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Obstructive sleep apnea (OSA) is the most common type of sleep disordered breathing, with a significant impact on health-related quality of life (HR-QoL). Continuous positive airway pressure (CPAP) is the gold-standard treatment for moderate-severe OSA, but is associated with poor patient compliance (due to financial issues and frequent side effects). The purpose of this study is to evaluate HR-QoL among patients with moderate-severe OSA from North-Eastern Romania, at baseline and after 2 months of CPAP. 75 patients were initially included in our study but only 59 subjects returned for a second evaluation. HR-QoL was assessed using the European Quality of Life 5 Domain questionnaire (EQ-5D-5L). OSA has a significant impact on quality of life in our group, with an average EQ-5D-5L index of 0.70±0.27 and an EQ-5D-5L Visual Analogue Scale (VAS) of 63.71±17.74%. Short-term CPAP use was associated with a statistically significant improvement in Epworth Sleepiness Scale (Δ = 4.44, p 4000 lei/month) decided to continue using the device, while the decision not to continue CPAP was significantly more frequent among patients with a low income (< 1000 lei /month - 52.63% versus 21.21%, p=0.01). Our results suggest that income level significantly influences CPAP compliance.

Background: Both obstructive sleep apnea (OSA) and metabolic syndrome (MS) promote arterial stiffening. As a basis for this study, we presumed that arterial stiffness could be assessed using the Arteriograph (TensioMed, Budapest, Hungary) to detect early modifications induced by continuous positive airway therapy (CPAP) in reversing this detrimental vascular remodeling. Arterial stiffness is increasingly acknowledged as a major cardiovascular risk factor and a marker of subclinical hypertension-mediated organ damage. The aim of this pilot study was to evaluate the arterial stiffness changes in patients with moderate–severe OSA and MS after short-term CPAP use. Methods: We performed a prospective study that included patients with moderate–severe OSA and MS who had not undergone previous CPAP therapy. All subjects underwent clinical examination and arterial stiffness assessment using the oscillometric technique with Arteriograph (TensioMed, Budapest, Hungary) detection before and after 8-week CPAP therapy. Results: 39 patients with moderate–severe OSA were included. Eight weeks of CPAP therapy significantly improved central systolic blood pressure (Δ = −11.4 mmHg, p = 0.009), aortic pulse wave velocity (aoPWV: Δ = −0.66 m/s, p = 0.03), and aortic augmentation index (aoAix: Δ = −8.25%, p = 0.01) only in patients who used the device for a minimum of 4 h/night (n = 20). Conclusions: Arterial stiffness was improved only among CPAP adherent patients and could be detected using the Arteriograph (TensioMed, Budapest, Hungary), which involves a noninvasive procedure that is easy to implement for the clinical evaluation of arterial stiffness.

Obstructive sleep apnea syndrome is a multisystemic disorder associated with a series of side effects. Obstructive sleep apnea syndrome (OSAS) includes hypoxemia and is correlated with an increased incidence for various neuronal conditions, including glaucoma, strokes, reduced mental ability, depressive disorders, peripheral neuropathy, and non-arteritic ischemic optic neuropathy. This study&rsquo, s aims are the evaluation of the degree of ocular surface damage in obstructive sleep apnea patients (in the absence of the continuous positive airway pressure treatment) and the structural changes in the optic nerve, and to establish correlation between the degree of damage to the ocular surface (eye dryness by Schirmer test) and corneal biomechanics by ocular response analyzer. The subjects included in the study will be grouped as follows: a group of patients with glaucoma and obstructive sleep apnea syndrome that will be compared to patients with glaucoma only as well as identifying the evolution of structural changes in patients with glaucoma and sleep apnea syndrome. A prospective study included 65 eyes from 65 subjects diagnosed with obstructive sleep apnea (45 eyes of 45 subjects with glaucoma and OSAS as well as 20 subjects, 20 eyes with dry-eye syndrome and OSAS) who did not follow the continuous positive airway pressure treatment. The control group consisted of 45 subjects (45 eyes) with (mild or moderate) primary open-angle treated glaucoma without obstructive sleep apnea. All patients had ophthalmologic evaluations according to a standardized protocol. Moreover, respiratory functional parameters (apnea&ndash, hypopnea index&mdash, AHI) and the body mass index were recorded. Within the studied group, patients with mild or moderate primary open-angle glaucoma, with moderate or severe dry-eye syndrome, patients with floppy-eyelid syndrome, with optical non-arteritis ischemic neuropathy, and a patient with retinal central vein occlusion were identified. The increased rate of the apnea syndrome during sleep produces a severe disorder of the ocular surface and a retinal neuro-degenerative disorder. The eyes of patients with sleep apnea syndrome (SAS) and glaucoma have lower mean intraocular pressure than eyes with glaucoma without SAS. However, the mean C/D ratio in eyes with glaucoma correlates with the severity of SAS. There is a positive correlation between the severity of the apnea and the ocular disorder&rsquo, s degree similar to the studies in the literature review. The joint cooperation between the sleep specialists and ophthalmologists can lead to the improvement of the vascular and ocular status for the obstructive sleep apnea patients.

Obstructive sleep apnea (OSA) causes recurrent apneas due to upper respiratory tract collapse, leading to sympathetic nervous system hyperactivation and increased cardiovascular risk. Moderate and severe forms of obstructive sleep apnea are associated with increased atrial volumes and affect left ventricular diastolic and then systolic function. Right ventricular ejection fraction can be accurately assessed via three-dimensional echocardiography, while bidimensional imaging can only provide a set of surrogate parameters to characterize systolic function (tricuspid annulus plane systolic excursion, right ventricular fractional area change, and lateral S’). Tissue Doppler imaging is a more sensitive tool in detecting functional ventricular impairment, but its use is limited by angle dependence and the unwanted influence of tethering forces. Two-dimensional speckle tracking echocardiography is considered more suitable for the assessment of ventricular function, as it is able to distinguish between active and passive wall motion. Abnormal strain values, a marker of subclinical myocardial dysfunction, can be detected even in patients with normal ejection fraction and chamber volumes. The left ventricular longitudinal strain is more affected by the presence of obstructive sleep apnea than circumferential strain values. Although the observed OSA-induced changes are subtle, the benefit of a detailed echocardiographic screening for subclinical heart failure in OSA patients on therapy adherence and outcome should be addressed by further studies.

Anthropometric Predictors of High Risk of Obstructive Sleep Apnea Syndrome in a Rural PopulationObjective. To evaluate which anthropometric parameter better predicts the high risk of obstructive sleep apnea syndrome (OSA) in a rural population. Material and Method. 254 subjects were enrolled. We measured weight, height, waist circumference (WC) and neck circumference (NC) and calculated body mass index (BMI), waist-to-height ratio (WHtR) and neck circumference/height ratio (NC/Height). The risk of OSA was assessed by using Berlin Questionnaire. Results. Subjects with high risk of OSA had a significant higher BMI, WC, WHtR, NC, and NC/Height. A higher percentage of those with large WC (≥80cm and ≥94cm for women and men, respectively) (pConclusions. WHtR was the best predictor for high risk of OSA as assessed by the Berlin Questionnaire.

Background It is proven that in patients with endstage renal disease (ESRD) the prevalence of sleep disorders (insomnia, periodic leg movement and sleep apnea) is high. This fact may contribute to an impaired quality of life and to an increased risk for cardiovascular diseases. However, only few published data are available with regard to sleepdisordered breathing in long-term hemodialysed patients.

The impressive progresse in biochemistry, biophysics and cellular biology in the latest decade has achieved many breakthroughs in the inner normal and pathological cellular processes, opening new vistas in the fundamental and applicative biochemical thinking and researches. As a fundamental biomedical science, physiology benefitted of these cognitive and applicative discoveries, becoming the reference system essential for various clinical and paraclinical biomedical acts. The homeostatic mechanisms of regulation, adaptation and neuro-endocrino-metabolic control have been first specified that lie at the basis of the “constant composition of the inner medium”, signalled by Claude Bernard (1852) (1). Brief data concerning homeostasis As a state of dynamic equilibrium of the constituents of liquid medium surrounding cellular level, homeostasis is essential for the survival and obtaining of various activity forms of the cells. About 100 trillion cells of the human body with structure, metabolism and highly differentiated functions are subject to a permanent adaptative control, starting with the self-regulation of the main functions of the organism and ending with the genetic control at the cellular level. The regulation and control systems necessary to maintain the cellular homeostatic equilibria are of two kinds: intrinsic (local) and extrinsic (nervous and endocrine). By these complex mechanisms the direct or reflex selfregulation of vascular tonus is obtained, as well as the differences of volume and circulating blood pressure, the concentration of constituents of the inner medium necessary for both extra and intracellular liquid exchanges (nutrient molecules, oxygen, carbon dioxide, salts, electrolytes, vitamins, hormones, mediators and chemical modulators, etc.) and for the thermal regulation, acido-basic equilibrium, concentration of secretion products and cellular degradation, etc. Thus, each cell, as part of various tissues and organs, contributes to the coordination and maintaining of local and general equilibria, a homeostasis absolutely essential for the organism normal activity.

Obstructive sleep apneea syndrome is highly prevalent in adult population and increases cardiovascular morbidity and mortality. Nasal continuous positive airway pressure (CPAP) remains the treatment of choice for obstructive sleep apnoea (OSA). Automatic CPAP (APAP) can be use, not only for treatment but also for suggesting the optimum CPAP setting. Ninety-five newly diagnosed patients were included (mean age 51±9.6 years) with moderate and severe obstructive sleep apnea syndrome. The patients were randomly allocated to one of the investigated devices: APAP or fixed pressure CPAP. A lower mean effective pressure seen in AUTO group 7.67cm H2O vs CPAP 8.51 cm H2O (CI 95% 0.08 – 1.6, p=0.03) and CPAP patients presented statistically significant lower residual AHI (mean difference 1.6, CI 95% 0.7 – 2.5, p=0.001). As a conclusion the AUTO approach seems to be similarly effective as CPAP and provide a method for determining a single fixed pressure, suitable for long term treatment with a conventional CPAP device.

The prevalence of sleep disorders is significantly higher (up to 80%) in patients with chronic uremia compared to the general population. Sleep disorders appear even in the early stages of chronic kidney disease. These disturbances are complex, including difficulties in falling asleep and awakening, interrupted sleep, nightmares, restless legs syndrome, sleep apnea syndrome, etc. There are still disagreements on the major etiological factors of sleep disorders in the uremic patient. Older age, long dialysis vintage, alcohol and tobacco abuse and, particularly, the presence of significant comorbidities are major determinants of sleep disorders in dialysis patients. Proper assessment of sleep disorders in the renal population is still under investigation; recent studies have mostly addressed patients’ perception based on questionnaires. More precise polysomnographic assessments are less studied in renal patients. Sleep disorders significantly affect quality of life in dialysis patients. An accurate and early identification of such disturbances would lead to a significant improvement in quality of life, and probably also in outcome, in uremic patients. Sleep apnea syndrome is extremely frequent in dialysis patients, with obvious consequences for cardiovascular morbidity and mortality. Proper diagnosis and therapy of sleep apnea syndrome could significantly reduce cardiovascular risk. Although sleep quality improves after renal transplantation, allograft recipients still have significantly more sleep disorders than healthy individuals. Here, we review recent data on sleep disturbances in renal patients, focusing on the end-stage renal disease patient treated by dialysis.

Adrenomedullin (ADM), a ubiquitous vasoactive peptide, has been the target of a multitude of studies concerning its effect on the vascular tone. The present work aims at clarifying a series of its interactions with the renin-angiotensin system.The study uses the rat aorta ring as a model of conductance vessels, with or without vascular endothelium, and the second order branch of rat mesenteric arteries as a model of resistance arteries. Interactions between various concentrations of ADM and angiotensin II (Ang II) were studied, in the presence of L-NAME (a nitric oxide [NO] synthase inhibitor) and methylene blue (MB; a soluble guanylate cyclase inhibitor).Results point out differences in the mechanism of the inhibitory action of ADM upon Ang II effects in the two vessel types studied. Inhibition of Ang II contraction by ADM involves guanylate cyclase in both cases. However, NO is involved in ADM-induced inhibition of angiotensinergic not in the resistance ones. vasoconstriction only in the conductance arteries, not in the resistance ones.

We explored a possible link between the cardiac cycle and the timing of recurrent hiccups in 10 patients with chronic, intractable hiccups. Recordings made during daytime naps in a sleep laboratory included sleep state; electrocardiogram; and respiration by means of a thermistor to detect airflow, bands around the rib cage and abdomen to assess expansion, and a bipolar surface electrode electromyogram over parasternal intercostal muscles. Hiccups could be detected on the abdominal bands and the parasternal electromyogram. The time of occurrence of each hiccup and each R wave in a continuous tracing of 100 or more hiccups were recorded and analyzed together with semiquantitive estimates of the phase of hiccup respiration. Whereas the hiccup rate ranged from approximately one-third to one-eighth of heart rate and was more variable than heart rate, hiccups showed a tendency, stronger in some subjects than others, to occur in midsystole. Variation in R-wave-R-wave (R-R) interval in association with hiccups was found in five patients. In three of these patients, hiccups were synchronized with respiration so that the cyclic change in R-R interval posthiccup could be explained as sinus arrhythmia, but, in two patients, the hiccups were not synchronized with respiration, so that hiccups are most likely responsible for the variation in heart rate. Also, the variation of R-R interval with hiccups suggests that there is some phasic autonomic efferent activity associated with hiccups.

The twitch occlusion technique is a promising tool for use in accessing central drive to the diaphragm and determining maximal transdiaphragmatic pressure (Pdi) from submaximal efforts. It clinical use is limited by difficulties inherent to bilateral electrical stimulation (BES) of the phrenic nerves. This study was designed to revisit the technique using cervical magnetic stimulation (CMS). In addition, the effects of a voluntary contraction on diaphragm response to magnetic stimulation of the cortex (CxMS) were studied. Seven volunteers aged 23-33 yrs were studied. Pdi was determined at relaxed functional residual capacity (FRC) in response to BES (Pdi,P-ES) and CMS (Pdi,p-CMS), and the effects of an increasing voluntary contraction (Pdi, vol) were assessed, The same procedure was applied to CxMS. Pdi,p-CMS at relaxed FRC was 27.5 +/- 2.2 cmH2O (mean+/-SEM), about 20% higher than Pdi,p-ES, and reported previously. Pd,p-CMS linearly decreased with Pdi, vol, and six out of seven subjects were capable of producing voluntary contractions sufficient to extinguish the twitch. More complex patterns were observed with CxMS. Cervical magnetic stimulation provides diaphragmatic twitch occlusion data very similar to bilateral electrical phrenic stimulation. Magnetic stimulation, be it cervical or cortical, could probably be helpful for the assessment of central and peripheral mechanisms of diaphragmatic dysfunction in the clinical setting.