both in the polygraphy (odds ratio, 1.779; 95% CI, 1.403.2.256; P < -001) and polysomnography groups (odds ratio, 1.424; 95% CI, 1.047.1.939; P = .025). Conclusions: Our data suggest a dose-response relationship betweenmild OSA and SAH risk, starting from 5 events/h in polygraphy recordings and continuing with a further risk increase in the 11-to <150-events/h range. These findings potentially introduce a challenge to traditional thresholds of OSA severity and may help to stratify participants with OSA according to cardiovascular risk.

Published
2020

13. Periodic limb movements during sleep and blood pressure changes in sleep apnoea: Data from the European Sleep Apnoea Database

Author

Lombardi, C, Parati, G, Soranna, D, Zambon, A, Sliwinski, P, Roisman, G, Pepin, J, Schiza, S, Riha, R, Joppa, P, Fietze, I, Hedner, J, Grote, L, Anttalainen, U, Barbe, F, Bonsignore, M, Basoglu, O, Bielicki, P, Dogas, Z, Dorkova, Z, Escourrou, P, Hein, H, Kvamme, J, Levy, P, Marrone, O, Masa, J, Mcnicholas, W, Montserrat, J, Pataka, A, Penzel, T, Petiet, E, Plywaczewski, R, Pretl, M, Ryan, S, Saaresranta, T, Schulz, R, Tasbakan, M, Tkacova, R, Staats, R, Steiropoulos, P, Varoneckas, G, Verbraecken, J, Lombardi C., Parati G., Soranna D., Zambon A., Sliwinski P., Roisman G., Pepin J. -L., Schiza S., Riha R., Joppa P., Fietze I., Hedner J., Grote L., Anttalainen U., Barbe F., Bonsignore M. R., Basoglu O. K., Bielicki P., Dogas Z., Dorkova Z., Escourrou P., Hein H., Kvamme J. A., Levy P., Marrone O., Masa J. F., McNicholas W. T., Montserrat J. M., Pataka A., Penzel T., Petiet E., Pepin J. L., Plywaczewski R., Pretl M., Riha R. L., Ryan S., Saaresranta T., Schulz R., Tasbakan M. S., Tkacova R., Staats R., Steiropoulos P., Varoneckas G., Verbraecken J., Lombardi, C, Parati, G, Soranna, D, Zambon, A, Sliwinski, P, Roisman, G, Pepin, J, Schiza, S, Riha, R, Joppa, P, Fietze, I, Hedner, J, Grote, L, Anttalainen, U, Barbe, F, Bonsignore, M, Basoglu, O, Bielicki, P, Dogas, Z, Dorkova, Z, Escourrou, P, Hein, H, Kvamme, J, Levy, P, Marrone, O, Masa, J, Mcnicholas, W, Montserrat, J, Pataka, A, Penzel, T, Petiet, E, Plywaczewski, R, Pretl, M, Ryan, S, Saaresranta, T, Schulz, R, Tasbakan, M, Tkacova, R, Staats, R, Steiropoulos, P, Varoneckas, G, Verbraecken, J, Lombardi C., Parati G., Soranna D., Zambon A., Sliwinski P., Roisman G., Pepin J. -L., Schiza S., Riha R., Joppa P., Fietze I., Hedner J., Grote L., Anttalainen U., Barbe F., Bonsignore M. R., Basoglu O. K., Bielicki P., Dogas Z., Dorkova Z., Escourrou P., Hein H., Kvamme J. A., Levy P., Marrone O., Masa J. F., McNicholas W. T., Montserrat J. M., Pataka A., Penzel T., Petiet E., Pepin J. L., Plywaczewski R., Pretl M., Riha R. L., Ryan S., Saaresranta T., Schulz R., Tasbakan M. S., Tkacova R., Staats R., Steiropoulos P., Varoneckas G., and Verbraecken J.

Abstract

Background and objective: OSA and PLMS are known to induce acute BP swings during sleep. Our current study aimed to address the independent effect of PLMS on BP in an unselected OSA patient cohort. Methods: This cross-sectional analysis included 1487 patients (1110 males, no previous hypertension diagnosis or treatment, mean age: 52.5 years, mean BMI: 30.5 kg/m2) with significant OSA (defined as AHI ≥ 10) recruited from the European Sleep Apnoea Cohort. Patients underwent overnight PSG. Patients were stratified into two groups: patients with significant PLMS (PLMSI > 25 events/hour of sleep) and patients without significant PLMS (PLMSI < 25 events/hour of sleep). SBP, DBP and PP were the variables of interest. For each of these, a multivariate regression linear model was fitted to evaluate the relationship between PLMS and outcome adjusting for sociodemographic and clinical covariates (gender, age, BMI, AHI, ESS, diabetes, smoking and sleep efficiency). Results: The univariate analysis of SBP showed an increment of BP equal to 4.70 mm Hg (P < 0.001) in patients with significant PLMS compared to patients without significant PLMS. This increment remained significant after implementing a multivariate regression model (2.64 mm Hg, P = 0.044). No significant increment of BP was observed for DBP and PP. Conclusion: PLMS is associated with a rise in SBP regardless of AHI, independent of clinical and sociodemographic confounders. A PLMS phenotype may carry an increased risk for cardiovascular disease in OSA patients.

Published
2020

14. Obstructive sleep apnoea independently predicts lipid levels: Data from the European Sleep Apnea Database

Author

Gündüz, Canan, Basoglu, Ozen K., Hedner, Jan, Zou, Ding, Bonsignore, Maria R., Hein, Holger, Staats, Richard, Pataka, Athanasia, Barbe, Ferran, Sliwinski, Pavel, Kent, Brian D., Pepin, Jean Lois, Grote, Ludger, Anttalainen, U., Barbé, F., Bonsignore, M. R., Basoglu, O. K., Bielicki, P., Bouloukaki, I., Dogas, Z., Dorkova, Z., Escourrou, P., Fietze, I., Grote, L., Hedner, J., Hein, H., Joppa, P., Kvamme, J. A., Levy, P., Lombardi, C., Marrone, O., Masa, J. F., McNicholas, W. T., Montserrat, J. M., Parati, G., Pataka, A., Penzel, T., Pépin, J. L., Plywaczewski, R., Pretl, M., Riha, R. L., Roisman, G., Ryan, S., Saaresranta, T., Schiza, S., Schulz, R., Sliwinski, P., Pepin, J. L., Petiet, Erna, Tasbakan, M. S., Tkacova, R., Staats, R., Steiropoulos, P., Varoneckas, G., Verbraecken, J., Vitols, A., Gündüz, C, Basoglu, O, Hedner, J, Zou, D, Bonsignore, M, Hein, H, Staats, R, Pataka, A, Barbe, F, Sliwinski, P, Kent, B, Pepin, J, Grote, L, Anttalainen, U, Barbé, F, Bielicki, P, Bouloukaki, I, Dogas, Z, Dorkova, Z, Escourrou, P, Fietze, I, Joppa, P, Kvamme, J, Levy, P, Lombardi, C, Marrone, O, Masa, J, Mcnicholas, W, Montserrat, J, Parati, G, Penzel, T, Pépin, J, Plywaczewski, R, Pretl, M, Riha, R, Roisman, G, Ryan, S, Saaresranta, T, Schiza, S, Schulz, R, Petiet, E, Tasbakan, M, Tkacova, R, Steiropoulos, P, Varoneckas, G, Verbraecken, J, Vitols, A, Gunduz, C, Hender, J, and Lepin, J

Subjects
Male, obesity, Databases, Factual, cholesterol, dyslipidemia, hypoxia, obesity, sleep apnoea, Gastroenterology, Cohort Studies, chemistry.chemical_compound, 0302 clinical medicine, Risk Factors, Hypolipidemic Agents, Oxygen saturation (medicine), Sleep Apnea, Obstructive, medicine.diagnostic_test, Sleep apnea, Middle Aged, Europe, Quartile, Cardiovascular Diseases, Cohort, Female, lipids (amino acids, peptides, and proteins), Adult, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Settore MED/10 - Malattie Dell'Apparato Respiratorio, 03 medical and health sciences, Internal medicine, medicine, Humans, Triglycerides, Dyslipidemias, hypoxia, Cholesterol, business.industry, Cholesterol, HDL, dyslipidemia, cholesterol, Cholesterol, LDL, ta3121, medicine.disease, Obesity, nervous system diseases, respiratory tract diseases, Cross-Sectional Studies, 030228 respiratory system, chemistry, Lipid profile, business, sleep apnoea, 030217 neurology & neurosurgery, Dyslipidemia
Abstract

Background and objective: Obstructive sleep apnoea (OSA) and dyslipidaemia are independent risk factors for cardiovascular disease. This study investigates the association between OSA and plasma lipid concentrations in patients enrolled in the European Sleep Apnea Database (ESADA) cohort. Methods: The cross-sectional analysis included 8592 patients without physician-diagnosed hyperlipidaemia or reported intake of a lipid-lowering drug (age 50.1 ± 12.7 years, 69.1% male, BMI: 30.8 ± 6.6 kg/m2, mean apnoea–hypopnoea index (AHI): 25.7 ± 25.9 events/h). The independent relationship between measures of OSA (AHI, oxygen desaturation index (ODI), mean and lowest oxygen saturation) and lipid profile (total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and fasting triglycerides (TG)) was determined by means of general linear model analysis. Results: There was a dose response relationship between TC and ODI (mean ± SE (mg/dL): 180.33 ± 2.46, 184.59 ± 2.42, 185.44 ± 2.42 and 185.73 ± 2.44; P < 0.001 across ODI quartiles I–IV). TG and LDL concentrations were better predicted by AHI than by ODI. HDL-C was significantly reduced in the highest AHI quartile (mean ± SE (mg/dL): 48.8 ± 1.49 vs 46.50 ± 1.48; P = 0.002, AHI quartile I vs IV). Morbid obesity was associated with lower TC and higher HDL-C values. Lipid status was influenced by geographical location with the highest TC concentration recorded in Northern Europe. Conclusion: OSA severity was independently associated with cholesterol and TG concentrations.

Published
2018

16. EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

Author

Bassetti, C. L. A., primary, Randerath, W., additional, Vignatelli, L., additional, Ferini‐Strambi, L., additional, Brill, A.‐K., additional, Bonsignore, M. R., additional, Grote, L., additional, Jennum, P., additional, Leys, D., additional, Minnerup, J., additional, Nobili, L., additional, Tonia, T., additional, Morgan, R., additional, Kerry, J., additional, Riha, R., additional, McNicholas, W. T., additional, and Papavasileiou, V., additional

Published
2020
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17. Challenges and perspectives in obstructive sleep apnoea

Author

Randerath W., Bassetti C. L., Bonsignore M. R., Farre R., Ferini-Strambi L., Grote L., Hedner J., Kohler M., Martinez-Garcia M. -A., Mihaicuta S., Montserrat J., Pepin J. -L., Pevernagie D., Pizza F., Polo O., Riha R., Ryan S., Verbraecken J., McNicholas W. T., Randerath, W., Bassetti, C. L., Bonsignore, M. R., Farre, R., Ferini-Strambi, L., Grote, L., Hedner, J., Kohler, M., Martinez-Garcia, M. -A., Mihaicuta, S., Montserrat, J., Pepin, J. -L., Pevernagie, D., Pizza, F., Polo, O., Riha, R., Ryan, S., Verbraecken, J., and Mcnicholas, W. T.

Subjects
Europe, Sleep Apnea, Obstructive, Polysomnography, Humans, Comorbidity, Societies, Medical
Abstract

Obstructive sleep apnoea (OSA) is a major challenge for physicians and healthcare systems throughout the world. The high prevalence and the impact on daily life of OSA oblige clinicians to offer effective and acceptable treatment options. However, recent evidence has raised questions about the benefits of positive airway pressure therapy in ameliorating comorbidities. An international expert group considered the current state of knowledge based on the most relevant publications in the previous 5 years, discussed the current challenges in the field, and proposed topics for future research on epidemiology, phenotyping, underlying mechanisms, prognostic implications and optimal treatment of patients with OSA. The group concluded that a revision to the diagnostic criteria for OSA is required to include factors that reflect different clinical and pathophysiological phenotypes and relevant comorbidities (e.g. nondipping nocturnal blood pressure). Furthermore, current severity thresholds require revision to reflect factors such as the disparity in the apnoea–hypopnoea index (AHI) between polysomnography and sleep studies that do not include sleep stage measurements, in addition to the poor correlation between AHI and daytime symptoms such as sleepiness. Management decisions should be linked to the underlying phenotype and consider outcomes beyond AHI.

Published
2018

18. Continuing professional development: introducing the ERS International Certificate in Respiratory Sleep Medicine

Author

Mitchell S., Riha R. L., Rohde C., Simonds A. K., Bonsignore M. R., Cooper B., Penzel T., Randerath W. J., De Backer W., Mitchell S., Riha R.L., Rohde C., Simonds A.K., Bonsignore M.R., Cooper B., Penzel T., Randerath W.J., De Backer W., RS: NUTRIM - R3 - Respiratory & Age-related Health, Pulmonologie, MUMC+: MA Med Staf Spec Longziekten (9), and RS: NUTRIM - R3 - Chronic inflammatory disease and wasting

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, education, Respiratory System, Certification, Settore MED/10 - Malattie Dell'Apparato Respiratorio, Sleep medicine, 03 medical and health sciences, 0302 clinical medicine, medicine, 030212 general & internal medicine, lcsh:RC705-779, Medical education, Science & Technology, business.industry, Editorials, lcsh:Diseases of the respiratory system, Certificate, humanities, Editorial, 030228 respiratory system, Continuing professional development, business, Life Sciences & Biomedicine, Education, respiratory medicine
Abstract

What is the greatest challenge in the delivery of quality care to respiratory disease patients? Is it lack of resources, avoidable harm to patients, or more complex disease presentation? Healthcare delivery has been in the media spotlight in recent months across many countries and the question of how to deliver safe, effective and efficient care to patients remains at the forefront of political agendas at a national level. Education is the passport to the future and the European Respiratory Society (ERS) is in the unique position of being able to work with the most respected respiratory experts internationally in order to design and deliver educational activities to raise standards of training for our respiratory health practitioners., Certification of specialists in respiratory sleep medicine for the purposes of continuing professional development http://ow.ly/4uX9309g3Hs

Published
2017

20. Hyperlipidaemia prevalence and cholesterol control in obstructive sleep apnoea: Data from the European sleep apnea database (ESADA)

Author

Gunduz, C., Basoglu, O. Kacmaz, Hedner, J., Bonsignore, M. R., Hein, H., Staats, R., Bouloukaki, I, Roisman, G., Pataka, A., Sliwinski, P., Ludka, O., Pepin, J. L., Grote, L., Steiropoulos, P., Verbraecken, Johan, Petiet, E., Trakada, G., Montserrat, J. M., Fietze, I, Penzel, T., Ondrej, L., Rodenstein, D., Masa, J. F., Schiza, S., Kent, B., McNicholas, W. T., Ryan, S., Riha, R. L., Kvamme, J. A., Schulz, R., Zou, D., Pepina, J. L., Levy, P., Bailly, S., Lavie, L., Lavie, P., Basoglu, O. K., Tasbakan, M. S., Varoneckas, G., Joppa, P., Tkacova, R., Barbe, F., Lombardi, C., Parati, G., Drummond, M., van Zeller, M., Marrone, O., Petitjean, M., Pretl, M., Vitols, A., Dogas, Z., Galic, T., Anttalainen, U., Saaresranta, T., Plywaczewski, R., Bielicki, P., Gunduz, C, Basoglu, O, Hedner, J, Bonsignore, M, Hein, H, Staats, R, Bouloukaki, I, Roisman, G, Pataka, A, Sliwinski, P, Ludka, O, Pepin, J, Grote, L, Steiropoulos, P, Verbraecken, J, Petiet, E, Trakada, G, Montserrat, J, Fietze, I, Penzel, T, Rodenstein, D, Masa, J, Schiza, S, Kent, B, Mcnicholas, W, Ryan, S, Riha, R, Kvamme, J, Schulz, R, Zou, D, Levy, P, Bailly, S, Lavie, L, Lavie, P, Tasbakan, M, Varoneckas, G, Joppa, P, Tkacova, R, Barbe, F, Lombardi, C, Parati, G, Drummond, M, van Zeller, M, Marrone, O, Petitjean, M, Pretl, M, Vitols, A, Dogas, Z, Galic, T, Anttalainen, U, Saaresranta, T, Plywaczewski, R, Bielicki, P, Tıp Fakültesi, Gunduz C., Basoglu O.K., Hedner J., Bonsignore M.R., Hein H., Staats R., Bouloukaki I., Roisman G., Pataka A., Sliwinski P., Ludka O., Pepin J.L., Grote L., Steiropoulos P., Verbraecken J., Petiet E., Trakada G., Montserrat J.M., Fietze I., Penzel T., Rodenstein D., Masa J.F., Schiza S., Kent B., McNicholas W.T., Ryan S., Riha R.L., Kvamme J.A., Schulz R., Zou D., Levy P., Bailly S., Lavie L., Lavie P., Tasbakan M.S., Varoneckas G., Joppa P., Tkacova R., Barbe F., Lombardi C., Parati G., Drummond M., van Zeller M., Marrone O., Petitjean M., Pretl M., Vitols A., Dogas Z., Galic T., Anttalainen U., Saaresranta T., Plywaczewski R., Bielicki P., SALAS, Danielle, Biruni University [Istanbul] (BU), Ege university, University of Gothenburg (GU), Sahlgrenska University Hospital [Gothenburg], Università degli studi di Palermo - University of Palermo, CNR-IBIM : National Research Council-Institute of Biomedicine and Molecular Immunology, St. Adolf-Stift Hospital [Reinbek, Germany] (SASH), Hospital de Santa Maria [Lisboa], University of Crete [Heraklion] (UOC), AP-HP - Hôpital Antoine Béclère [Clamart], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), General Hospital of Thessaloniki George Papanikolaou, Institute of Tuberculosis and Lung Diseases [Warsaw, Poland] (ITLD), University Hospital Brno, St. Anne’s University Hospital [Brno], Hypoxie et PhysioPathologie (HP2), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA), Centre Hospitalier Universitaire [Grenoble] (CHU), European Sleep Apnoea Database collaborators: P Steiropoulos, J Verbraecken, E Petiet, G Trakada, J M Montserrat, I Fietze, T Penzel, D Rodenstein, J F Masa, S Schiza, B Kent, W T McNicholas, S Ryan, R L Riha, J A Kvamme, R Schulz, D Zou, J L Pépin, P Levy, S Bailly, L Lavie, P Lavie, M S Tasbakan, G Varoneckas, P Joppa, R Tkacova, F Barbé, C Lombardi, G Parati, M Drummond, M van Zeller, O Marrone, M Petitjean, M Pretl, A Vitols, Z Dogas, T Galic, U Anttalainen, T Saaresranta, R Plywaczewski, P Bielicki, and European Sleep Apnoea Database Col

Subjects
Male, 0301 basic medicine, [SDV]Life Sciences [q-bio], Polysomnography, Hyperlipidemias, Settore MED/10 - Malattie Dell'Apparato Respiratorio, 030204 cardiovascular system & hematology, computer.software_genre, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Diabetes mellitus, Prevalence, Internal Medicine, Humans, Medicine, cholesterol, hyperlipidaemia, hypoxia, obesity, sleep apnoea, Obesity, Sleep Apnea, Obstructive, Database, business.industry, Confounding, Sleep apnea, Odds ratio, Middle Aged, medicine.disease, respiratory tract diseases, [SDV] Life Sciences [q-bio], Europe, Cross-Sectional Studies, 030104 developmental biology, Quartile, Cardiovascular Diseases, Cohort, Female, Human medicine, business, Body mass index, computer
Abstract

Gunduz C, Basoglu OK, Hedner J, et al; onbehalf of the European Sleep Apnoea Databasecollaborators (Biruni University; Ege University;Gothenburg University; Sahlgrenska UniversityHospital; University of Palermo; CNR Institute ofBiomedicine and Molecular Immunology; St. AdolfStift; Hospital de Santa Maria; University of Crete;Antoine-Beclere Hospital; G. PapanikolaouHospital; Institute of Tuberculosis and LungDiseases; University Hospital Brno; St. Ann’sUniversity Hospital; Universite ́ Grenoble Alpes)Hyperlipidaemia prevalence and cholesterolcontrol in obstructive sleep apnoea: Data from theEuropean sleep apnea database (ESADA).J InternMed2019;286: 676–688.Background and objective.Obstructive sleep apnoea(OSA) and hyperlipidaemia are independent riskfactors for cardiovascular disease. This studyinvestigates the association between OSA andprevalence of hyperlipidaemia in patients of theEuropean Sleep Apnea Database (ESADA) cohort.Methods.The cross-sectional analysis included11 892 patients (age 51.9 12.5 years, 70% male,body mass index (BMI) 31.3 6.6 kg/m2, meanoxygen desaturation index (ODI) 23.7 25.5events/h) investigated for OSA. The independentodds ratio (OR) for hyperlipidaemia in relation tomeasures of OSA (ODI, apnoea-hypopnoea index,mean and lowest oxygen saturation) was deter-mined by means of general linear model analysiswith adjustment for important confounders suchas age, BMI, comorbidities and study site.Results.Hyperlipidaemia prevalence increased from15.1% in subjects without OSA to 26.1% in thosewith severe OSA,P

Published
2019

21. Cancer prevalence is increased in females with sleep apnoea: data from the ESADA study

Author

Pataka, Athanasia Bonsignore, Maria R. Ryan, Silke Riha, Renata L. Pepin, Jean-Louis Schiza, Sofia Basoglu, Ozen K. and Sliwinski, Pawel Ludka, Ondrej Steiropoulos, Paschalis and Anttalainen, Ulla McNicholas, Walter T. Hedner, Jan Grote, Ludger Steiropoulos, P. Verbraecken, J. Petiet, E. and Trakada, G. Montserrat, J. M. Fietze, I. Penzel, T. and Ludka, O. Rodenstein, D. Masa, J. F. Bouloukaki, I. and Schiza, S. Kent, B. McNicholas, W. T. Ryan, S. Riha, R. L. Kvamme, J. A. Schulz, R. Grote, L. Hedner, J. and Pepin, J-L. Levy, P. Lavie, L. Lavie, P. Hein, H. and Basoglu, O. K. Tasbakan, M. S. Varoneckas, G. Joppa, P. and Safarik, P. J. Tkacova, R. Staats, R. Barbe, F. and Lombardi, C. Parati, G. Drummond, M. van Zeller, M. and Bonsignore, M. R. Marrone, O. Escourrou, P. Roisman, G. and Pretl, M. Vitols, A. Dogas, Z. Galic, T. Pataka, A. and Anttalainen, U. Saaresranta, T. Sliwinski, P. Plywaczewski, R. Bielicki, P. ESADA Study Grp

Published
2019

23. Comment to the editorial by KS Park and EW Kang “Is only fixed positive airway pressure a robust tool for kidney protection in patients with obstructive sleep apnea?”

Author

Marrone, O, Cibella, F, Pepin, J, Grote, L, Verbraecken, J, Saaresranta, T, Kvamme, J, Basoglu, O, Lombardi, C, Mcnicholas, W, Hedner, J, Bonsignore, M, Marrone O., Cibella F., Pepin J. -L., Grote L., Verbraecken J., Saaresranta T., Kvamme J. A., Basoglu O. K., Lombardi C., McNicholas W. T., Hedner J., Bonsignore M. R., Marrone, O, Cibella, F, Pepin, J, Grote, L, Verbraecken, J, Saaresranta, T, Kvamme, J, Basoglu, O, Lombardi, C, Mcnicholas, W, Hedner, J, Bonsignore, M, Marrone O., Cibella F., Pepin J. -L., Grote L., Verbraecken J., Saaresranta T., Kvamme J. A., Basoglu O. K., Lombardi C., McNicholas W. T., Hedner J., and Bonsignore M. R.

Published
2019

24. Use of the Clinical Global Impression scale in sleep apnea patients – Results from the ESADA database

Author

Dieltjens, M, Verbraecken, J, Hedner, J, Vanderveken, O, Steiropoulos, P, Kvamme, J, Saaresranta, T, Tkacova, R, Marrone, O, Dogas, Z, Schiza, S, Grote, L, Petiet, E, Trakada, G, Montserrat, J, Fietze, I, Penzel, T, Ludka, O, Rodenstein, D, Masa, J, Bouloukaki, I, Kent, B, Mcnicholas, W, Ryan, S, Riha, R, Schulz, R, Zou, D, Pepin, J, Levy, P, Bailly, S, Lavie, L, Lavie, P, Hein, H, Basoglu, O, Tasbakan, M, Varoneckas, G, Joppa, P, Staats, R, Barbe, F, Lombardi, C, Parati, G, Drummond, M, van Zeller, M, Bonsignore, M, Escourrou, P, Roisman, G, Pretl, M, Vitols, A, Galic, T, Pataka, A, Anttalainen, U, Sliwinski, P, Plywaczewski, R, Bielicki, P, Zielinski, J, Dieltjens M., Verbraecken J. A., Hedner J., Vanderveken O. M., Steiropoulos P., Kvamme J. A., Saaresranta T., Tkacova R., Marrone O., Dogas Z., Schiza S., Grote L., Verbraecken J., Petiet E., Trakada G., Montserrat J. M., Fietze I., Penzel T., Ludka O., Rodenstein D., Masa J. F., Bouloukaki I., Kent B., McNicholas W. T., Ryan S., Riha R. L., Schulz R., Zou D., Pepin J. L., Levy P., Bailly S., Lavie L., Lavie P., Hein H., Basoglu O. K., Tasbakan M. S., Varoneckas G., Joppa P., Staats R., Barbe F., Lombardi C., Parati G., Drummond M., van Zeller M., Bonsignore M. R., Escourrou P., Roisman G., Pretl M., Vitols A., Galic T., Pataka A., Anttalainen U., Sliwinski P., Plywaczewski R., Bielicki P., Zielinski J., Dieltjens, M, Verbraecken, J, Hedner, J, Vanderveken, O, Steiropoulos, P, Kvamme, J, Saaresranta, T, Tkacova, R, Marrone, O, Dogas, Z, Schiza, S, Grote, L, Petiet, E, Trakada, G, Montserrat, J, Fietze, I, Penzel, T, Ludka, O, Rodenstein, D, Masa, J, Bouloukaki, I, Kent, B, Mcnicholas, W, Ryan, S, Riha, R, Schulz, R, Zou, D, Pepin, J, Levy, P, Bailly, S, Lavie, L, Lavie, P, Hein, H, Basoglu, O, Tasbakan, M, Varoneckas, G, Joppa, P, Staats, R, Barbe, F, Lombardi, C, Parati, G, Drummond, M, van Zeller, M, Bonsignore, M, Escourrou, P, Roisman, G, Pretl, M, Vitols, A, Galic, T, Pataka, A, Anttalainen, U, Sliwinski, P, Plywaczewski, R, Bielicki, P, Zielinski, J, Dieltjens M., Verbraecken J. A., Hedner J., Vanderveken O. M., Steiropoulos P., Kvamme J. A., Saaresranta T., Tkacova R., Marrone O., Dogas Z., Schiza S., Grote L., Verbraecken J., Petiet E., Trakada G., Montserrat J. M., Fietze I., Penzel T., Ludka O., Rodenstein D., Masa J. F., Bouloukaki I., Kent B., McNicholas W. T., Ryan S., Riha R. L., Schulz R., Zou D., Pepin J. L., Levy P., Bailly S., Lavie L., Lavie P., Hein H., Basoglu O. K., Tasbakan M. S., Varoneckas G., Joppa P., Staats R., Barbe F., Lombardi C., Parati G., Drummond M., van Zeller M., Bonsignore M. R., Escourrou P., Roisman G., Pretl M., Vitols A., Galic T., Pataka A., Anttalainen U., Sliwinski P., Plywaczewski R., Bielicki P., and Zielinski J.

Abstract

Objective/Background: The Clinical Global Impression scale (CGI) reflects the clinician's assessment of the disease impact on patient's global functioning. We assessed predictors of CGI scale rating in patients with obstructive sleep apnea (OSA). Patients/Methods: Consecutive patients with suspected OSA (n = 7581) were identified in the European Sleep Apnea Database (ESADA). Anthropometrics, comorbidities, apnea severity obtained by polygraphy or polysomnography, and daytime sleepiness [Epworth Sleepiness Scale (ESS)] were assessed. The CGI 7-point scale was completed at the end of the diagnostic process (CGI-severity, ie, CGI-S) and, in a subpopulation, at treatment follow-up (CGI-Improvement). Results: CGI-S was rated mild to moderate in 44% of patients. CGI rating at any given apnea intensity was worse in women than in men (p < 0.01). Patients undergoing polygraphy (n = 5075) were more frequently rated as severely ill compared to those studied with polysomnography (19.0% vs 13.0%, p < 0.001). In patients aged ≤65 years, CGI scoring was generally better than in the elderly despite a similar degree of OSA (eg, ‘normal, not ill’ 24.2% vs 15.3%, p < 0.01, respectively). Independent predictors of CGI rating included age, BMI, AHI, ESS, cardio-metabolic comorbidities, and diagnosis based on polygraphy. CGI-improvement rating (Beta = −0.406, p < 0.01) was superior to sleep apnea severity or ESS-score (Beta = 0.052 and −0.021, p = 0.154 and 0.538 respectively) at baseline for prediction of good CPAP compliance at follow-up. Conclusions: CGI rating is confounded by gender, age class and the type of sleep diagnostic method. As OSA phenotypes differ, CGI may contribute as a clinical tool to reflect the significance of clinical disease.

Published
2019

25. Hyperlipidaemia prevalence and cholesterol control in obstructive sleep apnoea: Data from the European sleep apnea database (ESADA)

Author

Gunduz, C, Basoglu, O, Hedner, J, Bonsignore, M, Hein, H, Staats, R, Bouloukaki, I, Roisman, G, Pataka, A, Sliwinski, P, Ludka, O, Pepin, J, Grote, L, Steiropoulos, P, Verbraecken, J, Petiet, E, Trakada, G, Montserrat, J, Fietze, I, Penzel, T, Rodenstein, D, Masa, J, Schiza, S, Kent, B, Mcnicholas, W, Ryan, S, Riha, R, Kvamme, J, Schulz, R, Zou, D, Levy, P, Bailly, S, Lavie, L, Lavie, P, Tasbakan, M, Varoneckas, G, Joppa, P, Tkacova, R, Barbe, F, Lombardi, C, Parati, G, Drummond, M, van Zeller, M, Marrone, O, Petitjean, M, Pretl, M, Vitols, A, Dogas, Z, Galic, T, Anttalainen, U, Saaresranta, T, Plywaczewski, R, Bielicki, P, Gunduz C., Basoglu O. K., Hedner J., Bonsignore M. R., Hein H., Staats R., Bouloukaki I., Roisman G., Pataka A., Sliwinski P., Ludka O., Pepin J. L., Grote L., Steiropoulos P., Verbraecken J., Petiet E., Trakada G., Montserrat J. M., Fietze I., Penzel T., Rodenstein D., Masa J. F., Schiza S., Kent B., McNicholas W. T., Ryan S., Riha R. L., Kvamme J. A., Schulz R., Zou D., Levy P., Bailly S., Lavie L., Lavie P., Tasbakan M. S., Varoneckas G., Joppa P., Tkacova R., Barbe F., Lombardi C., Parati G., Drummond M., van Zeller M., Marrone O., Petitjean M., Pretl M., Vitols A., Dogas Z., Galic T., Anttalainen U., Saaresranta T., Plywaczewski R., Bielicki P., Gunduz, C, Basoglu, O, Hedner, J, Bonsignore, M, Hein, H, Staats, R, Bouloukaki, I, Roisman, G, Pataka, A, Sliwinski, P, Ludka, O, Pepin, J, Grote, L, Steiropoulos, P, Verbraecken, J, Petiet, E, Trakada, G, Montserrat, J, Fietze, I, Penzel, T, Rodenstein, D, Masa, J, Schiza, S, Kent, B, Mcnicholas, W, Ryan, S, Riha, R, Kvamme, J, Schulz, R, Zou, D, Levy, P, Bailly, S, Lavie, L, Lavie, P, Tasbakan, M, Varoneckas, G, Joppa, P, Tkacova, R, Barbe, F, Lombardi, C, Parati, G, Drummond, M, van Zeller, M, Marrone, O, Petitjean, M, Pretl, M, Vitols, A, Dogas, Z, Galic, T, Anttalainen, U, Saaresranta, T, Plywaczewski, R, Bielicki, P, Gunduz C., Basoglu O. K., Hedner J., Bonsignore M. R., Hein H., Staats R., Bouloukaki I., Roisman G., Pataka A., Sliwinski P., Ludka O., Pepin J. L., Grote L., Steiropoulos P., Verbraecken J., Petiet E., Trakada G., Montserrat J. M., Fietze I., Penzel T., Rodenstein D., Masa J. F., Schiza S., Kent B., McNicholas W. T., Ryan S., Riha R. L., Kvamme J. A., Schulz R., Zou D., Levy P., Bailly S., Lavie L., Lavie P., Tasbakan M. S., Varoneckas G., Joppa P., Tkacova R., Barbe F., Lombardi C., Parati G., Drummond M., van Zeller M., Marrone O., Petitjean M., Pretl M., Vitols A., Dogas Z., Galic T., Anttalainen U., Saaresranta T., Plywaczewski R., and Bielicki P.

Abstract

Background and objective: Obstructive sleep apnoea (OSA) and hyperlipidaemia are independent risk factors for cardiovascular disease. This study investigates the association between OSA and prevalence of hyperlipidaemia in patients of the European Sleep Apnea Database (ESADA) cohort. Methods: The cross-sectional analysis included 11 892 patients (age 51.9 ± 12.5 years, 70% male, body mass index (BMI) 31.3 ± 6.6 kg/m2, mean oxygen desaturation index (ODI) 23.7 ± 25.5 events/h) investigated for OSA. The independent odds ratio (OR) for hyperlipidaemia in relation to measures of OSA (ODI, apnoea-hypopnoea index, mean and lowest oxygen saturation) was determined by means of general linear model analysis with adjustment for important confounders such as age, BMI, comorbidities and study site. Results: Hyperlipidaemia prevalence increased from 15.1% in subjects without OSA to 26.1% in those with severe OSA, P < 0.001. Corresponding numbers in patients with diabetes were 8.5% and 41.5%, P < 0.001. Compared with ODI quartile I, patients in ODI quartiles II-IV had an adjusted OR (95% CI) of 1.33 (1.15–1.55), 1.37 (1.17–1.61) and 1.33 (1.12–1.58) (P < 0.001), respectively, for hyperlipidaemia. Obesity was defined as a significant risk factor for hyperlipidaemia. Subgroups of OSA patients with cardio-metabolic comorbidities demonstrated higher prevalence of HL. In addition, differences in hyperlipidaemia prevalence were reported in European geographical regions with the highest prevalence in Central Europe. Conclusion: Obstructive sleep apnoea, in particular intermittent hypoxia, was independently associated with the prevalence of hyperlipidaemia diagnosis.

Published
2019

26. Insomnia symptoms combined with nocturnal hypoxia associate with cardiovascular comorbidity in the European sleep apnea cohort (ESADA)

Author

Anttalainen, U, Grote, L, Fietze, I, Riha, R, Ryan, S, Staats, R, Hedner, J, Saaresranta, T, Barbe, F, Bonsignore, M, Basoglu, O, Bielicki, P, Bouloukaki, I, Dogas, Z, Dorkova, Z, Escourrou, P, Esquinas, C, Hayes, L, Joppa, P, Kurki, S, Kvamme, J, Tamisier, R, Lombardi, C, Marrone, O, Mcnicholas, W, Montserrat, J, Parati, G, Pataka, A, Penzel, T, Pepin, J, Pretl, M, Roisman, G, Schiza, S, Schulz, R, Sliwinski, P, Tasbakan, M, Tkacova, R, Varoneckas, G, Verbraecken, J, Vrints, H, Anttalainen U., Grote L., Fietze I., Riha R. L., Ryan S., Staats R., Hedner J., Saaresranta T., Barbe F., Bonsignore M. R., Basoglu O., Bielicki P., Bouloukaki I., Dogas Z., Dorkova Z., Escourrou P., Esquinas C., Hayes L., Joppa P., Kurki S., Kvamme J. A., Tamisier R., Lombardi C., Marrone O., McNicholas W. T., Montserrat J. M., Parati G., Pataka A., Penzel T., Pepin J. L., Pretl M., Roisman G., Schiza S. E., Schulz R., Sliwinski P., Tasbakan M. S., Tkacova R., Varoneckas G., Verbraecken J., Vrints H., Anttalainen, U, Grote, L, Fietze, I, Riha, R, Ryan, S, Staats, R, Hedner, J, Saaresranta, T, Barbe, F, Bonsignore, M, Basoglu, O, Bielicki, P, Bouloukaki, I, Dogas, Z, Dorkova, Z, Escourrou, P, Esquinas, C, Hayes, L, Joppa, P, Kurki, S, Kvamme, J, Tamisier, R, Lombardi, C, Marrone, O, Mcnicholas, W, Montserrat, J, Parati, G, Pataka, A, Penzel, T, Pepin, J, Pretl, M, Roisman, G, Schiza, S, Schulz, R, Sliwinski, P, Tasbakan, M, Tkacova, R, Varoneckas, G, Verbraecken, J, Vrints, H, Anttalainen U., Grote L., Fietze I., Riha R. L., Ryan S., Staats R., Hedner J., Saaresranta T., Barbe F., Bonsignore M. R., Basoglu O., Bielicki P., Bouloukaki I., Dogas Z., Dorkova Z., Escourrou P., Esquinas C., Hayes L., Joppa P., Kurki S., Kvamme J. A., Tamisier R., Lombardi C., Marrone O., McNicholas W. T., Montserrat J. M., Parati G., Pataka A., Penzel T., Pepin J. L., Pretl M., Roisman G., Schiza S. E., Schulz R., Sliwinski P., Tasbakan M. S., Tkacova R., Varoneckas G., Verbraecken J., and Vrints H.

Abstract

Purpose: The aim of the current study was to further investigate the concept of previously reported high occurrence of comorbidities in obstructive sleep patients (OSA) with insomnia-like symptoms. We hypothesized that this finding at least partly is mediated by nocturnal hypoxia. Moreover, we speculated that the spectrum of the clinical OSA phenotypes differs between European geographical regions. Methods: Cohort of the European Sleep Apnea Database (n = 17,325; 29.9% females) was divided into five subcohorts according to geographical region (North, East, South, West, Central) and further into four clinical presentation phenotypes based on daytime symptoms (EDS) and characteristics suggestive of insomnia. Results: The insomnia phenotype (alone or together with EDS) dominated in all European regions. Isolated insomnia, however, was less common in the West. Insomnia phenotype was associated with the highest proportion of cardiovascular comorbidity (51.7% in the insomnia vs. 43.9% in the EDS type). Measures of nocturnal hypoxemia were independently associated with cardiovascular comorbidity in phenotypes with insomnia-like symptoms. The burden of comorbidities was high across all geographical regions and clinical phenotypes. Regional differences were clinically relevant for age (48 vs. 54 years), BMI (29 vs. 34 kg/m2), and ODI (15 vs. 32/h). Conclusion: High prevalence of particularly cardiovascular comorbidity among patients with insomnia-like symptoms was linked to nocturnal hypoxemia. Considerable differences in clinical presentation were found among OSA patients across Europe. Our data underline that physicians should ask their patients with suspected OSA also for insomnia symptoms. It remains to be explored if a reduction of nocturnal hypoxemia predicts the improvement of insomnia symptoms.

Published
2019

28. Obstructive sleep apnoea independently predicts lipid levels: Data from the European Sleep Apnea Database

Author

Gündüz, C, Basoglu, O, Hedner, J, Zou, D, Bonsignore, M, Hein, H, Staats, R, Pataka, A, Barbe, F, Sliwinski, P, Kent, B, Pepin, J, Grote, L, Anttalainen, U, Barbé, F, Bielicki, P, Bouloukaki, I, Dogas, Z, Dorkova, Z, Escourrou, P, Fietze, I, Joppa, P, Kvamme, J, Levy, P, Lombardi, C, Marrone, O, Masa, J, Mcnicholas, W, Montserrat, J, Parati, G, Penzel, T, Pépin, J, Plywaczewski, R, Pretl, M, Riha, R, Roisman, G, Ryan, S, Saaresranta, T, Schiza, S, Schulz, R, Petiet, E, Tasbakan, M, Tkacova, R, Steiropoulos, P, Varoneckas, G, Verbraecken, J, Vitols, A, Gündüz, Canan, Basoglu, Ozen K., Hedner, Jan, Zou, Ding, Bonsignore, Maria R., Hein, Holger, Staats, Richard, Pataka, Athanasia, Barbe, Ferran, Sliwinski, Pavel, Kent, Brian D., Pepin, Jean Lois, Grote, Ludger, Anttalainen, U., Barbé, F., Bonsignore, M. R., Basoglu, O. K., Bielicki, P., Bouloukaki, I., Dogas, Z., Dorkova, Z., Escourrou, P., Fietze, I., Grote, L., Hedner, J., Hein, H., Joppa, P., Kvamme, J. A., Levy, P., Lombardi, C., Marrone, O., Masa, J. F., McNicholas, W. T., Montserrat, J. M., Parati, G., Pataka, A., Penzel, T., Pépin, J. L., Plywaczewski, R., Pretl, M., Riha, R. L., Roisman, G., Ryan, S., Saaresranta, T., Schiza, S., Schulz, R., Sliwinski, P., Pepin, J. L., Petiet, Erna, Tasbakan, M. S., Tkacova, R., Staats, R., Steiropoulos, P., Varoneckas, G., Verbraecken, J., Vitols, A., Gündüz, C, Basoglu, O, Hedner, J, Zou, D, Bonsignore, M, Hein, H, Staats, R, Pataka, A, Barbe, F, Sliwinski, P, Kent, B, Pepin, J, Grote, L, Anttalainen, U, Barbé, F, Bielicki, P, Bouloukaki, I, Dogas, Z, Dorkova, Z, Escourrou, P, Fietze, I, Joppa, P, Kvamme, J, Levy, P, Lombardi, C, Marrone, O, Masa, J, Mcnicholas, W, Montserrat, J, Parati, G, Penzel, T, Pépin, J, Plywaczewski, R, Pretl, M, Riha, R, Roisman, G, Ryan, S, Saaresranta, T, Schiza, S, Schulz, R, Petiet, E, Tasbakan, M, Tkacova, R, Steiropoulos, P, Varoneckas, G, Verbraecken, J, Vitols, A, Gündüz, Canan, Basoglu, Ozen K., Hedner, Jan, Zou, Ding, Bonsignore, Maria R., Hein, Holger, Staats, Richard, Pataka, Athanasia, Barbe, Ferran, Sliwinski, Pavel, Kent, Brian D., Pepin, Jean Lois, Grote, Ludger, Anttalainen, U., Barbé, F., Bonsignore, M. R., Basoglu, O. K., Bielicki, P., Bouloukaki, I., Dogas, Z., Dorkova, Z., Escourrou, P., Fietze, I., Grote, L., Hedner, J., Hein, H., Joppa, P., Kvamme, J. A., Levy, P., Lombardi, C., Marrone, O., Masa, J. F., McNicholas, W. T., Montserrat, J. M., Parati, G., Pataka, A., Penzel, T., Pépin, J. L., Plywaczewski, R., Pretl, M., Riha, R. L., Roisman, G., Ryan, S., Saaresranta, T., Schiza, S., Schulz, R., Sliwinski, P., Pepin, J. L., Petiet, Erna, Tasbakan, M. S., Tkacova, R., Staats, R., Steiropoulos, P., Varoneckas, G., Verbraecken, J., and Vitols, A.

Abstract

Background and objective: Obstructive sleep apnoea (OSA) and dyslipidaemia are independent risk factors for cardiovascular disease. This study investigates the association between OSA and plasma lipid concentrations in patients enrolled in the European Sleep Apnea Database (ESADA) cohort. Methods: The cross-sectional analysis included 8592 patients without physician-diagnosed hyperlipidaemia or reported intake of a lipid-lowering drug (age 50.1 ± 12.7 years, 69.1% male, BMI: 30.8 ± 6.6 kg/m2, mean apnoea–hypopnoea index (AHI): 25.7 ± 25.9 events/h). The independent relationship between measures of OSA (AHI, oxygen desaturation index (ODI), mean and lowest oxygen saturation) and lipid profile (total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and fasting triglycerides (TG)) was determined by means of general linear model analysis. Results: There was a dose response relationship between TC and ODI (mean ± SE (mg/dL): 180.33 ± 2.46, 184.59 ± 2.42, 185.44 ± 2.42 and 185.73 ± 2.44; P < 0.001 across ODI quartiles I–IV). TG and LDL concentrations were better predicted by AHI than by ODI. HDL-C was significantly reduced in the highest AHI quartile (mean ± SE (mg/dL): 48.8 ± 1.49 vs 46.50 ± 1.48; P = 0.002, AHI quartile I vs IV). Morbid obesity was associated with lower TC and higher HDL-C values. Lipid status was influenced by geographical location with the highest TC concentration recorded in Northern Europe. Conclusion: OSA severity was independently associated with cholesterol and TG concentrations.

Published
2018

31. Cancer prevalence is increased in females with sleep apnoea: data from the ESADA study

Author

Pataka, Athanasia, Bonsignore, Maria R., Ryan, Silke, Riha, Renata L., Pepin, Jean-Louis, Schiza, Sofia, Basoglu, Ozen K., Sliwinski, Pawel, Ludka, Ondrej, Steiropoulos, Paschalis, Anttalainen, Ulla, McNicholas, Walter T., Hedner, Jan, Grote, Ludger, Steiropoulos, P., Verbraecken, Johan, Petiet, E., Trakada, G., Montserrat, J. M., Fietze, I., Penzel, T., Ludka, O., Rodenstein, D., Masa, J. F., Bouloukaki, I., Schiza, S., Kent, B., McNicholas, W. T., Ryan, S., Riha, R. L., Kvamme, J. A., Schulz, R., Grote, L., Hedner, J., Pepin, J-L., Levy, P., Lavie, L., Lavie, P., Hein, H., Basoglu, O. K., Tasbakan, M. S., Varoneckas, G., Joppa, P., Safarik, P. J., Tkacova, R., Staats, R., Barbe, F., Lombardi, C., Parati, G., Drummond, M., van Zeller, M., Bonsignore, M. R., Marrone, O., Escourrou, P., Roisman, G., Pretl, M., Vitols, A., Dogas, Z., Galic, T., Pataka, A., Anttalainen, U., Saaresranta, T., Sliwinski, P., Plywaczewski, R., Bielicki, P., ESADA Study Grp, Pataka A., Bonsignore M.R., Ryan S., Riha R.L., Pepin J.-L., Schiza S., Basoglu O.K., Sliwinski P., Ludka O., Steiropoulos P., Anttalainen U., McNicholas W.T., Hedner J., Grote L., Aristotle University of Thessaloniki, Università degli studi di Palermo - University of Palermo, University College Dublin [Dublin] (UCD), Royal Infirmary of Edinburgh, Hypoxie et PhysioPathologie (HP2), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA), Centre Hospitalier Universitaire [Grenoble] (CHU), University of Crete [Heraklion] (UOC), Ege university, National Institute of Tuberculosis and Lung Diseases, St. Anne’s University Hospital [Brno], Democritus University of Thrace (DUTH), University of Turku, Sahlgrenska University Hospital [Gothenburg], University of Gothenburg (GU), ESADA study group: P Steiropoulos, J Verbraecken, E Petiet, G Trakada, J M Montserrat, I Fietze, T Penzel, O Ludka, D Rodenstein, J F Masa, I Bouloukaki, S Schiza, B Kent, W T McNicholas, S Ryan, R L Riha, J A Kvamme, R Schulz, L Grote, J Hedner, J L Pepin, P Levy, L Lavie, P Lavie, H Hein, O K Basoglu, M S Tasbakan, G Varoneckas, P Joppa, R Tkacova, R Staats, F Barbe, C Lombardi, G Parati, M Drummond, M van Zeller, M R Bonsignore, O Marrone, P Escourrou, G Roisman, M Pretl, A Vitols, Z Dogas, T Galic, A Pataka, U Anttalainen, T Saaresranta, P Sliwinski, R Plywaczewski, P Bielicki, and SALAS, Danielle

Subjects
Male, obesity, Letter, Databases, Factual, Download, [SDV]Life Sciences [q-bio], cigarette smoking, Polysomnography, cancer risk, disease burden, apnea hypopnea index, sleep disordered breathing, study design, 0302 clinical medicine, polysomnography, Risk Factors, Nothing, cancer diagnosis, Neoplasms, middle aged, gender, Prevalence, 030212 general & internal medicine, Sleep study, obstructive sleep apnea, Sleep Apnea, Obstructive, education.field_of_study, anthropometry, quantitative analysis, medicine.diagnostic_test, adult, risk assessment, clinical trial, cohort analysis, prostate cancer, pulse oximetry, [SDV] Life Sciences [q-bio], Europe, not available, comorbidity, aged, female, waist hip ratio, colon cancer, priority journal, risk factor, factual database, disease severity, cerebrovascular accident, Pulmonary and Respiratory Medicine, medicine.medical_specialty, alcohol consumption, intermittent hypoxia, Population, MEDLINE, lymphoma, Settore MED/10 - Malattie Dell'Apparato Respiratorio, malignant neoplasm, cancer growth, 03 medical and health sciences, melanoma, medicine, cancer, cross-sectional study, Humans, controlled study, human, education, Cancer prevalence, hypoxia, business.industry, statistical model, Conflict of interest, prediction, major clinical study, body mass, oxygen saturation, lung cancer, multicenter study, Cross-Sectional Studies, Logistic Models, age, 030228 respiratory system, disease severity assessment, Family medicine, oxygen desaturation index, head and neck cancer, Human medicine, business, neoplasm
Abstract

[No abstract available], ResMed Foundation; Philips; European Respiratory Society, ERS; Fondation Air Liquide, Conflict of interest: A. Pataka has nothing to disclose. M.R. Bonsignore has nothing to disclose. S. Ryan has nothing to disclose. R.L. Riha has nothing to disclose. J-L. Pepin reports grants and research funds from Air Liquide Foundation, Agiradom, AstraZeneca, Fisher and Paykel, Mutualia, Philips, Resmed and Vitalaire, personal fees from Agiradom, AstraZeneca, Boehringer Ingelheim, Jazz Pharmaceutical, Night Balance, Philips, Resmed and Sefam. S. Schiza has nothing to disclose. O.K. Basoglu has nothing to disclose. P. Sliwinski has nothing to disclose. O. Ludka has nothing to disclose. P. Steiropoulos has nothing to disclose. U. Anttalainen has nothing to disclose. W.T. McNicholas has nothing to disclose. J. Hedner reports grants from ResMed Foundation, Philips Respironics and the European Respiratory Society, for start-up and conduct of the study. L. Grote reports grants from Resmed Foundation and Respironics Foundation, during the conduct of the study; personal fees for lecturing from Resmed, Philips and Itamar, grants from Resmed, other (equipment) from Itamar, outside the submitted work; in addition, L. Grote has a patent for sleep apnoea treatment pending., Support statement: The ESADA network has received support from the European Union COST action B26 and is currently a Clinical Research Collaboration funded by the European Respiratory Society. Additionally, the ESADA study group has received unrestricted seeding grants from the ResMed and the Philips Respironics Foundation for the establishment of the database in 2007 and 2011. The ESADA has an ongoing collaboration with Bayer AG. Non-financial support was provided by the European Sleep Research Society and the European Respiratory Society for communication, meetings and data presentations for the ESADA collaborators.

Published
2019

34. Clinical phenotypes and comorbidity in European sleep apnoea patients

Author

Saaresranta T., Hedner J., Bonsignore M. R., Riha R. L., McNicholas W. T., Penzel T., Anttalainen U., Kvamme J. A., Pretl M., Sliwinski P., Verbraecken J., Grote L., Barbe F., Basoglu B., Bielicki P., Dorkova Z., Escourrou P., Fietze I., Esquinas C., Hayes L., Kumor M., Kurki S., Lavie L., Lavie P., Levy P., Lombardi C., Marrone O., Masa J. F., Montserrat J. M., Parati G., Pataka A., Pepin J. L., Plywaczewski R., Rodenstein D., Roisman G., Ryan S., Schulz R., Tkacova R., Staats R., Steiropoulos P., Varoneckas G., Vitols A., Vrints H., Zielinski J., Saaresranta, T, Hedner, J, Bonsignore, M, Riha, R, Mcnicholas, W, Penzel, T, Anttalainen, U, Kvamme, J, Pretl, M, Sliwinski, P, Verbraecken, J, Grote, L, Barbe, F, Basoglu, B, Bielicki, P, Dorkova, Z, Escourrou, P, Fietze, I, Esquinas, C, Hayes, L, Kumor, M, Kurki, S, Lavie, L, Lavie, P, Levy, P, Lombardi, C, Marrone, O, Masa, J, Montserrat, J, Parati, G, Pataka, A, Pepin, J, Plywaczewski, R, Rodenstein, D, Roisman, G, Ryan, S, Schulz, R, Tkacova, R, Staats, R, Steiropoulos, P, Varoneckas, G, Vitols, A, Vrints, H, Zielinski, J, ESADA Study Group, Ege Üniversitesi, ESADA Study Grp, UCL - SSS/IREC/PNEU - Pôle de Pneumologie, ORL et Dermatologie, UCL - (SLuc) Service de pneumologie, Saaresranta, T., Hedner, J., Bonsignore, M., Riha, R., Mcnicholas, W., Penzel, T., Anttalainen, U., Kvamme, J., Pretl, M., Sliwinski, P., Verbraecken, J., Grote, L., Barbé, F., Basoglu, B., Bielicki, P., Dorkova, Z., Escourrou, P., Fietze, I., Esquinas, C., Hayes, L., Kumor, M., Kurki, S., Lavie, L., Lavie, P., Levy, P., Lombardi, C., Marrone, O., Masa, J., Montserrat, J., Parati, G., Pataka, A., Pépin, J., Plywaczewski, R., Rodenstein, D., Roisman, G., Ryan, S., Schulz, R., Tkacova, R., Staats, R., Steiropoulos, P., Varoneckas, G., Vitols, A., Vrints, H., and Zielinski, J.

Subjects
Male, Pulmonology, Physiology, Apnea, medicine.medical_treatment, lcsh:Medicine, Comorbidity, Polysomnography, Cardiovascular Medicine, Medicine (all), Biochemistry, Genetics and Molecular Biology (all), Agricultural and Biological Sciences (all), THERAPY, Body Mass Index, 0302 clinical medicine, Risk Factors, Positive airway pressure, Medicine and Health Sciences, Insomnia, Medicine, Prospective Studies, Continuous positive airway pressure, lcsh:Science, Prospective cohort study, Clinical Neurophysiology, Aged, 80 and over, Hypersomnia, Multidisciplinary, medicine.diagnostic_test, Sleep apnea, Middle Aged, DEPRESSION, PREVALENCE, ComputingMilieux_MANAGEMENTOFCOMPUTINGANDINFORMATIONSYSTEMS, Phenotype, Neurology, Physiological Parameters, Cardiovascular Diseases, CARDIOVASCULAR-DISEASE, Female, InformationSystems_MISCELLANEOUS, medicine.symptom, Engineering sciences. Technology, Hypopnea, INSOMNIA SYMPTOMS, Research Article, Adult, medicine.medical_specialty, Sleep Apnea, Adolescent, POSITIVE AIRWAY PRESSURE, Settore MED/10 - Malattie Dell'Apparato Respiratorio, White People, Young Adult, 03 medical and health sciences, Sleep Apnea Syndromes, DAYTIME, stomatognathic system, Comorbiditat, Diagnostic Medicine, Internal medicine, mental disorders, Humans, COMMON, Aged, HYPOPNEA, HYPERTENSION, business.industry, lcsh:R, Body Weight, ComputerSystemsOrganization_COMPUTER-COMMUNICATIONNETWORKS, Biology and Life Sciences, ta3121, medicine.disease, Dyssomnias, respiratory tract diseases, nervous system diseases, ComputingMethodologies_PATTERNRECOGNITION, 030228 respiratory system, Physical therapy, lcsh:Q, Sleep Disorders, Physiological Processes, Sleep, business, 030217 neurology & neurosurgery, Follow-Up Studies
Abstract

PubMed ID: 27701416, Background Clinical presentation phenotypes of obstructive sleep apnoea (OSA) and their association with comorbidity as well as impact on adherence to continuous positive airway pressure (CPAP) treatment have not been established. Methods A prospective follow-up cohort of adult patients with OSA (apnoea-hypopnoea index (AHI) of ?5/h) from 17 European countries and Israel (n = 6,555) was divided into four clinical presentation phenotypes based on daytime symptoms labelled as excessive daytime sleepiness ("EDS") and nocturnal sleep problems other than OSA (labelled as "insomnia"): 1) EDS (daytime+/nighttime-), 2) EDS/insomnia (daytime+/nighttime+), 3) non-EDS/noninsomnia (daytime-/nighttime-), 4) and insomnia (daytime-/nighttime+) phenotype. Results The EDS phenotype comprised 20.7%, the non-EDS/non-insomnia type 25.8%, the EDS/ insomnia type 23.7%, and the insomnia phenotype 29.8% of the entire cohort. Thus, clinical presentation phenotypes with insomnia symptoms were dominant with 53.5%, but only 5.6% had physician diagnosed insomnia. Cardiovascular comorbidity was less prevalent in the EDS and most common in the insomnia phenotype (48.9% vs. 56.8%, p

Published
2016

35. Clinical phenotypes and comorbidity in European sleep apnoea patients

Author

Saaresranta, T, Hedner, J, Bonsignore, M, Riha, R, Mcnicholas, W, Penzel, T, Anttalainen, U, Kvamme, J, Pretl, M, Sliwinski, P, Verbraecken, J, Grote, L, Barbe, F, Basoglu, B, Bielicki, P, Dorkova, Z, Escourrou, P, Fietze, I, Esquinas, C, Hayes, L, Kumor, M, Kurki, S, Lavie, L, Lavie, P, Levy, P, Lombardi, C, Marrone, O, Masa, J, Montserrat, J, Parati, G, Pataka, A, Pepin, J, Plywaczewski, R, Rodenstein, D, Roisman, G, Ryan, S, Schulz, R, Tkacova, R, Staats, R, Steiropoulos, P, Varoneckas, G, Vitols, A, Vrints, H, Zielinski, J, Saaresranta T., Hedner J., Bonsignore M. R., Riha R. L., McNicholas W. T., Penzel T., Anttalainen U., Kvamme J. A., Pretl M., Sliwinski P., Verbraecken J., Grote L., Barbe F., Basoglu B., Bielicki P., Dorkova Z., Escourrou P., Fietze I., Esquinas C., Hayes L., Kumor M., Kurki S., Lavie L., Lavie P., Levy P., Lombardi C., Marrone O., Masa J. F., Montserrat J. M., Parati G., Pataka A., Pepin J. L., Plywaczewski R., Rodenstein D., Roisman G., Ryan S., Schulz R., Tkacova R., Staats R., Steiropoulos P., Varoneckas G., Vitols A., Vrints H., Zielinski J., Saaresranta, T, Hedner, J, Bonsignore, M, Riha, R, Mcnicholas, W, Penzel, T, Anttalainen, U, Kvamme, J, Pretl, M, Sliwinski, P, Verbraecken, J, Grote, L, Barbe, F, Basoglu, B, Bielicki, P, Dorkova, Z, Escourrou, P, Fietze, I, Esquinas, C, Hayes, L, Kumor, M, Kurki, S, Lavie, L, Lavie, P, Levy, P, Lombardi, C, Marrone, O, Masa, J, Montserrat, J, Parati, G, Pataka, A, Pepin, J, Plywaczewski, R, Rodenstein, D, Roisman, G, Ryan, S, Schulz, R, Tkacova, R, Staats, R, Steiropoulos, P, Varoneckas, G, Vitols, A, Vrints, H, Zielinski, J, Saaresranta T., Hedner J., Bonsignore M. R., Riha R. L., McNicholas W. T., Penzel T., Anttalainen U., Kvamme J. A., Pretl M., Sliwinski P., Verbraecken J., Grote L., Barbe F., Basoglu B., Bielicki P., Dorkova Z., Escourrou P., Fietze I., Esquinas C., Hayes L., Kumor M., Kurki S., Lavie L., Lavie P., Levy P., Lombardi C., Marrone O., Masa J. F., Montserrat J. M., Parati G., Pataka A., Pepin J. L., Plywaczewski R., Rodenstein D., Roisman G., Ryan S., Schulz R., Tkacova R., Staats R., Steiropoulos P., Varoneckas G., Vitols A., Vrints H., and Zielinski J.

Abstract

Background Clinical presentation phenotypes of obstructive sleep apnoea (OSA) and their association with comorbidity as well as impact on adherence to continuous positive airway pressure (CPAP) treatment have not been established. Methods A prospective follow-up cohort of adult patients with OSA (apnoea-hypopnoea index (AHI) of ≥5/h) from 17 European countries and Israel (n = 6,555) was divided into four clinical presentation phenotypes based on daytime symptoms labelled as excessive daytime sleepiness ("EDS") and nocturnal sleep problems other than OSA (labelled as "insomnia"): 1) EDS (daytime+/nighttime-), 2) EDS/insomnia (daytime+/nighttime+), 3) non-EDS/noninsomnia (daytime-/nighttime-), 4) and insomnia (daytime-/nighttime+) phenotype. Results The EDS phenotype comprised 20.7%, the non-EDS/non-insomnia type 25.8%, the EDS/ insomnia type 23.7%, and the insomnia phenotype 29.8% of the entire cohort. Thus, clinical presentation phenotypes with insomnia symptoms were dominant with 53.5%, but only 5.6% had physician diagnosed insomnia. Cardiovascular comorbidity was less prevalent in the EDS and most common in the insomnia phenotype (48.9% vs. 56.8%, p<0.001) despite more severe OSA in the EDS group (AHI 35.0±25.5/h vs. 27.9±22.5/h, p<0.001, respectively). Psychiatric comorbidity was associated with insomnia like OSA phenotypes independent of age, gender and body mass index (HR 1.5 (1.188-1.905), p<0.001). The EDS phenotype tended to associate with higher CPAP usage (22.7 min/d, p = 0.069) when controlled for age, gender, BMI and sleep apnoea severity. Conclusions Phenotypes with insomnia symptoms comprised more than half of OSA patients and were more frequently linked with comorbidity than those with EDS, despite less severe OSA. CPAP usage was slightly higher in phenotypes with EDS.

Published
2016

36. Abnormal thyroid hormones and non-thyroidal illness syndrome in obstructive sleep apnea, and effects of CPAP treatment.

Author

Petrone, Albino, Mormile, Flaminio, Bruni, G., Quartieri, M, Bonsignore, M. r., Marrone, O., Mormile, Flaminio (ORCID:0000-0003-0790-3272), Petrone, Albino, Mormile, Flaminio, Bruni, G., Quartieri, M, Bonsignore, M. r., Marrone, O., and Mormile, Flaminio (ORCID:0000-0003-0790-3272)

Abstract

OBJECTIVE: In obstructive sleep apnea (OSA), while both hypothyroidism and hyperthyroidism have been studied, the occurrence of non-thyroidal illness syndrome (NTIS) (normal thyroid stimulating hormone [TSH] with low triiodotironine) has not been investigated. We explored the occurrence of NTIS in patients with moderate to severe OSA and its relationship to the severity of nocturnal respiratory disorders. We also studied the occurrence of subclinical hypothyroidism (SH, ie, high TSH with normal thyroxine) in OSA and changes in circulating TSH, free triiodotironine (fT3) and free thyroxine (fT4) after CPAP treatment. METHODS: After a nocturnal respiratory polysomnography, 125 consecutive patients with moderate to severe OSA and 60 control subjects with normal nocturnal respiration were recruited. Morning circulating TSH, fT3, and fT4 were measured in all subjects. In a subsample of patients, nocturnal polysomnography and hormonal determinations were repeated after CPAP treatment for five months. RESULTS: NTIS was found in 13 (10.4%), and SH in ten (8%) OSA subjects, but not in any control subjects. Patients with NTIS showed worse mean nocturnal oxygen saturation and time with saturation <90% (both p < 0.001). After treatment, NTIS subjects (n = 13) showed an increase in fT3 (p < 0.001) to the normal range, and SH subjects (n = 6) a slight decrease in TSH (p = 0.01). In the patients with normal hormones before treatment (n = 45), no change was observed. CONCLUSIONS: NTIS may occur in OSA patients with severe nocturnal hypoxemia. OSA treatment is followed by an improvement in TSH in patients with abnormal baseline levels of this hormone, and by recovery of NTIS.

Published
2016

37. Metabolic effects of hypoxia and sleep at hight altitude (5050)

Author

Morici, G., Bonanno, A., Licciardi, A., Valli, G., Passino, C., Bonardi, D., Fasano, V., 5 Marta Agnesi, Bernardi, L., Locorotondo, N., Palange, P., Cogo, Annaluisa, and Bonsignore, M. R.

Subjects
physiology, hipoxia, biomarkers
Published
2010

38. Plasma leptin or VEGF are little affected by maximal exercise at high altitude (5050 m)

Author

Morici, G., Bonanno, A., Licciardi, A., Valli, G., Passino, C., Bonardi, D., Fasano, V., Agnesi, M., Bernardi, L., Chimenti, L., Palange, P., Cogo, Annaluisa, Bonsignore, M. R., Morici, G, Bonanno, AM, Licciardi, A, Valli, G, Passino, C, Bonardi, D, Fasano, V, Agnesi, M, Bernardi, L, Chimenti, L, Palange, P, Cogo, A, and Bonsignore, MR

Subjects
hypoxemia, hypoxia, physical activity, extrapulmonary impact, Settore MED/10 - Malattie Dell'Apparato Respiratorio, hypobaric hypoxia, Settore BIO/09 - Fisiologia, incremental exercise
Published
2010

39. Management of obstructive sleep apnea in Europe

Author

Fietze, I, Penzel, T, Alonderis, A, Barbe, F, Bonsignore, M R, Calverly, P, De Backer, W, Diefenbach, K, Donic, V, Eijsvogel, M M, Franklin, Karl A, Gislason, T, Grote, L, Hedner, J, Jennum, P, Lavie, L, Lavie, P, Levy, P, Lombardi, C, Mallin, W, Marrone, O, Montserrat, J M, Papathanasiou, E S, Parati, G, Plywaczewski, R, Pretl, M, Riha, R L, Rodenstein, D, Saaresranta, T, Schulz, R, Sliwinski, P, Steiropoulos, P, Svaza, J, Tomori, Z, Tonnesen, P, Varoneckas, G, Verbraecken, J, Vesely, J, Vitols, A, Zielinski, J, McNicholas, W T, Fietze, I, Penzel, T, Alonderis, A, Barbe, F, Bonsignore, M R, Calverly, P, De Backer, W, Diefenbach, K, Donic, V, Eijsvogel, M M, Franklin, Karl A, Gislason, T, Grote, L, Hedner, J, Jennum, P, Lavie, L, Lavie, P, Levy, P, Lombardi, C, Mallin, W, Marrone, O, Montserrat, J M, Papathanasiou, E S, Parati, G, Plywaczewski, R, Pretl, M, Riha, R L, Rodenstein, D, Saaresranta, T, Schulz, R, Sliwinski, P, Steiropoulos, P, Svaza, J, Tomori, Z, Tonnesen, P, Varoneckas, G, Verbraecken, J, Vesely, J, Vitols, A, Zielinski, J, and McNicholas, W T

Abstract

Objectives: In Europe, the services provided for the investigation and management of obstructive sleep apnoea (OSA) varies from country to country. The aim of this questionnaire-based study was to investigate the current status of diagnostic pathways and therapeutic approaches applied in the treatment of OSA in Europe, qualification requirements of physicians involved in diagnosis and treatment of OSA, and reimbursement of these services. Methods: Two questionnaires were sent to 39 physicians in 22 countries in Europe. In order to standardize the responses, the questionnaire was accompanied by an example. Results: Sleep centers from 21 countries (38 physicians) participated. A broad consistency among countries with respect to the following was found: pathways included referral to sleep physicians/sleep laboratories, necessity for objective diagnosis (primarily by polysomnography), use of polygraphic methods, analysis of polysomnography (PSG), indications for positive airway pressure (PAP) therapy, application of standard continuous PAP (CPAP) therapy (100% with an CPAP/APAP ratio of 2.24:1), and the need (90.5%) and management of follow-up. Differences were apparent in reimbursement of the diagnostic procedures and follow-up, in the procedures for PAP titration from home APAP titration with portable sleep apnea monitoring (38.1%) up to hospital monitoring with PSG and APAP (85.7%), and in the qualification requirements of sleep physicians. Conclusions: Management of OSA in different European countries is similar except for reimbursement rules, qualification of sleep specialists and procedures for titration of the CPAP treatment. A European network (such as the one accomplished by the European Cooperation in Science and Technology [COST] B26 Action) could be helpful for implementing these findings into health-service research in order to standardize management in a cost effective perspective.

Published
2011
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48. Autonomic cardiac regulation in obstructive sleep apnea syndrome: evidence from spontaneous baroreflex analysis during sleep

Author

Parati, G, Di Rienzo, M, Bonsignore, M, Insalaco, G, Marrone, O, Castiglioni, P, Bonsignore, G, Mancia, G, Bonsignore, M R, Parati, G, Di Rienzo, M, Bonsignore, M, Insalaco, G, Marrone, O, Castiglioni, P, Bonsignore, G, Mancia, G, and Bonsignore, M R

Abstract

Objective. To assess spontaneous baroreceptor-heart rate reflex sensitivity during sleep in patients with obstructive sleep apnea syndrome, a condition associated with increased cardiovascular morbidity and mortality and characterized by marked sympathetic activation, which is believed to originate from hypoxic chemoreceptor stimulation, although little is known of other possible mechanisms such as baroreflex impairment. Design and methods. In 11 patients with severe obstructive sleep apnea syndrome (mean ± SD age 46.8 ± 8.1 years, apnea/hypopnea index 67.9 ± 19.1 h), who were normotensive or borderline hypertensive during wakefulness by clinic blood pressure measurements, finger blood pressure was monitored beat-by-beat non-invasively (Finapres) at night during polysomnography. Periods of wakefulness and sleep were identified based on electroencephalographic recordings. Baroreflex sensitivity was assessed by the sequence technique, as the slope of the regression line between spontaneous increases or reductions in systolic blood pressure (SBP) and the related lengthening or shortening in the RR interval, occurring over spontaneous sequences of four or more consecutive beats. The number of these sequences was also computed, as an additional index of baroreflex engagement by the spontaneous blood pressure fluctuations. The controls were age-related normotensive or borderline hypertensive subjects without sleep apnea who had been investigated in previous studies; in these subjects blood pressure was recorded intra-arterially over 24 h in ambulatory conditions and spontaneous baroreflex sensitivity was assessed by the sequence technique. Results. In our patients the lowest nocturnal arterial oxygen saturation was 78.6 ± 12.1% (mean ± SD). During sleep, the number of pooled +RR/+SBP and -RR/-SBP sequences per hour was 20.3 ± 2.7 per h in patients with sleep apnea and 27.1 ± 12.1/h in controls (means ± SEM). The average baroreflex sensitivity during sleep periods was 7.04

Published
1997

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