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Introduction: Patients with obstructive sleep apnea (OSA) suffer from several neurocognitive deficits. We investigated the cognitive and socio-cognitive profiles of patients with severe OSA, controlling for potentially relevant mediating variables (i.e. age, body-mass index, cognitive reserve and depression). Moreover, we studied the neuropsychological profile of a high-risk OSA phenotype characterized by severe OSA and severe nocturnal hypoxemia. Method: We assessed 29 previously untreated severe OSA patients with a mean age of 55.6 ( 9.9 years) and a mean apnea-hypopnea index (AHI) of 53.1 ( 17.4). A control group of 34 healthy participants was also enrolled. Participants completed an extensive neuropsychological battery that included social cognition, a relatively new investigation area among OSA patients. Data analysis: Data were analyzed with a Bayesian approach. Specifically, Bayesian ANCOVA was used to investigate whether the grouping variable could predict test performance. Age, body-mass index, cognitive reserve and state of depression were added as covariates to the null model to weight the effects of these potential confounding factors. Three groups were analyzed: healthy controls (H), OSA with severe apnea and severe nocturnal oxygen desaturation (D+), and OSA with severe apnea non-desaturators (D−). Performances on the various neuropsychological tests were treated as the dependent variables. Results: The results indicate that non-verbal reasoning, the theory of mind skills, and mental shifting ability were impaired in OSA patients. Patients with severe nocturnal hypoxemia underperformed compared to patients with the same severity of apnea but non-desaturators. Additionally, we observed a trend toward a worse performance among OSA desaturator patients in the following abilities: constructional ability, short term verbal memory, phonological fluency, and the ability to inhibit automatic and dominant responses. Conclusion: The data suggest a key role of hypoxemia in affecting cognitive functioning in OSA patients. Executive functions and the concomitant involvement of social cognition are particularly affected.

Una review sulle scienze OMICHE nella gestione del paziente con sindrome dell’apnea ostruttiva del sonno.La sindrome da apnea ostruttiva nel sonno (OSA) è una condizione caratterizzata dalla presenza di completo o parziale collasso delle vie aeree superiori durante il sonno, con conseguente frammentazione del sonno associata a rapidi episodi di ipossia intermittente (IH) e attivazione del sistema nervoso simpatico e dello stress ossidativo. L’OSA è associata ad un ampio spettro di patologie cardiovascolari, metaboliche, neurocognitive e comorbidità che appaiono particolarmente evidenti nei pazienti obesi, interessando entrambi i sessi in modo diverso e variando la gravità a seconda del sesso e dell’età. Negli ultimi anni, gli studi sull’OSA sono aumentati considerevolmente, ma nella pratica clinica, si tratta ancora di una malattia altamente sottodiagnosticata. Ad oggi, il gold standard per la diagnosi di OSA è la polisonnografia notturna (PSG). Tuttavia, poiché non è adatto ad un gran numero di pazienti, anche l’Home Sleep Test (HST) è un metodo diagnostico accettato. Attualmente, l’obiettivo principale della ricerca è quello di identificare metodi non invasivi per ottenere un sistema di screening altamente predittivo e non invasivo per questa categoria di soggetti. I lavori più recenti indicano che la ricerca in questo campo ha compiuto progressi significativi nell’identificazione di possibili biomarcatori in OSA, utilizzando approcci OMICI, in particolare nel campo della proteomica e della metabolomica. In questa review, analizziamo una lista di questi biomarcatori presenti in letteratura.Obstructive sleep apnaea (OSA) syndrome is a condition characterised by the presence of complete or partial collapse of the upper airways during sleep, resulting in fragmentation of sleep associated with rapid episodes of intermittent hypoxia (IH), activation of the sympathetic nervous system and oxidative stress. OSA is associated with a broad spectrum of cardiovascular, metabolic and neurocognitive comorbidities that appear to be particularly evident in obese patients, while affecting both sexes in a different manner and varying in severity according to gender and age. In recent years, studies on OSA have increased considerably, but in clinical practice, it is still a highly underdiagnosed disease. To date, the gold standard for the diagnosis of OSA is nocturnal polysomnography (PSG). However, since it is not well suited for a large number of patients, the Home Sleep Test (HST) is also an accepted diagnostic method. Currently, the major aim of research is to identify non-invasive methods to achieve a highly predictive, non-invasive screening system for these subjects. The most recent reports indicate that research in this field has made significant progress in identifying possible biomarkers in OSA, using -OMIC approaches, particularly in the fields of proteomics and metabolomics. In this review, we analyse these OMIC biomarkers found in the literature.

Objectives: The purpose of this observational retrospective study was to evaluate, in patients with a severe acute respiratory syndrome coronavirus 2 infection, the association between the severity of coronavirus disease 2019 (COVID-19) respiratory illness and the risk of infected patients to develop obstructive sleep apnea (OSA). Methods: Ninety-six patients with confirmed COVID-19 infection were enrolled in the study. The STOP-BANG questionnaire to investigate the risk of the OSA syndrome was filled in by the patients at admission. The enrolled patients were divided into 2 groups according to the respiratory disease: group 1 (72 patients), hospitalized patients undergoing conventional oxygen therapy; group 2 (24 patients), patients requiring enhanced respiratory support. STOP-BANG results of these 2 groups were compared to observe whether patients with high OSA risk more frequently presented a severe form of COVID-19. Results: 41.6% of the patients in group 2 had a STOP-BANG score between 5 and 8 (high risk of having apnea); in contrast, 20.8% of the patients in group 1 had a STOP-BANG score between 5 and 8, with a statistically significant difference between the 2 groups ( P = .05). A complementary trend was observed regarding the proportion of patients in the range 0 to 2, which classifies patients at a low risk of OSA (48.6% vs 20.8% for groups 1 and 2, P = .01). Conclusions: According to our data, the chances of having a severe case of COVID-19 should be considered in patients at high risk of OSA. Current Knowledge/Study Rationale: Emerging research suggests that OSA could represent a potentially important risk factor for the severe forms of COVID-19. The purpose of this observational retrospective study was to evaluate the potential association between OSA and the severity of COVID-19 disease. Study Impact: According to our data, the likelihood of contracting a severe form of COVID-19 disease should be considered in patients at high risk of OSA.

Obstructive sleep apnea (OSA) is one of the most common sleep breathing disorders (SRBDs). It is associated with (under-recognized) cognitive impairment as well as with psychiatric disorders, motor vehicle accidents, low work performance, low social functioning and decrease in quality of life. As a result of the cognitive deficits that characterize patients with OSA, the syndrome has been included in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders. However, it is not clear whether OSA causes an impairment in the majority cognitive processes or whether it affects only some and specific cognitive skills. In this study we assessed 29 previously untreated severe OSA patients (mean age of 55.6 ± 9.9 years) on wide range of cognitive skills as well as (for first time) on socio-cognitive skills. A control group was also enrolled. Data were analysed with a Bayesian approach. The final aim of the study was to address an open fundamental question in experimental psychology and socio-cognitive neuroscience literatures: is there a "social brain" specialized in the processing social stimuli? Results indicate that OSA does not affect all cognitive processes, but mainly executive and socio-cognitive skills. Finally, our results support a dissociation between socio-cognitive ability and other domain-general cognitive functions. OSA affect mainly (and independently of each other) executive and social brain.

This study aims to compare polygraphic data in patients with OSA treated with Barbed Reposition Pharyn-goplasty (BRP) performed with a simplified technique compared to the standard method. Variations of tech-nique were performed and tested with the purpose of promoting tolerability and diffusion of this simplified technique. To evaluate the efficacy of the simplified BRP method, a sample of 99 patients was divided into two groups: Group A was treated with BRP (BRP group) and Group B was treated with simplified BRP (sBRP group). The results obtained on the two groups were compared with the two sample Bootstrap t-tests method, showing a substantial overlap in polygraphic results recorded 6 months after surgery.

To illustrate a new technological advance in the standard drug-induced sleep endoscopy (DISE) model, a new machine was used, the Experimental 5 Video Stream System (5VsEs), which is capable of simultaneously visualizing all the decisional parameters on a single monitor, and recording and storing them in a single uneditable video. The DISE procedure was performed on 48 obstructive sleep apnea (OSA) or snoring patients. The parameters simultaneously recorded on a single monitor are (1) the pharmacokinetics and pharmacodynamics of propofol (through the target controlled infusion (TCI) pump monitor), (2) the endoscopic upper airway view, (3) the polygraphic pattern, and (4) the level of sedation (through the bispectral index (BIS) value). In parallel to the BIS recording, the middle latency auditory evoked potential (MLAEP) was also recorded and provided. Recorded videos from the 5VsEs machine were re-evaluated six months later by the same clinician and a second clinician to evaluate the concordance of the therapeutic indications between the two. After the six-month period, the same operator confirmed all their clinical decisions for 45 out of 48 videos. Three videos were no longer evaluable for technical reasons, so were excluded from further analysis. The comparison between the two operators showed a complete adherence in 98% of cases. The 5VsEs machine provides a multiparametric evaluation setting, defined as an &ldquo, all in one glance&rdquo, strategy, which allows a faster and more effective interpretation of all the simultaneous parameters during the DISE procedure, improving the diagnostic accuracy, and providing a more accurate post-analysis, as well as legal and research advantages.

Introduction: Patients with obstructive sleep apnea (OSA) suffer from several neurocognitive disturbances. One of the neuropsychological processes most investigated in OSA patients is attention, but the results have been controversial. Here, we update the attention profile of OSA patients with the final aim to improve attention assessment, with a possible impact on clinical and medical-legal practices, in terms of which attention subdomains and parameters need consideration and which one is a high-risk OSA phenotype for attention dysfunctions. Method: For this purpose, we assessed 32 previously untreated OSA patients (26 men and 6 women) under 65 years of age (mean age 53.2 ± 7.3; mean education level 10.4 ± 3.4 years) suffering from moderate to severe sleep apnea and hypopnea (mean apnea-hypopnea index (AHI) 45.3 ± 22.9, range 16.1–69.6). A control group of 34 healthy participants matched with OSA patients for age, education level, and general cognitive functioning were also enrolled. The OSA patients and healthy participants were tested through an extensive computerized battery (Test of Attentional Performance, TAP) that evaluated intensive (i.e., alertness and vigilance) and selective (i.e., divided and selective) dimensions of attention and returned different outcome parameters (i.e., reaction time, stability of performance, and various types of errors). Data analysis: The data were analyzed by ANCOVA which compared the speed and accuracy performance of the OSA and control participants (cognitive reserve was treated as a covariate). The possible mechanisms underlying attention deficits in OSA patients were examined through correlation analysis among AHI, oxygenation parameters, sleepiness scores, and TAP outcomes and by comparing the following three phenotypes of patients: severe OSA and severe nocturnal desaturators (AHI++D+), severe OSA nondesaturators (AHI++D–), and moderate OSA nondesaturators (AHI+D–). Results: The results suggest that the OSA patients manifest deficits in both intensive and selective attention processes and that reaction time (RT) alone is ineffective for detecting and characterizing their problems, for which error analysis and stability of performance also have to be considered. Patients with severe OSA and severe hypoxemia underperformed on alertness and vigilance attention subtests. Conclusions: The data suggest the importance of evaluating attention deficits among OSA patients through several parameters (including performance instability). Moreover, the data suggest a multifaceted mechanism underlying attention dysfunction in OSA patients.

BACKGROUND. Bacteriocins are peptides with antimicrobial efficacy produced by certain bacterial species. Probiotics indeed seem a promising method in the prevention of upper respiratory infections and our study would like to contribute to the results available in the literature, in order to underlie their true therapeutic potential role. MATERIAL AND METHODS. Our multicenter pilot prospective study investigates 366 patients from September 2015 to February 2016. All the patients were treated with a topical device made up of a suspension of two specific bacterial strains: Streptococcus salivarius 24SMB and Streptococcus oralis 89a to be administered as nasal spray. The nasal spray was administered twice daily for 7 days per month for three consecutive months. A questionnaire about the subjective efficacy of the therapy correlated to an improvement of symptoms was also collected from patients. RESULTS. After one year from the enrolment, a 70.07% reduction in the number of events compared with the number of expected episodes was observed. CONCLUSION. The aim of our data is to propose a new therapeutic approach to treat the recurrence of upper airway infection and to support an adequate therapy in all cases where the traditional antibiotic therapeutic protocol did not obtain completely efficient results in terms of recurrence.

Apnea notturna centrale da transitoria depressione ventilatoria polmonare e risposta chemo-recettoriale periferica causata da debolezza dei muscoli respiratori nei pazienti operati per l’apnea ostruttiva del sonno.

To analyze the middle latency auditory evoked potential index (MLAEPi), compared to the standard bispectral index (BIS), as a method for evaluating the sedation level in drug-induced sleep endoscopy (DISE). In this controlled clinical study on a sample of 99 obstructive sleep apnea (OSA) or snoring patients, we compared the MLAEPi with the BIS after propofol infusion during the standard DISE technique in order to define the MLAEPi values within the observational window of the procedure. The DISE procedure was divided into eight steps, and we collected both MLAEPi and BIS data values from the same patient in every step. The MLAEPi showed a faster response than the BIS after propofol infusion during DISE. Therefore, the clinical use of the MLAEPi in evaluating the sedation level seems to be a good alternative to the current technological standards.

Obstructive sleep apnoea (OSA) is characterized by repetitive interruptions of breathing, causing Chronic Intermittent Hypoxia (CIH) that can be involved in the development and progression of cardiovascular diseases. There is evidence showing a close relationship between OSA and atherosclerosis, even in patients who do not show co-morbidities such as hypertension, diabetes, high levels of lowdensity lipoprotein cholesterol (LDL-C), cigarette smoking and obesity, which can activate the endothelium. This endothelium activation due to CIH and specific to OSA seems to be dependent on a different pathway. The current first line therapy for OSA is the application of the continuous positive airway pressure (CPAP), but it alone is not enough to reduce cardiometabolic risk in patients with OSA. In contrast, statins, via their pleiotropic property, might be able to change inflammation and early atherosclerosis, lipid profile and cardiovascular outcomes in OSA. The role of statins in OSA patients with or without any co-morbidities could potentially prevent coronary vascular risk and stroke and in the future, represent an additional treatment option along with CPAP therapy. Strengthening the prevention strategies against atherosclerosis in OSA should be one of the focal aims for healthcare programs of the future.

Obstructive Sleep Apnea Syndrome (OSAS) is one of the most common causes of excessive daytime sleepiness, therefore an important determinant of road and work accidents, as well as being associated with multiple chronic-degenerative diseases. The recent transposition of the European Commission Directive 2014/85/EU on driver licensing highlighted the need to tackle the problem appropriately, not only for its high prevalence in the general population, but also for its significant impact on occupational safety and health, and related social costs. The Occupational Health Physician is required to play a strategic role in this regard, not just for early diagnosis, but also for monitoring the therapeutic efficacy in maintaining or reintegrating workers into specific jobs. The effectiveness of his/her work will depend primarily on the level of interaction he/she will be able to establish with the different specialists who are in charge of the diagnostic and therapeutic process, in order to maintain a satisfactory work performance and to prevent possible deleterious effects on health in the medium and long-term period. The logic of this multidisciplinary approach has led nineteen scientific Societies and Associations to establish a Joint Technical Committee and to address the problem in the light of effectiveness and efficiency criteria in the interest of the individual and the community.

Obstructive sleep apnea (OSA) syndrome is an underdiagnosed widespread chronic disease involving both sexes and all ages. Undiagnosed and untreated OSA is associated with workplace productivity losses and significant direct and indirect medical costs. A cost analysis of OSA was carried out in Italy ten years ago. Overall OSA medical costs, largely due to treatment of comorbidity, amounted to € 2,9 billion or 55% of total medical costs. Direct medical costs, due to diagnosis and treatment of OSA, were 6% of overall OSA costs, while medical costs due to the absence of diagnosis and of prevention of comorbidities represented 49% of the overall cost. Non-medical costs made up for the remaining 45%. € 1.5 billion could be saved by promoting screening campaigns aimed at detecting OSA that would otherwise remain undiagnosed and by improving adherence to treatment. Bearing in mind the increasing OSA prevalence and the recent quantification of avoidable OSA-related road accidents, the real cost of OSA is higher than estimated up to now.

Obstructive sleep apnea syndrome (OSAS) is a highly prevalent sleep disorder associated with severe cardiovascular events, morbidity and mortality. Recent evidence has highlighted OSAS as an independent risk factor for an excessive platelet activation and arterial thrombosis, but the underlying mechanisms have not yet been determined. Studies in cell culture and animal models have significantly increased our understanding of the mechanisms of inflammation in OSAS. Hypoxia is a critical pathophysiological element that leads to an intense sympathetic activity, in association with systemic inflammation, oxidative stress and procoagulant activity. While platelet dysfunction and/or hypercoagulability play an important role in the pathogenesis of vascular disease, there are limited studies on the potential role of blood viscosity in the development of vascular disease in OSAS. Further studies are required to determine the precise role of hypercoagulability in the cardiovascular pathogenesis of OSAS, particularly its interaction with oxidative stress, thrombotic tendency and endothelial dysfunction. Nasal continuous positive airway pressure (nCPAP), the gold standard treatment for OSAS, not only significantly reduced apnea-hypopnoea indices but also markers of hypercoagulability, thus representing a potential mechanisms by which CPAP reduces the rate of cardiovascular morbidity and mortality in OSAS patients.

Rationale.The gold standard for the diagnosis of Obstructive Sleep Apnea (OSA) is polysomnography, whose access is however reduced by costs and limited availability, so that additional diagnostic tests are needed.Objectives.To analyze the diagnostic accuracy of the Obstructive Airway Adult Test (OAAT) compared to polysomnography for the diagnosis of OSA in adult patients.Methods.Ninety patients affected by OSA verified with polysomnography (AHI ≥ 5) and ten healthy patients, randomly selected, were included and all were interviewed by one blind examiner with OAAT questions.Measurements and Main Results.The Spearman rho, evaluated to measure the correlation between OAAT and polysomnography, was 0.72 (p<0.01). The area under the ROC curve (95% CI) was the parameter to evaluate the accuracy of the OAAT: it was 0.91 (0.81–1.00) for the diagnosis of OSA (AHI ≥ 5), 0.90 (0.82–0.98) for moderate OSA (AHI ≥ 15), and 0.84 (0.76–0.92) for severe OSA (AHI ≥ 30).Conclusions.The OAAT has shown a high correlation with polysomnography and also a high diagnostic accuracy for the diagnosis of OSA. It has also been shown to be able to discriminate among the different degrees of severity of OSA. Additional large studies aiming to validate this questionnaire as a screening or diagnostic test are needed.

Obstructive sleep apnea syndrome (OSAS) is an independent risk factor for atherosclerosis and arterial thrombosis, which are associated with high cardiovascular (CV) morbidity and mortality. In studies performed in clinical populations with elevated CV event risk profiles, the occurrence of moderate to severe OSAS was very often accompanied by a worsened vascular function and increased prevalence of structural abnormalities. Recent investigations of atherosclerosis in OSAS have focused on thrombotic tendency and blood viscosity, providing new insight into mechanisms of the disease. Despite that knowledge about the mechanisms of development of CV disease in patients with OSAS is still incomplete, observations confirm a relationship between sleep-disordered breathing and the rheological properties (flow properties) of blood. While platelet dysfunction and hypercoagulability (PDMPs, PaI-1, and SF) play important roles in the pathogenesis of vascular disease, there are limited studies on the potential role of blood viscosity in the development of vascular disease in OSAS.

Severe adenotonsillar hypertrophy can be the main cause of nocturnal respiratory affections, as confirmed by the improvement of symptoms seen after adenotonsillectomy. Unsuccessful surgical treatment can be due to craniofacial morphological alterations. Hypotony of the pharyngeal muscles could also be responsible together with tonsil hypertrophy. In our study, we enrolled 125 patients (87 males and 38 females), aged from 3 to 8 years, suffering from chronic snoring. All the patients underwent adenotonsillectomy. The follow-up was carried out at 2, 4 and 6 months after the operation. Snoring and nocturnal apneas were no longer present in almost all the patients. Overnight polysomnography remains the gold standard diagnostic test for obstructive sleep apnea syndrome, but its feasibility in clinical practice is debated. Rhinomanometry, which gives an objective evaluation of ventilatory nasal function, acoustic rhinometry, which measures the cross-section in fixed nasal areas, and nasal mucociliary transport time can be considered useful tests to evaluate the cause of respiratory obstruction.

Severe adenotonsillar hypertrophy can be the main cause of nocturnal respiratory affections, as confirmed by the improvement of symptoms seen after adenotonsillectomy. Unsuccessful surgical treatment can be due to craniofacial morphological alterations. Hypotony of the pharyngeal muscles could also be responsible together with tonsil hypertrophy. In our study, we enrolled 125 patients (87 males and 38 females), aged from 3 to 8 years, suffering from chronic snoring. All the patients underwent adenotonsillectomy. The follow-up was carried out at 2, 4 and 6 months after the operation. Snoring and nocturnal apneas were no longer present in almost all the patients. Overnight polysomnography remains the gold standard diagnostic test for obstructive sleep apnea syndrome, but its feasibility in clinical practice is debated. Rhinomanometry, which gives an objective evaluation of ventilatory nasal function, acoustic rhinometry, which measures the cross-section in fixed nasal areas, and nasal mucociliary transport time can be considered useful tests to evaluate the cause of respiratory obstruction.

Cochlear implants partially restore auditory sensation in individuals affected by severe to profound hearing loss. We investigated vowel detection, identification, and discrimination in a group of congenitally-deafened, unilaterally-implanted, Italian children and in a group of age-matched controls, by combining behavioral and neurophysiologic measures. Comparable vowel identification and discrimination performance emerged for cochlear-implant and normalhearing children at the behavioral level. At the neurophysiologic level, on the other hand, cochlear-implant children appeared to lag behind their age-matched normalhearing peers for vowel detection and identification, but not for vowel discrimination. Length of cochlear implant use significantly affected vowel processing at the neurophysiologic level, although not systematically. Index Terms: vowel processing, behavioral measures, neurophysiologic measures, Italian cochlear-implants children.