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2. Sleep-Related Breathing Disorders in Multiple Sclerosis: Prevalence, Features and Associated Factors

Author

Sparasci D, Fanfulla F, Ferri R, Aricò D, Distefano D, Pravatà E, Heinzer R, Haba-Rubio J, Berger M, Riccitelli GC, Gobbi C, Zecca C, and Manconi M

Subjects
sleep-related breathing disorders, multiple sclerosis, sleep quality, polysomnography, Psychiatry, RC435-571, Neurophysiology and neuropsychology, QP351-495
Abstract

Davide Sparasci,1 Francesco Fanfulla,2 Raffaele Ferri,3 Debora Aricò,3 Daniela Distefano,4 Emanuele Pravatà,4 Raphael Heinzer,5 José Haba-Rubio,5 Mathieu Berger,5 Gianna Carla Riccitelli,6– 8 Claudio Gobbi,6,8 Chiara Zecca,6,8,* Mauro Manconi1,8,* 1Sleep Medicine Unit, Neurocenter of Southern Switzerland, Lugano, Switzerland; 2Sleep Medicine Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Pavia, Pavia, Italy; 3Sleep Research Centre; Department of Neurology I.C., Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy; 4Neuroradiology Clinic, Ospedale Regionale di Lugano, Neurocenter of Southern Switzerland, Lugano, Switzerland; 5Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland; 6Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Lugano, Switzerland; 7Neuropsychology and Behavioural Neurology Research Unit, Neurocenter of Southern Switzerland, Lugano, Switzerland; 8Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland*These authors contributed equally to this workCorrespondence: Raffaele Ferri, Sleep Research Centre; Department of Neurology I.C., Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Via Conte Ruggero 73, Troina, 94018, Italy, Email rferri@oasi.en.itBackground: Multiple sclerosis (MS) represents a risk factor for sleep disorders, but there are conflicting results about the prevalence and severity of sleep-related breathing disorders (SRBD) in MS. Most available data come from self-administered questionnaires.Objective: To conduct a polysomnographic study in MS focused on SRBD, compared to a group of healthy controls (HC), also considering the neuroimaging findings. To evaluate the impact of SRBD on vigilance, fatigue and depression in MS.Methods: In this cross-sectional, observational, instrumental study, 67 MS patients (men/women: 20/47; mean age: 50.6± 8.2 years) underwent PSG and maintenance of wakefulness test. Findings were compared to 67 age-, sex-, BMI-matched HC, by using parametric (Student’s t-test) and nonparametric statistics (chi-squared test). A subgroup analysis was then performed, evaluating the influence of brainstem (mesencephalic, pontine and medullary) lesions at neuroimaging on instrumental and clinical data: MS patients with at least one brainstem lesion vs MS patients without vs HC.Results: The frequency of SRBD was comparable in MS patients and HC. No MS patient had a central apnea index ≥ 2/h. The respiratory disturbance index (RDI) did not correlate to clinical parameters such as fatigue and depression. Patients with MS were drowsier than HC (47% vs 26%, p = 0.019) and showed a worse sleep pattern, in terms of duration, efficiency and architecture.Conclusion: Our study does not provide evidence of an association between MS-specific symptoms such as fatigue, sleepiness, depression and central or obstructive apneas, even in the presence of brainstem lesions.Keywords: sleep-related breathing disorders, multiple sclerosis, sleep quality, polysomnography

Published
2022

3. Obstructive and Central Sleep Apnea in First Ever Ischemic Stroke are Associated with Different Time Course and Autonomic Activation

Author

Riglietti A, Fanfulla F, Pagani M, Lucini D, Malacarne M, Manconi M, Ferretti G, Esposito F, Cereda CW, and Pons M

Subjects
sleep disorder breathing, baroreflex, chemoreflex, brain lesion., Psychiatry, RC435-571, Neurophysiology and neuropsychology, QP351-495
Abstract

Alessia Riglietti,1,* Francesco Fanfulla,2,* Massimo Pagani,3 Daniela Lucini,3,4 Mara Malacarne,3,4 Mauro Manconi,5– 7 Guido Ferretti,8,9 Fabio Esposito,10,11 Carlo W Cereda,12 Marco Pons1 1Department of Pulmonology, Regional Hospital of Lugano (EOC), Lugano, 6900, Switzerland; 2Respiratory Function and Sleep Unit – Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy; 3Exercise Medicine Unit, Istituto Auxologico Italiano, MIlan, 20133, Italy; 4University of Milan, BIOMETRA Department, Milan, Italy; 5Sleep and Epilepsy Center, Neurocenter of the Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland; 6Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; 7Department of Neurology, University Hospital, Inselspital, Bern, Switzerland; 8Department APSI, University of Geneva, Geneva, Switzerland; 9Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy; 10Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; 11IRCCS Istituto Ortopedico Galeazzi, Milan, Italy; 12Stroke Center EOC, Department of Neurology, Neurocenter of Southern Switzerland Regional Hospital (EOC) of Lugano, Lugano, Switzerland*These authors contributed equally to this workCorrespondence: Mauro ManconiRegional Hospital of Lugano, Via Tesserete, 46, Lugano, 6903, SwitzerlandTel +41-91-8116825Email mauro.manconi@eoc.chIntroduction: Sleep-related breathing disorders are highly prevalent in patients with ischemic stroke. Among sleep-disordered breathing disorders, obstructive sleep apnea is the most represented one, but central sleep apnea, isolated or in the context of a periodic breathing/Cheyne–Stokes respiration, is frequently reported in these patients. Altered baroreflex responses have been reported in the acute phases of a cerebral event.Methods: We conducted, in a group of patients with ischemic stroke (n=60), a prospective 3-month follow-up physiological study to describe the breathing pattern during sleep and baroreflex sensitivity in the acute phase and in the recovery phase.Results: In the acute phase, within 10 days from the onset of symptoms, 22.4% of patients had a normal breathing pattern, 40.3% had an obstructive pattern, 16.4% had a central pattern, and 29.9% showed a mixed pattern. Smaller variations in the Apnea–Hypopnea Index were found in normal breathing and obstructive groups (ΔAHI 2.1± 4.1 and − 2.8± 11.6, respectively) in comparison with central and mixed patterns (ΔAHI − 6.9± 15.1 and − 12.5± 13.1, respectively; ANOVA p=0.01). The obstructive pattern became the most frequent pattern, in 38.3% of patients at baseline and 61.7% of patients at follow-up. Modification of baroreflex sensitivity over time was influenced by the site of the lesion and by the sleep disorder pattern in the acute phase (MANOVA p=0.005).Conclusion: We suggest that a down-regulation of autonomic activity, possibly related to reduced vagal modulation, may help the recovery after stroke, or a transitory disconnection from the cortical node that participates in the regulation of sympathetic outflow.Keywords: sleep-disordered breathing, baroreflex, chemoreflex, brain lesion

Published
2021

6. 1st Italian SMA Family Association Consensus Meeting:: Management and recommendations for respiratory involvement in spinal muscular atrophy (SMA) types I–III, Rome, Italy, 30–31 January 2015

Author

Agosto, C., Banfi, P., Baranello, G., Bignamini, E., Chiarini, M.B., Cutrera, R., D'amico, A., Dusio, M., Fanfulla, F., Garuti, G., Giretti, R., Gorni, K., Gregoretti, C., Luccoli, L., Messina, S., Pane, M., Pavone, M., Pedemonte, M., Pera, M.C., Piastra, M., Profazio, C., Rao, F., Salvo, I., Testa, R., Villanova, M., Sansone, V.A., Racca, F., Ottonello, G., Vianello, A., Berardinelli, A., Crescimanno, G., and Casiraghi, J.L.

Published
2015
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7. Clinical Impact and Polysomnographic Features of Sleep Disturbances in Multiple Sclerosis

Author

Sparasci, D., primary, Ferri, R., additional, Fanfulla, F., additional, Castelnovo, A., additional, Miano, S., additional, Tanioka, K., additional, Tachibana, N., additional, Heinzer, R., additional, Haba-Rubio, J., additional, Berger, M., additional, Riccitelli, G.C., additional, Disanto, G., additional, Zecca, C., additional, Gobbi, C., additional, and Manconi, M., additional

Published
2022
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12. Breath-holding as a novel approach to risk stratification in COVID-19

Author

Messineo, L, Perger, E, Corda, L, Joosten, S, Fanfulla, F, Pedroni, L, Terrill, P, Lombardi, C, Wellman, A, Hamilton, G, Malhotra, A, Vailati, G, Parati, G, Sands, S, Messineo L., Perger E., Corda L., Joosten S. A., Fanfulla F., Pedroni L., Terrill P. I., Lombardi C., Wellman A., Hamilton G. S., Malhotra A., Vailati G., Parati G., Sands S. A., Messineo, L, Perger, E, Corda, L, Joosten, S, Fanfulla, F, Pedroni, L, Terrill, P, Lombardi, C, Wellman, A, Hamilton, G, Malhotra, A, Vailati, G, Parati, G, Sands, S, Messineo L., Perger E., Corda L., Joosten S. A., Fanfulla F., Pedroni L., Terrill P. I., Lombardi C., Wellman A., Hamilton G. S., Malhotra A., Vailati G., Parati G., and Sands S. A.

Abstract

Background: Despite considerable progress, it remains unclear why some patients admitted for COVID-19 develop adverse outcomes while others recover spontaneously. Clues may lie with the predisposition to hypoxemia or unexpected absence of dyspnea (‘silent hypoxemia’) in some patients who later develop respiratory failure. Using a recently-validated breath-holding technique, we sought to test the hypothesis that gas exchange and ventilatory control deficits observed at admission are associated with subsequent adverse COVID-19 outcomes (composite primary outcome: non-invasive ventilatory support, intensive care admission, or death). Methods: Patients with COVID-19 (N = 50) performed breath-holds to obtain measurements reflecting the predisposition to oxygen desaturation (mean desaturation after 20-s) and reduced chemosensitivity to hypoxic-hypercapnia (including maximal breath-hold duration). Associations with the primary composite outcome were modeled adjusting for baseline oxygen saturation, obesity, sex, age, and prior cardiovascular disease. Healthy controls (N = 23) provided a normative comparison. Results: The adverse composite outcome (observed in N = 11/50) was associated with breath-holding measures at admission (likelihood ratio test, p = 0.020); specifically, greater mean desaturation (12-fold greater odds of adverse composite outcome with 4% compared with 2% desaturation, p = 0.002) and greater maximal breath-holding duration (2.7-fold greater odds per 10-s increase, p = 0.036). COVID-19 patients who did not develop the adverse composite outcome had similar mean desaturation to healthy controls. Conclusions: Breath-holding offers a novel method to identify patients with high risk of respiratory failure in COVID-19. Greater breath-hold induced desaturation (gas exchange deficit) and greater breath-holding tolerance (ventilatory control deficit) may be independent harbingers of progression to severe disease.

Published
2021

13. 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

16. Excessive Daytime Sleepiness in Obstructive Sleep Apnea Patients Treated With Continuous Positive Airway Pressure: Data From the European Sleep Apnea Database

Author

Bonsignore, M.R. Pepin, J.L. Cibella, F. Barbera, C.D. Marrone, O. Verbraecken, J. Saaresranta, T. Basoglu, O.K. Trakada, G. Bouloukaki, I. McNicholas, W.T. Bailly, S. Pataka, A. Kvamme, J.A. Hein, H. Mihaicuta, S. Grote, L. Fanfulla, F. ESADA Study Group

Subjects
respiratory tract diseases
Abstract

Excessive daytime sleepiness (EDS) is a symptom of obstructive sleep apnea (OSA) that resolves under treatment with continuous positive airway pressure (CPAP). In some patients, sleepiness persists despite CPAP treatment. We retrospectively analyzed data on subjective residual EDS, assessed as an Epworth Sleepiness Scale score (ESS) >10, in patients from the European Sleep Apnea Database (n = 4,853, mean age ± SD 54.8 ± 11.8 years, 26.1% females), at baseline and at the first visit (median follow-up: 5 months, interquartile range 3–13). An ESS > 10 occurred in 56% of patients at baseline and in 28.2% of patients at follow-up. Residual EDS was analyzed in 2,190 patients (age: 55.1 ± 12.0 years, 26.1% females) with sleep monitoring data (median follow-up: 3 months, interquartile range 1–15). Sleep studies during CPAP use were obtained in 58% of these patients; EDS was reported by 47.2% of patients at baseline and by 30.3% at follow-up. Residual OSA, defined as an apnea–hypopnea index >10/h, and insufficient CPAP adherence, defined as nightly use 10 at the first follow-up visit was associated directly with ESS at baseline and inversely with duration of follow-up, and CPAP use (R2 of the model: 0.417). EDS showed heterogeneity in different European countries both at baseline and at the first follow-up visit, suggesting modulation by cultural and lifestyle factors. In conclusion, residual EDS in CPAP-treated OSA occurred in approximately one in four patients at follow-up; its prevalence was highest (40%) in the first 3 months of treatment and subsequently decreased. The finding of residual EDS in a significant percentage of optimally treated OSA patients suggests that wake-promoting agents may be useful, but their indication should be evaluated after at least 3 months of treatment. © Copyright © 2021 Bonsignore, Pepin, Cibella, Barbera, Marrone, Verbraecken, Saaresranta, Basoglu, Trakada, Bouloukaki, McNicholas, Bailly, Pataka, Kvamme, Hein, Mihaicuta, Grote, Fanfulla and ESADA Study Group.

Published
2021

17. Breath-holding as a novel approach to risk stratification in COVID-19.

Author

Messineo L., Perger E., Corda L., Joosten S.A., Fanfulla F., Pedroni L., Terrill P.I., Lombardi C., Wellman A., Hamilton G.S., Malhotra A., Vailati G., Parati G., Sands S.A., Messineo L., Perger E., Corda L., Joosten S.A., Fanfulla F., Pedroni L., Terrill P.I., Lombardi C., Wellman A., Hamilton G.S., Malhotra A., Vailati G., Parati G., and Sands S.A.

Abstract

Background: Despite considerable progress, it remains unclear why some patients admitted for COVID-19 develop adverse outcomes while others recover spontaneously. Clues may lie with the predisposition to hypoxemia or unexpected absence of dyspnea ('silent hypoxemia') in some patients who later develop respiratory failure. Using a recently-validated breath-holding technique, we sought to test the hypothesis that gas exchange and ventilatory control deficits observed at admission are associated with subsequent adverse COVID-19 outcomes (composite primary outcome: non-invasive ventilatory support, intensive care admission, or death). Method(s): Patients with COVID-19 (N = 50) performed breath-holds to obtain measurements reflecting the predisposition to oxygen desaturation (mean desaturation after 20-s) and reduced chemosensitivity to hypoxic-hypercapnia (including maximal breath-hold duration). Associations with the primary composite outcome were modeled adjusting for baseline oxygen saturation, obesity, sex, age, and prior cardiovascular disease. Healthy controls (N = 23) provided a normative comparison. Result(s): The adverse composite outcome (observed in N = 11/50) was associated with breath-holding measures at admission (likelihood ratio test, p = 0.020); specifically, greater mean desaturation (12-fold greater odds of adverse composite outcome with 4% compared with 2% desaturation, p = 0.002) and greater maximal breath-holding duration (2.7-fold greater odds per 10-s increase, p = 0.036). COVID-19 patients who did not develop the adverse composite outcome had similar mean desaturation to healthy controls. Conclusion(s): Breath-holding offers a novel method to identify patients with high risk of respiratory failure in COVID-19. Greater breath-hold induced desaturation (gas exchange deficit) and greater breath-holding tolerance (ventilatory control deficit) may be independent harbingers of progression to severe disease.Copyright © 2021, The Author(s).

Published
2021

18. Sleep apnoea management in Europe during the COVID-19 pandemic: data from the European Sleep Apnoea Database (ESADA)

Author

Grote L, McNicholas WT, Hedner J, ESADA collaborators (Anttalainen U, Saaresranta T, Basoglu OK, Gunduz C, Tasbakan S, Bouloukaki I, Schiza SE, Bonsignore MR, Marrone O, Petitjean M, Roisman G, Fietze I, Laharnar N, Penzel T, Zou D, Kent BD, Ryan S, Kvamme JA, 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, Ege Üniversitesi, 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, and Testelmans, D

Subjects
Pulmonary and Respiratory Medicine, Pediatrics, medicine.medical_specialty, Databases, Factual, Polysomnography, medicine.medical_treatment, Pneumonia, Viral, Personnel Staffing and Scheduling, Disease, Covid, sleep laboratory, Betacoronavirus, 03 medical and health sciences, Sleep Apnea Syndrome, Sleep Apnea Syndromes, 0302 clinical medicine, Surveys and Questionnaires, mental disorders, Research Letter, medicine, Humans, cardiovascular diseases, 030212 general & internal medicine, Continuous positive airway pressure, Pandemics, Sleep Medicine Specialty, Continuous Positive Airway Pressure, medicine.diagnostic_test, Coronavirus Infection, SARS-CoV-2, business.industry, Sleep apnea, COVID-19, Atrial fibrillation, medicine.disease, Comorbidity, Obesity, Telemedicine, Europe, 030228 respiratory system, Heart failure, Coronavirus Infections, business, Delivery of Health Care, management
Abstract

Sleep disordered breathing (SDB) is highly prevalent with a male to female predominance of two to one, and is more common in middle-aged and elderly subjects [1]. Affected patients often present with comorbidities such as obesity, cardiovascular disease (systemic hypertension, heart failure, atrial fibrillation), and diabetes mellitus Type II [2]. The strong overlap between the profile for SDB patients and the identified risk factors for adverse outcomes of COVID-19 infection that include age, male gender, and cardio-metabolic comorbidity [3] suggest that SDB patients may benefit from effective therapy if confronted with COVID-19 infection [4].

Published
2020

19. Medico-legal implications of sleep apnoea syndrome: Driving license regulations in Europe

Author

Alonderis, A., Barbé, F., Bonsignore, M., Calverley, P., De Backer, W., Diefenbach, K., Donic, V., Fanfulla, F., Fietze, I., Franklin, K., Grote, L., Hedner, J., Jennum, P., Krieger, J., Levy, P., McNicholas, W., Montserrat, J., Parati, G., Pascu, M., Penzel, T., Riha, R., Rodenstein, D., Sanna, A., Schulz, R., Sforza, E., Sliwinski, P., Tomori, Z., Tonnesen, P., Varoneckas, G., Zielinski, J., and Kostelidou, K.

Published
2008
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20. Sleep apnoea management in Europe during the COVID-19 pandemic – Data from the European Sleep Apnoea Database (ESADA)

Author

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. Hedner, J. Zou, D. Grote, L. Kent, B.D. McNicholas, W.T. Ryan, S. Kvamme, J.A. Bailly, S. Pépin, 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. Bušková, J. Hein, H. Drummond, M. van Zeller, M. Dogas, Z. Galic, T. Gouveris, H. Mihaicuta, S. Randerath, W. Herkenrath, S. Fanfulla, F. Testelmans, D. ESADA collaborators

Published
2020

21. Effect of paced breathing on ventilatory and cardiovascular variability parameters during short-term investigations of autonomic function

Author

Pinna, G.D., Maestri, R., La Rovere, M.T., Gobbi, E., and Fanfulla, F.

Subjects
Breathing exercises -- Research, Heart beat -- Research, Spectrum analysis -- Methods, Cardiovascular research, Biological sciences
Abstract

Paced breathing (PB) around 0.25 Hz has been advocated as a means to avoid confounding and to standardize measurements in short-term investigations of autonomic cardiovascular regulation. Controversy remains, however, as to whether it causes any alteration in autonomic control. We addressed this issue in 40 supine, middle-aged, healthy volunteers by assessing the changes induced by PB (0.25 Hz for 8 min) on 1) ventilatory parameters, 2) the indexes of autonomic control of cardiovascular function, and 3) the spectral indexes of cardiovascular variability. Subjects were grouped into group 1 (n = 31), if spontaneous breathing was regular and within the high-frequency (HF) band (0.15-0.45 Hz), or group 2 (n = 9), if it was irregular or slow ( heart rate variability; controlled breathing; baroreflex sensitivity; spectral analysis

Published
2006

30. Heart failure and sleep related breathing disorders: Data from PROMISES (Progetto Multicentrico Italiano Sonno e Scompenso Cardiaco) study

Author

Lombardi, C, Faini, A, La Rovere, M, Fanfulla, F, Mattaliano, P, Caravita, S, Contini, M, Agostoni, P, Perrone-Filardi, P, Parati, G, Lombardi, Carolina, Faini, Andrea, La Rovere, MariaTeresa, Fanfulla, Francesco, Mattaliano, Paola, Caravita, Sergio, Contini, Mauro, Agostoni, Piergiuseppe, Perrone-Filardi, Pasquale, Parati, Gianfranco, Lombardi, C, Faini, A, La Rovere, M, Fanfulla, F, Mattaliano, P, Caravita, S, Contini, M, Agostoni, P, Perrone-Filardi, P, Parati, G, Lombardi, Carolina, Faini, Andrea, La Rovere, MariaTeresa, Fanfulla, Francesco, Mattaliano, Paola, Caravita, Sergio, Contini, Mauro, Agostoni, Piergiuseppe, Perrone-Filardi, Pasquale, and Parati, Gianfranco

Abstract

In heart failure (HF) sleep problems and sleep-related breathing disorders are frequently reported and are associated with poor prognosis. However, only few large clinical studies have investigated this issue in heart failure through breathing pattern analysis by polysomnography., Background: In heart failure (HF) sleep problems and sleep-related breathing disorders are frequently reported and are associated with poor prognosis. However, only few large clinical studies have investigated this issue in heart failure through breathing pattern analysis by polysomnography. Methods and results: 370 HF patients, with either moderate-severe reduced ejection fraction or with clinical decompensation, consecutively referred to 10 participating cardiology centers, have been enrolled in the PROMISES Study, an Italian project aimed at generating a large, multidisciplinary database of anthropometric, clinical, echocardiographic and sleep data, the last derived from overnight unattended cardio-respiratory polysomnography in HF patients. Obstructive sleep apnea was the most frequent form of sleep related breathing disorders observed in our cohort (35.4% with an AHI cutoff of 15). The possible determinants of sleep related breathing disorders were analyzed through stepwise logistic regression analysis and two multivariate models showing that a markedly reduced left ventricular ejection fraction was the most important factor associated with central sleep apneas (OR = 7.7 for AHI cutoff = 15 and LVEF ≤ 35%) together with male gender and increasing age. Conventional risk factors for obstructive sleep apnea did not identify HF patients affected by this condition. Conversely, a greater neck circumference was associated with an increased risk for central apneas. Conclusions: Our paper offers a deeper insight into the features of SRBD and its determinants in HF patients, leading in turn to a better clinical management of these comorbid patients.

Published
2018

31. Longitudinal assessment of Upper Limb function in DMD patients: 12 month changes

Author

Sansone, V. A., Racca, F., Ottonello, G., Vianello, A., Berardinelli, A., Crescimanno, G., Agosto, C., Banfi, P., Baranello, G., Bignamini, E., Chiarini, M. B., Cutrera, R., D'Amico, A., Dusio, M., Fanfulla, F., Garuti, G., Giretti, R., Goorni, K., Gregoretti, C., Luccoli, L., Messina, Sonia, Pane, M., Pavone, M., Pedemonte, M., Pera, M. C., Piastra, M., Profazio, Claudia, Rao, F., Salvo, I., Testa, R., Villanova, M., and Casiraghi, J. L.

Published
2015

33. 1st Italian SMA Family Association Consensus Meeting

Author

Sansone, V.A., primary, Racca, F., additional, Ottonello, G., additional, Vianello, A., additional, Berardinelli, A., additional, Crescimanno, G., additional, Casiraghi, J.L., additional, Agosto, C., additional, Banfi, P., additional, Baranello, G., additional, Bignamini, E., additional, Chiarini, M.B., additional, Cutrera, R., additional, D'amico, A., additional, Dusio, M., additional, Fanfulla, F., additional, Garuti, G., additional, Giretti, R., additional, Gorni, K., additional, Gregoretti, C., additional, Luccoli, L., additional, Messina, S., additional, Pane, M., additional, Pavone, M., additional, Pedemonte, M., additional, Pera, M.C., additional, Piastra, M., additional, Profazio, C., additional, Rao, F., additional, Salvo, I., additional, Testa, R., additional, and Villanova, M., additional

Published
2015
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34. Commentary from the Italian Association of Sleep Medicine on the AASM manual for the scoring of sleep and associated events: for debate and discussion

Author

Parrino, L, Ferri, R, Zucconi, M, Fanfulla, F, Ferrillo, F, Gigli, Gian Luigi, and Braghiroli, A.

Subjects
medicine.medical_specialty, Polysomnography, MEDLINE, Differential Threshold, Electroencephalography, Sleep medicine, Medicine, Humans, Muscle, Skeletal, Sleep Medicine Specialty, Sleep Apnea, Obstructive, medicine.diagnostic_test, business.industry, Electromyography, Sleep apnea, General Medicine, medicine.disease, Nocturnal Myoclonus Syndrome, Italy, Bruxism, Sleep (system call), Sleep Stages, business, Arousal, Hypopnea, Clinical psychology
Abstract

In 2007, the American Academy of Sleep Medicine (AASM) completed a new manual for the scoring of sleep and associated events. The AASM manual is divided into separate sections relative to the parameters reported for polysomnography. The present commentary, accomplished by a Task Force of the Italian Association of Sleep Medicine, focuses on sleep scoring data, arousal rules, movement and respiratory events. Comparisons with the previous Rechtschaffen and Kales system are detailed and a number of methodological weaknesses are pointed out. Major comments address the 30-s scoring epochs, the restrictive approach to arousals and EEG activating patterns, the incomplete quantification of motor events and the thresholds for the definition of hypopnea. Since the new AASM manual is an iterative process, proposals for discussion and re-examination of the agreed criteria with other national and international organizations are encouraged.

Published
2009

35. Allergic rhinitis and asthma comorbidity in a survey of young adults in Italy

Author

Bugiani, M., Carosso, A., Migliore, E., Piccioni, P., Corsico, A., Olivieri, M., Ferrari, M., Pirina, P., Marinoni, R. de Marco on behalf of ISAYA: Principal researchers: A., Carolei, A., Montomoli, C., Villani, S., Comelli, M., Ponzio, M., Grassi, M., Rezzani, C., Casali, L., Cerveri, I., Zoia, M. C., Colato, S., Moscato, G., Perfetti, L., Alesina, R., Basso, O., Berrayah, L., Brusotti, R., Fanfulla, F., Moi, P., Frati, C., Karytinos, P., Arossa, W., Caria, E., Castiglioni, G., Romano, Canzio, Fabbro, D., Ciccone, G., Magnani, C., Dalmasso, P., Bono, Roberto, Gigli, G., Giraudo, A., Brussino, M. C., Bucca, Caterina, Rolla, Giovanni, Aime, M., Cerutti, A., Chiampo, F., Gallo, W., Sulotto, F., de Marco, R., Verlato, G., Accordini, S., Zanolin, M. E., Locatelli, F., Cazzoletti, L., Pattaro, C., Sartori, S., Poli, A., Dorigo, N., Cantarelli, S., Ciresola, D., Lo Cascio, V., Biasin, C., Campello, C., Rossi, F., Cannistra`, A., Cenci, B., Destefani, E., Girotto, M., Lampronti, G., Martini, C., Tardivo, S., Villani, A., Lauriola, P., Danielli, G., Sesti, D., Ghigli, E., P. Natale, M. Grosa, Tacconi, A., Frontero, P., and Salomoni, A.

Published
2005

38. Is the prevalence of adult asthma and allergic rhinitis still increasing? Results of an Italian study

Author

Verlato, G, Corsico, A, Villani, S, Cerveri, I, Migliore, E, Accordini, S, Carolei, A, Piccioni, P, Bugiani, M, Lo Cascio, V, Marinoni, A, Poli, A, Ecrhs, de Marco R., Marinoni, ISAYA group Principal researchers: A., Carolei, A., Montomoli, C., Villani, S., Comelli, M., Ponzio, M., Grassi, M., Rezzani, C., Casali, L., Cerveri, I., Zoia, M. C., Corsico, A., Colato, S., Moscato, G., Perfetti, L., Alesina, R., Basso, O., Berrayah, L., Brusotti, R., Fanfulla, F., Moi, P., Frati, C., Karytinos, P., Bugiani, M., Piccioni, P., Carosso, A., Arossa, W., Caria, E., Castiglioni, G., Migliore, E., Romano, C., Fabbro, D., Ciccone, G., Magnani, C., Dalmasso, Paola, Bono, Roberto, Gigli, G., Giraudo, A., Brussino, Luisa, Bucca, Caterina, Rolla, Giovanni, Aime, M., Cerutti, A., Chiampo, F., Gallo, W., Sulotto, F., de Marco, R., Verlato, G., Accordini, S., Zanolin, M. E., Locatelli, F., Cazzoletti, L., Pattaro, C., Sartori, S., Poli, A., Dorigo, N., Cantarelli, S., Ciresola, D., Lo Cascio, V., Olivieri, M., Ferrari, M., Biasin, C., Campello, C., Rossi, F., Cannistrà, A., Cenci, B., Destefani, E., Girotto, M., Lampronti, G., Martini, C., Tardivo, S., Villani, A., Lauriola, P., Danielli, G., Sesti, D., Ghigli, E., Natale, P., Grosa, M., Tacconi, A., Frontero, P., and Salomoni, A.

Subjects
Adult, Male, Pediatrics, medicine.medical_specialty, Allergy, Rhinitis, Allergic, Perennial, temporal trend, Immunology, Logistic regression, asthma, allergic rhinitis, temporal trend, epidemiology, Epidemiology, Prevalence, Immunology and Allergy, Medicine, Humans, Non-response bias, Young adult, Asthma, Response rate (survey), allergic rhinitis, business.industry, Rhinitis, Allergic, Seasonal, Odds ratio, asthma, medicine.disease, Italy, Female, epidemiology, business
Abstract

The prevalence of asthma and allergic rhinitis has increased worldwide during the 1970s and 1980s.This study was aimed at evaluating whether the increasing trend in prevalence persisted during the 1990s in the young adult Italian population.In 1998 to 2000 a screening questionnaire was sent by mail to a general population sample aged 20 to 44 years; nonresponders were contacted again first by mail and then by phone, achieving a final response rate of 78.1% (6876 of 8800). Prevalence estimates, adjusted to correct for nonresponse bias, were compared with those recorded in Italy in 1991 to 1993 during the European Community Respiratory Health Survey, when response rate had been slightly higher (87.6%). Temporal variations in symptom prevalence were analyzed by a logistic regression model, controlling for sex, age, site of residence (urban vs suburban areas), season of response, response rate, and type of contact (mail vs phone).The prevalence of asthma attacks did not vary significantly from 1991 to 1993 (3.6%) to 1998 to 2000 (3.2%) (P =.188). The prevalence of asthma-like symptoms (wheezing, chest tightness, shortness of breath) tended to decrease in the age classes of 32.5 to 45 years, while increasing in the youngest age class (20 to 26 years). A clear-cut increase from 15.4% to 18.3% was observed for the prevalence of allergic rhinitis (P.001), whereas the proportion of people under antiasthmatic treatment increased in suburban areas but not in urban areas (interaction time-site of residence, P.001).Asthma prevalence has not increased during the last decade in Italy. The persistence of an increasing trend in allergic rhinitis prevalence deserves attention.

Published
2003

39. Prevalence and features of allergic rhinitis in Italy

Author

Olivieri, M., Verlato, G., Corsico, A., Lo Cascio, V., Bugiani, M., Marinoni, A., de Marco, R., for the Italian ECRHS group: *Members of the European Community Respiratory Health Survey, Italy, de Marco, 1. 9. 9. 1. –. 1. 9. 9. 3. Universita` di Verona: R., Campello, C., Rossi, F., Biasin, C., Cannistra`, A., Cenci, B., Destefani, E., Ferrari, M., Girotto, M., Lampronti, G., Martini, C., Poli, A., Tardivo, S., Villani, A., Marinoni, M. E. Z. a. n. o. l. i. n. Universita` di Pavia: A., Cerveri, I., Alesina, R., Basso, O., Berrayah, L., Brusotti, . R., Fanfulla, F., Bucca, Caterina, Romano, Canzio, Aime, M., Cerutti, A., Chiampo, F., Gallo, W., Rolla, Giovanni, Casali*, F. S. u. l. o. t. t. o. USSL77 Pavia: L., Frati, C., Karytinos, P., Bugiani, ASL4 Torino: M., Arossa, . W., Caria, E., Carosso, A., Castiglioni, G., and principal investigators, P. P. i. c. c. i. o. n. i.

Subjects
allergic rhinitis
Published
2002

40. Medico-legal implications of sleep apnoea syndrome: driving license regulations in Europe

Author

Alonderis, A, Barbé, F, Bonsignore, M, Calverley, P, De Backer, W, Diefenbach, K, Donic, V, Fanfulla, F, Fietze, I, Franklin, K, Grote, L, Hedner, J, Jennum, P, J. Krieger, J, Levy, P, Mcnicholas, W, Montserrat, J, Parati, G, Pascu, M, Penzels, T, Rihat, R, Rodensteinu, D, Sannav, A, Schulzw, R, Sforzax, E, Sliwinskiy, P, Tomorig, Z, Tonnesenz, P, Varoneckasa, G, Zielinskiy, J, Kostelidour, K, COST Action B., 2, McNicholas, W, COST Action B. 261, PARATI, GIANFRANCO, Alonderis, A, Barbé, F, Bonsignore, M, Calverley, P, De Backer, W, Diefenbach, K, Donic, V, Fanfulla, F, Fietze, I, Franklin, K, Grote, L, Hedner, J, Jennum, P, J. Krieger, J, Levy, P, Mcnicholas, W, Montserrat, J, Parati, G, Pascu, M, Penzels, T, Rihat, R, Rodensteinu, D, Sannav, A, Schulzw, R, Sforzax, E, Sliwinskiy, P, Tomorig, Z, Tonnesenz, P, Varoneckasa, G, Zielinskiy, J, Kostelidour, K, COST Action B., 2, McNicholas, W, COST Action B. 261, and PARATI, GIANFRANCO

Abstract

Background: Sleep apnoea syndrome (SAS), one of the main medical causes of excessive daytime sleepiness, has been shown to be a risk factor for traffic accidents. Treating SAS results in a normalized rate of traffic accidents. As part of the COST Action B-26, we looked at driving license regulations, and especially at its medical aspects in the European region. Methods: We obtained data from Transport Authorities in 25 countries (Austria, AT; Belgium, BE; Czech Republic, CZ; Denmark, DK; Estonia, EE; Finland, FI; France, FR; Germany, DE; Greece, GR; Hungary, HU; Ireland, IE; Italy, IT; Lithuania, LT; Luxembourg, LU; Malta, MT; Netherlands, NL; Norway, EC; Poland, PL; Portugal, PT; Slovakia, SK; Slovenia, SI; Spain, ES; Sweden, SE; Switzerland, CH; United Kingdom, UK). Results: Driving license regulations date from 1997 onwards. Excessive daytime sleepiness is mentioned in nine, whereas sleep apnoea syndrome is mentioned in 10 countries. A patient with untreated sleep apnoea is always considered unfit to drive. To recover the driving capacity, seven countries rely on a physician's medical certificate based on symptom control and compliance with therapy, whereas in two countries it is up to the patient to decide (on his doctor's advice) to drive again. Only FR requires a normalized electroencephalography (EEG)-based Maintenance of Wakefulness Test for professional drivers. Rare conditions (e.g., narcolepsy) are considered a driving safety risk more frequently than sleep apnoea syndrome. Conclusion: Despite the available scientific evidence, most countries in Europe do not include sleep apnoea syndrome or excessive daytime sleepiness among the specific medical conditions to be considered when judging whether or not a person is fit to drive. A unified European Directive seems desirable. © 2007 Elsevier B.V. All rights reserved.

Published
2008

41. Determinants of bronchial responsiveness in the European Community Respiratory Health Survey in Italy: evidence of an independent role of atopy, total serum IgE levels, and asthma symptoms

Author

DE MARCO, Roberto, LO CASCIO, Vincenzo, Campello, Cesare, Ferrari, Marcello, Biasin, C, Cannistra, A, Cenci, Beatrice, Destefani, E, Girotto, M, Lampronti, Guido, Martini, Claudio, Olivieri, Mario, Poli, Albino, Tardivo, Stefano, Verlato, Giuseppe, Villani, A, Zanolin, Maria Elisabetta, Marinoni, A, Cerveri, I, Alesina, R, Basso, O, Berrayah, L, Brusotti, R, Fanfulla, F, Moi, P, Zoia, Mc, Bucca, V, Romano, C, Aime, M, Cerutti, A, Chiampo, F, Gallo, W, Rola, G, Sulotto, F, Casali, L, Fratti, C, Karytinos, P, Bugiani, M, Arossa, W, Caria, E, Carosso, A, Castiglioni, G, and Piccioni, P.

Subjects
Adult, Hypersensitivity, Immediate, Male, bronchial hyperresponsiveness, Dose-Response Relationship, Drug, airway caliber, asthma epidemiology, IgE levels, skin test reactivity, Immunology, Immunoglobulin E, Asthma, Italy, Antibody Specificity, Risk Factors, Immunology and Allergy, Humans, Methacholine Compounds, Female, Bronchial Hyperreactivity, Skin Tests
Abstract

The aim of the analysis was to test whether total serum IgE levels, specific serum IgE levels, and asthma symptoms are independent predictors of bronchial hyperresponsiveness (BHR), after controlling for known risk factors or potential confounders. The study was carried out on a sample of 875 young adults, 20-44 years old, who took part in the European Community Respiratory Health Survey in Italy. The subjects underwent a dose-response methacholine challenge test. We also measured airway caliber as the baseline FEV1 in absolute terms and as percentage of forced vital capacity (FVC); skin wheal response to 11 common environmental allergens; and total and specific serum IgE levels to mites, molds, pets, and respiratory symptoms by means of a standardized questionnaire. Atopy (positive skin prick test and/or positive specific IgE assay), total IgE, asthma symptoms, airway caliber, and age appeared to be independent predictors of BHR. When all the other risk factors were taken into account, atopy and total IgE were associated with a threefold increase in BHR risk and thus emerged as the main determinants of BHR. The importance of symptom status as a determinant of BHR decreased remarkably after controlling for atopy and IgE: the odds ratio of current asthmatics to asymptomatic subjects decreased from 15.3 to 8.8. When controlling for symptoms and atopy, a family history of allergic diseases and early respiratory infections was not found to be associated with BHR. Both FEV1 and FEV1/FVC were strongly and inversely associated with BHR. When airway caliber was taken into account, older age was associated with decreased responsiveness, and the level of responsiveness did not differ significantly between males and females and between smokers and nonsmokers. The results from this analysis indicate that at any given age, irrespective of sex and smoking habits, total serum IgE, specific IgE, airway caliber, and asthma symptoms are the main independent factors influencing the occurrence of BHR in a young adult sample.

Published
1998

42. The efficacy of noninvasive mechanical ventilation on nocturnal hypoxaemia in Duchenne's muscular dystrophy

Author

Fanfulla F, angela berardinelli, Gualtieri G, Mc, Zoia, Ottolini A, Vianello A, Lanzi G, and Cerveri I

Subjects
Male, Positive-Pressure Respiration, Sleep Apnea Syndromes, Time Factors, Adolescent, Humans, Follow-Up Studies, Hypoxia, Muscular Dystrophies
Abstract

The aim of this 2 yr follow-up study was to evaluate the efficacy of nocturnal noninvasive mechanical ventilation in a group of 10 Duchenne's muscular dystrophy (DMD) patients who desaturated during the night but had normal daytime blood gases: mean (range) age 18.3 (15-22) yrs; mean (SD) vital capacity (VC) 752.5 (460-1,308) mL; mean time in bed (TIB) with arterial oxygen saturation (Sa,O2)90% 22.8% of total TIB (range: 16.6-32.0); mean arterial oxygen tension (Pa,O2) 10.3 (9.3-11.7) kPa (78 (70.0-87.8) mmHg); mean arterial carbon dioxide tension (Pa,CO2) 5.9 (4.8-6.5) kPa (44.3 (36.3-48.5) mmHg). All the patients were noninvasively ventilated during the night with a bilevel positive pressure ventilation (BiPAP) devise in spontaneous mode in order to correct the episodes of nocturnal desaturation. Nocturnal Sa,O2 values normalized during nocturnal noninvasive mechanical ventilation, and daytime sleep-disordered breathing disappeared, for the entire study period. No statistically significant differences were observed between baseline and follow-up daytime blood gas values, although a slight increase in Pa,O2 was found. During the follow-up, VC declined at a rate of 79.1 +/- 25 mL.yr-1, less than that generally reported in the past in untreated patients in the same age range. In conclusion, our data suggest that patients with advanced Duchenne's muscular dystrophy with pronounced nocturnal desaturation, not fulfilling criteria for imperative ventilation, could be successfully treated with "elective" nocturnal ventilation with immediate benefits consequent to the correction of the nocturnal blood gas anomalies and with long-term benefits related to the preservation of residual respiratory function, delay of development of chronic hypercapnia and thus the requirement for imperative mechanical ventilation.

Published
1998

44. Evaluation of methacholine dose-response curves by linear and exponential mathematical models: goodness-of-fit and validity of extrapolation

Author

Verlato, G., Cerveri, I., Villani, A., Pasquetto, M., Ferrari, M., Fanfulla, F., Zanolin, E., Rijcken, B., de Marco, R. de M. a. r. c. o. Università di Verona: R., Lo Cascio, V., Campello, C., Rossi, F., Biasin, C., Cannistrà, A., Cenci, B., Destefani, E., Girotto, M., Lampronti, G., Martini, C., Olivieri, M., Poli, A., Tardivo, S., Zanolin, M. E., Marinoni, Università di Pavia: A., Alesina, R., Basso, O., Berrayah, L., Brusotti, R., Moi, P., Zoia, M. C., Università di Torino, Bucca, Caterina, Romano, Canzio, Aime, M., Cerutti, A., Chiampo, F., Gallo, W., Rolla, Giovanni, Sulotto, F., Casali, USSL 77 Pavia: L., Frati, C., Karytinos, P., Bugiani, USSL 7 Torino: M., Arossa, W., Caria, E., Carosso, A., Castiglioni, G., and Piccioni, P.

Subjects
methacholine challenge, dose-response curve
Published
1996

45. Prevalence of asthma and asthma symptoms in a general population sample from northern Italy

Author

DE MARCO, Roberto, LO CASCIO, Vincenzo, Campello, Cesare, Rossi, F, Biasin, C, Cannistrà, A, Cenci, Beatrice, Destefani, E, Ferrari, Marcello, Girotto, M, Lampronti, Guido, Martini, Claudio, Olivieri, Mario, Poli, Albino, Tardivo, Stefano, Verlato, Giuseppe, Villani, A, Zanolin, Maria Elisabetta, Marinoni, A, Cerveri, I, Alesina, R, Basso, O, Berrayah, L, Brusotti, R, Fanfulla, F, Moi, P, Zoia, Mc, Bucca, C, Romano, C, Aime, M, Cerutti, A, Chiampo, F, Gallo, W, Rola, G, and Sulotto, F.

Subjects
asthma • asthma symptoms • epidemiology • prevalence
Published
1995

46. Prevalence of asthma and asthma symptoms in a general-population sample from northern italy

Author

Demarco, R, Locascio, V, Campello, C, Rossi, F, Biasin, C, Cannistra, A, Cenci, B, Destefani, E, Ferrari, M, Girotto, M, Lampronti, G, Martini, C, Olivieri, M, Poli, A, Tardivo, S, Verlato, G, Villani, A, Zanolin, Me, Marinoni, A, Cerveri, I, Alesina, R, Basso, O, Berrayah, L, Brusotti, R, Fanfulla, F, Moi, P, Zoia, Mc, Bucca, Caterina, Romano, Canzio, Aime, M, Cerutti, A, Chiampo, F, Gallo, W, Rola, G, Sulotto, F, Casali, L, Fratti, C, Karytinos, P, Bugiani, M, Arossa, W, Caria, E, Carosso, A, Castiglioni, G, Piccioni, P., and Rolla, Giovanni

Subjects
ASTHMA SYMPTOMS, ASTHMA, EPIDEMIOLOGY, PREVALENCE
Published
1995

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